Episode 36: Making patients evangelists (raving fans) with Dr. Brad Block

The latest BOSS podcast features Dr. Brad Block. He is an otolaryngologist and began podcasting nearly 4 years ago to help doctors learn better ways to take care of patients. He realized that as residents, our focus is on the OR, but as attending surgeons we spend most of our time in office hours. He focused on social engineering ideas and found inspiration everywhere including dating podcasts and invited guests onto his podcast that could offer new ideas like nonverbal communication. 

When he realized that hanging out in the doctors lounge and bringing gifts to practices didn’t help fill the clinic, he realized that making patients evangelists for him was the way to increase his referrals. Here are some highlights:

- The key is showing interest in the patient (nonverbal cues and dialing up our persona) and maintaining authority (facial expressions, vocal tonality and not hem/hawing)

- Dialing up our persona to ensure they know we are engaged and interested in them. We may not be showing we are as engaged and interested as we actually are

- Sitting down makes the visit seem longer 

- We lead the patients with our cues to help set boundaries for the visit

- He documents in the room with Dragon so they can hear and get a visit summary at the end of the visit. They know what is said and walk out with a plan. It is also a cue that it is time to leave. 

- They will often come with a question behind the question- they come in with a concern, but they don’t verbalize their concern. You must predict it and verbalize it. What is it that bothers you about this? Don’t minimize that problem. Leave room for doubt in case there is an issue you are missing. Explain your thoughts and offer them follow up. Add a personal anecdote to humanize their concern. Follow ups offer relief for anxiety and provide boundaries. 

He reminds us that clinic can be a grind if you don’t learn how to enjoy it. And that notes are a gas that will fill the space that is given. We can apply artificial urgency to help get the notes done. He encouraged us to practice office hour skills just like we would practice operative skills. 

The goal is for the patient to tell their friends, family and referring doctor, “You HAVE to see him (or her!)!”

You can find him at PhysiciansGuidetoDoctoring.com and on Twitter and rarely on Instagram @physiciansguide. You can’t find him on TikTok, Snapchat, Etsy or on Pinterest and you probably never will.

Episode 35: Improving clinic efficiency with Dr. Sarah Beth Snell

The latest podcast features Dr. Sarah Beth Snell, a breast surgical oncologist who has been recognized for her efficiency in clinic. She talks to us about how we can all do better for our patients by improving their experience in clinic. This is especially important for new graduates and those moving to new jobs.

Some of the highlights from the episode:

-It takes a while to get the team in line with your vision, but when they see how good it is for the patient and the improved efficiency, they will buy in

 - Showing data doesn’t help for buy in, you must create a team that believes in your vision and continue to give them feedback that it is working

- You may have to work in the system you have, but if you stay true to your vision of what the system could be, all you must do is wait for the feedback to help change

- they will see there are less phone calls and the patients are happier

- The more you can coordinate for the patient, the happier they will be because they already have so much to worry about. Recognizing that the patient has a hard time navigating the system

- When suggesting a change, realize it takes time, effort and sometimes turnover

- Use your staff. Delegation is necessary to empower the team and paying them what they are worth will help. They likely have ideas that could help.

- Bad staff is worse than no staff

- Treat people like they are the only one for the job but have system in place where their job can go on even if they leave.

Episode 34: Getting patients into clinic by supporting PCPs with Dr. Sarah Lee-Davisson

The latest BOSS podcast features Dr.  Sarah Lee-Davisson, a minimally invasive surgeon with excellent advice on getting patients into clinic by supporting our primary care physicians (and APPs in the current environment). We had a great time recording this, and there is pure gold advice for every surgeon in practice. 

The top tips:

- Take good care of the patients and make the PCP look good by sending patients to you

- Send your notes right away and follow up with a call if something is important

- Tell the PCP what you have done, summarize important information like studies, stage of cancer, etc into your note so they don't have to dig for the information

- Get to know your PCP with visits, mixers and local societies

- Take thoughtful gifts, business and bio cards, your cell number to PCP offices and inquire how you can help serve them better

- Ask patients if they have a PCP, and if not refer to your PCPs that support you

- Ensure the patients have a great first impression with your office staff and empower your office staff to support you by checking tasks, faxes, voicemails daily. Help you and them by having templates of everyday activities 

This is the last couple of days to sign up for "Everything is a Negotiation" coaching. Now is the time to learn how you can advocate for yourself and negotiation more effectively with yourself, your time, your family and at your job. Find more information at https://www.bosssurgery.com/

Boss Business of Surgery Series – Episode 49

Stop Hating Clinic (Webinar Replay)

In this episode of the Boss Business of Surgery Series, Dr. Amy Vertrees replays her popular Stop Hating Clinic webinar, where she tackles one of the most common frustrations in surgical practice: clinic burnout.

Clinic doesn’t have to feel draining, chaotic, or endless. Drawing on her experience in military medicine, employed practice, private practice, and surgeon coaching, Dr. Vertrees breaks down why clinic feels so hard—and how surgeons can regain control, confidence, and efficiency.

Rather than offering surface-level productivity hacks, this episode dives into the thoughts, emotions, and systems that drive clinic overwhelm. You’ll learn how mindset, leadership, boundaries, and delegation all play a critical role in making clinic sustainable.

In this episode, Dr. Vertrees discusses:

• Why surgeons often dread clinic—and how that dread starts before the clinic day even begins

• The importance of identifying where your biggest clinic pain points occur (before, during, or after clinic)

• How underestimating time leads to overwhelm, resentment, and unfinished work

• Why doing everything yourself undermines leadership and team effectiveness

• Practical delegation strategies, including the “tell, show, do” method

• How to set and enforce boundaries with patients who dominate visit time

• Communication techniques for navigating difficult patient interactions

• Strategies for finishing notes in a reasonable amount of time

• The hidden cost of unpaid after-hours work and chronic undercoding

• How understanding—and questioning—the “rules” of your system can open the door to change

This episode is especially valuable for surgeons who feel trapped by clinic schedules, EMR burden, endless notes, or staffing challenges—and want a more empowered, intentional way to practice medicine.

Resources mentioned:

• Boss Business of Surgery Series: https://bossurgery.com 

• Article: Physicians Need Growth Days

• Book: Never Split the Difference by Chris Voss

• Boss Business of Surgery Series Facebook Group

If you’re ready to stop hating clinic and start leading your time, your team, and your practice more effectively, this episode is a must-listen.

Boss Business of Surgery Series – Episode 55

Why Nurse Practitioners and Physician Assistants Matter (and How to Work With Them Well)

In this Thanksgiving-week episode of the Boss Business of Surgery Series, Dr. Amy Vertrees continues her conversation with Dr. Seaworth to explore the real value of nurse practitioners (NPs) and physician assistants (PAs) in surgical practice.

This discussion goes far beyond staffing logistics. Together, they unpack how midlevel providers can transform clinic flow, expand access, reduce burnout, improve patient experience, and create both financial and non-financial returns for surgeons—when they are integrated thoughtfully and led well.

The episode also addresses common concerns, misconceptions, and mistakes surgeons make when working with extenders, offering a realistic look at training timelines, boundaries, leadership, and relationship-building.

In this episode, you’ll learn:

• The two primary roles of midlevel providers: widening the funnel and improving lifestyle

• How NPs and PAs increase patient access without overwhelming surgeons

• Why training extenders is a long-term investment, not a short-term fix

• How midlevels help surgeons work at the top of their license

• Common pitfalls when introducing PAs/NPs—and how to avoid them

• Why setting expectations with patients is critical to success

• The financial realities of hiring a PA or NP, including early losses and long-term gains

• How extenders reduce unpaid after-hours work and documentation burden

• The often-overlooked non-monetary benefits: energy, connection, and sustainability

• Why your relationship with your PA or NP matters as much as clinical skill

• How sharing a PA, training students, or using urgent care models can ease transitions

• What surgeons need to understand about leadership, boundaries, and burnout prevention

• How private practice flexibility allows surgeons to remain nimble in a changing healthcare landscape

Key concepts discussed:

• Working as a team rather than as isolated individuals

• Delegation as a leadership skill—not a loss of control

• Respecting lifestyle expectations to prevent extender burnout

• Viewing PAs/NPs as long-term partners, not short-term labor

• Balancing financial decisions with autonomy and choice

• Adapting surgical practices to consumer-driven healthcare

This episode is especially valuable for surgeons considering hiring a nurse practitioner or physician assistant—or those who already have one and want to build a healthier, more sustainable working relationship that benefits patients, providers, and the practice as a whole.

Episode 69: Mid-career slump and a better use of clinic time with Dr. David Canes

The latest BOSS podcast features Dr. David Canes, a urologist located in Boston who found a way out of his mid-career slump by creating an innovative product that will help save time in the clinic.

After coaching hundreds of surgeons, I can tell you a common theme. There is a mid-career slump where everything gets a little less… interesting. The little admin and other picky things that didn’t bother us before start really bothering us. And it starts to feel like burnout, and we think something has gone wrong.

Dr. David Canes and I talked about this very situation: when you get to a point in your career, and you feel like something needs to change. We don’t hear about it in residency, and likely our mentors either didn’t talk about it or they thought something was wrong (like we think something is wrong) and shame keeps us from sharing.

 My theory is that you have reached the mid-career slump, and it means it is time for a change for the better, not that there is something wrong with you. You have reached stasis, and you are ready for something new.

This is where innovation happens. A new practice (like I did) and what David Canes did as well.

He took what was bothering him (repeating yourself time and time again with counseling patients on common topics) and he created a business to help off-load some of the tasks that don’t really need us to spend our precious time on anymore.

He talks about taking large amounts of time off your plate and helping patients MORE by letting them get the information before your visit. His talks about his product and his method for patient counseling and how it can also help you get more patient reviews. (I am not an affiliate, just a fan).

https://www.wellprept.com https://twitter.com/canesdavid

Episode 100: Creating and Empowering Work Environment with Dr. Tamara Beckford

Does this sound familiar? You've been told to simply increase your staff's workload and expect better results, but instead, you're left with exhausted and disengaged employees. The pain of trying to improve productivity and happiness in your private practice, only to see it backfire, is all too real. But there is a better way. By creating an empowering and supportive work environment, you can finally achieve the increased employee happiness and productivity you've been longing for.

In this episode, you will hear about how to:

• Boost employee happiness and productivity in your private practice with engaging and rejuvenating retreats.

• Create an empowering work environment that fosters collaboration and support among staff, leading to improved patient care and satisfaction.

• Shift into the future of private practice by embracing a new mindset and approach that will drive growth and success in a rapidly changing healthcare landscape.

• Unlock the potential for creativity and innovation in your practice, resulting in fresh ideas and solutions to improve patient outcomes and differentiate your services.

• Harness the power of technology and social media platforms to elevate your private practice, reaching new patients and maximizing your success in the digital age.

My special guest is Tamara Beckford

Dr. Tamara Beckford is a highly experienced emergency room physician based in Houston, Texas. With nearly 15 years of practice, she brings a wealth of knowledge and expertise to the table. Dr. Beckford is also the host of the popular LinkedIn live streaming channel, UR Caring Docs, where she engages in insightful discussions with industry experts. Her focus is on helping private practice owners and physicians create an empowering and supportive work environment. Through her platform, she shares valuable insights on topics such as increasing profitability, improving work environments, and enhancing employee satisfaction and productivity. Dr. Beckford's dedication to mentoring and supporting her fellow physicians has earned her a reputation as a trusted resource in the medical community. 

The key moments in this episode are:
00:00:00 - Introduction,

00:03:34 - The Yearning to Do More,

00:08:48 - The Importance of CEO Time,

00:10:49 - Building a Playground or a Prison,

00:11:58 - Addressing Burnout in Small Practices,

00:16:53 - Tapping into Talent and Improving Processes,

00:18:12 - Building Team Connection and Unity,

00:20:22 - Collaborating with Different Perspectives,

00:22:15 - Setting Up Physician Retreats,

00:26:21 - Addressing Personnel Concerns,

00:32:44 - Introduction to the Tamara Beckford Show,

00:33:14 - Ways to Connect with Dr. Vertrees,

00:34:09 - Private Practice is Not Dead,

00:34:50 - The Answer Lies Within,

00:35:22 - Conclusion,

Free Private Practice Guide Download  https://www.urcaringdocs.com/private-practice-retreats   Social Media Links:

Website: www.urcaringdocs.com 

LinkedIn: http://www.linkedin.com/in/drtamarabeckford 

Facebook: https://www.facebook.com/drtamarabeckford 

Facebook: https://www.facebook.com/URcaringdocs 

Episode 146: Using AI for Notes with Dr. Junaid Niazi

Free training with Dr. Niazi:
Leave Your Work at Work Wed, Aug 14th at 7pm CT

Register- Join his free training "Leave your work at work" here:

Leave Your Work at Work Wed, Aug 14th at 7pm CT Register here: www.leaveyourworkatwork.com

- Join his "Charting Conquered" at this affiliate link here:
https://www.chartingconquered.com/a/2147915367/poAV3ngM

Summary

The BOSS podcast this week discusses the potential of AI in assisting with medical note-taking and documentation. Dr. Junaid Niazi, an expert in time management for physicians, shares his insights on the current state of AI-powered scribing tools and their limitations. He highlights that while AI can be helpful in capturing patient histories and chief complaints, it still struggles with interpreting and organizing information coherently. AI may also hallucinate or make up information, requiring careful proofreading. Niazi emphasizes that AI alone cannot solve the deeper mindset issues like perfectionism and imposter syndrome that lead to excessive note-taking. He suggests that physicians need to restructure their workflows to fully utilize AI's benefits. Dr. Niazi offers a program called 'Charting Conquered' to help physicians reclaim their time and achieve a better work-life balance through mindset coaching and practical strategies for efficient note-taking and message management.

Chapters

Introduction to AI in Medical Note-Taking

The article introduces the topic of AI's potential in assisting with medical note-taking, a task that many physicians find burdensome. Dr. Genaid Niazi, an expert in helping physicians reclaim their time through efficient note-taking, is interviewed to share his insights on this topic.

Current State of AI-Powered Scribing Tools

Niazi explains that the advent of large language models like ChatGPT has enabled virtual scribe companies to offer AI-powered transcription services at lower costs. These AI tools can interface with electronic health records (EHRs) and transcribe dictations directly into patient charts. However, Niazi notes that some tools still require copy-pasting, which he finds less desirable. AI is also being used for tasks like message triage and generating initial responses to patient messages.

Limitations of AI in Note-Taking

While AI can be useful for capturing patient histories and chief complaints, Niazi points out several limitations. AI struggles with organizing information coherently, interpreting data, and generating coherent assessment and plan sections. It may also hallucinate or make up information, requiring careful proofreading. Additionally, AI cannot replace the human touch and interpersonal aspects of the physician-patient relationship.

Mindset Issues and Workflow Restructuring

Niazi emphasizes that AI alone cannot solve deeper mindset issues like perfectionism and imposter syndrome that lead to excessive note-taking. Physicians need to restructure their workflows to fully utilize AI's benefits. For example, Niazi may not use AI for physical exams where he already has a streamlined process. He also suggests that physicians need to trust themselves more and find a balance between thoroughness and efficiency.

Charting Conquered Program

Niazi offers a program called 'Charting Conquered' to help physicians reclaim their time and achieve a better work-life balance. The program includes a course on mindset and practical strategies for efficient note-taking and message management, as well as group coaching sessions and co-working sessions for accountability.

Action Items

1. Restructure workflows to fully utilize the benefits of AI in note-taking and documentation
2. Carefully proofread AI-generated notes and be aware of potential hallucinations or made-up information
3. Address mindset issues like perfectionism and imposter syndrome that contribute to excessive note-taking
4. Find a balance between thoroughness and efficiency in note-taking to avoid missing important information
5. Consider participating in Niazi's 'Charting Conquered' program for mindset coaching and practical strategies for efficient note-taking and message management

Episode 157: A Great Relationship with Your Office Manager is the Key to Your Success with Dr. Amy Vertrees

This transcript is a conversation between Dr. Amy Vertrees, a general surgeon, and Carrie Glass, her office manager. They discuss the crucial role of an office manager in ensuring smooth operations, managing staff, handling patient interactions, and navigating various administrative tasks. Carrie shares her background and how she transitioned into the office manager role after gaining diverse experience in the medical field. They delve into the challenges of scheduling patients, managing late arrivals, collecting copays, and dealing with difficult situations. Keri emphasizes the importance of documentation, coding, and proper billing procedures to ensure timely reimbursements from insurance companies. They also discuss strategies for maintaining staff morale, addressing performance issues, and enforcing boundaries. Throughout the conversation, Keri's expertise and Dr. Vertrees' appreciation for her contributions are evident, highlighting the significance of a strong office manager in a successful medical practice.

Chapters

Introduction and Background

Dr. Vertrees introduces Carrie Glass, her office manager, and highlights the importance of understanding the office manager's role. Carrie shares her background, starting in the medical field at a young age and gaining diverse experience in various roles before becoming an office manager.

Managing Patient Interactions

Carrie discusses her approach to managing patient interactions, including scheduling appointments, handling late arrivals with compassion, and explaining policies like copay collection. She emphasizes the importance of being a mediator between patients and providers, ensuring smooth communication and understanding.

Staff Management and Morale

Carrie shares her strategies for managing staff, addressing performance issues, and maintaining morale. She highlights the importance of open communication, being a team player, and creating a positive work environment through small gestures like buying lunch or allowing early departures on slow days.

Documentation and Coding

The conversation shifts to the importance of proper documentation and coding for successful billing and reimbursement. Carrie explains the pitfalls of incorrect coding, the need for accurate documentation, and the challenges of working with insurance companies' requirements.

Revenue Cycle and Reimbursement

Carrie and Dr. Vertrees discuss the revenue cycle, from scheduling and pre-authorization to coding, billing, and collecting payments. They highlight the importance of each step and the potential consequences of missing any part of the process, emphasizing the need for collaboration between providers and office staff.

Relationship and Collaboration

Throughout the conversation, the strong relationship and collaboration between Dr. Vertrees and Carrie are evident. They discuss the importance of mutual support, understanding each other's roles, and working together to overcome challenges and achieve success in the medical practice.

Action Items

1. Establish clear communication channels between providers and office staff to address scheduling conflicts, documentation requirements, and coding queries.
2. Implement regular training sessions for staff on coding best practices, insurance requirements, and documentation standards to ensure accurate billing and reimbursement.
3. Develop a comprehensive policy for managing late patient arrivals, addressing the root causes with compassion while maintaining office efficiency.
4. Foster a positive work environment by recognizing staff contributions, offering flexibility when possible, and promoting team-building activities.
5. Conduct periodic reviews of the revenue cycle process, identifying potential bottlenecks or areas for improvement, and implementing necessary changes to streamline operations.
6. Encourage providers to document procedures using precise terminology aligned with coding guidelines to facilitate accurate coding and minimize denials or delays in reimbursement.
7. Establish clear boundaries and enforce policies consistently, addressing performance issues promptly while maintaining open communication and offering support when needed.

Episode 168: What you don't know about insurance contracts with Frank Lobb

The meeting featured Frank Lobb, a former Navy pilot, discussing healthcare insurance contracts and their impact on medical care. Lobb shared his personal experience of losing his wife after being denied healthcare coverage, despite offering to pay out of pocket. He explained how his investigation through legal proceedings revealed that healthcare insurance contracts are secret, state-approved documents that effectively allow insurance companies to ration healthcare. Lobb discovered that these contracts, standardized around 1990, contain provisions that prevent patients from paying for care when insurance denies coverage. He emphasized how the Consumer Financial Protection Bureau's recent involvement has shifted the burden of proof for billing accuracy to healthcare providers. The discussion highlighted how the current system disadvantages both patients and healthcare providers, with Lobb suggesting that medical organizations like the AMA should push for contract reform.

Chapters

Introduction to Frank Lobb and His Healthcare Experience

Frank Lobb introduced himself as a former Navy pilot who became involved in healthcare contract analysis after personal tragedy. He shared his experience with DuPont's Clean Air Act negotiations, demonstrating his ability to analyze complex legal situations despite not being an attorney.

Personal Tragedy and Legal Investigation

Lobb described how his wife's illness led to his investigation of healthcare contracts. Despite offering to pay, multiple hospitals denied care after his insurance company's denial. Through legal proceedings, he gained rare access to typically secret insurance contracts.

Evolution of Healthcare Insurance System

Lobb explained how healthcare insurance evolved from a simple fee-for-service model in 1929-1930 to the current complex system. He highlighted the Supreme Court's 1990 ruling that confirmed insurance companies' right to ration healthcare.

Contract Structure and Patient Rights

Lobb revealed that unlike other insurance types, health insurance operates on a single contract system. He emphasized that patients don't actually have contracts with their insurance companies, only providers do.

Consumer Financial Protection Bureau's Impact

Lobb discussed how the Consumer Financial Protection Bureau's involvement has shifted the burden of proof for billing accuracy to healthcare providers, potentially creating leverage for system reform.

Episode 197: Medical office mastery: office manager insights

With decades of experience running medical offices, Carrie shares insider knowledge that every new attending needs to hear—from credentialing pitfalls and the revenue cycle to handling disruptive patients, managing staff, and mastering delegation. Together, Dr. Vertrees and Carrie explore how communication, boundaries, and trust between physicians and office managers can quite literally “make or break your life in the clinic.”

Carrie also introduces her new venture, Medical Office Mastery, designed to equip both physicians and office managers with the tools they need for smoother, more effective practice management.

💡 Whether you’re a brand-new attending or a seasoned physician looking to strengthen your team, this episode delivers actionable advice to help you build a foundation of success in your practice.

Highlights include:

• Why your relationship with your office manager is one of the most important of your career

• The hidden paperwork and credentialing hurdles new attendings face (and how to get ahead of them)

• How communication style sets the tone before you even arrive in practice

• The physician’s role in the revenue cycle and why timely documentation matters

• The behind-the-scenes heroics of prior authorizations and last-minute surgeries

• Strategies for managing disruptive patients, toxic staff, and no-shows

• The right way to delegate—and why skipping training leads to burnout and frustration

• The value of regular meetings and clear professional boundaries

• Why appreciation and recognition matter more than donuts

Episode 227: Reclaiming Physician Value: Coding, Control, and Private Practice

Dr. Jessica Hott shares her journey from hospital-employed surgeon and medical director to private practice founder after uncovering systemic billing and coding failures that prevented physicians from receiving credit for the care they were already providing.

Her investigation revealed a critical truth: physician burnout is often not caused by workload alone — but by invisible, uncompensated work embedded within healthcare systems.

Key Topics Discussed

The Productivity Paradox

• Physicians working harder while appearing less productive
• EMR reports failing to capture real clinical work
• Administrative decisions driven by flawed data

The Billing Education Gap

• Minimal training in billing and coding during residency
• Generational transfer of incorrect practices
• Why physicians must understand the business of medicine

Global OB Care Misconceptions

• What global care actually includes
• Common services physicians unknowingly provide for free
• How small documentation changes dramatically affect reimbursement

Post-Operative Visit Pitfalls

• How EMR labeling influences coder behavior
• When post-op visits become separately billable care
• New diagnoses vs. surgical global periods

Coding Strategy That Changed Everything

• Diagnosis alignment with procedures
• Real-world ureteral lysis coding example
• Working effectively with coders and billing teams

Modifier 22 & Surgical Complexity

• Documenting increased time, risk, and technical difficulty
• When complex cases justify additional RVUs
• Why many systems fail to recognize complexity

Why Health Systems Don’t Fix This

• Surgical departments already subsidize hospitals
• Administrative focus on loss centers instead of optimization
• Misaligned incentives inside healthcare finance

The Hidden Cost of Physician Turnover

• Recruitment and onboarding expenses
• Budget silos masking true institutional losses
• The financial impact of losing experienced surgeons

The Turning Point: Leaving Employment

• Moral injury vs burnout
• Stress vs passion: control as the defining difference
• Choosing private practice ownership

Building a Physician-Designed Practice

• Renovating a new surgical facility
• Creating efficiency systems and patient education workflows
• Attracting mission-aligned team members

Key Takeaways

• Physicians often underbill because they were never taught otherwise.
• Productivity data may not reflect true clinical value.
• Knowledge of coding is a form of physician empowerment.
• Administrative systems rarely reward initiative without structural change.
• Ownership restores agency, control, and professional fulfillment.

Actionable Insights for Physicians

• Audit what services fall outside global billing.
• Review how visits are labeled in your EMR.
• Learn modifier usage and complexity documentation.
• Partner actively with coders instead of delegating blindly.
• Understand the financial model of your practice environment.

Memorable Quote Themes

• “You’re not underproducing — your work isn’t being counted.”
• “Burnout often starts when value and recognition disconnect.”
• “Stress is when you can’t fix the problem. Passion is when you can.”

Ideal Audience

• Employed physicians questioning productivity metrics
• Surgeons considering private practice
• Physician leaders and medical directors
• Doctors interested in financial literacy and practice ownership