The BOSS Business of Surgery Series Podcast

Episode 17: Pitfalls of different surgery practice models with Dr. Matt Endara

he latest podcast episode is with Dr. Matt Endara- a plastic surgeon who has experienced multiple practice models. I thought this would be a great time to talk about different models given that many of you are looking for jobs. 

On this episode, we talked about how you get paid: 

Many hospital-based practices are rvu based. This is a productivity model with rvu (relative value unit) as the benchmark for determining your productivity. Each case, note, procedure have an assigned rvu value. The amount you get paid per rvu is dependent on the region you are in, and can be negotiated. 

Private practice models are run by individual surgeons. They can be small or large, depending on the specialty or the area. It is important to understand the overhead (expenses) and income generated to know if you are joining a viable practice. Many private practices are joining practice management groups which handle the HR, regulations, bills/insurance denials, negotiating contracts with insurance companies. This hybrid allows control of the practice without some of the headaches (Dr. Vertrees' practice is this model)

Aesthetics is often fee-for-service models without going through insurance. Many plastic surgeons will have a mixed model with aesthetics (fee-for-service) and insurance based practice (Dr. Endara's practice is this model). 

(although we didn't talk about it- Kaiser is an example of paying by the hours worked with possibility of partner. We also did not cover private practices where you "buy in" and have the potential to "make partner". Definitely get a lawyer and an accountant to review the options for a job like this).  

What are some of the pitfalls to look for?: 

- Family-run business or mom-and-pop businesses that don't know their numbers. They may have a viable practice, but noone really knows

- The payor mix in the area. If there are a lot of uninsured, you may have challenges maintaining a viable practice

- What will you get paid after the guaranteed income is up?

- Do you know what are the trade-offs for big city practices and smaller community hospitals?

- Are you keeping up with the times (new technology) and protecting against lack of diversity (pandemic-proofing your practice)

Please rate and review the show! 

 Do you have a topic you want covered? Send me an email at [email protected]

Dr. Endara can be found at https://perfectenn.com/about

Episode 29: When you love your career, but life happens with Dr. Riikka Mohorn

Dr. Riikka Mohorn is a trauma/general surgeon and sudden widow when her husband unexpectedly passed away at 46 years old. Her life was initially all chaos managing her three young children and a general surgery career that she loved. She found help anywhere she could, and although it was difficult, she knew that it had to be possible to manage it all. Over time, she gradually prioritized her life. She loved her career and had what most surgeons have: the “can’t work less” mentality. She learned that she can do a lot of things, but not all things were possible. She had mom guilt that she sometimes overcame, and sometimes didn’t. She discovered coaching and learned that she could pivot her career, work less and live more, although it took her years to overcome the overworking mentality. She trained herself to see the small wins, and not the failures. She became a coach herself, and she is helping others realize they do have options when they have been thinking they don’t, and that it is ok to prioritize yourself and to have hobbies. She and her husband always delayed their plans, and she is encouraging us all to live now. She discovered life is fantastic when you get to do the things you enjoy. That life can be hard, but it can also be fabulous.

Boss Business of Surgery Series – Episode 31

Money, Meaning, and Building a Career on Your Own Terms

with Dr. Bethany Malone

In this episode of the Boss Business of Surgery Series, Dr. Amy Vertrees speaks with Dr. Bethany Malone, general surgeon and physician entrepreneur, about the complicated relationship physicians have with money — and how financial clarity can unlock freedom, alignment, and intentional career choices.

Dr. Malone shares her journey through traditional surgical training, early career decision-making, and the realization that financial literacy is not optional for physicians who want autonomy. Together, they explore how money beliefs formed during training quietly shape fear, overwork, and people-pleasing — and how learning to understand, plan for, and talk openly about money changes everything.

This episode reframes money not as a taboo or moral issue, but as a tool for choice, stability, and self-trust.

In this episode, you’ll learn:

• Why physicians are often highly paid but financially anxious

• How medical training discourages open conversations about money

• Why earning more does not automatically create freedom

• How lifestyle inflation traps physicians in decisions they no longer want

• The difference between income and financial security

• Why financial literacy is a form of self-advocacy

• How fear-based money decisions show up as overwork and burnout

• Why surgeons stay in misaligned jobs longer than necessary

• How clarity about numbers reduces emotional decision-making

• Why money shame keeps physicians silent and isolated

• How financial planning creates options — not pressure

• Why understanding your “enough” number changes how you practice

• How money beliefs intersect with worth, identity, and success

• Why asking for help with finances is not weakness

• How entrepreneurship can complement — not replace — a surgical career

• Why intentional planning protects against regret

• How aligning money with values restores agency

Key themes:

• Money is a tool, not a moral judgment

• Financial literacy creates freedom of choice

• Fear thrives in vagueness; clarity restores power

• Overwork is often a financial problem in disguise

• You don’t have to sacrifice fulfillment for security

• “Enough” is a powerful and personal number

• Talking about money reduces shame

• Autonomy grows with understanding

Resources & mentions:

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

• Become the Boss MD

• Physician entrepreneurship and coaching resources

This episode is essential listening for surgeons who feel uneasy about finances, uncertain about long-term sustainability, or quietly worried that money — rather than values — is driving their career decisions. Dr. Malone’s message is both practical and reassuring: when you understand your money, you gain the freedom to choose a career that actually fits your life.

Boss Business of Surgery Series – Episode 45

Permission to Want More: Identity, Alignment, and Redefining Success

with Amanda Hill, Attorney

In this episode of the Boss Business of Surgery Series, Dr. Amy Vertrees speaks with Amanda Hill, attorney and professional coach, about the quiet but powerful tension many high-achieving professionals experience: doing everything they were taught to do — and still feeling misaligned, constrained, or unfulfilled.

Drawing on her legal background and coaching work, Amanda brings an outside-of-medicine perspective to conversations surgeons often have only with themselves: Is this really what success is supposed to feel like? Together, Amy and Amanda explore how external achievement, titles, and approval can mask internal disconnection — and how giving yourself permission to want more is often the first step toward sustainable change.

This episode is about identity, values, and learning to trust yourself when the life you built no longer fits the person you’re becoming.

In this episode, you’ll learn:

• Why external success doesn’t always translate into fulfillment

• How high-achieving cultures condition people to ignore internal signals

• Why “this should be enough” is a red-flag thought

• How achievement can become a substitute for self-trust

• Why dissatisfaction doesn’t mean you chose the wrong career

• How guilt shows up when professionals imagine different paths

• Why wanting more is not the same as being ungrateful

• How identity becomes fused with role, title, and reputation

• Why slowing down can feel more threatening than pushing harder

• How values clarification changes decision-making

• Why comparison keeps people stuck in roles they’ve outgrown

• How fear of disappointing others overrides personal truth

• Why burnout often follows prolonged self-abandonment

• How curiosity opens doors that force never will

• Why you’re allowed to evolve beyond earlier goals

• How redefining success restores agency

• Why alignment matters more than optics

• How internal permission creates momentum

Key themes:

• Wanting more is not failure

• Alignment matters as much as achievement

• Identity is allowed to evolve

• Guilt often signals growth

• Self-trust is a learnable skill

• Burnout is a message, not a verdict

• Success is personal, not inherited

• You don’t need permission from anyone but yourself

Resources & mentions:

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

• Become the Boss MD

• Coaching and professional alignment resources

This episode is essential listening for surgeons who look successful on paper but feel restless, constrained, or quietly disconnected from their work. Amanda Hill’s perspective offers a refreshing reminder from outside medicine: you are allowed to want a life that fits — and you don’t have to justify that desire to anyone.

Episode 44: Normalizing negotiation with Michael Johnson Jr, Esq, physician contract lawyer

The latest podcast episode features Michael Johnson Jr. Esq, a physician contract lawyer who is committed to help physicians negotiate effectively and stand up for what is right.  

We covered so much in this episode!

- When should you start considering contract negotiations? (it's earlier than you think!)

- What may hold you back from starting your job and keep you from making money?

- What should you ask on interviews? 

- Do you have an exit strategy, and what should your contract have in it to support this strategy? 

- Can you negotiate if they say "this is a standard contract"? 

- What are the most common mistakes made in contract negotiations?

Find more information on Michael Johnson, Jr:

www.physiciancontracts.com

Instagram @physiciancontracts.com

Episode 60: When a big system doesn't understand what you do with Dr. Steve Siegal

Website: www.gisurgical.com Tweets: @SteveSiegalMD Instagram: @SteveSiegalMD LinkedIn: https://www.linkedin.com/in/SteveSiegalMD

Youtube: https://www.youtube.com/c/SteveSiegalMD Email: [email protected]

Episode 66: Location-Based Job Search with Dr. Amy Saleh

Are you looking for a job, and have a particular location in mind?
On the latest BOSS podcast episode, I talk with Dr. Amy Saleh about a location-based job search. 

• She cold-called to get her job
• There are pitfalls she wants you all to avoid
• She focused on her values, which helped her find the right job AND navigate her role in the practice
• If you have a long list of requirements, you have likely not worked out what is most important to you.
• Our training didn't prepare us for how to create a sustainable career, because training is performance and metrics based, jobs are value-based.
• Take the time to look at your values, this is where you will be the most fulfilled.

You can change your external circumstances (the job), but until you do the internal work, you likely won't find the job you want anywhere. 

Episode 107: Leaving By Choice or Not; What to do Next with Amanda Hill and Dr. Amy Vertrees

Reflect on your current situation: Take a moment to think about your goals and aspirations in medicine. Are you truly happy where you are, or do you need to make a change? Consider whether reforming your current job may be a viable option before jumping into a new opportunity.

In this episode, you will be able to:

• Gain clarity and find fulfillment in your work by navigating career transitions with confidence.
• Empower and support physicians in finding career satisfaction and maintaining work-life balance.
• Discover strategies for negotiating contracts that maximize your value and ensure a fair deal.
• Engage in self-reflection and exploration to uncover what truly brings you career fulfillment.
• Seek professional help and create a plan to achieve career success on your own terms.

Sign up for the free webinar here: https://www.bosssurgery.com/ or https://www.guardmypractice.com/.

Amanda Hill is a healthcare attorney in Austin, Texas.  She worked for the U.S. Government defending large hospitals before becoming General Counsel for several large groups. She has worked with physicians and health care management her entire career, providing guidance, training, and counsel. 

Recently, Amanda launched Guard My Practice to try and prevent problems doctors were facing BEFORE they occurred and help to train and educate physicians about the business side of medicine.  This company provides courses on all kinds of topics that affect physicians to help them feel safe and protected, such as contracts, fraud and abuse, employment issues, partnership concerns, HIPAA, dealing with difficult patients, and more. 

The key moments in this episode are:
- 00:00:00 - Introduction and Purpose of the Webinar
- 00:00:30 - The Importance of Empowerment and Collaboration
- 00:03:25 - Understanding the Challenges Faced by Doctors
- 00:05:03 - Introducing Personal Backgrounds
- 00:06:50 - Dr. Amy's Journey and Coaching Career
- 00:12:47 - The Impact of Negative Reviews
- 00:13:53 - Empowerment for Physicians
- 00:14:33 - Fear and Unknown in Job Transitions
- 00:16:28 - The Option to Stay in the Current Job
- 00:19:35 - Loving Yourself in Your Job
- 00:25:46 - Life Expectancy in an Institution
- 00:26:42 - Recognizing the Problem
- 00:27:51 - Knowing What You Want
- 00:31:48 - Permission to Complain
- 00:38:14 - Creating the Future You Want
- 00:39:23 - Understanding Your Contract
- 00:41:40 - Strategizing Your Exit
- 00:43:56 - Building Leverage and Timing
- 00:46:48 - Introduction to the Course
- 00:50:20 - Reflecting on Mistakes and Embracing the Future
- 00:51:11 - Confidentiality and Privacy on Zoom Calls
- 00:53:28 - Course Details and Value
- 00:56:55 - Closing a Practice and Retirement
- 00:58:31 - Freebies and Prizes
- 01:02:11 - Introduction and Overview
- 01:02:29 - Email Communication
- 01:02:49 - First Step Towards Change
- 01:03:00 - Conclusion

Episode 126: If You Are Employed, Your Job is at Risk with Amanda Hill JD

If you are employed, your job is at risk. 

This has been true for all industries, but medicine seemed to be immune from these trends for the most part. Last year, medicine was the third largest industry experiencing layoffs. From new graduates to higher up physician leaders, there does not seem to be anyone who is safe. Private practice has likely been the canary in the coal mine and first to experience the hit of decreased reimbursements. 

Amanda Hill, JD is a strong advocate for physicians. We recorded this episode a few days ago, because we have been seeing these alarming trends accelerating. 

We joined forces last year to create the program 90 Day Notice to help. It is more relevant than ever. Find out more information here

Boss Business of Surgery Series – Episode 131

Are Noncompetes Really Going Away?

with Amanda Hill, JD

In this episode of the Boss Business of Surgery Series, Dr. Amy Vertrees speaks with Amanda Hill, JD, employment attorney, about the evolving legal landscape surrounding noncompete agreements — and what recent headlines actually mean for physicians.

Amanda breaks down the difference between media soundbites and legal reality, helping surgeons understand what has changed, what hasn’t, and what still depends heavily on state law, timing, and contract specifics. Together, they explore why confusion around noncompetes is so widespread, how misinformation creates false reassurance or unnecessary fear, and what physicians should be paying attention to right now when negotiating contracts or considering a job change.

This episode is a practical, grounding conversation designed to replace anxiety with clarity and informed decision-making.

In this episode, you’ll learn:

• Why many physicians believe noncompetes are “going away” — and why that’s misleading

• What recent FTC actions actually proposed (and what they did not finalize)

• Why state law still plays a major role in enforceability

• How noncompetes differ from non-solicitation and confidentiality clauses

• Why physicians should not assume their noncompete is unenforceable

• How timing, geography, and role affect legal outcomes

• Why hospitals and employers may still include noncompetes

• How misinformation can lead to risky career decisions

• What physicians should review before signing or exiting a contract

• Why enforcement often depends on leverage, not just legality

• How to assess risk without panic

• Why legal advice matters more during transitions

• How physicians can protect themselves proactively

• Why “waiting it out” is rarely a strategy

• How clarity reduces fear and restores agency

• Why understanding contracts is a form of self-advocacy

• What questions to ask before assuming freedom of movement

• How knowledge shifts power back to physicians

Key themes:

• Headlines are not law

• Noncompetes are nuanced, not binary

• State law still matters

• Assumptions create risk

• Knowledge restores agency

• Contracts deserve careful review

• Clarity beats speculation

• Informed decisions protect careers

Resources & mentions:

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

• Employment law and contract-review resources

• Become the Boss MD

This episode is essential listening for surgeons who are considering a job change, negotiating a new contract, or wondering whether recent news truly changes their options. Amanda Hill’s perspective brings much-needed realism and reassurance: noncompetes may be evolving, but assumptions are still dangerous — understanding the law is how you protect your freedom and your future.

Episode 140: Returning to the Operating Room with Dr. Jennifer Zakhireh

What happens if life gets in the way and you want to take a break from surgery. Dr. Zakhireh shares her experience of taking a clinical gap from her surgical practice for several years to care for her three young daughters, and her subsequent journey to re-enter her practice.

There were challenges and doubts she faced from her peers. She felt isolated, but also determined to make it work. Her determination helped her to return to her passion despite the lack of a clear pathway. She shares the strategies she employed, such as maintaining her medical knowledge, collaborating with an open-minded credentialing committee, and designing an individualized re-entry plan. She emphasizes the importance of self-compassion, relying on her core values, and having a supportive village during the process. Her experience highlights the need for more open-mindedness and empowerment within the surgical community to accommodate life events and prevent the loss of talented surgeons.

Suggestions if you want to take a gap from operating:
1. Maintain non-clinical obligations and medical knowledge during a clinical gap to ensure readiness for re-entry.
2. Collaborate with hospital credentialing committees and design an individualized re-entry plan that can be modified based on progress.
3. Work closely with mentors and colleagues to proctor cases and assess competency during the re-entry process.
4. Monitor outcomes, complication rates, and return to surgery rates, and remain open to peer assessment and feedback.
5. Speak kindly to oneself and trust one's judgment during the re-entry process, while also being open to seeking help when needed.
6. Explore all options, such as part-time work or reduced hours, before taking a significant clinical gap, if possible.
7. Rely on core values, life mission, and a supportive village to navigate the challenges and uncertainties of a clinical gap and re-entry.

Episode 152: Challenges in Job Transitions; Insights From the 90 Day Notice Program with Amanda Hill JD and Dr. Amy Vertrees

In this episode, we dive into a group coaching session centered around job transitions and the '90 Day Notice' program offered by Amy and Amanda. This session is packed with practical advice for professionals, especially doctors, who are contemplating or undergoing a job change.

Chapters:

1. Introduction and Overview

   • Amy welcomes listeners to the group coaching session, setting the stage for an open discussion about job transitions. She introduces the '90 Day Notice' program and outlines the session's purpose.

2. Limiting Thoughts and Negative Emotions

   • Amy addresses common limiting beliefs that can impede job changes, such as worries about reputation and financial stability. Amanda shares insights on managing emotions like anger and hurt, and how to redirect these feelings constructively.

3. The '90 Day Notice' Program

   • Amy provides a detailed overview of the '90 Day Notice' program, including its components: online lessons, live calls, a roadmap, and resources. The program covers everything from assessing your current situation to preparing for exit interviews.

4. Negotiation Tactics and Leverage

   • Amanda discusses the importance of understanding your leverage in negotiations. She advises against making demands and instead focuses on showcasing your value and understanding market rates. Amy and Amanda explore communication strategies like curiosity, tactical empathy, and storytelling to aid successful negotiations.

5. Leaving a Job and Setting Oneself Up for Success

   • The coaches offer guidance on leaving a job professionally, avoiding common pitfalls like burning bridges or airing grievances. They stress the importance of maintaining a forward-focused mindset and preparing for success in a new role by addressing limiting beliefs and fostering positive relationships.

Action Items:

1. Explore the idea of leaving your job to understand the associated thoughts and feelings.
2. Challenge limiting beliefs about job transitions, such as concerns about reputation or finances.
3. Constructively process and manage negative emotions related to job changes.
4. Understand and communicate your leverage during negotiations by focusing on your value and market rates.
5. Use effective communication strategies, including curiosity and empathy, to maintain positive relationships during negotiations.
6. Stay professional and focus on the future when leaving a job, avoiding emotional outbursts.
7. Seek support to address and process negative experiences from past roles.
8. Set clear expectations and build positive relationships in your new job to ensure success.

Tune in to gain valuable insights and strategies to navigate job transitions with confidence and professionalism!