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Join Amy Vertrees, a general surgeon, as she shares her journey navigating workplace dynamics in the medical field. From identifying early signs of toxicity to fostering open communication and embracing change, Amy provides valuable insights into managing personnel and maintaining a healthy work environment. Discover practical strategies and lessons learned from her experiences in private practice, offering listeners a roadmap for success in their own professional endeavors.

Amy Vertrees is a general surgeon.

She discusses the KevinMD article, “The truth about employee turnover: It’s inevitable (and OK!)”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Amy Vertrees. She’s a general surgeon and a physician coach. Today’s KevinMD article is “The truth about employee turnover: It’s inevitable (and OK!)” Amy, welcome to the show.

Amy Vertrees: Thanks, Dr. Pho, I really appreciate this again.

This article has been in my mind for actually a couple years. I’ve been in private practice for four years. I was in the Army for 17, then employed for three years, because everyone said you’re supposed to. But then I decided to leave and started a private practice.

And the last four years have been really amazing for me, to understand what human behavior is like, what medicine is like on a deeper level. And people say private practice is dead all the time, but my thought is, private practice is actually a canary in a coal mine. We’re seeing the decreased reimbursements in real time, and the systems are seeing it on a bigger level.

And so I’ve been coaching surgeons for the last four years, which has helped me understand some of the challenges, and understand what other people’s motivations might be, and what my feelings are.

And the article was based on a pretty painful turnover that we had about two years ago. So I started the private practice really small. I had a core group of people and it was exactly what I wanted. I had buy-in, and we were really invested in the practice and caring for patients the way we saw fit. And I expected it to be really small, but what happened is that we kept growing and growing, and now we have three surgeons and a nurse practitioner. So it really grew really fast.

And about two years in we started noticing some changes, and there’s where the challenge was. I thought I opened one practice, and what I’ve discovered is that each year has been a different model of the practice.

So what happened about year two is, it started stretching the people who started the practice. The practice that they were in was not the one that they were hired in. And I didn’t see it, and I don’t think they did either.

So I’d always heard, now that I was responsible for hiring and letting people go, that if you see someone who’s like a bad seed you just let them go right away. And we had that, we had someone who joined us and we let her go right away. And so I was under the impression it was like, you identified someone who’s not working and you let them go right away.

But what had happened was, the job had changed. The people were the same, they looked the same, the job superficially looked the same, but it was really more responsibility, more changes.

And I started realizing, people do just leave, and they’re supposed to leave. And it’s kind of like death. I mean, we never talk about death, but it’s coming for all of us. And it occurred to me, this thought that came in loud and clear, everyone will leave their job, everyone, including us.

And it helped me to understand that they grew and evolved and it wasn’t the job for them anymore. It allowed me to let other people go after that free and clear, of saying, like, you don’t have to feel bad. We really changed how people left.

And then it also gave me some permission of saying that I don’t need to hold on so tight, which took a lot of pressure off me. I don’t need to hold on to people. And I actually give myself permission to leave if I want. And that part has been the most freeing, of saying that life changes and jobs change and we’re not actually stuck.

Kevin Pho: So before I ask some follow-up questions, just give us some context in terms of your private practice. How many employees in general do you have?

Amy Vertrees: That’s great, yeah. We started just with two people, and then we just hired on from there. So I had an office manager and a support person. Then we hired a nurse who didn’t last very long, it just wasn’t a good fit. It’s hard to do this, because you’re responsible, with a small group. And they gave a lot of attention, we really accomplished a lot.

But then we started adding a nurse practitioner, and then we added more MAs to help, then we added front staff, then we added PRN people, and then we added another surgeon two years ago, and we’re adding another one this summer. So it’s turned to where we’re anywhere from like 9 to 11, with some people just PRN. And it grew fast, and there’s a lot to manage.

And it’s a lot of pressure too, because now I don’t know what everyone’s job is. So my role in it changed as well, versus me being all hands and all of the things. And it grows to a point where you can’t do that, so you have to rely on people.

I found pressure within myself to want to hold on to people who really, you know, one person I really had a hard time letting her go because she was so valuable. But I learned, if I hold on to someone who tells me, look, it’s time for me to go, if I hold on to them, they’re now staying out of obligation, not from a place of, this is the place for me.

Kevin Pho: Now, when you said that the people were the same but their job description was different because of the growth of the practice, give us an example of who you’re talking about, or what exactly that means.

Amy Vertrees: Yeah, that’s a good question. One was my office manager, and she was just responsible for coming up with systems and really reaching out and working on the growth of things. And so that skill set of being a collaborator and being detail oriented and system based is fantastic. But then you interact with people on your own terms, and I also had a lot of personal involvement with it too. So this was someone who enjoyed a lot of close collaboration.

But as we got busier, we added more people, there were more layers between me and her and the person who started. So they were not getting as much direct input from me, but also it became managing other people in real time.

And starting to realize, someone who may be an introvert who just likes challenges and likes systems, when it now turns into, now you’re managing more people and all the problems that come up with it, and the system gets more complicated, then it could be a big challenge for someone who may be an introvert. And it’s hard to predict how the jobs will change over time.

And so I didn’t see it coming, and it’s one of those things where it slowly came up to where it wasn’t really clear when that was. And I remember one day where she said, those exact words, I think I was the best person to start this, but I don’t think I’m the best person to continue.

And I just thought she was having a bad day. I was like, it’s fine. You can see the cracks happening, you think. I mean, everyone I’ve seen has times where they slump a bit. I’ve had times where I’m like, I’m just getting by. But being able to tell now when it’s cracks versus, oh, time to go, is definitely something I’ve learned a little bit with some experience.

Kevin Pho: Now, you mentioned that you transitioned from one practice into your private practice. Did you have any business skills or private practice skills before going into this growing private practice, or is it something that you’ve just learned on the job?

Amy Vertrees: That’s a great question. I was in the military, and they were really great about letting us take ownership of patients and clinic early on, so I knew how to run an efficient clinic before I left residency, which definitely is not necessarily always the case.

I had always had an interest in coding and other business aspects. I started the BOSS, Business of Surgery, series in 2015 when I was a young attending, because we really just wanted to increase attendance at our American College of Surgeons chapter meetings. And I said, you’ve got to give them something to do. And I needed to know all that. So that led me into creating this BOSS, Business of Surgery, series that was initially just in-person meetings, but has evolved since then to a podcast.

And knowing that I had the ability to do the private practice, because if not me, then who? So it came from a personal interest. And you really do have to find this information on your own. With the internet now, it’s so much easier to find information, but it is complex, it’s complex to do all those things, and realize there’s regulations that you can get in trouble with, the reimbursement’s a challenge, and you really have to have some idea about financial situations, so you’re not overpopulating your clinic, because it is one of your big expenses.

Kevin Pho: So let’s go through a scenario. If an employee comes to you and says something like, I may not be the right fit for your organization, or this job may not be right for me anymore. From your experience running a private practice, what are some common reasons that they would come up to you for that conversation?

Amy Vertrees: It’s all interpersonal. And I’ve definitely learned this over time. One of the main things that I coach on is the difficult colleague, and realizing that we often will respond to what we think and not what’s actually said.

And that’s why a lot of people struggle at work, is we come with our own doubts and our own worries about how we’re doing in the job. So when someone says something, either in person or in an email, we will interpret it based on what we’re thinking about ourselves already, and we take their words as validation.

So a lot of times what I do when I have an experience like this is, I try to get them, and me, to see what the facts are. What were the words said, what were the email details? Because a lot of times you start to realize that there’s layers that you’re adding to it that aren’t there.

And this is where a lot of people get frustrated when they get in a bigger place and get HR involved, because any third party that comes in is only going to look at the facts and not see the layers. So I’ve discovered that, because a lot of people do already have their own thoughts about themselves, that I basically just get out what they’re worried about, and then deal with whatever the facts are in the situation, and then we kind of start from scratch and work on what’s actually the problem.

Which is almost always a common theme of, I’m not sure I’m doing a good job. And that we have some control over, when we can talk to them and say, how are you in the job, are you happy, are you satisfied, are you challenged?

And one way you can also see, that great performer, if you’ve ever had that great performer who’s said, I need to leave, you’re like, but you’re so great. And then you start to realize, I don’t actually touch base with them anymore. They’ve been so great, I basically know I can ignore them because they’re going to do a great job. So what happens, our reaction to them has changed. They used to get lots of praise because they would go over and above.

And the two things that happen are, either we stopped complimenting them, because we forget to, because we’ve done it for so much and we really appreciate it but we don’t tell them. Or the second thing is that they’re the kind of people who want to please other people, and if they’re not challenged in a way where they’re really pleasing other people, to where they’re really happy, they’re going to find somewhere else where they do. So it can be a challenge of reading people and seeing what their real motivations are.

Kevin Pho: So you’re saying that the majority of cases why people would want to move on are interpersonal, and it’s less frequently things like more money, better benefits elsewhere. Is that correct?

Amy Vertrees: Oh yeah. So before, when I was employed, we negotiated a huge raise. I was so proud of myself. I had gotten coaching at the time, and I started just experimenting with things. I got a huge raise, and then I quit like three months later.

And that’s what I discovered, is that for me personally, money is helpful, and money tells you that you’re appreciated, but it’s complex to see what you really need to get out of the job.

So in that job, as a lot of people who are employed experience, is that money is important because it tells you some value. But if you don’t have control over stuff, and people act towards you in a way that’s not really helpful, then you’re not going to stay, because you’re not satisfied. Satisfaction comes from different levels.

And I think a lot of us have not stopped to question what makes us satisfied in our job. And I think once we start doing that, we’ll know what we’re going to ask for, which is often appreciation, not just monetary, and challenge, and really using people’s skills the most that you can. And most of the time we just don’t want to bother people. Failure to delegate is actually not appreciating other people. So that’s another skill that’s worth another whole 20 minutes to talk about.

Kevin Pho: So is it plausible that an employee comes to you thinking that they may want to leave, but then you change the workplace environment to address some of their concerns and make them want to stay? Is that a plausible scenario? Because you said earlier, if someone wants to leave they’re only staying out of obligation. Is there a scenario other than that where they would want to stay if you made the appropriate workspace changes?

Amy Vertrees: Yeah, you have to see what it is that they’re unhappy with. If it’s another person, it’s usually interpersonal. If it’s, I’m not challenged anymore, then it’s a little interpersonal, because you have not challenged them enough, or you haven’t identified what their skill set is, or they haven’t identified it.

And if it reaches a point where they’ve already decided to leave, because that’s usually what happens, people are dissatisfied, don’t speak up, find another job, and now that job has become this idealized future for them. So you have to catch people’s hints earlier on than when they’re coming to tell you that they’re ready to leave.

Kevin Pho: Now, for those physicians who were in your shoes years ago and just starting their private practice, and certainly may not have the benefit of your wisdom or even your business background, what are some of the most important things that physicians should know about managing employees?

Amy Vertrees: Oh, that’s a great question. I think really just open communication, and realize that there’s so much dialogue in all of our heads that most of the conversations we think we’re having are not actually happening. Meaning that, of course I appreciate you, but I don’t say it. Or, gosh, I wish you would do something different, but I don’t say it.

And really, like a 360 feedback all the time, maybe not necessarily formal evaluations, especially at first, but checking in and saying, I wonder if I’ve been telling them that I appreciate them. I wonder if I’ve asked them if they feel challenged in their job. And asking yourself, like, why am I not asking them to do something that I feel like they should be doing, so now I’m not acting from a place of resentment for them?

So it’s not honestly particularly hard or needs a lot of skills. It needs some conscious dedication to get out of your own head, to then make sure someone else is not in their head, and you’re communicating on the same page, and saying, I just want to make sure that this job is still what you think it is and what you want it to be. And asking all the time, is there anything I can do to help you grow and evolve, and allow them to do so, is one aspect.

And another aspect that helps them and you and the next person is to ask them, what do you do day to day? I just want to understand what you do. So you’re both appreciating them for the work that they’re doing, and you encourage them to write that down, which means you’re now not relying on one person, the pressure is not on that one person to do everything. So now they can go on vacation, they can leave if they need to eventually, and you’ve already started building up the job description and whatever is in that job itself, which will allow you to let them go as well.

So I think that really helps a lot, because we don’t usually know what people’s jobs are and how much they’re actually doing. So when you have them verbalize it and you have them write it down with standard operating procedures, then you start to understand what their job is, and then you can start to see whether they’re outpacing the job, as you get to know them.

But if they do leave, you’re not starting from scratch with a new employee. They can come in and say, here are our standard operating procedures, and we’re going to be interested in your input to see how that can change. So that’s how it’s the job, not the people, that will help you. Because now you can develop the people and they could stay or go, but the job will always be evolving in a good way.

Kevin Pho: We’re talking to Amy Vertrees. She’s a general surgeon and a physician coach. Today’s KevinMD article is “The truth about employee turnover: It’s inevitable (and OK!)” Amy, we’ll end with your take-home messages to the KevinMD audience.

Amy Vertrees: My take-home message is, this is really all just about communicating with other people. It sounds hard, it’s really not. It’s basically, when you have someone who works for you, it’s a great honor, and respecting that as the person, and really helping them be the best person that they’re going to be, is really the best winning strategy for that. And it’s honestly so much easier.

Kevin Pho: Amy, as always, thank you so much for sharing your perspective and insight, and thanks for coming back on the show.

Amy Vertrees: Thanks, I appreciate it.