Surgeons with Purpose

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Every surgeon enters the profession knowing the clinical risks. Complications happen. Patients are unhappy. Outcomes fall short. That is part of the contract.
But what about the other risks? The systemic and structural ones that have nothing to do with how compassionate of a human you are, how good of a diagnostician you are, or how slick of a technician you are? You got into this to take care of people. But the system was designed to protect patients from bad actors, and those protections can be weaponized against good doctors for nefarious reasons.
In this 100th episode, neurosurgeon Dr. Christian Bowers joins me for an unfiltered convo about the systems governing physician careers and the gap between what those systems were designed to do and how they actually function. Dr. Bowers draws on years of watching colleagues' careers upended to illuminate what no one teaches in training.
"The thing that could totally derail someone's career overnight, with no fault of their own, is never discussed," — Dr. Christian Bowers
THE KANGAROO COURTS
Academic medical centers operate as large corporations with financial incentives that diverge from physician protection.
The house always holds the cards, and that matters for surgeons who find themselves in its crosshairs.
A predetermined outcome can be built through paper trails before a physician ever knows they are being targeted.

SHAM PEER REVIEW
The "disruptive physician" label is legally vague, subjectively applied, and the starting point for building a paper trail.
Things that were never a problem before all of a sudden become problems when an institution has decided to move on from you.
HCQIA (1986): designed to protect peer reviewers from retaliation, with the unintended consequence of making bad-faith reviews difficult to challenge.
A small group of aligned physicians often leads the charge, which makes this harder to see coming.

DARVO
Deny, Attack, Reverse Victim and Offender: the pattern coined by psychologist Jennifer Freyd that Dr. Bowers has seen play out repeatedly in institutional settings.
Physicians who have never heard of this concept are the most vulnerable to it.
DARVO typically shows up alongside sham peer review.

THE ROLE OF PIPS, THE MEDICAL BOARD, AND THE NPDB
Performance improvement plans and professionalism reviews are tools institutions use alongside sham peer review when they have decided to move on from a physician.
Medical board complaints and NPDB reporting are downstream consequences that can encumber a physician's ability to find their next position.
The damage is typically done upfront.
The goal of legal counsel is protecting you for the next job, not saving the current one.

THE ACGME & STRUCTURAL ACCOUNTABILITY
The ACGME is a private organization, not a government agency. It is accountable to its interests, not to trainees.
The Glass-Steagall parallel: the same perverse incentive structure between regulators and the institutions they regulate contributed to the 2008 financial crisis Medicine now has a version of exactly that.
Resident unionization may be one of the few structural checks on this dynamic.

PRACTICAL ADVICE FROM DR. BOWERS
Going into academic medicine as a highly sub-specialized surgeon may be the highest-risk career setup.
The two-hospital model: having multiple institutions competing for your cases fundamentally changes your negotiating position and safety.
When to consult an attorney, why you do NOT need to tell the hospital you have one, and what an attorney can and cannot do for you.
The controlled retreat strategy: protect yourself for the next job even when the current one is already lost.
Non-competes, NPDB, contracts, and what to investigate before signing anything.

Closing Reflection: The 100th Episode
Every system discussed in this episode was built with a legitimate purpose. The Board of Registration in Medicine protects the public. HCQIA was designed to encourage good-faith quality review. The ACGME exists to ensure training standards. Each one began with a just cause.
Over time, changes in how medicine is organized and how physicians are employed have created dynamics the original frameworks were not written for. The physician who simply showed up and did excellent work inside a broken system did not cause that drift. But they are the ones absorbing its cost.
The majority of physicians are not the bad actors these systems were designed to catch. They are doing their best inside systems that apply the same rules to the rare bad actor and to the exhausted surgeon who had a difficult patient or staff interaction after a long night of call.
Knowing that is clarity of environment, and clarity is the first form of protection.
Key Terms Referenced
Sham Peer Review: The use of the peer review process to target a physician for non-clinical reasons, typically when an institution has decided to remove someone and needs a documented justification.
HCQIA: Healthcare Quality Improvement Act (1986). Grants qualified immunity to hospitals and peer reviewers. Designed to encourage good-faith review; the unintended consequence is that bad-faith reviews are difficult to challenge.
NPDB: National Practitioner Data Bank. A federal repository of adverse actions against clinicians. An adverse report follows a physician across state lines and employers permanently.
PIP: Performance Improvement Plan. Can be a legitimate corrective process or a documented pathway toward termination, depending on the institutional context.
DARVO: Deny, Attack, Reverse Victim and Offender. Coined by psychologist Jennifer Freyd. A pattern that can arise when individuals or institutions face accountability, with or without conscious intent.
ACGME: Accreditation Council for Graduate Medical Education. A private, non-government organization that accredits residency and fellowship programs.

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Dr. Won Kim is a brain and tumor neurosurgeon at UCLA Health, where he trained, completed a fellowship in stereotactic and functional neurosurgery, and built a practice around treating tumors that were once considered inoperable. He is also the kind of surgeon who will tell you he is hard to work for, that M&M should be about quality improvement not blame, and that the last five percent of a perfect resection isn't worth the cost of your patient's quality of life.
Won's path to neurosurgery started with a childhood friend who had clinical depression. He wanted to understand how a brain could work so well and suffer so much at the same time. That question took him from a fascination with psychology to watching his first awake craniotomy, and it never really let him go. He ultimately chose neurosurgery over psychiatry. But the question of what makes one person able to thrive while another person can't escape the darkness has followed him throughout his career.
In this conversation, we talk about what it actually means to treat the patient and not the scan and why the pursuit of perfection can be its own form of hubris. He talks about what it means to go to sleep without shame or guilt, as long as you prepared to give your best.
We also get into his AI startup, why AI will paradoxically create more demand for radiologists rather than less, and what he has learned about becoming a better teacher and mentor.
Follow Dr. Kim on instagram here.
Are you a surgeon with a story to tell? Yes you are! Email me at [email protected]

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Dr. Red Hoffman has spent her career sitting with people at the hardest moments of their lives. As a physician who combines trauma care and palliative medicine, she has built a practice around something most of us spend our whole lives avoiding: death. But what makes Red's perspective so singular is that she isn't just a professional witness to loss. She has lived it, repeatedly and violently. Her grandparents died in a car accident when she was 12. Her father was killed in a terrorist attack in Egypt when she was 19. Her partner sustained a traumatic brain injury and later died by suicide when she was 49. This is a woman who knows grief from the inside out, and she has chosen to meet it with love rather than distance.
In this conversation, we talk about what it actually means to have a good death, and what it means for the people left behind. Red explains why violent deaths carry a unique burden — not just the loss itself, but the law enforcement, the media, the legal system, all the unknown layers that pile on top of an already impossible experience. She shares what to say to someone who is grieving when you don't know what to say, and why the most important thing is not to assign meaning to someone else's loss. That work belongs to the bereaved.
We also get into what it looks like to build a life on your own terms inside a system that wasn't designed for you. Red talks about navigating a corporate hospital buyout, watching her community get hit by Hurricane Helene, and finding genuine love for a corporation she once might have resisted. She talks about long COVID, what it is like to go from healthy to chronically ill, and how she has learned to ask for what she needs inside a system that makes that incredibly hard.
And we talk about twriting the book she wishes she had when her father was killed: a guide to surviving violent death for the people left behind.
Red carries a lot of loss and a lot of love, and somehow in her hands those two things are not opposites. I think you are going to feel that.
Learn more about Dr. Red Hoffman here.
Follow her on instagram here.

Join us inside Empowered Surgeons Group here.
What happens when being a doctor is no longer enough to sustain you?
Dr. Shieva Ghofrany, OB/GYN and founder of A Tribe Called V joins me to explore identity, autonomy, and the hidden pressures of practicing medicine.
Dr. Ghofrany didn’t follow a traditional path into medicine, and she doesn’t practice it traditionally either. From switching majors multiple times to building a parallel business, she shares what it looks like to question expectations, tolerate failure, and expand beyond the narrow identity many physicians inherit.
We talk about the emotional and psychological realities of OB/GYN, the weight of responsibility in high-stakes situations, and the courage it takes to step outside the “golden handcuffs” of medicine.
This episode is about more than career decisions.
It’s about how you relate to yourself, especially when things don’t go as planned.
🔍 In This Episode, We Discuss
Why identity in medicine can become limiting and how to expand beyond it
The concept of “golden handcuffs” and why so many physicians feel stuck
Learning to tolerate failure (and why it’s essential for fulfillment)
Building A Tribe Called V and what entrepreneurship revealed about her strengths and blind spots
The emotional toll of OB/GYN, including moral injury and high-risk deliveries
The psychological pressure physicians face in moments like shoulder dystocia
Her personal journey through endometriosis, infertility, and ovarian cancer
What illness taught her about resilience, perspective, and life beyond medicine
The importance of playfulness in the OR and how it shifts performance
A powerful daily mindset practice that shapes how she shows up
Why resentment is not useful in surgery—and what to do instead
Communication, emotional intelligence, and how to navigate patient retaliation

🧭 Why This Conversation Matters
You can follow every rule, do everything “right,” and still feel constrained by your career.
This episode challenges the idea that medicine alone should define you—and offers a different way to think about autonomy, fulfillment, and what it means to build a life that actually works.
👤 About Dr. Shieva Ghofrany
Dr. Shieva Ghofrany is an OB/GYN in private practice and the founder of A Tribe Called V, a platform dedicated to increasing knowledge and reducing anxiety around women’s health.
Her work sits at the intersection of medicine, education, and empowerment—helping women better understand their bodies while encouraging physicians to think more broadly about identity and impact.
Learn more about Dr. Ghofrani here.

You don’t have a skill problem.
You have a mindset problem, and it's time you learned the skillset of mindset mastery.
In this special episode, I break down my why behind OR Energetics: The Mindset Mastery Intensive for Surgeons. White-knuckling your way through cases, patients, and your life is not mastery. It’s survival.
And survival has an expiration date.
Your hands were trained.
But no one trained you to control your thoughts, your emotions, or the energy you bring into every case, every interaction, every decision.
So what happens?
You overthink.
You second-guess.
You carry the weight of every complication, every conversation, every expectation… home with you.
And you call it “part of the job.”
It’s not.
You can be an exceptional surgeon… and still be completely out of control internally.
And if you don’t fix that, it will catch up with you.
OR Energetics is where that changes.
If you’re done surviving your career, and ready to actually feel powerful inside it, this episode is your entry point.
Join us inside OR Energetics here.
Doors close May 9th.