Saturday Morning Rounds January 2nd, 2021 - Why you're probably breathing wrong, and how fixing it will help you in negotiations

Posted by BossB, MD on January 2, 2021

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

Happy new year!!!

Your inbox and social media feeds are probably chock-full of "a look back at 2020" and "a look forward to 2021" articles. The former are not nearly as useful as most people think, and we've already covered the latter pretty thoroughly, so instead we're gonna get back to "normal" around here and share something that blew our minds this past week.

The last, and possibly most influential, book we read in 2020 was Breath: The New Science of A Lost Art by James Nestor.

A number of other books that we read in 2020:

It was clearly a great reading year!

No book, however, has changed the way we live moment-to-moment as much as Breath. Because it literally changed the way we breathe and our awareness of that process, and we suspect that it will do so for you as well.

The publisher - as one might expect - did a better job of describing the book than we could:

"There is nothing more essential to our health and well-being than breathing: take air in, let it out, repeat twenty-five thousand times a day. Yet, as a species, humans have lost the ability to breathe correctly, with grave consequences.

Journalist James Nestor travels the world to figure out what went wrong and how to fix it. The answers aren’t found in pulmonology labs, as we might expect, but in the muddy digs of ancient burial sites, secret Soviet facilities, New Jersey choir schools, and the smoggy streets of São Paulo. Nestor tracks down men and women exploring the hidden science behind ancient breathing practices like Pranayama, Sudarshan Kriya, and Tummo and teams up with pulmonary tinkerers to scientifically test long-held beliefs about how we breathe.

Modern research is showing us that making even slight adjustments to the way we inhale and exhale can jump-start athletic performance; rejuvenate internal organs; halt snoring, asthma, and autoimmune disease; and even straighten scoliotic spines. None of this should be possible, and yet it is.

Drawing on thousands of years of medical texts and recent cutting-edge studies in pulmonology, psychology, biochemistry, and human physiology, Breath turns the conventional wisdom of what we thought we knew about our most basic biological function on its head. You will never breathe the same again."

We'll leave it up to you to decide the medical implications of what you'll read in the book and whether pulmonology labs are really deserving of the shade thrown at them above - we just know that this changed our personal approaches to breathing and gave us a lot of new tools to synthesize into our lives and our curriculum. More on that last bit below :) 

Who we're following

If you're interested in learning more about breathing and the topics covered in the book, the author's Twitter page (@MrJamesNestor) is worth a follow. He doesn't post that often which is great in our opinion because we've already got plenty of follows who do. When he does post, however, it's usually both relevant and interesting. Here's an example (that some of you might wanna share w/your SOs) of such content - the results from his n=1 study on himself, comparing mouth-breathing vs nose-breathing during sleep:

BBMD tip of the week

If we've said it once we've said it a million times - your STATE (physical, mental, emotional, etc) going into a business conversation, and especially a negotiation, is the single most important thing you could possibly impact. If you take care of that, the rest tends to take care of itself.

What we hadn't fully understood until reading this book, however, is just how powerful a tool breath could be in affecting desired state changes - especially in the multitudes who struggle to do so because of anxiety and/or a pattern of sympathetic nervous system dominance during the kinds of scenarios that we teach about.

There are many big claims made about the power of breath in this week's book, but its ability to impact one's nervous system and with a little practice to influence or even control one's nervous system is incredibly promising for all kinds of applications.

We're not yet sure which breathing exercises are best for which situations, this simple one called "Box Breathing" is used be special forces soldiers before and during missions to achieve that "sweet spot" state of activated yet calm and in control. The steps are simple:

  • Inhale to a count of 4 (preferably through your nose)
  • Hold 4
  • Exhale 4 
  • Hold 4
  • Repeat

The simplicity of this is a key to its effectiveness - you only have to count to 4 over and over. It's quite meditative. Longer exhalations, however, will bring about a stronger parasympathetic nervous system response. So if you want to take it a step further, do a 6-count exhale and a 2-count hold on empty lungs.

Quote we're contemplating

 "'Yes, they are elves,' Legolas said, 'and they say that you breathe so loud they could shoot you in the dark.'

Sam hastily covered his mouth.”

- J.R.R. Tolkien

PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds December 19th, 2020 - Why you probably over-apologize, and what to do about it

Posted by BossB, MD on December 19, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

Just this past week we've had a couple different clients struggle with what we like to call "apologizing their way into an ask."

We were doing some negotiation role-plays to practice for their actuaupcoming negotiations, and they had a lot of trouble with saying "I'm sorry" - or something like it - before every back-and-forth exchange.

This is a super-common issue for our clients, and we wrote about it around this time last year after one of the democratic debates. While a lot has changed since then in the world, not much has changed about our stance on the topic - so if you find that this is something you struggle with, keep reading:

A couple of weeks back we were watching the December democratic debates when an interesting question was posed. The candidates were asked, "in the spirit of the season," to either give a gift or apologize for something, to their fellow candidates.

What happened next led to one of those unsurprised-but-still-disappointed looooong sigh moments.

Every single one of the men offered a gift - in most cases their book.

Both of the women on stage offered an apology for "getting worked up" or "being blunt," respectively.

Turns out, apologizing is an incredibly complex, still unsolved conundrum in the worlds of both psychology and economics. So we did a deep dive on some of the best resources to summarize what we know so far about the topic:

  • This Atlantic article is a great summary of the high-level research on which types of apologies are best in which situations, as well as the gender gap in apologizing
  • This podcast episode (and transcript) is a fascinating conversation about the economics of apologizing, game theory, and how the chief economist at Uber approached the problem of how the company should apologize for a bad ride
  • This article from the Association of Psychological Science summarizes research on the six elements of an effective apology

But none of them do justice to the single most important thing we can do when it comes to our apologies, which is to STOP GIVING SO DAMN MANY OF THEM! We'll explain why and how in our "tip of the week"

Who we're following

Any time we're reading about economics we can't help but give a shout-out to our favorite BossB economist, Dr. Emily Oster, PhD (@ProfEmilyOster). She focuses her work on what we believe to be the most systematically intractable component of the gender gap - having and raising kids. Even though she doesn't focus on the workplace implications of family life, her Twitter feed is a treasure trove of well-curated content on those topics and funny/endearing personal posts.

BBMD tip of the week

There's a central tension that has to be addressed anytime we talk about apologizing:

  • The urge to apologize, and specifically women's tendency to do so far more often, is actually a sign of higher emotional intelligence, which can be a professional superpower if wielded correctly
  • Apologizing, in the majority of cases, makes one look weaker, less trustworthy, and more guilty in the eyes of observers

So how can we throw out the "bathwater" of over-apologizing, and at the same time spare the "baby" of emotional intelligence & resonance? We're so glad you asked! Here are a few quick rules to help you:

  • No harm, no foul - Unless you've actually caused someone some type of harm, don't let the words "I'm sorry" escape your mouth. That means no more apologizing for letting your voice be heard ("I'm sorry, but") or taking up physical space, which should cut out of 50%+ of apologies right there
  • Say "thank you" instead - Sometimes we do a small amount of harm to someone that needs to be addressed; a common example is showing up late to a meeting. Next time something of that nature happens, try instead to say "thank you for <insert whatever virtue they need to get over it>." So in the event of showing up late for a meeting, you'd say "thanks for your patience." It addresses the value of their time without weakening your position or committing too much self-flagellation, and gives them no option but to get over it quickly (or not live up to the positive image of themselves that you've painted)
  • Download this gmail plugin - This awesome little addition to your online ecosystem not only draws your attention to every time you write an apology, it also highlights any kind of language that might undermine your message or diminish your voice. Seriously, download this and your professional correspondence will massively improve. Better yet, use it to draft scripts of what you might say verbally in order to strengthen your spoken messages too!
  • Apologize empathetically, sincerely, and unequivocally when it counts - Saying sorry still has an incredibly important place, it's just probably well under 10% of our current use of the term. If you use it more sparingly, it will start to mean a lot more when you do say it.

Quote we're contemplating

Food for thought on why we have this urge and how to replace the important role it plays without undermining our position:

"For many women, and a fair number of men, saying 'I'm sorry' isn't literally an apology; it's a ritual way of restoring balance to a conversation." - Deborah Tannen

PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds December 12th, 2020 - What can trees teach you about networking? A lot, as it turns out

Posted by BossB, MD on December 12, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

The Social Life of Forests

Uplifting journalism pieces are few and far between nowadays, so we'll take 'em where we can get 'em - and this one is great.

It's the story of a scientist - Dr. Suzanne Simard, PhD, RPF - who discovered that trees communicate with each other (and almost everything else on the forest floor, for that matter).

Her love of forestry started young, growing up in the Canadian woods among a family of low impact horse loggers. She went on to undergrad and grad school, where she bucked the trend of studying forestry yield and other directly commercial questions, turning her attention instead toward an intuition she had that the forest was more alive and interconnected than we ever thought.

"By analyzing the DNA in root tips and tracing the movement of molecules through underground conduits, Simard has discovered that fungal threads link nearly every tree in a forest — even trees of different species. Carbon, water, nutrients, alarm signals and hormones can pass from tree to tree through these subterranean circuits. Resources tend to flow from the oldest and biggest trees to the youngest and smallest. Chemical alarm signals generated by one tree prepare nearby trees for danger. Seedlings severed from the forest’s underground lifelines are much more likely to die than their networked counterparts. And if a tree is on the brink of death, it sometimes bequeaths a substantial share of its carbon to its neighbors."

In taking this chance, she changed the entire field of forestry, became a leading authority, and launched what's been a long, successful, and presumably meaningful career - and paved the way for woman scientists to be taken more seriously.

"Although Simard’s peers were skeptical and sometimes even disparaging of her early work, they now generally regard her as one of the most rigorous and innovative scientists studying plant communication and behavior."

It's not often that we get to celebrate such a legend while they're still living and working in their field - and learn something fascinating about the natural world to boot. Definitely worth a read.

Who we're following

We've long followed Dr. Elisabeth Poorman, MD (@DrPoorman) for her mix of thoughtful and humorous Tweets - one she posted this week is getting some hilarious replies:

BBMD tip of the week

If trees, fungi, and other presumably inanimate forest organisms have such strong networks, there's no reason for you not to as well.

And you can take a page from their book!

Just like the trees communicate to each other through another organism, rather than directly, the best way to get a job is often by taking advantage of 2nd degree connections using your network's network. 

This strategy takes advantage of what's called "the power of weak ties" - here's a sample of how we teach it in our curriculum:

Quote we're contemplating

"Maybe you are searching among the branches,

For what only appears in the roots"

- Rumi

PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds December 5th, 2020 - What to expect from a post-corona world, and how to set yourself up to win in it

Posted by BossB, MD on December 5, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

We don't often highlight long-form content like podcasts on here, because we know how busy y'all are. That being said - this podcast, and especially certain sections of it - is spectacular, timely, and worth a listen.
If you're not familiar with Scott Galloway, he's one of the clearest, most prescient thinkers in the business world today. But this podcast isn't just about business (and neither is the book he's doing this podcast to promote -   Post Corona  - which we've not yet read) - it's about how culture and values affect pandemic response, it's about how to approach this crazy topsy-turvy investment market that's completely divorced from the economy, and most of all it's about the rapid seismic changes that are coming to medicine and higher ed in the next handful of years.
You might not be equally interested in all of that, so here's a timeline of the podcast w/topic breakdown (we listened on Spotify so your timestamps might be different depending on how you listen, but they should approximate):
  • 0:00 - 12:00: Intro
  • 12:00 - 20:00: On COVID-19
    • How culture and values shaped response
    • A per(during)-mortem on our response, esp where we failed
  • 20:00 - : 60:00: The Economy pt 1
    • How the economy is changing
    • What will happen to cities
    • Why commercial real estate is dead in the water and why residential will see a boom
    •  How to pick winners in this crazy market/economy mismatch
    • Why a recession is the best time to start your own business
  • 60:00 - 65:00: Higher Education pt 1
    • Current state, how broken it really is
  • 65:00 - 73:00: Healthcare
    • HUGE reallocation of capital to virtual mediums, telehealth, virtual pharma delivery, etc
    • Why the medical customer experience is one of the worst retail experiences in the world, making it ripe for innovation and disruption
  • 73:00 - 79:00: Higher Education pt 2
    • What will the fix look like (much like health, it'll center around tech - somebody will offer 80% of the value for 50% of the price)
  • 79:00 - 92:00: The Economy pt 2
    • Focus on the monopolies, the sector-leaders, and the companies with the strongest moats (Amazon, AirBnB, Google, etc)
    • What's changing in the media landscape, and what we can learn from HBO's massive nosedive in the last 2-3yrs
    • How the stimulus never hit the economy (ppl) and just went straight to the market (capital)
  • 92:00 - 97:00: Final Thoughts

Who we're following

Scott Galloway (@profgalloway) isn't just a great professor, author, and thinker - he's also a damn good Tweeter. If you want one of the best pound-for-pound (maybe character-for-character is the Twitter equivalent?) follows to get a high quality, nuance, long-term perspective on business and society, he's your guy.

BBMD tip of the week

Like most economic upheavals - and especially the modern, technology-enhanced ones - the next few years will likely create a small number of parabolic/exponential "win" stories, and a much larger number of linear, go-to-zero "loss" stories.

Every single thing we do at this company is aimed at helping you - yeah, you personally reading this right now - to first and foremost avoid losing, and ideally to end up on the winning side of things.

And the harsh reality facing us as healthcare workers - and many of us doubly as healthcare and higher ed workers - is that our institutions are about to come under a siege that a plurality of them will not survive.

The only logical response to that reality is to make sure that you're not 100% reliant on your institution.

And it just so happens that we have some thoughts on how to achieve exactly that.

First off, a CYA statement - we are not investment advisors and none of this is investment advice.

Okay, now that that's out of the way, if we - and Scott Galloway - are right, then there are three main strategies that will likely work well this decade:

  1. Invest in yourself
  2. Invest in stable, low-risk cash flow (ie rental properties > flipping houses, dividend-paying stocks > appreciation-only stocks, etc)
  3. Invest in things that can, and have the highest possible probability to, go parabolic (ie increase in value exponentially)

Strategies 2 & 3, when combined, are called barbell investing - and you'll learn more googling and youtubing that term than we can probably teach you effectively (we do have some hot takes on which sectors will go parabolic, but they're conjecture and a distraction from this conversation, so feel free to reply to this email if you really wanna hear 'em and we'll be happy to share 1:1).

Strategy 1, however, happens to be one of our personal areas of expertise, and it also happens to be about the only opportunity you have of creating your own parabolic growth, rather than hoping for a slice of someone else's.

We've already written on this topic previously over the course of a few weeks, so we'll condense that down here for you to walk through, should you so choose:


Set a time for 2.5min brainstorm 10 ideas for side-hustles.

Ready...set...go! really shouldn't read ahead before you've done this, we promise...

We start with this because it gets the creative juices flowing and encourages divergent, "outside-the-box" creative thinking, which is your friend at this stage of the process.


Give each one of those ideas its own 0-10 scores in the following 3 categories:

  • Monetary investment to establish and maintain (think of this as a reverse-coded question - 0 for a high monetary investment because that's bad, 10 for a low monetary investment because that's good)
  • Time investment to establish and maintain (again - 0 for high, 10 for low)
  • How much the idea capitalizes upon YOUR UNIQUE gifts/talents/skills/assets (0 for not at all, 10 for completely)

Now, calculate the blended average for each idea and re-order the list based on that score, highest to lowest.


Now we're gonna transition out of our heads and into our guts, away from our numbers and toward our intuition, and most importantly out of our own experience and into that of our potential customers (all businesses have a customer, after all).

  • Pick whichever idea from the top 3 in your list has the most energy/draw/attraction/excitement for you - trust your gut, your intuition in this step
  • Commit to trying to make at least $1 off that idea in the next month - It's even easier than it sounds, but also one of the most fundamentally gratifying and exciting and encouraging things most entrepreneurs ever do; presales are your friend ;)
  • Create a crystal-clear (first draft) vision of your perfect customer
    1. Read this short essay
    2. Watch this 2min video on customer personas 
    3. Watch this 3min video on the customer adoption curve and try to think about who your "innovators" and "early adopters" will be
    4. Brainstorm about the demographics, psychographics, motivators - and really anything else you'd find interesting or helpful (preferred brands, favorite color, favorite season, etc) - of your perfect customer, then edit and crystallize it into something that's easily digestible and memorable for you
    5. Give the customer a name (extra points for alliteration ie "Soccer Sarah", extra points for attaching an image)

And now you've got a better start than most successful businesses out in the world today even had! 

There's a lot more to this entrepreneurship/side-hustle/multiple-revenue-stream game than we could fit into even months' worth of newsletters, and we don't wanna bore you if this isn't up your alley. So, if you ARE interested in learning more about the topic (or are stoked about one of your ideas and want to share it with someone/get some feedback), please reply to this email to let us know!

Quote we're contemplating

"I'm not a businessman

I'm a business, man"

- Shawn Carter (Jay-Z)

PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds November 28th, 2020 - The AMA is the wooooorrrrrsssst (and we had no idea)

Posted by BossB, MD on November 28, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians


What got our attention


That first acronym refers to the American Medical Association, an organization with which our readers are almost certainly well-acquainted. We'll spare you the parsing of the second acronym, except to say that it's not friendly. And for good reason.

In this article (which might be paywalled but which we'll summarize the highlights of below), the author conducts a systematic and thorough takedown of the AMA and its so-called "non-profit" business practices.

We usually don't give space to takedowns and negativity in this newsletter, but the egregiously predatory nature of their business practices is something we felt that you, as their intended prey, need to know. So here goes:

"In 2018, the American Medical Association had total revenues of $332 million. That’s not a typo or an extra zero or two in there. That’s three hundred and thirty two million American dollars in revenue. In one year.

I figured membership dues would be the biggest revenue line item, but no, not even close. Membership dues from all you doctors comes to just over 10% of revenues – $36.8 million. The AMA got almost as much in revenue from direct sales of merch – $29.7 million – and with a COGS of $5 million you really gotta admire their margins. Subscription revenues of $39.7 million were a bit higher than membership dues, but still not the biggest revenue item. Nor was the advertising revenue of $15.7 million, nor the dividend income of $12.4 million on an investment portfolio of publicly traded securities valued at $643 million, nor the profit on securities sold of $14.0 million, nor the “credentialing” revenue of $14.0 million, nor the “reprints and permissions” revenue of $7.4 million, nor all the other odds and ends categories.

No, by far the primary annual revenue engine for the AMA is … royalties.

In 2018, the American Medical Association made $158.6 million in 100% gross margin revenues by licensing its name and logo and membership lists to everyone from its own insurance brokerage subsidiary – the AMA Insurance Agency – to every pharma co or medical device co or whatever co that was willing to pay for that stamp of approval and halo of authority.

That’s how the AMA makes its money. Not so much by selling TO you – the doctors of America – with membership dues and overpriced PPE and merch, but by selling YOU – the doctors of America – to anyone who wants to buy your name and your reputation.

Okay, okay, but I’m sure it’s all for a good cause! Tell me about all the outreach programs and charitable grants that the AMA administers, Ben!

Yeah, well, about that …

In 2018, the AMA made $4.9 million in grants to 82 separate 501(c)(3) organizations. Almost all were quite small and for specific programs, except for a $1.8 million grant for “general support” to the PCPI Foundation, a Chicago-based medical consortium that is very closely linked to the – golly, can this be right – Chicago-based AMA. So really it was $3.1 million to 81 recipients, and yes, you can do that math as easily as I can: in 2018, the AMA handed out less than 1% of its revenues in grants and awards to independent medical charities and research programs.

The AMA spent more money on office equipment ($3.9 million) than on grants and awards. The AMA spent as much money on market research and telemarketing sales ($3.0 million) than on grants and awards. The AMA spent twice as much on advertising and promotion ($6.1 million) than on grants and awards. The AMA spent more than twice as much on membership solicitation ($7.8 million) than on grants and awards.

Of course you see where this is going.

In 2018, the American Medical Association spent $168.7 million on employee salaries and benefits.

The AMA had twenty-four Trustees in 2018, each paid an annual stipend ranging from $70,000 to $290,000. Four former Trustees, who had no apparent ongoing connection with the AMA, still collected $10,000 to $25,000 that year.

The AMA has five Senior Vice Presidents paid between $880,000 and $1,050,000 in 2018.

The AMA has a Chief Strategy Officer who was paid $1,130,000 in 2018.

The AMA has a Chief Operating Officer who was paid $1,350,000 in 2018.

So the AMA makes their money by selling YOUR information, and does about the minimum humanly possible in terms of charity to maintain their not-for-profit tax filing status.
But wait! There's more. They're one of the worst offenders we've seen when it comes to the gender pay AND leadership gaps in medicine

"The AMA has a Chief Financial Officer who was paid … huh? … only $730,000 in 2018. Wow, that’s weird. I mean, she’s the only woman in the C-suite, but I’m sure that has nothing to do with it. I think we all know that being a CFO is nowhere near as rigorous or demanding a job as being a ((checks notes)) Chief Strategy Officer, especially one who was the CEO’s best bud when they were both working at the University of Chicago Medical Center, a best bud who replaced the CEO and made sure he got his $2.7 million severance payment when the CEO was forced to resign."

In conclusion:

"The AMA is not a charitable organization.

The AMA is not an educational organization.

The AMA is a tax-exempt hedge fund and licensing corporation.

The American Medical Association is designed from the ground up to enrich its executives.

Publicly, it espouses a doubleplusgood narrative of social justice and health equity. Privately, the only interests it serves are its own bureaucratic imperatives and the self-aggrandizement of its “leaders”.

There is no “fixing” the AMA. There is no “reforming” the AMA. This is … this is an abomination.

Burn. It. The. F***. Down."

While this all seems to be pretty spot-on, we didn't do the primary research ourselves and we don't like to take such a strong stance on much of anything that we haven't dug into deeply ourselves. So, if you know something we don't or if there's a part of this story that you feel is missing, please let us know. Otherwise, we recommend you act on this information however you deem fit while it's still top of mind.

Who we're following

The American Medical Women's Association (@AMWADoctors) is:

  • Not affiliated with the AMA, as far as we can tell (though unfortunately named in a very similar manner, hence our desire to highlight and exonerate them this week)
  • An organization that actually spends money judiciously to support its charter
  • Probably the most powerful and effective advocate out there for closing the gender gap in all areas of medicine

If you were a member, follower, or even silent tolerator of the AMA, we humbly suggest that you consider transferring that energy and those resources in this more productive direction :)

BBMD tip of the week

Language can lie, money cannot.

Note and remember the huge difference between the language of the AMA and the way it actually allocates its assets. Anytime you're engaging with an institution, and especially anytime you're interviewing to work somewhere, ask to see the receipts.

What do we mean by that?

Look up public filings about how they spend money. This will tell you a lot more than any "mission & vision" section of their website ever could.

Ask to see the monthly and yearly "books" of the business, especially if you're becoming enmeshed in their finances (ie interviewing for a job in which you'll eventually become a partner or get some other kind of profit-share/ownership). And review it separately with your own accountant. This will tell you more than a full week of interviews with all the senior partners and administrators ever could.

Quote we're contemplating

"Hope has two beautiful daughters - Anger and Courage. Anger at the way things are, and Courage to see that they do not remain as they are." - St. Augustine

PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds November 21st, 2020 - On COVID & Caretaking

Posted by BossB, MD on November 21, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians


What got our attention

We hesitated to share this post because, honestly, who needs more bad news in the shitstorm of bad news (that tends to disproportionately harm women & POC) that is 2020?
But, it's important and we think we can help, so here goes.
The gist of it is this, women are publishing A LOT less than men during COVID, especially women in medicine
"In a new analysis   published Sept. 17, researchers from the University of Texas analyzed preprints of papers in medRxiv and bioRxiv—two databases that curate preprints of medical scientific papers and biological scientific papers, respectively—and found that the proportion of papers with female authors had declined in both during the pandemic.
The change was especially dramatic on medRxiv. In January, male scientists were authors on about 20% more papers, a gap that likely exists because there have been historically  more clinician researchers who are men than women. By April, however, that figure was over 50%. For papers published in bioRxiv, the publishing gap only increased slightly—from 46% to 47%."

What's the leading hypothesis as to why this might be happening, you ask? You won't be surprised to find that:

"The authors suggest that female clinician scientists—physicians who also publish scientific research, who have gone through the decades of education required to obtain both an MD and PhD—have faced more caregiving duties that have kept them from working at home over the course of the pandemic than their male counterparts."

Now, we can't in good faith promise you that anything we'll teach you is gonna reverse childcare norms that have probably been in existence for as long as humans have, and giving you a framework to have these hard conversations with your childcare partner is a hot potato we've touched before.

What we can promise in good faith, however, is that paid maternity leave is:

  • One of the best tangible policies that could help narrow this particular gender hap
  • Woefully uncommon in medicine
  • Something that we're pretty darn good at helping women negotiate for

So that's where we'll focus in our "tip of the week"

Who we're following

Dr, Mackzie Wehner, MD, MPhil (@MWehnerMD) is an Assistant Professor in Health Services Research and Dermatology at The University of Texas MD Anderson Cancer Center in Houston, TX.

She's also the first author of the research we're highlighting today, and has a Twitter feed with one of the highest quality:quantity post ratios (in our opinions) that we've ever seen. Definitely worth a follow, and maybe a DM thanking her for doing this work!

BBMD tip of the week

What is everyone's favorite radio station?

Go ahead, take a second and think about it!


We'll wait...


Okay, stumped yet?

The answer is that everyone's favorite radio station is WIIFM - "What's In It For Me?"

While this is undoubtedly the single most corny, cringe-worthy persuasion rule we've ever heard, its memorable because of how bad it is, and that's why it works.

Now what the hell does that have to do with maternity leave? Good question!

We've found that the best way to get maternity leave is to avoid using those particular words at pretty much all costs, and to instead focus on something that can benefit a wider audience. What might that be?

Now we will be the first to say that being pregnant is not a disability. What we really want to focus on here is negotiating for a policy that benefits the most people possible to increase your chances of success. Let's walk through the logic:

Which demographic makes the most policy decisions in medicine? 

  • Older men

Which demographic will be most likely to benefit from a short-term disability policy?

  • Older people

Do many short-term disability insurance policies cover a healthy pregnancy?

  • YES!!!

It's much easier to sell the idea of short-term disability insurance to a group of old dudes than it is to sell maternity leave. It's much easier to sell "parental leave" to a group that has a single male than it is to sell maternity leave.

On top of that, starting with short-term disability then moving to parental leave gives you a much stronger position to actually achieve maternity leave concessions in your negotiation. In our curriculum we call this creating "Lines of Retreat." Please allow us to nerd our for a moment

Imagine any battle scene in any movie or TV show ever - Lord of The Rings, Game of Thrones, etc. The armies almost never start in the most fortified part of their  positions - they try to win in the open field first. If that doesn't work, they usually have 2 or 3 fallback points where they'll reassemble and try again, until they reach a final "last stand" situation.

Makes for some great on-screen moments, and it also makes for a great negotiation framework.

If the decision-makers across the table from you have already said no to short-term disability insurance AND parental leave in general, then it's going to be a lot harder for them to say no to your next ask - maternity leave. It simply violates the social contract to have too many negative back-and-forth exchanges in a negotiation. And people are very uncomfortable violating our unwritten social contract.

Which means you'll be maximizing your chances of success.

Quote we're contemplating

“The supreme art of war is to subdue the enemy without fighting.” - Sun Tzu

PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds November 14th, 2020 - Gender differences in conflict

Posted by BossB, MD on November 14, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians


What got our attention

A number of clients this week have asked us to help them with hard conversations coming up in their near futures - some over job negotiations, some over issues at their existing work, and even one who wanted to strategize and role-play an upcoming conversation in her personal life.

The thread that binds between all of these hard conversations, the thing that makes them hard for most people in the first place, is that they all carry a potential for "conflict."

We're going to focus on that topic as the theme of this week's rounds, and we'd like to start with some research on the differences between how men and women approach interpersonal conflicts.

In an article titled Brief Report: Young Adult Women Resolving Interpersonal Conflicts, the author (Dr. Patricia Flynn Weitzman, PhD, CMC) conducted a "study of social cognition during interpersonal conflict... with 100 young adult women (mean age = 25 years)" in which she surveyed the "nature of the relationship between the participant and the other person (work-based, personal, or impersonal)," then coded their interpersonal negotiation strategies using the following model:

The author found that:

"Most strategies used (46%) were low-level unilateral strategies, e.g., giving in to the demands of the other person. Most participants reported conflicts at work. These data, taken with other research on young adults' perceived lack of ability at handling conflicts at work, suggest that constructive conflict management programs may be important for young adult women in the school-to-work transition."

In another study titled Women's and Men's Scripts for Interpersonal Conflict, author Judi Beinstein Miller conducted 2 studies.

"In the first, exploratory study, undergraduate women and men wrote scripts for a conflict between two friends over broken promises. In the second, they created scripts for five different types of interpersonal conflicts by selecting from among previously written responses that depict alternative beginnings, middles, and ends to each conflict..."

"Development of the men's scripts depended more on the offended party's initiation of conflict, whereas development of women's scripts depended more on whether the offending party apologized. Results suggest that men may use more personal or independent criteria in representing the management of conflict, whereas women may use more interpersonal or interdependent criteria."

So to summarize, it seems that women in conflict (a) tend to choose low-assertiveness strategies (especially at work), and (b) are less likely than men to initiate conflict, often choosing to do so by apologizing when they do initiate.

And that is likely not a problem, when women are negotiating with other women.

However, when negotiating with men (or with women who are operating under rules and procedures written by men, in a system created by men :/), these strategies will lead to catastrophic results.

The authors of these respective studies, being the good scientists they are, focus far more on describing differences than prescribing solutions, so we'll dive into the latter in our "tip of the week."

Who we're following

First off, Veteran's Day occurred this past week in the USA, so happy (belated) Veteran's Day to everyone, and to our readers who served, thank you. In that vein, one of our favorite Tweeps in general also happens to fit that description, so we'd like to take this opportunity to highlight her! Dr. Agnieszka Solberg, MD (@AgnesSolberg) is an interventional radiologist, a social media leader and founder of RadChicks (a group that advocates for gender equity in radiology), a US Army veteran, and just an all-around badass. Most definitely worth a follow if you haven't already!!

BBMD tip of the week

While there are definitely gender differences, on average, between how women and men approach conflict, we aren't here to teach you how to:

"<insert anything we teach> like a man"

nor to

"<insert anything we teach> like a woman"

We're here to teach you how to be effective, regardless of whether you identify as masculine, feminine, somewhere in between, or all/none of the above.

So, what are the keys to engaging in conflict effectively? 

  • Reframe - Your relationship with conflict and your expectations going into one
  • Own - The emotional state, or "frame," of the conversation
  • Seek to Understand - Your counterpart's values, priorities, emotions, and goals
  • Assert - Yourself, your values, your priorities, your emotions, and your goals
  • Persist - Toward either (a) a solution that's acceptable to all parties, or (b) the conclusion that no such solution is possible

The first and most important step of this process is reframing.

When most people think of conflict, they associate "damage" as an inevitable result. However, conflict is defined by us simply as "a state of mismatched or competing goals."

When we understand that conflict doesn't have to involve any kind of damage, relational or otherwise, it frees us to see conflict for what it truly is - the state in which the real progress and growth, in any relationship, occurs.

Conflict has the potential to be productive or destructive, pleasant or painful, and which side of the spectrum it ends up on relies largely upon your expectations going in.

Okay, so now you've developed a positive personal relationship with conflict - congrats! But what about your counterpart? What if they're not on the same page? The fact of the matter is that you cannot control whomever you're engaging with, so it's on YOU own the emotional frame of the conversation, regardless of your counterpart's actions.

If things are pleasant and productive, that doesn't take a whole lot of effort.

However, when you feel the emotional resonance between you and your counterpart start to dip, when you sense that emotions are becoming negatively charged, it's your job to take ownership in that moment and steer the ship toward smoother waters.

Don't worry though, there's a little thought exercise you can use to help control the situation. Whenever you see someone start to get worked up, when you see that their emotions are beginning to control them instead of the other way around, imagine that they *poof* just turned into a toddler throwing a temper tantrum. It'll enable you to maintain:

  • Empathy for your counterpart - they're just a toddler after all!
  • Control over yourself - it's a lot easier to react adaptively when you don't view your counterpart's negative emotional swings as a threat
  • Levity - A sense of humor and lightness is key to moving past the moment of conflict without your counterpart losing face; graciousness wins here

Once you've reframed and owned the conflict, the rest is honestly downhill from there.

Lean into empathy, first seeking to understand your counterpart's position. This will make them feel heard and valued, while also providing you an informational advantage.

Next, assert your own position. We use the term "assert" very intentionally - assertiveness is the midpoint on the line between weakness and aggressiveness, so make sure that your statements cannot be misunderstood as either weak or aggressive, and you're doing it! Simply state your points in a pleasant yet matter-of-fact tone, and let silence do the work from there.

Lastly, engage the entire time with a sense of certainty that you'll either reach a mutually beneficial agreement, or you'll discover that no such solution is possible. When we persist forward toward a solution with an understanding that the "worst case" won't occur unless it's already inevitable before we've started (ie we'll leave no stone unturned in our seeking for a solution), it "takes the sting out" of the conversation and removes fear from the equation, allowing us to move more freely and effectively.


This is all a lot easier said than done, and you don't want to be caught trying to remember these steps in your head for the first time during one of the most important negotiations of your life.

Which is exactly why our curriculum is structured in such a way that you get to:

  • Learn about the theory
  • Practice using role-play scenarios and other activities
  • Watch us deliver a model response/example
  • Practice again until you have your own version of "perfect" down pat

Quote we're contemplating

"Yesterday I was clever, so I wanted to change the world. Today I am wise, so I am changing myself." - Rumi

PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds November 7th, 2020 - Congresswoman Shirley Chisholm and how to claim your seat at the table

Posted by BossB, MD on November 7, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

A Seat at The Table - a virtual museum exhibit about the life and work of Congresswoman Shirley Chisholm.

There are so many reasons we loved visiting this virtual museum about Congresswoman Chisholm this week. First off, it only seems natural to pay homage to the first black woman elected to congress on the cusp of *probably* celebrating the first black woman elected to the executive branch. Speaking of the election - like most people, we couldn't get our minds off politics this week, but a virtual museum tour was a much better way of engaging with the topic than refreshing Twitter and our continually open google search for "election results" every free moment of every day. Lastly, we really miss museums and this was a fun way to experience one in a new medium.

The exhibit itself 

"shares how Congresswoman Chisholm stepped up, claimed her seat at the table of public discourse, and made a difference by representing a wide range of people and issues.

The trailblazing Congresswoman once said, 'If they don’t give you a seat at the table, bring a folding chair' — a phrase that has since served as a mantra and rallying cry for many Americans.

What can you actually expect to see if you "visit?"

"chairs that were created by community groups and individuals during Institute-hosted workshops at schools, community organizations, libraries, and social justice offices. The chair-makers creatively show their thoughts on identity, values, and the social issues that need to be addressed at inclusive tables of power."

It's a powerful, creative installation of works inspired by one of America's most trailblazing public servants. And it's really easy to experience - you can spend a little time and see a lot, or spend hours digging into the pieces, the artists' back-stories, and the like. Regardless of your politics or whether you're a museum person, this is definitely worth checking out this weekend.

PS - We're good friends with some grad students who are doing research on peoples' experience of this installation, so if you'd like to support this work, completing this quick survey would be a wonderful way to do so!

Who we're following

The organization that sponsors this exhibit, the Edward M. Kennedy Institute for the US Senate (@EMKInstitute) is one that we just recently learned about, but whose mission:

"Invigorating public discourse, inspiring the next generation of teachers, students, and citizens. Using technology to break new ground in immersive learning."

is definitely something we can get behind. Their profile is full of interesting articles, resources, and other content centered around that topic, so if you're into this kinda thing we definitely recommend a follow.

BBMD tip of the week

Congresswoman Chisholm embodied the energy and power of being willing to "bring your own folding chair," and funnily enough we've used office furniture analogies - tables, to be specific - since our inception to teach about personal power and how to access confidence in contexts where it might not come as naturally.

We often talk about the importance of bringing the confidence you have at the exam table or operating table (or really wherever you feel most self-actualized and powerful) - to the negotiation table. You're the same person - it's just a different table - and remembering + channeling who you are at your best is one of the most effective shortcuts to success in contexts where you might feel out of place.

If you want to learn some more specific tips from our curriculum on how to do this, here's a quick video on the topic:

Quote we're contemplating

“Service is the rent we pay for the privilege of living on this earth.” ― Congresswoman Shirley Chisholm

PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds October 24th, 2020 - How to focus on the one important thing

Posted by BossB, MD on October 24, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

How to Focus on The One Important Thing

It's not often that we highlight general business content - something not related explicitly to women or medicine - so when we do so, there's a high bar for the quality that content must deliver.

And "deliver" this podcast certainly does.

The link above is an episode of the Tim Ferriss podcast in which Tim Keller (that's two Tims so far), the founder of Keller-Williams real estate, tells his story. It's an incredibly informative, useful interview that Carlton assigns to his "Intro to Business" students each year, and we couldn't recommend highly enough that you listen to it as well, regardless of whether you ever want to get into any kind of "business" (other than what you're already doing).

The core question the interview addresses is one that Keller asks himself every day, and credits for his success:

“What’s the one thing I could do, such that by doing it, everything else will be either easier or unnecessary?”

Now, this might seem like a simple productivity hack at first glance, but posing this question in its exact phrasing can provide some really amazing results across domains. 

Keller shares examples of his "one thing" for many different areas of his life:

  • Business - Asks this daily, weekly, monthly, yearly, and distributes efforts accordingly
  • With his wife - Kiss her as soon as he walks in the door
  • With his mom - Buy her a basketball subscription on TV and play dominoes with her so that he can avoid the usual negative, gossip-filled conversations she tends to steer toward if left to her own devices
  • With his dog - Get on the floor with her and play for a few minutes early in the day

In the world of strategy, we call something that "makes everything after it easier or unnecessary" a force multiplier. We'll talk in our "tip of the week" about how you can use this in your own business conversations, especially negotiations.

Who we're following

In the spirit of our highlighted content this week, we'll ask ourselves:

"Who’s the one account I could follow on Twitter, such that by doing so, everything else on Twitter will be either easier or unnecessary?”

Now first off, we'd actually love to hear your thoughts on how you'd answer this question, because there's bound to be a variety of answers and we definitely don't wanna be missing out on the kinds of superlative Tweeps that would come up!

For us, the answer is clearly Dr. Kimberly Manning, MD (@gradydoctor). We've highlighted her in this newsletter before, and it's quite probable that you follow her already, but we love her Twitter profile because it's the perfect mix of (a) uplifting, meaningful, beautifully-presented medical content/stories, and (b) what's going on in the #MedTwitter world, as she seems to be a speaker or attendee at pretty much every good conference or event that happens.

This means that every time we visit her profile, we get our dose of feel-good brain chemicals, some tips that can make us better physicians and humans, and an update about what we should be paying attention to on #MedTwitter, all in one place.

BBMD tip of the week

Now we'll turn this question to business conversations and negotiations:

"What’s the one thing I could do in a business conversation or negotiation, such that by doing it, everything else will be either easier or unnecessary?” 

And the answer again becomes immediately crystal clear - CONNECT.

We've given this many names over the years. Emotional resonance. Humanizing yourself and your counterpart. Being "other-centered." Assuming best intent. Building rapport. Those are all really just different shades of the same primary color - connection.

Why is this so important?

Because much to economists' chagrin, humans are not rational, self-interested decision-makers. We are emotional decision-makers first, foremost, and always, and we generally use reason to reverse-engineer justifications for our decisions.

Things like the scientific method have attempted to counteract this tendency, but the fact remains that emotion is default decision-making input for almost all humans, and sadly, not many people apply the scientific method to their business conversations and decisions.

If you can use this fact to your advantage, you'll have an upper-hand in every business interaction you ever walk into. Why? Because we do nice things for people we connect with. We're more agreeable and generous toward people we connect with. We make more concessions and give more ground to people we connect with. The list goes on, but the fact of the matter is that there's unlimited upside to increasing a sense of connection with your counterpart, and almost no downside. 

So we get that it's important, but why can it be so hard to do so in a negotiation? Because the natural inclination is to get focused on the thing you're talking about rather than the person you're talking with.

We tend to focus on the salary in the negotiation or the "required qualifications" in the interview or the price of the car at the dealership, rather than the person sitting in front of us. But the way to INFLUENCE the salary, the interview outcome, and the car price is almost always through the person sitting in front of you. 

So, build rapport. Maximize emotional resonance. Assume best intent. Be "other-centered." Humanize. Listen (really, pay someone to teach you to listen better, even if it's not us - improv comedy/theater, coaching training, etc are some great places to start).


The rest will almost certainly take care of itself

Quote we're contemplating

 "People don't care how much you know until they know how much you care" - Theodore Roosevelt

PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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Saturday Morning Rounds October 17th, 2020 - 9 things every health care leader should know about compensation

Posted by BossB, MD on October 17, 2020

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

9 things every health care leader should know about compensation

Not only should every healthcare leader know these things - every healthcare provider should understand them as well. 

This article is one of the best we've ever read on this topic. It immediately recognizes and dives into the emotional nature of such conversations, yet grounds itself in the importance of a rational, evidence-based approach. It's insightful, and packs a lot into a very short read.

While we totally recommend you take the small amount of time needed to read it yourself, here are the "9 things" in summary (break-downs and more detailed explanation of each can be found in the article):

  1. Studies show that, after accounting for co-variates such as part-time work, productivity, and a host of other factors, there is a documented problem of gender-related pay gap disparities for women physicians
  2. Women who also identify with one or more other underrepresented groups may be at particularly high risk for inequitable compensation
  3. Published calls to action state that paying women physicians fairly should be a top priority for every dean, chair, health care executive, and business administrator
  4. Expecting new hires to negotiate fair pay, particularly early in their careers, is not considered best practice
  5. Paying women less than men for the same work is increasingly becoming illegal as states enact fair pay laws
  6. Paying women less than men for the same work is unethical
  7. Paying women physicians unfairly begins with their first position after training, and plagues them throughout their career
  8. Women may be at a disadvantage for fair pay due to a host of nuanced issues that are documented in the literature (but are often left out of discussions)
  9. People who dismiss or minimize pay disparities may not be knowledgeable about the evidence-base on physician compensation

Who we're following

The author of this week's article - Dr. Julie Silver, MD (@JulieSilverMD) - is the PM&R Department Chair as well as the Leadership CME Director at Harvard, with a fascinating career that's spanned business, medicine, diversity & inclusion efforts, and seemingly everything in between. Give her a follow to stay up to date with what she's doing!

BBMD tip of the week

While this whole article is spectacular, one of the things that most stood out to us about it was the early focus on the importance of emotion in negotiations. Dr. Silver hit the nail on the head when she wrote:

"current leaders may feel defensive about their decisions and actions involving paying people who work for them, and workers may feel angry or upset if they know or perceive that they are not being paid fairly."

And that's what our tip of the week is all about - defensiveness - the single most important emotion to avoid during a negotiation (or really any conversation you want to have go well).

That's it, that's our TED talk.

Avoid defensiveness in yourself and your counterpart at almost all costs. If you only have bandwidth to focus on a few key things during a negotiation, that should definitely be one of them. 

How do we avoid defensiveness? Well, thinking about doing so explicitly is 80% of the battle, and once you know that's the target for which you're aiming, you'll naturally adjust your approach. But here are a few of the tactics we've taught over the years that work for our clients:

  • "Assume best intent" - Pretty self-explanatory (we like to add the assumption of intelligence, as well)
  • "Invite the elephant into the room" - A tactic we teach of saying the worst thing that could be in your counterpart's mind, the worst possible interpretation of your own actions, so that you can openly address it and signal that you're not defensive
  • "Preemptively save their face" - Paint your counterpart's actions in the best possible light, out loud, preemptively, and you'll give them a positive vision of themselves to live up to

This is only a small set of examples, but the core message of avoiding defensiveness will serve you well in just about any conversation we can think of. 

Quote we're contemplating

"...during this time when misinformation and disinformation is common, good health care leaders can distinguish themselves by educating others about what is known to be true. Great leaders, regardless of their gender, will be ethical (Silver, 2018) and use science and facts to drive change--even when they encounter resistance--to ensure that women are paid fairly." - Dr. Julie Silver, MD

PS - If you were forwarded this email and enjoyed it,  subscribe here to make sure you don't miss out on future ones!
PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to  @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!
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