Engle began her two-year contractual term of employment with Physician Landing Zone, a physician practice plan established by Highmark, Inc.[3] Her employment contract automatically renewed unless Physician Landing Zone decided in writing to not automatically renew. Dr. Engle worked, at least initially, at West Penn Hospital.[4] As a general surgeon at West Penn Hospital, Dr. Engle worked every day of the week seeing patients, taking calls, interacting with residents, doing consultations, and performing surgery.[5]