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Aspirations for an Ideal Future in Medicine: Obstacles and Strategies

We are continuing our series involving your ideal future in medicine. For those of you out there saying, “Enough with the dreaming and mindset stuff; I want to take action,” this is your month. 


If you haven’t already, write your goals and the vision behind them. You can use the steps I gave three weeks ago.


Now, I’m going to encourage something contrary to my typical suggestions. I want you to let your mind go wild with the impossibilities and roadblocks you’re likely to encounter, preventing you from achieving your vision of what you want your practice to look like in our current state of affairs. Look inside and around every nook and cranny of your cerebral gyri. Take 2-3 minutes to do this.


Write each of the barriers down.  I will use the categories my friend and colleague Dr. Tyra Fainstad used when we co-led a presentation on this topic.


Underline the self-imposed ones.

Highlight those that are skill gaps.

Circle those that are more logistical.

Star those more related to networking, connections, and system support.




I gave you tips to deal with those based in fear and negative self-talk a couple of weeks ago and the ones that have more to do with limiting beliefs, here


If you identify any others, commit to journaling about them until you get some ideas or they begin to fade or shift.



Our brains automatically categorize logical obstacles, skill gaps, and connection barriers as STOP signs - especially if there are several. However, we are going to change that, and we will turn those obstacles into strategies with brainstorming.


Skill gap examples:

"I don’t have the depth of colposcopy experience that I want in order to offer comprehensive women’s health".

Strategy - flip it. "I will get more experience."

Brainstorm: ASCCP course, work alongside more experienced colposcopists at a private office or the MUNI. Reach out to experienced colposcopists to debrief cases.


When the barriers seem overwhelmingly large, break them down into categories.


“Considering owning a practice is too big. I can't consider it”

Break it into categories. The biggest category could be Knowledge Deficit of Physician Owned Practices.

Then brainstorm ideas to fill the gap such as: 

  1. Learn about the current state of private practices in the areas I want to work from several perspectives.
  2. Attend business meetings at my current location and ask questions.
  3. Look for practices that are recruiting where I could learn on the job.
  4. Look up conferences for private practice or direct primary care to learn more.
  5. Pull up FPM on the AAFP website and browse their recent articles.

I know graduates who have worked in a physician-owned practice that learned on the job, so it was a smooth transition when the senior parter was ready to retire. There are residents who are rotating in DPC offices to get an idea of the pros, cons, and systems. 


Logistical example:

Or ”How would I get my current practice to consider value-based care?” Consider what large steps make sense to you. Break it down and brainstorm 

  1. Identify those in my current setting who agree that this may be worth considering.
  2. Assess our current metrics and financials
  3. Educate ourselves more about Value-Based Care* (categorize as a skill gap strategy and use steps above)
  4. Consider what change management framework I want to use.


*As an aside, here is an upcoming conference.

Now, you can break them down into smaller steps in each category. Now your obstacles have strategies.



Connection Barrier Example.

“The people in the C-suite don’t even know me but I need them on-board.”


Who do I know that might get me one step closer to them?

What is the acceptable cultural chain to get to talk with them?

Break into steps.

When, where, and how will I ask the intermediaries?  In-person, email, phone, etc

What am I asking them for? Write it out and edit. 

Decide where to meet.

Set up the invite and explore times.

Repeat until you now have time with the C-suite and all other stakeholders and decision-makers.


Okay, that was a lot of work done today! Great job. Next week, we will explore the next steps.


Until then, have a joy-filled week! Tonya

Join me in my Weekend Reads for Sunday's Story with Sides of resources, fun, coaching, and reflections. 


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