Have you suddenly realized that you're not where you want to be in life? Perplexed, you remember the promise that stretched out before you as a medical student, when the world ahead was yours and one day you would rule it. But now, you feel a vague sense of disappointment and consider yourself stuck. What happened?

Another common barrier involves staying entrenched in old attitudes. Medical training fosters an impression that physicians belong at the top of a rigid hierarchical structure. But a team-oriented attitude is often much more helpful in many practice settings. The drive to stay at the top of the hierarchy may keep you out of touch with the collaborative behaviors that build greater alliances and help you accomplish more and make important liaisons.

Other factors may also be at work. Perhaps you don't have a realistic assessment of your interactions with those around you (for instance, you may believe that your colleagues or staff members respect and appreciate your combative style, when in truth, they resent you). Fear of conflict often makes it tougher for physicians to navigate shifting environments.

Or maybe you know what you'd like to achieve but don't push yourself to reach for it. Physicians are typically competitive, bright people, but fear of failure often prompts them to ignore opportunities.

Finally, external factors may create barriers. Financial and regulatory concerns, increasing scrutiny of billing practices and professional relationships, and personal issues such as family obligations and debt may make it difficult to work toward your goal or explore opportunities.

Fortunately, you can overcome many of the barriers to reaching your potential:

Develop goals. Make time to think about and identify your professional goals in both broad and specific terms. Then, perform a gap analysis: Figure out the difference between where you are and where you want to be.

As you evaluate yourself, assess your skills realistically. Don't focus only on technical skills, which are assessed through peer review and other mechanisms. Do you need to manage your time better? Do you have the people skills and professional skills to get where you want to be? One way to assess your interpersonal skills is through feedback. You may be able to extract some of this information from 360-degree evaluations, in which colleagues or subordinates give feedback to a third party about your style and performance; you receive a report from the third party.

Once you've identified your goals, look at the risks and costs involved in committing to reach those aspirations. Some goals may require time that you're not willing to take away from your practice or your family. Be sure your risk and cost assessments are realistic; people often underestimate real risk and overestimate false negatives. You may decide that a particular aspiration isn't right for you right now, and that you need to defer or modify it.

Create an action plan. Break down each goal into smaller steps. Identify in detail the action required to complete each segment. Be very precise. For example, if your goal is to "Write a medical book," break the steps down into learning the structure of a book, developing the chapter outlines by a particular date, and planning to complete the first chapter by a certain target.