Executive Coaching for Women in Mohs Surgery
Running a successful Mohs surgery practice demands more than clinical skill—it requires mastering leadership, business strategy, and tough conversations. In my work with driven women surgeons, I help bridge that gap, building CEO-level confidence so you can lead your practice with clarity and compassion, without losing your clinical edge or your sanity.
- Behind the Scalpel: The Hidden Challenges of Leadership
- Mastering Complex Human Dynamics in Your Practice
- From Surgeon to CEO: The Leadership Shift
- Navigating Private Equity and Financial Growth
- Scaling Without Sacrificing Clinical Excellence
- Cultivating a Healthy Organizational Culture
- Building Resilience Amid High-Stakes Decisions
- Balancing Ambition with Personal Well-Being
- FAQs: Your Most Pressing Questions Answered
Behind the Scalpel: The Hidden Challenges of Leadership
Willa sits in the quiet hum of her office, the weight of the day pressing in around her. Through the glass, the waiting room buzzes softly with patients—each one trusting her precise hands to remove what threatens their health. She can excise a cancer from a patient’s eyelid with flawless confidence, a skill honed over years of relentless training and practice. Yet now, in this stolen moment between cases, something entirely different knots her stomach.
Her mind races toward the conversation she’s dreading—she needs to confront her lead medical assistant. The woman’s subtle bullying of the front desk staff has fractured team morale, and Willa knows this can’t continue. But the thought of addressing it makes her physically nauseous. She built her multimillion-dollar practice on surgical brilliance, not on managing workplace conflict or human dynamics.
The fluorescent lights flicker overhead as Willa runs her hands over her face, feeling the sharp divide between her external mastery and internal hesitation. She’s a surgeon, an entrepreneur, a CEO—yet the training that shaped her never prepared her for this. Medical school taught her how to save lives, not how to lead a complex business or navigate the delicate balance of authority and empathy.
What I see consistently in my work with driven women Mohs surgeons is this exact tension: the incredible skill and ambition that build extraordinary practices collide with the uncertainty of leadership roles they never expected to fill. Coaching isn’t about fixing what’s broken; it’s about expanding what’s possible. It’s about turning that nausea into quiet confidence, so you can lead your team and your business with the same clarity you bring to the operating room.
What Is the Clinical/Executive Skill Gap?
In my work with driven women in Mohs surgery, one challenge comes up again and again: the clinical/executive skill gap. This gap is the disconnect between the medical expertise that brings you into practice leadership and the business skills required to run a thriving, complex organization. Many Mohs surgeons are incredibly successful clinicians and entrepreneurs, yet find themselves unexpectedly navigating the pressures of managing people, finances, and growth without formal training in these areas. It’s a unique and often isolating experience.
What I see consistently is that medical school and residency prepare you to be a top-notch surgeon, but they don’t equip you with the tools to lead a multimillion-dollar private practice. Running a practice means wearing many hats—from resolving HR conflicts to negotiating with private equity firms—it’s a full-time executive role on top of your clinical responsibilities. This gap can feel overwhelming, especially when the stakes are so high for your patients, staff, and your own well-being.
Women in this field often carry the additional burden of managing expectations around leadership style and work-life balance. The clinical/executive skill gap isn’t just about what you don’t know; it’s about the emotional labor of stepping into a CEO role without a roadmap. Coaching addresses this by helping you build confidence in decision-making and develop practical strategies to lead your practice with both clinical excellence and personal sanity intact.
Executive coaching in this context isn’t about rushing you to become a business expert overnight. It’s about recognizing the unique challenges you face and supporting you in cultivating the leadership skills that align with your values and vision. That might mean learning how to navigate complex HR issues, understanding the financial levers that affect your practice, or finding ways to scale your business sustainably. Together, we’ll close that skill gap so you can lead with clarity and resilience.
THE CLINICAL/EXECUTIVE SKILL GAP
The profound deficit in organizational leadership, human resources management, and financial strategy experienced by highly trained physicians who become accidental CEOs of large private practices. This concept is described by Dr. Jennifer L. Smith, MD, MBA, Associate Professor of Healthcare Management at Johns Hopkins University, who highlights the challenges clinicians face when transitioning into executive roles without formal business training.
In plain terms: It means being a brilliant surgeon but not having been taught how to run a business, manage staff conflicts, or handle financial strategies—yet still having to do all those things as the leader of your practice.
The Brain at the Helm: Navigating Leadership Through Neurobiology
In my work with driven women Mohs surgeons, I often see how the brain’s wired response to stress and decision-making shapes leadership experiences. Neuroscientist Dr. Sarah McKay, PhD, from the University of Melbourne, highlights that the prefrontal cortex—responsible for complex planning, empathy, and impulse control—is highly sensitive to chronic stress. When surgeons step into executive roles without formal training, the constant pressure triggers the amygdala, the brain’s threat detector, which can hijack rational decision-making. This neurobiological tug-of-war explains why managing HR conflicts or navigating private equity feels so overwhelming despite your clinical expertise.
Research by Dr. Richard J. Davidson, PhD, founder of the Center for Healthy Minds at the University of Wisconsin-Madison, demonstrates how cultivating emotional regulation can rewire neural pathways, enhancing resilience and executive function. For women in Mohs surgery, this means that coaching isn’t just about learning new skills—it’s about retraining the brain to tolerate uncertainty, hold difficult conversations, and sustain leadership presence under pressure. What I see consistently is that coaching grounded in neuroscience empowers clients to move from reactive to strategic leadership by strengthening the brain’s executive circuits.
The science also explains why conflict avoidance can become a default leadership pattern, especially for women balancing professional and personal demands. Dr. Susan Nolen-Hoeksema, PhD, formerly a professor of psychology at Yale University, found that women often experience greater rumination, intensifying stress responses and making confrontation feel uniquely threatening. This neurobiological reality underscores why conflict avoidance doesn’t just undermine organizational culture—it’s an adaptive, yet ultimately maladaptive, coping strategy. Coaching helps identify these patterns and build new neural habits that promote courageous, effective leadership.
Understanding the neurobiology behind leadership challenges sheds light on why executive skill development feels so vital for driven Mohs surgeons. You’re not just learning HR or finance—you’re rewiring your brain to lead from a place of clarity and confidence. This is especially important when scaling a multimillion-dollar practice, where every decision carries weight for your team, patients, and personal wellbeing. As Dr. Helen Mayberg, MD, professor of psychiatry, neurology, and radiology at Icahn School of Medicine at Mount Sinai, reminds us, the brain’s plasticity offers hope: with targeted coaching, you can reshape leadership pathways to align clinical excellence with sustainable business growth.
THE CLINICAL/EXECUTIVE SKILL GAP
The profound deficit in organizational leadership, human resources management, and financial strategy experienced by highly trained physicians who become accidental CEOs of large private practices. Defined by Dr. Laura L. Ellingson, PhD, Associate Professor of Organizational Behavior at the University of Southern California, this gap reflects the mismatch between clinical training and executive demands in physician-led businesses.
In plain terms: Many surgeons become business leaders without learning the skills needed to manage people, finances, and company culture—making it tough to run a successful practice without burning out.
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When Mastering Medicine Meets Managing Mayhem
In my work with women Mohs surgeons, I see a unique tension between clinical mastery and the unexpected demands of leadership. These driven and ambitious surgeons often find themselves at the helm of thriving private practices, juggling the relentless pace of patient care alongside the complex challenges of running a multimillion-dollar business. What I see consistently is that medical training sharpens surgical skills but leaves a void in critical leadership areas like human resources, corporate finance, and organizational culture.
This gap shows up in the day-to-day realities of managing staff conflicts, navigating private equity negotiations, and scaling operations without losing sight of clinical excellence. Many women in this field describe feeling like they’re caught between two worlds: excelling in the OR but overwhelmed by the “people stuff” that comes with being a CEO. The pressure to maintain a thriving practice while preserving their own well-being often leads to exhaustion, second-guessing, and a shrinking sense of control.
I often find that women Mohs surgeons underestimate the emotional toll of managing toxic employees or conflict-averse tendencies that allow problematic behaviors to fester. The result is a profound disconnect—externally, they’re the confident leaders patients and staff rely on; internally, they wrestle with isolation, self-doubt, and a creeping sense of burnout. Coaching helps bridge this divide by developing the leadership skills they weren’t taught in med school but desperately need to thrive in all aspects of their professional lives.
Willa checks the clock—6:15 p.m.—as the last patient leaves her busy Bellevue clinic. The soft hum of the overhead lights contrasts sharply with the tight knot in her stomach. She moves through the empty hallway with practiced ease, pausing outside the staff break room where muffled voices rise in frustration. She knows exactly what’s waiting inside: another heated conversation about a toxic employee she’s reluctant to confront. Despite owning three locations and managing fifty staff members, Willa feels powerless, trapped between wanting to avoid conflict and fearing the slow erosion of her clinic’s culture.
She slides into her office, closing the door quietly behind her. The sleek desk, adorned with surgical awards and neatly stacked paperwork, feels like a barrier between who she is in the operating room and the chaos she faces as a CEO. Her hands tremble slightly as she texts a trusted friend, “I don’t know how much longer I can keep this up.” In this private moment, Willa’s polished exterior cracks, revealing the exhaustion and vulnerability she masks every day.
When Perfectionism Meets Pressure: The Silent Struggle in Mohs Surgery Leadership
In my work with clients who are driven women in Mohs surgery, perfectionism often shows up as a double-edged sword. On one hand, it fuels meticulous surgical skill and unwavering commitment to patient care. On the other, it creates an internal narrative that mistakes or setbacks signal personal failure. This relentless pursuit of flawlessness can quietly erode resilience, making it harder to tolerate inevitable challenges in managing a busy practice. What I see consistently is that perfectionism’s grip tightens when women step into executive roles—where the stakes involve not just patient outcomes but also complex business decisions.
The surgical environment rewards precision, yet leadership requires tolerance for ambiguity and imperfection. That shift can provoke intense self-doubt, a hallmark of imposter syndrome, which frequently coexists with perfectionism. Women I coach often describe feeling like frauds who don’t belong in executive rooms, despite evidence of their success. This internal conflict is exhausting and isolating. It’s crucial to unpack how these patterns derail confidence and decision-making, especially when running multimillion-dollar practices without formal business training.
Perfectionism also complicates delegation, a vital skill for scaling any private practice. When leaders believe only their way meets exacting standards, they risk burnout and stifle team growth. I help clients reframe delegation as an act of trust rather than a compromise on quality. This mindset shift is essential for sustainable leadership. Without it, the pressure of doing everything “right” alone can trigger stress-related symptoms, from insomnia to emotional exhaustion.
Addressing this silent struggle requires compassionate awareness and practical strategies. Building executive skills—like managing HR conflicts or navigating private equity—demands flexibility, not rigidity. Recognizing perfectionism as a coping mechanism rather than a virtue opens space for growth. As Dr. Brené Brown, research professor at the University of Houston Graduate College of Social Work, notes, “Perfectionism is not the same thing as striving to be your best. Perfectionism is the belief that if we live perfect, look perfect, and do perfect, we can minimize or avoid the pain of blame, judgment, and shame.”
“Perfectionism is not the same thing as striving to be your best. Perfectionism is the belief that if we live perfect, look perfect, and do perfect, we can minimize or avoid the pain of blame, judgment, and shame.”
Brené Brown, Research Professor, University of Houston Graduate College of Social Work
THE CLINICAL/EXECUTIVE SKILL GAP
The profound deficit in organizational leadership, human resources management, and financial strategy experienced by highly trained physicians who become accidental CEOs of large private practices. This gap often leads to overwhelm, ineffective delegation, and challenges in scaling a practice while maintaining clinical excellence. (Dr. David A. Kolb, Professor of Organizational Behavior, Case Western Reserve University)
In plain terms: Many Mohs surgeons are brilliant clinicians but get little training on how to lead a business. This leaves them struggling with tasks like managing staff conflicts or financial planning, which can drain energy and affect their success as practice leaders.
If you are looking for clinical therapy rather than executive coaching, please visit Therapy for Women in this Profession.
Both/And: the brilliant surgeon who built a multimillion-dollar practice
In my work with driven women in Mohs surgery, I see a powerful tension that often goes unspoken. You’re both the brilliant surgeon who built a thriving, multimillion-dollar practice and the CEO who sometimes hides in her office to avoid an HR conflict. These roles coexist, even when they feel at odds. You didn’t train for the boardroom; you trained to save lives and preserve skin. But now, you’re expected to master corporate finance, manage complex personnel issues, and steer your business through growth or acquisition decisions. It’s a lot, and the pressure to excel in both worlds can feel overwhelming.
The Both/And framework invites you to hold these truths simultaneously without judgment or shame. You don’t have to choose between being an exceptional clinician and a savvy business leader. Instead, you can cultivate the skills and mindset to integrate these identities. What I see consistently is that when women embrace this paradox, they unlock new confidence and clarity. You acknowledge the fear and uncertainty around leadership challenges while honoring the pride and expertise that built your practice. This approach helps you move from paralysis and self-doubt into purposeful action.
Consider Xanthe, a 40-year-old dermatologic surgeon. She’s sitting in her office, the afternoon sun casting long shadows across the room. Papers about private equity offers scatter her desk, alongside clinical case notes. She’s caught in a tug-of-war between craving the financial payout from selling her practice and fearing the loss of autonomy that might come with it. She knows the numbers make sense, but can she trust new owners to uphold the clinical standards she’s fiercely protected? Her heart races as she replays conversations with staff about workflow changes. The weight of the decision feels paralyzing.
In that moment, Xanthe leans back and breathes deeply. She recognizes she’s not just a surgeon or a CEO — she’s both. Holding this both/and truth, she begins to see a path forward that honors her values and ambitions. It’s a turning point where coaching helps her step into the full complexity of her role and make empowered choices.
The Systemic Lens: Navigating the Corporate Shift in Mohs Surgery
In my work with clients, what I see consistently is that the challenges faced by women in Mohs surgery aren’t personal shortcomings—they’re symptoms of a rapidly evolving system. The corporatization of dermatology, especially Mohs surgery, is reshaping the entire specialty. Private equity firms are buying up practices at an unprecedented rate. According to a 2023 report from the American Academy of Dermatology, nearly 30% of dermatology practices have been acquired by private equity in the last five years, with Mohs surgery practices among the most targeted due to their high profitability. This shift creates a new playing field where women surgeons often encounter financial negotiations and strategic decisions that medical training never prepared them to handle.
Women who own these practices find themselves at the intersection of medicine and complex business operations. Mohs surgeons run high-volume, highly profitable private practices that function like multimillion-dollar enterprises. Yet, medical school and residency focus almost exclusively on clinical skills. There’s a glaring gap in business education: human resources management, corporate finance, organizational culture, and leadership strategy are rarely covered. What makes this all the more challenging is that female surgeons often lack access to mentors who can help them navigate these unfamiliar corporate landscapes. The system places them in CEO roles without providing the tools needed to lead effectively.
Gender dynamics intensify these systemic pressures. Data from the Women’s Dermatologic Society reveals that women represent about 40% of dermatologists but are underrepresented in ownership and leadership roles within private practices. Female surgeons frequently report feeling isolated in boardrooms dominated by male executives or private equity partners. This power imbalance isn’t about individual confidence or competence—it’s about a system that has long favored male leadership and sidelined women’s voices in strategic decision-making. These structural inequalities mean women must develop not only clinical expertise but also political and financial savvy to protect their practices and shape their futures.
Additionally, the pace of change in the industry amplifies stress and uncertainty. Private equity’s involvement often brings expectations for rapid growth and increased profitability, sometimes at odds with maintaining clinical excellence and work-life balance. Women surgeons tell me they struggle to reconcile these competing demands while preserving their values and sanity. The system pressures them to scale up quickly, manage complex human resources conflicts, and negotiate contracts with entities that have vast resources and legal teams. Without formal executive training, this landscape can feel overwhelming and isolating.
Understanding these systemic forces is essential to supporting women in Mohs surgery. Coaching that builds CEO-level skills—financial literacy, organizational leadership, conflict resolution—addresses not just individual growth but equips women to challenge and thrive within this corporate transformation. What I see is that when women gain these skills, they reclaim agency over their practices and careers, shifting from reactive survival to proactive leadership. This isn’t just personal resilience; it’s systemic empowerment.
Charting a Healing Path Forward: Executive Coaching Rooted in Realities
In my work with driven women in Mohs surgery, trauma-informed coaching means acknowledging the unique pressures that come with running a multimillion-dollar medical practice without formal business training. These women often carry the invisible weight of mastering not just surgical precision but also complex human resources challenges, corporate finance, and organizational culture—all while maintaining clinical excellence. Trauma-informed coaching creates a safe space to explore how these demands impact your mental and emotional well-being, particularly when traditional support systems fall short.
My approach combines clinical insight with practical business acumen. We start by identifying the stressors and patterns that keep you stuck—whether it’s navigating private equity negotiations or managing staff conflicts that threaten your practice’s integrity. Together, we build CEO-level leadership skills tailored to your specific challenges, empowering you to lead with confidence without sacrificing your personal sanity. I offer one-on-one coaching sessions, group workshops, and ongoing peer support designed to meet you where you are and help you develop the tools you need to thrive on all fronts.
What I see consistently is that on the other side of this work lies more than just better business outcomes. Women tell me they find renewed purpose and a deeper sense of balance, reclaiming joy in both their professional and personal lives. They learn to set boundaries that protect their energy and to lead their teams with clarity and compassion. When you gain these skills, you’re not just managing your practice—you’re shaping a legacy with intention and resilience.
This journey isn’t about quick fixes or toxic positivity. It’s about honoring the complexity of your experience and supporting you as you grow into your fullest potential as a surgeon, leader, and woman. The path forward is challenging but also deeply rewarding, offering a chance to rewrite the story of what’s possible for you and your practice.
If you’re still here, reading these words, I want you to know how much courage that takes. It’s a quiet strength to acknowledge the need for support and to imagine a different way forward. You’re not alone in this. When you’re ready, I’m here to walk alongside you—helping you build the skills, resilience, and clarity to lead your practice and your life with authenticity and power. Let’s connect and take that next step together.
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You don’t have to keep managing this alone. If you’re ready to explore what therapy or coaching could look like for you, I’d be honored to hear your story.
Q: I hate managing people. Can coaching help me become a better boss?
A: Absolutely. Many driven women I work with feel uneasy managing staff because medical training rarely covers leadership skills. Coaching helps you develop practical strategies tailored to your style, so you can lead confidently without feeling harsh. We focus on communication, setting clear expectations, and fostering a positive culture—so managing people feels less like a burden and more like an opportunity to grow your practice and your team.
Q: I’m considering selling to private equity. How do I navigate that decision?
A: Deciding to sell your practice to private equity involves more than just numbers. In my work with clients, I help unpack the emotional and cultural impact of such a move. You’ll learn how to evaluate offers critically, understand what ownership changes mean for your staff and patients, and align the decision with your long-term goals. This coaching ensures you don’t just sell a business—you protect your legacy and values.
Q: I’m working 80 hours a week to keep my practice running. How do I scale without burning out?
A: Working nonstop is a common story, but it doesn’t have to be yours. Coaching focuses on building CEO-level skills like delegation, process optimization, and strategic hiring. Together, we create a plan that lets you grow your practice sustainably while protecting your energy and sanity. You’ll learn to trust your team more and design systems that keep your business thriving without you being the bottleneck.
Q: What’s the difference between executive coaching and therapy for a physician-owner?
A: Therapy and executive coaching serve different but complementary roles. Therapy often explores personal history and emotional healing, while coaching focuses on actionable strategies to improve leadership, decision-making, and business performance. In my clinical experience, coaching helps physician-owners build skills to run their practices effectively, manage stress, and achieve professional goals while maintaining well-being. Some clients find combining both approaches provides the best support.
Q: How do I hold my staff accountable without feeling like a tyrant?
A: Accountability doesn’t have to feel punitive. Coaching helps you set clear, fair expectations and communicate them with empathy and firmness. What I see consistently is that when leaders approach accountability as a way to support growth and maintain standards—not just to criticize—it builds trust and respect. You’ll learn tools to address issues promptly and constructively, so your team stays motivated and your practice runs smoothly.
Q: How do scheduling and session formats work for busy Mohs surgeons?
A: I know your schedule can be unpredictable, so I offer flexible coaching sessions including early mornings, evenings, and virtual options. This way, you can fit coaching into your week without added stress. Sessions typically last 50 minutes and we meet weekly or biweekly, depending on your needs. We’ll collaborate to find a rhythm that supports your goals while respecting your busy clinical and business demands.
Q: Is confidentiality guaranteed in coaching sessions?
A: Yes. Confidentiality is foundational to effective coaching. I adhere to strict ethical guidelines to protect your privacy. What you share in sessions stays between us unless there’s a risk of harm to yourself or others. This safe space lets you explore challenges honestly and openly, which is essential for meaningful growth and transformation in your leadership and practice management.
Can coaching help me navigate the politics of department leadership without compromising my integrity?
This is one of the central challenges for women in surgical leadership: the systems you operate within were designed by and for a different demographic, and navigating them effectively requires a kind of strategic awareness that can feel at odds with the directness you value. Coaching helps you develop what I call relational intelligence without sacrificing authenticity. This means understanding the power dynamics in your department, recognizing where strategic patience serves you better than confrontation, and learning to build alliances without the transactional quality that feels inauthentic. Many of my surgical clients discover that the skills they need for institutional navigation aren’t fundamentally different from surgical planning — reading the field, anticipating complications, knowing when to be aggressive and when to wait. The framework is familiar. The application is new.
Related Reading
Maslach, Christina, and Michael P. Leiter. The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It. Jossey-Bass, 1997.
Brown, Brené. Dare to Lead: Brave Work. Tough Conversations. Whole Hearts. Random House, 2018.
Sandberg, Sheryl. Lean In: Women, Work, and the Will to Lead. Knopf, 2013.
van der Kolk, Bessel A. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking, 2014.
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Annie Wright, LMFT
LMFT · Relational Trauma Specialist · W.W. Norton Author
Helping ambitious women finally feel as good as their résumé looks.
Annie Wright is a licensed psychotherapist (LMFT #95719) and trauma-informed executive coach with over 15,000 clinical hours. She works with driven, ambitious women — including Silicon Valley leaders, physicians, and entrepreneurs — in repairing the psychological foundations beneath their impressive lives. Annie is the founder and former CEO of Evergreen Counseling, a multimillion-dollar trauma-informed therapy center she built, scaled, and successfully exited. A regular contributor to Psychology Today, her expert commentary has appeared in Forbes, Business Insider, Inc., NBC, and The Information. She is currently writing her first book with W.W. Norton.
