The Four Mindsets Surgeons Need to Know
Over thirteen years of taking care of patients and hundreds of hours coaching surgeons, a pattern of four mindsets has presented itself to me.
As you read, consider which mindset you tend to slip into, and which one might help you move forward.
We’ll cover:
The Trainee Mindset
The Perfectionist Mindset
The Transactional Mindset
And the Asset Mindset
At the end, I’ll give you powerful thoughts and questions to help you shift into a mindset that actually serves you.
1. The Trainee Mindset
This one starts early.
We grow up being told we’re “special snowflakes.” We get gold stars, A+ grades, and glowing evaluations. We move up the ladder by performing perfectly according to someone else’s standard.
By the time we enter residency and fellowship, we’ve learned to trust others’ ideas, techniques, and opinions more than our own. We’ve learned to look outside ourselves for validation and direction.
That’s the trap of the trainee mindset; it creates a ceiling. It teaches our brain that everything important has already been discovered, that our job is to memorize and repeat rather than innovate.
We prioritize our patients’ time over our own.
We rely on textbooks and guidelines instead of our clinical acumen.
We fan over other people’s genius instead of our own.
And nothing cracks us open because we secretly believe the answer always lives outside of us.
That’s how training conditions us. But the moment we step into independent practice, we’re expected to think for ourselves, make decisions alone, and step into the identity of expert. That’s a huge leap. For many of us, it can take years. And some of us never fully make the transition out of “trainee” into “expert”.
2. The Perfectionist Mindset
Perfection feels safe.
Many of us learned early on that being perfect was how we earned approval, safety, or even love.
In surgery, the stakes are even higher: an imperfect outcome feels dangerous.
So we tell ourselves, as long as I do it perfectly, everything will be okay.
But here’s the rub. Perfectionism isn’t actually about the patient; it’s about perception.
It’s about how we think we’ll be seen.
From the mindset of perfectionism, we chase perfect outcomes to prove our worth. It’s a game we never win.
Perfectionism teaches us to fear failure so deeply that we stop taking imperfect or creative action—the very kind that leads to growth.
And so we stay small. We avoid risk. All for the mirage of safety. And the result is a sense of stuckness, stagnation, and lack of fulfillment.
3. The Transactional Mindset
Transactional mindset asks “what am I getting from this?” It tells us to take action only when we know we will be rewarded for it.
It teaches us to focus on external validation like RVUs, compensation, awards, 5-star reviews, promotions, “likes” on social media.
Each one gives us a dopamine hit.
It’s like an existential slot machine. It doesn’t last.
And if we keep chasing external rewards, it leads straight to burnout.
We go through the motions—see patients in clinic, operate, take call—but the work feels like an obligation to survive. We’re disconnected.
When we’re in service only to what we get (money, recognition), we fall out of alignment with why we became a surgeon in the first place.
But when we reconnect to impact—when we remember why we do what we do—our work becomes fulfilling again.
Service isn’t about transaction. It’s about impact. It’s about what we give; not what we get on the back end.
4. The Asset Mindset
This is where things shift.
The Asset Mindset is when we recognize we are the most important player in the system.
We are the asset.
It’s the mindset that says:
”My ideas, techniques, and opinions are highly valuable. They matter more than anything.”
When I was in practice, I developed a procedure I called a caudal septal reconstruction to solve a problem I kept seeing in patients.
No one taught it to me.
I combined what I knew from thousands of septoplasties and some facial plastics training to create something new that worked.
Innovation in surgery comes from an Asset Mindset.
When we trust our intuition, experience, and creativity to solve problems safely and effectively, we are living in Asset Mindset.
We also treat our time and energy like the precious resources they are.
We rest. We recover. We fill our own tank.
Because without us, there is no surgery.
We are the asset.
How to Tell Which Mindset You’re In
Notice your mind when:
A patient challenges you or asks for a second opinion.
You’re in a difficult case or dealing with unexpected anatomy.
You’re managing a complication.
Do you default to looking outside yourself? To striving for perfection? To proving your worth?
Or do you pause, breathe, and trust your clinical judgment?
Trainee, perfectionist, and transactional mindsets are all, at their core, self-focused.
They’re about being right, seen, or rewarded.
The Asset Mindset, on the other hand, is patient-focused.
It asks, “How can I sustainably help this patient solve their problem?”
That’s the paradox: when you treat yourself as the asset, you serve others better.
Powerful Thoughts to Anchor the Asset Mindset
My ideas, opinions, and surgical techniques are just as good as my mentors’. In fact they might even be better.
I have genius inside of me.
It’s not about me, and it never was.
If I help even one person, it will all be worth it.
Powerful Questions to Guide You
Is this for the patient, or is this for me?
What’s the impact of this action?
Why does this matter?
When you focus on why—on impact, service, and sustainability—you’ll never run out of motivation.
External rewards (money, praise, status) are temporary.
Internal motivation lasts a lifetime.
Final Thought
The more you practice operating from the Asset Mindset, the more you’ll find yourself grounded, creative, and resilient, even in high-stakes moments.
When you start treating yourself as the most important asset in your surgical practice, everyone benefits—especially your patients.
