Scalability, in the basic business model of a doctor, is one of the main reasons not to study medicine. Trading your time for money? Hardly conducive to building long-term wealth.
In this series I aim to take a break from offering the usual hints, tips and strategies for students and get more real about the limitations of the career instead.
Where most articles have us dreaming about the big salaries and positive social impact of the job, they often forget to mention some of the harsher realities too.
So that’s my aim here , not only to depress you but also show you possible ways around these problems!
What is Scale?
Having had a career outside of medical school, I’m no stranger to the concept of scale.
I’m constantly thinking about ways med students can break out of the limitations of scale and start building wealth before they practice (more on this later)
But as for what scale is, I think of in terms of growth. And growth with increased revenue (or earning capacity) in mind.
As a med student you’re not really scalable. You can’t make multiple copies of yourself; have one of you attend a boring class or lecture and another do your homework.
Although that would be nice!
Why Medicine (Generally) Isn’t Scalable
Understanding why medicine isn’t (easily) scaled is perhaps best understood by learning from others.
Naval Ravikant, billionaire web entrepreneur and founder of the excellent podcast How to Get Rich, knows a few things about it.
In almost any salaried job, even at one that’s paying a lot per hour like a lawyer, or a doctor, you’re still putting in the hours, and every hour you get paid…So, what that means is when you’re sleeping, you’re not earning. When you’re retired, you’re not earning. When you’re on vacation, you’re not earning. And you can’t earn non-linearly.
What Naval highlights here is a fundamental problem with medicine as a career.
Like other jobs that require you to trade your time for money, there’s very little room for scale. People buy into your expertise. But it’s difficult to separate that expertise from yourself!
Software engineers don’t have this problem. They build stand-alone products that solve problems; inputting their energy once and continuing to get a pay off years down the line.
It’s very difficult to productize your input this way in medicine. At least in the conventional sense that most students think about anyway.
This is also one of the reasons I encourage medical students to think of skill acquisition outside of medicine. If only to get a sense of what’s possible in other industries!
When is Medicine Scalable?
Medicine, I’d argue, is more scalable in private healthcare (US) than it is in social (UK).
Although I’m no expert, I at least know a little about either system to recognise that private gives greater opportunity for wealth-creation in the long-run. This is why American physicians have greater earning capacities.
Compare this to a UK consultant, on the other hand, who, despite a nice annual salary, is still employed in a social model.
Scope for scaling their earnings (although many do in the private sector), is capped here by the fact they don’t own their business. They’re constantly trading their time for money; limited by the fact there’s only 24 hours in a day.
To better understand what’s possible in terms of a physician breaking out of this scalability trap then, we can again turn back to Naval.
If you look at even doctors who get rich, like really rich, it’s because they open a business. They open a private practice. And that private practice builds a brand, and that brand attracts people. Or they build some kind of a medical device, or a procedure, or a process with an intellectual property.
Notice how he mentions procedures, devices and processes as ways of productizing your knowledge? Those are ways you can stop trading your time for money while building significant wealth as a physician. Each is a potential business in itself.
The Case for Private Practice
This conversation wouldn’t be complete without discussing the other thing Naval suggests. Owning a private practice.
This is where the downsides of solving problems of scale for a physician present. A lot of the time, especially in the case of the salaried, people just don’t want the stress that goes with being their own boss.
Then there’s the argument that privatizing medicine obstructs millions of people from receiving care in the first place (just as we see in the US).
Should your desire; to own your business and scale your expertise, come at the expense of shutting out those unfortunate enough to pay? Only you can decide if that’s worth it.
The way I see it is that there is something of a compromise. At least in the UK (where I plan to practice) where you can have the best of both both worlds by becoming a GP practice partner.
This allows you to be both a business owner while having the perks of a social health care system to back you up.
People (other doctors, nurses, receptionists etc) work for you, expand your reach in the community and help you build your brand. The same way private practice doctors do but also with the support of the state.
It’s a route, especially compared to becoming a top level specialist operating in a hospital, that’s also faster. it requires fewer years of training with more potential years earning.
There’s plenty said about the benefits of studying medicine but not too much said on reasons not to. The problems involved trading your time for money? Possibly a major one — especially given many students have big dreams of making it rich!
What I hope I’ve done in this article however is to raise a few questions you might not otherwise be thinking about. Of course I don’t want to say don’t go to med school (I’m biased) but you’ve got to think about the practicalities too.
As for what you can do now to prepare and overcome these issues should you meet them? Here’s a few ideas:
- Consider where you choose to practice medicine (different countries and their healthcare systems)
- Identify the opportunities for scale each might have
- Learn new “scalable” skills (product design, content creation, coding etc) outside the field that could give you leverage if building wealth is an aim
- Identify the challenges of certain specialisms in terms of trading time for money
- Find ways to build at scale despite (or in the face of) these challenges anyway
I’d love to hear, later down the line, exactly how you get on!
For more information on what it takes to build real wealth — and overcome problems trading time for money — check out Naval Ravikant’s series How to Get Rich. It’s well worth the 3 hour listen.
Born and raised in the UK, Will went into medicine late (31) after a career in journalism. He’s into football (soccer), learned Spanish after 5 years in Spain, and has had his work published all over the web. Read more.