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!
Reasons Not to Study Medicine: What is Scale?
Having had a bit of a career outside of medical school (long story), I’m no stranger to the concept of scale. Those of you unfamiliar to it however might benefit from a clear definition.
According to the Free Dictionary, scalability, at least in terms of healthcare, means “the ability to expand to meet the increased demands by users.” But it might also be better understood in business terms too — “improving or maintaining profit margins as sales volumes increase”.
Simply put, scaling can be analogous to growth. Where you are able to give more of something (or in a physicians case, themselves) without damaging (or worsening the quality of) the end line. As students, for example, we’re not scalable. We can’t make multiple copies of ourselves; have one of us attend a boring class or lecture and another do our homework. Although that would be nice!
Blackboard – an online content management tool used by medical universities – is scalable however. It’s built once by engineers and then given out to each new student beginning a course.
Why Medicine (Generally) Isn’t Scalable
Understanding why medicine isn’t (easily) scaled is perhaps best understood by stepping out of the sector itself. 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.
Basically 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.
As I previously mentioned with the example of Blackboard; 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 (obviously), 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 pretty 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 own 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 being a potential business in itself.
Of course these methods aren’t easy. They require serious dedication, creativity and resources in the first place. But that’s the issue with wealth creation — if it was easy every doctor would be doing it!
The Case for Private Practice
This conversation wouldn’t be complete of course 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 stable salaried, people just don’t want the stress that goes with being their own boss.
Then there’s the argument that privatising 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 however, is that there is 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 — compared to becoming a top level specialist operating in a hospital — that’s also much faster too. Requiring fewer years of training with more years spent at the top of your game.
That’s definitely something to think about if you plan on working in the UK at least. But that’s not to say you can’t build wealth working in other areas either. Just ask your average radiologist/surgeon who do something similar; spending half their days between the state (picking up a nice pension) and scaling up in the private.
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.