I spoke at the Association of Anaesthetists Annual Congress this week, and the title was:

More Than an Anaesthetist: The Opportunities Hidden in Your Training.

But I've been thinking about the idea behind that title ever since.

Because it isn't just about anaesthesia.

It's about what happens when you spend years becoming good at something and the potential attached to that.

I began with a question I've been thinking about for a while:

What is all this training actually for?

The obvious answer is to become a skilled doctor and leader. Of course, that's true.

But I'm increasingly convinced that's only part of the answer.

For those who were at the Congress, I promised I'd send you the Portfolio Doctor Diagnostic I mentioned. It's included later in this email.

But before you take it, I want to explain the idea behind it.

What if the most valuable things your training gave you aren't the qualifications you collected along the way?

Medicine gives us a very clear way of thinking about progress.

We go to medical school, graduate, enter training, pass exams and collect competencies.

Eventually all of that effort produces something very visible:

A job.

But because the destination is so clearly defined, it's easy to assume the job is what all those years produced.

Training → expertise → job.

But I think that's an incomplete accounting of what happened.

Whilst we were all learning to do medicine, something else was happening in parallel.

We were picking up, how to make decisions without perfect information.

How to explain something complicated to somebody who is frightened.

How to distinguish signal from noise.

How to work alongside people with completely different expertise.

anticipation of what might go wrong and how to operate inside complex systems.

Then on top of that, how to teach, lead and take responsibility when the answer isn't obvious.

most importantly...

You did all of this so many times that eventually it stopped feeling particularly remarkable.

Because there's something strange about expertise.

The better you become at something, the easier it is to forget that it was ever difficult.

You're surrounded by other doctors who can do many of these things too.

So they feel normal, and when something feels normal, you rarely think of it as valuable.

But normal to you isn't the same as normal.

It may have taken you ten years to make it look ordinary.

I love football, so I used it to explain this concept…

Think about someone like Jude Bellingham.

The obvious thing we see is a footballer.

Years of training have produced someone capable of performing a very specific job at an extraordinarily high level.

But zoom out.

And we see that football is much bigger than the person kicking the ball.

There's a broader ecosystem attached to the individual expertise

Technology. Data. Medicine.Performance. Media. Sponsorship. Coaching.

Events. Hospitality.Business.

Even Medicine snuck in there..

And different assets become valuable in different parts of it.

Which made me wonder:

Why don't we think about our careers in the same way?

Medicine has an ecosystem too.

Yet when doctors start thinking about doing something different, we often begin with:

"What other jobs can doctors do?"

That usually leads to searching for job titles.

We look at what other doctors have done, or fall back on another course or add even more qualifications.

Which is interesting when you think about it.

Because after spending years accumulating expertise, our first assumption is often that we need to go and accumulate something else.

Maybe that's the wrong place to start.

Maybe the first question isn't:

What else could I do?

Maybe it's:

What have I already built?

I've seen this in my own career.

Medicine has taken me into anaesthesia, Premier League football, publishing, digital health, education and entrepreneurship.

I also run a music festival.

On paper, some of those things make very little sense together.

But underneath the job titles, there's much more continuity.

Take the festival. Anaesthetic training did not teach me how to run a music festival, but it absolutely shaped how I operate when running one. Before the event, I'm thinking about people, equipment, logistics, risk and contingencies.

Then the event goes live. Multiple teams are operating simultaneously.

Information is sometimes incomplete and something inevitably doesn't go according to plan. Decisions need to be made without allowing one problem to derail everything else.

Then afterwards, you work out what happened, what needs following up and what you'll change next time.

I sometimes joke that I run it like an operating list.

Pre-op. Intra-op. Post-op.

Completely different environment.

Very familiar way of thinking, and once I noticed that, I started seeing it everywhere.

Clinical knowledge and multidisciplinary working travelled naturally into professional football.

Understanding clinical context and communicating complexity became useful in publishing.

Understanding healthcare systems and clinical workflows became useful in digital health.

Teaching, diagnosis and pattern recognition now show up in much of the coaching work I do with other doctors.

The environments changed.

The assets travelled too

I wasn't starting from zero every time.

I've worked with doctors who've turned their existing expertise into femtech consulting...

They've taken expertise accumulated through medicine and discovered where else it could create value.

That's become one of the ideas at the centre of how I think about portfolio careers:

ASSET → ECOSYSTEM → OPPORTUNITY

First:

Not just qualifications.

Knowledge, skills, relationships, reputation, even your way of thinking.

Then:

Only then do you ask:

The order matters.

Because if you start with opportunities, the world looks like a list of things you're not yet qualified to do.

If you start with assets, you begin to see how much you've already built.

Once you recognise what you've been accumulating, you start to see how it could give you more choices. I've said before that success should buy you more choices over the work you do, how you use your time, where your income comes from and which opportunities you pursue.

Expertise doesn't only make you more capable of doing the same thing. It leaves you with assets you can compound into greater independence, resilience and optionality. You just have to pay attention to them.

That doesn't mean you have to leave medicine. It means recognising that your current role is one application of everything you've become capable of doing.

Not necessarily the only one.

Which brings me back to the question I started with.

If all this training has been building assets along the way, what have you actually accumulated?

A useful place to start is to ask:

What feels completely ordinary to you now that once took years to learn?

Because the things you've stopped noticing may be some of the most valuable things you own.

For those who joined The Second Opinion after Thursday’s talk, I promised I'd send you the diagnostic I mentioned.

And if you've been reading for a while, I wanted you to have it too.

[TAKE THE PORTFOLIO DOCTOR DIAGNOSTIC →HERE]

It'll help you take inventory of where you are now, how you naturally operate and some of the directions your existing experience could potentially take you.

But don't treat the result as an instruction.

Treat it as a hypothesis.

Something to investigate.

Because perhaps the next stage of your career doesn't begin with more training.

Perhaps it begins with deciding what you want all that training to be for.

Speak soon,

Dr Niks