When your career feels like a game of Monopoly

Hey,

Not sure if you missed the competition ratios for UK Doctors, but they’re pretty high, so a lot of people are talking about them..

On the surface, it looks like a career problem. If you zoom out, you’ll see it’s actually a business problem.

Medicine as a Market

In most industries, employees operate in one of three environments:

• Competitive markets: multiple buyers and sellers.

• Example: tech contractors. If one client underpays, you find another.

• Oligopolies: a few dominant employers. Example: airlines. Pilots have options, but still limited.

• Monopsonies: a single buyer of labour. That’s medicine in many countries.

  The NHS in the UK. The public health system in others.

When one organisation controls the market for your skills, it controls:

Price (your pay rates)

Access (training numbers, consultant posts, fellowships)

Conditions (rota, pensions, contracts)

If this were a business case study, you’d say: doctors are suppliers in a monopsony. And monopsonies always extract maximum value while giving as little back as possible.

Human Capital: Where You Fit In

In finance, human capital = the economic value of your skills, knowledge, and experience.

Doctors invest hundreds of thousands in training and years of opportunity cost. That’s capital.

But if your capital is locked into a single employer, its value is capped.
Think of it like holding stock in just one company. No diversification, no hedge, no leverage. If that company underperforms, so do you.

Lessons from Business

Here are three takeaways from business and finance that apply directly to medicine:

Diversification protects you. Businesses don’t bet on one client. Investors don’t bet on one stock. Doctors shouldn’t bet their entire career on one employer.

Leverage creates freedom. Businesses scale through systems, products, and IP that earn beyond one person’s hours. Doctors can do the same with writing, consulting, teaching, or digital assets.

Capital compounds. Whether it’s skills, networks, or money — the earlier you invest in building parallel streams, the more time they have to grow.

Why Portfolio Careers Matter

Medicine isn’t as rigid as it looks. A portfolio career means:

• You don’t live and die by one application outcome.

• You protect yourself financially with multiple income streams.

• You get to express more of you the creative, the entrepreneur, the problem-solver.

That’s why I talk about portfolio careers so much. They give you leverage in a system that can otherwise feel like it has all the control.

Portfolio Careers = The Hedge Strategy

It’s not rebellion. It doesn’t have to be “leaving medicine.”

It’s simply good risk management.

A portfolio career gives you:

• Multiple markets for your human capital (public, private, non-clinical).

• Diversified income (clinical + capital + skills + business).

• Optionality the freedom to say no when terms don’t work.

Finances: The Hidden Cost of Training

One thing they don’t tell you is how expensive training actually is.

Exams, courses, relocation… the bills stack up fast.

I made a video breaking this down the real cost of training. If you haven’t watched it, I’d highly recommend it. Because understanding the financial side early is the first step to protecting yourself, whether you’re in training or not.

And if you’re not in training right now?

That might just be the perfect time to save money, increase income through side projects, or even start investing. Sometimes the “detour” gives you the breathing room to do things you couldn’t inside the treadmill.

Giveaway:

2 Tickets to PalmWine Sessions 🎶

On a lighter note… music has always been an outlet for me. It’s where I recharge, reflect, and remember that life is bigger than the next application result.

So I’m giving away two tickets to Palmwine Sessions.

It’s my way of bringing some joy, into what I know can be a heavy season.

👉 To enter, just reply to this email and tell me:

What’s one thing you’d do if you knew you wouldn’t fail this year?

Ps: If you are outside of the UK, what are competition numbers like? How much do you pay for training.. is it worth it?

Dr Niks