The Scarcity Trap in Medicine: Why More Is Never Enough | Ep17

Michael Hersh, MD

[00:00:00] 

More time, more money, more recognition. And yet, no matter how much you get, it never feels like enough. That's the trap of scarcity, and it drives more of our lives in medicine than most of us want would admit. That's what we're talking about today.

Well, hey everyone and welcome back to Better Physician Life. Thank you so much for being here today. So what if the biggest lie we've been sold in medicine is this, there's not enough. Not enough time. Not enough money, not enough recognition, and somehow never enough for you. Scarcity shows up everywhere.

For physicians, not as some abstract concept, but in the daily grind, the pressure we carry and the weight that never seems to let up, it comes up all the time. Every [00:01:00] year around Thanksgiving, I find myself reflecting not just on gratitude, but on this deeper question of enoughness, like how much is enough and what happens when we believe the answer is always not yet.

There's this quote from Michael Beckwith that has really stuck with me over the years. He says. There's a lie that acts like a virus within the mind of humanity that there's not enough good to go around. There's lack and limitation and just not enough. The truth is there is more than enough good to go around.

It's a really powerful quote, and that one line, a lie that acts like a virus. It is pretty striking. Because that's exactly what scarcity does. It gets into your head [00:02:00] and runs in the background until you hardly notice it's there. And if you've been in medicine long enough, you know it's not just a passing thought.

Scarcity can feel like the air we breathe. From day one, as a pre-med, the message was hammered in. There are only so many seats. There are only so many honors. There's only so much room at the top, and years later, after training, after the job, after the partnership or the leadership title, the script really hasn't changed all that much.

Now it sounds like will there be enough patients if the hospital hires someone new? Will my RVU hold up this year? Am I keeping pace with my colleagues financially? What if I'm falling behind? And here's the thing, that scarcity, it doesn't just stay at the hospital. It follows [00:03:00] us home suddenly. It's not just about RVUs or promotions, it's about your neighbor's new kitchen, your colleagues, early retirement, or even your own vacation, slipping away too fast.

It's not just comparison. It's this constant hum of anxiety, and those thoughts aren't harmless for me. Scarcity poured gasoline on my burnout, especially around money and time. Money scarcity showed up in my RVU every single quarter. It felt like I was in a race I couldn't afford to lose. Compensation tied to volume and financial independence always just out of reach.

The pressure to provide was relentless and no matter how much I earned the story in my head was always the same. It's not enough. It's not enough. I need to be doing more. [00:04:00] It's not enough. Now. Financial scarcity is one thing, but time scarcity. That one runs even deeper for me. The belief that there's never enough time is still one of my biggest struggles, always racing the clock, feeling overwhelmed, thinking, I don't have the bandwidth for this.

Even when on paper I'm doing fine. It just never feels fine. The schedule always looks too full. The inbox always feels too heavy. The days are too short, and the cost of that thinking was obvious. I can't be fully present, not with my patients, not with my family, not even with myself. Now, looking back, I can see how scarcity pushed me into directions.

I never meant to go. The endless hustle, taking extra shifts, [00:05:00] stacking leadership roles, padding the CV, chasing financial milestones. It all looked like ambition, but underneath most of it was just anxiety in disguise. And here's the kicker. Medicine rewards it. The scarcity-driven hustle gets praised.

You're the hard worker, the reliable one always available, never turns down an opportunity. Always willing to serve on another committee, quick to pick up the slack. It looks so good on the outside, like dedication and leadership, like being a team player. Those are the traits that built our careers. But over time, that same hustle stops being a choice and starts feeling like a cage.

The recognition fades, but the demands don't. And suddenly you realize the very behaviors that earned you [00:06:00] respect are the same ones pulling you away from your family, your health, and even the joy you once felt in the work itself. And I've often asked myself, if scarcity gives you the adrenaline to keep hustling, what does it take away?

For me, it took my peace. It took the chance to be truly present with my kids instead of half-distracted. It turned evenings with my wife into nothing but logistics, bills, schedules, and kid activities instead of real connection, and it took the joy I used to feel in the work itself. That's the hidden cost.

Scarcity will keep you grinding. But it'll quietly strip away the very things you're grinding for. The first time I really saw scarcity for what it was, wasn't in a textbook. It wasn't in a lecture. [00:07:00] It was through physician coaching. Until then, I thought not enough was just a reality I never considered.

It might be a belief I could actually question. But once I started noticing it, I saw it everywhere. Like saving that special bottle of wine for some perfect occasion that never actually arrived or hanging onto stuff in my closet just in case.

Or counting how many conferences I'd been invited to, how many committees I sat on, how many circles I was in, like it was some scoreboard, and maybe that's why Thanksgiving always pulls me back into this question of enoughness. Not just food on the table, but enough connection, enough time, enough presence.

Scarcity convinces us that if we don't grab our piece now, we'll be left behind. [00:08:00] Like if you don't say yes to the extra shift or the leadership role, the opportunity might never come again. But here's the thing, most of the time the world is way more generous than scarcity would have you believe. And it's not just about money or time.

Scarcity also creeps into how we think about belonging. If time, money, and status feel scarce, then connection must be scarce too. Respect must be scarce. Acceptance must be scarce, and that's where it gets dangerous because it tempts us to shrink back, to keep the mask on, to avoid being vulnerable . To say no to the dinner invite or to the phone call to the chance to let someone really know us, and that's how we end up alone in a crowd [00:09:00] surrounded by people, but not truly connected.

Scarcity makes us think there's not enough recognition to go around. Not enough respect, not enough belonging. But how do you move out of that? The good news is just noticing it is already a big step. Most of us spend decades letting scarcity run the show before we ever call it out.

Once you see it, you can start to shift and no. That doesn't mean believing that life is easy or magical. It's not about ignoring reality. For me, abundance has meant something much simpler. Choosing to believe there really are enough resources, enough opportunities, enough connections for everyone, including me.

Here's a real example. So when I first joined my group, I was the second [00:10:00] gastroenterologist. And every time we got too busy to handle the workload and needed to hire another physician, it felt like a threat. What's gonna happen to my referrals, my schedule, my compensation? But over time, something surprising happened.

Two doctors became three, and three became six, then nine and 10. And instead of shrinking, everything expanded. Our reach grew, our reputation strengthened, and my practice stayed plenty busy, and each time we hired someone new, I gained flexibility and a little more sanity. Everybody won. The group, the hospital, and most importantly, the patients who finally had shorter wait times and better access.

The pie didn't shrink like I thought it would. It got bigger. More slices. [00:11:00] Yes, but because the pie was bigger, the slices grew too. And that's what shifting from scarcity to abundance looks like. Now let's be clear. Abundance isn't magic. It doesn't mean sitting back, waiting for life to hand you gifts.

We're physicians, we know better. For me, abundance is about how you approach what happens. It's choosing to relax into possibility instead of bracing for loss, and that shift feels risky at first. I still catch myself in old patterns, hoarding responsibilities, refusing to delegate, worrying.

I am not in the right circles to stay relevant. And maybe you felt that too. The thought that if you let go, if you trust a younger colleague with a case, or if you step back from yet another leadership [00:12:00] role, you'll lose ground. You'll be forgotten. You'll fall behind. But the truth is, abundance means realizing the opposite, that sometimes the pie gets bigger when you share it.

That delegating creates breathing room. That saying no to one opportunity can open the door to something better aligned. It's not easy. Scarcity always whispers in the background, but abundance is about asking a different question. Is it possible things are unfolding exactly the way they're supposed to?

Not mystical, just practical instead of racing to stay ahead. Sometimes peace comes from trusting the process, even when you don't fully understand it yet. And here's something that surprised me too, that. The antidote to scarcity isn't always [00:13:00] abundance. 

Sometimes it's just enough. Not more patience, not more accolades, not another leadership role. Just enough, enough RVUs to keep the lights on without sacrificing every evening. Enough time with your kids that you actually remember the season of life they're in. Not just the logistics. Enough energy left at the end of the day to sit with your spouse and talk about more than schedules, enough space to protect your health so that you can keep showing up, not just as a physician, but as a man or a woman, a husband, a wife, a father, a mother, a friend.

That's not laziness. That's freedom and sure, scarcity thoughts sneak back in. They always do the just in case mindset, the itch to say yes to everything. The urge to [00:14:00] keep climbing. That's why it takes practice. And for me, the antidote starts with gratitude, with noticing what's already here. With questioning the reflex that says more is always better.

It's the courage to define your own enough and to actually give yourself a chance to rest there. And defining enough doesn't mean lowering the bar. It doesn't mean giving up on growth or settling for less. It just means you stop grinding from a place of fear. Start building from a place of stability.

Here's a story that really stuck with me from my own family. So when my mom turned 18, her dad gave her two things, a Saint Christopher Medallion for protection and a $10 bill. So she'd never be without money, [00:15:00] and she's kept both her entire life. Untouched for her. There are quiet, reassurance, proof shall never truly go without, and I accepted that story at face value.

And when my daughter was born, I did the same thing for her. I tucked away a $10 bill so she'd always have money. But over time I realized the real gift I want to pass on to my daughter isn't money at all. It's mindset, it's curiosity, it's possibility. It's the belief that she can create and nurture what she wants and needs in this world.

I want her to know that she's not limited by her current circumstances, that the only limit is the size of her own dreams. And honestly, the same is true for us in medicine at any stage of our careers. What do we really want [00:16:00] for ourselves, our colleagues, our trainees? Not more possessions, not more lines on our CV, but more possibility, more space to grow, more mindset that fuels things like connection, creativity, and meaning.

 But the thing is that scarcity shows up everywhere. In the calendar, obsessing over every block of time in clinic worrying about what new hires will mean for us in the comparison game of whose house is bigger, whose vacation looks better, and again, in our careers, believing one missed opportunity means we'll never be asked again.

And for me, the most relentless form is time scarcity. That hum of there's never enough time. Not for my patients, not for my family, not for me. But here's the shift. Every time I pause and ask, do I have enough for [00:17:00] today? Things change. It's almost never about actually needing more. It's about being intentional.

I can't add hours to the clock, but I can choose how to spend the ones I've got, and that's where boundaries matter. That's where priorities come alive. And the longer I practice medicine, the clearer it becomes. Money may fluctuate, but time, time only goes in one direction. It's the one resource we can't ever replace, and that's why growth so often feels uncomfortable.

Each time our group hired another gastroenterologist. I felt it, that tightness in my chest, the worry about RVUs, about my schedule, about what I might lose. But each time the opposite happened, we grew, everyone thrived. The collective got stronger, and that's the paradox. Growth [00:18:00] almost always requires discomfort.

It shows up in delegating when you'd rather keep control in saying no to another leadership role. So you can say yes to your health or your family in trusting that a younger colleague can step up without you needing to hover in realizing that you don't have to be in every room or on every committee to still matter.

Those moments sting a little because they brush against the scarcity script we've been carrying for decades. But they're also the moments that free us. That's what abundance looks like in real life, not magical thinking, not unlimited ease, but the courage to trade, the discomfort of scarcity for the discomfort of growth.

And that's how we find the time that we need. And sometimes it's not even about growth at all. Sometimes it's about detours. A couple of Thanksgivings Ago, we were headed to New York to visit family [00:19:00] bags, packed family anxiously awaiting our arrival. And the night before my son got sick again, trip canceled.

It was super disappointed and honestly a little angry because expectations matter. And when you've worked really hard to carve out the time and finally plan something, it hurts when it unravels. Then came the choice, gratitude that we were together. Gratitude that my kids don't even like Turkey.

Gratitude for avoiding the airport on Thanksgiving Eve. That's what enough looks like in real life, and it's the same in medicine. The detours come whether we want them or not. The last-minute schedule changes the procedure. That takes twice as long the leadership role that goes to someone else. Scarcity tells us those moments are losses, that something was taken away, but if we pay [00:20:00] attention, there are almost always gifts in the detours.

Rarely obvious right away, but clearer with time. Okay, let's wrap this up. Abundance isn't about pretending everything is easy and it's not about chasing more. Sometimes the antidote to scarcity is simply enough, enough RVUs to do your job well without burning out enough time with your kids that you remember more than their sports schedules and homework assignments.

Enough energy to sit with your spouse at the end of the day and actually connect enough margin to protect your health so you can keep showing up, not just as a doctor, but as a spouse and a parent and a friend. That's not settling, that's building a life that lasts. So, as we approach Thanksgiving, here are some questions to think about.

Where does scarcity show up most for you right now? [00:21:00] Time, money, recognition, belonging. When you feel the push for more, could you pause and ask, do I already have enough ? If the answer is yes, could you let that be enough? Because in the end, money goes up and down. But time, time only runs one way, and when it's gone, it's gone.

The real question is when you look back, what do you wanna remember? Another quarter's worth of numbers, where the life you actually lived. And if you're like me, you've spent years planning your career, but not much time planning your life. so I did design a free guide called Design Your Life, a Goal Setting Guide for Physicians.

It's a simple worksheet that helps you think through the bigger picture, what you want, your career, your relationships, and your life to look like 5, 10, even 25 years from now, because you can't create the [00:22:00] future if you don't start planning it today. You can download it at betterphysicianlife.com/design-your-life. I'll make sure that's included in the show notes. 

Thank you so much for being here with me today. Take care of yourself. I'll see you next time on Better Physician Life.