When Physician Compensation Becomes the Scoreboard: Why Income Matters More Than It Should | Ep41

Michael Hersh, MD

[00:00:00] 

Do you ever notice how fast the calculation happens? You get another recruiter email, you hear what a colleague negotiated. You read about another reimbursement cut. You look at your own numbers. Before you even realize it, your brain is running the math. Is this even worth it anymore? The hours, the call, the inbox, the liability, the missed dinners, all the pressure.

You don't usually say it out loud like that. You say something a lot more familiar, like, I should be making more. For what we deal with. This isn't enough. And if they're gonna expect this much, they need to pay for it. And on the surface, that sounds like a compensation conversation, but most of the time it's not just about the money.

Well, hey everyone, and [00:01:00] welcome back to the Better Physician Life Podcast. Thank you so much for being here today. Now, today I want to talk about physician compensation, not the numbers themselves, but what happens when compensation becomes the way you decide if your career is working. When it becomes the actual scoreboard for whether this whole thing is worth it or not.

And let's be very clear about this from the beginning. Money matters. Compensation matters. Fair Pay matters. This isn't an episode about pretending that it doesn't. You trained for a long time. You took on debt, you delayed earning, you carry risk. Of course it matters, but at some point in many physicians' careers, compensation stops feeling like pay and starts feeling like proof.[00:02:00] 

Proof that all of this time, effort, and energy was worth it. Proof that you didn't make a mistake. Early on, money feels like validation. You finish your training, you sign your first contract, the number feels big, and it feels like arrival, like confirmation that all those years meant something and then something shifts.

The number might go up, but so does the friction. There's more metrics, more oversight, more portal messages, more expectations, more volume, a lot less margin, and quietly the internal calculations starts to change. It's no longer I'm well compensated, and it becomes, is this enough to make this tolerable?

That is a completely different equation. [00:03:00] I saw this exact transition in my own career. I wasn't thinking about fulfillment at all. I was thinking about financial independence and escaping medicine and all of the trade-offs. If I'm gonna be this busy, if I'm gonna be this on call, if I'm gonna have to deal with all this pressure.

Then my compensation better reflect it. Now, on the surface, that sounds very reasonable, but what I didn't realize at the time was that I had reduced my entire professional life to a financial equation. Money became the only way to decide if I was doing okay. If the paycheck felt strong, I felt fine. If my RVUs dipped or comparisons crept in, irritation wasn't far behind. And if I was asked to do something at work for free frustration followed pretty quickly. [00:04:00] Not because I'm greedy, but because compensation had become the last remaining scoreboard. When autonomy shrinks, you look for something you can still measure. And when you feel second-guessed or worse, disrespected, you look for something you can point to, something solid, something that proves you still matter, and compensation becomes the obvious place.

Money is concrete, it's clean, it's numeric, it's objective, or at least it feels that way. But here's the problem. If compensation becomes the primary metric for whether your career makes sense, you will always feel behind. There is always someone making more than you with fewer weekends, with less call, with a lighter inbox, the comparison [00:05:00] never ends, and even when you win the compensation game.

The relief is temporary because the underlying friction is still there. The inbox doesn't disappear because your RVUs went up. The administrative burden doesn't shrink because your base salary increased, so you end up in this loop. If I can just get paid a little more, this will feel better, but it rarely does. Not for long, at least.

And again, this isn't about dismissing the importance of compensation; it's about noticing what you're asking money to solve. Sometimes when physicians say, I should be making more, it seems like a money conversation, but it's usually something more like, if I'm gonna be putting up with all of this, they need to pay me more.

And underneath all of that is something else. I want more control. I [00:06:00] want more say, I want this to feel fair. I want this time for money exchange thing that I'm doing to make sense. That's not about greed, and it's not about ego. It's about control. It's about leverage, and it's about position. And when those feel thin or maybe even non-existent.

Compensation fills the gap. It becomes the thing you can point to because the things you actually care about don't show up on a spreadsheet. Respect, influence, time at home, breathing room, and that's a heavy load for your paycheck to carry. Now there's another layer to this that comes up all the time.

When I speak to physicians, especially for male physicians, for a lot of doctors, [00:07:00] compensation isn't just professional, it's personal. It's tied to being the provider, the one who carries a lot of financial responsibility at home. And when that compensation number moves, it doesn't feel neutral. It feels destabilizing because the structure you rely on feels less solid and the responsibility you carry at home suddenly feels heavier, not because you forgot who you are, but because you've been trained to measure stability in numbers, you were trained to measure performance and to quantify progress.

So when the numbers shift, you measure yourself against it. But here's the question I needed to start asking myself. If the money doubled tomorrow, but nothing else changed, would the friction disappear? Would I suddenly feel less rushed, less irritable, more present at home, or would I [00:08:00] just feel better for a week?

It's not a trick question. It's meant to separate two things that often get tangled: compensation and alignment. And when those things drift apart, frustration grows. And if you don't notice it, clearly it starts leaking out sideways. As sarcasm, as disengagement, as that low-grade edge that follows you home.

It looks like you're frustrated about money, but most of the time, you're frustrated about what you're giving up for the money. Time for income. Energy for stability. Autonomy for predictability. So what do you do with that? Not by quitting tomorrow or blowing up your contract, but by getting clear on what actually matters.

If money is the only metric, you will chase it indefinitely. If it's just one [00:09:00] factor, it stops driving everything. And so sometimes the better question is, what would actually make this feel better besides more money? More control over your schedule, fewer unpaid tasks, clearer inbox boundaries, a different call structure.

Sometimes the answer is financial. Sometimes it's structural, and sometimes it's both. But when you lump everything into compensation, you lose leverage because the only solution becomes pay me more. And a lot of the time, that is not fully in your control. What you can control is getting specific. What's actually bothering you and what part of it can you change?

And sometimes the most important shift isn't in the contract. It's in recognizing that your career [00:10:00] cannot be reduced to a single number. There's another piece of this I didn't see until I caught it in myself. For a lot of physicians, compensation isn't just about lifestyle; it's about position, trajectory, knowing you're still moving forward.

So when your income plateaus or dips, or you intentionally choose a structure that earns less. It feels like you're falling behind even if you're not. For me, I remember adjusting parts of my schedule and watching the numbers change. I told myself I valued time that I wanted more margin and white space in my life, and I genuinely did.

But when I looked at my paycheck and saw the difference, my chest still tightened, not because I needed the money to survive. But because I was more attached to the number than I had realized. It had become a signal. A signal [00:11:00] that I was succeeding, still competitive still where I was supposed to be. When that number changes, even by choice, it exposes what you've been using it to measure.

Of course it does. In this profession, there's always been a number. Grades. Board scores, percentile case numbers. So when the numbers move, now, of course, you measure yourself against them, but something has to give. If you push hard to maximize income, something else usually shrinks and that something is your time.

If you protect your time, income might suffer. That's math. The mistake is thinking you can maximize both forever. Eventually the math catches up. Every physician is investing in something. Some push hard for income, some protect their time. [00:12:00] Neither is wrong, but drifting into one without deciding. That's where resentment starts.

And if you calibrate even a little, you're gonna feel it. When you open the reconciliation and see your RVUs, when a colleague signs a bigger deal, when you hear what someone else negotiated, that discomfort doesn't automatically mean you chose wrong. It means you changed what you're measuring, and it takes time to get used to that.

Here's the part that matters. Compensation is a metric and it's an important one. It's still just a metric when it becomes identity. Every slight fluctuation feels personal. When it stays a tool, you can manage it. It doesn't get to manage you, and it's less dramatic than you think. No big announcement.

Just a [00:13:00] different way of keeping score. Before we close, I wanna offer something practical. If you've ever walked outta work, running mental calculations about productivity or reimbursement and walked into your house, still carrying those numbers in your head, you know how quickly it changes the tone at home, that transition matters.

So I built the five-minute commute reset for exactly that moment. Not to make you ignore real financial considerations, but to help you leave the calculations at work. It's short, it fits into a drive you're already taking and it gives your day a clear stopping point. And you can download it at betterphysicianlife.com/ commutereset. And I'll link it in the show notes. 

Because the goal isn't to stop caring about compensation. It's to make sure it isn't the only thing, deciding whether your career is working. Money is a tool and it's important. And it is [00:14:00] real. But when it becomes the only way you decide if you're okay, it starts doing a job it can't do very well. 

You don't need to pretend money doesn't matter, and you don't need to feel guilty for caring about it. You just get clear on what you're actually trying to fix. Is it income or is it time or control or respect? When you separate those, you have a lot more room to move. And that's where things start to feel different. That's the better physician life. 

Thank you so much for being here, and I'll see you on the next episode of the Better Physician Life Podcast.

Amazing. You started to mention some of the incredible work that you have been doing.You mentioned the two books that you've published, which just for clarity purposes, these are stories from real physicians navigating lives and careers in healthcare, and I think that they provide such an important piece of normalizing what it is to be a human and a doctor, and [00:24:00] navigating all of the things that come up for all of us.

Talk to us about that, and then I'd love for you to tell everybody more about this retreat that you have coming up in October of 2026. 

Sure. So about the books, I feel like when doctors read these, and also the people who have endorsed the book, well actually, Heath Joliff had shared in the first book that physicians are speaking up, not because it's easy, but because staying silent costs too much.

And when doctors read these stories, they'll feel less alone. And one doctor told me that when she read this book, she felt like somebody was giving her a big hug. So it just validates all of your experiences. And then the great thing is my website is. Stand up for doctors.org and there's a books tab, and you can see the faces of every physician who wrote chapters in each of these books, including yours, with how our listeners or the readers can get in touch with those doctors.

So if a chapter resonates with you, [00:25:00] you can actually reach out to that doctor. And, in the first book, the chapters are everything from, connection mitigates trauma. When the doctor becomes the patient, we talk about workplace bullying vulnerability in the power of boundaries. Unique challenges of really career physicians, self-compassion, and the power of storytelling.

So any doctor will see themself in some of these stories. Then this book we speak to things like, preserving the physician-patient relationship, processing grief. Am I cut out to be a doctor? rediscovering joy in medicine and reclaiming, ah, supporting yourself outside of medicine to feel better inside of medicine from isolation to be belonging, how to become unburnable and leadership, building trust and positive culture in healthcare.

So I don't think there's any doctor. Who would read this and not see themselves or not feel a little bit better by reading it and hope because [00:26:00] they're messages of hope. And then also hearing stories from physicians, their gratitude to physicians. And then also hearing from a couple physicians spouses, because when it's not only a life of sacrifice for the doctor, it's a life of sacrifice for the physician family.

And not only did. Doctors not often receive the gratitude they should be getting. physician families. Rarely, if ever, do. 

Yeah. And for those who are listening, the title of the first book was, White Coat's Courageous Hearts. Yes. And the second book, White Coat's Human Hearts. And they're of both available on Amazon and paperback and Kindle. And we would really love reviews, that really helps the books to reach more people. 

And then tell us about this retreat that you have coming up in October of 2026. 

Sure. So it is just so exciting, I cannot even wait. And it kind of started, [00:27:00] so Dr. Tamara Beckford and, Dr. Jillian Rigert to shared a little video a couple years ago and they were dancing and I said, oh, you guys have great dance moves.

And then Dr. Tamara Beckford started joking around saying, oh, when are we gonna have a dance party? And she lives in Texas. They both do. And so at first I was kind of laughing about it, but then I was like, well, I've connected so many doctors and you become real friends with some of them. But I'm like, you would never get together because you're different specialties and around the country.

Like there isn't one conference that would draw you all. And I was like, well, I could do it. And I'm turning 60 in October, and I wanna celebrate doctors that are keeping me alive. So I'm inviting my own physicians, and I believe they at least plan on coming to the gratitude dinner on the Saturday night.

And I wanna show them, I'm bringing all these doctors that I've met to them and the first night will be a welcome dinner. And then it's all by doctors and for doctors. So there's gonna be improv for doctors and it's just gonna be [00:28:00] fun icebreakers. And then through the weekend there's gonna be various topics and activities, and the physicians are choosing the topics that they know that their colleagues would want to hear about.

Everything from incorporating trauma-informed leadership for doctors and patients. To boundary setting, reclaiming your time the inner critic, all of those kinds of things. And then we're interspersing that though with activities that bring you into your body that are good for other people and doctors too, because doctors are people.

That'll be everything from, Dr. Beatriz Olsen a functional medicine endocrinologist and an artist, and we're gonna have abstract art, so you don't have to know anything about art and you can participate. And we're gonna have a little line dancing and, why write? And a drum circle and just so many, different activities and everything is optional.

And, one of my favorite parts, I think will be Sunday morning where we're having a physician [00:29:00] advocacy section where the doctors that are there over the weekend will decide what do they wanna talk about. And we'll break into small groups and they'll have time to talk about that. And we'll have a quick break.

So if they wanna switch table. They can or continue on. And then after a couple rounds of that, we'll have a spokesperson from each table, share what they learn, kind of like what should we do in action steps, and we might have some zooms ahead of time. So the retreat won't be the beginning or the end.

It'll be the middle of, again, taking it's me messages of hope and how we can move medicine forward in a way that's sustainable for our physicians. And it's gonna be fun. 

Incredible. Yeah. And for physicians to know they can use CME funds for this CME will be available. Is that correct?

Absolutely. And I can also offer a secret VIP code that I could either share here or it could be in the show notes. 

What is the code? 

VIP100 [00:30:00], all capital letters VIP 100. 

And what will that do for people 

That will take a hundred dollars off your registration fee? And we are limited, we have 46 slots.

And at the time of this recording where. About halfway there with formal registrations, and another dozen doctors have said they're gonna register soon. So we don't have a ton of slots left, but we would love to have you join us and highlighting the importance of community. we've spent a long time in this conversation talking about autonomy and burnout and moral injury.

And one of the things that really does help to mitigate all of this. Is community is networking. these are not topics that are taught in medical school. And I know this has been a huge part of my own personal journey in terms of finding community, finding, networking, finding a way to keep me full-time practicing in medicine.

Community and networking has played such a huge [00:31:00] role and. Kim Downey, you have been a huge part of that and so thank you so much. We will link the information for your books and for your upcoming retreat in October of 2026, as well as the VIP code for listeners of the podcast. Thank you so much for being here.

To the listeners, thank you so much for joining us today and, we'll see you next time on the Better Physician Life Podcast.