There’s a quiet assumption baked into how most physicians think about their careers: If you have the capacity to earn a certain income, you should. More RVUs, more shifts, more call. The math always seems to point in one direction.
I want to question that assumption, because I’m watching it cost the doctors I coach something they can’t get back. When physicians come to me feeling depleted, the first instinct, theirs and often mine, is to optimize. Tighten the schedule. Build better boundaries. Get faster at notes. Learn to say no. All of that helps. But lately I’ve started to notice something the optimization conversation tends to skip right past: Sometimes the problem isn’t how you’re working. It’s how much.
The clients of mine who have dropped to 0.8 or 0.6 FTE tell me a version of the same story. The pay cut they were so afraid of turned out to have almost no effect on whether they could make ends meet, and an enormous effect on the rest of their lives. The thing they braced for as a sacrifice barely registered. The thing they got in return changed everything.
That math isn’t identical for everyone. Debt, family, geography, and stage of career all move the numbers. But for a lot of physicians who assume the trade-off is brutal, the honest accounting comes out very differently than they expect.
Real physician voices, twice a week
Free, and one click to unsubscribe.
What I find most interesting is what makes the shift possible in the first place. It isn’t a spreadsheet. The clients who can actually let go of the extra income are usually the ones who have reconnected with why they went into medicine to begin with. And when they tell me those reasons, money is never on the list. The list is empathy. Connection. The chance to actually help someone. When you’re anchored to that, an extra clinic day in pursuit of a higher number starts to feel less like ambition and more like drift.
I know this pattern from the inside, because I lived a version of it in my own work. I became a coach to help people create real, transformational change. That was the whole reason. But once I started getting clients and the income started coming in, a different story crept in. I should add more clients. Then I could bring on another coach. Then I could grow from there. And underneath all of it was a belief I didn’t examine for a long time: If I become financially successful, people will notice, and then I’ll finally feel good about myself.
So I kept adding. I got up past 25 clients a week while running every other part of the business alone. I was, technically, successful. I was also burning out.
What I eventually understood is that self-confidence and fulfillment don’t arrive from outside. No amount of external validation was going to deliver the feeling I was chasing, because that feeling was never going to come from out there. A business does need to be financially healthy. It does not always need to grow.
So I stepped back. I got deliberate about how I wanted to focus my impact and which work actually energized me. I cut down to 10 clients a week. That decision gave me my mornings back, and I work out every day now. It left me with enough at the end of the day to cook dinner and be present with my wife instead of running on fumes. It made room to keep growing as a coach rather than just grinding as one. And here’s the part I didn’t see coming: Stepping back gave me the exact sense of confidence and success I had been trying to manufacture by taking on too much. The thing I was chasing by overworking, I found by doing less.
I’m not telling you to drop your FTE. I’m not telling anyone what their number should be. What I am saying is that “I can, therefore I must” is a story, not a law, and it’s worth holding up to the light.
So a couple of honest questions, the kind I ask my clients. Why did you choose medicine? And if you’re working at a level that’s quietly costing you, is it actually buying you something you want, or is it buying you a story about yourself that you don’t need anymore?
You can earn more. The real question is whether you have to.
Michael Carlini is the founder of Carlini Coaching LLC, which has been empowering medical professionals with ADHD for over six years. As an associate certified coach (ACC), he focuses on helping clients transform challenges into strengths by tailoring strategies to the unique demands of medical careers. By creating systems that foster clarity, balance, and sustainable success, Michael combines deep knowledge of both the medical field and ADHD to deliver results with empathy and expertise. Through one-on-one coaching, workshops, and public speaking, he inspires clients to thrive both personally and professionally. His mission is to help medical professionals confidently navigate their careers while reclaiming time for what matters most. Learn more on his website or connect with him on LinkedIn.
