One note before this week's piece. The newsletter went quiet for ten weeks between August and October, and I have added three months to every paid subscription to cover the issues you missed. Thank you for staying.
I didn't know how I was going to fend for myself. That was 2014. My son was a few months old and our expenses shot up almost overnight. I was saving almost nothing except the SIPs, which I refused to stop no matter what, and the credit cards were maxing out. On top of that, some of the surgeons I had operated for simply did not pay me what they owed.
I didn't chase them. I'm a professional; you behave in a professional manner. I believed that if I did the work well, the payment would come. I was too naive.
The lightest feelings of greatness I had were brought down to earth very sharply. I was taken aback that life can bottom out like that.
Some of you read in July about the plane ticket I couldn't pay for. This is about the dues behind it, and what I changed afterwards.
There are two ways I have watched surgeons wear themselves out. The complainers burn out first. They become the bitter colleague everyone avoids. The system is unfair, they are right, and being right changes nothing. The negativity becomes their reputation.
The grinders burn out second. Same exit, different speed. They do the extra calls, the thankless research, the weekend rounds nobody wants, and one day they look up and realise the queue has not moved and nobody was holding their place in it anyway. If your audit was presented under a senior's name, if the referrals still go to the senior by default, if your case list never grows, you already know which one you are.
The complainer and the grinder are making the same mistake from opposite ends. Both believe the system decides. One protests the verdict; the other waits politely for it.
Here is what that queue looks like in numbers. A self-selected survey of 93 surgeons and trainees, published in the American Journal of Surgery (2026), found that 65% had a mentor and only 28% had a sponsor. Only 48% knew the difference between a mentor, a coach and a sponsor. It's a small survey. The shape is familiar: plenty of advice, very little advocacy.
Business researchers found the same shape in 2010. Herminia Ibarra and her colleagues followed more than 4,000 high-potential graduates of top business schools. More of the women had mentors than the men, 83% against 76%. Yet among people with an active mentor, 72% of the men had been promoted by 2010, against 65% of the women. The women's mentors, the researchers concluded, had less clout. Their phrase: "overmentored and undersponsored."
None of this is your fault. Training pays us in one currency: hours, obedience, results in theatre. The stance was always that the mentor or the consultant was always correct and there was no room for being wrong. A study of graduating orthopaedic residents from a single programme concluded that they "appear to be inadequately prepared to effectively manage business issues in their practices." We leave as excellent technicians who believe the system will notice.
Sometimes it does notice, and keeps you exactly where you are. Years ago, a junior was offered a fellowship with a surgeon doing very high numbers. His consultant refused him leave: "No, we want you here at this time." Ridiculous and unpleasant. It was unfair. The same logic doesn't end with training. A department that runs on reliable hands has every reason to keep its most reliable consultant on the roster and out of the room where posts are decided.
I considered change. I considered the fact that it is not too late to change in your life. I changed hospital. I started doing work I wasn't normally doing, became more general, and in the end left Chennai altogether. Rebooted everything and started afresh.
When I came to Muscat, the first thing I did was not hesitate to charge. I did not think about whether the patient can pay or cannot pay. That was not the problem, because I was not working in a charity-based institution. I was working in a private hospital, and all patients who came to this hospital knew that this is a private set-up and you have to pay for your services. There should not be any hesitation on my side to charge.
It's a different thing that if there was a needy patient, I could waive my fees. But that's not what I came here for. If I did that for every patient, I would be back in the situation I was in.
Any time a patient says the charges are more, I always say, "You can go to the doctor next door, or to the hospital down the road, and they will help you out. I'm sure they'll do a good job as well." Every time I did that, the patients actually revolted against the idea and told me, "No, we came for you. We want you to do the job."
The fact that they wanted me to do the job allowed me to charge my normal fees without any discount. That was a big change in mindset, in my behaviour, and patients started respecting me. Now I get patients from all over looking for me, because I was very clear about what I'm going to give: my best. I should not hesitate about charging for giving my best. This is the one change that made the biggest difference.
In 2014 I would not ask for dues I had already earned. In Muscat, the very first thing I did was not be embarrassed or hesitant about charging my fees. Same surgeon, same hands. I had stopped waiting.
Saying plainly what your work is worth is the third path in miniature. It is not politics, and it is not scheming. Inside a hospital, though, the currency isn't fees; it's whose name gets spoken in the room. Getting yours spoken comes down to three moves most surgeons never learn.