🎯 I was the better surgeon. He got all the patients.

He wasn't better than my mentor — not even close. But in Chennai, this orthopaedic surgeon charged five times what I charged for the same procedures. Every month, I'd tell myself the same thing: "This must be his last case at that price." Then he'd get another one. And another. He did so well that eventually he started calling me to do his surgeries.

I need you to sit with that for a moment. The guy charging premium fees was hiring the guy charging discount fees to actually operate. I had the skills. He had the patients. Would those patients ever know who was technically superior? Never. They'd shake his hand after surgery, thank him for saving their knee, and recommend him enthusiastically to their relatives — never knowing that the hands inside the wound belonged to someone else entirely.

You've done this. I know you have. You've quoted a fee, watched the patient's expression shift slightly, and immediately started backpedalling. "Of course, that includes everything — the surgery, the hospital stay, the prosthesis, the follow-ups..." You've filled the silence with justifications before anyone asked for them. You've shaved ₹10,000 off your fee in your head before the words even left your mouth.

The Lie We Tell Ourselves

I spent years watching this pattern repeat, convinced there was something fundamentally unfair about the universe. Here I was, technically superior, willing to work harder, and yet the market kept rewarding him. My logic seemed airtight at the time: charge less, attract more patients. Lower the barrier to entry. Volume would compensate for margin.

Here's what I wish someone told me: I wasn't attracting more patients. I was attracting a different kind of patient.

He attracted patients who could pay and would pay without flinching. I attracted patients who couldn't pay, who'd negotiate every rupee, who'd disappear for second opinions at three other hospitals and come back only when cheaper options fell through. We were fishing in different ponds entirely. He was selective. I was desperate. And the market could smell the difference.

I'd congratulated myself for being "humble about money" while watching colleagues with half my skill earn twice my income. I thought I was being approachable. The brutal truth: I was being invisible.

The Psychology Nobody Taught Us

Here's what the Chennai surgeon understood that I didn't: the market cannot value you higher than you value yourself.

Your fee is a mirror reflecting your self-belief back at the patient. They're not medical experts. They cannot evaluate your surgical technique or compare your complication rates. They didn't attend your residency. They haven't reviewed your case logs. What they can sense — what they're exquisitely tuned to detect — is confidence.

Research confirms what I learned through years of lost revenue and bruised ego. Psychologists Daniel Kahneman and Amos Tversky demonstrated something called anchoring bias — the first number stated in any negotiation becomes the psychological anchor around which all subsequent discussion revolves. State a high number and hold firm, and that high number shapes every perception that follows.

Here's what nobody tells you: 70% of professionals experience imposter syndrome, and pricing is the number one trigger. You see a big number, feel clammy, hear your inner critic screaming "Who do you think you are?" — and shave off the amount before the words leave your mouth. The patient never had to negotiate. You negotiated for them.

The research also reveals something that should make you angry: there's no significant correlation between premium pricing and clinical quality. A study of medical practices found no meaningful difference in outcomes between high-priced and low-priced providers. What premium pricing reflects isn't clinical superiority — it's perceived confidence, positioning, and reputation.

The surgeons commanding higher fees aren't necessarily better surgeons. They're surgeons who believe they deserve higher fees and communicate that belief without apology. Confidence commands premium. Competence alone doesn't.

I wish I could tell you I figured this out through insight or intelligence. I didn't. I escaped to Muscat.

Moving felt like failure at the time. I was running from a game I couldn't win, leaving behind a practice I'd built for years to start over in a country where nobody knew my name. But distance gave me something Chennai never could: a clean slate with nothing to protect.

No reputation to maintain. No referring physicians to offend. No fear of being seen as "too commercial."

Something shifted in that empty clinic. I started stating my fee as a matter of fact, not apologetically. "My fee is X." Full stop. No justification. No elaboration. No "but I know that seems high, so let me explain." Just the number, followed by silence.

The first time I did it, my palms were sweating. I braced myself for the pushback I'd spent my entire career anticipating — the haggling, the second-guessing, the awkward conversation where I'd have to backtrack. Instead, the patient nodded. "When can we schedule?"

That moment rewired something in my brain. The pushback I'd been bracing for — the negotiation I'd spent years pre-emptively surrendering to — had been largely imaginary. Or rather, I'd been creating it.