When hospitals promise everything, YOU become the sacrifice

Two years into my first hospital job, I walked into what I thought was a promotion interview. Consultant post. Better title. Better money. I'd earned it—or so I believed.

The department head opened a file. My logbook. Two years of cases, complications, assists, everything documented the way we're trained to document. He flipped through pages I'd filled during 36-hour shifts, pages stained with coffee and exhaustion. Then he looked up and asked the question that would haunt me for the next decade: "Based on your logbook, what is it that you're doing that supports your call for doing higher number of cases?"

I sat there, stunned. I wasn't being evaluated on potential. I was being asked to prove I'd already been exploited enough to deserve better treatment. Every case I'd documented, every assist where I did 80% of the work while the senior took credit—all of it was now evidence for why I should be allowed to do more of the same. The trap was elegant. Work hard enough to fill your logbook, and you've proven you'll accept the current terms. Don't work hard enough, and you've proven you don't deserve advancement.

You've felt this. Maybe not in an interview room, but in the quiet moments after a shift when you compare yourself to the senior consultant down the hall. He works half your hours. He earns triple your income. And you tell yourself: "He's been here longer. He's earned the right to charge more. My turn will come." You discount your fees because you're building volume. You take every case because you're building experience. You accept terms you know are unfair because you're building a career.

Here's what nobody told me: You're not building. You're being built upon.

The Triangle Nobody Drew For You

Every healthcare administrator knows the Iron Triangle. Cost. Quality. Access. The brutal physics of healthcare says you cannot maximise all three simultaneously. Want broad access and low cost? Quality suffers. Want high quality and broad access? Costs explode. The triangle is real, and it's unforgiving.

But there's something the textbooks leave out. When a hospital promises all three—when they market themselves as affordable, excellent, AND available to everyone—physics doesn't bend. Something still has to give. And in corporate hospitals across India and America, that something has a name.

It's you.

Your time. Your income per case. Your family dinners. Your sleep. Your sanity. When the hospital makes impossible promises to patients, the surgeon becomes the pressure release valve. The triangle doesn't have three corners. It has four. And you're standing on the fourth.

I learned this the slow way. When I started practice, I did what every young surgeon does—I looked at what seniors charged and discounted myself significantly. The logic seemed bulletproof: lower prices attract more patients, more patients mean more cases, more cases mean more experience, more experience eventually justifies higher fees. I thought if I kept my prices low, patients who normally went to Apollo would come to me instead. Every financial advisor who's never operated would approve.

The problem? I was training patients to undervalue me from day one. Worse, I was training myself to undervalue me. The discount I offered as strategy became the ceiling I couldn't break through. The "temporary" positioning became permanent identity.

The golden handcuffs tightened so gradually I didn't notice. Fixed remuneration felt like security. No lean months. No uncertainty. Just predictable income, month after month. What I didn't see was what that security was costing me.

When you accept fixed remuneration, you stop thinking about earning more. You stop experimenting with different approaches. You stop taking the risks that lead to discovery—professional or financial. The security mindset kills the experimentation mindset. You accept what you have instead of testing what's possible. The hospital knows this. That's why they offer it.

Here's what 25 years taught me: To think that you are secure, you are basically getting in a zone of not taking risk in life. And taking risks are important—not reckless risks, but calculated ones. The kind that let you discover which strategies work and which don't. The kind that let you build something that's yours.

Almost always, it becomes apparent in corporate hospitals that they don't like any particular doctor to get very strong—in earning, in reputation, in status. The system is designed not to enable your growth but to cap it. When you become too valuable, you become a threat. They'd rather have ten replaceable surgeons than one indispensable one.

Run the numbers yourself. Take your consultation fee—say ₹15,000. Sounds respectable. Now divide it by all the hours that consultation actually cost you: the 78-hour weeks, the administrative work, the call nights, the unpaid documentation, the travel between hospitals. Your real hourly rate? ₹195.

One hundred and ninety-five rupees per hour.

The Uber driver who brought your last patient to the hospital earns more than that. But nobody teaches you to calculate this number. There's no software bridging the hospital's information system with your own tracking. The blindness is useful to the system. You can't fight what you can't measure.

The Pattern That Changed Everything

For years, I noticed something I couldn't explain. Surgeons with identical skills charging vastly different fees. Surgeons in the same city, same specialty, same training—one struggling while another thrived. And every month, I'd tell myself the same thing about the ones charging more: "This must be their last case at that price." Then they'd get another one. And another.

That's when I understood. The difference between struggling surgeons and thriving surgeons had nothing to do with skill. It had everything to do with positioning within the triangle.

The surgeons who weren't struggling had done something I hadn't: they'd diagnosed their employer's triangle before signing the contract. They knew which corner their hospital sacrificed. They knew whether that sacrifice aligned with their career stage. And when the hospital started shifting which corner to squeeze, they recognized the signals and moved before the trap closed.

The brutal truth: Technical mastery alone is not sufficient.

You can be the best surgeon in your city. The most meticulous. The fastest. The one with the lowest complication rate. None of it matters if you're positioned wrong in the triangle. Your scalpel skill determines whether patients survive. Your triangle position determines whether your career does.