Doctors Sell Time, Dentists and Surgeons Sell Outcomes

How a subtle reframe changes an entire conversation?

I want to talk about something I’ve been sitting with for a while. It’s anecdotal, it’s a bit uncomfortable, and I’m genuinely not sure I have the full answer. But I think it’s worth saying out loud. Or putting pen to paper and voicing it

Have you ever noticed that doctors and surgeons have a fundamentally different relationship with money?

Not in terms of how much they earn. I mean, in how they think about what they’re selling.

A doctor, broadly speaking, sells time. The whole structure of medical work is built around it. Your Clinics are scheduled in ten-minute slots, On calls are measured in hours, Job plans for consultants are carved up into programmed activities, which are essentially time blocks dressed up in NHS language. When a doctor asks for more pay, the argument almost always comes back to the same place: I am working X hours and I should be paid Y per hour. It’s a reasonable argument. But it’s also a losing one.

Now think about a surgeon. Or a dentist.

A surgeon isn’t pricing their time. Nobody sits across from a patient and says “the cholecystectomy took 47 minutes so here’s what I’m charging.” The procedure has a value. That value reflects years of training, the judgment calls made before anyone opens anything, the risk managed in the room, and the outcome delivered on the other side. You’re not paying for 47 minutes. You’re paying for the fact that it went well. So in essence you are selling the outcome of the surgery.

Dentistry is even more instructive, especially in the UK, where you can see both models running side by side. NHS dentistry is clunky and underfunded, but private dentistry has fully embraced procedure-based pricing. Nobody apologises for charging £800 for an implant. The procedure has a price. That price reflects skill and expertise and outcome, and the conversation about whether it’s fair happens in a completely different register to the one medics are having.

And here’s what I’ve noticed anecdotally, so please take this as observation rather than gospel. There seems to be a different cultural reception to money talk across these groups. Surgeons and dentists seem more comfortable having commercial conversations. When i’m reaching out to either tthey are more receptive to discussing money generally. More open to giving you advice that pertains to how to build a career and also how to build wealth. Medics on the other hand are still largely fighting for incremental pay rises and comparing themselves to other employed professionals. Teachers. Lawyers. Civil servants.

That comparison is the trap.

When you benchmark yourself against other people who sell time, the argument becomes about relative hourly rates. And that is an exhausting argument to win because it never ends. Someone will always find a reason why your hour shouldn’t be worth more than someone else’s. But when you price an outcome, the conversation shifts. The question is no longer what is an hour of you worth. It’s what is this result worth, and what does it cost if you get it wrong.

I think some of this is structural. The NHS trains doctors to think in time units because that is how the system is designed. Job plans, clinic slots, rotas. It’s all time. So it makes sense that the culture follows the structure.

But I also think some of it is something older and harder to name. Medicine has always carried this idea that being too focused on money is somehow in tension with caring about patients. That the truly dedicated doctor is above commercial thinking. Surgery doesn’t carry that same weight, maybe because procedural work feels more like a craft, and we’ve always been comfortable pricing craft.

Whatever the reason, the practical effect is this: if you’re always selling time, you will always struggle to justify why your time should cost more. Because someone will always find a cheaper hour. But if you’re selling judgment, expertise, and outcome, the case makes itself. The knowledge that goes into a diagnosis. The pattern recognition built over fifteen years. The decision made at 2am that saved someone from a week of unnecessary treatment. None of that fits neatly into a time slot. And yet that’s exactly how we’re pricing it.

I don’t have a clean answer for what this means. But I think it matters for how the profession talks about its own value. And it definitely matters for what the business of healthcare looks like as AI, physician associates, and new care models start to do more of the time-based work that doctors currently own.

If we don’t change how we frame what we’re worth, someone else will frame it for us.

And they won’t be generous about it.