The Physician Scarcity Mindset: What The Psychology of Money Gets Right About “Enough”
I've been thinking about money a lot lately. Reason: I've developed quite the açaí bowl habit, and it’s not been cheap. Fifteen dollars once is nothing. Fifteen dollars twice a week, every week, for a month, and I'm somehow living like the Scrooge McDuck GIF while feeling like the black-and-white toddler throwing money out the window GIF. Both at once. I contain multitudes.
Then our wealth management service (we call them our "retirement guys," which should tell you everything about how seriously I take this) hosted a discussion of The Psychology of Money by Morgan Housel. If you're thinking about thinking about your money more (what stage of motivational interviewing is that?), it's a good one, and a fast read. I'd sum it up as: everybody's running their own race, so keep your eyes in your own lane, and life is unpredictable, so save enough that the surprises don't ruin you.
As physicians, we're in the enviable position of high income. (Still in training? Your time is coming, I promise.) And despite that, I've spent my adult life with a genuinely serious scarcity mentality about money. We've never missed a bill. I've always hit the retirement match. We save outside the 403(b). We give to the causes that matter to us. So where does the fear come from?
The fear is that I'll lose my job, spend down every dollar, sell everything we own (our "assets," I suppose, be still my Scrooge McDuck heart), and end up under a bridge. In this scenario, the extremely obvious possibility that I could just get another job never once enters the math. Somewhere in there, my partner also vanishes, probably because some quiet, insulting corner of my brain suspects he's only around for the salary. (Which has nothing to do with him and everything to do with my own inferiority complex, and I cannot stress that enough.)
Two moments from the book discussion have stuck with me.
The first: if your net worth doubled today, what would change on your calendar? My honest first answer was nothing, because doubling our net worth still wouldn't make me feel safe, which is objectively ridiculous. I am not doing the backstroke through a silo of gold coins, but double what we have now is more than enough for the rest of my life. Someone else in the group said they'd like their housekeeper to come weekly instead of monthly. Head Retirement Guy asked her, gently, whether that actually required double her net worth, or whether she'd simply never done the math on what it would cost now. She hadn't. The point isn't that her fear was smaller than mine. The point is that scarcity mentality doesn't just make us afraid of the worst case; it keeps us from checking whether the thing we actually want is already sitting well within reach.
The second is an old story. At a party thrown by a billionaire, Kurt Vonnegut tells Joseph Heller that their host made more in a day than Catch-22 had earned Heller in its entire history. Heller's answer: he has something the billionaire will never have. Enough.
I think about that word a lot in this line of work, and I don't just mean the retirement accounts. I mean the version of "enough" that shows up when I look at my census compared to my colleague’s. I mean the version that shows up when I've said “no” to a professional society ask and spent the rest of the day waiting for the consequences to arrive. Scarcity mentality doesn't stay in your bank account. It moves into your calendar, your CV, your sense of whether you've earned the right to stop. I have caught myself doing to my career exactly what I do to our net worth: assuming that no matter how much I accumulate, safety is always one more accomplishment away. Doubling it wouldn't help there either.
Heller didn't say he had more than the billionaire. He said he had something the billionaire didn't. That's a different claim, and a better one. It isn't about the number. It's about deciding the number you already have is allowed to be the answer.
So here's what I'm actually asking. Take scarcity out of it for one minute. Not "what more do I need," but "what do I already have." Sure, your finances. But also your practice. Or your schedule. The version of yourself you've spent years trying to prove. What if the number was never the problem? What if you already have enough?