Doctors Aren’t Risk-Averse. They’re Pricing Risk Wrong.

Here’s a choice. £50,000, guaranteed, today. Or a coin flip: heads you get £100,000, tails you get nothing.

Most people take the £50,000. Mathematically the two options are worth the same, yet the certain one wins almost every time.

Now flip it. You must lose £50,000 for certain. Or you flip the coin: heads you lose nothing, tails you lose £100,000.

Suddenly, most people gamble.

That reversal is loss aversion, and it sits at the heart of prospect theory, the work that helped earn Daniel Kahneman a Nobel Prize. The finding that matters for you is simple: losses hurt roughly twice as much as equivalent gains feel good. As a result, we play safe when we’re protecting a gain, and we take reckless risks to avoid locking in a loss.

Doctors are the textbook case. But not in the way you’d expect.

The salary is the £50,000

Your salary is the guaranteed option. It arrives on time, it rises with your grade, and it sits on top of one of the best defined benefit pensions left in the UK. So any idea that might dent it — dropping a session, spending evenings on something that pays nothing yet — gets filed as a potential loss. And because loss aversion makes losses feel twice as heavy, the idea rarely makes it past the kitchen table.

That feels like prudence. In reality, it’s a framing error, and it has two parts.

Error one: you’ve overestimated the downside

Most founders who fail lose their savings, their house, or the career they walked away from. You don’t. Your registration is a safety net almost nobody else starting something gets. If a side venture flops, you can pick up bank shifts next month. Meanwhile, the skills don’t evaporate, and the demand for doctors isn’t going anywhere.

I know this because I tested it.

Before COVID, I left clinical medicine to work as a financial adviser in the City of London. The pay was commission. On paper, that’s exactly the kind of bet a loss-averse doctor never takes. So I didn’t take it naked. I commuted from North Devon three or four days a week, and I worked shifts in medicine for the rest of the week, with very little time off in between. Medicine paid the basics. Commission could be as good or as bad as it came.

That’s the point most “take the leap” advice misses. I didn’t leap. I kept one foot on the floor.

Error two: you’ve mislabelled the safe option

Here’s the part loss aversion hides. The salary isn’t only a guaranteed gain. It’s also a guaranteed loss — of time.

Every year, a full-time doctor sells somewhere around 2,000 hours at a fixed rate. Those hours are gone the moment they’re worked. Furthermore, when you stop working, the salary stops too. Nothing you did in those hours keeps paying you.

So the real choice isn’t “certain income versus risky business.” Instead, it’s closer to “a certain loss of time with nothing left over, versus a small, capped bet that might build something.”

Once you see it as a choice between two losses, prospect theory predicts something useful. You become far more willing to take the bet.

What the failed bet actually paid

Was my City year worth it? At the time, no. It didn’t work, and the commuting on top of shifts cost me time at home I don’t get back.

In the long run, though, it almost certainly changed my financial trajectory. That wasn’t because of what I earned. It was because of what I learned: finance is a system, with rules, an order of operations and a handful of levers, and most high earners have simply never been shown it. That lesson is the reason Building Out exists.

Crucially, that learning was only possible because the downside was capped. A bet you can survive is a bet you can learn from. By contrast, a bet that ruins you teaches you only one thing — never to bet again.

How I size bets now

These days I’m building Emergency Medicine Update and Building Out alongside clinical work. My rule is simple. I don’t borrow money to get something going, and profits get reinvested into growth. The business funds its own expansion, so the most I can lose is always something I’ve already accepted.

It’s slower. I’m fine with that, because there’s real purpose behind it and I’m building at my own pace.

The system, not the leap

None of this means handing in your notice. Rather, it means replacing a vague fear with numbers. Loss aversion thrives on vagueness, because “what if it all goes wrong?” feels infinite. On the other hand, “the worst case is £1,500 and three months of Tuesday evenings” feels like what it actually is: survivable.

That’s the whole game. Measure the floor. Cap the loss. Name the cost of standing still. Then place a bet small enough that failing is just tuition.

How to beat loss aversion this week

1. Calculate your floor. Add up your essential monthly outgoings — mortgage or rent, bills, food, childcare — and divide by what you’d take home from one bank or locum shift. That’s how many shifts stand between you and “everything’s covered.” For most doctors, it’s smaller than the fear suggests. Clinical work was my floor during the City year, and it’s what made the bet possible.
2. Set an affordable-loss budget. Before you start anything, write down the maximum £ and the hours per week you’ll accept losing over 90 days. This is the affordable-loss principle from entrepreneurship research: decide what you can afford to lose, not what you hope to gain. Mine is built into the structure — no borrowing, profits reinvested — but a written number does the same job if you’re starting from zero.
3. Write out the certain loss. On one page, write the hours you’ll sell this year. Underneath, write what those hours will leave you with the day you stop working. Seeing the “safe” option in the loss column is what flips the frame.
4. Run a pre-mortem on one idea. Imagine it’s six months from now and the idea has failed. List every reason why, then fix the top two before you begin. Finally, add one line: what you’d still have learned if it failed anyway. My failed bet is the reason I think that line matters most.
5. Place the first small bet. Choose one action this week that costs under £100 or three hours. Ask five colleagues whether they’d pay for the thing you keep thinking about, publish one piece of writing, or put up a simple pre-sale page. The goal isn’t success. It’s proof that trying doesn’t break anything.

Use the safety net

Your registration is the safety net. The only question is whether you ever let yourself use it.

So here’s the real question: what’s the “safe” option in your life that’s actually just a slower loss? Tell me below — I’d genuinely like to know.

This post is for educational purposes only and does not constitute financial advice. Always do your own research and, if needed, ask for advice from a qualified financial adviser regulated by the FCA.

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