Go ahead. Look me in the eye and tell me the first thing you did when you got that job offer wasn't flip straight to the salary line. That's what I thought. It is an undeniable basic instinct. We've all done it. This behavior repeats your entire career, whether it is your first job, 5th job, or 15th year of practice. Vacation days? Checked. Bonus pay? Calculated. CME allowance? Negotiated. And then somewhere around page 4 of the contract you come across the noncompete clause and the malpractice tail coverage. Certainly, then you probably thought, "I'll deal with that later."
Read Between the Lines
Here's the thing: You just spent the better part of a decade in medical school, residency, and maybe even a fellowship to become one of the most highly trained specialists in medicine. You are so on your game that people allow you to go inside their eye to fix stuff. And yet, when it comes time to enter the workforce, we allow ourselves to reduce our entire professional identity to a number on a spreadsheet.
Your value to an organization goes far beyond your production numbers. This truth is a concept that never becomes apparent until you look for it. Many go an entire career and never realize it exists. The initiative comes from within and requires some reflection with real work. And once you understand that everything changes.
Evolve Beyond Billing Reports
The moment you walk through the door of a practice or health system, you become part of its culture whether you intend to or not. Organizations aren't just collections of exam rooms and billing codes. They're living things, shaped by the personalities, energy, and attitudes of the people inside them. And you are one of those people now.
Think about the colleagues who've shaped your training. There was probably one who always stopped to explain things to the resident, even on a brutal OR day. The one who knew not only the names of office employees' children, but also their sports and summer plans. Then there is also the one who just kept their head down, saw patients each day without complaint, and kept the whole machine running. Cheerleader. Thought leader. Workhorse. None of these roles is lesser. All of them are essential. The question is: Which one are you, and are you owning it?
If you have not done that self-reflection, you may drift into a role that doesn't fit—or worse, join an organization that doesn't recognize or support the role you want to play. Think of the cataract surgeon who is quietly developing drop-free protocols but cannot get her practice to fully adopt them, or the physician-entrepreneur who is trying to innovate with a platform but grows exhausted fighting with management trying to explain what is possible. That mismatch is where resentment quietly takes root.
Aristotle declared, “Knowing yourself is the beginning of all wisdom.” Know what you bring to your job and your culture. Name it. Learn to not deny it—instead, lean into it. That's where your agency begins.
Sit in the Right Seat, or Find the Right Seat
Self-awareness without action is just a very productive form of suffering. Once you know your value, the next question is whether your current environment is actually set up for you to deploy it. Imagine you're a glaucoma specialist who thrives on complex surgical cases: MIGS procedures, tube shunts, the works. But you've landed in a high-volume general ophthalmology practice where the model is efficiency: turnover, throughput, next patient. Nobody is doing anything wrong. It's just the wrong seat. You'll feel it every Monday morning. Or maybe you're a natural innovator. The kind of doctor who lights up by integrating technology and innovation into a practice. One who is not all right with now but looking for what is next. But your practice finds this exhausting and keeps asking, "Why can’t you work with what you have…like the other doctors?" Evolution is a process, but in the wrong setting it becomes painful and feels more like a revolution. Your best energy is going nowhere.
Knowing your value means periodically asking yourself: Is this organization structured in a way that lets me be the best version of what I do? Do I have the surgical volume or types of cases to stay engaged? Is there room to grow, innovate, and evolve? Is there someone above me who actually advocates for my professional development or am I just a production unit with a parking spot? If the answer to most of those is yes, you're in the right seat. If you're wincing at most of these questions or constantly being told to stay in your lane, then keep reading.
Don't Just Simmer: Adapt, Advocate, or Move On
Viktor Frankl said, “Between stimulus and response there is a space. In that space is our power to choose our response.” Response is where most of us get stuck. We recognize the problem. We quietly feel undervalued, underutilized, or just misaligned. And then we do the absolute worst thing possible: nothing. We simmer. We complain to our partners over a glass of wine (a Barolo, hopefully). And we show up Monday and do it all again.
Inaction is a decision. It just happens to be the decision most likely to make you miserable. The good news is you have real options. First, try to change the system from within. It is always best to try to fix where you are. Share your concerns with leadership with honest, direct language that creates a game plan for success. Ask for feedback, outline concrete goals that align with your newly perceived self-value, and set a time to meet again in a few weeks to determine whether change is happening. If you've built a referral relationship with a group of optometrists that's genuinely driving new surgical volume, make that case to leadership with data that support purchasing more innovative technology to stay ahead of competition. If you think your practice should be offering a new IOL technology or a new service line, build the argument and present it. Organizations often want to evolve; they just need someone with the credibility and the initiative to lead the way. A no-drama, pragmatic approach will test your current practice with concepts and plans so obvious that you can quickly know if you still belong.
Second, if internal change isn't happening, take an honest look at fit. Sometimes the organization needs to adapt to you. Sometimes you need to adapt to it. And sometimes, you need to recognize and admit that neither adaptation will not resolve things. In this case, the most professionally courageous thing you can do is plan your exit thoughtfully, without burning bridges, and without waiting another 5 years.
Anger makes for a terrible career advisor. It clouds judgment, strains relationships, and tends to accelerate decisions that should be made carefully. You can be clear-eyed about a situation being wrong for you without being bitter about it. Don't spend your career fighting reality. Assess it clearly, make your move, and go build something better.
You spent a decade training and sacrificing so you could see things that others may miss. It turns out the most important thing you need to look at clearly is yourself. So, the next time you get an offer letter, flip to the salary line first. We all do it and that is all right. Take a moment to picture your name on the door. It means more than your name on the contract. Salaries get renegotiated. Bonuses fluctuate. Vacation days disappear somehow every December. But the value you bring to an organization, the culture you shape, the patients you serve, the colleagues you lift up—those compound every single year. Invest accordingly.