Series: The Better Bargain · Episode 9 · Pillar 2: Financial Growth
By Rod Gamble | Week 36, 2026 | Pillar 2: Financial Growth
Years before anyone paid me well, I started building my career as plans within plans — so no single failure could take the whole thing down.
I didn’t have the language for it then. I just knew that everything around me ran on a single thread: one employer, one wage, one pair of hands you didn’t control holding the scissors. So when it came time to choose a career, I made an odd decision for a teenager. I chose two.
I’ll come back to that. First, let’s talk about this year, because if you work in healthcare in the UK, the US, or Ireland, you’ve just watched the single-thread problem play out in public.
The Year One Salary Showed Its Limits
If you’re in the NHS, you know how the 2026 pay round went. Nurses, midwives and paramedics received a 3.3% award, paid from April — the first time in six years the award has actually landed on time. That is genuinely better process. But the disputes rumble on across almost every grade; Channel 4’s FactCheck team needed a full explainer just to map who is currently in dispute with whom. I’m not going to litigate the politics of any of it, and I’d encourage you not to let anyone else litigate it at you either.
I want you to notice something quieter underneath it. Even when the process works — on time, negotiated, signed — the entire conversation is still about one number, on one payslip, decided by people you will never meet. The phrase I keep hearing from clinicians on both sides of the Atlantic isn’t about the percentage at all. It’s simpler and sadder: “not worth it.”
So the question most clinicians reach for is: how do I get a bigger number? But I think that’s the wrong question. The better one — the one this series exists to ask — is: how many threads is your financial life hanging from? For most clinicians the honest answer is one. One salary, one employer, one banding decision. In engineering we have a name for that. It’s called a single point of failure.
Plans Within Plans
Here’s the decision I made all those years ago. I picked healthcare first, for the most unromantic reason imaginable: there are always sick people. A nursing degree was a bet that could not go to zero. Then I picked a second bet built on pure intellect — computer science. And then I spent the rest of my career deliberately fusing the two.
The fusion wasn’t theoretical. While I was working as a bedside nurse in the early 2000s, I was also finishing a master’s in computer science — and my graduate project was, of all things, hospital information systems. I remember the two halves of the plan touching for the first time and thinking: these don’t know they’re the same career yet. Within a couple of years I was a nurse who coded, working on hospital software — and that fusion became everything that followed: analyst, engineer, programme leader, consultant, and eventually a consultancy of my own.
The stack got tested. Markets turned. Contracts ended, sometimes with a phone call. A pandemic sent me home. I moved my whole life across an ocean and rebuilt in a new country. Individual jobs failed — but the career never collapsed, because it was never one thing. That’s the whole design: three overlapping sets of possibilities, so no single failure could take the system down.
What a Stacked Career Looks Like in 2026
The good news is that the raw material — your clinical credential — is appreciating. Indeed’s analysis of the best US jobs for 2026 found that seven of the top ten are in healthcare, all with six-figure median salaries; nurse practitioners sit around $143,000. Your licence is not the thing holding you back. It’s the most defensible asset in the market.
Digital health itself is hiring selectively. Through this year’s contraction, companies have been cutting product, operations and customer-success teams while restructuring around AI — yet clinical and clinical-leadership roles keep hiring. The moat, in other words, is the clinical background itself. But let me be honest with you, because honesty is the brand: digital health is not a safe harbour. Hazel Health cut 135 staff in February, clinicians included — its second round in four months. A tech employer is still one employer. If all you do is swap one payslip for another, you’ve changed the scenery, not the structure.
Two more honest numbers. First, a first informatics role can pay less than experienced bedside work with differentials — US informatics nurses average around $83,500, clinical informatics specialists around $93,000, informatics managers around $106,000. Financial growth in this field is a trajectory argument, not a day-one raise. Second, landing a first remote role commonly takes twenty to fifty applications. Nobody owes you the fairy-tale version, and you should distrust anyone selling it.
And yet clinicians are quietly building the stack anyway. Roughly four in ten US physicians now run a side gig, and about three-quarters say the work is as fulfilling as clinical practice — or more. Read that again: the fulfilment number is the surprise. This isn’t hustle culture. It’s career design — self employment and consulting income arriving not as an escape hatch but as a second thread, built while the salary still pays the bills. That is what multiple revenue streams actually look like when they’re chosen rather than forced.
Steps You Can Take Now
Inventory your stack. Write down what you already own: clinical judgement, plus every adjacent skill you’ve collected without noticing — audit, teaching, quality improvement, rostering, the spreadsheet nobody else will touch. Most clinicians have two threads already and price the second at zero.
Add one deliberate layer. Pick a single adjacent capability — workflow design, informatics fundamentals, data literacy — and drill it until it’s automatic. One layer per quarter compounds; five started at once collapse.
Open one small stream while salaried. A paid advisory hour. A teaching session. A documentation-review engagement. Career advancement toward consulting income starts with one deliberate deposit, funded by the safety of the job you already have.
Run the single-point-of-failure test. Ask yourself: if my employer vanished tomorrow, what still earns within ninety days? Whatever the weakest answer is — that’s your next quarter’s project.
The pay round will come again next year, and the year after, and it will always be about one number on one payslip. You can spend those years waiting on the number, or you can build the structure that makes the number matter less. One income is a plan. The better bargain is plans within plans.
When you’re ready to talk, rodgamble.com is where to find me.
References
1. Department of Health and Social Care (gov.uk). “NHS pay awards for 2026 and resident doctor strikes: everything you need to know.” https://healthmedia.blog.gov.uk/2026/03/26/nhs-pay-awards-for-2026-and-resident-doctor-strikes-everything-you-need-to-know/
2. Channel 4 News FactCheck. “Will doctors and nurses strike again? NHS pay disputes explained.” https://www.channel4.com/news/factcheck/factcheck-will-doctors-and-nurses-strike-again-nhs-pay-disputes-explained
3. Forbes (Adaira Landry). “Side Gigs For Physicians Boom As Salaries Flatten And Burnout Continues.” https://www.forbes.com/sites/adairalandry/2025/10/04/side-gigs-for-physicians-boom-as-salaries-flatten-and-burnout-continues/
4. Axios (Indeed data). “The best jobs of 2026: healthcare dominates as AI reshapes hiring.” https://axios.com/2026/01/13/ai-indeed-best-jobs-2026-healthcare
5. MD+DI. “The Future of Medtech Jobs Looks Different in 2026.” https://www.mddionline.com/business/the-future-of-medtech-jobs-looks-different-in-2026
6. Xtalks. “Healthcare Layoffs 2026: A Running Roundup.” https://xtalks.com/healthcare-layoffs-2026-a-running-roundup-4622/
7. Payscale. “Informatics Nurse Salary” (and related clinical informatics roles). https://www.payscale.com/research/US/Job=Informatics_Nurse/Salary/a055589e/Early-Career
8. Nursing Flowsheet. “Remote Nursing Jobs That Pay” (application-volume expectations for first remote roles). https://nursingflowsheet.com/remote-nursing-jobs-that-pay/
