Series: The Better Bargain · Episode 17 · Pillar 2: Financial Growth
By Rod Gamble | Week 44, 2026 | Pillar 2: Financial Growth
Most of us have sold everything we know to one buyer, at one price, and nobody ever showed us another way.
I include myself in that. For a long time I assumed my work had a price. It took me years to see that it only ever had a buyer — and that I had met exactly one kind.
One Lever, Pulled Harder
When clinicians need more money, we reach for the only lever we have been shown. More hours. In Nurse.org’s 2026 State of Nursing survey — around two thousand nurses, published this April — more than a third said money had pushed them into extra shifts or overtime, and 15% had taken a second job. About a quarter had some secondary income. The survey’s own verdict is the line worth sitting with: most of that income comes from doing more nursing work, not from building an independent income stream.
That is not a second income. It is a longer shift.
Then the premiums harden. An allnurses article this summer called it the golden handcuffs: the overtime and shift differentials quietly become the household budget, and walking away starts to look like a cut of 15 to 25 per cent or more. So when nurses describe leaving, they almost always describe going down. One old forum thread was titled simply “a pay cut for sanity.” A poster in it said they earned about $50,000 a year less than they could, and that it was “SO worth it.” I believe them. I also notice how many people in that thread mentioned a paid-off house.
Doctors wear the same handcuffs in a different metal: debt, family pride, the credential gate. In England, resident doctors accepted the government’s offer in June, and among the details is that the first two attempts at each Royal College exam, and College membership fees, will now be funded. Good news — and a quiet reminder of how much of a doctor’s own money training had been consuming all along. For UK nurses, the RCN says the pay review body process has “achieved nothing but suppress the pay” of the profession, with the next round’s evidence due this autumn. And in physiotherapy, a newly qualified US physio wrote a few years ago that the career “does not pay well in comparison to the price of the education.”
Different professions, one shape. One employer or one payer. A price set somewhere else. A single lever, which is more of yourself. Therefore the question most of us end up asking, usually at three in the morning: if more hours won’t fix it, and leaving means earning less, what is actually left?
Nobody Showed Us
When I brought my college paperwork home, my dad bridged his fingers and asked, “And how are you going to pay for all that?” He wasn’t being cruel. My parents genuinely didn’t know how, because nobody had ever shown them. So I worked, took afternoon work-release, and stuffed my savings into an envelope on the fridge that I called my college sock. That envelope got me through my first semester.
I think about that question whenever a clinician talks to me about money, because I hear the same gap. Our training taught us an extraordinary amount about the patient and almost nothing about the price. One physician put it better than I can, on a doctors’ forum: “we were trained … to not particularly advocate for ourselves. That’s where the problem is, NOT the job market.”
That isn’t a character flaw. It’s a missing lesson. But a missing lesson can be learned.
The Price Belongs to the Buyer
Here is what that gap hides. We assume our expertise has a price, the way a pay band or a fee schedule has a price. It doesn’t. It has whatever price the person buying it puts on it — and most of us have only ever met one buyer.
The clearest example I have read came from a man describing his wife, a physician, changing employers after the pandemic: “Her pay jumps from under $100,000 to close to $400,000. Same work, same city, less headaches, nearly four times the pay.” To be clear, that was one clinical job to another, not a move into digital health. That is exactly why it matters. Nothing about her changed. The buyer changed.
You can see the same thing in digital health. Look up what a nursing informatics specialist earns and you’ll find roughly $91,000 on PayScale and roughly $143,000 on Glassdoor. Same title. That spread isn’t a data error. It’s a market telling you the price is negotiable — and that plenty of people inside it never negotiated.
Now the honest part, because I won’t sell you a queue with no line. An informatics consultant on one nursing forum warned that the analyst market is “beyond saturated” outside revenue cycle, with hospitals “low balling” candidates. A physician on another thread pointed out that the bulk of doctors’ money is still made practising medicine. Both are right. This is not an argument for leaving. Some of us should stay in the hospital, and some of us should move into digital health. Either way, it is an argument for no longer assuming there is only one price — because the moment you have a second buyer, even a small one, your first buyer’s number stops being the only number in the room.
Steps You Can Take Now
1. List three buyers of your judgement who aren’t your employer. A software vendor whose product your ward uses every day. A consultancy delivering an EPR programme. A medical-device company that needs a clinician to explain a workflow. A firm that needs clinical records reviewed. You’re not applying yet. You’re mapping who else would pay for what you know.
2. Get one real price from outside. Pull three current postings, or ask one recruiter what a role using your judgement pays. Write down the range, not a single figure. The range is the truth.
3. Run the fake pay cut. The allnurses piece gets this right: for three months, live on the lower number a first move might pay and bank the difference. If you manage it, you have proved the move is survivable. If you don’t, you’ve learned what to fix first — without resigning to find out.
4. Keep a bridge. Bank shifts, PRN, a part-time contract. Your registration and a few shifts a month are what make trying a second buyer sane rather than reckless.
5. Name what a second income stream is made of. Consulting. Advisory work. Clinical review. Not a “side hustle” pitched in a nursing group by someone you’ve never met. If you can’t say who the buyer is and what they are buying, it isn’t a stream.
Expect the first step to be small and the first move, if you make one, to pay less than you hoped. This is a pricing skill you build, not a door you walk through once.
My dad asked how I was going to pay for it. Nobody in my training ever asked the next question — who else would pay for what I know? Nothing about you has to change for your price to change. Only the buyer does.
When you’re ready to talk, rodgamble.com is where to find me.
#CoachRod #CareerGrowth #careerchange #healthcarejobs #nursingcareers #digitalhealth #digitalhealthjobs #healthcareconsulting #healthcarecareeradvancement #multiplerevenuestreams
References
1. Nurse.org. “2026 State of Nursing Survey: Stress, Pay, Safety & Beyond” (published April 2026). https://nurse.org/articles/state-of-nursing-survey-2026/
2. Nurse.org. “More Nurses Are Working Two Jobs. Here’s Why One Isn’t Enough Anymore” (2026). https://nurse.org/news/nurses-working-multiple-jobs-prn-side-hustles-2026/
3. allnurses.com. “Escaping the Golden Handcuffs” (June 2026). https://allnurses.com/news/why-bedside-nurses-staying-for-paycheck-r75/
4. British Medical Association. “Government offer to resident doctors in England to end the dispute on jobs and pay (June 2026).” https://www.bma.org.uk/our-campaigns/resident-doctor-campaigns/pay-in-england/government-offer-to-resident-doctors-in-england-to-end-the-dispute-on-jobs-and-pay-june-2026
5. Royal College of Nursing. “RCN responds to NHS PRB remit letter 2027/28” (July 2026). https://www.rcn.org.uk/news-and-events/Press-Releases/rcn-responds-nhs-prb-remit-letter-2027-28
6. Student Doctor Network forums. “Residents – do NOT believe attendings who tell you non-clinical options are viable” (public thread, May–June 2024). https://forums.studentdoctor.net/threads/residents-do-not-believe-attendings-who-tell-you-non-clinical-options-are-viable.1496005/
7. Nurse.org. “Nursing Informatics Salary” (2026), with PayScale and Glassdoor salary pages. https://nurse.org/resources/nursing-informatics-salary/ · https://www.payscale.com/research/US/Job=Nursing_Informatics_Specialist/Salary · https://www.glassdoor.com/Salaries/nursing-informatics-salary-SRCH_KO0,19.htm
8. allnurses.com. “Nurse informatics salary” (public thread, January–February 2024) and “Anyone taken a pay cut for sanity?” (public thread, September 2021). https://allnurses.com/nurse-informatics-salary-t756974/ · https://allnurses.com/anyone-taken-pay-cut-sanity-t737663/
