A surgeon once told me this while on an all-too-rare vacation week.<\/p>\n
\n\u201cIf I\u2019m not working, I\u2019m falling behind.\u201d<\/p>\n<\/blockquote>\n
He was sitting by the pool, laptop balanced on his knees, answering hospital admin emails between bites of breakfast just before logging on to have therapy with me.<\/p>\n
He wasn\u2019t short on money (far from it). He wasn\u2019t behind on bills. But the idea of \u201cresting\u201d or \u201cslowing down\u201d made him deeply uneasy. It was clear to me that somewhere along the way, he had absorbed an unspoken yet powerful unconscious belief that time not spent producing, earning, or staying ahead was dangerous. That\u2019s a money script in action.<\/p>\n
What\u2019s a Money Script?<\/p>\n
The term \u201cmoney script\u201d comes from financial psychology. Think of money scripts as the deep-seated beliefs about money you picked up somewhere along the way in life without even realizing it. It could be from childhood (as is often the case), society\/culture, medical training, your peers, and life experience. Money scripts run like background software in your finances and how you move through life (financially and otherwise) throughout your adulthood.<\/p>\n
Most of us don\u2019t even realize we have them. They\u2019re usually not logical rules that we consciously decided to follow. They\u2019re more like reflexes. And when you\u2019re a physician, they\u2019re often amplified by the culture of medicine.<\/p>\n
As Ramit Sethi (a well-known financial expert<\/a> and a huge proponent of money scripts) likes to say, \u201cMoney is never just about money.\u201d Money is about identity, safety, love, belonging, self-worth, and more, all tangled together.<\/p>\n
8 Money Scripts I See All the Time in Physicians<\/p>\n
Over the years, both in my therapy practice as a psychologist for doctors<\/a> and at home as the spouse of a physician, I\u2019ve noticed certain money scripts that keep emerging. Some are quite predictable. Others might surprise you.<\/p>\n
Here are eight of the most common money scripts I see among doctors, paired with real-world examples.<\/p>\n
#1 Scarcity Mindset<\/p>\n
\n\u201cNo matter how much I have, it could disappear tomorrow.\u201d<\/p>\n<\/blockquote>\n
A pediatrician earning $400,000 per year still checks the clearance rack before buying clothes. She maxes out all retirement accounts, has a healthy emergency fund, and has no debt. But she can\u2019t shake the feeling that she\u2019s one bad decision away from losing everything.<\/p>\n
Turns out, her childhood was fraught with instability, having come from a rural working-class background where her father hopped from job to job while her mother clipped coupons, worked grueling night shifts, and scoured garage sales. This pediatrician\u2019s scarcity mindset money schema was deeply shaped by her upbringing.<\/p>\n
Medical training reinforces this: years of delayed gratification, low pay, and debt make abundance feel temporary and fragile. The result? Overworking, oversaving, and underenjoying your money.<\/p>\n
#2 Overcontrol<\/p>\n
\n\u201cIf I don\u2019t manage every detail, something will go wrong.\u201d<\/p>\n<\/blockquote>\n
An anesthesiologist I worked with in therapy used to spend hours every week reviewing his financial spreadsheets to the penny, all the way down to categorizing his kids\u2019 snack purchases. Yikes. His wife begged him to delegate these menial tasks to an accountant and a financial advisor, but letting go felt impossible for him.<\/p>\n
For this anesthesiologist, the overcontrol schema was molded by both childhood and his medical training. His childhood was fraught with chaos and instability in his parents\u2019 marriage, and he got into med school only after getting a near-perfect MCAT score that helped him recover from a less-than-stellar GPA.<\/p>\n
Perfectionism may serve you in medicine to some extent\u2014until it doesn\u2019t. With money, overcontrol can often be a mask for underlying anxiety<\/a>, disguised as diligence or \u201cbeing responsible.\u201d<\/p>\n
#3 Guilt About Wealth<\/p>\n
\n\u201cI shouldn\u2019t have more than other people.\u201d<\/p>\n<\/blockquote>\n
One of my therapy clients was a hospitalist from a modest background, and she told me she felt like an impostor in her own life. Her parents had never made more than $50,000 a year, and now she was earning eight times that<\/a>. When friends from home talked about struggling with rent, she\u2019d downplay her salary in an attempt to preserve the image of still fitting in with them.<\/p>\n
For many doctors, guilt creeps in<\/a> when your financial reality starts to look very different from the people you love or with whom you grew up. You might feel uneasy about having more, especially if you still carry the values of frugality, self-sacrifice, or fairness from your upbringing. And the medical profession itself can amplify it: when you see patients who can\u2019t afford basic care, the contrast between your paycheck and their circumstances can be jarring.<\/p>\n
The risk is that guilt can quietly drive financial decisions. You can unconsciously avoid opportunities to increase your income, underspend on yourself, or sacrifice yourself in ways that undermine your own security\u2014all in an unconscious effort to \u201cbalance the scales.\u201d<\/p>\n
#4 The \u2018Deserve’ Narrative<\/p>\n
\n\u201cI work hard, so I deserve to spend however I want.\u201d<\/p>\n<\/blockquote>\n
After paying off $250,000 in med school loans, an orthopedic surgeon rewards himself with a luxury SUV, a boat, and multiple high-end vacations\u2014all within a year. The spending initially feels euphoric, until the monthly payments become suffocating and eventually catastrophic.<\/p>\n
This \u201cI deserve it\u201d narrative can be a pendulum swing backlash against years of restriction during medical training and even further back to childhood. Again, years of delayed gratification can perniciously creep up on you like this once you have more resources if you don\u2019t stop to check yourself. Lifestyle creep<\/a> feeds into this, too\u2014especially when this money script plays in the background unacknowledged.<\/p>\n
#5 Endless Comparison<\/p>\n
\n\u201cI\u2019m doing well . . . but they\u2019re doing better.\u201d<\/p>\n<\/blockquote>\n
An ER doc friend once told me that he felt good about his savings rate until a colleague casually mentioned their passive income from rental properties. Overnight, his own progress felt small. He hadn\u2019t cared about real estate the day before, but now he was researching duplexes on his lunch break.<\/p>\n
Medicine trains you to measure yourself against others: board scores, match lists, case volume, RVUs. That same competitive lens can follow you into your financial life. You might feel fine about your financial plan until you learn what your co-resident-turned-orthopedist is pulling in with their annual salary.<\/p>\n
The trap is that there\u2019s always someone ahead in some category: higher net worth, bigger house, more vacation days, earlier retirement plans. Comparison can keep moving your goalposts until no achievement feels like enough. It\u2019s exhausting and corrosive to joy and contentment in life. It quietly robs you of the life satisfaction that is available all along.<\/p>\n
#6 Martyrdom Spending<\/p>\n
\n\u201cSpending is bad. And if I spend, I should spend all my money on my family, kids, or community. But not on myself.\u201d<\/p>\n<\/blockquote>\n
One of my therapy clients was a specialist physician who funded her niece\u2019s college tuition and her parents\u2019 mortgage and donated heavily to patient charities. These can all be admirable things in isolation. But she had paltry savings for her own retirement, and she hadn\u2019t taken a personal vacation in a decade. That\u2019s not OK.<\/p>\n
It took a lot of work in therapy and otherwise for this doctor to unearth how her self-martyring financial behaviors stemmed from unprocessed experiences from childhood, medical training, and other dynamics that reinforced to her the idea that to be considered \u201cgood,\u201d \u201cworthy,\u201d or \u201ccompetent,\u201d she had to put others before herself.<\/p>\n
Martyrdom can feel noble, but over time, neglecting your own security, needs, wants, and desires can risk breeding burnout<\/a>, resentment, poor boundaries, harmful self-sacrificial tendencies, and more.<\/p>\n
#7 Avoidance from Fear of Admitting Vulnerability<\/p>\n
\n\u201cIf I buy X, it means I\u2019m admitting I\u2019m not invincible.\u201d<\/p>\n<\/blockquote>\n
A healthy 40-year-old neurosurgeon delayed buying disability insurance<\/a> for years. He knew he should, but he kept putting it off for one excuse or another. Reaching out to an insurance agent to shop policies, much less signing the paperwork, felt to him like he was tempting fate\u2014as if to make the prudent choice to take out a policy would somehow mean that he is acknowledging he might not be able to work forever, or the even more terrifying possibility that something catastrophic could happen to him that would necessitate no longer having the ability to work.<\/p>\n
In therapy, we discovered that some of the roots of his avoidance stemmed from unprocessed grief and deferred meaning-making about the experience of suddenly losing his father in middle school due to a stroke from an undiscovered brain tumor.<\/p>\n
The avoidance mindset can block physicians from making protective investments, from the big tasks\/decisions like disability insurance or estate planning, and all the way down to the littlest of things like buying much-needed ergonomic equipment (oh my).<\/p>\n
#8 Money Avoidance<\/p>\n
\n\u201cIf I don\u2019t think about it, it\u2019s not a problem.\u201d<\/p>\n<\/blockquote>\n
A hospitalist making $300,000 a year didn\u2019t know his mortgage interest rate, how much he had in retirement, or his retirement asset allocation. Between work, parenting, and call shifts, he simply ignored his finances\u2014until a surprise tax bill caught him off guard.<\/p>\n
Avoidance often hides under busyness, but the costs (literal financial costs and otherwise) always inevitably surface when just the slightest thing blindsides you.<\/p>\n
More information here:<\/strong><\/p>\n
Strengthening Your Mental Health<\/a><\/p>\n
Burnout Is Expensive: The Financial Case for Prioritizing Mental Health<\/a><\/p>\n
Why Money Scripts Are So Hard to Change<\/p>\n
Knowing your money script isn\u2019t the same as changing it. Here\u2019s why they tend to stick around.<\/p>\n
#1 They\u2019re Wired into Your Brain<\/p>\n
From a neuroscience perspective, early experiences form \u201cdefault settings\u201d in your emotional memory networks. Those parts of the brain operate faster than the logical, problem-solving regions. That\u2019s why you can know you\u2019re financially secure but still feel anxious about spending. Your emotional brain is running an older, louder program.<\/p>\n
#2 They\u2019re Tied to Identity<\/p>\n
Psychologically speaking, money scripts are rarely just about money. They\u2019re often about our identity: who you believe you are. If you have a self-image of yourself as \u201cthe responsible one,\u201d \u201cthe provider,\u201d or \u201cthe one who never wastes money,\u201d then questioning those deeply seated, self-protecting beliefs can feel like a threat, as if it\u2019s upending your entire sense of self.<\/p>\n
#3 The Culture of Medicine Reinforces Them<\/p>\n
Medical training hardwires habits like delayed gratification, self-sacrifice, perfectionism, guilt\/anxiety, putting others first, etc. It\u2019s a perfect breeding ground for certain money scripts. Those habits and qualities may have helped you survive residency, but they can also lock you into financial patterns that no longer serve you post-training.<\/p>\n
#4 Behavioral Economics Plays Against You<\/p>\n
Biases like loss aversion (fearing losses more than valuing gains), confirmation bias (seeking proof for what you already believe), and status quo bias (preferring the familiar) keep old scripts in place. You\u2019re more likely to defend your habits than test them, much less do the work it takes to revise them.<\/p>\n
#5 They Often \u2018Work’\u2014Until They Don\u2019t<\/p>\n
A scarcity mindset might have kept you from overborrowing or overspending in med school. Overcontrol might have prevented costly mistakes while in training, and when a belief has \u201cprotected\u201d you in the past, it\u2019s hard to believe it could be limiting you now. Letting go can feel risky. It takes active effort both to see how you might be limited by outdated scripts and to put in the work of personal reflection and habit formation\/practice to change them.<\/p>\n
#6 They\u2019re Emotionally Self-Reinforcing<\/p>\n
Scripts create behaviors, which create outcomes that seem to \u201cprove\u201d the script is true. For example, if you believe \u201cspending is dangerous,\u201d you might avoid buying what you need and then feel validated when your bank account grows, reinforcing that belief.<\/p>\n
#7 Change Requires Tolerating Discomfort<\/p>\n
Whether it\u2019s spending a little more than feels safe, delegating investment decisions, or simply checking your accounts after months of avoidance, rewriting a script means sitting with anxiety, guilt, or uncertainty in the short term. That\u2019s not easy, especially for people trained to avoid mistakes at all costs.<\/p>\n
How to Start Rewriting Your Money Scripts<\/p>\n
Rewriting a money script isn\u2019t about flipping a switch. It\u2019s more like updating old software while the program is still running. It can be hard and it takes active effort, but it is definitely possible. Here\u2019s how to start.<\/p>\n
#1 Identify Them<\/p>\n
Start paying attention to your automatic money thoughts and behaviors, as well as the feelings that come up when you notice those thoughts and behaviors. Notice when you feel a quick emotional charge around money decisions. It could be a buzz of anxiety, a wave of guilt, or a sudden rush to defensiveness. \u201cAlways\u201d and \u201cnever\u201d statements are often a good giveaway.<\/p>\n
#2 Ask Yourself Where That Money Script Came From<\/p>\n
Trace back the belief. Was it something a parent said often? A painful lesson you learned during a financially tight year? Something you absorbed while observing peers in training? The origin story matters because it gives you a clue about whether the belief was built for your life vs. someone else\u2019s. Knowing where a script originated is the first step to deciding what you want to do with it moving forward\u2014be it changing it altogether, softening its hold on you, reshaping your relationship with the extent to which you let it run across your life vs. making it context-dependent, or anything else.<\/p>\n
#3 Test the Money Script Against Your Current Reality<\/p>\n
A script that kept you afloat in med school may not make sense when you\u2019re earning six or seven figures. Ask yourself: \u201cIf I learned this today, would it still make sense for me to believe it?\u201d Ask yourself whether this belief serves your life now or whether you\u2019re running on an older program.<\/p>\n
#4 Reframe, Don\u2019t Erase<\/p>\n
Throwing out a money script completely can feel unsafe or scary. Instead, start by trying to adjust it to fit your present reality. For example, \u201cI can\u2019t spend anything\u201d can become \u201cI can enjoy what I have and save responsibly.\u201d That balance helps reduce emotional whiplash.<\/p>\n
#5 Create Small, Safe Experiments<\/p>\n
If you tend toward scarcity, try spending a modest amount on something meaningful and sit with the discomfort of it, without undoing it. If you overcontrol, delegate one small piece of your finances and see what happens. If you tend to be susceptible to the martyr complex, try siphoning money to your own savings\/investment account that you previously earmarked for someone else. The goal is to gently expand your tolerance for new patterns.<\/p>\n
#6 Get Outside Perspective<\/p>\n
It\u2019s really hard for us to see our own blind spots. Trusted friends, a financial advisor, or a therapist (like in my practice) can reflect what they notice and help you challenge and remold unhelpful scripts.<\/p>\n
#7 Track Progress and Feelings, Not Just Numbers<\/p>\n
Pay attention to how changes in your money habits affect your stress levels, relationships, and overall satisfaction, rather than just your net worth. Sustainable change often shows up emotionally before it shows up financially. You might even try journaling about it or starting a habit tracker to monitor things over time.<\/p>\n
More information here:<\/strong><\/p>\n
Flourishing at Work: What Physicians Get Wrong About Career Happiness<\/a><\/p>\n