Before I ever held an intramedullary nail, I was holding spreadsheets and pitchbooks.

People look at me bewildered when I tell them I was previously an investment banking analyst before medical school. In finance, I spent countless nights combing through financial models, building DCF valuations, adjusting CapEx ratios, EBITDA margins, and aligning logos to perfection. My role focused on understanding drivers of cost in companies, analyzing mergers and acquisition candidates for synergies, and understanding the role of investment banking.

When I transitioned to orthopaedic surgery, I felt as if I had stepped into a completely new universe — and yet a slightly familiar one. Now, the metrics were radiographs, millimeters of displacement, pain scales, classification schemes, and fractures, fractures, fractures.

As I progressed through residency, I recognized the principles that I learned during my time in finance often held true and consistent in orthopaedics. “Value” remained the same, but the lexicon changed, the stakes changed, and the outcomes became far more human. The goal remained the same: How do we provide the greatest benefit with the finite resources we have?

Orthopaedics is a unique specialty that sits at a crossroads of clinical excellence and economic reality. My background in investment banking has shaped the way that I view this intersection.

Value is About Spending Wisely, Not About Spending Less

During banking, I learned that cutting costs is not the same as creating value. Financial modeling is based on the company’s financial health. Cutting costs could lead to greater profit margins, but at what cost? Does the product suffer? Does the quality of the services being provided fail in the long run?

In orthopaedics, a similar misconception can be encountered, that value-based care means "doing things cheaper." However, this is not the case: the true meaning of value in orthopaedics is about removing what doesn’t work and implementing what does. Clear patient selections, preoperative and postoperative protocols, in addition to the types of implants being used, specific sutures for capsular closure, down to the type of dressing used in the setting of a revision total hip arthroplasty — it is always about what will improve patient outcomes, reduce complications, decrease readmission rates and allow for better patient healing.

Finance taught me that the best investments are those with strong returns over time.

Medicine shows me that the same is true for patients.

Health Care Has Costs You Can’t See on an Income Statement

As I analyzed companies, I was forced to think beyond the financial statements: culture, morale, leadership, and public perception. These intangible factors were key for the future direction of a company. In orthopaedics, there are invisible costs such as the emotional toll of pain, anxiety of disability, the uncertainty of treatment decisions. Working in a trauma center as an orthopaedic resident, we are often intimately privy to the patient’s mentality and its course throughout the hospital stay. Patients are certainly concerned about the literal cost of surgeries, and yet were most often worried about the financial burden of time off from work, daycare for children, the stress of long-term rehabilitation, none of which can be seen in any CPT code.

Finance taught me to analyze every line item quantitatively.

Orthopaedics teaches me to consider the ones that never get written down.

Efficiency is Not the Enemy of Compassion

Residency forces you to become efficient, just as investment banking did. Not because it requires a heartless attitude, but because there is more care to be given and tasks to complete. Efficiency was pivotal in finance — the more accurate your work was in a timely manner, the more projects you would be staffed on and the more experience you would add to your resume. I carried this sense of urgency and efficiency with me to residency. However, I also brought with me the fear that I may come off apathetic or cold. Expectations of an efficient resident are that they have time to thoroughly examine a patient without being rushed, explain consent forms for procedures in a way that is clear and concise, support the nursing staff whenever they can to help manage floor responsibilities, and show up for co-residents whenever help is needed.

Efficiency in banking was about maximizing output.

Efficiency in medicine is about maximizing presence.

Data Matters, But So Does Judgment

Finance is a world of numbers reliant upon accounting, financial models, earnings, projections, and ratios. Yes, the spreadsheet is important, but when valuing a company, judgment always matters.

This is also true in orthopaedics. Two patients may have the same fracture pattern, comorbidities, and radiographs — but different goals. One wants to return to high-demand athletics; another just wants to walk without a limp. The “right” operation might be different for each.

Investment banking taught me that data is a starting point, not the decision itself.

Medicine teaches me that patients aren’t datasets — they’re people with priorities.

Perspective is The Most Valuable Skill I Brought With Me

The greatest lesson learned from investment banking was not related to numbers, or excel worksheets, or money. It was about perspective: learning to zoom out, see the entire system, and ask bigger questions.

In orthopaedics, I now ask:

• How can we build systems that work better for patients and clinicians?
• How do we minimize waste without compromising care?
• How do we protect the doctor-patient relationship in an increasingly "financialized" health care environment?

Residency teaches you how to fix fractures. Finance taught me to examine the structures around them. Put together, they’ve taught me how to spot value — not just in companies, but in people, teams, workflows, and health care systems.

I didn’t think my past life in spreadsheets and client meetings would matter when I stepped into the OR. But it turns out that the lessons I learned there have helped me understand the forces that shape orthopaedic care today. The future of orthopaedics will belong to the clinicians who can deliver excellent patient care while navigating and improving the systems behind it.

Value, I’ve learned, isn’t just a financial concept.

In surgery, it’s a human one.

Nabil Z. Khan, MD, is a PGY-3 orthopaedic surgery resident and former investment banking analyst focused on the future of musculoskeletal care, ASC workflows, and medtech innovation. Connect with him on LinkedIn: linkedin.com/in/khannabil.

Illustration by Jennifer Bogartz