There’s a lot you learn in medicine that never appears in a syllabus.
Most of us are familiar with the term "hidden curriculum" — the unspoken rules, values, and expectations you absorb by simply being in a certain system. It’s the stuff you pick up from watching how people act, not from what they say. First coined in education circles in the 1960s, the term gained traction in medical education in the 90s when people began recognizing that what shapes doctors isn’t just what’s taught in lectures — it’s everything else happening in the background.
In medicine, the hidden curriculum teaches us how to navigate hierarchy, how (or whether) to ask for help, how to deal with suffering, and often, how to stay silent about it. But there’s one part of that hidden curriculum that almost no one talks about: money.
From day one, there’s a quiet but firm message that discussing salary is off-limits. You’re here to serve, not to earn. You’re a professional. You don’t talk about compensation. Medicine is a calling — and while that’s true, it’s also a job that demands an enormous amount from you. It requires years of training, huge financial investment, long hours, and personal sacrifice. And yet, talking about pay is treated like bad form.
So we don’t talk. We don’t ask. And we don’t learn.
No course in medical school teaches you how to read a contract. No rotation covers how to negotiate a job offer. There is no lecture on how to structure your billing, understand RVUs, or evaluate partnership tracks. That information simply isn’t offered — not in the formal curriculum, and not in the hidden one either.
To be fair, it’s not entirely the fault of the academic faculty. Many attendings who train residents have never been in private practice themselves. They’ve never had to negotiate directly with insurance companies, run a practice, or consider buying into a surgery center. They may be brilliant clinicians and generous mentors, but they often don’t have the real-world business experience to pass along. So it’s left to the trainees to figure it out on their own.
And that’s exactly what they do. They turn to online resources like "White Coat Investor," "Physician on FIRE," "The Prudent Plastic Surgeon," and others, trying to learn as quickly as possible how to manage a paycheck that suddenly arrives after years of earning next to nothing. That kind of self-education is valuable, even empowering. However, for many, it’s too late and doesn’t fully compensate for the gap in formal training.
We wouldn’t send residents into practice without preparing them for critical clinical scenarios. Why do we send them out financially unprepared?
Even among colleagues, salary remains a taboo topic. Most doctors don’t know what others in their specialty, or even in their own group, are making. They’re even more unlikely to know the details that really matter: productivity numbers, RVU rates, and call stipends. Without that information, it’s hard to know where you stand. And national averages don’t tell the whole story. They don’t show the wide salary spread within a single specialty, or what's possible depending on region, call burden, productivity, or practice structure. When we don’t see those numbers, we can’t advocate effectively for ourselves. We don’t know what to ask for or what’s fair.
This silence doesn’t protect us — it holds us back. It perpetuates inequities, complicates contract negotiations, and forces physicians to make career decisions in the dark. When we don’t understand how compensation works or have appropriate benchmarks, we risk undervaluing ourselves and accepting roles that don’t reflect our worth or priorities. Over time, that misalignment can lead to simmering resentment, emotional exhaustion, and, ultimately, burnout.
Transparency changes that. It builds trust in a system that often feels obscure and gives physicians agency and information to navigate their careers with intention. Fair compensation isn’t always about earning more — it’s about earning appropriately. When we understand how we're paid and why, we can confidently choose roles that align with our values, lifestyle, and long-term goals.
It’s time to shine a light on this part of the hidden curriculum and bring it out of the dark. The next generation of physicians deserves more than vague whispers and haphazard Googling. They deserve structured education, honest mentorship, and open conversation about the business of medicine. They deserve to graduate not just as competent clinicians, but as prepared professionals ready to step into all types of practice and know what they’re worth when they do.
Talking about the business of medicine isn’t selfish. It’s necessary. And it’s long overdue.
What do you wish you were taught about physician finances in medical school? Share in the comments!
Dr. Rob Anderson is a practicing anesthesiologist in Richmond, VA and the co-founder of Marit Health, which brings salary transparency to medicine.
Image by invincible_bulldog / Getty
