Ali Abdaal on Building a YouTube Empire, Personal Branding and Passive Income as a Medic

Yeah, absolutely. My journey was very good, thank you very much for asking — the traffic was a bit delayed. Whatever those softball questions are.

I would make a personal website, under my real name. I'd hope the domain aliabdaal.com hadn't been taken — it probably hasn't at this point. And I'd do a lot of writing online.

I'd start with all the books I've ever read and all the podcasts I've ever listened to that have resonated with me. I'd write notes on those, so it becomes almost a curated source where people can come and find interesting book and podcast recommendations. Once I've got a system for that, I'd trawl through PubMed and find research papers you can gain interesting insights from — a lot of psychology, maybe some neuroscience. And I'd summarise the insights from those scientific papers in a way people can apply to their lives.

There are all sorts of places on the internet where you can find links to obscure PDFs — you know, that study from the 1970s that looked at swimmers and the factors that made some of them elite performers and some just club-level. Those are long, 30-page papers, but as a medic, as someone who knows how to read papers, I could draw out the insights and turn it into a nice blog post. Then I'd summarise the blog post as a series of tweets, and start regularly tweeting everything I've read, watched and listened to. I'd try to build up my personal brand as being the guy who distils difficult-to-find information from obscure sources and makes it easy for the masses.

Then I'd make a YouTube channel doing exactly the same thing. The idea would be to create once and chop multiple times — this is something Gary Vee says a lot. One pillar of content, the summary of a paper, then chopped into Twitter, blog, YouTube, Instagram, whatever. That's how I'd rebuild from the ground up.

I'd probably still make a video about how I ranked first in Cambridge, just because it's a good clickbait title. But I wouldn't make any getting-into-med-school stuff. I get so many calls from medical students, usually first or second years, usually Asians, who say, "Hey, I want to make a business, I want to make money online — why don't I teach BMAT or UCAT?" And I just think: oh God, because that's literally the lowest-hanging fruit. Any Asian with a shred of entrepreneurialism is going to want to do that.

And fine — that's literally exactly what I did. But back in 2012 there were far fewer people in the market, and it was much harder to make a pretty-looking website. Just by having one, I could differentiate our services in a way other people couldn't. These days it's 2020. Every year, ten of these new companies start and ten of them flop, because everyone realises there's money to be made and thinks, "Why don't I undercut the market?" It's a fun, easy business to start — if you want to learn about business it certainly beats an online business course. But there are so many better things you could do that are a bit more unique, rather than this very well-trodden "why don't I private-tutor people about UCAT" situation.

I feel very strongly about this, because a lot of medical students who are very much like me are wasting their time tutoring UCAT when they could be doing something so much more fulfilling and interesting — something that teaches them more than "hey guys, this is how section one of the UCAT works."

Absolutely. Yes. 100%.

I can't imagine why it wouldn't work. The only two things I needed for it were faith and consistency. Provided you have the consistency, and you can maintain the faith that at some point it will work, then it just will. I cannot imagine a universe in which a well-put-together, nicely designed, nicely curated website — with summaries of books and podcasts and scientific papers — would not be successful. The only world in which it fails is if someone doesn't stick with it for two years.

Given everything I've done over the last eight years of doing this stuff, I'd tell myself not to expect any growth at all. The mistake people make is: "Well, I've written my first blog post but no one's reading it." And it's like — all right, mate, write a blog post a week for the next two years and then come back to me and see if still no one's reading it. At that point you can start to expect something. But at the start, you've got to put stuff out into the void. You've got to shout into the open and no one's going to listen — but you've got to keep doing it to have any chance of making it big.

At least once a week. Twice or three times is even better, but at least once a week — showing up every single week. Setting up an email newsletter is a very easy way to do that, and it's one of the things that most changed my writing habits. I had a blog in 2016 and intended to write a post every week, but it never happened — I wrote maybe three blog posts in two years. Then in April 2018, when I started my email newsletter, I sent one out every single Sunday. For the last 112 weeks or whatever, I've sent it every Sunday. I think I've missed two weeks where I forgot and had to send it Monday morning instead. That's 112 weeks of consistently writing something and putting it out there.

Some weeks I'd think, "Oh crap, it's midnight on Sunday, I don't know what to write, let me just make something up." A few of those have really resonated. I made up this random thing called the "write-off principle" — at the end of the day you can decide to write the rest of the day off and do something unproductive. But I spelt it R-E-I-T-O-F-F, so it sounded like some German philosopher who came up with it. And loads of people emailed being like, "Oh my God, this write-off principle has changed my life." I still get tweets about it. And that was just some drivel I came up with because I had to send an email out.

So if you can apply consistency to whatever you're doing and just keep showing up week after week, eventually it grows and good things happen — but you can't predict the good things. That's the point. You're doing what David Perell calls creating a "serendipity vehicle" — this thing that allows people to find you and your stuff even while you're sleeping. That's the aim of building a personal brand.

I'm saying everyone should have a mailing list, because everyone has email. It's the one thing everyone checks every day. If you're a secondary-school student without a good reason to use email, then fine — you and your friends probably don't check it. But as soon as you get to university, all communication is still done by email. I don't think every society you sign up to is using Microsoft Teams or Slack yet. And especially when you go into the world of work, everyone uses email for everything.

The nice thing about a mailing list is that it's the only thing you actually control. I don't own my audience on YouTube. I don't own my audience on Instagram. But I do own the emails on my mailing list — I can do whatever I want with them. Those people have signed up to actively hear from me every week. So in a few years, if I want to write a book or launch a product, I've got a mailing list of a few thousand — a few tens of thousands — of people who immediately want to hear what I have to say. That's the value of a mailing list.

Yeah. Whenever you're building an audience on a platform, you've got to be slightly concerned about platform risk. Think of the people who were big on Vine — then Vine disappears. Where does that audience go? Some took to Twitter, some to Snapchat, some to YouTube and were very successful. But the ones who didn't lost their audiences essentially overnight. That's a bad thing.

I don't think that'll happen with YouTube — it's now "too big to fail." But we've heard that before. So one of the things that keeps me up at night is the level of risk in having all my eggs in the YouTube basket. It's a big priority to grow the YouTube audience, but also to funnel some of it into the podcast, Instagram and email newsletter — with the mailing list as the ultimate destination, because that's the only thing I control. How do I make my own personal website a destination people would be happy to go to even if my YouTube wasn't a thing?

I think it's important to start in one domain. If people listening to this suddenly go, "Right, tomorrow I'm starting a YouTube channel and an Instagram and a newsletter and a podcast" — that's not going to work. It's like forming any new habit: you don't want to start meditating and reading an hour a day and stretching and doing pull-ups all at once. Start with a single thing, make sure you can do it consistently, then add over time. Then you get the cross-pollination — if you grow on YouTube and want to create a newsletter, great, you've got people to funnel into it, and vice versa. Start with one, then diversify, because you don't want the platform risk.

Everyone has a personal brand whether you like it or not — it's just your professional reputation. Whether or not you're actively thinking about it, you have one, and everyone listening does or will. Think of the consultants you've been on placement with: they have personal brands. They might have a website advertising their private practice; they might be well-known in upper-GI surgery for a particular oesophagectomy technique they present at conferences. We all have personal brands to some capacity. And since you can't get away from it, it makes sense to think about how to curate it in the way you want.

For me — I don't really care about niche medical topics these days. You're not going to find me writing about GLP-1 antagonists, unless they relate to anti-ageing, in which case fair enough, because that's something I'm interested in. But you might find me teaching about general personal development, health, happiness, productivity. It's about figuring out what you want your personal brand to be, and then getting started.

As for the benefits — they're things you can't really predict. The most obvious benefit is that you can monetise it further down the line. If I want to make a new Skillshare class or write a book, I know I've got an audience of people who'll buy the thing. So there's a very clear monetary return on investment. But on top of that are the opportunities you wouldn't have predicted — people like you reaching out via the podcast, making friends over the internet. I've started doing YouTube live streams with people I admire from all around the world, and now those people have become friends. If I want to go to Oxford and hang out with Derek Sivers, or go to America and hang out with YouTubers I've looked up to, I now can, because I've connected with them through the personal brand. It's all very serendipitous — you can never predict it, but the more you put yourself out there, the more surface area you create for these serendipitous events to happen to you.

But one of the issues we have as medics is that we tend not to do stuff unless there's a clear ROI on it. We think: how will this benefit my CV? How many points will this get me for my FPAS application, so I can apply to a London deanery, so I can get 87 points rather than 84? We think in these ridiculous ways — I need to do A in order to lead to B.

That's the mindset we've all grown up with: get the good grades, get the good A-levels, get to a good university, get your good F1 job, get your good ST3 job, and then maybe you'll be happy. Almost every medic I've spoken to — and this was certainly a problem for me — finds it really hard to do anything if there's no clear, immediate value add. Building a personal brand is one of those things where you never know what it's going to lead to. You just have to have the faith and the consistency. And if you have both, you'll succeed in whatever definition of success you want to use.

So, what is productivity? Most definitions would say it's output per unit resource. If you're a factory owner, the productivity of your factory might be output per worker, and you'd have a more productive factory if you got more output per worker. That's an industrial-revolution definition.

In the modern day, for knowledge workers, productivity is more output per unit time — how much can I get done in as little time as possible? But we need to add a caveat: it should be useful output divided by time, because there's no point spinning on a hamster wheel outputting loads of stuff if it's not useful. So you define what useful means to you — what are your goals, what are you aiming for? — and then, if you can increase your useful output or decrease your time, you're becoming more productive.

The real insight, which I came up with randomly in the shower, is that when people ask how I'm so productive, it's not that I do more useful output or spend less time. It's mostly that I have a lot of fun doing all the things I'm doing. So there needs to be an F in the equation — a fun factor that everything gets multiplied by — because the more fun you can have, the more productive you're naturally going to be. You can have the same useful output over time, but if you're having twice as much fun as someone else, you're implicitly going to be more productive. There was a tweet by Tiago Forte recently — just two days ago — where he said you can't compete against someone who's having fun. And I thought, that is so good. You really can't. So when people ask what book they should read, what language they should learn to code in, what they should do with their life, a big part of the answer is: do what you enjoy. Because it makes you more productive, and it makes life more fun.

It depends on the scale. Say I'm just starting a YouTube channel — my unit of useful output would be videos released. I might think I'm being productive by listening to loads of podcasts, but that's not useful output, it's just output. Or I might feel productive taking notes on loads of stuff I'm reading — but unless I'm producing something I've defined as useful, I'm not actually being productive.

These days I'm at a different scale. It's not "how do I bring myself to make a YouTube video," it's "how do I make the best video I can?" Things that feel productive might not be useful — spending five hours researching some niche bit about the Microsoft Surface, when I'm not going to make a video on it and my audience doesn't care about the niche aspects. That's not useful output, that's just spinning the hamster wheel. What I'm thinking now is: where are the bits in the system where I can personally apply leverage — use my own brain, my own insight, to generate value someone else couldn't? I've got two full-time team members now, and I often ask: what's something I should be doing versus something they should be doing? That's how I define useful. We all know what's actually moving the needle versus "I've spent all day listening to podcasts and reading books but I didn't really produce anything."

This is probably not relevant to a lot of people, but that's fine. With the whole YouTube thing, people always ask, "How do you have time to make videos when you're a full-time doctor?" At the start I was doing everything myself, and it was about being super personally productive — organising your time so you can batch-film videos, learning to edit really quickly, because any time you shave off editing is time saved for other things. You're juggling lots of balls, trying to keep everything afloat.

But once you're making enough money that you can look to scale, hiring your first team member becomes incredible. Around June 2019 I first started working with a freelance video editor. Immediately that was magic. He charged £25 an hour and spent about four or five hours per video — so around £125 a video. I was making about £500 a month from AdSense at the time, so I knew I could afford for him to edit four of my videos a month. Offloading the editing meant I could spend my own time on the bits unique to me. I'd thought no one could match my editing style, but within a few videos and a bit of feedback, this guy was matching it. So I realised — actually, I'm not that special. Editing videos isn't that hard: you cut out the pauses and the hundred mistakes, add some timestamps and a few pictures. I'd film a video, send it via Google Drive, and within two days get a complete video back. It felt like a superpower.

Then, after chatting to a friend and mentor, I took the plunge on a full-time employee. At the time I really couldn't afford it — I wasn't making enough per month to justify the salary. But my mentor said: when you have a full-time employee, you'll find things for them to do, and magically your output and revenue will increase, because you're very incentivised to give this person work since you're actively paying them. So I put out a post on my website looking for a head of content. This guy Christian, from Romania of all places, applied and got the job because he was amazing — a really good writer and editor, also a graphic designer, who'd been working for a YouTuber for ten years. Initially I'd thought I'd hire someone in Cambridge I could meet in person weekly, but Christian was a jack of all trades, so he became the first full-time hire.

Then around January 2020, this guy Angus emailed — he'd stumbled across the job posting on the Cambridge careers website. He'd just graduated from Cambridge, wanted to be a journalist, and was doing freelance projects. I said, let's try you out one day a week writing scripts. He was amazing, just churning out content, so it went up to two days, then three, then four. Then he lost some of his other gigs thanks to coronavirus, so I thought, I can snap this guy up. He's been full-time for a few months and it's been amazing. It's probably not applicable to most people, but the advice I'd give is: as soon as you've got revenue coming in from your side project, think about hiring a team, because the possibilities it unlocks are absolutely incredible.

I'd want to teach the basics of graphic design — making stuff look pretty. What is good typography? What's good spacing when you have text? Tweaking typography just a little adds a huge amount of production value. If you look at posters at most medical conferences, they look terrible, and the reason is bad colours and bad typography. Even just spending an hour going over examples of good line spacing and letter spacing immediately makes every single thing you produce for the rest of your life look better — a conference poster, a PowerPoint, teaching slides, even a physical paper.

I'd also teach video editing. There was a tweet going around that video editing is the new coding, and given video keeps going up as a platform, understanding the basics is really helpful. Because of coronavirus there are all these virtual conferences now. We recently submitted something to ASME — the Association for the Study of Medical Education — which asked for video submissions, and because I knew how to edit, ours was pretty good and the others weren't; they'd just recorded a Zoom call. That's another very basic, easy-to-learn skill you'll have for the rest of your life.

Beyond that, I'd set a personal project so that by the end everyone has their own website — their real name on a domain — and their own email newsletter. For the rest of the four weeks, each week they'd write an assignment about something they're interested in and send out a newsletter. By the end they've sent four newsletters, they've got the website, everything's sorted. That sets them up for success later in life, however you define it.

There's a Chrome extension called Muzli — M-U-Z dot L-I — which replaces your new-tab page with web-design and graphic-design inspiration. Just having that as a bare minimum, so every time you open a tab you see examples of good design, is a good starting point. Over time you appreciate what makes design look pretty, and next time you're writing a proposal or PowerPoint or poster, you start applying those principles. If you haven't seen what good typography looks like, you won't appreciate it when your own looks amateur. Why does the Apple website always look so nice? A big part is the typography and letter spacing. If you tweaked the letter spacing it would look terrible, and you'd think, who made this website, why is it so amateur? But you don't appreciate white space and line height until you've seen lots of these websites.

The whole passive-income lifestyle is what I've been chasing ever since I read The 4-Hour Workweek back in 2011 or 2012. To now be in a position where medicine makes up only a small chunk of my overall income is very nice. It gives me the freedom to do what I'm doing from August — taking an F3 year. Instead of thinking, "I need a clinical fellow job in London" or "I need to get onto a locum bank," I can literally do whatever I want. It gives me the option of, for example, travelling the world, if the lockdown rules open up by then.

When you're not reliant on medicine for income, it changes things. At the moment there are all sorts of issues with the rotas and coronavirus, and a lot of my colleagues are struggling — messages in the WhatsApp group quibbling over whether we'll be paid for extra hours. Chatting to registrars and other trainees, there's a real sense of, "I'm trying to get on the property ladder, how do I get the money for a house? I've got kids, my partner's a doctor too, how do we make this happen with childcare?" Even when you're a doctor the money problems don't go away — we all struggle to get onto the property ladder. Having multiple streams of passive income means if you want to get on the property ladder it's not that hard.

People say money doesn't solve all your problems, but it does solve all of your money problems. I've started to think about four domains of life: money, physical health, mental health and happiness, and relationships. If you can sort the money side out, you can focus on the other three — the stuff that actually matters. Money problems tend to get in the way of what would otherwise be a happy, fulfilled life. So the sooner you can solve the money problems, the sooner you can focus on the stuff that matters.

Sort of. I've just got signed off for my F2 ARCP, so I'm now officially finished F2, and I'm counting down the days until August the 3rd when I leave. It's not that I don't enjoy it — it's that having done it for eight years, and now having the option of doing other things, I'm excited by the possibilities the freedom affords. I do want to go back into medicine; a good long-term goal is part-time, maybe two or three days a week. But at least in the short term, while I have no responsibilities and no family and don't have to worry about a mortgage, it makes sense to explore and try other things, because otherwise it's very easy for medicine to become all-encompassing.

There are so many people I know who were great musicians or actors or dancers, and then they did medicine and now they don't do any of it because they don't have time. So I want to spend a few years exploring other interests — get better at guitar, piano, singing; learn ice skating — all these things where being a medical student and then having a full-time job meant I could use the excuse of not having time.

It's less weird than I thought. More and more people are coming round to the idea that medicine isn't all-encompassing. In F1 I was at Addenbrooke's, and in every placement, when people found out about the YouTube thing, they'd say, "Oh my God, it's so good you have something outside of medicine." The upper-GI consultants were very supportive — one of them apparently now tells his new F1s, "My F1s from last year had all these things going on the side; what's your side project?" The other F1 working with me on upper GI is a Grammy-nominated music producer; he's taken a year out, been signed to Sony, and is producing music.

My mum might say, "Focus on your exams, focus on becoming a consultant, and then you can do all this stuff." But most of the consultants I speak to say, "Actually, if you've got the option, travelling the world while you're young and don't have to worry about money is a really good thing." I thought it would be weirder than it was — which is why I don't really mention it — but people are generally very supportive, which is really nice.

I had one complaint when I was an F1. I made a video about how I use my iPad at work, and I came across as a little blasé about data security. Someone sent a complaint into my hospital saying, "This doctor is completely blasé about data security." Fair enough — I could see how it came across that way. So I took the video down, reshot it, and added bits to show that the data security actually isn't an issue. That was the only actively negative thing that's happened. Otherwise, no real downsides. Occasionally I get recognised by patients, which is funny and a bit of banter for the nurses on the ward.

People often worry that if you become famous it'll be really bad because you'll get mobbed. But there's such a spectrum of it. There's no one knowing who you are at all, and then there's being Brad Pitt or Beyoncé or Ed Sheeran, where you physically can't go on the streets. My level is much, much closer to the "no one knows who you are" end. Even with 700,000 subscribers around the world, it means maybe once or twice roaming around London I get recognised — but by the sort of person who watches nerdy videos about tech and productivity and studying. The sort of person I'd love to talk to. So there really aren't downsides to being famous to the right sort of people. I have no interest in being famous to the general public, but I'd love to be famous to people who care about tech and productivity and becoming effective students. That's my tribe.

People worry about this GMC thing a lot — "Am I really allowed to...?" It's such a gut defence. Immediately, if you think, "I want to start a YouTube channel and put my face up there," you think, "Oh crap, what's the GMC going to say?" Why on earth would the GMC care, unless you're actively being a dick? If you're not, then — the GMC's job is to protect patients. Obviously don't go around talking about the patients you've seen that day; these are basic confidentiality rules. Beyond that, would the GMC care if you reacted to some medical memes? No. Would they care if you reviewed a book? Probably not. Who cares?

This GMC thing is just an easy external thing to blame our fear of putting ourselves out there on. "I'm worried I might not get a good rating from my consultant because they'll think my whole interest is YouTube, not medicine." It's all just excuses for the fear of putting ourselves out there. The sooner we get over that fear, the sooner life becomes more colourful and interesting.

Not really because of the GMC. A few months ago, when the coronavirus thing was first starting, I floated the idea to my team of a "reacting to coronavirus memes" video. They unanimously felt it would be in poor taste, whereas I thought it'd be a bit of banter. So we didn't do it. Maybe in a few years, once it's blown over. But the stuff I release is fairly PG — I'm not doing anything blasé or maverick. I'm not going to a forest to film suicides. So I really don't need to worry about the GMC.

There was one annoying instance. I have a friend who's a plastic-surgery trainee, and I had a subungual haematoma — a haematoma under my fingernail. I happened to be visiting him for an unrelated reason, and he offered to take the nail bed off, remove it and put a dressing on. So we filmed all of it, and it was going to feature in a vlog. It was really cool footage — hand surgery being done on my nail, my reaction to the anaesthetic going in. But then he messaged me afterwards: "I've spoken to my educational supervisor, he thinks it's probably a bad idea, we shouldn't upload it." I was like, why the hell not? I'm the patient. And he said, "Yeah, but what's the GMC going to say?" I was so annoyed — this was incredible footage that, as a doctor, you have access to and a member of the public just doesn't. He'd made the mistake of asking his supervisor, who said no, and now he couldn't release it.

We all worry way too much about what the GMC has to say about stuff they really don't care about. I actually emailed the GMC about this video and asked, "Would this be reasonable?" And they said, "As long as you have appropriate consent and you're not breaking patient confidentiality, it's fine. We don't care."

I'm a big believer that everyone should try to monetise their hobbies — although "everyone" is maybe a bit strong. My housemate Molly enjoys taking photos of food; she's got a food Instagram, Cambridge.foodie — check it out, link in the video description. She says she doesn't care about monetisation, but if push came to shove, she really does — she gets free food from restaurants now, she's been offered hotel stays to review restaurants. The monetisation layer adds to it rather than takes away from it.

I can't think of anyone who, if the choice was "you're really into this art thing — would you be opposed if people started paying you for it?" would say no. Occasionally people say, "It's just a hobby," or "I don't think my art's good enough to sell." But if I offered them £300 for their artwork, they'd freaking sell it, because they'd be like, "Oh my God, I can now sell my art." So I'm very bullish on people monetising their hobbies, because in addition to the hobby you get the extra fun of trying to make money from it — and in doing so you learn a whole load of skills. You learn how to write stuff that sells, how to create something other people find valuable. And there's that exciting thing: "Oh my God, someone is actually paying me for work I've done outside my day job." When you make your first dollar on the internet, your life changes, because you're like, bloody hell, I can actually make real money on the internet. It changes the game completely.

Where it starts to get bad is relying on your hobby to make money. If you need to make a full-time living from your art, you end up spending 90% of your time on the business side and 10% on the art. But if you don't need a full-time living from it — if you're happy making a few hundred pounds here and there — that is, in my opinion, objectively more fun than just doing the art by itself. So I'm huge on everyone monetising their hobbies to whatever extent they can.

I don't really think a lot about the position right now. I tend to be quite future-focused. Ultimately we're all optimising for happiness and meaning — happiness loosely defined as enjoying the stuff I'm doing right now, and meaning as being useful to other people. If you have that combination, in addition to the money problems being sorted plus physical health, mental health and relationships, then you're winning at life — even though it's not a competition.

So, yeah, it's a ridiculously privileged position, but I don't spend time patting myself on the back. The only thing in my mind is: how can I take this good thing I've got and keep it going for the long term? The thing I think about all the time is: will I still be relevant in ten years? Will that generation still care about watching "study with me" videos? Possibly not. So what are the investments I can make today — in my website, my personal brand — that in ten years will age well with me, rather than me ageing out with them?

Look at someone like Seth Godin — he's been writing a daily blog for 30 years, written dozens of books, a world expert in marketing seen as a thought leader. That's a good place to get to. Or Tim Ferriss — he wrote The 4-Hour Workweek in 2006 and has only gotten bigger every year, because he expanded out. He didn't rest on the laurels of that one success; he wrote more books, started the podcast, added value in all these different ways. That's what I think about now: I've got this initial success, but what are the aspects of it I know will be useful in ten years?

That's why, for example, we're redesigning my website to put all my book reviews and summaries of books and podcasts on it — because that's the sort of resource that compounds over time. No one's going to say, "This website has too many book summaries." They'll say, "Oh my God, this guy's been writing book reviews for 15 years — this is amazing." I've also started interviewing people on my channel, getting other people's expertise on board, following the Tim Ferriss model. There's only so far you can go if it's all about you. When Tim made his podcast, actively promoting other people, it took him to another level. That's the direction I'm going with my YouTube channel — being a connector who adds value, rather than purely documenting my own stuff. But the thing I think about most is: how do I stay relevant?

Probably Show Your Work by Austin Kleon. It's very small — takes about half an hour to read — and it's the book that encouraged me to start a personal blog. Without it I don't think I'd have started my blog or my YouTube channel. That book changed my life. Show Your Work by Austin Kleon is what every single person who's gotten this far in the podcast should read.

There's a message I try to preach whenever I get the chance: really think about what game you're playing. I don't think we think about this enough. In school, you're playing the game of getting decent results so you can get into a good university, and you're not thinking much beyond that — "I guess I'll be a doctor one day, that's kind of cool." At university you're playing the game of maximising CV points, because then you'll have a more competitive shot at your F1 deanery. And if you're feeling super pro, "I want that cardiothoracic ST3 number, so I need to do all these things." It's very easy to get caught up in playing these games without seriously questioning them.

I know people who've been optimising for the ST3 training-number game, and in doing so they've not enjoyed the university experience — burning themselves out, working too hard in the hope of one extra decile, one extra point, essentially pissing away six years of university to play this game. At some point you have to ask: what are we actually aiming for? Most people would agree happiness, meaning and fulfilment is a reasonable thing to shoot for. So do you really think that ST3 number in cardiothoracics is going to make you happy and fulfilled, and justify the six years of pain you put yourself through? Possibly not. If you speak to ST3 and ST4 cardiothoracic trainees, are they all loving life? Probably not. If you asked them, "If you won the lottery, would you still do medicine?", most would say they'd go part-time, if not leave completely. So whatever you do, really think about the game you're playing and what you're really optimising for. If you decide you just freaking love cardiothoracic surgery, then by all means go for it — but at least you've thought about it.

For me, when I asked what game I was playing, I realised the game early on was "how do I get CV points?" Then I realised, why am I playing this game? And even now, the game I've been playing until recently is "how do I maximise my sources of passive income?" Now I'm questioning that too. I'm glad I played it for the last eight years, but I think I'm at the point where I need to think about the next game — adding value to the world, happiness, meaning — without just trying to rack up the revenue numbers, which would be another easy game to fall into.

On the same analogy: I don't know how into board games you are, but with a lot of serious board games there are different victory conditions. You can get the most victory points, or have the biggest army, or conquer the most land. A good piece of advice for those games is to always look at the rule book and rethink the victory conditions. Your strategy at the start might be, "I need to maximise the sheep on my farm so I can get more food, then more gold, then win by having the biggest army." But as the game progresses you want to reassess: is there another victory condition I could be optimising for instead? Do I really want the biggest army, or do I want the most victory points from culture-generating monuments? Maybe your strategy doesn't change — maybe you're doing the right things — but you want to keep reconsidering the victory conditions.

My worry, especially for medical students, is that it's so easy to go through medicine, to go through life, not really thinking about the victory conditions — getting stuck in this rat race of "I need my points for FPAS, I need my points for ST3." And if we really think about it, we might realise that's not what will bring us happiness and fulfilment. So that would be the final preachy note I'd want to end on.