As a doctor, former financial advisor, and property investor, I'm sharing the lessons I learned from being a busy, time-poor professional to building a life of time and financial freedom. 

My journey to financial freedom began with the standard advice of getting a great job, working hard, and hoping the system would take care of me.  After 20 years of service in the Royal Navy and as a doctor, I realised this was a myth.  This standard narrative will only take you so far, and I have started to seek better ways to build time and financial freedom for myself and my family. This realisation inspired me to share my journey and the lessons I've learned with you. 

My journey led me to earn my MBA, work as a financial adviser in London, and eventually transition into entrepreneurship. Investing in property and sharing financial lessons through our financial education start-up Building Out.  

I hope that sharing these lessons will help you on your path to Building Out a life of time and financial freedom.  The journey can be challenging, but it's certainly worth it!

Sign up for our free weekly newsletter at: 

www.building-out.com

Good luck on your journey!

Nothing on our website, blog, socials or newsletter is designed to provide financial advice and is for educational purposes only. For individual financial advice on your circumstance, please seek the advice of an FCA-approved advisor.

Diarmaid Mcmenamin

The NHS operates as a monopsony.
What's that? 

A monopsony is a market with one dominant buyer of labour.

Most doctors never learn that word in medical school.

But they feel its effects every single day.

Here’s what a monopsony does:

→ Pay is influenced by political budgets rather than market value
→ Working conditions are centrally determined
→ Exit options are limited and costly
→ Individual bargaining power is minimal

In most professions, if your employer undervalues you, you move.

In UK medicine, mobility is constrained by training pathways, geography, and licensing barriers.

So what do you do?

You stop relying on a single employer for 100% of your income.

You build a portfolio career:

• Locum work for schedule control
• Medico-legal work for premium fees
• Digital products for scalable income
• Investments for compounding wealth

You don’t have to leave medicine.

You just stop letting one institution hold all the cards.

♻️ Repost if this resonates with a doctor you know.

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Building Out

Property Investor

Partner

Royal Navy

As a doctor, former financial advisor, and property investor, I’m sharing the lessons on the path from being a busy, time-poor professional to building a life of time and financial freedom.

A UK consultant earned £1 more. Their tax bill went up by £22,000.
Here's why: 

That is not a typo.

The pension annual allowance taper means a single pound of additional income can trigger a five-figure tax charge.

The BMA surveyed its members. This is what they found.

Mid-career doctors exist in a financial "kill zone":

→ Highest effective marginal tax rates of any UK profession

→ 35% real-terms pay cut since 2008

→ Mandatory professional fees just to be allowed to practice

→ A pension system that penalises you for working more

The public sees a six-figure salary.

The doctor sees 29p of every additional pound earned.

The system extracts maximum clinical output while capping the ability to build wealth.

Financial freedom in this environment is not an accident.

It is an engineering project.

Full breakdown on the blog → link in comments.

♻️ Repost if a doctor you know needs to see this.

Every doctor should know one number.
It's this:

Not their salary.

Not their pension statement.

Not their student loan balance.

Their Freedom Floor.

Here’s what it is:

The minimum annual cost of the life you actually want to live.

Not the consultant lifestyle.
Not the Instagram version.
Not the “after I make partner” fantasy.

Your real life.

Roof.
Food.
Heating.
Kids’ shoes.
The occasional takeaway.

Strip it back.

Calculate it.

Most people never do.

Because if the number is lower than they thought...

They’d have to admit they’re working far harder than necessary.

Once you know your Freedom Floor, work backwards.

What invested capital — earning a reasonable long-term return — would cover it?

That’s your Freedom Number.

When your assets cover your floor, something shifts.

Work becomes optional.

And optional work behaves very differently from mandatory work.

Optional work energises.
Mandatory work erodes.

Same hospital.
Same rota.
Different psychology.

You don’t need £5 million.

You need clarity.

Know your number.

Everything changes after that.

www.building-out.com

33% of UK doctors say they are struggling with daily workloads. 16% have already taken steps to leave medicine. But here’s the uncomfortable truth:

Most of them don’t actually hate medicine.

They hate financial dependence.

Because when your life looks like this:

Mortgage → depends on your job
School fees → depend on your job
Car → depends on your job
Family security → depends on your job

You don’t just have a profession.

You have one fragile income pillar.

And when everything sits on one pillar...

even a good job starts to feel like a trap.

So the solution isn’t more “resilience training”.

It’s financial architecture.

Doctors who regain control usually start with four moves:

→ Claim the tax relief you’re owed (many forget you can go back 4 years)

→ Use pension contributions to escape the £100k tax trap

→ Build a portfolio career (over half of UK doctors already have one)

→ Create income that isn’t tied to NHS shifts

Something interesting happens when you do this.

Medicine stops feeling like a cage.

And starts feeling like a choice again.

Don’t hate the profession.

Understand the trap.

Then build your way out of it.

www.building-out.com

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Do you know the biggest financial mistake mid-career doctors make?
It's this:

They try to earn their way to wealth.

But when your marginal tax rate is 60–71%...

Working harder is the least efficient strategy you have.

Every extra shift:

→ Loses Personal Allowance
→ Gets taxed at punitive rates
→ Increases burnout risk
→ Barely moves your net position

You don’t have an income problem.

You have a structure problem.

The leverage isn’t in the extra hour on the shop floor.

It’s in tax efficiency and asset protection.

3 moves that actually shift the needle:

Max your ISA
£20k per year.
Tax-free growth.
Tax-free withdrawal.

Salary sacrifice
Reclaim your Personal Allowance.
Avoid the 60% trap.

Build income outside the NHS
Assets that earn without you being present.

Because here’s the uncomfortable truth:

If your wealth depends entirely on NHS policy...

You don’t own your future.

The goal isn’t more income.

It’s optionality.

A portfolio that compounds quietly in the background
means the next pension reform or pay freeze
doesn’t dictate your decisions.

Extra shifts increase income.

Assets increase freedom.

Choose accordingly. ♻️

24% of UK consultants have cut waiting list work.

Not because they’re lazy.
Not because they don’t care.

Because the incentives are broken.

The BMA surveyed 5,000+ senior doctors and found:
almost 1 in 4 consultants reduced WLI sessions due to pension tax taper rules.

Stack the penalties and the question gets uncomfortable:

Are you paying to work?

Pension “cliff edges” that punish extra sessions

The 60% tax band that turns pay rises into rounding errors

Mandatory professional overheads paid from net income

Frozen thresholds pulling more people in each year

If the answer is “yes” — even occasionally — something needs to change.

Not the system (that’s a long fight).

Your personal setup.

A practical checklist:

→ Audit your marginal tax exposure
→ Model pension outcomes before you take extra work
→ Build assets outside the NHS so policy changes don’t own you
→ Get specialist advice (not generic “financial planning” chat)

Financial freedom for mid-career doctors doesn’t happen by accident.

You build it. You protect it. You keep it.

Want to know more?
www.building-out.com

building-out.com

Most doctors were told the same story.
But it was wrong: 

Work hard.
Get the grades.
Choose the “right” career.
The system will look after you.

I believed it.

I spent nearly 20 years as a military doctor in the Royal Navy.

High income.
Prestige.
Security.

And yet...

I wasn’t building wealth.
I wasn’t buying time.
I was renting a lifestyle from my calendar.

After leaving the Navy, I did something unusual.

I qualified and worked as a financial advisor in London.
I passed a MBA. 
I trained with some of the best property investors in the country.
I studied how money actually works.

That’s when it hit me:

Doctors don’t have a money problem.

We have a structural problem.

Late earning.
Heavy taxation.
Complex pensions.
Golden handcuffs disguised as stability.

And almost zero financial education.

I still love medicine.

But I no longer rely on it as my only financial strategy.

Now I help doctors understand the rules of the game:

→ How tax really works
→ How to build assets outside the NHS
→ How to buy back time without walking away from medicine

You can be a good doctor.

And still build optionality.

You can enjoy clinical work.

And still design a life that isn’t dependent on it.

The system won’t build that for you.

But you can.

If you’re a doctor who wants more control over your time and money, sign up for our LinkedIn newsletter above or visit www.building-out.com and sign up for our free newsletter there. 

Good luck on your journey!

“Gold is a perfect inflation hedge.”

Half true.

Which makes it dangerous.

Here’s what the data actually shows:

→ Gold tends to respond well to inflation spikes in the short run
→ Over long periods, the relationship weakens
→ It reacts most when inflation accelerates sharply
→ In low, stable inflation, it often does very little

Gold isn’t a thermostat.

It’s a smoke alarm.

It doesn’t gently adjust with every temperature change.

It screams when something is burning.

And stays quiet when it isn’t.

That’s an important distinction.

If you buy gold expecting it to steadily track CPI, you’ll be disappointed.

If you own it for regime shifts — policy mistakes, currency stress, sudden inflation shocks — you understand its role.

Don’t buy gold because you’re confident inflation is coming.

Buy it because you accept that you might be wrong about the future.

Insurance isn’t about prediction.

It’s about humility.

Most UK doctors don’t realise they’re in a 60% tax bracket.
Here's why:

Earn £100,001
and your next £1 can be taxed at 60%.

Not a loophole.
Not a mistake.

Just how the system works.

Here’s why:

Between £100,000 and £125,140
you lose £1 of Personal Allowance
for every £2 you earn.

By £125,140?
Your entire £12,570 tax-free allowance is gone.

That creates a stealth marginal rate of 60%.

(67.5% in Scotland.)

This isn’t rare.

The average consultant salary sits right in this range.

And because thresholds are frozen until 2031,
inflation alone is dragging more doctors into it every year.

You don’t need a pay rise to hit 60%.

The system moves you there automatically.

The fix is boring — and powerful.

Reduce your adjusted net income below £100k.

Most commonly:

→ Pension contributions
→ Salary sacrifice (EV, cycle-to-work)

Example:

A £10,000 pension contribution
can save ~£6,000 in tax.

That’s a 60% instant return.
Before the money is even invested.

Sometimes the smartest financial move
isn’t earning more.

It’s understanding the rules
before they understand you.

If you’re a consultant drifting above £100k,
this is worth checking.

And someone in your department probably hasn’t. ♻️

How much does it cost you before you even get to work? 


Name another profession
where you pay thousands each year
just to be allowed to work.

I’ll wait.

UK doctors carry mandatory overheads
that come straight off net income:

→ GMC registration: ~£455/year
→ Royal College fees: £200–£600+
→ Indemnity for private work: often thousands
→ Postgraduate exams: £2,000+ per sitting
→ Courses, CPD, portfolio fees

This isn’t optional.

You can’t practise without them.

And here’s the part most people miss:

These costs come out of post-tax income.

So if you’re in the £100k–£125k band...

You earn £10,000.
HMRC keeps ~£6,000.
You pay your regulator with what’s left.

A corporate executive doesn’t pay a licence fee to attend meetings.

A management consultant doesn’t fund their own regulator.

Doctors?

They pay to practise.

Then they’re taxed at 60% on the rest.

This isn’t outrage.

It’s arithmetic.

And arithmetic compounds.

Are you telling yourself that everything will be ok when you reach the next milestone? This is the Deferred Life Trap, and here's how to escape it.

A career committed to protecting life requires you to defer your own. Nobody puts it that bluntly in the admissions brochure. But every doctor reading

How To Escape the Deferred-Life Trap For Doctors

You buy a £5 ready meal. You microwave it. It tastes awful.
Do you finish it?

Most people do.

Because throwing it away feels like wasting £5.

But the £5 is gone either way.

Finishing it just adds 10 minutes of misery.

Now replace £5 with:

→ 6 years of medical school
→ A decade of training
→ £100,000+ of debt
→ Your twenties and thirties

This is the Sunk Cost Fallacy in scrubs.

Doctors stay in:

• Toxic departments
• Specialties they’ve outgrown
• Jobs that drain them

Because walking away feels like wasting the investment.

But here’s the uncomfortable truth:

The investment is already gone.

The only thing you control now is the next 10 years.

Staying miserable doesn’t honour the sacrifice.

It compounds it.

You’re not “quitting.”

You’re reallocating capital.

Your time.
Your energy.
Your remaining decades.

Smart investors don’t throw good money after bad.

So why are smart doctors throwing good years after bad?

Stop eating the bad meal.

Becoming a doctor costs more than tuition.
After graduation, you're immediately hit with:

→ GMC registration: £433/year

→ Indemnity insurance: £hundreds/year

→ BMA membership

→ Royal College fees

→ MRCP Part 1: £478

→ MRCP Part 2: £478

→ PACES: £694

→ MRCGP AKT: £505

→ MRCGP CSA: £1,674

Fail an exam? Pay again.

A GP registrar earning £40,257 can face over £5,000 in mandatory professional costs.

Before travel. Before courses. Before portfolio expenses.

The BMA called these costs "completely unaffordable."

And here's the part most doctors miss:

You can claim tax relief on some of these fees.

But almost nobody tells you that.

Because nobody taught you to ask.

www.building-out.com

Do you feel successful but still trapped financially?

I. The Paradox of the Modern Medical Career You made it. Consultant. GP Partner. Specialty Doctor with a decade of experience under your belt. Whateve

Why Doctors Feel Successful but Financially Paralysed

In 1896, an Italian economist noticed something strange in his garden.


20% of his pea pods produced 80% of the peas.

So he looked at land ownership across Italy.

Same pattern.

80% of the land was owned by 20% of the population.

Vilfredo Pareto had stumbled onto something bigger than agriculture.

The pattern shows up everywhere.

Business.
Wealth.
Medicine.
Time.

In your world it looks like this:

→ 80% of your clinical impact comes from 20% of your decisions
→ 80% of your stress comes from 20% of your tasks
→ 80% of your income comes from 20% of your leverage
→ 80% of your admin doesn’t require your brain

Yet most professionals optimise the wrong 80%.

They refine emails.

Tweak slides.

Perfect discharge letters.

While their real 20% — the decisions, the strategy, the leverage — gets squeezed into whatever energy is left.

The question isn’t:

“How do I do more?”

It’s:

“What actually moves the needle?”

Find your vital 20%.

Protect it like an asset.

Delegate, delete, or downgrade the rest.

Because productivity isn’t about volume.

It’s about asymmetry.

And most people are working very hard in the wrong half of the equation.

www.building-out.com

Most doctors don't realise they're caught in a monopsony.
What's that? 

It's a market with one dominant buyer of your labour.

Most learn the word eventually, but only when it hits home.

Your pay isn't set by market forces.

It's dictated by budgets, politics, and central control.

Working conditions? Mostly decided from above.

Options to exit? Limited and expensive.

Your bargaining power? Almost zero.

In most jobs, if you're undervalued, you leave.

In UK medicine, that's hard.

Training pathways, licensing, geography, they keep you stuck.

So what can you do?

Stop relying on one employer for everything.

Build a portfolio.

Locum shifts for flexibility.

Medico-legal work for premium rates.

Digital products that scale.

Investments that compound over time.

You don't need to quit medicine.

You just need to stop letting a single institution call all the shots.

Because when your income depends on one buyer, your power is limited.

Real wealth comes from diversifying that power.

Should I invest in gold? Here's some food for thought

You don't invest in gold. You insure with it. And if that sentence irritates you, good. It means you've been taught to think about gold the wrong way.

Why Invest In Gold - For the Busy Professional

A brief history of gold and money:

1870–1914
The Classical Gold Standard.
Currencies pegged to gold.
Trade imbalances self-correct.
Stability.

1944–1971
Bretton Woods.
The dollar pegged to gold at $35/oz.
Other currencies pegged to the dollar.
It works... until the Triffin Dilemma makes it mathematically unsustainable.

August 15, 1971
Nixon ends gold convertibility.
The dollar floats.
Gold floats.
A new era begins.

Since then?
Pure fiat.

Now look at the present.

2010–2026
Central banks flip from net sellers to aggressive buyers.
By 2024: 1,000+ tonnes annually.
The largest sustained accumulation in modern history.

Why?

Because monetary systems don’t last forever.

They stretch.
They strain.
They reset.

The pattern isn’t ideological.

It’s structural.

Every few decades, the rules change.

Gold is the only asset that has existed in every version.

Empires change.
Currencies change.
Policy changes.

Gold remains.

You don’t need to predict the next reset.

You need to survive it.

Why is it that high earners are still not financially free?

The Paradox of the “Rich” Doctor You've reached the milestone. Thirteen years of training. Maybe more. The exams, the rotations, the nights where you 

Why Most High Earning Doctors Aren't Financially Free

There’s a salary band in the UK where every extra £1 you earn...
You only keep 38p. And you can lose £10,000 in childcare.

Not a typo.

Between £100,000 and £125,140:

→ You lose £1 of Personal Allowance for every £2 earned
→ Effective marginal tax rate: 62%
→ With a Plan 2 student loan? 70%+

But here’s the real landmine.

Earn £100,001.

One pound over.

And you lose:

❌ 30 hours free childcare
❌ Tax-Free Childcare eligibility

No taper.
No smoothing.
A cliff edge.

I’ve seen this happen in real life:

A consultant accepts a £2,000 Clinical Lead allowance.

Salary moves from £99.5k to £101.5k.

Net result?

Worse off by ~£8,000.

The system wasn’t designed to punish doctors.

But it absolutely punishes drift.

Here’s the fix (and it’s boring):

Lower your adjusted net income below £100k.

Most common way?

→ Pension sacrifice.

Do that and you:

• Restore your Personal Allowance
• Regain childcare eligibility
• Avoid the 60%+ trap

For a family with two children, that one decision can be worth £20–25k a year.

This isn’t tax optimisation.

It’s financial self-defence.

If this surprised you,
someone in your department is about to walk into it. ♻️

KICS-ICS

Chief Operating Officer

MSAQS

Conducting gap analysis, technical writing for SOPs, WIs, and forms, and auditing across GCP and PV are key components. Training in GCP includes workshops on change control, deviations, CAPA, writing effective SOPs, and auditing. Management of change, change control, and implementation are also crucial. Risk management and mitigation, particularly in clinical trial risk management, are essential. Gap analysis and process mapping are integral in bridging gaps. Additionally, creating custom QMS for small biotech/pharma companies is a specialized service.
www.msaqs.co.uk

Founder

Oncacare

Responsible for the Quality, GCP function; working cross-functionally throughout the company to establish a Quality and compliance vision and implement effective Quality strategies that drive efficiency, improvement and organisation transformation.
Designing and implementing the bespoke GCP QMS for Oncacare and it’s network of clinical sites.
Strategy design and implementation for the Operational Compliance function.
Leading the quality and operational compliance function to ensure high compliance both internally and across all the sites on the Oncacare network.

Design and implementation of the risk assessment process for vendor and audit scheduling.
Design and implementation of the global GCP audit schedule.
Creation of the KPI and metric system for reporting trending/identifying trend analysis. 
Oversight of the global training program for Oncacare, including identifying training requirements for all staff. 
Creative insights to the operational compliance function including training handbook and training program.
Design and roll out of the Internal auditor training workshop.
Training developed and rolled out for CAPA, Root Cause Analysis, Audit Response, Inspection Management/Preparation.

Head Of Quality Assurance

EUSA Pharma

GCP and PVG Quality Assurance Lead for both clinical and post marketing acitivites.
Leading the drive to create and establish the eQMS using Veeva  to support clinical development 
Auditing (Internal / External)
Leading QA support for Externally Sponsored Research Studies.
Chairing cross functional GxP meetings
FDA and MHRA Inspection preparedness.
Providing QA Consulting services internally 
Managing consultant auditors 
Conducting audits of critical vendors 
Troubleshooting deviation, change control and CAPA.
Lead host for all GCP inspections
Strategy planning

Senior Manager Global Clinical Quality Assurance (GCP/GVP)

Bionical Emas

Internal and External GxP audits
Annual audit risk assessments
QA Business Development 
Management of consultant auditors
Engaging with clients and promotion of QA 
Reporting critical issues to senior leadership team
Providing consultative advice for Chinese Pharma in setting up PVG System.

Director QA

APCER Life Sciences

Management of Global Audit Schedule
Hosting client audits and inspection 
Conducting PV system audits 
PV Auditor training
Awareness of PV legislation
Audit risk planning 
Risk Assessment
Vendor audits
CAPA and CAPA metrics.
Root cause analysis, deviation, change control 
Reviewing metrics for CAPA from audits/inspections
Quality Assurance leadership

Senior Manager QA

International AIDS Vaccine Initiative (IAVI)

Quality Assurance Manager

St Stephens AIDS Trust

6 month contract 
Providing advice on setting up and establishing robust quality management systems
Providing consultation advice on SOP development, writing and implementation
Driving Gap Analysis 
Developing strategies for working towards attaining regulatory accreditation
Escalating GCP Compliance Issues.
Conducting audits
Leading the group to ensuring high levels of compliance. 
Developing quality leadership

Takeda Pharmaceuticals

Deputised for the Clinical Quality Assurance (‘CQA’) Manager
Developed, managed and executed strategic systems and/or process clinical QA audit programmes for Takeda
Oversaw the planning, conduct and execution of international audits of clinical sites, documents, databases, vendors and internal systems
Developed strategies for and executed GCP related misconduct investigations
Managed audit teams, including outside contractor auditors
Identified potential systemic compliance risks, through audit activities
Provided GCP compliance support

QA Programme Manager

Chiltern International

Deputised for the QA Manager (Europe) as appropriate
Represented the QA group within the company
Provided quality support and contributed to process improvement within QA and other departments
Audited clinical trials against the defined project-specific quality and performance standards as well as relevant Standard Operating Procedures (‘SOPs’), International Consensus on Harmonisation (‘ICH’) GCP, and local requirements, including but not restricted to systems and vendor assurance audits as required 
Created (or supervised and/or co-ordinated the creation of) SOPs required for the proper functioning of the clinical trial process
Acted as a catalyst for quality improvement and placed emphasis on preventing errors
Mentored  junior auditors
Managed European audit programmes and European auditors calendars

Senior QA Auditor

At KICS-ICS, my dedication is to seamlessly integrate comprehensive quality management with strategic healthcare administration. Spearheading efforts to enhance clinical research quality, my expertise lies in developing and implementing bespoke Quality Management Systems that ensure compliance and operational excellence. 

The foundation of my approach at MSAQS is built upon meticulous gap analysis and risk mitigation. With a focus on GCP, I deliver specialized training and auditing services that empower small biotech and pharma companies to surpass industry standards. Our organization's vision is to drive transformation and set new benchmarks in clinical trial risk management.

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