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Dr. Self_made_human, or: How I Learned to Stop Worrying and Love the
BombLLM[Context: I'm a doctor from India who has recently begun his career in psychiatry in the UK]
I’m an anxious person. Not, I think, in the sense of possessing an intrinsically neurotic personality – medicine tends to select for a certain baseline conscientiousness often intertwined with neuroticism, and if anything, I suspect I worry less than circumstance often warrants. Rather, I’m anxious because I have accumulated a portfolio of concrete reasons to be anxious. Some are brute facts about the present, others probabilistic spectres looming over the future. I’m sure there exist individuals of stoic temperament who can contemplate the 50% likelihood of their profession evaporating under the silicon gaze of automation within five years, or entertain a 20% personal probability of doom from AI x-risk, without breaking a sweat. I confess, I am not one of them.
All said and done, I think I handle my concerns well. Sure, I'm depressed, but that has very little to do with any of the above, beyond a pervasive dissatisfaction with life in the UK, when compared to where I want to be. It's still an immense achievement, I beat competition ratios that had ballooned to 9:1 (0.7 when I first began preparing), I make far more money (a cure for many ailments), and I have an employment contract that insulates me to some degree from the risk of being out on my ass. The UK isn't ideal, but I still think it beats India (stiff competition, isn't it?).
It was on a Friday afternoon, adrift in the unusual calm following a week where my elderly psychiatric patients had behaved like absolute lambs, leaving me with precious little actual work to do, that I decided to grapple with an important question: what is the implicit rate at which I, self_made_human, CT1 in Psychiatry, am willing to exchange my finite time under the sun for money?
We’ve all heard the Bill Gates anecdote – spotting a hundred-dollar bill, the time taken to bend over costs more in passive income than the note itself. True, perhaps, yet I suspect he’d still pocket it. Habits forged in the crucible of becoming the world’s richest man, especially the habit of not refusing practically free money, likely die hard. My own history with this calculation was less auspicious. Years ago, as a junior doctor in India making a pittance, an online calculator spat out a figure suggesting my time was worth a pitiful $3 an hour, based on my willingness to pay to skip queues or take taxis. While grimly appropriate then (and about how much I was being paid to show up to work), I knew my price had inflated since landing in the UK. The NHS, for all its faults, pays better than that. But how much better? How much did I truly value my time now? Uncertain, I turned to an interlocutor I’d recently found surprisingly insightful: Google’s Gemini 2.5 Pro.
The AI responded not with answers, but with questions, probing and precise. My current salary? Hours worked (contracted vs. actual)? The minimum rate for sacrificing a weekend to the locum gods? The pain threshold – the hourly sum that would make me grind myself down to the bone? How did I spend my precious free time (arguing with internet strangers featured prominently, naturally)? And, crucially, how did I feel at the end of a typical week?
On that last point, asked to rate my state on the familiar 1-to-10 scale – a reductive system, yes, but far from meaningless – the answer was a stark ‘3’. Drained. Listless yet restless. This wasn't burnout from overwork; paradoxically, my current placement was the quietest I’d known. Two, maybe five hours of actual work on a typical day, often spent typing notes or sitting through meetings. The rest was downtime, theoretically for study or portfolio work (aided significantly by a recent dextroamphetamine prescription), but often bleeding into the same web-browsing I’d do at home. No, the ‘3’ stemmed from elsewhere, for [REDACTED] reasons. While almost everything about my current situation is a clear upgrade from what came before, I have to reconcile it with the dissonance of hating the day-to-day reality of this specific job. A living nightmare gilded with objective fortune.
My initial answers on monetary thresholds reflected this internal state. A locum shift in psych? Minimum £40/h gross to pique interest. The hellscape of A&E? £100/h might just about tempt me to endure it. And the breaking point? North of £200/h, I confessed, would have me work until physical or mental collapse intervened.
Then came the reality check. Curious about actual locum rates, I asked a colleague. "About £40-45 an hour," he confirmed, before delivering the coup de grâce: "...but that’s gross. After tax, NI, maybe student loan... you’re looking at barely £21 an hour net." Abysmal. Roughly my standard hourly rate, maybe less considering the commute. Why trade precious recovery time for zero effective gain? The tales of £70-£100/hr junior locums felt like ancient history, replaced by rate caps, cartel action in places like London, and an oversupply of doctors grateful just to have a training number.
This financial non-incentive threw my feelings into sharper relief. The guilt started gnawing. Here I was, feeling miserable in a job that was, objectively, vastly better paid and less demanding than my time in India, or the relentless decades my father, a surgeon, had put in. His story – a penniless refugee fleeing genocide, building a life, a practice, a small hospital, ensuring his sons became doctors – weighed heavily. He's in his 60s now, recently diagnosed with AF, still back to working punishing hours less than a week after diagnosis. My desire to make him proud was immense, matched only by the desperate wish that he could finally stop, rest, enjoy the security he’d fought so hard to build. How could I feel so drained, so entitled to 'take it easy', when he was still hustling? Was my current 'sloth', my reluctance to grab even poorly paid extra work, a luxury I couldn't afford, a future regret in the making?
The AI’s questions pushed further, probing my actual finances beyond the initial £50k estimate. Digging into bank statements and payslips revealed a more complex, and ultimately more reassuring, picture. Recent Scottish pay uplifts and back pay meant my average net monthly income was significantly higher than initially expected. Combined with my relatively frugal lifestyle (less deliberate austerity, more inertia), I was saving over 50% of my income almost effortlessly. This was immense fortune, sheer luck of timing and circumstance.*
It still hit me. The sheer misery. Guilt about earning as much as my father with 10% the effort. Yet more guilt stemming from the fact that I turned up my nose at locum rates that would have had people killing to grab them, when my own financial situation seemed precarious. A mere £500 for 24 hours of work? That's more than many doctors in India make in a month.
I broke down. I'm not sure if I managed to hide this from my colleague, I don't think I succeeded, but he was either oblivious or too awkward to say anything. I needed to call my dad, to tell him I love him, that now I understand what he's been through for my sake.
I did that. Work had no pressing hold on me. I caught him at the end of his office hours, surgeries dealt with, a few patients still hovering around in the hope of discussing changes or seeking follow-up. I haven't been the best son, and I call far less than I ought to, so he evidently expected something unusual. I laid it all out, between sobbing breaths. How much he meant to me, how hard I aspired to make him proud. It felt good, if you're the kind to bottle up your feelings towards your parents, then don't. They grow old and they die, that impression of invincibility and invulnerability is an illusion. You can hope that your love and respect were evident from your actions, but you can never be sure. Even typing this still makes me seize up.
He handled it well. He made time to talk to me, and instead of mere emotional reassurance (not that it's not important), he did his best to tell me why things might not be as dire as I feared. They're arguments that would fit easily into this forum, and are ones I've heard before. I'm not cutting my dad slack because he's a typical Indian doctor approaching retirement, not steeped in the same informational milieu as us, dear reader, yet he did make a good case. And, as he told me, if things all went to shit, then all of us would be in the shit together. Misery loves company. (I think you can see where I get some of my streak of black humor)
All of these arguments were priced in, but it did help. I can only aspire towards perfect rationality and equipoise, I'm a flawed system trying to emulate a better one in my own head. I pinned him on the crux of my concern: There are good reasons that I'm afraid of being unemployed and forced to limp back home, to India, the one place that'll probably have me if I'm not eligible for gainful employment elsewhere. Would I be okay, would I survive? I demanded answers.
His answer bowled me over. It's not a sum that would raise eyebrows, and might be anemic for financially prudent First Worlders by the time they're reaching retirement. Yet for India? Assuming that money didn't go out of fashion, it was enough, he told me (and I confirmed), most of our assets could be liquidated to support the four of us comfortably for decades. Not a lavish lifestyle, but one that wouldn't pinch. That's what he'd aimed for, he told me. He never tried to keep up with the Joneses, not when worse surgeons drove flashier cars, keeping us well below the ceiling that his financial prudence could allow. I hadn't carpooled to school because we couldn't afford better, it was because my dad thought the money was better spent elsewhere. Not squandered, but saved for a rainy day. And oh brother (or sister), I expect some heavy rain.
The relief was instantaneous, visceral. A crushing weight lifted. The fear of absolute financial ruin, of failing to provide for my family or myself, receded dramatically. But relief’s shadow was immediate and sharp: guilt, intensified. Understanding the sheer scale of that safety net brought home the staggering scale of my father’s lifetime of toil and sacrifice. My 'hardships' felt utterly trivial in comparison. Maybe, if I'm a lucky man, I will have a son who thinks of me the way I look up to my dad. That would be a big ask, I'd need to go from the sum I currently have to something approaching billionaire status to have ensured the same leap ahead in social and financial status. Not happening, but I think I'm on track to make more than I spend.**
So many considerations and sacrifices my parents had to make for me are ones I don't even need to consider. I don't have to pickup spilled chillies under the baking sun to flip for a profit. I don't have to grave-rob a cemetery (don't ask). Even in a world that sees modest change, compared to transformational potential, I don't see myself needing to save for my kid's college. We're already waking up to the fact that, with AI only a few generations ahead of GPT-4, that the whole thing is being reduced to a credentialist farce. Soon it might eliminate the need for those credentials.
With this full context – the demanding-yet-light job leaving me drained, the dismal net locum rates, my surprisingly high current income and savings, the existential anxieties buffered by an extremely strong family safety net, and the complex weight of gratitude and guilt towards my father – the initial question about my time/money exchange rate could finally be answered coherently.
Chasing an extra £50k net over 5 years would mean sacrificing ~10 hours of vital recovery time every week for 5 years, likely worsening my mental health and risking burnout severe enough to derail my entire career progression, all for a net hourly rate barely matching my current one. That £50k, while a significant boost to my personal savings, would be a marginal addition to the overall family safety net. The cost-benefit analysis was stark.***
The journey, facilitated by Gemini’s persistent questioning, hadn't just yielded a number. It had forced me to confront the tangled interplay of my financial reality, my psychological state, my family history, and my future fears. It revealed that my initial reluctance to trade time for money wasn't laziness or ingratitude, but a rational response to my specific circumstances.
(Well, I'm probably still lazy, but I'm not lacking in gratitude)
Prioritizing my well-being, ensuring sustainable progress through training, wasn't 'sloth'; it was the most sensible investment I could make. The greatest luxury wasn't avoiding work, but having the financial security – earned through my own savings and my father’s incredible sacrifice – to choose not to sacrifice my well-being for diminishing returns. The anxiety remains, perhaps, but the path forward feels clearer, paved not with frantic accumulation, but with protected time and sustainable effort. I'll make more money every year, and my dad's lifelong efforts to enforce a habit of frugality means I can't begin to spend it faster than it comes in. I can do my time, get my credentials while they mean something, take risks, and hope for the best while preparing for the worst.
They say the saddest day in your life is the one the one where your parents picked you up as a child, groaned at the effort, and never did so again. While they can't do it literally without throwing their backs, my parents are still carrying me today. Maybe yours are too. Call them. ****
If you've made it this far, then I'm happy to disclose that I've finally made a Substack. USSRI is now open to all comers. This counts as the inaugural post.
*I've recently talked to people concerned about AI sycophancy. Do yourself a favor and consider switching to Gemini 2.5. It noted the aberrant spike in my income, and raised all kinds of alarms about potential tax errors. I'm happy to say that there were benign explanations, but it didn't let things lie without explanation.
**India is still a very risky place to be in a time of automation-induced unemployment. It's a service economy, and many of the services it provides, like Sams with suspicious accents, or code-monkeys for TCS, are things that could be replaced today. The word is getting out. The outcome won't be pretty. Yet the probabilities are disjunctive, P(I'm laid off and India burns) is still significantly lower than P(I'm laid off), even if the two are likely related. There are also competing concerns that mean that make financial forecasting fraught. Will automation cause a manufacturing boom and impose strong deflationary pressures that make consumer goods cheaper, faster than salaries are depressed? Will the world embrace UBI?
***Note that a consistent extra ten hours of locum work a week is approaching pipe-dream status. There are simply too many doctors desperate for any job.
****That was a good way to end the body of the essay. That being said, I am immensely impressed by Gemini's capabilities and its emotional tact. It asked good questions, gave good answers, handled my rambling tear-streaked inputs with grace. I can see the thoughts in its LLM head, or at least the ones that it's been trained to output. I grimly chuckled when I could see it cogitating over the same considerations I'd have when seeing a human patient with a real problem, but an unproductive response. I made sure to thank it too, not that I think that actually matters. I'm afraid, that of all the people who've argued with me in an effort to dispel my concerns about the future, the entity that managed to actually help me discharge all that pent-up angst was a chatbot (and my dad, of course). The irony isn't lost on me, but when psychiatrists are obsolete, at least their replacements will be very good at the job.
@Throwaway05 , since I promised to ping you
Speaking of Bill Gates, even he has recently started spreading the word about mass unemployment due to automation. It’s happening. The assets that make up the wealthy’s net worth are worthless in a world without consumers (that’s why inequality falls during big recessions like 2008, because asset prices decline as demand struggles). The effort and coordination among elites required to mount some kind of total abolition of all democracy and then automated drone genocide of everyone without $20m in cash or whatever doesn’t exist, the first wave of huge layoffs is probably less than 18 or even 12 months away.
Capitalism versus conservatism was an ideological debate about the management of labor. Labor still existed; capitalists weren’t, leftist rhetoric aside, telling the poor to starve, they just believed in another (superior) system. This is different, it’s happening to everyone, including senior management. It’s going to be scary for a while, possibly (although hopefully not) even violent, and there’s still the other side of AI risk to consider (we have LessWrong for that kind of doomerism). There will be 5 or 10 really dicey years (and I look forward to discussing them with you all here).
But I’m increasingly optimistic. As Dario Amodei suggested recently, this is going to happen to all of us at almost the same time. The progress at humanoid robotics startups in the last 18 months is insane, and manufacturing costs collapse at scale (especially with robots on the assembly line). That makes me far more optimistic than a slow Manna or Humans Need Not Apply style rollout. We can figure it out. This is an abundance problem.
Who do you think is furthest ahead, or who are several of the frontrunners if there's no clear leader?
https://blog.google/products/gemini/how-we-built-gemini-robotics/
This would be a strong contender, alongside Boston Dynamics and their Chinese counterparts. The capabilities demonstrated here are staggering, they just need to get a little faster and cheaper.
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