A surgeon once told me this while on an all-too-rare vacation week.

“If I’m not working, I’m falling behind.”

He was sitting by the pool, laptop balanced on his knees, answering hospital admin emails between bites of breakfast just before logging on to have therapy with me.

He wasn’t short on money (far from it). He wasn’t behind on bills. But the idea of “resting” or “slowing down” made him deeply uneasy. It was clear to me that somewhere along the way, he had absorbed an unspoken yet powerful unconscious belief that time not spent producing, earning, or staying ahead was dangerous. That’s a money script in action.

What’s a Money Script?

The term “money script” comes from financial psychology. Think of money scripts as the deep-seated beliefs about money you picked up somewhere along the way in life without even realizing it. It could be from childhood (as is often the case), society/culture, medical training, your peers, and life experience. Money scripts run like background software in your finances and how you move through life (financially and otherwise) throughout your adulthood.

Most of us don’t even realize we have them. They’re usually not logical rules that we consciously decided to follow. They’re more like reflexes. And when you’re a physician, they’re often amplified by the culture of medicine.

As Ramit Sethi (a well-known financial expert and a huge proponent of money scripts) likes to say, “Money is never just about money.” Money is about identity, safety, love, belonging, self-worth, and more, all tangled together.

8 Money Scripts I See All the Time in Physicians

Over the years, both in my therapy practice as a psychologist for doctors and at home as the spouse of a physician, I’ve noticed certain money scripts that keep emerging. Some are quite predictable. Others might surprise you.

Here are eight of the most common money scripts I see among doctors, paired with real-world examples.

#1 Scarcity Mindset

“No matter how much I have, it could disappear tomorrow.”

A pediatrician earning $400,000 per year still checks the clearance rack before buying clothes. She maxes out all retirement accounts, has a healthy emergency fund, and has no debt. But she can’t shake the feeling that she’s one bad decision away from losing everything.

Turns out, her childhood was fraught with instability, having come from a rural working-class background where her father hopped from job to job while her mother clipped coupons, worked grueling night shifts, and scoured garage sales. This pediatrician’s scarcity mindset money schema was deeply shaped by her upbringing.

Medical training reinforces this: years of delayed gratification, low pay, and debt make abundance feel temporary and fragile. The result? Overworking, oversaving, and underenjoying your money.

#2 Overcontrol

“If I don’t manage every detail, something will go wrong.”

An anesthesiologist I worked with in therapy used to spend hours every week reviewing his financial spreadsheets to the penny, all the way down to categorizing his kids’ snack purchases. Yikes. His wife begged him to delegate these menial tasks to an accountant and a financial advisor, but letting go felt impossible for him.

For this anesthesiologist, the overcontrol schema was molded by both childhood and his medical training. His childhood was fraught with chaos and instability in his parents’ marriage, and he got into med school only after getting a near-perfect MCAT score that helped him recover from a less-than-stellar GPA.

Perfectionism may serve you in medicine to some extent—until it doesn’t. With money, overcontrol can often be a mask for underlying anxiety, disguised as diligence or “being responsible.”

#3 Guilt About Wealth

“I shouldn’t have more than other people.”

One of my therapy clients was a hospitalist from a modest background, and she told me she felt like an impostor in her own life. Her parents had never made more than $50,000 a year, and now she was earning eight times that. When friends from home talked about struggling with rent, she’d downplay her salary in an attempt to preserve the image of still fitting in with them.

For many doctors, guilt creeps in when your financial reality starts to look very different from the people you love or with whom you grew up. You might feel uneasy about having more, especially if you still carry the values of frugality, self-sacrifice, or fairness from your upbringing. And the medical profession itself can amplify it: when you see patients who can’t afford basic care, the contrast between your paycheck and their circumstances can be jarring.

The risk is that guilt can quietly drive financial decisions. You can unconsciously avoid opportunities to increase your income, underspend on yourself, or sacrifice yourself in ways that undermine your own security—all in an unconscious effort to “balance the scales.”

#4 The ‘Deserve' Narrative

“I work hard, so I deserve to spend however I want.”

After paying off $250,000 in med school loans, an orthopedic surgeon rewards himself with a luxury SUV, a boat, and multiple high-end vacations—all within a year. The spending initially feels euphoric, until the monthly payments become suffocating and eventually catastrophic.

This “I deserve it” narrative can be a pendulum swing backlash against years of restriction during medical training and even further back to childhood. Again, years of delayed gratification can perniciously creep up on you like this once you have more resources if you don’t stop to check yourself. Lifestyle creep feeds into this, too—especially when this money script plays in the background unacknowledged.

#5 Endless Comparison

“I’m doing well . . . but they’re doing better.”

An ER doc friend once told me that he felt good about his savings rate until a colleague casually mentioned their passive income from rental properties. Overnight, his own progress felt small. He hadn’t cared about real estate the day before, but now he was researching duplexes on his lunch break.

Medicine trains you to measure yourself against others: board scores, match lists, case volume, RVUs. That same competitive lens can follow you into your financial life. You might feel fine about your financial plan until you learn what your co-resident-turned-orthopedist is pulling in with their annual salary.

The trap is that there’s always someone ahead in some category: higher net worth, bigger house, more vacation days, earlier retirement plans. Comparison can keep moving your goalposts until no achievement feels like enough. It’s exhausting and corrosive to joy and contentment in life. It quietly robs you of the life satisfaction that is available all along.

#6 Martyrdom Spending

“Spending is bad. And if I spend, I should spend all my money on my family, kids, or community. But not on myself.”

One of my therapy clients was a specialist physician who funded her niece’s college tuition and her parents’ mortgage and donated heavily to patient charities. These can all be admirable things in isolation. But she had paltry savings for her own retirement, and she hadn’t taken a personal vacation in a decade. That’s not OK.

It took a lot of work in therapy and otherwise for this doctor to unearth how her self-martyring financial behaviors stemmed from unprocessed experiences from childhood, medical training, and other dynamics that reinforced to her the idea that to be considered “good,” “worthy,” or “competent,” she had to put others before herself.

Martyrdom can feel noble, but over time, neglecting your own security, needs, wants, and desires can risk breeding burnout, resentment, poor boundaries, harmful self-sacrificial tendencies, and more.

#7 Avoidance from Fear of Admitting Vulnerability

“If I buy X, it means I’m admitting I’m not invincible.”

A healthy 40-year-old neurosurgeon delayed buying disability insurance for years. He knew he should, but he kept putting it off for one excuse or another. Reaching out to an insurance agent to shop policies, much less signing the paperwork, felt to him like he was tempting fate—as if to make the prudent choice to take out a policy would somehow mean that he is acknowledging he might not be able to work forever, or the even more terrifying possibility that something catastrophic could happen to him that would necessitate no longer having the ability to work.

In therapy, we discovered that some of the roots of his avoidance stemmed from unprocessed grief and deferred meaning-making about the experience of suddenly losing his father in middle school due to a stroke from an undiscovered brain tumor.

The avoidance mindset can block physicians from making protective investments, from the big tasks/decisions like disability insurance or estate planning, and all the way down to the littlest of things like buying much-needed ergonomic equipment (oh my).

#8 Money Avoidance

“If I don’t think about it, it’s not a problem.”

A hospitalist making $300,000 a year didn’t know his mortgage interest rate, how much he had in retirement, or his retirement asset allocation. Between work, parenting, and call shifts, he simply ignored his finances—until a surprise tax bill caught him off guard.

Avoidance often hides under busyness, but the costs (literal financial costs and otherwise) always inevitably surface when just the slightest thing blindsides you.

More information here:

Strengthening Your Mental Health

Burnout Is Expensive: The Financial Case for Prioritizing Mental Health

Why Money Scripts Are So Hard to Change

Knowing your money script isn’t the same as changing it. Here’s why they tend to stick around.

#1 They’re Wired into Your Brain

From a neuroscience perspective, early experiences form “default settings” in your emotional memory networks. Those parts of the brain operate faster than the logical, problem-solving regions. That’s why you can know you’re financially secure but still feel anxious about spending. Your emotional brain is running an older, louder program.

#2 They’re Tied to Identity

Psychologically speaking, money scripts are rarely just about money. They’re often about our identity: who you believe you are. If you have a self-image of yourself as “the responsible one,” “the provider,” or “the one who never wastes money,” then questioning those deeply seated, self-protecting beliefs can feel like a threat, as if it’s upending your entire sense of self.

#3 The Culture of Medicine Reinforces Them

Medical training hardwires habits like delayed gratification, self-sacrifice, perfectionism, guilt/anxiety, putting others first, etc. It’s a perfect breeding ground for certain money scripts. Those habits and qualities may have helped you survive residency, but they can also lock you into financial patterns that no longer serve you post-training.

#4 Behavioral Economics Plays Against You

Biases like loss aversion (fearing losses more than valuing gains), confirmation bias (seeking proof for what you already believe), and status quo bias (preferring the familiar) keep old scripts in place. You’re more likely to defend your habits than test them, much less do the work it takes to revise them.

#5 They Often ‘Work'—Until They Don’t

A scarcity mindset might have kept you from overborrowing or overspending in med school. Overcontrol might have prevented costly mistakes while in training, and when a belief has “protected” you in the past, it’s hard to believe it could be limiting you now. Letting go can feel risky. It takes active effort both to see how you might be limited by outdated scripts and to put in the work of personal reflection and habit formation/practice to change them.

#6 They’re Emotionally Self-Reinforcing

Scripts create behaviors, which create outcomes that seem to “prove” the script is true. For example, if you believe “spending is dangerous,” you might avoid buying what you need and then feel validated when your bank account grows, reinforcing that belief.

#7 Change Requires Tolerating Discomfort

Whether it’s spending a little more than feels safe, delegating investment decisions, or simply checking your accounts after months of avoidance, rewriting a script means sitting with anxiety, guilt, or uncertainty in the short term. That’s not easy, especially for people trained to avoid mistakes at all costs.

How to Start Rewriting Your Money Scripts

Rewriting a money script isn’t about flipping a switch. It’s more like updating old software while the program is still running. It can be hard and it takes active effort, but it is definitely possible. Here’s how to start.

#1 Identify Them

Start paying attention to your automatic money thoughts and behaviors, as well as the feelings that come up when you notice those thoughts and behaviors. Notice when you feel a quick emotional charge around money decisions. It could be a buzz of anxiety, a wave of guilt, or a sudden rush to defensiveness. “Always” and “never” statements are often a good giveaway.

#2 Ask Yourself Where That Money Script Came From

Trace back the belief. Was it something a parent said often? A painful lesson you learned during a financially tight year? Something you absorbed while observing peers in training? The origin story matters because it gives you a clue about whether the belief was built for your life vs. someone else’s. Knowing where a script originated is the first step to deciding what you want to do with it moving forward—be it changing it altogether, softening its hold on you, reshaping your relationship with the extent to which you let it run across your life vs. making it context-dependent, or anything else.

#3 Test the Money Script Against Your Current Reality

A script that kept you afloat in med school may not make sense when you’re earning six or seven figures. Ask yourself: “If I learned this today, would it still make sense for me to believe it?” Ask yourself whether this belief serves your life now or whether you’re running on an older program.

#4 Reframe, Don’t Erase

Throwing out a money script completely can feel unsafe or scary. Instead, start by trying to adjust it to fit your present reality. For example, “I can’t spend anything” can become “I can enjoy what I have and save responsibly.” That balance helps reduce emotional whiplash.

#5 Create Small, Safe Experiments

If you tend toward scarcity, try spending a modest amount on something meaningful and sit with the discomfort of it, without undoing it. If you overcontrol, delegate one small piece of your finances and see what happens. If you tend to be susceptible to the martyr complex, try siphoning money to your own savings/investment account that you previously earmarked for someone else. The goal is to gently expand your tolerance for new patterns.

#6 Get Outside Perspective

It’s really hard for us to see our own blind spots. Trusted friends, a financial advisor, or a therapist (like in my practice) can reflect what they notice and help you challenge and remold unhelpful scripts.

#7 Track Progress and Feelings, Not Just Numbers

Pay attention to how changes in your money habits affect your stress levels, relationships, and overall satisfaction, rather than just your net worth. Sustainable change often shows up emotionally before it shows up financially. You might even try journaling about it or starting a habit tracker to monitor things over time.

More information here:

Flourishing at Work: What Physicians Get Wrong About Career Happiness

Loss Aversion: A Killer to Successful Investing, and How to Beat It

The Role of Therapy

Sometimes, self-reflection and small experiments are enough to loosen the grip of a money script. Other times, you may not even know where to start or you keep circling the same patterns despite knowing what they are. That’s when it can help to have guidance in the form of therapy.

Therapy isn’t about telling you which stock to pick or what percentage of your income to save. It’s about uncovering the underlying drivers behind your financial decisions—the “why” beneath the numbers. For physicians, that can often mean exploring:

  • How early family dynamics shaped your beliefs about money and work.
  • How those beliefs interact with the culture of medicine.
  • How your money habits affect—and are affected by—relationships, identity, and self-worth.

In therapy, we work on slowing down enough to notice the old rules you’ve been following automatically, and we practice tolerating the discomfort of trying something different. Over time, that creates space for more flexible, intentional choices with money and in life more broadly.

If you’re a physician and this is resonating, you don’t have to figure it out alone. Many doctors try to white-knuckle through things for too long, and far too many have old-school ideas about therapy that preclude them from reaching out to get support. Doctors can also get hung up on finding the right therapist, so it can help to see a therapist who specializes in serving doctors.

The Bottom Line

Over time, that surgeon by the pool built better habits and mental schemas that helped him slow down and take permission to rest and relax. But these changes only arose once he confronted his money script of, “If I slow down, I lose ground.”

At first, he experimented in small ways, silencing his phone during dinner with the family, leaving his laptop at the office when coming home, carving out one weekend morning to sleep in instead of rounding through his inbox. Each time, he noticed the world didn’t collapse when he stepped away. And his net worth didn’t suffer either. Slowly, the belief that “rest equals falling behind” gave way to something more balanced: “Rest helps me show up sharper over time.”

That’s the heart of rewriting money scripts. They don’t change overnight, and they also don’t disappear completely. But with awareness and practice, you can loosen their grip.

Money scripts aren’t moral failings. They’re survival tools you learned along the way. The goal isn’t to erase them but to bring them into conscious awareness so you can choose when to keep them and when to let them go.

By acknowledging and processing your money scripts, you can move from living on autopilot to writing new programming for yourself—whether that means finally closing the laptop at the pool, truly enjoying the vacation you worked so hard for, or simply trusting that your money and your life can support both security and joy.

If you notice your money habits don’t match your goals, ask yourself: where did I learn this? And most importantly: do I still want this old programming running my life?

Have you noticed that you have money scripts? Are they positive or negative in your life? How have you tried to change them?