From Proximity to Scale
🍏 #40 of Heer’s Heuristics | How Impact Changes as You Scale
Hey friends,
When I left full-time medicine, I told myself it was about impact at scale.
I wanted my work to reach beyond the few dozen patients I could see on a ward. I wanted to influence macro healthcare systems, not just individuals.
And in many ways, that’s what happened.
I moved from the bedside into health-tech, and later into consulting. My work expanded from patients, to hospitals, to organisations operating across countries.
But what I didn’t anticipate was that scale changes how impact feels.
1. Tangible Impact
Medicine offers something rare: proximity to the outcome.
When you assess patients, run investigations and start treatments, you often see results within hours or days. Infections settle, oxygen saturations improve and patients recover.
As a doctor, I spent much of my time in Oncology speaking to patients and families about prognosis. Those conversations happen in deeply vulnerable moments and the opportunity to offer clarity or reassurance is a privilege.
To me, medicine has always been an art. It is personal and deeply human, and the daily interactions constantly reinforce the reasons for doing this work.
Even on the most difficult shifts, when you lose a patient or are on-call all night answering bleeps, the small moments make the work worthwhile.
2. Closed vs Open Feedback Loops
In medicine, feedback loops are relatively contained and common. If a treatment works, the patient improves. If it doesn’t, you adjust. The connection between cause and effect is not always perfect, but it is usually legible.
But in health-tech and consulting, that loop is far broader.
At MediShout, I helped design products that would be used across multiple hospitals. On paper, the problem was consistent. In reality, NHS trusts often operate in silos. The same issue can require different solutions depending on local culture, leadership, staffing pressures and priorities.
In consulting, we advise executives and boards, but implementation can vary widely depending on management capability, market conditions and how willing the organisation is to change.
As the system becomes larger, more variables sit between effort and outcome and therefore, attribution becomes less certain.
While the potential reach increases, the line between what you personally did and what changed becomes harder to trace.
Thankfully, there is a third option.
3. The Beauty of Hybrid Careers
Career decisions in medicine are often framed as binary:
Stay clinical or leave. Work at scale or stay close to patients. But in reality, the boundaries are more fluid.
The qualities that make medicine special do not have to disappear when you choose a different path - proximity and scale are not mutually exclusive.
It is possible for clinicians to split their time between patient care and technology, strategy or leadership roles. Some continue practising part-time while building companies. Others hold advisory or executive positions while maintaining clinical sessions each month.
These paths are rarer and require coordination. They come with trade-offs, but they offer something distinct.
They preserve the human immediacy of medicine while engaging with broader systems. They allow tangible contribution alongside scaled influence.
I have always found myself drawn toward that middle ground rather than one extreme.
Hybrid careers are not the easiest route, but they recognise a simple truth: impact is multidimensional. You can shape systems and still stay connected to individuals.
4. A Handy Framework
If you are considering a move away from full-time clinical work, it helps to approach the decision deliberately.
Annie Duke writes in How to Decide that strong decisions are defined by the quality of the process, not the certainty of the outcome. You cannot control how things will unfold, but you can be clear about the variables you are weighing.
When thinking through my own moves, I sketched simple decision trees. I listed the obvious factors such as pay, flexibility and progression, but I also included the less tangible elements that are harder to measure:
How close will I feel to the outcome?
How much ambiguity am I willing to tolerate in the day-to-day work?
Those variables rarely appear in job descriptions, but they shape your experience far more than you expect.
There are far more options for doctors today than even a few years ago. Tech and strategy roles increasingly offer flexible, hybrid arrangements, and it is now possible to design careers that sit somewhere between proximity and scale.
More choice does not remove trade-offs, but it does create space to be intentional about the kind of impact you want to make.
Because impact is not only about reach. It is also about maintaining a connection.
Heer ✌🏼
Find me on LinkedIn & Instagram
Header Image by S M Imrul Quayes on vecteezy.com