When You Won't Pay Your Staff What They're Worth, This Is What You're Actually Telling Them

I have this conversation with practice owners more than almost any other, where they tell me they would absolutely pay their best people more if they could, and that the margins just don't allow it right now, and honestly I believe them most of the time, because I have spent twenty five years looking at budgets and the money really is tight for most owners more often than not. But here's the thing I keep coming back to, which is that being tight on money is a fact about your business, and how you let that fact land on the people doing the work is a choice, and it's a choice that costs practices far more than the raise they were trying to avoid.

Let me give you a picture of what I mean rather than just talking in general terms. Say you have someone on your team who built an entire new revenue stream for the practice from nothing, who worked out how the service would run day to day, rewrote your SOPs so the whole team could actually follow the process consistently instead of everyone doing it their own way, and sat there thinking through every single thing that could go wrong for the practice along the way, from a compliance gap to a complaint to some scenario nobody else had even considered, quietly closing each one of those risks before it ever became your problem to deal with. That isn't admin, and it isn't someone simply being helpful, it's the kind of thinking most practices would pay a consultant a serious amount of money to do for them, and she just did it as part of her job.

A year on, the revenue stream is working, it's bringing money into the practice steadily, and she is sitting on exactly the same base pay she was on before she built any of it, which raises the obvious question of what that actually tells her. It has nothing to do with your margins and everything to do with whether the value she created actually registered with you as something worth acknowledging. You can tell yourself all day that you value her enormously and that you're just waiting for the right moment to sort it out, but she isn't hearing any of that internal reasoning, she's looking at a number that hasn't moved, and a number that hasn't moved after that much effort tells her the practice noticed what she built well enough to keep using it, without noticing it well enough to pay for it.

What makes this so easy to miss from the owner's side is that it almost never happens as one deliberate decision, because nobody sits down and consciously decides not to pay their best person properly. It happens through a string of smaller moments that each feel reasonable on their own, and one of the biggest is what happens when the wage bill lands in front of an accountant. An accountant looking at your numbers sees a line item that has gone up, and their job is to flag that, because that is genuinely what they are there to do, but what they are not looking at is the revenue stream that person built from scratch, the SOPs that now keep the whole team consistent, or the risks that got quietly shut down before they ever became a complaint or a compliance problem. None of that shows up on the same page as the wage line, so it never gets weighed against it, and a pay rise that would be completely justified if you looked at the full picture gets trimmed or delayed because the only picture in front of anyone in that moment is a number going the wrong direction. If you let the accountant's view of the wage bill be the only voice in that decision, you are letting someone who has never seen the value being created make the call on what it's worth, and that is how genuinely excellent people end up on the same pay as everyone else around them.

And that silence is doing a lot more than it looks like it's doing. The people who carry a practice, the ones who show up early and stay late and are the reason everything holds together on the days it shouldn't, are also the ones who notice fastest when effort and pay stop lining up, and they watch someone doing a fraction of what they do land on similar money without complaining about it, because complaining has never really been their style. What they do instead is quietly decide how much of themselves they're actually willing to keep giving, and a practice that has slowly taught its best people to hold back is in a much harder position than a practice that's just lost one strong staff member to resignation, because a resignation you can see coming, whereas the slow pullback tends to stay invisible right up until the day it isn't.

It's worth saying too that this was never really only about money, even though money is the part everyone focuses on because it's the easiest thing to measure and the easiest thing to argue about. What people are actually reading in that payslip is whether they've been seen properly, whether the thinking and the risk and the extra hours were noticed for what they were rather than absorbed as though they were simply part of the job. You could hand someone a modest pay rise alongside genuine recognition of what they built and it would land completely differently to the same number handed over silently as a routine adjustment, because the number was never really the whole message, it was just the part that's easiest to check.

None of this means every practice has spare money sitting around waiting to be handed out, because most genuinely don't and I'm not going to pretend otherwise. What it does mean is being properly honest with yourself about what your pay decisions are actually saying to the people affected by them, and doing the work to close the gap between how much you actually value someone and how much they can see reflected in their payslip, whether that's a conversation that's simply overdue and hasn't happened yet, or a harder look at how your practice generates revenue in the first place so there's genuinely more room to work with. Either way it's worth doing properly instead of avoiding it for another year and calling it a cost of living adjustment.