After great consideration of risks, benefits, and consequences, I recently left my academic position. I now work in a nearby community hospital with a democratic group. Happily, we did not need to sell our undervalued home, and I am still involved in teaching. Time and experience will tell if I have chosen wisely. Since making my decision, I have been thinking about why, in general, doctors choose to leave a group or hospital.

My buddy Steve Grider always tells me that at work there are three conditions that, when handled correctly, make many little aggravations tolerable: the check, the schedule, and the treatment.

We all would like to be paid well for our work. From the housekeeper’s and the government’s viewpoint, we make way too much. Each would like to see more of our income directed their way. Few understand how truly productive we are and how much complimentary care is provided. Those emergency physicians who work with a less-than-stellar payer mix know this very well. It is the hospital’s responsibility to provide care to all who enter regardless of ability to pay.

Many hospitals have lost sight of this and demand that emergency physicians carry too much of this burden. There is a point at which physicians must proclaim there is not an .org after their names and vote with their feet. If enough doctors leave a place, eventually the pointy headed, silk suit, and shiny shoes crowd will get the message.

Anyone who has worked more than a few months has been stuck with a bad schedule. Sometimes, somebody has to get the shaft in order to make the schedule work that month. It’s just dreamy when you see that your only weekend off in the month comes right after a stretch of five nights. You are never happy about it, but you do it because you are a team player. Misery happens when you are the one who always gets the extra night, the extra weekend, or the crappy holiday schedule. If these inequities, after checking your numbers and bitching up a storm, are corrected over time, the contentment equilibrium is restored. When these issues persist, it’s like a boil on your backside. Evacuation may be the best solution.

No matter who you are, everyone wants to be appreciated.

It’s human nature, even for doctors. You can see four patients an hour, be nice to everyone, and find the elusive PE in a board member’s wife, and you won’t even get a birthday card. Drop a few points for one quarter on the sacred satisfaction score and you would think you had dropped your pants in the lobby. Constructive feedback is great, but there needs to be a balance between the high fives and the slaps to the back of the head.

A strong collegial relationship with the other doctors at your hospital can make work life quite pleasing. Medical staffs seem to be getting better about not treating the emergency physicians as the red-headed stepchildren. There are some hospitals and many doctors, however, who prefer to live in the era where nurses wore funny little hats and emergency physicians dwelled in an RV in the back lot. There are a few of these jokers at every hospital. When there are enough of them to make a baseball team, it may be time to switch leagues.

In addition to the big three, the spouse cannot be forgotten. Few can argue that the happiness of a spouse is essential for overall contentment. No matter how great your location, pay, clinical setting, or group dynamics, an unhappy spouse can trump all of it. If your spouse is far from family or likes four seasons or prefers a rural setting and your situation is otherwise, dark clouds loom on the horizon. Prevention, of course, is the best remedy, and detailed discussion is imperative before the move happens in the first place. Unhappiness, unfortunately, can be unpredictable, and at times only experience will tell. If the spouse has given ample time for adjustment and compromise is lost, then another move may be the only solution to discontent.

Moving on can be difficult. Friends and colleagues will be left behind, and new relationships and alliances will need to be made. And the last thing anyone wants to do is to learn 50 new names, a new EHR, and five new passwords plus spend 6 hours on credentialing forms. Security clearance at the Pentagon probably takes less paper.

The decision to move should not be done on impulse and never when angry. An important but often forgotten aspect to consider is what pesky little problems will follow you. If your problems are self-inflicted, you will be no happier down the street. Sometimes when we move, certain behaviors or attitudes must be left behind.

Many hospitals breed cynicism like lab mice. For future success we must unlearn the snarky demeanor and learn to function appropriately in a setting where people are not driving you to drink.

When a spot opens up at a hospital, usually someone is leaving. Unless that person is retiring or was hit by a bus, he may be leaving for the same reason as you. What seems trivial today may be a bigger deal 2 years down the road. Keep your eyes wide open, and remember that even if the garden is more beautiful, you still have to weed it.

Be happy.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine at Wood County Hospital. Your feedback is welcome at David.Baehren@utoledo.edu.