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.