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.