Sunday, August 10, 2008


It's what's for dinner! (Quite seriously, we've ordered every form of takeout you can imagine this week!) It is the theme of the week. I just can't get excited or motivated about a darn thing. I assume that this is a typical problem, adjusting back to the daily grind after some much needed time off; I just can't seem to get back into the groove. At the heart of the matter, I'm aware, is the cold hard fact that I am tired of being tired. I find myself mentally withdrawing from my current place of employment. It isn't hard when you are welcomed back to the office with 8 patients scheduled in your first hour of the day. I'm over getting fired up about it. I've drawn out templates, been nice about it, stomped my feet about it, and taken it to the office manager that hates me, and nothing has changed. I know very much where I stand in this office. The writing is on the wall.

I know that staying in this position is no longer a viable solution, and while I know this will open up the chance for a much better life for me and my family, I am very sad about my patients. I am going to *miss* (most of) them a lot! Of course, I haven't told anyone that I am even looking for another position, and hope not to be forced to do so until I have a reliable back up option in place. You know, just in case they tell me to go ahead and get lost when I do reveal that I am seeking another opportunity. I find myself seeing my annual exams, and writing for a 12 month follow up visit, knowing full well that I'll likely already be gone. I feel so *deceptive*. I want to tell them to start looking now for a new physician. I'm so torn between my desire to get the heck out of dodge and make my life better, and the guilt I feel about leaving my patients. I've already gotten an attractive offer, but the catch is that they would like me to start in the early part of 2009. Ack! I'm not ready! I'll still have pregnant patients due then! How can I leave them mid-pregnancy? Don't get me wrong, I suffer no delusions that I am so awesome that all of my patients will be just crushed when I leave. I am *just* the doctor to the vast majority, I am certain, but I do know a few that will be crushed. The worst thing is that I let this guilt come to be on par with my family's need for a better lifestyle. My husband tries to reason that it is "just a job," but, to someone in medicine, it really is so much more.

On so many levels, I'm past ready to move on. I know that the decision I am making will be the best one for my family. I think the apathy that I am feeling is a resistance to the change that is coming. If I don't get things ready for leaving, like putting the house on the market or making the proper preparations to leave one practice for another, then it isn't truly real. It *is* real, and I need to embrace it. There is much to I think I'll sit here and play on the Internet for a little while longer. Queen of procrastination, am I. If anyone out there has been in a similar situation, I'd love some advice on how you handled transitioning out of a busy practice. This is brand new territory for me, since leaving residency was inevitable, so I never worried about the aftermath of leaving. Sorry for such a downer of a post! I use the blog to get things organized in my mind, and this has been weighing heavily all week long. More fun filled L&D hi jinks soon, promise!


faedrake said...

Balancing obligations is never fun. If you want a distraction suggestion, try this game:

Unknown said...

I'm sorry you're having such a hard time! Leaving anything can be hard.

I really appreciate your perspective on this. I have often wondered about it and I felt like even though my doctor and I, my ob especially, were not close or anything that we did have some type of connection. My family and I are considering moving and part of what is slowing me down is that I don't want to leave my OB before I'm done having kids. I love her. I value her opinion and I do consider her to be a very important part of my life. She didn't make it to my last delivery in time and actually cried because she did deliver my daughter, whom we both worked very hard to keep alive during a high risk pregnancy.
I can imagine how difficult it must be to walk away from your patients. I have to wonder if your husband's point of view or reasoning has a little bit to do with him being male. No insult intended just that women are generally more emotionally attached. Just a thought!

Again, I'm sorry you're having such a hard time! I hope it gets exponentially easier for you! Sorry I rambled!!! :)

Elaine said...

The situation with leaving patients will never change, however long you delay a move, so I think you have to bite the bullet and go for it.

Best of luck!

Beach Bum said...

I felt that way when I applied to medicine this last time. I was teaching music at the time, and felt dishonest about planning stuff with my students, when I knew there was, at the very least, a possibility that I wouldn't be there to follow through. I have a couple of thoughts:

-While it's important to take care of patients, sometimes you have to put your needs ahead of theirs. It's never an us or them scenario, sometimes their needs trump ours, and sometimes our needs trump theirs.

-No job is going to be perfect, but if your working environment is so poisonous that your anger rubs off on patients, you are not serving them by staying.

-I think that sometimes our reluctance to change is caused by a needy arrogance that says, "No one can replace me." While you are excellent at your job, no one is irreplaceable.

-Things happen for a reason. THe horrifying job environments that I had taught me a lot, but I learned to be ready to leave when the going was good. Have you learned what you need to?

-Life is hard, and too short to surround yourself with bitter, angry, crazy, emotionally abusive people. Just say no to crazy!

Jody said...

Ok I've been in a similiar situation and let me tell you how it went.
I was an RN on a very busy surgical floor but my Heart was in OB. I knew I had to do my 6 months in my position (company policy), but as soon as it passed I started making my plans. I quietly emailed all the managers of the various OB depts. L&D, PostPart., ect ect. I recieved replys from all of them; but the L&D manager was Most receptive. I asked to shadow a nurse for 4 hrs. I did this and knew instantly that altho this was a huge learning curve; it was my hearts desire. No one on my floor; not even my closest friends knew I had done this. Things get around when shared and I did Not want my manager to get all pis*y about it. I met with the L&D manager the next day and she offered me a job on the spot. I hadn't expected this! I accepted! The next shift I came in I wrote my letter to my present manager. Did she get annoyed? Heck yeah! She even tried to block my transfer. But in the end she couldn't. Or didn't..not sure totally. My friends were shocked that they didn't know, but all confided that I was smart to do it "under the covers" so to speak.

I had my new position ready before notifying them. I'd suggest you very carefully and quietly do the same.

Yes I've seen a few nurse who did it the other way. They told their boss they wanted to go to another floor. Then when they had their starting date, were told they could "leave" early. LOL. Yeah no workie no pay. Shesh.
Good luck with your search. Remember, you will always have memorys of your present patients; but just Think of the exciting new people you will meet. And you Will love them just as much.

Go for it!!

Anonymous said...

HI..I've been reading your blog for about a year and truly enjoy it! I'm an OB nurse and it's interesting to see the "flip side" as it is. Obviously I don't have any words of wisdom as far as the practice goes, but I have been on the receiving end of the deal. We had an OB leave our facility last year. Not only did we lose a great OB, but I also lost my friend (and my OB!). It was tough. But since I keep in touch with her, I realize how much happier she is since she has left. She is so much more relaxed and able to enjoy her time off (!), her hobbies, and most importantly, her family. Even though we as her patients miss her, we have moved on. So. Good luck to you! I hope you find the best match for you and your family, and I look forward to reading about it!

Laura from MN

Anonymous said...

Okay, so my 1st thought on the 8 pts per hr was that maybe you are in such demand and pts are demanding to SEE YOU!!! Maybe you are more to MOST of them than *JUST* a Dr. IDK how far away your offer is, but early 2009 seems doable with plenty of notice to your current practice. If its not too far i am sure 1/2 of those folks who you are more than just a dr. will follow you. Another factor is insurance. I drive 2hrs to see my Dr. and could never imagine seeing anyone else, but i love her and would want what is best for her children. Ask yourself who will remember *your job change* the longest your children or your patients. HTH

ER's Mom said...

Hey email me, medgoddess at I can sympathize - I left my old practice and am starting up a hybrid charity clinic and private practice through the hospital. I think I made the right choice.

ER's Mom

Anonymous said...

So true...very hard to leave the patients. You are going to be AMAZED at how much appreciation you get after you tell them you're leaving. People understand that you have other priorities and they will cope. A couple of suggestions:
1. Have a signed contract in hand before you tell anyone you're leaving.
2. Check your current contract for how much notice you have to give. I suggest 2 months. For me, 3 months was too long. Think I said goodbye to some folks several times. It just got old and toward the end people were saying, "You still here?"
3. It's natural to drag your feet as you appreciate the good things about your current life. Your paralysis will pass once you get excited about your future.

Glad to hear you have more interviews scheduled. Bet one of them--maybe more!--will be The One. Best of luck to you,

Rural ObGyn

Anonymous said...

Don't fret over the patients, dear. They'd leave you in a heartbeat for $5 less on a copay. And you never know which one will turn on you. Do what's best for your patients, but don't make the mistake of thinking they're your family. Your real family is much more important. Sorry if this sounds cynical but time and experience have taught me this is so.

Not Afraid to Use It said...

It is really nice of you to have such feelings towards your pregnant patients, but I have to say that many patients will follow you. Esp. those who know you are going to a practice where you can actually give them the time they need and are not scheduled at 8 patients per hour. Also keep in mind that you will ALWAYS have pregnant patients, it just depends on WHEN you make the break because it sounds as if your situation is becoming more unbearable by the minute. It sounds as though the sooner you leave, the happier you will be.

Tori O. said...

I feel your pain. Count me in the miserable where I'm at group, too. Best of luck in finding something that makes going to work a joy.

Anonymous said...

You'd be surprised how many of your patients will miss you. Women get quite attached to their caregivers when they're pregnant. For the patients that you think might be most upset by your departure, can you tell them in confidence that you'll probably be leaving in the near future? It's risky, but the trustworthy ones will keep your secret. After all, they'll miss you but will want the best for you as well. God bless you!

Anonymous said...

Well, if you really want advice from a total stranger here will be sad to leave your patients but it sounds like it must be done. Save yourself. You've worked too hard, and are too young, to be stuck in a place where you're not appreciated and valued. You owe it to yourself and your family to cut the ties and move on to a better situation. As for the pregnant patients, well that is never going to stop is it? Once they are delivered, there will another whole set coming up. They may be upset to change MD's in the middle or end of their pregnancies, but they can adjust. I've been seeing the same GYN for over 20 years now, but I know he will retire at some point! We're all adults and can let go. :-) Besides, at 8 per hour, they're only seeing you for 7.5 minutes at a time anyway. YIKES! Anyway, good luck. I'm sure you'll make the right decision!

Anonymous said...

having left a bad situation in rural america for greener lifestyle pastures myself, there is no good time. you will always have a favorite pt who you really want to deliver etc. the ideal time frame is 3 months notice. if you give too long a notice you will stop getting any new patients and if you have a situation where you need to bring in x amt of dollars a month that may put you in the hole. any longer than 3 months also prolongs the agony of having to tell your pts every. single. day.
now that i think about it 2 months might be better!
good luck; from someone who has been at this since 1999 (grad residency obgyn) your blog makes me cringe when i read how much you are doing and how relatively little you are being compensated.

elizabethanddennis said...

I stumbled upon your blog over a year ago and have enjoyed your witty style. I wanted to respond to your post, but I am not a doctor, I am a patient--twice an OB patient.

From reading your post, you HAVE to do what is right for you and your family. You are fooling yourself if you think your colleagues won't begin (if they haven't already) started to notice your apathy.

My primary physican, whom I'd known since I moved to my town 12 years ago, joined a group practice as he neared retirement. He wrote a letter to all his patients explaining everything and I loved that. Then when he left the group practice, there was nothing. I went to make an apt. and was informed he was gone--hated that.

My OB has been telling me he is going to retire since I had my first child 3.5 years ago. I keep telling him to stay on for me to have one more child. I'm trying to imagine someone else delivering my baby (I'm not even pg). But, if that happens, I will survive.

Regardless of how close you get to your OB and vice versa, your patients who really like you will understand, and while not happy will survive (provided there is a good physican you can refer them to in your existing practice--no one wants to change practices mid-pregnancy). But maybe as a doctor you're not allowed to refer within the practice?

I am sure you have considered if the potentially new practice would allow you to finish out the pregnancies you've got--that might even further cement for them what a good and caring doctor you are (and buy you more time to relocate).

Good luck.

Somenurse said...

I think you are making the right decision for yourself. I wish you luck and skill in your smooth transition!

Anonymous said...

You'd be surprised how many of your patients will miss you. I think many pregnant women get attached to their doctors - especially if you're even minimally concerned for their welfare. With your patients who you think might take your leaving hard you might want to tip them off about your eventual departure. It's a bit risky, but if you trust them they'll keep your business decisions to themselves. God bless you!

Anonymous said...

look into birmingham, is like a big city with small town atmosphere. great medical care and wonderful hospitals to choose from.

Just Me said...

I live in Appalachia. Therefore finding good doctors is hard, and I have complicating factors like multiple and severe med allergies and a number of rare health conditions.

About 3 years ago the doctor I was seeing kept trying to prescribe me an antibiotic over the phone he had already told me I couldn't take. After 4 rounds of this I reported it to the medical board and found a new doctor. I had a very blunt discussion with the new dr. about my allergies (and volatile meds) mean I will not take anything that I don't see him run through a computer, and if questions arise about treatment he is to get on the phone to the specialist at the university hospital 2 hours away. (She actually had wound up having to do some primary care stuff for me because the previous doctor was so bad). He agreed to all that, and followed it.

A year ago when I tried to make an appointment he had moved. I tracked him down through my insurance and was, thankfully, accepted as a new patient.

The thing is that now I get better care than I did with his original practice because he is in the city and the hospital and lab options are so much better. When I needed another specialist he was able to find one who was willing to work with both the primary doc AND my psychiatrist (I have diabetes insipidus from lithium and I NEEDED to stay on lithium--thanks to his coordination and convincing my new nephrologist I could manage the meds, I am doing this).

My point is that there may be benefits to your patients, even if they lose you. For one thing, they'll lose your partner....I do not think I would want your partner to deliver my baby, or even touch me.

Without having a good primary care doctor I never would have been awakened to how important it is.

Anonymous said...

Oh, I can imagine this is so so hard...but I sure do wish you would move to Philly!!!

Anonymous said...

Do what you need to do for yourself and your family. Life is too short to spend in a toxic environment. Although you may not always have patience, you will always have patients.