Convincing yourself to quit/walk away

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TrailRun said:
Is the VA typically no nights? Is there a mini night ie 5p-3a or something?
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It depends on the VA. Only reason the job I’m looking at says no nights is because they have dedicated nocturnists. That goes away and I probably have to pick up some.

Other docs at other vas I’ve seen say they’ve work 0-2 nights in the last 4 years. Plus the Va is staffed differently, so nights are actually doable. Unlike CMG gig where you’re solo covered seeing 17 after midnight.
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From those who have quit, did they do so in person, with a meeting, or via email? I really dread quitting in person.
 
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Email is perfectly fine, done that before in this field.
 
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turkeyjerky said:
I've quit 3 jobs. Two were somewhat contentious and I did one of these via email and one via a phone call. The third was in person.
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If you don't mind sharing how did the contentious ones went down, I think some of us could benefit from your experience. I often hear about "reputation is everything" and "EM is a small world" but ultimately if there's a need, some group out there will hire you...
 
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turkeyjerky said:
I've quit 3 jobs. Two were somewhat contentious and I did one of these via email and one via a phone call. The third was in person.
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As the person who's been on the receiving end (not in EM if that's relevant for this particular topic), it doesn't really matter. A phone call is fine. If you work with the person fairly regularly, and have a good relationship with them in general, in person seems like the right thing to do.

Email is pretty weaksauce, but if you're quitting via email, you're probably not going to ask that person for a reference in the future, and if you're stupid enough to do so, you deserve the reference you get.

In the last 3 years I've had 4 docs quit on me. One finally retired (after threatening to do so every 4 months for the past 5 years) and called me to tell me it was finally time. He's also sticking around as per diem as long as the days we need him don't interfere with his golf tournaments. One told me when I called her to discuss moving her to a clinic that was both closer to her home and where I thought I could better contain the damage she does...she told me she'd just been offered a job 2000 miles away and was planning to take it...it was all I could do to not ask who to send the both of Pappy Van Winkle 23 to in thanks. The other 2 called to tell me they'd taken jobs on the other side of the country to be closer to family. Both have signed contracts and will be moving back here to work with my group again before the end of the year.

Bottom line, if you want to quit with a one finger salute because the work environment is that terrible, do it however you want. If it's the work, not the job, that you can't stand, a more personal message is what your mom would want you to do.
 
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In the end it’s a job like any other. If you have a good working relationship with your superiors medical Director etc. then an email followed up with a phone call or in person conversation is fine.

If it’s some big corporate CMG and you don’t actually know who you technically report to, an email CCed to your medical Director, scheduler and whoever else you think needs to know that you won’t be reporting in the agreed-upon contractual amount of time 90 days or 2 weeks is fine.

” To whom it may concern:

This email serves as formal notice of my last day of employment “under big-name contract”. As per our contract agreement I am notifying you “X number of days in advance “ of my final day of work.

I thank you for the opportunity to have worked with “big name hospital group“.

sincerely

Hasta la vista MD”

Remember to “them“ you are but a cog in the machine.

If it’s a small group and the email is followed by in person is best, or in person followed by email is probably better as not to burn any bridges but if you don’t care and will never work for the group again then so be it. You want a paper trail anyway to have a last day in writing.

And the three times my spouse changed EM jobs:

one he Resigned by email, followed by a conv w/ med director to settle on a last day. No fallout. He was able to use them as a reference.

second he was simply taken off of the CMG schedule with no formal resignation process, (Always make sure you put verbiage in your contract to prevent this from happening)

three the contract changed groups and he simply did not sign on with the new group.
 
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If your home is paid off and you have 1.5 mil in investment/savings, call it a day or work 4-6 shifts per month.
 
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Birdstrike said:
A unicorn job is one that leaves you feeling you could be happy doing it as long as you need to.
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emergentmd said:
This is indeed my definition of a Unicorn job. I plan on working my unicorn job until it stops being a unicorn or I can't physically do it. Either way, once I walk away from medicine, I will have one foot in the grave.
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Sad state of affairs we have these days. A "Unicorn Job" got the name because it was so rare that it was thought by many to be non-existent like unicorns.

Now, a job that you can work until retirement is considered so rare that it may be non-existent by people who graduated college at the top of their class and then but in 60-80 hours a week for 7-8 years.
 
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Email don’t think you have to call. You need something written to break your relationship. Also if you fear of a bad “reference” for sending an email then that job isn’t really for you.

Physicians network and that determines the job plus we make a lot of money they should be thankful for your labor and service. You did work they make announcements all the time letting people go.

Plus it’s not like you’re leaving suddenly you often have to stay for 90 days you’re not leaving in two weeks.
 
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HemorrhagicShock said:
If you don't mind sharing how did the contentious ones went down, I think some of us could benefit from your experience. I often hear about "reputation is everything" and "EM is a small world" but ultimately if there's a need, some group out there will hire you...
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Job #1 was my first job out of residency, where I worked at for about 4 years. Other than the medical director I was actually the longest serving doc there, as there had been a contract change shortly before I started. I got pissed off over what I felt was a ****ty response from hospital admin and the directory about a few issues over the years. I was planning on moving anyway and had already secured some locums gigs. I worked out my remaining shifts and stayed on prn for a few months after. I had secured recommendations from a few other docs in the months beforehand. I can't honestly remember why I sent an email instead of calling or in-person, I think it might have just been convenience related.

Job #2 I only worked at for 6 mo., within 3 I realized it wasn't gonna work out. Group looked nearly ideal on paper other than location (sdg staffing a nice mix of 4 hospitals including a residency site) but had a nefarious underbelly and a dictatorial group president. After I interviewed at a few spots and secured a new position, I called him (well scheduled a phone call through his personal secretary) and told him I was resigning. I didn't really pull punches as to the reasons why. He called me back the next day and offered me 20k severance to stop working out my assigned shifts and we settled on 50.
 
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I think it really depends on the situation.
My previous assistant-medical-director gig got eaten by TH. I stayed on but stepped down, then went part time, then when they said they didn't want part timers I (maybe a bit over the top) said that this might be the opportunity I'd been looking for to really pursue my dreams of exploring hospice and palliative care... and gracefully "retired." When they made new assistant director call me groveling to ask if I'd, ahem, come out of retirement (I really liked this guy - I'd hired him, after all), I told him that I loved what I was doing, but no. I did stay in the same town and am using the same referral base, so I didn't want to burn bridges. And was exceptionally careful not to. (And still run into my referring docs who still love me. Heck, the EM guys do too... even the director.) You kill more flies with honey, so it really depends on your situation.

When I left other groups, I called or wrote an email with my intentions, which were always to retire from EM.
 
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dchristismi said:
I think it really depends on the situation.
My previous assistant-medical-director gig got eaten by TH. I stayed on but stepped down, then went part time, then when they said they didn't want part timers I (maybe a bit over the top) said that this might be the opportunity I'd been looking for to really pursue my dreams of exploring hospice and palliative care... and gracefully "retired." When they made new assistant director call me groveling to ask if I'd, ahem, come out of retirement (I really liked this guy - I'd hired him, after all), I told him that I loved what I was doing, but no. I did stay in the same town and am using the same referral base, so I didn't want to burn bridges. And was exceptionally careful not to. (And still run into my referring docs who still love me. Heck, the EM guys do too... even the director.) You kill more flies with honey, so it really depends on your situation.

When I left other groups, I called or wrote an email with my intentions, which were always to retire from EM.
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We need more posts from you on here.
 
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I quit.
Never been happier.
 
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Free.
 

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Congrats! So how did you do it? Email? In person?
 
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Backpack234 said:
Congrats! So how did you do it? Email? In person?
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So, this is kind of funny. I texted my director (whom I like as much as one can like a director- he's a good guy) and said I needed to chat with him: I have literally never called him before, but he seemed to think this was a normal request, even though I made sure to say we could talk on the phone or via Zoom or in person. We played phone tag that day and the next.

I finally got in touch with him two days after the initial text chain and just told him. He was shocked, absolutely shocked. I mean, I've been there for YEARS. It told them it's me, not you and then sent a formal email.

And that seemed to go fine.

I should add that I have a very friendly and casual department.

No idea what comes next. Maybe nothing! But, open to ideas.

Never felt better.
 
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Good for you. Want to move to Florida and apprentice under me doing exactly what I do? The sister hospice house to mine has an opening for an inpatient doc.

I mean, Florida is a dumpster fire, so there's that, but...
 
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dchristismi said:
Good for you. Want to move to Florida and apprentice under me doing exactly what I do? The sister hospice house to mine has an opening for an inpatient doc.

I mean, Florida is a dumpster fire, so there's that, but...
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Oooh, cool, thank you for the offer! Maybe. I look at the FL license application and want to take a nap.
 
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I’ve played director for more years than I will admit now, and I’ve had a good handful of docs and PAs resign / retire.

We’re a small group (usually 8-10 docs, maybe a couple more per diem; 4PAs and a couple per diems) and are rather inbred as far as training, and operate as close to a SDG as you can be without having your own contract. So we’re mostly really friendly amongst ourselves, and at this point I technically hired almost everyone that works in our ED… or at least had a big role in it. Anyway we tend to be family more than a corporate gig, understanding that in the end this is just a job… but we look out for each other.

Anyway, I’ve had people call me to resign, I’ve had them email, I’ve had them text, and the most common is tell me in person. I’ve had someone come in Saturday AM when they weren’t working (and I was!) because they wanted to tell me in person and it turned into a total tearjerker with most of the nurses crying (long time PA). I’ve had some text and destroy my schedule, but I still love them and… well the text was really appropriate. I’ve had people warn the entire group for 2years that they are going to eventually move far away for family, and finally give 7+ months notice when they found their new gig, telling everyone individually in person their plans and arranging their departure to minimize any disruption for the rest of us (we wish we could all be so wonderful). I’ve had an evening doc drop the SHOCKING news he was leaving during sign out as I was starting my overnight on a code disaster all rooms are boarders no one is taking transfers shifts from hell (hey, they told me to my face!).

At least two people have texted/emailed to arrange phone calls with me, which always sets off the awkward alarm bells since we chat a lot in person and via text/email, but never via phone. But there is something personal about voice, even if its awkward. I’ve had people want to leave rapidly and come to a mutual arrangement where they stay a bit longer to help us out.


I say all of this to explain… it doesn’t really matter in the end. Your relationship with your group / director should guide you. Small group, everyone gets along? Tell them in person or at the staff meeting, they’ll be excited for you. I’m so happy for everyone that has left to retire! Or retire early! Or move near family! Or get married! Or get a sweet 50% non-clinical gig across town! I miss them all, but that is life and they all busted their asses when they worked with me, so you better believe I’ll write them recommendations until the end of time.

If someone left with no notice and a bunch of scheduled shifts they refused to fill, that would be a bit messy. But if you are fulfilling your contract / standard group practice… the precise method of news delivery is much less important than your history as a pit doc, and your explanation of your reasons for leaving and exit plan…
 
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Thank you for all the quit advice....

So as I plod through my last 90 days, I can't say I regret quitting- I'm enjoying the change in the power differential, and I know it wasn't the right place for me. Insane patient satisfaction expectations, crap salary ($188 days ranged to $250 weekend nights, averaged out to about $225 an hour plus a potential $15 an hour bonus of which I usually get a portion, never get all). So I would say grossly underpaid and high stress because of near-constant emails/meetings/HR "help" about patient satisfaction and complaints, even though my satisfaction scores were in the 90th plus percentile, often 98th-99th! I kid you not.

I have money for an extended sabbatical. Eventually I will have to work. Is there anyone who has been through this and who might like to share advice/insight/tips?

Thank you all.
 
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miacomet said:
Thank you for all the quit advice....

So as I plod through my last 90 days, I can't say I regret quitting- I'm enjoying the change in the power differential, and I know it wasn't the right place for me. Insane patient satisfaction expectations, crap salary ($188 days ranged to $250 weekend nights, averaged out to about $225 an hour plus a potential $15 an hour bonus of which I usually get a portion, never get all). So I would say grossly underpaid and high stress because of near-constant emails/meetings/HR "help" about patient satisfaction and complaints, even though my satisfaction scores were in the 90th plus percentile, often 98th-99th! I kid you not.

I have money for an extended sabbatical. Eventually I will have to work. Is there anyone who has been through this and who might like to share advice/insight/tips?

Thank you all.
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Depending how mobile you are – and your sense of adventure – there's a locums market and some different medical slices from the same fruit down in Australasia.
 
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miacomet said:
Thank you for all the quit advice....

So as I plod through my last 90 days, I can't say I regret quitting- I'm enjoying the change in the power differential, and I know it wasn't the right place for me. Insane patient satisfaction expectations, crap salary ($188 days ranged to $250 weekend nights, averaged out to about $225 an hour plus a potential $15 an hour bonus of which I usually get a portion, never get all). So I would say grossly underpaid and high stress because of near-constant emails/meetings/HR "help" about patient satisfaction and complaints, even though my satisfaction scores were in the 90th plus percentile, often 98th-99th! I kid you not.

I have money for an extended sabbatical. Eventually I will have to work. Is there anyone who has been through this and who might like to share advice/insight/tips?

Thank you all.
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Whoa!
Did we work together at Country Club Medical Center?
 
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miacomet said:
Thank you for all the quit advice....

So as I plod through my last 90 days, I can't say I regret quitting- I'm enjoying the change in the power differential, and I know it wasn't the right place for me. Insane patient satisfaction expectations, crap salary ($188 days ranged to $250 weekend nights, averaged out to about $225 an hour plus a potential $15 an hour bonus of which I usually get a portion, never get all). So I would say grossly underpaid and high stress because of near-constant emails/meetings/HR "help" about patient satisfaction and complaints, even though my satisfaction scores were in the 90th plus percentile, often 98th-99th! I kid you not.

I have money for an extended sabbatical. Eventually I will have to work. Is there anyone who has been through this and who might like to share advice/insight/tips?

Thank you all.
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I know you were considering an independent medical examiner gig where you’re doing disability evals. If you’re still up for that, can probably land that job without having to leave town…
 
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So I have been giving this issue some deep thought as well. Our contract is changing hands to a CMG that now has the monopoly. aka- BIGCMG now has all non hospital employee, or SDG (local sweat equity is 2 years) contracts. I could hold out for another 2-3 years until fire, but went looking for other options.

I was surprised at the amount of remote work there is for physicians.

Not just telehealth "supervision" aka "collaborative" agreements (est hourly $100)-would not touch those unless I was lighting my license on fire. (if your at the tail end of your career maybe that's OK for you)

Best of both worlds if you don't want to move, you don't have too. No fellowship, still 6 figures and benefits.

Below are some examples for your perusal. Salaries posted were part of job posting or estimates from online salary calculators (reality may vary)
__________________________________________________________________________________________________________________________________
Clinical:
Addiction medicine programs (can grandfather in for boards until 2025)- The average Addiction Medicine Physician salary in the United States is $208,023 as of July 26, 2022, but the salary range typically falls between $186,410 and $232,691. many require collaborative agreements though. Primarily as MAT provider part of multidisciplinary team. Many different start ups. May practice locally in person too if you want.

Non Patient facing but still kind of medicine:

Utilization management seems to be at the top of the pay scale (not for me but YMMV)
example: Medical Director for Utilization Management 100% Remote Pay Rate: $278672.28 - 334000.00

Consultant/Subject matter expert for federal offices:
Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Clinical Standards and Quality (CCSQ), Clinical Standards Group (CSG) As a Physician, GS-0602-15, you will serve as an expert advisor and medical consultant for CSG. $112,890 - $146,757 per year​

Disability reviewer was mentioned but this can be done remotely too:
As a Supervisory Physician, Branch Chief of the Medical Analysis Branch for the National Vaccine Injury Compensation Program. Salary $112,890 - $146,757 per year & The Physician (Deputy Director, VET-HOME) duties include, but are not limited to: Salary $145,000 - $249,900 per year (remote)​

Medicine adjacent:
Scientific Communications Medical Reviewer est salary $189,442 to $285,423
Medical Reviewers research and communicate clinical data relevant to &&& products and provide medical review of documents written by team members who do not have clinical experience. MD or DO with medical device experience preferred
 
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