It's a simple idea, but we don't think about it. Everyone will quit their jobs, including us. This thought came to me as our office was undergoing a painful change. I started my private practice in 2020, expecting it to be a small, close-knit office. I had a vision of practicing medicine the way I thought it should be practiced, with attentive, caring staff who truly cared about patients and each other.
After about two years of private practice, something changed. Our office was growing, making a lot of money, taking care of people the way I wanted, but the dynamic within the office started to change. The atmosphere was becoming toxic. A few people in our office, some of whom had started when the office opened, decided to leave. It was a time of confusion, betrayal and suffering. Looking back, it is clear that change was inevitable.
Even if we stay in the same place, our jobs continually change because everyone changes. We evolve in our work, and we evolve in ways that will likely lead us to outgrow the job. Personally, we can outgrow work if the work that challenged us no longer does. What we once were passionate about feels like work. Some may feel taken for granted if we always show up and do a good job, but the appreciation is not as strong or as frequent. Worse yet, we can become complacent in our work, not even doing as good a job as we used to (and we know it).
When is it time to quit a job? A dismissal is obvious. Considering that medicine ranks third in industries laid off in 2023, many doctors have no choice. A layoff could be seen as a calling to see your value and find where your value will be appreciated. Learning from why you weren't valued is worth it, but struggling with the reality of being fired is a waste of time and effort.
It's more of a challenge to leave a good job. The one that superficially meets all your needs: to get paid, to feel stable and somewhat appreciated. It's time to leave when you start to feel a lack of appreciation, inspiration and motivation, or worse; you start to feel exhausted, inferior, or devalued. But we usually don't leave at that time because it's much easier to stay than to try your luck elsewhere. We may like the people we work with, respect our boss, or fear making things difficult for others if we leave. But it does mean avoiding any feelings of obligation, worry, or insecurity.
I learned this lesson the hard way. An employee who had become particularly toxic said during one of our meetings: “I think I was the right person to start here, but I don't think I'm the right person to continue.” » I thought they were having a bad day or a difficult time because I didn't see that the work had changed. We were getting bigger with more people, they were dealing with more people, and I wasn't giving the employees the same attention that I was giving them before because the business was thriving. I told them, “Don’t quit on your worst day,” because I misunderstood what was really happening. They told me their truth, but I didn't see it. I suspect they stayed because I was convincing, they either didn't know what was going on, or they liked me (but that quickly changed).
It is important to let go of an employee who signals to you that he wants or needs to leave. I had heard this before, but I thought that statement meant you had discovered a bad seed and contained the damage. I looked at the same faces that I had enjoyed so much the previous two years. It's the jobs that have changed, and the people haven't changed with them.
Once the confusion and hurt feelings passed, a clarifying thought appeared. Everyone will leave. Far from being sad or limiting, it was liberating. I didn't have to hold back people who wanted or needed to leave. It would hurt them and me. Instead, I realized that every person has a job, that they can help me understand what their job is, and that we could create a system that explains what they did. These systems were independent of a single person. Each person added and elevated the work, and they could also take vacations or leave freely and clearly because the work would continue. Adding assessments and benchmarks, encouraging open communication, and identifying red flags ahead of time are strategies I've found helpful.
It also allowed me to consider leaving. In private practice, it can feel like you're holding everything back, and it feels like a house of cards. I didn't realize the enormous pressure I felt when I had to rely on people to do the work that needed to be done. Letting go of worrying about them leaving made my stay safer. It made me appreciate people, encourage them to improve, and allow them to train and learn more, because if they outgrow the job, then that's a good thing. I didn't have to cling to anyone; I could allow them to be themselves and grow and work for as long as they were supposed to be there.
There are avoidable dramas when you or someone else leaves your job. You're not betraying anyone if you move forward within the confines of the contracts you have in place. You don't have to be ashamed of leaving when it's best for you, as your vacancy could be filled by someone better suited or identify a job that isn't sustainable for anyone. You don't need to feel guilty about leaving more work to others. It may be true that it will be harder for them, but staying out of obligation or fear will only lead to bitterness and perhaps resentment. Fighting to keep our “good” person from leaving often fails to recognize that the good person left a long time ago, and it's time to find the next “good” person. If you hire people who are dedicated to you, they have the personality to be dedicated to the work and to you. Their characteristics may cause them to start taking care of other things because they are taken for granted, or they don't get the same validation for things they've already done. There is no need for resentment, because they are not doing this to you, they are doing it for themselves.
Give them permission to leave. Understanding why someone would leave a good job will give you a better understanding of when you want to leave. You will see how it feels, you will identify the warning signs telling you to leave, and you will give yourself permission to leave. Whether you or others stay or go to work doesn't matter. We are at our best when we give ourselves permission to go and act from a place of inspiration, motivation and freedom.
Amy Vertrees is a general surgeon and founder, BOSS Business of Surgery Series.