The Hospital Will Not Love You Back: Vagabond MD

Bitterness is cancer – it eats upon the host. It doesn’t do anything to the object of its displeasure.

Maya Angelou

At a recent holiday party, I was talking to a close friend who works at Ivory Tower U, in my field, where I trained. In addition to being a close friend (we introduced him to his wife, in fact), I have always considered him to be my best source for substantive information and idle gossip of the goings on in my old department. I secretly considered him a potential future employer, too, for some theoretical next chapter in my career.

I knew from recent conversations that he was increasingly unhappy with his practice, but I figured it was the usual doctor bitching. Few of us docs in our 50’s are “rainbows and unicorns” happy about our jobs.

On this particular occasion, however, he informed me that he had reached the end of the line, and he was plotting his mid-50’s escape.

In addition to being a world class and renowned expert in his field, he had been such a great ambassador for his department in the past. Now, there was nothing left but loathing.

The negativity, in both his voice and facial expressions, was powerful, overwhelming and unexpected… but familiar at the same time. Where had I seen such turnabout resentment before?

Oh, yeah, that was me a couple years ago.

A Bitter Pill

Bitterness is an emotion that is increasingly found in ourselves and in our medical colleagues, in this era of endless acronyms that hold sway, our individual and collective lack of control, and a society that has largely turned on its healers. One can easily understand the waves of resentment that build among physicians.

In fact, pick your poison:
EMR
MOC
MACRA/MIPS
Abusive administration
Insurance company denials
Online reviews
Entitled patients
Less-than-collegial colleagues
Declining reimbursement
Increasing regulation
Increasing documentation requirements
Poor Leadership
Workplace politics
“Publish or perish”
Medical malpractice threats
Large student loan burdens
(Name your “bitter pill” that I have failed to include)

We all deal with one or more of these, daily, and sometimes multiple factors at once.

It is a wonder, at times, that anyone chooses to continue to work in a medical career. “Will the last Doc left please turn out the lights?”

Bitterness is not productive

Bitterness is a reaction, usually to multiple assaults over time, and is not the least bit productive. (See Maya Angelou quote above.) It is usually pretty obvious when you are bitter, and people around you will sense your bitterness.

Resentment reflects poorly on you and adds to the negativity of the work environment, a vicious cycle that can contribute even more to your bitterness.

And that’s not good for anyone.

Bitterness is not burnout, but they are certainly first cousins and may co-exist. The bitter doctor will not be focused more on his/her own issues, not those of the patient or the organization. No one benefits from burnout, least of all the aggrieved.

The Hospital will not love you back

When I was in an earlier bitter stage, I felt that my Hospital did not appreciate me, that I had given it my blood, sweat, and tears for 20 years, and I was not treated with the same level of loyalty and value.

I felt like a scorned lover.

A wise partner, one had a previous life in the US Army prior to going to medical school, recognized this and told me that they had a saying in the Army: “The Army will not love you back.”

And the same is true of the Hospital. The Hospital will not love you back.

Is Money the Cure?

Maybe.

Both my bitter friend and I are financially independent (FI). In other words, we do not have to work, but we work because we want to work. If bitterness is creeping into your professional life, it is time to flex the FI muscle and find or create a work life that does not leave that bitter taste in your mouth.

There are other potential cures, too.

You cannot often choose your immediate circumstances, but you can certainly choose to respond to them. If there are tangible things that are inciting this sense of bitterness, perhaps you can strip some of these away, and maybe the bitterness will be assuaged.

Take Home

My friend gave notice this week that he will part company with his current position. He has found a new amalgamation of part time jobs and roles that will allow him to work on his terms and on clinical work, research and teaching projects that he values the most.

The politics and negativity of the unloving Ivory Tower will no longer be in his life, and the bitterness will fade.

There are multiple lessons here, from the experience of myself and my colleague.

  1. Bitterness is a common reaction to the numerous, cumulative disappointments of the medical career.
  2. As a wasted negative emotion, bitterness has no redeeming value.
  3. It is poison to the people around you (at work and at home).
  4. Maintaining an emotional distance, an arm’s length relationship, with your employer, your department, your Hospital (system), and or your University (if applicable) may help stave off bitterness.

I am no longer bitter.

It is a temporary state, when expectations are unmet and often unrealistic. It usually occurs when the individual has made too great an emotional investment in his or her career.

I no longer love my Hospital or practice, though I certainly have great fondness for many of the people. I am primarily doing the work I enjoy, mostly on my terms, which we should all strive to do over time.

Vagabond: I always love your posts. So, it was with great honor that I post this one. Your view on balancing expectations and reality is key here. Being a doctor who has bordered on burnout (or bitterness) over the last six months, what you are preaching is very real. 

Thanks for being a living example of what balance looks like and how to achieve it.


21 thoughts on “The Hospital Will Not Love You Back: Vagabond MD

  1. I’m leaving my current job and felt a large amount of guilt l, not bitterness, about leaving my collegues in the lurch and things unfinished.

    I guess that’s because we are moving to be closer to family and out of this big city, not because I am dissatisfied with work.

    When I told this to my boss he said that this is one of those times it’s ok to be selfish and that they will be fine.

    The hospital will carry on and hardly know I am gone but if you are lucky enough to work with good people then maybe some of them will love you back.

  2. Kpeds, thanks for reading and commenting. I have long said, somewhat tongue in cheek, that one month after you leave your medical job, few if any will remember who you are or that you were even there. We place so much of our identity and energy into doctoring but barely leave an impression.

    The word “guilt” can easily be substituted for “bitterness” in the Maya Angelou quote.

  3. The hospital may not love me back, but she’s one heck of a sugar momma.

    Like you, I think I will continue working in some capacity after FI. I look forward to the day I can eliminate nights, weekends and holidays though.

    As long as I find joy caring for patients and find humor in the craziness that washes up on the ED shore I will continue to love Medicine (even if it’s a one way relationship).

  4. I agree. It is the nature of many physicians to give their “heart and soul” to their work, including myself. But the problem occurs because hospitals (and other employers) are narcissistic and selfish. They “love you back” when it is convenient. When it becomes inconvenient, you are abused, neglected, or spurned. Employed physicians have an asymmetric relationship with their employer having all the power. It’s good when they say it is, and it’s over when they say it is. Employers tend to be fickle, which creates constant anxiety about the relationship. At best you have some negotiating power, but mostly your power is just to leave. Been there, done that.

    PS: I’ve very, very happy in my current employed position, but I don’t fall in love anymore. I’m prepared for the other shoe to drop…That’s another reason why FI is so important!

  5. It is truly sad that some great physicians are lost due to the very reasons you mentioned.

    The practice of medicine has gone from a wonderful physician-patient relationship to a physician-corporation/business-patient relationship.

    That intervening member has caused a lot of bitterness, especially among the older docs who remember the old days. Feeling underappreciated just feeds the bitterness fire which continues to grow and either consumes you or the people around you.

    Glad your friend made the wise decision (as did you Vagabond). Great post.

  6. One key point here is that we cannot control our emotions (we are all human after all). However, we can control our reactions to our emotions.

    Bitterness is an emotion. And it’s okay to feel bitter once in awhile. But people shouldn’t let negative emotions consume them. We shouldn’t worry or have anxiety over things that are beyond our control. As much as possible, just let that negative emotion pass and counter it with a positive reaction.

    Gratitude and gratefulness is one great positive reaction that can counteract any negative emotion. I try to practice gratitude every day.

    Of course, having FI money, the option to work less (or not at all), and being grateful for having those choices is powerful too!!!

  7. She winked at me from across the bar, and she seemed truly charmed. I waited three days before calling her to start our relationship from a position of strength instead of neediness. I gave her two solid decades of commitment.

    But it’s time to come to terms: The hospital’s just not that into me.

    Or in the immortal words of Bel Biv Davoe: That girl is poison.

    It especially hurts when your version of the poster child for a fulfilled medical career goes sour – how do you reinterpret reality when the happiest doc you know stops whistling?

    Hopefully, following bitterness and guilt, your colleague will let go of those feelings to find an identity that exists beyond medicine, and discover pleasures outside of the hospital that restore his joy in living.

    Precisely and painfully rendered, Vagabond.

    • So true, CD. It is particularly sad when this impacts even those that are held to a high standard as an “example flag bearer”. But this is where medicine is going until someone changes it.

      Until then, we must learn to deal with bitter emotions and now dwell on them.

  8. When I was a kid my parents encouraged me to be a doctor. My parent’s weren’t physicians but there were some in my family. One of my Dad’s biggest complaints was that he worked for a boss and as a doctor you can be your own boss. Fast forward a few decades later, I ended up a doctor but I work for a hospital.

    Some of the bitter pills on your list I suspect are present in medicine, no matter whether you are employed or not. However, I think one benefit of employment is some degree of security. One thing I think that helps is to get into a leadership position. This leads you to have the ability to exact change at your organization (although even if you’re in a leadership position, unless you’re the chairman of the board you have a boss).

    I agree though, that you always have to put yourself first. I feel like employers expect some degree of loyalty and I’ve seen chairs feel “betrayed” when physicians leave. I feel like you have to view your situation on balance and decide is the far side grass truly greener.

    Not to get slightly political, but in the past I’ve never been a big believer in unions for “highly skilled” employed professionals like teachers, nurses, etc. I’ve often seen where they can get in the way of good care (nursing). However, over the years my views have shifted. I feel like given how easy it is for employees to take advantage of employers I think if employed doctors were to unionize we would see benefits.

    • Yeah, the grass is greener syndrome is the real deal. Far too often it isn’t that we hate our job, we are just doing too much of it and it is demanding more than it should.

      It is when autonomy gets threatened that these feelings crop up.

  9. An ER doc once told me, “Get your lovin’ at home!” I think he meant that if you have a great day and work and people are nice to you then enjoy it. But don’t expect it. There won’t be love, gratitude, and loyalty at work all the time. Nor will work supply all you need. Especially not companionship, tenderness, and bliss. Seek those elsewhere. I have tried to follow that advice.

    I agree that being FI provides more options, peace of mind, and strength in workplace negotiations.

  10. Great post vagabond MD! I’ve done a lot of thinking about this topic over my 7 year career (and still going). I used to think that this profession is my calling and to think otherwise would be betraying the training/sacrifice I have undergone. But, I have since come to the conclusion is that work is work. The key is finding your passion in the little elements of your work that will keep you going. If those things outweigh the elements which can make you bitter, then you will ultimately be satisfied. Pursuing passions outside of this vocation will lead to more sanity and stability as well.

    • Completely agree. It’s all about finding what you are passionate about and carving out as much time as we can doing that. Theoretically, this would be great as we all have different passions and it could make for a really well rounded experience for the departments in which we work and for the trainees that learn from us.

  11. Thanks to all who have read and commented. I love you all more than your Hospitals do.

    And thanks again to The Physician Philosopher for allowing me to guest post on his site.

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