This place sucks had become my mantra as I powered through every bloody, chaotic, understaffed shift.

Fresh out of residency, I had accepted a job in the ER of a community hospital which — though it had appeared calm, functional, and replete with helpful consultants during the 15-minute tour I took during my interview — had turned into exactly the opposite when I was slugging through the night shifts alone and disgruntled a few months later. The consultants refused to come in. The triage process was a disaster. The waiting room churned with angry patients who would occasionally erupt past the security doors to vent the frustration that an 8-hour wait will stoke. And I was introduced to far more patients by way of apnea alarm than I would have liked.

The mantra was cemented by week two when I started seriously considering turning in my badge. Was this just first-job washout? Had I just been hopelessly naive about what life in the community was really like? Would all departments be like this? In the hope that things would turn around, I decided to stick it out for one year, but when that anniversary neared and the going was still rough, I bolted for greener pastures.

I started a new job a few weeks later, but despite the significant upgrade in functionality, I found myself having trouble saying goodbye to the department that I had bemoaned for a whole year. While I was gaining a little less occupational heartache, I suddenly became aware of everything that the transition cost me:

1. Reputation doesn’t follow you. When I previously had a soft admit, I could depend on the fact that the hospitalist (when they called back) had admitted a hundred of my patients before and knew that when I said a patient was sick, the patient was genuinely sick. Now my consultants don’t know me (or my admitting practices), which turns every phone call into a game of hot potato.

2. Learning site-specific protocols = death by a thousand tiny mistakes. For a neurology admission at 6 p.m. you call neurology attending then admit with the medicine PA, but at 6:01 p.m. you call the neurology PA and then admit to medicine attending unless the patient is on blood thinners or takes herbal supplements or has blonde hair or likes the White Sox, and then it is entirely different. The specific protocols at each hospital vary so widely that the only way to get them down is by putting in your time. The result is yet another year of delays and frustration.

3. Staff relationships aren’t plug-and-play. Street cred with the nursing staff, once earned, is priceless, but it takes a few good crises before they start to make up their minds about you. Physicians so often work either solo or only peripherally with other doctors, but our relationships with the nursing staff are constant and intimate and has the potential to make or break a shift. Knowing who you want with you in that train wreck, and who you need to double and triple check is critical to the outcome of your patients. I miss my nurses most of all.

4. Dysfunction is in the eye of the beholder. At my first staff meeting in the new place I was introduced to the group and waxed eloquently about my enthusiasm for what I perceived as strong and functional department. This was greeted by a few blank stares, a suppressed chuckle, and then a multi-party tirade from three physicians who repeatedly referred to the same department as “a mess! A %#a$ing disaster!”

Was I missing something? This was such a huge step up from where I had come from, but these guys seemed as miserable here as I was at the other place. Perhaps we each had our own pet peeves, and the new place had fewer of my detested dysfunctions than the old. Or perhaps I’ll be just like them in 5 years.

5. There was some green grass back there. I hate to admit it, but I think a lot of the problems that I had with my old job could have been changed with an attitude adjustment on my part. I made up my mind too soon and became extremely and unflinchingly negative. I frequently had very good reasons for my complaints, but some of the things I was incensed about were either in the process of being changed or were at least quirks I could have gotten used to. Some of the system errors that I decried as crazy/pointless/ridiculous/stupid were on the docket to be changed and have been already.

What I think about the most is how, if I had stayed, I might have had a role to play in changing things. A well-run ship is a nice place to put in your hours, but it is a tough place to leave a mark. I wish I would have thought of that before I jumped overboard.

The author is an anonymous emergency physician.

Image credit: Shutterstock.com