Before I walk into clinic, I already know their response if I submitted my resignation letter today.

I hear it monthly from multiple patients who have no reason to believe I’m leaving: “You aren’t going to leave too, are you?” “It took us years to get here after the last doctor left.” “Please promise me if you move on, you will let me know where you go.”

They have baseline trauma from actively encountering care access barriers. And I have my own trauma: if I leave, I know the company can choose to misinform or simply not inform patients of anything other than my absence.

Hope kept me going last year when things started to sour:

I had just transferred my patients here.

I had just started this job.

It was COVID — surely, that was causing the chaos.

It was not a good idea to quit without really trying everything I could first.

This place had been stable for years — this was just a bad few months.

These were my thoughts then.

Now:

Last year, we had 75 percent staff turnover. We are understaffed by at least 50 percent, soon to be 70 percent. Our manager is leaving. I have no medical assistant. Even after resigning, I’m obliged to see patients for months afterward, per contract. That’s true if I have no assistant, an untrained assistant, poor records, no safety net, and question if patients get their messages.

This isn’t the food industry, or somewhere else, where leaving can be mercifully brief. No, we work in health care, where our duty is to stand, regardless of anything, even personal safety.

We do no harm. For this professional tenet, we sacrifice pride, relaxation, health, and relationships. For this, providers stay in untenable situations that either endangers their licenses or, at the very least, are toxic and miserable.

For this, we think: If I wait, maybe it will get better. If I leave, how do I say goodbye?

The double standard is absurd. Here’s the problem: I could be fired for being unprofessional, refusing to see patients, failing to live up to standards of good care. I could — it seems — be fired for anything. There is no mutual clause in my contract. I may not hold employers to quality measures, proper staffing, or having an assistant. Worse, the only way to vote is with my feet.

I remember talking to a lawyer about this failing in medical contracts when a former boss was fired — and his patients were dumped, overnight, into my care.

That doctor was already more than fully booked, and I was full. Imagine terrified, frantic, upset people. The number of red messages in my patient portal gave me heartburn. I came home at midnight some days and came in early by an hour or two. There was no end. I was terrified to misinform complex patients whom I had no time to see, only skimming their messages or seeing them, new to me, for 15 minutes, after multiple emergency department visits.

I was tearful all the time. I started gagging if I ate more than a few bites. It got to the point where my partner, in a not very gentle reality check, told me that all I did was sleep and cry, he barely saw me, and something needed to change. The lawyer I spoke with told me, “Appealing this will bankrupt you and take longer than putting in your notice [90-120 days]. And you’ll still lose. They are a corporation. You just have to live out your contract and leave if you feel it is unsafe.” He assured me this was quite common, and I was unlikely to be ever able to negotiate a clause of mutual responsibility.

But even if I work myself senseless for patients, if I throw in the towel, for whatever reason, patients feel betrayed. I’m not even sure that leaving a microcosm that “may” cause harm due to lack of safety nets and high error risk isn’t a betrayal. The entire macrocosm “may” cause harm.

Visualize the health care macrocosm as a creaking, groaning network of obsolete trains and buses, barely running, full of delays. When one part of the system fails, how do you get patients off that car and onto another one, still old and creaky, less actively dangerous? My answer is, you don’t always.

Patients leave, some faster than others, and then start hunting around and finding their own ways. Sometimes they have a little “help” from their friends. The ones with money run further and faster, but even they can’t hijack the system every time. In short, people suffer and find harm.

So, I didn’t run when colleagues started accusing each other of mis-billing and mis-charting, descending into slanders about fraud and patient abandonment. I stayed when my medical assistant said, “This job is ruining my health,” put in her notice, and left for a happier job.

That was months ago. We hired people we didn’t train, we didn’t notify staff who had to do double coverage, and we kept on keeping on at full capacity. We let go of new assistants, some quit. The front desk staff quit, and the strongest assistant in the clinic put in notice. People whisper in the hallways, cry at the front desk and throw middle fingers to the security cameras. Supposedly, it is bad enough that there will now be change. Yet currently, it’s always a surprise, always chaos, never smooth sailing.

And I still have patients on a full schedule.

If I leave now, I still deal with this for months, plus all of my patient’s grief and feelings of betrayal. If I stay, maybe it will get better. It could hardly get worse. But in the end, I don’t want to lose myself either, and at some point, there has to be a line that is too far.

It is just hard to know what that is anymore.

The author is an anonymous nurse practitioner.

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