To the quiet physician who keeps her head down and powers through her days while secretly calculating the ratio of BS-to-be-tolerated versus time-to-retirement:

I have some tough love for you.

You are in a toxic relationship.

How do I know? I’ll let you in on my secret: I was in a psychologically and emotionally manipulative marriage for over twenty years.

At the start of our relationship, I felt blissfully lucky to have met such a well-spoken, attentive, charming man who made me feel like the most important person in the world. Over time, however, my ex morphed into the polar opposite: uncaring, manipulative, and remorseless. This behavior, so disparate from how he initially acted, bewildered me. Surely the man I fell in love with was still there, I reasoned. I held out hope that Mr. Wonderful would return. By the time I figured out he was never coming back, I’d invested years and felt trapped.

Just as I fell in love with Mr. Wonderful, chances are you fell in love with Medicine, The Calling, a noble, rewarding, intellectually stimulating, and deeply important profession. But over time, Medicine The Calling morphed into Medicine The Job, which feels anything but. Though you dreamed of happily ever after with Medicine The Calling, you now spend your waking hours shackled to Medicine The Job.

I know this idea sounds preposterous but stay with me. Let me share some telltale signs of a toxic relationship, things my ex did to me, which Medicine The Job is doing to you right now.

1. An abuser never admits to being wrong. Instead, you clean up the abuser’s messes. 

In my dysfunctional marriage, it was my “job” to make my ex look good, no matter how badly he behaved or whom he harmed.

So, think of the last time you had to write a prior authorization for a medication or a study that is uncontroversially standard of care. Then you contacted the patient and apologized for the delay, even though the delay was entirely outside your control. That’s abusive behavior. Medicine The Job is failing to deliver the prompt, high-quality care it promises, yet you scramble to remedy the system’s shortcomings.

2. An abuser never trusts you. 

Even though my husband was the one who was cheating, he monitored my every move as if I was a suspect.

Medicine The Job is treating you no better. It requires you to use a cumbersome EHR and employs armies of administrators, none of whom hold a medical degree, to keep tabs on your productivity and second-guess your work.

3. An abuser does whatever he wants and expects you to roll with the punches.

During my marriage, I found myself putting up with circumstances I never imagined I would tolerate. Even when I spoke up, my ex made not one scintilla of effort to change.

The same thing happens to you when your employer expects you to sacrifice your professional standards by seeing more patients, doing more procedures, or reading more studies than you know is reasonable and safe. Or when they make substantial changes to your contract by fiat rather than by negotiation. What happens if you speak up in these situations? You get labeled “disruptive.” That’s Abuse 101.

4. An abuser will tell you you’re special but sees other people on the side.

I mentioned my ex’s cheating, right? The term “serial philanderer” sums him up.

Medicine The Job is treating you no better. When mid-levels are put on par with physicians, and physicians are demoted to “providers,” it delivers the same gut punch as a spouse seeing other people. Medicine The Job doesn’t feel it owes you any more loyalty than my ex felt loyal to me.

5. An abuser expects you to support his sleazy freeloader friends. 

My ex repeatedly bought gifts, jewelry, and vacations for other women using the money I earned.

Similarly, Medicine The Job is a master of having freeloaders profit from your work. Think of all the pharmacy benefit managers, insurance administrators, malpractice insurance companies, collectors of MOC fees, state medical boards, and credentialing agencies, who – let’s be honest – provide little to no benefit to patients. Your hard work pays their salaries. To Medicine The Job, you are a source of capital. It only values you to the extent that it can use you.

6. Abusers make their victims wholly dependent on them and inflate the consequences of escaping the relationship.

It took me an embarrassingly long time to disentangle myself from my toxic marriage because I was convinced (against all reason) that I would lose my kids, my money, my house, etc.

Guess what: I feared losing the same things when I considered leaving conventional medicine. Just as my ex did, Medicine The Job convinced me I was worthless and helpless without it and that I could only secure my future by sticking with the status quo.

I know it may be difficult to accept the idea of being in a toxic relationship with a career. Still, the truth is organizations and institutions can be as manipulative and destructive as living with an emotionally abusive person. Just ask any cult survivor.

Yet, for all of my toxic relationship experience, I haven’t lost faith in love. I don’t hate the idea of marriage, and I don’t blame men for the bad behavior of one man.

The same is true for Medicine The Calling. Despite the misery Medicine The Job is inflicting on us, I have great faith in physicians and our mission of healing and curing.

So hear this: nothing – not a person, a company, or a career – should make you feel unworthy or unvalued. You are too precious. I believe in you. And it would be best if you believed in yourself, too, so you can return to being the doctor you were meant to be.

You just need to break free from the SOB first.

Elizabeth Hughes is a dermatologist.