It is a simple idea, but we don’t think about it. Everyone will leave their job, including us. This thought occurred to me as our office was undergoing a painful turnover. I started my private practice in 2020, expecting it to be a small, close-knit office. I had the vision of practicing medicine as I thought it should be practiced, with attentive and caring staff who truly cared about the patients and each other.

About two years into the private practice, something changed. Our office was growing, making good money, caring for people like I wanted, but the dynamics in the office began shifting. The atmosphere was turning toxic. A few of the people in our office, some of whom started when the practice opened, decided to leave. It was a time of confusion, betrayal, and hurt feelings. Looking back, it’s obvious that the change was inevitable.

Even if we stay in one place, our jobs are continually changing because everyone is changing. We are evolving in the job, and we are evolving in ways that will likely lead us to outgrow the job. Personally, we can outgrow the job If the job that used to challenge us doesn’t anymore. What used to excite us feels like work. Some may feel taken for granted if we always show up and do a good job, but the appreciation isn’t as loud or as often. Worse, we may become complacent in our job, not even doing as good of a job as what we were doing before (and we know it).

When is it time to leave a job? A layoff is obvious. Considering that medicine ranked third in industries undergoing layoffs in 2023, many doctors don’t have a choice. A layoff could be seen as a calling to see your value and find where your value will be appreciated. Learning the lessons of why you weren’t valued is worthwhile, but fighting the reality of being laid off is a waste of time and effort.

It’s more of a challenge to leave a good job. One that superficially serves all your needs: getting paid, feeling stable, and somewhat appreciated. It’s time to leave when you start to feel the lack of appreciation, inspiration, and motivation, or worse; you start to feel depleted, less-than, or devalued. But we usually don’t leave at that point because it is so much easier to stay than to take a chance elsewhere. We might like the people with whom we work, respect our boss, or worry that we will make it hard for others if we leave. But that means staying away from a sense of obligation, worry, or insecurity.

I learned that lesson the hard way. One employee who turned particularly toxic had said in one of our meetings, “I think I was the right person to start here, but I don’t think I am the right person to continue.” I thought that they were having a bad day or a rough patch because I did not see that the job had changed. We were getting bigger with more people, they were dealing with more people, and I was not giving the employees the same attention I had given them before because the business was thriving. I told them, “Don’t quit on your worst day,” because I misunderstood what was actually going on. They had told me their truth, but I didn’t see it. I suspect they stayed because I was convincing, they weren’t clear what was happening either, or they liked me (but that quickly changed).

Letting go of an employee who gives you a sign they want or need to go is important. I had heard that before, but I thought the statement meant you discovered a bad seed and contained the damage. I was looking at the same faces I had appreciated so much the previous two years. It was the jobs that had changed, and the people didn’t change with it.

Once the confusion and hurt feelings passed, a clarifying thought came through. Everyone will leave. Far from being sad or limiting, it was freeing. I did not have to hold on to people who wanted or needed to go. It would hurt them and me. Instead, I realized that each person has a job, and they can help me understand what their job is, and we could create a system that explains what they did. These systems were independent of one person. Each person added to and elevated the job, and they could also take vacation or leave free and clear because the job would keep going. Adding evaluations and benchmarks, encouraging open communication, and identifying red flags ahead of time were strategies I have found helpful.

It also allowed me to consider leaving. In private practice, it can feel like you are holding up everything, and it feels like a house of cards. I did not realize the tremendous pressure that I felt relying on people to do the jobs that needed to get done. Letting go of the worry that they will leave made it safer for me to stay. It allowed me to appreciate the people, encourage them to get better and allow them to cross-train and learn more because if they outgrow the job, then that is a good thing. I didn’t have to hold on to anyone; I could allow them to be themselves and grow and be at the job for as long as they were meant to be there.

There is avoidable drama when you or someone else leaves the job. You are not betraying someone If you move on within the boundaries of the contracts you have in place. You do not have to feel shame for leaving when it is best for you because your vacancy could be filled with someone who is a better fit or identify a job that is not sustainable for anyone. You do not need to feel guilty for leaving more work for other people. It might be true that it will be harder for them, but staying out of obligation or fear will only lead to bitterness and maybe resentment. Fighting to keep our “good” person from leaving often is not recognizing that the good person left long ago, and it’s time to find the next “good” person. If you hire people who are dedicated to you, they have the personality of being dedicated to the job and you. Their characteristics may lead them to start caring for other things as they are taken for granted, or they don’t get the same validation for things they have already done. There is no need for resentment, because they are not doing this to you, they are doing this for them.

Give them permission to leave. Understanding why someone would leave a good job is going to give you a greater understanding of when you want to leave. You will see what it feels like, you will identify the red flags telling you to leave, and you will give yourself permission to leave. Whether you or others stay or go in the job is beside the point. We are at our best when we give ourselves permission to leave and are acting from a place of inspiration, motivation, and freedom.

Amy Vertrees is a general surgeon and founder, BOSS Business of Surgery Series.