When It’s Time to Leave

Recently I had first-hand experience with an issue that many early career psychiatrists encounter, though the subject is often taboo. This is the question of how to leave a job.

Throughout college, medical school, and residency, there were predetermined endings to my experiences. I never had to decide when to leave a work situation voluntarily. Now, as a psychiatrist who is out of training and in the workforce, however, I do have to make such decisions for myself.

Over the past two years, I have watched a number of staff come and go while working within a community mental health clinic in northern California. People left for retirement, for promotions, or for better lifestyles. The difference was that these people were all nonphysicians. Aside from one other early career psychiatrist, the psychiatrists in my clinic had been there for 10 or more years. I had few role models of psychiatrists who decided to leave their jobs here.

Pondering this issue, I came to realize that it is not a question of whether one leaves a position, but really of when. We all leave our jobs sometime—either with retirement or sooner.

For me, the work at the clinic was slowly taking its toll. I enjoyed the challenge of working with individuals with severe mental illness, but the no-shows, the paperwork, and a role that was limited largely to psychopharmacology discouraged me. I was more and more exhausted by the end of each day. In contrast, working in my small private practice was nowhere near as stressful. Though my private-practice days were filled with emotionally intense psychotherapy sessions, I would go home with a greater sense of professional satisfaction.

Still, I struggled with my decision to leave the clinic. I felt guilty about leaving my clinic patients with whom I worked so long. I knew I would miss the clinic staff’s camaraderie. I considered the loss of a steady income and benefits. Leaving would place more emotional and fiscal importance on my private practice. I also knew that the termination process with clinic staff and patients would be very difficult.

Then the September 11 tragedy hit. The events of that day led me to refocus on what my priorities were. I came to the decision that life was too short for me to end each day worn down by work.

Saying goodbye would be hard, but I needed to move on.

I realized, however, that I knew little about the etiquette of resigning from a position. This subject was never taught in medical school or residency. So I turned to friends both inside and outside of medicine to discover what they thought was appropriate when leaving a professional position.

I learned that outside of medicine, two weeks’ notice to your employer is considered appropriate. An informal poll of psychiatric colleagues revealed that 30 days is considered the minimum amount of notice for leaving jobs that do not involve psychotherapy. I was also warned, however, that giving too much advance notice might lead to an awkward period in which the psychiatrist is viewed as a “lame duck.” Taking this advice into consideration, I decided to compromise and give seven weeks’ notice.

I arrived at my final decision to tell the clinic I was leaving the morning after a particularly vivid dream suggested that I was psychologically as ready as I could be. I spoke with my clinic’s medical director and placed an official letter in his mailbox the following day. While taking that step was a daunting task, I was happy to have it behind me. I knew my decision was the right thing to do. The clinic job just had not worked out for me, I realized.

Now, I look ahead to creating closure with my clinic patients and reshaping my professional life.

I leave with the bittersweet sense of having grown during my time in the clinic from a recently graduated resident to an early career psychiatrist who is less afraid of changing the world around me. ▪