Who quits a job in a recession? Me!

The job I held was becoming just that: a job, not a life-work or labor of love. I had just returned home after spending a little time in Iraq with the U.S. Army Reserve. I had thought to settle back in, start seeing patients again, and scheduling surgeries, but I got this notion that I should ask my boss for a hike in pay to at least mirror my military compensation. The salary and benefits in that practice were average for my area of the country, and the work atmosphere was pleasant enough. Still, I sensed no room for growth in either personal income or the nebulous personal integrity. I didn't realize how unfulfilled I was until I had been away for a while and returned with a fresh look.

I was supposed to be able to make productivity-related bonuses, but those bonuses always dwindled once the overhead was factored into the equation. The office overhead was forever my nemesis, ever increasing without any forces to rein it in. Our lease for the building was bundled with the equipment, and the cost ballooned over the course of several years to the point that our profits were being eaten up. That fact, coupled with the ever-lower reimbursements from insurance companies, meant that we were working harder and longer to make less every year. The realization that this situation was not going to get better any time soon hit me like a brick.

The country was in the midst of an economic recession when I drove off the cliff with no advance planning, but I figured that it couldn't be difficult to find a job. I had been receiving emails and calls from headhunters over the years, and I always had kept the door to change open just a crack in case I got restless. I knew I could pick up the phone and have a job in short order, but what if I was trading one set of impossible circumstances for another?

The job offers all looked the same: an enticing base salary and the promise of bonuses beyond that. There were loan repayment offers, sign-on bonuses, retention bonuses, relocation bonuses, and other perks, but there had to be a catch. That money had to come from somewhere and had to be repaid to the institution somehow. Nothing is really free, and I was reluctant to jump on board if the ship was going down in the long run.

In my own hometown rural community, I watched the local hospital systematically buy out multiple physician-owned practices only to have the money run dry within 2 to 3 years of doing so. Those doctors, who had been enjoying employed practice on the hospital's dime, suddenly found themselves in need of jobs. Their productivity did not match their inflated salaries in a down economy, and the hospital could no longer sustain the monthly drain and was looking for a bailout of its own.