014: The Hospital Exit Checklist

You know you want to leave. What you don't know is what actually needs to be in place before you do. In this episode Dr. Kristine walks through the exact checklist she used — the income, the benefits, the timeline, and the conversation she was most terrified to have — so you can make your exit a calculated move, not a leap of faith.

Key Topics:

• Recognizing when your body is telling you it's time to leave
• Using a hard deadline as a commitment device
• Building remote income before you give notice
• Creating an emergency fund as part of your exit runway
• How to time your exit to avoid a benefits gap
• Replacing malpractice, retirement, and health insurance
• How to tell your boss you're leaving — and what to say
• Navigating the emotional complexity of leaving a mentor
• The difference between leaving a person and leaving a system
• The Hospital Exit Checklist — the six steps in order

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Transcript

SPEAKER_00 0:01

Most physicians know they want out. What they don't know is what actually needs to be in place before they can leave their toxic job. The income, the benefits, the timeline. Today I'm walking you through all of it from my very own experience. How I went from burnout in full-time academia to booking a one-way ticket to Columbia without telling a single person what I had in place before I gave notice, and what it actually felt like to sit across from the mentor who had done more for my career than almost anyone and tell him I quit. And if you are ready to figure out what needs to be in place for you specifically, your specialty, your numbers, your timeline, book a one-to-one call where we will build and execute that plan together. The link is in the show notes. Let's get into it. You're listening to Doctors Abroad, the podcast for doctors who want to build remote income and create location independence. I'm Dr. Christine Goins, founder of Nomad MD. I've exceeded my hospital income while working part-time and living abroad, and on this show, we break down how to make hospital income optional. Let's get started. If you've been waiting until everything is perfectly lined up before you leave full-time hospital medicine or start working remotely, this episode is going to change what you think you need. Leaving full-time hospital medicine doesn't have to be a leap of faith. It can be a calculated move with a runway underneath it. Today I'm walking you through exactly what that looked like for me. The income I had in place, the timeline, the benefits, the conversation I was most afraid to have. So you can see what it actually looks like when it's done successfully. I want to start with where I actually was because I think it's important to be honest about how uncomfortable my life became before I made the shift. Because I know some of you are there right now. And I want you to know that what you're feeling is real and it's also information. I was two years into my first job as an attending, and my weekends were completely consumed by documentation. And I'm talking about 30 patient notes or more every single weekend. I would literally finish just in time for a Monday morning because I could never bring myself to go into a new week without notes done. That's how perfectionistic I was. That's how much the work had taken over my life. The time I did have church, yoga, Pilates, swimming, seeing my siblings who were both living near me and DC at the time, it felt stolen. Like I was out and recuperating just so that I could get back to eventually finishing my work. And then my body started sending me signals. I would get chest pains in the middle of the day while commuting from one clinic to another. I couldn't sleep for more than four or five hours. I'd wake up in the middle of the night and just lie there, waiting for my alarm to go off at 6 a.m. Then came the tremors. It started with my eye twitching, then my arms, then my legs, then it got bad enough that I genuinely thought that I had a neurological condition. So I made an appointment with the neurologist. I want you to sit with that for a second. Here I was, a psychiatrist who had become so unwell from her work environment that she was booking appointments with neurologists thinking something was wrong with her brain. I got into the appointment, and within about 60 seconds, I was telling this doc everything: how stressed I was, the overwhelm, how much I was working, how little I was sleeping. And he just cut me off. He looked at me and he said, I can prescribe you Lexapro. I paused and I gave him a very confused look because I was very confused. And I asked, Why? And he said, Well, you're not gonna quit your job, are you? And that was the moment. Like I sat there looking at a doctor who was about to prescribe me an antidepressant for the fact that I was overworked and overwhelmed in a system that was consuming all of my time and even my health. And something in me just went, no, this is not a serotonin problem. This is a life design problem. I finished the appointment, I left without the prescription, and I walked out of that office knowing that something had shifted in me. People don't like the phrase work-life balance. It feels like a buzzword that speaks of impossibilities. But I want to say that having a balanced life is real. Of course, it's determined by how you define balance and what you want your life to look like, but I actually live it now. And what I had in that moment was the complete opposite of it. My body was sending me every possible sign that it could not sustain the pressure of that lifestyle. And I finally listened. I went home and I went online and I booked a one-way ticket to Columbia. I didn't tell anyone, I didn't confer with my family, I didn't consult my friends, I just booked it. And I want to explain why. Because it wasn't impulsive, and even though it probably sounds that way, I knew myself well enough to know that if I didn't create a hard external deadline, I would talk myself out of it. There were a million reasons to stay comfortable within the uncomfortable. The salary, the benefits, the familiarity, the relationships, the titles and leadership positions, a million reasons that would have whispered, not yet. Wait a little longer. Now is not the right time. The ticket was me refusing to listen to those reasons. It was me telling myself, no, this is real. This date is your deadline. By this date, we are leaving this country, which means by this date, we will also have left this job. That ticket was about six months out from when I was actually going to be leaving. So it wasn't a next month decision. It was a six-month runway I had just given myself. And from that moment, everything I did was oriented around that date. A few weeks later, after I booked that ticket, I emailed my boss and asked if we could meet to talk about my position and my work. I kept it that general. I didn't say in the email that I was leaving I respected the relationship enough to want to have that real conversation not be something that he found out by reading a few sentences on the screen. And I'm not gonna lie, I was so nervous sending that email. There was something about making it official, even just requesting the meeting, that made it real in a different way than the ticket had. The ticket was private, but this was the beginning of it becoming real and known to the rest of my world. I need to tell you who this person was to me. So he wasn't just my boss. He had been a mentor and a sponsor. And as you likely know, there is a difference, right? A mentor gives you guidance. A sponsor puts your name in rooms you can't get into yet. He would be in conversations I had no access to, and he would say my name, right? He put me in positions that were genuinely significant for someone only two years out of training. He believed in me in a way that I felt and that mattered. So when we got on that call, it was virtual, but I wanted it to be face to face, right? I told him I was leaving. I told him how grateful I was. I told him what he had meant to my career. And I remember saying to him, this feels like a breakup, because it genuinely did. And he did not make it easy either. He said, What would it take? What could we change? We'll scrap everything. We will start from scratch, whatever it is that you need. And I will admit that it took a lot not to cave in at that moment. Because when someone you respect is genuinely offering you a way to stay comfortable, even if you know it's not truly the life that you want, it's hard to say no. But that is the moment where I took a deep breath and had to say, it's not you, it's me. Because that was the truth. It was not personal. It wasn't about him or his leadership, which was phenomenal. It wasn't about what he had offered me or what the position was going to be. It was about what the system that we were both in required of me in order to stay in it. And that requirement was costing me my health, my time. And ultimately the vision I had for my life, the kind of life that really mattered to me, one with the type of time and location freedom that hospital-based systems just don't take seriously. But I think more physicians really need to understand this distinction. Leaving a hospital system is not a betrayal of the people inside it who have supported you. You can be deeply grateful for a mentor and still need to leave the structure they operate within. Those two things are not in conflict. I owed it to myself to do what was necessary for my vision to be real. And that meant leaving behind something that, in a lot of ways, was hurting me, but that I also loved in a lot of ways too. That bittersweet combination is real. I don't want to pretend it wasn't. That meeting was about two months into my six-month runway. I gave him four months' notice. And those four months were where the real preparation happened. So here's what the next four months actually looked like because I want you to see that there was work happening between booking that ticket and getting on the plane. One thing that you're going to want is a financial runaway. I have been saving during those first two years of being and attending, and I continued saving so that I had a good emergency fund built up, well over six months. I had also been creating remote income through a direct remote contract I had secured before I ever gave my boss notice. This had initially been discussed with both the clinic I was contracting with, as well as HR at my full-time employer. So there weren't any surprises or contract breaches happening in this process. So when I left the hospital, I wasn't stepping into a gap. I was stepping into something I had already started building alongside my hospital work. Build before you leave. You need at least one income stream that is bringing in money monthly and proof of concept that remote medicine or your remote business works. Now for the benefits timeline. About two months before leaving, I created my new retirement accounts, making sure that they were set up correctly and functioning. So I knew where my employer retirement accounts were going to be rolling over into. Then about a month before leaving, I secured my new international health insurance. I had it lined up and ready to activate. Typically, if you leave on the first, your employer health insurance covers you through the end of that month, which meant I had a full month of overlap between my old insurance and my new international coverage. No gaps. And that was intentional. In the last two months before leaving, I also made sure that I completed every health appointment that I could think of. Annual appointments, anything that I had been putting off, I used that coverage fully and deliberately before it ended. Malpractice was already in place for me at that point because I had been doing remote work. So that one was handled. So when you think about that hospital exit checklist, number one, you want to secure your remote income. And number two, along with that, make sure that you have malpractice coverage. Number three is that you want to build your emergency fund and have well over six months of your expenses. I like to include my regular lifestyle money also, not just my expenses, in that emergency fund. Number four, set your quit date and create an external anchor that'll really hold the date. Number five, schedule the conversation with your boss and give notice. Number six, set up your new retirement plan. And number seven, secure your new health insurance. Now, of course, there was housing to secure abroad. There were belongings in my apartment that I needed to deal with. I had meetings with lawyers and with CPAs, all of it. And we're going to get into each of those in future episodes because they each deserve their own conversation. But the income, the benefits, and the timeline, that's what I wanted to make sure you had a clear picture of today. Because that's where a lot of us get stuck before we ever even give notice. And I'm sharing all of this not because my story is the template. Your leaving will look different. Your breaking point might be quieter or louder. Your timeline might be shorter or longer. Your conversation with your employer might go differently. But I want you to have a real picture of what it can look like. It can look like your body sending signals you've been ignoring. It can look like a doctor offering you a prescription for a problem that medication alone is never going to solve. It can look like choosing a deadline because you need to make the decision real before you talk yourself out of your own freedom. Six months of preparation, securing a contract, income building, emergency funds, retirement, and health insurance replacement. That's what leaving can look like when it is done successfully. Not fearless, just decided. And if you haven't listened to episode 13, is remote work financially secure? That one pairs directly with today. The emotional story is here. The financial framework is there. Thanks for listening to Doctors Abroad. If this episode was helpful, share it with a colleague who's been thinking about building more freedom and flexibility in medicine. And if you're ready to make hospital income optional, book a one to one freedom consultation at thenomadmd.com. I'll see you in the next episode.