Ah, well...there were many issues very specific to that practice and situation which could not be resolved on a timescale I was willing to tolerate - if they could be resolved at all.
The core of it was really around safety, and I don't mean silly things with no clinical consequences. I mean things like...well, like if I was a manager at a Boeing factory and I had brought a bunch of concerns to the C-suite, and they ignored me, and then doors starting falling off planes mid-flight. That kind of stuff.
But, contributing to that was simply my concerns over the future of the last vestige of private practice Radiation Oncology. The group was on a PSA with a couple of hospitals spread out over a small geographic region. Just like literally everywhere else in the country, consolidation had started to rapidly increase in the years before and after I joined.
The hospitals the group covered did not merge with the same networks. The networks had their own Radiation Oncologists in other hospitals. As I recall, they were all employed in some form or the other.
I strongly suspect that there will come a time in the near future where the group's PSA contract will not be renewed. At that time, the best they can hope for is the network(s) off to keep them on as employees, and the deal isn't wildly different (in terms of compensation) than it is now.
Because: this is Radiation Oncology. The hospitals can offer employment with a 50% pay cut, because they know there's no other linacs in a commuting distance. Or, they could have other RadOncs waiting in the wings, already employed, to take over the positions immediately (also cheaper).
Which just brings us to the most important point in business, or the business of medicine:
Always be prepared to walk away.
That's what I did. I had started the job hunt when it became clear the "doors falling off planes" was not going to be addressed. I made one last big plea at a partners meeting.
It fell on deaf ears.
So my resignation letter fell on them, instead.
They never saw it coming. Because it's RadOnc. They knew there were no linacs in commuting distance. They knew geography was important to me.
Always be prepared to walk away.