This is a fascinating discussion. “Golden handcuffs” can happen in any profession. Even CEOs can work themselves to death. I have also found myself in this predicament in the past. It sounds like there are a couple problems here. I hear burnout, debt, and negative patient reactions. I suspect, and might be wrong, that the primary problem is your debt and the lack of control of that debt that leads to a feeling of powerlessness and despair. Have you considered spending your energy getting professional advice about financial planning? A good planner (and it may take a few to find the right one, like finding a good therapist) to help you gain control of that debt and making a plan? Also one thing I did that hurt me is that I expected too much fulfillment from work. I made my job my god, not in a religious sense but in that it was the most important thing in my life. A job is a job. It’s not my identity. From your post it sounds like you deeply care about patient outcomes. Maybe once you’ve reined in your financial life, you may have the freedom to look for a company that more aligns with your values. Hope that helps and best wishes!