Should I just quit?

Hello,

I'm an 35y ophthalmologist, trained in an eastern european country, 5 years out as a consultant (mostly in a shared responsibility clinic), but since 3 months ago I moved countries (think western europe now) and I joined another private practice where I'm mostly on my own, running my own clinic.

I've wanted to do this move for a while, since the pay back home was atrocious (think, slightly lower than average income of the country), and there was no financial stability coming out of that, and because my end goal would be to continue into a subspecialty training in the UK (medical/surgical retina or plastics, yeah I know). This was supposed to be a middle step, a low acuity outpatient clinic with specific patient load and very good pay.

Now, I've always struggled with perfectionism, responsibility, and anxiety in my professional life, as a lot of you were/are. I was in a toxic residency program where the load was enormous, the patients too complicated / dumps from all over the country, and the head of the department made us feel responsible for the patient's outcome, regardless of if we did everything right, even if our consultants chose the wrong path to follow. I was a good enough surgical trainee with very few complications but also took very few risks, I handed over any case that felt going out of reach (remember, the head was breathing over every complication).

When I transitioned over the shared responsibility clinic, I had a good enough environment where I could see what I felt comfortable with, and refer internally the others, but that reached a point very early where I was "handcuffed" and couldn't continue getting more experience because I was being taken over by the rest. I also didn't get support to properly continue my surgical career, because they wanted a clear out that the patient actively chose me as the surgeon and no patient was chosing me as a surgeon when they were around.

In this new clinic, I specifically chose a medical only setting to make it even easier on me.

And now the actual problem. In this new country, the referrals and the constant writing back and forth between doctors has made, in my opinion, a very "defensive medicine" system, where bullshit stuff is being going back and forth just to protect everyone's asses. And I don't have any actual guidance from the seniors here, so I'm forced to guess or try to copy what I found out they have done in similar case.

Another actual point that I should mention is that I don't actually have a "say" in what kind of referrals are being placed into my clinic. I just arrive at the morning and see things that make me anxious, or worried that I'm not comfortable treating.

Now, the real question. My experience right now is one of a 4 year comp consultant, with informal mentorship/medical training under a vitreoretinal surgeon and an oculoplastics surgeon, but with no formal suspecialty fellowship. So I know a lot of stuff but I'm not comfortable being the sole responsible doctor for all of this stuff. And this 2-3 months, my schedule actually looks like:

1. urgent/acute referrals that do not have access to the emergency department (they don't accept walk-ins, only referrals). So I'm talking about ulcers, shingles, dacryocystitis, cellulitis

2. Optometrists "exclusions" alongside an anxious patient/parent: suspect papilledema, suspect ulcers, suspect cancer

3. Children, a lot of "acute" children (not really, but optom/GP is scared)

4. Very few actually routine "glaucoma suspect, AMD suspect, diabetic retinopathy, cataract"

This has thrown me into a spiral of thoughts again, if I can actually continue being a doctor/ophthalmologist, which I've had in the past numerous times, and I didn't know who else to ask, so I came here. My colleagues in real life have either actually abandoned medicine (like at least 3-5 close fellow students at my class) or are pushing through / don't really understand what I'm saying and are replying with things like "what do you even want to do? This is ophtho, do the correct thing, go on, doesn't matter, get better etc".

• Is it possible for me to actually do this job, without having to mess with anxious acute patients, in any setting? to not have to deal with acute issues all the time (I don't mind the 1 per day case, that I can tell to go straight to emergency; I hate having to do the role of emergency because they are insufficient).

• Can I find a setting where I can deny any referrals I don't feel comfortable (at any level) treating? I know, I might be out of patients.

• Is there any universe where I will be able to handle UK subspecialty in a system with more shared responsibility (under consultant) but I may run into all of the examples from colleagues who trained in the UK where the consultant is only available on the phone and never actually examines the patient? I think I'm fine in a hospital setting with consultants available to share the responsibility of me handling all the acute and complicated shit. I don't want to be left alone and be responsible to handle them when the resources are low and nobody expects it to be actually done in time. Residency in such a setting destroyed me.

Let me know your thoughts. Sorry for the long text.