I think I've touched on this before, about feeling bad when people have to leave here, but the guilt issue is really the worst part of this whole setup.
Most people, even if they have to change doctors ("have to" vs choose to is a different topic), are not bitter or angry, and send their verbal support and words of encouragement. There's a source of guilt right there, these people aren't mad or bad, and I'm "driving them away". Then, there are the angry ones, I am ok with them leaving, because I don't really like to deal with angry people anyway. But there are others who might as well have taken lessons from my Mom about how to make me feel guilty. One lady couldn't even call me herself, her daughter called to cancel her appointment because the patient had been in the hospital twice "because of all the stress I had caused her." Her appointment was scheduled before the Medicare end date, but she could not even bear to come in and see me. As unrealistic as that is, and as much as logically I want to say "if you're that upset about it, find a hundred dollars or fill out the financial hardship form!!", I know this lady, she matters to me, and while I think she needs to reevaluate her coping skills, I truly do not want to cause stress in her life. Part of my job is to help people through stresses, not to cause them (real or imagined). I have also heard from several people variations on "how can you do this to me?" and "I thought we were friends". And really, I do have a connection with these people. I don't just look at them as "customers" or "clients".
Then, there are the ones who stay. I know that it is hard for some of them to come up with $100, or the discounted fee schedule if they qualify. And it is near impossible for me to charge people the $175 for "extended" visit. That's a lot of money. And I just keep telling myself that the plumber, the electrician, the mechanic, the vet, the lawyer all charge high fees, and many of them do not have student loans the size of a small mortgage. But I still feel bad.
Then of course there's all the other things in this job I can feel bad about, making people wait (not usually too long), addressing lifestyle issues like weight and smoking without offending people, my own human error and (hopefully rare) mistakes, and delivering bad news. I'm mostly used to that stuff though, and that's part of why they pay me the big bucks...