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Monday, July 29, 2013

8 tips on how to take a sabbatical

In October 2011 I left my job of 17 years, which I loved, mostly, and started a 2-year sabbatical. Since sabbatical implies that there is one year of rest every 7 years, I have built up at least 2 years since finishing medical school in 1986. Nobody in my office or medical community did sabbaticals, but we discussed that it would be a great idea when we first set up our practice. Various life changing events including 1 death, a retirement and the launching of 2 children required a response from me, and thus the sabbatical.

Physicians ought to do this. We are frequently overworked and burned out and rate ourselves as undercompensated for what we do despite the fact that we belong to one of the best paid occupations in the U.S. We develop a sense of duty and dread and get so busy trying to hold families and practices and administrative responsibilities together that we have neither the time nor the energy to figure out how to rejuvenate ourselves. We end up not loving the job that initially energized us through gruelingly difficult medical school and residencies. We were mostly the best and the brightest, the motivated high school and college students with a drive to serve others and the sparkle to get ourselves into competitive medical schools. We become hurried and harried, with compassion fatigue and dark circles under our eyes. We burn out and become worse doctors and serve our patients less well and burden our families with our ill humor.

I gave notice at my traditional internal medicine practice and got hooked up with various locum tenens companies. I found out that, as a hospitalist, I could make more than enough money to support myself. By working blocks of 7 day, 12 hour shifts at hospitals in various locations I could support various educational projects and travel since locums hospitalist medicine is so much better compensated than my regular job was. I wrote about how that process worked here.

I also did the things that I had regretted not being able to do for 17 years. I took lots of continuing medical education. Wherever there was a good class in something I wanted to learn, I went there. When my son went to college, I did a road trip with my husband across 4 states to deliver him and stayed with my sister. We camped along the way. I did a meditation retreat for a week. I went to the Republic of Georgia for 3 weeks and learned to sing new weird folk songs and performed with a small group at a symposium there. I learned to do bedside ultrasound and had enough money, through my lucrative locums jobs, to pay for a small ultrasound machine and a full month ultrasound fellowship in California.

I took off enough time to really study for my internal medicine boards and took the test to requalify, which for me was voluntary. I applied for fellowship in the American College of Physicians, attended their meeting and walked in the ceremony to get the fellowship. It was in San Francisco, so I got to walk to Chinatown and eat good Chinese food at the breaks and buy cheap Chinese underwear and tea. I spent some quality time with my dog, walking on the mountain near here. I am visiting friends on the east coast this next week, whom I have wanted to visit for years, but never took the time. I am also going to Tanzania in 2 weeks to supervise medical student researchers and teach ultrasound. On my to-do list are trips to India to see how their medical system works (perhaps I could teach bedside ultrasound there) and to South Sudan to work with a friend who treats visceral leischmaniasis.

I also saw over 1,000 patients, many of whom were very sick and all of whom taught me something. I saw the inner workings of 7 hospitals and met dozens of new colleagues, who have also taught me stuff I could never get from books or conferences. I learned how to sleep so I could function on night shifts, learned how to use about 5 different computerized medical record systems, how to apply for medical licenses and that I am very hard to fingerprint. I learned how to be very efficient with my time, and that I am not fast and don't care to be. I learned how to pack a suitcase or a car so I don't forget the important stuff, and various things about airport security, including the fact that it feels nice to be patted down when you are cold and tired.

So, some tips for the doctor who is interested in taking a sabbatical:
1) Do it. It's a good idea.
2) Do something difficult. If you do locum tenens hospitalist work, that counts. Intense work that taxes you, combined with a healthy amount of sleep deprivation leads to personal growth, so long as you don't do it all the time.
3) Do something that is not difficult. Maybe even just a few weeks where you only hang out and garden and go for walks.
4) Do something exotic. Once you are no longer burned out and overworked, this is really fun.
5) Do something that is not medicine.
6) Learn something. It's not a bad idea to take some sort of organized review that leads to a recertification, but there are so many interesting things to learn, in and out of medicine. Go for it.
7) If you do locums, set money aside for income taxes. You are an independent contractor and none of what you make is deducted ahead of time. April 15th can be surprisingly painful.
8) See to your family. They will miss you when you are out and about, pursuing your dreams.

So what, one may ask, about my patients who I have deserted, and those that other sabbaticalizing doctors will desert? What goes around comes around, and they will be better served eventually if we love what we do and are better at it.

I am not done with my sabbatical, but can now visualize a time when I will work here in my hometown and have a regular schedule. I will probably do some "moonlighting" since working away is still interesting. I would like to do both outpatient and inpatient medicine and use what I have learned to help move health care in the right direction, and haven't quite figured out what that is going to look like.

This, of course, is an issue with a sabbatical, the re-entry. I will have to design my job in such a way that it continues to allow me to do the things that, when I am on my deathbed, I will look back upon with satisfaction. Right now I'm thinking I'll buy an old ambulance, paint "Doc-o Truck" on the side (like the taco trucks that make those excellent tiny tacos), do mobile medicine in underserved areas, support this clearly financially untenable enterprise with hospitalist shifts, and write about what happens. More on the Doc-o Truck later.

Janice Boughton, MD, ACP Member, practiced in the Seattle area for four years and in rural Idaho for 17 years before deciding to take a few years off to see more places, learn more about medicine and increase her knowledge base and perspective by practicing hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling. Disturbed by various aspects of the practice of medicine that make no sense and concerned about the cost of providing health care to every American, she blogs at Why is American Health Care So Expensive?, where this post originally appeared.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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