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Monday, September 19, 2011

Walk, sing, practice medicine

I have worked as a primary care internal medicine doctor in a small university town for the last 17 years and have loved it more each year. I like my office, I feel at home and appreciated at the hospital across the street where I care for patients I know and for some who I eventually get to know through doctoring them. I can do intensive care medicine, take care of patients with delicate social situations and pick up the medical pieces with patients who have surgeries or injuries. It is never dull and it only rarely makes me feel sad or frustrated. I know the nurses well, count on them and am almost never disappointed. My relationships with my fellow physicians are warm and I respect them.

On October 31 of this year I am quitting my job. I am not old, so I am not retiring. It's just time to do something else. Various things happened which were the universe's way of telling me that I needed to do something different. My nurse practitioner partner with whom I shared an office, a world view and plans for future brilliant schemes, died suddenly in April, and one of 3 remaining partners in my clinic decided to take a job elsewhere as a kind of partial retirement. It is not possible to effectively hire another internal medicine doctor for a clinic such as ours in a small town such as ours with any degree of certainty, and my remaining partner and I were becoming swamped. It is possible to keep up with the level of work we were doing for a few months, but not for the rest of my work life.

My plan is to get as many experiences as possible practicing medicine as many places and settings as I can for the next two years. I want to see how other people do what I do, how other systems work, how they don't work, what they smell like, feel like, taste like. I would also like to take long walks in places I've never been, and since I'm asking for what I want, sing. I love singing with people and it is a hobby that is not hard to indulge. I especially like singing with small groups in harmony. But more about that later, perhaps. I bet I'll be able to squeeze some good music into the next year or two. I will also take lots of delicious continuing medical education courses and learn from academics how to do things that I don't know how to do.

I'm calling it a sabbatical. The term "walkabout" would also be accurate. That term, as I understand it, refers to native Australian's need to leave what they are doing and do something else, somewhere else, for a time. It's a fascinating concept, but it is not entirely clear how it's going to work. I have started to look into my options by signing up with a locums company, a group that will find me jobs in places where they desperately need a doctor to fill in for a time. Ideally, these positions would be for just long enough for me to experience a new place and get familiar with their routines, meet new people, explore my new communities. I'm finding out, though, that jobs want me for as long as possible, as full time as possible, and preferably they would like me to eventually move there and take the job full time.

I would also like to go back to Haiti, to La Gonave, and work with the communities that I have started to get to know on public health issues such as birth control, safe sex, contraception and building healthcare teams. This is expensive for me, but will be less expensive when I am not having to pay a staff and an office to run in my absence.

I also plan to work in a rather remote clinic in Alaska where a friend of mine has worked for years, intermittently, but probably not starting in the dead of winter. I will work this out myself, with the help of the hospital administrator there.

Locum tenens companies, like the one I signed up with, take care of the details of credentialing, malpractice insurance, arranging licenses, travel, housing and any money negotiations that have to happen. They also charge a lot of money for doing this, which is absorbed by the poor desperate hospital or clinic that uses their services to fill a slot. This means that, by participating in this process I will be directly contributing to high health care costs. I do like the idea of having everything arranged, but in the best of all possible worlds, I will find at least some of my own jobs and negotiate the details myself.

Other than the fact that I am leaving my patients and community in a lurch, this is a great plan. I get the idea, though, that it won't go particularly smoothly. It seems entirely possible that I won't get exactly what I want, and sometimes not vaguely what I want. I am expecting that by the process of trying various things, failing and succeeding, I will learn lots of amazing stuff, including how to do this thing that I'm going to be doing. If I do figure that out, maybe it will make this kind of thing easier for other physicians to do. The reason that it is a great idea is that medical practices are kind of like little Galapagos islands, developing procedures, tricks, solutions that they never share with other groups. Deliberately learning new stuff and sharing it just has to be something that holds hope for improving medical care and efficiency.

I will be using this blog to document my adventures, should I have them, and the perils and pitfalls of getting this stuff all arranged. I will also continue to write about the wonderful tidbits of American medical care in its glory and absurdity as I have been doing.

2 comments:

Mary Kay Nitchie Lodwick said...

Janice, I look forward to your posts as you embark on this adventure!

Anonymous said...

Janice - you are a brave soul to move forward with what you really want and I admire that. Your patients and collegues will miss you but oh, the stories you will have to share with us when you return. Hugs and ENJOY!