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Monday, June 17, 2013

Be back soon!

After doing a week of night shifts, I went to Newark, NJ to take a 3 day course to get me sufficiently full of details of physics and anatomy to take the written test for ultrasound certification (RDMS). It was put on by ESP Ultrasound and is intended primarily for certification of technicians, so there were many mostly young women there who had very different backgrounds than I did. An experienced ultrasound tech knows tons of intimate details of anatomy after visualizing its inner mysteries daily. I have much to learn. As for how those intricate parts behave in health and disease, I definitely know more. The physics of ultrasound is complex and fascinating, but that was not what was covered in the course. It unabashedly provided us with the information we would need to pass the test. I am grateful, if unenlightened. I then hung out with friends in rural New Jersey for a week forgetting anything medical, singing and laughing and eating good food.

Today I head to Tanzania with my Chinese ultrasound machine and several University of California medical students to do a study on ultrasound and Malaria diagnosis and teach medical professionals to start doing bedside ultrasound. This is what I expect we are doing, but from my experience in Haiti, we will probably do something else which is, as yet, a mystery. I will probably not write anything while I'm there, but then it may turn out that it is perfectly possible to post from some random computer in an Internet cafe. I'm sure, at the very least, I will post something by early July, most likely something exotic and fascinating. I will leave my cheap but adequate Chinese ultrasound machine behind and will have a good idea about how it works and some photos to post. See you in July!

Wednesday, June 5, 2013

How to take a doctor sabbatical

In October of 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 US. 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 1000 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.