A Gap Year Away From Medicine: One Physician’s Experience

Today’s post comes from an early-career west coast cardiologist named EJ. He puts out great stuff on his own site called Dads Dollars Debts, and was kind enough to share his experience in a guest post here today.

In the post, the good doctor talks about burnout, travel, a sabbatical, and more — all great topics to be discussed here at Physician on FIRE. Take it away, EJ!


 

Do you ever get that feeling that you can’t go any further? You are fatigued, unable to get going, and negative about your day to day. Or maybe, every little thing that is said or done makes you explode. You pass through your day feeling like at any moment you might lose it. Well, these are signs of burnout and by the end of 2009 I had all of them. I was officially burned out!

 

Why was I burned out

 

One year of weekly call as a fellow! That’s why.

Having attendings second-guess the majority of my decisions. Doing donor echocardiograms at odd hours of the night. Being the alpha and omega for questions. My days were looking bleak. I was exhausted, unhappy, and unsure if my choice of cardiology was the right one.

The light at the end of the tunnel was snuffed out. It was so bad that my grandmother, my sweet grandmother, told me she had not seen me smile in a year. My brother, an attending at the same institution, said a medical student told him I was mean. If you know me, then you know I am the furthest thing from mean.

But in February of 2009, I likely was at least moderately rude. I was burned out and not enjoying my day-to-day practice. I am not saying this is unusual as many of you probably feel the same way, but this was my experience.

 

A idea forms!

 

So while this was happening, my wife and I got to talking. Neither of us had taken time to do international travel and both of us wanted to. Maybe a year off would do the trick in revitalizing my passion for medicine. As attendinghood and a “real job” approached, I imagined it was only going to get harder to travel and get the chance to experience another culture.

How could I tell my hospital I wanted a year off to live abroad? It was not going to happen if I wanted them to take me seriously! Maybe if I had a FIRE plan like Physician on Fire. But that is not really a gap year and more like a book end to a career.

I decided I had to find a way to live abroad, and the sooner the better. I planned and finally organized a year in Argentina doing research. And it was awesome!

Awesome, you say?

 

How was it awesome? It turned that frown upside down. I rid myself of the attitude and came back rejuvenated. What did I do that year?

 

Whales in Peninsula Valdez

Whales in Peninsula Valdez

 

I lived in Buenos Aires allowing for a good home base. From there, my wife and I traveled to 5 different spots in Argentina from the north (Iguazu Falls) to the south (Tierra Del Fuego- one of the closest places to Antarctica you can get without being on a ship). I ate lamb slowly cooked on a skewer over an open flame in Patagonia. I enjoyed more meat then I can recount, including pieces of the cow that I would not imagine eating such as blood sausage and chunchullo.

We visited Chile including Easter Island (one of the most remote inhabited islands), saw pink dolphins on a river cruise in the Bolivian Amazon Rainforest, traveled to Machu Picchu and climbed Ausangate. This was just some of the travel we took. We packed more travel into the year than either of us had done our entire lives.

 

Life in Buenos Aires

 

In Buenos Aires, I learned Spanish and danced the Tango. The Spanish was hard work requiring regular classes.  The Tango was not much easier.

 

It takes two… to tango.

 

Still, by the time I left, I could do both well. We traveled the city, enjoyed the music, and ate dinner at 9pm like the locals. Finally, we made lifelong friends from all over the world.

So yes, I came back to the US rejuvenated and ready to tackle the rest of my training and the beginning of my career. [El Doctor en Fuego: Muy bien! También quiero aprender a hablar mejor español]

 

How can you take a gap year from clinical medicine?

 

How did I finally take my gap year from training? I used research, and throughout the year I did a lot of work including writing a grant, publishing numerous research papers, and helping my mentor on larger projects. I worked as hard as I would in the States, but with the benefit of being somewhere completely new and using it as a springboard for exploring. While research is one way to pursue a gap year, there are a few ways people can practice medicine abroad.

Here they are:

 

A leave of absence.

This is probably the worst way to take time off. To go this route, I suspect there would need to be a good medical or personal reason, such as a death in the family or a diagnosis of cancer. Events that lead to leaves of absence typically do not lead to a gap year, but a year coping with whatever tragedy has occurred.

Plus, it can be messy to coordinate, organize, and explain moving forward with a career. Therefore, I would not recommend this avenue to pursue a gap year.

[PoF: I wouldn’t recommend a sabbatical in training, but it can be an entirely reasonable option as an attending, particularly if you are planning on changing jobs. Why not take some time for yourself in between?]

 

El Calafate

go see El Calafate

 

Performing clinical work abroad

This is a nice avenue, but I am not sure how feasible it is. There are away rotations the can be pursued in training, but most of these are only for a month at a time.

Furthermore, certain fields, such as emergency medicine, afford more of these opportunities. Most of these opportunities improve health in underserved areas or developing countries, so I doubt the time will be spent sipping lattes in Italy. Here are some articles on pursuing away rotations here and here, but all in all there is no defined rotation so you have to kind of wing it.

 

Perform research abroad

For me, research was the ticket. I have always done research and received various training grants over the years. Continuing this path abroad made sense. My contacts grew, my research skills developed, and I lived in a different culture.

So what did I do? I applied for a Fogarty International Clinical Rotation- Fellowship through the NIH (now known as the Global Health Program).

I was lucky getting funding which supported my year abroad. This method, while more defined then a clinical rotation, still is difficult to pursue as 1) It requires the residency or fellowship program director’s blessing and 2) needs sufficient research experience to competitively write a grant and receive funding.

The downside to this path for living abroad is that after a year away from clinical work, there will be some rust to clean off when returning to the clinic, hospital, or operating room, particularly for proceduralists.

 

Finish residency, take a year off, then start fellowship

If there is a gap year between residency and fellowship, why not take that time to travel and rejuvenate. I have one friend who finished residency and moved to Argentina with his family. In his 3rd year of residency he applied and was accepted into Gastroenterology fellowship. When he came back from his gap year, he had a fellowship waiting for him. This may be a nice option for individuals not looking to do research or practice medicine abroad. It allows for a break in training without hurting future employment opportunities.

 

Fishing in the Bolivian Rainforest

Take a year off… and go fishin’

 

Work locums a few months a year and take the rest of the year off to travel

This is technically not a gap year, but would lead to a nice lifestyle. I have friends who worked this way for a few years after residency prior to starting a full time job. I have also heard of individuals with US licenses practicing in Australia, and from what I can tell that is Physician on Fire’s plan.

 

Go to a medical school abroad

This is also technically not a gap year. The downside of this route is that you will be a Foreign Medical Graduate, which may make matching into a United States internship/residency more difficult. If you are a US citizen or Green Card holder, much of the difficulty in the match is removed. I have American friends that have gone to medical school in the Caribbean (a local favorite), Ireland (I thought that was cool and unique), and there is even the option for the University of Queensland, Ochsner Clinical School where the first two years are in Australia and the last two years are in New Orleans. Talk about two awesome cultural experiences. This may not help with burn out as it is at the beginning of the career but I thought it was worth noting.

 

What are the steps to setting up an away clinical or research rotation?

 

First off, planning should occur at least 1 year before your expected rotation or travel. Start thinking about this in the first year of training; applying and arranging in the second year of training; and actually doing it in the third year of training.

 

1) Check with the program director

Have a clear plan such as, “I am interested in applying for the FICR grant to do research in Latin America in Chagas Disease” or “I would like to take a month to do a clinical rotation in Africa to evaluate how they manage HIV followup.” The request should be clear but not necessarily finalized. Discuss with the program director the plans for setting up the away rotation (see below). Most programs will be on board as it is prestigious to have trainees perform research and international clinical work. If they are not on board, then this is a hard stop. It is unlikely that an away rotation will be your near future. Sorry but at least you asked.

2) Find and contact various program directors at international sites

Ideally there is already a connection to one of these sites. If there are no prior connections, then go ahead and send a cold email. The worst-case scenario is that they do not write back. At best, they show enthusiasm and want to progress with the relationship.

 

Here is an example of an email I wrote to obtain my research fellowship.

 

Dear Dr. X,

My name is EJ and I am a Cardiology Fellow at XX Institution. I am interested in applying for the Global Health Program (insert link here) and performing a year of research at your institution. After reading your site (or better yet, I was referred to you by X, my mentor), I see that you do research in hypertension in South Africa. I was wondering if you would be willing to discuss with me possible research opportunities or mentorship for July 2018 to May 2019. Attached is a copy of my CV.

 

Thank you for your time. I look forward to hearing from you.

 

Sincerely,

-EJ

 

The key to this letter is it is short and to the point. It quickly states who is writing the letter, why they are writing it, any common contacts, and when they will be available to work. Send email to multiple people with minor adjustments. The CV should be up to date.

 

Once the program director and an interested party in a foreign country have approved, start the paperwork.

 

This will vary depending on where you will be going and what you will be doing.. If it is research, then you may need to apply for a grant.

 

That’s it. Easier said then done, but worth all of the effort. It can lead to an awesome year and I was able to perform research, learn Spanish, make amazing friends, and live in a new city and culture. I would recommend pursuing travel abroad to anyone who can afford to do it. It is a true privilege and one often missed in this country.

 

Machu picchu through the clouds

Machu Picchu through the clouds.

 

Has anyone here taken a gap year from training or found ways to do work abroad?

 


What, you’re still not using Personal Capital? Track all your accounts in one place like I do.


 

[PoF: Be sure to check out more from EJ at his site Dads Dollars Debts. You can also follow him on Twitter @DadDollarDebt

Thanks again for sharing your inspiring story, EJ. You’re not making any less interested in FIRE with your story and travel photos. Cheers!]

Subscribe for Free Calculators & More!

No spam guarantee.

25 comments

  • Thanks for sharing your experience, DDD! Sometimes, I wonder if a way to get around a noncompete clause of a contract is to take a gap year as you described, and then return after a year rejuvenated and ready to work at the new job.

    DDD, did you feel that your skills were eroded at all after the research fellowship? Or were you able to return to the clinical rotations of fellowship without missing a beat?

    • Interesting question about the non-compete. Your employer would have to be willing to let you go abroad for the year, so that may make it tricky. But where there is a will, there is a way.

      My clinical skills definitely took a hit and that is why I decided to do the year between second and third year of fellowship. When I came back I was able to get up to speed within a month or so and by the time I was out as an attending I felt back to my usual state of clinical prowess!

  • Awesome. Someday I may too adventure forth. In the mean time, I live vicariously through travelers like you.

  • Dave

    I would like to see some suggestions for physicians further into their career. The timelines mentioned here all seem to take place around training stages in our career. Burnout often is the result of doing the same thing for many years. By then many of us have other obligations tying us to our jobs or our community.

    It would be great to hear about some experiences from more senior physician’s.

    • Great point and unfortunately I do not have that experience to share with you. I am only 5 years into my attending career but my goal for now is to take a sabbatical in 10 years if I am still working full time.

      How I can orchestrate this is still unknown but having an employer open to taking 6 months to a year off is helpful. This is where being an employed physician can be beneficial. If you own your practice, taking that much time becomes much more difficult.

    • Taking a year of is pretty difficult once you are established in a job. The best time to do it is probably in between jobs. I went part time fairly early in my career which I credit with saving it. Of course if you do locums or short term contract work you can take a gap year any time you want.

      • Very true which is one reason I did it between 2nd and 3rd year of training. Especially since my plan at the time was to be an Interventional Cardiologist (proceduralist) which would make taking a year of very difficult.

        Part time is a great mix- as PoF will likely see. I suspect I will go part time sooner then later, but whether that is 80 or 90% has yet to be seen. Then at a later time I can even go down to 60%.

        After a year off, I know that I like living abroad but can get a similar relaxation with 2 weeks off.

    • I am working on a post on my site (DadsDollarsDebts.com) about how attending can take retirement breaks throughout their careers. It will be published this Thursday if interested.

  • Great guest post EJ! While I’m not a physician, burnout is a huge problem in my career as well. Being aware of burnout and taking action is so important. Great tips to help address this problem.

  • Burnout can be brutal and definitely affects many careers. In medicine there is more discussion about the issue now. Discussions surround being mindful, assistance for patient emails, etc. I think some discussion around how to take time off for a month or three would also be helpful.

  • Well played DDD! I assume this little taste of the world out there waiting to be explored not only helped with burnout and creating great memories, but also helps to keep you motivated to get to eventual early retirement.

    • It also led me to realize that my job is not my life. I attribute it to helping me decide to give up a career in interventional cardiology (for the non-doctors out there it is a much more rigorous schedule with more chances of people doing poorly/dying while you are working).

      After I tasted a life without clinical medicine, I realized I can be fulfilled with things outside my career as much as with in my career. It is definitely worth taking a break if you can swing it.

  • Great story, thanks for sharing. I’m assuming all this was before you had kids ha! After all you are “Dads…”

    My wife and I have talked about going on an extended trip (3-6mo.) and living in different countries (and taking the kids!). We definitely don’t want to wait until we’re retired to do this. We’re trying to put ourselves in a position with other streams of income so that we can literally just take all that time off and not have to worry about our finances. It also helps to be in a field and part of a group that would allow this. We’re getting there and hopefully soon we’ll have a great story to tell like yours!

  • Traveling with kids is definitely possible. My friend from residency actually lived n our same apartment in Argentina the year before us. They had 2 kids and did it in between residency and fellowship.

    Setting up income streams so that you can take off without worrying is great. For me, the income stream will be my invested income.

  • HarjotSingh

    Or do Tele-Medicine.
    I have been doing it for over 11 years.
    You don’t have to do it full time, and a lot of Physicians can integrate Tele-Medicine into their work even if they cannot do it full time.
    Some states are weird about it and most are okay with it.
    It’s not for everyone.
    I wonder if this factor can help someone decide their career choice though.

    • May I ask what field you are in? Tele-medicine sounds great for radiologist or dermatologist but may be more difficult for other fields (ER, surgery, etc.). It would be a great way to travel and work at the same time. You would just have to insure a good internet connection on your travels.

      • HarjotSingh

        Psychiatry – mainly Child and Adolescent Psychiatry, and Executive Coaching/training – mainly about Physician/provider Burnout. Expanding into CME training for Primary Care Providers in Psychiatry.
        It is all by conscious design, and not just accident that I do things that can all be done remotely. And Telecardiology is a real thing.
        When most organizations set up Tele-Medicine, they ask their IT because somehow people think that IT people know more about it; they only make you spend about 10 times more money on useless and clunky stuff (literally true, recent example at one of our sites) without even knowing what a Physician really needs. It’s the same stuff you deal with when you ask an IT person to build an EMR without Physician input.
        If you have a good nurse on the other end, many specialties can use Tele-Medicine. E.g. for regular follow up for stable patients, how much of the time does a Physician need to do a Physical exam, and when can a nurse do it? What percentage of your practice can be set up like this? What percentage of a work can a specialist do for Primary Care offices like this without having to travel there? There is a bit of a learning curve to set it up and provide good service though.

        • Sounds like a promising future for medicine. Very cool and thanks for sharing your thoughts. I suspect over the next 10 years these tele-medicine fields will become more mainstreamed. I do video and phone visits at my current job for some follow up.

          At the end of the day the billing piece becomes important and it will be interested to see what insurers do.

          • HarjotSingh

            It’s all because of state laws, and they are changing for good. There are new codes and it is important to keep up, e.g. new codes of case management that can work for the coordinator who helps you on the other end.
            The big legislative push from American Telemedicine Association is for National Licensing for Physicians instead of state by state licensing.
            If you are really curious to incorporate more of Tele-medicine, may I suggest attending national annual meeting for American Tele-medicine association. The vendors have stuff that will give you great ideas and you’ll meet people who are really doing new things. It is more like going to a technology conference instead of going to the same meetings typically in medicine where there is not a whole lot new after a few years of practice- unless you go there to party.

  • I’ve thought about taking 4-6 months off before my daughter starts kindergarten. It is about 4 years away from happening. I’m not sure how my employer would react – I’m sure they wouldn’t be happy but I think they’d be flexible and let me do it.

    • I think for those who are seriously considering early retirement, finding times to take 1-6 months off will make staying in our careers more palatable. Kudos to you for thinking of doing it. Now that you have the idea, you can start forming the plan.

  • Joe

    I’ll forward this to my brother. He has been so stressed out lately. He traveled quite a bit when he was a student and I think he misses it. He spent part of this study and residence in Denmark, Hawaii, and a couple other locations.
    It sounds hard to take a year off, but it’d be great to recharge.

    • I hope he finds it useful. I think that individuals who get out there and catch the travel bug find it hard to settle down. That is how I have been and why I need to continue planning a somewhat early retirement.

  • Pingback: Dealing With The Guilt of Early Retirement - Stocks Masters

Leave a Reply

Your email address will not be published. Required fields are marked *