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.
An 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?
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.
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?]
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.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.
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.
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.
Has anyone here taken a gap year from training or found ways to do work abroad?
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Thanks again for sharing your inspiring story, EJ. You’re not making any less interested in FIRE with your story and travel photos. Cheers!]