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President's Column

When a vacation isn't enough, consider taking a sabbatical

From the January 1998 ACP Observer, copyright 1998 by the American College of Physicians.

By William A. Reynolds, FACP

The practice of internal medicine is a wonderful, satisfying and rewarding career, but there come times when a change of scene and pace is welcome. I'm not referring to the all-too-short two-week vacation, but a several month mini-sabbatical.

The concept of the periodic sabbatical is well-established among academic institutions both here and abroad, but the concept is relatively new for practicing physicians, particularly those in group practices. With proper planning and determination, however, it can be a reality for most practitioners.

My own interest in sabbaticals dates back to the 1960s, when I joined a group practice that allowed physicians to take a three-month sabbatical every five years at half pay. During my first sabbatical, I spent two months filling an endocrinology fellow's slot at Duke University, which provided a great opportunity to hone my endocrine skills early in my career.

During a second sabbatical, I spent three months in an endocrinology department in Christchurch, New Zealand (Clinical School, Otago University) as a visiting staff member. Then in 1992, I served as a health policy volunteer staffer for Sen. Max Baucus (D-Mont.) in his Washington, D.C. office. This was an exciting period in the health care reform debate, when universal health insurance was being debated.

Opportunities

There are many opportunities for a sabbatical in North America and abroad. A few formal programs in academic centers, such as the mini-sabbatical in geriatrics offered by the University of California, Los Angeles, offer sabbatical experiences. In addition, a number of university medical centers will make special arrangements for individuals interested in taking a sabbatical. (To inquire about arranging this type of sabbatical, try writing to the chief of service where you have an interest or to the head of the department of medicine.)

For a more exciting and romantic sabbatical, spend several months in a foreign country. The opportunity to make new friends and to participate in a different culture is an exhilarating experience. Opportunities include working with a volunteer organization or mission hospital.

Remember that most internists from our part of the world will face problems delivering primary care in many third-world situations. You are frequently expected to do minor surgery and obstetrics, so investigate thoroughly before accepting such an assignment.

A better choice for many is to select a teaching hospital abroad where the language is not a problem, and where you offer your services as a teacher to students and residents and provide consultative services. Many internists feel they have made a greater contribution in this role than they could in a small rural hospital.

Plan ahead

If you are interested in taking a sabbatical, begin planning at least a year in advance. Getting someone to cover for you may be a problem, but it tends to be less of an issue in large group practices. You can always bring in a locum tenums, or even consider bringing in a new partner to help fill the gaps while you are gone.

You will need to start by contacting a organization that will sponsor you or deal directly with the institution where you wish to serve. Medical school addresses are listed in the "World Directory of Medical Schools," which is found in most medical libraries. For an extensive list of organizations that provide service opportunities abroad, see the Aug. 7, 1997, issue of Journal of the American Medical Association.

Work out as many details in advance as possible, including an agreement in writing with your host institution. You may also need a license to practice (I needed one in New Zealand), which can require a fair amount of paperwork. Passport and visa, if required, are essential.

ACP has a working agreement with Health Volunteers Overseas (HVO), which has a limited number of placements for internists. HVO also has useful information and publications. (Information: Executive Director, Health Volunteers Overseas, c/o Washington Station, P.O. Box 65157, Washington, D.C. 20035-5157; 202-269-0928.)

Finally, ACP may soon be offering an opportunity to go to parts of the former Soviet Union with expenses paid by a federal program. Keep an eye out for an announcement of the program in a future issue of ACP Observer.

One caveat: If your spouse is accompanying you, take planning of his or her needs into account. My New Zealand experience was marred by a lack of activities for my wife.

Sabbaticals are increasingly being recognized as a crucial fountain for intellectual and emotional renewal, and they can be of benefit both to the participant and his or her colleagues at home as well as those of the host institution. If you want to put real zest back in your life, start planning yours today.


Sabbatical resources: some suggestions

With my own experiences in mind, I put together a syllabus of all the information I could gather on the subject of sabbaticals. The syllabus includes a literature review, copies of contemporary articles, a list of organizations that sponsor programs and other information. While it was last updated in 1994 and may be getting a little out of date, the syllabus would be helpful for anyone considering a sabbatical. For a copy, write me at 429 King St., Missoula, Mont. 59801 with a self-addressed, stamped ($1.24) 9x12 envelope.

Here are some other sources of information I have found on sabbaticals:

  • In the Sept. 12, 1987, issue of the British Medical Journal, Ian Tait, MD, suggests doing something different during a sabbatical, to try to adopt a new rhythm of life and perhaps a different identity.
  • In the March 1987 issue of Annals Royal College of Physicians and Surgeons of Canada, Jock Murray, MACP, Past Chair of the Board of Regents, observes that sabbaticals allow physicians to study new areas of knowledge in more depth, to improve and update skills, and perhaps to switch practice patterns by concentrating on one area with further training. Dr. Murray also speculates that by giving practicing physicians a refuge, sabbaticals may decrease the high incidence of emotional problems, alcoholism, stress and suicide among physicians.
  • The recent book, "Six Months Off," was written for persons in any walk of life but has several sections of great value to physicians. It sells for $12.95 and is published as an Owl Book by Henry Holt & Co. N.Y.
  • For a list of the many sabbatical resources available on the Internet, go to the AltaVista Web site (www.altavista.com) and do a search on "medical sabbaticals."

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