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The question of what to do between completing a fellowship and starting a new job is a big one.
Ignatius Nyatsanza, MD
Imagine you are approaching the end of your fellowship training. Soon all the arduous years of study since medical school will be behind you. You may have even secured your dream job by now or be winding down your search. One question: What are you going to do between completing your fellowship and starting your new job? Rather than letting this be an afterthought, give the question more consideration, especially because for many of us, this may be the only opportunity for a long break before retirement.
During my fellowship training in Chicago, Illinois, I frequently took care of patients who did not speak English. With Chicago as diverse as it is, I treated patients who spoke Spanish, Cantonese, Mandarin, and Polish. For translation, we relied on a service we could reach by phone or tablet. The reception was often poor, tablets were limited, and it seemed patients always remembered 1 more very important question moments after we had disconnected the call.
Hematology/oncology, like all medicine, depends on clear communication and a good rapport with patients. So I decided to learn Spanish to overcome the limits of technology. Part of learning a language is also learning the culture, so I tried to immerse myself in that as well.
Given my desire to improve my Spanish, especially if I wanted to remain in Chicago, and my curiosity to experience healthcare firsthand in parts of the world other than the United States and Zimbabwe, where I earned my medical degree, I developed the urge to practice, if only briefly, in another country.
During one of my vacations while in fellowship, I visited Colombia, where everyone speaks Spanish and very few speak English. I met a linguistics professor from London just starting a 1-year sabbatical, most of which she was planning to spend in South America. I told her I wished I had the opportunity to do something similar. “So why not?” she answered. I told her I was in fellowship. And she replied, “What about when you get done with fellowship?”
No prospective employer would likely allow me significant time off prior to my contract for something outside traditional reasons. Later on, when I was on my own, I thought about my excuses. Were they valid? Or was I just afraid of trying something different?
I started online by researching career breaks and sabbaticals. Other professions seemed to accept and encourage the practice, but I didn’t find much information related to physicians, especially in the United States.
As if by fate, I came across a blog (bit.ly/2S0cZSY) by a US-based physician, Jonathan Kirsch, MD, who went to Cali, Colombia, while on a 1-year sabbatical from the University of Minnesota. He outlined his experiences in the country and gave practical advice on topics such as finding a place to live, getting health insurance in a foreign country, and determining how much to save before leaving.
It seemed reasonable, and the worst any prospective employer could say was no. If I was ever going to do this, the transition from fellowship would be my best, if not my only, opportunity, and I didn’t want any regrets.
What I found surprising was how others responded to my plan. At my midyear review, my program director wanted to know more about my plan. Even potential employers I met with were open to both the amount of time I wanted to take and my reasons.
Eventually, I went back to Colombia and settled in the second-largest city in the country, Medellin, the City of Eternal Spring. San Vicente Fundación, a teaching hospital associated with the University of Antioquia, caught my interest. I emailed them my request, and they were excited to receive me. As I would later learn, they often host fellows from Europe who go there for up to 6 months at a time. I figured 6 months in the hematology/ oncology department would be just right for me.
I obviously did not know what to expect and went into the whole project with an open mind. I learned more Spanish than I had anticipated, even though I haven’t been able to shake my accent. I had more free time to prepare for boards and to read in general. I traveled throughout the region. I found my other foot in salsa— learning the dance is a prerequisite for living in Colombia. It is amazing what you can do and learn in 6 months.
If you ever have even the slightest inkling to take a career break or a sabbatical after fellowship for nontraditional reasons, please give it a shot. Employers are more accepting than you think, and you may land your dream job not in spite of your sabbatical but because of it.
Ignatius Nyatsanza, MD, is a hematologist/oncologist at Advocate Health Care.