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Dear Director,
I’m completing my residency and as I look ahead at my first job, I just can’t see myself jumping right into a traditional ED setting. I want something more exciting; I want to travel. Is this a feasible dream? What are the consequences of delaying my first “real job” for a couple years?
-Dr. Wanderlust

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Venture to Antarctica for a position at a research station (and catch a glimpse of Aurora Australis). 

 

As a college student, my goal was to one day land a job that would allow me to spend six months working in Antarctica. Then the realities of med school, residency, and life hit, and I lost track of this path. A few months ago, I saw an ad seeking a physician to go to Antarctica and the old dream came flooding back. While I think I missed that particular opportunity, the point is that for the right residency graduate, there are lots of exciting opportunities out there that will deviate from the standard post-residency path.

Locums
Summers in Maine and winters in Hawaii? Where do I sign up? Since most of us work to pay our bills, I really admire the people who go against the flow and work in order to support their chosen lifestyle. There may be no better way to do that than to find a job that’s located near your hobbies. Whether you like to ski or sail, surf or turf, there are plenty of temporary jobs around the country through Locum Tenens companies. For the uninitiated – or those who just never asked – “locum tenens” is Latin for “place holder.” A locums doc is someone who literally fills the place of another person. Because of the added stress of traveling, the extra flexibility required, and the unpredictable hours, locums docs are typically rewarded with higher salaries while also getting to experience different environments and cultures. Through the locum lifestyle, I really do know people who summered at the beach and wintered in Hawaii and took time off in between. However, what you gain in choosing your location you typically lose in the clinical environment. Chances are, you’re going to pick a job based on the location and take the clinical cards you’re dealt, rather than choose between multiple hospitals based on coverage, back up, efficiency and shift length.

There are literally thousands of locums opportunities all over the U.S. if you’re interested in short or long term flexibility, but if you want to do even more globetrotting, there are international positions as well. I’ve worked with two docs who have traveled to New Zealand through locums assignments. One hasn’t come back after 10 years and I think it’s unlikely the other will either.  Beyond New Zealand, there are numerous other countries that are in need of emergency physicians and have their own unique draw.

Humanitarian
For those looking to contribute to a humanitarian mission, there are several organizations that respond to countries where survival is threatened by violence, neglect or catastrophe. Most of these organizations are looking for a 6-12 month commitment, though there are relief organizations that do 1-2 week trips. One of the best known is Doctor’s Without Borders, known throughout the world as Medicine Sans Frontieres or MSF. They ask for a minimum six-month commitment, but once your first tour is completed, you might be asked to help out with other trips with a shorter commitment. A colleague who did several trips with MSF served in West Africa twice and then was called to assist for a month after the earthquake in Haiti. He felt that he became a better clinician because the lack of available testing forced him to depend on a combination of his history and physical skills and his gut instinct. He learned to take care of people by practicing medicine rather than by ordering tests. For emergency physicians, the actual medicine that you do in these scenarios can vary greatly, ranging from standard emergency medicine and initial trauma resuscitation to managing an ICU or a malnutrition center. Other humanitarian groups in need of physicians include the World Health Organization and International Red Cross.

There are numerous humanitarian organizations that provide short term missionary work. Many hospitals even plan their own trips. One worth mentioning is Remote Area Medical which does both international and domestic healthcare. While trips use physician volunteers, they only require a few days of time, thus allowing you to have your regular job while contributing care to underserved individuals in a non-traditional setting.

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Make new friends in Malawi while working with Save the Children

 

Other Cool Jobs
Beyond locums and humanitarian work, there are other emergency medicine opportunities that simply offer the opportunity to practice medicine in truly non-traditional environments. If you’re not tied down to a mortgage and love the sea, consider spending six months aboard a cruise ship as a ship’s doctor. Managing a STEMI takes on a whole new meaning when you’re hundreds of miles from land. I used to work in a hospital adjacent to a cruise ship port and we would get the patients who had been in their “ICU” for days awaiting the ship’s return to shore.  While the pay is typically much less than a traditional post-residency job and the living quarters could be small, the food and fun are hard to beat.

A UK-based company called Expedition and Wilderness Medicine offers numerous courses that teach health care professionals to operate in inhospitable environments. Courses range from jungle to arctic to desert to dive medicine and once you’ve been through their courses, you can use their job finder to look for expedition and remote medicine jobs all over the world.

For those who like cold weather, there are even volunteer opportunities for physicians who climb or trek through the Himalayan Rescue Association. Combining wilderness and high altitude medicine, these doctors take care of the climbers and trekkers in base camp medical clinics at the base station at Mt. Everest and throughout the Himalayas. And yes, there are even jobs in Antarctica, through the Raytheon Corporation, though attending experience is necessary.

Weighing the Pros and Cons
Residency is hard and tiring and the thought of doing something afterwards that lets you earn a living being a physician while having fun can certainly be appealing. That said, I think there is a tremendous amount of personal and professional growth that occurs the first 6-12 months after residency in a traditional ED setting. I believe the learning curve in that time period is as steep as at the beginning of your internship, so you may be better served to place yourself in a position to continue to learn your craft. Additionally, when you interview for a full time, more permanent job, you’ll need to be able to address things like productivity, patient satisfaction, and quality of care. Certainly, there are positives about doing each non-traditional job listed above. The people skills and EMR flexibility is critical as a locums and if you can do that successfully, you can probably fit in anywhere. The confidence that comes with managing critically ill patients with limited resources is also an asset. As one of my favorite attendings used to say to the charge nurse who wanted us to go into crisis mode because we had 30 people waiting for a bed: “30 people isn’t a crisis. 10,000 people with no electricity or running water in need of healthcare is a crisis.” I guess it’s all in your perspective and some of these jobs will give you unparalleled experiences.

As it turns out, emergency physicians are perfectly trained to take on a lot of non-traditional healthcare roles both stateside and abroad. There is no lack of opportunity for the emergency physician looking for a job away from the day-to-day grind of an ED. While locums may be perfectly appropriate for a recent residency graduate, other jobs may be better suited, or even require, 3 years of post residency experience. Ultimately, whether you are working to play or providing humanitarian relief, there are numerous opportunities to explore while still gaining personal and professional growth.
 

Michael Silverman, MD, is a partner at Emergency Medicine Associates and is chairman of emergency medicine at the Virginia Hospital Center.

 

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