Now that was a sabbatical!

How the author and his family managed six months off to see the world.

Theodore J. Clarke, MD
Orthopedic Surgeon/Denver

"I'm out of here, guys. See you in six months." That's what I told my office staff before setting out on an odyssey that began in the Caribbean and ended in Washington, DC. My departure, toward the end of 1999, wasn't spontaneous. My wife, Carol, and I had planned this trip for three years, and I had given my partners two years' notice.

With ample time to prepare for my departure, we recruited a new surgeon to fill the void. We also drafted a business plan to cover the financial aspects of my sabbatical. Our attorney suggested using the Desert Storm model he'd devised for several groups whose partners had served in the Persian Gulf war.

He recommended dividing my practice-based expenses into three-month segments. For the first half of my sabbatical, I would pay 100 percent of my usual share of office overhead; for the second three months, the figure would drop to 50 percent. If I extended my leave beyond six months, the payment would revert to 100 percent. This agreement had the added benefit of providing our group with a standard contingency plan for prolonged disability of a partner.

I also had to do something about my malpractice coverage with Copic Insurance. Fortunately, I'd had only one claim against me in my 14-year career, a nuisance suit that had been thrown out before trial. Since several other carriers were bidding for our group's business at the time, Copic was quite cooperative: The company offered me coverage for my six-month leave for a token 1 percent of my normal premium.

Because my orthopedic practice is largely based on referrals from primary care physicians, I needed to let them and other colleagues know about my plans. So I sent out sabbatical announcements two months before my departure. My colleagues' reaction was mixed: "Did you win the lottery?"

"You're nuts. You'll never get your practice back."

"I wish I had the guts to do that. I can't even get away for a week."

A retired internist told me, "Not traveling is one of the regrets of our lives. Now, with my hip and my wife's heart, we could never make such a trip. Go for it."

My patients were supportive, particularly the elderly ones I had known for years. "You'll never regret it," a retired schoolteacher said. "It's a once-in-a-lifetime opportunity."

My sentiments exactly.

Satisfying personal and professional goals

I didn't just want a six-month vacation: Carol and I wanted a chance for our family to grow closer while our children—ages 15, 12, and 9—were still willing to participate in such adventures. About 20 years ago, Carol and I had spent two months in London as part of my training, and we still vividly recall the excitement of living abroad. We wanted our kids to have similar memories.

But we also knew that they needed to keep up with their classmates. Fortunately, we had no trouble finding an abundance of home school curricula. With her background in elementary education, Carol agreed to teach third-grader Bayley and seventh-grader Ryan. I took charge of ninth-grader Coley. During our trip, most days began with two and a half hours of tutorial, followed by real-life adventures.

One of my own goals was to experience third world orthopedics, and I wanted my family to be involved. I contacted Health Volunteers Overseas (202-296-0928, www.hvousa.org ), which arranges stints for medical professionals in developing countries. I picked a one-month surgical rotation at St. Jude Hospital in St. Lucia, an island in the Caribbean. Although it has a year-round population of 150,000, plus thousands of tourists, the island has no full-time orthopedist.

As a result, the staff of St. Jude welcomed my family warmly and provided us with two rooms adjacent to the main building. Carol and the kids volunteered by painting the pediatric ward, running the thrift shop, and helping me in the clinics. I was very busy that month, mostly treating trauma and infections. Late every afternoon, we all joined the staff for a swim in the Caribbean—quite a treat for a family from Colorado.

Another one of my goals was to improve my professional skills. So I arranged a four-week mini-fellowship in Dublin, Ireland, at the end of the sabbatical. I worked there with Michael Stephens, a noted orthopedist at Mater Misericordiae Hospital. After several months of travel, it was fun to be on the learning curve again, observing and practicing new techniques and procedures.

My other goals for the sabbatical were to replenish my spirit with travel and to enable our family to experience foreign lands and cultures. So between our stays in St. Lucia and Dublin, we completed a 30,000-mile trip around the world, spending most of our time in English-speaking countries.

We hiked New Zealand's Milford Track, snorkeled at Australia's Great Barrier Reef, rode elephants and rafted the River Kwai in Thailand. In Europe, we enjoyed the magic of carnival in Venice, survived the autobahn in Germany, renewed friendships in Belgium, and explored London's theater district. In Dublin, we rode the DART rapid transit system, walked the streets James Joyce had walked, and attended plays at the Abbey Theatre. We also explored the surrounding countryside, finding the Irish to be gracious hosts.

History came alive at Waterloo and Pearl Harbor. We marveled at the architecture of the Duomo in Florence and the Grand Palace in Bangkok. Before returning home, we spent 10 days in Washington, DC, where the kids got a cram course in civics. After nearly six months traveling around the world, we had all gained a new appreciation for our own country.

Re-entry, and the lessons of a sabbatical

By the time we returned to Colorado, the kids couldn't wait to get back home to their friends. Thanks to our tutoring, they had managed to keep up with their classmates. They're now back in school, and racing from piano lessons to soccer games in the afternoons.

I, too, was eager to get back and return to work. I had missed doing surgery and being a doctor. Fortunately, my re-entry into medicine proved quicker than I'd anticipated. Unlike the early days of my practice, this time I already had an established patient base.

Knowing that my referring physicians were my bread and butter, I made a point of attending staff meetings and being in the doctors' lounge between 7:30 and 8 am. I even had myself paged several times at the hospital, just to let everyone there hear my name. Having expected that it would take six months to get my practice up and running again, I was pleasantly surprised to find I was quite busy after only three. Within six months of my return, my practice had returned to its normal routine.

The total cost for our grand adventure was roughly $100,000, including my share of office overhead. Our round-the-world airline tickets cost $2,500 each, and thanks to the strength of the dollar last year, our out-of-pocket expenses were surprisingly low—about $10,000 a month. Though our accommodations in Europe were usually three-star, our lodging elsewhere was luxurious. We cut costs by staying in places that included breakfast.

I figure it cost me about $36,000 ($6,000 per month) for overhead expenses. But since it would have cost well over that amount to close down and start up a practice (and since I didn't want to leave the group), that seemed like a reasonable expense.

Then there was my lost practice income. Several of my patients needed reconstructive surgery during my absence, and I had to refer them to my partners or associates. Upon my return, I noticed how the increased earnings of my two junior partners corresponded to my own losses. Nevertheless, several patients had waited for my return to have their surgery. And after my six months away from the call rotation, my partners were quite willing to offer me extra call chances in order to rebuild my practice.

Aside from what I learned during my stints in St. Lucia and Dublin, my sabbatical has had other positive effects on my attitude at work. When the OR here sometimes seems inefficient, I think back to the one at St. Jude. When the clinic here sometimes seems hectic, I reflect on the endless lines of people waiting for hours to see the doctor at Mater Misericordiae.

At home, we often look at our photo album of "Adventure 2000." Our six-month odyssey did bring the family together, as I'd hoped. And we all learned a great deal from our experiences. In fact, we enjoyed it so much that we're already thinking about our next sabbatical, probably in Central and South America.

 

Theodore Clarke. Now that was a sabbatical! Medical Economics Dec. 3, 2001;78:36.