From the Red Centre to the sea

In the era of year to year contracts, the medical “gap year” has become common practice for doctors-in-training. There are lots of reasons to take time off – travel, time for family and friends, or seeking space to gain career-perspective before returning to the pressures of training. A gap year can also be a positive response to not getting the job you wanted exactly when you wanted it, and a way to turn a disappointment into a windfall.

At the end of 2017, we found ourselves exhausted by the demands of training. Long hours whilst studying for exams and moving house every couple of terms for secondments was draining. Both of us were in supportive networks but even in optimal conditions the job can be demanding. Alexander especially found himself not looking forward to shifts, a feeling that didn’t go away after a couple of days off – a red flag for burnout. It was a sign to take some time to focus on our own goals and interests outside of training.

It would be easy (and perhaps more fun) to tell you about the adventures we had in 2018; we travelled to Taiwan and Japan, and got weird in Tasmania at Dark Mofo. We moved to the Northern Territory for a few months, discovering a deep love for the quiet expanse of the desert. We crewed a ship in Liberia with Sea Shepherd, working with the military patrolling for illegal fishing vessels, and managed to contract a few exotic ailments and fractured bones in the process. We somehow even managed to chase some academic projects in between times. Of course, we procrastinated a lot, too, and watched a lot of Netflix. We still, despite all our lofty intentions, can’t speak French or meditate properly. A year off didn’t hinder us in securing the training jobs we wanted. In fact, most departments were interested to hear what we could offer thanks to our broader professional experiences.

However, it wasn’t the highlights reel that fuelled our professional development. Locuming can be challenging. Shifts are often in rural hospitals far from home as these are the most affected by workplace shortages. The lessons we’ve carried with us into our new roles aren’t so much based on the good things as the inequality, glaring injustices and groaning bureaucracy we witnessed in the Australian health system. Realities you are often protected from in tertiary training hospitals. We discovered how dangerous the job can be in small under-resourced facilities when Eliza was physically assaulted by an irate patient in a private hospital with no after-hours security, how First Nations people encounter significant barriers to care when there’s no funding to make health spaces culturally safe, how length-of-stay can blow out when there’s inadequate imaging and investigation services, and how expensive and logistically difficult retrieval becomes when health is increasingly centralised (as well as how alienating this can be for patients who wish to remain close to family).

For doctors who have been training in metropolitan areas it’s easy to underestimate the impact workplace shortages are having on rural and regional Australia. We found ourselves running rural hospitals or being the sole doctors on site, despite lack of local systems or community knowledge. This is common for locums as regional hospitals struggle to recruit full-time staff. In many hospitals your closest help may be whoever is in town that night and the on-call system merely a phone-tree of numbers to try hoping someone answers. Working in these conditions forces you to think about your own responsibility, culpability and safety in a way that being protected inside a teaching hospital does not.

While at times frustrating and not always relaxing, taking some time out from training broadened our horizons and career goals and we would recommend it to anyone wondering what else is out there. If you’re burnt-out and unsure what you’re getting out of your career, the chance to compare options can give you richer insight into the health system and valuable experience to bring to a permanent role with a renewed sense of purpose. It may also lead more doctors-in-training to positive experiences in rural and remote areas, increasing uptake of permanent positions in these places in the future. Shop around for locum agencies, find hospitals you enjoy working in that you can book semi-regular work in and of course, remember to take some time to forget the job all together!

Co-written by Drs Eliza Milliken and Alexander Whitfield