Are sabbaticals still an option for today’s doctors?BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1212 (Published 04 February 2014) Cite this as: BMJ 2014;348:g1212
Sabbaticals can provide life changing experiences, but doctors increasingly have to overcome obstacles to take such time out of practice. Kathy Oxtoby considers the benefits of sabbaticals and whether the perception of them has changed in recent years
For decades, sabbaticals have formed part of a typical doctor’s career. They can provide life changing experiences and give doctors the chance to contemplate their career, learn new skills, and take a fresh perspective on clinical practice.
In recent years, however, doctors have found it more difficult to broach the subject of a sabbatical with their trust or practice. Mark Salter, a consultant adult general psychiatrist in Hackney, east London, says it is becoming harder for consultants to gain consent from trusts for a sabbatical. “Increasingly, managers’ attitudes towards sabbaticals are that they are a gift rather than an entitlement, which means that when clinicians try to negotiate them they are starting from a position of submission,” he says.
Catherine Mathews, careers fellow at the Royal College of Physicians, says that doctors now have to negotiate any time off, since employers will need to agree to fund cover for any doctor’s absence.
“I wonder if, in the current climate, with financial pressures being what they are, employers think sabbaticals are a luxury that the NHS can’t afford,” she says. “It’s a shame and a bit short sighted of trusts not to invest in sabbaticals, given that they risk losing people from the profession—those who may have lost their enthusiasm, but who by having a period away could come back feeling refreshed and potentially be sharing experiences that are beneficial to their departments.”
Doctors decide to take a sabbatical for many reasons. Some do so because they feel burnt out or disaffected with their career as a doctor and want some time out of the profession. Others have a passion for a particular aspect of medicine but have so far not had the opportunity to pursue it.
Michael Dixon, chair of the NHS Alliance and a general practitioner (GP) in Cullompton, Devon, says that many general practitioners “get a 10-year itch” because they feel swamped by their workload. “There are so many added pressures on GPs these days that there’s no time to get away from the ‘shop’ so they decide to recharge their batteries,” he says.
Helen Stokes-Lampard, treasurer of the Royal College of General Practitioners and a GP in Staffordshire, agrees that “feeling burned out” is one of the most common reasons why clinicians want to take a sabbatical. “We are all working at a frantic pace and it’s incredibly hard to have space and time to reflect so we can be at our most productive,” she says. “Sometimes we need time out to remember why we became doctors and to see the bigger picture. Often you’re so busy fire fighting it’s easy to miss changes to our practice that could stop that fire starting in the first place.”
Stokes-Lampard says that a sabbatical may have benefits for doctors who feel worn out or in need of a “breathing space,” are dealing with organisational changes, or believe their role is being undermined. She says that, for these doctors, a sabbatical “can be a constructive coping strategy for retaining dignity during difficult times rather than ‘ploughing on.’” She points out that doctors may also “have a desire to learn something different and want to bring that knowledge back to their practice.”
Sabbaticals can entail anything from taking a course related to medicine, such as a diploma in tropical medicine, to doing research, writing a book, or working abroad doing humanitarian work. Some clinicians opt for an extreme adventure—for example, becoming a medical doctor at a base camp on Everest or a flying doctor in Australia, or offering their clinical skills to benefit a charity. Others choose to step outside the confines of their typical clinical experience by taking courses in acupuncture or neurolinguistic programming.
Taking a sabbatical has traditionally been an option for doctors looking to reinvigorate their career, try something new, or progress in their specialty. For GPs, the ability to take a sabbatical will depend on the individual practice. Some are strongly in favour of sabbaticals, such as Dixon’s practice, where GPs are encouraged to take time out, but other practices may look on sabbaticals less favourably. For consultants, whether or not they can take a sabbatical will depend on the policy at their local trust. The consultant contract states: “A consultant may apply for sabbatical leave in accordance with the employing organisation’s current arrangements. Any proposal for sabbatical leave should be made before the annual appraisal and considered in the annual job plan review (www.nhsemployers.org/SiteCollectionDocuments/Consultant_Contract_V9_Revised_Terms_and_Conditions_300813_bt.pdf).
Despite the potential benefits of sabbaticals, it is not just managers who are creating barriers for those thinking of taking one. Attitudes from colleagues can also deter doctors from doing so. Stokes-Lampard says that, although many GP practices retain an option for partners to take a sabbatical, “having that option and exercising it are two different things as it depends on how colleagues perceive the request.”
She says that, when workload pressures are stretching colleagues to the limit, sabbaticals “are low on the list of priorities and seen as a disruption to the smooth running of a practice—which is a shame given that they can reinvigorate colleagues and widen their experience.”
Beryl De Souza, honorary secretary for the Medical Women’s Federation, says that concerns about finances, family situations, and how a role might change during an absence from the workplace also create barriers for doctors considering a sabbatical.
The ability to take a sabbatical may also vary across specialties. Salter says that specialties that entail close doctor-patient relationships, such as psychiatry, may make clinicians reluctant to take time out from treating individuals. On the other hand, he says, doctors in other specialties may feel more able “to get up and go tomorrow.” Nonetheless, Salter believes a clinician’s choice of specialty “shouldn’t get in the way [of] taking a sabbatical as long as they plan things carefully and do their homework.”
Doctors who take sabbaticals say their experiences have been invaluable in the way they inform their practice. Dixon says that, when he took his first sabbatical in 1993, he was feeling “burnt out and overcome by the suffering I was used to dealing with in surgery.” To help him cope with the rigours of daily practice he took three months’ unpaid time out to analyse the work of complementary practitioners, and wrote a book about his experiences.
Salter also enjoyed the experience of taking an unpaid year’s sabbatical in New Zealand, where he worked in a community outreach team in South Island. He says that, as well as appreciating the skills he learnt from colleagues, he also “had the time of my life.” “The people were friendly and I was working in one of the most beautiful parts of world,” he says.
Those considering taking a sabbatical may assume that their colleagues will be envious of them, but Salter says that many colleagues will be supportive. “People may think this world is plagued by mistrust and envy, but most colleagues think ‘good on you’ and are often inspired to take a sabbatical too,” he says.
In addition, doctors who come back from a sabbatical report that they are inspired and invigorated by their experiences. Dixon says: “People come back with their eyes a bit brighter and more bounce in their stride and they are more amenable and positive about their work.” He describes his sabbatical as an invaluable experience, which he remembers fondly and from which he has never looked back. “In 1993, I was in danger of having a complete burnout,” he says. “I’ve learned so much from it—such as not fitting patients into a typical medical model—so now I really listen to their story. I’m a fan of sabbaticals. Without one I would have become more miserable and ineffective. It saved my career.”
Salter says he gained a great deal from his sabbatical. “I learned the art of saying ‘no’ and about how to delegate, and that there are other ways of being clinically confident in challenging situations,” he says. “I also became more self sufficient. I have held on to the gains I took from that experience, and look back at my time away as the happiest time of my life.”
Sally Davies, a consultant in clinical genetics at Cardiff All Wales Medical Genetics Service, highlights the benefits of having a sabbatical. She says: “For many years my particular interest has been in medical education, which has included my role as the sub dean at the Wales deanery until 2013, and presenting at international conferences, including New Zealand. Between May and August 2013 I went to Auckland University Hospital on a sabbatical to see how things work there and what was similar [to] and different [from] the United Kingdom.
“It was interesting to compare the way the service was run. It was covering a much bigger territory, but the work was similar. Most of my time was spent looking at doctors’ performance and revalidation and discussing how revalidation is being rolled out in the UK. I was invited to New Zealand for my expertise—but I also learned from that experience—for example, I was impressed by doctors’ paper work and electronic portfolios, while I also encouraged a more formalised curriculum and assessment process.
“It was a fantastic experience. I’ve learned from having a sabbatical that it can refresh you, and give you a different perspective on practice. Now I’m back to reality, training consultants about appraisals, but I feel energised and am enjoying my work more than I have for many years. To anyone considering taking a sabbatical, I would say, ‘Don’t hesitate.’ It’s a wonderful opportunity to do something that may be related to your specialty, rather than going on extended annual leave, and it also gives you the opportunity to meet fascinating people and make life-long friends.”
Stokes-Lampard says that any homework before a sabbatical should start with thorough reading of a contract. “Financial arrangements vary from job to job so read your contract carefully, including the small print, to establish what you’re entitled to,” she says. The BMA’s industrial relations department also provides advice about contracts (http://bma.org.uk/practical-support-at-work/contracts).
If you are thinking about taking a sabbatical, you should have a clear plan and be explicit about the benefits the sabbatical will bring you, your department or practice, and the NHS. Having made a plan, it is important that you then talk to your trust or practice partners and medical indemnity organisation. You can also explore funding opportunities—for example, travel scholarships, charities, sponsorship, and fundraising.
Once you have approval for taking a sabbatical, you need to plan for what happens during that period. This may include deciding what will happen to your home in your absence and notifying your insurance company.
The prospect of taking time out from work can be daunting, so it is helpful to plan activities and goals on a monthly basis, such as applying for visas, travel vaccinations, and insurance and arranging for bills to be paid. You may also need to find suitable equipment, such as a medical kit and books, and to hone the skills you’ll need, such as teaching, training, or languages.
For GPs concerned about running the business side of their practice, allowing sufficient time for planning and finding a suitable replacement is a crucial part of taking a sabbatical. Any practicalities about taking on the post should therefore be organised before going on sabbatical, rather than as potential issues arise.
Competing interests: We have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.