A successful sabbatical can take years of planning

Erica Weirich, MD, a family physician in Los Altos, Calif., recently returned from a two-month sabbatical, during which she traveled to Bhutan in Asia to study the Himalayan country's health care system.

The trip was more than educational and personally fulfilling. Dr. Weirich calls it a definite retention device, a way the Palo Alto (Calif.) Medical Foundation has rewarded her loyalty over the last 7½ years.

"Could I ever have imagined this much flexibility in my work life? No. It's been great. I will definitely look at taking more in the future," she said.

Physicians and medical groups offering sabbaticals say the incentive has a positive effect on them both, as physicians burned out from their long hours usually return revitalized and happy. And satisfied physicians equate to better quality care, they say.

Of course, taking a sabbatical is a luxury that not every physician -- or practice -- can afford. Coverage has to be arranged, often a locum tenens that will come at an extra cost to the practice. The doctor who leaves on sabbatical has to be ready to give up all practice income during the time he or she is gone. A practice also could risk losing patients who decide to see another physician or group during the doctor's absence, and then decide never to return.

Still, it is something some physicians and practices find worth the time and expense. Practice experts, as well as doctors who have taken sabbaticals and practices who have offered them, say the key to a successful sabbatical for all partners is years of planning, down to details such as what your family will do and how you'll let patients know what you're planning.

Timothy Gilmore, MD, an occupational health specialist for Group Health in Seattle, is about to embark on his second sabbatical. He plans to spend one year traveling and relaxing, and teaching a class to medical students in New Zealand. Dr. Gilmore says it takes time to plan a successful sabbatical.

"Decide what you want to do during the time off and negotiate with your family about two to three years before leaving," he said, noting they might have their own ideas on how to spend the time. About a year and a half before leaving, line up your replacement, he said.

Dr. Weirich said it also can take years to make the arrangements for a sabbatical even if you're sure where you're going and what you'll do. She said it took two to three years of fighting red tape in Bhutan before she got approval to enter the country.

Other considerations

At a smaller or solo practice, a year-long sabbatical isn't completely out of the question -- but it clearly would be much more difficult to pull off. "It could work for a month or two, but not a year. It could be a big load for the other doctors to bear," said Michael Adams, MD, a family physician in solo practice in Marion, Ill. He hasn't taken a sabbatical. He said it's hard enough to swing a week off for a simple vacation.

Generally, a physician in any size practice has to take the following factors into account before embarking on a sabbatical:

• Eligibility. Each medical group establishes its own guidelines on when a physician is eligible to take a sabbatical. At Palo Alto Medical Foundation, after two years of continuous service, physicians are able to take two months off for every four years worked, said Terrigal Burn, MD, internist and chair of the group's board of directors. At a smaller group where policies are less formal, and a physician's absence is more immediately felt, experts advise talking with partner physicians about their level of support before taking even the first steps on booking a sabbatical.
• Coordination of care. No matter how long the sabbatical, arrangements to cover the absent physician's patients will need to be made. The American Academy of Family Physicians says it's up to the practice whether it wants to hire a locum tenens, or have the other doctors pick up the slack. For a solo doctor, the choice is a locum tenens, or risk losing your patients by referring them to other physicians while you're gone.
• Compensation. Some groups provide a sliding-scale salary during a sabbatical; others, like Palo Alto, give physicians their full salary and benefits during the time off. A small practice needs to do the numbers to figure out whether it can afford to pay a physician during a sabbatical, or determine other means to adjust compensation models for all doctors while one is gone.
• Permitted activity. Most groups allow physicians to do whatever they want -- whether it be taking an extended trip, furthering their education or volunteering in a faraway place. Experts recommend that when a doctor has the first conversation about a sabbatical with his or her partners, the length of the sabbatical and what the physician will do during it should be worked out up front.
• Emergency recall. Some medical practices, especially small ones, may need to recall a physician on sabbatical if another group member dies, becomes disabled or quits during the leave. Check the wording in your contract to see if that is the case in your group. If yours is a small group, be sure that that issue is covered in writing before the sabbatical.