Humanities
Sabbaticals: Why Every Physician Needs a “Braindusting”
T. Jock Murray, MD
About the Author
Jock Murray is a former dean of Dalhousie Medical School and professor of medicine (neurology) and founding director of the Dalhousie Multiple Sclerosis Research Unit. He has appointments in medicine, the Division of Medical Education, and medical humanities at Dalhousie University, Halifax, Nova Scotia. Correspondence may be directed to jock.murray@dal.ca.
Sir William Osler said there were three things to maintain a physician’s education - a notebook, a library and a quinquennial braindusting.1 He recognized that the “braindusting,” a period of study and experience away from the dailiness of practice, was the hardest to manage but was essential for “renovation, rehabilitation, rejuvenation, reintegration, resuscitation.” He encouraged practicing physicians to begin saving years ahead for a period away. He thought the rural doctor, John Y. Bassett, who spent a year in Paris, to be a heroic figure for making the sacrifices necessary to improve his knowledge and skill.2
I suspect everyone has pondered, especially when practice is getting hectic, the possibility of a time away from the constant responsibilities, the endless requests, the interruptions, the sea of paper, the multiplying e-mails, the dreary meetings, the sameness of it all. Wouldn’t it be rewarding to take time off to learn something new, take a new direction, experience something totally different?
This was well expressed by Dr. Walter Channing of Boston, who after 40 years of practice, took 1856 as a sabbatical year3:
I was desirest to get out of the harness with a whole ocean between me and work – to feel as free as in my earliest days of conscious liberty, – to go when and where I pleased – to be conscious of an entire new mode of life; of one especially which was not to be daily determined by the variety of professional calls, – the different phases of disease, – to see life, health, and countries in their beauty, power, truth, – and to find everywhere, and in everything, opportunities of varied observation, thought, and pleasure, and to enjoy them. And I did enjoy them all.
Historic Basis of Sabbaticals
A sabbatical (Latin sabbaticus, Greek sabbatikos, Hebrew shabbathon) refers to a period of rest from work, a hiatus. Our understanding of the sabbatical relates to a Jewish concept but may date even further back to the Babylonian festival of “sapattu,” which corresponds to the cycles of the full moon.4 The Jews celebrate the Sabbath as a day of rest and prayer on the seventh day of the week, while Christians have adopted the Sabbath on the first day of the week, and Muslims have Yaum al-Jum’ah (the Day of Assembly) on Fridays.
A number of rules and laws became associated with the Sabbath. In Babylonian times, people were prohibited from eating salted meats cooked over embers, wearing white, changing clothes, offering sacrifices, and making wishes. Physicians were not permitted to touch the sick on these days unless this avoidance would be life threatening. In the Jewish tradition every seventh year, “the land must rest so the poor and wild animals may eat the fruits of the earth” (Ezekiel 23:10, 11). In the sabbatical year, laws also referred to the release of slaves, cancellation of debts, and the sharing of goods, but the longest lasting tradition was the rule to let the land lie fallow every seventh year.3
It seems that the first academic sabbatical was in the late 1880s, negotiated by philologist Charles Lanman as part of the agreement for him to leave Johns Hopkins University for Harvard. By the turn of the twentieth century, 10 American universities had adopted the idea of the sabbatical, and now all universities have a policy regarding sabbaticals, as well as paid and unpaid leave.3
In recent years, sabbaticals have been adopted by individuals and organizations as a way to encourage creativity, learn, or experience something new and to ward off burnout. After a growth period in the 1990s, there has been some decline as physicians have become busier and practices more complicated, and as the business world has undergone cutbacks, downsizing, and layoffs. When the atmosphere was focused on creativity, sabbaticals flourished as an important catalyst to innovation. When the scene changed to time pressures, efficiency, and cost cutting, sabbaticals were regarded as a costly frill. In the current economic downturn, it is likely that fewer will seek or be granted sabbaticals, but I would argue they are even more important in difficult times when people feel more strained and pressured. When an organization cannot bring in new blood, it is even more important to keep people rejuvenated and vibrant.4
In the academic world, a sabbatical is a period of leave after 6 years of employment. Implied are certain concepts: that the person will be paid 80–100% of the usual pay, sometimes supplemented by travel or research grants; that the activity will be beneficial not only to the individual but to the institution; and that the person will return to the institution following the sabbatical and report on the activities. Each institution has differing arrangements, rules, and support, so read the regulations of your organization first and seek discussion of any unanswered questions. In medical practice groups, there can be an arrangement to share income, defer costs and on-call duties, and make other arrangements to permit periods away, usually for months.
Who Should Have a Sabbatical?
Everyone needs a sabbatical. One could argue that the farmer, the single parent, the housewife, the minimum wage worker all need a sabbatical more than the academician or the professional, who have ways to vary their lives. Impractical as it may sound, everyone would benefit from a period away from the predictable routine of work to revise priorities, learn a new skill, or carry out a project, and to redirect the next period of life. Although originally for those in academic life, sabbaticals are now arranged by community physicians, corporate executives, lawyers, writers, musicians, and actors, all seeking to “recharge the batteries.”
Beneficial as this might be, only a small number of people who are allowed sabbaticals take advantage of the opportunity, especially physicians. There are many reasons for this. Some are comfortable staying in fixed settings and responsibilities. Others have difficulty seeing how they could manage the pressures of their finances, mortgage, children’s schooling, added costs, disruption of life, and covering responsibilities to get away for an extended period. The idea of interrupting patient care, teaching, and research projects, arranging for others to cover these responsibilities, taking the kids out of school, renting out the house, disrupting the spouse’s work and life all seems too daunting. And all of this has to be balanced while developing the sabbatical projects with unfamiliar people in unfamiliar places. Many think it is better to stay home and go to work. But those who do go on sabbatical usually say it was the most life-changing event they experienced in their professional lives.
Sabbaticals for Physicians
Community physicians have taken sabbaticals to experience practice and teaching in an academic centre, write a book, volunteer in a developing country, experience a new culture and language, or learn a new skill. There is no limit to the possibilities. Rarely do we hear of a physician lounging on the beach for months. A cynical friend, when he heard I was going on sabbatical, stated, “How do you spell sabbatical? H-o-l-i-d-a-y?” Those who write about their sabbaticals talk not about relaxation but how productive and busy they were.5
No matter what the activity, almost all speak of re-evaluating life and practice and of important family experiences. There has been a lot of discussion of having sabbaticals to reduce the possibility of burnout, but those who take sabbaticals are usually busy, productive, and successful individuals in their current lives. An American study of medical school sabbaticals noted that most found the time away very productive, culturally enriching, and strengthening for family relationships. The small number who found the experience less rewarding had inadequate preplanning, were not very productive prior to sabbatical, and had unrealistic expectations that the time away would result in substantial career change.5
The greatest benefits of a sabbatical come to the physician and the family. A sabbatical is certainly expected to benefit the individual but also the group or institution that supports the period away. In almost all cases this is achieved. The physician can access resources, libraries, and colleagues beyond the experiences available at home. The institutions also benefit from visiting physicians and the positive effect new blood has in a group. The visiting physician brings new ideas and projects and establishes creative collaborations that last long after the sabbatical is over.
Almost all sabbaticals are successful, but they take effort, sacrifice, and cooperation. I believe the major secret of arranging a sabbatical, beyond the decision to do it, is to decide long enough in advance so that there is time to make everything fall in place. Preplanning is the secret to a successful experience. Seldom can someone arrange the complex nature of professional and family lives in less than a year or two, and I would recommend planning at least 2 years in advance.
The impact on the whole department must be assessed. Are there enough professors to take up the slack? Will courses be interrupted or ongoing research disrupted? Normally, it is not a problem because, as Vinet explains, McGill generally assumes, for planning purposes, that one-seventh of its professors are away on sabbaticals or other forms of leave at any given time.
It is always challenging to make arrangements for the aspirations and lives of other family members. Often the spouse has commitments and responsibilities that are equally difficult to suspend. The children have their lives and their friends and often feel more pull from their peer group than the call of far-off lands. I am reminded of the comment of Dr. Samuel Johnson who responded to a man who wished to see the Great Wall of China but felt he could not as he had children. Johnson said: “Sir, (said he) by doing so, you would do what would be of importance in raising your children to eminence. There would be a lustre reflected upon them from your spirit and curiosity. They would be at all times regarded as the children of a man who had gone to view the wall of China. I am serious, Sir.”
During my career I had three 6-month sabbaticals in London and six or seven shorter ones in London and South Carolina to work, research, and write. Janet was always very supportive and did much of the background planning. Our four children initially found it hard to leave their friends and school but were great travellers and adventurers. They now say the sabbaticals were one of the most formative adventures in their lives, and they are now taking sabbaticals with their children.
When times are tough it may be even more important to have sabbaticals available to physicians. When work is more pressured and recruitment is increasingly limited, it is even more important to have opportunities to become renewed, stimulated, and rejuvenated.6
Share Your Experiences
I’m sure many of you have had sabbatical experiences involving creative ways to combine a period of study, exploration, or travel with your busy lives and practice. Write to me about your experiences: Dr. T. Jock Murray, 16 Bobolink St., Halifax, NS, B3M 1W3 jock.murray@dal.ca. In a later issue, we will publish excerpts to help others plan their sabbatical experience.
References
1. Murray TJ. President’s message: Osler’s braindusting. Oslerian 2006;7:1–2.
2. Osler WO. An Alabama Student. London, England: Henry Froude; 1909.
3. Channing W. A physician’s vacation: or, a summer in Europe. Boston: Ticknor and Fields; 1856:87–90.
4. Kimball BA. The origin of the sabbatical and its legacy to the modern sabbatical. J Higher Educ 1978;49:305–15.
5. Jarecky RK, Sandifer MG. Faculty members’ evaluation of sabbaticals. J Med Educ 1986;61:803–7.
6. Murray TJ. Sabbaticals for physicians. Ann R Coll Physicians Surg Can 1987;20:125–8.
Article Citation: Murray J. Sabbaticals: Why every physician needs a "braindusting". Can J Gen Intern Med2009;4(2):75-76 |
