We owe it to ourselves and to our patients to take time out when we need to
As I near the end of a one year career break, it has become clear to me that this opportunity to temporarily step aside from medicine has been hidden away as though it’s a closely guarded secret. It is something to which we are all entitled, yet many doctors may be unaware of the option. It is time to acknowledge what a break can offer, because as individuals and as a profession we could immeasurably benefit from one somewhere along the lengthy and intense vocational career path that we surrender ourselves to.
Not everyone will want to consider an extended break. But access to one is still rather camouflaged: both by the lack of awareness (no establishment is likely to promote extended leave) and information (I had no prior knowledge of where this policy resided).
As doctors, we are inherently highly committed to our responsibilities, but this can present another barrier to career breaks. In an already pressurised system (the recurrent winter crisis being one recent example of how demanding an environment it can be) the expectations placed upon us, and those we place upon ourselves, can prevent us from feeling that we have earned the “right” to take time out, despite what we put into our jobs on a daily basis. Regardless of specialty, our duty of care is at our core: duty to our patients, our teams, our vocation, and to carrying out our obligations. But it can seem like a never ending continuum as we ensconce ourselves in this duty.
Ours isn’t a “normal” job, and perhaps the standardised leave structure isn’t enough in medicine. Even after a brutal 14 month battle with cancer 12 years ago (my first, and involuntary, “career break”), I didn’t give myself permission to pause. My dedication and sense of obligation to my work competed with my own needs. In the end, my current career break was only catalysed by my husband’s work taking him abroad—an experience that has positively changed my perspective on many levels, and in ways quite different to how my illness did.
Some may say that there aren’t enough of us already, and that extended absences could place further staffing pressures on the NHS. But keeping up the pace indefinitely isn’t sustainable either and, inevitably, this takes a physical and emotional toll on doctors. While we can’t easily reverse the greater troubles that our NHS is facing, we can try to address the burnout, ill health, resentment, and voluntary departure of doctors that is widely reported as rife right now. Reports of deteriorating mental health and the tragic suicides within our profession cannot be ignored either and must be addressed.
Life and work will always be each other’s constant nemesis, and as doctors we are good at putting ourselves last. Being a doctor can indeed be bad for our health, and self-neglect is high. We don’t often manage to drink enough, eat enough, or even pee enough in a given day. We often surrender our own wellbeing to preserve the health and wellbeing of others—our occupational paradox—but the effects can be cumulative, and ultimately this just isn’t okay for us or, vitally, our patients.
Maternity leave is the most recognised and well established example of taking a voluntary set period of time off from work: a tidy policy with its measured time off, structured payments, and return to work schemes (keeping in touch (KIT) days). As teams we support and reorganise in order to accommodate this temporary absence, and we have time to plan for it. This approach could easily be mirrored for voluntary career breaks, and could even be facilitated by being organised on a rotational basis.
Far from employers, teams, and trusts fearing career breaks, they should support them and recognise that all parties can reap the rewards from doctors restoring their motivation and energy, and by retaining good physical and mental health among staff. Career breaks may even improve the retention of our workforce and, if made more accessible, doctors may feel more supported and reassured in the knowledge that there is the option of a timeout along the endless tunnel of their high intensity working lives. And surely, planned absence is better than unplanned.
We, as individuals, have a responsibility to be aware of when burnout may be compromising our performance and to act on it. Perhaps the recent crop of junior doctors, who have reportedly been more likely to take career breaks than previous years, have recognised this and have better awareness now than many of us before them of how to better preserve a healthier longevity in their careers.
Naturally, there are several things to consider, and taking a break will be a personal choice, including deciding how long it will be. There will obviously be potential implications for earnings, pensions, continuity of care, workplace status, confidence, retention of skills, and revalidation, and a smooth return to work is prudent. Yet continual work in this profession can have bigger personal and physical sacrifices than these. With good planning and well structured policies, supportive teams and trusts can positively assist in easing the process, and I’m hugely grateful to mine.
Many doctors’ personal accounts reveal the benefits of a career break and the advantages for me have been far reaching. I have embraced the privileged freedom to recharge, reflect, realign, and rebalance—things often missing in our busy vocational careers. I have refocused my priorities and my personal and professional aspirations, and I have had more time to nourish my health in the way that it deserves. The experience has been positively restorative and transformative, and I have regained a renewed energy and motivation to return to work.
This requirement for space doesn’t necessarily happen only once in a career or after a significant life event—it may be needed more than once, and by all of us, and previous absence for reasons such as maternity leave or illness should not be exclusions. Even short extended breaks can bring about positive reflection and change. It is optional, but perhaps it should be prescribed.
We work for a large part of our life, and should be looking to extend the quality of both. We owe it to ourselves and to our patients to take time out when we need to. And I know I will return a better doctor for it.
Samantha Anthony has trained in surgery and general practice, and now works in dermatology as an associate specialist at West Hertfordshire Hospitals NHS Trust, primarily in a surgical role. She will be using the hashtag #PermittedToPause as a platform to share ways of making small positive changes to promote doctors’ wellbeing.
Competing interests: None declared.