Questioning Myself

I started writing this post about a month ago when I was entering the final month of my year-long journey in Mekelle. I was having issues with setting up work in the states. Frustrated and annoyed, I partially wrote this post and am now finishing it today.

As many of you know, when I first started planning to work abroad many of my mentors and friends warned that this ambition would be risky for my career. Of course, I listened to their advice but if I didn’t do this, perhaps the internal regret would more of a risk. When I returned to the states for a meeting recently, of course there were still people with that same thought, but it seemed like doors were opening in every direction. So, I decided to take a risk and wait for the perfect job, talk to as many people as possible and to chase what I thought would be perfect for me. It makes me nervous to do this, but for the first time in my United States career, I am doing what I want to do.

While waiting for the perfect job to surface, I need to earn USD. In Ethiopia I’m paid in the local currency which is essentially impossible to change over to USD. At least in any amount worth doing so. Thus, what made the most sense was to do Locums. A type of profession that allows you to be placed in an area of need for as much time as you are willing to give. Local hospitals in need hire various Locums companies to headhunt for doctors. In return, these companies arrange everything for the doctor including housing and a medical license for that state, for example.

After searching for a couple months, I settled with Comphealth which established a rotation for me in Maine and New Mexico over a 4 month period. This allowed me to make USD, pay off loans and visit some beautiful places in the states while providing care. Perfect.

Fast forward 3 months of daily calls, endless paperwork and organization of a 72 hour trip to the states for fingerprinting, I was all set to begin work at the end of July. But, one week before my trip to the states, the company calls to tell me that they refuse to credential me and that the jobs they had promised, were off the table. In other words, I’m now unemployed.

Doctors need to be credentialed in order to perform procedures. Thus, they need to verify that I can do what I say I do. There’s no objective way to do this. They use logs from our residency and fellowship to show the number of cases we’ve done in the past and call my former teachers to ask them if I’m competent.

It’s kind of a joke to me because it’s such a soft way to verify training. Other than the word of my mentors, there’s absolutely no way to verify that I actually know what I’m doing. This is a problem in all American surgery. Scary, isn’t it?

A version of this issue surfaced on the recent popular podcast “Dr. Death,” which told of a United States trained neurosurgeon that, in his first year of private work, permanently injured more than 2/3rds of his patients and killed 2 of them. He was able to jump from hospital to hospital and obtain credentialing despite his former hospitals being fully aware of his danger. This occurred for two main reasons: 1. Hospitals are fearful of litigation from a wrongful firing case and 2. There is no good way to objectively evaluate a surgeon’s skill before hiring them. That’s what the credentialing process is supposed to do, but there are so many holes.

I think I’m a pretty good and safe surgeon but the problem lies in the fact that I haven’t performed any surgeries in the United States for over a year. And, although my cases here in Ethiopia require exponentially more intuition and ingenuity to be successful, cases I’ve completed here do not count towards my credentialing process (because there is no way to confirm their validity). I get it, but it’s completely unfair.

Thus, I can’t be credentialed  and I am unemployed for the first time in my life. Odd statement to put down on paper.

I could be upset about this (and I certainly was), but I made this bed for myself and I’m prepared to keep it. My options are many and it’s entertaining to flip through the options while I wait for my ideal job to materialize:

  1. Remain in Ethiopia: I could easily do this. All the infrastructure is already set up for me. But here are the two big issues:
    1. I strongly feel that in order for this residency that we created together to become fully sustainable, it needs to fail in free-fall. In other words, they need to fly solo without me and undoubtedly some things will fall apart. Time away would help me analyze when needs to changed to increase the likelihood of sustainability. I have to leave.
    2. Secondly, I’m stressed. The millions of factors I can’t control eat at me and I need a change. At times I can feel my attention to detail slip for this reason and I think that distancing myself for a short period of time will make me a stronger clinician when I return.
  2. Try to find a different temporary job. This might work with another locums company who doesn’t have the crazy 12-month rule or a local hospital willing to hire me short time, but either way, it will take time and money. I want to be back in Ethiopia in the winter, so this may not work. I’ve got something cooking on this, but its not 100% confirmed yet.
  3. Focus on my academic side my previous year and future. Countless papers could be written and my aspirations to design a global fellowship in ENT have yet to formalize. 3-4 months of downtime in the US could be very productive for me. Maybe I could become a bartender to make enough for rent… similar to a surgeon, right?
    1. The problem with this is that since I started residency 7 years ago, I haven’t gone more than 2 weeks without performing a surgery. I strongly feel that one of the keys to a good surgeon is habitual practice. Plus, I might go crazy not operating.

With those options in mind, I’m sure I’ll take full advantage of this upcoming 4-month period.

I’m writing this today as a way to organize and formalize my thoughts. This blog has always been therapeutic for me. So thank you all for listening.

And hey, if there’s anyone out there in the blog world that knows of a job for me from August through December, you know how to contact me 😊.

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