Student loans

How I Spent 17 Months Away from Clinical Practice

In August of 2017, I left a PA position that I had held (and loved) for nearly a decade with no real plan for what came next.

My idea had been to take a few months off before looking for my next role, but those few months blossomed, at first unexpectedly and then very intentionally, into nearly a year and a half.

When, during my time off, I was asked how I did it, it seemed that people were asking me one of two questions: How did I manage to swing it? Or, how was I spending my time?

I'd respond to these questions with something like, "I saved up for it" or "Managing to stay busy."

But, these were overly simplistic responses delivered because I assumed the asker didn't want or have the time to hear the real ones. The real answers were long and convoluted.

How I spent my time changed quite a bit during that period. I passed through phases of sleeping in, working like a maniac, being catatonic, and then, eventually, traveling around national parks from Maine to California and back again with my dog in tow.

How I was able to live with no planned income for that stretch is more strategic.

But the story of how I ever considered doing any of it began with a "why."

The “why” behind my break

In the early part of 2015, my dog, Lulu, was diagnosed with the dog version of ALS - the same gene that causes it in humans is also responsible for the disease in dogs, though it goes by a different name.

Her symptoms were quite subtle, just a very occasional delayed step in a back paw. But, that was enough for me to worry. Within a couple of weeks, she had a neurologist. Within days of her consultation, MRIs and genetic testing confirmed her diagnosis.

The prognosis for a dog of her size was total paralysis within six months, and eventually, her breathing would be compromised.

I considered quitting my job immediately. The two of us could buy a Jeep, drive out west so she could sniff the air and let her ears flap in the wind the entire way, and live out her remaining days having mountain adventures.

Even if you're not a dog person, I promise that if you'd known Lulu, you would have considered the same.

But, I learned that the progression could potentially be slowed with physical therapy. Yes, there are dog physical therapists. Or at least there are in Houston. So I signed her up.

Even though we didn't leave our lives for a new mountain adventure, the willingness I had to do it at that time planted a seed.

I adored my job in Houston. I wanted to be an oncology PA from the start of my career, and I had moved to Texas to work at the top cancer hospital in the country. The plan had been to spend a couple of years there before moving on to the next thing.

But I loved my job and my new life more than I expected. As the years passed, it got harder to leave.

Looking back, it makes perfect sense that the final push I'd need to leave that position came from my situation with Lulu. I wasn't likely to move from the job that I thoroughly enjoyed to a maybe-it-will-be-okay job elsewhere.

Leaving my job without immediately moving on to the next one was a middle ground that I had never considered. It took all of the pressure off of finding a position worth leaving for. Quitting without a concrete plan for what came next seemed like a side step rather than a leap.

This might sound a bit crazy, I know. But as I thought about quitting without having a new job lined up, I started to view it as a real possibility. I didn't need to work continually.

I had paid off my student loans years before. I kept my expenses low and had a few-year headstart on building up my savings. (I'm fully aware of how incredibly fortunate I am to be in this position, and that most people don't have this advantage when making life choices.)

Even with dog neurologists and weekly physical therapy, I could pile up more savings as a cushion for down the line when Lulu needed me around more. I'd quit then.

How I Took a 17-Month Hiatus from My PA CareerlBe a Physician Assistant

She did remarkably well though. Physical therapy helped to keep her functional. Her back legs weakened, but she could still get around. Though I'd obsess over any change, whether perceived or real, she blew right through her expected prognosis date.

Two years passed before I seriously considered leaving my job again. Yes, Lulu was still around.

I attribute her staying power to a combination of physical therapy and the stray puppy, later to be known as Frankie, who I found running in traffic that October and kept her on her toes.

But, Lulu did need more help over that period. When the timing started to feel right, I put in my notice in May of 2017. My last day would be August 4, 2017.

The hiatus

While a stretch of time with no agenda may sound like an unimaginable paradise, it didn't' feel like one - at first. I never expected the adjustment to be so difficult.

In the past, if I had a week off it would feel like I had all the time in the world to unwind and relax. But here I was with zero plans, and I do mean zero plans, and I had the same feeling in the pit of my stomach as I had walking into a clinical day that I knew was overbooked by 40%. All. the. time.

I'm not anxious by nature, but going cold turkey on work made me antsy. And not because I felt purposeless or because I'm a workaholic at heart, I didn't, and I'm not.

I still can't entirely quite explain why I felt apprehensive, but I did. I had all my usual hallmarks of unrecognized stress — right eye twitching, intermittent heart palpitations, and a constant feeling as if I was forgetting something.

It took about two and a half months for me to settle down. When I started to feel back to baseline, I realized that I had been out of work for the equivalent of most maternity leaves. Is that really all the time someone gets? With a baby? I could barely manage myself, two dogs (who were totally on board with sleeping in), and no schedule.

But once I was out of the initial fog of change, I settled into a reasonably productive routine. Within short order, I had four months of blog posts written and in the queue for publication. I was able to do more one-on-one work with aspiring PAs. I stopped mindlessly searching in my bag for a phantom pager that was no longer in my possession.

I did still, on occasion, introduce myself as "Ryanne from M. D. Anderson" when I'd call Comcast. And to this day I haven't yet broken the habit of reaching for a pen in the top pocket of the white coat I'm not wearing.

Though I stopped working as a PA, I didn't stop being a PA. I still had the same knowledge that I had just a few months before. No one took my license or certifications away when I quit.

But, until I stopped working, I never realized how much of my identity was tied up with what I did and where I worked. I was part of something huge for nearly ten years, and then I wasn't.

Perhaps that's where my initial post-work jitters came from, but it was never a connection I made at the time.

Fielding questions about what I was doing next during that time was strange. It's a natural question. People don't usually leave something for nothing. But for me, there wasn't a "next," and that was by design.

We had a routine down, but traveling with Lulu was tough. Moving somewhere else was unimaginable. We had a good set up where we were, and I wasn't about to upend things unnecessarily. Whatever came next would mean that Lu was gone, so I was perfectly content to live in the present.

I thought I had timed leaving my job perfectly — I'd be around for Lulu's final few months and then Frankie and I would make plans for the future. But my quitting was the start of Lu's resurgence.

Turns out, having someone around to give you multiple massages and continual head scratches throughout the day slows down the progression of dog-ALS. Or so Lulu would have you believe.

She lived for nearly eight more months after I left my job, a full three years from her diagnosis. It was unheard of for a dog of her size. And even though I was fully aware that it was coming all of that time, I was crushed when she died.

I can't imagine how I would have gone back to work within even a few weeks if I had still been working. I know I'm lucky not to have had to find out and admire those who somehow pull off being operational even when they're going through deep grief.

But it was March, which meant that the CASPA cycle was approaching. In the few weeks that followed, my client list grew exponentially. I was busier than I had ever been reviewing application essays and coaching prospective PAs.

Pulling myself together for a couple of hours a day to do the work was manageable. Between editing essays and chatting with applicants, Frankie and I went on long walks. He was happy outside but moped when we got back home.

As this pattern continued, I began to believe it was because Frankie noticed Lulu being gone more when we were at home than when we were out. I didn't want to leave Frankie all alone, and I wasn't ready to go back to work yet anyway. But we didn't have to stay in Houston.

So, what if we just put everything in storage and took our walks to some national parks? Frankie could be outside and in new places where he might be happier, and I could work on essays and make calls from anywhere.

My coaching work had become so busy that I stopped offering essay-only services by May. I didn't know it at the time, but I'd spend most of the summer working through applications, essays, and, a bit further down the road, supplemental applications for the clients I had already taken on.

Frankie and I moved out of Houston in mid-June and started our North American Summer Tour, as I liked to call it, at Acadia National Park in Maine. We made our way through the Northeast, down through Philly and DC, to Asheville, through the Smoky Mountains, back through Texas, the Southwest, the West Coast, Pacific Northwest, Idaho, Montana, Salt Lake City, back through Texas, saw some cool caverns in Kentucky, then back to Pennsylvania in late September to hang out with my family.

Along the way, technology enabled me to talk to future PAs from what I believe was a child's playhouse/Airbnb in remote Vermont to the side of Route 66 when my phone overheated as we made our way through Amarillo to what I can only describe as an urban jungle with a terrible Wifi connection in Portland, Oregon.

About a month in, I realized that my coaching business had become so busy that I couldn't work as a PA for probably another six months to have enough availability to serve the clients I had committed to. Though I had been consistently taking on new clients for a few years, a new fever pitch was reached in the Spring of 2018. If I ever hoped to get back to practice as a PA, I had to be more intentional with the services I offered and how I offered them.

Once I learned how to balance my workload a bit better and could imagine a future that allowed for both clinical practice and coaching, I started looking for my next clinical position.

My search

Here's the funny thing that happened after having a year away from clinical work: I considered non-oncology jobs for the first time.

Each major step of how my work hiatus unfolded is steeped in me seeing new possibilities.

Years ago, I couldn't imagine my finances not being burdened by student loan debt. Then, once I understood the real potential for paying them off quickly and followed through, it opened up opportunities would have never before seemed possible.

Changing my money habits made it conceivable for me even to consider quitting my job when Lulu got sick. Once that idea was in my head, I saw taking a break from work as a real option.

Only after we didn't have to live in Houston any more did I realize that living nowhere was on the table.

Only after I was on my work hiatus could I understand what being "unattached" to an institution and job I so deeply identified with could feel like. And once I did, I was open to examining what was most important to me in the next PA role I took.

These shifts are quite easy to see from the outside. Everyone knows that PAs can switch specialties.

But to shift your perspective to consider alternative options as real possibilities for yourself is something different.

And while not magical new ideas, to me, each one of these realizations felt like an epiphany.

When it came to looking for a new job, my approach had changed entirely from what it would have been had I searched for a new position while still employed. Not having to choose to leave one job for another gave me clarity that I'm not sure I could have had otherwise.

Again, I realize that this is a crazy privilege to have. Not everyone can quit their job, zen out, and then go on a job hunt in a new state of mind. Shifting perspective doesn't require that you leave your job and go on an epic summer road trip, but it worked for me.

So, my priorities in my job hunt were, in order:

  1. Challenging enough that I couldn't have done it 8-10 years ago

  2. Non-Monday-Friday 8-5 schedule (so Be a PA can co-exist)

  3. Working closely with a team

  4. Treating medically complex patients

  5. Oncology

Between the days of driving through deserts and hiking in the mountains, I kept my eyes out for jobs. When you're the Goldilocks of job hunting, it takes a while.

After carefully watching job boards for months, I found a position that hit the first 4 of my five priorities in early September, interviewed in October, and started in February. Because that's how long it takes to get licensed and credentialled in a new state!

And also because I had to unearth all of my stuff from that storage locker in Texas and have it hauled to the Northeast.

So far, I'm quite happy with the position I chose, and I'll be sharing more about it in the months ahead.

Frankie, on the other hand, is holding my return to work against me every morning when I leave and forgiving me every evening when I walk back through the door. But don't worry too much about him.

Now that I have some practice with seeing unconventional possibilities as real choices, I expect that there'll be another work hiatus and grand traveling adventure in our future.