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Palliative care physician and certified physician development coach Christie Mulholland discusses her article “Why every physician needs a sabbatical (and how to take one).” Christie reveals the harsh reality that while sabbaticals exist on paper, unwritten rules often prevent doctors from accessing this critical recovery tool until it is too late. She shares her personal journey of taking an unsanctioned, unpaid break to combat burnout and how that decision allowed her to return to medicine with renewed purpose. The conversation explores why elite athletes and tech companies prioritize strategic rest while health care treats it as a luxury, offering practical steps for financial planning and reentry. Discover how stepping away from the grind might actually be the only way to stay in the profession you love.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Christie Mulholland, palliative care physician and certified physician development coach. Today’s KevinMD article is “Why every physician needs a sabbatical and how to take one.” Christie, welcome back to the show.

Christie Mulholland: Thanks for having me back.

Kevin Pho: All right, so tell us what led you to write about this particular article, and then tell us about the article itself.

Christie Mulholland: Well, Kevin, have you been watching The Pitt on HBO Max?

Kevin Pho: I would love to. I have heard only great things about it, but actually don’t subscribe to HBO Max.

Christie Mulholland: Oh, well if you ever do, I highly recommend binging it. Health care workers love The Pitt. I think when we watch it, we recognize ourselves in the characters. We feel seen and we recognize the situations that they are dealing with in this emergency department where all of the societal problems come through the doors of this ER.

So when I saw that the beginning of season two of The Pitt opens up with the main character, Noah Wyle’s character Dr. Robby, being there for his last shift before he leaves for a three-month sabbatical, I was really excited. It tells me something about the cultural conversation that is happening right now among our medical world. Season one of The Pitt was really a lot about how resilient these doctors were and how they always found a way to take care of their patients no matter the obstacles. Some of them were even doing that until they broke or broke down, including Dr. Robby. He did have a little bit of a breakdown at the end of season one. So when I saw that he had made this decision to take some time off, it tells me that this is a conversation that perhaps we are a little more open to.

Kevin Pho: So how common is it for practicing physicians to take sabbaticals?

Christie Mulholland: It is pretty rare to think of a physician that actually takes the standard sabbatical. This is what you think of where the medical school dean authorizes three months or six months or a whole year to go away and then just come back to your job. This is something that I think seems to be a standard across academic medicine where there might be a sabbatical policy on paper somewhere. But in practice, it is very rarely authorized and it is rarely used.

Actually, there is a survey from the American Journal of Medicine from 2021. They interviewed associate deans at a bunch of medical schools, and I think they talked to a thousand physician sample. Only 51 percent of those medical schools had any faculty at all that took a sabbatical. Among the schools that did have faculty taking a sabbatical, the median number was three faculty. Who were these physicians? They actually tended to be more senior white male PhD researchers rather than medical doctors doing clinical work. So it is quite rare. I will say though that I do think there are a lot of doctors that find a way to take some time off perhaps by leaving one job and then waiting a little while until starting the next job. But the actual official sabbatical that is authorized is quite rare.

Kevin Pho: So my impression of a sabbatical was that someone would take one in order to do a research project and something like that. So from a clinical standpoint, what are some reasons why clinical physicians may take sabbaticals?

Christie Mulholland: Yeah, usually it is something like that. It is to go and do some specialized research in a lab and come back and bring back a product that is of benefit to the medical school. So the medical school is happy to authorize that. That is the most common reason. I think that some of the personal reasons why physicians might step away or sort of create their own sabbatical are perhaps to consider making some kind of a career pivot. Maybe they are interested in going into private practice. Maybe it is just to take some personal time to attend to family situations at home like an illness or caregiving responsibilities.

Kevin Pho: In your KevinMD article, you talk about your own experience requesting a sabbatical. So tell us about that.

Christie Mulholland: So about a year ago I had reached a point in my career where I was performing well. I was hitting all of my metrics. At the same time, I was getting a little crispy around the edges. I felt pretty irritable and disillusioned with some of the circumstances I would see every day at work. It was to a point where other people around me were starting to notice. I really felt that I could use a break to just reenergize and recharge.

When I asked for a sabbatical, it wasn’t approved. They were kind of like: “Come back in 10 years when you’re a full professor and then we can talk.” So it was kind of a snarky comment. Maybe it wasn’t made in such a snarky way, but that was what I left with. The response was really just that this isn’t a thing that is done. That was data for me. But I didn’t stop there. I didn’t let the conversation end there. I decided that this was an important thing for me to do. So I continued working to find a way to make it happen for myself.

Kevin Pho: So what kind of things did you do to try and achieve that sabbatical?

Christie Mulholland: Some things were easy and some things were really hard. There were some big trade-offs that I needed to make. So the first part of that was getting clear on which trade-offs I was willing to make for myself and my own life. The biggest one was that I actually needed to resign my full-time position in order to step away for three months and then come back to the same institution where I now work part-time. Finding the allies at my institution who were willing to make that work with me and go outside of the box and come up with this arrangement required a lot of intentional work. It isn’t a standard arrangement that a lot of people have. It involved finding some areas of common ground where I could provide value to my employer and an arrangement that everyone could live with.

Kevin Pho: Now, what does that say about our current medical culture, the fact that you really had to go through a lot of obstacles and it seems like to me a lot of friction in order for you to get the sabbatical that you wanted? What does that say about our current medical culture and the potential resistance to other clinical physicians who want that same thing?

Christie Mulholland: I think what it says about our culture is something that people aren’t going to be surprised by. There is a mentality that you are all in medicine or you are out and you are not serious about medicine. I think that it is shortsighted. That is an aspect of it that I would love to see change because I do think that in the long term, if health care is able to find a way to let these high-performing physicians take a break when they need one and then come back, it ends up saving a lot of hassle and a lot of expense. If that same doctor can’t get a sabbatical where they work, they end up leaving and going and working somewhere else. Well, that means that the institution is going to need to recruit somebody new, onboard them, and train them. We know that that is very expensive.

Kevin Pho: So, if a clinical physician is listening to us today and thinking of maybe taking a sabbatical, a break, or a leave of absence, what are some things that they need to think about before proceeding?

Christie Mulholland: So I would invite everyone to read the article where there is a detailed breakdown. I will give an overview here of the four main steps that any physician can take.

The first one is your financial planning. You are going to need a runway in order to be able to afford this sabbatical. I argue that financial planning should start earlier and start well before you need that break. Because when you get to the point where you need it, if you haven’t planned for it, then it is not going to happen. One simple thing that any physician can do if you think you might ever want to take a sabbatical is just open a savings account and give it a name and call it “Sabbatical Fund.” Start putting in a little bit at a time. If you are just starting out and you are a junior doctor, maybe you can put in 10 dollars a day and then as you go, you can accelerate that. So that is step one, financial planning for the sabbatical.

Step two is design your sabbatical. Give it some purpose. If you don’t have any North Stars regarding your main priorities for your sabbatical, you are going to risk just having a long, anxious vacation where you are waking up every day and questioning what you are doing. For my sabbatical, for instance, my three North Stars were clear. Number one was family. I got married during my sabbatical. I became a dog mom. I took some time in Hawaii. I wanted to reconnect with nature. I live in New York City, so I spent a month in the Catskills in a cabin just reconnecting with nature. My third priority was launching my coaching business. So giving your sabbatical some structure is step two of preparing.

Step three is to think about your reentry plan. How are you going to go back to working and earning income again? Are you able to go back to your same employer? Have those conversations and negotiations, and find those allies that are willing to work with you. If that is not possible, determine when you are going to start networking and looking around for your next job.

Then the last step, step four of the process, is making sure you have a support system. Going rogue and doing a DIY sabbatical can be very vulnerable. So you need people who believe in you and want to help you make this happen. Talk to your family. Find other doctors who have taken some time off. If you start asking intentionally, you will find them. If it is not doctors, find other communities of professionals that believe in taking sabbaticals. “Mini-retirements” is another word for sabbaticals. There is this great podcast called Retire Often where different guests go on and they talk about their own sabbaticals.

Kevin Pho: Now as you reflect on your own sabbatical, it doesn’t sound like at your academic institution there was a lot of support, and we talked about the culture of medicine. Tell us about the support system that you had during your own sabbatical journey.

Christie Mulholland: Well, to talk about my workplace, when it first came up there really was a lot of friction like you said. Then as time went on and it became clear to the people that I worked with and my bosses that I was going to find a way to make the sabbatical happen, it is almost like their position changed on that. They became more supportive when they saw how important it was to me that I was going to persist.

Of course with my family, my husband and I had a lot of conversations. I realized that I had this fear that if I stopped being a doctor even for a little while that my own husband would see me differently. He had only known me as this palliative care doctor who worked at a prestigious institution. So having lots of conversations with him where I could really feel his belief in me was important. He told me that he was more afraid that I would go on being unhappy than he was afraid about me taking a risk in my career. The more I got into the planning, the more I shared my experience with other friends and other colleagues in medicine. I think that when they could hear my own belief in myself, their support only grew.

Kevin Pho: Should physicians worry if they take some time off from their employment that they eventually may be replaced? As you know, there is a business mentality when it comes to administration and I think increasingly physicians are viewed as being easily replaceable. Should physicians worry about that if they take extended time off?

Christie Mulholland: It is a worry, and I would not dismiss that worry. It might be one of the very difficult trade-offs that physicians need to make when they make this choice. On the other hand, if you work somewhere that considers you to be easily replaceable, then what does that say about that environment for you to work there for your whole career? It is a big world out there. We need doctors and we are facing doctor shortages in the future as practicing health care in the U.S. continues to get more complicated and dysfunctional.

So, I would say interrogate that fear that you are easily replaced and you will never find a job again. In coaching, there is this great concept called a limiting belief. A limiting belief is a false belief and it is often a negative belief. It can hold us back from pursuing something that we want or taking a risk or reaching our full potential. Limiting beliefs often come from past experiences we have had or stories that we have been told. Maybe it is a story that was told to us as a small child by our parent that we just never outgrew. Or I think a lot of limiting beliefs are ingrained in us in our medical training.

Examples of these things are: “I am going to destroy my career if I take a sabbatical,” or “I can’t afford a sabbatical.” Because we hold these beliefs so close to our hearts, we can’t always interrogate them alone. This is where working with a coach or a mentor or a therapist helps. Having that outside point of view to just ask you revealing questions about the stories that you are telling yourself allows you to see if you can develop insight about what is true in your life versus what is a story you are telling yourself that limits you unnecessarily.

Kevin Pho: Now, as you again reflect on your own sabbatical journey, is there anything that you would have done differently if you had to do it again?

Christie Mulholland: Kevin, I really wish that I would have done it sooner. I wish that I would have done it before I was getting crispy or irritable because I would have been able to have hard conversations at work much more gracefully. I would have been able to speak about taking a break as something that would be really positive for me. The way that it played out was a little more like I felt badly, things weren’t great with my current situation, and I needed a way out for a little while. So I wish that I would have had more foresight to start planning it in a more intentional way sooner.

Kevin Pho: We are talking to Christie Mulholland, palliative care physician and physician development coach. Today’s KevinMD article is “Why every physician needs a sabbatical and how to take one.” Christie, as always, we will end with take-home messages that you want to leave with the KevinMD audience.

Christie Mulholland: So if you are out there and you are even thinking about taking a sabbatical but you are worried that it is just not possible, I challenge you to do a lot of reflection. Are you limiting yourself and holding yourself back? Sabbaticals currently do not exist as a standard in practice in the medical system, and I hope that will change someday. But in the meantime, you have more power than you think to start intentionally planning your own sabbatical because you don’t need someone else’s permission to take care of yourself.

Kevin Pho: Christie, as always, thank you so much for sharing your story, time, and insight. Thanks again for coming back on the show.

Christie Mulholland: Thanks. It was a pleasure being here.