You’ve finished your specialty training and you’re looking for opportunities to work overseas. Great. You know how to run a code and diagnose a pneumonia. Fantastic.

Now the work begins.

International medicine is such a broad field that whenever I am approached by a physician who wants to work overseas I always ask them to tell me a little about their overall goals. Do you want to make international medicine a career pursuit? Is your goal to work short-term in a variety of locations while holding a full-time position back home? Where do you see yourself in 5-10 years?

It’s true that life has a way of rerouting even our best-laid plans, but it’s always better to have some sort of plan before embarking on a new career pursuit. For those that don’t really know where to begin, I recommend the following:

1. Just get some experience

You can’t go wrong just getting a few short trips under your belt. Whether you want to simply dabble in international health as a side career or begin to build a full-time career as an international medicine specialist with hopes of leading a non-governmental organization (NGO) or academic research group, the place to start is with a few short volunteer trips. No NGO or credible organization is going to actually pay you to do international health if you’ve never worked “in the field.” If you ask any seasoned person in international medicine, they always say time in the field is one of the biggest criteria they have for important hires. You might be brilliant. You might have great “people skills.” You might have incredible letters of recommendation, but if you’ve never packed your bags and lived in a remote place for a time providing medical care, then you’re basically an untested commodity. No credible organization will take a chance on an untested person and place them in a position of responsibility if they can avoid it. If you want to make international health a part of your life, you need to get some experience.

Where do you go to get experience? Well, there are two easy places to begin.

First, visit your local faith centers or nonprofits and see if there are any positions available for volunteer physicians overseas. In today’s world, you’d be surprised how many local religious organizations and nonprofits are sending people to obscure places and would absolutely love to have a physician come along (especially if the physician is paying their own way—and you need to be prepared to pay your own way in the beginning). This is a great way to practice preparing for a trip, evaluating the medical gear you will and will not need, working with others (not a physician strong suit typically), and working in an unfamiliar environment. Many individuals who go on to formal international medicine careers begin as volunteers in positions just like this.

Second, there are multiple locum tenens companies who are placing more and more physicians in foreign environments. Obviously, working in a fully staffed hospital in Australia is much different than working in a remote clinic like the Everest Base Camp ER, but you have to start somewhere and using a locums company like Global Medical Staffing to get your initial experience internationally can be a good place to start.

2. Network

I’m not a fan of joining organizations simply for the sake of joining. However, there is a lot to be said for joining a couple of organizations in the beginning and attending a few medical conferences designed for international medicine, especially if you don’t have a lot of connections in these fields already.

In the United States, the three organizations that seem to most help individuals looking for opportunities in international medicine are (in no particular order) the Wilderness Medical Society (WMS), the International Society of Travel Medicine (ISTM), and The American Society of Tropical Medicine and Hygiene (ASTMH). All of these organizations offer medical conferences where you can meet potential mentors and network with other event participants. In addition to these organizations, there are a couple of private conferences that always garner great participant reviews. The first is our ExpedMed events (yes, I direct these events and I am biased, but we do get great reviews and we draw top talent from the WMS, ISTM, and ASTMH, as well as many academic institutions, as speakers each year). Information on ExpedMed can be found at www.ExpedMed.org . The other private group that always receives great reviews are the folks at www.Wilderness-Medicine.com . Yes, I guess the reality is that these guys are really competitors of ExpedMed, but we use some of the same faculty and we consider them friends, so I don’t have a problem recommending them.

I’m sure there are plenty of other great organizations and events that I could mention here, but these are the ones I hear about the most and the ones with which I have personal experience. If you need a good place to start, I’d begin with one of these entities.

3. Read

It goes without saying that if you’re interested in a career in international medicine you should be reading about the subject. There are some great journals and textbooks out there, including our Expedition & Wilderness Medicine textbook, but don’t just stop there. Read blogs about international medicine. Get some adventure stories that are non-medical but involve international health in some fashion (Shackleton’s adventure for instance or Teddy Roosevelt’s River of Doubt journey). Use these resources to not only stimulate your desire to travel but also to learn the history of the field you’re entering. Oh, and when you read the academic work, don’t just read for clinical knowledge, read to see who the authors are and where they’re working. Look through the bibliography and see who is cited and where the research is taking place. You never know where this sort of “sleuthing” might take you or what connections you might make.

4. Investigate formal training opportunities

I say "investigate" because depending on your career goals you may or may not need/want formal training. However, it's worth looking into since there are some great programs to teach things like tropical medicine or public health in disaster situations.

For Emergency Medicine specialists, formal fellowships in International Emergency Medicine are available around the country. I completed one of these programs at Johns Hopkins in 2004, and really enjoyed the experience. I wrote a prior post on the subject of International Emergency Medicine and for EM docs looking to move into the world of international medicine in a formal way, a fellowship is a great way to jump-start the process.

If tropical medicine is your thing, there are some excellent 3-4 month courses around the world that offer intensive tropical medicine education. The two most famous are the Gorgas Course in Lima, Peru, and the course at the London School of Hygiene & Tropical Medicine. I have friends who have graduated from and teach at these events and both are widely respected. You can check out a prior post here on Freelance MD that serves as an introduction to these courses.

The Health Emergencies in Large Populations (HELP) course is a great way to get exposure to handling public health issues after disasters (more information on this course can be found here ), and for those who really want to go deep, a Masters degree in Public Health from a university with an international focus like Hopkins or Harvard, will significantly broaden your view while deepening your understanding of international public health issues.

These tips should get you going and when you have some experience under your belt and some colleagues in the field to call, you’ll be surprised at the opportunities that begin presenting themselves.

Jeff Barson

December 14, 2011

Expedition Medicine, Wilderness Medicine

The ExpedMed Textbook: Expedition & WIlderness Medicine

Jeff Barson

December 14, 2011

Expedition Medicine, Wilderness Medicine

For those of you who are interested in learning more about Expedition Medicine or Wilderness Medicine, I'd like to mention our textbook, Expedition & Wilderness Medicine, that was recently published by Cambridge University Press.

This textbook is used as the syllabus for our Expedition Medicine National Conference and also as a teaching tool for many other courses and organizations around the globe.

The textbook is a hardcover text over 700 pages in length, with full-color photos and diagrams. We recruited more than sixty experts from around the world who contributed content for this project. Contributors include many notable individuals such as

Richard Carmona, MD, MPH, FACS: 17th Surgeon General of the United States

Luanne Freer, MD, FACEP, FAWM: past president of the Wilderness Medical Society and founder and director of Everest ER

Ken Kamler, MD: Vice President of The Explorers Club and author of Doctor on Everest

Richard Williams, MD, FACS: Chief Health and Medical Officer for NASA

Peter Hackett, MD: Director, Institute of Altitude Medicine

We have been pleased to read many favorable reviews of our book in multiple journals including the New England Journal of Medicine and JAMA. Here's an excerpt from the JAMA review:

Expedition&Wilderness Medicine, edited by Bledsoe, Manyak, and Townes, is a comprehensive guide to the multitude of issues facing the expedition physician. The book is organized into 3 sections covering expedition planning, specific and unique environments, and specific wilderness illnesses and injuries. The comprehensive and often humorous chapters have been edited in a style that allows for easy reading, and they include numerous excellent illustrations.

Several of the chapters are written by some of the world’s authorities on the topic. Not only have many of the authors published widely on their areas of expertise, they have spent considerable time in the field. The authors have diverse experience ranging from serving as the expedition physician on a climb of an 8000-m peak in the Himalayas to providing medical care to a patient injured thousands of feet underground in a Mexican cave. This experience—and the willingness of many of the authors to illustrate ways to avoid future problems by describing their own misadventures in the field—contribute to the strength of this text.

Expedition & Wilderness Medicine is a must-read before any expedition. It carefully details what an expedition medical kit should contain, along with details on what to consider taking along for toxicological and dental emergencies. Although this book is aimed at the expedition and wilderness medicine physician, many of the chapters are superb summaries of core emergency medicine knowledge that are better distilled and presented than chapters in some more traditional textbooks of emergency medicine. We recommend this text to all who practice acute care medicine and all physicians who hike, climb, or vacation outside the city or who might encounter anyone else who does.

Jones ID, and CM Slovis. JAMA. 2009;302(4):442-44

We'll be writing more about opportunities in Wilderness Medicine and Expedition Medicine here on Freelance MD, but for those of you who need something to begin your journey, pick up a copy of our textbook online or attend our Expedition Medicine National Conference and receive the book for free.