I started working at the Children’s Hospital of Bordeaux, as an attending pediatric anesthesiologist, two weeks ago. For the first two years, I will be making about 1/5 what I was making as a locum anesthesiologist in the US. After this probationary period (which all docs coming from outside the European Union have to go through in France), my salary will increase to reflect my 17 years of experience as an attending pediatric anesthesiologist and will be about 40% of what I could make in the US.
It has been a long road, at times frustrating, but there is no place I would rather be. The trade off for the lower salary is a slower pace of life, a better life, a life focused on happiness rather than on consumerism and ownership of things.
Professional Reasons to Move
Life in Anesthesia Land in the US has been going through a lot of changes in the past decade. Hedge fund groups noticed we were part of the money-making engine in US hospitals and that we were more easily malleable than surgeons. They started to buy anesthesia group practices or form new ones to compete with and undercut established groups.
Hospitals started forcing experienced (i.e., more costly) docs to retire early by requiring longer work hours, prohibiting part-time employment, decreasing or eliminating established retirement plans, and hiring newly graduated anesthesiologists with a lower salary and with fewer benefits. Some hospitals tried the wholesale firing of established groups (sometimes with 30+ years of life in the hospital) and attempted to hire 100% with locums anesthesiologists (yep, I was in this pool of locums after I decided to obtain a medical license in France and had quit my job) while they worked to hire all new anesthesiology graduates and pay them less. Changes in leadership often resulted in decreased pay and increased workload.
I knew of one colleague who had an MI in the OR after we had been compelled to work post-call in a system that was already so profit-driven that we were doing elective C-sections until 2am. I mean, I love my job, but I don’t love it so much that I’m willing to give my life for it. This was when I started to look at my own chains to the system. The golden handcuffs. The reasons I believed I was trapped and had to comply. And I started to look for a way out.
Personal Reasons to Move
I don’t have children, so the decision to find a way to live on less and sell all my stuff (house, furniture, car, etc) and move overseas was a bit easier than it might have been otherwise.
Why France? Well, who doesn’t want to live in France, right? But for me, there were some personal reasons. My mother’s side of the family were immigrants from France, so I have personal ties. My grandmother did a genealogy search and was able to trace her side of the family back to a 9 year old who survived the St Bartholomew’s Day massacre in Metz, France in 1572. They immigrated to Illinois just after the Louisiana Purchase, when everyone there still spoke French. In fact, the entire mid-section of the US, from Canada to Mexico, had been a French territory, New France, from 1534-1763. My grandfather’s grandfather immigrated from Arles, France to the midwest via New York City in the late 1800s.
It had always been a hobby of mine to study the French language and French culture. After college French and level 5 of Rosetta Stone and innumerable hours of tutoring, I could still maybe order a full meal and buy some groceries in French. As we all know, life as a doc in the US doesn’t leave much time for hobbies.
Process of Moving to France
I quit my job (and started doing locums) and moved to France in January of 2018 to begin the process of becoming fluent in French. The best way to learn to speak a foreign language is to live in the country and immerse yourself in it. For three and a half years, I lived about half time in France and worked locums jobs in the US the other half of the year. I enrolled in an intensive, immersive program in a language school when I first moved here. In order to live in France for more than 3 months at a time, which you can do as a tourist from the US, you need a visa de long séjour which is renewable yearly.
Obtaining medical registration in France was a much harder nut to crack than I’d anticipated. I arrogantly thought that my US education and training would be recognised here. Or at least that it would make getting licensed here easier. Wrong. One of the things I both love and find frustrating about the medical system in France is its socialism and egalitarianism. France and other EU countries recognise each others’ licensed docs. But at least for France, anyone coming from outside the EU, the process is much more difficult – I outline the process of medical licensure in France here.
I feel incredibly fortunate to live in France and incredibly lucky to be able to practice medicine here. The food is of a much higher quality than what we have in the United States and there is an emphasis on quality of life that I’m still trying to get used to (it took me the better part of 3 years to really begin to get over my burn out). I would do it again in a heartbeat.
Jill F Arthur, MD FAAP is a pediatric anesthesiologist who has been in practice for 17 years, 15 of which have been exclusively pediatric. After fellowship at Boston Children’s, her wide-eyed plan was a career in academia. Attending positions that followed included some at big-name institutions with long-standing reputations in research and academics, but the exigencies of practicing in a system that increasingly stresses money over advancement of knowledge brought that dream quickly (and sadly) to an end. Hope sprang eternal anyway, for the next dozen years, believing she could actually change the system. But in the end, its’ abuse and the burn-out it caused just made the decision to leave her country and find a way to practice in France, easier.