Worldwide Adventure Awaits

Do you want to work in an exotic locale? In a different country every couple of years? Have the challenge of practicing healthcare with limited staff and scarce resources? Do you want to look after a small group of patients whom you see on a regular basis?

Medical personnel working as foreign service employees with the US Department of State get to do all this. And they receive paid housing (or a tax-free housing allowance), health coverage, federal retirement benefits, free education for dependent children, and paid leave. Sounds good, doesn't it?

It sounded good to Carol Dorsey back in the early '80s. All it took for the family nurse practitioner (NP), who was working in rural Wisconsin at the time, was a small two-line ad in a nursing journal and she was off to her first job looking after embassy staff, in Yaounde, Cameroon.

Initially, Dorsey planned to stay with the Department of State for just two years, but she found the work so fulfilling that, 22 years later, she is still a foreign service employee. Now, however, Dorsey and her husband live closer to home, in Washington, DC (where the Department of State headquarters is located), and she is responsible for recruiting NPs and physician assistants (PA) to work in embassies around the world.

On the Job: What's Involved

The Department of State hires health practitioners (NPs and PAs), medical technologists (these positions are more rare), and regional medical officers (physicians and psychiatrists). There are currently 130 medical personnel who care for Department of State employees and their families. Starting salaries for PAs and NPs range from US$55,901 to US$82,093.

New employees must serve an initial two-year tour, and he/she must be willing to serve anywhere in the world. For the first two postings, which are both two years in length, new hires have no choice in where they will work; after that, however, they can rank their order of preferences, and they have a good chance of going where they want.

Health practitioners may serve in remote locations where they are responsible for all aspects of medical care for embassy employees and their families. And, in these situations, the job can be very demanding: while they may be assisted by locally hired staff (Dorsey worked on her own in some postings; in others, she hired local nurses), they are generally on call 24/7.

In some cities, such as Rome and Paris, the Department of State does not post foreign service medical providers but utilizes local resources. But in other major cities, such as London and Cairo, where the foreign service does use NPs, the work involves primary care, coordinating medevacs, and preventive health education.

Most of the posts, however, are in medically underserved areas: "You are often practicing what I call 'white-knuckle medicine.' You are doing primary care in very isolated, austere environments," says Dorsey. And some postings, such as those in Kabul, Afghanistan, are unaccompanied (you can't bring your family) due to the security risk.

Most health practitioners will spend an average of 60% of their foreign service career abroad, moving, according to department policy, at two- to four-year intervals. The remainder of their time will be spent in Washington, DC, where roles are primarily administrative, or in Fort Lauderdale, Florida, which is the medevac site for embassy employees from Latin America.

And while one might think young people would be most attracted to this career, Dorsey says, currently, older applicants are gaining in number with an average age in the 50s. "They're very experienced in their fields and are looking for a life and career change."

A Fulfilling Career

Dorsey was stationed abroad for 19 years, and she served in embassies in Cameroon, Ecuador, Sudan, Mauritania, the Czech Republic, and Peru. Along the way, she dealt with illnesses ranging from malaria to schistosomiasis, and she learned procedures such as how to pull mango worms from underneath people's skin and how to rig up IVs in airplanes during medevacs.

Dorsey's frontline experience and enthusiasm for the job make her a persuasive recruiter for the Department of State. "You get to know people well because you're the one responsible for all aspects of their care. It's like being an old-fashioned family doc," she says adding, "I always tell people who are interested in this work that it will be the best job they've ever had."

How to Join the Foreign Service Applicants for health practitioner posts for the Department of State must be a US citizen between the ages of 21 and 59 (hired before 60th birthday) and must have a minimum of four years of recent experience in providing direct patient care (two years of which should be as a NP or PA). Applicants undergo a multi-step process, which includes an oral assessment (a written exercise and a structured job interview), background check, and security clearance. Because they are likely to serve in countries that lack decent medical facilities, they must also be in excellent physical condition. Once they have passed the initial screening, their names are placed on a list of eligible hires in rank order, according to the score they received after their oral assessment. Offers of employment are made to candidates beginning at the top of the list. If applicants haven't received (and accepted) an offer of employment after 24 months, their names are dropped from the list. For more information about medical careers with the US Department of State, visit their website.

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