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Paradise Found
April 3, 2009
“The happiness that is genuinely satisfying is accompanied by the fullest exercise of our faculties and the fullest realization of the world in which we live.” –Bertrand Russell
This sentiment embodies the current trek of Dr. Joe Harris, now retired from Premier, but not from life’s promises and challenges. Dr. Harris picked up stakes in the United States and moved to New Zealand. He and his wife Joan have been living their well-planned and open-ended dream for the past year and a half.
Joe and Joan are now settled in Timaru in their recently remodeled home, a partially restored 1914 farmhouse that sits on five acres of north-facing hillside (the sunny side in NZ). Joe says, “On a clear day, we can see the summit of Mt. Cook (120 km to the west) and the Pacific Ocean (12 km to the east).” They share their space with several handpicked Nubian goats, which they hope to grow into a small dairy herd. Dr. Harris practices Emergency Medicine at a local hospital, and Joan works part-time as a Practice Nurse with a local GP.
Joe began his career in EM in 1982 at a small Florence, Kentucky hospital. “My choice of EM was a bit serendipitous.” Joe shares, “I completed my residency in Family Medicine and Joan wanted to return to Kentucky to complete her degree. I had done a lot of moonlighting in the ED during my residency, but I was still considering joining a Family Medicine practice when I completed training. But after a number of interviews with groups that offered lots of night call and very little compensation, I decided to take a position in the ED. I quickly found it better suited my temperament and was a better fit with the lifestyle I envisioned. I immediately began to pursue ABEM certification through the practice track and never again considered Family Medicine.”
Over the next 15 years, Joe practiced with several EM groups in the greater Cincinnati area, eventually discovering the elusiveness of promised partnership. Dr. Harris says, “Joan and I were able to travel pretty extensively overseas during this time, and the practice of EM was enjoyable.” Eventually the feeling of not being treated fairly by his colleagues wore on him, and he realized he “would need to start over with a new group—and I felt like I needed a break anyway. Joan and I had always talked about a long sailing journey, so we decided now was a good time to depart. We bought and extensively outfitted a sailboat and took off in January 1990 for a two and a half year trip to the Mediterranean and the Caribbean islands, returning to the USA in August 1992.
“After that length of time off, I had to brush up on my ACLS/ATLS skills, but I felt comfortable to be back in the ED. I joined the group staffing Mercy Hamilton and Mercy Fairfield—and eventually Ft. Hamilton Hospital. In 1997, that group merged with Premier.” Dr. Harris spent the last 10 years of his US career with Premier prior to retirement in 2007 and his move to NZ. He says, “I’m still enjoying Emergency Medicine—albeit in a completely different environment than before.” The questions frequently asked of him these days are: why now, why there?
Many wondered why Joe would retire at the young age of 54. He explains: “The answer is twofold, relating to lifestyle and professional issues. The lifestyle issue was that Joan and I had already decided we wanted to live in New Zealand for a prolonged period of time—maybe permanently. NZ has pretty tough immigration laws, and it is much easier to qualify for permanent residency if you are no more than 55 years old and have a skill they need (EM definitely qualifies). I just turned 56 two months ago, so the time frame was one impetus to retire now, not later.”
The professional perspective of patient care and administrative responsibility also affected Dr. Harris’ decision. He says he still enjoys taking care of sick people, as he currently does in NZ, but he eventually felt the increasing regulatory constraints in the US sapped much of the joy he derived from the practice. Joe also felt like he had contributed as much as he could administratively. “I had a great time serving as Medical Director of Fort Hamilton for five years and even more enjoyment serving on the Board of Directors at Premier. But I realized that I had achieved most of what I had wanted to accomplish, and it was time to step aside for some new blood to carry on.”
The second frequently asked question regarding Dr. Harris’ retirement is, why New Zealand? Joe says, “Although I have not been asked this by anyone who has visited here, it is often asked by native New Zealanders! I still wanted to practice medicine, so wherever we went had to be English speaking.” So Joe and Joan decided to continue their medical careers in the NZ medical system.
“And most importantly, we have always wanted to go to NZ. Although we have traveled extensively, we had never been to NZ until we made the decision to move. We knew we would love it. We came for a month in late 2006 to tour the country, and I had interviews set up at a number of hospitals. It was an exciting prospect really. We were starting over with a clean slate (we had no family or friends here) and we could choose anywhere to live. We eventually chose Timaru, a town of 35,000 on the east coast of the South Island. The worst that could happen is that we found it was not for us (in which case we pick a new town, or come back to the USA)—but fortunately, we love the place.” They rented a house for the first year, but were certain enough they would stay that they purchased their current home within six months.
From a lifestyle vantage point, Joe explains that full-time practice in NZ consists of ten 10-hour shifts every three weeks, with six weeks off yearly (including public holidays, personal time, and CME). There is no night work because a resident physician covers the hospital and the ED from 11 pm–8 am. He’s enthusiastic that this leaves lots of time for other interests and was pleased that “the hiking here (called ‘tramping’) is spectacular, with a hut system that obviates the need for a tent. Mountain biking trails are everywhere. Timaru has an airport with an active aero club, so I have been able to transfer my US pilot’s license, and I’m looking forward to some mountain flying this year.”
Currently, Joe and Joan’s biggest interest is their dairy goats. They have the two aforementioned Nubians and hope to have a herd of ten or so within two years. The Harrises say it’s only a hobby, but one wonders if it is an enterprise in the making. They’ve discovered “it’s tough to find fresh goat cheese here so we hope to produce enough for our use and maybe a weekly stall at the farmers’ market.” Joe and Joan spent time at a goat dairy farm before leaving the US, but with their first goats, they’ve “found that they make great pets, in addition to producing a useful product (both milk and meat).” Their initial acclimation with their lovable goats included several escapes from the paddock. They no longer run away, but “the first day was an epic involving three neighbors, a mob of sheep, and a flying tackle, but we won’t go into that,” laughs Joe. “Now they just want to get in the backyard and come into the house!” The sky seems to be the limit for these two sojourners, so might we one day look for a new import label? Perhaps Smiling Goat, Billy Boy Buche, or Nubian Niblets will grace the shelves of our local delis.
On the medical practice side of life in New Zealand, Dr. Harris considers Emergency Medicine there a great “career extender.” Most days physicians have time to spend with patients because most everyone has and uses a GP. So you can generally “understand why the patient or GP thought the ED was the appropriate venue for care.” He also likes that “charts are all brief, handwritten, pertinent notes (think USA about 1985)” and that “malpractice litigation is essentially nonexistent, and the practice of evidence-based medicine is actively encouraged.” The downside to this simplicity is physician compensation, which Joe says is significantly less than in the US. He says the average salary for a “consultant” emergency physician (the NZ equivalent of ABEM certified) is about $102K, USD, but relates that that salary “still puts you in the top 20% of incomes in NZ.” Since the cost of living is lower in NZ, an ED physician can still live very comfortably, as long as you’re not still paying off remaining debts in the US.
One notable difference in practice in NZ is the drug formulary. Joe says, “Most chemical names are the same but brand names almost never are.” Some things that strike him as strange are: “Diphenhydramine is not available in injectable form. Promethazine is used exclusively as an antihistamine here (and NEVER given IV). The most common antiemetic is metoclopramide, although ondansetron is available. There is no injectable calcium-channel blocker available in NZ.” Another notable difference: “Very few people (patients and other staff) address me as ‘Dr. Harris,’ and even fewer doctors would introduce themselves as ‘Dr.’ The common interaction is ‘Hello, I’m Joe Harris, one of the doctors.’ And most patients reply, ‘Hi Joe, nice to meet you.’ A bit odd initially, but it puts you on even footing with the patient. Maybe I should have used that introduction more often in the US.”
In the final analysis, Dr. Harris’ 25+ years of perspective have given him an honest and healthy outlook on his life and lifestyle. Joe says, “I’m happy that I found a career in EM. Once in awhile, you save someone’s life. It has allowed me to take prolonged periods away from practice and return without difficulty. It offers international mobility, since aside from a certain set of skills and knowledge base, our most important skills are: 1) knowing who is sick and who is not; 2) ability to thrive on multitasking; and 3) making critical decisions with limited amounts of information. These skills translate to anywhere you can communicate with the patient.”
Joe is also glad he joined Premier. “I found it rewarding to work for a forward-looking group that was keenly interested in recognizing and developing future leaders. It was also an advantage to be part of a group big enough (in terms of number of contracts and asset base) to weather whatever the next storm will be, but small enough that most folks still know each other,” says Joe.
It’s apparent to most of us vicariously sharing Joe and Joan’s Great Adventure how glad they are to have the opportunity to live and practice medicine in New Zealand. Joe does concede that there are certainly some trade-offs, but so far they feel they made the right choice. Perhaps that’s the underlying message of the Harris’ story—choices.
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