What is the Foreign Service?

Here’s the tea (and by tea I mean coffee- you know i don’t drink tea!)

“So are you like a travel nurse?” - real question from a family member (I love you mom).

In all fairness, I did travel nursing at one point so I get the confusion! This is a strange job and I think a lot of family and friends are still baffled at what the heck we are doing in East Africa. Going to break down some common questions below. Shout out to fellow FS medical provider blogger Nick (worldwidenp) I kinda stole this idea from him!! check out his awesome blog here!!

The Foreign Service (FS) is essentially a work force of people that are America’s representation abroad. We are a branch of the Department of State and work within embassies and consulates around the globe. The job is to interact with foreign governments and entities promoting diplomacy.

Jobs in the FS fall into two sections: Generalists and Specialists. Most jobs are overseas but there are domestic positions as well- usually in DC.

It seems to me that the majority of specialists (like medical providers) are experienced professionals within their respective subspecialty. Specialists are bringing their established expertise and skills that the embassy needs to function on a day to day basis. Examples of other specialists are: IT, security, financial management and construction/facilities.

Generalists (these are the foreign service officers) can be found in consular, economic, political and public diplomacy. The consular section for example, is in charge of issuing visa’s and providing assistance to Americans that may be traveling in the country. (Find yourself in a bind while abroad? Reach out the the consular section at the local American embassy they are truly fabulous). The political and economic sections have officers that maintain relationships with key figures in the community and government- they are constantly meeting local leaders, analyzing data and reporting local trends back to DC.

What’s the difference between generalists and specialists? IMO- generalists often have the career ambition to become an ambassador. Specialists don’t have that career trajectory and to me that difference has been palpable.

We all move and shift locations every 2-3 years. Sometimes you can extend- so you may be able to stay somewhere for 4 years, but in general this is a nomadic life and we are always on the move.

The best way I can describe it is that an embassy is like a mini country. We have our president (the ambassador) and the Vice president (the Deputy chief of mission or DCM). There is representation at the embassy from USAID- that finances assistance to local causes, and representation from the military (DOD), sometimes CDC and other agencies are up in the mix. We all work together in this kind of weird mini America within a host nation.

What is a Foreign Service Medical Provider?

Almost every U.S. embassy and consulate across the globe has a health clinic located inside to provide medical care to embassy staff. The FS hires MD’s, NP’s and PA’s to staff these clinics. For the local staff we provide occupational health (as I mentioned before, majority of FS staff is actually local staff) and for the Americans, their families and children we provide primary medical care. The job looks different of course depending on what country you are in. For example, in Burundi with poor local health facilities, American staff are coming to the embassy health clinic for ALL of their health needs. If you are in western Europe- then you have more options to get care locally.

I was at a dinner party recently with diplomats from Belgium and France, and one of the Belgiums was absolutely shocked that we had a fully functioning clinic inside our embassy. This gave me the impression that this is not common and perhaps other countries don’t provide this service to their diplomats.

And yes, as medical providers we are considered diplomats and given diplomatic passports and privileges.

Check out my previous post- a day in the life of a foreign service Nurse Practitioner to see what a day in the embassy clinic looks like for me and if you are interested in the hiring process (it can be complicated)- then read my overview of the process and timeline here!

The main thing to consider is that you need at least 5 years of NP experience before you can even apply. There is no way around it (trust me i tried).

You should really have experience in family practice (ER and urgent care are also acceptable)- because you will be expected to care for people across the lifespan- including providing prenatal care. We are often in very austere locations, so you should be confident in your skills and ready to practice autonomously.

Do you get to choose where you go?

Our first two tours are “Directed” and they last two years each. That means for your first 4 years when it comes to bidding time, you get a list of about 10-15 locations that you rank from high to low and then you are assigned a location- you don’t get to choose. They do take into consideration your family and medical needs and try to accommodate you as best they can, but nothing is promised and you should be prepared to be world wide available. After 4 years or 2 posts then you hopefully qualify for tenure- and you are able to apply to jobs that are available for your class and rank. This is my first post, so third post bidding still seems like a mystery to me- stay tuned for how that all goes down.

For now I’m waiting for my next bid list which will hopefully come out in the next several months!

How did you find this Job and WHY?!!

I can’t recall who exactly told me about this job, but I was still in NP school and once I read the description I thought YESSS and It immediately became my career goal. I was intrigued by the ability to live and work internationally while continuing to work clinically as a Nurse Practitioner.

V and I had a great life in the Bay area and I know friends and family were confused about why we would uproot ourselves to live in austere locations around the globe.

The answer is simple- we were craving adventure!

When we were discussing whether or not I should accept this job we kept coming back to the same thought- if we don’t like it then no big deal we can come back to our awesome life in California and we can chalk it all up to a two year adventure.

What does your spouse do?

V continues to run his consulting business remotely. It has been challenging with the time difference and unpredictable wifi. I think if you have a partner, success in this lifestyle is largely related to their employment opportunities and of course their happiness/willingness to continuously move with you. There are job opportunities at the embassy for spouses (Bujumbura has quite a few), but i think the competitiveness (and quality) of these positions really varies from post to post. If you end up at a post with no open positions, and perhaps a town that does not have much going on, you may have a miserable spouse- this is a real concern and fairly common occurrence.

Will you ever come home?

TBD. We will keep doing this until it doesn’t make sense for our family anymore or we get sick of the lifestyle and moving. I came into this with the goal of it being my long term career.

Are you always posted internationally?

Headquarters are in Washington DC and some of us (both generalists and specialists) can get posted back in DC for tours. Medical providers don’t seem to have as much opportunity to do this, but it IS definitely a possibility for medical providers to get posted to DC- albeit i think you need to be more seasoned because the MED jobs in DC seem to be more leadership roles. I’m not sure if this is something we would ever consider- still too early on to tell!

Another random tidbit to share if you are interested in this career- there are some new medical provider positions that have been created and they are called “Rover” positions. You are on the road most of the time filling in staffing gaps, but your home base is international. I think previous rover positions were based in DC, but since most of us prefer to live abroad they created these new positions. I can’t say the exact locations, but trust me they are in some pretty amazing cities around the world.

What is it like?!

I’m going to keep it super real- this life is privileged and sometimes I feel weird/guilty about it. We are currently sitting in a 4 bedroom home with someone full time to cook meals and clean for us. We don’t have to pay for housing or utilities, we have diplomatic plates on our car so we are somewhat protected from being pulled over frivolously by local police. We have access to motorpool 24/7 which is a fleet of cars and drivers to drive you wherever you need to go. This life is a trip- i knew what i was getting into, but living it in real time is completely different. My hope and goal is that my family and I stay grounded through all of this, because you certainly see people decades in that have become entitled with this lifestyle and I suppose it’s hard not to when the red carpet is being rolled out for you everywhere you go.

To stay grounded we try and spend most of our time with people outside of the diplomatic community- we have some parents from Chotu’s school that work in local NGO’s- super down to earth people doing really interesting work. I hope to get involved a bit more in the community in my down time- i think all of this will keep us sane in this process.

What about the pay?

The actual salary can be found here- it mostly depends on what class and step you enter at. Full disclosure- the base pay was MUCH lower than my bay area salary- but don’t let this dissuade you from joining!! My take home salary is actually much more. Here is how:

• Housing is provided and utilities (except maybe your wifi) are covered. So you essentially have minimal bills. That’s right no rent or utilities!!

• We make extra money from hardship differential and something called COLA. For example, in Burundi I’m getting a 30% hardship differential so this is 30% extra from by base pay. COLA (cost of living allowance) is tax free and is additional money to offset the higher cost of goods at some posts. In Burundi we get a 15% COLA UNTAXED! Adding this all together, with the lower cost of living and well we are able to save a lot more money than when we were in the bay area.

Any other questions? Thoughts? Are you thinking of applying?