I am often asked through this website or through friends and family if there have been any negatives to the job, lifestyle, or in general since joining the Foreign Service. I am a positive guy by nature, and I definitely try to keep things light and positive here (mostly because I don’t want to offend my employer or host government), but also because in general, my experience has been overwhelmingly positive thus far. Now having said that, there are certainly some big negatives that come with this job, which may or may not matter or play a role for you. I’ll try and list some things that aren’t so great, even if they’re known and predictable before you even apply.

• Moving away from your friends and family. -This one really stinks. You know you’re doing this the second you take the job, and it factors into your decision to even apply, but it doesn’t make it any easier when the time comes. Unless you’re a hermit that has no connections, this is very difficult.
• Moving in general. – Moving ssssuuuuuuuuuuuuuuucccccckkkksssssss. No other way to put it. Even with the State Department footing the bill for movers, packing up your whole life is pretty much pure misery and one of the biggest annoyances of life. Now that you’re in the State Department, you get to do it all the time. Literally every 2-3 years. You also have to coordinate it all while you continue to work fulltime, right up until you move all over again. Get used to it.
• Booking travel is a nightmare. – I’ve mentioned it before and I will say it again, the travel agency the State Department uses to book travel from the United States is a travesty and a stain on an organization that prides itself on being worldwide available. Once you’re at post you have your own regional travel agency that is much easier to deal with, but if you have to call to book flights in the U.S. to anywhere else (they don’t offer an internet option for booking in the year 2022), buckle in for hours on hold only for them to likely spell one of your family members name wrong and getting to do it all over again.
• Limited choice in where you end up. – Most people applying realize this, but I was still startled there were a few people in my orientation that didn’t understand just how little say you have in where you will be spending years of your life. Several spouses seemed downright upset when they didn’t land in a choice European vacation spot. Guess what, it’s going to be that way your entire career. MED folks, especially at the mid-level will have a lot more flexibility/freedom, but even then you’re choosing places off a pre-determined list and that country you would love to live in might not be available during that cycle, and even if it is, no guarantee you get it. Don’t sign up for the Foreign Service expecting to spend 20 years prancing around Europe.
• Little Foresight in where you move next. – In MED, you start your career, 6 weeks later learn your assignment, and 6 weeks later are living there. It’s really strange going through the process knowing you will be moving your family halfway around the world in a couple of months, but have absolutely no clue where. As your career progresses, you usually find out your next post about a 10 months in advance. Definitely better than 6 weeks, but still a fairly quick turnaround when it comes to moving your whole life again and getting all the required documents for another country squared away.
• Your coworkers are your neighbors and social circle. – You know how as a provider it is sometimes weird when you bump into a patient in the wild? Well, that is literally everyday of your life in the FS. Your bosses are also your patients and neighbors. What if they don’t agree with a treatment or diagnosis, then you see them at the weekend BBQ, and they also happen to be the person that writes your performance reviews? What happens if you really dislike your boss and he lives next door? What happens when you are drinking a beer in the pool and they want to talk to you about their health problems? I have had no issues, am thoroughly enjoying myself, and it takes a lot to phase me, but it’s reasonable to expect in a lengthy career some or all of these scenarios happening. It’s definitely easy to escape in larger posts, but in smaller ones in areas where there isn’t much to do, you really have to hope your coworkers make great neighbors and friends.
• You are on call 24/7 – As the acting medical authority, you’re pretty much on call, all the time. Even if you have another provider at post or a nurse handle the “duty phone”, if something really bad happens, you’re getting notified. How much you get called will be totally random and post size dependent, but even for me in a smallish post I have already been awoken and gone in at strange hours.
• Spouse Employment -This is such an unknown. My wife is a nurse practitioner and doing this job was basically asking her to never work as a Nurse Practitioner again due to the robust nepotism rules the department has, she wouldn’t be able to work with me as I supervise the health unit. Now, since we have arrived in country she has found volunteer work at an NGO and will likly get some part time provider work in our region, but in the interim she has taken a management job working with our general services department. She’s excited about it, and it’s interesting work, but also nothing close to what she is capable of doing. It’s also a sort of blessing there was a job for her to do in general. Some embassies have very limited opportunities for spouses and every single assignment will result in a different working situation for her. It is a VERY BIG ASK on your spouse to make this leap with you, especially if they have a very established career.
• Lack of stability for children. – A perk of this job to me is having my children experience different cultures and languages as we travel the world, but it also means they are going to attend half a dozen schools by the end of high school, and have numerous friendships split up as a result of the job. My baby daughter has a few years before this becomes an issue. My 7 year old is doing well, but still misses her friends in Texas. Thank god for video calling.
• Your boss isn’t a medical professional. – Maybe a blessing and a curse, but in the State Department, you report to the posts head management officer, not someone in the Medical Bureau. I personally haven’t minded this so far, but I also have enjoyed working with my boss. However, I know from my time in the private sector that non-medical people making medical decisions or policy was often frustrating or infuriating. The silver lining though, is most of what you say, folks don’t really understand the technical details, and often just nod and agree with you. Ordering medical supplies also seems to be a breeze and is fast tracked by the people with the coin purse.
• Bureaucracy – The grandest of them all. If you’re used to a lean and streamlined private sector, get ready for a lot of bloat and a way of doing things that might not make much sense. For example, I recently got approved funding for an online CME course. A cable was issued that sent funding to my embassy, and all that needed to be done was I go to the Finance section, and sign up for the course and enter the embassy credit card info meant for such transactions. At least, that’s how they told me in Washington it should happen, and apparently what some but not all of peers ended up doing. What actually ended up happening, is I had to apply for an “Online CME” course on paper, via snail mail, and the embassy had to send them a check, via snail mail. The CME company then had to register me themselves and then give me the login info. Start to finish took 6 weeks for something that would have taken 2 minutes on a computer.
• Shutdowns/Freezes – It hasn’t happened much lately, but in the last decade there have been government hiring freezes and shutdowns. In a shutdown, you won’t get paid until congress passes a budget/raises the debt ceiling. Can you go a few months without a paycheck? Most American’s can’t. If they institute a hiring freeze, your spouse might not be able to work, or in your section you might not be fully staffed and end up with an increased workload.
• Family Separation – There may be times in your career where you are “directed” to do a tour in a country your family can’t follow. It isn’t a sure thing, and they look for volunteers, but it happens enough that there are lots of people I know already that have done so. Are you prepared to spend at least a year apart?
• Creature Comforts – This goes without saying, but be prepared once you leave your bubble to be removed from lot’s of things you love. Favorite restaurant, type of food, drinks, social spot. Whatever. Some countries will more than make up for it for what they have to offer. Other’s have limited options on the market, and often times the places you like the most might make you sick. For some reason, folks in the Foreign Service are all addicted to Trader Joe’s and love to talk about how much they miss it. I guess I’m glad I’m from a place it didn’t exist.
• Malaria Meds – Chances are you will end up serving a tour where they are recommended. Even as a Medical Provider it gives me pause having to give my children medication for two straight years. But I guess getting malaria in that time is even worse. Some folks do multiple tours in Africa. Are you okay being on these medications with pretty well established side effects for years at a time?

So yeah. It isn’t all perfect, but a lot of it you pretty much know or have an idea of before you apply. I definitely feel like the positives outweigh the negatives in the Foreign Service, but it is easy to see from the list above that this line of work isn’t for everyone. Until next time! -Nick