Therapy for Physicians: Physicians on Vacation

This is a summary and thoughts of a JAMA article by Christine A Sinsky, Mickey T Trockel, Lotte Dyrbye et al. titled “Vacation Days Taken, Work During Vacation, and Burnout Among US Physicians.

Summary of Study

Investigators completed a cross-sectional study of 3024 US physicians. Findings include 59.6% took 3 weeks of vacation or less per year, and 70.4% worked while on vacation on a typical day. These findings were associated with higher burnout rates. Findings suggest that support for taking vacation and efforts to reduce physicians’ obligations to work on vacation should be considered to prevent burnout. 

Vacation days vary by specialty. Anesthesiology, radiology, radiation oncology and pathology had the highest proportion of physicians taking more than 3 weeks of vacation. Family medicine, physical medicine and rehabilitation, general internal medicine, and emergency medicine had the lowest proportion of physicians taking more than 3 weeks. 

Time spent while on vacation also varied by specialty. Emergency medicine, radiology, and pathology had the lowest percentage who performed 30 minutes of work while on vacation on a typical vacation day. Urology, neurology and surgery subspecialties had the highest percentage who performed 30 minutes of work while on vacation on a typical vacation day. A majority of physicians (70.4) did perform work while on vacation with one–third working 30 minutes or more per day. 

More than one-third of physicians indicated that the following were barriers to taking a vacation: finding coverage for clinical responsibilities, the financial impact of taking a vacation (not meeting production and continued overhead costs), and their EHR inbox when they returned to work. 

The investigators identified the following factors associated with taking 3 weeks of vacation per year: Relationship status for being married, finding clinical coverage, financial concerns, hours worked per week, and working in the VA or active military setting vs private practice.

The investigators state that the fact that physicians are obligated to continue to work “while on vacation should be considered a marker of poorly designed systems of teamwork, inadequate clinical staffing, and poorly designed cross-coverage systems.”

Thoughts of Physician Vacation

Just under 60% of participating physicians took less than 3 weeks of vacation per year and those that did worked on vacation. Barriers to taking a vacation include finding coverage, financial issues, and coming back to a full inbox. What kind of garbage is this? It’s no wonder why there are high rates of burnout in medicine.

As more and more physicians are becoming employed vs being in private practice, many of these issues should really tell you about the organization and the issues they have. As the investigators stated at the end of the study, the environment that physicians are working in is poorly designed. They stated that they are ‘poorly designed systems of teamwork, inadequate clinical staffing, and poorly designed cross-coverage systems.” If you are burning out, it’s not necessarily only you. The system plays a huge role in burnout. According to the AMA, emergency med has a 62% burnout rate, followed by family med at 58%, and internal med at 52%. 

Here is food for thought for employed physicians. The onus of handling the barriers to taking a vacation does not fully rest on your shoulders. You are not a business owner and you can’t directly change the system and protocols. You can give feedback and suggestions but you can’t implement the changes yourself. 

With that said, please remember patients are not “Yours.” Though a patient is assigned to you, they are not “your” patient. The patient is the patient of the healthcare system you are employed by. The system can easily direct that patient to another provider as they choose. Remember, you are a cog in the system. You are exchanging your skills and time for a steady paycheck. You work for shareholders and admin. Admin wants you to provide patient care to the highest number of patients possible to generate as much revenue as possible. When you are employed, your job isn’t to patients. Remember that.

Finding coverage for clinical work should not be your responsibility. I know I know. But it is. You need to think deeply about that though. Here’s the frame. Are you the business owner? Can you directly change the system? This is a systems issue and it’s not going to be changed anytime soon. This is the medical system abusing your good-heartedness. If you don’t take care of the patient, then who will? The other healthcare providers in your healthcare organization will take care of the patient. Remember, the patient is not your patient. The patient is the responsibility of the healthcare organization you work for. The healthcare organization should be responsible for finding clinical coverage for you. This is a healthcare system-wide issue. If this was your own business, that’s a different story. The company should be addressing this issue. If they are not, what does this say about your company?

The next barrier is the financial issues. This includes both income and overhead expenses. Each of these areas significantly. For income, how are you being paid? Base? RVU? Kill what you eat? One frame to think about is how much more money will you make if you work instead of going on vacation.

Here’s a real-world example: You are Family Med and get a base of 200k plus a bonus of every RVU above 3500. You expect to hit 4500 RVU if you work 48 weeks out of the year with a full schedule. How much more money will you make if you work 48 weeks vs 40 weeks? This frame is much different than if you think in terms of how much money you lost if you didn’t work those other weeks. The idea of gaining something vs losing something is a much different framework.

In terms of overhead expenses, is this your own business or are you a cog employee. If this is your own business, that’s a different story. If you are employed, this should not be your worry. If this is your own business, we should be thinking about financial planning and how to plan this into your business. I know a doctor that took 3 straight weeks off to play in Europe. This same doctor regularly takes Mondays and Fridays off. This business owner & doctor planned. Allocate money for your vacation if you won't bring in money at this time. Plan for this situation. You have enough income to handle a vacation.

Finally, the dreaded inbox. I’ve talked with docs about coming back from vacation. They always say that it’s a rush right before vacation and a rush right when they get back. The inbox doesn’t stop and things need to get answered. It appears that having a clear inbox is a badge of honor. I always ask why the inbox is always a pressing issue. The answer I receive is that it’s always there and always needs to be taken care of. Patients need answers. I’m not disputing that patients need answers. What I do challenge is the idea of when they need to be answered and what a timely answer is. How high up the hierarchy is clearing your inbox? Also, if your in box isn’t clear by the end of the day, is the work being put on your plate too much? We all know the answer to that. Is it worth stretching yourself, working that extra unpaid hour, and missing out on time with family, friends, or activities that fill your cup?

Reach out for Therapy for Physicians

Your work environment is burning you out. When you’re ready to make a change, reach out. Start your journey with Chris Rabanera, take the first steps with a free 15-minute consultation. I provide online therapy in California, online therapy in Michigan, online therapy in Nebraska, and online therapy in Las Vegas. As an experienced therapist, I specialize in physician burnout, grief counseling, anxiety, and depression. I also provide mental health treatment for men.