Research shows that doctors have difficulty taking full time off from stressful jobs. Even then, I often work on my days off.
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Wolfgang Kaehler/LightRocket, Getty Images
Research shows that doctors have difficulty taking full time off from stressful jobs. Even then, I often work on my days off.
Wolfgang Kaehler/LightRocket, Getty Images
A few weeks ago I went on vacation with my family. We went hiking in a national park in southern Utah and felt happy to have a break from work.
I'm a family doctor, so taking time off from work means not seeing patients. It also meant not responding to messages from patients or checking work email. For a whole week I was free.
By taking a full-fledged break, you'll feel rejuvenated and ready to take care of patients when you return, without needing sneaky computer time to run a few prescription refill requests. felt.
But apparently, as a doctor who doesn't work on vacation, I'm in a complete minority of American doctors.
Research published in JAMA network open This year, we're looking to accurately quantify how physicians are using their time off, and how it's impacting healthcare professionals struggling with burnout and dissatisfaction, as well as those considering leaving the practice. We set out to quantify whether there is.
“There's a strong business case to support actual vacation taking,” says lead author Dr. Christine Shinsky. “Burnout is incredibly costly to organizations.”
Researchers surveyed 3,024 physicians who were part of the American Medical Association Cohort, which was designed to be representative of the U.S. physician workforce. They found that 59.6% of American doctors take 15 days or less of vacation per year. This is a little more than the average American. According to the U.S. Bureau of Labor Statistics, most workers who have been on the job for more than a year receive 10 to 14 days of paid vacation.
But most doctors don't accept it genuine vacation. More than 70% of the doctors surveyed said they worked on their regular vacation days.
“I've heard doctors refer to PTO as 'pretending vacation,'” Shinskey says. This is an acronym for “paid vacation.”
Sinsky and his co-authors found that vacation is associated with happiness and job satisfaction, and that physicians who took three or more weeks of vacation per year had lower rates of burnout than those who took less. discovered.
And those doctors who spend their vacations sitting by the pool with their laptops, still busy with work? Shinskey argues that this has serious implications for healthcare.
Physician burnout is associated with issues such as high turnover rates and excessive health care costs, among others.
Still, changing the workaholic culture in healthcare can be difficult. The study authors also confessed to having worked during their vacation.
“I remember when our first happiness paper was published,” says Dr. Colin West, a co-author of the new study and a health workforce researcher at the Mayo Clinic. “I completed the revision at my family's cabin in northern Minnesota during the holidays.”
Shinskey agreed. “I don't take all my vacations, which I realize is a delicious irony of the whole thing,” she says.
She is the American Medical Association's Vice President for Job Satisfaction. If she can't take a proper vacation, what hope does she have for the rest of us?
I interviewed six fellow doctors and chatted with many friends and colleagues off the record to understand why we find it so difficult to give ourselves a break. Here are some theories as to why it's so bad for doctors to take time off.
I don't want my coworker to do more work than this.
The authors of the study JAMA network open While I haven't researched exactly what doctors do during their time off, the doctors I spoke to had some ideas.
“If you're not doing anything, triage your email a little bit,” says Jocelyn Fitzgerald, a urologist at the University of Pittsburgh who was not involved in the study. “Also, certain high-priority virtual meetings may fall on vacation.”
Even if a doctor isn't scheduled to see a patient, there's almost always plenty to do, such as responding to emergencies, refilling medications, and handling paperwork. For many of us, electronic medical records (EMRs) are relentless taskmasters that provide a near-constant stream of bureaucratic to-dos.
When I go on vacation, my primary care physician colleagues do the work for me, and I do the same for them.
But it can feel like a lot to ask, especially if your coworkers are doing the work on top of their regular workload.
“You end up putting people in some kind of awkward situation and asking them for a favor, and they [feel they] You have to pay it back,” says Jay Shelley Allen, a family physician and preventive medicine fellow at the Mayo Clinic.
She says her practice has a “doctor of the day” who responds to all urgent calls and messages, which makes her feel some less guilty about taking time off.
Still, there are still non-urgent tasks that need to be completed when she returns. She says she typically logs into her EMR while on vacation so tasks don't pile up when she returns. If you don't, Allen estimates you'll be looking at about eight hours of paperwork after a week or so of vacation.
“I definitely don't recommend my strategy,” Allen says. But “I think that's better than going back to a perfect storm.”
Too little flexibility about when to take vacation
Lauren Wooten, a pediatrics resident at the University of California, San Francisco, says she takes 100% of her vacation time. However, there are many stipulations as to how exactly she uses it.
She has to separate every two weeks. “That’s a long time to do all at once,” she says. And once the primary resident assigns a date, it's difficult to change the schedule.
“Sometimes I wish I had time off in the middle of two very mentally demanding rotations, like the ICU rotation and the oncology rotation,” she said of the intensive care unit. “At this point in our careers, we don't have control over our schedule.”
Once Wooten completes her training and becomes an attending physician, it's likely she will have more autonomy during her time off, but that's not necessarily the case.
“Patients plan their schedules far in advance, so they need to know in advance when their vacation will be,'' said Fitzgerald, a gynecologist.
Taking a vacation means giving up a potential salary
Many doctors receive compensation based on the number of patients they see or the number of procedures they complete. If you take time off from work, your income will decrease.
“Vacation is like money,” says West, the physician health researcher. “People have a hard time getting off the treadmill.”
The American Medical Association's 2022 survey summary found that more than 55% of U.S. physicians want to be compensated at least in part on “productivity,” rather than a flat rate regardless of patient volume. It is estimated that there are. In other words, the more patients a doctor can squeeze into their schedule, the more money they can earn. Going on vacation may reduce your take-home pay.
But West says it's important to weigh the financial benefits of not taking time off against the risk of burnout from working too much.
Physician burnout is associated not only with excessive medical costs but also with increased rates of medical errors. For example, in a large survey of American surgeons, surgeons who experienced burnout were more likely to report having been involved in serious medical errors. (However, it is unclear to what extent burnout caused errors, or whether errors caused burnout.)
Doctors think they are the only ones who can do their job.
When I go on vacation, my colleagues see patients for me. Since I work in a small clinic, I know the other doctors well and trust that my patients will feel comfortable receiving care when I am not available.
But some physicians may find it difficult to cede control to colleagues, especially when it comes to difficult patients or large research projects.
“I think we need to learn to trust our colleagues more,” said Adi Shah, an infectious disease physician at the Mayo Clinic. “You don't have to micromanage every PowerPoint slide. That's okay.”
Well-being researcher West said health care is moving toward a team-based model and away from a culture where individual doctors are responsible for everything. Still, he added, it can be difficult for some doctors to accept help.
“You can be a brain surgeon. Tomorrow you're supposed to be on vacation, and you're going to be operating on patients, and you're going to be at risk for complications and complications, and you're going to have relationships with their families.” you,” West says. “It's really, really hard for us to say, 'You have a great relationship with the rest of my team.'
What doctors need to do, West says, is to “alleviate their God complex.”
We have no interest in anything other than medicine.
Shah, an infectious disease doctor; Frequently post humorous memes on X (Formerly known as Twitter) About medical culture. Unplugging on vacation is one of his favorite topics, even though he has a hard time following his own advice.
He encourages doctors to have hobbies. That way he can find something better to do than work all the time.
“Stop taking yourself too seriously,” he says. Shah argues that many doctors neglect pursuing interests outside of medicine due to the busy schedule of medical training. When fully trained doctors finally complete their education, he says, they are at a loss as to what to do with their newfound freedom.
Since completing her training several years ago, Shah has taken up new hobbies such as salsa dancing. He is planning to go to a kite flying festival next year.
Shah also makes it a priority to make the long trip from Minnesota to visit family in India at least twice a year, a trip that requires significant time off from work. He is planning a trip there this month.
“It's been 11 years since I went to India in the summer to eat mangoes in May, which is the peak season for mangoes,” Shah said.
Wooten, the pediatrician, agrees. She works hard to build a fulfilling life outside of her career.
“I think throughout our secondary and medical education, we have been indoctrinated to put the institution above ourselves,” Wooten added. “It takes effort to overcome it.”
Mara Gordon is a family physician in Camden, New Jersey, and a contributor to NPR.She is appearing in X @MaraGordon.
