Prescriptions for Balance: The Struggle of Doctors to Take Real Breaks in a World of 'Pretend Time Off' (PTO)

Amidst the breathtaking landscapes of southern Utah's national parks, I recently embarked on a journey with my family, leaving the hectic world of medicine behind. As a family physician, true respite meant disconnecting entirely – no patient consultations, no email responses, just pure leisure. For an entire week, I relished in the luxury of freedom. Surprisingly, my commitment to a work-free vacation places me among the minority of physicians in the United States.

This revelation stems from a study published in JAMA Network Open, spearheaded by Dr. Christine Sinsky, shedding light on the vacation habits of medical professionals and the repercussions for an already burdened healthcare system. Of the 3,024 physicians surveyed, a staggering 59.6% reported taking no more than 15 days off annually – a stark contrast to the typical American worker's vacation allotment. What's more, over 70% admitted to working even on designated vacation days, earning the grim moniker of "pretend time off" for their PTO.

Dr. Sinsky underscores the economic imperative of genuine vacation time, as burnout incurs exorbitant costs for healthcare organizations. Strikingly, physicians indulging in over three weeks of vacation demonstrated lower burnout rates, highlighting the indispensable link between time off and professional well-being. Yet, the prevalence of doctors laboring away during supposed breaks carries dire implications for healthcare delivery. Mounting evidence connects physician burnout with heightened turnover rates and escalated healthcare expenses, amplifying the urgency for systemic change.

In the serene embrace of nature, my hiatus from the demands of medicine not only rejuvenated my spirit but reinforced the imperative of authentic rest for healthcare professionals. The journey towards a healthier, more sustainable medical workforce begins with acknowledging the value of genuine time off.

Navigating the entrenched culture of workaholism within the medical profession poses a formidable challenge. Even the architects of recent well-being studies, like Dr. Colin West of the Mayo Clinic, find themselves succumbing to work obligations during supposed leisure time. "I remember responding to revisions for one of our initial well-being papers while vacationing at the family cabin in northern Minnesota," West recalls, echoing the sentiments shared by Dr. Christine Sinsky, the American Medical Association's vice president of professional satisfaction. Despite their roles in advocating for physician well-being, they too grapple with the paradox of unclaimed vacation days.

Intrigued by this paradox, I embarked on a quest, interviewing numerous physicians and engaging in candid discussions with friends and colleagues. Through these conversations, I uncovered insights into why doctors find it arduous to grant themselves respite. While the study published in JAMA Network Open didn't delve into the specifics of doctors' work during vacations, anecdotal evidence offers a glimpse into their struggles.

Jocelyn Fitzgerald, a urogynecologist at the University of Pittsburgh, shares her experience of triaging emails and attending virtual meetings even amidst vacation bliss. The ceaseless demands of emergencies, medication refills, and administrative tasks, compounded by the omnipresent electronic medical record (EMR), ensure that downtime remains a scarce commodity. While reciprocal coverage among colleagues alleviates some of the burden, it often incites feelings of indebtedness and guilt.

Dr. Jay-Sheree Allen, a family physician at the Mayo Clinic, recounts the intricate dance of scheduling "doctor of the day" coverage to mitigate the guilt associated with taking time off. Yet, the pervasive sense of obligation persists, underscoring the systemic challenges that impede doctors from embracing much-needed rest.

As physicians continue to navigate the delicate balance between professional duty and personal well-being, confronting the root causes of workaholism becomes imperative. Only through concerted efforts to reshape the cultural norms surrounding work and vacation can physicians reclaim agency over their time and foster a healthier, more sustainable healthcare workforce.

Despite her best efforts to delegate tasks, Jay-Sheree Allen, a family physician at the Mayo Clinic, finds herself grappling with a mounting pile of non-urgent paperwork upon her return from vacation. In a bid to preempt the post-vacation deluge, she reluctantly logs into the electronic medical record (EMR) during her time off, a strategy she acknowledges as less than ideal but preferable to facing an overwhelming backlog upon her return. "My strategy, I absolutely do not recommend," Allen admits, "But I would prefer that than coming back to the total storm.

Lawren Wooten, a resident physician specializing in pediatrics at the University of California San Francisco, endeavors to utilize her entire vacation allocation. However, constraints imposed by her residency program dictate the duration and timing of her breaks, leaving her with little control over her schedule. Wooten reflects on the challenge of navigating emotionally demanding rotations and yearns for more flexibility in scheduling to accommodate her needs.

Aspiring to attain greater autonomy over their time, physicians like Allen and Wooten anticipate the transition to attending status. Yet, the reality of scheduling constraints persists even at this stage of their careers. Jocelyn Fitzgerald, a gynecologist, highlights the predicament faced by many physicians who rely on patient volume for income. Vacation time equates to money left on the table, a notion echoed by Dr. Colin West, a researcher in physician well-being. He emphasizes the financial incentives tied to productivity-based compensation models prevalent in the medical field, where higher patient throughput translates to increased earnings.

The lure of financial gain often clashes with the imperative of self-care, prompting physicians to grapple with the trade-off between income and well-being. While the allure of maximizing earnings may dissuade some from taking time off, West underscores the insidious toll of burnout resulting from relentless work schedules. As physicians navigate the intricate web of financial incentives and personal health, striking a balance between professional demands and self-preservation emerges as a pressing imperative.

The ramifications of physician burnout extend far beyond the individual, reverberating throughout the healthcare system and jeopardizing patient safety. Studies have illuminated a concerning correlation between burnout and medical errors, with overwhelmed physicians more prone to critical lapses in patient care. In a notable survey of American surgeons, those grappling with burnout were alarmingly more likely to report involvement in major medical errors, although the causal relationship remains ambiguous.

When I embark on vacation, I entrust my patients to the capable hands of my colleagues, fostering a culture of mutual support and collaboration within our small practice. Adi Shah, an infectious disease specialist at the Mayo Clinic, underscores the importance of relinquishing control and embracing the team-based approach increasingly favored in modern healthcare. Yet, for many physicians, relinquishing autonomy proves challenging, particularly in cases involving complex patients or intensive research endeavors.

Colin West, an advocate for physician well-being, emphasizes the evolving landscape of healthcare, which emphasizes collective responsibility over individual heroism. However, he acknowledges the psychological barriers hindering some physicians from seeking or accepting assistance, citing ingrained notions of professional omnipotence.

Shah injects humor into the discourse, leveraging social media to critique the pervasive work-centric ethos of medicine. Despite his own struggles to detach from work during vacations, he advocates for cultivating interests beyond medicine as a means of fostering holistic well-being. Encouraging doctors to embrace leisure pursuits and shed the burdensome "God complex," Shah champions the pursuit of diverse hobbies post-training. Embracing this philosophy, Shah immerses himself in salsa dancing and eagerly anticipates future adventures, symbolized by his upcoming participation in a kite festival.

As physicians navigate the labyrinth of professional obligations and personal fulfillment, the imperative of combating burnout and nurturing well-being remains paramount. Through fostering a culture of collaboration, relinquishing the myth of individual invincibility, and embracing leisure pursuits, physicians can embark on a journey towards holistic fulfillment and sustainable medical practice.

Shah, recognizing the importance of work-life balance, diligently carves out time to nurture familial connections despite the geographical distance separating him from his loved ones in India. Twice a year, he embarks on the arduous journey from Minnesota to India, prioritizing quality time with family over professional commitments. His upcoming trip holds special significance, marking the first summer visit in over a decade and offering the rare opportunity to savor the succulent sweetness of mangoes in their peak season.

Wooten echoes Shah's sentiments, advocating for the cultivation of a rich and fulfilling life beyond the confines of one's career. Reflecting on the pervasive institutional ethos ingrained throughout medical education, Wooten emphasizes the importance of actively challenging ingrained norms to reclaim agency over personal well-being.

Mara Gordon, a dedicated family physician based in Camden, New Jersey, and a respected contributor to NPR, underscores the significance of embracing diverse pursuits outside of medicine. Engaging with the online community under the moniker @MaraGordonMD, she exemplifies the multifaceted nature of modern medical practice, championing a holistic approach to professional fulfillment and personal enrichment.

In conclusion, the narratives of physicians like Adi Shah, Lawren Wooten, and Mara Gordon underscore the imperative of prioritizing work-life balance and pursuing diverse interests outside of medicine. These individuals challenge ingrained cultural norms within the medical profession, advocating for a holistic approach to professional fulfillment and personal well-being. By fostering familial connections, nurturing passions beyond the confines of their careers, and actively confronting institutional expectations, they embody a paradigm shift towards a more sustainable and fulfilling medical practice. As the healthcare landscape continues to evolve, their stories serve as poignant reminders of the importance of cultivating a life rich in meaning, connection, and self-care amidst the rigors of medical practice.