Doctors Don’t Need More Vacation

by The Darwinian Doctor

Doctors don’t need more vacation. They need better support, autonomy, and compensation to mitigate the burnout that plagues their day-to-day work lives.

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When you’re out to lunch with your friend who is a doctor, there’s a good chance that they might mention to you that they’re burnt out.  After all, about half of physicians report burnout, according to the 2024 Medscape Physician Burnout and Depression Report.  This is better than the approximately 63% of physicians that manifested burnout symptoms in 2021 during the Covid pandemic, but it’s clearly still a widely prevalent problem. 

After your doctor friend mentions their feelings of burnout, you might be tempted to offer them some advice.  But if you tell them to “just take some more vacation,” don’t be surprised if you see a grimace.

As Dani Blum wrote in the NY Times article “Back From Vacation and Still Burned Out,” workers who are burnt out aren’t going to be magically healed by a beach getaway.  (Incidentally, Blum gets credit for one of the best article opening lines I’ve read in a while:  “The email does not find you well.”)

In the article, Blum offers some helpful suggestions to help mitigate the transition back to work, but falls short of addressing the burnout problem itself.  I don’t fault her for this, because every job has a particular set of circumstances that can contribute to the burnout of its workers.  It’s impossible to address every type of job in a brief article. 

Watch the Video version of this post on YouTube!

Why physicians experience burnout

When it comes to physicians, the problems that contribute to burnout are well documented.  Here are a few of them (there are many more):

Unfortunately, these are issues that a tropical getaway can’t cure.  In fact, when I was a full time, employed physician, I felt that vacations would actually make my day-to-day experience worse!

Below, I’m going to describe why this was the case. 

(Note: my experience is not unique.  This same situation is true for most physicians, and plenty of other workers outside of medicine as well.  Things are a bit different for me now that I’m a locum tenens physician, but the memory of my years of full time employment are fresh in my mind.)

Why vacation makes it worse

The fact is that your average physician workload is relatively constant.  Just because you’ve planned out a week’s vacation to the French Riviera, your duties and responsibilities don’t just pause.  Your patient’s medical conditions don’t also go on vacation, magically stabilizing until you get back.  And the patients who need surgery?  They still need surgery. 

So when I was a full-time, employed urologic surgeon, I felt that upcoming vacations actually negative impacted my day-to-day situation and worsened my burnout. Here are a few reasons why below.

Call coverage

Taking overnight call was probably the worst part of my job. It was stressful, exhausting, and didn’t compensate in a way that was proportional to the torture. Honestly I resented it. When I was chief of my urology department, it was one of the areas that I worked on the most to improve.

We divided up the call burden evenly in my group.  So if I wanted to take off time for vacation, that meant that my call duties got concentrated in the weeks leading up to the vacation.  This kept things equitable but had the side effect of worsening my day-to-day mental and physical exhaustion. 

So that’s reason number one why vacation made things worse: it increased the frequency of overnight call.

Read more: The Comedy of Home Call

Clinic coverage

As a traditional surgical subspecialist, clinic is a necessity.  It’s where you see patients both pre-operatively and post-operatively. It’s also where you advise patients who have any issues related to your specialty.  It’s your “home base,” but it’s also one of the more exhausting parts of being a doctor.

In a typical clinic day, it’s common for solo primary care docs to smush about 27 hours of work into one clinic day. This is part of the reason why doctor visits seem so short these days. Clearly some of the issue stems from the high number of patients seen in a single day. Many physicians see anywhere between 30-60 patients a day by themselves, or double that amount if they have the help of a mid-level provider. On top of that patient volume are the tons of other tasks that doctors don’t get paid for, like insurance pre-authorizations for tests, medications, and procedures.

As a urologic surgeon, I didn’t have as many paperwork related duties as a primary care doctor, but I still spent the majority of my days in clinic, where I saw around 30 patients a day.

If I wanted to take vacation, my patients didn’t just give me a free pass until I got back. While I was gone, I needed to make sure there was a plan in place to cover my patients who had any acute issues.  This meant either taking care of the issues myself before I left, or handing them off to my colleagues to handle while I was gone.

In my group, we actually were expected to add an extra clinic day onto our schedules in the week or two prior to vacation.  This helped us stay “in access” with the flow of consults coming to the clinic and helped provide landing spots for our own routine patients. 

So similar to my call duties, my clinic duties also became concentrated in the weeks leading up to any vacation.

Message and results coverage

Additionally, the onslaught of patient messages, lab and tests results never stops.  Most days as a full-time doc, I’d get somewhere around 50 messages or results to review.  I’d often let these pile up to the end of the day, then take care of them in one batch before I left for my evening commute.  Often times, if I was too tired, I’d leave some of the less urgent ones to the next day.  Therefore, these items tended to pile up, especially if I had a busy week of surgery or call. 

 If I wanted to go on vacation, I’d have to do a few things to deal with the messages and results specifically.

First of all, I would have to spend an extra few hours on the computer, cleaning out all of those messages and results.  This usually was the day before I left, so I’d end up leaving the hospital or clinic around 8PM whenever I had vacation.

Next, I’d have to decide on a plan to review the messages while I was gone.   

While the vast majority of the results and messages are not urgent, there are inevitably a few that will require immediate attention. Therefore, there were really only two options.  Either I would log onto the EMR remotely during vacation and work for an hour or two every day, or a colleague at work could do this for me. 

In my group, we had no standard approach to this problem.  Over the last few years of my employment, I would just work on my messages daily during vacations.  While this was annoying, it helped reduce the workload when I returned from vacation.  It also allowed me to feel less guilt about going on vacation and leaving behind my patients. 

End of Vacation Blues

This last phenomenon was particularly annoying.  If I had a week-long vacation scheduled, my work anxiety would follow a familiar pattern.  It would take me at least two days of vacation before my stress and anxiety level started to reduce.  By day three of vacation, I’d finally start to feel relaxed. 

But by days four to five, I’d begin thinking about the mountain of work that awaited me as soon as I returned from vacation.  My stress levels and blood pressure would jump up erratically whenever something reminded me about work.  And by the time I was returning home from vacation, it was almost like I never left. 

It was basically like a more extreme version of “Sunday night blues,” except spread out over a week instead of over a weekend. 

Solutions to the vacation problem

Every physician likely has their own set of specialty specific reasons why taking vacation is painful. For the minority of physicians still in private practice, for example, vacation might be painful because it doesn’t generate revenue. With decreasing Medicare compensation, it’s harder than ever to run a profitable medical practice on your own.

But I can offer some general suggestions, that I will now list in no particular order:

  • More ancillary support from nurses and mid levels
  • Better tools like artificial intelligence to mitigate the demands of documentation
  • Compensation that actually keeps pace with inflation
  • More decision making power over their day to day (more autonomy)
  • Better financial resources to help physicians move towards financial freedom

The first three of these suggestions are not rocket science. They’re just expensive, which can explain why hospitals fight so hard to put as much of the burden on physicians as possible. From the hospital’s perspective, why should they hire a nurse practitioner or physician assistant to help with clinic when the doctors will handle it themselves?

The last suggestion is in support of my theory that doctors who are financially stable are better, happier physicians. They also are more willing to fight for the betterment of all physicians.

Read more: Physicians, No One is Coming to Save Us

Conclusion

So there you have it.  That’s a quick insight into the reason why vacation isn’t the cure-all you’d expect for your average physician.  In retrospect, vacation did very little to help with the burnout that I experienced as a physician.  In many ways, it made it worse! 

So when you’re talking to your doctor friends, don’t just tell them to take more vacation. Nod sympathetically and ask if there’s any new technologies like AI coming down the pike to help with their plight.

Daniel Shin, MD

The Darwinian Doctor


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Melvin Weiss, MD (Retired)
Melvin Weiss, MD (Retired)
9 hours ago

Corporate medicine is destroying the practice of medicine!

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