With burn out rampant in the physician community, you would think physicians would cherish their vacation time. Since vacation is a time to take a break from our normal routine and recharge our body battery, we should come back from our vacations rested and ready to work again. But many physicians don’t get any rest during their vacation time.
They use vacations to cram as much “play time” or “quality time” or “family time” into their schedule as they can. They concern themselves with the “we may never get back here again so we need to see everything” attitude rather than the “let’s take some time for a refreshing recharge of our lives.” Then when they get home, they need a vacation from their vacation, but instead they must get back to work. They come home from their time off more tired than when they left.
Vacations done right combat burnout. Vacations done wrong contribute to burnout. Following are six vacationing mistakes physicians make that are contributing to burnout.
One: Never take more than a week off at a time
Two big reasons that lead physicians to take short vacations is either they think they are indispensable, or they don’t know how to make proper arrangements so their work does not pile up while they are gone.
Those who think they are indispensable feel their practice cannot function if they are not present. They feel no one else can do the job they do. But the fact is, if you died tomorrow and never came back to work, your patients would get taken care of by someone else just fine. If patients can continue to get their medical needs met upon your death, they can survive if you take two weeks off.
The other reason physicians don’t want to leave for longer than a week is they hate coming back to the big pile of unfinished work that builds up while they were gone. There are three solutions for this. First, have someone cover for you so your urgent patients are being seen and therefore don’t build up. Second, arrange for your nurse to do everything possible to keep your paperwork and email up to date. Third, make the first day back to work a catchup day with nothing scheduled. Spend that day signing charts, returning emails, returning phone calls, reading mail… without any patient obligations. Then you can start clean the next day.
The job we do is very stressful and requires down time to recharge. The first week of vacation is just unwinding from work. The second week is the actual vacation.
A few years ago, I discussed this principal with one of my physician friends who was in his 60s. He realized he had never taken more than one week off in a stretch in his whole career. A couple of months later he decided to take a two-week vacation. He came home more refreshed, having had extra time to destress. He was also upset that he had never taken an extended vacation before. He was a typical work-a-holic and felt lost if he wasn’t at work. He never understood the real meaning of vacation until after he took his first two week vacation. After that, he scheduled all his vacations for at least two weeks.
I took a three-week motorhome trip almost every summer during the years I practiced medicine. Every time I came home refreshed and ready to return to work. I also took two four-week vacations and one six-week vacation during my 20-year practice. Don’t miss out on the opportunity to have that second, true vacation week, at least once each year.
Two: Don’t use all their vacation time
I never understood why people did not take all their allotted vacation time. They speak of it as if it was some great feat they were performing in not using their vacation time, as if they would get some reward for working extra.
You get vacation time for a reason; because you need it! Don’t leave it on the table.
Some physicians don’t use all their vacation because they have put themselves in a position to need the money. In private practice, you lose money when you are not seeing patients. If you feel you need the money more than you need a vacation, then make changes in your financial situation so you can afford to take vacations. Often this means PAYING OFF YOUR DEBT.
Most employed physicians do not have a contract that gives them enough time off to recharge even when they take all their vacation time. Skipping earned vacation is very hard on them, their patients, and their family.
Three: Only go on vacations that have CME
Some physicians are so obsessed with money that they only travel if it is for CME so they can write it off. Better financial planning will remove this burden.
This is a horrible mistake! CME is work and the purpose of vacation is to get away from work and give our mind and body a break. Our family doesn’t see us enough when we are home, now they are not even seeing us while on vacation because saving a few dollars in taxes by attending a CME meeting is more important than vacationing with our family.
When you go to CME events, leave your family at home so you can work and get what you are supposed to get out of the CME. When you go on vacation, leave your work at home so your family has all of you during the vacation. There is no such thing as a “working vacation.”
Four: Send the family on vacation while you stay home and work
Another horrible idea. Your family doesn’t want to go without you and you shouldn’t ever let this be an option. The main reason physicians do this is because they feel they can’t afford to not be working. All physicians make a good income and all physicians can afford to go on vacation. If you feel you can’t, it is time to get your finances in order so you feel you can go on vacation. I can help with this if you need outside assistance.
When I was young my grandfather was the superintendent at a mill. He truly believed the mill could not get by without him for long. Although he owned an RV trailer, he rarely used it. But each summer he would take my brother and I to a nearby lake on the weekend, drop us off to spend the week with our Grammy. The next weekend he would come back to pick us up. We went on vacation without him.
We loved the week with Grammy, but it would have been a lot better if both our grandparents were present.
Five: Only take long weekends
Another horrible idea. It was hard to believe my friend had never taken more than a week of vacation at a time. But to discover physicians who have never taken a full week off was even worse.
I always ask my coaching clients, “When was the last time you took a week of true vacation?” The most common answer I get is: I don’t remember.
They then proceed to tell me they tend to use their vacation a couple days at a time and take multiple long weekends each year.
A long weekend is definitely not enough time to let your work worries leave your mind so you can rest and recharge. Please take at least one real vacation annually.
Six: Cram all they can into their vacation
Vacation is a time to recharge, not a time to cram every activity you can into the week. Cramming activities into your schedule is what you do during the weeks you work. Vacation is a time to slow down.
I recently wrote about how I screwed up the start of a vacation by cramming to much stuff in before I left. I ended up pulling an all-nighter before leaving. What a mistake, the first couple of days of vacation I was too tired to enjoy myself. The next trip I took I intentionally had no planned obligations the day before we left, and we took off on an afternoon flight the next day. What a difference that made, this time we started our vacation unfrazzled.
Many physicians work all day Friday, run home, grab the family and catch a red eye flight in order to start their vacation as soon as possible. They cram the days full of activities, run themselves into the ground getting no rest or recovery. Then they take a late flight home, getting back just after midnight, only to wake up at 5am Monday morning to start their work week.
These people need a vacation from their vacation! This problem is self-imposed. Slow down while on vacation, have fun and relax. Enjoy the place you visit without cramming everything in. You can come back another time if you really need to see the rest of the tourist attractions.
Return a day early so you can start your work week rested. Maybe even take Monday off, as mentioned earlier, to catch everything up at the office so you can start Tuesday all caught up, rested and ready to conquer the week.
Bonus: Taking a “nanny” on vacation
If this is a family vacation, you should not need a nanny. Be a parent and enjoy time with your children. If you want time for you and your spouse to be alone, then take a separate vacation for just the two of you, and leave the kids with someone like a grandparent while you are gone. Give your nanny the week off.
I took 8-12 weeks of vacation every year while I was in practice. Yes that cost me a lot of money to be gone that much, but if you plan for it, the money will work out just fine. One of those weeks each year we scheduled a trip for just my wife and I. We would get some alone time and the kids would get some extended time with their grandparents.
We took care of the kids for these annual honeymoons three ways. The kids went to their grandparents’ home while we were gone, the grandparents came to our home for a week (great while the kids were in school), or the kids went on a motorhome trip with their grandparents.
Summary
A physician’s life is tough, with a high rate of burnout. We need to do all we can to get enough rest and relaxation to recharge from our busy schedules by making our vacations count. One of my favorite memories happened when we were ending a three-week motorhome trip. As we rounded the last corner and our son saw our house, he turned to me and said, “No dad! I don’t want to go home yet.”
I love that my son loved our vacation together so much that he didn’t want it to end. He didn’t, however, feel that way as a teen. Enjoy it while you can.
Many of my vacations have been ruined by complications that occur RIGHT before I leave – ie pp hemorrhage, unexpected bad baby, return to OR for bleeding, etc…… You get the idea. So I can’t relax while I am on vacation cause I am so worried about my patients. I hate to leave my patients and I hate to leave complications for my partners to handle. I’ve gone home early to care for patients. My family is understanding, but it is very stressful.
Yes it is hard to turn off the care we have for our patients and relax. That is why we need longer vacations. It took me about a week to turn off my doctor brain, then I could relax.
Nice article.
Just returned from a super week at an all inclusive resort. It was out of country so my office email could not reach me- no sign in allowed from out of country for security reasons. I work in a group practice so coverage available. First couple days back always busier with catch-up but worth it!
Regarding finances, if 4-6 weeks of vacation are “budgeted” in your mind annually, then you are not “losing money” by not working.
Matt, great points. I’m glad you prioritize taking time off to recharge. Love the idea of being where you can’t bet internet to check your email.
These all sound like perfectly reasonable ideas…in a world I don’t live in!
Backstory: Family Doctor with OB – for 23 years – same place
1. Taking more than a week off at a time. This is barely do-able on rare occassions (I did it in 2016 – by scheduling CME and vacation back to back). Only 2 (out of 6) can be out of the office at one time (hospital weeks are also out of office).
a.) With regard to the “covering” – all of my colleagues are as swamped as I am! Today I was covering 4 other doctors – obviously a bunch of stuff got punted until they got back on Monday – I was seeing patients or teaching residents all day
b.) You have your own nurse? That sounds delightful!
c.) schedule a catch-up day to wade through all of the stuff that accumulated while you were gone? That sounds like heaven…but that schedule was already filled 4 months ago and then the urgent patients that only will see “Their PCP” got double-booked on top. (You get to block your own schedule?) It usually takes me 3 weeks to recover from a vacation even though I am “working” (i.e. trying to get caught up) the while time.
2. Not taking all of vacation time – guilty…Not because I need the money (I’m on salary = same pay if I work, vacate, or call-out sick (I literally don’t have the time/energy to figure out when I can take vacation when other people aren’t off, 6 months ahead of time, etc. Eventually my boss told the schedulers to just put one in every quarter wherever it fit!
3. I just turn in the CME credits that I have been doing all along and don’t travel at all – I need that week (plus my vacations weeks, plus my weekends, plus my evening) to catch up on paper(computer)work that contributes nothing to my doctoring or teaching but ensures that SOMEBODY gets under paid for the actual work that I do.
4. N/A – I have a spouse and two dogs, they can go wherever they want whenever, with or without me. I don’t know how you folks with kids do it!
5. N/A – we are encouraged to take a week or nothing – scheduling is too crazy otherwise
6. WIN! – I got this one down! See, 10 years ago I bought my forever home and THAT is where I want to be when I am not at work.
For me, it comes down to the fact that, in addition to being the doctor/teacher – I also need to be my own scribe/transcriptionis/biller/coder/etc. ad nauseum) and answer patient meds/refilll e-requests, etc, etc. (that could all be handled by non-MDs (circling items on a sheet was SOOOO much easier that clicking 8 burrons and then having to repeat it …..until it goes through (<50% of the time – and I have to spend 35 minutes on hold (while two patients are wait) to be told that she will need to get a supervisor on the line
You all know the system is broken. 2+ decades in and am tired – spending hours trying to get tests you want authorized, filling out endless Prior Auth forms (used to be handled by nursesI I will keep trying to hold my end together with duct tape and wire coat hangers, scavanged sample and discount cards. I don't know the answer – I am trying not to drown. But if any of you have any pull – please put a word in for the PCPs – we are drowning, bad.
Thank you for this comment as it makes my point exactly. My article was written for exactly the world you live in, which is the same world almost all physicians, including myself, live in. With a little planning you are able to overcome every one of the excuses you used for not taking adequate vacation. In fact, your list is so good, I plan to use the examples in a follow up article. My goal is to help every physician who feels they can’t get enough vacation to overcome the obstacles they face and transform their vacation life to one that feels relaxed, and enjoyable, so they can return to work ready to survive a very tough schedule. Your statements show us just how tough it can be to live the life of a physician. We are overworked, can’t seem to get all the work done before we should go home, our system makes it feel like we can’t get vacation time in, have to meet many outside requirements, and consequently have a very high burnout and suicide rate. Exactly the reasons we need to get our vacations. When we operate on patients, we tell them to take time off from work to recover, because they are damaged and need to heal. We need to take our own advice. When we get run down by a super hard schedule, we need to take time off from work to recover because we are damaged and need to heal. Thanks again for your comment.
My mistake on vacation is that I do not cut myself off from work. I am still responding to emails and patient issues, and since my job is half patient care and half administrative there’s just no end of things that need to be addressed. I don’t feel like there’s anyone who is willing and able to cover while I’m gone.
Mark, This is a problem for a lot of physicians. You MUST sign out to someone to cover your patients when you are on vacation or it is not a vacation. I’m reminded of the end of one of the James Bond movies when James tells M he is going on that vacation she promised as soon as the current assignment was finished. She asked where he was going. He said, “If I told you, it wouldn’t be a vacation!”
Sign out to someone. Find another doctor in the same boat and agree to cover each other for vacation. If you are already in a group this should not be happening. If you are employed, it is not vacation if they require you to work. Put an auto responder on your emails sending back a reply that you are out of the office until a certain date and if the issue can’t wait until you get back to call X who is covering for your emergencies.
Every physician deserves to get their vacation time. Consider putting your phone on airplane mode and take a break even from your social media.
Spot on Dr Fawcett. Most of us are guilty of all of the above