Yes, Every Physician Can Get Better Vacation Time; Here’s Some Tips

A few weeks ago I published an article titled Many Physicians Waste Their Vacation Time. It is the preface to today’s article, so if you haven’t read it, click on the link to do so before continuing with this article. One physician wrote me, in response to the above article, expressing the issues they faced when trying to book vacation time. This is a great example of the type of person I geared my article towards: The physician who truly believes they cannot get the time off they need because of outside pressures. 

So today I will take each of this readers obstacles and give options on how to overcome each difficulty. Without outside coaching we tend to get stuck in our same thought process. We get hung up and tell ourselves things like “That’s the way we’ve always done it,” “No one will agree to what I want to do,” “But my situation is different,” “You just don’t understand what I’m dealing with,” or “These all sound like perfectly reasonable ideas…in a world I don’t live in.”

That last quote is the opening quote from the physician who responded to my article, the false assumption that my world as a general surgeon was vastly different from their world as a family doc doing obstetrics. Our worlds are more similar than they are different. We face nearly identical challenges when taking time off. We are both over worked, don’t get enough time off, need to coordinate our time off with our colleagues and schedule it well in advance, burdened with taking call, need to have someone cover for us when we are absent, have a pile of work accumulated when we return, have more patients who want to see us than we have time to see to name a few.

If you feel the same as this reader, you are not alone. Many physicians suffer with the same issues, which is why I wrote the original article. While reading the following the sentence in bold is the physician’s situation or concern followed by my comments on getting around that obstacle. Keep an open mind, look at the options I present, and find the ones that will work for you. You deserve to take all your vacation time.

Taking more than a week off at a time. This is barely do-able on rare occasions (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).

This is such a common issue, many physicians think they can’t take more than one week off at a time. Interestingly, this physician says they have done it in the past. If it was done once, it is doable. Since a situation worked out to take two weeks off in a row by combining CME with vacation, a larger block of time can be taken again in the future. It doesn’t matter why one is gone, if the practice got by without you for two weeks once, then they can do it again. 

Having a rule that only two of the six physicians can be out at a time isn’t an obstacle at all. That is how all physician offices work. Schedule your vacations well in advance (this has many advantages) so you are the first one who is scheduled out. Then the others will be making their vacation schedules around your schedule. If you are scheduling in advance and two people already have the time off you desire, then you have plenty of time to adjust it away from their dates. Planning well in advance leaves a lot of wiggle room. 

Scheduling vacations well in advance also eliminates trying to work around the call schedule, the need to move patients that are already booked, having to dance around the other physician’s schedules, fighting for space at overbooked resorts, and sold out airlines. These factors make advance vacation planning less time consuming on your busy schedule.

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

Call coverage is a universal problem for physician vacations. Our patients need someone to contact whether we are in town or not. Here is how we handled this in our practice of six surgeons. I made sure I left on vacation with everything caught up. If you need a lighter day to get caught up before you leave, then when you book your vacation be sure the day before is set up to be a light day. Don’t cram it full. Never do a big procedure and then jump on a plane.

When a patient called in with an urgent concern, the call was forwarded to whoever was on call that day. Whether your call is one day at a time, one weekend at a time, or one week at a time (I’ve worked in all three situations) this system automatically spreads the work evenly. You will be covering for others on vacation just as much as they cover for you. You are all in the same boat and you all need your vacation time. So, work together to find a solution that works for everyone. 

If you were able to cover for four other doctors at the same time, then they will have no problem covering for you when you are on vacation.

You have your own nurse? That sounds delightful!

This comment was in response to me suggesting having your nurse handle the phone calls. No, I did not have my own nurse, the six physicians in my office shared one nurse. 

The nurse or physician’s assistant or whatever other type of person you have helping out at the office can handle some of the issues that come up while you are gone. They should know it is part of their job to handle those issues for any doctor who is out of the office. If the assistant can’t handle a particular question, then they can take the issue to the doctor on call.

Use the available tools you have in your practice even when you are not on vacation. Your staff are there to make your life better; pass off everything that they are qualified to handle. 

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 whole time.

Anytime you tell yourself “that sounds like heaven” you have found an opportunity to improve your life. When you say that, start making plans to make it happen. 

If you are scheduling your vacations well in advance, there will be no patients on the schedule yet. Figure out how much time it takes you to catch up after a vacation and book that amount of time patient free when you return to work. If your first day back requires about a half day to catch up, then book the morning with no patients. This is not time off, this is not part of your vacation, this is working time. You will be in the office working, just not seeing patients. Then when the afternoon patients begin, you are all caught up and ready for your first patient.

Don’t allow your schedulers to “double book” anyone without your expressed permission. Look back at how often you “double booked” patients and plan ahead for them. Every office has a need to work in urgent patients just like you do. You can look back and see how frequently that happens in your office. If it averages two people per day, then book two open slots every day that are used only for working in last minute urgent patients. This is a slot that can only be used within 24 hours of it opening and only for a truly urgent patient. If the slot goes unused some days, that is a bonus!

If it takes three weeks to recover from a vacation, then it’s imperative you make changes immediately. You cannot live your life dreading vacations because of the workload you face when you return. You must make accommodations for this. You are not the only doctor facing this problem. Don’t ignore it, fix it. Sit down with your colleagues and find a solution so you don’t all continue in misery.

Not taking all of my 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!

If you are on salary and you get paid the same whether you are on vacation or working, it is a horrible choice to skip your vacations. After all, it is part of your contract, and you don’t get paid for the extra work you do when you should have been on vacation. 

I’m glad that your boss knows the importance of taking time off and has found a way to force you to include vacation in your schedule. However, it is a grave mistake to let your schedulers pick when you are on vacation. If you don’t care about your vacation time, then your time off will never be good. Vacations are to rest, and recharge … so you can return to work excited and ready to do your best.  

Since you are married, have your spouse coordinate your vacations with the office if you don’t have the time.

If your boss is forcing you to take a vacation, you are by definition a workaholic. Get that problem under control. The real issue is not that you don’t have the ability to take your vacations, it is you don’t have the desire to do so.

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 vacation weeks, plus my weekends, plus my evenings) 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.

This is an entirely separate issue. It goes along with being a workaholic. You are either seeing too many patients, doing too much paperwork, or you need to learn to do it quicker. Whatever the reason, please address this so you are not taking work home or spending vacation time to complete your work.

NEVER, NEVER, NEVER use your vacation time to catch up at work. If you do, your time off is not a vacation and you are on the fast road to burnout.

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!

This is getting to the heart of the problem. Families with kids make their kids a priority. The kids are included in the schedule. It is not easy to do, but family time is very important. Everyone has the choice of what they do with their non-working hours. Look at your schedule and you will see where your priorities lay. 

You have the luxury of a lot of extra time most physicians do not have since you don’t have children. Soccer games, dance recitals, birthday parties, tennis lessons, school functions, kid’s sick days, or the time it takes to arrange a sitter are not even in your week. Exactly what are you doing with all that extra time you have?

We are encouraged to take a week or nothing – scheduling is too crazy otherwise.

This is the perfect situation. When you do take time off it forces you to take it in one-week increments. So try two or three weeks at least once a year. I took one week vacations most of the time. But once every summer we loaded up the motorhome and took off on a three week vacation. That was heaven. Try it sometime. My practice never fell apart while I was gone.

Ten years ago I bought my forever home and THAT is where I want to be when I am not at work.

I love this concept. Your home should be a sanctuary of joy, not a ball and chain around your neck, which is often what the “Doctor McMansion” turns out to be. 

One thing you can do to make sure your home stays that way is to not bring work home. I had one client who struggled with bringing work home. We devised a system for him to blow a whistle at the end of the work day to signify the ref has now ended the game. Since the game is now over, he stop playing.

This worked well for him as he could feel a symbolic clean break between work and home. They could stay separate that way. He also blew the whistle just before getting out of the car at the office in the morning to signal the start of the game.

I hope my answers to the questions above will provide some examples to help you craft a working situation that is conducive to taking your vacations in peace. You all work very hard and need down time to recover. When we operate on a patient we tell them to take time off work to heal. We doctors need to take the same advice. Our jobs can injure us and we need to take time off to heal.

If you are struggling with not taking enough time off or not enjoying coming back to work after a vacation, my High Performance Coaching Program can help. Or, ask your colleagues who seem to have it together to show you how they include vacation into their schedule. Please take your vacations.