For most people who get paid time off (PTO), it’s an opportunity to step away from work and unplug. For physicians, however, the reality is often quite different. Their sheer volume of work can make a vacation feel less like a break and more like a change of scenery for taking patient calls.
Burnout is common among physicians — affecting an estimated 45% of U.S. doctors according to a 2023 survey — and lack of true PTO is likely a contributing factor. The concept of a work-life balance for doctors can seem unattainable when time off is consistently interrupted by work-related demands. A shift to a culture where rest is not just a luxury, but a respected necessity could benefit physicians, and by extension their patients.
Why PTO doesn’t feel like time off
A Sermo poll illustrated just how common it is for physicians to work during their PTO. 21% of voters said they always complete tasks like patient messages, admin and calls while they’re off, and 38% said they often do. Often, they feel like they don’t have any other choice. “In my practice, I cannot really say I have real time off…” writes a pathologist on Sermo. “Even if I am time off, I still feel obligated to be available if called upon.”
Sermo members highlight a deeply ingrained cultural expectation in medicine that “rest is optional,” is to blame. “It’s difficult, given the dynamics of our profession, to completely detach ourselves from work in our free time,” shares a pediatrician on Sermo.
Physicians themselves often feel like a requirement to be always “on” is inevitable in their profession. “I believe it’s important to recognize that medicine is a profession we knowingly chose,” explains an internal medicine doctor. “… I do understand the need for balance and rest, but ultimately, our patients depend on us, and that’s a responsibility we signed up for.” A family medicine physician feels the same way. “…I chose this profession at a time when I understood fully that there would be very little real time off,” they share. “… If you want a lot of free time… pick a different profession!”
Barriers to true disconnection
Physicians can feel obligated to work during their PTO for a multitude of reasons. In a Sermo poll, physicians ranked their most common barriers to disconnection as follows:
- Administrative Backlog: 32% of Sermo members work during PTO to manage the mountain of paperwork and electronic health record (EHR) tasks that accumulate.
- Patient Expectations: 29% feel a direct responsibility to be available for their patients’ needs, even when they have coverage. “It’s hard to disconnect 100% from work during time off because the tasks left pending have to do with other people’s health,” reveals a clinical radiation oncology resident.
- Staff Shortages: 16% of voters pointed to inadequate staffing and a lack of reliable coverage as their main barrier to true time off. “Our rest is affected by several factors, among them…staff shortages or excess of patients that exceed our capacity,” writes a stomatologist.
- Guilt: A smaller portion (14%) of physicians struggle with guilt when they take time off, feeling they are burdening their team or neglecting their duties.
The toll on well-being and retention
The inability to truly disconnect is more than just a minor inconvenience; it’s a direct threat to physician well-being since it can be a driver of burnout. One study found that taking 30 minutes or longer on vacation to complete work tasks was associated with higher rates of burnout in physicians.
The mental and physical exhaustion that characterizes burnout can impair clinical judgment and diminish empathy. Physician burnout can be particularly harmful compared to other professions, and is linked to lower patient satisfaction and quality of care, including medical errors that lead to malpractice lawsuits in the worst cases, one study notes. In another study, burnout in residents was linked to lower empathy for patients, leading the authors to suggest that management should take steps to reduce burnout.
It’s so exhausting that many physicians think about leaving their roles to find balance. In a survey of Sermo members, 49% said they have or have considered leaving their role because they were unable to take meaningful time off. If this resonates with you, explore our article on alternative career paths for burnt-out doctors for more.
Some Sermo members argue that employers should take steps to encourage true disconnection during PTO. “I hope physicians get institutionalized support and are not pressured into guilt when they are not available,” states an internal medicine resident.
Rethinking PTO: What physicians need
The majority of polled Sermo members are in favor of institutional support that could allow physicians to truly disconnect when they take vacation days. 50% think institutions should always provide this support, and another 32% are in favor in some settings. “Being a doctor and having the life and health of others in your hands is a physically and mentally exhausting job,” writes one OBGYN on Sermo. “There must be more strategies to preserve the physical and mental health of doctors.”
Support can include auto-forwarding e-mail inboxes or protected handoff policies that allow physicians to transfer their care while they’re gone, for instance. And tools like Sermo mobile can allow Sermo members to contact patients from their personal device without revealing their direct number; and if a patient tries to call back, the call is routed to the office.
Sermo members are also in favor of longer PTO allotments. In another poll, 46% said six or more weeks of PTO would allow them to feel more well-rested, 33% said four to five weeks and 13% chose two to three weeks.
Building a culture of rest in medicine
Sermo members suggest that in some regions, a culture of rest already exists. “I practice in Spain and vacations are sacred…” one emergency medicine doctor reveals. “I disconnect from the world of work, to come back recharged, all doctors, colleagues should do the same.”
In other areas, creating a culture of rest can require a shift in long-held cultural expectations in the medical field. “In my country it’s really difficult sometimes to manage all,” a U.S.-based GP on Sermo shares. If you can relate, you might benefit from resources designed to help promote true time off. For example, the American Medical Association (AMA) created a toolkit specific to medicine for achieving “real PTO.”
Institutions and individuals can both contribute to a culture of rest in medicine. Here are some practical steps forward for healthcare leaders:
- Normalize true coverage systems. Institutions must invest in robust cross-coverage systems where the covering physician has the time and resources to manage the additional patient load without being overwhelmed.
- Provide training in time-off management. Medical training can include modules on how to prepare for and return from leave, manage patient expectations, and execute effective handoffs. “I think we should learn to think about our own health and really take time off,” writes an internal medicine physician on Sermo “…It’s something that should be promoted in our training, because no one talks to us about these issues.”
- Institutionalize protected PTO. Hospitals and clinics should implement policies that protect a physician’s time off, such as automatically forwarding messages and redistributing critical tasks.
Physicians themselves can also take steps to move toward more restorative PTO:
- Respect colleagues’ time off. Physicians can look out for their peers. Avoid contacting colleagues who are on PTO unless it is a true emergency. Affording others this courtesy makes it more likely they will do the same for you.
- Implement boundaries during your PTO. If you manage to truly disconnect during your time off, it can help ensure that you’re able to recharge. “My favorite is now to leave for a week on vacation with no internet,” shares a family medicine physician on Sermo. Granted, it can be easier said than done. “I never stop working on vacation,” another family medicine physician reveals.
- Advocate for better PTO policies. You can advocate for cross-coverage systems and PTO-protective policies to the leadership in your workplace if it doesn’t already have them in place.
- Make an effort to use up all your PTO. It’s extremely common to leave PTO days on the table—About 46% of workers across industries in the U.S. don’t use up all their vacation time, according to Pew Research Center data. Ideally you’ll use up the time allotted to, taking time to rest throughout the year.
A cultural shift could impact physician well-being, ensuring quality patient care in the process. A well-rested doctor is a better, more empathetic and more effective doctor. “As a GP I find that when I step away from work, I allow myself the space to truly recharge,” shares one general practitioner on Sermo. “Disconnecting from my responsibilities gives me clarity, focus, and renewed compassion.”
