What makes taking time off different for physicians than for other professionals? It’s the clinical coverage responsibilities that do not seem to stop when physicians are on vacation because, after all, patients still get sick and require care.
There’s also the EHR inbox, which is a huge burden for physicians. This gets in the way of physicians being able to fully step away, contributing to burnout. And it is why health systems need to figure out how to help physicians take that much needed personal time off (PTO) without logging into the EHR.
“The bottom line is that physicians who do not take time off, who do not take vacation, have higher rates of burnout,” Jill O. Jin, MD, MPH, an internist and senior physician adviser for the AMA, said during the AMA STEPS Forward® Innovation Academy’s most recent “Saving Time: Practice Innovation Boot Camp.” The boot camp aims to equip attendees with the time-saving tools and strategies needed to reform their organizations and enhance professional satisfaction.
Researchers have found that “spending over 30 minutes per day working while on vacation was linked with a higher risk of burnout. And then on the flip side, those who took more than three weeks of vacation per year were at a lower risk of burnout,” Dr. Jin said. Also, “we know that burnout is linked to turnover and intent to leave. So, there is a cost to organizations when physicians don’t take vacation.”
That is why it is important to move from “pretend time off” to “real PTO,” she said.
During the boot camp, Dr. Jin shared three steps health care organizations can take to encourage physicians to take that much needed time off. These steps are part of an upcoming AMA STEPS Forward toolkit that will be discussed in the June 18 webinar “Reducing Barriers To Physician PTO.”
Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.
Far too many American physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.
Normalize the culture of time off
“This might be the hardest step of all of them because for physicians, the culture of self-sacrifice, feeling like you should be on 24/7, is so deeply ingrained,” Dr. Jin said. One way to overcome this is by ensuring “that leaders model taking time off for themselves.”
That means as a leader, when you “are off or on vacation, don’t check your email. Don’t respond to emails. Let your team know that you’re taking time off, that you’re on vacation, that you also need time off and that’s normal and that’s human,” she explained. Additionally, “incorporate respect for time off into professional etiquette. If you know your colleague is on vacation, don’t email them.”
It is also important to try not to praise working while off. That sends the message that organizations want physicians to work while on vacation, Dr. Jin said.
Provide adequate coverage
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Health care organizations should provide adequate coverage of clinical responsibilities. This means both direct patient care as well as the EHR in-basket.
“The bottom line is the physician who is away should not feel the need to be checking their inbox while they’re away. They should have full coverage of their inbox by a team member through the team-based care model, where most things can be handled by a nonphysician team member,” Dr. Jin said. “The other part of this is that the burden to find this coverage should not fall on the person who is taking time away. This should be the responsibility of the organization to have a plan in place.”
Include PTO in compensation model
“A lot of physicians who are productivity-based complain that they have no paid vacation. But that is actually not true, because they’re still getting a paycheck during their weeks of vacation.” Dr. Jin said. “What is important to realize is that what physicians really are complaining about when they say we get no paid vacation is that we have no guilt-free paid vacation in terms of RVU [relative value unit] losses.”
“The key is that there is a difference between compensation versus expectation,” she said. “The big barrier is the expectation piece—as an organization, whatever your expectation is for the weekly RVU generation for your physicians has to be realistic and attainable, and it has to be something that’s less than 52 weeks a year. This includes thresholds for productivity bonuses—it has to be realistic and take expected time off into account.
For example, “if physicians have three to five weeks of vacation a year, add that onto a week of CME and then holidays, which are about 10 days or two weeks a year—that’s about six to eight weeks per year of nonproductive time,” Dr. Jin said. “That translates to 44 to 46 weeks of productive time per year. That’s the number that you should be budgeting for.”
