Emergency physicians serve on medicine’s front lines and have the burnout rates to show for it, topping the list of specialties with the highest levels of burnout with 56.5% doing so in 2023, according to exclusive AMA survey data. But it’s long been thought that the saving grace for emergency doctors is that once off the job, unlike physicians in some other specialties, they are truly off the clock.
Well—about that.
Nearly one-third of 1,162 emergency physicians—30.8%—who responded to AMA surveys said they took five or fewer days of paid time off (PTO) in the previous 12 months. And while 59.6% of physicians from all specialties surveyed took less than three weeks of PTO, that figure was 76.2% for emergency physicians, says a research letter published last month in Academic Emergency Medicine.
Emergency medicine “has traditionally been viewed as one of the specialties with a ‘controllable lifestyle,’” the study says, “with shift-based clinical work considered one of the draws,” while adding that the most recent analysis “raised more questions than answers about whether expectations of EM [emergency medicine] as a specialty that is amenable to work-life balance and flexibility are accurate.”
According to a separate study drawn from the same survey research published this January in JAMA Network Open, about 20% of physicians from all specialties took five or fewer PTO days in the previous year. Of the emergency physician respondents in the new study, 45.3% said they took between 6 and 15 days off, while 23.8% said they took more than 15 days of vacation in the preceding year.
Burnout and PTO
There is a clear link between burnout and the amount and quality of vacation a physician takes, with research showing that having restorative, “true” PTO and taking more than three weeks of vacation a year is correlated with lower rates of burnout.
Despite a slight reduction in the share of physicians reporting symptoms of burnout after the high-water mark in 2021, burnout remains a serious and complex problem in the U.S., with clear negative repercussions for individual physicians, U.S. health care systems and patients alike.
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™. Among those solutions is an AMA STEPS Forward® toolkit on how to reduce barriers to “real PTO” for physicians.
A vacation emergency in the ER
Unlike physicians in other specialties, most emergency physicians said in the survey that they were “not at all” influenced in their vacation decisions by lack of coverage for clinical responsibilities, the financial impact of taking vacation, or by the prospect of heavy EHR workloads upon returning to work.
Researchers found no appreciable difference in the amount of vacation days based on demographic differences of the emergency physicians, with age, gender, relationship status and the age of the physician’s youngest child not found to be factors. There also seemed to be no impact based upon the number of hours worked per week, the primary practice setting or whether the physician’s compensation was based on productivity.
The study’s authors said that it was unclear why emergency physicians took less vacation than physicians in all other specialties, noting that getting time off work in emergency medicine must be repaid as a matter of sorts.
If an emergency physician “wishes to have a week off, they likely have to work the same number of shifts that month but fitted into the days before and after the week off,” the Academic Emergency Medicine research letter says. The arrangement also means the physician must “‘pay’ for vacation by taking on more burdensome clinical responsibilities in the weeks before or after time off,” wrote the study’s authors, who include the AMA’s Christine A. Sinsky, MD, and Lindsey E. Carlasare.
Give PTO a boost
A greater percentage of emergency physicians in academic medical centers—39.6%, compared with 14.1% of those in private practice—said they spent more than 30 minutes working every day they were on vacation. And time recovering from the circadian disruption of 24-hour shifts may affect how emergency physicians view the time away from work, the research letter says.
Changes, however, can be made to encourage emergency physicians to take adequate PTO.
“Regardless of how EPs [emergency physicians] define vacation, the benefits of taking time away from work should make it a priority for physicians and their employers,” the study’s authors wrote.
Some options are decreasing expected shifts during the month that vacation is taken, letting emergency physicians “bank shifts, alter compensation models to build in PTO and using AI tools to analyze physician schedules. Finally, emergency physicians “themselves may also consider policing and limiting their own workload to allow vacation time,” the research letter says.
“This may require a change in perspective such that time devoted to vacation is not viewed as ‘lost compensation’ but rather an essential and expected part of the job that promotes career longevity and well-being,” the authors wrote.
Get the latest news on physician well-being
Subscribe for insights and real-world solutions delivered straight to your inbox.
