Are vacation days taken and working while on vacation associated with physician burnout?

By Priyanjana Pramanik, MSc.Jan 17 2024Reviewed by Lily Ramsey, LLM

In a recent study published in JAMA Network Open, researchers explored associations between the vacation days taken by physicians per year, how much work they do during that time, and professional fulfillment and burnout.

Their findings indicate that most surveyed physicians work on vacation, primarily due to financial concerns and challenges in finding someone to cover their responsibilities.

Study: Vacation Days Taken, Work During Vacation, and Burnout Among US Physicians. Image Credit: Iryna Rahalskaya/Shutterstock.com

Background

Physicians around the world are experiencing persistent work overload. In the US, doctors work 54 hours a week on average, far longer than the rest of the working population.

Longer working hours are not only associated with high levels of burnout but are also detrimental to health – they have been associated with a greater incidence of mental health issues, stroke, and heart disease.

The consequences of physician burnout go beyond its effect on the doctor and their family – it can lead to medical errors, lower patient satisfaction, longer hospital stays, and even higher mortality.

Time spent away from work offers opportunities to rest and can improve work performance, increase productivity, life satisfaction, and professional fulfillment, and reduce burnout.

Little research has been done on how US-based physicians utilize their paid time off and the role of institutional policies in facilitating or hindering vacation time.

Previous studies have suggested that one-third of doctors took two weeks or less time off per year and that disconnecting from work reduces depersonalization and emotional exhaustion, which are known to contribute to physician burnout.

There may also be gender inequities, as there are indications that women work longer after hours and show higher rates of burnout than their male colleagues.

Further investigation is required to identify the role of institutional factors in facilitating improved work-life balance for physicians and enhanced patient outcomes.

About the study

Researchers used an almost complete list of all physicians in the US who were invited to participate in mailed or electronic surveys between November 2020 and March 2021.

By comparing the demographic information of the participants, the research team was able to conclude that their sample was representative of the US population of physicians.

The vacation component of the survey, which was sent out to randomly selected physicians, included questions about how many vacation days physicians took each year, their inbox coverage while they were away from work, how much time they spent working on vacation (WOV), and the barriers they faced in taking vacation time.

They were also asked if they had electronic health record (EHR) coverage while on vacation. Other survey components assessed their depersonalization and emotional exhaustion levels through the Maslach Burnout Inventory. At the same time, the Stanford Professional Fulfillment Index was used to measure physicians' levels of occupational fulfillment (0-10, with higher scores indicating higher fulfillment).

Demographic questions included gender, age, relationship status, weekly hours worked, specialty, and practice setting. The data were analyzed using t- and χ² tests, analysis of variance, and multivariable logistic regressions.

Findings

Out of the entire physician population, 3,128 were sent the vacation component of the survey, and nearly 97% answered at least one question, though sample sizes varied for each vacation-related question.

Almost 60% of respondents took less than three weeks or less vacation time per year, and less than half said they had complete EHR inbox coverage during their vacations. Over 70% spent at least some time working on a typical vacation day.

Across specialty disciplines, physicians in general internal medicine, emergency medicine, family medicine, physical medicine, and rehabilitation were least likely to take more than three weeks off. Urologists, neurologists, and surgeons would most likely work at least 30 minutes daily while on vacation.

More than 33% of physicians felt that financial concerns, EHR work accumulated while away, and finding another provider to take on their clinical responsibilities were significant barriers to vacation time.

In the multivariate analysis, married physicians were likelier to take more than three weeks of vacation. Physicians were significantly less likely to WOV if they had full EHR coverage, but only half of physicians did so.

Female physicians also reported higher levels of WOV, as did physicians who worked at academic medical centers and had children between five and 12 years.

Physicians who worked longer hours were more likely to report WOV. Respondents who took more than three weeks of vacation and had full HER inbox coverage were less likely to report burnout. Still, WOV was associated with higher burnout rates and lower professional fulfillment.

Conclusions

Systemic changes that encourage physicians to take three weeks or more vacation time and ensure that they do not need to work during that period can improve their work-life balance, reduce burnout, and benefit patients and the healthcare system.

The first step to doing so is normalizing the practice of disconnecting from work while away and providing the necessary organizational support to ensure physicians can make the most of their paid time off.