Fewer vacation days taken, working while on vacation increases physician burnout
Click Here to Manage Email Alerts
Key takeaways:
- Fewer female physicians reported taking more than 3 weeks of vacation than male physicians.
- More female physicians reported performing 30 minutes or more work while on vacation vs. male physicians.
More than half of physicians surveyed reported taking less than 3 weeks of vacation annually and most reported performing patient-related work while on vacation, according to study results published in JAMA Network Open.
Researchers recommend system-level efforts to ensure physicians take adequate vacation days and provide coverage for clinical responsibilities, including electronic health record inbox, to help reduce physician burnout.
Anecdotal observations
“We observed anecdotally that many physicians were not able to take their full allotted vacation time, and many physicians felt obligated to perform patient-related EHR inbox work while ‘on vacation.’ We, therefore, wanted to know how common these vacation behaviors were and to determine if they were associated with higher rates of burnout,” Christine A. Sinsky, MD, MACP, AMA vice president of professional satisfaction, told Healio.
“Burnout among physicians is at an alarmingly high level,” Sinsky said. “This matters to patients because errors are higher when physicians are burned out. It also matters to payors because of higher health care costs associated with burnout, and to organizational leaders because of higher rates of physician turnover with burnout.”
Researchers conducted a cross-sectional survey among 3,024 physicians between Nov. 20, 2020, and March 23, 2021, to assess individual and organizational characteristics in the number of vacation days taken annually, the magnitude of physician work while on vacation, and the association with physician burnout and professional fulfillment.
They collected the number of vacation days taken within the previous year, time spent working on patient care and other professional tasks per typical vacation day, EHR inbox coverage while on vacation, barriers to taking vacation and other standard demographics. Then they used the Maslach Burnout Index to measure burnout and the Stanford Professional Fulfillment Index to measure professional fulfillment.
Survey findings
Results showed that 59.6% of physicians reported taking 15 or fewer vacation days within the previous year, with 19.9% taking five or fewer days.
Researchers additionally found that 70.4% of respondents reported performing patient care-related tasks while on vacation, including 33.1% who reported working 30 minutes or more on a typical vacation day.
Of note, only 49.1% of physicians reported having full EHR inbox coverage while on vacation.
Results of univariable analysis showed a lower proportion of female physicians who reported taking more than 3 weeks of vacation vs. male physicians (38% vs. 41.9%).
In addition, more women reported performing 30 minutes or more work while on vacation compared with men (38% vs. 30%).
Results of multivariable analysis that adjusted for personal and professional factors showed concern among physicians over finding coverage of clinical responsibilities (somewhat concerned, OR = 0.48; 95% CI, 0.35-0.65; very concerned, OR = 0.3; 95% CI, 0.21-0.43), as well as financial concerns (somewhat concerned, OR = 0.49; 95% CI, 0.36-0.66; very concerned, OR = 0.38; 95% CI, 0.27-0.54) that led to a decreased likelihood of taking more than 3 weeks of vacation annually.
Factors associated with lower rates of burnout included taking more than 3 weeks of vacation annually (between 16 and 20 days, OR = 0.66; 95% CI, 0.45-0.98; more than 20 days vs. none, OR = 0.59; 95% CI, 0.4-0.86) and having full EHR inbox coverage while on vacation (OR = 0.74; 95% CI, 0.63-0.88).
Conversely, factors associated higher rates of burnout included spending 30 minutes or more per vacation day on patient-related work (between 30 and 60 minutes, OR = 1.58; 95% CI, 1.22-2.04; between 60 and 90 minutes, OR = 1.97; 95% CI, 1.41-2.77; more than 90 minutes, OR = 1.92; 95% CI, 1.36-2.73).
‘Actionable results’
“These are actionable results. Physicians have a human need to periodically truly unplug from work and recharge,” Sinsky said. “Health system leaders who want to reduce burnout, and thereby also anticipate reducing turnover and improving quality, can make tangible changes to support physicians taking full vacation. Ensuring full inbox coverage while on vacation and reducing any financial penalties for taking vacation are practical steps to reduce burnout and improve care delivery. We have been able to demonstrate an association between these three vacation characteristics and burnout.”
Researchers recommend the need for longitudinal studies to determine the efficacy of systemic interventions to support the taking of full vacation time, including changes in cultural expectations, practice-level support and financial incentives.
“We are all better physicians when we care for ourselves as well as our patients,” Sinsky said. “We are also better parents, partners and friends. We can prioritize our own individual efforts to truly take vacation while also working for systemic changes, so that our organizations provide institutional support for individual self-care.”
For more information:
Christine A. Sinsky, MD, MACP, can be reached at christine.sinsky@ama-assn.org.
Collapse
Read more about
Click Here to Manage Email Alerts