Seventy percent of physicians work on vacation, contributing to burnout

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Most physicians – about 70% of them, in fact – work on their days off and during vacations, while about 20% of physicians took less than one week of vacation during the previous year, research in JAMA Network Open has found.

Among those who tend to work on their vacation days, about one-third work 30 minutes or more on those days, with women more likely than men to work for that duration. Those working in Veterans Administration or an active military setting were less likely to take three or more weeks of vacation, while working in an academic setting was linked to more than twice the odds of working while on vacation.

According to the data, about 60% of physicians take three or fewer weeks of vacation per year, with one in five taking five or fewer days. In uncovering the reasons behind this trend, researchers found concerns about finding cross-coverage for clinical responsibilities and concerns about the financial impact of taking vacation, such as not meeting productivity targets or continued overhead costs.

Taking less vacation and working while on vacation were associated with higher mean emotional exhaustion and depersonalization scores, as well as lower professional-fulfillment scores. After adjusting for factors such as age, gender, specialty and practice setting, authors found that the number of vacation days taken, and having full EHR inbox coverage while on vacation, were factors linked to lower odds of burnout, while working for 30 minutes or more on a typical vacation day was linked to higher burnout.

WHAT'S THE IMPACT?

The evidence shows that many physicians are experiencing chronic work overload. Physicians work more hours per week than the general U.S. working population, with the typical full-time physician working 54 hours per week – averaging 10 hours more than other U.S. workers. Less than 10% of workers in other fields (9.2%) reported working 55 hours or more per week, compared with 40.7% of physicians.

Working longer hours per week is associated with higher rates of burnout among physicians, with an approximately 2% increase in the odds of burnout for each extra hour worked per week. And working long hours may impact workers' physical health: Working 55 hours or more per week is associated with higher rates of heart disease and stroke.

The current data suggests that most physicians are not fully "disconnecting" while on vacation, and these behaviors are likely to exacerbate the effects of chronic work overload associated with long work hours. Chronic work overload is linked to higher rates of burnout and lower professional fulfillment. 

Occupational burnout among physicians, authors said, is a serious threat to patient and physician wellbeing and health system goals. It has been associated with higher rates of medical errors, longer hospital stays, greater mortality, lower rates of patient satisfaction, reduction in work hours, turnover, excess healthcare costs, and physical and mental health issues for physicians.

"The fact that two-thirds of physicians are obligated to continue to provide clinical care to their patients while on vacation should be considered a marker of poorly designed systems of teamwork, inadequate clinical staffing, and poorly designed cross-coverage systems," the research asserted.

The study suggested that overt efforts to track and normalize vacation-taking would likely be helpful. For example, organizations could track the percentage of allotted vacation days taken and amount of patient care work done while on vacation in organizational dashboards as leading indicators of systemic stress and occupational burnout.

The data also hints that providing full clinical and EHR inbox coverage for physicians while on vacation, and reducing the financial incentives that encourage physicians to forgo vacation – such as overreliance on relative value unit-related incentive-based compensation – may increase uptake of vacation time, and help physicians disconnect more fully.

THE LARGER TREND

A 2023 survey from the American Medical Association found that 62% of emergency medicine physicians report feelings of burnout, ranking it as the top specialty affected by burnout.

Rounding out the top six most burned-out specialties are hospital medicine (59%), family medicine (58%), pediatrics (55%), obstetrics and gynecology (54%), and internal medicine (52%).

A separate survey from nurse.org showed 62% of nurses are concerned about the future of the profession, and are still reporting high levels of burnout, mental health issues and lack of support, among other hardships. About 39% of them said they were dissatisfied with their current job, though this answer varied based on education level and specialty.

Clinicians have faced new sources of stress since the beginning of the pandemic, including fear of the virus, inability to modulate workload, changes in childcare and eldercare responsibilities, requirements for care that is felt to be ethically untenable (such as rationing), and some degree of questioning their meaning and purpose in the profession, JAMA Health Forum researchers found in 2022.

These stressors have led to clinician exhaustion and burnout and turnover from practices, issues that are unsustainable, authors said.
 

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.