Docs’ Vacation Habits May Be Fueling Burnout

Taking fewer vacation days and working during vacation time were associated with higher rates of burnout among physicians, according to a cross-sectional study.

In a nationally representative survey of 3,024 U.S. physicians, 59.6% reported taking three or fewer weeks of vacation time over the previous year, while 70.4% reported working during a typical vacation day, including tackling patient care-related tasks, said Christine A. Sinsky, MD, MACP, of the American Medical Association, and co-authors.

Only about half of respondents reported having full coverage of their electronic health record (EHR) inbox while on vacation, the authors wrote in JAMA Network Open.

On multivariable analysis, physicians who vacationed for 16-20 days (OR 0.66, 95% CI 0.45-0.98) or more than 20 days (OR 0.59, 95% CI 0.40-0.86) each year had lower odds of burnout compared with physicians who didn’t vacation at all. Meanwhile, having full EHR inbox coverage while on vacation was associated with lower rates of burnout (OR 0.74, 95% CI 0.63-0.88).

Furthermore, spending 30 minutes or longer per vacation day on patient-related work was associated with higher rates of burnout:

• 30-60 minutes: OR 1.58 (95% CI 1.22-2.04)
• 60-90 minutes: OR 1.97 (95% CI 1.41-2.77)
• >90 minutes: OR 1.92 (95% CI 1.36-2.73)

“We had observed anecdotally that many physicians were not able to take their full allotted vacation, and in addition, that many physicians felt obligated to do patient-related EHR inbox work while ‘on vacation,'” Sinsky told MedPage Today. “We wanted to know how common these vacation behaviors were and to determine if they were associated with higher rates of burnout.”

Sinsky said that 63% of U.S. physicians have reported symptoms of burnout; because of the prevalence of these symptoms, the quality and quantity of time away from work appears to be very important for physicians.

“Burnout among physicians is at an alarmingly high level,” she noted. “This matters to patients, because errors are higher when physicians are burned out.”

Sinsky said that this issue should also matter to payers and healthcare organizations because higher rates of burnout have also been shown to be associated with higher healthcare costs and higher rates of physician turnover.

“Like other workers, physicians have a human need to periodically truly unplug from work and recharge,” she 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.”

The researchers initially invited 3,128 U.S. physicians to participate in the vacation survey between Nov. 20, 2020 and March 23, 2021. In total, 3,024 (96.7%) completed at least one item on the survey. Most of the respondents were men (62%) and 35 to 64 years old.

The survey consisted of a series of questions about the respondents’ number of vacation days taken each year, the coverage of their EHR inbox during vacations, and time spent working during vacation days.

Burnout was measured using the Maslach Burnout Inventory, which assesses emotional exhaustion and depersonalization dimensions.

On multivariable analysis, concern about finding someone to cover clinical responsibilities and financial concerns were associated with decreased likelihood of taking more than 3 weeks of vacation per year.

The study was limited by its cross-sectional approach, the authors noted. In addition, survey participants did not report details about time off outside of vacation time, which could have had an effect on the results.

“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.”