July 20th, 2017
Needing a Vacation after your Vacation? Primary Care Providers Feel the Same!
Elizabeth Donahue, RN, MSN, NP-C
Elizabeth Donahue, RN, MSN, NP-C, practices adult primary care medicine in Boston, MA.
I just finished a week of vacation and, truth be told, I’m seated at a bar on this particular Sunday night seriously considering early retirement. Small problem being, at the tender age of 34, it’s probably a little too soon for this to be a feasible option. I’m trying to figure out how to make retirement work because I’m seated at this bar because of its excellent internet connectivity and not because of the attractive cocktail list. I have a salad and a glass of water and my laptop before me. I’m checking messages, prescription requests, and lab results from the last week — preparing to return to work tomorrow, hoping to reduce the to-do list before I’m physically back in action and actively adding to it.
I know that I’m not alone in this experience. A physician colleague returned from her own vacation about two weeks ago and since we she was in Europe (where she was less able to dock in remotely), she was completely overwhelmed on her first day back in the office. A full clinic day scheduled, with the backlog of messages and requests, and just one really sick patient to manage can leave even the most competent and experienced provider flummoxed. And all of this occurs despite having in-office coverage by a colleague for “urgent” requests and likely several hours of advance work put in by the provider in the week before vacation. It’s leading me to be a little more inquisitive about vacation practices in healthcare settings.
A photo from my recent vacation in Burlington, Vermont (Lake Champlain in background)
How much vacation do most providers take? Are there specialties that find it easier to take a vacation than others (perhaps some that have less continuity of care burden)? What is the impact of all of the technology we have in 2017? Electronic health records make accessing messages and records outside the office quite easy, smartphones connect our work email instantly, almost unavoidably keeping us tied to work? Why do providers struggle with completely “signing out,” and are patients willing to accept that providers need time off too?
A quick internet search shows that general vacation policies in the U.S. are widely varied. Ours is one of the only developed countries that does not have labor laws dictating that employers MUST provide paid vacation time to employees. Other developed countries are required to give employees an average of 2 to 4 weeks of vacation per year. Small U.S. employers are unlikely to give any paid vacation while other companies have recently begun to provide unlimited vacation time (most are startups and technology companies but this has also been seen with more traditional companies like Grant Thornton and General Electric). I’m not sure unlimited vacation time would get any legs here in the healthcare industry! Like U.S. vacation policies and practices in general, those among healthcare providers also seem to vary; one survey in 2012 showed that anesthesiologists and radiologists reported taking nearly twice as much vacation time as their colleagues in family and internal medicine.
Wareham, MA
How do you manage your vacation time? How often do you find yourself checking in when you’re not in the office, and how do you support your colleagues when they are on vacation? I’d love to hear about your experiences.
All early (OK, really early) retirement dreams aside, I will likely work until the average primary care provider retirement age of 65. Until then (actually, until my next vacation), back to that to-do list!”
10 Responses to “Needing a Vacation after your Vacation? Primary Care Providers Feel the Same!”
NP/PA Bloggers
Elizabeth Donahue, RN, MSN, NP‑C
Alexandra Godfrey, BSc PT, MS PA‑C
Emily F. Moore, RN, MSN, CPNP‑PC, CCRN
Advanced practice clinicians treating patients in a variety of settings and specialties
Learn more about In Practice: Reflections from NPs and PAs.
This is a story of pre-burn out – not a “vacation failure”. One way burnout creps up on us is validating the notion that you (singular) are “essential” to everything – when in fact you are essential to nothing (sorry for the ego blow – but it’s a clinical fact).
More vacation does not usually relieve these types of patterns. . . .
I don’t “keep up” during vacation, but always spend 1/2 day per week of vacation catching up. My catch-up days are on the weekend before I return to work. This is how I ran my solo Family Practice for 20 yrs.
Now that I work at the VA, they are astounded that I will come in on a weekend day to catch up. But knowing I’ll do that makes vacation more enjoyable, and during vacation I can leave work at work. And I don’t plan to retire until I can’t do the work anymore. But I’m of the generation that precedes you.
We all need to completely disengage. Hard to do for sure but as Max says, necessary to realize that we can leave our work to others and go away to actually clear our minds. It will be interesting to see what happens to the “younger” folks who are addicted to their ipads and cell phones and just can’t disengage. In the business sector, many are engaging while on vacation nonetheless. In medicine, the stress makes it all the more necessary to put it all down for at least a few days.
Dave
I am just today returning from vacation as well. I feel your pain, though early retirement is more feasible for me at 60. Glad to hear it’s not just us old farts, who matured before the computer revolution, who are feeling the pain.
In our practice, vacationing clinicians are covered more thoroughly by colleagues than in yours. All refill requests are routed to the on call doctor, and all of us pitch in on the inbox. I would really rather not come back from vacation to a 2 week old scary lab result. That makes covering a vacationing clinician a pain, but it is well worth it when you are on your own vacation. Quid pro quo is a defining characteristic of our species, after all.
Still, I spent an hour cleaning things up yesterday, and still have some stuff that can’t be done remotely waiting for me. During a usual work week, the only day I don’t log in is Saturday, and that’s only if I’m not on call.
In our primary care clinic, we pair up with another provider for vacation coverage. Our team based approach allows a provider to go on vacation and not feel a need to “check in”. Some do, but that is their personal choice. The covering provider is responsible for everything that comes in both electronic and paper. It makes for some additional work by the covering provider, but we have keep it running smoothly for 9 years so far on our team. I always make sure all my work is cleared before I leave, notify my coverage of issues which may come up, and then tune out. I do clear out email once daily on vacation, just to keep up. I usually spend several hours the day before coming back catching up and any pre-work for the upcoming week. I take roughly 4 weeks of vacation a year and random days off in other months to just keep with life outside of work.
I am a solo pcp with an NP. Vacation is critical to preventing burnout! I take 4-5 weeks every year and can’t quite understand how other physicians take little or no vacation. Having said that, taking vaction does mean planning on doing some catch up prior to your return to make your first day back as manageable as possible. I like to spend an hour every few days on vacation checking my messages in my emr and email, but an alternative is to schedule a day or two at home prior to your return to do this necessary work. I do agree that we are not indispensable, but that doesn’t mean we will have no extra work to attend to upon our return. We have a great system in place so that the majority of work is completed, but there is paperwork my NP cannot complete in my absence and I have administrative duties that also fall out of her responsibilities.
As a general internist, my vacation time has grown over the last 30 years of practice from 1 week per year to currently about 1 week per 3 months. My vacation coverage in my group primarily consists of partners’ screening tasks for critical issues that can not wait for my return. This leaves me with a substantial number of in-box tasks on my return. As a result I have made my first day back from vacation an “admin + urgents” day. As I leave for vacation, that first day back has no patients scheduled. However, during my absence, staff may add the few patients identified with truly semi-urgent needs into that day’s schedule. On the day of my return I will also see urgent same-day patients. This typically leaves me with several hours of “down” time to catch up with the backlog of tasks in my in-box so that I can start the second day back with a clean slate.
In addition, I have found over the last 30 years, a number of situations where my unique knowledge of a specific patient’s clinical circumstance could or would make the difference between an easily resolved problem versus a “therapeutic misadventure”. As a result, I always make my cellphone available to my staff for curbside consultation while I am away. They are always judicious in its use and I find the grief that it prevents, and the reduction in my vacation anxiety for what minefield I may return to, is well worth the sacrifice of not fully cutting the umbilical cord.
These two key policies have gone a huge way to improving the quality of my vacations and leaving my battery feeling recharged even after the first day back.
(In another chapter we can discuss how the overwhelming nonclinical burdens of modern care effectively re-drain my battery in time for my next vacation!)
When I take a vacation, I have a colleague cover for the “urgent ” needs and prescriptions. When I return, I take the first 2hr on day one to get messages done and catch up. I learned to do this after having the same experience as the author. There is no sense in taking vacation if you cannot really relax and unwind. Knowing that you have a mountain of work to return to gets in the way of your final days of rest and leaves you with a truncated vacation. We are very dedicated to our work but we can’t take care of others if we don’t take care of ourselves. Being able to access all our work from anywhere, anytime does allow for some flexibility but you have to set boundaries. Set a time nightly where you are off all electronics and do not look at emails or work items. Without those boundaries, I find myself working all the time. After all, there’s always more work to be done . The truth is, I’m more efficient when I set those boundaries and my work quality is improved as well. These are a few ways to individually prevent burnout . Still, organizations need to help too as a lot of burnout comes from the environment in which we do medicine.
As a retail pharmacist, our struggles are similar yet different. Three years ago I had been working 70-80 hours a week and was tied to the pharmacy. Even when I did leave, my phone was always going off. But here I am now to tell you it’s partly our fault for letting that happen. We vacation out of the country more often than in the US because my husband wants to make sure I have no internet access therefore I CANNOT check my phone. It actually feels good to leave the room and not even carry my phone unless I want to take pictures. We NEED to disconnect. It’s good for our health and we all know we are the worst patients. Health care professionals never put themselves first and if you are parents as well, you are really on the bottom of your own list. And as rewarding as it is to be needed to keep work afloat, and no matter how good we are, we are completely replaceable even if you don’t think you are. I left an insanely busy 24 hour retail store to take a better offer and that previous store fell apart. But you know what? They still go on every day and they survived. Long story short, we need to put ourselves first or there won’t be anything left of us to help anyone. Now I clock out and go home and rarely ever consider the store. I don’t get paid to worry and internalize what may be happening when I am not there. I often work extra before I leave and when I return but no working on days off. Those are for me and my family and we deserve that. So do all of you.
I am an American doctor who came to NEw Zealand for a year long sabbatical 3 years ago and never left. I practice in a small town on the South Island. Our District Health Board employs 2 full time locum doctors to cover vacation for the 20 + GPs in the district. I returned from a 3.5 week vacation with an empty inbox and nothing to “catch up”: so different from my practice in the US where the end of vacation was filled with dread of the pile of things to do. Seems to me that larger groups (eg hospital affiliated systems) ought to be able to arrange the same thing but in my experience they never do.