November 9th, 2017

Time Off for Good Behavior: Vacation Cultures in the U.K. vs. U.S.

Megan Tetlow, PA-C

Megan Tetlow, PA-C, is from Fort Myers, Florida, now working in Sheffield, England, as part of the National Physician Associate Expansion Program. She practices in gynecologic oncology and is a guest blogger for In Practice.

When I met my doctor in the hall for rounds this morning, it occurred to me that I hadn’t seen her for a good month. We had each been alternately away — me camping in Iceland and my doc on her own holiday in sunny Spain. As she gave me a warm hello and asked with genuine enthusiasm about my trip and we chatted about our various adventures, I couldn’t help thinking that this conversation probably wouldn’t happen if I was working in the U.S. But why?

One reason is that all full-time U.K. employees have legally protected paid vacation time of 5.5 weeks. In contrast, the U.S. does not have any required vacation time, paid or unpaid. Among industrialized nations, this is uniquely American. According to recent U.S. Bureau of Labor statistics, 23% of Americans working in the private sector do not have any paid time off. And even if you are one of the lucky 77% who do have paid time off, the average you’ll get is just 2 weeks (after 1 year of service). It’s also worth pointing out that the paid vacation time mandated in the U.K. is additional to paid sick time. If you really want to make your British colleagues scratch their heads, try to explain the concept of paid time off (“PTO”) and how your sick time and vacation time can be one and the same.

Additionally, in the U.S., many Americans feel that they can’t take the vacation time they are given. A survey by Allianz Travel found that almost half of millennials (those aged 18-34) surveyed did not take the full amount of their allotted time off. And over half reported feeling either nervous, guilty, anxious, or shameful when they did request time off. These are very different attitudes from those I’ve observed in the U.K. Providers, staff, and administrators here all take their annual leave, and are highly encouraged to do so. It’s considered a right, not a privilege, and certainly has no bearing on how you’re perceived as a healthcare provider or employee.

There is also a culture here in the U.K. of supporting coworkers when they take vacation time. Upon returning from my first week-long holiday from my job in the NHS, I headed to my shared desk, gearing myself up to plow through the stack of results and letters that had surely accumulated in my absence. What I found instead was an empty cubbyhole, because my colleagues had already taken care of the work.

One last difference I have noticed is how patients react to their doctor being away. Perhaps because employees in the U.K. have leave (and take it), there’s not a question of “what do you mean Dr. xyz isn’t available?” My doctor will see a patient prior to surgery and will tell them: “I’m away the rest of the week, but the team will take good care of you” and never once have I seen a patient concerned about this. In fact, the only time I can recall a patient having a follow-up question was to ask my doctor if he or she was going somewhere nice.

I urge all of us to take a page from the book of U.K. holiday norms. If you have vacation time, take it. Tell your patients you’re unavailable. Keep your laptop closed and your emailed signed out. Go do whatever brings you joy and encourage your colleagues to do the same. Offer to help manage your colleagues’ workload while they’re away. Finally, throw any feelings of guilt out the window. You simply can’t be the best provider you can be when you’re exhausted and burnt out. Self-care is not selfish. You need to take time to unwind and recharge. You owe that to yourself and to your patients too.


Register Now for more NEJM Journal Watch Content

4 Responses to “Time Off for Good Behavior: Vacation Cultures in the U.K. vs. U.S.”

  1. Max Voysey says:

    Any evidence that UK physicians are LESS burnt out than US/ non PTO jurisdictions?

  2. Cathy Ruck says:

    So true! We (Americans) save our time up like squirrel gather nuts for the long winter….
    5.5 week is more than I can imagine …
    And sick time too?
    The Britts definitely do this right!

  3. Jeff Burtaine says:

    You couldn’t be more correct. I’ve worked for Swedish and French companies and when their summer month’s vacation comes you are NOT to call them.

  4. Yehuda A Mond says:

    There are pros and cons to every system (the drawback of the UK system is the pay…), but there are definitely things we can learn (individually or from a company standpoint) to improve our conditions in the workplace.

NP/PA Bloggers

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.