It’s not that physicians don’t want time off. Typically, they’re even given vacation time, with surveys showing that the average physician gets 25 to 35 days of paid time off (PTO) per year. But there’s a disconnect, experts say, pointing to a 2024 study of thousands of physicians in the U.S. in which about 60% said they took 15 or fewer days of vacation per year. One in five took less than five days.
“It boils down to having adequate clinical coverage for your patients—that's both direct patient care as well as the EHR in-basket or inbox coverage while you're gone,” said Jill Jin, MD, MPH, an internist at Northwestern Medicine, senior physician adviser for the AMA, and co-author of the AMA STEPS Forward® “Value of Feeling Valued Playbook.”
“Another challenge is the compensation and having this time off not have any negative effect,” Dr. Jin added.
Physician burnout, which brings with it a cavalcade of downstream negative consequences, continues to be a pervasive problem. Though the percentages of physicians reporting symptoms of burnout have declined from the sky-high numbers seen during the COVID-19 public health emergency, nearly half of physicians still say they’re experiencing burnout.
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.
One proven factor related to lower burnout levels is feeling valued in an organization. The playbook makes the case for showing physicians they’re valued and lays out five strategies that organizations and leaders can use to accomplish that goal.
The second strategy covers how to ensure that physicians are getting the kind of restorative time off that pays dividends for everyone from the doctors themselves to the patients they treat. Some of the benefits of taking PTO of both adequate quantity and quality include reduced burnout—which can reduce turnover and lower costs—and improved engagement and patient care.
Changing over to “real PTO”
Physicians, the playbook says, want to take PTO. Yet they also don’t want to compromise patient care, don’t want to burden their colleagues and don’t want to face a mountain of work upon their return. And the vast majority—70% of physicians—work on a typical “vacation day,” rendering it a break in name only.
“As a result, their PTO is not truly time off—but rather ‘pretend time off’—so what's the point in taking it?” the playbook reads.
Real, restorative PTO brings with it a multitude of benefits. Taking more than three weeks of vacation per year and having full EHR inbox coverage while out were both associated with lower odds of burnout, research shows. And spending too much time on patient-related work while on PTO was associated with higher rates of burnout.
So, what’s the key to reaching “real PTO?”
The playbook offers seven steps:
- Embracing real PTO’s components.
- Understanding the business case for real PTO.
- Normalizing the culture of taking time off.
- Providing adequate coverage, including EHR inbox coverage, during PTO.
- Creating reasonable on-ramp and off-ramp policies.
- Designing a compensation model that includes adequate time off.
- Tracking time off to ensure fairness.
Making compensation work for PTO
There’s no doubt about it: Figuring out compensation related to PTO can be tricky. But the resultant positive effect for physicians is worth the time investment.
“Compensation is very complex and there are different models,” Dr. Jin acknowledged. “Whether you’re productivity-based or salaried makes a difference. There are so many different compensation models and it's hard to have one solution.”
The playbook provides ways to reduce or remove the financial hit physicians take when they are on vacation, with specific suggestions for different compensation models, including salary-based, RVU-based and alternative compensation structures.
For productivity-based compensation, Dr. Jin said it’s important not to base thresholds for bonuses on 52 weeks a year. If organizations do that, she said, then it will be virtually impossible for physicians to hit their desired markers and still take time off.
“If you set the markers based on a 44- to 46-week productive year, which is what's realistic with adequate PTO … if that's set as your 100% productivity, then it's much more realistic for physicians to reach their threshold for the bonuses,” she said.
There is an optics issue, as well, when compensation and schedules are so complex that the true financial impact of PTO is hidden from physicians.
“The bottom line is making sure there's no real or perceived compensation penalty, and I say perceived because sometimes there’s not actually a significant difference in compensation from taking time off,” Dr. Jin said, “but because the compensation plan is so complicated, a lot of physicians end up being scared to take time off because they feel like it will really negatively impact their compensation.”
Making it easier to take time off
Also, the key is removing barriers to scheduling time off, the playbook’s authors write.
“If you're getting a salary, then you should just have the certain number of PTO weeks built into that schedule template so that the time is automatically blocked and you don't have to worry about rescheduling patients,” Dr. Jin said. Those weeks should be blocked off “a year in advance, if possible.”
Without adequate lead time, PTO can result in canceled patients, physicians working while they’re out, patient frustration and a poor experience for everyone involved.
“That's when people run into difficulties, when the vacation time is not proactively built into the template,” she said. “And then the physician’s schedule fills up six months or a year in advance and then when they take a vacation, they have to move all those patients, that's where it becomes a challenge.”
Changing the culture of 24/7 work
Ultimately, the move to “real PTO” requires a commitment to changing the perception that physicians must deny their own needs to care for their patients, the authors write.
“The culture of self-sacrifice and 24/7 availability is infused into the sentiment that medicine is a calling—physicians chose the field because they wanted to help and heal, which inherently involves some degree of self-sacrifice and work outside of traditional work hours,” the playbook says. “However, when taken to the extreme, this culture becomes detrimental to both physician well-being and patient care.”
AMA STEPS Forward® open-access toolkits and playbooks offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These resources can help you prevent burnout, create the organizational foundation for joy in medicine and improve practice efficiency.