Vacation Days Taken, Work During Vacation, and Burnout Among US Physicians

Sinsky, C. A., Trockel, M. T., Dyrbye, L. N., Wang, H., Carlasare, L. E., West, C. P., & Shanafelt, T. D. (2024). Vacation Days Taken, Work During Vacation, and Burnout Among US Physicians. JAMA network open, 7(1), e2351635. https://doi.org/10.1001/jamanetworkopen.2023.51635

So, I am on holiday. I won’t reveal where, but it is far enough away to feel like I am truly away from home.

It is complicated. It makes me anxious. I am by myself. I went to a big city, with lots of people, and became very anxious. I am now in the countryside, and things are better.

I am with a group here, all aged 65 and over. They are really lovely, caring, and considerate. It has made a big difference. Still, I sometimes find myself wanting to stay in my room rather than explore the city. Even now, as I write this, I am sitting in the public library.

But that is me. I have to remember that this is who I am, and that I do not need to change for others.

As I sit here and write this, I can look out the window. I see different people here, all of us quietly working away. Maybe someone is a poet. Maybe another is a theoretical physicist. I like seeing all the books written in a foreign language — even the psychiatry ones. This is good, and it is good for me.

Unfortunately, however, there are some not-so-good things I am doing while on holiday — at least according to this article.

One of them is this: I have my laptop.

And yes, I have opened it. And yes, I have occasionally done some work.

Let me pause here by saying that all of my patients are absolutely lovely. They are all very understanding of boundaries and of my need to have a break. I also want to feel well rested so I can be fully present and in the moment when I am at work.

But I care, and I worry.

I wonder if someone has had a low lithium level, or if they are becoming more unwell. I worry about what might happen if I cannot be there. And I think this goes beyond the profession. I think I am, honestly, a caring person. I set up my clinic because I wanted to care for others. I guess that has its pros and cons.

For today, though, Joann has temporarily locked my access so I cannot check emails.

It is good — the boundary. I need to make sure my mind is rested.

This leads on to the article for journal club. And yes, I know that even writing this blog is work, but I think I needed to get some words onto paper.

Let’s start with some background. This article was published in JAMA. I love JAMA — they publish high-quality material that somehow still feels readable. The author affiliations include the AMA in Chicago, Stanford Medicine, the University of Colorado Medicine, and the Mayo Clinic. Christine A. Sinsky and colleagues have been a real powerhouse in the field of physician health.

The article begins with an introduction exploring the background in the United States: taking time off, the benefits of leave, and the challenges doctors face in actually disconnecting.

One line stood out to me:

“Among workers with a postgraduate degree, 41% report often or extremely often responding to email or other messages outside of their normal work hours.”

The team then surveyed 3,128 doctors and asked them to complete a burnout inventory — basically a questionnaire — as well as questions about their vacation habits.

Let’s jump down to psychiatry.

Among psychiatrists, 8% had taken fewer than five vacation days in the past year, 38% had taken 5–15 days, and 44% had taken more than 15 days. Psychiatry sits around the average: neither particularly low nor particularly high compared with other medical specialties.

The researchers then did some really interesting mathematics. They found that doctors who were worried about who would look after their patients while they were away were less likely to take leave.

It sounds obvious, but here is the science to back it up.

And here is where I get into trouble.

Spending 30 minutes or more on work during a holiday is associated with a higher risk of burnout, and that risk increases the longer you spend working. But it seems at least one in three doctors do this.

Taking less vacation, or working while on leave, is associated with higher exhaustion, more depersonalisation, and lower professional fulfilment.

The data suggests — example one being me — that we do not fully disconnect while on holiday. And that is not good for us, or for our patients.

Of course, the US nature of the study limits how much we can generalise to the Australian context. But it makes sense. The data and statistics support it.

We need to normalise taking time off, and fully disconnecting.

I need to do this for myself and for my patients.

And I think that is the key message from the article.

I hope to do this, and to come back from leave feeling rested and excited.