Doctors on holidays… or are they?

With legislation allowing Australian workers to ‘disconnect’ from their jobs being considered because of the unending demands of our smartphones, the impact of increasing workloads on American doctors has crept into that most sacred of times – holidays.

Research shows that many US doctors face chronic work overload — putting in more hours per week than the general population, with the typical full-time physician working 54 hours per week, averaging 10 hours more than other US workers. 

Less than 10% of workers in other fields reported working 55 hours or more per week, compared with 40.7% of physicians, and critically, longer work hours per week have been linked to higher rates of burnout among doctors, with a 2% increase in odds of burnout for each extra hour. 

“In addition, working 55 hours or more week is associated with higher rates of heart disease and stroke,” lead author of the study, Dr Christine Sinsky from the American Medical Association, said. 

“Taking a holiday has been associated with improved physical and mental health, including lower risk of cardiovascular mortality, reduced cellular-level markers of stress, and fewer symptoms of depression and anxiety – yet fully detaching from work during time off is not universal.  

“A 2023 survey of a convenience sample composed of 9175 physicians in 29 specialties found that one in three physicians took two weeks or less of vacation each year, but a 2020 study of 490 physicians found that being able to disconnect from work was associated with lower emotional exhaustion and depersonalization, the two key dimensions of burnout.” 

Between November 2020 and March 2021, the team surveyed a sample of physicians from all specialties listed in the American Medical Association’s Masterfile. 

Among the 3,671 recipients invited to participate in the mailed survey, 31.7% responded, and of the 90,000 physicians invited to participate in the electronic survey, 7.1% completed it. 

Most physicians (70.4%) performed work on vacation on a typical day off, with one-third working 30 minutes or more per vacation day.  

Women were more likely to perform more than 30 minutes of work on vacation, and time spent on patient-related tasks while on vacation also varied by specialty, with the highest rates among those working in urology, neurology and surgery subspecialties. 

Physicians were also asked to rate how much of a barrier to taking vacation each of the following dimensions was for them — finding someone to cover clinical responsibilities, financial impact on professional compensation, and the volume of inbox work to be faced on return. 

More than one-third of physicians indicated that at least one of these aspects was a significant concern. 

“Occupational burnout among physicians is a serious threat to patient and physician well-being and health system goals and has been associated with higher rates of medical errors, longer hospital stays, greater mortality, lower rates of patient satisfaction, reduction in work hours, turnover, excess health care costs, and physical and mental health issues for physicians,” the authors said. 

“The fact that two-thirds of physicians are obligated to continue to provide clinical care to their patients while on vacation should be considered a marker of poorly designed systems of teamwork, inadequate clinical staffing, and poorly designed cross-coverage systems.”