By Philip R. Fischer, MD, DTM&H
Synopsis: There is a shortage of physicians in the United States, and many current physicians are considering reducing or ending their current clinical practices. Leading risk factors for discontinuing clinical work are taking fewer than 15 days of vacation each year, continuing to respond to electronic medical record inbox messages during vacation, and working more than 30 minutes per day during vacation.
Source: Sinsky CA, Shah P, Carlasare LE, et al. Association between vacation characteristics and career intentions of US physicians — a cross-sectional analysis. Mayo Clin Proc. 2025 Mar 6:S0025-6196(24)00482-8. doi: 10.1016/j.mayocp.2024.09.020.
There is a growing shortage of physicians in the United States, and many (40%) expect to reduce their workload during the next year; 26% plan to leave their current jobs within two years, and 4% intend to leave medical practice completely. Difficulties with workload, burnout, and work-life integration contribute toward physicians’ desires to work less (or not to work in medicine at all). Recruitment and retention of physicians should be a priority of healthcare systems.
Vacations offer potential for physicians to rest and rejuvenate. However, most physicians take fewer than 15 vacation days each year, and most physicians continue to respond to patient messages and/or to do other work during their vacations. Limited vacation time and working during vacation have been associated with physician burnout.
The current study was done to determine if and how vacation characteristics relate to physicians’ plans to reduce or cease working.
From November 2022 to September 2023, survey responses were obtained and then analyzed from 5,059 physicians working in 50 different organizations that employ at least 100 physicians. Of respondents, 52% identified as male, 84% worked full-time clinically, and 41% practiced with both inpatients and outpatients. In this survey, 1.2% of respondents were involved in infectious disease practices.
Among respondents, 10% reported having used five or fewer days of vacation during the previous 12 months, and 48% had taken 15 or fewer days of vacation during the preceding year. (“Only” 40% of infectious disease specialists reported taking 15 or fewer vacation days per year.) During vacations, 49% were at least partly responsible for covering electronic health record inbox messages from patients. A total of 72% of physicians reported doing work during their vacations, and 33% (51% of infectious disease specialists) did more than 30 minutes of work on a typical vacation day. Of those who did not need to cover inbox messages, 24% still did more than 30 minutes of work per vacation day.
Taking fewer vacation days per year, managing patient messages during vacation, and doing more work on a typical vacation day each were associated with a greater likelihood of intending to reduce work hours and intending to leave medical practice. These associations were not related to gender, race, years in practice, practice setting, or specialty. Emotional exhaustion and burnout both aggravated but did not fully explain an intention to reduce or cease practice.
Respondents intending to reduce their work hours were asked what might keep them in practice. Key opportunities were to improve work flow efficiency and to change the management of the electronic medical record.
The current and worsening shortage of physicians in the United States could be ameliorated by either training more physicians or reducing the number of physicians who leave their practices. It is estimated that it costs a healthcare organization approximately $1 million to replace each physician who leaves the practice. Providing and fostering use of adequate vacation days potentially could help organizations retain physicians and, in the process, save money. Ensuring that physicians do not feel obligated to work during vacations also could reduce premature cessation of clinical practice.
At the same time, some physicians opt not to accept help with coverage of their patients, and some physicians opt not to use all their available vacation time. While this study did not prove that using more vacation days would keep physicians working more and longer, it certainly seems likely that at least some physicians could be helped by taking their available vacation time and working less during their vacations.
Commentary
Only 51% of U.S. infectious disease fellowship programs filled their available positions for new fellows starting this year.1 The Infectious Diseases Society of America is committed to bolstering the supply of highly trained infectious disease clinicians to meet unmet current and future demands.1 Training more infectious disease subspecialists is vitally important, but retaining those already in practice also is necessary. Retention of currently practicing clinicians depends, in part, on effectively dealing with burnout, reduced professional satisfaction, and inadequate work-life integration. Although many clinicians are considering reducing or ending their clinical practices, most could benefit from strategies designed to improve professional and personal lives within our current settings.
Much of the academic research done about burnout, career satisfaction, and work-life integration, including this new study, has been done by Dr. Tait Shanafelt and his teams (previously at Mayo Clinic in Minnesota, now at Stanford University in California). Here, we review some of their previous findings not specifically related to vacations, findings that potentially could prompt interventions that lead to practical improvements in the integration of professional and personal lives, to tangible reductions in symptoms of burnout, to enhanced career satisfaction, and to greater retention of physicians within the workforce.
Acknowledge difficulties and deal with them.2 Burnout is common. Physicians experience more burnout and have less satisfaction with their work-life integration than does the general population. Internal medicine subspecialists fare less well in these regards than do pediatricians and psychiatrists but better than emergency medicine physicians and most surgeons. Those in private practice do a bit better than those working in academic centers. Female physicians are less satisfied with work-life integration than are male physicians. Physicians of either gender older than 35 years of age do less well in terms of burnout and satisfaction than do younger physicians. Systemic change should help alleviate these problems.
Have non-medical conversations with colleagues over meals.3 A decade ago, 125 internal medicine specialists at an academic medical center were randomized into a controlled study. Subjects in the intervention group had biweekly meals provided during which they had self-facilitated discussion fostering reflection, shared experience, and small group learning (not only about medical topics). Over six months, the “treated” group decreased burnout and depression by 13% while the control group increased in these domains by 1% to 2%. Job satisfaction rose in the meal discussion group. Personally, I talked with some of the physicians involved in the treatment arm of this study, and their enthusiastic endorsement of shared mealtime conversations paralleled the significant changes revealed by the data.
Spend time with your spouse, at least 20 minutes per day.4 Fourteen years ago, 891 spouses of physicians participated in a survey about satisfaction with their marriages, and more than 85% of spouses were satisfied with their marriages. But the factor most influencing marital satisfaction was the number of minutes of awake time the couple spent together each day. Hours of work, specialty, practice setting, and the non-physician spouse’s work schedule were not significantly linked to marital satisfaction. There was a “dose-response” relationship between satisfaction and minutes spent awake together, but the break-point was at 20 minutes. Spouses who spent at least 20 minutes awake and interacting with their physician spouses each day were more satisfied than those who did not. (And those who spent at least two hours together awake each day were the most satisfied.)
Schedule at least 20% of your work time doing what you find most meaningful.5 Sixteen years ago, 465 physicians participated in a survey of burnout; 34% qualified for a diagnosis of burnout at that time. The physicians identified the aspect of their work they found most meaningful, with 68% favoring patient care, 19% favoring research, 9% favoring education, and 3% preferring administration. Time spent engaged with the most meaningful activity was most predictive of burnout. For example, 54% of those spending less than 20% of their working time on the activity they found most meaningful were burned out. Physicians and their employers should ensure that each physician spends at least 20% of their working hours doing what is most meaningful (and, presumably, rejuvenating) among their varied activities.
Gain control over your work.6 From November 2022 through December 2023, 2,144 physicians were surveyed about their sense of control over their work situation as well as about career satisfaction and the possibility of reducing or discontinuing their medical practices. Thirty-nine percent felt like they did not have adequate control over their work situations — specifically related to the number of patients seen, overall workload, and clinical schedules. Lack of control in each of those domains was directly related to burnout; patient load and workload were related to thoughts about reducing work hours. Efforts to overcome burnout and to retain physician staff should incorporate the provision of more control by physicians of their clinical workload.
Philip R. Fischer, MD, DTM&H, is Professor of Pediatrics, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
References
1. Infectious Disease Society of America. ID Fellowship Match Results. www.idsociety.org/professional-development/student--resident-opportunities/id-match/match-resources
2. Tawfik DS, Shanafelt TD, Dyrbye LN, et al. Personal and professional factors associated with work-life integration among US physicians. JAMA Netw Open. 2021;4(5):e2111575.
3. West CP, Dyrbye LN, Satele DV, et al. Colleagues meeting to promote and sustain satisfaction (COMPASS) groups for physician well-being: A randomized clinical trial. Mayo Clin Proc. 2021;96(10):2606-2614.
4. Shanafelt TD, Boone SL, Dyrbye LN, et al. The medical marriage: A national survey of the spouses/partners of US physicians. Mayo Clin Proc. 2013;88(3):216-225.
5. Shanafelt TD, West CP, Sloan JA, et al. Career fit and burnout among academic faculty. Arch Intern Med. 2009;169(10):990-995.
6. Sinsky CA, Brown RL, Rotenstein L, et al. Association of work control with burnout and career intentions among US physicians: A multi-institution study. Ann Intern Med. 2025;178(1):20-28.
There is a shortage of physicians in the United States, and many current physicians are considering reducing or ending their current clinical practices. Leading risk factors for discontinuing clinical work are taking fewer than 15 days of vacation each year, continuing to respond to electronic medical record inbox messages during vacation, and working more than 30 minutes per day during vacation.
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