Physician Health

Pretend Time Off: JAMA burnout study, PTO for doctors and how to help physician burnout


AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.

How to heal from physician burnout: Can a vacation help with burnout? How much vacation do doctors get? What are risk factors for burnout? Why do physicians leave their jobs?

Our guest is Christine Sinsky, MD, vice president of Professional Satisfaction at the American Medical Association. AMA Chief Experience Officer Todd Unger hosts.


  • Christine Sinsky, MD, vice president of professional satisfaction, AMA

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Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about a new study that examines the link between vacation time and physician burnout. Our guest is the lead author of the study, Dr. Christine Sinsky, vice president of professional satisfaction at the AMA, who's joining us from Madison, Wisconsin. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Sinsky, it's a pleasure to have you back.

Dr. Sinsky: Thanks so much, Todd. It's great to be back.

Unger: Well, Dr. Sinsky, your study had a lot of interesting takeaways, and one had to do with the amount of vacation time that physicians are taking or, as the case may be, not taking. Why don't you just start by telling us about the findings there.

Dr. Sinsky: Yeah, sure, Todd. Happy to. So what we found was that the vast majority of physicians were not taking their full vacation. Almost 60% reported taking three or fewer weeks of vacation every year. And one in five physicians, 20%, reported taking five days or less vacation in an entire year.

Unger: That is not a lot of vacation. And worse, I think what your study saw is that, even when physicians take a vacation, they're not really able to fully disconnect. Tell us more about that.

Dr. Sinsky: Right. Even those who take vacation aren't fully unplugging, so they don't have a chance to really fully recharge. We found that 70% of physicians did some kind of patient-related work on a typical vacation day, and over 30% did over 30 minutes on a typical vacation day of patient-related work.

So that's a really big deal for physicians. It means they're really not taking full vacation. And we think some of that is that physicians don't have full inbox coverage. Only half of physicians had full inbox coverage.

So to continue to keep their patients safe, physicians need to continue to check in on their patients through the portal to see what needs are, what results have come back. And really, they're they are not able to fully disconnect from work when on vacation.

Unger: And I think that, obviously, it's tough to recharge when you have to check in over and over like that. What impact does this have on physician well-being?

Dr. Sinsky: So we know that each one of those factors, taking less than three weeks of vacation, not having inbox coverage, doing any kind of patient-related work while you're on vacation—each of those are independently associated with higher rates of burnout. And we know burnout is expensive to organizations, both in terms of the quality of care that patients receive but also, as importantly, in terms of cost because it predicts that physicians will leave the organization. And replacing those physicians is expensive. So when physicians don't take their full vacation, it's really costly to their employers.

Unger: And vacation is, you're kind of saying, basically, it's supposed to be a time to recharge. But in this case, if you're having to check in constantly, it might actually be contributing to the burnout problem. Why is it so hard for physicians to get the time off that they need?

Dr. Sinsky: Well, first, I'd like to say we talk about PTO as paid time off. But there's another name for that, and it's called pretend time off, which is, I think, something that captures the experience that physicians have while they're off but not actually really off. And so I think it is a ballooning problem for physicians but also for health systems.

And I thought I'd give you a sneak preview of some additional work that we've just finished and some analysis that we've done. And we find that physicians who take less vacation, who don't have inbox coverage, or who—and who also do work on vacation, they're much more likely to intend to leave their organization. So it is a predictor, if you will, or is likely a predictor of intending to leave the organization, again, very expensive for health care systems.

Unger: Absolutely. And like in much of your work that you've discussed in the past with us, this is not just a matter of, at the individual, the inability of a physician to disconnect. And like so much, it's connected to broader systemic issues that need to be addressed. Dr. Sinsky, what can practices do to address some of those system-level problems that are contributing?

Dr. Sinsky: Right. So first, I want to underline this is not an individual problem. It's not that physicians are unwilling to take vacation. It's that their professionalism mandates, in a sense, that they actually keep their patients safe.

So what can systems do to make it more likely that they can take vacation? I call it institutional support for individual self care. Well, provide inbox coverage. Make sure that that is systematically built in, that physicians don't have to feel like they're imposing on their partners or ask informally their partner to cover their inbox and then plan to do the same.

I think we have to reconceptualize the inbox and the patient portal as a team responsibility and not solely a physician responsibility. So many organizations now have the physician as the first responder to the inbox rather than having a well-trained nurse who can respond to most of the inbox messages and then check in with a physician who's on call for the practice for those few things that need a physician engagement that can't wait until the person's personal physician is back. So that's one thing.

And there are many others. Just this week, we published our latest STEPS Forward toolkit, which is on real PTO, taking vacation and things that systems can do to facilitate the taking of vacation. So we have seven different steps that organizations can take to increase the likelihood that physicians are taking vacation.

Unger: We'll put a link to that toolkit in the description of this episode. Those are going to be important resources. Dr. Sinsky, anything else that AMA has, resource wise, to help practices implement changes like that?

Dr. Sinsky: Sure. I'm glad you asked, Todd, because Dr. Jill Jin and Marie Brown, who wrote our STEPS Forward toolkit on real PTO, have also just recently hosted a webinar on the same subject. And so you can—one can go to the AMA website and search for this webinar that was held recently and learn more from those experts.

Unger: Encourage you to take a look at that. Lots of great information in there. Dr. Sinsky, thank you so much for joining us and just for you and the team's continuous work to address these systemic issues. And it's so interesting. I look forward to seeing more details about that connection between vacation, or lack thereof, and physician burnout.

As the leader in physician well-being, the AMA has everything you need to reduce burnout in your practice. And to support our work, we encourage you to become an AMA member at That wraps up today's episode, and we'll be back soon with another AMA Update.

Be sure to subscribe for all our new episodes and videos and podcasts at Thanks for joining us today. Please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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