The Art and Science of Vacationing
Foad Nahai, MD, FACS
It is not unusual for a physician-in-training to assume that during those critical years of intensive education virtually every other aspect of his or her life must be held in abeyance. Experience has shown us, however, that this expectation can be fraught with danger both in the short- and long-term, sometimes having a permanent impact on an individual’s later ability to achieve a healthy and satisfying work-life balance. A recent poll of over 2000 practicing physicians found that 54% of those surveyed consider themselves workaholics or, as defined by Merriam-Webster, compulsive workers. The percentage of workaholics in the general population is estimated to be about 30%.3 It has been argued that, because of the expectations placed upon physicians throughout our training, we are particularly prone to becoming “workaholic perfectionists,” and that this mentality is a prescription for physician burnout.4 Most if not all of us were trained to be tough. Those of a certain era were required to withstand the rigors of a virtually limitless on-call schedule and never complain. But as we have discussed in previous articles and editorials,4,5 modern medical practice subjects us more than ever before to the perils of burnout. While a variety of strategies are necessary to combat this trend, one that should not be overlooked is periodic vacations from work, whether in the form of recreational activities, travel, or simply “time off.”
All of us have stress in our lives, even if we tell ourselves that we don’t. Chronic stress can affect health on many different levels, often contributing to anxiety and depression, problems with memory, poor digestion, and impaired sleep. Vacations are a proven method of breaking the stress cycle.6 They also assist personal and social development by broadening learning opportunities and improving family relationships through what is termed crescive bonding, or shared experience. An active vacation that offers new challenges is likely to be most beneficial.7 Yet, despite the consensus that vacations are important to mental and physical health, many of us seem to regard them as nonessential. Some, even those who are self-employed, feel guilty about taking time off from work.
Physicians are not alone when it comes to failing to make vacation time a priority. The average American worker is entitled to 13 vacation days annually, but 34% don’t use a single vacation day during the year. Even among those who do take a vacation, 30% report an inability to relax due to worrying about their work.3 With the proliferation of mobile communication devices, many people find it impossible to totally separate themselves from their work environment even for a few days. Yet taking a break from work can be a very positive thing for you and your practice, if you adequately prepare for it.
Taking a vacation may be somewhat more difficult for a solo practitioner than for a physician in a group practice, but it is no less essential. Additionally, those who are new in practice may find it more challenging to coordinate all the “moving parts” that must continue to seamlessly function in their absence. As a plastic surgeon who spends some time traveling internationally, I feel that I’ve mastered the art and science of vacationing, or more accurately, being away from the office. Granted, a great deal of my travel is work-related, such as for education and in my role as Editor-in-Chief of Aesthetic Surgery Journal, but that doesn’t stop me from using such opportunities to decompress from the day-to-day stresses of a busy aesthetic practice.
One of the most essential things I do before every extended absence from my practice is to clearly communicate my travel plans to all staff and to current or prospective patients. Any patient considering a surgical date that falls immediately before my departure is immediately informed by my patient coordinator that I will be leaving town that evening or the next morning, giving my patient the option to select a different date. (Interestingly, I can remember only one patient choosing to reschedule.) On the day of surgery, I again confirm with the patient that he or she knows my travel plans and that, if it is a trip abroad, I would be unable to return in case of an emergency. I provide the name of the partner who will be available in the rare event of a problem, and I always try to introduce that doctor to my patient. I am fortunate to have partners in whom I have complete confidence, all of whom have an excellent bedside manner. If you are in solo practice, you will need to establish some type of reciprocal arrangement with another surgeon in your locale; make sure it is someone with whom you are well acquainted. If I feel that a particular patient may be difficult to manage postoperatively, either for physiological or psychological reasons, I make every effort to schedule that individual’s surgery for a time when I am personally available for emergency or follow-up care.
Even when I have made arrangements for someone to look after my patients, I choose to stay informed of any untoward events. I tell my partners that I always want to know if they were called upon to attend one of my patients, regardless of the time of day or night and wherever in the world I might be. If necessary, I will place a call to the patient myself. In general, though, I believe it is important when traveling on business or vacation to set boundaries to direct patient communication. There should be personnel available at the office who are fully capable of handling patient questions and minor problems. If you do not have that level of confidence in your staff, then you undoubtedly need to make a few changes, not only for the sake of being able to take a vacation but because it indicates your practice is not functioning at the highest level.
There is always a financial impact to going on vacation, not just the cost of the trip but the lost income. You will enjoy yourself more on vacation if you plan for this in advance. Patients sometimes laugh when I say that as a plastic surgeon I am a journeyman jobber, which is to say that if I’m not working with my hands, I’m not making any money. But isn’t it true? When I’m out of the office for an extended period, I have no money coming in, but I still must pay my staff and keep up with my ongoing practice expenses. Factor in, too, that I may need to slow down the practice at least a little bit during the week or few days before my departure, and when I get back it may take some time before things pick up to full speed. If the financial loss involved in taking a longer vacation is too much of a burden, you might consider the strategy of taking shorter but more frequent vacations, maybe three-day weekends at times when your practice tends to be slow anyway. Obviously, international travel does not accommodate itself to that kind of a schedule, but if you enjoy hiking or skiing or any number of other leisure activities that are good stress-reducers, getting away somewhere for even a few days at a time can be refreshing and impact positively on your productivity after you return.
Technology, as I mentioned earlier, is both a blessing and a curse when on vacation. I have had countless experiences traveling or visiting with other doctors who are purportedly “on vacation” but can’t seem to separate themselves from their cell phone or computer. Much to my family’s chagrin, I happen to be one myself. It may be a good idea to establish a policy for exactly when you will check email and voicemail while you are away, and convey that policy to relevant staff so they will know when to expect return communication from you. You may also want to define or set limitations on the types of information you wish to receive while away. On the other hand, if you are the kind of person who dreads coming home to hundreds of messages waiting in your inbox, then you may feel less stressed if you allow yourself enough “tech time” every day to clear away the worst of your email before you get home.
Most of us are fortunate enough to be able to afford a vacation, and we know it would be good for us to take some time off. But if you’re still hesitating, here are a couple of additional benefits to consider.
You could live longer. The Framingham Heart Study suggests that women who vacation the least are nearly 8 times more likely to experience heart problems such as heart attacks and death from heart disease compared to women who vacation at least biannually.
You might improve your love life. According to a Nielsen survey, 80% of people who vacation every year report being satisfied with their romantic life compared to only 56% of those who forego vacationing.
While the Nielsen survey might not stand up to scientific scrutiny, nevertheless it makes a good point. A special vacation taken with a loved one often becomes a cherished life-long memory. And, when you think about it, what could be more important than that?