Take these 7 steps to ensure physicians get “real PTO” (2024)

Far too many physicians either are not taking enough time off or are continuing to work while they are on vacation, practices that increase their chances of burnout—damaging them, their patients and their organization. But there is another way: “real PTO.”

An AMA STEPS Forward^® toolkit on reducing barriers to taking time off outlines how health systems and organizations can achieve the kind of restful, restorative time off that helps reduce physician burnout.

Jill Jin, MD, MPH, a coauthor of the toolkit and senior physician adviser for the AMA, said it requires battling the culture among physicians.

“We all knew and expected to some degree when we chose the field of medicine that there would be an element of self-sacrifice and being accessible outside the typical 9-to-5 work hours for the sake of helping our patients, for healing patients. That's why we went into the field. That's what we're passionate about,” Dr. Jin said in a recent webinar about the toolkit.

“The problem, of course, is when it's taken to an extreme and doctors are expected to be available literally 24/7 and have zero time to disconnect and take time for ourselves or our families, then of course that becomes harmful,” she added.

In a 2024 study of more than 3,000 U.S. physicians, published in JAMA Network Open, 59.6% of doctors reported that they take 15 or fewer days of vacation per year. Meanwhile, about 20% said they take five or fewer days per year.

The link to burnout is clear: When physicians take three weeks or more off each year, their burnout risk is lower. On the flip side, when a physician’s PTO is not truly restorative—when they must spend part of each vacation day continuing to work—their risk of burnout also increases.

As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.

The new toolkit offers seven steps to give physicians “real PTO” and ensure they are enjoying their vacation without the EHR.

There are three aspects to real PTO. To start, it’s time off during which all of a physician’s responsibilities, including patient care and EHR demands, have been moved to other team members without causing the physician to feel guilty about overburdening others. It also gives enough ramp-up and ramp-down time so that an onerous amount of work isn’t required beforehand and afterward. And, finally, the physician’s compensation model should account for PTO in a way that doesn’t financially penalize taking time off.

Discover three ways to help physicians get the time off they need.

Though the ethical case for real PTO is clear, there’s also a strong business case to be made for the practice. Physicians who don’t take enough time off, and those who don’t take enough restorative time off, are likely also to be burned out, causing a raft of other issues not just for patients and colleagues, but also for the organization that employs them.

For example, burnout increases physician turnover, which in turn requires more resources, decreased access to care for patients and less continuity of care. But it’s not just the so-called “hard costs” that arise when physicians don’t take enough restful time off. There’s also an erosion of trust, increased apathy and more resentment for an organization that doesn’t support physicians’ understandable need to decompress from a highly stressful and demanding job.

Physicians care about their jobs—passionately—and know how important they are. But organizations can either encourage or discourage the mistaken belief that physicians should completely sacrifice their well-being at the altar of service. The toolkit says that leaders should model the desired behavior by taking their own time off and writing out-of-office messages that make it clear they are using PTO themselves.

The language used in communications about PTO is also important. Physicians shouldn’t be praised for working on vacation or for avoiding time off. Additionally, requests for documentation of CME time off should be handled using a supportive and trusting tone.

Additionally, PTO policies should be clear and simple, and physicians should be able to easily check how much time off they have remaining. Consider proactively blocking off PTO time in a physician’s schedule, while allowing them to make changes as needed. Look for ways to tailor PTO for different specialties. And, finally, celebrate the time off.

The first step is changing mindsets. Responsibilities should be thought of as belonging to the organization, not the physician. Then, ensure that the practice EHR inboxes use team-based workflows so that physicians are not spending their time away on administrative tasks.

This should include selecting a way of covering for physicians that minimizes workload and guilt. The best way to do that, the toolkit says, is by creating and training a team of nurses, medical assistants or nonphysician providers to shoulder the load while doctors are out.

Also, manage the inevitable decrease in patient continuity and access to their physician, both by communication and by scheduling blocks of time for same-day appointments after the physician’s return and catch-up time.

The process of requesting time off should be simple and should encourage physicians to plan ahead whenever possible. Patients should also have their expectations managed with communications from the office or automated messaging. After time off, physicians should be allowed a reasonable amount of time to catch up.

Physicians should not feel as if they’re being financially penalized for taking time off. No matter what compensation system an organization uses, there are fair ways to build in PTO. Meanwhile, physicians may still be compensated via RVUs for working extra weeks. But the organization should make it clear that there is not an expectation to do so. This is a subtle, but crucial distinction.

Organizations should also set their own RVU benchmarks and bonus tiers for individual physicians based on an expected 44 weeks per year of productive time. This should include a realistically attainable number of RVUs per week.

It’s tough to track time off in a way that both shows trust for the physician and yet also accurately depicts the state of PTO in an organization. Filling out timecards can be demeaning and time-consuming, so instead encourage work units to brainstorm and discuss options that will work best.

For example, using a shared calendar that can be accessed and changed by physicians. Then, track who is not taking time off and who is accessing EHR inboxes while on vacation to follow up with struggling physicians. But this model will not work for every practice. There should be discussion to find a solution that works for everyone.

Ultimately, the goal is that physicians can feel confident that when they take PTO, they will be able to recharge their batteries without causing suffering to themselves, their colleagues or their patients. That time off, the “real PTO,” is the kind that helps physicians—and their organizations—thrive.

AMA STEPS Forward open-access toolkits offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These resources can help you prevent burnout, create the organizational foundation for joy in medicine and improve practice efficiency.