PTO: Paid Time Off, Personal Time Off or Partial Time Off?

No more Holidys for many doctors…

Fresh back from almost back-to back oceanside beach vacations with my significant other, I feel called to write about being on vacation as a physician these days. But first, we had a great time on Old Orchard Beach during Fourth of July week with her siblings, all older than we are, and then in Bar Harbor with my children and grandchildren to celebrate my birthday.

Large healthcare organizations often have many different “service lines”, some acute and 24/7, some totally prescheduled and elective. But they often end up with the same personnel policies and benefits across the board. Because of this, I ended up in my previous job having to budget “PTO” time or else not get paid for Christmas Day, for example, even though my clinic was closed so there was no way for me to work that day. And in my current job, I forgot to ask for the Fourth of July off. Even though my clinic was closed, there seemed to be a remote possibility that I would be deployed on a house call or video visit. That didn’t happen, but there was definitely some confusion there.

A few other things are happening to many doctors when they take time off. One is that we get messages from nursing staff or sometimes covering providers about patients that we know particularly well. That happens to me fairly often in my telemedicine Suboxone clinic for Bucksport patients. I have made it clear with them that I do not log into the EMR unless I get a text message saying there’s an issue for me to handle. That way I’m less tied down looking for interruptions in my vacation.

Another issue that sometimes cuts into our vacation time is refills of controlled substances. I see medical providers, colleagues, who would trust me with their patients or even their own lives either refuse to refill stable patients’ controlled substances or only do it for a limited number of days until I’m back at work. This either means I’ll be contacted on my vacation to refill the prescription they would not or I will have to do the math all over when I want to resume my patient’s usual intervals between refills. In that case the patient may have to pay a full copay for a 3-7 day prescription and another one when I refill their usual amount.

I was around when pagers were the most high tech handhelds (and cell phones back then were all over-the-shoulder). It was easy to be unreachable then. Instant connectivity can be great for those who need us, but how much of that is too much for us? The higher the constant availability pressure is during our normal work weeks, the more sense it makes to disconnect when you’re on vacation. Maybe if you’re the only one in your specialty in your county or state, you can’t disconnect completely, but in primary care, there are options - we are probably not quite as indispensable as we think we are…

And, as an aside, I have gone from one extreme to the other, then back again a few times in my publishing endeavors, sometimes posting twice a day and sometimes not for weeks. So, yes I’ve been a little quiet lately, but that is what happens when you pay attention to friends, family and other parts of your life besides “performing”. I’ll never stop, I’ve just been busy with some of those other things.