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Vacation deprivation

August 2015
Family biking

Published in the August 2015 issue of Today’s Hospitalist

OUR FAMILY just returned from a road trip to Chicago. It was a quintessential American experience involving a minivan with a cargo box on top, non-restorative hotel sleep and little kids hopped up on junk food for days. This was billed as a vacation, although work didn’t entirely stop and my wife and I returned home exhausted. But good parents apparently do these sorts of things, so we’re heading out to the Black Hills in a few weeks for more of the same.

Working less but more
There has recently been a lot of commentary on the American worker, including a July/August 2015 cover story in The Atlantic and a substantial piece in the May 26, 2014, issue of The New Yorker.

One theme involves technology reducing or eliminating work, and, by extension, workers. The counterpoint is that technology has made work ubiquitous and that there’s really no separation any more between our personal and professional lives.

An earlier story in the July 2013 issue of The Atlantic noted that the average American currently works 200 hours less per year compared to his or her counterpart in 1950. The reductions have been even larger across Europe. In France, for example, the number per year has dropped by 684 hours. And in Germany, the corresponding figure is a mindboggling 991.

But much of that is an illusion. The 2013 article pointed out that professionals in North America work 90 hours per week. Roughly two-thirds is actual work, whereas the remainder is classified as “monitoring.” That consists of following developments at the office via mobile technology and remaining available to colleagues, if needed.

My trip to Chicago was a case in point. I did my best to unplug, but I still received phone calls and text messages about work-related issues. I tried to ignore them but felt guilty that I was being a bad boss. So I responded to a few texts “and then felt like a bad dad for working on vacation.

At least I was trying to take a vacation, imperfect as it sometimes was. According to 2014 data from the Harris Poll, Americans used just 51% of their eligible vacation time in the preceding year. On the extremes, 15% of employees took no time off, and only 25% used up their entire benefit.

Root causes
Humans are relatively rational actors. Why would they choose to forfeit vacation, which is akin to working for free? A recent survey conducted by Oxford Economics provides some insights. The top reason was pathetic but not too profound: Roughly 40% of people reported that they simply had too much work to do. The next two reasons (multiple answers were allowed) made a little more sense: the desire to accumulate vacation for future use and the ability to convert vacation days into cash.

Answers in the middle frequency “about 15% to 20% of people endorsed each one “started to lose coherence and bordered on grandiose:

  • don’t need the days
  • I can’t afford to travel
  • I enjoy my job
  • hard to schedule, and
  • my company needs meAnd dead last, with less than 5% each, were “discouraged by my employer” and “it would put my job at risk.”Other questions on the survey explored managers’ attitudes toward employees who take vacation. Employees who took all of their entitled time off were not perceived as less productive or less dedicated to their jobs. Moreover, using their full vacation benefit was unlikely to have a negative impact on career advancement.

But who cares? People are working more than they should, but no one’s dying, right?Well, it turns out that failing to vacation, much like skipping breakfast, sleep and exercise, is bad for you. Not death per se, but it’s slowly robbing you of happiness and human potential.Gallup, the company that conducts political polls, has also done tons of research on wellbeing “that is, how to live a balanced and fulfilling life. In a recent survey, it found that those who “[make] time for regular trips or vacations with family and friends” have higher levels of wellbeing.

Moreover, vacations trump income. Low-income earners (less than $24,000 per year) who take vacations have substantially higher wellbeing than top-income earners ($120,000 or more per year) who don’t vacation. Yet another demonstration that money doesn’t buy happiness.

Now, admittedly, wellbeing is a little squishy and potentially self-centered. How about something a little more tangible that employers might care about?

Oxford Economics also looked at the impact of vacations on workplace productivity. About 70% of employees reported feeling “recharged and refreshed” after taking time off, and 40% or more stated that they felt more focused and less stressed. This, in turn, boosted productivity. One-third to one-half of employees (depending on who was surveyed) reported higher productivity after returning from vacation.

Tony Schwartz, the business writer and visionary founder of the Energy Project, has described vacation as “the secret sauce.” He recommends “[taking] every day of vacation you’re given. Don’t hold it over and don’t tell yourself the story that you don’t have the time to spare.”

He also advises quarterly vacations, even if it’s only a staycation, and long breaks. Finally, he notes, “If you have an intense job, my experience is that it takes at least two consecutive weeks away from work to fully restore yourself.”

That last prescription is hard for most hospitalists to follow. Although block schedules include seemingly crazy amounts of time off, it’s far less usable than it seems. You work like a fiend for a week or two, possibly switching from days to nights along the way. You’re typically fried by the time you go off service. A week off is more like resuscitation than vacation. Then you start the cycle all over again.

And what if you want to take a trip to India or Italy? Stringing together several weeks of uninterrupted time off presents some very serious challenges. You need either very accommodating partners or lots of casual hospitalists to plug holes in schedules.

To invoke Ronald Reagan, “there may be no easy solutions, but there’s a simple solution.” In this case, the simple solution involves a block schedule with major and minor cycles.

The major cycle is two or three weeks of uninterrupted vacation every three months. The minor cycle is scheduled time off following periods of service. Maybe you work seven days and get the next three off. For two weeks of continuous service, perhaps the recovery period is seven days.

This solution, as you can imagine, isn’t easy. Hospital administrators need to agree that physician burnout, which is currently an epidemic, requires aggressive staffing. This goes beyond the usual RVU bean counting to an honest assessment of the costs associated with provider attrition, patchwork coverage and physicians who are chronically fatigued. A full accounting, I’m convinced, argues for more hospitalists, fewer encounters per day or both.

Maybe we need “vacation RVUs” that provide strong financial incentives to rest rather than work. Or perhaps “vacationists” whose sole job is to cover for other hospitalists when they’re recharging. And, of course, we all need to stop “monitoring” when we are off.

“You may say I’m a dreamer/But I’m not the only one.”

David A. Frenz, MD, is a hospitalist for HealthEast Care System in St. Paul, Minn., and is board certified in both family and addiction medicine. You can learn more about him and his work at www.davidfrenz.com or via LinkedIn.