Physicians Reluctantly Pack The EHR In Their Carry-On Luggage

(AMA, Georgia Garvey) — A physician’s most intrusive, unwelcome and demanding travel companion just may be the EHR—the coworker they can’t leave behind, according to a recent study published in JAMA Network Open.

The study on EHR use during paid time off (PTO) showed that, too often, physicians must continue to work during what is intended to be vacation time. This is something that contributes to physician burnout, poor job satisfaction and turnover.

In fact, primary care physicians often toil in the EHR during what was supposed to be time off, “particularly at the start and end of longer vacations, reflecting challenges in fully disconnecting from work,” the study says.

A previous study, using a national survey of 3,024 physicians in different specialties, found that 70.4% reported having worked during their vacation and 59.6% took 15 or fewer vacation days in the previous year. Meanwhile, physicians named finding clinical coverage, absorbing the financial impact and managing the EHR inbox volume as barriers to PTO.

To expand on that, this latest study looked to build on the previous findings using EHR data to determine the amount of physicians’ work during PTO.

Among the physicians included in this study, the median amount of time spent working in the EHR per PTO day was 16.1 minutes. Meanwhile, the study found a median of 39% of days in which physicians spent at least some time in the EHR while 19% of physicians spent more than 30 minutes per day of time in the EHR. The study also found that longer blocks of PTO were associated with less time spent in the EHR, “suggesting that extended vacations enable better disengagement.”

“Organizations should implement strategies to minimize clinical tasks during PTO,” the study says, adding that “future research should explore interventions that help physicians fully disconnect from work.”

The problem of lack of paid time off is endemic among physicians and has clear links to burnout. An exclusive AMA survey found that nearly half of physicians—48.9%—said they took three weeks or less of vacation, with 5% saying they took no vacation days in the previous year.

Research shows that taking more—and more restorative—vacation time, is associated with less likelihood of burnout. In 2023, the physician burnout rate dropped to 48.2%, the first time in four years that the rate was below 50%. But many physicians continue to suffer the ill effects of burnout—and their loved ones, patients and health systems suffer along with them.

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™

Health systems are making a change

Many health systems are trying to turn the tide on burnout, making changes to help ensure physicians can truly unwind and relax on their vacations.

These examples from health care organizations that are members of the AMA Health System Program—which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine—show commitment to reducing EHR use while on vacation and improving well-being.

Ensure physicians come back to an empty inbox

As part of its efforts to reduce the burden on physicians to manage their inboxes while they’re on paid time off, Baptist Health Medical Group has created a pilot program to tackle EHR use on vacation. As part of the program, a team—which consists of a physician, nurse practitioner or nonphysician provider—helps to offload some of the messages received by physicians who are out of the office.

To help physicians enjoy their vacations and time away from the office, Baptist Health also established a group—which includes project managers from different departments, an IT member, an operations manager and three physicians—that meets every two weeks to address issues related to inbox burden.

Provide help while away, keep time off flexible

At Confluence Health in Wenatchee, Washington, about half of their physicians take four weeks or more of vacation per year and the health system also boasts high job satisfaction rates. It’s not just about the vacation time itself, though.

In a primary care department effort at Confluence Health that is looking to be scaled more broadly, messages are pooled when a physician is out of office or on vacation. Other physician partners in the department either rotate responsibility for or get assigned to the messages. Ideally, physicians return to an empty inbox, with no messages.

They also try to keep time off flexible, requiring a minimum number of days worked per year. The remaining days can be used for holidays, vacations, CME, personal days or other time off as needed.

Help physicians feel supported

At Hattiesburg Clinic in Mississippi, as part of exploring the link between feeling valued and reducing burnout, leaders are looking for system-wide strategies to show physicians how vital they are to the group’s success.

And a key part of helping physicians feel supported is allowing them the ability to unwind and unplug with clinical coverage—particularly EHR inbox coverage—while they are out of the office without burdening their colleagues.

Change the culture to encourage PTO

At Marshfield Clinic Health System, leaders are looking to change the culture to lead to positive changes in physician well-being. An organizational biopsy showed that Marshfield Clinic physicians are better at using four weeks of vacation time compared to national statistics, and administrative tasks for physicians are less onerous than those seen nationally, but burnout was high.

As a result, Marshfield has looked to supporting individual physicians. The clinic formed a peer group called the Physician and Allied Professionals Health Committee to provide resources to physicians and advocate for system-level changes intended to promote physician well-being among them on the PTO front.

Learn more from an AMA STEPS Forward® toolkit about reducing barriers to taking time off. AMA STEPS Forward open-access toolkits and playbooks 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.

Also, discover the cost of physician turnover attributable to doctors not having full inbox coverage while on vacation. Meanwhile, this calculator will help determine the cost of physician turnover due to doctors taking less than three weeks of vacation per year.