Physicians: Take a Vacation

Elizabeth Scott, therapist and author of an upcoming book called "8 Keys to Stress Management," makes a living telling people how to manage stress. It's her belief that vacations are an important outlet. "People think of vacations as unaffordable luxuries," she says. "But considering the increased risk for health issues and burnout from chronic stress, those risks are a lot costlier than a few days away to recharge."

Who hasn't come to the end of the work year with a pile of vacation hours accrued? Physicians are some of the worst at breaking away. Scott says doctors face job stressors more intense than those of most other jobs; the types of stressors most related to physician burnout are high pressure, long hours, and heavy consequences for mistakes.

Phillip Hemphill, director of the Professional Enhancement Program at Pine Grove Treatment Center in Hattiesburg, Miss., echoes the fact that physicians find it tough to take time off.

"Being a physician carries a unique privilege, so part of their training itself is problematic," he says. "It is extremely competitive, and individuals must be comfortable with making tough decisions, all while suppressing emotions. There are very high - nearly superhuman - expectations from everyone involved in a physician's world, and it can result in self-neglect."

Time for a timeout?

How do you know when it's time to ditch the office for awhile?

Hemphill says there are clear signs indicating the need for a dose of time off. For example:

• Missing more deadlines

• Not managing boundaries well in terms of time, money, and work productivity

• An uptick in conflicts with coworkers, including a rising need to blame others

Walter Gaman, physician and copartner of Executive Medicine of Texas, located in Southlake, Texas, offers a few more warning signs that it's vacation time.

"Feeling overwhelmed occasionally is part of being a professional, but when it feels like you're in over your head with things that don't normally bother you, it's time to back off a bit," Gaman says. Anger, too, is a red flag. "Feeling aggravation toward a patient is one thing," he says. "But if every single person you see is driving you crazy or if you feel enraged over a minor situation, like a patient who is late, time off is definitely in order."

At home, becoming more short-tempered than usual with your spouse and other family members, or experiencing a lack of interest in sexual intimacy can quite possibly be remedied by a little vacation therapy. Another reason for practicing good vacation hygiene, Gaman says, is "When you're in this state of mental exhaustion and don't go for a break - your business, health, and marriage will suffer and you're at greater risk for malpractice."

Scott backs up that claim, citing a 2009 study published in JAMA by Mayo Clinic researchers from the Department of Medicine Program on Physician Well-Being. The study of more than 300 internal medicine residents concluded that higher levels of fatigue and distress are associated with self-perceived medical errors.

Tailored treatment

Vacations are not one-size-fits-all therapy. One man's exhilarating excursion is another's frenetic travel fiasco. If you're in a rut, choosing the same place and time to get away each year, stop and think again. What do your routine vacation choices say about you?

Hemphill explains, "Physicians are adept at detachment. You have to manage yourself privately and collegially. If someone's always taking work-related vacations, they're not truly breaking from work mode."

He says the vacation type that works best for you - whether that's with the family along for the ride, just you and your spouse, or completely solo - is determined partly by personality traits, but each kind of trip has its place in the restoration process.

Doctors are notorious for using medical conferences as "vacations" - after all, you can bring the family and write the trip off on your taxes. But given the chance to drum up her own dream vacation, you'll be hard-pressed to find a physician who thinks attending 7 a.m. seminars and making plans to squeeze in a swim with the kids before a poolside dinner with colleagues is really all that relaxing.

"You aren't able to truly set aside work issues on such trips," Hemphill cautions. Of course, if having your brood tag along to a conference is as good as it gets for you, at least tack on some work-free days before or after meetings to catch your breath.

Family vacations are one kind of fun. Gaman reflects on a trip to Hawaii, including the kids. "It was fun, but there's a lot of work involved, and you spend a lot of time not doing what you want to do."

Ready? Set? Get out

Changing up your vacation scenery is a potent way of treating the stress that ails you. Simply do something different.

Monika Sundem of Adventure Life, a travel advice and planning agency, sees a clear pattern in physician clients.

"Doctors with high-stress occupations enjoy either our multisport trips - which keep them active and almost force them to avoid e-mails during the trip - or they like to visit remote destinations where there is no Wi-Fi signal," Sundem says.

Multisport-style trips combine many activities during one vacation, ranging from whitewater rafting or kayaking to hiking and biking. Sundem says having a ready-made selection of things, like zip line tours, market trips, and tours of ruins, "keeps travelers active in the morning and the afternoon. Typically the only down-time is in the evenings. Busy days really promote restful nights."

Adventure destination vacations offer very remote locations, like the Torres del Paine National Park, Patagonia, Antarctica, or the Amazon rainforest - lodge-based trips that usually include hiking and wildlife viewing. You're guaranteed to be out of touch with the office.

If disconnecting is high on your priority list for vacation benefits, consider the increasingly popular meditation retreat. You don't have to be Buddhist to take advantage of Vipassana meditation classes offered around the United States by affiliated organizations. This particular technique requires participants take a vow of silence for up to 10 days. But don't be mistaken and think you'll be napping in a hammock during such retreats as those also led by the Insight Meditation Society in Massachusetts. Each day's schedule is structured from dawn to bedtime. Your basic needs are met for you (unless you're a return retreater - then you'll have kitchen and clean-up duties), and your teachers are experienced in meditation, wise in the ways of societal urges (so you might be asked to leave your cell phone in a basket.)

Not all meditation retreat centers are based on Eastern philosophies. The Franciscan Monastery Hermitage, for example, offers a tiny, forested refuge right in Washington, D.C. And of course, a lot of resorts are getting in on the popularity of meditation, boosting their yoga-for-couples classes interspersed with guided meditation time.

An even more cutting-edge trend in getaways is the Paleo experience. With a definitive emphasis on community-building as opposed to solitude, Backtracks, LLC, makes arrangements on remote private land for gatherings that encompass primitive camping and classes in ancestral living skills. More than leisurely outdoor living, campers come away with experiences in long-forgotten survival techniques like cloth making, trapping, snaring, and otherwise finding and gathering food, fire making, and more.

Pamper yourself

If your vacation needs are of a more luxuriant variety, head for a spa. The spa industry has grown huge in recent years for good reason.

Susie Ellis, president of SpaFinder Wellness, says, "Years ago, it was rare to see a doctor at a spa. Now, they're realizing the true health benefits. Once they have their own spa experience, they are hooked and may even recommend it to their patients." Besides providing a way to navigate through thousands of spa options via their website,  the company recently started an online database of studies called SpaEvidence.com, providing medical evidence on the benefits of spa and wellness therapies.

"There's more to spas now than just massage," Ellis elaborates, "[like] golf, horseback riding, even hiking and sports activities. Boot camps are very popular now, especially when combined with some luxurious touches in the same trip."

Not that massage isn't still a great idea. Gaman is one physician who once scoffed at spa retreats and now is a believer, saying it creates a space and time where he and his wife can feel indulgent and pampered, even if only for a few days.

"We do things during that time off that we wouldn't have time or inclination to do in daily life, like a couple's massage, and return feeling totally refreshed and recharged," he says.

And it's nearly impossible to place a value on that kind of medicine.

Tracy Morris is a freelance writer based in Houston, Texas. She's been a writer and editor for healthcare industry publications and websites, as well as a consulting writer for practices ranging from solo physicians to national corporate networks. She can be reached via editor@physicianspractice.com.

This article originally appeared in the April 2013 issue of Physicians Practice.