Always On Call: Why You Can’t Unplug and How You Finally Can

Each morning on many vacations, Emily K. Osman, MD, would stay in her hotel room until she’d made all her patient phone calls and reviewed their test results. This often meant missing nearly half a day with her family. Palm trees may have been swaying outside, but this reproductive endocrinologist might just as well have been back in her office at RMA, New Jersey.

Overall, 70% of doctors work during a typical vacation day, according to a 2024 JAMA study of 3024 physicians. About one third spend at least 30 minutes per vacation day on work-related correspondence.

PTO for doctors has been referred to as “pretend time off.”

That’s for the ones who take vacation time.

“At my practice, I see more than 25 patients a day and typically have limited time to spend with them during their visits,” shared Catherine Churchill, DPM, a podiatrist at Jersey Shore Podiatric Associates, New Jersey, and medical director of Podiatry at ModMed, Boca Raton, Florida. “Too often, not everything can be finished when the office closes, so I’m left working into the evening or concerned about what wasn’t completed that day.” She responds to patient messages and phone calls on nights and weekends.

When doctors are always “on,” they don’t give their nervous systems a chance to toggle between “fight or flight” (sympathetic) and “rest and digest” (parasympathetic). In the short term, high levels of cortisol and adrenaline can impair mood, memory, and decision-making and even increase the risk for medical errors. In the long term? Burnout and damage to the cardiovascular, immune, and nervous systems.

Here’s why it’s so hard to unplug and how to get the restorative time you need.

Problem #1: Overwhelming Electronic Health Record (EHR) Inboxes, Not Enough Backup

More than half the doctors cited returning to an overloaded inbox as a reason they didn’t take more vacation, according to the 2024 JAMA study.

“EHRs and patient portals come with constant alerts and notifications about test results or patient messages. These systems often blur the boundaries between work and personal life, making it difficult to unplug entirely,” said James Lyons, MD, physician and medical consultant for Synergy Houses, West Chester, Pennsylvania.

Many doctors also struggle with anxiety about finding people to cover their clinical responsibilities. “Most healthcare systems are understaffed, and when a physician takes time off, it puts a strain on the rest of the system,” said Ryan Sultan, MD, assistant professor of clinical psychiatry at Columbia University Irving Medical Center/New York State Psychiatric Institute, New York City. Because their work usually can’t wait, others need to take on their tasks in addition to their own. And the stakes are high: If they don’t, patients can be left without care.

Problem #2: The Medical Mindset

“Medicine doesn’t come with an off switch — it’s a suit of armor you can never take off,” said Felipe Torres, MD, a former emergency medicine physician who now teaches functional breathing. “It’s our identity. Even when we’re off the clock, the armor stays on. We either replay the difficult cases, the tough conversations, the hasty prescriptions, or worry about patients, and prepare for what might come next.”

The “always-on” approach tends to be glorified, he added. When doctors do set boundaries, they often face judgement. “They’re labeled lazy or negligent because they dare to step outside the impossible ‘superhero’ archetype.”

Perfectionism is common — and fraught — and disconnecting can feel irresponsible or even callous. “It’s common for doctors to carry the mental load of ‘what if’ scenarios long after leaving work,” said Lyons. “Doctors form bonds with their patients, and it is hard not to take their struggles home with us. Whether it is worrying about a challenging diagnosis or empathizing with a patient’s pain, that emotional investment can make it challenging to detach fully.”

But it’s critical to try…

Solution #1: Nix the Guilt

Begin by reframing your mindset to view rest as a necessity rather than an indulgence, suggests Rebecka Parker, MSW, LCSW, a clinical social worker/therapist and writer at BIRP Notes.

“I used to feel I had to be available for all things all the time,” admitted preventive medicine physician Riva Rahl, MD, medical director of Cooper Clinic Platinum, Dallas. But then she began meditating and running each morning. Acknowledging she didn’t need to respond to everything right away and developing trust in her team helped her unplug and “feel good about it,” she said.

That’s the formula:

• First give yourself permission to disconnect.
• Set healthy boundaries for a long enough time so people learn to respect them. Define “on call” and “off duty” periods and use auto replies, recommends Parker.
• When you’re not on call or in the office, turn off your alerts and avoid checking messages.

It may feel wrong at first, said Rahl, and that may be the biggest battle of all: Doing it anyway.

Solution #2: Be Intentional About the ‘Where’ and ‘Why’ With PTO

Sometimes, you need to literally get away to “get away.” So plan trips that will replenish you, counseled Bayo Curry-Winchell, MD, medical director of Urgent Care clinics at Saint Mary’s Regional Medical Center in Reno, Nevada, and founder of Beyond Clinical Walls.

If you think your phone will pose too much of a distraction, consider a meditation or wilderness retreat, where you’ll be forced to unplug.

Pamela Wible, MD, a former family physician who now runs a suicide helpline and peer support groups for doctors, strongly advocates digital detoxes while on vacation. On the doctor retreats she leads, Wible asks participants to hand over their phones.

“They feel uncomfortable turning over their electronics, but they thank me later,” she said.

Solution #3: Maximize What You Can From Office Resources

Even if you’re able to take a break from your phone, you might still worry about insufficient EHR inbox and patient coverage. That’s why a robust hand-off system is so helpful. Michael May, medical director and principal surgeon of the Wimpole Clinic, London, England, said his team uses a shared inbox and only interrupts someone’s PTO when there’s a “true emergency.” Because they manage messages collectively, “no one feels pressured to return from a holiday to an overwhelming workload,” he said.

Unfortunately, not all practices have such systems in place. If not, investigate whether you can ease back into work.

Osman, admittedly a lead physician at her company, was finally able to stop working during her vacations when she started leaving her first day back appointment-free. Knowing she would have time to catch up on correspondence and review test results before seeing patients again went a long way toward reducing stress and allowing Osman to relax.

Solution #4: Give Yourself a ‘Finish Line’ for a Daily De-Stress

You don’t need to wait for a vacation to unwind. Establish a clear finish line–style boundary between your professional and personal lives and make crossing it a daily ritual.

Asim Cheema, MD, an internal medicine and cardiology physician at Your Doctors Online, Toronto, Ontario, Canada, meditates in his car for a few minutes, listens to music during his drive home, and immediately changes out of his scrubs once he walks in the door. Dr Cheema gets a rest while Asim enjoys the evening.

Disconnect to Reconnect

Whether you make a small change (like turning off your alerts during PTO) or a larger one (like taking every last day of your vacation time), disconnecting from work works.

Although it sounds counterintuitive, true R&R will help you stay connected to yourself, your work, and your patients. After all, you’re not only a doctor but also a full-fledged person, reminded Wible.

“Doctors are only human, and at the end of the day, we can only serve others fully if we’re fully healthy ourselves,” said Torres. “You can’t pour from an empty cup. And you can’t carry the weight of the world in armor that’s already cracking.”