By Dr. Margaret Curtis, WCI Columnist

[Editor's Note: Readers of The White Coat Investor might know our columnist Dr. Margaret Curtis as a pediatrician, half of a dual-physician household, and the proud owner of a sidewalk sofa. She has been around long enough to have seen and experienced all kinds of professional challenges that physicians face. As her alter-ego, Auntie Marge, she shares opinions and gives advice. If you have questions about your work or financial life, Auntie Marge is here for you. The following is a real question posed to a Facebook group, with identifying details changed. This question was not directed at Auntie Marge, but she's going to answer it anyway.]

“I feel guilty about taking my paid time off (PTO). When I do, I make sure I am available for time-sensitive issues. Is that the right decision?”

Auntie Marge wants you to be happy and successful. She also wants you to make sense.

You are probably early in your career. Many physicians come out of training brimming with enthusiasm, an overdeveloped sense of responsibility, and maybe a little bit of a hero complex. We are set up perfectly for guilt and overwork. Your work ethic is admirable, but you will at some point come up against the hard reality of practicing medicine which is: it’s exhausting, and your time and energy are finite. Create some healthy boundaries now or you will find yourself miserable, exhausted, and maybe even the subject of a business school study.

Keeping yourself “available” is not really taking time off. Just about everything we do is “time-sensitive” and all your colleagues and staff will have different thresholds for contacting you. Some will call you only when they have exhausted every other avenue, and some will call you as soon as they see your name on a lab result—not out of malice necessarily but because you are the shortest distance between them and the point of getting this thing off their desktop.

I could give you all the data on physician burnout, but you are smart enough to know all that. Instead, I'm going to give you other reasons why you should always take all the time off that is afforded to you.


Reasons Why You Need to Take PTO


You Have a Job That Actually Pays You on Your Days Off

You may not always have that. You may someday be solely productivity-based or have your own practice, and your days out of the office will cost you money. Enjoy PTO while you can.

There are reasons a physician should feel guilty: taking shortcuts, gossiping, being rude to the front desk staff. (Unfortunately, the people most likely to commit these offenses are also, generally, the ones least likely to have insight into their own behavior and therefore don’t feel guilty—ever. So, if you have ever wondered if you are on this list, you are probably not.)

Not a reason to feel guilty: following the terms of your contract. You are surely doing all that your contract requires of you in terms of patient care, call, and maintaining your skills. You should expect your employer to keep its side of the bargain by paying your agreed-upon salary and benefits. You should also, therefore, take the paid time off that is in your contract. I can assure you it is not excessive.

The people who hired you did not allot you a certain amount of time off out of the goodness of their hearts. They did it because if they didn’t, they wouldn’t be able to hire anyone. Even the most starry-eyed resident knows that somewhere in their new attending contract there should be some mention of vacation. Your contract includes stipulations about time off that are in keeping with the market for physicians in your location and specialty. Nothing to feel bad about.

Whatever you hear about “wellness” and “work-life balance,” you can’t rely on the people who run your hospital to look out for your best interests. I am going to tell you a story that illustrates my point. This is also the Auntie Marge Origin Story, part 1:

I had a job that paid entirely based on productivity. Both my contract and the physician handbook mentioned “paid time off.” My colleagues (who had the same contract) and I all assumed that “paid time off” meant exactly that. Then, COVID hit, and I took a 40% pay cut because I was seeing few patients and because I was still in arrears from a week of vacation I had taken IN OCTOBER 2019. I combed through all my employment documents and had my lawyer review them. The language was incredibly slippery. I requested a meeting with my supervisor and a guy from finance to clarify. It went like this:

Me: “So, we do not get paid time off.”

Supervisor: “You can take time off and get a paycheck as usual.”

Me: “But we don’t get paid time off.”

Supervisor: “You get paid for your RVUs.”

Me: “And if we take time off, we still have to earn RVUs to cover the paycheck we get while we are taking time off.”

Supervisor: “I think of it as an opportunity: the opportunity to see more patients instead of taking time off . . .”

Me: “So, we do not get paid time off.”

Finance guy: “You do not get paid time off.”

This was just one step on my journey from an idealistic new grad to the hard-bitten veteran that I am today. I will still do just about anything for my team and my patients, but I no longer spare even a moment’s thought to the desires of people like that supervisor.

More information here:

How Can I Make My Terrible Doctor Job Less Terrible?: Auntie Marge Explains It All


You Need to Keep Your Work in Perspective

taking PTO

If you start thinking that no one else can possibly take care of your patients as well as you can, you run the risk of becoming a narcissist. I would not want that for you.

Maybe your reluctance to use your PTO comes from a kind of perfectionism that just about every physician experiences at some point. If so, come on over to the Club of Imperfect People. It’s a much more enjoyable place to hang out than where you are now. I’ll save you a seat.


You Can

Life is short, and the world is wide. Someday, you will be too old to go have all the fun you could be having right now. The people who matter—your friends and family—need you to spend uninterrupted time with them. They need you to be happy.

If what I’ve written here doesn’t convince you to enjoy your time off, it may be time for some therapy to help you understand why it is hard for you to step out of the traces. I do not feel the slightest bit guilty about taking time off, and neither should you. So compose that “out of office” email, grab your backpack or your beach towel or your opera glasses or whatever your little heart desires, and go have fun. If you need help deciding what to do with your vacation—or you just need more convincing—I’m here for you.

More information here:

You Should Invest Like a 50-Year-Old Woman

From Maine to Ukraine: A Physician Finds Meaning in a War Zone


Today’s bonus question is an amalgam of multiple questions posted in multiple online physician forums.

“I sign charts for a nurse practitioner at a remote site/medispa/nursing home who does botox injections/knee aspirations/high colonics. My question is: what should I ask for as compensation?”

Your question should be, “How can I extricate myself as quickly as possible?”

I was once approached by a clinic owner who asked if I wanted to be on staff so their acupuncturist could bill services as “incident to” mine. I explained how “incident to” billing works. I explained that, as a pediatrician, I would find it hard to convince Medicare investigators that I had done an initial evaluation and plan of care for elders with back pain. I explained that this would constitute Medicare fraud, and on the scale of stupid decisions, Medicare fraud falls somewhere between “I’m going to outrun this cop” and “I’m going to invade Russia in winter.” Then, I stopped explaining because, while I am a proud member of the Club of Imperfect People, I do not have time for nonsense.

My scenario wasn’t even courting the serious medical liability in yours so stop with the nonsense. Call whoever is using your medical license and your reputation and tell them that your credentials are no longer for rent. Check your malpractice coverage and hope there are no claims against you for whatever the heck happened at this remote site. Lastly, vow never to let yourself be put in this position again. If you do all these things, I will be here for you.

Do you feel guilty about taking PTO? Does your employer have a problem with it? Do you have any other questions for Auntie Marge? Comment below!