Out of Office, Still Logged On

In this episode of Joint Effort PAs, we’re diving into the complicated relationship healthcare providers have with time off, productivity, and the constant pressure to “do more.” Why does taking PTO somehow feel more stressful than just going to work? Why is medicine filled with people competing in the Productivity Olympics? And at what point does being “driven” turn into burnout disguised as dedication?

We talk about the culture of overworking in medicine, the unspoken pride people take in never stopping, and the mindset of “I work harder than everyone else” that somehow became a badge of honor in healthcare. From answering Epic messages on vacation to feeling guilty for using benefits we literally earned, we unpack why so many providers struggle to truly disconnect.

Transcript

SPEAKER_02 0:00

Welcome to Joint Effort PAs, where two orthopedic surgery PAs get real about life in medicine. From tips and tricks to professional growth, work-life balance, and everything in between. We're here to share what we've learned and what we're still figuring out. Let's get into it. Okay, well, we'll get started. But first weekly recap as much as you can. I don't know that can't handle it. We we already had our weekly recap for the past 40 minutes, and I don't know that like mentally you can revisit that again. No, at least in as much detail.

SPEAKER_01 0:38

Yeah, no, it was uh it was kind of a stressful week. Again, we have our weeks planned as well as we can plan them. So they start off relatively predictable. And to be totally honest with you, my OR day Tuesday, I didn't even tell you about this. My OR Day Tuesday got cut short. Now we have um two days a month. We're at the hospital. This is to accommodate patients that don't have appropriate insurance, they're too sick for the surgery center, and that that's you know, it's one of my days. So um, first patient ACL, second patient knee, third patient shoulder, fourth patient, the anesthesiologist who is like super young and super new, comes in the room and says, Hey, so your um your shoulder is a diabetic, they're on a GLP one, they stopped it last Sunday, so they went off of it for nine days, but they ate yesterday at six. We're like, okay. They're like, Well, they can't do that. It's like according to who, like, what rule is that? So, um, of course, I'm I'm like looking at all the guidelines, whatever, and I'm seeing an email that I missed that said like they have to do clear liquids. And um he said, No, I mean, this is technically an elective case. We want them on a clear liquid diet for 24 hours. I was like, anyway, so the doc looked at me and he goes, Why would you tell them to eat? Right? Yeah. And I was like, Oh my god. Like, it was instantly like took me from zero to zero to a hundred. I was like, Why would I tell them not to eat? Like when you guys update policy, like you have to let us know. Yeah, yeah. So yeah, the anesthesiologist said, Well, your clinical team told him it was okay to eat. And I was like, Oh my God, right? So anyway, it was canceled, just no questions asked, right? Yeah. So then that's that spurred conversation of like, hey, let me talk to the head anesthesiologist. So the doc I work with was like, all right, cool, let me get on a group text with him and then the other guy.

SPEAKER_02 2:24

Yeah.

SPEAKER_01 2:24

So he says, Well, it's kind of case-by-case scenario. And the other guy says, Well, if they're using it for diabetes and not weight loss, and then the other one's like, Well, and here's this scenario. I'm like, whoa, whoa, whoa. So why did this guy get canceled?

SPEAKER_02 2:37

Yeah, like everybody asked me these questions. I'm actually gonna mention because we have had several cases where there was like some question about it, and I feel like it's a big flip-flop on the GLP ones. Yeah, and you do a whole episode on GLP ones in the relation to build up, but very, very like superficially.

SPEAKER_01 2:52

If someone's taking a GLP one because they're a diabetic, they are okay to stay on it, but have to go clear liquid diet for 24 hours prior to surgery.

SPEAKER_02 3:01

24 hours.

SPEAKER_01 3:01

If someone is taking GLP one for weight loss, they have to stop it a week ahead of time and also do the 24-hour clear liquid diet. Now, let me tell you, if the issue is gastric emptying, who gives a fuck if they're diabetic or not?

SPEAKER_02 3:12

Yeah, I was gonna say, like, what's the difference? The drug is doing the same thing in their body, right? Yeah.

SPEAKER_01 3:17

So the issue was this guy was taking it and he was diabetic. So he got off of it, which technically wasn't the recommendation, even though no one told me that.

SPEAKER_02 3:24

I mean, if I told you that, would you think that that was well, I guess so they're wanting them, if they're diabetic, they just want better blood sugar control, so that's why they want them on it. But again, there was no conversation.

SPEAKER_01 3:32

The guy was like, So I guess we're gonna cancel him.

SPEAKER_02 3:34

I'm like, But here's my thing, then why would it matter it as much? So you can be on it if you're diabetic because you want better blood sugar control um with doing the fast. If somebody did take it after that seven-day time frame, but they did the fast, would they still be canceled? Because a diabetic person would be allowed to have still been taking it.

SPEAKER_01 3:54

I'll take it one step further. This is a shoulder case, they're sitting up. So, like, I mean, I would be more concerned if we're laying down, aspirating versus sitting up and aspirating. I'm not that it's impossible, but like, hello, yeah, like it's kind of hard. Yeah, yeah. I don't know. Anyway, so it was canceled. So I started the week annoyed that my week was gonna be kind of underwhelming, right? Yeah, yeah. And then it turned into turned into the whole thing. But anyway, no, so that was um it was Tuesday surgery day, Wednesday clinic, Thursday clinic, crazy, Friday OR day, crazy. We had a couple add-on cases and seeing a patient that's still in the hospital over the weekend.

SPEAKER_02 4:24

So yeah, that just typical, just normal. Typical. Yeah. Oh, we had a busy week. It was like normal, busy though. Um, I was frustrated. One of the cases that we had that um had gotten canceled from the week prior because the patient didn't have a uh appropriate ride to surgery, like they were gonna take a cab to surgery, and you can't just take a taxi to your surgery, apparently. Which, like, I mean, like I get why not, but like also I don't know, you can you just can't let them know you can, yeah. But you have to have somebody that's like with you that they can talk to. And I, you know, unless you like really pay off your Uber driver, I guess, and be like, hey, pretend you're like my dad or something, which maybe you can do that. I don't know. I could, I would try. Yeah. Um, then you know, they have to like sit around and wait for you, just have to pay them extra, I guess. I'm not condoning this, but I'm just saying there's ways around situations. There's ways around me having a full surgery then. Yeah, exactly. Yeah. Um, so that didn't happen. And then, you know, we scheduled him for another day, and apparently things depend it another anesthesia thing. Like, depending on who you have that day, they have different policies, I feel like. So they wanted this person to have somebody with them through the whole night. Whereas the person before was like, Oh, I just need somebody to like a responsible person to be with you who's taking you back in the same house or something. Yeah. Um, and so that morning of canceled again. So now we have to do it at the hospital so that he can stay overnight since he has no responsible person to stay with him. Do you find that? So he has to get admitted for one night for a whole radius for actually. Oh, I've had that.

SPEAKER_01 5:56

And listen, I had an ACL who decided day of she didn't want to go home because she lives on the third floor. And guess when she left the hospital? One week later. Oh my god, one week later. Because then physical therapy plays into it. Physical therapy is like, oh my god, they're not safe. I'm like, why do we ask you?

SPEAKER_02 6:12

I know. I had somebody do that, and I'm like, I feel like you played me. Like we talked about this before surgery that, like, you don't, but really they played themselves because they're gonna get the bills for it and their insurance isn't gonna cover for an outpatient surgery.

SPEAKER_01 6:24

So anyway, so among other things this week, this is a weird just side note for a second, interesting clinical thing. We had an ACL patient on Friday, right? We do ACLs on Friday, they go home over the weekend. This lady did therapy the same day, so she was like equipped. I get a text from the on-call person, they're like, Hey, weird scenario, your ACL called. She was doing her exercises, sitting on her hand because she didn't want her hand to grab her knee. She's trying to be like trying to do her exercises without getting out of here.

SPEAKER_02 6:49

Without like insisting, yeah.

SPEAKER_01 6:51

Knocked out of radial nerve, wrist drop. Oh my god. She's like, What do you want me to do? I'm like, it's terrible. Assure her that it might take six months. I know. I was like, get her a wrist brace, gabba pen, whatever, whatever. But I've never had that one before.

SPEAKER_02 7:05

Yeah, it was self-inflicted.

SPEAKER_01 7:06

Yeah.

SPEAKER_02 7:07

Well, I mean, a lot of the tests they call it like Saturday night palsy because you like drunk people pass out in a weird position on their arm and wake up and they're like, But if you've ever seen that, it's like it works. Yeah, yeah. I mean, I've seen a couple of cases from like self-inflicted, um, and then you know, we've had a couple actually like traumatic radial nerve injuries. The knife one that that guy never got it fixed to he never showed up. We talked about that before. But yeah, overall, not a bad week. Just like, I don't know, there's constant stresses of the uh the business. Of the system, the business side of medicine and the the system, yeah, fighting the system always.

SPEAKER_01 7:48

Well, so yeah, so let's talk about what we're gonna talk about today is taking time off. Like, why is it so hard? When do we fit it in? What is the appropriate amount of time off? And again, the sub question when you're taking time off for just a mental situation versus you're taking a vacation, those need to be two different things.

SPEAKER_02 8:08

Like you mean like a mental health break. So I uh they both the same thing. Uh like isn't a vacation a mental health break or something.

SPEAKER_01 8:16

It is, but I don't think mental health break is a vacation, right?

SPEAKER_02 8:19

Uh yeah, true. Like just because you're going on a mental health break doesn't mean you're going to like Aruba to take that mental health break.

SPEAKER_01 8:26

Yeah. So I think working in a field where you have patients and patients have needs, whether you're here or not, I think one, that makes it hard. Two, I think in a private practice or in a subspecialty, you we thrive on being productive. Like if we're not productive, I feel like we're, you know, for lack of a better word, on the chopping block. Like, why? Why is this provider slacking? Like, why are they not doing their job? So God forbid you have vacation planned and so-and-so gets married, and then whoops, your grandfather died.

SPEAKER_02 8:54

Like, yeah, like do we have to choose which ones to go to? I already feel like I'm on the chopping block weekly. Like, if somebody in my family dies, please don't because that'll push me over the edge. I will virtually attend. I can't. Sorry.

SPEAKER_01 9:07

Like, I got it out on my night clinics. But I think, I think we are, at least in our practice, we we uh give our providers four weeks off per year. And they can't again, like that's generous, I feel like. It's generous. Now that doesn't count holidays, which are already given, right? Yeah. Um that doesn't count a week of CMEs. Yes. That doesn't count that's a fifth week, right? That doesn't count bereavement, which is never planned, but it's also there, and you don't have to dip in your PTO.

SPEAKER_02 9:34

But I mean like one day of bereavement. It's two. Well, it depends on how direct the family member is.

SPEAKER_01 9:39

And it also depends on how long your days are because it's hours, not days. Oh, okay. But anyway, yes, how how real real family are they versus not real family? Yeah. Um, but I think uh it's worth talking about because we celebrate productivity and we don't celebrate the same amount your um reprieve or your mental health or your like, you know, I need some time to to unplug so I can come back even better, right? Yeah. So how do you feel about time off? We've talked about this before.

SPEAKER_02 10:11

I'm a terrible person to ask about this. I probably sound very uh I'm like the Ebenezer Scrooge of this topic, I feel like. But um, I'll play the devil's advocate during it. And I don't like I I think this is very personal to each person because I would never like I think it's great for people to, I think it's necessary for people to take time off. Do I do that? No. But I also I want my mindset, I'm not gonna be able to enjoy time off unless I feel like it has purpose and I wanted to take that time. Unless I have a very specific reason that I want to take that time off. I'm not just gonna like book a week at the beach and sit by myself and read a book and feel not anxious about not working.

SPEAKER_01 10:54

Yeah.

SPEAKER_02 10:54

Because I I would rather be here.

SPEAKER_01 10:56

Yeah. But but is it worth it though, if you take your vacations and they become stressful and not restorative? Is it worth it if you take time off, but you're secretly checking your texts to see that everything's okay in your absence?

SPEAKER_02 11:12

Um I think it's the type of job though, like it and when I talk to people about like new PAs going in, what kind of role do you want? Like, there are jobs that that is certainly gonna be possible. You're not gonna have to check your phone when you leave, you're just gonna be plugged out. Like, is that what you want? Yeah, it's or do you want something that you are more like constantly invested in? Yeah. And if you're constantly invested in something, that's just not gonna be possible for me at least. Yeah. Yeah.

SPEAKER_01 11:39

So let's let's dive into, and again, we can give our personal feelings about how we feel about this productivity, culture, and medicine. Okay. So since when you train, all right. Now, if you have a cadaver lab, let's say that you're doing in school and it's scheduled on a Sunday, and you're like, oh, but I kind of have like my I don't know, my roommate's baby shower or something.

SPEAKER_02 12:01

That's a baby shower in PA school.

SPEAKER_01 12:04

Say, let's say it's a test, it makes you have to decide from the get-go, which is more important. Yeah, yeah. So I think everybody would handle that differently. If we sampled 20 people, 10 would say I'd go to Kid Hour Lab, 10 would say I'd go to the baby shower. But like from that point on, it sets the tone for are you making the right decisions? Are you someone who says yes says yes all the time? Um, being readily available. We talked with the PAOS guys about this, being very being available all the time, but like to what extent?

SPEAKER_02 12:31

Yeah, I don't know. I don't know what the right answer is.

SPEAKER_01 12:33

Like But I think though, when you have a busy schedule, I respect you.

SPEAKER_02 12:38

Yeah, no, I mean So I I played where did that come from though? Where did that come from? Like what previous life trauma or something bred that in us?

SPEAKER_01 12:50

I don't know. Somehow in the mix, somehow this happened to me still. But both you and I, I think, have our identity in how productive we are.

SPEAKER_02 12:57

It is, it is. And I don't think that there's some Freudian reason there. Yeah. And it's not, look, it's not a bad thing. I think like it doesn't, you don't have to look at it as something that has to be changed. But I also recognize that in myself as not I need to like check myself when I judge other people. Yeah. For being different, you know.

SPEAKER_01 13:16

I guess what I'm I wish is I wish that, like, in the world we live in, if I'm like, wow, Hannah saw 105 patients this week, like that's impressive, versus a week that Hannah saw 89 patients and also she learned a new skill. Like, I don't have the same visceral response to that.

SPEAKER_02 13:34

You want the higher patient number.

SPEAKER_01 13:36

I wanted you to see 105 and another. And do it. Yeah, I know. You know what I'm saying? Yeah, so me too. I put that expectation on those around me, but I know, but that that does that breed sustainability in medicine. I don't know.

SPEAKER_02 13:49

I haven't burnt out yet, so I'll I'll keep you updated when that happens.

SPEAKER_01 13:53

All right. It's like your it's like your growth chart at the pediatrician. I'm gonna have to map you and say, Hannah, there's a plateau with your pace right now.

SPEAKER_02 14:02

Like with your pace, something bad is gonna happen to you.

SPEAKER_01 14:04

But I think um, unfortunately, our productivity is tied to our identity and our self-worth. So um I think sometimes when we are not overwhelmed with things, we feel a little bit like we're not doing anything, right? I do. Um, when you're really tired at the end of the week or have had a really stressful week, part of me is like, wow, that was really stressful. Part of me was like, I handled it.

SPEAKER_02 14:26

I loved it. Yeah, I came home with 50 notes on Friday. I crushed them all. The second I finished, I was like, I think I want to do a research study. Like so I started planning. I was like, how can I make this happen? Like, what IRB can I use? So that's where that's where I'm heads at it.

SPEAKER_01 14:44

Well, but do you think this is true in other aspects in other um professions?

SPEAKER_02 14:49

Or you think it's just medicine? Uh no, I think it's probably the case in other professions too. I don't like realtors in that. Like they're I don't know. Are there any realtors out there listening to this? Do you I bet I bet the top realtors in the world feel like this? Okay.

SPEAKER_01 15:06

So I will tell you something. On Friday night, um, my daughter had like an end of the year soccer party as 5 30 to 7 30, and I was incapable of getting her there at 5 30 because our hour day ran late. Yeah. And then um I ended up picking her up at five at 7 30, and all the other parents stayed. Like they didn't drop their kids off, they stayed. So I came for the old pickup and I realized very quickly when I watched, I was like, Oh, oh, this was a thing. So everyone was like, Where were you? I was like, I like just got out of work. Like, oh my god, oh what? Wow. What kind of job do you have? Like, what do you even do? I know quit your job. I know, right? So I was like, oh my God. I just, you know, in in in like my people here at work, they would be like, wow man, that's so cool. So many cool cases, but like real life, they were all they all looked at me like I was insane. Crazy, yeah. Like, why would you miss this?

SPEAKER_02 15:53

And I was like, well, yeah, but that that is that is another difference too. Like, I I think things would be different in my mind if I had like, I don't know, if I had kids or something, like right, I probably would look at things from a different perspective that maybe this isn't the most important thing in my life. But when does that change? Right now, right now it's it's like dog and somebody can play it out. My fiddly fig is dead at home. Like oh my god. Just kidding. I'm cutting that out for sure.

SPEAKER_00 16:27

Oh depressing. I should leave it. I probably wouldn't. Okay.

SPEAKER_01 16:31

So next topic taking time off. When you take time off and you go on like an amazing vacation, like, do you really feel like you are disconnected? No. No. Okay, me neither. Second question What is the extremes that you have gone through to remain connected or something was asked of you and you didn't want to tell someone that you were on vacation, you did the thing.

SPEAKER_02 16:52

I would never tell somebody I'm on vacation. Like, I've gotten texts from people in urgent care. They're like, I'm so sorry to bother you this late at night or in the morning. I'm like, no, I'm logged on right now. Meanwhile, I'm in my car hotspotting something, like trying to type and drive at the same time. I'm like, I actually was just already logged on, sitting in a cafe. It was so convenient that you texted me. Like, not a problem at all.

SPEAKER_01 17:14

No, definitely. I've downloaded Epic on like my mother-in-law's computer because I'd be I'd be somewhere and something needed to happen on Epic, and I'm like, oh my god, I don't know. My computer, oh, I could just just download this, talk to IT at the hospital, get it all connected. Yeah, fine. Um, I've talked about this before. I've had to admit a patient one time when I was on vacation and it was like so windy under the plane. It was like the sand and all the wind and stuff. But um, other thing, I will not put the automated message on my email. I've never done that. I've never done that.

SPEAKER_02 17:47

I don't know how to do that either. I don't even know. I know how to do it.

SPEAKER_01 17:49

I just refuse to do it because I don't want people to think that I don't care.

SPEAKER_02 17:52

Or that you're not gonna respond. Or that I'm not gonna respond. Like I still respond in the same amount of time otherwise.

SPEAKER_01 17:57

The only people I will tell that I'm out of town are those that work directly on my team. And I will tell them, much like I would someone watching my house, all the steps of all the things they need to do.

SPEAKER_02 18:07

Like a checklist.

SPEAKER_01 18:08

Like a checklist that I feel comfortable with it. And also, you know, if you need to text me, text me. But I will I will say though, if you need something, text me, email me. I prefer if you don't call me because I don't want to feel like you have to answer right now. You have to answer it. Yeah. So I I will define, I guess, I guess that's called that's healthy. Those are boundaries, right?

SPEAKER_02 18:26

Those are some boundaries. Some would call them very loose boundaries, but they are boundaries. Yeah. Um, so that we're gonna call this what we just described like the unhealthy realm of work-life balance. Yeah. Then let's uh let's contrast this with potentially what the people of 2026 would call a healthy work-life balance, which might be to the opposite end of the extreme. Yeah. You know? Yeah, that's that's the mental health days. The mental health days. I crushing mental health and its importance, but like, I don't know, you gotta get a paycheck too.

SPEAKER_00 18:59

Yeah.

SPEAKER_01 18:59

So I put on my calendar, and this happened to be because the doc was away for something on a surgery day. And as you know, on those days, you can either choose to open a clinic or you take the day off. And like gun to my head, I'm gonna open a clinic. I just am right this time, and it wasn't it wasn't this time, it wasn't last year, it might have been the year before that. I put on there, like, no, I think I'm gonna take the day off. And everyone on my team was like, What happened to you? Okay, yeah. Yeah. So I was like, Well, I think I'm gonna go like I'm gonna get a haircut. Yeah, I'm gonna go, I don't know, uh, maybe take my daughter out to lunch. So they put on the calendar best mental health day, and I got made fun of for weeks.

SPEAKER_02 19:38

We're taking one day off to do a normal thing that like people would but like but to that to that effect, when do you get your hair done? Um, I planned one for a Saturday three weeks from now, actually. Yeah, okay. I don't see Saturdays. Saturday we won't, we won't touch here.

SPEAKER_01 19:53

We will not touch hair, but like hair appointments, eye doctor appointments. Like, when do you do that?

SPEAKER_02 19:57

I've never seen an eye doctor. Um and my mom works at a dental office, and the last time I went, they were like, Wow, you haven't been here in three years.

SPEAKER_01 20:07

So I will go, but but I will do I will do the I haven't did the eye doctor in two years, and they text me all the time. But the dentist, I will do the dentist at their 11:30 or 12 o'clock appointment. At lunch. And but but for what? Self-sacrifice. I don't get to eat lunch that day, which is I guess not definitely. I mean, like, but eats lunch. But there's no time for that stuff. So, like, I I guess what I'm saying is we need to, if we want to be as productive as we are, we need to also kind of save some time for the human things that make us human and it make us able to do these things.

SPEAKER_02 20:37

Botox appointments, Botox, yeah. You can get those on a weekend usually, so that's not a problem.

SPEAKER_01 20:42

Yeah. Now, the feeling of vacation. Now, I work with another PA that is soon to be retired military. And what he will do is once a month, he does his weekend kind of mandatory report for duty, right? He will once a year take two weeks and have to do a two-week stint somewhere. Now, my initial response, and again, I am not a monster, I'm just a human being who has to take up his burden when he's gone. I was like, okay, so if you're gone for two weeks, then maybe you work an extra day the week before and then the week when you're back. And he is not of a different generation than me. So it's not that it's it's not millennials. Well, but I will tell you, this is never brought up as, hey, how would I do this? This is always me saying asking, and you're the bad person. Well, I'm not the bad person, I'm just the person who's asking more of him.

SPEAKER_02 21:35

Yeah.

SPEAKER_01 21:36

Because again, he'll say, like, hey, I need to take these two weeks off. I understand you're gonna pick up all my load. Thank you.

SPEAKER_02 21:43

So, like, what can I do?

SPEAKER_01 21:44

No, yeah, it's never that. I'm like, hey, why don't we do this? And then every the weekend that he takes off, he also closes a clinic every Friday. So at the end of 12, 12 months, it's 12 Fridays. So, like, I expect maybe half of those you'll work another day. Yeah. But it's always a conversation. It's always a little bit tough. So I feel I feel like I'm kind of like the bad guy. But at the same time, if I were to take a week off, I am looking the week before to kind of see a little bit more because the week when I come back, I will die. Like it just is so busy and there's so many patients. I just feel like it's like not worth it. Well, yeah, it's like the fear of when you're gone for a week, like what am I coming back to? Yeah. You know? Yeah. Unless they did turn off my email.

SPEAKER_02 22:25

I don't want to read all those emails in a week. No. And I want like I would love to talk to somebody who works like in a hospital system or something where it just like it's not the same. Your patients aren't like your patients all the time. Yeah. You know, it's just so different where you can maybe like completely sign off like that. But to be perfectly honest, I don't know that I would like personally, that's not what I would like. Yeah. Like I want to be invested and know what's happening to my people in any given moment.

SPEAKER_01 22:55

But do your family members ever say to you, like, why? Like my family members would say, like, oh, were you on call today? And like, I don't know how to answer that. Like, yes.

SPEAKER_02 23:03

No, my my family understands at this point if we get it. Yeah. Which is helpful.

SPEAKER_01 23:08

Now, what about like this? A lot of us aren't just taking vacation. We're just relocating our anxiety.

SPEAKER_02 23:14

Relocating your anxiety? Quotes up. Yeah, no, that's that's what I would be doing, though, relocating my anxiety. I'm just taking it to a different place. Would it be worse? Because I feel like when I am anxious about things, when I'm here, I don't have to like process those things and think about them because I'm busy. That's why I love seeing like as many patients a day as possible. I don't have to like think about any of the things I could potentially be anxious about. If I were to take a week off to sit with my thoughts, like Yeah, yeah, yeah. What would that look like? Not good.

SPEAKER_01 23:47

Not good. Now, since we're talking about it, do you think a week is too long? I've never taken a week vacation. Okay, so the answer to that is yes. So, what is your perfect amount of time if you were to go away to get away to feel like you really like stepped back, but wasn't too long.

SPEAKER_02 24:03

It's like Thursday, Friday, Saturday, Sunday. So forty weekend. Long weekend. So four day weekend. Yeah, a long weekend. Yeah, I just did one of those. It was actually like perfect. Yeah, it was perfect. Um, I felt like I didn't really miss out on that many things. Also, partially that's because the doc I work with took off the same days, so I really didn't miss out on anything. And so yeah, that felt very perfect for me.

SPEAKER_01 24:23

So four to five days. Four to five days max. I love it. Two days not enough. Two days is like well, like that's a weekend. That's a normal time. All right, fair. I think seven days is good, but I feel like seven days is like max. I did a um, I did an RV road trip like during COVID, I think. Well, that could be part of the reason it felt like too much. It did, it felt like too much, but it was Thursday, Friday, and then the whole next week. That felt it felt like a lot. Yeah. And I've I don't think I've ever done that. It's not so true of my honeymoon I did, but anyway. Oh, that's different. That's different.

SPEAKER_02 24:55

Yeah. I mean, I think so, all things considered, vacations are important. You have to find a way to balance it though, depending on the type of role you have. You're somebody that has like a hospital role that doesn't, you know, you don't have like your specific patient base that you're answering to and your specific duties that only are allocated to you typically. That's a lot easier. It's harder when you work in this type of setting and you feel like those things are always only on you. It's doable for sure. Um, but you just have to be better at planning it and you have to be willing to like maybe put in extra effort around those times. Um, and maybe just not have like hard stops on like, no, nobody can talk to me if I'm gone. You know, that's not reasonable. Um, what about taking time off for CME? Do you partake in that?

SPEAKER_01 25:48

I don't, and I'll tell you why. Because any CME stuff that I do, that's not true. I have done CME stuff, but it will be like around a weekend or something like that. Or if I did, it would be, and I'll bring a couple kids with me because it's somewhere where we can do something. Like I'll piggyback something on top of that. Um, but a lot of my CME stuff is either after work or in the morning time. Like for my uh boards, I have to do the whatever every quarter. Like I'm not taking a day off for that. Yeah. I'm just gonna do that after before Sunday or whatever. Um, but again, I think it's it's not funny, that's definitely not the word. But we um we praise those that are bold enough to take a vacation to recharge, but those that take CME, it's like, oh, but you're you just came back from vacation. Are you sure you want to take some more time off? And I'll say that to my my military guy. I was like, when you go on your two-week vacation, he's like, Well, it's it's serving my country.

SPEAKER_02 26:42

And I was like, I mean, I'm protecting your freedoms. Right.

SPEAKER_01 26:46

I was like, okay, well, so you know, we're saying the same thing. So when you go on your two-week vacation, he gets really offended. He's like, it's not a vacation.

SPEAKER_02 26:53

I was like, I'm sleeping in a tent in the wilderness. Like, yeah.

SPEAKER_01 26:57

No, but we don't um, we don't celebrate that. And in fact, at the end of the year, it's very hard to put revenue numbers next to um, you know, let me see how much time you spend in development. I do. I mean, when I review PAs, we'll talk about what they did or what they didn't do, and I will say, like, hey, you really should, but at the same time, balance it with everything else.

SPEAKER_02 27:17

Yeah, but at the same time, don't do, but yeah, not that much.

SPEAKER_01 27:22

But I think for new providers and for those that are at our practice and then leave, one of the feedback they will give is I just feel like I stopped learning, which again hurts a little bit because I'm like, wait, what? Like I'd love to teach, but at the same time, it's on you. But it's on you.

SPEAKER_02 27:37

It is, it is totally on you. You have to.

SPEAKER_01 27:39

But also, don't you want like when patients are like, hey, have you read about this new and plantable CMC, like, you know, joint? Yeah, and you're like, I know all three of them. Yeah. And if you're like, wait, no, like I hate that feeling. That's so embarrassing. I hate that feeling. Um, so I think CME time is really important, even if you sprinkle it where you can. But again, for those looking for a new job, there should be a different bank for CME than there is for vacation. Yeah, there totally should be.

SPEAKER_02 28:04

Because I will use my CME bank. Yes, I use it up every year. Yeah. My PTO bank, different story. Different story. But I like my CME bank.

SPEAKER_01 28:10

So is there any guilt with CME time versus like long weekend time?

SPEAKER_02 28:14

I don't feel guilt with CME time because I see that as a way of like investing myself back into what I'm doing. Because I think it's important.

SPEAKER_01 28:21

Yeah, and I think we touched a little bit on like family time. I mean, you just went to a conference where you incorporate I did. I yeah, you can incorporate both at the same time. So I think that's that's really important to do that, especially if you get to go somewhere that is destination-wise, you can kind of make that a little bit of both. And I think that that's you know, smart. You have to plan it and you just see when is it, you know, what time of year and what stuff's around. But I think that that's certainly um doable.

SPEAKER_02 28:45

You know, what would be a great destination is Naples. It would, it would be. No, I haven't.

SPEAKER_01 28:53

So I heard it's a a glorious healthcare facility, but maybe I guess the one in Raleigh's okay for now.

SPEAKER_02 29:00

Yeah, I guess. We'll see. So still banking on that at some point.

SPEAKER_01 29:06

That's right. Um, so do you think though that if there is any, you know, we're we just finished the first quarter, right? So we did January, February, March. We won't get those numbers for product productivity until April, and then we really see the impact of them them in May. And we'll even see some of the revenue coming in from the first quarter now. So do you see when your numbers are down, you immediately go to defending yourself? Like why? Why was it down?

SPEAKER_02 29:30

Yeah. I keep a spreadsheet of these things actually, and I keep uh tabs of what days we were out, each uh how many people we saw in clinic, how many surgeries we did, and um yeah, so I I keep a tight lock on these.

SPEAKER_01 29:42

So I find the need to be like, oh, why were we down in January?

SPEAKER_02 29:45

Well, because there was a snow day, okay? Like I can't control. I literally have on my spreadsheet somewhere here snow days. I know.

SPEAKER_01 29:52

Well, those are but those are the things because if you and your doc collectively see on a random day 70 patients, it really matters. Like, was that by your choice to not come in? Or do we learn about another surgery?

SPEAKER_02 30:05

Yeah, do we stuck or like was there a legitimate reason for it? Yeah. I already was looking ahead. Memorial day is coming up. That's a Monday, that's a big clinic day for me. I'm like, I know what do I do to replace them?

SPEAKER_01 30:17

So yeah, so my the PA that I work with, we are off that Monday, it's Memorial Day, and then that Friday he's off. And I was like, why would you do why would you do that? Yeah, yeah. No, so I was like, are you gonna work Monday or like I'm in Tuesday?

SPEAKER_02 30:30

I I truly want to know, are there other reach out to us, are there other people out here that experience these same things? There has to be, right? There has to be. There has to be. There has to be. Yeah. Or are they just like showing up to work every day and like, ooh, I have 20 patients on my schedule to be great.

SPEAKER_01 30:45

So my husband, my husband, uh, this past week, Monday, Monday was the fourth, right? Monday. Yeah. Um, I was doing, I was doing laundry Sunday, and I looked at our little like board that we have of stuff that's going on. There's like little paper things up there for kids' tests, whatever. And I was like, huh, he is jury duty tomorrow. So you're supposed to call the night before, right? And he called and they're like, no, we expect to see you. So we did jury duty Monday, and then he got picked for the case. What? So that was then his Tuesday, and they said, like, don't be surprised if you're here till Thursday. And I was like, if the the shoes were, you know, I like I I don't think I could do that.

SPEAKER_02 31:24

No, I do think I get out of jury duty though. I think if your doc wrote a letter and was like, No, yeah, like that.

SPEAKER_01 31:29

Yeah, but like, but again, but here's the whole issue like, am I that important? Does it really matter? Yeah, like would I do but would I do better seeing patients or sitting on a jury? Like, I mean patients. I know, but were the ears that get or the eyes that get that letter, would they also agree? Or would they be like, nice, try and rip it up in front of me?

SPEAKER_02 31:47

No, I I feel like when they see something like medical, even maybe you don't have to say like you're seeing, you know, non-emergent ACL tangers. Like you don't have to put that in. You can just say that like you're seeing post op patients. Yeah.

SPEAKER_01 32:02

And like I feel like that's enough. Yeah, I think if I put a number to it, I guess. I don't know. But anyway, he seemed completely unaffected. He was like, Well, I guess I just won't go to work. They're like next three days.

SPEAKER_00 32:10

I was like, oh my God. Like, how are you functioning right now?

SPEAKER_02 32:14

Are you okay? Are you okay? Insane.

SPEAKER_01 32:18

But do you think you will ever, and again, this is this is honesty. This is not the world, this is just Hannah and I. Do you think you will ever look at someone who uses their own PTO and say to yourself, Wow, I think they're really making the right choice? Or do you think you're like, why would they do that?

SPEAKER_02 32:33

Like, what is your like gut reaction to that? I don't know. My gut reaction is just that it is different for everybody. I will take PTO when I'm ready to take PTO. Like, don't like don't pressure me into taking vacations and not wanting to do what I'm doing right now. This is like, I do what I do because I want to do it, and that's on me. And if somebody wants to, you know, take more vacations and maximize their PTO, then that's on them. And those are their priorities. Um, I'm not gonna judge them for that necessarily unless it starts to affect the greater picture. I guess what I'm saying is there's an issue, right?

SPEAKER_01 33:11

Do you think they care less? And is that like is that a thought we put on them because it's us, or is that reality? Like they must care less.

SPEAKER_02 33:19

Uh yeah. When I did my general surgery rotation, I rotated with um this uh what was his name? Sakai, Dr. Sakai. I'll say his name because he'll never listen. He'll never listen to this. It's fine. I remember on my first day, he was like, What are you interested in? And I said, I'm gonna do orthopedic surgery. Because I was very honest. I was like not bullshitting around with all my preceptors, like, ooh, maybe I want to do OBGYN. No, I know I want to do orthosurgery. And I want you to give me what I need from this experience that's gonna translate to that. Um and he's like, Okay, well, you know, this is obviously a surgical subspecialty. He's like, I'm gonna get a feel from you if you're ready for surgery based on the lifestyle. And he was like, Look, surgery and surgical subspecialties aren't for everybody. Um he's like, You you know, do you know how many hours of sleep are technically necessary for somebody to function well? And I was like, eight? Like, right? Like that's the right answer. I don't know. And he's like, I get like two hours of sleep a night. And he's like, the studies have shown that it's fine. I don't know if that's true or not, but that's insane. And he's like, you will miss a lot of things and you will, you know, you will basically feel like you're working all the time and you'll be available all the time and on all the time. And yeah, I that rotation I remember vividly. I would I slept in my car two nights because there was like two hours between we got out of the OR at 3 a.m. and I had to pre-round. Um and I never asked to go home early because that was that would be that right. But I it'll be wicked. Yeah. But so needless to say, like that is, I feel like that's like kind of the toxic culture of certain aspects of medicine where they're like the more you put in, like, that makes you better than other people. It doesn't, but there are certain there, there's some people that need to be that way for things to function, and not everybody has to be that way. But you can't like look down on no.

SPEAKER_01 35:22

I think there's a healthy balance, and that is going to be on the scale of you know, healthiest and not as healthy, right?

SPEAKER_02 35:29

I think there's a balance, and I think depending on what generation you grew up in, I think you are uh what's gonna happen to the world when like our generation is not gonna be good.

SPEAKER_01 35:40

But I think the generation above me would say two hours of sleep, like that's just how it goes. I think the generation below me would say, No, my self-preservation is the most important. Everything else is secondary. Yeah, 10. I mean, and if I got less than 12 sometimes. Um, I think you and I are just a little combination of like the old generation and not quite the new generation.

SPEAKER_02 36:00

But where do we fall on the scale of healthiness? Like, oh, like overall, like life, healthiness, I feel like we're thriving. We're thriving. Yeah, we're thriving. Yeah, yeah. I just but what I just did my deadlifts and uh chased it with champagne. They're thriving. I'm thriving. But you're thriving, but where are we on the health uh on that on that um spectrum for work what life balance?

SPEAKER_01 36:22

Balanced, balanced, yeah. I feel like we're on our version of balance. Dude, if you've ever seen, if you've ever seen if you've ever seen like a tight rope walker, that's me every day. Like, ah when you're like about to fall.

SPEAKER_02 36:37

I would want nothing less than feeling like I'm about to lose it.

SPEAKER_01 36:41

No, I feel I feel like I I ride that balance really well. But I also like five years ago, ten years ago, I don't think that I did because everything was that important all the time. And I feel like I can mentally like put things in different places of what's important and what's not, but I feel like my load still is the same.

SPEAKER_02 36:54

Yeah.

SPEAKER_01 36:55

Um, I'm better about vacationing, but I'm also not someone, even if you gave me two weeks, it was like, please go take two weeks. I would be like, wait, what? I'd have to do, I'd have to do something else. Yeah, exactly. Two weeks.

SPEAKER_02 37:05

Oh my God. It's like half a month. That is literally half a month. Yeah. Like I couldn't do that. Gosh, do you think I'll get maybe I will get to that point where I'm better at vacations. My death less than 10 years ago. I think so. I think so. I think so.

SPEAKER_01 37:19

I think so. Yeah. But anyway, I think it's really important to talk about these things, acknowledge these things, kind of find where you are on the scale, and then um, you know, uh be your advocate for yourself. If it's really important for you that you need that time because you're not as good if you don't have that time, then take the time. If you find that you are at a point in your career where you need to invest in momentum, then maybe it's not the time to take that time. Yeah.

SPEAKER_02 37:44

You don't have to do it if you don't feel like you want to do it. And if it's important to you, then you do it and you find a way to make it work.

SPEAKER_01 37:50

Um and I also though, like I should have known when I went on each of my maternity leaves, I took like eight weeks because 12 weeks was just like too much. Not because I was dying to get back to work, but because it was like too much of one thing, like it was too much.

SPEAKER_02 38:03

And on that note, happy Mother's Day.

SPEAKER_00 38:07

Yeah.

SPEAKER_01 38:09

Anyway, so I think that was that was good timing. Um, no, I think that that's I think it's just different for different people. Yeah. And I think if you need a reset and that reset can happen in a shorter period of time, more power to you.

SPEAKER_00 38:20

Yeah. All right. Anyway, yeah. Until next time.

SPEAKER_01 38:36

Thanks for tuning in to Joint Effort PAs. If you enjoyed this episode, be sure to subscribe, leave a review, and share it with a fellow PA or med minded friend. You can also follow us on Instagram at Joint EffortPAs for updates and extra content. See you next time.