Cultivating healthy relationships takes time. A survey of physicians’ spouses demonstrated that it is time spent together, rather than work hours, that is most directly associated with relationship satisfaction.1 Yet, time is a commodity often in short supply among physicians who work long hours when on duty and often continue electronic health record (EHR) management on nights and weekends after normal work hours. In a recent national survey,2 60% of US physicians take fewer than 15 days of vacation per year. Even when physicians are supposedly on vacation, they are frequently not really off work. One-half of US physicians do not have EHR inbox coverage while on vacation; 70% perform patient care–related tasks on vacation, and 30% perform more than 30 minutes of clinical work on the average vacation day.2 The report by Obermiller et al3 confirms these findings using objective EHR use metrics. The family medicine and internal medicine physicians studied engaged in some EHR work on approximately 40% of their vacation days and did so for more than 30 minutes on approximately one-fourth of paid time off days.3
A lack of adequate vacation and having to perform clinical work via the EHR while on vacation are simply examples of the many ways in which physicians’ work impacts their personal relationships. Physicians, on average, experience a greater negative impact of work on personal relationships (IWPR) than workers in other fields.4 Even after adjusting for work hours, the increased IWPR burden among physicians persists. Within every work hour category, physicians are much more likely than workers in other fields to report a moderate-to-severe IWPR, suggesting other aspects of the practice of medicine and its organizational and cultural context contribute to negative IWPR.4 For physicians, having full EHR inbox coverage while on vacation and spending 30 minutes or longer per vacation day on patient-related work are independently associated with higher rates of occupational burnout, an established predictor of quality of care, patient experience, and physician turnover.2 Notably, after adjusting for the combination of work hours and IWPR, physicians are not at elevated risk for burnout compared with workers in other fields, indicating the importance of this domain to occupational well-being.4
A deeper understanding of the ways in which work structure contributes to IWPR, such as how EHR-based work encroaches on vacation, will point the way to effective interventions. The US Surgeon General’s office recommends that workplaces establish social connection as a strategic priority and “put in place policies that protect workers’ ability to nurture their relationships outside work.”5 The scope of these policies should target operational practices and workplace social norms and collective attitudes related to the importance of healthy relationships outside of work. As suggested by Sinsky et al2 and Obermiller et al,3 improving EHR inbox management support and creating better cross-coverage systems may help physicians take unencumbered time off without abandoning their patients. In our experience, drawing the connection between IWPR and quality of care6 and contextualizing these tactics as part of a holistic organizational strategy to mitigate negative IWPR underscores their importance and maximizes impact. Examples of interventions targeting operational factors as part of an overall strategy to mitigate negative IWPR among physicians may include the following: (1) improving cross-coverage of EHR inbox and other clinical care demands while physicians are on vacation; (2) optimizing scheduling and coverage so physicians leave work at more reasonable times in the evening; (3) improving predictability of work schedules so that physicians reliably know with adequate lead time specific days each month when they will be able to leave the hospital, operating room, or clinic at a predictable time so they can plan events with family and others outside of work; (4) implementing new models of team-based care to optimize task distribution, improve efficiency, and shorten the workday; (5) developing clinical staffing models that include margin to proactively plan for and cover predictable decreases in physician person power due to illness, childbirth and/or parental leave, and professional development (eg, continuing medical education activities, professional development leave, and sabbatical); (6) defining ideal parameters regarding the consecutive number of days and nights on call and design systems to realize these goals; (7) developing an operational metric relevant to the organization that evaluates IWPR at regular intervals and applying it to identify opportunities and evaluate the effectiveness of interventions; and (8) establishing equitable and transparent policies and procedures for scheduling of shifts, call responsibilities, weekend duties, and vacation and evaluating and optimizing the timing of meetings to minimize encroachment on personal time.
These operational interventions to mitigate negative IWPR will be less effective and less sustainable unless the professional norms and attitudes of physicians and other decision-makers that impact IWPR are concurrently addressed. Examples of interventions targeting relevant social norms and collective attitudes at work may include the following: (1) leadership training that includes education on the importance of the health of clinicians’ relationships outside of work for sustainable effectiveness at work as well as retention; (2) policies, communication campaigns, and other interventions to establish new professional and organizational norms that emphasize the importance of healthy personal relationships for both physicians’ well-being and clinical performance and the organization’s desire to create a work environment that affirms this; and (3) weekend retreats that include workshops for physicians and their spouses that are designed to cultivate increased awareness of medical practice demands and norms that contribute to negative IWPR among physicians and to provide space for recommitment to appropriate prioritization of personal relationships.
Healthy relationships confer impressive physical and psychological health benefits.5 Social connection is associated with lower rates of infectious disease, cardiovascular disease, diabetes, hypertension, anxiety, depression, suicidality, and overall mortality.5 A seminal meta-analysis pooling results of 144 studies from 17 different countries demonstrated reductions in mortality risk associated with high vs low social support that exceeded previously published mortality risk reduction estimates associated with smoking cessation, abstinence from alcohol vs heavy drinking, lean vs obese body mass index, and physical activity.7
For physicians, healthy personal relationships may improve clinical performance and result in a higher quality of care for their patients. Although more research evaluating the effect of physicians’ personal relationships on their clinical performance is needed, one study6 demonstrated that IWPR was a stronger correlate with unsolicited complaints from their patients than depression, anxiety, sleep-related impairment, low professional fulfillment, or burnout. Physicians who are able to appropriately prioritize personal relationships in their own lives will also be more capable of following the Surgeon General’s advice to address the health of their patients’ social connection.5
Historically, it was often necessary for physicians to perpetually defer precious time with loved ones to provide care for patients. In 2025, such expectations typically reflect poorly designed systems and staffing models. Given the evidence that IWPR has detrimental consequences for patient experience and quality of care, it is time for system interventions to mitigate the IWPR be developed and tested along with evolution of professional norms so that physicians are able to protect and nurture their personal relationships.
Article Information
Published: March 11, 2025. doi:10.1001/jamanetworkopen.2025.0469
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2025 Trockel MT et al. JAMA Network Open.
Corresponding Author: Mickey T. Trockel, MD, PhD, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94305 (trockel@stanford.edu).
Conflict of Interest Disclosures: Dr Trockel reported receiving personal fees from Marvin Behavioral Health, Inc, and receiving honoraria for presenting keynote lectures and grand rounds on physician well-being outside the submitted work. Dr Shanafelt reported being coinventor of the Well-Being Index Instruments and Mayo Leadership Impact Index, with copyright owned by Mayo Clinic and royalties paid from Mayo Clinic; and receiving honoraria for presenting keynote lectures and grand rounds and advising health care organizations on how they can advance clinician well-being. No other disclosures were reported.