Take a Vacation!

December 16, 2009

How can you afford to take a vacation, but still manage overhead costs and lost profits from a lack of work? All it takes is a little planning. Besides, you can't postpone living indefinitely.

Now this is a fun topic. I've always liked writing, "For a vacation" on a script pad for those stressed out patients who need to go on one. Even a weekend away, or in this economy, a staycation. It's all good, good for the soul. And it's a good use of medical authority to help your patients.

In my organization we always required everyone, docs and staff alike, to take their's every year. No accrued time, no conversion into money, just go/stay away and clear the cobwebs. And of course the ones who needed it the most were the ones most reluctant to go. At the other end, everyone comes back refreshed and admits it was a good idea.

Ahh, but this column is about the financial side of affairs medical and so we must pay the piper. For that steadily dwindling number of us in private practice, especially overhead-heavy primary care, there is always that "Aha!...uh-oh" moment early on when we realize just how expensive time off can be.

At first you think, well I'll just budget whatever our projected trip will be and that's that. But then an awareness creeps up that while you are away your overhead keeps ticking along, covered by your production or not. On top of that, your profit, or salary if you will, also disappears if you are not working. Your vacation costs have just developed into a triple whammy. If you have scheduled that dream month off in tropical climes the true cost has now become surprising, if not prohibitive.

For those who have the cash reserve, personal or in the practice, you can amortize your expense over the year. If not, you can hire a locums which may soften the blow, if you do the math. Or you can work longer and/or harder. Or start selling Amway. Or just settle for a week at the inlaws. Not an encouraging list of choices.

Or, you can plan ahead, improve your coding, do group purchasing and other efficiencies, and have the vacation covered. The other great aid to physician vacations, especially for those in private practice, is the CME industry that has grown up in spots like Hawaii and Aspen.

CME is required to maintain licensure and board certification, so why not do it in your desired venue instead of some dreary downtown medical school classroom? Sorry if I stepped on a few toes there, but let's get real - there are a lot of good, certified programs to choose from in these vacation venues. Also, if it takes place in the US and you keep the records that your CPA specifies, you are killing 3 birds with one stone: required CME, a pleasant holiday site, and financial relief courtesy of Uncle Sam as an "ordinary and necessary" business expense.

This has gotten to be such an integral part of many docs' lives that when I told some friends that I was taking a foreign vacation with no medical meeting involved, the slack-jawed looks I got waere amazing to see.

And there are other ways for the enterprising. For instance, if you can get some number of other people, ten or whatever, check with your travel agent, to go with you, as the organizing party you can get a free trip out of the deal, medical or not.

Another trick that docs in my group used to use was to sign up to be a ship's doctor on a cruise. They would typically cover night call for the regular ship's doctor. And spouses and family comps are negotiable depending on the availability of unsold cabins and your history with the company. Personally, I always thought a vacation was to get away from being on call (plus you could always find a good deal on a cruise if you do your homework), but check the Net if this appeals to you.

And let me digress to push the cruise experience for those of you who have never done it. It's a very seductive way of life; food, travel, and entertainment is included. You don't unpack and the service is terrific. And some deals are as little as $70 per day. You can't live that cheaply at home! I've known of some people who made a deal with a cruise line and just moved on board. And for those frenetic docs who say, "I'd be bored," let me tell you that there are more activities than hours in the day. However, I do remember one young doc I met on board a ship who actually disembarked early - from an expensive cabin by the way - because he literally did not know how to relax. Kind of sad, really.

Anyway, as Martha Stewart says, vacations are "a good thing," and you can afford it if you just plan ahead. Ultimately, you can't afford not to, and you can't postpone living indefinitely. I remember someone who told me, "I'll do all my traveling when I retire," and then unexpectedly died just before starting off. I know, "Man plans and God laughs," but you still have to plan.

Have a good vacation!