An email arrives sometime between the gravy being poured and the pie. 

You had promised family that this year would be different — phone face down, laptop zipped away, at least one uninterrupted holiday meal. But the subject line glowed from across the table: “Schedule change for Monday – URGENT.” In that moment, Thanksgiving shifted from gratitude and rest back to a familiar checklist: coverage, portals, payroll, patient complaints. 

Or perhaps it’s stepping out of family events to answer staffing texts. Quietly checking inboxes between airport connections. Logging in “just to clear messages” on days marked as vacation.

In a Nov. 18, 2025, MGMA Stat poll, we asked practice administrators and executives whether they could take fully unplugged time off — no email, no calls — in 2025 compared to 2024. The smallest share of respondents (14%) said they managed to carve out more real rest this year, and slightly more (20%) reported their unplugged time stayed about the same, while 29% reported that time had shrunk this year. 

But the biggest response? “I never disconnect” (36%) — respondents who largely pointed to structural barriers: C-suite or sole-administrator roles in small private practices, thin management layers, and lack of cross-trained staff or true coverage make it feel impossible to step away. Many said that more staff, stronger middle management, and better training/delegation — including someone with real authority to act in their absence — would be essential for any hope of real time off.  

The poll had 416 applicable responses. 

Why can’t practice leaders unplug? 

A big theme was workplace culture and physician/owner expectations: leaders cited a lack of respect for PTO, a belief that everything is an emergency, and little appreciation for the administrative burdens they confront. Several also acknowledged personal factors such as their own personality, work ethic, boundaries, and difficulty trusting others, with some concluding that retirement or a different role may be the only way they will ever truly disconnect. 

In the group reporting less time, practice leaders cited staffing shortages, turnover, and “do more with less” expectations as the primary barriers. Many described heavier workloads and growing complexity — new EHRs and other tech implementations, organizational restructuring, and added leadership responsibilities — that make it feel impossible to step away.  

Several noted unreasonable expectations from physicians, corporate leadership, or culture, including being expected to be available “24/7/365” and always “putting out fires.” Financial pressures, shrinking budgets, revenue concerns, and a lack of trusted or seasoned staff to cover their duties further reduced their ability to take true vacations or unplug, even when PTO exists on paper. 

Healthcare isn’t alone 

Across the broader workforce, Americans are struggling to step away.  

• Nearly half of U.S. workers left some PTO unused in 2024, even as most said they wanted more time off.  
• Most employees say they would still check emails from their boss on vacation, and more than half have taken work calls during their time off.  
• Add in the reality that most workers regularly check email outside normal hours, and it’s clear that “out of office” often just means “working from somewhere else.” 

None of this happens in a vacuum. MGMA Stat has tracked a steady rise in practice leader stress: an April 2024 poll found that 75% of medical group leaders reported their own stress and/or burnout had increased last year. When your inbox is full of coverage issues, open positions and complex payer updates, it can feel unrealistic — even irresponsible — to disappear for a few days. 

Who is finding the time to actually log off? 

Respondents who took more real time off in 2025 overwhelmingly pointed to stronger personal boundaries and a deliberate focus on preventing burnout, including prioritizing self-care and recognizing the mental health need to unplug. Many credited supportive leadership, better staffing, and stronger processes/delegation for making it easier to be truly off (e.g., well-trained staff, helpful managers, AI-assisted phone systems).  

Several noted job changes or role shifts that removed them from constant HR or operational fires, which made disconnecting more realistic. Others mentioned family milestones and travel — grandkids, honeymoons, trips without internet — as factors that encouraged them to say “no” to calls and email. 

Many respondents who reported “about the same” time off said their ability to disconnect is shaped by staffing and structure: competent assistants and stronger management teams made it a bit easier, while shortages, growth, and constant projects made it harder. Several noted that unique responsibilities (“things only I can do”) keep them tethered to work even on PTO, with some saying they’re “never really off” and that high expectations erode setting better boundaries.  

Only a smattering of respondents emphasized personal perspective and boundaries — treating work as “just work” or refusing to give back earned time. Others pointed to policy and environment factors such as PTO accrual changes, economic pressure, and a tough job market that discourage stepping away, even if organizational culture nominally supports taking time off. 

Why disconnecting still matters 

The work you do depends on you being able to step away from it. 

Practice leaders consistently hold multiple threads: finance and access, staffing and strategy, technology and patient experience. Living in a constant state of partial attention makes it harder to see patterns in your data, coach your managers, or have the hard conversations that move a practice forward — the very factors that make a practice leader confident in logging off. 

What might be viewed as indulgence is instead a kind of maintenance — of judgment, patience, and the ability to keep leading into 2026. 

Making the last weeks of 2025 different 

None of this is meant to pile on guilt about the time you didn’t take in 2025. For many practice leaders, the year has been defined by tight margins, near-constant chaos, and a difficult labor market. The system is not designed to make it easy to unplug. 

Instead, consider the final weeks of the year as a chance to experiment with boundaries that fit your reality: 

• Redefine what “time off” looks like for you. Maybe it’s a full week away with another administrator holding the on-call phone. Maybe it’s one afternoon during the holidays when you silence notifications, put on a real out-of-office message and trust your team. 
• Make micro-breaks non-negotiable. If extended PTO isn’t possible, protect smaller pockets of true off time: a daily walk without your phone, a family dinner where no one at the table sees you scroll, a Sunday morning when your dashboards aren’t open. 
• Tell your team what you’re modeling. When leaders communicate that they’re stepping away (and why), it normalizes rest for managers and staff as well. That can make it easier to ask others to truly unplug when it’s their turn. 

As Thanksgiving approaches, you may not be able to stop the scheduling alerts or payer emails from landing in your inbox. You can, however, choose a few moments — or if you’re fortunate, a few days — when you really are out of office in more than name only. 

Your practice will still be there when you return. With a bit of intentional rest, you might come back seeing it — and leading it — a little more clearly. 

Join MGMA Stat 

Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit mgma.com/mgma-stat. Polls will be sent to your phone via text message.