Time Off Isn't Time Off If Every Decision Still Runs Through You – A Special SNACK Episode, EP 287
Ask a practice owner when they last took two weeks off without checking in once, and you'll usually get a long pause. In this SNACK episode, Miranda Dorta turns the mic around and puts Tracy Cherpeski in the interview seat to talk about what it really takes to step away from your practice, with the holidays close enough to make it urgent.
The numbers back up what you already feel. A 2024 study in JAMA Network Open found that about 70% of the physicians surveyed worked on vacation, and fewer than half had full coverage for their EHR inbox while they were gone. For an independent practice owner, Tracy says, the inbox is only the visible part. When every decision runs through one person, time off turns into work from a different location.
Tracy walks through how to run a successful medical practice that doesn't depend on you being in the building: get decision rights written down, put real coverage in place, and practice with a long weekend before you try a week or two. It's practical, a little funny, and doable even if all you have this week is 10 minutes. If you want a private practice without burnout, this is a good place to start.
Key Takeaways
Start with decision rights. Before coverage, write down which decisions truly need the owner, get buy-in from the team, and put it in the office manual where everyone can find it.
Sort decisions with the ABCD quadrant. Tracy applies her time leadership delegation quadrant to the whole team. A decisions stay with the owner, and the rest move to a practice manager, front office manager, or clinical manager.
Hand your inbox to someone with a system. A good person can triage your email, answer what doesn't need you, and have the rest organized when you return.
Practice with a long weekend first. Tracy compares it to exposure therapy: start at lower stakes, put your phone in the hotel safe, and tell the team emergencies only.
Ease back in. Skip the inbox first thing, expect that a few things didn't go exactly your way, and trust that most mistakes are recoverable.
Q&A
Why is it so hard for practice owners to take real time off?
Tracy points to a lack of operational structure and what she calls the decision-making matrix. Many of the decisions that run through the owner don't need to, but either the structure isn't in place or the question never crossed the owner's mind until it became a pain point. She also reminds listeners that people who start their own practice tend to like being in charge. When structure is missing, she sees owners start to feel resentful toward their practice.
What should be in place before a practice owner leaves for vacation?
Decision rights come first: who decides what, written down and available to the whole team, ideally in your office manual. Coverage comes next, starting with the inbox. To sort decisions, Tracy suggests an honest inventory using the ABCD system. A decisions, like a large purchase, a clinical decision, or a major operational change, stay with the owner. Others go to a practice manager, front office manager, or clinical manager, depending on the size of the practice. It takes time up front, but it creates open time and less decision fatigue later.
How do you test time off before taking a week or two?
Start with a long weekend. If you see patients Monday through Thursday, Tracy suggests taking Thursday and Friday off, plus at least one more clinical day if you can. Put your phone in the hotel safe and let your team know it's emergencies only. She expects the team to be on your side: they respect you, they want to see you relax, and they tend to take real pride in what they handle while you're away.
How do you keep the first day back from undoing your time off?
Be realistic. Some things probably didn't go the way you would have done them, but the team did their best and most mistakes can be recovered. Tracy also recommends not opening your inbox first thing. If someone has been triaging it, your priorities will already be sorted, and you can simply ask whether anything needs your eyes right now.
Episode Highlights
Why Tracy still gets nervous before every SNACK recording, and before every talk
Her honest answer to "when did you last take two weeks off without checking in?"
The decision-making matrix and why so many decisions pile up on the owner
Why decision rights come before coverage, and what belongs in your office manual
Applying the ABCD delegation quadrant to team decisions
How to hand off your inbox so what needs you is ready when you return
Testing time off like exposure therapy: a long weekend and the phone in the hotel safe
Tracy's read on why women physicians may be more likely to work on vacation: perfectionism and social conditioning
A 10-minute exercise to start this week, and how to bring your team into the conversation
Memorable Quotes
“Do all these decisions really need to go through you, the practice owner?” — Tracy Cherpeski
“...from everything goes through me to only the things that only need me go through me.” — Tracy Cherpeski
“Start with something that's a little bit lower stakes.” — Tracy Cherpeski
“Do not try to tackle your inbox the first thing you do when you walk back in. It'll still be there.” — Tracy Cherpeski
“We see sometimes people starting to feel a little resentful towards their practice, and it's almost always because there's a lack of structure.” — Tracy Cherpeski
Real time off isn't a willpower problem. It's a structure problem, and structure can be built in 10-minute pieces. Start by writing down the decisions you expect to come up while you're gone, then bring your team into the conversation and try a long weekend before the holidays. If you'd like help building a practice that runs well while you're away, schedule a consultation with Tracy at practicesuccess.co, and learn more about the Thriving Practice Community at thrivingpracticecommunity.com. And share this episode with the colleague who still answers email from the beach.
Source for Statistics Mentioned: Shanafelt TD, et al. Vacation Days Taken, Work During Vacation, and Burnout Among US Physicians. JAMA Network Open. 2024;7(1):e2351635.
Miranda’s Bio:
Miranda Dorta, B.F.A. (she/her/hers) is the Manager of Operations and PR at Tracy Cherpeski International. A graduate of Savannah College of Art and Design with expertise in writing and creative storytelling, Miranda brings her skills in operations, public relations, and communication strategies to the Thriving Practice community. Based in the City of Oaks, she joined the team in 2021 and has been instrumental in streamlining operations while managing the company's public presence since 2022.
Tracy’s Bio:
Tracy Cherpeski, MBA, MA, CPSC (she/her/hers) is the Founder of Tracy Cherpeski International and Thriving Practice Community. As a Business Consultant and Executive Coach, Tracy helps healthcare practice owners scale their businesses without sacrificing wellbeing. Through strategic planning, leadership development, and mindset mastery, she empowers clients to reclaim their time and reach their potential. Tracy designs and delivers CME-accredited wellness retreats and workshops in partnership with medical associations, bringing burnout prevention and sustainable practice management to physicians nationwide. Based in Chapel Hill, NC, Tracy serves clients worldwide and is the Executive Producer and Host of the Thriving Practice podcast. Her guiding philosophy: Survival is not enough; life is meant to be celebrated.
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