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Paul Edward Sax, MD, has worked on Christmas at Brigham and Women’s Hospital, Boston, 25 of the past 32 years.

It’s a choice he willingly makes, in part because his family does not celebrate Christmas. In addition, “I have grown to realize how important it is for people who do celebrate to be with their families,” Sax, clinical director, Division of Infectious Diseases, Brigham and Women’s Hospital, told Medscape Medical News.

Thanksgiving and Passover are equally important to him, which is why he always barters to make sure he gets those days off, said Sax, who is also a professor of medicine at Harvard Medical School, Boston.

He helps coordinate the coverage schedule with input from other faculty. He said, “We make sure that people are doing their fair share of holiday coverage,” which means he hasn’t worked Thanksgiving “in a very long time!”

Sax listed what he sees as the many benefits to working during the end-of-year holidays in a column for NEJM Journal Watch earlier this year.

At the top of the list: camaraderie. What he called “the immediate recognition among those in the hospital that we’re in this together.”

Clinicians “might get some additional meaning knowing that you’re doing this for your colleague on Christmas,” agreed Jonathan Ripp, MD, MPH, chief wellness officer at the Icahn School of Medicine at Mount Sinai in New York City.

The sense is “we’re part of a team where we support each other so that we can fulfill our collaborative mission,” Ripp, professor of medicine, medical education and geriatrics and palliative medicine, told Medscape Medical News.

Deborah Fletcher, MD, an emergency physician in Louisiana, said it was “fun” to help coworkers by working on Christmas. “When I was young and not married yet, I would volunteer for the early morning shifts so that my partners with young kids could do ‘Santa’ with their children. It was my gift to my friends,” said Fletcher, an American College of Emergency Physicians (ACEP) representative.

Few Want to Be There

“I think everybody prefers to have the holidays off,” said Ripp. Equally important, “nobody wants to be a patient on Christmas or New Year’s or Thanksgiving.”

Sax said that, often, patients in the hospital over the holidays can be quite sick, socially disadvantaged, or both and “usually pretty upset about having to be there.” The job of the clinician is “to try and expedite their care and also to present a positive face at a truly difficult time,” he said.

“I am reminded every year that for many people, the holidays aren’t necessarily happy, and that pain can be more acute for people who are lonely or struggling,” said Torree McGowan, MD, an Oregon emergency physician and ACEP representative.

“Every Christmas Day, someone comes in who has a vague complaint but really just didn’t want to be alone,” said McGowan. She and her colleagues “make them a plate of our potluck, do a minimal amount of testing, and let them join our ED [emergency department] family for a little while,” she said.

McGowan said, sadly, she also seems to always diagnose new or metastatic cancer around the holidays. “Taking care of suicide attempts is also really hard,” she said.

Being a doctor during the holidays “means oftentimes working while other people are celebrating because, of course, illnesses and injuries don’t take a break,” said Lisa M. MacLean, MD, director of physician wellness at Henry Ford Hospital and Health System in Detroit.

MacLean, currently filling in as the psychiatry residency director, said that holidays can be especially difficult for residents, as they have less control over their schedules. They may come from other states or countries and “haven’t really put their roots down,” she said. The holidays, typically family-oriented, “can be really isolating,” she said.

When MacLean has worked holidays, she remembers telling herself, “I’m going to be here and I have to work, so I’m going to embrace, kind of the positive aspects of being here, that I’m there doing good, and it feels good to do good.”

Sax said it’s almost guaranteed that “plenty of people will thank you” if you work on a holiday. That includes patients, doctors, and nurses.

Physicians learn early on that working holidays is a part of the landscape, said Ripp. “If it’s Christmas morning, and you’d rather not be going to work, you may be feeling a little down,” he said. But “you also know, this is what I signed up for,” he said.

That’s especially true in the emergency department.

“Most emergency physicians understand that working on holidays — and nights and weekends and all the other ‘off-hours’ times — is a part of the gig and are proud to be available for patients whenever care is needed for whatever care they need,” said Nebraska-based Jordan M. Warchol, MD, MPH, an ACEP representative.

Morale Boosters and Coping Tactics

For those who do choose to work, there can be financial and emotional rewards and plenty of indulgences, too.

At Brigham and Women’s Hospital, the Division of Infectious Diseases offers a small bonus to on-service faculty and a bump of one and a half to two times the hourly rate for salaried workers, according to Sax. Lunch and dinner in the cafeteria tend to be free, and “the hospital is full of yummy snacks and treats,” he said.

MacLean recalls during a pandemic Thanksgiving joining with her chair of medicine to wheel a “Care Cart” down the hallways. They dispensed hand sanitizer, lotion, lip balm, energy bars, and various treats. There were a lot of hugs, she said, especially as the staff realized that she and the chair were not required to be there but had chosen to be there.

“Every emergency department I have worked in has made holidays fun by having potlucks, dressing in theme, and making sure patients who need extra holiday cheer get some special treatment, too,” said Warchol, the Nebraska physician.

It’s a common theme. “Our departments commonly have potlucks over the holidays, celebrating when time allows,” said North Carolina emergency physician Bret Nicks, MD, MHA, an ACEP representative. There’s also a Secret Santa gift exchange for those who want to participate and a yearly department holiday party outside of the hospital, “which does wonders for morale and camaraderie,” said Nicks.

“Many of us enjoy working holidays, despite missing our families, as it is really a great way to help make what is commonly a difficult day for our patients just a little bit better,” he said.

For those who feel the tug of the family, MacLean suggests scheduling a virtual call as a way to still feel connected.

She also urges clinicians not to forget to take care of themselves — to make sure they are eating right, taking breaks, and trying to manage stress.

“At the same time, I don’t think it’s healthy to just deprive yourself of all of those things that maybe are nostalgic for you or bring a smile to your face,” she said.

Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in publications including JAMA and Smithsonian.com. You can find her on X: @aliciaault.