The PTO Abyss (or, How I Learned to Stop Worrying and Love the Spreadsheet)
Nothing says "benefit" like using your vacation to cover hospital holidays
I Had Surgery Once
It was for a reconstruction of my fifth metacarpal on my right hand, which decided to become structurally optional. I told my manager I’d be out for a bit. I didn’t say “FMLA,” of course; I wasn’t trying to make it formal, just survivable. I said something vague and polite, “I might need a little time off for a minor procedure.” She, misreading my hesitance as a request, responded with a strangely cheerful warning:
“You should take the FMLA—just in case. You know, for the what-ifs.”
So I did. I checked the right boxes, submitted the right forms to the right portal that redirected me to the wrong portal, and then made one specific request: that no PTO be deducted from my balance. I was assured this was possible. I believed them.
They deducted it anyway.
The hours vanished. I refreshed the PTO screen daily. I called. I emailed. I escalated. At one point, I began cc’ing myself as a gesture of solidarity.
Eventually, after enough digital smoke signals and politely worded breakdowns, someone in Benefits reversed the deduction. It was, of course, blamed on “a systems error,” as if the spreadsheet itself had grown fangs and fed on my paid leave. The point is: they’ll always take it first and apologize later, if they think to apologize at all.
Let Me Tell You About a Miracle in Reverse
Paid Time Off. PTO. The mythical benefit that exists simultaneously as a promise, a trapdoor, and a petty accounting trick authored by someone named Deborah in HR who refers to herself as “part of the People Operations Team.”
We enter the system (bright-eyed, badge-photoed, maybe even with a lunchbox full of optimism) and we’re told, soothingly, that PTO is ours. That it accrues. That it is generous. That we “earn it.” This is technically true in the same way a game show contestant earns the toaster oven, which they will be taxed on later.
But what they don’t tell you, and is somehow omitted and codified in 27-page PDFs that self-immolate when opened, is that your PTO is not yours. It is merely on loan and, like all debts to the institution, it will be collected. Often suddenly. Often without explanation. Often by Deborah.
I. The Holiday Heist
You would think, naïvely, that when the hospital closes for Christmas (because even illness is given a calendar reprieve), you would be given that day. Paid, naturally. Like in the stories. You might even circle it on your calendar with a small heart.
In many American healthcare institutions—particularly the nonprofit-for-profit ones—holidays are not given, they are taken. Specifically, from your accrued PTO bank, like a reverse Santa skimming your vacation balance while you sleep.
“We combine vacation, sick, and holiday time into one flexible PTO bank,” Deborah will chirp in orientation, without blinking.
“So you can use it however you want.”
(As long as how you want is staying home involuntarily while the building is locked and still somehow paying for it.)
The logic is that you earn more PTO, to offset the theft. This is like being handed a slightly taller ladder before being pushed into a deeper hole.
II. Census Is Low. Morale Will Follow.
Hospitals, contrary to popular belief, are not always full. Sometimes the census is low. And during those sacred dips in volume, when God Himself whispers, “Maybe we don’t need three PCTs and two RNs for one guy with gout,” your manager will call you at 5:46 AM to let you know your shift is canceled.
But not unpaid, no. That would be indecent.
Instead, you are required, legally compelled by the fine print in the HR scrolls, to use your PTO. Rarely offered the option. Rarely consulted. You will, on that involuntary day off, be burning through your own paid leave so that the organization may remain lean, efficient, and fiscally optimized.
“It’s for your well-being,” Deborah will explain, probably with a clip-on microphone.
“We want to ensure you get the rest you deserve.”
(Rest you didn’t request. Rest you now can’t reschedule. Rest that cost you three hours of PTO you were saving for your cousin’s beach wedding.)
This is called shared sacrifice. And by “shared,” they mean yours.
III. The Half-Day Docking Station
Imagine working through lunch, staying after your shift, skipping smoke breaks (heroically), only to need to leave two hours early one day to pick up your child, whose school called because she has somehow contracted pink eye and possibly communism.
You leave. You think nothing of it. You're salaried. You’re exempt. You’re a professional.
The next week, your paycheck is fine, but your PTO balance is mysteriously lower by 2.13 hours, a precise incision made by the same system that loses your license renewal paperwork.
“Exempt employees are still required to use PTO for partial-day absences,” Deborah notes brightly in the email footer you didn’t read.
“It maintains equity.”
(Equity, of course, meaning everyone must suffer equally in units divisible by fifteen-minute blocks.)
If you ask why, they will cite “the integrity of the timesheet.”
If you continue asking, they will cite “policy.”
If you ask for the policy, they will send you a SharePoint link that no longer works.
IV. The Canceled Vacation (aka Time Off Schrödinger-ized)
And then there is the great cosmic joke: approved PTO. You submit your request months in advance. It is approved. You book a flight. You schedule pet care. You envision, foolishly, the sun.
Then the email arrives:
“Due to staffing needs, we will be unable to honor your previously approved PTO. Thank you for your flexibility.”
This happens often in the week leading up to a Joint Commission visit, which is healthcare’s version of the Spanish Inquisition—no one expects it, and everyone wears special lanyards.
You protest. You explain that the PTO was approved.
“Yes,” Deborah replies, “but per policy, all PTO is subject to operational needs.”
(Operational needs being the bureaucratic euphemism for ‘someone in charge forgot to plan.’)
You lose your trip. You lose your refund. You lose three days of faith in humanity. But don’t worry. You still have your job. For now.
V. FMLA: First Must Lose All
Finally, the grand finale. You’re having a baby. Or cancer. Or your spine is protesting the way you’ve been sleeping. You qualify for FMLA, the sacred 12-week unpaid leave that protects your job but nothing else.
You apply. It’s approved. You exhale. But before you can frame the letter, HR informs you that you must use all your PTO before the FMLA clock ticks.
“It’s so you can continue to receive income during your leave,” they say, as if explaining gravity.
(And so that when you return, you will have no PTO, and will need to come back immediately. Like, the next day. Probably with a note from your doctor.)
This ensures you are adequately punished for your biological frailty and that you will reenter the workforce exhausted, broke, and deeply loyal.
Appendix A: What Deborah Will Say
“It’s in the handbook.”
“It’s our standard policy across all departments.”
“We aim to foster work-life balance.”
“I’m just the messenger.”
“Have you tried the Employee Wellness Portal?”
Appendix B: What You Should Say
You won’t say anything. You’ll smile and nod and return to your work, quietly calculating how many hours of PTO you have left and whether they will cover both your upcoming colonoscopy and the week your sister is visiting from Milwaukee.
You will be grateful, in the way people are grateful not to be fired.
You will be tired, like people are tired when the system is working exactly as designed.
And you will learn, eventually, not to ask questions.
After all, you’ve still got your PTO.
(For now.)
I’m keeping this free because that feels right. If you want to support it anyway, out of some quiet belief in people making things, there’s a button for that. There are no special perks, just the work and a thank you.