I take a week off every 3 months. I plan vacations 2-3 months out. I run all my expenses for business and personal through two awards credit cards so am able to rack up some pretty good rewards doing that. We have my parents or wife's parents come down and 'visit' with the kids when we want to go as a couple somewhere. Otherwise we take the kids with us when possible. Sometimes we'll have a local 20 something recently married, no kids yet, couple from the ward watch our kids. I usually have someone cover any emergency patient situations that might come up when I'm away. We usually budget $7.5-10k a yr or so for family vacations.