There are differences between PTO and vacation pay. In some states, you don’t carry over. There are also caps set by the company as part of a time off policy. I see both systems being abused. I had a staff member who maxed out on his vacation of 6 weeks and never took a sick day. Upper management wanted him to take a day here and there to lower the number but discouraged from taking the whole 6 weeks at once due to staffing issues. I told him he could do whatever he wants and I will find ways to cover him.
Time off is a perk and great companies that have great employees will have a great work/life balance. If there isn’t people burn out and leave.