Burnout in veterinary medicine: let’s talk action

Veterinarians are unhappy with our profession

The well-being and happiness of veterinarians has become a large topic of conversation in our industry.  The recent Merck Animal Health Survey of 3500 veterinarians reported that that 1 in 20 veterinarians suffers from serious psychological distress. Depression, burnout and anxiety topped the list of problems.

In a January JAVMA article , Charlotte Hansen, a statistical analyst at the AVMA Vet Economics Division, reported that increasing numbers of veterinarians have low gratification from work.   In 2005, 76% of veterinarians would recommend our profession to a friend or family member.  However, this number dropped to under half by 2015.  In the recent Merck study, only 41% of veterinarians overall and only 24% of veterinarians younger than 34 would recommend pursuing a veterinary medicine in veterinary medicine.

What is driving this burnout and unhappiness at work?

First and foremost, the debt issue is real

Most veterinarians are now graduating with over $135,000 of debt from vet school alone.  Tuition is rising by an average of $4500/year while salaries are only rising $700/year.   In addition, there is real apprehension and risk that increasing consolidation will put continual downward pressure on salaries.   I believe the debt issue combined with production based salaries with negative accrual also sets up ethical issues we need to discuss. While veterinarians are incredibly giving individuals who want to help pets, we need to realize that the pressure to feed your family has the potential to influence treatment recommendations in the wrong hospital culture.

Debt was by far the top concern of veterinarians answering the Merck survey.  However, it was not the only issue.

Stress was the second biggest problem mentioned

Stress can occur for lots of reasons and can either be motivating or debilitating. Compassion fatigue is related to the burden felt from caring for people and animals who are suffering. It is the emotional residue and strain of being exposed to those with trauma.  It is the result of stress from WHAT we do.

In contrast, burnout is the emotional and physical exhaustion we feel when we don’t have control over things that cause us stress or frustration.  While compassion fatigue is related to WHAT we do, burnout is more related to WHERE we work.

A dvm360 survey in 2015 asked, “What is your biggest on the job stress?”  Only 1% of veterinarians answered euthanasia and only 5% mentioned critical patients. The largest groups answered time management issues (23%) and difficult clients (21%).

I believe that burnout, frustrations and stress from WHERE we work needs to be understood and addressed.  The stress of time management and dealing with client issues for veterinarians is a reflection of frustration with lack of control over flow and systems in their workplaces.  When we get home late yet again due to problems with hospital flow that we don’t have the power to fix, we get annoyed.  When we feel like we can’t treat the case in front of us well because we don’t have enough staff, we disagree with the pricing structure, or because we are dealing with equipment issues, we start to feel like maybe it isn’t worth it.   Studies on burnout show that lack of autonomy, values conflict, work overload, and unfairness are large contributors to the problem. It is interesting that in the Merck survey, veterinary practice owners, people who have more control, reported better well-being than associates.  As practice ownership declines, is it any surprise that the well-being of veterinarians is also declining?

Timeline correlations

We also have to discuss consolidation and non-veterinary ownership as a possible contributor to our increasing dissatisfaction with our workplaces. While there are likely many factors involved, the timeline of increasing consolidation lines up with the timeline of increasing unhappiness. As practices get larger, they become less nimble and less able to change quickly.  Thus, structural and organizational problems take much longer to fix than in small workplaces.  In addition, technology becomes more expensive to roll out in large groups and thus harder to replace if it doesn’t work as intended.  With more middle management, associates have less voice and less control over the way work happens.  Clients may also be more likely to complain when they feel the structure is corporate rather than owned by someone with whom they have a relationship.  To be clear, I am not suggesting that going back to Yorkshire and the days of James Herriot will solve our problems.

Solutions

So what do we do?

First off, we need to continue to teach and learn self-care, resiliency, and well-being.  Studies of resilient doctors have shown they are more likely to build in time and ways to re-charge and reflect.  They are also more likely to set boundaries.

However, we also need to acknowledge and address the real problems our industry is facing. We have to be on the alert for the downward pressure on salaries that can occur with an increasingly consolidated industry. We need to teach business skills and contract negotiation to finishing graduates (see last week’s blog). We need to continue to encourage and finance veterinarians to purchase practices. We also need to lobby our government for better support for higher education to help decrease spiraling tuition costs.  We need to talk about the ethical issues surrounding production pay in an era of overwhelming debt. We need to talk about what SYSTEMS work and what don’t and start using quality improvement tools in our workplaces. Finally, we need research that asks questions directly about workplace conditions and job satisfaction so we really understand the frustrations and stressors that we face.

Next week, I’ll talk about some of the research and work being done in human healthcare to directly change cultures and improve joy at work.