How veterinarians can manage burnout and support well-being

Veterinary practices face increasing demand for services while practitioners continue to deal with remote communications, strained interactions with clients, increased feelings of isolation, and in some cases, having to turn patients away. The pandemic exacerbated the pace and pressure of veterinary work, shining a spotlight on burnout and exhaustion among practice staffers in all roles. It also made everything feel harder and take longer as everyone's brains worked to adapt to new protocols.

Keep in mind that compassion fatigue and veterinary burnout aren't synonymous. Thomas C. Favale, Jr., DVM, LMSW, and Andrew Lufkin, LMSW, from the University of Tennessee College of Veterinary Medicine, Veterinary Social Work program explain that compassion fatigue means exposure to unsettling emotionally shared experiences. It's often referred to as vicarious trauma or secondary traumatic stress, as veterinary professionals essentially experience and take on the weight of patients' illness and death and their families' own emotional responses to everything that happens.

Veterinarians also face ethical dilemmas or moral stress several times a week, which contributes to compassion fatigue. Burnout, on the other hand, typically comes from workplace struggles such as long hours, disagreements, and lack of resources.

Consequences + outcomes

Left unchecked, one consequence of these stressors is attrition, with some people leaving the profession entirely and many others scrambling for reasons to stay.

Jon Shipley, with AmeriBen, a human resources consulting company, points to exhaustion and feelings of inefficacy that often lead to cynicism and detachment from co-workers, clients, and patients.

Favale and Lufkin also list these downstream effects:

• Poor performance, including tardiness, apathy, and incomplete records
• Medical errors
• Changes in attitudes and tolerance
• Decreased coping abilities
• Increased symptomology with current mental health issues
• Strained ability to maintain a thriving business

What happens at work doesn't stay at work, though, and veterinary professionals may struggle with everything from relationship and financial problems to substance use disorders.

Most critically, those in the profession have higher rates of suicide compared to the general population — 2.1 times higher for male veterinarians and 3.5 times higher for female veterinarians. A study published in 2019 also found that the standardized mortality ratios (SMRs) for suicide in "male and female veterinary technologists (5.0 and 2.3, respectively) were significantly greater than those for the general population."

Systemic + individual action

To address and prevent mental health issues and burnout, veterinary practice leadership needs to implement and model systemic changes. Eric Richman, MSW, LICSW, hospital social worker at the Cummings School of Veterinary Medicine at Tufts University says, "There's the question of cultural change in the organization. That has to be paired with individual responsibility or individual focus on things like mental health and burnout. So, I think it's not an either/or. It's both, but I do think it starts with leadership and the culture."

Richman says leadership can model those changes by talking openly about mental health and well-being and by turning off email and text messages at night or during non-work hours.

He sees some benefit to debriefing about events and feelings. "There's not a quick fix, necessarily, but there's power to and healing in some respects of being able to express yourself and have it witnessed by people who can understand it," Richman says.

Small resets throughout the day can bring stress levels back to a healthier baseline:

• Take breaks to stretch, practice deep breathing, or make a quick lap of the building
• Sit down to eat or leave the facility for meals
• Focus on three positives from each day
• Create end-of-shift rituals that make the transition to personal time more concrete, such as changing clothes or taking a few moments of mindfulness

Richman cautions, however, that wellness work cannot be a one-and-done thing. He says, "You can't kind of go along as normal and then throw in some mental health and well-being programs and hope that's going to really change the culture or the way people respond to burnout and stress. I really think it has to be a more systemic approach."

Scheduling + benefits

Human medicine uses scheduling to lessen the impact of long-term stress and compassion fatigue — by working longer hours on fewer days, such as three 12-hour shifts or four 10-hour shifts. Longer breaks in between give staff time to decompress.

Darlene Bos, MA, executive director of Not One More Vet (NOMV), anticipates a new program called Clear Blueprint. Set to launch in 2022, it will include better staffing and scheduling models along with other scalable comprehensive workplace wellness guidelines to address veterinary staff burnout and attrition.

True focus on a healthy workplace, of course, includes things like good paid time off and compensation as well as health insurance with mental health benefits and other resources for those in crisis or headed there.

Often, veterinary teams need help beyond what practice owners themselves can provide, which is why some turn to employee assistance programs (EAPs). Cory Friedman is the managing director of Alera Group's veterinary division and what he calls the "conduit" for the Veterinary Hospital Managers Association's (VHMA) EAP program for members, which has seen an uptick in interest during the pandemic.

"Utilization of EAPs is much higher in the veterinary industry than it is in other places because there is a greater need for it," Friedman says.
He estimates usage in veterinary medicine at nearly double the usage in other types of workplaces. Between Q2 2020 and Q1 2021, Friedman says the VHMA EAP program saw 7.84 percent utilization. Of the cases handled in that time through unlimited phone consults and limited in-person consults per issue, 98.48 percent found resolution through the EAP support services alone. The other 1.52 percent resulted in a referral to mental health providers, potentially covered by health insurance offered by the practice.

In the latest EAP reporting period, the case topics broke down as follows:

• 29.55 percent — personal stress
• 21.97 percent — anxiety
• 10.61 percent — depression
• 9 percent — job stress
• 9 percent — legal
• 6 percent — marital/relationship

Unlike health insurance benefits that are typically only available to full-time employees, Friedman points out that EAP programs provide equitable access to all employees at all compensation levels with in-the-moment, short-term support. "If there's a financial barrier that's preventing somebody from seeking help that they recognize they need, the EAP offers help, even if it's limited, for free."

Compassion + peer support

Lifeboat, a live-chat app from NOMV scheduled for beta release in later 2021, will provide anonymous, in-depth, long-term, personalized peer support from three trained volunteers working in the same type of role — practitioner, biotech/research, veterinary technician, etc.

"If someone is suffering from a crisis, they need to call a hotline," Bos explains. "This is more of a warmline concept. The idea behind a warmline is you are not in crisis, but you know that you're headed toward one."

Lifeboat and other resources and education options through NOMV work more holistically to offer help for all the manifestations of compassion fatigue, burnout, financial strains, and interpersonal conflict and communication. The benefit of veterinary-specific peer support is connecting with people who truly understand the unique issues of veterinary practice.

"We're dealing with all sorts of aspects of mental health and wellness," Bos says. "The goal of the organization is to make the veterinary profession a more mentally well place, and if we do that, then we eliminate suicide by default."

One + all

What works for one veterinary professional won't necessarily work for all. Veterinary teams need compassionate, flexible, and comprehensive options to support their individual wellness. Veterinary burnout and staffing crises driven by an exodus of exhausted professionals in many veterinary roles need to be addressed both through systemic change at the practice culture level and through access to help for those brave enough to admit they're struggling.