Feel Something, Say Something

Recognizing Stress Within the Veterinary Profession

by Lowell Ackerman, DVM, DACVD, MBA, MPA, CVA, MRCVS

Veterinary professionals and paraprofessionals are stressed, and the causes shouldn’t be difficult to discern. But they are not always taken seriously or acted upon with the urgency needed. This shouldn’t be the case because we know and fully appreciate the damaging effects of other harmful but invisible elements.

For example, veterinary team members realize the importance of wearing radiation dosimeters to track their exposure over time to dangerous ionizing radiation, but there is no such gauge for exposure to repeated stress over time, which can be similarly dangerous. In fact, it would be difficult to even construct such a stress-o-meter for veterinary team members because causes of stress are not necessarily the same for all individuals, and their tolerances for coping with those stresses are also quite personal.

This shouldn’t surprise anyone in the profession. We know there are many causes of heart disease, and the pathomechanisms might be quite different, but individuals can adjust and compensate for a certain amount of cardiac dysfunction before it results in a potential common endpoint—decompensation and eventual heart failure.

Our approach as medical professionals and paraprofessionals is predictable. We want to understand risk factors for individuals and prevent these problems from ever starting if possible. We employ early detection strategies to determine problems at the earliest opportunity, when we have the most options for changing the course of the disease and effecting successful outcomes.

But if we wait until the problem is clinically evident, we have missed many opportunities to mitigate its adverse effects and have to contend with sometimes heroic efforts to achieve a positive outcome. Stress is no different. We really do have the ability to focus on understanding the causes and put emphasis on prevention and early detection with intervention.

Because causes of stress within the veterinary profession vary with the individual, it can be difficult to make generalizations that would apply to everyone. But we can encourage everyone to be self-aware as to what causes them stress and support them in sharing with trusted team members so solutions can be explored. In addition, veterinary practices can similarly endeavor to create lower-stress workplaces on the basis of what is already well known and studied.

Since many of the deleterious effects of stress tend to be cumulative, and adverse outcomes tend to occur as threshold events, it is not critical that all potential causes of stress be eliminated for major benefits to be achieved. As medical professionals and paraprofessionals, we understand the physiological basis for damage caused by chronic stress in our patients, and yet what does it say if we consider such topics taboo in our discussions with our own team members and managers?

If we are going to recognize the harmful effects of stress—not only on the individual but on the organizations in which they are employed, the clients and patients with which they interact, and the profession in general—then we need to take this seriously. Successful hospital models of the present and future will need to understand the potential causes of stress in veterinary team members and have stress mitigation plans that make these hospitals more desirable places to work. It’s not as difficult a challenge as it might first appear, and such an approach pays dividends when it comes to client satisfaction, team member fulfillment, and less presenteeism (not fully functioning while on the job).

It is anticipated that any profession dealing with health issues and life-and-death decisions will have associated stress, and yet this alone does not explain the near epidemic rates of suicide among veterinary team members in many parts of the world. While the ultimate causes of such extreme reactions to stress are complex, there are some aspects of veterinary medicine that are worthy of reflection in the hopes of better understanding why the profession seems so susceptible to this problem.

Compassion Fatigue

Compassion fatigue results from the trauma of witnessing and dealing with the suffering of others, so everyone in caring professions is likely similarly at risk to varying extents. There are many stressful events that veterinary teams encounter on a regular basis, including illness, euthanasia, cruelty to animals, and the fact that it is not always possible to provide services to clients who are unable or unwilling to pay.

Veterinary teams want to help animals, but eventually, even the most compassionate individuals can become indifferent or emotionally exhausted by the nonstop nature of caring.

Burnout

While compassion fatigue results from the type of work that veterinary teams deliver, burnout results from stress associated with the work environment itself. This can result from work overload, conflict in the workplace, lack of control over duties or responsibilities, inconsistency in following hospital policies, workplace incivility, lack of consequences for those in the hospital demonstrating toxic or hostile behavior, not receiving the level of pay that would be commensurate with efforts extended, and many other stressors.

It is important to remember that burnout and compassion fatigue can affect all members of the hospital team, not just veterinarians. Perhaps not surprisingly, burnout is often associated with lower client satisfaction, lapses in patient care, higher medical error rates, increased staff turnover, and a variety of negative behavior patterns that can culminate in suicide.

Compromise Fatigue

Compromise fatigue results from interpersonal conflict with animal owners and other stakeholders and stress associated with not being able to deliver the level of care desired, either because animal owners don’t accept recommendations being made (because they can’t or won’t spend the money needed) or because of differing goals of clinicians, pet owners, and hospital management.

It can be particularly vexing when clients expect veterinary teams to provide care for their animals that the team did not anticipate and plan for or when they expect that our efforts should be more charitable because we work with animals. In human medicine, the term “moral injury” is sometimes used to indicate the distress that occurs in trying to reconcile the needs of many stakeholders, including the hospital, the patient, the insurer, and the medical team.

Leadership Fatigue

Whether veterinarians are comfortable with the concept or not, they are perceived as leaders by those they work with and within the community at large. However, only a relatively small proportion of practicing veterinarians actively seek out positions of leadership through practice ownership or management roles. Still, many often find themselves responsible for managing others, adhering to policies and procedures, and potentially dealing with crises that are not necessarily of their making. As such, while they may be employees or even independent contractors, there is the expectation that they will accept leadership duties as part of their clinical responsibilities. For veterinarians who have not had leadership training or did not aspire to such positions of leadership, these situations can be extremely stressful, and can exacerbate other sources of anxiety in the hospital setting.

Imposter Syndrome

Imposter syndrome is increasingly being recognized in medical professionals and students. It results from the situation where we feel we need to present ourselves as experts but perhaps do not consider ourselves as such. In a profession where there is some expectation that veterinarians know everything about all species and breeds and are proficient in all disciplines (surgery, ophthalmology, dentistry, emergency, and critical care, etc.), is it at all surprising that individuals may sometimes feel that they don’t measure up to the image they are trying to project to the public?

In human medicine, physicians often go through internship and residency programs before they are expected to take full patient responsibility. But in veterinary medicine, there is often a negligible grace period between graduating from veterinary school and working within the profession with full patient accountability. While there are programs such as mentorships and clerkships that can help improve competencies in multiple disciplines and procedures, it is unrealistic to assume that we can all become experts in all aspects of clinical care—and do so immediately upon graduation.

Mental Health

It’s not that veterinary team members have more mental health issues than others, but rather that mental health issues are rising in the population in general, and veterinary team members are no exception. Superimposed on that are situational issues that increase stress, such as the pandemic, uncertainties in the economic markets, pressures of inflation, interpersonal conflict, student debt, climate change, threats against world peace, political divisiveness that has reached catastrophic proportions, and the fact that social media has increased bullying, fear of retribution for opinions shared, and general malaise over the state of human interactions. Is there any wonder that rates of depression have climbed and can exacerbate all the other contributing factors to stress in the veterinary workplace?

Conclusion

While there are no simple solutions to the impact of stress on the veterinary profession, the first step is to admit that these stressors are real, and stresses that become manifested are unlikely to resolve on their own. Thus, it is important to realize that hospitals can take concrete steps to reduce stress for team members, which creates better workplace dynamics and more successful practices. For individuals who think admitting that these stressors exist is a sign of weakness, we need to collectively correct this misinformation.

Stress is a natural part of life, and developing coping mechanisms is healthy. But acknowledging that stress can become toxic and can quickly affect our wellbeing and satisfaction with the profession is critical. Seeking help when it is needed is very appropriate for a profession that thrives on caring, preventive care, early detection of problems, and appropriate treatment. Even better is to be proactive and reduce causes of stress before they become critical. This is in everyone’s best interest.

Some of this material has been abstracted from Pet-Specific Care for the Veterinary Team.

Lowell Ackerman, DVM, DACVD, MBA, MPA, CVA, MRCVS, is editor-in-chief for both Pet-Specific Care for the Veterinary Team and Blackwell’s Five-Minute Veterinary Practice Management Consult, 3rd Edition, and he lectures globally on medicine and management topics.

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