(Adapted from the 2019 Proceedings of the American College of Veterinary Internal Medicine, Phoenix, Arizona)
A silent crisis is at hand in veterinary medicine. Veterinarians are increasingly struggling with their “dream” job choice, taking on a higher educational debt load than ever before, and unable to balance their desire to enhance the lives of animals with their own life. A recent study demonstrated that 33% of veterinarians surveyed stated they would choose another profession if starting again, and another 26% were unsure if they chose the correct profession(Merck, 2018). In the US, nearly 1 in 10 veterinarians are thought to suffer from serious psychological distress, with 1 in 6 having experienced suicidal ideation, and most alarming, a higher suicide prevalence as compared with the general US population. Female veterinarians in clinical and nonclinical roles were 3.4 and 5.0 times as likely to die by suicide as the general population, respectively (Nett et al 2015; Tomasi et al 2019).
Burnout among healthcare workers has been defined as a chronic, progressive condition resulting in emotional exhaustion, depersonalization, and decreased feeling of accomplishments. A multitude of the drivers of doctor burnout have been categorized into individual, work unit, and organizational factors that revolve around workload demands, workplace efficiency and resources, having meaningful work, culture and values, individual control and flexibility, surrounding workplace community support, and life with work harmony. (Shanafelt and Noseworthy, 2017)
Unique to veterinary medicine is the complex ethical conflict many veterinarians face using their skills to best provide care for their patients that is prevented by owner’s decisions to not provide that care due to financial or emotional considerations.
More than 70% of 889 veterinarians surveyed in North America reported that the obstacles they faced preventing them from providing appropriate care resulted in moderate to severe distress to their teams.(Moses et al, 2018) Moreover, 79% reported being asked to provide care that they considered futile. Compounding these negative emotional reactions is the result that 70% of doctors reported that they received no training in conflict resolution or self-care. (Moses et al, 2018)
Complicating the effect of the workplace on doctor wellbeing is the recent finding that personality was a better predictor of occupational stress than the environment in 311 UK veterinarians. (Dawson and Thompson, 2017) Moreover, neuroticism (anxiety, fear, moodiness, worry, loneliness) was identified as the personality trait to predict high levels of occupational stress, with depression and anger hostility the major contributors. Younger doctors were at greater risk to develop high levels of stress that those well-established in the profession.
Overwhelming evidence has demonstrated the positive correlation between enhanced doctor wellbeing with higher quality patient care, reduced medical errors, and stronger organizational growth. (Bower, 2017) A successful program to improve doctor wellbeing must move from an individual approach to one that is an organizational approach.
Organizational approaches have been shown to be more effective than individual ones when burnout was the primary outcome variable. (West et al 2016) In general, more traditional approaches in medicine have focused on helping individuals in a vacuum to the organizational goals. This approach is often met with cynicism, distrust, and disengagement by the doctor.
An organizational approach, on the other hand, accepts responsibility of their contribution to burnout, legitimizes the problem, and moves to create a collaborative approach focused on a culture of fairness, teamwork, and respect. Healthcare team member wellbeing should be an organizational core competency to address systemic factors contributing to burnout and compassion fatigue.
Development of an organizational strategic plan to promote doctor wellbeing is essential for our collective continued success to preserve the integrity of the veterinary profession. There are five key initiatives as the foundation of an overarching strategy in veterinary medicine as outlined in Table 1. (adapted from Shanafelt and Noseworthy, 2017)
Table 1. Five Key Strategic Initiatives to Promote Doctor Wellbeing
- Acknowledge and assess the problem
- Message of an “Us” problem and not a “You” problem
- Top down, high level and personal leadership acknowledgement of the problem through open and respectful communications
- Develop a standardized measure of doctor wellbeing
- Harness the power of organizational and local leadership
- Thoughtful selection of leaders
- Develop and equip leaders with the toolkit to be effective team leaders
- Assess leadership performance by the individuals they lead
- Align mission, vision and values to strengthen the organizational culture
- Develop and maintain a strong value-oriented culture by fully engaging our strategies
- Assess methods and means to reinvigorate these values
- Periodic review of how actions and values align
- Identify specific areas of deficiency with targeted intervention
- Prioritize efforts
- Change mindset from being a “victim” of a broken system to an engaged and empowered partner
- Drive change
- Provide resources to promote life with work harmony and personal resilience and self-care
- Cultivate peer to peer community at work
- Create work environment that encourages a healthy lifestyle
- Professional resources to enhance personal resilience
At MedVet, we are committed to enhancing doctor wellbeing as one aspect of our larger focus on wellbeing for all employees. Wellbeing is already one of the five key dimensions of the Employee Experience that is the current multi-year hospital-wide, all employee encompassing operational plan.
Enhancing doctor wellbeing not only has direct impact on the individual but also is a key driver to our organizational success of delivery of the MedVet experience: outstanding patient care, compassionate client experience, and strong referral partner relationships. Ultimately, the longer-term benefits include a better workplace culture, better patient-client-doctor relationships, stronger doctor recruitment and retention that all lead to stronger healthy hospital growth.
We have formulated a doctor wellbeing framework that aligns with our organizational wellbeing framework of workplace, personal and financial wellbeing. We have established a Doctor Wellbeing Task Force that will lead us to further evaluate and help design an action plan around this framework as follows:
- Improve doctor workplace wellbeing through workflow optimization, creation of flexible work schedules within a collaborative framework, encouraging focused growth and professional development, and developing and maintaining a strong collaborative and values driven culture.
- Enhance personal wellbeing by promoting methods for improved physical and a positive mental health approach, development of strategies to enhance resilience and recovery, create opportunities for focused personal and professional development, and encourage peer and outside community engagement.
- Refine and reinforce financial wellbeing with competitive compensation packages, support development of strong referral partner support for high caseloads, and continue investment opportunities in MedVet.
- Brower K (2017) Organization-level interventions to promote physician health and well-being: From taking care of physicians to giving care to patients. In: Brower KJ, Riba MB (eds) Physician mental health and wellbeing. Springer, pp 295-323.
- Dawson BF and Thompson NJ (2017) The effect t of personality on occupational stress in veterinary surgeons. J Vet Med Educ 44:72-83.
- Nett F et al., (2015) Notes from the field: Prevalence of risk factors for suicide amount veterinarians- United States, 2014. CDC, MMWR, 64(05);131-132.
- Moses L et al (2018) Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. J Vet Intern Med, 1-8
- Shanafelt T and Noseworthy JH (2017) Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 92:129-146.
- Tomasi SE et al. (2019) Suicide among veterinarians in the United States from 1979 through 2015. JAVMA 254:104-112.
- West CP et al, (2016) Interventions to reduce and prevent physician burnout: systematic review and meta-analysis. Lancet 388:2272-2281.