Why do veterinarians leave clinical practice? A qualitative study using thematic analysis

Career transition plans of veterinarians in clinical practice

Objective

Gain an understanding of the career transition plans of veterinarians in clinical practice.

Sample

Veterinary members of the Veterinary Information Network (VIN) working as small animal clinicians.

Procedures

An electronic survey distributed via the VIN data collection portal.

Results

A total of 1,256 responses from veterinarians in clinical practice were analyzed, with 61% indicating they plan to decrease their clinical work, and 31% to stop entirely within the next 5 years. The most common reasons for these choices were to have more free time for oneself and/or family/friends (76%), to maintain good health (59%), and feeling burned out (50%). Factors that might entice them to retain their current number of clinical hours included reduced workload or shorter hours (42%), financial incentivization (38%), and improved working conditions (26%). Concerns related to retirement were common with 47% of participants in our study reported feeling concerned about the loss of professional identity, 34% reported concern about reduced social connections, and 28% reported concern as to how they would fill their time.

Conclusions and clinical relevance

The reported desire to reduce/stop one's clinical work within the next 5 years by 42% of veterinarians ≤44 years of age, with burnout a primary predictor, offers insights into the necessity of change at the organizational, systemic (versus individual) level. The fact that many participants reported concerns related to retirement and 32% reported that they did not have adequate retirement information suggests a need for supportive services to help ensure a successful transition.

Veterinary and pet owner perspectives on addressing access to veterinary care and workforce challenges

Objectives

(1) Assess and compare the perceptions of pet owners and veterinary professionals pertaining to the extent of veterinary workforce and access to care challenges in 2023 in Colorado, and (2) Assess what programs, policies, and resources veterinary professionals and pet owners believe would be most effective at addressing access to care and workforce challenges in Colorado.

Sample

736 veterinarians, veterinary technicians, or practice/owner manager ("veterinary professionals") in Colorado. A total of 1,209 pet owners (919 from an online survey and 290 from in-person surveying).

Procedures

Distribution of an online anonymous survey to veterinary professionals in Colorado. Pet owners were surveyed both online and in-person at pet pantry or shelter events.

Results

Veterinary professionals reported significant workforce challenges, including having to frequently divert clients, clients forced to decline medical care or having to euthanize their pets due to cost. Veterinary professionals were especially supportive of policy efforts to enhance recruitment and retention of technicians, including through mechanisms such as clarifying their scope of practice, loan repayment programs, and enhancing career pathways. Colorado pet owners' responses pertaining to the scope of access to care challenges were similar to prior national research. Pet owners reported particularly needing low-cost emergency clinics in their community as well as resources to reduce the cost of care. Pet owners were generally supportive of expanding veterinary care access through telemedicine; indicating they would feel comfortable seeing a veterinarian via telemedicine, even for the first time, and that expanded use of telemedicine would increase their ability to obtain care.

Conclusions and clinical relevance

Colorado pet owners and veterinary professionals both identified numerous access to care challenges as well as indicated support for the development of several potential initiatives to address the problem. Low-cost clinics that provide sick and emergency care was the resource rated as being most helpful among pet owners. Further exploration of grants, voucher programs, expansion of telemedicine, increased utilization and title protection for CVTs, and the creation of the veterinary professional associate position are all initiatives that were noted to be worthy of further exploration.

Understanding psychological outcomes following exposure to potentially morally injurious events in animal care: development of the Moral Distress-Posttraumatic Growth Scale for Veterinary Professionals

AIMS

To generate a taxonomy of potentially morally injurious events (PMIE) encountered in veterinary care and develop an instrument to measure moral distress and posttraumatic growth following exposure to PMIE in the veterinary population.

METHODS

Development and preliminary evaluation of the Moral Distress-Posttraumatic Growth Scale for Veterinary Professionals (MD-PTG-VP) employed data from veterinary professionals (veterinarians, veterinary nurses, veterinary technicians) from Australia and New Zealand across three phases: (1) item generation, (2) content validation, and (3) construct validation. In Phase 1 respondents (n = 46) were asked whether they had experienced any of six PMIE and to identify any PMIE not listed that they had experienced. In Phase 2 a different group of respondents (n = 11) assessed a list of 10 PMIE for relevance, clarity and appropriateness. In Phase 3 the final instrument was tested with a third group of respondents (n = 104) who also completed the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT), a measure of posttraumatic stress, and the Stress-Related Growth Scale-Short Form (SRGS-SF) a measure of perceived posttraumatic growth. Spearman's correlation coefficients were calculated between respondent scores on each of the MD-PTG-VP subscales, the SPRINT, and the SRGS-SF to assess construct validity.

RESULTS

A 10-item taxonomy of PMIE encountered in veterinary care was generated in Phase 1. Items were deemed relevant, clear and appropriate by veterinary professionals in Phase 2. These were included in the developed instrument which measures frequency and impact of exposure to 10 PMIE, yielding three subscale scores (exposure frequency, moral distress, and posttraumatic growth). Assessment of construct validity by measuring correlation with SPRINT and SRGS-SF indicated satisfactory validity.

CONCLUSIONS

The MD-PTG-VP provides an informative tool that can be employed to examine professionals' mental health and wellbeing following exposure to PMIE frequently encountered in animal care. Further evaluation is required to ascertain population norms and confirm score cut-offs that reflect clinical presentation.

CLINICAL RELEVANCE

Once fully validated this instrument may be useful to quantify the frequency and intensity of positive and negative aspects of PMIE exposure on veterinary professionals so that accurate population comparisons can be made and changes measured over time.

A comparison between veterinary small animal general practitioners and emergency practitioners in Australia. Part 1: demographic and work-related factors

Occupational stressors are commonly encountered in small animal veterinary practice and have been associated with burnout. The working context of veterinarians differs by specialty, and this can potentially lead to variable exposures to risk factors for burnout. The aim of this study was to explore differences in demographic and working conditions of veterinary general practitioners (GPs) and emergency practitioners (EPs) to compare exposure to different potential stressors. An anonymous, online survey was administered to veterinary GPs and EPs practicing in metropolitan regions of Australia. In total, 320 participant responses were analyzed (n = 237, 74.2% GPs and n = 83, 25.9% EPs). Significant differences (P < 0.05) in the demographics and work-related exposures were found between the two groups. GPs were found to be older than EPs with a greater number of years of experience in their field (P < 0.001). Most veterinary GPs worked only day shifts (207/236, 87.7%); where EPs worked a greater variety of shift patterns, with "only day shifts" being the least common shift pattern (P < 0.001). Most GPs worked a set and predictable roster pattern (195/236, 83.6%), while most EPs did not (51/83, 61.5%). EPs worked more weekends and public holidays (P < 0.001). The EP group performed more hours of work each week but worked less overtime. The main contributing factors for overtime were scheduling factors for GPs and staffing issues for EPs. EPs were commonly not able to take meal-breaks and GPs' meal-breaks were commonly interrupted by work. EPs were more frequently exposed to patient death, euthanasia (including for financial reasons), emotionally distressed clients and delivering negative news (P < 0.001). Both groups indicated that most work environments were collegiate and supportive, and a minority reported toxic colleagues (11.8%) or management teams (26.9%). Just under one-half of respondents reported having witnessed or experienced workplace bullying. Of our respondent group, 52.0% (166/319) were not satisfied with their remuneration. Desire to leave their principal area of practice was prevalent among this survey group (192/319, 60.2%) with approximately one-third considering leaving the veterinary profession. We discuss the implications of these workplace factors, including mitigation strategies.

'All I do is fight fires': Qualitative exploration of UK veterinarians' attitudes towards and experiences of pre-purchase consultations regarding brachycephalic dogs

BACKGROUND

Demand for brachycephalic dogs has dramatically increased over the past decade, despite growing evidence of strong associations between brachycephaly and severe, chronic disease. Positive post-purchase attitudes of owners towards brachycephalic dogs are highly intractable, facilitated by normalisation of breed-related disease and strong dog-owner bonds. Veterinarian-led pre-purchase consultations (PPCs) have been promoted as an opportunity to influence acquisition decisions regarding brachycephalic dogs.

METHODS

Using reflexive thematic analysis, this qualitative study investigated veterinarians' attitudes towards, and experiences of, engaging in PPCs for brachycephalic dogs.

RESULTS

Veterinarians described significant structural barriers, such as lack of time and staff, and perceptual barriers, such as perceived futility, negative outcomes of PPCs and public distrust in the profession, that combine to inhibit many veterinarians from offering or delivering brachycephalic PPCs. Some of these barriers are intractable at an individual-veterinarian level and lead to moral distress due to conflicts between veterinarians' responsibilities to animal welfare versus clients' and business needs, with resultant censorship of authentic views on brachycephalic ownership compromising professional integrity and autonomy.

LIMITATIONS

Wider views and/or experiences may exist outside of the sampled population.

CONCLUSION

Stronger veterinary leadership, including from the RCVS, BVA and veterinary corporates, is now urgently required to build profession-wide solutions that overcome the barriers identified to create public-facing consensus and innovative solutions to the 'brachycephalic crisis'.

'All we found were bones': Veterinary workers' distress and trauma after Australia's Black Summer bushfires

BACKGROUND

Australia's 2019/2020 Black Summer bushfires affected billions of animals, many of which were rescued and cared for by veterinary and animal care workers (VACWs). Little is known about VACWs' disaster-related experiences and how these experiences may affect them.

METHODS

We used a convergent mixed-methods design to explore how a variety of VACWs experienced the Black Summer bushfires. Data were gathered between April and July 2020. Participants (N = 93) were recruited via Facebook posts and emails that contained a link to an online survey. The survey included open-ended questions about VACWs' bushfire-related experiences and quantitative measures of posttraumatic stress disorder symptoms, psychological distress, burnout and grief.

RESULTS

Participants reported a variety of bushfire-related experiences and described several ways the disaster affected their work, personal lives and communities. Overall, participants scored highly on measures of psychological ill-health.

LIMITATIONS

Our cross-sectional design and use of non-probability sampling limited the generalisability of the results and may have introduced a response bias.

CONCLUSION

Our results contribute new information on the experiences of VACWs during and after bushfires and the psychological hazards they may face due to the extreme and prolonged stressors produced by such disasters. Implications for policy and veterinary practice are discussed.

Ethical challenges experienced by veterinary practitioners in relation to adverse events: Insights from a qualitative study

BACKGROUND

Understanding ethical challenges experienced in relation to adverse events is necessary to inform strategies that optimise patient safety and practitioner wellbeing.

METHODS

A qualitative exploration of UK veterinary practitioners' experiences of adverse events was conducted. Data were collected via 12 focus groups and 20 interviews and analysed using an inductive coding technique.

RESULTS

Questions surrounding acceptable boundaries of care, decision-making autonomy, personal scope of practice, use of evidence and speaking up about patient safety concerns were identified as ethically challenging to practitioners when endeavouring to prevent adverse events. Issues of appropriate accountability, interaction and communication with animal owners and the prioritisation of emotional and technical support for themselves and others were identified as ethically challenging in the aftermath of adverse events.

LIMITATIONS

The qualitative nature of this study limits the generalisability of the findings.

CONCLUSIONS

Ethical challenges are experienced by veterinary practitioners in relation to both preventing and responding in the aftermath of adverse events. Strategies that facilitate ethical decision making and reflection and encourage openness and learning from adverse events would likely improve patient safety and enhance practitioner wellbeing. Further research is needed to develop and implement support for practitioners who experience ethical challenges in relation to adverse events.

Veterinarian burnout demographics and organizational impacts: a narrative review

Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.

Mental health in the veterinary profession: an individual or organisational focus?

The veterinary profession is experiencing a shortage of veterinarians, with attrition recognised as a substantial contributor. Research has also indicated increased levels of mental ill health and alarming suicide rates in practitioners. The primary aim of this study was to investigate the impact of eleven modifiable workplace factors on mental health outcomes, job appreciation and intention to leave the veterinary profession. The second aim was to ascertain whether workplace factors influence mental health outcomes after controlling for individual resilience. An online survey was completed by 73 practising Australian veterinarians. Unfavourable workplace factors correlated with adverse outcomes including depression, stress, reduced job appreciation and increased likelihood of leaving both the role and the profession. Workplace factors remained linked with the outcomes of job appreciation, depression and stress whilst controlling for practitioner resilience. Job appreciation was a significant predictor of intention to leave both the current role and the profession. Via multiple linear regression, two categories were identified as associated with improved psychological outcomes and job appreciation. These were workplace factors that represent breaks from workload and control or decision latitude in the workplace. Whilst resilience represents a key area for intervention, workplace factors potentially represent an easier-to-modify area for intervention.

Australian veterinarians' perspectives on the contribution of the veterinary workforce to the Australian animal health surveillance system

This study investigated the involvement of private veterinarians in surveillance activities and the veterinary workforce's contribution to the Australian animal health surveillance system. The perception that there is overall a decreased engagement by veterinarians in surveillance outcomes at a time when there is increased need for bolstering of surveillance systems was investigated. Three key questions were considered: (1) What is the current contribution of private veterinarians to the Australian surveillance system? (2) What is the veterinary professions capacity to assume a more prominent role in surveillance? (3) What is the interest and ability of the veterinary profession in Australia to undertake this surveillance role now and into the future? Semi-structured telephone interviews were conducted with 17 private veterinarians with data analyzed qualitatively to identify key themes. Results demonstrate that private veterinarians are aware of their responsibilities and are engaged in surveillance activities at both formal and informal levels. The key challenges associated with current and future contributions were related to workload, remuneration, conflicts of interest and clarity over how responsibility for surveillance is shared amongst those involved in the system. The study has demonstrated that even amongst an engaged population, barriers do need to be addressed if private veterinarians are to be tasked with increasing their involvement in animal health surveillance activities.

Mental well-being and diversity, equity, and inclusiveness in the veterinary profession: Pathways to a more resilient profession

Mental well-being (MWB) and diversity, equity, and inclusiveness (DEI) continue to be critical within the veterinary profession but there is less information regarding how professional associations around the world tackle these issues. A mixed-method study including an international online survey in English (n = 137 responses via snowball sampling), fourteen interviews, and two webinars was used to identify the availability and impact of MWB and DEI support programs for veterinarians. Survey results showed that more veterinary organizations designated MWB and DEI challenges (54%, n = 43/79 and 58%, n = 45/78, respectively) as a key priority area than veterinary clinics (26%, n = 15/57 and 33%, n = 19/57, respectively). Whereas, MWB support programs were available in a moderate number of mainly English-speaking countries, DEI support programs were available in only a few countries and focused primarily on specific groups, with an unknown impact due to their recent implementation. Universally, survey respondents believed activities for specific groups, such as MWB webinars, training, and awareness campaigns, as well as MWB/DEI helplines and DEI peer-to-peer support programs had a high impact (median 3.5–4/5) yet were underemployed by both veterinary organization and veterinary clinics. Further feedback from respondents during focused interviews indicated that requiring initial and continuing training as well as tailored group activities would be most beneficial to improve MWB/DEI throughout the veterinary professional career. There are many areas of the intersection between MWB and DEI that remain to be elucidated in the future studies. Having a sufficient sample size, improving accessibility, and addressing varying cultural perceptions are the main challenges, as seen in our study. To truly address MWB and DEI disparities, change is also needed in veterinary workplace culture and environment. In conclusion, raising awareness for an inclusive profession, including increasing openness and acceptance to enhance DEI and destigmatizing MWB challenges, is needed to ensure a thriving, modern veterinary profession.

“There Was a Sense That Our Load Had Been Lightened”: Evaluating Outcomes of Virtual Ethics Rounds for Veterinary Team Members

Clinical ethics support services (CESS) are employed in healthcare to improve patient care and help team members develop skills to recognize and navigate ethically challenging situations (ECS). The objective of this study was to evaluate the impact of ethics rounds, one form of CESS, on veterinary team members. An anonymous, online mixed-methods survey incorporating a 15-item instrument designed to assess the outcomes of moral case deliberation originally developed for human healthcare workers (the Euro-MCD 2.0), was developed. The survey was administered to veterinary team members prior to and following participation in a 90-min virtual ethics rounds session. A total of 23 sessions of virtual ethics rounds were held. In total, 213 individuals participated, and 89 completed both surveys (response rate 41.8%). Most respondents were female (n = 70, 81%). Most were veterinarians (n = 51, 59%), followed by other veterinary team members (practice manager, animal attendant) (n = 18, 21%), veterinary nurses or animal health technicians (n = 10, 12%) and veterinary students (n = 8, 9%). Age ranged from 20 to 73 (median 41, IQR 32–52, n = 87). While there was no statistically significant difference between overall modified Euro-MCD 2.0 scores between T1 and T2, there were statistically significant changes in 7 out of 15 Euro-MCD 2.0 items in the domains of moral competence and moral teamwork. Reflexive thematic analysis of free-text responses identified themes including the types, impact and barriers to resolving ECS, the impacts of ethics rounds on veterinary team members and constraints preventing veterinary team members from speaking up in the face of ECS. While participants largely described the impact of ethics rounds as beneficial (for example, by facilitating clarification of thinking about ECS, allowing participants to see ECS from the perspective of others and providing a safe space for discussion), reflecting on ECS could be stressful for participants. Active participation in ethics rounds may be inhibited in the context of power imbalance, or in settings where bullying occurs. Overall, carefully facilitated ethics rounds has the potential to improve the ability of veterinary team members to identify and navigate ECS, and potentially mitigate moral distress.

A Mixed Methods Investigation of Stress and Wellbeing Factors Contributing to Burnout and Job Satisfaction in a Specialist Small Animal Hospital

Occupational burnout is a critical issue affecting the welfare of veterinary care providers, their patients, and the sustainability of veterinary healthcare organizations. The current research aimed to evaluate the prevalence of and factors contributing to stress, wellbeing, burnout symptoms and job satisfaction among clinical and non-clinical staff at a large specialist small animal hospital in Australia. Participants completed an anonymous online survey including self-report measures of job satisfaction and symptoms of burnout, and open-text response questions probing sources of stress and wellbeing. Subsequently, participants rated how frequently they experienced commonly reported sources of veterinary stress, and a series of focus groups were conducted with clinical and non-clinical teams. The survey was completed by 249 participants (overall response rate = 70%; 67.1% “clinical;” 17.3% “non-clinical;” 5.6% “other”). Five focus groups (including 38 of the survey participants) were subsequently conducted with groups of clinical and non-clinical staff. The majority of respondents (80.7%) reported being satisfied, very satisfied, or extremely satisfied with their job. At the same time, 57.7% of respondents exceeded the threshold for burnout on at least one burnout dimension, with 48.1% reporting high levels of emotional exhaustion, 30.2% reported high levels of cynicism, and 16.3% reporting low levels of professional efficacy. Open text responses and focus group transcripts revealed three common sources of stress and wellbeing. Stressors included communication (conflict within teams), clients (dealing with client emotions and expectations), and heavy caseload. Wellbeing was enhanced by people (team cohesion, respect for colleagues), practice (variety, autonomy, challenge), and purpose (meaningful work and impact). Overall, for both clinical and non-clinical survey respondents, “heavy workload” was rated as the most frequent source of stress. Despite high levels of job satisfaction, approximately two thirds of respondents reported at least one symptom of burnout. Convergent results from the survey and focus groups indicated that strong relationships with colleagues and the intrinsic meaningfulness of the work were key sources of wellbeing and job satisfaction. On the other hand, challenging workplace interactions with colleagues and clients, as well as heavy workload, were identified as key stressors contributing to burnout symptoms.

"Refugees from practice"? Exploring why some vets move from the clinic to the laboratory

BACKGROUND

Named veterinary surgeons (NVSs) are a mandated presence in licensed animal research establishments in the UK. Some NVSs come into their laboratory roles having left general veterinary practice, which is currently facing significant recruitment and retention challenges. Understanding the factors that motivate veterinary professionals to move from practice to laboratory roles provides insight into the issues underlying recruitment and retention challenges in veterinary practice.

METHODS

Qualitative semi-structured interviews with 33 NVSs were conducted in-person or over the telephone. The interviews were transcribed, anonymised and analysed using an inductive approach.

RESULTS

Participants' accounts of their career trajectories generally emphasised push factors motivating them to leave practice, rather than pull factors to move into a laboratory role: Indeed, many participants recalled originally having little knowledge of the NVS role upon discovering it. The push factors recounted by interviewees strongly reflect the factors identified in recent research into recruitment and retention in the veterinary profession, such as business concerns and poor work-life balance.

CONCLUSION

This study shows that laboratory animal work is often considered by NVSs as more manageable or fulfilling than practice work. To improve retention, the push factors identified by NVSs should be addressed in practice management and veterinary pedagogy.

What Would You Do? Types of Ethical Challenging Situations Depicted in Vignettes Published in the Veterinary Literature from 1990 to 2020

Veterinary team members encounter a wide range of ethically challenging situations (ECS) in their work. Inability to resolve ECS in accordance with their values may negatively impact the wellbeing of veterinary team members. We sought to determine the types of ECS described in published ethical vignettes in the veterinary literature. We performed a strategic literature search, followed by a thematic analysis of vignettes published in the veterinary literature from 1990-2020. We identified 567 published vignettes in 544 publications. In the majority of vignettes, the protagonist was a veterinarian (61.6%) and the most common categories of animal involved were dogs (28.0%), livestock in general (10.8%), and cattle (10.6%). The primary type of ECS was coded for each scenario, generating 29 themes. These findings extend knowledge about types of ECS that may be encountered by veterinary team members. These themes can help to inform curricula and better prepare veterinary team members to navigate ECS. They may also highlight factors that contribute to ECS that can be addressed on a broad scale, such as through regulation, continuing professional development, or stakeholder education. Knowing that others may experience similar ECS may help veterinary team members feel part of a moral community.

Risk factors associated with veterinary attrition from clinical practice: a descriptive study

A sustainable workforce is important for the veterinary profession to meet the demands of society. To maintain a sustainable workforce, it has been recommended to retain veterinary clinicians. However, there seems to be an increasing issue with retention of veterinarians in clinical practice. In the following study, the researchers sought to understand the associations between demographic and work-related factors and attrition of veterinarians from clinical practice. Responses to an online cross-sectional survey of 881 current and former Australian veterinary clinicians were analysed. A logistic regression model was used to identify and describe associations between attrition from veterinary clinical practice and salary, working hours, role in practice, years of experience, field of work, interaction with regulatory authorities, region of work and on-call duties. Lower salary, longer working hours, having on-call duties and having worked in both rural and metropolitan regions were found to significantly (P < 0.05) increase the likelihood of leaving clinical practice. The results may inform intervention strategies to assist the industry to retain veterinarians in clinical practice.

Sustainability as a “New Normal” for Modern Businesses: Are SMEs of Pakistan Ready to Adopt It?

While in developed countries, the concept of sustainability is being recognized as a “new normal” for modern businesses, the situation is entirely different in the context of developing and underdeveloped regions of the world. Shockingly, most of the developing nations do not consider the environmental dimension of CSR as their priority, and this is one of the reasons that the issue of climate change is a hot topic of debate among contemporary researchers and policymakers from developing economies. The present study aims to explore the type and level of CSR engagement among different organizations of the SME sector in Pakistan. Further, the study also intends to uncover any potential difference between medium-sized enterprises and small-sized enterprises in terms of their CSR preferences and engagements. The study uses a qualitative approach in order to get deeper insights to meet study objectives through in-depth semi-structured interviews. In this regard, the data were collected from nine SMEs belonging to different sectors in Lahore city of Pakistan. The authors used thematic analysis in order to analyze in-depth interviews, and three main themes were extracted, including social CSR, economic CSR, and environmental CSR. The results revealed that most of the medium-sized enterprises prefer the social dimension of CSR, whereas small-sized enterprises are largely concerned with the economic dimension of CSR. It has also been revealed that the environmental dimension of CSR is non-existent in the case of small-sized enterprises. The results of the present study will help policymakers to better understand the phenomenon of CSR and to rethink their CSR policies for a better and sustainable future.