Compassion satisfaction, burnout, and secondary traumatic stress among full-time veterinarians in the United States (2016-2018)

Zoo professionals and volunteers in the U.S: experiences and prevalence of burnout, mental health, and animal loss

Introduction

Burnout and mental health among animal care and health professionals (ACHPs) has received increasing attention in recent years. Despite rapid growth of research in this area, the wellbeing of individuals who work and/or volunteer in zoo settings has received minimal attention.

Method

An anonymous online survey was created to evaluate zoo staff and volunteers' experiences of animal-related loss, rates of professional fulfillment and burnout, mental health, perceived organizational support, and resilience. Participants included 1695 zoo professionals (72% ACHPs, 20% other staff) and volunteers (7%) who were recruited through relevant professional listservs and online platforms, and flyers on zoo grounds.

Results

ACHPs reported higher levels of anxiety, depression, and burnout and lower levels of professional fulfillment than other zoo staff and volunteers. The most common animal-related losses experienced by ACHPs in the past year were unexpected death (80%) and anticipated loss (74%), with more than half of these losses occurring within the past 3 months. ACHPs' reported bond with animals under their care was positively associated with depression and anxiety. Having a formal ritual or process following the death of an animal was positively associated with job fulfillment and perceived organizational support and negatively associated with depression and burnout-yet only 17% of participants in our sample indicated that their zoo had such a process or ritual.

Discussion

Our findings suggest that many ACHPs are struggling with burnout, anxiety, depression, and low rates of professional fulfilment and perceived organizational support. We recommend that zoos develop organizational plans that foster a culture which normalizes and validates grief/loss experiences and is proactive in responding to animal loss, related trauma, and other occupational stressors. The results of this research demonstrate the need for systemic changes within the zoo industry, for the betterment and welfare of both humans and the animals under their care.

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.

Veterinarian-Chasing A Dream Job? A Comparative Survey on Wellbeing and Stress Levels among European Veterinarians between 2018 and 2023

Whilst recognizing the abundantly positive aspects within the different domains of the veterinary profession, the challenging socio-economic and cultural working climate has been identified as a source of veterinary mental wellbeing issues. This mixed methods study provides an overview of the mental state of veterinarians across Europe via two cross-sectional surveys in 2018/2019 (n = 14,559 veterinarians) and in 2022/2023 (n = 12,393 veterinarians). Mental wellbeing was assessed using 3 indicators: self-reported stress levels, the need for medical leave due to reduced mental wellbeing (22% and 23%, resp., in 2018/2019 and 2022/2023) and the seven-question Warwick-Edinburgh Mental Wellbeing Scale (2018/2019: 25, 2022/2023: 24.8). In both surveys, important differences were spotlighted between countries, but early-career veterinarians and female veterinarians were most at risk of decreased mental wellbeing all over Europe for all indicators. In conclusion, stress levels and need for medical leave due to reduced mental wellbeing remained at comparatively high levels across the two surveys and standardized mental wellbeing scores remained equally low. Notwithstanding the increased attention given to veterinary wellbeing in the last decade, our results underline that major efforts remain necessary, by creating more supportive and attractive workplaces that prioritize wellbeing, a good work/life balance, and providing job satisfaction.

Recasting the gold standard - part I of II: delineating healthcare options across a continuum of care

AIM

This is the first part of a two-part series on spectrum of care that encourages practitioners to embrace a non-binary approach to healthcare delivery. When care is not framed as all-or-none, either/or or best versus lesser, the provider and client can agree to diagnostic and/or treatment plans that individualize the practice of veterinary medicine. Care is tailored to the patient along a continuum of acceptable options. Care may also be intentionally incremental, with plans to reassess the patient and revise case management as needed.

RELEVANCE

Acknowledgment and ultimately acceptance that patient care journeys can be distinct, yet equitably appropriate, offers providers the flexibility to adapt case management competently and confidently to the patient based upon contextualized circumstances including client needs, wants and expectations for healthcare outcomes. Thinking outside the box to recast the historic gold standard with a continuum of care strategically offers feline practitioners a means by which they can overcome barriers to healthcare delivery.

SERIES OUTLINE

This first article introduces spectrum of care as an appropriate approach to case management and broadens its definition beyond cost of care. Part II explores communication strategies that enhance veterinary professionals' delivery of spectrum of care through open exchange of relationship-centered dialogue.

Well-being of veterinarians in rural and urban areas

Introduction

The field of veterinary medicine is characterized by a variety of challenging working conditions. The alarmingly low mental well-being of veterinarians has been examined from various perspectives. However, the influence of work location on the well-being of veterinary professionals has scarcely been investigated. The aim of the study was therefore to analyze the well-being of German veterinarians and to determine whether there is a correlation between well-being and work location.

Methods

As part of a cross-sectional study, 999 veterinary professionals answered questions regarding their work location (self-designed questions) and well-being (WHO-Five Well-being Index, WHO-5). A differentiation was made according to work location: urban cities (population > 100,000), medium/small cities (population < 100,000 inhabitants), and rural areas.

Results

Overall, the surveyed veterinarians had low well-being (ranging from 56.8% in rural areas to 61.3% in medium/small towns). The results of the general linear model indicated a significant difference in the WHO total score among veterinarians from different work locations (p < 0.001). However, when sex, age, type of employment, and field of specialization were included in the analysis, no significant between-subject effects were found.

Conclusion

According to the results, work location does not seem to have a significant influence on the well-being of veterinarians and therefore may be of lower priority in the development and implementation of interventions. However, further investigation of work-related predictors of the mental health of veterinarians is recommended, as the results indicate a low well-being among these professionals.

Predictors of Suicide Risk and Mental Health Outcomes among Hong Kong Veterinarians: A Cross-Sectional Study

The professional quality of life (ProQOL) in the veterinary profession has gained increasing attention, yet little is known about its association with the mental health status of Hong Kong veterinarians. This study aimed to examine the impact of elements that make up ProQOL on the risk of suicide, depression, and anxiety among Hong Kong veterinarians. All veterinarians registered and practicing in Hong Kong at the time of recruitment were eligible to take part in the e-survey study between 1 January and 31 March 2022. Binary logistic regression was used to analyze the data from 56 participants. The results showed that 22.0% of the participants were at risk of suicide, 19.6% had current suicidal ideation, 29.4% had depression, and 29.4% had anxiety symptoms. The findings suggested poor mental health status among Hong Kong veterinarians and were comparable to or more prevalent than those reported in Anglophone and European countries. Results from the binary logistic regression suggested that burnout was a predictor of depressive symptoms, and that secondary traumatic stress showed potential in predicting suicide risk. Our study, however, did not find conclusive evidence supporting compassion satisfaction as a predictor of reduced symptoms of common mental issues. Further investigation into contextual factors affecting the mental health of veterinarians in Hong Kong is warranted. Improving the profession's mental health literacy and self-efficacy should be prioritized as a suicide prevention strategy to enhance mental health awareness.

Relationships between diversity demographics, psychological distress, and suicidal thinking in the veterinary profession: a nationwide cross-sectional study during COVID-19

Purpose

This study aimed to determine the relationship between demographic diversity and veterinary professionals regarding their psychological distress and suicidal experiences. This study also aimed to determine what demographic factors were associated with psychological distress and suicidal experiences for veterinary professionals.

Methods

This study used a cross-sectional web-based questionnaire to assess the prevalence of diversity, psychological distress, and suicidality in individuals over 18 working in the veterinary field within the United States. The study received 2,482 responses resulting in 2,208 responses that were included in the analysis. Descriptive statistics were performed to identify the categories with the highest rates of psychological distress, suicidal thoughts, and suicidal behaviors. Binomial logistic regressions were conducted to identify the strongest statistical predictors of psychological distress (Kessler-6-K6), suicidal thinking and suicide behaviors.

Results

Of the 2,208 respondents included in the analysis, 888 (41%) were experiencing serious psychological distress and 381 (17.3%) had considered suicide in the past 12 months. Results of the binomial regressions indicate gender, social class, age, and disability status were the strongest predictors of psychological distress. When controlling for psychological distress, the strongest predictors of suicidal thinking were sexual orientation, marital status, and professional role.

Implications

Limited research has been done to explore the relationship between demographic diversity of veterinary professionals and psychological distress, suicidal thoughts, and suicidal behaviors specifically. These results shed light on multiple demographic factors that promote and attenuate mental health, as well as the importance of asking respondents their demographic identities in veterinary medicine research. This research attempts to identify these mental health factors without collapsing categories with small sample sizes, which does cause a limitation in statistical power, yet also demonstrates how to increase inclusivity in research.

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.

A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors

Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.

Suicide in veterinary medicine: A literature review

Veterinarians are commonly exposed to occupational stressors, including excessive workload and financial constraints. These stressors can lead to psychological distress, which typically results in mental health disorders such as depression, anxiety, and burnout and can even culminate in suicide attempts or suicide deaths. Risk factors associated with poor mental health and high rates of suicide in veterinary practitioners include continuous exposure to challenging scenarios, such as interpersonal conflicts, performing euthanasia, and easy access to lethal means of suicide, such as opioids and anesthetics. The previous studies highlight the urgent need for a better understanding of predisposing factors, mental health-related improvements in the professional environment, and the subsequent establishment of primary mental health-related care policies. Effective ways to promote mental health and prevent suicide may include social support, resilience, developing coping skills, promoting a healthy work environment, and discouraging perfectionist behaviors. This review aimed to summarize findings in studies that have investigated mental health and suicide in veterinarians and veterinary students and highlight measures that could be implemented as options for mental health promotion and suicide prevention.

Professional quality of life among Spanish veterinarians

BACKGROUND

In Spain, the perceived professional quality of life among veterinarians has not been explored.

METHODS

Veterinarians were invited to complete an online questionnaire in which they answered the Professional Quality of Life scale, the Medical Outcomes Study Social Support Survey and the Warwick-Edinburgh Mental Well-Being Scale. Participants were asked whether they were receiving psychological therapy or were taking anxiolytics, hypnotics or antidepressant medication. Alcohol consumption was measured using the Alcohol Use Disorders Identification Test and nicotine dependence was assessed using the Fagerström test; participants were asked whether they took illegal drugs.

RESULTS

The study sample comprised a total of 602 veterinarians, most of whom reported average levels of compassion satisfaction, secondary stress trauma and burnout. Emotional support and mental wellbeing influenced participants' professional quality of life. The percentage of veterinarians in psychological therapy and/or taking anxiolytics was higher than in the general population.

CONCLUSIONS

A considerable number of clinical veterinarians in Spain may be suffering from work-related stress. Our study identifies salary, emotional support and mental wellbeing as important factors that affect the professional quality of life. Interventions to improve veterinary clinicians' professional quality of life should therefore focus on these factors.

Factors that impact recruitment and retention of veterinarians in emergency practice

OBJECTIVE

To examine factors that impact emergency veterinarians' decisions in selecting a place of employment and their perceptions of factors important in fostering a work environment conducive to long-term employment.

SAMPLE

433 Veterinary Information Network members who reported practicing emergency medicine in the US and were not diplomates of the American College of Veterinary Emergency and Critical Care.

PROCEDURES

An electronic survey distributed via the Veterinary Information Network data collection portal, made available from May 25, 2022, through June 15, 2022.

RESULTS

Factors rated as most important in selecting a place of employment included working with a highly trained support staff and collegiality of coworkers. Factor analysis was used to extract factors that can influence emergency medicine practitioners' views of a work environment conducive to long-term employment. The factor found to be most important was leadership. All factors, except for professional growth, were rated as more important by female practitioners when compared to male practitioners.

CLINICAL RELEVANCE

Aspects promoted in emergency medicine veterinarian recruitment efforts should include, in addition to the innate nature of the position, the elements identified as most attractive to current practitioners. By better understanding the impact of gender, children status, and years practicing emergency medicine on the relative importance in creating workplace environments conducive to long term employment, hospitals can be better equipped to meet the needs of both their current employees as well as potential new hires.

Benefits of practice ownership among US private practice veterinarians extend to professional quality of life

Objective

To estimate the effects of practice ownership on wellbeing of US private practice veterinarians.

Sample

1,217 practice owners and 1,414 associate veterinarians (ie, nonowners) who participated in the 2021 AVMA Census of Veterinarians and Practice Owners Survey.

Procedures

A professional quality of life instrument was used to measure compassion satisfaction (CS; a positive attribute), burnout (BO), and secondary traumatic stress (STS) in practice owners and nonowners both as scores and as score categories (low, moderate, and high CS, BO, and STS). For hypothesis tests, propensity score matching was used, with owners (n = 595) matched to nonowners (595) on several demographic and employment factors.

Results

Owners had significantly (P < .001) higher CS scores (mean ± SE, 34.1 ± 0.3) and lower BO scores (26.1 ± 0.3) than nonowners (32.8 ± 0.3 and 26.9 ± 0.3, respectively), but STS scores were comparable between groups (27.4 ± 0.3 and 27.5 ± 0.3; P = .55). The prevalence of low CS scores and high BO scores was significantly (P < .001) higher for nonowners versus owners (53.8% vs 42.7% and 51.6% vs 46.4%, respectively). Both owners and nonowners had a high prevalence of high STS scores (81.8% and 83.2%, respectively; P = .53).

Clinical Relevance

Results suggested that practice ownership confers a benefit to private practice veterinarians in terms of CS and BO, but not STS. The prevalence of poor CS, BO, and STS scores was higher than reported previously for 2016 to 2018, suggesting an impact of the COVID-19 pandemic. The high prevalence of high STS scores in both groups warrants attention and action to protect the welfare of the veterinary workforce and support optimal patient care.

An acceptance and commitment training program reduces burden transfer, stress, and burnout among veterinary healthcare teams

OBJECTIVE

To determine whether an acceptance and commitment training (ACT) program targeting reactions to difficult client interactions would reduce burden transfer, stress, and burnout among veterinary healthcare teams.

SAMPLE

Small animal veterinary hospital employees randomly assigned to participate in an ACT program (intervention group; n = 72) or to not undergo the training program (control group; 71).

PROCEDURES

The study was designed as a randomized, controlled, parallel-arms trial. All participants completed prestudy assessments of burden transfer, stress, and burnout. The ACT program consisted of 3 small-group–format educational sessions tailored to reducing reactivity to difficult veterinary client interactions; sessions were delivered via video teleconference. At the end of the educational sessions (posttest) and 1 month later (1-month follow-up), assessments of burden transfer, stress, and burnout were repeated, and participants in the intervention group provided ratings of program helpfulness and frequency of use for techniques taught in the program.

RESULTS

Participants receiving the program rated it as helpful and reported frequent use of program techniques. Relative to the control group, the intervention group showed significantly reduced burden transfer, stress, work-related burnout, and client-related burnout after completing the educational sessions. These improvements were maintained at the 1-month follow-up.

CLINICAL RELEVANCE

Findings support the usefulness of this program in reducing occupational distress in veterinary medicine. Future work is needed to examine whether it is similarly effective in formats that could be more broadly disseminated (eg, asynchronous, self-paced, independent learning).

The Economic Cost of Burnout in Veterinary Medicine

The purpose of this study is to estimate the economic cost of burnout in the veterinary profession and highlight the financial reasons why the industry should address the burnout crisis from an organizational perspective. Using data from 5,786 associate veterinarians in private practice, information was obtained using employment information related to compensation, work hours, hour preferences, and job turnover. Burnout was measured using the Professional Quality of Life Scale and used to calculate conditional probabilities on turnover and reduced working hours due to burnout. Lost revenue from each outcome (turnover and reduced working hours) was then used to calculate the economic costs to the veterinary services industry. The attributable cost of burnout of veterinarians to the US industry is between $1 and 2 billion annually in lost revenue, though there is a large amount of uncertainty. The cost is dependent on whether veterinary technicians are included in the analysis. The highest economic cost per veterinarian is among food animal practitioners, while the lowest is among equine. This study demonstrates that there are significant economic costs due to burnout among veterinarians and veterinary technicians. We suggest pursuing organizational interventions as these have shown the most impact in decreasing burnout and increasing satisfaction among human health physicians.

Characteristics of and comparisons between US fourth-year veterinary students graduating with and without educational debt from 2001 through 2020

OBJECTIVE

To characterize and compare fourth-year students of US veterinary schools graduating with and without related educational debt (ie, DVM debt) from 2001 through 2020.

SAMPLE

45,756 fourth-year veterinary students who participated in the annual AVMA Senior Survey from 2001 through 2020.

PROCEDURES

Survey data were summarized for variables hypothesized to be associated with DVM debt. Multivariable modeling was used to investigate associations between these variables and the likelihood of graduating with DVM debt.

RESULTS

Mean DVM debt increased fairly steadily from $56,824 in 2001 (n = 1,587) to $157,146 in 2020 (2,859). Of 45,756 students, 6,129 (13.4%) had no DVM debt. Attending Tuskegee University and having children (both men and women) were associated with an increased likelihood of DVM debt. Attending certain other veterinary schools and more recent survey year were associated with a decreased likelihood. For 2020, the likelihood of DVM debt decreased with increasing percentage of tuition paid by family and increased with increasing percentage of tuition paid by educational loans, being a woman with children, and increasing total cost of attendance. No association was found with state cost of living index or per capita income.

CLINICAL RELEVANCE

Results suggested a growing rift between US veterinary students who cannot afford tuition and fees without accumulating financially concerning levels of debt and those who have the financial ability or family situation to fully fund veterinary school. Efforts should be undertaken to recruit across socioeconomic statuses and provide meaningful scholarships to students with greatest financial needs to support diversity, equity, and inclusion in veterinary medicine.

Social Workers in Animal Shelters: A Strategy Toward Reducing Occupational Stress Among Animal Shelter Workers

Animal shelter workers (ASWs) are at disproportionate risk of moral injury, secondary trauma, compassion fatigue, and burn-out. While there is an emerging body of literature developing on understanding the nuances of these experiences for ASWs, little work has been done on developing strategies to ameliorate occupational stressors and the negative effects of such for ASWs. Within this paper, occupational risks and protective factors for ASWs are summarized, and the emergence of social work within animal shelter settings as one strategy for helping to ameliorate the occupational stress experienced by ASWs is delineated.