In today's VETgirl online veterinary continuing education blog, we discuss the importance of wellness for veterinary professionals. Why is it that we care for our veterinary patients so well and constantly advocate for their quality of life, but have poor self care? Due to the growing prevalence of suicide in veterinary medicine, we wanted to review a recent study that was published in JAVMA in October 2015 on the importance of wellness for veterinarians. Make sure you've also checked out our other podcast on “Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians,” along with our free VETgirl webinar on suicide (by Jeannine Moga).
In a study by Brannick et al entitled “Taking stock and making strides towards wellness in the veterinary workplace,” the authors highlight the fact that veterinary medicine attracts people with a drive to help others, as well as high levels of compassion and empathy. While these traits enable veterinary professionals to experience compassion satisfaction that is a joy or sense of achievement in helping others and providing high quality patient care, this can take its toll personally and professionally over time. With repeated exposure to traumatic events such as animal abuse, diagnosis of serious illnesses, or euthanasia, as well as moral dilemmas and occupational demands, compassion fatigue or burnout can occur.
First, what's the difference between compassion fatigue and burnout? Compassion fatigue results from the caregiver’s unique relationship with sick or dying patients and the empathy they feel. It's a profound emotional and physical loss that occurs when caregivers are unable to refuel and regenerate. Conversely, burnout describes the physical and emotional exhaustion that occurs when workers have low job satisfaction and feel powerless and overwhelmed at work. Whereas burnout can be more easily resolved with changing jobs or adjusting duties at work, compassion fatigue cumulates over time and can become evident in our professional and personal lives. Between 15 and 67% of veterinarians are at high risk of burnout, as are 35% of other animal care team members. Both compassion fatigue and burnout can manifest as negative psychosocial behaviors such as detachment or avoidance, as well as physical illness and detrimental workplace conduct including interpersonal conflict or absenteeism. Moreover, compassion fatigue or burnout can establish a negative feedback cycle that can erode a veterinary care provider’s strong human-animal bond, thus reducing the feelings of compassion and empathy for patients and clients.
Over the last several decades, evidence has shown veterinarians and other caregivers in a variety of workplaces (including veterinary practice to the corporate world, animal shelters, and academia) all face high levels of work-related stress. Occupational stressors that have been identified include:
- high workloads
- lack of sufficient downtime during the work week
- lack of vacation time
- interpersonal conflicts
- administrative tasks
- duration and timing of work hours (including overtime, weekends, and on-call).
Other work-related stressors include professional mistakes, the threat of malpractice litigation, pressure from clients, unanticipated outcomes, animal death, and moral stressors in clinical decision-making, such as when euthanasia is selected for a condition that is potentially treatable but not financially feasible for the owner. Surprisingly, it is estimated that veterinarians face life and death situations five times more frequently than physicians.
Other common stressors that are especially impactful for younger veterinarians include personal finances, relationships outside of the workplace, and personal expectations of high performance. But regardless of the underlying cause, both compassion fatigue and burnout can have serious long term effects on veterinary care givers as well as others in the workplace or home. Therefore, ways to reduce or prevent compassion fatigue and burnout are necessary.
Reported manifestations of compassion fatigue and burnout range from uncontrolled mood swings, irritability, and lack of concentration, to insomnia and depression. Over time, these psychosocial signs can progress to physical symptoms including headaches, gastrointestinal upset, and inappetence, as well as detachment from the workplace and everyday life. Consider the classmate or colleague that kept calling in sick, changed jobs frequently, or became distant from his or her patients and co-workers or friends…
Veterinary caregivers also seem to be at a higher risk of adopting negative coping strategies such as alcoholism, overeating, drug use, or excessive sleep. Other veterinary caregivers fail to cope at all, leave the profession altogether, or pursue suicidal thoughts as we hear all too often. The sad and frustrating part is that despite the empirical data outlining these risks, research into workplace issues facing animal caregivers is lacking, especially in the field of compassion fatigue and burnout, when compared to other caregiver professions.
The good news is that studies show that positive coping strategies can reinforce compassion satisfaction and lessen compassion fatigue among other similar care giving professionals. Mentorship, increased work group cohesion, organization commitment to ameliorate stress, and access to external helplines and healthcare professionals enhances support for individuals experiencing compassion fatigue and burnout. Likewise, training in mind-body skills, mindfulness, cognitive coping strategies, and stress education have also been shown to enhance resilience. Learning about self-regulation, intentionality, self-validation, and the importance of social connection and self-care also have the ability to reduce stress and burnout. Other activities such as exercise, meditation, and fostering positive co-worker relationships also improve compassion satisfaction.
There is no doubt that being trained to recognize and respond to compassion fatigue and burnout needs to begin early. Professional students such as medical and dental students who are taught mindfulness during their schooling have decreased stress, anxiety, and depression and exhibit increased empathy and self-compassion. While training in self-care and mindfulness are still largely lacking, there are some veterinary schools taking tremendous steps in this direction including the University of Tennessee where a wellness class that covers leadership, finances, communication, exercise, nutrition and mental health was recently made a mandatory throughout the veterinary curriculum.
Experience within other medical professions indicates that compassion fatigue is not easily recognized by individuals without an initial awareness that the condition exists. Therefore, veterinarians and other animal care givers must learn to recognize signs of compassion fatigue and burnout in themselves and others. In order to do this, we must take stock of our individual and collective levels of compassion satisfaction, compassion fatigue, and burnout starting now and over time. We must also work to find solutions to underlying problems and to find effective coping strategies to counteract compassion fatigue and burnout. This includes normalizing feelings related to stressful events or stressors. Just like many of our clients need validation that the grief they are feeling over the difficult decision to euthanize their pet is normal, as veterinary professionals, we too need validation that the feelings of burnout and compassion fatigue are more common than we think and nothing to feel ashamed of.
Thankfully, the authors of this article worked to gather resources on veterinary workplace wellness during the 2014-2015 AVMA Future Leaders Program. One of the identified resources was a survey called the Professional Quality of Life Scale, which is a validated self-assessment tool measuring compassion satisfaction, compassion fatigue, and burnout in medical professionals. This is available to all AVMA members through the AVMA Wellness website, which can be found at www.avma.org/wellness. All AVMA members should complete the survey and will receive immediate feedback regarding their current workplace wellness status. These survey results can also be saved and repeated to create serial scores for comparison over time. The AVMA Wellness website also has an online toolkit with resources to help veterinarians and other veterinary care givers find the support needed to achieve balance in all facets of their lives.
It has become obvious that those of us in care giving careers need to care for ourselves in order to continue caring for others. We must recognize, reverse, and prevent compassion fatigue and burnout in ourselves and others to maintain the highest standards of care and compassion within our veterinary workplaces. So, don’t waste any time, after you finish this podcast, complete the Professional Quality of Life self-assessment and then pick one thing that you can do to enhance wellness in your workplace. Just the simplest change such as starting a running group or attending a weekly yoga class could make a world of difference!
- Brannick EM, DeWilde CA, Frey E, et al. Taking stock and making strides toward wellness in the veterinary workplace. J Am Vet Med Assoc 2015;247(7):739-742.