Understanding Veterinary Wellbeing

Introduction

Many healthcare professionals have been reporting increases stressors such as burnout and fatigue since the early 2000’s, culminating in 2019 with the National Academies of Sciences, Engineering, and Medicine landmark book, Taking Action Against Clinician Burnout: A Systemic Approach to Professional Wellbeing.[1]  With the onset of the COVID-19 pandemic, those stressors have only increased for all healthcare professionals, reporting increases in burnout and stress in both medical and veterinary practices.

 This article will highlight wellbeing in veterinary medicine and offer suggestions to improve or incorporate wellbeing practices into your life.

What is Wellbeing?

There are many definitions of wellbeing as it’s a subjective measure that is defined by self-report.  One of the earliest definitions by the World Health Organization in 1948 offers a robust definition that includes not only the person but their working and living environment: “a state of complete physical, mental and social wellbeing, not merely the absence disease or infirmity.” '[2]

Since 1948, numerous organizations, including healthcare systems throughout the world have expanded this definition to include:

·      Economic wellbeing

·      Development and activity

·      Emotional wellbeing

·      Psychological wellbeing

·      Life satisfaction

·      Domain specific satisfaction

·      Engaging activities and work [3]

Improved Wellbeing Effects on Health 

Numerous outcome studies have looked at the health effects on wellbeing programs for employees and found improvements in many areas.  In one meta-analysis looking at the impact of wellbeing on health outcomes, wellbeing was found to positively impact:

·      Short-term health outcomes

·      Long-term health outcomes

·      Disease or symptom control [4]

Another meta-analysis looked at the effectiveness of digital mental health interventions such as cognitive behavioral therapy (CBT) delivered in the workplace and found a small positive effect on psychological employee wellbeing.  The authors concluded the digital mental health interventions were just as effective as those offered in traditional outpatient settings. [5]

Employer Benefits of Wellbeing Programs

Numerous employers and organizations have reported the many benefits of wellbeing programs that include:

·      Increased productivity

·      Increase employee morale

·      Higher employee retention

·      Decrease in sick days taken

·      Decrease in stress

·      Improved worker engagement and teamwork

·      Reduced healthcare costs

Wellbeing in Veterinary Medicine

In 2022, Merck Animal Health released their third study on veterinary wellbeing for nearly 2,500 veterinarians and approximately 450 veterinary staff.  Some of those findings include:

·      Over 55% of veterinarians reported a high level of wellbeing (consistent with the general population)

·      Older veterinarians (> 55) reported higher levels of wellbeing

·      Serious psychological distress was reported for nearly 10% of veterinarians, an 83% increase from the 2017 Merck Animal Health Wellbeing study; attributed to working extended hours

·      Over 30% of veterinarians reported high levels of burnout with younger veterinarians (< 55) reporting the highest levels

Veterinary staff reported lower levels of wellbeing as compared to veterinarians:

·      Approximately 25% of veterinary staff reported high levels of wellbeing

·      Serious psychological distress was reported for over 18% of veterinary staff

·      Nearly 50% of veterinary staff reported high levels of burnout

·      Approximately, 30% of staff plan to leave their jobs within two years [6]

COVID-19 and Wellbeing in Veterinary Medicine

As with most healthcare professions the COVID-19 pandemic negatively impacted veterinary medicine with the following reported outcomes:

• Over 75% of veterinarians and 80% of staff reported being shorthanded due to the pandemic

• Over 50% of veterinarians and 46% of staff reported working longer hours during the pandemic

• Over 60% of veterinarians and staff reported their jobs contributing to their exposure to COVID-19

• More than 20% of veterinarians and over 30% of staff reporting having to isolate due to COVID-19 exposure resulting in loss of work and income [6-7]

Workplace Resources

Similar to veterinary medicine, human medicine is also experiencing high levels of burnout and stress. Numerous studies have looked at what interventions can be implemented in the workplace to help elevate employee burnout and stress. One meta-analysis found workplace resources were effective at all levels of an organization, i.e., Individual, Group, Leader, Organizational or IGLO levels. [8] Those resources include:

• Individual: Inherent resources within the individual such as self-efficacy, competence, and self-esteem

• Group: Social context of the workplace such as social support and interpersonal relationships among the employees

• Leader: Leadership characteristics such as role modeling influence the organization including employee wellbeing

• Organizational: Organizational policies that develop and enhance employee skills and abilities as well as policies to motivate their performance [8]

The IGLO level workplace resources not only place an emphasis on the value of each employee but seeks to enhance their contribution to the organization. Merck Animal Health published wellbeing guidelines for both veterinarian practices as well as veterinarians and staff to incorporate into their daily lives that mirror the IGLO level resources.

Group, Leader, and Organizational Changes to Reduce Stress:

• Reduce stigma by incorporating discussions within the practice on mental health, burnout, stress, and other factors contributing to psychological distress; hire a mental health provider to lead a discussion

• Create a safe workplace environment to allow the discussion of sensitive issues such as being overwhelmed and promote wellbeing

• Have frequent in-service trainings with local mental health professionals to discuss topics related to burnout, stress, depression, etc.

• Offer health insurance that include an employee assistance program (EAP) and mental health benefits

Create and foster a work environment that incorporates a team atmosphere where all employees are valued not only for their work but for their contributions to the veterinary practice [6]

Veterinarian and Staff Changes to Reduce Stress:

• Incorporating healthy coping strategies and a stress management plan into daily life, such as self-care exercises, gratitude exercises (future MentorVet article), regular exercise, and healthy eating

• Reduce extended work hours

• Consistent engagement in non-work-related activities, e.g., socializing with friends, walking, hiking, cycling, etc.

• Since early-career veterinarians identified struggles with student loan debt, engaging with a financial advisor is recommended [6]

Resources

Some resources for veterinarians and their staff include:

AVMA Brace Space Certificate Program

A self-paced learning curriculum that teaches participants how to gain deeper understandings of the people around us and create healthier, safer, more inclusive veterinary teams, practices, and organizations.

AVMA My Vet Life

My Veterinary Life® is provided by the American Veterinary Medical Association (AVMA), the nation’s leading advocate for the veterinary profession.  Representing more than 99,500 members at every career stage, the AVMA is committed to advance the shared interests, values and goals of our member veterinarians.  Starting from your time in veterinary school and continuing through your entire veterinary career, the AVMA helps you succeed with tools and resources to simplify and improve your everyday life.

AVMA Reading List: Work-life Balance

This link can direct veterinarians to resources that can help establish and maintain a good work-life balance.

AVMA—Stress Management for Veterinarians

This link provides strategies for coping with stress as well as additional links on tips to help manage stress and the negative health effects of stress.

AVMA Veterinary Leadership Conference

The VLC is open to all veterinary professionals Including: Veterinary Students, Veterinarians, Technicians, Association Executives and other industry professionals interested in developing their leadership skills for their professional and personal development are encouraged to attend.

AVMA Wellbeing Resources

AVMA tools and resources that support personal and professional wellbeing; Learn steps you can take at work and home to support a culture of wellbeing; and, Learn how to find a wellbeing program or peer assistance contact in your state.

AVMA—Work and Compassion Fatigue

This link offers a short but comprehensive look at compassion fatigue in veterinary medicine and includes what symptoms to be aware of; how to address compassion fatigue; and, steps to take to address it.

AVMA Workplace Wellbeing Certificate

The AVMA Workplace Wellbeing Certificate Program seeks to empower veterinarians and team members with the knowledge and skills to create a culture of wellbeing in their veterinary workplace.  The program is comprised of multiple modules that can be taken individually or completed as a unit, culminating in an AVMA Workplace Wellbeing Certificate of Completion

Modules include: 

• Creating a Culture of Wellbeing

• How to Request, Receive, and Give Feedback Effectively

• Transforming Conflict

• Question.  Persuade.  Refer.  (QPR) Assessment 

• Diversity and Inclusion

Mental Health Resources

Anxiety & Depression Association of America- This website provides useful downloadable brochures on depression in several languages.

American Counseling Association- This is a website that provides resources for depression, including locating a counselor who treats depression as well as articles on depression.  A subscription is needed to access some of their resources.  

Mental Health America

Online screening is one of the quickest and easiest ways to determine whether you are experiencing symptoms of a mental health condition.

Mental Health First Aid Mental Health Resources

A resource for anyone who is experiencing a mental health or substance use problem, there are several resources available to find out more information or get connected with help.

National Association of Mental Illness (NAMI) National Help Line Resource Directory- The NAMI Help Line is an online directory for anyone interested in finding resources for depression and other behavioral health illnesses.  The Help Line can be accessed via telephone at 800-950-NAMI (800-950-6264) or text “NAMI.

National Suicide Prevention Lifeline

The National Suicide Prevention Lifeline provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week, across the United States.  The Lifeline is comprised of a national network of over 200 local crisis centers, combining custom local care and resources with national standards and best practices.

Call 1-800-273-8255 or Lifeline chat 

As of July 16, 2022, call 488

Financial Resources

AVMA Managing Personal Finances Resources

Find money management resources, including the AVMA personal financial planning tool.

VIN Foundation Student Debt Center for Veterinary School Students.

The VIN Foundation Student Debt Center is a mobile-friendly comprehensive resource helping pre-veterinary students, veterinary students, veterinarians, and those who support them reduce their costs as well as manage student debt through school and beyond.

Financial Planning: National Association of Personal Financial Advisors. 

The National Association of Personal Financial Advisors (NAPFA) is the country’s leading professional association of Fee-Only financial advisors—highly trained professionals who are committed to working in the best interests of those they serve. 

Pro Bono Financial Counseling: NAPFA Foundation

The NAPFA Consumer Education Foundation (NCEF) was formed in 2005 by NAPFA members as a 501(c)(3) non-profit organization with the purpose to serve consumers and advisors by supporting and advocating education in matters of personal finance.  Their mission is to empower consumers to achieve positive financial outcomes by supporting fee-only financial advisors in providing objective financial guidance on a pro-bono basis.

National Foundation for Credit Counseling 

The National Foundation for Credit Counseling (NFCC) is the oldest nonprofit dedicated to improving people’s financial wellbeing.  With 1,215 NFCC Certified Credit Counselors serving 50 states and all U.S. territories, our NFCC Certified Credit Counselors are financial advocates, empowering millions of consumers to take charge of their finances through one-on-one financial reviews that address credit card debt, student loans, housing decisions, and overall money management.

Conclusion

We have discussed problems within the veterinary profession that interfere with wellbeing.  Since the COVID-19 pandemic workplace burnout and stress has only increased and affected every aspect of veterinary medicine.  We presented some startling statistics from the Merck Animal Health study in 2022, but we’ve also presented interventions that veterinary organizations, veterinarians, and staff can implement as a way to increase one’s wellbeing both in the workplace and outside of work.  Resources specific to veterinarians as well as general resources for mental health and financial planning were also discussed.

References

[1] National Academies of Sciences, Engineering, and Medicine 2019.  Taking Action Against Clinician Burnout: A Systems Approach to Professional Wellbeing.  Washington, DC: The National Academies Press.  https://doi.org/10.17226/25521.

[2] Jakab Z.  Designing the road to better health and wellbeing in Europe.  Presentation at the 14th European Health Forum Gastein.  Bad Hofgastein, Austria.  October 7, 2011.  https://www.euro.who.int/__data/assets/pdf_file/0003/152184/RD_Dastein_speech_wellbeing_07Oct.pdf.   Accessed September 7, 2022.

[3] U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.  Wellbeing concepts.  October 31, 2018.  https://www.cdc.gov/hrqol/wellbeing.htm.  Accessed September 7, 2022.

[4] Howell RT, Kern MK, Lyubomirsky S.  Health benefits: Meta-analytically determining the impact of wellbeing on objective health outcomes.  Health Psychology Review.  2017;1(1):83-136.  DOI: 10.1080/17437190701492486.

[5] Carolan S, Harris PR, Cavanagh K.  Improving employee wellbeing and effectiveness: Systematic review and meta-analysis of web-based psychological interventions delivered in the workplace.  Journal of Medical Internet Research.  2017;19(7).  DOI: 10.2196/jmir.7583.

[6] Merck Animal Health.  Veterinary mental health and wellbeing and how to improve them: Learnings from the Merck Animal Health veterinarian wellbeing study III.  https://www.merck-animal-health-usa.com/wp-content/uploads/sites/54/2022/02/2021-PSV-Veterinary-Wellbeing-Presentation_V2.pdf.  Published 2022.   Accessed September 8, 2022.

[7] Volk JO, Schimmack US, Strand EB, et al.  Executive summary of the Merck animal health veterinary wellbeing study III and veterinary support staff study.  JAVMA.  2022;256(11): 1237-1244.  https://www.doi.org/10.2460/javma.22.03.0134.

[8] Nielson K, Nielson MB, Ogbonnaya C, Känsälä M, Saari E, Isaksson K.  Workplace resources to improve both employee wellbeing and performance: A systematic review and meta-analysis.  Work & Stress.  2017;31(2):101-120.  http://dx.doi.org/10.1080/02678373.2017.1304463.