Work-related stress is a huge contributor to cynicism, exhaustion, and feeling ineffective…and if you didn’t know this already, these are classic signs of burnout.  Stress in the workplace has also been associated with depression and suicide among men and women, which makes recognizing stressors in veterinary practice imperative in the task to improve veterinarian mental health and wellbeing.

A survey conducted in 2015 in conjunction with the Center for Disease Control sought to evaluate practice-related stressors among more than 11,000 veterinarians practicing in the United States.  Participants were provided with a list of practice-related stressors, as well as an option to write others that were not listed.  The 14 practice-related stressors included in the survey were: demands of practice; practice management responsibilities; professional mistakes; clients complaints; dealing with personal, staff, or client grief; expectations from clients to be an expert in all veterinary subject areas; animal deaths; competition with other practices; ethical dilemmas; fear of malpractice litigation; student loan debt; lack of social support; unclear management / work role; and an inability to participate in decisions.  The first in this list (demands of practice) was by far the most prevalent practice-related stressor selected (by more than 60% of veterinarians) and the remainder are listed in descending order from most to least cited by those surveyed.

However, more than 1,500 participants reported that at least one of their practice-related stressors was not included in the list and they subsequently shared their own response.  A recent study analyzed these written responses and published the results in a report outlining a comprehensive list of veterinary practice-related stressors cited by veterinarians currently working in the profession.  While the results of this analysis might seem like just another exhaustive list of what’s wrong with veterinary practice, the hope is that this list will serve as standardized nomenclature so that we can better understand the relationship between practice-related stressors and symptoms of depression, suicidal tendencies, and psychological distress among veterinarians with future studies.

The authors included 15 categories of veterinary practice-related stressors, as well as subcategories and illustrative quotations from participants that were used to provide specific examples. I am certain that when you read these categories and subcategories you will have no trouble coming up with your own specific examples.  They are listed in order from most to least frequent category (subcategory) here:

1. Financial insecurity (low income, cost of maintaining practice, low return on investment, debt, job outlook, retirement)
2. Clients (unwilling or unable to pay, unrealistic expectations for treatment, lack of compliance or responsibility for pet, expectations of availability)
3. Co-worker or interpersonal issues (lack of support, work environment, abusive or bullying coworkers, unethical practices)
4. Work-life balance (being on call)
5. Management issues (lack of support or guidance, abusive or bullying management)
6. Job pressure (too many responsibilities, fear of mistakes or failure, surgery, complexity)
7. Private or public sector (government or state board policies, competition, ethics, access to drugs)
8. Training or staffing (low-skilled staff or lack of training, understaffing)
9. Feelings of inadequacy (knowing how to help but can’t, underappreciated or lack of respect, not knowing how to help, gender bias)
10. Personal issues (family, illness, boredom or lack of job fit)
11. Future of the profession (shift of focus to profit, technology or method of advancement)
12. Stress from animals (compassion fatigue or grief, suffering or owner mistreatment)
13. Negative public perception (social media and internet)
14. High personal expectations
15. Academia

When I look at this list and reflect on my experiences working in private referral and academic practice as an emergency and critical care specialist, I can think of stressful moments that fall within each one of these categories.  Low income (in comparison to human health providers); clients who treat veterinarians in ways they would never dream of treating their physician; working in a toxic environment; spending evenings and weekends on call; feeling unappreciated by administration or management; jumping through hoops to become licensed in different jurisdictions; working with poorly trained support staff; feeling unqualified to provide mental health support; feeling like I do not fit in with the team; worrying about the future of emergency medicine and how hospitals will retain sufficient staff; struggling with cases that require more advanced care that the owners cannot afford; feeling misunderstood by the public (i.e., veterinarians only care about money); believing I must remain up-to-date on all things emergency / critical care; and worrying about meeting benchmarks needed for promotion and tenure.

Veterinarians are not unique in that they have work-related stressors; however, their work-related stressors are unique in that they do not exist in other professions.  Recognizing and naming these stressors is important in taking the next step, which is to determine how these stressors specifically contribute to the mental health and psychological well-being of veterinary team members.