A survey on workload and wellbeing

Veterinary mental health and wellbeing

In recent years the mental health and wellbeing of veterinary practitioners has become a hot topic worldwide. Several papers have reported that those in the sector are at a greater risk of burnout (Box 1), depression, and even suicide when compared to other occupational groups 1. In a recent study 35% of full-time veterinarians in the USA were classified as having low compassion satisfaction*, 50% as having high burnout scores, and 59% as having high secondary traumatic stress scores** 2. These numbers alone would seem to be enough to justify the need for actions that will improve wellbeing within the veterinary sector, and although various initiatives have been set up over the last few years to address these concerns, a great deal more remains to be done. This article considers the results of a survey undertaken at two recent congresses, where veterinarians were asked their opinion on the importance of wellbeing, difficulties with recruitment, and their experience with interventions taken to tackle job demands.

*Compassion satisfaction may be defined as the pleasure or positive feelings derived from the ability to assist others.
**Secondary traumatic stress may be defined as the stress resulting from an indirect experience of a traumatic event, i.e., something that was experienced by someone else.

Box 1. What is veterinary burnout?

The job demands-resources model

Given that burnout is an occupational phenomenon, managing stress in the working environment is all about balance: occupational wellbeing encompasses both positive and negative factors. This is explained in the Job Demands-Resources (JD-R) model, which we used as the theoretical framework for this study 8 (Figure 1). The model regards work-related stress and wellbeing as the result of interactions between job demands and job resources. Demands are “physical, social, or organizational aspects of the job that require sustained physical or mental effort and are therefore associated with psycho-physiological costs” 8. This includes, but is not limited to, workload and shift work, work-home interference and environmental stressors. Resources can be defined as “physical, social, or organizational aspects of the job that can be functional in achieving work goals, reduce job demands or stimulate personal growth and development” 8. These can include rewards, personal control over allocated tasks, and positive feedback and support. According to the JD-R model, job demands can evoke an energy depletion process, potentially leading to exhaustion and eventually burnout, whereas job resources can induce a motivational process, which can promote work engagement 9. A lack of resources complicates the ability of an individual to fulfill their job demands, which may lead to disengagement from work, and also plays a role in the development of burnout.

Methodology and data demographics

To gather information on recruitment and wellbeing, Royal Canin devised a survey consisting of seven questions (Table 1). The survey was split into two sections, recruitment and wellbeing. If respondents said that they did not face difficulties in recruiting (Q.1), the first section was concluded at this point; similarly, if respondents thought that wellbeing at work was not important (Q.5) the second section was terminated at this stage. The survey was conducted at the 2022 European Congress of Veterinary Internal Medicine for Companion Animals (ECVIM-CA) in Gothenburg and the 2022 European Veterinary Dermatology Congress (EVDC) in Porto (Figure 2). Royal Canin exclusively chose veterinary students to conduct the survey, as they have an affinity for the subject and empathy with the respondents. In addition, it was decided to have multiple surveyors (4 at ECVIM, 6 at EVDC) to triangulate the data, and a study leader was appointed to oversee data collection and to optimize the consistency and credibility of the surveys at both congresses. Pre-survey discussion between the study leader and the surveyors was undertaken to create a shared understanding of the project and to minimize inter-surveyor differences.

All surveys were then collected and used by the study leader to create a database. Analysis showed the main outcomes to be difficulties in the recruitment of staff for veterinary clinics, the importance of wellbeing, actions taken for wellbeing, and levels of burnout in the workplace. These data were both quantitative and qualitative, with the qualitative data classified following the JD-R model. The “signalment” of the respondents included their workplace (private practice/corporate practice/university/other), country of employment, and gender. The outcomes were analyzed by comparing groups using either a Chi-Square or Fisher’s exact test of independence, where appropriate. Any analyses were carried out using SPSS software, with two-sided p-value < 0.05 denoting statistical significance.

Congress participants (all qualified veterinarians) were surveyed at random, resulting in 222 respondents (89 at ECVIM and 133 at EVDC) from 33 different countries. In total, 187 (85%) respondents live and work in Europe, 11 in South America, 9 in North America, 8 in Oceania, 4 in Asia, and 1 in Africa; there were 2 responses where the country of work was not available (NA). The surveyed group consisted of 66 men (32%) and 143 women (68%) (13 NA). 114 (55%) worked at independently owned clinics, 50 (24%) at corporate owned clinics, 38 (18%) at university clinics, and 6 (3%) labeled their workplace as “other” (14 NA). Note that only one person from each workplace was surveyed.

Survey results

Wellbeing in the veterinary workplace

Most vets think of their (and their colleagues’) wellbeing as important: of the 213 who answered, 94% gave a positive response. Since there were so few negative answers, it was impossible to analyze this cohort for significant differences in gender, workplace or country.

80% of all workplaces had implemented actions to improve the wellbeing of their employed veterinarians and/or nurses/technicians. With the idea that occupational wellbeing is a result of the balance between job demands and job resources (Figure 1), we decided to categorize the various actions. Measures that address job demands are those that have a positive effect on the work-home interference, workload or shift work, and include flexible shifts, free days or a 4-day working week. Measures that positively add to job resources are rewards or stimulants for personal growth or professional development. Of the 164 workplaces where wellbeing steps were being taken, 26 workplaces acted on job demands, 109 acted on job resources, and at 29 places there were actions that influenced both job demands and job resources (Figure 3).

Following the definitions of job resources (as described previously), we defined three subcategories. We found that 39 actions were primarily physical, acting on tangible matters, 59 actions were social events (Figure 4), and 91 were organizational, targeting the functioning or development of the employee in the workplace (Figure 5). Table 2 gives examples of the resources that were mentioned and how they were categorized.

Table 2. Examples of job resources.

Relatively few clinics (private or corporate) were said not to take any actions to promote wellbeing (respectively 16% and 15%), whereas at university establishments this figure rose to 35%. We also found that actions that influence both job demands and job resources (instead of only one of them) were taken mainly by private clinics. The difference in actions for wellbeing between workplaces was significant, considering Fisher’s exact test of independence (p = 0.042), meaning that in private clinics significantly more actions were taken than in other types of workplaces.

Burnout

70% of all respondents indicated that there had been at least one burnout at their workplace in the last 12 months (either themselves or a fellow veterinarian/nurse/student residents) (Table 3). Of these, 54% were veterinarians, 12% nurses, 32% involved both veterinarians and nurses, and 2% were students. There were less respondents reporting burnout among veterinarians that own or work in a private clinic (61%) than those in corporate clinics (80%) or at a university (83%). This difference is significant with the Pearson Chi-Square test (p = 0.009). There was, however, no significant difference in reported burnout between respondents working in practices that did or did not take action for the wellbeing of their employees, 68% and 73%, respectively.

Table 3. Burnout is significantly higher in corporate practices and university vs. independent clinics (p = 0.009 between * and **).

20 respondents gave no answer to this.

Difficulties in recruitment

When it came to recruiting new employees within the past year, we had 183 responses (Figure 6); others who were surveyed said they were not hiring, or did not know anything about the recruitment process, and thus were not taken into account for this section. Of the 183 people that did answer, 97 (53%) of veterinarians said they (or their workplace) had experienced a lot of difficulty in recruiting, and 55 (30%) a little, with 31 (17%) respondents reporting that they had not experienced much or any difficulty. In general, difficulties had been experienced in recruiting both veterinary surgeons and nurses; where only one category was identified as being problematic, it was that veterinary surgeons were more difficult to recruit.

People also stated that difficulties in recruitment had affected the choice of a new employee. 195 respondents worked in an establishment where a new veterinarian had been employed; of these, 41% said that subsequently the appointment was not a good fit, but that there had been no other options and the individual had been hired out of availability rather than waiting longer. The situation for nurse vacancies is similar: 45% of the 199 respondents who had contracted a new nurse did not subsequently think the person employed was a good fit.

Various reasons for the recruitment difficulties were reported, with some respondents offering more than one reason. The most frequently cited (96) was the general dearth in available veterinarians and nurses. Other important reasons were low pay (52) and the workload/arduous shifts (46). Less frequently mentioned were a rural location of the clinic (14), COVID (7), and other reasons.

Discussion

We found that most veterinarians are aware of the importance of their wellbeing, and that the majority of workplaces are taking steps to improve the wellbeing of their staff. Nevertheless, the burnout rate is still high, especially among veterinarians. Whilst the lowest frequency of burnout was in the private sector, 60.9% of these practices had still seen at least one case recently. This was significantly lower than the number of burnouts in corporate (80%) and university practices (83%), a finding in line with a previous study in Finland, which noted that veterinarians in private practice are least affected by burnout 10. (Interestingly, a 2021 AVMA survey found that burnout is more prevalent among associates in private practice compared to the practice owners 11, but our survey did not differentiate between employees and owners of private practices.) One reason for the lower prevalence of burnout in private practice could be that they are better at taking pro-active preventative measures, as we found that significantly more wellbeing actions were taken in this sector than in corporate or university practices, and that the actions being taken address both job demands and job resources rather than being focused on just one of these. However, it should be noted that the survey did not attempt to gather details of the workplaces, e.g., in terms of size/number of employees, so we are unable to say if there may be other factors involved here.

Together, job demands and resources determine occupational wellbeing, as displayed in the JD-R model. Although the difference in reporting burnout in practices where actions were taken (68%) compared to practices with no action (73%) was not significant in our study, a recent large Australian study reported that job resources are inversely correlated with burnout, and that some job demands are positively correlated with burnout 7. Actions that address both job demands and resources may be more effective, as evidence has shown that combined interventions are the most useful in tackling burnout 12. It is unclear why non-corporate practices have taken more actions than other workplaces; one could speculate that owner-veterinarians who are also employers will be more in touch with their employees and are therefore more aware of the need to be mindful of their wellbeing.

Furthermore, we found that many veterinary establishments are having difficulties recruiting new colleagues; almost half of the respondents had experienced considerable problems. Since a “veterinary shortage” was frequently cited as the cause (96 times), we investigated whether there is evidence for this and how big the problem is. A shortage in the veterinary workforce would mean that there is a lack of practitioners (supply) in relation to animals needing care (demand) in an area; this may arise from either a shrinking number of available veterinarians or an increasing demand for pet healthcare, or both. Data certainly point to an increase in demand; Europe has seen an overall increase in the number of companion animals (and a stable livestock population) between 2010 and 2017 13. In addition, figures show that the average number of clinic appointments at veterinary practices in the USA increased 6.5% from 2020 to 2021 14. From the supply side of things, the ratio of veterinarians per head of population has not changed between 2015 and 2018, with an average of 0.38 veterinarians per 1,000 people 15. However, it is possible there is a decrease in availability, not in the total number of veterinarians but in the number of hours worked, as well as the productivity per person. In our study, nine veterinarians identified that part-time (rather than full time) working is an important reason for the shortage, and a 2021 survey among veterinary professionals worldwide revealed that one in four respondents reported a desire to reduce their hours through part-time or locum work 16, whilst another AVMA survey found that 30% of companion animal veterinarians said they wanted to work fewer hours, compared with 23-24% in 2017-19 14. Moreover, veterinarians in the USA saw fewer patients per hour, and average productivity declined by almost 25%, when 2020 figures were compared with 2019 14. Overall, it can be argued that there is a veterinary workforce crisis, at least in some areas. The Federation of Veterinarians of Europe (FVE) found that 78.5% of respondents in a 2020 survey experienced a shortage of veterinarians in all 28 European countries surveyed 15, which is in line with our findings. The FVE states that this shortage is a problem specifically in rural and remote areas, and that it is not linked to an overall nationwide shortage, although in our study a rural clinic location was reported as one of the lesser reasons for recruitment difficulties. Data from VetsSurvey also identifies the recruitment of suitable staff as one of the biggest challenges that the profession currently faces, and considers this to be one cause in the increased numbers of unhappy employees in the sector 16.

The question is then whether the shortage is a cause of the perceived decline in job satisfaction levels and the rise in burnout 16, or the result. We believe it works both ways, and that they affect each other in a downward spiral. The shortage definitely plays a role in the wellbeing of veterinary staff, since the remaining practitioners often need to work more hours to comply with the high demand from animal owners. A German study showed that the number of hours worked was proportional to the stress felt by veterinarians 17. In addition, the fact that practices will often employ veterinarians and nurses that are not suitable for the job must be significant. Our results show that in 41% of cases a recently employed veterinarian was not a really good fit (according to the other employees), which is detrimental, as a close-knit team is one of the most important factors in occupational wellbeing (Figure 7). On the other hand, burnouts tend to lead to retention problems; 40% of veterinarians are considering leaving the profession, with the top two reasons cited being work-life balance and mental health challenges 14,17. Burnout is a significant predictor both for someone’s intention to leave their current role, and for abandoning the profession altogether 7. This is linked with the high turnover rate in veterinary medicine, especially when compared with other healthcare professions. The average turnover for veterinarians is twice as high as it is for physicians in medical practice – i.e., a physician will on average stay in a post for twice the time a veterinarian remains in a post 5,15. Thus, the vicious circle continues; a greater workforce shortage due to burnouts, and more burnouts due to increased workload.

It is important to emphasize that the survey was quite basic and did not seek to explore all the factors involved in wellbeing and job retention for the veterinary workplace. It also focused on specialists and residents at two congresses, so the fields of dermatology and internal medicine may not be a representative sample of “work wellbeing” throughout the entire veterinary profession, but it offers a snapshot of the current situation. However, it should be noted that we had recognized that practitioners suffering from burnout were unlikely to attend congress (or may not wish to admit to previous burnouts), hence we asked about occurrences within the practice in order to de-personalize things, which could explain the high rate of burnout (70%) we found in comparison with other studies. Future surveys could look at other areas within the veterinary sector to ascertain if the same patterns emerge, and attempt to identify the average age of someone when they suffer burnout. Furthermore, given that specialists in corporate practices and universities appear to be more likely to experience burnout, it would be useful to investigate potential confounding factors (such as age, gender, clinic size, and working hours) in any subsequent survey.

Conclusion

According to this survey, veterinary clinic staff are at high risk of burnout, an occupational phenomenon associated with multiple adverse consequences, with the highest rates seen in corporate practice and university. Together with a shortage in veterinarians, creating difficulties in recruitment, this forms a threat for the profession. In the fight against burnout, there is awareness for the importance of occupational wellbeing, and many workplaces now have actions in place to improve employee wellbeing. However, evaluations of these initiatives are scarce, and it was beyond the scope of the survey to determine which resources might be the most effective. To further improve occupational wellbeing, robust analysis of possible interventions is urgently needed, and the JD-R model could be a useful tool to facilitate the development and evaluation of various resources.