It happened around 2010. I had been in practice for about 16 years when it hit me. The experience is complicated because you don’t know what’s happening until after the fact. However, when I see pictures of myself from back then, I look exhausted and beaten down. My burnout seeped out in behavioral symptoms like:
- Crankiness.
- Shortness with staff.
- Thinking that most pet owners are stupid.
- Drained at the end of the day.
- Judgmental of everyone.
- Happy only when out of the clinic.
How could I have gotten to that stage in a career I loved and wanted since I was a 6-year-old kid? Here are six solutions that would have kept me in the saddle and saved me.
1. Close the Clinic on Weekends
Opening veterinary hospitals on Saturday, and eventually Sunday, became popular in the early 2000s. Many clinics offered Saturday morning hours at least to help working-class clients find time to bring in their pets outside of the Monday through Friday, 8 a.m. to 5 p.m. schedule. The first extra day drove revenue, so we thought, “Let’s open this baby up and boost the bottom line even more” by going to seven days.
Well, we screwed up. The problem was that we needed doctors (and staff) to run those hours, so we started making it normal for veterinary teams to work on weekends. We sacrificed a mental health break and precious family time (soccer games and Sunday morning pancakes with the kids) to pursue money. However, I have discovered that pet owners will figure out ways to visit during the week, whether for a drop-off exam or ER visit, so all we did was dilute the weekday revenue.
If closing on weekends seems too big of a jump for your practice, consider embracing telemedicine. Adding it to your arsenal is ideal because you can give advice via texting on the weekends and keep your sanity.
2. Build Charting Time Into the Schedule
For every exam that comes in the door, the doctor needs to SOAP it. Each case will take about five minutes for a seasoned doctor to write up. (I’m being conservative.) That means a doctor who sees 15 patients a day needs at least
75 minutes to write up the cases. I’ve never heard of a practice building time into the schedule for it, which is why most veterinarians work straight through lunch and stay well after closing hours to complete this critical responsibility. And let’s pray the case isn’t so complicated that you need to research or phone a consultant. There’s definitely no time for that.
Many practices try to run 20-minute appointments consecutively. If a break occurs, they squeeze in urgent cases. If you think about it, the math in those situations never works out as far as supporting a work-life balance for any veterinarian. The doctors always feel behind and rushed, day after day, which contributes to chronic stress.
The solution: Build one full hour (minimum) into the schedule for charting and researching. It’s different from a lunch break. Give your veterinarians the time to do their job. If, by some chance, they don’t need the whole hour, using it to phone clients or chat with the team, building meaningful relationships, will be time well spent.
3. Make Time for Urgent-Care Cases
Building an appointment schedule is one of the most challenging jobs in veterinary practice because any given day has so many variables. The biggest is how many pets will wake up sick or in pain that morning, requiring same-day care. Most practices deal with it by setting aside same-day urgent-care slots, but once you fill them, then what? Another popular solution is the drop-off appointment. But the work can quickly become insurmountable unless you limit the number.
Here are a couple of ideas to consider if you experience an overload of urgent-care cases:
- Add more slots: You should have just enough urgent-care slots to end up nearly full most days. If you fill five daily slots within 30 minutes of opening, you don’t have enough. Each clinic will differ, but you should strive to be “just right.” You might discover over time that your clinic’s focus needs to pivot from wellness care to urgent care. We must never forget that our responsibility is to help the sick and hurt first, with wellness care coming in second. Therefore, do what you need to make time for the ill and injured.
- Dedicate part of the day to walk-ins: If you’re getting overwhelmed with same-day urgent care, consider turning one to two hours a day into walk-in-only time. Maybe it’s 1 to 3 p.m. or 8 to 9 a.m. Then, you have a first-come, first-served model in which unscheduled pets wait to be seen. By controlling the uncontrollable, you set yourself up for success.
- Block the first appointment of the day: I can’t begin to tell you how often I arrived at work to find unscheduled clients waiting in the parking lot for our practice to open. You might find it helpful to leave the first morning appointment open. If no one is waiting, consider it a glorious time to start your day by having a cup of coffee, checking your messages and reviewing what’s on deck (like the average person).
4. Get Rid of 10- to 12-Hour Shifts
Many practices schedule their doctors and support teams to work four 10-hour shifts a week. That strategy seems appealing because each person gets three days off. However, 10 hours at a veterinary practice (which often turns into 12) is different from 10 hours at pretty much any other non-medical job. As veterinarians, we live at the intersection of heart and commerce, which means we handle highly charged situations for a big part of our day. Such as:
- Dealing with people who can’t afford veterinary care.
- Euthanizing pets.
- Wading in the owners’ grief.
- Trying to care for our struggling colleagues.
Ten hours on the front lines is too much for any average human. I’m not sure what the appropriate length is, but my experience leads me to think we should limit shifts to six hours on the front lines and two hours for surgery, client interactions and charting. Does that scenario mean you will work five days a week? Yes, but you will get home in time for dinner and not fall asleep on the couch during every movie you try to watch with your family.
5. Provide Mandatory Counseling
I wish someone had me get counseling. Of course, I knew I had the option, but counseling has so much stigma associated with it. I was in denial about where I was in my burnout journey, so talking to a professional was a hard “no.” Also, I didn’t know who would understand my job since it was so different from most everyone else’s. But think about police departments. They likely have mandatory counseling for employees involved in a shooting or other traumatic events. Why shouldn’t we have the same? We deal with a lot of trauma every day, from sweet little animals being in pain to humans expelling their fears on us. It’s not a surprise that we need help. Counseling should be required because:
- Most people don’t realize they need it.
- Its acceptance would take away the stigma of appearing weak.
6. Stop Production-Based Pay
One of the worst mistakes the veterinary community has made is production-based pay. When we talk to the generation of veterinarians from the ’70s and ’80s, they didn’t have the same burnout rates and mental health issues that we experience now. I would argue that they euthanized more animals and that clients have always struggled to pay their veterinary bills. So, what changed?
In the late ’90s, a movement started to move veterinarians from salaried to paying them based on their production. When I got my first job in 1996, I was on salary ($32,000 a year!), but our practice moved to a production model in 1998. We were owned by one of the first corporate groups, National PetCare Centers (later acquired by VCA). The thinking was:
- The business could control EBITDA (earnings before interest, taxes, depreciation and amortization) by making the doctor cost proportional to the revenue.
- The business wouldn’t get too far over its skis when revenue declined.
By controlling the percentage of pay to doctors, production-pay clinics thought they would always be in tandem with revenue. There was also a feeling that veterinarians would be incentivized to perform their best medicine. Therein lies the biggest problem in our profession. What the executives didn’t understand was that money doesn’t drive veterinarians. If it did, we would have entered human medicine. The problem is veterinarians desperately need money because of their giant student debt loads. This is where things go off the rails. Let me explain it this way:
One night, I got an emergency call from a lady whose German shepherd was “trying to vomit,” but nothing was coming out, and his stomach seemed distended — the classic gastric dilatation-volvulus. One part of my brain thought, “Oh, no, this poor dog is in so much pain and is probably going to die.” But the other part of my brain was doing the math. These cases typically go out the door for $5,000, and with my 23% commission, I was going to make over $1,000 that night!
Such dual thinking puts me in moral conflict. I experience guilt because I feel so happy and relieved that I can put a dent in my credit card bill, all at the expense of a suffering little creature I had dedicated my life to helping.
Do you see, dear reader, why that is unhealthy? I can only imagine what the public would say if they knew it’s how many veterinarians are paid. Does production pay lead to excessive recommendations? Probably. But even if we aren’t suggesting every test and treatment, veterinarians are humans, too, and we try to do the right thing.
Production pay is like wearing Gollum’s Ring all day, every day. We fly under the umbrella of “doing what is best for the pet,” but the subconscious guilt is always in direct conflict with our purpose.
The solution: hybrid pay. The doctors get a straight salary, with 75% based on the revenue they generate in the prior year and 25% on their client, patient, team and leadership skills. The strategy is recalibrated for the upcoming year based on performance. Such a reset aligns the incentives for the business and veterinarian.
What About the Revenue?
As you contemplate ways to solve the burnout crisis, you will undoubtedly think sacrificing revenue is impossible. However, we must consider the long-term cost of running the thoroughbred around the track at full speed indefinitely. We’re seeing the mental health effects of pushing too hard on the veterinary community. We must change how our profession operates before we lose more of us to other industries, or worse. And, like my mentor, Dr. Dan Parkinson, always said, “If we do the right thing, the money will come.”
So, what happened to me? Instead of focusing my energy on improving myself and my practice, I started a company called Vet2Pet and left daily clinic life. The move was bittersweet, though.
People ask me all the time if I miss veterinary practice. My answer is, “Some of it.” I miss my little patients mostly. However, leaving saved my life because I didn’t have the tools then to get myself out of the depths of burnout.
READY TO HELP
A Veterinary Hospital Managers Association survey published in August 2023 found that 90% of practices set aside daily appointment time for same-day emergency cases.
LEARN MORE
VetFolio’s continuing education catalog features an array of online courses on personal wellness. Here are a few:
- “Ask: Assess, Support, Know”: bit.ly/3QxpvJB
- “The Mindful Practice”: bit.ly/3tJVqgO
- “Reducing Stigma: Normalizing Mental Health in Veterinary Medicine”: bit.ly/3tZlx3m
- “Nurturing Resilience and Self Compassion in Veterinary Practice”: bit.ly/45JL661
- “Manager’s Toolbox: Staff Training and Self Care”: bit.ly/3qX3RQH