We can all agree with the headline on Discharge Notes columnist Dr. Andy Roark’s article “Personal Wellness Isn’t One-Size-Fits-All.” While there are general themes we can all embrace to increase our well-being, their exact shape and structure is a very individual process. For instance, a recently published study in the Journal of the American Veterinary Medical Association highlighted the importance of work-life balance to mental well-being. For one person, that balance may be a pottery class; for someone else, it may be coaching their kid’s soccer team. Indeed, there is not a one-size-fits-all solution to well-being. However, there is a wealth of data on the framework that we can all use to explore our own well-being. And while we celebrate the progress we have all made, it’s important to recognize that systemic change and intervention are very much needed in our field.
There is much reason for optimism. As Dr. Roark pointed out in his article [go.navc.com/wellness], the 2023 Merck Wellbeing study showed that 55% of our veterinarian colleagues are flourishing. We celebrate their success, but that does not mean our work is done. Dr. Frederic Ouedraogo, an economist and data scientist with the AVMA, published in 2021 that 50.2% of veterinarians have high burnout scores, and 59% have high secondary traumatic stress scores.
Secondary traumatic stress, also called vicarious trauma, mirrors PTSD and is found in people chronically exposed to the traumatic circumstances of others, like medical caregivers and police. When more than half of our colleagues are exhibiting signs akin to PTSD, we need to admit there are systemic issues that need to be addressed. Dr. Roark asked if we should be meeting the “normal hardships of the veterinary profession with mental health language and tools.” We would counter with the question, “Why should we consider these hardships normal?” And if these hardships are inherent to the profession, aren’t we obligated to address them systemically?
Normalizing the Abnormal
Unfortunately, veterinary culture still holds much that is abnormal, even pathologic, as a due course for our profession. During a Not One More Vet committee meeting at the beginning of the pandemic, one of our veterinary volunteers and two mental health professionals struck up a conversation. The veterinarian got COVID-19 because an intern had been forced to work sick, as she had no sick days left. The other veterinary professionals on the call nodded because that is the norm at most veterinary hospitals. However, the mental health professionals, even though they work closely with veterinarians, were shocked and called this out as abnormal, even dangerous. Certainly, this experience proved them correct. A woman who was so sick that she could barely stand was made to come to work, and, as a consequence, not only was she suffering, but she got multiple team members sick, including one with a pre-existing health problem who was then out of work for a month.
Unfortunately, these impacts also show up in the arena of mental health. In another study, 72% of veterinarians said burnout is a normal part of the job.
When someone expects misery, experiencing it hardly seems abnormal or worthy of intervention. Therefore, we must be cautious when labeling the things we face in our profession as “normal hardships,” as these stressors are how we got to these troubling statistics in the first place.
What Research Shows
Acculturation to unhealthy behavior starts early in our careers. In a 2022 study of veterinary students, a prevalent belief emerged that feeling miserable, overworked and overwhelmed was par for the course in veterinary school. Consequently, 61% of the students believed their struggles weren’t severe enough to warrant seeking help. Like the fable of the frog in slowly boiling water, the students became accustomed to suffering and even expected it, ultimately to their detriment. Even when they recognized that they were suffering, feelings of shame prevailed, as the students expressed that they shouldn’t need help and should be able to fix it themselves.
One of the ways we battle stigma is to put structures in place that encourage open communication about a job’s mental health impacts. Understandably, those wellness interventions might feel burdensome if you are not suffering or if you are one of the majority of veterinarians who are already burned out. However, things like team debriefs are repeatedly shown in peer review to have positive effects in abating psychological stressors, and they also improve team effectiveness and performance. For instance, when implemented, reviews of ethical conflicts were found to increase moral competence in a veterinary teaching hospital and teamwork.
As a practice owner, Not One More Vet board member Dr. Carrie Jurney has had a weekly team debrief for years. At the meetings, the team discusses things that could have gone better, frustrations from the week and how the team might solve them together. Recently, a serious medical error occurred when a seizure medication was filled incorrectly, resulting in a severe cluster seizure and euthanasia. The assistant responsible for the mistake was devastated. However, because debriefs were part of the culture, Dr. Jurney’s team members quickly rallied around their co-worker, supported her and problem-solved to prevent another such error.
Both aspects of that meeting, the practical and the emotional, are equally important to a functional team. Currently, 36% of U.S. veterinary teams have meetings where they openly discuss well-being and mental health, so there is significant room for improvement.
Team Debriefs Work
It’s not usual that these interventions are met with hesitation when first introduced. In a human hospital setting, only 13% of employees were comfortable implementing the team debrief. However, after training, the number rose to 81%. Furthermore:
- 68% of respondents had been in situations where they felt the process would be useful.
- 97% recommended it be used in other hospitals.
So, instead of resisting these interventions, we suggest that, as a profession, we educate ourselves and our teams on how to best implement interventions in our practices.
It’s also important to recognize the progress we have made. As well-being and mental health discussions become more commonplace in veterinary practices, we are actively combating stigma and increasing help-seeking behavior. In the past five years, we’ve seen a significant increase in veterinarians both supporting mental health treatment and seeking care for themselves.
Now is not the time to take our foot off the gas. Talking about these things might feel uncomfortable at first, but, in the end, the benefits to ourselves, our co-workers and our profession are worth the momentary discomfort.
LEARN MORE
- “Work-Life Balance Is Essential to Reducing Burnout, Improving Well-Being,” Journal of the American Veterinary Medical Association, bit.ly/3YyCH5e
- “Sociocultural Barriers to Seeking Mental Health Services Among Veterinary Medical Students,” Journal of Veterinary Medical Education, bit.ly/46CjGks
- “Use of a Team Immediate Debrief Tool to Improve Staff Well-Being After Potentially Traumatic Events,” Anaesthesia, bit.ly/3WDjvR9