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Are You Burned Out?

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When we consider the risks of being a veterinarian, most of us think of zoonotic diseases, bite wounds, kicks, and lifting injuries. These are the hazards most veterinarians learn about during veterinary school and in continuing education seminars. Sadly, our profession has traditionally kept quiet about the elephant in the room: veterinary burnout. We are all at risk, and once it sets in, we become highly susceptible to mental and physical health conditions, some of which are life threatening, such as substance abuse, heart disease and suicide.

It is important to understand this job related hazard, not only for our own self care, but so we can recognize symptoms in coworkers and friends. By developing an awareness of these issues, we become compassionate colleagues within the veterinary community, where the health and well being of doctors is supported.

What is burnout?
According to psychologist Christina Maslach¹, who was the first to define the phenomenon of caregiver burnout in the early 1980s, the signs are:
• Emotional exhaustion: a feeling that there is very little, or nothing at all, left to give to clients, family and community. The caregiver becomes more detached from patients and coworkers. There is an overall decline in social contact.
• Depersonalization of others: we develop negative attitudes towards our work, and may fail to truly connect to our patients, clients and coworkers. Hostility and negative feelings may permeate our lives.
• A feeling of reduced personal accomplishment (lowered self esteem): the caregiver develops feelings of inadequacy and a loss of self respect.

A caregiver suffering from burnout will often lose interest in his/her own wellness care. This can lead to poor nutrition, lack of sleep and decreased exercise, which in turn may lead to deeper pathologies in the physical and mental planes. Without recognition and intervention of some sort, many caregivers will develop stress related ailments, substance abuse, anger issues, clinical depression and even suicidal thoughts.

Compassion fatigue

Within the general category of burnout is a subset of stress, known as compassion fatigue. In their book Compassion Fatigue in the Animal-Care Community, Figley and Roop explain that compassion stress is the demand to be compassionate, empathic and effective while trying to be helpful to those who are suffering.2

Compassion fatigue is exhaustion due to compassion stress, which occurs when the caregiver is traumatized by trying to help. The authors conclude that compassion fatigue is a form of post-traumatic stress disorder (PTSD) and that symptoms include re-experiencing the events, avoiding reminders of the events, and physical distress while recalling an event. When we lie in bed at night, replaying in our minds a stressful event that marred our day, we are experiencing compassion fatigue. Ironically, this “fatigue” often keeps us from sleeping well!

Suicide risk is high in veterinary medicine

All persons who work in caregiving professions are susceptible to burnout. However, in a recent review article in the UK’s Veterinary Record, Bertram and Baldwin looked at studies from California, England, Scotland, Norway and Australia, and concluded that veterinarians are four times as likely to die from suicide than the general population — this is approximately two times the rate noted in other health care professions!3

Factors that may influence the rate of suicide among veterinarians include:

• High risk for burnout: Platt’s extensive review of 36 studies on veterinary burnout identified 12 areas of potential occupational stress for veterinarians: long hours, workload, financial issues, client demands/expectations, work-life balance, area of work, euthanasia, lack of professional support, job dissatisfaction, career change (either within the profession or to another profession), general work-related stress, and “other factors”.4

• Access to means of suicide: Veterinarians have easy access to lethal drugs and working knowledge of the means of administration. Suicidal thoughts are more often completed when the patient has easy access to lethal means. • Exposure and attitudes toward euthanasia: Veterinarians face death in the course of their work, as a routine occurrence. During their careers, most are personally responsible for bringing an end to thousands of lives. Veterinarians are more likely than the general public to favor the topic of euthanasia in human medicine. In addition, they tend to consider euthanasia as a treatment option when a patient is facing a terminal disease or has a poor quality of life • High exposure to grief: Veterinarians are working with patients with very short lifespans, so they must experience the passing of thousands of patients during their careers, whether by euthanasia or natural causes. Although the life expectancy is relatively short in companion animals, veterinarians are often left wishing they could have done more, or that they may have failed their patient in some way, when that patient reaches the end of his/her life. This high level of exposure to grief, self doubt and the need to support clients is a major factor in the development of burnout and mental health issues.

• Shifting demographics in veterinary medicine: Veterinary medicine in the US is now a female dominated profession. Research in veterinary mental health issues has repeatedly shown that female veterinarians, especially younger women, are more prone than men to depression, psychological distress, burnout and suicide.5,6,7 One study of female veterinarians in the US reports that two-thirds of the women sampled experienced early signs of burnout, a rate significantly higher than the males studied. It is an unfortunate reality that unless effective outreach and support are put in place, the number of veterinarians suffering from compassion fatigue, depression, substance abuse and suicide will rise as even greater proportions of the population are made up of women.

• Economic stressors: Veterinary students and recent graduates experience a great deal of stress related to student loan debt. In addition, female veterinarians experience pressure from gender discrimination. Recent AVMA survey results indicate that not only is there a disparity in starting salaries between male and female associates, but that it has become worse in recent years.8 In 2006, males started at a 6% higher salary than females, and in 2009 they started at 11% higher salary.

• Lack of a professional support network: Veterinary Practice News (2010) reported that “Veterinary medicine is the only US medical profession that does not have a national monitoring program for substance abuse and mental health issues. Considering that medical professionals in general have a statistically higher incidence of suicide, drug and alcohol abuse, many who are passionate about veterinary wellness are asking why DVMs are excluded.” Support networks have long existed in the medical and legal professions, but in 2004 the AVMA discontinued their wellness committee, turning over the responsibility to individual state VMAs. Less than half of all US state VMAs have wellness committees, and only a handful have easily accessible resources for vets in crisis.

Healer, heal thyself ?

Just as we would never diagnose and treat ourselves for a life threatening zoonotic disease, we need to seek professional help with mental health issues. However, we can and should take the time to know about these occupational hazards, to assess our own risk, monitor symptoms and take preventative measures. If we do recognize symptoms in ourselves, we need to feel comfortable seeking professional evaluation and treatment. This is often the hardest step, because of the stigma of mental health issues.

In addition to conventional counseling and pharmaceuticals, we may wish to consider homeopathy, herbal medicine, acupuncture, chiropractic care and contemplative studies. It is of utmost importance that we seek the assistance of practitioners trained and experienced in treating people with these modalities, and not self-medicate in the face of serious symptoms.

Prevention is the best medicine

Most importantly, we need to be well informed about how to prevent these problems in the first place, and how to keep little issues from becoming more serious. Some simple adjustments to our lifestyles and attention to self care can help immensely to relieve the stresses that may lead to burnout. Many integrative therapies and other activities such as yoga, Tai chi, Qigong, meditation and spirituality can play an important part in the prevention and/or treatment of mental wellness issues (see sidebar).

In conclusion

Wellness for the doctor is as important as wellness for the patient. At times, we are so busy and caught up in our professional and/or personal lives that we may not give ourselves the attention we need to maintain our own health. There are many avenues to explore to nourish your spirit. It matters not so much which road you take, but that you begin the journey. When a person is feeling very depressed or stressed, these suggestions may sound impossible, even repulsive. This is a sure sign you may need professional help. With time and treatment, it is possible for the spirit to recover from its burdens, and rise to a level of well being once again.

1 Maslach, C. Burnout — the Cost of Caring. Englewood Cliffs NJ: Prentice-Hall, 1982. 2 Figley Cr, Roop RG.“Compassion fatigue in the Animal-Care Community”. Humane Society of the US, pp 11, 2006. 3 Bartram DJ, Baldwin MB, The Veterinary Record, 162:36-40, 2008. 4 Platt, Hawton, Simkin and Mellanby.”Suicidal behavior and psychosocial problems in veterinary surgeons: a systematic review”. Soc Psychiat Epidemiolog. Dec 2010. 5 Fairnie HM. “Occupational injury, disease and stress in the veterinary profession”. PhD thesis, Curtin University of Technology, Australia, 2005. 6 Welsch BB. “Gender differences in job stress, burnout and job satisfaction as mediated by coping style of veterinarians in private equine practice”. Dissertation, Univ of Florida States. J Am Vet Med Assoc 200:604–608, 1998. 8 AVMA online news post: www.avma.org/onlnews/javma/jun04/040601z.as.

Dr Liz Hassinger graduated from the Tufts School of Veterinary Medicine in 1989. In 1997, she completed the IVAS course in veterinary acupuncture, and built and opened the Wolf Rock Animal Health Center, an integrative veterinary practice in Exeter, Rhode Island. Since that time, she has also completed training in homeopathy, Western and Chinese herbal medicine, and animal chiropractic. Dr Hassinger has been writing and lecturing on the topic of wellness in veterinary medicine since 2008, and serves on the AHVMA’s Council of Elders. She is currently working on the development of a veterinary wellness website, to provide a resource for American veterinarians, in collaboration with the AHVMA.