Burnout is a common occurrence within veterinarians. Developing awareness and self care habits are essential to having a successful practice.

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.

11 suggestions for self care

1. Natural remedies: Homeopathy, flower essences, aromatherapy, Reiki, massage and medicinal herbs can all help relieve stress and achieve balance. In most cases, it’s best to involve a practitioner with training and experience in treating humans.
2. Improve your working environment: Take a look at where you spend your days working as a veterinarian. Since you spend so much time there, do everything you can to make it healthy and supportive. Improvements can be made with music, light, color, aromatherapy and Feng Shui. You may find it helpful to have a variety of plants and photos throughout the workspace. Plants bring an element of the earth and outdoors, while photographs can bring back happy memories and reinforce positive energy. Save and post pictures of special patients, clients and fellow veterinary professionals who have made a difference in your life. When you’re in the middle of a busy or trying day, and you catch a glance of a special memory, use that as a spark of positive energy to lift your spirits.
3. Save the good, and take out the trash: Save all thank you cards and keep a simple journal of your clinical successes and special patients. If you receive a negative comment, consider what you may have done differently, make changes if needed, then discard the burden of the negativity. When you go to bed at night, and your mind begins to churn with a negative event that trashed your day, visualize that event as a pile of waste that you take to the dumpster and walk away from. Then recall all the successes, smiles and positive interactions you have enjoyed in your work.
4. Make a simple ritual out of the start and end of your workday:This way, your days can be compartmentalized and not spill over into every second of your personal life. In the mornings, take a few moments to sit quietly and visualize a positive day. Even a simple statement as you walk in the clinic door – “this will be a good day” – can influence the outcome. During your day, if you encounter a difficult client, or have to perform euthanasia, take a moment afterward to clear that negative or painful energy before going to the next task. This can be done very simply by stopping to wash your hands and visualizing the experience being rinsed away from your psyche. At the end of each workday, visualize a closure. Say to yourself: “I’ve done a great job, I’ve done what I can for one day, and now I am returning to my personal life.” Wash your hands one more time, remove your scrubs or change your clothes, and as you walk out the door, visualize yourself closing a book and putting it away on a shelf for another day.
5. Let go of high expectations: Veterinarians tend to be over achievers as well as competitive and perfectionist. While it is important to strive to do well, no one is perfect, and try as we might, there will always be cases that will remain unresolved or have a bad outcome. It is crucial you recognize that you are tackling great challenges on a daily basis. Acknowledge all your successes, and realize that not all cases will have a successful outcome. Your current job may not be the job of your dreams, but make it the best it can be, and work towards realizing your dreams. If you find you are truly in a toxic or demoralizing position, you need to make changes.
6. Seek support and guidance from old friends and peers: Veterinarians are a unique group of professionals. Sometimes the best support and guidance will come from an old friend or colleague. Open yourself to meeting and sharing with other veterinarians. Often, the best learning experience you can have at a conference comes from conversing with others, before or after seminars.
7. Take time to stop and smell the roses: Adopting this as your mantra can become a gift to yourself and an invaluable self care tool. Along the road to or from work, when you see a lovely flower, a beautiful scene or an animal – stop for a moment and give yourself a spiritual tune-up by simply taking in the beauty that nature has provided. Recognize and give thanks for the simple pleasures that pop up all around you in the course of a day.
8. Eat well: Brain chemistry is greatly affected by the foods we eat. Often when people are undergoing stress, their dietary habits change, and this may become a factor in a continuing downward spiral for their mental health. Hypoglycemia can quickly lead to changes in mental function, including symptoms of depression, anxiety, fatigue, mental confusion and irritability. Stress can lead to either anorexic hypoglycemia, or to increased consumption of highly refined carbohydrates, which then produces reactive hypoglycemia. Alcohol consumption can also lead to hypoglycemia. Increased levels of sugar, caffeine and alcohol have all been linked to increased risk of depression. A nourishing diet, including a variety of fresh vegetables, whole grains, high quality proteins and essential fatty acids is crucial. Depressed patients are often found to have low levels of some or all of the following nutrients: folic acid, vitamin B12, selenium, SAMe, zinc, omega 3 fatty acids, and especially vitamin D. Supplementation with these nutrients has been shown to be beneficial in the treatment of depression.
9. Exercise: Countless studies have demonstrated the mood elevating effects of exercise in the treatment and prevention of depression and substance abuse. People who exercise regularly have improved self esteem, reduced physical pain complaints and greater happiness compared to those who do not. Regular exercise can be inexpensive, and easily accessible. The biggest hurdle is that it takes effort, and when people are stressed and feeling down, the last thing they feel like is making an effort. In order to become motivated, you might want to enlist the support of a friend, join a gym, sign up for a class, or simply commit to walking your dog more. If you must, force yourself to get started. If you find yourself unable to initiate exercise in any way, you may need a professional’s help because this is a sign of clinical depression. Yoga, Qigong and Tai chi are especially helpful as they combine physical exercise with a relaxed and contemplative state.
10. Life coaching: This can be an excellent way to prevent burnout and stress. While coaching is not psychotherapy, it can relieve mild emotional distress by helping you take action to improve your personal and professional life, which in turn helps you feel better.
11. Spiritual, energetic and hands on treatments: One of the greatest ways to relieve stress and heal ourselves is through increasing our own level of self understanding and spirituality. Taking the time to introduce gratitude, hope and forgiveness into our daily thinking process can make great positive change in our lives. There are also numerous energetic or spiritual treatments and lifestyle choices that have positive effects on mental health and well being. Examples include organized religion, Ho’oponopono, Tai chi, Qigong, meditation and Reiki. Whether you choose to follow one or a variety of practices, the important thing is to make an effort to nourish your spirit.

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.

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.

⁷ Elkins AD, Kearney M (1992). “Professional burnout among female veterinarians in the United States”. J Am Vet Med Assoc 200:604–608.

⁸ AVMA online news post: www.avma.org/onlnews/javma/jun04/040601z.as.