Well-being of Shelter Veterinarians and Staff

Created 4/2023
(click here for pdf)

The Association of Shelter Veterinarians believes the positive well-being of shelter veterinarians and staff is essential to the practice of shelter medicine and the improvement of community animal health and well-being. The animal welfare community must recognize and address the factors that influence human well-being and psychological distress in the shelter setting.

Well-being can be improved by targeting three main domains: physical, psychological, and financial. Animal sheltering organizations should support physical and psychological well-being by providing adequate staffing for all shelter operations and operating within their capacity for care. Compensation for shelter veterinarians and staff should be fair and in alignment with other sectors of the veterinary profession. Shelter leadership should support an organizational culture that emphasizes health and well-being and mitigates negative influences at employer, peer, and personal levels.

Backgrounder 

The Association of Shelter Veterinarians believes that employers, peers, and individuals within the animal welfare field should recognize and mitigate the unique occupational hazards that negatively impact the well-being of shelter veterinarians and staff. A multi-level approach (organization, peer, individual) should be used to counteract occupational stressors targeting three main domains: physical, psychological, and financial.

1.   Physical stressors

The intensity of repetitive surgical procedures, a unique risk for HQHVSN veterinarians, is commonly experienced by those working in the shelter or community focused organizations. Without attention to ergonomics, the likelihood of injury related to repetitive motions is increased. One study found that 76.7% of spay-neuter veterinarians were experiencing hand or wrist pain and 98.2% were experiencing body pain (White 2013). Increased weekly hours in surgery and decreased job satisfaction were the work-related factors most closely associated with reported hand pain severity and total pain; the total time spent in surgery, rather than the number of surgeries performed, was the greater predictor of  prevalence and severity of pain. Finally, many veterinarians continue to work despite experiencing moderate to severe pain.

Other stressors that pose physical hazards to shelter veterinarians and staff include working with animals, especially those experiencing fear and distress, which increase the risk of bites, scratches, and falls. Biological and chemical hazards are also important risks to veterinarian and staff health, and are further outlined in the Public Health section of the 2nd edition of the ASV Guidelines.

Physical stress solutions

Employers should set limitations on work hours and physical workload to avoid injuries. To minimize the risk of musculoskeletal pain in veterinarians performing HQHVSN spay-neuter surgery, the number of weekly hours worked in surgery should be tracked and limited. Since total patient numbers did not correlate to musculoskeletal pain, increases in surgical flow efficiency may allow surgeons to complete the same number of procedures in less time and with less pain (White 2013). Optimal scheduling (such as intermixing spays and neuters) helps reduce pain and fatigue and allows for a smoother surgical flow. Clinics should provide anti-fatigue floor mats and stools, select and properly maintain quality surgical instruments and suture needles, ensure optimal surgery table height and patient positioning. Surgeons should consider orthotics and compression wear and use breaks and pauses for stretching, intentional movement, and biological needs.  Training in optimal instrument-handling techniques and in appropriate positioning and use of the hands and body during surgery can increase surgeon comfort and efficiency. Surgeons should be given sufficient time off to recover from physically demanding work and should recognize and promptly pursue diagnostics and treatment for any pain or discomfort.

Solutions for working with animals that pose bite risks and other physical hazards:

• use of behavioral medications and sedation
• humane animal handling (e.g. fear free or low stress techniques)
• proper and well-maintained humane restraint equipment
• facilities equipped with fall mitigation materials esp when floors are wet
• appropriate and functional drainage and ventilation
• sufficient indoor and outdoor lighting

2.   Psychological  stressors

As caregiving professionals, veterinarians are at risk for the occupational hazards of compassion fatigue and burnout (Huggard 2008, Stoewen 2019, WHO 2019). Symptoms of these conditions overlap and can include sleep disorders, feelings of inadequacy and lack of self-worth, sadness, anger and/or irritability. If not addressed, these issues can worsen mental and physical health (Mayo Clinic).

Suicide and poor mental health are significant concerns in the veterinary profession. One in six veterinarians has had suicidal thoughts since graduating from vet school, and veterinarians working in shelter medicine may be at particularly high risk of serious psychological distress, depression, and suicidal ideation (Nett 2015). The main factors associated with psychological distress include long work hours, financial hardship (including student debt), and perfectionism (Tomasi 2019).

The Merck Veterinary Wellbeing studies also found that age was a risk factor for psychological distress, with younger veterinarians reporting lower well-being, indicating they may require increased support.  This may be due to the increased stress related to inexperience on the job (Volk 2020, Volk 2022). 

Neuroticism has been shown to be the strongest personality predictor of low well-being, serious psychological distress, and high levels of burnout. Individuals that score high in neuroticism tend to be worriers and are more vulnerable to stress than those that score lower, and they are more likely to have negative associations with stressful situations. Veterinarians score higher in neuroticism than employed adults in the general population (Volk 2018, Volk 2020, Volk 2022). 

Many veterinarians experience ethical conflict and moral stress within their practice (Moses 2018).  Shelter veterinarians face uniquely severe situations that may serve as a source of moral distress, including issues involving capacity for care, limitations on their practice role, euthanasia and animal cruelty, divisive language and public scrutiny.

Capacity for Care.  The ASV Guidelines state that “operating beyond an organization’s capacity for care is an unacceptable practice” (JSMCAH 2022). When an organization exceeds its capacity for care, the individuals working within the shelter system are unable to ensure good welfare for the animals and as a consequence, may suffer from overwork and/or moral distress. For veterinarians in particular, who have a sworn responsibility to protect animal health and welfare and prevent and relieve animal suffering (AVMA), working in a shelter that is exceeding its capacity for care can result in serious ethical conflicts.

Limitations on practice role:  Many shelter veterinarians value being participants in tasks beyond direct animal care, including training personnel, communicating with stakeholders, supporting field services, providing medical program oversight, and engaging in organizational policy and protocol development. However, in some shelters, the role of veterinarians is narrow and limited to surgical and medical care of individual animals (Laderman-Jones 2016, Kreisler 2013, Steneroden 2011). One survey of shelter veterinarians found those involved in management and decision-making were more likely to be retained in the field (Powell 2021).

Euthanasia and Animal Cruelty: Shelter veterinarians may be heavily involved in euthanasia decisions for animals that might not be euthanized under different circumstances. These decisions may involve significant conflict among various stakeholders, and induce psychological distress, both before and after the fact. Veterinarians and shelter staff may also experience psychological distress when they are performing euthanasia, when they are responsible for euthanasia decisions, or after repeated exposures to animals who have been maltreated through neglect or abuse (Andrukonis 2020, Jacobs 2021, Scotney 2015).

Public scrutiny and divisive language: Sheltering organizations and their staff may be subjected to media and public scrutiny around decisions related to individual animal outcomes or population-level practices. Furthermore, ethical conflict and psychological distress may result from divisive language within the animal welfare movement used to characterize a shelter or its personnel on the basis of a single policy (e.g.,“no kill” and “kill”), practice (e.g., limited admission) or event (e.g., outbreak.) (see Terminology Info Doc).

Lack of Mental Health Treatment for Veterinarians:  According to the 2022 Merck Animal Health Veterinary Wellbeing Study 59% of veterinarians with serious psychological distress knew they needed help but didn’t or couldn’t get it; fewer than one-third of veterinarians reported having access to an Employee Assistance Program. Wellbeing Study authors also suggest that there is a stigma attached to seeking help, though this stigma does seem to be improving over time. This illustrates a large mental health treatment gap for most veterinarians.

Interpersonal conflict: Interpersonal conflicts at work can also be a source of psychological stress and can negatively impact well-being as well as patient safety in veterinary settings.  Moral dilemmas over individual patient care and outcomes are a specific source of conflict that may commonly be encountered in shelter settings. When conflict is handled well, however, it can strengthen interpersonal relationships between colleagues (Strand 2019).

Psychological stress solutions

At the organizational leadership level, employers should take steps to ensure a work environment that promotes job satisfaction by minimizing work stress and facilitating positive work experiences. Organizations should:

• Establish clear work and, when required, on-call hours
• Respect the boundaries of work and non-work hours so that staff have the opportunity to fully recover from work in their off time
• Operate within the shelter’s capacity for care
• Maintain adequate numbers of personnel
• Provide appropriate training for personnel
• Ensure adequate security over controlled drugs, reducing risks of drug abuse and suicide.  (Roark, Tomasi 2019)
• Develop and implement transparent, consistent processes for shared decision making, including euthanasia decisions
• Rotate euthanasia performance duties

Encouraging routine use of mental health benefits, particularly of online counseling/therapy platforms, may help normalize utilization of mental health resources beyond traditional use of EAPs or counselors in crisis situations.

• Provide Employee Assistance Programs (EAPs) and/or other mental health benefits
• Ensure staff are aware of these programs and how to access them (Merck study 2022).
• Provide training in conflict resolution and effective communication.
• Provide staff training in Mental Health First Aid, which teaches staff to recognize the signs of compassion fatigue, burnout, and psychological distress in others and effectively intervene during crisis situations.
• Provide staff training in suicide prevention, such as Question-Persuade-Refer (QPR).
• Offer staff training in strategies to promote well-being, such as AVMA Workplace Wellbeing Certificate program.
• Create an infrastructure to facilitate peer support groups.

Within the organization, colleagues can support coworkers through daily interactions :

• Encourage peers to participate in well-being activities, including mutual support for allotted breaks and time off
• Engage in mental health first aid, the first step of which is simply asking others how they're doing
• Implement strategies to constructively resolve interpersonal conflict
• Support co-workers in seeking mental health support
• Participate in supportive peer groups
• These can take many different forms, including social groups, personal support networks, mentor-mentee relationships, and Balint groups, which are traditionally led by a psychiatrist or psychotherapist and examine stressful, emotionally demanding situations in a safe place.
• Voluntary psychological debriefing following traumatic events may be beneficial, though this is not indicated in highly conflictual workplaces. 
• Participation in peer groups conducted in a supportive environment may increase well-being and help individuals to leave work at work (Huggard 2008).

At the individual level, veterinarians should, with support from their employers and colleagues, consistently engage in appropriate self-care and recognize their own signs of compassion fatigue and/or burnout:

• Avail themselves of online tools to evaluate their own work-life balance, such as ProQOL and Life Wheel.
• Engage in activities shown to be beneficial for mental health, such as exercise, hobbies and time spent in nature
• Maintain an appropriate and healthy balance between work and non-work
• Avoid activities known to adversely affect mental health, such as excessive time spent on social media. (Hunt 2018, Kross 2013, Volk 2018)
• Seek mental health support when needed. 
• Implement a healthy coping method for dealing with stress (Volk 2022)

Collectively, these strategies at all levels of the organization can lead to a culture of compassion, satisfaction, and resilience (Figure 1).
 

Figure 1. Psychological stress solutions.

3.   Financial Stressors

Since the early 2000s, the cost of a veterinary education has rapidly outpaced increases in veterinary starting salaries. As a result, new veterinarians are graduating with debt-to-income ratios (DIRs) that frequently exceed 2:1 while financial advisors recommend a graduating DIR of <1:1 (Dicks 2015, VIN). The AVMA’s Economic State of the Profession reports show that DTIs for veterinarians entering public practice, including jobs in government and non-profit animal shelters, are consistently higher than for those entering private practice. This difference is likely related to starting incomes for public practice veterinarians, which have been lower than those entering private practice since approximately 2008 ( Bain 2020, Bain 2021). The mean starting salary for 2020 graduates entering public practice was $76,117, compared to $92,702 for those entering private practice (Bain 2021).

High DIRs are serious stressors for many veterinarians, especially new graduates (Nett 2015). The 2022 Merck Animal Health Veterinary Wellbeing Study found that the high level of student debt was considered a significant challenge by 88% of veterinarians, and personal student debt was a factor associated with a higher risk of psychological distress.  When well-being was examined, veterinarians with the highest levels of debt were the least likely to be “flourishing” (i.e. experiencing a high level of well-being.)  Only 47% of veterinarians surveyed in 2021 would recommend the profession. For those that would not, the top reasons for not recommending the profession included stress, poor compensation, and student debt (Volk 2018, Volk 2020, Volk 2022).

Financial Stress Solutions

Shelter veterinarians should be compensated fairly and comparably to other sectors of the veterinary profession. In addition to standard benefits such as medical, dental, disability insurance, liability insurance, and retirement savings plans, employment benefits should include paid time off for vacation and family/medical leave, paid time for continuing education, membership dues for professional organizations, coverage of costs for licenses and permits, and access to financial planning services. Access to financial planning is available through some state VMA memberships. Engaging a financial planner to manage debt is associated with a lower risk of serious psychological distress for veterinarians (Volk 2022).

Many shelter veterinarians and shelter staff are eligible for the Public Service Loan Forgiveness program (PSLF) created in 2007. The PSLF allows borrowers who work full-time for nonprofit and government agencies to have their outstanding debt forgiven after 120 qualifying payments. Employers should provide encouragement and support for employees seeking PSLF qualification, and should consider internal student loan assistance for staff that are ineligible or cannot yet participate in federal forgiveness programs. These steps are likely to directly impact the retention and recruitment of shelter veterinarians.

References

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