On Tuesday afternoon at the 2019 AAEP Convention, a series of presentations addressed boundaries and burnout in the veterinary industry. Betsy Charles, DVM, led off the afternoon with a talk on boundary setting. She described why boundaries are essential for a fulfilling career. Charles stated that failure to set clear boundaries is one of the largest contributors to stress and unhappiness in the profession. She said boundaries are “a property line that defines what we are responsible for or not responsible for.”
Because it is impossible to set boundaries without understanding our values, first we must determine what matters to us the most, Charles stated. She recommended reviewing the work of Brené Brown online to assist in identifying values and setting boundaries.
After identifying values, the next step is to “operationalize” them through identifying the specific behaviors that will satisfy those values. For example, if a core value is your family, then “operationalizing” that value would include setting boundaries so you can be home three nights of five in time to spend meaningful time with your family.
The next step is to communicate your boundary lines so that others have proper expectations and are not surprised.
Learning to say “no” and considering it a complete sentence is difficult, said Charles. She recommended the book “Boundaries: When to Say Yes, How to Say No to Take Control of Your Life” written by Drs. Henry Cloud and John Townsend.
Charles emphasized that respecting others’ boundaries is critical in reducing workplace stress. She concluded that only through meeting this challenge will future equine practitioners thrive.
Shannon Reed, DVM, MS, DACVS-LA, is a surgeon at The Ohio State University. She, like all veterinarians, experiences frequent stress. By approaching wellness as a daily personal priority, she seeks to mitigate its negative effects. In her presentation, Reed defined wellness as the combination of physical, mental and emotional health and well-being.
She said the first step in creating a personal wellness plan is to determine what constitutes well-being for you; each person has different needs. It is also necessary to figure out the barriers that might prevent you from achieving your goals. Many times, a veterinarian’s strong work ethic prevents him or her from pursuing wellness goals that might conflict with the work of continually fulfilling client or patient demands. However, research with physicians has shown that attention to well-being will significantly increase performance. Stress, burnout, fatigue and depression negatively and markedly affect patient care.
Seeing personal wellness as a path to better patient care rather than a selfish act can allow some practitioners to practice self-care, she stated.
A holistic approach is necessary to integrate a personal wellness plan into the successful management of a veterinary practice, said Reed. Each step of the plan must be considered with the practice in mind. By asking certain questions of yourself, well-being can increase for all in the practice.
Reed said that the first questions involve whether you approach your colleagues at work with a mindset of collaboration or with a defensive, competitive stance. Creating room for personal wellness requires working with others as a team and relying on each other.
The next questions identify whether you feel ethically challenged by the services your clients ask of you, and whether you feel failure when a case does poorly or feel personally responsible for the outcome. These answers will help you know whether you can easily let go of your cases to colleagues in order to create space for self-care.
A big part of personal wellness is caring for your health, the speaker stated. Do you consistently take the time for necessary health appointments at your personal physician, dentist, therapist, etc.? Do you make thoughtful dietary choices and exercise regularly?
Getting adequate sleep is also important, along with periods of quiet contemplation, such as meditation, yoga or prayer.
Unfortunately, equine practice workloads mean veterinarians often can’t control overtime. Boundaries can help in this regard, she said.
Veterinarians should also think about their own efficiency and resiliency. The speaker suggested forming a list of personal goals and standards to create a more controlled work setting where time away is more easily achieved. To-do lists and time schedules can help you accomplish that, Reed said. It is important to reassess your priorities on the to-do list regularly and act proactively. With these steps, occupational stress can be a manageable risk rather than an intrinsic condition of the profession.
Ashleigh Olds-Sanchez, DVM, DABVP-Equine Practice, an ambulatory practitioner with many years of experience, discussed avoiding burnout as a solo practitioner. She began by acknowledging the current reality that many equine-oriented veterinarians either leave the equine profession within a few years for companion animal medicine or decide to simply begin their careers there. Although she directed her talk to solo practitioners, she stated that her ideas for preventing burnout could be helpful for all equine practitioners, regardless of the size of their practices.
Olds-Sanchez defined burnout as a state of physical and mental exhaustion that culminates in a loss of identity or sense of purpose. Important causes of burnout include lack of social support, imbalance in work and life outside of work, lack of control over schedules and workload, and dysfunctional work cultures, she said.
Burnout is common among all kinds of healthcare workers, she said. Equine and large animal veterinarians are often affected.
Many practices struggle to attract and retain associate veterinarians, primarily due to low salaries and the lifestyle, she said. Equine practitioners experienced a decline in average income of 6.7% between 2006 and 2012. That was compared to an increase of 22.7% for companion animal veterinarians during the same time period. So it is not surprising that many vets have made the choice to leave equine, especially in light of the increasing educational debt that many young veterinarians carry.
Emergency duty on weekends and nights, along with the long daily hours that often accompany equine practice, are also reasons for the exodus, Olds-Sanchez said. Being available for emergencies is unavoidable for large animal veterinarians. Most of the time these services must be provided in the ambulatory setting. For solo practitioners, the obligation to be “on call” all of the time is a major cause of burnout.
Many new graduates are unwilling to undertake large animal practice if the job requires much on-call service.
Minimizing the impact of emergency duty can be challenging, but there are several ways to approach this problem, the speaker shared.
First, forming a local emergency cooperative can help in reducing this burden.
Second, consider sharing emergency duty with a part-time employee veterinarian, possibly sharing the expense of that vet with another practice. Although traditionally practices are leery about not being available because their clients might not accept an outsider, Olds-Sanchez emphasized that by building a strong brand, this concern can be minimized. If you are lucky enough to be near a large referral hospital or university, she suggested forming a relationship that allows you to use those facilities for your clients’ emergency needs when you need a break.
Another important aspect of preventing burnout includes formally scheduling personal time into each day or week, the speaker said. She suggested scheduling these times in the morning to ensure that they are not overwhelmed by the day. Other recommendations included attending focused continuing education to learn new skills that you can be excited about adding to your repertoire, networking with regional veterinarians at social events to build community and practicing mindfulness with intention. The latter can be done by appreciating simple moments of beautiful scenery or warm sunshine on a cold day, she said. This appreciation can build joy and gratitude into every day.
Lastly, the speaker counseled that strategies to provide financial outcomes more comparable with companion animal practice involve raising fees for services, being better at collecting payment, and being more savvy in practice management.
In closing, Olds-Sanchez suggested that although many equine veterinarians struggle with their quality of life and career satisfaction, utilizing steps outlined in this article can make a marked difference.