Compassion Fatigue and Suicide in the Veterinary Profession

September serves as Suicide Prevention & Awareness Month, with today (September 10th) marking World Suicide Prevention Day. The Meowing Vet highlights a side of veterinary medicine often hidden to pet owners: the epidemic of compassion fatigue and suicide in the veterinary profession. Learn how you can help save a life.

Trigger Warning: This article discusses mental health struggles and suicide. If you are experiencing suicidal ideation, please call a trusted loved one, therapist, or the National Suicide Prevention Lifeline (24/7, USA): 1-800-273-8255

I was going to be just another statistic if I continued on the way I had been going. A statistic. A number. A data entry point in a sadly growing list of veterinarians across the globe who silently battle depression, anxiety, compassion fatigue, and contemplation of suicide. Or worse… those veterinary professionals who are so distraught that they become a numbered tick mark on a mortality register – no longer a flesh and blood person with a beating heart, alive to see his or her importance as an individual and as a member of the veterinary community.

Veterinarians hold the highest rate of suicide across any civilian profession in the United States, shared only with firefighters and police officers. One in six U.S. veterinarians has contemplated suicide since graduating. A greater number are suffering in silence. Similar statistics have been reported in studies conducted in Canada, the United Kingdom and Wales, Scotland, Australia, Norway, Finland, Denmark, and Belgium. The suicide rate of veterinarians in several of these nations is four to six times higher than that of the general population and at least twice as high as other healthcare professionals, such as medical doctors and dentists. The Centers for Disease Control & Prevention (CDC) is currently investigating this plague that is taking the lives of members of the veterinary industry – whether literally by the ending of one’s own life or by thwarting that individual from enjoying his or her quality of the life due to emotional and mental distress. Veterinary professionals are truly dying for their patients – not a badge of honor we should wear with any pride.

Veterinarians in small animal general practice, particularly in rural or low socioeconomic areas are at the greatest risk of suffering from suicidal thoughts and attempts, depression, and anxiety. However, not only do veterinarians in general practice suffer, but also specialists, vet techs and nurses, veterinary students, veterinarians undergoing intensive internships and specialty residency programs, and other animal caretakers, including animal control officers. According to the NAVTA 2016 Demographic Survey, at least 41% of U.S. veterinary technicians have indicated that they experience compassion fatigue*, a manifestation of emotional distress by caregiving professionals that can lead to depression and considerations of suicide in severe cases (*discussed in more detail below). Animal shelter workers are also at increased risk of depression and suicidal thought and behavior, significantly associated with the 300 million dogs and cats who are euthanized annually worldwide due to lack of funding and space as well as overpopulation from a failure of individuals to spay and neuter their pets. Even before they enter practice, veterinary students begin to express feelings of depression and performance anxiety, recently prompting vet schools to provide emotional and mental health resources to students as well as incorporate discussions on compassion fatigue and suicide into the curriculum. This problem is an epidemic affecting the entire veterinary industry.

“Compassion fatigue” may be better termed “empathy fatigue“. It is not so much the compassion shown to pets and their owners that causes emotional fatigue; it is the vast amount of empathy, or feeling the pain that another being is feeling, that can lead to distress and fatigue.

Today (September 10) marks World Suicide Prevention Day, within National Suicide Prevention Week, of Suicide Prevention and Awareness Month held each September. What better time than now to address this growing plight in vet med and highlight this industry problem with our clients, pet owners? Over the past few years, several high-profile veterinarian suicides have thrust the problem of veterinary depression and suicidality into the mainstream:

Taiwanese shelter veterinarian Chien Chih-cheng (2016), who killed herself out of despair from the high number of euthanasia procedures she performed as a result of unwanted animals that could not be housed in the limited space of her shelter
U.S. veterinarian Shirley Koshi (2014), a victim of cyberbullying
World-renowned U.S. veterinarian and animal behavior specialist Dr. Sophia Yin (2014), an advocate of stress-free pet handling
U.S. veterinarian Patty Gaddis (1998), who before taking her own life, left a note dictating treatment instructions for the care of patients she left behind. She cared for animals even in death.

And then there are the many other veterinary workers who may not have garnered the same public remembrance as the veterinarians discussed above, but whose lives and deaths are just as significant. The topic of suicide in veterinary medicine deserves to be discussed, to honor our colleagues who have gone through with it and to prevent others from following suit. I wish to dispel the myth that talking about suicide instills that idea in other people’s heads. In actuality, striking a conversation with a person who may be harboring suicidal inclinations thereby grants him or her an opportunity to feel heard and helps reduce the likelihood of that person taking his or her own life. I not only want to unite the veterinary community to resist our predicament together and make necessary changes within ourselves and our profession to lead to healing, but I also wish to inform pet owners of our struggle. Good, responsible, and appreciative clients, we thank you for your role in caring for your pets – our patients, whom we also love. Patrick Cullen writes for Get Leashed Magazine (June 14, 2017), “While you might not be a part of the problem, you can be a part of making the problem better.” Pet owners, we need your help, your support, your respect, your compassion – the same compassion we show to your pets. We’re not so different after all, for we have commonalities: a love for animals and a desire to provide them with the best care possible. But to be able to provide animals with our professional care, we have to be around to do so… we have to be alive. Psychologist Laurie Fonken explains, “[Vets] don’t want to die. They just want to escape from the pain” (Scheidegger. DVM360 Magazine. May 1, 2015). “What a suicidal personal most often wants is not to actually carry through with suicide, but to avoid life in its present form and find a way to handle the circumstances that are difficult and impossible to beat,” writes Debbie L. Stoewen for The Canadian Veterinary Journal (January 2015). So please hear our plea to notice our pain and help us to reduce our own suffering, much as we do for your pets even when we’re running on empty. Like you, we are human.

“No matter where we live, what we do, and what our state of the world, we share the common experiences of joy and sadness, face strife and hardship, and struggle to meet life’s challenges.”
– Debbie L. Stoewen (The Canadian Veterinary Journal, January 2015).

Why Veterinary Professionals Don’t Seek Help

I felt so guilty and ashamed to be struggling with the beginnings of compassion fatigue so early on in my career as a new graduate. I felt silly, weak, like a fraud. I felt alone; how could I be struggling so prematurely when my peers seemed so resilient? However, I wasn’t truly alone. The suicide mortality rate is higher in veterinarians working in the industry for less than 30 years. Among many other factors, the emotional, mental, and physical demands of veterinary medicine have led many veterinary workers to question their choice of career. According to a recent U.S. survey conducted by Merck Animal Health, “only 24 percent of veterinarians age 34 and younger would recommend a veterinary career to a friend or family member… [and] only 41 percent of veterinarians overall would recommend the profession to a friend of family member” (Reimer Fender. DVM360 Magazine. February 16, 2018).

Suicidal thoughts are most likely to first develop in newly certified veterinarians as they make their transition from veterinary school to practice. Feelings of depression, anxiety, and diminishing feelings of well-being tend to develop or worsen within the first six months of practice. According to the Journal of Veterinary Medicine Education, two-thirds of veterinarians have suffered from clinical depression. The Journal of the American Veterinary Medical Association (JAVMA, March 2015) reports that one in ten U.S. vets may experience serious psychological distress. However, only half of those veterinarians with a history of suicidal thoughts tend to confide in someone or seek professional help, primarily out of guilt or shame.

Mental illness may be unfairly labeled as a weakness in professions with zero acceptance for such conditions. According to Dr. Fonken, “The stigma is that a veterinarian who admits a need for help is weak or vulnerable” (Scheidegger. DVM360 Magazine. May 1, 2015). As Stoewen explains for The Canadian Veterinary Journal (January 2015), a veterinarian’s identity is “firmly entrenched as ‘the helper.’ The need for ‘helpers’ to seek rather than offer help, especially as it relates to mental health, may be perceived as a sign of weakness, engendering feelings of guilt and shame as well as worry about career implications. Stigma is problematic, as it reduces help-seeking behavior, thereby enabling suicide planning.” As caregivers and helpers, vets often refrain from discussing struggles with others so as not to be a burden. Others blame a lack of time to seek help as reasoning to keep trucking on. How can vets possibly squeeze in an hour-long therapy appointment into a 15-hour work day with family commitments waiting at home afterward? However, postponing treatment grants depressive and suicidal thoughts time to gain a foothold. Veterinary professionals need to realize that seeking professional help is not a sign of weakness, for “veterinarians and other caregiving professionals have a moral imperative not just to help patients but also to help themselves,” advises the American Veterinary Medical Association (AVMA).

What Is “Compassion Fatigue” and “Burnout”?

If you don’t take care of yourself, there will come a time when you can’t take care of others. Veterinary medicine is stressful – no doubt about it. Training is intensive and days are long and trying. Chronic stress (physical, mental, and emotional) without proper rest and balance can manifest as physical health consequences: musculoskeletal and gastrointestinal disorders, insomnia, and cognitive impairment. Over time, feelings of isolation, helplessness, and hopelessness seep in, leading to clinical depression, anxiety disorders, and oftentimes substance abuse or self-harm. Depression is a risk factor for the development of suicidal contemplation and action. But why do veterinary professionals allow chronic stress to devolve into such physical, mental, and emotional ailments? Because many veterinarians and other veterinary workers struggle with compassion fatigue and burnout.

Burnout is the exhaustion and stripping of one’s motivation and drive caused by the physical and mental stress of work conditions (for example, you desperately need a break from staying up late five nights in a row to work on that business report that your boss expects on her desk tomorrow morning). On the other hand, compassion fatigue, also termed emotional exhaustion or secondary traumatic stress disorder (STSD), is the result of emotional depletion of caregivers, who act like an emotional sponge as they try to whisk suffering away from the animals or other people around them. Members of the veterinary community, medical health field, pet owners, and people taking care of animals and other people in pain are all at risk of developing compassion fatigue. It’s not just the long hours, lack of sleep, and mental exertion of surgical planning, diagnostic deciphering, and treatment formulation that is so exhausting – it’s the emotional investment that we place into each one of our patients that can leave us feeling depleted the most. And we don’t leave our emotions at work; they follow us home. We worry into the night about our patients’ welfare; they cannot speak to tell us what’s wrong, so we sometimes second-guess ourselves concerning their medical care. This worry and genuine concern twists itself into anxiety, robbing us of what little quality time we have at home for our families and to replenish ourselves. So we go to work the next day, aiming for perfectionism all the more in order to silence that niggling feeling of anxiety – that voice inside our heads telling us we’re not good enough. This diligence can have the opposite effect for which we were hoping, leaving us even more anxious. We begin to feel helpless, trapped, and hopeless, so we attempt to numb these overwhelming feelings, and the beginnings of depression set in. We find it difficult to set boundaries, so we over-commit to our work. As Christopher G. Byers, DVM, DACVECC, DACVIM (SAIM), CVJ, a dual-boarded veterinary specialist explains, “When we try to set reasonable limits with clients, we’re berated and branded as ‘uncaring’, ‘inaccessible’, and ‘only in it for the money’” (Critical Care DVM). We don’t make the time to recharge (physically or emotionally) in order to return fresh and able to provide the best quality care to our patients. We partially are at fault for allowing ourselves to think and act this way, yet we need someone to tell us that it’s okay to rest and take care of ourselves too.

Julie Squires, Certified Compassion Fatigue Specialist & Educator and founder of Rekindle LLC, defines compassion fatigue as “the combination of emotional, physical, psychological, and spiritual exhaustion and depletion that can result when we are repeatedly exposed to another’s pain and suffering” (Today’s Veterinary Nurse, January/February 2017). Those most at risk? The very ones who have the personality traits to be drawn into veterinary medicine in the first place: those individuals who are compassionate, empathic carers. It’s a catch-22. Molly Sumner, trained by the QPR Institute to aid suicidal individuals in times of crisis, “notes that those with a deep compassion for animals take a considerable amount of weight on their shoulders. Because animals cannot speak for themselves, rescuers feel they must break their own personal limits to give a voice to those in need” (Regina Lizik. BarkPost®, 2015). This overwhelming pressure and chronic stress “can sometimes cause vets to think they’re underperforming, or somewhat unfit to practice medicine on animals,” leaving us feeling like fakes, impostors. As Dr. Rosie Allister of Vetlife, a support charity for U.K. vets in crisis, explains, “When your whole identity is around your work, trying to do something good, and often making really big sacrifices to do that, it can…then be really difficult when that identity is challenged and you feel it’s going to be taken away, even if that perception isn’t grounded in fact” (Joe Bish. VICE UK. March 15, 2017).

“It is our compassion toward and ability to relate to the suffering of animals that attract us to this profession. Only compassionate, empathic, loving and caring people suffer from compassion fatigue – the very people who are so vital to the animal-care field,” explains Katherine Dobbs, RVT, CVPM, PHR (Veterinary Practice News. August 30, 2012).

Society’s attitude towards pets has shifted over the past century; pets are now regarded as fur-babies and members of the family, awarding veterinarians with an even greater responsibility for the patients in our care. “We have a keen awareness of our tremendous responsibility for the life and death of our patients,” discusses Dr. Byers (Critical Care DVM). Former Australian Veterinary Association President, Helen Jones, says, “People are dependent on veterinarians – particularly rural veterinarians – and the vets feel responsible, so I think they take the world’s problems on their shoulders” (Dr. Anne Fawcett. Small Animal Talk. February 26, 2014). Sometimes we don’t even know that we’re beginning to experience compassion fatigue until we’re smacked in the face with it. We then try a 180° turn in an attempt to numb ourselves to dull the pain of others that we’ve let seep into us, often leaving many of us dull shells of our former ultra-empathic selves. As Dobbs states, “With compassion fatigue, we reach a point where we care too much, or care too little” (Veterinary Practice News. August 30, 2012)

Some argue that the problem would be better termed “ethical fatigue” rather than “compassion fatigue” because our compassion stores can never really be stripped no matter how much pain we absorb. It’s not that we actually run out of compassion; it’s just that we begin to feel helpless to do anything to alleviate the suffering of those animals we care about. According to Elizabeth Strand, PhD at the University of Tennessee College of Veterinary Medicine, “research shows that veterinarians face ethical dilemmas three to five times per week, and such moral stress is a primary contributor to compassion fatigue” (AVMA). Veterinarian Dani McVety explains that clients’ financial constraints which alter her ability “to do the very best for [her] patients… could arguably border on ethical dilemmas” (DVM360 Magazine. January 17, 2017). We vets have to make a plethora of life-or-death decisions multiple times daily for our patients, and we are left exhausted. D.J. Bartram and David Baldwin deftly described the struggle of ethical fatigue in their journal entry for Veterinary Record (March 27, 2010): “Veterinary practice occupies a difficult and complex moral position because it serves animal and human interests, which may conflict… Ethical challenges are common-place as veterinarians seek to balance their obligations to ensure the welfare of their patients while accommodating the owners’ expectations or demands, often within strict economic constraints, the views of professional peers, the wider interests of society as a whole, and the commercial interests of private practice.”

Risk Factors Contributing to Compassion Fatigue and Suicide in the Veterinary Profession

So how on earth did veterinary medicine implode like this? A variety of factors have been attributed to the crisis state of compassion fatigue and suicidality within the profession – factors not only in the profession itself but within the innate qualities of the individuals who seek veterinary medicine in the first place.

Personality traits

Chicken or the egg? A cyclical effect appears to exist in veterinary medicine in which the profession can be a factor for the development of depression in some people, yet veterinary work may also attract individuals who are already prone to depression.

Veterinarians tend to be hard-working, high-achieving, driven doers with Type A personalities. We’re perfectionists. We have to be. In order to enter vet school, excellent grades and the completion of extensive extracurricular activities are required. With a relatively limited number of veterinary schools, only the academic cream of the crop are selected. Veterinarians undergo intensive training. In the United States, vets complete 4 years of undergraduate schooling and 4 years in veterinary school, oftentimes followed by 1-2 years of internships and 3-4 years of residency for specialty training. That’s a total of 8-14 years of education and commitment, all while accumulating student debt for the majority of students. We have to know the anatomy of multiple animal species, their various disease processes, and diverse nutritional requirements. Even as a general practitioner in veterinary medicine, we become somewhat specialized, being pediatrician to puppies and kittens, hospice workers to geriatric pets, internists, nutritionists, pharmacists, behaviorists, radiologists, and surgeons. Likewise, our credentialed veterinary technicians or nurses are also well-educated and skilled, making them vital members of our clinics and hospitals.

Those who seek a profession in veterinary medicine not only love animals but are highly conscientious, compassionate, empathic, and self-criticizing. We have to have a scientific mind, non-squeamish nerve, steel drive, and kind heart. Our role is more than just a job title… it’s our calling, our identity. So when our role as a veterinary professional is attacked by the general public or clients in clinical practice or online, we feel debased as a person… less than a veterinary member and less than a human being.

The incredible traits that we possess can sometimes flip-flop to our detriment. When something goes amiss with their strengths, these same qualities can inadvertently become weaknesses. But the profession needs people like us, for if we don’t enter the industry, who will? So we trudge on, we don’t give up because that’s what we do, that’s what we know. Dr. Christopher Byers informs that “most veterinarians are introverts, [so] we internalize these feelings, a practice that can become toxic to our souls” (Critical Care DVM). We feel more and more isolated and begin to think that it’s just us who feel defeated… like a failure. Failure. That’s a scary word for many of us, especially those of us who are used to receiving good grades and academic honors. Dr. Carlin Jones says that those who pursue veterinary medicine are “not used to failing. So when we feel like we’ve done just that – for example, when a disease wins – we’re crushed. We’re truly devastated, and are left quite emotionally vulnerable” (Critical Care DVM). The concept of “failing” can be relative; for many of us, “failing” means that if we don’t do everything perfectly or with a happy face, we’re failing at our career and as a person in general.

Financial constraints

Many pet owners falsely assume that because veterinary expenses seem expensive, veterinarians must be well-paid. That’s largely untrue. The average starting salary of a U.S. GP vet is $60,000/year while the average annual salary of a vet in the U.K. is £31,000. That may seem like a decent wage, but vets have one of the lowest starting salaries among medical professionals, with most of us earning less than a third as much as medical doctors and dentists. Even boarded veterinary specialists earn two to three times less than their medical doctor equivalents. To worsen matters, vets have the highest educational debt-to-income ratio of all medical-based professions, reports the New England Journal of Medicine (2013), being double that of medical doctors. The average student debt for a U.S. veterinary student is $167,534.89 (AVMA 2016) while one in five graduates have >$200,000 in debt. Similarly, the average student debt for a U.K. vet student is £100,000. Figure in the average $1,000/month in interest that such debt accrues, and you’re looking at a long period in the red when paired with a disproportionately low salary. Debt is a known risk factor for suicidal considerations in the general population, and vets are also at risk of crumbling under the weight of outstanding financial loans. They can’t take a break from work until they actually break down, for they need a steady paycheck to pay off their debt, and with their educational training, a job in vet med seems like the only way to go.

And the financial state may worsen. Over the past 60 years, a gender shift has occurred in veterinary medicine. In the U.S. in the 1960s, only 10% of vet students were women; now, over 80% are women. However, “economic data from other professions show that once women dominate a profession, wages in that profession tend to stagnate,” reports Dr. Tracy Stokol for CNN (August 22, 2017). Despite female vets now dominating the profession, a wage gap persists with male vets often being paid better than their female counterparts.

So why are vet prices so high, you may ask? Good quality medicine carries an expense, no doubt about it. However, veterinary fees are actually much lower in comparison to human medical and dental prices, although that fact is often missed since most veterinarians are not reimbursed by pet insurance. Many vets loathe dealing with finances, and if we could lower costs further, we would. However, we have bills to pay in order to keep our clinic doors open and services operating for the next pet who needs us. Yet some clients unfairly play on our kindnesses; angry at vet fees for which they did not plan, many pet owners think we should work for free if we truly loved animals. “Being blamed by owners for forcing them to kill their pet because they can’t afford veterinary care is perhaps one of the meanest and harshest things I’ve ever heard. This is a wicked form of emotional bribery, and is entirely unacceptable,” implores Dr. Byers (Critical Care DVM).

Work conditions

Long working hours, being on-call after-hours, sacrificing weekends, work stress, ethical dilemmas, being the bearer of bad news, managing client expectations, the gravity of making a medical or surgical error, poor work-life balance, minuscule time to devote to personal life and family. We know all these things when entering the profession, but even so, having such little down-time to recharge and invest in our personal relationships is enough to break anyone over time, especially with an “imbalance between effort and reward” that many of veterinary professionals begin to feel (Bartram and Baldwin. Veterinary Record. March 27, 2010).

Female veterinary workers are especially distressed by the “effect of marital and family stress on their career and lower levels of spousal support” in comparison to their male colleagues (Bartram and Baldwin. Veterinary Record. March 27, 2010). Yet we need to remain professional and upbeat for our clients and patients, so we often stifle our inner feelings to put on a happy face in the workplace. This means ping-ponging from consoling grieving owners following a euthanasia in one room to forcing a smile for the new puppy or kitten visit during the next appointment. “It’s emotional whiplash,” describes Dr. Rebecca Johnson (Mariana Dale. KJZZ. December 4, 2017). Dr. Marie K. Holowaychuk describes our actions as emotional labor: “the process of managing feelings and expressions to fulfill the emotional requirements of our job… This sometimes means showing feelings that do not match how we are feeling inside…[and] is typically much more demanding than the physical and intellectual labors of the work that we do as veterinary care providers” (Greg Kelly. Veterinarian’s Money Digest. October 20, 2017). The result? We are left feeling empty.

Problematic clientele

Most clients are amazing (thank you!), yet veterinary professionals still deal with a barrage of problems from others: blame, disrespect, disregard of our knowledge and skills, non-compliance to our instructions for a pet’s medical care, threat of irrational complaints and litigation, cyberbullying, and disgruntlement due to vet fees. Such workplace issues are growing into a worsening problem as society becomes based in instant gratification, demanding an immediate diagnosis and cure yet not wanting to spend money on required diagnostic tests and treatments. Such behavior is degrading the veterinary health field by converting it into a service industry. Though a “quick-fix” may pacify clients in the short-term, this shift shall certainly not benefit the welfare of their pets or their vets in the long-term. Our jobs in the veterinary field are much more complex than many give us credit for. We don’t just get to snuggle puppies and kittens all day. We are doctors of veterinary medicine and deserve the respect earned through our training.

Patient deaths and euthanasia

Employees of the veterinary field in particular deal with a high volume of crisis: the distraught or grieving clients and a large number of animals suffering due to sickness, injury, neglect and abuse, as well as euthanasia and death. In fact, vets deal with death seventeen times more frequently than general practitioners in human medicine, largely because of the shorter lifespans of our animal patients and because of the gift of euthanasia we can offer them. However, many clients assume that one of the biggest issues with which we grapple in the veterinary profession is euthanasia. And that’s sometimes true. Euthanasias are extremely sad, particularly when we say goodbye to a beloved patient or try to console a mourning pet owner, and for animal shelter workers who must euthanize society’s unwanted dogs and cats, even if they’re healthy – a problem caused largely by a lack of spaying and neutering.

However, what’s typically more trying to our emotional stores is when our hands are tied by clients demanding unnecessary procedures for their pets, “such as when an animal’s suffering was prolonged because its owner did not accept that its disease was incurable and that death was inevitable” (Bartram and Baldwin. Veterinary Record. March 27, 2010). In those situations, euthanasia is preferred by vet workers as our “profession philosophically accepts euthanasia as a way to end suffering” (Greg Kelly. Veterinarian’s Money Digest. October 20, 2017).

The gift of euthanasia in veterinary medicine is a unique and special one. “Because vets can offer gentle deaths to their patients with euthanasia, they may see death as a way out of pain,” explains Sy Montgomery for The Boston Globe (September 18, 2016). Dr. Rosie Allister elucidates further, “We [vets] see euthanasia sometimes as a positive thing. We see euthanasia as relieving suffering, as a solution, sometimes, to intractable problems. So if an animal is really suffering, we can help that animal by alleviating its suffering. And the argument was that – to vets – death is then normalized as a solution to problems” (Joe Bish. VICE UK. March 15, 2017). We may thereby incorrectly extrapolate this belief to our own lives, seeing suicide as relief. As Dr. Shawn Finch, a veterinarian who has battled depression and anxiety, says, “Suicide is relief. It is Wrong. It is Not the Answer. It is A Permanent Solution to a Temporary Problem. But it is relief from that overwhelming oppressive state” (Dr. Andy Roark. July 7, 2015).

How Can Pet Owners and Clients Help Their Veterinary Team?

The majority of veterinary clients are amazing! However, some pet owners distrust or disrespect veterinarians without reason, discounting professional advice in favor of a breeder’s opinion, a half-truth Internet article ripe with non-scientific myths, and pet health recommendations gathered by a search engine. This causes a break in the client-doctor relationship and contributes to the very issue about which pet owners complain, becoming a self-fulfilling prophecy of poor communication and relationships between you and your vet. Everyone deserves to feel appreciated and respected – including you and your veterinary team. So how can pet owners help the problems of compassion fatigue and suicide in the veterinary profession?

Plan ahead financially for your pet with a pet insurance policy and by setting up a savings account to plan for emergencies. As discussed, veterinarians do not typically make much money, especially when compared to the average student debt, and we have bills to pay in order to keep our clinics running to provide health care to other sick animals. Despite a high debt-to-income ratio, vets are drawn to the profession not due to financial gains but to help animals. “For this reason, impugning our integrity about our intentions is deeply insulting and infuriating, and only serves to drive cynicism and create barriers to collaborative partnerships,” expresses Dr. Christopher Byers (Critical Care DVM).
Trust our advice to vaccinate your dogs and cats; use heartworm, flea, and tick prevention; and spay and neuter your pets. These services are not a scam to make us money. Preventative medicine may seem expensive up-front, but they will save you money in the long-run by preventing diseases, thereby keeping your pets healthier.
Please don’t use the words “just” or “only” when describing a veterinary tech or nurse – or anyone for that matter. Such wording undermines their professional and personal worth. How do I adequately convey how much a vet nurse or tech, kennel assistant, receptionist, and staff member in charge of clinic inventory does for your pets as well as for you? These oftentimes thankless individuals are a vet’s right-hand men and women, and their advanced skills and kindnesses help keep your pets feeling healthy, safe, and loved. They deserve your utmost respect.
Avoid cyberbullying: Cyberbullying is “an Internet lynch mob mentality,” says Dr. Kimberly May of the American Veterinary Medical Association (AVMA) (Mandkin and Larkin. AVMA. October 29, 2014). It is unfair. It is wrong. It can potentially mean life or death to someone teetering on the edge. Don’t rely on your perceptions of half-truths or false assumptions of only a small piece of a complex picture, and refrain from smearing your vet’s reputation online. If you have a true concern or complaint, discuss it directly with your veterinarian or veterinary staff, bringing an equal portion of rationality, kindness, and empathy with your potential anger or annoyance. Let’s work as a team to come up with a solution that’s best for your pet.
Keep your cool: The majority of us are pet owners ourselves, so we get it: emotions run high, especially if your pet’s life is at risk. However, your vet staff is there to help, not to unfairly be your personal punching bag. We need to work together as a team.
Humanize us: Remember, we are people with families and interests outside of work. As much as we try to avoid them, we sometimes make mistakes. We’re not robots; we’re fallible humans. We get sick, get tired, and have emotions the same as you.

How Can Veterinary Professionals Help Themselves?

I was one of the fortunate ones – not because I didn’t share those same overwhelming feelings of hopelessness that so many of my colleagues do, but because I found a way to change my path. With the support of a core group of friends and family members, I sought professional help through a psychologist, transitioned from full-time clinical practice to veterinary relief work and veterinary writing, and even took time off completely – setting aside hands-on practice altogether for a spell and focusing on non-clinical veterinary modalities until a return to clinic life occurs in the healthiest manner possible – to set myself up for future success through hard work behind the scenes to alter my previous ways of thinking and feeling.

So how can veterinary professionals help themselves? Firstly, change begins from within. Improving the veterinary work culture from the inside is the most important step in ending this mental health crisis within our profession; full blame cannot be cast on ungrateful and bullying clients alone. We in the vet community must be the first to reform toxic clinic culture. We must establish and honor our own boundaries. We must demand lunch breaks, to leave on time, to receive a decent income and more paid time off, and to be kind to one another as well as to ourselves. Normalize these basic, humanizing changes which can drastically improve work conditions. Choose a clinic that treats you with respect as both a professional and as a person.

Fortunately, compassion fatigue doesn’t have to be inevitable; it is preventable, explains Certified Compassion Fatigue Specialist & Educator Julie Squires (Today’s Veterinary Nurse, January/February 2017). How? Confide in a well-trusted support system, such as a close friend or family member. Discuss the situation with your boss or staff, and implement resources into the workplace. Rediscover a creative outlet or hobby. Visit with a loved one, and catch a movie. Practice the art of mindfulness: savoring the little triumphs, appreciations, and happy things. We humans tend to focus on the negatives as an evolutionary protection mechanism that kept our cavemen forefathers from being predated; though these thoughts are no longer useful in most scenarios, we struggle to shake the negative thoughts. Squires advises that we remember why we’re doing what we’re doing. Remember the “thankful clients, the patients that get better…pride in our work, educating clients, caring for our patients, learning new skills, working as a team, and making a difference in someone’s life”; ask yourself “Do we celebrate the wins as much as we fixate on the losses?” (Today’s Veterinary Nurse, January/February 2017). Focus on compassion satisfaction instead. Jessica Dolce, also a Certified Compassion Fatigue Educator, reminds us to stay true to what we’re feeling, as it’s “important to experience and accept feelings of sadness and loss,” for “it’s perfectly normal to be affected by our work” (Regina Lizik. BarkPost®, 2015). So take a few moments to process how you feel. Write in a journal. Meditate. Pray. Go outdoors. Sleep. Eat well and exercise. Take a few moments, an hour, or even a day or longer to practice self-care by tending to your own well-being, not as an indulgence but as a necessity.

But the problems run deeper, and though some of our “fixes” may perk us up temporarily, they don’t really reach our core issues. We have been trying in vain to control the symptoms of un-wellness in veterinary medicine rather than directing our efforts to understand and treat the root cause of it, said Michele C. Gaspar, DVM, DABVP (Feline Practice), MA, LCPC, as a speaker at the American College of Veterinary Internal Medicine (ACVIM) Forum in June 2018. The unique dual training of Dr. Gaspar, a veterinarian and a licensed clinical counselor, makes her an invaluable resource to the veterinary community. Her position allows her to shed light on the plague of burnout and suicidality in our profession, helping to bridge the gap between veterinary work and mental and emotional wellness. She believes we need to dig deeper into the core of the problem in our profession and suggests working with a therapist to understand compassion fatigue, burnout, attachment theory, caregiving (including how to care generously and healthily rather than defensively), and perfectionism – focusing on self-compassion to best help ourselves, our clients, and our patients. Self-care, while important, is not the answer; it merely manages a symptom of the disease of compassion fatigue. Without understanding and altering the underlying factors, we won’t actually treat the root cause. We’ll simply return to our same ways of thinking once we begin to feel a bit better, thus starting over the cycle of emotional and physical fatigue unless we change our mindset and work conditions. We need to first understand why we care before we can learn how best to care. (Click the hyperlinks above for books, journals, and other important resources recommended by Dr. Gaspar.)

For this reason, professional help is invaluable as it not only provides a confidential outlet for expressing concerns and hurts, but therapy can also trigger a paradigm shift, helping us alter our well-rooted viewpoints (firmly ingrained in us since our developmental years). We can learn how to care in a healthier manner in order to benefit all, once again using our innate traits of a strong work ethic, diligence, and empathy – but this time, reclaiming them as strengths in order to also help ourselves.

Dr. Gaspar also helps staff Vets4Vets®, an online confidential support group for veterinarians. Similar groups provide online and/or phone support for veterinary professionals, including the Compassion Fatigue Awareness Project, Vetlife (U.K.), Mind Matters Initiative at the Royal College of Veterinary Services (U.K.), Suicide Awareness in Veterinary Education (S.A.V.E.) at the University of Tennessee College of Veterinary Medicine (U.S.), and Not One More Vet (NOMV) group. Such programs provide excellent outreach for veterinary workers in crisis. Certified compassion fatigue coaches can also offer veterinarians and their staff training to learn how to guard against compassion fatigue. Vet staff are encouraged to utilize these resources via speaker presentations, online courses, and webinars. Additionally, veterinary social workers play an important role in helping people struggling in veterinary medicine.

However, sometimes even with intensive professional help and personal effort, an individual may feel that a change is necessary for his or her well-being. Veterinarian Cherie Buisson says that vet school doesn’t “teach us that it’s completely ok to want something different”, so people are left feeling “inadequate” and “like a failure.” “If what you’re doing right now isn’t making your life better, change it. There are endless possibilities for what a veterinarian can do,” says Dr. Buisson, so make sure you’re living the life you wanted (Dr. Andy Roark). Being a veterinary professional is a choice, so remind yourself why you’re doing it. “Breathe in both the responsibility and the freedom in this acknowledgment,” says Squires (Today’s Veterinary Nurse, January/February 2017).

Whatever your ultimate decision may be, I leave you with wise words from colleagues in the veterinary industry:

Don’t feel bad if you need to leave. It isn’t a failure. And even if it is, it’s okay to fail. It’s a normal part of the human experience, and you need to experience it. You need to do what’s right for YOU, what will make you happy and mentally healthy. Working in practice has taught you things, and made you grow as a person—it’s impossible not to have. It hasn’t been a waste of time. Value your mental health. Put it at the forefront of your priorities because that’s where it should be. Don’t allow yourself to hurt yourself by being afraid or unwilling to make big changes. DO WHAT’S RIGHT FOR YOU.

– Kelly, 30, USA, veterinarian (3 years in practice)

Support each other. Remember when it gets crazy that we’re all in this together. We’re a team! It should be how can I help you, help the team, not how can I help myself or make myself look good. We’re all working towards a common goal and we need to take a step back, breathe and remember that. Team Work can lessen everyone’s stress and reduce the risk for stress, conflict, burnout and compassion fatigue.

– Sam, 32, USA, veterinary technician student (8 years in the veterinary field in small animal clinics), also aspiring to become a Certified Compassion Fatigue Professional to help fellow veterinary professionals suffering with burnout / compassion fatigue

It’s not taboo! You’re not alone!

All in this field struggle with the challenges of compassion fatigue, decision fatigue, burnout, anxiety, or depression (often a combination of these). Triggers come from coworkers, clients, and yourself. Please, always remember that even if they’re not showing signs of it, others at work are probably dealing with some of these struggles.

Bosses: don’t be absent. Be present in the clinics and talk to your staff. Hear their concerns. Praise when praise is due. Maintain consistency among the staff (who gets called in to work, who takes off too much and puts others in a bad spot, what necessitates reprimand, etc).

Vets: support each other, and validate your staff. Pay attention to your senior staff, technicians, assistants, kennel staff, and front of house. Listen to them, and don’t for a second believe you are “high and mighty”. They deserve respect as coworkers, members of the veterinary team, licensed professionals as it pertains, and human beings. You are all going to make mistakes. Be there for each other as a united team.

Technicians: support each other, and don’t undermine or harshly critique vets (especially young vets). They look to you for so much, and your opinions of them matters more than you know. Support one another, and please always know how important you are to the team and to the patients. You are often overworked, underpaid, and go without due thanks. If I can speak for myself and the rest of the veterinary community, you are appreciated and loved and the heart/soul of the veterinary team.

Clients: we all go through training to be able to serve you and your pets to the best of our abilities. When you make comments like “so you’re just going to sit there and watch him/her suffer” because of circumstances beyond our control, you don’t understand how that affects us. We are not in this business for money. Our prices are WAY cheaper than those in human medicine, but aren’t masked by insurance. We do not make a lot of money, and many of us are in as much (if not more) debt than our human medicine equivalents. We take our work home with us, we think about your pets while we’re eating dinner or trying to fall asleep. We take every single word you say to us to heart, because to us our job is who we are. When you offer up a simple “thank you” or a kind letter, you bring encouragement to the whole team. Our passion and our calling is to take care of your fur babies, and if we let them or you down, it takes a severe toll on us. Please be understanding. Please treat us like humans with the respect and kindness you would want from us.

– Danielle, USA, veterinarian

I was going to be just another statistic. I found a way to change and find happiness and my passion again. I continue to remain diligent not only in my own quest toward inner peace as a person and as a veterinarian, but also to help other individuals in the veterinary community. I urge my colleagues and clients worldwide to make a stand. Let’s strike an open dialogue… no more suffering in silence.

“Depression is not a sign of weakness. It’s a sign that you have been strong for too long.” – anonymous

Pet owners, be kind and respectful to your vet – not only to be part of a joint team to improve the quality of veterinary medicine for yourselves and for your pets, but also (and more importantly) to help save a human life. I was going to be just another statistic, but now I’m working to prevent others from being one. Join me. A single life is worth saving, and it’s okay if it’s your own.

– Maranda Elswick, DVM

If you are contemplating suicide, confide in a close friend or family member, seek professional help, and call the U.S. National Suicide Prevention Lifeline at 1-800-273-8255 (available 24/7). For hotlines in other countries, please visit http://www.suicide.org/international-suicide-hotlines.html. You are not alone. You are important, valuable, and we need you here.

Dr. Maranda Elswick graduated from Virginia-Maryland College of Veterinary Medicine (VMCVM) in the United States with an emphasis in small animal general practice and special interests in preventative medicine, hospice care, client communication, and client education. In addition to managing The Meowing Vet, LLC, Dr. Elswick is currently a licensed veterinarian in small animal community practice in Virginia and Florida.

What Your Veterinarian Needs You to Know about Compassion Fatigue and Suicide in the Veterinary Profession - The Meowing Vet

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What Your Veterinarian Needs You to Know about Compassion Fatigue and Suicide in the Veterinary Profession

Trigger Warning: This article discusses mental health struggles and suicide. If you are experiencing suicidal ideation, please call a trusted loved one, therapist, or the National Suicide Prevention Lifeline (24/7, USA): 1-800-273-8255

“Compassion fatigue” may be better termed “empathy fatigue“. It is not so much the compassion shown to pets and their owners that causes emotional fatigue; it is the vast amount of empathy, or feeling the pain that another being is feeling, that can lead to distress and fatigue.

Why Veterinary Professionals Don’t Seek Help

What Is “Compassion Fatigue” and “Burnout”?

Risk Factors Contributing to Compassion Fatigue and Suicide in the Veterinary Profession

How Can Pet Owners and Clients Help Their Veterinary Team?

How Can Veterinary Professionals Help Themselves?

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themeowingvet

Trigger Warning: This article discusses mental health struggles and suicide. If you are experiencing suicidal ideation, please call a trusted loved one, therapist, or the National Suicide Prevention Lifeline (24/7, USA): 1-800-273-8255

“Compassion fatigue” may be better termed “empathy fatigue“. It is not so much the compassion shown to pets and their owners that causes emotional fatigue; it is the vast amount of empathy, or feeling the pain that another being is feeling, that can lead to distress and fatigue.

Why Veterinary Professionals Don’t Seek Help

What Is “Compassion Fatigue” and “Burnout”?

Risk Factors Contributing to Compassion Fatigue and Suicide in the Veterinary Profession

How Can Pet Owners and Clients Help Their Veterinary Team?

How Can Veterinary Professionals Help Themselves?

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