Written by By Dave Shuey — IndeVets Veterinarian Social Worker
I knew that my veterinary technician career was doomed when the work no longer meant anything to me. I could no longer make myself care about whether or not the patients got better. Nights of providing futile intensive care because necessary conversations about euthanasia were not occurring, other nights of unsafely staffed hospital floors and barns and whatever permutation of impossible workloads that contained.
The only nights that provided real relief were when I could escape into the stall of a favorite equine patient and cry into her neck, telling her that we were all doing the best we could. I worked all these nights in a state of self-preservation, a sense of threat and isolation, trying to practice a standard of care that the work environment and its demands made impossible. “Make sure you’re taking care of yourself,” people would say. That statement began to fall on deaf ears, it was cliched and meaningless in the face of the persistent challenges and lack of change.
Eventually, I found new meaning in veterinary end-of-life care, and finally mental health and wellness for veterinary professionals. As I write, I reflect that the loss of meaning is the last critical threshold one crosses before thoughts like quitting, not caring, and self-harm begin to stir.
In this essay I’ll show that veterinary burnout is not a disorder (despite its dubious acquisition of its own ICD-10 code), but rather a group of symptoms that begin with environmental imbalances and hazards and end with crippling emotional exhaustion and loss of the sense that one is working for anything. I will also suggest changes that go far deeper than self-care, and that hopefully provide relief and insight to suffering individuals and organizations.
The Symptoms and Drivers of Veterinary Burnout
In 1974, the psychologist Herbert Freudenberger was observing mental health workers volunteering their time at a free clinic for people in New York City. He watched as person after person entered this unpredictable, emotionally charged, highly complex and acute, and often desperate setting full of energy and the courageous desire to help.
One by one, they succumbed to crippling emotional exhaustion, cynicism and resentment of patient, clinic, and each other, and the eventual loss of ideals and sense of competence, and eventually any real meaning for their lives. He coined the term “burnout,” which has since been thoroughly studied, understood, misunderstood, debated, ignored, and profited from depending on one’s motivations, for the past half century. It is self-evident that the veterinarian’s experience of their environment is often indistinguishable from that of those mental health workers in New York.
Less than 10 years after the birth of the term “burnout,” Christina Maslach and Susan Jackson of the Association for Psychological Science produced the Maslach Burnout Inventory, which has become the most widely administered instrument for assessing burnout regardless of industry or occupation. The inventory has been increasingly used in veterinary medicine, yielding important but predictably alarming information about what happens to veterinarians in their work. It makes no claim to diagnose or prescribe, but rather seeks to reflect the experience of the sufferer and address the causes of that suffering. Let’s briefly look at the basic domains of the Inventory and see where Veterinary Burnout shows itself.
- Emotional Exhaustion: Veterinarians accumulate emotional exhaustion, the feeling of being stretched beyond the ability to effectively practice, in a variety of ways unique to the profession. These include workload demands, unsafe shortage of resources (staffing), the ethical and personal conflict of seeing treatment plans thwarted by client financial constraints, the exposure to sometimes deranged and abusive online reviews, and the practice of euthanasia, to name but a few. Emotional exhaustion grows out of a chronically stressed state in which body and brain learn to survive in a constant mode of threat-management.
- Depersonalization: This symptom begins as a normal coping response to ongoing emotional exhaustion. Like the denial or numbing of acute grief and loss, depersonalization is the brain trying to keep the sufferer from feeling too much at once. Over time, untreated depersonalization develops into cynical resentment, which is often expressed as mistrust of clients and colleagues, or the inability to appreciate one’s very real successes.
- Personal Accomplishment: The Inventory explains that increased levels of emotional exhaustion and depersonalization are the main indicators of burnout, but a decrease in this particular score indicates the generalized effects of the first two. This person is suffering terribly. Veterinarians, like other helping professionals, place profound meaning in their ability to cure, to alleviate suffering, to find a definitive diagnosis, correct a like-threatening surgical problem, and so on. The loss of this sense of meaning completes the symptomatologic picture of veterinary burnout and brings to light the heightened danger (three times the national average) of considering suicide as a final, curative coping strategy.
The Maslach Burnout Inventory is paired with its counterpart, the Areas of Worklife Survey. This survey explores what Maslach and Jackson name as the cause of burnout, the working environment. Areas of Worklife identifies the quality of relationship between the individual and their work based on six areas: workload, control, community, fairness, reward, and values. Quality is described in degrees of “fit” between the individual and the organization. Areas of “mismatch,” as the survey expresses it, refer to the actual environmental stressors that contribute to veterinary burnout as they become toxic.
Whatever meaning one assigns to these areas, the critical point for the veterinarian to hold on to is that the mismatch originates in the environment and not the person. As Drs. Dean and Talbot remind us, the demands of the job and the resources (hence much of the ability) to meet them are controlled by leadership, who creates and maintains the working environment and claims the values to which it holds its employees. To overcome veterinary burnout, top-down change is required, not self-care prescriptions or “official” recognitions, and most of all not the victim-blaming that the term “burnout” too often perpetrates.
Self-Care is Not a Solution: Coping is not a Goal
Perhaps it has become apparent that veterinary burnout, which is really moral injury, is something that happens to veterinary professionals and not something that is wrong with them. If this definition is granted, it follows that the excessive focus on self-care and coping strategies like yoga, meditation, cognitive reframing, breathing, and setting boundaries misdirects the responsibility of right back onto the sufferer and allows the underlying problem to continue to be ignored. It would be like equipping a victim of physical abuse with the latest and greatest of mental and physical health resources and strategies, and the person still goes home to their abuser. To heal moral injury and reduce veterinary burnout, I suggest a few changes that will happen both within the organization and individual. These changes are devoted to the theme of honest self-reflection.
External Changes (For the Organization)
- Show vulnerability in relation to the stated core values, admitting when they fall short.
- Provide informal, direct, daily support (that means actually see, talk with, and listen to the person, you know, a relationship?) instead of officially designating a “veterinary so-and-so week” once a year.
- Join clinical workers in their environment and learn the sensory experience of it.
Internal Changes (For the Individual)
- Build on strengths, don’t attack weaknesses. There is nothing wrong with you.
- Take all of the time off provided to you by the organization.
- Make friends with fallibility, uncertainty, and ambiguity, and find friends to talk about it.
Conclusion and Hope
Veterinary burnout is a stress-related illness caused by a unique work environment, one that includes both the preservation and the taking of life. The work environment is an expression of an organization’s culture, and of the behavior of the people who hold power over resources and communication. Unsafely high degrees of workload or unsafely low degrees of control, community, reward, values, and communication lead to moral injury. Moral injury shows up as emotional exhaustion, unhealthy detachment, and loss of meaning. The hope for overcoming veterinary burnout lies in the health of the relationships among coworkers and the vulnerability of leadership. That hope is conveyed and kept alive through informal touches, generous and genuine communication, and the grateful giving and receiving of help.