Written by Joric McLean
“The Edge…There is no honest way to explain it because the only people who really know where it is are the ones who have gone over. The others, the living, are those who pushed their control as far as they felt they could handle it, and then pulled back, or slowed down, or did whatever they had to when it came time to choose between now and later. But the edge is still out there.” – Hunter S. Thompson
For over 9 years, I served as an HR Director for a group of animal hospitals. I had the opportunity to work with over 200 veterinarians and spoke to hundreds more. From students pursuing their DVM to doctors working in my area, across the nation, and beyond, all had a unique story to tell. In those thousands of conversations, I began to understand the pressures you face on a daily basis. Several doctors confided they had attempted suicide, while others candidly admitted they were having a hard time seeing a light at the end of the tunnel. I feel it did not matter whether I was speaking to someone who was a Baby Boomer, a Gen-Xer, or a Millennial. There were some common threads that bound all three generations. It is in these threads where I believe doctors may begin to lose hope.
There are numerous environmental factors to weigh when talking about the pressures veterinarians face today. Over the last 15 years, the pet industry has experienced an explosion of pet parenting no one saw coming. This has left the industry in a reactive mode on all fronts. Universities are scrambling to fill their vet classes with qualified candidates, creating a chasm of low doctor supply and increasingly higher client demand. Those same universities never stopped to look at their class demographics, which shifted greatly towards women in the last 20 years. They did not think about how the vet community would be impacted by having a female-dominated industry, with a high percentage wanting to be working moms. Working short-staffed has become a way of life for many in the veterinary community. Employers have been slow to react to both the high demand for pet-related services and more females in doctor and leadership roles, who want to be mothers too. Even the corporate giants have been slow to recognize the influx of female talent at all levels and the time off required to have children. Staff pay has been historically low, leaving clinics big and small with a turnstile of staff coming and going. And let’s not forget about clients. Clients are becoming more educated and a bit more challenging in how they question methods and standards of care for their pets. Sometimes those conversations end up being more combative than collaborative. In short, more clients are coming in more often, with more pets, for more treatments, to clinics with fewer doctors and staff to treat them. That is a recipe for disaster. Lastly, I have reached out to several 2021 new grads, and their debt load has surpassed $500,000. That is a massive anchor weighing down new grads before they even start their veterinary career. The pressure to perform, produce, and pay off those loans has never been so great. Most of the female doctors I worked for, were moms. How on earth did they pull this off without pulling out their hair? I have no idea.
General mindset of a doctor
This is my rough, amateur analysis of a typical veterinarian. This comes from thousands of talks and meetings, so I hope I don’t offend. In a general sense, I found veterinarians to be more relaxed and easy-going individuals, a typical Type B personality. Most are driven and quite competitive. Veterinarians had to be to get in and graduate from vet school. I found most doctors to be non-confrontational. Genuine and kind, but more introverted. Veterinarians tended to be strong empaths, which seems to run through the DNA of those associated with a medical profession. Exceptional people, with good hearts and great intentions. Almost all were willing to pitch in and help whatever the cause. Honestly, all but a few were very likable and highly regarded by their employees, clients, and the greater vet community. I believe doctors like to work and want to give. Sometimes employers and clients can exploit and take advantage of that sentiment, and the “giving” does not get balanced with enough taking.
Inability to say “NO”
If someone asked a doctor to stay late, work an extra shift, or take on the last-minute emergency, invariably, the response would be, “OK.” As stated in the last paragraph, this seems to be innate for veterinarians to always want to do more and find a way to say yes to any situation. But as businesses demand more shifts and hours, and as clients become more challenging, there is a need for veterinarians to learn how to set boundaries. It’s in your blood to help, and vets will pay whatever personal price is necessary to do so. Oddly though, I did find a theme of doctors saying, “No” to their families and personal time, in order to say “Yes” to work. Sometimes a doctor will make a conscious choice of work over family. But just as often, the business would guilt a doctor into working an extra shift. Unlike karma, rarely did that extra shift worked come around to them in the form of supplemental time off. Employers in every profession are willing to take whatever you are willing to give. I have worked in organizations where tag lines like, “do more with less”, and “help us out now and we will take care of you later” were like the empty campaign promise most politicians make, and rarely deliver on. I spoke to many younger doctors who yearned for a more balanced work-life, and many pushed off having kids until they were farther into their careers. Business demands often derail those who need that precious time to be with family and friends. One veteran doctor, who was an owner once commented, “I can’t say no. I have to say yes because I’m an owner. If a doctor calls out sick, I have to show up. As an owner, it is my responsibility. I can’t tell you the last time I was out with my husband, and I’ve missed so many recitals I just have my hubby send the videos to my phone while I’m working.” The pros and cons of ownership will be a future blog. Yes, owners have greater demands on their time and do not have the ability to say no as often, if at all. That is part and parcel of owning a business. I tried without success to be diplomatic when I asked the doctor, “you said you can’t say no, but you seem to have no problem saying no to your family. Why?” Right after she gave me some choice words, she sat back in silence and thought about it. Part of my role was to play cheerleader for the company, but this doctor needed someone to tell her it’s ok to say no to work once in a while. It might mean selling off ownership and working as an associate again. If that offered more flexibility and saying yes to her family more often, I thought it might be worth it. When doctors stand up for themselves to say no or push back, many employers think you are not being a “team player.” Good teams and good employers set their people up for success, not failure. Teamwork is a two-way street. If you feel your team/company is not setting you up for success, think about making a change. If your family keeps ending up getting the short end of the stick, and you want something different, seek employment elsewhere.
Pursuit of perfection and client expectations
A common echo in doctors’ voices was a pursuit of perfection that is at the core of many working in this profession. Pursuing perfection in two areas. First, you cannot lose a patient. Vets may save dozens of animals from certain death but will spend weeks perseverating on the one patient that did not make it. Second, I heard from many doctors who had hundreds of glowing reviews and genuine love from their clients who bring in cookies, flowers, etc., but focused on the one client who was combative or left a nasty review on social media. Over nine years in the industry, client expectations rose to the level of sometimes being impossible to meet. Not all clients, but a few more each week, means more stress, more arguments, or tense conversations. Veterinarians are struggling to meet or exceed these heightened expectations, often falling short and blaming themselves, versus the client or society who placed those expectations on them. Most doctors I worked with never thought about the miracles they performed during a shift, often focusing more on the patients they could not save or the clients they could not satisfy. I never thought I would be involved in numerous legal proceedings like obtaining orders of protection and so much litigation against clients. Social media has really gone sideways when it comes to pets. A memorable Facebook post, which was later turned into a Yelp review, stated, “If that happened to my dog, I would go into that hospital and mow down ever one of those mother****ers.” Thankfully nothing happened, but that chilling post impacted every employee, as well as their family and friends who saw it on their social media feeds. I wish I could say that was a one-off message, but sadly, dozens of those types of messages were posted over the years by people hiding behind anonymous names and avatars. As doctors, you are trying to do your level best every day, and there is a growing percentage of the public who believe doing everything you can is not enough. I think at some point, doctors have to give themselves a pat on the back and relax and realize not every client is going to be happy, mistakes will get made, and being perfect is not a goal. Of course, that is easier said than done, but going back to my comment about give and take. I think veterinarians are taking too much flak from clients, and more clients are getting more comfortable questioning, in a negative way, your methods. Some clients need to be fired. It’s the cost of doing business. The revenue coming in does not outweigh the hostile work environment created by any client. You and your staff deserve to work in a safe environment.
I had no idea what this was before I entered the industry. The emotional toll that builds up for doctors and staff is something the public needs to be aware of. Doctors stated compassion fatigue often triggered thoughts about whether their career or their life, was worth it. I found compassion fatigue to be acute with doctors who routinely performed euthanasia or end-of-life service. To make matters worse, if you are great at compassion and the handling of this very emotional event, you will be called upon and even referred to by other clients to perform this service. I worked with several doctors who, based upon their exceptional ability to connect with clients in these traumatic times, were the “go-to” doctors for this service. A vet’s job is to try and do what is in the best interest of the patient, with the outcome of saving the patient whenever possible. One colleague was the go-to euthanasia doctor at a practice. After years of performing multiple daily euthanasia’s, she admitted to me that most nights were spent trying to swim her way down to the bottom of a bottle of Jose Cuervo. The general stress of the job can get to the best and most senior doctors. In one case, I called a doctor to congratulate her on a work anniversary. It was her day off and I thought a verbal high-five was in order. I left the message around 9 am. She returned the call after 3 pm. When I answered, she was crying saying, “I waited hours to call you back because I had six train wreck appointments in a row yesterday, and I was trying to figure out which one you were calling about. I figured you were going to tell me one of the clients was upset. I just could not take any more negativity after yesterday. I’ve been frozen in bed most of today.” This was not coming from a new grad or younger doctor. She had been practicing for over 15 years. She was dealing with compassion fatigue and a healthy dose of burnout. A few months later, I ran into another doctor and her family at a restaurant who pulled me aside to say, “I’ve worked 18 days in a row. I have missed or been late to five of my kid’s events in the last two weeks. This is the first time the family has been together in almost a month. I’m fried. If I have one more client get upset with me, I’m going to have a meltdown. Then, I’m going to pack up my hubby and kids, get in my car and drive away to leave this profession in my rear-view mirror. I can’t do this much longer.” This was also a seasoned doctor, with over 20 years of experience. There is a pressure cooker building steam in this profession, and it’s destroying some amazing human beings.
Vet schools have a funny knack for hiking tuition fees, creating incredible stress for new grads. As a new grad, debt loads are reaching as much as $500,000. At some point, students will seek more cost-effective degrees, not involving veterinary medicine. This will only exacerbate the supply and demand issue. I believe every vet school is doing a disservice by not exposing students to the realities of vet life. Performing daily euthanasia’s, frequently working at short-staffed clinics (doctor and tech shortages), and a higher percentage of confrontational clients who engage in attacks in person and on social media, are not the recruiting strategies a university wants to employ before they take in six figures of financial aid. It’s common for new grads to come out of school less prepared than their prior generation. I say this as older doctors stated they received more clinical experience than their younger counterparts. Many newer doctors agreed. If this is true, more focus on textbooks and less focus on clinical experience create a harsh learning curve after graduation. Then, you get a new job and need to repay insane student loans while learning a craft that you are not being fully prepared for. On many occasions, I’d ask new vets, those out of school less than two years, what was the biggest stressor for them in the workplace. The overwhelming top response was, “My student debt.” Where are the professors, counselors, and mentors advising young women on how to cope with the stressors in this business? Are there mental health topics openly discussed at the university level? I had coffee with 4 doctors before I left the industry. Each had eerily identical stories. All of the relationships with their partners were in trouble, they were tired of missing or showing up late to their kid’s games and social events, but the weight of their financial burden made them feel like they had no choice but to choose work over family every single time. I must be honest I don’t know what will need to happen for a change. School needs to be more affordable, but it does not seem like the government, or the schools are looking to help in this regard.
Not taking time off
I just mentioned the financial pressures placed on doctors and it brings me to another sore subject, time off. This is a topic for almost anyone working in the United States. A majority of employees in the US do not take all of their allotted paid time off. There are studies that suggest many Americans do not even take 75% of their paid time off and veterinarians are in this group. One afternoon I spotted a doctor leaving for the day. She looked exhausted saying, “I feel guilty because we are short-staffed, and down two doctors.” I had to smile at the “all for one, one for all mindset”, but that mindset is prevalent amongst doctors, and it is eating you alive. Unfortunately, I don’t think employers will change. A change needs to start from the ground up, where doctors get together in practices and demand change. That might mean practices open later and close earlier. Maybe the business needs to amend their weekend or evening hours. My belief is that the veterinarian business was so male for so long, businesses have not updated their business priorities to realize women, most of whom will have kids, are not seeking to work 50–60-hour weeks like their male counterparts from previous generations. A doctor who wanted to start a family once confided, “I don’t have enough time. I literally do not see my husband long enough for us to be together to procreate, let alone have a family. Someday we will figure it out, but I’m not sure when or how.” I think her comments are a reality for many women who want a family but feel stuck on the hamster wheel of work, work, work.
The rise of female doctors
I got a kick out of going to vet schools to recruit students. Often, I would sit in an empty classroom and speak to students as they walked by. In between interviews, I would walk the hallowed halls and see the photos from each graduating class through the years. From the first classes through the Baby Boomers, those photos looked really white and really male. The graduates looked like me. Viewing graduation photos from the Gen-Xers, there was a transition happening with some schools producing up to 50% female graduates. As I saw the end of the Gen-X classes transition to Millennials, those graduation photos were overwhelmingly female. I could not help but stare at those faces and wonder how many would have kids, and how that would impact their personal and professional lives, as well as the entire industry. How many women would need to work part-time? How many would step in and out of the industry as their family grew? How many would forgo having children altogether, for the sake of their career? It is clear to me the majority of veterinary businesses, big and small, have no prudent strategy. The lack of strategy makes going to work each day more difficult for every doctor and their staff. What about working moms? Do businesses believe female veterinarians won’t have kids, or will only take the minimum time off when having a newborn? This is where I think you have strength in numbers. You may be able to unite and demand longer leaves, paid leaves in states where there are none, disability insurance to help cover maternity leave, sabbaticals, or extended personal leave time, amending hospital hours to help manage doctor schedules. This is not only about you and your fellow doctors, but it is to think about the future and those students in school right now, or young girls wanting to be a doctor down the road. If things are this out of balance now, what will it look like in 20 years?
Low staff pay
The veterinary community has a history of paying low wages to techs, receptionists, and others. The argument has been many states do not require four-year degrees like RNs in human medicine. This low pay is creating a widening gap in the type and quality of service a clinic can provide. In many US metropolitan areas, I am able to get paid more to flip burgers at certain franchises than work as a veterinary technician. It is my argument that working as a technician in the veterinary field is several times more mentally challenging and probably more physically challenging, than flipping burgers. Working short-staffed has become a way of life for many in the veterinary community and wages play a big part in that shortage. Employers have to reconsider staff pay. Techs do not need to get paid as much as RNs, but I think they should be paid more than someone placing a burger between two buns. There is the old adage, you get what you pay for. I am of the belief employees are a company’s best asset. Although I don’t feel I worked for any business that actually believed this, I do. If you are a sole practice owner or have ownership in a partnership model, ask yourself this question. Why would any reasonable person work for you if they could make $3-$5 more an hour, working at a burger joint with far less stress on their minds and bodies?
The current state of the animal health industry has led many veterinarians down some dark alleys. I think the solutions lie with you, the doctors. There is an old movie from the ’70s called, Network. The iconic line from the movie goes like this, “I’m as mad as hell and I’m not going to take it anymore.” I think you doctors, you DVMoms, need to put up your hands and say, “Enough is enough.” Be willing to walk away from bad bosses and bad clinics. Yes, the financial burden from college the government saddles you with is something that can’t be expunged. There is no immediate solution for this issue. But pushing back on work demands, learning how to say “no” more often to employers, and standing up to prickly clients may in some respects, help empower you to have more control over your career and your life. As you have read in prior blogs, I’m a believer in using a mental health professional to help you get through this ridiculous time we are living in. Suicide in the veterinary profession is not going away. It needs to be discussed in every clinic. Every conference and continuing education event should have some component of suicide awareness. Talking about this subject openly and candidly may help more doctors feel comfortable about coming forward with their stories to get help. The industry needs to take a long look in the mirror to see what part it has played in pushing doctors to the brink. The answers are out there, and I hope we find them before more doctors go over the edge.