Dr. Wendy Hauser is the founder of Peak Veterinary Consulting. She writes extensively and speaks frequently about hospital culture, communications, leadership, client relations and operations. She is a member of the AVMA Veterinary Economic Strategy Committee.Read Articles Written by Wendy Hauser
Today, many veterinary professionals feel exhausted, overwhelmed and frustrated by their lack of control over day-to-day workplace responsibilities. These emotions — symptoms of burnout — are so commonplace that veterinary students have normalized the condition as part of what it means to be a veterinarian. But what is burnout? And more importantly, should it remain an expectation?
Burnout is an occupational syndrome that arises from chronic interpersonal job stressors. According to researcher Dr. Christina Maslach, workplace burnout has three key characteristics:
- Emotional exhaustion.
- A sense of reduced personal accomplishment.
Employees experiencing burnout are emotionally and physically exhausted, often feel overwhelmed and isolated, and think their job performances don’t make a difference. They become pessimistic, detached and even hostile. They treat others as objects, diminishing their colleagues’ individuality and keeping them at an arm’s length.
Why Does Burnout Matter?
Burnout in a veterinary practice hurts the individual, co-workers, clients, patients and the business. Burnout is not hierarchal and can strike any employee. Studies found that burned-out employees are more than twice as likely to look for another job.
Given the lack of qualified veterinary professionals, hospitals cannot afford to lose their most valuable assets: their people.
Burnout has been associated with absenteeism and reduced productivity, and it contributes to a poor workplace culture. In human medicine, it has been associated with more medical errors, decreased patient safety, a poorer quality of care and lower patient satisfaction scores.
Most significantly, individuals experiencing burnout pay the highest price. Besides mental and physical distress, often present are sleep disorders, chronic fatigue and mood changes, such as increased irritability and withdrawal. Burnout also is tied to increased alcohol and substance abuse, further contributing to the downward spiral.
The Truth About Burnout
Burnout is mistakenly thought to be primarily caused by an individual’s response to workplace stress. Efforts to mitigate burnout often focus on the employee, such as programs to improve mindfulness through meditation and tactics to reduce daily job strain and anxiety. While these strategies are important, they fail to address the root causes of burnout.
The truth is that burnout is a work-related problem caused by the workplace and not the individual.
3 Ways to Extinguish Burnout
1. CREATE WORKFLOW EFFICIENCIES
As you serve your clients and their pets, where do bottlenecks occur? Here are two easy ways to identify where pain points exist:
- Spend a day watching where things go well in your workflow and where breakdowns occur. Prolonged patient visits can cause inefficiencies. For example, are appointments on time from start to finish or delayed due to inadequate staffing, poor communication, bad scheduling or an excessive patient volume? Are mistakes made in the medication dispensed or on client invoices? Do pet owners complain about the fees, which could indicate a lack of client education about the value of the services?
- Ask your team members. They know where problems exist and likely have good ideas for improvements.
Let’s examine two common areas that create inefficiencies: medical record keeping and the misappropriation of staff.
In one study, outpatient physicians spent two hours completing medical records for every hour they spent face to face with clients. Administrative burden is a well-documented cause of burnout because it prevents doctors from doing the work that they find most meaningful: helping patients.
A common source of inefficiency in veterinary hospitals is medical record keeping. A solution found in human health care is to hire dedicated exam room scribes, who capture real-time medical findings and clinical recommendations. The cost of the scribes was offset in two ways:
- The ability of doctors to see more patients.
- The increased retention of physicians who could now engage in more purposeful work.
When veterinary team members do the work that they are trained to perform, efficiency improves. In your hospital, is the right work being done by the right team member at the right time? Are you leveraging your teams so that veterinary assistants help in the exam rooms and fill medications, allowing technicians to focus on diagnostics and provide advanced care to hospitalized patients? Rather than hire a professional cleaning service, do you insist that your team stay after-hours to clean the hospital? How can the utilization of team members be aligned to create a better workflow and enhance workplace engagement?
2. RE-EXAMINE HOW TEAM MEMBERS ARE COMPENSATED.
Production-based pay is associated with higher rates of burnout in human medicine. In veterinary medicine, the unintended consequences of production-based pay include case hoarding by veterinarians, competition over more complicated cases and a damaged workplace culture. The perceived lack of fairness also is a burnout risk factor.
An alternative to production-based pay is salary plus merit-based bonus, a structure described in the article “A Prescription for Change.” (Read it at bit.ly/change-TVB.)
A challenge for many veterinary hospitals is how to appropriately develop and compensate team members. Frequently, higher rates of pay are associated with tenure and not necessarily with ability, which creates conflict when employees with more advanced skills or experience are hired. A solution is to create position-specific mastery levels. Within each level is a clear list of skills and education that an employee must master before being eligible to advance. The tiered approach:
- Creates a clear path for continued growth and advancement within a specific position.
- Appropriately compensates an employee based on proficiency rather than tenure.
- Promotes a learning culture in which team members are encouraged and rewarded for attaining new competencies.
- Supports a more engaged workforce, which helps to prevent burnout.
3. ALIGN PERSONAL PURPOSE TO WORKPLACE ACTIVITIES.
A mismatch of values between the employee and veterinary hospital creates chronic interpersonal stress, burnout and turnover. Do this to create alignment and cohesiveness between the hospital and team members:
- Ask yourself, “What are our organizational values?” Every organization has values that help define who is served and how. Are your hospital’s guiding principles clearly articulated and actively reinforced? Are the core values lived daily? At my former hospital, some of our core values were friendliness, professionalism and active education. These were evident in every interaction with clients and each other.
- Ask yourself, “Do each employee’s work responsibilities match with what motivates them?” Too often, we hire employees to fill a specific job description and fail to look for ways the position can be tailored to what motivates them. Observe your employees as they complete their work. Which parts of the job bring them joy, as seen by increased engagement, happiness and passion? Which ones do they struggle to complete, as seen by substandard work, procrastination and a lack of accountability? How can their positions be realigned so that they spend more time on tasks that fulfill their purpose? For example, I had a talented credentialed technician whose passion was creating and documenting processes and procedures. We restructured her work responsibilities so that she could dedicate four hours a week to creating documents that helped us to be consistent with our clients and in our work. She was happy, and my hospital, team and clients benefited from her beautifully crafted work.
Burnout cannot and should not be an expectation that accompanies a veterinary degree or something implicitly accepted as normal. When hospital leaders recognize that burnout is created in the workplace and by the workplace, then they can take active steps to douse the destructive behaviors contributing to such a costly and insidious workplace hazard.
12 CONTRIBUTORS TO BURNOUT
Burnout has six commonly recognized workplace causes. After an exhaustive review of veterinary and medical literature, I believe that six additional unique factors contribute to burnout in veterinary hospitals.
- Unsustainable workload: This includes the unrelenting pace, volume and workload intensity that veterinary teams face in providing services in increasingly inefficient ways.
- Lack of perceived control: Veterinary team members have little control over when, how and with whom they do work.
- Insufficient rewards: While financial incentives are important, increased compensation is not a burnout remedy. An employee’s sense of purpose and well-being are reinforced when hospital leaders and co-workers recognize and acknowledge that the person’s efforts make a difference to the team, clients and patient well-being.
- Lack of a supportive community: Veterinary medicine is a caregiving profession, so co-worker support is an important component in managing daily stresses. Burnout increases when affection, caring and compassion are lacking in the workplace.
- Lack of fairness: This occurs during misalignment between personal and organizational values. It’s unknowingly worsened when policies and procedures are applied unevenly.
- Mismatched values and skills: Engaging in meaningful work that motivates the employee is a powerful antidote to burnout.
UNIQUE CONTRIBUTORS IN VETERINARY HOSPITALS
- Chaos in the workplace: When veterinary hospitals manage themselves, chaos is the norm. The symptoms include less teamwork and professionalism, inefficiencies, and a lack of guidelines governing how team members do their work.
- Production-based pay: In human medicine, production-based pay contributes to burnout. In veterinary medicine, it creates an inducement to work too much, especially by newly graduated veterinarians with high educational debt. It also decreases teamwork, which is another risk factor.
- Client financial limitations: Recognized in many studies as a primary or contributory factor to burnout, a pet owner’s inability to pay for necessary veterinary care is a source of moral stress for the veterinary professional. The cumulative effects of negotiating with owners for needed pet care is exhausting and disheartening.
- Disrespect for veterinary technicians: A recent study found that the key role of veterinary technicians in animal care is poorly understood and largely unrecognized by society. When combined with how they are devalued within some hospitals, such as routinely being used as janitors or for animal restraint, technicians lack a clear professional identity, which places them at a high risk of burnout.
- Feminization of the veterinary workforce: Being female is a recognized risk factor for burnout given the societal pressures on women to spend time after work on child care and household activities. In one study, married female physicians with children spent 100 additional minutes a day on such activities compared with married male doctors who were fathers.
- Corporatization of the veterinary profession: In human medicine, small independent practices experience lower rates of burnout, most likely due to increased autonomy and control. While corporatization in veterinary medicine tends to be more hands off, it should be considered a possible contributor to burnout.