Studies: Stressed pet owners, toxic workplaces contribute to team burnout

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Professional quality of life is becoming an increasingly transparent topic in the veterinary field, with much attention focusing on the high rates of depression and suicide experienced by veterinarians, compared to other professions.

Spotlight on suicide

September is National Suicide Prevention Month-a chance for mental health advocates, prevention organizations, survivors, allies and communities to unite to promote suicide prevention awareness-and it's no secret that this is a huge issue in the veterinary profession. This month we're focusing on this important subject in a special dvm360 Spotlight Series; watch for them online and in print. In the meantime, if you're struggling with suicidal ideation or even just plain old burnout or depression, be sure to access our list of veterinary-specific mental health resources at dvm360.com/mentalhealthlist.

Two studies recently published in JAVMA addressed how veterinary hospital environment and interactions with clients contribute to occupational stress.

How toxic teams, workplaces affect the whole veterinary team

In one of the two studies, researchers at Colorado State University and the University of Guelph examined how the practice environment affects job satisfaction and quality of life, not just for veterinarians but also for all team members. Employees from 10 companion animal practices around the United States were recruited to participate in the study.

Personnel completed a Team Effectiveness Instrument (TEI) questionnaire, this one focusing on issues specific to the veterinary practice environment. Shared goals, communication, teamwork and conflict were used to indicate coordinated vs. toxic environments, and levels of individual and team-oriented engagement were assessed using questions on respect, trust, appreciation and responsibility.

To gain insight into respondents' compassion satisfaction versus compassion fatigue, investigators administered two additional assessments: the Interpersonal Reactivity Index and the Professional Quality of Life Scale. Participants were also asked to answer the question, “On the whole, how satisfied are you with your job?” on a scale from 0 (extremely dissatisfied) to 100 (extremely satisfied).

Twenty-one percent of the 232 respondents were veterinarians, while the remaining 79% included veterinary technicians, practice managers, kennel workers, client service representatives and other team members.

Responses demonstrated that health and wellbeing in the veterinary profession have multiple influences, including age, number of years in the profession and level of empathy for others. Respondents who were more established in their current positions reported higher levels of compassion satisfaction, compared to those relatively new to their jobs. However, it's important to note that respondents with longer careers in veterinary medicine indicated higher levels of burnout, empathetic concern and personal distress than did those who were newer to veterinary medicine.

Secondary traumatic stress-emotional distress felt from another person's trauma (and the subject of our upcoming November 2019 dvm360 Leadership Challenge)-was more pronounced for associate veterinarians than other team members; this form of stress also correlated positively with the number of years spent in the veterinary profession. Respondents with the highest reported levels of empathy were also most likely to suffer from burnout. This important finding suggests that, although a certain level of empathy toward clients and other team members is beneficial, highly empathic individuals need to develop coping skills to prevent burnout and preserve job satisfaction.

Not surprisingly, indicators of a toxic work environment-such as interpersonal conflict, poor communication and lack of recognition of hard work-were associated with employee burnout. This risk can be minimized, however, by fostering a positive team environment, including respect for all team members and open communication regarding mental health and stress management techniques.

How caregiver burden affects veterinarians

Caregiver burden, or the strain caused by caring for an ill family member, is a known contributor to depression and low quality of life. Studies in human medicine have also shown that distressed patients may overuse medical care, which can impact the medical team's workload. In the second of the two studies, researchers at Kent State University and Colorado State University recently studied how caregiver burden experienced by pet owners affects veterinarian wellbeing.

Investigators conducted a literature review and consulted with veterinary practitioners to identify potential client-related stressors, particularly those involving interactions with owners of chronically or terminally ill pets. They created a survey encompassing these topics, the Burden Transfer Inventory (BTI). In its final format, the survey was distributed through the Veterinary Information Network (VIN) to practicing companion animal veterinarians. Participants were asked to rate the frequency at which certain client interactions had occurred within the past week as well as the veterinarian's reaction to each interaction, ranging from “not bothered or upset” to “extremely bothered or upset.” Examples of client behaviors included poor memory for instructions, treatment non-adherence, grief, anger and excessive communication. The 1,151 responding veterinarians also completed the Perceived Stress Scale and Copenhagen Burnout Inventory to examine how burden transfer correlated with levels of stress and burnout.

The authors also distributed a modified version of the BTI to pet owners to assess the frequency of demonstrated behaviors. To target owners of chronically and terminally ill pets, the survey was distributed through social media to members of several pet disease groups. The 372 respondents also completed the Zarit Burden Interview, an assessment of caregiver burden modified for companion animal owners.

For veterinarians, burden transfer (indicated by BTI results) correlated positively with stress and burnout. Confrontational client behaviors-such as anger, blame or unwillingness to pay-occurred less frequently but elicited stronger reactions than did other interactions. Interestingly, the veterinarian's reaction to client behavior, rather than the behavior itself, had the greatest influence on stress and burnout. This is an important reminder that, while negative interactions may be unavoidable in practice, healthy coping mechanisms are important in maintaining professional wellbeing.

Compared to pet owners with low levels of caregiver burden, those experiencing high caregiver burden reported a higher frequency of the indicated behaviors on the BTI. This suggests that a client's underlying distress can negatively affect various aspects of the veterinarian-client-patient relationship, including treatment adherence, communication and trust. In cases of chronic or terminal illness, it's important to recognize and address the risk of caregiver burden with pet owners. Proactively communicating about this topic may, in turn, help minimize the likelihood of negative client interactions down the road.

Take-home points

Issues surrounding emotional wellbeing, including stress and compassion fatigue, affect not only the veterinarian, but the entire veterinary team. Emphasizing team building practices can, in turn, increase job satisfaction and minimize the risk of employee burnout. Team members who feel recognized and empowered in their work are less likely to feel distressed.

Likewise, results suggest that caregiver burden impairs treatment adherence and communication, thus increasing the risk of burden transfer to the veterinarian. Effective coping strategies can help improve wellbeing for both the veterinarian and client, thereby optimizing patient care.

References

1. Pizzolon CN, Coe JB, Shaw JR. Evaluation of team effectiveness and personal empathy for associations with professional quality of life and job satisfaction in companion animal practice personnel. J Am Vet Med Assoc 2019;254(10):1204-1217.

2. Spitznagel MB, Ben-Porath YS, Rishniw M, et al. Development and validation of a Burden Transfer Inventory for predicting veterinarian stress related to client behavior. J Am Vet Med Assoc 2019;254(1):133-144.

Dr. Natalie Stilwell provides freelance medical writing and aquatic veterinary consulting services through her business, Seastar Communications and Consulting. In addition to her DVM obtained from Auburn University, she holds a MS in fisheries and aquatic sciences and a PhD in veterinary medical sciences from the University of Florida.