In his quest to understand the huge problem of burnout in the veterinary profession, Dr Ivan Zakharenkov has been quite surprised by some of his research findings. By Rob Johnson
Everyone loves the vet until they have to pay the bill. For the 12 years he was working as an emergency veterinarian in Canada, Dr Ivan ‘Zak’ Zakharenkov would see it firsthand: the panicked client, the desperate dash to the clinic, the distressed animal vomiting on the vets and the nurses through triage, the diagnosis and treatment plan … “Then you present clients with the estimates and you hear from every second or third person that you’re doing it for money, you don’t love animals, and this is not why you chose this profession,” he sighs. It’s one of the major contributors to burnout in the profession. It was why he left—twice.
But he also realised it wasn’t as simple as stressed clients. He had watched the consolidation of clinics under corporate brands. He saw it continue when he switched to software development with SmartFlow, then with IDEXX, then his own company, Veterinary Integration Solutions (VIS). He suspected that this new, corporatised world might offer both a cause and a cure for burnout.
He enrolled in an MBA at the University of Cumbria. “I was struggling with the approach that everybody takes towards burnout,” he says. “For the most part, people say that veterinarians need to learn more about self-care, and I agree with that. But I just think that we need to stop pointing at the veterinarian.”
To start his research, he “just wanted to, as a baseline, find out, ‘are we burned out?’ I wanted to have a broader view on the industry, not just veterinarians. The nurses and the managers too, because it’s a business in which there are other functions rather than veterinarian. And we sure proved that, yes, everybody’s burnt out.”
But who was most burnt out … and why … proved very surprising.
Dr Zak devised an outreach campaign for his Burnout Survey. The participants were veterinary professionals mostly from English-speaking countries: USA, Canada, UK, Australia, and New Zealand. It received 1457 responses, a large enough sample to draw robust conclusions. When he started breaking the data down, he uncovered some surprising correlations. Firstly, that burnout was not significantly different between consolidated and independent practices. Secondly, that the age group under 30 (which constituted 27 percent of respondents), showed the most significant burnout among veterinary professionals. They were also less enthusiastic and more physically exhausted than their peers in other age groups.
And thirdly, there is a dangerously low level of job satisfaction among veterinary technicians or nurses. It was significantly worse than the satisfaction rate of the veterinarians.
Dr Vanessa Rohlf is a consultant, therapist and educator specialising in compassion fatigue, stress management, and animal bereavement. A former veterinary nurse, she is currently a research fellow in the School of Psychology and Public Health at La Trobe University looking at burnout among Australian veterinarians with colleagues Rebekah Scotney, Holly Monaghan, and Pauleen Bennett. Dr Zak’s findings about the age difference in burnout rates don’t tally immediately with what she’s finding in her research—but her counselling and training work offer some clues as to why younger vets are at greater risk.
“Anecdotally, based on people that I see and observe, I think the stressors for vets might be things like having those financial discussions, working long hours with poor pay,” she says. “But when we’re talking about young veterinarians, they come from their training where everything’s clinical—there’s a clear answer to problems when you’re at university. And they come into a clinic and everything’s so murky and complex.
“They’re working with large cases in highly charged emotional situations and they’ve got to make quick decisions, with limited clarity about what’s the right thing to do. And I think for them that’s a major stressor as well.”
The finding about nurses being burnt out reinforces other anecdotal evidence, she says. “When we look at the research as a whole, we know a lot more about factors predicting burnout in veterinarians compared to veterinary nurses. We need to do a lot more research of veterinary nurses. I think the factors which contribute to burnout are also probably different. Even though they’re working in the same workplace, they come from very different backgrounds, different education levels, and there’s different stressors I think which impact those levels of burnout.”
Dr Zak hopes his research will contribute towards a better understanding of the reasons veterinary nurses are so burnt out. But from what he’s done and seen so far, he has a pretty good idea.
“Well, I don’t want to be executed for saying this,” he says. “But they burn out because of the vets.”
It’s not me … it’s you
Dr Zak’s experience of how an average clinic runs comes from his years as a relief vet, as well as his observations in his current role. He could see that on the ground, it was almost always the same—the practice was run day-to-day by the technicians or nurses.
“Through my entire veterinary career, if you’re working with experienced technicians, they will examine the pet for you, take the history, and will explain everything,” he says. “They will almost lead you to the most common conclusion out of everything you see. The vet just signs off and prescribes medications. So I think the nurses do most of the work, but they’re not appreciated enough.
“In many instances, technician is a tough job. Most of these people go into the profession because they genuinely love animals. It’s definitely not to become rich. It has a certain ceiling you hit in your late 30s by which time you’re physically exhausted. The shifts are brutal, and you’re not paid enough. This is a direct path to burnout.”
It’s also why Dr Zak’s initial hypothesis—that consolidated practices would have higher burn out rates—wasn’t borne out by the numbers. It didn’t matter whether a practice was part of a large group or a small independent. Burnout was the result of low pay, long hours, aggressive clients, and a boss who won’t give you any alternatives. For example, pressure from the top to do unnecessary work to increase profits for the clinic would feed directly into the problem.
The workplace culture at the level of the individual practice seems to be where the problem lies. As Dr Rohlf points out, people drawn to the veterinary profession are high on empathy, which makes them vulnerable if they’re working for, or among, burnt out colleagues. “In the research that I’ve done, what I’ve found is organisational factors like work pressure, having control of your job, flexibility, the emotional demands of the job, opportunities for development, all contributes to burnout too.”
And that’s where the solution lies.
The management theory that first interested Dr Zak and informed his research was the ‘lean’ methodology, first championed by Toyota in the 1930s.
“Everybody thinks the lean method is about eliminating the waste, which is, from the business perspective, one very important aspect,” says Dr Zak. “But one of the principles of lean is empowering the frontline staff. I think that continuously empowering the technicians and the veterinarians, is the key in lean thinking and it can be successfully applied to healthcare.
“Empowering the staff means letting them own a part of the process. When you’re thinking you want to improve something, pitch it to the staff. And then let them walk to the conclusion, develop the process. If you allow technicians to develop processes, they’ll love it, they will pass it along, they will all stick to it and they will keep each other accountable.”
Because lean methods can be applied at a practice level, it is a suitable management model for both consolidated and independent clinics. Although it’s not necessarily a replacement for self-care approaches to managing burnout, it does tally up with some of the findings from Dr Rohlf’s research too. “Opportunities for development actually are one of the most important factors that contribute to burnout,” she says. “So if staff are given a lot of opportunities for development, they’re less likely to experience burnout. That’s really consistent with these lean management techniques.”
One of the biggest challenges to change the way you do things is finding the time to change. If you and your staff are already pulling 12-hour shifts every day, it’s hard to step away from that and devise new ways of running your business. But one of the appeals of Dr Zak’s suggested solution is you don’t have to devise the process—just set the right goal.
“You guide them through it,” he says. “You set the goals. If you’re setting the goal by saying, this is what we’re trying to do—we’re trying to improve throughput of the patients through the front desk. You need to come up with a ‘why’. If the ‘why’ is because I want a new boat, it might not be empowering. If the ‘why’ is because we all want to get a bonus or a raise or celebrate, then you all own it.”
To read more about Dr Zak’s research, read his whitepaper at vetintegrations.com/insights/burnout2020/