Don’t ignore the tough questions: A qualitative investigation into occupational stressors impacting veterinarians’ mental health

Abstract

Objective

To explore Canadian clinical veterinarians’ perspectives of occupational stressors. Although extant research has emphasized quantitative reporting of workplace stressors in veterinary medicine, a qualitative approach can lend depth and context.

Procedure

One-on-one interviews were conducted with 25 veterinarians at the 2016 Canadian Veterinary Medical Association Conference.

Results

Thematic analysis revealed 9 occupational stressor themes: nature of the profession, veterinary relationships, client interactions, inadequate personal finances, early-career veterinarian strain, practice-owner strain, onus of responsibility, self-described personal characteristics, and moral stressors and moral distress. Participants also discussed perceived implications of these stressors.

Conclusion

This study contributes to knowledge on veterinarians’ mental health and discusses recommendations for mitigating occupational stressors to promote veterinarian well-being.

Clinical relevance

Understanding the occupational stressors that clinical veterinarians experience and the effects of these occupational stressors can lead to more targeted and comprehensive strategies to support veterinarians’ mental well-being in a clinical setting.

INTRODUCTION

Occupational stress is a dynamic process resulting from an imbalance between high work pressures and an inability to cope (1,2). A stressor is a perceived challenge or threat to an individual (3). Associations between occupational stressors and perceived high stress (4,5) in veterinarians have been reported (6). High work demands (4,6,7) and client challenges (4,6,8), moral distress (i.e., psychological distress when individuals violate their morality due to external constraints) (5,9) related to factors such as convenience euthanasia or balancing animal care with clients’ financial constraints, and animal welfare concerns have also been reported in veterinarians (5,10).

Personality elements (e.g., perfectionism) may increase susceptibility to stress, particularly within already stressful contexts such as veterinary medicine. Perfectionism is defined as requiring a higher expectation of oneself or others than the situation warrants (11,12). High perfectionism may be a prevalent personality trait in the veterinary community (8), despite some dissent (13). Trait perfectionism, a facet of perfectionism, is having consistently high standards for oneself or others and has been linked to psychological distress in veterinarians (5). Veterinarians with high levels of perfectionism are also more psychologically susceptible to moral stressors (5). Hence, although personality is not the cause of stress in veterinary medicine, perfectionism may exacerbate the effects of occupational stressors faced by veterinarians.

Chronic stress has been associated with burnout (14) and workforce attrition (10) in veterinarians. Furthermore, some veterinarians experiencing high levels of occupational stress also experience elevated anxiety (4,5) and depression (4,15). Indeed, longitudinal studies illustrated a causal relationship between occupational stress and anxiety or depression in other workforce sectors (16,17).

Although several quantitative survey studies have identified occupational stressors in veterinarians (6,7), qualitative studies, with their focused use of open-ended questions, allow participants to share ideas beyond those considered. For example, euthanasia is widely regarded as a stressor in the veterinary profession (6,7); however, when it was explored using semi-structured qualitative interviews, only some aspects of euthanasia were identified as stressful (having a close bond with the animal, identifying with the client during euthanasia, or euthanizing unwanted animals) (8). Hence, qualitative exploration of perceived stressors among veterinarians may provide new insights. The aim of the present study was to explore veterinarians’ perceptions of occupational stressors.

MATERIALS AND METHODS

Participant recruitment

Participants were recruited via newsletters and emails from provincial and national veterinary and practitioner organizations [e.g., Ontario Veterinary Medical Association, Canadian Veterinary Medical Association (CVMA)] and flyers sent to veterinary clinics. The researchers and the Ontario Veterinary College (Guelph, Ontario) communications team also publicised the study via social media [Twitter (now “X”) and Facebook].

Eligibility criteria were holding a Doctor of Veterinary Medicine (DVM) degree or equivalent; being English-speaking; and attending the CVMA Conference on July 7 to 10, 2016, in Niagara Falls, Ontario. An a priori sample size of 25 participants was elected based on logistical demands and similar sample sizes used in other qualitative veterinary studies (8,10). Theoretical data saturation (18) was also considered, as additional interviews would have been conducted if participants continued to provide new insights not heard in previous interviews.

Interviews

One-on-one research interviews were conducted at the CVMA conference and averaged 57 min in length (range, 24 to 90 min). A semi-structured interview guide was used. Questions pertained to participants’ direct experiences with stress and poor mental health, effects of personal well-being on work, and supports for resilience and coping. Additional information can be found in the discussion guide (Appendix 1, available online from: Supplementary Materials). Only results related to stress and stressors are reported. All interviews were audio-recorded and transcribed verbatim by a professional transcriptionist.

Analyses

This study used a phenomenological approach within a constructivist paradigm (19). Transcripts were analyzed to identify meaningful patterns within the dataset using thematic analysis (20), and to offer a diversity of perspectives, while acknowledging consistencies and variations in insights within and across the dataset (20,21).

The primary author (MC) carefully read the transcripts to explore the dataset for initial patterns (20), and drafted an initial codebook. Three analysts (authors MC, BH, AJ) inductively and independently open-coded the same 3 transcripts selected by the primary author. This analysis team discussed the codes, and the draft codebook was modified to produce the working codebook (21) that was used by at least 2 investigators to analyze each remaining transcript. As new codes and themes were uncovered, the working codebook was refined through an iterative process. Quirkos v.2 data-analysis software (22) was used to organize and examine codes to assist in rich interpretations (21). Candidate themes were refined, merged, and/or separated as needed until the analysis team was satisfied that each theme helped reveal the underlying significance of the dataset (20). We used STATA v.16 software (23) to calculate frequencies and means for the demographic data.

Credibility was established using member-checking and peer debriefings (24,25). Dependability was enhanced using an audit trail to establish a clear pathway of the decision-making process (26). Conformability was strengthened by the primary author’s use of a reflexivity journal during the analysis stage and by having multiple researchers collaboratively analyze the dataset (26,27).

Ethical considerations

The study protocol was approved by the University of Guelph Ethics Board (REB # 16MY029) and all participants provided written informed consent. Following interview completion, each participant received a $100 (CAD) honorarium. Identifying data (names, dates, and places) were removed to protect participant confidentiality.

RESULTS

Most participants self-identified as women (20/25; 80%), were married (21/25; 84%), practiced small-animal medicine (19/25; 76%), and were associate veterinarians (13/25; 52%). The mean age was 49.7 y (Table 1).

TABLE 1.

Demographic information of 25 veterinarian participants.

Variable	Subcategory	n	Percentage	Range
Gender	Woman	20	80	—
	Man	5	20	—
Age range (y)				31 to 69
	30 to 40	7	28	—
	41 to 50	4	16	—
	51 to 60	9	36	—
	61 to 70	5	20	—
Type of veterinary medicine practiceda	Small animal	19	76	—
	Equine/bovine	4	16	—
	Avian/exotic	6	24	—
	Small ruminant	1	4	—
	Otherb	6	24	—
Relationship status	Married	21	84	—
	Divorced	1	4	—
	Committed relationship	2	8	—
	Single	1	4	—
Salary range ($K)				45 to 200
	45 to 95	16	64	—
	96 to 145	6	24	—
	146 to 200	3	12	—
Role at clinic	Associate	13	52	—
	Owner	4	16	—
	Otherc	5	20	—
	Missing/did not respond	3	12	—

^aMore than 1 response was possible; hence, values sum to > 100%.

^b”Other” included educators at veterinary institutions, locum practitioners, and specialists.

^c“Other” included academic, locum practitioner, specialist, owner who was transitioning back to an associate, and unspecified.

Participant descriptions of occupational stress and stressors were captured by 9 major themes: i) nature of the profession, ii) veterinary relationships, iii) client interactions, iv) inadequate personal finances, v) early-career veterinarian strain, vi) practice-owner stress, vii) onus of responsibility, viii) self-described personal characteristics, and ix) moral stressors and moral distress (Figure 1). Many participants also readily discussed implications of occupational stressors. Each of the themes and their associated sub-themes are discussed below.

FIGURE 1.

Thematic map of interconnected stressor themes and their connected implications. The inner circle contains the 9 stressor themes, and the outer circle represents various implications. A solid line indicates a stressor was described as having a direct relationship with the implication; a dotted line indicates a stressor described to exacerbate another stressor. Darker themes are stressors described by participants to most greatly impact their mental health.

Theme 1: Nature of the profession (Table 2)

TABLE 2.

Occupational stressors: Nature of the profession.

Sub-themes	Exemplar quotes
Overwhelming caseload	“You know, when you throw another case on a really busy day, and you’re drowning, that’s a stressor that you know, one straw after another, that becomes negative reinforcement, and I think we see that a lot in the vet industry. We get burdened with far too much work, day after day.” — (DVM 15)
	“And then of course you’re trying to rush to catch up, so you don’t take the time to eat, you don’t take the time to sit down for 5 minutes and gather your thoughts, it’s just person to person to person to person without giving yourself time to process anything and I feel like that gets really overwhelming at times.” — (DVM 17)
Long working hours	“But the fact that our colleagues are constantly working 12-hour shifts that are actually 16-hour shifts, okay, and so that feeds your ability to have a life outside of practice, ability to spend time with your kids, ability to have 8 hours of sleep, ability to exercise or eat well.” — (DVM 1)
	“We’re dispensable as people, and so you burn out, you leave, doesn’t matter, we’ll fill another — and maybe that’s because of where I am now, I’m in an emergency specialty clinic, where it’s get the job done, and you have to do your shift, and yet when you’re done your shift you’re still responsible for your reports… and I’m not an emergency doctor, but it’s a minimum of 10, 12, 14 hours, and then you have to do your records, even if you were so busy, there’s no vet to relieve you, there’s nobody in that time.” — (DVM 15)
Implications
Loss of control	“It was out of control, like booked too heavily, and then an extra thing would happen on top of what you already knew was going to be a busy day, and like an emergency came in or whatever. And I think it was that loss of control…but it’s feeling like you have to somehow handle it all, and you know it’s like oh, I don’t know how I’m going to do the best possible job for each of these cases when it’s so rushed.” — (DVM 23)
Lack of energy	“So, by the end of your workday, you’d given out so much energy there was no energy left, so that’s why I think all the self-care things that normal people hopefully will do for themselves, like prepare a proper meal, that wasn’t happening… Just, you know, the plug was pulled, and the water drained out.” — (DVM 3)

Many participants commented on the “grueling,” “day after day,” continuous work overload associated with veterinary practice. They described high work demands stemming from unanticipated additional appointments being “crammed” into their work schedules or feeling as though there is “so much [work] to catch up on” due to late appointments.

Participants further described long working hours — those beyond scheduled shift time, due to paperwork or emergency cases at the end of shifts — and being on call as all being “unspoken rule[s]” of the veterinary industry. All were associated with feelings of exhaustion and poor work-life balance. Other effects of persistent high work demands included self-reported “burnout,” “anxiety,” “loss of control,” “making mistakes,” “exhaustion,” “time-constraint stress,” “focus issues,” and decreased quality of care as “things get missed.” Several participants described exhaustion as increasing propensity for mistakes and resulting in mentally “shutting down.”

To combat long working hours, high work demands, and their associated implications, 1 participant proposed having 1 h of flex time scheduled into veterinarians’ workday, to “catch up on cases that were in the hospital” or “return [phone] calls,” whereas another recommended compulsory breaks. Break times were reported to reduce participants’ feelings of being overwhelmed, by enabling downtime to “turn myself off for 20, 25 minutes.”

Theme 2: Veterinary relationships (Table 3)

TABLE 3.

Occupational stressors: Veterinary relationships.

Sub-themes	Exemplar quotes
Poor veterinarian-technician relationship	“A technician can make or break your mental health, I think, and if you have positive technicians, who are helpful, and um, work as a team, I think it can make your life so much better. If you work with negative technicians who are always bitching and second guessing you, and saying, ‘Dr. So-and-so would have done it this way,’ they can kick you [LAUGHS] down to the depths of Hell.” — (DVM 4)
Poor associate veterinarian-employer relationship	“But at the same time if you’re acknowledging that there’s such a high rate of suicide in the profession, why don’t you take better care of the interns and the people that you work with? There should be better awareness if you acknowledge this as a problem. I don’t know, I just felt like there was this total discord between acknowledgement of the issue and actually doing anything to deal with it.” — (DVM 20)
Poor veterinarian-veterinarian relationship	“And it’s frustrating because it’s like I’m a peer, and you’re just throwing me under this hypothetical bus, and it gets really upsetting because this is a person who should have my back.” — (DVM 17)
Implication
Strained staff relationships affecting clinic vibes	“Managers often say, you can figure out the emotional status of a practice within a minute of walking in the door. I think that’s very true. And we may not see it, or feel it necessarily, but we can walk into other businesses ourselves and you know feel that right away [SNAPS FINGERS].” — (DVM 2)

Although many participants described good camaraderie and teamwork, some participants noted that “toxic relationships” or “infighting” contributed to occupational stress. Three categories of poor veterinary relationships were identified: veterinarian-technician, associate veterinarian-owner/employer, and veterinarian-veterinarian relationships.

Early-career veterinarians discussed conflict with veterinary technicians. Three participants expressed feeling frustrated or insecure and having low self-esteem when veterinary technicians questioned or opposed their case management. One participant described that perceived “resistance” from veterinary technicians hindered her decision-making.

Several associate veterinarians mentioned poor relationships with their employers. These participants described sources of tension stemming from owners saying they were “not billing enough,” receiving “no positive reinforcement,” a “lack of support,” or “nepotism.” Some effects of these poor relationships with employers were described as long-standing. One participant described being suspicious of her new employer’s intentions as she “look[ed] for the game in it” or wondered, “Is it a test?” due to her strained relationship with her previous boss. Another participant felt that the clinicians overseeing her internship had “very little care as to how [interns] were handling it, how overworked they were, how tired they were.” There was a “lack of compassion” from her supervisors despite them recognizing the mental health issues prevalent within the veterinary profession.

A few veterinarians described veterinary colleagues as being unsupportive or “just not being helpful,” having a “cutthroat mentality,” and “putting each other down,” and suggesting that “vets kind of, yeah, talk negatively about other vets.” One veterinarian attributed commission-based pay to “damaging” relationships with fellow colleagues, whereas another indicated that a lack of mentorship could foster an unsupportive work environment. Others expressed feeling unable to share calls with specialists, as veterinarians were afraid that these colleagues would “steal their case” or that they would ultimately lose a client. One veterinarian postulated that this competitive “individual[istic]” nature contributed to the longer working hours of veterinarians. Veterinarians felt that they needed “to be, do everything” and that this resulted in their needing to continuously “work, work, work.”

Interpersonal dynamics among members of the clinic team were reported to affect the overall “feel of the clinic.” One participant described having “zero patience’” when other staff members began to divulge their own “personal drama” Another shared that, when they bring pessimism into the workplace, “my technicians, my assistants, tend to all kind of chime in with their negativities, too.” Impacts of interpersonal dynamics thus extended beyond the individuals and affected everyone in the clinic. In fact, a palpable sense of “workplace energy” was said to be readily apparent to everyone from staff to clients. For example, participants described clients being able to sense if the staff was “upbeat,” as employees were “smiling,” which “sets the tone for the entire exam.” Conversely, participants described being able to “walk in the practice” and “feel” tension or issues with one or more staff members.

Theme 3: Client interactions (Table 4)

TABLE 4.

Occupational stressors: Client interactions.

Sub-themes	Exemplar quotes
Clients comparing veterinary medicine to human medicine	“The expectation that people have [is] that they want veterinary medicine, the care to be on par with human medicine, but they don’t want to pay the money.” — (DVM 5)
Price discrepancies	“Because [clients are] like, ‘Why can I go [to a different clinic] and get it done for 60 bucks, or 150 dollars? And you guys are charging me 300?’… You know, I have three [registered veterinary technicians] RVTs I employ and they’re closely monitoring your animal the entire time… And we’re giving pain meds for so many days after, we’re seeing you for rechecks, no charge afterwards, to make sure everything is fine. Like they don’t understand what goes into the 300 dollars.” — (DVM 16)
Billing clients when outcome is unfavorable	“I’m embarrassed about handing this person a bill for X amount when the outcome was poor. If the outcome was good, I’d be like ‘Here, I don’t have any guilty feelings [about] you paying this much.’ Cuz, you always second-guess yourself if the outcome was poor, you always say, ‘If I’d done this, would this be a different outcome?’” — (DVM 24)
Client underappreciation	“When you’re acting from a very good place, it’s very hard when people come in and either sort of try to tell you how to do your job, or you know, don’t respect your job.” — (DVM 16)
	“And I think vets start to feel that way after a little while too, just really unappreciated for what they do…and you feel like society has kind of lost faith and trust in what you do and what you recommend, and that gets really frustrating and overwhelming at times.” — (DVM 17)
Implication
Implication of client dissatisfaction	“Absolutely, forget all the good things you’ve done because that one person is just nagging in the back of your brain, I’ve definitely experienced that. That’s frustrating, because you go home and you’ve done like amazing things all day, and all you can focus on is this one person is angry, what could I have changed, what could I have done better, versus ‘hey I did all these awesome things today’. So again, it’s a war with ourselves, right?” — (DVM 17)

Many veterinarians spoke highly of their long-term clients, noting that good clients positively contributed to their mental health. For example, one participant noted, “And when you do get those patients that call back, ‘Oh, he’s doing great, thank you so much,’ it’s really an ego boost, right?” — (DVM 5). Other participants spoke about having “good clients” they were able to develop trust with. Client trust was the backbone to building a good veterinarian-client relationship in which the client valued and listened to the veterinarian’s medical advice. However, most participants readily described unfavorable veterinarian-client interactions as part of the occupational stressors they encountered. Some participants spoke of the distrustful nature of some clients, including clients questioning their competencies or disregarding their diagnoses after accessing online health information (e.g., ‘Dr. Google’), or the client perception that veterinarians are “money gougers.” Indeed, billing clients for services rendered was a commonly described stressor. One veterinarian spoke about the difficulty of “being under the microscope” or having “[clients who] are assessing your skills and then you have to get money from them.” Some clients were described as trying to “impart guilt” onto the veterinarian for “charging” for their services. One participant felt “hypocritical” and guilty billing pet owners when there was an unfavorable outcome.

Several participants described contending with underappreciation and often feeling as though theirs was a “thankless job.” Commonly, participants said their clients’ lack of understanding of the veterinary profession was a source of stress. For instance, the perceived client belief that veterinarians just “play with dogs and cats all day long” was said to contribute to client underappreciation of the depth of a veterinarian’s knowledge. This underestimation of veterinary expertise was further demonstrated when participants described clients that tried to “be a vet” and “Google those symptoms.”

Many participants described an influence of the Canadian human medical system on clients’ perceptions and expectations of veterinary medicine. For example, several participants described clients not understanding the cost of veterinary medicine was the likely result of Canadians not “footing the bill” for their own healthcare or “because [clients] have no idea what they pay for their [human] medicine.” Other participants described clients who based their final decisions on costs, yet did not consider the level of veterinary care reflected in the prices.

Due to a strong human-animal bond, many companion animals were described as “part of the family.” This status was often noted as beneficial, as it could mean clients were willing to seek more options for patient care. And yet, this human-animal bond also led to “extra emotional considerations [being placed] on these pets” that further elevated clients’ expectations and added to veterinarians’ stress.

Typically, veterinarians recounted poor patient outcomes as fueling client dissatisfaction. Sometimes, dissatisfied clients left negative reviews online (which could detract from the business and contribute to client distrust) or would “rage, and be rude, or be unreasonable.” These interactions were described to dampen workplace energy, contribute to veterinary stress, reduce participants’ self-confidence, fuel self-criticism, and overshadow the beneficial contributions veterinarians had made.

Some participants described a physiological response to client anger, such as sweating, nervousness, or in rare instances, responding with anger or curtness themselves. Whereas the experience of negative interactions with clients was common and said to be highly impactful, several veterinarians also spoke about taking perspective as a coping mechanism, reflecting on the “good” of one’s life, or learning to “side-step” client-provoked emotions.

Theme 4: Inadequate personal finances (Table 5)

TABLE 5.

Occupational stressors: Inadequate personal finances.

Theme	Exemplar quotes
Inadequate personal finances	“We are so underpaid compared to the amount of education we do, so that’s really disheartening when you get out of school, you’ve put all this time into school, and you’re not really making any more than, say, a nurse, and they may have only done 5 years of education, of school, right?” — (DVM 10)
	“I guess just because of the financial stress, not only that, the hours. It’s not how much money you make in a year, it’s how much you make per hour, and for many years the number of hours, the amount of money I made per hour was minimum wage. And especially if you counted [being on-] call.”

Many veterinarians shared feelings of frustration with the perceived lack of appropriate compensation in the veterinary profession, and that “we’re not paid nearly as well as ‘real’ doctors.” This was compounded with younger participants expressing concern over having to pay off substantial student debt. Many veterinarians believed that higher remuneration would decrease their “money stress” and enable prioritization of their health and mental well-being.

Theme 5: Early-career veterinarian strain (Table 6)

TABLE 6.

Occupational stressors: Early-career veterinarian strain.

Sub-themes	Exemplar quotes
Lack of confidence	“I think that [the stress] largely had to do with the sort of like gnawing in the pit of your stomach when you don’t know what’s coming in the door, and you’re just not sure if you’re going to be able to deal with it properly.” — (DVM 12)
Lacking the benefit of experience	“Experience, I would say. I mean when you do things enough or you do things over and over you start to see patterns, and just even seeing most of the cases and going through them, you’re more confident in your diagnosis because you’ve seen this before, now you’ve treated like 5 or 6 of the same case, and you’re like okay, now I know what to do.” — (DVM 8)
Reality versus expectations in the veterinary field	“From my experience? There’s a big disconnect between our intentions when we went to school of you know being Dr. Dolittle, and helping all the animals, and what we’re allowed to do, mostly by clients, mostly because of financial constraints, I think that’s very stressful.” — (DVM 14)

The transition from veterinary school into clinical practice was described as turbulent for some participants, who referred to it as a “hard” and “shocking” time. Participants with the most difficult adjustments to a clinical environment frequently described working alone and being devoid of mentorships. Veterinarians early in their careers often described “second-guessing” their case management and doubting their veterinary skills.

One participant noted that eventually gaining clinical experience quelled her self-doubt and gave her more self-confidence. Other participants described self-doubt regularly resurfacing, especially when conducting difficult procedures and surgeries. Participants also mentioned that veterinary medicine “doesn’t end up being a career that a lot of kids dream it’s going to be” or that they were “expecting so much more [from veterinary medicine] than what [I] got in the end.” This conflict between the expectations and reality of a clinic environment was considered a “struggle.”

Mentorship was said to be helpful for all veterinarians, from new graduates transitioning into clinical practice to veterinarians with more experience who wanted a “sounding board” from their colleagues. Mentors were described to help participants “talk things through” or be a reassuring source of support, such as when supportive colleagues would say, “No, nobody has those answers,” or “That sucks, it really sucks.” Whereas mentorship was described as beneficial, few participants said they received this guidance at any stage in their career.

Theme 6: Practice-owner strain (Table 7)

TABLE 7.

Occupational stressors: Clinic-owner strain.

Sub-theme	Exemplar quote
Role conflict	“Children need parents, and they need support, and you have to be able to spend the time. And if you’re stretched to the point of trying to make the business work and succeed and grow, uh, you know it comes down to choices, and it’s really hard to do it all.” — (DVM 2)

Veterinarians who owned clinical practices reported needing to manage high work demands and poor work-life balance while also undertaking large financial and managerial responsibilities. Several practice owners commented on the difficulty of needing to “deal with staff conflict” or “babysit the staff” to ensure employees remained on-task. Financial stress was readily described as “trying to struggle to make ends meet.” Role conflict was another issue common to multiple practice owners who described difficulty in managing demands of their personal and professional lives.

Practice-owner stress was also said to affect staff, with 1 associate veterinarian commenting that “it’s just not a nice work environment when the boss is stressed.” Practice owners described accessible business training as a potential solution to help prospective or current owners navigate the “cold and hard” financial industry. However, even with the added responsibilities and stressors of ownership, 2 practice owners shared enjoying the autonomy of owning their own clinic, with one saying, “One of the reasons that I don’t just sell immediately and go back to being an associate is that I kind of like being my own boss and not having somebody tell me what to do and impose their ways of doing business on me” — (DVM 14).

Theme 7: Onus of responsibility (Table 8)

TABLE 8.

Occupational stressors: The onus of responsibility.

Sub-themes	Exemplar quotes
Client pressures	“You start to realize that these clients really count on you as a person more than they should [CHUCKLES], that there’s a big responsibility on helping people make very big decisions in their life, like putting this animal to sleep or not spending 5000 dollars, or I mean going and taking a loan out or not, to fix their pet. And a lot of that — we’re ill-equipped, we’re ill-equipped to deal with those types of situations.” — (DVM 19)
Feeling responsible outside veterinary clinic hours	“‘I think [the cat] needs to be cleaned up.’ It’s like 2 or 3 o’clock in the morning… I got up out of bed, my partner got up out of bed, and we went into the clinic and gave the cat a bath. [My partner was] like, ‘Do you realize this is a little bit crazy, like the cat is okay, fine, but you’re getting out of bed at this hour because you can’t let it out of your mind?’” — (DVM 3)

Participants described “being responsible for other people and other living things” as an occupational stressor. Some participants disliked “making those final calls” or the looming notion that “if something that goes wrong, I’m going to be the one that kills [the pet].” Others described feeling pressured by clients to make decisions on behalf of the animal, and the added pressure associated with intense, loving, human-animal bonds. For example, participants recounted clients who exclaimed, “You have to save [the pet], he’s all I’ve got in the whole world.” For some participants, this responsibility did not remain at the clinic but was said to permeate into personal off-work hours. Participants recounted, “I just can’t stop thinking about this cat,” or “[I spent] the last 48 h living [the client’s] pet for [them].”

Theme 8: Self-described personal characteristics (Table 9)

TABLE 9.

Occupational stressors: Self-described personal characteristics.

Sub-themes	Exemplar quotes
Superhero complex	“Maybe just, I don’t know, the tendency to, well, I guess, again, not to show your weakness, that you want to handle everything, you want to be on top of everything, and you can’t let, I don’t know… It’s just destructive because I feel like it’s a false — it’s a non-realistic ambition, I guess, it just makes you feel like you have to do everything and be everything all the time, and that’s, like, virtually impossible.” — (DVM 20)
Introversion/extraversion	“It’s made me more comfortable with people, because I got into veterinary medicine so I wouldn’t have to deal with people and got into vet medicine to just deal with animals, but I’ve learned how to be a situational extrovert, so that has helped.” — (DVM 13)
Self-criticism	“Yeah, yeah. Just thinking about a case, you had that day, and you wake up and go, ‘Oh, I should have done this differently,’ and then you can’t fall back asleep.” — (DVM 19)

Numerous participants indicated that specific personal characteristics contributed to self-imposed stress. Participants commonly described characteristics such as “Type-A,” “perfectionistic,” “driven,” “overachieving,” and “introverted” as contributing to high stress and poor mental health. Whereas a few participants described these characteristics as assets (e.g., helping them gain admission to veterinary college or be able to “meet work goals,”) most spoke of an inability to “put limits on my work life” and noted that their drive in “meeting work goals” was “at the expense of our mental health.” The data painted a picture of a “superhero mindset”: participants described needing to complete all tasks perfectly, independently, without the aid of colleagues, all the time. In addition to contributing to feelings of being overwhelmed, this superhero mindset was also reported to impede veterinarians’ help-seeking behaviour. For example, 3 participants described feeling unable to ask for help because, if they were “true professionals,” they should be capable of fixing their own problems.

Being introverted but needing to interact with other humans was another personal characteristic described by participants as heightening occupational stress. Several participants explained that they elected for careers in veterinary medicine due to their affinity for animals over humans. Thus, having to engage with human clients in a professional capacity was described as “very stressful” for some. Nevertheless, 2 veterinarians described how veterinary medicine had helped them refine their people skills.

Participants frequently described being self-critical when they could not meet their high self-expectations. Intense self-criticism often surfaced when making mistakes, when unable to “figure out” a clinical case, or when “a case goes poorly.” Self-criticism was described as “beat[ing] myself up” and “taking things personally.” Although participants sometimes recognized that “there is no way I can do anything differently” when cases took an unexpected downturn, they nevertheless often expressed guilt because, “[well] I’m not God, I guess.” Self-criticism was frequently described in conjunction with self-doubt and contributed to poor work life balance, “sleepless nights,” lowered self-esteem, and self-reported anxiety.

Less commonly described was the practice of self-compassion in responding to mistakes. One participant openly discussed oversights she had made at work with her children, to normalize mistake-making behaviour. She said, “And I think what saves many of us [veterinarians], myself included, is I recognized that fairly early on, you are going to make mistakes. You have to understand that, and just try not to make the same exact one the next time” — (DVM 12).

Theme 9: Moral stressors and moral distress (Table 10)

TABLE 10.

Occupational stressors: Moral distress.

Sub-themes	Exemplar quotes
Cost constraints resulting in a euthanasia	“I mean, killing an animal, especially a healthy one, or a potentially healthy one, that could be healthy, but for the lack of 1000 dollars, it’s tough.” — (DVM 19)
Unable to help a suffering animal	“The guilt is that the animal is essentially suffering, or to my perception that the animal is in pain, and the guilt is the inability to do something about it.” — (DVM 9)

Moral distress was a key theme affecting the mental well-being of participants and was often described as having to balance the needs of clients and the animals. Since “[the animals] don’t have a voice,” veterinarians frequently described pets’ medical needs being overshadowed by the financial or personal motivations of the pet-owner. For example, participants spoke about clients who demanded “cheap fixes” and expected the veterinarian to provide care to restore their pet’s health “for very little money.” In reality, those cheap fixes failed to treat the underlying health problem of the animal and instead treated the symptoms. Veterinarians were “only covering [the problem] up, there’s nothing we’re treating.”

Frequently, participants described being restricted by a client’s financial circumstances, which resulted in euthanasia of the animal. These financial constraints fueling euthanasia were “stressful” and a “struggle” for participants. Similarly, moral distress was evident when veterinarians described clients who refused both treatment and then subsequent euthanasia of the animal, thus prolonging patient “suffering.”

A less common but still meaningful aspect of euthanasia described by participants was the “euthanizing of healthy pets,” also referred to as “convenience euthanasia.” A small number of participants described having the autonomy to refuse convenience euthanasia that they “don’t agree with”; however, this was not without stress. For example, 1 participant stated that her refusal to “euthanize a healthy, like, 2-year-old cat that has a laceration,” led to client anger; others described consequences of clients “bad-mouthing” them or the clinic. Although circumstances of euthanasia had resulted in moral distress for some participants, many veterinarians had “reconciled” euthanasia for sick or elderly animals, and this was not described to negatively affect veterinarians’ well-being.

Guilt was a common response for veterinarians experiencing moral distress resulting from being unable to help an animal. To circumvent moral distress and the accompanying guilt, 2 veterinarians discussed learning to separate their personal values from their clients’ values. One veterinarian elaborated, “You also have to accept that pets are different to everybody; in that situation, that is their pet, and that pet means something different to them than it might to you, and that’s okay” — (DVM 1).

Implications of the stressors (Table 11)

TABLE 11.

Participants’ reported implications of occupational stressors in veterinary medicine.

Exemplar quotes
“Sometimes I’d look at difficult animals, especially if, like, they’re really wriggly, you can’t get a catheter into them, or they’re really sick. I was like, I don’t, I don’t care anymore. I just hit a point where I was just like, ‘I don’t care if you live or die, just go away.’ And that was probably a really low point.” — (DVM 5)
“[CRYING] Well, practice is very difficult, and as much as you love working with the animals, it’s very difficult to stay motivated, and not to have to deal with everything that goes on there. And I’m not just talking about the business, its clients, and staff, and after so many years you just get beaten down.” — (DVM 22)
“So, I learned very quickly that was a situation where I didn’t want to be, very soon after graduating, I didn’t want to be a veterinarian anymore, because I didn’t have any support. And I wanted to escape really badly, I wanted to get out of that — well, not just that situation, but when you don’t have a mentor and you’re taught that you can’t fail or you’ve got to achieve, and you’ve got to know everything and you shouldn’t ask anyone because you’re supposed to know, and really don’t have anyone to ask, and it’s very competitive.” — (DVM 3)

Many of the occupational stressors experienced by participants were described as occurring simultaneously, having synergistic effects in amplifying stress, and having negative impacts. Although not the focus of this paper, words used to described implications of the cumulative effects of stressors were “want[ing] to explode,” “frustration, helplessness, desperation,” “burning out,” “sheer exhaustion,” “hopeless,” and being under a “black cloud.” Self-reported compassion fatigue, burnout, and depression were all described as mental health outcomes associated with the burden of various occupational stressors, as were thoughts of leaving veterinary medicine.

Whereas negative effects of stressors were the focus of the participants’ discourse, it is important to note that not all described stressors resulted in distress. For example, 1 veterinarian described the positive contributions of stress as “what helps empower you, and helps you grow.” Many veterinarians took solace knowing that other veterinarians experienced similar occupational stress, as this meant they did not feel “alone” within the veterinary community.

DISCUSSION

A broad range of occupational stressors in the veterinary profession have been reported (6,7,28). In this study, we explored clinical veterinarians’ perceptions and lived experiences of occupational stressors through qualitative methods, providing additional context and depth of understanding.

The high work demands and long working hours typical of the profession were discussed by the participants and are well-known stressors within the veterinary profession (4–7). Ways to mitigate the high work demands and long working hours of the profession could include reserving 30 min for specific appointments so that veterinarians do not feel rushed (29), allocating time to catch up on past work (29), and making more fulsome use of registered veterinary technicians’ skillsets to better manage veterinarians’ time (30). Participants described a deep sense of identity tied to being a veterinarian, which caused them to “neglect” other roles in their lives. Ideally, veterinarians could explore and devote time to other aspects of their identities to improve their overall well-being. However, organizational changes and decreased workloads are likely required in many clinics to facilitate this.

Interpersonal conflicts within the clinic were described as stressors affecting work satisfaction and mental health. Several early-career veterinarians described their frustration and self-doubt when veterinary technicians doubted their case management. This is supported by Moore and colleagues (31), who reported that some registered veterinary technicians questioned the capabilities of veterinarians who were perceived as unconfident or lacking skill (31). Lack of employer or colleague support is cause for concern, given that this stressor was reported to contribute to veterinary turnover in clinical practice in Canadian (32) and Australian (10) studies.

Veterinary conflict was also described to occur between veterinarians and their employers. Not only did associate veterinarians identify veterinarian-employer conflict as a source of stress, but associate veterinarians also indirectly experienced personal negative effects from practice-ownership stressors experienced by clinic owners. In line with previous reports from veterinary employers (33), our findings highlight the need for accessible business training for veterinarians, which could reduce ownership stress and the transference of stress to others in the workplace. Although strides have been made to incorporate such training into the veterinary curriculum, the effectiveness of this remains largely unknown (33) and is a future direction for research. Another avenue to reduce ownership strain could be hiring a practice manager. Although a practice manager represents an additional cost for the practice, their management of the daily activities of the clinic could allow the veterinarian-owner to serve more clients and generate additional income for the practice (34).

The tense interpersonal relationships described in this study affected the well-being of the people sharing the space and “set the tone” for the day, similar to another report in which negative energy from veterinary team members dampened the mood, affected the morale of the entire team, and contributed to a toxic work environment (31). Such toxicity has been negatively correlated with job satisfaction and positively correlated with cynicism and exhaustion (35). Conflict management could be one option to combat poor interpersonal relationships. Conflict management techniques and measures are implemented in the workplace to help veterinary teams resolve disputes when they occur (36). Approaches to manage conflict include talking with team members promptly after conflict occurs, providing job responsibilities for all staff, and ensuring that the resources and training are in place for every employee to do their job (36). Emotional-intelligence training can help employees better recognize, understand, express, and regulate their emotions, which can help reduce personal and interpersonal tensions and better position team members to respond to those stressors (37).

Research has shown that pet owners are more receptive to veterinarians’ recommendations when there is a strong veterinarian-client relationship and clients trust their veterinarian (38). In other reports, some clients were suspicious of veterinary professionals’ intentions and whether recommendations were being made to generate revenue rather than from concern for animal well-being (39). In our study, words associated with underappreciation and disrespect suggested that clients’ distrust detracted from participants’ sense of meaning and purpose. As connection with meaning and purpose are positively correlated with well-being (40), strengthening of client-veterinarian communication to build trust could have benefits beyond the relationships themselves. To strengthen the veterinarian-client relationship, veterinarians are encouraged to explain costs, clarify how veterinary service could improve pet health, and seek out and address clients’ concerns where possible (41).

Several challenges of transitioning from veterinary school to clinical practice were discussed in this study, including the absence of a mentor and working in isolation, similar to elsewhere (42). These results may indicate a need for increased independence of veterinary schools to better prepare students for the reality of the veterinary workplace, and for formal mentorship programs in the workplace. Yet mentorships may prove difficult to provide if time constraints limit mentors’ abilities to meaningfully advise their mentees (42). In the Netherlands, early-career veterinarians reported increased self-esteem and better communication with colleagues and clients after completing a development program with online modules plus 6 in-person training days (43). In addition to mentorship programs, virtual or hybrid development programs may be another avenue for career development for Canadian veterinarians. This represents an important research direction.

One interesting finding of this study was that participants described a clear need for high drive, independence, and perfectionism — to the point of feeling the need to be “a superhero.” Many participants reported feeling the need to do all tasks perfectly, independently, and self-sufficiently, all of the time. This intense attempt to be a superhero is not unique to veterinarians but may apply to the broader culture of healthcare professionals. For example, physicians in New Zealand and Canada have described pressure to perform professionally when feeling hungry, ill, or exhausted — behaviors said to stem from intrinsic pressures but also perpetuated by senior healthcare professionals (44) and society (45). The “superhero complex” in the context of veterinary medicine has also been discussed by Steffey and colleagues, who stated that the need to be a superhero has been required and reinforced through various policies, systems, and workplaces that veterinarians’ have encountered (46). It is unknown whether participants in this study experienced the “superhero complex” because of intrinsic pressure or a wider systemic issue within the profession, but this could be a future direction of research. Regardless, the possibility of a culture in veterinary medicine that drives the superhero mindset requires review and change. Although such systemic, profession-wide/institutional change is imperative, cognitive reframing and self-compassion training to challenge thoughts around needing to be unexceptionally perfect could also be helpful (47).

Moral stressors in veterinary medicine have been cited in relation to the following: animal-welfare concerns when balancing the needs of clients and patients (5), clients’ inability to pay for veterinary services (5), and “convenience euthanasia” (10); all of these were identified in this study. One proposed strategy to help mitigate cost-restraint euthanasia-related moral stress is promotion of pet insurance. One study concluded that only 10% of pets whose owners had pet insurance underwent euthanasia compared to 37% of animals not insured for a specific animal health condition (48). Clinics could establish standard policies regarding specific moral stressors (e.g., convenience euthanasia), outlining when euthanasia would be recommended and when veterinarians could refuse based on the condition or age of the animal, for example (49).

Informal sharing and debriefing with colleagues, as well as self-compassion training, could also be helpful in mitigating the emotional toll veterinarians may be experiencing. Furthermore, self-compassion training could help veterinarians manage emotions around moral stressors and difficult days in caregiving (50). Occupational stressors reported in this study were numerous and varied. Participants shared insights into perceived effects, such as burnout, compassion fatigue, depression, and risk of attrition from the profession. These are supported by extant research on anxiety and depression (4) and burnout and suicidal ideation in the veterinary profession (51). With society facing serious issues related to veterinarian shortages, these findings serve as a strong call to action for systemic structural changes and investment in veterinary team well-being.

Strengths and limitations

This study provides context for and in-depth insights into a variety of occupational stressors from veterinarians of varying ages with a variety of clinical roles. This study used a nonrandom sample of veterinarians attending a national conference, which limited the ability for extrapolation. Qualitative data are not meant to be generalized to all individuals in a population; rather, they are meant to garner rich, in-depth, individualistic perspectives (27). A further limitation of this study was inclusion of only veterinarian perspectives. Views of other veterinary team members, such as veterinary technicians, animal care assistants, and hospital managers, would provide important insights. Finally, these data were collected before the COVID-19 pandemic and stressors encountered by clinical veterinarians during that public health emergency (52) were not captured in this study.

In conclusion, participating veterinarians faced a myriad of occupational stressors, summarized across 9 themes, ranging from self-imposed internal pressures to professional relationships, pressures stemming from clients, and nature of the profession. The effects described included substantial emotional tolls, depression, compassion fatigue, burnout, and attrition, which could have serious ramifications for society by way of a depleted veterinarian workforce. Veterinary student curriculum developments, clinic-level adaptations, professional continuing education, and further research are worthwhile exploring as strategies to improve veterinary team well-being and to support sustainability of the profession.