Table 1.

Categories, subcategories, and examples of written-in responses from 1,422 US veterinarians regarding types of practice-related stressors not specifically listed in a previous survey.⁶

Category and subcategory	No. (%) in category	Example response
1. Financial insecurity	289 (20.3)	“Cost of providing good service.”
Low income	98 (6.9)	“Not making enough money to pay the bills and my staff.”
Cost of maintaining practice	56 (3.9)	“Maintaining enough veterinarians to run practice to provide quality of life.”
Low return on investment	31 (2.2)	“Disappointing economic return on the hours, work & dollars invested.”
Debt	29 (2.0)	“The bills that are always due from owning a practice. There is NEVER enough money after school loans, bank loans, taxes and the rising cost of supplies.”
Job outlook	17 (1.2)	“Lack of employment opportunities.”
Retirement	16 (1.1)	“Lack of ability to prepare for retirement.”
2. Clients	254 (17.9)	“Client complaints very stressful.”
Unwilling or unable to pay	118 (8.3)	“Being bullied or shamed by clients who are unable to pay for services and feel I should provide services at a reduced cost or for free.”
Unrealistic expectations for treatment	42 (3.0)	“Client unrealistic expectations/taking their own problems out on us.”
Lack of compliance or responsibility for pet	24 (1.7)	“Frustration with clients and compliance and actually having them listen and taking recommendations.”
Expectations of availability	21 (15)	“Client expectation of being always available.”
3. Coworker or interpersonal issues	181 (12.7)	“The conflict, drama, and confrontations that seem never ending in all of the hospitals I have worked, including as a tech. This goes on between veterinarians, staff, clients, everyone.”
Lack of support	34 (2.4)	“Hypercompetitive and unsympathetic colleagues.”
Work environment	23 (1.6)	“Dysfunctional and hostile work environments in many veterinary hospitals.”
Abusive or bullying coworkers	20 (1.4)	“Bullying from other staff members.”
Unethical practices	11 (0.8)	“Unethical practice of fellow veterinarians, lowering the quality standards and therefore the profession prestige.”
4. Work-life balance	166 (11.7)	“Unable to have a normal home life and social life because of practice demands.”
Being on call	43 (3.0)	“Always on call.”
5. Management issues	118 (8.3)	“Poor management threatening case load, practice reputation, and morale.”
Lack of support or guidance	35 (2.5)	“Management being unsupportive of staff, when they automatically assume the client is always right and you must be at fault.”
Abusive or bullying management	24 (1.7)	“Abusive management.”
6. Job pressure	93 (6.5)	“Making the right clinical decision.”
Too many responsibilities	44 (3.1)	“Too many responsibilities; never being ‘done’ with work when I leave.”
Fear of mistakes or failure	18 (1.3)	“Fear of making professional mistakes or appearance thereof.”
Surgery	13 (0.9)	“Performing surgery.”
Complexity	6 (0.4)	“Having every day and every case be a test and/or judgement of my skill level. I am overall very successful with cases and clients, but every day is a new day, a new challenge, and after 30 years it has worn me down.”
7. Private or public sector	83 (5.8)	“Increasing demand by government policies, rules, and unreasonable involvement in small business.”
Government or state board policies	48 (3.4)	“State Board micromanaging practice and ‘guilty until proven innocent’ attitude.”
Competition	17 (1.2)	“Competition from corporations for veterinary services (drugs, etc).”
Ethics	9 (0.6)	“Working in a laboratory animal facility and witnessing the studies and procedures performed. My personal disagreement with the value of much of the research causes a lot of depression and anger during my workday.”
Drugs	2 (0.1)	“Access to drugs.”
8. Training or staffing	73 (5.1)	“Human resource issues.”
Low-skill staff or lack of training	26 (1.8)	“Lack of efficiency & training of support staff (receptionists, technicians), mistakes made by those staff members that affect my job and patient care.”
Understaffing	12 (0.8)	“Trying to hire a good skilled vet/new grad.”
9. Feelings of inadequacy	67 (4.7)	“Feeling inadequate, not smart enough, like I may mess up or miss something.”
Knowing how to help but can’t	22 (1.5)	“Economically depressed area where I practice leading to less than optimal treatment plans.”
Underappreciated or lack of respect	18 (1.3)	“Being taken for granted, not appreciated, not valued.”
Not knowing how to help	12 (0.8)	“The amount of frustrating cases where you can’t do anything to help.”
Gender bias	6 (0.4)	“Professional competency questioned by clients and staff due to ethnicity, gender and age.”
10. Personal issues	63 (4.4)	“Stress in personal life.”
Family	22 (1.5)	“My wife has an anxiety disorder and that wears on me.”
Illness	17 (12)	“Chronic pain.”
Boredom or lack of job fit	12 (0.8)	“Boredom with profession.”
11. Future of the profession	37 (2.6)	“Fear of future of vet medicine as a career.”
Shift of focus to profit	12 (0.8)	“The corporatization of veterinary medicine and the excessive emphasis on profit above all.”
Technology or method advancement	11 (0.8)	“Time needed to convert to paperless record keeping.”
12. Stress from animals	37 (2.6)	“I am a hospice veterinarian, so I see a lot more of illness and death than the average vet.”
Compassion fatigue or grief	26 (1.8)	“Emotional baggage, compassion overload.”
Suffering or owner mistreatment	9 (0.6)	“Dealing with the depressing side of shelter medicine, cruelty, noncaring owners, too many animals year after year.”
Risk of injury	7 (0.5)	“Constant low-grade trauma to the body that is gradually leading to debilitation.”
13. Negative public perception	24 (1.7)	“Public perception of us not being ‘real doctors’ and attitude that we should be treating animals for free since we love them so much.”
Social media and internet	10 (0.7)	“Being extorted online (Yelp) and by clients who demand free services or retaliate by attempting to ruin my reputation.”
14. High personal expectations	22 (1.5)	“Being perfect.”
15. Academia	20 (1.4)	“Generating funding for research programs and student support.”