How do you measure burnout among veterinarians?

The term burnout has been getting thrown around a lot lately and is certainly rampant among my colleagues working in emergency and critical care. Burnout is characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. Veterinarians who become burnt out feel overwhelmed and unable to face the demands of their job or engage with co-workers and clients. They often develop a cynical detachment from work and can view patients as objects rather than animals. The sense of ineffectiveness at work occurs because they no longer feel able to contribute to their work in a meaningful way.

Burnout is very common among human healthcare workers due to time pressures, lack of control over work, potential for work-related conflict, and the emotional intensity of clinical work. Estimates of burnout among nurses range from 10-70% and among physicians 30-50%. And a study conducted by the Mayo Clinic and American Medical Association in 2015 found that more than half of American physicians had at least one sign of burnout. However, diagnosing a person with burnout is not that easy, which likely accounts for the wide range of incidences and low number of studies in veterinary medicine.

Burnout is most frequently assessed using the Maslach Burnout Inventory (MBI), a 22-question survey that asks questions related to three symptoms: emotional exhaustion, depersonalization, and sense of personal accomplishment. The questions for each of these areas are in the form of a frequency rating scale with responses that include: never, a few times per year or less, once per month or less, a few times per month, once per week, a few times per week, or every day. The responses that occur the most frequently imply that respondents are at higher risk of experiencing that symptom of burnout.

Because there is no accepted standard definition of burnout, dichotomizing the survey results into burnout versus no burnout is difficult. As such, it is more common to assess individuals as having at least one symptom of burnout if they have high scores in either of the emotional exhaustion or depersonalization categories or a low score in the sense of personal accomplishment category.

There is a large body of research demonstrating associations between burnout as measured by the MBI and human healthcare related outcomes such as medical errors, malpractice claims, suboptimal patient care, physician turnover, early retirement, loss of productivity, alcohol abuse, motor vehicle accidents, and thoughts of suicide. The above-mentioned factors that contribute to burnout in human medicine likely also contribute to burnout among veterinarians and one could argue that veterinarians also experience similar consequences. However, the incidence of burnout among veterinary team members is not well-studied.

Findings from a veterinary study published in 2014 included results from a survey created to assess team effectiveness. The survey was disseminated to 48 companion animal veterinary teams, along with the MBI survey. Measures of team effectiveness included factors related to having a coordinated team environment, toxic team environment, team engagement, and individual engagement. Almost 300 team members completed the survey and the MBI results revealed that 22% were in the high-risk category for exhaustion, 23% were in the high-risk category for cynicism, and 9% were in the high-risk category for personal efficacy. Not surprisingly, a toxic team environment was associated with lower job satisfaction and higher levels of emotional exhaustion and cynicism. The study confirms what many of us have experienced: a toxic work environment can significantly influence our job satisfaction and risk of burnout.

Studies suggest that physicians working on the front lines of human healthcare (e.g., emergency medicine, family medicine, general internal medicine) have the highest risk of burnout. I would argue the same for my veterinary colleagues who work in emergency, general practice, and internal medicine. But they aren’t the only veterinarians affected by burnout…so what other factors can contribute?  Studies demonstrate that burnout in human medicine is highly associated with: work hours (3% increased risk for each additional hour per week), night or weekend call (3-9% percent increased risk for each additional night or weekend on call), time spent at home on work-related tasks (2% increased risk for each additional hour per week), and work-home conflict (200-250% increased risk).

Human nurses also cite high patient per nurse staff ratio as a risk factor for burnout and I am certain that veterinary technicians / nurses would agree with this statement: there’s nothing worse than being a vet tech and walking into an ICU full of patients, all of whom need treatments and assessments done at the same time!

I am pleased to say that we recently completed a study investigating the incidence of burnout and the contributing practice-related factors among veterinary emergency and critical care veterinary team members. It was completed earlier this year by way of an anonymous survey that was disseminated to emergency and critical care specialists, emergency veterinarians, technicians, and team members working at least part time (20 hours per week) in an emergency and/or critical care practice setting. The survey included the MBI, in addition to the Areas of Worklife Survey, created to assess employee’s perceptions of work setting qualities that play a role in whether they experience engagement or burnout at work.

The results of the survey will be compiled and assessed statistically for associations between practice setting (e.g., private versus academic), practice role (e.g., vet versus tech), duration of time in practice, number of hours worked per week, on-call responsibilities, and work-related factors to determine whether work setting qualities or other variables are associated with a higher risk of burnout. These results will be shared in the Spring of 2019 and will be submitted for publication thereafter. Hopefully as more research is gained by studies such as this, the veterinary industry will be able to adjust and reduce factors known to contribute to veterinary team burnout.