Out Of The Old Black Bag

 

OUT OF THE OLD BLACK BAG

 

Burnout: Save the Beasts and the Children

By Anthony Kovatch, M.D.

 

Musical Accompaniment: “Bless the Beasts and the Children” by the Carpenters

 

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“BE KIND: For everyone you meet is fighting a hard battle”      

— Plato

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It makes eminent sense that pediatricians and veterinarians are kindred spirits. Everybody knows that children are not just “small adults,” and taking care of babies and little children who are yet incapable of verbally reporting their symptoms is often equated with veterinary medicine. Both groups are distinguished from others in the health care field and are defined by their passion and compassion for making the welfare of their subjects paramount, often to their own privation. 

 

The 2022 Kids Marathon:  The kids are out racing again; their pediatrician needs to outrun burnout!

 

The COVID-19 pandemic has intensified the emotional and existential bonds between owners and their pets, just as it has between parents and their children. Many adults have coped with the imposed isolation of the past 2-plus years by choosing to nuture a pet for the first time in their lives, hence there has been an excess of demands on veterinarians to keep these pets healthy and alive. The world literature is replete with stories championing the fact that humans love their animals as much as, or even more than, their children. It is indisputable, and I quote the closing lines from Marjorie Kinnan Rawling’s tender novel, “The Yearling,” narrated about a lonely young boy named Jody Baxter coming of age on a farm in rural Florida:

“He did not believe he should ever again love anything, man or woman or his own child, as he had loved the yearling. […] Somewhere beyond the sink-hole, past the magnolia, under the live oaks, a boy and a yearling ran side by side, and were gone forever.”

 

 

As I explored the relationship between veterinarians and their clients, I made the biased (in the other direction) conclusion that the love between vets and their breasts surpasses that between pediatricians and their patients. Vets have more to sacrifice. The intense pressures on vets have notoriously produced a culture of suicide. A 2019 report by the American Veterinary Medicine Association concluded that vets are 2.7 times more likely than the general population to die by suicide. That figure increased to 3.5 times for women, who comprise 60% of the current workforce and 80% of the current students in vet schools. One in six vets had contemplated suicide since their graduation; about 10% of all deaths among female vets from 2000 to 2015 were by suicide. Cry, our beloved vets!

These are startling statistics which have only been worsened by the present pandemic. I must admit that I was completely oblivious to the built-in stressors of that noble profession until my eyes crossed an article in my college magazine, The Pennsylvania Gazette, entitled “Rescue Mission.” Our society has not granted equality to veterinarians. In addition to the increase in workload due to the explosion in pet ownership triggered by the pandemic cited above — superimposed on an already grueling work schedule — the profession has been a victim of the same staff shortages suffered by the entire medical field. Other external stressors include astronomical vet school debt following graduation (anywhere from $200,000 to $275,000) coupled with a seemingly inequitably low salary.  

The average starting salary of $70,045 for a vet in 2019 pales in comparison of those for physicians in general (around $200,00), pediatricians ($160,000), and lawyers ($127,000). This is likely driven by the fact that three-quarters of animal owners don’t have pet insurance, leading to an emotional and demanding clientele who have no choice financially than to challenge the cost of medical treatments or plead for leniency from a specialty recognized for its empathy.

Although the general consensus is overwhelming that nobody enters into veterinary medicine to make money, those who do are bolstered by the public recognition that they are a compassionate phenotype with big hearts and a passion for high achievement, who are not dispirited by working extraordinarily long hours for low compensation and low respect. On the flip-side, those training in the field often admit that much of their stress is self-imposed. Recent graduate from Penn Veterinary School Greg Kaiman candidly states in the “Rescue Mission” article:

“I find that a lot of us in the veterinary field are very self-driven people who always wonder whether or not they are good enough, a kind of imposter syndrome which is all too common in our field.”

 

Veterinarians love all creatures — tamed and wild!

 

However, the major differentiating occupational hazard is that vets must incorporate the art of euthanasia into the fabric of their everyday practice. While in pediatrics we might lose a single patient per year to an unexpected catastrophe or to an untreatable condition, this is a daily consideration for the vet, making grieving a consistent barrier to job satisfaction and sometimes personal happiness. The processing of grief and guilt (some owners simply cannot pay for life-sustaining therapies) constantly intrudes into a veterinary practice — holidays included.

The American Medical Association has promised to fix the problem of burnout that has been increasingly plaguing our health care system. The problem existed well before the COVID-19 pandemic and has been defined by the World Health Organization as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” Specifically, burnout has three dimensions:

• Feelings of energy depletion or exhaustion.

• Reduced professional efficiency.

• Increased mental distance from one’s job or feelings of negativism or cynicism related to one’s job.

 

I think burnout likely affects 100% of practicing physicians and vets on any given day of the year, especially the sense of “dissociation” listed above. The statistics are alarming, but pediatricians are relatively spared. While one half of physicians overall report chronic burnout, 35% of pediatricians report the same (still a significant number, although one of the lowest rates among the specialties; conversely, pediatricians voice one of the lowest rates of happiness because of a high degree of anxiety about the future).

 The rate in surveys involving vets has recently been determined to be 50.2%. Again:  Cry, our beloved vets!

When confronted with the suffering of chronic burnout, health care workers have resorted to two options: suicide versus flight from the profession. As pointed out on The PediaBlog last week, a recent survey conducted by the Larry A. Green Center in Virginia reported that primary care physicians have been pushed to their limits to the degree that one in five are planning to leave the profession (not simply retire early) altogether. The conclusion of the research was “it’s been bad for primary care over the pandemic and it’s getting worse!”

Already afflicted with a high rate of suicide, we should extrapolate that the burnout rate among veterinarians likely IS in the range of 50%. Fortunately, the awareness of their high suicide rate has galvanized the profession to take a hands-on, proactive stance to overcoming the problem. The “Rescue Mission” article referred to above detailed the workings of an organization called Not One More Vet (NOMV).  Since its founding in 2014 as a peer support network for vets on Facebook, NOMV has swelled to a membership of 30,000 worldwide. “NOMV provides the necessary support to all members of veterinary teams and students alike who are struggling with burnout or considering suicide,” stated the group’s website. “Because you are good enough and you are NEVER ALONE.”

In addition, recognizing that Facebook may not be appropriate for everyone, NOMV recently launched a new program called Lifeboat, where vet professionals can be connected completely anonymously with three of their peers who are trained in trauma-informed peer support. “Those three people are going to be there for you and talk to you in a very private environment about whatever’s happening to you and hopefully help you get through that,” says current NOMV board president Dr. Carrie Jurney.  

I think because of their history, vets have surpassed us pediatricians in their efforts to stem the tide of burnout. It is an example of the old adage “Necessity is the mother of invention.” On researching possible resources for physicians on social media, I was only able to find one burnout focus group with 93 members. I think we rely too much on the large organizations of which we are employees to afford us with mental health connectivity. More open intimate discussion needs to be encouraged with complete removal of any stigma. 

As our kindred spirits have already done, pediatricians must evolve. There is much at stake here saving the beasts and the children of our globe.

 

 

 

May is Mental Health Awareness Month

 

source http://www.thepediablog.com/2022/05/19/out-of-the-old-black-bag-21/