Addressing concerns of a dwindling veterinary labor force: steps toward sustainability

Dr Charles McMillan created a list of areas he finds paramount to the discussion of sustainable solutions for revitalizing the veterinary labor force.

In Greek mythology, Sisyphus, the king of Ephyra, was eternally punished by Zeus for his misdeeds by being cursed to push a boulder up a hill, only for it to roll down every time it neared the top. For many veterinarians, work has turned into a similar endless grind with no reprieve in sight. The COVID-19 pandemic exposed fault lines in the veterinary infrastructure and exploited an already fragile and strained workforce.

According to a 2020 study by the North American Veterinary Community (NAVC), 26% of veterinarians are likely to leave the profession within the next 5 years.1 The NAVC study found that veterinarians’ top 3 job stressors were student loans/practice debt, pressure to adhere to time restrictions per patient, and balancing work with family life. Recent research on veterinarians’ wellbeing has pointed to the need to set goals for associates as a way of reframing work. Examining the psyche of the veterinary laborer has led to a mushrooming of initiatives aimed at improving the work experience. But focusing exclusively on how veterinarians are coping in their environment shifts the emphasis away from where it should lie—the environment.

In a 2018 AVMA report titled “The Market for Veterinarians,” veterinarians’ wellbeing did not appear different from other specialized professions (ie, medical doctors, engineers, and lawyers) when accessed through the ProQOL tool, which measures compassion satisfaction, burnout, and secondary traumatic stress. Yet the turnover rate for veterinarians is 15-17%, nearly double that of physicians.2

When comparing veterinary medicine to other specialized professions, there are additional considerations that may contribute to the acceleration and magnitude of wellbeing depreciation. These include, but are not limited to, perceived social standing, wages, and upward mobility potential. As clinics and hospitals struggle to hire associates, a deeper look into factors influencing the veterinary landscape must be pursued.

goals

Goals are essential in all walks of life. They act as our North Star as we attempt to navigate through a world full of uncertainty. Without them, we lose focus and live a life of purpose seems unattainable. But goals, not unlike motivation, mean different things to different people. Thus, an individualized approach is needed when setting goals for ourselves and others. According to the work of an American psychologist, everyone, regardless of culture, race, or gender, has one of 3 primary motivating factors: achievement, affiliation, or power/influence.3

Achievement-motivated people primarily desire accomplishment and results. Affiliation-motivated people are primarily driven by the opportunity to interact socially and collaborate. Finally, the power/influence-motivated are driven by proximity to powerful and influential people and the opportunity to sway others. Most, but not all, veterinarians fall into the achievement category. Achievers prefer moderately challenging projects with a clear start and finish. They like routine feedback, but not being micromanaged. Specific milestones are a plus, and collaboration in achieving them is vital. Achievers’ favorite form of recognition is a promotion.

However, setting goals for an achievement-motivated veterinarian looks a lot different than setting goals for, say, a power-and-influence-motivated one. Veterinarians in the latter category are more likely to be enamored by longer-term and higher-visibility outcomes. They need to feel that their decisions have an impact on the strategic direction of a company. They welcome opportunities to expand their network with people in positions of power and influence. Their favorite form of recognition is acknowledgment of how their decisions positively impacted outcomes and if the affirmation comes from those in power, all the better. Taking the time to assess current and future associates’ motivational needs is essential in crafting individualized goals.

This sort of targeted approach is needed for long-lasting and sustainable engagement and goes a long way in allowing a veterinarian to assign value and meaning to their work. Veterinarians can benefit from having goals, but rather than being the same for all associates, these goals must be based on their primary motivating factors.

Money

“The answer to all your questions is money,” an often recited quote by Don Ohlmeyer—an American television producer—is not exactly a truism. While it would be wrong to say that wages are the only factor contributing to the depression of the veterinary labor force, it would be equally wrong to dismiss their widely permeating impact. Mean annual income for veterinarians in 2021 is just over $119,000.4 For comparison, the average annual income for a family medicine physician (the 2nd lowest average annual income among physicians) in 2021 is $236,000.5 Research supports the concept that there is a financial threshold as it relates to be well when working in less than desirable conditions.

Stated differently, an employee making over the financial threshold is unlikely to have an improved outlook about the work environment if offered more money. Large sign-on bonuses are being flaunted due to the high demand for workers. While these are incentives to join a particular practice, consideration must also be given to developing financial packages meant to retain workers. Bloated salaries and high sign-on bonuses need to be balanced with sustained raises and opportunities for veterinarians to increase their salaries beyond a traditional production model. Due to unevenness in the veterinary labor market, veterinarians are likely to relocate for higher-paying employment to counteract indebtedness. This in turn exacerbates the maldistribution of labor. Paying veterinarians more cannot by itself threat burnout, but it would raise perceived social standing and allow associates to address student debt.

Shoring up workplace culture

Maintaining a positive work culture is vital to recruiting and retaining quality associates and cultivating motivation. In the absence of a positive work environment, motivation dwindles, and apathy and cynicism metastasize through your organization. High turnover seen with veterinarians (15-17%) and technicians (25%) is a side effect of a poor work environment.2 Identifying and addressing motivational obstacles is a must to guarantee that employees bring their best selves to work. Evaluating your workplace culture involves assessing practices and policies, tapping into the strengths of employees, and both being aware of individual goals and creating paths for employees to reach them.

Reinforcing gold standards across the industry

A common concern from veterinarians is the non-compliant owner. Having to battle misinformation from the internet is a source of stress and attrition among associates and adding to this challenge is having to counteract previous poor client experiences and suboptimal or outdated medical practices. Reinforcing gold-standard medicine, therefore, can help to narrow the recommendations gap by increasing owner education and awareness. Late stages of burnout can be characterized by no longer caring whether your clients adhere to your recommendations. Reinforcing best practices will help consolidate owner expectations and alleviate any reluctance they may have when dealing with someone other than their primary care provider. Compliance is a quality-of-care issue and when recommendations are adhered to, positive outcomes occur, and hospital team morale is boosted. This then contributes to the maintenance of a positive work culture. Delivering positive outcomes bolsters veterinarians’ sense of purpose and reminds them why they joined the profession.

Increasing veterinary school admission rate

There is debate about the usefulness of increasing student enrollment in veterinary schools. Most uncertainty occurs when increasing student numbers is spoken about as a panacea for the workforce shortage. While increasing the labor force will not address issues with productivity or burnout, simple mathematics allow us to understand the need to expand the labor force to keep up with increasing demands. Without these increases, hospitals will continue to overpay for associates and have more likelihood of hiring mistakes.6 This in turn leads to more turnover and rearranging of the issues. A 2019 AAVMC report examining the quality in the applicant pool found that the number of academically-qualified candidates exceeded the number of admissions offers extended.7 This means that despite the increasing number of veterinary students entering and graduating from veterinary programs, the applicant pool was sufficient in size and quality to sustain the increases.7 The surplus of qualified applicants is welcome news for the profession and counters any argument of watering down student quality by increasing admission.

In conclusion

With shifting demographics of pet ownership and the strong consumer demand for pet education, products, and services, the gap between job vacancies and jobseekers is expected to grow. Causes for the tightness in the labor market are multifactorial and thus require a multifaceted approach to address them. The issues outlined above are salient, but more exist, and certainly, more will emerge as others are addressed. Focusing on factors that increase veterinarians’ wellbeing will help with retention, as will improving the veterinary workplace ecosystem. Likewise, more creativity is needed when considering compensation packages that will improve veterinarians’ social standing while also assuming student debt concerns. Increasing the labor force before repairing the defects in the veterinary infrastructure is akin to pouring water into a bucket with a hole in it. Paying attention to workers’ wellbeing and advancing infrastructure is a sign that an industry is healthy, and we are willing to invest in its future.

Charles McMillan, DVM, is a dvm360® editorial advisory board member and a 2012 graduate of the Tuskegee College of Veterinary Medicine. A small animal practitioner in suburban Atlanta, he enjoys writing about issues of race and culture in veterinary medicine and the techniques and practices for establishing a healthy workplace ecosystem. You can reach him on Instagram at @yourfavoritepetdoc or at doctorthinker.com.

References

  1. North American Veterinary Community. Amplifying the Voice of the Veterinary Community. 2020
  2. Getting to the root of overworked and burned-out veterinary practices. American Veterinary Medical Association. Accessed February 17, 2022. https://www.avma.org/javma-news/2021-12-01/getting-root-overworked-and-burned-out-veterinary-practices
  3. Mish R. Motivating People for High Performance. Cornell University, LSM596. 2021
  4. Fierce competition over veterinary laboratory. American Veterinary Medical Association. Accessed February 17, 2022. https://www.avma.org/javma-news/2021-12-01/fierce-competition-over-veterinary-labor
  5. Medscape Family Physician Compensation Report 2021. Medscape.com. Accessed February 15, 2022. https://www.medscape.com/slideshow/2021-compensation-family-physician-6013848
  6. Lloyd JW. Characterizing the current US employment market for veterinarians -June 2019. Vin.com. Accessed February 15, 2022. https://news.vin.com/apputil/image/handler.ashx?docid=9399950
  7. Lloyd JW. Evaluating the depth of quality in the 2018 aavmc applicant pool. aavmc.org Published 2019. Accessed February 15, 2022. https://www.aavmc.org/assets/Site_18/files/About_AAVMC/applicant_pool.pdf