Guest: Dr. Addie Reinhard – It’s no surprise that both veterinarians and their support staff have high rates of burnout, but are these groups experiencing stress for the same reasons? What can individuals do to reduce these stresses? What can practices do to protect their people, and what role does personal autonomy play in all of this? New research, the Merck Animal Health Veterinary Wellbeing Study III, sheds light on not just the factors causing psychological stress in the veterinary profession, but also what we can do about it.
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LINKS
Merck Animal Health Veterinary Wellbeing Study III: www.merck-animal-health-usa.com/about-us/…ing-study
Are They Ready? Trials, Tribulations, and Professional Skills Vital for New Veterinary Graduate Success: www.frontiersin.org/articles/10.338…021.785844/full
AVMA Wellbeing Resources: www.avma.org/resources-tools/wellbeing
QPR Training: www.avma.org/resources-tools/we…revention-training
MentorVet Website: www.mentorvet.net
MentorVet Instagram: www.instagram.com/mentorvet/
Uncharted Veterinary Podcast: unchartedvet.com/blog/
Uncharted Veterinary Conference: unchartedvet.com/uncharted-april-2022/
What’s on my Scrubs?! Card Game: drandyroark.com/training-tools/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Dr. Addie Reinhard is a veterinary wellbeing researcher. Her research focuses on developing and evaluating innovative interventions to support mental health and wellbeing within the veterinary profession. She is the Founder and CEO of MentorVet, an evidence-based mentorship and professional development program for recent veterinary graduates. She is on the research team for the next phase of the Merck Animal Health Veterinary Wellbeing Study. In 2021, she completed a master’s degree in Community and Leadership Development and a Graduate Certificate in College Teaching and Learning from the University of Kentucky and holds a certificate in Veterinary Human Support from the University of Tennessee. She is also a certified QPR instructor.
EPISODE TRANSCRIPT
This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.
Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here today with one of my good friends, Dr. Addie Reinhard. For those of you who do not know her, she’s a veterinary wellbeing researcher. She is the founder and CEO of MentorVet. She is an awesome, enthusiastic speaker, presenter, thought leader. She is someone who you are going to hear about in the coming years and decades in vet medicine because she just brings such passion and enthusiasm, and she’s doing such cool stuff. I’m super fan boy over Dr. Reinhard. She’s just phenomenal. You’ll hear why I’m such a big fan on this podcast.
Dr. Andy Roark:
She is here talking about brand new research. It’s the Merck animal health veterinary wellbeing study. She presented this at VMX conference, which is where I got to become aware of it. Man, this is not just research on stress and burnout. This is research on what do we do about it, and how does the staff feel it, and why and how is the staff different than the doctors, and what do we do about that, and what are the role of the individual doctors, and what are the role of the practices, and what are the role of the individual staff members as far as actually fixing some of these problems.
Dr. Andy Roark:
So if you’re ready to get a little bit more insight and then some actual real thoughts on what steps we as a profession can take to start making this problem better, guys, this is the podcast for you. Let’s get into it.
Kelsey Beth Carpenter:
(singing) This is your show, we’re glad you’re here, we want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark:
Welcome to the podcast, Dr. Addie Reinhard. Thanks for being here.
Dr. Addie Reinhard:
Hi. Thanks for having me. So excited to join.
Dr. Andy Roark:
It’s my pleasure. You are a shooting star. A shooting star is like somebody’s falling, but you’re the opposite. You’re like a launching star like Magellan. We’re going into space. I just met you a year ago and you are doing the most amazing things, and I’m not kidding. I’m kidding about Magellan, but otherwise, I’m 100% serious about your meteor rise, and you’re doing freaking amazing stuff. So I met you through the company that you are the CEO and founder of, which is MentorVet. You are leaning heavy into a research-based approach into mentorship and wellness, mental health wellness, and veterinary medicine, and you are doing really good work.
Dr. Andy Roark:
You and I talked a couple times on the phone and then I got to meet you in-person at VMX. I’m so impressed with you and such a big fan and supporter of what you’re doing. So I am really thrilled to be able to have you here to talk about some research that you are actually presenting at VMX.
Dr. Addie Reinhard:
Yes. Yeah. One, thank you for inviting me, and it’s been great to connect. Yeah. I think it’s been an amazing journey to get here. I feel like where I was a year ago, I was actually in grad school still one year ago, and I hadn’t even started MentorVet. I mean, we had piloted MentorVet, but really, just the transformation in one year has been really incredible to see just how far that we’ve come. So yes, we presented the data from the wellbeing study at VMX, which is super exciting. We have a lot of exciting new data to share with the community.
Dr. Andy Roark:
Yeah. So I was looking at it. So this is the Merck animal health veterinary wellbeing study that came out just this year, 2022. It was done in September-October, 2021. Merck, just pause for a second, their wellbeing studies, this is I think the third one that they’ve put out, they have been very good and very insightful and very useful for actionable steps as we look at our profession and be like, “Hey, what’s working? What’s not working?”
Dr. Andy Roark:
So just props to Merck for supporting this because, honestly, I don’t know exactly what their return on investment on a study like this is compared to selling products. I feel like it’s just a good thing that they are doing and have done. So I just want to stop for a second and say thanks to those guys for investing into the wellbeing of our profession. That was really an awesome thing.
Dr. Addie Reinhard:
Yeah. Yeah. They’ve been in the wellbeing space. I say this, they’ve been in the wellbeing space before it was cool. So they’ve actually been doing these studies for, this is the third study that they’ve done of the wellbeing study. So I feel like in the last year or two there’s really been a drive for more wellbeing initiatives, but they’ve been doing this before anybody else was doing it. I think that I’m very grateful for them for that, not only that research, but they also support MentorVet in a big way. So they’re really backing a lot of other wellbeing initiatives that are evidence-based and really making an impact on the profession.
Dr. Addie Reinhard:
So yeah, they’re very aligned with sustainability of the veterinarian and the profession because without veterinarians, who’s going to sell the product? So I think they recognize how important the vets are in this entire picture of our veterinarian industry. We have to keep our vets healthy and well so that we can continue in the good work that we’re doing in the communities.
Dr. Andy Roark:
Yeah. One of the things I like a lot about this particular study, too, is they dig a lot into the support staff. So I just loved it. It’s more of a holistic view on the practice, I think. So anyway, let’s get into this because, honestly, I was looking at this, I didn’t get a chance to come to the talk at VMX and I was like, “Ah, I know what I’ll do. I’ll get Addie to come here and just give me the information directly,” and it’s more convenient in my schedule. That’s the arrogant thought that I had.
Dr. Addie Reinhard:
You get a private viewing of the wellbeing stuff.
Dr. Andy Roark:
That’s what I wanted. I was like, “Break this down for me.”
Dr. Addie Reinhard:
“I don’t have time to go to the VMX presentation. I want a private viewing of this presentation.”
Dr. Andy Roark:
I know. I lead a charmed life. There you go. So wellbeing study, what is new? What are high level takeaways? Let’s just get started and crack this thing open. So break down the study a little bit. How did it go? What was it? Then you and I will start to dig to some findings and then we’re going to get into some recommended action steps after that.
Dr. Addie Reinhard:
Okay. Yeah. So I think big picture, not a huge surprise, but as far as psychological distress, we’re in a worse place as we were two years ago. So there’s a higher rate of serious psychological distress among veterinarians, and we think that a lot of this might be related to pandemic stressors. We also know, interestingly, burnout has not increased since two years ago, and wellbeing has actually stayed pretty consistent as well.
Dr. Addie Reinhard:
We know also that the burnout rate among veterinarians is actually not, sorry, the wellbeing rate among veterinarians is actually not significantly different than the general population. So wellbeing, in general, seems to be, average wellbeing, seems to be consistent for veterinarians in the general population, but the level of serious psychological distress is the concern.
Dr. Addie Reinhard:
I think when we break it down, too, by age, the levels of serious psychological distress or burnout or poor wellbeing tends to be much worse in the earlier career for younger veterinarians is really what we’re seeing. I think that’s new for this study is that when we’re looking at essentially concerns and what vets are concerned about really consistent from previous waves of the study that vets are concerned about the stress levels of vets and the staff. They’re concerned about the high student debt. They’re concerned about the suicide rate, but new for this phase is they’re concerned about perceived shortage of veterinarians.
Dr. Addie Reinhard:
So there’s definitely a lot of more concern, I think. I’m sure just with workflow and efficiencies, people are really starting to see some strain and stressors with that. Then you mentioned the support staff side of things. So yeah, we got some data, which I’m really excited about because I feel like there’s not been a lot of survey research done on veterinary support staff. So we knew that maybe they were having issues as well.
Dr. Addie Reinhard:
There was a few studies here and there. Recent studies showed that the suicide rate of veterinary technicians may be even higher than veterinarians. So there’s definitely been some concern there, but we did find actually that the mental health and wellbeing of our support staff does seem to be worse than veterinarians, which is also pretty concerning.
Dr. Addie Reinhard:
I think there’s also a concern about the shortage of qualified support staff as well in addition to the shortage of veterinarians, too. So I think those are some of the big takeaways from the research, but essentially, a big part of doing this research is to track trends over time. So doing a temperature check of the profession every two years to see where we’re at, and it does appear, at least when we’re looking at serious psychological distress, that things have gotten worse since two years ago, which is concerning to me.
Dr. Andy Roark:
Okay. All right. So there’s a lot to unpack, Addie. That’s a lot. All right. I need to step back for a second. Let’s define some terms because there’s important nuance here. So talk to me a little bit about serious psychological stress or psychological stress as you put it, burnout and wellbeing as three distinct states. So while serious psychological stress is going up, our wellbeing seems to be staying the same. Break it down enough for me so that I can understand the terms so I can see how those things can be true at the same time.
Dr. Addie Reinhard:
Yes. Love it. Thank you for that. I think when you’re so ingrained in this research, sometimes these terms are very just used commonly and people might not understand the distinction. So I appreciate the question. So essentially when we’re looking at wellbeing, that is levels of happiness. So wellbeing is not the absence of mental illness. You can have no mental illness and still have poor wellbeing. So essentially, it’s your level of happiness in life and your life satisfaction or work satisfaction or overall satisfaction with your life as a whole.
Dr. Addie Reinhard:
So that’s wellbeing, and then we have psychological distress or we use a scale called the Kessler-6 to measure serious psychological distress, and that’s really gauging mental health and mental health conditions. So it asks six questions. Some of the questions might be related to how often in the last month have you been feeling hopeless or anxious or stressed, things like that. So it really tracks more of your mental health.
Dr. Addie Reinhard:
Then the third is burnout. So we know burnout is a work-related condition, and this burnout is essentially a psychological syndrome that emerges when you have prolonged stress on the job, you’re not coping with it in a healthy way, and the main three symptoms of burnout are cynicism, exhaustion, and lack of professional efficacy or feeling like the work that you’re doing isn’t making any impact.
Dr. Addie Reinhard:
So there are three very distinct things, and they measure each of these scales that we ask essentially measure three very different things. So you can have worse, serious psychological distress, but wellbeing could be okay, right? So I think that that’s the distinction there.
Dr. Andy Roark:
Okay. All right. That makes sense. So jumping back, tell me the story about how wellbeing and psychological stress interfaces for the veterinarian. So I guess when you say wellbeing doesn’t seem like it’s changed, but psychological stress has changed. What does that mean in layman’s terms as far as what is the experience of veterinarians when we’re seeing these intersection of burnout, psychological stress, and then maintaining wellbeing?
Dr. Addie Reinhard:
Yeah. So I think that just tells us that perhaps individuals are having more mental health or a higher proportion of individuals are having mental health challenges right now, but the overall level of happiness in the profession hasn’t really changed in the past two years.
Dr. Andy Roark:
Gotcha. Okay.
Dr. Addie Reinhard:
So I think that’s how I would break that down if that makes sense.
Dr. Andy Roark:
All right. That definitely makes sense. Let’s talk a little bit about, we talked about the last two years specifically, and these are exceptional times, and there’s a global pandemic, and we saw all the things that come with that, and people picking up curbside, and clients not wearing masks or worrying about the staff being sick and having staff being out because someone got COVID and now the staff is contact tracing and things like that. I mean, these were really strange times. Can you unpack a little bit more what exactly the impacts of COVID were on the mental health of the doctors and staff and how does that manifest?
Dr. Addie Reinhard:
Yeah. So we essentially asked several questions about the impact of the COVID-19 pandemic on both the team, as well as veterinarians, and some of the most pressing issues that were experienced were some of the things that you mentioned. So the practice being short staffed due to individuals being away for illness or family care, the job just increased the exposure to COVID-19, people were working longer hours. Many people did report working longer hours during the pandemic. So I think being that short staffed part of this, I think that was a huge driver in some of the challenges that our veterinarians were facing as far as looking at the impact of this on our bets.
Dr. Andy Roark:
Tell me a little bit about how the staff experience is different from the veterinarian experience.
Dr. Addie Reinhard:
Hmm. Ooh, that’s good. I think that, in general, what we saw at least from the data is that the clinic staff were more impacted by being shorthanded than the veterinarians were, at least looking at the percentage of vets who felt like they faced a barrier because of being shorthanded, but a lot of the staff, I think, faced more challenges. Oftentimes, these individuals are on the front lines, being the first contact for owners at times. Everybody’s on edge right now, right? So there’s likely a lot more conflict happening. They’re getting a lot more of that, I think, than some of the veterinarians are, potentially.
Dr. Addie Reinhard:
Yeah. I think just having a shortage of veterinary support staff in general makes it really hard for the support staff that are currently working. So I don’t know too many of the other differences that we saw, but that was the main one is that the staff were a little bit more impacted by the shortages than the veterinarians were.
Dr. Andy Roark:
Okay. Is there insight into retention inside the profession as far as … Do we think that these shifts that we’re seeing are going to lead to a higher number of doctors or support staff leaving in the coming years?
Dr. Addie Reinhard:
So as far as retention goes, there was very little concern that we would have retention issues in the next two years, at least for the veterinarian side of things. So most of the veterinarians actually answered that they were unlikely or very unlikely to leave the profession in the next two years. So looking at the veterinarians who were under the age of 55, around 75% of them said very unlikely or unlikely to be leaving the profession in the next two years.
Dr. Addie Reinhard:
So I don’t think we’re horribly concerned about a mass exodus, at least from these data, but I think with the shortage of the support staff, so a lot more support staff said that they would be leaving the profession in the next two years. So I think there are more concerns about retention for our support staff, and that’s definitely, I think, an area that we probably need to focus on a bit more. I think nearly a third of vet staff were likely to leave the practice in the next two years. So definitely much more of a concern on that side of things.
Dr. Andy Roark:
Yeah. That’s brutal. I’m going to come back to where we go from here and what do we do about that, but can you unpack a little bit of demographic differences? So I’m talking about types of practice, and then also ages or time in the profession because that seem to have a significant impact.
Dr. Addie Reinhard:
Yeah. So in general when we’re looking at most of these data, in general, younger veterinarians are typically going to be more at risk for serious psychological distress, for burnout, for lower wellbeing as compared to older veterinarians. So I think age has a huge factor in this. So when we’re looking at particularly burnout, around 75% of vets under the age of 35 are moderately or severely burnt out based on the survey.
Dr. Andy Roark:
That’s abysmal.
Dr. Addie Reinhard:
That’s a lot. Only a quarter of vets of early career vets were feeling low levels of burnout. So that’s a concern because I think when you look later in the career, so it tends to slowly improve over time. So I think a little over around 60% of vets over the age of 35 were in that range. So still a lot, yeah, right around 60% vets are feeling moderate to severe burnout right now even in the older age groups. So that’s a concern to me.
Dr. Addie Reinhard:
I mean, we know burnout is an issue in the general population as well. So I don’t think it’s unique to veterinary medicine, but it still is a problem that we need to address, right? So that’s very concerning to me, especially we’re looking at interventions or what we can do about it. Definitely, our early career vets are a huge focus, and for a lot of the work that I do, a big focus is how can we reduce burnout and make this career more enjoyable because the vets aren’t going to leave. They said they’re not going to leave the profession the next year, but they’re so, so incredibly burnt out.
Dr. Addie Reinhard:
So how can we make it to where they’re not so upset and feeling trapped because I think that’s where you get into trouble when somebody feels like they’re trapped in the career or they’re not going to leave in two years, but they’re so incredibly burnt out. When you’re incredibly burnt out, you feel like quitting the career.
Dr. Addie Reinhard:
So to me, that suggests perhaps these individuals might feel just overwhelmed, trapped by the work that they’re doing. As far as the practice groups, we definitely see, in general, companion animal veterinarians having lower, worse mental health and the equine and food animal veterinarians, at least from this study, had better mental health.
Dr. Addie Reinhard:
So I think that that’s interesting to me, but there are stressors in every industry. I sometimes wonder, and this is an aside from the study speaking from a personal viewpoint, I wonder sometimes the impact, especially when we’re looking at food animal versus companion animal, how much of the stressors that our veterinarians are experiencing are related to access to care issues and these ethical dilemmas and providing care given limited client finances. That’s something that food animal practitioners don’t really have to, they have their own ethical issues, but a lot of our companion animal veterinarians are dealing with these kinds of situations almost every day.
Dr. Addie Reinhard:
When you’ve been taught one way, and this is the gold standard way and this best care or you’re not doing the best that you could do, there’s, I think, a lot of guilt and moral stress there when you’re not able to provide the care that you think you should. So I do think when I look at, at least the distinction between companion animal and food animal, that that’s one factor that I think plays a part in this at least.
Dr. Andy Roark:
Hey, guys. I just want to jump in here with a couple quick updates. If you haven’t checked them out yet, you got to check out the cool gift that we got from our friends at Banfield Pet Hospital. They have decided to support us in putting out transcripts of The Cone of Shame Podcast and also The Uncharted Veterinary Podcast. They’re supporting us in improving accessibility and inclusivity in vet medicine. It is something that Banfield feels strong about and they actually have stepped up and leaned in to make this possible. We could not do it without them. I am so proud to be able to do this, but, yeah. Head over to the drandyroark.com website. You can click on the show notes and you can find the link tree. It’ll take you there as well, but for all of our episodes, we have transcripts.
Dr. Andy Roark:
So spread the word. Check them out. Use them how you need to, however they’ll be helpful to get the word out about the work that we’re doing on the podcast. I just have to say, thanks so much to Banfield.
Dr. Andy Roark:
Over on The Unchartered Veterinary Podcast, speaking of which, we have a brand new episode came out yesterday. It’s about being the newly promoted manager and being friends with the people that you used to work shoulder to shoulder with. We had someone who was like, “Hey, they went out for drinks and I didn’t get invited because I’m the manager now, and this really hurts my feelings.” Yeah, that’ll happen. Stephanie Goss and I break it down. We talk all about how to navigate that, what that’s like, what that emotional process is, maybe where your head should be, some of the pitfalls that people fall into when they go through this transition of going from working with people to going to being the manager of people. If that sounds like you, if that sounds interesting, check out The Uncharted Podcast wherever you get your podcasts. There’s also a link in the show notes.
Dr. Andy Roark:
Guys, that’s enough of that. Let’s get back into this episode.
Dr. Andy Roark:
I saw some research not long ago that talks about the mental health benefits of being outside.
Dr. Addie Reinhard:
Ooh, yeah.
Dr. Andy Roark:
Again, that seems so super simple, but I do wonder, is that a piece of it as well? I mean, really, it’s like when you think about, just think about the workplace, right? So there’s this Buddhist idea that the environment that you’re in deeply affects your thinking and your experience. I think that’s true, and I sit in a messy, cluttered office. I feel anxious and crappy, and when it’s nice and clean, I feel like my life is in control. So I think about the difference in working in an exam room all day long and then also being outside, going to a farm, going to a production area, things like that. It’s part of it.
Dr. Andy Roark:
The other part I actually wonder, and again, this may be absolutely nothing, but the travel time. If you’re a large animal person or you’re going between places, having those little breaks in the middle of the day and actually changing environment, again, this is complete hypotheses just on my part, but anyway, I think about that. The idea of the economics are different. There’s different economic structure. I think that makes a ton of sense and I think that’s maybe more. I’m like, “It’s truck time,” and you’re like, “No. It’s the economics of the …” I’m like, “No. I think it’s the trucks.”
Dr. Addie Reinhard:
It’s the trucks. I do agree with you, though, and just talking with a lot of my mentees in the program, at least some of the vets who do farm calls, they get a little bit more break in between, and they get more time to process, and they have more time to think about cases in between, not saying that it’s still not really stressful and they’re working a ton of hours, but I think when you’re going, and this is coming from a companion animal practitioner’s perspective, but-
Dr. Andy Roark:
Yeah. Totally. We are two dog and cat that’s being like, “I don’t know what their experience.”
Dr. Addie Reinhard:
I don’t know. I don’t know. Yeah.
Dr. Andy Roark:
I think it’s because they’re wearing boots.
Dr. Addie Reinhard:
There’s most certainly I think stressors in both, and it’s really interesting because I’ve done a lot of my own research on the stressors in the early career and why do we see these higher rates of stress and poor mental health specifically in the early career. It’s really interesting because when I’ve talked with vets in small animal or food animal, swine or equine, the interesting thing is the stressors. They are all essentially the same, but the context is slightly different, but the heart of it, the heart of the stressors like conflict, like ethics, like issues around leadership, all of these things are very similar.
Dr. Addie Reinhard:
So it’s really interesting because when I educate a lot of the early career vets on how to cope with some of these stressors that they’re experiencing, in general, the curriculum is pretty consistent across the board for a food animal vet, an equine vet or a small animal vet, but the case examples that I provide are just different and tailored to that aspect of the career.
Dr. Addie Reinhard:
So it is really interesting to think, and I think part of going forward with this issue is all of us, as far as any walk of life in veterinary medicine, are having these similar shared challenges. So if we can come together, instead of saying they have it worse or we have it worse, we’re all facing really similar challenges, and I think coming together and working on these as a shared community will be good going forward.
Dr. Andy Roark:
Oh, yeah. The suffering Olympics are something that we do not want to participate in and we need to stop going. No, I agree with that, and 100%. I only look at that to say, well, if there’s a group that seems less burned out than another group, we should look at what they’re doing, and try to parse that out and say, “What are they doing?” and how do we bring into other places, not, “Look, that’s why I have it worse than them.” It’s like, “No, no.” How do we move this forward? What do you think?
Dr. Addie Reinhard:
That’s a good point. We have to stop that, too, with looking at vets have it worse than just people in general. I think I hear it a lot, especially with the suicide rate. That concerns me, and I think we have to have an awareness that these issues are present within our profession, but I think we need to pull away from the blame game, as well as the comparison game of we have it worse than you because, gosh, we all have it. Everybody, not just vets, are having struggles right now.
Dr. Andy Roark:
Oh, yeah. I think that’s important context. I’ve gotten in trouble for of this a couple times, but I keep trying to bring it back up because I think it’s really important. There’s obviously a lot of specific stressors for our profession. We do have a very stressful job. The narrative that we are the worst profession for suicide, that’s not true. That’s not factually correct.
Dr. Addie Reinhard:
Not true.
Dr. Andy Roark:
That doesn’t mean the individual people aren’t struggling and suffering. Those things can both be true. I think that we have a bad habit of playing a martyr game where we say, “I have it worse.” Again, I think a lot of people take their suffering as a badge of commitment. You know what I mean? It’s almost like, “I give so much that that’s how I see value in myself is I shoulder this heavy burden.” I just think that’s something we need to work back against. The other-
Dr. Addie Reinhard:
Yeah. Oh, go ahead.
Dr. Andy Roark:
The other thing I guess I would just jump in and say real quick is when we talk about mental health is occupational stress is a driver of mental health issues, but it is not the driver of mental health issues that family genetics predisposition or family history relationship, stress, chronic illness, chronic pain, all these other things that generally mental health issues are multifactorial, and a stressful profession can definitely be a factor and a big factor, but again, to break it down to, “Well, this profession feels this way and this profession feels this way,” I think that oversimplifies it and it puts so much weight on our job that if …
Dr. Andy Roark:
I think you touched on it really nicely earlier on, right? If you have this idea that, “I’m not going to leave the profession, but this profession is guaranteed to make me miserable, then I have just given away all of my personal agency, my ability to,” I don’t know, “to feel like I can fix this or I can get out of it. Essentially, I’ve abandoned hope because I say there’s no escape from this, and I refuse to leave, and I go, ‘Well, I don’t know what the path is. That’s not into darkness from there.'” So I think we set ourselves up into that place.
Dr. Addie Reinhard:
Yeah, and I think you bring up a really good point of all the factors with mental health and wellbeing, and that’s one thing, at least with the study that we’ve found is that’s our more neurotic. There’s higher levels of neuroticism in our profession than the general population. We have lower levels of extroversion as well. So we have, in general, more neurotic, more introverted profession, and neuroticism is essentially a level of worry, how much you’re worried about stuff in general.
Dr. Addie Reinhard:
So we know that neuroticism can play a factor in mental health and can be predictive of mental health challenges, especially when put in a stressful environment. So when you’re working, so somebody without high levels of neuroticism may work 50, 60, 70 hours a week and be fine. Whereas somebody with neuroticism working that many hours may predispose them or contribute to mental health challenges, right?
Dr. Addie Reinhard:
So some of these personality factors definitely do play a role. So I think knowing your own personality and what you are able to cope with, and you might not be able to pull the 80 hours a week like your mentor is doing in the practice, and you might not be able to do that and still be okay, and that’s fine. You might have to set boundaries so that you’re not doing that so that you keep yourself well.
Dr. Addie Reinhard:
So I think, again, trying not to, I think you called it a badge, we don’t have to wear that badge. I think we can admit that, “I am not able to work 70 hours a week.” I burnt out at 40 hours a week in veterinary medicine. I experienced a fear burnout twice at 40 hours a week in veterinary medicine. So it can happen, I think, even not working a lot of hours, but I definitely think hours worked combined with personality type of our profession is another factor in all of this.
Dr. Andy Roark:
Yeah. So taking that, one of the things I’m just really interested in, whether it’s in the wellbeing study or whether it’s just your own experience from MentorVet, what is your take as far as the primary drivers for earlier career vets being more burned out than later career vets? Is it financial? Is it a debt thing? Is it a lack of financial stability thing? Is it, I don’t know, a cultural thing? Is it access to social media? I don’t know. What is it?
Dr. Addie Reinhard:
Yeah. So I think in general when we’re looking at wellbeing, it typically improves over time in the general population. So we know, in general, the older you get, the happier you get. So there’s a little bit of just that factor in general, but I think when we’re specifically looking at the veterinary profession, so I did a focus group. It’s been about two years ago now, pre-COVID, assessing the stressors of our early career veterinarians.
Dr. Addie Reinhard:
I think a big factor is essentially going from an environment where you have little responsibility as a fourth year vet student. You have a lot of checks all along the way. You’re transitioning into this environment now where you’re expected to have full responsibility so suddenly. It happens overnight. These are your patients and you are terrified of screwing up. You’re just so scared, this fear, overwhelming fear of making mistakes, and maybe you don’t even make the mistakes, but you’re just terrified of screwing up. I think that’s a big factor is this self-sufficiency and self-doubt.
Dr. Addie Reinhard:
I think another factor is conflict. So learning how to navigate conflict or how to navigate these tough ethical situations, and when you’ve been in practice five, 10 years, you learn as you go. You learn these skills. You get more comfortable with these conversations or how to operate in this gray area. I think that’s a huge stressor for our early career vets is learning how to operate in the gray area because in veterinary school, often we’re taught a gold standard approach and not really any in between options.
Dr. Addie Reinhard:
So when you get into a practice setting where there’s barriers, whether that be financial, your own skills and availability, your staff’s availability, you can’t always do the gold standard, and maybe it’s not always the right thing to do, the gold standard. So I think a lot of the stressors that they experience is learning how to be a practitioner in not an academic setting, operating in that gray area, and feeling good about the care that they’re providing. I think that’s the really tough part because often they feel like they are a bad vet. They’re not doing what was modeled in the academic institution.
Dr. Addie Reinhard:
There’s been a lot of research around essentially identity developments in the early career and in vet school, and veterinarians who have this more diagnosis-focused identity where, “I am only getting joy from my work if I diagnose this pet and provide the gold standard treatment,” right? So those vets are going to be really unhappy in private practice because they aren’t going to get to do that very often. Whereas there’s another identity, essentially this challenge-focused identity, that’s more focused on professional autonomy and how I can use my judgment in each individual case to provide the care for this context and this situation and adapt and manage challenges and looking at how my joy is coming from my work and more than one way than just treating and diagnosing animals.
Dr. Addie Reinhard:
So is it helping an owner? They had $100 and I helped them and, wow, we made the pet better. Maybe we didn’t do the gold standard thing, but the pet’s better now. So that’s a huge win. So I think those are the main things I see at least assuming a leadership role as well, just learning how to delegate, being new in a practice and really learning to navigate the intricacies of the support staff and learning how to delegate. So I think as far as my research goes, particularly looking at the transition of practice, those are some of the main contributors to stress.
Dr. Andy Roark:
Yeah. That’s really insightful. That makes a ton of sense. Let’s transition now to some action steps. Actually, one of the things I really liked in this were recommended steps for both the individual and then also the employer. I think they’re both important to hit on. I’ve got this real belief that our best approach to mental health problems in our profession is three-tiered. It’s at a professional level, it’s at a practice level and it’s at an individual level. So I like to see things broken out into this is what the individual can do, and this is what the employer can do. I feel like those two things go hand-in-hand. So do you want to lay down the pieces, whether we do individual or employer first, but lay down those pieces and then how they interact?
Dr. Addie Reinhard:
Yeah. Let’s start with individual because I’m a big fan of the individual approaches. I know these get critiqued a lot because I think that, I mean, it can feel hard when you’re feeling burnt out and somebody’s just telling you do more self-care and your organization is not changing, right?
Dr. Andy Roark:
You know what helps me? Breathing. That helps me and you go, “I can’t. I can’t with you.”
Dr. Addie Reinhard:
Yeah, but I do believe that individuals have such power, and teaching individuals how to advocate and speak up about their needs because often our employers don’t even know that there is an issue. So part of this whole aspect of self-care stress management is just learning how to speak up about what you’re experiencing and what your challenges are. So essentially from the study, when we’re looking at individual strategies, one of the, this profession is inherently stressful, right? We know that veterinary medicine, clients aren’t magically going to be nicer to us, and the ethical dilemmas are never going to go away.
Dr. Addie Reinhard:
There are things that can be reduced as far as stressors go, but even in the most supportive practice environments, if we’re not taking care of ourselves, then you’re probably still going to burn out, right? So one of the big factors at promoting wellbeing and mental health is having a healthy way to manage your stress. So individuals that felt like they had a healthy way to manage their stress were less likely to have distress or serious psychological distress and mental health challenges. So just starting to think about what is your stress management plan, what are you doing to manage your own stress, and I’m not just saying meditation and breathing, and it can be helpful.
Dr. Andy Roark:
Yeah. That can be great. I wasn’t trying to knock it earlier on, but-
Dr. Addie Reinhard:
Yeah, yeah. It can be helpful for some, but for others maybe not, but looking at self-care in a different way of instead, how are you setting boundaries? How are you talking with your practice about your needs? How are you advocating for yourself and your team? What are you doing? Because self-care is not going to work unless you set boundaries to make it happen. Then the self-care comes after that.
Dr. Addie Reinhard:
I’m an advocate of individualized self care. Everybody’s self-care is going to look a little different, basic exercise, sleep, nutrition, and then advanced self-care, whatever works best for you, but just knowing what works to reduce your stress. I know when I’m stressed, I need to exercise. I need to go for a run. I need to do 10 minutes of meditation. There are things that I know that I need to do when I’m starting to feel overwhelmed and stressed. I know that I have a healthy way to manage my stress.
Dr. Addie Reinhard:
So I think for listeners out there, if there’s one thing that you can do, it’s start to think about what is your stress management plan, what are you going to do when you start feeling stressed and do those things, and really having that work-life integration and figuring out what that means for you I think is also really important. I think the individual strategies can be really helpful and talking about, especially the student debt, and that’s a stressor that I didn’t mention before for early career vets that you did, and I do think that’s a big stressor is financial health, and graduating with a huge mountain of student debt and, “How am I going to pay this off?”
Dr. Addie Reinhard:
So engaging with a financial planner or a financial coach, somebody that can help you work through your personal finances so that it doesn’t feel so overwhelming, so it doesn’t feel like you’re trapped in the profession because you’re not, and really engaging with somebody who can help you get some hope around your financial situation I think is really, really important as far as individual strategies go.
Dr. Andy Roark:
Yeah. That makes a ton of sense. What are the key strategies for employers who want to take care of their people?
Dr. Addie Reinhard:
Yeah. So there are a lot of things that employers can do. I think one of the biggest things that we’re talking about now is employee assistance programs. So making sure that your employees have access to an EAP. They’re not horribly expensive. They’re really not. It’s just a thing, and not even just having one, but making sure that your team knows that you have one, too, and communicating that because that was one thing from the study is a lot of people didn’t even know. A lot of people didn’t even know that if their health insurance covered mental health challenges or not. So being able to communicate with your employees, “This health insurance does cover these mental health things or this EAP is available to you,” and communicating that.
Dr. Addie Reinhard:
I think there’s still stigma in the profession around mental health and wellbeing. So I think acknowledging that this is an issue, encouraging our team members to address those issues and, again, not making them feel bad if they have to take off some time from work. I think a lot of individuals who might be in that space might feel guilty for taking some time off for themselves to seek mental health help, but if our employers are very supportive and you don’t guilt them if they have to take morning off to go to a therapy appointment, making sure that this is a normal part of our jobs and our careers is keeping our brains healthy, too, right? It’s just like any other body system. We have to keep ourselves well if we’re going to keep doing the work that we need to do.
Dr. Addie Reinhard:
I think that really thinking about practice environment, so making sure that we’re making a collaborative environment. Chaotic versus collaborative was an interesting finding in that. There was more burnout in these chaotic work environments, which makes sense, right?
Dr. Andy Roark:
Totally.
Dr. Addie Reinhard:
So having more of a calm, collaborative environment versus this chaotic, competing environment I think is definitely really important. Growing the belongingness to the team, team building activities, developing trust in the organization, candid and open communication, and allowing your, I think, and this is not from the study, but flexibility and autonomy is huge. So if your employees feel like they have the flexibility, for example, you want to go to a concert on a Thursday night and you don’t want to feel bad about leaving work early and you give your employee the flexibility to do that thing that they enjoy doing.
Dr. Addie Reinhard:
It’s interesting with the MentorVet curriculum, a lot of my mentees, we have meetings, monthly meetings, and they meet with about five to 10 vets every month, and it’s once a month, and it’s in the evening. It’s usually at 7:30-8:30 at night or on a Sunday, and we’re very flexible with these times. Yet still, a lot of them are not able to make it to their meeting. They miss their meeting. They work late. They’re charting. Make this thing more of a priority. Why can’t we include this in the first hour of the day? Block off an hour for your staff to be able to do professional developments or I don’t know.
Dr. Addie Reinhard:
I think making it a little bit more flexible so our team members don’t feel bad. I think some of this is self-inflicted, too. I mean, I’ve been there, right? I’ve been there. Nobody was pressuring me to stay late and see these patients, and I did it because I wanted to help the pets, but you can also encourage your employees to take care of themselves, too. It makes it easier as an employee to take care of yourself when your employer is encouraging you to.
Dr. Andy Roark:
Yeah. That’s one of my big things that I beat up on employers about is if your wellness strategy is the veterinarian looking at a crying pet owner and setting personal boundaries, then that’s a crap wellness strategy. That’s just a terrible strategy, protocols that, again, you don’t have to dictate everything, but protocols that dictate how we’re going to end our day, what’s going to happen when people come in after a certain time and how we’re going to hand them off to an emergency clinic and just have things like that are protocols that are not on the ground decisions that someone has to make, and we know that making those moral and ethical decisions again and again leads to ethical fatigue. The more of those things that we can systematize in a way that protect our people while still serving our values as a practice, I think those things are really important.
Dr. Addie Reinhard:
Yeah. I agree. The ethical thing, I think, having more open communication about those ethical dilemmas and creating that environment where we are regularly debriefing and talking about this really tough stuff instead of just ignoring it and hoping it goes away, but really starting these open … I think that speaks to candid and open communication among the team. The more that we can openly talk about the shared challenges and struggles, and then not make it a ranting test but a productive discussion of, “These are some of the challenges that we are facing. What is one thing that we can do in the next month to address one of these challenges?” Starting small and, really, anytime I’m developing any kind of intervention, starting first with what are the specific stressors that your practice is experiencing, and to learn that, you have to ask your team. Get your team together, ask them what challenges they’re experiencing, and have them identify one or two of their top concerns, and then make some type of intervention and just do it, and have the team provide feedback on how that’s going.
Dr. Addie Reinhard:
It can be really small, but really starting to listen to your team and starting to implement some of the changes that maybe they could see because often our frontline workers know better than we do what could work, right? So really, I believe in these local solutions, for sure, for our team.
Dr. Andy Roark:
No, I completely agree. Addie, thank you so much for being here. Where can people learn more about MentorVet? Where can they learn more about the Merck wellbeing study?
Dr. Addie Reinhard:
So our website, mentorvet.net and you can also follow us on social media. So we’re @MentorVet on Instagram. We are @MentorVet1 on Facebook. You can learn more about the Merck animal health veterinary wellbeing study on the Merck animal health website. There is a wonderful page that includes a PowerPoint of all this information. So I would recommend going there and checking out the PowerPoint and fact checking some of my statistics that I shared today. Yeah. I think if you’re at a conference, we’re definitely speaking a lot on this topic this year. So if you’re at a conference, see if we’re talking about this topic to learn more, for sure.
Dr. Andy Roark:
Awesome. Awesome. I’ll put links to the show notes, links in the show notes to all of those things. Guys, take care of yourselves. Have a wonderful week. Addie, thanks for being here.
Dr. Addie Reinhard:
Thank you so much. It was fantastic.
Dr. Andy Roark:
That’s what we got for you. That’s the episode. Guys, I hope you enjoyed it. I hope you got something out of it. As always, the kindest thing that you can do is leave an honest review wherever you get your podcast. I really do appreciate it. It helps people find the show. Guys, take care of yourself. Be well. Talk to you soon. Bye.
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