Introduction

The demand for veterinary services is projected to grow rapidly through 2026,^1–3 creating the need to attract and retain small animal veterinarians. Driven in part by the fact that increasing numbers of pet owners view their pets as family members, especially the younger generation,^1,4 the need for veterinary care is expected to continue outpacing the number of veterinarians.^2,5 As a result of demand, many pet owners are utilizing emergency services because they are unable to be seen quickly by their general practitioner, creating additional burdens on already stretched-thin emergency services⁶ and intensifying the need for emergency veterinarians.^3,7,8 As a consequence, even though the number of veterinarians in emergency and critical care medicine has grown more than any other area of private practice,⁹ it cannot keep up with the increased demand—over 30% within the past 5 years.⁷

Yet, emergency medicine is not for everyone; some veterinarians find emergency work intimidating,¹⁰ and many new graduates do not feel they have the experience needed to be successful in an emergency setting.^7,10 This has prompted several veterinary corporations to develop training and mentorship programs to help support new graduates interested in emergency medicine.^10,11 In addition, rates of burnout and compassion fatigue appear especially prevalent in emergency medicine.^7,12,13 This has been attributed to the challenging nature of emergency work, demanding schedule, and negative impact of the job on veterinarians’ personal lives.^10,13

While recent research¹⁰ has suggested that most emergency veterinarians enjoy the nature of emergency medicine, many voice concerns about the sustainability of the work. Given the increasing demand for veterinarians, retention is a critically important topic. For both recruitment and retention efforts, it is imperative to gain a better understanding of what factors impact how emergency veterinarians select a particular position or hospital as well as the factors they feel are important in creating an environment conducive to long-term employment. Results of several studies^10,13–16 suggest that personal characteristics such as gender, years in practice, and child status can impact veterinarians’ mental health, job satisfaction, burnout, and compassion fatigue. Therefore, our objectives, using an online survey distributed to veterinarians employed in emergency medicine, were to examine how these factors may impact emergency veterinarians’ decisions in selecting a place of employment and perceptions of factors important in fostering a work environment conducive to long-term employment.

Materials and Methods

We created an anonymous online survey (Supplementary Appendix S1) to assess opinions of currently practicing emergency veterinarians about factors they feel are important in selecting a particular place of employment, as well as factors important in fostering a work environment conducive to long-term employment. The survey consisted of primarily 4-level Likert scale questions (possible range: 0 = not at all, to 3 = very), with free-text boxes provided for brief alternative answers when applicable. We additionally collected demographic items (gender, diplomate status, veterinary school graduation year, years practicing emergency medicine, children in the home [ages younger than 5, 5 to 12, 13 to 18, 19 to 23, and older than 23], and intent to have children in the next 3 to 5 years). A series of items was presented in which participants were asked to indicate how important each item is to them in selecting an emergency position or hospital using a 4-level Likert scale (0 = not at all, a little, or somewhat, to 3 = very). Items included the variety of cases, working fewer shifts but longer hours and having longer blocks of time off, and opportunities for professional educational growth. A second series of statements was presented with the instructions to rate each item in importance in fostering a work environment conducive to long-term employment using the same 4-level Likert scale (0 = not at all, a little, or somewhat, to 3 = very). A final question at the end of the survey allowed for free-text entry for any comments participants chose to make about factors they consider important to sustaining a career in emergency medicine.

The survey was voluntary, and participants could choose to stop at any point. Participants could also choose to skip any questions they did not wish to answer. No incentives were offered for participation, and the estimated time for survey completion was less than 10 minutes. The survey was distributed via an email invitation to Veterinary Information Network members (approx 43,000), targeting emergency veterinarians. A link to the survey was also distributed to eligible Veterinary Emergency and Critical Care Society members. The survey was available from May 25, 2022, through June 15, 2022. A follow-up message was sent 2 weeks after the initial invitation. Only data from US respondents who stated they currently worked in emergency medicine and were not board certified in Emergency and Critical Care were included in the analyses.

Statistical analysis

We calculated descriptive statistics for most questions. To examine differences in proportions of various responses on the basis of various demographic factors, we used χ² tests (after checking for violations of assumptions). All assumptions (eg, categorical, independent data with adequate data cells) were met. We then used factor analysis to identify broad, independent factors that might predict longevity. Factor analysis was conducted on the 18 statements pertaining to fostering a work environment conducive to long-term employment. After assessing for missing data (all participants completed at least 75% of survey items) and collinearity between the variables, intercorrelation among items was assessed to ensure all items were contributing to the latent construct. Since no items correlated at a level higher than 0.8, each item was determined to be conceptually distinct with no multicollinearity or singularity issues. Next, the 18 items were examined using the Kaiser-Meyer-Olkin measure of sampling adequacy and deemed acceptable at 0.85, Bartlett’s test of sphericity was significant (χ² [153] = 2088.69; P < .001), and the communalities were all above 0.30. Therefore, the 18 items were found to share some common variance with other items and were deemed to be suitable for factor analysis. Principal axis factor, with principal component analysis was chosen as the extraction method because our goal was to reduce the dimensionality of the data to a small number of principal components. We used direct oblimin with Kaiser normalization as the rotation method. Finally, we utilized linear regression to examine the effect of each factor on longevity. All analyses were performed with a commercial statistical package (SPSS Statistics version 28.01; IBM). Statistical significance for each comparison was set at P < .05 without correction for experiment-wise error.

Results

Factors important in selecting a hospital

Participants were asked to rate 15 statements in terms of their importance in selecting a place to work. The factors rated as most important include working with a highly trained support staff, collegiality of coworkers, remuneration, working fewer shifts but longer hours and having longer blocks of time off, the variety of the cases, and opportunities for professional educational growth. The least important factors included working with clients in times of high stress and working overnights and weekends (Figure 1). The only factor associated with number of years in emergency medicine (P < .001) was receiving mentorship from more experienced coworkers; specifically, those practicing for fewer years rated mentorship as more important than those in practice longer. Significantly (P = .026) more male participants considered the challenging nature of the cases a more important factor than female participants. Conversely, female participants considered working alongside (other) specialists (P = .003), collegiality of coworkers (P < .001), and receiving mentorship from more experienced coworkers (P = .021) more important factors than male participants.

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Rated importance of 15 factors in selecting a particular hospital by veterinarians practicing emergency medicine in the US (n = 432).

Citation: Journal of the American Veterinary Medical Association 260, 15; 10.2460/javma.22.07.0306

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Important factors in fostering a work environment conducive to long-term employment

Participants were asked to rate a series of 18 items in terms of importance in fostering a work environment conducive to long-term employment. Factors rated as the most important included leaders recognizing the value you bring to the practice, obtaining reasonable approval for personal time off, obtaining help when you request it, an environment where a positive attitude is a high priority, being able to provide help when it’s requested of you, and having rounds be a pleasant experience. The least important factors were opportunities to mentor less experienced emergency vets and having an American College of Veterinary Emergency Critical Care diplomate provide mentorship (Figure 2).

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Rated importance of 18 factors in fostering a work environment conducive to long-term employment by veterinarians practicing emergency medicine in the US (n = 419).

Citation: Journal of the American Veterinary Medical Association 260, 15; 10.2460/javma.22.07.0306

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Discussion

Our study assessed 2 questions pertaining to the recruitment and retention of emergency medicine veterinarians. There are certainly factors that influence both selecting a place of employment and retention decisions, yet we found several aspects unique to each question. The first question was designed to help us understand which workplace factors emergency medicine veterinarians feel are important when selecting a place of employment. The second question was aimed at better understanding which factors veterinarians currently practicing emergency medicine feel are important in remaining in the field. For both of these questions, we examined whether gender, child status, or years practicing emergency medicine could help predict the rated importance of these factors.

We found that the factors rated as most important in selecting a specific job included working with a highly trained support staff, collegiality of coworkers, remuneration, and working fewer shifts but longer hours and having longer blocks of time off. Demographic nuances, however, were found to impact the perceived importance of these factors. For example, female veterinarians and veterinarians with less experience valued mentorship more than male veterinarians or veterinarians who had been practicing emergency medicine longer. Female veterinarians also valued working alongside (other) specialists and collegiality of coworkers more than male veterinarians. These results mirrored those of other studies,^17–19 which found that perceptions of work relationships and support impact female veterinarians’ job satisfaction more than male veterinarians.

When we assessed the factors most important in fostering a work environment conducive to long-term employment (employee retention), the aspects rated as most important included leaders recognizing the value the veterinarian brings to the practice, obtaining reasonable approval for personal time off, obtaining help when requested, and an environment where a positive attitude is a high priority. When we compared the 5 broad categories of these elements derived from factor analysis (ie, schedule, professional growth, environmental tone or atmosphere, medical support, and leadership), we found that leadership was rated higher than any other factor. Good veterinarians do not necessarily make good leaders, and being a good leader is not an innate skill.^20–22 Prioritizing leadership training for hospital administrators can help improve hospital environments and increase the likelihood that emergency medicine veterinarians feel recognized, heard, and valued. Numerous options are available for leadership training,^10,11,23 and incentives should be offered to those who make the effort required to hone their leadership skills. Examples include those offered by the AVMA, consisting of continuing education sessions and networking opportunities.²⁴ On the other hand, those veterinarians who excel at their job, but either do not want leadership roles or are deemed unsuitable as leaders, can be rewarded by other means than promotion to administrative leadership positions (eg, remuneration, increased schedule flexibility, and time off).

When exploring the importance of all factors, including leadership, we found that gender, years in emergency medicine, and child status impacted participating veterinarians’ perspectives. For example, we found that the intent to have children in the next 3 to 5 years impacted veterinarians’ perceptions of the importance of schedule; those intending to have children in the near future rated schedule as more important than those not intending to have children. It is important to note that this was true for both male and female veterinarians, and thoughtful schedule planning to enhance veterinarians’ abilities to balance home and work may help with retention. Challenges with work life balance are one of the leading stressors for veterinarians, especially for those with children.^25–28

The number of years veterinarians had been working in emergency medicine was found to impact the reported importance of both medical support and professional growth. Newer graduates valued these factors more than seasoned practitioners. While it might seem obvious that those newer to emergency medicine might value medical support and professional growth more than those in the field longer, it is not clear if this knowledge translates into tailoring work benefits and environments to best match individual emergency medicine veterinarians’ needs. Yet, given the critical need to retain talented emergency medicine veterinarians, this seems a logical next step.

While years practicing emergency medicine and child status were important characteristics in predicting the importance of some work-related factors, practitioners’ gender appeared to be the most influential. Female practitioners rated all factors (schedule, environmental tone or atmosphere, medical support, and leadership) except for professional growth, as more important than male practitioners. Given that 63% of veterinarians are female,²⁹ and that the profession is continuing to become increasingly feminized,³⁰ the fact that female veterinarians valued each of these elements more than male veterinarians is an important finding. Those responsible for employment and retention of emergency medicine veterinarians are likely to face an increasing demand to create work conditions that female employees consider attractive and conducive to a positive work environment.

While deemed important by all participants, female veterinarians rated leadership as more important than male veterinarians. The leadership factor consisted of 2 items: leaders recognizing the value their subordinates bring to the practice and leaders knowing their subordinates as individuals. Environmental tone or atmosphere and medical support were 2 other factors rated as more important by female veterinarians. Environmental tone or atmosphere consisted of elements such as leaders and colleagues who provide emotional support when needed, routine and regular constructive feedback, an environment where a positive attitude is a high priority, and having rounds be a pleasant experience (rather than a competition or belittlement session). Medical support consisted of obtaining help and mentorship when needed. There are many possible reasons why the female veterinarians in our study indicated they value emotional support, regular feedback, a positive environment, help or mentorship, and recognition by leaders more than male veterinarians. It has been suggested, for example, that while men are socialized to be self-reliant and independent, women tend to be socialized to seek out and desire support.³¹ Socialization and resultant messages while growing up often result in different work styles for men and women, whereby women place a greater priority on interpersonal relationships than men. Women are also more likely to be motivated by encouragement and respond positively to collaboration and support, while men are traditionally more motivated by competition and individual achievements.^32,33 Generational differences, as well as the impact of the COVID-19 pandemic on clinical experiences during veterinary school for newer graduates, are factors that also may have impacted the gender differences seen in this study.

Schedule is a factor that impacts all emergency medicine veterinarians, with many struggling to balance work and home.^13,34 In this study, the schedule factor included such things as obtaining reasonable approval for personal time off, being able to switch or trade shifts easily, and having the ability to work part time while continuing to get benefits on a prorated basis. These elements can be critical in navigating the often-competing needs of work and family. For numerous reasons, female veterinarians may place a higher value on work and life balance.^35–37 The fact that women spend more time on household chores and childcare than men^30,38,39 might help explain why they place a higher value on schedule.

Limitations to this study were those inherent in an online voluntary survey. Our sample consisted of Veterinary Information Network members practicing emergency medicine in the US, so caution is advised when generalizing to other veterinarians. Another limitation was response bias; it is possible that those interested in this subject are not representative of emergency veterinarians. Additionally, further analysis focused on the potential impact of years in practice is warranted. It is also important to note that, although female practitioners rated several work-related factors (schedule, environmental tone or atmosphere, medical support, and leadership) as more important than male practitioners, the variables gender, years in practice, and child status were all weak predictors of factors associated with fostering a work environment conducive to long-term employment. Additional research to determine what other factors influence work-related decisions, as well as the ability to generalize these findings to other types of veterinarians, are important next steps in positively impacting recruitment and retention across the field. While results of this study suggest gender may impact views of several work-related factors, it is unknown if this is a result of societal gender differences or other variables yet to be explored. Given the weak predictive value of gender, further analysis is needed to better understand the relationship between gender and the field of veterinary emergency medicine.

In summary, these results suggest that it is imperative that hospitals recognize the importance of leadership, schedule, environmental tone or atmosphere, and medical support for all veterinarians and work toward creating work environments that foster and emphasize these elements if they hope to recruit and retain quality clinicians. There are essential aspects of emergency medicine positions that are inherent in the job: the pace, intensity, unpredictability, and stress. Yet, the factors identified in this study as important to practitioners in both selecting a specific hospital and remaining in the field are all changeable. With proper attention, training, and allocation of resources, hospitals can use the information gained from this study to make substantive changes that can truly make a difference in the recruitment and retention of emergency medicine practitioners.

Supplementary Materials

Supplementary materials are posted online at the journal website: avmajournals.avma.org