Introduction

Credentialed veterinary technicians (CVTs) are a formally educated and credentialed subset of professionals within the veterinary industry. To become a CVT, most state and provincial veterinary oversight agencies require an individual to pass the Veterinary Technician National Examination. Other state and provincial requirements may include graduating from a veterinary technology program accredited by the AVMA Committee on Veterinary Technician Education and Activity (CVTEA), a specific number of hours in clinical practice with documented completion of specific tasks under the direct supervision of a licensed veterinarian, and a criminal background check. The introduction of CVTs into the veterinary profession has created a dynamic of interprofessional work within veterinary practices that is based on trust and value of CVT skills and knowledge and contains identifiable benefits and challenges.¹ From an economic perspective, the veterinary industry has benefited from the creation of the CVT profession, specifically when comparing veterinary practices that employ and utilize CVTs to practices that rely on noncredentialed veterinary assistants (NCVAs).^2,3

Intrinsic and extrinsic rewards of being a CVT affect important economic variables including job satisfaction, pay satisfaction, employee performance, hiring and retention, personal well-being, and job turnover.^4–8 Intrinsic rewards are derived from individual needs for perceived competence, relatedness, and autonomy, and intrinsic rewards are either elicited and sustained or subdued and diminished by workplace conditions.⁹ The 4 primary workplace conditions that provide intrinsic rewards for a CVT are perceived meaningfulness of job task objectives, a sense of autonomy or choice within job tasks, a view of being sufficiently competent at job tasks, and a sense that effort is impactful in the workplace and is supported by management.¹⁰

Extrinsic rewards are independent of job tasks and are received for performing job tasks.¹¹ Workplace extrinsic rewards for a CVT are provided through the compensation system and include compensation level, compensation hierarchy, performance rewards, and benefits.¹² Workplace motivation is dependent on a CVT identifying a probability that his or her effort will lead to intrinsic and extrinsic rewards, and the perceived likelihood that those intrinsic and extrinsic rewards will sufficiently meet security, social, esteem, and self-actualization needs.¹³

The relationship between intrinsic and extrinsic motivation is complex, with early psychology research indicating that extrinsic rewards have a negative effect on intrinsic motivation, specifically once money is used as a reward for an activity the individual experiences reduced intrinsic motivation.^14,15 More recent economic research has shown a variable relationship between intrinsic and extrinsic motivation, with employment scenarios in which extrinsic rewards can undermine intrinsic motivation and scenarios where extrinsic and intrinsic rewards can be synergistic.¹⁶

The identity and usage of CVTs may not be adequately differentiated from that of NCVAs. The AVMA Task Force on Veterinary Technician Utilization has made recommendations regarding the CVT profession, including highlighting the value of CVTs within the industry, using consistent wording that differentiates CVTs from NCVAs, advancing utilization of CVTs, and increasing economic study of the CVT profession.¹⁷ The objective of this article was to provide an economic review of literature and survey data that assess the benefits and challenges of the CVT profession. The benefits and challenges of the CVT profession will be viewed through the theoretical framework of intrinsic and extrinsic rewards and interrelated topics, as found in the economic and psychology literature.

In this paper, CVT or CVTs will be used when the author or publishing institution of an included study or data set identified individuals or respondents as certified veterinary technicians, registered veterinary technicians, licensed veterinary technicians, licensed veterinary medical technicians, or registered animal health technologists. The term veterinary technician will be used in instances where the author or publishing institution of an included study or data set described individuals or respondents as veterinary technicians, or when CVTs and NCVAs were grouped together and published under the category of veterinary technicians.

Intrinsic Rewards

One of the largest CVT surveys to date is the National Association of Veterinary Technicians in America (NAVTA) 2016 Demographic Survey (NAVTA 2016).¹⁸ This survey indicates the presence of multiple intrinsic rewards within the CVT profession, including the ability to affect the well-being of animal patients, the formation of relationships with pet owners and coworkers, managing a variety of challenges, problem solving, having opportunities to maintain competence in medical/surgical/technology topics, contributing as part of a larger healthcare team, and feeling that clients respect their professional advice. Managerial support is noted as the least fulfilling intrinsic reward for CVTs in this survey.

Sanders¹⁹ documented intrinsic rewards associated with veterinary technician job tasks in a 3-year, ethnographic study at what is characterized as a large, mixed-practice veterinary hospital. Sanders¹⁹ remarked on the similarity between veterinary technician intrinsic rewards and those of other technically skilled healthcare professionals who are in close contact with patients, such as nurses and home healthcare aids. Intrinsic rewards described in this study include meaningfulness of working with animals, forming relationships with others, acquiring and using specialized skills, working as part of a positive occupational team, decision-making autonomy during job tasks, positively benefiting the lives of others, and the shared emotional experience of the profession. Working with animals was the most rewarding intrinsic reward, and it was postulated that the combined presence of all the intrinsic rewards caused veterinary technicians to strongly value their career. Sanders noted the intrinsic rewards of veterinary technician job tasks help with positive self-identity formation and may offset the physically and emotionally unpleasant aspects of the job.

Workplace Incivility, Burnout, and Intrinsic Reward Interrelationships

Coworkers and pet owners can be a source of workplace incivility for CVTs, which can reduce or negate intrinsic rewards and contribute to emotional burnout.²⁰ Workplace incivility is a prevalent form of socially deviant behavior experienced in the workplace and is classified as rude, discourteous, or disrespectful behavior that violates norms for mutual respect.²¹ The effects of workplace incivility events are cumulative, and an employee can react to incivility by engaging in uncivil behavior toward the specific offending individual or toward individuals not directly involved, thereby potentiating the single incivility event.²² A focus group study by Moore et al²³ evaluated veterinary healthcare toxic attitudes and environments and noted multiple incivility behaviors within the veterinary healthcare team. These behaviors included leaving tasks for others to complete, being persistently pessimistic, excessive criticism of others, and demeaning fellow team members. Incivility directed at CVTs during the study came from both customers and coworkers and occurred from individual to individual as well as group to group, such as receptionists to CVTs and veterinarians to CVTs. Moore et al²³ found multiple factors associated with incivility behaviors in the veterinary workplace, including working with unskilled or self-doubting individuals, not feeling appreciated, disagreements over workplace authority structure, personality conflicts, chronically negative individuals, employee turnover, inconsistency in following hospital policy, lack of consequence for toxic or hostile behavior, perception of unreasonable expectations on the individual or team, conflicting demands, and lack of leadership.

Wallace and Buchanan²⁴ examined workplace incivility among veterinary healthcare providers and found the effects of workplace incivility can be reduced or offset if the veterinary workplace is structured so that more intrinsic rewards are present. The specific intrinsic rewards that reduced or offset veterinary client and coworker incivility were job autonomy, experiencing varying and interesting work, the possibility of work creativity, learning new things, perceived meaningfulness of work, and utilizing skills and abilities. They noted the distribution of challenging work, and therefore the tools used to compensate for incivility are uneven across the veterinary workplace, with veterinarians having more access to compensatory tools than CVTs. CVTs expressed feeling a lack of respect, lack of trust, and fear in their interactions with veterinarians. Work overload, economic stress due to low pay, and concerns about the financial health of the practice were regarded as potential aggravators of workplace incivility.

Workplace incivility, perceived work overload, feelings of diminished personal accomplishment, and low perceived organizational support are important causes of emotional exhaustion and burnout.²⁵ Increasing workplace intrinsic rewards, such as work autonomy and the opportunity for positive interpersonal connections, positively offsets the causes of emotional exhaustion and gives employees the emotional resources to reduce burnout.²⁶ Kogan et al²⁷ surveyed 1,642 CVTs in a study on CVT burnout and examined how enabling certain job resources might reduce feelings of burnout. Indicators of burnout in this study were emotional exhaustion, increased cynicism, and reduced professional efficacy. High levels of burnout were found based on these 3 components, and intrinsic rewards found to mitigate burnout were control over work schedule, opportunities to learn, a sense of respect from colleagues, and using skills and knowledge.

Moore et al²³ evaluated burnout in the veterinary team by surveying 274 veterinary healthcare team members, of which 90 were CVTs. Emotional exhaustion, cynicism, and professional efficacy were used as indicators of burnout. With respect to other members of the veterinary team, CVTs had the highest mean scores for emotional exhaustion and cynicism, indicating a relatively higher risk of burnout relating to these 2 categories. CVTs had the second lowest score for professional efficacy, with kennel attendants being the lowest. Moore et al²³ found a toxic work environment, characterized by increased indicators of coworker incivility and work overload, to be associated with higher levels of exhaustion and cynicism. Higher individual intrinsic rewards, such as feelings of making contributions to the clinic and feelings of being an important team member, were associated with lower levels of emotional exhaustion and cynicism and higher levels of professional efficacy.

Pizzolon et al²⁸ evaluated the veterinary team by surveying 232 veterinary healthcare team members, of which 15 were CVTs and 54 were NCVAs. The authors found burnout to be positively associated with a toxic team environment and years in the profession. High levels of individual engagement and intrinsic rewards such as being appreciated and recognized for work, being assigned important and relevant responsibilities, and being recognized as a valuable team member were protective against burnout. Hayes et al²⁹ studied 256 CVTs at specialty teaching hospitals and used emotional exhaustion, depersonalization, and personal accomplishment as burnout subscale measurements. All 3 burnout subscale measurements were significantly associated with workload and schedule, interpersonal relationships, intellectual enrichment, and physical characteristics of the work environment. Workflow structure and negative interpersonal relationships were most strongly associated with burnout.

Extrinsic Rewards

Many frontline healthcare jobs provide relatively low levels of extrinsic rewards.³⁰ Individuals may accept or tolerate low extrinsic rewards due to the elevated value of the intrinsic rewards associated with healthcare job tasks.³¹ Of the 7 healthcare occupations listed by the US Bureau of Labor Statistics requiring an associate degree, veterinary technologists and technicians received the lowest median pay in 2020 at $36,260.³² If this healthcare occupation category is expanded to include the 13 healthcare occupations for which a lower level of education is required, veterinary technologist and technicians median 2020 pay is lower than 8 of those additional 13 healthcare occupations.

In a 2020 report³³ by the American Animal Hospital Association (AAHA) titled Compensation and Benefits, veterinary practices had an average full-time CVT hourly rate of $17.56. A majority of veterinary practices reported providing 1 or more benefits to CVTs, and 36% of veterinary practices reported providing bonuses to veterinary technicians. Benefits available to full-time veterinary technicians were continuing education (CE) allowance, paid CE days, life insurance, short-term disability insurance, long-term disability insurance, license fees paid, 100% of professional association dues paid, and uniforms.

CVT respondents in the California Veterinary Medical Association (CVMA) Economic Issues Survey reported a median salary of $40,000 with regional variation, and 29% reported receiving bonuses.³⁴ Benefits provided to CVT respondents include vacation, health insurance, CE registration fees, dental insurance, uniform allowance, license fees, 401(k), vision insurance, life insurance, paid time off for CE, disability insurance, and association membership dues.

Extrinsic Rewards Satisfaction

Extrinsic rewards satisfaction is a consequential employee state that influences employee performance, turnover, absenteeism, punctuality, attitude toward the employer, and theft.³⁵ It is in part based on the ability of the compensation system to meet basic needs outside of work.³⁶ NAVTA 2016¹⁸ reflects potentially negative extrinsic reward satisfaction, with a majority of respondents agreeing or strongly agreeing that CVT pay is so poor that the ability to stay in the profession is declining, and noted low compensation as the most significant problem facing CVTs.

According to the US Bureau of Labor Statistics (BLS) the 3 states that employ the highest number of veterinary technicians in decreasing order are Texas, Florida, and California, and the hourly mean wage amounts dated May 2020 for these 3 states were $16.17, $17.07, and $22.88, respectively.³⁷ The Massachusetts Institute of Technology (MIT) living wage calculator estimates the living wage for a 1-adult with 0-children household in Texas, Florida, and California reported in 2020 dollars to be $14.01, $14.82, and $18.66, respectively. The May 2020 BLS hourly mean wage and the 2020 MIT living wage calculator results indicate veterinary technician wages in these 3 states may be adequate for meeting basic needs outside of work in a 1-adult household.³⁸ In all 3 states, the May 2020 BLS mean wage of a veterinary technician was lower than the 2020 MIT living wage estimates for a 1-adult with 1-child household and a 2-adults household where only one adult was working. For Texas and California, the May 2020 BLS mean wage was higher than the 2020 MIT living wage estimate for the 2-adults (both working) with 1-child household but is lower than the 2-adults (both working) with 2-children household estimate. In Florida, the 2020 BLS mean wage was lower than the 2020 MIT living wage estimate for the 2-adults (both working) with 1-child household.

Along with the ability to meet basic needs, extrinsic rewards satisfaction is determined by the discrepancy between perceived pay level and what the employee believes pay should be based on multiple comparisons.^39,40 CVTs will likely use similar and dissimilar comparisons to judge their compensation system, and comparisons may include CVT coworkers, NCVA coworkers, CVTs at other veterinary practices, veterinarians in the practice, other staff members within the practice, and professionals in human healthcare.⁴¹ In the scenario of a CVT comparing their compensation system to a veterinarian, greater feelings of deprivation and perceptions of injustice can occur when members of an upward dissimilar group are perceived to earn considerably more instead of slightly more.⁴² Feelings of compensation deprivation and injustice may also arise from the perceived fairness of the compensation system, especially when the individual regards performance-based pay as being more fair than predetermined pay.⁴³ With regard to CVT pay-level comparisons, the reported average gross annual compensation for an associate veterinarian in the Compensation and Benefits report³³ was $107,738 (hourly associate veterinarian rate was not published), and the average hourly rate for a head technician/technician manager, CVT, NCVA, head receptionist, receptionist, veterinary assistant, and kennel assistant was $19.34, $17.56, $15.41, $15.58, $13.72, $13.08, and $11.44, respectively. Using an hourly to salary calculator and assuming a 40-hour work week over 52 weeks, the CVT hourly rate of $17.56 converts to a $36,524 annual salary, and the NCVA hourly rate of $15.41 converts to a $32,052 annual salary.⁴⁴ In contrast, the 2020 median hourly rate for a registered nurse was $36.22 and median annual salary was $75,330.⁴⁵ Regarding CVT compensation system differences and performance-based pay, a majority of associate veterinarians in the Compensation and Benefits report³³ and the CVMA Economic Issues Survey³⁴ were reported as receiving a form of production pay, whereas production pay is not described as being received by CVTs, NCVAs, or other staff.

Extrinsic Rewards Determinants

In the absence of collective bargaining agreements, managers evaluate the individual, job tasks, company pay standards, and industry benchmark data to make pay decisions, and industry benchmark data have the most influence over pay decisions.⁴⁶ By mimicking benchmark data, a business is able to achieve legitimacy and implement known successful economic strategies, especially with regard to pay strategies, and is able to assess ways to strategically diverge from benchmark levels to gain a competitive advantage.⁴⁷ The AAHA encourages veterinary practice managers to use veterinary benchmark data to improve practice financial performance, retain staff members, and deliver high-quality patient care.⁴⁸ The AAHA publishes practice management benchmarks in Financial and Productivity Pulsepoints to assist practice managers with improving economic results.⁴⁹ In the 10th edition, the benchmark for nonveterinarian staff salary/wages, which includes CVTs along with NCVAs and other veterinary practice staff, is 18.9% of total practice revenue, not including benefits. This is statistically consistent across practices with differing numbers of veterinarians, total revenue, and years at the current location. Benchmark levels including nonveterinarian staff per full-time equivalent (FTE) veterinarian, FTE technician per veterinarian, revenue per FTE nonveterinarian employee, and revenue per FTE veterinarian are also present in Financial and Productivity Pulsepoints³³ and can provide further guidance on CVT compensation decisions.

In addition to benchmark data, determinants of pay amount and pay structure include labor supply and demand, gender, age, level of education, year of graduation, and employee productivity.^50–53 Gilliam and Coates⁵⁴ published a paper with 1,289 CVT respondents that studied salary comparisons of CVTs with 2-year, 4-year, and graduate degrees. CVTs with a 4-year bachelor’s degree earned a higher hourly wage than those with a 2-year associate’s degree, and those with a master’s degree earned the highest hourly wage. CVT pay levels varied in association with gender, years worked in the profession, and years worked at the current employer, and the highest paid category profile was a male CVT with > 16 years of experience and a master’s degree. A previous study by Norkus⁵⁵ with 163 CVT respondents did not show CVT pay to be significantly associated with age, gender, highest degree earned, geographic region, practice location, or academy membership. Pay was significantly higher for CVTs with more experience, management responsibilities, longer employment at the practice, and those employed by a pharmaceutical or other nonveterinary practice setting.

CVTs appear to add financial value to the veterinary industry compared to NCVAs that perform some of the same tasks. Based on veterinarian survey data from multiple veterinary practices, Fanning and Shepherd showed an increase in average veterinarian gross revenue of $93,311 for each additional CVT per veterinarian.² The number of NCVAs per veterinarian was not significantly associated with an increase in gross practice revenue. Shock et al³ found an increase in gross annual revenue per veterinarian of $79,118 for each additional CVT per veterinarian in the practice.³ It is not reported to what extent, if at all, the economic benefit of CVTs directly influences the compensation level of CVTs or the $2.15 hourly rate difference between full-time CVTs and full-time NCVAs reported in Compensation and Benefits.

The veterinary industry is currently operating within the challenges and changes caused by the COVID-19 pandemic. Salois and Golab⁵⁶ encourage caution when assessing the economic effects of COVID-19 and note it is still too early to ascertain the long-lasting economic effects of COVID-19. They indicated COVID-19 has increased pressure on veterinary labor supply and created an upward momentum in veterinary labor demand, both of which have the potential to affect CVT compensation.

Job Satisfaction

Job satisfaction is a feeling and perception an individual develops regarding their job and is based on intrinsic and extrinsic rewards of the job, with intrinsic rewards generating job satisfaction and lack of extrinsic rewards generating job dissatisfaction.⁵⁷ Employee job satisfaction positively influences customer service, operational performance, and business profitability in high-contact service industries.⁵⁸ Importantly, structuring work in a way that improves job satisfaction, especially regarding job autonomy and job control, assists in maintaining and improving the mental health of employees.⁵⁹ The CVMA Economic Issues Survey reported 83% of CVT respondents expressed some degree of job satisfaction and 15% expressed some degree of dissatisfaction. NAVTA 2016 reported 51.3% of CVTs as very satisfied and intending to stay in the profession, 28.6% as probably staying in the profession, 9.6% as probably changing to another profession in the future, and 1.8% as dissatisfied and intending to change to another field.

Liss et al⁶⁰ published a study with 873 CVT respondents and investigated job satisfaction and individual engagement among CVTs. The results showed a mean value for CVT job satisfaction of 5.4 (1 = extremely dissatisfied and 7 = extremely satisfied). Working an overnight shift and more veterinarians in the practice were associated with lower job satisfaction. Holding a supervisor role, more veterinary technicians in the practice, and higher hourly wage were associated with higher job satisfaction. They found a significant correlation between the factors that affected job satisfaction and individual engagement.

The veterinary healthcare team studies by Moore et al²³ and Pizzolon et al²⁸ also evaluated job satisfaction. Moore et al²³ found veterinary technicians had the second lowest job satisfaction within the healthcare team with a mean score of 5.06 (1 = extremely dissatisfied and 7 = extremely satisfied). Kennel attendants had the lowest mean score at 4.80. A toxic team environment was found to be negatively associated with job satisfaction, and individual engagement was positively associated with job satisfaction. Full-time veterinary team members had significantly less job satisfaction than part-time employees, and years in veterinary medicine significantly reduced job satisfaction. Job satisfaction increased with time at the practice, possibly due to the likelihood of a satisfied individual remaining in their current position. Pizzolon et al²⁸ found the mean job satisfaction score for the whole veterinary team to be 73.95 (0 = extremely dissatisfied and 100 = extremely satisfied). Individual engagement and age were positively associated with job satisfaction, and toxic team environment was negatively associated with job satisfaction.

Preliminary survey results presented at the 2021 AVMA Veterinary Business and Economic Forum indicated that veterinary technician job satisfaction was positively correlated with working directly with clients, feeling appreciated by their boss, and years spent as a technician.⁶¹ Job satisfaction was negatively correlated with the number of places a technician had previously worked.

Turnover

Employee turnover is significantly affected by intrinsic and extrinsic rewards and their effects on job satisfaction, and turnover intent may result in an employee leaving for another employer within the same field or exiting the profession.^62,63 High turnover and low retention are a concern in human healthcare, and there are multiple studies^64–66 examining the intrinsic and extrinsic factors associated with nurse turnover and turnover intention. High turnover is present in the CVT profession, although there is a relative lack of large-scale, published data that directly questions CVTs regarding turnover causes.³³

Huerkamp⁶⁷ performed a study at Emory University School of Medicine and found an overall mean annual veterinary technician turnover rate of 36% at their institution during the years 1984 to 2004. Family reasons were the most common reported cause for separation. Fults et al⁶⁸ published a study on the development of a novel veterinary nurse graduate program, and although the focus was not employee turnover, there were 29 CVT, NCVA, and veterinary assistant respondents in the study that left the profession. Fifteen of 29 reported leaving due to poor financial outlook and 11 of 29 reported leaving due to lack of career advancement opportunities.

In the preliminary survey results presented by House at the 2021 AVMA Veterinary Business and Economic Forum, veterinary technicians who planned on remaining in the profession were more likely to have graduated from a 4-year AVMA-accredited program, were accredited in more states, had children at home, and reported being overused.⁶¹ Those who did not plan on remaining in the profession were more likely to have worked as a technician at more practices, worked more hours per week, worked at practices with more employees, and reported being underused.

Discussion

The CVT profession has many intrinsic rewards that contribute positively toward job satisfaction and promote positive self-identity. Client and coworker incivility, along with work overload, appear to be challenges for the veterinary profession from an economic perspective and, more importantly, from a mental and emotional health perspective. CVT extrinsic rewards appear adequate as an entry-level position into a healthcare field but are not likely to promote healthy economic growth for the individual or the veterinary industry. Given the relatively high turnover of CVTs, further research is warranted on the topic of CVT turnover intention including questions regarding low compensation and work environment factors that attenuate intrinsic rewards. Continued research into CVT intrinsic and extrinsic rewards, and industry modifications based on current information, should be pursued to improve industry economic performance and to improve work conditions as well as quality of life outside of work for CVTs.

The veterinary literature indicates a desire to increase CVT utilization, and the studies by Fanning and Shepherd² as well as Shock et al³ suggest doing so would be economically beneficial to veterinary practices. Employee-employer reciprocal obligation expectation indicates that plans to increase CVT utilization should include ways in which intrinsic and extrinsic rewards will be increased for CVTs, especially extrinsic rewards, and neglecting to do so will be counterproductive.⁶⁹ An innovative increase of CVT utilization that further differentiates the role of CVTs from NCVAs, such as the creation of a midprofessional role similar to a physician assistant, provides an opportunity to improve CVT intrinsic and extrinsic rewards, can create new revenue streams, and increase access to veterinary care if done effectively.^56,68 Similarly, continuing to optimize CVT utilization and creating new roles that fit within the current CVT scope of practice, with special attention being given to NAVTA-certified Veterinary Technician Specialists, could serve the same purpose. Developing new CVT-dependent revenue streams and recognizing current CVT-dependent revenue, such as dentistry and patient diagnostics and treatments, allow for the possibility of CVT production pay. It is not a standard practice to provide production pay to CVTs, although reconsideration of this is warranted given that production pay can potentially improve CVT productivity, CVT compensation level, CVT extrinsic reward satisfaction, and veterinary practice economic performance.⁷⁰

The author of this review article recognizes veterinary technicians as those who have graduated from AVMA CVTEA–accredited programs in veterinary technology and have passed credentialing examinations. For clarity of information and professional dignity, future authors and institutions should reserve the title of veterinary technician for CVTs only. Because of the varied usage of the term veterinary technician, caution should be exercised when allowing individuals to self-identify as a CVT or veterinary technician within a study, and consideration should be given to verifying the credentials of study participants. Future authors and publishing institutions are encouraged to use the term NCVA or veterinary assistant to identify individuals performing job tasks that are similar to those of a CVT but have not graduated from an AVMA CVTEA–accredited program or have not met other credentialing requirements.