Introduction

Historically, many veterinary organizations have offered resources for individuals to help prevent and address work-related stressors to improve work-life balance. While positive, these efforts do not address organizational or systemic sources of distress that impact the entire veterinary workforce; but focus on the individual building resilience and managing their own well-being. Over the past several years, there has been increased awareness of systems-level interventions and a desire to establish a more collaborative and coordinated effort to sustainably address all sectors of well-being throughout the profession. To ensure a strong and interconnected veterinary health ecosystem, collective action is urgently needed. An important step is a well-coordinated plan that provides government, industry leadership, individuals, educators, and leaders in other cross-disciplinary sectors with the tools and approaches required to drive policy and systems change. A systems approach recognizes no single variable in the veterinary profession is to blame for occupational distress, and that it takes multiple levers for change to redesign environments and realign our values.

During the COVID-19 pandemic, burnout and work-related distress were exacerbated among human healthcare workers.^1–9 In October 2022, the National Academy of Medicine (NAM) disseminated a National Plan for Health Workforce Well-Being⁶ with the intention to drive collective action toward strengthening the well-being of the health workforce, creating supportive environments, enhancing the care experience, reducing costs, and advancing human health equity. The NAM National Plan focuses on 7 priority actions: 1) Create and sustain positive work and learning environments and culture; 2) Invest in measurement, assessment, strategies, and research; 3) Support mental health and reduce stigma; 4) Address compliance, regulatory, and policy barriers for daily work; 5) Engage effective technology tools; 6) Institutionalize well-being as a long-term value; and 7) Recruit and retain a diverse and inclusive health workforce. The NAM National Plan also identifies the following actor groups and what aspects of the plan each group could have engagement and accountability for different parts of the profession including:

• Academic institutions and clinical training programs

• Accreditation bodies

• Health Systems

• Private & Non-Profit Organizations

• Health Professionals (this would be inclusive of technicians, nurses, assistants, etc)

• Professional & Specialty Societies

• Federal, State, and Local Governments

• Media & Communications

• Health Information Technology Companies

• Insurers & Payers

• Clients

Using the NAM National Plan’s framework to develop a plan for the veterinary profession could potentially improve the well-being of veterinary healthcare teams, which includes all employees in clinical practice. Some examples of the veterinary healthcare team include but not limited to: veterinarians, veterinary technicians/technologists, office managers, veterinary assistants, kennel staff, farriers, groomers, trainers, and front desk employees. The NAM National Plan’s framework could also enhance the client experience, and ultimately improve animal health. Below is the breakdown of the priorities and how the veterinary profession could benefit from the NAM National Plan framework.

Create and sustain positive work and learning environments and culture

Transform health systems, as well as education and training, by prioritizing and investing in efforts to optimize environments that prevent and reduce burnout, foster professional well-being, and support quality care. By creating a positive work environment for healthcare workers, patient care is transformed, resulting in improved patient care and patient outcomes. Furthermore, research suggests positive work environments reduce staff turnover, saving time and money associated with hiring and training new employees and strengthening the long-term viability of the organization.¹⁰ Like the human healthcare profession, the veterinary profession is also experiencing burnout. The Merck Animal Health Veterinary Wellbeing studies^11,12 have indicated about a third of veterinarians and half of veterinary support staff are experiencing stress and high burnout. Another study¹³ using data from the AVMA Census of Veterinarians in 2016, 2017, and 2018, indicated a high prevalence of burnout and secondary traumatic stress among veterinarians, especially newer graduates. Furthermore, researchers suggest veterinary healthcare worker burnout impacts the quality of veterinary patient care; thus impacting the individual veterinary healthcare worker’s income and hospital revenue.^14,15 High worker burnout is also associated with high employee turnover; potentially worsening the current veterinary healthcare worker shortage¹⁶ and costing the veterinary profession time and resources to recruit, train, and replace veterinary staff.¹⁴ By promoting a clinic environment that supports well-being, the veterinary profession might reduce burnout among veterinary healthcare workers, improve the quality of patient care, and reduce the economic costs associated with burnout.¹⁴ The NAM National Plan proposes goals with action items to integrate well-being into all areas, improve diversity, equity, and inclusion, increase retention and decrease turnover, emphasize the importance of worker well-being among professional leaders, and adopt accountability standards and best practices for well-being.⁶ Although directed at the human healthcare profession, many of these actions could be adopted or provide framework for the veterinary profession to build stronger veterinary healthcare teams, reduce burnout, and increase staff and client retention. Previous veterinary well-being studies^11,17–19 have indicated work-related factors including work overload, client complaints, and making a mistake as work-relate factors associated with burnout and anxiety. Furthermore, the Merck Animal Health Veterinary Wellbeing Study III¹¹ identified 4 work characteristics that veterinarians considered to have a healthy work environment: strong sense of belonging to a team, high degree of trust in the organization, candid and open communication among team members, and sufficient time for each appointment to provide high-quality patient care. Although many survey respondents reported their current work environment provided a sense of belonging and trust, few survey participants reported currently receiving appropriate time allotment for each appointment or good communication.¹¹ In 2022, a study that systematically reviewed veterinarian well-being surveys came to the conclusion that veterinary professionals should expand clinical support to reduce veterinary healthcare teams workload.²⁰ The NAM National Plan suggests that setting reasonable productivity expectations and providing adequate resources to support expectations might help reduce the impact of work overload.⁶ However, for this and other goals to improve veterinary worker recruitment and retention, support and action from all parts of the profession will be required.

Invest in measurement, assessment, strategies, and research

Expand the uptake of existing tools at the health system level and advance national and international research on decreasing occupational burnout and improving well-being. The NAM National Plan recommends using a validated tool to perform longitudinal studies to assess the prevalence of burnout and distress in each individual healthcare settings as well as the whole human healthcare profession. These tools can also be used to assess the impact of prevention strategies. Because the AVMA Census of Veterinarians surveys includes Professional Quality of Life (ProQOL) questions, previous studies have used Census of Veterinarian surveys to calculate burnout prevalence, turnover, and reduction of work hours at the organization level.^14,21 Neill et al¹⁴ also used data from the National Association of Veterinary Technicians to calculate the prevalence of burnout for veterinary technicians. However, Neill et al¹⁴ were not able to assess the prevalence of burnout among other veterinary healthcare workers including veterinary assistants, kennel staff, or front desk staff. Developing or identifying and consistently utilizing validated tools that could be administered through veterinary institutions, veterinary hospital organizations, corporate partners, and specialty practices could determine the burnout prevalence and other occupational well-being–related metrics among all members of the profession, including workers not previously evaluated. However, embracing the NAM strategy would also involve individual practices administering the tool to determine burnout prevalence and the impact of prevention strategies for each practice facility. Administering burnout assessment tools at the practice level could identify individual practice challenges that lead to worker fatigue, anxiety, and burnout. Studying the impact of burnout in the veterinary profession at the national level and the practice level could help guide the development and distribution of prevention strategies and resources. These tools could be used by veterinary profession leaders to expand prevention strategies that currently focus on the individual veterinary healthcare worker by creating organizational level prevention strategies; thus, providing a broader approach to improve veterinary healthcare worker well-being.

Support mental health and reduce stigma

Provide support to health professionals by eliminating barriers and reducing stigma associated with seeking services needed to address mental health challenges. Research has indicated poor mental health impacts the quality of healthcare delivery and patient safety may suffer.²² Therefore, improving healthcare worker mental health helps maintain or improve the quality of patient care and safety. To address mental health among healthcare workers, it is critical that health systems address contributors to depression, anxiety, and other mental health issues at the workplace and remove barriers and stigma around seeking mental health treatment. As reported by Nett et al,¹⁷ veterinarians, especially those experiencing depression, anxiety, and other mental health issues, believe there is a stigma toward those who seek support for emotional and mental health issues. Stigma or the concern of stigma may prevent individual workers from seeking mental health treatment.²³ Eliminating barriers and stigma for seeking mental health treatment in the veterinary profession needs to be addressed at the organizational and hospital level to change the current culture. Addressing this priority includes making sure there are adequate mental health services available, workers have accessibility to the services, services are included in benefits, and workers are encouraged to use the services. Furthermore, veterinary workers should not receive any punitive actions when seeking mental health services.

Address compliance, regulatory, and policy barriers for daily work

This priority focuses on preventing or reducing unnecessary burdens that stem from laws, regulations, policies, and standards placed on the profession and its professionals. A commonly identified burden in the veterinary profession is work overload. One way to help reduce work overload would include leveraging the training and education of the nonveterinarian team members, especially certified veterinary technicians. This may help distribute the workload among all the team members and allow all clinical team members to operate at the top of their capabilities and licensure. Another burden for some veterinary professionals is obtaining licenses in multiple states because each state sets their own licensing criteria. Burdens to obtain multiple state licenses limit veterinary professionals’ ability to protect animal populations and public health when they need to cross a state boundary. Furthermore, barriers to multiple licenses can limit individual and hospital incomes by restricting practicing areas or delaying the start dates for new licensed employees. This burden could be alleviated by encouraging states to reduce barriers for obtaining veterinary professional licenses for those in good standing in their current state.

Engage effective technology tools

Optimize and expand the use of health information technologies that support professionals in providing high-quality patient care and serving population health and minimize technologies that inhibit clinical decision-making or add to administrative burden. Poorly designed technology can increase frustrations, healthcare errors, and lead to anxiety and burnout.²⁴ Although, most studies cited in the NAM National Plan focus on electronic health records in human healthcare, many of the electronic record technologies in the veterinary profession can be burdensome as well. Furthermore, this priority stresses how inefficient workflow or excessive job demands can be stressful and burdensome for healthcare professionals. Job demands are considered a combination of work duration, work intensity, and workload, and excessive job demands are associated with cognitive burden, delayed task completion, and increased risk of forgetting tasks.²⁴ In the veterinary healthcare profession, excessive job demands are also linked to occupational stress and addressing workload in the veterinary business model might help reduce occupational stress.^{17,20,25–27} Managing job demands based on the veterinary healthcare teams capabilities would allow the veterinary healthcare team to ensure they are providing thorough, safe, high-quality veterinary care to each patient. This NAM priority requires review of the business model and ensuring all team members are trained and competent to effectively perform their role. Furthermore, the NAM priority explains the review of the business model should include an understanding of a hospital’s maximum capacity and a backup plan for emergencies. A similar framework could be used for the veterinary business model with the support of all veterinary healthcare team members.

Institutionalize well-being as a long-term value

Ensure that efforts address the toll on occupational well-being and bolster healthcare systems for future emergencies. The COVID-19 pandemic impacted how the veterinary healthcare profession provided patient care and communicated with clients. Because of personal protection equipment and supply shortages, veterinary teams were limited on the services they could provide their patients.²⁸ Veterinary teams were also faced with the dilemma of defining a valid veterinary-client-patient relationship while social distancing.²⁸ Furthermore, COVID-19 outbreaks among employees at meat and poultry processing facilities led to mass depopulations of animals that could not be processed for food; potentially leading to increased moral stress and burnout for veterinary healthcare professionals involved in depopulation processes.^28–30 A study looking at common ethically challenging situations experienced by veterinary healthcare professionals reported an increase in these events during the COVID-19 pandemic²⁸; adding additional occupational stressors to veterinary healthcare teams and impacting well-being and mental health. Learning from the COVID-19 pandemic could help the profession be prepared for the next public health emergency.

Recruit and retain a diverse and inclusive health workforce

Promote careers in the profession and increase pathways and systems for a diverse, inclusive, and thriving workforce. The majority of professionals in veterinary healthcare are white non-Hispanic³¹ and the veterinary profession is one of the least racially and ethnically diverse health professions.^32,33 Reports have shown diverse healthcare teams are better at problem solving, have stronger communications skills, and reach a larger population of pet owners; thus improving animal health.^31,34–36 Furthermore, having a diverse, equitable, and inclusive veterinary profession helps build a more resistant workforce to occupational stressors.^33,37 Developing a diverse and inclusive veterinary healthcare workforce starts with enrolling a diverse and inclusive student population in veterinary educational programs, which includes not just racial and ethnic diversity, but also neurodiversity, disabilities, sexual orientation, socio-economic status, age, gender, and geography. However, this requires mitigating or removing social, academic, and financial barriers and developing a supportive work environment.³⁷

Although there are numerous similarities between human healthcare and veterinary healthcare teams, there are some key differences that potentially impact mental health and well-being in more nuanced ways. The NAM National Plan does not provide goals, actors, or action items that address these complex and unique areas of the veterinary profession. Therefore, we are only suggesting the veterinary profession consider the NAM National Plan as a starting framework to develop their own unique plan to improve mental health and well-being among veterinary healthcare teams. Furthermore, we do not recommend we let our complexities and uniqueness prevent us from looking at other professions for ways to improve our mental health.

Improving occupational well-being in the veterinary profession is a shared responsibility that requires collective action by all actors in the animal health ecosystem and those who influence the policies and systems that support it. Although, maintaining balance between a worker’s personal and professional life can help build individual resiliency and decrease emotional stress in the short-term, organization level changes can have a bigger, longer-lasting, and more sustainable impact on reducing occupational burnout.^14,38 No single group or actor is responsible for making the significant investments needed to result in sustainable, system-wide changes and to achieve the vision set out in the NAM National Plan.

Understanding the root causes of occupational burnout and other work-related stressors among veterinarians through validated research tools used at the professional and practice level could further guide the development and distribution of prevention resources. Eliminating barriers and stigma for seeking mental health treatment and ensuring such services are adequate and accessible would provide much needed support to our profession, which is known to be affected by mental health issues.² Reducing inefficient workflows that distract from clinical care would reduce the daily mental burden associated with burnout and allow staff to appropriately focus on their patients. A profession that works to help its workforce feel supported and valued would create stronger veterinary healthcare teams, contributing to professional retention, and saving the resources to recruit, train, and replace veterinary staff. The goals, actions, and actors identified in the NAM National Plan are interconnected and aim to support occupational well-being and a thriving profession. Ultimately, many of these actions would require changes to the training, care delivery, and practice business models with needed input from all stakeholders—including clients and communities our professionals serve. It will be a complex process; however, as the NAM National Plan states, complexity cannot be a reason for inaction.⁶ While we have made progress, more commitment and investment to address burnout and improve occupational well-being is imperative to ensure that the veterinary profession can support animal health, domestically and globally, now and in the future.

Disclosures

This information is distributed solely for the purpose of predissemination peer review under applicable information quality guidelines. It has not been formally disseminated by the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. It does not represent and should not be construed to represent any agency determination or policy.

No AI-assisted technologies were used in the generation of this manuscript.

Funding

The authors have nothing to disclose.