Veterinary team members experiencing high levels of burden transfer are more likely to report burnout and a less optimal psychosocial work environment

Kirsten Blokland Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada

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Jason B. Coe Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada

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Mary Beth Spitznagel Department of Psychological Sciences, Kent State University, Kent, OH

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Abstract

OBJECTIVE

To describe burden transfer in a sample of veterinary workers employed by a Canadian veterinary corporation and to examine the association between different levels of burden transfer and employee burnout and perceived psychosocial work environment.

SAMPLE

475 employees of small-animal veterinary hospitals owned by a corporate practice group.

METHODS

Veterinary team members among 14 working groups responded to an online survey that included assessments of burden transfer, psychosocial environment, and burnout within the workplace. Participants were divided into groups on the basis of self-reported burden-transfer scores being low, mid, or high, and multivariate analysis of covariance was conducted to ascertain associations between level of burden transfer, psychosocial environment, and burnout.

RESULTS

On average, participants perceived difficult encounters with clients to occur with moderate frequency and reported reactions that were low-moderate in intensity. Individuals with high burden-transfer scores were identified in all working groups. Across the 3 burden-transfer groups, the key finding was that high-level burden transfer was associated with perception of greater emotional demands within the workplace, reduced support from supervisors, reduced feeling of social community in the workplace, and elevated rates of burnout among these participants.

CLINICAL RELEVANCE

Findings highlight elevated risks for a certain population of veterinary employees experiencing high levels of burden transfer and underscore the potential need for targeted interventions to support these individuals. Employees who currently react to challenging client interactions with moderate or low intensity may also benefit from these programs as a preventative measure.

Abstract

OBJECTIVE

To describe burden transfer in a sample of veterinary workers employed by a Canadian veterinary corporation and to examine the association between different levels of burden transfer and employee burnout and perceived psychosocial work environment.

SAMPLE

475 employees of small-animal veterinary hospitals owned by a corporate practice group.

METHODS

Veterinary team members among 14 working groups responded to an online survey that included assessments of burden transfer, psychosocial environment, and burnout within the workplace. Participants were divided into groups on the basis of self-reported burden-transfer scores being low, mid, or high, and multivariate analysis of covariance was conducted to ascertain associations between level of burden transfer, psychosocial environment, and burnout.

RESULTS

On average, participants perceived difficult encounters with clients to occur with moderate frequency and reported reactions that were low-moderate in intensity. Individuals with high burden-transfer scores were identified in all working groups. Across the 3 burden-transfer groups, the key finding was that high-level burden transfer was associated with perception of greater emotional demands within the workplace, reduced support from supervisors, reduced feeling of social community in the workplace, and elevated rates of burnout among these participants.

CLINICAL RELEVANCE

Findings highlight elevated risks for a certain population of veterinary employees experiencing high levels of burden transfer and underscore the potential need for targeted interventions to support these individuals. Employees who currently react to challenging client interactions with moderate or low intensity may also benefit from these programs as a preventative measure.

Introduction

The veterinary field demands a great deal from its workers, often taking a considerable toll on them physically and psychologically.1,2 Researchers are just beginning to build a body of scientific literature regarding the nature of hardships experienced by veterinary workers—an awareness that is critical for the provision of effective supports. For example, a large study3 of American veterinarians indicated that over 90% were suffering or merely getting by in terms of their well-being, with fewer than 10% reporting that they were flourishing in their occupation. Similarly concerning, the study found that burnout scores for veterinarians were 155% higher than in the general population of American workers and nearly 40% higher than in American physicians. Thus, research is needed to further understand the factors influencing well-being and burnout within veterinary teams and how the industry can work together to learn how to best provide support.

A relatively new area of research involves examining the role of difficult interactions with veterinary clients who are distressed about their pet’s illness, known as caregiver burden.4 These difficult interactions have been shown to have the effect of transferring some of the client’s burden of distress to the veterinary healthcare team—a phenomenon known as burden transfer.5,6 Studies on burden transfer have demonstrated that when burden transfer is greater (as measured by intensity of reaction to negative client encounters), veterinary team members experience increased stress and burnout,5 thus establishing burden transfer as a critical area of inquiry for supporting veterinary team members’ well-being.

To date, burden transfer has not been studied in the population of Canadian veterinary workers, either on its own or as it relates to other variables of interest, nor has previous work identified whether certain individuals within a veterinary practice are at higher risk for experiencing burden transfer. To bridge this gap, as 1 part of a larger study, the present paper aimed to build on existing work by accomplishing 2 objectives: (1) to describe burden transfer in a sample of veterinary workers employed in Canadian veterinary hospitals and (2) to identify factors associated with elevated burden-transfer risk by examining the association between levels of burden transfer and (a) aspects of the psychosocial work environment pertaining to well-being and (b) individual burnout as a metric of personal well-being.

Methods

The study protocol was reviewed and approved by the University of Guelph Research Ethics Board (REB No. 22-02-026) and is reported following Strengthening the Reporting of Observational Studies in Epidemiology guidelines.7

Participant recruitment

The sample was drawn from employees of a veterinary corporation in Canada. All survey responders met the following eligibility criteria: employed by or volunteering for a veterinary hospital owned by the corporation, having an active corporate email address, and at least 16 years old. The age criterion was chosen on the basis of wanting to be inclusive of younger volunteers and was permitted by Health Canada’s research ethics consent guidelines, which stipulate that youth who are 16 and older can consent to minimal-risk studies.8

Data collection

A mass email message was distributed by the corporation’s internal communications department to all 4,676 individuals employed by or volunteering at a veterinary hospital owned by the corporation, inviting them to participate in the study. The recruitment email and survey were offered in English and French. Two reminder emails were sent 1 week and 2 weeks after the initial invitation. No monetary or material incentives were offered for participation. By clicking on “Agree” at the bottom of the consent and proceeding with the survey, participants were able to access the survey questions. Survey data were collected from May 10 to June 30, 2022, using the online survey platform Qualtrics (version May/June 2022; Qualtrics), and exported into SPSS (version 28.0.1.1; IBM Corp) for statistical analysis.

Survey structure and measurement tools

The study survey included the following 5 sections of inquiry: a section collecting demographic information pertaining to the participant’s background in the veterinary field as well as personal demographics; the Relational Coordination Survey 2.0, used to measure the coordination of tasks across multiple roles within the veterinary hospital9; the Three-Component Model Employee Commitment Survey–Revised, to assess employee commitment to their hospital10; the Burden Transfer Inventory–Abbreviated (BTI-A), to evaluate the frequency and intensity of experiencing the transfer of distress from clients11; and the Copenhagen Psychosocial Questionnaire (COPSOQ), to assess the psychosocial environment and individual well-being within the hospital.12 Of these 5 areas of inquiry, the present paper draws on data pertaining to demographics, burden transfer, psychosocial environment within the veterinary hospital, and individual burnout, each of which will be described below.

Demographic questions—Demographic information collected for the study and reported here included participant age, gender identity, ethnicity, education, primary role in the veterinary hospital, hospital setting, hours worked per week, employment status, length of time in the veterinary field, and length of time in current hospital.

Burden Transfer Inventory–Abbreviated—The 10-item BTI-A11 was used to assess participant perceptions of how often they encounter veterinary clients in their hospital who are difficult to deal with and the extent to which this is experienced as burdensome by the veterinary provider. The BTI-A has been validated within veterinary medicine.11 Across the 10 items (Table 1), respondents were asked to endorse both frequency of and reactivity to 2 scenario examples for each of the 5 domains of client interactions relating to burden transfer: daily hassles, affect, nonadherent/inconsiderate behaviors, confrontations, and excess communications. For measuring participants’ frequency of experiencing each scenario within the 5 domains of burden transfer in relation to client interactions, a 5-point scale was used (ie, 0 = never occurred; 1 = has occurred, but not in past week; 2 = once or twice in the past week; 3 = approximately daily; and 4 = more often than daily), along with a sixth option representing not applicable (N/A = does not apply to my work environment). Participants’ reports of their reactivity to such scenarios were elicited by asking “how much the situations bothered or upset you” on another 5-point rating scale (ie, 0 = not at all, 1 = a little, 2 = moderately, 3 = very much, and 4 = extremely), with a sixth option representing not applicable (N/A = has not occurred). Items for each of the 2 subscales were summed to produce a frequency total score and reactivity total score, respectively. Note that N/A responses do not contribute to the total scores. Higher frequency total score indicates more encounters with difficult/distressed clients, and higher reactivity total score indicates higher personal reactivity to these situations.

Table 1

The abbreviated 10-item Burden Transfer Inventory (BTI-A) items11 and descriptive statistics for the present sample.

BTI-A items*
  1. 1.Client shows poor memory or comprehension for instructions.
  2. 2.Client conducts “research” (eg, online searches) about pet’s problems or disease.
  3. 3.Client demonstrates grief or sadness.
  4. 4.Client requires euthanasia counseling.
  5. 5.Client declines recommended work-up.
  6. 6.Client declines recommended treatment.
  7. 7.Client unwilling to pay.
  8. 8.Client blames you for poor outcomes (eg, failure to improve, death).
  9. 9.Repeated or unsolicited client email contact.
  10. 10.Repeated or unsolicited client telephone contact.
Descriptive statistics
Variable M ± SD Median Min–max n
Frequency total 17.97 ± 6.71 18.00 0–38 475
Reactivity total 14.34 ± 7.04 14.00 0–35 475

*Rated for frequency and intensity of reaction, as follows:

Frequency: 0 = never occurred; 1 = has occurred, but not in past week; 2 = once or twice in the past week; 3 = approximately daily; 4 = more often than daily; and N/A = does not apply to my work environment.

Intensity of reaction: 0 = not at all, 1 = a little, 2 = moderately, 3 = very much, 4 = extremely, and N/A = has not occurred.

Copenhagen Psychosocial Questionnaire—The COPSOQ12 was used to measure psychosocial environment and individual well-being within the veterinary hospital. The COPSOQ captures a broad range of dimensions reflecting the psychosocial work environment and has been validated in a variety of countries, languages, and employment industries. This research instrument offers short, mid, and long versions,13 in addition to the option to use individual items or scales as indicated for a particular study.

In the larger study, 46 COPSOQ items were used (matching those in a previous study14), plus 1 additional COPSOQ item reflecting burnout.12 The present paper focuses on 4 scales pertaining to dimensions of well-being as reflected in the psychosocial work environment—emotional demands (3 items), support from supervisors (2 items), support from colleagues (1 item), and social community at work (1 item)—and a fifth scale reflecting burnout (1 item; Table 2). The first 4 scales were rated on a 5-point response scale to indicate how frequently the situation occurs in the workplace (ie, 0 = never/hardly ever, 25 = seldom, 50 = sometimes, 75 = often, and 100 = always) or how strongly the situation affects the respondent (ie, 0 = to a very small extent, 25 = to a small extent, 50 = somewhat, 75 = to a large extent, and 100 = to a very large extent). The item from the burnout scale was rated on a 5-point response scale reflecting how frequently the individual feels worn out (ie, 0 = not at all, 25 = a small part of the time, 50 = part of the time, 75 = a large part of the time, and 100 = all the time). Scales with multiple items used the mean of the collective item scores. For all scales in the COPSOQ instrument, higher scores indicated greater endorsement of the dimension being assessed, regardless of positive-negative valence.

Table 2

The Copenhagen Psychosocial Questionnaire (COPSOQ) well-being scales, items,12,14 and descriptive statistics for the present sample.

COPSOQ well-being scales and items
  • Emotional demands

    • Does your work put you in emotionally disturbing situations?*

    • Do you have to deal with other people’s personal problems as part of your work?*

    • Is your work emotionally demanding?†

  • Support from supervisors

    • How often would your immediate superior be willing to listen to your problems at work, if needed?*

    • How often would you get help and support from your immediate superior, if needed?*

  • Support from colleagues

    • How often could you get help and support from your colleagues, if needed?*

  • Social community at work

    • Is there a good atmosphere between you and your colleagues?*

  • Burnout

    • How often have you felt worn out?‡

Descriptive statistics
Variable M ± SD Median Min–max n
Emotional demands 61.07 ± 19.22 58.33 0–100 481
Support from supervisors 72.33 ± 23.07 75.00 0–100 478
Support from colleagues 75.63 ± 21.41 75.00 0–100 475
Social community at work 76.57 ± 17.74 75.00 0–100 478
Burnout 62.34 ± 24.80 75.00 0–100 478

Rated as follows: *0 = never/hardly ever, 25 = seldom, 50 = sometimes, 75 = often, and 100 = always. †0 = to a very small extent, 25 = to a small extent, 50 = somewhat, 75 = to a large extent, and 100 = to a very large extent. ‡0 = not at all, 25 = a small part of the time, 50 = part of the time, 75 = a large part of the time, and 100 = all the time.

Statistical analysis

Descriptive statistics were used to characterize all variables in the present study. Specifically, mean, SD, median, minimum, and maximum values were calculated for continuous data, and frequencies were calculated for noncontinuous data. The distribution of continuous variables was tested for normality with the Shapiro-Wilk test. Inferential analyses ensued based on Gaussian models, given the conditions of large sample size, mild deviations from normality, and robustness of Gaussian models to nonnormality under these conditions.15 Burden-transfer data were compared to data from an American reference sample of veterinary professionals,11 using a Summary Independent Samples t test, to ascertain the degree of similarity with the sample collected for the present study.

Next, 3 groups were created on the basis of severity of reaction to difficult interactions with clients: a high-reaction group, consisting of participants who scored 1 or more SDs above the full-sample mean; a low-reaction group, consisting of participants who scored 1 or more SDs below the full-sample mean; and a mid-reaction group, consisting of all remaining participants.

Parametric assumptions were evaluated for all continuous variables to be used in the analysis assessing the association between the 3 burden-transfer groups and the 5 well-being variables: homogeneity of covariance matrices of the well-being variables being equal across levels of the burden-transfer groups was evaluated using the Box M test, and the assumption of equality of error variances of the well-being variables across levels of the burden-transfer groups was evaluated using the Levene test.

To ascertain whether the 3 burden-transfer groups differed significantly in their reports of how often they experience difficult encounters with clients, a general linear model (GLM) ANOVA was conducted, the results of which would inform whether frequency should be used as a covariate in the assessment of the link between burden-transfer levels and well-being variables. Next, an evaluation of the association between the 3 burden-transfer groups and the 5 well-being variables was planned: if the previous GLM was significant, the final analysis would be a 1-way multivariate analysis of covariance (MANCOVA) to control for the frequency of difficult encounters with veterinary clients, and if the previous GLM indicated no significant differences in frequency across levels of burden transfer, the final analysis would be a 1-way multivariate ANOVA. Finally, a 3 (burden-transfer groups) by 8 (veterinary role groups) χ2 analysis was conducted to assess differences in the distribution of high-, mid-, and low-level burden transfer across roles. Significant differences were considered to be those at or below a P value of .05, and marginally significant differences were considered at or below .10.

Results

Study sample

Of the 4,676 individuals invited to participate, 655 followed the survey link and consented to the study, of whom 475 completed the entire survey, 103 completed part of the survey, and 77 did not provide any survey responses after consenting. This resulted in a total sample size of 578 participants (12.36% [578/4,676]).

Descriptive analyses

Demographics—In general, participants were an average age of approximately 36.9 years old, primarily identified as “woman” and “White/European,” with the majority having attained a college/university degree or additional higher education. Participants’ primary role within their hospital indicated that approximately 20% were some type of veterinarian, 13% worked in a managerial role, 46% were veterinary technicians, 17% worked in client care and 3% in animal/patient care, and the remaining 2% or so fell into an Other category. All participants who contributed data reported in the present study had client-facing roles at least some of the time. Participants mostly came from a primary-care setting, with fewer from mixed- or specialty-practice settings (Table 3).

Table 3

Descriptive statistics for demographic variables.*

Demographic variable Value
Age (M ± SD; median; min–max; n) 36.88 ± 10.82; 35.00; 19–78; 465
Gender identity (%/n)
  Woman 86.50/411
  Man 9.90/47
  My gender is not listed/Prefer not to answer 13.60/17
Ethnicity (%/n)
  White/European 90.21/424
  Other 9.79/46
Education (%/n)
  Completed college/university 53.90/256
  Additional graduate education 2.80/13
  Professional degree (DVM, MD, etc) 21.10/100
  High school/partial degree/apprenticeship/trades 22.30/106
Primary role in veterinary hospital (%/n)
  Medical Director 5.00/29
  Veterinary Specialist 4.20/24
  Emergency Veterinarian 2.60/15
  Primary Care Veterinarian 7.60/44
  Hospital Manager/General Manager 11.80/68
  Assistant Manager 1.40/8
  Client Care Manager/Coordinator 2.20/13
  Registered Veterinary Technician 21.50/124
  Veterinary Technician 10.70/62
  Technician Assistant 13.50/78
  Client Care Specialist/Receptionist 14.50/84
  Animal Care Attendant/Kennel Assistant 2.80/16
  Patient Care Coordinator 0.20/1
  Other* 2.10/12
Hospital setting (%/n)
  Primary care 61.24/354
  Specialty 24.05/139
  Mixed 14.71/85
Hours worked/wk (M ± SD; median; min–max; n) 41.47 ± 19.35; 40.00; 0–140; 569
Employment status (%/n)
  Permanent full-time 88.40/504
  Permanent part-time 8.40/48
  Other 3.30/18
Years in veterinary field (M ± SD; median; min–max; n) 9.32 ± 8.87; 5.67; 0.21–44.00; 219
Years in current hospital (M ± SD; median; min–max; n) 6.37 ± 7.11; 3.50; 0.04–37.00; 261

*Roles held by fewer than 8 employees across the corporate veterinary organization were recategorized into Other.

Burden transfer—On average across the full sample, the veterinary workers perceived difficult encounters with clients to occur with moderate frequency. Reactions to these encounters were, on average, reported to be low to moderate in intensity (Table 1).

Psychosocial environment and individual well-being within the veterinary hospital—The following pattern was observed across the sample as a whole: emotional demands within the hospital were perceived to occur fairly frequently; support from supervisors was reported to be offered often, as was support from colleagues; a sense of social community (phrased in terms of positive atmosphere) within the hospital was experienced often; and individual burnout was experienced part of the time to a large part of the time (Table 2).

Comparison of burden transfer data to an American reference sample

Compared to an American sample studied by Spitznagel et al11 consisting of a cross section of veterinary roles, the present Canadian sample did not differ significantly in their perceptions of the frequency of (t[866.66] = –0.45; P = .65 [2-tailed]) or their intensity of reactions to (t[913] = 0.44; P = .66 [2-tailed]) difficult encounters with clients.

Association between burden transfer and well-being in the workplace

Within the 3 groups created in preparation for examining the association between levels of burden transfer and well-being, there were 68 (14.3%) participants who fell into the high-reactivity group and 332 (69.9%) and 75 (15.8%) who fell into the mid- and low-reactivity groups, respectively.

The preliminary analyses for evaluation of parametric assumptions indicated that there was some evidence of heterogeneity of covariance matrices of the well-being variables across levels of the burden-transfer groups (Box M = 52.91; F[30,115794.17] = 1.72; P = .009); therefore, the more conservative Pillai Trace criterion was used for interpreting the output.16

The GLM for examining whether the 3 burden-transfer groups differed in their reports of how frequently they experience difficult encounters with clients revealed a significant difference across groups (F[2,472] = 42.98; P < .001; R2 = 0.15; Table 4). Therefore, frequency was used as a covariate in the MANCOVA assessing the link between burden-transfer levels and well-being variables. Dunnett C post hoc comparisons indicated that the high-reaction group reported encounters of these sorts to be significantly more frequent compared to reports from the mid- and low-reaction groups, and that the mid-reaction group reported these encounters to be significantly more frequent compared to the low-reaction group. All post hoc comparisons were significant at P = .05.

Table 4

Frequency ratings of difficult interactions with clients across burden-transfer reactivity groups.

Reactivity group M frequency* SD n
High 21.96 5.82 68
Mid 18.36 5.81 332
Low 12.61 7.86 75

*Post hoc Dunnett C: High > Mid, Low; Mid > Low. All comparisons significant at P = .05.

The 1-way MANCOVA revealed that there was a significant difference among the burden-transfer groups on the combined set of well-being variables after controlling for frequency of difficult client encounters: F(10,934) = 2.62; P = .004; Pillai Trace = .06; η2 = .03. The η2 indicates that 3% of the multivariate (ie, combined) variance within the set of well-being variables was associated with veterinary team members’ intensity of reaction.

Because the multivariate test revealed a significant association between levels of burden transfer and the set of well-being variables, the univariate ANCOVA results (Table 5) were examined to identify which of the well-being variables contributed to the association with burden transfer. Controlling for frequency of difficult client encounters, the univariate tests revealed that there was a significant association between participants’ level of burden transfer and their perceptions regarding emotional demands within the hospital environment (F[3,470] = 20.66; P < .001; η2 = .12), support from supervisors (F[3,470] = 4.64; P = .003; η2 = .03), social community at work (F[3,470] = 3.37; P = .02; η2 = .02), and burnout (F[3,470] = 15.72; P < .001; η2 = .09). The univariate ANCOVA for support from colleagues did not reach significance.

Table 5

Estimated marginal means (EMM) and SEs for the variables reflecting well-being in the workplace, as a function of each burden-transfer reactivity group, adjusted for frequency of difficult encounters with clients.

Well-being variable Reactivity group EMM* SE n
Emotional demands High 68.55 2.27 68
Mid 60.62 1.00 331
Low 57.07 2.22 75
Support from supervisor High 68.26 2.85 68
Mid 73.91 1.26 331
Low 68.78 2.79 75
Support from colleagues High 71.55 2.67 68
Mid 76.84 1.18 331
Low 73.69 2.61 75
Social community at work High 73.31 2.16 68
Mid 78.11 0.95 331
Low 73.47 2.11 75
Burnout High 71.81 2.95 68
Mid 61.16 1.30 331
Low 59.62 2.89 75

*Adjusted for the frequency of difficult interactions with clients (the covariate), which was evaluated at the value of 17.97 (the mean value within the sample).

Pairwise comparisons between burden-transfer groups across the 5 well-being variables revealed significant group differences in 3 of the well-being variables and marginally significant group differences in the remaining 2 well-being variables (Table 5). The significant differences between burden-transfer groups were found in participants’ perceptions pertaining to (1) emotional demands within their hospital environment, with the high-reaction group perceiving significantly greater emotional demands compared to the mid-reaction group (P = .001) and the low-reaction group (P < .001); (2) social community at work, with the mid-reaction group perceiving the atmosphere to be significantly more positive compared to perceptions from the low-reaction group (P = .05) and the high-reaction group (P = .04); and (3) burnout, with the high-reaction group reporting significantly higher rates of burnout compared to the mid-reaction group (P < .001) and the low-reaction group (P = .005). The marginally significant pairwise comparisons between burden-transfer groups were found in participants’ perceptions pertaining to (1) support from supervisors, with the mid-reaction group reporting greater support compared to reports from the low-reaction group (P = .10) and the high-reaction group (P = .07) and (2) support from colleagues, with the mid-reaction group reporting greater support compared to the high-reaction group (P = .07) but not compared to the low-reaction group.

Association between burden transfer and veterinary roles

The χ2 analysis assessing the distribution of high-, mid-, and low-level burden transfer did not differ significantly across the roles in the study sample (χ2[22] = 18.06; P = .70). As illustrated (Figure 1), the percentages indicate that all levels of burden transfer were observed within each role group and that no role stood out from others as being significantly more likely to have individuals identified with a high level of burden transfer.

Figure 1
Figure 1

Percentage of high-, mid-, and low-level burden transfer in each role within veterinary hospitals does not differ significantly across the roles sampled. (Roles with fewer than 8 participants were omitted.) A.Mng = Assistant Manager. ACA = Animal Care Attendant/Kennel Assistant. CC.Mng = Client Care Manager/Coordinator. CSR = Client Care Specialist/Receptionist. Em.Vet = Emergency Veterinarian. H.Mng = Hospital Manager/General Manager. M.Dir = Medical Director. PC.Vet = Primary Care Veterinarian. RVT = Registered Veterinary Technician. TA = Technician Assistant. Vet.Spec = Veterinary Specialist. VT = Veterinary Technician.

Citation: Journal of the American Veterinary Medical Association 262, 3; 10.2460/javma.23.06.0354

Discussion

The present study was the first to examine burden transfer in a sample of Canadian veterinary providers and the first to document the association between distinct levels of reactivity to difficult encounters with veterinary clients and variables reflecting the psychosocial workplace environment and individual burnout. This study’s identification of factors associated with high-level burden transfer may be viewed as a step toward addressing the presence of burden transfer within the field.

The present findings indicate that, on average, participating veterinary team members within this sample perceived difficult encounters with clients to occur with moderate frequency and that their reactions to these types of encounters were low to moderate in intensity. These findings replicate those by Spitznagel et al,11 whose burden-transfer data were generated during the pandemic from a cross section of veterinary workers, just as in the present study. The methodological and empirical parallels indicate that the phenomenon of client distress transferring to veterinary team members is likely experienced broadly within veterinary medicine.

While the frequency of these encounters is beyond the control of veterinary teams, the intensity with which individuals react to these encounters may be modifiable and warrants closer attention. Spitznagel et al5 demonstrated that veterinarian reactivity is a more robust predictor of stress and burnout. The observed low-to-moderate intensity of reaction, on average, within the American sample of Spitznagel et al11 and within the present sample indicates that widespread support is worth considering for all client-facing roles within a veterinary team. In addition, the finding that every role had a subgroup of individuals in the high-level burden-transfer group speaks to the need for support that is available to all team members.

Regardless of role, the group within the present sample who reported experiencing high levels of reaction were significantly more at risk for compromised perceptions about the psychosocial environment within their veterinary hospital and for individual burnout, compared to team members in the mid- and low-reaction groups. The toll of burnout on the individual and the profession has been well documented in previous research, with workplace burnout projected to cost the American veterinary industry nearly $2 billion a year.3,17 The present study’s findings highlight that individuals who experience high reactivity to difficult client encounters are particularly in need of being identified and supported.

Evidence is beginning to emerge regarding the benefit of a new intervention developed by Spitznagel et al18 aimed at reducing burden transfer in veterinary medicine. Specifically, an acceptance and commitment training educational program, Unburdened, designed to reduce veterinary-provider reactivity to difficult encounters with clients, demonstrated not only reduced reactivity compared to veterinary team members in the control group, but also decreased stress from overload and unpredictability, and decreased burnout. A key takeaway from the intervention study by Spitznagel et al18 is that burden transfer is modifiable, and when it is reduced, other positive changes occur as well. Based on findings from the present study, identifying veterinary professionals with high reactivity to difficult encounters and making such training accessible for these individuals is likely to have an important impact on their health and well-being. Furthermore, supporting these individuals in this way is likely to be beneficial more broadly for the health of the veterinary profession.

Although in the present study we identified 3 levels of reactivity (and in turn, groupings) based on the severity of reaction to difficult interactions with clients, it would be valuable for future research to explore whether there is a burden-transfer threshold that would put a veterinary provider into a clinical range, signaling the need for expedited support. Within human healthcare, a clinical cutoff has been established for caregiver burden in some areas of medicine19 but not for burden transfer onto the healthcare provider, to the best of our knowledge. Therefore, establishing a threshold for clinically meaningful burden transfer could be beneficial for identifying health professionals at risk of sequelae from burden transfer, making a novel contribution to both the veterinary and human healthcare fields.

A surprising finding to emerge from the present study stems from the psychosocial variables reflecting support and social community within the veterinary setting. One might expect the low-reactivity group to have perceived their work environment to be more favorable in these ways, but that was not the case. Instead, the group with mid-level reactivity to difficult client encounters scored the highest on these social-environment variables. Possible explanations may include individual differences in emotion regulation and associated effects on access to one’s emotions. Moderate levels of reactivity may be argued to reflect optimal emotion regulation, where one is able to access and freely express one’s feelings about burden transfer, without either suppression or hyperawareness of one’s feelings. This notion is supported by a study by Mérida-López et al,20 in which healthy emotion regulation was found to be positively related to perceptions of support from coworkers and supervisors. Further research in this area is warranted.

Compared to a study by Shahidi et al21 using the COPSOQ with a Canadian sample of workers prior to the COVID-19 pandemic, the workplace well-being findings from the present study have varying degrees of similarity: the present sample rated support from supervisors to be more favorable compared to the sample of Shahidi et al21 but perceived greater emotional demands within the workplace environment, a reduced feeling of community with colleagues, greater rates of burnout, and a similar level of support from colleagues. Given that the present study’s data were collected 2 years into the pandemic, one may expect less-favorable well-being within the workplace on all 5 measures obtained, but this was not the case and reflects the supportive work culture generally perceived by participants. Cross-study comparisons within the veterinary medicine literature also indicate consistencies between the present study’s finding of moderate to high rates of burnout among veterinary professionals and levels found in previous studies using data collected prior to the pandemic.22,23

The present study included only a portion of workers employed by a large veterinary corporation, with just over 12% participating. Although this figure is similar to the 12% response rate within a national COPSOQ reference sample collected by Shahidi et al21 and higher than the 8% response rate in a recent Canadian Veterinary Medical Association Workforce study,24 it would have been preferable to have had a greater proportion of the target population reflected in the present sample. Also, the current sample contains an underrepresentation of minority racial groups, with only 13% self-identifying as non-White/European, compared to about 30% of the Canadian population identifying as non-White/European.25 Similarly, minority racial groups were underrepresented in the study by Spitznagel et al,11 in which about 9% of their cross-sectional sample identified as non-White/Caucasian, compared to 38% of the American population identifying as non-White/Caucasian.26 The underrepresentation of minority racial groups is likely a continued reflection of the fact that veterinary medicine is among the least diversified health professions.27 Nonetheless, future studies should attempt to focus on burden transfer and measures of well-being among veterinary staff who are underrepresented to ensure that their experiences of these phenomena are properly understood and considered.

In conclusion, this study was the first to examine burden transfer in veterinary medicine within a Canadian sample and to relate burden transfer to aspects of well-being within such a sample. Results confirmed that burden transfer does indeed play a role in the work life of veterinary providers regardless of their role within the hospital, and that pronounced burden transfer is linked with perception of greater emotional demands within the workplace, reduced support from supervisors, reduced feeling of social community within the veterinary workplace, and an elevated level of burnout. The investigation of burden transfer within veterinary medicine is still in its early stages, with many questions remaining to be answered. Among the most pressing questions is which flags to watch for in providers that may indicate elevated risk of developing high reactivity to difficult client encounters and who therefore may be candidates for early intervention. The present study suggests that some flags may reside in providers’ perceptions of their psychosocial environment. What is already very clear is that there is an urgent need for intervention to support veterinary personnel—particularly those with elevated reactivity—with modifying their intensity of reaction to difficult client encounters. While early efforts in this direction are underway and point to the efficacy of such intervention programs, the next steps must address the need for intervention to be accessible to all veterinary healthcare teams and their members.

Acknowledgments

The authors thank Veterinary Centers of America (VCA) Canada for access to their population of veterinary professionals and VCA Canada associates who participated in the survey.

Disclosures

Participants in this study were associates from VCA Canada. Dr. Blokland’s position is funded by the VCA Canada Chair in Relationship-Centred Veterinary Medicine at the Ontario Veterinary College, University of Guelph, held by Dr. Coe. Dr. Coe regularly receives research funding and honoraria from and consults for various veterinary organizations and commercial companies. Dr. Spitznagel developed and runs the Unburdened educational training program described in this manuscript. VCA Canada reviewed and cleared the final survey procedure and instrument prior to dissemination, provided a means of direct communication with VCA Canada associates for the purposes of study recruitment, and reviewed and cleared the final manuscript prior to submission with no requested changes. VCA Canada was not involved in the development of the survey or recruitment materials, data collection, analysis, interpretation, or writing of this manuscript.

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

Funding

The authors have nothing to disclose.

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    Jones-Bitton A, Gillis D, Peterson M, McKee H. Latent burnout profiles of veterinarians in Canada: findings from a cross-sectional study. Vet Rec. 2022;192(2):e2281. doi:10.1002/vetr.2281

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  • Figure 1

    Percentage of high-, mid-, and low-level burden transfer in each role within veterinary hospitals does not differ significantly across the roles sampled. (Roles with fewer than 8 participants were omitted.) A.Mng = Assistant Manager. ACA = Animal Care Attendant/Kennel Assistant. CC.Mng = Client Care Manager/Coordinator. CSR = Client Care Specialist/Receptionist. Em.Vet = Emergency Veterinarian. H.Mng = Hospital Manager/General Manager. M.Dir = Medical Director. PC.Vet = Primary Care Veterinarian. RVT = Registered Veterinary Technician. TA = Technician Assistant. Vet.Spec = Veterinary Specialist. VT = Veterinary Technician.

  • 1.

    Nett RJ, Witte TK, Holzbauer SM, et al. Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians. J Am Vet Med Assoc. 2015;247(8):945-955. doi:10.2460/javma.247.8.945

    • Search Google Scholar
    • Export Citation
  • 2.

    Scotney RL, McLaughlin D, Keates HL. A systematic review of the effects of euthanasia and occupational stress in personnel working with animals in animal shelters, veterinary clinics, and biomedical research facilities. J Am Vet Med Assoc. 2015;247(10):1121-1130. doi:10.2460/javma.247.10.1121

    • Search Google Scholar
    • Export Citation
  • 3.

    Volk JO, Schimmack U, Strand EB, Vasconcelos J, Siren CW. Executive summary of the Merck Animal Health Veterinarian Wellbeing Study II. J Am Vet Med Assoc. 2020;256(11):1237-1244. doi:10.2460/javma.256.11.1237

    • Search Google Scholar
    • Export Citation
  • 4.

    Spitznagel MB, Jacobson DM, Cox MD, Carlson MD. Caregiver burden in owners of a sick companion animal: a cross-sectional observational study. Vet Rec. 2017;181(12):321. doi:10.1136/vr.104295

    • Search Google Scholar
    • Export Citation
  • 5.

    Spitznagel MB, Ben-Porath YS, Rishniw M, Kogan LR, Carlson MD. Development and validation of a Burden Transfer Inventory for predicting veterinarian stress related to client behavior. J Am Vet Med Assoc. 2019;254(1):133-144. doi:10.2460/javma.254.1.133

    • Search Google Scholar
    • Export Citation
  • 6.

    Spitznagel MB, Updegraff ASG, Twohig MP, Carlson MD, Fulkerson CM. Reducing occupational distress in veterinary medicine personnel with acceptance and commitment training: a pilot study. N Z Vet J. 2022;70(6):319-325. doi:10.1080/00480169.2021.1938270

    • Search Google Scholar
    • Export Citation
  • 7.

    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-1457. doi:10.1016/S0140-6736(07)61602-X

    • Search Google Scholar
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  • 8.

    Research Ethics Board: consent process. Government of Canada. Accessed Jan 24, 2022. https://www.canada.ca/en/health-canada/services/science-research/science-advice-decision-making/research-ethics-board/consent-process.html

    • Search Google Scholar
    • Export Citation
  • 9.

    Gittell JH. Relational Coordination: Guidelines for Theory, Measurement and Analysis. Relational Coordination Research Collaboration; 2011.

    • Search Google Scholar
    • Export Citation
  • 10.

    Meyer JP, Allen NJ, Smith CA. Commitment to organizations and occupations: extension and test of a three-component conceptualization. J Appl Psychol. 1993;78(4):538-551. doi:10.1037/0021-9010.78.4.538

    • Search Google Scholar
    • Export Citation
  • 11.

    Spitznagel MB, Martin JT, Carlson MD, Fulkerson CM. Validation of the Burden Transfer Inventory-abbreviated and examination across veterinary medicine positions and settings in the United States. Vet Rec Open. 2022a;9(1):e46. doi:10.1002/vro2.46

    • Search Google Scholar
    • Export Citation
  • 12.

    Kristensen TS, Hannerz H, Høgh A, Borg V. The Copenhagen Psychosocial Questionnaire-a tool for the assessment and improvement of the psychosocial work environment. Scand J Work Environ Health. 2005;31(6):438-449. doi:10.5271/sjweh.948

    • Search Google Scholar
    • Export Citation
  • 13.

    Burr H, Berthelsen H, Moncada S, et al; International COPSOQ Network. The Third Version of the Copenhagen Psychosocial Questionnaire. Saf Health Work. 2019;10(4):482-503. doi:10.1016/j.shaw.2019.10.002

    • Search Google Scholar
    • Export Citation
  • 14.

    Ramkissoon A, Smith P, Oudyk J. Dissecting the effect of workplace exposures on workers’ rating of psychological health and safety. Am J Ind Med. 2019;62(5):412-421. doi:10.1002/ajim.22964

    • Search Google Scholar
    • Export Citation
  • 15.

    Knief U, Forstmeier W. Violating the normality assumption may be the lesser of two evils. Behav Res Methods. 2021;53(6):2576-2590. doi:10.3758/s13428-021-01587-5

    • Search Google Scholar
    • Export Citation
  • 16.

    Tabachnick BG, Fidell LS, Ullman JB. Using Multivariate Statistics. 7th ed. Pearson; 2019.

  • 17.

    Neill CL, Hansen CR, Salois M. The economic cost of burnout in veterinary medicine. Front Vet Sci. 2022;9:814104. doi:10.3389/fvets.2022.814104

    • Search Google Scholar
    • Export Citation
  • 18.

    Spitznagel MB, Updegraff ASG, Was C, et al. An acceptance and commitment training program reduces burden transfer, stress, and burnout among veterinary healthcare teams. J Am Vet Med Assoc. 2022;260(12):1554-1561. doi:10.2460/javma.22.05.0196

    • Search Google Scholar
    • Export Citation
  • 19.

    Burke T, Elamin M, Galvin M, Hardiman O, Pender N. Caregiver burden in amyotrophic lateral sclerosis: a cross-sectional investigation of predictors. J Neurol. 2015;262(6):1526-1532. doi:10.1007/s00415-015-7746-z

    • Search Google Scholar
    • Export Citation
  • 20.

    Mérida-López S, Extremera N, Quintana-Orts C, Rey L. In pursuit of job satisfaction and happiness: testing the interactive contribution of emotion-regulation ability and workplace social support. Scand J Psychol. 2019;60(1):59-66. doi:10.1111/sjop.12483

    • Search Google Scholar
    • Export Citation
  • 21.

    Shahidi FV, Gignac MAM, Oudyk J, Smith PM. Assessing the psychosocial work environment in relation to mental health: a comprehensive approach. Ann Work Expo Health. 2021;65(4):418-431. doi:10.1093/annweh/wxaa130

    • Search Google Scholar
    • Export Citation
  • 22.

    Jones-Bitton A, Gillis D, Peterson M, McKee H. Latent burnout profiles of veterinarians in Canada: findings from a cross-sectional study. Vet Rec. 2022;192(2):e2281. doi:10.1002/vetr.2281

    • Search Google Scholar
    • Export Citation
  • 23.

    Ouedraogo FB, Lefebvre SL, Hansen CR, Brorsen BW. Compassion satisfaction, burnout, and secondary traumatic stress among full-time veterinarians in the United States (2016-2018). J Am Vet Med Assoc. 2021;258(11):1259-1270. doi:10.2460/javma.258.11.1259

    • Search Google Scholar
    • Export Citation
  • 24.

    Report of the Working Group on the 2020 CVMA Workforce Study. Canadian Veterinary Workforce. Accessed Mar 21, 2023. https://www.canadianveterinarians.net/media/pv0lbm1y/report-of-the-working-group-on-the-2020-cvma-workforce-study-final.pdf

    • Search Google Scholar
    • Export Citation
  • 25.

    2021 Census. Statistics Canada. Accessed Mar 21, 2023. https://www150.statcan.gc.ca/n1/daily-quotidien/221026/dq221026b-eng.htm

  • 26.

    2020 Census. United States Census Bureau. Accessed Mar 21, 2023. https://data.census.gov/profile/United_States

  • 27.

    Chun R, Davis E, Frank N, et al. Can veterinary medicine improve diversity in post-graduate training programs? Current state of academic veterinary medicine and recommendations on best practices. J Am Vet Med Assoc. 2022;261(3):417-423. doi:10.2460/javma.22.09.0430

    • Search Google Scholar
    • Export Citation

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