It was just a few weeks before Christmas and Andrea Loar, DVM was having a hard day. An emergency clinic veterinarian, she had seen a difficult case, the kind that lingers long after the tearful clients had left her exam room with their critically sick cat in tow, their footsteps echoing down the linoleum halls.
Some supportive care treatments that fell within the family’s budget had been administered, but the prognosis was grave. The cat died on the way home in the car.
“In emergency medicine, we are at the intersection between emotion and finance. I’m seeing people with their pets on what is often the worst day of their lives,” Dr. Loar says. “They’re terrified and they’re frustrated that they may not have the funds to deal [with a problem]. They are, a lot of the time, overwhelmed. We are the easy target for all of those emotions.”
In this case, the target was Dr. Loar. “[The clients] went on Facebook and posted a long rant about what money-grubbing people [veterinarians] are, and that we wouldn’t help them around Christmas with a new baby, and that their cat died because of it.
“It took me a week to be able to read the Facebook post, because I saw the beginning of [the thread] and I saw where it was going, and I thought, ‘I can’t handle it.’”
Dr. Loar’s experience is far from unique. In both large and small animal medicine, the pressures facing American veterinarians today hit on multiple levels, and they don’t remain at the office. For better or for worse, texting and social media have created fewer boundaries than ever before between a veterinarian’s personal and professional lives. The proof is right there on the cell phone in their pocket or waiting at home behind an idle laptop screen.
From debt and compassion fatigue to long hours and client relations, these stressors have one thing in common: a prolonged and often debilitating impact on a veterinarian’s mental health. That impact has taken a heavy toll.
According to a recent Center for Disease Control (CDC) study published in the Journal of the American Veterinary Medical Association (AVMA), veterinarians are 3½ times more likely to die by suicide than members of the general population. The study analyzed the death records of some 11,620 veterinarians between the years of 1979 and 2015 — a period during which 398 vets, 326 men and 72 women, died by suicide.
What’s more, less than half of veterinarians currently in practice would recommend their career path to others, according to the Cornell University College of Veterinary Medicine. It’s a fact that’s so well known inside the profession that it’s become a running joke between professors and their students.
“When I talk to vet students, first of all, I tell them not to go to vet school,” says Texas-based equine practitioner, Dr. Caren Chellgren. “I feel like every vet I talked to when I was in vet school and in that position told me not to go [into the field]. I just kind of do it as a joke because everyone told me not to go, and I have to pass that down.”
Finances Meet Fatigue
Dr. Sophia Yin was a pioneer in force-free, positive reinforcement dog training. Her videos, books, blog, and website made her one of the most well-known veterinary behaviorists in the country. But like so many in her profession, Dr. Yin also struggled privately with feelings of inadequacy and mounting financial pressures associated with running her business. In 2014, she took her own life, becoming one of the most prominent casualties to date in the veterinary suicide epidemic.
At age 48, Dr. Yin had, by most measures, established herself as a respected practitioner with a highly successful career. But even from their very first day on the job, the strains faced by young veterinarians can be extreme. The ever-increasing debt-to-income ratio is a significant factor, with many young vets beginning their career more than $143,000 in debt, according to a 2016 AVMA study. The cost of vet school tuition rose by 14.1% between 2015 and 2017, and while salaries have increased slightly in the last year, the debt-to-income ratio remains high. Though veterinary students attend four years of school — and thereby often incur four years of debt — in the same way that medical students do, their future prospects are far less rosy. The 2018 starting salary for a veterinarian is less than $80,000 a year; by comparison, the average first-year salary for a family medicine physician is $241,000 — more than three times that amount.
Veterinarians are 3½ times more likely to die by suicide than members of the general population.
For young professionals trying to make student loan payments or run their own business, the need to draw a hard financial line early in their career is essential. But for those in the business of compassion, it’s a necessity that’s far easier said than done. Dr. Chellgren says, “There are a lot of clients out there who are like, ‘Well, you’re a veterinarian, so you should take care of my dog, and I don’t care what time it is because you should do it. And you should do it for less [money], because you love animals.’”
Dr. Loar agrees. “The first thing is, we’re all doing our best. We have their pets’ best interests at heart. But we’re a business. We can’t continue to help their pets if we can’t [stay] open because we gave everything away for free.
“Pet insurance is really available at affordable [rates], and when you get a new puppy or kitten, that’s the first thing you should buy. It’s more important than the bed or the bowl or the toy.”
The very nature of the veterinary profession — the need to care about the well being and outcome of every patient that walks through the door — can be a heavy emotional burden. When that burden comes at the detriment of a vet’s own self-care, it results in what’s commonly known as compassion fatigue. That, too, can have a critical impact on a veterinarian’s mental state.
“With compassion fatigue, people [often] start having problems at home. They are less likely to go out and engage with their friends; they just don’t have the resources anymore,” says Jamie Holms, a Registered Veterinary Technician (RVT) and Mental Health First Aid Responder who writes and speaks frequently on the topic of suicide prevention for the veterinary website, DrAndyRoark.com. “It causes you to be preoccupied, you tend to lose sleep, those kinds of things. You’ve put so much into caring for others that you lose the ability to care for yourself.”
As early as vet school, Dr. Chellgren learned that she needed to become an advocate for her own mental health, and her colleagues’ as well. “I feel like the kind of person you have to be to be a veterinarian — you have to care, you have to want to fix everything — takes a lot of energy and time out of your mental health,” she says. “I was diagnosed with severe depression and anxiety my second semester of vet school. I went through that and it was very difficult for me.
“I [became] very vocal about it in vet school, and I kind of helped a lot of my classmates realize, hey, this is not normal to be super sad, or angry, or crying all the time,” Dr. Chellgren says, adding that one way she’s learned to cope is by carving out some essential time for herself during the week. “I religiously go to therapy, I get massages, and I get my nails done. Those are three things I do for myself. I probably need to do more, but I feel like at least I am doing something.
“We’re all Type-A personalities and we don’t want to ask for help — we don’t want to admit that we need help. So it’s kind of just this silent issue.”
For a veterinarian who does find him or herself suffering to the point of contemplating suicide — as a 2015 CDC study found that 1 in 6 do — there are typically fewer obstacles to overcome than might be present in other fields. It’s a profession where controlled substances such as euthanasia and barbiturate drugs are readily available, and although the AVMA’s suicide study did not isolate the use of euthanasia drugs in their findings, 32% of male veterinarians and 64% of female veterinarians committed suicide by poisoning, with barbiturates playing a substantial role. (Firearms were the most common method overall, used by 51% of men and 18% of women.)
“We [as a profession] don’t have the same barrier to death and violence that the average individual has,” Jamie notes. “We spend a lot of time talking to people about how euthanasia is the right choice — [that] it’s okay to let go, that there are times when pain is too much and quality of life is important. We have these kinds of conversations where we’re justifying death and dying.”
Large Animals, Small Boundaries
Large animal medicine, and equine practitioners in particular, face a unique set of challenges. A colicky horse doesn’t take time off for late night or weekend hours, and veterinarians don’t either. “I think it’s a little bit easier when you’re a small animal vet, because you just close your doors and that’s when you’re closed,” says Dr. Chellgren, who struck out on her own to establish Horse and Hound Mobile Veterinary Services in August.
“When it’s me out here, especially the type of person I am, it’s very hard to say, ‘No, I can’t come see your horse because I need to go home and see my fiancé and maybe eat dinner.’
“Equine practices don’t have the model like small animal, where you have emergency services,” adds an equine veterinarian, amateur rider, and practice owner with more than 20 years in the field who preferred to remain anonymous. “Back in the day, when there were just phones and no texting, you could say, ‘I’m out of the country on my honeymoon, I’ll be back December.’ Now, with texting, the owner doesn’t know that you’re gone.
“When I do some soul searching, that is really one of the stressors [for me],” he continues. “You get this imbalance between your personal life and business life. You may miss your kid’s soccer practice or his first basketball game, and too much of that stuff starts to accumulate, and you start to feel pretty bad about yourself.”
Still, the source notes that the very nature of a successful equine practice almost always requires the sacrifice of personal time and boundaries to one degree or another. “In an AAEP [American Association of Equine Practitioners] poll, when they asked horse owners what the most important thing to them was, 24-hour veterinary availability was the overwhelming answer.
“Veterinary medicine has a high attrition rate. Often, I see mostly female veterinarians, who graduated an equine-oriented program, and they have fantastic equine internships, and they get a job, [but] then they end up [giving it up],” he says.
“It’s not just about the medicine, it’s about dealing with people.”
A Double-Edged Sword
In the age of social media, cyber-bullying incidents like the one Dr. Loar experienced on Facebook represent a major shift in the vet/client relationship. More than a decade ago, disagreements between a pet owner and a veterinarian may have been heated, but they were limited in scope. Today, a dissatisfied client, right or wrong, can simply dash off a scathing Facebook post and wait for their friends to weigh in — sometimes with far-reaching implications for the practice and vet in question.
"With only 40% of veterinarians recommending their profession, I take that as an indicator that the profession as a whole is unwell."
The highly publicized suicide of Bronx, New York, veterinarian Dr. Shirley Koshi provided a window into this phenomenon. In 2013, Dr. Koshi, 55, was engaged in an intense legal dispute with a woman claiming ownership over a cat the vet had adopted as a stray at her clinic. The woman and her supporters held a public protest and incited widespread attacks on Dr. Koshi on internet forums and Facebook. The veterinarian took her own life a few months later.
Jamie says she believes that social media has affected the way that vets and clients relate to one another. “While you’re in your appointment, and [it’s running] five minutes late, you can be putting your Yelp review out there,” she says. “You haven’t had the opportunity [yet] to meet with the doctor who comes in, and says, ‘Oh, thank you so much for waiting, I’m sorry I’m late, there was this dog that was hit by a car …’
“There’s a lot of accessibility that wasn’t there before, necessarily.”
“I think it is hard, because [social media] gives people a more anonymous platform to come out and attack us,” Dr. Loar adds. “It’s a worldwide attack, and not just a local attack, as it would be if somebody wrote to the newspaper, or something like that.”
Ironically, while Dr. Loar has found reasons to dread the social network, it’s also provided her with some of her greatest support. More than a year ago, Dr. Loar joined Not One More Vet (NOMV), a private Facebook group for veterinarians with more than 1,500 international members. “We post trials, tribulations, struggles, good things that happen — you can post anonymously or you can message the administrators anonymously,” Dr. Loar explains. “They have more than once talked me down off the ledge when I was having a really awful day. They’re amazing.”
NOMV has also become a leading nonprofit in the fight against veterinary suicide, providing educational resources and grant program assistance to veterinarians struggling to get help for mental health issues, whether that struggle is related to finding the time, affording the treatment, or otherwise.
Dr. Chellgren also maintains an active professional presence on Facebook, where she frequently interacts with clients. For her, social media is a tool, and like any tool, it comes with both positives and negatives. “A lot of my clients are also friends on my personal Facebook page, and I try to share articles that help them to understand what veterinarians go through in this field, [such as] compassion fatigue and mental health problems. Most of them are very compassionate to me about these things and, thankfully, I have some really great clients who do not abuse my personal time.
“I have had to create some hard boundaries with [others] when they abuse or cross the line [on Facebook], which is super difficult for me to do because I loathe conflict. But at the end of the day, I have to take care of my mental state and that has to be my priority before anything else.”
A Way Forward
It’s no surprise that, in recent years, ‘wellness’ has become a serious buzzword in the veterinary community. Led by the AVMA (which did not respond to multiple requests for an interview), the profession has embraced a multifaceted approach, conducting and publicizing new research and promoting online tools and resources for struggling veterinarians.
Among them: a guide to cyber-bullying and monitoring your online reputation, and tips for coping with stress, compassion fatigue, finances, and a skewed work-life balance, among others. The site also offers a well-being checklist and self-assessment, along with hotline numbers for those in need of immediate help. But many in the industry agree that solving the problem starts with early intervention and equipping young professionals with the tools they need before there’s an issue. Though wellness initiatives are gaining ground in veterinary schools around the country, the question still remains: Is it all too little, too late?
Dr. Loar, who graduated from vet school at Cornell in 2014, says mental health issues weren’t addressed in her early training and were only talked about in a limited way while she was in school. “[There was] some client interaction and role-playing stuff, which I think, for some of the students that hadn’t ever dealt with an angry client before, may have been helpful. But just strictly [as curriculum that relates to] mental health goes, no.”
“I think [vets and technicians] are just as much at fault for the communication conflict,” Jamie notes. “In order to resolve it, I think we have to have more classes on communication and conflict resolution in our schools — in vet school, in technician school, in society in general.”
"We spend a lot of time talking to people about how euthanasia is the right choice ..."
At Cornell, that framework is being laid, beginning with moving mental health topics from elective or extra-curricular options into the core curriculum. “With only 40% of veterinarians recommending their profession, I take that as an indicator that the profession as a whole is unwell. We need to make a culture change, and that starts with how we train our students,” says Makenzie Peterson, Wellness Program Director at Cornell University College of Veterinary Medicine.
“People are talking more openly about the level of stress in their lives than they did 10 years ago. I don’t view this as a reflection of younger veterinarians having less grit, but as a manifestation that the financial landscape has shifted, the stigma around mental health is slowly diminishing, and people are trying to equally value more aspects of their lives besides their profession,” Makenzie says.
For Dr. Chellgren, opening her own equine practice last year was an important decision made for both her professional and personal well-being. She recommends that young veterinarians learn to listen to their own gut as well. “My advice would be, don’t be afraid to ask for help. Don’t be afraid to admit that you’re struggling, and get the help that you need before you implode. And also, don’t be afraid to change something you’re not happy with. I think a lot of [young veterinarians] will be in bad work environments and they just think that that’s it — that’s their life now — and it doesn’t have to be that way.”
Read this next: Is Modern Technology a Threat (Or a Complement) to Good Horsemanship?
This article was originally published in issue 14 of NOËLLE FLOYD Magazine.
All photos by Dani Maczynski.