3 steps to improving well-being and managing stress in veterinary practice

Take the love you feel for animals and give it to yourself with healthy nutrition, exercise and emotional reflection. (Shutterstock.com)

The data on stress in the profession

Veterinary medicine is a stressful profession.

You know it from experience. Here's the data: In the past year, 66 percent of practicing veterinarians-including an astonishing 79 percent of associate veterinarians-have experienced depression, anxiety, compassion fatigue, burnout and/or alcohol or drug abuse.

That's according to a comprehensive national study, the Merck Animal Health Veterinary Wellbeing Study.1 The study was conducted in collaboration with the AVMA and Brakke Consulting.

The study also found that when veterinarians were presented a long list of issues facing the profession, “stress levels of veterinarians” was among the top three most critically important named by respondents. (High student debt and suicide among veterinarians were the other two most critically important issues.)

Though not measured in the study, veterinary team members are as vulnerable to stress as veterinarians. Moreover, illness and death of animals create stress in clients, too. Research has shown that about 30 percent of clients experience severe grief when they euthanize or otherwise lose a valued pet.2

References

1. Volk JO, Schimmack S, Strand EB, et al. Executive summary of the Merck Animal Health Veterinary Wellbeing Study. J Am Vet Med Assoc 2018;252(10):1231-1238.

2. Adams CL, Bonnett BN, Meek AH. Predictors of owner response to companion animal death in 177 clients from 14 practices in Ontario. J Am Vet Med Assoc 2000;217(9):1303-1309.

Stress in veterinary medicine comes from dealing with life and death, emergencies, schedule disruptions, work-life balance conflicts and the very real financial pressures that come not only from reconciling patient care with client resources, but also the student debt faced by a large number of practitioners. The stoic “game face” some people put on does not mitigate the real negative effects that unmanaged stress can take on one's mental and physical health.

Of course, stress can be beneficial, triggering the release of adrenaline that facilitates rapid reaction time and even heroic accomplishments. In that respect, stress is nature's stimulus to increase proficiency and productivity at critical times. A tree or vine under drought stress, for example, will often produce more fruit because fruit is what propagates the species. That's why the best vineyards are planted on poor, rocky soil unsuitable for most other types of agriculture.

In and of itself, stress is not problematic. In fact, a life without any stress may feel boring and without meaning. We feel stressed when we're engaging in work or relationships and activities that we care about. Stress becomes problematic when it's not acknowledged or managed. Chronic and poorly managed stress can be debilitating and result in poor physical and mental health. It can tear at the fabric that holds a team together. Therefore, it's important to take proactive measures to manage personal and team stress.

Step 1. Don't be afraid to talk about it

Recognize and acknowledge that stress is part of the environment in veterinary practice. Openly discussing stress gives people “permission” to acknowledge their own stressors and deal with them. It also brings relief to those who feel burdened by stress but feel isolated in their experience.

Discuss stress at your next team meeting. Share some of the data from the Merck Animal Health Veterinary Wellbeing Study (get the findings at vetwellbeing.com). Encourage people to recognize stress in their own lives and the circumstances that most often trigger it.

Step 2. Nourish well-being in your practice

“Well-being” is a well-established psychological construct. It's basically a subjective measure of how people feel about their lives compared to the best or worst possible lives they can imagine. Our study found that, on average, older veterinarians had higher levels of well-being and younger veterinarians lower compared to the general population.

Well-being and stress can be related. The study found that higher levels of well-being were associated with people who:

• Travel for pleasure

• Read for pleasure

• Spend time with family

• Socialize with friends

• Have a hobby

• Exercise regularly          

These activities represent a person's investment in self-care and work-life balance. They should be encouraged and celebrated in the work environment. Here's a way to do that: Periodically, in team meetings, invite people to talk about their hobbies, what they did on their last vacation or what their favorite social activity is when they get together with friends. Give a Starbucks gift certificate to the person voted by the team with the most unusual hobby, most novel vacation or most fun-sounding social activity.

What else can you do to reduce stress and foster well-being in practice?

• Bring healthy snacks like nuts, trail mix or fruit to team meetings or the break room, instead of donuts or sweets. Evidence continues to grow about the way nutrition affects mental health.

• Hang inspirational or motivational posters in work areas. They foster positive thinking. Such posters are widely available from Internet suppliers and office supply stores.

• Provide a comfortable space of an entire room for veterinary team members to briefly exercise or do yoga, or even to get away for a few minutes of reading or reflection. It's amazing what a few minutes of “downtime” after a stressful episode can do to refresh people.

• Periodically invite a mental health professional from the community to speak to your team about the importance of self-care, stress management plans and well-being (see “Manage your mental messes” on the next page).

Manage your mental messes

In addition to healthy activities, it's valuable for each individual to have a personal stress management plan. Such a plan includes activities you commit to doing daily. It's likely impossible to do everything on your stress management plan every day, but committing to one activity per day is doable and necessary to maintain health as a veterinary professional. Here are some examples:

• Five to seven minutes of high-intensity interval training (HIIT). HIIT generally involves a brief warm-up followed by physical activity (for example, fast walking, jogging, jumping jacks or stair climbing) followed by a brief cool-down period. The goal is to have a 2:1 ratio of work to recovery. HIIT works not only to reduce stress and improve condition, but also to improve glucose metabolism.

• Breathing exercises. Here's how one model, 4-7-8, works: Breathe in through your nose for four counts, hold your breath for seven counts, and breathe out for eight counts. Repeat. This can help you calm down during the day or fall back asleep at night by engaging the parasympathetic nervous system.

• Relaxation techniques. Here's a sample: Sit in a chair or lie still and concentrate on relaxing each part of your body, one limb at a time. Start with, say, your left foot, then left leg, right foot then right leg, and so on. Keep each limb relaxed as you progress. Relax your head and neck last.

• Eat yogurt. Getting enough probiotics in your diet can help your central nervous system manage stress.3

• Eat snacks. Eating plenty of fruits, veggies and nuts is not only good for your body, but also supports positive improvement in mood.4,5

• Practice mindfulness. Five minutes of mindfulness could look like this: Sit in a chair or cross-legged on the floor with your back straight. (If on the floor, sit on a pillow to raise your hips off the floor.) Breathe in and out for one count. Count your breaths out until you reach five. Start again. If you get to 10, you may notice your mind has wandered. That's OK and expected. Just start again. Consider downloading the app Insight Timer at insighttimer.com. It's free with many resources for learning to practice mindfulness.

• Call a friend. In this day and age, when we spend so much time emailing and texting, it's good to actually have a conversation. Call a personal friend or family member-a connection outside of work and someone positive who lifts your spirits. Even a 10-minute conversation can help put work stress into perspective.

People should pick the stress relief mechanisms that work best for them.

References

3. Daniel J, Davis HM, Doerr AK, et al. Lactobacillus plantarum attenuates anxiety-related behavior and protects against stress-induced dysbiosis in adult zebrafish. Scientific Reports 2016;6:33726.

4. Mujcic R, J Oswald A. Evolution of well-being and happiness after increases in consumption of fruit and vegetables. Am J Public Health 2016;106(8):1504-1510.

5. Pribis P. Effects of walnut consumption on mood in young adults-A randomized controlled trial. Nutrients 2016;8(11):668.

Step 3. Publicize resources

Every practice should post a list of outside resources that people can turn to when needed. Distribute this list to practice employees and put the list in the employee manual.

Financial planners. Our study demonstrated that financial pressures, often caused by high student debt loads, were one of the biggest sources of stress for associate veterinarians. A financial plan can help an associate determine how to best deal not only with student debt but also with other needs such as home and car purchases, child care and perhaps even saving for retirement or investing in a veterinary practice. Identify certified financial planners in the community and share their contact information with employees.

Community social workers and psychologists. Nearly 10 percent of veterinarians younger than 45 years old are suffering from severe psychological distress, according to our study. Only about half are receiving professional treatment. Identify mental health professionals in the community, and share the list with employees so it's available if and when they need it. Employees should be encouraged to work with counselors when needed. Just as important, the practice should allow employees time off for these appointments.          

Telebehavioral health services. Phone calls, video chats and message boards are a new way emoloyees can work with a counselor. There are several available through e-counseling.com. Another novel service is 7cups.com, a free, anonymous and confidential online text chat service with trained listeners, online therapists and counselors.

Veterinary organization resources. Many professional veterinary organizations now have services or more information on stress available online. These include dvm360.com, AVMA, AAHA, VIN and many state veterinary medical associations. Those resources can be found on the organizations' websites.

Local Mobile Crisis Units. If someone appears to be facing an immediate mental health crisis, help is available in virtually every community by typing “Mobile Crisis” into your computer search engine.

911. Any time you suspect that someone may be a danger to themselves or others, dial 911 immediately.

Suicide prevention hotline. If someone you know or suspect is feeling suicidal, the National Suicide Prevention Hotline is 800-273-8255. You can also text "HELLO" to 741741 for the Crisis Text Line or visit crisistextline.org, and a live trained counselor will respond.

Stress is an inescapable component of veterinary practice. However, stress in and of itself is not “bad.” It's necessary for living a productive and meaningful life and is the result of caring about what you do. Stress can be managed on an individual as well as practice level, and you'll enjoy the benefits of higher personal well-being as well as better employee morale.

Elizabeth Strand, PhD, is director of Veterinary Social Work at University of Tennessee College of Veterinary Medicine. John Volk is senior consultant at Brakke Consulting.