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Embedded stressors strain veterinarian mental health; new research to investigate

The challenges that veterinarians face include high levels of student loan debt, struggles explaining the cost of services to clients, and complex moral conundrums connected to end-of-life animal care, says Athena Diesch-Chham. 

Andrea Birkeland, DVM, with her dog Jazz
Andrea Birkeland, DVM, with her dog Jazz: "Some days can be pretty challenging, but I do not regret it."
Courtesy of Andrea Birkeland

Andrea Birkeland, DVM, went into veterinary medicine with her eyes wide open. 

“I wanted to be a vet since I was five years old,” she said. “So It would have been easy for me to think that being a vet would be all roses and smiles and playing with kittens and puppies.” But, because she is a careful planner by nature, when she was in college Birkeland shadowed a veterinarian whom she pressed to answer her questions about the profession honestly and openly. 

Birkeland’s mentor revealed many of the harder truths about a vet’s life. “She told me how tough it would be to get into vet med school,” Birkeland said. “She talked about how tough the classes are. She told me about the emotional stresses. She talked about some of the tougher aspects of the job.” 

Armed with this daunting information, Birkeland wasn’t deterred. She applied, and was accepted to the University of Minnesota’s College of Veterinary Medicine. Today she’s a veterinarian in private practice at a small animal hospital in Minneapolis. 

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“I’m glad I knew what I was getting into,” Birkeland said. “It was tough, and some days can be pretty challenging, but I do not regret it.” 

While vets struggle with common mental illness like anxiety and depression at rates similar to other Americans, research conducted by the Journal of the American Veterinary Medical Association (AVMA) revealed an alarming reality: Veterinarians die by suicide between 2-3.5 times more often than the general U.S. population.

This is a disturbing fact that Birkeland and her colleagues in the profession can’t ignore.

Athena Diesch-Chham
Athena Diesch-Chham
“A lot of the people who go into vet school have been looking into doing this for their whole life,” she said. “They are usually very well prepared. In theory they know how difficult this career is going to be. But I don’t think anything can really prepare you for what it is actually like to be a vet. You have to jump in and deal with it, and there are some very real challenges that you are going to face.” 

Athena Diesch-Chham, a clinical social worker who counsels students, faculty, staff and clients at the College of Veterinary Medicine, said that the very real challenges that veterinarians face include high levels of student loan debt, struggles explaining the cost of services to clients, and complex moral conundrums connected to end-of-life animal care. 

She said that the AVMA report highlighted an issue that had been quietly simmering over the last few decades in the veterinary community: The very personality type that is drawn to the profession tends to be at higher risk for mental illness. In order to care for its members, she added, the profession needs to acknowledge that fact — and do what it can to address the mental health needs of its members.

“Those called or brought to vet med tend to be highly driven, highly perfectionistic individuals,” Diesch-Chham said. “When we put that characteristic into a mental health diagnosis, there goes our anxiety. They are high performers. They have to be. They want this so badly. When things don’t work out, there goes our depression. It’s a perfect storm, and something needs to be done.” 

Generation gap

Though mental illness among veterinarians isn’t a new phenomenon, Diesch-Chham said that the younger millennial generation of veterinarians is more willing to speak up about expectations that they will continue to work through situations that they find emotionally or ethically challenging. Concerned for their own mental health and for the health of the profession, they are pushing back against this reality and working to improve life for themselves and their colleagues. 

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“If we look at the general population, our current generation is more help-seeking than the generations before them,” Diesch-Chham said. “They are more willing to talk about the issues, to destigmatize mental health in general. Within vet med, this is playing out with young vets speaking up and saying, ‘Wait a minute. We have to do something about this high depression and suicide rate.’”

Ann Brownlee, DVM, has cared for small animals at Grand Avenue Veterinary Center in St. Paul for nearly three decades. She sees herself as part of a transitional generation of veterinarians who watched their profession move from a mostly male workforce to now majority female. While the gender shift doesn’t explain the mental health crisis, Brownlee said, she does believe that there is a certain personality type that is drawn to the work, and that individuals with that personality type are more likely to struggle with their mental health — or at least be willing to admit to struggling. 

“It seems like there’s a pattern of people who are drawn into this work and they are high-achievers; over-achievers; perfectionists; with big, huge hearts that just get out into it and get beaten up,” Brownlee said. Some of this change is good, she added: Younger veterinarians and vet techs in her practice are more open to discussing their mental health concerns. That more open approach, while it requires more time and attention from colleagues, she said, feels like a healthy change for the profession. 

Ann Brownlee
MinnPost photo by Andy Steiner
Ann Brownlee
One source of significant stress for younger veterinarians is loan debt. Since she got her vet med degree, Brownlee said the cost of education has grown wildly. She thinks the heavy loan burden that many new vets carry is a common cause of anxiety and even depression. 

“We have vet students and pre-vet students who are working at this clinic,” Brownlee said. “They all tell me, ‘I know I am going to come out with up to $200,000 in debt.’   These are young women. I feel like men are trained not to bury themselves in debt like that just because they feel their heart needs something more than anything in the world. You have to think, ‘Who are these people who are following their heart to that degree?’ And then they are going into a profession that can be very hard. When I started out, school wasn’t nearly that expensive. It’s a completely different reality today.” 

Diesch-Chham said that a generational tension is visible in the way faculty and staff at many vet med schools react to students who refuse to accept things as they are and not push for change. 

“There are a lot of unwritten messages in vet med,” she said. “One is, ‘You will work and you will work a lot and you will not complain about it.’ Older vets will say, ‘That’s what it was like when I did it, so get on board.’ Some students aren’t having that.” 

Amelia Campbell, DVM, an internal medicine resident at the University of Minnesota College of Veterinary Medicine, said that some younger veterinarians like herself can feel disillusioned when the job they dreamed of their whole life turns out to be harder than they ever imagined it could be. 

Typical veterinary medicine students are, Campbell said, “mostly people who are extremely driven and self-motivated and prone to be very hard on themselves. A lot of people go into it with high expectations. It’s a dream job, but there is a lot of unanticipated stress involved in dealing with highly emotional owners in situations where their animals are quite sick.” Older veterinarians may have been trained to swallow disappointment, she said, but that doesn’t always sit well with her generation. “When things are not going right, we want to fix them.” 

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Moral injury

One important part of a veterinarian’s job is helping to counsel clients around end-of-life decisions for their animals. This work, which ideally involves the practice of euthanasia for animals who are terminally ill or in severe pain but sometimes involves owners who make what feels like morally questionable requests, can be a source of significant stress for many in the field. 

Diesch-Chham said that euthanasia, while universally accepted in the field as a sound and ethical practice, is often complicated by pet owners who have a hard time accepting that their animal is suffering and has no chance of recovery. 

“On a regular basis our vets are being put in situations where they have a very clear direction they should go and they are not allowed to go that direction because their client won’t allow them to do that,” Diesch-Chham said. “If they see an animal is suffering and it is not something they can fix, euthanasia is their answer. It is beautiful. It works great. But some clients won’t go there. And that can cause a vet a painful moral struggle.” 

And sometimes veterinarians encounter pet owners who ask them to put a healthy animal down because its existence interferes with their lifestyle. In the profession, these are known as “convenience euthanasias,” and most veterinarians refuse to perform them. 

“Sometimes vets are put in situations that they don’t agree with,” Diesch-Chham said, “like when a healthy animal walks in and they are asked to euthanize them. When they get put in these situations where they know what they should do but they are being asked to do something else, vets struggle. They are not trained around what to do with that.” 

Sometimes, she added, an animal is suffering from an illness that could be cured with an expensive treatment that the owner can’t afford. Then the only available option may be euthanasia: “The moral and ethical complications take a toll on their mental health. It is huge.” 

“Having to put down pets that have treatable conditions is one of the hardest things that we are asked to do,” Birkeland said. “It’s not that the owners don’t care. They just don’t have the money, so we decide it is the best thing for those pets.” 

Brownlee said that in her practice she rarely gets asked to perform a convenience euthanasia. 

“In my case, I’m almost always walking a path with somebody who I’ve known for most of their pet’s life,” she said. “We don’t ever do euthanasias that we don’t agree with.” 

It’s been a few years since someone has asked her to perform a convenience euthanasia, she added. When it happens, Brownlee said she has a clear response: “I say, ‘If you don’t want to have a long conversation with me about why I’m uncomfortable with this request and whether I can come to a level of comfort with it, we can end this now and you bring your pet to the Animal Humane Society and say, ‘I need to euthanize this pet.’”

A sign welcoming pets to Ann Brownlee's clinic.
MinnPost photo by Andy Steiner
A sign welcoming pets to Ann Brownlee's clinic.
Most of the time, Birkeland said, euthanasia feels like a morally sound decision, a responsible step in the care and treatment of animals. “Euthanasias aren’t always bad,” Birkeland said. “I’d say most of the time, myself and other vets and vet techs can feel good about having to euthanize a pet who is really sick. It is a way to relieve suffering.” 

But once in a while she encounters a situation that sits firmly in a gray zone. “You have those really sad ones that stick with you for a long time,” she said. “Sometimes it has to do with money, where owners can’t afford to do all the diagnostics and treatment that would be the gold standard and euthanasia is the only option.”

Diesch-Chham is so interested in the moral impact that euthanasia has on veterinarians that she is studying the connection between veterinarian mental health and the highly charged moral decisions they are asked to make. 

“I am doing research on the link between a well-known phenomenon in military veterans called ‘moral injury,’ and veterinarian mental health,” she explained. “In veterans it is a well-studied thing. The first time I heard about it, I said to myself, ‘That makes sense to me in veterinarians,’ so I decided to do some research.” 

For her study, Diesch-Chham has interviewed more than 100 veterinarians about the mental health impact of the ambiguous moral decisions they are asked to make. “I asked study participants to talk about participating in veterinary acts that they didn’t agree with and what that did to them,” she said.

The study is in the analysis phase. “I don’t have anything to report yet,” Diesch-Chham said. “I’m hoping to get more into the data in this school year,” she said. The final report, she added, “is still a ways out.” 

Financial pressure 

Caring for a sick animal can be expensive. This is a fact that many pet owners seem to forget until they are confronted with veterinary bills. Sometimes, when a client is confronted with the true cost of care for their animal, they complain or say that their vet is trying to cheat them out of their money. 

This is a serious cause of anxiety and stress for veterinarians, Diesch-Chham said. 

“Some of it is clients who say, ‘I’ve got a decently healthy animal but we can’t afford spend $100 on what this animal needs.’ What does a vet do with that? Or what about situations where clients have all the money in the world but no matter how much money they throw at the situation we can’t fix their animal? Both kinds of situations create anxiety.”

Owners who are surprised by the cost of animal care often forget that health insurance masks the cost of health care for humans, Birkeland said. 

“Because we have health insurance for human medicine, the vast majority of us don’t see the true cost for health care,” Birkeland said. “Because of that, some people have trouble swallowing the fact that vets have to charge for their services.” 

Because the cost of veterinary care often comes as a surprise to her clients, Birkeland said she sometimes encounters people who react angrily to their bills. 

“I have clients yell and scream at me on the phone all the time,” she said. “I’ve had clients approve costs in full for treatment in advance but when it comes time to pay a bill, they refuse to pay it.” 

Unfortunately, this reaction is common among pet owners, Brownlee said. “I think vets get guilted a lot about what we charge. I think that’s a big deal.”

To cut that reaction off as much as possible, Brownlee said that she and her staff try to let clients know about the cost of care as early as possible. 

“We do a lot of educating in initial visits,” she said. And insurance policies are available for animal care: “We just started at least trying to mention pet insurance to people when they first come in so at least they’re aware of it.” 

Because she is an internist, Campbell said that she only sees animals that have been referred to her from their primary care vets. 

“So usually people have been warned in advance about the costs of treatment and come to us with an awareness.” That said, finances can quickly become stressful for an owner when an animal has to be hospitalized or requires in-depth treatment, Campbell said. “When a person gets a bill of $5,000 or $10,000, that’s stressful for anyone.” 

The pros outweigh the cons’ 

Despite the many stresses connected with veterinary medicine, many vets say that they still feel deeply connected to the profession and couldn’t imagine doing any other kind of work. 

“I love my work, I love my hospital, I love my clients,” Birkeland said. “No matter where you work there are always going to be those difficult days or difficult clients and sad cases that we need to see. Nothing that you could do could prevent that sort of thing from happening, and this is a reality that I choose to accept.” 

When she encounters a particularly tough case, Birkeland turns to her coworkers for support.

“Vets aren’t the only people who are impacted by these cases,” she said. “I’ve got vet techs that are as impacted by it as much as I am. We support each other. Talking about it is so important.” 

When she works with clients who thank her for the care she provided for their animals, when she’s been able to help a pet get better and see a smile on their owner’s face, the stress of her job feels worth it. “I do love being a vet,” Birkeland said. “Nothing could be more rewarding for me. The pros outweigh the cons.” 

Brownlee said she feels the same way. “I love what I do more than anything. Work for me has always been a very positive place, almost my most positive place. I always felt like I can help and do things. I’ve been able to see so much positive every single day so that I can handle the negative.” 

That approach of weighing positives against negatives is a way many veterinarians use to strike a healthy balance between their love of the work and the stresses it carries. She’s hoping that her research will uncover more healthy ways of living for struggling vets.

“People who are very happy in the profession have really solid coping mechanisms,” Diesch-Chham said. “They have done the work to feel like what they do sits OK with them. They have figured out what sustainable practice looks like for them and they have stuck with that. We need to get that message out to everyone in the practice.”