Coping with Stress and Burnout as a Veterinarian

Nadine Hamilton

Positive Psych Solutions




The leading evidence-based resource supporting
better wellbeing for veterinary professionals


"As a vet of nearly 20 years experience, I cannot believe the difference that your book has made to the way I see myself, my profession, and my coworkers. I am genuinely enjoying being a vet again.”


"There are copies of this book at every Greencross Vets clinic as a means to empower vets in their everyday routines. It's a tough conversation to have, but an important one.
Andrew McInerney, Chief Operating Officer, Greencross

"I greatly enjoyed reading this book. It is an excellent resource. Every third-year DVM student at our school gets a copy of this book.”
Prof. Anna Meredith, Head of Melbourne Veterinary School

The best way to tackle the unique nature of veterinary stress that can lead to anxiety, depression and suicide is to use evidence-based research to create an intervention able to have a scientifically measurable positive impact on wellbeing. That's why psychologist Dr Nadine Hamilton wrote this book after spending over 15 years researching, working with thousands of stressed vets, and consulting with industry associations, practice managers and owners. This unique resource combines reading on mindfulness, positive psychology, wellbeing, and resiliency training with a ‘toolkit’ of practical tasks and tips to teach people how to cope with everyday pressures, so they no longer feel like suicide is the only way out. Its approach has been tested with statistically significant results showing reduced stress, depression, anxiety, and negative affect.

Working in the veterinary profession can be a rewarding, challenging and demanding career, requiring a passion for animals, excellent interpersonal skills and a strong work ethic.

It also has a dark and very dangerous side.

The suicide rate for veterinarians as measured across Australia, the US, UK, New Zealand and Canada is almost four times higher than the general population. This suicide risk has been shown to surface at graduation and remain for the rest of a vet’s working life.

The veterinary profession faces a severe mental health issue.

The effects of working long hours, performing euthanasia on animals, emotional pressure, financial issues, unrealistic expectations, and dealing with distressed clients place considerable stress on both the vet themselves and their families at home. Failure to cope with such stress upsets mental wellbeing and can lead to serious emotional, physical, and behavioural issues.

Strategies across the globe such as awareness campaigns, crisis support, mentoring, and calls for changes to drug regulation are currently trying to encourage more vets to acknowledge the issue for themselves and their colleagues and to seek help. Professional veterinary member groups are using programs based on concepts such as ‘compassion fatigue’, resilience, and the clear need to care for oneself, in further efforts to reduce vet stress. The 2018 Merck Animal Health Veterinary Wellbeing Study recommended that employers educate all team members on the importance of mental health and wellbeing.

Psychologist Dr Nadine Hamilton is passionate about veterinary suicide prevention, having been touched by the tragic effects of suicide within her own family. A chance encounter early in her psychology career led to her interest in the mental wellbeing of veterinary professionals. She has spent over 15 years in her specialty psychology practice working with thousands of stressed vets as well as consulting to industry associations, practice managers and owners to increase wellbeing, productivity, and retention in the workplace. In support of her aim to create a ‘paradigm shift’ within the veterinary industry, in 2018 she founded love your Pet Love Your Vet, a not-for-profit charity raising awareness about the issues within the veterinary industry and reducing stigma in veterinary professionals seeking help.

Her postgraduate research at the University of Southern Queensland focussed on how key evidence-based psychological strategies could be used to decrease the risk of psychological ill-health and suicide by vets due to their day-to-day stress levels. What she found was that the best way to tackle the unique nature of veterinary stress was to combine certain psychoeducational elements. That meant specific education on the principles of positive psychology, mindfulness, and ACT along with a ‘toolkit’ of practical tasks from these fields. Combining these elements with supportive strategies such as stress management and communication tips results in a holistic intervention able to have a scientifically measurable positive impact on wellbeing. She uses this approach in her popular Coping and Wellbeing for Veterinary Professionals workshop.

Building on this workshop, she produced Coping With Stress and Burnout as a Veterinarian as a cost-effective highly accessible way to empower vets in their everyday work lives to use psychological knowledge and skills to combat stress, burnout, anxiety, depression and suicide. It is an easy read for individual vets both experienced and freshly minted and sits well with existing veterinary HR approaches as well as supporting face-to-face counselling and industry association mental health programs. It also provides a clear call-to-arms for veterinary industry leaders.

The book is structured in four sections. The first two provide vets with both an understanding and an acknowledgement of the uniqueness of their work and the mental health issues that come with that work. A section on psychology provides a comprehensive overview of several psychological fields that assist wellbeing. The final section includes specially selected strategies along with some references to a vet’s workday.

Together, these elements result in a unique resource able to provide self-help as well as support for existing vet wellbeing programs. Research has shown the importance of reinforcing the immediate-term effects of mental health interventions with take-home resources — something that reminds people of the information they have learnt and is able to be referred back to in difficult times. For some who take it off a practice shelf the book will simply be a confirmation that they or a colleague are not alone in experiencing stress and that their issues are understood, for others they will find practical tools helpful in their working day, for leaders it might help guide their interactions with staff, or it might help someone to seek professional help.

That’s why the book is not only popular with individuals working in local vet practices, it has also been taken up by vet schools, large vet hospitals and across hundreds of practices managed by ‘mega’ practice groups. For these corporate businesses, the book is seen as a major cost-effective mental health investment for the benefit of their staff and a commitment to the global fight against workplace suicide.

The veterinary industry is in fact currently attracting significant private equity investment on a global scale as these mega practice groups buy up traditional owner-operator veterinary clinics en masse and major pet supply companies expand into veterinary services. Some vets fear a detrimental culture change for a profession already under pressure.

Yet this ‘corporatisation of veterinary medicine’ can be positive for the profession through the injection of fresh funds and infrastructure into supporting vet staff. It makes good sense, both for HR management goals and corporate social responsibility endeavours, for larger vet practices, corporate-owned vet groups, and vet hospitals to include coping With Stress and Burnout as a Veterinarian as an essential resource in their ongoing work. Evidence-based and reader-friendly, the book is easy to keep on hand as a reliable staff resource or in support of employee assistance programs (EAP), continuing professional development CPD, or wellbeing support initiatives. In fact, larger veterinary groups and hospitals benefit from special discounts for bulk purchases of the book and options for customised branding with a personalised opening page message.



For further information on bulk orders, please contact the publisher Stephen May stephen@australianacademicpress.com.au.


Includes Foreword by Emeritus Professor Trevor Heath OAM.

Spanish edition due 2021.


Praise for Coping With Stress and Burnout as a Veterinarian:

"I greatly enjoyed reading this book. It is an excellent resource. Every third-year DVM student at our school now receives a copy of this book.”

Prof. Anna Meredith, Head of Melbourne Veterinary School


"Nadine’s book greatly helps VetPartners meet its vital HR commitment to the wellbeing of all of our staff and our goal as a veterinary employer of choice.”

Dr. Brett Hodgkin, Chief Veterinary Officer, VetPartners Australia New Zealand


"UQ School of Veterinary Science strongly endorses' Nadine's book. We have copies available for all students across key areas, including staff year group mentors and key personnel, and have incoporated the book in a package of mental health support information.”

Prof. Nigel Perkins, Head of University of Queensland School of Veterinary Science


"There are copies of this book at every Greencross vets clinic as a means to empower vets in their everyday routines. It's a tough conversation to have, but an important one — and this book is not a solution, but a start.”

Andrew McInerney, Chief Operating Officer, Greencross


"Highly recommended, a very easy and enjoyable read, this book should be readily available in clinics for all staff. Many of the stressors will be experienced by anyone working in a clinic, and our veterinary nurses and receptionists often bear the brunt of grief and unrealistic client expectations.”

Dr Jenny Weston, Massey University Dean of Veterinary Sciences


"Every veterinary and mental health care professional who works with veterinary staff should read this book with an eye on helping shape a better future for people and animals. ”

Melanie Goble, DVM, Not One More Vet Inc. (NOMV.org)


"The suicide rate among veterinarians is a concern for the WVA and we use Nadine’s book as a reference while working on the issue of stress in the profession.”

Dr. Zeev Noga, Deputy Executive Director, World Veterinary Association


"Finally a practical self-help book aimed specifically at the veterinary profession. Easy to read and with lots of practical advice and the tools to traverse the corrugated road of professional life.”

Dr. Brian Mc Erlean, Trustee, AVA Benevolent Fund and Veterinary Suicide Prevention Advocate


"It is almost an unspoken rule or even a general acceptance that stress and burnout are just a fact of life if you are a veterinarian. It doesn't have to be that way. I believe this book will make a difference, help veterinarians have successful and fulfilling careers and also most importantly save lives of our dear colleagues."

Dr. Gerardo Poli, Hospital Director, Animal Emergency Service


"Thank you Nadine, for recognising and building awareness around such an important issue. I highly recommend this book, it may just save a life one day.”

Dr. Andy Pieris, Owner, Casuarina Seaside Vet


"As a clinical psychotherapist with over 30 years working with high performer medical professionals, I can say that Dr Nadine Hamilton has a deep understanding of the stresses, conflicts, and unique challenges facing veterinarians today. I highly recommend this book to veterinarians and to the educators and mental health professionals who work with them.

Dr. Fern Kazlow, Clinical Psychotherapist, New York, Founder of The No Doubt Zone


Helpful links that talk about the book and Nadine's work


Vet Practice magazine article — For the Love of Vets

Psychologist Ellen Jackson interviews Nadine for the Potential Psychologypodcast

Nadine talks with Dr. Kimberley Khodakhah from Vetopia INCabout resilience, LYPLYV and the work behind her book.

Great interview with Nadine at I Love Veterinary

The Vet Vault features a mental health masterclass as vets Gerardo and Hubert talk with Nadine about her book and her research.

Yahoo Lifestyletalks with Nadine about a profession "that's not just about playing with puppies and kittens".

The guys from Two Vets Talk Pets Apple Podcast give a quick review of the book and how it fits in with the profession's fight against suicide. (about 11 mins in)

Listen to The Wellness Couch podcast with Nadine.

Nadine is interviewed in the US news on Fox 35 Orlando.



About the Author

Psychologist Dr Nadine Hamilton is passionate about suicide prevention, having been touched by its tragic effects within her own family. She has also held a love of animals since childhood. A chance encounter early in her psychology career led her to become a proud supporter and advocate for the mental wellbeing veterinary professionals. In her private practice, she helped many vets develop better coping strategies to get on top of stress and psychological fatigue to avoid burnout and suicide. She has also worked with veterinary practice managers and owners to increase wellbeing, productivity, and retention in the workplace. In support of her aim to create a ‘paradigm shift’ within the veterinary industry, in 2018 she founded Love Your Pet Love Your Vet, a not-for-profit charity raising awareness about the issues within the veterinary industry and reducing stigma in veterinary professionals seeking help. Her book Coping With Stress and Burnout as a Veterinarian developed out of her earlier work developing and validating a group workshop to help vets build protective attitudes, enhanced wellbeing, and increased coping skills to try and prevent the psychological distress that can lead to suicide. 

Reviews

Journal of the American Veterinary Medical Association, December 15, 2019, Vol. 255, No. 12 , Pages 1353-1357

Reviewed by Melanie Noble, DVM, CCFP

Renewed Strength Veterinary Services and Not One More Vet Inc

 

Coping With Stress and Burnout as a Veterinarian: An Evidence-based Solution to Increase Wellbeing is an excellent introduction to a discussion of the mental health and wellbeing issues that have faced the veterinary profession worldwide for decades. The information is presented in an easy-to-understand manner for anyone interested in the health and wellbeing of veterinarians. I hope this book lands in the hands of many mental health workers worldwide. Although it discusses the dark side of veterinary medicine, it does not stop there and provides hope that the mental health landscape can improve. Through explanations of multiple psychological techniques and theories, it allows nonmental health professionals to understand how our thoughts impact our lives, as well as how we can reshape the way we process and react to our thoughts and experiences. The final section of the book gives clear action steps (in worksheet form) to help improve general wellbeing of individuals. I highly encourage anyone who is struggling in the veterinary profession, or life in general, to take time to read this book and take a chance on yourself. You are worth it.


Review by

Dr Jenny Weston

Dean of Veterinary Sciences

Massey University

Published August 2019 in VetScript, the flagship magazine of the New Zealand Veterinary Association (NZVA)

https://www.nzva.org.nz/page/VetScript1

THIS 173-PAGE BOOK is billed as an evidence-based solution to increase wellbeing, and includes in its last 70 pages a modular coping and wellbeing programme. The author is an Australian psychologist who has worked extensively with veterinarians and has undertaken postgraduate research into veterinary wellbeing. She founded the ‘Love Your Pet, Love Your Vet’ non-profit charity to raise awareness about the challenges facing many veterinarians.

The book comes highly recommended by a number of Australian veterinarians who are well-known proponents of veterinary wellbeing, including Brian McErlean and Emeritus Professor Trevor Heath, who writes an insightful foreword. In the introduction, Nadine explains her career path and how her childhood aspirations changed from being a veterinarian to becoming a psychologist.

The book is divided into sections, the first being a concise summary of the ‘dark side’ of the profession, including the theories and statistics about veterinarian mental health. Section two covers the reality of working as a clinical veterinarian and how things have changed in the past 30 years. In this section, Nadine eloquently describes the personal, emotional and financial challenges that most of us are aware of. Her insights are spot-on, and are no doubt a result of what she has learned from working with many veterinarians in the past.

Section three discusses the nuances between different forms of psychology that can assist us (or anyone) to thrive. I particularly liked the chapter covering positive psychology, an area I was already reasonably familiar with and which covers the factors that allow optimal human functioning by considering how we view our past, present and the future. Much of this can be affected by how we view events – preferably through a positive lens and with hope and optimism. This doesn’t mean we should all have a naïve, Pollyannaish take on life, but that we keep things in perspective and realise that everyone has challenges in their life at some point. Positive psychology isn’t just about fixing what’s wrong, it also focuses on strategies that support and nurture our physical and mental wellbeing.

The other chapters in this section cover Acceptance and Commitment Therapy (ACT) and Career Construction Theory. The author lost me a little in these chapters when a little more psychological jargon was thrown around, but there were intertwining themes about what makes a life worth living – positive relationships, meaningful work, a sense of achievement, and making a positive difference in the lives of others. All this doesn’t need to be earth-shattering, ‘ save-the-world’ type action – random acts of kindness and being adaptable are all important. The final chapter in section three covers resilience, which was also very interesting.

The perspective that you can bounce back from setbacks as opposed to grinding on with gritted teeth is useful. While there is evidence for a genetic component in resilience, it is good to know that resilience and optimism can be learned.

Section four, titled ‘Intervention’, outlines the seven modules that anyone can work through to improve their coping and wellbeing strategies. These modules come as a combination of information and worksheets that you could photocopy to assist you to work through the exercises. The modules cover: stress management, time management, communication and assertiveness, relaxation, SMART goal setting, ACT and positive psychology. All of the modules looked relatively easy to work through, and I’m sure they would help you feel that you had more control over your life (both at work and at home) and assist with keeping things in perspective and focusing on what gives you a sense of satisfaction and happiness.

A comprehensive bibliography is provided at the end of the book. A minor criticism is that I would prefer references to be listed alongside the text to make it easier to read more around a particular subject, rather than just looking at all the articles and books listed in the bibliography and then guessing which ones might have the relevant information.

This is a very easy and enjoyable read, and Nadine is no doubt an expert in the field. her recommendations are based on science and her experience of working with veterinarians. I strongly recommend that this book be readily available in clinics for all staff to browse. Many of the stressors will be experienced by anyone working in a clinic, and our veterinary nurses and receptionists often bear the brunt of grief and unrealistic client expectations. Highly recommended.


Review by


Stress-busting strategies to tackle "dark" work risks

06 March 2019 1:28pm

A new book focusing on stress, burnout and the high suicide rate among veterinarians has outlined a seven-module "coping and wellbeing program", which includes important lessons for all time-poor or socially isolated workers.

in Coping with Stress and Burnout as a Veterinarian(Australian Academic Press), psychologist Dr Nadine Hamilton says there is a "dark side" to the veterinary profession, with workers operating within a "culture of death" (animal slaughter and euthanasia) and struggling with financial issues, despite the often-incorrect belief that they are wealthy due to the high charge-out rates for their treatment of pets.

In some Australian states, the suicide rate for vets is about four times higher than the rate for the general adult population, while UK research shows that vets are more likely to suffer from severe or very severe symptoms of depression, their suicide risk is higher than for medical doctors and dentists, and their access to lethal medication "can translate thoughts of suicide into actual behaviour", she says.

Factors that adversely affect a vet's wellbeing include poor work-life balance and a lower-than-expected income, given the nature of the work and the extensive training required to enter the profession, Hamilton says.

The high costs of setting up, running or maintaining a practice significantly reduce profit margins, while veterinary nurses can have "limited scope for advance once they have already reached practice manager status, placing a ceiling on their earning capacity", she says.

Vets must also deal with "difficult or emotionally distressed" animal owners, perform complex work at a fast pace for long hours, work on their own and in remote locations, and perform euthanasia, which is distressing for multiple reasons, she adds.

The threat of suicidality in vets can be tackled through career counselling and providing a "psychological toolbox of resources they can refer to when required", the book says.

The book includes the " complete coping and wellbeing program for veterinary professionals", with strategies for proactively managing stress and increasing resilience grouped into seven modules: stress management; time management; communication and assertiveness; relaxation; SMART goal setting; acceptance and commitment therapy; and positive psychology.

The first module incorporates a 10-point "stress-busting list" that includes:

  • Know your stressors– learn to recognise the things that "get you stressed" and work on strategies for coping with them;
  • Recognise your symptoms– try to recognise the signs of stress, like feeling nauseous, being irritable or sweating, so you can "take a more proactive role in combating stress";
  • Practice mindfulness– focus on "being in the moment" instead of getting "caught up in the past or future";
  • Socialisation– surround yourself with supportive friends and family, and be aware that laughing releases endorphins that help you "de-stress in the long run"; and
  • Seek professional help– speak to your GP or psychologist if "you feel like stress has control of you" and "you do not feel like you have appropriate strategies".

Hamilton has spent a decade researching the mental wellbeing of veterinarians, and founded the global campaign "Love Your Pet Love Your Vet", to raise awareness of the high burnout and suicide rates in the profession, and reduce the stigma of seeking help for vets.

Table of Contents

Acknowledgements

About the Author

Foreword

Introduction

SECTION ONE – THE CHALLENGE

Chapter 1 – The ‘dark side' of the veterinary profession

The Problem

Why do so many vets contemplate suicide?

What do we do to help vets at risk?

The Coping and Wellbeing Program for Veterinary Professionals

SECTION TWO – THE REALITY

Chapter 2 — Being a vet

Impacts on Vet Wellbeing

Students and Fresh Graduates

Major Strengths Supporting Vet Wellbeing

The Next Step

SECTION THREE — WHAT CAN HELP

Chapter 3 — Positive Psychology

Authentic Happiness Theory to Wellbeing Theory

PERMA

Positive Education

The Core Virtues of Positive Psychology

Another Step to Go

Chapter 4 — Acceptance and Commitment Therapy

Psychological Flexibility

Mindfulness

Core Pathological Processes

Overlap Among Pathological Processes

A Further Step Yet

Chapter 5 — Career Construction Theory

Life Themes

Vocational Personality

Career Adaptability

Career Construction Theory in Action

One More Step

Chapter 6 — Resilience

Keys for a Resilient Life

SECTION FOUR — INTERVENTION

The Coping and Wellbeing Program for Veterinary Professionals

Module 1 Stress management

Module 2 Time management

Module 3 Communication and assertiveness

Module 4 Relaxation

Module 5 SMART goal setting

Module 6 Acceptance and Commitment Therapy

Module 7 Positive Psychology

Helpful Contacts

Bibliography