Life as a practising veterinarian can be a demanding one, with high workloads, client complaints1 and other client-related factors, including economic limitations, unrealistic expectations and lack of compliance at the top of the list when it comes to workplace stressors2,3. On top of which, by virtue of their profession, veterinarians often interact with distressed clients or those experiencing caregiver burden (strain from caring for an ill loved one4), which can result in a transfer of burden from client to veterinarian5.
When you consider the cumulative effect of repeated exposure to stressful interactions and working conditions, it’s easy to understand why psychological occupational hazards are common in the veterinary (and wider animal care) industry. Unfortunately, symptoms of compassion fatigue, workplace stress and burnout often go unnoticed, unreported or are poorly managed. So, what can be done to improve conditions? Can client interactions that cause stress for veterinarians be predicted, and how could this stress be better managed?
To address these questions, researchers from Kent State University (OH) developed and validated the Burden Transfer Inventory (BTI). In their recently published article, Spitznagel et al. (2019) suggest the BTI can be utilised as a tool to predict veterinarian stress relating to client behaviour and assist with the development of targeted and streamlined treatment and support measures to manage that stress.
To develop this tool the research team conducted a 3-stage study between 2016 and 2018. Initially (Stage 1), a list of 34 stressful client interactions were identified through an exploratory survey (n=19). Following this, 1170 veterinarians completed a refined version of the survey and rated the occurrence (0 = never, 4 = daily) of the 34 client interactions and their reaction to these interactions (0 = not bothered/upset, 4 = very bothered/upset) (Stage 2). Finally (Stage 3), 372 owners currently caring for a chronic or terminally ill dog or cat, and actively accessing veterinary care were recruited through a social media platform to complete an online version of the survey. In this version of the survey, interactions were reformatted from the client’s perspective with the aim of investigating whether they were linked to caregiver burden.
The researchers found a positive correlation between BTI items (client interactions) and stress and burnout indicators for veterinarians. They also found a positive correlation between caregiver burden and the frequency in which owners engaged in BTI interactions. In other words, the stress and strain of caring for their ill animal drives owners to engage in behaviours and interactions that are stressful for veterinarians. Logic would suggest that if caregiver burden is reduced, so too should veterinary stress and burnout - but will that alone be enough?
It’s true, frequency of stressful client interactions is a major factor. However, what’s more surprising is that the veterinarian’s reaction to the client interactions proved to be a significantly more reliable predictor of stress and burnout than the frequency with which the interactions occurred. So, while addressing client caregiver burden may reduce the frequency of certain stressful client interactions, it won’t necessarily impact the way in which a veterinarian reacts or responds to these interactions. The study’s authors suggest preventative training and targeted treatment could be beneficial to improve veterinary coping skills and reduce negative responses arising from client interactions.
The results of this study have huge potential. However, as noted by the authors, there are several limitations to consider. The small number (19) of veterinarians involved in the exploratory survey (stage 1) to identify the initial BTI item pool is certainly noteworthy. A larger item pool may have been generated if more veterinarians were involved at this stage. This limitation in somewhat mitigated by the inclusion of a free text space in the stage 2 BTI survey as it enabled respondents to include items not already identified in the BTI. It is also possible that highly stressed veterinarians were more motivated to complete the online surveys, which may have resulted in stressed veterinarians being over-represented in the study. Finally, Caucasian females were the primary respondents for the surveys in stage 2 and 3 therefore the results lack demographic diversity. Demographic diversity aside, this finding poses some interesting questions. Are Caucasian female veterinarians more susceptible to stress and burnout? Or does this represent a tendency for men and other cultures to keep quiet about mental health? Perhaps this is a topic to be explored in future research.
This study by Spitznagel et al. (2019) has produced valuable findings with the potential to change the way veterinary stress and burnout is identified and managed. The BTI developed and validated in this research can be adapted and used by employers, mental health providers, social workers and veterinary education providers to improve counselling and training services offered to veterinarians. Ultimately, a 2-pronged approach to reduce client caregiver burden and increase veterinary resilience would be most beneficial in improving the mental well-being of veterinarians.
Spitznagel, M., Ben-Porath, Y., Rishniw, M., Kogan, L. and Carlson, M. (2019). Development and validation of a Burden Transfer Inventory for predicting veterinarian stress related to client behavior. Journal of the American Veterinary Medical Association, 254(1), pp.133-144.
 Nett, R., Witte, T., Holzbauer, S., Elchos, B., Campagnolo, E., Musgrave, K., Carter, K., Kurkjian, K., Vanicek, C., O'Leary, D., Pride, K. and Funk, R. (2015). Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians. Journal of the American Veterinary Medical Association, 247(8), pp.945-955.
 Kipperman, B., Kass, P. and Rishniw, M. (2017). Factors that influence small animal veterinarians’ opinions and actions regarding cost of care and effects of economic limitations on patient care and outcome and professional career satisfaction and burnout. Journal of the American Veterinary Medical Association, 250(7), pp.785-794.
 Vande Griek, O., Clark, M., Witte, T., Nett, R., Moeller, A. and Stabler, M. (2018). Development of a taxonomy of practice-related stressors experienced by veterinarians in the United States. Journal of the American Veterinary Medical Association, 252(2), pp.227-233.
 Tremont, G., Davis, JD., Spitznagel, MB. (2005). Understanding and managing caregiver burden in cerebrovascular disease. In: Paul RH, Cohen R, Ott BR, et al, eds. Vascular dementia: cerebrovascular mechanisms and clinical management. Totowa, NJ: Humana Press, 2005;305–321. Spitznagel, M., Jacobson, D., Cox, M. and Carlson, M. (2017). Caregiver burden in owners of a sick companion animal: a cross-sectional observational study. Veterinary Record, 181(12), pp.321-321.
 Spitznagel, M., Jacobson, D., Cox, M. and Carlson, M. (2017). Caregiver burden in owners of a sick companion animal: a cross-sectional observational study. Veterinary Record, 181(12), pp.321-321.
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