Dr. Bill Wagner
What Does the Work-Life Balance Revolution Mean for Veterinary Medicine?
The winds of change have hit veterinary medicine in many ways in recent years, one being a growing focus among veterinary healthcare workers on work-life balance. Their passion for their work remains an important part of the lives of the younger members of the veterinary workforce, but they are making it increasingly clear to their employers that their work is not their entire lives. This is accentuated by the fact that industry consolidation by large corporate groups and skyrocketing student loan debt means that fewer veterinarians see themselves on track for ownership at any point in their careers.
Employees have inherently different incentive structure than employers: even with production-based compensation, the benefits of putting work ahead of personal commitments are smaller and temporary compared to the long-term value that a work-first mentality can build for business owners. Veterinary practice owners are finding themselves in a difficult position where a tight job market and higher expectations (both in compensation and work environment) from prospective associates are making it hard for practice owners to fill much-needed positions at their hospitals. The push for better work-life balance is a long overdue one that is an objectively positive thing for the profession (at least in this author’s opinion), but the way the profession operates at the macro-scale will need to shift in order to accomplish this goal.
The important part: Better work-life balance in veterinary medicine is a fundamentally good thing
Veterinary medicine is facing a mental health crisis. Female veterinarians are 3.5x more likely to die by suicide and male veterinarians are 2.1x more likely to die by suicide than the general population. From 2000-2015 about 10% of all deaths among female veterinarians were by suicide. A 2015 study found that 1 in 6 veterinarians have considered suicide. It is impossible to connect this trend back to a single cause or issue because there isn’t just one issue at play: the practice of veterinary medicine is a “perfect storm” of factors coming together to put veterinary healthcare workers at risk of depression and suicide. The approach to addressing this crisis needs to be multifaceted and acknowledge the many underlying drivers. Employers ensuring positive work-life balance for their veterinary healthcare employees is one of the more impactful ways that we can start tackling this serious issue, as there is a clear link between poor work-life balance and anxiety and depression.
Change is always difficult, and it is easy to point to the past as justification for not trying to shape a better future. However, just because something was done a certain way in the past doesn’t mean it should continue to be done that way. Survivorship bias will always paint a rosier picture of the past than true reality. It is unclear how much of the veterinary mental healthcare crisis is truly new, or an unmasking via removing stigma of a longstanding poor mental health among veterinarians - this author suspects the latter. In a passion career where veterinary healthcare workers have set so much financial upside aside by turning down more lucrative career paths, the bar should be set at both “I love my job” and “I love my ability to have a life outside of my job”. Ensuring that veterinary healthcare workers have high job satisfaction, have good mental health, and view their relationship with their work in a positive light is a win for all parties involved: Workers, employers, and patients.
The industry has been caught doubly unprepared, making change more painful than it should be
Rapidly growing demand for veterinary services over the last decade has challenged the veterinary workforce in unprecedented ways. Pet ownership is growing rapidly, and a societal shift in the perception of pets as members of the immediate family means that most veterinary hospitals find themselves mobbed with more pet parents looking for great care for their pets than they’re able to handle. This workforce shortfall has been exacerbated by hesitancy within the profession to increase graduating class sizes in the wake of the 2007-08 financial crisis, even as the societal drivers of what was predictably going to be an explosive growth in the demand for veterinary healthcare services were already visible. The veterinary industry now finds itself squeezed from both directions: Growing demand that it did not plan ahead for by proactively expanding the size of the workforce, and now a work-life balance revolution that is resulting in fewer average work hours (again – a good thing!) per clinician already in the workforce. There is a concerted effort underway to increase class sizes and accredit more DVM programs, but we find ourselves with a significant lag time to navigate before that translates into sufficient workforce growth to meet the current level of need, let alone match the projected ongoing growth in demand.
Student loan debt dictates compensation and is driving a disconnect between practice owners and associates
Associate veterinarian job seekers need to ask for pay that arrives at a viable debt-to-income ratio that enables them to afford not only their base cost of living, but very expensive student loan payments on top of that. On the other hand, practice owners typically have established, narrow profit margins that don’t support hiring an associate at a level of compensation where production and pay aren’t aligned. This misalignment becomes worse when it comes to less experienced vets who also require mentorship to achieve full utilization.
The important part of this impasse is that there are no “bad guys” here. Associate job seekers aren’t being greedy by expecting that their compensation achieves a survivable debt-to-income ratio. Practice owners aren’t being cheap by being unwilling to commit to levels of compensation that their practice can’t financially support. The true enemy here is the unsustainable growth in the cost of obtaining a veterinary medical degree.
As discussed in a previous blog, one potential profession-level solution involves linking average graduate debt-to-income ratio and administrative overhead restrictions to accreditation. Veterinary medical schools seem unwilling or unable to control cost on their own, content in the knowledge that veterinary medical students have easy access to imprudent amounts of easy debt, meaning that external pressure (threat of loss of accreditation) is necessary to prevent the cost of a DVM/VMD from spiraling further out of control. Importantly, excessive debt contributes to poor mental health in ways that manageable debt does not so it is important to view the skyrocketing student loan debt crisis in veterinary medicine as a contributing factor to the mental health crisis in veterinary medicine.
At the practice level, creating paths for associates to achieve an equity stake is a win-win solution for practice owners to address this disconnect. Ownership is a great way to boost income to a level better able to service student loan debt, and well-aligns incentives between owners and associates.
A sustainable solution needs to involve rising to meet industry demand
Just as it isn’t reasonable for practice owners to expect associates to work an excessive amount, we can’t expect practice owners to continue to turn away cases or ERs to continue to pick up the overflow from general practices. Pet owners rely on us being there. We need a better solution than laying that burden at the feet of an overworked workforce, but the burden exists regardless. Modern pet parents largely want to do the right thing when it comes to the care of their pets, creating a pivotal moment for the veterinary profession to shine. Here are a few ways that we can rise to the occasion as a profession:
1) Leverage and utilize the workforce that we have better: Most veterinary hospitals, like most small businesses, are rife with operational inefficiencies that result in wasted effort and lower productivity. They also often aren’t utilizing many of the modern tools available to leverage their workers with technology. Telehealth, automation, and good tracking and interpretation of data allow for modernized practices to get more done with less effort.
2) Re-evaluate the degree of subsidy of veterinary healthcare: The cost of veterinary healthcare is fundamentally subsidized by its workforce. That isn’t meant to be a value statement, just a statement of fact. When we compare the cost of providing various medical services and the pay of comparable jobs and educational requirements between healthcare for humans and animals, it is clear that the consumer cost of veterinary healthcare is kept artificially low at least in part through subsidy from worker wages. That is an unavoidable reality of veterinary healthcare being largely paid for via the discretionary income of pet owners and a lack of governmental or other institutional subsidy for care in veterinary medicine. However, it does mean that any reassessment of work-life balance will need to be assessed within the context of how improving the manageability of workload for veterinary healthcare workers will impact financial productivity. Maintaining compensation levels while reducing working hours means that a financial lever must be pulled somewhere, whether that is improving productivity rate (adding operational efficiencies) or improving margins (increasing prices and/or reducing expenses).
3) Increase the size of the veterinary healthcare workforce: As previously discussed, this won’t happen overnight but it is an important part of the equation. Importantly, increasing the size of the workforce isn’t just a matter of increasing input, but also reducing preventable loss. Poor mental health, burnout, and lack of financial upside are all drivers for veterinary healthcare workers to leave the profession earlier than intended retirement. Creating a more positive work environment in the profession will drive better retention and make growth of the workforce more feasible.
4) Rethink the role and compensation of technicians in the delivery of vet healthcare and consider adding a paraprofessional role that can potentially fill the gap between DVM and technician skillset: We recently discussed the critical role of veterinary technicians in high-performing practices. As a bold additional step, the veterinary healthcare profession may want to consider going a step further towards adding a true paraprofessional role comparable to Physician Assistants and Nurse Practitioners in human healthcare that can supplement and augment the role of veterinarians, as well as contribute to reducing the shortage of general practitioners. This is a more controversial and drastic approach, and one that some veterinarians feel could undermine the role of veterinarians in ensuring that every patient receives gold standard assessment from a doctor with comprehensive veterinary medical training, but ultimately may become a necessary path if the provider workforce shortage continues to grow. Ultimately, a patient receiving care from a paraprofessional for routine concerns is preferable to waiting weeks for an appointment or being forced to seek care at an emergency facility for a non-emergent issue due to a shortage of general practice access. However, if the profession does elect to pivot in this direction it will be critical to make sure that the scope of practice of paraprofessionals is strictly limited and involves appropriate veterinarian supervision in order to ensure that quality of care is not compromised. The role of veterinarians in the delivery of care can be supplemented, but cannot be safely replaced.
5) Economies of scale improve margins and create space for positive change...in the right hands: Larger businesses have access to financial levers that are largely unavailable to small businesses. Lowering the base cost of operation through economies of scale frees up room in the bottom line, creating advantage in opportunity to innovate. Unfortunately, many of the larger companies in the veterinary medical space are not taking advantage of that opportunity due to pressure from private equity backers to focus on short term profitability rather than building long term value for their practices and the greater veterinary profession. At AVP we are not private equity-backed and are committed to building sustainable, long-term success for our partners and setting a higher bar that our competitors will be forced to rise to match. As a vet-founded, vet-operated company we know exactly where that bar belongs: “I love my job” and “I love my ability to have a life outside of my job”.