Is Work Killing You? 
A Doctor’s Prescription for Treating Workplace Stress

David Posen, MD

I saw this book on the book shelf, and almost yelled in the middle of the library “YES!!!! Veterinarians ARE dying!!!!” The topic of workplace stress is not unique to us. It has generated a lot of attention across all professions, which I think we should be investigating. This book doesn’t address issues specific to veterinary medicine (euthanasia, loan-income ratio, managing the emotional strain of financial aspects), but it does address many aspects that do affect us, which we can learn from. 

Dr. Posen makes a strong case for the harmfulness of chronic stress. Did you know that dendrites (especially those involved in short-term memory) bathed in cortisol over the long-term become pruned? That means they no workey the way we want. (It’s not your fault, or necessarily normal that you are becoming so forgetful!) If you are an employer, you should care if your employees are stressed, because it impacts work output. In fact, those with the least control over their workload have the highest levels of stress. If you haven’t felt the strain of finding and keeping qualified technicians, I’m sure you will within the near future! Furthermore, Dr. Posen points out that stress is contagious. If you have employees that are chronically stressed, the whole hospital can feel it, and you will not be immune! 

He summarizes that the major factors of work stress fall under volume, velocity or abuse. 

Volume 

Generally, volume would be understood as workload. This is comprised by both internal demands and external demands. It is the responsibility of both the worker and the employer to manage volume appropriately- both parties share contribution to burnout. 

The worker manages the internal demands (beliefs, personality traits and internal demands). The employer manages the expectations for external demands (deadlines, peer pressure, e-mail, case-load, paperwork). It behooves the employer to pay attention to how the expectations the work culture generates contribute to the shaping of the internal demands of an employee. The work-life balance of any worker is most directly influenced by the example the boss sets. If you are struggling, your employees are likely also struggling. It is not selfish to find solutions to managing the volume of e-mails, or maximizing the efficiency of doing medical records. It has a direct impact on everyone in the clinic! Remember- “Being busy is not the same as being productive.”  This is also a good warning for job-seekers to be wary of clinics that have high production expectations, or very short appointment times. The stress will be high for most people in these environments. 

Multi-tasking is the flavor of a veterinarian’s day. But did you know that it can reduce efficiency by as much as 50%? Now, we all know it’s not realistic to eliminate multitasking completely.  But, we can help manage it. Is there time factored into your doctor’s day that is strictly dedicated to completing medical records? No phone calls, no pestering for signatures, no e-mail? Maybe there should be. Placed in an environment conducive to doing this- not dead central in the middle of the chaos. Are your doctors expected to answer phone calls ASAP? No matter the urgency? Or do they have time to focus only on communication as they deem necessary? Do your staff establish realistic expectations with owners regarding the expected timeline for communication? Finally, how much do their responsibilities impose on their private life? Are they expected to communicate results on their days off? Are they on call frequently? If they are on call, does their workload the next day have flexibility to adjust accordingly if they have not had appropriate rest? Productivity does not equal more hours- rest has a huge impact on productivity. Protecting your staff’s time off translates into better performance. 

Velocity

Velocity would be the pace and pressure generated for each work day (or work tasks). There is no denying that in today’s work environment, we are asked to do more in a shorter amount of time. See more patients. Write ALL the communication in the record. Have a flawless and perfectly complete medical record for each encounter of the day. Answer all the calls. Communicate all the results. Look up all the things you don’t know. Answer the same question four times, in as many different ways. And don’t forget to have a life and be fresh for work the next day too. While technology has made many of those things far more efficient, our capacity to multi-task and process all that information remains the same. So the pressure has increased. And technology has also added some burdens. The expectation of immediate answers for all questions. The expectation of more complete and thorough records. Many medical record systems have distinct hang-ups and snags in efficiency, often expanding the time it takes to complete them, rather than improving efficiency. 

Management carries the responsibility of being aware of whether expectations of their employees are achievable and sustainable, and at what cost they are coming. They also bear the burden of managing client expectations. Again, be aware. What precedents are you setting that are going to burn you in the future? Communicate and negotiate turn-around times and appointment times realistically. Avoid over-servicing and spoiling people! Define what is “good enough” for your practice. Being 5% better than your competition still makes you better. Striving for 50% better without appropriate resources burns through your employees when they can’t sustain the expectations long-term. 

One of the biggest things I think we need to work on: Set boundaries. Boundaries around family and personal time!!! Do not expect or encourage your staff to be doing work when they are NOT at work! Timeouts during work can make a huge impact on productivity and work morale. About 20 minutes of down time every 90 minutes of hard work can reduce stress, restore energy, improve reflection/perspective, and maximize problem solving. Obviously, a walk around the block or some other sort of disengagement isn’t always possible (although ideal!), however, even 20 minutes every 90 minutes of appointments allows a doctor to reset, catch up on records, review the complexities of each case, and communicate the tasks necessary in a non-rushed manner. This allows your doctors to be firing on all cylinders and give each patient the consideration and rumination it deserves! It will show through in your staff stress, your owner perception of the care they are receiving, and the retention of your staff! 

Abuse

Abuse is the mistreatment of employees. This can happen from management, co-workers, or from clients. Destructive. Period. Dr. Posen focused on the employees and bosses. This sadly still happens in vet med, and should not be tolerated in any capacity. If you are an employee being verbally, emotionally, or mentally abused by your employer, you are far too valuable and precious to tolerate it. Get it fixed, or get out. DO. NOT. TOLERATE. Your staying in the situation only enables them to continue this behavior. If they don’t have or retain employees, they can’t abuse them. 

If you have an employee that is constantly abusing other employees or even clients, NOT doing anything about it is a drain on EVERY resource in your possession. The pain and aversion to letting them go is short-lived, compared to seeing a string of stellar employees fleeing. Rip the band-aid off. Be a defender of your employees. You will have remarkable loyalty and retention if you are proactively seeking their well-being. 

My experience has been that the abuse is far more likely to come from the clients. I consider this equally intolerable. We are not obligated to see every client. And the types of clients you tolerate sets the tone of your staff’s days. If you allow these clients to continue to abuse your staff, you are an enabler to this behavior. If you are in a position of management, I consider it part of your job responsibility to protect your staff from abusive clients. It is incredibly demoralizing and disempowering to all staff, to be hopelessly powerless in the face of unrealistic and caustic demands and communication. You want to see burn-out? Choose not be selective in your clientele. Now, this is not an invitation to fire everyone who doesn’t love you, or those that are respectfully informing you of weaknesses and mistakes within your business. But if you are faced with having to choose between your client or your employee because of bad client behavior, choosing the client is a lose-lose situation in every way. 

Conclusion

Dr. Posen makes some excellent points, but largely focuses on the problems that management contribute or control. There is less focus on the personal responsibility. Given the work schema of veterinary medicine, and the potential directions it is going, I have a few personal thoughts. Corporations are growing and expanding left and right. They will likely become the major source of jobs. Corporations in and of themselves are not entirely bad. However, they are income and output focused, and largely owned and steered by non-veterinarians. That can be a blessing for those of us that have no interest in ownership and management.  However, it generates a lot of blind spots and avenues for unrealistic pressures. My warning isn’t meant to bash corporations. My warning is to be very alert and intentional to what we are tolerating in this profession. Corporate veterinary entities cannot exist without veterinarians and veterinary technicians. If we are tolerating unrealistic expectations, and not helping to define realistic work load with these employers, we will continue to lose more people from this field at an even higher rate. While they are still in the early stages of entry into this field, we need to be vocal and assertive in what we want our work-life to be. To quote one of Dr. Posen’s wise, outspoken nurse staff, “Start as you mean to continue.” It is infinitely more difficult to address work stress when you are already buckling under the pressure, than it is to identify and establish clear needs and boundaries around what your work will consist of from the beginning. Not impossible, but much, much harder. 

Advocating for yourself is also advocating for everyone around and after you. Choose a good work environment to do good work.  

Further Reading/Resources:
Should I Stay, Or Should I Go?
Book Rounds: Well Being.