The term burnout has been getting thrown around a lot lately and is certainly rampant among my colleagues working in emergency and critical care. Burnout is characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. Veterinarians who become burnt out feel overwhelmed and unable to face the demands of their job or engage with co-workers and clients. They often develop a cynical detachment from work and can view patients as objects rather than animals. The sense of ineffectiveness at work occurs because they no longer feel able to contribute to their work in a meaningful way.  Burnout is very common among human healthcare workers due to time pressures, lack of control over work, potential for work-related conflict, and the emotional intensity of clinical work. Estimates of burnout among nurses range from 10-70% and among physicians 30-50%. And a study conducted by the Mayo Clinic and American Medical Association in 2015 found that more than half of American physicians had at least one sign of burnout. However, diagnosing a person with burnout is not that easy, which likely accounts for the wide range of incidences and low number of studies in veterinary medicine. Burnout is most frequently assessed using the Maslach Burnout Inventory (MBI), a 22-question survey that asks questions related to three symptoms: emotional exhaustion, depersonalization, and sense of personal accomplishment. The questions for each of these areas are in the form of a frequency rating scale with responses that include: never, a few times per year or less, once per month or less, a few times per month, once per week, a few times per week, or every day. The responses that occur the most frequently imply that respondents are at higher risk of experiencing that symptom of burnout. Because there is no accepted standard definition of burnout, dichotomizing the survey results into burnout versus no burnout is difficult. As such, it is more common to assess individuals as having at least one symptom of burnout if they have high scores in either of the emotional exhaustion or depersonalization categories or a low score in the sense of personal accomplishment category. There is a large body of research demonstrating associations between burnout as measured by the MBI and human healthcare related outcomes such as medical errors, malpractice claims, suboptimal patient care, physician turnover, early retirement, loss of productivity, alcohol abuse, motor vehicle accidents, and thoughts of suicide. The above-mentioned factors that contribute to burnout in human medicine likely also contribute to burnout among veterinarians and one could argue that veterinarians also experience similar consequences. However, the incidence of burnout among veterinary team members is not well-studied.   Findings from a veterinary study published in 2014 included results from a survey created to assess team effectiveness. The survey was disseminated to 48 companion animal veterinary teams, along with the MBI survey. Measures of team effectiveness included factors related to having a coordinated team environment, toxic team environment, team engagement, and individual engagement. Almost 300 team members completed the survey and the MBI results revealed that 22% were in the high-risk category for exhaustion, 23% were in the high-risk category for cynicism, and 9% were in the high-risk category for personal efficacy. Not surprisingly, a toxic team environment was associated with lower job satisfaction and higher levels of emotional exhaustion and cynicism. The study confirms what many of us have experienced: a toxic work environment can significantly influence our job satisfaction and risk of burnout.      Studies suggest that physicians working on the front lines of human healthcare (e.g., emergency medicine, family medicine, general internal medicine) have the highest risk of burnout. I would argue the same for my veterinary colleagues who work in emergency, general practice, and internal medicine. But they aren’t the only veterinarians affected by burnout…so what other factors can contribute?  Studies demonstrate that burnout in human medicine is highly associated with: work hours (3% increased risk for each additional hour per week), night or weekend call (3-9% percent increased risk for each additional night or weekend on call), time spent at home on work-related tasks (2% increased risk for each additional hour per week), and work-home conflict (200-250% increased risk).     Human nurses also cite high patient per nurse staff ratio as a risk factor for burnout and I am certain that veterinary technicians / nurses would agree with this statement: there’s nothing worse than being a vet tech and walking into an ICU full of patients, all of whom need treatments and assessments done at the same time!  I am pleased to say that we recently completed a study investigating the incidence of burnout and the contributing practice-related factors among veterinary emergency and critical care veterinary team members. It was completed earlier this year by way of an anonymous survey that was disseminated to emergency and critical care specialists, emergency veterinarians, technicians, and team members working at least part time (20 hours per week) in an emergency and/or critical care practice setting. The survey included the MBI, in addition to the Areas of Worklife Survey, created to assess employee’s perceptions of work setting qualities that play a role in whether they experience engagement or burnout at work. The results of the survey will be compiled and assessed statistically for associations between practice setting (e.g., private versus academic), practice role (e.g., vet versus tech), duration of time in practice, number of hours worked per week, on-call responsibilities, and work-related factors to determine whether work setting qualities or other variables are associated with a higher risk of burnout. These results will be shared in the Spring of 2019 and will be submitted for publication thereafter. Hopefully as more research is gained by studies such as this, the veterinary industry will be able to adjust and reduce factors known to contribute to veterinary team burnout. Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals. In 2019, Marie will be offering personalized wellness sessions to those who work in the veterinary profession. To sign up for newsletters containing information regarding these sessions, please click here. More information about Marie and her other offerings can be found at www.criticalcarevet.ca.        

During a recent trip to New York City, my phone was damaged to the point where the touch screen stopped working (oh, how I miss my sturdy keyboard-containing Blackberry). It happened as I was passing my phone to the gate agent upon boarding my flight from Calgary to Toronto – the phone fell on the floor and despite my protective case, the screen cracked and I was thereafter unable to unlock my phone. And that’s when the panic began: I was traveling in another country, speaking at a conference, and attending meetings with no use of my cell phone. How the heck was I going to survive?! In this era of technology, it’s incredible how much we rely on our smart phones every moment of our day. From the time I wake up in the morning and listen to my app-based meditation recording, check my digital schedule, and respond to pertinent emails and text messages, to the end of the day when I check my social media sites and set my alarm to wake up the next day – there are few moments during the day when I do not need my phone for one task or another. This is especially true when traveling, given how directionally-challenged I am and therefore how heavily I rely on Google Maps and Uber or Lyft. Thankfully, this was a work trip, so I was traveling with my laptop and able to “research” places to eat, things to do, and most importantly, how to get there. And once my work-related duties were over, my mom joined me on the trip and we could rely on her phone for maps, ride-sharing, and other necessities. There were many times during my trip when I asked myself “how did we survive before smart phones”?! As a Xennial (person born between the Millennial and Gen-X generations), I remember a time before cell phones and high-speed internet (I had dial-up internet during veterinary school) and have fond memories of paper maps (which guided me across the USA from my internship in WA to my residency in NC) and pay phones (funny how often I noticed these in public spaces while traveling without my phone). There were also several times during my trip when I recognized that I use my phone more often than I need to. While waiting in line at a store, sitting at a coffee shop, or puttering at the airport gate, I kept reaching for my phone and realizing that it was not there. This awareness reminded of a statistic I heard recently that North Americans check their cell phone an average of 80 times per day (some check as many as 300 times per day)! A few months ago, I installed an app on my phone to assess my usage patterns. The app is called “Quality Time” and it tracks the number of screen unlocks per day, as well as the apps used most frequently and how long they are used for. This was very enlightening, and I feel embarrassed to say that I check my phone an average of 40-50 times per day (thankfully still less than the average)! And what’s interesting is that the days when I feel most stressed or anxious are the days that I check my phone most often. This makes sense given that the simple act of looking at your cell phone (not even unlocking / checking it) results in a dopamine release in the body, which equates to the high an addict experiences with a hit. Scary, right? Then is it any surprise that people in Denmark who took a week-long break from Facebook had improved life satisfaction and positive emotions, in comparison to those who continued using Facebook? These effects were greater for heavy Facebook users and those who used Facebook passively (i.e., scrolling and liking posts, rather than commenting or connecting with others). Perhaps a phone hiatus was just what the doctor ordered for someone like me who struggles with anxiety? There were some definite benefits during my week-long vacation from my phone including the plethora of “free time” I had while not scrolling social media or checking my phone unnecessarily, the absent worry about my phone battery and when / where I would charge it next, and the general “freeing” feeling of not being tied to my phone or having to respond in a certain time to messages from others. But there were plenty of cons such as not having immediate access to my calendar (aka lifeline), not having an alarm clock (thank heavens for old-school wake-up calls), not having a camera (I asked others to take pics and send them to me), and not being able to text, call, or connect with my friends and family. Unfortunately, as long as I have a digital calendar, no land line, and a rigorous travel schedule, I will continue to be dependent on my phone. But my week-long digital detox gave me a renewed awareness that I can survive without it.   Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals. Starting in 2019, Marie will be offering personalized wellness sessions to those who work in the veterinary profession.  To sign up for newsletters containing information regarding these sessions, please click here. More information about Marie and her other offerings can be found at www.criticalcarevet.ca.

For years, experts have questioned whether spending time on social media is helpful or hurtful to mental health. I use social media (i.e., Linkedin, Facebook, and Twitter) for my business, to stay engaged with followers, share pertinent information, and form new connections. I also use a personal Facebook account to stay connected with friends and family from across the world. After 15 years of living in 6 different cities in Canada and the USA, it is easiest to post pertinent updates on social media rather than connect with individuals on a regular basis. However, the downsides of social media are becoming more apparent and many of us can relate. Scrolling through social media mindlessly can be a major time suck. I recently installed the app Quality Time on my phone and was disgusted with how many times I checked my phone or spent time on social media during the day. Having this awareness has helped me pare down on social media usage, or at the very least, use my time more efficiently. Social media use also leads to comparison, which can cultivate feelings of envy and depression. It’s no secret that most of us save our best pictures and favorite features for our social media posts, while leaving our dull or downtrodden moments hidden away. This gives others the false sense that our lives are amazing or even glamorous! People frequently say to me “I’m so jealous of your life and all of the travel you get to do”, but that’s because they don’t see the hours spent packing/prepping, sitting in airports, or spending time alone in hotel rooms. Trust me – it’s not glamorous. There is more research coming out to explain the positives and pitfalls of social media use, which will hopefully guide our decisions when it comes to if and how we engage with others online. The Merck Animal Health Veterinary Wellbeing Survey recently shared that veterinarians using social media for > 1 hour per day have poorer mental health and wellbeing as assessed by validated scoring systems. Conversely, other studies investigating social media use among young adults and the general adult population have found conflicting results when it comes to the duration of social media use and mental health. Which is why recent studies have begun to investigate the subtler nuances of how people are engaging on social media and how that impacts wellbeing. For example, a recent study compared active social media use such as messaging a friend or commenting in a group to passive social media use including scrolling through and liking posts. Results from more than 700 adults showed that passive social media use was associated with a 33% increase in depressive symptoms, whereas active social media used was associated with a 15% decrease in depressive symptoms. So, whether you are just sitting and scrolling through posts rather than reading, commenting, and engaging with other users appears to play a big role in the mental health effects.  Rather than try to manage the way in which they use social media, some people have chosen to forego the use of social media altogether. I have several friends and family members who have deleted their Facebook accounts to break free from the time suck / comparison trap of social media, sometimes on the advice of a mental health provider. Studies seem to support this: in Denmark, people who took a week-long break from Facebook had improved life satisfaction and positive emotions in comparison to those who continued using Facebook. These effects were greater for heavy Facebook users and those who used Facebook passively. Perhaps a social media hiatus (or vacation) is something each of us could consider to improve our mental health? I am not opposed to social media and am grateful to have it for the professional and personal uses I stated above. However, I do think the way in which it is used has the biggest impact on our mental health and wellbeing. As such, I would urge anyone using Facebook, Linkedin, and other social media tools to consider the following five strategies to foster active use: Share posts that are meaningful (i.e., pertinent life updates) rather than random food pics or unnecessary rants Engage with others by commenting on their posts or sharing posts that you feel others would benefit from Send messages to friends and loved ones to maintain connections with people in distant time zones whom you cannot readily call Search for local events to attend in person and invite others to join you for face-to-face connection time   Find, create, or join closed groups where you can engage with other like-minded individuals in a meaningful way Finally, if you have not done the exercise of logging your phone or social media app time, I urge you to become aware of your usage by installing a time monitoring app such as Quality Time, Offtime, or Moment. Awareness is the first step in realizing that a change is needed to foster health and wellbeing. Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals. Starting in 2019, Marie will be offering personalized wellness sessions to those who work in the veterinary profession.  To sign up for newsletters containing information regarding these sessions, please click here. More information about Marie and her other offerings can be found at www.criticalcarevet.ca.        

As an advocate for health and wellbeing among veterinary care providers, I often lecture and blog about the importance of sleep hygiene. (Hint: this has nothing to do with the cleanliness of your bed sheets, but everything to do with the activities you do to help fall asleep each night.)  Among my top recommendations for improving sleep hygiene: turn off technology 1-2 hours before bedtime in an effort to reduce exposure to blue light (suppresses melatonin release); spend 20-30 minutes outside every day to help regulate the circadian rhythm (sleep-wake cycle); exercise for 30 minutes each day (to help the body feel ready for rest by the time bedtime rolls around); and establish a bedtime routine that you perform every night (to help the mind and body know that it is time to wind down and relax in preparation for sleep). I am constantly researching and learning new things about sleep hygiene and, as a veterinarian and pet owner, I have often wondered: do people who struggle with their sleep have pets in their bedroom that keep them up at night? I am clearly not the only person to question this, as researchers at the Center for Sleep Medicine at the Mayo Clinic in Arizona began to investigate sleep struggles among pet owners in 2015. Researchers surveyed 150 consecutive human patients with sleep disorders by questionnaire or interview and found that 49% were pet owners and 41% of pet owners had multiple pets. More than half of those pet owners (56%) allowed their pets to sleep in the bedroom. Interestingly, 20% described their pets as “disruptive”, whereas 41% perceived their pets as “unobtrusive or even beneficial to sleep”. I happen to agree with the latter of the two groups: my Standard Poodle “Faith” slept with me every night, on my bed until her arthritis got worse and she preferred to sleep on her bed on the floor of my bedroom. After she passed away, her presence in the room was missed and my sleep felt very disrupted – much more so than when she was alive and sharing the bedroom with me! So, how does the presence of pets in the bedroom affect people who don’t have sleep disorders? A recent study performed by the Mayo Clinic helped to answer this question. Between August and December 2015, researchers evaluated the sleep of people and dogs sleeping in the same bedroom to determine the impact on sleep. There were 40 healthy adults (without sleep disorders) and their dogs (no puppies < 6 months old). Adults and dogs wore accelerometers, which are devices that track movement and can gauge sleep quality. The study participants were 88% women (average 44 years old) and the dogs were an average of 15 kg and 5 years old. Human and canine participants wore the accelerometers for 7 nights during which time sleep efficiency was calculated. Sleep efficiency is essentially the amount of time spent asleep as a percentage of the amount of time spent in bed and includes the time between going to bed and falling asleep, middle-of-the-night awakenings, and waking up earlier than an alarm. A normal sleep efficiency for adults is > 85% and anything > 90% is considered very good. So, if you go to bed at 11 PM and fall asleep within 30 minutes, wake up once to pee, and then fall back asleep within 30 minutes until your alarm goes off at 7 AM, you have a normal sleep efficiency.     The human participants in the Mayo Clinic study spent an average of 7.9 hours in bed, while sleeping for 6.7 hours: the equivalent of an 81% sleep efficiency. During the human’s corresponding sleep time, dogs spent an average of 6.9 hours sleeping, 1 hour active, and 2 minutes playing (no doubt at the most inopportune time ). The dogs had an average sleep efficiency of 85%. Perhaps the most interesting finding from this study is that the sleep efficiency of the human participants was lower if their dog slept on the bed, as opposed to if the dog was simply in the room. Which makes sense, as middle-of-the-night awakenings and difficulty falling asleep are often caused by partners, pets, or children coming into or out of the bed through the night. So, while people with a single dog in their bedroom can maintain good sleep efficiency, the dog’s position on or off the bed seems to make a difference. As such, as much as it can be nice to snuggle with your dog before and after falling asleep, if sleep is a struggle for you, perhaps this sleeping arrangement might need to be modified. Finally, I have yet to find a study investigating the consequences of having a cat in the bedroom that lays on your head, purrs loudly in your ear, or makes biscuits on your back at all hours of the night…but I would venture to say that if your cat is keeping you up at night (and reducing your sleep efficiency) that it would be best to keep him or her out of the bedroom! Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals. Starting in 2019, Marie will be offering personalized wellness sessions to those who work in the veterinary profession.  To sign up for newsletters containing information regarding these sessions, please click here. More information about Marie and her other offerings can be found at www.criticalcarevet.ca.        

I was a bit taken aback a few weeks ago when I received a comment on one of my blogs accusing me of “discriminating against male veterinarians”. Having not been accused of sexism before and considering myself a “lover of all beings”, I was confused and concerned by this claim. After engaging in a “virtual” conversation with the individual, I discovered that he felt that my blogs focused more on struggles felt by women compared to men, and he wanted me to be sure to know that male veterinarians are struggling just the same. Of course, I apologized for my oversight and scanned through my last year of bi-weekly blogs to see if this was indeed the case. While I cannot say that I agree with his claim, I admit that I can only really speak to my perspective and experience, which is that of a female veterinarian. That said, it got me thinking…are men really struggling as much as women in the veterinary profession? When you consider the research investigating mental health among adults, there are some notable sex-related differences. According to the World Health Organization, overall rates of psychiatric disorder are almost identical for men and women; however, prominent gender differences are found in the patterns of mental illness. These differences occur particularly in the rates of common mental disorders such as depression and anxiety. Women are particularly susceptible to these disorders, which affect approximately 1 in 3 people. Unipolar depression, predicted to be the second leading cause of global disability burden by 2020, is twice as common in women. On the other hand, alcohol dependence, another common disorder, is more than twice as likely to affect men compared to women. In developed countries, approximately 1 in 5 men and 1 in 12 women develop alcohol dependence during their lives. But what about the stats when it comes to veterinarians in particular? While studies consistently describe moderate levels of stress reported equally by male and female veterinarians, those same studies suggest that female vets are more likely to report burnout compared to male vets. Likewise, several studies investigating the mental health of veterinarians suggest that women are more likely to report psychological distress and depression than men. But do these findings mean that women are struggling more with their mental health? Or are they simply a reflection of women’s willingness to disclose their struggles more than men? I think there are probably a lot of men out there who would rather not admit they are struggling, especially given the stigma that veterinarians have around mental health. In the UK, male veterinarians are 3 times more likely and female veterinarians 4-6 times more likely than the general population to die by suicide. But is that to say that female veterinarians are suffering more than men or rather that women in veterinary medicine are proportionately more likely than women in other professions to die by suicide? I don’t have the answers to these questions, but it is grounds for an interesting discussion. Recently, the Merck Animal Health Veterinary Wellbeing Study published findings from more than 3,500 survey responses from veterinarians working in the USA. The study measured wellbeing with an index based on three standard questions that were scored on a scale of 0 to 10. Veterinarians were then allocated to three categories: flourishing (scores of 7-10), getting by (scores of 4-6), and suffering (scores of 0-3). On average, male vets scored higher in wellbeing than female vets. Interestingly, vets who were married or in a relationship (not single) and working in food animal (not other veterinary practice) had higher wellbeing scores, and (I’m generalizing here) I know more male than female veterinarians who fall into these categories. So, is it gender or other factors that determine a veterinarian’s wellbeing? While these statistics suggest that perhaps female veterinarians really do struggle more with their mental health and wellbeing compared to male vets, I acknowledge it is not cut and dry. In other words, just because you are a woman in veterinary medicine does not mean you will have mental health problems, and just because you are a man in veterinary medicine does not mean you will have it easier when it comes to your mental health and wellbeing. There are clearly many factors at play. The Merck Animal Health study found that participating in healthy activities not related to work such as traveling, reading for pleasure, spending time with family, socializing with friends, having a hobby, exercising regularly, and being in a relationship, were strongly associated with higher levels of wellbeing. So, while the research is ongoing when it comes to veterinarian mental health, in the meantime, regardless of sex, we can all benefit from spending more time partaking in activities unrelated to veterinary medicine. Ukulele lessons, here I come! Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals. Starting in 2019, Marie will be offering personalized wellness sessions to those who work in the veterinary profession.  To sign up for newsletters containing information regarding these sessions, please click here. More information about Marie and her other offerings can be found at www.criticalcarevet.ca.