Dr. Matt Salois

AVMA photo by Scott Nolan

Matt Salois, chief economist of the American Veterinary Medical Association, offered his take on the profession's economic health to the House of Delegates, which met Jan. 7-8 in Chicago. More than half of all delegates attended the meeting virtually due to the ongoing pandemic.

A rash of pet spending during the pandemic has helped to strengthen the U.S. veterinary economy, driving revenue up by more than 11% in some recent months, compared with the previous year, according to figures from the American Veterinary Medical Association. Many practices, it seems, have never been busier.

That snapshot, however, belies major issues facing veterinary medicine: high turnover, practice inefficiencies, an epidemic of burnout and a rollercoaster economy that's showing signs of slowing to pre-pandemic levels in terms of patients and visits. What's more, inflation is rising: Year-over-year veterinary prices paid by consumers climbed an average of 7% in December 2021, up from 4% in March 2020.

"Just to put this into context, at a 7% price increase growth rate, the average cost of veterinary care to a pet owner will double in about 10 years. Clearly, we have an affordability challenge that needs to be on our minds," warned Matthew Salois, director of the AVMA Veterinary Economics Division.

Citing data from Veterinary Industry Tracker, an economic tool developed jointly by the AVMA and the data analysis company VetSuccess, Salois forecasts an end to a patient backlog that's burned out much of the profession since the March 2020 rise of COVID-19. During a presentation to the AVMA House of Delegates, which met this month in Chicago, he relayed that "part of what is driving our burnout and our workforce challenges in veterinary medicine is a rising demand for veterinary care that we all observed and experienced during the pandemic.

"We have had a two-year roller-coaster experience," he said, "and we are starting to see signs that both spending and visits are decelerating and returning to previous trends that we experienced before COVID."

Still, job satisfaction is suffering, he warned: "A growing number of veterinarians are thinking of leaving the profession."

Analyzing attrition

That finding reflects attitudes gleaned from the annual AVMA Census of Veterinarians, which polls members about employment, compensation, work conditions and well-being. The census, last distributed to AVMA members in spring 2021, gleaned 4,700 responses to questions such as:

• Have you ever considered leaving the veterinary profession other than for retirement?
• How serious are you about leaving the veterinary profession?
• What is your primary reason in considering leaving the veterinary profession?

The result: 44% expressed a desire to exit veterinary medicine, up from 38% in 2020. "The primary issues are not difficult clients, or wanting higher compensation or lower student debt, or even the feeling that there is too much work," Salois said. "Rather, the leading reasons come down to issues of mental health and a work-life balance, a desire to better manage stress, anxiety and depression."

Feeding such struggles are some universal stressors, Salois said. Veterinarians and their staff are burned out from playing catch-up from shutdowns during the onset of the pandemic, incorporating COVID-19 protocols, squeezing patients into overbooked schedules, managing with staff shortages and dealing with angry clients.

Barriers to practice efficiency, such as high turnover and the inefficient use of support staff, weigh on veterinary care teams as they struggle to keep pace with demand, Salois said. "This does not mean that our practices and our people are doing less work," he said. "What it means is they've been asked to move from running a mile on a treadmill to running a mile on a beach, exerting more effort just to achieve the same amount of work."

Taken together, lack of efficiency, attrition and satisfaction challenges pose a threat to the profession's future well-being and workforce, Salois said. Focus on these systemic issues, he said, is needed to arrive "at true solutions rather than applying Band-Aid-style actions."

Imagining a midlevel professional

Some in the profession propose that a midlevel professional, envisioned as a new job category between a credentialed veterinary technician and veterinarian, could help alleviate staffing and productivity struggles. 

High turnover, Salois has pointed out, magnifies practice busyness, and a midlevel professional category could offer career advancement for technicians, a group with the highest turnover of any health profession.

But the idea is premature, he said, and could have mixed results. A thorough examination of the veterinary profession is warranted to ensure the market can support a midlevel professional, Salois said. The framework for the new layer and where it might fit in the profession "isn't entirely clear and has admittedly taken several different shapes," he said.

"There is no programmatic accreditation pathway, statutory or regulatory framework that exists at the state or national level" to allow for a new category of licensure, Salois explained.

Even so, the AVMA is reviewing several ideas on the topic:

• a veterinary extender for licensed technicians that includes on-the-job training for clinical care coordination;
• a veterinary registered nurse title that would allow licensees to diagnose, prognose, prescribe and perform surgery under the direct supervision of a veterinarian; and
• a master's degree for credentialed veterinary technicians designed to provide an educational track for a newly created position.

Transforming the profession to incorporate a midlevel professional would not be quick or easy. It would require defining the category's scope, developing education programs, and getting regulators, accreditors and other experts on board to consider the impact that it would have on workforce caliber and quality, Salois said.

"Diagnosis, prognosis, prescribing, surgery — these are the practice of veterinary medicine," he said, "and we are opening ourselves potentially to legal risks to graduates from these programs, legal risk to veterinarians supervising them, and legal risks to practices employing them.

"We need to be careful about making long-term business decisions, especially those involving people, particularly even more so when the future is so uncertain," Salois continued. "Is this the right course of action? And what sort of impact will a new layer have on the economics of the profession? We don't have clear answers yet."

Stress hits staff harder

Meanwhile, Salois offered suggestions for reducing the pressure of work overload: Use technology to make inventory control, purchasing and accounting easier, and empower staff by better tapping their skills. 

"Credentialed veterinary technicians should be spending less time answering phones and cleaning exam rooms and more times administering vaccines and assisting with pre-operative preparation for surgery," he said.

But John Volk, a senior consultant with Brakke Consulting, suggests that burnout is less of a problem for veterinarians than for their staff. In a presentation to delegates, he shared findings from the third and latest Merck Animal Health Veterinary Wellbeing Study. A collaborative effort of the AVMA with Brakke, the research is "the most comprehensive and poignant study that we've ever done on the mental health of veterinarians," Volk said, adding that for the first time, the research also addresses the mental health and well-being of support staff.

The study is based on an online poll, conducted in September and October 2021, of a nationally representative sample of 2,495 veterinarians who were asked to complete the questionnaire and then pass it to their veterinary technicians, assistants, managers and other staff. A total of 448 completed questionnaires were returned.

The results, Volk said, show that the percentage of veterinarians with serious psychological distress increased to 9.7% in 2021, as measured by the Kessler Psychological Distress Scale, compared with 6.4% in 2019, largely due to the ongoing pandemic. But on the whole, well-being among veterinarians mirrors that of the general population, with some variation among subgroups. "Older veterinarians tend to have higher well-being, younger veterinarians lower," he said.

Volk offered assurance that stressed veterinarians aren't planning to leave the profession in droves: "I can say, thankfully, that we see no likely evidence of an exodus of veterinarians in the near future."

That's not necessarily true of support staff, who've borne the brunt of the pandemic's impact, he said. The study found that the prevalence of serious psychological distress was nearly twice as high among staff, at 18.1%. In addition, nearly half of staff respondents reported high levels of burnout, compared with 30% of veterinarians. 

Those effects are compounded by the fact that staff often lack the tools to deal with stress, Volk said. "They haven't learned many of the techniques that veterinarians learned in vet school and subsequently," he said. "And they are less confident of having support from the leadership in the practices that they work in."

The report is slated for full release in February during the Western Veterinary Conference in Las Vegas.