Mar 23 2014

Suicide

By Dr. Karen Karsten, B.Comm, BSc, DVM.

Now there’s a word that tends to grab everyone’s attention and absolutely should. I imagine you are wondering why I have put such a loaded word as the title of this blog-style article. Well there is a very good reason for it and it was prompted by some negative comments veterinarians have been receiving in both mass and social media lately. Consequently, I decided to write this article about my views of the veterinary profession. Hopefully after getting a glimpse into the lives of veterinarians, some understanding may arise. On that note, this is my opinion only. While I know many of my colleagues have shared similar sentiments with me, it certainly is not intended to reflect the views all veterinarians.

So back to the opening word…suicide. Did you know that a study coming out of the United Kingdom found veterinarians four times more likely to commit suicide than the general public and twice that of any other profession including the much touted dentists? Most other countries, including Canada and the US, are presumed to have similar statistics. Many contributing factors were considered and while I recognize that we have a more in-depth knowledge of initiating a humane death process I don’t believe that is the most important factor, not by a long shot.

It all starts out with the type of person we are. We are virtually all type “A” personalities who are over-achieving perfectionists. We have to be to have gotten where we are. It starts with the competition to be admitted to veterinary school. I am originally from Alberta and we had a quota of only 20 students per year (BC had a slightly lower quota). That’s it, that’s how many people were permitted to go to vet school from each province with hundreds of qualified applicants fiercely competing for those much desired spots. If you didn’t have an “A” average in your undergraduate degree, then you basically need not apply. You will not make it to the interview stage, period. End of story. Bye, bye dreams. That brutal level of competition remains today. Experience in the field is also absolutely required, undoubtedly to enlighten the prospective students as to what lies ahead and trust me, they need to know. Anyone who has worked in veterinary medicine is well aware of the fact that is by no means all “cute puppies and fluffy kittens”. It is unbelievably hard work and very emotionally exhausting.

Compassion fatigue is a huge problem for veterinarians. Of course, as perfectionist/type A people, we rarely if ever let anyone know what we are feeling for fear of appearing less than perfect. We carry on and internally chant “I’m fine, I’m fine!” even when we most certainly are not. I have had days in emergency medicine where I have euthanized 5 or 6 animals in a matter of a few hours. All of them had wonderful owners who loved them dearly. Each person’s pain and sense of loss comes off in palpable waves of anguish. From children with broken hearts who only know life with the pet beside them to a senior who feels they have little left in this world to live for…plus everyone in between who is equally devastated. I listen compassionately to all their stories and try to help them with the grieving process while also showing their pet the honour and respect it deserves. Many a time I have left a room after a euthanasia and gone to a quiet place in the hospital to cry. Sometimes I can’t hold my emotions back and cry along with the owners…and then felt that I was failing them because I believed I needed to be stronger for them. If that isn’t bad enough, I typically get a couple minutes (at most) before I have to pull myself together and face the next case which might be even more heart-rending. This happens more often that you can begin to imagine. We also have pets that we love as family members…so yes, we do understand the depth of your bond with your pet. We are truly compassionate people with huge hearts who chose this profession because we care, but it comes with a huge cost to us emotionally. Make no mistakes, despite the brave front we show you (or at least try!), we are affected deeply by both you and your pet’s situation.

The volume of information we are expected to have at our fingertips is unbelievable and expectations are growing along with the rapid increase in overall knowledge. I am your surgeon, your dentist, your internist, your dermatologist, your allergist, your pharmacist, your radiologist, your pathologist, your…well you get the picture. I have to be all that and do it well enough to not only to meet your expectations, but to meet my own which I assure you exceeds anything you are expecting of me (I’m a

type A/perfectionist …remember?). I also have to compete with “Dr. Google” and other sources that are all too often providing incomplete and/or inaccurate knowledge based on testimonials or anecdotal stories and rarely on sound scientific knowledge. I have to sift through all this to find the correct information to diagnose your pet and create the best treatment plan. I also have to help you understand and work through the challenges of treating your pet in a manner that you can absorb in your (understandably) emotionally charged state. So guess what, I’m also your psychologist, especially when the big decision of life and death arises.

We work long hours, often eating lunch on the fly and rarely taking breaks as emergencies and illnesses can’t be scheduled or predicted. Those vets working “on-call” after hours have even more drain on their time as they struggle with sleep-disrupted lives. It is not uncommon for them to respond to multiple calls through the night and have a full day of work scheduled that very morning. The work doesn’t stop after the appointments are done for the day either. We are constantly writing up medical files, calling clients back, researching cases that we are struggling to diagnose and treat, reviewing articles or attending required continuing education seminars to keep our knowledge current. And it goes even further…I can’t begin to count the number of nights I have laid awake wondering what more (if anything) could have been done for a pet or trying to figure out a diagnosis that was eluding me. We obsess, perfectionists do that, we can’t help ourselves and do it endlessly to the detriment of our sleep and our families, often consuming all of our “free” time. We are entrusted with lives and as I’m hoping you are beginning to understand, we do not take that lightly.

There is a huge misconception that we make lots of money. Well, one could argue with typically 8 years of university training and the associated costs, we deserve fair compensation similar to other education-riddled professions. Putting that aside, one asks, does the average vet make enough to own a villa in the south of France? The answer is a resounding “No”. Of all the professional designations, we often make the least. I have heard that the average wage in BC is about $70,000. But regardless where in BC or Canada that we practice, our wage compared to many other professional designations is at or near the bottom of the barrel. Another interesting component is the fact that most vets now are graduating with an average student debt load of almost $100,000. Paid off over 10 years on a monthly basis, that’s $1000-1250 a month (depending on interest rates) adding up to nearly $15,000 a year…in after tax dollars no less. So if you factor back in the taxes, suddenly veterinarians are making much closer to an average Canadian income for at least our first 10 years of practice. To add insult to injury, most vets will not earn the “average wage” for the first few years as they struggle to increase their skills and knowledge base. So with the grades required to get into vet school paired with our drive to succeed (exceed?), one begs to ask why we didn’t become phamacists, engineers, dentists, doctors or lawyers (or whatever) and potentially earn higher incomes, often with less stress? Well, here’s why…it’s who we are, this profession is a calling to so many of us.

Back to the issue of suicide. So now we have a profession that is geared towards type A personalities who are self-critical to an often frightening level, we are under heavy debt loads at graduation after dedicating a huge chunk of our lives to our education, we earn a comparably low wage for the level of training we have endured, we battle long hours, we suffer from compassion fatigue on a daily basis and we have to fight to stay ahead of the rapidly increasing knowledge base. But is that enough to induce thoughts of suicide? Maybe, but it is even more challenging of a career choice…read on.

In comes a client who has a very sick pet. They want to pursue treatment but their financial resources are limited and they have not invested in pet insurance (I beg of you to do this if you can’t afford care!!!). Despite accusations to the contrary, we do understand your situation. But unfortunately, much as we wish a veterinary practice was not a business and we could treat every pet for free, this is not realistic. Revenue must exceed expenses or the business fails, it is simple math…same as every other business around you. Keep in mind, unlike our human counterparts, we do not receive a single penny of government funding. With our very high equipment and staffing costs, a veterinary practice is exceedingly expensive to run especially with the increasing standard of care demanded of us. Thus, our margins for financial survival are much tighter than you think. While some practices are owned by huge

corporations (which is another discussion entirely), the vast majority of clinics are still owned by individuals, like me, who are sometimes operating at or near the break-even point. The struggle to keep the practice running in the black, that my staff and family depend on for income, adds yet another enormous layer of stress and responsibility to my life.

When faced with a client who wants services for free or a reduced cost, I am often drawn to the following analogy. Consider the vast numbers of people in Canada who are hungry at this very moment. Yet, does anyone go to the local grocery store and makes them feel guilty for not providing food at or below cost to a starving adult or child. Alternately, what about a hotel? Do we tirade against them when they leave heated hotel rooms vacant on a cold, rainy (or snowy) night with homeless people and runaway children freezing on the street. You have the choice to obtain a pet (it is luxury, not a right) but you require food and safe, warm shelter as a basic need. So why is a veterinary practice expected to give services away and risk bankruptcy to avoid accusations of being insensitive, self-serving and cruel? It hardly seems fair.

Strange as it sounds, accusations of being money-grubbing, unethical and insensitive tends to wear on us. Think how it would impact you if you were accused of this on an all too regular basis when you are in reality a very compassionate person. We desire above all else to serve as the animal’s advocate, sometimes when no one else will. We see cruelty and neglect much too often and it tears us apart. Picture a sweet dog, a claw hammer and an abusive owner…I can’t begin to describe what I have seen in my career! Our devotion to your pet is demonstrated even in the face of adversity and conflict. Think about this…we often know the people who have slandered us behind our backs (or publically on FaceBook, etc), yet when they call us at 3am in a panic to save their pet we are still there to help. I bet you would be hard pressed to find a friend who would support you after such a vicious and disrespectful attack. Yet there we are, even in the middle of the night.

So here you have a bit of an outline of our profession. Underpaid, debt ridden, trying to assist clients with financial restrictions (and accusing us of being only about money), high expectations that are often impossible to meet (clients and our own), a huge growing knowledge base to stay ahead of, long hours, stress from watching animals and owners suffering, daily exposure to death and grief, dealing with animals that have been abused or neglected horribly, all while juggling our personal lives often to the detriment of our children and marriages. If you can begin to grasp this, you will realize how the pressure can become unbearable and suddenly suicide becomes a viable option for some.

Am I considering suicide, no. Do I understand why a few of my colleagues do, yes. With all these negative stressors in mind, I also believe the statistics that indicate nearly 60% of veterinarians, given a choice, would not repeat their careers in the profession that they fought so hard to be a part of. As an emergency veterinarian and practice owner, the 60-80 hour weeks I typically work for that comparably poor wage is nothing I regret. I have so many clients who are grateful for the basic care I give their pets. When I am fortunate enough to save an animal against the odds, every moment I spent struggling to help is paid back a thousand times over. Alternately, if an animal’s time has come, I am grateful that I can release it from its suffering and support the owner through the grieving process. I also give back to my community through charity work and professional support on a regular basis. Ultimately, I know that no matter what anyone else’s perception of me or my profession is, I can look in the mirror at the end of each day and say that I worked hard to make a positive difference…and know deep inside that I did.

While I am so grateful that I have found a balance that ensures my career will not push me towards suicide, my heart goes out to my colleagues that have taken their lives and the families they left behind. I wish we could have done more to support them before they made that choice. Hopefully talking openly about the pressures of our profession will be a first step towards providing the necessary level of understanding and compassion to help those who of us who feel they are at their limits. I also hope that our clients will be more enlightened about how much of ourselves we truly dedicate to our profession and provide us with additional support and understanding.

Dr. Karen Karsten operates the Central Island Veterinary Emergency Hospital in Nanaimo, BC on beautiful Vancouver Island.

 

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