Anyone working in companion animal practice in the USA, Canada, and many other parts of the world, is well aware of the current crisis impacting emergency veterinary hospitals. Over the last few months, there have been several news stories with headlines citing emergency practices closing their doors due to insufficient staff to deal with the overwhelming caseload. Here in Calgary where I currently live, several emergency practices have discontinued seeing cases overnight, and others have closed for days at a time because they simply do not have veterinarians (or technicians) to fill the shifts. 

This has created a ripple effect of stress impacting all companion animal practices that have fewer options to send their clients who have emergencies with their pets outside of regular business hours. And more importantly, this distressing situation has also increased the burden on other emergency veterinary hospitals that have remained open during this time. 

The retention of veterinarians in emergency practice has always been relatively low, anecdotally, with many interns staying on for a few years, before eventually gravitating towards 9-5 jobs in general practice. In my conversations with those who decide to leave, they often cite wanting a slower pace, preferring a predictable schedule, and feeling exhausted by swing and overnight shifts as the most common reasons. 

Given the increase in pet ownership over the last 18 months of the pandemic, coupled with an increasing exit of veterinarians from emergency practice, a crisis situation has ensued, which has led to a task force formed by the American College of Veterinary Emergency and Critical Care, to determine how to improve recruitment and retention within emergency and critical care practice. With that, we hope to gain more information as to what can be done to reverse this concerning and worsening trend. 

A recent study in the Journal of Veterinary Emergency and Critical Care published results of an online survey conducted in the summer of 2020, which sought to determine what factors were associated with veterinarians’ desire to stay in or leave emergency practice. Almost 800 veterinarians who were currently in emergency practice and 755 veterinarians who had previously worked in emergency practice but had left the field, completed the survey. More than half of veterinarians currently working in ER practice had done so for > 5 years, compared to approximately ⅓ of veterinarians who had left. 

When the veterinarians currently in emergency practice were asked what was fuelling their inclination to stay, the most common responses were liking the style of emergency medicine, believing the pay was better, being encouraged to work in emergency practice by their colleagues or mentors, not having a long-term veterinary-client-patient relationship, and having flexible work hours or benefits. 

Alternatively, of the veterinarians currently working in emergency practice who indicated they intended to leave in the foreseeable future, all cited job stress and burnout as factors. Interestingly, only slightly more than half of those respondents said they enjoyed the style of medicine and almost all disliked the hours/schedule and work environment. 

Clearly emergency practice is a bit of a double-edged sword: the elements that draw many of us to it are those that turn other veterinarians off. People often ask me why I was attracted to small animal emergency and critical care as a specialty and my answer is always the same: I love the challenging cases, fast-paced environment, and that every shift brings something new and different. But if you asked me what it is about emergency practice that causes me stress, my answers would be: the difficult cases, the gruelling caseload, and the unpredictability of the shifts. 

So, the question remains, what can be done to attract veterinarians to emergency practice, and more importantly, keep them from leaving for jobs in general practice or non-clinical roles? 

In that same survey study, when the veterinarians who had already left emergency practice were asked what may have encouraged them to stay, 70% cited a supportive team and 60% said higher pay or greater flexibility of work hours / scheduling. 

I am encouraged by these responses because, while we cannot change the overwhelming caseload and other stressors currently plaguing emergency practice, we do have some control over scheduling and salary. 

The authors of that study go on to suggest that emergency practices should adopt a scheduling structure that rewards loyalty by offering more flexible options and desirable shifts to those who remain in the practice longer. Likewise, they advise scheduling new emergency veterinarians alongside more experienced colleagues, so that they have the opportunity to ask questions or seek support as needed. Finally, the authors recommend employing emergency veterinarians as part-time with pro-rated benefits to allow them to pick up shifts where they can but gain benefits along the way. 

Now, don’t get me wrong, I am not suggesting that all of our staffing problems in emergency practice will go away if we simply make these changes. The sad (and scary) reality is that many emergency hospitals are already offering lucrative stipends and flexible scheduling, yet they still do not have enough experienced doctors to fill their shifts, never mind mentor their new graduates. 

The good news is that, in the meantime, there are teleconsulting companies offering specialist support (by phone) for veterinarians in emergency and general practice. I happen to work for one of these companies (full disclosure: as a part-time contract specialist) and can say that this is a game-changer for our industry until we can fix our staffing shortage. Most desirable for inexperienced veterinarians or new graduates entering emergency practice, they can share their case information and questions with a consulting emergency and critical care specialist and receive the advice and support they need by phone to diagnose and manage the patient. 

We don’t have easy answers for this distressing situation and it is not something that will be fixed overnight. But I do hope that these survey results, task force initiatives, and teleconsulting support will help to shed light and alleviate some of the stress in the interim.

Dr. Marie Holowaychuk is a small animal emergency and critical care specialist and certified yoga and meditation teacher who passionately advocates for the mental health and wellbeing of veterinary teams. Marie facilitates online CE-approved wellbeing programs for those who work in the veterinary profession. To sign up for Marie’s biweekly e-newsletter, please click here.