The Hardest Decisions We Make as Veterinarians Aren’t Medical
A few months ago we made a post about this idea and it seemed to resonate. We’ve seen too many doctors step away from practice recently. We became curious why friends and colleagues reached burn out around 5-7 years post-graduation—and either left the field or suffered every shift.
Our observations led us to this conclusion: the hardest part of our job is not making medical decisions. It’s making financial and ethical decisions.
The Spectrum of Care
We often work in inner-city veterinary ERs where we get a mixed bag of customers. One end of the spectrum is customers who elect to hospitalize their dog with pancreatitis for 4 days, saying yes to NG tubes, ultrasounds, and daily bloodwork checks. The other end of the spectrum is customers who have a puppy with progressing parvo, but no funds for even the emergency exam fee. We see cases all over the map between these two examples. They’re often all entangled with complex ethical and financial decisions that need to be made.
Finances are Intertwined with Every Treatment Plan
For those in vet med, we know that our ability to diagnose and treat pets depends on what the customer can afford. For those not in vet med, we provide an estimate to every pet parent after we get a clinical history from you and perform our initial exam to determine what we need to do next.
In a daytime vet practice, the average bill is probably $200-400. At the ER, the average bill is $1000. This is the cost of care and we can assure you that vets are not hiking prices simply because they can. The increased cost of veterinary care over the last 10 years is primarily due to the elevated standard of care expected for pets now that they're often treated as family members. The prices are also what they are to be able to sustain fair wages for vets and vet nurses/vet techs. This point alone can be an entire post. Of course things like rent, cost of goods, equipment, etc. have inflated too, consistent with other industries.
All of this to say, veterinary care is a service that costs money. Sure, it’s similar to human medicine in ways, but insurance isn’t widespread, there’s no medicare or medicaid, and there’s no vet clinics required to treat pets with no money (like a hospital would for a person who can’t afford care). This little “finance” difference profoundly changes the way we practice vet med.
Tough Decisions We’ve Had to Make
We want to highlight the complexity of decisions we make as veterinarians. Clearly these decisions haunt us because of the emotional toll they took to make in the moment and process later.
3yo MI overweight bulldog with acute respiratory distress due in large part to brachycephalic obstructive airway syndrome (BOAS), exacerbated by heat. About to arrest. Wet sounds in lungs. Ideal estimate was $2,000+ with surgical correction of BOAS needed after emergency stabilization for a few days. Surprise, the customer had $100. Gave options for an abbreviated estimate + helped them apply for 3 different credit lines (declined on each). Middle of the night with no transfer options. Pet is suffering. What do we do? It’s agonizing to euthanize young pets that have a shot at being cured. But that’s what we did.
4yo FS DSH cat hit by the neighbor’s car on accident. The owner was willing to do everything to save his cat. His cat looked stable, but $2000 later after pain meds and diagnostics, we realized his cat had a ruptured bladder, broken pelvis, and an open fracture near one of her joints. The customer kept asking me if his cat would make a full recovery, if she’d 100% survive if he transferred to specialty, and what the approximate price would be. Sure, each injury on its own can technically be treated. But we can’t guarantee that if he spends $20,000 his cat will be ok. This was a hard call given the factors at play: the man wanted to do the right thing, he’d already spent a good amount of money, it was sad that the accident occurred, the man travels for work and was flying out that afternoon for a 2 week trip, the cat was young, and each injury alone could technically be fixed. But that’s a long road to recovery for a cat and a big commitment for him to make. What do we do? We ended up euthanizing. I cried in this one.
6 month old mixed breed puppy presented for ingesting part of his e-collar after having an emergency foreign body surgery with us 4 days ago. The owners blamed us for the e-collar being a “high risk” for ingestion (...yes, true story). We tried inducing vomiting but it didn’t work because the owners gave the dog cerenia earlier. We discussed the risks that this could cause another foreign body. The owners were upset (obviously, this situation sucks) but they took it out on us, blaming us for being careless. What do I do? I have empathy for what they’re going through and I’m also firm and clear that we provided excellent care, there’s still a risk present, they may be back, and it will be an additional cost.
8yo MN DSH cat that presented for his eye twitching a few times that day, but otherwise healthy. Bloodwork was normal. Came back the next day and the eye twitching progressed to be more frequent and was affecting a wider area. Offered hospitalization, full diagnostic workup, and anti-seizure meds. 6 hours later at 2am, twitching progressed to full body seizures breaking through all medications. What do I do? The owners were SO kind. I called them to come up to the hospital, explaining we either need to transfer to an ER with neuro or humanely euthanize. These owners would do anything and they did all the right things, but the latter was elected. This was a sad one for myself and the whole team.
Here’s Why These Cases Are Tough
The wild part is that of the 10-20 cases we often see in a shift, at least a quarter of them are complex like these listed above. They’re complex because
It requires making a hard call (hello, decision fatigue, regret, and second-guessing)
It’s sad (euthanasia is ALWAYS sad)
It’s hurtful when people blame us (fortunately these are more rare because I’ve worked on my comms skills, but when it happens, I feel a sense of anger, defeat, and unfairness that I’m being blamed when I care about what’s best for the pet).
We don’t have time to process our emotions in the moment (they stay mitigated throughout the shift so we can move from case to case)
THIS IS WHY VETS BURN OUT. This is why vets leave the profession. This is why vets have pre-shift anxiety. This is why vets have trauma. This is why vets search for ways to numb out. Arguably, this is why some vets seek out leadership roles off the floor (yes I know, bad reason to get into leadership, but we’ve seen it many times). It’s not the medicine. It’s the other stuff.
Vet Med is Challenging, So Let’s Rise to the Challenge
If being a veterinarian were only about the medicine, maybe we wouldn’t have as much burnout. But that’s not reality. We must work within the constraints we have. Vet med isn’t the only industry that has hard parts.
There’s real skills that can be developed to deal with these situations in healthier ways. The problem is that most vets NEVER learn them. Here’s what helped us the most:
Reading - This helps normalize what we’re going through and provide solutions. A few noteworthy books: The Body Keeps the Score, How to Win Friends and Influence People, and The Power of a Positive No
Therapy - Therapy helps us process the hard moments and let go of what isn’t serving us. Why did I get personally offended by a customer or by a boss? Why was that one shift so draining for me? How am I making it harder than it needs to be?
A Coach - We almost always have a coach. Coaches are action-oriented. They hold us accountable. They help us level up. They give us practical ways to set boundaries, do things for fun, make decisions that better align with our values, and make changes when we’re out of alignment.
Happy Vet Med Colleagues - It’s important to have a healthy group of friends who can relate to what we’re going through and offer positive reframes. Find the people who are ENJOYING vet med AND enjoying their whole lives. Hint: we have so many of these people in The Evolved Vets Membership!
It’s Time to Take Action
If you’re reading this and shaking your head yes to everything, what are you doing about it?
If you’re happy and fulfilled, amazing. We want to hear what works for you. If you’re stuck and ready to let go of your old life to show up thriving in and out of vet med, reach out. If you want a 1:1 coach, book an Alignment Call with us. And if you’re not ready to commit to coaching, check out our FREE meditation: Shift Shedding to help you process and let go of your shift at the end of the day.
