Coping with On-Call Responsibilities in Veterinary Practice | Episode 54 | Reviving Vet Med

Being on-call is a reality that many veterinary professionals face, often bringing long hours, interrupted sleep, and the pressure of urgent decision-making. The unpredictability of being on-call can disrupt personal lives, creating tension between professional responsibilities and the need for rest and recovery. This constant state of readiness can also lead to burnout and impact mental health, making it challenging to maintain work-life balance and focus on self-care.

In this episode, we explore the impact of on-call shifts on wellbeing and share strategies for managing the unique stressors of this demanding role. We'll discuss actionable ways to set boundaries, prioritize rest, and protect mental health, offering tools to help veterinary professionals not just cope, but thrive. Whether you're navigating on-call shifts yourself or supporting a team that does, this episode provides valuable insights for cultivating resilience and sustainability in your career.

Resources

On-Call Duties: The Perceived Impact on Veterinarians' Job Satisfaction, Well-Being and Personal Relationships (article): https://pubmed.ncbi.nlm.nih.gov/34778429/

Retaining vets in farm animal practice: a cross-sectional study (article): https://pubmed.ncbi.nlm.nih.gov/26002092/

Risk factors associated with veterinary attrition from clinical practice: a descriptive study (article): https://pubmed.ncbi.nlm.nih.gov/34389973/

Support needs of veterinary surgeons during the first few years of practice: perceptions of recent graduates and senior partners (article): https://pubmed.ncbi.nlm.nih.gov/11888109/

Factors associated with the career path choices of veterinarians in western Canada (article): https://pubmed.ncbi.nlm.nih.gov/19721783/

'No-one knows where you are': veterinary perceptions regarding safety and risk when alone and on-call (article): https://pubmed.ncbi.nlm.nih.gov/31611295/

Sleep patterns, fatigue, and working hours among veterinary house officers: a cross-sectional survey study (article): https://pubmed.ncbi.nlm.nih.gov/35429371/

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Transcript

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Hey everyone, welcome to another episode of Reviving Vet Med. Today we're tackling a topic that affects almost every veterinarian at some point in their career on-call responsibilities. In fact, for many of us, the burden of on-call is one of the most challenging aspects of the job. I spent a lot of time in clinical practice, both as a vet and a faculty member, and I know how much on-call shifts can weigh on you physically, mentally and emotionally. In today's episode, we're going to dive deep into what it means to be on-call as a veterinary professional, how it impacts your well-being, and what we can do about it. If you've ever spent a night on-call or found yourself on the brink of burnout from after-hours responsibilities, I think you'll find this episode valuable.

So, with that said, let's go ahead and get into the content. This is the Reviving Vet Med podcast and I'm your host, Dr. Marie Holowaychuk. My mission is to improve the mental health and well-being of veterinary professionals around the world. So, it's not uncommon for members of the veterinary team to be required to be on-call, whether that's veterinary technicians or nurses, veterinarians themselves, or even practice managers and owners. This means that they can be outside of the hospital, but they have to remain available and close enough to be contacted for advice over the phone or to come into the hospital if they're needed. So, while scheduling people on-call can help to save money that would otherwise require them to be on the premises, it's not without cost to those team members.

When on-call, people have to plan their lives around their schedule, including limiting behaviors or activities that would otherwise interfere with their ability to work right. They have to be ready to put on that professional work mode at any time. And this can be challenging. And this can take away from engaging in other activities. The unpredictable nature of being on-call can also generate a great sense of stress when home life is interrupted, and people are asked to shift into their professional role. And this presents a lot of unique challenges not encountered by those working set schedules or even those working rotated shifts who don't spend time on-call. So, it's probably not surprising that research has shown that on-call work can have a major influence on health, lifestyle and interactions with family and friends.

Many people who work on-call regularly experience variations in their work patterns because they can be expected to work at night or for longer than normal hours in total. And it's interesting if you look at the research around human physicians, those who work on-call often cite it as the first or second leading stressor in their work. Interruption of sleep is another major component of on-call work, especially for those who are on-call nights or weekends and can be called in to tend to emergencies at all hours. And the research shows amongst many different professions that people have a greater difficulty falling asleep and staying asleep and that less sleep occurs if at home while on-call versus in a practice or away for work.

And this is probably because when we're spending time at home while we're on-call, we still have our family and other obligations to tend to that might take away from our sleep as well. Interestingly, studies also demonstrate that regardless of being called while on-call, all workers share that they feel more tired, tense or unwell. And they even have higher salivary cortisol levels in the morning after an on-call shift compared to when they don't have an on-call shift. There's also research in the UK to suggest that physicians performing on-call shifts have a higher incidence of decreased mental health and anxiety as well as depression. And there's also reports of medical professionals citing concerns for personal safety when they're leaving home alone at night to go to work if they're called in, although this has been less well studied.

So, let's start back at the beginning. I want to share my on-call journey. And of course, it began when I was in vet school. You know, back then I had no idea how deeply on-call responsibilities would affect me in vet school. My first experience with on-call came during my clinical rotations. We didn't have cell phones back then, just pagers, and those pagers would beep at the most inconvenient times. I was on-call during my anesthesia Rotation during small animal surgery, internal medicine, and also during a bovine rotation for cabbing emergencies. And some nights I would stay at the school dorm and sleep there. And then, you know, they would page us, and we would just come down to the hospital. And other nights I would go home, and I would wait for the call to come back in.

And looking back, those early experiences were really just the beginning of what would become a pervasive yearlong part of my professional life when it comes to on-call. During my internship, I was often the only vet on-call in the hospital, handling all the emergencies on my own. And that was really challenging. I remember the pager going off and it was a pager where it wouldn't just beep, it would, somebody would say something. And we had the most hilarious calls. You know, it would be like Dr. Holowaychuk calling about a lost chicken, or Dr. Holowaychuk calling about salamanders with a laceration. You know, like we would see the weirdest cases. I was at Washington State University and was one of the only emergency hospitals in the area for quite some time.

And so, we would get everything from exotics to wildlife, you know, to regular dogs and cats. Thankfully, I didn't have to do large animal on-call during my small animal internship, but nevertheless, it was quite interesting. Obviously, I was on-call during my residency. Back then we still use pagers as well. I'm dating how old I am. And again, those were now texting pagers. So, we would get messages that would say, you know, call the ICU or you need to come in or whatever it might be. And you know, as I advanced in my career, my on-call responsibilities grew to be even more demanding. When I was on faculty at the Ontario Vet College as an emergency and critical care medicine specialist, I was sharing on-call duties with just one other faculty member. And we both became exhausted by the responsibility.

It was tiring to spend half of our time on-call. And so, it wasn't long before we decided that we would incorporate residents into the rotation to just help alleviate that pressure. So, once our residents moved into third year, we shared some of the workload with them so that we could get, you know, the occasional weekend off. And that was really helpful. But of course, being on-call still took a toll. So, what are the physiological and physical impacts of on-call duties? I've already mentioned some of them. You know, just briefly, the research we have in general about individuals from all industries who spend time on-call, as well as some stuff from the human medical literature. All of which really consistently points towards the fact that on-call shifts have significant impacts on job satisfaction. Well, personal lives.

If we look specifically at veterinary medicine, you know, it's an interesting experience when you're on-call. It's not just about being ready to treat animals. It's about being mentally prepared for the unknown. You never know when the phone will ring or what kind of a case will come through the door or what you might be asked to do. There was a 2017 survey that found that nearly one third of US vets report spending five to eight nights on-call per month, with 2 and 5 saying that they were on-call during weekends and holidays. So, you can imagine that this constant state of readiness can lead to physical and psychological exhaustion. Another study I found that was published in Frontiers of Veterinary Science, looked at the experiences of almost 2000 veterinarians in the US and the results are really startling.

on-call duties were linked to negative health effects, including sleep disturbances, anxiety, and even gastrointestinal issues. Many veterinarians felt they couldn't truly relax when they were on-call, which of course led to burnout. And one of the things that really has struck me in my own career is how the anxiety associated with being on-call can build up over time. I don't think I realized how stressed it made me until after I stopped being on-call. Of course, I'm still on-call from time to time when I pick up locum critical care shifts. But for months after I left my role at the Ontario Veterinary College, just hearing a phone ring would just make me tense up. And it took a lot of time to shake that anxiety.

And I remember speaking to a friend of mine who is a dairy veterinarian and has spent, you know, decades on-call at this point. And, you know, early on, when it was really taking its toll on him, before he had more, you know, colleagues to share the call with, you know, the microwave would beep and he would think, oh, you know, that's my pager going off. And of course, now times have changed, and we have texting and phone calls and other ways to get in touch. But for those of us who lived through the beeper eras, you know, it was just hearing that sound that would really elucidate those negative reactions. And, you know, this isn't just a personal experience for a few of us. The research shows that many vets face similar struggles.

In fact, a 2015 study found that sleep deprivation caused by on-call duties leads to cognitive impairments such as slower reaction time, poorer memory and decreased focus. It also increases stress levels and decreases job satisfaction. And one study even linked call responsibilities to a higher risk of medical errors in both human and veterinary medicine due to that impact on cognitive performance. So, we know that there are big ramifications that can be seen here. So, one of the more unique situations in veterinary medicine is in rural practice. And I have to say that those working in rural practice have incredibly challenging conditions. I've spoken with a lot of rural vets who handle everything from large animal emergencies to wildlife rescues all on their own. And the burden of being on-call in these settings is more than just physically exhausting.

It's mentally and emotionally taxing, because rural vets, especially those working in mixed or food animal practices, can find themselves on-call for a majority of their career. They may be the only vet available for miles with no backup. And this isolation, combined with the pressure of on-call, can create an environment that is really ripe for burnout. So, in rural areas, veterinarians are often expected to handle emergencies without the same level of support that urban practitioners have. And this stress from this kind of responsibility can be overwhelming. And it's a major factor contributing to the shortage of veterinarians in rural regions. In fact, a 2006 survey in Western Canada found that on-call duties were a key reason why many vets left mixed and food animal practices. And one of the primary reasons vets leave rural practices is this burden of being on-call.

When I spoke with a few of my classmates who had made the switch to companion animal practice, not having on-call duties was one of the main reasons they chose to leave their rural mixed animal roles. You know, when you think about it, logistically, small animals, even if the, you know, nearest ER is a couple of hours away, they can still put their pet in the car and drive. For large animals, that's not possible in a lot of emergency situations. So, it really is inevitable that if you work with larger species, you will have some sort of on-call duty to which you may have to go to the client's farm to tend to their animals. So, the reality is that rural practices often do face higher rates of burnout secondary to being on-call.

Now, a lot of the research has shown that food animal vets do have the highest levels of job satisfaction and wellbeing compared to other veterinarians. But we know, according to research in a 2014 study published in BMC Veterinary Research, that rural vets do experience burnout and job dissatisfaction that is primarily related to on-call pressures, a lack of support, and the feeling of isolation.

And this can be an intense experience, especially when you're constantly balancing the needs of the animals with your own well-being, which is something I hear a lot from vets that tell me, you know, they reach out and they say, you know, I know that I feel better and I can function better when I'm not on-call, but I feel so badly taking myself off the roster because I know that some animals might not get the care that they need or that my other team members are going to need to step up, and that's a really challenging position to be in. One of the other big factors when we think about on-call is the lack of mentorship for new grads that find themselves on-call.

I have a few classmates who, 20 years ago, when they first entered practice, were just thrown into high pressure on-call situations. Their practice owners were so happy to have somebody to relieve them that they just said, you know, I'm out, You're on your own. You can figure it out, just like I did. I have to say that I was really lucky to have supportive mentors early on in my internship, but not everybody has that luxury. You know, I remember my first emergency shifts having these just cases that were just so challenging and way out of my comfort zone, and I was managing them by myself. And I always knew that I had someone to call.

And in fact, I remember reaching out to one of my mentors, who is still a mentor to me this day, who was the emergency and critical care specialist at Washington State when I was doing my internship, and, you know, waking her up and feeling so bad to call and having her talk me through, you know, cases on occasion, and just feeling so grateful that I had someone to call in those situations. Otherwise, I would have felt completely alone. And many new graduates do feel overwhelmed because they don't have guidance that they need to feel confident in making decisions under pressure when they're first on-call. So, this can be especially hard. And, you know, the pressure to handle these cases alone, especially when you're just starting out, can lead to a lot of distress.

There was actually a survey that was conducted in the UK that found that three of five vets were on-call within their first week of their first job. And in those early years, the lack of support can make the on-call experience even more stressful, exacerbating these feelings of inadequacy and isolation. And I think one of the most important things to help new grads cope with on-call duties is having proper mentorship. You know, a study in the vet record found that new vets who had mentorship during their first few years were more likely to stay in their jobs and to feel confident handling on-call situations. So, we need to definitely make that a priority and not just leave new grads hanging when they are starting out in these new jobs and having on-call duties.

So, what can we do to alleviate the burden of on-call duties? It's clear that these responsibilities can have a huge effect on our mental and physical health. But there are strategies that can make a difference, and one of those strategies is sharing coverage. This is a practical solution, right? Having multiple vets shared on-call can reduce the number of nights that a person is expected to be available and allow for more recovery time. This is something that we implemented, as I mentioned, while I was at the Ontario Vet College. And while it can be challenging, it certainly can make the workload more manageable. I speak to a lot of sole practitioners or independent practice owners that work alone that, you know, do all of the on-call all the time.

And I have encouraged them to reach out to neighboring practices to share the burden, you know, and I think oftentimes the fear is that a person might lose clients, or they feel badly, you know, sending their clients to another vet. But this has become the reality in veterinary practice today. You know, gone are the days when you see your vet and it's the same vet and, you know, they've been working in your town for 40 years. We do have access to more veterinarians, and we need to lean on each other more for support so that it is not sole practitioners bearing the burden here. Another solution that individuals can consider is teletriage, which involves using technology to assess and manage cases remotely.

So I, in full disclosure, have a friend of mine who is a registered veterinary technologist who started up a teletriage company here in Alberta, where I live. And I know from experience, from those who use her services and hearing from her and what she hears from her clients, that this can massively transform the wellbeing of veterinarians who spend time on-call. You know, I think that all of the veterinarians listening who spend time on-call can attest to getting these calls that are completely unnecessary to get in the middle of the night. My dog is itching, or they're shaking their ears or they're dragging their bum. I think they have anal gland issue, or they vomited once, but they ate their dinner really fast, and they seem totally fine otherwise.

You know, there's all of these situations that can be triaged and resolved over the phone. And, you know, either have an appointment scheduled the next day to see the vet or be referred to a nearby emergency hospital if needed, or in some circumstances to call the veterinarian on-call and say, hey, this case really does need to be seen. They're going to meet you at the hospital. So, you know, the key here is making sure that there's a system in place to properly triage these cases so that the veterinarian who's on-call is not expected to handle cases, you know, and talk to owners every single time so that they can get some rest. And this has been huge. I know. For those who have been engaging in these services, another way that we can support each other is of course, through mentorship.

As we discussed earlier, having structured, mentored, you know, situations where new graduates can feel like they are supported during their first, certainly few weeks to months, if not a year on the job, especially when on-call. You know, there should always be a backup system. There should always be someone that they can reach out to if they find themselves struggling to know how to handle a case. It maybe doesn't need to be that they need to have another vet accompany them on every call, but just so they have someone to call. Just that sense of knowing you've got someone to call can be a huge alleviation to anxiety. Finally, we also need to advocate for better work life balance in the profession as a whole. On-call duties shouldn't take over a person's entire life.

I think there needs to be a cultural shift in how we view these responsibilities. And we really do need to prioritize, well, being over, constantly being available, because at the end of the day, we've lost people from our industry or veterinary medicine practice because they have burnt out because of being on-call. And so it would be wonderful if we could do something earlier on to intervene so that we are not losing an individual completely from the profession, but rather we might just be losing them to having them on-call consistently. And, you know, I think there needs to be a little bit of a shift in mindset around this. Again, in not being fearful about losing clients because we send them to another vet or because we send them to an ER.

I think sharing responsibilities with each other, you know, this goes for practice owners and managers. I don't think any practice owner or manager should be on-call 100% of the time sharing those duties. Is there someone else on your team that you can lean into to be on-call, you know, some part of the time and even have you as a backup? But just so that you are not the go to person every single time that someone in the practice has a problem. So again, just really finding new and creative ways to ensure that we have that work life balance, which really just means a sense of work life separation where we have some time in our day and week to fully disconnect from the job. And we can't do that when we're on-call.

Something else to think about as well is to also make sure that we are treating on-call duties as a part of the job. This means, you know, making sure that people are being compensated when they are on-call. So, I know that most people when they're on-call, they only get compensated when they come in. They don't get compensated just for carrying a pager or a cell phone. In today's world, we want to make sure that this is considered another shift, that this is time that people are spending in work mode. So, whether that's compensation in terms of time off in lieu, compensation in terms of an hourly rate for carrying a pager or cell phone, or you know, some other creative way to compensate.

I know that there have been practices who compensate on-call with grocery cards or gas cards or other point systems in terms of being on-call. So, there's lots of different things that we can do to help with this and remember that, you know, this is just a really important part of making sure that people can continue to have job satisfaction and hopefully also preserve their mental health and stay in this career long term. I think it's also important to be very open with your clinic when you are on-call and set boundaries as you need to. If you feel that you're burning out and that this is becoming not sustainable for you, I know that it's hard, but you do have to be honest about where you're at and what your needs are.

It doesn't mean that you're saying no to on-call forever or that you're saying no to all on-call, but maybe making it so that it's more manageable and finding ways to make that work for everyone. I think another thing to think about is how you want to be contacted when you're on-call. I know when I spend time on-call, I definitely set the boundary that I want people to call me, not text me. I don't like having notifications on my phones and that includes audit, you know, audible notifications, like having text beeps. So, I don't want to feel like I constantly have to check my phone. However, I know if my phone is ringing, it's important and I'm going to pick it up. So, making sure that if you are on-call, when is it okay to text?

Maybe it's, you know, until 9:00 and then after that you want your team to call you. Make sure that you have those boundaries set including how to reach you and when you should be reached. And then of course, very importantly, if you are somebody who spends time on-call, you want to preserve the time when you are not on-call. This means that you are not contacted, you're not checking your phone, you're not doing work related stuff, you're not checking work emails. You are using that time to really separate from work so that you do have an opportunity to turn off that work brain and really look after your health and wellbeing. So, as we wrap up this conversation, I want to leave you with this, and it is that self-care is essential to not just surviving but thriving in vet medicine.

If you're constantly on-call, it can feel like you're never off the clock. And I've learned the hard way that we have to prioritize our health first. We have a responsibility to take care of ourselves so we can give the best care for our patients. If you're spending an inordinate amount of time on-call and there aren't good boundaries in terms of how and when you're contacted, that's going to start to build up and that's going to start to impact you during your regular work shifts. So, be open to having tough conversations with your boss, with your colleagues, so that we can all try to create a more sustainable and fulfilling career. Because if there's one thing I've learned over the years, it's that we can't keep giving to others when our own cups are empty.

So yes, on-call duties are a reality for many of us in veterinary practice, but they don't have to define our careers or our well-being. By acknowledging the impact that these shifts can have, and exploring solutions like shared coverage, teletriage, and a cultural shift towards better work life balance as well as work life separation, we can make on-call responsibilities much more manageable. So, that's it for this episode of Reviving Vet Med. I hope today's episode has provided some insight into the challenges and solutions surrounding on-call duties in vet medicine. Please take a moment to forward this episode to a colleague or co-worker who you think would benefit from it. Specifically, someone you know who spends time on-call.

We would also appreciate it if you would subscribe to the podcast so that you are sure to get the new episodes as soon as they're released. If you're interested in any of the resources mentioned in today's episode, please check out the show Notes. You can also follow us on social media @RevivingVetMed for more tips and strategies for well-being in vet medicine. And if you have questions about today's episode, suggestions for future topics, or inquiries about sponsorship, please email podcast@revivingvetmed.com. I'd like to thank Asia and her team at Bear Beat Productions for producing this episode, and I'd also like to thank you for listening. I hope you'll tune in next time. In the meantime, take care of yourself. Bye for now.