From Burden Transfer to Resilience: A Study of Veterinary Teams

Feeling burnt out? You're not alone. Mary Beth Spitznagel and Jason Coe illuminate the often overlooked issue of burden transfer and its consequent burnout within veterinary teams. Their JAVMA article details the widespread nature of this concern, emphasizing the need to support each other's well-being in a profession where everyone, regardless of their role, is susceptible to the significant stress and burnout.

Hear Mary Beth's personal narrative on how her experiences as a pet owner motivated her to investigate this pressing issue further. We challenge you to comprehend and tackle the five domains of burden transfer - daily hassles, affect, nonadherent/inconsiderate behaviors, confrontations, and excess communications. These domains are more than just theoretical constructs; they have profound impacts that can disrupt the harmony within veterinary teams.

From burden transfer, we pivot towards resilience and determination, two must-have traits to thrive not just in veterinary practice but any professional field. Mary Beth and Jason recount their personal experiences with failure and disconnection, and how they've turned their adversities into vehicles for resilience and determination. Tune in to Veterinary Vertex to understand, manage, and overcome the challenges of burden transfer and burnout. This episode promises a meaningful conversation that's essential for anyone in the veterinary profession or anyone grappling with burnout in their careers. Don't miss it!

Full article: https://doi.org/10.2460/javma.23.06.0354

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Transcript

Sarah Wright: 0:00

You're listening to Veterinary Vertex, a podcast of the AVMA Journals. In this episode we chat about burden transfer and burnout amongst veterinary team members with our guests Mary Beth Spitznagel and Jason Coe.

Lisa Fortier: 0:19

Welcome to Veterinary Vertex. I'm Editor-in-Chief, Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today, we have some really great experts with us Mary Beth and Jason. Thank you so much for being here with us today.

Sarah Wright: 0:36

All right, let's dive right in. Jason, can you share with our listeners what they can expect from your JAVMA article?

Jason Coe: 0:45

Yeah. So this really is work that's building on the great work that Beth has done previously, looking at first, caregiver burden within clients and the distress that they experience around having an ill-peptical even more chronic ill-pet and how that distress can be transferred onto the veterinary health care team in terms of burden transfer. And so with this work, we really wanted to build off of the great work that Beth has done. I'd encourage anyone to go and read that work because it is foundational and so the work that we wanted to do here was again look broadly within the veterinary team, yet starting to explore. Was there even more information we could start to discern to identify individuals that might be at higher risk for experiencing burden transfer? And so this project really was about taking a fairly large sample and understanding burden transfer within that sample and starting to use that information to identify other certain things that we can pick out that might help us detect and therefore support those individuals that are a little more vulnerable.

Sarah Wright: 1:51

This is such important research, especially in today's day and age, so thank you very much for sharing it with JAVMA.

Jason Coe: 1:59

Thank you for having us and publishing it.

Sarah Wright: 2:01

Of course. So, Jason, what were some of the important insights from this article?

Jason Coe: 2:07

So I think one of the things that really hit me in relation to this article is that when we looked across all the different roles that exist within a veterinary practice, we identified individuals within each of those roles that fell into what we call the high level of experiencing burden transfer, and I think that's really important as we look at the well-being of the veterinary profession.

Jason Coe: 2:31

I think for a long time, I've had concerns that we've been very veterinary- centric in our approach to well-being, and I would say even our own research team has been very veterinary- centric in the work that we do, and so it really was important, I think, in terms of the work and the findings of this work, to identify that, regardless of role, there were people that were in that high level burden transfer, and so again, it speaks to that anything we do to try and support people in veterinary practice really needs to be holistic, where we're giving the opportunity to all of the different members within a veterinary practice team.

Jason Coe: 3:04

The other thing that I'd really want to highlight in relation to this work is that Beth had done some previous work with a US sample of veterinary professionals across different roles, and so one of the things we did because we were working with a Canadian sample was look and see other differences in their frequency of having difficult interactions with clients that lead to burden transfer, as well as the reaction to those interactions, and what we found was no significant difference between our Canadian sample and best US sample, which really speaks to. This isn't something that is just unique to US population. I think it really is something that the veterinary profession globally needs to be aware of and we need to think about how can we support veterinary profession, how can we support the veterinary profession as it relates to burden transfer, and I think there's real opportunity with the work that Beth has done today.

Lisa Fortier: 4:01

Yeah, Jason, we just didn't talk about it right. You saw it on the face of your whole team. You saw the sadness when you lost an animal, or when somebody couldn't afford to fix it, or an ungrateful client beating up your front office. We all saw it on the whole team, but, as you said, bringing awareness to it and starting this conversation. So thank you to you and Beth for doing that. It's really critical for our whole profession.

Jason Coe: 4:30

Yeah, and I think one of the things we found in this study was there was an association between a person's perception of the emotional demands of their workplace and being in that high level of burden transfer. And so, even to what you're saying, Lisa, being able to detect those people that really are struggling with the emotional aspects of practice could be a signal that hey, maybe this is someone we can support in tools, resources to help manage some of that burden transfer. And so I think being able to identify individuals that maybe need a little bit more support is gonna be critical. Yet I'd also say that having the tools is relevant to everybody in a veterinary practice, from being prepared for those experiences that they can encounter.

Lisa Fortier: 5:16

Yeah, a great analogy might be. We all have. Well, most of us have employee assistance programs. Right, you don't have to be a leader or a staff or whoever it is. If you see somebody struggling, you can always, just, without getting personal, you can just say do you know about these wonderful resources? So thank you again for bringing this awareness to everybody so they can start to develop these tools. But you talked a little bit about Beth's earlier work and your work as well. Specifically, what inspired you to write this manuscript?

Jason Coe: 5:50

Yeah, I appreciate you asking that question. I think I have to start off with a thank you to Dr. Andy Hillier. A few years ago, Beth and I were both invited to do a presentation where we shared a lecture slot and as a result we were brought together to kind of better understand what each of us was going to bring to that lecture slot, and so I got to hear about the work that Beth was doing, particularly at that time, around caregiver burden. Yet burden transfer was also on the radar as it related to that, and caregiver burden really related to the work we've been doing within our lab, looking at communication, particularly between veterinarians and clients, and understanding that client's experience and using that understanding of their experience to really work with a client on a tailored plan to help them in managing the care of their animal. And so Beth and I did this lecture and at the end of it I remember and I don't really remember who it was us talking, because it was virtual at the time was in the middle of the pandemic, saying you know, we should collaborate. And so we then were brought back together to do another conference a little bit a couple months later, and at the end of it, you know, we said again we should collaborate, and so that led to Beth inviting me to be involved in one of Beth's studies.

Jason Coe: 7:02

And then a few I wouldn't say a few a year later probably, I received a VCA Canada Chair in Relationship Centered Veterinary Medicine at the Ontario Veterinary College, where we really wanted to move beyond the individual veterinary client aspects of the research we were doing to really start and look this whole team aspect, and so we had an opportunity to work with corporate practice in Canada. And then we wanted to do a large survey that was gonna actually end up being several different studies, and one of them that I was really interested in looking at was burden transfer, and so I asked Beth if she would be interested in collaborating on this. Beth was interested in. It really led to this piece of work that we're here to chat about today.

Lisa Fortier: 7:44

Yeah, thank you, beth, we'll turn to you now. I just heard that you got asked. That's different than being like really inspired and like what sparked your personal research interest in veterinary team member burden transfer.

Mary Beth Spitznagel: 7:57

Yeah, I mean, it's actually kind of a it's a little bit of a story, I guess. So I, several years ago I had a dog that was, you know, aging. She had a lot of problems, so she had a combination of transitional cell carcinoma. She was diagnosed with some canine cognitive dysfunction and it was just real struggle providing care for this dog for many, many months. And I am actually a neuropsychologist by training, and up until that time when I had that dog, most of my work was in dementia and, you know, working with the caregivers, people of people who have dementia, working with those family members and the loved ones who experienced those day to day challenges of, you know, having a loved one that has this illness and you're trying to provide care, and sometimes it's a struggle.

Mary Beth Spitznagel: 8:49

And I, just as a researcher who did work in human caregiving, I recognized that, having this dog, I was a burden caregiver and so I just kind of looked, you know, in the literature a little bit. I was just curious to see what's been done in veterinary medicine with caregiver burden, and I found that pretty much almost nothing really had been, and so I just undertook an initial study looking at caregiver burden and pet owners with our own veterinarian, and so that really was kind of where it got started, thinking about what the what the pet owner is experiencing. But, very, very quickly, I recognize that, even you know, as somebody who is, you know, knowledgeable about caregiving, knowledgeable about burden, I'm still behaving in these ways. You know, with this sick dog, I'm calling my veterinarian all the time and I feel like I'm kind of a little bit anxious and stressed out and I'm probably being kind of demanding. You know, I'm trying to be nice but I'm probably being kind of irritating and that just kind of got me thinking, you know what, what behaviors might be different in those clients who have a sick pet, and how is that distress in the client actually adding on to stress in the day of people working in veterinary medicine? So that's kind of where all of that started and the original research that we conducted, which was actually published in JAVMA back in 2018, looking at this, this question of burden transfer is this something that's going on really identified. There are five different domains of what we call we've come to call burden transfer at this point, so, and we call it the burden transfer dance, and dance is the acronym for those five domains and the D is for the daily hassles, kind of the everyday things.

Mary Beth Spitznagel: 10:30

Clients maybe say or do that that you know it happens a lot. They're asking you know, why does it cost more to do this procedure here, you know, compared to down the road? Or you know the folks who maybe, you know, need a lot of repetition of you know the. You know what you're trying to describe is going on with the pattern they need. You know you need to describe it to somebody else because they're not understanding. So those things that happen and it's not a huge, huge problem but but on a day to day basis it kind of adds up.

Mary Beth Spitznagel: 11:01

So that's the D, the A stands for affect. Those are those high kind of emotions. You know the, the, the guilt, the grief, the anxiety. You know that can be associated with illness and the animal and is for non adherence and inconsiderate behaviors. You know when people don't want to follow treatment recommendation see those confrontations. You know when there's maybe a conflict with a client and then he is access communications, and so what we found is that is all of these, all of these behaviors that clients do on a pretty regular basis. You look at them all together. They're actually very strongly related to stress and burnout in our veterinary health care teams and I think that you know that to me has been then, kind of the driving inspiration and kind of the you know what. What keeps me going is thinking about the impact that the client's behaviors are having on the veterinary health care team.

Lisa Fortier: 11:56

Yeah, it's real and you know that's just a veterinary healthcare team. We take it home right. So it's affecting our significant others and our children and our pets. It's real. So thank you for trying to enlighten and hopefully resolve some of it. Not maybe. What were the maybe the most important findings in the article? Because there's many of them. I'm really surprised, you and Jason.

Mary Beth Spitznagel: 12:26

To me anyway.

Mary Beth Spitznagel: 12:26

I think so surprising maybe not surprising to me, I think, you know, something that I was thrilled, really thrilled to see was that replication Even though this is a different sample, this is a Canadian sample, most of my work had been done in the United States that what we're seeing, it was so similar, those patterns were so similar, that connection between that burden transfer and burnout, you know, in the veterinary healthcare team.

Mary Beth Spitznagel: 12:54

To me that really, as Jason kind of already mentioned, it speaks to this being maybe kind of a global issue. Right, this isn't just something that's specific to folks in the United States or how veterinary medicine is practiced in the United States, but maybe it's something that's, you know, something that we need to look at on a larger scale. And to me it was, you know, I don't want to say thrilling. In some ways it's terrible that we're replicating this finding, but at the same time, what it means is that you know, we've found something that really is an authentic predictor of stress and burnout in our veterinary healthcare teams and if we can identify a predictor of stress and burnout, that gives us a mechanism to operate on and something that we can try to change and fix and make better.

Sarah Wright: 13:39

Yeah, I practiced in Canada and British Columbia for a year and, just anecdotally, even chatting with some of the support staff too, they encountered a lot of the same challenges that we do, too, in the US. So it's really great that you have that sample to hopefully provide some perspective on this issue and to our listeners that are just joining us. We're chatting with Mary Beth and Jason about veterinary team member burden transfer and burnout, and they're providing some really useful insight that hopefully our clinicians can take to their practice. So, speaking of this, Jason, what is one piece of information veterinary professionals, regardless of their role, should know about this topic.

Jason Coe: 14:18

Yeah. So I guess there's two things. I know you asked for one. I'll mention two and I think the first is just normalizing that anyone working in a veterinary practice can have the experience of burden transfer and so acknowledging that that, or normalizing that that can exist. The second is recognizing there are resources and Beth has developed an amazing program called Unburdened, which is really tailored to support veterinary professionals in managing burden transfer, so managing those interactions, the difficult interactions that they're having with clients, and I think that the more and more we can get this in the hands of all people working in veterinary practice, the more and more we can support the veterinary profession and the well-being of the profession as a whole.

Sarah Wright: 15:01

It sounds like an excellent resource. Mary Beth, can you tell us more about Unburdened?

Mary Beth Spitznagel: 15:07

Absolutely so. We started this out, actually, when we first identified burden transfer as something that this looks like. This is something that's going on in veterinary medicine we identified that it wasn't just about the frequency of these difficult interactions with clients that was predicting stress and burnout. It was also, and actually more so, about the reactivity of the individual person to these situations. And so, in from my perspective as somebody with the background in the psychological sciences, whenever we see reactivity, one of the things that we know can be really beneficial for reactivity is something called acceptance and commitment training, and this is it's a really well-validated, well-established method for just helping people kind of acknowledge the emotion and emotional reaction that they're having, acknowledge the thoughts that they're thinking, and find kind of a way to sort of shift focus and refocus on things that really have meaning for them. So, instead of getting sort of sucked into their feelings and reacting to feelings, it's about noticing them, acknowledging them and then making a choice to very intentionally pursue kind of a different avenue and one that maybe brings more meaning and makes your day a little bit more fulfilling, and by doing that you can really kind of buffer yourself against some stress and burnout, and that's so we developed a program specifically kind of tailored to veterinary medicine, looking at really, these difficult client interactions and helping people identify when they are experiencing this, you know, a point of burden transfer, and helping them be able to utilize specific kind of hands-on skills that they can, you know, use to shift their focus. And so there's a program we initially, you know, created it was something that I was running these programs, I was running tons and tons of programs.

Mary Beth Spitznagel: 17:00

We're doing this research and recognize this is something we actually are able to show.

Mary Beth Spitznagel: 17:05

In a randomized, controlled trial, which JAVMA also published so lots of plugs for JAVMA here we were able to show that there was, you know, a difference between the people who had been randomly assigned to that intervention relative to their control and relative to a control group and relative to their own baseline.

Mary Beth Spitznagel: 17:26

So what we're left with is really, how do we make this bigger and scalable? Because I can't be in every veterinary clinic, you know, in the country or across the world. So we started, you know, operating, working on kind of finding asynchronous ways of, you know, putting some of these materials together so that people may be able to access them, and what we've found so far is that this is actually something that can be of benefit, even if it's not an interactive, you know, with a group leader type of situation, something that a person is watching a video and doing some worksheets, and so we're kind of gradually working toward making this something that's easily packageable and something that can be disseminated really broadly. We're kind of still in the midst of research and actually Jason is partnering with, you know, some piloting that we're doing right now and hoping to move into kind of bigger venues in the near future with that. But it would be our goal, I think, to get this out into a format that is really readily available to everybody who's working in the field, hopefully very soon.

Lisa Fortier: 18:28

Sounds like that would be useful for lots of life situations, not just burden transfer. As you were speaking, I was like, yeah, I could do that in a lot of different scenarios in life.

Mary Beth Spitznagel: 18:42

Oftentimes when we're talking and I often say that actually you can think about that burden transfer situation in a group setting it's best if we focus on the things that we all have in common the difficult interactions with clients, but if you want to take this home and use this with your mother in law, that'll work too Exactly.

Lisa Fortier: 19:02

To both of you. You amazingly accomplished world leaders in a lot of these well-being fields. We often talk about needing grit, or resilience, or determination to make it and get through all of this as a professional. We'll start with you, Mary Beth, while I have you on here. Where do you think your resilience came from?

Mary Beth Spitznagel: 19:23

I think one of the things that I really love about science is the repeated failure of it. I think that's where resilience comes from. At least to me, resilience comes from experiencing things that don't go the way you plan. And then you take a look at it and what went wrong here, where did I fail, and what does that tell me about how I can approach this differently in the future, taking that as a growth experience and really beginning to have greater appreciation of those times when things don't work out. That also, I think it just makes it all the more thrilling when things do work out the way you did plan.

Lisa Fortier: 20:05

That's a great. I had a really amazing mentor, Linda Sandel, when I wrote my first research grant on my own, like nobody from my graduate committee or any of that stuff. I wrote it on embryo stem cells and I didn't think the research committee would understand what I was writing about. I kind of dumbed it down. And who did I get in trouble? It got rejected and I called my friend Linda and I said, wow, I got these scathing reviews and she said were they fair, were they true? I was like yeah, she said to me you're going to make it because you just said it's my bad. I didn't blame the reviewers, I didn't blame the system. I didn't say, oh, they're playing favorites with somebody else. I raised my hand. I was like Mia Culpa.

Mary Beth Spitznagel: 20:52

Absolutely.

Lisa Fortier: 20:53

Jason, how about you? Where do you think your determination came from?

Jason Coe: 20:58

Yeah, that's an interesting question and a great opportunity for reflection. I mean, I'm being very fortunate in my career and a lot of it I attribute to just seeing where I feel there are opportunities to support and enhance the veterinary profession. I would even say some of the things that I've done over time have maybe been ahead of the curve and so haven't always been necessarily accepted readily. Yet knowing that I felt that it was going to be good for the profession and that this was going to be a valuable contribution, I think has always helped me move through even those more challenging times. Then I would say the other thing is just being able to make sure I disconnect. I was just sharing with some student veterinarians yesterday that my family and I probably end up camping about 50 nights a year because that's my real opportunity to step away and disconnect from everything else that's going on. That's a really important piece, I would say, to my ability to continue to do what I do every day, yet making sure I take time to disconnect as well.

Lisa Fortier: 21:59

Yeah, mindful disconnection is really important. For me it's riding horse and playing piano. I can't be thinking about other. You shouldn't be thinking about other things when you're jumping three foot or you're gonna do a Humpty Dumpty, so, and then we'll stick with you. Jason, as we wind down a little more of a personal question where it kind of ages a lot of us. But what was the first concert you attended?

Jason Coe: 22:23

Yeah, it's interesting, we were taking a little bit of a sneak peek just before you jumped on, lisa. And so my very first conference not my conference concert was when I was in high school, and it was the Canadian band Bare-Naked Ladies, and so it was at a small grew up in a town of 20,000. They were coming to the local Coliseum and so, again, really small venue, and had an opportunity to hear the Bare-Naked Ladies.

Lisa Fortier: 22:55

Very good. How about you Beth?

Mary Beth Spitznagel: 22:58

So I think the first concert that was really a concert that was driven by my interests, not my parents bringing me along to something that they were doing was going to the Cure, which was actually when I was 16 and I was in Germany. I was an exchange student at the time and I went with my host sister. We went to Bremen. We were living in a little tiny town. We went up to Bremen and to the Stadthalle and saw the Cure and Concert and it was amazing.

Sarah Wright: 23:28

Yeah, I already shared my response earlier with Jason and Mary Beth, but it was Justin Bieber for our listeners, if you're curious, in middle school at the B96 Jingle Bash at Allstate Arena outside of Chicago. So, yeah, definitely a fun question. We really like hearing the answers to that too. And just thank you again, Jason and Marybeth. You really appreciate your time and again for contributing so many wonderful manuscripts to JAVMA. I think you're really doing a lot for our profession, so thank you.

Sarah Wright: 23:56

Thank you for having us and to our listeners. You can read Jason and Mary Beth's article in print, JAVMA and on our journals website. I'm Sarah Wright with Lisa Fortier. We want to thank each of you for joining us on this episode of the Veterinary Vertex Podcast. We love sharing cutting edge veterinary research with you and we want to hear from you. Be sure to leave us a rating and review on Apple Podcast or have a platform you listen to. We'll see you next time. We'll see you next time.