The demand for veterinary services currently exceeds the number of practicing veterinarians (American Pet Products Association, 2019; Lloyd, 2021), creating a situation in which many pet owners are turning to emergency services. This has led to an increased need for emergency veterinarians; (Cima, 2018, 2019; Bain et al, 2020) a need unable to be filled by the current number of veterinarians in emergency and critical care medicine (Cima, 2019).
While many veterinarians enjoy the nature of emergency medicine, it is not for everyone, as evidenced by the fact that burnout and compassion fatigue appear especially prevalent in emergency medicine (Cima, 2019; American Veterinary Medical Association 2020; Andela, 2020). This has been attributed to several factors including the challenging nature of emergency work, and the demanding schedule (Andela, 2020, Booth et al, 2021). As the need for emergency veterinarians continues to grow, it is imperative to understand the factors that impact how emergency veterinarians select a particular position or hospital, as well as what they feel is important for creating an environment conducive for long-term employment. This study was designed to explore these issues.
Materials and methods
An anonymous online survey was disseminated to emergency veterinarians via an email invitation to Veterinary Information Network (VIN) members. A link to the survey was also distributed to eligible Veterinary Emergency and Critical Care Society (VECCS) members. Participants were asked to indicate: 1) their opinions about factors they feel are important in selecting a particular place of employment and 2) things they feel are important in fostering a work environment conducive to long-term employment; both using a 4-level Likert scale (1= not at all important, 4= very important). The survey also included demographic items (such as gender, years practicing emergency medicine, children in the home, etc). The survey was available from May 25, 2022 through June 15, 2022. Only data from respondents who stated they currently work in emergency medicine and were not board certified in Emergency and Critical Care were included in the analyses.
Statistical analyses
The authors calculated descriptive statistics for most questions. To examine differences in proportions of various responses based on various demographic factors, Chi-squared tests were used. The authors then used factor analysis to identify broad, independent factors that might predict long-term employment. Finally, linear regression was used to examine the effect of each factor on longevity.
Results
Demographics
A total of 433 veterinarians practicing emergency medicine in the United States completed the survey, including 350 (81%) females, 76 (18%) males, and 7 (2%) non-binary or preferred to not answer. For additional analysis, gender was limited to male and female. The majority of participants had no children (n=262, 61%), nor planned to have children in the next 3–5 years (317, 74%). Most participants graduated after 1991 and had been practicing emergency medicine for 3 years or more (Table 1).
Table 1. Demographics of veterinarians practicing emergency medicine in the United States who completed the survey (n=433)
| N | % | ||
|---|---|---|---|
| Gender: n=433 | Female | 350 | 80.8 |
| Male | 76 | 17.6 | |
| Non-binary/prefer not to answer | 7 | 1.6 | |
| Children: n=433 | None | 262 | 60.5 |
| One | 116 | 26.8 | |
| Two | 50 | 11.5 | |
| Three or more | 5 | 1.1 | |
| Age of children (of those with children): n=171 | Under 5 | 60 | 13.9 |
| 5–12 | 74 | 17.1 | |
| 13–18 | 66 | 15.2 | |
| 19–23 | 25 | 5.8 | |
| Older than 23 | 7 | 1.6 | |
| Plan to have children in the next 3-5 years: n=426 | No | 317 | 74.4 |
| Yes | 63 | 14.8 | |
| Unsure | 46 | 10.8 | |
| Year graduated from veterinary school: n=433 | 1991 or earlier | 47 | 10.9 |
| 1992–2001 | 83 | 19.2 | |
| 2002–2011 | 143 | 33 | |
| 2012–2016 | 79 | 18.2 | |
| 2017–2021 | 81 | 18.7 | |
| Years practicing emergency medicine: n=404 | 2 years or less | 61 | 15.1 |
| 3–5 years | 73 | 18.1 | |
| 6–10 years | 81 | 20 | |
| 11 years or more | 189 | 46.8 |
Important factors in hospital selection
Participants were asked to rate 15 statements in terms of their importance in selecting a place to work. The factors rated as most important included:
- Working with a highly trained support staff
- Collegiality of co-workers
- Remuneration
- Working fewer shifts but longer hours and having longer blocks of time off
- The variety of the cases
- Opportunities for professional and educational growth (Figure 1).
Male participants considered the challenging nature of the cases as more important than female participants (P=0.026). Female veterinarians considered working alongside (other) specialists (P=0.003), collegiality of co-workers (P<0.001), and receiving mentorship from more experienced co-workers more important factors than male participants (P=0.021).
Important factors in fostering a work environment conducive to long-term employment
When participants were asked to rate a series of items in terms of importance in fostering a work environment conducive to longterm employment, the factors they rated as the most important included leaders recognising the value they bring to the practice, obtaining reasonable approval for personal time off, and obtaining help when requested (Figure 2).
Factor analysis
The authors conducted factor analysis and identified five factors which explained 59.0% of the variance in participant responses associated with long-term employment: schedule (α=0.71), professional growth (α=0.68), environmental tone/atmosphere (α=0.69), medical support (α=0.57), and leadership (α=0.66); explaining 29.34%, 10.39%, 7.66%, 6.011%, and 5.56% of the variance respectively. The mean value of each factor was calculated, placing the factors in the following order of importance: leadership (x=2.55), schedule (x=2.33), medical support (x=2.15), environmental tone/atmosphere (x=2.25), and professional growth (x=1.96).
Linear regression
The authors next performed a series of multiple linear regression analyses to assess the predictive value of gender, child status (having children or intending to have children) and years practicing emergency medicine on each of the five factors associated with fostering a work environment conducive to long-term employment:
- Leadership: a weak relationship with gender (r2=0.046)
- Females rated leadership as more important than males.
- Schedule: a weak relationship with gender and intent to have children (r2=0.04)
- Females rated schedule as more important than males
- Respondents expecting to have children in the next 3–5 years considered schedule as more important than those who were not expecting to have children in the next 3–5 years
- Medical support: a weak relationship with gender, years in emergency medicine and current children (r2=0.064)
- Females rated medical support as more important than males
- Those practicing emergency medicine for 2 years or less rated medical support as more important than those who had been practicing longer
- Practitioners without children rated medical support as more important than those with children
- Environmental tone/atmosphere: a weak relationship with gender (r2=0.068)
- Females rated environmental tone/atmosphere as more important than males
- Professional growth: a weak relationship with years in emergency practice (r2=0.084)
- Those practicing for less than 5 years rated professional growth as more important than those practicing for more years.
Discussion
This study assessed two important issues pertaining to the recruitment and retention of emergency medicine veterinarians: 1) the workplace factors emergency medicine veterinarians feel are important when selecting a place of employment, and 2) which factors emergency medicine veterinarians deem important in fostering a positive work environment favorable for long-term employment. For both of these questions, the authors assessed whether practitioners' gender, child status or years practicing emergency medicine (factors identified as impacting veterinarians' mental health and job satisfaction; Scotney et al, 2019; Andela, 2020; Wayne et al, 2020; Booth et al, 2021; Ouedraogot al, 2021) can help predict the rated importance of these factors.
The authors found that the factors rated as most important in selecting a specific job include working with a highly trained support staff, collegiality of co-workers, remuneration, and working fewer shifts but longer hours and having longer blocks of time off. However, demographic nuances exist in the perceived importance of these factors. For example, it was found that both female veterinarians and those with less experience value mentorship more than male veterinarians, or those who have been practicing emergency medicine longer. Female veterinarians also appeared to value working alongside (other) specialists and the collegiality of co-workers more than male veterinarians. These results mirror other studies that have found perceptions of work relationships and support impact females' job satisfaction more than males (Bilimoria et al, 2006; Johnson et al, 2020; Trudell et al, 2022).
When assessing the factors most important in promoting employee retention, the aspects rated as most important include leaders who recognise the value a veterinarian brings to the practice, obtaining reasonable approval for personal time off, obtaining help when it is requested, and an environment where a positive attitude is a high priority.
When the authors compared the five broad categories of the factors derived from factor analysis (schedule, professional growth, environmental tone/atmosphere, medical support, and leadership), it was found that leadership was rated higher than any other factor. Yet, good veterinarians do not necessarily make good leaders. Leadership training can help improve hospital environments and increase the likelihood that emergency medicine veterinarians feel recognised, heard, and valued (Booth et al, 2021; Elce, 2021; Noyes et al, 2021).
When exploring the importance of the five factors, including leadership, it was found that gender, years in emergency medicine, and child status impacted participating veterinarians' perspectives. For example, the intent to have children in the next 3–5 years impacted veterinarians' perceptions of the importance of schedule, with those intending to have children in the near future rated schedule as more important than those not intending to have children soon. It is important to note that this was true for both male and female veterinarians. Challenges with work/life balance are one of the leading stressors for veterinarians, especially for those with children (Elkins and Kearney, 1992; Shirangi et al, 2013; Griek et al, 2018; Clise et al, 2021). Thoughtful schedule planning to enhance veterinarians' ability to balance home and work may help with staff retention.
The number of years veterinarians had been working in emergency medicine was found to impact the reported importance of medical support and professional growth, with newer graduates valuing these factors more than seasoned practitioners. This information validates the field's growing emphasis on training and mentoring that many hospitals are implementing.
Even though years in practice and child status are important characteristics in predicting the importance of some work-related factors, gender is the most influential. Female practitioners rated schedule, environmental tone/atmosphere, medical support, and leadership as more important than male practitioners. Given that 63% of US veterinarians are female (Nolen, 2020) and that the profession is continuing to become increasingly feminised (Wallace and Kay, 2022), the fact that female veterinarians value each of these elements more than male veterinarians is an important finding. Those responsible for employment and retention of emergency medicine veterinarians are encouraged to focus on these factors to ensure they are creating conditions that attract and support female employees.
Conclusions
The results of this study suggest that it is important for hospitals to recognise the importance of leadership, schedule, environmental tone/atmosphere and medical support in creating work environments that attract and retain quality clinicians. Veterinary leaders can make a difference in the recruitment and retention of emergency medicine practitioners by allocating training and resources around these factors. While this study was conducted in the US and thus the findings may not be generalisable to other countries, the findings warrant consideration and further research.
KEY POINTS
- Emergency veterinarians find collegiality of co-workers, working with a highly trained support staff, and the opportunity to work fewer, but longer, shifts the most important factors when selecting a place of employment.
- Emergency veterinarians find leaders who recognise the value a veterinarian brings to the practice, reasonable approval for personal time off, and obtaining help when it is requested the most important factors in creating an environment conducive for long term employment.
- Nearly all of the major factors we found to be important for long term employment (schedule, professional growth, environmental tone/atmosphere, medical support and leadership) were more important to female veterinarians when compared to male veterinarians.