There is a concerning trend in the world of equine healthcare. The equine veterinary profession is grappling with a concerning rise of burnout and attrition. This is leading to a shortage of experienced professionals who can provide essential care for horses. Veterinarians, especially those in equine practice, often face significant challenges that contribute to dissatisfaction and an exodus from the profession. The first five years of practice are particularly critical. Many veterinarians leave within those years to other fields, resulting in a dwindling supply of equine veterinary expertise. Furthermore, there’s a notable discrepancy between the demand for equine medical care and the available services, especially in emergency situations. This convergence of factors underscores the urgency of addressing the underlying issues within the equine veterinary profession.
“Being part of the industry, we recognize that our customer who is the equine veterinarian, has been suffering from burnout. And this is not new. It’s been happening for a while. The profession itself has been suffering from loss of employees of equine veterinarians. Typically, most of those who leave, do so around the 5th year mark of being in equine practice.”
Julie Settlage, DVM, Professional Services Veterinarian, Boehringer Ingelheim
I sat down with Josh Vaisman of Flourish Veterinary Consulting, and Julie Settlage, DVM, Professional Services Veterinarian, Boehringer Ingelheim, an equine veterinary surgeon with a lengthy track record in the industry and in higher education. We discussed this growing concern, what can be done, and how horse owners can help. In an industry where the well-being of both practitioners and equine patients is intricately linked, nurturing strong relationships between horse owners and equine veterinarians is imperative.
The Problem
Veterinarians often face obstacles that make it challenging for them to thrive in their practices. This results in a high attrition rate, especially within the first five years of practice. Burnout is a real concern in this profession. And veterinarians across the nation are facing challenges within the practice that quite often lead them to leave the equine industry in pursuit of other endeavors.
Dr. Julie Settlage, a veteran of the equine veterinary industry with over 20 years in clinical practice, brings light to this concerning situation. She has been working on a solution to bring balance back to the world of equine veterinary medicine. She says, “Being part of the industry, we recognize that our customer who is the equine veterinarian, has been suffering from burnout. And this is not new. It’s been happening for a while. The profession itself has been suffering from loss of employees of equine veterinarians. Typically, most of those who leave, do so around the 5th year mark of being in equine practice.”
Beyond the extensive hours, extreme workload, and financial concerns, is the real problem of emotional burnout. Veterinary medicine is a difficult industry, filled with people that care deeply about their clients and equine patients. As the workload stacks up and without time to rest and recharge, the burden becomes heavier.
The question is, why? And the next step is determining how to slow down the mass exodus of equine vets. And how to help prevent burnout in the industry.
A Giving Profession
Vaisman is no stranger to the world of animal medicine. He has a background of 25+ years in animal medicine, working in almost every role aside from a DVM. He has seen the toll that the profession can take and experienced it himself. Although he is newer to the equine side of the industry, Vaisman is passionate about helping equine vets find balance. With a Master’s degree in the science of Applied Positive Psychology, he is committed to making positive work environments for human thriving.
“It’s a giving profession”, says Vaisman in regard to equine medicine. “Most people who come to professions like that come with a deep sense of purpose behind why they’re doing that kind of work, and that purpose is a driving force to find alignment between. This is where I find meaning in life and this is how I can activate that, meaning that’s what work ends up becoming. And those kinds of professions I think are really wrought with these types of challenge.”
Dr. Settlage confirms that this is an accurate assessment of equine medical practitioners. And stresses the importance of creating a positive work environment that will benefit vets, horse owners, and the horses themselves. She notes, “The industry over the past two to five years has really started focusing in on how we can make our profession the place people want to be and stay.”
Equine vets are passionate and dedicated to their job, but burnout is a real threat to the industry. Alina555/gettyimages.com
More Than a Full Time Job
If a 40-hour workweek is considered a full-time job, then veterinarians surely work more than a full-time gig. If a practitioner is part of a larger clinic or practice that has more hands to balance the workload, these hours might be more manageable. However, according to Dr. Settlage, “the average equine practitioner is in a one- or two-person practice. If they aren’t in a two-person practice, then there’s also that mental load burden too.”
This poses a problem in terms of burnout, finding time to balance all your tasks, and bearing the brunt of the emotional and mental burden as well. Dr. Settlage expands on this, saying “When you don’t have a huge community that you’re working with, then who is getting the ordering done and managing appointments? And if I’m having a difficult conversation, who can I turn to bounce ideas off of if I have a hard case? There are no water cooler moments when you’re by yourself, and that can be really, really hard.”
The Numbers Don’t Lie
If the anecdotal evidence from practicing veterinarians doesn’t spell out the problem, the numbers surely will. According to Dr. Settlage, around 5% of veterinary students are pursuing the equine field. “And so within five years, for each class we’re down 50%. And so, the number of graduating students varies, especially the last couple of years, because we’ve had new schools come online. Some of them don’t even have routine equine faculty to mentor, or to be an ongoing mentor for these equine students.”
Aside from that concerning trend regarding veterinary students, the number of practicing equine vets is vastly smaller than the number of horses in need of veterinary care. “The American Horse Council says there’s about over 7 million horses in the US, and that accounts for 1.6 million households that own horses” states Dr. Settlage, citing a 2017 study.
“And there’s only about 4000 equine vets, and about 50% of horses don’t see a veterinarian routinely.” This means that the growing divide between horses needing care and equine vets leaving the practice grows wider every year.
An Unsustainable Trend
Vaisman expands on this concern, saying “If we just do simple math that is not sustainable. It’s impossible to actually deliver high quality care to that. That is compounded by the fact that the story behind that data of 5% of students declaring the equine track shows a narrative in the community that you don’t want to be an equine vet.” Although equine veterinarians are fiercely passionate about their profession, and dedicated to their career, the numbers don’t lie in regard to the effects of burnout.
Sharing his concern about where this trend will lead, Vaisman says, “If we persist in this direction, the number of horses will increase. And the number of caretakers will decrease.” Not to mention, burnout often leads to higher instances of medical errors. This happens when equine vets become tired, distracted, or unable to focus on their high caseloads, according to Dr. Settlage.
Enter: The Stable Life Initiative
A small wellness initiative called The Stable Life Initiative, started by Dr. Settlage and her colleagues at Boehringer Ingelheim has steadily grown in size. In 2022, The Stable Life was launched, an internal grassroots movement by equine vets, for equine vets. Introduced in 2022 to the nation at AAEP (American Association of Equine Practitioners), The Stable Life Initiative continues to seek solutions to the problems of burnout that equine vets face. “The Stable Life is actively working to change the narrative”, says Vaisman. “They’re actively working to change the narrative in the community that this not only can be a viable career path through you, but it can also be one in which you can find joy and fulfillment. And that I think is worthwhile because the end point is ultimately helping not just the practitioners, but the horses.”
Hosting events, symposiums, and starting the discussion around this crucial topic, The Stable Life is dedicated to the health and wellbeing of equine practitioners. Helping equine vets find work-life balance, and empowering the people in the industry, this grassroots wellness initiative couldn’t have come at a better time.
Outreach Matters
Dr. Settlage expands on the importance of education through this initiative. Partnering with experts in the field, like Vaisman, The Stable Life brings information to the front lines of equine medicine. “Part of what he (Vaisman) has been participating in is offering national level webinars. We have partnered with not only Vaisman, but other experts in their fields to try and provide some resources and toolkits for practitioners.” The movement has taken off and is gaining traction across the nation, Dr. Settlage says. “There’s a practitioner out in California that also has an MBA that has spoken about the utilization of telehealth to improve efficiency. And then another veterinary MBA has talked about why you should own a practice. Showing practitioners that you can have a very lucrative career as a practice owner and why you should do it. We’re providing the toolkits for these things.”
Vaisman notes the importance of work-life balance and job satisfaction, “Job satisfaction is most strongly predicted by the quality of the relationships that you have at work. So, we’ve offered a lot of resources on how you develop positive workplace environments, how do you create high quality teamwork so that when you’re doing the difficult work out in the field, you’re also getting that resource and support that you need back in the home office?”
Support for the Equine Vet
The Stable Life Initiative focuses on the importance of positive workplace relationships, and growing your own practice. It also educates on signs of burnout and strategies to reduce it. “We have a lecture and/or workshop around what actually burnout is. And then how you utilize boundaries to try and keep burnout at bay. We can go into clinics to help increase the self-awareness of individuals to try and improve how they interact with each other. This provides them a toolkit to try and improve their culture and ability to work together” states Dr. Settlage.
She continues, saying, “We’re trying to scan the gamut of national things and then down into the local level. And we also send volunteers to the Veterinary Leadership Institute.”
The Lead Program is another way that The Stable Life Initiative is reaching equine vets. Vaisman explains the program, “AAEP delivers this program once a year. It’s a weekend long experience for early career equine practitioners to develop leadership skills within the profession, and within their organization.” Vaisman and his colleague Andy, delivered the Lead Program at last year’s AAEP and continued the momentum that they started. “Andy and I got to deliver the lead experience this past year and then built on this ongoing momentum. Andy and I, once a month, got back together with that cohort of 15 or so practitioners. We talked about leadership concepts and checked in with how they’re doing personally and professionally, to provide ongoing support.” The event, sponsored by Boehringer Ingelheim, as well as The Stable Life Initiative serve as bright beacons of hope for equine medicine.
Setting Healthy Boundaries
When asked what could potentially help alleviate the burnout that equine vets experience, the answer lies partially within the hands of the horse owners, themselves. Building a solid working relationship with your equine vet should be a goal for every horse owner. What does this look like? It starts with understanding boundaries with your vet. Although your equine vet might not explicitly tell you about their boundaries in terms of work hours, what constitutes an emergency, or how to interact with them, a healthy working relationship always has boundaries. Vaisman encourages horse owners to be proactive in this regard. “I would actually encourage clients to proactively ask their veterinarian, ‘what are the boundaries you would like me to hold to’ rather than waiting for the veterinarian to share boundaries.”
Dr. Settlage acknowledges that vets want to help their clients and are passionate about horses. However, equine vets need to determine their own boundaries as well. Perhaps this looks like not taking a call about writing health papers at 9:30 PM. Or letting clients know what constitutes an emergency, and when to call regardless of the time. Vaisman gives an example of how to ask your vet what their boundaries are if you are unsure. “Hey, you know, I’ve been thinking a lot about how much you helped me. And I’m wondering if maybe I’m asking too much of you. Can you help me understand what a reasonable ask is, and when are times I might have crossed the line having that conversation?”
A Sense of Guilt
Vaisman and Dr. Settlage share that vets often take the late-night phone calls, overload their work schedule, and are always available out of a sense of guilt. Because of their passion for equine medicine, they might feel guilty if they aren’t always readily available. After having a conversation about boundaries with your vet, Vaisman acknowledges that then the choice is up to them. “Now the veterinarian gets to decide when and how they provide that helping care choice. They may still do the same things. They still may take your calls at 11:00 o’clock at night.
Sure, they still may show up at your barn at 2:00 in the morning when it wasn’t totally necessary, but they’ve chosen to do it instead of doing it out of a sense of guilt. Fulfillment comes from that.”
Communication is Key
With all working relationships, communication with your vet is paramount. Being open and honest, even if that means having a difficult discussion is best for you, your horse, and your vet. Dr. Settlage notes that sometimes equine vets don’t keep their own boundaries, and that can lead to owners being unsure of where the line is. “We sometimes don’t keep good boundaries, but we also often expect our owners to keep good boundaries. And then we get mad at them when they don’t. Then they get mad at us when we do, and we’ve failed all over the place to even talk about it. And that can be a big source of disgruntlement between owners and veterinarians.”
With all working relationships, communication with your vet is paramount. PeopleImages/gettyimages.com
Don’t expect that your vet is always available immediately. As with any profession, instant gratification is not something that is feasible for your equine vet to provide. Whether they are on another call, taking a day off, sleeping, or handling emergencies, understand that they cannot always be available right away. Dr. Settlage notes that oftentimes, an equine vet not working out of a multi-person practice will be the one to answer their own phone. They might not have a receptionist or someone taking calls. Therefore, don’t be alarmed if there is a delay while they finish up their task at hand before responding. This is also where it is important to establish protocol for horse owners during a true emergency.
Importance of Educating Yourself
“Try to proactively know what the emergency is and then also know what basic first aid looks like in a horse,” recommends Dr. Settlage. “If you have a laceration, there’s some lacerations that are absolutely emergencies, those that are near joints. But there are other lacerations that really can wait until the next day and aren’t emergencies. They need to be seen the next day, but you don’t need to wake up your veterinarian at midnight to see it.” She also recommends horse owners have a working knowledge of their horse’s baseline health and what constitutes an emergency. “You can ask your vet for resources where you can get information that the veterinarian supports, because we all know there’s a lot of information on the web that is suspect. Of course, there are always gray areas, and that is where the communication piece with your vet comes into play.”
Train Your Horse; Help Your Vet
Another way that horse owners can build a good relationship with their equine vet, is to work with their horse to ensure a positive experience for horse, owner, and vet. Dr. Settlage states, “It’s not just good manners, but you know a lot of the owners train their horse to do what they want them to do, but forget that to be a good veterinary patient, the horse needs to accept what the veterinarian wants to do.”
Working with your horse on standing patiently, accepting needles, and being a good patient are things that should be practiced before an emergency takes place. Of course, this can vary with horses of different ages and backgrounds, but your farrier and equine vet will appreciate a well-mannered horse that makes the visit a smoother process. This also helps your horse avoid traumatic situations where he might be scared, flighty, and unsure how to accept veterinary care.
Hope for the Future
As horse owners, we want the absolute best care for our four-legged friend that we can get. And oftentimes our equine vets aren’t just valued members of our horse’s health team–they’re our friends as well. With a genuine concern about burnout and a diminishing number of equine vets looming on the horizon, we all need to work together to find a solution.
When asked what Dr. Settlage hoped to see in the future, she reflected on students she had taught in her time at Virginia Tech. “There were so many amazing equine students that I looked at as the future of equine veterinary medicine. I was proud to have been part of their lives. It’s my hope that the equine veterinary student that is deeply passionate about being an equine veterinarian is able to thrive in their chosen field.”
Starting the Conversation
Vaisman agreed and expanded on the importance of starting the conversation between equine vets and horse owners. Saying, “The more that we share lived experience, the more mutual understanding we have, and it does go both ways. I’m just really grateful that these conversations are happening.”
Although the problem of burnout in equine medicine might not be at the forefront of the minds of horse owners, it is a serious and growing concern. As less students graduate in equine medicine, and more practicing veterinarians leave the field, the threat increases for less accessible healthcare for horses. As horse owners and equine vets continue what they’re doing for the love of the horse, we must work together to ensure positive working partnerships, and doing the best we can for the animals we love. This starts by opening the conversation and acknowledging the problem.
Talk with your vet about how you can be the best client you can be. Work with your horse to accept medical care. Honestly and kindly open the lines of communication between you and your horse’s vet. Even when it requires you to be vulnerable and have difficult conversations. Because as Vaisman says, “Change happens when we talk about it.”
