Nicole McArthur, DVM
I started a little FB group on October 1, 2014 after the suicide of renown veterinarian Dr. Sophia Yin. Since that time, our secret group has grown steadily by word of mouth. I created it as a place where veterinarians could come and talk about all of the good, the bad and the ugly that we face in our daily lives. A place where we can celebrate victories and vent frustrations to a group who understands without needing a translation.
This little group is called Not One More Vet, or NOMV. Our goal is a lofty one in that we want not one more vet lost to suicide. I would like to say that we have succeeded, but we have lost many colleagues since Sophia.
There are currently more than 15,000 veterinarians who have joined NOMV and we have nearly a quarter of a million engagements per month. That means veterinarians are posting, our colleagues are responding, creating a community where we can feel supported, understood and most importantly, not alone.
NOMV is not a perfect place as we are all human. As with any community, there are arguments and there are hurt feelings. The admins and moderators of NOMV have heard some awful insults and accusations as to the merits of this page. We take most with a grain of salt as we realize that most come from a place of hurt. But there is one insult that I refuse to accept: NOMV doesn't save lives. I would argue quite the opposite.
There have been numerous times that NOMV admins have been alerted to the possibility that a member is suicidal. We make attempts to contact the individual and see what is going on... triage, if you will. Sometimes, the NOMVer needs a sympathetic ear and the simple act of reaching out is enough. Other times, it is a code red situation and we must make decisions quickly. It happened recently when Carrie, Melanie and I happened to be sharing a room at WVC. When a situation like this occurs, we are usually working on it alone (we live all across the US). This is the first time we could act as a team and we were able to work together to gather information so that we could call police for a welfare check.
Most of the time, we don't know where the member lives, much less where they are located at that moment in time. Melanie was able to determine an approximate location and contacted the local police department. All the while, Carrie was communicating with our concerned NOMVer, who was understandably shaken.
We sat and waited. And talked about the next step, and the next. Any time we call the police, we know that our trust with that individual might be broken. But as Carrie likes to say "better mad than dead". So we prepared ourselves for the inevitable anger. We also prepared ourselves for the very real fact that our colleague may already be dead.
Melanie's phone rang and we were given the good news that our colleague was alive, albeit angry. And we were okay with that. Better mad than dead.
When the police assured us that the NOMVer was safe, we breathed a sigh of relief. Melanie and I gave each other a hug. And we looked over at Carrie, who had fallen asleep at her keyboard.
When I gently pulled the laptop from her lap, her fingers began typing. I swear this woman never, ever stops.
The NOMV admins are 100% committed to our goal of not one more vet lost to suicide. We have all completed QPR training - Question, Persuade, Refer. Our goal is not to fix your underlying problem, but to get you through the dark moments so that you can get help from a licensed mental health professional. We strongly recommend QPR Gatekeeper Training for all of our members and you can read more about it at qprinstitute.com.
By Abby Whiting, DVM
I graduated from veterinary school in 2011…and I started a great first job at a busy multi doctor full service general practice. I remember being so excited to finally start work, and feel like a “big kid”! I also remember it wasn’t easy…as a matter of fact there were all kinds of challenges I wasn’t expecting.
I distinctly remember one day very early on; a sick dog in room one with labored breathing and the owner was already crying. I went right in and started my PE. As I examined the dog my stomach fell farther and farther down, like it may actually fall into my feet. I started sweating, I was probably pale. As I listened to the dog’s chest I remember being lost for a moment…totally in another plane of thought…I listened and I listened…and again some more. All I could hear was my inner voice saying “Oh, no this dog needs a doctor! Oh NO! I AM this dog’s doctor”. Turns out, lucky for both me and the dog, I got a pretty state of the art education, but what I was lacking was something school couldn’t help me with.
My first six months in practice I was so emotionally and intellectually drained that I couldn’t manage to check me email….ridiculous I know, but true. I was consumed with reviewing cases, did I make good choices, do I need more information, did I say the right things, would that pet be better off with someone else? I was insanely hard on myself. One night a bunch of my local vet friends got together for a pot luck, and it turns out, all of us were feeling exactly the same way. Some of us were struggling to do email, laundry, self-care, etc. Others were struggling with imposter syndrome, or with developing our communication skills with clients and staff. After supper I felt a whole lot better. I breezed back into work proud I had discovered the transition from student to doctor is hard…only to find out the human brain does odd things sometimes…the more experienced practitioners were stunned and shocked and acted like I was a bit off center on that one. It was in that moment I realized….no one truly understands the transition unless they too are in it. It was then I discovered the value of building a tribe of people who understand. Like every time I adopt a puppy I seem to magically forget how exhausting crate training can be early on…like some sort of mystical spell overrides my intellect…the same phenomenon seems to happen as we move further from school and get more comfortable as the doctor.
After that one pot luck a few friends and I gathered monthly to “share war stories” of practice, of transition, of client care, of staff interactions. We all learned a ton and we all supported each other like a tiny little think tank devoted to making the transition easier, smoother and better. We needed this M/M rounds of sorts. After a few meetings I founded the new graduate task force for my state VMA to try to further this mission. In doing so I have learned a few great tid bits I share with all of you, especially the newer graduates.
1). You’re Not a baby vet, you are a newly minted badass with superhero powers. You aren’t “the new doctor”, you just joined the practice. Don’t ever talk down about yourself, there are too many folks already trying to bring you down…resist the temptation. Your brain will believe what you tell it over time, so be careful the lessons to teach it. My life coach likes to ask me if the streets that run through my head are safe? Or are they filled with doubt self-hatred, blame, and inadequacy.
2). Self care is critical: you MUST do it…not later, not after this case, or next week…you MUST commit to it as part of your routine, whatever that means. I like to get outside, or cook, or turn OFF my cell phone. Find something non animal related and do it for FUN.
3). Staff pets: if a staff member asks you to look at their pet: do so with reverence. The staff trusting you is a big deal, and marks a big milestone in you as the new addition to the team. Give them the time and dedication it warrants, and it will repay you! Soon they will refer clients to you over the phone, or in person. Soon your schedule is full, your opportunities are greater…and you feel like part of something. I don’t give my cell number out to clients, except top staff, and no one has ever abused it.
4). Stay in touch with your friends from vet school: in school we have stressors and hardship, successes and triumphs; always shared with our closest mates. Once graduation hits, we all go separate ways, suddenly the 24/7 support system and comradery is gone like mist. Call them, text them, get together, share stories, vent, laugh, cry. Hold each other up when necessary and be each other’s biggest cheer leaders.
5). Give yourself time to make the transition, its big one. Its ok if you can’t do everything…even if you can’t check those emails for a bit.
6). Reach out if you are struggling: no matter what the subject. Whether its cases and needing someone to coach you, or feeling overwhelmed, or lonely. Reach out and tell folks if you need support. Most of us are not psychic and we need a little direction, but when prompted we want to help. You are not alone.
7). Its ok if you like veterinary medicine. Sometimes our culture/profession is faced with so many challenges it can be easy to get swept into the abyss of unhappiness or dissatisfaction. Sometimes I am even quiet or reserved about that fact I truly love my job and my profession…but don’t be. It is ok to love it. In fact its ok to discover it may not be for you. What I adore most about the DVM/VMD is there are endless things you can do with this education. None of us are locked into a particular facet of practice…no matter what the gremlins in our heads might say.
Welcome to the profession, we need you, we love you, we are glad you are here!
by Andy Mathis DVM
Veterinarians and veterinary medicine have an image problem. The general public sees us as “greedy bastards that only care about money”. Which isnʼt true. No one goes to vet school to get rich, but that is the stigma we are dealing with. Having read social media posts and comments made by people throwing our profession under the bus, I knew this. But even I was surprised how vast this (incorrect) perception truly was until I started getting emails and messages after a good samaritan case went viral online in Feb. 2016. 9 out of 10 messages and emails had the same, and similar sentiment - ʻwe wished more vets cared about their patients”, “we wish more vets were like you”, “my vet treats me like a commodity”, “vets only care about money and getting paid”. Different versions and yet the same.
Dr. Mathis in the video that went viral
Which isnʼt true. Iʼm like every other veterinarian out there. On some days, Iʼm trying to pay the bills to keep the doors open, and on other days, trying to save everybody. Those two objectives are often on opposite ends of the spectrum.
So why does the public get this wrong? They donʼt know medicine, so they are coming to this conclusion and belief in other ways. And if they canʼt judge veterinary care based on medicine and quality of care, they judge it based on price and personal experience.
Some refuse to believe that veterinarians care about their patients. Others, since they donʼt know medicine, donʼt understand and canʼt see that a vet cares. And the third reason, veterinarians have trouble communicating that they care about their patients.
And thatʼs because of the curse of knowledge. We know medicine, but donʼt realize how little clients do, so in trying to explain things, they are left confused.
Another factor that happened when the internet came around, was that we had our revenue streams and profit taken away, or we gave it away, depending on how you look at it, by online pharmacies. And for those in general practice, more profit was taken away with vaccine clinics and spay -neuter clinics. The profit that paid salaries and overhead. So a client that went to the vet for a sick patient before all this, might have paid $15 for an office visit. Today, they might pay $40-45 for the same service. In their mind, that makes us greedy.
So what does this have to do with the mental health and well being of veterinarians and veterinary staff? A lot actually. Much has been written about how those in the vet med profession are more likely to suffer from depression, anxiety, burnout, and even suicide.
Many new graduates come out of veterinary school with a huge student loan burden to deal with. Practice owners are trying to figure out to pay the bills, cover everyoneʼs salaries, and deal with unrealistic client expectations. It creates a stressful environment.
The Bayer Veterinary Study came out in 2011 and 2014 and looked at the reason why people quit going to the veterinarian. But it didnʼt offer much insight into how to fix the problem.
The other problem- not all clinics are affected. Some clinics are busy and doing well, while others are struggling to attract clients. It has nothing to do with medicine. Specialty practices are a little bit insulated, but they will be affected if general practices close. For those affected, the solution is smarter marketing. Giving clients and potential new clients, a reason to pick you over some of these other options.
As Seth Godin has said, People donʼt buy goods and services. They buy relations,
stories, and magic.
If you find yourself struggling in practice- whatever the reason- take a step back and look for the source. For every problem, there is a solution. If you are not happy dealing with clients and staff, set some boundaries, and enforce them. If you are struggling financially, perhaps you have a visibility problem with not enough appointments. Not enough people know that you exist, where you are, or why they should choose you.
Look at both your online and offline marketing collateral with a critical eye to determine what needs to change to attract your ideal client. Your website, your social media accounts, your in-office interactions between clients and staff. Sometimes its difficult to see the forest for the trees, so to speak, so it might be helpful to seek the advice of an outsider.
Your zone of genius is a mix of your talent and skills, your knowledge, and your life experiences. When clients show up there itʼs a win-win for everybody.
Posted by Abby Whiting
We are excited to share with you a FREE webinar CE opportunity: Healthcare Provider Mental Health: Building Resilience and Preventing Suicide! This event is made possible through the generous commitments of The Pet Poison Hotline and AVMA Life. Join us in NOMV nation and sign up for the webinar today! The actual event is Thursday, April 19, 12:00 pm CST. follow the link for more information.
Here’s a common situation veterinarians will find themselves in:
I’m a new graduate and I got a job offer. The money is just OK and I know there’s better practices out there, but it’s near where I want to live and, well, if I don’t accept the offer, what if I don’t get any other offers.
6 months later… I used to love veterinary medicine but now I hate it. I dread coming to work and I really don’t get along with some of the other vets because they expect me to do things I don’t feel are right. But I don’t know if I should leave. I’ll feel like a failure if I quit. Why can other people handle this and I can’t? What’s wrong with me?
My first job was one of those overworked, underpaid, zero life outside of work, physically exhausting ones that also challenged my ethical beliefs and practice standards (small town mixed practice). My boss was great but I was clearly not meant to be there. It actually took a really good sit down between me and my boss with a mutual agreement to this fact, and I am grateful to her that she respected me (and the health of her practice) enough to help me.
I didn’t know what I was supposed to do otherwise but I knew I wanted to go back to the ocean and hadn’t seen my family in such a long time, so those values took priority.
During my transition I sat down and wrote a list of "my practice philosophy". It was about how I believed I should practice medicine, how I felt my clients and patients should be treated and how I felt I should be treated. A little like when you've been single awhile and make a dreams and deal-breakers list. Only you make this list with lots of consideration for yourself and don't drink a bunch of wine first. And never make it out of anger. I promised that for my job search this would be my guiding light.
My next job was really great. All of the vets practiced to such a standard that I would feel comfortable letting them do anything with my pets if they were in trouble and I couldn't be reached. I also felt comfortable leaving my patients with them when needed. The support staff were great. What made the difference was that I went into that set of interviews with that paper of my practice philosophy in my hand and I pretty much interviewed them. It helped that they had a defined set of goals and standards themselves.
I left that job for family reasons, plus I realized I couldn't be on call any longer and stay healthy, but that 7 years made me a better vet because it was a good environment medicine-wise. There were a few hierarchical things that went on and now that experience has added to my new practice philosophy to treat the younger vets well.
I would encourage any vet, no matter of what type of practice, to take some time through this exercise. You can wing it and speak from the heart, or you can look for processes that others have developed (I’ve created Desire Maps in the past). We take jobs based on pay or just the fact that someone wanting us makes our imposter syndrome slightly less evident, but we would never make a major investment like this anywhere else in life without a list of values. I even had a deal breakers list for buying a new car that took more consideration than when I found my first vet job.
I've been feeling for a long time that our profession is broken. I have my theories on why, and I'm sure some of you do as well. Maybe if we value ourselves enough and choose our work for the right reasons we can have a future that I like to call "humane treatment of vets". Now that I'm in a position of interviewing vets (although I'm not owner) I make it clear what the clinics philosophy is and try to get deeper into the vets I'm interviewing.
As a manager, I’ve never yet held a job interview with a prospective veterinarian who had a solid set of values. I always ask the question though, and inevitably catch them off guard. We discuss it and the biggest thing that comes out for it for me is how much I learn, if I listen (that’s the trick). Skills can be taught, values are innate. The values will be the reason why people stay, leave, or open a successful practice down the road from mine. These values also teach me what kind of human I’m going to be spending my time with, passing my cases on to, and leading to future success. They remind me that the DVM and piece of paper sitting in front of me is actually human and it creates more respect. Most of all, they remind me of why I chose this career in the first place since sometimes that gets lost in the stress of it all.
I would encourage every veterinarian to write a practice philosophy on your CV or cover letter. It will make you stand out, make the employer think about this when they are meeting you (and anyone else) and allow you to create value that you are more than just a DVM and a heartbeat. You are a caring, life-saving, motivated, hard-working, amazing human being, who also needs to care for yourself!
We all have values, we can’t be too scared to express them. Being human and setting standards is a strength, and trust me, if people don’t want to hear about your values, they’re not worth your time.
Link to The Desire Map:
By Dr. Heather James
So I feel like I need to write something to people struggling with the “I feel like a failure because I lost a patient” guilt/shame enough on this board that I’m going to make a new post just so my thoughts aren’t buried in a reply thread.
I struggle with it still but please try to remember how much good you remarkable minds do for this world.
My latest version replying to an anonymous post is copied below, (edited to be less specific to that post.)
I hope every one here knows that what you do is literally awesome, in the truest biggest sense of the word.
“YOU ARE A BADASS WARRIOR HEALER.
YOU WERE/ARE FIGHTING AN UNRELENTING, COLD, INEXORABLE ENEMY THAT NEVER QUITS.
YOU WERE BATTLING DEATH. FFS.
Most of the time- fuck, most of the time- we lose.
It is the worst thing about medicine— we are fighting what is almost always a losing battle.
But it is a deeply noble and necessary fight. It is a gift to the world to pull on your coat and wade back in to the battlefield.
And you did it to the best of your ability.
Not only should you not be feeling like a failure— you should be fucking proud. Hell we are ALL proud of you.
You hold your head up— you stared death in the face and fought until you couldn’t fight anymore. That’s fucking HEROIC.
Shame on those who belittle your efforts. They are unworthy of your awesomeness.
So, how do you move on? One step at a time. One case at a time one differential and one diagnostic. One tiny win at a time.
But never forget you are a brilliant mind doing important good in the world. No matter how many complications. No matter how many time we lose. No matter how many times we fall.
The winning comes when you decide to get back up. Stand up.
Stare that heartless bitch Death down one more time. For your patients. And for the joy and the love and good THEY add to the world.
You’re a warrior for those who can’t fight for themselves. Always.
You/We are part of the 0.03% of people with the brilliance and know how to push back against death. Thats truly amazing.
You/We (ALL OF US) are amazing.
Always remember that.
And the rest of us are here if you need us.”
by Monique Koll, DVM
Do you know what mindfulness is? It is “the psychological process of bringing one's attention to the internal experiences occurring in the present moment, which can be developed through the practice of meditation and other training.”
It has been proven to be a valuable practice for improving the cognitive symptoms of depression, such as distorted thinking and distractibility. It helps individuals recognize these more subtle symptoms, realize that thoughts are not facts and refocus their attention to the present.
Meditation is a way to practice mindfulness, which can be difficult when you’re distressed, as it is hard to break that one-way train of thought. I find that guided meditations are a great entry point in a way to start practicing mindfulness, and Tara Brach was recommended to me by a double-Mastered practicing mental health specialist. Here is a link to her website and some of her meditations.
We're very pleased to announce the launch of MightyVet!
MightyVet is a movement to help further education and mentorship for all veterinary professionals. The MightyVet website will provide free RACE certified CE, access to mentors in the field, and much much more!
Please join us in helping our community become the best version of itself!
Sign up to receive more information at www.MightyVet.Org
by Dr. Monique Koll DVM
Hi, I’m Dr. Monique Koll, a USA licensed and accredited veterinarian since 2005. I’ve been in small animal day practice for years and now do full time emergency medicine.
I also spent 5.5 years in nonhuman primate research, which ended when a C7 incomplete spinal cord injury paralyzed me when I was hit by an unlicensed/uninsured driver. All that, on top of being a single mother, in an incredibly abusive relationship and high student debt, and I’ve been through suicidal thoughts and financial struggles and all of the above. I’m lucky; I’m only partially paralyzed and can practice again, I had good support and now am in the healthiest relationship of my life and my son has actually benefited from what we’ve been through and is emotionally mature and well grounded.
My injury, and subsequent determination to still race half marathons and triathlons, has earned me a spot on the Today Show, as well as a couple of times in the Huffington Post, and several television, news and blog interviews on a local, national and international scale. Being from New Orleans, I am the epitome of outspoken and non-judgmental. This inevitably led to me becoming involved in “active transportation” and worked with my local and state governments to help change rules to benefit society. I’ve written several articles and have given several speeches to this end, and while city planning and transportation is still a hobby of mine, veterinary medicine is my first love and I want to use my spare time and resources to support our profession. I am dedicated to do what I can to help our mental, emotional and financial health, and the best way I can help at this time is to contribute to NOMV’s blog. Overall we will come through this a stronger and even better loved and respected profession than before, and I want to be part of that. If you have any questions or concerns, any general or specific topic you’d like more information about; if you see a media piece you think may be helpful or even have something you’d personally like to contribute, please let me know via Facebook or firstname.lastname@example.org
I am excited to work for and with all of you.
Monique Koll, DVM
The Admin Team of NOMV is a group of veterinarians dedicated to improving veterinary mental health.