Attrition of veterinarians from clinical practice and the influence of moral distress

Abstract

The veterinary profession is recording anecdotal reports of workforce shortage despite surplus expectation. There are two reasons for this concern: a) the time taken to fill available veterinary practice positions is longer, and b) the percentage of intention to leave professional practice is increasing. It is anticipated that these issues arise from veterinarians leaving practice rather than a reduced intake into the profession. Due to the critical role veterinarians have in society, maintaining an adequate workforce is paramount, prompting necessary research to understand the reasons that might be associated with veterinarians leaving clinical practice. Previous research in veterinary attrition has focused on specific groups, such as farm animal veterinarians and emergency clinicians. Only recently has investigating strategies that improve overall retention in veterinarians received attention. Previously reported reasons for attrition include: having emergency duties, poor work-life balance, poor salary, negative work environments and occupational stress. A phenomenon known as moral distress, has been related to career attrition and staff turnover in medical professionals. Moral distress is defined as the psychological and emotional anguish a professional experiences when confronted with a situation where they cannot undergo what they consider to be the morally correct path. This phenomenon has been linked to emotional distress in veterinarians but received limited investigation in veterinary clinical practice. Due to the magnitude of the deleterious effects on staff wellbeing and patient care as well as its relationship with job abandonment in healthcare professionals, an investigation of moral distress and its relationship to attrition from clinical practice was deemed warranted. This dissertation aims to identify why veterinarians leave clinical practice, and establish a possible link between attrition from practice and moral distress. Firstly, the literature on moral distress in veterinarians was examined for a clear definition. A theoretical model was developed illustrating how exposure to a moral conflict can create a moral deliberation pathway into moral distress. The literature for healthcare professionals exposes moral distress as a possible cause for staff turnover, indicating that a similar contribution could occur in veterinary clinicians. A qualitative exploration of attrition from clinical practice was performed using this theory. A thematic analysis was conducted to understand why former veterinary clinicians had left clinical practice. Two themes emerged: Personal Factors and Work Experiences. It is ascertained that a combination of these two themes influenced veterinarians to leave practice. Several subthemes within these two broad categories emerged, outlining a detailed list of factors hypothesised to be associated with attrition in veterinarians, including moral and ethical conflict. Following the qualitative study, a survey was disseminated among current and former veterinary clinicians to test the association between factors identified in the qualitative study and attrition from practice. The results link attrition from clinical practice to: working longer hours, having on-call duties, working for lower salaries, working in metropolitan regions, being motivated by social purpose, experiencing lower burnout and lower compassion satisfaction, being dissatisfied with scheduling, and experiencing low personal job satisfaction. The results in relation to burnout and compassion satisfaction need to be interpreted in the light of the scale limitations when used in a retrospective fashion. A scale for veterinary clinicians (MDS-V) was created to evaluate the influence of moral distress. The MDS-V has three sub-scales: 1) team relationships that compromise patient and client care, 2) conflicting client interactions, and 3) situations perceived as personal threats. Although moral distress was not significantly associated with attrition, it is associated with psychological ill-health in veterinarians and medical professionals. Therefore, it is important to understand moral distress in order to mitigate its deleterious effects. This study provides a better understanding of this phenomenon in veterinarians. Aims of the dissertation 1. To explore the pathway of moral distress when exposed to a moral conflict in veterinarians. 2. To understand the reasons for former veterinary clinicians to have left practice. 3. To develop a moral distress scale to measure moral distress in veterinary clinicians. 4. To assess the risk factors associated with attrition from clinical practice (including moral distress) in veterinarians.