Suicide in veterinary medicine is a huge problem right now [PODCAST]

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“I am a veterinarian. More specifically, I am a veterinary specialist, board-certified in emergency and critical care. I don’t play with puppies and kittens. I treat the worst of the worst in a specialty hospital setting with a state-of-the-art ER and ICU. Despite years of education, including veterinary school, internship, fellowship, and residency to obtain this education and specialty board certification, I was not prepared for the emotional toll of becoming a veterinarian.”

Garret Pachtinger is a veterinarian.

He shares his story and discusses his KevinMD article, “Suicide in veterinary medicine is a huge problem right now.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Garret Pachtinger. He is a veterinary specialist, and he wrote the KevinMD article “Suicide in veterinary medicine is a huge problem right now.” Garret, welcome to the show.

Garret Pachtinger: Thanks so much for having me. Honored to be here.

Kevin Pho: So I’m interested in hearing your story and your journey to where you are today.

Garret Pachtinger: Excellent, love to. So veterinary medicine is a little bit different from human medicine. So, similarities: I went to four years of undergrad. I went to Muhlenberg College in Allentown, Pennsylvania. After that, I did my veterinary school at the University of Pennsylvania in Philadelphia.

A little bit different, though, from human medicine: In theory, if I wanted to stop right there and be a general practitioner after my four years of undergrad and four years of veterinary school, I could have stopped right there. I was a veterinarian, and I could have been a great general practitioner, at least I’d like to hope I would have been. But I had a little bit of a different path.

So as you said, I became a specialist, and what I did in my path is, after my four years of veterinary school, I then did a one-year general rotating internship. There are many veterinarians that do that general rotating internship, get another great clinical year under their belt, and then decide, “I’m going to go back out and be a general practitioner.” I decided to take it one or two steps further. So after my one-year rotating internship, I did a one-year fellowship in emergency and critical care, followed by a three-year residency in emergency and critical care medicine, and then took and thankfully passed my boards and became a critical care specialist.

So a little bit of a different path. I was not very diverse in that I did all of my training at the University of Pennsylvania, one of the big meccas for critical care. So I was technically there from ’01 until 2010, doing my vet school, internship, fellowship, and residency, and then moved out to private practice following those few years of education and training.

Kevin Pho: Can you give us some illustrations or stories of some of the cases that you see? And how has the pandemic affected what you’re seeing from your lens?

Garret Pachtinger: Absolutely. And so I’ll start with the cases. As a critical care ER doctor, I mean, literally, I see everything in the ER, from a simple torn toenail to a terrible ear infection, which may not seem that critical or emergent, all the way through the critical stuff you see on TV and you read in books and even in human medicine. So everything up and through a patient on a mechanical ventilator. The same machines that you use, we use as well: the same fluid pumps, the same CRI pumps, the same dialysis machines, or peritoneal dialysis, or CRRT, or mechanical ventilators.

So the bad stuff that I tend to see in the critical care unit are the terrible heart failures, respiratory failure, ARDS, DIC, major trauma, vehicular trauma, hit by car, attacked by other animals, terrible toxins that we see, some reversible, some without an antidote, and then, again, everything through being on a ventilator or needing dialysis. It’s sort of a huge, wide array, a huge gamut of things we get to see in the ER, just like in human medicine. So some fun stuff, some scary stuff, but a whole wide variety, which is really what drew me into emergency medicine. I get to see variety. I can kind of know and do everything, rather than be sort of a little bit filtered down to only seeing these types of cases. It gives me that variety and that adrenaline rush that I love and that I need.

But to go back to your other question, how has the pandemic changed who we are or what we do? I think the biggest takeaway for me is, not that I didn’t know this already, but veterinary professionals are incredibly resilient, and we can adapt to a lot. Most veterinary professionals started, and are likely still doing, a curbside approach. So it’s a little more challenging. Rather than having the family, the owner, the client, come into the building, come into an examination room with you, examine their pet with them, and talk to them face-to-face, now everything for us is pretty much curbside, where they pull up in front of our building. We have nurses that we call runners, in a sense, where they’ll get the quick history. If it’s a stat triage, they rush them right in. And much of what we do now is either a phone call or a FaceTime or something if we need to get face-to-face.

But it isn’t that same face-to-face experience, which I’m sure brings a little bit of a plus and a minus for everybody. But for me, being in the emergency room setting, everything is an emergency or a stress to that family, whether it’s a terrible ear infection, which is causing that dog to be up all night, or a hit by car, or an internal bleeding, or hemolytic anemia, or you name it, right, the more serious stuff. For me, it’s always nice to have that face-to-face communication so I can draw from the emotion, the body language, the eye contact that that family is giving me.

It’s a little more challenging to do that over the phone, when I can’t read those verbal or nonverbal cues from the family to know how this conversation is going. Are they slinking away in this conversation because something is over their head, or are they just so stressed? I can’t get that over the phone. So there are definitely challenges, and curbside has brought a lot of challenges.

But to me, again, the positives, we have to take the positives away from this, is we’ve really come together as a veterinary community and risen up and accepted these challenges and found amazing workarounds and ways that we can interact with families on a different basis, whether that is truly FaceTiming their pet when they’re in the hospital with us, because they can’t visit due to COVID regulations, or calling them an extra time or two just to make sure they know we’re taking care of their pets when they can’t visit. There are a lot of great things that I think have come out of this really stressful and challenging situation of COVID.

Kevin Pho: Let’s transition now into your KevinMD article, “Suicide in veterinary medicine is a huge problem right now.” Now, for those who didn’t read that article, can you just walk my audience through it and share the story of why you decided to write it?

Garret Pachtinger: Absolutely. And I would say, I don’t feel, and we should all say this out loud, this is not a veterinary-only problem. In fact, from the article, what I did is I first quoted one of your other blog articles that talked about this in the human medical profession just the same. So to be very clear, I don’t think this is a veterinary-only problem.

But for me, when it came to light was probably around, oh, geez, about seven years ago, when a notable veterinary specialist, a behaviorist, committed suicide. Up till then, it was one of those things where we knew it existed. We knew there was a problem, and it was one of those underlying rumblings within the profession, kind of like that old purple elephant in the room, right? We all see it; we just don’t want to address it. We feel as veterinary professionals we’re resilient. We’ve gone through a lot. We’re all type A people that have made it through a challenging schooling and profession, and there’s a lot of expectation. We all just kind of dealt with it. We kept it inside.

And then really, to me, this is my sort of door-opening, window-opening point. It was that veterinary behaviorist, her name was Sophia Yin. When she passed away, when she committed suicide, I think it really was eye-opening to the veterinary profession. And if nothing else, because clearly nothing about suicide is good, if nothing else, what we took from that is it really opened the door to the discussion of mental health in our profession.

And please, I understand this is not a veterinary-only problem. I know physicians deal with this: the constant phone calls and emails and communication. Veterinarians face this all the time, and you feel like you have to be on all the time. You have your shift, your 12-hour shift, and then you go home and you’re answering emails, and then someone’s upset you didn’t call back soon enough. And we all just accepted this to be part of what we do, who we are, our genetic makeup. To be veterinarians is, we are there to provide service.

And I think what it helped us recognize, and I don’t know that this truly is something we’ll ever really achieve, as we are all type A people, is that discussion of work-life balance and what does it mean to me to take care of myself so I can take care of you afterwards. And if nothing else, as terrible as Sophia’s death was, what it did was it really opened up our eyes as a profession to how prevalent mental health, or mental health issues, I should say, are in our profession and how prevalent suicide is.

And when you compare, and the numbers are in that blog, when you compare suicide in our profession as compared to the general public, which is often how it is standardized, it’s up to three and a half, if not more, times for female veterinarians, female veterinary professionals, as compared to the general public, to commit suicide. And even in the article, I said, you know, 60 percent of veterinary professionals are veterinarians, depending on where you look. I mean, the numbers are as high as 80 to 90 percent of veterinary professionals are female. Veterinary school classes, some of them are 100 percent female. When I went to veterinary school, from ’01 to ’05 at Penn, I was one of about 10 students, so maybe 10 or 15 students out of 115, that were male. So this field is predominantly female, and we have to recognize there are stresses on both men and women in this field.

But getting that out there, again, with Sophia’s death, nothing great about that, but I think we as a profession now talk a lot more about mental health. Many of these major organizations now have mental health initiatives where we’re being taught about mental health, we’re being taught about ways to improve our mental health, ways to seek guidance if we’re concerned about our mental health, or seek ways to improve it. There’s been a huge initiative across the veterinary landscape in the past, if I had to say, three years, and it intensifies each year, because this is a serious, serious concern.

The access is there. Veterinarians have access to euthanasia drugs. We have access to heavy opioids, the same in the human medical profession. We have access to many chemicals that, truthfully, it’s way too easy, if that is what’s on your mind, to do that. The access is there. Almost every veterinary hospital has something that can be used to commit suicide if you want to. When I was in veterinary school, we had students that were abusing opioids because access was simply there and too easy.

And so there have been many initiatives: mental health, some security. And now, like human medicine, we have the major, huge drug inventory systems that require fingerprints, sometimes double fingerprints, sometimes passwords. It’s not just opening up a cabinet now and there are your drugs, which can be detrimental if you’re not in the right state of mind.

And so if nothing else, my hope is my blog with you is one very small piece just to continue the conversation, to allow everybody, pet families, veterinary professionals. Because listen, I mean, we deal with this, and you deal with this as well. How many times can we ignore a one-star review on the internet, which, truthfully, isn’t accurate, right? There are only so many ways that we can have a rebuttal on Facebook or on Instagram about why something was said or done before it weighs on you, because we take pride and passion, a lot of it, in what we do.

And simply put, I mean, most veterinary professionals are simply not in this for a paycheck. The reality is we get paid much less than our counterparts in the human medical field, for a variety of reasons. That’s not my point or topic, but the point is we don’t do this for the paycheck. We do this because of what we feel like we were born to do: our genetic makeup, our love for pets, our love for families, our love for medicine.

You know, I know for me, I didn’t get into this initially, but before I decided I wanted to become a veterinarian, when I was much younger, as I was just figuring myself out, I had a family member, my grandfather, who was an optometrist. My mother is a hygienist. I did a pediatric externship in a human hospital, and I was trying to feel myself out. And some things didn’t feel right. This felt right, and it wasn’t for the paycheck. I had no idea at 13 or 14 or 15 years old who got paid what. I wanted to know what I would love to do, because I want to do something I love every day.

You know, when I was little, I loved playing baseball. That was my passion until I graduated college. I played baseball. I loved doing it. It wasn’t a chore to get up in the morning and go for the 5 a.m. run that was team-mandated or hit the weight room. I wanted to have that passion in my profession like I had it in my amateur athletic activities, right? And so I didn’t care about that. No one cares, when you’re 15, how much you’re going to make. You wanted to do something every day you love.

And we do this because we love it, but we also have to recognize that our love needs to be one part of the puzzle in what we do. Our mental health has to be there to continue to love what we do, right? No different than any profession. So I think, again, in summarizing that, all professions, including our medical profession, human and veterinary together, we need to recognize that in order to take care of others, we do need to take care of ourselves, make sure we’re in the right physical and mental capacity and emotional capacity, right, to do that.

And so to continue this conversation is simply one thing that I can do positively for our profession, and just continuing to say this exists. Mental health awareness needs to be out there. Mental health problems exist, and it’s not a scarlet letter. It doesn’t tarnish you. You know, I always think about this when it draws back to me: From what I understand, a lot of psychiatrists or psychologists seek talking to somebody else as part of what they do, just the same, right? They’re not perfect. They listen to us, but somebody else listens to them. And that to me is always a reminder we don’t have to be perfect. Nobody’s perfect. We just have to be ourselves, right, and recognize when something is not right, recognize when we need support, and it’s OK to do that. It’s very OK to do that. And to continue that message is incredibly important.

Kevin Pho: Right, absolutely. I think that one of the things that I try to do on my site, in my blog, is really to normalize mental health conversations and problems across the health care spectrum. And like you said, this is not just a physician problem or nurse problem, but it spans across any type of health care spectrum. Now, from a veterinary lens, what are some specific challenges that may lead veterinarians towards burnout and down that path to behavioral health issues?

Garret Pachtinger: Great question. And I think it stems from the fact that most people go into veterinary medicine thinking, “I’m going to go to school, undergrad, veterinary school, and I’m going to become a veterinarian. I’m going to see cases.” That’s all they think is out there in veterinary medicine. They don’t recognize that if there comes a point where you are burnt out, whether it is because caseload is just too high or the employment situation isn’t ideal for you, there are so many options out there. It’s almost that you feel stuck where you are right now. There are so many job opportunities, employment opportunities, for veterinarians outside of simply seeing cases, and there are so many practices that you can move or go to. You feel stuck.

And I think that veterinary medicine is not unique among medicine, but I think is unique in a field where there’s not a lot of transition. It is very common for somebody to enter a practice and work there 10, 15, 20, 30 years and to be lifers within that practice. I have friends and family members that are in different fields, and they never stay in one place. In fact, it’s incredibly hard for them to vertically become promoted or do something more with their lives because there’s already somebody in that position.

And so what they do is they gain a couple of years of experience here, and then they get headhunted and go somewhere else, and it’s this zigzag mentality until they go where they want. But they get variety. They get change. They get experience. They get the excitement and re-energize by going to another organization, seeing other people, doing something else. And that’s super exciting for them, to be able to go into that field and do something else over and over and over in a different job.

Whereas veterinarians, again, they go to that one field, that one hospital, that one practice, and they’re there forever, and they don’t recognize, they don’t see a way out. They don’t see a better way of doing things. And I think the biggest takeaway I have for them is to recognize the veterinary field is diverse. It is unique. And if you’re not happy where you are, and that’s contributing to your stress or your anxiety, there are so many opportunities, whether it’s a different practice to keep seeing cases, because you love medicine, to go into academia, to go into writing, to go into industry. The options are endless. To go into government, I mean, I shouldn’t avoid that; government has great opportunities. These opportunities are absolutely endless in our field.

Kevin Pho: We’re talking to Garret Pachtinger. He is a veterinary specialist, and he wrote the KevinMD article “Suicide in veterinary medicine is a huge problem right now.” Garret, for those veterinarians who may be feeling signs of burnout and perhaps behavioral health issues, what are some pieces of advice that you could give them, and what are some resources that they can look up?

Garret Pachtinger: Absolutely. And the first piece of advice is, I’m glad that they have recognized this problem, because I think just recognizing that you need help or support is easily the first step, right? The second step is to talk to, I would recommend talking to, your physician. They’re the people that can put you in touch with the mental health professionals that you need to talk to.

The other thing that I would say is, as long as you trust your employer, and it’s always hard to know everyone’s unique situation, many, many people like ourselves have opportunities to take PTO, personal time off, whether it’s a day here and there for mental health, or it truly is to take time off, whether it’s a sabbatical or something else, to re-energize, to get your life back together, to reflect, to decide if that’s what you want to do.

Many organizations, I will also say, have this in place already for you, and it’s just that you didn’t know or you didn’t ask. I know some of the major corporate veterinary practices not only have on staff licensed social workers or therapists that are veterinary-oriented. Outside of my clinical work, my other sort of role is I’m the co-founder of an online education company called VETgirl, and we actually employ Jeannine Moga, who is a human and veterinary licensed social worker, and she does educational concepts for us. I know there’s another veterinary organization, Banfield, that also has a licensed social worker in their system.

And many of these organizations now have them in place already. They have also people that are there for you from a confidential standpoint, that you don’t have to give any personal information. You can go to them anonymously. They are bound by that anonymous statute, where they’re not going to tell your employer. They are there simply for you.

But I would easily argue that if you are feeling down, there are hotlines to call. If you are feeling depressed, there are hotlines to call. Or if you’re feeling you just need somebody to talk to, most professionals now have this already in place. You may just not know it is there. So seek help, seek support, seek advice. It is there for you. There are absolutely people to talk to each and every day, 24 hours a day. They’re in place for you already.

And again, as I said before, there is no shame in talking about this. It is no different than having an infection. This is something that medical professionals are there for. We should shout this from the rooftops, right? You need to know this is there, this exists, that suicide is not the way out. Maybe leaving your job is, maybe changing your job is, maybe taking time off from your job is, but suicide is not the answer. There are many people that love and care for you and that are there for you each and every day.

Kevin Pho: And my final question: What is your take-home message you want to leave with the KevinMD audience?

Garret Pachtinger: I think, no, I think I know my take-home message: I’ve never been more proud to be part of the veterinary industry. You know, my two roles right now, as I said, I work in the education environment with VETgirl, and I’m also, a job transition, I’m now the director of critical care education for a group called VEG, the Veterinary Emergency Group. And I’ve done that for myself because I needed a change from the clinical setting, right?

So what I’ve learned over the past 15, 20 years being in this profession is, as veterinary professionals, our front desk staff, our nurses, our technicians, our doctors, and everybody around this profession, we are resilient. We are incredibly dedicated to what we do each and every day. And I think that we have to understand that we have put ourselves in a position of high regard and high esteem.

There are many people, and I say this to myself every day when I sort of wake up and do what I do, that I can’t count. I can count on one hand in the next five seconds how many people would say to me, “I wanted to be a veterinarian, but,” when I see them in practice, so when I talk to them over the phone. I think about that every day, and I’m blessed to be part of this industry.

And I want everyone out there in the veterinary industry to know how thankful we are to have you in this profession, how thankful the families and clients are each and every day when they bring in their pets. And I want you to always remember that. So when there’s a down moment, yes, there’s somebody to talk to, but you have to know how valued, trusted, and respected you are in this industry, and to always remember that, especially in those down, turbulent, trying moments, is that people love, care for, and respect you and would do anything to be in your place.

Kevin Pho: Garret, thank you so much for sharing your time and insight, and thanks again for being on the show.

Garret Pachtinger: Thanks for having me.

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