The Complex Relationship Between Veterinarian Mental Health and Client Satisfaction
It has been noted that Canadian veterinarians tend to experience relatively poor mental health compared to the general population, being afflicted by higher levels of anxiety, depression as well as occupation-specific conditions such as burnout and secondary traumatic stress. Little research has been published regarding the impact that veterinarian mental health may have on veterinary clients and patients. In the human medical field, the mental health of the caregiver is associated with caregiver professionalism, patient safety as well as patient satisfaction. However, in the veterinary field the unique relationship between veterinary-patient-client and the broad scope of veterinary general practice can make the analysis of patient outcomes challenging. Client satisfaction does represent an important part of healthcare which is more easily measured.
Veterinary client satisfaction can influence the outcomes for all three members of the veterinarian-client-patient relationship. A satisfied client is more likely to adhere or intend to adhere to veterinary recommendations, which directly impacts patient outcomes. Client adherence is also likely to impact clinic income as client satisfaction can have a powerful impact on the business revenue stream. At the same time, veterinary mental health and career satisfaction may be impacted by client satisfaction, as building relationships with clients and patients are some of the most rewarding aspects of the profession.
In the following study, a target size of 60 veterinarians in southwestern Ontario, Canada were recruited to complete a survey that included psychometric scales measuring resilience, perceived stress, anxiety, depression, emotional distress, emotional exhaustion, personal accomplishment, burnout, depersonalization, personal accomplishment, secondary traumatic stress and compassion satisfaction. 995 companion animal clients of these veterinarians were then recruited in-clinic over 2-3 days and were asked to complete a post-appointment survey including the Client Satisfaction Questionnaire, which asked about different aspects of the appointment. This study, being the first to assess the practical impact of veterinarian mental health on veterinary clients and patients, had the following results:
- Overall there were associations between client satisfaction scores and the mental health measures, but the complexity of the association is the most important finding of the project
- In several of the models, relatively higher client satisfaction was unexpectedly associated with poor veterinarian mental health states, whilst lower client satisfaction was associated with mental health scores suggestive of wellness
- The interaction between veterinarian gender and age had a significant association with the Client Satisfaction Questionnaire score in multilevel, univariable analysis as well as all multilevel, multivariable models. For female veterinarians, CSQ was positively associated with age and for male veterinarians, it was negatively associated with age
- The relationship between CSQ and the Connor-Davidson Resilience (CD-RISC) scale score was not linear and was best fit with a third-order polynomial of the CD-RISC score
- The relationship between the CSQ score and the Perceived Stress Scale (PSS) score was not linear but also fit best with a third-order polynomial of the PSS score
- The relationship between the HADS Anxiety Subscale, the HADS Depression Subscale and the HADS Total Score – Emotional Stress were not linear and fit a second-order polynomial
- Of the associations, client satisfaction scores were estimated to have the most variation across the range of secondary traumatic stress scores relative to the other mental health measures
- Although the personal accomplishment scale demonstrated the positive association with client satisfaction, the magnitude of the association was fairly small compared to many of the other scales, many of which estimated relatively higher client satisfaction scores at the end of the scale suggestive of poor mental health. This was unexpected given the outcomes in the human healthcare setting, where negative mental health measures were associated with lower satisfaction
- Recent research into the sources of stress within the veterinary profession has drawn attention to ethical conflict in the veterinarian-client-patient relationship. For example, while veterinarians get satisfaction from empathy toward their animal patients, client satisfaction is based more on expressions of empathy directed toward the client
- Since this present study was cross-sectional, the direction of causal relationships cannot be determined. Therefore the associations described may suggest that overall client satisfaction has a significant impact on veterinarian mental health
In conclusion, further studies are needed to explore the association between client satisfaction and client adherence to other types of veterinarian recommendations, clinic revenue and other effects suggested by the human medical literature. Since most small veterinary clinics rely heavily on a small business model, of which client satisfaction plays an important factor in determining client loyalty and referrals, the relatively small variation in client satisfaction scores overall, veterinarian and clinic income and career satisfaction means that the significant associations with veterinarian mental health requires further investigation.
Original Research Article:
Front. Vet. Sci. 25 February 2020