I tell Mr. Smith what I tell all my clients when they say this to me — “A peaceful death is the best last gift we can give them, after all the years of loving friendship and loyalty they give us.” It’s how I truly feel, especially after watching family members pass away in a hospital or in a hospice setting. After I’ve given the drugs and confirmed Fluffy has passed Mr. Smith kisses the old poodle’s head and mumbles, “See you soon buddy. Give mom a kiss for me.”

Mr. Smith coming to the ER for a euthanasia is a symptom of the greater issue in veterinarian medicine. His normal veterinarian retired after 40 years in practice and the two vets who took over didn’t have an opening for three weeks. Fluffy couldn’t make it that long.

There’s been a lot of talk about the crisis of veterinary medicine — from mental health and suicide rates to staffing shortages. There’s also been a lot of conjecture on what to do to fix this problem, with corporations leading the call for mid-level practitioners (likely so they can pay people less and see more patients) and new schools being built without a full staff of doctors.

What is driving this worldwide veterinary crisis?

Suicide

The most common discussion about the veterinary crisis focuses on suicide. Male veterinarians are 1.6 times more likely to complete suicide than the general public, and female veterinarians are 2.4 times more likely. An often-ignored statistic is that 5 times as many male veterinary technicians and 2.3 times as many female technicians complete suicide over the general public. (2020 Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report)

These numbers are all pre-COVID figures, which don’t consider the sudden uptick in veterinary visits during the pandemic. 9.7% of veterinarians complained of “serious psychological distress” in the fall of 2021, up from 6.4% in the fall of 2019. Their top stressors? Shortage of qualified staff members, high levels of debt, the suicide rate and an overall shortage of veterinarians. 18% of veterinary support staff reported feeling “serious psychological distress” during this time. (Merck Animal Healthy Veterinary Wellbeing Study III)

Euthanasia

“Chance is suffering, we can give him a peaceful passing. His last memory will be falling asleep in your arms,” I tell a client. Chance has an auto-immune disease where he destroys his own red blood cells, and in the last few hours he’s thrown a blood clot to his lungs. He’s now in respiratory distress, and the owners don’t want to put him on a ventilator.

I’ll use that statement multiple times during the day, along with, “There are things worse than death.”

Many veterinarians who experience burn out leave traditional practice for mobile euthanasia, where they go to owners’ homes to euthanize their pets. They talk about flexible hours and grateful clients, how switching to exclusively euthanasia has reinvigorated their love for the field.

Whenever someone blames euthanasia for the veterinary suicide rate, I can’t help but wonder — is it that we are the only field to euthanize our patients, or that we internalize the idea of a ‘peaceful end to suffering’ and relate it to our own suffering?

Student Loan Debt

According to the AVMA (American Veterinary Medical Association) the class of 2019 has an average of $183,302 student debt from veterinary school alone. Federal loans for professional students are no longer subsidized, meaning they accrue interest the minute they’re taken out. Those interest rates vary from 5–9%, and compound daily.

Yes, daily — that’s not a typo. Depending on the debt burden, these students can accrue up to $40–90 in interest a day. That means a $183,000 loan accrues $1,024 in interest a month, assuming 7% interest. Most borrowers opt for an income-based repayment plan, which means they pay a monthly payment based on their income and after 25 years of never missing a payment the remaining amount is forgiven.

That forgiven amount? Taxable income. Most veterinarians have a savings account just for the tax bomb they see after those 25 years. Pairing with median income of veterinarians hanging around $95,000 you can quickly see how this is a load too heavy to bear.

That’s not even factoring in large animal or equine veterinarians, who make even less a year. They’re also a quickly disappearing work force, leaving the remaining large animal veterinarians to service hundreds of miles of clients.

Imagine taking out a home loan in 2019 for $180,000 and making a monthly payment on it. At the end of your mortgage term, you’ll own a house. Making the same monthly payments to a student loan burden of the same amount leaves you owing more than you originally took out in 25 years.

It’s easy to blame student debt — but student debt is not unique to veterinarians. Pharmacists, M.D.s, and dentists all have large student debt. While their incomes tend to be considerably higher, there must be more to the story.

Ethical Stressors

Ms. Anderson brings in her dog Bella because she’s been vomiting for 3 days. Bella has two sets of at home vaccines and tests positive for parvovirus. Parvovirus is a serious GI virus that can be fatal, even if aggressively treated. The options for treating parvo are –

a) hospitalize to the tune of several thousand dollars with an 80–90% survival rate,

b) try your luck with at home treatment for a few hundred dollars and a 50/50 chance of survival, or

c) euthanasia.

Ms. Anderson is surrounded by her three young children, who all clutch Bella and sob. They love Bella, she’s the best puppy they’ve ever had. Ms. Anderson is a single mom, and it took scraping by the last 3 days to get the money for the exam. Does she take Bella home and try to treat her, while also risking having her young children watch their puppy die? Or does she euthanize her now and save the family potential heartbreak?

A snarky person would say, “Vaccines are $10, should have gone through an actual vet” or “if you can’t afford the vet, don’t get the pet.”

The veterinarian dealing with the case knows these statements are irrelevant — Ms. Anderson is here now with Bella, not 3 weeks ago when she got the puppy. Since when are low-income people not allowed to have pets?

Sometimes, in the middle of euthanizing an animal for a completely treatable disease due to finances I ask myself, “I came into this field to help — who the hell am I helping?”

Then there’s Mrs. Butler and her indoor/outdoor cat. Well, it’s not her cat, she just feeds it and it’s lived in her house for 10 years. The cat is so thin you can count all its ribs, and it’s so dehydrated that its eyes are sunken in. The cat also hasn’t moved during my entire exam, too weak to get up. I diagnose it with FIV, a disease similar to HIV in cats, which is transmissible to other cats by bites. I inform Mrs. Butler that if the cat survives, it can no longer be an outdoor cat, as it has the risk of infecting every cat in the neighborhood.

She refuses further testing, electing instead to take home some antibiotics — which is the only reason she came in today anyway. She also tells me she will not make the cat indoor only. I discuss euthanasia, because the cat is clearly not doing well, and she declines. “He’s always been a little thin, and he’s probably just tired because it’s hot out.”

When I call animal control for a wellness check they tell me, “Well, she brought the cat into the vet — you can’t make her treat it.”

Client Abuse

Mr. Johnson brings in Toby because he was hit by a car three days ago. Since then, he hasn’t urinated or defecated, he also can’t walk. He just sits on the ground and cries. When the veterinarian expresses their concern that Toby may have a broken pelvis and will likely need expensive surgery, Mr. Johnson takes his frustration out on the staff.

“How do you sleep at night knowing you’re the reason my pet will die?”

“The fact you don’t take payment plans shows how heartless you truly are.”

“You’re all in it for the money, it’s always money with you people.”

If you did payment plans, you’d go bankrupt in less than a year — statistics back that up.

These are not exaggerations — these are accusations constantly lobbed at both the veterinarian and their support staff.

There’s been countless cases of people taking to social media to critique their vet. Due to privacy laws most veterinarians cannot tell their side of the story, and so they have to watch as a client destroys their clinic or their name. Clinics sometimes must turn their phones off because of the constant barrage of death threats over a viral post, limiting their ability to treat their patients.

It doesn’t stop at cyberbullying — there’s the physical threats too. A few years ago a man in Oregon tried to light an ER on fire with pets inside it. Just a few weeks ago a veterinary technician was shot and killed by an irate client.

At the end of the day, you never know which client is going to be the one to go through with their threats.

Selection Bias

The average GPA of the incoming class of 2024 was a 3.6.

Applicants averaged over 1,500 veterinary hours or about a thousand animal hours, which equates to 19–28 hours a week over a year, or 10–14 hours a week over two years. That means that when they get to veterinary school they’ve spent the last few years prioritizing exclusively animal and veterinary related activities. Other activities, things that would make a student ‘well rounded,’ fall by the wayside.

When the only thing you know is school and your job, is it such a mystery when these people crash so hard when one of those two things fail?

When you select for compassionate, intelligent, hyper-focused people who’ve hinged most of their young adult life on becoming a veterinarian, it shouldn’t surprise anyone that when they meet bumps in the road their world crashes down a lot harder than it would for some others.

Retention

Short staffing was one of the top reasons for veterinary stress. Many schools and industry leaders are trying to solve this problem by creating more veterinarians or more veterinary technicians. This doesn’t address a big part of the problem — that the field has a huge turnover rate.

According to AAHA’s 2020 Compensation & Benefits surgery, veterinary technicians have a 23.4% turnover rate and associate veterinarians have a 16% turnover rate, with an average of 23% turnover rate across all members of the staff. This is compared to a national average of 19.3%.

While there are no numbers about how many of those are leaving the field completely (some estimates say 50% of vet techs leave the field each year), an AVMA study in January of 2020 reported that 40% of veterinarians contemplated leaving the field all together.

You can keep adding water to a bucket, but if you don’t fill in the holes, you’ll always have a leak.

Small workforce

According to the AVMA, there are 124,069 veterinarians in the United States. 78,717 of those work in clinical practice. Of that 78,717, 67% work in small animal, 4.2% work in a mixed practice of large and small animal, 4.1% work in equine, and 3.9% work in food animal.

That means that in the entire United States, there are about 66,387 veterinarians to take care of companion animals.

In the entire United States, there are about 3,785 equine veterinarians.

Compare this to 66% of households own a pet, with an estimated 65.1 million U.S households owning a dog and 46.5 million owning a cat (American Pet Products Association 2023–2024).

Where does that leave us?

When I talk to people about the “dark side” of veterinarian medicine on my account, this is what I mean. The stressors that affect the field are multifactorial, and when added together they create a pressure that isn’t conducive to a happy life. Low income, cruel clients, high student debt burden, compassion fatigue and short staffing lead to an environment that sets people up for failure.

The crisis isn’t just one numeric — it’s all of them.

It’s a field of workers who are underpaid and underappreciated.

It’s new graduates with student loan burdens so high they can only take certain jobs, causing a shortage amongst the lower paying ones.

Less veterinarians means more stress in certain fields and locations, creating burn out and unsustainable work life balance.

Less support staff means that veterinarians cannot see as many patients as they want to, or spend more time doing technical tasks and less time on records.

High turnover rate means spending more money to train new hires, effectively having less money to go around for the current employees.

It’s the worry that one viral video telling a one-sided tale could topple your entire clinic and livelihood, with no repercussions for the other side.

It’s emotional blackmail and compassion fatigue when you just can’t handle another sick puppy, or another preventable euthanasia.

The crisis is far from being understood or mitigated, and I don’t think there’s a one size fits all solution to the problem. Educating clients on the cause of wait times and staffing issues is one step to garner understanding, and hopefully take some stress off the veterinary staff.