The Hardest Decisions I Make as Veterinarian Aren’t Medical

A few months ago I made a post about this idea and it seemed to resonate. I’ve seen too many doctors step away from practice recently. I became curious why friends and colleagues reached burnout around 5–7 years post-graduation—and either left the field or suffered every shift.

My observations led me to this conclusion: the hardest part of my job is not making medical decisions. It’s making financial and ethical decisions.

The Spectrum of Care

I often work in inner-city veterinary ERs where I get a mixed bag of customers. One end of the spectrum is customers who elect to hospitalize their dog with pancreatitis for 4 days, saying yes to NG tubes, ultrasounds, and daily bloodwork checks. The other end of the spectrum is customers who have a puppy with progressing parvo, but no funds for even the emergency exam fee. I see cases all over the map between these two examples. They’re often entangled with complex ethical and financial decisions that need to be made.

Finances are Intertwined with Every Treatment Plan

For those in vet med, you know that your ability to diagnose and treat pets depends on what the customer can afford. For those not in vet med, I provide an estimate to every pet parent after getting a clinical history and performing an initial exam to determine what needs to happen next.

In a daytime vet practice, the average bill is probably $200–400. At the ER, the average bill is $1000. This is the cost of care, and I can assure you that vets are not hiking prices simply because they can. The increased cost of veterinary care over the last 10 years is primarily due to the elevated standard of care expected for pets now that they’re often treated as family members. Prices are also what they are to sustain fair wages for vets and vet nurses/vet techs. This point alone could be an entire post. Of course things like rent, cost of goods, equipment, etc. have inflated too, consistent with other industries.

All of this to say, veterinary care is a service that costs money. It’s similar to human medicine in some ways, but insurance isn’t widespread, there’s no Medicare or Medicaid, and there are no vet clinics required to treat pets with no money (like a hospital would for a person who can’t afford care). This little “finance” difference profoundly changes the way I practice vet med.

Tough Decisions I’ve Had to Make

I want to highlight the complexity of decisions I make as a veterinarian. Clearly these decisions haunt me because of the emotional toll they took in the moment and while processing them later.

• 3yo MI overweight bulldog with acute respiratory distress due in large part to brachycephalic obstructive airway syndrome (BOAS), exacerbated by heat. About to arrest. Wet sounds in lungs. The ideal estimate was $2,000+ with surgical correction of BOAS needed after emergency stabilization for a few days. Surprise—the customer had $100. I gave options for an abbreviated estimate and helped them apply for 3 different credit lines (declined on each). Middle of the night with no transfer options. The pet is suffering. What do I do? It’s agonizing to euthanize young pets that have a shot at being cured. But that’s what I did.
• 4yo FS DSH cat hit by the neighbor’s car. The owner was willing to do everything to save his cat. The cat looked stable, but $2000 later after pain meds and diagnostics, I realized the cat had a ruptured bladder, broken pelvis, and an open fracture near one of her joints. The owner kept asking me if his cat would make a full recovery, if she’d 100% survive if he transferred to specialty, and what the approximate price would be. Sure, each injury on its own can technically be treated. But I can’t guarantee that if he spends $20,000 his cat will be okay. This was a hard call given the factors at play: he wanted to do the right thing, he’d already spent a good amount of money, the accident was tragic, he travels for work and was flying out that afternoon for a two-week trip, the cat was young, and each injury alone could technically be fixed. But that’s a long road to recovery for a cat and a big commitment for him to make. What do I do? We ended up euthanizing. I cried in this one.
• 6-month-old mixed breed puppy presented for ingesting part of his e-collar after having emergency foreign body surgery at the hospital 4 days ago. The owners blamed the hospital for the e-collar being a “high risk” for ingestion (...yes, true story). I tried inducing vomiting but it didn’t work because the owners gave the dog Cerenia earlier. I discussed the risks that this could cause another foreign body. The owners were upset (obviously, the situation sucks) but they took it out on me, blaming me for being careless. What do I do? I have empathy for what they’re going through and I’m also firm and clear that hospital provided excellent care, there’s still a risk present, they may be back, and it will be an additional cost.
• 8yo MN DSH cat presented for eye twitching a few times that day but was otherwise healthy. Bloodwork was normal. The cat came back the next day and the twitching progressed to be more frequent and affect a wider area. I offered hospitalization, a full diagnostic workup, and anti-seizure meds. Six hours later at 2am, the twitching progressed to full-body seizures breaking through all medications. What do I do? The owners were SO kind. I called them to come to the hospital, explaining the options were to transfer to an ER with neuro or humanely euthanize. These owners would do anything and they did all the right things, but the latter was elected. This was a sad one for me and the whole team.

Here’s Why These Cases Are Tough

The wild part is that of the 10–20 cases I often see in a shift, at least a quarter of them are complex like those listed above. They’re complex because:

• It requires making a hard call (hello, decision fatigue, regret, and second-guessing)

• It’s sad (euthanasia is ALWAYS sad)

• It hurts when people blame me (fortunately these are more rare because I’ve worked on my communication skills, but when it happens I feel anger, defeat, and unfairness because I truly care about what’s best for the pet)

• I don’t have time to process my emotions in the moment (they stay suppressed throughout the shift so I can move from case to case)

THIS IS WHY VETS BURN OUT. This is why vets leave the profession. This is why vets have pre-shift anxiety. This is why vets have trauma. This is why vets search for ways to numb out. Arguably, this is why some vets seek out leadership roles off the floor (yes, I know—bad reason to get into leadership, but I’ve seen it many times). It’s not the medicine. It’s the other stuff.

Vet Med is Challenging, So Let’s Rise to the Challenge

If being a veterinarian were only about the medicine, maybe burnout wouldn’t be as common. But that’s not reality. I have to work within the constraints that exist. Vet med isn’t the only industry with difficult parts.

There are real skills that can be developed to deal with these situations in healthier ways. The problem is that most vets NEVER learn them. Here’s what has helped me the most:

1. Reading – This helps normalize what I’m going through and provides solutions. A few noteworthy books: The Body Keeps the Score, How to Win Friends and Influence People, and The Power of a Positive No.
2. Therapy – Therapy helps me process the hard moments and let go of what isn’t serving me. Why did I get personally offended by a customer or by a boss? Why was that one shift so draining for me? How am I making it harder than it needs to be?
3. A Coach – I almost always have a coach. Coaches are action-oriented. They hold me accountable. They help me level up. They give me practical ways to set boundaries, do things for fun, make decisions that align with my values, and make changes when I’m out of alignment.
4. Happy Vet Med Colleagues – It’s important to have a healthy group of friends who can relate to what I’m going through and offer positive reframes. Find the people who are ENJOYING vet med and enjoying their whole lives. Hint: I’ve met many of these people in the The Evolved Vets Membership!

It’s Time to Take Action

If you’re reading this and shaking your head yes to everything, what are you doing about it?

If you’re happy and fulfilled, amazing. I want to hear what works for you. If you’re stuck and ready to let go of your old life so you can thrive in and out of vet med, reach out. If you want a 1:1 coach, book an Alignment Call with me. And if you’re not ready to commit to coaching, check out the FREE meditation: Shift Shedding to help you process and let go of your shift at the end of the day.