Where are all the vets?

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Recruitment crisis, or retainment catastrophe, or something else? A Perfect Storm

There is a lot of talk in the veterinary profession, not just in the UK but also North America and Australia, regarding a ‘recruitment crisis’. Looking back through articles published in the past 30 years, this is not a new phenomenon but only in recent years has the profession started to ask whether this is a true experience or is it a zeitgeist/trend? And what are the underlying causes? What can we do? Despite multiple surveys and studies from organisations, the profession still seems somewhat unsure as to whether there is a problem or not and, if so, how significant it may be. It seems it has become the ugly problem that is mentioned constantly but is not fully considered and definitely not addressed. We can describe what we see (lots of ads, employers on job forums asking where all the vets are, employees complaining of clinics running short staffed) but what are the causes? Knowing the causes means we have a chance of fixing this!

Recruitment and retainment have been issues for the profession for decades; this is not a recent phenomenon. Over the past 80 years in the UK, the profession has sought to engineer itself¹ by controlling numbers of vet schools, numbers of graduating vets and until 20 years ago, who could own veterinary practices. But that world is very much in the past and the needs of the profession and the professionals that work in it are very different and are changing ever more rapidly, particularly due to Brexit and the 2020 COVID pandemic which are catalysts for even faster and broader cultural changes. For example, vets furloughed then realised how much better their lives were with less, or even no – ‘vet’ in it, and I predict we will see increasing numbers leave the profession once the COVID pandemic has settled to the new normal.

Do we have a recruitment crisis?

There are some very telling statistics out there that show that for some businesses at least, there is a very real recruitment crisis. On the Vet Record website on the 25^th May 2021 there were 590 vet jobs advertised in the UK, of which 537 are companion animal roles, and on the same day on the IVC website (one corporate employer that has less than 20% market share of the UK market) there were 335 vet vacancies in the UK. We can see from these numbers there are a good number of vacancies available, likely far more than the apparent number of available vets looking for jobs, so what does this look like for the practices that are recruiting? A BVA survey in 2018² revealed an increase in vacancies and a decline in applications, with only 39% of advertised roles being filled within three months, and a significant number (11%) of vacancies being withdrawn due to a lack of suitable candidates. This is borne out by a more recent study published in the Vet Record³, in which veterinary employers took between a month and five years to recruit a veterinary surgeon with an average of four months but with a huge variation, including 17% of practices taking over a year to recruit. Additionally, over half of employers had only between one and three applicants per vet position, so this must surely affect the choice available to them. Other surveys by the BEVA/BSAVA⁴ and SPVS³ also give similar gloomy outlooks for recruitment.

What all this means is that there are more jobs available than vets available to work them, leading to a seismic shift in recruitment power from employer to employee which is hastening the changes in job structure. On the 20^th May 2021, the AVMA on Instagram shared an infographic showing that for every 1 vet looking for a job there are 12.5 jobs available.

It is a fact that recruitment happens constantly in all businesses due to a natural turnover of staff. In my opinion, the normal level of employee turnover has been traditionally under-recognised in the veterinary profession. For general business, it is stated as between 15% and even as high as 30% in health workers by the Official for National Statistics. Do we actually know what vet employee turnover is in the profession? The answer is a resounding NO. I’ve found statistics on vet technicians in the USA where 30-50% is quoted and vet industry as a whole in the USA of 21%. The closest I can get to in the UK is that about 40% of vets are thinking about leaving their employment in the next two years (from BVA 2019²) which suggests an annual vet turnover of 20%. What this means in real terms is that in a clinic of 5 vets, natural turnover will mean you will need to recruit a new vet every year and on average it will take you 4 months, though it could be a lot longer for some.

Recruitment has a monetary and time cost and yet I don’t think this is taken seriously until practices acutely feel the pain of an inability to recruit. There is some degree of talent shortage and I suspect staff turnover may be a bigger factor than some have considered and probably even higher recently due to COVID, but we are not going to see these figures for several years. Another overlooked pain point during recruitment is that there is very likely to be a period of time when the practice is short-staffed, leading to additional pressures on remaining staff or the additional costs of locum cover. I’m sure I don’t need to point out the dangers of overwork on remaining staff.

The recruitment crisis is very real for the individual practices affected; I read about the pain these practices are in on a weekly basis on social media and forums. But overall, the level of turnover is within the same range as other industries – perhaps this is something to accept and to plan for in advance of the crisis point? Yet despite this, some practices don’t have a problem with recruitment, they are always fully stocked with vets and have dozens of applicants when they do get the word out they are recruiting. Perhaps there is something to learn from them?

Or is it a retainment catastrophe?

We often hear of the ‘leaky bucket’ of vets leaving the profession – is it real? The numbers of graduating vets in the UK has greatly increased in the past decade (increased 50% ⁵) with increasing numbers coming from Europe coinciding with Eastern bloc countries joining the EU. So where are the records that show the number of vets leaving, and are vets leaving the profession or just talking about it? This is something that only recently has been measured through qualitative surveys.

There is a lot of talk of vets leaving the profession, and one often requoted statistic is that half of vets leave the profession within a few years of graduation. Yet, nowhere in my extensive reading and through directly contacting the BVA has this been borne out in published studies or surveys. It is in fact faux news, probably a mis-quote of the BVA VetFutures survey from 2015⁶ that showed that 55% of newly graduated vets are looking for a change in work – however this is made up of 23% who want another job in the same field . Only 10% are considering leaving the profession.

Other sources give variable numbers for vets leaving the profession. BVA Voice of the Profession survey from 2018² has 37% actively thinking of leaving the profession – that is one in three vets; BSAVA/BEVA Recruitment and Retainment Survey 2019⁴ has 9.7% actively leaving profession but doesn’t also include numbers moving to other parts of the industry; 2019 RCVS survey of the profession⁷ has 9.5% of vets and 24.8% of RVNs saying they wished to leave the profession for reasons other than retirement; BVA in 2020³ 9.2% intend to leave the profession. From these surveys it looks like about 1 in 10 vets are actively looking to leave the profession – these are point in time surveys from recent years so it is not clear whether these are the same 10% across these surveys or sequential 10% because that would be concerning! Also, wishing and thinking about leaving the profession is a very different thing to actually leaving and yet there are no surveys that accurately record the numbers who have left the profession.

Unfortunately, no-one is actually measuring the numbers of vets leaving the profession; the closest I could get was to compare total numbers of vets on the RCVS register over time with newly registered vets and the numbers removed (new registrations 2069, removed 1579 – 2018 RCVS facts⁷) but this is fraught with problems. It also doesn’t account for vets leaving the profession, permanently or temporarily, but staying on the register as a fall-back/insurance policy, and speaking to vets in other lines of work than pure clinical vet work, this is surprisingly common. Everyone who graduates goes on the register but not everyone who stops working is removed. Surveys can also be flawed and biased by who they are sampling and the questions they ask. Many people may say they want to leave or are considering it but due to barriers and restrictions, won’t ever leave. Also, those who have actually left will be unlikely to be the ones who fill out such surveys. Is it a myth being perpetuated? Is there is in fact no ‘leaky bucket’?

If we look at the RCVS 2019 Survey of the profession⁸, the majority of vets working within the profession who responded to the survey (79.2%) indicate that they plan to stay in the profession for more than five years, more or less comparable to the percentages who planned to stay in the profession ‘for the foreseeable future’ in 2014 and 2010. Similarly, the overall percentage planning to leave the profession within the next year for reasons other than retirement is close to that of 2014 and 2010, with small increases in the numbers signalling their retirement. The 2019 Survey of the Veterinary Profession added together, the percentages of those who plan to leave within the next one to two years, and within the next three to five years, is a little greater than in 2014 or 2010 (8.1% compared to 6.5% in 2014 and 5.6% in 2010) BUT not by much – this is not an exodus of vets from the profession and has been relatively steady over the past decade.

So are we actually short of vets?

It has been suggested there is about a 11% shortage of vets (^{9 and 10}). A 2017 SPVS survey⁵ found that over 50% of practices surveyed were short staffed. Again, we need to consider the validity of these numbers – do they represent the number of vacancies that need to be filled, or the number of FTE (full-time equivalent) vets required to provide the work required? We need to be talking in full time equivalents because I believe we need to consider the impact of the total number of hours that people work is reducing over time. If there is a skills shortage of 11% then if this is FTE shortage, we may actually need 15-20% more vets to cover the clinical time shortage. We also need a standardised measure of FTE as what employers and employees view as full/part time are often quite different – I have been classed as part-time when ‘only’ working 42 hours a week. Is full time 36 hours or 60 hours, and what about on call?

However, talent and skills shortages of this magnitude or higher are normal in many industries, so is it the way traditional veterinary businesses are structured that means a relatively low level of shortage is magnified to be a big problem?

We also need to consider that there are more physical vet practices requiring to be staffed. A couple of decades ago in the UK, there were about 2500 sites equating to about 7500 vets and 1500 nurses. Now there are over 5000 sites requiring 15,000 vets and 30,000 nurses (figures from Alison Lambert, Onswitch). That 15,000 clinical vets is getting very close to the number registered by the RCVS, without taking into account FTE vs clinical work hours available. This is borne out by the RCVS – the number of registered veterinary premises in the UK has increased by 40 per cent in the last decade (to 2018), growing the number of registered veterinary premises by 38 per cent to 5536.

We also need to consider the supply of new vets. The number of students graduating from vet schools in the UK is not indicative of the numbers of British vets (RCVS facts 2018⁷ – at some vet schools, half the annual intake is of overseas students) or people that will stay in the UK once graduated – an increasing number are made up of North American students who pay full fees and who primarily want to get back to their home country where their family is based, where the pay is better to pay off the student debts and are restricted by the visa requirements if they did want to stay. The Vet Futures 2015 survey⁶ showed almost three-quarters (73%) of students intended to work in the UK, which suggests a quarter won’t, and maybe more will only work in UK for short time until they have done any other required exams to move to another country.

Or something else?

Overall, we have increased numbers of vets registered (increase in 50% in the past decade⁵) and a small number of vets leaving although this has remained mostly constant over the past decade. There has always been employee turnover and it is unclear if it is really any higher at present. So, are there other factors at play? For me, this unconsidered category has the biggest effect on availability of working vets. These are the people who trained as vets, are on the register but are not available for clinical work or only for limited hours. Increased demand for services (long before the COVID-driven increase in pet numbers) along with unrealistic expectations of clinical load deliverable by the existing veterinary workforce and systems all contribute. On top of this there is an unmeasured increase in the clinical work needing to be done. This chronic shortage compounded by the acute factors of Brexit and the Covid pandemic has led to a perfect storm. I think it is all 3 – it is an AND.

In short, this boils down to:

1. More clinical work,
2. A decrease in the number of vets available to do clinical work and reduced clinical work hours available per vet despite more registered vets,
3. Vets not liking the current traditional model of working, so finding other ways of ‘vetting’. Current work options are not fitting with their life requirements such as caring for a family or simply not getting home every day exhausted. As a result we are seeing people choosing to do less clinical work, moving to having a portfolio career, working as locums or even leaving the profession entirely.

Let’s look at these in turn. There is a good deal of overlap between these arbitrary categories so please forgive me if there is some repetition; I will put the detail only under the point where I feel it is most appropriate. Many of these factors may seem minor and not of importance in the under supply of vets but what I aim to demonstrate here is that these unconsidered factors each of which on their own would be inconsequential to the supply of veterinary labour, together have added to the perfect storm of the crisis. Also, I aim to show that many of these factors are due to culture and society as a whole changing, not inherent problems within the profession.

The increase in demand for clinical work

There is undoubtedly a long-term increase in demand for clinical work due to multiple reasons; changes and advances in the profession increasing the work requiring to be done such as increases in work-ups as more diagnostics and more varied and complex treatments become available and the availability and up-take of insurance to pay for it; increase in pet ownership, especially over the past year; increased number of practices even for the smallest of which still require an overall increase in the number of vets; owners want more done for their pets as their pet is now part of the family, an increasing humanisation of pets. The veterinary profession is an industry in growth, we haven’t reached steady state yet.

I’m sure you are aware of the increase in pet ownership – there are 3.2 million more pets since the start of the pandemic which equates to a 20% increase in pet numbers and a good number of these are new pet owners, not households adding a second pet which is an increase from 14 million pet owning households to 17 million. It is not surprising this will lead to an increase in demand for vet services, with the biggest period for this coming after puppy-hood, so in a decade or so as these pets age.

The profession is in growth. One third of vet job positions are due to expansion not replacement – 241 replacement positions vs 182 due to expansion⁴. In the USA, employment projections shows vet occupations are expected to grow at a rate of 19% by 2026 which is 3 times faster than the 7% average projected for all occupations.

A decrease in number of vets available to do clinical work – why the RCVS register doesn’t give us a true picture

Looking at RCVS registration numbers it is almost impossible to work out who is working, how much and where. There are several large studies (from the RCVS and BVA) that ask these questions in qualitative surveys but often they ask leading questions, not all the profession interacts with them (probably more clinical vets answer the surveys, sometimes non-clinical vets are even barred from replying), and give statistics summaries that are easily misunderstood or misquoted.

There is an unquantifiable number of vets who remain on the register but who not available for clinical work in the UK. Some of these are those that have left the profession, either temporarily or permanently, but stay on the register as a fall-back/insurance policy, for prestige in a non-vet career, or continue to do a small amount of irregular vet work, which may or may not be clinical. Also, it needs to be considered that a number are on the register but work outside the UK. A breakdown of respondents by RCVS membership category shows that 76 per cent are UK-practising, ten per cent are practising outside the UK (and an additional 2% working in Ireland), and 12 per cent are non-practising.  Some remain on the register but do work outside the clinical vet profession (not needing a vet licence for their role) and it is not until you start talking to these people do you realise that this number is not inconsiderable. It is easier and cheaper to remain on the register than trying to get back on the active register.

The biggest chunk of vets on the register but who are not available for clinical work are those taking some kind of break:

• Maternity leave is not measured on any surveys as they tend to ask what the person is doing at that point in time, whereas maternity leave is rarely a full year in the vet profession (who can survive a year on statutory minimum pay?) so a point-in-time survey is potentially only picking up half of potential maternity breaks in the year assuming an average maternity break of six months.
• Career breaks and sabbaticals. Variable numbers are found for this – 2.5% from the RCVS in 2019⁸, 8% from the BVA in 2020³ – and of those taking a career break, over three-quarters (78.5%) are female⁸ but not just for maternity reasons. Unemployment is 2.8%⁴ – due to the employment market I doubt this is true unemployment but awaiting the right fit job.
• The retiring age has got younger as independent practice owners sell to corporate businesses  and reduce hours worked or take early retirement. Not all of these vets move to the retired register as they continue to do some vet work, some may be clinical but an increasing number turn to non-clinical work and become advisors, board trustees, and such. In 2019, 11.5% of vets⁸ intend to retire at some point over the next five years, a higher percentage planning to retire than in previous surveys.
• Emigrating for better conditions and pay – North America and Australia also have vet work-force shortages and better wages and this should not be under-estimated though it is not accounted for in surveys that I can find.

We also need to consider the considerable effect Brexit has had on the labour supply, and will continue to have, compounded by the COVID pandemic causing travel difficulties. Until 2020, half of annual RCVS registrations were from the EU¹⁰ and post-Brexit these vets are less likely to look favourably on working in the UK (¹⁵ and look at Facebook negativity). For some that would be drawn to work in the UK, their degree may not now be recognised so they are required to sit the full RCVS exam, and they may now have visa requirements (which cost money and needs a sponsor). Of 31,338 vets on the register in 2018⁷, 20,049 have a UK registration and 8,590 have an EU qualification compared to in 2008¹¹ of 22,754 on register of whom 16,593 had UK qualification and 3,228 had EU qualification. We are just about seeing the full impact of this on the supply of vets willing to work in the UK post Brexit.

A decrease in clinical work hours available per vet

There are several reasons for less clinical work per vet:

• There is an overall trend to reducing the hours of work over time with the work-life balance trend towards more manageable working hours reducing the number of working hours each vet does. This trend is across all ages of the work-force so is not ‘millennial issue’. The overall average for full-time was 42.5 hours per week 2018⁷; this has reduced from 44 hours in 2014 and 45 hours in 2010¹¹. Surveys consistently show that more vets would choose to work fewer hours compared to the number who would like to work more hours. We also need to consider the gap between expectation and reality in full-time vs part-time work in employers and employees. It is not uncommon to have an employee feeling they are full time doing  four 10-hour days a week but the boss doesn’t count unpaid lunch breaks, overtime or on-call so the 40 hours drops to 36 hours and is classed as ‘part-time’. Only 50 % of vets agree they that they have a good work-life balance. The long hours used to be partially because assistants put in the extra work with an eye on getting into a partnership – this is now vanishingly rare.
• Increase in part-time working and not just for the obvious working parents. The number of respondents in part-time work has continued to rise over the past decades, more than doubling from 11% in 2000 to 23.4% in 2019⁸.
• An increase in referral work so a larger proportion of vets are servicing fewer clients/pets – 6.7% in 2010 to 9.5% in 2019⁸. In 2018⁷ there were 844 RCVS specialists and 381 RCVS diploma holders, compared in 2008¹¹ 269 RCVS specialists 269 and 360 RCVS diploma holders 360. Some of these may be working outside the UK, but this breakdown is not obtainable. According to the AVMA, the U.S. is adding specialists at a faster rate than veterinarians overall, up 47 percent from 2007-17, a period during which the overall veterinarian population grew by almost a third.
• Increase in vets working in non-clinical roles due to both push and pull factors. More vets are using their veterinary degree to diversify into roles that give them what the profession currently can’t, to resolve issues created by traditional clinical practice and a society that no longer expects one job for life. The proportion of recent graduates (<8 years) that want to work outside of clinical practice is as high as 18% (VetFutures 2015⁶). The assumption that being a vet equals being in clinical practice is increasingly seen as out-dated. Some of these vets continue to do some clinical work or a job that requires continued registration on the RCVS register – meat inspectors, for example – and so it is difficult to tease apart the numbers in the surveys.
• Increasing proportion of women in the profession so maternity leave, career breaks and part time working due to the burden of childcare and other caring roles is still resting unequally with women. In 2014, 70% of veterinary assistants were women (RCVS 2014). Just over one-third (36%) of respondents have one or more dependent children living with them, and 5.4 per cent have caring responsibilities for one or more adults⁸. Currently the profession does not fully support these vets:
• Barriers to returning to work. There are difficulties getting part-time positions or flexible positions to fit around family needs so this hastens the move to non-clinical work or even leaving the profession entirely. It is incredibly difficult to fit traditional clinical practice work around childcare. Pay also has a strong push factor for working mothers in the profession – “females account for 59% of those who are leaving [the profession] on grounds of pay”². There is a lack of options for re-entering the profession after a break – training and support, and the cost and time to undertake these.
• More vets choosing to work independently, for example as a locum. This could be to have control overworking hours and working patterns, or to work flexibly and/or shorter hours then traditional clinical practice. In 2019 the proportion of vets working as independents (locums, independent vet service providers or independent consultants/peripatetic) was 15% as reported in the RCVS Survey of the Veterinary Profession, compared to the 52% of traditionally employed assistants, and this proportion has been seen to increase year on year. This means one in four vets who are not owners, partners or directors are now locuming. Have a look at my article on reasons why increasing numbers are opting to locum.
• Increasing amounts of management within defined roles for senior vets taking away clinical work time (rather than the traditional model of practice owners doing a good amount of the business tasks in evenings and weekends, ad hoc) so fewer hours available for clinical work. Among those who spend time on practice management/administration, this activity takes 11 to 12 per cent of both working and on-call time⁸.
• Consults are longer than they used to be – 20 years ago the average was 10 mins, now 15-20 mins is normal so fewer patients can be seen in a day per clinical vet.
• Pull factors to other lines of work due to conditions and pay. There is wage stagnation while the cost of living continues to spiral ^{12 and 13}, salaries have not been keeping up with inflation for over a decade, and student debt is massively increasing – average debt is now £70k (AVA/BVA Student market research 2020). These are strong pull factors that draw highly intelligent, hard-working vets into other work, especially when it is combined with work patterns that are unavailable in the vet profession currently.

Summary

In summary, we are short of vets. This is not a new phenomenon, rather the culmination of decades of the supply of new vets not meeting the needs of a growing profession in a changing world and a reliance on vets immigrating from Europe which has more recently brought into sharp focus with the shock factors of Brexit and the COVID pandemic. It has been shown that many people in our industry would choose not to revert back to their pre-COVID work pattern (Flexee, 2020) and Brexit is here to stay. We need to find solutions to the situation and stop perpetuating the myths that vets are leaving the profession in droves (they aren’t leaving at any higher levels than the previous few years), that modern generations don’t want to work the hours of previous generations (all generations are reducing their working hours) and that it is all because there are too many women in the profession (the profession isn’t attracting men to work in it so if fewer women want to work as vets then there will be even fewer vets). We have become complacent in recent years believing that the increased demand for veterinary work will be filled by the 50% of EEA-Qualified vets that are registered with the RCVS each year¹³; this source has suddenly dried up and won’t restart anytime soon.

The myth is so widely discussed that it has become seen as indisputable fact, but there is in fact no ‘leaky bucket’; the vets are still here, they are just choosing to not work for some practices or to work in other ways under the umbrella of ‘vet’. So perhaps the question is wrong. It is not ‘where are all the vets’ but ‘where are the vets who want to work in traditional clinical practice’? Now we can see where the issues lie and suggest some solutions.

There aren’t enough vets for the work that is to be done and the reasons for this are varied and numerous. Vets increasingly have more choice over how they work and these choices are more visible to them due to social media, increases in career coaching, and role models of vets outside traditional practice, and they are increasingly choosing not to work in the systems and ways that vets had worked in until even a decade ago. Also, the vet profession has been slow to adopt modern technologies and systems of working that would at least partially offset the lack of clinical vet time which has been hastened by COVID-specific demands such as car park consulting.

Society as a whole is changing faster than the profession and many of the changes have led to an ever-widening gap between expectation and reality. We have a problem when 39% of vets in the UK are unhappy with their job and looking at leaving the profession and only 53% are currently satisfied with their jobs⁴. Some traditionalists say we should be altering vets’ expectations of the job because they are currently unrealistic, and that we should manipulate vet school intakes to change the graduates’ expectations to fit with the reality of current vet practice. But there is another way, a way that is quicker, fairer, and more realistic, though it will be hard for some to hear and harder to implement the change. And that is to change reality, to modernise the veterinary profession and change the expectations of practices to fit the reality of what the work force and society requires.

References

1 https://bvajournals.onlinelibrary.wiley.com/doi/10.1136/vr.m4096 It shouldn’t happen to a veterinary profession: the evolving challenges of recruitment and retention in the UK.

2 https://www.bva.co.uk/media/2990/motivation-satisfaction-and-retention-bva-workforce-report-nov-2018-1.pdf Also known as the BVA Voice of the Profession Survey, undertaken in 2018 and published in 2019.

3 https://bvajournals.onlinelibrary.wiley.com/doi/10.1136/vr.106044 Investigation of factors affecting recruitment and retention in the UK veterinary profession.

4 BSAVA/BEVA retention and recruitment survey https://www.beva.org.uk/retention-survey

5 https://bvajournals.onlinelibrary.wiley.com/doi/10.1136/vr.106044  Investigation of factors affecting recruitment and retention in the UK veterinary profession

6 https://www.vetfutures.org.uk/only-half-of-recent-graduates-say-their-career-has-matched-expectations/   https://www.vetfutures.org.uk/resource/voices-from-the-future-of-the-profession-july-2015/

7 https://www.rcvs.org.uk/news-and-views/publications/rcvs-facts-2018/?destination=%2Fnews-and-views%2Fpublications%2F%3Ffilter-keyword%3D%26filter-type%3D18 published 21 July 2020, accessed May 2021

8 RCVS Survey of the profession 2019 , accessed May 2021 https://www.rcvs.org.uk/news-and-views/publications/the-2019-survey-of-the-veterinary-profession/?destination=%2Fnews-and-views%2Fpublications%2F

9 https://www.rcvs.org.uk/document-library/letter-to-the-department-of-education-regarding-a-potential-cap/  Connell et al., 2020

10 https://committees.parliament.uk/oralevidence/869/html/

11 https://www.rcvs.org.uk/news-and-views/publications/rcvs-facts-2008/

12 https://www.theguardian.com/science/2019/jan/18/australian-vets-leaving-the-profession-in-droves-over-stress-and-poor-pay

13 Vet Rec2018 Jan 20;182(3):62-65. Veterinary salaries in the UK are stagnating or in decline, surveys show

14 https://www.cm-research.com/wsava-2021-cm-research-virtual-seminar/

15  https://veterinary-practice.com/article/the-profession-needs-to-stop-losing-vets-from-its-ranks-of-two-years-plus-qualified-vets