Balancing the Bottom Line & Best Practice

In the Literature

Pradies C. With head and heart: how emotions shape paradox navigation in veterinary work. Acad Manag J. 2023;66(2):521-552. doi:10.5465/amj.2019.0633

The Research …

A significant emotional drain in veterinary medicine is the business–care paradox (ie, balancing financial realities of a business with compassionate patient care). Client financial limitations may hinder provision of desired care.¹

This study explored the role of emotions during confrontation of and response to paradoxical demands of veterinary practice. Semistructured interviews were conducted with 63 clinicians in France (59% owners or partners) with an average of 14 years of experience. Interviews and observations of clinician–client interactions helped identify themes that informed creation of a proposed model of how emotions are used to navigate paradoxes in practice.

Veterinary practices in the study had protocols for situations in which clients could not afford necessary care; however, how clinicians navigated and used the protocols varied and were often guided by intuition. Key factors influencing actions included social emotions derived from a willingness to work with clients and patients perceived as deserving (eg, kind, loyal to the clinic). In addition, perceived rigidity of billing norms influenced clinician ability to accommodate clients with financial limitations.

Balancing care and cost evoked emotions, including compassion, empathy, and guilt. Focusing on patient care enhanced emotional energy, whereas concentrating on cost led to emotional fatigue. Prioritizing patient care over financial considerations brought a sense of relief and professional fulfillment.

Many clinicians found rationalization of the balance between care and billing easier when emotions were set aside. Identifying as a trained professional who provides valuable medical expertise rather than a humanitarian who saves animals was helpful for some clinicians. Electing to create emotional distance to better process a difficult situation exemplifies how individuals can learn from previous emotional experiences in paradoxical situations to set effective barriers, helping avoid future emotional fatigue and building professional resilience and success.

… The Takeaways

Key pearls to put into practice:

• Practices should establish clear protocols for addressing situations in which clients cannot afford care to protect clinicians from assuming emotional responsibility for cost versus care decisions and to ensure patients receive necessary care.

• Spectrum of care involves tailoring care based on contextual factors, including the client, patient, and clinician.² Training on how to employ a spectrum of care approach in a variety of contexts, including when finances conflict with care, is important.

• Moral distress is common in veterinary medicine and predictive of lower levels of professional fulfillment.³ Debriefing with colleagues and/or mental health providers after situations that cause moral distress is important for emotional relief and coping to prevent burnout.

• Paradoxes in veterinary medicine can be especially challenging to those new in practice. Preparing new clinicians with insight on development of healthy emotional coping strategies is therefore important to help sustain professional passion and effectiveness.