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Under pressure

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    Under pressure

    The University of Minnesota College of Veterinary Medicine works to combat the industry-wide mental illness epidemic in veterinary medicine

    Illustration by Megan Murrell 

Veterinary medicine is a perfect storm of personal susceptibility and environmental stress. Recently, a study by the Centers for Disease Control and Prevention and the American Veterinary Medical Association (AVMA) reported the suicide rate for U.S. veterinary professionals is up to 3.5 times higher than the national average—exceeding the suicide rate among human medical professionals, which is roughly double the national average. The qualities that draw students to the field often make them vulnerable to the emotional burnout of clinical care, and financial insecurity amplifies stressors. The epidemic made national news in 2018.

Students, faculty, technician staff, and alumni at the University of Minnesota College of Veterinary Medicine (CVM) are all affected by the problem. “I know where our students are at emotionally because I surveyed them, and it is not pretty,” says Erin Malone, DVM, PhD, professor in the Department of Veterinary Population Medicine.

Malone was appointed to a curriculum coordinator position in 2013. As curriculum coordinator, she helps students by monitoring their workload and utilizing this information to shape how the CVM schedules courses and exams. This effort aims to make academic intensity easier for students to navigate. 

Laura Molgaard, DVM, associate dean for academic and student affairs, also makes it a top priority to understand the challenges students at the CVM often face. She says, "The CVM has taken these issues very seriously for years. We are working to provide support in a myriad of ways, including incorporating financial and personal wellness topics in our curriculum." 

Debilitating debt

“When you talk about well-being, you need to talk about tuition,” says Sarah Neuser, a fourth year DVM student and immediate past-president of the Student American Veterinary Medical Association (SAVMA). “The amount of debt veterinary students graduate with across the country is traumatizing.”

While veterinary college tuition increases nationwide, starting salaries lag behind—in 2018, the average Minnesota veterinary student’s debt totaled $214,562, with an average starting income of $58,450. This number is impacted by the nearly 40 percent of recent DVM grads pursue advanced training, including internships, residencies, and PhD programs. When these lower stipends are excluded, the average starting salary is $83,230.

Many students enter veterinary school with roughly $10,000 of student debt from undergrad studies but accrue about $200,000 more pursuing their DVM. After graduation, veterinary professionals often work well over 50 hours a week to chip away at this debt and cover the cost of living, which leaves little time for self-care.

In an effort to soften the financial blow of tuition cost, the CVM has nearly tripled the amount of scholarship money it gives to students over the last decade. The CVM has also worked closely with the Minnesota Veterinary Medical Association (MVMA) to lobby the legislature to create the Minnesota Rural Veterinarian Loan Repayment Program, which was established to provide assistance to eligible veterinarians serving in designated rural areas around the state.

The CVM has also worked to mitigate its impact on the national debt crisis by minimizing annual tuition increases. For the last five years, the CVM has kept annual tuition increases below 1.5 percent—half of the University of Minnesota's standard practice of roughly 3 percent. And for the last three years, the College has kept it below 1 percent. With the average rate of inflation across the country resting around 2 percent, this tuition freeze makes a tangible impact. From 2017 to 2018, the average debt among CVM students dropped by $15,569. The CVM’s efforts to further shrink this figure reflect an active commitment to student welfare.

Struggling for success

Financial stress is perhaps the strongest among DVMs who begin pursuing an advanced degree, internship, or residency immediately after graduating. In 2018, the AVMA reported an average stipend of $30,667 for recent DVMs in this category. Many who complete such programs go on to earn a higher salary than average, but veterinary academia presents other stressors, too.

Lisa Hubinger headshot
Lisa Hubinger

Lisa Hubinger, the graduate program coordinator for the CVM, says students pursuing MS and PhDs in both the Veterinary Medicine and the Comparative and Molecular Biosciences graduate programs face tremendous pressures: to publish, to acquire funding—for their degrees as well as living expenses—and to ace competitive preliminary exams. Specialized research also chips away at mental well-being. “You spend a lot of time in the lab or out in the field,” Hubinger explains. “That social isolation just feeds into depression and anxiety.”

Hubinger commends the University of Minnesota for expanding its number of counselors and wellness service options. “I think there’s been a true effort to destigmatize mental health issues,” she says.

Initiating change

One key way in which the U has encouraged a shift in combatting mental health issues is through a collaboration between the Provost’s Council for Student Mental Health, the Disability Resource Center (DRC), Boynton Health, Student Counseling Services, the Office for Student Affairs, and the Office for Undergraduate Education, which launched a mental health advocates network in 2016. Mental health advocates are instructors, advisors, and others who receive training and information on addressing students with mental health needs. The network is embedded into every college and provides staff with information on available resources and how to make a referral when students require support. “The goal is that each college has one mental health advocate—and the CVM has three,” says Barbara Blacklock, MA, LISW, program coordinator and CVM liaison for the DRC..

Hubinger is a mental health advocate for students in the CVM’s graduate programs. “I’m somebody who listens,” she says, “and I’m somebody who’s aware of what the various resources are at the University.” Hubinger's counterparts in the DVM program are Malone and Athena Diesch-Chham, MSW, LICSW, the CVM's social worker.

As the CVM's DRC liaison, Blacklock also partners with the University community to shift attitudes toward valuing and fully including qualified students with disabilities. "The U values disability as an aspect of diversity because disability enriches education," she says. "Students with disabilities who need minor adjustments in their environment can progress successfully through demanding programs like those at the CVM. The vet school has a lot of highly qualified students who also have disabilities."

Blacklock works closely with Joe Douglass in the Academic and Student Affairs Office at the CVM to execute and coordinate testing and environmental accommodations. The CVM has received two DRC Access Awards over the years for the College's role in supporting students with reasonable accommodations. "One strength I have seen really evolve in the CVM, thanks to the work of Drs. Malone, Molgaard, and Peggy Root, DVM, PhD, is the normalization of help-seeking," Blacklock says. "CVM students are perfectionists who try to put their heads down and do better, but you can ask for help and still have high standards and be successful." Blacklock and Douglass have helped many students receive accommodations on the North American Veterinary Licensing Examination. 

The University also offers an online cognitive behavioral program called "Learn to Live" to any fee-paying student. The program is hosted on the U of M's mental health resource website. Malone often shows this 12-year-old resource to incoming fourth year veterinary students as they prepare for rotations.

Since finances are often cited as a major stressor for many students, including those at the CVM, the U makes financial wellness counseling available from orientation to graduation. The service helps students make informed, sustainable financial decisions that match their individual needs. Scheduling a financial wellness appointment is free of charge.

Guiding the way

At the CVM, helping students increase their earning potential is another key approach to tackling the debt problem. The College is active in the Veterinary Business Management Association (VBMA), which describes itself as "a student-driven organization dedicated to advancing the profession through increasing business knowledge, creating networking opportunities, and empowering students to achieve their personal and professional goals." According to Molgaard, the VBMA empowers students to pursue careers as either associates or practice owners, both of which are important to help offset the debt.

The CVM also partners with the MVMA to host a career fair each year. David Lee, DVM, MBA, director of the Veterinary Medical Center at the CVM, offers further career guidance to students in the form of resume review and contract negotiation support. Not only do these efforts bolster students' financial planning by helping them maximize their earning potential, but they also help students feel confident and supported as they transition out of school.

“When professors tell me the mistakes they have made, it reminds me of their humanness and makes me more open to being able to ask for help. It makes me feel less alone.”

Sarah Neuser, class of 2019

One newer program, Mentor Connection—a resource from the CVM’s Alumni and Friends Society—enhances DVM students' futures by connecting them with practicing veterinarians. Beyond career guidance, it provides students with the reassurance of professionals who can empathize on a personal level.

Erika Wehmhoff, a second year DVM student and president-elect of SAVMA’s Minnesota chapter, received a mentor pep talk before a big test. “I asked her what she did in school to keep herself up and she talked me through it,” Wehmhoff says. Her fellow students report receiving similar guidance. “Almost a quarter of the first and second year students now have a connection outside of the school they can use as a resource.”

Both Wehmhoff and Sarah Neuser cite the value of professor mentorship. “When professors tell me the mistakes they have made, it reminds me of their humanness and makes me more open to being able to ask for help,” says Neuser. “It makes me feel less alone.” She considers Malone an excellent example.

Talking it out

CVM students also benefit from appointments with the CVM's social worker Diesch, who has long dedicated 20 percent of her time exclusively to student needs, and will begin setting aside half of her time to CVM student wellness in July. "Fifty percent is better than 20 percent, and we’re moving in the direction we need to go," she says. "I do a lot of individual work, meeting with students on a one-on-one basis." At the end of April, Diesch had hosted 130 visits with students throughout the 2018–19 academic year.

Most of the students Diesch sees are in crises, which means they are exhibiting habits of self-harm, behavioral or mental health concerns, eating disorders, family issues, or substance use issues. "There are a few students who I have a close eye on because they have long-term mental health concerns that the stress of this environment is not helping." Diesch also does lunch-and-learn sessions for student clubs, where she shares strategies and insight into self-care. 

"We have also been very lucky to have great partnerships with Student Counseling Services at the University," says Molgaard, "particularly with great staff psychologists who really get to know the CVM and the challenges that our students face." Molgaard meets with a staff psychologist at least yearly—maintaining strict confidentiality, of course—to learn about the top stressors students report. She also talks with staff psychologists about changes the CVM is making to reduce those stressors as well as new issues that may be cropping up.

Last fall, Malone and Molgaard also helped the CVM celebrate RUOK? Day—a national day of action in September dedicated to reminding people to routinely check in with family, friends, and colleagues in a meaningful way. They utilized a grant from the AVMA to host local writer John Moe as a special guest speaker. Moe hosts “The Hilarious World of Depression,” an award-winning mental health podcast. Moe spoke about his personal experience with depression.

At the event, Gopher Orientation and Leadership Experience (GOALE) mentors and course coordinators also discussed challenges in meeting student mental health needs. The CVM rolled out GOALE—a largely experiential course designed to introduce first year students to core skills and values of the veterinary profession—in 2004 with the intention of building a community to support student wellness. "This is a core course that is built into our curriculum," Molgaard says. 

A close camaraderie

The College's community-building routine has helped students, faculty, and staff to connect on a deeper level. Wellness Wednesdays allow faculty, staff, and students to gather over cups of tea or coloring books for an hour and a half on the first Wednesday of every month. The College protects this time by disallowing other programming to be scheduled in conflict. Additionally, students and faculty can chat over breakfast at the Wake up for Wellness event series.

Students at the CVM have been intentional about building bonds with each other. For examples, students in the DVM class of 2021 implemented Wellness Houses, mirroring a program created by the Class of 2020 at North Carolina State University’s (NCSU) College of Veterinary Medicine. Both the University of North Carolina at Chapel Hill and Vanderbilt University in Nashville have implemented the house system in their medical schools as well. In all cases, the houses are part of a student wellness initiative.

Incoming CVM studeents are sorted into the same four houses as those at NCSU, creating direct links to the greater veterinary community. The houses are organized to each include a variety of students with different interests, backgrounds, and home states. Students meet their housemates during orientation and are literally housed together during GOALE. Each house sponsors a wellness activity over the course of the academic year. Students earn points for their houses by participating in events. Beyond the four Wellness House–sponsored events, students can also earn points for individual or group wellness-related initiatives and activities. Each month, the winning house gets to redecorate a CVM classroom in its colors and enjoys boasting rights for the following month.

Students utilize these opportunities not only to create a strong network amongst themselves but also to reach out to the larger community—by pouring energy into various extracurricular or service endeavors, students connect with more people, practice their skills, and blow off steam.

Working for wellness

CVM student-run organizations such as Student Initiative for Reservation Veterinary Services (SIRVS) and Veterinary Treatment Outreach for Urban Community Health (VeTouch) help students learn and unwind at the same time. SIRVS is a group of veterinary students who have recognized a need for veterinary services in underserved Reservation communities in Minnesota. The group's mission is to train future veterinarians by serving communities in need. VeTouch also provides basic veterinary medical care to the pets of low-income and no-income residents of the Twin Cities to promote urban community health and enhance the welfare of people and animals in Minnesota. 

"In my first three years, I would often choose to attend events hosted by SIRVS and VeTouch over studying the night before exams because I thought they were more beneficial for both my education and my sanity," says Emily Dorjath, DVM class of 2019. "These events allowed me to relieve the stress of the upcoming exam by allowing me to practice my skills and think practically in a real-life setting."

"Being in vet school is hard, and in first and second year, there are almost no opportunities to work with live animals in the curriculum," says Jonathan Elbaz, class of 2021. "Sitting in lectures for hours each day is taxing on my mental health, but having opportunities where I can get out of the classroom and apply my knowledge in a positive learning environment keeps me motivated to keep studying." 

Diesch has woven wellness into the fabric of VeTouch. "I consult with VeTouch on a regular basis," she says. "I supervise three interns from the School of Social Work here at the U. I make it mandatory for them to be part of VeTouch to address client concerns as well as the emotional mental health of the participating students, who are working in a complex environment. A lot of these clients have a lot of things stacked against them, so the students see a lot."

Externally, SAVMA supports student wellness at its annual national meeting, where the organization's Wellness Committee gives the Supporter of Student Wellbeing Award, honoring outstanding professors who are receptive to feedback and active in promoting student mental health resources. At the 2019 meeting, Malone was honored with this award. Other national grants help the UMN SAVMA chapter’s Student Wellness Committee fund campus events. The committee personalizes these initiatives especially for the CVM, often collaborating with other CVM student-led organizations, such as Just Breathe.

Just Breathe encourages community fellowship through stress relief. At club meetings, speakers share personal health strategies. The group also hosts Wellness Wednesdays on the first Wednesday of each month, featuring activities led by volunteer faculty and staff—options might include coloring, yoga, or venting over tea.

Veterinarians as One Inclusive Community for Empowerment (VOICE) contributes frequently to Wellness Wednesdays. Members also host social events, like dessert potlucks, and community service efforts. VOICE recognizes diversity in mental wellness. As a champion for campus inclusiveness, it ensures support for students of underrepresented backgrounds.

"Being in vet school is hard. Sitting in lectures for hours each day is taxing on my mental health, but having opportunities where I can get out of the classroom and apply my knowledge in a positive learning environment keeps me motivated to keep studying."

Jonathan Elbaz, class of 2021

Better together

Coryell, Malone, Neuser, and Wehmhoff

(From left to right) SAVMA senior delegate Jessi Coryell, class of 2021; Malone; Neuser; and Wehmhoff celebrate VetMed United Day on April 4, wearing ribbons that represent anxiety and suicide awareness. The national movement focuses on supporting personal wellness and mental health as well as remembering victims of suicide in the veterinary field. 

Photo by Nathan Pasch

As SAVMA president, Neuser worked at the national level to challenge outdated support models and “Band-Aid solutions” for DVM students. Large-scale wellness advocacy requires foundational change—tackling a root issue like financial insecurity, for example, with better funding for student loan repayment programs. But basic resource access is also critical. Currently, SAVMA is collaborating with the AVMA Council on Education to ensure all schools offer mental health specialists.

Of course, finances are only one piece of the wellness puzzle. At the personal level, Wehmhoff considers scheduling a major hurdle for DVM students. Intense workloads sap time away from self-care. “I think that’s the biggest challenge to wellness,” she says. But Wehmhoff sees glimmers of progress. “With my class, I can see a shift where people are starting to take more time for themselves.”

At the CVM, mental wellness—as personal as it may be—seems to flourish most through united efforts. “If you can trigger one person and they can trigger one more, there’s a small chain of effective kindness,” says Neuser. “We are better together.”

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