Veterinary students voice concerns over duty hours

Veterinary college is an intensive time, where students not only put in hours studying for examinations, but also spend a lot of time in the clinics to get as much direct hands-on experience as possible. But is, or should, there be limits? How much is too much?

In August 2023, a group of veterinary students and recent graduates from the University of Pennsylvania School of Veterinary Medicine (Penn Vet) wrote a letter to their administration alleging the school routinely broke duty hour guidance from the Student AVMA (SAVMA).

According to a January 30 article in the Daily Pennsylvanian, many students were working more than 100 hours a week. They say the hours affected their own health and the level of care they could provide for patients. 

A year earlier, veterinary students at Iowa State University voiced similar concerns about working conditions in an article by the student newspaper, Iowa State Daily.

Then and now

Duty hours generally refer to clinical rotations for final-year veterinary students. This time is, for some, the first long-term exposure to the clinical setting during veterinary college. It can be challenging for students as they adapt to new tasks and settings along with a significant shift in teaching and learning methods.

Veterinary students' duty hours have varied by time and college; however, there has been a history of expecting students to put in long, hard hours, explained Dr. Bonnie Beaver, a professor in the Department of Small Animal Clinical Sciences at Texas A&M University School of Veterinary Medicine & Biomedical Sciences.

“Clinicians tend to follow historical trends in what is expected from students,” she said. “Mentors who put in long workdays and work weeks in their academic journeys and professional lives expect the same from the students.”

Dr. Beaver continued, “In the past, a clinician usually showed compassion for an individual student who needed help, but an emphasis on personal wellbeing as applied to students as a whole is newly emerging. ‘Suck it up and do the job’ is gradually giving way to more realistic and balanced expectations.”

A study published online this February in the Journal of Veterinary Medical Education (JVME) examined stressors and stress levels experienced by veterinary students at the University of Veterinary Medicine in Vienna, Austria, during their clinical training.

The primary source of stress for the veterinary students was related to intense workload and long working hours. That was true across all four unique stress profiles of the veterinary students studied: the generally stressed group, responsibilities uncertainty group, overtasked group, and unstressed group.

“Generally, some groups of students seem to not struggle at all and thus not require any support, while certain groups of students who experience higher levels of stress may require more frequent and intensive support,” the authors wrote. “In particular, the present results suggest the need for interventions targeting highly stressed students and broad measures to reduce heavy workloads. Concrete measures could include time management trainings to provide students with practical strategies and skills to effectively manage their workload during clinical training.”

Remembering his experiences in veterinary school, Dr. Andrew T. Maccabe, CEO of the American Association of Veterinary Medical Colleges (AAVMC), said, “We worked hard, but maybe it wasn't the healthiest thing for us or our patients. Maybe we can learn a little bit about the importance of having time to regroup and avoiding unnecessary stress and burnout.” 

Setting standards for veterinary colleges

“The overall goal is to establish an environment and a culture that is conducive to learning,” Dr. Maccabe added. “If students are overworked, they get stressed out. They don't learn and it leads to burnout.”

Veterinary schools are not required to follow SAVMA’s Duty Hours Guidelines, which suggest that students not work more than 80 hours a week, not work more than 24 consecutive hours in continuous on-site duty, and be provided with breaks when they are on call.

Similarly, the AAVMC’s Guidelines for Veterinary Intern & Resident Wellbeing, which recommend a limit on duty hours to 60 hours averaged over four weeks, are voluntary for veterinary colleges’ intern and resident programs. The AAVMC does not have guidelines for veterinary student duty hours.

Dr. Maccabe explained that one challenge with the idea of a national standard is that each veterinary school has different needs and operates in different environments with certain limitations.

“I think if we get too prescriptive with guidelines, then it's kind of a one-size-fits-all approach and that's not always appropriate,” Dr. Maccabe said. “Individual schools need to be responsive to all of their stakeholders and balance all the equities that are involved.”

All training environments should foster a culture that is beneficial to learning, he said. Managing the facility and the role of veterinary students, staff, faculty, interns, and residents is the responsibility of the institutions. However, that doesn’t mean that veterinary students aren’t allowed a say.

“I think that students at every institution can and should work with their administration and their colleges to see how best to set their own standards,” Dr. Maccabe added.

Penn Vet response

Penn Vet told AVMA News in a statement that veterinary students routinely work between 40 and 80 hours, aligning with SAVMA guidelines, citing data collected from clinical rotation leaders, along with reports from student logs. However, “Penn Vet recognizes that students may exceed 80 hours, especially during clinical rotations with high caseloads or if students are called in for emergency cases,” Penn Vet Chief Communications Officer Martin Hackett wrote.

He continued, “We have intensified our efforts to identify and address when students approach these limits. And we have moved to a proactive posture of increasing time off after on-call procedures, leveling case distribution, and making sure students are indeed taking breaks. This ensures that their in-clinics time is appropriate and serves their educational needs.”

In addition, Hackett said, Penn Vet has an embedded social work team consisting of a full-time social worker, a part-time social worker, a student counseling therapist, a social work graduate intern, and a master’s level social work volunteer.

The social work team created a wellbeing curriculum and organizes debriefing groups for students, house officers, faculty, and employees to support them when confronted with challenges as veterinary professionals.

Penn Vet spearheaded the Philadelphia ER Coalition for patient diversion in response to the high caseload stress. Controlling the caseload gives Penn Vet a mechanism to maintain an ideal teaching caseload while protecting the wellbeing of employees and students.

Finally, Penn Vet has hired a full-time nursing staff recruiter to address shortages.

Human medicine training

“It is important to acknowledge that across all health professions there is a tension between once-acceptable clinical training demands and trainee well-being; this is far from a unique issue to veterinary medicine,” Penn Vet’s Hackett wrote in a statement to AVMA News.

In human medicine, the Liaison Committee on Medical Education (LCME) standards broadly state that medical schools should monitor students' time spent in academic activities. The Association of American Medical Colleges (AAMC) doesn’t provide guidance regarding duty hours in medical education.

In contrast, resident physician duty hours are closely regulated. The Accreditation Council for Graduate Medical Education (ACGME) developed a set of required duty hours regulations in 2003 for residents. It mandates a maximum 80-hour work week—averaged over a four-week period—along with regulations addressing shift length and time off from clinical duties. Since then, many medical schools adopted similar guidelines for their students.

In 2017, the ACGME’s Common Program Requirements underwent substantial revisions to provide greater flexibility for programs to structure their clinical education while keeping the 80-hour limit.

“Clinical and educational work hours represent only one part of the larger issue of conditions of the learning and working environment,” according to the document’s background, adding that the document was expanded to pay greater attention to patient safety and resident and faculty member well-being.

The document also states: “Ensuring that flexibility is used in an appropriate manner is a shared responsibility of the program and residents. With this flexibility comes a responsibility for residents and faculty members to recognize the need to hand off care of a patient to another provider when a resident is too fatigued to provide safe, high-quality care and for programs to ensure that residents remain within the 80-hour maximum weekly limit.”

Notably, in the revised requirements, the term “clinical experience and education” replaces the term “duty hours” in response to concerns that the previous use of the term “duty” in reference to number of hours worked may have led some to conclude that residents’ duty to “clock out” on time superseded their duty to their patients.

Balancing academics and health

For veterinary schools, too, finding a balance between providing excellent patient care as well as enough clinical experience for veterinary students to gain the necessary skills while also supporting their wellness is challenging.

“We know there will be discomfort during the training process. Even within the guidelines for duty hours that Penn Vet has been working with for years, it is important to acknowledge the rigors of medical education and training to achieve optimal patient safety and outcomes. The hours spent during a veterinary student's clinical year are demanding and can be stressful,” Hackett said.

At the same time, more veterinary colleges are putting greater emphasis on student wellbeing, from hiring mental health professionals to providing programming to develop the individual and community wellbeing of their institution’s students, staff members, residents and interns, faculty, and leadership.

Some of the impetus is from veterinary students themselves. The SAVMA Wellbeing Committee was created in response to veterinary student mental health concerns such as high levels of stress, anxiety, and depression.

The committee promotes student physical, mental, and emotional wellbeing at veterinary schools by encouraging chapters to become involved in student wellbeing initiatives at their respective schools and colleges. SAVMA created a new position last year, wellbeing officer, to help carry out the committee mission.  

Tara Fellows Barron, SAVMA president, said one of her platforms as president-elect was amending the SAVMA Duty Hours Guidelines, which were first introduced in 2011 and last revised in 2019. She told AVMA News that while she respects the hard work of earlier generations of veterinary students, she recognizes today that students nationwide are communicating the need for more balanced schedules.