Mental Health Challenges in the Practice: How to Identify and Combat Them
Veterinary Business Advisors, Inc.
In February 2015, the U.S. Centers for Disease Control and Prevention (CDC) released survey results focused on responses given by more than 10,000 practicing veterinarians, most of whom were in small animal practice (69%). The results are worrying.
- 8% of males in the profession have a serious mental illness/psychiatric disorder, with feelings of hopelessness and worthlessness; this is twice the prevalence, nationally, for males in the United States
- Figures for females are even higher, at 10.9%, which is two to three times the national prevalence
- 4% of males and 19.1% of females in the profession have considered suicide, three times the U.S. national average
Here’s where it gets even more concerning. The three primary stressors identified by survey respondents were:
- Demands of veterinary practice
- Veterinary practice management responsibilities
- Professional mistakes and client complaints
The reason that this is so concerning: although the survey provides no empirical data about veterinary practice staff:
- When the veterinarian is dealing with mental illness challenges, this affects the entire practice
- The stressors that are negatively affecting the veterinarians themselves also affect the entire practice
So, it is likely that the disturbing statistics about veterinarians and their mental health challenges are just the tip of the iceberg. How, then, can this problem be addressed? First we will look at the challenges in more depth and then provide recommended strategies.
Closer look at the challenges
In an article by the American Veterinarian Medical Association titled Veterinarians and Mental Health: CDC Results and Resources, another challenge is identified: stigma. “There is a stigma among our profession,” the article reads, “toward those with mental illness, as though mental illness is a weakness that should be stifled, overcome or simply cut out like a surgeon excising a growth. But it’s not that simple. Mental illness is not a weakness or a personal or professional failing; it’s a real medical condition that must be treated.”
Harvard Health Publications acknowledges the difficulties that mental illness stigmas can create: “the stigma attached to having a psychiatric disorder,” the article reads, “is such that employees may be reluctant to seek treatment . . . out of fear that they might jeopardize their jobs. At the same time, managers may want to help but aren’t sure how to do so. And clinicians may find themselves in unfamiliar territory, simultaneously trying to treat a patient while providing advice about dealing with the illness at work. As a result, mental health disorders often go unrecognized and untreated – not only damaging an individual’s health and career, but also reducing productivity at work.”
Common psychological problems in the workplace include depression, bipolar disorder, attention deficit hyperactivity disorder and anxiety – and the economic consequences are tangible. In one study that focused on the financial impact of 25 chronic physical and mental problems, depression was most costly, with anxiety ranking fifth. Furthermore, “Many of the studies in this field have concluded that the indirect costs of mental health disorders – particularly lost productivity – exceed companies’ spending on direct costs, such as health insurance contributions and pharmacy expenses. Given the generally low rates of treatment, the researchers suggest that companies should invest in the mental health of workers – not only for the sake of the employees but to improve their own bottom line.”
Here are more granular statistics about mental illness and the U.S. workforce; note that these are not specifically focused on veterinary practices:
- Approximately 6% of employees experience depression symptoms per year and these workers report the equivalent of 27 lost work days per year, nine because of actual absence and 18 because of lost productivity. Only 57% of employees with major depressive symptoms received mental health treatment in the past year, with only 42% of those in treatment receiving adequate help.
- Approximately 1% of American employees deal with bipolar symptoms per year, with an average of 28 work days lost per year because of absenteeism and another 35 in lost productivity. About 2/3 received treatment, but only 9% who sought care from general practitioners received care meeting recommended guidelines, with 45% meeting that goal when they consulted with mental health professionals.
- Approximately 6% of the population suffers from anxiety but it tends to go undiagnosed for 5 to 10 years.
- Approximately 3.5% of employees have ADHD, and they lose, on average, 22 work days a year – and are 18 times as likely to be disciplined for behavioral/other work problems and two to four times as likely to be terminated. Only 13% of these workers are being treated in a given year.
Dealing with the challenges
Harvard suggests that employers think of mental health care as an investment. When depression is treated, as one example, “companies reduce job-related accidents, sick days, and employee turnover, as well as improve the number of hours worked and employee productivity.”
Mental Health America suggests the following strategies to help employees:
- Ask your insurance carrier about (adequate) mental health coverage
- Provide access to employee assistance programs (EAPs)
- Be accommodating, creating an environment for people with special needs
- Bring in an expert on mental health to speak to the practice
- Create and enforce a return-to-work policy, including for those with mental illnesses
CDC suggests that practices also provide depression recognition screenings and make available confidential self-rating sheets. Meanwhile, the AMVA provides numerous resources to help practices with wellness strategies at https://www.avma.org/ProfessionalDevelopment/Personal/PeerAndWellness/Pages/default.aspx
“Mental health problems in the workplace,” Harvard Health Publications, February 1, 2010, http://www.health.harvard.edu/newsletter_article/mental-health-problems-in-the-workplace
Nett, Randall J., Tracy K Witte, Stacy M. Holzbauer, et. al., “Notes from the Field: Prevalence of Risk Factors for Suicide Among Veterinarians – United States, 2014,” Centers for Disease Control and Prevention, February 13, 2015, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6405a6.htm?s_cid=mm6405a6_e
“Support an Employee,” Mental Health America, http://www.mentalhealthamerica.net/support-employee
“Veterinarians and Mental Health: CDC Results and Resources,” American Veterinary Medical Association, February 12, 2015, http://atwork.avma.org/2015/02/12/veterinarians-and-mental-health-cdc-results-and-resources/
“Workplace Health Promotion: Depression,” Centers for Disease Control and Prevention, October 23, 2013, http://www.cdc.gov/workplacehealthpromotion/implementation/topics/depression.html
Exit Interviews: Who, What, When, Where, Why, and How
Kellie G. Olah, CVPM, SPHR, SHRM-CP
Veterinary Business Advisors, Inc.
One of the most valuable assets at your veterinary practice is the people you employ, with skilled ones having the ability to boost the quality of service you provide to clients and their animal companions. Sometimes, though, these employees leave, doing so for a variety of reasons. This can present challenges for your practice, but it also offers a silver lining opportunity if you conduct an exit interview to gather insights from that departing team member.
To help your practice extract maximum value out of these interviews, we’ll share insights into the who, what, when, where, why, and how of it all—starting with the “why.”
Employees often have deep insights into what works well at your practice—and what doesn’t. They may not have felt comfortable sharing their thoughts while working at the organization but may feel freer to have an honest conversation once they will be leaving.
Through these exit interviews, you can glean information about why this particular employee is leaving and then use what you learn to improve working conditions and boost productivity and retention—which in turn can save your practice money. After all, it isn’t cheap to recruit, hire, and train new employees.
Reasons why people leave can range from their salary and benefits to being recruited by another company that appeals to them, experiencing problems with management and/or other employees, and so forth. Some people may be reluctant to share issues of concern, even on their way out, while others will be happy to have the opportunity. So, it’s important to prepare an approach for either possibility.
You can also take what you learn from exit interviews to look for patterns. If one person admits she is leaving because of a particular manager, it may be a personality conflict. If four out of the last five people who left mention that same manager, that’s an entirely different situation.
People involved in the exit interview will include the employee who is leaving the practice, along with the person or people conducting the interview and collecting data. This raises the question of who the interviewer(s) should be. Many companies assume this is a human resources function and so they have their HR manager conduct the interview. Although this can elicit helpful information, this person will almost certainly focus on HR issues—salary, benefits, and so forth—and may miss out on the bigger scope.
Having a direct supervisor conduct the interview can create a comfortable atmosphere, given that the employee and supervisor had an open and positive relationship. However, if the employee is leaving—in part or in full—because of that supervisor, that approach can be fraught with difficulties.
Some experts suggest having the supervisor’s supervisor (or, if part of a large company, even one level above that) conduct the interviews. At a small practice, this may mean the practice owner would be the one to hold them. For some exiting employees, this could feel intimidating. For others, though, it could be viewed as a sign that their feedback is being taken seriously.
Still other companies use a consultant to conduct exit interviews. This costs money, which some practices may not want to spend. On the positive side, employees may feel more comfortable giving authentic feedback to a neutral party. Plus, an experienced consultant has the ability to draw out valuable insights and provide reliable information to the practice. Some companies have in-house exit interviews conducted, following them up with consultant-led ones.
As you can see, there is no one right answer. Think about your practice and make a savvy choice, continuing to improve upon the interviewing process whenever possible.
The first part of the process is to schedule and hold the exit interview (more about when and where next). Explain how the purpose of the interview is to get feedback from the exiting employee to improve working conditions and otherwise meet employee needs in better ways in the future.
It makes sense to have a set of questions to use but allow for flexibility. For example, you could start by asking why the person is leaving the practice. Here are two contrasting responses you could get:
- I got a better job.
- I’m going to take a break from the workforce to spend more time with my young children.
You would follow up quite differently with each of these. With response one, you might use these follow-up questions:
- What makes this a better job (salary, benefits, flexibility, etc.)?
- When did you start looking for a new job? What was the triggering event?
- Why did you choose to accept the new job that you did? What is more appealing to you there?
With response two, if you wanted to retain this employee, you might decide to ask if there is a way you could restructure this person’s job to allow them to have more family time while still working at your practice. Is a part-time position available?
Other questions, in general, to ask can include:
- Did we provide you with what you needed to do your job well?
- Did you receive helpful and clear feedback from us?
- What else could we have provided you (training, equipment, and so forth)?
- What are your impressions about our practice’s culture?
- If you could change some things about our culture or working conditions, what would they be?
- What would have helped you to stay at our practice?
- Were you happy (or at least satisfied) with management here? If not, why not?
- Would you consider returning here if the opportunity arose? Why or why not?
People conducting the exit interviews must be open to feedback and respectful and listen well.
In general, it makes sense to conduct the exit interview a few days before the employee will be done at the practice. If held when the person gives notice—perhaps two weeks or a month before actually leaving—then the employee may be somewhat reluctant to share less than wonderful feedback about the practice. After all, they would still be working with the people they may criticize for a period of time.
Conversely, it’s best to avoid the last day. For some exiting employees, all they’ll be thinking about is what lies ahead and so they may not give the interview their full attention. Other employees—perhaps emotionally touched by a going away party given that day—may only give wonderful feedback, thus preventing the practice from receiving constructive criticism.
Exit interviews should be held, ideally in person, in a place that’s both convenient and private. Locations could range from a private office where the conversation won’t be overheard to a restaurant where a reasonably uninterrupted conversation could take place over lunch.
How should data collected be used?
After gathering information from exit interviews, members of the practice’s management should analyze what was shared to see if changes should be made to better meet the needs of current employees. Are there, for example, voluntary benefits that you should add to your practice’s menu of choices? Should your practice offer more training opportunities? Seek out ways to build in some flex time?
After you make changes, update your employee manual appropriately and monitor the effects that changes made have on employee satisfaction, productivity, retention and so forth. Composite insights can be used in the practice’s strategic planning and recruiting strategies going forward and otherwise be factored in when making decisions that can affect employee satisfaction, productivity, and retention.
Sidebar: Stay Interviews
Valuable as exit interviews can be, they are still a look into a rear-view mirror. This is feedback from employees who will no longer be part of your practice. So, also consider “stay interviews” where you interview the best of your current employees. This allows you to keep a finger on your practice’s pulse. How satisfied are these employees? What issues are the most important to them? Have any of them considered seeking greener pastures? If so, when and why? Are any of them being recruited by other practices or organizations?
This gives you an opportunity to compare what you’ve learned from exit interviews with what current star employees tell you. How will this impact the changes you make at your practice? How can you use what you learn to recruit, hire, train, and retain employees in the future to strengthen your practice?
Work-Life Balance—or Work-Life Integration?
Kellie G. Olah, CVPM, SPHR
The topic of work-life balance has been discussed for decades, with a variety of experts weighing in with different perspectives. Over the past few years, though, a new phrase has been tossed into the mix—that of work-life integration—and you may be wondering if there is really a difference, or if an old phrase has just been given a fresher name. The short answer is that the idea of work-life balance has evolved into a new and more holistic concept—that of integration. Here’s more.
Balance Versus Integration
The idea of balance suggests that the amount of time or energy spent on one activity—whether work or life outside of it—takes away from the other activity. As a visual, imagine a double-pan scale. If you put weights on one side, the other side automatically goes up while the side with the weights goes down. So, in a work-life balance scenario, time spent at work automatically takes away time spent with family, friends, and so forth—and vice versa.
This concept does have value, though. It’s simple and straightforward. You’re working or you’re otherwise living your life. Either/or. Plus, when this concept began to be discussed in the 1970s and 1980s, it did shine a spotlight on stressed, even burned out workers—initially the Baby Boomers—and it acknowledged the need for personal time.
More recently, experts and human resource leaders have begun to challenge this concept, or at least point out flaws. For example, many Millennials are looking at the work-life equation somewhat differently, in a way that doesn’t fit within the notion of balancing the two options.
These Millennials are envisioning what a meaningful life would look like to them and then seeking out jobs and pursuing careers that would allow that to happen. This is in contrast to the approach that’s traditionally been used—that of finding a job and then fitting in family and leisure activities around employment.
So, in short, work-life integration replaces an either/or dynamic with a holistic one that has more fluidity and flexibility.
Which Combination Resonates?
An example of the traditional concept of work-life balance would be a “banker’s hours” type of job where a person goes to work from, say, 9 a.m. to 5 p.m. Before they go into work and after they get home—and on the weekends—work is left behind, and they focus on other aspects of life. Shift hours don’t have to be 9 to 5; this is being used to illustrate the either/or nature of a work-life balance.
Now picture a continuum. One the far left are people whose passion for their careers is so great that they largely prefer a work-work balance. Any free time they have would preferably be spent finding additional ways to contribute, career-wise, and to advance in the workplace. On the far right are people with a life-life balance, where they may work because they have to for income, but their career is not a focus. Free time goes to friends, family members, hobbies, and so forth.
Now, the middle of our continuum can represent work-life integration, a situation where the two aspects of life fuse together in a satisfactory way. At this point of our illustration, the continuum image still works symbolically, but not literally—because the combination of work and life that works for one person won’t work for another, and it’s typically not an equal balance of the two activities. Each person can have a different spot on the continuum.
How Your Practice Can Respond
First, it’s important to understand what each of your employees needs, and what each one values, and then brainstorm ways to contribute. The underlying philosophy is that, as your practice’s team is able to take care of family commitments and otherwise participate in meaningful events, the more they’ll be able to provide their best quality of work. After all, even employees with the highest levels of commitment can fall short when they’re feeling burned out or worried because they can’t be present during important family moments.
Next, practice managers can hold conversations with each employee to talk about how to cooperatively create and optimize his or her work-life integration. A key component of this would be to see how flexible the work environment can be. Can employees, for example, switch shifts as long as it’s done in an equitable way that won’t leave gaps in service? Can an employee’s hours be tweaked on certain days? Are there any circumstances in which an employee can do some work remotely?
If employees struggle to fit in exercise with their work and family responsibilities, can your practice have someone lead them in yoga stretches during lunch? If they want or need to obtain continuing education credits, but find it difficult to earn them after work hours, how can you incorporate opportunities in company lunch and learns?
Will this system work perfectly, every day? Of course not. Integration is an ongoing process. On some days, a work schedule may be more demanding; on other days, a personal emergency could arise. Plus, work-related needs and non-work needs can evolve, which means that a process of continual assessment and adjustment will be required.
Practice Managers and Owners
To help develop a flexible work culture, practice managers should also look after their own integration needs. This helps to prevent burn out and sets a good example. It’s also important to not micro-manage the flexibility options that have been given to employees. If, for example, employees are allowed to switch shifts as long as gaps as covered, don’t hover over the employees’ shoulders.
Establish reasonable processes and procedures; include them in your employee manual; communicate them clearly to employees; and then give practice team members some breathing room in implementing them. Encourage them to work out challenges together as a team, only entering the process when they have reached a stalemate.
How Practices Can Benefit
When a practice flexibly collaborates with employees to help them maintain work-life integration, employees are more likely to stay at that practice. This allows managers to recruit and retain quality professionals—which in turns reduces turnover costs associated with recruiting and training new employees.
Plus, when an employee is given opportunities to integrate their lives more fully, they will likely be happier and more committed to the practice—and that shows in the service they provide to clients and their animal companions. This will allow them to serve as better role models for new employees, more willing to help their office mates to achieve their own work-life integrations.
SIDE BAR: Work-Life Integration During COVID-19
The coronavirus pandemic has changed people’s lifestyles in numerous ways. Some people may be working fewer hours than before or have been laid off or furloughed, while others may be working more hours than ever. Some people have been directly impacted by the virus, perhaps needing to care for a loved one or to recover from illness personally. Although specifics will vary by person, today’s realities can have a significant impact on how you view work-life integration and may trigger evolutions in perspectives.
In other words, you now have an opportunity to evaluate what you truly value through a new and unexpected lens. There are no right or wrong responses when it comes to your thoughts and feelings about work-life integration during the pandemic—so analyze your own unique reactions.
How would you (re)prioritize each aspect of your life? What things that once seemed important can now be set aside for a later time? What now feels crucial to you that you wouldn’t necessary have prioritized so highly, pre-COVID? What aspects of life do you now realize you are ready to eliminate from your lifestyle? What elements of self care do you now plan to implement?
Three Workplace Issues to Consider About the Internet
When you think about legal issues associated with the internet that can affect veterinary practices, you may think about telemedicine – and that is an excellent example, although not the only internet-based legal issue faced by practices today. This article provides an overview of three different legal issues associated with the internet.
Researching Potential Employees on Social Media
Social media makes it so easy to find information; including about people your practice is considering hiring. But, is it legitimate to search on social media platforms to discover information about job candidates? As with most broad questions posed about the ever-evolving internet, the answer is “it depends.”
It is not, in general, illegal to research job applicants’ social media profiles, but don’t do so haphazardly. Instead, create a clear written policy about what sites will be reviewed to find what clearly-defined pieces of information. Also determine who will review these profiles and what information will be housed in your records. To add a layer of protection to your social media policy, consider having a person without the ability to hire, a non-decision maker, do the research.
Make sure you follow your policy consistently for all candidates, not only certain ones. If you act inconsistently when an issue involves a protected class, this could open you up to a discrimination lawsuit. A protected class is any group of people with common characteristics who have legal protections from discrimination because of those characteristics. These characteristics include race, color, religion, national origin, age, gender, pregnancy status, disabilities and more.
Here’s how something could quickly go wrong. Let’s say you obtain a piece of information that theoretically could lead to your not hiring a candidate. Then let’s say you don’t hire that candidate, but this piece of information had no bearing on your decision whatsoever. The candidate could still claim a connection between your hiring decision and an employment or labor law violation.
Here’s another issue to consider. If your investigation includes a review of the job applicants’ credit history, financial history, driver’s license verification and/or other pieces of related information, you may run afoul of the U.S. Fair Credit Reporting Act.
Employee Use of the Internet
As of September 2016, 87 percent of people in the United States use the internet, according to PewInternet.org. And, according to another PewInternet.org report from November 2016, 79 percent of Americans who use the internet are on Facebook. Smaller percentages of people are on other social media channels, such as Instagram (32 percent), Pinterest (31 percent), LinkedIn (29 percent) and Twitter (24 percent).
The bottom line, though, is that virtually every veterinary practice in the country will have at least some employees who use the internet – so, how do you, as a practice, monitor employees’ internet use while on the clock? Employees want privacy in their internet use, whereas the practice wants to make sure that time on the clock is well spent. Employers also want to ensure that computer use in the practice does not involve any inappropriate or even illegal activities.
The solution? However you choose to monitor employee usage, do so consistently, and create a clear written policy about internet use during company hours. If you don’t provide this policy, then employees could have justification for a breach of privacy lawsuit. If you decide to monitor, what are your options? Some practices may decide to install site-blocking software on all office computers or use software that limits the amount of time that someone can browse a non-work-related site.
What about texting? Should your employees be allowed to text during work hours? Again, a clear written policy about text use is crucial so employees know what is and isn’t acceptable. When crafting the policy, consider context. Having an employee ask his or her child to text when he or she is home from school is a very different situation from an employee who texts about party plans when he or she should be helping with an agitated patient.
Internet Harassment and Cyber Bullying in the Workplace
A serious downside to the internet is online harassment and cyber bullying, and that unfortunately can take place among coworkers. And, at the risk of sounding like a broken record, a clear written policy about how online harassment and cyber bullying will not be tolerated is crucial. In this statement, clearly define what you mean by harassment and by bullying, and state that examples given in your policy do not constitute the full range of behaviors that fall into these two categories. Share the consequences, up to and including termination, if the policies are not followed.
Consider working with your entire practice team to develop a values statement so that employees can play a role in its formation. Besides creating a useful statement, if you sit in on the meeting, you can likely identify people who are less likely to abide by it.
If you notice higher turnover, be especially vigilant in watching for bullying behaviors and, when identified, deal with them firmly. Also watch out for behaviors and statements that are presented as jokes, with people who don’t find them funny being told they have no sense of humor and need to lighten up.
If someone comes to you to report bullying or harassing behaviors – ones that are occurring to the person reporting them or to someone else – take them seriously. Slow down, listen and respond accordingly. Also consider what resources to offer to people being bullied or harassed, from stress management strategies to counseling services.
These are three of the more common legal issues connected to internet use in the workplace, but this is not a comprehensive list. Use this article as your starting point and remember to update your policies and procedures as internet technology evolves. Also watch for information about court cases where boundaries of cyber bullying are adjudicated in the courtroom.
When Can an Employer Influence an Employee’s Healthcare?
Kellie G. Olah, CVPM, SPHR
Veterinary Business Advisors, Inc.
Although few if any employees would object if their workplace offered free gym memberships or access to voluntary smoking cessation programs, the situation could be quite different if certain health benchmarks or procedures were made mandatory.
This therefore raises the question of when an employer can require employees to have a vaccine, for example, or to stop smoking, lose weight, or comply with other health-related actions, including with legal activities that take place outside the workplace.
Here is some guidance on four different topics.
With more than one COVID-19 vaccine on the horizon, the question of whether employers can mandate vaccinations is a hot topic, especially in workplaces that provide health-related services—and, in general, the answer is “yes.” Vaccinations can in fact be required, given that employers appropriately consider any requests for religious and medical accommodations.
More specifically, employers who plan to mandate the vaccine should consider:
- Religious accommodation requests under Title VII of the Civil Rights Act of 1964: How a “sincerely held religious belief” is defined will depend upon the court; in general, a personal objection to a vaccine—or an ethical one—is not sufficient and, even if such a sincerely held belief is effectively established, an employer can still mandate the vaccination if the lack of one will create an undue hardship for the company.
- Medical accommodations requests under the American with Disabilities Act (ADA): Employees who work for companies that will require a vaccine and want to obtain a medical accommodation must provide evidence for a disability that’s covered by the ADA. As far as vaccine sensitivity or allergies go, court decisions have been split over whether those qualify.
Although it’s COVID-19 that is bringing this issue to the forefront, the topic of mandatory vaccinations is not new. The same debates that will likely occur have already happened in connection with the flu vaccine, with case law currently existing in places where employees would be providing direct patient case. How court decisions will unfold during the pandemic era—and whether current case law will be upheld for COVID-19—remains to be seen.
If, after examining pros and cons, your practice plans to have a mandatory vaccination requirement, create a carefully written policy so that employees are clear about what’s required, including the process for requesting accommodations or waivers. When vaccination time draws near, be prepared to address any requests for accommodations thoughtfully and consistently, and then carefully document what takes place.
People who smoke are, overall, sick more often, using up more sick days. Because of this, they use their health insurance more often than non-smokers. In general, they often take more breaks at work, usually because they want to smoke a cigarette.
Companies that are concerned about how smoking can affect a worker’s absenteeism rates and productivity during the day may decide to implement a mandatory smoking cessation policy. This policy may, for example, give employees a certain time frame to stop smoking and, to help, the company may decide to cover the costs of a smoking cessation program. Companies that provide health care benefits for employees may be more likely to implement a required cessation policy because employees who smoke are more expensive to cover than non-smokers.
But is that legal?
As far as federal law goes, this issue isn’t addressed. So, to discern whether your practice could implement this kind of policy, look at your state laws—more specifically, looking for any “lifestyle discrimination” or “off-duty conduct” laws. In some states, employers cannot dictate whether or not an employee engages in a legal activity on their own time at a location outside the workplace. In states where these laws don’t exist, your practice may be able to create a policy where employees must stop smoking as a condition of continued employment.
Weight Loss Mandates
Now, what about workplaces that require employees to manage their weight, either because of health or health care concerns, or because it projects the wrong image for a company? Is this possible?
First, weight is not a protected class under federal law, unlike race, age, gender and so forth. So, this means that employers can often legally fire employees who are overweight. Having said that, if an employee’s weight qualifies as a disability, an employer who terminates that employee may be engaging in disability discrimination, according to ADA. Plus, if a company did decide to fire overweight employees—and this disproportionately affected ones of a particular gender or certain race—this may not be legal.
It’s also important to look at state and city law to see what, if any of them, provide relevant anti-discrimination protection for employees. In the case of weight issues, the state of Michigan and a few cities, including Washington D.C. and San Francisco, protect employees from weight-related discrimination. Because new laws are put on the books all the time, check yours before creating any policies that may run contrary to them.
Also consider the Affordable Care Act (ACA) as well as the ADA before requiring employees to be part of weight loss programs. By requiring them to set weight loss goals and weigh in to continue receiving benefits or to avoid work-related discipline, this could be considered illegal under both of these laws.
If your practice is considering the implementation of any of these health-related requirements for employees, it makes sense to consult with your human resources attorney before creating a policy and then to have the attorney check it before it is shared.
Once a policy is approved, ensure that everyone in the workplace receives a copy (it can be wise to have them sign that they’ve received their copy) and set aside a time to discuss the new policy with them and answer any questions.
Also, the Centers for Disease Control and Prevention (CDC) encourages employers to implement workplace health programs and policies to “meet the health and safety needs of all employees.” This can include offering health education workshops, providing employees with access to local gyms, having a tobacco-free workplace, providing healthy snacks, and creating an environment that values health and wellness.
Steps include conducting a workplace health assessment and then planning an appropriate program to meet employee needs. Implement and monitor the program to determine its impact and adjust elements of the program, as needed, for optimal success.
Sidebar: Pregnancy-Related Discrimination
As a related matter, ensure that your workplace policies do not potentially discriminate against pregnant employees. When the Pregnancy Discrimination Act amended Title VII, this effectively provided federal protection for them. This means that an employer cannot have special pregnancy-related procedures when it comes to addressing an employee’s ability or inability to work. If, for example, an employee temporarily can’t perform job duties because of her pregnancy, the employer must respond in the same way that they would for any other temporarily disabled employees.
In other words, if non-pregnant employees who are temporarily disabled can modify their work tasks or take on other tasks, or can take a leave, the same must be made available for employees who need accommodations because of pregnancy.
Plus, pregnant employees must be allowed to continue their job as long as they are able. If an employee needs some time off because of pregnancy-related issues, but is able to return to work, the employer cannot require her to stay off work until after the baby is born or require a certain amount of time off duty after childbirth.
How to Manage Narcissistic Personality Disorder
Veterinary Business Advisors, Inc.
*Principles of this blog are based off the National Business Institute’s course on “Dealing with Narcissistic Personality Disorder in the Legal Practice: Clients, Counsel, and Others”.
Whether a client or a coworker, unhealthy narcissism can derail an otherwise straightforward experience together.
In 2020, there were 7 million American adults who have NPD or narcistic style. People who have this tend to see others as objects for their personal gratification, or as potential threats. Their world view tends to be win or lose. When those diagnosed with NPD, behavior traits include:
- Lack of empathy
- Grandiose sense of self-importance
- Excessively concerned about their image
- Dirven to seek attention and admiration
- Largely superficial relationships
- Feel entitled to manipulate or exploit others
- Rarely admit they are wrong
- Become enraged when they feel disrespected or humiliated
- Play the victim or martyr
How do you know or feel in the presence of narcissists? You can feel often belittled, under scrutiny or even judged, as if nothing you are doing is good enough, among many other feelings. Unfortunately, narcissists hide behind a façade of fear.
Working with Narcissists & Communicating with Clients with NPD –
The Narcissist’s Code – have you ever had a client or colleague that you sense may exhibit these traits? It’s helpful to know what may be motivating them, especially if it’s not obvious. One of the key points is that image is everything for them. Next is getting attention – it’s often when they feel listened to or admired – they feel expansive and fueled. If they are not at the center of attention, they can feel depressed, and often aggressive. Honesty is optional for them! Narcissist’s can be great liars as they seek image enhancement, being incredibly convincing in the moment. Next, they tend to believe others are either against them or out to get them. Narcissists tend to be driven by emotions and impulses. Winning is everything for them. Knowing these traits can allow you to be aware, and even create strategies to respond.
What could this look like with a potential client? Clients could think they know more or better than you as the veterinarian or technician, and will even demean or manipulate other members of your staff. They expect to be admired and rules are an exception to them.
Key Tip: A practical tip to respond include sharing that their treatment doesn’t feel respectful, which can ultimately interfere with helping them achieve their goals.
|Argue with them
||Authentically praise their strong points
|Try to get them to accept responsibility
||Educate them on possible consequences, then let them choose
|Take what they say personally
||Recognize that they are like this with everybody
|Argue for a win-win approach
||Focus the narcissist on his/her interests rather than what the opposing party receives
|Respond to dramatics or ultimatums
||Return to the narcissist’s goals and interests
|Take the bait when criticized
||Reassure them that you are on their side, and refocus on the case
|Overlook any failures to follow your policies
||Document, document, document. Make exceptions to your policies sparingly, if at all.
It can often be incredibly mentally and emotionally draining when dealing with someone who exhibits NPD. It’s important however, to hold onto your voice and set boundaries. It is not your responsibility to fix them. Dr. Dan Neuharth shares the “11 Things NOT to Do with Narcissists”:
- Don’t take them at face value
- Don’t over-share personal information
- Don’t feel a need to justify your thoughts, feelings or actions
- Don’t minimize their dysfunctional behavior
- Don’t expect them to take responsibility
- Don’t assume they share your values and worldview
- Don’t try to beat them at their own game
- Don’t take their actions personally
- Don’t expect empathy or fairness
- Don’t expect them to change
- Don’t underestimate the power of narcissism
Many of this can be easier said than done, but try to remember: in most cases, it’s not your responsibility to satisfy their cravings for admiration and praise. We can have compassion for the suffering of narcissists, but it does not mean excusing them for their narcissistic actions. Rather, focusing on the patient or case at hand, focusing on facts and trying a tip or two from the above table.