Abstract
Veterinary hospitals nationwide have been struggling for years to maintain adequate support staff (more specifically, credentialed veterinary technicians) due to extremely high turnover rates. This is a multifactorial problem that includes low wages, burnout, lack of upward mobility and autonomy, and improper utilization of their talents because of antiquated practice management models. This will be a recurring problem until veterinary practices around the nation subscribe to updated economic theories and utilization standards for their vital support staff and give credentialed veterinary technicians a career, not just a job.
Introduction
As the practice of veterinary medicine rapidly evolves to meet the extremely high demands on existing infrastructure and staff at veterinary hospitals around the country, one of the most severely affected portions of the hospital team are the credentialed veterinary technicians (LVT/CVT/RVTs). These technicians often work long hours (beyond the normal work shift), face understaffing problems, and are poorly compensated considering the demands of the job and requirements in training and certification. It should therefore come as no surprise that the average turnover of this portion of veterinary hospital staff is astoundingly high. In fact, according to a survey conducted by the 2018 AAHA Compensation and Benefits report, this segment of the veterinary staff has a 23% turnover rate (national average for job turnover at this time was 15%).[1] This therefore represents a major problem that the industry must contend with and correct for the future sustainability of the profession and continued availability of affordable quality animal healthcare.
This review will examine this problem in detail and propose some potential areas for improvement, specifically for credentialed professionals. For purposes of this analysis, a credentialed veterinary technician is someone who has pursued two to four years of additional education in an American Veterinary Medical Association’s Committee on Veterinary Technician Education and Activities (AVMA-CVETA) accredited veterinary technician program (although there is some variability in definition by state) and achieved a passing grade on the Veterinary Technician National Exam (VTNE) and applicable state licensing tests for the state of practice.
The Problem
Pay
While the problems leading to dissatisfaction and high turnover of credentialed veterinary technicians are multifactorial and complex, pay is commonly cited as one of the most significant problems that results in someone voluntarily leaving a veterinary practice. The average salary of a licensed veterinary technician in the Bureau of Labor Statistics 2020 census was just $36,260/year or $17.43 per hour.[2] As shown in figure 1, this is approximately $10,000 per year less than their average human health technologist/technician counterparts. On the BLS website, it states (under the occupational outlook summary) that this “[job] may be physically and emotionally demanding [and] many work evenings, weekends, or holidays … [with many of the employment openings resulting] from the need to replace workers who transfer to different occupations.”[3] Furthermore, according to the BLS server, a credentialed veterinary technician is one of just four occupations with a minimum education level of an associate’s degree and an average salary less than $40,000 per year. When taxes (income, payroll, social security, etc.) are factored in, these veterinary technicians are left just slightly above the national poverty line (which does not account for higher costs of living in urban areas where many of these workers are located). This means that most of these credentialed veterinary technicians must have multiple jobs (with one third of techs working two or even three jobs)[4] just to pay their bills–an obvious limitation on making veterinary medicine their career, and a major contributor to burnout, low morale, and the associated suffering of productivity while on the job. If a practice doesn’t offer healthcare benefits or 401k plans, this compounds the challenges.
In addition to the low pay, these credentialed veterinary technicians are usually saddled with debt arising from the costs of pursuing their education to become credentialed. Although the costs vary according to the type of program (two or four years, online or in-person) and by location, in general, a veterinary technician has thousands of dollars invested in their licensing before they even step foot in the veterinary hospital.
Banfield Pet Hospitals recently instituted wage increases for all its employees in recognition of the financial difficulties faced by its technician staff, and their annual turnover went from 40% prior to the wage increase to just 16% (about the national average for job turnover).[5] Banfield has also committed to assisting with the costs of becoming trained and credentialed as a veterinary technician.
In a 2017 study of credentialed veterinary technicians in all different regions and practice types, there was a strong positive association between the hourly wage and both individual engagement and job satisfaction ratings, and it was noted that CVTs with hourly rates of >$21 per hour had significantly higher overall workplace engagement scores.[6] Both of these ratings (individual engagement and job satisfaction) were found to be negatively associated with exhaustion and cynicism, which tend to occur when employees are overworked, undercompensated, and undervalued.
Another problem of note is the disparity between wages of female and male credentialed technicians. While females make up 95% of the credentialed veterinary technicians and males only 5%, males on average make 23% more per year for the same job.[7]
Lack of Autonomy and Respect, Burnout, and Staff Shortages
According to the North America Veterinary Technician Association (NAVTA), in addition to the insufficient pay, a “lack of respect from employers and burnout … [are major drivers causing credentialed support staff to leave the profession].”[8] Many technicians feel like “glorified pet holders” because they are not being given the chance to get involved and utilize the information that they went to school for; in fact most clients don’t even know that these credentialed veterinary technicians had to go through school and a certification process.[9] One former veterinary technician, when asked about the matter, reported being “[discouraged by practice owners] from asking questions about patient diagnoses and treatments in an environment where she was treated like a moron.”[10] This LVT left the profession for computer science because she “didn’t see the vet tech profession ever gaining any respect.”
In a 2017 survey published by Liss et al (2020), it was noted that holding a supervisor role was positively correlated with individual engagement. This was theorized to be a result of more autonomy, more managerial attention to concerns raised, and greater sense of value (organizational and self).[11]
Lack of Proper Distinction of Credentialed Veterinary Technician from Assistants (who may or may not be certified)
In a survey of credentialed veterinary technicians, 76% of respondents cited the lack of national standardization of credentialing for veterinary technicians as being a major problem affecting their future in the industry as many practices and even clients fail to recognize the vast differences in skills and knowledge, and thus fail to compensate accordingly and commensurate with the additional investment in education and licensing.[12] A recent push to unite credentialed veterinary technicians under the title of “veterinary nurse” has begun to try to get uniform credentialing requirements and a uniform definition to the scope of medicine that these “nurses” are allowed to perform.[13] Many credentialed veterinary technicians complain that, as long as there are veterinary assistants that erode the market for credentialed veterinary technicians because of the pervasive view of technician work being “on the job training,” things will never improve and they won’t get paid for their expertise.[14]
Summing it Up with Maslow’s Hierarchy of Needs
Based on the above discussion of problems, traditional veterinary business has failed in some cases to satisfy even the most basic levels of the hierarchy (physiologic: inability to financially support themselves), and also fails with esteem and self-actualization (as seen in figure 2). Until these problems are addressed, the attrition rates are likely to remain high.
The Solutions
Pay a living wage
One of the obvious solutions is to pay credentialed veterinary technicians a wage that would allow them to have a career instead of having multiple jobs to simply earn a living wage. As discussed previously, Banfield significantly reduced their turnover rates (less than half of previous levels) when they increased support staff wages. Many veterinarians/practice managers struggle with this idea because they fail to consider the additional income brought in by these trained technicians when utilized properly.
In an unprecedented move, the Veterinary Emergency Group (VEG) has recently committed to boosting credentialed employees up to $40 per hour, more than doubling the national average pay and setting the new standard for veterinary technical staff compensation.[15] The new scale that VEG set forth ranges from $23-$40 per hour according to credentials, skills, and location. Specialists receive an even higher pay range. VEG is also encouraging its technicians to go through the credentialing process by offering large bonuses and tuition/fee/exam reimbursement programs for its technician staff and a large pay increase upon successful completion of the program.
The age-old adage that you get what you pay for is true in veterinary medicine just like it is everywhere else. Veterinary businesses need to become more comfortable with the idea of paying for quality and knowledge and utilizing it in a way that it is affordable for the clients while also being sustainable for the practice.
Full Utilization
Full utilization of credentialed veterinary technician staff is not simply good for the bottom line of the practice; it is also good for staff retention. Credentialed veterinary technicians are extremely valuable members of the veterinary health care team because of their skills and above-average knowledge, and they represent a valuable asset that can be used for client communication, a variety of medical procedures, record keeping, and more, all of which frees up the doctor’s time to do what doctors do best–provide quality care that brings in revenue.
On average a credentialed veterinary technician will increase the gross revenue of a practice by $161,493 per year with an average annual per-vet increase in gross revenue of around $93,311.[16] Uncredentialled veterinary technicians, by comparison, bring in no significant additional gross revenue per technician. The value difference here is significant and shows that a certified veterinary technician more than pays for themselves.
There are intangible benefits to credentialed veterinary technicians as well. From saving time to allow veterinarians finish and get home earlier (shorter workdays for the doctors and thus less burnout) to having someone to help keep track of billing, make calls, schedule and greet appointments, perform medical procedures and surgical preparation, manage inventory, increase the safety of the veterinarian and client, and reduce liabilities associated with malpractice suits that may be avoidable with experienced staff, there are many intangible benefits that come with properly utilized credentialed veterinary technicians.[17] Even for a large animal ambulatory solo practitioner, it is reported that adding a credentialed veterinary technician would result in the veterinarian earning just $120 less per year, which is a small price to pay for all of the benefits afforded by having this helping hand, including peace of mind and shortened workdays.[18]
Underutilization is one of the critical problems that has plagued credentialed veterinary technicians and prevented their upward mobility in many practices through no fault of their own. As shown in figure 3, properly utilized technicians are happier technicians because they get to become more personally invested in the medicine and care of their patients, form relationships with the clients, and experience autonomy and trust.[19] Allowing credentialed technicians to get more involved gives them a chance to utilize the knowledge that they invested in while also improving the efficiency of the veterinary practice–a win for both sides. Furthermore, practices that utilize their technicians effectively tend to have higher satisfaction rates, which translates into return customers and practice goodwill in addition to the lower staff turnover rates and associated costs therein.[20] The veterinarian may bring in the clients, but good/knowledgeable and consistent staff is what leads to client retention.[21] Banfield has recently joined this movement by announcing that it will be promoting credentialed technicians to “work at the top of their license,” meaning that they will be delegating to technicians all tasks that they can legally perform.[22]
One of the most valuable uses of the credentialed veterinary technician is as the first point of contact and educator for clients on some of the more basic pathophysiological processes.[23] Technicians can spend more time talking with clients without having to worry about seeming rushed or delaying other appointments. In a 2021 study on information communication and clinical decision making in the veterinary practice setting, one of the most cited problems by veterinarians that hinders effective client communication is the time constraint. Many appointments feel rushed (which lowers client satisfaction) and standardized appointment lengths fail to meet the variability in patient needs.[24] Furthermore, the effectiveness of communication in the practice setting has a tremendous impact on client and veterinarian satisfaction; client ability to recall information and adhere to therapeutic plans; and overall appointment efficiency and accuracy. Therefore, many veterinarians indicate that their hospital team is a critical component for ensuring that relevant information is communicated to the clients.[25]
It is important for practices to focus on strategic hiring of credentialed technicians to fill gaps in their staff. The ideal technician is motivated and dedicated to lifelong learning (a quality that is in the best interest of the practice to foster through continuing education benefits, journals, and paid time off for workshops and skills development).[26] It is important, however, that technicians know and understand the bounds of their licensure within the specific state of the practice.
Economics
There is currently no research investigating the true costs of veterinary technician turnover to the practice. So, although using studies on human nursing turnover isn’t a perfectly dovetailed analogy, it may offer insights into the problems being discussed. Human nurses also have a high turnover rate with many citing similar problems as those being discussed above for veterinary technicians. The costs associated with employee turnover include training costs, marketing/hiring, and interviewing (which may include large human resource budgets), losses in efficiency during the training period, reduced team morale and cohesiveness, and dead-duck-period mistakes (when an employee doesn’t care anymore because of imminent departure, they are more likely to make mistakes from inattention to detail or cynicism).[27] In a 2010 study that investigated the cost of human nurse turnover to the human healthcare industry, it was determined that turnover represented >5% of the total annual operating budget of most hospitals with each nurse costing about $15,825 to replace.[28] While this is not necessarily an ideal representation of the cost of credentialed veterinary technician turnover to the veterinary practice, many of the principles illustrated are applicable. Therefore, based on marginal cost theory, the veterinary practice would be better suited to pay up to this cost of replacement to maintain their staff rather than having to pay the additional cost of replacing their technicians because of poor retention. Each individual veterinary practice would be well-suited to run the calculations of turnover cost, where possible, to determine what pay bonuses they can afford to give their technical staff while causing no additional financial liability to the company (other than would normally be assumed by hiring and retraining/replacement).
Summary
The credentialed veterinary technician is the backbone of the veterinary practice and the foundation of its profitability. Although a series of problems has led to extremely high turnover rates in this profession over the past twenty years, these problems are relatively straightforward to rectify, including higher pay commensurate with skills and knowledge and better utilization in recognition of their knowledge, skills, and value to the hospital and to the healthcare of animals. It is important that practice owners more fully recognize that these skilled staff members are not just an hourly liability to their income statements but, rather, an asset that must be invested in for retention.
[1] Liss, D.J., Kerl, M.E., Tsai, C.L. (2020). “Factors associated with job satisfaction and engagement among credentialed small animal veterinary technicians in the United States.” Journal of American Veterinary Medical Association (257) no. 5 (September 2020) 537-545.
[2] https://www.bls.gov/ooh/healthcare/veterinary-technologists-and-technicians.htm
[3] BLS 2020
[4] Larkin, M. (2018). “Prime issue for veterinary technicians: Underutilization.” https://www.avma.org/javma-news/2018-11-15/prime-issue-veterinary-technicians-underutilization
[5] Wogan, Lisa (2018). “Veterinary technicians get a boost from a major employer.” https://news.vin.com/default.aspx?pid=210&Id=8771453
[6] Liss, D.J. et al. (2020).
[7] Lacroix, C. (2015). “Improve your practices bottom line: Effectively use veterinary technicians.” VSIPP 2015. www.veterinarybusinessadvisors.com [Slide39]
[8] Wogan, Lisa (2018).
[9] Wogan, Lisa (2018).
[10] Griffith, D.A., (2011). “Veterinary Technicians: Opportunities, but at what cost? Support staff cite low wages, spotty professional respect.” https://news.vin.com/default.aspx?pid=210&Id=4919421&useobjecttypeid=10&fromVINNEWSASPX=1
[11] Liss et al. (2020)
[12] 2016 NAVTA Demographic Survey Results. 2016_navta_demographic_survey_results.pdf
[13] Larkin, M. (2018).
[14] Griffith, D.A., (2011). “Veterinary Technicians: Opportunities, but at what cost? Support staff cite low wages, spotty professional respect.” https://news.vin.com/default.aspx?pid=210&Id=4919421&useobjecttypeid=10&fromVINNEWSASPX=1
[15] Today’s Veterinary Business 2021. https://todaysveterinarybusiness.com/veg-technicians-pay/#:~:text=Credentialed%20veterinary%20technicians%20employed%20at%20the%2024-hospital%20Veterinary,the%20technician%E2%80%99s%20credentials%2C%20skill%20level%20and%20hospital%20location.
[16] Facts and Figures (2007). “Contribution of veterinary technicians to veterinary business revenue, 2007.” https://www.vin.com/apputil/image/handler.ashx?docid=4910593
[17] Wright, C. and Kelly Zeytoonian (2021). “How to improve practice efficiency, revenue, and job satisfaction by hiring a licensed veterinary technician.” AAEP.HowtoImprovePracticeEfficiencyRevenueJobSatisfactionwVetTech(10.2021).pdf
[18] American Association of Equine Practitioners. 2016 AVMA AAEP Equine Economic Survey. http://aaep.org/sites/default/files/Documents/2019%20FINAL_AVMA_AAEP_Equine_Report.pdf
[19] Larkin, M. (2018).
[20] VBA (2016). “Technicians.” www.veterinarybusinessadvisors.com
[21] Lacroix, C. (2015). “Improve your practices bottom line: Effectively use veterinary technicians.” VSIPP 2015. www.veterinarybusinessadvisors.com [Slide20]
[22] Wogan, L. (2018).
[23] Lacroix, C. (2015). “Improve your practices bottom line: Effectively use veterinary technicians.” VSIPP 2015. www.veterinarybusinessadvisors.com [Slide24]
[24] Janke, N., Coe, J.B., Bernardo, T.M., Dewey, C.E., Stone, E.A. (2021). “Pet owners’ and veterinarians’ perceptions of information exchange and clinical decision-making in companion animal practice.” https://doi.org/10.1371/journal.pone.0245632
[25] Janke, N. et al (2021).
[26] VBA (2016). “Technicians.”
[27] Waldman, J.D, Kelly, F., Sanjeev, A., Smith, H.L. (2010). “The shocking cost of turnover in health care.” Health Care Management Review (2010) 35; 206-211. doi: 10.1097/HMR.0b013e3181e3940e
[28] Waldman, J.D. et al (2010).
