It’s one of the biggest reasons that I left my job as an assistant professor at a veterinary school – the time that I was required to spend on-call. As one of two small animal emergency and critical care faculty members, I spent approximately 26 weeks of the year and almost 50% of my weekends on-call. I remember those weekends well – feeling stuck within the 15-minute driving radius around the veterinary school, turning down plans with friends, and often spending time working in my office because I was going to be “at work anyways”. Thankfully, our senior resident would cover some weekends as well. This provided a bit of a reprieve, but there is no denying the toll that this amount of on-call had on me. And this is nothing compared to the sole practitioners and practice owners who spend 100% of their lives on-call!
Veterinary care providers are often required to be on-call, which typically means that they can be outside of the hospital, but remain available and close enough to be contacted for advice over the phone or to come in to the hospital if needed. While being on-call allows people to leave work rather than staying on the premises 24/7, it is not without its costs. When on-call, people must plan their lives around their schedule, including limiting behaviors that would otherwise interfere with their ability to work (e.g., enjoying a glass of wine with dinner), or foregoing activities that might make them inaccessible (e.g., going on a hike out of cell-phone range). For the longest time I remember skipping yoga classes in the evenings that I was on-call, because I was not allowed to bring my cell phone into the studio! Obviously these accommodations take their toll and can make self-care very difficult.
The unpredictable nature of being on-call can also generate a great deal of stress when home life is interrupted and people are required to shift to their professional role at any time. I can remember being out to dinner with friends and having to excuse myself to take a call from a resident or ask for my food to-go so that I could rush back to the hospital. In addition the effects on lifestyle and interactions with family and friends, research has shown that on-call work also has a major influence on health. Studies demonstrate that regardless of whether a person is “called in” while on-call, workers are more tired, tense, and “unwell”, and have higher salivary cortisol levels the morning after an on-call shift, compared to after not being on-call. There is also research in the UK to suggest that physicians performing on-call shifts have worse mental health and a higher incidence of anxiety and depression compared to physicians that do not have on-call duties. And while less commonly discussed, there are reports of medical professionals citing concerns for personal safety due to leaving home alone at night to attend work. Is it any surprise that physicians who work on-call often cite it as the first or second leading stressor in their work?
Many people who work on-call regularly experience variations in their work patterns, in addition to being expected to work at night or for longer than normal hours in total. When veterinary care providers are required to spend time on the phone or, even worse, back in the hospital for hours in the evening after their regular shift, this can add a tremendous amount of time to the work-week, further digging into time spent with family, friends, or pets, as well as time dedicated to self-care. Interruption of sleep, which is such an important part of health and well-being, is another major component of on-call work, especially for those who are on-call nights or weekends and can be called in to tend to emergencies occurring at all hours. During nights spent on-call, studies show that people have greater difficulty falling asleep and staying asleep, and that less sleep occurs if “at home” while on-call versus “away” (likely due to family and home obligations that interfere with sleep).
So, what is the solution to the on-call obligation? I’m not sure there’s an easy answer. The nature of veterinary medicine is that pets can become ill or injured 24-hours every day and the reality is that there are practitioners who service large rural areas that do not have access to a nearby emergency clinic out of hours. In those situations, time spent on-call is unavoidable. But ideally it would be limited or shared amongst nearby neighboring practices or colleagues. Additionally, it is very important that time spent away from work (when not on-call) be truly “off” duty time, in order to allow the mind and body time to recharge while fully engaging with family, friends, and self-care; because ultimately veterinary care providers who do not take time for self-care will not be able to care for their clients or patients either.