The Last Vet on Call

The call comes at 2.47 in the morning. A dog has been hit by a car. The owner is in the car park, shaking, holding the dog in a towel. The vet on duty — who has been on shift for nine hours and has five to go — pushes through the double doors and begins. This is emergency veterinary medicine, and it looks nothing like the daytime clinic. There are no appointments, no routine vaccinations, no cheerful handovers. There is only what has just happened, and what needs to be done about it in the next few minutes.

This account is illustrative — a composite drawn from published accounts, workforce surveys, and the extensive literature on emergency veterinary practice — but the details it contains are drawn from real experiences documented by the profession. Emergency veterinary medicine is one of the most demanding medical specialties in existence, in any species. It is also one of the most understudied in terms of workforce wellbeing. That is beginning to change.

The shape of an emergency shift

Emergency veterinary practice is, by definition, defined by the unpredictable. Where a daytime clinic can be managed by appointment, an emergency and critical care (ECC) facility takes whatever arrives — and in a large urban centre, what arrives, around the clock, is a sustained stream of acutely unwell animals. Gastric dilatation-volvulus in a Great Dane. Urethral obstruction in a male cat. A small dog that has eaten something it should not have. A road traffic accident. A sudden collapse that nobody saw coming.

The veterinary professionals who staff these facilities work long shifts — twelve hours is standard in many practices, sometimes longer in under-resourced environments. They make life-and-death decisions under pressure, often with incomplete information and always with time constraints. Unlike human emergency medicine, there is no ambulance triage system, no pre-arrival handover. The animal arrives and the vet assesses from zero.

The cost conversation

There is a moment in every difficult emergency consultation that does not appear in any medical training curriculum, but that every veterinary professional knows by heart. The animal needs a particular intervention. The intervention has a price. The owner — already distressed, often in the middle of the night, never having anticipated this — must make a financial decision in real time, in a state of acute emotional arousal, that will determine whether their animal lives or dies.

This is the ethical fault line at the centre of emergency veterinary practice. Veterinary care is not free at the point of delivery. In the absence of comprehensive pet insurance — and insurance uptake remains low in many markets, including Singapore and most of Asia — the cost of emergency care falls entirely on the owner, immediately. A gastric dilatation-volvulus surgery in a large dog can cost US$3,000–7,000. A femur repair US$2,000–4,000. Critical care monitoring at US$500–1,500 per day.

Moral distress and the profession

The term that emergency veterinary professionals use — and that the veterinary wellbeing literature has adopted — is "moral distress." It describes the experience of knowing the right medical course of action and being unable to pursue it, usually because of financial constraints. The vet knows what would give the animal the best chance; the owner cannot afford it. This situation, repeated across shifts and years, is one of the most consistent findings in research on veterinary burnout.

The data on veterinary wellbeing is stark and has been for some years. A 2019 study in JAVMA found that veterinarians in the United States were at significantly elevated risk of suicide compared to the general population. The AVMA's wellbeing research, and studies published in Vet Record in the UK, have consistently found high rates of burnout, psychological distress, and compassion fatigue across the profession — with emergency and critical care practitioners among the most affected.

The staffing crisis

The wellbeing problem intersects with a structural staffing crisis that emerged sharply in many markets during and after the COVID-19 pandemic. Pet ownership surged — estimates suggested a 20–30% increase in pet acquisition in the UK and US during 2020–2021 — at precisely the moment when the veterinary workforce was under greatest strain. Emergency clinics reported waiting times measured in hours; some closed their doors overnight because they had no staff to run safely.

The pipeline into emergency veterinary practice is long and demanding. A veterinary degree is four to six years, followed by an internship, followed — for a board-certified ECC specialist — by a three-year residency. The British Veterinary Association has published workforce surveys noting that significant proportions of recently qualified vets are considering leaving the profession within five years, citing workload, pay relative to training costs, and mental health.

What the profession is doing about it

The veterinary profession has, in recent years, moved from treating these statistics as background noise to treating them as an emergency in their own right. The AVMA launched its veterinary wellbeing initiative and published a framework of practice-level recommendations. The British Veterinary Association has made mental health a stated priority. Veterinary schools have expanded wellbeing support for students, recognising that distress often begins before graduation.

At the practice level, the changes are incremental but real: structured shift limits, peer support programmes, debriefing protocols after difficult cases, and — significantly — more open conversation about the emotional labour involved. Compassion fatigue — the secondary traumatic stress that accumulates from repeated exposure to others' suffering — was for a long time something veterinary professionals bore privately. It is now, at least in the better-resourced practices, something that can be named and addressed.

Back in the car park

The dog hit by the car: in our illustrative composite, the story goes two ways, as it does in real emergency practice. Sometimes the dog comes through — the haemorrhage is controlled, the fracture is stabilised, the owner gets to take their animal home in a week. Sometimes the damage is too severe, and what the vet does, in the most careful language they can find at three in the morning, is help the owner understand what they are facing and what choices they have.

Either way, when the shift ends and the vet drives home in the early light, they carry it with them. The animals they could not save. The owners they had to tell. The constraints they could not work around. This is not a complaint; it is the nature of the calling. But it is a cost. And the owners who walk through those double doors at 2.47 in the morning with their dog in a towel have, in the panic, no idea that the person on the other side of the doors is carrying all of it. They would probably be grateful if they did.