A note for anyone who is providing a service that everyone else has stopped providing
There is a special kind of pain in veterinary medicine that is much more common than people think. I call it the pain of the last one standing, and it’s heartbreaking.
Imagine for a moment that you live and practice in a rural community. Maybe there are five other clinics in town, but the nearest emergency clinic is two hours away. That’s not too much of a problem though because most of the clinics will see after-hours appointments for pets and clients in need. Across the community, the veterinarians have always kind of made it work.
Now imagine that, one after another, the clinics decide they are not going to be on call anymore. The doctors, very understandably, don’t want to work nights and weekends on top of their already jam-packed schedules. As each clinic ends their after-hours service, all the other clinics try to absorb the additional pets in need. As the number of after-hours patients increases for the remaining practices, the burden on the vets still seeing them goes up and thus their desire to either end the after-hours service or to take a job at the clinic that won’t call them on nights or weekends increases. This growing frustration (and a fear of losing doctors) applies pressure to the owners of the remaining clinics to discontinue the service. In a service death spiral, every clinic that stops taking after-hour cases unintentionally shifts a greater burden to the remaining clinics until one after another they tap out.
But rural practices generally don’t all stop taking after-hours or weekend emergencies. No. Some of these veterinarians are made of absolute iron with willpower that does not waiver. That’s why there is usually a “last one standing.” This is the clinic that held on because they felt pet owners needed the service. As the other clinics left the emergency game, the need the last one standing was meeting only became greater. Now, the last one standing is the only clinic in town that sees emergencies after 7 pm or on Sundays. They don’t feel they can stop because no one else will be there for the pets.
This is the pain of the last one standing. It’s like the most horrible nose game anyone can imagine. This poor clinic looked around and realized everyone else was touching their noses… and switching their phones over at the end of the workday.
If you’re the last one standing, people who are not your clients are telling you that their pet needs help and no one else will do it. The volume of cases is far beyond what a single practice would handle if they were only seeing their own clients, and the risk of resentment is sky high. It’s one thing to help people because you know them and you want to be there. It’s something different to help people because everyone else seemingly took comfort in the knowledge that you would still be working and went home to live their lives.
For the last one standing, there’s almost always a mixture of fatigue from constantly being available and simmering resentment because others got to back away without the guilt of leaving pet owners without options. All the other practices knew that someone would still be open, after all. The pain of the last one standing doesn’t end unless a new option for pet owners appears or more veterinarians willing to take these after-hours cases can be hired. Sometimes these things happen, but they are hardly guaranteed.
Before I go on, please let me tell you why I am not writing this article. I am not writing this to put down or shame veterinarians or veterinary clinics who decided they wanted to be off work when they were scheduled to be off work. I am personally much less likely to be the last one standing than the first one to decide he wants to work hard and see all the pets possible while the clinic is open and then go home and be present with his children. I don’t say this to take anything away from the virtue of those who sacrifice to serve the community. I think the last ones standing deserve our gratitude and admiration. I also think it’s important to note that veterinarians wanting to have a life outside the clinic is not a weakness or moral failure. Vet medicine has a terrible burnout and turnover problem as a profession, and I’m not convinced that normalizing working outside of normal clinic hours would actually help access to care. The clinics might answer more phone calls, but I suspect there would be even fewer veterinarians in rural practice to answer them.
My intention with this piece is to call out to the last ones standing and let them know that they are not alone. This situation is far more common than I think people want to acknowledge. For those generous souls, it must feel like the world is moving on to a new way of working but their community is simply not set up to support that. I hear from veterinarians and practice managers who are fighting this battle again and again, and I suspect these people feel like they are the only ones carrying this burden. That’s not the case. You are not alone. What you are doing is deeply noble.
If you are a last one standing and supporting your community is filling your cup, then I hope you will keep going. I hope you will find meaning being there for others and that you will be a hero among your community. I hope that your practice will flourish as people who come to you on emergency realize how special you and your clinic are and either become your client now or decide that, should they ever leave their current veterinarian, you will be the one they use in the future. I have seen the last one standing grow thriving practices with strong cultures and clients lining up to become regulars. If this is your desire, then I wish it for you and I want to tell you I’ve seen this happen.
If, however, you are the last one standing and you are feeling trapped – I want you to know that you always have options. If you are the last one standing, I want you to know that there is a secret “last one standing card” that you can play whenever you want. This is a card that allows you to break whatever rules you have in your head regarding how a veterinary clinic should operate because you are the last one standing. If you are committed to working Sundays because that’s when no one else is available, I want you to know that you can use your card and decide to close on Fridays. I want you to know that you can use your card to decide that on two Sundays per month, pet owners are just going to have to drive two hours to the emergency clinic because you need that time off to prevent yourself from burning out. If you are only able to see appointments every other Sunday, then you are still making a bigger impact on access to care on Sundays than all of the other clinics combined. That’s not intended to criticise the other clinics. It’s to point out that you are still going above and beyond, and hopefully doing it this way will be sustainable for you.
The “last one standing card” is supremely flexible. Think outside the box on how to use it. You have permission to set up your clinic however you want to meet your needs. It doesn’t matter if every other clinic is open from 8-6 Monday through Friday. They don’t have a last one standing card and you do. If you want to be closed on Wednesdays and that’s what you need to do to keep going, then you should consider it without a shred of guilt.
And finally, if you are the last one standing and everyone else tapped out well before you did and now you don’t think you can keep going anymore, then please hear me when I say that you can tap out as well. No, it’s not ideal. Yes, pet owners will be unhappy and they will have to drive long distances and pay emergency fees if they need care on Sundays or late at night. You did not wish for those realities to exist. You do not benefit from pet owners having to make this sacrifice, and you did not cause a lack of access in your area. You did everything you could for as long as you could to prevent this from being the case. You do not deserve to feel guilty if you reach a point where you need to step back after having tried your hardest and outlasted everyone else.
I hope that I don’t make veterinarians who stopped taking call feel criticized. I was very happy when our clinic stopped working after hours, and do not wish to go back. I hope that I do not enrage pet owners who live far from an emergency clinic and who rely on a last one standing. I see you, I want you to be supported, and I’m sorry if this makes your life or your pets’ lives harder. There are some hardships baked into living in a remote area, and unfortunately getting emergency veterinary care might become one of them. I am saddened if that happens.
However, I need everyone to understand that the last one standing is a special kind of person and that it serves no one for us to look away while they work until they break. We need to be grateful for those who give of themselves like this, and we need to be supportive if and when they need to make changes to take care of themselves and their families. They deserve our admiration, and they deserve to know that they are not trapped.
