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Vet Tech Life

The Bad Economics of Veterinary Medicine

March 30, 2016 by Sarah Boston, DVM, DVSC, DIPL ACVS

It starts early. At least it did for me. I had decided to be a veterinarian when I was very young. Before I understood anything about money or the fact that the reason you work is related to making an income. Even once I got into veterinary school, I was incredibly naïve. It wasn’t until well into my second year of veterinary school that I even had the faintest idea about how much a veterinarian makes. I heard some fourth years talking about their contracts for their first jobs. One of them was going to be making $45,000 a year. It was 1994, but still, I thought it sounded like a lot of money. I thought wrong.

Most veterinary students are also blissfully unaware of the cost of veterinary school. Because the training to be a physician is relatively similar to the training of a veterinarian, the cost of training a veterinarian is also similar. The only problem is that once you graduate, the salary of a veterinarian is a fraction of that of a physician. I was somewhat shielded from this as I graduated in 1996 from a Canadian veterinary school. However, I still managed to rack up about $40,000 in student debt during university, which I only just managed to pay off. (I kept trying to get loan forgiveness as I was really sorry, but I was never forgiven.)

The Debt and the Graduate

Now it is relatively common for American veterinary students to graduate with $200,000 in student debt. This is a tragedy. This problem is further compounded by the off-shore veterinary school industry (yes, it is an industry) which then serves to overproduce veterinarians, which drives their salaries down. Academic institutions are complicit in this quiet crisis, as they admit off-shore veterinary students into their programs for their clinical year for a huge tuition (around $50,000). This hit of money is a significant source of income for veterinary colleges. Now they are addicted to the money and they can’t stop. In fact, they want more.

This bad economy continues once veterinarians graduate. They have little to no training in business and many of them have a short or long term goal of starting or buying in to a business. When I was in veterinary school, there were zero courses in business, human resource management and communication. Most veterinarians will run a business, have to manage human resources and will need excellent communication skills. Things have improved a bit, for at least now there is some awareness that a veterinary practice is actually a business and (maybe), an academic veterinary hospital is too.

veterinarian putting bandage on the paw of a pug

I can clearly remember in veterinary school having no idea what bandage material costs. We wanted to put bandages on for free because the material was just sitting on the shelf  (so it must be free or almost free) and the owner should not have to pay for our skill in placing a bandage or our time in assessing a wound. Also, we should feel really bad about charging them for it.

Cost and Care: Finding the Sweet Spot

Once practicing, the real struggle begins. We want to practice the best quality medicine possible. Our clients also demand this from us. The best quality of medicine at the lowest possible cost. If the cost is too high, we are heartless, money-grubbing veterinarians who don’t care about animals. If the quality of the care is too low, we lack skill and competence.

We strive for the sweet spot where the quality of medicine is good enough and the cost is not too high, but usually the differential between the quality and cost is filled in with our margins (which is our salaries and our technicians’ salaries), our time (we donate a large amount of time for free), and sometimes the quality (which creates guilt because we always want to do better for our patients). Over time, this will serve to devalue our skills and services and create guilt for charging too much. This leads to some of the negative feelings we have about ourselves and our profession. It is hard to be a pretend-MD.

The best example of this is the dilemma of overnight care in general practice. Most general practices do not have staff to care for patients overnight. With the advent of emergency clinics in cities during the late nineties, some of this burden has been relieved by transferring sick patients for overnight care. However, shuttling sick patients back and forth to emergency hospitals is far from ideal.

a cat rests on a wooden floor

Then there are the patients that are not sick, like the healthy dog spay. This is a young healthy dog, who also just had a major abdominal surgery and general anesthesia. Some clinics will send these dogs home that night, because at least someone is there to watch them. This is probably the better choice, but this usually results in a rough night for both the dog and the owner.

The other option is to keep them overnight for “monitoring” but there is no one there to “monitor” them. They are in a cage alone with no one in the clinic. Sometimes a night technician will come in once to check patients, but usually there is no one there for 8-12 hours. When clients discover this, they are horrified that no one is there overnight, and maybe rightfully so, but most dog spays are performed well under the actual cost of the procedure. Bringing in 24-hour care would drive the costs up, to the point that it would be more than the market would bear. This is a huge dilemma. No veterinarian feels good about leaving their patients alone at night, but often there are no other options.

That is the problem, veterinary medicine in general is more than the market will bear. We can’t afford the education or the care that our patients and clients ask of us and that we ask of ourselves. We need to work on rectifying this disparity, and educating our clients on the real costs of medical care.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Filed Under: Blog Tagged With: Vet Tech Life

It’s OK to Love your Life Outside Your Work

March 28, 2016 by Katie Berlin, DVM

I have a confession to make:

Practicing veterinary medicine is not my favorite thing to do.

It’s hard sometimes, being surrounded by people who say things like “It’s my calling” and “I’ve never wanted to do anything else” and “I can’t imagine my life if I were not a veterinarian.” I don’t feel that way at all. I was a “nontraditional” vet student with an art history degree and a few years of post-college life under my belt. I needed to find a profession that would keep me interested and challenged for the rest of my working life. I loved vet school and have been largely very lucky in the jobs I’ve had as a small animal general practitioner. I enjoy my work, feel I’m reasonably good at it, and have a very strong drive to get better, learn more, and be the best I can be at what I’m expected to do every day.

But I’m that way with pretty much everything I do. It’s still just a job to me. 

It’s a good job. I love the feeling when things go well. I like to pull diseased teeth. I like seeing puppies and kittens grow up and sick animals get a new lease on life. I love our motivated, compassionate staff and the clients who have lost a dog that come back to see me with their new puppy because they can’t imagine having anyone else take care of their pets. But if something happened where I couldn’t be a vet anymore, I’d be sad for a while, but I have no doubt that I’d find something else to do and have a similar drive to be good at that too.

There are about a million things I’m interested in. I can’t remember ever being bored – ever. There is never enough time to do everything I want to do. But for several years I was really unhappy. Work burned me out, and I started to become a person I didn’t like very much. I tore my ACL and had surgery, and while I was getting back to working full time I realized I was a whole lot happier with just a little bit less time at the office. 

Border Collie Dog Catching Frisbee In Jump

So I went to a rehab gym to get stronger post-op, and stayed there learning to do things like Zercher squats and sled pushes. I discovered I can do pull-ups. I ride horses. I got certified to teach two group fitness classes and now I have a regular Tuesday night class that nothing at work that day can keep me from. I read – everything from novels to history to social psychology. I love podcasts and listen ALL the time – I’m constantly inspired.

I’ve become a running junkie and half marathoner. I’ve turned out to be our clinic’s biggest advocate for Fear Free practice methods, reducing compassion fatigue, and using social media to encourage more client engagement and loyalty. My actual job, seeing appointments and prescribing medications and talking to clients on the phone, is fine. I like it. I get positive feelings from doing it well. But it’s not who I am. It’s not what lights my fire and gets me out of bed in the morning. All the other stuff is what does that. And because that fire is lit, I am happier and better at work. 

In our profession, as in many others, it often seems understood that we are to live and breathe our jobs and that we took them on because we felt we barely had a choice. We were MEANT to do what we do. Maybe that’s the case for some people, but I don’t envy them. I love that I have so many passions and have made peace with the fact that seeing appointments all day is not one of them. It does not lessen my skill or my compassion, or make me any less a veterinarian than the person who hasn’t considered another career since she was 6 years old.

So, to vet students, new grads, recent grads in the 5-year slump, and veterans who keep thinking, “Is this all there is? When do I get a break?” – I’m telling you. It’s OK to do other things, and to love them, and to love them more than your job. At the end of your life you will not wish you were more obsessed with work. You will wonder what you could have done if you had been less obsessed, or if you had let go of the expectation of obsession. Life is short. Choose joy. Live what you love – whatever that is.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.


Dr. Katie Berlin

ABOUT THE AUTHOR

Dr. Katie Berlin is a small animal general practitioner in Mechanicsburg, PA. She is also a reader, a rider, a runner, a lifter, a teacher, and an art lover. She graduated from Williams College in 2000 with a degree in Art History and worked in art museums before going back to school and earning her DVM from Cornell in 2009. She is an avid supporter of Fear Free practice and the battle against compassion fatigue in the veterinary profession.

Filed Under: Blog Tagged With: Vet Tech Life

TISI: I Had To Leave a Job Because of the Toxic Atmosphere

March 4, 2016 by Anonymous

Welcome to There, I Said It- a column where we give you, the reader, a chance to get something off your chest in an anonymous fashion. Be it embarrassing, frustrating, or just something you didn’t want to admit out loud, it still might make someone else having a bad day feel just a bit better. If you have a story of your own, unburden yourself at TISI@drandyroark.com.

My most recent job has left me scarred. It was both the best and worst position I have ever had. I was still working on my certification when I took this position and it was a new and exciting type of medicine to practice. When reading back over the notes I noticed a lot of initials of staff that had come and gone and could not understand why anyone would not want to do this work. There were experienced people around me that I was hoping to learn from as I completed my coursework. The clients were mostly very pleasant and grateful for the services they were receiving. I thought I would be there for many years.

I moved to a new state for this unique job opportunity. When I first took the position I noticed that the staff was at best cordial, but often just cold. They were friendly among themselves but not towards me. I tried to shadow and ask questions to learn but would receive either one-word answers to my questions or just be ignored altogether. I felt anxious as if I was doing something wrong (which is possible since I was just learning this type of practice) but no one would tell me what.

I soon had my own patients and began to learn a routine for myself, and over time my schedule was filling up to the point that I was booked from open to close. Some of my clients were complaining that if they didn’t keep appointments scheduled for at least two weeks ahead that they couldn’t get in to see me. To me this is a sign that I was doing something right, but aside from a text once telling me that I was doing a great job, I got no feedback. There was still very little socialization with the staff, not even normal work conversation, and I felt like a leper. Because I was new to the area and did not have any friends, the loneliness at work began to weigh on me.

After work there was the breakdown of the clinic, laundry and floor cleaning and room organization. Often the staff would hurry to do the minimum and then leave with the intention to finish the rest the following morning before the clients came. Once the staff left I could relax, because the energy would change from heavy and negative to just quiet and peaceful. So it became my routine to finish as much of the clinic chores  as I knew how to do (a good hours worth of work after everyone left) and then sit for the next 2 hours doing my notes and looking up the patients for the next day to prepare their treatments. Thus I was working 13-15 hour days routinely.

The staff began to have some light conversation with me about six months after I had been working there, but much of this was used to discuss patients. Every conversation was about something that was wrong or annoying. All this negative talk gave me a constant stomachache. I tried to point out positive things but no one ever had anything nice to say about anyone.

I remember a client who had been with the clinic for years sitting on the floor with her dog one day after we were done. I was cleaning up but eventually, I made my way over to her to see if she needed help. She told me that she was waiting to see the person that she normally worked with because she had decided to euthanize her dog and wanted to say a last goodbye. I sat on the floor with her for about 20 minutes discussing end-of-life issues and euthanasias while she held her baby. Finally, she decided to leave.

Once she left the person she was waiting for came out of the office expressing frustration that she had to “hide” from that client for so long. Her insensitivity towards a longtime client who was wanting to share the last hours of her pet’s life with us was beyond my ability to understand or accept. This was just a minor example of the contempt that the staff seemed to have for the majority of clients and patients.

I finished my coursework and studied for and passed my final, achieving my certification. I was exhausted from the continuous running around all day , the appointments running over, and the draining atmosphere with all the negative and sarcastic conversation. The overall morale in the clinic deteriorated to the point that we reached out to the boss to ask for some encouragement. Instead of the “yea, go team” talk that I expected, the boss expressed anger and frustration at the staff in general.

Instead of having any patience for me or addressing any of the concerns I had about the work situation, I was told that “my therapies were an insult to the other therapists” and that I had been doing a poor job since I had been hired. I asked for specific examples but none could be provided to me. That night my frustration bubbled over and when everyone else left the clinic I stood in the middle of the treatment area and screamed at the top of my lungs. I became certain that if I stayed my health would start to suffer, and so I gave my notice.

I have over a decade of experience as a clinician and yet have never worked so hard to gain approval and be a good employee. This job has left me anxious and insecure. I have been unwilling to even apply for another veterinary job and as a result I am probably going to lose my house. I confess my experience here because I cannot understand how we can have so little care for each other- how employers can have so little care for the employees who are busting their butts making money for them and instead of building the team up, are very content to try to tear them down.

I have experienced this before, but never to the degree that I did in this position. Yes, there are employees who have problems. Yes, there are employees who need a lot of hand-holding. But these are people! How can we claim to love animals so much and be so hurtful to each other? While fear or intimidation can be great motivators, they will not create a sustainable staff and it certainly creates a horrible work environment. I urge everyone to look at the energy that is created in the workplace and see if it is something that you would be proud of. Why should an emotionally abusive work environment be part of the dark side of veterinary medicine?

TISI banner

The views and opinions featured on There, I Said It are those of the authors and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Filed Under: Blog Tagged With: Team Culture, There I Said It, Vet Tech Life

The 5 Technicians You Will Meet At the Clinic

February 20, 2016 by Kelsey Carpenter

Veterinary medicine is comprised of a lot of different personality types. In many ways, it is why I love my job – I am surrounded by people of varying backgrounds, plenty of whom had entire previous careers before landing in an animal hospital. I was a dance major in college, who woulda thunk! However, the very thing that makes us such a diverse and well rounded group of people also makes for some challenging working relationships. Here are a few of the common personalities we encounter among Veterinary Technicians and the ways I’ve been successful in dealing with them.

1 – The Enthusiast

via GIPHY

This person is excited about everything. They want to be involved in every thrilling case that walks (or is stretchered) through the front doors. They are often the ones to drop everything for a GDV, but then can’t be found when it comes time to do annual vaccines. They want to learn and grow, but in pursuing valuable experience, they often prioritize inefficiently, leaving others to do their less exciting work for them. This person means well. However, their intense drive to jump into interesting or exciting cases doesn’t allow them to see things in a bigger picture.

How to deal with an Enthusiast: Remind yourself that this person means no harm. They see things as an opportunity and don’t necessarily realize how they are inconveniencing or overshadowing others. In my experience, the Enthusiast has two basic needs: to feel that they are learning, and to feel that they are important. Find productive ways to harness that energy: Get them involved in hospital projects, put them in charge of training a new employee, have them create training workshops. Enthusiasm is a very valuable trait, and it is something we never want to smother.

[tweetthis]The 5 Technicians You Will Meet at the Clinic[/tweetthis]

2 – The Know-It-All

via GIPHY

This person asks no questions and knows all answers. Some of their favorite pastimes are butting into conversations, answering questions not directed at them, and spewing out phrases like, “That’s what I was going to say”. This person has experienced everything and wants you to know it.

How to deal with a Know-It-All: This person doesn’t always realize what they’re doing. When they butt into your conversation, they aren’t trying to be disrespectful. When they cut someone off to answer your question, it’s just because they are so eager to show you they know the answer. The Know-It-All has an intense need to prove themselves, and it often stems from a place of insecurity.

Give the Know-It-All appropriate venues in which to demonstrate their knowledge, and create scenarios in which it is comfortable for them to admit to actually not knowing something. Know-It-Alls do great with new hire training. Let them show your new employees how to use the computer system and how things function on a day-to-day setting in your hospital. Know-It-Alls LOVE to be asked questions, so while this kind of basic training can be dull and repetitive to others, the Know-It-All will absolutely thrive in this kind of position.

Try to also set the stage to allow the Know-It-All to ask questions in a comfortable way. The Know-It-All needs to know they will not be looked at as inferior if they don’t know something, so make it common and acceptable. For example, let’s say my Know-It-All has no experience with IO catheters, but I know he/she is ready to learn. I would approach the concept by saying something like “Hey, I have no idea how to place an IO catheter, and Susie said she would teach me. Do you want to come with me?” The Know-It-All is given an invitation to learn without being given the invitation to teach, and by admitting your own technical deficits, the Know-It-All may feel more comfortable in acknowledging their own without ever having to feel inferior.

3 – The Bully

via GIPHY

This person will try to intimidate you. This is often someone you encounter within the first week at a new job – they will make an effort to throw you into an uncomfortable situation to see if you will sink or swim. They will test you. The Bully often has a temper and can be unpredictable. Their goal is to be the Alpha, and to establish a certain level of fear among their peers so as to put them in a dominant position. The Bully will point fingers at anyone but themselves – they can often be found blaming a failed blood draw on the holder or pointing out flaws in a client who refuses to work with them. Nothing is their fault, and they will try to intimidate you into agreeing.

How to deal with a Bully: Be secure in yourself. Do not cave to a Bully’s intimidation efforts, but also do not fight back. Do not engage with a Bully, and most of all, do not apologize if you have done no wrong. As humans, we have a tendency to overuse the phrase “I’m sorry”, and a Bully sees that as weakness and submission.

With Bullies, I keep it all business. I will give you an example: It was my first day at a job, and a Bully had me restrain a dog for her. She couldn’t hit the vein for the life of her, and I saw her quickly becoming frustrated and trying to blame her own failures on my restraint technique. I knew it had nothing to do with my restraint, so I said “I’d be happy to find someone else to help you.” I did not apologize or acknowledge her accusations. A few days later, she asked me for help again. She recognized that I wasn’t going to fight and I wasn’t going to apologize. I was confident in my ability and secure in myself, and that’s all it took. They say you teach people how to treat you, and I think that is especially true when it comes to working with a Bully.

4 – The Doubter

via GIPHY

The Doubter is a wonderful and talented person who doesn’t know it. They are often incredibly skilled and natural at what they do. They are fast learners and hard workers, well-liked, compassionate and dedicated. Their only flaw is their lack of confidence in themselves. The Doubter is the person who will give up too soon, or not even try at all. They often do not take advantage of practice opportunities because they do not trust in their own ability. The Doubters are the ones often overshadowed by the Enthusiasts. While the Enthusiasts jump into situations they may not be ready for, the Doubters hand off opportunities to others even when they are perfectly capable.

How to handle a Doubter: Encouragement! Doubters need to be cheered on and acknowledged and reminded of why they are great. They are not fishing for compliments, but truly need their confidence to come from an outside source. Every good technician or doctor has a healthy level of fear. However, Doubters take their fear too far, and allow it to slow their growth.

Doubters need extra motivation to jump into scenarios and try new things, so sometimes pairing an Enthusiast with a Doubter is actually a match made in heaven. Give the Enthusiast the job of helping the Doubter learn a new skill, and the Enthusiast will provide them with the encouragement and the extra little push that the Doubter needs.

Another thing I try to do with Doubters is to relate. I talk to them about my failures, and let them know how normal they are. Often times, Doubters see everyone around them as amazing and talented and incredible. Letting a Doubter see your weaknesses or hear about your failures helps to bridge the gap between themselves and what they see as superior, letting them know that they are not so far behind after all.

5 – The Perfectionist

via GIPHY

We are all perfectionists in Veterinary Medicine, but there are some who take it to an unhealthy level. These people cannot stand to fail. A Perfectionist may miss one blood draw and question their ability to hit a vein for the next two weeks. A Perfectionist may miss a low grade heart murmur and dwell on it for the next three months. These people carry their shortcomings with them for much longer than the average person. They are generally quite supportive and understanding of the failures of those around them, but are unable to rationalize their own. They have trouble moving on and are known to beat themselves up over the littlest things.

How to deal with a Perfectionist: A Perfectionist needs things to be put into perspective for them. Their failures are all they can remember after a day full of successes. The one thing a Perfectionist needs is a reason to forgive themselves. Often times, relating to a peer is difficult, but relating to a role model can be helpful. Placing focus on successes and strengths is also key when dealing with a Perfectionist – let them know that you still rely on them and their strong skills even after their failure. The key in working with a Perfectionist is patience – you cannot make them feel better about their failures, but you can give them reasons to start to forgive themselves.

Each of us has elements of all five of these personalities within us. Some of us have a healthy level of each, while others lean way too far into one specific category. The key in working with anyone in any field is to find a way to relate without sacrificing oneself, and I think that rings very true for the veterinary field. In the end, if we take the extra time to interact with coworkers in the way that is most comfortable and supportive for their personality, it makes for a more positive and efficient workplace, and that reflects on the care our patients receive. Regardless of personality, that is one goal we all share – to take care of the animals and the people who love them in the best possible way.

[tweetthis]The key in working with anyone in any field is to find a way to relate without sacrificing oneself.[/tweetthis]

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Filed Under: Blog Tagged With: Vet Tech Life

There, I Said It: Your Medical Records Stink

February 18, 2016 by Anonymous

Welcome to There, I Said It- a column where we give you, the reader, a chance to get something off your chest in an anonymous fashion. Be it embarrassing, frustrating, or just something you didn’t want to admit out loud, it still might make someone else having a bad day feel just a bit better. If you have a story of your own, unburden yourself at TISI@drandyroark.com.

“Your medical records stink.”

Yep, I just said that. Right now you may be thinking, “Who is this person and where do they get off being so self-righteous?” Well, have I got news for you. If you are the one thinking these things, then your medical records probably do stink.

You know who you are. You are the one that is two weeks behind on medical records and somehow has the uncanny ability to extract from the nether regions of your brain accurate details of each pet’s comprehensive exam. You are the one that writes a two line history for a pet that presents for vomiting and lethargy for a week. Or maybe you are the one that frequently uses “PE = WNL” for the main body of your medical record.

[tweetthis]If you are the one thinking these things, then your medical records probably do stink.[/tweetthis]

By now, some of you are rolling with laughter and others are just rolling their eyes. You’re part of the problem too, even if you are one who does it right. This type of medical record keeping is so common that everyone shrugs it off. How many times have you been to a veterinary conference and people joke about medical record keeping when really it is not that funny? It is actually shameful.

Think about this for a moment. Everyone learned proper medical record writing in veterinary school. The state VMAs have been recommending and in some cases borderline begging us for almost two decades to put more effort into our medical records and have pretty much waved the white flag.

Businessman Preparing Checklist

Uh oh, I know what’s coming. I just heard someone use the most common excuses: “We are still much better than the human side”, “My boss complains that I take too much time”, “I do not get paid enough to stay and finish my records”, or “I am the only one that is ever going to read it”. Any of those sound familiar? They probably do.

So, who is to blame? You are. I am. We all are. Why? Because as individuals, we should have enough pride in our education and skill set to strive to maintain a higher written standard. Because as business managers and owners, we should have enough intestinal fortitude to enforce a standard and lead by example. Because as veterinary medical governing bodies, we should hold businesses and individuals accountable for egregious medical record keeping.

It would not be fair to end this editorial without proposing some solutions. If you are an individual that truly believes in writing thorough medical records and maintaining a standard, do not sacrifice your ethics for others. Ask for time to finish your medical records during your shift. Ask for more “warm bodies” so you can spend less time “doc-teching” and more time completing your medical records. This isn’t a luxury, it’s a necessity.

If you are a business manager or owner, you need to have enough respect for medical record standards to enforce them with your veterinarians and hold them accountable. Value your doctors enough to provide them with sufficient staff for them to be able to spend more time on their medical records. Recognize that you may need to sacrifice on your bottom line in order to hire another doctor to create more time for all your doctors to be able to finish their medical records without each one working 60 hour weeks in four days. And, if you are part of a veterinary governing body, please start holding accountable those who blatantly disregard the written standards of our profession. Our integrity depends on it.

[tweetthis]We should have enough pride in our education and skill set to maintain a higher written standard.[/tweetthis]
TISI bannerThe views and opinions featured on There, I Said It are those of the authors and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Filed Under: Blog Tagged With: There I Said It, Vet Tech Life

Top 5 Ways Technicians Fail Doctors

October 16, 2015 by Andy Roark DVM MS

Drs Andy Roark and Dave Nicol speak candidly about the 5 ways technicians fail veterinarians. But let’s face it, number four is difficult for anyone to endure.

 

 

[tweetthis]How #VetTechs fail #veterinarians [/tweetthis]

Filed Under: Blog Tagged With: Vet Tech Life

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