On-Call Days

Down-time and Silent Days

Making the most of it

There are on-call days when the phone is silent. This silence comes with its own secret recipe for stress…4 parts foreboding for 1 part paranioa. It can feel like the longer the silence, the more intense the impending ER storm is going to be. It took me awhile to figure out what to do, or not do, during down-time while “on-call.” After trial and error, I have developed strong on-call-but-not-on-a-call habits. When I first started taking on-call, it felt normal to be poised by the cell phone just waiting for it to ring. When an ER did ring, I could spring into action and be out the door in less than 5 minutes. But when the phone didn’t ring, a faint feeling of regret would creep in. Not only did I feel that the day was (personally) wasted, but I also felt (professionally) unfulfilled.

For me, utilizing down-time while still on-call is essential for avoiding burn-out, promoting work-life balance and reinforcing the truth that work has not become my life. When I say utilizaing, I mean being productive enough that time doesn’t feel wasted in wait for an ER than never comes. On the other hand, any project that is started has to be one that can be dropped at a moment’s notice. But on silent days…I still check my phone a minimum 5 times/hr, confirm max volume 2 times/hr and check that airplane mode is not activated once/hour.

My most recent day on call was anything but silent. Between 7:30am and 11:30pm, we had attended 7 emergencies and saw 2 add-on appointments. That’s a full day, especially during the slow season. As I drove home at 1am, I found myself running through the day’s events and eventually mulling over two emergencies in particular. It wasn’t that these two emergencies were clinically distinct, fascinating or dangerous…in fact, they are both circumstances that I would normally shrug off as inconveniences of the job. However, I think the nature of the two circumstanaces is important when gaining perspective into a day-in-the-life of a veterinarian.


The “Nevermind” Emergency

The ER call rang 15 minutes before the start of our doctors’ meeting. Susan, who was not a current client of our practice, was frantic over the phone. While in the midst of explaining what was happening with her mare, she repeatedly interrupted herself to say

“My vet’s not answering. I can’t get ahold of my vet. I don’t understand why she’s not answering.”

I can imagine how confusion, fear and panic in the moment, is exacerbated when a client’s trusted lifetime vet of 15-20 years is MIA. Tone of voice, pitch, inflection and word-choice can paint a vivid emotional picture, especially of the client feeling pain and confusion brought on by a sense of abandonment. On rare occasions, bitterness and resentment are aimed at whichever vet does respond to the call. From firsthand experience, this type of treatment from clients is hard to swallow.

“Shelving” Client Mistreatment

When it comes to professional advocacy, I think simply swallowing mistreatment from clients does the profession a disservice. In my opinion, having the issue temporarily “shelved” vs. simply swallowed, establishes a line between acceptable and unacceptable behavior. While I don’t think disrespect is something to just “put up with,” having an open discussion requires a particular environment and mindset that emergencies cannot always afford. Bottomline: In order for me to do my job, I have to focus on the reason I am there. This means “shelving” issues that are not imminent or critical.

On the otherhand, I know some vets get upset when they are called only as a “last resort.” Sometimes, clients say that.

“I am only calling you because my vet is out of town.”

“I just need a vet, any vet.”

“I wouldn’t be calling you if I had other options.”

I take these comments in context of the extremely difficult circumstance the client is in, the difficult spot this puts their vet in and the fact that I’m here to help. This thought process keeps the negative thoughts at bay. It also helps that I am an empath by nature.

8 minutes away

Returning to the ER at hand…I kept Susan focused, making sure she was in a safe situation, the mare was contained, and gave her a few minutes to call me back with their physical address. Caught up in overwhelming situations, sometimes you can’t remember how to spell your own name. In this instance, she had to find a piece of mail so she could read off her home address. According to GPS, we would arrive at Susan’s in 45 minutes. During the first half of the drive, the office relayed two other ERs to respond to. When my phone rang again, I recognized the number as Susan’s.

In my experience, when a client calls while you’re still in route, it is for one of three reasons:
– The situation has become dire, they are panicking and have lost all sense of time
– To find out where you are because it’s past your original ETA
– They are canceling the farm call for one reason or another

I answered the phone as google maps’ estimated ETA read 8 minutes.

“I actually don’t need you to come out. My vet just got here.”

This isn’t too uncommon that another vet beats you to a call, either because the client called other vets to see which would arrive fastest or because their regular vet returned their call. I will be honest, this is frustrating. I wished Susan and her horse the best.


Order of Operations

Determining Which Emergency to See First

When faced with multiple ERs, I prioritize based on severity, urgency and the potential risk to human safety. Numerous times, I’ve been less than 5 minutes from the ER when the client calls to let me know that another vet showed up. This ultimately ends up in re-routing, lost time and money, but most importantly, an unnecessary delay in rendering aid to other patients and clients. Our policy is to bill an in-route cancelation fee, but I have yet to follow through with this. With new clients that don’t have established payment methods with us, pursuing payment is nearly impossible.

I understand the panic and desperation owners feel when their horse is injured or sick. In a situation of overwhelming helplessness, the only help they can provide is getting a vet on the premises. For this reason and out of empathy for clients in these scenarios, I have not had it in me to bill them a cancelation fee. And then there are those rare occasions when the driving force behind a client’s actions are not driven by shear concern, fear and panic. There are times when a client’s motives and intentions are not upfront or even honest…


ER Disguises

Critical, urgent and not-so-urgent cases

The second emergency was located 45 minutes south, within a mile of our office. It was a choke, which resolved mostly on its own by the time we arrived. As we were finishing up this second ER, the office alerted us to another emergency. Now, the ER waiting list included a mildly painful colic, a moderately painful colic that did not improve with banamine, and a laceration that had significant, uncontrolled hemorrhage. Despite pressure wraps, the owner could not get the bleeding to stop and she feared the horse would bleed out soon. We headed straight to the laceration emergency, ready to face a chaotic, blood-soaked scene upon arrival. As we pulled up to the barn, I could hear laughter and followed the voices to a small group of people standing around a bay polo pony in the wash rack. There wasn’t a drop of blood in sight, and pony appeared healthy enough.

“I’m here for an emergency, do you know where the horse with the laceration is?”

A middle-aged woman and what I presumed was her daughter, nodded.

“This is him. This is Emo.”

For a moment, I thought I had made a grave mistake and navigated to the wrong emergency (the mild colic). I reached out for something to say, still confused and mortified that I had made this profound error. The woman turned to look at Emo, walked over to his right front cannonbone and pointed at a scrape…a two inch long superficial abrasion with only the hair missing.

“I don’t know how he did it, but he managed to lacerate his leg here.”

I thought I had gone crazy, but was much more horrified upon realizing that this scrape was the previously described uncontrollable hemorrhage. She must have read my face.

“I didn’t want to be waiting around the barn all afternoon, so I might have exaggerated a little over the phone.”

She chuckled sheepishly. The other people started to dissipate once the uncomfortable silence kicked in. On an untimely cue, my assistant came huffing down the barn aisle with arms full of wraps, suture and scrub kits, fluids, clippers and even a tourniquet tucked into the v-neck of her scrub top.


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The Doctors’ Meetings

Every other Friday, before each doctor sets out for the day’s appointments, the four of us meet at the only diner in town. Our practice sits on the edge of a quaint town with no need for a single stoplight or stop sign. One of only two restaurants, the diner is nestled in a row of buildings that look straight out of a stagecoach western. State patrol frequently choses this humble eatery as the location for their change-of-shift. On those particular mornings, the diner’s small gravel parking is overrun by patrol cars. This is also the only time when the town experiences traffic as a result of overly-cautious commuters going 10 below the 25 mph speed limit.

Our doctor meetings are held over breakfast, with discussion prompted by 2 or 3 items on the “doctors meeting list” or DML. Items that make it onto the DML come from a wide range of topics, vary in importance and certainly are not guaranteed to stimulate rivoting conversation. Over the past couple months, items on the DML have include updated pricing, barn packages, changes to inventory, on-call schedules, charging tax on products, assistant performance issues, standard protocols for packing equipment, damaged or missing equipment, new drugs we’d like to have on hand…etc.

Once the items on the DML have been checked off, there is an end to the meeting formalities. This is when the meetings get interesting. This is my favorite part of the doctors meetings, when I get to revel in the hard-earned wisdom of seasoned vets.

Case discussions.

It starts off with one of us seeking input on a particularly challenging case. Without fail, it leads to the opening of the case discussion floodgates. In discussing one case, someone inevitably remembers a case they would like insight on…which triggers another doctor to bring up their recent patients and so on.

I call it the case dominos effect.

These dominos turn half-hour meetings into 1.5 hour meetings, subsequently making us all late to our first appointments and causing a chaotic post-meeting scramble in the office. While fascinating and rich with info, there is another reason I look forward to these talks. Its the environment that has been created for the conversations. The table is a safe place to talk openly and without fear. There is no room for judgment, shaming or belittling. These moments are key to nurturing a honest, sincere comradery between colleagues and fosters a strong sense of moral and unity…things I have rarely seen in multi-doctor practices. In an effort to net suggestions or help from our combined 48 years of experience, we also create a robust support system and receive encouragement.

And there have rare occasions when our conversation divulges to less professionally astute topics in veterinary medicine, like the newest gossip about neighboring vets and practices. That’s a subject for another time, and a deserves it’s own blogpost.

And if the DML is blank? We still meet for breakfast because that’s just a pleasant way to start the day.

Treating more than the horse

We treat more than pets. Legally, of course. The person attached to our patient is just as important as the patient itself. Whether it is an annual exam or late night emergency, attending to the client is, in essence, attending to the patient. Help the client to help the horse. I think there are floating misconceptions among some vets, and about vets, that our profession only serves the patient part of the equation. By ignoring, negating or dismissing the client half of the equation, I believe vets are neglecting the very reason we even have a patient…that someone reached out to us.

Why did you become a veterinarian?

I’m always curious to hear other veterinary professionals discuss their reasons for choosing this profession. By far, the overwhelming majority of answers are centered around a core feeling of compassion/love for animals, coupled with a desire to maintain, improve and advocate for animal health. On a rare occasion, I hear a starkly different answer along the lines of “because I don’t like people.”

People and Medicine

The “because I don’t like people” reason strikes a contrast with the more common reason. Firstly, it comes off as void of sentiment and does not even mention a regard, concern or care of animals. In fact, there is no mention at all of the locus- animals. Second, the veterinary profession is comprised of and dependent on people. People infiltrate the entirety of veterinary medicine, filling diverse roles such as colleagues, professors, CE conventions, receptionists, assistants, lab technicians, owners, trainers, buyers, caretakers, transporters, state and federal government personnel, pharmacists, sellers, externs, drug reps, students…

There’s comical memes out there about this very reason for becoming a vet. Or similar ideology such as “the only thing I like about you is your pets.” I appreciate the humor. Truth is, this is a sincere reason for pursuing a DVM according to some. I’ve never heard a practicing veterinarian cite this reason. The only subset of people I’ve heard use the “Because I don’t like people” are vetmed hopefuls.

Ideal vs. Real

Veterinary hopefuls seeking a career free of people, are bound for personal and professional disappointment. Travel the road to DVM long enough, and it becomes unmistakably clear that the there can be no veterinary field without people.

Over the last year and half in private practice, especially as an equine practitioner, I have become increasingly aware of the importance of people skills. Not just refined communication skills and strong bedside manner, but the ability to perceive, listen, collaborate and recognize client needs. Especially as an equine practitioner, we are on the forefront of this interface and often times dealing with all interactions one-on-one. Back to the basics, there would be no patient if there was no owner caring to have their pet seen.

Don’t like people? Doesn’t mean you aren’t capable of being a veterinarian. There is already a tremendous, seemingly infinite list of inherent challenges that come with the job. Adding another parameter obstacle, not only increases this weight of challenges…but I imagine it becomes a thief of what would otherwise be some of the richest, most rewarding experiences in veterinary medicine. Even more detrimental and profound, is what this limitation means for the care of the patient, quality of medicine and overall health of the profession.

I’ll say this. You don’t have to be a social butterfly or extrovert. Plenty of “I”s in the vet field. But if you don’t like people, maybe one of the most rewarding outcomes of joining this profession will be a change in heart.


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Thomas

There are certain patients and clients you know you’ll never forget. Some cases that almost haunt you, arising from the subconcious on a whim. Little reminders seem to be hidden in tiny corners and crevaces of every day life. Whether its meeting a person or horse with the same name, diagnosing another patient with the same disease, or even sitting at AAEP lectures with the topic being similar in nature…a horse with a similar disposition, or sometimes just a single word on a billboard. It seems just as time has gone by, there is a reminder somewhere that brings the memories trickling (sometimes flooding) back.

This is the story of Thomas, one of the cases that for many reasons, I will not forget.

I first met Thomas in January for a routine dental and vaccines. His owner, Emma, had been referred to me by the practice that performed his pre-purchase exam only a month prior. His PPE had gone smoothly with no significant abnormalities found during the extensive work-up. The owner wasn’t able to attend this first appointment, but the trainer was present. She lead the handsome young gelding into the washrack. Just watching him walk into the washrack, I could see incoordination and exagerated gate in the hind end. His hind feet were parked oddly out from under his body, with his front feet almost ontop of one another. He stumbled and stepped on himself multiple times in the 5 minutes I spent observing. He had a slight head tilt to the left and the left side of his lower lip drooped. The nature of the appointment instantly changed, with the focus turning to neurological examination instead of a routine dental.

The findings of the neurological exam revealed cranial nerve deficits, especially noteable on the left side. Facial nerve paralysis, the head tild and decreased pupillary reflex times were the most significant CN abnormalities. On dynamic assessment, he had a grade III hindend ataxia and grade II bilateral forelimb ataxia. He had assymetrical muscling of his gluteal muscles, with the right being much more extreme than the left. He had marked weakness during the tail-pull to the right, at one point he almost fell over. Given the cranial nerve deficits and generalized ataxia, we decided to rule out a top differential of EPM. He had neck radiographs taken at the PPE, which after second review, were normal. No traumatic events were in his history.

His EPM titer results came a week later. The titer levels were high, indicating a 95% likelihood that his signs were attributed to EPM. We moved forward with a standard treatment protocol of daily Ponazuril and Vitamin E. In a month, we would return for a recheck neurological exam.

We continued the Ponazuril another month, during which his imrovement plateaued. Emma, opting to give him every fighting chance, elected to try another EPM medication called Protazil. After a month on the protazil, his recheck exam found significant improvement. His neurological signs had improved enough that now a right hind limb lameness became apparent.


5 months later

Now 5 months after diagnosing the EPM, with most of his facial nerve and ataxia signs resolved, we moved forward with his routine care. His vaccines and dental went without complications and he continued to receive his bodywork and acupuncture. I’ve held some skepticism in thepast, but the bodywork and acupuncture had a profound effect on his physical and mental state. He looked brighter, moved easier and the right hindlimb lameness was resolved.

A month later, I received a text that he had relapsed. The same day, I went out to exam him,. He was dull, quiet and his neurologic abnormalities at returned worse than before. After heavy consideration, Emma made the difficult decision to let him go. Unfortunately, for insurance to cover the costly treatments and reimberse for all the money spent, a necropsy at a certified facility had to be performed. I won’t name the insurance company, but I will say that how all the details were handled was grotesque. The insurance company required that Thomas’ necropsy be performed with 8 hours of his euthanasia. Since the only lab near by was 6 hours away, and since Thomas was not safe to transport, it took detailed coordination between all of us to meet the time constraints. In the veterinary field, you develop a way of talking about these things in a tactful, professional manner. I have never had a client involved in the details of this process, and honestly, I had never been involved in planning such intricate, time senstive logistics. The whole process was heartbreaking and gruesome for Emma, a nightmare for anyone whose beloved companion becomes an object, entity or commodity to company policies. I admire her and all of the strength she clearly showed through this painful process.

To meet the time constraints and laboratory hours, we had to euthanize Thomas in the middle of the night. After working that day, I set my alarm for 12am so that I could make it to the barn by 1 am. His transportation (provided by my assistant) would deliver him to the lab between 7 and 8 am. I set the alarm, just in case…but I definitely did not sleep. I had discussed his case with multiple internists, researched novel treatments so extensively that anytime I went onto google, it asked if I wanted to search new research in EPM. Although I was confident in my diagnosis and that the treatments we had done were the present gold standard, there was still that little voice whispering “but maybe…”

We arrived at the barn just before 1am. We placed the catheter, sedated Thomas and lead him out of the barn. Fog had crept in and it was starting to rain. Then, it started to pour. I remember the syringes being slippery, and all of us squinting through the beams of the headlamps as we laid him down under using anesthetics. He went down gently onto his side, deep in a sleep state, before Emma gave the gesture to give the final injection. Within minutes, Thomas was gone.


Answers

It was 2 weeks before the necropsy results came back. The trouble with EPM, is a definitive diagnosis is not always possible even with necropsy and microscopes. The chances of identifying the organism, especially after months of treatment, becomes slim. My fear was that the necropsy would not identify the organism anywhere, and determine the cause of his neurological disease indeterminant. When I read the results, my heart sank. No EPM organisms had been identified on necropsy and histopathology. But down, at the very bottom of the extensive report, a note said that the abnormalities found in the spinal cord were consistent with those seen in EPM.

We had all reached a point where we wanted answered. We wouldn’t get the answers as to why he suddenly relapsed, or why he didn’t respond to treatments like some horses. EPM, the heartbreaking disease that it is, can do anything at any time…making it a challenge and yet another disease warranting further research.

We did not get the answers we wanted, but we did get the answer we needed.

At a horse show a couple weeks ago, I ran into Emma. We small-talked a little, and she hugged me before we parted ways. She expresed sincere gratitude for my efforts. She said one day she might look at bringing another horse into her life, but that she isn’t ready. I returned the hug. Sometimes, at the end of it all, that’s all you can do.


Click here for information on Equine protozoal myeloencephalitis (EPM)


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When we cannot save them all, but we can save some

Like many rescues in the area,”Starfish Rescue” used to rotate through all the local vets. Almost as if going through phases. Before I eve stepped foot on the property, I was warned ahead of time. One, their bill is outstanding at over $5,000 owed. Two, overcrowding. Three, don’t be surprised if compliance is low. Four, don’t get sucked in.

My first time arriving at the rescue was in response to a horse that was down and seizing. We never determined the cause, and he never seized again. My second visit, months later, was to recheck a laminitis case that my colleague had seen a couple of weeks prior. The mare had recently had her feet trimmed, and Maureen (owner of the rescue)reported the mare was still having difficulties walking. It was difficult to focus on the laminitis over the glaring neurological deficits. After a full neurological work-up, EPM was at the top of our differential list. With titers returning at >3500 with two subspecies, we felt comfortable with the confirmed diagnosis and began treatment.

Over the next couple months, I attended several more emergencies at the rescue. Sick foals, colicking mares, face wounds, terrible leg wounds, even a sweet gelding hit by a car…cases I will never forget for both good and sorrowful reasons. And trying to make a difference, while balancing financial constraints with high quality diagnostics/treatments means a lot of advanced diagnostics went under the radar. With a limited budget composed of donations, it is a different challenge all of its own trying to negotiate and prioritize which horses to treat and which horses could not be saved…especially when the rescue’s conviction stands behind saving them all.

Early on, my recommendations based on poor prognosis (septic joints, fractured joints) was unheeded. It would take weeks for the rescue to come to the same conclusion, with the euthanasia being performed by the same person who picks up the horses afterwards. A bullet to the skull can be an effective form of euthanasia, but when it goes terribly wrong, it can be one of the most inhumane ways.

6 months in, and I have earned their trust. Early on, I would have to defend every diagnostic, medication, treatment protocol and justify quality of life concern. Now, not only am I greeted with open arms, but their compliance with my instructions and view of my professional opinion, does not waver. It is amazing what time (on and off the clock), patience and a whole lot of energy can do for a relationship, especially a professional veterinary one.

There have been cases that tugged my heartstrings, and cases that I spent night after night attending. We have lost some horses and saved some horses, but with every horse, we have always tried our best. It was some of these strange cases that I further expanded on my skill set, performing joint lavages and regional limb perfusions. With money a constant wall we are up against, I’ve put in many calls to specialists and board certified surgeons/internists. I am thankful for both their time and energy, and the helpful advice that has led me to treating cases in unconventional, yet successful manners.

So, although I didn’t know it when I showed up at Starfish Rescue the first time, it would come to be one of those places with some of the most sincerely compassionate people I have ever met…and something I have wholeheartedly become thankful for this year. And it reminds me of medicine in general, that we cannot save them all, but we can certainly save some.

Case of the Mondays

Like most things in life, do something long enough and often enough, and it gets easier. Drawing blood, placing catheters, passing a nasogastric tube, suturing…do it often, with a goal of doing it well. Then, there comes the added benefit of confidence. And there’s no better way to appreciate a skill, than to have acquired it and then lost it. About halfway through a “typical” day, I was made aware of those skills I take for granted.


BAL Gone [every kind of] Wrong

It started with performing a bronchoalveolar lavage on a gelding with intermittent coughing over the past year which fluctuated with weather, exercise and environment. With non-specific findings on ultrasound, we proceeded in our diagnostic plan to determine the nature of the cough. We elected to retrieve a non sterile sample from the lower airways to evaluate for RAO and IAD. I’ve passed an endoscope countless times, and performed it successfully and easily enough that I consider it at acquired, reliable skill.

By the conclusion of the BAL, I felt like I had rehearsed for a performance demonstrating everything that could not go right. The highlights of this performance included:

  1. BAL tubing hit the ethymoids, causing a profound nosebleed
  2. Projectile, unrelenting spraying of clots across self, assistant, owner, trainer and three innocent onlookers
  3. BAL tube entered the esophagus, rather than the trachea
  4. BAL tube retroflexed and came out the oral cavity
  5. BAL tube severed by teeth when traveling through the oral cavity
  6. BAL tube #1 ruined, retrieved BAL tube #2
  7. BAL tube positioned correctly in trachea, cuff would not inflate
  8. BAL tube #2 leaky cuff confirmed
  9. Continuation of #2 problem (Projectile, unrelenting spraying of clots across self, assistant, owner, trainer and onlookers)
  10. BAL tube in position, cuff inflated, saline injected in…unable to collect any saline
  11. Added more saline through tubing, retrieved <40 ml

I was relieved when the whole thing was done. After all the above complications, at least the sample was collected and submitted. What else could go wrong? Then, I got the lab report stating:

Sample has insufficient cells, inconclusive. Recommend collect second sample for analysis.

This was just the first appointment of the day.


Miscommunications, mistakes, mishaps and misfortune

When not a soul could be found at our second appointment, I called the owner. Turns out, the appointment had been rescheduled to the following week…news of which, didn’t happen to make it to today’s day schedule.
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Our third appointment canceled.

Our fourth and fifth appointments had the wrong addresses (showed up at a neighbor developement and then mistakenly went to the owner’s house instead of the boarding facility).

Collected the wrong blood tubes, forgot to dispense a medication refill, double-charged on an invoice, made at least 12 U-turns…

And the cherry on top? At 6pm, as we’re wrapping up at the last appointment and about to begin our 90 minute drive home through late rush hour traffic…my assistant hesitantly asks,

“Hey, have you been having problems with the gas gauge?”

I hadn’t. No one had. About 4 minutes later, the thing we were dreading came to fruition. We ran out of gas.


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Newest Vet on the Totem Pole

Whenever I become frustrated while learning and improving upon particular skillsets or techniques, especially when my progress isn’t meeting my expectations, I think of a specific phrase to provide perspective. Every vet was a new vet at some point. The only way to get 10 years of experience, is to spend the 10 years gaining experience. It goes without saying that no vet was born with a doctorate straight out of the woom. Any expert, instructor, teacher, trainer, mentor etc…was at some point, a beginner themselves.
While sometimes I feel TOO aware of where my inherient new grad weaknesses are, itwwould not be safe for me to assume my boss and more seasoned colleagues are just as aware. There have been times when I have had appointments put on my scheudle that I had absolutely no or an insecure amount) aof experience performing or even interpretting. For this reason, the seasoned and invested colleagues of the practice are worth their weight in gold.
I’ve been an associate at my first “serious” multi-doctor practice for a little under a year. Soon, my one year employment contract will be over and I am already looking ahead to negotiating the contract for the second year. To be hoenst, I was in sucha pinch to find a new job after leaving my first private practice job, I did absolutely no contract negotating. I will say this is “new vet” lesson #1. Coming in as the new vet does not mean you “Take what you can get” and certainly doesn’t mean that you’ll have to tough it out with a “pay your dues” themed contract. To any “new vet,” my first recommendation is to negoatiate and not just settle for the minimum.

The lessons learned over the past year are countless, but I put together a list of the more prominent lessons, surprises, realizations and adversity I faced in this first year, in the context of a new graduate and new hire. Every practice is different, and maybe some of my list is unique to my practice…but worth sharing regardless
  • Desire to “prove” yourself is natural. But proving your worth does not mean you have an inherent labor or favor debt to other associates.
  • Case-pushing and dodging. You’ll get the bottom of the barrel for cases and clients. There were clients and patients that other vets refused to see once I was around. Clients that wer rude, inappropriate, didn’t pay their bills, used other vet practices interchangeably and sometimes even notorious patients (mean, dangerous, feral). Whatever cases other doctors wished they did not have on their schedule, would end up on mine.
  • Opposite of case-pushing, is case-nabbing. These tend to be new clients that would contribute to a strong clientel of an already established vet. On multiple occasions I had new clients who were put on my schedule for gastroscopies (or other advanced diagnostics/treatments) but several days later suddenly appeared on a different doctor’s schedule…for no reason, with no discussion.
  • New grad and new vet double wammy. I have lost count of the number of times I arrived at an appointment and the first thing clients commented on was my age. Most commonly something along the lines of “Aren’t you a little young to be a doctor?” or “You must be the assistant. When does the doctor arrive?” There are also the demeaning references based on the gender and age included calling me girl, missy, little lady, youngin, gal, or refusing to address me as doctor.
  • Skepticism. Yeah, you may be absolutely right on your diagnosis and treatment recommendations…but for it to be legit, you’ll need the backing of another associate that you’re doing the right thing
  • The interpersonal dynamics of the practice alone have been difficult. The biggest difficulties have been when staff refuses to show the same amount of respect to the new doctor (especially if they are outgoing, kind and amiable) as they do the senior vets that are hard on staff.
  • Favors. That can become a slippery slope when the staff finds out the new vet will not be so protective of their time and feel too guilty about charging for services. I did a dental for a staff member who had one horse, and I did not charge for my time. Another vet in our practice would’ve charged 300 compared to my 75. Word got around and suddenly I was at the beckoning call of every staff member who owned a horse. This is a great way to fill your schedule and prevent you from getting actual cleints. This is also another way to end up getting called for emergencies for staff animals when you aren’t even on call that night!
  • Establish your professional and personal boundaries. A favor is simply that, and no one is entitled to favors.
  • You’ll do things different. You’ll get called out on it by non-vets. I had an assistant argue with me about passing a NG tube up the wrong nostril. I always pass on the left so I can see the tube go through the esophagus for visual confirmation. Apparently all the other doctors tube on the right. The assistant telling me I was doing it different, and not like all the other vets, seeded an unnecesary amount of anxienty and fear in the client…while also undermining my professional knwoeledge and abilities.
  • Don’t take it personally when you meet a colleague’s client, establish a great rapport, save their horse from a critical emergency….then see months later that they insist on sticking with your colleague for upcoming dentals, vaccines etc. Don’t assume that this is because you did something wrong. Don’t underestimate the bonds between your colleagues and their clients.
  • The learning curve is steep but you don’t have to do it alone.