Logistics behind Ambulatory Work

Occasionally, we have ride-alongs or people doing job shadows, usually students ranging from high school to vet school. For those considering a career in veterinary medicine or future ambulatory vets, it is an interactive, uncensored day-in-the-life experience. The types of questions I did not really expect to get were regarding commuting and driving. The questions I get asked most often include:

  • How big of an area do you serve? What are the logistics behind scheduling appointments? Who determines the route? How do you know how much to charge for a farm call?
  • How much time do you spend in the car on average per day? What is the longest you’ve ever driven to one place? What do you do in the car all day?
  • Does getting car sick mean you can’t be an ambulatory vet?
  • Does the truck ever break down? Have you ever gotten in an accident with the work truck?

I’ve received these questions often enough that I decided to write a couple posts about this side of the profession from my personal experience.


The Realm

Our service area (which I refer to as the realm) is vast, one of the largest I’ve seen. From where our office is located, we service up to an hour and a half in every direction…meaning our call radius is 1.5 hours, not factoring in traffic. The realm ends up being a large part of the western side of our state. While the majority of our work is North, an emergency an hour South of our office could mean a 2.5 hour drive from one end of our range to the other. Most practices I’ve spent time with service a 40 minute radius around their hub.

As for navigating the realm? I have to give a shout out to navigation apps. All of this would be a lot more difficult without today’s smart phones, GPS etc. I consider myself very fortunate to practice in a time when this technology is easily available. Not afraid to admit that I cannot imagine the farm call experience before Google maps existed. For the vast majority of our navigation, we use Google maps and Waze, which do a great job 95% of the time.


Scheduling

Luckily, our front office staff are all locals with an excellent knowledge of the cities/towns and road system. Equally important is knowledge about traffic. The commute to a particular barn in the morning could be well over an hour, while the same route could take 30 minutes if its around lunch time.

Efficiency requires concise, well-planned routes, the front desk carries the heavy burden of scheduling. And they are phenomenal at avoiding the big scheduling mistakes, which off the time of my head are:

  • Return trips (same barn more than once in a day)
  • Same stops (different doctors to the same barn in a day)
  • To-and-fro (alternating near and far locations like North  South  North  South …vs. starting north and working south throughout the day)
  • Localizing (keeping all farms in a particular direction, vs having calls at complete opposite ends of the service radius)

I have full respect and appreciation for the skills of the front desk staff, because I dabbled in scheduling at my previous job and found it to be a pain-staking, hair-pulling mess.


The Financial Side

Minimizing drive time is essential, as our farm call fees (ranging from $80-140) over times barely cover the overhead and wages one way…not to mention if the next call is equally far at the other end of our range. Often times, the company actually loses money as the basic, rough example below shows:

Farm call 40 miles from office, 1 hour drive time

  • Farm call fee charged to client: $100
  • Gas: $10
  • Vehicle wear and tear, mileage, licensing, insurance: $25
  • Assistant’s time (company cost): $25
  • Doctor’s time (company cost): $60
  • Total cost to company for farm call (one direction): $120

Not a precise or perfect example, but easy to see why scheduling and routes are so important. And after all the effort is made into tactfully planning an efficient day, there comes an emergency call that changes it all…and even if the call is at the other side of the realm, traveling in peak traffic hours, those facts don’t register because the focus shifts to getting there safely and as soon as possible, so that we can do what we joined this profession to do- care for our equine patients and the clients attached to them.

the Vet’s Assistant

The idea of having a vet assistant in the field was obscene to my first employer. She viewed them as an unnecessary (and even impossible) expense and liability for any solo practitioner. Whether it’s for the similar reasons, most vets in the area do not have assistants. I remember reading an AAEP article back in vet school, which discussed a multitude of reasons and scenarios in which it does pay off for a solo practitioner to hire a field assistant. I remember reading the article, never having seen an equine vet with an assistant, and thinking what a luxury it would be.

Then I hit that job lottery, the place I work now. It’s not that assistants are merely an option, but that taking assistants in encouraged…and there is the obvious list of reasons. There is also the not-so-obvious list of benefits and rewards that come with having a comrade out in the field.


Teamwork Makes the Dream Work

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DVM 360 has a recent article about this very topic, called Equine vet techs deserve a seat.

Our assistants are wonderful, and with individualized training, their potential is endless. The basic responsibilities in our practice include managing daily truck inventory and restocking, manage truck maintenance/repairs/cleaning, cleaning/maintenance/trouble shooting of all equipment (xrays, ultrasound, endoscope, dental equipment etc), cleaning/organizing/packing up for all appointments, horse handling (some vaccinate and draw blood), processing in-house lab work, uploading all digital imaging/lab results, help manage schedule, driving (allowing plenty o time to SOAP and invoice for the doctor) and so forth. With the help of the assistant, I can do 3 dentals in the time it took me to do one alone. I easily see three times the number of appointments in a day with how our team works.


Unsung Heroes in the Field

But aside from the logistics, there’s the other advantages…company. It’s a lot of hours in a truck most days (2-3 hours of driving usually, sometimes up to 6 for a day with ERs and appointments). You can’t put a dollar amount on good company, especially on long exhausting or stressful days, where you have someone who was with you for every moment of it. It’s both a professional and a personal bond. Comic relief, podcast discussions, small talk, singing along with the radio, reviewing cases we saw that day, an ear to listen, or even just the feeling that you’re not alone taking on the world of equine medicine. Not to mention the safety…unfortunately, not all owners are as skilled at handling their horses as we would hope. There has been many a time (and more often than not) that the situation becomes significantly safer by having the assistant handle the horse with special restrain techniques, or even just positioning for exams/flexions/nerve blocks. I remember coming back from an ER at 3AM, after a full day of work, and rolling down the windows singing at the top of my lungs trying to stay awake on a windy back-country road….I came close to falling asleep at the wheel multiple times, and am very thankful I haven’t had to do that again.

And for everything they do, the things doctors expect, appreciate and need….there is an endless list of all the unseen, unmentioned ways that they support us on a daily basis. Being a veterinarian, you face challenging, humbling, heartbreaking and gut wrenching experiences…and experience equally rewarding, uplifting and inspiring moments. It’s those rewarding experiences that give me the feeling of happiness…and the only thing that makes that happiness even greater, is when it’s shared with a teammate.


Thank you to all the veterinary assistants and technicians who remain unsung heroes in the veterinary field. Whether you’re in the exam room, surgery suite or field, the wonderful aspects of vetmed would not be nearly as wonderful (or even possible) without you!

Luckiest vet in the world


The hostile work environment, professional sabotage and unethical veterinary practices I faced at my first job as an equine practitioner in private practice made the first 6 months a living hell. After working over 100 hours per week, my boss’s vengeful decision to “punish” me by withholding my paycheck, brought me to the breaking point. Against the advice from my family, and with the support of my friends and colleagues, I quit my first job without a 2 week notice. If having profane names yelled at me wasn’t enough, my boss then told me “I know all the vets in this area. You’re never going to be an equine vet in this state.”  My assertive response was “Not you, or anyone, will ever stop me from being an equine vet.”


2 months later

By October, I was hired as an associate at a multi-doctor equine private practice that not only has a phenomenal reputation and rapport with the equine community, but also has a “work family” atmosphere. Although I knew my previous job was horrendous, I didn’t realize how terrible it was until I started at my new job. Better hours, better pay, respect, benefits (health, retirement), mentors, the opportunity to be my own doctor, strong support staff, emphasis on the highest standard of care, safe/reliable work truck…for the first couple months I felt like it was too good to be true. I was waiting for the facade to come down, but now 6 months into my new job, and this is sincerely, genuinely the wonderful place I work.

 

The only negative/downside? My goal was to spend 3-4 years at my first job before moving to Colorado for a “dream/forever” job…and there is a little part of me that thinks darn, I found my dream job already and it happens to be in the wrong state.

 

And if that’s my only complaint…I may be the luckiest vet in the world.

Facing the Repercussions

To really understand this post in context, you’ll need to understand the backstory. If you haven’t already read the predecessor to this entry, I highly recommend it.

In order to make an employee’s last two weeks a “living hell,” Dr. Cray gave the office staff and myself her decree to engage in work-place warfare. My last post left off at a pivotal moment. I accepted the reality of the work-place situation and the brutal truth about my boss’s nature. Then, I did the thing I should have done months ago. I spoke up. I refuse to make someone’s life a living hell. And from that point on, the work-place is becoming my living a hell.


My Redefined Role and Responsibilities

Everything but a Veterinarian

Unable to hire new employees, the office was severely understaffed. Now, instead of seeing appointments in the afternoons, I was assigned to the front desk as a receptionist. This is when I began to struggle, both personally and professionally. And the troubles didn’t stay at work. With only two other employees, Dr. Cray’s started singling me out. She became uncharacteristically kind to the other two office personell, bringing them gifts each morning and asking about their weekend. When she turned to face me, she snap at me to go clean her instrument tray from the ER last night or go count the vaccines in her truck. Everything became a test or barrage of rapid-firing questions (to which some of the questions were about patients I never saw, prescriptions I was never involved in, or billing accounts that were from 5 years ago). She seemed content if I did not know an answer, and became vicious when I did. She took to devaluing me in front of clients and other employees.

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Within a couple weeks, she allowed me to see appointments only 1 day a week. When clients requested appointments with me, she told the office to tell them I wasn’t available…little by little, I watched the only benefit to my job dissipate. Veterinary experience, the only thing worth staying for, was slowly replaced by my new duties which included:

  • Restocking supplies, tracking orders,
  • Create and maintain inventory system
  • Truck inventory, maintenance
  • Manage all social media accounts
  • IT for all office equipment (phones, computer, scanners, fax, internet)
  • Invoicing
  • Equipment maintenance
  • Barn tasks (feeding, stall cleaning, turn-out)
  • Yard upkeep

Veterinarian turned Receptionist turned Detective

All those hours I put in at the front desk paid off. In an attempt to fully analyze the situation, and come up with a plan…I started gathering intel. When the UPS guy saw me up front, he said he wouldn’t bother learning anyone’s name because no one sticks around long enough for it to be worthwhile. Thanks to the UPS guy, I started looking for more information about the previous associates. I remembered she didn’t order me business cards for the first 2 months in case I was going to quit. She said she’d spent too much money on wasted cards. After looking into the business card order history, what I found was startling.

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Over the past 10 years, 9 associates were hired, and of the nine associates not a single one worked for Dr. Cray longer than a month. No surprise there! I also had mixed emotions about what this said about me. Obviously someone with a healthy amount of self respect would not put up with or stay in this type of environment. I don’t like to quit, and I will endure, endure, endure. Although I gave myself credit for getting through the last four months, I also had to change my way of thinking. I’m not here to endure. My goal and aspirations are not to endure life, endure each day. What is the sense in being in the profession I love, if every day I dread and resent going to work? I suffer, my relationships suffer, and it doesn’t do the profession any good.


If someone doesn’t know whats wrong, how can they fix it? I’m a believer in that concept, and I had been silent for too long. If we were going to make this work, we were going to have to make some changes. It was time to sit down and have a chat with Dr. Cray. I worked the meeting into our schedules, and gave her a heads up that there were some items I wanted to discuss with her.

And in 2 days, that’s exactly what we’ll do.

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