'Clinical pathology:' 10 red flags for new graduates
Your workday finally ends around 10 p.m. as you sit down to change your shoes for the walk home. You realize this is the first time that you've been off your feet since 8 a.m.
As usual, you saw appointments through your lunch and dinner breaks, and now, finally, 14 hours later, it's all over. You take a drink of water and a slow deep breath-two more firsts for the busy day-and feel the perpetual tightness in your chest, shoulders and back slowly begin to dissipate.
You would begin the drive home, except that at your new graduate salary of $26,000 after taxes, $17,000 after student loans, $13,000 after life, disability, malpractice and other insurance premiums-you and your new spouse can't afford a second vehicle without risking default on your house lease or credit card debts. So you make do, keeping the old truck that got you through four years of veterinary school, and the five or six years before that.
Fortunately, you live within a mile or two of the clinic, so the roundtrip walk to work isn't too bad. Besides, it's the only exercise you get, especially since the daily fitness/lunch break you specifically requested and were promised has never materialized.
When you get home, your dogs will enjoy a romp in the fresh snow that fell unnoticed throughout your busy day. They were always there for you through veterinary school, but lately you've been there less and less for them. And when there is time, you find yourself irritable, impatient and tense. You are the same way with your spouse, who has his/her own worries about finding meaningful work in this new community.
As you anxiously prepare to leave for the day, you receive an emergency call, which you are responsible for handling. It's a non-client with a dog that hasn't been seen by a veterinarian for four years and which is now vomiting for the third consecutive day. It will take the caller at least 45 minutes to get to the clinic. You are stunned, then angry. "Why tonight?" you shout, slamming down your briefcase and unknowingly spilling your uneaten lunch all over its interior.
Is this the way you intended life to go after you were awarded that hard won and coveted veterinary degree? Did you expect to find yourself on the verge of burnout, clinical depression and bankruptcy after only a few months on the job? Where did you go wrong? Can you save your career? Your marriage? Yourself?
If you are a veterinary student soon to graduate, take heed. This scenario isn't some delusional imagining, it is a real world drama that, unfortunately, unfolds every day in many clinics and with many young associates across the country. You can minimize your risk of falling into the same trap with an awareness of what I call "clinical pathology." These are ten situations that shout "watch out!" and spell danger for a new graduate and prospective employee.
1. The schedule book. Today, many clinics use software-based scheduling. Others use professionally manufactured and bound planning notebooks. Both of these methods of tracking the daily schedule are fine.
A homemade, loose-leaf, photocopied schedule book at the reception desk in this day and age, however, is totally unprofessional and invariably a dead giveaway of a poorly managed practice whose owners are more concerned with cutting corners and saving money than they are with providing reasonable veterinary care. If you had only one physical factor by which to judge a practice, this would be it.
2. Needles and pins. Ranking a close second to the schedule book for judging the merits of a practice is the handling of needles, scalpel blades and syringes. Regardless, of how one feels about recycling, wasteful packaging or other environmental concerns, these items are not meant for reuse and doing so is a medical and professional no-no.
The same holds true for sterilized surgical packs. Beware of veterinarians who insist that blood is sterile and claim that the use of the same surgical instruments on more than one animal, without proper sterilization between, is acceptable. It isn't.
3. Husband-wife or wife-husband teams. I know I'll take some heat for this one, as there are many successful clinics predicated on spousal teams. On the other hand, there are also many successful clinics not run by spousal teams. Try to stick with them. Why? Consider this: how many Fortune 500 companies are run by husband-and-wife units? The answer: not many. How many are overseen by wife-husband teams? Answer: even fewer.
Still not convinced? Then remember the old adage, "Don't mix business with pleasure." A spousal team cannot possibly adhere to this advice, unless, in fact, the clinic is not being run as a business, or the marriage doesn't fall within the category of pleasure. These scenarios occur too often among spousal teams. Take my advice, don't take a chance and get caught in the middle.
4. Fee schedule. The new employee has little say in how services and items are priced in a clinic, yet these fees have a huge impact on employee earnings. Always compare the fees of nearby clinics to determine where in the market your employer's clinic fits.
In our area, for example, one veterinarian-using only manual restraint-charges a mere $20 to unblock and place a urinary catheter in a male cat. A veterinarian at another clinic would charge a minimum of $150, which includes mandatory anesthesia and analgesia. Both of these veterinarians have successful, busy practices, yet each obviously serves a different segment of the pet-owning community. With whom would you rather work?
A kitten visit at a clinic where I once worked ran $65. This included the exam, an FELV-FIV test, a fecal float, deworming, rabies and FVRCP vaccinations, an ear cleaning, and a bottle of ear cleaner. The same routine at the clinic where I worked the following year-in the same general area-totaled $125. Considering your $120,000 education, which is the more reasonable pricing for your time and services?
5. High turnover. Few things speak more loudly and directly of an unsatisfactory work environment than high-employee turnover. Obviously, every business is bound to lose an employee or two periodically. However, one clinic of which I am aware, burned through eight veterinarians in five years. These were not lousy doctors, either. It is telling that the longest tenure among the dearly departed was a mere two years; for most, myself included, it was less than one year.
Unfortunately, his clinic is not an isolated example-just watch the classifieds for a few months, or better yet a few years, and see how many consistently repeated ads there are. You'll be surprised.
Don't be shy, this is your future at stake. During your interview, ask specifically about employee turnover. If the list of past employees conjures up images of cliff-diving lemmings in the far North, then think twice about signing on.
6. Overly restrictive contracts. A contract is meant to be a meeting of the minds between two parties. Beware of inflexibility. A prospective employer who admonishes, "This is the way we've always done it," when it comes to a contract may be providing key insight into their management and medical styles.
Protect yourself and your family by negotiating for a three-to-six month trial period with your new employer before any non-competition covenant takes effect. Remember also, it pays to have a professional contract attorney review all contracts.
7. Clinic appearance and upkeep. A clinic doesn't have to look as if it were build by Frank Lloyd Wright or landscaped like a country club to provide high-quality pet, client and employee care. Basic upkeep and grooming are critical, though, if for no other reason than the professional pride that they reflect. Beware of weathered signs or buildings in need of fresh paint. Look critically at untrimmed or weedy lawns, unfilled light sockets, exam room and treatment area disarray, and excessive odors, dust, dirt and stains.
Helpful hints: Carefully observe the number, placement and use of mops, buckets and other basic cleaning supplies and disinfectants in the clinic. Look for feces and urine in cages with patients and note whether waste is regularly picked up outside and in runs where animals are exercised. In my experience, hospitals with high standards for cleanliness and equipment upkeep also have high standards for patient, client and employee care.
Believe it or not, I know of a three-floor 5,000-square-feet clinic that had only one mop and bucket for the entire facility. At one point, this clinic, which had three doctors, four exam rooms and a small boarding facility, was working with only one thermometer as well. Topping it off was the reception area, which featured an algae-covered aquarium teeming with dead, yes, dead fish! What a practice builder that was. Obviously, sanitation, equipment upkeep and quality care were not high priorities for this clinic's owners.
Also be alert for any high-priced equipment, like an ECG, ultrasound, suction or cautery unit, that is stuffed in a corner gathering dust, or worse, stacked atop the radiograph table, thereby rendering it effectively out of service as well. These are key indicators of poor purchase planning, an inadequate maintenance program, and/or an inferior quality of medicine.
Finally, turn on a few otoscopes and ophthalmoscopes to assure adequate brightness. Dim lights signify a dim future. Have you ever heard of nosocomial infections? I thought so. So while you're at it, check out a few otoscope cones. Like every thermometer and every pair of clipper blades, after each use, otoscope cones should be cleaned, disinfected and readied for the next patient. I'm amazed at how infrequently this is actually done, even by doctors and technicians who absolutely know better. It's sad.
8. Staff-to-doctor ratio. This oft-cited figure is of paramount importance to the practicing veterinarian, experienced or inexperienced. Study after study has demonstrated the value of adding technicians and assistants to the hospital staff. I am convinced that many clinics seeking an additional veterinarian today would instead be much better off hiring one or two technicians and/or assistants and then letting them do what they are trained to do.
Beware of clinics operating at a staff-to-doctor ratio of less than 3:1. I don't include receptionists or kennel crew in this ratio, and, in fact, I recommend prospective associates be extra cautious if they see a receptionist doing double duty on the same shift pinch-hitting as a technician or assistant.
This is not to say that a receptionist is unable to do the work of a tech or assistant, or that hospital employees shouldn't be cross-trained in multiple disciplines. Rather, understand that each position has its own responsibilities and duties, and when it comes to clinic management, mixing these up in the daily routine is, as the saying goes, "Robbing Peter to pay Paul."
9. Emergency service. Without a doubt, emergency service is one of the most challenging and rewarding facets of the profession. Nonetheless, there may be no more common cause of burnout and dissatisfaction with the veterinary profession than this, particularly when the emergency or on-call duty is stacked atop a full day of practice. Talk to nearly any physician, physician assistant, nurse practitioner, or nurse and they will inevitably tell you the same thing.
Thankfully, there is a trend these days toward more and more emergency-only, or after-hours, veterinary clinics. Unfortunately, rural practitioners-be they human or animal doctors-are often too far removed from such facilities to benefit. By necessity, then, these noble professionals continue to work the long, hard hours that would stupefy the normal mortal.
The bottom line is this. In this day and age, unless one is of a very special personality and comportment, burning the clinical candle at both ends is ill-advised. While you may not be able to avoid - or may not want to avoid - emergency duty in your new position, this is one area that for quality of life reasons should be examined closely and carefully negotiated.
10. Life philosophy. No other factor is ultimately as important as this. While common sense might dictate that one will choose to work with someone who most closely shares his views on the fundamental issues of life, it is surprising how often this critical factor is overlooked.
Everybody has their buttons. Prospective employees can be blinded by fancy equipment, a balanced caseload, a competent, capable and amicable staff, affluent clientele, geographic preferences and the promise of unparalleled mentorship, high pay and a stellar future.
Don't be hornswoggled. Before you accept any position, go back to basics. Do your prospective employer and colleagues look at life as you do or as you aspire to? What are your short and long-term goals? What are theirs? Are you a workaholic or a family person? A "hugger" or a "kicker?" Introverted or extroverted? Single or married? What are your outside interests and passions? Are you a quiet, stay-at-home type or do you crave "la vida loca?"
Do you have or plan to have children? How will you raise them? What values will you instill in them? Do you have pets? What relationship do you maintain with them? What are acceptable behaviors for your children and/or pets and how do you promote these?
Obviously, no two people see eye-to-eye on everything, but if they differ too much in their fundamental outlook on life and its rewards and challenges then it is doubtful a close, productive, meaningful and long-term business association will pan out.
Your first job after graduation is critical in shaping you as the veterinarian and even to some extent the person you will be. Select this position with care and common sense. If possible, spend at least three full days working in any prospective practice to get a true feel for its flow and character.
The possibilities in private practice are endless, ranging from a nine-to-five with no on-call responsibilities job, to an 8 a.m. to 8 or 10 p.m. routine with additional emergency duties, and everything in between. There will undoubtedly be tradeoffs-lots of them. The above 10 factors, however, have proven to be highly useful in assessing and comparing the merits of various clinics and job offers.
In selecting your first associate position, weigh your needs and wants against the realities of business operation, economics, your training and your fundamental values, ethics, morals and-most importantly-your dreams.
Dr. Tischendorf is a 1997 graduate of Colorado State University College of Veterinary Medicine. He is founder and director of PetOne Animal Medical Consultation Group in State College, Penn. and Great Falls, Montana.