A tale of two clinics
"Two roads diverged in a wood and I - I took the one less traveled by, and that has made all the difference." Robert Frost
am Smith walked purposely toward the restaurant. He had just registered for the annual meeting and was anxious to meet Jim Warren, a classmate, for lunch. He had not seen Jim since vet school and was wondering if he had gained weight and lost his hair like he had.
Although Sam had been to a few veterinary meetings since graduating from veterinary school, he now was here for a new purpose. Sam had received information that he must attend some form of continuing education this year in order to maintain his license.
"Hey Sam, is that you?" Jim called from a corner booth. Sam peered over his spectacles and saw a man that reasonably looked like the Jim Warren he used to know 25 years ago.
"Hi, Jim. Thanks for meeting me here," Sam replied as he struggled to squeeze his ample abdomen under the tabletop.
"You here for the whole meeting?" inquired Jim.
"I'll be here just two days. Enough to get in my 20 hours of CE and get out of here."
"I thought I saw you here briefly last year but haven't really seen you at any of the other meetings I usually attend."
"Yeah, I really don't learn anything here I don't already know. Most of it does not apply to me anyway. You know these university types want you to do a bunch of things clients don't really want or can afford. It is mostly a waste of time," Sam spouted this with authority. He waited in vain for Jim to nod in agreement.
Finally Jim frowned imperceptibly and then was silent for another moment.
"Sam, you said you'd like to talk to me and I'm all ears. It sure is good to see you."
"Thanks. You know I am really thinking about selling out and going to Florida or somewhere warm. I need to get away from all the hassle of running the practice. I had a stint put in my heart last year and I just don't need it all anymore."
"Gosh, I am sorry to hear that." Jim said.
"Do you have any associates?" Jim replied looking for a place to start.
"That's a joke. These kids today want to earn as much as I do. Then when I hire 'em they want to change everything. I've had two associates over the years and they both took off when they smelled a little more money down the street."
Jim now tried valiantly to move the conversation forward.
"Have you attended any seminars concerning practice evaluation and sales?" asked Jim.
"Why bother? Those people all sound like a broken record-raise prices, raise prices. They don't know how bad the economy has been for the past 10 years."
Sam smugly leaned back and again waited for confirmation. At the few meetings he did manage to attend, he was used to carping about the profession with some of the colleagues he knew. He expected Jim to join in for a lively discussion of the sorry state of the profession. He also expected at least some discussion concerning the lazy vets coming out of vet schools these days. Jim would not bite.
"Sam, you know there may be more here than I can deal with in just a few minutes at lunch. Can you meet me at my hospital in a few weeks?"
Two weeks later:
Sam was impressed by Jim's hospital and was given the tour. In the back, Sam saw two technicians pulling blood and another taking an X-ray with an assistant.
Sam could hear Jim's associate in an exam room with an assistant explaining the necessity of a full work-up on a suspected Cushing's patient.
Sam looked at Jim and said, " You know, I have seen thousands of patients over the years and have never seen a Cushing's case yet."
Jim smiled and gently replied, "Maybe you have overlooked a few."
Sam was oblivious to the comment and moved the conversation to another level.
"I don't hire anybody any more except the kennel girl. That's all the hassle I can take; what with all the vets in my area I'm not as busy as I used to be anyway."
Sam looked at the scene before him and added, "I bet you must work 80 hours a week in this clinic? "
" Well, actually, I take a few days off a week and now I work less than 40."
Sam laughed audibly and offered, "Impossible! You must have a million management hours logged."
"I hired a manager years ago and she keeps me informed. But really, I just come in here now and mostly just do medicine and surgery. Don't get me wrong, there are problems, but the team helps me work them out as we go along."
" 'Team?' What kind of blather is that? You surely mean the employees."
"I used to refer to them as staff but we like to call ourselves 'the team'".
"Well, I can tell you right now, I pay the bills and I make 100 percent of the decisions at my place. A man has to be king somewhere."
By now, it was obvious that these old colleagues had, over the years, taken quite a different approach to the practice of veterinary medicine. Jim asked Sam to step into his office. Sam did not know it, but Jim was about to give Sam his prescription for having a more positive outlook on practice life. In doing so, he was hoping to show Sam that many changes would be in order if he expected to sell his practice.
Now we don't know exactly what Jim is about to tell Sam, but we should applaud him for sincerely trying to help his colleague. Jim and Sam have, over the years, decided to travel down two different paths.
A common scene
It is not unusual to see and talk to many "Sams" at veterinary conferences or at local meetings. They all have one thing in common. They are entrenched in their own ideas and have been in practice long enough to dig a hole and sit in it.
All of us have had a little bit of Sam's attitude crop up in our conversations from time to time and it is certainly not confined to solo practice. However, solo practice seems to cultivate, over a period of time, mindsets that can be difficult to change.
It should be noted that solo practice is still, by far, the norm for our profession. Additionally, high quality medicine and surgery can and is found in a solo setting-especially if the practitioner uses staff well and refers often to specialists.
This article addresses the emotional impediments that can impact the long range planning of those who may plan to exit the profession.
One of the problems facing a veterinarian practicing without a colleague or partner is the sense of isolation. This can be happening even without the practitioner realizing it.
Of course, going it alone is an absolute necessity if you are going to start out from scratch (unless you married another veterinarian), yet it has many drawbacks. Working alone often creates isolation that can lead to:
A feeling of disconnection
Since many patients get better whether we practice good or bad medicine, it is easy for an isolated veterinarian to feel the most of his or her decisions made in isolation are correct and beneficial.
Since no one is there to balance your approach, it is easy to fall into bad habits and ideas that are self-defeating.
Victories and defeats are unshared except with staff-this leads to burnout and further isolation.
View of the outside profession
It can be discouraging for anyone to see the advances in veterinary medicine occurring at the universities and in the wealthy suburbs and not be able to participate in these advances within your own practice.
In addition, it is easy to feel deflated when you see the large and expensive hospitals being showcased in some of the veterinary trade journals.
This tends to jade the practitioner and walls of isolation are further erected. This view of the outside world and the perceived realities of practice in their own community along with the competitive pressure of new local practices tend to justify an attitude of being trapped.
It follows in the mind of the practitioner that outside factors make it impossible to make the adjustments necessary to make progress with the rest of the profession. It is easy to let your mind fall prey to this thinking which leads to inaction on the part of the practitioner. Inaction leads to a decline in the practice and its value.
Although it is impractical to match what others may be doing in other settings, it is especially unsettling to new practitioners right out of school and soloists. This can lead to an unhealthy self-image.
We are a small profession with a fabulous public image. At the same time, most veterinarians have a poor self-image due to feelings of inferiority when compared to other professionals in the human health care field. Veterinarians also seem to have a poor understanding of the value that the general public places on their worth.
Therefore, in order for us to have a healthy outlook on what we do, it is very important to understand our role in veterinary medicine as primary providers and embrace it. That is, as the primary providers of veterinary care we are the "first line of care" for a client's precious pets and generally are how the public perceives the profession. Although you may not have an MRI machine handy, you and only you have the opportunity and the privilege of providing a lifetime of care for the family pet. Although a throwback to a bygone era, the veterinarian in private practice may be the last remaining professional who can have an impact on the family as a complete unit.
We definitely need to make a favorable impression from across the exam table every day. This can be difficult if the trials of day to day practice lead to burnout and discouragement.
Especially in a solo situation, cynicism can start to creep in to our daily discourse with clients and staff. This is an extremely dangerous situation for a veterinarian to be in. It affects his or her emotional health and ultimately the economic and ultimate salability of the practice.
The rugged individualist
The process of becoming a veterinarian is not a team effort.
Until recently, individuals aspiring to be veterinarians or those attending veterinary school achieved goals based on individual effort. Awards and grades are an individual accomplishment. Is it any wonder that veterinarians lack the team-oriented skills so essential in today's veterinary workplace? It is incumbent on the schools of veterinary medicine to promote team learning if tomorrow's veterinarian has any hope of integrating into tomorrow's veterinary workplace.
The Jim's Warrens of the veterinary world have made adjustments and have, over time, embraced the team philosophy so necessary to make a business venture an ongoing enterprise worthy of sale to another practitioner.
The end result
Sam Smith, the cynical solo practitioner, was not made overnight. He is a product of his views of the profession outside his own practice walls. He is also a victim of his own rugged individualism that helps him mask his deteriorating self-image as a veterinarian. This has led to a conclusion in his own mind that veterinary medicine always reduces itself to the lowest common denominator and that outside forces have shaped who he is and what his practice has become.
In other words, 'who he is' as a veterinarian is under someone else's control. He is under the assumption that all of this is unchangeable. Sam's unwillingness to work with others and his rugged "me against the world" attitude are his undoing. In the end, he extols a self-fulfilling prophecy-the value he places on his self-image may indeed equal the end value of his practice in dollars-zero.
A road less traveled
Pushing yourself beyond what seems to be the gravitational forces of the business environment that you long ago selected for yourself is the key to professional growth.
It makes all the difference in world as it relates to professional life that will become what you know to be your practice. Granted, the unique niche that veterinary medicine occupies in a local business environment often makes this a tough proposition.
This sometimes difficult business environment is more than balanced by the unique position that veterinarians are held-something that should never be squandered. Jim Warren is well award of this.
However, those who take the upper road and push themselves beyond are rewarded with long hours and many setbacks. The saving grace is the employees and the clients that form the core of your professional growth team. If you use them properly, you will be able to move the practice from one plateau to the next. Moreover, in the end it will make your practice worthy to be passed on to the next generation of veterinarians.
Thus, we comprehend the genius of Robert Frost.