Week 9: Top 10 Practice Problems, Lab Animal Rotation, and Ethics!
This week started off with a debriefing from our final problem-based learning session on Pepper the Singapura cat with chronic gastrointestinal distress. The overall consensus was that differentiating irritable bowel syndrome from small cell lymphoma is extremely difficult. Sometimes these diseases have so much overlap that it is not always possible to come to a clear diagnosis. This can be hard to come to terms with for people who like things to be black or white but it is a good reminder that veterinary medicine encompasses a lot of shades of grey and things will not always be clear. The remainder of the afternoon was spent in an ethics lecture discussing the use of laboratory animals. Prior to this lecture I had not put much thought into the ethics behind lab animal medicine and it was refreshing to see that there are fairly tight regulations regarding their treatment and what they can be used for. It is also nice to know that there are veterinarians actively involved in making sure that these animals are healthy and that unnecessary suffering is avoided.
Tuesday was completely blocked off for study time since a big exam was scheduled for Wednesday. Churro and I started the day off with a run around the Arboretum and then studied for the remainder of the morning and early afternoon. That afternoon I had the veterinary Spanish class and we went over more of the key components of a physical exam along with some common diseases.
Wednesday started off with our third exam of the "Fundamentals" block. This exam covered neurology, neurotransmission, the nervous system, imaging modalities (CT, MRI, radiology and ultrasonography), inflammation, and neoplasia. I think the exam went well and it is always exciting to reflect on the fact that just a few short weeks ago I had way less knowledge on these topics! That afternoon continued with an amazing lunch talk from Jeff Stanford titled “Top Ten Practice Problems: Investigating, Understanding, and Mitigating Risk in Selecting a Work Opportunity.” This talk emphasized the idea that a successful practice is built on good leadership, people and a system. When one of those pillars fall short, the practice suffers. He also highlighted the importance of understanding your worth and finding a place that is going to support you and fit your needs as a new graduate. Here are the top 10 things that new graduates (or seasoned vets) should look at and ask themselves before jumping into a practice.
1. Is the space respected?
Is the clinic taken care of or does it look old and rundown? The appearance of a business can influence the type of clientele it attracts. A rundown practice may seem appealing to some because they expect lower prices than the shiny new hospital down the road. It was also emphasized that over time, paper-based practices will cost a lot of extra time and money and this could eventually lead to a poorer level of care.
2. The “you do you” philosophy is a red flag
A clinic where every doctor runs the show a little differently can become confusing to clients and can lead to poor client satisfaction. One example that was given was that if one of the doctors in a practice uses a "Fear Free" style, the clients become accustomed to that type of treatment and may be put off if a different doctor does not act in a similar manner. This is less likely to happen if everyone in the clinic is on the same page and understands how they are expected to act. You want to look for a clinic where the leader molds and shapes the belief system and everyone has common goals. With common beliefs, leadership can give direction and this will help the clinic operate like a well-oiled machine.
3. Is it a cost practice or a wellness practice?
You will want to look around and see if the clinic seems to be hyper focused on cost instead of the overall care of the animals. Jeff highlighted that “you get what you inspect, not what you expect”. Creating a solid amount of clientele starts with great wellness appointments and thorough follow-through. When the owners feel valued and receive good care they are more likely to schedule upcoming appointments which creates a more reliable flow for the clinic.
4. Find out what type of volume doctors are hitting.
As a new graduate this is super important because if you are going into a high-volume practice those expectations will likely be passed onto you and this may lead to burnout. It has been seen that the law of diminishing marginal returns occurs when the appointment number gets above 20 per day.
5. Is there a sense of community?
“Customers will never love a company until the employees love it first”. Having a good relationship with everyone in the practice is crucial for fostering a positive work environment and keeping everyone on the same page. Starting the day with morning rounds to make sure everyone knows the day’s plan and doing frequent team meetings are great ways to create a sense of community and allows for open communication among staff.
6. Look at the inventory!
A clinic with loads of inventory is likely wasting money that could be spent on other things. It is also important to look and see if the clinic is often opting for cheaper options of different medications, products, etc. because these are not always in the best interest of the animal. These two examples were given during the talk: one clinic spent 18% on the cost of goods (COG) and their revenue was 4.6 million while the other clinic spent 36% on COG and their revenue was 3.5 million. The goal is to be more like the first clinic and not waste money on inventory that could be used in a more productive way.
7. How is the facility set up?
The layout of the clinic is important to keep in mind because it has the potential to limit your production ability. There should be at least one to two exam rooms per working veterinarian so that they are not held up if a treatment is taking longer to complete.
8. Is there a game plan?
Are the veterinarians more reactionary or intentional with they way they interact with clients? People often like having things done in front of them because it makes them feel more involved with the care that their animal is getting. This leads to a higher level of client satisfaction which results in a higher chance that they will follow your medical advice. Doing discharges in the room has also been seen to increase client satisfaction and forward scheduling is another key way to keep clients on a regular care schedule.
9. “Do you wanna” vs recommendations
You want to work with, and learn from doctors who are confident in their recommendations. This makes the owner feel more comfortable and trust that the doctor knows what they are doing. If you come to the client with a wishy washy treatment plan it is harder to gain credibility and client compliance may be lower.
10. Mentoring vs onboarding
The final point Jeff emphasized was that wherever you go, make sure that you are going to get the attention you need. Understand their promise for your success and get it in writing! Assess if they have the time, and capacity, to lead and be the example that you need them to be. The first few years out of school is crucial in your development as a veterinarian so having the right type of mentor is extremely important. Advocate for yourself because you are valuable and just because one clinic wasn’t the right fit doesn’t mean that you are stuck. There are an average of 3 jobs available per veterinarian so be selective and find the one that best fits you!
Wednesday afternoon finished off with a hot yoga session with my roommates to celebrate finishing the third exam!
The following day was the second VMTH day of the semester! These days are “mini-rotations” where we get to shadow a fourth-year student and join them on one of their clinical days. I was randomly assigned to the lab animal service and to be completely honest, I was not ecstatic. I expected to be working with mice and rats all day and to my surprise, I did not even see a rodent that day. The lab animal service is slightly different in the way that there were no fourth-year students on that rotation so it was just Vickie (another first-year) and a third-year resident. We started off the day visiting the pigs and giving them a little pudding snack and then went to go help with some rabbit intake exams. These rabbits were going to be used for a heart study, so the resident had to make sure that there were no prior cardiac abnormalities. Everyone got a clean bill of health and then we went down to visit the cat and dog colony. These animals were finishing up their research projects and were getting ready to be adopted out. I was thoroughly surprised by the level of care and husbandry that these animals receive. We got to love on them for a while and then went back to a different rabbit colony and did some rechecks. These rabbits had been dealing with pododermatitis, so we measured their lesions and they all seemed to be responding well to treatment! Before heading back for lunch, we checked out the bearded dragon colony. These little guys were being used in a study to understand hepatic lipidosis and their enclosures were bigger than the ones most people use to keep their pets in! We then took a quick lunch break and our resident went to assist with an undergraduate lab. The rest of the afternoon we were paired with one of the clinicians and helped with some rechecks in another cat colony. These cats needed blood work done so the veterinarian sedated them to limit any stress. He then let us pull the blood and walked us through a thorough physical exam. Having this one-on-one teaching was incredible and I gained an entirely new perspective on lab animal medicine. The main role of these veterinarians is to ensure the safety and wellbeing of the animals that are being used for experiments. They are the animal’s biggest advocate and that was apparent as we went through the day. Each time we came to a new colony of animals the resident or clinician would show us their favorite and they knew them by name. It was awesome to see the level of awareness that was taken to make sure these animals have the best quality of life possible. From the massive enclosures and sedation before blood work, to ultimately adopting as many of these animals out as possible permanently shifted my perspective on lab animal medicine and I am glad that I had the opportunity to learn about this side of veterinary medicine.
Friday began with three lectures on population health and then afternoon concluded with a problem-based learning session focused on a zoonotic outbreak. This was the first of three sessions so each group was split into a few different roles and we have until Wednesday to gather some research on this outbreak and come up with a game plan to help those that were affected and to prevent potential spread!
This weekend wrapped up with another long run, some quality time studying and long walks with Churro. I also got to grab dinner and catch up with with my cousin Sage who is finishing up his undergraduate degree in Animal Science at UC Davis!
Quote of the week: "It's the nice part about being dead, you don't have to worry about inflammation." - Dr. Woolard
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