'Clinical pathology:' 10 red flags for new graduates

Article

A few clues make it obvious whether a practice is the right choice for your first job

Your workday finally ends around 10 p.m. as you sit down to change yourshoes for the walk home. You realize this is the first time that you'vebeen 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 waterand a slow deep breath-two more firsts for the busy day-and feel the perpetualtightness in your chest, shoulders and back slowly begin to dissipate.

You would begin the drive home, except that at your new graduate salaryof $26,000 after taxes, $17,000 after student loans, $13,000 after life,disability, malpractice and other insurance premiums-you and your new spousecan't afford a second vehicle without risking default on your house leaseor credit card debts. So you make do, keeping the old truck that got youthrough four years of veterinary school, and the five or six years beforethat.

Fortunately, you live within a mile or two of the clinic, so the roundtripwalk to work isn't too bad. Besides, it's the only exercise you get, especiallysince the daily fitness/lunch break you specifically requested and werepromised has never materialized.

When you get home, your dogs will enjoy a romp in the fresh snow thatfell unnoticed throughout your busy day. They were always there for youthrough veterinary school, but lately you've been there less and less forthem. And when there is time, you find yourself irritable, impatient andtense. You are the same way with your spouse, who has his/her own worriesabout finding meaningful work in this new community.

As you anxiously prepare to leave for the day, you receive an emergencycall, which you are responsible for handling. It's a non-client with a dogthat hasn't been seen by a veterinarian for four years and which is nowvomiting for the third consecutive day. It will take the caller at least45 minutes to get to the clinic. You are stunned, then angry. "Whytonight?" you shout, slamming down your briefcase and unknowingly spillingyour uneaten lunch all over its interior.

Is this the way you intended life to go after you were awarded that hardwon and coveted veterinary degree? Did you expect to find yourself on theverge of burnout, clinical depression and bankruptcy after only a few monthson 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 scenarioisn't some delusional imagining, it is a real world drama that, unfortunately,unfolds every day in many clinics and with many young associates acrossthe country. You can minimize your risk of falling into the same trap withan awareness of what I call "clinical pathology." These are tensituations that shout "watch out!" and spell danger for a newgraduate and prospective employee.

1. The schedule book. Today, many clinics use software-based scheduling.Others use professionally manufactured and bound planning notebooks. Bothof these methods of tracking the daily schedule are fine.

A homemade, loose-leaf, photocopied schedule book at the reception deskin this day and age, however, is totally unprofessional and invariably adead giveaway of a poorly managed practice whose owners are more concernedwith cutting corners and saving money than they are with providing reasonableveterinary care. If you had only one physical factor by which to judge apractice, this would be it.

2. Needles and pins. Ranking a close second to the schedule bookfor judging the merits of a practice is the handling of needles, scalpelblades and syringes. Regardless, of how one feels about recycling, wastefulpackaging or other environmental concerns, these items are not meant forreuse and doing so is a medical and professional no-no.

The same holds true for sterilized surgical packs. Beware of veterinarianswho insist that blood is sterile and claim that the use of the same surgicalinstruments 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 heatfor this one, as there are many successful clinics predicated on spousalteams. On the other hand, there are also many successful clinics not runby spousal teams. Try to stick with them. Why? Consider this: how many Fortune500 companies are run by husband-and-wife units? The answer: not many. Howmany are overseen by wife-husband teams? Answer: even fewer.

Still not convinced? Then remember the old adage, "Don't mix businesswith pleasure." A spousal team cannot possibly adhere to this advice,unless, in fact, the clinic is not being run as a business, or the marriagedoesn't fall within the category of pleasure. These scenarios occur toooften among spousal teams. Take my advice, don't take a chance and get caughtin the middle.

4. Fee schedule. The new employee has little say in how servicesand items are priced in a clinic, yet these fees have a huge impact on employeeearnings. Always compare the fees of nearby clinics to determine where inthe market your employer's clinic fits.

In our area, for example, one veterinarian-using only manual restraint-chargesa mere $20 to unblock and place a urinary catheter in a male cat. A veterinarianat another clinic would charge a minimum of $150, which includes mandatoryanesthesia and analgesia. Both of these veterinarians have successful, busypractices, yet each obviously serves a different segment of the pet-owningcommunity. With whom would you rather work?

A kitten visit at a clinic where I once worked ran $65. This includedthe 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 clinicwhere I worked the following year-in the same general area-totaled $125.Considering your $120,000 education, which is the more reasonable pricingfor your time and services?

5. High turnover. Few things speak more loudly and directly ofan 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 fiveyears. These were not lousy doctors, either. It is telling that the longesttenure among the dearly departed was a mere two years; for most, myselfincluded, it was less than one year.

Unfortunately, his clinic is not an isolated example-just watch the classifiedsfor a few months, or better yet a few years, and see how many consistentlyrepeated ads there are. You'll be surprised.

Don't be shy, this is your future at stake. During your interview, askspecifically about employee turnover. If the list of past employees conjuresup images of cliff-diving lemmings in the far North, then think twice aboutsigning on.

6. Overly restrictive contracts. A contract is meant to be a meetingof the minds between two parties. Beware of inflexibility. A prospectiveemployer who admonishes, "This is the way we've always done it,"when it comes to a contract may be providing key insight into their managementand medical styles.

Protect yourself and your family by negotiating for a three-to-six monthtrial period with your new employer before any non-competition covenanttakes effect. Remember also, it pays to have a professional contract attorneyreview all contracts.

7. Clinic appearance and upkeep. A clinic doesn't have to lookas if it were build by Frank Lloyd Wright or landscaped like a country clubto provide high-quality pet, client and employee care. Basic upkeep andgrooming are critical, though, if for no other reason than the professionalpride that they reflect. Beware of weathered signs or buildings in needof fresh paint. Look critically at untrimmed or weedy lawns, unfilled lightsockets, 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 isregularly picked up outside and in runs where animals are exercised. Inmy experience, hospitals with high standards for cleanliness and equipmentupkeep 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 thathad only one mop and bucket for the entire facility. At one point, thisclinic, 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 receptionarea, which featured an algae-covered aquarium teeming with dead, yes, deadfish! What a practice builder that was. Obviously, sanitation, equipmentupkeep 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, orworse, stacked atop the radiograph table, thereby rendering it effectivelyout 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 adequatebrightness. Dim lights signify a dim future. Have you ever heard of nosocomialinfections? I thought so. So while you're at it, check out a few otoscopecones. Like every thermometer and every pair of clipper blades, after eachuse, otoscope cones should be cleaned, disinfected and readied for the nextpatient. I'm amazed at how infrequently this is actually done, even by doctorsand technicians who absolutely know better. It's sad.

8. Staff-to-doctor ratio. This oft-cited figure is of paramountimportance to the practicing veterinarian, experienced or inexperienced.Study after study has demonstrated the value of adding technicians and assistantsto the hospital staff. I am convinced that many clinics seeking an additionalveterinarian today would instead be much better off hiring one or two techniciansand/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 receptionistdoing 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 atech or assistant, or that hospital employees shouldn't be cross-trainedin multiple disciplines. Rather, understand that each position has its ownresponsibilities and duties, and when it comes to clinic management, mixingthese up in the daily routine is, as the saying goes, "Robbing Peterto pay Paul."

9. Emergency service. Without a doubt, emergency service is oneof the most challenging and rewarding facets of the profession. Nonetheless,there may be no more common cause of burnout and dissatisfaction with theveterinary profession than this, particularly when the emergency or on-callduty is stacked atop a full day of practice. Talk to nearly any physician,physician assistant, nurse practitioner, or nurse and they will inevitablytell 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-bethey human or animal doctors-are often too far removed from such facilitiesto benefit. By necessity, then, these noble professionals continue to workthe long, hard hours that would stupefy the normal mortal.

The bottom line is this. In this day and age, unless one is of a veryspecial personality and comportment, burning the clinical candle at bothends is ill-advised. While you may not be able to avoid - or may not wantto avoid - emergency duty in your new position, this is one area that forquality of life reasons should be examined closely and carefully negotiated.

10. Life philosophy. No other factor is ultimately as importantas this. While common sense might dictate that one will choose to work withsomeone 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 byfancy equipment, a balanced caseload, a competent, capable and amicablestaff, affluent clientele, geographic preferences and the promise of unparalleledmentorship, 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 asyou 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 interestsand passions? Are you a quiet, stay-at-home type or do you crave "lavida loca?"

Do you have or plan to have children? How will you raise them? What valueswill you instill in them? Do you have pets? What relationship do you maintainwith them? What are acceptable behaviors for your children and/or pets andhow do you promote these?

Obviously, no two people see eye-to-eye on everything, but if they differtoo much in their fundamental outlook on life and its rewards and challengesthen it is doubtful a close, productive, meaningful and long-term businessassociation will pan out.

Your first job after graduation is critical in shaping you as the veterinarianand even to some extent the person you will be. Select this position withcare and common sense. If possible, spend at least three full days workingin 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-fivewith no on-call responsibilities job, to an 8 a.m. to 8 or 10 p.m. routinewith additional emergency duties, and everything in between. There willundoubtedly be tradeoffs-lots of them. The above 10 factors, however, haveproven to be highly useful in assessing and comparing the merits of variousclinics and job offers.

In selecting your first associate position, weigh your needs and wantsagainst the realities of business operation, economics, your training andyour fundamental values, ethics, morals and-most importantly-your dreams.

Dr. Tischendorf is a 1997 graduate of Colorado StateUniversity College of Veterinary Medicine. He is founder and director ofPetOne Animal Medical Consultation Group in State College, Penn. and GreatFalls, Montana.

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