Q&A: An emergency medicine leader's advice for new veterinarians

Anthony Coronado, DVM, vice president of emergency medicine at Thrive Pet Healthcare, joined host Adam Christman, DVM, MBA, on a recent episode of The Vet Blast Podcast to talk through the fundamentals he leans on most in his career: trusting your training, treating documentation as a core part of the job, and building the emotional intelligence to handle difficult conversations with clients and colleagues alike.

Below is a transcript of the conversation, lightly edited for clarity.

Adam Christman, DVM, MBA: Joining us is our awesome colleague, Dr. Anthony Coronado. [He] is the vice president of emergency services for Thrive Pet Healthcare. He's an experienced emergency and specialty veterinary leader with a career spanning clinical practice, hospital operations, recruitment, mentorship, which we're going to talk about, and business development. Dr. Coronado currently oversees emergency services across multiple locations and leads a national team of traveling emergency doctors, while also supporting ER doctor mentorship and community development. With experience as a national medical director, regional medical excellence coach, medical director, shareholder, and emergency veterinarian, Dr. Coronado brings a unique perspective on clinical confidence, communication, leadership, and what it really takes to succeed in the first year after veterinary school, my gosh, you've done quite a bit.

Anthony Coronado, DVM: It’s been a long career. And fun!

Christman: I always find it so interesting — of all of our career paths, this is what I love about our profession is how you're always evolving, right? You have these newer positions that you're growing into. If you said to the younger Dr. Anthony, you probably would never have guessed where you are now, right?

Coronado: Never, never thought I'd be in this role. Never thought I'd even dive into emergency medicine. I started out in GP and thought that's where I'd be my whole life, and maybe eventually owning a clinic.

Christman: Tell me more about that. So, what got you into ER?

Coronado: You know, it was the simple fact is that my salary was pretty low. I had two kids, a wife already, and you know my take home pay every two weeks was about $800. And my monthly rent was $900. So, you can see the math is not adding up well. I needed money, so I started moonlighting at an ER.

I wound up not liking it at all because I would go from work, to working an overnight shift, and then right back to work the next morning. All I wanted to do was sleep. And quite frankly, the expectations of an ER doctor back then were a lot less. Just get through the night was pretty much the name of the game.

And then, after five years of doing that, I went full time with ER in order to get capital so I could open my own practice. And when I didn't have to get up and go to a daytime practice anymore — I'm a night owl anyway — suddenly, it was way better and changed. I had also started working with specialty, and so the expectations started to rise. What we're allowed to do started to rise. The medical quality was going up, I found it to be immensely rewarding, and I never left.

That led into being a leader in the practice, then a partner, a shareholder, starting to help start a national company, and into my current role. So, I never would have imagined that I would go down that path.

Christman: A lot of new graduates, especially in the ER, fumble with imposter syndrome. What advice would you give to a new veterinarian who feels overwhelmed or worries they're just not ready for real world medicine in general.

Coronado: Well, I guess the first thing I would say is that's normal. That's natural that you're going to feel that way and understand that's not true. You’ve got to trust your training. You just went through an intensive four-year program. If you're coming into ER, ideally you should have also done some other postgraduate training, like an internship or an ER academy. But you know the medicine, and you certainly know more than the person in front of you who has that pet. Where you struggle a little bit coming out of [training] is just how to access that. You just got a bunch of information downloaded into you. Now you've got to learn how to get to it and get to it quickly. So that takes a little bit time.

And so, the other side of that is to say, “Hey, you know what, Mr. Jones? I understand [that] you know this is what's going on with Fluffy. And you know what? I'm not entirely sure right now what's going on, but the good news is I know how to figure it out, so let's work on this together.”

Now, while you're going down that path, back to the first statement I said: trust your training, stick to the basics, start unlocking everything — A, B, and C — we were taught those things for a reason because that is how you get your answers. And then, when you start getting past the basics and you start wondering, “okay, what's next?” — use your resources. You've got your mentors who you had in school. You've got your classmates you can turn to, and of course other doctors. Exploit your organizational resources for mentorship that they might have.

Don't be afraid to ask for help. The biggest mistake I see people [make] is they're afraid to admit when they don't know, and that gets into trouble.

Christman: Yeah, absolutely. What are some common mistakes that you've seen in your own career, or you see new veterinarians make clinically, and how can they avoid them?

Coronado: It's not just that I've seen them in my own career; I've done a lot of them, so I made a lot of these mistakes myself.

The first one's going to be — I went back to this, and I'm going to hit on this over and over again — trust your training. Don't stray from the basics. We're taught a specific diagnostic workup in school, and it's pretty all inclusive. A lot of people feel like, "Oh my gosh, that's ivory tower. We don't really need to do that in the real world. People can't afford that.” What happens then, is when you start cutting corners and cutting out things, is you're missing stuff. The tendency is to jump to the latest and greatest new diagnostic tests that companies will promote to you, and you skip the basics.

As my years went on, I started migrating from general practice into ER, and then specialty, then I'm receiving referrals from doctors to specialists — kind of backdooring through the ER. I would see that if they'd have just done the basics, that pet never actually would have come to our door. They wouldn't have needed to, [the vet] would have had the answer and that animal would have been served sooner.

So, stay with the basics; they're there for a reason. The difference between a mediocre doctor and a good doctor is that adherence to the basics. And then from good to great is dotting every “i,” crossing every “t,” and not skipping [steps]. Don't get tunnel vision.

We have a saying in medicine: “when you hear hoofbeats, you look for horses. You don't look for unicorns.” You don't look for the strange things out there. Common things happen commonly, so don't try and fit a diagnosis to what you see. It's the other way around — let what you see lead you to the diagnosis. [It’s] that adage of “treat the pet, not the test.” If the test result tells you [that] something doesn't match what you're seeing, then you have to look at the clinical picture.

Start with the basics, [then] move forward. My mistakes initially, as I started jumping away from the basics, was listening to some of the folks in my ear saying, "Oh, you don't really need to do that.” It burned me, and unfortunately, it led to pets taking longer to get better.

Christman: Yeah, there are two factors. I've always said to the graduates that come to me and shadow me [that] there's clinical bias and client bias, and it's very easy to get stuck in both of those.

So, when I talk about clinical bias, [it’s] kind of exactly what you're saying. Like, “This dog, Dr. Christman, acts, quacks, [and] looks like Cushing’s, why is it not showing up on the blood work?” Because maybe it's not. You want it to be a certain diagnosis, but it's leading you down a different path. So, you have to take those blinds off, like you were talking about.

And then, with client bias, when I first started practicing, I would say, "Oh, they're probably not going to go for the ultrasound, so I'm not going to even talk about it.” And then you happen to casually talk about it, and they say, "Oh, oh no, let's do the abdominal ultrasound.”

So, to your point about ivory towers and avoiding client bias, just offering what's available — we live in a world where we talk a lot about spectrum of care — you just never know what clients may be willing to do, or see the value or the why behind the medicine.

Coronado: That is 100% true. You don't know what that client can and cannot afford, and the good news is that's not your responsibility. Your responsibility is [to] offer the best to every patient, every client, every time.

And so back to, “Hey Mr. Jones . . .” [clients] understand you have the exam fee. Well, the good news is the exam fee gives you access to all of my knowledge. So, I'm going to tell you everything I think we should do, and I'm going to tell you why I think so. If that works, then great. If it doesn't work, that's okay, we'll figure out together what we need to do.

That lets you put the best in front of the client every single time. They feel like you're on their side and you're not trying to just get every dollar out of them. You’ve given them that psychological safety of, “If you can't do it, that's okay. We'll figure it out. But I owe you this information as part of my job.” That's a huge passion point.

Christman: The other thing we're going to pivot a little bit towards is documentation. You hear often “If it's not documented, it didn't happen.” So why is the medical record quality so important, and what are some documentation habits new graduates should develop immediately?

Coronado: It’s very important because, like you said, if it if it's not documented, it didn't happen. Most importantly, it’s [for] whoever follows after you to treat that patient. If you're not there the next day and that pet comes back in, they don't know what you did or where you left off. So, it really helps your your team keep track of where you're going. For me, documenting very much helped me organize my thoughts and plan, and allowed me to see, “Oh, I forgot this or that,” and add in what was needed.

[Documenting] provides a reference for your team and your clients. I like to tell our doctors that what you do medically is extremely important. What you document is equally as important because it helps everybody keep track of where you're going.

Ultimately, [it] does protect you legally. Heaven forbid it comes to a situation where you're at a disagreement point with a client, you've got [documentation] that says, hey we did this, this, this here.

It's your responsibility, and today it's easier than ever because of all the AI and note-taking software that's out there. If I'd had this stuff back when I was in practice, I'd easily have four or five hours back every day out of my time.

But you have to document. It's a non-negotiable thing.

Christman: Vet schools are working hard on teaching more about emotional intelligence. Why do you believe that can be one of the strongest predictors of career success and well-being in vet med?

Coronado: I would just take out the vet med part — it's one of the strongest predictors of success in any career.

In veterinary medicine, we tend to attract a more introverted crowd. You know, when you ask someone why they got into veterinary medicine instead of human medicine, it's like, “Well, I don't like people.” I hear that all the time.

So, we take people that are a little bit more introverted who tend to be more conflict averse, a bit more risk averse, who don't like confrontation at all. You take a bunch of people that don't like people and make them work with other people that don't like people, put four walls around them, add sick pets and money into it, and think that's going to go well. It doesn't tend to, but that's not wrong or right. It just is. And so, how do we give our teams the tools to succeed?

When you talk about emotional intelligence, that helps people take what they are perceiving as personal attacks, set it aside, and let them focus on “What's the communication? What's the issue. How do I work with this individual together?”

Every pet is attached to an owner, so we've got to be able to work with them. Every clinic has techs and doctors, and we all have to work together. If we can't communicate well and we can't get our ideas across, then we're just not going to succeed. You know, our profession is known for being a little rough on each other, and if we could focus more on just the pets and not kind of the drama that we get in there, it helps.

Then we get to a culture [where] we hold each other accountable, and we're able to do so without it turning into an argument. It gives us psychological safety to go into work, but most importantly, it allows us to avoid the one thing that is huge in our profession — the emotional burnout that comes from a challenge from clients who are upset about what's happening with their pet. The natural tendency is to project that, and who's in front of them? Your veterinarian or your technician, and so forth. Then we do it to each other.

And so, if folks really strengthen their focus on emotional intelligence and the training that goes along with it, then that tends to fall away. You see doctors who are long term career, you know, especially [in the] ER 12,13,14,15 years, they learn how to do this.

I have five things. There's recognizing the emotions that you're going through and their impact on you. [Then], how do we control that so we don't get emotionally hijacked on things that we shouldn't? [Next] is recognizing that in other people. Then the fourth part is helping them navigate through there so it's not taking them into a dark place. The fifth is putting all that together.

EQ training is probably the most effective thing you can do to advance your career. You can be brilliant at medicine, but if you don't have good emotional intelligence training, you won't succeed. Or, let me rephrase that: it's not that you won't succeed; you just won't be exceptional at what you do because you have to communicate with others and get along with them.

Christman: As someone who was a vet tech and went on to become a veterinarian, I was always enamored by my mentors on the amount of trust that the clients had with their veterinarians. As a vet tech, I’d say said to the doctor “I want to be able to have that special sweet spot that you have when they come in. They give you a hug. They just go ahead and do whatever they consent because they trust you.” And I feel like some new graduates now have a little bit of hard time gaining client trust, and some of that boils down to communication. So, what communication techniques do you find are successful for that?

Coronado: It boils down to some of the prior things we talked about. Specifically, the emotional intelligence.

Like you, when I started my career, I was in a general practice. Our scheduled appointments for the day were posted on the cupboard, and they were color coded for people that specifically requested you. And of course, as I came into of my career, I had none of those, and I just got the overflow. There were doctors that were there forever who also had very few people that would request them. But then there were the stars of the practice. They were completely colored, their whole schedule. And over time, I started getting a lot of color in there. I think the big thing is [that] you just really have to be honest with the clients, don't judge them, don't give them the feeling that they're less than because they can't necessarily afford what you're trying to recommend for their pet. Just be open and tell them, “I'm going to tell you everything I think we need to do, and I'm going to give you the why.”

I think part of the problem I see a lot of doctors run into is they're afraid to go in and say the why. They just say, “You need to do this.” Or they're too technical in their jargon. I think when doctors become uncomfortable in a situation or are not sure what exactly is going on, they're afraid to admit they don't know. They get a lot more technical, and it's kind of a defensive measure. I like to use analogies to put things in perspective for the client so they understand it from the standpoint of, “We're in this together.”

Too many times, it's kind of a back-and-forth model — [the doctor] recommends something, [the client] declines, and the tech going back and forth with different estimates. That's like a used car experience. There's no value in that for that client. You have to believe in what you're presenting and do it with them.

I've got several analogies that I use. One of them is the windshield analogy — I recommend all the diagnostics to the owner and just say, “You have to look at what I'm recommending like cleaning off your windshield in a snowy environment. You have a bunch of snow on your windshield, if you just do the bare minimum, just clean off a little spot, we might get where we need to be safely, but there's a heck of a lot of risk. There's a lot that go wrong because we just don't know what's happening here. The more of the windshield we clean off, the more diagnostics we do, the more we know, the safer it is to proceed. It still may not turn out the way we want, but there's a much better chance of a good outcome because we know more and it's much safer to proceed. We just need to figure out together how much of the windshield we can clean off today. It's putting things in ways that [clients] can understand without making them feel less than or not as intelligent. You have to be open and a little bit vulnerable to say, "Hey, I do or do not know, but I do know how to figure out how to get there.”

Because of the challenges we have with presenting estimates, that's a form of conflict. Our doctors don't like conflict. Our techs don't like conflict, and ironically, our doctors often put it on our technicians, or sometimes our front staff, to present those estimates. They don't necessarily have the net medical knowledge to help put the force behind why [the client] should be doing this, and the explanation behind it.

So be open, communicate, and don't be afraid to admit that you don't know. Also, don't be afraid to refer. Like, “This one's out of my league, I need to send you a specialist.”

Christman: If you could give every new graduate one piece of advice for not just surviving but thriving during their first year and beyond, what would it be and why?

Coronado: It's your career and nobody else's, so it's up to you to take control of your career and optimize all the things we just spoke about. Do the CE and explore emotional intelligence training. Do the things your associates aren't doing. That's what's going to differentiate you.

But the big thing is, don't wait for somebody to hand something to you. You go get it. That's the biggest thing I would say — if you just wait for the magic to happen, wait for someone to hand you a practice to buy, it's just not going to happen. It's your job to do that in a healthy way so you don't burn any bridges while you're at it.

So that that would be the big thing — take control of your career.