Thursday, December 26, 2013

The Disconnect Has Been Duly Noted

    Greetings from the Midwest branch of the VBB Animal Hospital.  As the New Year approaches, we often take stock of our lives, our livelihoods, and we look for areas to change and improve. That is actually what I have been doing for the past year. Professionally, I have grown cagey and anxious. I am worried about the attacks on my profession, and I have had a growing dissatisfaction with the public. When you get right down to it, there are just more bad days than good ones.

    Because of this, I have started to explore what I can do with my hard earned veterinary degree, OTHER than seeing patients and clients all day. In order to begin to make a career change I have explored positions in both academia and the animal health industry. Surprisingly, what I have learned is that the institutions that produce veterinarians, and the industry that makes medications and products for our use actually have no idea what it is that we actually DO all day.

    After a couple of days of interviewing for a position at one of our nation’s veterinary colleges, I learned that they are extremely hopeful about the future of veterinary medicine and they see a positive, if not completely idyllic future for their graduates. I expressed concern that class sizes are increasing, student debt is rising, graduates cannot find jobs to pay off their loans, and the public is becoming more and more hesitant to spend their money on their pets’ health care needs. Not so according to the universities!!!! Class sizes are increasing because that is in their budget! The increase in tuition adds to hiring additional faculty. More papers are written, more specialists are produced and everyone is happy.  If they are not producing specialists, they can certainly produce general practitioners who will find wonderful, well paid, fulfilling jobs where the public will flock to them with all of their concerns for their well loved and well cared for pets. I was assured that “Things will turn around - You just wait!”  Now, these people with careers in academia are surely much smarter than me, yet I remain skeptical.

    I have also interviewed for a position with a large animal health company.  During a long day of interviews and meeting a variety of people, I was asked questions similar to the following:

Them: “Do you get stressed out having to meet deadlines?”
Me: “uh, no, not really. I have to meet 20-40 urgent deadlines every day”
Them: “Do you have a hard time making decisions?”
Me: “No. I can make decisions quickly. I rarely have owners who allow me to have enough information to make an informed decision, however. It would be like heaven to actually have a fairly full picture prior to having to made decisions regarding treatment plans, recommendations, and euthanasia.”
Them: “You have a very active job currently. How would you transition to sitting at a desk most of the day?
Me: “Are you kidding me?! That would be fabulous!!!! I’m so exhausted by the end of my day that I can barely lift the wine glass to my lips!!!” Well, ok, that wasn’t really my answer, but I think you get the point.

    These experiences have made me realize that there is HUGE disconnect in this profession. The institutions that produce us, and the companies that sell products to us actually have little idea what our day-to-day existence is like. I think they would like to believe that we play with healthy puppy and kittens all day, with appreciative owners who trust us and follow our advice. If this were true, I don’t think we would have the highest suicide rate of any profession. Currently, I feel like I exist in a very shaky house of cards, built on a pyramid scheme.

    So, I go back to doing what I do and try to find joy in it. I look for the things that make me happy, and help me to make a difference to someone. Because occasionally there is that ONE pet, with that ONE owner, who wants to work with me as a partner to ensure that their pet gets the best healthcare possible. And THAT? Well. THAT is nirvana.


  1. I don't know if small-animal vets made a good living 50 years ago, but as someone who has had a lot of cats and dogs for 50 years, I utterly agree with your observation about a disconnect these days. At a time when human doctors can't make the kinds of livings they used to make, vets seem determined to milk as much as possible from the animal-owning public.

    It used to be that if an animal needed his teeth cleaned, it cost maybe a couple of hundred because there were preliminary blood tests and anesthesia, but a tech would do the scraping. Now, at the "newer" clinics, they inform you that a dental "specialist" must do it, that with x-rays and what-not, it will run close to $2K. Seriously? Dentists don't charge people that much. And if a pet gets cancer, they will blithely recommend radiation and chemo even though there is zero chance of curing the cancer, and all you will do is prolong the poor thing's life, which will now be miserable as a result of the treatment. And it will cost $7K. Again, seriously? And we're in a recession. People are becoming homeless, having no incomes, etc., but we're supposed to "love" a pet enough to invest in pointless treatments or ridiculous procedures when we're living in our cars? And we're bad pet owners for being appalled by that?

    We want you vets to make a living...but not everyone prints money in his basement. I spent 7 years without any healthcare (because I couldn't afford it), at the same time spending money I didn't have on my animals. But there had to be limits. When the idiot vet wanted me to pay $2K to clean a dogs teeth, I said no, and scraped them myself. (Drugstores sell dental picks.) No anesthesia, just patience over a couple of days worked just fine. I'm sure my attitude seriously annoyed my former vet because I deprived him of his cut from the specialist, and deprived the specialist of his living. Good. I hope so.

    1. you aren't interested in the veterinary medical advances of the last 50 years. Best to find a vet who isn't interested in them either....they do still exist. I'm sure your former vet would be happy to steer you in an appropriate direction if that's what you want. But be honest and say so plainly. If you pretend you are interested in improved veterinary care when you aren't, then invariably you will be disappointed with a vet who is more current.

      But I suspect that's not really the case. What you really want is the benefit of the advances of the last 50 years, without having to pay for them. You aren't alone. You are a classic example of the disconnect this column is about.

    2. Hildegard, you are exactly the type of client who is causing Doctor Sarcasm to not want to see clients anymore. You and other people who apparently got their veterinary degrees from Dr. Google or know better because you've 'owned animals for 50 years' are what drives over the edge. Scaling your own dogs teeth does not 'work just fine,' guaranteed. See my last post about non-anesthetic dentals. Chemo can help animals go into remission from cancer and radiation therapy after surgery can result in cure. And unlike human medicine, veterinary oncology has no tolerance for negative side effects of chemo, because we want animals to be happy and healthy. There is no point to chemo otherwise. No one is forcing you to spend thousands of dollars on care for your pets, but it is our responsibility to present all of the options, just as it is your responsibility to take the best care you can of the animals you choose to own.

    3. I left practice last year. It was the smartest career decision I've made in a long, long time. Money-wise, it was at best a lateral move, but my salary is predictable. Sure, there's stress. I have a lot of responsibility. Sometimes my decisions don't please everyone. I work long hours.

      OTOH, I don't have to deal with ignorant, POS clients like hildegarde.

      Furthermore, I completely agree with the disconnect between Big Veterinary and the Real World. It's ludicrous. One point you didn't mention: most of those new specialists are planning to work at the brand-new veterinary schools opening over the next few years.

    4. You can still get a standard dental for a few hundred dollars. Did you even bother to look into other options? If you're offered a medical treatment - whether for yourself, your pet, or anyone else you may be making decisions for - you can always say "that sounds too expensive/painful/time-consuming/whatever. What are my other options?" You can also go somewhere else and get a second opinion. Your options are not limited to overpriced professional treatment or inadequate DIY.

    5. When its all said and done, the reason veterinary schools can raise tuition year after year, and veterinary schools keep popping up all over the map, is a steady stream of students who are willing to pay whatever price it takes to become veterinarians. Where there is a demand there will always be a supply. Call it a disconnect, call it unethical, call it what you will, but there are a lot of kids out there who love animals and think that their love for animals is a good reason to become a veterinarian. These same animal loving kids will go on to become veterinarians who run their practices based on their desire to help animals rather than on sound business practices. While I don't necessarily agree with all of hildegarde's comments, as a veterinarian I respect her right to set a dollar amount on what she can afford for veterinary care. As long as she respects my right to set my fees at a level that I feel will optimize my cash flow while allowing me to relieve animal suffering, then she'd be welcome at my clinic anytime. We practice up to date medicine, and make recommendations based upon the best available diagnostics and treatments. However if I can make more money doing 5 dentals a week at $250 each, I definitely am not going to do 1 a month at $2000 just because I think a dental ought to be worth that much! Conversely if I'm seeing 20-40 patients a day and I am burning out, it's okay to raise my fees until I am only seeing 10-15 patients a day owned by clients who value my services. It will mean that fewer pets will receive the best care, and I may end up putting more animals down, but as long as I am ending suffering I don't see a problem with that. It has nothing to do with the quality of my medicine, it's about supply and demand, and until our profession figures that out there will continue to be a steady stream of dissatisfied, over-worked, underpaid veterinarians.

  2. You must be amazingly talented that you could see the terrible dental disease lurking beneath your pet's gumline. Can you come work at my clinic please and save me from idiocy??

  3. And you couldn't be more wrong. We are obligated as medical professionals to offer ALL the options to owners. Some owners DO WANT to spend 7k for chemotherapy to spend up to a year or more with their beloved pets. Just because you don't want to hear about it doesn't mean that the next owner doesn't want the option. I personally would not do chemotherapy on my pet, but I realize that everyone is different and everyone would like to have choices.

  4. This comment has been removed by the author.

  5. Some more depressing reading on how devalued the profession is getting from the southern areas of the world - its an international trend and it makes me reluctant to recommend it to people as a profession.

  6. I am sorry to say that when I am asked to advise someone who is considering vet school - especially parents whose son or daughter "adores animals" and thinks it would be "super-cool" to hang out with puppies and kittens all day - I outright tell them to reconsider that career path. When I tell them about the difficulty of getting into vet school, how you're slapped with an enormous tuition that may take upwards of 20 yrs to pay off, how long and painful work days can be, how often you bring the crap of your day home with you, how sometimes you work for clinic owners who are more concerned about their bottom line than what is best for the patient and the client, and how ugly and unappreciative some clients can be, in the end I wonder myself how I ever stuck with this profession. Thankfully, about 2 yrs ago, I made the best decision ever - to bail the hell out of private practice and start my own in-home service. Whereas I have several colleagues who are trying to extricate themselves from this profession for which they had once worked so hard and so passionately to become a part of, I am my own boss, I have no employees, I make my own hours, I have clients that are of moderate means and upward, and most importantly, they are ALWAYS appreciative of my service. And, in the end, I know in my heart that I am performing a service that is invaluable to every patient, which is ultimately the reason I became a veterinarian in the first place. I am incredibly fortunate to have had the means and the support to make the change, and my heart goes out to those who are in the trenches and have to deal with the bullish*t day in and day out.