Thursday, February 28, 2013

The Readers speak!

  1. OK, one reader speaks. The rest of you slackers, feel free to chime in any time. Our reader Jenna commented so eloquently on our previous post, we obtained permission to repost her remarks here as a separate blog post. 

    From Jenna:
    It's convenient to blame the current generation's parents for encouraging to follow their dreams, no matter how unrealistic, or the current generation, for expecting "someone", whether that be the government or Mom and Dad to bail them out. 
    You are on the brink of retirement. What do you have to say to someone like me, who graduated over a decade ago? I am NOT part of this new generation, nor am I of their parents' generation. I'm from the group stuck in between, the practice owners who are still paying back loans they once thought were reasonable and manageable. 
    I paid for my first year of veterinary school with savings I'd earned in a job I'd worked for half-a-dozen years before I applied to veterinary school. Unfortunately, I reside in a state with an expensive in-state veterinary school. I graduated with loans around the national average for the year that I graduated. After working for other people and doing my best to absorb all I could from my mentors, I set up practice in a rural community, figuring if I were good, I'd always be able to make a living in large animal practice. 
    I didn't anticipate the economy tanking. 
    I didn't foresee a hefty percentage of my clients leaving the area or losing their homes. 
    I didn't see all those farms being sold for development and paved over to build yet another shopping center or McMansion development. 
    I didn't expect veterinary schools to increase the number of new grads to a point that the number of practicing veterinarians would balloon out of control. 
    I didn't plan on those new grads starting their own practices when they couldn't find jobs. 
    I didn't guess that a huge percentage of those new grads would come from wealthy backgrounds, so they'd own nicer equipment (digital x-ray, etc.) than I could afford unless I overextended myself on credit, equipment that impresses clients but doesn't actually improve outcomes. 
    I had no clue those wealthy young grads would prefer "boutique" work, offering only the profitable, 9-5 services like lameness and "alternative therapies". 
    I didn't know the "retired" large animal veterinarians in my area had never actually given up the predictably profitable portions of practice (basically excluding illness and emergencies) or that a sizable number would come out of retirement when the stock market crashed. 
    I didn't realize the small animal veterinarians who had "retired" from large animal practice were selling vaccines and dispensing drugs to their "good" clients without ever setting foot on farms. 
    I didn't have an inkling I'd lose such a huge percentage of my routine work to lay people (e.g. tooth fairies), internet sales, and human chiropractors and physical therapists. 
    I never suspected that my colleagues, my fellow veterinarians, would find themselves so desperate for a source of income that they'd engage in race-to-the-bottom pricing in order to attract clients, any clients, even temporarily. 
    I banked on my clients' loyalty, only to find that if there are 10 practices working in an area that formerly supported 3, after a certain point this benefits only the clients, not the veterinarians... and after another, later point, this benefits neither group. Everyone loses.  
    Sure, I'm still a good veterinarian, but I am very, very tired of this profession. What does anyone have to say to people like me who did what we were supposed to do: work hard, pay back student loans in full and on schedule, all while providing full-service veterinary care? All this, and I bought a home I could actually afford, and as a result have never missed a mortgage payment.
    I'll soon be closing my practice and going on to a job as a non-practicing veterinarian. I've practiced just long enough that I will remember the good times without forgetting they were far in the past, in a practice climate far different than what I see in 2013. 
    The young people in my life will never be veterinarians, if I have anything at all to say about it. 
    And yes, Lindsay, veterinarians have a suicide rate double that of other high risk professions (law enforcement, military, physicians). I've already lost two colleagues to suicide.

    Jenna, we at VBB central feel your pain. A number of us are in the same situation! I remember my mom telling me "they can never take away your education, and that's your most valuable asset." I'm not sure that's true anymore in this economy!

Tuesday, February 26, 2013

back in the trenches

It's not all politics around here. Yeah, the AVMA is annoying lately with their whole "let's spend $80K on finding out whether we really need a new logo and if so what it should be like" thing. Yeah, there was an article in the NY Times about our profession & its economic issues, and I'm sure that you, dear readers, have noticed that we VBB have strong feelings about these matters. That said - there's more to life, and as we struggle to keep our heads above water and pay down our loans, we are kicking butts and taking names - and sometimes seeing patients.

I had a client call me today to find out whether or not Fluffy needed to continue his medication. Before calling the client back, I went into our trusty EMR and looked up Fluffy's history. I noticed that Fluffy is on Optimmune, and has been on Optimmune for 3 years now. I further noticed that the last several labels printed out for Fluffy's Optimmune all contained the statement "DO NOT DISCONTINUE - CALL FOR REFILL BEFORE RUNNING OUT - THIS IS A LIFELONG MEDICAL TREATMENT!" So, I banged my head on the desk a few times before making that call. It didn't help.

I've been treating a million-year-old Small Fluffy White Dog that belongs to a million-year-old dementia patient. The client's caregiver comes with the dog & the lady to our appointments, thank goodness. Last week I saw the SFWD on a recheck four days after her previous visit which had been with a colleague. When my colleague saw SFWD she'd noted lumbar pain, hind end pain, generalized weakness, and a high white count. She'd started methocarbamol & amoxi/clav. Apparently this hadn't worked so well because when I saw SFWD she was pretty flat. Dehydrated, not eating/drinking, not walking, not standing unassisted, and temp in the range of 104 F. Euthanasia was not on the table that day - you know, this dog is the demented old lady's only real family left, and the demented old lady was not capable of understanding the kindness it would be to release the dog from her suffering, it seemed to me. Certainly the caregiver wasn't about to consent. So, I did some hemming and hawing and ended up giving fluids, and sending SFWD home with mirtazapine and Zeniquin on top of the rest of the stuff. Imagine my surprise to find out today the dog is doing great! Eating, drinking, walking around normally. I just wish I could be sure - is she really better, or is this the sweet spot before they find her dead in the kitchen or something?

Today I also saw a young adult longhaired mutt cat. She was presented by a woman claiming to be the mother of the actual owner, who was a 12 year old girl. The girl was not there. The woman stated that her daughter said the cat had bumps on its skin. She further stated that they had used a Furminator on the cat four months ago, and she'd "been like this ever since," where "like this" equals "practically no hair on the caudal half of the cat." To make a LOOOOOOOOOOOONG story short, there were no significant findings on any of our diagnostics, and a trichogram revealed growth-phase hairs that were broken off rather than normally tapered. The owner did state that the cat had a history of food allergy. In despair, I decided to give 10 mg of Depo-Medrol. I had a discussion with the owner in which I explained that I really wasn't sure what was going on, but that hopefully in the event of allergic or inflammatory condition the steroid would help. Of course I also explained that if there were in fact a fungal, parasitic, or infectious condition I had not uncovered, the cat could get worse. The owner looked at me for a moment and said "ok, sounds good. Either she will get better, or she will get worse. If she gets worse, I'll bring her back for more tests. Right?" "Yes. Either she will get better or she will get worse. I realize that sounds bad...." We all laughed. It was really nice to have an understanding client for a change. I put a lot of pressure on myself to always figure it out up front, to always be right, never make a mistake, etc. This cat just did me in and it was wonderful that the owner was understanding. Here's hoping kitty improves.

Sunday, February 24, 2013

Thank you, David Segal!

Industry insiders have probably already seen this floating around Facebook & Twitter. We've already received several emailed requests to post about it and it's only been published for about a day! Steve, hat tip to you for being the most concise :) It's an article in the NY Times from the Business Day section, by a journalist named David Segal who for some reason has taken pity on our profession and chosen to shed some light on things. Go ahead, click the link and read the story. I'll wait here.

OK. Was that not incredible? I don't know Mr. Segal, but he is to be commended. If you want to share your thanks or give him any additional information, you can email him - there's a link to do so directly from the NY Times website if you click on his name above where it's hotlinked.

I know you can't always believe what you read, even in the New York Times - but Mr. Segal is speaking the truth here, and our upcoming veterinary students and those aspiring to become veterinary students need to take a long look at this story. Here's the link again: High Debt and Falling Demand Trap New Vets.

Read it and weep. Then email it to your friends & family. Tweet about it. Share it on Facebook. We want the Times to take notice that this story has legs!

Tuesday, February 19, 2013

VBB: The Next Generation

As any parent reading this already knows, and non-parents may have heard, kids do unexpected things all the time. The young son of  Dr. VBB is no exception! This morning at 0-dark-30, Dr. VBB said "son, go outside and find that dog of yours. You need to bring her in, before we leave to go to school." The boy enthusiastically bounded outside and was gone for a good bit. After a while, the door opened and in came boy and dog.

Boy: Mom. MOM! DogBehavingBadly puked out there.
Dr. VBB: oh really? Was it food, or just bile? How many times?
Boy: [whips out iphone] Here. Let me show you the video.

I mean, really. Child stood there, and recorded the DBB puking. What does this say about him? What does this say about me? Am I raising him wrong? Not to be all "kids today!" but seriously....

At least when he showed me the video he was able to point out the plant material contained in the vomitus and to postulate that DBB had once again gone empty-stomach-grazing outside. But "and look! I already put it on YouTube!" -- really?


Funny. I might have expected him to come running in yelling "she's womitin', womitin' bad, sorr!" - but I guess times have changed.

Tuesday, February 5, 2013

Getting Crispy Around the Edges

Burnout can be insidious. I noticed the signs in myself today as I prepared myself to call a client regarding the findings on his dog's physical exam. The dog had been dropped off for grooming & my exam had revealed some significant progression of the dog's heart disease. I could hear the conversation playing out in my head before I picked up the phone. I was sure it would go like this:

[ring ring]
Mr. Apathy: Hello?
Me: Hi, Mr. Apathy. This is Dr. VBB from VBB Animal hospital. I'm calling about Foxglove.
Mr. Apathy: Well, I'm at work. What do you want?
Me: As you requested at drop off, I did perform a physical exam on Foxy today and-
Mr. Apathy: Can we discuss this when I pick her up?
Me: No, Foxy needs additional diagnostics and treatments because her heart is-
Mr. Apathy: She saw a cardiologist six months ago. We already did the heart stuff.
Me: well, today she is having trouble breathing and -
Mr. Apathy: I'm not talking about this again right now. I'll discuss it at pick up.

I was so sure I would be having that conversation that I postponed making the call for probably an extra ten minutes. I got myself all worked into a frenzy internally. I'm sure I ground off some tooth enamel. However, after a few deep cleansing breaths I psyched myself up for it. I made the call.

[ring ring]
Mr. RealGuy: Hello?
Me: Hi, Mr. RealGuy. This is Dr. VBB from -
Mr. RealGuy: Doc! How's Foxglove?
Me: I have some concerns, and -
Mr. RealGuy: is it her heart? I know, I was supposed to bring her back to the cardiologist for a recheck in December, but I got so busy and she seemed fine. Is she in trouble now? I feel terrible.
Me: well, I think her medication needs some tweaking. I'd like to go ahead and give her some extra diuretics today, but I do want her to see the cardiologist as soon as possible too.
Mr. RealGuy: I was actually planning to take her next week, but they almost always can get me in same day. I'll call them right now and see if we can go there this afternoon or tomorrow.
Me: Great. I'll have her records ready to go for you.
Mr. RealGuy: thanks doc! See you soon!

I was of course really pleased that my patient will get the specialty care she deserves. I was also really pleased that I had a nice client interaction. I was DISPLEASED by the realization that I am starting to always expect the worst. This bothers me a lot. I don't want to be one of those old and crispy burned out people!! I want to be able to think positive! Or even be like the Whether Man from The Phantom Tollbooth, who said "Expect everything, I always say, and the unexpected never happens!" But to always expect the worst - well, it's draining. Any creative tips on dealing with burnout??