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Monday, December 31, 2012

Facing Setbacks In Vet School

Time to close out the year by closing out my inbox.  Here's an email from Rachel....

Happy holidays!  I am a 25yo 4th yr vet student in Kansas.  I have only recently discovered your blog and find it an enjoyable respite from the 24/7 stress at a teaching hospital.

I have not always wanted to be a veterinarian, but there was never a moment I could not admit that animals were fascinating to me.  The past 3.5yrs have not been kind or easy.  But I made it to 4th yr despite the challenges.

My previous rotation was anesthesia.  I did not pass the rotation.  I readily admit that pharmacology has never come easy to me, ever.  And I am allowed to continue on with my last year here, finishing up with repeating anesthesia after graduation.

My question for you is did you ever face a similar challenge, this far along in your journey?  This upset has made me question if I am the person for the job, the work.  The doubt makes continuing on with the rotations, ICU duty, and emergency shifts almost impossible.  Job searching seems like a fantasy, as I won't be able to gain licensure until all my transcripts are received.  The transcript for repeat anesthesia won't be available till August/September due to academic bureaucracy.

How did you keep going, moving forward?  I would appreciate any words of wisdom.

Veterinary school is extremely difficult.  Learning how to detect, diagnose, and treat diseases is complicated and requires a lot of hard work and knowledge.  This is compounded with veterinarians because the physiologies and anatomies of the different species can be quite different.  Not everyone can make it through the process and not everyone that does make it did so easily.

I graduated in the dead middle of my veterinary class, right at the 50th percentile.  I never failed a class, but I got several Cs and some of those were only by the skin of my teeth.  Some classes and rotations were much easier for me than others due to my interest and the complexity of the subject.  None of it was easy.

It frustrated me to see some of my classmates seeming to breeze through the classes, especially the ones that maintained a 4.0 average.  Yes, I probably could have studied and worked harder, but I didn't exactly goof off.  So when I was struggling and one of my friends aced a test I felt pretty down.  And Rachel, pharmacology was difficult for me as well, and was one of my Cs.

While I didn't fail anything, one of my classmates did.  In our third year he was doing very poorly and was placed on academic probation.  His grades continued to stay low and get lower, so after discussions with the Dean and administration, he agreed to stay back and repeat the third year.  I can't imagine how he felt, watching his classmates advance while it was well known that he had failed and was lucky to still even be in school.  It must have been depressing and discouraging.

So what happened to him?  He made it through school and went on to be a very successful veterinarian in Las Vegas.  I've talked to him a couple of times over the years and he seemed to be happy with where he was, and I knew he had done well for himself.  Despite his challenges and setbacks he overcame and followed his dream.

Rachel, the road ahead is not going to be easy for you.  You first have mental and emotional struggles to face, trying to overcome your own sense of failure.  But keep in mind that you failed one class, not your whole education.  Once you graduate nobody is going to care what your grades were or how narrowly you may have made it through school.  If you've done well in your other classes you can succeed in this.  It's going to be difficult and you're going to have to work even harder to make up this class.  You'll also be delayed in getting your first job.  But now that you know your areas of deficiency you can spend the next several months preparing yourself.  In a way you have an advantage over your classmates because you know exactly what you're facing and what you need to do to perform well.  Spend all of your spare time (little though it may be) becoming an expert in anesthesia.  You have the time.

As far as your other rotations, start cracking the books.  If this is really your dream, cancel any social life or fun and spend all of your time studying and preparing.  Yes, this has hit you mentally and makes you doubt yourself.  But you can make the choice right now.  Are you going to throw in the towel, or are you going to dig your heels in and work even harder?  Sometimes when you have a hard time seeing yourself walking down the entire road, switch your focus and concentrate only on the next step.

On that note I wish everyone a blessed and joyous new year!

Friday, December 28, 2012

Finding God's Will

I don't often blatantly discuss religion on this blog (that's what my other one is for), but I also don't hide that side of me.  My faith in Christ guides just about everything I do, including my work as a vet, and that will come out from time to time.  So I received this email from Rachel:

I am so glad to have come across your 7/24/11 post called 'God and Veterinary medicine'. I have a pressing question which I know only God knows the answer to, but I wanted to open it to you for honest insight... 

My name is Rachel and I'm a pre-veterinary student at the moment, after having graduated with an unrelated bachelor's degree a few years ago. I don't know how to put my passion for helping animals into words that don't sound cliche. I want to help and heal them to my highest ability, which is why I changed my course and returned to school in pursuit of a career as a veterinarian. At the time when I made this decision, there were many signs that this is the way, and many wondered why I hadn't chosen this path in the first place. Simply put, I'm crazy about God's animals, and to see them ailing brings me to my knees.

I have always believed in God, but only a few weeks ago I fully accepted Christ into my life and my relationship with Him is growing everyday. Before, I admit to being guilty of putting animals above humans - honestly, I was people-fearing, even loathing. After reading the Bible, I realize that as a follower of Christ, I cannot live or think that way - we must love one another as Christ does. I heard a sermon not too long ago that said once you accept God into your life, He does with your life as He pleases, and He will take/make you far from who you think you are, and you certainly may not like it at first. 

Thinking of this brings me anxiety, panic, and confusion, because not long after, a thought came to my mind (from me or God, I do not know) that I should be a human doctor, and specialize in oncology to be exact. I don't know if this was God talking to me, or me messing with mind trying to stir up anxiety again (not uncommon). I feel that everything that has happened for me in the past two years - volunteering, participating in veterinary mission trips abroad, meeting wonderful contacts in the field, finding inspiration in the veterinarians I have followed - all of these things I feel were/are blessings from God. They all came to me at the right place and time; coincidence is impossible. I enjoy and am fulfilled when I help people day to day, but animals have been in my heart, as are many other God-given passions and talents, since my beginning.

Perhaps it is God trying to tell me that I need to balance myself out and dedicate more time to helping people in need? This I can believe. I have merely just begun my walk with God and I am just starting to learn more about Him. Of course I want to always say 'Yes' to God! He knows what is best for us. I can only hope it was a silly 'what-if'  thought that came to mind. Now I can't help but worry as I continue my studies that I am displeasing God, and being selfish for pursuing what I love. I have prayed about this, but nothing is yet clear to me. 

I am coming to you because I trust your honest insight, and I am sure you understand more about God's character than I do right now. What are your thoughts?

First I want to say that I'm not an expert on God, just a devoted layperson who makes mistakes and still sins.  I'm no better than anybody else, so take any of my advice with a grain (or three) of salt.  And I can't say that I understand more about God....I'm still trying to figure a lot of it out myself!

God is not the author of confusion.  That's the domain of Satan.  But we as fallible, sinful humans can mess with our own minds without the Devil's help.  I've certainly had plenty of doubts and confusion of my own and have doubted what God wants for me, yet I don't think Satan is behind all of that.  We have our own free wills, and that includes the freedom to doubt.  But if you're moving in a direction that God wants, Satan can certainly intervene and muddy the waters.

I agree that too many people put animals over humans.  Humans have a special place in God's creation, and though animals are special they are not on the same level as people.  I do believe that animals have emotions and can show love and devotion, but that alone doesn't place them above or even equal to humans.  In Genesis God gives Adam (and therefore all his descendants) authority over animals.  But that doesn't mean that we can do whatever we want to them with impunity.  God still wants us to take care of His creation.  Animals are there for us to be able to use, but also for us to act as caretakers.  That is a big responsibility and ties directly to those of us in the veterinary profession.  But no matter how much I love animals, I firmly believe that any human has more value to God than any animal.  As a follower of Christ, I need to mirror that attitude.

Rachel, I can't tell you what God wants from you, even if I knew you.  I would first recommend finding a local pastor, priest, or other spiritual leader that you respect and with whom you feel comfortable.  Talk to them and ask them to pray for you.  Also spend daily time with God, praying and above all listening.  I think that too much prayer time is spent with us talking while God wants his turn to speak to us.  Be quiet and focus on His will and His presence.  Read the Bible daily and get to know His character.  You'll find great wisdom in His words that will help you understand what He wants from you.

Think about where your true passions and interests lie.  When I think about human medicine I get a bit weirded out.  I find things related to humans rather disgusting and could never imagine myself being part of that, even though I deal with the same things on animals.  I also don't feel a burning desire to help people in this way.  God has never given me a heart or passion to be involved with human medicine.  That's not me being selfish, that's just how I've always been.  God creates each of us with innate talents and interests, even before we turn to Him.  He creates us to do certain things, even if we may not realize it at the time.

He did the same thing with you, Rachel.  If you feel strongly drawn to human medicine and oncology, start to look into that.  Perhaps volunteer at a hospital where you can work with cancer patients.  If you feel your heart crying out to these people and wanting to be around them, then consider switching your path.  But if you feel uncomfortable and nervous in this situation, it may not be right for you.  If you go into human oncology you can still help animals by giving to charitable organizations and volunteering at shelters or as a foster parent.  If you pursue veterinary medicine but still feel that God wants you involved with human cancer patients you can do something similar, volunteering at a hospital or with hospice, or giving to cancer research foundations. It is possible to have a passion for one thing but still help out in another area.

Both veterinary and human medical schools will stress and tax you in ways you can't imagine.  Both are worthwhile pursuits, but you should be sure of which one you want to pursue before starting.  Spend more time with God, listen to Him, and find a local pastor to help you.  I hope that some of my words may also help, and I will pray for you.

Friday, December 21, 2012

A Dog's Night Before Christmas

In a couple of days I'm going away with my family to the Tennessee mountains to have some private Christmas time away from the rest of the world.  Just me, my wife, and our kids having some quality family time.  So no new blogging for about a week, though I hope that most of you will be enjoying your own families rather than reading my little corner of the Internet.

I wish all of you a Merry Christmas and Happy Holidays!

The Night Before Christmas graphic produced by Pet365 and Dogorama. Click here to view the original post.

Wednesday, December 19, 2012

Vet + Dad = Pressure

Regular readers of this blog should remember the loss of my daughter's rat, Adara, a few weeks ago.  That was a tragic day in the Bern household and my little girl was distraught for several days.  We added a new rat, Princess Leia, and my daughter's heart was healed.

Leia always seemed a little odd compared to most rats.  A little withdrawn and less active.  However, rats have different personalities like any animal, so I chalked it up to that.  I hadn't handled her much after the first day or two, relying on my daughter to let me know if there were any issues.  

A week ago my wife surprised all of us by actually holding Leia.  This was a momentous occasion!  She had always been averse to rats and never even wanted to touch one.  I made sure to take pictures to celebrate.  But when we had Leia out I noticed that she seemed a bit thin.  She was being fed and my daughter is a very responsible pet owner, so I knew it wasn't due to a lack of care.  I made a mental note to check on her more often.

This evening I went and checked on her.  I became worried when she was thinner than the last time I held her.  She was also making some snuffling sinus-related sounds.  I went into vet mode and started really looking her over.  Besides being thin and having upper respiratory sounds she was dehydrated.  And though she was active, she didn't seem exactly energetic.  Then I looked at her mouth and noticed a problem.  Her upper incisors were missing and her lower ones were severely overgrown to the point of pushing into the roof of her mouth.

I couldn't believe that I had missed that.  If a sick rodent came to see me in my office I would examine the mouth as part of a routine exam.  For whatever reason I hadn't done that on my own daughter's pet and it was almost disastrous.  I should have done a quick exam when we first got her at the pet store.  The little thing had been gradually suffering for weeks, not being able to eat or drink enough, and I had missed it.

At times like this it's really hard to balance being a vet and being a father.  If it was a client-owned pet I would have some degree of objectivity and could have handled it.  But this was the pet of my own 10 year-old girl.  She had just lost a pet that she really loved and I was worried that the same thing would happen with Leia.  Of course my daughter came upstairs while I was trying to handle it and I had to figure out how much to say and what to do.

I think there is more pressure in a situation like this than with a client's pet because it's my own family and my own child that is affected.  My wife and kids know that I'm a vet and expect me to be able to take care of our pets.  I have to play double duty as doctor and father/husband and if I fail in the first part I worry that I've failed in the second.

I feel lucky that I caught the problem with Leia before it went any further.  I trimmed her teeth and when I put her back in her cage she began drinking and drinking.  It was encouraging to me because it meant that she was better enough that she could start replacing the lost fluids.  If I had a bag of fluids and syringes at home I would have given her some subcutaneously.  The hole in the roof of her mouth is pretty deep and likely is at the point of going into the sinuses, so tomorrow when I go in to work I'm going to get antibiotics.  I'll also have to keep her teeth trimmed monthly, but I can do that from home with a Dremmel tool.  

If she responds well everything will be okay, though she will need more maintenance than an average rat.  If she doesn't do well I'll have a heartbroken daughter.  I'll keep my fingers crossed and hope that I caught the problem early enough.

Being a dad and a vet at the same time is tough!

Monday, December 17, 2012

Veterinary Christmas Wish List

Seth emailed me with the following question.  I was a bit surprised, because in over four years of blogging I haven't been asked this and honestly haven't thought much about it.  

Question please, What do vets want for Christmas? I have been dating vet who own's her own practice and I am trying to think of things that a vet would want for him/herself but may not necessarily buy. Is it a super sweet stethoscope or otoscope? If so which one? Is it something else cool and different? What would you want to get for x-mass? I am a computer guy so, while I minimally understand and appreciate the business end of being a vet, I am pretty clueless about this end of things. Looking forward to your response.

A gift for a vet doesn't have to be specific to veterinary medicine.  In fact, I prefer gifts that have nothing to do with my profession.  I typically ask for action figures, cool geeky t-shirts, books, DVDs, and so on.  The gifts I want generally revolve around my non-veterinary interests because by the time I get home I want to be Chris, not Dr. Bern.  But that's just me.

Personally I wouldn't recommend getting a practical piece of equipment.  First of all, you may break your budget.  A high-quality stethoscope will cost $100-200.  Otoscopes and and other instruments can go higher than that.  If you have that money and want to spend it on her, great.  But just be aware of the costs involved.  Since she owns her own practice she probably already has those things, and if she needs more it becomes a business expense for her and therefore a tax deduction.  It would also be tough for you as a non-vet to pick just the right thing that she wants, as there are many technical issues and preferences that you wouldn't be easily aware of.

Lastly, and forgive me if I'm being a "guy" here or sexist as it's not intended, you're talking about practical gifts.  In my experience a woman really doesn't want gifts like that for gifts and birthdays, despite what the commercials make you think.  Would you give her a new, fancy vacuum cleaner?  What about a set of kitchen utensils?  Probably not.  I know that my wife certainly wouldn't want those as gifts since it's not really "special" and just has to do with day-to-day household tasks.  A stethoscope would be the veterinary equivalent of a vacuum.  It's something you need and a good one does a much better job than a cheap one, but in the end it's a tool and not an object to cherish.  Now if the object was specific to her interests, that would be a different story.  For example, if the kitchen utensils had Mickey Mouse or Tinker Bell my wife would be very interested in them.

So what to get her?

Start with her likes and dislikes.  Depending on what she wears and uses in work you can find medical-related gifts that may show those interests.  For example, I have a scrub top that has "Starfleet Medical Academy" and the logo printed on it (from Star Trek for you non-geeks).  That kind of thing would be a great gift for someone like me!  You can find scrub tops and cloth surgical caps with all kinds of prints and patterns, such as sports teams, animals, cartoon characters, and so on.  There are stethoscopes and stethoscope covers that you can also find with different prints.  Those stethoscopes are an acrylic mold and have a bell on one side, so she may not like that style.

Does she have a favorite breed of dog?  You should be able to find a business card holder that has that breed on it.  Or you can find a desk set with a theme that she likes.  My wife has a Tinker Bell desk set that includes a business card holder, stapler, tape dispenser, paper clip holder, and so on.  I have a similar kind of set that is a Pirates of the Caribbean theme.  As a practice owner I'm sure she has a desk, so that is something that is practical for her to use daily yet can show some fun and personality.

If you want to get her something to use in her practice, get sneaky and question her staff.  They will know her day-to-day pattern and usage better than anyone else.  Her assistants will know if she loves or hates her stethoscope, or if she has dreamed of a fancy electronic one (very pricey but very cool!).  The staff will know if she has a favorite kind of coffee or snack.  They'll know what equipment she's always talking about or what is breaking down in the place.  If they've worked for her for long they'll also know a lot about her personality as a vet.  All of that can help you figure out the gift.

But in the end remember that she's a woman and a person before she's a vet.  She has interests outside of veterinary medicine and may have more passion in those areas than in her job.  Don't limit yourself to a gift related to her profession if she really might like something else.

So what about all of you veterinarians and vet students who read this blog?  Am I on the right track or are there vet-specific gifts you're dying to have?  If this was your boyfriend, would you want him to get you a veterinary gift or something else?  I'd love to hear your comments!

Seth, this is a GREAT topic, and I'm really glad you wrote it!

Sunday, December 16, 2012

Unwavering Belief In Santa

How about we talk about something a bit more hopeful and upbeat!  I think that after Friday's events in the US we could use some whimsy.

My son is 11 1/2 and my daughter just turned 10.  They have an absolutely unshakable belief in Santa Claus and the Tooth Fairy.  It's actually to the point where I'm not sure if even we as parents can convince them otherwise!  Just this week my wife decided to "test the waters" and told them that it was really her and me who bought the presents.  The kids didn't believe her!  They said that the presents from Santa were too expensive for us to be able to buy, so they must come from him.

My wife and I really believe in fostering imagination and wonder in our children and each other.  With all of the darkness that can be in the world we want to be able to see corners of light and brightness.  We don't think that belief in these things contradict our religious beliefs and instead add a more magical and supernatural aspect to the world than we see in the news and media.  We have actively continued to talk about Santa, the Easter bunny, the tooth fairy, and others.  And the kids don't know that we scrimp and save for the Christmas presents as well as look for sales, specials, and other good deals.  We really don't have much extra money, but we want to spoil our kids a little and save for that goal.

A couple of months ago our daughter wrote a letter to the tooth fairy that I responded to.  That started a series of written exchanges between our kids and the tooth fairy which firmed their belief.  Similar things have happened with Santa and Jul Tomte (the Swedish version of Father Christmas/Santa).  A couple of years ago the kids tried to leave a video camera out to tape Santa to prove to their friends that he existed.  Thankfully there was an auto shutoff so that plan didn't work.  Last year our daughter literally cried when once again we were out of the house when Jul Tomte came to visit.  This year we have enlisted a friend of ours to come and play the part.

This is actually becoming a bit of a problem for us as parents!  As our kids are getting older we are struggling to find ways to deal with their increasing perception, intelligence, and persistence.  It's getting harder to find ways to get around their attempts to discover and meet these mythological beings.  And the kids are convinced that Santa can get anything, no matter the cost, so their wish list gets more advanced and expensive.

For us it's a bit of a catch-22.  We know that at some point the truth will come out and at their age may be sooner rather than later.  Heck, it would be a lot easier for us in many ways if they knew.  At the same time we really enjoy a bit of magic and charm in our kids lives.  They will have plenty of time to learn about the harsh realities of life. We want to give them magical memories like I had.  We want them to have a childhood and not grow up too fast.  

In fact, I think this world could use a little magic, whimsy, and fun.  There is violence, tragedy, sadness, and hardship all around us.  There are so many reasons not to smile or laugh.  If people could see the joy in the world, especially in the joy of things we can't directly see, there would be more happiness.  And if more people were happy, there would be less strife and anger.  A bit simplistic?  Perhaps.  But not all problems need a complicated answer.

One day soon our kids will learn the truth.  But not yet.

Friday, December 14, 2012

Evil Is In The World

There was a senseless tragedy in Connecticut today.  If you've been under a rock and haven't seen any media (at least here in the US), a demented, evil person walked into an elementary school and shot to death 20 children and 8 adults.  We may never know the underlying reasons for his murderous rampage, but nothing in his past could ever excuse such a horrible act.

Think about the parents, family, friends, and other children for a moment.  These children had gone to a normal day of school like so many million do every day.  Newtown is a small community, not what you would ever consider as prone to such an event.  This could happen in any school in the country.  The timing could hardly be worse as we are 11 days away from Christmas.  That means that in all likelihood presents were already bought for those who were murdered.  They may actually already be wrapped and under the tree at this moment.  What must it feel like to find out your child has been killed at their school in a mass shooting, then go home and see the present you bought for them wrapped neatly and awaiting eager hands to open it Christmas Day?  

I heard about the news when I got into my car after having watched The Hobbit with my wife and two children.  My kids are 10 and 11, close to the age of those who died.  I can't imagine having to face what these parents are going through.  As I was running errands my wife was watching the news reports on TV and crying.  My son came in and saw the newcasters talking about the shooting.  "Mommy, why would someone do that?" he asked her.

How do you answer something like that?  Because I don't think anyone has a good answer.  There is absolutely no reason to explain why anyone would murder like this.  Nothing except evil.

I am a Christian and fully believe in Satan as a real entity.  I believe in demons and I believe in pure evil.  Now, I don't think everything bad that happens is due to demon-possessed people.  Humans are quite depraved enough in their own souls to perform heinous acts by their own inner evil and don't need external help.  But I also know that Satan does try to influence people both directly and indirectly.  The only excuse for murdering children in this manner is pure evil, whether internal or external.  And though this may somewhat explain the behavior, it in no way gives credence to it.

We are seeing and hearing more about things like this in modern times.  Remember the shooting at the midnight showing of The Dark Knight Rises in Colorado this year? There have been others like that in malls, schools, and other public places.  Such mass shootings often make individual murders seem trivial and go unnoticed by the public at large.  But the killing of even one person is a tragedy to those that love them.  Is the sorrow of a parent who has lost their child in a car accident any less than that of one of the parents in Newtown, Connecticut?  We need to remember and pray for everyone who is going through such hardships, not just the ones affected today.

So what can we do?  First of all, put politics aside.  Though I'm a political and social conservative, I really don't want to hear about the arguments for or against gun control on a day like this.  We're not going to solve the problems that lead to tragedies through laws or lack thereof.  The root cause of these evil events is in the heart, not in the legal or social system.  Today if I see a politician using this tragedy to promote their own viewpoint I would want to go up and slap them.  This isn't about politics.

We need to change hearts.  We need to embrace love.  No, I'm not going all "hippie" on you, and I don't believe in the kind of "tolerance" that the American political Left promotes.  We need to have a society that is based on morals and that embraces supporting each other rather than dividing ourselves.  Even just in my lifetime I've seen a breaking down of the family and an acceptance of things that really shouldn't be allowed.  All in the name of "tolerance".  I'm sorry, but there are many things in our society that we should not tolerate. By having a relativistic point of view we no longer tell people that something is "right" or "wrong".  And that leads to a belief that nothing is wrong.

Of course, as a fairly fundamentalist Christian (though non-traditional since I'm also a geek), I'm going to talk about the need for God.  As we have pushed God out of school, business, and the public eye we have also gotten rid of our moral yardstick and the sense of something holy.  We have lost our reverential fear of our Creator and the consequences of our actions.  The idea of loving enemies and supporting those in need seems so far away in much of today's society.  I actually feel sorry for those who don't have Christ in their lives, as in times of tragedy He is the perfect person to go to and rely on.  I know that God wants to comfort the broken hearts, if only people will let Him.  And if more people followed the example of Jesus, we would have fewer events like happened today.

Sorry if I've rambled today.  This entry is a bit more free-form than I usually do, and I plan on leaving it that way.  The events today made me think more than many things I hear on the news, in part because the children killed could have been friends of my own kids.

Stop right now and pray for these people and others like them around the world.  Then immediately find or call your own children, hug them if you can, and tell them that you love them.

Thursday, December 13, 2012

Owning A Practice No Longer The Dream

I've never wanted to be a veterinary practice owner.  That may be a shock to some people, and I've even argued with some of my staff who think I should go out and open my own clinic.  When I was in veterinary school in the mid-90s it was an unspoken almost certainty that any of us becoming small animal general practitioners would eventually open their own practice.  That was just what veterinarians did!  And historically this has been the case.  Owning a practice has never appealed to me because I don't enjoy the stress of the business side of things.  In my current practice I do manage the location and am partially responsible for profitability and performance, but I also don't have the specter of failure hanging over my head.  They way I've always looked at it is if my practice went bankrupt I have the skills that I could find a new job in a few weeks.  But if it was my own personal practice that went bankrupt it would affect my mental health and personal finances in a more serious and deep way.  I also have some flexibility in being able to move and leave my current job, which I wouldn't have as a practice owner.  Sorry, just not for me.

It appears that I'm not alone and perhaps was ahead of my time in vet school.  In the most recent issue of DVM Newsmagazine there is an interesting article on practice ownership.  Over the last six years there has been a very dramatic move away from owning a practice.  In 2006 53% of those surveyed said that owning a practice was one of their aspirations.  That decreased to 43% in 2009 and to 30% in 2012.  So 70% of practicing veterinarians have no desire to open or buy into a practice!  Before you say "Well, that's because there are more women as vets and they aren't as interested in business," let me share another statistic from the study.  Thirty-two percent of women and only 27% of men said that they wanted to own a clinic.  So there is no real difference between genders.  This is an overall trend across demographics.

The article points to several reasons for the change, and I would agree with them.  It's mostly about work-life balance, where vets no longer want to spend 60+ hours per week building and running their clinic.  They also don't want to have the hassles of doing a job (business manager) for which they were never adequately trained.  More and more vets simply want to be a doctor and enjoy that aspect, yet don't want to do anything outside of that job.  In fact, when asked what their greatest professional fear is, respondents overwhelmingly indicated "lack of balance in career/personal life", with 43% of people chosing it as their top concern.

High costs of doing business is also a big worry.  US and global economies aren't very good, and that makes it difficult to have a successful business in any field.  The article says that to open a successful stand-alone practice can cost around $3 million.  With burdensome debt loads fewer vets will find themselves in a position to build or even buy into a practice.  Newer vets are finding it hard to simply make ends meet, let alone have the finances to invest in their own clinic.

So what does this mean for the future of the profession?

First of all, this is a serious problem for existing veterinarian practice owners who expected to sell their clinic to fund retirement.  In just six years we've gone from over half of veterinarians wanting to own a practice to under a third.  There simply aren't people who are in a financial position to buy a practice or even want to.  I feel bad for those older vets because their "investment" in the practice likely won't pay off as much as they had hoped.

Like always happens, I firmly believe that veterinary medicine will adapt.  We are already seeing growth in large corporate practices such as VCA and Banfield Pet Hospitals.  But smaller corporate practices are also becoming more frequent and larger. Rather than being national, such vet clinics can be regional over an area, state or a few states.  This model of practice allows the business to be managed centrally by those with the skills and desire to do so, taking the risks and burdens off of individual veterinarians who can then concentrate in being doctors.  I don't think that we'll ever get away from single-owner clinics, but the numbers clearly indicate a very strong shift away from this idea.  And I predict that the trend will continue and will be the "new normal" in the profession.  It makes me glad that I decided long ago not to go the route of ownership.

Wednesday, December 12, 2012

Working "Blind"

Vets have to deal with many problems in their daily careers.  Some of them deal with life-or-death situations or serious complaints from clients.  Some problems are annoying or silly.  And some are just plain frustrating yet you can do little about.

For the last few years I've worn contact lenses to work.  It started as a way to avoid having to wear glasses when I'm doing costuming at sci-fi cons like Dragon*Con.  However, I discovered that I liked not having to worry about my glasses fogging up when I have a surgical mask on.  So most of the time I work with my contacts and leave my glasses at home.  Normally that's not an issue.  But it was today.

I'm not a morning person.  Or, as my wife puts it, "'Not a morning person' doesn't even begin to cover it!".  So as I'm getting ready for work in the morning I'm still pretty groggy and don't really wake up for at least an hour.  On a typical day this is not an issue as I've always been this way and know how to cope and handle my routine.  For some reason this morning I missed the fact that one of my contacts fell out.  This is not unusual as I'm a bit of a doofus when it comes to putting them in, but I normally notice when one doesn't go in well or falls out.  Not so today.

So I'm at work and I can tell that my vision is a little blurry.  At first I thought I was still waking up, but the problem didn't go away.  Then I thought I was getting a migraine, which will sometimes happen.  But it didn't really feel like one so I went into the bathroom to try and take out my right lens and try to clean it.  That's when I discovered that I had nothing to take out! 

All day I've been dealing with it.  Thankfully I can still see well without corrective lenses, though edges are a bit blurred.  I can even read up close without contacts or glasses, even if the letters are somewhat fuzzy.  So I'm not completely blind.  But I'm not used to trying to see without anything other than my natural vision, so it can be a strain.

No, I don't typically keep my glasses with me as a backup (though I really should).  I also work about 35 minutes from home, so I don't have time to easily run home to get the glasses or a new contact.  So I just have to put up with it and get through the day.

Yes, even vets have to worry about minor problems like this.  We're just as human as the next person.

Thursday, December 6, 2012

No Money, No Options, No Luck

Earlier in the week I mentioned a specific case and someone in the comments asked for details.  I was planning on posting about it anyway because it illustrates a very difficult situation with which we are sometimes faced.

Last week we had another area clinic call us about one of their clients, apparently because we are a large practice with several area satellite locations.  The client had a dog that was suspected of having an intestinal foreign body and they didn't have any money.  Care Credit had declined them and they were hoping that we might be able to help out with our charity donation system.

Quick aside....My practice has a fund that clients can donate to and for which we do periodic fundraisers.  We use the money in this fund to help people that really don't have the money to treat their pets for a serious condition.  To make sure that the truly needy get this money we have means testing, have to make sure that they have first applied for and been declined for Care Credit, and the client must contribute at least a little money to the care.

The client came to us for more information, bringing the dog.  We quickly learned that their combined monthly income was above our required threshold and we couldn't use our funds for them.  I examined the dog as a courtesy and talked to them.  The dog was a sweet American Stafordshire terrier and seemed depressed even though I had never seen him before.  The client said that he was known to chew on and eat objects around the house and just last week they had found a pair of underwear in his feces.  On his exam I noticed that he was uncomfortable when I put pressure on the upper right part of his abdomen.  This can mean pancreatitis as well as something obstructed or inflamed, so with the client agreeing to a minimal cost we did a quick test of a pancreatic enzyme.  This came up normal and considering his history I had to conclude that there was a very strong likelihood that he did indeed have something stuck in his stomach or small intestine.

Normally if we suspect a gastrointestinal foreign body we want to start with x-rays.  Softer objects blend in with the surrounding organs so cloth may not show up well.  In these cases we do a barium series, forcing the pet to swallow a non-toxic metallic liquid and taking a series of x-rays to watch the passage through the digestive tract.  A basic set of radiographs costs around $175 and a full barium series is around $450.  

In a case like this I would be willing to just jump to surgery as long as the client understood that we were taking some risks by not having a definitive answer beforehand. A very simple intestinal surgery costs around $1100-1500.  If we have to remove part of the intestine or there are any complications it can quickly top $2000, not including any overnight stays at an emergency clinic for monitoring.  If they went to a specialist they could easily pay over $4000 for the same surgery.

As I talked to the clients I learned that they both worked and had no money.  From the conversation I gathered that they had had their home foreclosed upon and their cars repossessed.  They were truly in dire needs with no funds. I truly felt bad for them and for their dog.  But there was nothing we could do to move forward with the surgery.

"Well, then you should have done the surgery!  If you really loved animals you would just do it!  You should worry about payment later!"

That's a nice sentiment, but it doesn't work out that way.  Remember that this client had no money.  They had such poor credit that they had been declined a credit line, meaning that they were unlikely to make regular payments.  Our clinic does have a charity fund but we limit it in certain ways to make sure that money isn't given out too often, thus depleting the fund for people who truly need it.  In this case we only had $2000 in the fund, which if used would have prevented us from helping anyone else for a while.  There was also no guarantee that the dog would survive surgery

As I've mentioned many, many times, we can't give away services, especially expensive, risky ones like this.  If we did that we wouldn't be able to stay open.  "But this was a special case!  You should have made an exception!"  To the pet owner, every case is special.  It's hard to say to someone "well, we made an exception in the last case but we can't do it in yours."  If everyone was an exception we'd run out of operating costs and have to close our doors.

These cases are heartbreaking.  It's times like this that I really wish I didn't have to worry about the money.  But the utilities companies, drug companies, and my employees aren't going to be very understanding if I say "I'm sorry but I can't pay you this month because I helped out a few clients who were in need and I'm short about $4000."  My power would get shut off, the distributors would stop selling to me, and my employees would quit.  I have to pay other people, so I have to expect people to be able to pay me.  Believe me, profit margins in veterinary practices aren't high and we're not rolling in dough.  It's not being money-grubbing, hard-hearted, or anything else that I'm sure my critics will throw at me.  It's simply part of the reality of life.

I offered euthanasia but the client wanted to take him home that night.  I never heard back from them so I don't know if they found money, had the dog put to sleep, or he died.  My heart really does go out to them.  Sometimes bad things do happen to good people.

Tuesday, December 4, 2012

Starting A Vet Clinic

My last post on Jennifer's email was actually not her main point in writing, though I thought it was certainly worth commenting on.  Here is the last part of her email to me....

My question to you is... what do you think the average expenses are to set-up a private practice? I have figured to start off having 1 vet tech and 1 receptionist and the salary/health benefits etc. But I am not entirely sure of what equipment is needed. I want to have the practice at my home and do house-calls also, so I wouldn't be adding the cost of rent. I know that kennels will be needed,but am having difficulty finding what items are important and what can be added later on. I know some vets coallate with universities for testing or refer to bigger clinics when they are a smaller practice.

I will have to plead some ignorance here, as I've never started my own veterinary practice and don't plan on doing so.  I'm comfortable working for a multi-location veterinary practice and managing one clinic.  I'm sure I could be successful at it but I don't have an entrepreneurial spirit.  Therefore my comments will be based on second-hand knowledge and I'll rely on my readers who have gone this route to chime in.

Jennifer, before starting your own practice I would first look hard at the finances of practice, talk to a veterinary consultant, and get some business classes under your belt as I mentioned in my last post.  If you're planning on opening a practice you should work for someone else first so that you're not learning how to be a business owner and a doctor at the same time.  Get some veterinary experience and learn what the day-to-day running of a practice will be like.  Then you can consider opening a practice.

It's also not going to be as easy as you might think to practice from your home.  First of all you may not even be allowed to do that depending on local zoning laws.  You will need to check with your city and county courts to see if you are allowed to start this kind of business from your home.  Even if you live in the country this may be prohibited and you can get into a lot of trouble by just doing it.  You'll also need to do modify your home.  Most states have strict laws on the facilities of a veterinary practice.  You may need to change your lighting to provide the right lumens.  If you're going to do surgery you will have to have proper ventilation systems installed, as well as a surgery suite.  You must have non-porous surfaces that can be disinfected.  You'll need to make sure you don't have any carpet where parasites and diseases can be harbored.  Depending on the age and setup of your home you may have to rewire the house, knock out some walls, and do other major renovations.  None of this will come cheaply or easily and you'll have to get inspected during the process with a veterinary inspector giving final approval.

Let's assume that you've succeeded in all of this and have a part of your home set aside as a veterinary clinic.  You said that you want to do house calls, which is a completely different situation.  I've been on some house-calls and it's not as easy as you might think.  If you just take some supplies you'll be very limited in what kind of services you can offer.  You will also need to consider bringing a staff member along to allow you to give injections and collect lab samples.  Most owners can't restrain effectively, and if they get injured while restraining their own pet in a veterinary situation, YOU can be held liable for their medical bills, lost wages, etc.  

Let's say that you want to be able to do most services on a mobile basis.  In that case you'll need to bring a lot of equipment with you and will need to invest in the proper storage system for your vehicle, even if you don't have a complete mobile clinic.  The most recent issue of Veterinary Practice News has a cover article on being a mobile veterinarian.  This would be a great article to read.  One section lists equipment that you should consider having:

"Practitioners well-versed in mobile veterinary care offered up some suggestions for medical and diagnostic equipment that every vet on the go should consider owning:
  • Digital scale
  • Blood pressure monitor
  • Traveling centrifuge
  • Portable ultrasound machine
  • Portable digital X-ray
  • Thermography camera"

What about lab equipment?  That will depend on what kind of practice you want to have.  Nowadays most veterinary clinics have in-house blood analyzers.  Yes, you can submit your samples to a major veterinary laboratory, but you may have to wait until the following day before you see the results, delaying your treatment.  In serious cases you'll want the basic answers right away, as waiting 12-24 hours could result in a severely worsening condition.  Radiology equipment is also pretty standard in modern veterinary medicine and not having it can significantly limit your practice.  Most clients would prefer to be able to get all of their services in one place and won't like the idea of going somewhere else for routine lab tests or diagnostics.  If you're going to concentrate on only preventative care you won't need much of this, but you'll also have a harder time being profitable and may not practice the kind of medicine you want.

You also may not want to start a veterinary practice in your area.  As the adage goes, there are three important things in real-estate:  location, location, location.  Your home and particular location may be too far from potential clients or too close to other vets to be successful.  It's recommended to hire a veterinary consultant to analyze your area, including demographics and average salaries.  This analysis can help determine if you really should start where you are or go somewhere else.  Having a practice out of your home to save rent and because it's convenient may sound nice, but it may also end up in bankruptcy if it's not a good place to start a business.

So the bottom line...what does it cost?  From my experience a small, simple, full-service veterinary practice needs around $200,000-300,000 to begin.  Some of my colleagues who have done this may be able to give a different number.  I know it's not difficult for a stand-alone practice to cost $500,000 to $1 million in construction, equipment, and other start-up fees.  Unless you've won the lottery you'll have to get a business loan, and a bank or other loan agent will want a solid business plan in hand as well as some reasonable assurance that you know how to manage a business before they will free up that kind of money.

So adding education and start-up costs, you're looking at having around $300k-400k of loans to pay back.  And now you're starting to see why a $50 office visit charge isn't so unreasonable.

Jennifer, my biggest advice to you is what I said in my last post.  Talk to a consultant.  Take business classes.  Work for a vet and learn what it's like behind the scenes.  Mentor with a vet who will walk you through the business side of veterinary medicine.  Right now I don't think you really understand what being a vet and a business owner is really like.  You can get that education before you get to that point, which will either deter you from that career or help you be more successful.  Either outcome is in your best interest.

For the last two entries I've talked heavily about the business side of being in veterinary medicine.  Though this was intended to coach someone through going into the profession, I think this is valuable for the average client to understand.  Vets really do struggle in their business and there really are many more costs and considerations than most people realize.  Loving animals and being a good doctor simply aren't enough to stay in business.  If clients can understand the challenges that vets face in simply keeping their doors open they may be more understanding of the charges that vet has.

Sunday, December 2, 2012

The Harsh Reality Of Veterinary Charges

Jennifer sent me this email, and since she is planning a career in veterinary medicine I thought it would be a good discussion for her and others to read.  I also think that my veterinary readers will be able to chime in with their own thoughts.

What really persuaded me to go back to school and begin my career in this field was that my previous vet charged me $1600 to neuter and spay 2 labrador puppies. An INSANE amount. She had been our vet for years, but had always bartered services with my parents (whom own a business and lived next door) When I became an adult, I wanted to be responsible for my own. Never did I ever imagine it would cost me almost two thousand dollars within the first 6 months of owning and caring for my first two puppies. I did not ask what the costs would be prior because most clinics charge $100 and I figured $300 max for private practice. When I picked them up and was told the balance for the day, I almost had a heart attack. How in the world could someone charge that much and justify it? But apparently, it's legal. I paid, being 19 and not really having a clue about contesting things. When I went home and told my mom, she flipped out and called the vet. She justified it with the cost of the surgery, providing medication, the cones, and other miscellaneous items. So, we decided to seek out a new vet. I found one close by, made an appointment for a check-up and yearly vaccines. The vet visit for each animal (I had 4 total, my 2 dogs and my parents' 2 dogs) was $50. And then rabies vaccine for each was $50. I really don't see how that could be justified either? I could understand $50 per visit for your entire pet family, and then each individual vaccination. Anyway, point of the story is, this made me decide to become a veterinarian.. NOT to make a fortune, but to prevent this. I love my dogs as if they were my children, and I now own an alpaca farm. If I had to pay $100/animal per visit, I would need a second income just for this. Many people cannot afford this and can barely afford to seek our medical attention for themselves. I really want to provide care and not turn anyone down.

Jennifer, I certainly appreciate your desire to help pets and their human families.  I'm not intending to be harsh or to discourage you, but I also think that a bit of a reality check is necessary here.  If you go into business thinking that your office visit charge will be $50 for an entire family of pets and design your pricing structure to match, I will predict that you will go bankrupt within a year of business.

Let's look at pricing of spays and neuters.  First, you need to determine what you're going to include in your packages.  Are you going to do spays with injectable anesthetics (ketamine, Telazol, etc.) and no monitoring?  Then you can get away with charging $100, but you will be taking sizeable risks with your patients that could be avoided with the right care.  Do you want to be a high-quality vet who is going to require pre-anesthetic blood testing, ECG, pulse-oximeter, IV catheter, pain medications, and safe gas anesthesia?  Then you're going to have to charge $300-400.  In fact, I read an analysis a few years ago on the "true" costs of a spay if you were doing the high-quality care and monitoring currently recommended.  That surgery should really be $600-800.  Similar surgeries such as removing bladder stones can cost $800 or more, yet are performed similarly to a spay and may not take any more time.  Admittedly I am a bit surprised that your vet averaged $800 for the two surgeries, as that is far above the typical cost to clients.  However, that is what the surgery should be and the only reason more vets don't charge that much is because spays and neuters are often shopped by clients looking for the best deal.  But I will promise you that there is no way that you can charge $100 and have the same care and services done by the vets doing a $800 or even $300 spay.

Let's look at the office visit charge.  Here in Georgia I have a $40 office visit charge for the first pet and $30 for each pet after that on the same visit.  And my practice is very average in our charges.  I know local practices who charge up to $60 for an office visit.  New Jersey has a higher cost of living that this area, so $50 for an office visit is not unreasonable.  If you compare this to human medicine, veterinary office visits are about 1/3 to 1/2 of what our human colleagues charge just to walk in and be examined.  Since most people only pay the copay they don't understand the true charges at their own doctor.

There are many, many charges that go into operating a business.  First and foremost you have to charge for your time.  Yes, this is actually the single most important thing you have to offer...your knowledge and expertise.  If you are an average veterinarian you will have $150,000 in loans to repay, which means a few thousand dollars per month.  That doesn't take into account your own salary and trying to cover rent/mortgage, food, car, etc. As an employer you also have to have both liability insurance for your clinic as well as worker's compensation for your employees.  You will likely have to cover health insurance.  Social Security tax?  Half of that comes from the employer, not the employee.  You will have rent and utilities on the building.  You will have salaries to pay.  You will have malpractice insurance as well as insurance on your building.  You will have a ton of expenses in equipment and facilities.  A single blood analyzer can cost over $10,000.  There will be far more cost than you realize.  If you don't charge appropriately you will quickly go out of business.

What about the dog who swallows a sock and will die without surgery?  Yet the client can't afford to pay more than your office visit?  You're looking at around $1000 or more for a simple surgery of this kind.  Will you turn that person away or will you do it anyway and just write off the cost?  That's not an unreal situation, as it's one I specifically faced just three days ago.  If you treat everyone regardless of their ability to pay you'll be losing money left and right and will go out of business quickly.

Jennifer, it's very admirable that you want to help everyone, not turn anyone away.  I also appreciate that you want to make things very affordable.  But inexpensive prices mean you're going to have to cut corners or eliminate services.  You can't have a high-quality veterinary practice and charge $100 for a spay or $20 for an office visit.  In order to charge the prices you want you may not be able to be the kind of vet you want to be.  Your dream may not be compatible with reality.

I would strongly recommend a few things.  First, take a basic business economics class at a local university or community college.  You're not going to get any of that in vet school and it may really open your eyes.  Find a vet that is successful and practices the kind of medicine you see yourself doing, regardless of how much they charge.  Ask to mentor with them and have them concentrate on teaching you the business of veterinary medicine.  Also, start reading Veterinary Economics magazine online or get a free subscription.  This journal discusses the financial and business side of the profession and will give you a lot of good information.  Lastly, consider paying a veterinary consultant for an hour or so of their time just to give you an idea of what you're going to have to consider when starting a practice.

Most small business fail in the first two years of existence, including veterinary practices.  The main reason for going bankrupt is under-charging and not understanding how to run a business.  With some education and pre-planning you can have a better chance of being successful.