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Sunday, July 20, 2014

Questioning A Veterinary Career Choice

Here's a question from Ingelin.  Though she's in Norway (I love having an international readership!), her frustrations and concerns are universal and really shows some of the challenges for veterinarians world-wide.  I could take out the country references and completely believe that she is here in the US.
I am a Norwegian veterinary student, studying in Budapest, starting on my 5th year this fall.
I am currently - and have been for the last year or so, afraid that I have chosen the wrong profession.
Ever since I was a little girl (yep, as "all the others" also say..), I have imagined that nothing in the entire world would be better than doing veterinary medicine. My love for animals hasn't changed at all - I would almost say it has become stronger by seeing all the cruel things going on in research, labs and especially in the farm industry. Though, i sit here - closer to the goal than ever, feeling nothing but sad and frustrated.
This summer I am doing my practice in, so to say, the only horse clinic in Norway. The past months i have spoken to every vet i could, asking them about their working life and what they have to say about it. As I really really want to do horses, as this is where I feel most confident, I know the horse sport and I have been a horse owner myself for many years, and I feel like this is where I could do best - I have mostly spoken to horse practitioners. In general, most of them tell me: Life is tough. They spend hours and hours working their a**** off, earning nothing compared to what they do. They walk around in horse s*** all day long, one got his arm broken by a horse and a year later his mandibula. Another got her collar bone broken by a horse and actually, just after recovery - her knee got crushed by a horse. One got back problems after just working a year and is now in a lab.
Working 70-80 hours a week, one of them were in a period of 7 years in three car accidents due to driving from farm to farm - being so tired and falling asleep behind the wheel. They tell me that driving around day in and day out all alone without a supporting team around you is very hard. The physical work is tough, the organization of equipment that you need is both expensive and lots of work, all the billing/invoice work is time consuming and you would optimally need some knowledge in economics to do it well, it's hard with customers/owners not being willing to pay, or arguing with you that the treatment is too expensive, and especially as a woman you will meet many tough physical challenges and farmers can be very "oh jesus are YOU gonna do that - I could do it better". Ok, I think you got my point.
Some veterinarians tell me: do an internship straight after graduating, choose exactly what field you want to specialize in and stick to that. (For example not just equine surgery, but equine orthopedics). Others tell me that doing internships is "lethal": the salary is very little, you get to do very little "hands on" if you are at a big clinic with lots of specialists ect, maybe you wont get work in that field when you finish.. Do a mixed practice and learn a bit of everything so you can fall back on things if you have a hard time to get a job. Oh everyone is giving me different advises.

I feel really lost and I would almost say depressed. I have worked so hard to get where I am now and I want to feel nothing but proud and happy. I spoke to my supervisor at the horse clinic today which is on of the only horse surgeons in Norway. I have thought about doing and externship, and then hopefully get an internship, at the horse clinic in Kentucky, which my surgeon professors at my university has recommended me to do. Today my supervisor told me that the need for horse surgeons in Norway are very very limited, and if I want to work in Norway, DON'T do it. He recommended me small animals - but in Norway, believe it or not, the salary for a small animal practitioner is worse than working on the supermarket. Although there are opportunities to start your own clinic, get a good job if you do specialization first etc - so well, there are always options.
So to my conclusion: I have strongly considered changing to human medicine. In one way it makes me feel as an egoistic and cynical person - I always lived for the animals. They give us so much and I want to give back to them. But I see all the advantages as a human doctor compared to a veterinarian. You have a huge support team and always someone to ask, you never have limitations in treatments (so to say), I would have the chance to specialize in Norway and not having to do many more years abroad, you don't have to deal with everything on the economic aspect but can rather focus on your own profession, and you actually get paid for the hard work you do, which I think is important to a certain point for quality of life. To a human at least they can understand why you are doing what you are. To an animal however, I get a feeling of hopelessness. I know I am helping of course, but it's like: "hey this is gonna hurt like hell but don't worry it's to help you". They get angry, afraid, frustrated and aggressive, and I have never seen so many unhappy and suffering animals and I never thought it would be this tough. (Not that seeing severely ill people is easy..)

Ok i'm gonna put the finish line here. Sorry for all my thoughts and the very long email, but I would really really appreciate an answer! Maybe you have some encouraging thoughts to share.
Thank you very much in advance.
I thought it was worth printing all of Ingelin's email, as her thoughts, feelings, and experiences are actually pretty common.  I think that any veterinarian or vet student reading this will be nodding their heads in agreement, having run through the same scenarios in their mind.  I also think this is very important for pet owners to understand, as vets aren't sitting on their duffs just counting their wads of cash.  This is a hard, often thankless profession for which we are significantly underpaid for our level of skill and knowledge.
I'm a small animal veterinarian and haven't worked with horses in about 18 years.  I've never practiced on them and have never considered a career in large animal medicine.  But I'm at least basically familiar with that part of the profession and know that Ingelin's experiences are shared here in the US also.  I do think that the typical 70-80 hour work week is gradually going away as we graduate new vets who realize that they can't be everything to everyone, and are trying to have a decent work-life balance.  But it's still long hours.  You often find yourself in creeks in the dead of winter and in shadeless fields in blazing summers.  While most horse vets I've known manage to get away with few major injuries, it is still a much higher risk than with small animals.  There is absolutely the risk of serious injury and broken bones when dealing with animals this large and strong.  It is definitely a physically demanding profession and not one for the faint-hearted.
The business aspect depends on where you work.  Many vets, especially younger ones, are learning the benefits of hiring an office manager to handle the financial side of things.  A solo equine practitioner is in for an incredible amount of work if they do everything by themselves.  But if you get into a practice with a physical location and hire a good staff, you can get an office manager to handle payroll, billing, ordering, invoices, and so on.
Customers not wanting to pay?  Welcome to veterinary medicine!  Certainly you can get a bias against females among some farmers, as well as sometimes an attitude that they know more than you do because they're older and the farm has been in their family for generations.  You won't find as much of that in small animal medicine.  But if you are seeing client-owned animals you will quickly become frustrated with people who can't or won't pay for needed care.  The species of the patient is irrelevant.  I deal with at least a few clients like this every single day that I work, and have for my whole career.  Because pretty much all of animal health care comes straight from the owner's pocket you see them holding tighter to their purse strings than when it comes to their own medical expenses that are generally covered by insurance. 
Animals suffering breaking your heart?  Having a hard time dealing with animals in pain when you can't explain things to them?  Again, welcome to the profession.  It takes a special kind of person to be objective and distant enough to handle sick and injured animals while still maintaining compassion and empathy.  Working in any medical field can be emotionally draining and requires some good mental resilience. 
Internships and residencies are indeed brutal.  If you don't really, truly want to specialize I don't think I'd recommend it.  You make less than half of what you would make being in practice and the hours are much longer.  Should you consider going into a specialized field?  Only if you really have a super-strong interest in that area.  When I was in vet school I spent a few weeks working side-by-side with a board-certified surgical specialist.  He told me that he did make more than a general practitioner, but it took him about six years after vet school doing internships and residencies to reach that point.  For those six years he made about 1/3 of what his classmates made.  His lifetime earnings were going to be no different than a general practitioner due to the significant delay in finally practicing his speciality.
From what I understand in the US, your prospects of finding a good job in equine medicine may be better than in Norway.  It would certainly depend on where you wanted to live and work, as some areas are more under-served than others.  The areas with fewer vets working with horses and other large animals unfortunately tend to be areas where the salaries would be lower and you'd be working hard due to a lack of qualified vets.  But you may not want to leave your home country, especially for an entire career, so this is something you'd have to think hard about.
Personally I could never work in human medicine.  Humans gross me out and I can't handle that sort of thing.  I get feces and urine on me every single day and it's not a big deal.  But the idea of getting human feces on me makes my stomach churn.  Yes, the pay is higher, you have much more support staff, and you get to do more things without worrying about money.  But I'm not willing to make that trade because I can't handle seeing human illness and injuries.  It digusts me and makes me uncomfortable.  That may seem strange to some people, but it's actually a common thing among those in veterinary medicine.
Ingelin, I had to be a downer but you have actually expressed the same frustrations shared by the majority of the profession.  You have expertly described the daily problems we have and why this is not the best profession in the world.  I actually agree with everything you said, as it's true here in the US as well as other countries.  That is the depressing nature and harsh reality of veterinary medicine.
So why do it?
There are moments of greatness every day.  You will meet wonderful clients who think the world of you and will follow your every instruction.  Today we had a client bring us fresh, homemade eggrolls, still warm when she brought them in.  I got to work with some incredible cute and sweet puppies.  I was able to tell an owner that her cat didn't have a blocked bladder and had a treatable infeciton.  I helped comfort a client by easing the passage of their terminal cat.  I got to teach an eager veterinary student.  I can walk out of my clinic today proud of the fact that I helped to change and improve lives. 
It isn't an easy job and I frequently question my career choice.  But I've also reach the point in my life where I can see the joy in the day and be able to smile when I've helped someone.  Would I do it all over again if I had the chance to go back and make changes?  Probably not, except for the fact that I love my wife, family, and faith, and I wouldn't have those if it wasn't for my choices in and after vet school.  I would definitely pick a completely different career.  But I also don't hate my job (most days) and am very content where life has taken me.  It's a good job and I've been successful at it.
This probably doesn't help, and if you go back through the archives of my blog you'll find that I think this is a bad time to try and get into veterinary medicine.  Should you change your career, Ingelin?  It depends on how much passion you feel about veterinary medicine, how desperately you want to work with animals, and how well you can deal with the long hours and low pay.  That's certainly not a simple, easy choice and I don't have an easy answer.