Movin' On Up

I may have left some readers hanging at only #2 of the Selecting a Veterinary Internship series and I know the VIRMP match decisions were due earlier this month, so I deeply apologize. Life has gotten away from me in a good way.

One positive consequence, was that I have created a much sleeker website where I will continue to post to my blog, but the overall goal is to also have pages specifically for current and prospective students where internship data and other information will be available. It is in its infancy stages, but nonetheless I will begin posting new blog entries to that site as of...today 12/30/13.

http://veterinarybrainstorm.wordpress.com/

Please check it frequently as changes will be occurring over the next year with loads of new material in the works.

Veterinary Internship- Selection Tips #2

2. Decide academic (university) vs. private practice internship.

• If you are considering a residency program, I would strongly consider an academic internship over a private practice.  That being said, some private practice internships have good residency placement percentages, just be sure to inquire diligently.  Speak with current and past interns and ask the internship director about  residency placement rates.
• In order to obtain a residency, it is highly advised that you publish a paper or two during your internship year. In order to accomplish this task during an already busy year, you will need a supportive environment with research-oriented clinicians.  This is very typical and can be easier to find at a university. In addition, this task is not always possible in a private practice situation due to the volume of the case load. Some of the specialists likely entered private practice to focus on clinical work versus research-based work, so not everyone at a private practice will be interested in conducting a great research project that will make for a great publication.
• What is the day-to-day difference?
• Academia: lower case load, less individual case management/responsibility, building contacts (aka recommendation letters) in academia, typically more rounds, and journal presentations than private practice.
• Private Practice: higher caseload, more individual case responsibility (typically from the start), less educational rounds (this will vary greatly by hospital), some have less time for elective rotations. 

Note: In a private practice internship, it can be trickier to defer your student loan payment.  It can be accomplished but may require more research and paperwork, then if you complete an internship with a university.  Contact your loan provider or student financial aid office for more information, as these policies change.

Veterinary Internships Part 2- The Selection Process

Finally, one my biggest projects for my website and blog has been completed. I hope this will be a great information source for 3rd and 4th year veterinary students considering an internship. Since the post is long, I will post it in 10 separate weekly blog entries.  If you need any advice sooner, please contact me or post a comment. Without further aideu, I bring you:

How to Choose the Right Internship Program- Step One:

So you have reviewed Part One and decided that you do want to pursue a veterinary internship. Fantastic! So how do you go about selecting one from the large pool of internships? Here is my top 10 item list that should help you select the program that is right for you.

1.  Decide VIRMP vs. a program not included in VIRMP  match program.

• VIRMP aka Veterinary Internship and Residency Matching Program aka the match is the formal program for internships and residencies. It does have requirements in order for hospitals to be listed in the program, including specialist rotations, educational rounds, etc. The organization, however, does not rank the programs or conduct inspections of the programs to my knowledge. They do have good descriptions of past programs and a checklist of a variety of program components, such as case load, # surgeons, etc.
• Get familiar with this site asap. http://virmp.org/
• There are programs, some very reputable, that are not in the match system. Some clinics have had bad luck with how the ranking system works and have chosen to have internships, outside of the match. Make sure you either know someone who completed the program, or have a chance to visit, since there are no minimum requirements for these internships. 
• Note: If you are doing an internship to obtain a residency I would stay within the VIRMP.

An aside: How does "the match" aspect of VIRMP work?

Some will say it is voodoo and luck. Others, like myself, believe in the system. Basically you rank the programs you like in order of most liked to least liked (see below- never rank where you don't want to go!) .  The program then also ranks candidates from best fit to worst fit and the computer system matches the candidate to program using that information. I was one of the lucky ones that was matched at my first choice. This means that my first choice also ranked me as a top choice.

Additional Reading on Women in Leadership

The following is a recommended reading list based on the Harvard Busines Review Spotlight Section on Women in Leadership:

• Women and Leadership: Defining the Challenges, by Robin J. Ely and Deborah L. Rhode. From The Handbook of Leadership Theory and Practice.

http://hbr.org/product/women-and-leadership-defining-the-challenges/an/6144BC-PDF-ENG

• "Impossible Selves: Image Strategies and Identity Threat in Professional Women's Career Transitions," by Herminia Ibarra and Jennifer Petriglieri

http://www.insead.edu/facultyresearch/research/doc.cfm?did=18696

• "Taking Gender into Account: theory and Design for Women's Leadership Development Programs," by Robin J. Ely, Herminia Ibarra, and Deborah Kolb

http://www.insead.edu/facultyresearch/research/doc.cfm?did=48085

• The Feminine Mistake: Are We Giving Up Too Much, by Leslie Bennetts. 2007

• Lean In: Women, Work and the Will to Lead, by Sheryl Sandberg. 2013

• Nice Girls Don't Get the Corner Office: 101 Unconscious Mistakes Women Make That Sabotage Their Careers (A NICE GIRLS Book), by Lois P. Frankel. 2010 reprint

Note: You may want to join the LinkedIn group: Women's Veterinary Leadership Development Initiative (WVLDI). They post some interesting articles and have an active discussion board. Also a networking opportunity!

If you have a good article feel free to post a link in the comment section. Ideas welcome. 

Women, Business, and Veterinary Medicine

First off, I apologize for not having a new post sooner. A lot of my ideas require research, and among training for my pet insurance presentations, transitioning into my new role as clinic manager, and life, I have not had much time.

The September 2013 edition of the Harvard Business Review had several articles regarding the current state of women in business. For those readers that are thinking, "but I am a veterinarian, not a business woman (and I know you are out there)," I would beg you to keep reading. This type of thinking is just not the case, and is part of the problem. Multiple employment statistics for the veterinary profession have shown that male veterinarians earn more than their female counterparts. Some of this discrepancy has been attributed to practice ownership; more men than women own their own practice. However, this fact does not explain the entire discrepancy.

In addition, market research on clients has shown that many clients will spend more if recommendations are made from a male veterinarian.  The question we need to ask ourselves in this female dominated field is why? There should not be a glass ceiling in a primarily female profession.

There is a newer concept entitled, second-generation gender bias, that helps explain why the glass ceiling may be limiting our profession. Some key points of this concept are:

• Women are not being deliberately excluded, but do have consistent under-representation in leadership roles.
• Women tend to form (or not form at all) weaker informal networks, and therefore are less likely to have a mentor than men. Men tend to see other men as more likely to succeed than other women and will deliberately seek those men out to form a mentorship-like relationship.
• In our culture, masculinity and leadership are linked and traits include decisiveness, assertiveness, and independence. Women are expected to be nice and caring. Numerous studies show that women leaders are competent, but less likable than their male counterparts. The same behaviors that we expect from male leaders, can be construed as arrogant or abrasive in women. If women leaders attempt a feminine style of leadership, they tend to lose respect; a catch-22.

Results of this gender bias on practice ownership:

• We had previously believed that women wanted to have a family and this is why they were not practice owners, but this may not be the only reason.
• Ownership opportunities are being offered to men over women due to their ability form networked relationships. As a result, women are not asserting themselves or showing their practice owner they are interested. 
• Women also feel that they are not business-savy or are not competent to own a practice. Studies have shown that men will apply for jobs, which they are not qualified for. Women, on the other hand, will not apply unless they know they qualify completely. As a result, men may be buying into practices earlier and more often in their careers than women.

Results of this gender bias on treatment plans, client communication:

• When women veterinarians present a treatment plan/estimate to the client, they risk being too assertive and "out for money." On the contrary, they may also come across as not assertive enough and give away services for free. In addition, they may not be insisting on what is best for the pet and empathizing too much with the owner's desires versus what may be medically necessary.

As a profession we need to understand these inherent biases in order to change them. It will help our profession financially and as a female-dominated profession we can help alleviate some these biases in society and the workplace once we are made aware of them.

How to Reign in Dr. Google

While the economy may be on its' way out of a recession, many clients are still hesitant to spend their discretionary income. These financial challenges, coupled with the availability of information on the internet is hurting veterinary clinics, both emergency and general practice. Clients will Google many diseases/problems prior to bringing their pet in. Often they will explain, "well I googled it and I got so worried I came in right away." Unfortunately however, more often they will explain, "Well on Google it said to wait a few days..." For better or for worse, many people choose Dr. Google first and their veterinarian second.

http://rebloggy.com/post/lol-art-google-tech-facebook-cartoons-technology-superheroes-illustrations-justi/29120689494

So how do we as doctors and as a profession combat the ease and affordability of the internet? Communication, as usual is the key. Here are some resources to consider:

1. Partners for Healthy Pets-  the face of the Partnership for Preventive Pet Healthcare^™, a committee of the non-profit American Veterinary Medical Foundation that was created to ensure that pets receive the preventive healthcare they deserve through regular visits to a veterinarian. This alliance of more than 20 leading veterinary associations and animal health companies is committed to a vision of improved overall health for pets.

Partners for Healthy Pets supports the mission, vision, and objectives of the Partnership through the provision of tools and resources that enhance the overall vitality of pets and veterinary practices, the delivery of preventive healthcare services, and communication with pet owners
about the value of routine care.

Our Goals: We are dedicated to helping veterinary professionals provide the best preventive healthcare by:

• Addressing the increasing prevalence of serious diseases and the declining health of our nation's pets
• Enhancing pet owners' perceived value of preventive veterinary care
• Ensuring regular veterinary visits become the norm
• Increasing the understanding of the veterinarians's central role in the health and happiness of pets
• Making increasing preventive healthcare of cats a priority

http://www.partnersforhealthypets.org

2. Direct clients to some good websites/resources, before they start searching.
At their first visit hand them a resource list for reputable websites. Some of the ones I like include:

• http://www.veterinarypartner.com/- run by VIN with approved content this a great, free resource for clients
• Let clients know they can call with questions anytime for free. You may even consider setting up an email account that either a technician or trained client service representative runs and answers in 48 hours.
• http://www.njveterinaryblog.com/-  is run by Ocean County Veterinary Hospital in New Jersey and has great articles on pet health care.
• Direct clients to your state VMA (veterinary medical association). Many of them have great client resources. 
• http://azvma.org/displaycommon.cfm?an=7

3. Encourage clients to purchase pet insurance and wellness plans. Studies have shown that clients that subscribe to these programs, see their veterinarian more often. By increasing office visits, we ensure their pets health and have time for communication.

4. The simplest answer is to warn clients. Help them understand that while the internet is a great resource, nothing can take the place of a physical exam of their pet. 

Veterinary Nutrition Myth 4

Myth 4: Raw meat diets are healthier.

•          There is currently no scientific evidence to suggest that the benefits of a raw diet outweigh the potential risks.
•         Potential risks of a raw meat diet include: gastroenteritis (vomiting and diarrhea) from high dietary fat and/or bacterial infection from Salmonella or Clostridium, sepsis, and fractured teeth from large bone fragments.
•          Up to 44% of commercial raw pet diets are contaminated with Salmonella, which can be shed in feces and cause disease in pets and can also be transmitted to humans.

     While yes this is what our pets would eat in the wild, they were not our pets then. They lived shorter life spans and no one worried if a bone got stuck in their throat causing airway obstruction or esophagitis. We do and these diets are not the best for our pets who we wish could live forever.

So what should you feed your pet?

The best resource for nutritional information is your veterinarian. Your veterinarian can consider your pet’s current health status and lifestyle to offer the most appropriate suggestions on selecting a brand and type of food.  Veterinarians have access to the latest nutritional research and will select a pet food company based on: where the food is manufactured, the company’s quality controls, and whether the company conducts research to make continued improvements to their diets. Veterinarians are trained professionals with your pet’s best interest in mind.

 

Surf the internet, but don't rot your brain

Do you ever feel like time gets lost while watching s sitcom or surfing the internet aimlessly? I know I certainly do some days. As I am internet researching for my blog and my career, I have found that having a plan seems to be helpful in avoiding the aimless searching. Try making a list of what you want to accomplish and give yourself a time limit to get it done.  90 minutes to 2 hours is usually a good block of time. It is reasonable amount of time to block off your schedule, keep your focus and get something done.

That being said if you want to escape why not do it productively. I found this article (link below) helpful about 13 websites that will make you smarter.

https://www.openforum.com/articles/9-websites-that-will-make-you-smarter/?extlink=of-syndication-sb-p

Sitcoms are there to entertain and help you forget your day, the internet can serve that purpose too and may even make you smarter.

Veterinary Nutrition Myth #3: False- animal byproducts=poor quality food

Myth 3: Avoid Animal Byproducts, it means poor quality food.

•         The American Association of Feed Control Officials (AAFCO) that oversees pet food ingredients defines a meat by-product as “the non-rendered clean parts, other than meat, derived from slaughtered mammals.”
•          By-products in pet food are animal organs, such as liver, lungs, bone that the animal would likely ingest in its wild state and are higher in essential nutrients and palatable.
•         Hooves, horns, teeth, hair, feces, and roadkill do NOT constitute “meat by-product.” These elements are not included in high quality pet food.
•          If you are against animal by-products, than you should probably avoid Fido’s favorite raw hide, pig ears or bully stick, as these items are by definition by-products.
•         Inclusion of these animal materials also reduces waste by allowing the entire animal to be used for the nutrition of humans and pets.

The Client's Perspective

Working in emergency small animal medicine, we ask every client to sign a CPR/DNR form when the patient is admitted to the hospital. For those that do not know it is a consent that if the animal goes into cardiac or respiratory arrest, do they elect euthanasia or that CPR be performed.  This form is a blessing and a curse. It allows us to act on the clients behalf for the pet.  There are times though when it can be a very frustrating document.

Sometimes the owner will become very emotional about this form (especially if the pet is sick), and it can hold up the treatment process. Sometimes, the owner has limited funds for treatment and diagnostics, yet will request CPR. Many times owners do not understand that, unlike in people, statistically only 2-5% of animals that arrest walk out of the hospital.

This morning two of my own fur babies were dropped off for a dental and I had to sign this form. I quickly realized how hard it must be when a pet is sick (especially critically ill suddenly). In an already stressful situation the client is told that their pet could arrest, and by the way do want to euthanize or have CPR performed. Today, I struggled myself with what I wanted to do. In the end, I decided on CPR because they are very healthy and the one time CPR is typically effective is when arrest occurs secondary to anesthesia. My cats made it through their dental unscathed, but I have a new appreciation for the horror that come with filling out the DNR form.

This experience will make me more mindful in the future of how to approach this form in a way that can make the client's more comfortable. Sometimes it is important to put ourselves in our clients' shoes in order to evolve our profession and become more empathetic. Time to brainstorm how...

5 Myths of Veterinary Nutrition- Myth 2

I know many people out there have been eagerly awaiting the second popular myth of veterinary nutrition today. So without further adieu:

Myth 2: Grain-free is the way to be.        

• Many grain-containing diets are comparable in nutritional profiles to grain-free diets. Many grain-free formulations use tapioca, pea, or potato in place of corn meal or oats. However, potato and tapioca often contain less protein and more sugars than grains themselves, such as corn meal.
• Grains are an uncommon source of food allergies- see above under the corn myth for more information.
• Diets that contain grains do not automatically lead to obesity; any diet if fed improperly can contribute to obesity. Many grain-free diets are also calorie dense, and as a result can contribute to weight management issues.
•  Low carbohydrate diets have not been proven to be of benefit in diabetic dogs, nor have they been proven to cause diabetes mellitus in dogs.
• It is important to focus on the overall dietary quality and the overall nutrient profile versus concentrating on an individual ingredient. Unfortunately, it is difficult to assess the nutritional profile due to current minimum label requirements. (Which is why your veterinarian may be your best resource on choosing a diet!)

·        Overall, grain-free may be the right choice for your pet if your dog has an intolerance to grains or a need for a low carbohydrate diet. But remember, that grain-free diets do not necessarily offer health benefits over grain-containing diets.