Trying to exit honorably

In a prior blog post, I mentioned pursuing a new job opportunity, with more of a management role along with continuing my small animal ER clinical duties. Last week, I gave my notice to my employer, who shall remain nameless. After advice from many friends and professionals, I decided to focus on pursuing the management opportunity as my reason for leaving, and not mention the other issues I was having with the company. Be diplomatic, and don't burn my bridge.

I nervously but confidently, walked in and when asked when I would leave I replied that I would honor my 45 days notice stipulated in my contract. He asked if I could stay on an extra 10 days, since covering shifts can be difficult, and I happily agreed and my new employer was flexible. The next day a company email went out (which I was conveniently left off of) asking to cover my shifts effective immediately and to not let me know.  It even stated that this was because I was going to a competing clinic. I have no proprietary information, and I would have been flexible if he had told me that when we met. He still has not told me of his plan, and feel this behavior was unprofessional and underhanded.

I am sharing this knowledge because sometimes you can do the right thing and it does not matter. My bridge is burned, an ego is bruised, but in the end I am all the better for it.  As for my reaction, I have reneged on my agreement to stay the extra 10 days, but have requested in email for confirmation of my last day as my 45th day since giving notice. Again, the honorable and professional way. No underhanded emails or scare tactics. If I am asked to leave early, well, so be it.

When in doubt, be professional and do the right thing. This profession is small and I am confident that people are taking notice of the right and wrong way to exit honorably.

The Future of Veterinary Mentorship

As you will note in my Veterinary Internships Part 1 post, many veterinary students are seeking internships to gain mentorship and more experience after veterinary school. The big question is, is this economically and professionally the best option?

Another question to ponder is, what defines a mentorship? This question is being heavily researched by the AVMA, AAHA, and other trade organizations. AAHA has devised mentorship guidelines between an employer/mentor and the new graduate/mentee, and a plan or agreement to enforce the relationship. These tools are amazing and useful, however, sometimes new graduates feel comfortable discussing certain topics with a mentor outside of their organization.

As a new graduate myself, I value the importance of having mentors and having mentees. I am enrolled in the mentor program through my state veterinary association, but I feel a disconnect to my mentee. I have never met her and only spoken with her over email twice, mainly to introduce myself. I have been at a loss as to how to offer my support. As a mentee in school, my mentor was approachable and nice, but again we stumbled to find topics of discussion and did not meet very often.

So mentorships are improtant and there are outlets to provide them, so why aren't they living up to their potential.  A new program by the AVMA seems to provide some solution. In late 2012, the AVMA introduced the Compass Mentoring Program in Connecticut. This program has funding and support from the state veterinary association and Zoetis. The funding allows for newsletters and functions. But it is not just money that has led to the success of the program, it is the organization. The organizers send out a newsletter to the participants with useful information, such as communication tools, as well as discussion topics. The mentees feel it is a nice forum to discuss weaknesses, career paths, etc outside of their work environments.  The goal of the program is to have the pair meet up monthly, in-person and the relationship is followed up with participation surveys every 3 months.  Accountability and topics for discussion are likely the keys to the success of this program thus far.

It is wonderful and vital to have a veterinarian you work with there for mentorship as you being to practice.  It is also wonderful to have contacts outside of your hospital to create a more open forum, free of judgement.  For example, what if you are unsure you are in the right practice and you want to discuss it with someone who has more experience and objectivity?

I hope that the Compass program will be expanded through the AVMA, and/or that more state veterinary associations will adopt a more formal approach to their already existing mentorship programs; our new and old graduates only stand to benefit.

Please see https://www.aahanet.org/Library/Mentoring.aspx for AAHA mentorship guidelines.

Veterinary marijuana- Taboo or to do?

Veterinary marijuana?
NewStat | California veterinarian campaigning to legalize pet medical marijuana

Recently in the most prestigious veterinary journal (JAVMA) there was a news article (see links above) about the use of marijuana in veterinary medicine.  With the legalization of marijuana in 2 states and medical marijuana admitted in 16 states, it is likely to become a hot topic. In addition, our four-legged family members are living longer, and in turn, developing diseases like cancer and arthritis. Pets with these diseases could benefit from the positive effects of marijuana.

As an emergency clinician in Arizona, I have seen my fair share of marijuana toxicity cases. For the most part, animals recover with low mortality, moderate morbidity. However, signs are dose dependent and the animals do not look happy when they are "stoned." They can have seizures, cardiac changes, temperature abnormalities, blood pressure changes and tend to have a glazed look, dribble urine, and can be very sensitive to light and touch.

So if this substance is toxic to pets, how could it help. Well it would need to be at the right dose and given by the right route. There is apparently a glycerin tincture that is sold in some licensed medical marijuana dispensaries currently in California.  Testimonials from clients and some veterinarians is that it may help, in cases where more traditional pain therapies (tramadol, gabapentin, NSAIDs) did not.

Veterinarians that have seen these beneficial effects do not want to prescribe it for all cases. They do believe, however, there is a need to investigate marijuana further to determine that case reports are not seeing placebo effect results.

The problem is that pet owners are not patiently waiting for the scientific evidence, and if they have access to medical marijuana they may try to give some to their pets. Some owners are trying the drug on the pets for separation anxiety, appetite stimulant, irritable bowel syndrome, in addition to palliative pain treatment. There are testimonials that topical cannabis oil is used to treat skin tumors. Owners do not understand dosing a pet is different from humans, and that medications can affect animals differently than they affect humans.

Veterinarians who are on the forefront of this movement agree there is enough justification to study the potential effects. The problem is what companies/institutions will finance this research? Perhaps as medical marijuana becomes legal for humans, and a company capitalizes on that they will support veterinary-related research as well.  Until that time, I would urge veterinarians to become comfortable talking with clients (especially in the medical usage states) about the possible toxic effects and the lack of research. Client education is key. As a community, we need to consider developing a consensus statement and hand out to be prepared when clients ask us our thoughts; or, when they do not ask and we suspect they are treating their animals without medical advice.

Kudos to JAVMA for bringing up a controversial topic that needs a responsible medical focus going forward.

Time to Turn Another Corner

As you become older, you realize life is all about decisions- both big and small. This is probably why many children want to be older; they want to make their own decisions.  Then you grow up and wish someone could tell you what to do. Oh the irony of life.

I am Type A, as many of you are too if you are engaged in veterinary medicine. I like the timeline of life to be neat and tidy and make sense. Through the last 2 months I have realized that life does not always want to be neat and tidy and you have to throw that desire out the window and become comfortable with change.

I have recently decided to switch employers for a career opportunity to become a clinic manager in addition to the duties of an associate veterinarian. I struggled with my strong pull toward loyalty to my employer and my fear of becoming complacent in my career. In the end, I chose to further my career. The decision seems straight forward now, but at the time I was trying to make the decision based on what if scenarios. What if I start a family in the next year? What if Matt finds a job in another location? Should I switch jobs after only 1 year, will I look like a job hopper?

With some help from my friends for some perspective, I took a risk. While I have not started the new position yet, it just feels right. Since I am Type A, it's funny how I have made some of biggest decisions on "it just feels right"- my marriage, my first dog adoption (unplanned), even my decision to leave my career in finance and go to vet school (this was not always the case if you read my previous blog).

When it became time to write out the pros and cons of moving on, the decision was clear. Luckily, I had the support to move forward. I spent time at the other clinic to try to ensure it was the right fit, and I tried to negotiate the areas of my current job I was unsatisfied with. The right decision presented itself clearly after a week of deliberation.

In summary, it is important to take risks and continue moving forward with life.  Unfortunately, we all have to make decisions. Some will be wrong, even if they feel right. The best thing is to take your time, keep a level head, and make a list- the right choice will pop out at you.

Politically Incorrect Rant On Breeder Advice

Warning: This blog post will offend breeders. Read at your own risk.

In every professional field there are groups that butt heads. Architects and engineers, artists and art gallery managers; the relationship between breeders and veterinarians is no exception.  I recently had a client make a very interesting comment that her dog was having diarrhea in the warmer weather to cool itself off.  When I asked why the owner thought this, the owner replied, "oh the breeder told me." When I tried to discuss the chronic diarrhea and low body condition score, the owner got very defensive and insisted her dog was eating fine and had no issues.

To many owners, the breeders' knowledge is gold. To many veterinarians, the breeder is NOT a medically trained professional who pursued 8+ years advanced education. We, as veterinarians, must spend a lot of our time re-educating owners and explaining the truth behind what they already believe. Needless to say, this can make our already challenging jobs, even more demanding.

Responsible breeders who believe in the welfare of their animals and are not out for just a pretty penny, can really have an impact on wellness care for the life of that animal. Unfortunately, not all breeders take the time to work with veterinarians to educate themselves, thereby the owners. Many rely on Dr. Google.  For example, many breeders do not follow recommended deworming protocols and do not inform the owner that deworming needs to occur multiple times. For many owners, their understanding is "my pet was dewormed, so how could they have intestinal parasites?" There is also a lot of circulation of information against spaying and neutering, including waiting until the animal is older. For dogs, spaying before their first heat significantly reduces the risks of ovarian and mammary cancer. With each heat cycle, however, that benefit declines. While there is debate, even among veterinary professionals, among the best time to spay/neuter, the full story is not always communicated to owners. Often, breeders recommend not fixing an animal or waiting too long.

Then there is the issue of vaccines. Unfortunately in Arizona, parvovirus and distemper virus are current infectious diseases. These diseases are essentially eradicated in certain geographic areas, where the majority of dogs receive the proper vaccination protocols. In Arizona, however, so many dogs do not receive the full puppy series or not vaccinated by a veterinarian and these diseases are all too common. While not all the blame relies on the breeder, it is the informed owners fault if they were told to have the next vaccine in x weeks with your veterinarian- not a feed store vaccine. I have seen expensive bulldogs and pure bred cats, that have never been to a veterinarian for an exam, much less a vaccination, because the owner can just call the breeder for advice.

Like any conflict, the welfare of the subject would be better served if both sides tried to make things right. Many veterinarians work with breeders closely and help educate them, to which some breeders are responsive.

Regrettably, in my experience, many breeders use Dr. Google to inform an owner not to seek a veterinary consult regarding chronic diarrhea and poor weight gain; it probably just is a cooling mechanism.

Veterinary Internships Part 1- To sacrifice or not to sacrifice

Many current veterinary students have to face the looming question of whether or not to pursue an internship after graduation. Wait a second I have my DVM degree, can't I just start practicing? Indeed you can, but internships have become more popular for clinics and students. For the graduating new veterinarian an internship has pros and cons that need to be weighed before making this major decision. In this post, I will break the answer down from simplest to most complicated situation. In a follow-up post, I will discuss what an internship is like, based upon my actual experience.

Scenario 1: If as a student you know for certain that you want to specialize and embark on the journey to become a veterinary surgeon or oncologist, etc. this is your only option.  There is no need to read any further.

Scenario 2: If you think you may want to specialize, but you are not 100% sure, you should probably complete an internship. Once you practice full-time, regressing to an intern salary will prove more difficult, as will being a student vs. practitioner. Some internships, many in fact, allow you to be your own practitioner with guidance as needed. However, there is always some hazing/unfairness in being an intern and not an associate. Completing an internship may also provide the information you need to make your next career move. Many internships rotate through the specialities and have elective time. These opportunities would give you a chance to decide if you want to specialize. These opportunities may also provide good references and potential mentorship opportunities for your future specialization. It may even open a door to a specialization internship- the new wave in the long road to a veterinary specialty.

Scenario 3: I want to go to into emergency medicine. The simple answer used to be: complete a small animal internship. This is the path that I chose. I chose this path because I exclusively wanted to work in emergency and most of the larger small animal emergency hospitals n major metropolitan areas only hire internship-trained veterinarians, and occasionally will hire seasoned general practitioners. I was not taking any chances. I also have toyed with the idea of doing a critical care residency (see scenario 2).  My experience was difficult, but worthwhile. When it came time to apply for a job in a new state, I was a very competitive candidiate because of my internship experience.

The flip side to this story is that at least 3 of my classmates found positions with good mentoring in emergency clinics as their first or second job. They also have now received more surgical experience then I have. The risk you take is the question of good mentorship, I am not a risk taker, but if you are and are willing to weigh your options, completing an internship is not a requirement for a position in small animal emergency.  It does provide a competitive advantage in a tight job market. You must also consider I made a 1/3rd of my current salary during my internship year, so there is an opportunity cost.

Scenario 4: I want more mentorship and experience prior to becoming an associate. This is where the question becomes harder and will be different for every person. For many graduating students, jumping into practice is scary and they do not feel they are ready.  You are more ready than you think, however the first 3-6 months is tough with or without an internship.

The cons of doing an internship in this situation are:

• opportunity cost, less earning potential your first year
• There is little evidence to support you will make more money as an associate after completing an internship, but depending on your field and the job market you may have a competitive advantage.
• spending time doing emergency medicine if you don't like it- this can be brutal
• longer hours
• more learning/research based, especially if you are at a university
• less surgical experience
• One more year at the bottom of the veterinary food chain- ego's can take a beating

The pros of doing an internship in this situation are: 

• Depending on your field and the job market you may have a competitive advantage upon completion. Some practice owners prefer non-internship trained students, so they can be modled. Others prefer internship trained and find the associates more seasoned, stronger medically, and more efficient.
• Keeps the door open for a specialty.
• Guaranteed mentorship, although this will differ in style by program.
• The first few months may be tougher, but you will edge up the learning curve faster than your peers. This is important to some people but in no way a requirement.
• More time to explore specialized interests in veterinary medicine.

This debate rages on, as more students have been selecting internships post-graduation. The AVMA’s 2011 survey found that, of about 1,540 graduates who had accepted employment offers, 700 had accepted internships, according to JAVMA. The 2009 survey indicated that, of 1,525 graduates who had accepted a position, 600 had accepted internships. 

Source: American Association of Veterinary Clinicians​

Based on AVMA data, the average internship salary is $25,000 annually versus $65,000 mean starting salary for all veterinary employment types. 

In conclusion, there is no black and white answer for scenario 4. My best advice is to know yourself and do your research. Consider the financial and career implications in order to make the best decision.

https://www.avma.org/ProfessionalDevelopment/Education/Pages/Veterinary-Internships.aspx

Quick Post: Top 10 Small Animal Conditions

While I am working on my internship guide blog series, I wanted to post a list of the Top 10 conditions for dogs and cats to quickly get in my weekly post. The list is compiled from Veterinary Pet Insurance Co. (VPI) based on their policy claims for 2012. It is important for pet owners and veterinarians to familiarize themselves with the most common medical conditions, most of which can occur in any pet.

Top 10 Canine Conditions:
1. Skin Allergies (my mixed breed dog has skin allergies, so breed selection won't get you out of this one). average cost $96/visit
2. Ear Infection...good old otitis externa- also allergy related
3. Skin Infection
4. Non-cancerous Skin Growth- so dermatology is almost 50% of medical conditions in dogs...yup?!
5. Vomiting
6. Arthritis- average cost $260/visit
7. Diarrhea
8. Urinary Tract Infection
9. Dental Disease
10. Bruise or Contusion

Top 10 Feline Conditions:
1. Bladder Infection- I assume this is more likely urinary signs related to Feline Cystitis. Average claim cost $251/visit. This typically involves checking kidney values, x-rays to screen for bladder stones, a urinalysis and medications.
2. Dental Disease
3. Hyperthyroid- typically occurs in middle aged to older cats
4. Chronic Kidney Disease- typically occurs in middle aged to older cats
5. Vomiting
6. Diabetes Mellitus- typically occurs in middle aged to older overweight cats
7. Diarrhea
8. Skin Allergies- okay so not the top 4 but still very common in our kitties
9. Lymphoma (cancer)- can occur at any age and affect the GI tract, nervous system, lymph nodes
10. Upper Respiratory Tract Infection- usually due to herpesvirus, calicivirus or secondary bacterial infection.

Many of these issues are chronic and can be frustrating to treat if they recur. This would be a good list to share with new dog/cat owners and to remind frustrated clients currently treating these diseases. Luckily, because they are common new treatments are constantly being researched.