Class of 2021 . . . how ya doin?

[Trilt]

So simply email the board group to ask?

Sure, won't hurt.

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[battie]

Email sent asking what equivalent to an internship would be. Depending on the response, may have a better idea on life directions

 

[battie]

Update: the ACVB got back to me saying it depends on the practice and how much exposure I would get to various specialty cases. I'm able to submit information about my hospital to see what sort of timeline I would have here. So waiting for them to let me know what sort of information they need and how to submit it!

Second update: meeting with a non-boarded behaviorist tomorrow to discuss career goals and how to reach them. So say I need 3 or 5 years at this practice, but she's willing to take me to her practice, then that may happen.

 

[vetmedhead]

Update: the ACVB got back to me saying it depends on the practice and how much exposure I would get to various specialty cases. I'm able to submit information about my hospital to see what sort of timeline I would have here. So waiting for them to let me know what sort of information they need and how to submit it!

Second update: meeting with a non-boarded behaviorist tomorrow to discuss career goals and how to reach them. So say I need 3 or 5 years at this practice, but she's willing to take me to her practice, then that may happen.

I'm so glad you reached out! It's refreshing to know that your goals aren't as farfetched or far off as they seem at first

 

[cdo96]

I did a stat pericardiocentesis today! on a cat too!

My first pericardiocentesis!!! Did I feel like I was going to die? Yes. Did I? no!

 

[cdo96]

I did a stat pericardiocentesis today! on a cat too!

My first pericardiocentesis!!! Did I feel like I was going to die? Yes. Did I? no!

oh, and might I add that this was the first day where a DACVECC/ senior resident wasn't in the hospital with me that morning (DACVECC was sick). So I grabbed the overnight vet who was still there doing records and was like "yeah you're helping me with this one k thnx"

 

[Coopah]

oh, and might I add that this was the first day where a DACVECC/ senior resident wasn't in the hospital with me that morning (DACVECC was sick). So I grabbed the overnight vet who was still there doing records and was like "yeah you're helping me with this one k thnx"

You're so badass!!! Well done!

 

[finnickthedog]

a parasite rare enough that even the internist you called to ask questions has never heard of it...

And now I've seen it twice.

 

[battie]

Update: changed life plans.

Definitely dislike GP life in managing chronic conditions. I love euthanasia and I have been doing pretty well on ER. I have a phone call with a purely ER place with minimal to no follow up on Sunday and a call with an at home euthanasia group on Wednesday. Depending on if I can get guaranteed maternity leave, my goal is to change by Decmber 31 (since that's how far out our current schedule is). I've definitely realized that I have zero desire for long term client/patient care and I have major anxiety in call owners with updated plans for subsequent steps over the course of weeks.

I love my coworkers. But I won't be able to stay here after Baby Bats is born anyways. No point in staying.

 

[finnickthedog]

It was like a good 3-4 months of work before I got to do my first c-section.

And now in the last 3-4 months, I have done four of them.
Closing the big incision is annoying, but the rest of it is fun.

Also did my first foreign body and it went well. I feel like I've come a long way with my surgical skills which is awesome because I did not get as much experience as I wanted or planned during school.

 

[battie]

Been home for cold like symptoms since Thursday and pending covid test. So what did I do with my time this morning? Make an excel student loan payment schedule (that I actually had a lot of fun making tbh). But now seeing how long it will take to pay them off makes me sad. I wish I had known what I was doing when I signed my contract with annual production payout -_- Using that production every quarter would be nice

 

[ResoluteMike]

It was like a good 3-4 months of work before I got to do my first c-section.

And now in the last 3-4 months, I have done four of them.
Closing the big incision is annoying, but the rest of it is fun.

Also did my first foreign body and it went well. I feel like I've come a long way with my surgical skills which is awesome because I did not get as much experience as I wanted or planned during school.

It has been almost a year since my last spay and my first one recently is a c-section on a 10 year old lab mix. It was awful and immediately followed by a pyloric sand impaction.

 

[cdo96]

I saw a puppy on ER today for having the zoomies. They’re new to puppy ownership and didn’t understand why it was running around like crazy.

Not gonna lie, I felt guilty having to charge them $150 for an exam fee to tell them their dog was completely fine, but it did feel better than immediately after where I told a 2 year old lab’s owner that it had cancer

 

[battie]

I felt guilty having to charge them $150 for an exam fee

Do you get any leeway with charges? We're allowed to waive our exam fee at our discretion because then we're waiving the charge fornour services. Or do you guys not get that sort of discretion due to intern status or hospital/doff corporate than me status?

 

[Trilt]

Do you get any leeway with charges? We're allowed to waive our exam fee at our discretion because then we're waiving the charge fornour services. Or do you guys not get that sort of discretion due to intern status or hospital/doff corporate than me status?

100% would have gotten a waived fee so I didn't have to write a damn record. 😂

 

[SkiOtter]

I’m almost positive our ER would’ve triaged them away before even making it to a doctor so there wouldn’t be a few or paperwork 😂

 

[battie]

100% would have gotten a waived fee so I didn't have to write a damn record. 😂

I waive my ER fee for criticals that end up euthanized/coding, QOL discussions that don't take long, and situations like this. Some things I'll still write a brief record (criticals that code); but overall, most of those things get "Patient presented normal. Advised clients of puppy behavior and supplied Sophia yin website". Boom. Done

And my techs definitely would have stopped this at the phone call lol

 

[cdo96]

Do you get any leeway with charges? We're allowed to waive our exam fee at our discretion because then we're waiving the charge fornour services. Or do you guys not get that sort of discretion due to intern status or hospital/doff corporate than me status?

Correct we don’t get the discretion.

100% would have gotten a waived fee so I didn't have to write a damn record. 😂

I’ve done this with some simple things hahaha. Torn nail? Tech visit.

I’m almost positive our ER would’ve triaged them away before even making it to a doctor so there wouldn’t be a few or paperwork 😂

That’s where the technician comes into place. The owner asked the tech “could this be bloat?” and she said “I don’t know, I’m not a doctor”. So yes usually they do a good job with triaging them away, especially if they call. But if they show up it’s not the same.

I waive my ER fee for criticals that end up euthanized/coding, QOL discussions that don't take long, and situations like this. Some things I'll still write a brief record (criticals that code); but overall, most of those things get "Patient presented normal. Advised clients of puppy behavior and supplied Sophia yin website". Boom. Done

And my techs definitely would have stopped this at the phone call lol

We have a “euthanasia consult and support” fee for things like that which… is the exact same cost. I don’t waive the ER fee for those who end up euthanized or coding. If it takes more than 5 minutes or 1 tech, they have to get charged the full amount. It’s not like I get paid the Dr fee, but it goes to help pay for the rest of the staff

 

[Trilt]

We have a “euthanasia consult and support” fee for things like that which… is the exact same cost. I don’t waive the ER fee for those who end up euthanized or coding. If it takes more than 5 minutes or 1 tech, they have to get charged the full amount. It’s not like I get paid the Dr fee, but it goes to help pay for the rest of the staff

We have a euth only charge if they come in requesting euthanasia (though obviously doctor's discretion to actually perform), but if it's an exam and conversation with the owner they get charged the exam fee (+ a moderately lower "euth with exam/workup" fee). Doing CPR also definitely gets charged out, that's way too much adrenaline and staff time to not.

I think it's a nice happy medium to make sure the time and skills get reimbursed while not aggressively charging for sadness.

 

[battie]

Correct we don’t get the discretion.


I’ve done this with some simple things hahaha. Torn nail? Tech visit.


That’s where the technician comes into place. The owner asked the tech “could this be bloat?” and she said “I don’t know, I’m not a doctor”. So yes usually they do a good job with triaging them away, especially if they call. But if they show up it’s not the same.


We have a “euthanasia consult and support” fee for things like that which… is the exact same cost. I don’t waive the ER fee for those who end up euthanized or coding. If it takes more than 5 minutes or 1 tech, they have to get charged the full amount. It’s not like I get paid the Dr fee, but it goes to help pay for the rest of the staff

We have a euth only charge if they come in requesting euthanasia (though obviously doctor's discretion to actually perform), but if it's an exam and conversation with the owner they get charged the exam fee (+ a moderately lower "euth with exam/workup" fee). Doing CPR also definitely gets charged out, that's way too much adrenaline and staff time to not.

I think it's a nice happy medium to make sure the time and skills get reimbursed while not aggressively charging for sadness.

For the criticals that run in actively dying and end up dead/euthanized, the only thing I don't charge is the exam fee. I still have to charge out CPR, emergency drugs, etc. because those are "products" per corporate, not a "service" I'm providing. They are then charged for the euthanasia drugs, cremation, etc. on top of the life saving measures. How that distinction works, im not really sure; I just go with it. My discretion of not charging the ER fee ($132 in my hospital) is the same thing; paying for appropriate stuff, but wanting to limit the financial hardship on top of the emotional suck. Since switching to 50/50 ER/GP, I've been hitting production and beyond. So I'm willing to take the hit on the $27 I would make off it and I'm more than pulling my weight financially from corporate's perspective. Granted, we'll see what happens when April/June comes around and they actually look at my numbers for contract negotiations 😅

For scheduled euthanasias, they are 99% exclusively handled by the ER team because the vast majority of clients aren't making that decision 4 weeks out when we have available wellness appointments. So they aren't charged an ER or euthanasia exam fee of any sort. Just the cost of drugs and the euthanasia package per se. That's a hospital policy because in general, they are less than 5 minute situations.

 

[SkiOtter]

That’s where the technician comes into place. The owner asked the tech “could this be bloat?” and she said “I don’t know, I’m not a doctor”. So yes usually they do a good job with triaging them away, especially if they call. But if they show up it’s not the same.

Oh we will straight up send them away from the vth. When the tech goes up to triage they will most definitely send **** away if it doesn’t need to be seen.

 

[finnickthedog]

10 months or so in and I think I've done pretty much all the surgeries I desire to do (which is not say I won't ever end up doing others) and I'm a little bored at the moment so I decided to rank them in order of most fun to least fun...

C-section
Dog Neuter
Small-Med Dog Spay
Cat Spay
Large Dog Spay
Cat Neuter
Mass Removal
Mastectomy
Cystotomy
Enterotomy
Dental Extraction (assuming it's not already on it's way to falling out of the mouth because those are easy)

That's all. Carry on.

 

[cdo96]

Of the 6 house officers at my hospital, 5 of us have Covid/ the flu, myself included. The only one who is healthy is on an out rotation.

To say our hospital is having its own outbreak is saying it lightly. We’re down to only 3 ER doctors and the 4 criticalists for the entire week.

I feel like hot garbage and I’m out of commission for 5 days. Which, since I only have 5 days of PTO, means that I just lost my “end of internship/ pre-residency” vacation.

 

[SkiOtter]

If anyone else (who I'm friends with on fb) wants invites let me know, I'll just invite you to the ones I have and you can pick which ones you like.

I’ll bother you for those in 365 days

Sorry I’m late it’s been 370 days

 

[WildZoo]

Sorry I’m late it’s been 370 days

Pepper your angus, invites are coming your way

 

[supershorty]

Pepper your angus

dubz plz why

 

[battie]

We've been doctors for a year, guys!!! Any changes, any highlights/lowlights?

 

[jaboo]

We've been doctors for a year, guys!!! Any changes, any highlights/lowlights?

Words of wisdom for new grads?

 

[genny]

Words of wisdom for new grads?

Close your mouth when expressing anal glands. Everything else will be fine as long as you remember that.

 

[battie]

Words of wisdom for new grads?

Just do your best.
Don't be afraid to ask for help.
Have boundaries.
And you're not married to a specific clinic/hospital, practicing style, set of drugs, etc. Don't be afraid of change.
Teamwork makes the dream work, but also take care of yourself.

 

[Trilt]

Words of wisdom for new grads?

Go watch the first season of Scrubs. It's one of the most accurate representations of the transition from baby doc to competent clinicians out there, imo. It covers the gamut.

....oh, you want real suggestions that aren't a TV binge? Disjointed thoughts:

We have a really freaking cool career, but an intense one. Be better about your mental health than I was.

You're going to care more about some of your patients than their owners, and that's going to hurt. Accept it now and think about management strategies (that aren't booze).

Even if something is potentially fixable - in complicated cases there needs to be emotional, financial and time buy-in. If these aren't available, a kind euthanasia is rarely the wrong decision.

With that said, expect to end up with a new animal in the next year or two, probably without a leg or eye or something. Sometimes it's just too much, especially when you haven't 100% figured out your mental barriers and coping strategies.

Do no harm, BUT take no ****. Assume benign intent until people have proven otherwise, then act kindly but ruthlessly.

Feed your support staff regularly. Try to include a vegan/GF option, because most clinics have one or the other.

Realize clients who are dinguses to your support staff but are nice to you are dinguses.

Listen to your techs, especially experienced ones. My only patient I've had die in radiology a tech warned me about, and I ignored her. I was experienced enough to know better, and bawled with the owner.

With that said, techs are techs, and they don't hold the liability. Listen to them, but forge your path.

Learn from your mistakes. Even better, learn from other people's mistakes!

If your first clinic isn't a good fit, leave sooner rather than later. Nobody will hold it against you - sometimes it takes time to find the right place! And toxic situations make you a stressed, sad doctor, not a thriving one.

Don't feel broken if a clinic that works for someone else doesn't work for you. We're like plants. Some need different climates and watering.

Everyone has no idea what they're doing like, all the time. How often that "all the time" is does eventually go down, but as far as I can tell doesn't go away, haha.

Also there will ALWAYS be someone who could be a better doctor for that particular patient with that particular disease. Even if you're a specialist. Even if you have thirty years of experience. But you're the one in front of them right now so you're the best doctor RIGHT NOW, do your best.

Okay I gotta go into a shift now. Feel free to stay tuned for more Troutisms.

 

[MOOSEygoosey]

Go watch the first season of Scrubs. It's one of the most accurate representations of the transition from baby doc to competent clinicians out there, imo. It covers the gamut.

....oh, you want real suggestions that aren't a TV binge? Disjointed thoughts:

We have a really freaking cool career, but an intense one. Be better about your mental health than I was.

You're going to care more about some of your patients than their owners, and that's going to hurt. Accept it now and think about management strategies (that aren't booze).

Even if something is potentially fixable - in complicated cases there needs to be emotional, financial and time buy-in. If these aren't available, a kind euthanasia is rarely the wrong decision.

With that said, expect to end up with a new animal in the next year or two, probably without a leg or eye or something. Sometimes it's just too much, especially when you haven't 100% figured out your mental barriers and coping strategies.

Do no harm, BUT take no ****. Assume benign intent until people have proven otherwise, then act kindly but ruthlessly.

Feed your support staff regularly. Try to include a vegan/GF option, because most clinics have one or the other.

Realize clients who are dinguses to your support staff but are nice to you are dinguses.

Listen to your techs, especially experienced ones. My only patient I've had die in radiology a tech warned me about, and I ignored her. I was experienced enough to know better, and bawled with the owner.

With that said, techs are techs, and they don't hold the liability. Listen to them, but forge your path.

Learn from your mistakes. Even better, learn from other people's mistakes!

If your first clinic isn't a good fit, leave sooner rather than later. Nobody will hold it against you - sometimes it takes time to find the right place! And toxic situations make you a stressed, sad doctor, not a thriving one.

Don't feel broken if a clinic that works for someone else doesn't work for you. We're like plants. Some need different climates and watering.

Everyone has no idea what they're doing like, all the time. How often that "all the time" is does eventually go down, but as far as I can tell doesn't go away, haha.

Also there will ALWAYS be someone who could be a better doctor for that particular patient with that particular disease. Even if you're a specialist. Even if you have thirty years of experience. But you're the one in front of them right now so you're the best doctor RIGHT NOW, do your best.

Okay I gotta go into a shift now. Feel free to stay tuned for more Troutisms.

Why have you not written a book or done a TED talk?!

 

[finnickthedog]

We've been doctors for a year, guys!!! Any changes, any highlights/lowlights?

Psh, too many of both to even list.

Words of wisdom for new grads?

Staying on top of your notes is underrated.

 

[WildZoo]

dubz plz why

I didn't expect you to see it

 

[cdo96]

Made my first true misdiagnosis on Friday night that’s still eating at me. One of our other locations transferred over a DKA that they had already worked up for continued hospitalization because their location was closing. Something didn’t quite feel right but I was in a rush and didn’t do the math. Came to me after 10 hours of fluids and insulin CRIs as hyponatremic, wickedly hyperglycemic, and still behind on fluids.

Turns out it was HHS, and I didn’t realize until the morning after the until blood glucose bottomed out and had to start a dextrose CRI after I had spent the night slamming it with fluids and an insulin CRI…

I know we make mistakes but I think this is my first true mistake that contributed to morbidity… sucks.

 

[that redhead]

@cdo96 it always sucks when you get something wrong. Don’t let it eat at you too much - learn the lesson and onward you go! (Plus internet hug)

 

[finnickthedog]

Friday was a rough day with a client that seemed really nice but then turned hostile. By the end of the day I was just burned out and I kinda wanted to go home and cry.

But today I got results back on a dog I neutered who apparently had a seminoma, leydig, and sertoli tumor. Guess he was trying to collect them all.

 

[cdo96]

Week 1 of residency:

• I hate EST
• I am scared

 

[finnickthedog]

I hate EST

Rood.

 

[finnickthedog]

I pulled a puppy out of a uterus today.

I'm sure in the not terribly distant future this will feel like a typical day to me, but today it's exciting.

As I did another c-section today, I randomly remembered this post of mine.

I average a c-section a month now and they're still exciting.

 

[cdo96]

A haiku detailing my first month of residency:

I regret my choice
And I am always tired
… It’s only the start

 

[that redhead]

A haiku detailing my first month of residency:

I regret my choice
And I am always tired
… It’s only the start

What about your choice do you regret, out of curiosity? I’m sorry that your first month haiku is a sad one.

 

[cdo96]

What about your choice do you regret, out of curiosity? I’m sorry that your first month haiku is a sad one.

I just feel like an absolute idiot all the time. I’m constantly busy, never able to ever stop. Between working 70+ hours a week in the hospital and then doing readings, assignments, teaching, research, and being on call for my cases 24/7, I feel like I work from 6 am to easily 1 am every day.

I’m sure it’s just getting used to everything but it’s just been a hard adjustment

 

[cdo96]

I just feel like an absolute idiot all the time. I’m constantly busy, never able to ever stop. Between working 70+ hours a week in the hospital and then doing readings, assignments, teaching, research, and being on call for my cases 24/7, I feel like I work from 6 am to easily 1 am every day.

I’m sure it’s just getting used to everything but it’s just been a hard adjustment

I’m already 7 months behind in journal reading and I’m just… super excited about the prospect of doing this for 35 more months

 

[that redhead]

I’m already 7 months behind in journal reading and I’m just… super excited about the prospect of doing this for 35 more months

That sounds really difficult, from all angles. Big hug.

 

[battie]

I've low key been considering a new hospital for quite a while. With the baby, I finally pulled the trigger to talk to new hospitals as I drive 30 miles one way four days a week during rush hour. It's just not going to work.

The hospital I talked to this morning is literally better in every way on paper. The hospital is currently being built and will be brand new. A personal plus to me is two dedicated lactation suites and a social worker for clients. It is 13 miles from my house with a 20 minute commute vs 30 miles and an hour commute.

The listing originally stated opening in spring 2023. That was perfect cause then I could give the new routine the good old college try and give reasonable notice. But talking them today, they said constriction and hiring is going well and they now estimate an opening of late October 😶 I'm totally down for that. My only concern is giving my current hospital a minimum a month's notice and not burning bridges. I'm sure it'll look obvious that I was looking before coming back from maternity leave. But this opportunity is one I don't think I can pass up.

Any general thoughts?

 

[MixedAnimals77]

@battie that sounds like an awesome opportunity. IDK your work environment but I think if you're honest about not being able to justify the commute especially with a new born it's totally reasonable. Just out of general curiosity what is the social worker's role envisioned to be? Like I can imagine how one could be integrated and it sounds fantastic especially with some clients...

 

[battie]

@battie that sounds like an awesome opportunity. IDK your work environment but I think if you're honest about not being able to justify the commute especially with a new born it's totally reasonable. Just out of general curiosity what is the social worker's role envisioned to be? Like I can imagine how one could be integrated and it sounds fantastic especially with some clients...

Social worker is there to help clients navigate tough choices for their animal. It's an ER only hospital. Social worker is also there to help staff with resources on grief/burn out.

 

[genny]

I've low key been considering a new hospital for quite a while. With the baby, I finally pulled the trigger to talk to new hospitals as I drive 30 miles one way four days a week during rush hour. It's just not going to work.

The hospital I talked to this morning is literally better in every way on paper. The hospital is currently being built and will be brand new. A personal plus to me is two dedicated lactation suites and a social worker for clients. It is 13 miles from my house with a 20 minute commute vs 30 miles and an hour commute.

The listing originally stated opening in spring 2023. That was perfect cause then I could give the new routine the good old college try and give reasonable notice. But talking them today, they said constriction and hiring is going well and they now estimate an opening of late October 😶 I'm totally down for that. My only concern is giving my current hospital a minimum a month's notice and not burning bridges. I'm sure it'll look obvious that I was looking before coming back from maternity leave. But this opportunity is one I don't think I can pass up.

Any general thoughts?

Does your contract specify how much notice you have to give? If not, then a month is fine. They’ll be mad until they replace you, but sometimes you just have to take the opportunity that shows up.

 

[SkiOtter]

You already know I say to do it considering I also was originally saying to not even come back from maternity leave and find something closer like 4 months ago when you started asking for thoughts 😂