Would you do it over again?

[lei325]

I looked at my previous post, and I'm not sure I would do it again now. I'm coming to the end of a second internship, originally planning on going into equine surgery. About 3 months in, said "**** surgery" and stuck with the internship because 1. contract, and 2. it's part ambulatory, so I would get good experience for when I entered the working world. Now, I'm seriously contemplating leaving equine, if not vet med, forever. The pay is ****, the job interviews I've been on made it seem impossible for there to be any kind of work/life balance at all. One had the gall to bitch about his low-paying job in his first four years of practice, then turn around and offer me $5000 more than his starting salary (20 YEARS AGO).

So...yeah. I'm ending this internship, moving in with my parents at the age of 30 with no job, and going to a Red Sox game on July 8th. Right now, that's all I got.

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[Minnerbelle]

I looked at my previous post, and I'm not sure I would do it again now. I'm coming to the end of a second internship, originally planning on going into equine surgery. About 3 months in, said "**** surgery" and stuck with the internship because 1. contract, and 2. it's part ambulatory, so I would get good experience for when I entered the working world. Now, I'm seriously contemplating leaving equine, if not vet med, forever. The pay is ****, the job interviews I've been on made it seem impossible for there to be any kind of work/life balance at all. One had the gall to bitch about his low-paying job in his first four years of practice, then turn around and offer me $5000 more than his starting salary (20 YEARS AGO).

So...yeah. I'm ending this internship, moving in with my parents at the age of 30 with no job, and going to a Red Sox game on July 8th. Right now, that's all I got.

Equine is a tough road. Have you thought about switching over? And/or relocating?


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[katryn]

I'm going to sarcastically laugh at the idea that I was "trained" to handle emergencies in school. Sure, we attended some lectures where they discussed how to theoretically tap chests, hearts, and bellies, do shock fluids, administer CPR, etc. How many times were the lowly students allowed to touch such a case on clinics? Zero. How often did the clinicians debrief students after said cases and talk about how to act in an emergency? Zero.

It's sad, but I don't feel like I was "trained" to do any ER work in school. I have blindly ridden by the seat of my pants through 2 true emergencies and had the common sense to admit to the owners up front that I had never handled that type of case/procedure before and didn't have anything approaching the full capacity to do so.

The sad and sorry truth is that many of us who go straight to GP don't ever get that training, and many of us work in clinics that aren't truly equipped for it anyway. Kuddos to people who manage better than I do, but I thank my lucky stars to work close to a true ER facility and have no problem crossing my fingers that owners elect to risk transfer instead of asking me to stumble blindly through things.




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[Minnerbelle]

I'm going to sarcastically laugh at the idea that I was "trained" to handle emergencies in school. Sure, we attended some lectures where they discussed how to theoretically tap chests, hearts, and bellies, do shock fluids, administer CPR, etc. How many times were the lowly students allowed to touch such a case on clinics? Zero. How often did the clinicians debrief students after said cases and talk about how to act in an emergency? Zero.

It's true that I learned a lot on the job working at an ER, but I felt like I was given fairly good guidance during clinics.

Sure, something like a tension pneumo case isn't going to be touched by a student. But I was allowed to tap a couple of chests, a couple of abdomens, trocharize a bloat, got one stab at a pericardiocentesis, and even put in a chest tube as a student. And I felt like I was allowed in the loop enough to understand what to do for the shocky hbc, addisonians, etc... The clinicians weren't going to wait for me to sit down and make a plan, but they were involved enough to go "so minnerbelle, what do we start with?" Or "ok so patient's shocky, what type of fluids and how much do you want to give over how long?" Even if they had the answer in their head. I mean there were very few emergencies for which every second mattered such that they couldn't have me directly involved. At the very least I felt like I was adequately briefed on what happened, what thought went into decision making, etc... There's obviously no way for students to see enough of a caseload for them to be practice ready for every imaginable type of thing that could occur, but I felt like I was given fairly good training for the cases I did encounter. And I've never had to do an emergency trach, but I've done a couple in cadavers during school, with the reasoning being that if it's needed, you probably don't have time to turf it so you should at least do one just so you can tell yourself you can do it if the occasion presents itself.

At the end of the day though, you know yourself best. If it's going to take you as much time to do whatever you think is indicated, as it would for the animal to be already at the ER, you may very well be doing the patient a favor just to turf it. If a case sounds really bad, our receptionists are instructed to tell the client on the phone to go directly to the ER 10-15 min away and not even bother stopping by. That solves a lot of our problems. Something I wish some judgy ER people would understand is that for a busy GP, these emergencies are barreling in creating a grinding halt to everything in the clinic that has a full schedule of 20-30 min appointments. The patient isn't going to get the optimal care because of it. We're juggling way too many things. Most GPs are not staffed to accommodate these critical patients. A HBC requires one person who sticks with the patient, and for a good part of things, at least a second person to help with getting the treatments/diagnostics going. That can easily be half of your staff that is available to you that day... And you are now three appointments behind, on top of the 8 other appointments you have scheduled before lunch including a euthanasia you don't want to keep waiting. And somehow on top of stabilizing the patient, you need to call the ER, fill out referral paperwork, and get everything ready for transport. It's easy to play Monday-morning quarterback and snicker at how much better you might have handled the case that's in front of you post transport or get all upset about it, but unless you were there, you can't judge.


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[shortnsweet]

I looked at my previous post, and I'm not sure I would do it again now. I'm coming to the end of a second internship, originally planning on going into equine surgery. About 3 months in, said "**** surgery" and stuck with the internship because 1. contract, and 2. it's part ambulatory, so I would get good experience for when I entered the working world. Now, I'm seriously contemplating leaving equine, if not vet med, forever. The pay is ****, the job interviews I've been on made it seem impossible for there to be any kind of work/life balance at all. One had the gall to bitch about his low-paying job in his first four years of practice, then turn around and offer me $5000 more than his starting salary (20 YEARS AGO).

So...yeah. I'm ending this internship, moving in with my parents at the age of 30 with no job, and going to a Red Sox game on July 8th. Right now, that's all I got.

If you ever need someone to vent to, feel free. I understand the equine crazy.

 

[Trilt]

If you have an active veterinary license, you are considered qualified and it is up to you to keep those skills available. You are comparing a lay person without any tools or training (don't tell me you don't keep needles or dextrose, etc in your hospital) to someone who was trained and licensed to perform those tasks. We aren't even crossing species.

I still think it's fairly dickish to say something like that. I know you didn't mean it that way, but every vet didn't have a year of working under boarded ER/CC vets, doesn't have an ultrasound on hand, and see these cases fairly sparingly. To tell someone it is their fault that an animal dies because they recognized their limits...

 

[Trilt]

Oh, and clinics-wise... I've tapped one chest and one abdomen on living animals, although was def taught to do it in cadaver labs.

I didn't do all of the small animal rotations available, so maybe if I did I would have done a couple more, but I kind of doubt it. Both of those opportunities were ones that I specifically had to ask the resident on the case to do (vs. being offered) and wouldn't have happened if I didn't just happen to be the student on the case, so somewhat luck of the draw.

 

[jmo1012]

It's funny how quick people are to say internships are a waste of time and blah blah blah for non-specialists, however, they also cannot be expected to provide emergency care because they weren't trained.

 

[DVMDream]

I think we need to stop judging. I don't know if an internship would have ever been "worth it" or a "waste of time" for me because I will never do one. I can't judge if it would have been "worth it". However, I also can't judge what another vet was doing/thinking in the moment of an emergency, nor would I dare place blame on another vet that an animal died because of what they did/did not do, since I was not there.

Let's not judge each other's experiences and let's not put blame onto others. An internship may very well be a wonderful thing for some people even if you are just going to do GP work after and it may not be right for others. I might be able to provide a bolus of IV fluids to a patient in shock but I would not be able to do a pericardiocentesis without risk to the patient, that is better off referred to the local emergency clinic. We all have to make judgement calls in our abilities and capabilities as well as take into consideration the supplies and staff we have on hand to deal with certain emergencies. Judgement by other colleagues does not help and only hurts. The same goes for judging others for doing internships, not doing internships, doing an internship then not doing a residency, etc, etc.

 

[CalliopeDVM]

It's funny how quick people are to say internships are a waste of time and blah blah blah for non-specialists, however, they also cannot be expected to provide emergency care because they weren't trained.

I don't think it's funny at all, or even ironic. I honestly don't think one has anything to do with the other.

Why should every veterinarian be expected to provide emergency care across the board? Do you seriously think that's a reasonable expectation, and do you think that it is an expectation that other health care providers adhere to? Do you think every MD should be expected to be skilled and supplied at his/her office to provide emergency, life saving care to people? It sounds like you think a psychiatrist should be expected to place a trach tube if a patient gets an occluded airway during an appointment, because he/she is a medical doctor and once learned how to deal with emergencies.

You need to seriously get off your high horse and stop expecting all vets to be all to every animal. I bet that's a standard even you can't live up to.....for every important thing that you can do that I can't, I can come up with an important thing that I can do that you can't, I'm sure. While an internship accelerates learning some things, it decelerates learning others. And, in the end, we all end up with a narrower field of knowledge and practice than we started with (and sometimes than we wanted).


And remember, experience (not an internship, or even a residency) is the best training.

 

[Trilt]

It's funny how quick people are to say internships are a waste of time and blah blah blah for non-specialists, however, they also cannot be expected to provide emergency care because they weren't trained.

I don't think a single person here has said their internship was a waste of time. I do think that (as someone wanting to do GP) having to uproot my life, spending a year in an emergency/referral setting being a slave, and just watching my loan interest accumulate is not worth it. That'd be a ~40kish decrease in salary over what I expect in GP and at least another ~5k in interest. Not worth it to me, as I want to be debt free asap. Obviously it is to others.

If that means that I will not provide the 120% best care to an animal in an emergency setting, you know what, that's real life. Because I'm going to be a GP, that applies to any damn thing I do. I can't have the knowledge of a cardiologist, neurologist, ophthalmologist, dentist, internist, oncologist, criticalist, dermatologist... we graze on the important bits of those fields, strive to do the best we can, and get people referral when they need it.

Bitch at the vet schools for not properly training people for emergencies, not the people who have chosen different paths. You're just going to raise hackles placing blame on people who love animals and do their best day in, day out.

 

[Minnerbelle]

It's funny how quick people are to say internships are a waste of time and blah blah blah for non-specialists, however, they also cannot be expected to provide emergency care because they weren't trained.

I think you're way out of line here. I've always respected you as a person, but this kind of loses it for me. There's no reason for you to be so judgmental. You don't even know what it's like to be out in practice. So there's no reason for you to be all holier than thou about this.

No one said internships were a waste of time. Just that it may not be worth it for what you get out of it vs what you sacrifice for it vs what you can learn instead in practice.

I worked in a general practice where I was the only person who was not internship trained out of 4 doctors. But you know what, I dealt with the critical emergencies more often than the others (esp the older docs), because by now they're decades away from their internships and you lose the skills you don't use. And how to deal with the types of true emergencies you might absolutely have to see once every several months is not priority for CE.

Yours is the type of mentality that creates an environment within academia where faculty thinks you're essentially worthless if you're not pursuing an internship and is not supportive of students going out into practice. Of course they feel like internships are the greatest things ever, because you're asking a group of people in academia who have all done internships and residencies and feel superior because of it.



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[dyachei]

couple thoughts:

we are already judged harshly by clients and other professions. Maybe we could stick together as a profession instead of judging each other harshly, too. We need to remember that suicidal ideation and compassion fatigue are already giant issues. Let's work to make those things less instead of more.

Internships are not a waste of time. I think they are great. I couldn't afford to do one. In the long run, the finances don't make sense unless you intend on specializing.

On ECC: I can do basics and stabilize, but this is why referral clinics exist. You have the specialized training. You do this day in and day out. My guess is that you aren't quite as good as I am at the more "routine" stuff that I do day in and out (treating skin and ears, managing chronic disease, etc). I can even do a FAST scan if needed, tap bellies, place chest tubes. But for me to have all the equipment that you need for ECC is ridiculously expensive and not used often.

ETA: It's kind of a turn-off to me if ECC thinks of me like that. Would make me want to refer less.

 

[chickenlittle]

I think you're way out of line here. I've always respected you as a person, but this kind of loses it for me. There's no reason for you to be so judgmental. You don't even know what it's like to be out in practice. So there's no reason for you to be all holier than thou about this.

.....

I worked in a general practice where I was the only person who was not internship trained out of 4 doctors. But you know what, I dealt with the critical emergencies more often than the others (esp the older docs), because by now they're decades away from their internships and you lose the skills you don't use. And how to deal with the types of true emergencies you might absolutely have to see once every several months is not priority for CE.

This. While I didn't do an internship, I spent my first 3 years in a practice where we did all kinds of fun emergency stuff. I was very comfortable with tapping chests, managing emergencies, and did a number of cool surgeries while I worked there. But now, after seven years of working in much more 'boring' practices, I've lost most of those skills. I haven't tapped a chest in probably about 5ish years. I haven't done a limb amputation in 9 years. The opportunities haven't presented themselves and, when they did, the client wanted to see a specialist (and this was best for the pet, given my very rare experiences doing those things and the fact that the speciality hospitals have access to toys and tools that I do not). Doing an internship will have very little impact on your skills 5 years down the road, because most of those skills will go unused if you end up in general practice.

We recently had an internship-trained doctor quit because, after less than a year in GP, she already could tell that she was losing most of the skills gained during school and her internship. She decided to go into emergency medicine and so, for her, the internship will be beneficial. If she had stayed in GP, especially at a corporate practice with an emphasis on preventive care? Not so much.

 

[twelvetigers]

If I get an animal that needs a chest tube or pericardiocentesis and my mentor is not available, even at least by phone, I am NOT doing it.

If it comes in while he is there, we can do it together and then maybe I will be ready for the next one.

I say maybe, because we have not had one yet. Our biggest emergency so far was a bromethalin tox case, and it was both of us. And I helped him figure out that it wasn't something that vitamin K would help and we needed to flush the dog out as much and as quickly as possible.

 

[Coquette22]

ETA: It's kind of a turn-off to me if ECC thinks of me like that. Would make me want to refer less.

This. If I'm referring something, it's because I have acknowledged that it's outside my scope of practice. I'd hate for the specialist to throw me under the bus.

ETA: I'd also add that in my <1 year of general practice, I do a lot of ultrasounds, read a ton of radiographs, I have tapped bellies and chests, haven't done any chest tubes because we just really haven't had a call for it, done CPR, done emergency resussicitation of neonates, treated a few status epilepticus, etc.

 

[bbeventer]

I looked at my previous post, and I'm not sure I would do it again now. I'm coming to the end of a second internship, originally planning on going into equine surgery. About 3 months in, said "**** surgery" and stuck with the internship because 1. contract, and 2. it's part ambulatory, so I would get good experience for when I entered the working world. Now, I'm seriously contemplating leaving equine, if not vet med, forever. The pay is ****, the job interviews I've been on made it seem impossible for there to be any kind of work/life balance at all. One had the gall to bitch about his low-paying job in his first four years of practice, then turn around and offer me $5000 more than his starting salary (20 YEARS AGO).

So...yeah. I'm ending this internship, moving in with my parents at the age of 30 with no job, and going to a Red Sox game on July 8th. Right now, that's all I got.

Yikes, this is moderately depressing as I'm preparing to begin an equine internship.

 

[cowgirla]

At the end of the day though, you know yourself best. If it's going to take you as much time to do whatever you think is indicated, as it would for the animal to be already at the ER, you may very well be doing the patient a favor just to turf it. If a case sounds really bad, our receptionists are instructed to tell the client on the phone to go directly to the ER 10-15 min away and not even bother stopping by. That solves a lot of our problems. Something I wish some judgy ER people would understand is that for a busy GP, these emergencies are barreling in creating a grinding halt to everything in the clinic that has a full schedule of 20-30 min appointments. The patient isn't going to get the optimal care because of it. We're juggling way too many things. Most GPs are not staffed to accommodate these critical patients. A HBC requires one person who sticks with the patient, and for a good part of things, at least a second person to help with getting the treatments/diagnostics going. That can easily be half of your staff that is available to you that day... And you are now three appointments behind, on top of the 8 other appointments you have scheduled before lunch including a euthanasia you don't want to keep waiting. And somehow on top of stabilizing the patient, you need to call the ER, fill out referral paperwork, and get everything ready for transport. It's easy to play Monday-morning quarterback and snicker at how much better you might have handled the case that's in front of you post transport or get all upset about it, but unless you were there, you can't judge.


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This. There are many hours of the day when I am the only doctor in the building. I've had emergencies walk in while I'm in the middle of surgery. sorry, but I'm not leaving a patient on the table with their abdomen open to go see anything else. Some things I can relay and have the techs do to buy some time, but not everything. So yes, there are things that I've shipped to the e-clinic that probably could have benefitted from some stabilization.

I've also spent plenty of time stabilizing HBCs and ketoacidotic and hypoglycemic patients that walk in, and ended up with a lobby full of sick patients and euthanasias waiting. Either way it sucks when your attention is divided and then mistakes can happen. We are not staffed for walk in emergencies during certain times of the day, and barely have enough assistants to run regular appointments some days. We are also not equipped for hospitalizing so either way those patients are headed to the ER. It's not always a matter of the rDVMs ability.

 

[chickenlittle]

This. There are many hours of the day when I am the only doctor in the building. I've had emergencies walk in while I'm in the middle of surgery. sorry, but I'm not leaving a patient on the table with their abdomen open to go see anything else. Some things I can relay and have the techs do to buy some time, but not everything. So yes, there are things that I've shipped to the e-clinic that probably could have benefitted from some stabilization.

I've also spent plenty of time stabilizing HBCs and ketoacidotic and hypoglycemic patients that walk in, and ended up with a lobby full of sick patients and euthanasias waiting. Either way it sucks when your attention is divided and then mistakes can happen. We are not staffed for walk in emergencies during certain times of the day, and barely have enough assistants to run regular appointments some days. We are also not equipped for hospitalizing so either way those patients are headed to the ER. It's not always a matter of the rDVMs ability.

Amen to all of this. Most days, I am the only doctor in the building. I work with one receptionist and 3 vet assistants in the morning, but one of those vet assistants leaves as soon as I finish surgery. I don't have the staff or many of the necessary tools to handle emergencies (no ultrasound, no blood gas machines, no apomorphine, the list goes in and on). I am typically scheduled to do 4 surgeries per day and see 20-22 additional patients. If an emergency shows up and it is a life or death situation, sure, I'll do what I can... But then no one is getting good care - not the emergency, not the 20-25 other pets I'm seeing that say, no one. So if they call first, or sometimes even if they walk in with a pet that is emergent but stable enough to make it the 5 minutes to the e-clinic, I'm sending them there so they can get the level of care they deserve.

 

[lei325]

Equine is a tough road. Have you thought about switching over? And/or relocating?


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I have, and I am. Moving home is going to be a bit like a restart button for me. I went straight from vet school to internship #1 in 3 days (I finished exams on a Thursday, flew home on a Friday, moved to NY on Sunday and started on Monday), and from internship #1 to internship #2 in a week (including an 1100 mile, 3 day drive with two cats, my parents and a U-haul van). I need a bit of a break. And today, I applied to a small animal position (no out of hours) near my hometown. So we'll see.

Yikes, this is moderately depressing as I'm preparing to begin an equine internship.

Not all experiences are like mine. And I'm trying to find a job in the Northeast, which is notoriously difficult.

If you ever need someone to vent to, feel free. I understand the equine crazy.

Thanks.

 

[LetItSnow]

ETA: It's kind of a turn-off to me if ECC thinks of me like that. Would make me want to refer less.

For the record, this ER doc doesn't think of my RDVMs like that. I don't expect them to be equipped as well as we are, or to do the same things we do, or to have the staff/time to deal with them. A critically emergent case can tie up a lot of people for a long time. GPs have appointments to keep.

Last week I had an RDVM frantically send me a pericardial effusion. Could she have tapped it? Probably. Was she comfortable? No.

Fine. Fair enough. She probably hardly ever does it. I do it often enough that it's routine. And, by coming to me, I can rope in the Internal Medicine doctor to do an echo and give the owners (somewhat) better prognostic information right away as opposed to tapping and making them wait a few days for a cardio consult to find out their dog has hemangio. As long as the dog isn't actively dying, I think it makes a lot of sense for the GP to risk the 30-45 minute car ride to come to me rather than to blindly stab the sac, hopefully not piss off the heart, and then still not be able to truly tell the owner why their dog filled up with blood.

So no. I don't judge GPs for turfing critical cases. That's why we exist. I do CPR day in and day out, so yes, I'm more practiced at it currently. But that's a skill that deteriorates quickly. I went a month without doing CPR earlier this year by some fluke (wooo!) and the next time I had to do it, I had to think instead of things being automatic. I can only imagine going into GP and doing it hardly ever and then having to drum it up out of nowhere in an incredibly tense situation. I don't look at skin scrapings hardly ever, so I take pictures with my phone awkwardly through the microscope lens and text it to my GP friend(s) saying "Ummmm.... help?" It doesn't make them or me less of a doctor to rely on someone else's expertise.

The times I get grumpy at GPs are when they 1) turf something unstable/critical but don't call or send records, 2) when they don't give clients <some> idea of the cost. I've literally had people tell me "I thought the cost was covered in what I paid at my vet," or 3) send illegible records.

None of those are 'medical' or 'competency' things, really. They're all communication things. And I assume GPs would get frustrated with me if I didn't send records or sent illegible records, so it's not a GP vs ER thing.

 

[dyachei]

For the record, this ER doc doesn't think of my RDVMs like that. I don't expect them to be equipped as well as we are, or to do the same things we do, or to have the staff/time to deal with them. A critically emergent case can tie up a lot of people for a long time. GPs have appointments to keep.

Last week I had an RDVM frantically send me a pericardial effusion. Could she have tapped it? Probably. Was she comfortable? No.

Fine. Fair enough. She probably hardly ever does it. I do it often enough that it's routine. And, by coming to me, I can rope in the Internal Medicine doctor to do an echo and give the owners (somewhat) better prognostic information right away as opposed to tapping and making them wait a few days for a cardio consult to find out their dog has hemangio. As long as the dog isn't actively dying, I think it makes a lot of sense for the GP to risk the 30-45 minute car ride to come to me rather than to blindly stab the sac, hopefully not piss off the heart, and then still not be able to truly tell the owner why their dog filled up with blood.

So no. I don't judge GPs for turfing critical cases. That's why we exist. I do CPR day in and day out, so yes, I'm more practiced at it currently. But that's a skill that deteriorates quickly. I went a month without doing CPR earlier this year by some fluke (wooo!) and the next time I had to do it, I had to think instead of things being automatic. I can only imagine going into GP and doing it hardly ever and then having to drum it up out of nowhere in an incredibly tense situation. I don't look at skin scrapings hardly ever, so I take pictures with my phone awkwardly through the microscope lens and text it to my GP friend(s) saying "Ummmm.... help?" It doesn't make them or me less of a doctor to rely on someone else's expertise.

The times I get grumpy at GPs are when they 1) turf something unstable/critical but don't call or send records, 2) when they don't give clients <some> idea of the cost. I've literally had people tell me "I thought the cost was covered in what I paid at my vet," or 3) send illegible records.

None of those are 'medical' or 'competency' things, really. They're all communication things. And I assume GPs would get frustrated with me if I didn't send records or sent illegible records, so it's not a GP vs ER thing.

Yeah, but this user is in my market. I tend to call/send notes (you and I have discussed this before) or at least give a heads up. And I try to stabilize as much as I'm able. But I would hate to think that ECC here resents getting those cases turfed. There are like 3 ECC clinics in my radius. If one resents it, I will send to another one.

 

[CalliopeDVM]

so I take pictures with my phone awkwardly through the microscope lens

Off topic -- get yourself (or your clinic) a smartphone optics adapter for taking easy and great photos or videos from any microscope (or telescope). Here is one option that I personally haven't tried because it's not available in Canada, but I hear good things about: https://backpackbang.com/item/B013D2ULO6 . (I used this link, but it's easily available on Amazon). The one I use is from Carson - more expensive and kind of clumsy, but it works.

 

[rdc]

And remember, experience (not an internship, or even a residency) is the best training.

I'm going to disagree with this (having completed both an internship and almost finished a residency).


Appropriate baseline training is a necessity on which to build your experience, and i don't think any level of GP experience is comparable to residency training.

 

[CalliopeDVM]

I'm going to disagree with this (having completed both an internship and almost finished a residency).


Appropriate baseline training is a necessity on which to build your experience, and i don't think any level of GP experience is comparable to residency training.

Actually, I know of several non-boarded vets who have excellent skills in a particular realm of practice without having done a residency, and I have known some Boarded vets whom I wouldn't choose over a GP because I've seen some mistakes and omissions that makes it not worth it to my clients to go out of their way (in time and money) to see a specialist.

Don't get me wrong......I know some excellent specialists; I don't hesitate to refer clients, and I recently took my own dog to a specialist. But being Board Certified isn't enough for me to say that he/she knows more or can do better.

 

[rdc]

Actually, I know of several non-boarded vets who have excellent skills in a particular realm of practice without having done a residency, and I have known some Boarded vets whom I wouldn't choose over a GP because I've seen some mistakes and omissions that makes it not worth it to my clients to go out of their way (in time and money) to see a specialist.

Don't get me wrong......I know some excellent specialists; I don't hesitate to refer clients, and I recently took my own dog to a specialist. But being Board Certified isn't enough for me to say that he/she knows more or can do better.

The idea that a GP has the skills and knowledge equivalent to someone who has gone through the process of a residency and sitting boards is lunacy. I'm not saying that every specialist out there has excellent clinical acumen and superior skills, but from a knowledge standpoint (i.e.: knowledge of the literature, knowledge of their speciality, etc) there's zero comparison. And to be honest, the only person who is going to say that a GP is comparable to a specialist is someone who has never done an internship or a residency, and doesn't know what they don't know.

GPs and specialists have different jobs. In fact, I think GPs jobs are the most difficult in our field. I would be a terrible GP and I have the utmost respect for what they do. However I don't presume to be able to to a GPs job better than they can and it is almost insulting that GPs think they can do mine better than me.

 

[CalliopeDVM]

The idea that a GP has the skills and knowledge equivalent to someone who has gone through the process of a residency and sitting boards is lunacy. I'm not saying that every specialist out there has excellent clinical acumen and superior skills, but from a knowledge standpoint (i.e.: knowledge of the literature, knowledge of their speciality, etc) there's zero comparison. And to be honest, the only person who is going to say that a GP is comparable to a specialist is someone who has never done an internship or a residency, and doesn't know what they don't know.

GPs and specialists have different jobs. In fact, I think GPs jobs are the most difficult in our field. I would be a terrible GP and I have the utmost respect for what they do. However I don't presume to be able to to a GPs job better than they can and it is almost insulting that GPs think they can do mine better than me.

Not lunacy at all.......they are vets who took a lot of time, energy, and money to develop skills in a particular area; the fact that you think it's "lunacy" either shows that you've never met one of these vets, or you don't believe they are that good at what they do. To imply that I don't know a skilled and talented ophthomologist, for instance, is both rude and ignorant. And egotistical, LOL. You may be insulted that a non-Boarded vet is thought to be (and considers himself to be) as good at what you do as you do, but to not accept it's a possibility shows your ignorance. There is more than one path to the same goal.

Residency programs were rare until relatively recently (there probably weren't more than a dozen residency programs by 1990; that seems like a long time ago, but vets who graduated vet school in 1990 are just in their 50s now, probably the "prime" of their careers) and the first couple of decades of most specialties were filled with specialists who never went through a residency program. It is certainly a lot easier and more efficient to learn and gain great experience through a residency program, but it's not the only way to get very, very good at a narrow area of practice.

 

[DVMDream]

I'm going to disagree with this (having completed both an internship and almost finished a residency).


Appropriate baseline training is a necessity on which to build your experience, and i don't think any level of GP experience is comparable to residency training.

Residency training in what? Performing a pericardiocentesis? Providing fluid boluses? The discussion wasn't about who can do the job of a specialist better, it was about what a GP should be doing prior to referring a patient to emergency. I would think for some of the basic procedures that were being discussed... belly taps, chest taps, fluid boluses, etc... that there is zero difference between being "taught" that your first year out as a GP vs. being taught that during your internship. In those cases, experience is the only thing that will perfect those skills... you can be taught it a thousand times over, but experience is what will make those skills stick. And you do not need to go through residency in order to do those tasks. And yes, GP experience will be more than enough for those procedures and I do think it is a bit condescending to suggest that a GP can't gain those experiences enough to perform them and that they will be lacking some sort of baseline training. The point for a GP isn't to get the narrowed view/experience of a specialist, it is to have a broad experience knowing a bit about everything. And, yes, there are going to be some things that a GP is "better" at than a specialist and vice versa. I guarantee I know GP's that could dance circles around a soft tissue surgeon when it comes to doing a spay, but the surgeon will easily be better than them at removing a kidney. And that is how it is supposed to be.

We don't need to be degrading what others are doing. We don't need to be saying that "any level of GP experience is not comparable to residency training"... well, no ****, a GP isn't looking to do the specialized things that a resident is taught. And a resident isn't looking to do the more "basic" things that a GP does every day. Instead of comparing the two and trying to draw some line about which is "better" why don't we just accept that each has its place? I guarantee the experience I obtain while working in GP will be 1000x "better" than the experience you gained in your residency for the job that I want to do. Just like the experience you gained in your residency is 1000x "better" than gaining GP experience for the job you want to do. We need to stop thinking of specialists and GPs as having the "same" job, we don't. We have very different jobs and we need to respect each others positions and experiences.

 

[Minnerbelle]

In all fairness, I don't think we're all talking about the same things. I think we all need to stop taking things so personally (that is, unless someone is actually insulting what you're doing). I think rdc was clear in saying that residency training in X specialty was going to be superior to any level of experience obtained by a GP in that specialty (not veterinary medicine overall). Totally a tangent and nothing to do with the previous discussion on handling emergencies.

Clearly, someone who spends 3 years in a cardio residency is going to be far superior in cardiology than others who have not been through a residency. Same with radiology, dentistry, surgery, whatever. You can have a huge interest in abdominal ultrasound or whatever and do it on ten animals a day, but you sure are not going to see the caseload of difficult cases you need to see to become an expert without the high volume referrals that a radiology resident sees. Nor will you be studying the theory and publications about it to the extent that a resident is forced to.

Can a non boarded person become "just as good as" a specialist at certain things? Yeah absolutely. A spay/neuter vet I'm sure will be the most efficient at a spay with probably the smallest incision with the patient none worse for the wear. But that's a stretch from saying that vet is just as good a surgeon as a boarded surgeon. I'm sure there are some GP vets that are great at lateral sutures or whatever. The difference in the boarded specialist is the depth and breadth of expertise they have in that particular field. You can't expect a non-boarded person to have that. That would be insane. While it's true that the founding members of different veterinary specialty boards were "grandfathered" in and were essentially self made people, the standard of care of those specialties tend to ramp up exponentially after that. So once the colleges and residency programs have been well established, I think it becomes difficult for people to achieve the same level of competency without the residency as with a residency for many if not most specialties. And the environment nowadays over the past 10 years or so have made it very difficult.






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[dyachei]

I'd argue that there may be a GP with a special interest in something (and practicing mostly that for 10+ years) may be better at it than a board-certified newly minted specialist. But it doesn't matter.

not doing an internship or residency should result in judgemental insults just as choosing to do one shouldn't. Different goals.

 

[katatak]

I have a related question. For those of you that have graduated and are out in the real world (or getting ready for a Red Sox game), if you didn't have debt would you still not do it over again? Also which route would you consider post graduation? Starting to work right away or internship?

Thanks!

 

[CalliopeDVM]

Clearly, someone who spends 3 years in a cardio residency is going to be far superior in cardiology than others who have not been through a residency. Same with radiology, dentistry, surgery, whatever.

I don't think it's clear at all.......if a vet has done significant continuing ed, spent the majority of their clinical time doing X, and done it for 10 or 15 years, I think it certainly is possible to be as good as someone who's been through a residency and had a couple of years in clinical practice.

 

[WhtsThFrequency]

I don't think it's clear at all.......if a vet has done significant continuing ed, spent the majority of their clinical time doing X, and done it for 10 or 15 years, I think it certainly is possible to be as good as someone who's been through a residency and had a couple of years in clinical practice.

I would wager that this is extremely dependent on specialty. For things like internal medicine and surgery, I would be inclined to agree. But others like microbiology, radiology, pathology...no GP is ever going to have the time, formal training, or the (essential) diversity of caseload to be equivalent to a specialist. And that's not me acting high and mighty (hell I probably couldn't even spay anything anymore, lol) it's just a fact.

 

[Minnerbelle]

I don't think it's clear at all.......if a vet has done significant continuing ed, spent the majority of their clinical time doing X, and done it for 10 or 15 years, I think it certainly is possible to be as good as someone who's been through a residency and had a couple of years in clinical practice.

I think we're going to have to agree to disagree. I know there are nonboarded people who are good at doing laminectomies, echos, or exams with slit lamps or whatever, and they may have a great success rate. And *maybe* they are even better at those than someone who's finished their residency. I don't think there's really any point in arguing over that because I don't think there's anything that anyone can say to convince anyone on either end of the fence to believe differently.

But those same people are not also doing MRIs, pacemaker placements, or phaecos. And even less likely craniotomies, VSD occlusion, or parotid duct transposition or whatever else they do.




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[DVMDream]

In all fairness, I don't think we're all talking about the same things. I think we all need to stop taking things so personally (that is, unless someone is actually insulting what you're doing). I think rdc was clear in saying that residency training in X specialty was going to be superior to any level of experience obtained by a GP in that specialty (not veterinary medicine overall). Totally a tangent and nothing to do with the previous discussion on handling emergencies.

Clearly, someone who spends 3 years in a cardio residency is going to be far superior in cardiology than others who have not been through a residency. Same with radiology, dentistry, surgery, whatever. You can have a huge interest in abdominal ultrasound or whatever and do it on ten animals a day, but you sure are not going to see the caseload of difficult cases you need to see to become an expert without the high volume referrals that a radiology resident sees. Nor will you be studying the theory and publications about it to the extent that a resident is forced to.

Can a non boarded person become "just as good as" a specialist at certain things? Yeah absolutely. A spay/neuter vet I'm sure will be the most efficient at a spay with probably the smallest incision with the patient none worse for the wear. But that's a stretch from saying that vet is just as good a surgeon as a boarded surgeon. I'm sure there are some GP vets that are great at lateral sutures or whatever. The difference in the boarded specialist is the depth and breadth of expertise they have in that particular field. You can't expect a non-boarded person to have that. That would be insane. While it's true that the founding members of different veterinary specialty boards were "grandfathered" in and were essentially self made people, the standard of care of those specialties tend to ramp up exponentially after that. So once the colleges and residency programs have been well established, I think it becomes difficult for people to achieve the same level of competency without the residency as with a residency for many if not most specialties. And the environment nowadays over the past 10 years or so have made it very difficult.






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I was kind of trying to say this same thing but probably just did a really ****ty job at saying this. Basically, I agree with the above.

 

[CalliopeDVM]

I would wager that this is extremely dependent on specialty. For things like internal medicine and surgery, I would be inclined to agree. But others like microbiology, radiology, pathology...no GP is ever going to have the time, formal training, or the (essential) diversity of caseload to be equivalent to a specialist. And that's not me acting high and mighty (hell I probably couldn't even spay anything anymore, lol) it's just a fact.

Yes, definitely -- for the clinical specialties. It is also hugely dependent on location......a vet who wants to focus solely on surgery (or ophtho, or derm), for instance, will get a huge caseload from local and region referrals in places where there aren't any specialists nearby (within at least 2-3 hours +). That vet might be the only one who knows how to use an U/S, or have the only dental x-ray machine, or be the only one with orthopedic surgery equipment, etc. in the region.....combine that with motivation and continuing education, and they can get to be very, very good at those things.

 

[Trilt]

Yes, definitely -- for the clinical specialties. It is also hugely dependent on location......a vet who wants to focus solely on surgery (or ophtho, or derm), for instance, will get a huge caseload from local and region referrals in places where there aren't any specialists nearby (within at least 2-3 hours +). That vet might be the only one who knows how to use an U/S, or have the only dental x-ray machine, or be the only one with orthopedic surgery equipment, etc. in the region.....combine that with motivation and continuing education, and they can get to be very, very good at those things.

We have a local non-boarded vet whom the school refers dentistry cases to when we don't have a dentist, because I think otherwise the closest is 3ish hours away. (This is, of course, assuming the other services give a damn about the condition of their patients' mouth... mild pet peeve).

I know lots of local clinics who do the same, even when the school does manage to have someone boarded around. So I think, like you're saying, it just really depends on the specialty and availability of services.

 

[lei325]

I have a related question. For those of you that have graduated and are out in the real world (or getting ready for a Red Sox game), if you didn't have debt would you still not do it over again? Also which route would you consider post graduation? Starting to work right away or internship?

Thanks!

Without the debt, probably. Financial stress is a huge part of my decision making process at the moment.

 

[nyanko]

I'm not even sure why there is an argument here about the merits of doing a residency in today's specialty climate. I can only speak for one field (one that has both surgical and medical aspects), but it's borderline insanity to suggest that there's not going to be a huge gap between a residency trained (actual) specialist who deals with the entire nervous system and someone with a special interest who's gone to a lot of CE and can do a fast, clean hemilam or whatever. Maybe this gap was smaller with all the founders who were grandfathered in, but today? Don't be ridiculous.

edit: I guess it boils down to if you want to specialize in most fields, you do a residency. Even if 30 years ago none of the founders had to, you do now. This is the most efficient and most regulated way to ensure that specialists have a baseline level of competency.

And if I didn't want to specialize and wanted to do GP, there is no way in hell I would have done one internship, let alone two. That's my take on that.

 

[CalliopeDVM]

I'm not even sure why there is an argument here about the merits of doing a residency in today's specialty climate.

What it "today's specialty climate"?

 

[chickenlittle]

What it "today's specialty climate"?

Not sure what the other poster meant, but there are 3 specialty hospitals within an hour of my semi-rural clinic. Clients have a lot of options and I would never recommend referral to a non-boarded specialist for most things.

There are 2 exceptions. 1) A guy who does TONS of exotics at regular GP prices. I always recommend the boarded specialist first many clients decline due to the higher exam fee. 2) An ABVP vet who does TONS of ultrasounds... I'll send patients to him that just need an ultrasound (ie. 'Is there a liver mass? If so, please aspirate') without full ACVIM workup & treatment.

 

[TerraVet]

Eek.

As someone about to start their first year in vet school this thread definitely put a damper on the "OMG SQUEEEEEE" feeling I've been experiencing. I got into vet med after ruling out several other careers I tried over the course of 4 years, and I've worked as a tech for 4 years since then and have at least an idea of the (sometimes significant and overwhelming) downsides of my path. I'm sure I'll discover more in the future, but I'll have to wait a few years to find out.

Most vets I've worked with have said they would do it over. A few clearly didn't like the career and were actively searching for alternatives, but that was probably 2/13. Of course, none of them are recent grads (all 10 years out) and none had the substantial bone crushing debt current grads face.

I do sometimes wonder if there was a way to fix some of the cultural problems the field faces (underappreciation and low pay). I occasionally fantasize about an PSA/educational campaign called "why you pay your vet money (hint: because their time and service is valuble)" or, "why you should be nice to your vet and follow their instructions (and yes, they are a 'REAL' doctor)."

 

[CalliopeDVM]

Not sure what the other poster meant, but there are 3 specialty hospitals within an hour of my semi-rural clinic. Clients have a lot of options and I would never recommend referral to a non-boarded specialist for most things.

Very different from my environment......I do a lot of work where specialists are over 2 hours away, and some of the places I work are 4-6 h0urs from a specialist.

 

[LydiaC]

This thread is making me wonder if I should back out of pursuing vet med? I'm planning on becoming a tech, taking on volunteer opportunities to improve my resume, and eventually applying to vet school. But this thread is making veterinary medicine sound like a special circle of hell. Is it really that bad?

 

[katryn]

This thread is making me wonder if I should back out of pursuing vet med? I'm planning on becoming a tech, taking on volunteer opportunities to improve my resume, and eventually applying to vet school. But this thread is making veterinary medicine sound like a special circle of hell. Is it really that bad?

Yes and no, it depends on a lot of different factors. There are a lot of really good places out there, and I feel like most of the key is finding one that fits for you. It is more prevalent to have a bad experience with internships and residencies because they are inherently difficult. And even the best of places will have a few things that don't sit right with you.

I know that's not a super helpful answer, but it's true. Getting as much exposure as possible will help you decide if vet med is right for you. Asking questions about what drives the vets, makes them happy, makes the crazy, etc, will give you some good perspectives.

I've said it here before but who has time to dig up buried posts.... I'm happy overall. I've got a good schedule, my practice has a great team and overall good clients, and my boss is understanding about me having a family to take care of outside work. There's some equipment lacking in our practice that I'd love to have, one thing that I'd change about my schedule, and a few policies that I understand but don't agree with. But because those things don't fundamentally disagree with my core values, they aren't worth leaving over. I deal with them and genuinely enjoy the rest.


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[lei325]

This thread is making me wonder if I should back out of pursuing vet med? I'm planning on becoming a tech, taking on volunteer opportunities to improve my resume, and eventually applying to vet school. But this thread is making veterinary medicine sound like a special circle of hell. Is it really that bad?

I agree with katryn. You have to see if it's the right decision for you, and the only way to do that is getting more experience in vet med. In all honesty, in any field of work it's all about the people you work with and how much work/life balance you have.

 

[Coquette22]

I have a related question. For those of you that have graduated and are out in the real world (or getting ready for a Red Sox game), if you didn't have debt would you still not do it over again? Also which route would you consider post graduation? Starting to work right away or internship?

Thanks!

If I had no debt at all*, would I have done an internship? Eh... I don't know. I probably still would have gone in to general practice right away because I wouldn't do an internship without having an end specialty in mind and I have yet to find a specialty I'd like to do. I still like the variety that being a GP offers me. And I have reasons of location as well; there aren't any internships or residencies (or call for specialists) in the province I want to live in.

*My debt is significant but pales in comparison to some Americans.

 

[DVMDream]

I have a related question. For those of you that have graduated and are out in the real world (or getting ready for a Red Sox game), if you didn't have debt would you still not do it over again? Also which route would you consider post graduation? Starting to work right away or internship?

Thanks!

Note: Have graduated, haven't started working yet.

I would probably do it over again if I had no debt coming out. I would still probably go straight into practice after graduation. Reasons being, I have a couple specialties that I would be interested in. I would also prefer to start working and making a decent salary. And it would also just come down to the fact that I was so over the academic side of medicine and I was just ready to get out of there and to private practice (and yes, I know internships can be done at private practice specialty clinics, I still just, I dunno, just got tired of the constant ivory towerness of specialty med).

 

[LetItSnow]

And it would also just come down to the fact that I was so over the academic side of medicine and I was just ready to get out of there and to private practice (and yes, I know internships can be done at private practice specialty clinics, I still just, I dunno, just got tired of the constant ivory towerness of specialty med).

The whole internship vs direct into practice question is also complicated by such diversity in internships along with diversity in private practice.

My situation is direct into practice. But I work alongside specialists and alongside 20+ yr experienced ER docs who have really gone to the matt for me as far as teaching, mentoring, etc. I didn't do an internship but I'd be willing to bet my experience is as good as MANY internships. It is hard to objectively come up with what the "average" internship is vs the "average" direct into practice experience is.....

And everyone's opinion is based off their one experience with only half of that equation.

 

[Liquid_Phoenix]

Nope, I wouldn't do it again.

I knew that the finances of veterinary medicine didn't make sense (although I was fortunate to have a lot of financial support from my parents and therefore minimal debt, so I was in a much better position than most people) but I thought the other intangible factors would make up for it. I thought I'd be 'doing what I loved,' advocating for animals, working in a great environment, helping my clients, etc etc. In other words, I guess I sort of felt like I'd be performing some sort of public service that I'd feel so passionate about that I'd be okay with the low pay ($45k at my first job). Kind of like working in social services, the ministry, etc.

Then reality hit. Yes, I try to advocate for the animals, but I have to be extremely careful because doing so often puts me in an adversarial relationship with my clients. Maintaining a positive relationship with my clients often means going against what's best for the patient. It's a constant tightrope walk and sometimes it feels like you just can't win. For example, urinary issues in young cats are almost never caused by infection. Your best chances at treating urinary issues in a young cat are increased water intake and environmental modification to decrease stress.... so that's what I need to focus on, if I want to advocate for the pet. The clients, however, don't get that. They want antibiotics because a) that's what is done in people, b) that's what the last vet did. No matter how many times you try to tell them that signs will resolve without antibiotics, overzealous antibiotic use contributes to superbugs, etc... they still want their antibiotics. So you're stuck. And that type of situation comes up several times every day, with all sorts of other conditions (the client who just wants steroids for his allergic dog, the client who refuses behavior modification and only wants pills for her dog's anxiety, etc).

I guess I didn't expect that, because the vets that I worked for before vet school were all the type who WOULD have given antibiotics to the lower urinary tract disease, steroids to the itchy dog, and drugs to the anxious dog..... and either they didn't know or just didn't bother telling me that those treatments weren't the best options and could potentially have negative affects.

At the risk of sounding silly, I guess I expected to feel more like a 'hero'.... like I was making this huge sacrifice to be a vet, but I was doing it for the good of the animals and the clients would recognize that and appreciate that. Instead, I spend much of my time hearing how I'm money-grubbing, making up things like heartworm disease, lying when I tell people that quality commercial pet foods are better than raw foods, etc. I've worked in several different clinics and each has their own issue (at my current job, the clients are mostly on-board with heartworm prevention but LOOOOVE the local pet boutiques and ferociously defend their awful food recommendations), but overall I guess I just didn't expect to be so unappreciated at work. Then you go online and see articles about how much some people actually DESPISE veterinarians (or your friends let their own anti-vet beliefs slip out in conversation) and it just sucks.

I wouldn't do it again. I'm actually looking to get out of vet med soon ( or at least cut back to part-time on the vet thing and find something more rewarding to do with the remaining hours in the week). My husband and I are trying for a second child and my clinic's policy is that they don't hold jobs for maternity leaves - they'll look for a replacement and only take me back if they haven't found anyone by the time I'm ready to return to work. Totally crappy, but legal.... and maybe that will give me the kick in the butt that I need to get out of this field.

For every bit of wisdom in this response, I commend you. You are right in the views and feelings from clients, but you are not right that you are not a 'hero'. Staying true to your recommendations of treatment for your patients is your top priority and it is very obvious from your words how much you truly care about your patients.....THAT IS A HERO. You care about that they are eating the right kinds of food and not suffering from Cushing's disease years later from the doses of steroids their owner knew they "just had to have to relieve the itching". Client education is the 2 MOST IMPORTANT words in this field. Clients need to know WHAT these medications/food cause and WHY you do not recommend them. If they then choose to not abide by your recommendations, do not blame yourself. If I have learned anything in this field, it is that you can only offer the best treatment plan in the world, but it is up to the client as to what they choose to do or what they can afford...we can only persuade them so much.

My suggestion to you....find a clinic with more DVM's who share your views on how to treat their clients and their "babies". If you have the ability to leave where you are now, I hope you have the ability to find a place that you WANT to work at. If you can't find it....start your own practice. I know there are more DVM's like you because I have had the pleasure of working with them. This field lacks the kind of veterinarians who care and are truly in it for the animals...please don't give up. It is obvious to me that you are one of the "good ones".