by Andy Mathis DVM
Veterinarians and veterinary medicine have an image problem. The general public sees us as “greedy bastards that only care about money”. Which isnʼt true. No one goes to vet school to get rich, but that is the stigma we are dealing with. Having read social media posts and comments made by people throwing our profession under the bus, I knew this. But even I was surprised how vast this (incorrect) perception truly was until I started getting emails and messages after a good samaritan case went viral online in Feb. 2016. 9 out of 10 messages and emails had the same, and similar sentiment - ʻwe wished more vets cared about their patients”, “we wish more vets were like you”, “my vet treats me like a commodity”, “vets only care about money and getting paid”. Different versions and yet the same.
Dr. Mathis in the video that went viral
Which isnʼt true. Iʼm like every other veterinarian out there. On some days, Iʼm trying to pay the bills to keep the doors open, and on other days, trying to save everybody. Those two objectives are often on opposite ends of the spectrum.
So why does the public get this wrong? They donʼt know medicine, so they are coming to this conclusion and belief in other ways. And if they canʼt judge veterinary care based on medicine and quality of care, they judge it based on price and personal experience.
Some refuse to believe that veterinarians care about their patients. Others, since they donʼt know medicine, donʼt understand and canʼt see that a vet cares. And the third reason, veterinarians have trouble communicating that they care about their patients.
And thatʼs because of the curse of knowledge. We know medicine, but donʼt realize how little clients do, so in trying to explain things, they are left confused.
Another factor that happened when the internet came around, was that we had our revenue streams and profit taken away, or we gave it away, depending on how you look at it, by online pharmacies. And for those in general practice, more profit was taken away with vaccine clinics and spay -neuter clinics. The profit that paid salaries and overhead. So a client that went to the vet for a sick patient before all this, might have paid $15 for an office visit. Today, they might pay $40-45 for the same service. In their mind, that makes us greedy.
So what does this have to do with the mental health and well being of veterinarians and veterinary staff? A lot actually. Much has been written about how those in the vet med profession are more likely to suffer from depression, anxiety, burnout, and even suicide.
Many new graduates come out of veterinary school with a huge student loan burden to deal with. Practice owners are trying to figure out to pay the bills, cover everyoneʼs salaries, and deal with unrealistic client expectations. It creates a stressful environment.
The Bayer Veterinary Study came out in 2011 and 2014 and looked at the reason why people quit going to the veterinarian. But it didnʼt offer much insight into how to fix the problem.
The other problem- not all clinics are affected. Some clinics are busy and doing well, while others are struggling to attract clients. It has nothing to do with medicine. Specialty practices are a little bit insulated, but they will be affected if general practices close. For those affected, the solution is smarter marketing. Giving clients and potential new clients, a reason to pick you over some of these other options.
As Seth Godin has said, People donʼt buy goods and services. They buy relations,
stories, and magic.
If you find yourself struggling in practice- whatever the reason- take a step back and look for the source. For every problem, there is a solution. If you are not happy dealing with clients and staff, set some boundaries, and enforce them. If you are struggling financially, perhaps you have a visibility problem with not enough appointments. Not enough people know that you exist, where you are, or why they should choose you.
Look at both your online and offline marketing collateral with a critical eye to determine what needs to change to attract your ideal client. Your website, your social media accounts, your in-office interactions between clients and staff. Sometimes its difficult to see the forest for the trees, so to speak, so it might be helpful to seek the advice of an outsider.
Your zone of genius is a mix of your talent and skills, your knowledge, and your life experiences. When clients show up there itʼs a win-win for everybody.
Posted by Abby Whiting
We are excited to share with you a FREE webinar CE opportunity: Healthcare Provider Mental Health: Building Resilience and Preventing Suicide! This event is made possible through the generous commitments of The Pet Poison Hotline and AVMA Life. Join us in NOMV nation and sign up for the webinar today! The actual event is Thursday, April 19, 12:00 pm CST. follow the link for more information.
Here’s a common situation veterinarians will find themselves in:
I’m a new graduate and I got a job offer. The money is just OK and I know there’s better practices out there, but it’s near where I want to live and, well, if I don’t accept the offer, what if I don’t get any other offers.
6 months later… I used to love veterinary medicine but now I hate it. I dread coming to work and I really don’t get along with some of the other vets because they expect me to do things I don’t feel are right. But I don’t know if I should leave. I’ll feel like a failure if I quit. Why can other people handle this and I can’t? What’s wrong with me?
My first job was one of those overworked, underpaid, zero life outside of work, physically exhausting ones that also challenged my ethical beliefs and practice standards (small town mixed practice). My boss was great but I was clearly not meant to be there. It actually took a really good sit down between me and my boss with a mutual agreement to this fact, and I am grateful to her that she respected me (and the health of her practice) enough to help me.
I didn’t know what I was supposed to do otherwise but I knew I wanted to go back to the ocean and hadn’t seen my family in such a long time, so those values took priority.
During my transition I sat down and wrote a list of "my practice philosophy". It was about how I believed I should practice medicine, how I felt my clients and patients should be treated and how I felt I should be treated. A little like when you've been single awhile and make a dreams and deal-breakers list. Only you make this list with lots of consideration for yourself and don't drink a bunch of wine first. And never make it out of anger. I promised that for my job search this would be my guiding light.
My next job was really great. All of the vets practiced to such a standard that I would feel comfortable letting them do anything with my pets if they were in trouble and I couldn't be reached. I also felt comfortable leaving my patients with them when needed. The support staff were great. What made the difference was that I went into that set of interviews with that paper of my practice philosophy in my hand and I pretty much interviewed them. It helped that they had a defined set of goals and standards themselves.
I left that job for family reasons, plus I realized I couldn't be on call any longer and stay healthy, but that 7 years made me a better vet because it was a good environment medicine-wise. There were a few hierarchical things that went on and now that experience has added to my new practice philosophy to treat the younger vets well.
I would encourage any vet, no matter of what type of practice, to take some time through this exercise. You can wing it and speak from the heart, or you can look for processes that others have developed (I’ve created Desire Maps in the past). We take jobs based on pay or just the fact that someone wanting us makes our imposter syndrome slightly less evident, but we would never make a major investment like this anywhere else in life without a list of values. I even had a deal breakers list for buying a new car that took more consideration than when I found my first vet job.
I've been feeling for a long time that our profession is broken. I have my theories on why, and I'm sure some of you do as well. Maybe if we value ourselves enough and choose our work for the right reasons we can have a future that I like to call "humane treatment of vets". Now that I'm in a position of interviewing vets (although I'm not owner) I make it clear what the clinics philosophy is and try to get deeper into the vets I'm interviewing.
As a manager, I’ve never yet held a job interview with a prospective veterinarian who had a solid set of values. I always ask the question though, and inevitably catch them off guard. We discuss it and the biggest thing that comes out for it for me is how much I learn, if I listen (that’s the trick). Skills can be taught, values are innate. The values will be the reason why people stay, leave, or open a successful practice down the road from mine. These values also teach me what kind of human I’m going to be spending my time with, passing my cases on to, and leading to future success. They remind me that the DVM and piece of paper sitting in front of me is actually human and it creates more respect. Most of all, they remind me of why I chose this career in the first place since sometimes that gets lost in the stress of it all.
I would encourage every veterinarian to write a practice philosophy on your CV or cover letter. It will make you stand out, make the employer think about this when they are meeting you (and anyone else) and allow you to create value that you are more than just a DVM and a heartbeat. You are a caring, life-saving, motivated, hard-working, amazing human being, who also needs to care for yourself!
We all have values, we can’t be too scared to express them. Being human and setting standards is a strength, and trust me, if people don’t want to hear about your values, they’re not worth your time.
Link to The Desire Map:
By Dr. Heather James
So I feel like I need to write something to people struggling with the “I feel like a failure because I lost a patient” guilt/shame enough on this board that I’m going to make a new post just so my thoughts aren’t buried in a reply thread.
I struggle with it still but please try to remember how much good you remarkable minds do for this world.
My latest version replying to an anonymous post is copied below, (edited to be less specific to that post.)
I hope every one here knows that what you do is literally awesome, in the truest biggest sense of the word.
“YOU ARE A BADASS WARRIOR HEALER.
YOU WERE/ARE FIGHTING AN UNRELENTING, COLD, INEXORABLE ENEMY THAT NEVER QUITS.
YOU WERE BATTLING DEATH. FFS.
Most of the time- fuck, most of the time- we lose.
It is the worst thing about medicine— we are fighting what is almost always a losing battle.
But it is a deeply noble and necessary fight. It is a gift to the world to pull on your coat and wade back in to the battlefield.
And you did it to the best of your ability.
Not only should you not be feeling like a failure— you should be fucking proud. Hell we are ALL proud of you.
You hold your head up— you stared death in the face and fought until you couldn’t fight anymore. That’s fucking HEROIC.
Shame on those who belittle your efforts. They are unworthy of your awesomeness.
So, how do you move on? One step at a time. One case at a time one differential and one diagnostic. One tiny win at a time.
But never forget you are a brilliant mind doing important good in the world. No matter how many complications. No matter how many time we lose. No matter how many times we fall.
The winning comes when you decide to get back up. Stand up.
Stare that heartless bitch Death down one more time. For your patients. And for the joy and the love and good THEY add to the world.
You’re a warrior for those who can’t fight for themselves. Always.
You/We are part of the 0.03% of people with the brilliance and know how to push back against death. Thats truly amazing.
You/We (ALL OF US) are amazing.
Always remember that.
And the rest of us are here if you need us.”
by Monique Koll, DVM
Do you know what mindfulness is? It is “the psychological process of bringing one's attention to the internal experiences occurring in the present moment, which can be developed through the practice of meditation and other training.”
It has been proven to be a valuable practice for improving the cognitive symptoms of depression, such as distorted thinking and distractibility. It helps individuals recognize these more subtle symptoms, realize that thoughts are not facts and refocus their attention to the present.
Meditation is a way to practice mindfulness, which can be difficult when you’re distressed, as it is hard to break that one-way train of thought. I find that guided meditations are a great entry point in a way to start practicing mindfulness, and Tara Brach was recommended to me by a double-Mastered practicing mental health specialist. Here is a link to her website and some of her meditations.
We're very pleased to announce the launch of MightyVet!
MightyVet is a movement to help further education and mentorship for all veterinary professionals. The MightyVet website will provide free RACE certified CE, access to mentors in the field, and much much more!
Please join us in helping our community become the best version of itself!
Sign up to receive more information at www.MightyVet.Org
by Dr. Monique Koll DVM
Hi, I’m Dr. Monique Koll, a USA licensed and accredited veterinarian since 2005. I’ve been in small animal day practice for years and now do full time emergency medicine.
I also spent 5.5 years in nonhuman primate research, which ended when a C7 incomplete spinal cord injury paralyzed me when I was hit by an unlicensed/uninsured driver. All that, on top of being a single mother, in an incredibly abusive relationship and high student debt, and I’ve been through suicidal thoughts and financial struggles and all of the above. I’m lucky; I’m only partially paralyzed and can practice again, I had good support and now am in the healthiest relationship of my life and my son has actually benefited from what we’ve been through and is emotionally mature and well grounded.
My injury, and subsequent determination to still race half marathons and triathlons, has earned me a spot on the Today Show, as well as a couple of times in the Huffington Post, and several television, news and blog interviews on a local, national and international scale. Being from New Orleans, I am the epitome of outspoken and non-judgmental. This inevitably led to me becoming involved in “active transportation” and worked with my local and state governments to help change rules to benefit society. I’ve written several articles and have given several speeches to this end, and while city planning and transportation is still a hobby of mine, veterinary medicine is my first love and I want to use my spare time and resources to support our profession. I am dedicated to do what I can to help our mental, emotional and financial health, and the best way I can help at this time is to contribute to NOMV’s blog. Overall we will come through this a stronger and even better loved and respected profession than before, and I want to be part of that. If you have any questions or concerns, any general or specific topic you’d like more information about; if you see a media piece you think may be helpful or even have something you’d personally like to contribute, please let me know via Facebook or firstname.lastname@example.org
I am excited to work for and with all of you.
Monique Koll, DVM
For those of who know me, know I am obsessed with the 10,000 hour rule. A theory I learned about from Malcolm Gladwell’s book Outliers. To simplify: it states humans require 10,000 hours of exposure or practice to become proficient at anything…proficient meaning within the middle of the bell curve, or in middle school terms; a C average.. Those who know me also know I am fascinated by the far right of the bell curve…the top 2%: The “Outliers”: the Beatles, the Bill Gates, the Phil Jackson...the beyond expert level dots on the graph.
I was not always a super hero vet. In my former life (IE my twenties) I was in entertainment management. Now when I say that, it has no real meaning for most people…but most assume I was an actress, a singer, or a rock star. Far from true. I managed logistics and people for entertainment ventures like plays, Broadway style musicals, operas, Shakespeare shows, rock and roll, country music etc. I worked “behind the scenes”. The job sounds really romantic and fabulous…it was a fun job…but not glamorous or exciting as it sounds. But it was my training grounds. It was the location of my first 10,000 hours.
What I know for sure: I know that it takes 10,000 hours for any of us to begin to become really good at anything…and that When God giveth he can also taketh away. I have had the pleasure of working with some truly gifted and talented artists, directors, producers, and musicians over the years. I have seen firsthand, how when you are truly gifted at one area of your life, there is a good chance you truly struggle in another. For example some of the amazing people I worked with lacked completely in social skills, or self-management, or discipline, or impulse control. They would be defined in my current language as, “Difficult or Challenging Clients”. They were demanding, judgmental, entitled, and emotionally overcharged. This is where I became an outlier when it comes to working with hard clients, or tough coworkers.
I was working a music show for a big name…big venue holding 10,000 ticket buying fans one night when in the middle of the first song the star left the stage and locked themselves in the dressing room. They went on to tell me how disrespectful the audience was and how they were not going to perform. Meanwhile on the cell phone: the producer and the sponsors are advising me I work for them, as does the star, and the star has already been paid for the performance and I had better find a way to get them back to playing nice, and they had better put on a show worthy of the ticket price. No problem, right?
The problem with the audience? Well the bathroom entrances and hallways had been covered with hanging black curtains, that billowed when someone walked through, thus letting the fluorescent light shine into the auditorium. “How dare a human use the restroom during a show…how dare they not realize how important I am”. ….Right….I see how you’re feeling says my mouth as I struggle not to slap someone. Moments later my assistant comes running up to me. “ I quit” he says…The star threw the entire glass vase of 24 long stem roses at him and it hit the wall right next to his head…that kid was done. And I gotta say I can’t blame him…we were on an irrational and emotional nonsense ride.
The end of the story is as non glamorous as any other: After letting the star talk and vent and letting them know I understood and I had compassion and empathy…and redirecting them to remember their priorities, commitments and reputation…off to the stage they went. We blamed it on “technical difficulties” (my all-time favorite excuse). To date I don’t think the audience was upset at all…or even realized drama was unfolding. I was exhausted but proud of myself. I demonstrated my communication skills are pliable, fluid, and solid. I had learned how not to give someone else my sanity, or permission to ruin my mental state.
When people find out I am a 2nd career vet they always ask what my first career was…and then launch backward in shock as they truly think one has nothing to do with the other. But I attest…they are similar in some ways. I am a companion animal DVM…I work primarily with people and their “family pets”. These pets are precious to them. Which means in reality I work with “challenging clients”… a lot. As a matter of fact in my practice we have a saying: “This is a Whiting client”. It doesn’t mean I have a relationship with them, it means others find it hard to communicate with them and therefore I’m the pinch hitter, and I’m up. Usually I do rather well with them, and I come out feeling OK…not angry, not disrespected, not frustrated.
I attribute that to my training. I have learned how to communicate with the overly emotional, the irrational, and the emotional terrorists if you will: With the frightened, the insecure, the misunderstood. I have spent countless hours not only practicing my communication in these situations, but also my internal reaction to it. I have trained my brain not to attribute these struggles to myself. Not to see it has an opportunity to let my imposter syndrome take hold. These events are not about me being an inadequate vet, or person …they are about a client in crisis. They do not reflect on me in any way unless I let them. I have learned not to give these emotional terrorists permission to influence my self-worth or my happiness. I have learned not to judge others for their emotions under stress.
I am now just passed 6 years or so in practice full time: I have just crossed my 10,000 hours in practice, and sure enough I am feeling more and more like a functional, and even good doctor. I have a ways to go…but I am wondering if we all could benefit from 10,000 hours in personal wellness and appreciation?
Abby Whiting, DVM
Good morning, NOMV Nation!
I’m back at NOMV World Headquarters @ NOMV Plaza after a great time at the VMX Conference, where I managed to consume, uh *learn*, a great deal. Marshall Tucker is asking me if “I can see” as I write a brief synopsis. Here in the Land of the Fucked, there remains much reason for hope.
1. The power of Community. Everywhere I went I saw people I knew. We talked and laughed and watched the super bowl. We lost our voice from screaming. (I for one got a bruise on my right bicep from it being grabbed every time the Eagles scored.) We are wired by God and evolution to be with others. We are like overgrown meerkats. Even introverts need company at times, before we scurry back into our burrows.
2. The power of a hug. I was hugged more times than I can count with my shoes on. Touch is one of my “love languages”. I’m like my daughter’s dog, Bentley. Bentley is a basset lab cross or something. He looks like his legs are on backwards, with his feet pointed at a 40 degree angle to his direction of travel, but he *has* to be touching you. Hugs are great therapy, whether from dogs or people, but people hugs rock.
3. The power of sharing coffee or a refreshing adult beverage. More than once I spent a few minutes or hours over a hot or cold drink talking and learning about my friends and they me. In learning, we can anticipate and or respond to the needs of our friends.
I’m just a dog doctor, but if I know anything from dogs it’s we need to spend time with people so we know when they need something. Like needing to pee. To learn to read their body language. Some are more obvious than others. Some just quietly stand at the door as if to say “notice me”. We need to learn to *notice* those we know and love.
4. You’ll be hearing more in coming months about the statistics of depression and wellbeing in veterinary medicine. Whatever the stats tell us, behind them are people. People who have their story. Listen to their story. Tell yours. There is bonding over shared stories and in them we realize we are the same. Broken and beautiful. Imaginative and infuriating. In turn, sad and sanguine.
NOMV Nation is now roughly 15,000 strong. Roughly the size of the town in which I practiced. Spread out though we are, we are a community who likes, loves, needs, wants, and cares for one another. We are ALLONE, as my good friend Jason reminds us. We are not a replacement for personal friendships, therapy, or anything else, but perhaps we are a springboard for those things. In fact my life is immeasurably richer because of you.
This is what I learned this week. More important to me than a few credits of CE.
Love alone is worth the fight,
This is my first blog about mental health, and to be frank, it is quite a daunting molehill to climb. I’ve written blogs for clinics I have worked at, some of my favorites called ‘Tick Talk’ with the title being a deliberate play on the sound of time passing. Those blogs were easy to do. Easy to plan. Easy to write. Easy to post.
This one? This is a whole different beast of a blog. I know how to be detached, medical, scientific, sterile. Or as my counselor tells me at almost every visit, I’m ‘really quite great at compartmentalizing’. I’ve had to be able to euthanize a patient in one room, wash my hands (it allows me a moment to wash off the emotions/stress/grief), and move on to a family with their first puppy in the next room. After a day full of extreme highs and lows, taking responsibility for it all, making hundreds of life and death decisions in a split second I go home and leave it all at work. Actually, I found myself leaving it all in the car ride home. Those 20 to 30 minutes became the key time for my brain to unwind and to switch from being the one making all the decisions to being ‘just’ a human again. After all, it’s healthy to take off the superhero cape and the all the weight associated with it.
That was my life. The one I had dreamed of and strived towards for as long as I have memories. I’m sure many of you can relate… We veterinarians tend to be a breed set apart from the muggles, yet so like one another.
One day, 2 years ago, I hit my head. In a freak accident. It should never have happened, but there is no point thinking about the coulda woulda shouldas.
Since then, my world has been dumped upside down and wrung inside out.
There are many sequelae that do their best to suck my soul. However, among the worst offenders is the Isolation. I spend hours and hours alone. From 630am until 630pm my partner is away from our home. He also sleeps from 930pm until 545am. That means that I get, at most, 3 evening hours around him where we are awake. In those hours we eat dinner, clean up the kitchen and by that point I am usually so exhausted/painful/symptomatic that I need to lay down. I can’t carry on conversation coherently any more. It’s cruel, because I want to be able to communicate yet I can barely focus long enough to remember the beginning of his sentence never mind the thread of the conversation.
I have one local friend. She is in her 70s, and we do a short walk together once a week. All the others have fallen away as it became clear my symptoms weren’t going to improve in what they perceived to be a tolerable amount of time.
I have no local family. Our parents and siblings all live a 2.5 hour ferry ride plus a 10 hour drive away. I can’t handle that amount of travel, and they are all too busy to visit me.
I do interact with medical professionals during my menagerie of appointments. I see neurologists, physiatrists, pain clinic occupational therapists, massage therapists, physiotherapists, kinesiologists, a counselor, general practitioners and the list goes on. They see me for 10 minutes or so, and then move on to the next one. I’m quickly a blip in their rear-view mirror.
There are 5 people who still check in regularly with me through various messenger apps.
I share this so that you can see I spend a lot of time Isolated. So Alone. Soul suckingly alone. I share this with you not to be all ‘woe is me’, but rather to make you think. Is there someone with chronic health issues that has fallen off your radar? Sending a text may take you 20 seconds but may well be the highlight of their afternoon/day/week. Reach out. Keep asking people to attend social stuff who have previously had to cancel due to their health. They may not be able to but will appreciate being asked. If you plan to go out for coffee with them and they end up not being able to that day, bring them a coffee instead. Or ask if you can bring them something else. Don’t forget them and add to their Isolation. Make an effort. It may save their life.
But that’s a blog for another day…
Dr. M. Brink