The Wagging Tail

Summer is more than half over, and back-to-school time signals the beginning of a busy rush of clients in your veterinary practice. As a veterinary professional, you may begin feeling squeezed, again, with too much to do and not enough time to get it done. This can lead to burnout, a term well known and often used in our industry. Burnout is defined most often as exhaustion of physical or emotional strength, usually as a result of prolonged stress or frustration. ~Figley and Roop, 2006

We all can relate to this, particularly when the work load overwhelms our ability to do it all…and maintain a good attitude at the same time! The good news is that burnout is a process, not an event, and is marked by physical, emotional, and behavioral indicators that can be easily recognized. If we remain aware of our response to the increased workload, we can keep burnout in check by utilizing these coping methods:

• Accept that the situation itself is stressful
• Share your feelings with a trusted friend or colleague
• Enhance your communication skills to lessen feeling of being unheard
• Initiate positive action to change your environment
• Suggest solutions to proper management
• Care for your personal needs (i.e., good nutrition, hygiene, exercise)
• Take time away from your stressful situation, and allow others to help

So then what is this new term, compassion fatigue? As a perfect example, burnout and compassion fatigue were contrasted by member of the “human” medical profession: Burnout results from stresses that arise from the clinician’s interaction with the work environment…while compassion fatigue evolves specifically from the relationship between the clinician and the patient.  ~Kearney et. al., 2009

When the workload is heavy, the hours long, the coworkers grumpy, the equipment shabby, those are all examples of the work environment causing stress, i.e., burnout. But compassion fatigue is different; it’s about personal relationships with your clients and patients. It would stand to reason then that you have some measure of control over burnout. You can use some of those coping methods listed above, and make appropriate changes to your work environment. In fact, you can change your work environment altogether by quitting and getting a new job. Burnout is more about WHERE you work.

But compassion fatigue is more about the work you DO, and as long as you remain in a care giving role, you will need to be able to recognize and minimize compassion fatigue. First, how do you diagnose compassion fatigue? Here are the some of the symptoms:

• Bottled up emotions
• Impulse to rescue anyone (or anyTHING) in need
• Isolation from others
• Sadness and apathy
• Feeling the need to voice excessive complaints about management and coworkers
• Lack of interest in self-care practices
• Reoccurring nightmare, flashbacks
• Persistent physical ailments
• Difficulties concentrating and mentally tired
• Prone to accidents

As you may imagine, these personal effects also spill over to affect the organization as a whole. So how do we change to a healthier emotional status? It’s mainly about sustainable self-care. We must turn our care giving inward to provide for ourselves, so we have the energy to sustain our care giving role in the profession. Here are Eight Laws Governing Healthy Caregiving, from Patricia Smith, founder of the Compassion Fatigue Awareness Project:

• Sustain your compassion
• Retain healthy skepticism
• Learn to let go
• Remain optimistic
• Be the solution
• Embrace discernment
• Practice sustainable self care
• Acknowledge your successes

Resources:

• Compassion Fatigue workshops and webinars at http://www.katherinedobbs.com/
• Compassion Fatigue discussion forum at http://www.compassionfatigue.org/
• Compassion Fatigue in the Animal Care Community, a book from the Humane Society
• To Weep For a Stranger: Compassion Fatigue in Caregiving, a book by Patricia Smith

How many of you are smiling and enjoying work right this minute?  Come on. Let’s be honest: you are reading this BLOG which means work is not stimulating you.  Are you really excited to go to work each day?  How great would it be if you laughed at least once every day at work?   Do you work better if you are having fun?  I think so. Veterinary medicine allows me to help Pets and that is what I live for. But of course, it can be very stressful dealing with disease and illness.  I hope each day that my work fulfills me, but let’s face it, it is easy to get drained.  So how do I keep my bucket filled?  The answer is simple: HUMOR.

I try infusing a little humor into everything I do.  Here are a few ideas to help your team get through the day.  PLAY WORK BINGO:  Simply fill out a few cards for your team members with spaces that have items such as “answered the phone in 2 rings,” “made a client smile today,” “signed up a Pet on a wellness plan,” etc.   Once the card is full, the team member yells bingo and gets a prize.  PLAY WORD INFUSION:  First pick a product such as Firstshield and offer a challenge to your team who ever is able to infuse Firstshield flea and tick education into the most client interactions today gets a Starbuck’s coffee break. Finally, my favorite game is SPECIMEN KING, where  each associate saves the best or weirdest or grossest specimen to show the doctor. 

Fun can be a great motivator, release tension and even create communication and trust. Enjoying work can lead to productivity, higher retention and owning your place of business.  I work harder when I am having fun. So then next time  you are at work I challenge you to try a little levity. Maybe tap a co-worker on the shoulder and yell “TAG YOUR IT!” and run away.  Think about it.

For the first time in the history of the veterinary profession, there are more female than male veterinarians.

Almost 80% of new veterinary school graduates are now female.  

Fewer veterinarians are going into large animal practice.  

Fewer veterinarians have practice ownership as a goal.  

Many have speculated on how these changes will affect our profession overall.  I can not speak for all veterinarians, or even all female veterinarians of course.  But I can, as a female veterinarian, give my perspective on some of the issues we as individuals and a profession have before us.

I will start with what I know best, my own present experience, and work backwards to when I first knew I would end up here, though I did not know exactly what this would look like.  Today, I am a female veterinarian in my thirties.  I graduated in 1998.  I am a wife and a mother of two daughters.  I love our profession.  I love my part time job and the family-friendly hours that I work.  I need you to understand that I am as hard-working and dedicated to veterinary medicine as you are.

I am a small animal veterinarian in the city.  I apologize for not being the buyer for the practice on which you are relying for retirement.  I apologize for not taking over the care of the large animal patients you now tend, or being there for the small town whose veterinary needs you have met for all these decades.  I need you to figure out a Plan B. 

I am home with my newborn on maternity leave.  It is my first time away from full time veterinary work since I started my career.  I need to be included in team meetings and continuing education opportunities, and to be kept up to date on cases we treated together, and told about new cases you are seeing. 

I am only a few years into practice and considering starting a family.  I need you to consider flexible schedules or job sharing or part time employment as I look forward to my new life as both a mother and a veterinarian.

I am a veterinary school graduate searching for my first job.  I do not expect you to ignore the possibility that I may decide to procreate at any time, but I do not want to be interrogated about my family plans or asked to make promises that have no bearing on whether I am the best person for the job you have available.  I need you to believe me when I say that I will give your practice my very best if you hire me. 

I am a twelve-year-old girl in your waiting room with my sick friend in my lap.  I want to be like you when I grow up.  I need you to tell me that even though you do not know exactly what that will look like, you do know that it is possible.

I am the future of veterinary medicine.  We are the future of veterinary medicine.  I need you to walk through this new chapter of our profession alongside me.  We will combine our strengths and work through the upcoming challenges, making our profession better than it has ever been.   Even though I do not know exactly what that will look like, I do know that it is possible.

If you haven’t actually started an official gift list, you’ve more then likely begun thinking about what you want to do to show your friends, family and co-workers that you care for and appreciate them this holiday season. But loved ones aren’t always the only ones on our minds this time of year. Many of us feel a tug at our hearts, a heightened sense of awareness for the less fortunate, including “the forgotten ones,” the well-deserved Pets who have no one to take care of them. Given this, I thought it would be appropriate to share some great ways to give back to the Pet community this Yuletide season.

Consider volunteering a few hours at your local animal shelter.

I know you already spend a ton of time with animals, but volunteering at an animal shelter can do a lot to brighten an animal’s day, not to mention provide well-deserved relief for a weary kennel worker. And if you have a niece, nephew or children of your own, bring them along! Giving back will give you the satisfaction that only comes from helping others, (not to mention get you in the holiday spirit) and will set a philanthropic example for our rising citizens.

Be a part of the Season of Suppers Campaign.

Banfield Charitable Trust (BCT) and Meals On Wheels Association of America (MOWAA) are teaming up this holiday season to help homebound seniors feed their pets. Helping keep companion Pets well fed, healthy and part of the family for as long as possible is the primary focus of this initiative. You can donate Pet food or money at your local Banfield hospital. You may even want to support a Season of Suppers fundraising event in your community. All proceeds will be donated to the Season of Suppers Campaign.

Give to your favorite Pet-focused charity.

There are tons of them out there, so I did a little research and came up with six well-deserving and reputable organizations worth considering:

• The American Society for the Prevention of Cruelty to Animals
• Humane Society of the United States
• World Wildlife Federation
• Dogs for Deaf and Disabled Americans
• Delta Society
• National Association for Search and Rescue

Hope this information is helpful. Remember, even the smallest of efforts can bring about a measurable difference in quality of life. If you have a few minutes, I would love to know how you plan to give back this holiday season.

“There’s only so much I can do!”  How many times have you wrestled with the feeling that you didn’t accomplish enough?   At the end of the day, you think about the patients and clients you interacted with, reflecting on whether or not you did everything you could to measure-up to your standard.  Your mind then shifts to a conversation you had with a team member that morning, and you question the way you handled the exchange.

Dealing with sick animals, bereaved clients, newly hired team members, managing the practice and trying to be the family person you want to be is a tall bill.  Being a veterinarian is rewarding and yet, absolutely taxing – physically and emotionally at times.  You love, and are devoted to, your family and your job, but the demands of both get to you, maybe more often than you’d like to admit, even to yourself.

Renee Rucinsky, DVM, DABVP, and contributing writer for dvm360.com, refers to the feeling of emotional overload in her article, Compassion Fatigue. What is compassion fatigue?  We know that compassion is about feeling for others while fatigue is related to a lack of energy. Dr. Rucinsky believes that compassion fatigue is a state of complete exhaustion that leaves a person feeling physically and mentally overwhelmed.

No doubt, we’ve all experienced extreme stress at times, but veterinarians are more likely to suffer from compassion fatigue for a number of reasons: 1) the profession inherently calls upon vets to deal with many intense emotions on a daily basis 2) vets are innately caring people which means they feel for others on a very deep level, and 3) vets tend to be perfectionists, which causes them to expect too much from themselves.

What can you do to combat compassion fatigue? First, know the symptoms. In Dr. Rucinsky’s article, her list includes, “excessive complaining, isolation, compulsive behaviors (excessive spending, eating or other addictions), poor sleep habits, poor hygiene, apathy, difficulty concentrating, recurrent infections or chronic aches and pains.” Using a few of Dr. Rucinsky’s techniques as a guide in fighting compassion fatigue, start by saying “No” to stepping out of the exam room to answer that non-emergency client call, and reduce your stress by empowering your team to handle any issues that arise.

There are steps you can take to change things – and that might even include seeking professional help. We all know what’s good for us. Dr. Rucinsky touches upon the usual such as regular exercise (taking a brisk walk during your lunch hour), making healthy food choices (brown bagging it instead of heading for fast food), surrounding yourself with positive people (the vet tech who’s always willing to jump in and help wherever needed), for example.

If you start from within, you can consciously change your attitude — and that’s a good first step to a better outlook on life that will ultimately help you combat compassion fatigue.

Most of us came to this profession as a calling, not as a result of a measured analytical decision process. Veterinary professionals share a sincere, idealistic, and passionate desire to give back by helping Pets and families.  We are excited by the opportunity to participate in that magic bond between Pets and their Pet parents.  It turns out that our choice of profession was not only a sound emotional decision, but also a good rational choice given today’s uncertain and changing economy.

Since 1972, the U.S. economy has suffered through six major recessions.  Through the previous five the overall gross domestic product (GDP) shrank while the veterinary profession grew.  The current sixth recession is once again proving to be kind to our profession.  According to Fritz Wood CPA, CFP and noted veterinary accountant, eighty percent of small animal veterinary practices are continuing to grow despite the current economic climate.

The Pet care industry (of which veterinary medicine makes up the lion’s share) accounted for $23 billion in 2008.  This is projected to grow to $34 billion by 2013.  Currently the second fastest growing segment of consumer spending is Pet care (second only to consumer electronics).

The Bureau of Labor Statistics reports Certified Veterinary Technician as the second fastest growing profession and Veterinarian as the ninth fastest growing profession.  New graduate veterinarians and technicians continue to entertain multiple job offers.

Veterinarians continue to be ranked as one of the most admired professions. In fact, Money Magazine (November 2009) just listed veterinarian as one of the top 25 “Best Jobs” in America. Veterinarians were ranked as an “A” in benefiting society and scored near the top of all careers in job security, personal satisfaction and future growth.

And it just keeps getting better!  The bond between Pets and families continues to grow stronger.  Technology is allowing us to do things we couldn’t even imagine a generation ago, and a huge number of Pets remain in need of quality veterinary care.

The economy will rise and fall, recessions will come and go, but the bond between Pets and families continues to grow, and the need for great veterinary care is stronger than ever.  There has never been a better time to be a veterinary professional!

My husband is crazy about fly fishing. I, on the other hand, am not. Until recently, the discrepancy hadn’t been much of an issue. A combination of luck and cleverness on my part had helped me successfully dodge the fly-fishing bullet since our nuptials, 19 years ago. We had kids soon after getting married, which meant there was little time together, early on—coupled with the fact that we live far away from extended family, and you can see why “together time” was next to impossible. Lucky for me, as soon as my son was old enough to hold a fishing pole, fly-fishing became synonymous with father/son bonding time, which, conveniently, got me “off the hook.”

Now, don’t get me wrong, I’m not a girly-girl who’s afraid of getting dirty or wet or waking up at 4:30 a.m. I’ve avoided fly-fishing for one reason and one reason only: It didn’t sound like fun. I don’t care how beautiful the surroundings, the mere thought of casting over and over again all day made my eyelids droop.

But as it is with everything in life, circumstances change. My children are grown-up and my son prefers to do things other than fish with Dad. He’s now 18 and my daughter is 16, which means we can leave them safely home alone. As soon as this revelation hit, another one rapidly followed . . . my jig was up! My husband’s long-standing fishing partner was no longer a given. I knew it was time to face the inevitable.

I really didn’t want to go, but I made up my mind to do something I didn’t want to for the right reasons. So I put on a pair of my yuckiest sneakers and my best happy face and joined my husband on his next fly-fishing adventure. And you know what? It wasn’t horrible. The anxiety that once surrounded the “thought of fly-fishing” is gone because I understand what’s involved, and I gained new insight into the world and who my husband is now. I’m actually open to going again! In the end, I showed my husband that the second half of our lives together didn’t have to be all about me. I’ve matured and I’ve proved it to both of us!

Why do we recoil at the thought of attempting new things? And why is it we can find a hundred reasons to support our inclination to leave life as it is and not venture out?

The unfamiliar is fertile ground for growth. Maybe it’s time to consider going to a VMA meeting, speaking at a conference, giving a presentation to future veterinarians or organizing a fund raising event for a local shelter. Or maybe it’s time to try fly-fishing. I have found that when I pause to allow myself to be open to a new experience, I’m always happy I did. There is something to be said about taking a risk, creating a little internal friction, and allowing yourself to be open to learning something new. Moving outside your proverbial “comfort zone” isn’t always comfortable, but it can push you to a higher level of success in your personal and professional life.

If you’ve got kids in school — whether they’re big, small or in-between – I’d wager you’re feeling more stressed and overwhelmed right now than most other times of the year – except maybe the holidays. Even if you don’t have children, it’s inevitable that you’ll see clients who are struggling with the stress that comes with this time of year.
Back-to-school time creates an additional “whammy” into what already feels like a hectic lifestyle. And what is it about June, July and August that makes them sail by so effortlessly, then only to meet their ending with such an abrupt exit?

It’s funny because just as soon as you figure out your summer routine and things seem like they’re clicking along, bam! It’s time to once again, re-adjust to a new school year and all that it entails. And when you’re a professional trying to balance two worlds – new bus routes, new teachers with new sets of rules and expectations, homework, daycare and the unexpected minutia that comes-up in the hospital, it can all take a toll on your mental state.

How do you get through this time without making it hard on yourself, your family, your clients, patients, staff and the guy who just passed you without using his blinker? I think it begins with a change in perspective.

It’s important to first recognize that everyone is struggling, trying to make it all work. Consider that frazzled client in front of you in the exam room… What could you do to let him/her know that you understand what they are going through? Even just a knowing smile can help ease tension they may be feeling.

This time of year, it’s also helpful to remember the old saying, “This too shall pass”. There’s a lot of wisdom in those few words. And although school season will always be busy, back-to-school really only lasts a few weeks or so. Taking yourself out of the moment and realizing that this time is short-lived can help you gain a gentler perspective on where you (or your clients) are at this point.

Often times when asked what I do for a living, I respond by saying, “I am a veterinarian.” Then I wonder, What does a veterinarian look like? So I qualify my response with, “I work as a veterinarian.” Either way, the revelation of my career inevitably invokes wonderful stories of beloved Pets. Most people are so happy to talk to a veterinarian! They hold us in high esteem. They smile with pleasure as they share their stories. Who smiles when talking about visiting a doctor? Our clients!

I am proud to be part of such a well thought of profession. I often call myself “The Good Doctor” when I tell people that I AM a veterinarian. And I realize that with my chosen career path comes a certain responsibility to be a part of local, regional, state and national VMAs.
It’s easier as a student. SAVMA is a visible part of our curriculum, and many of us attend the AVMA meetings annually as students. Let’s not forget to do that as graduates! The helm of the associations must eventually pass onto the next generation of veterinarians. YOU are that next generation of bright young veterinarians, and I can’t encourage you enough to become a member of our professional associations after graduation.

Become involved in your local VMA and AVMA. Become a spokesperson in your association that the media can contact for Pet health expertise. Be ready to lobby for veterinary related topics with your local politicos and VMAs. The profession needs you!

Each year, the Georgia VMA hosts a ‘Veterinarian on the Capital Day’ in Atlanta where all GVMA members are invited to the state capital for networking and recognition. On that day, we attend sessions of the state senate and house of representatives, and we receive recognition from each legislative body. When they call us to stand and be recognized as the caretakers of Georgia’s animals, there is palpable pride of self and profession in the air. The governor of Georgia is a veterinarian. He comes down to meet us and takes a photo with the group. It’s pretty cool to be a part of the Georgia State VMA and know that our state values our contribution.

Before you shrug off joining a VMA, think of how you can be a part of representing your profession just by being there. Paying your dues to support your local/state VMA actions will help support our profession in Washington.

When attending AVMA there is such a sense of collectiveness. You look around and though everyone doesn’t look like you, they are you. Those other veterinarians share with you a common thread of education, long nights of study, sweat, tears — and most importantly — a common passion. I not only work as a veterinarian, I am a veterinarian. And WE are our profession.

I have provided financing for the purchase of over 150 veterinary practices and millions of dollars of equipment.  I have reviewed easily five times that number of transactions that never got completed.  As I read through these loan applications, I often ask myself whether the applicants really understand the economics of owning and running a veterinary practice.

There is no real “magic” to understanding the basic economic principles that rule the business side of practicing veterinary medicine.  At its core, you need to be able to generate enough cash to service both your fixed and variable expenses plus provide a return on your investment (the purchase price of an existing practice or cost to set up your own practice).

Fixed expenses are those that occur weekly, monthly and annually and are not related to changes in revenue.  This includes expenses such as rent or the mortgage payment.  It includes other general expenses such as insurance, utilities, office supplies, repairs and maintenance.

Variable expenses are those expenses tied to revenue.  For example pharmaceuticals, medical supplies, support staff labor and veterinary salaries (including that of the owner for their clinical services while working in the practice).

After accounting for both fixed and variable expenses, the “net profit” is what remains.  There are more expenses, however, that drain on net profit.  The most prominent are interest, depreciation, and paying off long-term debt. For an intriguing article about today’s Veterinary Economic Reality, click here

As I review loan applications, one of the first things I review is the applicant’s personal financial situation.  I apply the same criteria to them that I do to the practice they want to purchase.  What are the applicant’s fixed and variable expenses and will the practice they want to purchase generate enough cash to meet those expenses?  What I find to be most troubling is that many veterinarians applying for practice ownership have piled on fixed expenses to the level that it becomes nearly impossible for a practice to support such a cash load.

Take, for example, student debt.  I have seen some students graduate with upwards of $200,000 in loans.  If you see 15 Pets per day, five days per week, for the next 20 years, $5.00 of your Average Patient Charge (APC) is going to have to go to paying off just your student loans!  Add in the home loan (or rent), car loan (or lease), insurance, utilities, food and other expenses and generating a true profit from the practice (a return on your original investment) starts looking more difficult.

There are only two things one can do to control the economics of veterinary medicine.  Either control costs or increase prices (margin).  The idea of personal fiscal responsibility needs to be addressed with students and new veterinarians if they have practice ownership as a goal.  They need to understand that it will take sacrificing the things they want today in order to accomplish the goal of practice ownership in the future.