Discharge Notes columnist Dr. Andy Roark is a practicing veterinarian, international speaker and author. He founded the Uncharted Veterinary Conference. His Facebook page, podcast, website and YouTube show reach millions of people every month. Dr. Roark is a three-time winner of the NAVC Practice Management Speaker of the Year Award. Learn more at drandyroark.comRead Articles Written by Andy Roark
I encountered a veterinarian who wanted to sacrifice herself to our profession and a technician who wanted to rebel against it. The veterinarian — we’ll call her Jane — is a full-time doctor, married to a spouse who travels more than 50% of the time, and the mother of a 6-month-old daughter. Her daughter’s child care is located 20 minutes in the opposite direction from the clinic where she works, so her commute is about an hour each way. Jane was raised to believe in the tremendous value of a strong work ethic. Adversity, she was taught, can always be overcome through dogged determination.
For the past few months, Jane has worked a reduced schedule as an associate veterinarian. A married couple owns the practice. The wife manages it, and the husband is Jane’s partner, the other doctor. The manager is pushing hard for Jane to return to work full time, both because the clinic caseload is enormous and because her husband shows signs of severe burnout.
When I spoke with Jane, she was distraught. She had a harder time than anticipated getting child care to cover full-time hours. Moreover, she realized that even if she could find adequate child care, she didn’t have the strength to do everything the practice demanded. But according to her partner and the manager, the demand to return full time was non-negotiable. They insisted she had a responsibility to support the practice and her fatigued colleague. Of course, she understood their position. Jane told me she intends to “suck it up and figure it out,” though she’s unsure exactly how.
The day after I spoke to Jane, I saw a social media post from a veterinary technician that was getting lots of attention. The post read, “When you request time off from work, you’re not asking permission. You’re just letting them know they might want to find someone to cover your shift because you won’t be there.”
The post had about 2,000 likes. The comment section was split between people telling nightmare stories of being forced to work during important life events — a parent’s funeral or a sibling’s wedding, for example — and those questioning how a clinic was supposed to serve clients and create a healthy work environment if employees refused to take a collaborative and flexible approach to time-off requests.
Thinking about the perspectives of this veterinarian and technician, I’m struck by how related they are. To me, they seem like polar opposite responses to the pressing demands of work, and they demonstrate two sides of the same problem: Most of us don’t have a healthy relationship with the profession we love.
A Blemished Profession
I sometimes wonder if I’m the only person who struggles when asked, “Would you recommend veterinary medicine as a career?” I vividly recall looking into the eyes of an eager middle school student and trying to guess how mentally fragile the kid was before I shared truths about the career with which she was enamored.
For me, veterinary medicine is like being married to someone whom you love but who has a habit of making strange choices and irrational demands. Picture a relationship with a wildly eccentric spouse who sings opera at 3 a.m., cries often for no apparent reason and breaks the dishes every night after dinner instead of washing them. The relationship might make me happy for many other reasons. I might love how it’s always full of surprises, but I would hesitate before recommending it to others. That’s how I feel about our profession: I love it, but it’s not lost on me that it is fundamentally flawed and difficult.
Many professions follow simple supply-and-demand economic principles. If the demand for a service increases, the supply decreases as customers gobble it up. Usually, when a service is in high demand, the price also increases, which helps to push the demand back to a level that can be met.
For example, if a baker is consistently swamped with wedding cake orders, he might raise the price until the number of people willing to pay his fee is small enough for him to handle comfortably. At the very least, he will determine how many cakes he can make and stop taking orders after that. What he wouldn’t do if he were a reasonable businessperson is keep his prices where they are, keep taking orders, and work his employees until they quit and he ends up weeping in his car at the end of the day because he just can’t take it anymore.
Deciding to raise prices or cap supply might be tough for the baker, but in veterinary medicine, I’d argue it’s incredibly challenging. In this business, the idea of raising prices to decrease demand or turning away clients because we’re too busy comes with a sense of moral struggle. It’s not that we don’t understand basic economic principles; it’s that we carry the emotional burden of wanting to help all those who cannot help themselves.
It hurts to tell people that their adorable dog will continue to scratch until they figure out how to afford flea prevention for all their pets. Many of us lie in bed at night and ruminate on the pet owners who walked in at the end of the day, on top of our packed schedule, begging us to see one more sick animal after closing time. Whether we sent them away or stayed to help, was it the right decision? The demand for veterinary care is infinite, and it feels like we’ll never be able to fulfill it. That’s the quandary that faces everyone in our profession, and it’s not going away.
Accept The Facts
One of the best pieces of marriage advice I received was to love the person you marry for who they are, not for the person you hope they will become. Going into marriage with the idea that you will change your spouse into someone else is, according to all the people I know who tried it, a terrible plan.
I’ve decided that the advice applies to our profession as well. The only way a relationship with this job can work is if we accept that veterinary medicine is a worthy partner with a major flaw that is not going away. There’s a lot we can change about how our business works, but the seemingly bottomless need for our services is something that will never change.
In the face of that need, veterinarians aren’t going to raise prices astronomically high until we drive down the demand for pet care, nor are we going to callously turn our backs on sick animals and their owners. People called to this profession typically don’t have the capacity for those kinds of behaviors. We wouldn’t be veterinary professionals if we did. So, where does that leave us?
The people in veterinary practices who can set boundaries must do it. In fact, I’d say that if practice leaders aren’t proactively making hard decisions — such as creating protocols for how to address case overloads and clients who cannot afford necessary services — they are abdicating their responsibilities. Failing to set guidelines for these situations amounts to passing the moral quandaries to the front-line workers, who then have to make those choices while looking pets and clients in the eyes. It can only lead to burnout, compassion fatigue and resentment.
Every practice needs clear guidelines and protocols that the doctors and staff can point to when pressed. There should be a plan and a process in place for helping clients who need assistance paying for services, and the plan should not end with veterinarians “just making it work.” The front desk staff should know when to stop taking additional cases each day and what to say to clients who miss the deadline. They should be confident that the clinic has their back — that they will not be overruled if the client goes over their head and appeals to the veterinarian. Organizational boundaries like this are an absolute necessity, and many clinics are overdue in establishing them.
Find the Middle Path
Going back to Jane, the doctor who told me she plans to “suck it up,” and to the technician who is “not asking permission.” I think that, at some point, we have all felt the sentiments both of them expressed. When we are faced with frustratingly high demands, giving in or rebelling can seem to be the two obvious choices. Neither option is quite right, though.
Those of us who want to have a lifelong relationship with veterinary medicine must embrace the path of ongoing compromise while encouraging others to do the same. We can neither martyr ourselves to the cause nor ignore people who need our cooperation. Yes, we must be clear and firm about what we need to be healthy and work sustainably, and we must listen to our colleagues’ concerns.
Jane cannot and should not just “suck it up and figure it out.” From what she told me, there’s no way that barreling ahead with an unworkable situation is going to end well. If her relationship with the practice is to continue, she needs concessions and support. Nor should our technician friend be forced to “stop asking permission” when it comes to working as part of a team. If those clinics want to keep working with these people, they, too, will need to open a dialogue and adjust. They might need to tweak policies to make their valued employees feel as though their personal needs are being met and that their work can fit into their lives.
Sometimes, Just Separate
Part of setting healthy boundaries is being willing to walk away from the relationship if those boundaries aren’t respected. There’s no shame in leaving a relationship that doesn’t (and never will) work for you. As the saying goes, sometimes a good divorce beats a bad marriage. For some, this might mean leaving one practice for another. For others, it could mean leaving clinical practice or the profession entirely. Some relationships are simply not meant to be.
If Jane’s manager and partner can’t work out a schedule that suits her life situation, I hope she finds a new clinic that does. I hope the technician comes to feel heard and respected — and to hear and respect the rest of the team — when she asks for things such as time off. I hope more practices will commit themselves to protect doctors and staff members from the most flawed parts of our profession, even as we acknowledge that those flaws exist. And I hope that all of us can see enough value in ourselves to express our needs, compromise where we can, and enjoy our relationships with the wild and strange profession of veterinary medicine.