Monday, August 30, 2021

An Open Letter On Entering a Profession In Crisis.

     Normally, I like to keep it science-y here. As any long-time readers know, I'm very passionate about evidence-based medicine and accessible science communications. This one is personal. Feel free to turn back now. 

    In less than a year, I'll be a veterinarian, but I am already very much a part of this profession. I have been there in the flurry of CPR on a dog whose name I don't even know-- because he arrived already coding. I have spent day after day with long term ICU patients providing nursing support to get them back with their family. I have worked through strings of 14-16 hour days. I have cried alongside people I barely know in the collective grief of providing a suffering animal permanent relief, a safe and peaceful passage to the rainbow bridge. And I have suffered. 

But I've also played with puppies. I've assisted in the wonders of helping new lives come into this world. I've cuddled kittens. I've danced in the play yard with the boarding dogs. I've laughed. I 've worked alongside so many amazing people. I've loved my patients. I love interacting with pet owners. And I love this field. 

    I love this field so much, I'm currently staring down more than $200,000 in student loans-- and that's with scholarship aid! I love this field so much, the mounting debt and the bad days and the sights of suffering and the long hours and the sleepless nights and the grueling curriculum rarely haunt me. I love this field so much, I am at total peace with the awful debt to income ratio that awaits me, burdened with the knowledge that I and my colleagues will be almost certainly overworked and underpaid.

But today I had an experience that shook me. One that was not the first, and will not be the last, and is not unique to me, but that represents a really dark side to being in this profession:

Some of the people whose pets we treat see us as monsters. 

   

This exchange occurred in the comments of a public Facebook post about dog food. The post nor the individual will be named, because that isn't the point. This happens every day to veterinary professionals all over the world. 


At the end of the day ... healthy dogs won't pay my bills. 

There are a lot of problems to unpack with that. And this letter is me unpacking. But first and foremost, I need to make sure it's clear that healthy dogs do pay veterinary bills. Based on data from the 2020 AVMA Economic State of the Profession report, wellness exams produce roughly 20-30% of the revenue in a small animal private practice. Wellness exams are for providing preventative care to healthy animals and keeping them healthy. Even still, there is no need for anyone to purposefully make pets ill in order to profit off of fixing them. There is enough incidental illness, enough trauma, enough toxin ingestion, enough congenital disease, enough infectious disease, for clinics to already struggle to fit everything in. 

With the intellectual problems out of the way, think about the implied accusations here: 
  • A veterinarian will purposefully cause harm to an animal to profit off of the suffering. 
  • Again, she is saying: Vets make pets sick for job security
  • A veterinarian has no regard for their medical oath
  • A veterinarian goes into the profession with one goal in mind: $$$$

    I chose veterinary medicine for a few reasons. When I made this decision, with was after a long discussion with my dad. When I was graduating high school and trying to figure out my future, he told me it will never matter how much money I make unless I am happy while I'm earning it. You can make ends meet with any career, and you'll live within your means, so make sure that you wake up every day and you want to do your job and live your life.  

    When I chose veterinary medicine, I wasn't thinking about money. I was thinking about my love for animals. I was thinking about the call to provide aid and relieve suffering. I was thinking about my love for learning. I was thinking about my love for teaching. For making people smile. For wanting so much to make the world I existed in better, even just a little, than it was when I woke up that morning. A little brighter, a little safer, a little healthier, a little more educated. Veterinary medicine was, and remains, the perfect intersection of learning, teaching, and caring. 

And when I made that decision, I was not thinking about money. When I made that decision, I did not know that veterinary medicine is a profession in crisis. Only 41% of veterinarians would recommend the profession. Among vets under 34 years of age... only 24% would. 

We are in a financial crisis. 
Veterinarians graduate with hundreds of thousands of dollars in debt. 33% of veterinary students graduate with greater than $200,000 in debt. An additional 45% have between $100,000 and $200,000. I'll be a member of the first group. This becomes a problem when veterinarian income is considered: the average new graduate doing companion animal clinical work starts with a salary of $90,000. Graduates that pursue internship? $35,000 is more the expectation. 

When faced with shortfall in their private practice, almost 60% of practice owners said they would compensate by forgoing their own salary. 

There is little to no public funding for veterinary care. There is no ER funded by taxpayer dollars that can see any patient and provide lifesaving treatment without going bankrupt. And so finances become a barrier to care. But that obstacle cannot be overcome by veterinarians working for free. 

We are in a mental health crisis. 
These stats have gone viral in recent years. They don't need to be belabored. Since I have been in vet school (2018) I have seen multiple posts cross my timeline of peers, colleagues, coworkers, or friends from veterinary conferences mourning the loss of a veterinarian or veterinary support staff member to suicide. Data shows that veterinarians, like many healthcare professionals, are at a greatly elevated risk of suicide when compared to the general population. There is no end of proposed reasons for this: the debt, the long hours, aggressive client interaction, online defamation, the burnout, imposter syndrome, guilt associated with negative patient outcomes, access to means, fearlessness of death from desensitization during euthanasia procedures.... one could go on. 

We are in a staffing crisis.
The pandemic has not helped, but this issue is also not new. We are drowning in patients. Inappropriate patient to caregiver ratios are linked to burnout, and as staff turnover increases due to high stress levels, the problem is exacerbated and feeds back into itself. Many clinics are booked weeks to months in advance and struggling to fit in all of their clients, meaning urgent cases must be sent to emergency facilities. In some regions in the USA, veterinary emergency facilities are hitting capacity. 

We are in a crisis of misinformation and distrust of science
There is now near infinite access to obtaining anyone's opinion and experience on any given issue, regardless of their expertise. Every veterinarian has experienced a client trying to tell them that they, the client, know better. Experienced an emergency where a dog or cat has an acute toxicity from a medication they were given by an owner trying to treat at home without seeing a vet. Chronic health issues from delayed medical care. There are entire Facebook groups dedicated to telling people how to avoid the vet and save on vet bills. On how to treat your pet "naturally." There is a distrust of scientific professionals and medical providers that only seems to be growing in the midst of this unending global health crisis that is COVID-19.  It is the root of exchanges like the one above. It is accusations of "Big Pet Food" and "Big Pharma" driving medical advice. It is pursuit of "alternative medicine." It is applying your hard-earned expertise and being told that your diagnostic or treatment plan isn't good enough, having it declined or refused, just to see the same dog or cat a week later, in a much worse state, because the needed medical care wasn't provided. It is mentally and emotionally exhausting. It is unsustainable. And it's why I write. 

I am not in crisis. I know where my intentions and my ethics stand. I know why I chose this profession, and I have chosen it again and again every day on this journey to becoming a veterinarian. The exchange earlier elicited more anger in me than it did grief or despair.

But that doesn't mean that one day, I won't be in crisis. 

That I won't be overwhelmed,

at the end of my rope, 

facing self-doubt and feeling like the world stands against me.

It doesn't mean that I don't have peers or colleagues in crisis- yesterday, today, or tomorrow. 

And if this profession hemorrhages, if veterinarians close their doors, hang up their coats, and seek another career... animals will suffer and there will be no one there to help. 

The message I'm trying to get across here is not that I hate this profession. I love it. I love it so dearly. This is a profession of passion and of commitment and of a faith that we can make the world a better place. The message here is more dire: veterinarians and their support staff need your help. We need your compassion. We need your empathy. We need your patience. We need pet owners to know that we are not the enemy. We are not greedy. We are not monsters. And we would never intentionally harm your pet for the sake of our pocketbook. This feels so absurd to even write, and yet every day I see people shamelessly claim it as easily and casually as one might sip on coffee. We are pet lovers too. We are pet parents too. 

For the clients that do show their veterinary team grace, and it is many clients: We see you, and we appreciate you more than words can express, and you make every day of the job worth it. Truly. Thank you for that and please know that these feelings are not about you. 

But negativity bias is human nature, and it can be so hard to hear a hundred complements through the deafening discouragement of a single scathing accusation. One that cuts to the core of everything you do and believe and twists it into a horror show caricature of what your profession stands for. Of what you stand for. 

If we could do the work we do without charging a dime and still make a living, if we could practice medicine to the highest of our abilities and knowledge without the financial constraints of reality... of course we all would. But that isn't the world we live in. Veterinarians deserve to make a living for the work that they do and it does not mean that they care more about money than they do your pet. 

It just means that we deserve to survive, too. 

Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health and welfare, the prevention and relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge.

I will practice my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics.

I accept as a lifelong obligation the continual improvement of my professional knowledge and competence. 


Not One More Vet: Join the Community
    For veterinary students: https://www.facebook.com/groups/NOMVStudents/ 

Veterinary Interactive Screening Program: Take a questionnaire for personalized assessment and next-step options.   

National Suicide Prevention Lifeline: 1-800-273-8255
Crisis Text Line: HOME to 741741

7 comments:

  1. I am sorry some people really feel this way. They honestly should not own any pets! They don't expect their children or even their own human medical conditions/visits/procedures to be performed for free, do they? This is just ridiculous to even fathom!

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  2. Did you kill healthy dogs during vet school and do exploratory surgeries on them? Did you work with labratory animals - doomed to be afflicted with whatever horrific disease we bred them to have and help kill them during vet school?

    Do you recommend a food that is roughly 50% carbohydrates with synthetic nutrients to replace the meat?

    There is no increase in DCM the giant study on 65,000 dogs already demonstrated that! And you still can't explain how Purina's grain-free with only 38% of the protein in it coming from meat is not causing DCM but TOTW with 78% somehow is. And that your opinion flies in the face of respected nutritionists.

    Ask yourselves those questions and wonder why patients no longer trust vets to help their pets.

    Do you speak against the breeding of extremely brachycephalic dogs? Or do you encourage people to go to a "good breeder" who selects for deformed dogs? Vets don't speak out on this at all. One vet already wrote an article that when he sees a Frenchie puppy he sees dollar signs.

    Recommend yearly vaccinations when 3 years is more than sufficient?

    No wonder the veterinary profession is in crisis.

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    Replies
    1. Jessica,

      I have not killed any healthy dogs in my curriculum in order to do exploratory surgery on them— or for any other purpose, in or outside of the curriculum. I have performed surgery, under the close supervision and guidance of a surgeon, scrubbed and gloved in beside me, and my patients have lived and suffered no complications. My patients were scheduled for elective spay and neuter independent of my needing a learning opportunity.

      I have worked with laboratory animals. I did this on an elective basis to better understand what the animal care teams in a laboratory setting do and what their role in biomedical sciences are. The veterinary care teams at laboratory animal facilities exist not to conduct experiments, but to ensure high standards of animal welfare are maintained by the researchers working out of that facility. That includes providing a voice against research that violates welfare standards or needlessly inflicts harm or suffering.

      I recommend a food that is complete and balanced to meet the nutritional needs of the species eating it, in a way that is safe, free from adulteration, consistent, digestible, and bioavailable.

      Your concerns regarding DCM and the surrounding investigation have been addressed elsewhere on this blog and if you’d like to discuss that subject further, please navigate to the Q+A on DCM found on the nutrition tab of this website.

      Yes, I and many of my colleagues and peers are opposed to the breeding of extremely brachycephalic dogs. I too have also heard vets say that when they see a Frenchie, they see dollar signs. That does not mean that the vet condones that the dog is going to suffer from many expensive health conditions, or celebrates it. It’s often used as an exaggerated expression to convey to someone just how consistently unhealthy these animals are. You can find many blogs and articles from veterinary professionals opposing the popularity and mass breeding of brachycephalic dogs.

      I’ve written about vaccines and welcome you to find the article under the preventative care tab.

      I’m sorry that the theme of this piece didn’t resonate with you but I hope you can reflect on the response I’ve given and the possibility that many of your assumptions about veterinary professionals are misplaced and should be revisited.

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  3. Don't even get me started on the AVMA's dumb position on horse slaughter and how veterinarians keep horrible factory farms up and running. Nope. Don't convince me you care about animals unless you speak out against these things. I have fostered retired greyhounds - yup you vet students used to kill perfectly healthy greyhounds - and practice your surgeries on them. You still do - but now it's just shelter dogs now that you've run out of greyhounds. It's sick.

    Your profession doesn't even entertain the notion that human doctors could be right and fresh whole food is better than kibble.

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    Replies
    1. Are you really showing up on a post discussing the devastating mental health repercussions of speaking to people this way, and speaking to someone this way? Jessica, this is a disgusting reaction to this post and I'm embarrassed on your behalf.

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    2. Jessica,
      You are part of the problem and should be ashamed of the way you are speaking about this profession. It's already riddled with suicide and mental health problems, why in the world are you trying to make that worse #NOMV

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