Work/Life Balance

Erin asks a great question...

Hi, I have been interested in being a vet since I can remember but I just wanted to ask, how do you fit you family life/ love life around your work if you have to work so hard all the time till your about 30 before you've become a proper vet?

If someone finds the ultimate answer to this they can make a living writing books and giving seminars.  Honestly, this is something that is really hard to do.  In my opinion it's about priorities and what you want at any given point in your life.  Also remember that there are very few things you have a "right" to.  I believe in a strong family and know that it's hard to be alone and not have a good love-life.  However, you may have to sacrifice part of this to get what you want and shouldn't feel like you are entitled to such luxuries.  Acquiring an advanced degree is very difficult and takes a great investment of time, money, and effort.  When you're in veterinary school this needs to be your single priority if you want to do well.  You will spend the huge majority of your time attending classes, labs, or studying.  If you shirk these you may not make it through school and therefore may not reach your goals. Thankfully your schedule gets more reasonable once you're a practicing vet.

Now this doesn't mean that you can't have friends, relationships, or any kind of social life.  It just makes it more difficult.  Break-ups and divorces are not uncommon during medical schools because of the immense strains on time and emotion, often leaving little for a significant other.  But with a little balance, you can have life outside of school.

First, always keep in mind that your education is your priority, and make sure your family and potential relationships are aware of this also.  Keep up with your studies (always easy to say and hard to do) so you're not having to cram at the last minute.  Schedule at least an evening of "personal time" every week.  You can't have this time every night, so don't expect it, but you'll go crazy if you don't have some each week.  This personal time can be used for dates, family dinners, social events, or a quiet evening at home.  Keep a calendar and schedule so you can keep everything straight and know when you do and do not have free time.  Thankfully you'll have holidays and summers to get caught up on relationships and rest.  You can also find books that will help with general work/life balance and those can be applied to veterinarians.

One big hint though.  As hard as it is to think about, I advise against trying to start a family and have kids while in veterinary school.  It's hard enough if you already have kids, but if you're dealing with pregnancy and an infant it can make it nearly impossible.  After having stated that I'm fully expecting to get strongly worded comments from female readers and vets.  Note that I'm saying it's not impossible, just very difficult.

Once you're a vet you won't have as much to tie you up after hours since you won't be studying and preparing for exams.  So even though you're working often long hours, it is easier than being in school.  So even as a new vet it's simply the challenges of having a life while working, something that everyone faces.

Erin, this may not have helped much, as this is something I've struggled with myself.  If any readers have any other hints and suggestions, I'm sure there are plenty of people who would love to hear how you've managed to have a life while being a vet.

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The Cost Of Snow Days

Remember my rant about winter weather?  Well, it looks like the weather reports were correct and some of the worry was a little justified.  It's still nowhere close to what northern and mountainous parts of the country get, but in this area they're calling it "Snowpocalypse".  It's the most snow in Georgia since the early 1990s, and many of the interstates have been completely shut down due to accidents and jackknifed big-rigs.  Much of this is due to the ice rather than snow, as parts of the area received up to a quarter-inch of sleet and freezing rain. Even Wal-Mart closed early yesterday, which is pretty much unheard-of.

This is more snow than my kids ever remember seeing, and it's been great to share it with them.  My wife made snow cream, we had a snowball fight, and the they got to go sledding with some of their neighborhood friends.  Personally I love snow and winter weather and don't get enough of it for my taste.  So all-in-all, this has been a nice little vacation for my family.

However, as a business manager I have a different perspective on things.  We were closed yesterday because of the extreme weather and the risk of staff getting to the clinic safely.  Since officials were telling people to stay off the roads except for extreme need, this was a pretty easy decision.  Today we contemplated opening late since the snow and ice had stopped coming down and road conditions had improved a little.  At the same time we would likely close early since the roads would re-freeze after dark.  However, my receptionist and tech couldn't get out of their neighborhoods safely, and our other staff lived even farther away. Even if I could have gotten in, I wouldn't have had anyone there.  We don't board pets and don't have any hospitalized patients right now, so there wasn't an imperative need for someone to have to be there.  In all likelihood we would have few to no clients since everyone else would be staying home also, so I erred on the side of safety for my staff and closed today as well.

All of that sounds nice and logical, and I do feel that it was the right decision to make.  However, part of my purpose for this blog is to give people a look "behind the curtain" of being a vet and running a business.  Our gross revenues this time of the year run around $2000-3000 per day, with some days being higher (we'll push $5000 on a really busy day).  So by closing for two days we've effectively lost $4000-6000 compared to normal weather conditions.  We do save in paying staff, which will offset the losses slightly.  But insurance costs, employee benefits, and many other costs stay the same regardless of whether or not we're open.  Our landlord also doesn't give us a break on our rent just because we can't make it in for a few days.  So there are plenty of costs that we're paying out even when we're not there and not bringing in revenues.

Don't get me wrong, I don't regret closing for a few days.  Besides just looking at the numbers and money I have to realize that my staff are real people with families and I need to consider their safety also.  Running a business involves making tough decisions like this.  In order to stay profitable (and therefore stay open) we will have to make up these losses at some point.  Thankfully it's early in the year, so that is a very reasonable goal. 

There is soooo much more to running a veterinary practice than simply practicing medicine!

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Winter Weather Rant

Here in northern Georgia we are expecting a major winter storm to hit tonight and into tomorrow.  There will be several inches of snow and up to a quarter inch of ice.  For our part of the country this is a pretty big event.  For those not familiar with US geography, our region doesn't get snow very often, so it doesn't take much winter weather to cause panic and shut things down.  People in this area simply don't know how to handle snow and ice, so they freak out a little (or a lot) when it happens.

Even though I've grown up in the South and have lived most of my life here, I simply don't understand the panic.  I remember several years ago when 1/2 inch of snow shut down Raleigh, North Carolina and ended up in some children having to spend the night at their schools because the buses couldn't get out.  Last year my kids' school was closed for a day because there was a threat of flurries!  Not even confirmed real snow!  Northern parts of the US will get several inches in a day and still function normally.  You'd think that would be the case everywhere.

However, that's not the part of all of this that frustrates me the most.  I realize that the state and city transportation departments have more limited resources than their northern counterparts because of the infrequency of truly bad winter weather here.  I also know that people live here in part because they don't like severe winter weather.  Safely driving in snow and ice requires experience, and people here really don't have any.  If you're not safe driving in such weather, it's safer for everyone if you stay home.  So I do somewhat understand a little of the fear that hits some people.

What really gets to me is the rush on grocery stores.  People buy food like they're going to be locked in for a week or more during an apocalyptic winter.  Yet even in the absolute worst blizzard I've experienced I was trapped in my apartment for only three days.  The items that get sold out quickest?  Bread and milk.  Why those two?  First, like I just mentioned there is little chance of being stuck in your home for long.  But even if I was, I'd rather have chips, soda, and pizza.  If I'm isolated in my house for a few days, I'm going to want to relax, have fun, and maybe have a little party with the family.  I'm going to want food other than bread and milk.  So why do those two things get sold out?  It never makes sense to me, and I think people do it because that's what everyone else does.

So the bad weather starts tonight and continues through Monday and into early Tuesday morning.  By Wednesday the highs for the rest of the week are scheduled to be above freezing.  All kidding aside I really do pray that nobody gets hurt or killed.  And there's a very good chance that I won't be able to make it into work on Monday, so I may get to have that little party with my family.  Soda?  Check.  Chips?  Check.  I'm set!

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Microchips & Tumors

In 2007 a press report stated that there was a direct relationship between microchips and certain tumors in mice, rats, and dogs. Depending on the studies reviewed, tumors happened in anywhere from 1-10% of the animals who had chips implanted. This article has caused an uproar and concern in those who have read it. Now there are people who are extremely concerned that microchips will cause tumors in their pets.

However, I haven't seen any good evidence that this is a true risk. Here are some quotes from the original article, which I think are overlooked in the discussion.

Dr. Cheryl London, a veterinarian oncologist at Ohio State University, noted: "It's much easier to cause cancer in mice than it is in people. So it may be that what you're seeing in mice represents an exaggerated phenomenon of what may occur in people."

Tens of thousands of dogs have been chipped, she said, and veterinary pathologists haven't reported outbreaks of related sarcomas in the area of the neck, where canine implants are often done. (Published reports detailing malignant tumors in two chipped dogs turned up in AP's four-month examination of research on chips and health. In one dog, the researchers said cancer appeared linked to the presence of the embedded chip; in the other, the cancer's cause was uncertain.)

A Time article had more interesting quotes.

In an exclusive interview with TIME, Silverman provided a list of 34 studies the company included in its FDA application, including one of the three mentioned in the AP article, which showed that less than 1% of 4,279 chipped mice developed tumors "clearly due to the implanted microchips" but were otherwise healthy, and that "no clinical symptoms except the nodule on their backs were shown." The second study, conducted in France in 2006, two years after VeriChip's FDA application was approved, found that while 4% of the 1,260 mice in the study developed tumors, none of them were malignant. As for the third study, Silverman says it was conducted in mice specifically bred to produce tumors, and was therefore omitted from the sheaf of studies included in the FDA application.

Dr. Lawrence D. McGill, a veterinarian and leading expert in animal pathology says the tumor development in rodents is unsurprising. "Even if you put in a bland piece of plastic, it will produce tumors in rats and mice," says McGill, who assessed the studies on behalf of VeriChip. He says it would be a leap to apply the findings of studies in mice to cats or dogs — or to humans, for that matter — which are much more complex animals. Few official scientific studies have been conducted on the effects of microchip implants on house pets, but none have found a link between the chips and cancer, says McGill. If there were a problem, he says, we would have already seen lots of cancer among the approximately 10 million pets that have been chipped over the past 15 years. Says Silverman, "There are no reported incidents to the FDA of any cancer formation around that."

The American Veterinary Medical Association did release a position statement shortly after the original article came out.

In a Sept. 13 statement posted online, the AVMA said staff and member veterinarians are actively looking into the potential for electronic identification implants to induce tumors in dogs, cats, or people but must await more definitive data and test results before taking further action.

Considering how a large number of pets have been implanted with microchips with a relatively small number of confirmed cases of tumors associated with microchips, the AVMA advises against a rush to judgment on the technology.

In fact, there is a concern among veterinary medical researchers that some of the research into supposed chip-induced tumors may be flawed, because the animals used were genetically predisposed to cancer. In addition, removal of the chip is a more invasive procedure and not without potential complications.

The Time article further quotes a representative of the AVMA.

The AVMA officially counsels against removing the chip, while assuring pet owners it will continue to monitor the situation. "At this point we do not recommend that people should stop microchipping," says Dr. Rosemary LoGiudice, a veterinarian and assistant director with the AVMA. "We are actively watching. For the number of animals that are said to actually have microchips, when you consider the number of animals that have been microchipped and returned to their owners, the benefits are huge compared to the few and suspect cases that have been reported to have tumor formation."

Personally, I don't think there is a large enough risk of tumors to be concerned.  Is the potential there?  Quite possibly.  However, there really is nothing out there without any risk at all.  Vaccines, routine surgeries, antibiotics...they all carry some risk.  Some time read the warnings and side-effects on a label of ibuprofen or aspirin, and you may be surprised and scared.  No matter what medicine we take or procedure we undergo, there will be various degrees of risk.  Thankfully, most of the time nothing adverse happens.  So there could be minor risk in some patients, but I see no evidence that it's a worry for the majority of pet owners.

In my years of practice I have never seen any tumor associated with a microchip or talked to any other vet who has seen it.  Millions of pets and livestock world-wide have received microchips, yet there are no reports of wide-spread tumors.  In fact, this one 2007 article is the only I've ever heard of that has looked into the issue, and if it was really a true concern, I would think that more data would have come out in the three years since it was published.

I know that there are some people who are vehemently opposed to microchips, and I'm sure that I won't convince them otherwise.  But based on the available data I think that microchips are overall safe.  I recommend them to my own clients, and believe in them enough to implant them in my own pets.

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Tattoo or Not Tattoo

"De plane, boss!  De plane!"

Sorry, I couldn't resist.  And my younger readers probably have no clue what the heck that means.

Yesterday I talked about microchips.  In the discussion about identifying pets, tattooing usually comes up.  In fact, many people are strong advocates of tattoos over microchips.  Tattoos cannot fail, and short of cosmetic surgery to remove the skin, they can't be lost.  However, I think they are less than ideal methods of identification, and I don't recommend them.  Here are some reasons.

1.  In my experience few veterinarians have tattoo equipment.  The tattoos normally used for livestock are the ones most commonly seen in veterinary offices, and even then usually only with large animal vets.  So finding someone who can tattoo a pet may be a bit tricky.
2.  Tattoos can be altered or covered over by anyone with tattoo equipment.  This may even be done by non-vets with human tattoo equipment.
3. Placing a microchip is very quick, taking a couple of seconds.  Giving a tattoo is a lengthier procedure, and may require heavy sedation.
4.  My biggest objection to tattoos is that there is no standard.  Some will put their dog's AKC registration number.  However, many or most non-vets probably won't know what the numbers are.  And what about mixed-breed dogs?  They don't have an AKC identification number.  Tattoo your phone number?  There's a good chance that you will not have that number for the rest of your pet's life, and then what do you do?  Use your Social Security number (in the US)?  First, that's a huge risk for identity theft.  Second, there's no way to get in touch with you through that number.  Tattoo a pattern or a string of random numbers?  Sure, you could tell that a pet is yours pretty quickly, but when someone finds your pet how are they supposed to get in contact with you?  All-in-all, tattoos provide a pretty poor way to find the lost pet's owner, in my opinion.

If you're one of the ones who are big supporters of tattooing as a method of identifying your pet, I'm sorry if I've ruffled your feathers.  But based on the reasons above I can't recommend it to my clients.

Tomorrow I'll close out this latest discussion on pet identification by discussing whether or not there is a risk of tumors associated with microchips.

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Microchip Failures?

Recently I received a question from Cindi, who is part of a poodle flickr group.  A discussion came up because several members of the group had found that the microchips implanted in their dogs could not be read.  I won't copy the entire discussion here, but this is a basic summary:  Several chips from different manufacturers in different pets and different geographical locations could not be read by multiple scanners.  Within a veterinary practice 2-3 different scanners were used and none of them could find the chip.  So obviously people are concerned about the microchips in their pets.  And this is a good and valid topic for discussion!

First, let me point you to a post I made in 2009 about the basics of microchips:  read this and then come back.  I won't repeat information from that post here, and it will give you good basic information about some of the current microchipping issues (which haven't changed since I wrote it).

Microchips function as passive transmitters.  The microchip itself has no battery or other power source.  Until activated it's basically an inert object that simply sits under the skin and does nothing.  The scanners broadcast a radio frequency over a short distance. Some scanners broadcast a specific frequency while most newer ones will broadcast multiple frequencies to cover different types of chips.  Each chip responds to only one specific frequency of radio wave.  When that frequency hits the chip, it gives it enough power to broadcast a small amount of data (its number) over a short distance.

Now there is a problem with microchips in the US because there are a couple of different competing frequencies (see my previous post).  Modern universal scanners should be able to read all frequencies.  However, there is one company, Avid, that has encoded their chips so only an Avid-brand scanner will read them.  There was even a controversy because all other microchip manufacturers agreed to unencode their chips so all scanners could read them, but in the US Avid refused to do so (even though they have different frequencies and open-read microchips outside of the US).  Some scanner companies found ways to "crack" the code and can now read Avid chips.  However, this isn't consistent or reliable, so in some cases an Avid microchip can only be read by an Avid scanner.  I'll be nice and not give my personal feelings about Avid because of this issue (though you can probably guess that I'm not a fan of them).

In my opinion, microchip failure is very rare, and overall they are one of the best ways of identifying your pet if lost.  I believe in them enough that I have microchipped all of my own pets, and will continue to do so.  However, a microchip is an electronic device, and any such device does have a chance of failing.  It's a fact of the laws of entropy that any mechanical or electronic object has the potential of breaking down.  You can manufacture an object to be very reliable and have a low chance of failure, but it's impossible to make something that will never stop working.

Personally I haven't seen or read any reports of wide-spread microchip failures.  There has been nothing reported in any of the US veterinary journals that I receive, and I haven't personally seen this as a wide-spread issue.  I can think of a couple of cases over my career where the client said they had a microchip and I couldn't find it with my universal scanner.  In those cases I recommended going back to the shelter or vet who implanted the chip and have them scan it with one of their scanners.  I can't say that I ever heard back from those clients to see if the chip was found.

In my own practice I'm a big advocate of microchips, and we use the 134 kHz chips.  We routinely scan new pets, especially any that are brought in as strays.  I can think of at least a half dozen stray pets over my career that I have personally found microchips in and been able to track down the owner.  I can also say that when a client says their pet has a chip and I scan it, I'll find at least 99% of them even if we didn't implant them.  So I believe that as a whole, microchips are very reliable.  Are they perfect and immune to failure?  No.  That's why I tell my clients to still use collars and ID tags, and both of my dogs have this form of identification on them.  But when a collar or tag is lost and the pet gets away, a microchip is still your best chance of having that pet found.

Cindi, I hope this answers the questions your group had on this topic.  There were some comments regarding tattoos as a method of identification, and I'm going to talk about that tomorrow.

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Where Does Obligation End? Part 2

Back in November I started the most recent poll, asking if veterinarians had an obligation to provide treatment for a pet even if the owner couldn't afford it.  The question was based on a situation with a client, and though it was one of the more extreme situations I've seen, it wasn't the first one on this subject.  The results of the poll surprised me somewhat, as I didn't expect such a large percentage to say a vet has an obligation to treat.

No--56%
Yes--30%
I'm Not Sure--12%

I think that many people don't realize how much money it takes to run a veterinary practice.  Most vets run on a slim profit margin, and it's not uncommon for veterinary clinics to go out of business.  The most common reasons for such failure usually revolve around the vets not charging for services, giving away services, or having too low prices.  While it may seem nice to a client to have low veterinary prices, these low prices often come at the cost of the veterinarian.  Not charging and keeping prices too low are key reasons for vets to end up in a failed business, and ending up having to close their doors.

Veterinary practices are expensive.  Routine in-house blood analyzers can cost over $20,000.  An electronic tonopen, used for measuring eye pressure during glaucoma screens, runs around $3000.  My practice usually spends $2000-3000 per week ordering routine supplies, vaccines, and medications (and we're an average practice, not a really big one). About 40-45% of our monthly budget goes into meeting our payroll.  Each month we have to pay rent, utilities, unemployment insurance, liability insurance, benefits for the staff, data and phone lines, and a long list of other expenses that most people don't think about.  We are a profitable practice, but there isn't a lot of wiggle room.

So let's say that we took the obligation to treat all pets, even if the owner couldn't afford it.  When we're using medications, bandaging, surgical supplies, and so on to treat pets for free, it still costs our business to order them.  We still have to pay all of our obligations.  I can't call the phone company and say "We gave away about $1000 in services to needy pets this month. We're a little short on our phone bill.  Can you give us a break this month?"  I'm not sure my staff would stick around long if I told them I couldn't pay them for their hours worked because we did a lot of charity services this week.  And I wouldn't get far with our suppliers if I wanted to order more things but hadn't brought in enough money to do so. We have expenses and bills regardless of how much money comes in.  When we lose more money than we make we have to close he business.  And who can we help in those situations?

It's really nice to wish that we could see any pet and treat it.  But the reality is that this is not sustainable. I know that many of the people who voted were likely thinking of their own pets, and looking at themselves as the exception.  "Well, the vet makes enough money I'm sure he could afford to absorb a few hundred dollars for my pet."  Once in a while this may be the case, and I don't have a problem with vets who do occasionally help out clients by writing off costs or allowing payments.  But this can't be maintained by any vet.  And remember that there are many people who want the same consideration.  If the poll numbers are representative, 30% of the clients are expecting the other 70% to help pay for their medical care.   Or looking at it another way, veterinarians are being expected to keep their high level of medical quality and services, but doing so with 30% less income.  It simply can't be done.

So here's my question for anyone who voted "Yes" to the question "Do veterinarians have an obligation to treat a pet even if the owner can't afford it?"  How are the veterinarians supposed to pay their bills and stay open if they treat every pet without regards for payment or compensation?

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