Is this a 40 hour week?

RE: Is this a 40 hour week?

Neil Wheadon — Wed, 19 Jan 2022 15:23:59 GMT

[quote userid="5012" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235287#235287"]Any standard first opinion practice or vet should be able to carry out initial assessment and basic triage.[/quote]

These have for a long time been a 'canary in a coalmine' We seem to be applying this to dogs and cats where 'I can't handle that because X.Y or Z' is better at it'

I could go on about Animal Welfare etc, but I look at it this way. They are usually interesting, the clients are grateful and are memorable

Only last month I saw a swan brought in by an inspector who had been turned away by 4 different practices. The swan in it's bag just needed a cut checked and the RSPCA inspector needed that to be done. In the end, nearly everyone in the practice had a look at the swan and it made our day.

As vets we need to be stimulated and challenged, by pushing things away all the time, you are decreasing your pleasure in doing the job.

Neil

RE: Is this a 40 hour week?

Clive Ansell — Wed, 19 Jan 2022 14:56:21 GMT

[quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235258#235258"]This is a different problem, and unrelated to OOH provision...it's unlikely those practices would see it in the daytime either.[/quote]

True.

I'm working in a 3 vet practice at the moment that sees a lot of exotics, about 35% of the total caseload. 2 of the fulltime vets are working towards their certificates.

They see cases from very far away, often 60 or 70 miles, because no one else will see them.

Many are either dead or PTS immediately on welfare grounds upon arrival. Any standard first opinion practice or vet should be able to carry out initial assessment and basic triage. If it's something more complex, it can always be referred on. On Monday they saw a parakeet that had flown into a mirror and broke or dislocated its neck, still alive, but nobody locally to them would see it. They had to travel about 40 miles and over an hour through rush hour traffic just to pts.

RE: Is this a 40 hour week?

Gillian Mostyn — Mon, 17 Jan 2022 19:56:02 GMT

[quote userid="7269" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235244#235244"]She wasn’t registered anywhere and had tried another 4 practices before us, all of whom said they “didn’t do exotics” so wouldn’t see her. [/quote]

This is a different problem, and unrelated to OOH provision...it's unlikely those practices would see it in the daytime either.

As someone who used to work in an exotics practice, it was both depressing and incredibly annoying how many dying animals were passed from pillar to post before ending up with us many hours (or days) later simply for PTS.

RE: Is this a 40 hour week?

cairncross — Mon, 17 Jan 2022 06:25:51 GMT

The future is not to be omnicompitent. Everyone has been encouraged to to be a "specialist" if you are the rabbit person the dental person the cardiac person then you can come in mornings 3 days per week and see yoir cases they are some other ones problem until you are back.

If you learn how ti deal with everything everything will be thrown at you.

This is becoming a self fulfilling circle, no one doing most things in a practise means next generation learn to refer and not do.

RE: Is this a 40 hour week?

Julian Earl — Sun, 16 Jan 2022 21:42:20 GMT

[quote userid="7269" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235244#235244"]It made me very sad for our profession. [/quote]

Is ashamed too strong a word?/ If the reeason/excuase is lack of experienvce, then the answer is obvious!? Even as a new inexperienced graduate I was eager/keen to see exotic species as beoing something different by definiton and a useful learning opportunity! Hence in my early career, I saw a racoon, a Coatimundi, a2-0cm Tarantula with a broken leg, numerous snakes of different sizesand species, plus, my favourite patient ever, the tortoise aged 96 years old! The TRaccoon, incidentally was at a at a Pet Shop for sale and was duffering from Canine Distemper! You did not need to be anexotic specialist to recognise this conition when seeing it weekly in the local dogs!! All very important and memorable experiences!

RE: Is this a 40 hour week?

Joyce Whitehead — Sun, 16 Jan 2022 21:27:26 GMT

I agree in general Gillian, hopefully most practices will see emergencies. However we were on call on the Monday bank holiday after Christmas. I had a call in the morning from a lady with a sick chinchilla, barely able to stand, not eating, sudden onset the night before. She wasn’t registered anywhere and had tried another 4 practices before us, all of whom said they “didn’t do exotics” so wouldn’t see her. Now we are a long way from an exotic practice but I have a fair bit of common sense. Examination revealed a very painful swollen area of intestine, the poor thing couldn’t stand and was significantly dehydrated. It felt like an intussuception. We discussed surgery, the risk of ga etc and the owner opted for euthanasia, probably correctly. She just didn’t want to see it suffer any longer. It made me very sad for our profession.

RE: Is this a 40 hour week?

cairncross — Sun, 16 Jan 2022 20:54:15 GMT

I dont know if this idea of having our own clients exists anymore.

Practises have changed hands and changed hands again with various changes to protocol prices and where and which branch clients may be sent to. Vets are so mobile between jpbs i know of one person who saw the same vet in 3 different practises in 2 months. Use of locums is commonplace. Cliebts are sent from pillar to post for ooh. Specialists in everything from cardiac to homeopathy has cropped up to facilitate those who cant work outside limited daytime hours these advertise fairly heavily and people drift back and forth looking for magic solutions more often than specific specialist items. One practise locally has opened sunday afternoons and our clients go there rather than pay ooh to come here i dont care infact its goid. . Similar another local is onpen on saturday to 5pm i close at 1 my clients wont pay an ooh till 5 and go to the neighbour. I run a sunday am vacc clinic to try and reduce other clinics overload (it was also an attempt to offer an economic emergency clinic to those phoning on Sat pm not wanting to wait till monday, that failed they either come on sat night or get angry re the fee. Pdsa clients turn up under their real name regularly shuttling back and forth. No longer are practises stable with a handful of fairly omnicompetant vets able to handle most things instead MrX or Ms Y can do that proceedure but they only work every other wed to Friday and the dog needs it tomorrow..

Everybody is busy clients phone round all the time now to see who can see them before wednesday week. If you dont fit them in they go elsewhere. Not a buisiness problem as if you are busy you cant see any more but as we get fewer vets working fewer hours that cycle will increase.

I used to think an obligation to see with in 24h would be a solution.,Real dire emergencies are not going to be solved cheaply the client is going to need dedicated ooh leveks of money anyway if thesecare going to get care. I think we are past that now as we have so few that even getting urgent cases seen in daytime isnt always possible. Ooh is certainly partly busy because cases arnt being seen during the day often clients fault but increasingly as they cant get appointment during the day.

RE: Is this a 40 hour week?

cairncross — Sun, 16 Jan 2022 20:33:21 GMT

I did this and a colleague from uni days relieved me a couple of long weekends once i was 2 years in. I got to 4 vets not 7 though I know two others in the county who did the same got to at least 4 vets. Unfortunately now i am back to 2 and they have are on their own, i presume i soon will be too. I cant see joining forces for ooh as an option, we all have to work the next days so having 3 practises ooh every 3rd night would not be possible you can manage the next day with some sleep but not with none. As we are all surrounded by other practises still doing theor own ooh (the local economic circumstance means only a small percentage can use the dedicated city ooh, clients wouldnt go to the ooh they would go to the neighbpur still providing ooh and sign up there. Going to the ooh service simply isnt an option for the significant majority.

There are some multigenerational practises in family hands which are a bit better off

RE: Is this a 40 hour week?

Clive Ansell — Sun, 16 Jan 2022 12:58:03 GMT

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235221#235221"]The point I was trying to make was that if you are unable to do the OOH stuff yourself don't whinge about how much those who actually do it for you charge. [/quote]

Those who do the OOH work, are doing it for the client, not for us. That's where the line of thinking needs to change, and the responsibility laid squarely where it belongs, back with the client, not us.

I've worked two locums in the Netherlands, standard first opinion practice. They don't and don't have to provide OOH cover, There are other local larger practices that do, and clients go there. It works well with no issues, but the responsibility to source and fund it lies entirely with the client, not the practice. I think this is the direction we should go.

RE: Is this a 40 hour week?

Clive Ansell — Sun, 16 Jan 2022 12:49:49 GMT

[quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235232#235232"]I'm not sure this could work either.[/quote][quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235232#235232"]However, having a contractual agreement puts the power back in the hands of the client. [/quote]

It would depend on what is in the contract. One could draw up an agreement that states OOH care is provided for registered clients and animals, for emergencies only, and a condition of registration is that a pet is seen at least annually for vaccination.

[quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235232#235232"]There are too many clients who use different practices for different things ... People would register somewhere simply to ensure OOH cover. [/quote]

One could choose whether to accept these as clients or not. One of my regular independent practices does not; clients are told go there or stay here. At the moment the books are full and they are not taking new clients, if someone leaves they cannot come back quickly.

[quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235232#235232"]I don't know any vet working OOH who would refuse to see an animal who needs it. But they do need to be able to refuse![/quote]

I've never point blank refused, but I and many other vets I have worked with, have redirected clients back to their own practice or OOH provider. I have refused many that don't actually need seeing.

RE: Is this a 40 hour week?

Gillian Mostyn — Sun, 16 Jan 2022 12:23:23 GMT

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235221#235221"] moving to a contractual arrangement with clients[/quote]

I'm not sure this could work either. There are too many clients who use different practices for different things ... People would register somewhere simply to ensure OOH cover. It is getting the balance of routine work and OOH that matters, to ensure the staff numbers and workload is reasonable at nights and weekends.

I'm all in favour of vets being allowed to decide who they will see, and being able to refuse frivolous requests etc without fear of disciplinary action. However, having a contractual agreement puts the power back in the hands of the client.

I don't know any vet working OOH who would refuse to see an animal who needs it. But they do need to be able to refuse!

RE: Is this a 40 hour week?

Alastair Welch — Sat, 15 Jan 2022 20:40:10 GMT

Yes. The 24/7 obligation should be lifted, moving to a contractual arrangement with clients.

The point I was trying to make was that if you are unable to do the OOH stuff yourself don't whinge about how much those who actually do it for you charge.

RE: Is this a 40 hour week?

Clive Ansell — Sat, 15 Jan 2022 20:31:13 GMT

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235218#235218"]

A number of years ago I took a week off and did a locum for a neighbouring practice. It was a single-handed affair with the vet having been working and on-call 24/7 for around 2 years straight without a day off but they had reached the point where they felt secure enough to have a short holiday.

Through hard work the practice is now 7 vets and trades out of its own purpose built premises.

It is not easy, but it is possible. It's not 40 hrs a week.

[/quote]

The point; is that it has become so much harder to do that. Fewer practices covering there own OOH, and clients with increased, often ludicrous, demands, and clients of other practices refusing to pay higher fees and travelling greater distances to OOH clinics, have all put unsustainable pressure on the few who still choose to cover their own OOH.

The two practices I mentioned above, have both said if the big black RCVS cloud was lifted and they could comfortably see only their own clients, and with no comeback if they turn away all others, they may well consider covering OOH again.

RE: Is this a 40 hour week?

Alastair Welch — Sat, 15 Jan 2022 17:44:15 GMT

Clive,

Through hard work the practice is now 7 vets and trades out of its own purpose built premises.

It is not easy, but it is possible. It's not 40 hrs a week.

RE: Is this a 40 hour week?

cairncross — Sat, 15 Jan 2022 13:14:46 GMT

All this exactly happening up and down the country. 3b and 4 barely an issue until the last year ish. The rest have been in offing 5 to 7 years. Could i add

5 we have now reached the point where there isnt enough staff for daytime work so fewer appointments and clients either opt for ooh as they can get seen before wednesday fortnight or b the case developes into an ooh case as it should have been seen daytime.

RE: Is this a 40 hour week?

Clive Ansell — Sat, 15 Jan 2022 12:37:22 GMT

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235194#235194"]If you think OOH care costs too much just do it yourself. [/quote]

Not everybody can.

I know two independent practices that have in the past covered their own OOH, and would still like to be able too.

They have effectively been forced out of it, because

1) They cannot recruit staff that will do it, most of their employed vets are now young mothers with child care commitments, who have partners with their own careers.

2) Daytime practice has got very much busier, so it would not be reasonable to expect staff to be on call in addition.

3) Demand from clients OOH has reached ridiculous levels

a) Clients expecting a full on 24/7 full service, but without paying for it. 2am anal gland emptying etc.

b) Increased number of clients registered elsewhere, or unregistered, trying to avoid the costs and 30-40 mile distances to OOH clinics. Many of these folk are threatening and abusive.

4) Something like 90% of bad debts, problem clients, negative social media reviews, and complaints were connected with OOH work, often to non clients.

So, they both reluctantly bailed.

RE: Is this a 40 hour week?

Bibs — Sat, 15 Jan 2022 12:10:37 GMT

I should also add....lets not pretend that there are not many many very experienced older bosses out there giving performance feedback based almost totally on how much you charge/ how many tests you do.

RE: Is this a 40 hour week?

Bibs — Sat, 15 Jan 2022 11:57:17 GMT

Then there are people like me who are experienced and though I wouldn't say I over test as such - I get most of my enjoyment of the job from the technical aspects. My 3rd boss said I was doing the right number of blood tests based off some standard or other he's analysed everyone by. I also struggle with assertiveness and being over agreeable. This has resulted in mistakes involving trying to help the client too much - being dragged out on house visits that were never paid for and where a domestic was happening over what should happen to the dog. The police said to just go and see what happens. Stuff that I should have known better to just say no to - but I didn't have the knowledge of my rights, or the confidence to say no to. Also when equipment and staff doesn't allow you to do things to a standard you think is just moderate. I think I'm still working on all of this and could use help - others probably feel the same.

RE: Is this a 40 hour week?

Rob Davis — Sat, 15 Jan 2022 11:44:13 GMT

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235207#235207"]We need as a profession to dial back from 'gold standard' (hideous term)[/quote]

I agree with this and the rest of your post, however the confidence not to over test etc comes with experience. Recent graduates are trained in referral centres where they see also sorts of complex cases and work ups. It is particularly so for this year's graduates, some of whom have seen little or no GP practice in their final year due to Covid. Many of them struggle not to automatically blood test and scan everything - there is a real fear of missing something here.

I think there may be a place for the type of CPD which Bibs is suggesting, though I don't think that you, Neil Wheadon, are likely to be the target audience (though perhaps a provider...?)

RE: Is this a 40 hour week?

Bibs — Sat, 15 Jan 2022 11:18:30 GMT

Well this is probably the crux of the problem. Your post makes sense but it's not that easy to fix. There are reasons people like me are like this.

RE: Is this a 40 hour week?

Neil Wheadon — Sat, 15 Jan 2022 11:07:54 GMT

[quote userid="11590" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235206#235206"]What I think might save the profession is setting up a CPD company that focuses on GP cased based discussions covering - law&ethics, health and safety boundaries, low cost treatment options, when to say no to clients and complaint handling, psychology. Basically how to handle risk and how to know your rights.[/quote]

I sit here sometimes and wonder where we are going as I just don't recognise this in my day to day vetting and so wonder what others are thinking. I see histories from other vets and there seems to be a recurring theme of we must do the absolute maximum for every case or 'all hell will let loose'

I don't want to go into a long post as no-one will read it but here's a few bullet points

1) Deal with what the client wants, listen to them. If they only have £50 then work within this. An aged cat with diarrhoea, give it preds, don't ultrasound it. If it's a lame 5 year old labrador, don't refer it for a CT scan, put it on pardale or give them a dose of paracetamol

2) Complaints. These divide into two really and it's either a) Not offering enough so simply say 'we can do X,Y or Z but would I do that to my dog or it will cost you £xxx which leads to b) Money. Tell people what things will cost and that includes the tablets they are getting, if that's too much look for an alternative

3) Please stop being defensive and worrying about everything. The chances of being struck off are vanishingly small and if you are sued for monies that's what the VDS are for, and before the reader thinks ' well I expect he's had a few cases.' In 31 years, I've had 1 payout, that was 2 years ago where I left an ovarian remnant in, on a huge fat dog that had polycystic ovaries and no other vet would touch the operation, it was settled amicably, someone else went in and fished it out and the VDS paid the bill - thankyou whoever you were. We work in an industry where there are shades of grey, that's why we are insured.

We need as a profession to dial back from 'gold standard' (hideous term)

Neil

RE: Is this a 40 hour week?

Bibs — Sat, 15 Jan 2022 09:42:35 GMT

What I think might save the profession is setting up a CPD company that focuses on GP cased based discussions covering - law&ethics, health and safety boundaries, low cost treatment options, when to say no to clients and complaint handling, psychology. Basically how to handle risk and how to know your rights. Does this exist or does anyone want to set up a business with me ? I think everyone is leaving because they're patting their shints all day every day that what they're doing isn't good enough because practice is messy and no-one taught them how to deal with that. Now it's worse because basic physiological needs of workers are not even being met.

RE: Is this a 40 hour week?

Bibs — Sat, 15 Jan 2022 09:33:29 GMT

Did your two neighbouring practices say why their assistants handed in their notice?

RE: Is this a 40 hour week?

cairncross — Fri, 14 Jan 2022 23:45:17 GMT

Its not me who despirately needs an associate im not sure if i even want one now its not the future. it is EVERY practise in the county they are ALL advertising spoke to two neighboiring today who have had assistants hand in notice this week. They were aready 50 percent short of vets. This is not about if i might get an assistant, thats an irelivant concept nowadays if i get one it would be a very temporary relief of no real use in organising or planning anything. This is about how the hell we reorganise the profession as we have less and less vets for the next 10 years.

AVERAGE! average disposible income in NI is 100 pounds. If a billionaire walks into a pub everyone on average is a millionaire. The vast majority dont have 100 pounds to save, a lucky few have thousands even tens of thousands to save. That leaves a large majority with next to nothing. If you were in the few with 100 yes in 8 Or 10 weeks you could save for a lower level visit to our main ooh clinic, or a decent standard cat dental as quoted on another thread here. as long as the car didnt breakdown or the boiler or you went out with friends once because actually your sanity and mental health needed it or you want to provide something for your kid .The dog might only need a couple of visits per lifetime but these other things crop up too I think it would surprise you what percentage of clients here will never have 2000 pounds no matter how they try to save. Maybe they shouldnt have a dog it doesnt matter millions and millions of people in this situation do and they are going to turn up at my door and that of every practise in the county who are at 50 percent staffing and diminishing. That buck for 55million pets falls on the lap of at most a couple of thousand clinical directors and practise owners

Sorry re rant, i am certainly not angry at you for adding to the debate, i am not angry at clients for being likeveveryone else in the country and having a pet. we wouldnt be needed if they didnt.

I am not some altruistic superperson. I am a very bog standard and below vet with plenty of flaws and quite selfish. I cant think of anything i have done to contribute to the beterment of the profession i have only bumped along the bottom of it.

RE: Is this a 40 hour week?

Martin Hamilton — Fri, 14 Jan 2022 22:15:24 GMT

[quote userid="19228" url="~/001/nonclinical/f/life-in-practice-discussions/30134/is-this-a-40-hour-week/235094#235094"]The average family disposible income round here was 100 pounds per week[/quote]

I appreciate your hard work and effort to try and care for as many animals as possible James, it is certainly commendable but does not seem sustainable. I hope you are able to take a break soon.

I quoted the above as you have repeatedly replied that many of these clients that have very low disposable income that have tattoos, designer dogs etc have made these as impulse purchases (judging by the cost of Frenchie's before I left the UK in 2018 these are ~£2000 "impulse buys"). I ask that if they are able to make these impulse purchases on a whim, why can't they also afford an emergency visit which, even if at an OOH centre, costs less than one of these purchases? You should not feel that you have to be responsible for their personal finances. As an anecdote, I didn't get my first pet until I had paid off all my debt from university and had saved up an emergency fund of ~£2000 which was 4 years out of vet school.

Although £100/week is not a lot by any means, if these owners took their personal finances and managed them appropriately they could save for an OoH consult in a matter of weeks and save it for a rainy day. Emergency visits often only occur once or twice in a pets lifetime (or never if you're lucky).

The passion you have for this job is clear James, but unfortunately it doesn't matter how low your out of hours fees are etc, there are always going to be those who cannot afford it and will not prioritise their animals care as much as other impulse purchases such as boozing with their mates, smoking, going out, buying the newest iPhone, fancy breed puppy etc.

Wishing you all the best James, fingers crossed an associate comes your way soon!