Advise re alternatives or re-kindling the flame.

RE: Advise re alternatives or re-kindling the flame.

Julie Innes — Wed, 24 Aug 2022 08:30:32 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/30382/advise-re-alternatives-or-re-kindling-the-flame/238797#238797"] set up this practice over 20 years ago because nobody local would offer me a job and I wanted to move back to be close to the children. [/quote]

Bob, this was me too! The school threatened to stop the school bus (I used to put my daughter on at the first stop at 8.10am so I could do 2 different nursery drop offs and still be at work half an hour away at 9!) This was disastrous for me (husband in armed forces, away for months at a time)...so I opened a practice across the road from the school! Not through ambition, or any desire to build an empire, but just so I could juggle work and kids!

RE: Advise re alternatives or re-kindling the flame.

Dalya Livy — Tue, 23 Aug 2022 14:50:50 GMT

Bibs, are you a locum? Because if you are, that does not marry up with how you seem to enjoy practicing, and you may be happier with a position in a practice that shares your style. Like ours, but we don't need any vets at the moment ;)

Luciano, you've had some very good advice so far. I would add that you should look at your own personal values, what is important to you in your work and in the rest of your life, what you want to do with your career overall and with your life overall, and figuring out what sort of job/workplace fits the bill. And if you can't find one that does, then you need to decide what is more important - that perfect job and career fulfilment, or family. Life is a compromise for many of us, and some (many?) can't have both, at least not at the same time.

I've worked in GP, then did an internship, then worked speciality ER, then GP again - solo branch for a bit and then about a decade in a hospital, now I own a small animal/exotics practice. I have an alphabet soup behind my name, and I'm still learning. Every day, no matter how mundane it seems, is an opportunity for progression, but you do need some degree of intrinsic motivation. Was any one of those jobs perfect? Nope. There are always pros and cons. Our careers change and evolve, just like we change and evolve. I don't believe in "one job for life", not even now. I'm unlikely to spend the rest of my career in my current practice, ownership notwithstanding. But what you need to do is to identify what it is that you want and why, be prepared for your wants and needs to change with time and career maturity, and not be afraid to change with them. I have 4 kids 8yo and under, and no family in this country apart from my husband. Life can be bloody hard, but if you know what drives you and where you're going, the decisions you make to get there are easier.

Clients are people, and people come in all sorts of flavours. Nowhere is safe from the unpalatable ones, but having some control over how you deal with them helps.

RE: Advise re alternatives or re-kindling the flame.

Bob Russell — Mon, 22 Aug 2022 13:07:30 GMT

[quote userid="7811" url="~/001/nonclinical/f/life-in-practice-discussions/30382/advise-re-alternatives-or-re-kindling-the-flame/238704#238704"]I definitely don't fit your description of a "red" person. I don't like being the boss, but I try my best to be a good one. I am crippled by self doubt! I think there is, or will soon be, a rise in practices like mine[/quote]

I love this statement. It is more true to life than all the red bosses and snowflakes can possibly be!

I set up this practice over 20 years ago because nobody local would offer me a job and I wanted to move back to be close to the children. Those that bothered to write back said they were not looking for more Chiefs, just Indians! I did not want to be a Chief any more and would have happily settled somewhere with a supportive environment to build on experience and enjoy the challenges!

Like many vets I live with self-doubt and guilt when things do not go to plan. I am more forgiving than I was in the past and more accepting of my limitations.

Everyone here has family committments and we are flexible. A child is sick, people still get paid. This works because nobody takes the p+ss.

Children and dogs fill the office at times but we cope.

RE: Advise re alternatives or re-kindling the flame.

Bob Russell — Thu, 18 Aug 2022 10:49:55 GMT

We take the swabs, nurse processing them and we report the results later. It does mean there is a chance that a medication change might be appropriate but usually not.

Luciano's figures indicate an increase practices recording an increase in client numbers not cases seen or income generated. 50% of UK practices indicated an increase in clients, not a 50% increase in income.There is a world of difference!

RE: Advise re alternatives or re-kindling the flame.

Neil Wheadon — Thu, 18 Aug 2022 10:26:47 GMT

[quote userid="11590" url="~/001/nonclinical/f/life-in-practice-discussions/30382/advise-re-alternatives-or-re-kindling-the-flame/238745#238745"]I actually wonder whether this is where I’m going wrong. I notice that CPD always trains us to do this and that test e.g. ear cytology on OE cases. I then try to do such things because it’s better for the case and more interesting for me. The problem is that if everyone else isn’t doing it then there is no time or facilities to efficiently do it. This leads to me being the “slow vet” compared to another who writes one line of history and doesn't do any tests.[/quote]

This is an extraordinarily good point

'Where's the microscope' ... 'It's broken'

I need to take the swab, stain it, look at it and then talk to the client, all in 15 minutes

2 solutions I've seen

1) Catch up breaks in the middle of a session, and don't fill these with appointments, just because. If they stay free that's where you do the repeat prescriptions etc. 30 minutes in the middle of a 4 hour morning consulting sesion works well

2) If the practice is large enough you can take these through to the back and ask a nurse/operating vet to do it, even if you have to admit the animal for a few hours. Clients understand this, after all would your GP see you, swab you and report the result in the same appointment?

Neil

RE: Advise re alternatives or re-kindling the flame.

Bibs — Thu, 18 Aug 2022 09:46:28 GMT

I actually wonder whether this is where I’m going wrong. I notice that CPD always trains us to do this and that test e.g. ear cytology on OE cases. I then try to do such things because it’s better for the case and more interesting for me. The problem is that if everyone else isn’t doing it then there is no time or facilities to efficiently do it. This leads to me being the “slow vet” compared to another who writes one line of history and doesn't do any tests. It’s a fine line between being too detail orientated and too superficial. I feel that that to function happily in practice I’d have to change my ways and became the sparse notes and minimal tests vet - which to be honest may be best Ian balance and serve more clients and pets better, but that’s not really what I naturally enjoy. I’d need to do that not to feel so exhausted. What to do. I could do with a quickness and efficiency coach maybe? Maybe a change of attitude to what’s important? Maybe just accept more risk?

RE: Advise re alternatives or re-kindling the flame.

Neil Wheadon — Thu, 18 Aug 2022 09:30:57 GMT

[quote userid="7145" url="~/001/nonclinical/f/life-in-practice-discussions/30382/advise-re-alternatives-or-re-kindling-the-flame"]The practice is very busy but most of the members of the staff are slow pace, which makes it nice enough however the workload becomes unfair and unsustainable for the people that work faster. [/quote]

Interesting as also relates to the workload thread

Consider this https://www.theguardian.com/money/shortcuts/2018/nov/13/why-coasting-at-work-is-the-best-thing-for-your-career-health-and-happiness and https://www.bbc.com/worklife/article/20220329-the-coasting-workers-whove-checked-out-of-their-jobs

No reason at all why vets shouldn't be in that 1/3 of workers.

Neil

RE: Advise re alternatives or re-kindling the flame.

Julian Earl — Thu, 18 Aug 2022 08:41:17 GMT

Someonereferred in his tread about saying the dreaded Q-word and tempting fate just before you are dueto close!!I am not impressed! Do the University Cinical Years teach othing These Days?? Surely everybody knows no tosay the word out LOUD! wehen even thinking it is a bit of a gamble?? But I expect everyone learnt their lesson her hard way as a result? Still itis a good way to learn to d major surgery like a GDV when under a bit of pressure? But when is a GDV ever not done not iunder pressure?? Good Luck Friends!!

Smugly retired away from such events nowadays, thanks!!

Julian...

RE: Advise re alternatives or re-kindling the flame.

Julie Innes — Thu, 18 Aug 2022 08:29:10 GMT

Yes, Luciano, but longer hours during covid did not necessarily mean more income- things took a LOT longer, so we worked hard, but saw less! Most practices around here closed their books to new clients(new puppy owners really struggled), and we only re-opened ours a couple of months ago, so the puppy boom did not bring us any increased revenue. Sadly stats will show quite a few of those dogs have already been rehomed...

I'm not moaning- it was my decision to try to reduce pressure on my staff, but it cost me money!

RE: Advise re alternatives or re-kindling the flame.

Joyce Whitehead — Thu, 18 Aug 2022 07:52:36 GMT

Hi Luciano. Our non vets are contracted to 7pm but if we are all finished we put the phones to the answering service at 6.30 and go. The on call vet does evening surgery and is usually away by 6.30, the others at 5.30 ish depending on work. Obviously things can change due to circumstances. I was covering on call on Tuesday due to holidays and a GDV arrived at 6pm. One of the other vet was still there so stayed as did my nurse and my husband (also a vet but equine mainly) was there too. We all stayed till dog was back in her kennel. Obviously I was then checking the rest of the night. All our staff are flexible and will help where they can. If someone had a pressing engagement we certainly wouldn’t expect them to stay, but the extra vet on Tuesday made a big diffference, and as a bonus as a relatively new grad she hadn’t seen a GDV before so good experience for her. Equally if it is quiet this evening (the dreaded Q word) that vet will go home early, it was her day off yesterday.

RE: Advise re alternatives or re-kindling the flame.

Luciano Nebiante PGCertSAS — Wed, 17 Aug 2022 20:32:20 GMT

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/30382/advise-re-alternatives-or-re-kindling-the-flame/238724#238724"]I think, you're going to have to justify that one Luciano[/quote]

Extracts from RCVS report:

Page 7 "Changes in working hours, working patterns and pay ■ During the pandemic, a fairly high 40.1 per cent said they had, at some point during the pandemic, had to work additional hours due to others being furloughed. ● Of these, just over half (53%) were unpaid, or mostly unpaid, for these additional hours, while 36.4 per cent were paid / mostly paid and 10.6 experienced a fairly equal mixture of paid and unpaid.

Page 27 "It is also very apparent that most respondents had personally seen an increase in caseload due to new animal ownership.......The top-scoring statement for both VSs and VNs related to the increase in caseload due to new animal ownership."

Page 32 "Positive outcomes included: increased business because of new pets, especially the ‘puppy boom’;"

Page 33 "When asked to describe the downsides of the pandemic for the veterinary profession: ● Many comments related to the relentless work, long hours, and increased workload. Some added that staff were leaving because they could no longer cope with the pressures."

So this is one report. Showing puppy boom, increased workload, increased caseload and 53% of the VSs that worked overtime were unpaid.

In this situation the practices made more money out of the increased workload and made more money by using the VSs for extra hours and not paying them.

Then you can read this on bvajournals.onlinelibrary.wiley.com/.../vetr.151

"Client numbers

Despite the difficulties and new ways of working resulting from the pandemic, for many clinics client numbers increased – especially in North America and Australia. In Canada, 78 per cent reported an increase, and elsewhere figures were: USA 76 per cent, Australia 74 per cent and the Netherlands 65 per cent. The figure for the UK was 50 per cent."

I am not arguing. What I am saying is that I worked in 2 permanent roles throughout the past 2 years. Both clinics worked harder and longer than normal. Both clinics were seeing clients from the local practices that were struggling. Both clinics accepted referrals because specialist centres were too full, in few instances I operated on animals that Dick White Referrals could not accept because their hospital facilities were full, something unheard of!

Maybe both practices were lucky, but considering they are 3 miles within one another, I doubt it.

Maybe some other practices struggled. The two practices are still thriving and one of them has recently acquired a local practice as well.

RE: Advise re alternatives or re-kindling the flame.

Bob Russell — Wed, 17 Aug 2022 15:04:18 GMT

Not cheeky at all. As a locum it is fair enough to make efforts to check your preformance against the norm.

We made our first trading 'loss' over the covid period because staff needed to be paid but we were unable to work normally. Overheads have shot up as well so it is no surprise fees have risen.

Not a particularly happy situation overall.

RE: Advise re alternatives or re-kindling the flame.

Neil Wheadon — Wed, 17 Aug 2022 12:59:31 GMT

[quote userid="7145" url="~/001/nonclinical/f/life-in-practice-discussions/30382/advise-re-alternatives-or-re-kindling-the-flame/238712#238712"]Figures shows that most practices have doubled/tripled their income.[/quote]

I think, you're going to have to justify that one Luciano

Yes practices have increased their prices but not by this amount. It's certainly not my impression in the practices I locum in and I do ask the cheeky question at the end of the day 'how much did we take today?'

Neil

RE: Advise re alternatives or re-kindling the flame.

Bob Russell — Wed, 17 Aug 2022 12:41:31 GMT

If emplyees genuinely believe practice incomes have doubled or trippled then this may explain some disatisfaction. You cannot double or treble your income unless you double or treble your workload. That is not possible in most practices (if any).

We are also finding more and more people are being unreasonable. I am willing to write off a consultation fee just to tell them to go elsewhere.

Yesterday was told by a complete novice dog owner that my puppy check was inadequate after they spoke to 'other vets'. Boll*cks it was! I wish their new vet the best of luck! Today someone did not think we should have charged for a re-examination because ' you just took bloods'.

I am getting to dislike my job based on a tiny minority of f+ckwits when I should be concentrating on the vast majority of clients that are great!!

RE: Advise re alternatives or re-kindling the flame.

Julie Innes — Wed, 17 Aug 2022 12:30:46 GMT

We definitely lost money during the last couple of years, as we scaled everything back precisely to protect staff- no new clients, telephone consults or 30 minute consults to allow phone history/ dog in with another staff member holding/ call with conclusions and discuss next steps. I can't see how anyone increased profitability with each consult taking 3 times longer than normal!!

To Bibs: I totally get the stress. I have struggled with it all my life as a vet. 2am is usually the time I suddenly remember that case i'm worried about, or replay a conversation over and over and over in my head. But I suspect I would have been this way whatever job I'd done. As a pizza waitress I still had to deal with rude customers and demanding people- you can't easily avoid them nowadays!!

RE: Advise re alternatives or re-kindling the flame.

Bob Russell — Wed, 17 Aug 2022 08:54:40 GMT

Love to see the figures suggesting most practices have doubled or tripled their incomes. Against lockdown numbers perhaps.

We are busy but not making that much difference.

RE: Advise re alternatives or re-kindling the flame.

Luciano Nebiante PGCertSAS — Tue, 16 Aug 2022 14:50:49 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/30382/advise-re-alternatives-or-re-kindling-the-flame/238707#238707"]Not sure why this happened but the stresses of running businesses over the last two plus years should not be underestimated. Most employees have not had the concerns directly on their shoulders.[/quote]

Figures shows that most practices have doubled/tripled their income. I would say if we put things on a graph, the stress level and workload of the employees has a similar upward direction, yet the salary or time off are not compensating for this.

Maybe I will pick pumpkins at Halloween.

RE: Advise re alternatives or re-kindling the flame.

Bob Russell — Tue, 16 Aug 2022 14:07:52 GMT

I was a little surprised when my optician turned up for an appointment ill shaven. Turns out he is now a delivery driver!!

Not sure why this happened but the stresses of running businesses over the last two plus years should not be underestimated. Most employees have not had the concerns directly on their shoulders.

I don't like this red boss description. A boss is good, bad or somewhere between.

If you have a nice, good boss then talk to him/her and try to work things out. If this fails or the boss is unapproachable then it may be time to look round.

I am considering collecting trolleys at Tescos as my next career move!

RE: Advise re alternatives or re-kindling the flame.

Luciano Nebiante PGCertSAS — Tue, 16 Aug 2022 13:46:16 GMT

[quote userid="11590" url="~/001/nonclinical/f/life-in-practice-discussions/30382/advise-re-alternatives-or-re-kindling-the-flame/238705#238705"]we need time to recover. I think maybe my red bosses didn’t need all that so much.[/quote]

I think most red bosses/people need that time too, they just don't give it to themselves because they see it as "a waste of time" when in reality it is the best investement they can do for their health.

Chronic stress has been proven to be associated with all sorts of physical illnesses, maybe they would give themselves more time if they would see what happens in the long run.

RE: Advise re alternatives or re-kindling the flame.

Bibs — Tue, 16 Aug 2022 12:55:29 GMT

I don’t know if this makes sense but it’s not so much the hours worked , as the stress and isolation multiplied by hours worked. I am happy to stay back and work late, I’ve worked nights for months on end, I’ve been an intern, I’ve done certificates in my own time. I’ve done on call, I’ve worked hard. I think it’s the feeling of being alone with stress, no sharing of responsibility when you’re feeling out your depth and on top of that long draining sessions of consulting and no down time. I’m sure I over simplified when I said most bosses are red, but I think a lot are that I’ve had. We need back up, we need sounding boards, we need case discussion and we need time to recover. I think maybe my red bosses didn’t need all that so much. It’s good to know there are other types of bosses out there - I think some self doubt is healthy.

RE: Advise re alternatives or re-kindling the flame.

Julie Innes — Tue, 16 Aug 2022 12:39:21 GMT

It makes me sad that there are so many bad experiences of practice life out there. Certainly, when I was younger, I worked a lot harder!

We are currently open 9-5 (although we will probably extend back to 6 again) Last appt is half hour before closing. I personally find 3 hours is the maximum I can consult for without a break, so that is the way we are set up. Everyone should always get a lunch hour, apart from the odd occasion where there are emergencies. I don't mind missing my lunch hour or staying a little late for a genuine emergency, but if bad planning and overbooking are the cause it needs looked into.

I have had 3 children, and understand the need to be flexible with working hours. If that means morning consults don't start until 9.30 to allow school drop offs, it's not a big deal. I will try and accommodate most people's needs (all my staff are female!) and I thik they do appreciate it. Its NOT the way it's always been, it really isn't! There are lots of employers who understand the need to alter working patterns- in fact, that is one of the reasons I set up myself, so I could block off appointments to go to the kids nativity play or parents evening. Lots more people similarly opening practices, precisely BECAUSE they want to do things differently!

I definitely don't fit your description of a "red" person. I don't like being the boss, but I try my best to be a good one. I am crippled by self doubt! I think there is, or will soon be, a rise in practices like mine

RE: Advise re alternatives or re-kindling the flame.

George Cooper — Tue, 16 Aug 2022 12:31:37 GMT

[quote userid="7145" url="~/001/nonclinical/f/life-in-practice-discussions/30382/advise-re-alternatives-or-re-kindling-the-flame/238701#238701"]The people that stayed longer in those practices were working part time and were not part of the on call rota. Is that a signal that we are missing something?[/quote]

Indeed! When I last owned a practice we did indeed utilise the services of part time vets and nurses, one difference being that they did contribute to the OOH rota. It worked very well and roughly panned out to each VS doing a single night a week. One other benefit that I found was that the part timers were quite happy to hang on for an extra half hour or an hour if their phone calls needed catching up on, for example.

The call is to "find a solution", yet this presupposes that we actually "know" what the problem is. There are many veterinary brains attempting to identify this and yet it does not appear to be anywhere near understood. It seems easy to lay the blame at the feet of our clients - yet they are what they are and it surely is up to us in a service profession to adapt and adjust our responses to their demands. It is my belief that we, as individuals need to adapt, and my observations are that many in the profession take the client behaviour to be personal, and this causes resentment, not acceptance.

The practice I worked in after returning to being a GP had the same staff for the 15 years I was there until we were acquired by a Corporate. The Boss and I worked a job-share, tending to see our own clients ,and despite other practitioners feeling disgruntled this was not an issue that we recognised. However as soon as the takeover happened,, the atmosphere changed, and there was a total change of staff to the point where we were being "found" via social media by clients who were upset by the changes wondering if were were still in practice, just elsewhere.

RE: Advise re alternatives or re-kindling the flame.

Luciano Nebiante PGCertSAS — Tue, 16 Aug 2022 12:07:50 GMT

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/30382/advise-re-alternatives-or-re-kindling-the-flame/238689#238689"]They had decent breaks, a supportive envoironment and if anyone did CPD for a few days, they had a meeting to share the knowledge.[/quote]

Hi Neil,

"They had decent breaks, a supportive environment and if anyone did CPD for a few days, they had a meeting to share the knowledge."

I found this to be very important. Allow time to recharge throughout the day and also allocate time for vets/nurses to share their new knowledge but also to simply unload about a difficult client they faced or a difficult case they could do with having "brain storming" ideas thrown at them.

That is a pro-active environment. Our brain is moulded to see the worse scenarios, it seems to do with our evolution and biology. The good scenarios? People don't bring them up because the good ones are thought to be simply "common sense" so there shouldn't be the need to highlight them.

However the worse scenarios are not looking at themselves, they are not looking at resolution, at compromise. Therefore they will not be looking at "common sense".

Aside from my personal circumstances and Bibs and many others, the over all aim should be to improve the health of every veterinary team. And in the spirit of Arlo "moderate in favour of the best!".

I am not being pessimistic here, I believe there are better ways to do things and why aren't we looking at them is my biggest concern.

To add a personal experience, I worked with 4 different corporates and 2 different privately owned practices. At some point they all presented the same problem and it became unbearable. And I ended up moving. The people that stayed longer in those practices were working part time and were not part of the on call rota. Is that a signal that we are missing something?

RE: Advise re alternatives or re-kindling the flame.

Luciano Nebiante PGCertSAS — Tue, 16 Aug 2022 10:38:22 GMT

Hi Alistair,

too many hours consulting can be draining. And so can be working every other Saturday, Working the day, being on call the night and working the next day. Doing that on-call every week. Having to work over-time but not being paid for it, would any other professional accept that?

The answer you get is "Oh but it's the nature of the job". Sorry that is just not good enough, I don't want to be in my death bed and think "Oh well it was the nature of the job", meantime I missed time with my family, with my friends and most of all I missed the time for myself, to take care of my own needs. At least the practices will be grateful I worked so hard for them, right? No, I don't think so.

RE: Advise re alternatives or re-kindling the flame.

Dinu Catilina — Tue, 16 Aug 2022 10:35:01 GMT

[quote userid="11590" url="~/001/nonclinical/f/life-in-practice-discussions/30382/advise-re-alternatives-or-re-kindling-the-flame/238692#238692"]The thing is I really really want a solution. The way to try and do that often feels that it might be to ask for help or ideas on forums like this. Just as the OP of this thread has. My negative post was a real attempt and trying to look for solutions. I’m not imagining the issue. [/quote]

I honestly think that good practices are there and we should talk about them as well. They will not fix your problem and they don't trivialise it either. The issues within the profession are very real, nobody can say different but looking at how these practices work might help others to find a solution.

I think my practice is decent. We sometimes don't have a lunch break but we almost always do. We are never fully booked and first and last appointments of the day are blocked. Every 4 appointments we have a slot for emergencies.

Some days or chaos but that can not be helped. We had a Friday with 3 emergencies caesareans and a Tuesday with a cesarean and a GDV arriving at the same time. These situations can't be helped but overall we don't have it as bad,

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/30382/advise-re-alternatives-or-re-kindling-the-flame/238691#238691"]

I disagree that forums and social media always bring out the worst.

[/quote]

They do Arlo. Those that have it well will not shout out loud about it. It can come across as not supportive towards your colleagues.

[quote userid="7145" url="~/001/nonclinical/f/life-in-practice-discussions/30382/advise-re-alternatives-or-re-kindling-the-flame/238694#238694"]. I think with my family and parents still living in Italy and aging, opening my own practice could become a problem that I might not be able to get away in case my parents fall ill. [/quote]

This is the same if you are employed Luciano. In reality, even though you have more responsibility, you will also have more freedom if you own your own practice.

[quote userid="7145" url="~/001/nonclinical/f/life-in-practice-discussions/30382/advise-re-alternatives-or-re-kindling-the-flame/238694#238694"] Also I don't have that drive to please clients that are for ever increasingly demanding, sometimes rude and also not willing to pay fairly for our services. Really the market is not appeasing to me.[/quote]

That's the beauty of owning your own practice. You just ask these clients to go :)