Losing your job isn't a threat; it's an opportunity

In veterinary practices, trust and job security have a unique relationship.

Trust most often leads to increased job proficiency but job securitydoes not mean there is trust. Wage levels are not good indicators sincethey are often tenure-based and not true recognition (advancement). In fact,job security in veterinary practices often becomes an inverse of trust,when no one else can be trusted with the task(s) and the status quo becomesthe standard of security. With all that said and done, how does a new veterinarianhandle the threat of unemployment?

Start at the beginning

When we look at a standard industrial production formula, we see input(people and other resources added to an idea or plan) going through a process(manufacturing, job description, or other change process) resulting in anoutput (a product, a service, or a purchase). In healthcare this formulais inadequate. The output is not the end of the work formula, it is onlya manifestation of the process. Outcome is the success factor in healthcaredelivery.

* input --> process --> output --> outcome n

This is not a radical thought. It is the essential success factor ofthe management texts of the 1990s. In healthcare delivery, patient wellnessis the output, but in veterinary medicine, as in pediatrics, a happy clientand some level of profit are the real outcomes desired from a patient encounter.

A new veterinary medical graduate has only been taught how to derivethe output (curative medicine). Seldom is the outcome a concern of our educationsystem. In fact, most veterinary schools have become tertiary care facilities,meaning their clients are now the referring veterinarians and not reallythe clients. This causes the unskilled practice owner to threaten unemploymentrather than primary healthcare delivery training, which has three basicoutcomes:

1. If you have accepted the fact that you need primary healthcaredelivery training, and you have informed your practice owner, they may either:

* Fire you on the spot!

* Remember their first practice and provide you time to learn.

2. If you have accepted the fact that you need primary healthcaredelivery training, but have not informed the practice owner, then you mayeither:

* Ask your employer for a reconsideration training time.

* Get gas money and go look for a new job!

3. If you have NOT accepted the fact that you need primary healthcaredelivery training, but have been informed by the practice owner that yourperformance is not up to expectations, then you may either:

* Expect to be fired

* Get gas money and go look for a new job!

It is most often about your client-center, or your patient advocacy;many practices call this the bottomline and confuse the new graduate withmoney numbers like average client transaction (ACT) or gross sales (netincome), but in the end, it is about quality healthcare delivery. In thepast decade, we heard about building job descriptions, protocols and developingthe "perfect" employee "ad nauseam"; it never workedin the real world! In healthcare, job descriptions can only be the startingpoint, NEVER the end point. We are in the continuous pursuit of problemsolution, not cookbook compliance. If a client is at the front desk, theyhave a problem they want solved. No job description provides the latitudeto react differently to different client speech rates, to their perceptionsor to medical misadventures.

Review the evolution of the phrase "medical misadventure,"a term that became popular in the 1980s. Most often it meant the healthcarefacility screwed up, but based on percentages and statistics, it shouldhave been "expected."

The problem is the patient (or client) never expected it! In most casespeople were doing "their job". . . doing their job description."This is the disaster phrase in healthcare-human or veterinary. People expectmore. The job description should delineate the basic skills expected bythe end of the orientation period (probationary period). For untrained staffmembers, 90 days are never enough, but some practices think assigning atitle and providing a job description equate to an adequate training programand people are ready to start. This is where disasters are caused, not bythe new member of the healthcare delivery team.

Standards are required

Every practice hires good people. Granted, some veterinary practiceshire a person out of desperation, but the practice does not hire someonebecause they prefer a person's "bad attitude," lack of skillsor inferior knowledge.

In most all cases, these terms evolve after the first 90 days of employment.

It appears we need to inform new staff members of a new set of job standardsin today's work place:

Standard

1. You are responsible for your career. Career choices are madeby the individual, not the practice. Excellent work skills, the abilityto contribute at a high level of efficiency and a cooperative team attitudewill need to be continually improved if upward mobility in salary or positionis desired (e.g., the VPC Brokerage can find you a job at more than $50,000if you are geographically mobile and hold a valid license to practice).

Standard

2. There is no such thing as job security. You are hired for aspecific set of tasks, and if the tasks change, you must also. You weregiven a job description with the basic skill and knowledge expectations,but continuous quality improvement (CQI) is expected for continuous upwardmobility in salary or position. Moving to a better job environment is nowfacilitated by veterinary job brokerage firms, which does the match makingand most of the contract negotiations.

Standard

3. Knowing what the practice expects of you is your responsibility.The ground rules will change, with the patient, the veterinarian and thestate-of-the-art of the profession. While you should be told, the communicationsystem in the practice is a multi-directional system. Feedback and peerdiscussions are just as important as the downward cascade. You must be responsiblefor clarifying the expectations and you must continually strive to exceedthem. PRIDE is found when expectations are exceeded, and continuous effortsto improve are needed for upward practice mobility in salary or position.

Standard

4. Practice loyalty means pursuing practice goals. Close personalrelationships form in veterinary practices, it is the nature of the team,but it does not replace competency and proficiency. The growth of the practicedepends on happy clients, well pets and profit, and the three are equallyimportant. The practice is a legal entity, responsible to the laws and regulationsof the land, and the employment contract requires you to continually pursuequality improvement in these three elements to survive here. If you becomedoctor-centered (e.g., I want, I need, etc.), the new client-centered practice(bond-centered practice) will likely fire you and release you to find aposition that better suits your bias.

Standard

5. You were hired to solve problems, not to do a job. As statedearlier, the veterinary profession is a series of never-ending problems,from clients, patients, veterinarians, staff, government and special interestgroups. You are expected to continually strive for harmony by improvingthe situation beyond the expectations of each of these problem sources.This continual improvement of the quality of life and healthcare operationsis required for upward mobility, in salary or position.

As unlikely as it seems, these standards are the basis of practice successas well as common methods of human resource management. The healthcare deliveryteam must respond to the doctor's treatment plan. There is no latitude inthat area. But the rest of the time, they need to be making the practicebetter.

There are specific traits that are common to the practice environmentwhere trust and job security go hand-in-hand. A lot has been written aboutthe traits of leadership, the styles of management, the skills of humanresource utilization and related pursuits.

New graduates, trust me on this one, you will probably not find the perfectpractice when you first start out of the gate. Most of us are not livingwith the person we first dated. In practice, the veterinarians must be compatiblein their quality and continuity of care. The staff and doctors must reinforcethe strength of the whole, support the practice vision, and be loyal tothe practice's healthcare delivery philosophy (in Montana, we called it,"riding for the brand".)With multiple jobs for every new graduate,you are not bound to stay in any practice environment which makes you loseyour dream.

If you have a boss who threatens to fire you, the handwriting is on thewall; your contract will not likely be renewed even if you survive the currenttirade. The three choices stated earlier in this article might have soundedtrite, but I hope you see the reality . . . if you do not take control ofyour own destiny, you will NEVER get where you want to be. If you have burnedtoo many bridges (or allowed to many OHE patients to die under your knife),relocation is essential, so:

* You can start to use what you learned at the school of realityand stress.

* You do not have to say you are sorry to people who do not forgive.

* You can ask for help/assistance earlier and faster.

* You can find a better climate, better benefits, better hours,better life.

Do not fear the new horizon that relocation offers. Do not fear the nextjob, since now you can negotiate better, having proven experience to drawupon. Do not fear the opportunity to find better benefits, a different communityor even a practice that better matches your personal healthcare philosophy.The fear of the status quo must be the worst fear in your life as you seekthe better career path. So dear new graduates, stride forth with confidence;the adventure is about to begin.

Dr. Catanzaro can be reached at Veterinary Practice Consultants®(Catanzaro & Associates, Inc.), 1217 Washington Ave.; Golden, CO 80401;(303) 277-9800; FAX: (303) 277-9888, e-mail: Cat9800@aol.com; or visit theWeb site at