A tale of two clinics

"Two roads diverged in a wood and I - I took the one less traveled by, and that has made all the difference." ­ Robert Frost

am Smith walked purposely toward the restaurant. He had just registeredfor the annual meeting and was anxious to meet Jim Warren, a classmate,for lunch. He had not seen Jim since vet school and was wondering if hehad gained weight and lost his hair like he had.

Although Sam had been to a few veterinary meetings since graduating fromveterinary school, he now was here for a new purpose. Sam had received informationthat he must attend some form of continuing education this year in orderto maintain his license.

"Hey Sam, is that you?" Jim called from a corner booth. Sampeered over his spectacles and saw a man that reasonably looked like theJim Warren he used to know 25 years ago.

"Hi, Jim. Thanks for meeting me here," Sam replied as he struggledto squeeze his ample abdomen under the tabletop.

"You here for the whole meeting?" inquired Jim.

"I'll be here just two days. Enough to get in my 20 hours of CEand get out of here."

"I thought I saw you here briefly last year but haven't really seenyou at any of the other meetings I usually attend."

"Yeah, I really don't learn anything here I don't already know.Most of it does not apply to me anyway. You know these university typeswant you to do a bunch of things clients don't really want or can afford.It is mostly a waste of time," Sam spouted this with authority. Hewaited in vain for Jim to nod in agreement.

Finally Jim frowned imperceptibly and then was silent for another moment.

"Sam, you said you'd like to talk to me and I'm all ears. It sureis good to see you."

"Thanks. You know I am really thinking about selling out and goingto Florida or somewhere warm. I need to get away from all the hassle ofrunning the practice. I had a stint put in my heart last year and I justdon't need it all anymore."

"Gosh, I am sorry to hear that." Jim said.

"Do you have any associates?" Jim replied looking for a placeto start.

"That's a joke. These kids today want to earn as much as I do. Thenwhen I hire 'em they want to change everything. I've had two associatesover the years and they both took off when they smelled a little more moneydown the street."

Jim now tried valiantly to move the conversation forward.

"Have you attended any seminars concerning practice evaluation andsales?" asked Jim.

"Why bother? Those people all sound like a broken record-raise prices,raise prices. They don't know how bad the economy has been for the past10 years."

Sam smugly leaned back and again waited for confirmation. At the fewmeetings he did manage to attend, he was used to carping about the professionwith some of the colleagues he knew. He expected Jim to join in for a livelydiscussion of the sorry state of the profession. He also expected at leastsome discussion concerning the lazy vets coming out of vet schools thesedays. Jim would not bite.

"Sam, you know there may be more here than I can deal with in justa few minutes at lunch. Can you meet me at my hospital in a few weeks?"

They agreed.

Two weeks later:

Sam was impressed by Jim's hospital and was given the tour. In the back,Sam saw two technicians pulling blood and another taking an X-ray with anassistant.

Sam could hear Jim's associate in an exam room with an assistant explainingthe necessity of a full work-up on a suspected Cushing's patient.

Sam looked at Jim and said, " You know, I have seen thousands ofpatients over the years and have never seen a Cushing's case yet."

Jim smiled and gently replied, "Maybe you have overlooked a few."

Sam was oblivious to the comment and moved the conversation to anotherlevel.

"I don't hire anybody any more except the kennel girl. That's allthe hassle I can take; what with all the vets in my area I'm not as busyas I used to be anyway."

Sam looked at the scene before him and added, "I bet you must work80 hours a week in this clinic? "

" Well, actually, I take a few days off a week and now I work lessthan 40."

Sam laughed audibly and offered, "Impossible! You must have a millionmanagement hours logged."

"I hired a manager years ago and she keeps me informed. But really,I just come in here now and mostly just do medicine and surgery. Don't getme wrong, there are problems, but the team helps me work them out as wego along."

" 'Team?' What kind of blather is that? You surely mean the employees."

"I used to refer to them as staff but we like to call ourselves'the team'".

"Well, I can tell you right now, I pay the bills and I make 100percent of the decisions at my place. A man has to be king somewhere."

By now, it was obvious that these old colleagues had, over the years,taken quite a different approach to the practice of veterinary medicine.Jim asked Sam to step into his office. Sam did not know it, but Jim wasabout to give Sam his prescription for having a more positive outlook onpractice life. In doing so, he was hoping to show Sam that many changeswould be in order if he expected to sell his practice.

Now we don't know exactly what Jim is about to tell Sam, but we shouldapplaud him for sincerely trying to help his colleague. Jim and Sam have,over the years, decided to travel down two different paths.

A common scene

It is not unusual to see and talk to many "Sams" at veterinaryconferences or at local meetings. They all have one thing in common. Theyare entrenched in their own ideas and have been in practice long enoughto dig a hole and sit in it.

All of us have had a little bit of Sam's attitude crop up in our conversationsfrom time to time and it is certainly not confined to solo practice. However,solo practice seems to cultivate, over a period of time, mindsets that canbe difficult to change.

It should be noted that solo practice is still, by far, the norm forour profession. Additionally, high quality medicine and surgery can andis found in a solo setting-especially if the practitioner uses staff welland refers often to specialists.

This article addresses the emotional impediments that can impact thelong range planning of those who may plan to exit the profession.

Isolation

One of the problems facing a veterinarian practicing without a colleagueor partner is the sense of isolation. This can be happening even withoutthe practitioner realizing it.

Of course, going it alone is an absolute necessity if you are going tostart out from scratch (unless you married another veterinarian), yet ithas many drawbacks. Working alone often creates isolation that can leadto:

A feeling of disconnection

Since many patients get better whether we practice good or bad medicine,it is easy for an isolated veterinarian to feel the most of his or her decisionsmade in isolation are correct and beneficial.

Since no one is there to balance your approach, it is easy to fall intobad habits and ideas that are self-defeating.

Victories and defeats are unshared except with staff-this leads to burnoutand further isolation.

View of the outside profession

It can be discouraging for anyone to see the advances in veterinary medicineoccurring at the universities and in the wealthy suburbs and not be ableto participate in these advances within your own practice.

In addition, it is easy to feel deflated when you see the large and expensivehospitals being showcased in some of the veterinary trade journals.

This tends to jade the practitioner and walls of isolation are furthererected. This view of the outside world and the perceived realities of practicein their own community along with the competitive pressure of new localpractices tend to justify an attitude of being trapped.

It follows in the mind of the practitioner that outside factors makeit impossible to make the adjustments necessary to make progress with therest of the profession. It is easy to let your mind fall prey to this thinkingwhich leads to inaction on the part of the practitioner. Inaction leadsto a decline in the practice and its value.

Self image

Although it is impractical to match what others may be doing in othersettings, it is especially unsettling to new practitioners right out ofschool and soloists. This can lead to an unhealthy self-image.

We are a small profession with a fabulous public image. At the same time,most veterinarians have a poor self-image due to feelings of inferioritywhen compared to other professionals in the human health care field. Veterinariansalso seem to have a poor understanding of the value that the general publicplaces on their worth.

Therefore, in order for us to have a healthy outlook on what we do, itis very important to understand our role in veterinary medicine as primaryproviders and embrace it. That is, as the primary providers of veterinarycare we are the "first line of care" for a client's precious petsand generally are how the public perceives the profession. Although youmay not have an MRI machine handy, you and only you have the opportunityand the privilege of providing a lifetime of care for the family pet. Althougha throwback to a bygone era, the veterinarian in private practice may bethe last remaining professional who can have an impact on the family asa complete unit.

We definitely need to make a favorable impression from across the examtable every day. This can be difficult if the trials of day to day practicelead to burnout and discouragement.

Especially in a solo situation, cynicism can start to creep in to ourdaily discourse with clients and staff. This is an extremely dangerous situationfor a veterinarian to be in. It affects his or her emotional health andultimately the economic and ultimate salability of the practice.

The rugged individualist

The process of becoming a veterinarian is not a team effort.

Until recently, individuals aspiring to be veterinarians or those attendingveterinary school achieved goals based on individual effort. Awards andgrades are an individual accomplishment. Is it any wonder that veterinarianslack the team-oriented skills so essential in today's veterinary workplace?It is incumbent on the schools of veterinary medicine to promote team learningif tomorrow's veterinarian has any hope of integrating into tomorrow's veterinaryworkplace.

The Jim's Warrens of the veterinary world have made adjustments and have,over time, embraced the team philosophy so necessary to make a businessventure an ongoing enterprise worthy of sale to another practitioner.

The end result

Sam Smith, the cynical solo practitioner, was not made overnight. Heis a product of his views of the profession outside his own practice walls.He is also a victim of his own rugged individualism that helps him maskhis deteriorating self-image as a veterinarian. This has led to a conclusionin his own mind that veterinary medicine always reduces itself to the lowestcommon denominator and that outside forces have shaped who he is and whathis practice has become.

In other words, 'who he is' as a veterinarian is under someone else'scontrol. He is under the assumption that all of this is unchangeable. Sam'sunwillingness to work with others and his rugged "me against the world"attitude are his undoing. In the end, he extols a self-fulfilling prophecy-thevalue he places on his self-image may indeed equal the end value of hispractice in dollars-zero.

A road less traveled

Pushing yourself beyond what seems to be the gravitational forces ofthe business environment that you long ago selected for yourself is thekey to professional growth.

It makes all the difference in world as it relates to professional lifethat will become what you know to be your practice. Granted, the uniqueniche that veterinary medicine occupies in a local business environmentoften makes this a tough proposition.

This sometimes difficult business environment is more than balanced bythe unique position that veterinarians are held-something that should neverbe squandered. Jim Warren is well award of this.

However, those who take the upper road and push themselves beyond arerewarded with long hours and many setbacks. The saving grace is the employeesand the clients that form the core of your professional growth team. Ifyou use them properly, you will be able to move the practice from one plateauto the next. Moreover, in the end it will make your practice worthy to bepassed on to the next generation of veterinarians.

Thus, we comprehend the genius of Robert Frost.