We have a small, consistent staff at Roman Acres Veterinary Hospital. Many of our clients know most of our staff from long before we were RAVH. We were quite surprised to see how many of our clients don't know about the different roles we have at our hospital!
While I know the forces that control what we see on social media likely drive my personal content to include lots of pet and veterinary topics, I see lots of posts suggesting that many people are starting to realize the challenges faced by the veterinary community. Veterinarians have one of the highest suicide rates of any profession, second only to dentists, in the United States. While this fact focuses on us doctors, it doesn't address our veterinary staff who are actually reported to have just as significant a level of mental health struggles, but are far less talked about. Numerous members of the veterinary work force, both doctors and staff alike, have left clinical practice or the field altogether in an understandable attempt to improve their own well-being. I support any individual taking steps to improve their mental health and I also want to try to improve the conditions of the field in whatever ways that I can. This is a major reason that Jeffrey and I made the decision to purchase the hospital, so that we can try to make the changes necessary to help, even if we are only one hospital.
In talking with my own staff as well as some from other hospitals, in addition to the reported challenges of long hours and an industry-wide history of lower pay and benefits, a recurring theme seemed to be the misunderstanding of roles in the veterinary hospital by clients. It seems that, while improving, the general public has an overall poor understanding of what education and training is required by each position as well as what part each role plays in the hospital. While I understand we cannot change the world with a single blog post, my hope is that this, along with daily discussions with clients, will help change some of the misconceptions associated with the veterinary field to help improve the quality of life of the work force, or at least my hospital's work force, in whatever way I can.
The first voice you hear and face you see - our Client Service Representatives
When you first call our hospital after your Labrador Retriever puppy has just eaten one Oreo cookie, this team member is there to not only calm your sense of panic, but also serve as the first person to triage your pet. You may be calling to schedule vaccines, uncertain of which ones are due or when they were last given, and our CSRs promptly review the record to determine what vaccines may be necessary, if they need to be updated immediately to avoid needing boosters, or if you need this appointment scheduled with the veterinarian vs the licensed veterinary technician. Or perhaps you need to call for an end of life appointment to discuss humane euthanasia where this team member works to talk you through your options during a highly emotional time.
Once you get to the hospital, our CSRs again serve as the first point of triage, looking at each pet who walks in, recording their weights, and checking them in. With years of experience and training, they are the first team member who might suggest that your pet needs to be promptly evaluated as they might not be stable. They're also there to go over the legal and financial terms of veterinary visits throughout this process. They're trained on the different financial options available to owners and can walk clients through each option, answering questions.
In addition to the client-facing aspect of the job, our Client Service Representatives start the process of refilling medications, through submitting refill requests through our system, handling outside pharmacy requests sent in to us, or confirming doses and progress statuses on pets for new medications. They direct questions from clients through the hospital to the doctor or licensed veterinary technicians and follow up with owners with answers. They also interact with local and referral hospitals to transfer records appropriately so that all doctors managing the case can stay informed and provide the best care to their shared patients.
Client Service Representatives are more than just receptionists - they're your guide to our veterinary hospital.
From start to finish, our Veterinary Assistants accompany pets through the hospital
Once you've been brought into the hospital, our Veterinary Assistants (VAs) will provide a second triage opportunity for your pet. These individuals work with pets all day, from providing comfort to fearful pets to rewarding and laughing with playful ones; they are aware of the difference between a quiet, shy animal and one that may be truly sick or unstable. Our VAs also provide the foundation for all diagnoses by asking the questions necessary to get a thorough history on your pet and their presenting complaints. In addition to this, our team of VAs is extremely knowledgeable on all of our vaccinations and preventative screening as well as parasite prevention and common medications. They're able to compare different options with you and explain the risks and benefits of each product. Personally I love that if they don't know the answer, they're honest with you and will find the answer from a reputable source, such as a licensed veterinary technician or veterinarian. For end of life appointments, these team members will discuss all of your options and if you elect to not be present during a humane euthanasia, they stay by your pet's side offering kind words and treats as they pass on.
These individuals are trained in hospital and have the expertise in animal body language to properly restrain an animal safely throughout an examination, diagnostics, and procedures to ensure pets and people alike are kept from harm. These individuals work to provide comfort to your pets when staying in hospital by making sure their bedding is appropriate, they have fresh water at all times when medically appropriate, and that they regularly go out for bathroom breaks and exercise. Our VA's assist the licensed veterinary technicians and doctors through their appointments, provide assistance during surgery, and assist in maintaining a hygienic environment to reduce the risk of spread of disease within the hospital. Our veterinary assistants have a very physical role in our hospital that can be extremely demanding as well as an emotional role as they are present throughout the entirety of all appointments in the hospital - from healthy new puppies, to sick elderly pets.
Our veterinary assistants to more than just support staff - they're your pets guide through our veterinary hospital.
The role with the most hats is held by our Licensed Veterinary Technicians
Licensed Veterinary Technicians are occasionally called Veterinary Nurses in some practices and the American Veterinary Medical Association is working towards finding better terminology to encompass all that they do. An LVT goes through at least 2 years of schooling and in New York State must pass a licensing examination to perform the duties of a technician (this varies by state). These team members are the first notified if anyone in the hospital is concerned that a pet may not be stable. They obtain initial vitals and can begin preparing emergency care that may be directed by a veterinarian. If they determine that a pet is not stable, or may quickly become unstable, they notify the veterinarian promptly so that treatments may be initiated. These individuals are trained in life-saving care, including but not limited to CPR compressions and vitals monitoring, IV catheter placement, phlebotomy, intubation, IV medication administration, jugular catheter placement, abdominocentesis, and more.
In addition to life-saving care, LVTs administer anesthesia ordered by a veterinarian and monitor throughout surgery, perform the duties of a human dental hygienist taking dental radiographs and scaling teeth, obtain x-rays, place urinary catheters, obtain other diagnostic samples such as pharyngeal swabs, obtain intraocular pressure readings, and much more.
LVTs perform duties beyond that of patient care, as well. They have their own appointments updating vaccines, trimming nails and expressing anal glands, discussing nutrition, demonstrating diabetic management to owners, removing sutures, and discharging surgeries, to name a few. They are both formally educated and trained individuals that are able to answer a wide variety of questions about medications, preventative care, post-surgical care, behavior, illness concerns that may require an appointment, and much more. Many of our LVTs have additional roles, such as maintaining lab equipment, hospital inventory, communication with vaccine companies regarding reactions or client concerns, monitoring controlled substances in the hospital, and protocol creation and evaluation.
In New York State, LVTs are required to obtain 24 continuing education hours every 3 years. It is important to note that some LVT's seek continuing education to be certified in an area, such as obtaining ultrasound images. Others seek further certification to specialize in an area of interest such as dentistry or critical care. This career is physically demanding and can take an emotional toll on individuals. The role has a focus on patient care while also requiring communication skills with owners to help spread important pet care information. It is also important to note that while some technicians may decide to return to school to become a veterinarian, it is not a stepping stone towards becoming a vet. This is a profession of its own that works closely with the veterinarian to diagnose and treat pets. At RAVH, we are extremely proud to have our licensed veterinary technicians and could not care for pets the way that we do if we did not have them.
Putting the pieces together, our final role is our Veterinarian
The final role we have at our hospital is the veterinarian. The Doctor of Veterinary Medicine (DVM) [I'd like to add here that some have the title of VMD (Veterinariae Medicinae Doctoris) which is the same title, except it comes from the University of Pennsylvania] is a degree awarded to those who complete four years of undergraduate education followed by four years of post graduated veterinary medical education. I should note that not all veterinary schools require an undergraduate degree, however all prerequisites must be satisfied for such schools and it is usually the equivalent of an undergraduate degree, anyway. At the time of this post, there are 32 accredited veterinary schools in the United States. Most schools consist of some variation of three years didactic learning followed by one year of clinical experience and externships to prove technical competencies. Education focuses on four main species, cat, dogs, horses, cows, but touches on many others. After completion of this training, potential DVMs must sit for the North American Veterinary Licensing exam which consists of 300 questions they must pass in order to practice veterinary medicine in the US. Each state then has individual requirements in order to practice within that state. In NYS, a veterinarian must complete 45 continuing education hours every 3 years to maintain their license. Veterinarians can begin practicing at this point, but some will choose to obtain further training or to even specialize in an area of interest. This often requires one year of an internship followed by 1-3 years of residency. These residents can then sit for an additional examination to obtain specialization.
At RAVH, the role of a veterinarian varies depending on each case. I personally feel that a majority of my job is about client education. It is my responsibility to inform owners of the risks and benefits of disease, vaccination, treatment, prevention, and diagnostics. I am there to answer questions and give owners the tools they need to care for their pets. We as veterinarians work together with an owner to determine the best preventative care plan based off of a pet's lifestyle and risks.
Of course, I also treat sick animals. A veterinarian will quickly assess an unstable patient, request point of care diagnostics and calculate medication doses to provide orders for initial stabilizing treatments to a patient. We rely on our LVTs and VAs to continue care in our absence while we discuss the findings and recommendations with owners. We come up with a plan that is feasible for owners and our hospital, or we offer referral to a specialty hospital if advanced care is needed. When owners opt for referral, we contact the specialty hospital to round the doctors on the transferred case and confirm any additional treatments that may be necessary before moving this pet. Finally, there is a lot of paperwork and record keeping to be completed.
For me personally, the veterinarian role is much less physical and more mental. We certainly perform a physical examination as well as surgery, which requires a level of physical skill of course. A vast majority of my job, however, is putting the pieces together. I take the history I've been provided by my VAs and combine it with my physical exam as well as the diagnostics performed by my LVTs to develop a list of most probable diagnoses. That is then used to create a treatment plan and we must evaluate and reevaluate response to the treatment plan based off of owner, VA, and LVT observation of response. Because animals can't tell us what's wrong, there is a lot of observation done to evaluate pain and comfort and we do need to rely on diagnostics to come to a diagnosis in many cases.
The veterinarian may lead the charge, but cannot operate without each member of our team.
It is important to note that many hospitals have additional roles, such as an office manager, HR representative, etc. The roles defined in this article are specific to RAVH and I cannot speak for other hospitals.
Further challenges in veterinary medicine
I would like to point out that throughout this post I mentioned different types of cases, from preventative care to emergency to end of life appointments. It's important that owners know that at any one time in the hospital, we usually have all three going on at once, each in a different room. I didn't mention the drop-off urgent care appointments or scheduled surgery appointments. This is in addition to phone calls, emails, and clients coming in to pick up medication refills or prescription diets. Which brings us to the other main component driving the challenges faced by veterinary professionals - a lack of compassion from some pet owners.
This does not apply to all pet owners - most pet owners are kind and understanding. And we aren't looking for sympathy, but perhaps some empathy and patience. Unfortunately, we have clients who scream at our CSRs because the doctor hasn't called them back within an hour of their last phone call or death threats made to staff members because the hospital couldn't fit their dog with itchy ears in that day as we already had three emergencies. All too common are the comments that if we really loved animals, we'd do it for free - but we need to charge for our services in order to continue to provide care at all. I'd like to say this is rare, but in reality we see it at least once a week. We know how stressful it is when your furry companion isn't well. While we aim for a high standard of client satisfaction and our staff undergo conflict resolution training, we also have a zero tolerance policy for poor behavior towards our staff.
In an effort to protect all members of our team, aggressive, abusive, or disrespectful behavior will result in an official letter terminating the relationship between Roman Acres Veterinary Hospital and said client in addition to a copy of all medical records for owners to seek care elsewhere. As I mentioned above, all members of our staff are vital to our success and each one deserves to work in an environment that is safe for them both physically and emotionally.
Moving Forward
The future of veterinary medicine seems a bit unclear at this time given the current struggles reported by all members of the team across the industry, but we're striving for improvements each day. We all went into this out of a love for animals and veterinary medicine, but there are challenges that go beyond what was addressed in this post alone that make some people question those decisions. As I previously mentioned, I hope that we can help spread a better understanding about what we do and experience daily, with the goal of improving the overall health and satisfaction of our team members. I cannot emphasize enough how important each individual at RAVH is and what they contribute to the high quality care that we strive to provide.
We send a sincere thank-you to all of our supportive clients who have seen us through our transition in ownership. Myself and our team truly love your pets and find joy in caring for them. We hope to continue to grow here in Greene, NY and provide you with the pet care that you need.
For more information on the current challenges in veterinary medicine, or ways that you may be able to help, visit https://www.nomv.org/
Comentarios