PetVet August 2019 by Barkleigh Productions

WWW. PET VETMAGAZINE .COM

VOL. 2 ED. 4 • AUGUST / SEPTEMBER 2019

DR. KIMBERLY POPE–ROBINSON

1 LIFE AT A TIME ROAD MAP TO STARTING

A VETERINARY PRACTICE

PHOTO PROVIDED BY DR. KIMBERLY POPE–ROBINSON

IT’S NOT JUST A BOWL MERCK It could spread a disease worse than Bordetella

Compare the risks Highly contagious Unresponsive to antibiotic treatment Primary cause of pneumonia Vaccine recommended in AAHA* guidelines

Bordetella

Canine Influenza (CIV)

YES NO NO YES

YES YES YES YES

Recommend vaccination for CIV in addition to Bordetella.

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AUGUST/September 2019

CONTENTS 5

Veterinarian Life Advice

PetVet Advisory Board

A Practical Guide for Pet Health Professionals

ROAD MAP

What You Need to Know About Veterinary Telemedicine

TO STARTING A VETERINARY

10 Jazzmyn Carter: Taking the

Initiative to Help Those Who Need It Most

PRACTICE

Anti-Vaxxers: Putting Pets at Risk in a City Near You!

18 5 Lessons from the First 5 Years 26 The Spark & The Switch: How to Avoid Burnout as a Veterinary Professional

Dr. Kim ber ly Pop e-Rob ins on

32 PetVet 10: Ten Things to Do

This Month

ON THE COVER WWW. PET VETMAGAZINE .COM

VOL. 2 ED. 4 • AUGUST / SEPTEMBER 2019

1 LIFE AT A T IM

DR. KIMBERLY POPE–ROBINSON

By Brennan Pitard, DVM 1 LIFE AT A TIME 14

PETVET MAGAZINE

ROAD MAP TO STARTING

A VETERINARY PRACTICE

PetVetMag

@PetVet_Magazine

PHOTO PROVIDED BY DR. KIMBERLY POPE–ROBINSON

DR. KIMBERLY POPE-ROBINSON PHOTO PROVIDED DR. KIMBERLY POPE-ROBINSON

Copyright July 2019. PetVet Magazine is published bimonthly by Barkleigh Productions, Inc, 970 West Trindle Road, Mechanicsburg PA 17055. Postmaster: Send change of address to Pet Vet Magazine c/o Barkleigh Productions, Inc., 970 West Trindle Road, Mechanicsburg PA 17055. No part of this publication may be reproduced without written permission of the publisher. Editorial offices: 970 West Trindle Road, Mechanicsburg PA 17055. (717) 691–3388 FAX (717) 691–3381 Email: info@barkleigh.com

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VETERINARIAN LIFE ADVICE

Your Motivation Starts Here LIFE ADVICE FROM THE COOLEST VETERINARY PROFESSIONALS WE KNOW

CONTACT Inquiries info@barkleigh.com (717) 691-3388 Editorial rebecca@barkleigh.com (717) 691-3388 (ext. 225) Advertising james@barkleigh.com (717) 691-3388 (ext. 224)

STAFF Publisher Barkleigh Productions, Inc. President Todd Shelly Vice President Gwen Shelly Chief Operations Officer Adam Lohr Executive Editor Rebecca Shipman

UNKNOWN

Art Director Laura Pennington

jump in the deep end first, test

Director of Marketing & Client Relations James Severs

If no one around you wants to the water and lead the way.â&#x20AC;?

Natalie Marks, DVM, Medical director, Blum Animal Hospital

Senior Graphic Designer Jenn Barraclough Junior Designer Jenny Thomas Web Master Luke Dumberth

Administrative / Marketing Assistant Karin Grottola Marketing Coordinator Alyx Robertson Social Media / PR Coordinator Evan Gummo

and Gold Paw Veterinarian of the Year 2017.

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ADVISORY BOARD

Meet our EDITORIAL

ADVISORY BOARD!

PetVet’s advisory board is here to help ensure quality content to motivate & educate Veterinarians and their staff.

Jenifer Chatfield DVM, DACZM

Courtney Campbell DVM “My passions ultimately drove me towards becoming a veterinarian, but when I was growing up I briefly flirted with the idea of becoming a magician. As a veterinarian, the ability to save lives, keep animals healthy, and strengthen the human–animal bond makes me realize there’s nothing more magical than that.”

Alberto Fernandez DVM, DACVECC "The human race will not be possible without the animal kingdom. It is our duty to take care of those that provide to us and to me it is an honor to do so."

Lisa Powell DVM, DACVECC

“People should be so lucky as to get to be a veterinarian. The broadbased education empowers us to be successful in multiple fields and affords us the opportunity to choose how we spend our professional time.”

Julie Legred CVT “I have had the privilege of working with a variety of animals in my career and my passion has allowed me to be involved in teaching veterinary students, interns, residents and other veterinarians. I continue to enjoy going to work every day to help critically ill dogs and cats, and love the client interactions as well. I am proud to be a part of this advisory board to help teach and spread my love for this profession to others in the veterinary community.”

Jill López DVM, MBA

A Practical Guide for Pet Health Professionals

“Do something every day to make an animal’s life better.”

“I have worked in many areas of veterinary medicine and veterinary technology over the last thirty five years, and it is amazing how far our profession has grown and paved the way for the betterment of animals' lives and happiness, as well as improving public health issues. It is an honor for me to be a part of this advisory board to offer additional education and opportunities to grow in our profession.”

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CLIENT SERVICES

elemedicine is not new to the medical field; human medical doctors have been using this platform for many years. The initial hurdle was to overcome state and federal laws requiring and defining a doctor/patient relationship. In the last several years, we have seen an increase in such services in the veterinary world, culminating with Banfield’s recent news that they were delving into this technology by launching “Vet Chat”. This new advancement allows members of the hospital’s Optimum Wellness Plan on-demand access to pet care advice and support from a veterinarian anytime and anywhere. A recent Banfield survey shows that 71 percent of pet owners turn to the internet instead of their veterinarian. According to the survey, 75 percent of veterinarians agree that knowing how long to wait before consulting a veterinarian is one of the biggest challenges their clients face. Also, 90 percent of veterinarians worry that pet owners may unknowingly put their pet at higher risk by taking bad advice from the internet.

We caught up with Dr. Aaron Smiley, a virtual veterinary care expert, to learn more:

By Jill López, DVM, MBA Does the world need televets? “I don’t know if we need veterinarians who are strictly “televets” but

PETVET MAGAZINE

I have found that clients really like veterinarians who effectively incorporate “tele” into their practice. In the past, this was strictly the telephone, but now clients are communicating with veterinarians via Facebook, SMS, WhatsApp, email, etc.”

How can we use telemedicine with our clients? “Almost all veterinarians practice telemedicine already. Clients will contact the clinic or doctor on the telephone, SMS or email with questions, and the doctor will communicate directions and/or advice remotely. I have found the most needed “tele” communication is post diagnosis or surgery. Almost all

veterinarians are televets already, but are not monetizing the process. Thankfully there is technology available now that makes the process of collecting fees for telemedicine much easier.”

Why did you become a televet? “I started practice as an ambulatory equine veterinarian and got comfortable talking with clients about medical problems over the phone. Once technology advanced and most people were communicating via text, I started looking for a way to allow my clients to text me and preserve my work/life balance.”

What is the best part and worst part of your job?

A Practical

We are using Guide telemedicine to connect for specialists to Pet ourHealth clients so more peoProfessionals ple have access to the best care. The worst part is that some problems can’t be fixed virtually.” 

S Q UA R E LO G O

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WHY IT MATTERS

NNYMAN

PHOTO BY HO

PE THOMAS

PHOTO BY JERYL PE

Jazz myn Carter

TA K IN G

TH E THOSE WHO NEED IT MOST By Angela-Marie Peña

or Jazzmyn Charmaine Carter, seeing an enormous number of dogs and cats lying motionless and bleeding on the side of roadways after being struck by vehicles in her Riverdale, Georgia community was heartbreaking. It was this and witnessing dozens of homeless dogs and cats roaming her neighborhood that also troubled her. During their quest, the animals often toppled garbage cans and ripped through trash bags searching for food while strewing refuse all over the streets

and in yards. Some of the animals were so emaciated, malnourished and bloated that their rib cages bulged. Filled with compassion and a willingness to go the extra mile to help, Jazzmyn often took a few to her home to care for and nurture. However, her efforts did very little to address the root of the problem. “I didn’t want to see any more animals die from being hit by cars or homeless and in need of help and medical care,” she said. “I had to take action and do something about the

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animal overpopulation. And I knew spaying, neutering and educating owners and the communities–at–large were the best solutions. However, I didn’t know where to begin.” After graduating with a Bachelor of Science degree in Animal Science from the University of Arkansas at Pine Bluff in 2012, she quickly immersed in the veterinary field. She became an Animal Behavior College Certified Veterinary Assistant (ABCVA) in 2013 and worked as a veterinary assistant in Decatur and

NNYMAN

soon founded Jazzy Paw, Inc. on March 10, 2017. Jazzy Paw is a canine and feline spay, neuter and wellness clinic for cats and dogs; it offers heartworm tests, deworming, microchipping and preventatives. “Wellness is an essential aspect of what the clinic teaches. There’s a lot more to owning pets than merely feeding them,” she said. “Pet ownership entails much responsibility and an investment of an owner’s time and resources. Part of that responsibility is ensuring the animal is neutered or spayed, is appropriately tagged with identification information or micro–chipped, is up–to–date on vaccinations and receives medical care when necessary.”

PHOTO BY JERYL PE

Atlanta, Georgia and as a triage supervisor for an animal shelter in Chattanooga, Tennessee. It was while working as a clinical operations manager for a spay/neuter clinic in Duluth, Georgia that she realized it was time to return to Georgia and tackle the animal overpopulation problem. “I always knew I’d return to my home county [Clayton County] to help animals, but didn’t know what the best solutions were,” Carter recalled. “Working in the veterinary field clarified everything, and I gained a better understanding of what needed to be done.” Ready to get started, Jazzmyn moved to Jonesboro, Georgia and

www.rememberapet.org

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PHOTO BY HOPE THOMAS

WHY IT WORKS Southern states such as Georgia and Texas have some of the highest euthanasia rates in the U.S. at 2.4 million and 2.7 million, respectively. In Henry County Georgia, for example, 482 dogs and 561 cats were euthanized in 2016. That number increased in 2017 to 560 dogs and 649 cats killed, according to Metro Atlanta Animal Control Statistics 2017 Statistical Data compiled by the Georgia Stopping Pet Overpopulation Together Society (SPOT). Jazzy Paw serves all residents, but primarily low–income individuals, including the elderly, college students and veterans who reside in four metro Atlanta, Georgia counties, including Clayton, Fayette, Henry and Spaulding. It began offering spay/neuter services in March 2019, and since then, it has neutered and spayed 633 animals—119 felines (161 of which are feral) and 353 canines to date.

WHY IT MATTERS “Animals depend on us to help them and provide the care they need. Overpopulation hurts them and our communities. We must use our knowledge to help them, their owners and each other by providing food, medical care, as well as shelter and companionship. It takes a village to successfully do this, and collectively we can fix this problem”, concludes Carter. 

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Angela-Marie Peña is the Director of Public Relations at Animal Behavior College. Founded in 1998, Animal Behavior College is a vocational school that trains professional veterinary assistants, dog trainers, cat trainers and pet groomers nationwide and in the 10 provinces of Canada. Its online Veterinary Assistant Program is one of four programs approved by the National Association of Veterinary Technicians in America (NAVTA), a distinction that is highly regarded in the veterinary community. Currently, more than 9,200 students have graduated from the program. To date, ABC has graduated more than 28,000 students from its four core programs combined. For more information, visit animalbehaviorcollege.com

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BUSINESS TRENDS

ROAD MAP

TO STARTING A VETERINARY

PRACTI CE Are you thinking of starting your own veterinary practice? A lot of thought and effort goes into this choice, while keeping in mind there will be little to no financial reward for at least the first year. Before pursuing this goal, be certain that you’re at a point in your life where you can give everything you have, plus more, to this new endeavor. It’s never too early to start thinking about the idea of practice ownership, but make sure you have the experience and confidence to back it up. I have the privilege to talk with many veterinarians on a day–to–day basis, and the ones who say, “I want to start my own practice,” truly inspire me. The courage it takes to purchase an existing practice is huge. But pursuing a start–up business—including purchasing equipment needed to operate a practice, building up a clientele, and, oh yeah, filling the role of doctor—is an enormous task. This takes an ambitious individual, an entrepreneurial spirit and the support of a knowledgeable team.

Building Your Team

By Brennan Pitard, DVM

Putting together a solid team is very important for any start–up entrepreneur. For a veterinary practice, the lineup may include, but certainly will not be limited to, a banker, practice consultant, architect and accountant. When choosing your team, don’t make your decisions lightly; you should choose professionals who understand the veterinary industry. For example, choose a bank that understands the nuances of a veterinary practice, find a practice consultant that works with veterinarians every day, an architect who has designed veterinary practices and an accountant who understands the

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finances specific to veterinary practices. Selecting a team that understands the veterinary industry will be one of the most important steps you will take in the process of starting a practice.

The Big Picture Once you start reaching out and getting members of your dream team together, you should start thinking about the big picture of your practice—location, species treated and services offered. Think of ways that you can differentiate your practice from other practices in the area. The beauty of veterinary medicine is that we have so many options in our practice format. However, you need to decide on a location and identify the specific needs of that area. Your consultant will play a large role in performing a location analysis to determine what the area can support. You definitely don’t want to start in an area that is saturated with veterinarians or seeing population decline.

Putting Together a Business Plan & Financial Projections After you have tackled the bigger picture, you can begin putting together a business plan along with three–year financial projections. A start-up veterinary practice is usually going to be funded by a bank via a Small Business Administration (SBA) loan. When going through the approval process of an SBA loan, you’ll need a solid business plan accompanied by three years of financial projections. Within those projections, the first two years will need a more focused month– to–month break down. The business plan will rely heavily on your personal resume, plus any previous veterinary and management experience. Projections will include gross income numbers, cost of goods sold, net income

and all expenses of the business. These numbers are put together to assess the cash flow of the proposed practice. Keep in mind that the location of the practice and the services offered will play a large role in the cash flow. For example, a start–up small animal practice located in a large city near an area where 1,000 new homes were recently built will probably scale more quickly than a similar practice located in a smaller town with no growth on the horizon. All of these variables come into play when putting together your plan. If you start to see that the location may not be as good for a start–up practice as you initially thought, don’t force it. Take a step back and regroup. This is not necessarily a bad thing, it just means you have put in the proper research and development. Now, get back together with your team and adjust your plan. With all of the variables that go into a start–up practice, expect some adjustments to your plan along the way. These course corrections will only help guide you to your more defined and ideal situation.

Financing Now that you have your location, business plan and projections together, let’s talk about the financing. Hopefully by this point you have a relationship with a veterinary–specific lender and have an idea of what your budget is. SBA loans require a down payment of 10% for a start–up practice and can include a term as long as 25 years if real estate is involved in the transaction. It is important to find a bank who understands the veterinary industry, along with SBA lending, and who can help tailor the loan to your needs. Typically, a start–up practice owner will need funds for furniture, fixtures, equipment, working capital, inventory and a build–out or leasehold improvements.

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And, of course, if you decide to buy your own commercial property, that will also add to the transaction. To start a veterinary practice in a leased space, a borrower is typically looking at a loan ranging from $400,000– $600,000—depending on how extensive the improvements are and how many of those improvements, if any, the landlord is willing to cover. For a borrower purchasing their own commercial real estate, they are usually looking at a loan ranging from $700,000–$1,000,000. Again, this depends on how much work is needed to turn the property into a functioning veterinary practice. An architect will play an important role here in helping you determine if the space is a reasonable option to be turned into a veterinary practice. Even though an existing practice purchase typically has you up and running the next day with an established clientele, in some cases, choosing to pursue a start–up practice instead may be the best fit for you. All of those thriving veterinary practices out there had to start somewhere, right?  Dr. Brennan Pitard is a veterinarian as well as a veterinary practice lender with First Financial Bank. He is a 2016 graduate of LSU School of Veterinary Medicine, where he was the Vice President of the VBMA chapter and served as a Hill’s Pet Nutrition Student Representative. His expertise and understanding of the industry has helped many veterinarians obtain the funding necessary to purchase or start a practice. He enjoys talking with veterinary students about what to expect when they start their practice and how to be prepared for a potential opportunity to buy an existing practice or start one themselves. He can be reached at bpitard@ffb1.com or you can connect with him @TheVetLender. For more resources, podcasts, webinars, and other info please check out ffb1.com.

INDUSTRY NEWS

ANTI-VAXXERS PUTTING PETS

AT RISK

IN A CITY

NEAR YOU

By Steve Dale

nti–vaxxers—those opposed to most or even all vaccines—are gaining momentum. Their claims are based largely on misguided and even made–up notions regarding human vaccines—and now even more distorted information regarding vaccines for animals. This isn’t a small cult without impact. According to the Centers for Disease Control, there are various measles outbreaks in the U.S. with an unparalleled number of sickened individuals. In New York City, as of April 15, 2019, there have been 329 confirmed cases of measles in Brooklyn and Queens since October of last year. The CDC says this only happens because people aren’t vaccinating. In April, The World Health Organization (WHO) listed “vaccine hesitancy”—defined as the reluctance or refusal to vaccinate, despite the availability of vaccine—among the top 10 public health threats of 2019. WHO indicates that vaccination is one of the most cost-effective ways to avoid disease, preventing two to three million deaths annually, and an additional 1.5 million more deaths could be prevented if vaccines were more widely available globally. With a vaccine on board, typically there’s no need for treatment because disease is prevented, which also saves millions in medical costs across the globe. This is all a consequence of undocumented effects of vaccines, such as allegedly causing autism or various autoimmune illnesses in people. Human health aside, there’s no peer-reviewed study confirming that vaccines cause or even contribute to these problems in pets. In fact, autism has yet 16

to be described in dogs and cats. Lack of research to support claims doesn’t seem to bother the so–called anti–vaxxers. And some of those anti–vaxxers have pets and carry their opinions over to making their pet health care decisions. One common complaint regarding vaccines is, “The vaccination will make my pet sick.” I’ll address this one first as an example as to how misinformation can spread from a spark begun by one group online to a wildfire. And it’s not only anti–vaxxers who make decisions based on misinformation. For example, during the H3N2 canine influenza outbreaks, some dog owners refused vaccines for fear that their best pal would get the flu from the vaccine intended to prevent the flu because they read that this is what happens. It’s not what happens. The dog flu vaccine is in fact a killed vaccine, not a live virus. Of course, it’s impossible for the vaccine to give dogs CIV. What I suppose is possible is that some dogs were infected before being vaccinated with the initial shot or the required booster. Actually, this potentially even more strongly suggests the importance of pro–actively preemptively vaccinating. Here is where there is a cause and effect: Vaccinate enough dogs, and there is no dog flu outbreak in the first place. Even veterinary professionals sometimes say, “Well, I don’t see it here.” And then it happens here—and it’s too late. People say all the time, “I see no distemper,” or even, “I see no rabies, so why should I vaccinate?” At least for rabies vaccines in dogs, it’s the law almost everywhere. You can describe

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Clients can be skeptical, wanting proof that you’re not just trying to sell vaccines. Send them to the American Animal Hospital Association (AAHA) online Lifestyle-Based Vaccine Calculator that addresses this issue for dogs. to clients what life would be like in the U.S. if lots of dogs were infected with rabies—likely the government would cull dogs. Who knows what would happen? That’s an extreme example, a better one may be leptospirosis. If lepto occurs near you, explain to clients just how sick their dog can get, conceivably even die. And that leptospirosis is zoonotic. And if that client happens to have a toddler, all the more reason to vaccinate. Clients can be skeptical, wanting proof that you’re not just trying to sell vaccines. Send them to the American Animal Hospital Association (AAHA) online Lifestyle-Based Vaccine Calculator1 that addresses this issue for dogs. You might even go through it with them, checking the boxes that describe the dog’s lifestyle, and the algorithm recommends the most important vaccines. For concerned clients, and also in conjunction with guidelines, one solution is to have clients return for an additional visit instead of administering all the vaccines at once; it’s typically done over two visits. Sometimes it’s not the “you’re over– vaccinating my pet” issue but hesitancy solely because the pet “hates” being given a shot. With the human–animal bond being what it is, some pet parents become anxious about thunderstorms solely because they know how their dog is about to respond. The same can be true for veterinary exams and any associated needles. Cat Friendly Practices® and

Fear Free Certified® practices with certified veterinary nurses/technicians and veterinarians who can provide enough distraction so the pet isn’t traumatized by the process of getting those stingy vaccines is one way to ease pet parents’ minds. Happy pet=happy owner! Still, increasingly, some clients want near-zero vaccines as their goal. In two states, anti–vax activists have sought to go the legislative route. The first such effort, a Connecticut House Bill, was filed in the state legislature in 2017 which would have permitted veterinarians not to administer rabies booster shots on schedule if a dog’s titers are at a certain threshold. The bill would have also allowed veterinarians to adjust vaccines by administering smaller doses to smaller dogs, though there is no science to demonstrate the validity of that plan. The bill failed as did a similar proposal in New Hampshire. But more proposed legislation is on the way, which would chip away at the authority of veterinary professionals to make decisions based on science. The anti-vaxxers suggest they are contemporary thinkers, pushing medicine forward to do what’s “natural.” In fact, the anti–vaxxers would take us all back to the dark ages.

Steve Dale, CABC (Certified Animal Behavior Consultant) is the author of a popular blog, www. stevedalepetworld.com. He is the host of two national radio shows, and is heard on WGN Radio, Chicago. His many TV appearances include Oprah to National Geographic Explorer, and is a contributor on syndicated “HouseSmarts TV.” Steve edited “Decoding Your Dog,” authored by American College of Veterinary Behaviorists, and has contributed to many books and publications. Steve speaks around the world at animal behavior and veterinary conferences and serves on the Boards of the Winn Feline Foundation and Human Animal Bond Association. His many awards and honors include the AVMA Humane Award, and he was inducted into the Dog Writer’s Association Hall of Fame.

References: 1. https://www.aaha.org/guidelines/ canine_vaccination_guidelines/vaccine_calculator.aspx

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BEST PRACTICES

By Kate Boatright, VMD

ach May, thousands of new veterinarians graduate and join the profession in a variety of career paths. Those entering private practice directly after graduation may hear their more experienced colleagues say two things:

“You will learn more in your first year

Takes Time

of practice than in four years of school,” and “You’ll really excel after about five years in practice.” I found both of those statements to hold a large amount of truth after my own graduation. Looking back on my first five years in practice, I’ve found that the most important lessons I’ve learned are not about medicine or surgery, but about myself and how to thrive in a profession that is full of challenge and is constantly changing.

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Every new graduate will have a different amount of confidence, shaped by clinical experience and innate self–confidence. For some, the transition from student to doctor is especially jarring

and may create feelings of imposter syndrome, or the feeling of being a fraud. Over time, young veterinarians will develop confidence in their clinical and communication skills and grow into the best doctors possible. Much of how a new veterinarian’s confidence is perceived comes from the way they communicate with clients, colleagues and staff members. I was initially nervous to admit that I didn’t know the answer to a question or a case, but I quickly learned that most clients are very open to an honest answer. It is never wrong to ask for a second opinion. Clients are generally receptive to statements such as, “I don’t know the answer to that, but I’ll look it up and get back to you,” or “I would like to consult with one of my colleagues on this case.” Clients appreciate a doctor who is willing to take the time to get them an answer—whether they’ve been practicing for a month, a year or even a decade. It is also essential for staff to remember that a lack of confidence is not the same as a lack of knowledge. New veterinarians may take longer to workup their cases or may need to rely on colleagues or other resources frequently at the beginning of their career, and this is okay. These young veterinarians have a lot of information and are learning how to apply it as each case comes along. More often than not, they know what should be done or where to find the information and just want the reassurance of an experienced colleague. Confidence will develop more quickly for those who are in a supportive clinic environment with strong mentorship and an understanding staff.

2 Spectrum One of the biggest challenges many veterinarians face daily is working within clients’ financial limitations. As compassionate veterinarians, we must find a way to care for our patients and clients within their means. Sometimes, economic euthanasia is the best option, but many times, there are numerous alternatives between this and the gold standard. At graduation, I knew the gold standard for diagnosis and treatment of many diseases; however, for many clients, the traditional gold standard was not financially feasible. I was fortunate

to begin my career in a clinic with a wide array of clientele and learned how to offer numerous options without judgment. As my clinical skills developed and my experience deepened, my comfort level with the various options grew. When I first graduated, the fear of missing something serious like metabolic disease or a foreign body often led me to push for diagnostics in all cases presenting for vomiting. Now, while all my vomiting patients are still offered diagnostics, I find myself reaching for supportive care options first in cases with a mild, acute presentation and unremarkable physical examination. When looking for a place to start a career, I encourage young veterinarians to decide where in the spectrum of care they would like to practice and find a clinic that supports that level of medicine and has a clientele that can afford it. With time, each veterinarian will develop their own comfort level within the spectrum of care.

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A Team Sport

Boundaries

Many veterinary clinics call themselves a family, and many operate like one. Just like a family, some clinic teams are more functional than others, but a good team will come together and support each other when times are tough. I was lucky to find a great team right out of vet school, and I give them a large amount of credit in helping me become the veterinarian I am today. While the characteristics of a good team will vary for every individual, great teams share some common traits: • They celebrate achievements and give credit where it is due to all members. • They provide support when cases don’t end well and help each other to learn from mistakes without judgment. • They create an overall positive working environment. • They allow each member to grow and develop into the best veterinarian, technician or receptionist that they can be. After a year of practice, I left the team and clinic I loved to relocate closer to family, and it took a while to find another great fit. Leaving my second clinic was a difficult decision, but it allowed me to find my current superstar team, who I have no intention of leaving any time soon. While it can be discouraging to work with a team that is a poor fit, young veterinarians should remember that they can move on. They will find a better fit. And it is not unusual for recent graduates to move between a few clinics before settling into a permanent position.

Setting boundaries is essential to thriving in this profession. While these boundaries will vary for each veterinarian, there are several types of boundaries that need to be established: • Separate work-life from home-life and learn to leave concerns about patients and case outcomes at the clinic to allow for complete focus on family, friends, hobbies and self outside of work. • Set expectations with the clinic in terms of working hours and how cases are handled when the primary clinician is out of the office. • Find a clinic that respects personal time away from the office for all employees. • Learn to say no to those who are looking for free veterinary advice outside of the office. It is certainly fine to help a family member or friend, but don’t be afraid to say no or advise them to call during office hours. I, like many new veterinarians, found leaving my cases at the office to be a particularly difficult boundary to set. Shortly after graduation, I managed two cases of Feline Panleukopenia from the same household. I sent my patients to the local emergency clinic for continued care over the weekend, but I worried about them constantly. On Sunday, I called the emergency clinic to check in. The ER doctor was happy to give me an update, but before we hung up the phone, he gave me some advice. He told me to relax and enjoy my time away from the hospital, and that it was his job to worry about the patients on the weekend, because I needed time to recharge for the coming week. I still go back to this conversation when I’m having a particularly hard time leaving worries about a patient or client at the office.

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5 Client There will always be clients who don’t like a certain veterinarian, sometimes because of the way a case ended and sometimes for no identifiable reason. It can be startling the first time a client makes a complaint, requests not to see you in the future or writes a negative review on social media. Sometimes, these relationships can be smoothed with time and open communication, but other

times, it will ultimately be less stressful to not see that particular client again. But those facts don’t make the initial insult hurt any less. My first boss assured me that I’d eventually have many more clients requesting me than those who were upset with me. Thankfully, that is now true. Sometimes, it is hard to remember the happy clients over the unhappy ones, but as the successful cases, thank you cards and gifts accumulate, it does get easier to find strength in the confidence of those clients who do appreciate the work we do. This list only begins to scratch the surface of the things I wish I’d known at the beginning of my career. I hope that my new colleagues will remember these lessons as they begin their journey in this wild, wonderful profession that we call veterinary medicine and add their own insights to pass on in the future. 

Dr. Kate Boatright is a 2013 graduate of the University of Pennsylvania. She currently works as a small animal general practitioner and emergency clinician in western Pennsylvania at NVA Butler Veterinary Associates and Emergency Center. Her clinical interests include feline medicine, surgery, internal medicine and emergency. As a freelance writer and speaker, Dr. Boatright enjoys educating veterinary students and colleagues about communication, team building, and the unique challenges facing recent graduates. Outside of the clinic, she is active in her state and local VMAs and serves on the VBMA Alumni Committee. In her remaining time, she enjoys running and spending time with her husband and three cats.

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PETVET PROFILE

Dr. Ki mb er ly Po pe-Rob in so n

1 LI FE AT A T I M

By Steve Dale Photos provided by Dr. Kimberly Pope-Robinson

“The day I almost ended my life started like any other day,” says Dr. Kimberly Pope–Robinson in her book The Unspoken Life:

Recognize Your Passion, Embrace Imperfection and Stay Connected.

ope–Robinson came as close as you can to taking a fatal dose of Vicodin. She thought, “Do I do this? Do I take these pills and end my life? Or do I continue into the abyss that is nothing what I expected life to be?” She thought about her rescued horse, Toby, who depended on her. And then Sanjay, her cat, ambled into the room as if on cue. Sanjay instantly snapped her out of it, enough at least for her to think of her husband, family and friends. Pope–Robinson says she came as close as you can get to letting it all go. Suicide is a real problem in veterinary medicine. So, she was hardly alone among those with that same feeling. She not only saved herself, but by creating her

company, 1 Life Connected, and by sharing her experience and communicating about her reality, she has saved likely more lives than she knows. To know Pope–Robinson back in 2010 you’d think she was a smart, ambitious woman. She may not have been happy in her job—but from the outside in, you’d never guess she would contemplate ending it all. After all, she had no history of diagnosed depression, her job didn’t deal with euthanasia and her loans had long been paid back. “Suicide is a moment of intention,” she explains. “In my case, I felt powerless, trapped, as a middle manager—stuff from above and below coming at me. I’d hear about doctors suffering on a daily basis, whatever they were dealing with, their compassion

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“1 Life Connected is about empowering yourself but not blaming or judging yourself or attempting to hide what you are feeling from yourself.” – Dr. Kimberly Pope-Robinson

fatigue and being overworked and all of it—and I was feeling traumatized. My bosses weren’t horrible—but they didn’t make it better either. I was overwhelmed with shame and blaming was made internal.” She says she was overcome by what she calls “sinkers.” These are negative things that pull us down. She hadn’t then learned to keep her balance and use “balloons” to pull her up. “Each of our journeys and interests are unique, so balloons are unique to all of us. We need to identify them, pay attention to them and celebrate them.” Balloons can be outside hobbies and interests; from Hula dancing to yoga, religion, friends and family, even work. These days Pope–Robinson is known as “the emotions girls” and is on the road a great deal of the

time, reaching as many veterinary professionals and students as she can, talking about balloons and sinkers and transparency about feelings. Her over–riding messages include, “If your sinkers are over–taking you, and you’re feeling like you’re falling. Well, you’re pretty normal. 1 Life Connected is about empowering yourself but not blaming or judging yourself or attempting to hide what you are feeling from yourself. As veterinarians and caregivers, we sometimes feel dark and lonely— trapped by our obligations and the expectations of the world. We care for so many lives. Yet our own lives can feel unspoken for. The good news is that we can cross that bridge back to connection, starting with just one step. And let those balloons rise.” After graduating from the UC

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Davis School of Veterinary Medicine, Pope-Robinson interned in equine medicine, and then worked at a large animal full–service specialty clinic near Sacramento. She loved the job, but after only six months, a major sinker hit her hard. She was diagnosed with Ehlers–Danlos syndrome (EDS), a disease that weakens connective tissues, which made both her job with large animals and one of her favorite hobbies, running, very difficult. Due to her health issues, she transitioned to small animals, first in private practice and then at Banfield where she was soon Medical Director and responsible for 40 hospitals and up to 140 veterinarians. “That was way too much,” she says. She eventually promoted someone to take about half of that work load.

In 2013 she accepted a job at what was then Pfizer Animal Health as a regional strategic veterinarian. Her job was to influence and develop key opinion leaders and build relationships. While she enjoyed the job, by 2015 she had begun to speak as the “emotions girl,” and soon left the security, benefits and salary of Zoetis (formerly Pfizer) to launch 1 Life Connected. In fact, Zoetis supported her, and overall most veterinary professionals are grateful to hear her message; grateful—if nothing else—to hear that they aren’t alone. Despite her illness, Pope–Robinson is back to running and is on her way to running a half–marathon in all 50 states. She’s now at 24 states, just finishing up a run in Michigan. For her, this is clearly a big balloon. “I am seeing parts of the U.S. I’d never otherwise see,” she says. “Your little part of the world is only just that, a little part of the world. We are all connected and I’ve enjoyed meeting new people in all parts of the country, and seeing places like Yellowstone, Fredericksburg, VA, and the Great Smokey Mountains.” She says that her other balloons include her tattoos, her purple hair, favorite pieces of jewelry, her friends, family and her husband, Jeff. She also serves on the Board of Directors of the Human Animal Bond Association. “Of course, my animals,” she adds. “And that includes the stuffed otter I travel with.” There’s, a cockatoo named Maui, a cat named Graciebird and Isabelle, a French Bulldog. “Most of all,” she says. “I know I’ve helped people—nothing can be more rewarding.”  For more information on

or to purchase Dr. Kimberly’s book, visit www.1lifecc.com.

“Your little part of the world is only just that, a little part of the world. We are all connected and I’ve enjoyed meeting new people in all parts of the country.”

– Dr. Kimberly Pope-Robinson

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LIFESTYLE

THE SPARK AND THE

SWITCH HOW TO AVOID BURNOUT AS A VETERINARY PROFESSIONAL

ecompression. It’s a word that is defined by releasing pressure or, in tech terms, it is the ability to convert something (i.e. a file) to an expanded or original size. As it applies to the veterinary healthcare environment, those definitions can be surprisingly accurate. The need to relieve the pressures from their career can be particularly acute for new graduate veterinarians. Even more, the alleviation of those pressures may help to expand your mind and professional success. A new graduate is thrust into a somewhat foreign professional landscape that may be filled with potential emotional stressors such as, new coworkers, office politics, challenging clientele, complex cases, steep learning curves and very long days. As healthcare providers, we reflexively provide support or assistance to those in need. Trying in earnest to help all of those in need (unrealistic goals) without the time to do it (insufficient resources) can lead to Burnout. A Centers for Disease Control and Prevention survey of over 10,000 US veterinarians in 2014 determined that more than 1 in 6 veterinarians

By Courtney A. Campbell DVM, DACVS-SA

might have experienced suicidal ideation and nearly 1 in 10 may have serious psychological distress.1 Furthermore, discussions of Burnout, compassion fatigue and sustainability have become regular features of continuing education seminars and, more recently, veterinary school curricula. This makes the prevention of Burnout quite possibly a life–saving exercise. The demands for your time and expertise will likely grow in tandem with your career. Essentially, the better you are, the more you will be needed. If you feel overwhelmed and your emotional engine is starting to lose a few revs, then utilize these two techniques to help you avoid Burnout: The Spark and the Switch.

The Spark According to Jessica Pryce–Jones’ book Happiness at Work, workers will spend an average of 90,000 hours at work in their lifetimes. For veterinary healthcare professionals, this is likely a conservative estimate. Moreover, for many new veterinary graduates, the bulk of those hours are accrued in

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In addition to being scientists, clinicians, surgeons, grief counselors (at times) and other roles, animal advocacy motivates many in the profession. It’s through advocacy that your Spark can also be found.

the beginning of their careers which may increase the threat of early Burnout. Fortunately, new veterinarians may benefit from a youthful exuberance, or a ‘novelty’ exuberance, whereby the excitement of starting a new job or the beginning their professional journey supersedes the daily physical exhaustion. If your mental engine starts to become a meow instead of a roar, search for the Spark that originally attracted you to the wonderful field of veterinary medicine. The Rules of Engagement Veterinarians are naturally inquisitive and intellectually curious writ large. New graduates, having recently left a richly educational environment, tend to gravitate towards continued learning opportunities. It is potentially in these learning opportunities where one can find the Spark. Searching for new research on common diseases, investigating a new surgical approach or taking a few moments to learn some of the unique benefits to common diagnostics are all potential sources for that Spark. The Spark is highly specific to you and helps to keep you engaged. It can come from anywhere including an area of veterinary medicine for which you’ve always been passionate. For example, learning the benefits and drawbacks of PCR helped to re-caffeinate my interest in the prevention and treatment of infectious disease. The Spark may come from slightly unconventional sources. Some veterinarians spend a lot of

time discussing non–medical topics including trying to navigate economic decisions, family conflicts as it relates to the care of the animal and insurance issues. Recruiting talented members of the veterinary healthcare team to assist you when discussing these non–medical issues will lessen the emotional burden and, more importantly, allow you to focus on your true passions within the profession. Essentially, clearing the excesses off your plate may allow to actually enjoy what you chose to put on it. Advocacy “If it is not right do not do it; if it is not true do not say it.” – Marcus Aurelius, Meditations Veterinarians can be fierce warriors for the profession and the animals they care for. In addition to being scientists, clinicians, surgeons, grief counselors (at times) and other roles, animal advocacy motivates many in the profession. It’s through advocacy that your Spark can also be found. Staunch advocacy is unmistakable when denouncing cases of animal abuse and neglect, but micronized instances of advocacy are sprinkled throughout the workday. Counseling a family on the perils of household toxins, discussing the hidden dangers of infectious disease, or providing thorough post–operative instructions to help protect pets from needless suffering are all examples of advocacy. Fighting against the need to provide PETVET MAGAZINE

healthcare for which you disagree is a unique way to champion animal health. Feeling obligated to provide non– recommended/non–beneficial care (i.e., requests for strictly futile interventions, requests for legally proscribed or discretionary treatments, etc.) can lead to moral and ethical stress which may ultimately lead to Burnout. Any scenario involving a potentially non–beneficial intervention (NBI) is dynamic, variable and value–laden communication, which may place a wedge between the veterinary healthcare team and their families. Scenarios like these can contribute heavily to your professional fatigue. Instead, consider reaching out to a specialist to assist in conflict resolution and communication. When you practice with a high level of confidence, integrity and conviction, the advocacy Spark shouldn’t be hard to find. If you are ever having trouble finding your Spark, think of any one of these four affirmations before you start your day: • Promoting animal health and wellness makes a real difference. • My work in the veterinary healthcare industry is meaningful. • When my job gets difficult, I still try my best with every patient, every client, every time. • I see every client and every pet as unique with their own story and specific needs. • By being part of this profession, I am fortunate to improve both the health of humans and animals. 27

Your resilience to Burnout depends on how well you can turn off the ‘noise’ from work. In fact, the ability to decompress is one of the keys to being resilient against mental fatigue and apathy.

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“It’s not a job, it’s a lifestyle.” The need for qualified animal healthcare workers and veterinary medical professionals is omnipresent. Not only are your skills in high demand at work, but even when you leave work, you may get a text from a friend asking you an animal question, you may be on emergency on– call or you may drive home with your head spinning from the events of the day. Your resilience to Burnout depends on how well you can turn off the ‘noise’ from work. In fact, the ability to decompress is one of the keys to being resilient against mental fatigue and apathy. This ability is the so–called Switch. Similar to the Spark, the Switch is your personal technique for freeing your mind from work when you leave. It’s the time that you’ve dedicated to turning off the ‘buzz’ in your head from the work day. Like shutting off a light switch, changing the channel on TV or turning your phone off, the ability to quickly transition your thoughts away from work and towards a different subject will help to avoid Burnout. To be sure, there is no panacea against Burnout—but some find that the endorphins released from a good workout, a good laugh with a friend, an evening spent relaxing with a glass of wine and a scintillating novel, or spending time with their children are great ways to decompress from work. There is no universal Switch. The technique you chose to mentally withdraw from work and recharge is specific to your needs.

Welcome the challenge of a new exercise routine, a new hobby or enjoy reconnecting with a friend you haven’t spoken to in a while as anti–Burnout techniques. Conversely, selecting an unhealthy technique to decompress may be inimical to your relaxation goals. Unhealthy habits may distract you temporarily, but they may also have secondary effects that could cause you to have more anxiety later. If you feel that your techniques are personally destructive, connect with a colleague, co-worker, friend or mental health professional to investigate healthier alternatives. Taking a Zumba class isn’t going to work for everybody, and making small changes in your personal life may not be sufficient for you to make the Switch successfully. So, if necessary, take the proactive step at work to help everyone on the team decompress. For example, if you feel like you are literally ‘at work’ all the time, the solution may not be simply leaving work earlier, but have leadership direct resources to sPosit these questions to your management team: “Why does this work environment feel so oppressively immersive that even when the staff are away, they still feel like they’re at work?”, “How can you improve the staff’s ability

to disconnect?” and “Why do they feel they have to stay constantly connected?” Likewise, if you feel like you are anxious about your work day, then the solution may not be to simply get a prescription for anti–anxiety medications. Propose these questions to leadership: “What is going on in this work environment that is causing team members to be anxious?”, “What can be done to improve their happiness?” and “How can we help team members cope with work stressors?” As a new grad, it may be difficult to know if you are able to decompress. Use the questions below to help guide you on whether you are consistently making the Switch: • I am able to choose whether or not to respond to work correspondence (email, text, etc.) during my free time. • I rarely lose sleep. And if I do, it is not due to work issues. • When I am away from work, I am not distracted by intermittent thoughts regarding work. • I can enjoy my personal time without focusing on work matters. Everyone can improve upon finding their Spark and making their Switch. For some, this exercise is relatively

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simple and continuously honed throughout their professional career. For others, this is truly a daily struggle. Burnout is especially pernicious, not only because it affects you personally, but it can be injurious to the patients we serve, the families we help and the profession we advocate for. It also may strain the relationships with your friends and family. If you feel the prelude to Burnout creeping into your life, consider seeking professional consultation for mental health and wellness before it critically impacts your personal and work life. Understanding how to prevent Burnout among the veterinary healthcare team needs further discussion and research. Fortunately, tackling this thorny issue has now become de rigueur within veterinary healthcare culture which, until now, had been largely overlooked. Good luck lighting that Spark and eventually making that Switch!  References: 1. Nett RJ, Witte TK, et al. Notes From the Field: Prevalence of Risk Factors for Suicide Among Veterinarians- United States, 2014. CDC Morbidity and Mortality Weekly Report Feb 13 2015; 64(05): 131-132. Dr. Campbell attended the University of Delaware for his undergraduate training and graduated from Tuskegee University School of Veterinary Medicine in 2005. He is currently the head of the surgical department at CARE Emergency and Specialty Animal Hospital in Santa Barbara, California. Dr. Campbell is a regular guest on programs such as The Doctors, Hallmark Channel's Home and Family, The Real, and The Pet Collective’s YouTube channel Ask a Vet. He is now the co-host of National Geographic's Pet Talk, a first of its kind talk show dedicated to the wonderful world of pets.

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2 LOOK OUT FOR

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Send out a fun reminder to your client base to prompt them to update pet ID tags and microchips with any info that may have changed.

PETVET top 10

Ten things to do this month see how many you can do!

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7Did you know that August is NATIONAL romance Awareness month? Celebrate your partner and take a cooking class together. Learning something new as a couple will help make you feel more connected.

6 Netflix night? In the mood for a

The third season of Stranger Things is out! Invite your friends over and take a shot every time Joyce Byers, played by Golden Globe-winning actress Winona Ryder, makes a crazy face.

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