A shortage of vets means a shortage of appointments: Life of a rural vet, part 2

Editor’s note: In this series, Dr. Chana Eisenstein offers readers an inside look at the experiences of a small-town vet in inland Mendocino County. The series will run in multiple parts throughout October 2022, and will include a history of emergency veterinary care in the county.

When we bought the practice in 2010, the agreement we made with Dr. Frank Grasse, the selling veterinarian, was that Dr. Grasse would work with me and for me two to three days a week, introduce me to the community, teach me all kinds of things I couldn’t know about the practice. He died by suicide 10 weeks later. Practice ownership didn’t start out easily: losing Dr. Grasse weeks after arriving left us to manage the practice without any knowledge or experience.

Maintenance and repairs on a very old building and surrounding property proved an unexpected challenge; the structure was so old that electricians and plumbers would no longer provide service or repairs. The former clinic building was a double-wide mobile home with four traditional stick-built add-ons. Navigating being a new vet in town, a new business owner, establishing new relationships as the community grieved Dr. Grasse was an unscripted part I had never imagined playing. Dr. Grasse was so burned out from working 24/7/365 for 35 years that he just wanted to escape. 

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Because Dr. Grasse had made himself available 24/7/365, we took on those responsibilities at first, believing, naively, that we could or should be everything to everyone in our community, because Dr. Grasse had done so. But he did so at the expense of his life. Veterinarians have a shockingly high suicide rate. Statistics indicate that the suicide rate in the veterinary profession is 2.4 times that of the general population. I spent the first half of a decade working 12- to 15-hour days, being on-call nights and weekends. Often, I would work all day and then start receiving emergencies after closing, get home around midnight to be called out again at 2am, back at work at 8:30 the next morning. Clinic hours and appointments and surgeries would carry on the next day and the days after, and the days and nights blurred into one giant exhausted wish that the weekend would come and I could sleep. Sometimes in the colder months, I could go a night or weekend without a call out, but in the hotter months, there are snakebites, auto accidents and bite wounds, ear infections, foxtails in ears, eyes and worse places. That model is simply not sustainable.

We were the light at the end of the tunnel that Dr. Grasse had been waiting and hoping for, for years. Dr. Grasse practiced for 35 years at East Hill Veterinary Clinic. I graduated in 2004. I had always dreamed of owning my own practice, but those dreams had long since dissipated by the time I’d been practicing in a corporate setting for five of my seven years out of veterinary school. The James Herriot fantasy of joining a practice, learning from a mentor, immersing oneself in a community and becoming part of it, then buying out a retiring veterinarian is now a cliché. At 41, with over $300,000 in student loans and interest billowing, I was fairly content earning a base salary plus production and average benefits, enjoying two weeks off per year, while shouldering the responsibility of being the medical director for a busy South Bay Area corporate practice. The model was: general practice open for appointments and urgent cases and emergencies during the day and Saturdays, while referring to nearby emergency and specialty practices after hours. I was one of two and sometimes three veterinarians at the practice. 

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Due to the relative ease of accessibility to emergency facilities, this model worked in a busy practice. Corporate dictated what products we could stock and recommend, what reference lab we could use, what drugs we could stock and prescribe. Giant corporations can flex their buying muscle by rebranding all kinds of products with their name. They pushed wellness plans, recommended screening diagnostics that, in my opinion, were unnecessary and were simply revenue drivers masked as good medicine. I detested their meetings. I detested their efforts to teach us how to sell products, diagnostics and services and then sit in meetings to discuss how well we did and how we could do more, push one more test per client per day, see if we could just increase the average client transaction a few more dollars by just “practicing better medicine.”

I’ve always been of the opinion that people don’t want discounts, coupons, rebates or plans. Just offer the product or service at an appropriate price and stop with the gimmicks. I am not an owner who studies reports and pressures my associates to produce or implement sales tactics to increase revenue. I do not pay my associates based on their production, a reimbursement model that is the standard in this industry now. I believe that if you do the right thing for your patients and your clients, the money will follow, and that has been true for my entire tenure here at East Hill.

In corporate practice, every decision about what broken or antiquated equipment to repair or replace was based on the regional director’s personal feelings about the staff. Often, equipment would remain broken for months because she would forget or not understand the need for it, especially if it was not a direct revenue-generator (like a piece of anesthesia monitoring equipment). The obscene way that staff and clients were treated, with money-driven decisions and poor-quality follow-through, frustrated and depressed me. A long-term key staff member’s mother died, and she was given 72 hours to grieve and get back to work or be fired. Staff with children were given no flexibility, staff members with illnesses needed to prove that they’d been sick before being allowed back to work. This was in the early aughts and staffing was less challenging than it was now. All staff were treated as easily replaceable revenue-generators. I made mental notes about how I would treat my future staff members. 

When a family member suggested that I buy a practice and do it better, I laughed. I laughed for about a week, and then I started looking for practices for sale in our area.  And what we saw was so ghastly that it warrants a whole separate article. We visited a dozen practices for sale around the Bay Area, and what we saw was shocking. Without exception, we met tired, depressed, miserable mostly older veterinarians, desperate to sell in the fallout of the recession of 2007/2008. They were stuck because there were no young eager veterinarians to hire or mentor or buy them out. We met veterinarians sick with cancer, getting chemo during a lunch break carved out of booked schedules, we saw 80-plus year-old vets relying heavily on staff to do most of work, but unable to retire. We met a veterinarian desperate for a buy- in partner after his non-medical business partner scammed him; he was unable to practice without supervision due to having become addicted to controlled drugs and losing his DEA license.

More and more vets are retiring and leaving the profession. More are leaving than joining, despite three newer veterinary schools in the US and several more accredited veterinary schools outside the US. I’ve had an influx of clients from the coast due to another practice closure and other veterinary practices not accepting new clients due to the same problems we face: burnout, depression, anxiety, frustration, rising costs, decreasing staffing options. I know of clinics that just shut down: the owner literally walks out and doesn’t come back. I’ve heard of clients waiting anywhere from 4 hours and up to 24 hours, and in one case 48 hours waiting to be seen at an emergency clinic because they are so busy dealing with real emergencies. Why is the wait so long? Because they are seeing more critical cases, but are also forced to serve as primary care because people are having to wait longer and longer to get in to see their regular veterinarian. 

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The trend is away from ownership, away from general practice and toward the adoption of a different mentality and a different lifestyle. Many veterinarians who were formerly owners or associates have turned to providing relief services. Relief veterinarians can charge literally anything they want and they will get it because we are desperate, we are exhausted. We can’t get away and leave our practices without a doctor, so we pay for a relief vet, if we are fortunate enough to find one with a pulse and a license who is willing to schlep all the way up to Mendocino County. In the twelve years I’ve owned EHVC, I’ve taken a vacation and hired a relief veterinarian four times. Three of those times I returned renewed and refreshed from a vacation or a conference and was met with piles of complaints from clients and staff and the overwhelming feeling that I was a mother who had gone off and left her baby with an unfriendly stranger, returning to find my baby crying, dirty and hungry. It took me longer to patch things up and try to put out fires than it was worth. It is easy to imagine why droves of veterinarians have left general practice as owners or associates to do relief. Imagine having no mortgage, no payroll, no costs at all except yourself and your debt, no management responsibilities, no need to hire or fire, to be able to create the schedule you want, work whenever you want, be off for however long whenever you want and dictate how much you’ll be paid. No holidays, no weekends, no on-call, no emergency, no boss. Sounds really good to me too! Emergency hospitals are also hungry for relief (interim/locum) veterinarians. 

The current veterinary staffing crisis has many root causes, but COVID was the final push that many needed to jump ship for relief and other niches within the field. Many general practices are staying open only with schedules pieced together with relief veterinarians. Some general practices and emergency practices have simply closed due to lack of staff. Other areas that are absorbing vets fleeing from general practice  include end-of-life-care vets, the pharmaceutical industry, FDA, internships, residencies, specialties, academia: anywhere but small animal private practice ownership with its financial uncertainty, staffing challenges, the long hours that it entails, and the increasingly hostile attitude from clients. For example, my second associate left to move to a state with a significantly lower cost of living because she was offered a complete pay-off of her student debt if she committed 10 years to work for the FDA supervising meat inspection. If you have that kind of debt to service and you can stomach that kind of work, who wouldn’t? She has all the federal benefits and protections that owners and associates of veterinary practices do not.

Editor’s note: the next portions of this series will be published in October, 2022; you can read the series here.

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