Life of a rural vet: part one

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 this month, and will include a history of emergency veterinary care in the county.

My wife and I are the sole private owners of a long-established busy small animal practice in a beautiful 4800-square-foot building in Willits. We bought East Hill Veterinary Clinic 12 years ago and moved to Mendocino County from the Bay Area, where I had become disillusioned with the way in which corporate practices treat their veterinary staff and clientele.  Dr Frank Grasse, the veterinarian who sold us East Hill Veterinary Clinic, was so burned-out from working 24/7/365 for 35 years that he just wanted to escape. He had been trying to sell for years with no prospects. 

We love and are dedicated to our clientele; we practice high quality medicine and surgery in a beautiful, comfortable setting with a skilled, professional staff, many of whom have been working here for a decade. We quickly outgrew the existing facility, so starting in 2015, we built a new one twice the size. We are currently a two-DVM practice, and we are so busy that we would be delighted to welcome a third and even a fourth veterinarian, if we could find them. In addition to taking care of our private clientele and their pets, East Hill Veterinary Clinic provides medical, surgical, and dental services for cats and dogs for our local no-kill shelter, Humane Society for Inland Mendocino County (HSIMC). We have one surgery day per week for our patients, and we recently added a second surgery day for shelter patients. The waiting list for spay and neuter is so long due to the current veterinary crisis that adoptions are delayed, with significant negative impact on the animals, the shelter, and the community.

East Hill Veterinary Clinic, like most small animal clinics, has all the usual bells and whistles under one roof: a pharmacy, diagnostic lab, imaging capabilities: digital radiology, digital dental radiology, diagnostic ultrasound, endoscopes (rigid and flexible; we can get into any orifice!). We have two surgical suites, and all the monitoring equipment needed to safely manage sedation and anesthesia for patients young and old. Our treatment room has four wet tables in a spacious open floor plan treatment room, and we do a large volume of dentistry and brachycephalic obstructive airway surgery. We have a full-service grooming salon for bathing and grooming; grooming can be a medical treatment when problems with skin or hair or when excessive matting or foxtails are present. 

We have four exam rooms equipped with folding exam tables, phones and PCs; however, we are still “modified curbside” so we spend little time in exam rooms at this time. Before COVID, we performed physical exams, nail trims, anal sac expressions, blood and urine collection, and other treatments in the exam rooms. This model proved not sustainable with COVID restrictions, and we had to reassess how we were doing things to maximize safety and workflow.

We were already extremely busy, hoping to add another DVM or two, but when COVID hit, everything exploded. Veterinarians are used to, to some degree, being blamed for high costs or bad outcomes, as people need someone to blame and blaming the messenger is an age-old veterinary reality. But with COVID, we suddenly had to contend with new challenges in workflow, client communication, and staffing. Several years ago, the veterinarian in Laytonville retired without being able to sell his practice. Shortly after, another veterinarian in Willits closed her practice abruptly. The coast clinics were already at capacity, and as a result, the pet-owning public had fewer choices and existing practices such as my own absorbed clients from areas with fewer or no veterinary practices. Recently, another practice in Fort Bragg closed, leaving pet owners with even fewer options for care. It is my understanding that no veterinarians on the coast are accepting new patients at this time. 

When COVID hit, we began scheduling routine cases a month or two out to try to accommodate more urgent and immediate needs.  As more information about COVID came out and public health requirements changed, we suffered staffing shortages. Our commitment to accommodate our clients never changed, but the demand increased dramatically. Suddenly, we were accepting half a dozen or more work-in cases on top of a fully booked schedule. Then one more person would call and say it was their pet’s time, and we could not fail them in their time of need, or someone was traveling through and their dog was sick or injured, and we couldn’t say no. It impacted us profoundly. 

With fewer staff, significantly more sick and injured cases, we worked late, often not able to call clients back until late into the evening, which was frustrating for clients and also for us. We had a couple of episodes of clients not hearing from us before closing time, and assuming that we had just closed up and walked away from their sick or injured pet. Of course we were still there, caring for their pet. A couple of those folks tore us up on Facebook without presenting an accurate story, which is upsetting, embarrassing and quite demoralizing. Other clinics across the nation have had it much worse. Some clinics have closed after receiving death threats after miscommunications and misunderstandings. Participating in online veterinary forums has been both comforting, knowing that thousands of veterinarians are facing the same issues in their own practices and lives, but also alarming, as threats of violence are becoming more commonplace. 

We are booked out 6-8 weeks for routine care, and we try hard to accommodate urgent cases in a timely fashion. If we have already accepted more same-day-work-ins than we can comfortably manage, we recommend that clients try to get in elsewhere, though every other practice has the same scheduling constraints (other practices may have more veterinarians) . If a client with an emergency cannot be accommodated because we are too busy, we refer them to emergency practices in Santa Rosa. Unfortunately, this can result in angry, abusive clients despite our attempts to explain that it is in their pet’s best interests to be seen sooner somewhere else.

For some elective services we are booked into next spring. We always set aside time for same-day emergencies and urgent cases, but those slots are filled within minutes of opening and then everyone else who calls must be worked in. A sick fit-in requires that time, already over-scheduled time, needs to be carved out to examine the patient, make a plan, communicate with the client, organize staff to draw blood, collect urine, run labs, take radiographs, hospitalize, place an IV, start IV fluids, give meds, keep owners updated. We can manage many fit-ins between the two of us, but there comes a point when we realize we are running frantically around, not providing adequate care to our patients because we haven’t eaten or used the bathroom all day. The hardest lesson of all has been learning to say no; I am still learning. Early in the pandemic, we did stop accepting new clients and patients but then resumed to accepting new clients on a case-by-case basis. 

We shifted to curbside care when COVID hit. The logistics are challenging. We attempted twice to return to exam rooms just as the variants started to cause spikes in cases. We now have semi-permanently adopted a modified curbside protocol. If a client chooses to come inside, and is willing to wear a mask, we allow them to come inside and go into an exam room. If they prefer to stay outside in their vehicle, we will accommodate that as well. Unfortunately, even with the best precautions, I caught COVID from a client, and subsequently turned around and infected my entire staff, including my associate, with COVID, thereby further diminishing clients’ access to veterinary care. We therefore redoubled our efforts to minimize the amount of time we spend, even masked, face-to-face in an enclosed space such as exam rooms. 

While COVID brought curbside care and therefore a shift in the exam room paradigm, it did not change our schedule. We reconfigured so that we can accomplish everything within the same time frame with curbside care. But the reality is that client behavior changed. My staff members are all genuinely nice, caring, helpful people. Reception in a veterinary clinic is a rough job in the best of times, and as we got busier, we noticed an uptick in bad client behavior. All of us are living with the same pandemic limitations and frustrations, and our fuses grew short. We are still squeezing in yet another sick patient, but clients, even those we’ve worked in, still complain about wait times even though they see the parking lot and front office full. 

Recently my staff was carrying a large dog on a stretcher from the parking lot into the hospital through the front doors. The dog was badly injured and there was blood everywhere. A client sitting in the front office blocked their path and demanded to know why this dog was going to be seen before his dog who had an ear infection. Another client barged into an exam room containing a weeping client while I was euthanizing their dog. He wanted to know what was going on as his appointment had been 15 minutes ago. People show up early and demand to be seen now. They show up late and demand to be seen now. They don’t show up and get angry that now they have to wait to get another appointment. Veterinarians, technicians and receptionists spent the freezing winter months running between cars in the parking lot attending to clients in snow and rain. They spent the hot summer months running back and forth in order to keep everyone safe and comfortable. And they still get screamed at, cussed at, threatened by upset clients. It was bad before, then COVID blew the roof off.

Editor’s note: This is the first in a series in which Dr. Chana Eisenstein offers readers an inside look at the experiences of a small-town vet in inland Mendocino County. You can read the entire series here.