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 this is the final installment: a history of emergency veterinary care in the county.
You know when you crave food from a specific restaurant and you check their website and it says they are open. Then you get there and they’re closed? It is not so nice when you’re hungry and tired, but when you have a true medical emergency with your pet and try to get care somewhere that says they provide it but doesn’t, it is not only potentially tragic, but unacceptable. This is why I believe that if one cannot consistently and reliably provide emergency veterinary services, one cannot provide them at all.
Being a rural county with nearest emergency and specialty referral centers 1.5 hours away or more depending on the season, clients largely depended on the existing emergency rotation which consisted of all of the veterinary practices in Ukiah and Redwood Valley (Mendocino Animal Hospital, Yokayo Veterinary Center, Ukiah Animal Hospital, Valley Veterinary). When I arrived in 2010, I joined the existing rotation with the expectation that in exchange for a few days a month of being on call for emergencies for all of our practices, my clients had access to local emergency services 24/7/365. And it worked, for the most part, for a while.
The coast vets had their own arrangements for emergencies, we inland vets had our own, and Wasson Memorial Veterinary Clinic in Lake County served as backup. From 2010 to 2015, as a sole practitioner, I worked 80+ hour weeks, taking calls after hours and on weekends and spent all of my off time sleeping. In 2014 we hired our first associate. It took about a year before she was comfortable seeing emergencies alone. By 2015, my associate joined the rotation and diluted the call schedule a teeny bit.
We all depended on an answering service to receive calls and connect the caller with the on-call veterinarian 24/7/365. One participating veterinarian created and distributed a randomized schedule based on the number of veterinarians in the practice. Conflicts with the schedule required finding a replacement, often an impossible ask. So, gaps in care occurred when a vet couldn’t find coverage and had to make a choice between attending a loved one’s graduation, birthday, wedding, memorial, or being on call. Problems occurred within and outside the group that caused it to fracture: some vets were frustrated when other practices failed to follow the rules of the group. Often the assigned on-call veterinarian would call off at the last moment, often not communicating this to the rest of the group, so we would come in after a weekend to very unhappy clients who tried to get in with an emergency only to have the on-call vet never call them back, refuse to see them, or just refer them to Santa Rosa even if they wanted to be seen locally. Veterinarians would request to be off with short notice and no replacement, on-call vets would fail to answer their on-call phone, clients reported bad experiences after being seen for an emergency at a participating practice. Everyone was already overworked and spread thin that the emergency group was a great idea that didn’t translate well into real life.
Sometime in 2015 Yokayo was bought out by a national corporate entity, and subsequently withdrew from the rotation, quickly followed by Mendocino Animal Hospital, stating staffing issues as its reason. The three remaining practices were solo DVM practices, and we quickly recognized that it is not feasible for three individuals to provide emergency services to meet the emergency veterinary needs of folks from Leggett to Hopland and anyone else passing though. If we can’t provide a service consistently and reliably, we can’t really provide it at all, so the group folded. By this time my first associate had moved on, and I had a second associate. Still strongly believing that it was our responsibility to be available to our clients in an emergency at any time, we teamed up with Willits Animal Hospital to share emergency on-call duty for clients of both practices. Willits Animal Hospital had not previously, to my knowledge, participated in an emergency rotation and almost immediately it became apparent that this arrangement would not work due to some of the reasons listed above and the fact that there simply were not enough veterinarians to do it all.
Meanwhile I was spending thousands of dollars a year advertising for another associate and coming up empty. I was drowning in work. By 2020, I hired a third associate and hoped to be able to staff up and create a four-day work week with rotating emergency call. Shortly thereafter, my second associate left private practice for myriad reasons, essentially because she was suffering from what we are all suffering from: exhaustion, burnout and the realization that she would never crawl her way out of the educational debt she carried on her back. One works towards, struggles through and finishes a veterinary education with a big heart and big dreams of helping animals. And then the grind begins. Burnout happens at different rates for people. Some are smart enough to get out before they are pulled under and become a statistic. And some, without the ability to bail, stay and hope for the best.
When we finally conceded that we could no longer provide emergency services, we were met with variety of responses from, “Wow, didn’t realize you did all that”, to “Good, take care of yourself, you’re a precious resource and we don’t want to lose you”, to “Ok, I’ll find another vet who does.” It took me years to be able to respond to a client asking about after-hours emergency care without feeling bad, guilty, inadequate, and irresponsible. But the bottom line is, I want to. I wish I could. But I also have to sleep and remain healthy in order to continue to do what I do. Now, when clients ask why we don’t offer after hours and emergency care, I simply tell them that there aren’t enough veterinarians and support staff to provide care after hours, and that , by living in Mendocino County we sacrifice lots of conveniences in exchange for the freedom from urban congestion, traffic, big box stores and little tiny boxes style of living. And one of the sacrifices we make, knowingly or not, is being pretty far removed from emergency care for our animals. This was true when I stopped offering emergency services, and it is now much more painfully true after nearly three years of COVID, and the changes COVID brought to the way we practice and the way we interact with other humans.
Like keyboard warriors hiding behind a screen, people behaved as if their masks entitled them to behave in an uncivilized manner, having lost their manners and sense of decorum, secondary I suppose, to isolation, illness, financial insecurity, and the massive stressful life changes everyone experienced. Keyboard warriors are not accountable for what they say online. Comfortable behind the cloak of a screen, across the phone lines or across a glass partition, now masks became the new cloak; people feel free to say what they would never have said if you could see their whole face. And as a result, veterinary Facebook forums have been and are continuing to explode with different versions of the same story. Across the world, it seems, people are losing their minds. And bringing home more pets, regardless of whether they could afford them. In the twelve years I’ve been a practice owner, I’ve fired maybe a dozen clients. In the last two years of COVID, I’ve fired twice that many because my tolerance for verbal abuse to my staff and myself is now zero.
I see folks on Facebook saying all we have to do is hire more vets. If only it were that simple. On days when my patience is thin, I suggest that they go right ahead and find me a vet at any price and I’ll hire them. Crickets. Or maybe if they are so inclined, they might like to go ahead and join us by going back to school and dedicating 12+ years plus a few hundred grand to possibly get into and out of vet school and come on up and help! Like all other medical professionals, newly graduating veterinarians prefer the higher pay, conveniences and social opportunities that city living offers. It’s hard, or shall I say nearly impossible to attract and retain veterinarians to rural counties in ideal times, and as we all know, times aren’t ideal right now. Veterinarians are leaving the profession in droves, those who are staying are demanding higher pay, fewer hours, and refusing after hour calls entirely. The culture now is leave at the end of your work day and refer everyone to emergency. I’m not agreeing or disagreeing, just reporting.
Do I still think about Stephen Davis, who started Comprehensive Care for Lake and Mendocino County Pets on Facebook, who is disabled and nearly blind, and who wanted to ensure that he would have local after-hours emergency veterinary care for his senior dog? Yes, all the time. Do I think about my elderly clients driving in the rain or snow down to Santa Rosa with a cat in distress? All the time. Do I think about my clients whose dog was hit by a car or bit by a rattlesnake or attacked by a raccoon over the weekend? Of course, I do. And there still aren’t enough vets to consistently provide emergency service that would allow for vets to work all day and then not work all night too. My priorities have shifted from a customer is always right mentality to protecting my staff and working to ensure their comfort; because at the end of the day, I can’t do my job without them, and pet owners can’t see me without them.
East Hill Veterinary Clinic is newer and bigger than any practice in the county, and it physically has the capacity to be a day practice as well as a night and weekend emergency facility, if we could staff it. We are ready and willing when we can find the staff to support it.
This is a terrific essay. Clear. Convincing.
Well put, if painful : for you, vets in general, us pet owners, and our pets.
Thanks Doc Channa you’ve always been a straightforward and no BS individual in my book. You’ve also always been extremely caring and compassionate. I know we all work hard, but thank you for your hard work and contribution to your community. It means a lot to me and so many in our town!