Veterinary Internships Part 1- To sacrifice or not to sacrifice

Many current veterinary students have to face the looming question of whether or not to pursue an internship after graduation. Wait a second I have my DVM degree, can’t I just start practicing? Indeed you can, but internships have become more popular for clinics and students. For the graduating new veterinarian an internship has pros and cons that need to be weighed before making this major decision. In this post, I will break the answer down from simplest to most complicated situation. In a follow-up post, I will discuss what an internship is like, based upon my actual experience.

Scenario 1: If as a student you know for certain that you want to specialize and embark on the journey to become a veterinary surgeon or oncologist, etc. this is your only option.  There is no need to read any further.

Scenario 2: If you think you may want to specialize, but you are not 100% sure, you should probably complete an internship. Once you practice full-time, regressing to an intern salary will prove more difficult, as will being a student vs. practitioner. Some internships, many in fact, allow you to be your own practitioner with guidance as needed. However, there is always some hazing/unfairness in being an intern and not an associate. Completing an internship may also provide the information you need to make your next career move. Many internships rotate through the specialities and have elective time. These opportunities would give you a chance to decide if you want to specialize. These opportunities may also provide good references and potential mentorship opportunities for your future specialization. It may even open a door to a specialization internship- the new wave in the long road to a veterinary specialty.

Scenario 3: I want to go to into emergency medicine. The simple answer used to be: complete a small animal internship. This is the path that I chose. I chose this path because I exclusively wanted to work in emergency and most of the larger small animal emergency hospitals n major metropolitan areas only hire internship-trained veterinarians, and occasionally will hire seasoned general practitioners. I was not taking any chances. I also have toyed with the idea of doing a critical care residency (see scenario 2).  My experience was difficult, but worthwhile. When it came time to apply for a job in a new state, I was a very competitive candidiate because of my internship experience.

The flip side to this story is that at least 3 of my classmates found positions with good mentoring in emergency clinics as their first or second job. They also have now received more surgical experience then I have. The risk you take is the question of good mentorship, I am not a risk taker, but if you are and are willing to weigh your options, completing an internship is not a requirement for a position in small animal emergency.  It does provide a competitive advantage in a tight job market. You must also consider I made a 1/3rd of my current salary during my internship year, so there is an opportunity cost.

Scenario 4: I want more mentorship and experience prior to becoming an associate. This is where the question becomes harder and will be different for every person. For many graduating students, jumping into practice is scary and they do not feel they are ready.  You are more ready than you think, however the first 3-6 months is tough with or without an internship.

The cons of doing an internship in this situation are:

  • opportunity cost, less earning potential your first year
    • There is little evidence to support you will make more money as an associate after completing an internship, but depending on your field and the job market you may have a competitive advantage.
  • spending time doing emergency medicine if you don’t like it- this can be brutal
  • longer hours
  • more learning/research based, especially if you are at a university
  • less surgical experience
  • One more year at the bottom of the veterinary food chain- ego’s can take a beating
The pros of doing an internship in this situation are:
  • Depending on your field and the job market you may have a competitive advantage upon completion. Some practice owners prefer non-internship trained students, so they can be modled. Others prefer internship trained and find the associates more seasoned, stronger medically, and more efficient.
  • Keeps the door open for a specialty.
  • Guaranteed mentorship, although this will differ in style by program.
  • The first few months may be tougher, but you will edge up the learning curve faster than your peers. This is important to some people but in no way a requirement.
  • More time to explore specialized interests in veterinary medicine.
This debate rages on, as more students have been selecting internships post-graduation. The AVMA’s 2011 survey found that, of about 1,540 graduates who had accepted employment offers, 700 had accepted internships, according to JAVMA. The 2009 survey indicated that, of 1,525 graduates who had accepted a position, 600 had accepted internships.
Source: American Association of Veterinary Clinicians
Based on AVMA data, the average internship salary is $25,000 annually versus $65,000 mean starting salary for all veterinary employment types. 
In conclusion, there is no black and white answer for scenario 4. My best advice is to know yourself and do your research. Consider the financial and career implications in order to make the best decision.

Quick Post: Top 10 Small Animal Conditions

While I am working on my internship guide blog series, I wanted to post a list of the Top 10 conditions for dogs and cats to quickly get in my weekly post. The list is compiled from Veterinary Pet Insurance Co. (VPI) based on their policy claims for 2012. It is important for pet owners and veterinarians to familiarize themselves with the most common medical conditions, most of which can occur in any pet.

Top 10 Canine Conditions:
1. Skin Allergies (my mixed breed dog has skin allergies, so breed selection won’t get you out of this one). average cost $96/visit
2. Ear Infection…good old otitis externa- also allergy related
3. Skin Infection
4. Non-cancerous Skin Growth- so dermatology is almost 50% of medical conditions in dogs…yup?!
5. Vomiting
6. Arthritis- average cost $260/visit
7. Diarrhea
8. Urinary Tract Infection
9. Dental Disease
10. Bruise or Contusion

Top 10 Feline Conditions:
1. Bladder Infection- I assume this is more likely urinary signs related to Feline Cystitis. Average claim cost $251/visit. This typically involves checking kidney values, x-rays to screen for bladder stones, a urinalysis and medications.
2. Dental Disease
3. Hyperthyroid- typically occurs in middle aged to older cats
4. Chronic Kidney Disease- typically occurs in middle aged to older cats
5. Vomiting
6. Diabetes Mellitus- typically occurs in middle aged to older overweight cats
7. Diarrhea
8. Skin Allergies- okay so not the top 4 but still very common in our kitties
9. Lymphoma (cancer)- can occur at any age and affect the GI tract, nervous system, lymph nodes
10. Upper Respiratory Tract Infection- usually due to herpesvirus, calicivirus or secondary bacterial infection.

Many of these issues are chronic and can be frustrating to treat if they recur. This would be a good list to share with new dog/cat owners and to remind frustrated clients currently treating these diseases. Luckily, because they are common new treatments are constantly being researched.

Humane Euthanasia: The Gray Zone

One of my recent emergency shifts was what we in business reluctantly call”one of those shifts.” This is a shift in which almost every patient that walks through the door is here for euthanasia, or PTS (put-to-sleep) for those in the jargon know. Nights like these, no matter how the end result may benefit the owner and/or the pet, take an emotional toll on the staff and myself. The term for this is empathy fatigue.

What tends to bother me the most is when it is a problem that goes undiagnosed, but the owner feels the patient is older and usually states, “while it’s not the money, I just don’t want to put him through testing when we don’t know how much longer he has.” While that makes sense to me emotionally, as a doctor, I want to find out more. I have a need to form a diagnosis in an attempt to treat and provide a prognosis.   I also feel that maybe we owe it to the pet to try some therapies, if the condition is treatable and the animal is not currently suffering, prior to ending a life. By offering diagnostics, I hope to give the client as much important information as possible to make an informed decision. The conflict arises because the amount of information needed is a personal choice and differs for everyone; and, ultimately the owner determines the right time for an animal to pass on.

If a client has a 13 year old dog and the dog started having some respiratory issues that clinically appear mild and a low grade heart murmur is detected, is that cause in itself for euthanasia without taking x-rays?  What about if, in addition to those signs, the owner may have to undergo a long distance move?

If we suspect strongly that a portosystemic shunt is the cause of persistent hypoglycemia that is difficult to manage, is it time to give up on that puppy prior to definitive diagnosis with an ultrasound?

Some clients worry about what they will find out and prefer to remember their pet in their best condition and accept the inevitable. So where do we draw the line between treating too aggressively and not treating enough? When is the right time to let our best friend go, and when is humane euthanasia an opt out card versus a means to end suffering? These are very real and permanent choices and questions we must face as part of being a responsible and caring pet owner.  There is, of course, no right or wrong answer. However, I know after nights of numerous euthanasias I start to wonder what my role should be in the decision process.

Heathcliff tries to hide
Heathcliff tries to hide

As a veterinarian, clients will ask you all the time, (especially with respect to humane euthanasia) what would you do if this was your pet? The truth is they usually already have a decision made and sometimes your job is to support them.  After all, it is their pet, their loved one, their choice…or should it always be?

Independent Contractor …on the side

I mentioned in my prior entry that I have started training to become a part-time field representative for VPI (Veterinary Pet Insurance). This position has completely reinvigorated my passion for the veterinary profession on many levels, so I think it deserves its own blog post. Some of you may be wondering, did I sell my soul to industry or why do i need a second job? The answers to those questions are no I have not sold my soul, but inspired it. I don’t need a second job, but who turns down free travel and some extra money.  The real reason I sought this position is the intangibles, and they are plentiful.

Over three years ago I was granted a one week externship with VPI in their headquarters in Brea, CA. VPI is the oldest pet insurance company and one of the most reputable. Having a business background, I thought it was important to stay in tune with that knowledge and apply it to veterinary medicine. I was also moved by my initial encounter with VPI. VPI has a department dedicated to their veterinary college program. The company sponsors some of the best veterinary business and legal speakers at the veterinary colleges, including materials, speaker fees, and lunch.  In return they give a one hour speech on how pet insurance works with a few slides about VPI specifically. The presentation focuses on what is pet insurance and why is it important. It also lists all the major players, not just VPI, and encourages students to do their research and select some companies to recommend to clients. Most importantly, it sparks a discussion about pet insurance with the goal to make the future generation less afraid.

Most students think insurance is bad, waste of money, and that it will dictate how we provide care for our patients. They leave the presentation understanding that it is insurance, so you may not make money from it, but it provides protection for those numerous small and sometimes one time large vet bills.  More importantly clients are more compliant and see the vet more often if they have pet insurance, so it raises the standard of care for our patients. We even discuss veterinary school debt and that insurance is one of the solutions in this multi-factorial puzzle (a separate post will address the student debt problem).  I am obviously passionate about the presentation, but the truth was in the experience. When I saw this presentation given by a general practitioner,  not a VPI employee, I was blown away; I wanted to inspire other students in the same way in the future.

I have been to two vet schools now observing the presentation and the students are engaged and understand the importance. They are excited about this new tool and the energy is contagious.

VPI is also a major sponsor of the VBMA (Veterinary Business Management Association), a student-run organization that believes in providing a business foundation for future veterinarians. As a student, I was very active with this organization on the local and national level, and I miss it. In this position, I now engage in a dinner with the VBMA Chapter officers and have first hand knowledge of how the organization is evolving, Furthermore, if I continue with this position I will be a part of the National VBMA meeting as a clinician.  In fact, this position was open because the VBMA has instituted a formal business certificate for veterinary students and the VPI presentation constitutes 1 credit hour, so the requests for presentations has grown, which is where I come in.

During my VPI externship I met with the veterinary medical director and I strongly expressed my interest in presenting to the colleges in the future. She told me, “finish school, get settled in practice, call me.”  With my career becoming settled and my desire to have a broader impact, I reached out. My networking paid off and I now have a side position that allows me to interact with students and the VBMA again, and creates a path for a future in organized veterinary medicine, and perhaps even industry.

Back to the Virtual World

I have been on blog hiatus since graduating veterinary school in 2011. In my prior blog life, I authored This blog logged my jounrney from getting accepted into vet school as a second career through graduation. My hiatus has been due to a number of factors, including a veterinary internship in small animal emergency and internal medicine 2011-2012, relocating to Phoenix, AZ and starting a career as a small animal emergency clinician, and writers bloc. As I began to settle into my career and make my way up the learning curve, I found myself entering 2013 thinking, “is this it?” While I pursued veterinary medicine because I found finance an unrewarding career, I would not say that I found emergency medicine unrewarding, but something was missing.  So before my previous fans get too upset, let me explain.
I enjoy small animal emergency medicine and become more confident each day.  There are frustrations, however, and after 4 months in practice, I started to revisit my long-term career goals. I realized that I missed my connection to the broader veterinary community, as well as veterinary students. I signed up to be a mentor through the AZ VMA and joined their Young Leaders Advisory Council and PR task force committees. These groups have been invigorating and enabled me to network with veterinarians in the local community and have an impact on the larger community outside of my practice.
While hiking with my husband, I was mentioning how I’d like to compose another blog, but I had nothing to write about. Writing a blog in vet school was easy, there was always something new and exciting happening or an exam to stress on. Daily practice, even emergency, is not always that exciting once it becomes a job.  He came up with many ideas such as discussing transitioning from school to my internship into practice, inspiring cases, and the list kept going. The foundation for Veterinary Brainstorm was forming.
The excitement to start typing, however, occurred on a trip to Mississippi State veterinary school as a field representative in training for Veterinary Pet Insurance (VPI). This position will be discussed in a future blog entry, but it made me realize that a new blog would further my connection to prospective veterinarians, students, and others in the profession beyond the local level.
My prior blog inspired many people who reached out to me via email, telephone, and even spawned some in-person meetings. I hope this blog will inspire similar connections and discussions about relevant topics in veterinary medicine and my new career as it takes shape.

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