Commentary Commentaire Clinical practice is not mandatory Bryce I. Fleming
T
his is a commentary on Dr. Heather Fenton’s article Can Vet J 2016;57:657–658. One of the most valuable qualities of the veterinary profession is the almost limitless spectrum of career options a DVM gives a graduate. When I do a brief survey of my classmates (WCVM ’87) I stand in awe of some of their accomplishments. Among my classmates are numbered an environmental activist, renowned medical researcher, one member of the Order of Canada, a cutting edge veterinary surgeon, and at least one university instructor. I am humbled when I compare my meager efforts over the last thirty years as just another grunt “in the trenches” of general practice. There are times when I agree with the well-known WCVM pathologist who once told me that my very presence in the veterinary college was an insult to the selection process. In those moments of melancholy, I have to remind myself about my original intent when I entered veterinary college and, indeed, the very thoughts that coursed through my mind as the PhD dressed me down all those years ago: all I ever wanted to be was a general veterinary practitioner working in the field and having the honor of actually directly contributing to my immediate community. Even if I could have qualified, I never aspired to an internship, residency, or speciality qualifications. While everyone around me seemed to believe that advanced degrees indicated superior intellect or skills, I always just saw them as yet another way to avoid actually facing the real world working at a real job. I realize now that I had a hopelessly biased attitude against academia, but I am still sure that I made the right choice (though I suspect that any instructor who remembers me would agree I really had no choice). There is a true honor in working in general practice and I personally believe that we are all too quick to consider it a “lesser” aspiration or “settling.” In fact, I would prefer that our colleges start telling the students the truth: we need durable general practitioners out here in the trenches and actually working in the community. There are easily enough specialists and academics these days (and more every day) to fill those rare and coveted institutional positions. I know well the stresses of general mixed practice, having spent nearly twenty years of my career flipping between treatPowell River Veterinary Hospital, Powell River, British Columbia V8A 2C2. Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.
CVJ / VOL 57 / AUGUST 2016
ing pets and probing the south-end of a north facing bovine, but I never once considered it to be a lesser calling than that of my academically inclined classmates. Perhaps dirtier, longer hours, infinitely colder during the winter and often more dangerous, but never lesser. I enjoyed the fact that I had to adapt to changing conditions on the fly, imagine novel solutions for unique problems and often invent entire new treatments when faced with difficult circumstances and limited resources. I still am proud of the fact that I managed to repair a broken jaw on an elderly stallion that had been turned away by the college as “too high risk.” While my learned colleagues offered euthanasia, I successfully reconstructed the shattered jaw with steel pins, a discarded naso-gastric tube, and plastic cement. That one case encapsulates the true nature of mixed general practice: practical solutions dreamed up in the field on the fly. Perhaps there are some who criticize the often meager resources available in general practice; certainly I have run into a few practices that are better described as museums rather than modern medical clinics. I remember well using X-ray machines that first saw duty about the time I was starting kindergarten. The problem I have with that generalization is that the majority of modern clinics are on par or even slightly ahead of many of our teaching institutes. As just a small town solo-practitioner I have no less than two ultrasound machines and a full service in-house laboratory. I would happily put any of my ultrasound images beside those captured at any of our Canadian veterinary colleges. Due to amazing Internet data bases such as found at Veterinary Information Network (VIN), most of us general practitioners have access to the cutting edge of modern veterinary medicine, getting exposure to diagnostics and treatments often a decade or more ahead of what is taught in the more conservative “Ivory Tower.” The impression that simple GP veterinarians are backward or outdated is far from modern reality and is just an urban myth created by inexperience. Thirty years ago, while still a student, I remember butting heads with a senior clinician who would frequently boast how he “knew real practice” because he had done his time in mixed practice prior to entering academia. Even at the time I understood the gross exaggeration of his claims; he had spent a grand total of two years in general practice before scampering back to the protection of his dear Alma Mater. Coming from a family of doctors where I had watched both my elder brothers’ grind through one year of internship followed by multiple years of residency before being able to hang out their shingles as qualified specialists, I understood those two years are just a pebble in the gravel road compared to the entirety of a career. To this day I still hear specialists tell me how they know the rigors of general 889
C O M M E N TA I R E
practice because they “did one or two years” before deciding to move onto something “more challenging.” The irony of their comments is that they are usually commiserating with me about how challenging they found general practice when they briefly dipped their toes in that deep pool. I am pretty firm in my opinion: you don’t know much at all about general practice if you have only done one or two years out “in the trenches,” In fact, one or two years of general practice has barely scratched the surface in reality since, for much of that time, a new graduate has often been shielded and shored-up by their employer. I am in the final quarter of my career in general practice now. I now limit my practice to small animals and I have developed a true passion for ultrasound imaging. I fill my free time working part-time for VIN (in a supporting role; God forbid that I would give advice to anyone) and I support a couple of charities that I personally established. I learn something every day and, even now, I still feel like a wet-behind-the-ears newbie from time to time. Rarely a day goes by that I don’t see something that makes me wonder at the marvels of life. Certainly, the 70 to 80 hour work-weeks are starting to wear on me, but the
890
thank-you cards and holiday treats (especially the traditional home-made baklava from Mrs. P. at Christmas) make me remember that I am an integral part of the local community, not just some faceless specialist from down-yonder in the big city. Perhaps I don’t have the alphabet soup after my name and nobody is stepping up to award me any dust-collectors for my mantle, but serving successive generations of families more than makes up for all that. Choosing a life in general practice is not settling on a lesser career; it is choosing instead to serve the community closest to you; your neighbors and friends, the people who will be there for you when you need them just as you are there when they call. It is with some irony that I recall the angry words of that long ago disappointed college pathologist: I’m still here, still serving and I have not wasted a moment of my career worrying about the internship or residency that I never aspired to. The key to a successful career in general practice is often as simple as really committing to the lifestyle and understanding that the first few years are going to be a bumpy ride. Some of the best destinations lay at the end of a hard road.
CVJ / VOL 57 / AUGUST 2016
T
his is a commentary on Dr. Heather Fenton’s article Can Vet J 2016;57:657–658. One of the most valuable qualities of the veterinary profession is the almost limitless spectrum of career options a DVM gives a graduate. When I do a brief survey of my classmates (WCVM ’87) I stand in awe of some of their accomplishments. Among my classmates are numbered an environmental activist, renowned medical researcher, one member of the Order of Canada, a cutting edge veterinary surgeon, and at least one university instructor. I am humbled when I compare my meager efforts over the last thirty years as just another grunt “in the trenches” of general practice. There are times when I agree with the well-known WCVM pathologist who once told me that my very presence in the veterinary college was an insult to the selection process. In those moments of melancholy, I have to remind myself about my original intent when I entered veterinary college and, indeed, the very thoughts that coursed through my mind as the PhD dressed me down all those years ago: all I ever wanted to be was a general veterinary practitioner working in the field and having the honor of actually directly contributing to my immediate community. Even if I could have qualified, I never aspired to an internship, residency, or speciality qualifications. While everyone around me seemed to believe that advanced degrees indicated superior intellect or skills, I always just saw them as yet another way to avoid actually facing the real world working at a real job. I realize now that I had a hopelessly biased attitude against academia, but I am still sure that I made the right choice (though I suspect that any instructor who remembers me would agree I really had no choice). There is a true honor in working in general practice and I personally believe that we are all too quick to consider it a “lesser” aspiration or “settling.” In fact, I would prefer that our colleges start telling the students the truth: we need durable general practitioners out here in the trenches and actually working in the community. There are easily enough specialists and academics these days (and more every day) to fill those rare and coveted institutional positions. I know well the stresses of general mixed practice, having spent nearly twenty years of my career flipping between treatPowell River Veterinary Hospital, Powell River, British Columbia V8A 2C2. Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere.
CVJ / VOL 57 / AUGUST 2016
ing pets and probing the south-end of a north facing bovine, but I never once considered it to be a lesser calling than that of my academically inclined classmates. Perhaps dirtier, longer hours, infinitely colder during the winter and often more dangerous, but never lesser. I enjoyed the fact that I had to adapt to changing conditions on the fly, imagine novel solutions for unique problems and often invent entire new treatments when faced with difficult circumstances and limited resources. I still am proud of the fact that I managed to repair a broken jaw on an elderly stallion that had been turned away by the college as “too high risk.” While my learned colleagues offered euthanasia, I successfully reconstructed the shattered jaw with steel pins, a discarded naso-gastric tube, and plastic cement. That one case encapsulates the true nature of mixed general practice: practical solutions dreamed up in the field on the fly. Perhaps there are some who criticize the often meager resources available in general practice; certainly I have run into a few practices that are better described as museums rather than modern medical clinics. I remember well using X-ray machines that first saw duty about the time I was starting kindergarten. The problem I have with that generalization is that the majority of modern clinics are on par or even slightly ahead of many of our teaching institutes. As just a small town solo-practitioner I have no less than two ultrasound machines and a full service in-house laboratory. I would happily put any of my ultrasound images beside those captured at any of our Canadian veterinary colleges. Due to amazing Internet data bases such as found at Veterinary Information Network (VIN), most of us general practitioners have access to the cutting edge of modern veterinary medicine, getting exposure to diagnostics and treatments often a decade or more ahead of what is taught in the more conservative “Ivory Tower.” The impression that simple GP veterinarians are backward or outdated is far from modern reality and is just an urban myth created by inexperience. Thirty years ago, while still a student, I remember butting heads with a senior clinician who would frequently boast how he “knew real practice” because he had done his time in mixed practice prior to entering academia. Even at the time I understood the gross exaggeration of his claims; he had spent a grand total of two years in general practice before scampering back to the protection of his dear Alma Mater. Coming from a family of doctors where I had watched both my elder brothers’ grind through one year of internship followed by multiple years of residency before being able to hang out their shingles as qualified specialists, I understood those two years are just a pebble in the gravel road compared to the entirety of a career. To this day I still hear specialists tell me how they know the rigors of general 889
C O M M E N TA I R E
practice because they “did one or two years” before deciding to move onto something “more challenging.” The irony of their comments is that they are usually commiserating with me about how challenging they found general practice when they briefly dipped their toes in that deep pool. I am pretty firm in my opinion: you don’t know much at all about general practice if you have only done one or two years out “in the trenches,” In fact, one or two years of general practice has barely scratched the surface in reality since, for much of that time, a new graduate has often been shielded and shored-up by their employer. I am in the final quarter of my career in general practice now. I now limit my practice to small animals and I have developed a true passion for ultrasound imaging. I fill my free time working part-time for VIN (in a supporting role; God forbid that I would give advice to anyone) and I support a couple of charities that I personally established. I learn something every day and, even now, I still feel like a wet-behind-the-ears newbie from time to time. Rarely a day goes by that I don’t see something that makes me wonder at the marvels of life. Certainly, the 70 to 80 hour work-weeks are starting to wear on me, but the
890
thank-you cards and holiday treats (especially the traditional home-made baklava from Mrs. P. at Christmas) make me remember that I am an integral part of the local community, not just some faceless specialist from down-yonder in the big city. Perhaps I don’t have the alphabet soup after my name and nobody is stepping up to award me any dust-collectors for my mantle, but serving successive generations of families more than makes up for all that. Choosing a life in general practice is not settling on a lesser career; it is choosing instead to serve the community closest to you; your neighbors and friends, the people who will be there for you when you need them just as you are there when they call. It is with some irony that I recall the angry words of that long ago disappointed college pathologist: I’m still here, still serving and I have not wasted a moment of my career worrying about the internship or residency that I never aspired to. The key to a successful career in general practice is often as simple as really committing to the lifestyle and understanding that the first few years are going to be a bumpy ride. Some of the best destinations lay at the end of a hard road.
CVJ / VOL 57 / AUGUST 2016
