Struggling with transition to full-fledged DVM

[ccam600]

Long-time lurker here, but just decided to create this account because it's eating me up inside and things are very hard for me right now, I'm overwhelmed like I have never been in my life... Hoping for some advice and experiences from you all.

I very recently got licensed and started practicing... and holy crap has it been unbelievably hard for me. I finished school a while ago in a different country, so it took a while (years) to get my DVM license in the U.S. I'm struggling with the medicine itself, but also with being inefficient. I struggle to make decisions because I don't really trust my own judgement, and because out of options A, B, and C I don't know which one is appropriate. This even goes for "simple" things that everyone just seems to understand and treat so effortlessly, like a vomiting or diarrhea case. On paper, I feel like I'm not a terrible veterinarian knowledge-wise. But in practice? I feel like I always have a deer-in-the-headlights look. I know mentorship is important starting out, and I feel like I can ask about anything and others will help and not make me feel stupid... it's just that I really thought I could handle more than a simple vaccine appointment and could handle a simple case without asking 20 questions to the other DVMs, who just like everyone else already have enough on their plate. It also feels like a number of technicians are annoyed at my inefficiency and lack of ease with decision-making. So add that on top of everything else...

I try so hard. I really do. I have books I keep outside the exam rooms, I look things up in between appointments, and I try my hardest to at least do no harm and help a little bit. But many times I feel like I did not help the problem at all, or at least not in the grand scheme of things. I get home exhausted after 12 hours and look up things I saw during the day, but then wonder about all the possible outcomes and have a hard time falling asleep, only to do it again the next day. I review the notes from other doctors and their cases just so I can get a feel for their thought process, and everyone just seems so competent and like they know their stuff although they might have been out for just a few months, with such great treatment plans and differentials and next steps... and here I am like do I need bloodwork or xrays more? And then I get results back and everything is normal, I get stuck because I'm stumped, don't have time while at work to look extensively at next steps, and then just get frustrated and stressed out, feeling anyone could have done a better job than I did handling this. It's just exhausting day in and day out... and it's only been a few weeks. How can I do this for the rest of my life?

A traditional internship is not an option for me due to many reasons (financial, emotional, extreme time commitment, etc.), and I doubt any employer will have any sort of sympathy for my inefficiency for more than a few months. I really want clinical practice to work out for me, I don't really want an office job or a non-traditional use for my degree, but I question if I'm ever going to be decent enough at some point in this field. My plan of eventually moving on to ER within a year or so is looking like the dumbest idea ever now, because I know that brings its own set of challenges. I'm just so lost and stressed out. Just like everyone else, I have bills to pay and responsibilities while being the sole breadwinner at home right now, and I can't just not do anything and have to keep going no matter what, but at what cost? Have any of you felt this overwhelmed starting out? How do I get a handle on it and become better at this? Just the thought of feeling anything like this for the rest of my life makes my chest feel heavy, and I don't know where to turn or what to do.

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[JustPaws]

I am not yet in clinical practice, but I wonder if it is possible that you are dealing with an anxiety disorder of some sort that is holding you back from feeling confident in your abilities and knowledge. Have you considered or are you currently utilizing any mental health services?

It sounds like you are already doing lots to get yourself sorted medicine-wise but it seems based on this one post that there may be ore to it. Good luck. I truly hope that you find success in the field!!

 

[battie]

it's just that I really thought I could handle more than a simple vaccine appointment and could handle a simple case without asking 20 questions to the other DVMs, who just like everyone else already have enough on their plate.

So I'm just going to answer or remark on some things that stood out to me. I'm a May 2021 grad from a US school that started June 1.

1) most of everyone feels this way starting out. Even over the vaccine/preventative appointments (which preventative should I recommend for their lifestyle?!?!) With how vet med is set up, we cant get all the know how from school. We get 1-2 years of clinics depending on where you go, and almost no one has an actual GP service in a teaching hospital. So going from student to doc with daily cases to manage, it's a huge jump.

2) If the docs are okay with helping you, dont sweat tacking their time. They would let you know otherwise. They want to help.

It also feels like a number of technicians are annoyed at my inefficiency and lack of ease with decision-making.

1) this is a time for communication on their part and your part. Understanding and compassion is necessary for a learning doctor to be successful. On the one hand, they should be able to offer tips and tricks that may help you learn efficiency. Likewise, express to them you need help thinking through the process. My techs have no problem with me thinking out loud to them about a case.

2) if they are uncomfortable working with you, they need to speak up to either you, your supervisor, or their supervisor.

But many times I feel like I did not help the problem at all, or at least not in the grand scheme of things.

1) the "grand scheme of things" is not world changing here. You're simply working one case for one family/patient. The goal is comfort and quality of life for the everyone involved. Whether that means life saving GDV surgery or ear meds and an ear cleaning, you've helped. It's not more complicated than that. Don't put the weight of the world on your shoulders for every single case.

everyone just seems so competent and like they know their stuff although they might have been out for just a few months, with such great treatment plans and differentials and next steps...

1) Fake it till you make it, baby!!! Clients are amazed that I've only been practicing 7 months because of how much/well I explain things. Or if I don't have an idea, I simply say, "This is a weird one for me. Let me consult with my colleagues who have been practicing longer." Out of hundreds of clients, I've had issues with 1 client after saying that.

2) even experienced clinicians have issues. Our main ER doctor mentored me through a suspect pneumonia vs heart failure case that was in hospital on oxygen about 48 hours, went home, and then showed up as a DOA a week or so later. We never learned the how, what, or why for that case. She's been doing ER since before I started vet school and she said she had no clue.

and then just get frustrated and stressed out, feeling anyone could have done a better job than I did handling this.

1) not necessarily, and in the end, it doesn't matter. You did the best you could with the info you had. You can't ask more of yourself than that. You can always offer referral to a specialist if necessary (I do this with many cases actually), but not everyone can afford to do that. So you do your best.

My plan of eventually moving on to ER within a year or so is looking like the dumbest idea ever now, because I know that brings its own set of challenges.

1) ER and GP are totally different beasts. I'm currently 30% ER and 70% GPA with the goal of going full ER after my baby is born. If you truly want to do just ER, there's no time like the present to start looking. There are corporations that do ER training periods (Blue Pearl's EmERge program and VEG's fellowship program come to mind) where they treat it like an internship period with better pay and decent to good mentorship. Likewise, plenty of privately owned ERs out there that need the help and are willing to train to round out their staff. Going in honest about your skills and they'll help you from there.

I can't just not do anything and have to keep going no matter what, but at what cost?

Boundaries. That is the number one thing you need. Vet med is your job, not your life. Its a job you can be passionate about and want to improve on. But it's still only an obligation to x number of hours of your time. I do 0 work outside my hospital and outside the time I'm working. I do absolutely 0 case look up at home after my shift. I had my first ever toxicity connected to compost ingestion yesterday on ER. Didn't really know anything about it when I started the case. Did flyby consult with one of the other docs in the hospital, did some quick and dirty googling about supportive vs specific care, and then moved on. When I got home, I watched an episode of Daredevil.

I refuse to break that boundary. I'll give it my all in my hospital. Sure, was I hella inefficient yesterday because of this curve ball case? Yes. Was my average wait time for simple ERs (UTI, GI upset, etc) 3 hours yesterday? Sure. Did one even walk out without seeing me (UTI)? Yep!! But ultimately I did the best I could and all my patients I actually saw and managed got good medicine because 1) I was efficient when I could be, 2) I asked for help when needed, and 3) kept communication with my staff and clients open. All I did was my best. For most clients and patients, my best was at least enough, if not super appreciated. For others it wasn't.

Ultimately, the most important opinion is yours. I highly recommend mental health help like Justpaws mentioned. Getting that outside objective view matters and can help you find your balance.

 

[ccam600]

I am not yet in clinical practice, but I wonder if it is possible that you are dealing with an anxiety disorder of some sort that is holding you back from feeling confident in your abilities and knowledge. Have you considered or are you currently utilizing any mental health services?

It sounds like you are already doing lots to get yourself sorted medicine-wise but it seems based on this one post that there may be ore to it. Good luck. I truly hope that you find success in the field!!

I currently have a talk set up with Vets4Vets through VIN before any mental health services. Definitely considering them if my quality of life keeps declining despite my best efforts. Thank you for the advice!

 

[ccam600]

So I'm just going to answer or remark on some things that stood out to me. I'm a May 2021 grad from a US school that started June 1.

1) most of everyone feels this way starting out. Even over the vaccine/preventative appointments (which preventative should I recommend for their lifestyle?!?!) With how vet med is set up, we cant get all the know how from school. We get 1-2 years of clinics depending on where you go, and almost no one has an actual GP service in a teaching hospital. So going from student to doc with daily cases to manage, it's a huge jump.

I'm relying on the technicians on some of these prevention questions (specific products and stuff), but still trying to study and learn those. With this less-than-smooth transition, those things are last on my list of things to review, but I'm getting to them. Glad to know I'm not the only one that doesn't have lots of product-specific knowledge.

2) If the docs are okay with helping you, dont sweat tacking their time. They would let you know otherwise. They want to help.

1) this is a time for communication on their part and your part. Understanding and compassion is necessary for a learning doctor to be successful. On the one hand, they should be able to offer tips and tricks that may help you learn efficiency. Likewise, express to them you need help thinking through the process. My techs have no problem with me thinking out loud to them about a case.

2) if they are uncomfortable working with you, they need to speak up to either you, your supervisor, or their supervisor.

I'll make sure to bring this up with them. A lot of times I see them running around so much (and granted, some of them are so production-driven) that I don't want to interrupt their flow... but I'd rather ask than mess up and harm a patient.

1) not necessarily, and in the end, it doesn't matter. You did the best you could with the info you had. You can't ask more of yourself than that. You can always offer referral to a specialist if necessary (I do this with many cases actually), but not everyone can afford to do that. So you do your best.

Very valid point. Although honestly, I'm terrified of having worked so hard for this and always being one medical misstep away from an angry client that sues me and makes me lose my license. That's another one of the big fears behind everything now that I think about it.

Boundaries. That is the number one thing you need. Vet med is your job, not your life. Its a job you can be passionate about and want to improve on. But it's still only an obligation to x number of hours of your time. I do 0 work outside my hospital and outside the time I'm working. I do absolutely 0 case look up at home after my shift. I had my first ever toxicity connected to compost ingestion yesterday on ER. Didn't really know anything about it when I started the case. Did flyby consult with one of the other docs in the hospital, did some quick and dirty googling about supportive vs specific care, and then moved on. When I got home, I watched an episode of Daredevil.

I refuse to break that boundary. I'll give it my all in my hospital. Sure, was I hella inefficient yesterday because of this curve ball case? Yes. Was my average wait time for simple ERs (UTI, GI upset, etc) 3 hours yesterday? Sure. Did one even walk out without seeing me (UTI)? Yep!! But ultimately I did the best I could and all my patients I actually saw and managed got good medicine because 1) I was efficient when I could be, 2) I asked for help when needed, and 3) kept communication with my staff and clients open. All I did was my best. For most clients and patients, my best was at least enough, if not super appreciated. For others it wasn't.

I think I'm going to have to start enforcing this as well, I find myself looking things up and going over cases before bed or even on on days off... which is slowly resulting in a decline in my QOL and time for the things that matter to me.

Ultimately, the most important opinion is yours. I highly recommend mental health help like Justpaws mentioned. Getting that outside objective view matters and can help you find your balance.

Thank you for taking the time to respond so thoroughly, I really appreciate it. You brought up a lot of valid points and things I hadn't even thought about.

 

[battie]

always being one medical misstep away from an angry client that sues me and makes me lose my license.

We all make mistakes. A doctor had the "why don't be a vet" talk, which includes making potentially fatal mistakes. It's an inevitability we all will meet at some point. Comes back to the concept of doing the best we can with what we have, and keeping that line of communication open with the client. Give them an honest assessment of the situation, give them options (including referral if you're out of your depth!), and then do your best with the option they choose. You do that, you've done what you can to legally protect yourself while trying to practice your best medicine.

Glad to know I'm not the only one that doesn't have lots of product-specific knowledge.

Pharmacology is one of my worst subjects!!! It was during a particularly difficult time of vet school and I honestly dont remember anything. I have plumbs saved on my phone and access it constantly. Drugs is one of the biggest things I ask for help with. Lol. It will take me years to be comfortable with drugs. And that's okay.

It's okay to be scared as long as you do what you can to do your best and improve.

You got this.

 

[CalliopeDVM]

I've been a vet for over 20 years, and worked with a lot of new grads as well -- everyone feels that way when they start practice, even those who grew up with parents who were vets. If they say they don't feel that way, they're lying, LOL. It's hard, it's supposed to be hard, and it definitely will get better as you get more practiced and get more comfortable there. It sounds like you're doing the right things: being willing to look things up, being willing to ask other vets, and even speaking with Vets4Vets.

In my experience, new grads can deal with 80% of what walks in the door - though not necessarily quickly or efficiently, but that's OK. Efficiency and speedy decisions will come in time. You have all the knowledge to put things together, you're just feeling overwhelmed. Don't worry, you'll be OK.