Twenty-one years ago today(-ish) I was trudging through the pervasive travesty commonly referred to as trial by fire. While working in my first months post-graduation as a full-fledged clinician—sans internship, residency or onsite mentor—I made hundreds of mistakes, at least one of which proved fatal. In retrospect, I consider the time spent slogging it out in the trenches profoundly formative but unforgivably frightening, too. Even by mid-’90s standards, our profession wasn’t exactly as humane as it should’ve been for its patients or practitioners. With colleagues still harboring bootstrap mentalities and few private-practice internships available, plenty of us plowed through the sausage-making morass of early surgery, ponderously list-fraught diagnostic challenges and awkward client communication experiences. Somehow we managed to become reasonably competent clinicians. Motivated by soaring indebtedness, our clinically minded graduates now pursue financial stability through a wider variety of pathways than even half a generation past might’ve predicted. Consider today’s options: Pursuit of residency training and specialization via the most competitive internship program possible (ideally in a teaching hospital but now typically in private-practice settings as a result of crushing competition for tertiary care positions). A higher market value via private-practice internship, though the learning opportunity on offer may prove an independent experience. Safety in corporate practice, where mentorship is ostensibly built into the system by some practice management calculus but actually varies wildly from location to location. Employment in a traditional private-practice setting with the understanding that they’ll sink like a brick, swim alone or get lucky and receive the kind of mentorship they deserve from a practice willing to take on an immediate graduate. Long Road to Disappointment Though ever more of our graduates enter internship programs looking for the guidance they’ve been told traditional private practices lack—reportedly more than half of our graduates—increasingly few find that nirvana beckons from beyond their doors. Shockingly exploitative internships abound, most looking for cheap labor with minimal regulatory oversight and few strings attached—all in the name of clinical competency. Unfortunately, mentorship is optional in many programs I’m familiar with. This despite the fact that the implicit relationship between interns and their internships—if not their contractual agreement—is predicated on the notions of acquiring advanced clinical skills in an environment where careful oversight and capable mentorship are on hand. A simple online search unearthed several firsthand accounts of internships gone wrong. There was the one where the surgical rotation was canceled due to a low caseload—the candidate was vying for a surgical residency—and another where over 80 hours a week were logged either performing ER duties or in front of a computer screen entering other clinicians’ notes. Then there was the one where all the practice’s internists moved overseas halfway through the year. These scenarios may not be routine, but they are considered common. Indeed, so egregiously unfair as some of these programs are in fulfilling their obligations, I’m impressed that more lawsuits haven’t been filed seeking compensation for wages interns might have earned in a traditional practice setting. After all, when internships don’t prove effective tools of higher learning, everyone loses. That is with the exception of the private companies that profit from hiring an employee at less than half the market rate (often way less given the extreme hours some internships demand). Regulatory Oversight Is Lacking Is that even legal, you ask? Despite internship guidelines issued by the American Veterinary Medical Association, there’s little formal oversight of these programs. Indeed, there are no enforceable guidelines these internships need adhere to. Even the American Animal Hospital Association, which would seem to be in an excellent position to regulate programs intended to raise clinical standards for veterinary care, has offered only milquetoast guidelines. Some say it’s the fault of the schools for not producing students with clinical training adequate to the task. After all, clinical confidence is the primary reason cited for pursuing an internship. I recently had cause to revisit these issues after interviewing prospective associates for my practice. Some were newly minted, others fresh from internships, and still others just out of corporate practice. They offered varying degrees of clinical competency, rigor of training and prestige of schooling. Ultimately, however, the decision to hire was based almost entirely on attitude. These included a willingness to learn and listen, an innate curiosity and an ability to communicate effectively. Clinical skill was not a big factor. All my younger candidates shared one overriding vision: to become a more competent clinician while effectively paying down their student debt. This dual vision had guided their career-focused decision-making since electing to become a veterinary clinician, which seemed kind of sad to me. I mean, I get the money thing. But why all the focus on clinical skills? Has our profession come to conflate compensation and clinical prowess so completely? Is that why our students are so internship obsessed? What does that say about traditional private practices and our ability to attract, retain and help better our associates? With all of the above in mind, I thought I’d write a letter to recent graduates and rising clinicians as they enter the veterinary job market: Dear Esteemed Colleague: Welcome to your brilliant career! It’s at this point in your veterinary life that you’ll make the transition from being officially in training to becoming an unofficial veterinary student for the remainder of your career. As this statement suggests, there is no point in your professional life when you’ll consider yourself clinically competent—not completely, anyway. You will always harbor feelings of self-doubt and inadequacy. But if you’re very lucky, you’ll learn to embrace these as a small price to pay to vanquish the evils of mediocrity and the crime of overconfidence. Given this reality, you should seek out professional environments where you will be as challenged and tested as you will be mentored and valued—always, not just at the beginning of your career. Consider further that clinical competency is not the measure of veterinary success; overall professional progress (via a myriad of exciting means!) and job satisfaction are. No matter what they tell you before or after you leave school, your value as a veterinarian is not equivalent to the sum total of clinical skills you bring to the table. Your can-do attitude, along with an ability to communicate effectively, offers your surest path to veterinary bliss. As such, maybe you should reconsider that internship. Don’t assume that it’ll increase your market value. (It usually won’t.) Don’t assume it’ll grant you clinical skills you wouldn’t get elsewhere (not if you’re teaching yourself how to cut a bloat, as I had to). And don’t assume it’ll assuage your feelings of clinical inadequacy (because it can’t). Sure, an internship can be a great investment in your future success and job satisfaction, but only if it’s educational. Otherwise you’ll be forgoing income in the name of either professional anxiety (your own fault) or profit (your internship program’s). So be sure to choose wisely. Demand mentorship. (Protest if you have the guts; resign if you must.) And pace yourself. After all, your career is lifelong! Dr. Patty Khuly owns a small animal practice in Miami and is a passionate blogger at www.drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News. Originally published in the October 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!
