Being an associate has its charms, to be sure. Most notably, associates enjoy the freedom to follow the leader. Policies and procedures are spelled out so you can concentrate on your core competency: clinical veterinary medicine. What’s more, as an associate you don’t have to get into bed with anyone you don’t like. So should the practice-associate relationship fly off the rails, you’re free to jump off the train. But what happens if you join a practice whose policies and procedures increasingly encroach on your professional space? No one wants to feel cramped, much less those who’ve suffered mightily in the service of the three little letters after our names... which is why professional claustrophobia is a thing. Feeling kept out of the decision-making loop is one thing. No associate expects (or wants) to get deep into the guts of the sausage, at least not at the level of vaccine pricing, client reminder systems or worse, human resources. But when those decisions start to drip, trickle by trickle, directly into your workspace, it can be hard to ignore. Here’s what I mean, in case you’re wondering: 1) Your practice adopted a new referral policy last year, which meant you could no longer refer cruciates to either boarded surgeons or rehab facilities. Ever since then, patients diagnosed with cruciate disease had to be treated in-house, surgically, no exceptions, period. And now this bulletin: “All surgical cases must be reviewed before they’re referred.” What? 2) Your practice’s vaccine schedule policy, which all associates are obligated to follow, was already problematic for you in that it required annual distemper and Parvo vaccines. Then they added the flu along with the distemper/parvo and bordetella every six months. What’s next? Corona? You’ve also started getting mad pushback whenever you fail to vaccinate a patient who is ill or allergic. 3) The practice has never let you script out medications or offer less expensive pharmaceutical alternatives, even when the client could barely afford to seek veterinary services. And now that you have a new vendor, you’ll be working with an even more restricted pharmacy. So you’re not just chastised each time you script out—some of your go-to drugs are unavailable to you. What’s worse, your practice manager keeps harping on you to prescribe certain drugs. 4) The new ultrasound unit has to get paid for. Hence the new policy: No urinary case may escape the ultrasound gauntlet. Each and every one gets a screen. You’ve been told you’ll soon be getting a list of other mandatory ultrasound package deals. 5) The radiologist your practice uses is a complete disaster. She can’t keep right and left straight, and the findings are highly questionable in most cases. Thank goodness she’s inexpensive! But now she’s taking 24 hours for a stat? What’s an associate to do? Feeling pressure If you’ve ever been an associate (or a motivated veterinary team member), you’ll recognize the tensions I’ve described. Most real-world examples, however, are far more indirect. Indeed, often it’s the subtlest administrative restrictions and “suggestions” that wear away at you (everything from requesting you use algorithms and templates to record keeping and product sales). They leave you feeling like you’re paid more to tow the party line, follow outlined steps, and talk pretty than to be a thinking veterinarian. The pressure to comply with a more structured veterinary workplace is increasingly being felt by associates in the trenches. Ever since the emergence of more formalized practice structures, especially those spearheaded and disseminated by corporate veterinary medicine, associates are given less decision-making and critical thinking space than ever before. It’s a perfect setup for the progressive erosion of associate autonomy. Can you envision a world where veterinarians stand behind a counter to treat their patients? Sadly, I have a healthy imagination. Visions like these keep me worrying about the state of our profession, and it’s why I continue to advance topics like this. I simply can’t abide watching corporate medicine sink its shiny, professionally whitened teeth into our brains via policies and procedures designed to kill our minds and our souls, and make us increasingly pliable. Do I exaggerate? OK sure, maybe a little. So what’s a smart, independent-minded, non-counter-serving veterinarian to do? Here’s a quick list, off the top of my head: 1) Pick the right practice in the first place. Take the time to research your prospective practice’s culture. Ask about vaccines, referrals, hospitalization policies, and other points of potential conflict. And here’s a tip: Be sure you read through the entire employee manual before signing on. You can tell a lot from this document, not least of which indicates the degree to which you, as an employee, will be required to bend in service of the practice. Study it well. How does the practice respond? Run for the hills if you must. 2) Play an active role in the practice’s culture. As a thinking person and one of the practice’s leaders, it’s partly up to you to steer the clinic’s culture. If there’s something you don’t agree with, ask for a meeting with the decision-makers. Consider submitting or requesting the subtraction of items from the employee handbook. This is a living document that should change over time. 3) Develop solutions that appeal to all parties. It may be possible for everyone to get what they want. Be smart. Communicate your issues clearly and be prepared to do some legwork to solve the problem. Talk to your colleagues to find out how they solved the issue. 4) Find workarounds that get your job done. Now, it may be that no one is prepared to listen, in which case, I give you permission to act accordingly, especially if the issue involves your ethics. Just be smart about it because if you get caught, you’ll probably find yourself on the street, and perhaps justifiably. (I am no legal expert, so please talk to an attorney before you do something silly.) 5) Go full-on legal. Is the practice asking you to do something you consider outside the bounds of moral decency or the law? If so, consider hiring an attorney. Being an activist isn’t all that hard. But you do have to be brave, have a little cash to work with, or a legal friend or family member who can steer you adroitly. 6) Pull the plug. Yes, sometimes packing it in is your best bet. When you do, be sure you let them know why. Do it nicely. Do it in writing. Maybe it’ll help change their future game. Not everyone cares about associate independence, including plenty of associates. I know some veterinarians who love nothing better than to play Simon Says for a living. They find it soothing. They take comfort in helping others in all capacities. And there’s no sense getting worked up over these things anyway, right? Unfortunately, that’s not me. Nor, frankly, would I care to witness an army of veterinary professionals as CVS pharmacists. I do believe every profession needs its chill individuals who don’t mind taking orders without complaint. Writ large, however, this scenario doesn’t describe the profession we were educated for. Patty Khuly, VMD, MBA, owns a small animal practice in Miami and is a passionate blogger at drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.
