Tips for adding a new graduate to your practice

Spring…that time when flowers break through the soil from their dormant bulbs, bears venture into the sunlight from their hibernation, and outdoor activities that had been on hold are suddenly possible again. For veterinary practices, spring means gearing up for puppies and kittens, snakebites, and the dog fight wounds that inevitably come when someone has the terrible idea to bring all the dogs to the extended family picnic. As appointments roll in, associate veterinarians run from room to room; squeezing in emergencies and a rare bathroom break. The idea of growing the team becomes more of a recognized necessity than a passing thought. Making the decision to expand your team was the first step; now what? Adding a new graduate to your team is not unlike adding a new addition to your family. Everything is going to change, at least for a little while, to accommodate the new baby; or in this case, “baby” doctor! It takes a treadmill to get off the hamster wheel The first, and most critical, element of adding a new graduate to your practice is accepting that daily practice life that must change: a new graduate completely alters the pace of the day. This acceptance is necessary for everyone. If you are thinking the receptionists, the technicians, and other doctors will not be impacted, only the new graduate will be slower, you need to look at it in the context of a treadmill. Someone who is fully fit and has been running on a treadmill for several minutes will be at a much faster pace than someone who is just starting. If you try to force them to step onto the treadmill at your current running speed, the individual will be painfully expelled off the back and feel humiliated by the experience. As a new graduate, jumping into a new hospital that has not adjusted its daily pace is the same way; with potentially the same result. When you hire a new graduate, explain to the team everything will be moving much slower for some weeks and you will work your way back up to full speed. This helps everyone for two very basic reasons: new graduates do not have the experience to know doses, treatments, or protocols without looking them up. Research, be it on a phone or in a book, takes time. Anticipating this reality and slowing the pace to allow them the time to look things up, will pay vast dividends in their level of comfort and developing confidence. More importantly, it will help prevent errors in dosages or procedures that could have severe consequences for an animal, the new doctor, and your practice. The second basic reason slowing everything down is necessary is the new doctor will have questions and need the guidance of a senior, more seasoned associate. You cannot provide adequate explanations, teach in a meaningful way, or exercise patience, if you are maintaining a demanding schedule of 15-plus appointments. Slowing the pace of practice for some weeks is an investment in your new hire, and in your own sanity. Be specific and realistic The second step to optimizing the experience of your new graduate is to outline your expectations and set realistic goals. It is much easier to accomplish benchmarks when they are clearly defined and everyone is on the same page. It is essential to understand what “clearly define” means: You don’t just want the new graduate to understand the goals, you want to make it impossible for them to misunderstand the goals. This is exactly the reason speed limits are clearly posted on roads. If driving were based upon the principle to “just drive at a safe speed” some people would do 20 mph everywhere and others would rarely dip below 100 mph. What may seem like common sense is an incredibly variable scale. By having the limit—the fastest acceptable speed posted—it is impossible for someone to misunderstand going 100 mph in a school zone was considered legally inappropriate. You need to make your goals for your new graduate just as clear as a speed limit sign. How many cases should they be able to see in an hour, a day, a week; at first? After a month, where should those numbers be? How many surgeries are they expected to be able to perform per shift? Also, what surgeries do you feel comfortable with them performing immediately? What are your goals for their surgical skills? Do you anticipate them being able to do a C-section and a pyometra immediately? What about a GDV or intestinal foreign body? Having a clear expectation in your own mind will make it easier to communicate expectations with a new doctor. Who is responsible for performing call backs? Are they required to come in on days off to deliver results, or will another doctor perform those calls? Will their medical records have to be reviewed for a period before you feel confident they meet the legal standard and are appropriately detailed? These are common areas of misunderstanding between new graduates and their hiring hospitals. What may seem like standard operating procedure to some established doctors is foreign to new graduates. Also, you may need to define details of your hospital’s culture and standards that have nothing to do with case load. For example, what is the attendance policy? If a doctor stays late to finish a surgery and is at the hospital three hours past their normal shift, do they get to come in three hours later the next morning? Another area of question is personal illness. If a doctor wakes up and they are sick, are they expected to come in anyway, wear a mask, do what they can; or do they not come in at all? Also, what if they have a very difficult case and that patient doesn’t survive; that is their first big loss. Are they expected to finish out the day? Are they allowed to take a mental health day to get their emotions under control and deal with their feelings of failure, loss, and insecurity? If that isn’t the case, that should be stated somewhere; like an orientation packet, or onboarding materials given at the time of hiring. More specifically, if the very idea of taking a mental health day after losing a patient seems ridiculous, then there is something else that must be understood. Many of the newer generation of veterinarians coming into practice had the concept of “self-care” taught as part of their curriculum. The suicide and burnout rates in our profession are very real. In an attempt to prevent that from happening to the next generation of doctors, self-care is now emphasized as a basic necessity; defined as “the practice of taking an active role in protecting one's own well-being and happiness, in particular during periods of stress.” With that definition in mind, be prepared for a new associate to potentially say they need a day off after they have suffered a heartbreaking loss. Expectations of new grads New graduates coming out of school are from a completely different generation and mindset than doctors who graduated more than five years ago. COVID changed many things in our world at large, and veterinary medicine is no different. Self-care and work-life balance are now much higher priorities given the burnout potential, and more tragically, the suicide rate associated with our profession. What does work-life balance mean exactly? While the actual definition involves having work be not more important, but an equal priority to home life, the practical definition seems to be changing in veterinary medicine. It used to be considered normal that a doctor ate lunch on the run, routinely stayed late, and came in on days off to check on patients. These standards never really were acceptable, but they were accepted. Logically, we understand everyone has a right to sit and eat unmolested for 30 minutes in a 10–12-hour shift; it just never happened, and nothing changed. That is not the case anymore; these historical standards are not accepted by newer graduates.They recognize this pace, this endless drive, contributes to burnout in our profession, and they are not willing to be a part of the problem. Just like adjusting expectations and slowing the pace of the hospital, you may need to be prepared to adjust and accommodate more self-care in your practice. Please note before you criticize this new mindset as being “soft,” or worse, “lazy,” you need to understand burnout is very real, and it will cost you far more money than slowing down, communicating, and being open to new realities. If you lose this new doctor, and have to try to hire another one all over again, that is a six-figure bill. A study in Frontiers in Veterinary Science shows the cost to replace a doctor at a practice is $104,000.1 While adjusting expectations and adapting may not have been part of the original plan when you hired a new graduate to expand the practice, the cost of losing them will be a much bigger burden. Mentorship opportunities A final component of hiring a new graduate that maybe unexpected is they will likely need some guidance in areas that are not strictly medical. If someone went straight through school, from undergraduate into veterinary school, they may have no experience paying back their student loans. They may not even understand the options of deferment or refinancing. Taking a few minutes to speak to them about their loans, if they need any guidance in that area, can help save them thousands of dollars over the coming years. Another area where many new graduates need guidance, that may not be immediately apparent, is helping them learn to “speak like a doctor;” especially on phone calls or in emails. Newer generations tend to use very informal communication given they were raised with cell phones and the acceptability of texting in abbreviations, or even just emojis. It takes training for them to learn this communication style is not acceptable in a professional setting. Not only does it fail to meet a legal standard for medical records, it can be very off putting to older clients and even sabotage their level of trust in their skills as a veterinarian. Obviously, self-sabotage is not any new doctor’s goal; help them to understand the letters that are now after their name mean something significant. Even if they don’t feel different, they are seen differently by the rest of the world, and the expectations placed upon them are different. Having the title of doctor is an earned privilege, but also, a responsibility. Adding a new graduate to your practice will take work and understanding by the entire staff. Yet, when given thoughtful time, nurturing guidance, and an opportunity to learn not just medicine, but what it takes to be a part of your team, they can actually help your practice improve. What are currently accepted as comfortable patterns may actually be complacency borne from inertia. New graduates bring new ideas, new optimism, and an opportunity for us to challenge ourselves to be better: better doctors, better mentors, and better team leaders. Adding a new graduate to a practice is like planting a new bulb in your garden. With time, care, and sunshine (encouragement), they will blossom, and make your world that much more beautiful. Sarah Hoggan, DVM, is residency trained and has worked exclusively as an emergency doctor since 2003. She is the medical director at VCA California Veterinary Specialists in Murrieta, CA. She grew up in Idaho and attended veterinary school at WSU. Reference Neill CL, Hansen CR, Salois M. “The Economic Cost of Burnout in Veterinary Medicine.” Front Vet Sci. January 2022;9(0):814104.

Cookie	Duration	Description
cookielawinfo-checkbox-analytics	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checkbox-functional	11 months	The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checkbox-necessary	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-others	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-performance	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
JSESSIONID	session	The JSESSIONID cookie is used by New Relic to store a session identifier so that New Relic can monitor session counts for an application.
viewed_cookie_policy	11 months	The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.

Cookie	Duration	Description
vuid	2 years	Vimeo installs this cookie to collect tracking information by setting a unique ID to embed videos to the website.
_ga	2 years	The _ga cookie, installed by Google Analytics, calculates visitor, session and campaign data and also keeps track of site usage for the site's analytics report. The cookie stores information anonymously and assigns a randomly generated number to recognize unique visitors.
_gat	1 minute	This cookie is installed by Google Universal Analytics to restrain request rate and thus limit the collection of data on high traffic sites.
_gat_UA-	1 minute	A variation of the _gat cookie set by Google Analytics and Google Tag Manager to allow website owners to track visitor behaviour and measure site performance. The pattern element in the name contains the unique identity number of the account or website it relates to.
_gid	1 day	Installed by Google Analytics, _gid cookie stores information on how visitors use a website, while also creating an analytics report of the website's performance. Some of the data that are collected include the number of visitors, their source, and the pages they visit anonymously.
__gads	1 year 24 days	The __gads cookie, set by Google, is stored under DoubleClick domain and tracks the number of times users see an advert, measures the success of the campaign and calculates its revenue. This cookie can only be read from the domain they are set on and will not track any data while browsing through other sites.

Cookie	Duration	Description
ADV_u_id	3 months 8 days	Unique customer identifier used to track unique ad views and interactions with some ads.
anj	3 months	AppNexus sets the anj cookie that contains data stating whether a cookie ID is synced with partners.
fr	3 months	Facebook sets this cookie to show relevant advertisements to users by tracking user behaviour across the web, on sites that have Facebook pixel or Facebook social plugin.
IDE	1 year 24 days	Google DoubleClick IDE cookies are used to store information about how the user uses the website to present them with relevant ads and according to the user profile.
loc	never	AddThis sets this geolocation cookie to help understand the location of users who share the information.
OAGEO	session	OpenX sets this cookie to avoid the repeated display of the same ad.
OAID	1 year	Cookie set to record whether the user has opted out of the collection of information by the AdsWizz Service Cookies.
test_cookie	15 minutes	The test_cookie is set by doubleclick.net and is used to determine if the user's browser supports cookies.
uuid2	3 months	The uuid2 cookie is set by AppNexus and records information that helps in differentiating between devices and browsers. This information is used to pick out ads delivered by the platform and assess the ad performance and its attribute payment.
_fbp	3 months	This cookie is set by Facebook to display advertisements when either on Facebook or on a digital platform powered by Facebook advertising, after visiting the website.

Tips for adding a new graduate to your practice

Consider it an investment in optimism

Membership Required