Changing Lifestyles in Equine Practice: Expanding Your Life While Setting Limits

1. Introduction

When we start out in practice, we've got stars in our eyes and hope we can be world-beaters, able to save every animal or at least try, and to be there for all the horses and every client who calls. Do you remember when the pager seemed like a nifty device that held promises of "hands-on experience" with ample adventures and learning? However, as time progresses, and one decade in practice turns into two, and even three, the 24 x 7 care becomes less enchanting and more wearing on the soul and body.

We spend so much of our professional lives looking after other peoples' problems and animals that sometimes we forget to look after ourselves. The theme of this practice management discussion is to focus on "me" the practitioner, not the horse and not the client. In light of the undercurrent of problems like burnout, frustration, financial difficulty, feeling overwhelmed, not enough time, limited personal life, and/or poor quality of life within the equine profession of today, AAEP is gearing efforts to encourage us to take care of ourselves as veterinarians with the same care and attention that we take care of our clients and their horses.

Some of you may find you are perfectly content with the status of your life and lifestyle and have no wish to change - I hope that someday everyone in our profession can say the same. In my own case, as a solo practitioner, more than two decades of practice found me running headlong into the woes of too much work and not enough time, and I had to make some changes. Driving the vet truck from farm to farm gave plenty of opportunity to contemplate about how much more richness there is to life than just being a workaholic. For this meeting, I was asked to share my observations as a solo practitioner, and although my solutions may not be appropriate in each instance and certainly aren't the end-all of solutions, perhaps some of the things I have tried will resonate with you to spark a fresh practice approach.

2. Trying a New Approach

One solution to this dilemma of 60-to 90-hour work weeks is mitigated by the group practice concept, but those of us who remain solo practitioners or nearly so have to explore other ways to provide responsible care for the horses and the clients. Always being available for emergencies eats up a tremendous amount of personal time. Most of us have worked out some method of sharing the emergency work among other area practitioners, with the added benefit of expanding one's working relationship with colleagues. Emergency medicine is one of the most interesting and challenging types of case-loads, as well as a great learning experience. What has worked best for me is to tailor a variation on sharing the emergency load - I have turned over the emergencies on nights and/or weekends to an ambitious recent graduate with the promise to mentor and share practical experience. It has been a net benefit for both of us. I get personal time off, and she gets to immerse herself in interesting and often lucrative cases, with me being available as support and teacher. My clients appreciate it because they know I am more rested and no longer as rushed at appointments. They know their horses receive conscientious first aid care for after-hours emergencies through my back-up colleague, and they know I'm available for any necessary follow-up care.

When I initially explained to my clients that I was implementing this new policy (turning nights and weekends over to a colleague), I didn't expect them to be entirely comfortable, but I realized the alternative was for me to stop practicing altogether because of burnout. I was taken by surprise by what they said to me - with few exceptions, the most prevalent comment was, "What took you so long" or "It's about time". Shocking, isn't it to realize that, although your clients seemingly want you there for them at every little moment, they actually understand that one person cannot provide for all, day after day, year after year. When I acted on the decision to stop the after-hours emergency work, I lost fewer clients than I can count on one hand. What a revelation, because all along I had professed to friends, colleagues, and my husband that it was impossible to conduct an equine practice without personally providing after-hours emergency calls. We think we are indispensable when, in fact, we are quite dispensable. Not only is it a natural evolution, but it is also a smart decision to pass the torch to fresh and energetic younger veterinarians who are motivated to practice as much as they can.

This one change in my own practice led me to think: if one practice management change worked so well for me, what other beneficial changes might I make? And those thoughts are what I'd like to explore with you as part of the AAEP practice management series. In order of presentation, today's themes are as follows: setting limits, saying no, free time, compensation, and multiple talents. These won't be answers for every practice and they aren't universal, but they are ideas that have worked for me.

3. Setting Limits

Ours is a respectable profession, and it is sobering to realize that we serve as role models for the youngsters coming along behind us, although there is concern that their numbers are fewer in recent years. There still remains an undercurrent of dissatisfaction amongst our ranks, particularly for well-seasoned practitioners. In a recent AAEP survey that queried equine veterinarians about how they view their practice experience, the over-riding thread is that of too little time and too little compensation for the time involved in fashioning a successful practice. As we are all too aware, our time and resources are tugged on from every direction - by our clients needing attention, by our family deserving attention, by our professional organizations requesting our attention, and by ourselves in living up to expectations of our personal performance. The answer is to set limits and stick with them. Sounds easy, doesn't it? However, I put this concept first because my experience is that this simple tool is the most difficult one of all to develop and implement.

It is my impression that the desires and habits of members of our profession often aim to please everyone and to accommodate everyone's needs. Such a compassionate person is often in demand, but no doubt you can commiserate with how this might end up with overload - feeling overworked, fatigued, exhausted, injured, bitter, overwhelmed, anxious, or frustrated. In the best-case scenario, the practitioner will develop a personal tool to be able to withstand the stress and challenges of juggling too many obligations with not enough hours in the day. Personal tools might take the form of ironic humor, taking someone along to talk to in the truck, trying to beat the daily appointment schedule, high-speed driving, or spending hours after work trying to line up tomorrow's successive appointments with clients in the same geographic area. A tool that works just as well is simply setting limits.

I realized early on that business practices at inception follow into future decades. I wish that I had also realized the importance of one of those business practices being that of setting limits. Because once a precedent (schedules, fees, communications) is set, it becomes hard to change it later. It is only human nature for clients to push privileges beyond consideration unless we set and maintain consistent and decisive limits.

As an example from my own practice, early on, I almost made the mistake of providing after-hour services to clients who had daytime obligations. However, I have found that clients concede to rearranging their schedules during regular business hours if it is made clear, firmly but kindly, that routine appointments are only scheduled for times within regular business hours, and no, this does not include weekends or evenings.

It really does take a community effort to raise a group consciousness, and the onus of responsibility for improving the situation for all equine veterinarians falls on each of our shoulders. Continuing with the example, if client demands are accommodated to service routine appointments in the evening or after-hours, it is not hard to see why clients would expect every veterinary "professional" to do the same and to be disappointed when one does not. This doesn't necessarily speak to professional dedication as much as it does to two other possible characteristics: (1) the inability to say no and (2) aspirations of increased financial compensation. This leads to a trade-off, with quality of life being exchanged for work and money, at the expense of personal time and of our family members. And it does affect all of us - inadvertently, it appears that the vet who sets boundaries doesn't "care" or isn't dedicated to helping animals, when, in fact, he or she may be exhibiting a bit of self-preservation.

Setting limits on professional service appointments should be easy for veterinarians because it is not a groundbreaking policy. Other professions have already anticipated the need for setting practice limits and have done so successfully. Both your family doctor and your banker would be flabbergasted if you called on a Sunday afternoon to "chat" about your sore knee or your checking account. Even if you did find him available for a chat, what are the chances that he would insist that you run right over to his office that afternoon? I have noticed that some veterinary colleagues have a mindset that we should be available for every little thing (besides emergencies) at any hour of the day or night, and of course, that leads clients to expect that we will. To alter this mindset will take an effort (and desire) on our part to educate our clients and the horse-owning public. If each of us establishes some boundaries with our clients, and by extension with ourselves, eventually the respect for the value of our time will pervade through the equine world, and owners will honor those boundaries you prefer to establish. They will call with true emergencies (colic, laceration, choke, etc.) rather than just because matters of convenience (lameness, dentals, sheath cleaning, etc.) fit best into their schedules. Most of all, the level of respect will expand within the veterinary profession.

It has been my experience that limits and boundaries do not preclude one's ability to continue a comfortable and communicative working relationship with clients while ministering to their animals. The desired end product is that time is allocated appropriately between clients' business and your own business. Without the pervasive element of fatigue, it is easier to do a better job of practicing veterinary medicine without burning out the passion.

4. Saying No Can Be Liberating

What a short and simple word "no" is, and how difficult it can be to say. It's a good thing that it is a simple sound to make, because it takes an ability and strength of character to say no, to make it stick, and to consider that you needn't qualify to clients the reasons why you can't accommodate client demands at every instance. It's not really surprising that your clients don't particularly care about your son's baseball game, or your daughter's graduation, or your mom's illness, or your friend's wedding, or your much-anticipated continuing education seminar, and it is natural for the client to focus on getting your attention for whatever it is they deem important in their day and for their horse. Just as it takes practice to set limits, it takes practice as well as a bit of politics to say NO. One way to ease the process is to learn how to provide alternatives to client requests/demands, especially if you pride yourself on accessibility. Keep a list of alternatives handy. Information handouts can be helpful, as are phone numbers. These can range from providing the number of the local animal rescue or fire department who have agreed to get a trapped horse out of a ditch to having contact information for other vets who may specialize in certain types of cases or in emergency care when you are not available. The teaching hospital of the nearest veterinary school may take referrals. There are ways to be friendly and accessible and to be of real value to the client without "enabling" clients to take advantage of your own "hands" on ability.

So, the trick to saying "no" gracefully is to provide an alternative. I have come to view the times when I say "no" as an interaction with an opportunity to educate clients, and each opportunity can be liberating by facilitating more balance between work and family/play time.

5. "The Extra Day"

Equine practice often involves travel; travel to symposiums, conventions, horse events, and lectures can be exhausting work as well as a lot of fun. When I first started traveling for business reasons, it just didn't seem right that travel time to an interesting area should end with a mad dash back to a busy practice. So I came up with the idea of an "extra" day - at the end of each event, I give myself one extra day before returning to the practice. This is usually a sightseeing day where I explore something special and unique to the area that I've been lucky enough to visit. My clients rarely notice that I've been gone one more day, and that extra day reassures me that my own priorities are in the right place. It works as an early warning system - sometimes I take the day and sometimes I don't, but if I decide to skip it, I am forced to take a hard look at my priorities.

6. Compensation

Another pressing issue mentioned in the AAEP survey is that there is too little financial remuneration for the degree of education and time-committed dedication to the job. Part of that goes with any complex profession, especially in the early years; veterinarians are not the exception to that, and newcomers should be aware of this. The good news is that increased compensation for our services seems to be tied to increased experience, and we must make sure to maintain this correlation. It is heart ening to be able to expect that the longer you do it, the better it gets.

In my mind, our most valuable commodity is our time - it is not a renewable resource because there is a finite amount of it in our lives. Today's equine veterinary practice is a lifestyle, often precluding other personal pursuits and at the expense of family time. It would seem this degree of commitment should be immediately correlated to a high degree of financial compensation, but it doesn't seem to be in all cases, and certainly not consistent with the extent of education and investment in becoming a veterinarian. Some of this is inevitable for the young vet. Our task in practice management is to minimize the effect on the new vet and to ensure that the experienced vet is earning a comfortable, living wage and is able to prepare for eventual retirement. In a perfect world, it would be possible to trade off money for more time, but in solo equine veterinary practice, when you aren't working, the bills aren't getting paid - thus, the practice management conflict between money and time.

The answer is to make our time at work pay off. This means we must have the mettle and self-esteem to charge value for time, especially as our knowledge and expertise grows, rather than practically giving away professional services or trying to undercut other colleagues/competitors in an attempt to pull in more business. Another management technique is to continually extend the responsibilities of your support staff, allowing you to improve revenues from increased veterinarian productivity. Where you have difficulty in setting limits, or saying no, surrounding yourself with staff and technicians who can is an obvious bonus and makes the support staff part of the practice management team. Not incidentally, this allows you to spend your time improving your veterinary productivity and thereby improving revenues.

It seems to be a fact of economic reality that, although there may be many veterinarians in competition for a smaller portion of the economic pie, if someone is competent and skilled, there will be more than enough business coming his or her way, regardless of the fees. That is the advantage of experience... or at least we hope so. The good news is that the compensation becomes better also. If experience is contributory to the compensation package, a reasonable strategy might be to make yourself the very best practitioner you can be - then you can charge a fair market value for your increased ability with the expectation that clients will be attracted to your business without you having to teeter on the edge of breaking even or being in the position of dragging fees down such that other colleagues end up teetering on the edge of financial difficulty. We are not only practicing veterinarians, but we are also independent businesspersons, and therefore, we are in the business of conducting business, not charity, to viably remain in practice. At first you may lose some clients to a lower-cost provider, but in my experience, the clients you do retain and those newly attracted to your practice will be those that can help you and your practice grow in a way that is satisfying.

We all know practitioners who stand out in their abilities. The clients they attract show courtesy (because they have set boundaries) and respect (because they respect themselves) for their time and expertise. Clients will pay a reasonable fee for enhanced quality of service, allowing you to expand your education and skills to provide even better service. In this way, you give yourself the best chance to achieve improved professional gratification and knowledge along with more available time and appropriate compensation.

7. Tapping into Multiple Talents

Just as we examine "the body as a whole" when considering the medical care of a horse, it is valuable to look at the "whole" of ourselves when assessing our professional options - there are multiple ways to bring fulfillment to our lives and to devise some healthy separation between work and personal pursuits. Clinical practice is only one avenue in which to use our skills. In the process of gaining our education, and in the personalities of those who pursue this profession, we have abundant skills that each of us might bring to the equine veterinary industry. It is possible that some of these have been overlooked.

Through the intensity and depth of our educational experience, we are fortunate in how many doors of opportunity are available to do just about anything with our knowledge set. Other professional paths are there for consideration - some practitioners have found their calling not only as practitioners but also as effective organizers, committee members, communicators, educators, writers, illustrators, researchers, politicians, entrepreneurs, administrators, and business consultants, all serving with a focus on veterinary medicine. Sometimes, we fall into these situations by accident; sometimes these skills are something we have brought with us when we entered vet school, not realizing how they could play an important role in the future. I was a writer and photographer before I went to vet school, but little did I know that these skills would become primary tools to help educate horse-owning clients. You may find hidden talents (and passions) of your own to tap that might improve your satisfaction and daily variety while dedicating yourself to your chosen profession. Using your hobbies and talents infuses your equine veterinary practice with versatility and creativity in addition to the stimulation provided by medical practice.

Editor's note: Dr. Jay Merriam's and Dr. Carol Sabo's papers were published in the AAEP 2007 Practice Management Seminar proceedings.