Telling thinking individuals with a conscience and a heart stuff they already know is fun, but less satisfying than really opening the eyes of someone operating under misguided perceptions of how things run.
As an example, I will throw out one of the most common questions asked of veterinarians (which I am sure will come as a surprise to most of you): Do you have to go to school to be a veterinarian?
I wish I were joking.
I have personally been asked this one, as have many folks I work with. It is asked often enough that I thought I would provide some insight into the training process and the steps involved in making a veterinarian in the United States – both a general practitioner and a specialist.
Both GPs and specialist veterinarians have to undergo a rigorous and lengthy (not to mention expensive, as30 the average debt load for a new grad veterinarian is now well over $150,000) training process. By the time I finished my residency and was able to take the board exam in emergency medicine I figured out that I had just completed the 24th grareside – and no damn recess for years, either.
The process usually starts in high school, or even before then for some driven and committed folks. As high school graduation nears, counselors and students start looking at schools that offer good pre-veterinary programs, and perhaps even have a veterinary school to transition to after college. Pre-vet classload is heavy on science (physics, organic chemistry, biology and the like) and the schools tend to be the larger land-grant or agricultural colleges. There are a few exceptions to this, but most schools that veterinarians attended as undergrads had ‘State’ somewhere in the name. A few vet schools will accept students after a rigorous 2-year immersive pre-vet program, but most require a 4-year bachelor’s degree. Mine was in zoology.
By the time they are ready for veterinary school, most people have attained the 16th grade.
Once someone has made the decision to apply for veterinary school, they have a mere 28 schools to choose from in the United States – and if they happen to reside in a state that already has a veterinary school, getting into another one is a challenge (and certainly more expensive for out-of-state tuition). There are a few schools in the Caribbean that some folks can choose from as well.
The application and interview process is a mind-numbing blur for most folks I know who have gone through it. Only afterward do they dimly remember some interviews, some travel, some cheap hotel rooms and a mountain of forms and essays. Example: ‘What animal would you most like to have dinner with?’ ‘What are your thoughts on cat juggling?’ ‘Dogs and cats living together – right or wrong?’
After you apply and interview…you wait. For weeks. It is similar to what people go through when applying to undergraduate school, but they seem to stretch out the process forever. The majority of veterinarians don’t get in on their first try – the sheer number of applicants coupled with the low number of schools makes sure of that. When I was a technician I worked with a veterinarian who applied seven times before finally getting in.
Veterinary school is usually divided into the ‘pre-clinical’ years (usually the first three) and the clinical year. The first three years are spent in the classroom, filling your brain with tables, graphs, algorithms and heuristics (unlike undergrad, where you are typically filling your brain with Cheetos, beer and pizza). Most veterinary schools have some exposure to clinical medicine scattered throughout the educational arc, but you really only get to work on actual living patients in the fourth year in the vast majority of cases.
Classes like anatomy, physiology, pharmacology and pathology dominate the early curriculum, and there are a few opportunities to rotate through working hospitals on externships and preceptorships as you near your fourth year.
The senior year is typically spent in the teaching hospital – seeing patients together with faculty, and learning the nuts and bolts of what it takes to become a proper veterinarian. During the first three years of veterinary school you hopefully learn the theoretical underpinnings of caring for sick patients. It is in the fourth year that you learn to think and act like a doctor.
By the time you have completed your fourth year, you have reached the 20th grade – if they had let you know this in third grade, you would have thought this was some form of torture.
At this point you are faced with a decision: move into practice or stay in school and complete an internship – the 21st grade. This is one way in which veterinary medicine differs from our human-medcounterparts. Most, if not all, MDs continue on for an internship - and even beyond, into a residency - as an expected part of their training, but for veterinarians it is perfectly acceptable to hang up your shingle and go into practice – after a mere eight years of higher education and the aforementioned hundreds of thousands of dollars in debt.
For those going into private practice right out of school, the path can be rigorous and perilous. Many times, a practice owner will hire a new grad, toss them the keys to the practice and say see ya, wouldn’t wanna be ya and head off on vacation (often a well-deserved one that has not been taken in years). This leaves the new grad, with a head full of book-learning and precious little practical knowledge, in charge of the caseload and patients’ lives.
Newly minted doctors tend to think that everything is sicker than it is, and that every case is suffering from some exotic and only-seen-once-since-the-Nixon-administration affliction. They need the benefit of an experienced guide to help them make the best call. And…if your experienced guide just took the wife and kids to Aruba, you and your patient might just be outta luck.
It is becoming an increasing trend for veterinarians to choose an internship instead of venturing right into private practice. An internship is a low-paying and immersive training program with an amazing amount of duty hours and supervision. Interns, I once figured out, make roughly $5 an hour, when you combine the low salary (often in the $20k range) with the long hours (80 hour workweeks are the rule – anyone working less is seen as a slacker). Burnout, depression and chemical abuse are ever-present dangers for interns, who often have the worst shifts and the worst cases. The payoff is the sort of ‘suffering builds character’ education that comes from surviving a test of wills: it either breaks you or it makes you a better doctor.
We have an outstanding lineup of eight interns at Purdue, and I have personally seen the majority of them have meltdowns after a hellish night of ER work. They work as hard as anyone in the hospital, and they do it for peanuts. We guide them, we mentor them and we support them, but it is a harsh process that separates the wheat from the chaff. It is not meant to be cruel, but sometimes it appears to be that way despite our best intentions.
For all this difficulty, both financial and personal, there must be some upside or no one would ever even consider entering the 21st grade. One of the benefits of doing an internship is the concept of mentoring – these new and green doctors don’t have to go it alone because they almost always have a faculty member helping out with cases. They have brains to pick on challenging patients and another set of eyes to help interpret X-rays. They also have their fellow interns to compare notes with as it helps to get through this sort of trying personal journey when there are others right there along with you.
After an internship, doctors have yet another fork in the road to take – the leap into private practice (armed with the experience that an internship provides) or enter the 22nd grade and complete a residency. Residency training is specialized – this is where you learn to become a cardiologist, internist, surgeon, ophthalmologist or any of the dozens of specialties available. Veterinarians are not quite as pigeon-holed as MDs are (for example we do not have pediatricians or gerontologists), but the number of specialties grows every year, as do the number of specialists. When I became board-certified in emergency medicine, I was one of only 200 such individuals in the country. With the release of 30 to 50 more every year, our number is now over 500 and climbing.
A residency is to an internship what Abbot was to Costello; longer and narrower. Residencies typically last for three years, and are limited to one field of study (such as the ones mentioned above; mine was in emergency medicine and critical care). On the brighter side, the pay is better – most residents get paid somewhere in the vicinity of $6 an hour for the privilege of practically living at the teaching hospital (it is called a ‘residency,’ after all), endless on-call duties and making sure interns don’t kill too many patients.
After this lengthy, exhausting path, you now find yourself completing the 24th grade – the last year of your residency. You now have reached the pinnacle of your profession, its very Zenith (or perhaps its Amana or Radarange) – you know as much as you are ever going to.
Your reward for all this toil? You get to take a three- or four-day examination and pay lots of money in order to do it. Yes, after making single digit hourly less-than-the-fry-guy-at-Arby’s wages for three years, you have to lay upwards of a grand down to sit in fluorescent hell somewhere and take your board exams. Lucky you.
Board exams are the brick wall that all residents slam into when they are done – they are the gatekeeper between what you have been trained to do and what you are able to do. Mine were in New Orleans and lasted three solid days. I can honestly say they are only a blur now, and all I can remember are tears, maniacal laughter, furious scrambling through notes, and perhaps a redheaded midget wearing roller skates while clutching a rotten tomato on a string. I am little fuzzy on that last bit; that might be the peyote.
Once successfully passed (the pass rate usually hovers around 65 to 75 percent range for most specialties) you are able to call yourself a specialist in your discipline. You have graduated the 24th grade – here’s your tie pin. Now go play.
That’s a pretty impressive litany of steps to go from everyday shlub to veterinarian and then onto veterinary specialist. Most days, I will still say it was all worth it – the great saves, the interactions with the many gifted and interesting people I have become acquainted with along the way (both pet owners and colleagues), and the midgets. On occasion, I look back and question the wisdom of my choices, but who doesn’t do that as part of being alive?
But if I had my druthers, I think 12 grades is really plenty.
November 5, 2012
November 5, 2012