Thanksgiving Special: Give Thanks

I don’t usually do posts which focus on holidays or current events, but my usual posting day fell on Thanksgiving, I am a big fan of appreciation, and I had an experience this week I thought would be good to share from a mental health/happiness/success standpoint.

For SAVMA Wellness Week last week at our institution, students answered a “What are you thankful for?” question. Some of the anonymous responses were sent out to the college, which I thought was wonderful. If you have read the blog much, you know I think appreciation is incredibly valuable for your professional success. Since veterinarians are leaders, we need to show appreciation to those we lead.

Some of the responses from the students indicate that they have a healthy, balanced approach to problems. This semester has been incredibly challenging for everyone. We are all stressed. I have communications with faculty at other institutions and they express the same feelings. Focusing on negative feelings, how terrible everything is, and all the bad things is a great way to lead to perpetual unhappiness.

Instead, my advice is like that I give when a medical error is made: acknowledge what happened, have your feelings about it, and then focus on what you can control going forward. I will add another step when everything seems terrible: try to find something positive from the experience.

Even though this semester has been very hard, some of the positive comments from our students included receiving support from friends and family, appreciation to faculty and administrators for trying their hardest, learning how adaptable they can be, and learning new technology and ways to learn. Seeing these notes of appreciation was wonderful to me. I worry sometimes that students focus too much on the negative. Seeing some realize that there was some good this semester was heartening.

My own exercise in appreciation for the semester:

  • I appreciate that the students were patient and understanding
  • I appreciate that the students gave very professional, helpful feedback to me to improve my course
  • I appreciate my friends and spouse who have provided wonderful social support so I never felt alone or lonely even though we couldn’t see people
  • I appreciate my colleagues for being patient with me in several delayed research projects and providing space for me to prioritize different professional responsibilities
  • I am grateful that I continue to be healthy and able to pursue the activities I like

What do you appreciate? What is going well in your life?

How to Be Successful: Circle of Control

Last year, I taught a course and some students struggled with my style.  I am a clinician, so I approach problems and teaching as a clinician.  I’m not very interested in students memorizing details and regurgitating them on a test; I want them to USE information to make decisions.  This is a different way of thinking and studying for a lot of students, so they struggle.  Inevitably, some students do poorly on an exam.  Then they worry about it.  I never understood why students worry about an exam that already took place, even when I was in vet school.  It’s in the past, what can you possibly do about it?

There are a lot of problems in the world today, and I know people who get stressed about them.  I used to be one of them.  But then I stopped and considered: What can *I* control?  I can control how I vote, how I donate money, and how I engage with other people.  But I can’t change other people’s minds, I can’t make something happen outside of my control.  I have a circle of control.

The circle of control principle I like the most comes from the philosophical approach of Stoicism.  The word stoic has come to mean “someone who doesn’t react” in our language, but that isn’t what Stoicism is about.  Stoicism is about living a good life, a meaningful life, having emotions and feelings, and focusing on what you can control in life.  If you can’t affect it, why worry about it?  

This parallels my advice on medical error.  When something bad happens, reflect on it, learn from it, be sad for a while, and then move on.  You can’t change the past.  You can’t resurrect that patient that died.  You can’t change the grade on your last exam.  You probably can’t change how I write and grade exams.  You can’t change what a letter of recommendation says.  So focus on what you can do.  You can make a different decision for the next patient you see like the one that died.  You can study differently to improve your future grades.  You can realize I am asking you to think differently and not just regurgitate information and try to adjust your thinking.  You can work hard and take advice from the How to Be Successful series so that someone WILL write you a good letter of recommendation.

I see this _all the time_ on the APVMA Facebook group and it makes me sad every time.  I’ve seen probably a hundred or more posts that are something like, “I got a C in Someclass, I’m worried I won’t get into vet school!” or “I only have 300 hours with horses, I’m worried it’s not enough!”  I understand these people are seeking assurance, and that’s fine.  But I wish they would focus on what they can control.  OK, you got a C.  It is what it is.  Can you retake the class?  Can you take a different class and do well to bump your GPA?  Can you study hard for the GRE to bump that part of your application?  Can you work incredibly hard to get good letters of recommendation?  Can you read this blog to improve your application and interview skills?  Yes, you can do all those things and more.  But you can’t change the past.

Focus on your circle of control.  I guarantee you that doing so will make you a more peaceful, contented human being.

My Benefits are Better Than Your Benefits

Except for a one-year stint in private practice for my internship, all of my full-time work has been in academia.  I did work part-time for an emergency practice in Atlanta for years, but that was as an independent contractor, not a W2 employee.  I’ve always heard “Oh the benefits in academia are great!”  I never really thought about it until I started learning more about retirement accounts, and what veterinarians in private practice get in terms of benefits.  Let’s look at the types of benefits you might get working in academia, and I’ll share my experience for each one.

Retirement Accounts

Most employers should offer a 401k, where you can put money to reduce your tax burden and save for retirement.  Some companies will provide a match, which is an amount they put in if you put in a similar amount.  No veterinary corporation I know of offers a pension, which is a set amount of money you get paid forever when you retire.  I have a pension already from one school where I worked, and will get a second if I work at my current institution for another 8 years.  The second institution where I worked, they put 10% of your salary into a 403b without you having to contribute anything.  No match, just free money.  This was basically a 10% pay bump on your salary. Some will offer 457 plans for those of us who want to save even more aggressively for retirement- almost no small practices will and few corporations will offer a 457 plan.  You will never get a pension or that kind of great deal unless you work for a university or the government.

Health Insurance

Everyone acknowledges America’s healthcare system is messed up, so the reality is you need health insurance if you live here.  You can usually pay your premiums before tax, and most companies will pay part of your premiums.  Universities often have amazing health insurance, with the employer paying a substantial chunk of the premiums.  One university where I worked had a high deductible health plan and gave you $1500 every year into your health savings account.  Again, just free money.

Vacation Time

Corporations are starting to improve on this, but universities still beat the majority of them.  All the institutions where I have worked give 3 weeks of vacation time, on top of major holidays and, sometimes, a whole week over the Christmas/New Years time.  Not many companies or private practices can match that.

Disability Insurance

If you’re a veterinarian, you NEED disability insurance.  If you don’t have it, stop reading this article and research how to get some.  We run the risk of suffering real physical injury in our jobs- bites, scratches, being kicked by a horse- which could make working impossible.  Most private practices don’t even offer this, and you have to get it on your own.  Every university for whom I have worked includes it as part of the deal, and facilitates you buying more coverage if you need it.

Life Insurance

My current institution pays out $35k if I die and I don’t have to pay for that.  Not a lot of money, but better than a kick in the teeth. I can elect to buy up to 5x my salary as a death benefit for a fairly low premium.

Education

I earned two Master’s degrees without paying a cent.  One of my friends at the last place I worked is doing the same thing with an online Master’s.  I have looked into getting a PhD at my current employer- again, without paying a cent.  Many of them provide a decreased tuition for children or even spouses.  Maybe some big corporations will offer something like this, but it won’t be nearly as good of a deal.  This is unique to working for universities.

Medical Care

Every university for whom I have worked has an on-site medical clinic you can go to for basic care.  Just walk on over or take the bus.  Services are often quite inexpensive, as they also serve the student body.  I don’t think any non-university veterinary hospital has a medical clinic you can go to for yourself. Two of the universities for whom I have worked offer some benefit if you do healthy things.  Currently I get $120 off my health insurance every year for doing a screening on campus.  I think some companies offer something for healthy living nowadays, but probably not many small practices.

Sabbatical

The institution where I worked the majority of my career didn’t have sabbatical leave, so I don’t know much about it.  In reading up at my current institution, it looks like I can take 1-2 semesters “off” work after 5 years of service.  Obviously, I need to be doing something professional-related while taking this time off.  I’m thinking about going to a little island in Ireland to write a book.  Does your non-academic job give you sabbatical leave?  I didn’t think so.

I’ve talked before about how amazing I think it is to work in academia.  It’s intellectually challenging and offers a great lifestyle.  People always say how the benefits in academia (and working for the government, to a lesser extent) are pretty nice, so here are the big ones spelled out.  It’s a pretty sweet gig.  Why NOT work for a university?

How to Address Peers

Photo by National Cancer Institute on Unsplash

Sometimes, I feel a little bit like Miss Manners.  There are all sorts of unwritten rules of etiquette in veterinary medicine.  For example, did you know that faculty don’t refer to each other as “Dr.” outside of medicine?  I’ve written about how to address people during an interview, but I’ve been thinking, “How do we decide how to address each other once we’re in a position?”  Here is my opinion, and it’s 100% just that, borne from experience observing other human beings in veterinary medicine and what *I* think is best.

Is this person the Dean?  If so, they are addressed as Dean Lastname or Dr. Lastname.  An exception may be made if you are also in a Dean position or higher.

Is this person in a higher level administrative position than you?  If so, they are addressed as Dr. Lastname.  For example, when you talk to your department head, to the hospital director, to the Associate Dean for Research, use Dr. Lastname.  An exception may be made if there is no one else around and you knew the person as a faculty peer before they became an administrator.

Are residents/interns/students around?  If so, use Title Lastname.  For example, if you’re in rounds and referring to what a different faculty said, say “I know Dr. Smith does things this way, and that’s OK.”  If you are in the OR and there are residents, when you check in with the surgeon about the case, “Dr. Smith, how are things going in there?”  Some people will just use Lastname alone, “Smith, how are things going in there?”  I think this is probably OK.  Don’t use first names when trainees are around.

Otherwise, use first names.  Faculty are peers and should treat each other accordingly.  It isn’t BAD if you address people as Dr. Lastname, it’s just unnecessary.  I tend to see more older faculty use Dr. Lastname when they refer to another faculty member in, for example, a department meeting.  So either is acceptable.  I prefer to use first names when it’s only faculty around to create a greater sense of community and cohesiveness to the professional culture.

I don’t want to be as prescriptive as Miss Manners.  Some of this will vary by your institution.  At one institution where I worked, EVERYONE used first names when I first got there.  It gave a significant air of unprofessionalism which I worked to improve upon.  Interpret these as my suggestions rather than rules.  What do you think?  Is this how your institution runs?

Long Term Goals and Money

If your family is paying for vet school, you can stop reading this and head over to the How to Be Successful series.  For the rest of you, read on!

I was working on a lecture I was planning to present at SAVMA Symposium 2020 about personal finance.  The title is “From $250,000 in Debt to Millionaire.”  In part of it, I work out an illustration of how the math works to get from $250k in debt to having $1M in assets for an average new graduate.  I imagined myself giving this presentation and railing to the attendees that if any of them went to Ross or Midwestern or other non-state schools without their family paying for vet school, that decision is going to affect the entire rest of their life.

So many pre-vet students have the goal of “get to vet school”.  But not enough think about after vet school.  Do you want to practice in a rural mixed animal practice?  Do you want to own a nice house?  Do you want to buy new cars?  Do you want to have kids and send them to private school or college?  Do you want to not have roommates?  Guess what?  It’s much harder to do ANY of these things if you have more than twice your yearly gross income in debt.

I urge you, sincerely and passionately, to think about what you want from your life.  You may not be materialistic- that’s great, neither am I.  I’m not talking about you being able to buy a BMW or live in Los Angeles.  I’m talking about you being able to buy a new Honda Civic and live anywhere other than rural Iowa.  I’m talking about you being able to buy a house less than 10 years after graduation.  I’m talking about you being able to go on a trip once a year.  I am talking about relatively basic assumptions most people make about their life after getting a professional degree.  You won’t be able to have any of these if you go into so much debt because of vet school.

The numbers work out something like this.  A debt of $250k paid off over 20 years at a rate of 6% will be a payment of $1,800 (assuming no income-based repayment, because who knows how long that program will be around).  Aiming for a $10k contribution to retirement, as well as taxes and saving for a house down payment, provides a budget of around $30k a year for an average new graduate.  That’s not a lot of money for life. This amount has to cover insurance, groceries, travel, clothes, utilities, entertainment, and everything else. That’s difficult to do, particularly if you’ve been putting off making any purchases throughout your many years of schooling.

Now, if you’re willing (or eager) to work small animal ER in Phoenix and take extra shifts, or do 4 more years of training to get a specialty, you can earn enough of a salary that the large debt is less of a problem.  If you can make $130k, your debt to income ratio is less than 2, which isn’t catastrophic.  But not everyone wants that kind of life.

So, before you go to a school which is going to put you massively in debt, please consider the lifetime repercussions.  Maybe it would be better to work for another year, get more experience, and re-apply to your state school next year.  Maybe it would be better to do a PhD, where you actually get a small stipend during school, rather than a DVM.  There are so many paths to a happy, successful life.  Don’t paint yourself into a corner obsessing over the DVM at all costs.

Stop Using “Utilize”

Photo by Matthew T Rader on Unsplash

This is going to be another short, PSA-style blog post.  It’s right there in the title.  Don’t use ‘utilize’.  Just excise it entirely from your writing.  It’s never necessary.  People use ‘utilize’ because they think it sounds more official and cooler than ‘use’.  It doesn’t and it isn’t.  It’s just distracting.

Technically, utilize is used when you want to express that you are using a thing for a function for which it was not originally intended.  For example, if you are using a brick as a hammer to pound nails into your dorm wall, you can say, “I utilized a brick as a hammer.”  However, you could ALSO say, “I used a brick as a hammer.”  Just use “use”.  There’s no practical reason, even if it were grammatically correct, to use ‘utilize’.  So please stop.

Assistant Professors: Don’t Get Sucked Into Clinics

Photo by John Paul Summers on Unsplash

You have recently finished your residency and (hopefully) passed your boards.  You are in your first professional faculty position as a clinician!  Your FTE probably has 30-60% of your time on clinic duty, with the balance being teaching, research, and (non-clinical) service.  If you are on a tenure track, you probably have some publication and funding expectations.  How do you proceed to be successful for promotion to Associate Professor with Tenure?

After a clinical residency, guess what?  You have been trained to be a CLINICIAN.  Most residencies spend a lot of time on your clinical skills: technical/procedure/surgical skills, decision making, challenging cases, etc.  These are essential to being a clinical specialist.  However, they do bugger-all for you in the other domains of your new positions: teaching, research, and service.

When you don’t have much experience with or knowledge of these other domains, they can be scary.  And guess what we avoid doing?  Scary (or new) things.  New clinical faculty tend to focus on what they have been trained to do, what they are good at, and what they know: being on clinics.  While being on clinic duty is an absolutely essential part of your job, do not get sucked into them!  You have other things to do!

I have seen numerous assistant professor faculty who are always on the clinic floor, even when the schedule indicates that they should be “off” clinics.  They just gravitate to the hospital.  Maybe they don’t see appointments, but they are around to help, maybe scrub in for some procedures, maybe teach some rounds, maybe supervise the house officers on their cases.  It’s so much more comfortable to be on the clinic floor than in your office doing… what, exactly?

Since new clinical faculty do not have that much experience with the teaching, research, and service component of their FTE, it can be difficult to figure out how to use your off-clinic time productively.  This is particularly true for those coming from residencies with very little off-clinic time.  You may feel, when you aren’t helping patients, that you aren’t being useful.  What new faculty may fail to realize is: 1) the job requirements for a clinical faculty include many components besides patient care and 2) you will be evaluated on these non-clinical components when it comes to annual review and promotion and tenure decisions.

So my single most important piece of advice to new clinical faculty is: stay away from the clinic when you are off clinics.  You need to protect that off clinic time like a Chihuahua backed into a corner in the exam room.  You have OTHER RESPONSIBILITIES now besides clinics, so you need time to take care of them.  The easiest, most effective way is to just avoid clinics.  Leave it to your competent colleagues to handle.  The less you know about what’s going on, the better.

Podcast Episode #12: Dr. Pedro Bento

Dr. Bento is the author of the Vetmed Survival Guide, a blog dedicated to helping those interested in pursuing internships and residencies. He’s also written a helpful guidebook for the same, which I encourage you to check out! He provides us with his extensive expertise in advising people who want to pursue an internship and residency and also comments on the field of veterinary internal medicine.

Examples of Aiming for +1

One of my bedrock principles for you to understand is to Aim for Zero.  Go read that post if you haven’t done so yet.  Why do people aim for +1 and fail so often?  I think it’s because they miss some important steps as they are reaching for +1. In the original post, I gave an example of a resident who was aiming for +1 and became a -1 in the process.  Here are some more examples from my life.

The Helpful Friend

We have one friend who tries SO HARD to be helpful.  I think it’s because her family relied on her to be The Responsible One when she was growing up.  She has a tendency to take charge of everything (even if we’ve Got This, because we’re grown ass adults) and tries to provide helpful information even when it isn’t correct, helpful, or necessary.  The most clear example is when we were out at a restaurant trying to figure out the menu.  The server came up and someone asked a question and our helpful friend answered.  The server, who was the professional who KNEW THE MENU, was right there? Why in the world would you try to answer instead of allowing the server to do so?  This happens constantly, and makes us feel like we’re being treated like incompetent children when we’re around her.

In order to avoid being this person, think about whether you’re the most qualified person to deal with a situation and/or whether a competent person is already taking care of it.  Do you always really need to ‘solve’ everything?  Just wait silently and see if someone else handles it in a competent way. Aim for Quietly Competent.

The Gunner

There are so many of these it’s hard to choose just one, so I will use a recent example.  I was on clinics and one of the students was trying so hard to be likeable and demonstrate that he was smart.  To that end, he struck up conversations at inappropriate times by asking slightly unprofessional questions.  One time he was monitoring a case in MRI and asked what my plans were for the weekend when I just quickly popped in to check on the case.  He clearly studied, but he studied esotera and asked questions which were esoteric, without having a solid grasp of the fundamental concepts.  For example, he couldn’t describe why the inspired anesthetic concentration was less than the vaporizer setting, but he asked a question during rounds about coronary steal.  Again, aim for Quietly Competent.

In order to avoid being this person, reflect on how you are feeling.  Are you feeling anxious and therefore the need to impress?  Are you feeling insecure?  Try to relax and just Do Your Best.  If you find you are asking questions which the rest of the students don’t even seem to understand or which requires a lengthy explanation by the instructor, or are met with, “We can discuss that later”, you may be asking Gunner questions.

The Competitor

My best friend is highly competitive, as are several other close friends.  It doesn’t bother me because I am 100% not competitive.  However, I can see how it may be bothersome to other people.  If someone in martial arts class does 50 push ups, he has to do 51.  I imagine this would be frustrating for people if they gauge their worth by comparing themselves with others rather than gauging compared to themselves of yesterday.  The competitive desire to be the best is analogous with aiming for +1.

In order to avoid being this person, consider how you relate to other people.  Do you feel pressure to one-up someone?  Do you do the humble brag?  If you aren’t number one, how do you feel about that?  If you are competitive, work on dialing it back a bit.

I actually had a harder time coming up with personal examples than I thought I would.  I think it’s because I tend to select for my friends from the RFHB group, and very few of them are aiming for +1.  I am not saying don’t be enthusiastic- you know I love enthusiastic friends and students and peers.  I’m not saying don’t be helpful.  I AM saying to just relax and Aim for Zero.  In all things, aim for moderation.

My Process for Writing a Letter of Intent

I just finished writing a letter of intent for a position I applied to.  I thought it would be valuable to share my process, to serve as inspiration for you if you are stuck or struggling with what to write.

Step 1) Review the job description.  I read through the entire job description, even though I have a pretty good idea of what it entails.  There weren’t any surprises, but if I had noticed anything noteworthy, I would have addressed it in my letter.

Step 2) What do they want? The job description specified they want a CV, three references, and “letter of interest describing teaching, research, leadership/administrative philosophies, and a vision of the Department’s role in the College and University.”  This is a little bit different from a faculty letter of intent description, particularly the vision piece.  Fortunately, I’ve written some applications for administrative positions before so have some experience writing vision statements.

Step 3) Research.  I reviewed the Office of Academic Affairs’ website, copied the mission to the top of my letter for reference, and researched the search chair’s information.  I already knew the people involved, since I am applying where I already work, but I re-read the mission statement several times while I wrote my letter to make sure I was addressing the key components.

Step 4) Re-read old letters.  As I mentioned, I have written letters with a vision statement before, and written dozens of letters of intent.  I reviewed the most recent ones for turns of phrase I liked, or concepts I think are important to include.  I originally tried copying and pasting them, but ultimately decided I needed to do a letter from scratch.  I did copy and paste some specific segments and sentences.

Step 5) Outline.  I know this seems like something you don’t do after leaving middle school, but trust me, it’s valuable.  I had four domains to touch on: teaching, research, leadership, and a vision.  I started with broad concepts that underlie my whole professional approach.  Then I put each of those domains into their own section and wrote.

Step 6) Review.  I re-read the whole thing a few times and used the spelling/grammar checker.

Step 7) Peer review.  I just sent 13 emails to friends, peers, former supervisors, former mentees, and my wife for feedback.  As I always say, have others review your materials!  I got some substantive, very helpful feedback which dramatically improved the letter while keeping it my own work.

Step 8) Revise.  Take the various pieces of conflicting advice you get from soliciting feedback and make it your own.  Once you are happy with the revisions, you are done!

It can be daunting tackling such an intimidating task as writing a letter of intent.  Particularly for internships and residencies, the letter is a very important part of your application.  If you have trouble, see my basic guide for writing a letter, and I hope my process here is inspirational.