A Tale of Two Interns

I have some bad news.  Life is not a meritocracy.  We all wish we lived in a world where, if you are the best candidate for a position, you get the position.  Unfortunately, that’s not the world we live in.  In our world, who you know has a tremendous impact on your ability to get a position.  Up to 85% of jobs in the business world are found through networking.  In veterinary medicine, this number is probably much lower, but nonetheless many people get a position due to Who They Know.  This is a case study which illustrates this concept.

Intern A is hard working.  She is dedicated to her patients and wants them up and aware after surgery.  She has her own ideas about how to do things and is not very receptive to input from other experts.  She walks around with a chip on her shoulder and rarely looks like she’s enjoying her work.

Intern B is hard working.  She is dedicated to her patients and wants them to be comfortable and pain-free after surgery.  She listens to feedback from others and seeks out others’ opinions.  She smiles constantly and is happy to be at work.

In a just world (which is a fallacy), which of these two interns should get a residency?  Based on my assessment, I would say Intern B.  Now, I’m not the direct supervisor for these interns, so it’s entirely possible there are amazing qualities of Intern A about which I am unaware.  But, from where I stand, Intern B would be the best choice.  Which one actually got a residency?  You probably saw this coming: Intern A.

This doesn’t mean that you shouldn’t TRY to be the best.  Chance favors the prepared, so if you happen to get a position somewhere with the right people, if you are more enthusiastic, more professional, and more engaged, you are more likely to successfully get your next position.  So absolutely do this: try hard, work hard, be pleasant to work with, have a good application packet.  All of these will help.  But, at the end of the day, it often comes not to who you know, not what you know. 

So some additional advice: cultivate your professional relationships, and reach out to people at institutions where you’re applying. However, if you don’t get the residency you wanted, try not to get too discouraged, criticize yourself, or take it personally. It might have nothing to do with you and everything to do with who someone else knew. Besides, you never know how much happier you might be with your second, third, or fiftieth choice!

Asking Non-Veterinary Supervisors to Write a Letter of Recommendation

A letter of recommendation (LOR) is one of the cornerstones of your application to vet school.  They are used to demonstrate to the selection committee that you know what you are getting into and have the fortitude to succeed.  At least one of your LORs should come from a veterinarian.  They have been through vet school, they know what it takes, and they understand the field.  But what do you do about letter writers who are not veterinarians?  They may need some guidance to write you a really good LOR.

The LOR is different depending on the culture.  In the United States, the LORs we write and receive are much longer than overseas.  The LORs in veterinary medicine are different from those in human medicine.  As a result, you cannot simply trust that a letter writer knows what is needed and appropriate to say in an LOR for vet school.

Far and away the most important positive part of an LOR is the free-text portion.  There are standard questions which are answered, but most of these merely establish the applicant as acceptable or not acceptable.  Where the LOR can really help the applicant stand out from the crowd is in the free-text portion.

That piece of information right there is key.  Many LOR writers don’t spend much time on the free-text portion at all.  They NEED to.  Most American evaluators interpret very little written in the free-text portion as “This writer doesn’t know the applicant”, “This writer has nothing good to say about the applicant”, or “This writer doesn’t know the cultural norms of veterinary medicine.”  Any of those are bad news for the applicant.

So, the first thing you need to impress on your LOR writers is that they need to complete the free-text portion, and not write only 3-4 lines.  It doesn’t need to be a textbook, but most free-text portions I write are a short 5-paragraph essay.  This demonstrates that I know the applicant well enough to comment on their qualities in depth AND put those qualities into context for the position to which they are applying.

I realize it can already be intimidating to ask someone to write you a LOR.  How do you tell them what to write?  After you have secured their agreement to write you a GOOD LOR, you can send them them an email along the lines of:

“Thank you again for agreeing to write me a LOR for veterinary school!  I’m not sure how many of these you have done.  The LOR for vet school is very particular.  The evaluators really want to see that you know me as a person and can ‘vouch’ for my competence and likelihood to succeed.  Evaluators expect that LOR writers put in a detailed and fair description of the applicant in the “Comments” section at the end of the form.  If you can make sure to address a few qualities that you think make me a particularly good applicant, and your experience seeing those qualities, that would be tremendously helpful.  Attached is an example of an LOR written for vet school.  Please let me know if you have any questions!”

If you are more comfortable having this discussion in person, that also works just fine.  You could even discuss it during the same conversation where you ask for a LOR.  “Thank you for agreeing to write for me!  I’ve been told that vet schools are very particular about what they want to see in an LOR.  Can I send you an example for some inspiration?”

I realize this may be more forward than some people are comfortable being.  Some may believe they will offend the LOR writer.  I don’t think that’s the case.  Anyone willing to write you a GOOD letter WANTS you to succeed.  They should be delighted to get any guidance to help them write a LOR which would help you be successful.  I have written a handful of LOR for medical school and I know I would have appreciated more details about what they are looking for or even an example.

You can’t expect everyone to know what veterinary medicine cultural standards are, so you need to help them out.  Be respectful and polite and approach it with an attitude of helpfulness.  I think this will improve the qualities of LORs I read and improve YOUR chances of getting an interview and acceptance.

My Ideal Candidate

I do not represent every veterinary professional.  I think that should be obvious, but I have to make that VERY clear for this particular post.  I have spoken with many veterinary professionals and academics, and I have trained dozens of house officers and thousands of students, and there are numerous ways to approach success in veterinary medicine.  I don’t think many people would argue with the principles I have in the How to Be Successful series.  I suspect some people may argue with my ideal candidate.  Nonetheless, I want to share with you my ideal candidate and why I believe they are the ideal candidate.

No matter the position- vet school, internship, residency, or faculty position- I have a short list of essential criteria.  I want them to be interested in working hard.  I want them to be humble.  And I want them to be pleasant to work with and able to get along with people.  I have heard this summarized as “hungry, humble, and smart.”  Why do I look for these particular qualities?

Hungry

Nobody wants to work with someone who is lazy.  Vet students who don’t work hard won’t learn what they need to pass, much less be successful veterinarians.  Interns who don’t work hard don’t learn to be competent clinicians.  Residents who don’t work hard are the worst- they drag the entire team down for years until they are let go.  Faculty who don’t work hard don’t usually impact me directly, but it’s a little disappointing to witness.  Step #1 is to Show Up.  You can’t be successful if you’re not there.

Humble

As a general rule, people who are humble are more teachable, they are interested in personal growth, they realize they are imperfect, and they acknowledge their mistakes.  Being humble is NOT the same as lacking confidence.  You can be humble and confident.  You can’t be humble and arrogant.  Who really wants to work with someone arrogant?  As a student, intern, or resident, I can’t teach such a person.  As a faculty member, they won’t admit to mistakes and instead push them off onto others.  I believe humility is essential to becoming a fully self-actualized, happy human being.  It’s also critically important in medicine, where you absolutely will make mistakes and need to deal with them.  One surgeon I worked with had a saying, “If you haven’t seen a complication doing this, you haven’t done enough of them.”

Smart

If someone doesn’t know something, I can teach them.  In fact, that’s my job.  But if they aren’t pleasant to work with and get along with people… I can’t fix that.  That’s going to take years of therapy on their part.  I’m not a therapist.  Who wants to work with someone unpleasant?  Everyone has their bad days- that’s OK.  But if someone doesn’t know how to deal with conflict, is constantly negative, puts other people down, or doesn’t show respect, I don’t want to be around that person.  You don’t need to be extroverted and outgoing and always “on”.  But you do at least need to understand that other people have feelings, they are trying to get through their day the same as you, and you need to work together to accomplish that.

It’s not a long list.  It doesn’t seem hard.  You don’t need to EXCEL in each of them.  I would argue I am reasonably hungry (though not as much as some), reasonably humble, and still working on developing my emotional intelligence.  But you DO need to at least be aware of each of these and, if you aren’t doing well yet, working to improve them.  The students, interns, residents and faculty I have seen fail have completely lacked- and been uninterested in improving- at least one of these.

This is why my ideal candidate focuses around these qualities.  There is some baseline assumption of intelligence, but anyone who gets into vet school I believe is sufficiently smart to become excellent, as long as they also have these three characteristics.  When I look through applications, I look for evidence that the applicant has OR DOES NOT have these qualities.  What qualities do YOU think are most important?

Red Flags in Faculty Positions

I think it’s actually quite hard to find out if a job/faculty position will be a poor fit for you until you work there for a while.  I have seen numerous people (including myself) take positions they thought would be good for them, only to discover those positions weren’t good.  Finding red flags before taking a job is quite challenging.  Here are some I can think of.

  1. Frequent turnover.  If the faculty turn over regularly, if they have a large exodus, or if they have a large number of positions open, that may suggest a systemic problem. You can ask about this phenomenon, and sometimes reading between the lines of the answer will give you an idea of whether it’s just bad luck or if there’s an actual issue.
  2. Too good to be true.  I think this applies to almost everything in life.  “If it’s too good to be true, it probably is.”  Some examples: A $100k signing bonus without a multi-year contract; a high salary with low clinic time and minimal research expectations; any excessive verbal promises.
  3. Poor leadership.  If the leader is a narcissistic sociopath, it’s probably not a great long-term position.  Hard to discover without a psych evaluation, though.
  4. Unhappy faculty.  Even if they aren’t leaving and creating high turnover, if the existing faculty are all miserable, that’s a bad sign. Again, this can be hard to establish, but a lot of times faculty will try to convey such issues even if they feel they can’t be brutally honest. 

Again, it’s hard to identify permanent positions which are bad fits.  Unfortunately, sometimes the only thing to do is try it out and see if it works for you.  If it doesn’t work out, specialists are always in demand, and you can probably find a better fit somewhere else. Unless YOU’RE the problem.

Red Flags in Residencies

The purpose of a residency is to prepare you to pass boards and train you to be a specialist clinician.  As long as you achieve that objective, then the residency is a success.  However, residencies are 2-4 years long, and you don’t want to suffer for that long if you work somewhere terrible.  These are the red flags I would consider when looking at residency programs.

  1. Low boards pass rate.  While those training residents SHOULD be focused on helping them pass boards, some programs just throw the resident to the cases without journal club, classes, or boards prep time.  Although practicing your specialty is necessary to pass boards, it’s not sufficient.  Find out what their boards pass rate is.  If it’s less than 80%, I would be worried.
  2. Low credentials acceptance rate.  For many specialties, you have to submit a case log and other materials indicating you are qualified to take the specialty board exam.  Some programs are notorious for not preparing their residents for credentials submission.  I see this most often with specialties that require an accepted peer-reviewed publication and programs that don’t do a good job of making sure their residents complete a publishable paper in time for credentials submission.  Again, ask what their credentials acceptance rate is.  This should be 100%; if it’s less than that I would ask where the problems were- it’s possible one resident didn’t do what they were supposed to.  But if more than one resident had a problem with this in the past, I would be suspicious of the program.
  3. Miserable residents.  Look, a residency is HARD- it’s not usually a time of puppies and rainbows.  But it shouldn’t be TERRIBLE.  If the current (or previous) residents all report that they get abused, or overworked, or yelled at, this is probably not a good situation to enter into.

Those are really the ones I can think of.  If a program has a good track record of credentials acceptance, boards pass, and not-miserable residents, it’s probably a reasonable residency experience.

Red Flags in Internships

Internships are entirely unregulated, working under the motto “caveat emptor”.  It is up to the individual applicant to determine if a program is a good one or not.  There are plenty of programs out there which are better than others, and many that are worse.  Therefore, it is absolutely vital to do your research to avoid the worst programs.  These are some red flags I consider in evaluating internship programs.

Lots of ER time

I would expect interns to spend a fair amount of time on emergency- that’s how they generate revenue for the clinic.  But if the intern is on ER duty more than 50% of their time, I don’t think that’s a “rotating” internship.  There’s not enough time in other disciplines to learn the essentials of medicine that you need.

No specialists

This one’s a no-brainer.  If there aren’t any specialists, this isn’t an internship, it’s a low-paying first-year job.

Few specialists

If the program only has one surgeon and one internist, you may get a decent experience, but I think it’s less likely than if there are a dozen specialists.  I would look very closely at a program with a small number of specialists.

Intern incompletion

If the number of interns who have completed the program is different from the number who started the program, this may be a problem.  It’s possible it’s because the individual interns dropped out but, in general, good programs do not have interns leave after starting.  This is available in the program description on VIRMP.

Resident match rate

If the program has many years of data, and their resident match rate is terrible (<20%), I would pause and consider going there if your eventual career goals include applying for residencies.

Low directly supervised time

If the time you are directly supervised is <50%, this again suggests they are just using you for cheap labor and not actually teaching you.

Poor current intern attitude

Definitely call and talk to current interns if you are concerned about a program.  If the current interns express discontent, that’s a bad sign.

Bad intern programs are out there, and these are some red flags you can look for to identify them.  Talking to current and past interns is probably the best way to get data, but is also the most difficult.  Look at the program description for the above characteristics to spot those red flags.

Red Flags in Veterinary Schools

I’ve said before that where you go to veterinary school Does Not Matter except for the cost of attendance.  I stand by that statement and genuinely believe it.  If your school is accredited by the AVMA, you will get a good education, so long as you are a good student.  Your education depends FAR more on YOU than it does on where you go to school.  Nonetheless, there are some aspects of schools that I think are red flags.

Not AVMA accredited

If it’s not accredited, it’s going to be a harder, longer road for you to get licensed to practice in the US and Canada.  It’s still possible, but definitely harder.  If the school from which you graduate is not accredited, you’ll have to go through the PAVE program.

AVMA Terminal Accreditation

This is a school which has repeatedly failed accreditation and it’s going to have its accreditation revoked.  Don’t go here.  In fact, they won’t be admitting new students.

AVMA Probationary Accreditation

The school has a Major deficiency in one of the core areas of accreditation.  This usually is a strong motivator for the school to fix that deficiency, and most of them will.  Nonetheless, if you have a choice between equally expensive schools and one has full accreditation and the other has probationary accreditation, I would go with the full accreditation school.

AVMA Provisional Accreditation

This is the distinction given to a school before it graduates its first veterinary class.  Don’t worry, your degree will be accredited, so I don’t consider this a major red flag.  The worst case scenario is the program doesn’t follow through with what they need to in order to earn full accreditation, in which case they will transition to a Terminal Accreditation.  But enrolled students will still be OK if they graduate from a program with Terminal Accreditation following failure of Provisional Accreditation.

Lots of faculty vacancies

Even for fully accredited programs, if they have a lot of empty faculty positions (one school had 28 open clinical faculty positions a few years ago), that’s a bad sign.  It suggests people don’t want to work there or they can’t attract quality faculty.  Maybe that means the faculty they CAN attract won’t be as keen on teaching.  I would be more cautious about a school with a lot of faculty leaving it than a school which doesn’t have difficulty recruiting faculty.

Unhappy faculty or students

If, during the interview process, you get the impression that the people at the school are generally unhappy, that’s a bad sign.  Obviously there will be occasional individuals who may be disgruntled no matter what but, if you detect a trend, that may suggest a systematic problem and may indicate YOU would be unhappy there.

That’s really all I can think of.  At the end of the day, where you go to vet school really doesn’t matter, except how in debt you are at the end of it.  You can get a good education anywhere.

Red Flags in Faculty Applicants

If I had a fool-proof method to identify good workers before they started a job, I would be a billionaire.  This question haunts hiring managers constantly.  You NEVER know if someone will be good at the job before they get into the thick of it.  Having personally hired faculty who were both outstanding and subpar, I can say it is VERY difficult to identify the subpar ones a priori.  

Nonetheless, there are definitely some applicants which I can spot as  likely to be bad faculty members from the outset.  If I can identify that they do not respect others, are lazy, are arrogant, or are unpleasant, I would not hire them.  Most faculty hires are made by the department head and dean, so really it’s up to what they think is important.  It definitely differs by individual, so take my advice with a big grain of salt.

Do Not Respect Others

This usually manifests in how the applicant interacts with staff.  If they don’t give staff (administrative assistants, technicians) a reasonable level of respect, they will probably cause problems as a faculty member.  We’re all part of a team.  Anyone that has an ego so big that they think the “little people” don’t matter is someone with whom I don’t want to work.

Laziness

Obviously, no one wants to work with someone who doesn’t do the job.  If I get the sense that the person wants to skate by on the bare minimum- or less than the bare minimum- I don’t want to hire them.

Arrogance

This ties closely in with not respecting others.  If someone doesn’t have at least some humility, they are going to be a pain to try to supervise.  This can be surprisingly difficult to pick up in an application or interview.  Indicators I look for are how they treat other people and talk about them.  If they think they’re the best thing since sliced bread, I’d rather kick them to the curb.

Unpleasantness

Someone who is unhappy, or seems disagreeable, or only focuses on problems is not someone I want to supervise.  I can just imagine them constantly darkening my doorstep with another imagined problem.

It’s difficult to spot problem faculty before they start.  Obviously, if you could do so, you wouldn’t hire them and there would never be any problem faculty ever.  In reality, that is not the case.  Every department has some members which are difficult for the supervisor, staff, and/or students.  If I can spot any of these characteristics during the application process, great, I know not to hire them.  But it’s hard to do.

Red Flags in Internship/Residency Applicants

I think it is surprisingly easy to get yourself flagged as “not rankable” for an internship or residency.  Most application evaluators maintain a “veto” system for applicants.  Any evaluator can veto any applicant for any reason.  Particularly for residents, NO ONE wants a resident whom one of the mentors does not want to work with.  So there are a lot of things that are interpreted as a red flag.

Unfortunately, those things are highly variable among evaluators, making it difficult to make generalizations.  I’ll touch on a few generalizations which I think most evaluators would consider a red flag, and then spend time on the ones I personally consider.  I think most evaluators would consider laziness, poor patient care, bad communication skills, incompetence, and lack of interest as red flags.  I will add (as always) arrogance and poor attitude as well as more than ONE PAGE on letters of intent for red flags I personally look out for.

Laziness

NO ONE wants an intern or resident who isn’t going to put the hours in.  You have to expect to do 12-16 hour days routinely as a house officer.  If, as a student, you are late to rounds and the first one out the door, your letters of recommendation will probably reflect that.  Step #1, as always, is to Show Up.

Poor Patient Care

If you don’t clean up your patients and let them sit in their own feces, if you don’t give medications on time or at all, if you don’t watch your patient but instead are on your phone, or if you give any indication you have no regard for your patients, people will not want you for a house officer.  This mostly comes out in the letters of recommendation.  So just… do your job.  You went to vet school to help animals, didn’t you?  So, HELP them!

Bad Communication Skills

You don’t need to be the best orator in the world but, if you’re routinely pissing off clients and staff, it will not reflect well in your letters of recommendation and you will get the axe from evaluators.  You have to at least have decent listening skills and the ability to share information about a case.

Incompetence

Obviously, no one wants a house officer who can’t do the job.  Unfortunately for foreign graduates, many evaluators assume the training they received is not up to US standards (and, many times, they are correct).  I have worked with several house officers with no US/Commonwealth veterinary experience and they struggled.  It’s just a different level of expectation for veterinary care in the US/Commonwealth.  If you’re a US graduate and your letters indicate you don’t do a good job, you will not get ranked.

Lack of Interest

If you apply to an anesthesia residency and your letter of intent indicates you want to do dermatology, you will not get ranked.  It seems simple, but I have seen several applications which I read and thought, “Why in the world are you applying for this position?”  Obviously, you have to want to do the job to get the job.

Arrogance

I believe humility is essential to effective learning.  If you can’t admit that you don’t know something, or when you made a mistake, how will you learn?  I can’t fix a personality flaw like this- I’m not your psychologist.  If I get any sense of arrogance from an applicant, I cut them from consideration.

Poor Attitude

Frankly, I want to work with people who are happy coming to work.  Sad sacks, constantly negative people, people who only complain or focus on the problem rather than the solution- all of these are no fun for me to work with.  People also need to have a growth mindset if they are going to learn during a training program.  If I get a sense that they are unpleasant to work with, I don’t want to work with them.

ONE PAGE

It’s right there in the title.  A letter of intent must be one page.  If you cannot articulate yourself in that space, you do not understand the social norms of this profession.  I don’t have time to read multi-page letters of intent from 100+ applicants.  ONE PAGE.

There are certainly many red flags that others may have.  What are some you are concerned about?

Red Flags in Vet School Applicants

In my opinion, there aren’t many reasons that applicants are flagged as not acceptable for entry into vet school.  In the application, the three I can think of are academics, experience, and ethics.  In the interview, the two I can think of are cluelessness and obnoxiousness.  Let’s break each one down.

Academics

“The art and science of medicine.”  This phrase is often used to describe the fact that science is a foundation for medicine, but there is personal style and approach which also makes it an art form.  For better or worse, you need to learn a LOT of information during vet school.  Some people are not academically inclined.  That doesn’t mean they’re not smart or not valuable people.  Maybe they didn’t have a family which gave them books growing up, or maybe they were never taught how to study effectively.  

Regardless, you need to be academically competent to get through vet school and be a competent veterinarian.  No one wants the vet who prescribes Temaril-P and deracoxib together (true story: I’ve seen at least three dogs with GI perforations due to this combination prescribed by licensed DVMs).  So if an applicant doesn’t have strong academics, they’re going to have a harder time getting in and- more importantly- progressing successfully through vet school.  No school wants to admit a student only to have them fail out.  Some people are just not able to become a veterinarian, and that’s OK.

A single “F” grade is not enough to indicate an academic problem, nor is a single  “W”.  I would say an applicant routinely taking <12 credits a semester (unless they have a good reason, such as working full time), an applicant who only ever takes one science class a semester, an applicant who only earns “C”s in science classes, or an applicant with an overall low GPA would be a red flag.  Vet school semesters are usually 18-22 credits and are almost ALL science courses.  If an applicant hasn’t demonstrated they can handle that load, that’s a little problematic.  If an applicant has a string of “F” or “W” grades without a good reason (e.g. personal illness), that’s also problematic.

Experience

If you don’t know what a veterinarian does, how can you possibly make an informed decision to go to vet school?  Applicants don’t necessarily need thousands of hours of experience, but they absolutely must have spent SOME decent amount of time with a veterinarian.  I have seen applications with zero veterinary experience and we did not admit those people.  You have to have some idea of what you’re getting into.

Ethics

Applicants with felony convictions, letters of recommendation which indicate they did the Wrong Thing, or a contradiction between what the applicant says and what is in their official materials are all serious problems.  Medicine requires a high ethical standard.  No school wants to accept someone who has questionable ethics.

Cluelessness

I’ve only had one interviewee about whom I wondered how in the world they got an interview, because they seemed to have no idea what veterinary medicine was.  This is mostly tied in with Experience, above.  If you’ve spent time with a vet, researched questions for an interview, and have an idea of the profession outside of taking care of individual patients, you will do fine in the interview.  If you don’t know that vet school is 4 years long, or that vets learn about pharmacology, or that vets do research and military work and food safety, you’re probably not going to do well in the interview.  Do your interview prep work and you’ll be fine.

Obnoxiousness

This one is HIGHLY variable among evaluators.  As I mentioned in the intro to this series, I have seen applicants I would never have admitted be ranked quite highly by other evaluators.  But everyone has their “thing” that bugs them about applicants.  Mine is arrogance.  I am a big fan of humility, so any sense of arrogance I get from someone puts them immediately in the bottom of the barrel.  For other evaluators, maybe they are irritated by lack of confidence or obsequiousness or brashness.  There’s not a lot you can do about this as an applicant, other than being an RFHB.

Those are the red flags I can think of.  Other evaluators may have different ones, but I think these are the major categories most of us would agree on.  Are there any elements of your application you are worried will be a red flag?