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?

Red Flags Series

I’ve written a lot about what evaluators look for in candidates and what I look for in particular.  Some people have asked me what I see as a red flag- an indication in an application or during an interview that I would definitely not want this person to move into the position.

I think these differ among evaluators pretty substantially.  There are some people who have gotten residencies about whom I think, “Really?  This person?”  But obviously the ones making the decisions thought they were a good candidate when I did not.

I will try to make it clear for red flags that I think MOST people would find problematic and ones which I personally would find problematic.  I’ll divide these into applicants for vet school, internship/residency, and faculty positions over the next two weeks. 

I’ve also added red flags to look for when you are evaluating positions. I’ve divided these into vet school, internship, residency, and faculty positions. Enjoy!

One Year of COVID-19

I feel like everyone is posting retrospectives.  I don’t usually hop on the bandwagon, but I think there are a few things worthy of reflection in the domain of veterinary academia in the time of the pandemic.  Here are my observations, some of them unique and some of them well-documented.

  1. I write when I travel.  I realized that my blog’s ready-to-post file got smaller and smaller and wasn’t being replenished as quickly as usual.  This is because, apparently, I do most of my blog writing when I travel.  With no travel, I had to force myself to write Sunday mornings to keep up with the blog.  I hope the quality of the posts has maintained in spite of not having the ‘protected’ writing space while I wait in airports.
  2. Veterinary medicine is booming.  Maybe it’s because people were sitting at home staring at their animals and thinking, “Have you always done that?  Is that normal?”  Maybe it’s because pets have become even more of a social support as we have stayed at home.  Every vet office I know of is flooded with work, and graduates are getting snatched up for jobs.  Specialists have always been in demand, but that’s even more true than usual.  It’s a good time to be finishing a program.  Is it a good time to be starting?  Impossible to know what the future holds.
  3. Applicants have increased.  The number of applicants to vet school increased notably this year, and of course that increases the competitive pressure because the number of seats hasn’t necessarily increased.  However, there are more schools that have come onboard in the past 5 years.  Unfortunately, most of them are expensive private schools.  Your best bet is still to wait to get into an inexpensive school if you are looking at attending vet school.
  4. The more things change…  Although we are all doing online learning and have gotten more competent at the necessary technology, I doubt it will lead to truly lasting change in veterinary medicine.  Do we really need to maintain 38 schools of veterinary medicine in the US and Canada?  Why do we need all this physical space if students can just be at home and a professor could teach a thousand- or ten thousand- students simultaneously?  There are some real opportunities here, but I don’t see them developing.  The institutions are too entrenched in their existing models to make that kind of sea change.
  5. The stress is real.  Even though veterinary business is good, people are getting jobs, students are getting educated…  everything’s still stressful.  I get freaked out when I do my once-a-week shopping trip and someone isn’t wearing a mask in Kroger.  I miss seeing my friends and traveling.  I am, ultimately, very happy and have an awesome life.  But just because you’re happy doesn’t mean there’s not a goddamn pandemic going on which is making everything harder.

What have you learned about yourself due to the pandemic?

Can You Do Anything You Want?

Photo by Greg Rakozy on Unsplash

I was having lunch with a colleague of mine a while ago and we were discussing vet students.  They were lamenting about one student who was really struggling.  They said, “We need to stop telling kids they can be anything they want to be.  Some are just not smart enough to get through vet school.”  I mostly agree with the sentiment, but there’s some nuance here we should unpack.

First, I don’t want to get into a lengthy discussion about nature vs. nurture.  Suffice to say that there may be some traits with which we are born which will make it harder (but not impossible) to achieve certain life goals.  I am reminded of a friend of mine who LOVES football.  One night he said to me, “Have you ever thought about doing a walk-on tryout?  I would love to be your size.  I bet you could get some position on a team.”  Now, I have 12 years of higher education in my brain.  I need my hands for highly technical work.  I don’t want my brain rattled around or my hands injured.  So of course I didn’t try out.  But this friend of mine clearly lamented that he wasn’t big enough to play professional football.  Similarly, at 6’6” tall, I’m never going to be a gymnast.  There are some things people can or can’t do based on their genetics.

Now that that’s out of the way, CAN you do anything you want?  I see this message dozens of times a month in various pre-vetmed groups.  Many people cheering each other on and saying, “You can do it!”  On many levels, I think this is great.  More positivity is needed in the world.  But I also think it may be doing a disservice to some people.

If you struggle with academics, is being a veterinarian really the best fit for you?  Doctorate-level professionals learn a lot of material.  Is it fair for you to get into vet school, struggle, and have to drop out in your third or fourth year?  Wouldn’t it be better to realize that before the expense and years of lost time?  Maybe you would be better suited to being a veterinary technician.  There is a horrible shortage of technicians in the US.  You get to help animals, you work a lot more directly with the animals, and it doesn’t require as long or as expensive of schooling.  If you struggle with academics, there are other routes to happiness.

If you struggle with motivation and showing up, it’s going to be difficult to get hours of veterinary and animal contact time for your application.  Is being a veterinarian the best fit for you?  Veterinarians are professionals; they are leaders.  You can’t phone it in during vet school and expect to pass.  The students I have seen who end up failing out during their senior year of vet school aren’t necessarily the ones who struggled with academics (although that often plays a part).  They’re the ones who are late to rounds, who don’t help their classmates, and who don’t take care of their patients.  I always feel terrible for those students.  I think, “Someone should have told you before you spent 3.5 years of your life and untold thousands of dollars that being a veterinarian is not for you.”

If all you’re focused on is the Next Step, or that ONE single goal, or believe you will FINALLY be happy once you get this ONE THING, I don’t think you will be.  I had one student tell me, “I don’t really care about this topic, I just want to be done.”  I can understand that sentiment- it’s a lot of school and some people don’t care for school.  But you’re learning what you need to be a veterinarian!  Isn’t that the most amazing thing?  What do you plan to do when you have a patient who comes to you and the client expects that you learned how to be a veterinarian but… you didn’t.  You just got the degree and ran.  No one outcome is going to solve your problems.  No one thing is going to make you happy.  I believe only focusing on the outcome, and not the process, will lead to chronic unhappiness.  The solution isn’t “Getting into vet school” or “Getting into a zoo med residency.”  The solution is to find contentment and happiness where and when you can.

I’m not saying you shouldn’t try hard.  I’m not saying you should let failure get you down or that you should stop working if you don’t succeed.  I am saying you should be realistic and honest with yourself.  If you do an internship, then a surgery internship, then another surgery internship, then ANOTHER surgery internship…  are you ever really going to get a residency?  Maybe after not getting the residency the first time you should look at other specialties which may be fulfilling.  Heck, I did and I have an incredible life!

Can you get any professional position you want to?  I don’t think so.  Too many things are outside your circle of control.  Can you find happiness and fulfillment and create a good life for yourself?  Abso-freaking-lutely.  Don’t get so focused on a single goal that you lose sight of what would really make you happy and what you can really accomplish.  It’s good to be driven.  It’s good to want something more.  But you HAVE to be honest with yourself, or I believe you WON’T be happy even if you achieve that goal.

Handling Conflicts with Mentors

What do you do if you have a conflict with a mentor or supervisor?  Veterinary medicine is such a small field, you can’t afford to upset anyone.  Also, conflict is unpleasant.  Also also, you can learn something about yourself and grow as a human being.  So, you have a problem with one of your mentors.  Now what?

  1. Reflect on your feelings.  What are you upset or frustrated about?  Why are you upset?  What led to your feelings?  Could you be the problem?  “If you meet one jerk, maybe they’re the jerk.  If you meet five jerks, maybe you’re the jerk.”
  2. Find an opportunity to casually speak to them.  I think the best time is when they are alone in their office and you can drop by.  Ask, “Do you have time to talk?”  Once they give permission, you can have a seat and open with, “I’d like to talk about how I’ve been feeling lately.”
  3. Phrase things in an “I feel” way and ask questions to seek understanding.  “I feel like I haven’t been getting the direction I’d like from you,”  “I feel bad when you put me down in front of the students,”  “I feel that I have a hard time bringing things to you.”  Try not to externalize or assume their own motivations or behavior.  Don’t say “You don’t teach me”, “You make fun of me”, “You don’t listen to me.”  Seek understanding.  “I was wondering what your preferred approach is to teaching me,” “How do you think I feel when you call me out in front of the students,” “How do you want me to bring issues to you.”
  4. Remain calm.  If you feel like you can’t remain calm OR can’t approach this individual, you may speak first to a mentor you have a closer relationship with or the program director.  DO NOT go to the person’s supervisor (e.g. department head) unless there is a serious grievance (e.g. harassment, abuse).
  5. Consider involving an ombudsman.  These people are trained in conflict management.  I would probably pursue this path if you have an initial chat with the mentor and it doesn’t go well.  I would suggest something like, “Would you be willing to meet with me and an ombudsman to discuss things?”
  6. If you don’t get anywhere with reasoned, calm discussions where you are talking about your feelings and asking questions, definitely approach other mentors or the program supervisor.  DON’T make yourself alone or isolated.  Unless you are the problem (see #1), there’s certainly someone who is able and willing to help you.

I had a conflict with one of my mentors during my residency where I felt like I couldn’t talk to them about some things.  I felt intimidated about speaking to them and so talked to a different mentor.  The person with whom I had a conflict found out and was subsequently even more upset.  So I learned then: the first step is to sit down and talk.  Assume the mentor’s an RFHB.  If they’re a narcissistic sociopath, keep your head down and just Get Through It.  I’ve had to do that, too, and it’s no fun.  Fortunately, in veterinary medicine, you generally have plenty of professional opportunities.  Don’t stay long-term in a terrible situation.