Podcast #39

Dr. Yu Wern joined us today to discuss his experiences through his internship as well as his experiences starting off in the veterinary profession and transitioning from his emergency internship to his general practice job.
Dr. Yu Wern’s Background:
Dr. Yu Wern graduated vet school in 2016 in the UK, and started his internship with AAE in Melbourne 6 months after graduation. He is now working for a PetStock clinic in Melbourne. He is enjoying general practice!
What made you decide to do an internship?:
lego EMT with lego Ambulance
Feeling comfortable with emergencies, and feeling that you are providing your patients with the care they deserve and need, is a huge motivator for some to pursue emergency internships.
“I did spend 5 months back home in Malaysia in a small animal hospital… I think the plan was always to practice somewhere with higher animal welfare standards compared to Malaysia.” Dr. Yu Wern, having trained in the UK, had a hard time working in Malaysia because veterinary medicine there is mainly treating neglected animals and not really working up or doing diagnostics on any cases. Dr. Yu Wern felt that he wasn’t using his skills and wasn’t treating his patients to his desired level, and therefore the plan was to go somewhere with higher standards.

“Emergency had been something I was never comfortable with… so that was the main reason I wanted to do it because I felt bad because I wasn’t comfortable dealing with emergencies. I made an effort to get to a stage where I knew what to do. It was a scary thought that I was a vet now but didn’t know how to deal with an animal that was hit by a car.” Dr. Yu Wern’s main driving force was to be able to provide the care he felt he owed to the animals.
What were your expectations for an internship?
Dr. Yu Wern applied for a bunch of jobs and since it was a bit difficult for him to come from Malaysia to Australia, he took the job that would provide him the best ability to improve his emergency care, and the job he could get being an international applicant.

“It was definitely advertised as a proper internship where you get specialist guidance and supervision… but it didn’t happen.” Dr. Yu Wern knew it was going to be hard, and knew it would be a lot of work, but he just wanted to get hands on learning to become a better vet. “I went into internship prepared to do anything, and I didn’t really plan what I wanted to get out of it, I just wanted to get thrown into the deep end and grow from the bottom up.” Overall he enjoyed the internship and felt it was a good experience, even though the experience wasn’t really as advertised. His goals of being a better vet, and becoming more experienced and comfortable with emergencies were met.
What were your biggest challenges?:
rock climber on side of mountain
As new graduates, or vets changing roles or positions, we all have mountains to climb. For some that will be technical skills, some it will be knowledge, and for some it will be client communication. The more you work at it however, the better you will get!
Dr. Yu Wern talks about client communications and not knowing the answer the right away as his biggest challenges, especially as a new graduate. He shares his feelings that the owner spending their money on the tests that he has recommended was a big challenge, because he felt he should know the answer right away. He had the definition of Imposter Syndrome. The balance between treating animals and not missing something, all while taking finances into account, is a challenge we all face. Dr. Yu Wern feels that this is something that he has learned and improved on, but it is still a struggle. “Trying to convince myself that is the right thing to do and relaying that to the owners,” is how Dr. Yu Wern feels when he KNOWS that the vomiting dog should have x-rays to check for a foreign body, even though it most likely is a gastro. It can be very hard to have that confidence to say “I don’t know” and Dr. Yu Wern shares that clients “can tell if you’re not confident with what you’re saying. They will attack you. They will try to make you feel bad.”

This is such a big challenge for new graduates, because not only are they working through cases for the first time, and trying to make the best clinical decision for the animals, they have the financial component on top of this, as well as then having to display 100% confidence to the clients. It’s not an easy job for anyone, and a huge learning curve for new grads!
Do you feel more confident now with 2 years experience?:
KICK ASS VETS has the experience to know that you need the test, and that tests will surprise you often enough that we are now confident recommending tests. Dr. Yu Wern feels that he is getting better at recommending tests he knows he needs, and has also learned the value of the test. He also shares that he knows that as long as he has recommended the test that the owners cannot come back on him later if the case goes poorly when diagnostics were declined. This legal aspect of ‘covering your ass' is unfortunately important in the veterinary world.

Dr. Yu Wern shares “a lot of it is experience. Different body language, are they the type of clients that will be tricky?… It’s going through and seeing different people and how they react.”
Would you recommend an internship?:
“Ya, 100%.” Dr. Yu Wern said that his expectations were different than most, it was personal and about professional growth and comfort instead of getting a certificate. He feels that if you are uncomfortable, if you can put yourself in that situation over and over, then you will improve. Dr. Yu Wern is now excited when emergencies come in, instead of feeling overwhelmed and underprepared. “It makes it a lot easier when you have a good team behind you” and when you finish it you feel like you’ve learned a lot.

Dr. Yu Wern admits that he was promised three months no sole charge with shadowing, and his 5th shift he was sole charge and had 3x ivermectin toxicities come in at once, and that was stressful. But despite this experience he still recommends it, because it made him a better vet and he feels he can provide a better service for his patients. He is glad he did the emergency before going into first opinion, because he feels he would otherwise have picked up a lot of bad habits at first opinion.
How was the transition from emergency to GP?:
Dr. Yu Wern admits that by the end of the internship he was fed up with it, and was looking forward to a bit of a change in personal life. He felt that everything was a lot more efficient in emergency, and that the pace of work is much slower in GP. He shares that it took him a while to get used to the slower pace, and he would initially become frustrated with nurses that were playing with the patients instead of just getting the work done. He has now become more accustomed to the GP pace and life, and is enjoying it!
Are you happy in your General Practice job?
Dr. Yu Wern shares that he is enjoying that he is doing more surgeries. He has a good team, and a boss that is “super chill” that allows Dr. Yu Wern to do his own thing but will help if he needs it. Dr. Yu Wern also shared that he still feels that he is lacking in his x-ray ability, so to improve this every anaesthetized patient is getting x-rays so they can learn and read many more x-rays, and see more survey x-rays. This is a great supportive boss that is putting effort into learning. Dr. Yu Wern also feels that he can really TRUST his boss.

When asked about how he arranged this ‘x-ray situation’ with his boss, Dr. Yu Wern says that his boss is really just easy to talk to, and is maybe a bit too relaxed, and between the two of them they often give clients discounts, do things for free, etc. For Dr. Yu Wern approaching his boss hasn’t been an issue, but he does understand that “at the end of the day it is a business, and if you don’t make money you won’t be there.” One way that Dr. Yu Wern’s boss has created this environment of trust, and continued learning, is with monthly informal ‘check-ins.’ These ‘check-ins’ involve discussing how the past month has gone, how professional development goals are being met, and what can be done to accomplish and address any other professional goals. These informal check-ins have been great for Dr. Yu Wern and have led to coming up with creative solutions to better patient care and professional growth.
If you are struggling with reading x-rays and don’t have a support network, firstly you can contact local surgeons who often will be helpful, or local emergency centres, but if that isn’t an option you can join the group “Radiology Rounds” on Facebook. This is a closed group of vets that post images and help each other out in an informal way. Since it has multinational members, at any time of day you likely will get a response. It’s like VIN, but without the specialists and free.
Dr. Yu Wern’s Raise:
coins and money bills
Getting paid what you are worth is important, and you won’t get a raise 99% of the time if you don’t ask! If you feel you need a raise, figure out the number you want, and just ASK!
Dr. Yu Wern shared that he did ask for a raise! It was a very informal conversation with his manager when they were discussing a different aspect of the clinic, and she asked Dr. Yu Wern if there was anything else he wanted to discuss and he said “oh ya, can I have a raise please?”

The manager said “OK, how much are you looking at?” Dr. Yu Wern had an amount prepared, which was a 30% raise. He didn’t even have to justify it, and he also asked for access to VIN and CE allowance, and he got all three without a fight. “So either I was being severely underpaid for the past 2 years or just [needed to] ask”… “if the company feels that you are worth it they will pay you… Otherwise if they aren’t in a position to pay you and you need that money there is always somewhere else you can go.”

Dr. Yu Wern shares that he was so happy after getting the raise, and wished he did it 6 months prior.
JUST ASK FOR A RAISE! Your boss likely isn’t even thinking about your salary, and doesn’t give it a second though, if you don’t ask for a raise then you are very unlikely to get one. The worst they can say is ‘no’.
Are you feeling stagnant?:
Dr. Yu Wern feels that since his clinic is so small, and so new, and even though they are growing super quickly, and it is a nice environment, but in terms of learning there is still a lot that he wants to do! Sometimes he feels that his day-to-day job is boring, but then there are days where he feels that he is not ‘good enough’ to service the animal, especially when the cases are very hard and would benefit from referral.

Dr. Yu Wern shares a story about a dog that had an osteosarcoma and had an amputation with his clinic, because the owner couldn’t afford referral to a surgical specialist. Unfortunately the dog died at the emergency clinic after suddenly seizing overnight. Dr. Yu Wern felt that had he done the surgery, he would have felt guilty, even if he knew it wasn’t anyone’s fault. Morbidity and Mortailty rounds can be very good for these cases, and for learning potential. Especially if you are working for a bigger company that has multiple clinics in one area, create a collective of clinics and each month have a different clinic present a case. KICK ASS VETS feels this is an under-utilized tool that larger companies have at their disposal.
How do you feel about not charging for services?:
Dr. Yu Wern admits that neither he, nor his boss, are very good about ensuring they are charging appropriately. “It’s good for the dog” is Dr. Yu Wern’s justification. He also admits that it is sometimes easier to just do it and not charge for it than fight with clients, and that clients are usually appreciative. He shares that he is getting a lot better, and he used to under-estimate and do things without charging much more frequently, however, he does share that he is better than his boss! Managers need to understand that creating consistency and having a set charging protocol for the clinic is important, because how is an associate supposed to charge appropriately if the boss isn’t, or if there is no clear direction?? KICK ASS VETS feels that it is very important for vets to value themselves and value their time, but it is hard to ensure you are doing this day-in, day-out. Dr. Yu Wern admits again that he uses the exuse “as a learning case” maybe too often.

Knowing how to charge appropriately is difficult! Clinics set charges and fees so that their costs are covered, and it is up to the vets to charge appropriately to hold up their end of the bargain. It is very difficult however, especially for locums, when clinics don’t have a clear protocol or fee structure.

KICK ASS VETS discusses the problem that if we aren’t charging properly than we are devaluing ourselves to clients, and devaluing veterinary service for the entire field. Also, when you don’t charge everyone appropriately, the clinic will have to increase all of its fees to get the money it needs to remain open. This means that those individuals that are being charged appropriately might be compensating for the ‘sneaky ultrasound’ you are doing. It’s more fair to just charge everyone appropriately.

Dr. Yu Wern discusses that the hardest part is when you are mid-procedure and something unexpected comes up, for example needing a dental extraction you didn’t expect. Do you just do the procedure and don’t charge? Do you not do the procedure and put the animal through a second anaesthetic? What about consent? What about what’s best for the animal?

KICK ASS VETS understands that sometimes things come up that are unexpected and you have to go ahead without consent or discussion of finances to save the animal.

A recent case example is a seizing snail bait toxicity that aspirated and needed a bronchoscope to immediately to get the chunks of kibble out of it’s airway so it didn’t die. There was no time to call the owner, seconds mattered in that animal's life, and it did live! It went home that night happy as a clam... and the amazing vet that I saw save this animal's life, who acted in milliseconds to get an airway, felt that she shouldn't charge the owner the ~1000$ that a scope costs, because she 'let it happen', and because she 'didn't prepare the owners for this specific possiblity.' She saved the animal, from part of the disease condition that it presented with... she should be paid for her actions!... but we digress...

However, as best as all possible, we need to to be getting consent, and preparing for possible outcomes and discussing these clients, prior to procedures. Not only to ensure we are then estimating and charging appropriately, but legally getting consent is vital. What if that extraction led to a broken jaw?? Get consent!
Dr. Yu Wern’s General Advice for New Grads:
1. Get a bunch of good friends and make sure you have support inside and outside work.

2. Find a place where the boss is supportive and even if you make mistakes they will have your back.

3. You will make mistakes, don’t get too bogged down by your mistakes- it’s when you learn the most.

4. Prioritize the animal’s welfare, and if you do that first you will never make too big of a mistake because that will make you careful and vigilant. Try your best and the rest will work out eventually.

5. “Whatever you learn in uni, it’s good, but you do need to understand what the owners are going through, I feel if you get down to their level and match their energy it helps.” When discussing arthritis for example you can compare it to a family member. “When the weather gets cold grandma gets cold, she starts complaining and doesn’t want to go anywhere, that’s how your dog feels”. Connecting with the clients in a way that you can get the owners to understand what the animals are feeling makes things a lot easier.

Dr. Yu Wern wishes he could tell himself from 3 years ago to “Believe in myself and not be such a push-over.”

Thank you so much Dr. Yu Wern for joining us, sharing your experiences and advice!
If you have a story, or an experience you would like to share, whether you LOVE your job, or if you HATE your job, or if you have pursued a different career path such as specializing, industry, government, technology, etc. please Contact Us to arrange an interview! The more we share our experiences good and bad, the more we can help each-other that are going through the same experiences and feelings!
Written by Dr. Ann Herbst BSc, DVM

Published August 9th, 2020

Advocate for yourself, you are the only one that will!

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