Crisis in the veterinary profession

RE: Crisis in the veterinary profession

jenni99 — Fri, 01 Oct 2021 11:50:06 GMT

[quote userid="2240" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177358#177358"]if it isn't bleeding out, pegging out or has something about to drop off I don't want to see it and if its not one of ours, if they cant support us in the good times they shouldn't expect us to support them in the bad times [/quote]

That made me giggle Sal :)

This is precisely the reason our branches put the answer phones on and shut the doors at lunch time at weekends now !! We are open (being traditionally a large animal practice & doing our own OOHs) but we were being overwhelmed with clients from other practices who couldn't / wouldn't travel to the OOHs providers used by their surgery (and to be fair one OOH place is 50 minutes by car, and is not the cheapest. Our biggest branch is on the edge of a very deprived area and we have no PDSA etc here

RE: Crisis in the veterinary profession

James Colver Cert. Ed, RVN — Fri, 01 Oct 2021 07:55:39 GMT

Aye the problems were festering since long before, which from the point of view of our profession made the Brexit vote even more absurd. I know so many EU vets who would fill odd gaps in the ECC rota, or some would come over every so often for a week or so to work and then return home. They will not come now. Their absence has made a huge difference in our ability to staff the service, similar I guess to how it is with the lorry drivers.

And still there are people who try to convince us that the current shortage of goods and people has nothing to do with the recent vote to end the free movement of goods and people. You couldn’t make it up :) I’m sorry but after all that happened, I strongly feel that those who asked for this need to start owning it - not that it’s any help now.

RE: Crisis in the veterinary profession

Sal the 1st — Fri, 01 Oct 2021 06:41:32 GMT

Brexit cannot be blamed for everything . The wheels were coming off the bus long before Brexit,

RE: Crisis in the veterinary profession

James Colver Cert. Ed, RVN — Fri, 01 Oct 2021 05:27:45 GMT

Yes! All of the things we said would happen before the ridiculous Brexit debacle that were dismissed as 'project fear' are coming true, and some. I remember arguing the points on here and feeling like I was banging my head against a wall, and now, here we are - the EU vets that helped massively to make up the shortfall have upped and left, exactly as expected.

RE: Crisis in the veterinary profession

Sal the 1st — Mon, 06 Sep 2021 20:09:37 GMT

[quote userid="29948" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177353#177353"]So what do you guys think? Did I do the right thing? I feel people like that should not get special treatment if they do not belong to our practice. Loyal clients with proper emergencies should be seen first. Hopefully, this will deter the husky owner from seeing us again and actually go to their own [/quote]

I think you did well. When I did ooh phones my instructions from boss were 'if it isn't bleeding out, pegging out or has something about to drop off I don't want to see it and if its not one of ours, if they cant support us in the good times they shouldn't expect us to support them in the bad times ( I thought it was best for everybody that he never took the initial call - the boss could be a grumpy old sod even on a good day)

RE: Crisis in the veterinary profession

Alison Clare Hickman — Mon, 06 Sep 2021 13:57:20 GMT

I think you handled the situation in an EXEMPLARY manner!

RE: Crisis in the veterinary profession

Chris Peters — Mon, 06 Sep 2021 13:23:33 GMT

So I had the joys of working over the weekend, being in charge of the OOHs phone. I had one person call saying that potentially their Husky had eaten a safety pin from a new shirt and that shirt got dragged into the garden so it was highly likely that the safety pin was still in the garden. This owner was not registered with us and was only coming to us because we were closer and use us only for the OOH service (warned owner she will get charged more because she is not our client). Because of the possible danger, I accepted for it to be examined. However, just after that call, I got a call from an ACTUAL client which the owner thought their cat may have a blocked bladder (turn out it very much did and was in a very bad state)

The owner of the Husky came to the practice, and I told her that she would have to wait as an actual client would need to be seen first as they were loyal to us and their cat was in a bad way. She wasn't exactly thrilled by this but went to her own OOH practice to be seen.

So what do you guys think? Did I do the right thing? I feel people like that should not get special treatment if they do not belong to our practice. Loyal clients with proper emergencies should be seen first. Hopefully, this will deter the husky owner from seeing us again and actually go to their own OOHs!

RE: Crisis in the veterinary profession

Sal the 1st — Sun, 05 Sep 2021 20:28:48 GMT

[quote userid="30516" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177351#177351"]Some people in genuine need would hang up[/quote]

There is always that risk . I worked for one vet who hardly ever got called ooh because if we had a client that used to call us a lot ooh for no good reason a) they paid through the nose for it and tended to to start being sensible on cost alone (genuine cases never got a pita surcharge) and b)a word in their shell likes by the boss suggesting if they cried wolf too many times people would have a tendency not to believe them when they really needed to

RE: Crisis in the veterinary profession

jenni99 — Sun, 05 Sep 2021 20:15:09 GMT

Sorry, I have a pay as you go phone, I work at a Mixed practice, Some people in genuine need would hang up

RE: Crisis in the veterinary profession

Arlo Guthrie — Fri, 03 Sep 2021 08:20:08 GMT

[quote userid="14162" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177348#177348"]I think Brexit hasn’t helped. We had two European vets leave - I’ve heard of more going. I know that doesn’t make it a fact, I just think it has contributed. That aspect was not so well planned and prepared.[/quote]

I'm sure you're right about it being a contributory factor.

[quote userid="14162" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177348#177348"]I worry that without OOH provision - or any kind of “go here for help” direction from the owner’s vet practice, we run the risk of being like the US, where the nearest OOH provision is miles away, and (some) owners delay seeking treatment. I worry about the opposite effect- less time wasting, idle call ins, and instead animals arriving the next day in a worse shape. [/quote]

Meant to reply yesterday, but got tied up announcing the results of my OOH survey:

And that survey is the point really. How does the profession, which is positively creaking under the pressure at the moment, meet the demands of an ever more demanding society? Some way needs to be found to reduce the unnecessary calls, whilst still meeting the needs of the genuine emergencies.

RE: Crisis in the veterinary profession

starla — Thu, 02 Sep 2021 09:19:00 GMT

I think Brexit hasn’t helped. We had two European vets leave - I’ve heard of more going. I know that doesn’t make it a fact, I just think it has contributed. That aspect was not so well planned and prepared.

The pandemic, quantity of animals being bred, irresponsibility, and people’s inability to consider the implications of animal ownership also, of course, massively play into it.

I worry that without OOH provision - or any kind of “go here for help” direction from the owner’s vet practice, we run the risk of being like the US, where the nearest OOH provision is miles away, and (some) owners delay seeking treatment. I worry about the opposite effect- less time wasting, idle call ins, and instead animals arriving the next day in a worse shape.

RE: Crisis in the veterinary profession

Arlo Guthrie — Thu, 02 Sep 2021 08:35:36 GMT

[quote userid="2240" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177331#177331"]my solution would be triage appointments - client would pay for triage appointment if they were insistent their pet was seen ooh[/quote]

Interesting thought. I've often thought veterinary OOH telephone lines should be premium rate. About £1,000 per minute. That would focus minds.

Joking aside, £5 a minute would mean at least a £25 charge, and that would make people think twice.

Actually, maybe that is the answer to a lot of this. All OOH lines to be met with a recorded message: This is an out-of-hours emergency service charged at £5 per minute. If your call is not a genuine emergency, you should hang up now.

One of the other problems is that medical professionals often give very cautious advice over the telephone. The risk if they get it wrong (of irate client) is too great, in this slag-your-vet-off-on-social-medja age we now live in.

[quote userid="14162" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177344#177344"]There’s no way the required OOH should be removed. If OOH isn’t in place then some owners won’t bother[/quote]

starla I'm not saying remove OOH, just don't require all practices to provide it. People would still go to their local vets now. But there would be more onus on the owner to make their OOH provision, and that might make it less likely they would use it for trivial matters.

[quote userid="14162" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177344#177344"]We were warned we’d find vacancies in many sectors post Brexit. I’m afraid I find it very frustrating as there was time to prepare.[/quote]

I'm not sure Brexit is the issue here, or even the biggest one. People have bought 3.2 million dogs during lockdown. That's staggering. Where did all these dogs come from. And what is going to become of them when people don't want their lockdown distraction any more. That's by the by. Point is that Brexit or no Brexit, there aren't enough vets to deal with that sudden increase, and I am not sure anyone could have prepared for that. I mean none of us saw the pandemic coming.

[quote userid="2368" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177346#177346"]Then the small animal clients phoning to make an appointment at midnight, wanting to order meds at 10pm getting hacked off when i explained sorry i dont have access to the computer system at the moment can they phone in the morning.[/quote]

I've heard so many OOH stories over the last few days that just beggar belief. I mean you must have the IQ of a stick of celery to think it is OK to ring at 10:00pm and ask for a wormer.

RE: Crisis in the veterinary profession

Selena Carnell — Wed, 01 Sep 2021 21:56:39 GMT

i used to take the OOH phones back in 2001 for the Equine, Farm and small animal practices. The farmers always knew when it was a true emergency and knew what they wanted. The Equine clients were always a bit more demanding but generally a genuine emergency, the occasional few would have a paddy if their requested vet wasn't available! (can't you call him he won't mind he knows me... sorry love more than my life it worth!!) Then the small animal clients phoning to make an appointment at midnight, wanting to order meds at 10pm getting hacked off when i explained sorry i dont have access to the computer system at the moment can they phone in the morning. I would be the sole nurse on duty over the weekend. Occasionally we would get clients turn up at the door with their animal.. and one i will never forget.. i was quietly sorting a cat in the cattery (which had large windows) it was pitch black outside... someone then knocked on the window loudly sticking their head up saying we've found a hedgehog... how i didn't have a heart attack i will never know, i honestly nearly pooped myself! the clients were quite sorry after they realised just how much they had scared me... considering it was the back window to the practice!!

RE: Crisis in the veterinary profession

starla — Wed, 01 Sep 2021 21:10:04 GMT

There’s no way the required OOH should be removed. If OOH isn’t in place then some owners won’t bother “the vet is shut, I can’t do more” , or use it as an excuse to wait until another day. Often at great expense of the animal.

I appreciate the issues. We were warned we’d find vacancies in many sectors post Brexit. I’m afraid I find it very frustrating as there was time to prepare.

RE: Crisis in the veterinary profession

Sal the 1st — Wed, 25 Aug 2021 20:21:03 GMT

my solution would be triage appointments - client would pay for triage appointment if they were insistent their pet was seen ooh, if an emergency then 'pass go and collect £200' if not then given an appointment for the next day within normal working hours. After paying for a few triage appointments and not getting treatment or what they wanted because its not an emergency then the message should gradually filter through.

RE: Crisis in the veterinary profession

Arlo Guthrie — Tue, 24 Aug 2021 17:32:11 GMT

[quote userid="35454" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177328#177328"]As a veterinary nurse who has been working OOH night shifts solely for the last 7months I wanted to add my input to this.[/quote]

Thank you rgreeny what a great, thoughtful post.

[quote userid="35454" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177328#177328"]Secondly a lot of the calls I get on nights are NOT EMERGENCIES.[/quote]

Which is anecdotally what I hear, but need to quantify, hence the survey I am running now.

[quote userid="35454" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177328#177328"]Now here's something I believe has been introduced to aid OOH providers but in my opinion does the opposite (sorry). The video vet consultation. Increasingly more owners are contacting video vets before ourselves and of course the advice from those vets is often that they should come into practice.[/quote]

I hadn't thought of that. Of course it kinds of stands to reason that a video consultation would err on the side of caution: see your vet. It is one of the reasons why I firmly believe that video consultations should be restricted to be offered only by practices to their clients.

[quote userid="35454" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177328#177328"]I am still recovering from one of the most abusive phone calls I received from an owner in my 8 year career the other night.[/quote]

Sounds AWFUL. It beggars belief that these sorts of people exist!

[quote userid="35454" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177329#177329"]Owner awareness would be hugely beneficial,[/quote]

Something you wrote earlier struck a chord. About A&E. Perhaps there needs to be a great effort to communicate to owners exactly that ... that vets OOH are like A&E.

In other words, you sit and wait on an uncomfortable chair till the early hours of the morning before seeing someone.

That would make people think twice about ringing for a pet passport at 3:00am. As long as it was pitched right, it might also make them less likely to call an emergency just because the dog vomited once.

RE: Crisis in the veterinary profession

rgreeny — Tue, 24 Aug 2021 17:06:52 GMT

Can I suggest a solution to this problem? No. Owner awareness would be hugely beneficial, people are often clueless and they just need a bit of guidance. They may also have no idea of what's going on at our end, so explaining the minimal team we have, or that there are more critical emergencies being seen, is usually enough to gain their understanding.

I personally feel corporatisation is killing off the profession. The layers of management and external 'control', or lack thereof, leave ground staff feeling unsupported, like another number and not an individual with concerns, feelings and opinions. I understand not all corporates are the same, and this could be a similar situation in private practice (having worked in both myself).

I'll leave this post on this note. During the time I have worked in my current position, I have been the only permanent night nurse. I have worked with 1 permanent night vet, who left after 5 months. The rest of the time it has been a string of ever changing loucms, or day staff being forced to cover shifts (sometimes with seriously lasting implications). We are over worked, and seriously understaffed and something needs to change soon before the bubble well and truly bursts.

RE: Crisis in the veterinary profession

rgreeny — Tue, 24 Aug 2021 16:53:22 GMT

As a veterinary nurse who has been working OOH night shifts solely for the last 7months I wanted to add my input to this.

OOH providers are already struggling to see the patients whose practices they cover as it stands. Clients get angry when you explain they will need to contact their own OOH provider in the first instance. I fear that if OOH care was left in the hands of the owners how would we be able to cap our numbers to the pets we see? Surely the usual registration service as with routine vets wouldn't work? Even when explaining to clients that 'we are unfortunately unable to see all the pets in London and so this is why OOH care is shared out' people continue to berate you for not caring about their pet.

Secondly a lot of the calls I get on nights are NOT EMERGENCIES. Where I am able to offer over the phone advice if a problem can wait until the next day, or care can be provided at home, both myself and the owners are happy. I don't mind providing this service to people, unless of course I am dealing with an emergency at the time. However, working in a 1 vet, 1 nurse night team I am very much used to being able to take a call, briefly assessing the problem and taking the number down to assist the owner at another time, whilst simultaneously dealing with an emergency (or if I feel necessary advising them to call another practice).

Now here's something I believe has been introduced to aid OOH providers but in my opinion does the opposite (sorry). The video vet consultation. Increasingly more owners are contacting video vets before ourselves and of course the advice from those vets is often that they should come into practice. HOWEVER, I feel that often the cases they send down are not emergencies, the animal would be perfectly fine to wait until the next day for a regular appointment, but perhaps because the vets taking these calls (at least in our area) do not work nights, or are worried about their own accountability, the patient is sent to us and takes up valuable time unnecessarily.

In terms of ridiculous calls, yes we get them. Where I am it doesn't tend to be for preventative treatment, it's almost always for travel. Once explaining to the owners that they are essentially calling an accident and emergency service they tend to be fine with the fact that we are unable to assist them. It's more the minor/non emergency cases who get the angriest.

I am still recovering from one of the most abusive phone calls I received from an owner in my 8 year career the other night. Of course, I will not go into details, but it was a non emergency, with little/zero chance that it could turn into an emergency. The owner demanded to be seen immediately but at that time we were dealing with 3 critical patients who could have crashed at any time (as well as an almost full hospital of other inpatients). Despite offering the owner advice, offering an appointment for 3hrs later (despite it not really being needed), and explaining that I needed to get off the line to give my attention to other patients, they were far from understanding. They verbally assaulted and threatened me on the phone, leaving me no option to hang up on them...of course they continued to call throughout the night at which instance we had to ignore the majority of their harassing calls. I am just luckily that the owner didn't turn up at our front door and start banging to get in, something that unfortunately does happen.

RE: Crisis in the veterinary profession

Arlo Guthrie — Tue, 24 Aug 2021 13:41:06 GMT

[quote userid="6058" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177306#177306"]Hmmmm.... difficult to answer as the situation has morphed due to client expectations from what they have seen offered (usually from the corporates) with no request being an unreasonable request i.e. prevention tx OOH!! [/quote]

I've just started a new thread, because it strikes me that the very first step is to quantify how big the OOH issue is.

In other words, are 75% of OOH calls about flea treatment? Or something which could wait till morning. If they are, there would surely be more efficient ways of dealing with that than requiring all practices to provide 24/7 cover.

[quote userid="6058" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177306#177306"].remember the days when the telly didn't start until morning and we waved goodbye to it with the National Anthem of an evening?! No? I do! Lol.[/quote]

yeah, I remember that!

RE: Crisis in the veterinary profession

Alison Clare Hickman — Sun, 22 Aug 2021 15:34:36 GMT

Pressed Enter before I'd finished...

Or, as the owner understands the scope of their vets OOH provision is prepared to do the travelling in an emergency in OOH...

Atm we have a demanding client base who want 24/7 vet cover because (perhaps) they think it's a right or just what IS right. But there simply aren't the people now to provide it (and, imo, that isn't going to change, just get worse). They demand it and we have to bust a gut to provide it 'or else' there are potential ramifications from the RCVS...hardly conducive to fabulous mental and physical health or indeed a profitable business. It's not do-able in it current format.

So. Manage the client expectations, make the OOH provision a choice for those who can do it (and do it well) and I do think we might meet in the middle...

Its not perfect by a long way.

I'd love it if every animal had immediate veterinary treatment when they needed it... But that's pie in the sky wishing .

RE: Crisis in the veterinary profession

Alison Clare Hickman — Sun, 22 Aug 2021 15:14:07 GMT

[quote userid="49745" url="~/001/nonclinical/f/life-in-veterinary-practice/32222/crisis-in-the-veterinary-profession/177307#177307"]I think removing the obligation for providing OOH care would cause some issues as true emergencies really do need to be seen, and most owners will blame the practice if this is not something they will help with[/quote]

I agree with you about seeing the emergencies...however that is supposing we have sufficient veterinary professionals to actually attend to them; which we don't This is the reality. I have some knowledge about the OOH provision in other countries and it isn't like the UK, far from it. I'm not saying it is better (because it isn't and yes, animals do have a long travel time to see a vet OOH e.g. Australia or US) however the main point is that their owners KNOW this and react differently to the emergency...the pet will get seen earlier (during the day)

RE: Crisis in the veterinary profession

Mel * — Sun, 22 Aug 2021 11:57:50 GMT

I think removing the obligation for providing OOH care would cause some issues as true emergencies really do need to be seen, and most owners will blame the practice if this is not something they will help with. We already get unacceptable behaviour from clients when we explain that our OOH care is provided off site, and they have to make a bit of effort to go to another location - despite it being on our paperwork and website so they are aware of this from the point of registration. If we simply wash our hands of it completely a lot of animals will likely suffer until the usual practice opens in the morning.

The infomercials would be welcome though. Not 'we won't be the ones to tell people that they are being unreasonable' type that we so often see though. Real life ones that tell people that pet ownership comes with responsibility for care, costs and social behaviour.

RE: Crisis in the veterinary profession

Alison Clare Hickman — Sun, 22 Aug 2021 11:43:23 GMT

Hmmmm.... difficult to answer as the situation has morphed due to client expectations from what they have seen offered (usually from the corporates) with no request being an unreasonable request i.e. prevention tx OOH!! Plus the general 24/7 society we now live in...remember the days when the telly didn't start until morning and we waved goodbye to it with the National Anthem of an evening?! No? I do! Lol.

I do think though that the (as I've quoted before) 'rusty cogs' of the RCVS must turn (and QUICKLY) to protect the profession from complete implosion...which I feel has already long begun.

Start with removing the requirement to provide OOH cover as an obligation (with the severe penalties for non observance that brings) and make it optional. Place the onus of responsibility for finding OOH cover firmly back in the hands of pet owners...which it always has been, yes, but make it KNOWN that they have zero recourse for complaint if they don't! Clearly displayed Practice notice in Waiting Room?

I know when I had dogs it's one of the very first things I did (I wasn't a veterinary professional at the time!!). Check who did what, when, travelling times, costs et al and made my decisions and provisions accordingly. However I do think I'm more the exception rather than the rule if you look at how little research many people put into pet ownership other than "I want a ..." and that's it. Education infoadverts? Put out by the RCVS?

Obviously we can put the 'blame' for our current dire circumstances on This That Whatever but that does little to resolve the problem. What is needed is cohesive rapid ACTION. That's not something the RCVS does well... Old Farty Stick in the Mud that it is (my opinion).

In summary. Stop the requirement for OOH. Poke the pet owner into action. Promulgation... infoadverts on TV/social media about it (with reasons WHY) ? RCVS to shoulder the backlash.

Am I wrong? It's just ideas!

RE: Crisis in the veterinary profession

Mel * — Sun, 22 Aug 2021 09:24:40 GMT

I certainly reflects what we are seeing in our area. We do not provide our own OOH but outsource, and we are getting communications from our OOH provider asking us to stop sending them cases or they will stop providing the service. And of course it is us that the client shouts at.

I think the main issue we see is the expectations of the client. There has been a massive increase in pet ownership over the past 12 months and several vets in our area have now closed their books to new clients as they are not able to provide them with the service. Also the demands of clients seems to have mushroomed aswell, putting extra pressure on the staff to meet unrealistic demands (yes, such as the emergency flea/worm treatment which if it isn't done immediately they will become abusive and make complaints via social media).

That, along with the new tax legislation affecting locums, has made it difficult to find staff to cope with the increased workload, thus exacerbating an already stressful situation.

Maybe client education would be the answer, if they are interested?

RE: Crisis in the veterinary profession

Ben Ogden — Thu, 19 Aug 2021 13:41:50 GMT

The Profession is reaping what it’s sowed.