Never apologize for wanting to be “just” a general practitioner

Alison G. Meindl 1Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30605.

Search for other papers by Alison G. Meindl in
Current site
Google Scholar
PubMed
Close
 DVM
,
Ira G. Roth 1Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30605.

Search for other papers by Ira G. Roth in
Current site
Google Scholar
PubMed
Close
 DVM, MS
, and
Sara E. Gonzalez 1Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30605.

Search for other papers by Sara E. Gonzalez in
Current site
Google Scholar
PubMed
Close
 DVM, MS

At the beginning of each primary care clinical rotation at the University of Georgia College of Veterinary Medicine, fourth-year students are asked to define their area of interest or ultimate career goal. As expected, the answers vary considerably, with students detailing plans that include working in government, industry, academia, public health, or general or specialty practice. In our experience, about a third of students express a desire to seek postgraduate education in a clinical specialty, such as internal medicine, surgery, oncology, cardiology, pathology, radiology, or zoo animal medicine. Most students proudly announce these educational and career plans, often explaining what led to their decision.

However, it is also our experience that students who plan to enter general practice following graduation frequently sound less proud or even apologetic when announcing their plans and goals. A common statement made by these students is, “I want to be just a general practitioner,” seemingly implying that being a general practitioner is somehow inferior to any other veterinary career path.

The fact that veterinary students might see general practice as being of somewhat lower status is, to us, not surprising. Several years ago, for instance, the dean of a veterinary medical college sent a college-wide email announcing and congratulating those who had been accepted into postgraduate training programs. However, no subsequent email congratulating upcoming graduates on their initial employment in general practice was sent by the college administration. Similarly, students have frequently reported to us that other faculty members have attempted to dissuade them from a career as a general practitioner, suggesting that this choice would not fulfill or challenge them.

As primary care educators, we believe that today's veterinary students should embrace their ambition of becoming general practitioners. Most veterinarians in North America are employed in general practices providing primary health-care needs for companion animals.1,2 Even though there are documented and expected shortages in other areas of veterinary medicine, including food animal medicine, laboratory animal medicine, biomedical research, and academia,3–6 most new graduates seek employment in traditional general practice settings. With that in mind, we believe it is crucial to encourage students to view general practice as a career path equal to any other.

General practice has its own demands and rewards, compared with the demands and rewards of other career paths, and in contrast to the perception that it may be somewhat less rigorous than, for example, specialty practice, general practice requires a vast array of expertise.7 Veterinarians in general practice are required to fill a wide variety of roles, including business manager, surgeon, diagnostician, obstetrician, and grief counselor. General practitioners emphasize disease prevention and health maintenance, but must also integrate nutrition, animal welfare, preventive medicine, effective communication, general medicine and surgery, and animal behavior. General practitioners provide health-care services that can range from diagnosis and monitoring of complicated endocrine disorders such as diabetes mellitus or hyperadrenocorticism to surgical removal of mast cell tumors to education about zoonotic parasitic diseases and more. Conscientious general practitioners quickly find that, more often than not, there is no such thing as a routine vaccination appointment and that a myriad of opportunities exist to provide high-quality care to patients while also building rapport with clients that extends throughout the lives of their pets.

Encouraging veterinary students to view careers in general practice as being on par with careers in other parts of the veterinary profession begins with the clinical faculty. Input from clinical faculty has been shown to have a bigger impact on veterinary students’ decisions to pursue an internship than does mentoring by basic science faculty or private practice veterinarians. In a previous study,8 for example, 41% of interns reported that they decided to pursue an internship during their fourth year, and veterinary students who participated in a mentoring relationship with a clinical faculty member were six times as likely to pursue postgraduate clinical training as were students who did not have a similar relationship. Because most clinical faculty members at veterinary medical colleges in the United States have completed postgraduate clinical training, it is not surprising that they might recommend postgraduate clinical training to the students they mentor. Still, clinical faculty could play a role in improving the standing of general practice.

Of course, we do not oppose the concept of postgraduate clinical training. We agree that most internships provide extensive exposure to the management of complicated medical and surgical cases and that this exposure likely results in a level of proficiency that those entering general practice develop over a longer period. However, we also believe that students considering internships should weigh the benefits of the experience and mentorship they might gain against the high workload and low salary associated with them. It would be interesting to survey veterinarians after their first year of employment to determine whether the perceived level of competency of those in general practice was impacted by the mentoring environment. We believe that new veterinarians who entered a general practice with a strong mentoring environment would rate their experiences high and report that the first year made them more complete veterinarians.

Students considering internships should also weigh the financial return of this decision. One analysis9 found that completing an internship was not likely to provide any long-term economic benefit unless it culminated in a residency. Of course, students seeking an internship are generally not doing so because they expect any economic benefit, and a previous survey10 found that almost half of graduating veterinary students who sought an internship did so because they believed they would be able to practice higher-quality veterinary medicine or thought they needed more training before entering veterinary practice. However, only 36% of students seeking internships stated that they planned on entering a residency.

Raising the status of general practice as a career option will also require a greater dedication to primary care education in veterinary college. Currently, much of the clinical education veterinary students receive occurs in tertiary care teaching hospital environments and is dominated by rotations through specialty medicine and surgery services that limit hands-on experiences for students.11 However, this emphasis on referral cases as educational opportunities for veterinary students may contribute to concerns that new graduates are not fully prepared to enter the workforce when they graduate.12,13

Because many students who enter an internship do so because they believe they need more training before entering veterinary practice, raising the status of general practice as a career option will require addressing this belief. Curricular changes that include increased emphasis on practical and technical skills and effective communication and that emphasize exposure to primary care cases appear to have a positive effect on new graduates entering the workforce.14 Increased focus on primary care cases would be expected to improve the overall confidence of new graduates, and a previous study15 found that student experiences in a comprehensive final year of study significantly improved their transition to independent practice as an entry-level veterinarian. Increasing students’ exposure to general practice cases and to operating in the resource-constrained environment of a typical general practice setting would be expected to assist new graduates’ clinical reasoning and skill development early in their career.16 Exposure to primary care cases would also help new graduates focus on continuity of care, time pressures, and the overall transition to general practice. Simply put, it makes sense for veterinary students to spend the most time in school focusing on cases they will see the most often once they are in the workforce.

That said, the challenge of providing a balance of primary care cases versus secondary or tertiary care cases to maximize learning experiences for both students and house officers (eg, interns and residents) has been an ongoing struggle for veterinary teaching hospitals and often leads to competition for available opportunities between veterinary students and house officers.17 We believe that this competition contributes to students’ belief that they are unprepared to enter the workforce and thus require postgraduate education. Defining the roles and expectations of students and house officers, creating supplemental learning opportunities for students (eg, supplemental surgery services), designating cases for exclusive management by students, and enhancing preclinical skills training are all suggestions for improving graduates’ readiness to enter the workforce.

Providing general practice experience to veterinary students during their training is also key to increasing their readiness to enter the workforce. Some veterinary colleges have stand-alone primary care hospitals near the teaching hospital, primary care rotations embedded into the clinical year, or remote primary care centers in underserved communities.18,19 Additional hands-on exposure for veterinary students has included primary care case responsibility with animal shelters and humane organizations. These programs have positively impacted students, better prepared students to meet employers’ expectations, and helped students obtain required core competencies.20 We believe that increasing students’ exposure to primary care medicine will allow students to be better equipped to enter the workforce following graduation.

Focusing on the specific skills necessary in general practice may also increase students’ perception of the value of pursuing a career in general practice. Outcomes assessments of new graduates and employers of new graduates of our veterinary college highlight weaknesses in certain core skills, including business and management skills, entry-level surgical and dental skills, effective communication skills, and skills related to the management of medical and emergency patients. Thus, we believe that veterinary colleges should focus more training in these areas.

Finally, students who participated in outcomes assessments frequently stated that they were not given adequate opportunities to provide feedback regarding their educational experiences while they were still in the program. We believe that it is important to obtain feedback from students so as to improve their learning opportunities during the clinical year, with the goal of making students more confident in their abilities prior to entering the workforce.

The field of veterinary medicine provides a rich variety of diverse career opportunities. It is important for veterinary educators to embrace the variety of career options available to today's veterinary students and to discuss differences in work-life balance, income potential, and job security and satisfaction that may be important factors as students plan their careers. Adequately preparing students to enter the workforce is a continued challenge as information growth makes educating students even more difficult in a traditional four-year curriculum. As educational debt increases, students need to critically evaluate whether the additional time and cost to complete a course of postgraduate study prior to entering general practice are in their best interest. Most importantly, suggesting that those who enter general practice following graduation are somehow less ambitious should not be part of the career advice offered, explicitly or implicitly, as we mentor our students. Designing a curriculum that enables typical veterinary graduates to be confident enough to enter general practice after graduation should be the goal of everyone involved in veterinary education. The following steps should be considered to help achieve this goal:

  • • Expand exposure to primary care case management.

  • • Increase surgical training opportunities, especially for entry-level procedures.

  • • Include basic business education in the curriculum.

  • • Provide more hands-on training opportunities during specialty rotations for fourth-year veterinary students.

  • • Develop robust, hands-on clinical skills training that supplements the didactic training.

  • • Create a mentoring program involving practice owners who employ entry-level veterinarians.

  • • Refine the curriculum to eliminate redundancy and reduce basic science coursework better suited to undergraduate study.

  • • Develop a culture that recognizes the importance of general practice.

  • • Recognize the additional economic burden that postgraduate education can cause for those who aspire to be general practitioners.

No student should ever feel a need to apologize for wanting to be a general practitioner. It is our hope that in the future, students who are prompted to state their career goals feel empowered to answer proudly, “I am going to be a general practitioner.”

Acknowledgments

No third-party funding or support was received in connection with the writing or publication of this manuscript. The authors declare that there were no conflicts of interest.

References

  • 1. Jelinski MD, Campbell JR, Lissemore K, et al. Demographics and career path choices of graduates from three Canadian veterinary colleges. Can Vet J 2008;49:9951001.

    • Search Google Scholar
    • Export Citation
  • 2. Shepherd AJ, Pikel L. Employment of female and male graduates of US veterinary colleges, 2011. J Am Vet Med Assoc 2011;239:10701074.

  • 3. Narver HL. Demographics, moral orientation, and veterinary shortages in food animal and laboratory animal medicine. J Am Vet Med Assoc 2007;230:17981804.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4. Rosol TJ, Moore RM, Saville WJ, et al. The need for veterinarians in biomedical research. J Vet Med Educ 2009;36:7075.

  • 5. Bruce Prince J, Andrus DM, Gwinner K. Academic food-supply veterinarians: future demand and likely shortages. J Vet Med Educ 2006;33:517524.

  • 6. Cockerell G, Meuten D, Ochoa R. The ACVP/STP coalition responds to the continued shortage of veterinary pathologists. Toxicol Pathol 2009;37:359360.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7. May S. Towards a scholarship of primary health care. Vet Rec 2015;176:677682.

  • 8. Barbur L, Shuman C, Sanderson MW, et al. Factors that influence the decision to pursue an internship: the importance of mentoring. J Vet Med Educ 2011;38:278287.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9. Fanning J, Shephard AJ. Impact of internship on veterinarian salaries, 2009. J Am Vet Med Assoc 2011;239:768769.

  • 10. Shepherd AJ, Pikel L. Employment, starting salaries, and educational indebtedness of year-2013 graduates of US veterinary medical colleges. J Am Vet Med Assoc 2013;243:983987.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11. Brown CM. The future of the North American Veterinary Teaching Hospital. J Vet Med Educ 2003;30:197202.

  • 12. Routly JE, Taylor IR, Turner R, et al. Support needs of veterinary surgeons during the first few years of practice: perceptions of recent graduates and senior partners. Vet Rec 2002;150:167171.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13. Bachynsky EA, Dale VH, Kinnison T, et al. A survey of the opinions of recent veterinary graduates and employers regarding early career business skills. Vet Rec 2013;172:604.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14. Jaarsma DA, Dolmans DH, Scherpbier AJ, et al. Preparation for practice by veterinary school: a comparison of the perceptions of alumni from a traditional and an innovative veterinary curriculum. J Vet Med Educ 2008;35:431438.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15. Matthew SM, Ellis RA, Taylor RM. New graduates’ conceptions of and approaches to veterinary professional practice, and relationships to achievement during an undergraduate internship programme. Adv Health Sci Educ Theory Pract 2011;16:167182.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16. Dixon WH, Kinnison T, May SA. Understanding the primary care paradigm: an experimental learning focus of the early veterinary graduate. Vet Rec 2017;181:480.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17. Kochevar DT, Peycke LE. Balancing veterinary students’ and house officers’ learning experience in veterinary teaching hospitals. J Vet Med Educ 2008;35:610.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18. Alvarez EE, Gilles WK, Lygo-Baker S, et al. Teaching cultural humility and implicit bias to veterinary medical students: a review and recommendation for best practices [published online ahead of print Mar 28, 2019]. J Vet Med Educ doi: 10.3138/jvme.1117–173r1.

    • Search Google Scholar
    • Export Citation
  • 19. McCobb E, Rozanski EA, Malcolm EL, et al. A novel model for teaching primary care in a community practice setting: Tufts at Tech Community Veterinary Clinic. J Vet Med Educ 2018;45:99107.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20. Shivley JM, Brookshire WC, Bushby PA, et al. Clinically prepared veterinary students: enhancing veterinary students hands-on experiences and supporting hospital caseload using shelter medicine program. Front Vet Sci 2018;5:95.

    • Crossref
    • Search Google Scholar
    • Export Citation

Contributor Notes

Address correspondence to Dr. Meindl (ameindl@uga.edu).
  • 1. Jelinski MD, Campbell JR, Lissemore K, et al. Demographics and career path choices of graduates from three Canadian veterinary colleges. Can Vet J 2008;49:9951001.

    • Search Google Scholar
    • Export Citation
  • 2. Shepherd AJ, Pikel L. Employment of female and male graduates of US veterinary colleges, 2011. J Am Vet Med Assoc 2011;239:10701074.

  • 3. Narver HL. Demographics, moral orientation, and veterinary shortages in food animal and laboratory animal medicine. J Am Vet Med Assoc 2007;230:17981804.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4. Rosol TJ, Moore RM, Saville WJ, et al. The need for veterinarians in biomedical research. J Vet Med Educ 2009;36:7075.

  • 5. Bruce Prince J, Andrus DM, Gwinner K. Academic food-supply veterinarians: future demand and likely shortages. J Vet Med Educ 2006;33:517524.

  • 6. Cockerell G, Meuten D, Ochoa R. The ACVP/STP coalition responds to the continued shortage of veterinary pathologists. Toxicol Pathol 2009;37:359360.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7. May S. Towards a scholarship of primary health care. Vet Rec 2015;176:677682.

  • 8. Barbur L, Shuman C, Sanderson MW, et al. Factors that influence the decision to pursue an internship: the importance of mentoring. J Vet Med Educ 2011;38:278287.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9. Fanning J, Shephard AJ. Impact of internship on veterinarian salaries, 2009. J Am Vet Med Assoc 2011;239:768769.

  • 10. Shepherd AJ, Pikel L. Employment, starting salaries, and educational indebtedness of year-2013 graduates of US veterinary medical colleges. J Am Vet Med Assoc 2013;243:983987.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11. Brown CM. The future of the North American Veterinary Teaching Hospital. J Vet Med Educ 2003;30:197202.

  • 12. Routly JE, Taylor IR, Turner R, et al. Support needs of veterinary surgeons during the first few years of practice: perceptions of recent graduates and senior partners. Vet Rec 2002;150:167171.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13. Bachynsky EA, Dale VH, Kinnison T, et al. A survey of the opinions of recent veterinary graduates and employers regarding early career business skills. Vet Rec 2013;172:604.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14. Jaarsma DA, Dolmans DH, Scherpbier AJ, et al. Preparation for practice by veterinary school: a comparison of the perceptions of alumni from a traditional and an innovative veterinary curriculum. J Vet Med Educ 2008;35:431438.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15. Matthew SM, Ellis RA, Taylor RM. New graduates’ conceptions of and approaches to veterinary professional practice, and relationships to achievement during an undergraduate internship programme. Adv Health Sci Educ Theory Pract 2011;16:167182.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16. Dixon WH, Kinnison T, May SA. Understanding the primary care paradigm: an experimental learning focus of the early veterinary graduate. Vet Rec 2017;181:480.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17. Kochevar DT, Peycke LE. Balancing veterinary students’ and house officers’ learning experience in veterinary teaching hospitals. J Vet Med Educ 2008;35:610.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18. Alvarez EE, Gilles WK, Lygo-Baker S, et al. Teaching cultural humility and implicit bias to veterinary medical students: a review and recommendation for best practices [published online ahead of print Mar 28, 2019]. J Vet Med Educ doi: 10.3138/jvme.1117–173r1.

    • Search Google Scholar
    • Export Citation
  • 19. McCobb E, Rozanski EA, Malcolm EL, et al. A novel model for teaching primary care in a community practice setting: Tufts at Tech Community Veterinary Clinic. J Vet Med Educ 2018;45:99107.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20. Shivley JM, Brookshire WC, Bushby PA, et al. Clinically prepared veterinary students: enhancing veterinary students hands-on experiences and supporting hospital caseload using shelter medicine program. Front Vet Sci 2018;5:95.

    • Crossref
    • Search Google Scholar
    • Export Citation

Advertisement