17 Nov 2021
“Practices that outsource their out-of-hours care have been warned to have a contingency plan,” writes Jordan Sinclair. However, in an age where people choose not to work OOH, where does that leave us?
Jordan Sinclair
Job Title
Image © Proxima Studio / Adobe Stock
The veterinary staffing crisis is hitting out-of-hours providers, which could potentially have a huge impact on the rest of the profession. Practices that outsource their out-of-hours care have been warned to have a contingency plan, while those struggling to staff their own in-house OOH services won’t have the option to outsource.
There is no ideal solution, but you simply cannot expect vets who have chosen to work in small animal practice without working OOH to suddenly start covering OOH again.
You can ask the question, but expect the answer to be no.
There are many reasons people choose not to work OOH, and they should not be judged for this. The outdated attitude of “we did it back in the day” will not stand. Life has moved on. Can you honestly say you would rather work all hours of the day and night at the expense of seeing your family, enjoying your hobbies or having a social life?
Many clients still hold the idyllic James Herriot ideology of being able to ring their own vet at any hour – and while I love All Creatures Great and Small as much as the next person, life is not like that any more. Would you really want to go back to the 1930s, a time when TB was killing off people and human healthcare was still a bit rudimentary?
Nowadays, client expectations have increased inversely proportionate to their respect for a vet’s time. Most of my small animal OOH are not genuine emergencies, simply that the owner can no longer cope with their dog’s diarrhoea at midnight.
And, in reality, what are we offering the client? In-house OOH is actually a bit crap – many clinics do not have a vet on site all night, and as much as you explain to the client that their pet will not be fully supervised all night, I still think many of them don’t fully understand this.
If the vet does need to stay for a critical patient, practices don’t have appropriate provision for this (no bed or “on call” room, for example). There are also lone working safety concerns – should there really be one person coming into the practice on their own throughout the night?
The RCVS has recently updated their guidance to state that “all veterinary surgeons in practice must take steps to provide 24-hour emergency first aid and pain relief to animals according to their skills and the specific situation”.
In theory, at the bare minimum, this means we are required to keep animals comfortable and alive until the morning, when they can then be appropriately worked up, and not by a half-asleep vet who can barely work out the correct dose of pain relief at 3am. But, again, clients don’t appreciate this and expect their dog that “won’t settle” to have a full set of X-rays during the night.
Expecting staff to suddenly start to work on call when they took a job on the basis of not having to be on call is the quickest way to find yourself with no vets at all. People are crying out for vets, and they will just walk, because they can.
I probably sound like a broken record, but so many practices just do not seem to be getting it; if you don’t listen to your staff and look after them, you will continue to lose them.
Recruitment is near impossible at the moment, so retention is key. I do not envy those in managerial roles, but this is your job. I appreciate that you did not sign up for COVID or for the staffing crisis, but this is part of that responsibility, and at the end of the day, you cannot force your assistants into work they didn’t agree to.
I am not preaching from a dreamy place of no OOH. I previously held a senior position and part of that was backing up new graduates on call. I did that because I never wanted them to feel abandoned or without help.
I chose to do a 1 in 2 rota to keep our large animal rota going for a period of time until we were able to recruit, but this was done at the price of reducing the number of working days a week. It was a good temporary compromise, but even with the extra days off, it was exhausting.
I currently do small animal and equine OOH, on about the best rota you could hope for – and it is still stressful and tiring.
There are ways to make in-house OOH better:
Even under the best conditions, for many people, the anxiety, lack of sleep and encroachment that OOH has on the rest of your life is just not worth it.
It is often insinuated that those vets who do not want to work OOH do not care about their patients. However, I think the opposite is true – overworked vets will often experience compassion fatigue, and so by preserving their mental well-being, or keeping some sort of work-life balance by not working on call, we are actually trying to salvage that compassion.
Being present and able to give your full attention to your cases is not possible when you’re exhausted.
