The benefits of a residency

So, my previous article (“Feeling the pressure”; VT40.42) caused a little bit of a stir and I had quite a few people reach out to me.

I want to thank everyone who took the time to get in contact and check in; I appreciate that it had a slightly negative tone to it and it’s great to see members of our profession looking out for each other.

The tone wasn’t the purpose of the article – my aim for this column is to provide an honest account of my experiences. No question, residencies are hard, but what we really need is informed consent for those people looking at taking that leap into further education.

A recent Facebook post about salaries among residents also sparked quite the debate. Don’t get me wrong, I’d love to be paid more – who wouldn’t? It’s so easy to focus on the negatives and try to compare to our human counterparts, but we aren’t doctors, and given the current pandemic I’m incredibly glad I’m not one.

I’ve never had a problem talking about salary and think it’s weird we get so embarrassed about it. I left general practice after two years at a salary of £32,000, roughly equating to £2,070 per month, and my current salary works out about £1,590 per month. Do I think I have £500 worth of CPD a month? Absolutely.

I want to try to steer away from making direct comparisons because my job now is completely different to how it was two years ago, but I really think we focus on salary a bit too much. If you earn more, you spend more.

Lots of people commented on how my salary is unacceptable for people with other commitments – families and children, for example. I’m not going to pretend I have a lot of experience in that area – I’m about as paternal as a rock – but I think it’s also worth considering the long-term prospects as a diplomate.

Let’s say I had decided to stay in general practice and by some miracle I was earning £45,000, and for ease we’ll say I’m currently earning £20,000 (bearing in mind my stipend is not taxed). So the “cost” of me doing a residency is going to be £75,000 – that’s a fair chunk of money.

But what about afterwards? What about a diplomate’s salary in private practice? How long do you think it would take for me to earn back that deficit?

My dad decided to change career in his 40s and retrain as a teacher. That involved going back to university and a substantial pay cut – it’s not just the veterinary profession that faces challenges to further education.

It’s just worth considering, but because I know very little about finance, I’m going to move on to something I do know a bit about – the benefits of a residency.

Case discussion

I had so many cases in general practice where I wanted to ask someone for advice. I was very lucky in that I had quite a few contacts who worked in referral, so I was able to ask for advice quite frequently, but it still wasn’t that easy.

Every day I am working at the RVC Queen Mother Hospital for Animals is a day I can have multiple case discussions with world-leading experts in pretty much any field out there. How can you put a price on that?

My job as a resident is to manage the case to the best of my knowledge, under the supervision of those who know a lot more than I.

As a resident, you get to be a sponge and try to absorb everything you can from those case discussions.

A residency is essentially daily CPD. Yes, you can put a negative spin on it, like we can do with anything – I’m constantly trying to read; trying to prepare the next journal or book club. How many times in your career can you say you have 100% dedicated yourself to professional development?

The old adage of “every day is a school day” is completely correct for the residency. I have learned so much in such a short period of time and it is fundamentally changing how I think about my patients on a daily basis.

I think it is really easy to get stuck in our ways when you don’t have someone questioning your actions. On reflection, there were definitely cases I managed in general practice that I could have managed better, or cases where I misinterpreted what I had been taught at university. But how do you know? How do you know if you’re doing the right or wrong thing for your patients if you don’t have someone questioning you or, at least, internally questioning yourself?

Every day I go to work, I challenge my belief system and knowledge – there’s nothing quite like that to build up your critical thinking skills.

Yes, I have the luxury of primarily dealing with insured clients. Yes, I have the benefit of board-certified radiologists, neurologists, surgeons, cardiologists, anaesthetists, oncologists, interns, dermatologists and clinical pathologists. The job I do now is completely different to what I did in general practice, and I absolutely love it.

I face different pressures on a daily basis compared to my time in general practice. Is one more stressful than the other? I really don’t think it’s fair to compare. There were times in general practice where I was way more stressed than I am now – working against the clock with a board full of ops and dentals, with afternoon consults on the way, all to finish with a list of telephone calls at the end of the day. Not to mention the constant gripe with clients about finances. How do you put a price on that stress?

Mastering veterinary medicine

Excuse the terrible pun, I just didn’t know how to segue into this one…

As well as preparing us for board examinations, the RVC residencies provide us with a Master of Veterinary Medicine. I’m not saying I chose the residency to get the master’s, but it’s certainly an additional benefit.

Currently, I don’t think I will ever leave the veterinary profession, but if I was to consider options elsewhere then that master’s would potentially help. Most master’s courses would be at least £9,000 a year – where does that factor into my residency salary?

A residency at the RVC is very heavily clinically orientated, but we also get additional education in areas such as learning theory, biomedical statistics and evidence-based veterinary medicine. These are the sort of topics I am sure will help me later in my career as I continue to, hopefully, contribute to further research in veterinary medicine, as well as teaching our undergraduate students.

Caseload

I can probably count on one hand the number of patients I had in two years of general practice with a severe acute kidney injury. I couldn’t do that each week here.

We have an insanely high caseload, and while I could complain about being busy, I think it’s also important to consider the purpose of the residency – to pass my board examinations and to go on to practise as a diplomate.

As previously mentioned, this is probably the only time in my career where I’m going to be able to put 100% effort into my professional development. Knowing this, would I rather work less hours and see fewer cases? Or would I rather put in the time now so it benefits me later on? I’ll let you ponder that.

I knew the residency would be difficult when I signed up for it. I don’t think the RVC, or any other establishment, hides what is expected of our residents. I had informed consent. I knew what I was getting into, and I knew how challenging it would be.

I learn best by reading about cases I’ve seen – when I was at Leonard Brothers Vets, I would often try to brainstorm around cases in my downtime. I would get the whiteboard out and go through “thrombocytopenia” or “approach to coagulopathies”, but I’d never see those cases – and within a few days that information would have dived back into the crevices of my brain.

Now, when I get to read around my cases, it benefits the similar case I’ll see later on that week.

I can’t stress how much satisfaction I get from seeing the cases I enjoy and find interesting, day in, day out.

This is why I think it’s so difficult to compare “stress levels” in different areas of the profession. I’m not trying to sugar‑coat the residency; as you can tell from my previous articles, it’s pretty stressful.

But just like I can write in a negative tone having just finished a run of busy shifts, which I could easily have had in general practice, I hope you can see I can also be incredibly positive about the life‑changing – and career-changing – opportunity I’m taking on.

That’s all folks!

The purpose of this article wasn’t to say how great residencies are and to ignore some of the challenges we face in the profession.

Do I think residents, and all vets and vet nurses, should be paid more for the level of work we do? Absolutely. Would it be nice to have more free time and a better work-life balance? Sure.

I agree we need to challenge the status quo and I think discussions are fantastic for this. But we also need to be fully informed about all sides of the story when having heated debates.

For every negative you pick out about a residency, I could pick out a positive. It’s all about perspective.

I am so incredibly glad that I’m doing what I’m doing – and I’m hardly suffering when it comes to my salary. I don’t have additional financial support from family or a partner, and I’m making it work. We all have choices to make and a cost-benefit analysis tells me I’ve made the right choice.

If at any point you have a question, or want to discuss a topic from ECC Endeavours, feel free to drop me an email at [email protected] and I will try to get back to you ASAP.

Until next time, take care.