July 15, 2013
Returning to clinical work after leave takes practice
Planning makes a critical difference
By: Phyllis DeGioia
For The VIN News Service
After owning two hospitals for a decade, Dr. Zack Mills took a job in industry with the intent of staying there 10 years. But it was 17 years before he returned to active practice. Mills opened a clinic in Duluth, Ga., last December.
Photo by Leslie Scarpa
During 17 years in industry, Dr. Zack Mills missed interacting with clients and patients. He opened his own clinic last December, and is seen here with one of his new patients, a boxer named Montana.
Spending nearly two decades largely away from patients could have left Mills pretty rusty. The prospect of losing one’s touch as a doctor is a common concern of veterinarians contemplating a leave of absence, whether to have a baby, to tend their personal health, to take a non-clinical job or something else.
Practice owners anticipating the return of employees who have gone on leave also wonder what to expect. “What have your experiences been with the return to work after (a) maternity or other long-term leave?” Dr. James McCorquodale, director of a 24-hour emergency clinic in Canada, recently asked colleagues in the Veterinary Information Network (VIN), an online community for the profession.
“I took off 2½ weeks in 1999 for my honeymoon, and I felt a little strange for the first five to 10 appointments the first morning back, so I can imagine that a full year would be more,” he said.
Judging from the experience of people who have returned to practice after an extended leave, the transition may be bumpy — sometimes in unexpected ways — but nothing that can’t be overcome.
Expecting that returning will take a little getting used to, and taking steps to keep skills as sharp as possible while away, can make a difference.
‘It does come back’
Mills, for example, made a point of finding ways to keep up his clinical skills while working for Merial, the animal-health division of pharmaceutical company Sanofi. Every year, Mills would spend a week of vacation working in a friend’s hospital. He also attended continuing-education classes throughout his tenure with the corporation.
When Mills decided it was time at last to go back to practice full-time, he negotiated a gradual exit that enabled him to work at a clinic for a few weeks without pay to refresh his skills and build his confidence.
A few things had changed since he last spent his days with patients. Pain control for companion animals has come a long way, for instance. Mills said he needed to learn the new pain-control techniques. The area wasn’t entirely new to him, though, as he had marketed pain-control products as a Merial executive.
To get up-to-speed on surgeries, he took a weeklong hands-on surgery course.
"It does come back," Mills said in a recent interview, although he acknowledged that among his clinical skills, surgery has been the toughest to reclaim.
He said he’s comfortable with soft-tissue surgeries but he’s not doing any orthopedic work, “not with so many board-certified surgeons around. But I might pick up more of it,” he added.
Mills could have stayed on with Merial, but he wanted to return to practice for the same reason he left clinical work: He loves change. At Merial, his responsibilities changed every five years or so, culminating with a position as vice president of U.S. companion animal sales. Mills said he believes people should have to learn something new every day.
"I'm still young enough to feel good about working 14 hours a day," said Mills, who is 55. "Most of the veterinarians my age have been doing the same thing for 30 years, and some burn out. I hope that 10 years from now, I'm still enjoying it, but if I'm not, I can cut back a little bit.”
Mills owns Tiger Tails Animal Hospital with his wife, Susan, who manages the practice. He relishes the lifestyle of a practice owner.
“It gives me more flexibility than industry would give me,” he said. “And I missed private practice. I loved my job at Merial, but I missed practice; I missed being part of the community. I was living in Atlanta, but it wasn't my home … (because) I was on the road constantly. I missed seeing clients at the grocery store. I wanted to get involved with the Chamber of Commerce. I missed what practice brings me, and I was missing it bad."
Now back in practice, the most difficult change for Mills has been the change in income. He said he misses the travel a little, too. He admits he liked being a mover-and-shaker and being involved in a different part of the veterinary profession.
Taking time out for a baby
Photo by Sarah Eddy
After her son's birth, Dr. Helen Eddy took a year off. Upon returning to the clinic, Eddy was surprised to discover that her communication skills had faltered, but not her clinical skills. "Surgery and other motor skills came back like riding a bicycle," she said.
Mills’ hiatus from active practice was much longer than most. A more common reason for leaves of absence is to have a baby. Such leaves typically last only weeks or months. In the United States, six to 12 weeks is usual. Under Canadian law, new mothers are allowed up to one calendar year (by combining pregnancy leave of up to 17 weeks unpaid time with parental leave of up to 35 weeks.
Dr. Helen Eddy of Whitehorse, Yukon, recently took a year off after the birth of her first child. She eased back to the clinic by working part-time for a month before returning full time.
During her leave, Eddy visited the clinic every other month for team meetings so she could keep up with changes taking place. Excited and nervous upon return, she discovered with relief that her clinical skills came back quickly.
"I thought it would be harder to come back," Eddy said. "I felt like things came back faster than anticipated."
She didn’t remember drug dosing automatically as before, but she had expected this, and made sure to double-check herself. She also found new drugs on the shelf and a few new protocols to learn.
Before her first surgery, Eddy prepared by watching a video on spays. She found her muscle memory came back fast.
Although she didn't feel back in the swing right away for everything, Eddy found she needed only to do something once or twice for it to feel familiar again. She compared the experience to riding a bicycle: once learned, your body doesn’t forget it.
To her immense surprise, Eddy found the hardest skill to get back was communication. While she didn't feel rusty making diagnoses and using treatment protocols, she fumbled in talking to clients; she said felt as if she spoke with the hesitancy and lack of confidence of a new graduate.
"I remember having a dog come in, a 10-year-old dog suddenly not weight-bearing on a front limb, and he hobbled across the room," Eddy said. Eddy said she suspected the dog had osteosarcoma, or bone cancer, but had trouble relaying this to the dog’s owner.
"I remember feeling like I was stumbling, like (the client) didn't trust me or believe me,” she said. “I didn't have the confidence, and I knew it. ... It took two or three months until I felt confident again."
What took even longer than regaining clinical and client communication skills, Eddy said, was adjusting simply to being a working mother. But now that she’s figured out that balance, she said she would take another year of leave for another child "in a heartbeat."
Tending to personal health
Photo by Alejandro Garcia
After a decade away from clinical work, Dr. Paula Ibsen volunteered at a clinic to rehone her skills before seeking employment.
Health problems are another reason some veterinarians may take a break from practice. That was the case for Dr. Paula Ibsen. The Davis, Calif., veterinarian has had lifelong medical issues as a result of being kicked in the face by a horse at age 13.
Throughout her adult life, she has needed periods of time away from practice for health reasons. The longest came when, beginning at age of 40, Ibsen had 15 surgeries within three years and did not work again until she was 45. She then worked for a vaccine manufacturer for five years until half the work force was let go in 2008 because of the poor economy. That's when she chose to return to clinical work.
As she hadn't worked in a clinic in a decade, Ibsen volunteered at one to bolster her surgical skills. A plethora of new drugs had come out during her time away, so she had to learn about those, as well.
What helped her the most, she said, was that she has always done a full physical examination, from nose to tail, on each patient; it made Ibsen comfortable to do something that was nearly as automatic to her as breathing.
Following her volunteer stint, Ibsen landed a full-time clinic job. But one year later, her hours were cut, once again due to the poor economy. At that point, she began working part-time for VIN. In 2011, she left practice for full-time work on VIN's member relations team.
"If I were to go back into clinical practice again, I'd do the same thing, volunteer for someone (first)," Ibsen said. "I would probably choose a shelter where I could do spays and neuters."
Easing back after military duty
For Mills, Eddy and Ibsen, the transition entailed a relatively simple adjustment from being outside a clinic to being inside a clinic. But when you’ve been away serving in a war zone, coming back requires readjusting to everything.
That’s what Dr. Daniel Cardosa Jr. faced following 15 months of service with the U.S. Army from 2005 to 2006.
"It wasn't just a matter of re-acclimating to clinical work, it’s re-acclimating to your whole life," said Cardosa, a practitioner in West Greenwich, R.I. "You're in a kind of surreal life while you're (serving). It's real while you're there, but when you're home, it's surreal."
Cardosa was not part of the U.S. Army Veterinary Corps, which would have enabled him to continue practicing medicine, but was assigned to civil-affairs duty in Iraq. Although the small-animal doctor worked on some public-health projects in which he dewormed livestock and did physical examinations, Cardosa’s assignment was varied. At times, he saw active combat while accompanying units on patrols seeking insurgents.
Photo courtesy of Dr. Daniel Cardosa
While serving with the U.S. Army in Iraq, Dr. Daniel Cardosa had limited hands-on clinical duties, consisting mostly of deworming livestock and performing physical examinations.
This being his third military tour of duty, Cardosa knew before he left that clinical and surgical skills are perishable. "You don't use them, you lose them,” he said. Determined to keep up, he packed four textbooks, and his wife Debbie sent veterinary journals. Cardosa read during his down time.
Once home, Cardosa did not work anything close to his typical 60 hours a week. Cardosa had the luxury of coming back gradually because the veterinarian who filled in while he was away stayed on.
Keenly aware of the stress that combat soldiers can face when they first return home, Debbie made only a few appointments for her husband, and scheduled them for half an hour rather than the usual 15 minutes. The doctor’s first appointments involved mostly simple things, such as vaccinations, ear infections and skin issues. He worked his way back to more complicated conditions.
His first surgeries upon return also were of the simpler variety, such as lump removals, castrations and spays. More detail-oriented surgical procedures, such as tibial plateau leveling osteotomies, he would send to a nearby referral facility until he felt comfortable enough to do them himself again.
Cardosa said it seemed that it took a long time to get up to speed — two to three months, he estimated. To his surprise, his wife said it actually took eight.
"I probably could have started doing things sooner but I was just being cautious," Cardosa said.
Colleagues may help
Returning to the clinic after any type of lengthy leave can be difficult, but steps such as volunteering, taking classes and otherwise keeping up with new advances may make the transition easier.
"I think that in the right atmosphere, and especially if you say, 'I will need a bit of mentoring' in whatever your weak spot is, you will get the information you need," Ibsen said. "Colleagues are usually open to helping one another."
Mills, who returned after 17 years in industry, concurs.
"Yes, there are changes, but not that much. You can pick it up quickly," he said. "Go to conferences and academies. Volunteer for a friend from school or (at) the shelter. Don't be afraid of going back."
VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email firstname.lastname@example.org.
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