Recent veterinary graduates have a lot to offer. With solid experience in their first jobs, they can grow into exceptional doctors.

I have been in private practice my entire career. I was an employee for four years, a partner for 23 years, and a sole owner for the past 23 years. Half of my career was in canine-feline practice. The other half has been in feline-only practice.

I started hosting fourth-year veterinary students in 2005. More than 125 externs from many states and several foreign countries have spent from two weeks to three months with me. These interactions have allowed me to understand what they are expecting from their careers.

You only get one opportunity to take your first job, and I believe this experience will have long-term effects on your career. I had an excellent first-job experience 50 years ago, from which I have benefitted since. It was the first important step in my successful career. Here, I share my learnings about the value and long-term effects of one’s first job.

Your first job

For a variety of reasons, it is unusual to last more than two years in your first job. However, it is your first stop in your career path and will likely be the most important one in your entire profession.

You will learn a great deal of new information and discover which diseases are horses and which ones are zebras. You will learn how to construct a reasonable differential list and develop and refine many skills, from drawing a blood sample to collecting urine, to placing an IV catheter to a host of surgical procedures. However, you will also come face-to-face with the “50 percent rule.” When my class was about to graduate, one of our professors told us:

“We have bad news, and we have worse news. The bad news is that 50 percent of what we taught you is wrong. The worse news is we do not know which half that is.”

When I think back to my original knowledge base, I doubt even 50 percent was correct. We like to think our understanding of diseases is much better now; however, it will not be the same in 50 years. You must develop an inquisitive mind and an attitude of continued education. The “facts” we know now will need to be updated repeatedly.

I have edited seven feline textbooks over the past 25 years. New editions were needed because our definition of “current knowledge” had to be revised repeatedly. The most important skill you can develop early in your career is the realization everything we know is subject to revision or rejection.

You need to be one of the members of our profession who is constantly looking for ways of doing old things better, and looking for totally new approaches to old and new diseases. Your first job will positively impact your career if you work for someone who has embraced this approach. Sadly, the reverse is also true. This is why I say your first job is extremely important because of its effects on the rest of your career.

What it should look like

Your first goal should be to work in a progressive, well-equipped practice for an “ideal practitioner.”

Equipping a practice can be like a dog chasing its tail. You cannot do advanced diagnostics and perform specialized techniques unless you have advanced equipment. However, you cannot afford to purchase advanced equipment unless you have the practice income to do so. As an employee, you have no part in obtaining equipment.

Your goal should be to find a practice that has done so. In my opinion, the “ideal practitioner” has the following characteristics:

Knowledgeable of diseases. Your knowledge base at graduation is just the beginning of knowledge acquisition. Spend a good deal of your personal time reading journals and attending conferences to constantly expand the knowledge base.
Sound with surgical and procedural skills. Some new graduates have had minimal or limited capacities in basic surgeries and advanced procedures. Your mentor needs to be proficient in all of these, so they can teach you.
Referrals to specialists only when truly necessary. Depending on the school attended, many new graduates are instructed on what they can do themselves (very little) and told to refer the other cases. This may be good for the referral centers, but it stifles your personal growth and your practice. You cannot be careless with difficult cases or surgeries, and you must let owners know some of your colleagues are better trained and equipped. However, the owner should have a choice, and it is often dictated by either their trust in you or a vast difference in cost. Let me explain. I recently had a cat with a compound femoral fracture. The veterinarian at the emergency center gave the owner three choices: A) Repair by a boarded surgeon with a plate for $6,000, B) amputation, or C) euthanasia. She came to me for a second opinion because none of those options were acceptable. I offered a fourth option: repair with an IM pin for $2,000. My option was not a plan A approach, and the owner knew because I told her. However, it worked just as well as it did 40 years ago and saved the cat from amputation or euthanasia. The “ideal practitioner” has learned to perform advanced procedures by doing them or learning them from hands-on training courses.
Appreciates the limits of the profession’s understanding of diseases. There are other major diseases to be discovered. Our knowledge base has definite limits. This goes back to the “50 percent rule.” When we believe we understand every disease affecting our patients, we are not motivated to seek better ways of doing things.
Recognizes personal limits. We cannot know everything about every disease, and the number of species we treat amplifies the problem. As a feline practitioner, I struggled with understanding feline heart disease. It took hours of personal study, including hands-on ultrasound training, to get a working knowledge of this subject.

Be teachable

I tell my new associates, “You come to me with a piece of paper containing several dots of knowledge.” Because of the 50 percent rule, my first job is to erase many of those dots. I know which ones to erase because of my heavy feline case load over 50 years. I talk to enough externs to get a good feel for what veterinary schools teach. This means I quickly recognize many of the dots need to be erased.

My next job is to add many more dots to their pages. Considering all the species that must be addressed in just four years, there is no way a new graduate can understand how to diagnose and treat the diseases of all of them. Thus, it is my job to supplement their education. My final job is to connect the dots.

You may know the four treatment options for hyperthyroidism, but you need to be able to assess the cat’s condition (early vs. late disease, co-morbidities, pillable or not, etc.) and the owner’s situation (financial ability, attachment to the cat, willing and able to treat daily, etc.) before you make a recommendation. When you connect the dots, you can make a credible recommendation
for treatment.

I prefer to hire new graduates simply because they have fewer dots needing to be erased. Experienced practitioners usually have many bogus dots, but they have used them long enough to be comfortable with them. Giving them up is not easy.

I prefer a new graduate who is scared to death on day one than one who is convinced this amazing education has created a ready-to-go practitioner. The latter new grads are headed for trouble very quickly. Their bubbles will burst, they will become disillusioned, and they may even have second thoughts about being a practitioner.

Compare apples to apples

Many new graduates look at their signing bonuses, salaries, commissions, and end-of-year bonuses and see impressive numbers. As they compare job offers, they compare bottom lines to bottom lines without considering cost of living differences. I had a student who was considering a job in a large northeastern city. She wanted to know if I could match the offer.

I went to a salary for cost-of-living website and found her $150,000 offer in that Northeast city was equivalent to $92,000 in my city (San Antonio, Texas). However, she insisted I match her $150,000 offer because she just could not possibly live on $92,000. She did not come to work for me.

Even though the financial package should not be the most important determinant in your job decision, it is still an important issue. However, be sure you are comparing apples-to-apples when you compare offers.

Summary

1) Your first job will have a major impact on the rest of your career. Choose it cautiously.

2) When you make this decision, be sure you are using the correct criteria. In my opinion, you need to see your first job as lasting one to two years. It is very unlikely to be your long-term employment. Therefore, your primary objective should be to put yourself where you can gain knowledge and experience while learning effective client-relation techniques.

3) Seek employment with a practitioner who has as many traits of an “ideal practitioner” as possible.

4) Be sure your first job includes a serious, proactive mentoring program.

5) Your career will be much more productive and satisfying if you start on the right foot, which you only get to do once.

FIRST JOB DON’TS

Taking on that first job is exciting but can get overwhelming. Here are three things to dodge when you’re at it:

1) The “opportunity” to run your own practice. It is often stated, “We are opening a new practice, and you are going to run it.” This means you will be the only veterinarian in the building. You are told your education is superior and has you equipped to handle whatever comes your way. Although your ego will be heavily stroked, do not buy into this.

You will struggle and will not have the on-site help you need to get you out of one crisis after another. You could easily end up in front of your State Board answering charges of malpractice, of which you will probably be guilty.

2) Working on commission. If you needed cardiac bypass surgery, would you want someone fresh out of a residency doing the surgery? The fact is no one trusts a rookie. Many employers offer a small base salary and about a 22 percent commission on production.

The first problem with production-based income is you will have an extremely low caseload for many months because you are a rookie. There will be minimal earned commissions, and your base salary will be insufficient to sustain you.

The second problem is mentoring. If you are on a production-based system, your associates will be also. They will be very hesitant to spend time helping you with your cases because it will take away time with their cases and cost them production income.

Even my associates of several years are on a straight salary (this increases regularly and is supplemented by a practice-wide bonus system). This allows us to work as a team and maximally help the new associate.

3) The promise of future ownership. Many job applicants are told future ownership or partnership is a realistic possibility “if things work out.” They rarely do. Do not allow this promise to influence your employment decision.

Gary D. Norsworthy, DVM, DABVP (Feline), is the owner of Alamo Feline Health Center in San Antonio, Texas. He has been in private practice for 50 years, including 25 in feline-only practice. Dr. Norsworthy lectures frequently on feline diseases and is the editor and major author of seven feline textbooks. He is a board-certified feline specialist (one of only two in South Texas) and an adjunct professor at the College of Veterinary Medicine, Mississippi State University, and the Western University of Health Sciences. He received the 2020 Distinguished Career Achievement Award by the Texas Veterinary Medical Association.