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Saturday, November 21, 2009

Specialist or Generalist?

So I'm a bit of a doomer. These days if you haven't had an uneasy feeling about the future you must be completely sleepwalking through life-eyes wide shut. I have been waking up to the fact that the status-quo will change, has to change as we run out of cheap energy, as sea levels rise and human migration occurs. I have no idea when any of this will happen or how; will it be slow and orderly or an apocalyptic four horsemen type ordeal? I have written before about adapting being the key to making the best of changes/surviving an apocalypse. This is the background coloring my general take on the future -yeah, cheery.
I am approaching a crossroad in my career where I need to decide -specialist or generalist. Our clinic has been changing alot over the past year, the level of care has gone up, we are providing really quality medicine and looking to push our selves further-with the purchase of an ultrasound-Doppler flow so our ACVIM DVM can start doing cardiology consults along with standard abdominal US. I have to admit to coasting a bit in the last two years- I have not been burned out and not very focused on my career. If I wish to perform at MY self-expected level within this practice I have some work to do, focused continuing education, a big backlog of journals to digest- I have NO wish to be the practice owner who is years behind, medically speaking. Part of me is excited by this prospect-we have a great group of veterinarians and clients who would appreciate this level of care for their beloved babies. This is the route the industry tells us a 'healthy practice' should strive for; specialization and a high standard of care (along with a healthy bottom line).

But the flip side is that I am feeling increasingly uncomfortable about where we are headed. We can do X for your dog, it but should we? Human health care costs have spiraled so high, and I can see similar things happening to veterinary care (but minus the insurance issues!). I am legally obligated to inform a client about the 'standard of care' for a particular issue. With the advent of the Internet the standard of care for Smallsville Wisconsin is the same as that in the most affluent Manhattan neighborhood. I can't bear to see my clients wrestle with the idea that the best option for their pet's condition is a procedure or medication which is so far out of their reach financially, I can't bear to see them feel like a failure because they cannot afford the best care or even the second best care. But it has to be offered. Period. Even to little old ladies with rusted out barely running cars, who are already supporting their unemployed daughter in FL and has a diabetic 14 yr old cat who really needs a dental (sorry, she is one of my clients!)

With our (planned) move to our (planned) homestead next summer, I have the opportunity to re-think my career. Perhaps I should become a generalist. Instead of investing my time into brushing up on cutting edge small animal medicine, I should learn (or should I say re-learn) about beef cows, small ruminants, and chickens. Will the need shift away from animals as surrogate children and back to animals as tools for survival with-in my working lifetime? Will pharmaceuticals be available at a reasonable price for animals? Should I concentrate on husbandry -not letting them get sick in the first place-will people be willing to pay $ (or firewood) for that? Should I learn to be a veterinary herbalist and grow my own medicine. This is where I am leaning, it scares the crap out of me, honestly.

Thanks for reading my rambling-I need to put thoughts into words and paragraphs to see how they hit my 'gut'. In writing this out I can see where my heart is taking me. Now to figure out how to make it work and still pay the bills.

PS-Mr Nice Farmer is interested in pursuing the land contract (maybe he needs the money just a little bit more than he let on). We would buy outright the easement and the building site (maybe 4 acres?) and write a contract for the rest. That will make the bank happy, and me too!


Sue said...

Wow, you're at a crossroads here, aren't you? I wish you luck in whatever path you choose. Maybe making your pro's/con's list will help with the decision?

Anonymous said...

I agree with Sue that maybe a pro/con list would be good. But at some point, its just that leap into whatever direction you pick. And that's scary. As someone with no animal experience (neither domestic nor husbandry) I'd think it makes good sense to invest up front in preventing sickness rather than dealing with the fall-out after, and I'd pay for that!

Is there a way to test waters? For example, adding the herbal treatments and seeing the reaction of your clients? Offering certain treatments as an adjunct to the practice? That might help determine where the need and direction lies?

hickchick said...

--my plan was to take an on-line herbalist course over the winter and then play with growing medicinals and creating tinctures, etc for personal/family/friends use before ever considering using them professionally. There is even a professional certification available from the Veterinary Botanical Medicine Association. I just need to figure out where to focus my energies so I actually achieve something rather than flail around!