Opening the door to emergency medicine

Over the past two years, many people have reassessed their careers to ask themselves: What do I really want from my job? This reshuffling led to new opportunities, including for Emily Dozeman, DVM, DACVECC, and Erik Zager, DVM, DACVECC. A friend and fellow veterinarian invited Dozeman and

Zager to lead the newly created Philadelphia Animal Specialty & Emergency (PASE). Dozeman explains, "We came from corporate hospitals that were hit hard with COVID and we didn't feel supported. We all left our lives and said, 'OK, let's do it.'"

Every employee counts

Opening a new veterinary care center was, of course, not without its challenges. Coming from larger hospitals, Dozeman and Zager were familiar with already-established management structures. At PASE, they had to build that from square one, considering how to make the structure as best as possible for all employees.

Being staffed round the clock raises the unique challenge of making sure every employee is heard. "We make sure we have representation for employees who work overnight, so they don't feel they're being ignored or devalued because changes are made by the people who are there during the daytime and who may not appreciate what's happening overnight," explains Zager.

Because the hospital is open 24/7, it became more of a juggling act to make sure there is always a shift lead, someone who is the go-to person in a crisis. Dozeman and Zager worked some overnight shifts themselves, to build a sense of camaraderie with all staff.

As a full-time clinician on the floor, Dozeman says, "I know exactly what's going on and I can relate to my staff with their issues." She and the other leaders foster a collaborative environment where everyone pitches solutions to problems. There is no disconnect between everyday patient care and what is happening with management. As emergency doctors, they had an intrinsic sense of urgency. "We had to learn to take a step back, to think about how to approach a problem and how to roll out the solution. That's been a learning experience," admits Dozeman.

The emotional cost of emergency care

Some of those recurring problems — not just at PASE but across veterinary medicine — are burnout and compassion fatigue. Given the higher volume of euthanasia cases that emergency care veterinary practices see, these emotions can have an even stronger presence. General practitioners may have the agility to send cases to the emergency clinic and in essence, step away from the situation. But then the emergency clinic staff are left with the burden of delivering bad news to a pet owner and dealing with how the owner handles the news.

Dozeman says, "It can take a toll on us because a lot of times in emergency medicine, people can't afford the care that's offered. So, we have to be OK with giving them other options. And I think our staff does a really good job being that support system."

A social worker came to the clinic to talk with the staff about compassion fatigue, burnout, grief, and loss. "It validated our feelings over pets that were not their own," acknowledges Zager. Those are patients we really invest in, but sometimes, it still feels awkward for us to feel sad about the losses." He recommends other practices provide tools and support for staff to process their feelings and try to avoid burnout.

Educating pet owners

Dozeman asks other veterinarians who show interest in opening an emergency care practice if they truly want to do emergency care or urgent care. She points out, "We're getting to the place in our profession where we need to differentiate."

She likens PASE to the emergency department of a human hospital. Emergency medicine is for patients who need an ultrasound or emergency surgery or who ultimately need to be hospitalized. Urgent care is for issues like ear infections and brief vomiting episodes and cases that doctors can see and treat, sending the patient on their way.

Dozeman advises fellow veterinarians that if they want to treat urgent cases, they also need to support emergency cases. Many pet owners are not clear on the differences and will bring pets with true emergencies to urgent care. Veterinarians must be able to stabilize those emergency cases before sending them to the emergency hospital.

The lack of education on urgent versus emergency care can make it difficult to run an urgent-care-only practice simply because that knowledge doesn't exist among pet owners yet. When opening a new clinic, veterinarians must make extra efforts to communicate to the public what services its offers. Training the front desk staff is another crucial step, so the receptionist can recognize whether the care team can treat a given patient.

It's a relationship-based industry

Veterinary medicine is at its heart, a customer service industry. One way that PASE serves its community is through compassionate care. For patients with pyometra, they offer spaying at costs significantly lower than those of other specialty hospitals. They have also performed C-sections on dogs diagnosed with dystocia. Not only does the hospital get additional business, but more importantly, these procedures mean fewer animals are euthanized unnecessarily. "It's heartbreaking to not be able to help those patients, so we decided we're able to help that community at a cheaper cost," explains Dozeman.

Beyond building relationships with the local community of pet owners, they emphasized the importance of relationships across the veterinary community when starting a new emergency or critical practice. Rapport with general practices is essential, so cases that aren't true emergencies can get to the general practitioner, and conversely, cases that need emergent care get the proper attention. It's all about working together to get the best care possible.

For their part, the staff at PASE are learning their limitations, such as when to send cases to an academic hospital. Zager says, "Opening up an emergency hospital is a big bite. We are realizing how much of an undertaking it is and how important partnerships are."

Another crucial relationship in veterinary emergency care is the one between the practice and its distributor. When a general practice runs out of something, there is typically an on-hand substitute, or they can wait to order. In emergency care, everything is needed now. The practice needs a distribution partner who is responsive, offers a good array of options, and gets them their orders quickly.

"If you are doing your ordering from a bunch of different places, such as eBay for equipment, you'll run into problems where things don't work and you don't have anybody on the other end of the phone," Zager tells his fellow veterinarians. "Having a distributor who is available to help you through a crisis is so valuable for an emergency hospital."