And the job search continues

I had 4 interviews in Minnesota and Wisconsin this week -- 2 initial interviews at hospitals in the Twin Cities area, and 2 all-day working interviews at hospitals in Wisconsin.

The working interviews are definitely a huge help in getting to know a practice. I'd previously had phone interviews with both of the Wisconsin practices, but that just isn't the same as spending all day with a hospital owner, their associates, office/practice manager, technical staff, and receptionists. It's a nice opportunity to see how everyone functions as a team (and how much yelling there is).

The shorter interviews I had in Minnesota were also helpful because it's nice to talk to people in-person instead of on the phone, even if it's only for half an hour or an hour. In both cases I got to talk to the practice owner along with either several associates or the practice manager, and in one case they showed me around their building too. Though I quite liked one of those two hospitals based on that brief interview, I would certainly want to arrange a working interview before committing to anything.

I could probably type for 3 days about all my interviews this week, but instead I'll summarize some of the "DOs" and "DON'Ts" I encountered this week:

Things I like to see or hear:

* Performing "COHATs" (Comprehensive Oral Health Assessment and Treatment) instead of "dentals" (#2)
* Having digital dental radiographs and actually using them (#2)
* Having ultrasound and using it (#2)
* A well-trained technical staff that is comfortable starting out the appointment, getting a TPR, obtaining a relatively accurate medical history, and doing a ton of client education (#1 > #2)
* A working relationship with the local humane society, within reasonable bounds (#2)
* Requiring or strongly recommending pre-anesthetic bloodwork on all patients (#2 > #1)
* A dedicated CVT assigned to every anesthetic case (whether surgical or dental) solely to monitor anesthesia (#1)
* Multi-parameter monitors including SPO2, EKG, pulse, and blood pressure (#1 > #2)
* Regular use of opioids as pre-emptive and peri-operative analgesia (#1 = #2)
* Hospitalizing patients overnight with no staff present as long as clients give informed consent (#1 = #2)
* Willingness to adjust anesthetic protocols based on an individual patient's needs (#2 > #1)
* Approach to diagnosis and treatment that actually includes seeking a diagnosis before randomly trying a trial treatment (#1)
* Recommending (with decent client compliance) screening bloodwork on healthy patients (#1)
* 3-year vaccine protocols (#1 > #2)
* When I ask why something is done a certain way, the reply includes a reference to a peer-reviewed study or a discussion with a specialist (#1 > #2)
* Ability to run a lot of bloodwork in-house, combined with daily pick-up service from an outside laboratory (#1 = #2)
* A lobby that smells delicious (#1)
* AAHA accreditation (#2)
* Being within a 1 hour drive from the nearest referral 24-hour care facility (#1)
* Having a technician on-call every night to help the DVM on call (#2)

Things I don't like to see or hear:

* Not performing an otoscopic exam on two patients in a row where such an exam was clearly indicated (a dog presenting for scratching the ears, and a cat presented for routine physical but with a lot of otitis found on PE) and instead saying "maybe next time" (#2)
* Giving all SQ injections between the shoulder blades, even in cats (#1)
* Having digital dental radiographs but admitting they are rarely used (#1)
* "The other practices around here don't really like us." (#1)
* Placing an IV catheter but not using IV fluids for "routine" surgeries (#1)
* Watching 3 certified technicians take about 6 total attempts to place a 24g IV catheter on a well-behaved cat (#2)
* Dentals performed by one lone technician in charge of monitoring anesthesia while also performing the dental cleaning and taking all the xrays (#2)
* Ignoring really crappy blood pressure readings on a patient based on the fact that their pulses feel okay; never monitoring blood pressure at all during a cat spay (#2)
* No place in the main treatment area to house hospitalized pets so someone can actually monitor and observe them (#2)
* Not having anywhere in exam rooms for the doctor to sit, resulting in either squatting on the floor or looming over the client (#1 = #2)
* A lobby that smells like eau-du-disinfectant-over-cat-pee (#2)
* Being 2 1/2 hours from the nearest referral 24-hour care facility (#2)
* Having an on-call schedule that includes 2 weeknights every week and every 3rd weekend (#2)
* Having an on-call schedule that includes 1 weeknight every week and every 4th weekend (#1)
* Not having a technician on-call to help with overnight and weekend emergencies (#1)
* The possibility of being expected to work a regular Sunday shift (#2)
* Observing a technician doing the initial check-in on a wellness exam and providing the client with complete misinformation about the hospital's puppy vaccine schedule and when to spay/neuter, and being repeatedly unable to convert between "14 weeks" and "3 1/2 months" (#2)

Both hospital #1 and hospital #2 had a lot of the pros and some of the cons. Overall, though, I liked hospital #1 better. I just feel like more of the "cons" that I found with hospital #1 are things that I could work around or do my own way. If I'm the one giving vaccinations, I can control where on patient's body I give the injection. If the practice has the physical capability for dental radiographs, I can talk to my clients about how important they are and see that they are used when needed (at least on my patients). As long as IV catheter is placed, fluids are available, and blood pressure is monitored, I guess I could live with not actually having fluids running in a young healthy patient with adequate blood pressure during a short procedure.

But with regards to hospital #2, I'm not sure how I feel about a hospital owner who feels it isn't "worth the effort" to do an otoscopic exam on a well-behaved, friendly pet with ear disease. I don't know how much I could do about a team of 3 CVTs who require 30 minutes to place and IV catheter on a health, friendly pet. I think it's incredibly dangerous to have a single technician trying to do a dental and monitor anesthesia at the same time, especially when my own observation shows that the CVT is ignoring (or just not noticing) some potentially alarming things with the anesthesia. Similarly, I think blood pressure is (in many cases) the most important parameter to monitor during anesthesia, particularly in cats, and particularly in the cat I watched who received acepromazine (which induces hypotension) as a pre-med and propofol (which also induces hypotension) as an induction drug and isoflurane (which also induces hypotension) as a maintenance inhalant.

Anyhow, I guess it's all moot unless I get offered both of these jobs at the same time. It sure goes to show the importance of working interviews, though, since I liked both of these practices quite a bit based on brief phone interviews and wouldn't have guessed at some of their differences.