Hello, it's Anthony Chadwick from the webinar that we're very fortunate today to Deborah Thompson, who's going to be speaking to us about tips and tricks from the locum trenches. Deborah does locums, but she does a lot, besides as well. She is a Tufts graduate.

She's got a DVM from Tufts plus a certificate in International Veterinary Medicine. As well as holding practise jobs, she also worked in Washington DC for a year as a congressional Science and Engineering Policy fellow. She is the chair of the One Health, education subgroup of the World Veterinary Association, and she's also a published author.

Her book The Art of Science Communication came out fairly recently. I'm sure we'll have a chance to also talk about those things as well, but . Deborah, thrilled to have you on and looking forward to some of your thoughts on that tricky job of moving into a practise that you don't know and working seamlessly and becoming very quickly a part of the team.

So over to you. Thank you so much, Anthony, and it's a pleasure to be here. Good evening everybody.

I'm calling in from the Washington DC area. So as you can see, it's a bit light out here, but I do appreciate being with you at any time, day or night as it is whoever you are on this planet. So welcome.

I'm Doctor Deborah Thompson. I have been a locum vet technically since 2013. I'll go into exactly what my career trajectory has been.

A lot of people have said that my my career is, is quite vast, and you know why it's vast? It's because I allowed myself to get out of my comfort zone and become a locum veterinarian. Yeah, on my LinkedIn page, I think it, it mentions the World Veterinary Association, but also I founded an organisation called One Health Lessons, excuse me, I wrote a book, I did policy work and doing first responder work and things like that, but it would not have been possible if I had a typical 9 to 5 or, you know, in our profession 9 to 9 job, .

So let's dive into how locum work can suit your needs as a human being, right? I mean, that's why we do it. We do it mainly for the flexibility, but let me just briefly tell you a little bit more.

The reason why there are these 3 dots in the United States is that these are the 3 states or these 3 areas where I have worked as a locum veterinarian. So, one thing in common, regardless of whatever species you are working with. You actually are truly working with people.

And that's what makes locum work fun because you don't know who you're going to be working with one day to the next. There is a book that Anthony just mentioned, The Art of Science Communication. The subtitle is sharing knowledge with students, the public, and policymakers.

This is particularly, interesting for newer grads, graduates who are veterinarians or clinic or physicians or any other scientists. That's right out of school, and they're having difficulty communicating medicine to their clients. To the people who really are going to be the decision makers.

You can't practise high quality medicine unless you can educate, I don't like saying convinced, you can educate your clients to then allow you to do the lab work, to do the procedure, and to allow for enough time for recovery. So this particular book, sharing knowledge with students, the public, and policymakers, it definitely touches upon some skills that I have acquired through the last about 10 years or so, last decade in veterinary medicine and beyond. So let's talk about a few different qualities of locum work.

Now, if you're in this in this venue, you're probably already a locum worker or you are considering to be a locum worker. Let's start with the pros. Flexibility.

Oh my lord, flexibility is absolutely amazing. Oh, I want to take 5 days off? Great.

I'll just clump up some days in advance, and then I'll take those 5 days off, or those 2 weeks off, or those 3 months off, right? You can do that. You cannot do that and expect to keep your job, oftentimes if you are working at a place full time.

Flexibility and not just the day, but the hours. So I started off working as a locum veterinarian, and I did full days, it was 8 to 6, but of course I stayed after to do paperwork because these days were quite busy. And I was paid by the day.

And the hospital surely took advantage of me on that front, because sometimes I was there for 12 hours, 13 hours, finishing up my records. And so what I do now is I say, OK, I'm 9 to 6. I do 99 in the morning to 6 p.m., but at this point in my career, I get paid hourly, and we'll talk about that shortly.

But I do that because if I have to stay after hours to finish up the medical records, to make phone calls, you know, to call back lab work and interpret lab work and all that, I get compensated for it. Flexibility. This is the beauty of veterinary medicine.

Have you ever heard your human medicine counterparts say something like this? Well, I could work in shelter medicine or emergency medicine or GP. And after I was finished with my veterinary school, I did an internship, that, as some of you, may have experienced, it was a quite a year.

It was 80 to 90 hour work weeks, and it was very heavy on emergency medicine. It was, it went pretty soft on the general practise though. So when I finished the internship and I got a position in a general practise, I felt like I was learning a whole new language.

Don't know if you can all relate to that, but it is very true. And later on if you want, we can discuss timing of when to start going into locum work. When is it the most efficient for your time, for your energy, and for your skills.

Another pro is, if you don't like a hospital, you cannot go back. Easy, easy. And you decide to pay.

So my question to you is, how would you use your free time? What would you do with your free time? What I have done is I created that organisation, One Health Lessons, and you're welcome to go to onehealth Lessons.com and explore that website a little bit, but it's combining my two passions, education and one health.

And in case you're not familiar with One Health, One Health can be explained in two different ways. It's the interconnection between our health and the health of the environment, animals and plants. And the one health approach is teamwork between people with different backgrounds, disciplines and strengths to prevent and solve health problems.

So, One Health and education, they're my passion, and you know what, I get to practise that passion in a clinic on a daily basis. Why? Some people ask, well, how does one health pertain to a small animal practitioner?

Well, if you are talking about doing cultures instead of just throwing antibiotics around, And you're talking about antibiotic resistance or antimicrobial resistance, and that's definitely a subset of one health. If you If you have a patient that needs flea and tick preventative, And you see that there are two options, a topical version or an oral version, and you hear that there's a toddler in the house. Well, you certainly don't want to go with the topical version because toddlers go with their hands everywhere, including in their mouths, right?

So it's that one health mindset. You're not just thinking about the patient in front of you, you're thinking about the family where this patient lives and the environment that's shared between all of the living organisms in that home. So that's how I spend my free time.

I create lessons about one health and those lessons have gone around the world, which I'm very, very grateful for. But challenges of locum work, right? It's not all rainbows and butterflies and unicorns.

There are some challenges, and when people say, come up to me and they ask, do you think it would be right for me? I say, well, it really truly depends on your personality, it depends on your comfort level, not just of clinical medicine, right? But also, Your comfort level in being in new environments and especially sometimes uncomfortable environments because in clinical medicine, you know, sometimes there are really difficult conversations we have to have with clients or, you know, sometimes with staff, but what are the challenges that are unique to locum work?

Well, I used this as a pro before, but really, how do you decide the rate? Do you actually figure out, OK, I want to be paid by the hour, by the day, some local marks, not very commonly, work off of commission. And then do you get paid for after hours?

If you get paid by the day, then you're not gonna be paid for after hours, typically. That's why I switched the hourly, and What I've seen is with a lot of hospitals, especially that are owned by managers or business people, they do understand that, of course, you need to get paid for the time that you're working. So that, that's a bonus, whereas, in some cases where it's a veterinarians, owning or being your manager, you know, sometimes they say, well, I, you know, I worked for decades, without, without this, so then you won't.

So, you know, it totally depends on the situation, . But happy to discuss further. I have not had much experience as a locum work working in large corporations.

I personally, have been trying to avoid those, but again, we can discuss that later. Challenges for this, at least in the United States, I'm not sure how it is in the UK, Great Britain in general, but budgeting, we have to take care of our own retirement funds, right? We have to pay our taxes and the taxes are quite substantial for independent contractors.

There's health insurance you have to think about, malpractice, life insurance, and then licencing fees. But then also we have to pay for our own continuing education fees. So it's something that you don't necessarily jump in too lightly.

You have to have a game plan if you want to be successful as a locum worker. And some other challenges is that Ultimately, as a good thing, you control where you work, as in you can leave when you don't want to be there, as in you don't, you don't wanna go back to this to the hard or difficult situation in the hospital, so you can go to another hospital. But really is where do you work?

Sure you can control where to work, but how do you find that work? Now, I have never worked for an agency. I have always, Whenever I moved to a new place, I went door to door or I did cold calls.

I took 1 or 2 shifts and then by the end of either the first shift or the second shift, they see how I work and then they book me for months at a time, that's typically the way it goes for me. But here are a few techniques, OK? Where to work, how do you figure out where to work?

Well, if you already know the area, you didn't just recently move or relocate, then ask around. Ask your, if you're not comfortable with your your speaking with the colleagues who you are working full time with, say, if you're transitioning to local work, then I would say look at any recent job postings in the area. Listen carefully when you are going to continuing education meetings and see what the chatter is.

Now, a really easy way to figure out where there is extra help needed is to look at the full time or the part time. Requests in some job posting sections. Certainly in the United States, the American Veterinary Medical Association, so I'm sure the British Veterinary Association has an area of their website where you could find job postings.

But even if you're not particularly interested in full-time work, well, you already know that they have a need for a veterinarian at that hospital. So you approach them, say, that you're a locum worker, and then They'll book you for a few shifts. And then see if it's a good fit.

It's not just a good fit for them, it has to be a good fit for you. And cold calls, cold calls, . Cold calls can be quite intimidating at the beginning, but the way I say it is, just say hi, I am a, a locum veterinarian in the area and I've heard great things about your hospital.

Is there a manager that I can speak with? And the thing is, if you don't speak directly with the manager and they say, oh, that person's busy, then be sure to get the name of the manager and the email. The email is incredibly important because then you have documentation.

If they ignore you, for instance, then you could just hit reply and try the next week, and maybe they just missed you, maybe they were on vacation. But that's a really good way to highlight with your CV attached in your cover letter, what you can bring to the hospital. And I would say when you really don't know the clinic or the hospital from any other hospital, just commit to 1 or 2 days max.

See if you like it. If you like it, book as much as you want. If you don't like it, Don't worry about it, just move on to the next one.

Now, you have identified a hospital that you want to approach, you see online in the job posting sections that they're looking for a veterinarian. OK. What do you, after you introduce yourself and they in the hospital expresses interest in hiring you for 1 or 2 days, there are certain things that I truly recommend you discuss prior to that, to stepping into that hospital.

If you are incredibly glorious at surgery, wonderful. I still don't recommend it on the first day. Why?

Because you don't know the skills of the support staff. You don't know what medications are in the hospital. So I, I, make it clear, with the manager or whoever's hiring me that I'm totally fine doing surgeries.

I just don't wanna do it on the first day. I want to understand really what's going on in the hospital, get my bearings, and then I'd be happy to do that. Set clear expectations for the appointment time.

30 minutes, 45 minutes? 20 minutes 15. See what is the normal for that hospital.

And if you're not comfortable doing that particular duration, tell them before the first day. If you like to have breaks between every 5th or 6th patient, tell them. If that's not their thing, then it might not be a good fit.

You have to do what makes you comfortable, right? And when I practise medicine and I try to do this in all walks of life, but I, I wanna do things that make me sleep well at night, you know. So try to have some clear expectations for the durations of the appointments.

And also that goes along with species. If you're not comfortable working with a certain species, discuss that before the first day. Know the equipment, know the limitations.

What do I mean by that? So I usually ask the manager or whoever I'm speaking with, say, if I have a cat that's blocked. What, what would the steps be in that hospital?

As in, can we run in-house lab work? Can we, Do we, do we ship them right away? Do we have overnight hospitalisation?

You know, you can get a lot of information that way. Do you have, and for dentals, do you have digital dental beds? You know, what type of ultrasound equipment do you have, things like that, right?

Just know what you're walking into, so you can be as comfortable as possible and the staff skills, . I wouldn't say necessarily ask something like, you know, how long has the staff worked there, because that doesn't really give you much. I would say.

What is the flow? I would leave it nice and general. What's the flow of a typical day between the support staff and the veterinarians?

And then the manager would say, oh well, you, as a vet would have, you know, 22 techs helping you, and then if there's surgery, then, you know, and they walk through it. But with that answer, you can have a better understanding of what are the skills of certain staff. And oftentimes managers are very honest.

Sometimes I hear, you know, we have a fresh staff. If you need to have an IV catheter placed, it's only 1 or 2 people in the hospital who could do it. And so that's really important to know, walking in.

And of course, I'm not gonna underemphasize this, this is really important. Figure out, do you want time for your overtime? If you have a set, your shift ends at 6, but you're there until 7, are you gonna be paid for that extra hour?

I know the attire. You don't want to be walking in scrubs if the general The general culture of the hospital is that the veterinarians are in business casual, for instance. So try to be a chameleon as best you can.

Now, I want to hear from you with a pole. I want to know why do you think we would want to review the hospital website before the first day? This is after you've already negotiated with the manager, you've already set the expectations.

And the question is, keep in mind what is likely not the reason, not the reason. So I think people know how to use the poll, just obviously there aren't that many using it at the moment, but just, you know, put what you think is, I think you, I'm not sure with this one if we can answer more than a couple of questions, so there may be a couple that you can actually . Put something down.

I think it's interesting also if people do look at the website, cause we, we've had 75% to see if the clinic has a hospital cash, which I can't see the point of that. I mean that is, it's always good to have a hospital cast, and then 25% said memorise staff names, so all these . Cheeky memory games are always useful as well.

So, just a few people have voted, but we've got 25% for memorise staff names and 75 to see if they, if they have a hospital cast. Oh, we've got to review the background of other vets as well. People are voting, it's just a bit behind.

Know the location, 17%, memorise staff names, 17%, review the background of the other vets, . It's changing all the time here, people have, have finally answered, so we've got no the location 29%. Memorise staff names 14%, review the background of other vets 14%, see if the clinic has a hospital cast 43%.

There are obviously cat lovers. In the room, Deborah. Awesome, awesome.

Yeah, so why would I want to look at the hospital website before? Because I don't want to be late to the first meeting, right? I don't want to be late on the first day.

And I want to know where it's exactly located, not necessarily for the distance, but for the traffic. If you're taking the bus, I would try my best to get there an hour early just in case the bus acts up, right? But know the location, if you're driving, not only the distance, but how many stoplights are there, things like that.

Don't be late to your first day. Try to memorise the staff names, and the reason why I say that is because The more often you use the names of your support staff, the more they can feel appreciated, and they would be impressed by you, since you would be the stranger coming in and having them be so honoured to be remembered by you. I think it's a really nice thing for the staff to recognise.

The other thing is review the other backgrounds of the vet. So the reason why I say this is because Say for instance, if there is somebody who writes on their website that they are really a proponent of raw diets, for instance, something like that. Well, then I know that I'm not going to be talking about raw diets with that person because I have, I have been trained to avoid raw diets like the plague, .

So, you know, it's one of those situations where you can walk into a A room and work side by side with somebody with a completely different type of way of practise, but that's the beauty of medicine, right? Medicine is an art. So I would say just review best you can, and the awesome thing is if you're from the same area of the world or of the country, and maybe you know the same people.

So that's something to chat up. Now, besides getting lost on the way to the clinic, other things that are important to know where things are, like, where's the crash cart, right? Where's the pharmacy and what's stocked in the pharmacy?

And where do you set up camp? Where do you, where do you, either sit in front of the computer or where do you write your notes? By hand.

Other challenges for locum work, something that we need to think about is how do we as individuals manage our process working with various personalities. Every single hospital I've worked at, and since I've been a relief vet for so long and two very large urban settings. I have worked at At least 20 hospitals, and every single hospital has a culture.

And certainly has different personalities, right? Sometimes the front staff gets along with the text, sometimes they don't. But you know what, you are an objective observer and you are there to provide assistance.

People want to have you there because if you weren't there, then their work would be harder. So I would just avoid any type of gossip. I would avoid any type of Confrontations between the normal or regular staffers and just be as professional as possible.

And I touched upon the styles of medicine, right? My goodness, there are so many different ways to take care of oral hematomas. There are so many different ways to deal with, my goodness, gastropexy, you know.

Is there a right way, is there a wrong way? No, it's an art, right? It's your comfort level.

So it comes down to respecting the the medicine of others, and if there are hard stops, like I like I referenced before, with nutrition or whatnot, then I would say, have the other person bring it up, but not necessarily make you the person to bring up such things. Expectations, every hospital has a different expectation for you. This is something that's worth asking the manager from the start, and I wouldn't necessarily say what are the expectations.

I would say something like, you know, some hospitals want the vets to call the relief vets to call lab work. What's the, what's the style at your hospital? Because I remember one clinic where they really didn't want me to call back lab work, because if they called back, if they call back lab work on their own patients and they had ordered even more tests from that, then they would get commission.

So they did not want the relief vets to touch that. Do you, as a relief vet care for inpatients and or outpatients? What's the setup?

Do you need to write discharge notes for all of the patients, some of the patients, or no, none of the patients? And this changes based on wherever you work. Should there be financial estimates given to every client, some clients, only for certain procedures?

What is the style there? So keep in mind, you're not alone, right? You were invited to come into the hospital, so people want you there.

If you feel overwhelmed, then just ask the person who you met at the start, probably the manager, say, you know, this computer system is, glitching on me. I, I don't understand where I'm going wrong. Can you just provide some help so I can get better at this.

You're not gonna be alone. Nobody in veterinary medicine can function alone. We definitely need support staff, and so we have to respect the support staff, of course, but keep in mind as well that as As many unknowns that you have walking into a hospital, the staff doesn't know you from anybody else.

So they're also trying to feel out your style of medicine, your personality. So on the first day at the new hospital, first impressions really do count. Now, you already got the job, you got there, you you were not late, you actually arrived at least 20 minutes early.

Now why do you think you would want to arrive at least 20 minutes early? On that first day, I do a lot of things. I learned at the hospital physically.

Where's the crash cart, where's the pharmacy? What is stocked in the pharmacy? I do a lot of derm, so what are the ear medications, where are the, where's the microscope for cytologies, things like that.

Meet the staff. And by now, since you've looked at the website, you know some of their names, but of course, don't lead on because that looks creepy. You say, hey, I'm doctor whatever, or if you want to be extra friendly, say your first name and then have the manager correct you and say, oh no, you're Doctor Thompson or whatever.

But at least that gives the staff It puts you in a more relatable position. Understand the medical record keeping system. Oh, that can take a few days to learn sometimes, especially if it's EMR electronic medical records, .

Given my experience working in 20 different hospitals, I know 6 or 7 different systems at this point. And then when it comes to paper records, it comes down to is there a sticker and then you just check off the box and if there's an abnormality, saying lungs, there's crackles on the left hand side, like where do you write that? So, get yourself familiar with the way the The medical notes are that.

And this is really important and it'll certainly Certainly help you, at least in the morning. If you have a lunch break, then you could start to review your medical records for the rest of the day. But if you review the medical records, you'll know which medications the patients are already on.

And also, are they coming in for vaccines or are they coming in for seizure? Well, hopefully not, hopefully not status or anything like that, but you know what I mean. Another challenge that's particular for locum work is that you don't know the comfort levels of some people.

You also don't know the staff dynamics, right, the personalities we touched on before, but you don't want to overshoot or undershoot. Because if you overshoot, you are gonna make a possibly a dangerous situation, right? If somebody's not comfortable or good at handling patients, then somebody might get bit and that's no good.

But if you undershoot, then you insult the staff and that's no good either. So what I typically do at the very start of the day is I listen with my eyes and my ears. I see who is doing what.

I don't necessarily make comments, right, but I just hang out in that area and You know, as Ask questions about, you know, oh, how long have you worked here, what have you been doing before that me or something like that, right? And at the same time, see, are they being productive or You see what I mean? .

See who's the ones placing catheters. See the ones who are, if you're not a sole practitioner in that hospital, see who the other veterinarian has taken into surgery, to see where people are comfortable. But again, it's not just you, knowing, having unknowns, it's them looking at you and not knowing what's going on in your head, right?

And your comfort levels. So here are a few. Different, desirable traits of local workers that I have collected by asking some vet tech friends, from front staff friends, associates, people at full-time hospitals, hospitals full time, and then vet manager friends.

So, The most important thing, I've seen documentation or I've heard things as well that you can practise the greatest medicine, but if you don't respect the support staff, you're not coming back. Right, that's the one thing that managers need. We need to keep our regular staff happy and respected.

Write thorough medical notes. As locum vets, we have seen lots of different styles of note taking. You know how frustrating it could be if you are walking into an appointment and you see that, I don't know, the dog's on Pred and you don't know why.

Is the dog on Pred because of allergies or is it because of autoimmune? I mean, sure they'd be different doses, but you get what I mean. High quality medicine.

And when I say high quality medicine, what I really refer to is solid communication skills because ultimately you could practise the best type of medicine, but if you are not communicating well to the clients or communicating your your needs or your wishes with the support staff, or documenting everything that you have recommended and offered to the clients. Then how would the next person taking over your case know what type of medicine you were practising, right? So, in the United States, and I think this is the same thing for Great Britain, but we have a soap subjective objective assessment and plan.

In the plan, I always write exam and then I I say the vaccines and then I say review. And I always go over possible signs of vaccine reactions with owners. Also, I talked about fibrosarcoma with the rabies vaccine and FELV vaccines, just so that they know what to be on the lookout for.

I also write down recommendations. I also say if the owner's declined anything, and I also say to go home medications and diagnostic. So I spell that out in a really straightforward manner.

Again, know the patient's histories before entering the appointment room. The clients know if you don't know the patient's history. It's, it's obvious to them.

So do your part and try to have as a, as a well prepared, . Appearance as possible. Now, this is really important for the managers.

The managers truly care about great bedside manner. So sometimes, And you might have found this to be the case too, and this is a very locum veterinary situation. You go into a hospital and you have somebody who's a client who's been there for 20 years, right?

Only sees Doctor R, only sees Doctor R, and was in is taken aback because they are seeing somebody else. Oh, the relief or the locum vet. Ah, oh no.

So they're gonna be in a mood anyway, right? What do you do because you have to walk into that room and evaluate the patient. You'd be as nice as possible, you'd be as confident as possible, and say, it's a pleasure to meet you.

I have reviewed the, the record and it looks like Fluffy is on these medications. Is that correct? So let's confirm the dosing.

And then from there, the owner will be like, oh, OK, well, they actually know what they're doing. It's a nice way to get get some buy-in from the owners and keep a good attitude. Nobody wants to be near a Eeyore from Winnie the Pooh.

Yeah, nobody wants to be around somebody who's so pessimistic, so keep a good attitude and they'll want you to come back. Now, being reliable comes hand in hand with being professional, right? And that goes without saying, but being adaptable, being adaptable is so important, so important, and true, when you work in an emergency hospital, adaptation is crucial because you don't know what's coming through the door in the next 5 minutes, let alone 5 hours, right?

But, with locum work, it's a different type of adaptation. It's a little bit more working more towards your soft skills and furthering your communication skills and making sure that people not only feel like you are reliable, but feel like you are very trustworthy too. Now, here are a few words to the wise.

And this is from lessons learned. So when it comes to euthanasia, every hospital has a different policy. There's private cremation, group cremation, sometimes the, the body goes home with the owners, .

Something that I realised is that some hospitals, the front desk staff say, OK, this patient is coming in for euthanasia. But after speaking with the owners at the very start, it sounds like, oh, they're not set on euthanasia, it's more like a discussion. So don't necessarily trust everything that you see coming in for on the computer system or on the schedule.

OK, so what I mean by that is Especially with euthanasia, make sure that you have a conversation with the owners before having the dog or cat or rabbit or or whatever, you know, get an IV catheter or get sedated or whatever your protocol is. Make sure there's clear communication because you never want to be in that position where they've already paid for the euthanasia, and then you go into the room and the dog's like wagon's tail, right? You don't want that.

So if euthanasia is on your schedule, try your best to be quite thorough in, not only what's the typical technique used at the hospital, but also Make sure that you have a conversation with the owners beforehand. Now, sometimes the, the hospital just says, oh yeah, this, this patient has been circling the drain for a while. But I think the clients would still appreciate just a quick introduction with you and you can eyeball the patient and see if they're really decrepit or not, right?

Take full advantage of your free time. I mean, locum work is amazing for many reasons, but particularly because you are in control of your schedule. So make sure that you have a really good work-life balance.

When preparing a new contract, be thorough. Be thorough. Make sure that you set the expectations.

How long do you want your appointments to be? What species are you comfortable seeing? Are you comfortable doing surgery or not no surgery?

Keep in mind if you do surgery, then you could probably ask for more money. And then also, are you comfortable being paid by the hour or by the day? So, or by the contract, that's a lot more rare.

If you're having any difficulties with clients or staff, OK, we have a few different options. We could. Improve our science communication skills by joining Toastmasters International, that what that is, it's a public speaking club, but you know what, I'd rather call it a communication club because it helps you not only actively listen, but Choose the right words to meet the needs of your audience.

When I first graduated from veterinary school, I was completely surrounded by either medical students or veterinary students, and my language was medicine. You wouldn't want to, you could probably relate to this. In veterinary school, I remember a group of us friends go out to restaurants and we talk about the most disgusting things at restaurants, and I'm like looking around and people are looking at us like, oh my gosh, we need to be more quiet.

I'm sure you can relate because we're all vets, right? But, you know, how, how can we translate medicine? To benefit our patients and to communicate efficiently, well, a good way to practise is with Toastmasters, and that's available all throughout the world.

Also, if you have difficulties with client or staff, speak with the management if you're comfortable doing so. Now, if you have difficulties with the management, then, you know, you can always move on to another place. Don't be afraid to move on because if you created a, a working relationship in one place, you can build a working relationship with another place.

So don't stay in a place where you're uncomfortable or if you feel unsafe, or if you're asked to do things you you don't want to do. There are other places to go, and another great way to, of course, improve science communication skills and medicine skills in relation to communication is by, of course, looking at my book, and it's available on Amazon. I'm more than happy to connect on LinkedIn, and this is my information you can look up, and I'm happy to answer any questions in these last, oh, I believe, 15 minutes or so.

So thank you very much for your attention. Thanks so much, Deborah, that was amazing. I, I think all the time, you know, with VDS when there are problems, the Veterinary defence Society, so our, our insurance company that helps us out when things go wrong.

Almost invariably or very often there is a communication problem. So actually how you explain things, if there is an issue, how you deal with that issue, do you close off and close down on the person, or do you listen to them, let them speak and then actually, you know, see if there is some common ground. How can we sort this problem out?

You know, so communication is, is so, so important, and, I think you did yourself a little bit of a disservice with the book of saying it was only for young graduates, cos I'm sure graduates of every age can get something from, from the book you've written. Yeah, thank you for that. yeah, the previous president of the BVA endorsed the book, so I know, I know that there have been fans throughout any age and generation of veterinary medicine and beyond.

Exactly, and so, yeah, let's go and have a look for it, those people who are listening. I'm, I'm sure there are questions, if people want to ask questions as a small group, if you want to ask them, you can raise your hand, we can get you to, to ask them, personally, or if you want to type them in, then, then I can ask them on your behalf, . But I think it was a really thorough, talk and a walk through what you should be doing.

Obviously I know some of the locums on will will be quite experienced locums, but nevertheless, I think it was still really good to go over those, some of those points, and some of the things were things, you know, again I, I hadn't thought of, so thank you so much for that. Maybe tell us a little bit, and I know you talked about it a little bit, but I. I think we have an obligation as as vets.

We're often seen as leaders in the community, we're looked up to, certainly in our roles, potentially as, as teachers, and I think probably most of us have been into a class at some point to tell people what being a vet is like. Or I know I went in to talk about actual plastics in the oceans and was able to say as a vet how disappointed I was because that harmed animals as well, so. I, I, and I think also for our role that we can play in being sustainability champions, which I think is so apt and important and very sort of in the news at the moment with COP 26.

So it's . Some, some, some points there maybe that people want to, to look at. We've got here Charmaine is asking a question whether you want to include some of the one health in a moment, but Charmaine saying, what do you recommend when practise policy is not the type of medicine that you are comfortable with, i.e., elective caesareans, are currently a major issue.

Yeah, and I've come across that. That concern as well. So thanks Charmaine for saying that.

What I would say is, especially if it's elective, then you could say you don't want to do it. You don't, you don't feel comfortable. I have never docked a tail in the US.

We, we do that sometimes, but I have never docked a tail. I've never declawed a cat. I've never cropped ears because it doesn't sit well with me.

And sure other other people it works fine, but for me, that's, that's my, that's my line in the sand. And so if it's really important to you, then at the start before your first day, right? Just say, you know, it's just important to have open communication, and I say that because, once the manager hears, oh, she's, he or she is, she's in communication, it's a nice thing, so I say open commun.

And I'm happy to have a conversation about this, so it doesn't sound like you're directing them, but just say, I'm not comfortable, doing certain procedures and they are blah blah blah blah. And then oftentimes if they are reasonable people, they would say, that's fine, we'll just book that with other people. Mm And of course often things like tail docking, it may be very much a, a whole practise thing.

I never. Also dock tails, the only time I had docked tails was because of an injury where I had to amputate a tail. Later on.

I, if I may just make a little punch, I mean, I think. If, if, and I think this is where you're saying an elective rather than than caesarean, sometimes, you know, a, a, a bulldog comes in, it needs to be, you know, it needs to have a caesarean. I, I think it's difficult because then we've got to look at the welfare of the animal in the here and now and you know, I absolutely agree with you that we shouldn't be, we really don't want to have lots of clients who are breeders of bulldogs and French bulldogs and so on.

But obviously in that short period, if something comes in and, you know, if we don't do it, the, the dog may have an issue or a problem, then, you know, I think that brings another, point across, but I know you made that particular word of elective in there, so, you know, I get that as well, but that would be my only other comment around there. Yeah, absolutely. I mean, like I said, I do things that make me sleep well at night.

So if it's something that will, you know, hurt, hurt a patient if I don't do it, then of course, I'm gonna, you know, say the patient or, or whatnot. But also, you know, think about your well, your well-being, you know, make sure that you are comfortable practising the medicine that you want to practise. We've just got another question there, how do you negotiate a rate when you go in, you've presumably got an awareness of what the rate is in the area, have you, Deborah?

No, not when you first moved to an area. So I was living out in California and then I moved out to Washington DC, that would be like 5000 kilometres away. I had no idea, no idea.

So I can say when I first started doing relief work in California, I let the first hospital tell me what they would pay me. And then, you know, I didn't argue with them or anything. I didn't negotiate because I just, I wanted to see how it was as a local.

And then the next hospital I bumped it up a little bit, and then the next hospital I bumped it up, and I just wanted to see where it was the cap in the area. Yeah. And I was really surprised how how much I was lowballed the first time.

This is true. I think it's really interesting, you know, we're obviously doing a lot of the payroll stuff now, so we have a new tax system called IR 35, which is. Really forced a lot of locums who may have been self-employed into employed status, and there are companies called umbrella companies, often they're not veterinary run, in fact they're usually not veterinary run.

And obviously I'm very passionate about the fact that, you know, we are struggling with human resource, you know, with vets and nurses within the profession, we've had Brexit that's happened, so a lot of European vets feel less comfortable coming to the UK and, you know, I can't blame them. Whenever I met a meet a European now, I, the 1st 5 minutes is me apologising for for leaving Europe. Even though I didn't vote for it, I do feel rather embarrassed about it.

So, . We are in a a tricky situation in the UK, but I think, you know, I've spoken to vets all over the world and I think there is, you know, a shortage of vets worldwide, or a shortage of vets who are out there working, you know, in, in practise, and obviously we've had the pandemic which has changed the whole way that we work as well, so we've we've had difficult situations there. One of the points that I would say about wages is we've just seen that our inflation rate is at about 4% instead of 2%.

And we're definitely seeing within the market, wage inflation as well. So I think we just need to, as locums be aware of that, that we don't want to push that too far because we can end up killing the golden goose as well, because I think we are paid well as locums. So we've just got to make sure we get that balance right would be the, the point I would make as as somebody who's in the UK and kind of is.

Seeing the situation on the grounds, and I, I know it's probably, you know, different in America. Yeah, it does sound different. Yeah, I mean, I wish I had somebody tell me, you know, this is the this is the general range of what would be acceptable in this area.

I was, I was coming with nothing, no information, so I had to work up, you know, based on experience in that area of the world. I think it's also interesting, Deborah, because I've seen sometimes some of the . Pay situations in America and actually, the American vets are, you know, whether they be in general permanent practise or as locums, but certainly in permanent practise they seem to be getting paid, Better, and I think somehow cor corporatization has happened and it has maybe, Ended up giving us a ceiling on which it's difficult to get above, and obviously we've got some very experienced locums in the virtual room.

It'll be really interesting to see what people are thinking in the room or whether I'm. Saying things that people disagree with, but my opinion is that American vets are, are paid better than UK vets at the moment. So that that's just something that, that, that's interesting as well, there's another question come through.

Let me see what that is. How much experience do you think a vet should have before they could consider being a locum? I get asked this many times when I go to different practises.

I personally had 2 years' experience, but then I have a slightly older vet and had a great lot of experiences in those 1st 2 years. I, I would say minimum 2 years. I do not recommend locum work for a new graduate.

No, no, no, no, no, no, no. I also don't recommend locum work. To somebody right out of an internship if that internship was like mine, where they didn't have GP experience or minimal experience.

So I, I would have considered locum work in the emergency setting right after my internship because of the amount of hours I was there. But if you're going to do locum for General practise, be comfortable with clinical medicine, and, I would be at least 2 years out of school to even start that because you have to be really efficient. You need to know your medications.

Oh my goodness. The medications that I know right now, some people ask me, oh, this flea and tic preventative, what, what is that? And I knew it from like 5 hospitals ago.

You know what I mean? It's not like pharmacy that you keep in your head of, oh yeah, the minimum age for that is 8 weeks. Oh, but for that it's 12 weeks, you know, that's, that's how you work.

But you can't do that if you're right out of school and you don't know that, you know, famotidine and Pepcidacy are the same thing, for instance. Yeah. No, I think it, I agree absolutely and I think, you know, the same comment there from Charmaine as well that.

Two years, especially if you've had some really good experience. I mean, my 1st 2 years in practise weren't, weren't so good. I had some bosses that, you know, weren't as supportive as they should have been, and, and that can be difficult.

Luckily I found, you know, a nice boss after that and it was it went a lot better for me, but those first two years were, were tricky, so it's great you had a, First two years where you've got lots of experience, because I think that's what we want, we want to be kept busy and learning how to do bit space and cat spaces and so on, and, and being able to go into a locum practise with those skills, as you've said, allows you to charge more than if you just go in and, and you, you know, you can't operate or whatever. Yeah, yeah, absolutely. The more skills that you have coming into a hospital, the more you'll be sought out.

So say if you like dental, or people will want you to work for them, for instance, or if you like exotics, right? And the only way you get that is in is in practise because of course. When I did, my degree there was very little dental training, and I don't think it's improved nearly as much as it should have done when you consider how much dental work there is in veterinary practise.

Right, right, yeah, same thing for me. We started the dental club in my year, to give you an idea because we saw that the, the amount of dentistry in general practise was incredibly high, but it didn't match our education. Yes.

Yeah. This is sometimes the problem in in university. I don't think I ever saw a dental operation in university.

But you see the more complex operations, but then you're, you know, a lot of the stuff that you see in GP practise is, is more routine, but if you've never seen it or done it, then of course it's not routine, it's difficult, isn't it? Absolutely, absolutely. I remember the first nail avulsion.

I'm like, I don't know how to do this, and then my, my supervising vet laughed at me. I'm like, I didn't see this before. Like I saw hit my cars all the time.

I didn't see this, you know what I mean? So you know it comes with experience. Yeah, great.

Don't think there are any more questions, do, do sort of feel free to. Feedback afterwards via email for us, you know, we're, we're, we're wanting to do these, for our locum community. You know, it can also be quite a lonely job, Deborah, can't it, because, you know, you're in a practise for two weeks, you move on.

It's hard to create those relationships necessarily, so we want people within the Simply Vet community and with within the larger webinar vet community as well, for those locums who do a. 10 shifts or more a month, we give them free membership of Webinarest. So we want you to feel that you know, we're somebody that, that you can come to that that it's a home, it's a friendly place for you, so, really appreciate people coming on today, obviously really appreciate Deborah you coming on as well.

I would just remind people. We do the vet chat podcast pretty much every week, there's 1 or 2 episodes coming out. I was with Deborah earlier on, chatting to her and doing a podcast which should come out in the next few weeks, so do look out for that.

And, just finally, you know, those of you who are working with Simply Bet, do let us know how we're getting on and if you're enjoying working with us, feel free to tell your friends about us as well. Deborah, thank you so much. It's not too bad, it's half or where you are, still just about lights.

Thank you for sharing so much of your day with me and I look forward to seeing you soon. Such a pleasure. Thank you for this invitation, and I wish everybody a good night.

Take care, bye bye.