Seeking out adrenaline: pursuing a career in emergency and critical care
This year I have reached the milestone of being qualified for 20 years, with over 15 years of those spent in emergency practice. When I first graduated, emergency and critical care (ECC) was an emerging field with job opportunities usually reserved for experienced small animal vets or thrust upon interns in academic institutions covering overnight shifts.
I wandered into the world of ECC by chance, without any specific interest in the area; however, from my very first shift, I was bitten by the bug. I became hooked on the adrenaline rush that comes from working on life-or-death cases, the pace of decision-making and the collaborative benefits of effective teamwork. Time spent on shift seemed to fly by and I gained experience at an exponential rate compared to my previous roles in small animal general practice. Without the routine vaccinations and minor ailment caseload, the acute cases racked up quickly.
However, there were some hurdles to navigate as there is no getting away from the reality of shift work. Prioritisation of sleep, maintaining hobbies and social commitments required a new perspective and my life changed completely in more ways than one.
For me, the reasons to love ECC are exactly the same reasons to loathe it! It is a little bit of everything – medicine, surgery, client care, teamwork, leadership, etc – but generally more towards the sharper end of all those things. You frequently need to step outside your comfort zone, which can sometimes be unsettling; and working overnight shifts leads to a different kind of team dynamic, which can ultimately produce rock-solid teamwork. Making a difference in life-and-death cases is truly one of the most rewarding parts of veterinary medicine for me, but it does come at a price, as the die is not always cast in our favour. However, working in ECC has always provided bucketloads of anecdotes and amusing stories that bring a smile to my face, when needed.
Although remuneration is often generous in ECC, working patterns can vary and the workload can also be challenging. I have yet to meet a vet who works in ECC long term purely for financial gain. It’s more likely to be the lure of challenging clinical cases, the cut and thrust of the unexpected and the opportunity to work in close-knit teams that keeps most of us in the job.
Routes into ECC
So, if you find yourself turning off the main thoroughfare of general small animal practice and want to move into small animal emergency practice, or if you are a student with a special interest in ECC, what are your options to enter this rewarding field? Nowadays, there’s a world of possibilities to choose from, in terms of pursuing your interest in ECC. The different routes into ECC aim to satisfy different career timings and aspirations.
Discipline-specific internships are available in ECC at both academic institutions and private referral hospitals within the UK and further afield. Although these internships will differ somewhat in their delivery, in general they will provide a foundation for those wishing to pursue specialist training in the future or for those keen to increase their knowledge and experience for general practice. In many cases, a previous rotating small animal internship or experience in general small animal practice is desirable, so this may not be a route open to newly graduated vets. The internship route may pave the way towards residency, which usually consists of a three-year commitment at an academic or referral institution. There are several institutions in the UK offering residencies in ECC. Once a residency has been completed and specialist examinations passed, a specialist in ECC can expect to work a mixture of day and night shifts in practice as well as pursuing other interests such as teaching, coaching and research depending on the job description.
Another route to consider is entering primary care emergency practice. This is a distilled version of general practice with proportionally more acute presentations, with all that accompanies those, from heightened emotions to rapid decision-making with limited information. Many vets may develop an interest in ECC after several years in practice and may have already gained experience in dealing with common emergencies.
There are several out-of-hours providers in the UK offering positions for vets seeking out the dark side. Some employers offer a more supported route and one of these is the Cutting Edge programme, run by Vets Now Ltd. This programme was established in 2010 and is an induction training programme for recently graduated vets wishing to transition into emergency practice. The programme is a blended learning experience with six weeks of small group learning, practicals and seminars, and four weeks of workplace-based learning within a clinical setting. Vets Now also offers the shorter AdvantEdge programme, which is aimed at vets with a solid experience base wishing to transition smoothly into emergency practice. I am currently the Head of Vets Now’s Edge Programmes so if I didn’t mention them, I really wouldn’t be doing my job properly, would I?
Further afield in North America, Blue Pearl offers the one-year emERge training programme for newly graduated vets interested in becoming emergency clinicians.
Whether a supported route appeals to you or you would prefer to jump straight in, there are options for everyone. Once you gain some experience, you may wish to pursue postgraduate certification in ECC and in the UK there are a number of providers. Gaining a certificate in ECC expanded my own clinical knowledge and my confidence improved as a result. That provided the springboard for me to become an Advanced Veterinary Practitioner in ECC, which in turn opened up many career options and offered me the opportunity to explore non-clinical and teaching roles within the sphere of ECC.
If you decide to take the leap, a growth mindset – as well as blackout blinds and a comfortable pair of ear plugs! – will take you just about as far as you’d like to go down the winding path of ECC. I can’t imagine what I would be doing now if I hadn’t stumbled into ECC all those years ago. It has already provided me with a lifetime of witty tales, a wealth of experience, a huge appreciation for the entire veterinary team and a wider perspective on the veterinary profession. Although it has not always been easy, it has always provided fresh challenges and for that I am truly grateful.