Veterinary internships succeed only when the intern and practice owner work at them.

What makes for an outstanding internship experience? According to interns, it’s not about the money. Rather, it’s about learning and being mentored, so long as that learning is accompanied by a reasonable work/life balance.

From the owner’s perspective, practices that sponsor thoughtful, well-managed internship experiences will be rewarded with high-quality candidates. At the same time, practices that treat their interns as technicians with little regard for the quality of the internship experience may find few quality graduates knocking on their door. Word of mouth travels fast in today’s online world.

“Internships should be a mutually beneficial exchange between the new graduate and the practice,” said veterinary business consultant Amy Grice, VMD, MBA. Dr. Grice was an ambulatory equine practitioner in New York’s Hudson Valley for 25 years and served as managing partner of Rhinebeck Equine in Rhinebeck, New York until 2015, when she opened her consulting firm. She is co-founder of Decade One, which provides supervised networking and learning for regional groups of colleagues. An offshoot program, Starting Gate, presents equine-specific business content to students and interns while helping them build connections and a community.

“The intern works long hours, often for less than half the pay of an associate, and in return must receive focused, intentional mentoring and specific skills training,” she said. “The intern should be exposed to increasing amounts of responsibility and independent clinical experiences, including emergency work. Regularly scheduled journal club, case rounds, and radiology rounds should be a part of the program.

“The mindset of the practice should be taking pride in producing well-rounded, skilled equine doctors ready to successfully undertake clinical practice or a residency position with an experience level that well exceeds that of a graduate that has one year as a general practice associate.”

Is it a match?

Successful internship programs start with a good match between practice owner and intern. “As the director of my former practice’s internship program for close to a decade, I leaned heavily on the ‘working interview’ that an externship at the practice provided,” said Dr. Grice. “Most prospective interns spent at least a week at the practice, and often two or more. Asking appropriate questions, exhibiting excellent communication skills, showing good judgment in their interactions with clients, having enthusiasm for learning, and jumping in to help the team when needed, all were positive attributes. All the doctors and staff gave their input on the candidates, and generally the team was in complete alignment about those who were the best fit for our practice.”

Jesse Tyma, DVM, Dipl. ACVS, of Rhinebeck Equine, believes that “from a general perspective, intern candidates should pursue internships in which previous interns have successfully pursued advanced training or gone on to careers in their specific area of interest, and they should ensure that there is a mentor in the practice within that clinical area of interest who can support their clinical growth and career trajectory.” Rhinebeck currently employs five intern doctors per year. “For the practice, choosing interns that fit in well with the entire team – not only senior doctors, but technicians and other support staff – and are team players in that setting is crucial.”

Dr. Tyma served as a member of the American Association of Equine Practitioners internship subcommittee of AAEP’s sustainability mission. “I am passionate about early career mentorship and think that an ethical, well-rounded internship and those early career professional relationships are foundational to retention in equine veterinary medicine,” she said.

“The successful internship from the intern doctor perspective is one that provides a well-rounded clinical and non-clinical education in a manner that offers increasing independence but continued oversight. Although basic technical skills are crucial, the intern’s workload should be primarily in the doctor – not the technician – role. Regular feedback and a formal review system are crucial.

“Regularly scheduled time off is imperative, and there needs to be a humane limit to scheduled working hours,” she said. “Interns need opportunities for learning off the clinic floor, including teaching rounds, journal club and case rounds, and should receive support to pursue continuing education. Monetary compensation must be at least a minimum wage so that no further debt is accrued in the intern year. Career guidance is a must and specific to each individual. Mentorship – that is, guidance, support, and opportunity for clinical and professional growth in a psychologically safe space – is a must.

“For the sponsoring practice, a successful internship is one in which the intern doctors support the clinical flow of the hospital/practice and become increasingly independent in a way that can often allow doctors some respite from primary emergency duties. The successful internship fosters an environment that supports the retention of those doctors in equine practice, both immediately following their internship year, and beyond.”

Well-being

Lisa M. Greenhill, MPA, EdD, chief diversity officer and senior director for institutional research at the American Association of Veterinary Medical Colleges, believes that “at the core, the expectations of having a mentored learning experience designed to improve clinical competence have not changed over the years. I think what has dramatically changed are trainee expectations about well-being and what that should look like in the training environment.

“Trainees are still very much interested in skill improvement as well as other forms of professional development, but there are increasing calls for internships and residencies to balance the programs in ways that promote and facilitate personal development and well-being,” she said. “Previous generations simply did not prioritize this. There was much more acceptance that ‘This is just the way it is.’

“There is also a growing population of young professionals who, at least anecdotally, are interested in getting more structured mentored training programs in private and corporate practices. Newer practices have successfully appealed to new graduates with these options, which anecdotally, seem to place a high priority on well-being.”

AAVMC member institutions coach and counsel students on their post-DVM goals, Dr. Greenhill said. “Many career professionals help students identify training programs that are a good fit during their research and interview processes. Additionally, faculty mentorship is critical to helping students begin to plan their initial years post-graduation.”

And when it’s over?

The American Veterinary Medical Association’s Veterinary Internship Guidelines call for practices to collect and use outcome measures to monitor program quality, identify areas for improvement, and assist candidates in the selection process. Such measures include:

The number and percentage of interns who have completed the program per year for the past five years.
The number of interns who applied for a residency in the past five years.
The number of interns who accepted a residency in the past five years, including the completion rate.

In addition, comprehensive exit interviews covering each area of the internship should be conducted upon completion to identify areas for program improvement, according to AVMA.

Dr. Grice said the AAEP is working on a system to improve the evaluation process. The AAEP Internship hub will sponsor a site on which former interns can share how their experience matched the description the practice gave of the position. “In the meantime, plenty of avenues exist for soon-to-be graduates to get a pulse on the quality of internship programs,” she said. For example, equinevetted.com includes reviews of externships and internships to help those coming behind them.

Challenges

Demand is high to fill intern spots, and many internship-sponsoring practices rely on intern doctors for their normal workflow, even if much of that work is technical, said Dr. Tyma. “This can be a real problem.

“Change is needed and happening – but not everyone is budging. Practices that recognize and honor the changing needs of intern doctors and early-career veterinarians have been better able to recruit interns and create an experience that interns want and need to feel like they have a place and can carve out a sustainable life as an equine practitioner.

“I think some practices feel that the more unrelenting internship model of the past should be upheld, but these practices just aren’t filling their spots. I think these challenges are overcome by being more open to change and creating an internship experience that fits the needs of both the intern doctor of 2024 (and beyond) while still providing benefit to the practice.”

Professional Guidelines for Internships

In its Veterinary Internship Guidelines, the AVMA advocates creating an employment contract or agreement that describes what is being provided and what is expected. According to the AVMA, the agreement should:

Specify working hours and on-call responsibility.
Specify the level of faculty and staff support to be provided.
Offer a salary commensurate with responsibility and level of training.
State whether there will be an opportunity to earn additional cash compensation and include an estimate of the additional income potential.
Specify all benefits, such as sick days, vacation, health/liability insurance, professional dues, meeting expenses, etc.
Specify regulatory requirements, including state/DEA license requirements and who covers the cost.

A non-compete clause is not typically included in internship employment agreements, according to the AVMA. But if a non-compete clause is necessary, it should include reasonable time and distance parameters.

Source: Veterinary Internship Guidelines, https://avma.org/resources-tools/avma-policies/veterinary-internships-guidelines

Starting Gate

Starting Gate presents equine-specific business content to students and interns while building connections and a community that will carry members through both their education and career. Equine practice business management knowledge is integral for success as both an associate and a practice owner. Topics will include but are not limited to career path planning, choosing externships and internships, negotiating employment agreements and non-compete clauses, and understanding cash flow.

https://decadeonevet.com/starting-gate

Image credits:

istockphoto.com/fotoedu, istockphoto.com/mgstudyo, istockphoto.com/Nevena1987

What Veterinary Interns Want