Month: February 2019

The HQHVSN Workplace

Years ago, in 2011, I set out to study spay neuter veterinarians with the aim of finding out about musculoskeletal pain risk factors and what we might be able to do about them. The resulting study was published here, but as with many research surveys, I collected data as background information that never made it into a publication (other than as a poster abstract in the 2012 Midwest Veterinary Conference proceedings). Although this extra data is not exactly groundbreaking, there are some interesting tidbits about our field, and even though the results are from a 2011 survey, I think many of the findings are still relevant. This is exactly the sort of research that the Journal of Incidental Findings and Freelance Inquiry (JIFFI) was designed to publish. So enjoy!

Characteristics of spay and neuter employment positions and contributors to efficiency

Methods: Online survey of veterinarians who currently or previously spay and neuter at least 4 hours per week.  Responses were solicited via the Association of Shelter Veterinarians’ Sheltervet listserv, the HQHVSNvets listserv, and conference attendees at the 2011 SNIP Summit, yielding 228 useable responses.

Results:

Where do spay neuter vets work? Lots of places, though most are in a stationary venue. And a lot of spay neuter vets work in more than one place, too– more than one shelter or clinic, or doing mobile and stationary spay neuter work for the same organization.

Of veterinarians in the four most common clinic types, mobile veterinarians have the longest total workdays (median 12 hours) and perform the most surgeries (median 34 daily) with a large staff (median 4 per veterinarian), but their surgery time is similar to veterinarians in stationary clinics and shelter clinics serving the public (median 6 hours daily).  Shelter-only clinics see fewer patients (median 18) in a shorter surgical workday (median 5 hours) with fewer staff (median 2 per veterinarian).

Clinics with 4 or more staff or volunteers per veterinarian performed more surgical units per hour (median 5.4) than clinics with one (3.28), two (4.57), or three (4.69) staff per veterinarian.

Approximately half of the surveyed veterinarians (116/216) work full time in spay/neuter.  For part-time spay/neuter veterinarians, in addition to having other job duties that limit time in spay/neuter, factors preventing full time spay/neuter work include finances (14.8%), prevention of burnout (58.2%), physical and musculoskeletal health (45.1%), family (36.0%), and limited availability of spay/neuter jobs (41.6%).

I like lunch, so I asked about it. Most spay neuter vets don’t take a lunch break during their spay neuter work day. It’s not necessarily as daunting as all that, though– many vets finish surgery mid-day, so can eat before and after surgery rather than breaking in the middle of surgery. For my MASH clinics, though, I insist on a sit-down lunch break if the surgery day will last past about 1:30 pm. Less efficient, maybe. Less hangry, definitely.

Discussion:What are the takeaways from this snapshot into the spay neuter workplace of 2011?

For me one of the most obvious, intuitive, but potentially overlooked (by management) findings is that having more support staff equals more surgeries per hour.

Since finding out about staffing levels wasn’t the main objective of the survey, there is still a lot we can’t say about how staffing and surgeries per hour relate to each other. I assume that having more staff doesn’t actually make a surgeon cut and sew faster– it just means that the surgeon gets to spend more time cutting and sewing, and less time restraining, injecting, waiting, or doing any other activity that keeps them away from the surgery itself.

For low volume clinics, this decreased efficiency from lower staffing levels may not be a problem. Sure, things could go more quickly, but the work gets done. But for anyplace looking to increase their efficiency, increasing staffing level is a good place to start.

Is this what our field of HQHVSN looks like now? Probably, mostly yes. Maybe I’ll ask again in a few years…

Mega-MASH clinic: The Spayathon for Puerto Rico

MASH spay and neuter clinics are nothing new for me: during the past 13 years I’ve done well over 1000 MASH clinic days in Vermont and New Hampshire. My own MASH clinics are small: one veterinarian, one veterinary technician, and between 2 and 10 other volunteers or shelter staff. We set up our clinic for just a day at a time and see somewhere between 20 and 60 patients in a day (depending on dog or cat, male or female).

But recently, I’ve had the chance to participate in Spayathon for Puerto Rico: four, one-week-long rounds of multi-site, multi-vet MASH clinics. I’ve spent Spayathon Rounds 2 and 3 with the group Veterinarians for Puerto Rico, a fabulous new group formed in the wake of Hurricane Maria. The Spayathon for PR clinics are large: some sites like ours served between 150 and 200 (or so) patients a day with about 4-7 veterinarians in surgery each day, while the biggest location served about 500-600 patients a day with about 20 vets in surgery each day. Lots of people have posted cute pictures of pets and owners at Spayathon and talked about the rewarding and exhausting experience of volunteering– just search #spayathon4pr to see some examples– so here I’m going to talk about the logistics and flow (physical and organizational ergonomics) of running a large MASH clinic like this.

Before: The community center in Toa Baja that would become the Vets for PR surgery site during Spayathon4PR round 3. The surgery area pictured at the beginning of this post is the area to the left in this picture.

Without these volunteers, Spayathon would not be possible

Large MASH clinics are full of logistical challenges. How do we create a safe and efficient flow of animals through the clinic? How do we keep the animals and the people as safe and un-stressed as possible? How do we make the best use of the space we have for the clinic? How do we make the best use of the dozens of volunteers at each site?

This round, utilizing our limited indoor space as efficiently as possible was one of our biggest challenges in Toa Baja. While the community center looked large when it was empty, it was much smaller than the sports arena we had occupied in round 2 in Aguada.

A client waits with her dog until it’s time for her dog to go inside for surgery

One of the space-savers was using the covered balcony area for dog physical exams; clients and dogs also waited outdoors (under the cover of tents, on the balcony, in the shade of the building, or on the small lawn) until it was their dog’s turn for surgery. When it was time for the dog to come inside for surgery, the owner was there too. Pets who had received their anesthetic injection waited in their owners arms or on a bed on the floor until the sedation kicked in and they fell asleep.

Clients wait with their dogs in the induction area. The dogs closest to the curtain towards the back of this picture have received an anesthetic injection.

Cats were a little different (they’re cats after all…). We admitted the cats in their carriers into the building so that they could have physical exams in a confined space, rather than using the open-air balcony with the dogs.

Cats and more cats waiting for physical exams
Watching cats fall asleep may not be the most glamorous job, but it’s one of the most important.

Once the cats were examined, they could be injected with anesthesia and brought out to a post-induction table (aka Kitty Sleepover Party) where they could be under continuous observation until they were anesthetized enough to move to a surgery prep table.

Dogs too were moved into surgery prep– this is where their pathway merges with that of the cats. And after prep, patients were moved to an unoccupied surgery table.

Veterinarians for Puerto Rico surgery area during Spayathon for Puerto Rico Round 3 in a community center in Toa Baja. The Kitty Sleepover Party table is located in the lower left of this picture, and surgical prep tables are on the lower right. The entrance from dog induction is to the right, outside the view of the photo. In the background are the 10 surgery tables (8 around the edges, two in the center), each with an anesthesia machine.

As in many high volume settings (but not in my own MASH clinics), the Vets for PR surgery area had more surgery tables than surgeons. This mean the surgeons don’t have to wait for the exchange of patients on their table; they can re-glove and move directly on to the next surgery. It also allows the postoperative patients an extra minute or two on the anesthesia machine, to breathe oxygen and breathe out the anesthetic gases before being moved to recovery.

The beach

After surgery, animals were moved directly to Recovery 1, or “the beach.” Here they were attended by a team of veterinarians, technicians, students, and volunteers who watched their recovery and recorded their temperature, pulse, and respiration at intervals throughout their recovery. The beach was all soft padding, heating pads, and “warmies,” the hot water bottles and rice socks that were microwaved and re-microwaved throughout the day to help the patients warm up. (The air-conditioned facility, while comfortable for most of the workers, was chilly for anesthetized patients, so we had to make efforts throughout the day to keep them warm, including heating pads on the tables in surgical prep and in surgery).

Recovery 1 area (“The Beach” 🏖) located just off the surgery room. Dogs on the floor, cats on the countertop.
The beach 🏝 from above. Veterinarians and technicians from the MSPCA in Massachusetts set up for the influx of patients. Having the small patients at an easy-to-reach standing height table makes caring for and monitoring them easier on the volunteers.
Owners helped in recovery, sitting with and holding their pets until ready for discharge

Once patients were warm and alert, they could leave the Recovery 1 beach and be reunited with their owners in Recovery 2. Veterinarians, technicians, and other volunteers watched over the roomful of “pet parents” waiting with their animals until the animals were recovered enough for discharge. An instructional video played, and owners also received instructions from and were able to ask questions of the vets and techs. Once their animals were recovered and ready to go home, they were discharged with post-operative instructions and emergency contact information, along with donated pet supplies and pet food.

Once the animals were gone, the work wasn’t done: data had to be entered from all the medical records into a centralized database that would allow researchers to study the users (clients and pets) and outcomes of the Spayathon clinics. Our site in Toa Baja had such limited indoor space that the data entry station was in a tent outdoors that was in theory air conditioned but was in actuality a bit of a sauna. Also, the data tent was the volunteer lounge and lunch tent, so data warriors also got to be lunch patrol (“only two plantains per person!”; “save the pitas and hummus for the vegans!”). Next round, we’re hoping for a space that puts these folks back inside the building in a climate controlled setting.

She’s not just wearing a harness, it’s a dress. How could I resist an embarrassed calico?

Meanwhile, I got to spend my time between many different areas of the clinic, but mostly between induction, prep, surgery, and recovery 1, trying to keep an eye on the big picture and flow, and pitching in where I could (and trying to remember to take pictures here and there). It was a great experience working with so many talented and dedicated people, and I’m looking forward to going back to the fourth round of Spayathon for Puerto Rico in May!