Lead Clinician in Cardiology, Langford Vets, University of Bristol
Veterinary Cardiologist at a glance
Around 55 per week
PT, FT and compressed hours available. Can work from home. Telemedicine increasingly available, so may be able to work from home or around school in that role.
1) Residency (ACVIM or ECVIM-CA); 2) Echocardiography on large and small animal species; 3) General medicine experience
Travel to give CPD around the UK, and to speak abroad. These are in my own time and therefore within my control.
1) Learn to echo; go on a good CPD course and buy a decent book; 2) Join the Veterinary Cardiovascular Society; 3) See practice with a Cardiologist
1) Good time manager and able to prioritise; 2) Enthusiastic and willing to teach; 3) Experience in general practice is desirable
Problem solving; compassion; teaching skills; support for fellow professionals; research skills; enterprise for new procedures or techniques
What were your first career steps and how did that work out?
When I started vet school, I wanted nothing more than to be a cow vet. After a phase interested in "exotics", and a stint of conservation work at vet school, I ended up most interested in small animal general practice. I worked in a fantastic, small practice in Derby for just over 6-months after graduation, essentially run by a brilliant team of nurses. There, I was thrown in at the deep end and did a LOT of surgery and found an ultrasound scanner in the downstairs loo. I decided to try to start using ultrasound, and discovered that scanning hearts - in a very basic way - was super cool and exciting! Although I'm not sure the wonderful nurses who helped restrain patients with me back then would agree... .
So how did you decide to work in cardiology?
After floundering around with basic echo and teaching myself from a book for a while, I decided I wanted to become a cardiologist at some level - either practitioner or Specialist - and started to bias my CPD towards this. I ended up doing my RCVS Certificate in practice in 2010, but almost immediately realised that - although I absolutely loved work in general practice - I had to follow what had become a passion and try to go down that road full-time as a Diploma holder.
What did you need to do to get into this career path?
I needed to undertake a Residency programme (3-year intensive training in Cardiology), followed by passing Diploma exams (American or European college).
It's easy to lose confidence - I have seen it happen to great potential candidates. Keep focusing on the long-term goal. You will have knock backs and challenges - they are not personal to you, and they should not dampen your passion for the subject; look at them as a side-show, not the main event
Were there any barriers to entry and how did you overcome them?
Initially my confidence - I didn't think I was smart enough to become a Specialist in anything; I actually didn't submit applications for a couple of junior training posts because of that. Then I did not get offered an Internship at Liverpool that I applied for. Next, my partner at the time (now my wife!) chose to do a Residency and we moved to somewhere without local cardiology Diplomates who could take Residents - and financially we couldn't make things work for both of us to be paid relatively poorly. Then I failed my Certificate casebook first time out, then the following year (when I passed), my supervisor told me they thought I would fail because I "wasn't ready". I was not offered the first Residency that I eventually applied for - at the centre where I ended up training. In the first 18 months of my 3-year Residency, for various reasons (mostly financial), my wife and young son lived in Bristol and I commuted to London for 7.30am Monday, returning late on Friday, and staying for weekends on call. That was the hardest bit. But I think you have to roll with the punches - ultimately I knew what I wanted to do and how to get there, and that it was a competitive field but persistence and hard work would probably pay off. I was lucky enough to have support around me, who I could reply upon to help me when I needed picking up.
What are the best bits about your current role and are there any downsides?
I work predominantly as a clinician. Now I see cardiac cases in all species, not just small animals. I am 90% in clinics and work 5-days a week plus on call. The best bits are sooo numerous! Here's a few:
1) I get to scan hearts LOADS which is just brilliant, and I get to talk about hearts with my colleagues and students all day. And we get to do interventional procedures on dogs and horses, which is cutting-edge stuff;
2) I get to teach students how to approach cardiac cases, auscultate in a structured way, make decisions about when/what to treat... All things that will be hugely useful when they graduate and probably work in practice - I hope that this will help FAR more animals over the next 20 years than I could ever do myself;
3) I teach post-graduate Residents and Interns, which challenges me and teaches me things every day;
4) I get to offer advice/telemedicine to vets in practice who need help with cardiac cases in their clinic that day, which will help animals and help vets be less stressed about a case that might be unusual or out of their comfort zone;
5) I undertake research which contributes just a little bit to our understanding of heart disease and how best to help the animals under our care;
6) I give CPD to practising vets and speak at conferences all over the world, which - again - helps vets to help their patients and thereby have a much greater impact on animal welfare than I ever could as a clinician myself - and I get to travel, which is a huge honour and privilege to meet vets in, say, Russia, Brazil, or China, and understand a little more about their world and how they work;
7) Sometimes I go home smelling a bit of ponies.
The downsides are the usual things that I have come to understand bug anybody, in any job, in any discipline. Bureaucracy within an organisation, episodes of random poor communication between management and the clinic floor, a moment of stress from a client manifesting as unpleasantness, an email taken the wrong way... Nothing frequent or insurmountable, and nowhere near enough to counter the positives .
Could you give us an overview of a typical day/tasks?
Kids (I now have four) fed and school snacks/drinks made up before work, dishwasher loaded/unloaded if I can, then commute in traffic for 35-45 minutes (or cycle for a bit longer) to check inpatients if we have them before 8.30am Resident teaching rounds or a 9am seminar depending on the day. One senior does student teaching rounds in the on site cafe twice weekly. Consults are from 9.30am for the morning. I either see cases myself or supervise a Resident on the case; this involves us essentially working on the case with them, reviewing the details of the history and physical exam, and then overseeing imaging and other diagnostics. We see 5-6 referral appointments daily, and normally have 6-8 (or more) in-house consults, usually accompanied by an echo, ECG or Holter fitting. The clinic is busy - in 2019, we had 500 patients come through our door by the first week of June. Advice emails / phone calls from vets (variable number, but often 2-3 per day) are dealt with as required around these patients in the clinic. We mostly see small animals, but may be asked to consult on a case for equine or farm departments. Our interventional procedures - we do around 50 per year - are mostly run in the mornings. We try to get patients in-and-out same-day, unless they have severe signs that require hospitalisation, so we have to get written discharge notes done around the clinical work for owners to take home with them. This means that there is a fair amount of paperwork going on as we work, in addition to liaising with other services (neurology, imaging, internal medicine, anaesthesia) as required. I try to teach students informally around each case that comes through the door, always trying to relate it to basic physiologic principles and bring the discussion back to cases that are likely to be seen in primary care practice, rather than our unreal, biased, referral caseload. Lunch is vital to our happiness, and our department make sure that all staff and students eat and get minimum 45 minutes break around 1pm - I can't function without it! I have to attend head of service hospital meetings every month in the afternoon, and occasionally we have research or service meetings later in the day. We are usually finished in the clinic between 5 and 6pm, which is followed by tying up any loose ends with paperwork or emails if we can. Then it's home to see the kids at bedtime and read stories or feed the smallest one a bottle. This is pretty much the most important deadline of my day, but I can't always meet it if things run late.
What sort of person would thrive in this career path?
Somebody enthusiastic about sharing their passion for a subject with students and vets, who has the perspective to realise that this is a vital part of their role as a Specialist within the profession. You need to be able to act as a clinician and an academic - which can pose a challenge sometimes. You have to be organised and to manage your time well to meet all of the demands upon you - my old supervisor used to say that Specialists are "a slave to many masters" - owners, referring vets, students, post-grads, hospital management, journal editors/reviewers, grant awarding bodies, conference organisers, telemedicine providers... It could be easy to lose yourself somewhere in that.
What advice would you give to someone wanting to work in cardiology?
It's easy to lose confidence - I have seen it happen to great potential candidates. Keep focusing on the long-term goal. You will have knockbacks and challenges - they are not personal to you, and they should not dampen your passion for the subject; look at them as a side-show, not the main event. When things get tough, re-focus by thinking about what you are grateful for now and where you want to be eventually. Get to know some cardiologists or cardiology Residents to see things from their perspective - a great way is by joining the Veterinary Cardiovascular Society and attending their CPD meetings. Go and see practice with cardiologists and understand how they work, and how they train their Residents. Engage with published research wherever you can. And remember that you are a vet and you have much more potential from your training than anybody told you at school.
"Things will begin to go wrong when you start to believe your own bullshit." Paraphrasing advice given by Rebecca Stepien to Adrian Boswood, then passed on to me at the end of my Residency!