Interview with Dr. Wells

Interviewing Dr. Wells

Introduction?

• My name is Reagen Wells, and I’m a veterinarian. I’m a specialist, so in veterinary medicine, we have the option of going through the 4 year post graduate program, and stopping there, and going right into practice. I elected to continue training, similar to the path of physicians where I did a rotating internship (1 yr) followed by a 3 year residency in emergency and critical care. I also did a masters degree with that program. That set me up to take an exam which is a rigorous examination process. I also had to be published in a peer review journal in order to obtain those credentials. I had to pass that test and then I was able to practice as a specialist in emergency and critical care. So, I’ve been doing that. I graduated in 2004 and have been practicing as a specialist since 2008. I have worked in a variety of settings

What made you want to go into the veterinary field?

• I’m different from most veterinarians you’d speak to. I’m not the traditional: “I’ve known since I was 5 years old and I want to grow up and take care of animals.” I wasn’t quite sure what I was going to do. I was an English major in undergrad, and I maxed out all of my English credits. I really paused and thought about what I was going to do career wise with this. I realized I really enjoyed science. I took a non majors biology class in undergrad. This is really cool stuff. In high school, I was led to believe that girls were not good at science and math. I believed in that and didn’t believe in myself. I just assumed that wasn’t in my cards. So, I just stumbled into the opportunity to volunteer at an emergency bed hospital to see if I enjoyed science. And I loved it. I’m a little bit of an adrenaline junkie. I tend to thrive in very stressful and chaotic situations, and I kind of calm down. I work very well, so it was a good match. I’m a fairly stubborn and persistent person. I was told over and over again that I started too late and if I wanted to be a veterinarian, it’s more competitive in medical school and you’ll never get in. Give up and find something else. That’s what fueled me even harder to be a veterinarian. I ended up staying in the ER all that time which was a surprise but a good fit for me.

What is a notable experience you had treating an animal?

• Lots of them. Probably one of the most notable experiences I had was as a resident. I was still in Colorado, and it was one of my first cases I had on my own as a specialist in training. I took a dog in that had a really perplexing presentation. That’s the thing with dogs; they are like children because they can’t tell you what is going on. So it required a lot of digging. It was a whirlwind. The dog deteriorated really quickly and ended up on a ventilator (couldn’t breathe). It necrosed all of its skeletal and cardiac muscle. We pulled him through that. He had a really unique owner who was sort of a loner type. It was a working dog. It was his bird dog. I remember he brought in this rag that smelled of gun cleaner to be with the dog. To make it feel like it was at home. We got that dog through that. And this was an owner who you would never thought would drop this kind of money on his pet and have this tremendous bond. It was super fulfilling to see this dog go home, and then work again. It wasn’t just a cute little Yorkie that somebody holds in their purse. It was a dog that still had a super important role in somebody's life, and was a working dog as well. Kind of a goofy dog. I ended up naming my favorite dog who has since died after him Eddie.

How do you think the veterinary field has changed over time?

• I think for this audience, and tying it to this discussion. Gender. When this profession started, it was dominated by men. In the 70s and 80s, there was a real shift and women wanting to become veterinarians and starting to get into veterinary school. Now, we are over 85 percent women in training or in practice. What I think is still quite frustrating for people at my age and this point in our careers is that we recognize that we are largely a profession of women, yet we are led primarily by men. And that’s a pretty significant frustration.

How do you think being a woman has influenced your experience in this field?

• I mean I think it has influenced everything. It has influenced me when I started a family. I started a family late in life. I think that was good. I had a lot of wonderful experiences traveling the world. I think I’m a much better parent because of that. I had my daughters when I was 39. I got pregnant at 38 and then delivered them at 39. I'm an older parent. I think I connect at a much more authentic level to my clients and the people I work with because of my gender and my experiences going through school, training, and my first job right after residency. I landed in a leadership role, and I wasn’t ready for that but there I was. I was answering to a board of all older, white men who had no idea what I did everyday. They just knew they needed to hire me because I was a specialist, but they kind of didn’t know for what. I had to really navigate quickly how I could help the team of people depending on me to provide care for pets. Somewhat manipulate situations. Probably taking advantage of my gender in some instances to get what I felt I needed out of that interaction.

What do you do as a Veterinary Criticalist?

• When I’m in practice as a criticalist, there’s really two specialties rolled into one. We refer to ourselves, or other people refer to us, as a criticalist, but by definition we are emergency and critical care specialists. What most people think of traditionally as a criticalist is that I would come in and take the sickest patients that are in the hospital. That way the emergency doctors can keep seeing patients and keep things moving, and I can really focus on these pets that have really complicated problems. Sometimes their problems aren’t complicated but their owners are complicated emotionally and they need a little bit of extra help to understand what’s happening. I have to balance multiple systems that could typically be failing in a pet, such as electrolyte disturbances, respiratory failure, urinary output issues. We put animals on mechanical ventilators, we do hemodialysis, hemoperfusion treatments. I also do surgery‒ not every criticalist does surgery, but I’ll do sometimes simple but sometimes advanced surgeries, like animals that have a tumor on the spleen that ruptures and causes acute bleeding. That’s a classic case that requires the skills of a skilled emergency doctor to get that out of that initial shock and a criticalist to balance their transfusion and anesthesia requirements, and I can also do the surgery to safely remove that spleen so we stop the bleeding and get a biopsy. I will also see throughout my shift ear infections, skin issues, a limping dog, really whatever. If an owner perceives it’s an emergency, we’re going to see it.

What obstacles or struggles did you have to observe working as a Veterinary Criticalist?

• I think the hardest thing to get used to, and I’m working through this right now with my recently trained criticalist on my team, is realizing when you join a hospital as a full fledged specialist, you are simultaneously the most important specialist in the building but the least important. We are expected to be at the hospital at night, on weekends, holidays when all the other specialists are at home enjoying their family. We are the lowest paid, the least appreciated, but we’re there when nobody else is and we make huge differences and outcomes, so you have to quickly get past outward recognition and find ways to recognize yourself in what we do.

What is some advice you would give to someone considering a field in veterinary medicine?

• The reality is the cost of education is there so have a very solid understanding of what that is and what potential implications there may be. Hopefully the person I’m talking to has the means to pay for school because I think it can be such a wonderful, fulfilling career if you’re not saddled with debt. I got lucky‒ I graduated with a fair amount of debt but it’s very low interest rate, so I’ve been able to just not focus on paying it, so I have a good quality of life. Sure I have school debt but it’s nothing like what a current student would do. Secondly, really work on having boundaries that are reasonable for your patients, yourself, and your employer. What I’ve seen is that there's definitely a swing to boundaries sometimes to the detriment of patient care or a successful business operation. It can’t only be about making the most money and working the least amount of hours‒ there has to be some reasonable balance there. Understanding the business is a really important piece of it and what it takes to operate a veterinary hospital so that when you’re done you’re not frustrated with your job or your leaders because you’re being asked to do things that are not necessarily through the lens of just medicine.

Do you have any advice specifically for people interested in your specialty?

• Very similarly, working on ways of recognizing yourself and not seeking external validation. I think that’s really important in my specialty.

So I understand you’ve worked in an academic setting and a private practice setting: can you please explain the difference between the two?

• The similarities are that if you can align yourself with the right type of private practice and your colleagues in that practice, you can practice very high quality medicine and you can even have a training program where you contribute to the education of future specialists or veterinary students that are on rotation through your hospital. However, you have to keep in mind that the primary reason you are there, 9 out of 10 instances, is to build the wealth of investors. At the end of the day, that’s what we’re about; private equity has really taken a stronghold of our profession and that sometimes is difficult to navigate, especially if you’re a purist with the focus of quality care as one of your top priorities. Going to academia allows you to take great care of pets, but you’re not necessarily doing that directly. Once you’re in academia as a professor, you’re doing that by having your residents and interns do a lot of the direct patient care and direct client communications where you’re more in a mentorship role and then you’re also focusing on research and getting money into your department, so it’s still about money but just in a different focus and there’s a different level of pressure. It’s about service, teaching, and research as your three big categories that you’re looking at and it’s a race to get tenure. That’s changing, the landscape is looking a little different. There are more positions that are non-tenure tracks which are good and bad. I think the bad part of that is there’s not as much job security, if you get a tenure professor job you’re good. You cannot lose your job; you have a lot of job security. And then you can do things like take a sabbatical, travel the world, get a really good grant, take yourself off the floor or even out of teaching for a while to focus on that. There’s a lot of opportunity that you just wouldn’t have in private practice. The pay is much less but again if you don’t have the student debt I think that’s a little less important.

How do you go about an average workday?

• I have two roles right now that I didn’t really get into in the ‘me’ of this interview. I’m in a leadership role now‒ I’m a medical director of a specialty hospital. When I’m in that role, my day is meetings, sitting down looking at budgets, making sure that we have enough money coming into the hospital to justify getting doctors or equipment, coming up with protocols to allow, for instance if I’m getting a new piece of medical equipment, making sure we have the training set up, all the right people learn how to use it, and use it safely. So that’s once our deal with clients that maybe are unhappy with their experience, maybe if they came in the weekend in the ER they felt they deserved different care than they received so I explore that, make sure that we did a good job there. And then when I’m on a clinical shift and I come in as an ER doctor or a critical care specialist, I arrive and just start seeing cases. There’s usually 10-20 people waiting to be seen. They’ve been waiting hours. Right now the pandemic has really had an impact on our profession and a lot of vets are at capacity, they can’t keep up, so that overflow happens and comes over to the ER. So usually you’re coming in and your colleagues are stressed out because they’ve been there already for 12-14 hours ready to go home and then you’ve got a stack of people that are waiting to see you. You kind of don’t know what you’re going to walk into when you meet that client: they might be super grateful that somebody’s finally seeing them or they might just be really frustrated that they’ve been waiting so long. You have to be prepared for whichever way that may go and react accordingly. Of course, I think the best part of my day is whenever I’m feeling overwhelmed thinking ‘this stuff is really hard’ or feeling sorry for myself in any way, I can just stop and look around and I see the cutest, most amazing pets. My team makes fun of me because I will literally stop with every single one of my patients saying ‘look at this dog/cat it’s so cute!’ That’s just a really unique thing, not a lot of people can do that and I think more vets should stop and really consider that in their day and it really helps lift me up. Reuniting those pets with their owners, or just telling a little something cool about their pet to the owner, for instance, ‘Oh I noticed he really likes it when you scratch his ear right here’ and they just love that because we all love our pets and their little quirks. Those moments keep me going.

Note: The following has been edited by Medical Matriarchs for clarity

Thank you for reading- CY, BC, PY