New veterinary graduates have clinical foundations but lack the volume fluency practices expect

A new veterinarian walks through the door on day one having completed four years of demanding professional training and passed the NAVLE. They have a foundation, not fluency, Dr. Dani Rabwin writes in Veterinary Practice News. "The technical confidence from volume and repetition is still ahead of them, and so is almost everything that surrounds clinical medicine in practice," according to the piece.

Rabwin, founder of the Ready, Vet, Go mentorship program and editor of an upcoming Wiley textbook on veterinary mentorship, draws a distinction in the piece "between what is lookupable and what is not." "Differential diagnoses, drug doses, surgical protocols, suture patterns, lookupable. How to talk with a client about a treatment plan they cannot fully access. How to make a confident recommendation under uncertainty. How to leave a hard day at the clinic without carrying it home. Those are not in any textbook, and they do not develop without support," she writes.

Most practices are failing to close this gap, Rabwin writes. "If your mentorship program focuses primarily on clinical milestones, you may be solving only part of the problem."

The safety net that determines whether new graduates stay

"Qualitative research interviewing early- to mid-career veterinarians found" that "the 'safety net' mentors provide, not just clinical backup, but the assurance of not being alone in one's uncertainty, was one of the strongest factors in whether new graduates stayed in practice," Rabwin reports. "Participants described leaving their first jobs specifically because of inadequate mentorship and described arriving at new practices still recovering from those early experiences."

Data from Rabwin's own Ready, Vet, Go program cohorts, 63 self-selected early-career veterinarians who participated in her structured remote mentorship program, reflect a similar pattern. "Among 63 early-career veterinarians who participated, 44 percent of open-ended responses about what mattered most named the same thing, without prompting: the experience of realizing they were not alone. Not a specific skill. Not a module. The recognition their struggles were shared," according to the piece.

That finding reframes what support means in the first year. "Practices that focus mentorship entirely on clinical guidance address real needs while leaving others completely unaddressed," Rabwin writes.

The client communication gap and what modeling builds

"A new graduate can have solid clinical instincts and still struggle in the exam room," Rabwin writes. "Communication with clients, especially in difficult moments, is a skill that takes modeling, practice, and feedback to develop. Many new graduates receive little of the three."

She describes a habit her own mentor had early in her career: "He would pull me out of an exam room to personally introduce me to long-standing clients. 'This is Dr. Rabwin,' he would say. 'She's new, which means she knows a lot of current information, and your pet will be in excellent hands.' With that one introduction, he built client trust, demonstrated confidence in me, and modeled the kind of warmth that puts people at ease. I did not know how to do any of that yet. I learned it by watching."

"He also role-played difficult conversations with me before I had them with actual clients, delivering bad news, admitting a mistake, and navigating a client who was angry or in denial. Those sessions were uncomfortable. They were also invaluable. When those moments came in real time, I was not improvising from scratch," she writes.

In Ready, Vet, Go cohort data, again self-reported by participants in Rabwin's own program, "59 percent of participants reported confidence in client communication at the start. By the end, that figure had risen to 91 percent. Participants consistently linked that shift to feeling more effective with clients and more settled in practice overall," according to the piece.

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The modified care plan problem and the fear it creates

"Veterinary school trains new graduates to deliver gold standard medicine," Rabwin writes. "What it rarely prepares them for is the full range of circumstances they will encounter in practice, clients with financial constraints, geographic barriers to access to specialists, varying personal values regarding care, and patients whose situations do not map neatly onto textbook recommendations. When new graduates encounter this reality, many are not equipped to navigate it."

The challenges are layered, she writes. "There is the emotional weight of recommending a modified plan and wondering whether it is enough. There is the communication challenge of having that conversation in a way that preserves trust and keeps the client engaged. There is the clinical judgment required to determine what is sound within the constraints at hand. Also, there is something that does not always get named directly: the fear of judgment, from colleagues, from themselves, and from the profession."

"New graduates worry about straying from the gold standard, about board complaints, about liability. In my work with hundreds of early-career veterinarians and veterinary students, these fears come up constantly. They are not hypothetical. They shape how new graduates approach every appointment where the textbook answer is out of reach," Rabwin writes.

Rabwin's own mentor "practiced in a semi-rural area with a genuinely diverse clientele, and early on he taught me delivering excellent care means meeting clients where they are, that a modified plan developed with clinical rigor and honest communication is not a compromise, but a different kind of medicine that requires its own skill set."

In her program data, "49 percent of participants reported feeling comfortable talking with clients about cost of care" before the program, Rabwin reports. "After, that rose to 77 percent. New graduates who are not supported in developing this skill tend either to carry chronic guilt about modified care plans or to avoid the conversations altogether. Neither outcome serves the patient, the client, or the practice."

The team integration gap and what builds psychological safety

"New graduates do not just join a practice. They join a team with culture, history, unspoken rules, and existing relationships. Learning to navigate that, to understand where they fit, how to build credibility with colleagues and staff, when to ask for help and when to trust their own judgment, takes time and support to develop," Rabwin writes.

Qualitative research found that "mentoring style, collaborative versus sink-or-swim, was one of the most significant factors in how new graduates experienced their first positions, and in whether they stayed," according to the piece. The AAHA Stay, Please study found "teamwork was the single strongest retention factor across all roles surveyed, above compensation, above flexibility, above nearly everything else."

Mentors can help new graduates integrate into the team, Rabwin writes, not by creating a false sense of belonging but by taking specific steps. "Making introductions. Helping the new graduate understand team norms. Debriefing after a difficult interaction with a colleague or staff member. Creating the conditions where the new hire feels safe to ask questions and make mistakes without social consequence, what researchers and practitioners call psychological safety," she writes. "In a clinical environment defined by hierarchy and high stakes, safety does not emerge on its own. It must be built deliberately, and mentors are often the ones best positioned to build it," according to the piece.

Confidence follows action, not the other way around

"One of the most common things I hear from new graduates is some version of 'I am waiting until I feel more confident.' One of the most important things a mentor can offer is a reframe: confidence follows action. It is not a prerequisite for it," Rabwin writes.

She describes working with "a veterinarian who was two years into her career and struggling" to find the clinical skills she needed. "What fear was doing to her day-to-day was more insidious than a knowledge gap. It was shaping every decision: which cases she felt she could handle, when she called for help, how she presented herself to clients. She was second-guessing herself before she even walked into the room."

"The turning point came when she performed her first pyometra surgery on a patient whose owner could not afford referral. She was scared. She did it anyway, with guidance. In doing it, she found not just her confidence, but her sense of purpose, the reason she had worked so hard to become a veterinarian," Rabwin writes.

"What made that possible was not clinical instruction alone. It was the psychological safety to attempt something uncertain, the knowledge she would not be abandoned in the hard moments, and that a mistake would be debriefed rather than held against her."

"That pattern shows up in program data in a way worth naming directly. In surveys of Ready, Vet, Go participants, clinical confidence increased significantly, even though the program does not teach clinical medicine. Mentorship has the potential to build confidence across the board, not just in the areas it directly addresses," according to the piece.

The qualitative research reflects the same dynamic, Rabwin writes. "Participants who described receiving consistent encouragement alongside clinical guidance-built confidence more durably than those who received only correction. Confidence is not something new graduates arrive with fully formed. It is something the mentorship environment either cultivates or suppresses."

What mentorship beyond clinical milestones requires

"Expanding mentorship beyond clinical milestones does not require a dramatic overhaul," Rabwin writes. "It requires broadening what mentorship conversations are expected to cover. Practices that invest in this kind of comprehensive mentorship see the difference. Veterinarians who are supported across the full range of what practice requires become more confident, more consistent, and more committed to the practice they are in. The ones who are not supported, clinically covered but otherwise on their own, tend to disengage quietly before anyone understands why."

Our read: this reframes the onboarding budget for owner-DVMs. The margin erosion in months one through six is not just covering slower appointment times while a new hire builds speed. It is the cost of building the judgment calls, the client communication fluency, and the team integration that determine whether that hire stays past year two. The veterinarian the practice needs is not the one who arrives fully formed.

For associate DVMs two years out, this is the support worth asking for explicitly in contract negotiations or job interviews. Not just clinical backup, but structured mentorship that covers the full scope of what is still being learned. The practices that offer it are the ones positioned to keep people.

For mid-career veterinarians training new hires, understanding what they have (a solid clinical foundation) versus what they lack (the repetition that builds judgment and the modeling that builds communication skill) changes what to expect in weeks one through twelve and what to prioritize in mentoring.

"New graduates need more than a clinical skills checklist," Rabwin writes. "The practices that recognize that, and build mentorship accordingly, are the ones best positioned to support early-career veterinarians through the full complexity of what practice requires."

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