An ENFJ man’s instrument is aimed at people, and it works, and people are portable. His output walks out of the building and gets counted somewhere else as somebody else’s hire, and on his own record it shows up as turnover.
The first thing Ren Halstrom ever said to me about my own work was that I had been wrong about a horse and that he was glad.
I was twenty-six and six weeks out of school and I had called a colic a surgical when it was not, and the referral clinic sent it home with a bill and a certain amount of tone in the discharge notes, and I had spent two days concluding I would not last.
He came out to the truck where I was pretending to inventory drawers.
“You called it early.”
I said I had called it wrong.
“You called it early and wrong, which is the only kind of wrong worth anything.” He leaned on the fender. “The other kind is late and right, and I’ve buried three horses for people who were late and right.”
I said the discharge notes had been fairly clear.
“They were. Read them again in a year.” He took a drawer out of my hands and put it back in the wrong slot on purpose, which I did not understand for about five years. “Sigrid, I’ve watched you for six weeks. You’re going to be a better surgeon than anybody in this building and you’re going to be it by thirty-one. What you’re not going to be is a person who can stand being wrong, and if you don’t fix that in the next two years it’ll be the whole of your career.”
I was a board-certified surgeon at thirty-two.
Ren came to Torvik in 1998, out of school, at twenty-eight. He has been medical director of that practice since 2009, which is the highest title available in a building of that size, and he has held it for seventeen years. He is a big, loud, permanently sunburned man who talks to everybody and remembers everything about them, and it is not a technique, and people who assume it is a technique work that out inside a month. He has a laugh that carries across a lot. He is late to everything by nine minutes. In twenty-eight years he has not worked anywhere else.
Torvik Veterinary Service is in Verrill and does mixed practice — dairy and beef out on the farms, small animal in the building, a little equine. Ottmar Torvik started it in 1979 and sold it in 2019 to the group I now work for, which owns forty-three practices across three states.
I was hired here in 2004 as a new graduate. I left in 2011, for a specialty residency and then for a practice three hours away that could pay me what a surgeon gets paid. I came back in 2021 as the group’s regional medical director, which means that for five years I have been Ren Halstrom’s boss.
Here is the sentence about him that gets said in this profession, in this region, at meetings, by clients, and by me, warmly, for twenty years.
Everybody who works for Ren ends up somewhere better.
The group is designating training practices this quarter — a title, a stipend, and a real budget — and the nominations are due in two weeks, and submitting them for this region is my job.
Padma Iyer runs the region above mine. She has a way of ending any discussion about a practice’s numbers.
“So what’s the retention story?”
The Truck
You cannot learn this job out of a book and everybody in it knows that and nobody has ever built a system around it.
A new graduate comes out of eight years of school able to pass an examination and unable to do the work. They do not lack knowledge. They lack the thing that happens in a truck at four in the morning on a farm they have never been to, with a producer standing there who has been at it for forty years, and a cow that is not going to wait while somebody looks something up.
So you ride. For two years, three if the practice is any good, a new doctor rides with an experienced one, and then goes out with a phone, and then goes out without needing it. Somewhere in there is a night that is the first one they take alone — a calving, or a down cow, or something late at night that nobody can name over the phone — and the person who trained them is at home with the ringer on.
Ren has had his ringer on for twenty-eight years, including for people who left in 2009.
Ovide Thibault, who milks a hundred and forty head north of Verrill and has been a client since Ottmar’s time, asked me something at a producers’ meeting that I sat on for a year.
“How many vets you figure I’ve had?”
I said I had no idea.
“Nine,” he said. “Eight of them came off Ren’s truck and seven of them are gone.” He was eating a sandwich. “You’re the other one.”
Here is the economics of that, which this profession does not like to say out loud. The training is paid for entirely by the practice that does it, in senior-doctor hours, in slower appointments, in the mistakes a learning doctor makes on a client’s animal. And nothing captures it. There is no bond and no indenture and no mechanism of any kind. A practice that trains well is a subsidy to the entire regional labour market, and the market knows exactly which practices those are.
A mixed-practice truck is a box on a one-ton with about forty drawers, refrigeration, hot water, and a hydraulic winch, and every single person arranges those drawers differently and will tell you at length why theirs is correct. Ren’s has a coffee thermos strapped into the ultrasound slot because the ultrasound lives in the cab.
I have never owned an animal. Not one, not ever, not as a child. People in this profession find that out and cannot get past it, and I no longer explain it.
The Destination
What Ren does is not encouragement, and calling it encouragement is how this profession has managed to not look at it for a century.
He moves people.
He can take a person from where they are to somewhere they could not have got on their own, and the mechanism is not information. It operates on how a person stands in a room, what they think they are, and what the people around them think they are, and he adjusts all three at once, in the open, in front of the others, without its ever being humiliating to anybody.
And where the destination comes from is the second thing, and it is the part I cannot account for even now.
He looks at a twenty-six-year-old who is bad at everything and sees the shape of the doctor they will be at thirty-one. Not a hope. A specific picture, with a weakness named in it. He told Teodor Bak in his second month that he would end up in pathology and that his hands were never going to be the thing, and Teodor was insulted and is now a diagnostic pathologist and tells that story himself.
He is right about this at a rate that would be a career for somebody who could write it down. He cannot write it down. Asked how he knew about Teodor, he says something about the way he held a scope, which is not an answer and is the only one he has.
Somewhere adjacent to this is a man whose second faculty is the stored past rather than the shape of what is coming; he reads a room against every previous room and he is a superb steward of a place. This one is no steward at all. He is aimed at where a person is going.
And where a person is going is almost never where you are.
I watched him do it to Oyin Adeleke in her fourth month, on a dairy, in front of the herdsman.
She had missed something on a fresh cow that anybody misses, and the herdsman had caught it, and he was pleased about it in the way herdsmen are.
Ren said, “She’s right that it’s not the uterus. Where’d you land on it?”
The herdsman said what he thought.
“That’s what I’d have said too and we’d both be wrong a good share of the time.” He turned to Oyin. “So what are we doing?”
She said she wanted to pull bloods and come back tomorrow.
“Then that’s what we’re doing,” Ren said, and to the herdsman, “She’ll call you before noon,” and got in the truck.
What happened in that yard is that a twenty-six-year-old who had just been corrected by a client left it as the person making the decision, and the client left it expecting a call from her rather than from Ren, and it took about forty seconds and cost nothing and I have never once managed it.
Maude Prinz does the same thing at a practice in the next county and has for as long. What gets said about Ren is that everybody who works for him ends up somewhere better. What gets said about Maude is that she is very good with the young ones, and then, in the next breath, that her practice has a revolving door, and I have heard both of those said in the same conversation by a person who owned neither practice. What the identical building-of-people costs a woman in this profession, and what she gets asked to do with it instead, gets counted on the page beside this one.
Forty-three practices in this group. Nine regional and above. Four are women.
Somewhere Better
I built the list in the spring because I wanted to look at it.
Doctors who did their first two years at Torvik under Ren Halstrom, 1999 to 2024: twenty-six.
Of those twenty-six, one is a board-certified surgeon, two are diplomates in internal medicine, one is a pathologist, one runs the diagnostic laboratory at a university, three own practices, two are medical directors inside this group, one is me, and eleven are in general practice in this region and are the reason there is veterinary coverage in four counties that would otherwise have none.
Two left the profession. One is dead.
I can tell you where twenty-three of them were trained because I have been at meetings with most of them, and in every one of those conversations Torvik comes up inside two minutes, and Ren comes up inside three, and neither of those facts has ever been written anywhere that a decision gets made from.
Of the twenty-six, four are still at Torvik, and two of them have been there under two years.
Now put that through the instrument my employer actually uses. Associate retention at Torvik over the trailing five years is the lowest in my region. Mean tenure of an associate doctor at that practice is three years and nine months. The group’s dashboard, which I receive monthly and which Padma receives monthly, has a column for that.
Bertine Klug has managed that practice since 2007 and does the payroll and knows everything.
I asked her what she thought the retention number meant.
“It means they got good,” she said.
I said the group would read it as a management problem.
“I know what the group reads it as.” There was no edge in it; she has known me since I was twenty-six. “I’m telling you what it means.”
It has no column for the other list. No field exists anywhere in this company into which the sentence this practice produced most of the general practitioners now serving this part of the state could be entered.
What I Said
I want to put down two things I did, because they are the whole argument.
The first is that in 2016, at the practice I went to after this one, I was put up for medical director and the owner asked me who had developed me.
And I said Torvik Veterinary Service.
That is a true statement. It is also, exactly, not the answer, and I knew it was not the answer while I was saying it, and I said it because I had a great boss is not a credential and I trained under Ren Halstrom meant nothing in that room and Torvik meant a practice with a reputation. I traded his name for the practice’s name because the practice’s name was worth something and his was not, and the reason his was not is that nobody had ever put it anywhere.
The second is what I wrote in 2022.
I had been back a year. I had to produce development plans for the practice medical directors in my region, on the group’s template, which has six boxes.
In Ren’s, under primary development focus, I wrote: Focus on associate retention.
I read that sentence to myself at the time and thought it was fair. His retention is the lowest in the region. It is a real operational problem and it costs this group real money and I am paid to say so.
What I did not write, in that box or any other box, in that plan or the next one, was a single word about the twenty-six.
He signed it. He signed it in the meeting, in about nine seconds, and said, “That’s fair,” and then asked me how my mother was, and I have turned the ordering of those two things over more than almost anything else this year.
Source Practices
The regional meeting in the spring had a talent acquisition presentation on the agenda and I nearly skipped it.
The recruiting director is good and the deck was good. Pipeline, school relationships, signing structures, the whole apparatus of trying to hire doctors in a market where there are not enough doctors.
Slide nine was called Source Practices.
It is a list of eleven independent and small-group practices in our footprint that the recruiting function targets specifically, because — and this is the language on the slide — they develop clinically strong associates who become available at the three-to-four-year mark.
Torvik is on it. Torvik is second on it, and the practice above it closed in 2023.
Torvik has been owned by this group since 2019, which means that for seven years my own employer has had a slide identifying a practice it owns as a place to recruit doctors out of, and both of those functions have been running, and neither has ever been in a room with the other.
I asked, in the meeting, in a voice I was quite proud of, whether the practices on that list knew they were on it.
The recruiting director said it was an internal working document.
I asked whether the doctors who run those practices are measured on retention.
There was a pause, and Padma said, “That’s a fair point,” and we moved to the next slide, and nothing has happened since, and nothing is going to.
His Numbers
Oyin Adeleke left last year, at three years and two months, for a specialty practice two hours south. She is going to be extraordinary. Ren drove her out there for the interview because her car was in the shop.
That departure is on his dashboard. It moved his trailing retention down.
I sat with him about it, which is my job, in the practice kitchen with the door open.
I said the number was going to be a problem for him with Padma, and that it had already come up twice on calls he was not on.
“It’ll be a problem,” he agreed.
I said he could have kept her — that with a partnership track, a real one, written down, she might have stayed.
“She might have. She’d have been a partner in a mixed practice in Verrill.” He was cleaning something. “She’s going to run a service by the time she’s forty.”
I said that was not going to help him.
“No,” he said, and then, “Are you asking me to stop?”
And I said no, obviously not, and we talked about a herd health contract, and that is where that conversation ended, and I have replayed it and I did not answer his question. He asked me a direct question about whether the person paying him would like him to do less of the thing he does, and I said no, obviously not, and then I filed a development plan that says the same thing in different words.
First Year
Every doctor who comes to Torvik takes a personality questionnaire in their first month, and Ren pays for it himself.
He has been doing it since about 2004, which I know because I took it. Sixteen boxes, four letters, a two-page profile, and then he sits down with you for an hour and a half and you talk about it, and the talking is the point and he would say so.
He took it himself in 1994, in a required first-year course in vet school, and he still has the sheet.
His says ENFJ.
That hour deserves an exact description, because it would be easy to make it sound like a party trick and it is not one. He does not use it to sort anybody. He uses it to get a twenty-six-year-old to say out loud, in the first month, what they are afraid they are bad at — and the instrument gives them permission, because it is the instrument saying it and not him.
It is also, and I checked, the only structured professional development anything that has ever happened at that practice. There is no budget line for it. He pays about ninety dollars a head out of his own pocket and has for twenty-two years.
The material worth having sits past the profile, at the back of the packet, where it says four letters are an order: one habit at the head, one feeding it, and a pair behind them that a man reaches only by going after them on purpose and accepting that it will be slow. How that runs for him is worked through wherever this type is written up alone, from the sixteen that questionnaire was built out of.
At the head of it is the moving of people. Not reading a room, though he reads one — moving it, and moving the individuals in it, by adjusting how a person stands relative to the others, which he does in the open and which nobody has ever found humiliating, which I would have said was impossible before I watched him do it several hundred times.
Supplying it is the destination: where this person is going. Not where they have been, and not what the practice needs. A specific picture of a doctor who does not exist yet, arrived at without derivation, correct at a rate nobody has ever measured.
And that is the entire structure of the problem, in one sentence. His instrument is aimed at people. People are portable. An institution’s instrument is aimed at itself.
The pair behind them are what would have let him keep any of it.
One is the private, impersonal analysis — the thing that would let him sit down with his own dashboard and construct the case that the trailing retention number and the twenty-six are the same fact viewed from two sides, and put it in front of Padma with a spine on it. He has never done that and he is not going to. Every faculty he owns points outward at somebody else.
The other is the immediate material present — the concrete state of whatever is actually under his hands. He is, at fifty-six, a worse clinician than six of the people he trained, and he knows it, and he says so, and it is because he has spent twenty-eight years watching people instead of watching animals.
The plain part, since I wrote focus on associate retention on a form. If the thing you are best at is developing other people, ask for it to be written into your job description with a measure attached — anything, alumni placement, first-year competency sign-offs, a count — because a contribution with no measure attached is invisible in every subsequent decision, including the ones nobody tells you about. And the reverse of that. Agreements that tie a person to an employer after training — non-competes, training-repayment provisions — are the instrument this problem tends to reach for, they are being narrowed by law in a lot of places and are enforceable in others, and nobody should sign one without getting their own advice on it rather than the employer’s. Temperament plays no part in it. The people for it are your own attorney, your professional association, and whatever complaints channel your employer runs.
The instrument’s own guidance says the results are for self-understanding and are not to be used for selection, placement, or career direction, and that of people sitting it again a month afterward, close to one in three lands in a different box.
Ren’s vet school career services office used it, in 1994, to advise students on specialty selection.
Two Weeks
The training practice nominations are due in two weeks. There are four criteria and I have them in front of me.
The fourth one is a three-year associate retention rate above a stated threshold.
Torvik does not meet it. Torvik is not close to meeting it. Under those criteria no arithmetic gets the practice that produced twenty-six doctors designated a training practice by the company that owns it, and I could write a two-page memo about that and I know exactly how far it would get, because I have been in this group for five years and I know what a criterion is.
Slide nine took two things apart.
The truck in 2004, first. I have been telling that story for twenty-two years — the only kind of wrong worth anything — and I have offered it as the day a good man gave me some confidence. That is not what happened on that fender. What happened is that a thirty-four-year-old looked at a six-week associate and named the specific defect that was going to end her career, and told her the year she would be a surgeon, and was right about both, and did it in ninety seconds by a fender, and then went and did a herd check. Nobody has ever paid him a dollar for that and those ninety seconds are the most valuable anybody has spent on me.
Then the form in 2022. I have carried that as an accurate operational note. It is an accurate operational note. It is also the only thing in this company’s files that describes what Ren Halstrom does, and what it says is that he should do less of it.
What the questionnaire left out. He was two years late filing a controlled-substance log the state asks for annually and let a technician think it was her lapse for most of a week; there is a son in another state whose graduation he did not attend and whom he does not talk about; and about one former partner of this practice he goes somewhere I have twice watched a room decide not to follow.
I called him about the nominations. I said the criteria were what they were and that I was going to put Verrill forward anyway and let it get rejected on paper, so that at least there would be a paper.
He said that was fine and that he did not want me spending anything on it, and then he wanted to know whether the rejection would come back in writing, because if it did he could show it to Bertine, who has been telling him for four years that he should be asking for something.
Then he asked whether the stipend, if a practice got one, could be used on the new graduates directly, and I said I would find out, and he said no, don’t, he would just ask.
The people in these essays are composites drawn from long observation. The theory is not.