Creative Disruption columnist Dr. Bob Lester is the chief medical officer at WellHaven Pet Health, a former practice owner and a founding member of Banfield Pet Hospital and the Lincoln Memorial University College of Veterinary Medicine. He serves on the boards of Pet Peace of Mind, WellHaven Pet Health and the Lincoln Memorial veterinary college. He is president-elect of the North American Veterinary Community.Read Articles Written by Bob Lester
Consumers will get what they want, when they want it and where they want it at a value they deem appropriate, and with little regard for who provides it. For example, consumers desired a taxi service that was more convenient, tech-forward, clean and at a good value. Frustration with the taxi industry was rampant. Similarly, dissatisfaction with the record industry proliferated. Purchasing a single song required buying an entire $15 CD at a brick-and-mortar store and playing it on old technology.
In both cases, the taxi and recording industries remained unresponsive to the demands of the consumer, not out of arrogance, ignorance or greed but because of what they deemed an insurmountable regulatory moat guarding them against competition. Protection through livery licenses in the taxi industry and copyright law in the recording industry provided legal protection from upstarts like Uber and Napster. Ultimately, regulatory bodies failed to stop Uber but did kill Napster, only to have Spotify, Pandora, Apple Music and others take up the torch.
The Clock Is Ticking
What does this have to do with our beloved veterinary profession? Let’s think about it. We all enjoy the exclusive privilege as licensed doctors and nurses to practice veterinary medicine. We are regulated by state licensing boards, whose role in part is to guard against the unlicensed practice of veterinary medicine. An insurmountable moat, right? Maybe not. Did the authority of livery licenses protect the taxi industry? Did copyright law guard the recording industry? Will our well-meaning, hard-working but under-resourced state boards be able to protect our profession from unregulated individuals practicing veterinary medicine? I’m not so sure.
If consumers decide they want veterinary care elsewhere, they will get it. If we don’t respond to pet owner demand for more access and better value, and if we don’t embrace technology in support of the client and pet experience, consumers will get the care somewhere else. This despite the best efforts of any regulatory agency.
We run the risk of the disintermediation of veterinary services from veterinary professionals. Just like with what happened to taxi drivers and CD producers, consumers will get the veterinary care they want, where they want it, when they want it and at a value they choose. Unless we respond to the desires of our consumers, pet care might be delivered by someone other than a veterinary professional.
I’m Bullish on Vet Med
Don’t get me wrong. I am an unabashed optimist. I am bullish on our profession. The tailwinds we enjoy are remarkable. The bond between PetGen (millennial + Gen Z = PetGen) and pets is the strongest of any generation to date. This leads to increased pet numbers, more pet spending, decreased euthanasia, longer pet lifespans — the list goes on. However, we can’t get complacent.
Let’s look a little closer in the mirror. How are we doing? What does the status quo look like today in veterinary medicine, particularly as viewed through the lens of the dominant PetGen consumer? PetGen members want things now, prefer clicks over bricks, consider their pet a child and are looking for value.
How’s our profession doing on convenience? Brick-and-mortar visits available only from 9 a.m. to 6 p.m. Monday through Friday and from noon to 4 on Saturday are not what today’s consumers consider convenient.
How about technology offerings for today’s PetGen consumer? Reliance on telephones is way out of date. The veterinary profession is technologically 10 years behind the times on a good day. What about telehealth apps, online appointments, social media, triage, texting and wearables? We can do better.
OK, how about value? Households with annual incomes under $75,000 are not visiting veterinarians. Would these families and their pets benefit from our care? Of course they would. According to recent Idexx data, only two out of three dogs will visit a veterinarian this year. Worse yet, only one in four cats will visit. Survey data out of the United Kingdom shows that pet owners are beginning to actively avoid veterinary visits because of cost concerns.
We can do better to meet today’s consumers’ desire for convenience, technology and value.
How We Compare
Regulatory capture is a form of government failure that occurs when a regulatory agency that was created to act in the public interest instead advances the concerns of groups that dominate the industry or sector it regulates. The interests of the status quo become prioritized over the interests of the public, leading to a net loss for society. Think livery licenses and recording copyright laws. Are we in danger of this occurring in our industry?
The first table shows how our profession stacks up with the taxi and recording industries.
How can we avoid what happened to protected industries like taxis and music recording? How can we do more when we’re struggling with an enormous doctor and nurse workforce shortage? How can we do more when burnout, compassion fatigue, mental health issues and suicide plague our profession? How can we keep pet owners from seeking care outside our current model without stressing an already stressed workforce? As Charles Darwin said, “It’s not the strongest or the most intelligent that will survive, but those that can manage change.”
I suggest two changes to the status quo. These are significant disruptors in support of our profession’s exclusive right to care for pets and in support of the wellness of our profession. What can protect our profession from the disintermediation of veterinary services from veterinary professionals and simultaneously promote professional well-being?
1. Adopt a Virtual Veterinarian-Client-Patient Relationship
I would argue we’ve had a virtual VCPR for decades. Over the phone or at a Little League game, we’ve always been able to determine whether immediate care is required, if care can wait until tomorrow, or if there’s nothing to worry about. We know what advice is or is not appropriate in the absence of the pet. We’ve always trusted our colleague’s clinical judgment to know when dealing with a case virtually or face to face is appropriate.
Using and understanding technology in support of a superior patient outcome is important whether virtual or on-site. We can do better, or someone else will.
A road map to a virtual VCPR exists. The American Association of Veterinary State Boards’ Practice Act Model suggests a way forward. It reads in part:
“The AAVSB recommends that each jurisdiction promulgate appropriate regulations defining how to establish sufficient knowledge of the animal(s), including the following:
“A. A recent examination of the animal or group of animals, either physically or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically; or
“B. Through medically appropriate and timely visits to the premises at which the animal or group of animals are kept.”
2. Better Utilize Nurses and Introduce the Veterinary Nurse Practitioner
Veterinarians, like other health professionals, can and should delegate much of what they do to other capable, willing and often more skilled professionals. Other forms of health care delivery are done through teams. For every physician and dentist are multiple skilled, licensed, respected and fairly compensated team members. Our profession has roughly one credentialed veterinary nurse for every veterinarian. According to the U.S. Bureau of Labor Statistics, there are currently 4.1 RNs for each M.D. Can you imagine your physician functioning with only one nurse?
Veterinarians have four jobs: diagnose, prescribe, perform surgery, and build relationships with our team and community. Veterinary nurses and veterinary nurse practitioners can be empowered and compensated appropriately to deliver more and better care.We can help more pets and pet families and improve our financial and workplace well-being. Our veterinary nurses deserve it, and so do our patients and clients.
The table at right shows the benefits of a veterinary nurse/veterinary nurse practitioner and a virtual VCPR. What you see are two actions, each not simple but possible: Embrace a virtual VCPR and promote the full use of veterinary nurses while introducing veterinary nurse practitioners. Both would provide today’s pet owners with the care they desire and not further stress an already stressed profession.
Consumers are going to get what they want, when they want it and where they want it. Are we willing to give it to them? If not, somebody else will.
The alternative is to keep doing what we’ve always done. In other words, treat barely half the U.S. pets, burn out our teams and cling to an old, failing model of care. Why should we change and adapt? After all, the status quo worked out well for Toys R Us, Sears, Blockbuster, Borders, Kodak, Circuit City, Radio Shack, AOL, Tower Records, Atari, Hostess, Blackberry and the dodo bird, right? Let’s not join the list.
Veterinarians were horse doctors at the turn of the 20th century. Henry Ford and the introduction of his Model T drove significant change in our profession.
Let’s continue to learn, unlearn and relearn. Let’s change, adapt and grow. Let’s embrace technology in support of our profession, and let’s further empower our veterinary nurses. We can do this!