Onward and Upward
Forced to adjust amid the pandemic, we proved we’re capable of radical change. We can do a lot more, from pushing for portable licensure to embracing asynchronous learning.
Our profession, an industry known for its aversion to change, has demonstrated a remarkable ability to adapt, innovate and grow over the past few months. Historically, we’ve been the poster child for a belts and suspenders industry, one that’s exceedingly cautious, but in the face of crisis, we’ve learned much that will help us to thrive in the years to come. Let’s continue to flex this newfound muscle and benefit society, the pets and families we serve, and ourselves. As George Bernard Shaw once said, “Those who cannot change their minds cannot change anything.”
Do you agree with the following? Disagree?
1. Portable licensure. Why do we need a license from every state we practice in? Didn’t we take a national exam? What benefit is derived by maintaining a separate license in every state where we practice, have practiced or might choose to practice?
2. Additional veterinary nurse duties such as simple extractions, skin and gingival closures, virtual and physical exams, rabies and Bangs vaccinations, microchipping, catheter placements, Coggins testing, cystocentesis, and endotracheal tube placement. The list goes on. Let’s open and update state practice acts and further empower veterinary nurses. Remember, doctors, our job is to diagnose, prescribe, perform surgery and build relationships. Everything else can be delegated.
3. Veterinary nurse practitioner. This position is way overdue. Think of a highly trained and empowered veterinary medical professional with state-approved authority to better meet the needs of our society and profession.
4. Virtual veterinarian-client-patient relationship. It’s time, when the situation makes sense, to eliminate the need for a face-to-face encounter. Doctor discretion will always make that determination. Telemedicine is one more tool with which we can better help pets, families and our profession. The American Association of Veterinary State Boards is in support. A number of states have suspended the VCPR in response to COVID-19. The Canadian province of Ontario, population 15 million, dropped the VCPR requirement several years ago. Did the sky fall? No. In fact, colleagues in Ontario report no issues. Clients and pets benefit, barriers to care drop, and brick-and-mortar visits increase. The time has come.
5. Enhanced DVM licensure, aka limited licensure. Why do we insist on a James Herriot-driven curriculum and licensure? An approach of all-things-taught-to-all students no longer makes sense. Imagine how much better prepared new graduates would be in their field of interest if we didn’t dilute valuable educational time on acquiring skills they will never use.
6. Hybrid-distributed models of clinical education. In this model of clinical education, academia partners with real-world clinical collaborators to provide an immersive, cost-effective, high-caseload, hands-on experience to best educate our future colleagues. All with the goal of teaching and learning commonly seen conditions uncommonly well and better preparing graduates for entry-level success. Under this model, students and their teachers are no longer constrained by the limitations and boundaries of a tertiary care teaching hospital, which by design focuses on uncommon and complex tertiary care delivery, often at the expense of primary care education. COVID-19 further validated the strength of the distributed model. While university teaching hospitals were shut down, private practices remained open as an essential service. Private practice figured out how to safely serve clients and patients, and host senior students. In a time in which the very fabric of traditional teaching hospital clinical learning has been compromised, the private practitioners stepped up to prepare students for clinical success.
7. Competency-based medical education. This is a learner-centered model that de-emphasizes equating competency with grades and focuses instead on abilities and achievement as salient learning outcomes. Competencies are the currency of the future workforce and will be captured on a secure digital learning ledger (blockchain) that never closes. Learning is a continuum. This allows learners to perpetually build their educational record, transfer it seamlessly, and train and retrain to meet the needs of our ever-changing society. The Association of American Veterinary Medical Colleges’ competency framework is a great start.
8. Asynchronous learning. A quarter, a semester, a year, a four-year degree — why do veterinary degrees take four years to complete? What’s so magical about four years? If I can learn at a faster pace, opt out of something I already know, take off a semester to immerse myself in an industry or private practice experience, or curate exactly what I want to learn, then why shouldn’t I? It’s happening in undergraduate programs. This is what the learner of tomorrow wants and society requires.
9. Mentern, aka reverse mentorship. These are cross-generational relationships established as an innovative way to facilitate learning. They involve pairing a mentor and a mentee to share one another’s experiences so that both can benefit. Typically, the mentee is focused on learning from the mentor’s experience, often with a focus on leadership development. The mentor learns of new technology, new operating systems and current thinking. Do you have a mentor, a mentee?
10. Diversity, equity and inclusion. I am ashamed that I know so little. I will listen, better understand my biases, learn how systemic discrimination impacts us all, and use my privilege to help drive change.
11. Life comes before work. My boomer generation can’t be reminded of this enough.
12. Wellness begets wellness. By committing to pet wellness care, we are safeguarding our personal wellness. How? Pet preventive care results in longer and happier pet lives and more frequent and deeper interactions between pet families and veterinary teams. The combination of fewer emergent situations, less unbudgeted care, less drama and better client relationships produces less stress on veterinary professionals. If you’re not happy where you’re at, go someplace else. If you’re still unhappy, you might need to look in the mirror.
13. Veterinarians and our teams before pets. We have to first take care of ourselves before we can take care of others.
14. Grow. Make new mistakes. Uncomfortable is good.
15. The top five human health issues are obesity, diabetes, anxiety, depression and cardiovascular disease. The secret to treating all five lies within our veterinary domain. Pets have healing power. Hug your pets.
16. Optimists live longer, happier lives. Choose optimism.
17. It’s time to move from a doctor-centered sick-care model to a team-based well-care model led by veterinary nurses. Our profession is largely mired in a doctor-centric paradigm prioritizing sick care in the face of overwhelming evidence that a team-based model promoting well care is better for pets, families and veterinary professionals.
18. The hands-on physical exam is not the gold standard. Heresy? Perhaps. Is the physical exam delivered to terrified patients in noisy, strange-smelling, sterile-cold, slippery, hostile environments really yielding reliable examination data? Not to mention that nearly half of pets in America will not visit a veterinarian this year and thus not benefit from any exam. Should we perform a thorough nose-to-tail physical exam whenever possible and humane? Of course, we should. But can’t we and our patients benefit from virtual exams, too? Wearable and implantable devices are not far away. They promise to radically disrupt our view of the traditional hands-on exam. Pets and our profession will benefit from rethinking the physical exam. Physicians already have. The choice need not be between the exam room and Dr. Google. Why not make it between the exam room and living room?
19. Technology. Embrace it.
20. The cost of care. Tens of millions of pets will not visit a veterinarian this year because of the cost. Can we deliver essential annual preventive care for $20 a month, an amount that a PetSmart Charities survey indicates even the lowest-income pet owners will support? Should you introduce a monthly subscription that offers twice-yearly exams, all necessary immunizations, parasite control and education on good nutrition, behavior and dental needs?
21. Move veterinary professionals to the center of the pet experience, not just the center of the pet medical experience. We are the acknowledged experts in the pet space. Let’s assert that position. Veterinary professionals should be involved in consulting and leading consumer education in pet retail, grooming, day care, boarding, dog parks, blogs, breed clubs, rescue groups, behavior, training and nutrition. It’s not OK to silo our knowledge in the medical domain. Pets need us in all phases of their lives.
22. A minimum of twice-a-year examinations, either physical or virtual. An annual exam is inadequate, particularly in juvenile and geriatric patients. The old model of one exam room, one doctor, one exam, one time a year doesn’t work. How can we properly educate pet owners in one 20-minute interaction one time a year? No, we can’t.
23. Forward-booking. You’re not forward-booking? Talk to your dentist. A one-year reminder is a one-year invitation for your client to find another veterinarian.
24. The pet effect. Celebrate the bond. Remind clients that because of their wise choice to include a pet in the family, they will suffer less cardiovascular disease, less depression and fewer allergies, lower their blood pressure, and better control their weight. Their physical and emotional well-being is enhanced. Pets heal.
Change Is Required
Change is not a four-letter word. Change is hard but necessary. Pet consumer behavior has forever changed. A new generation of pet owners is now dominant.
Our old model fails to meet the needs of too many pet families. Perhaps worse yet, the old model is damaging the personal and professional well-being of our colleagues.
Change is required. Let’s keep on innovating, growing and learning. We can change. COVID-19 proved it.
Creative Disruption columnist Dr. Bob Lester is chief medical officer of WellHaven Pet Health and a founding member of Banfield Pet Hospital and the Lincoln Memorial University College of Veterinary Medicine. He serves as vice president of the North American Veterinary Community.