The Paradox of Preventive Care
We should celebrate the state of nothingness. The absence of disease is a consequence of frequent visits and client compliance.
One of the many challenges our society faces with COVID-19 is that nothing happens if we wear a mask, wash our hands and physically distance from one another. Nothing is a good thing, right? No one gets sick. However, recognizing and reinforcing behavior that results in the absence of disease is difficult.
The same can be said for preventive care in veterinary medicine. When we see a pet at least twice a year, counsel on nutrition, behavior and dental care, and provide for parasite and immunizations needs, nothing happens. There are no dramatic hero moments to celebrate. Sounds like the premise of “Seinfeld,” the TV show about nothing yet regarded by many as the greatest sitcom of all time.
Disease intervention is comparatively easy. It generally can be seen, experienced and valued. The presence of a tumor versus the absence of one. An itchy pet versus a comfortable pet. Pretty obvious.
The absence of disease, on the other hand, is not so obvious. When was the last time a client walked into the exam room and high-fived you because of their pet’s lack of distemper, obesity or heartworm disease?
Our entire medical system (human and veterinary) is built on a reactive care model. Responding to disease states versus reinforcing a state of health. Reacting and repairing versus preventing and preparing.
Stop the Drama
The pandemic reinforced to veterinary professionals the value of preventive care. We postponed nonessential preventive care, though I would argue that very little is nonessential in veterinary practice. We then dealt with the predictable uptick in parvo, pyometra, Lyme disease and more. Physicians, dentists and optometrists saw similar downstream consequences from delayed preventive care.
Financial incentives further favor sickness over wellness. Reactive care results in a high single financial transaction compared with preventive care’s low single financial transaction.
One can make the case that comprehensive preventive care leads to a reduction in emergency medicine. Given the enormous increase in COVID-related emergency needs and our colleagues’ resulting stress in emergency care, that sounds like a good thing.
We heroize the reactive and dramatic at the expense of preventive care. Let’s stop the drama and make the absence of disease the hero. Celebrate health and make the invisible visible. Congratulate pet owners on their great care.
Wellness Begets Wellness
A veterinary professional’s well-being benefits from better pet preventive care. How? We improve the wellness of veterinary professionals by limiting dramatic, unbudgeted, traumatic, reactive events. In place of wellness-challenging reactive care is the relationship building, client educating and bond creating that takes place through routine preventive care. Deep human connections, trusting relationships and friendships result from multiple preventive care interactions. Well-care results in wellness for pets, their owners and veterinary teams.
Economic euthanasia, shortened pet life spans, suffering, crisis interactions and stressful client discussions all take a toll on veterinary professionals. Pets, pet owners and providers all benefit from good preventive pet care. Oh, and did I mention that those pets live longer, happier lives?
Room for Optimism
If I’m sounding too pessimistic, don’t get me wrong. I remain bullish on veterinary medicine. Pet numbers are up, pet spending is up, pet lifespans are up, euthanasias are down, shelters are emptying, and we remain among society’s most highly regarded professionals. We have much to celebrate.
However, wellness issues among veterinary professionals are real. I submit that a commitment to pet preventive care will reduce stress, burnout and compassion fatigue. By decreasing the number of dramatic urgent cases and through good client education and preventive care, we improve our well-being.
Perhaps it’s just me, but I’d rather see a routine healthy pet appointment involving a long-time client with whom my team and I have built a deep and trusting relationship than see an urgent case with an uncertain prognosis presented by a client I rarely see and often complicated by financial constraints. I smile a lot more often in the first scenario.
Turns Versus Earns
For preventive care to be embraced, the current model needs to be challenged. The old one-visit, one-doctor, once-a-year model will not hold up much longer for veterinary teams, clients and patients. An annual 20-minute appointment is not sufficient to educate clients about nutrition, behavior, dental care, immunizations and parasites. We need more client touches in person or virtually, either by the doctor or a team member. Ideally, three or four interactions a year are needed to best educate pet owners, build trust, improve communication and drive compliance with needed preventive care.
For some of us, this requires a fundamental shift in how we approach practice. I submit that we’ve taken an “earns” approach to the business of veterinary medicine when “turns” are far better suited. What do I mean? Visits per patient over one year (turns) correlates more strongly with practice revenue than the more commonly used single average client transaction (earns), according to a VetSuccess study. The research suggests that clients are more sensitive to the cost of a single visit than the amount spent over one year.
Lower costs per visit resulted in more visits. More visits correlate more strongly with higher revenue per patient. More visits, whether in person or virtual and with a doctor or veterinary nurse, result in better-educated clients and better pet care. Turns are more important than earns.
Recall the American Animal Hospital Association study from several years ago in which the lifetime value of a pet receiving all recommended care over a 12-year lifespan resulted in a spend of $17,700. This compared to the average AAHA-accredited hospital delivering only $3,600. That’s nearly a five-times difference.
Pet lifespans have risen dramatically over the past several decades, largely because of preventive care. Cats routinely live 12 to 15 years and dogs 10 to 13, but what is their biological potential? How old would cats and dogs live if compliance with preventive care approached 100%? I suspect we’d routinely see 20-year-old cats and teenage dogs.
Imagine the benefits to society should our beloved pets’ lifespans increase by 50%. What’s the benefit of an additional three or four or five years of life to pets, their owners and our profession? It’s immeasurable. The $17,700 per pet would be well over $20,000 and perhaps closer to $30,000. Preventive care benefits pets, people, providers and practices.
Our profession is essential to the well-being of society. We can, however, do a better job embracing preventive care. “Seinfeld” made a huge hit out of nothing. How can we make a hit out of prevention?
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 vice president of the North American Veterinary Community.
The WellHaven Pet Health family of practices found that subscription wellness plans are remarkably effective in delivering necessary preventive care. Wellness plans support the budgeting of pet care and incentivize more visits.