Dr. Peter Brown is president and co-founder of Cara Veterinary, a network of family-owned veterinary hospitals.Read Articles Written by Peter Brown
Vaccines have been the subject of so many articles over the last 50 years. We and our pets are living longer and healthier because of vaccines. Think of all the diseases we no longer see because of the use of modified live and killed vaccines: distemper, rabies, polio, tetanus. Without vaccines, our careers would be very different. I see many fewer parvo cases now than I did 20 years ago, thanks to vaccines.
Annual examinations (vaccine appointments) are dropping at general practices. Only two-thirds of dogs and one-third of cats were seen for a routine exam last year. There are two primary reasons:
- More vaccine-only clinics.
- Pet owner concerns about overvaccinating.
Times Have Changed
Historically, our profession used vaccines as the primary reason to get clients to bring “healthy” pets into our clinics. If you have not adapted to change vaccines as the driver, now is the time to do so because you will drive some clients away if you focus too much on the vaccine.
My approach is to look at an annual or semiannual exam in two parts: the prevention of disease and the early detection of disease.
Prevention is individualized and will include many things, including vaccination. Vaccines are only part of the prevention of disease. Disease prevention includes dental care, exercise, a proper diet, weight control, mental stimulation, titers and vaccines. For certain diseases — distemper, adenovirus 2, parvo, feline panleukopenia and rabies — the presence of high levels of antibodies are protective. Titer testing instead of booster vaccinating is recommended for pets with a suspected history of adverse events.
Early detection is the most important aspect of the routine annual exam. Pets cannot tell us when they are sick and clients often are not aware that their pets are sick. The pet needs a physical exam and diagnostic testing so that the veterinarian can diagnose disease early.
A client worried about “overvaccinating” should be listened to and educated about titer testing. For the rest of the diseases we vaccinate for, there is no evidence that antibody titers are an indication of protection, so in these cases we should not recommend titers. For all pets, clinicians need to assess a vaccine’s risk and reward.
Given all the positives of vaccines, some controversy exists. Feline injection-site sarcomas are the best example of a scientifically proven adversity associated with a vaccine. Because of this, many of us have changed how we vaccinate cats. There is controversy about other potential adverse effects: Are we causing immune-mediated disorders by boostering our pets every year? Are we causing an increase in cancer because of the stimulation of the immune system at frequent intervals?
While not the focus of this article, such issues worry our clients and are important to acknowledge. If we do not adapt to anti-vaccine concerns, fewer pets will come in for routine physicals and the entire pet population will be at greater risk of infectious disease.
What’s Being Missed
Pet owners flock to vaccine-only clinics because of the convenience and lower cost. From a disease-control perspective, the clinics are effective. My concern is with all the other aspects of the annual visit not being covered. Pet owners believe their pet is getting adequate preventive care by visiting a vaccine-only clinic once a year.
Prevention of disease, however, is much more than a couple of injections. We have a responsibility to help the whole animal by educating the client about lifestyle, dental care and diet. Is the education taking place at all vaccine clinics?
The complete physical examination is the first diagnostic we need to perform. How many opportunities at early disease detection are we missing when a pet goes to a vaccine clinic for its annual “exam”?
How do we reverse the trend of fewer pets coming in for routine wellness visits? Our goal should be to see every pet every year for a physical and early detection diagnostics. How do we get there?
The first step is knowledge. Spend time reading the newest published information on vaccine frequency, what diseases to vaccinate for, what vaccines are best, where to vaccinate on the animal, and the role of titers. This information is changing rapidly and we need to be the expert.
After you feel comfortable with the most current scientific-based knowledge, educate your support team and clients. Everyone should know why you do not recommend titer testing for FeLV instead of vaccinating. Your recommendation might be different today than it was five years ago and likely will be different five years from now.
The next step is getting clients to bring in their “healthy” pet. If your emphasis is on the vaccine, many clients will go to a vaccine-only clinic or, if they are scared of the vaccine, not go anywhere. You need to emphasize disease prevention and early detection. Your team needs to be prepared for the question “What do they need this year?” My teams are trained to respond, “We will determine specifics during the examination.”
Client reminders need to be changed to emphasize all the elements of the visit. One of the most impactful tools for driving future visits is how you and your team deliver the message during this year’s visit. Verbalize the exam, discuss everything you are looking for, celebrate the normal, and tell the client why you are running bloodwork, a urine test and anything else. The better we do in communicating the value of a visit (and the invoice), the more likely we are to see the client again.
As for vaccine opponents, acknowledge their fear and recite data. Never knowingly overvaccinate. Accept titers when they are scientifically proven to be protective. Part of our job is to discuss the pros and cons, the risks and rewards. Tell clients you know about the risks associated with vaccines as well as the incidence and severity of a particular disease. We as a profession cannot be ignorant of the fear many clients have in regard to vaccines.
A very effective way to drive pets into our hospitals for a routine visit is the wellness plan. In 2018, 26% of millennial pet owners said their pet was on a wellness program, compared with 13% among other generations. Clients today want predictable costs whenever they can. They also have trouble paying large single invoices.
I know many veterinarians are scared of wellness plans — why discount and let clients pay over time? I encourage you to revisit the concept. You do not need to discount to have a successful program. Look at wellness plans as a compliance tool. Great third-party software can help you interface a wellness plan with your practice software. Pet parents want these plans. If you do not offer them a solution, many will go elsewhere.
How will we change the trend of fewer pet visits? I have explored two of the many causes. There is not one magic fix. It is critical to the pet’s health that we change the concept of “vaccine appointments” one client at a time.