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
I’m certain that readers will agree when I remind them that veterinary professionals are brilliant, charming, good-looking, popular and humble. Can’t forget humble. In fact, we’ve never been more popular. Don’t believe me? Just look at your appointment book. Everyone wants to spend time with you. An American Pet Products Association survey reported that 11.38 million new pets entered households over just the first six months of the pandemic. Wow! Eleven-plus million.
Great news, right? More families will enjoy the tremendous benefits of the connection that comes from pet ownership. Oh, but wait. Sadly, a commensurate number of veterinarians and veterinary technicians/nurses did not join our ranks to help examine, educate, vaccinate, care for and bond with the millions of new pet families. Neither did more veterinary profes-sionals join us to lend a hand with our existing clients, who while stuck at home took a newfound interest in their beloved fur babies.
Veterinary professionals are fortunate to be able to pursue their passion, make a difference, and care for pets and people. COVID refocused our society on the value of family pets and brought about a significant increase in pets needing veterinary care.
To sum it up: More pets, fewer vets (and staff). An interesting dilemma. Better than the inverse, I suppose, but a problem nonetheless. How can an already busy profession dealing with significant mental health issues, compassion fatigue, a workforce shortage and burnout handle more pets? How can we treat more pets when we have fewer veterinary professionals?
We can’t work any harder. Our challenge is to be more productive and more humane. Take care of ourselves first and then help more pets, but how?
How about this? Three words: techs and tech. More specifically, fully utilize veterinary technicians and technology. Embrace team-based health care delivery driven by technicians and supported by technology. Not enough veterinary technicians, you say. There would be if we honored, empowered, paid and retained the ones we have. Utilize them to the top of their license. They are leaving our profession. What a waste of remarkably capable, competent and compassionate people. Honor them, utilize them, compensate them fairly.
As for technology, the use of telemedicine, teletriage, artificial intelligence, texting, e-commerce, cloud-based PIMs and virtual appointments by doctors and veterinary nurses will go a long way in driving efficiency. Millennials and Gen Zers have been waiting not so patiently for us to join them in the digital 21st century. Digital connections only further build on the strong personal relationships our profession is famous for.
Techs and tech can provide more productivity and not further sacrifice our personal lives.
Do the Math
Completely unscientific but directionally accurate data from a Google search shows that veterinarians see about 15 patients a day on average compared with 22 by optometrists, 24 by general practitioner MDs and 30 by dentists. (Dental hygienists account for 10 to 15 of those patients.)
Question: How are those other health care professionals so much more productive? Answer: They employ a team health care delivery model.
Further, for every physician there are roughly five empowered, fairly compensated, highly valued health care professionals (RN, LPN, NA, CNA, APRN, DNO, DNP, to name a few). For every dentist, about three. For every veterinarian, about one. One DVM per one CVT. Ouch.
Over 200 veterinary technician schools graduate 8,000-plus eager, trained, licensed and passionate technicians a year to work with 3,200 U.S. veterinary school graduates. If we just retained our CVT grads, the DVM-to-technician ratio rises to 1-to-2.5. That’s a health care team I’d join.
The math reminds me of an old saying. In math, 1+1+1+1+1 … equals infinity. In life, 1+1+1+1+1 … equals insanity. Should we desire to remain sane, we need to keep our veterinary nursing staff.
If a technician saw just two pets a day that a veterinarian currently sees, the doctor would be free to see two more pets in their place. Back-of-the-envelope math again shows that instead of seeing 15 pets a day, the team would help 17, a 13% increase. More pets helped, happier clients, happier teams, we go home on time (more often), and productivity rises substantially.
A 13% rise in pets cared for approaches 10,000 more DVM equivalents in the workplace. More math: If a veterinary nurse visit averages just $100 and two visits a day comes to 500 a year, that’s an additional $50,000 in revenue, not to mention the revenue realized from two more appointments.
So, one more time: Pets win, pet owners win, CVTs win, DVMs win, practice productivity wins, quality of life wins and practice financial health wins. Sounds pretty good to me.
The Utilization Solution
By some estimates, CVTs use only about 30% of their skills and competencies for which they were educated. There’s so much more they can do and want to do. For instance:
- Technician appointments
- Virtual consults
- Rabies vaccination
- Endotracheal tube placements
- Simple extractions
- Anal gland expressions
- Client education
- Dental prophies
- Catheter placements
- Skin and gingival suturing
The list goes on and on.
Good news: The American Association of Veterinary State Boards, a progressive and farsighted regulatory group, is working on a model CVT scope of practice guideline for individual state boards to adopt. Bad news: Some less-enlightened groups, like my own Oregon Veterinary Medical Examining Board, are retreating into the last century and denying technicians the authority to do even a simple dental prophy.
To date, our profession has largely squandered the opportunity to elevate the importance of the veterinary technician. Shame on us. Now is the time to embrace them.
Better Your Financial Health
Way back in 2008, an American Veterinary Medical Association economic survey revealed that, on average, for every licensed veterinary technician a practice employed, gross revenue rose by an additional $161,493. The same was not seen with non-credentialed veterinary staff. Rather, there was no significant revenue improvement.
Anyone up for an additional $161,000 in annual revenue? Count me in. At 3% annual inflation, $161,000 grows to about $228K in today’s dollars. That goes a long way toward fairly compensating your professional staff.
It’s not too late. Throughout the remainder of the pandemic and beyond, let’s work harder to empower, utilize and honor these vital veterinary health care professionals.
We work hard. The workforce shortage is not going away. Pet numbers are not going down. If we do our jobs well, pet lifespans will continue to rise, resulting in even more visits.
Question: How can our profession deal with more pets and fewer veterinary professionals? Answer: Techs and tech.
Empower your team, delegate, honor your veterinary technicians/nurses and utilize technology in support of great care. We can do it.
It’s tough being popular. Oh, and humble, too. Can’t forget humble.
We have four jobs as veterinarians: diagnose, prescribe, perform surgery and build relationships with the community. Anything else can be delegated.
Honor your veterinary nurse team, delegate, appreciate, respect and utilize. Trust your professional staff.
Technicians, push your veterinarians. Continue to remind them of your training, skills, heart and desire to do more for the patients in your care and their owners.
We must move away from the old-school idea of doctors delivering sick care and think of it as team-delivered, technology-enabled well care powered by veterinary technicians.
BUILDING BETTER TEAMS
The Veterinary Innovation Council, a nonprofit organization whose industry partners include the North American Veterinary Community, is leading an initiative to further the utilization of veterinary nurses/technicians. One proposal calls for the creation of a master of science degree in advanced veterinary clinical care.
“Interest is growing in a new midlevel veterinary professional following the model from human medicine of the physician assistant or nurse practitioner,” council members Dr. James W. Lloyd and Mark Cushing wrote in a February 2021 report.
While “case volume might not be adequate to warrant hiring such an individual in every practice,” they noted, “sufficient potential seems to exist across the profession to warrant development of several pilot training programs.”
The report can be found at bit.ly/304z5II.