Dr. Adam Little is a Vancouver, British Columbia-based veterinarian and co-founder of GoFetch Health. He is a former associate professor of practice at the Texas A&M College of Veterinary Medicine and Biomedical Sciences. Dr. Little holds a DVM degree from the Ontario Veterinary College and was the first veterinarian to complete the Graduate Studies Program at Singularity University. He is a past board member of the Ontario Veterinary Medical Association and Veterinarians Without Borders.Read Articles Written by Adam Little
It’s anything but business as usual in the veterinary profession. Over the past couple of months and likely for the next several months, practices have adapted to a world that looks very different. While each day brought surprises and challenges, there is a sense that practices have implemented protocols, adjusted hours and staffing, and begun offering new services such as telemedicine to continue to support clients and patients.
What is less clear are the long-term impacts that this period might have on the profession. Will the adjustments to how care is delivered transition to permanent behavior change? If so, what are the big and bold transformations that this will accelerate?
Here are three ideas of how this might look.
1. National VCPR and New Licensure Models
The role of the veterinarian-client-patient relationship has been of paramount focus during the COVID-19 pandemic as states and provinces evaluate how best to ensure the safety of patients while enabling new ways that veterinary services can be delivered. Historically, a lack of clarity and consistency around the VCPR has been a barrier to the widespread adoption of telemedicine.
In broad strokes, most states have not allowed a veterinarian-client-patient relationship to be formed for a new patient via telemedicine alone, but it’s far less clear in regard to existing clients and patients. What if the patient hasn’t been seen in more than 365 days or if the issue is entirely different? Or what if a client calls for a prescription refill but the veterinarian who saw the patient is unavailable and another veterinarian handles the interaction and prescription? The time requirements, condition requirements and other considerations tended to leave veterinarians unsure of where the “line” was.
As a result of this and a lack of clarity from state boards, telemedicine was adopted only by those who dared or by businesses that saw a client need being unfulfilled by veterinarians. The American Association of Veterinary State Boards, under the leadership of Jim Penrod, took a stand and stated that veterinary professionals should be empowered to exercise their professional medical opinion irrespective of the mode of communication. Whether through electronic tools or hands-on exams, veterinarians know when they have enough information to diagnose. The net result of the confusion: Animals in remote or impoverished situations received less care than they could have otherwise.
In response to COVID-19, state boards and associations are being forced to rapidly adjust and clarify the VCPR. The trend is toward openness to not just provide telemedicine to existing clients but, in some places, allow the establishment of a VCPR through telemedicine.
Most state boards are framing this as a temporary relaxation in response to the pandemic. However, the benefits will not be quickly relinquished if government agencies reinstitute the legislation. The thousands of veterinarians who have openly professed their desire to practice telemedicine and the tens of thousands of clients who have appreciated the service are not going to suddenly say, “Wow, I’m glad that’s over and I can go back to bringing my pet in for every single issue instead of just dropping a note to my vet to get a quick answer.” That’s very unlikely to happen.
As clinics become not just comfortable but confident in offering virtual services to a clientele that has been looking for these options, stopping it will be difficult. Cost and time savings are the two biggest drivers of business evolution. We’re in the midst of seeing those drivers morph into telemedicine consultations. We are participants in the evolution of veterinary care. Telemedicine will continue to operate as a part of the client experience.
2. The Creation of Pet-Only Clinics
As clinics closed their doors to people but not their pets, a creative model rooted in a familiar foundation took hold: pet-only appointments. Curbside drop-off is not just a convenience that is occasionally offered but is becoming the standard of care for clinics; anything more would compromise the health of the client and staff.
This model isn’t an entirely new approach for most clinics, as procedures and surgeries often operate with a similar flow. Without a client in front of the veterinarian, practices are forced to adopt new approaches to history gathering, payment, discharge and booking. However, some positive elements appear to be resonating for both clients and veterinarians that will reverberate long after COVID. For example, handling payments before an exam creates opportunities to streamline the appointment itself.
But at its core, we are still forcing facilities inherently built to foster in-person connections (larger exam rooms, waiting areas, reception seating) to instead pivot toward pet-only appointments. From this pandemic, we expect a new approach to the use of physical space centered around the drop-off experience.
Instead of fitting an existing clinic into this model, new spaces will be retrofitted or designed with the drop-off experience as the main flow. Clinics might look smaller, have more flexible components and use technology in ways that are core to the end-to-end experiences. We’ve already seen this in new, modern clinic environments where the drop-off model allows the veterinarian to prioritize her day and determine which cases she wants to address first while having the time to research those more-complex cases she will examine later. The resulting convenience for clients and veterinary staff is going to continue pushing this model to the forefront long after distancing ends.
What might follow is a new way to better reach and access pet owners. For example, such a model could easily integrate with neighborhood walking services or national peer-to-peer boarding and sitting services like Rover or Wag to open up veterinary care to pets when owners might not be available. We will also likely see new use cases of telemedicine where the pet is physically present in the clinic but the pre- and post-appointment communication is handled via telemedicine.
The pandemic created a sense of urgency in shifting the model of care and with that a realization that drop-off appointments, properly triaged and with a treatment plan in place to execute against, offer clients and veterinarians some advantages. However, today’s practices aren’t specifically designed to support that flow. Perhaps tomorrow’s will be.
3. The Entrepreneurial Vet
One segment hardest hit from COVID-19 is the community of relief or locum veterinarians and staff. Unfortunately, with the reduction in staff and hours, these individuals were the first wave to have their shifts cut. To make matters worse, they might be the last cohort of professionals to regain a steady stream of opportunities and income. In some cases, it’s not just about clinics “returning to normal” but about getting back to the level of activity and patient visits that require bringing in additional staffing resources. The long tail of recovery might make this a long time.
While there are avenues to help, from government subsidies to loan-deferment programs for precarious workers, these paths are not going to be sufficient to provide the kind of help that veterinarians are going to require.
Alternatives are going to emerge that will not only provide veterinarians with the ability to continue working with clinics, but their excess labor capacity will find a way to help animals in new and creative ways. For example, we’re going to see veterinarians self-organize around telemedicine opportunities in permissive states. Telemedicine will no longer be seen as a fringe benefit but as a necessary addition to continuity of care that begins long before the animal walks through the door and long after the SOAP notes are complete.
Clinic-bound veterinarians would do well to quickly determine ways to engage with these vets and incorporate them into their workflows now rather than wait for them to self-organize in spite of the veterinary practice.
Similar to the ways in which relief or locum veterinarians have allowed practices to augment their staff, these individuals also bring new service offerings to the practice that might create a blueprint for how relief veterinarians can introduce and scale telemedicine within a practice. One could imagine relief veterinarians bringing their turnkey telemedicine service offerings and developing a collaborative relationship whereby a relief veterinarian would provide the telemedicine service and leverage the existing relationships and access to the practice.
What follows is an opportunity for any practice to quickly and easily start offering the service to clients while retaining the core business focus of in-clinic care. This also would allow for new compensation models that provide clinic partners with a lower risk to getting started and provide relief veterinarians the opportunity to generate more income through production-based elements of pay.
The relief veterinary community is by its nature entrepreneurial and faced with its own challenges and lack of opportunities during this time. We will see creative solutions emerge that are more sustainable, approachable and impactful for practice.