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 is president of the North American Veterinary Community and serves on the boards of Pet Peace of Mind, WellHaven Pet Health and the Lincoln Memorial veterinary college.Read Articles Written by Bob Lester
Do you remember playing hide-and-seek as a kid? After closing your eyes and counting down to zero, you opened your eyes and called out, “Ready or not, here I come!” Meanwhile, your friends did their best to hide. Well, our profession has come to a “ready or not” moment. Ready or not, change is coming. We can help guide the direction of that change, or we can hide and be left behind.
Our profession has been slow to respond to the needs of a pet-loving society eager to get more veterinary care. Now, however, legislators are listening and jumping in to help fill the void. They’ve heard that their constituents (our clients) are concerned with the difficulty of finding care for their beloved pets. From virtual VCPRs and midlevel providers to expanding the role of the certified veterinary technician and veterinary technician specialist, change is coming through the legislative process. I am glad to see it.
I would rather our profession recognize the need to act, but in the absence of direction from our veterinary leaders (or sometimes obstruction from them), legislatures are working to solve the stresses our clients and industry face. Legislative bodies don’t always get everything right, but at least they act.
At times, it seems some people in our profession have a reflexive bias against change. I’m reminded of the Groucho Marx quote, “Whatever it is, I’m against it.” Unfounded protectionism? I hope not.
I also would point out that the stresses we face as a profession, difficult as they might be, are largely problems of abundance. America’s love affair with pets has resulted in more demand for veterinary care than we are equipped to manage. A problem for sure, but issues of abundance are far preferable to those of scarcity.
Changes are coming, ready or not. So, what can we look forward to?
We trust veterinarians with controlled drugs, with knowing when to refer patients, with public health and with the lives of pets. Why can’t we trust our colleagues to decide what is appropriate to do virtually or in person? Physicians trust one another. Pets suffer because of limited access to care.
Society is demanding more access. In a recent Colorado survey, over half of pet owners said they would be comfortable with virtual veterinary care. In addition, “More than a quarter of survey respondents also said they were significantly challenged in finding and making timely appointments with veterinarians in their area.” (Learn more at bit.ly/3NWKaFJ.)
As I write this column, legislation providing for a virtual veterinarian-client-patient relationship was signed in Arizona. The bill received overwhelming support in the Legislature, passing 58-1 in the House and 22-2 in the Senate.
Obstructionists might delay the inevitable move to a virtual VCPR, but they won’t stop it.
In the same Colorado survey, four out of five pet owners said they would not hesitate to have their pet seen by a midlevel veterinary professional. Over 50 years ago, the American Medical Association officially recognized physician assistants (PAs) after initial opposition. PA certification tests implemented by the National Board of Medical Examiners followed two years later.
Today, it’s hard to imagine two-legged health care without physician assistants and nurse practitioners.
What can our profession learn from the experience of human medicine? It’s clear what our clients want.
The Expanded Role of the CVT
Veterinary credentialed technicians/nurses are the heartbeat of our profession. Vet tech home euthanasia and hospice care, vet tech-led wellness centers, vet tech shelter surgeries, vet tech professors in veterinary school, increased VTS responsibilities — these veterinary professionals can do much more if allowed.
Access to care improves, bottom lines improve, and medical outcomes improve. What’s not to like?
Radiology, dermatology, cytology, customer service, clinical decision support — we’re only at the starting line. Artificial intelligence has enormous potential to drive down costs, improve efficiencies and enhance medical outcomes. ChatGPT? Why not CatGPT and DogGPT? It’s early, but artificial intelligence might well be a game changer.
I look forward to learning more about AI and including it in our veterinary care toolkit. Way cool!
New Care Models
We’re moving from our historical roots of generalized care for all creatures great and small to a future of segmented care for some creatures great and small. By that, I mean a profession historically reliant on generalization will offer new care models for underserved sectors. Think urgent care, dental only, veterinary technician/nurse delivery, spay/neuter, wellness walk-in, nonprofit community practice, telehealth, concierge, home euthanasia, mobile and more.
That is good. We’ll offer more choices to consumers and providers and lower barriers to care.
We’re shifting from traditional brick-and-mortar hospital care to home, virtual and community care. From the exam room to the living room, from bricks to clicks, it’s coming.
The Connected Pet
Sensors will continuously monitor multiple physiologic, lifestyle and nutritional data points. For example, pets connected to smart bowls, wearables, litter boxes, leashes, toys and cameras, all continuously checking an animal’s status. Millions of data points will be analyzed in real time, and abnormalities will be reported to the owner and veterinary provider. Results outside normal parameters will be flagged, and alerts will be sent.
Preventive medicine gone high tech. Wow!
Fecal, derm, otic, urine — clients submit samples directly to the lab from home. In human health care, at-home diagnostics are the norm. How many home COVID tests did your family run?
We can stonewall home diagnostics or get involved and keep veterinary professionals in the loop.
iPhones can measure heart rate, respiratory rate, blood pressure, ECG, activity, sleep, temperature, gait, pain, Mg, Glu, Na, pH, Ca, ketones, bowel sounds, ultrasound, retinal disease, and ear canal humidity and temperature. If you can think of it, technology can monitor it.
Veterinary professionals need to be in the conversation.
Come Out, Come Out, Wherever You Are!
What might the veterinary practice of tomorrow look like? Imagine the connected pet and validated AI advice. The client schedules a virtual or in-person appointment based on data collected from the connected pet and home diagnostics. An appointment at a veterinary diagnostic center for further workup and tests could follow that visit. If diagnostics and referrals indicate so, the pet might be directed to a procedure center for treatment and perhaps robot-assisted surgery.
At every stage of the growth and evolution of our profession, we must be willing to change, help direct and lead. The playwright George Bernard Shaw said, “Those who cannot change their minds cannot change anything.” Wise words.
A virtual VCPR is coming, a midlevel provider is coming, artificial intelligence is coming, CBD is coming, license reciprocity is coming, new models of care are coming, and medical educational advances are coming. Just look to other health care professions where similar changes have taken place.
Change is inevitable and largely for the best. How will you react to it? As a victim, helpless and depressed? As a critic, angry and failing to see any benefits? As a bystander, on the fence, unwilling to commit either way and waiting for others to lead? Or as a navigator of change, choosing a growth mindset that sees doing something for the first time as a chance to learn, improve, develop and lead.
Let’s have veterinary professionals lead change, embrace it and navigate it. Ready or not, here it comes.