Six Growing Issues
The veterinary world is getting more complicated. It’s time to embrace change for the good of the profession, clients and patients.
If you’ve been around long enough, you’ll remember these two reports: Pew Research Center’s “Future Directions for Veterinary Medicine” (1989) and KPMG’s “The Current and Future Market for Veterinarians and Veterinary Medical Services in the U.S.” (1999).
Both reports helped explain what was going on in the veterinary profession then and, more importantly, what the profession would need to change to be successful in the future. Most of the recommendations had to do with veterinary education, private practice and research.
Out of the KPMG report came projected trends that many veterinary associations and veterinarians accepted and in some cases attempted to rectify. These included:
- Substantial increases in veterinary educational debt.
- The emergence of large corporate organizations delivering veterinary services.
- Changes in how people viewed their pets and other animals.
Additionally, six critical issues were highlighted in the KPMG report:
- Stagnant veterinary incomes.
- The economic impact of large numbers of women in the profession.
- Global demand for veterinary services.
- The delivery system’s inefficiencies.
- An oversupply of veterinarians.
- The absence in veterinarians and veterinary students of some skills and aptitudes that contribute to financial success.
What the two reports didn’t predict was the speed at which the world would change technologically, demographically, psychographically and socially. While many of the issues first identified by Pew and KPMG remain valid, more have joined them.
As the COVID-19 pandemic continues its onslaught and influence on the world and the veterinary profession, we can’t lose sight of more recent issues and how they could impact the veterinary profession over the long term. We must keep these newer subjects in mind even as we are distracted by our current day-to-day challenges: a lack of personal protective equipment, curbside care and crazy clients.
Discussed below are six areas in which the world is changing dramatically and that have an ongoing influence on the veterinary profession. Each topic is critical by itself, but when you look at all of them together, you can see why our profession must embrace change to further a successful future. COVID-19 is now top of mind for most people, but it’s not hindering these new changes and, in some cases, is spurring them on.
Veterinary medicine is generally acknowledged as being one of the nation’s whitest professions. As the U.S. population grows, minorities continue to represent a higher and higher percentage of the population in general. However, while the number of veterinary students (and consequently, the number of working veterinarians) from underrepresented groups is increasing, these numbers haven’t caught up to the overall population numbers.
According to a PBS NewsHour report — read it at to.pbs.org/3dLeAXv — people of color are predicted to outnumber white people in the United States in less than a quarter century. If veterinary medicine is going to meet the needs of the changing pet-owning population, we must recruit, encourage, educate, assist, motivate and support people of color to enter and lead the profession.
How does one motivate people within any underrepresented community to become veterinary professionals if they don’t see people who look like them in our profession? Veterinary medicine is short on role models for people of color. Many of our Black colleagues became veterinarians because they were fortunate to see someone who looked like them across the exam room table when, at a young age, they brought their pets to a veterinary clinic.
The discussion of the need for veterinary role models is not a new one. Our profession needs to reach out to minority communities and help identify, mentor, coach and assist a new potential population of veterinary students. And then, further encourage and support them to return to their communities and be role models to others for the long-term future of the profession. The Association of American Veterinary Medical Colleges has led the charge on this and other initiatives related to diversity, equity and inclusion, but what we advocate is a change that requires effort from all segments of veterinary medicine. Local, state and national veterinary associations, industry, the American Association of Veterinary State Boards and practicing veterinarians will have to work together from a grassroots level to change the profession’s demographics through a long-term vision.
The need for diversity is not going away. We need to embrace the need for change and recognize not only the huge economic benefits to the profession but also, more importantly, the health care benefits to the pets in communities largely populated by underrepresented minorities.
2. Beyond Companion Animal Practice
In the private practice segment, the veterinary profession over the past half-century has reconfigured itself from a primarily agrarian, farm-call focus to a companion animal hospital, brick-and-mortar focus. The veterinary student applicant pool has dried up in the rural heartland and moved to the urban sprawls at the same time the need for food animal veterinarians has grown. Meanwhile, the opportunities and need for veterinarians in the areas of global safety and security (infectious and zoonotic disease outbreaks, emergency preparedness and response), food safety, production and shelter medicine have exploded.
The veterinary profession hasn’t caught up with society’s changing needs. The recruiting of individuals into veterinary jobs that have the greatest opportunity should be a focus for our profession. This is going to take a grassroots effort as well. Whether in the classrooms of rural America, at 4H and FFA meetings, or even on the farm, encouraging young people to think about the community they grew up in and its long-term need for veterinary care of both large and small animals is critical.
Persuading somebody from an urban background to move to a rural setting is not easy. What is much easier is to get people to return to the community from which they came, especially if incentives exist, such as higher salaries, practice ownership opportunities and student debt forgiveness. Scholarships, local and state government support, and even regional fundraising from community stakeholders could supplement the needs of a veterinarian who moves into a community that has a shortage of veterinary care.
It has been said before and we repeat it here: There is a maldistribution of veterinarians. A concerted effort is needed by communities and the veterinary schools that serve them to recruit and return future veterinarians.
The current focus on graduating companion animal veterinarians meets the needs of just a small part of the animal economy. The rest of the animal economy can ill afford to lose representation from the veterinary profession lest a decline in food safety or an increase in zoonotic diseases slips through the cracks because veterinarians are no longer involved. If the number of veterinarians who graduate cannot fill the needs in food safety, public health, shelter medicine and preventive medicine, these unfilled positions can lead to those problems.
3. One Health
If nothing else, the COVID-19 pandemic has demonstrated the importance of a One Health discussion and approach in the health care fields. The U.S. Centers for Disease Control and Prevention tracks over 300 potentially zoonotic diseases that at any point could wreak havoc on the human population. COVID, Ebola, HIV, SARS, MERS, avian influenza and swine influenza, among others, have crossed species.
After attending the Zoobiquity Conference several years ago, Dr. Weinstein obtained a much greater appreciation of the similarities between species. Whether renal or cardiac, thyroid or neurological, musculoskeletal or behavioral, there are more similarities than differences between the animal kingdom and the human kingdom.
We see an increasing need to cross-pollinate veterinary students and medical students in the similarities of the species. We don’t ever want to hear a medical doctor tell a pet owner to get rid of a pet because the pet gave a kid ringworm or, worse, lice!
According to the CDC, “One Health is a collaborative, multisectoral and transdisciplinary approach — working at the local, regional, national and global levels — with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants and the shared environment.”
The interconnection between people and animals offers huge opportunities for the veterinary profession. In public health, private practice and government, there are so many unserved opportunities to change the world. This viewpoint, from the CDC and the American Veterinary Medical Association, indicates why this arena is vital and so underserved: Three out of every four new or emerging infectious diseases in people are acquired from animals, according to the CDC.
Our profession also has clear evidence that owning pets contributes positively to human health. What can be done to collaborate with the human medical field to prescribe pets instead of pills? Why not have human health insurance companies make pet insurance payments or pay for veterinary care for the dog or cat that lowers a pet owner’s stress without the use of medications?
General practitioners, university faculty, public health veterinarians and their human counterparts should work together to educate the world about One Health. Again, education leads to opportunity and opportunity leads to better human and animal patient care. Also, better patient care is great for the economics of the veterinary profession. A stronger human-animal bond is frequently a forgotten sequela to better patient care and the mutual understanding of all health care providers.
4. Access To Care
Anytime a wall prevents somebody from accessing something — a resource, service or product — there is a need to determine why and what can be done about it. Access to veterinary care is a wall about which little was known before the release of the 2018 report “Access to Veterinary Care: Barriers, Current Practices and Public Policy.” (Read it at bit.ly/33ZfbAm.)
According to the report, which was produced by the University of Tennessee and Maddie’s Fund:
- An estimated 29 million dogs and cats live with families participating in the federal Supplemental Nutrition Assistance Program.
- Millions of other pets live with middle-class families that struggle financially.
- Most veterinary service providers recognize the lack of care as a genuine problem and feel a commitment to explore ways of addressing it.
The reasons for the lack of access to care and the solutions are complex, but the benefits are clear:
- Better veterinary care and less pain and suffering for pets not currently receiving care.
- An increased likelihood of keeping pets in families and giving more people the clearly recognized benefits of the human-animal bond.
- A positive impact on pet-related public health issues.
The biggest barrier to accessing veterinary care is, to no one’s surprise, the cost, according to the 2018 report. This is not, however, the only barrier. Others include:
- Not knowing what care is needed.
- Not knowing where to get the care.
- A lack of transportation. (This is an especially big issue for after-hours care.)
- Physical availability of a care provider.
There is no doubt that in many communities, income challenges, unemployment and an increasing cost of living limit the ability of pet owners to afford basic care. A standard response by veterinarians is that “people shouldn’t have pets if they can’t afford them,” but that is an unpalatable attitude to many and a ship that has sailed. While privately owned veterinary practices have to be at least reasonably profitable to be sustainable, has the focus on business models that insist on gold-standard care for all pushed veterinary fees outside of the accessible level and further away from the mainstream?
The 2018 UT/Maddie’s Fund report did not include the impact of the COVID-19 pandemic, of course. As unemployment rises and people’s financial situations deteriorate, access to care affects more pet owners. This is one of the areas in which the pandemic is having more of an impact.
The vast majority of veterinarians have done something to deal with this issue, including:
- Making clients aware of payment plan alternatives.
- Recommending affordable medical options that provide a reasonable standard of care.
- Providing services at lower or no cost.
- Donating to charitable funds that provide care for the pets of lower-income people.
- Volunteering their services at pet care events.
But the question remains: Can we create business models that allow independent practice owners to make a reasonable living, pay their staffs a livable wage and provide needed care, and at the same time be affordable to the average pet owner? Reinventing the veterinary hospital model and delivery model is a must-do.
In the mid-’80s, the number of U.S. veterinary medicine students reached gender equilibrium. It didn’t stay that way for long. Today, 80% of matriculated veterinary students are women and about 60% of all licensed veterinarians are women.
In the mid-’60s, the baby boomers started to give way to Generation X. In the early 1980s, Generation Y (aka millennials) arrived and grew in numbers. Finally, in the late 1990s, Generation Z emerged. Currently, veterinary medicine employs four generations of doctors and staff, and it delivers services to four generations of pet owners. Also, as we discussed above, racial, ethnic and gender diversity is changing rapidly. Each generation, regardless of differences, brings unique personalities, worldviews, and personal and professional desires.
Truly understanding the needs of each cohort and, within each group, the needs and wants of individuals is critical to a veterinary practice’s financial success and the quality of relationships between employees and clients. Practices that choose not to adapt will find that attracting the employees and clients they want will become even harder. Those practice owners also will face a more difficult time selling their clinics.
What employees want from their workplace has changed. Flexibility is a key to keeping a varied cohort of individuals happy. This means flexibility in compensation, work hours, communication styles and job roles. Some employees might want to be paid a higher hourly rate and forgo vacation time; others want the opposite. The total compensation package has to be equivalent for employees who bring equivalent skills to the veterinary practice, but equivalent doesn’t mean exactly the same.
The same holds with clients. Nine-to-five weekday office hours and communication only by phone doesn’t work for most clients. Practice teams must understand what clients want and how to deliver it.
The use of technology has increased dramatically across all demographic crosscuts and practices. Veterinary workplaces have to keep pace.
You can fight it or learn about it. Here’s a hint: You won’t win that battle.
6. COVID’s Parting Gifts
The changes we have seen over the past 10 months will have an indefinite impact on people individually, businesses globally and our profession indubitably. What isn’t clear are the things that genuinely changed and by how much, and which ones will remain changed.
Safety measures have changed a lot — team members are wearing masks, pets are dropped off at the curbside, social distancing is practiced inside the clinic and cleaning protocols have improved. These changes likely will be slow to revert to “normal.” We’ve seen a slow movement toward letting clients back inside hospitals under appropriate safety measures, but few practices have dropped curbside. Will they ever? What is necessary for that to happen? A fully COVID-vaccinated human population? A very low number of new daily cases?
Assuming that COVID-19 is fully eradicated, which protocols should we keep? Which would continue to provide value to the practice even without the pandemic?
Curbside care has driven a greater use of technology. Also, there seems to be a feeling that telemedicine has increased drastically, but is that so? We talk on the phone more, email more, text more and do more electronic payments, but are we really “seeing” more patients via technology for appointments that require a veterinarian-client-patient relationship? This would mean that instead of using curbside protocols, the client doesn’t come to the practice at all, uses some form of communication technology and is charged for the services provided. It’s not clear that that form of telemedicine has increased much. Many practices seem to be struggling with their comfort level with such care and don’t have the time to figure it out.
As we start to come out of the pandemic and life goes back to some kind of normal, veterinary practices need to not just revert to the old way of doing things but also give serious thought to which changes will add future value to the practice. This includes safety and curbside modifications as well as the use of online pharmacies, the practice’s delivery of food and medications, and a greater focus on leadership and team building.
All six issues will have an overarching impact on veterinary education, the veterinary business model, public health, food safety and organized veterinary medicine. Concurrently working on these issues and preparing for needed long-term changes cannot slow while we deal with COVID-19’s influence on the profession. If nothing else, there’s an even greater need to be forward-thinking in veterinary medicine.
Dr. Karen E. Felsted is the founder of PantheraT Veterinary Management Consulting. She spent three years as CEO of the National Commission on Veterinary Economic Issues. Dr. Peter Weinstein owns PAW Consulting and is the executive director of the Southern California Veterinary Medical Association. He serves as chair of the American Veterinary Medical Association’s Veterinary Economics Strategy Committee.