Dr. Sarah Wallace is the vice president of telehealth at Galaxy Vets. In 2018, she helped Fuzzy Pet Health build and launch a standalone telehealth platform and later was approached by Modern Animal to help improve its hospital-integrated telehealth solution.Read Articles Written by Sarah Wallace
Millions of low-income families can’t provide veterinary care for their pets because of affordability issues and a lack of physical access to veterinary medicine. The American Veterinary Medical Association described the problem as “arguably the most significant animal welfare crisis affecting owned pets in the United States.”
To provide veterinary care for a patient, a veterinarian-client-patient relationship must be established. VCPR laws were instituted to ensure pets received adequate professional veterinary care, but the VCPR requirement has become more of a barrier for pet owners who can’t access or afford traditional care.
Let’s dive deeper into the causes of the problem and how it can be solved.
From the Beginning
Each state issues rules of professional conduct that veterinarians must follow, including requirements for licensure and what encompasses the VCPR. While the rules are a little different for each state, the Principles of Veterinary Medical Ethics of the AVMA provide general guidance, which most states follow when drafting their rules. Typically, a VCPR is considered established when these requirements are met:
- Veterinary-client agreement: The veterinarian assumes responsibility for making clinical decisions about the pet’s health, and the client agrees to follow the veterinarian’s instructions.
- Examination: The veterinarian’s examination of the patient is thorough enough to gain sufficient knowledge of the pet and initiate a preliminary diagnosis.
- Reassess: The veterinarian is available for follow-up evaluations to assess the patient’s progress.
- Treatment oversight: The veterinarian ensures the pet owner understands the necessary care.
- Records: The veterinarian maintains accurate patient records.
One Obstacle to Accessing Care
Currently, a VCPR must be established to provide veterinary care through telemedicine. The veterinarian must physically examine every animal treated, including those with simple issues such as flea and tick infestations. This creates a significant obstacle for low-income families who can’t afford an in-person visit.
According to a survey conducted by the Access to Veterinary Care Coalition and the University of Tennessee’s Center for Applied Research and Evaluation, financial reasons prevented 8 in 10 low-income families from accessing veterinary care. These situations lead to nearly 1 in 6 pets missing essential, routine treatments, such as for vaccines and parasite prevention.
Circumventing the physical exam needed to establish a VCPR could improve animal and human welfare in many cases because parasites can transmit zoonotic diseases to people.
The Ontario Experience
Healthy Pets, Canada’s first video telemedicine service for animals, was officially launched in April 2018. Two months later, Ontario legalized the creation of a VCPR through telemedicine, but the veterinarian could not prescribe medication without physically examining the pet. When COVID-19 arrived, regulators allowed veterinarians to prescribe medications through a telemedicine VCPR.
Wanting to know how the allowance was working in the field, the Ontario Veterinary Medical Association conducted surveys. Two months after the new protocol was established, 90% of Ontario veterinarians were using telemedicine — 68% of them to triage cases and 56% to prescribe medications, particularly flea, tick and heartworm preventives.
The Veterinary Virtual Care Association, which has examined telemedicine usage since 2016, asked U.S. and Ontario veterinarians to confidentially share data indicating that any pets were harmed or killed by the use of telemedicine during the pandemic. No cases were reported.
Human Health Care
Primary care physicians are required to establish a doctor-patient relationship (DPR) to deliver optimal care. The relationship places a responsibility on the doctor to progress toward alleviating the patient’s ailment and conclude the relationship successfully. Essential factors for maintaining a healthy DPR include good communication, empathy, trust, informed consent and professional boundaries. The medical situation and the social scene influence the DPR, making the relationship a dynamic association.
Human physicians have used telemedicine and virtual care for 25 to 30 years in advance of veterinary medicine, and the practice is now a mainstay at all hospitals and clinics. Creating a DPR through telemedicine is legal in 49 states.
The AVMA’s current policies regarding the VCPR state:
- A veterinarian cannot establish a VCPR through telemedicine alone.
- Telemedicine can be conducted only when an existing VCPR has been established, except in emergency situations where advice can be given until the patient is seen by a veterinarian.
- Only veterinarians legally authorized to practice in the state are eligible to provide medical advice through telemedicine.
- Veterinarians providing telehealth services must ensure their clients are aware of the provider’s identity, location and licensure status.
- If a VCPR is not established, advice provided through telehealth must be general and non-specific to a patient, diagnosis or treatment.
- Except for emergency teletriage, such as poison control services, the AVMA opposes diagnosing or treating patients in the absence of a VCPR.
Veterinarians undergo extensive training, and the process is arduous and expensive. According to the Veterinary Information Network Foundation, the average cost of four years of veterinary school is more than $200,000 for in-state students and more than $275,000 for out-of-state students. In addition, the costs of annual license renewals and continuing education take a significant toll on the veterinarian’s pocketbook.
Despite their extensive training and the expense, veterinarians’ educated opinions are not enough to establish a VCPR through telemedicine.
In addition to increasing access to low-income families, allowing virtual VCPRs would expand opportunities for veterinary professionals, increasing their job flexibility and improving their work-life balance and task variety.
The AVMA’s policy on telehealth is under review and open for comment at bit.ly/3CM4nXH. Virtual VCPRs should be a part of the revised telehealth policy to increase access to veterinary care.