A race to the bottom

A race to the bottom

If we don't guide veterinary medicine's future, low-cost clinics and subpar care will.
Apr 01, 2010

Two recent items sizzled my senile synapses recently. First, another panel discussion was held at NAVC on the "Elephant in the Room"—student debt. Long discussion, no real answers.

The second was a little more immediate: a young black-and-white cat standing in a cage in our clinic, touching one front foot to the floor, then the other. A glance at the records showed that the cat had been declawed at the local low-cost "population control" clinic. Down at the bottom of the chart was a record of the pain control: butorphanol. Given once.

Neuropathic pain? Personally, I figured this young cat was in for a lifetime of discomfort. And the owner thought he was fine.

But this isn't about panel discussions or an unfortunate young cat. It's about who will be veterinarians and what they'll be doing 10 or 20 years from now. It's about what we'll look like as a profession way down the road.

We are becoming a stratified profession. Small animal practices, where most of us toil daily, have a difficult decision ahead. Will we be lower-cost, seat-of-the-pants clinics or top-of-the-line digital fortresses where every cat gets an ultrasound twice a year? Even now in many areas pet owners have two doctors. One is for routine cheap care, the other for when a pet gets sick. But how many Diagnostic Disneylands can clients support? There are already clinics defaulting on loans and leases for their expensive and little-used equipment as their clients seek care at the plethora of cheap clinics that now exist in every community.

I understand why people choose to pay less for services they perceive as identical. But we have to ask: Is this the face of veterinary medicine we want to show? The public thinks we all offer about the same standards of care. They think low-cost neutering is the de facto standard of practice. Is our goal low-quality care for every animal?

Now, this isn't about competing with low-cost clinics—we can't. They fill a need that most clients see as significant: saving money. But when it comes to these clinics' role in population control, we're kidding ourselves. No studies support these claims. In fact, a recent survey showed that roughly 40 percent of owned animals are intact. Low-cost neutering and vaccine clinics fill one need: our desire to feel good about ourselves.

But the other end of the profession is no more realistic. Almost half of veterinary graduates pursue internships and advanced training. Good for them—Lord knows we general practitioners have done a poor job of nurturing them in their first years of practice. But will they find jobs? Medical economics follows the bell curve, and there are only so many clients who'll pay for specialty care. Certainly not enough to support half our doctors, and certainly not enough to solve the student debt problem.

It all starts with veterinary school admissions committees. By and large, they admit good students. But studies show a lack of correlation between good scholarship and good medical care. In fact, they show that personality factors primarily determine a doctor's success, not academic performance. So we have to ask: Should we admit future doctors to our schools, or future students?

Sure, there's more in the mix of factors affecting the profession's future. Gender demographics, generational differences, and our own sense of self-worth come to mind. But we don't discuss these issues for fear of offending each other. And if we continue to avoid them, we won't keep our profession on top of the most-trusted-profession lists. I'm not optimistic about our ability to tackle our problems. Frank and honest discussions are anathema these days. But if we don't, our ship will encounter this sea change—with no one at the helm.

Dr. Craig Woloshyn, a Veterinary Economics Editorial Advisory Board member, owns Sun Dog Veterinary Consulting in Custer, S.D. Post comments online at http://dvm360.com/community.