Every veterinary team member is feeling the impact of COVID-19 differently, which is why flexibility among practice leaders is so important right now. Coming together during a crisis is what helps us get through it, says Kristina Guldbrand, CVT, BS, CSP.

“Community is the most important resource we have when dark times hit," she says. “It connects us, it makes us feel like we’re not in this alone." The keys for leaders, Guldbrand says, are to promote positivity and recognize that "everyone is doing the best they can right now."

Guldbrand offers three tips for veterinary leaders in the face of the pandemic:

Involve the entire team in devising solutions for modifying practice protocols.

In this video, Guldbrand explains how to put her tips into action.

Videos

Certified leadership and wellness coach Kristina Guldbrand shares some tips to help you keep your veterinary team connected during these challenging times.

How to lead your veterinary team during COVID-19 

” in the February 2020 issue of dvm360, I would—and do—operate differently from Dr. Stone. I am a practice owner in upstate New York and I have worked for owners like Dr. Stone. These owners want their technical staff and associate veterinarians to tolerate bad behavior from clients until the client is irate and belligerent. In my opinion, that is waiting way too long before protecting your staff.

I agree with Dr. Stone’s associate: It is not too much to ask to be treated with respect. At my hospital, if a client shows disrespect, gives attitude, is impolite or challenges my or my staff’s competence in a rude way, I fire the client with a polite, professionally worded letter informing them of the termination of service. The mental health of my staff and me outweighs the costs of letting clients go from the practice. In my area there is an abundance of pets and clients. As veterinary professionals, we are providing help and care. There is no reason to have to deal with unpleasant, mean-spirited people who return our kindness with a miserable attitude and ingratitude. If more veterinary professionals protected their staff more aggressively, respect for the veterinary profession would only increase.

I agree with Dr. Rosenberg. We are professionals when we step into the exam room and we need to be professional to convey our message to the client so that the necessary patient care is implemented. I also agree that there is no reason to escalate a confrontation with a client as this will not help with patient care.

But I agree and disagree with Dr. Rosenberg’s statement that “the key to successfully helping our pet patients depends on our successful interactions with their owners.” I have interacted with clients for 15+ years as a professional doing exactly as Dr. Stone and Dr. Rosenberg would have it. It does not make clients nicer or cause them to respect me or my staff. It just sends a clear message that bad behavior will be tolerated and they have the green light to behave poorly any time they feel like it.

I am all for professional behavior, but once a client shows that they are going to be rude, nasty, disrespectful and impolite on a consistent basis it is time to let the client go.

—Dr. James David Nickel, Whitesboro, NY


The title of this article really caught my attention. I have been the practice manager of a five-doctor practice for 37 years and we face this challenge every day.

We are in an affluent area just west of Boston, and the clients we serve have very high expectations of us and our hospital. We know that, and we try every day to meet these expectations. For a practice to be successful, we need to win over our difficult clients. We do try to kill them with kindness. If someone is unhappy, we try to find out why and let them know that we understand. It is a first reaction to lash out at bad behavior, but you should never stoop to their level. Remaining calm and cool in these situations is the answer.

That said, I do think there is something very important missing from this answer by Dr. Stone: We only occasionally have clients angry or lashing out at the doctors or technicians. I know from much experience that it’s the front desk staff that is hit the hardest in this area. The doctors do not understand how the front desk team members are treated. I find it very easy for a doctor to say “develop a thicker skin” when they rarely are the ones subjected to this behavior.

Difficult clients are an everyday occurrence at our practice, and I do try to have a manager or supervisor take over if a team member is being verbally abused. We practice tolerance and respect, but I truly believe sometimes the doctors have unreal expectations of how much abuse should be tolerated.

Moira A. Guigno, practice manager, Wellesley-Natick Veterinary Hospital, Natick, MA

I would like to offer a comment about a recent letter in dvm360 (‘

Whitest profession in America’ inappropriate

’). The facts are relatively straightforward: Over 90% of veterinarians are white in a country where about 81% of the workforce is white. Imagining this is an accident rather than the result of systemic racism is naive or disingenuous. Acknowledging an injustice is critical to rectifying it, and we cannot shy away from clearly and directly describing an unjust reality if we seriously hope to change it.

It is not unusual for white people to feel personally attacked or accused of racism when white privilege and discrimination against people of color are discussed, but it is an unfortunate and unnecessary reaction. I have been lucky in having friends patient enough to explain the difference between acknowledging the systemic factors that favor white people in American society and accusing individual white people of being undeserving or racist. White privilege doesn’t mean white people have not had to struggle or face adversity as individuals. It simply means that our skin color has been an advantage rather than an added obstacle in our life’s journey.

As a relatively old, white, male veterinarian, I can acknowledge the injustice that has favored those like me without feeling that the effort and struggles I endured to get where I am are being invalidated. I may be good at my job and even deserving of it as an individual, but so are many who have not had the same opportunities I’ve had. It does not diminish me to acknowledge this, but it does engender a responsibility to contribute to a more just future.

Rather than getting upset about the word “white” or open discussion of white privilege, I think it more useful to try and be part of the solution. The article Dr. Clemente responded to (‘

Institutional change in the whitest profession in America: Veterinary medicine

’) offers specific, appropriate steps to improving diversity and inclusion in veterinary medicine, including “leveraging power and privilege to advocate on behalf of others.” I find nothing at all objectionable in that.

—Brennen McKenzie, MA, MSc, VMD, Los Altos, CA, skeptvet.com

Articles


Several readers wrote to share their opinions about recent articles in dvm360. Here are three of them.


Reader feedback: Disagreeing with Dr. Stone, and ‘the whitest profession’

“All of us feel very overwhelmed at this point,” sympathized Marsha L. Heinke, DVM, EA, CPA, CVPM, owner of accounting and consulting firm Veterinary Practice Made Perfect, as she began a webinar on financial matters veterinary practice owners and managers should be focusing on during the COVID-19 pandemic. It may seem like your hospital has a plan at one moment of the day, but even an hour later things change drastically. “It’s like drinking from a firehose during a tsunami,” Dr. Heinke said.

Even with the unpredictability of the pandemic and its effects on daily life, the lifesaving services provided by veterinary hospitals are invaluable to clients and their pets. Presenting on behalf of the Veterinary Hospital Managers Association on March 31, Dr. Heinke provided guidance on money management, employee communication and updated laws to help navigate these uncharted waters.

Dr. Heinke explained that there is no blanket answer regarding which legislative bodies hospitals should reference at this time. Currently, many municipalities and states have regulations that are different, and sometimes stricter, than those of the federal government. Understanding the new regulations as they pertain to where your practice operates is one of the challenges decision-makers have to face.

“Generally, you want to start at the local community level and work your way up from there,” Dr. Heinke said. “If the community is silent on the matter, then go to the next authority, which might be the state government.”

In addition to staying current on new mandates, utilize the business experts in your quiver, Dr. Heinke advised. “It is very important to work closely with professional advisors, but understand that they are also overwhelmed trying to digest all of the changing information,” she said.

With layoffs and furloughs becoming a reality for many businesses, employees should know how their job will be impacted and the temporary changes the hospital may make.

Management needs to remain aware of timely updates and relay that information as it pertains to the practice, such as orders about essential and nonessential workers. “You owe it to your employees to let them know what is happening and what your plans are for the practice,” Dr. Heinke explained.

She also stressed the importance of remaining positive and taking a solutions-based approach to communication. Provide clear direction for how staff should interact with clients, explain proper sanitation protocols to limit exposure and review additional measures being taken to ensure the safety of staff, clients and patients. It is also vital to encourage questions and dialogue. “Remember that everyone is impacted personally and professionally,” she added.

While the government and different agencies are encouraging flexibility in sick leave and paid time-off policies, the 

 enacted on April 2 may impact your decisions on those policies, Dr. Heinke said. Paid FMLA leave and emergency paid sick leave are available to be used in addition to a hospital’s existing paid time-off policies, and some types of leave may run concurrently. Practices may not alter their policies to restrict time off in light of the new laws, she warned.

Additionally, hospital management must understand state and federal unemployment requirements. This includes reduced hours and wages, furloughs, layoffs and terminations. “You also want to be paying attention to unemployment insurance and disability benefits if you are in a state, such as New Jersey, that requires those,” Dr. Heinke explained. You have to think about how state and federal policies integrate with current hospital policies and updated laws.

Many hospitals are reducing hours, while some employees are choosing not to come into the office but may telework. Do you continue to pay the full salary? Are there Department of Labor (DOL) standards that apply? Following are some of the key aspects Dr. Heinke said to consider:

Review existing contracts to see if any applicable details are outlined.

The DOL requires that, to maintain exempt status, employees receive their full guaranteed salary for any week in which work is performed.

Some states’ laws require additional payment obligations.

If setting a new, temporary salary for an employee, it must be at or above federal and state minimums. The federal minimum is currently $648 per week, but many states have higher minimums.

Do not repeatedly reclassify employees as exempt and nonexempt. This could make it possible for salaried employees to put in claims for unpaid overtime hours they previously worked.

Evaluate which benefits your hospital is going to continue to pay for and which may be curtailed.

For nonexempt workers, Dr. Heinke encouraged reducing hours rather than reducing pay rates, but in instances where pay is reduced, hospitals must maintain the minimum applicable federal and state rates. Reduced hourly wages cannot be retroactive, and employees must be given notice.

Regardless of what measures hospitals decide to take, Dr. Heinke said now is not the time to become lax about record keeping. For instance, continue to require a doctor’s note from employees who have been diagnosed with COVID-19. “The reality is, you’re going to need that documentation in your files,” she said. If employees take advantage of the new paid sick leave laws, the hospital will be eligible for payroll tax credits to offset those costs but will need proper proof.

Now more than ever, anyone with cash flow oversight responsibilities needs a clear understanding of the daily break-even point and recent profit-and-loss statements. “You are going to need to be brutal about what you can reasonably cut that you don’t need but are paying for,” Dr. Heinke said.

Remain in contact with vendors and discuss possible payment deferments. If your practice is facing a cash flow shortage, Dr. Heinke said, it is important to prioritize what needs to be paid first, taking into consideration interest rates and penalties. It may also be time to explore other funding sources, she suggested. These include using existing lines of credit, practice owners temporarily forgoing compensation and owners contributing personal funds to maintain the practice.

Assess the loans that might be available through federal COVID-19 relief packages. “Many veterinary hospitals are seeing that this is necessary,” she explained. The CARES (Coronavirus Aid, Relief, and Economic Security) Act will provide small businesses with access to $350 billion in loans, a portion of which will be forgivable. Similarly, Paycheck Protection Program loans through the Small Business Administration are available to businesses with fewer than 500 employees.

While so much continues to change and hospitals must routinely readapt, Dr. Heinke predicted that the veterinary profession will fare well when restrictions are lifted. “We are going to look different, but perhaps much better in certain ways,” she said.

Amanda Carrozza is a freelance writer and editor in New Jersey.

As veterinary practices continually adjust clinic protocols in the face of COVID-19, they must also manage costs differently, abide by new employment laws, and keep staff calm and informed. Here’s what you need to know.


COVID-19: financial considerations for veterinary practice owners and managers 

The COVID-19 crisis continues to alter how veterinary professionals administer patient care. To ensure the safety of their staff and the public, practices have adjusted protocols drastically to help maintain proper social distancing.

For house-call veterinarian Patrick Mahaney, DVM, CVA, CVJ, certified veterinary acupuncturist and president and medical director of 

California Pet Acupuncture and Wellness 

(CPAW) in West Hollywood, CA, that means temporarily limiting wellness visits and addressing only serious health concerns.

In addition, he tells dvm360.com Chief Veterinary Officer Adam Christman, DVM, MBA, he's changing his approach to house calls. “When I go to clients' homes, we are changing up the circumstances, where maybe I’d be in their home, now I’m in their driveway or on the porch." For example, he says he had pregnant a client who requested that he administer care to her pet on the patio to prevent potentially exposing her baby to the virus.

Although Dr. Mahaney says he remains healthy, he will continue to adhere to all the recommended precautions. In addition to the previously mentioned changes, he’s also wearing personal protective equipment during appointments, including googles, a surgical mask and gloves. “This is the new normal…,” he says.

To hear more from Dr. Mahaney, watch the video below.

California house-call veterinarian Dr. Patrick Mahaney shares some of the changes he’s implemented during the COVID-19 pandemic.


From veterinary house calls to driveway visits

Orthopedic surgery and rehabilitation go hand in hand, say surgeon David Dycus, DVM, MS, CCRP, DACVS-SA, from Veterinary Orthopedic & Sports Medicine Group in Annapolis Junction, Maryland, and rehabilitation specialist Matthew Brunke, DVM, DACVSMR, CCRP, CVPP, CVA, from Veterinary Surgical Centers Rehabilitation in Vienna, Virginia. These former coworkers explain why it’s important for surgeons and rehab specialists to work together for optimal patient outcomes.

For people who undergo orthopedic surgery, the process typically follows the same course—surgery, home to rest, then physical therapy, Dr. Dycus says, noting that the animal surgical experience has begun to mirror that in humans. “Over the past 10 or 15 years, the field of veterinary rehabilitation has really started to boom and come into play as being something that’s recommended on a routine basis,” he says.

It’s important for rehab specialists to be aware of the types of orthopedic surgeries their patients may have undergone. “There are lots of ways to perform surgery on a cruciate ligament rupture, but not all the tissues are going to be manipulated the same, so having that kind of understanding can improve patient care,” he says.

This is where communication between the two specialties comes in: The doctors must be coordinated for future treatment. "If I do a TPLO versus a lateral suture, for example, we really want to create a patient-centered, specific response as to how we manipulate those tissues," Dr. Dycus says. Sharing this information is essential so the next specialist can take the right approach to the patient.

Drs. Dycus and Brunke are both Fetchdvm360 conference speakers and dvm360.com contributors. For more insight about veterinary orthopedic surgery and rehabilitation from these two specialists, check out these articles:

Every obese pet is a rehab case in the making

Clearing up misconceptions about regenerative medicine

Dr. Brunke agrees. "You guys can do wonderful work in the operating room [that] an owner can undo by not taking care of the dog going forward, or the cat going forward," he says. "Pass that baton of case management [to the] rehab doctors."

He notes that this team approach can then point back to the surgeon if something goes awry with the patient’s recovery.

“It’s all about the communication. We want to make sure these guys are comfortable, they’re going to have achievable goals, and then we set them up for success as we go through each step,” Dr. Brunke says. “But it has to be good communication because when something’s not right that we may notice, then it’s that team approach to get them back to you guys in the operating room if needed.”

In fact, he argues, “we’re probably actually going to have less of a complication rate because they’re going to be well managed. Think about all those owners that are out there that have four or five kids, working two jobs, and are maybe not trained on how to properly care for their pet … after surgery. The guidance and oversight from the rehab team—including technicians, physical therapists, and doctors—makes for a better outcome across the board.”


Solid communication between surgeons and rehabilitation specialists is the key to successful outcomes for orthopedic surgery patients. 


Orthopedic outcomes improve when veterinary surgeons and rehab teams collaborate

A cat in Belgium has become the third animal to test positive for the novel coronavirus, according to a report late last week in 

. The cat reportedly contracted the virus from its owner, who had recently been to Italy and has herself tested positive for COVID-19.

The cat began showing clinical signs of the virus, including diarrhea, vomiting and difficulty breathing, about a week after its owner became ill, at which time a test of the cat’s feces and vomit revealed traces of the virus. Both the cat and its owner are currently on the mend.

This first case of human-to-cat transmission of COVID-19 has sparked more questions about whether and how pets can become infected with or serve as vectors for the novel coronavirus—and how veterinary professionals should address the issue with concerned clients. For answers, dvm360 spoke with Jane Sykes, PhD, BVSc (Hons), chief veterinary medical officer at the University of California, Davis, School of Veterinary Medicine Veterinary Medical Teaching Hospital and founder of the International Society of Companion Animal Infectious Diseases.

What do you think it means that this cat showed clinical signs of COVID-19 while the dogs that tested positive in Hong Kong did not?

 During the 2003 severe acute respiratory syndrome (SARS) outbreak in Hong Kong, a small number of pet cats tested positive for the virus but none became sick. Ferrets could also become infected and did develop illness. Infection in dogs was not identified, but it is my understanding that widespread testing was not performed in dogs.

SARS-CoV-2, the virus that causes COVID-19, utilizes two receptors to enter human cells: the angiotensin-converting enzyme 2 (ACE-2) receptor and a type II transmembrane serine protease (this is similar to the original SARS virus in the early 2000s). The virus binding site on ACE-2 receptors in cats and ferrets are very similar to those of humans, so it would not be surprising if SARS-CoV-2 binds to ACE-2 receptors in cats and ferrets.

The canine receptor has a lower homology, which might explain why cats could be more susceptible to infection than dogs. However, given the low numbers of dogs and cats reported to be infected with COVID-19, it is impossible to say at this time whether cats are more susceptible to infection or clinical signs of disease. Recent studies in ferrets have shown that they can be infected with SARS-CoV-2 and develop clinical signs of fever, lethargy and cough. Ferrets could also transmit the virus to other, in-contact ferrets.

Does this development change what pet owners with signs of illness should be doing to keep their pets healthy?

he report of an cat infected does not change our recommendations. Currently, we don’t have enough information to know whether cats and dogs have the potential to infect humans. To date, all transmission has been human-to-human, after the initial jump from bats (most likely) to humans. In light of the report about the infected cat, the World Organisation for Animal Health (OIE) updated its 

 to note that although some examples of animal infections have been reported to the OIE, currently there is “no evidence to suggest that animals infected by humans are playing a role in the spread of COVID-19. Human outbreaks are driven by person-to-person contact.”

If dogs and cats can shed the virus, it is possible that the quantity of virus shed is too low for transmission to occur, especially if there are no signs of respiratory disease to create aerosols.

Because other infectious diseases can spread between animals and humans, it remains prudent to always exercise good hygiene when people, especially children and the immunocompromised, are around animals. This includes washing your hands (properly) after touching, feeding or cleaning up after your pet, avoiding rough play (especially between children and animals) and not allowing pets to sleep in bed with immunocompromised people or lick faces, wounds or healthcare devices.

Pet owners who a have tested positive for COVID-19, or those who are highly suspected to have it but have not been tested, additional precautions are warranted. These owners should limit contact—ideally having someone else in the household care for the pet—and wear a face mask. The pet should be quarantined with the owner and any signs of illness reported to their veterinarian.

Critically, we need to inform owners that it is important not to over-react and disconnect from their pets. The importance of the human-animal bond and its positive healthcare effects cannot be overestimated. Veterinary clients should be made aware of health benefits of pet ownership, including reductions in mental illness and cardiovascular disease, decreased blood pressure and improved self-esteem in children.

Owners should be advised not to panic about the possibility of pet infection and transmission, and instead enjoy all the positive healthcare benefits of the bond they have with their pets. On the one hand, restriction of human movement is likely to reduce adoption of pets from shelters, and more animals in need of homes may be euthanized as a result; on the other hand, there has been an increase in animal fostering by those looking for companionship during this shelter-in-place period, and this has raised some concerns that these animals will not receive adequate long-term care or will be abandoned when restrictions are relaxed.

 How should veterinarians advise clients who ask about the potential for their own pets to become infected with COVID-19?

Veterinarians should remain vigilant and watch for signs in animals that might represent COVID-19. However, many animal diagnostic laboratories are not currently set up to test for this specific coronavirus. 

 but are not offering testing at this time. The problem occurs when veterinarians have to perform the testing, because they would need to wear a special high-density face mask and a face shield. Face masks must be fitted in advance by a trained individual, and many veterinarians are not fit-tested on a regular basis, nor do they have high-density surgical masks on hand. Veterinarians should contact their local public health department or the CDC if an infected owner contacts them and requests that their pet be tested.

Should a dog or cat develop respiratory illness, pet owners need to remember that respiratory illnesses (‘kennel cough’ and ‘cat flu’) are extremely common in dogs and cats, especially those that board, attend doggy daycare or are acquired from shelter environments. Owners need to know that more than 10 different viruses and bacteria can cause these signs in dogs and cats, including a canine respiratory coronavirus that only infects dogs.

Any pet that develops respiratory illness is much, much, much more likely to be infected with a canine or feline respiratory virus or bacteria than with the novel coronavirus. These dog and cat viruses do not cause infections in people. Pet owners should be told to have their pet evaluated by a veterinarian if signs of runny nose/eyes, cough or sneezing develop, and they should not allow their pet contact with other animals in the meantime.

 Do you anticipate that cats, dogs or other pets could become vulnerable as the virus mutates?

Coronaviruses are less likely than influenza viruses to mutate significantly. Based on what we’ve seen in the past with both human coronaviruses and influenza viruses transmitted to pets, it is more likely that cats, dogs and other pets will remain as “dead end” hosts rather than becoming more vulnerable to infection and disease.


A symptomatic cat in Belgium has tested positive for the novel coronavirus, but experts reiterate that there is no proof that animals can transmit the disease.
