An ounce of prevention

NATIONAL REPORT — New health guidelines from the American Veterinary Medical Association (AVMA) and the American Animal Hospital Association (AAHA) are calling for a fundamental shift in veterinary care delivery—from sick-animal care to wellness.

The concept has been around as long as veterinarians have been giving health advice, but embracing wellness as a cornerstone to a practice's veterinary care delivery is another proposition altogether.

The guidelines, developed in response to statistics indicating visits to veterinarians are declining while preventable diseases in pets are increasing, are designed to provide the foundation for the veterinary practice team to promote preventive veterinary medicine.

"Preventive medicine has been very much neglected in veterinary medicine for the last 30 to 40 years," says Henry K. Yoo, DVM, MSc, MBA, executive consultant of Infinity Medical Consulting & Co. based in Santa Monica, Calif. "Many veterinarians feel that preventive medicine is only (about administering) vaccines, de-worming and (performing) simple procedures. They believe they already are doing that."

Instead, Yoo believes the concept of preventive medicine should be expanded to an entirely new level. "Weight management, dentistry and diagnostics are a fundamental structure of medical practice," he says.

Yet few clients avail themselves of these preventive care tools. Therefore, consistent education is key. And it all starts with staff training. "Once they are empowered, and they see clients are really listening to them," Yoo says, "the staff gets really motivated."

"Idea setting creates enthusiasm with the staff," he adds. "They need enthusiasm. And they need the tools. Having the right tools builds confidence, and they need that too."

If a person only goes to see a physician once a year for a check-up, why would they take their pet more often? Veterinarians are reluctant to require, or even suggest basic wellness tests for that reason alone.

"In veterinary medicine, we don't do it because we're scared we are going to be rejected by clients," Yoo says. The benefits far outweigh those aversions.

If a practice decides to move forward with a wellness plan, it is investing in itself and its staff, he says. "This is good medicine," Yoo says. "It is good practice."

Dr. Beth Boynton, professor of wellness at Western University agrees.

It's all about realizing that special bond between human and animal and understanding that most clients want his or her pet to live forever.

"Dental care, weight management—there are a lot of things we can do for our pets for them to live a longer, healthier life," Boynton says.

At Western University, students are introduced to wellness in their first or second year as part of the clinical skills course through three animal wellness protocols.

Some students quickly adopt it. Others are more reluctant.

"As veterinarians, we like to solve problems and use all of our skills," Boynton says. "It's satisfying to perform a surgery that took an animal from the brink of death to a healthy life. With wellness care, the thought is that students should be able to pick up on the 'easy' things on their own.

"All schools are showing more of an emphasis on primary care," Boynton says. "The things they need to work on for a practice are good communication and standard surgery. The cost to clients for some of these preventable diseases going unchecked—emotionally, physically and financially—is very high. If we can work to intervene early, and have that collaboration early, clients are going to have healthier animals living longer lives."

"When academia begins to extol the benefits, the cache goes up a bit," Boynton says.

Reducing stressors associated with veterinary visits will also help.

"How can we make this visit more comfortable, that's the question," Boynton says. "Working with the animal early, making visits low-stress for both human and animal, being as comforting as possible—if we can do that, it's win-win for everyone."

Considering the market has been experiencing a shrinking patient base, the wellness initiative couldn't come at a better time.

"For veterinarians who already think they are doing those things (wellness care), it's not going to change anything," says R. Michael Thomas, DVM, owner of Noah's Animal Hospitals in central Indiana. "And a lot say they already do."

Wellness care is not really a new focus. For the past seven years, there has been a push in this direction, but most schools continue to focus on treating illness, Thomas asserts.

"If there were more of an understanding for people coming out of school, that would help a lot," Thomas says. "It will be interesting to see what comes out of this. One good thing is the publicity."

The term "preventive" needs to be clearly defined.

"What is it, and how is it going to be different from what we did before?" Thomas asks. "It's hard to be too optimistic, but it can't hurt. It's a very well-intentioned program. It's a great thing for pets and pet owners. It may be an act of desperation, but it is certainly inspirational."

Michael McLaughlin, DVM, of Panther Park Animal Hospital in Plano, Texas, envisions logistical problems with this focus on wellness care. For example, if a client signs up to pay $29.99 per month for the next 12 months, and they pay the first month or two, but then something happens to their pet or the pet dies, he worries that the client is not going to continue to pay. Getting clients to pay an annual fee up front would be challenging as well because of the initial cost.

"Assuming payments are made, it is a reliable monthly income for the hospital," he says. "They are not going to go to another veterinarian, if they already pre-paid here."

Additionally, seeing the animal more frequently gives veterinarians the opportunity to see "little things" before they become big.

"This is not going to appeal to or attract anyone not already seeing the veterinarian," McLaughlin says. "It is going to reinforce existing client relations. This is PR. This is the Banfield packaged health plan they've been doing for years."

Success or failure for most practices comes down to access to discretionary income, McLaughlin adds.

"If it comes down to getting a rabies shot for the dog, or paying the electric bill, 'Sorry Fido, just don't get into any fights with raccoons,'" McLaughlin says. "And that won't get any better for at least three to five years. You can do as much cheering from the sidelines as you want, but nobody is going to come see me because the AVMA tells them to."

Overall, he doesn't see much of a future for this initiative.

"It will limp along, be endorsed by various professional organizations, and go nowhere," he says. "The fact that 45 percent of clients say they are interested in a wellness program is totally different from 45 percent of them signing up."