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A semi-retired owner confronts the challenges facing veterinary medicine
Demand more from the profession and defend our value.
I'm in limbo between practice ownership and retirement. I'm still the putative owner of the clinic I started 30 years ago, but I live 2,000 miles away and have curtailed some of my day-to-day on-site activities. Being away from the daily concerns of the clinic has given me a different perspective and a different relationship with pet owners. Here are some of the things I've learned from talking to people about their pets and reading online (with real quotes):
Assert our worth
“Diabetes! Glucose of 400 is from stress! What's wrong with that vet?” - Pet owner after consulting with Dr. Google
“Yeah, she ate a bunch of rhubarb, but we threw her in the car and went on our trip anyway. She puked a lot but survived okay.” - Acquaintance
From 1999 to 2006, Gallup polls found that only 2 percent of the public found veterinarians “below average” in honesty and ethics. We consistently ranked in the top five most-respected professions. Then in 2007, we disappeared from the polls. An entire profession deleted from the public's interest. “Advertising practitioners” are still on the list-whatever they are-along with car salesmen and lobbyists, but not us anymore. And then in 2012, The New York Times published an article that listed DVM as a “meh” degree. “Not hot. Not not. Just meh,” the writer explained.
We did this to ourselves. Although the Internet and other sources of veterinary advice have affected us, most of the change in perception is a result of things we control. We haven't taken advantage of the opportunities available to change our public persona. Rather than becoming organized and presenting a common front of skilled educated professionals to the public, we've devolved into a scrappy bunch of competitors. Instead of touting our education and expertise, we tell the public that we're too expensive and our work has little value.
As a profession, we don't make ourselves look very smart. Our public face is cute puppies, vaccines and spays, which medically are trivial tasks. We need to emphasize our more advanced capabilities and with our overall expertise in caring for pets. We have a segment of the profession (the low cost arena) where we're busy telling people that the other part of the profession is overpriced and largely unnecessary. So an ever-expanding group of doctors is spending their time undoing what the bulk of the profession has accomplished in the last 50 years.
Our devolution into a low-cost profession sets us apart from all others, and it's no surprise that the public believes a little Internet research and a trip to the feed store will fix Rex. We haven't given the public enough reasons to trust and value us. Our problem is, we've failed to hold up the “value received” part of the economic equation, making us less relevant and necessary to the public. Our role as experts is eroding.
Command the power
Client: “Hey, my wife dropped our cat off today at your place for surgery today.”
Veterinarian: “We didn't do any surgeries today.”
Client: “Must be the low-cost clinic. Oh well, same thing, right?”
The graduating class of physicians two years ago had just 1 percent decided to own a practice. The rest of them chose to work for corporations, citing the difficulties of ownership. (Sound familiar?) But if you peruse various MD articles now, you'll see great dissatisfaction that stems from the turning over of practice decisions to non-MDs. With insurance companies, CEOs, lawyers and regulators ruling the roost, MDs are feeling the strain of having little control over their professional lives. Maybe that's why half of them in one survey said they regretted their career choice, and only 24 percent said they'd choose the same practice setting as they now have. Is this the road we want to travel?
The Mayo Clinic's great reputation rests on the foundation that doctors within the system make the decisions that affect patient care, not accountants or MBAs. If we want to steer the profession, we need to be at the helm-that means ownership for us. Ownership at all levels of our profession-from spay-and-neuter clinics to specialty practices-allows us to make policies that benefit our patients, clients and associates.
As doctors from the younger generation staff nonprofits and low-cost clinics across the nation, they need to find ways to exert control over the decisions made by non-doctor management. Corporation and smaller chains need to keep doctors at the forefront of their decision-making process. Practice owners make the decisions that define the profession, and we give up that control at great peril.
Follow the evidence
“Don't know much about vets, except they use a lot of steroids and don't make many diagnoses.” - Physician in an online blog
“Lose that belly fat with magic coffee beans!” - Mehmet Oz, MD
Veterinarians now embrace everything for therapy from homeopathy to eating weeds. However, using our authority to endorse unproven treatments devalues us.
We can't remain experts if we endorse any idea because “it just might work.” As we get further away from science-based advice, we weaken our claim to be the authorities on medicine, and more people will and should turn to others for advice. If we want to remain relevant authorities on medicine, we need to call on our expert organizations to set guidelines as MDs do. Our schools must teach us how to evaluate new tests and therapies in a scientific framework more effectively.
We should improve recommendations for treatment of major diseases so we have stronger science to back up our therapies and public discussions. We need boarded and research doctors to be public advocates and the face of our evidence-based profession. We saw how a consensus of experts changed vaccines in a short time, and there's no reason we can't apply that process to many of the diseases we treat.
Share the love
There is a large group of people who love their veterinarians. They have great respect for them, acknowledge their expertise and take-and pay for-their advice. There are practices that thrive on enriching the human-animal bond with excellent medicine care and a compassionate atmosphere. There are shelters that work in conjunction with local private practices in a mutually beneficial way. And there are thousands of veterinarians across the country that go to work every day to enhance the lives of countless people and their pets.
These are the exemplars for us, the lights we should follow. Let's ask these practices, shelters and doctors what works. The profession is on a cusp now, splitting into warring factions competing against each other. I'm confident we can discover a new mutual course of action that unifies us as members of a proud profession with newfound respect and worth. The choice is ours-not the public's, the United States Humane Society or the mass media's. But time is short, and the next decade will decide our fate. Let's hope that in ten years no one asks, “Where did all the veterinarians go?”
Veterinary Economics Editorial Advisory Board member Dr. Craig Woloshyn has owned a clinic in Tampa Bay, Florida since 1985.