Taking the pulse of 2011 and beyond
General practice remains at a crossroads; hastened by the economy, specialization
National Report — Patient referrals won't be replacing examinations for veterinary general practitioners any time soon, but DVMs will need to learn new ways to work with clients—and each other— in a rapidly changing world.
"I think the veterinary profession, like many businesses, is kind of at a crossroads," says Dr. Peter Weinstein, DVM, MBA, executive director of the Southern California Veterinary Medical Association and partner at VeterinarySuccessServices.com. "In many industries, high-tech or even the medical profession, everything can be going along just fine and then something happens and the business model has to change.
"Veterinary medicine has been the same for 30 to 50 years, until the last few years. The delivery model has to change."
General practitioner or gatekeeper?
"I still see a bright future for general practice," says Dr. Michael Andrews, chair of the Board of Directors at the National Council on Veterinary Economic Issues and owner of Woodcrest Veterinary Clinic in Riverside, Calif. "I would be hopeful it isn't going the route of human medicine. General practice can handle many cases that come up, but specialty practices still are valuable for special expertise and use of special tools."
General practitioners are critical to the overall care of patients, he adds, for getting the bigger picture.
"Someone needs to have an overview of a (patient's) treatment," he says. "When that gets scattered out over various specialists, that overview can be lost."
"I think the future is not clear, relative to general and specialty practice, but there are a couple things we need to think about," adds Dr. John Albers, former executive director of the American Animal Hospital Association who now owns the consulting company Albers Veterinary Strategies.
During the recession, Albers says specialty practices suffered more than general practices, with general practitioners opting to keep more complicated cases in-house. Specialty practices number a lot higher than in year's past, so there is actually a decline in specialty practices that could be attributed to both the economy and possible saturation in the profession.
"How many specialists does the profession really need?" Albers asks. "I really have no idea if we're at that saturation point."
Some practices are opting to hire specialists to keep that revenue in-house, and Albers questions how many specialists can be supported within private practices.
But some lessons can be learned from human medicine, specifically how the general veterinary practice of the future works with specialists, Weinstein says.
Veterinary general practices need to change, he says, but that change is not a move toward becoming referral practices. Instead, veterinarians may need to look at adopting the physical set-up commonly used in human medicine.
"What I would like to see is more doctors in larger facilities providing general practice care, allowing for higher quality of life and more efficient delivery," Weinstein says, comparing this model to medical office buildings in human medicine where general practitioners are housed in the same facility as various specialists. "Having veterinarians learn to play together in a common physical plant delivering quality care and service, sharing equipment, sharing supplies, maybe even having their own technical staff I think is a model we have to look to. There is a tremendous amount of inefficiency in a single veterinary practice."
This model also would help general veterinary practitioners achieve better work/life balance—a strong consideration with the "genderational" changes occurring in the veterinary profession, Weinstein says.
"I think you're going to find different types of employees, but I think the model of veterinary medicine 25 years ago, working 60 to 80 hours a week, is not acceptable for anyone, especially with the returns on investment it provides veterinarians," he says. "We're seeing less desire to physically subject, and mentally subject, yourself to the 60-hour work weeks that baby boomers are willing to put themselves through.
"I don't see the current model as broken; I just don't think it's going to withstand all the pressures and changes that are going on around us. I think there's going to be a need to rethink how we deliver veterinary medicine," Weinstein adds. "I still think specialists and referral medicine will be part of the mix, but I'm not sure veterinary medicine will be a gatekeeper like in human care."
Veterinarian versus the Internet
How many times have clients come to their veterinary appointment armed with diagnoses and printouts from online pet health sources? This is not a trend that is going to go away anytime soon, Weinstein says.
"Twenty-five years ago, the source for information on anything was the expert person—the doctor, the dentist, the veterinarian. Now, the source for everything is the Internet," he explains. "We need to do a better job of being the source of that information."
It's happening a lot in human medicine, too, and even Albers admits to checking his symptoms on medical websites before visiting his physician.
"I think there's evidence that is happening in veterinary medicine, too," Albers suggests.
Clients diagnosing their pets online is a growing trend, but Weinstein doesn't believe it will replace a relationship with a veterinarian.
"I think the veterinarian-client-patient relationship is different than a person going on to WebMD and entering the symptoms they are having personally. Most people can only make a vague assessment of how their pet is acting," he says.
The expertise of the veterinarian is irreplaceable when it comes to reading a pet's behavior, Andrews adds.
"There is always going to be the need to be seen. There's no substitute for observation—listening, touching. You learn a lot of valuable information from those senses," he says.
While dealing with clients who habitually research their pet's symptoms online or second-guess their veterinarian can be frustrating for DVMs, Albers says the key is not in denying the client the value of going online for advice, but in helping them find the right advice.
"I think the critical thing for the profession is to make sure when people do go to the web that they go to credible sites," he says. "Give your clients a list of places you want them to go."
Some websites are even offering online veterinary consultations or second opinions on a pet's case, but the experts agree this is not a direction a practitioner would want to go.
"Without the patient in front of you, it's more speculation than anything," Albers says.
The others agreed that state veterinary boards would almost certainly take issue with veterinarians offering medical advice to an animal in another state without establishing a valid veterinarian-client-patient relationship.
Besides, Weinstein says, an online diagnosis does nothing to replace the relationship that is so important to many of today's clients who consider their pets as a part of the family.
A practitioner can have all the high-tech equipment and board-certifications he or she wants, but the key to a successful general practice is the relationship and trust that is developed with clients. Building those relationships are key to the practice of the future, Weinstein says.
"You can have all the digital radiology equipment and everything else in the world you want, but you have to engage the client, garner his or her trust, and build a relationship before they will let you use the fancy toy," he says.
"The James Herriot era, with respect to relationship, is the direction we need to go," Weinstein explains. "Clients are asking a lot more 'why?' Trust and accessibility is a big thing. We're a 24/7 world now. You don't want to do emergency calls, but you might have to starting checking e-mails or access Facebook and Twitter accounts."
Clients have a high level of knowledge and expect instant information. Learning to give clients what they have come to expect will take a lot more work on the part of practitioners, he adds.
"I think the veterinary profession is going to be challenged to enhance its communication skills, become much more enhanced and engage people at the level they want to be engaged," Weinstein says. "Clients are going to have a higher level of knowledge coming in, and we're going to have to keep up with that.
"Instead of telling clients what we want them to do, we have to listen to them telling us what they want to do."
The largest demographic signing up for a Facebook account these days is women ages 45 to 60, he notes. That's also the primary demographic for most veterinary general practices.
To avoid long nights at the practice, Weinstein recommends being available virtually, saying practitioners can respond to emergency questions with existing patients remotely without spending long hours at the clinic.
More engaged clients aren't necessarily a bad thing, though, Albers adds.
"I think the important thing, for me at least, is I see the pet continuing to be an important member of the family," Albers says. "We're not only there to fix a fracture or a skin disease, but we're there to counsel the owner on a wide range of issues. As long as the pet remains an important member of the family, veterinary medicine will continue to do well. Having an animal successfully in the family means more than flea control and vaccinations."
New economic realities
The economic downturn proved that veterinary medicine isn't as recession-proof as once believed, but the profession still hasn't taken the hit some other industries have.
Downsizing has not become a huge trend, says Andrews, but jobs are being modified to keep pace with economic challenges.
"There's not one way to run a veterinary practice. The traditional model has been one to three veterinarians having all the tools and being open maximum hours," Andrews says. "I think there's a variety of ways to approach this and what the ultimate test is going to be is whether the client perceives value in what you're offering."
There will be more emphasis on preventive care going forward, Albers says, but not all of that emphasis will coming out of veterinarian time.
Some downsizing has occurred, Weinstein says, though he believes more practices are simply not filling positions as opposed to letting people go.
The practice of the future will run leaner, scaling back doctors' hours or bringing in relief veterinarians to help pay the bills, he predicts.
"We've just got to start to think differently and get out of this fur-lined rut comfort zone we've been in for 30 or 40 years and think about what's going to be a better model for the future," Weinstein says.