Vet-in-a-box: Is it coming?

A few of us can remember when a physician came to our house to handle minor medical procedures. Ear infections, sore throats and the like were treated from a black bag and didn't usually require a trip to a physician's office. For most of our lives, however, primary care has been provided in a physician's clinic.

This care has traditionally been offered by physicians who practiced general or family medicine with the support of a team of nurses. These days, with declining access to physicians and rising costs of medical care, nurse practitioners and physician assistants (PAs) have become a front-line source of primary care. These nonphysicians provide the majority of primary and follow-up care under the “oversight” of a physician. It's becoming the norm to not even see a physician during a routine office visit. 

A more recent development has been the establishment of primary and urgent care facilities in unexpected locations such as strip malls and drugstores. These practices are increasing in numbers. Why? Because they're relatively convenient for patients and most medical insurance providers pay for the care. In fact, “doc in a box” healthcare centers are the new wave of medical care.

What does this mean for the veterinary profession?

Recent reports have pointed out that many veterinarians are disappointed or frustrated by their professional lives. In an article in the dvm360 Burden of Care Leadership Challenge series, a clear disenchantment was reflected in declining job satisfaction over the last 10 years (see “The current state of veterinary job satisfaction,” May 2015). Nonetheless, most veterinarians love being veterinarians in spite of the decline in quality of life. The same factors that impact veterinarians-long hours, emergency calls and lots of time on their feet-are considerations that have led human medical professionals to urgent care facilities as a source of employment.

Are we next? In a recent article on his blog KevinMD.com, physician Kevin Pho discusses a major shift occurring in the delivery of human primary healthcare. The title of his post-“Walgreens moves into primary care, and it's our own damn fault”-says it all. The date is April 12, 2013, when Walgreens had just announced that nurse practitioners and physicians assistants would begin to diagnose and manage chronic conditions such as diabetes and hypertension in an effort to “support physicians.”

Is this type of service for everyone? Of course not. But apparently it does appeal to many. Through its in-store clinics Walgreens has provided care through 24 million patient visits with a 95 percent customer satisfaction rating and is accredited by the joint commission that evaluates and certifies over 15,000 healthcare organizations and programs.

In January, CVS began work on a deal to acquire the pharmacy division of Target. And health clinics are already appearing in Target stores.

Why? Pricing, convenience, attitude of service delivery and value to the customer. At least part of the motive is obvious. Chronic-care patients require ongoing treatment and medications that are available a counter away. Drugstores have capitalized on the patients' desire for convenience coupled with their assumption of competency. 

Veterinarians are teetering on the brink of a similar transition. We have commoditized many services and products such as parasite preventives, nutriceuticals and pain management products. In an age of consumerism we have failed to revisit our pricing models and are no longer competitive with discount and online sources, or even national pharmacy chains. At the same time we have failed to differentiate ourselves, to point out new value equations and to maintain our relevant position as the best advocate for pet healthcare. Instead of viewing new sources of pet care as alternative suppliers or even healthcare partners, we have looked at them as competitors.

A few years ago the profession was looking down the barrel of legislation that encouraged greater competition and consumer protection with regard to veterinary care. Known as the Fairness to Pet Owners Act, HR 1406 was declared a dead issue by the American Veterinary Medical Association in 2012.  But now it's back. The profit motive-the desire by big box retailers to draw traffic in the form of veterinary prescriptions-is what brought it back to the table and what will keep it moving forward.

What stands in the way of vet-in-a-box?

I have heard repeatedly that a major obstruction to veterinary clinics and wellness facilities in retail locations is that animals are not usually allowed into businesses that sell foodstuffs. The exception is service dogs, which are allowed in shopping and dining establishments. However, the broadening of the term “service dogs” to include emotional support dogs makes it virtually impossible to restrict an individual dog from being in most businesses. In addition, there's always the potential for separate entrances.

The profession once predicted that corporate practices would have a difficult time staffing their medical facilities, but current trends indicate that we have a relative oversupply of veterinarians. We've already discussed the fact that while veterinarians are still glad they're veterinarians, many find practice more demanding and less personally fulfilling than they had anticipated. These somewhat disenchanted veterinarians will find a comfortable niche in vet-in-a-box facilities.

There's just a short hop between corporate practices like Banfield and small, cost-efficient, limited-service clinics. Both are appealing to veterinarians who want to reduce their practice-associated responsibilities. Protocols and guidelines provide a standardized level of care and reduced liability and responsibility for individual veterinarians.

Currently, veterinary technicians have little leeway to work without the immediate supervision of a veterinarian. But impending changes to state practice acts are very likely given current consumer demands and political attitudes. It's not out of the question that a facility associated with a box store could be staffed in large part by a technician. 

What can we do?

This is not an issue we can become defensive over. Frankly, it's too late. We lost many of the battles long ago and if we are to continue to be the voice and advocate for our patients and clients, we need to redesign much of what we do, how we do it and where we do it. We must focus on the consumer and not our professional ego. We must reshape our future or live in the past.