Veterinary practice, Caribbean island style

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Our concierge practice on the small island of Anguilla shows that high-quality care is not dictated by geography or income level.

Our concierge practice on the small island of Anguilla shows that high-quality care is not dictated by geography or income level.

The author's wife, Dr. Georgia Paul, with a patient on their Caribbean island home of Anguilla. Photos courtesy of Dr. Mike Paul.Fifteen years ago, after a combined 45 years in veterinary practice, my wife and I moved to a tiny island in the Caribbean called Anguilla, a British overseas territory with an area of about 35 square miles and a population of about 13,500. We built our home and hoped to develop a companion animal practice to meet the needs of the island's residents and their pets. Unfortunately the creation of our practice took a very circuitous route.

The best-laid plans

Our plans first took shape all those years ago when we met an elderly veterinarian who had moved to Anguilla years earlier and started a clinic, and we talked and dreamed with him about taking over that practice. When it came time to make the dream a reality, however, things didn't go as anticipated. Both my wife and I believe every client and every patient deserves the best we can offer, but we were admonished to “remember where you're practicing” and were told that a poor standard of care was what people not only expected but wanted!

Georgia told Dr. X that she only knew one way to offer veterinary care and it was not dictated by geography. She insisted that island pets and their people deserved the option of high-quality care. Needless to say our relationship soon ended-in fact that evening!

We decided to strike out on our own, but those plans were thwarted as well, at least initially. In Anguilla business permits and licenses are for the most part granted to those with special government “connections,” so for years we had to content ourselves with offering simple suggestions to our friends regarding their animals' health. Without a permit we were not able to provide real veterinary care.

Finally-a practice!

Then last year, after 15 years of being unable to practice, we became naturalized citizens and decided to pursue our original intention of practicing on our island, which is commonly referred to as “tranquility wrapped in blue.” We started Pelican Mobile Pet Care, a unique practice model that allowed us to provide care-under what we soon came to realize were less than ideal circumstances. Initially we had planned to do a mobile wellness clinic, but soon we changed our emphasis.

Instead we developed a concierge-type practice, a strictly in-home model that we have built with growing cooperation and support from island healthcare providers and with the aid of long-distance telemedicine consultations and our friends at DHL.

Imagine if you walked into your practice tomorrow and there was no radiography machine, no lab, no surgery suite. What would you do? How would you adjust? How would you provide care? You would probably do what we do-improvise. We make the best of current technology when we can and otherwise work within limitations we never thought we could adjust to. In some ways our practice is a time machine in which we practice in different eras depending on what resources we have available.

Since we don't have a clinic, our practice is conducted from our home and our old Subaru Outback. We've repaired lacerations and hematomas on veranda picnic tables and performed biopsies and lumpectomies where we could hear waves crashing. We've diagnosed conditions we never saw in the States, treated scads of Ehrlichia cases known locally as “tick fever,” managed a number of cases of heartworm infection in part because of erratic use of preventive, and diagnosed and treated several uncommon malignancies.

Drs. Mike and Georgia Paul with their Subaru Outback, which they take on mobile visits.We soon realized that in an exceptional veterianry environment, clients, pets and medical conditions were all out of the ordinary. Oh, I still treated my share of goats, but increasingly we were able to impress on people the need for parasite prevention and control and early intervention. A large expatriate community, along with increasingly sophisticated local pet owners, were soon presenting us with challenging cases and wanting the best care we could provide.

There is a well-equipped and fully staffed private human healthcare clinic on the island, and they have opened their doors to us for things like urine cultures, emergency blood tests, digital radiographs and even ultrasound. They sell us obscure supplies, and we have access to some drugs at local pharmacies (that's another story) and the hospital. Most of our supplies are ordered and shipped from U.S. suppliers, but nothing is easy nor cheap. International shipping is expensive, and together with import duties our costs are roughly double what folks in the States pay.

So we have developed our own pricing model that allows us to provide  affordable care while compensating ourselves adequately for our services. Georgia provides most of the care (my joints are not very amenable to working on the floor). I have been repurposed into a veterinary assistant-and I am told not a very good one.

We have a few dozen clients and patients, and believe me they receive personalized care and lots of our time.

Most of our clients know us personally and socially, and all of them have our home phone number, our mobile number and our email. We are rarely called at unreasonable hours; in fact most of our clients reach us by email. Because our lab tests are usually sent to the United States, we batch tests when possible to reduce shipping costs. We have developed a driving route that lets us deliver products, perform repeat evaluations and even administer medications for some clients.

Because time is rarely urgent and we operate on our clients' schedule (but on our hours), we spend a lot of time talking to clients and educating them.

What does this mean for you?

All of you have favorite clients and patients. You might consider our practice as a model for providing care for those special people. Pet owners are less inconvenienced since we go to them on their schedule and pets are less stressed because they are in their own home.

Look at your elderly clients. Look at your differently abled clients. Consider what makes your “difficult” patients so difficult. Look at your underutilized team members. Then ask yourself if a concierge arm of your practice would enhance your services.

Dr. Michael Paul is a nationally known speaker and columnist and the principal of Magpie Veterinary Consulting. He lives in Anguilla in the British West Indies.

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