Time For A Paradigm Shift in Veterinary Healthcare

by Kevin K. Haussler, DVM, DC, PhD

The problem

Veterinarians play a crucial role in society – they are responsible for the health and well-being of pets, livestock, and wildlife.

There have been cyclic shortages of veterinarians within the veterinary profession since its initial formal organization. The culmination of many factors both within and outside of veterinary medicine have now brought the issue to a crisis level where the demand for animal care services often outstrips the available supply of veterinarians.

Pet ownership continues to rise globally, and this surge has strained veterinary resources. Veterinarians, already facing burnout and high turnover rates, are stretched thin as they strive to meet the growing demand for their services.

Animal and owner perspective

• Increasing costs for animal health care
• Limited access for specialists and emergency care
• Extended wait times for routine appointments and urgent care
• Animals requiring ongoing management of chronic illnesses may face challenges in receiving consistent care and monitoring
• Financial constraints or inability to access veterinary care may lead to neglect or abandonment of animals by owners unable to afford necessary treatments
• During times of economic downturns or personal financial crises, the cost of caring for a horse—food, shelter, veterinary care—can become prohibitive for owners
• Horse owners may be left to their own devices
• Owners may seek advice online and care from non-veterinarians
• May be given conflicting advice for different sources
• Increased risk of disease and mortality
• Challenges in managing contagious disease outbreaks and emergency services
• Increased effect on low-income and underserved communities often resulting in patients that are more seriously ill on presentation
• May decrease farm profitability

Veterinary perspective

• Physical and mental exhaustion – stresses associated with running a business, long and intense work hours, not taking time off, emergency service requirements, suspected animal abuse, compassion fatigue, and performing euthanasia
• Quality of care – limited time and availability, balance between client versus patient needs, decreased client compliance, concerns of social license, maintaining standards of care, and devaluation of professional services
• Financial strain – high educational debt, low starting wages, lower compensation than companion animal positions, clients with limited finances, and corporate acquisitions of equine practices
• Client expectations – dealing with demanding owners, unrealistic expectations of immediate access and availability, dictate treatments, and expect immediate therapeutic responses

Proposed solutions

Over the years, many solutions have been discussed and implemented to varying degrees, with limited success:

• Reducing veterinarian turnover
• Improving efficiency
• Increasing the supply of graduates by increasing class size
• Increasing the number of veterinary training programs
• Increasing utilization of veterinary technicians and assistants
• Creating a new mid-level veterinary professional
• Prioritizing veterinarian mental health to combat burnout
• Expanding the use of technology to improve efficiency
• Encouraging a team-based approach to healthcare delivery
• Improving work schedules and financial compensation
• Setting boundaries around available time and accessibility
• Increasing use of telemedicine
• Increasing client education
• Increasing public awareness and advocacy

There is also a growing movement to explore how non-veterinarians can contribute effectively to the care and well-being of animals, under appropriate supervision and guidance. Non-veterinarian animal health practitioners bring unique skills and perspectives that complement veterinary care, contributing to comprehensive and holistic treatment approaches. Could more collaboration with and services provided by qualified non-veterinarian animal health practitioners be part of the solution to the veterinary workforce crisis?

Building a new collaborative culture

In times of crisis, a multidisciplinary approach and teamwork are more crucial than ever. By fostering collaboration between veterinarians, non-veterinarian animal health practitioners, and other related professionals such as animal behaviorists, nutritionists, and trainers, we can create a more holistic and comprehensive approach to animal care.

This approach allows for a more thorough assessment of each case and the development of tailored treatment plans that consider the physical, mental, and emotional well-being of the animal. Multidisciplinary teamwork in veterinary care brings together diverse expertise and perspectives to address complex cases, optimize treatment plans, and improve overall patient care.

Many of the solutions that have been considered by the veterinary profession seem to be just more of the same in-the-box thinking without actual vertical advancements in the profession. A couple of more recent developments that show more promise include increased use of community-based practices, the One Health Initiative, and incorporation of multidisciplinary team approaches to providing animal health care.

Community practice model

• Helps to service clients who do not have ready access to veterinary care
• Fosters positive interactions with clients through education and conservative care
• Objective of intervening as early as possible in the disease process to shift the balance in favor of primary prevention
• Predominantly provides services specific to disease surveillance, restorative medicine, and rehabilitation services
• Can provide advice about alternative courses of action
• Serves as a point of referral for more severe or advanced medical and surgical needs

One Health Initiative

• One Health is defined by the World Health Organization as the integrative effort of multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals and the environment
• Both human and veterinary medicine are vested in the concept of One Health
• From the veterinary perspective, it has mostly been involved in educating the public about zoonotic diseases, food safety, and other animal–human-related health concerns
• Additional issues include the importance of human-animal bonds, social license, and mental and emotional support

Challenges to building a new culture

Building a culture of multidisciplinary teamwork in the veterinary industry comes with its own set of challenges. Resistance to change and reluctance to embrace new approaches can impede progress towards a more inclusive and collaborative environment.

One of the primary obstacles is the traditional hierarchical structure of veterinary practices, which often leads to a top-down approach, with the veterinarian dictating medical management and a lack of collaboration between different team members.

Other challenges are:

• Attitudes and pre-conceived notions about other healthcare providers – a sense of entitlement and egos, protectionism, close-mindedness
• Different disciplines may have their own established practices, terminology, and priorities, making effective collaboration challenging
• Lack of or undefined mechanisms for interprofessional collaboration and case management
• Miscommunication or lack of effective communication protocols can lead to misunderstandings and errors in patient care
• Unclear delineation of roles and responsibilities within a multidisciplinary team can result in overlaps or gaps in care delivery
• Narrow scope of practice and limited services provided by non-veterinarian animal health practitioners – sometimes trained in single treatment modality, manage mostly healthy patients, lack in-depth clinical perspectives, limited experience working within a health care team
• Each profession or discipline may have its own organizational culture and approach to patient care, which can create tensions or resistance to change
• Establishing clear guidelines and regulations governing the roles and responsibilities of non-veterinarians is essential to ensure patient safety and uphold standards of care
• Aligning team members around shared goals and values, such as patient-centered care and continuous learning, strengthens teamwork and collaboration
• Comprehensive training programs and continuing education opportunities are crucial to equip non-veterinarians with the knowledge and skills necessary to work effectively
• Building a culture of collaboration and mutual respect between veterinarians and non-veterinarians is essential for fostering effective teamwork and communication
• Developing mechanisms for timely and effective communication between all team members
• Strong leadership that promotes collaboration, encourages open dialogue, and resolves conflicts constructively is crucial

Specific challenges for veterinarians

• Tightly regulated and often restrictive veterinary practice acts
• Lack of knowledge about what different non-veterinarian animal health practitioners and modalities can offer
• Concerns over patient care by non-veterinarians with unknown training and clinical acumen
• Veterinary legislation affects standards of practice and therefore liability issues
• Issues of owners spending money on non-essential care and then not having the resources to pay for needed medical and surgical care
• Need to address issues of pseudoscience and unsubstantiated claims of clinical indications and efficacy for unproven therapies
• Concern of competition versus collaboration and increased client referrals due to expansion of services offered

Specific challenges for non-veterinarian animal health practitioners

• Abilities – Can serve as health care sentinels and detect early onset of disease, provide basic education and comfort to clients, help ease minor pain and dysfunction, supportive care – muscle relaxation, minor pain management, strength and conditioning, horse-rider interactions, podiatry services, tack fit and use, behavioral modification, etc.
• Frustrations – veterinarians may be unwilling to collaborate and consult on cases
• Limitations – Only can provide conservative care for non-medical or surgical issues, mostly provide manual therapies, some physiotherapeutic modalities
• Insufficient education and training requirements – lack breadth and depth of quality education, no oversight by governing boards, inconsistent standards of care, limited practical training and case management, poor clinical competency assessments
• Unskilled – lack of understanding and respect for codes of conduct, unaware of best practices, poor written documentation skills, insufficient communication, limited interprofessional collaboration, unrefined case management
• Legal concerns – lack of awareness of red flag issues, inability to observe scopes of practice, absent liability insurance coverage
• Despite the desire to want to help support veterinarians and provide health care for animals, the demanding nature of the veterinary profession can also take a toll on the physical and mental health of non-veterinarian animal health practitioners. Long working hours, constant physical strain, and emotional stress can lead to similar issues that veterinarians face such as lack of work-life balance, physical strain on the body, financial struggles, emotions stress, and burnout. The importance of self-care cannot be overlooked or disregarded – Physician, heal thyself.

The importance of collaboration and communication

As we navigate the complexities of integrating non-veterinarians into the veterinary profession, communication and collaboration among the various stakeholders, as well as ongoing education are key.

Animal owners play a pivotal role as advocates for their pets’ health. By being proactive in preventive care, following vaccination schedules, and seeking regular check-ups, they can help reduce the frequency of urgent visits and support overall veterinary clinic efficiency.

Veterinary technicians, assistants, and animal care workers are invaluable members of the veterinary team. They provide essential support in handling routine procedures, monitoring patient recovery, and educating pet owners. Their role is crucial in easing the workload on veterinarians.

Collaboration with non-veterinarian animal health practitioners can provide valuable insights into preventive health strategies, behavioral interventions, and environmental enrichment that contribute to overall animal well-being.

The benefits outweigh the difficulties

While the challenges of building a culture of multidisciplinary teamwork in the veterinary industry are real and multifaceted, the benefits far outweigh the difficulties.

By embracing a multidisciplinary approach to animal care, we can optimize resources, improve access to veterinary services, and ultimately enhance the health and well-being of animals everywhere.

By embracing collaboration, veterinary professionals can improve patient outcomes, and ultimately elevate the standard of veterinary medicine:

• Increased access to animal care and veterinary services in underserved areas
• Improved patient care and animal welfare
• Increased client education and satisfaction
• Less stress and workload for veterinarians
• Improved job satisfaction and effective utilization of veterinary technicians
• Seamless integration of non-veterinarian animal health practitioners and the services that they provide
• Increased diversity and quality of services provided
• Development of effective health and wellness programs

Through ongoing commitment, communication, and respect for diverse expertise, the veterinary industry can continue to evolve towards a future where every animal receives the comprehensive and compassionate care they deserve.

Veterinarians can benefit from the expertise and insights of professionals in other fields, leading to improved diagnostic accuracy and treatment outcomes.

Non-veterinarian animal health practitioners can expand their skills and knowledge through collaboration with veterinarians and other professionals, enhancing their own professional development.

Pet owners can also benefit from a more holistic approach to pet care, gaining a better understanding of their pet’s needs and how to support their overall well-being.

In closing…

The global veterinary crisis calls for a paradigm shift towards a more collaborative and multidisciplinary approach to animal care. By working together, pet owners, allied animal health practitioners, and licensed professionals in related fields are able to provide some level of relief for overwhelmed clinics and ensure that all animals receive the care and attention they deserve. Embracing teamwork and building a new culture of collaboration in the veterinary industry will not only benefit animals but also lead to a more fulfilling and rewarding experience for everyone involved in their care. Raising awareness about the importance of veterinary medicine and advocating for policies that support the profession can garner public support and investment. The health and welfare of animals and their owners need to be the focus of care.

Contribute to this important conversation – join Dr. Haussler at our August 29^th Community Gathering with guest collaborators AAETT President Michele Haman and RAAHP Canada Chair Laurie Edge-Hughes.
Registration: vetcompendium.org/community-gatherings/