Think Out Loud

Increasing access to veterinary care is high priority for industry leaders meeting in Portland

By Elizabeth Castillo (OPB)
Sept. 27, 2022 6 p.m.

Broadcast: Tuesday, Sept. 27

Nationwide, many pets receive little to no care from veterinarians. That’s one issue industry leaders hope to tackle this week at the Veterinary Innovation Summit happening in Portland. Douglas Aspros is the chair of the Veterinary Innovation Council, the organization behind the event and the chief veterinary officer at Veterinary Practice Partners, an organization that co-owns veterinary practices with veterinarians. Apryl Steele is the president and CEO of the Dumb Friends League, an animal welfare organization. They join us with details about the summit and how the industry plans to reimagine pet healthcare.


Note: The following transcript was created by a computer and edited by a volunteer.

Dave Miller: Veterinarians from around the country are meeting in Portland today and tomorrow; they’ve come to take part in the Veterinary Innovation Summit. It’s put on by a nonprofit focused on both the well-being of animals and the professionals who take care of them. We were curious what issues are top of mind to these veterinarians right now so we’ve invited two of them to join us. Doug Aspros is the chair of the Veterinary Innovation Council–that’s the organization behind this event. Apryl Steele is the president and CEO of the Dumb Friends League, an animal welfare organization. Welcome to both of you.

Apryl Steele: Thank you, It’s great to be here.

Douglas Aspros: Thanks for having us.

Miller: Apryl Steele first. What do you see as the most urgent issues facing the veterinary profession right now?

Steele: I think we have two major issues. We have many issues but the biggest ones are our workforce issues. Our veterinary profession is at its maximum capacity for serving the patients that we are serving, the way we are serving them right now, and we know that more than 80 million animals are not getting care.  Despite the veterinary hospitals and veterinarians being very, very busy, people are waiting a long time to get appointments, emergencies are having to wait. So increasing the workforce and the ability to provide veterinary services to the public are really important and with that shortage, we also deal with the stress that this puts on the veterinarians there. We have compassionate perfectionists in this profession and they are overworked and quite stressed. And then the other major issue that I feel like we’re dealing with as a profession is access to veterinary care, especially for the underserved community but for all folks for different reasons.

Miller: You just introduced a lot of different ideas. Let’s go through them one by one. But Doug Aspros, one of the numbers that stood out there is that 80 million animals are not getting care. What do you mean when you say that you are in the industry?

Aspros: The way we think about this–and it’s probably the number that we quote these days–is that 88 million pets don’t receive regular veterinary care. We put them under the big rubric of access to care and they’re a bunch of dimensions to that. Some of them are financial.  Some of them are that there are veterinary deserts in this country. Some of them are actually in the desert and think about reservations across the country, especially in the Southwest, that have really no access to veterinarians because there are no veterinarians in their communities. And then there are the people who have a hard time with mobility issues and other things that really make it difficult for them to get their pet to a veterinarian and receive care when they need it. So, there are a lot of different things that need to be solved if we were to provide the care that our society is asking for for animals that really are part of our families these days. The human animal bond is more important than ever in our society and our animal families are just as important as our human families. And it’s our responsibility as veterinarians to solve that problem and provide access to care for those patients.

Miller: Apryl Steele, what are the health repercussions for those animals that aren’t getting care?

Steele: We know that if we diagnose and treat animals early, we have better outcomes with less cost. An example would be a skin mass that’s a cancerous mass just like us. If you don’t attend to it, it’s going to become more invasive, larger, more difficult and sometimes even incurable at that point, it’s the same thing for animals. We’re talking about preventing care so we can prevent disease, especially infectious diseases with vaccinations, but also sickness, illness, injuries that need to be addressed. And unfortunately it’s the people with the fewest resources that tend to have to wait the longest because the medical condition often has to rise to a level of criticality before the pet owner has the bandwidth to respond to it.

Miller: That gets to Doug Aspros. The first issue that you talked about in terms of the reasons behind this, this lack of getting care, which is money. What can the industry do to change that? We live in a world where humans act for themselves. In this country, they go on GoFundMe to pay for cancer treatments.  And given that, it’s not really a surprise that many people are not going to have money to pay for chemotherapy for their dog. So what can the veterinary industry do to make your services more affordable?

Aspros: To some extent we are with the best doctors we’ve ever been. You mentioned earlier that both Apryl and I have been frontline veterinarians for a long time. During that period of time, we’ve become better and better doctors; we can do more and more for our patients; we can keep them healthy and happy and in their homes longer and extend their lives, but all of that comes at a cost. And veterinary medicine is retail medicine. There isn’t a government that’s going to pay for it. Most of our patients don’t get healthcare and don’t have healthcare insurance to help fund those treatments.  And because we’ve expanded the quality of care, we’ve expanded the cost of care and one of the things that we’re really looking at the summit is what we sometimes call the gold standard of care. We want to do the very best we can for every one of our patients, but we also need to be able to meet our clients where they are, meaning that we can meet their ability to provide care. That means that while some patients can do really well with brain surgery and we can extend their lives and cure them, that’s not going to be something that most Americans can afford to do. And that doesn’t mean that their patients, that their animal families, don’t deserve care, don’t justify care, don’t benefit from care, but that has to be care that they actually can afford. It has to be care for which they can actually bring their patients in to get the treatments that they need because all of those access-to-care issues impact our ability or their ability to to take care of animals that are so important to their lives and their futures.

Miller: Apryl Steele, what could that look like in practice if there is the gold standard of care that would be technically the most beneficial in terms of the care itself, but also the most expensive? Then what’s your vision for a less expensive kind of care that could be more widely available and could be an increasingly important piece of the overall veterinary health care system?

Steele:  I like to call it incremental care. It’s kind of logical. It makes a lot of sense when you think about it. If a dog, let’s say presents to a veterinarian for intestinal upset and is vomiting. There’s the opportunity to do a myriad of tests from no testing to radiographs and ultrasounds and MRI’s and all kinds of things. So it has been sort of typical for veterinarians to test quite extensively at the first presentation and that’s not always necessary. It’s not wrong. You don’t want to miss anything. But I like to say probably 90% of those animals are going to get better with what we call trial treatment. So this animal comes in, the clinical signs are consistent with a bacterial overgrowth, we treat them for that and they’re better. Five percent probably would have had a much better outcome if we did all of the tests. And 5% aren’t going to respond no matter what we do. And those are just generic numbers. But to set an example, we don’t always have to do all the tests. We have to communicate very well. We have to tell people this is what we think is going on. This is the treatment plan. This is what you should see. If you’re not seeing these changes in these improvements. We need to reevaluate, but not start with all of the tests right out of the back.


Miller: What about the question of who is doing what? How much of the work that you’re describing needs to be done by a veterinary doctor as opposed to veterinary professionals that have absolutely gone through their education and gotten credentialed but are not veterinarians.

Steele: So it’s a great question. We have veterinary technicians or nurses depending on what term you want to use and they’re very qualified and they do so much work within the practice, they’re the radiologist, the anesthesiologist, the radiology technicians, they draw blood. They’re really the backbone of the practice and unfortunately they can be very underutilized at times. So those professionals should be doing more. We also need to create more bandwidth within the profession and we are discussing creating a physician assistant type role in veterinary medicine. As it stands now, there’s an associate degree that is for veterinary technicians; very few

but some technicians actually get a bachelor degree, it’s pretty rare; and, then there’s a doctorate degree and nothing in between. It makes sense to increase this workforce in a timely manner to create a professional that works under the direct supervision of a veterinarian but can really add to the bandwidth the veterinary practices have to treat these animals and can often and hopefully impact the price point for doing so?

Miller: What’s standing in the way of that text doing more right now if they are already getting good training and have good clinical experience and could do maybe more work right now, why isn’t that a more obvious and viable career path today?

Aspros: And it is, but we have not organized our veterinary practices around teams that deliver care. We’ve been very veterinary centric, very doctor centric in terms of  how we provide care to our patients and we if we’re going to meet the needs right now, we need to start working as a team and we need to decide who does what, what gets delegated to veterinary technicians who can really extend the value and the ability of the practice to meet the demands right now. Apryl talked at the beginning about just how much under the gun practices have been since COVID-19 and and beyond now. And if we’re going to, if we’re going to solve those problems, if we’re going to be able to actually provide care. It’s going to take a team effort, which means that it’s not the doctor doing everything. Doctors do what doctors do, technicians do what they need to do, assistants help them and do that. And, all of us have been through that kind of experience in how health care is provided for us.

Miller:  It’s been a seismic shift in 20 years in terms of physician assistance, and all kinds of people who are not MDs are increasingly being really, really frontline healthcare providers for humans.

Aspros: Absolutely. We need to do more of that because we haven’t been doing much of any of it at all up until now. And again, the post COVID-19 environment is really putting pressure on us. We’ve had this meeting organized to push pressure on ourselves to start to really get our hands around this and change the way we provide services.

Miller: We asked listeners on facebook if you don’t take your pet to a vet, what is standing in your way? Kate Frick wrote money more and more money. I think of vets like car mechanics. I know pet health care is important, but they so often recommend things that aren’t necessary or are so outrageously expensive. Also, she wrote flea treatments that actually work should just be available over the counter. Apryl Steelee, I’m curious how you respond to this comment.

Steele: I hear her and she’s not wrong. I will say that it’s important to remember that veterinarians are compassionate people that really want to find out what’s wrong with an animal and make it well. And so the motivation for these big veterinary bills is not big veterinary bills. It’s to do the right thing for the pet. In veterinary school, it is often taught that you need to do all these tests and there’s a fear of veterinarians, especially younger veterinarians, sometimes that if they don’t do all those tests they are going to get sued for missing something. And so that motivates some people to be a little bit more aggressive in testing and making sure they’re not they’re not missing something. We talk about looking for zebras. When you hear horse hooves, you should think of horses, not zebras. And sometimes veterinarians get caught up in searching for the disease that is a zebra. The intention is good. The intention is to make the animal well, but sometimes it does translate into unacceptable or frustrating veterinary bills and often ends up in a prescription that was pretty inexpensive and the animal gets better. And that adds to the frustration of paying for all of the tests.

Miller: Doug Astros early on in the pandemic. There are all these stories of people who are basically stuck at home getting puppies or kittens. Pandemic puppies was a famous phrase. And then six months later there are these anecdotal stories about people saying, oh I don’t want a dog, I wanted a pandemic puppy, but now I’m done with my sour dough. I’m done with being a pet owner.  Do you have more robust data than that than just these anecdotes? Is pet ownership actually up now overall from before the pandemic?

Aspros: The answer to that is a qualified yes. There are these sources kind of in both directions that maybe calls into question whether or not the pandemic puppy story, which is really really popular in the news media.

Miller: It was irresistible.

Aspros: It really is. I mean these are pretty irresistible, irresistible. But the reality is that Americans really are in love with dogs, not that they don’t love cats. They do. But the American  love affair with dogs has only gotten stronger. There are more dogs in households than ever before.  And during the pandemic when you really couldn’t see people, dogs became more and more important. So whether there was a huge  spike in new pets, there has been a gradual continual increase in dog ownership in the US. Cats not as much.

Miller: Doug Aspros and Apryl Steele, thanks very much.

Steele: Pleasure.

Aspros: Absolutely.

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