Never before has veterinary medicine undergone such rapid change. Corporate consolidation, plus the rise of artificial intelligence and surging pet owner acceptance of telehealth and online services, are twisting veterinary practice into an entirely different animal. Things are changing so fast that no one knows how it will all shake out.
When I look at the profession today, I see these five interest groups hoping to push our industry in ways that will benefit them:
- Clients want more affordable and accessible care for their pets.
- Veterinary support staff want higher wages and jobs that are more advanced.
- Tech companies want to take work and give it to AI.
- Practices want to be more profitable (often to satisfy outside investors).
- Veterinarians want to earn a good living without feeling overwhelmed or unappreciated.
I know a lot of people look at the potential conflicts of interest between those groups and think the future is bleak for at least some of us. (Almost no one is betting against AI.) I remain, however, cautiously optimistic.
Sure, paying technicians more, allowing them to do more, giving a good chunk of work to artificial intelligence, maintaining doctor salaries, getting practice revenue up, charging pet owners less and continuing to practice “good medicine” sometimes feels impossible.
Well, I propose a way to simultaneously accomplish (or at least get close to) all those objectives. It involves collaboration and possibly a reimagining of the general practice doctor.
What Is Good Medicine?
To discuss how everyone can achieve the future we want, we first must consider what constitutes “good medicine.” For some of us, good medicine is done by the person with the highest possible academic credentials. For others, it’s medicine that could be displayed on social media without receiving snide comments or condemnation, or it’s the medicine that would impress our veterinary school classmates.
None of those definitions, of course, make much sense. Everyone who has worked in practice for a few years has done their best under the circumstances presented to them. How many of us delivered medical care in environments we never would have chosen? How many of us provided care to the pets of people who “don’t believe in euthanasia,” who are religiously opposed to blood transfusions or who were unable or unwilling to pay for the treatment plan we deemed most appropriate? I think that’s most of us.
Having worked in those conditions, did we fail to provide “good medicine”? I think not. We can define good medicine as meeting the standard of care, benefiting the patient, and making the caregiver and pet owner feel good.
My point is a rigid standard for good medicine is infeasible (and always has been). What matters is providing the medicine that meets a basic standard of care and is done in a way that caregivers and pet owners feel good about. We must accept that medicine will be delivered in very different ways as the profession fragments and evolve.
Can’t We Just Speed Up?
In the past, our only real tool to maintain standards of care, raise wages and keep client costs down was efficiency. If we could just work faster, we could see more pets at or near the same prices we charge, we could maintain our medical standards, and we could pay our staff more. If we could go fast enough, we could theoretically do all those things and generate more revenue.
While I think AI will help, the problem is there’s always a tipping point where care providers exceed their physical, mental or emotional capacity for fast-paced work. When they reach that point, they make medical mistakes, cut corners on recommendations or suffer mental health consequences.
Yes, efficiency is essential, but it alone won’t get us where we want our profession to be. For all this to work, we must couple efficiency with a reallocation of health care responsibilities.
More Tasks for Technicians
The simplest way to raise technician wages and keep pet care affordable is to expand our support staff’s scope of work. Just think about it. Every task we move from a $70-an-hour laborer (the veterinarian) to a $30-an-hour laborer (the technician) is an opportunity to reduce the cost to the pet owner, maintain or increase practice profitability, and support the technician’s wage. Many practices are beginning to leverage the math with services like technician appointments, but that’s just the beginning of what’s possible.
For example, think about technicians doing ultrasound scans using teleguidance. They turn out abdominal scans at an affordable price for pet owners and a profitable price for practices. The technicians take pride in their ability to perform such a nuanced and valuable procedure.
I’ve also seen technicians running physical therapy and rehabilitation services out of a closet inside a small animal practice. Five years later, the practice expanded to better house that part of the business. Physical therapy is an example of a service that doesn’t need to be staffed by doctors, can be affordable to pet owners and is a revenue center.
In Seattle, a company called BoosterPet offers wellness appointments with a licensed technician onsite and doctors joining the appointments virtually. Cases needing treatment become urgent care appointments with an in-clinic veterinarian.
Other opportunities for leveraging technicians include:
- Virtual behavior consultations and follow-ups.
- Virtual pre-visit information sessions for new pet owners. (These increase compliance at the appointment.)
- Breed consultations for people considering a pet.
- Laser therapy sessions in post-op and rehabilitation cases.
- Fluorescent light energy sessions in dermatology cases.
- Genetic screening and microbiome consultations.
Regardless of how we go about it, the opportunity to increase our support staff’s scope of work is significant and immediate. So, why are we so resistant to pushing veterinary medicine in that direction?
The General Practice Vise
For the past 30 years, general practice veterinarians have faced increased pressure to refer advanced cases to specialists. Many of us observed advanced surgical or medical procedures in veterinary school and heard: “Don’t worry. You won’t have to do this. You’ll refer these cases.”
One of the downsides to having an education model where general practitioners are trained almost exclusively by specialists is that GPs and specialists tend to end up with overinflated views of what should be referred. Sure, the fastest and most medically sound way to handle a tough case is to send it to the most highly qualified person at the most well-equipped facility. But if “good medicine” is context-specific and requires that treatment be feasible for the pet owner, is that the obvious answer?
The specialty-centered approach to education has created and tightened the top of a vise holding the general practitioner. Cases deemed “too challenging” should be referred, we hear. On the flip side, think of the rising bottom of the vise as the chiseling away of the most basic services that GPs provide. Vaccine-only clinics, euthanasia-only practices, telehealth providers and online retailers are taking the low-hanging fruit that GPs traditionally offer. (No offense intended to those hard-working service providers.) And now that they’re hearing how technicians should take more tasks off the plates of veterinarians, it’s easy to see how GPs can feel trapped in a world taking shape around them.
Recutting the Pie
There’s a way out of this predicament, but it involves reallocating work beyond expanding the scope of what technicians can do. The shift doesn’t have to decimate a GP’s caseload and income. It does, however, necessitate that GPs shift their scope of practice.
As we push for technicians to work at the top of their licenses, GPs must also work at the top of theirs. To be successful going forward, general practitioners will need to provide services that can’t be:
- Done by people who never attended veterinary school.
- Carried out by AI chatbots.
- Learned by watching YouTube videos.
GPs must grow and maintain higher surgical competencies, have greater tolerance for ongoing medical workups and management, and coordinate and collaborate with teams of technicians to provide care at a greater scale.
Of course, GPs will recommend medically appropriate referrals. However, we should also provide a general practice alternative in more cases. Consider the surgery, cardiology and derm cases you refer to a specialist. What percentage of them could have been managed in general practice? Think about how many seizure-afflicted dogs are monitored by neurologists who would rather be doing neurosurgery (which should never be done by a GP). Think about how many ophthalmologists do enucleations that used to be routine in general practice. You get my point.
How Do We Get There?
I’m not advocating for throwing a switch and having doctors keep all their intimidating cases. Instead, we should establish the expanded scope of general practice as the acceptable training outcome and then work backward to get veterinarians to that point.
Veterinary schools should turn out GPs who are confident enough not to think referral is the first option in a complex case. Corporate practices should create mentorship and advanced training pathways that decisively move recent graduates toward the upper end of our scope of practice. Continuing education providers should get serious about interactive, hands-on education. And, of course, veterinarians should sign up for and attend such training.
Finally, general practitioners should mentor, support and encourage colleagues who take on challenging cases instead of telling them, “I would have referred that.” We must step up and recognize that a GP’s future isn’t in low-hanging fruit and that we will have engaging, stable jobs as long as we can manage complex cases and the interpersonal relationships with pet owners and our staff.
BY THE NUMBERS
According to the American College of Veterinary Internal Medicine, 458 of its 3,724 members specialize in neurology. Seven veterinarians were double-boarded in neurology and small animal internal medicine as of December 2023.