Access to Care: What does it mean to veterinary practitioners
Many in the veterinary profession reacted negatively to the development of high-volume low-cost spay-neuter clinics. We saw very few of these clinics until the mid-to late 1990s and now they seem to be everywhere. The expansion of these programs across the country was an initial response to the issue of Access to Care; the recognition that many families with pets cannot afford even basic veterinary care. In 1990, Dr. Gordon Robinson, then Chief of Surgery at the Henry Bergh Memorial Hospital of the ASPCS in NYC, wrote an article in Veterinary Economics entitled “How to Keep A Humane Society Hospital Out of Your Community.” 1 His premise was simple. At that time the ASPCA was performing approximately 4,000 low cost sterilization surgeries each year. But there were 150 veterinary clinics in NYC. If each veterinary clinic provided one, just one, low cost or free spay/neuter surgery a week that would result in over 7,000 low cost surgeries each year and would make the ASPCAs program unnecessary. If that concept had been accepted and implemented across the country, perhaps we might never have seen a low-cost spay-neuter clinic. But, of course, his concept was not accepted, and low cost spay neuter clinics are everywhere.
Now the issue is bigger than spay/neuter. A recent study from the Access to Veterinary Care Coalition documented the numbers of pets that have limited or no access to veterinary care primarily because of financial limitations. 2 The argument that Dr. Robinson made in his Veterinary Economics article was that humane societies wanted to get out of the “killing” business and the only way to do that was to stop reproduction. Since that required spay-neuter either private practitioners would have to perform the spays and neuters or the humane societies would have to establish clinics to perform the spay and neuters. 1 And that, of course, is what has happened. But now the goal of the humane groups goes beyond stopping the killing. Humane groups are stepping in to fill the void in veterinary care by beginning to develop low-cost wellness and basic care clinics. Humane Pennsylvania in their plans for a Universal Pet Health Care Community states “merely not being dead is not the standard by which any of us, or our pets, should live. We should expect to be healthy, or at least have meaningful access to high quality healthcare. Humane Pennsylvania can’t do much to make that a reality for people, but we can commit to providing it to our community’s pets.” 3
What impact will program such as this have on private full service practices? What impact will low-cost wellness and basic care clinics have on private practitioners? How can private practitioners respond? If the response by private practitioners to this current challenge is the same as the response to low-cost spay-neuter clinics then low-cost wellness and basic care clinics will be established across the country. Perhaps we can take a lesson from Dr. Robinson’s article from nearly 30 years ago. Can private practitioners identify basic services that can be offered at a reduced price? Lower prices and higher volume seems antithetical to the economic advice of numerous practice management consultants over the past few decades. But the alternative is leaving more and more pets without veterinary care and, thereby, inviting humane organizations to solve the problem. Would it not be better if veterinarians solved the problem? But where does one start?
One simple step that could be taken is to follow the recommendations of the Veterinary Task Force on Feline Sterilization Recommendations for Age of Spay and Neuter Surgery. The task force has recommended spay-neuter of cats prior to 5 months of age. This concept has been endorsed by the AVMA, AAHA, AAFP, ASV and numerous humane organizations. In a survey conducted in 2000 veterinarians who had been performing spays and neuters of pediatric and juvenile cats unanimously responded that the surgeries were easier and faster and recoveries were faster. 4 If practitioners charged less, significantly less, for these easier and faster surgeries, clients who historically have not been able to get their cats sterilized or who could only get them sterilized through low-cost clinics would be able to utilize private veterinary practices. Veterinarians that accept this approach can promote their services by listing their practice at: https://www.felinefixbyfive.org/veterinarian-signup.
Sterilizing cats prior to 5 months of age is only one example of things that can be done to reduce the barriers that currently exist to access to care. Veterinarians are innovative enough to discover many other approaches and we must.
Robinson G. How to keep a humane society hospital out of your community. Vet Econ 1990; : 32–41.
Access to Veterinary Care Coalition. Access to Veterinary Care. 2018. http://avcc.utk.edu/avcc-report.pdf (accessed May 6, 2019).
Minor K. What is Beyond No Kill? | BCTV. bctv.or . 2019. https://www.bctv.org/2019/08/07/what-is-beyond-no-kill/ (accessed Aug 7, 2019).
Land TDVM, Wall SDVM. Survey of the Coalition of Spay/Neuter Veterinarians. J Am Vet Med Assoc 2000; 216.