AAHA says national commission must be 'catalyst for change'

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In the months following the release of the executive summary of the Megastudy, and subsequent formation of the National Commission on Veterinary Economic Issues, the top priority of the commission, next to finding someone to take its reins, has been to generate interest among veterinarians in what the study says about the future of the profession.

During the AAHA's annual meeting in April, three of the association's representatives on the commission's board of directors told JAVMA News during an interview about the commission that it is moving forward in generating awareness in the leadership of organized veterinary medicine. Among individual veterinarians, however, there appears to be little awareness in the study and its implications, they said.

Veterinarians got their first glimpse of the Megastudy, known officially as "The Current and Future Market for Veterinarians and Veterinary Medical Services in the United States," this past July with the release of the executive summary. Drafted by John Brown and Jon Silverman of KPMG, the summary outlined a series of challenges and opportunities facing the veterinary profession.

To address these issues, the AVMA, AAHA, and Association of American Veterinary Medical Colleges together created the National Commission on Veterinary Economic Issues with the goal of encouraging the profession to rethink not only how it practices medicine — from the type of students admitted to veterinary schools to the advantages of practice consolidation — but also to acknowledge the value of veterinary contributions to society. As a result, human and animal health would benefit from improved veterinary services and veterinarians suitably compensated for their knowledge and skills.

But momentum has been slowed by the continuing search for a chief executive officer, someone who will raise discussion about the Megastudy to a national level by hosting forums and presentations across the country. Dr. Janet Donlin, AVMA associate executive vice president, has been serving as interim CEO until a permanent chief executive can be found.

Dr. Michael A. Paul, the AAHA's immediate past president and commission secretary, said there has been no shortage of excellent candidates, but, "We're looking for tremendous organizational and leadership skills, for passion and presence...and it's difficult to find that person."

In the meantime, the commission's 12-person board of directors, composed of members from the three associations, have been the Megastudy's principal evangelists, volunteering their time to speak at state and various meetings about the study and the need for change.

"We've just not been able to effectively get the word out as widely as we'd like," said Dr. John W. Albers, AAHA executive director.

One reason for low awareness, Dr. Albers said, is that the executive summary, which has appeared in the JAVMA, is a technical, economic document. Additionally, many veterinarians are too busy to take the time to read it. (Electronic and print versions of the study have since been made available for purchase.)

Dr. Paul implied the AAHA is a microcosm of the entire profession: much of what is true about the association is representative of veterinarians in all areas of practice. "We reflect many of the same attitudes and many of the same [struggles] that the rest of the profession does," he said.

Studies have shown that 70 percent to 80 percent of veterinarians go into small animal medicine. A growing number of these practitioners, Dr. Albers noted, are now opting for careers in the pharmaceutical industry and technical services in pet food companies. Others are returning to school for business degrees. The reason, he feels, is largely due to economic pressures.

The executive summary stated that veterinarians' income seriously lags behind that of similar professions, which affects their ability to repay student loans. Further complicating the matter is, despite the apparent willingness and ability of the pet-owning public to pay for quality veterinary care, most practitioners are not charging appropriately for their services.

And the summary predicts things will only worsen. Evidence suggests that, in strict economic terms, there will be a surplus of veterinarians over the next 10 years; too many, in fact, to make an adequate income with respect to business costs, inflation, and consumer demand.

Dr. Paul thinks part of the solution may lie in exposing veterinary students to opportunities in nontraditional veterinary fields sooner in their academic tenure.

"Should we be showing them other career paths so they can investigate those options earlier, and don't get frustrated with practice and find themselves in situations they don't want to be in?" he asked.

Consolation for those veterinarians in practice is that the Megastudy indicates a number of opportunities to "make the pie bigger," according to former AAHA president, Dr. Margaret J. Rucker. A critical first step is correcting veterinarians' inclination to underestimate clients' commitment to their animals. "The study tells us that people are much more willing to spend money for their pets than we think they will," she said.

Speaking from experience, Dr. Rucker, who owns a practice in rural Virginia, said veterinarians tend to work harder rather than smarter, and need to take a step away from their practices to assess their efficiency. Recently, after one such appraisal, Dr. Rucker raised prices at her clinic 20 percent, without a single complaint from her clients.

"I have office visits that are 45 minutes long, so when [clients] have got a problem and they want to speak to me, I make sure I'm available for that," she said. "They pay for it, but at the same time, that's what they want."

Compassion and altruism, combined with a calling to help animals, are the common traits of a person choosing a career in veterinary practice, Dr. Paul said. These characteristics, however, make for a moral dilemma when it comes time to place a price tag on the care they provide as veterinarians.

Dr. Paul argued, and the others agreed, that, "If we're doing quality work, if we have trained staff, and we're using all our expertise and our knowledge and all the technology available to help animals, why should we feel bad about charging people for that?"

What the National Commission on Veterinary Economic Issues must do then, is hammer away at veterinarians' perception that price increases are separate from care, whereas pricing does, in fact, influence the quality of care. It is the commission's opinion that the highest level of animal care depends on the economic well-being of veterinarians.

"We have to have people recognize that you simply cannot deliver a high quality of care if you're not economically successful, and that includes charging a fair price for what you're doing," Dr. Paul said.

During the next year, the commission must raise interest about this and other issues in the Megastudy to the place where there is a national conversation. The state associations, specialty groups, veterinary colleges, and other pertinent parties must all be discussing the study and thinking about what they can do to address the issues.

Other short-term goals include identifying areas of the study that warrant further research, such as the economic impact of the influx of women to the profession. A broad-based coalition must be established among individuals from every venue of veterinary medicine, from food animal practitioners to leaders in animal health corporations, so that their expertise can be accessed.

Care must be taken, however, that the commission is not seen as the solution to the profession's challenges. "The best that the National Commission on Veterinary Economic Issues can do is to be a catalyst to drive change. It can't implement change itself," Dr. Albers said.

Over the protests of those who say the study is saying nothing that was not widely known 20 years ago, the board of directors must convince veterinarians that the profession cannot continue as it is, that the time for action is now, and success will come only if the associations and individual veterinarians support the commission.

"We don't have an easy road ahead," Dr. Rucker admitted. "Change is extremely tough, and veterinarians are probably one of the toughest groups of individuals to change. It's very tough to change the mindset of individuals, but that's going to have to be the case."