The evolution of shelter medicine

Society is demanding medical care, rather than euthanasia, for shelter animals with treatable conditions—according to veterinarians in the field of shelter medicine.

And shelter medicine has emerged as a unique practice by a growing group of people who want to solve problems that start with dog and cat overpopulation.

Some veterinary colleges now include shelter medicine in courses, externships, rotations, or residencies. The Association of Shelter Veterinarians has enrolled more than 500 members and about a dozen student chapters since its formation five years ago. Animal shelters are hiring more staff veterinarians.

Shelter medicine is distinct from other veterinary practice largely because it applies concepts of herd health to companion animals.

"As much as we pay attention to the individual animal, we always have to be mindful and watch the entire population," said Dr. Julie D. Dinnage, an ASV founder who works at the Massachusetts Society for the Prevention of Cruelty to Animals.

She said animal shelters range in capacity from fewer than a hundred animals annually to tens of thousands. Shelter veterinarians must understand principles of surgery, pharmacology, preventive medicine, infectious disease, epidemiology, and public health—as well as how to work with available resources.

Dr. Dinnage added that the ASV has begun the long process of trying to gain recognition for shelter medicine as a boarded specialty.

"There's not any one particular specialty that will fit the bill for us," she said.

This specialty would encompass all kinds of medical challenges, a variety of veterinarians, and an assortment of tactics to reduce dog and cat overpopulation.

The practice

Zoonotic disease provides an example of the challenges of practicing medicine in an animal shelter. Dr. Jim Babbitt of the San Diego Humane Society and SPCA spoke on the subject at the annual conference of the American Humane Association from Sept. 28-30 in Schaumburg, Ill.

Dr. Babbitt started performing spay/neuter procedures for the humane society as a way to ease from private practice into retirement. He found the field of shelter medicine to be so stimulating that he became a full-time employee.

Dr. Babbitt also has revised the AHA manual on zoonoses. He said many shelters do not give zoonoses the attention they deserve.

"Why should we spend the time and money, which always seem to be in short supply in every organization?" Dr. Babbitt asked.

His answer was that zoonoses have rare but serious consequences for people, from illness to death. He said shelters also should consider potential legal implications and the possibility of bad publicity leading to a loss of adopters and donors.

Shelters are at high risk for spreading zoonotic disease from animals to people. Many animals arrive from an uncertain background, with little or no veterinary care, sometimes after roaming and scavenging. Staff, volunteers, and adopters can include susceptible individuals such as pregnant women, the elderly, and children.

"There are some factors that come into play here that we have no control over whatsoever," Dr. Babbitt said. "The good news is that there are many factors that are controllable."

He said shelter veterinarians should teach staff to look for signs of zoonoses, along with other diseases, and explain why euthanasia of animals might be necessary so the staff is willing to report cases. Veterinarians also should emphasize hand washing, making sure the shelter provides easy access to soap and water.

As part of promoting responsible pet ownership, he said, shelters should educate the public about zoonotic diseases—even though they might fear scaring away adopters.

Dr. Babbitt's talk was part of the AHA conference's track on shelter medicine, which the AVMA sponsored this year. The AHA was one of the first organizations to offer veterinary continuing education on shelter medicine. The array of topics this year extended beyond zoonoses to pain management, cat diseases, bird behavior, bird care, stress in shelter cats, and emergency response.

The people

Dr. Martha Smith, director of veterinary medical services at the Animal Rescue League of Boston, was one of the first veterinarians who focused on shelter medicine early in their career. 

"I find it incredibly rewarding to rehabilitate, and re-home, homeless animals," she said. Also, she added, "When hard decisions have to be made, it's a practical matter. It's not breaking an owner's heart."

Dr. Smith said another attraction of shelter medicine is how the field incorporates so many veterinary specialties—even wildlife medicine. The field also offers the challenge of trauma cases, intrigue of cruelty and neglect investigations, and pride of being the voice for an animal in court.

Recently, Dr. Smith developed the shelter medicine program for the Boston Animal Rescue League's new hospital in suburban Pembroke. She also oversees the hospital's mobile low-cost spay/neuter clinic and its community veterinary health center, an outpatient clinic complete with a behavior department.

Some of Dr. Smith's work is seasonal. The shelter is full of kittens in the spring, so veterinarians focus on keeping the population healthy and adoptable. When the shelter population wanes in the winter, the focus shifts to individual animals.

Dr. Smith expressed excitement about the possibility of shelter medicine becoming a specialty.

"It's so much of a different mindset that it deserves its own niche," she said.

Dr. Smith said shelter veterinarians have access to a tremendous amount of information as a group. Those data could be helpful to the entire veterinary profession, too, perhaps in detecting an emerging infectious disease.

Dr. Smith added that being a shelter veterinarian has perks. The hours are good, and veterinarians can practice medicine with the best interest of the animal in mind instead of the notions of a client.

"It's still really important to have good people skills because there is so much client education that goes on with your adopters," Dr. Smith said.

Dr. Smith fears that established veterinarians might not recognize shelter medicine as a high-quality field and that shelter veterinarians might face the assumption they couldn't find a job anywhere else. But she believes having veterinarians on staff at shelters is much more beneficial than having private practitioners donate a few hours every week.

The problem

Individual veterinarians and animal shelters keep trying out new tactics to solve the problem of dog and cat overpopulation and to reduce euthanasia. National groups, in turn, are trying to help coordinate these efforts.

The AHA, for example, launched the national initiative "Getting to Zero" at its 2006 conference. The goal is to end euthanasia at shelters of healthy animals and animals with treatable conditions by replicating the best programs for spay/neuter, adoption, foster care, behavior/training, and transfer of animals to shelters in areas with higher adoption rates.

Spay/neuter programs are a key method for reducing dog and cat overpopulation. The AVMA supports public policy and education to promote spay/neuter procedures, including early-age procedures, alongside programs that teach responsible pet ownership.

Veterinarians vary in their opinion of some approaches to spay/neuter procedures. Trap-neuter-return programs for feral cat colonies have prompted an ongoing debate. High-volume spay/neuter is another approach that is controversial.

Dr. W. Marvin Mackie, owner and director of the Animal Birth Control clinics in the Los Angeles area, has provided high-volume spay/neuter to shelters and pet owners for several decades.

Dr. Mackie said shelters often can't afford a veterinarian, while many pet owners can't or won't pay the going fee for spay/neuter procedures. He charges about 65 percent less than his local counterparts. The going fee is not unreasonable, he said, but it results because most clinics don't engage in "mass production."

Dr. Mackie streamlines surgery and cross-trains his staff. The staff emphasizes to pet owners that spay/neuter procedures are elective. The pets receive a cursory checkup, but the clinic does not attempt to discover other health or husbandry issues.

"Everything is based on efficiency and simplicity and repetition," he said.

Dr. Mackie said high-volume spay/neuter incorporates the concept of herd health. To solve dog and cat overpopulation, he suggested, some veterinarians need to perform spay/neuter procedures in serious numbers rather than offer a full selection of services to each animal.

An argument against high-volume spay/neuter is that veterinarians should attempt to discover other health and husbandry issues. The AVMA does not have a policy on high-volume spay/neuter, but it offers general guidelines for veterinarians participating in spay/neuter clinics. In part, the guidelines read: "Any animal, regardless of its ownership, deserves the best efforts of the licensed veterinarian, and a quality of care equal to that provided by the private sector of the veterinary profession."

The AHA lists a high-volume clinic—Pets ALIVE in Bloomington, Ind.—as an example of a successful spay/neuter program. The list mentions multiple shelter outreach programs that offer free or low-cost spay/neuter to local communities.

While spay/neuter programs are part and parcel of shelter medicine, fixing the dog and cat overpopulation problem is not in the foreseeable future.

So veterinarians who work with shelters in any capacity will be busy as long as dogs, cats, and other companion animals need homes.