Homeward bound

Dr. Dawn Straily walks into an apartment building in Chicago with a medical bag on her shoulder. She waves to the doorman as she steps into an elevator. "I know a lot of security guards and doormen from doing this job."

Dr. Straily is a house call veterinarian who provides annual examinations, vaccinations, and support for chronic conditions, among other services, to dogs and cats.

House call veterinary practice may not be new to the profession but has been almost exclusively confined to equine and large animal practice. Today, more small animal veterinarians have seen the benefit of providing at-home care, especially as pet owners seek a stress-free environment for their animals, younger pet owners push for personalized, convenient care, and the growing population of older pet owners explores care alternatives because of mobility issues.

"I started it really not knowing what I was getting into; I just thought it would be fun," said Dr. Straily. "It's sort of a weird thing when you do house calls. People don't quite know how to treat you. Are you their veterinarian or their guest? ... It's a vulnerable thing to let someone into your house, and so it tends to be a different dynamic."

Dr. Straily finds that people who seek out home care services are proactive about their pet's health. But when she started out, clients were hard to find.

"I didn't know how to market to them, because most people find their veterinarian (based on location) and I didn't have a location," said Dr. Straily.

Interest in her practice has increased over the years, Dr. Straily said. She points to a few keys to that success: A virtual office location so that her practice is searchable online, the millennial desire for concierge services, and word-of-mouth marketing. Dr. Straily estimates she has about 1,000 clients.

A friend recommended Dr. Straily to Andrew and Megan Lapish. Remy, their 5-month-old Bulldog, has seen Dr. Straily since he was 8 weeks old.

"(She) has seen Remy grow up," said Megan Lapish. "Remy knows them (Dr. Straily and her assistant, Daisy Miranda) and he's not scared of them," adding that they feel Remy receives care that is more comfortable and convenient because it is in their home.

A growing niche

Home-based care potentially benefits cats the most in addition to animals that have had traumatic veterinary experiences and multi-pet households, according to house call veterinarians.

"We find that in a home setting we are able to help a lot of pets that a regular clinic normally can't because we are in a more stress-free situation," said Dr. Jess Trimble, head of health at Fuzzy Pet Health, which provides in-home veterinary services in San Francisco and New York City. "We (try to) remove the stressors, the smell and the sounds of a veterinary clinic. We don't wear a white coat ... we try to wear normal clothing as much as possible, and we find that really helps the pet think that we are just their owner's friends over for a play date."

In addition to its house call veterinarians, Fuzzy provides telemedicine services. Since 2016, the company has provided services to about 10,000 people's pets virtually and in-home. Fuzzy plans to expand to other cities depending on demand.

According to Ali Shahid, co-founder and COO at Vetted Petcare, the veterinary industry could see a surge in spending if more cats receive care through innovative strategies such as house calls.

He estimates that annual spending on veterinary care could be around $20-$24 billion if more cats received care, compared with the $17.07 billion spent on veterinary care in 2017, according to statistics gathered by the American Pet Products Association.

"I like to think of it as we are capturing those lost patients. ... All those pets that otherwise wouldn't be making it into the clinic," said Dr. Sabrina Meldrum, a Vetted Petcare veterinarian based in Los Angeles.

Vetted is a startup offering in-home veterinary care in five cities. The company employs over 30 veterinarians and more than 30 veterinary technicians.

The popularity of in-home veterinary practice could be seeing a rise also because it naturally allows for transparency within the care process, according to Dr. Trimble.

"We have a lot of people that say: 'When I go to the regular veterinarian to have my dog's nails trimmed or his blood drawn, they take him to the back—the elusive back. What is that? What happens back there?'" she said.

For the millennial generation, pets are more like children than animals. And so, upcoming generations are expecting a more in-depth experience.

However, younger pet owners are not the only population benefiting from on-demand concierge services, said Dr. Trimble.

"We (also) appeal to an older generation that has pets but has mobility difficulties and to people that don't own a car. Getting your dog into a Lyft or an Uber can be a complete disaster sometimes."

Is the price right?

Veterinary clinics, hospitals, and veterinarians who perform house calls charge, on average, $138 per visit for routine or preventive care for dogs and $109 for cats, according to the 2017-18 edition of the U.S. Pet Ownership & Demographics Sourcebook published by the AVMA.

When Dr. Straily gets an initial client call, people are expecting the service to be much more expensive. However, the price for an appointment is at the discretion of the veterinarian or company, some of which include a convenience fee in the bill.

"The price should be appropriate," said Dr. John de Jong, AVMA president and a companion animal veterinarian who also does house calls. "(House call veterinarians should) charge more than they would for a brick-and-mortar hospital."

Some startups in the space, including FetchMyVet and Fuzzy, offer a subscription plan.

FetchMyVet, a Florida-based in-home veterinary service provider, has plans based on monthly payments for clients.

We find that in a home setting we are able to help a lot of pets that a regular clinic normally can't because we are in a more stress-free situation. We (try to) remove the stressors, the smell and the sounds of a veterinary clinic. We don't wear a white coat … we try to wear normal clothing as much as possible, and we find that really helps the pet think that we are just their owner's friends over for a play date.

Dr. Jess Trimble, head of health, Fuzzy

Fuzzy uses a membership payment model that covers vaccines, preventive care, and access to a veterinarian and has found that pet owners with fixed incomes appreciate a plan that allows for monthly payments.

"We have been able to help a lot of people that couldn't afford a basic level of care for their pets before," said Dr. Trimble.

Necessary veterinary skills

The upfront costs to start a house call practice are less than those associated with starting a clinic, potentially giving veterinarians an opportunity to become owners earlier in their career.

"(House calls) are a good way for veterinarians to make a decent income without massive overhead," said Dr. de Jong.

On the other hand, although appointment fees may be similar to the prices charged by clinics, house call veterinarians see fewer patients in a day—typically between six and eight.

"Financially, it is cheaper, but it's harder to recoup the money because you have (fewer) appointments," said Dr. Straily.

House call appointments also tend to last longer. Appointments within a clinic may take about 25 minutes, but a house call appointment can be around 30 minutes to an hour.

"Seeing a pet in its home environment is incredibly useful in managing disease and maintaining wellness. You might notice environmental factors that could influence the pet's health," said Dr. Carin A. Smith, president of Smith Veterinary Consulting and author of several books including "House Call: The House Call Veterinarian's Manual."

Individuals interested in house call work should have some clinical experience, according to working house call veterinarians.

The ideal candidate would have solid clinical skills, be comfortable handling different animal personalities, and have a sense of adventure, said Dr. Jeremy Gransky, partner and consultant at MVS Pet Care, a house call veterinary practice. Dr. Gransky also owns a veterinary house call practice in suburban Boston.

"Every day is different, and you really never know what you are walking into. I love that aspect of it. After working in a windowless exam room for so many years, I really love being out on the road," he said. But "there is some physicality to this style of practice that may be more rigorous than a hospital setting. The environment is a little less controlled—think about someone's whole house versus an exam room."

MVS Pet Care operates on a franchise model in 31 territories across several states. The company has plans to go nationwide.

There are also outside factors and challenges to consider when taking on this kind of work, such as managing time properly between appointments, handling unexpected weather conditions, dealing with traffic, finding parking, and figuring out where to go to the bathroom.

One of the bigger challenges, said Dr. Straily, is navigating people's homes. "People have varying degrees of clutter, furniture, and space. So that's hard sometimes," she said.

The technology behind the care

Some startups have brought their technology into the house call sector, including software for back-office duties and mobile apps.

"We took the medical expertise of our veterinarians and our expertise in building software and technology," said Ali Shahid of Vetted Petcare. "We have a lot of software that we built to ensure that our veterinarians are safe, and we know where they are at any given point in time. We built our own medical records software because we didn't like (what was) available in the market, so ours was built by us and it works really well for a house call practice."

Vetted also uses a call center with emergency veterinarians who can triage animals and instruct owners on whether they should take their pet to an emergency clinic.

While the business models behind these companies vary, MVS Petcare is possibly the only veterinary house call company working on a franchise model.

The franchise fee per territory, which includes about 200,000 households, is $25,000, plus $15,000-$20,000 in startup costs, and a weekly royalty fee of 9 percent, said CEO of MVS Pet Care, Todd Giatrellis.

He adds that with this setup, veterinarians have the ability to be their own boss and just have to work a minimum of 20 hours per week. "We want to make it so veterinarians (have) a great quality of life, much less stress," Giatrellis said.

MVS Pet Care handles all the phone calls, scheduling, and marketing for the franchisees.

Brick-and-mortar is still alive and well

House call veterinarians may be able to handle a lot inside a home, but some things just can't be done on a kitchen table, said Tarek El Gammel, president of FetchMyVet.

And, in fact, many house call veterinarians partner with clinics to use their space or to send clients to in case such services are required, such as surgeries, X-rays, and specialty cases.

"We work hand in hand with brick-and-mortar practices. I have been doing house calls exclusively for almost 14 years, and there really is a nice back and forth there. I think as there becomes more of an awareness that house call practice is an option, it will continue to build, but it is never going to replace a brick-and-mortar hospital entirely," said Gransky.

Advice for starting a house call practice

Dr. John de Jong, AVMA president and past president of the American Association of Housecall Veterinarians, has the following advice for veterinarians considering starting their own house call practice:

• Start small; don't buy too much equipment, just what's needed.
• Build a relationship with a brick-and-mortar practice that can be used for procedures that can't be done at home.
• Get the word out to local media and use social media to market your services.
• Keep track of mileage and vehicle expenses, which can be written off as business expenses on your taxes.
• Think about offering in-home euthanasia.
• Find a place to dispose of sharps appropriately.
• Train the owner, if there isn't a veterinary technician, to restrain the animal, if necessary for things such as blood sample collection. Make sure that proper animal restraint methods are used.