Veterinary clinics adapt to new regular

Veterinary medicine proved largely resilient to the Great Recession. The question now is whether the profession is pandemic-proof.

With around 400,000 novel coronavirus cases confirmed in the U.S. on April 7, the Trump administration announced the establishment of a coronavirus task force, declared a national emergency, and closed U.S. borders with Canada and Mexico while The State Department issued a Level 4 “Do Not Travel” notice recommending that US citizens not travel globally. In the meantime, at least 42 states, in addition to local governments, had responded with various protective measures to change infection behavior, such as closing schools, shopping malls and other businesses that were not considered material.

Veterinary organizations are calling on federal and state legislators to exempt veterinary practices from such measures and to allow the practices to remain open during quarantine. “Veterinary teams provide the necessary animal care, play a vital role in protecting the health of animals entering the food supply, and serve as trusted members of the local community in disaster situations,” AVMA said in a March 17 statement.

Improvise, adapt, overcome

Most jurisdictions recognize veterinary practices as essential and allow them to operate during the COVID-19 outbreak, but it is far from normal.

Many clinics have temporarily suspended elective procedures such as routine teeth cleaning and nail cuts while continuing to perform emergency procedures and some vaccinations. Physical distancing is observed by the roadside pickup so customers don’t have to enter the hospital. Customers who feel sick may be asked to reschedule their pet or have someone else bring the pet in. If this is not possible, other arrangements can be made.

Kathryn Coyne, CEO of Animal Medical Center in New York City, said the most obvious impact of the epidemic in the hospital was a decrease in election appointments and a 50% decrease in patient visits.

“An outdoor heated waiting area in our parking lot separates the general public seeking care from our medical and clinical staff to reduce the risk of virus transmission,” said Coyne. “With a few exceptions, there is no public access to the building, and all conversations with customers … take place over the phone as the animal is allowed to be cared for.

“We have separate hotline numbers, one for customers and one for referring vets, to ask questions and see if they should send an animal to our emergency room,” she added.

This is a time when a small business can really build relationships with its customers by making sure they are communicating clearly.

John Volk, Senior Consultant, Brakke Consulting

Coyne said the Usdan Institute for Animal Health Education at AMC held a live presentation on Facebook on March 18 to answer customer questions about COVID-19, available at facebook.com/theanimalmedicalcenter.

In addition to communicating with officials about the importance of veterinary services, AVMA also helps veterinary practices protect their teams while they continue to provide medical care to patients. AVMA resources contain recommendations for mobile practitioners and inpatient clinics to help ensure the safety of employees and customers, as well as the care of veterinary patients. Veterinary practices that remain open may need to provide records for employees traveling to and from work. While not required in all countries, AVMA has created a customizable template that can be used to issue key employee authorization letters when needed. In addition, the AVMA Board of Directors approved the delay in membership termination to June 1 for all members who are in default of paying dues by April 1.

The Board of Regents of the American College of Veterinary Surgeon issued a notice on March 24th asking veterinarians to use the following decision-making framework in determining the need for surgery:

• Work with local, state, and national health agencies to meet commitments to protecting animal health and welfare, preventing and alleviating animal suffering, and promoting public health.
• Make medical and surgical decisions for a single health and consider the impact of resource consumption on human and animal health at local, national and global levels.
• Surgery should be considered necessary, urgent, or emergency when failure to perform surgery causes irreversible damage. The criteria for determining irreversible harm include: danger to the patient’s life, risk of irreversible damage to the patient’s physical health, risk of permanent dysfunction of an extremity or an organ system, risk of metastasis or progression of the staging, and risk of rapid deterioration life’s severe symptoms.

Relaxation of restrictions on telemedicine

According to Dr. Lori Teller, Clinical Associate Professor of Telemedicine, many veterinarians are eager to adopt telemedicine to continue caring for their patients when they arrive at the clinic at the Texas A&M University College of Veterinary Medicine and Biomedical Sciences.

“Using telemedicine can help veterinarians and clients determine if a pet needs to come in or if the problem can be at least temporarily resolved at home,” said Dr. Teller, who is also a member of the AVMA board of directors. She noted that federal and many state agencies are relaxing the rules in several areas, including requirements related to the veterinarian, client and patient relationship, allowing veterinarians to help patients and clients to the best of their ability.

“It is important for veterinarians to know what their government agencies are saying about telemedicine and to continue to use common sense when collaborating with clients and patients through virtual visits,” said Dr. Plate. “Telemedicine is a practical tool and contains many useful indications for patient care. Use it wisely. “

On March 24, the Food and Drug Administration issued Immediate Implementation Guidelines that temporarily suspend enforcement of certain aspects of federal requirements relating to the veterinarian, client, and patient relationship. These temporary changes relate to the requirements for veterinarians to conduct personal examinations or on-site visits for extra-label drug use and the issuing of animal feed guidelines.

The FDA guidelines recognize that individual state VCPR requirements may be more stringent in some cases, and emphasize that the suspension of federal requirements is a temporary measure during the COVID-19 outbreak.

Communicate, communicate, communicate

One of the inevitable consequences of the COVID-19 pandemic is that, like most businesses, veterinary office revenues will decline regardless of how well they adapt to the new reality. “It will undoubtedly hurt business in the short term,” said John Volk, senior consultant at Brakke Consulting.

One reason is to see fewer patients for safety reasons. The other is recession.

“The coronavirus is bringing the global economy to a standstill and is likely to trigger a recession,” said Volk. “As we saw during the Great Recession, veterinary practices weren’t as vulnerable as some other companies, but it still hurt them financially.”

Volk said the three most important things a veterinary practice can do in this time of crisis, besides protecting employees and customers from infection, are “communicate, communicate, communicate”.

“This is a time when a small business can really build relationships with its customers by making sure they are communicating clearly,” he said, “by telling them whether they are open or not.” When they close, tell people where to take their pets in an emergency. If they only have emergencies, make sure their customers are aware of it. “

If the practice offers home delivery of medication or prescription diets, now is the time to let customers know.

“Of all the times when the practice should inform its customers that it is delivering home medicines and pet food, this is the right time,” said Volk. “This can go a long way in building closer relationships with your customers and letting them know they don’t have to come to the office to get their flea control or whatever. You can have it delivered straight to your home.

“This is a really important service right now.”

It’s important to keep in mind that the recession as a result of the COVID-19 pandemic will be unlike any other in our recent economic history, according to Matthew Salois, PhD, chief economic officer of AVMA.

“This downturn is not about the economic fundamentals – like the 2007/08 property bubble and the 2000/01 dotcom bankruptcy. This downturn is linked to a global natural disaster, ”said Dr. Salois.

He noted that more than 3 million Americans filed for unemployment benefits by the week of March 23, a number that is sure to rise as 40 million jobs are at high risk. “This is an unprecedented number and something that is hard to see outside of war,” noted Dr. Salois.

“Right now, the veterinary profession is grappling with the reality of providing veterinary services in an environment where people don’t get to the practice but still spend on veterinary care,” he continued. “We could soon face a situation where many pet owners are being forced to prioritize food and mortgage payments over veterinary care. AVMA has developed resources to help veterinarians prepare for and respond to such an environment. “