When Can an Employer Influence an Employee’s Healthcare?

When Can an Employer Influence an Employee’s Healthcare?

Kellie G. Olah, CVPM, SPHR

Veterinary Business Advisors, Inc.

Although few if any employees would object if their workplace offered free gym memberships or access to voluntary smoking cessation programs, the situation could be quite different if certain health benchmarks or procedures were made mandatory. 

This therefore raises the question of when an employer can require employees to have a vaccine, for example, or to stop smoking, lose weight, or comply with other health-related actions, including with legal activities that take place outside the workplace.

Here is some guidance on four different topics.

COVID-19 Vaccines

With more than one COVID-19 vaccine on the horizon, the question of whether employers can mandate vaccinations is a hot topic, especially in workplaces that provide health-related services—and, in general, the answer is “yes.” Vaccinations can in fact be required, given that employers appropriately consider any requests for religious and medical accommodations.

More specifically, employers who plan to mandate the vaccine should consider:

  • Religious accommodation requests under Title VII of the Civil Rights Act of 1964: How a “sincerely held religious belief” is defined will depend upon the court; in general, a personal objection to a vaccine—or an ethical one—is not sufficient and, even if such a sincerely held belief is effectively established, an employer can still mandate the vaccination if the lack of one will create an undue hardship for the company.
  • Medical accommodations requests under the American with Disabilities Act (ADA): Employees who work for companies that will require a vaccine and want to obtain a medical accommodation must provide evidence for a disability that’s covered by the ADA. As far as vaccine sensitivity or allergies go, court decisions have been split over whether those qualify.

Although it’s COVID-19 that is bringing this issue to the forefront, the topic of mandatory vaccinations is not new. The same debates that will likely occur have already happened in connection with the flu vaccine, with case law currently existing in places where employees would be providing direct patient case. How court decisions will unfold during the pandemic era—and whether current case law will be upheld for COVID-19—remains to be seen.

If, after examining pros and cons, your practice plans to have a mandatory vaccination requirement, create a carefully written policy so that employees are clear about what’s required, including the process for requesting accommodations or waivers. When vaccination time draws near, be prepared to address any requests for accommodations thoughtfully and consistently, and then carefully document what takes place.

Smoking Cessation

People who smoke are, overall, sick more often, using up more sick days. Because of this, they use their health insurance more often than non-smokers. In general, they often take more breaks at work, usually because they want to smoke a cigarette.

Companies that are concerned about how smoking can affect a worker’s absenteeism rates and productivity during the day may decide to implement a mandatory smoking cessation policy. This policy may, for example, give employees a certain time frame to stop smoking and, to help, the company may decide to cover the costs of a smoking cessation program. Companies that provide health care benefits for employees may be more likely to implement a required cessation policy because employees who smoke are more expensive to cover than non-smokers.

But is that legal?

As far as federal law goes, this issue isn’t addressed. So, to discern whether your practice could implement this kind of policy, look at your state laws—more specifically, looking for any “lifestyle discrimination” or “off-duty conduct” laws. In some states, employers cannot dictate whether or not an employee engages in a legal activity on their own time at a location outside the workplace. In states where these laws don’t exist, your practice may be able to create a policy where employees must stop smoking as a condition of continued employment.

Weight Loss Mandates

Now, what about workplaces that require employees to manage their weight, either because of health or health care concerns, or because it projects the wrong image for a company? Is this possible?

First, weight is not a protected class under federal law, unlike race, age, gender and so forth. So, this means that employers can often legally fire employees who are overweight. Having said that, if an employee’s weight qualifies as a disability, an employer who terminates that employee may be engaging in disability discrimination, according to ADA. Plus, if a company did decide to fire overweight employees—and this disproportionately affected ones of a particular gender or certain race—this may not be legal.

It’s also important to look at state and city law to see what, if any of them, provide relevant anti-discrimination protection for employees. In the case of weight issues, the state of Michigan and a few cities, including Washington D.C. and San Francisco, protect employees from weight-related discrimination. Because new laws are put on the books all the time, check yours before creating any policies that may run contrary to them.

Also consider the Affordable Care Act (ACA) as well as the ADA before requiring employees to be part of weight loss programs. By requiring them to set weight loss goals and weigh in to continue receiving benefits or to avoid work-related discipline, this could be considered illegal under both of these laws.

Next Steps

If your practice is considering the implementation of any of these health-related requirements for employees, it makes sense to consult with your human resources attorney before creating a policy and then to have the attorney check it before it is shared.

Once a policy is approved, ensure that everyone in the workplace receives a copy (it can be wise to have them sign that they’ve received their copy) and set aside a time to discuss the new policy with them and answer any questions.

Also, the Centers for Disease Control and Prevention (CDC) encourages employers to implement workplace health programs and policies to “meet the health and safety needs of all employees.” This can include offering health education workshops, providing employees with access to local gyms, having a tobacco-free workplace, providing healthy snacks, and creating an environment that values health and wellness.

Steps include conducting a workplace health assessment and then planning an appropriate program to meet employee needs. Implement and monitor the program to determine its impact and adjust elements of the program, as needed, for optimal success.

Sidebar: Pregnancy-Related Discrimination

As a related matter, ensure that your workplace policies do not potentially discriminate against pregnant employees. When the Pregnancy Discrimination Act amended Title VII, this effectively provided federal protection for them. This means that an employer cannot have special pregnancy-related procedures when it comes to addressing an employee’s ability or inability to work. If, for example, an employee temporarily can’t perform job duties because of her pregnancy, the employer must respond in the same way that they would for any other temporarily disabled employees.

In other words, if non-pregnant employees who are temporarily disabled can modify their work tasks or take on other tasks, or can take a leave, the same must be made available for employees who need accommodations because of pregnancy.

Plus, pregnant employees must be allowed to continue their job as long as they are able. If an employee needs some time off because of pregnancy-related issues, but is able to return to work, the employer cannot require her to stay off work until after the baby is born or require a certain amount of time off duty after childbirth.

Navigating the Haze of CBD Legalities in Equine Practice

Navigating the Haze of CBD Legalities in Equine Practice

CBD is becoming increasingly popular. However, a veterinarian turned attorney warns equine practitioners to tread cautiously when it comes to discussing CBD products with clients.

Posted by Stacey Oke, DVM, MSc I Jan 12, 2021 I AAEP Convention, AAEP Convention 2020, Horse Care, National & U.S. Legalities, Nutrition, State & Local Legalities, Supplements, Vet and Professional, Welfare and Industry

Are you an equine veterinarian interested in stocking, selling, and/or recommending CBD in your practice? Tread cautiously, Charlotte Lacroix, DVM,JD, a veterinarian turned attorney said during the 2020 American Association of Equine Practitioners’ Convention, held virtually.

In fact, you should check with your malpractice insurance provider as well as your state’s licensing board before even discussing CBD products with your clients, never mind selling or stocking them.

“Six states’ licensing bodies acknowledge that a veterinarian could lose their license if they even discuss CBD, two states said you can have a conversation with your clients but only if they initiate the conversation, and 18 states you may discuss CBD products but you cannot prescribe or dispense them,” said Lacroix.

Why is there such a fuss over hemp, which contains only trace amounts {<0.03%) of THC (the psychoactive ingredient in marijuana) and is decriminalized for human use in several states? Lacroix points out the following:

  • Even though a state may deem CBD legal for human use, it is still illegal at the federal level;
  • The Food and Drug Administration (FDA) does not approve the use of hemp in any form in animals;
  • The FDA has already approved CBD in humans as a A product cannot now be introduced as a nutritional supplement if it is an approved drug;
  • Nutritional supplements must contain one or more dietary ingredients that are naturally occurring nutrients in the horse’s CBD is not naturally found in animals; therefore, CBD cannot by itself be a nutritional supplement;
  • Nutritional supplements cannot have any claims to treat, mitigate, or prevent disease. Otherwise, they would be drugs and would need to be approved by the If you were in a court of law, how would you explain why you were recommending CBD to your client? Most veterinarians would need to acknowledge it’s to treat a specific condition such as pain/lameness/inflammation, anxiety/stress, and stereotypic behaviors, among others; and
  • Little research has been published supporting the use of CBD in Most of the data come from research conducted in small animals.

 

CBD is widely available, and owners already used it prolifically. Is it really illegal for veterinarians then to promote its usage, even if the product was purchased by the owner? The short answer is yes. However, the FDA simply does not have the resources available to stop this activity. It’s like speeding. We all know it’s illegal, but people are willing to push their luck knowing their chances of getting caught are relatively low overall.

Lacroix added that it is not illegal for owners to administer CBD to their own animals, because they are not veterinarians licensed and regulated by the government. It is also not illegal for manufacturers to sell if they do not make a treatment claim.

“In summary, while CBD may ultimately prove to be a wonderful treatment modality, it cannot currently be recommended, sold, or stocked by veterinarians,” concluded Lacroix.

The American Veterinary Medical Association has resources and provides additional information on using CBD in clinical practice. Equine veterinarians are encouraged to review these resources before deciding whether to integrate CBD into their practices.

Read the article online originally posted by The Horse HERE

 

How to Manage Narcissistic Personality Disorder

How to Manage Narcissistic Personality Disorder

Veterinary Business Advisors, Inc.

www.veterinarybusinessadvisors.com

*Principles of this blog are based off the National Business Institute’s course on “Dealing with Narcissistic Personality Disorder in the Legal Practice: Clients, Counsel, and Others”.

Whether a client or a coworker, unhealthy narcissism can derail an otherwise straightforward experience together.

In 2020, there were 7 million American adults who have NPD or narcistic style. People who have this tend to see others as objects for their personal gratification, or as potential threats.  Their world view tends to be win or lose. When those diagnosed with NPD, behavior traits include:

      • Lack of empathy
      • Grandiose sense of self-importance
      • Excessively concerned about their image
      • Dirven to seek attention and admiration
      • Largely superficial relationships
      • Feel entitled to manipulate or exploit others
      • Rarely admit they are wrong
      • Become enraged when they feel disrespected or humiliated
      • Play the victim or martyr

How do you know or feel in the presence of narcissists? You can feel often belittled, under scrutiny or even judged, as if nothing you are doing is good enough, among many other feelings. Unfortunately, narcissists hide behind a façade of fear.

Working with Narcissists & Communicating with Clients with NPD –

The Narcissist’s Code – have you ever had a client or colleague that you sense may exhibit these traits? It’s helpful to know what may be motivating them, especially if it’s not obvious. One of the key points is that image is everything for them.  Next is getting attention – it’s often when they feel listened to or admired – they feel expansive and fueled. If they are not at the center of attention, they can feel depressed, and often aggressive. Honesty is optional for them! Narcissist’s can be great liars as they seek image enhancement, being incredibly convincing in the moment. Next, they tend to believe others are either against them or out to get them.  Narcissists tend to be driven by emotions and impulses. Winning is everything for them. Knowing these traits can allow you to be aware, and even create strategies to respond.

What could this look like with a potential client? Clients could think they know more or better than you as the veterinarian or technician, and will even demean or manipulate other members of your staff.  They expect to be admired and rules are an exception to them.

Key Tip: A practical tip to respond include sharing that their treatment doesn’t feel respectful, which can ultimately interfere with helping them achieve their goals.

DON’T DO
Argue with them Authentically praise their strong points
Try to get them to accept responsibility Educate them on possible consequences, then let them choose
Take what they say personally Recognize that they are like this with everybody
Argue for a win-win approach Focus the narcissist on his/her interests rather than what the opposing party receives
Respond to dramatics or ultimatums Return to the narcissist’s goals and interests
Take the bait when criticized Reassure them that you are on their side, and refocus on the case
Overlook any failures to follow your policies Document, document, document. Make exceptions to your policies sparingly, if at all.

It can often be incredibly mentally and emotionally draining when dealing with someone who exhibits NPD.  It’s important however, to hold onto your voice and set boundaries.  It is not your responsibility to fix them. Dr. Dan Neuharth shares the “11 Things NOT to Do with Narcissists”:

  1. Don’t take them at face value
  2. Don’t over-share personal information
  3. Don’t feel a need to justify your thoughts, feelings or actions
  4. Don’t minimize their dysfunctional behavior
  5. Don’t expect them to take responsibility
  6. Don’t assume they share your values and worldview
  7. Don’t try to beat them at their own game
  8. Don’t take their actions personally
  9. Don’t expect empathy or fairness
  10. Don’t expect them to change
  11. Don’t underestimate the power of narcissism

Many of this can be easier said than done, but try to remember: in most cases, it’s not your responsibility to satisfy their cravings for admiration and praise. We can have compassion for the suffering of narcissists, but it does not mean excusing them for their narcissistic actions. Rather, focusing on the patient or case at hand, focusing on facts and trying a tip or two from the above table.

Compensation Best Practices in 2021

Compensation Best Practices in 2021

Veterinary Business Advisors, Inc.

www.veterinarybusinessadvisors.com

It would be so simple if practice owners could open a fortune cookie for each one of their employees and find the method by which to fairly compensate them.  While there are commonly accepted methods of compensation, their implementation in veterinary practices varies because different entrepreneurs have different business goals.  Also, “fairness” is a relative term that introduces variability into an equation that might otherwise be consistent from practice to practice.  This article describes the factors that practice owners should consider when determining compensation for veterinarians and paraprofessional staff.

Benchmarks

Below is a table that provides a snapshot of current key indicators available for small animal companion practices.  It is not meant to be all-inclusive, but rather to provide some guidelines that enable managers to take the practice’s compensation pulse. They can then determine if the practice is on track for the next year or needs to perform some diagnostics to prevent a fiscal derailment. Veterinary Compensation

Many periodicals and books discuss the factors one should consider in establishing a compensation policy for veterinarians. Of particular importance is the question of whether compensation should consist of a fixed salary, a percentage of the revenue generated by the veterinarian and collected by the practice (i.e., commission-based), or a combination of the two. If a commission-based component is present, it is also important to consider how the revenue figure will be calculated. Will it be limited to revenues generated from professional services, or will it include revenues generated from items like over-the-counter medications and foods?    Percentages can also vary in relation to the magnitude of the revenue number that is generated.  Implementing compensation systems in practice requires attention to the details of production calculation and timing of payment. The key to remember is there is NO one size fits all when determining the appropriate compensation for veterinary and non-veterinary staff.  There are numerous factors that go into assessing the actual method used for compensation, which often requires the assistance of an advisor.

National starting salary information is generally published annually in the Journal of the AVMA. (See: Employment, starting salaries, and educational indebtedness of year-2013 graduates of US veterinary medical colleges, October 1, 2013, Vol. 243, No. 7, Pages 983-987; Employment of male and female graduates of US veterinary medical colleges,  JAVMA October 1, 2011, Vol. 239, No. 7, Pages 953-957.) See also the latest biennial edition of the American Animal Hospital Association’s Compensation and Benefits-An In-Depth Look and the AVMA’s Economic Report on Veterinarians and Veterinary Practices (Wise, J., Center for Information Management, AVMA, Shaumberg, IL (Tel: 847-925-8070). Two periodicals, Veterinary Economics and Veterinary Hospital Management Association Newsletter, also regularly publish helpful articles. In addition, Wutchiett Tumblin and Veterinary Economics published Benchmarks 2019 Well Managed Practices.

Paraprofessional Compensation

Paraprofessionals are often compensated on an hourly basis and the industry has yet to develop widely adopted performance-based compensation models. Paraprofessionals generally report low job satisfaction and high turnover rates. In the 2016 NAVTA Demographic Survey, 38% of veterinary technicians left the practice due to insufficient pay, 20% due to lack of respect from an employer, 20% from burnout and 14% because of the lack of benefits. Full time technicians reported a salary between $15-20 per hour, while part-time technicians reported $14-16 per hour. After taxes, even the well-paid veterinary technicians are only slightly above what is considered the poverty line for a family of four in the United States ($24,300).

According to the United States Bureau of Labor Statistics, the median pay for veterinary technicians was $16.55 per hour in 2018. By comparison, a JAVMA published study on Jan. 1, 2016 of certified veterinary technician specialists reported that the weighted mean pay rate in 2013 was $23.50 per hour.

In AAHA’s 2020 Compensation & Benefits survey, average veterinary employee turnover was 23%.  Turnover was 32.5% for receptionists, 23.4% for veterinary technicians, 10.3% for managers, 16% for associate veterinarians, and 32.9% for all other staff. To compare with the national workforce, Compdata’s Annual Compensation Survey showed that national average turnover was 15.9% in 2010 and 19.3% in 2018.  The chart above can be helpful to calculate a practice’s turnover expenses. Turnover is a pervasive and expensive problem that can be mitigated by learning how to properly motivate employees.

 

The VCPR and Telemedicine

Introduction

Today’s consumers, especially those from—or younger than­—the Millennial generation, want the convenience of fast, easily accessible information and they have the same high expectations when it comes to the delivery of health care. Telemedicine is an innovation that has the potential to meet these needs in both human and animal health care, and COVID-19 has brought this medical delivery format to the forefront. Unfortunately, challenges still exist in the United States, both in telemedicine usage and acceptance, with laws not yet meshing with today’s reality.

The Human-Animal Bond

The human-animal bond can be a mutually beneficial relationship, influenced by several behaviors that are vital to the health and well-being of both the owner and pet. The role of veterinarians is to augment the potential of this connection between people and animals by supporting the health and well-being of the animal. Many pet owners want the best for their companions, with pets often considered to be members of the family. Because of that, there can be feelings of anxiety when it becomes challenging to provide fully for pets’ needs.

Technology Innovations

Fortunately, technological innovations have made caring for pets more convenient and accessible than ever in multiple ways. New trends and innovations that first gained a foothold in other sectors, especially those in human medicine, are continually being modified and updated to meet the wants and desires of the multi-billion-dollar global pet industry.

Recent innovations include the creation of a technological ecosystem in which owners have access to reliable pet services. Great examples include BabelBark, which helps connect owners to veterinarians and other services, and Rover, which helps match up dogs to local dog sitters. There are also litter box monitors that track usage, fitness trackers like PitPat and FitBark, which monitor activity levels, and smart food bowls like Obe ProBowl. Meanwhile, interactive technology like CleverPet’s hackerpet can keep pets engaged while owners are gone to help maintain or improve their cognitive health.

As increasing numbers of innovative smart solutions provide convenient and accessible pet care, it is likely that demand and usage of them will also continue to rise.

Disasters and Pandemics

How, though, will animal care be delivered when disaster strikes? Natural disasters and pandemics, such as the current COVID-19 outbreak, pose a huge hurdle as to how the veterinary profession will continue to practice the golden standard of medicine. Fortunately, all states have declared veterinary practice as an essential business that can remain open during the pandemic. But, like most other businesses, veterinary practices have had to adapt. The American Veterinary Medical Association (AVMA) suggests that practices temporarily defer all elective procedures, such as routine annual wellness visits, spays, and neuters, and to use personal protective equipment (PPE.)

Struggles faced by many veterinary practices during this pandemic include staffing issues, lack of PPE, cancellations of numerous appointments, dips in revenue, not being able to pay their bills and salaries, and more.

So, how can the veterinary industry continue serving their clients and patients with as little interruption as possible during current and future crises? Telemedicine.

What is telemedicine?

The Federation of State Medical Boards defines telemedicine as “the practice of medicine using electronic communications, information technology, or other means between a licensee in one location and a patient in another location, with or without an intervening health care provider.”

In veterinary medicine, a license may include primary care veterinarians, specialists, and subspecialists. The information may be used for diagnosis, therapy, follow-up, and/or education, and may include but is not limited to any of the following: patient medical records, medical images, real-time text communication, live two-way audio and video, output data from medical devices, and sound and video files.

Multiple platforms exist in veterinary medicine, which includes ones that can connect primary care veterinarians to clients and primary care veterinarians to specialists/consultants, and can focus on after-hours tele-triage. These may be enterprise solutions or they could be homegrown. Overall, these different platforms can provide improved care in multiple ways that otherwise may not have been available to the client, patient, and veterinarian.

Expected Benefits of Telemedicine

Veterinary telemedicine allows for improved access and convenience to medical care by enabling a client and patient to remain at a remote site. This is crucial in situations like the COVID-19 pandemic in which clients are not allowed to bring their pets in for routine care. It can also aid in breaching the barrier of access to veterinary care to clients who live in remote area, as well as possibly being a more affordable option for clients who otherwise would not seek veterinary care due to financial constrictions.

Telemedicine can also offer more efficient medical evaluation and management. Often times animals do not act the way they do at home when they are being seen by a doctor or technician. Unfortunately, many animals experience white coat syndrome and can be stressed due to the car ride, being in an unfamiliar place, being with strangers, or having had previous poor experiences at a practice.

There are plenty of instances, for example, where animals have been taken to see a veterinarian because of lameness and, by the time the doctor sees the animal, the limping has gone away. Lab results, as another example, can become skewed due to stress felt by the pet. So, why place a patient in situations that are scary or stressful to them when it can be avoided in certain cases?  Thanks to modern technology, there are better ways to manage and evaluate many patients.

In addition, obtaining the expertise of a distant specialist can now be possible with telemedicine, no matter where the client lives in the country. Specialists are not typically as readily accessible as general practitioners and now many clients can take advantage of their knowledge and skills in a patient’s care.

Potential Risks of Telemedicine

As with all innovations, there will undoubtedly be an increase in malpractice with the use of telemedicine. For example, before ultrasounds or radiographs, a doctor could have easily missed a specific diagnosis and that could have been considered an acceptable norm. However, as technology has improved and become more readily available, veterinarians are held to higher standards and thus the risk of malpractice is higher.

In telemedicine, such potential risks could include how the information being transmitted may not be sufficient (e.g., poor resolution of images) to allow for appropriate medical decision making by the veterinarian(s) and consultant(s). Failures of equipment could happen, which could potentially delay medical evaluation and treatment. A breach of privacy of personal medical information could occur if security protocols fail. Plus, a potential lack of access to complete medical records for whatever reason may result in adverse drug interactions or allergic reactions or other judgment errors.

However, the benefits of convenience, efficiency, and easy access for animal health care can far outweigh the potential risks when it comes to the use of telemedicine. When looking at human telemedical care for comparison purposes, a recent Vivify Health survey showed how 83% of consumers are interested in receiving virtual care. Plus, according to the American Hospital Association, 76% of hospitals connect with patients through telehealth and almost every state Medicaid program has some sort of coverage for telehealth services.

The VCPR

Question: What is holding back the veterinary field from jumping with both feet into telemedicine? Answer: the veterinary-client-patient relationship (VCPR) definition. The AVMA currently defines a valid VCPR as one where the following applies:

  • The licensed veterinarian has assumed the responsibility for making medical judgments regarding the health of the patient(s) and the need for medical therapy and has instructed the client on a course of therapy appropriate to the circumstance.
  • There is sufficient knowledge of the patient(s) by the veterinarian to initiate at least a general or preliminary diagnosis of the medical condition(s) of the patient(s).
  • The client has agreed to follow the licensed veterinarian’s recommendations.
  • The licensed veterinarian is readily available for follow up evaluation or has arranged for:
    • Emergency or urgent care coverage, or
    • Continuing care and treatment has been designated by the veterinarian with the prior relationship to a licensed veterinarian who has access to the patient’s medical records and/or who can provide reasonable and appropriate medical care.
  • The veterinarian provides oversight of treatment.
  • Such a relationship can exist only when the veterinarian has performed a timely physical examination of the patient(s) or is personally acquainted with the keeping and care of the patient(s) by virtue of medically appropriate and timely visits to the operation where the patient(s) is(are) kept, or both.
  • Patient records are maintained.

The AVMA also specifically states in Section 5 and commentary of the AVMA Model Veterinary Practice Act that “a veterinarian-client-patient relationship cannot be established solely by telephonic or other electronic means.” A physical exam is necessary in order to establish a VCPR. The U.S Food and Drug Administration (FDA) supports this definition.  Individual states do have the authority to define these specific terms more clearly within the definition of VCPR and, as of May 2020, every jurisdiction, except Alaska, Connecticut, Delaware, and the District of Columbia, has spelled out their requirements for a VCPR.

On the other hand, the American Association of Veterinary State Boards (AAVSR) does not believe a physical exam is necessary in order to determine VCPR. In their opinion a VCPR is established when “both the Veterinarian and Client agree for the Veterinarian to assume responsibility for making medical judgments regarding the health of the animal, the Veterinarian has sufficient knowledge of the animal(s) to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s), and the Veterinarian has provided the client with information for obtaining timely follow up care.”

Challenges with the VCPR

The federal standards for a VCPR were put into place to define when and how a veterinarian “legally” becomes the veterinarian for a particular animal. However, laws often trail innovation, especially during disastrous events, and the VCPR challenges are an ideal illustration of how laws don’t always dovetail with current realities. A study in MDPI, for example, showed that over 90% of cat and dog owners had visited a veterinarian at some time, but that only about 40% of them visited a veterinarian annually. These pet owners, for whatever reason, choose to not go to the veterinarian, which means their pets’ health care can go unattended. COVID-19, meanwhile, adds to the challenge.

Here’s something else to consider. Because 81% of Americans that own cellphones have smartphones, they have access to internet-based information to learn about their pet’s health, and some people are likely use this information to self-diagnose their animal companions. The most accurate source of information and medical treatment is not available to them, though, since veterinarians cannot engage with treating a client’s pet via electronic tools without having done a physical exam according to the current VCPR definition.

So, even though telemedicine is readily available to use, the definition of the VCPR is acting as a barrier instead of a doorway to veterinary care for many pet owners.

The Doctor-Client Relationship in Human Medicine

As of October 2018, all 50 states allow for a physician to establish a relationship with a new patient via telemedicine, though state laws differ in their specifics. A few states, such as Alabama, include some caveats to that general rule, restricting the setting in which a patient must be located in order to establish the doctor-client relationship.

Prior to that, in 2014, physicians voted to approve the following definition of a doctor-client relationship in telemedicine. The relationship can be established in a number of ways, including:

1) A face-to-face examination—an exam using two-way, real-time audio and visual capabilities, like a videoconference—if a face-to-face encounter would be required for the same service in person

2) A consultation with another physician who has an ongoing relationship with the patient

3) Meeting evidence-based telemedicine practice guidelines developed by major medical specialty societies for establishing a patient-physician relationship

 Once the doctor-client relationship is established, physicians can use telemedicine technologies with their patients at their discretion within their licensed state(s).

Current State of the VCPR Amidst Coved-19

The global pandemic has increased the awareness of the use of telemedicine and its challenges. The FDA and state boards have responded by assessing the VCPR, with the FDR reiterating that the VCPR definition cannot solely be met through telemedicine while also loosening the regulations on extra label drug use in animals. Some state boards, such as in Pennsylvania, have softened their stance on the VCPR, with that state deciding that “during the COVID-19 pandemic, there may be instances when your best medical and professional judgment weighs in favor of establishing a VCPR without an in-person physical examination.”

 Other state boards, like in California, have emphasized the importance of the current law with its requirement of a physical exam to establish a VCPR.

Need for Guidance

As telemedicine becomes more customary in veterinary medicine, the need for revised standards and guidelines is evident. During this process, the veterinary field must work through many of the same types of questions and challenges that the human medicine field has needed to deal with. For the veterinary industry, these may include:

  • What is the definition of a VCPR in light of the use of telemedicine?
  • Will state boards still require a veterinarian to be licensed in the state where the patient resides?
  • Can a state board require informed consent forms before a veterinarian can practice telemedicine—and, if so, what should be in these forms?
  • What medical cases can and cannot be managed via telemedicine?
  • What fees and costs are associated with providing telemedicine services?
  • Who is allowed to provide telemedicine services? Is it just the veterinarians or can other qualified staff provide it?
  • How will the client’s privacy and security be maintained?
  • Will the standards of care for telemedicine be the same as those for in-person examinations and treatments? If not, what differences will exist?

The veterinary field can look towards the American Association of Telehealth (ATA) as well as veterinary groups such as the AAVSB, AVMA’s Telehealth Resource Center, the Veterinary Telemedicine Community Facebook Group, and the newly established Veterinary Virtual Care Association (VVCA) for guidance in helping to answer these questions and establishing standards when it comes to the delivery of veterinary telemedicine.

Telemedicine Becoming a Staple of Pet Health Care

For telemedicine to become a staple of pet health care, each state must hold an open and informed debate amongst the veterinarians that are licensed to practice in that state. The veterinarians need to come to a consensus on the issue of telemedicine and whether a physical exam to establish a VCPR should be mandated by law or left to the professional judgment of the attending veterinarian. Once a general agreement is made, the state associations can reach out to their designated state boards to “lobby the legislature to make the applicable changes. This could be as little as authorizing the use of telemedicine and establishing guidelines for providing telemedicine consultations.”

Tips for Veterinarians

Telemedicine will someday become standard in veterinary medicine. It is no long a question of if, but when. Telemedicine is in fact the hot topic in the industry and is frequently being brought up in forums, along with veterinary news and social media outlets, and is being discussed and debated at conferences. Texas A&M College of Veterinary Medicine has even begun a full-time telemedicine position at their teaching hospital and is pioneering the way of incorporating telemedicine into the veterinary students’ curriculums. Not only are future generations of veterinarians being prepped to make telemedicine a part of their daily practice, but so are pet owners.

As human health care technology advances, so will clients’ expectations when it comes to the care of their pets. There is a change in culture happening. As Millennials and Generation Z consumers have become adults, they have embraced the pet-owning and pet-loving lifestyles to a far greater extent than the previous generation. More and more young adults are putting off having children and are getting pets instead. In the American Pet Product Association National Pet Owners Survey of 2019-2020, Baby Boomers account for 32% of pets owned, while households headed by younger cohorts account for 62% of pet ownership.

Millennials are currently the largest consumer group in the world. One can expect this generation to want the convenience of pet care to be at the tip of their fingers, just as easily accessible as ordering food from Grub Hub, booking a ride with Uber, or buying things in One-Click from Amazon. Veterinary medicine therefore needs to be fast, easily accessible, and readily available.

Since this is the wave of the future, it is best that veterinarians prepare for the changes now. Look at it as practicing preventative medicine instead of reactive medicine. Simply put, adapt, or die.

To summarize the future of telemedicine, Joshua Newman, M.D., chief medical officer, Salesforce Healthcare and Life Sciences, said in a statement that “Patients today are choosing their providers, in part, based on how well they use technology to communicate with them and manage their health. Care providers who build deeper patient relationships through care-from-anywhere options, the use of wearables and better communications post-discharge, will be in a strong position to be successful today and into the future.”