Charlotte Lacroix, DVM, JD
Veterinary Business Advisors, Inc.
Introduction
Imagine that you take your dog to the park after your daytime job, and a dog fight leaves the participants bloodied and limping. Your GP veterinarian cannot see your dog until late afternoon the next day, so you are left wondering whether or not to take the dog to the ER or wait a day until your GP is available. You elect to go to the ER where you encounter an overflowing waiting room and a twelve-hour wait. Ultimately, your pet is admitted and assessed, revealing that the injuries are superficial and no other damage, aside from some bruising, has occurred. While this is great news for your pet, you are left with a $2,000 bill and no sleep after a stressful night spent in the ER waiting room. Or, imagine that you rush to the GP veterinary hospital after you noticed your Shih Tzu’s stomach ballooning . The GP diagnoses a large obstruction in the esophagus. This is a life-threatening condition if not treated promptly. Unfortunately, the hospital does not have the equipment or the procedural expertise to remove the blockage themselves. You desperately call all the local ERs and even the local veterinary college to no avail; no one has room to see the dog that day or night. At one point, the GP even recommends humane euthanasia. You end up driving two hours to an ER in a different state that, fortunately, has room to see your dog, and the obstruction is removed. Your pet successfully recovers, and you are left with a $5,000 bill, no sleep, and a long drive home.
The sad truth is that scenarios such as these are not uncommon in today’s veterinary world and, while it is understandably distressing and frustrating for clients trying to do what is right for their pets’ health, it is also burning a hole within the veterinary community. From the patient’s perspective, they are not receiving timely care and that affects the prognoses. From the client’s perspective, they feel powerless and frustrated as their animal suffers, resulting in anger. From the veterinarian and staff perspective, they are overwhelmed, feel as if they’re failing to uphold the standard of care, and suffer from burnout, compassion fatigue, and depression.
Today’s Veterinary Crisis: An Overview
Over the last several years, the demand for veterinary services has increased at a far faster rate than the supply of veterinarians and staff. In one study by Animal Health Economics LLC conducted in 2021, they anticipate a 33 percent increase in demand for veterinary services by 2030 . If that increase holds true and the current vet/staff production rate remains consistent, here’s the situation: a shortage of 15,000 veterinarians and 130,000 certified veterinary technicians (CVTs) and nurses in 2030 to meet that demand . This will impact all parties: pets, clients, veterinarians, staff, and investors. Simply put, the demand is outpacing the supply and adds insult to injury in an already fragile ecosystem that has been struggling with efficiency issues, burnout, and turnover with a lack of sufficient access to healthcare in recent years. There has been much speculation from both the public and the professional veterinary community as to why there has been a decrease in available services, so let’s break down a couple myths and dive into a few of the general theories that experts have regarding the profession.
The first myth: the COVID pandemic sparked a massive increase in pet adoptions and ownership, leading in part to the supply and demand crisis . While it is true that pet ownership and spending are on the rise, it is not necessarily a result of the pandemic. A higher percentage of animals in shelters were adopted in 2020; however, the total number of animals adopted was actually less than each of the previous four years due to the smaller pool of animals available for adoption at shelters. There was not an unprecedented rise in new pets showing up to clinics.
The second myth: adding more veterinarians and CVTs is the simple solution to solve the staffing shortage2,3. Not so fast. While increasing the number of professionals and staff will certainly enhance the industry’s ability to handle increased client demands, it does more to address the symptoms of the industry than the underlying problems. On top of being a Band-aid solution, it is not a solution that can be applied quickly. MARS Veterinary Health estimates that, by the year 2030, an additional 41,000 veterinarians will be needed to meet the needs of companion animal health care. At the current rate of new graduates per year, that will leave the industry at 15,000 veterinarians short by 2030. The demand versus expected supply for credentialed veterinary technicians is even more sobering as the total expected supply of CVTs over the next thirty years will not be enough to meet the expected ten-year demand.
The third myth: added busyness has led to more stress in veterinary practices. Since 2019, the number of appointments booked per month has increased from 913 to 1,012 in 20214. While busyness in the clinic certainly plays a part in creating stress, this is encouraging and healthy growth and cannot be the sole perpetrator of chronic stress. So, what is going on? First, the amounts and types of services that clients are requesting have changed with clients requesting more services—and more high-quality ones—than in years past. Theories as to this change have not been proven, and there is ongoing work exploring this trend, but it is hypothesized that, during the pandemic, owners paid more attention to their pets and therefore would bring their pets to see the veterinarian more often , . Additionally, some owners may have had more disposable income due to decreased weekly spending and receiving government stimulation checks of which their pets were the benefactors of. There is also a growing theme of owners treating pets like members of their human families where they are more willing to spend on pet healthcare. For veterinarians, this is a welcome trend and further empowers practices to provide the highest standards of care possible.
However, once the pandemic began slowing down, clinics were facing a new problem: a backlog of wellness appointments4. The backlog was created during the height of the pandemic as many clinics pushed back wellness visits and prioritized sick appointments only or closed their doors altogether. With a population of clients more likely to bring their pets to the vet and another population of clients looking to make up their overdue wellness visits, clinics found themselves with booked-out schedules for months. Not only does this cause frustration among clients with sick patients looking for availability, but it also causes frustration in ERs now seeing non-life-threatening sick cases that, by definition, do not need to be seen by an emergency veterinarian.
Compounding this new issue of overbooked clinics are staff shortages4, . Veterinarians and their staff have traditionally had higher turnover rates (16 percent for vets, 26 percent for CVTs) than other medical professionals, but the pandemic hastened many employees’ departures for a variety of reasons such as stress, illness, taking care of loved ones, and early retirement. It is theorized that, as a result, teams grew smaller and thus productivity and efficiency fell within the clinic. Clinics seeing four patients per hour dropped to three patients per hour after the pandemic, contributing to the backlog and increased pressure on clinics with an ever-growing list of waiting patients. Statistically, efficiency (patients seen per week) has dropped by 25 percent while demand has increased 5 percent. This means that a clinic whose max capacity is one hundred patients a week is now being asked to see 105 patients (5 percent increase) while their capacity has dropped to 78 patients (25 percent decrease). It is important to note that the increased demand for additional veterinary services may have contributed to this drop in efficiency as well.
Ultimately, this has led to a vicious cycle of unmanageable demand for services, expedited burnout and stress, and professional turnover. Rinse and repeat. It is a brief summary of what has led the industry and public to acknowledge that there is a real problem within the veterinary community that needs to be addressed. With that being said, what has been summarized is far from all the issues plaguing the industry. Low pay, student debt, work life balance, and more all play roles in the cycle that leads to mental fatigue and turnover; and, on that same beat, there are many potential solutions that can limit the effects of select issues.
One glaring issue previously mentioned needs to be explored in more detail—meaning, the backlog of patients waiting to be seen by their local general practitioner (GP). Some, not all, GPs will find ways to fit emergent sick patients into a day stocked full of wellness and pre-scheduled sick appointments. For those clients not lucky enough to have a nearby clinic willing to see them, it leaves them looking for care elsewhere and, at an increasing rate, this has led them into the ER. Like GPs, ER veterinarians are also feeling the heat with overcrowded wait rooms and reduced staff . In fact, ER veterinarians experience burnout and turnover at an even higher rate. The difference between the backlog in ERs and that of GPs is that not every single patient waiting in the ER truly needs to be seen by an ER specialist as ERs have seen an increased number of patients with non-emergency medical ailments . Many patients in the latter category, given the opportunity, would best be seen and treated by their GP. This exposes a gap and an opportunity in the industry for an intermediary service between the GP and the ER. These facilities would have the potential to streamline care for non-life-threatening issues and create breathing room for all parties involved. Enter the urgent care center.
Urgent Care Centers: On the Spectrum of Care
Urgent care centers as defined by Ethos are “. . . for pet owners with a pet in a non-life-threatening condition, seeking urgent medical attention” . There are many similarities and differences between a true ER hospital, a GP, and an urgent care facility, ranging from the services provided, the hours of operations, the cases treated, and the types of staffing required. To find out where the urgent care lies on the spectrum of care, let’s start by summarizing the structure and purposes of its two “competitors”: the ER and the GP.
Emergency vet clinics operate first and foremost to triage, stabilize, and treat pets that are in life-threatening condition or pets that, without immediate care, may enter a life-threatening condition. Similar to human emergency centers, patients in the most critical condition are prioritized and seen by a doctor immediately while those that do not need immediate lifesaving care are placed on “hold” until the next doctor is available. Patients of the latter category are briefly assessed to ensure they are stable enough to wait. Reasons to visit a veterinary ER include but are not limited to serious trauma (i.e., hit by car), penetrating wounds, heat stroke, cardiac failure, sudden collapse/inability to use limbs, foreign body ingestion, unproductive retching/bloating, prolonged straining or inability to urinate or defecate, snake bite, toxin ingestion, unproductive labor, and respiratory distress (i.e., choking, difficulty breathing) . With a wide variety of emergent cases presenting every day, facilities must be prepared in every facet to offer 24/7 care as some pets require overnight or multiple day stays while others may be discharged sooner. This also depends upon the number and type of staff ERs employ.
Veterinarians who specialize in emergency and critical care (ECC) train for an additional four to five years after graduating from their primary veterinary education to earn a board certification in ECC and primarily work in ERs. Additionally, some ERs employ the services of other veterinary specialists such as board-certified surgeons, anesthesiologists, neurologists, cardiologists, internists, and radiologists. The immediate availability of these specialists depends on the location and structure of the ER as ERs may employ some, none, or all of the aforementioned. That being said, there are many veterinarians who do not pursue an advanced degree and work in ERs under the guidance of ECC specialists, honing their skills and becoming more independent with time. Together, they may make up the team of doctors who provide diagnoses, treatment, and prognoses to owners and their pets.
Appropriate, advanced equipment is necessary in any ER, including but not limited to advanced surgical instruments and machines, MRI, ultrasound, patient monitoring equipment, constant rate infusions (CRI), a variety of pharmaceutical and emergency drugs, and in-house blood analyzers. Working in tandem with doctors are the ever-important support staff members, including CVTs, veterinary assistants, and customer service representatives (CSRs). CVTs in ERs are typically more experienced with some pursuing advanced certification in areas such as ECC, internal medicine, and anesthesia/analgesia. An advanced degree is rarely required of CVTs in other lines of work but is extremely beneficial for the ER team as they can be trusted with more responsibility to treat and triage animals. Like nurses in human medicine, their limitation is that they cannot diagnose, perform surgery, or prescribe treatment for any patient—all of which must be performed or approved by a veterinarian. The CSRs, while not charged with any interaction with the patient, play an important role in the initial triage. Frequently, owners will call prior to coming in and typically ask whether or not their pet needs to be seen at an ER. CSRs’ ability to appropriately divert non-emergent cases and handle the brunt of client communication allows the medical staff to focus their attention on active cases in the ER. Altogether, staff or teams of doctors/CVTs/CSRs/assistants must be present and ready 24/7. Between the immediate and 24/7 access to care, advanced training, cutting-edge equipment and diagnostics, and the number of staff required to operate, the cost of an ER visit can balloon quickly. Initial entry and workup may range anywhere from $100-$600, and the final bill may exceed $10,000, depending on the length of stay and treatment required . This has created some frustration among clients and professionals claiming that money has created a barrier to care, leaving some pets and owners with few options.
The general practice, on the other hand, functions to create a lifelong relationship with the client and patient, care from puppyhood to old age. Once regarded as the “do-it-all,” times have shifted the GP towards a focus on wellness and preventative medicine while still offering other ancillary services for patients such as mass removals, spays and neuters, cytology, dental cleanings and extractions, prescription medications and diets, basic illness workups, endocrine disease screening, and management of chronic diseases that are not currently life threatening. Reasons for clients to bring a sick patient to the GP include but are not limited to coughing without distress, vomiting/diarrhea within twenty-four hours and no behavior changes, itchy ears and/or skin, mild limping, hot spots, and scooting. Equipment between GPs varies, but generally they lack advanced instrumentation and diagnostics that are available to specialists and ERs. This is not always the case, however, as some GPs offer advanced care in the event that the veterinarians are trained and there is enough demand for specific services to warrant purchasing expensive equipment. In the event that the patient is beyond the scope of care of the GP veterinarian, whether it be because of lack of training, equipment, staff, or time, the patients are either referred to a specialty center or an ER. Unlike the ER model, these GP facilities are never 24/7 and typically close between 5:30 p.m. and 8 p.m. As a result, GPs typically will not keep patients overnight unless the pet is healthy or is specifically boarding (a service offered by some GPs). GPs are staffed by veterinarians without advanced training although this does not bar entry to specialists wishing to leave their specialty to work in a GP setting. Similar to ERs, GPs will employ CVTs, veterinary assistants, kennel staff, and CSRs. CVTs rarely have advanced training and are usually outnumbered by the number of unlicensed veterinary assistants.
CSRs play a crucial role in triaging patients over the phone, answering client questions, filling the veterinarians’ schedule, and preventing overbooking. The cost of care at GPs is relatively cheap but is on the rise. On average, household annual expenditure on veterinary visits in 2020 was $224 and $362 in 2022 (note: these numbers do not account for inflation and the increase is much flatter when accounted for)5. The main complaint regarding GPs is the decreased accessibility for same day, even same week, services, causing a diversion of patients typically treated by GPs to either the ER or to a specialist. GPs are increasingly scheduling client wellness visits up to one year in advance to increase compliance and decrease last minute scheduling. One downfall of this is that GPs will turn away clients, even established clients, if the schedule is already booked to its capacity. Walk-ins are discouraged because it disrupts the flow of the hospital, leading to the diversion of patients to other facilities.
In an ideal world, healthy and non-life-threatening sick patients are treated by their GP and referred to a specialist or ER when necessary—at which point the patient receives timely care at the specialty hospital. However, this is not always the case as pointed out in the introductory stories. Timely care, whether necessary or not, is not guaranteed let alone the assurance that the pet will be admitted into an ER. Amidst the previously described veterinary crises that are contributing to this growing concern among veterinarians and clients, a new business opportunity has emerged to relieve some of the capacity pressures that GPs and ERs are facing. That model is urgent care, a type of clinic instituted first by human medicine and now being adopted by veterinarians. The purpose of urgent care is to provide same day care for urgent non-life-threatening conditions10. Reasons to bring a patient to an urgent care center include but are not limited to mild to serious wounds and cuts (i.e., dog fight), trouble walking, obvious limping, vomiting/diarrhea with change in behavior, difficulty urinating or defecating, persistent blood in urine/stool, prolonged low appetite and weight loss, allergic reactions, tick-borne disease, and ocular redness/squinting/discharge. Unlike an ER, an urgent care center will not perform surgeries that enter the body cavity and rarely will have all the advanced equipment that an ER possesses. Additionally, the urgent care is not open 24/7 like an ER; rather it is open six to seven days a week, closing between 8 p.m. and 12 a.m. Facilities are not structured ins a way to accept patients overnight as they prefer to refer patients requiring such services to an ER where they may receive 24/7 care.
With that being said, there are certainly opportunities for urgent care centers to expand their services as they please because there is no formal definition of what an urgent care can and cannot offer. Urgent care centers may benefit from the oversight of an ECC veterinarian or internist, but it is not required, and many primary veterinarians will switch over to urgent care from GPs or ERs. Similar to both ERs and GPs, they employ CVTs, assistants, and CSRs. CVTs may feel especially empowered in urgent care as their technical skills will be frequently called upon to assist in treating patients for various conditions. CSRs, like in ERs, play a very important role in triaging over the phone and communicating with clients looking to be seen, and CSRs can help to determine if a patient needs to see their GP, the urgent care, or the ER. These centers have already shown to attract a swath of patients, especially when located near an urban hub, and waiting rooms can quickly become overrun with waiting patients. The cost of entry is not nearly as high as an ER and allows access to clients of virtually all socioeconomic statuses. Note: this is not a solution that will solve all the industry’s problems, though, and it likely will encounter its own kinks and bumps in the road as the model becomes more commonplace.
Benefits of the Urgent Care Center
There are many theoretical benefits when considering urgent care centers. First and foremost, the patient benefits from increased access to same day care. As veterinarians, providing timely and high-quality care to relieve discomfort is one of the main priorities. Pets should not needlessly suffer if this can be helped, so UCCs can provide quicker access to care when compared to overbooked GPs and flooded ERs. Additionally, faster diagnoses and treatment generally correlates with improved prognosis for the patient.
The client benefits, as well, as a UCC is designed to be the Amazon Prime of veterinary services. In today’s society where same day services are a click away, clients will appreciate the speedy nature of a UCC, principally through the instant gratification felt when their pets’ ailments are promptly treated . On top of same day care, the client will pay a fraction of the cost for an ER visit. This may lessen client stress, increase client satisfaction, and lower the barrier of entry for urgent healthcare needs .
Hospitals within a certain geographic region naturally operate within the same network, regardless of ownership. UCCs have the potential to incorporate themselves into this network and divert appropriate cases away from ERs and handle cases the booked-out GPs are unable to see. This allows the ERs to focus on critical cases as their model is intended for and the GPs to comfortably divert sick appointments beyond their scope of care or scheduling to the UCC. As inappropriate or overwhelming caseloads of these hospitals decrease, respective employee burnout should be reduced, and respective hospital efficiencies should improve as a result of improved staff morale.
Veterinary professionals and their support staff should see a wide range of benefits from the implementation of UCCs. In a UCC, the veterinarian is able to feel the thrill of an ER with sick cases requiring immediate care while avoiding the critical, life-threatening cases and long overnight hours of the ER. These veterinarians may feel more engaged with their job, perhaps because of the instant gratification one feels when solving a problem and then discharging the patient out the door in the same day . These same concepts also apply to nurses and CVTs . Because only 30 percent of the available skillsets of nurses and CVTs are being utilized by practices, there is a massive opportunity to improve their engagement at work3. UCCs offer growth opportunities and empower nurses to take more responsibility. Of course, diligent supervision and task delegation by the attending veterinarian is required for this opportunity to be realized. When employees are challenged at an optimal level, their performance peaks and improves overall efficiency.
By empowering nurses, veterinarians are more fully leveraging their skills whiles delegating more responsibilities. Generally speaking, nurses are legally allowed to perform a variety of minor procedures under the supervision of the veterinarian; however, each state has its own overarching laws for what nurses can and cannot do, so it is important for veterinarians and managers to understand the legal limits of delegation. This increase in delegation opens the door for seeing more cases and treating them more efficiently.
With increased nurse responsibility comes increased compensation. While higher pay does not directly impact the day-to-day burnout, it certainly can play a part in increasing retention if it stands out from competitors’ wages. When it comes to the veterinarian’s compensation, it is tentatively assumed that compensation will be more than the average general practitioner, but it is also acknowledged that some GPs may actually outperform urgent care vets, depending on the types of services offered at the GP.
The UCC model not only appeals to veterinarians and nurses alike, but it also draws the attention of private equity and investment9,14,. Billions of dollars in private equity have flooded our industry, and one of their targets has been the expansion of UCCs. The assumption is that these UCCs can be very profitable. In comparison to GP and ER models, UCCs have potential to lower total wage costs (more nurses vs. vets) and equipment costs/leases (minimal surgery and advanced in-house diagnostics) as well as minimize wasted inventory. UCCs are structured to tackle a specific range of cases and more predictable services should mean more predictable inventory. Lastly, these UCCs may continue to grow. As profitability becomes more apparent, more and more investors will likely want to have skin in the game.
Opening an Urgent Care
There are multiple variables to consider when building or opening a UCC: locations, hours, doctor and support staff, team dynamics, equipment, physical layout and flow, wages, technology utilization, marketing, and education. The single most important factor to consider, though, is whether or not there is a need in the geographic region . If the goal is to provide quick care and alleviate caseload backups at ERs and GPs, then the community also needs to fit both criteria to accomplish those goals. For example, a small rural town over an hour from an urban center probably will not have much of a need for urgent care. In comparison to a small rural town, a bustling suburb outside an urban center will likely have high caseloads such that the UCC fills a niche within the community. In short, if there is not an identifiable problem surrounding timely veterinary care and there is easy access to urgent/emergency care, then it’s less likely that a UCC will be successful. A full market analysis is also warranted to gauge the competitors in the area as well as identify client populations that are likely to visit the UCC. Consider the community pet ownership levels, how far clients are willing to travel, how many ERs are in the area, and what locations are heavily trafficked.
The hours of the UCC should reflect times when there is a gap in available care, chiefly after GPs close on weekdays and weekends17. However, there are no standard hours that a UCC needs to be open. The hours should also represent the level of staffing available lest your UCC finds itself understaffed with unrealistic hours to fill. Consider whether or not the UCC will be an ancillary service to a larger ER/specialty hospital or GP and whether or not that will affect the hours it is open.
We have mentioned staffing and the crisis the veterinary industry faces because of shortages, which is why it is important to set expectations for how a UCC will be staffed. First, determine the types of employees required in a UCC. While CSRs play an incredibly important role as the first line of contact, consider other ways that this role can be filled. Traditional CSRs sit at the front desk answering phones, checking out clients, and managing the schedule. However, other systems of triage and client interaction are available, such as employing a third-party call center service or integrating an artificial intelligence (AI) chat into the call system and/or website. Nurses, as alluded to before, play a huge role in practice efficiency. In a perfect world, the most efficient practice would have a 4:1 nurse to Doctor of Veterinary Medicine (DVM) ratio3; however, that ratio is virtually impossible to achieve today given the current employee market. A 3:1 ratio is more feasible, but a 2:1 ratio is currently the industry average.
Regarding the DVM portion of that ratio, there are options as to what types of DVMs would staff these urgent care centers. There are no prerequisites required to work in an UCC let alone an ER; with that being said, it may behoove the owner to hire a DVM with emergency, internal medicine, or critical care experience. These DVMs can grow into and fill leadership roles such as mentoring DVMs who lack experience in urgent or emergency care or acting as the UCC supervisor/MD. The latter DVMs are then provided with support and a second opinion from someone who likely has seen and treated many of the expected UCC cases, bolstering their confidence and ability to advance their own skillsets. As for the number of DVMs, it will be important to run a market analysis to determine what the expected caseload may be. Consider how you are going to attract these employees and what unique benefits (monetary, educational, culture, shares, and so forth) you will offer to recruit and retain them. Despite UCCs filling a role in the community, the number of staff members will likely continue to be an issue, so creating creative benefits, attractive pay, and an engaging work environment will be paramount to compete in an ultra-competitive employee market.
Staff can be divided into teams, and a systematic approach to the formation, task delegation, and workflow of these teams would benefit the efficiency of the practice. There is no perfect formula to create the most efficient and well-oiled team; however, there are general concepts to utilize. Creating set responsibilities for team members (i.e., tasks techs should perform vs. a doctor), involving effective, closed-loop communication, and creating a systematic approach to patient triage, treatment, and discharge can help a UCC be most effective and reduce stress among staff. What’s unique about the UCC is the increased predictability of the type of cases admitted, which can aid in streamlining team roles for such cases and increasing the confidence in delegation. Delegating tasks between team members is chiefly the responsibility of the supervising DVM and can also be enforced by the lead technician. How the patient enters, is treated, and leaves the hospital is also up to the preference of the practice. On one hand, patients can traditionally be seen by a doctor and their team from start to finish. On the other hand, you could implement an alternate model where the patient is triaged by one team and then transferred to another, depending on the type of case. Furthermore, cases can be divided between teams based on individual members’ strengths, which may enhance job satisfaction and efficiency. The point is that there is room for creativity and innovation with the team, and that is exciting because the UCC may also be a breeding ground for solutions otherwise not tested in other hospital models.
Somewhat correlated with the staffing and the ways teams interact with patients is the physical layout and equipment of the hospital. Traditionally, patients enter the hospital and are placed in a waiting lobby that, with high case demand, often becomes crowded. That sort of environment is less than ideal for anxious owners and pets let alone those that have behavior flags such as dog aggression. One idea to consider is the elimination of the waiting room or a downsizing of its capacity. The goal would be to have clients sign up and wait in an online queue that alerts the client when they are ready, or almost ready, to be seen. That decreases the stress of both the patient and client by removing them from a stressful environment.
Additionally, it would help set owner expectations of how long they will wait since they will be able to see how many pets are in front of them in the queue. The treatment area has traditionally been off limits or with limited access to clients, but even that standard can be questioned. Consider whether or not your clinic would opt for an open floor model where the client is able to stay with their pet or watch from a side bench throughout their stay. Perhaps your UCC would like to stay traditional and separate clients from the treatment area; will there be separate areas for cat/dog treatments? It’s important to have an idea of how the patient will physically travel in the hospital as this will affect your decision making.
When it comes to services offered, plan to include or exclude common accommodations. For example, if the UCC does not plan to offer surgeries, there is no need to purchase advanced surgical equipment and reserve a room for sterile procedures (a traditional operating room). Speaking more on the equipment side of things, consider that many of the cases being seen would benefit from in-house diagnostics. These include but are not limited to fecals, bloodwork machines, SNAP tests, +/- anesthesia and scopes, wound repair packs, cytology supplies, radiology, point-of-care ultrasound, and cages for patients. Lastly, advanced and intelligent technologies should be considered to bolster efficiency and reduce tasks on employees. These can include AI chat bots, intrahospital communication platforms, telemedicine, and more. At the very least, the goal should be to use technologies that automate redundant tasks that do not require critical thinking.
Client education can often be overlooked when it comes to managing the flow of patients. Empowering clients to understand when something is life-threatening, urgent, or non-urgent is important, though, so that the right patients end up at the door versus a patient that can be seen at GP or ER. The best way to engage with the community is likely through a variety of social media to reach different age groups and demographics. These can include links to an easy to navigate website that offers education modules for topics such as dog bites, at-home triaging, pain scores, respiratory distress, true emergencies, and so forth. Many owners lack what is basic knowledge for many industry professionals, so even the smallest advancement in client education can help steer them in the right direction. It also provides a trusted alternative to Dr. Google, which can miseducate clients if they are not careful.
Anticipated Challenges
Despite the lauded benefits and opportunities that UCCs offer, they are not immune to the challenges that our industry faces, and unique problems will likely arise as the model becomes more popular. The alluded to benefits may in fact become fictitious promises if some of these challenges are not addressed appropriately.
The CSR is on the frontline of initial client contact and will hear a familiar question everyday: Should I bring my pet in? Their ability to triage and gather information from the client will have an impact on the number and type of cases the UCC sees; therefore providing training and education for CSRs is recommended. The training program should focus on creating easy to follow decision trees so that CSRs are able to efficiently characterize the presenting complaint. For example, if a client calls regarding a dog fight, the CSR will have a list of questions to ask for that specific complaint, including follow-up questions or a call to action following the client’s response. In addition, the CSRs should be trained to help the client conduct a basic vitals exam over the phone as well as shadow or cross train in the treatment area. By experiencing multiple roles in the hospitals, CSRs will better understand patient flow, treatment, triage, and case management in ways that a training manual cannot replicate. The goal is that this translates to more effective and accurate communication with clients when they inevitably have questions regarding their complaint. Without proper training, the UCC runs the risk of misinforming clients, providing inaccurate information, and failing to fully utilize the CSR position.
Though UCCs hold potential to alleviate pressure from GPs and ERs, the UCCs may very well experience some of their same problems: low staffing, overcrowded wait rooms, and burnout. UCCs will be drawing from the same pool of employees as the GPs and ERs and, while the job may be more appealing versus other models, the staffing shortage will likely be felt regardless. Expanding UCCs does not necessarily add more employees to the pool although it may attract newcomers to the industry. As to what extent UCCs will experience shortage remains to be seen. Just like in ERs and GPs, it will be important to utilize the staff’s full skillset and delegate tasks appropriately. Never sacrifice the standards of care when it comes to task delegation even if there is a hint that inappropriate use of the nurses would increase profit or total patients seen. This the responsibility of the supervising veterinarian to reasonably allow or not allow nurses to do certain procedures or tasks. Collecting data on the types of appointments, their frequency, and their length can also aid in maintaining an efficient practice.
Other challenges that UCCs will share with ERs and GPs are the difficulties of creating, promoting, and maintaining a positive culture with effective leadership. No matter the other issues and variables surrounding a practice, the presence of clear leadership roles or lack thereof can be the difference between a successful practice and a struggling one. Staff should have opportunities to take on leadership roles in a variety of areas such as CSR lead, treatment lead, standards lead, and so forth. This can boost engagement and the opportunities for increased compensation and education.
Lastly, the most important challenge to address is characterizing the geographic need for a UCC. This can be done with a market analysis; however, using solid data and having sound interpretation of the data can be a hurdle for some potential UCC owners, one that is crucial to appropriately navigate because fully ensuring that there is a community need and a business opportunity will play a large role in the success and preservation of the UCC in that region.
Conclusion
In conclusion, the veterinary industry is ripe for a new model of care that can provide a more immediate solution to the veterinary industry crisis. It cannot fix the staffing shortage, but it can help to improve the lives of those working in the industry and the patients they see. There are open opportunities in many communities across the country where these models can be implemented to divvy the patient caseload more appropriately and ultimately increase the efficiency and quality of patient care. The staffing shortage and its sequalae will continue to cause problems within the industry, but one variable that is under our immediate control is employee retention. The UCC has the potential to provide engaging levels of work, leadership, reasonable hours, and career growth. It does not come without its own challenges, including ones shared by ERs and GPs and others more specific to the UCC. Defining the need in the community can be challenging, as well, but the increasing availability of reliable data and analysis may make it possible to identify the perfect area to start a UCC.
References
1. Segall, Bob. “Wait Times Soar, Patients Turned Away at Indiana Veterinary Hospitals.” WTHR, WTHR 13 News, 2021, www.wthr.com/article/news/investigations/13-investigates/wait-times-soar-patients-turned-away-at-indiana-veterinary-hospitals-diversion-emergency-dog-cat-vet/531-9ab4cf74-05d1-4f28-8e2e-30a97671f1b5. Accessed 28 Feb. 2023.
2. Lloyd, James W. “Pet Healthcare in the US: Are There Enough Veterinarians?” Animal Health Economics, LLC, 14 Apr. 2021.
3. Lloyd, James W. “Pet Healthcare in the US: Are There Enough Veterinary Nurses/Technicians? Is There Adequate Training Capacity?” Animal Health Economics, LLC, 23 Aug. 2021
4. Salois, Matthew, and Gail Golab. “Are We in a Veterinary Workforce Crisis?” American Veterinary Medical Association, 15 Sept. 2021, www.avma.org/javma-news/2021-09-15/are-we-veterinary-workforce-crisis. Accessed 28 Feb. 2023
5. Nolan, Scott R. “Pet Ownership Rate Stabilizes as Spending Increases.” American Veterinary Medical Association, 26 Oct. 2022, www.avma.org/news/pet-ownership-rate-stabilizes-spending-increases
6. Burns, Katie. “New Report Takes a Deep Dive into Pet Ownership.” American Veterinary Medical Association, 20 June 2022, www.avma.org/news/new-report-takes-deep-dive-pet-ownership. Accessed 28 Feb. 2023
7. Bain, Bridgette, et al. Economic State of the Veterinary Profession. AVMA, Oct. 2022.
8. Zhang, Sarah. “The Great Veterinary Shortage.” The Atlantic, 6 July 2022, www.theatlantic.com/health/archive/2022/07/not-enough-veterinarians-animals/661497/. Accessed 25 Feb. 2023
9. Larkin, Malinda. “VCA Launches Urgent Care Hospitals.” American Veterinary Medical Association, 21 Sept. 2022, www.avma.org/news/vca-launches-urgent-care-hospitals. Accessed 28 Feb. 2023.
10. “Veterinary Urgent Care vs. ER.” Veterinary Urgent Care by Ethos, ETHOS, www.urgentpetdoc.com/animal-urgent-care-vs-er/. Accessed 28 Feb. 2023
11. Lee, Justine A. “When to Bring Your Dog to the ER.” Pet Health Network, IDEXX, 5 Aug. 2014, www.pethealthnetwork.com/dog-health/dog-diseases-conditions-a-z/when-bring-your-dog-er. Accessed 28 Feb. 2023
12. Ferrer, Andrea A. “How Much Is an Emergency Vet Visit?” Money, 22 July 2022, money.com/how-much-is-an-emergency-vet-visit/. Accessed 28 Feb. 2023
13. Lester, Bob. “Tear down the Wall.” Today’s Veterinary Business, 3 Feb. 2022, todaysveterinarybusiness.com/veterinary-care-models/. Accessed 28 Feb. 2023
14. Verdon, Joan. “Urgent Care for Pets: Bond Vet Launching Northeast Expansion.” Forbes, 14 Feb. 2022, www.forbes.com/sites/joanverdon/2022/02/14/urgent-care-for-pets-bond-vet-launching-northeast-expansion/?sh=f4a98f74ca16. Accessed 28 Feb. 2023
15. Horvath, Jeff (MBA, SHRM-SCP). “3 Veterinary Careers That Offer Balance between Professional Growth and Personal Life.” DVM 360, 13 May 2022, www.dvm360.com/view/3-veterinary-careers-that-offer-balance-between-professional-growth-and-personal-life. Accessed 28 Feb. 2023.
16. “How Empowering Veterinary Technicians Supports Practice Success.” American Veterinary Medical Association, 2023, www.avma.org/resources-tools/how-empowering-veterinary-technicians-supports-practice-success. Accessed 1 Mar. 2023.
17. “Expanding Your Veterinary Practice: Opening an Urgent Care Center.” Blog.ffb1.com, First Financial Bank, 15 Sept. 2021, blog.ffb1.com/expanding-your-veterinary-practice-opening-an-urgent-care-center/. Accessed 28 Feb. 2023
