The Global Veterinary Ethics Congress
How to Overcome the Overwhelm in Veterinary Medicine
Kate Boatright, VMD
No matter what area of
practice you work or what geographical region, you’re probably experiencing
unprecedented, overwhelming caseloads. Pet ownership in the United States has
grown by over 11 million in the last year. The veterinary workforce—already
suffering from shortages in many areas of both veterinarians and veterinary
nurses, has not.
In small animal medicine, general practices are booking weeks out for both sick and well pets. Referring a patient to a specialist can result in wait times of weeks or even months for an appointment.
Veterinary emergency rooms have become the overflow solution for pet owners. Have an ear infection that your regular vet can’t see for three weeks? Head to the ER. Have a pet who needs to see an internal medicine specialist due to its chronic gastrointestinal disease? Going through the ER should expedite the referral process, right? In the past, these have been viable options for pet owners, but the overflow from GP and specialists on top of the normal ER caseloads has become overwhelming.
Right now, it isn’t uncommon for ERs to have wait times of 8-12 hours or more for stable patients. Many ERs have been forced to cap their caseload and divert clients to other hospitals. Some ERs have reduced their hours or even stopped services completely. These decisions have not been made lightly. They have been made to preserve the best possible patient care and protect the mental, emotional, and physical health of the limited staff.
What can we as veterinary professionals do?
1. Set boundaries to protect yourself and your team.
It's okay to say "no, we can't see you today," but be empathetic. It is a difficult time to have a sick or injured pet and many clients are not used to hearing “no.” Provide them with alternative options for having their pet seen. Use phrases like, “I understand that you are worried about Fluffy, but we cannot provide quality care to any more patients today.”
It's also okay to tell a
client that we won't tolerate their behavior when they become aggressive and
abusive our staff. The stories of outrageous client behavior seem to have
multiplied amidst the pandemic. It’s okay for clients to be upset that they are
being turned away or asked to wait for hours. It’s not okay when they yell,
berate, and threaten our staff and our clinics. Setting firmer boundaries
around what client behavior will be tolerated in our clinics will help to
protect the emotional and mental health of our staff.
2. Improve collaboration between all levels of practice.
We need better collaboration between GP, ER and specialty veterinarians. GPs are often capable of performing preliminary workups or starting treatment of cases until the specialty appointment is available. GP vets can also do initial stabilization of emergencies. If we have the time, we can do the emergency surgery in our hospital and send the patient for post-operative care.
If your hospital lacks some of the necessary equipment, like ultrasound, reach out to surrounding hospitals to assess their expertise. Creating a collaborative approach between practices in our communities will improve patient care for all. There’s more than enough business to go around.
Finally, we in GP must start talking to our local ER and specialty hospitals before sending a client on their way. Is the clinic accepting patients? Is there anything else we should do before the client leaves our hospital? What is the current wait time? What is a rough estimate for the care based on the GP assessment? Knowing the answers to these questions allows GP clinics to take a couple of minutes to prepare the client for the best location to go to, potential wait times, and what the financial burden might be.
This can minimize
frustration for everyone involved. If a client can’t afford the specialty
hospital care, we’ve saved them a trip to the ER and saved the ER staff the
time it would take to triage and assess a patient whose owner cannot pursue
care. If euthanasia is the best option for the pet, most owners would rather
have the procedure performed by a veterinary team they know than strangers in
an emergency hospital.
3. Embrace new technologies.
Hello, telemedicine! While
this isn’t new, its use has accelerated faster than many anticipated.
Telehealth has brought new companies into the veterinary space. The good news
is that there are organizations working to provide guidelines on telehealth
(AAHA and the AVMA published guidelines
earlier in 2021 and the Virtual Veterinary Care Association was founded in 2020) and advocating with the
legislature in many states regarding its use in veterinary medicine. The
landscape of virtual care is in flux. The ethical, legal, and business
implications of virtual care are still being learned, but it is a powerful tool
that can assist us in providing better patient care and moderating our
caseloads as we move forward.
4. Educate clients.
Finally, veterinary professionals can work to educate pet owners on many things that can make the lives of those in the profession better. Share with your clients what our profession is experiencing, both due to the pandemic, and our longer-standing issues of poor mental health, high levels of burnout, and lack of diversity.
Teach clients why preventative care is so important to the health of their pets and how to be proactive when their pet is sick. Let’s try to help keep pets out of the ER, teach clients how some common emergencies can be prevented, and how to recognize a true emergency.
We can also teach clients what to expect at an emergency clinic and what triage means. This can help to assure them that their pet is not being ignored. Waiting to see the vet, especially at an emergency room, is a good thing because it means their pet is stable. Clients must trust that the veterinarians and veterinary nurses who are triaging patients are making their decisions with each pet’s best interest as a priority.
There might not seem to be
time to do all of these things, but we can utilize social media, our teams, our
professional organizations, and our industry partners to help spread this education
to the pet owning public.
It can be a really difficult time to be a veterinary professional right now. We are trying to see as many patients as possible without burning out our staff and veterinarians. We are navigating new technology and workflows.
But in my mind, it’s also an exciting time to be a veterinary professional. We have the opportunity to change the standards in our profession—to create a future that is more positive and sustainable for those who are in the profession today and those who will come after us.
Questions to Dr. Boatright?
Send them to DonDeForge100@gmail.com and they will be forwarded~
DH DeForge, VMD
Chair of the Global Veterinary Ethics Congress