The great veterinary shortage

[fledermaus]

There were essentially two large animal vets when I moved out here five years ago and both of them were over retirement age. One, who also had a small animal clinic, tried to transition his practice over to a couple who were both vets. The horse community (small but very talkative) rated them “pretty bad”, but when they published the news that our well-beloved Doc had retired, on their website – which he had NOT – the equine patronage dried up overnight. They no longer have a large animal practice.

The other guy had better luck. He had already hired two young female vets to work with him, who eventually co-owned the practice with him. He hired another young man out of vet school (the horse people thought he was a dick, but the small stock people liked him as he had a special interest in sheep and goats). But one of the women is pregnant with her second child and the other has three young children, their hours are now curtailed. Young guy met a girl and is relocating to be with her. They are hiring two new grads this summer but based on my experience with Young Guy, whom I had to show how to bandage a hock so it would stay bandaged (I learned this from Tufts), it takes a while to get up to speed.

Meanwhile they are months backlogged on routine care appointments. I love those vets, one of them found me on a back road when my horse fell out of her trailer (this is how I spent time at Tufts) and did her utmost to save my girl (who is fine now, just has a lot of “blemishes”). I hope to God they hire some good people, because right now they are the only game in a five town radius.

[cutter99]

These are the programs both @Montanas_Girl and I were referring to. The horse program is approximately twice the cost of the beef program.

https://utbeef.tennessee.edu/tennessee-master-beef-producer-program/

Tennessee Master Horse Program | UT Horse

[candyappy]

@Texarkana

But what do you do when there is no DMV to call? I mean that as an honest question. A lot of people live like that and many more will be joining the unfortunate lot.

For many large animal( all livestock) owners in certain places, the only answer is have a gun at the ready and be prepared to use it correctly ( and hope you never have to).

It seems that in the age we live in this shouldn’t be an issue but its is and on a very wide scale throughout the US. In some places there are no vets for people to access or even get their animals to by trailer .

I can’t imagine what that would be like and hope I never do.

[foggybok]

@Ghazzu

Please do not equate rectal exam in cattle with the same procedure in horses. Cattle are far more tolerant, medically speaking, than are horses of iatrogenic trauma to the rectal mucosa.
One of the leading causes of malpractice claims against equine DVMs is rectal tears.

While I don’t think it is an “unattainable skill” to be able to diagnose intestinal displacements via rectal palpation, it does require a fair amount of practice, and there are enough other clinical findings that would lead one to the conclusion that surgery or euthanasia is likely to be the humane choice: lack of gut sounds, abdominal distension, persistently elevated heart rate even with analgesics on board, poor perfusion as evidenced by mucous membrane color/refill, profuse sweating, rolling, etc.

As a trained professional who has not done a rectal exam in years, I wouldn’t do one right now. I did recently had a colic at my farm, it was a 32 year old Arab. He gave us plenty of information that his colic was surgical without doing a rectal. I did call out another vet as it was a client animal, not mine, and he did a rectal, but it didn’t add any information.

So yeah, I second not having lay people do rectals on horses. I remember my surgery professor in vet school saying it wasn’t a matter if if, it was when you would have a rectal tear. So I always avoided unless it was really needed. Of course it can give great info on colics, so that is one indication, but often rectal findings are ambiguous too.

Back in my internship a guy brought in a cow that was having issues. He had done his own rectal exam. When I stuck my arm in it literally fell into a giant void. He had blasted a hole so big there was nothing left. Poor girl, she didn’t have a chance.

[foggybok]

@frugalannie

The need for veterinarians is clear, and and even greater need is looming on the horizon. Given the importance of animals in the food industry, what if the government paid x amount towards training in the vet professions. It could negotiate with the vet schools for a fair, fixed rate. If students took on a part of the burden (but not all) they’d have skin in the game. The government tuition would be considered a loan, to be forgiven after so many years in practice in order to discourage dilettantes and those who start vet school and then transfer elsewhere.

There are programs for vets who want to go into rural practice. They have loan forgiveness programs and such. Still, it is very difficult to get people out into these positions and to keep them there when they go

[foggybok]

@Texarkana

As an owner and someone on the fringes, something I feel very frustrated about is how you, the vets, are bearing the brunt of this disaster while it seems like “everyone else” who is a player (legislators, pharmaceutical/industry folks who impact expenses, also education institutions to a lesser degree) throws their hands up and goes “aw shucks there is nothing we can do,” or “well we tried that and it didn’t work so we give up.”

Some of the schools are trying, for example they just opened a new school in west Texas. This is supposedly to increase the supply of rural veterinarians in the area. The problem is this doesn’t address the issue these folks are facing. In rural areas, it is very difficult for vets to make a living. The people can’t afford to pay for the appropriate skill levels, so the vets are either underpaid, overworked or both. Putting more vets out there in the same conditions is NOT going to help.

The idea of paraprofessional is not bad, but as Ghazzu stated, it’s going to be hard to get these people too since apparently, they would make less than a vet, which in those areas is very little.

I don’t have the answer, but it is a big problem and growing daily.

Around the country vets are leaving equine practice at an alarming rate. It’s going to be tough going…

[Rackonteur]

@frugalannie

Given the importance of animals in the food industry, what if the government paid x amount towards training in the vet professions.

Could this be the real reason we keep being told to stop drinking dairy milk and eating meat?

Your idea sounds sensible to me. It’s too bad the schools couldn’t agree on how to put it into practice.

[kmwines01]

I haven’t read all the comments but there is a federal loan repayment program for working in rural areas. Like most things federal government it is a convoluted program to get into and only applied to certain areas. So you still have to have someone who wants to work in highly rural areas.

[kmwines01]

It’s a really hard situation. I’m part of some large scale vet discussion groups and the struggle is real across the board. There are a lot of vets who do not recommend entering the profession to their children because of the abuse perpetuated by clients. We are not alone as vets, as a society, we’ve seemed to have lost our filters over the past 2 years. But the constant being screamed at, online bullied, and distrusted are ridiculous and extremely wearing. I don’t think vets are the only professionals being subjected to thus, just that we’re small enough that the exodus of people tired of dealing with it has been felt.
I left equine med after a very intense internship. The pay for equine just didn’t make up for the job requirements. $55,000 to be on call and work 6 days a week? Or small animal at 75,000 for 4 days a week with no emergency on call? It’s pretty demoralizing to realize the horse you’re working on was purchased for more than your yearly salary and yet that person is complaining to you about the cost to suture a laceration. The
When I was in school, it was the opposite situation. It was thought they were churning out too many vets and we weren’t going to be able to have jobs. This was coming out of the big recession in the late 2000s. The potential recession looming will make things interesting moving forward.

[Anne]

The dramatic rise in corporatization of the profession is having terrible consequences. Mars and VCA are the same company. They also own Antech (reference lab and diagnostic imaging) and what used to be PetPartnersUSA. They also own the BluePearl chain of specialty hospitals. In my region, BluePearl took 3 stable 24 hour emergency and specialty hospitals and has driven all 3 of them into the ground in less than 10 years. The older-ish specialists who were owners took the money and ran when BluePearl bought them, the ER doctors left when we were taken off production (for me this was a $50,000 a year pay cut, and they wanted us to work 3 more shifts each month in addition to this pay cut) and even the massive BluePearl marketing machine has been unable to recruit young veterinarians to the ER lifestyle. The loss or dramatic decrease in ER hours and specialist availability in this community now means that the other ERs and specialty hospitals in the area are overrun with cases, increasing wait times and dramatically reducing the quality of care.

I do small animal ER/CC because I like not knowing what will walk through the door. I explain it to people by saying I’m a dog trauma surgeon. These days I’m doing more and more primary care and care for chronic ongoing conditions, because people tell me their primary care vet can’t get them in for 3 weeks or a month or more. That’s never happened to me on this widespread level in 15 years of doing this.

It is currently nearly impossible for a single doctor to buy a practice. The corporations will offer up to 5x value. This is even true for equine practices, as NVA has entered the corporate market there.

There are no good answers, and I understand why our profession is in crisis and so many of my colleagues are suicidal. Creating an additional level of paraprofessional is not the answer IMO. Empowering LVT/CVT/RVT and speciality level technicians might be, but this is a long process.

[Kyrabee]

@Anne

These days I’m doing more and more primary care and care for chronic ongoing conditions, because people tell me their primary care vet can’t get them in for 3 weeks or a month or more. That’s never happened to me on this widespread level in 15 years of doing this.

I had this happen to me. My cat was having periodic respiratory distress (at least it started out that way). Now I would call that at least urgent. I got an appointment from her regular vet (have been a client for 16 yrs) SIX WEEKS out. They did call and change it to 4 weeks and said oh, if she gets worse take her to the ER. At the time, other vets I checked with were not taking new clients (Nov ‘21). Needless to say, she didn’t make it that long. She got tachypneic with a RR about 60 and ended up at the ER. I had no choice other than the ER and of course it was a Saturday. She got passed to internal medicine on Monday. About $5k later I brought her home. She was euthanized 3 weeks later as she just did not respond to treatment. The differentials were asthma (treated for same with steroids and inhalers) and cancer. Her bronchial tree was full of something and did not improve over 10 days of treatment (didn’t get worse either). I am reasonably sure that the outcome was probably going to be the same if she had been seen promptly by her regular vet but treatment could have been tried much sooner and also euthanized sooner if no improvement. I do not know why vets cannot leave slots for more urgent but not emergency cases? I think it comes back to that corporate thing. This practice was bought out by one. It is just super frustrating for an owner when you can’t do anything to help them and you know even a small issue is going to cost $1000 to +++++$$ to take them to the ER.

I know the vets are super frustrated too and leaving the profession. They see far too little of my $$ when they treat. Way back in the dark ages (late 70’s), I thought about going to vet school to become an equine vet. I worked with a vet a few times one summer and changed my mind to pharmacy and have had my horses for a very enjoyable hobby (and able to afford them).

Susan

[GoodTimes]

I’ve got a couple thoughts on this.

I’m in Canada, so the tuition here is a fraction of what it is in the US. But the reality is that vets just don’t make enough money. Most students are told that if they should go into human medicine or healthcare instead. There are techs and nurses out there making more money than the average vet, often with a better work life balance.

Second, there just aren’t enough spots for the ones who still want to be a vet. It’s incredibly competitive. Every vet you talk to has anxiety about the shortage that isn’t getting better. The population is growing, more people are owning animals. Yet the schools are accepting the same number of students.

I really think there should be some sort of fast track program, or specialty programs available to fill some of those gaps. I’ve looked into going back for DVM, but it’s been more than 10 years since I finished my undergrad, I would have to start all over. The US may be different because of the tuition costs, but I could see people in Canada being interested in going back to school for the equine veterinary equivalent of a nurse practitioner or physician’s assistant. Have a heavier emphasis on practical knowledge during admissions and during the program you weed out the people who can’t make it through the didactic portions. I’m sure you would have vet techs, nurses, ultrasound, etc looking for a second career. Limit the species and/or scope of practice so that you can shorten the program. Nurse practitioners have filled huge gaps in the Canadian healthcare system, we need something like that in veterinary medicine.
The vet that services the area where my parents farm is mentioned something similar a few years ago. She tried bringing on a second vet but there wasn’t enough work for both of them. She has never had a vet tech because she has never felt the benefit would be worth the expense since they can’t do much without her. But she said that she would love to have someone “inbetween”. Someone who she could send out for vaccinations or wound care, or diagnostics, or sutures while she did paperwork and emergencies. Instead she’s on her own. When she takes vacation my mom would have to trailer to a clinic 1.5hrs away for any emergency or to get prescription meds.

Similarly, create bridging programs between human technical programs and veterinary medicine. It has always seemed silly to me that you’ve got vets running around doing all of this diagnostic imaging (ultrasound in particular) when you could have a qualified tech doing the imaging and a vet can read them later in a fraction of the time. That frees up the vet for emergencies, etc.

[lenapesadie]

I too wanted to be a vet as a kid. I worked for a vet one year. That was enough. I still use that vet practice though! I reckon it must be a decent place to work as far as vet clinics go. They’ve retained a lot of staff for decades; from kennel cleaners to receptionists to techs. But being a vet wasn’t for me.

I’m happy with my office job and pet horses. Though I wish I’d worked with vet enough to learn how to do IV now

[clanter]

@Kyrabee

you know even a small issue is going to cost $1000 to +++++$$ to take them to the ER.

pretty sure around here it is $3000.00 to walk in the door at a small animal ER

[kmwines01]

Unfortunately we are leaving spots open every day for those urgent cases. They tend to get filled up depending on the practice. I’m at a corporate practice (have been since 2015). I typically see 20-28 patients a day with 5-6 of those being dentals/spays/sx. On my most busy days I’ve seen 30+. Typically will fit in 3-4 same day urgent care appointments.

[Incantation]

We just had one of our dogs at the ER over the weekend. Some dumb dumb (raises hand), made it possible for her to lick her surgical site (TPLO) just long enough to set up an infection. DH took her to an ER Fri night. I called before they left to make sure they could see her.

The vet wanted to pull the staples, revision the site, and re-suture, but they got slammed because their sister clinic was over capacity, and rerouting to them, so DH was sent home with antibiotics and instructions to go to another ER the next day, (that site is closed Sat due to staff shortages).

Sat DH took her to Angell Boston, as Angell West had no capacity. I was told the wait would be at least 2 hours. It was 3, then almost another hour inside, waiting on the surgery consult, after the initial exam. Thankfully, when the surgeon took a look at her, he decided that re-visioning would be very bad - risk of bone infection. DH was instructed to finish the antibiotic, and they did a culture with sensitivity. The weekend cost under $400 for both visits.

The antibiotics worked, she has one dose left and had her staples removed today, but the vet shortage is very real. I used to be able to go to the ER with less urgent matters that my mobile vet couldn’t see right away, but not anymore.

[shiloh]

ER prices in Central Coast area of CA start at $150 for just walking in the door and prices go up from there depending on what they do for you. But for sure you aren’t getting out the door for less than $150.

[BatCoach]

Like most of us animal-obsessed folks, I dreamed of being a vet when I was a child. In high school, I was lucky enough to work at a local small-animal vet that was biking distance in my neighborhood. I was basically a kennel cleaner, light office work and general extra hand, and I loved learning from the Dr’s when they let me watch a procedure. The reason I ultimately did not pursue vet medicine when I went to college is I was TERRIBLE at chemistry. I loved biology and was not squeamish, but I was so untalented at math & chem that I knew there was no way I would make it through organic chemistry at vet school. I have so much respect for people who can make it through a program.

Many years later, with my liberal arts degree firmly in-hand (haha) and a few years in the workforce. a well-known and respected equine practice was looking for a front office worker / back-up tech. I thought it was the perfect marriage of my work skills and my life’s passion. I did 2 successful ride alongs, but ultimately had to decline when I learned how low the pay range was. There was no way I could pay my rent and student loans on that salary, much less save for a horse.

It was eye-opening how underpaid these hardworking professionals are.

[ladybugsbw]

@BatCoach I could have written your post. Word for word. Even trying to go into the field recently. I would love to work for my office and have been offered a few opportunities, but I simply cannot afford to. I know they are paying the best they can, but when I am a teacher and say it isn’t enough, you know it’s bad.
I just keep telling my vets thank you and how much I appreciate them every chance I get. I know they are sacrificing a lot, and I really can’t tell them enough how thankful I am. Sadly not all of their clients even treat them like people.

[sparkygrace]

The shortage of vets send lots of animals to the local ER. It happened to us a few times. Those ER trips for our dogs have cost thousands. One visit was $4,000 and they missed an easy diagnosis. It’s really frustrating.

Friends of mine started a small animal practice about eight years ago. The business model was high-volume with reasonable prices. It was wildly successful. Part of the set-up allowed employees to invest in the practice. When they just sold the practice for millions to one of the big corporations a few of the techs got almost a million each as their share of the sale. Of course, the new owners raised prices.

I am lucky to live in an area with no shortage of large animal/equine vets. One practice has added a number of vets over the last few years.