Eagle Post: A consideration of the past year in the US

The year 2018 brought turmoil to the US veterinary profession, making it a miniature reflection of the turmoil in the US.

Mergers and acquisitions
Coming off its multibillion-dollar buy in 2017, of the second-largest veterinary hospital chain in North America (Veterinary Clinics of America or VCA), Mars Inc. (yes, the Mars chocolate brand) continued shopping for more practices. In June 2018, it bought the Linnaeus Group in the United Kingdom, adding 87 locations; and AniCura, owner of some 200 hospitals in seven continental European countries. Practice brands that Mars owns in the US are Banfield Pet Hospital, BluePearl and Pet Partners, along with VCA. In the US, as private equity investors fueled consolidators’ searches for lucrative pet hospitals, veterinarians spoke out on how to level a lopsided competitive field. During a meeting of the American Veterinary Medical Association (AVMA) House of Delegates in January 2018, practitioners lamented how large corporations not have only greater buying power but get price breaks as well on expenses such as association dues. Pushing back on the wave of bigger owners, the Independent Veterinary Practice Association was born to advocate for the interests of independent, locally owned practices.
With investor cash pouring into the veterinary-practice sphere, interest in opening more veterinary schools remained high. As the 29th and 30th veterinary schools in the US, Midwestern University in Arizona and Lincoln Memorial University in Tennessee, graduated their inaugural classes, three other universities pursued plans to establish programs of their own. The University of Arizona, refused in an earlier attempt to score provisional accreditation for a new program, persisted, hiring consultants and beginning its quest anew. An AVMA Council on Education (COE) team is scheduled to visit the campus May 12-16. Texas Tech University, which also had encountered setbacks in its plan for a veterinary school, also pushed ahead. It is on the COE’s calendar for a consultative site visit April 14-18.Long Island University Post, a private school in New York State, also applied for COE consideration, was visited by an accreditation team in August 2018 and is expected to learn the outcome in April 2019. It hopes to enroll its first class of students September 2019.

Suicide in veterinarians
Although recognized in Australia and the UK, research by the US Centers for Disease Control and Prevention (CDC) published in January 2019 by Tomasi, et al (www.ncbi.nlm.nih.gov/pubmed/30668293) verified long-held concerns that veterinarians are more likely than the general population to die by suicide. The study found that during 1979 through 2015, veterinarians were two to three-and-a-half times as likely as someone in the general public to end their own lives.
Another troubling sign of the emotional state of veterinary medicine came in answers to a major survey, which found that most veterinarians do not recommend the profession. The survey findings (www.merck-animal-health-usa.com/pdfs/vca/MAH-Well-Being-Study.pdf) were the basis of a study conducted by Brakke Consulting in collaboration with the AVMA and independent researchers. Results were made public in February 2018. Survey respondents were classified in measures of their well-being as flourishing, getting-by or suffering. Among younger male veterinarians, younger female veterinarians, older female veterinarians and older male veterinarians, only one group was flourishing: male veterinarians over the age of 45. While the survey did not ultimately determine the reason for the disparity, there were indications that financial pressures could be part of the problem: Two-thirds of respondents rated high educational debt as an important issue.
Commenting on the survey findings, psychology experts hypothesized that high levels of psychological distress stem from the growing prevalence of large corporate practices, which apparently put a greater emphasis on production; a greater sense of competition in veterinary school for internships and for residencies; and social media, both from the pressure to use it as a practice-promotion tool and from its use as a platform by bullies. On the positive side, the study found the rate of serious psychological distress among veterinarians to be comparable to that in the general population — this contradicted an earlier study that suggested veterinarians experience psychological distress at greater-than-normal rates.

Emerging diseases
Canine influenza, at one time considered a minor illness, gained a more virulent potential as a deadlier second subtype entered and spread around the US and Canada ( www.ncbi.nlm.nih.gov/pubmed/29875234). Subtype, H3N2, was first seen in the US in 2015. Researchers traced the outbreak, in Chicago, to a virus circulating among dogs in South Korea. In 2018 H3N2 entered Canada after a greyhound rescue group based in Detroit unwittingly imported two infected dogs from South Korea. The dogs had foster homes on both sides of the US-Canada border. In the US, H3N2 broke out in 2018 in locations from coast to coast, including the San Francisco Bay Area, New York City, and parts of Minnesota and Nevada. The more benign version of canine influenza, H3N8, which was the first subtype to be identified, appears to have diminished and almost disappeared in the US.
Another disease to attain publicity was the canine heart condition dilated cardiomyopathy (DCM). In dogs it is usually seen in certain genetically predisposed breeds, but veterinary cardiologists noticed the condition in other breeds (www.ncbi.nlm.nih.gov/pubmed/29665072). A characteristic common to many cases was an exclusive diet of grain-free or limited-ingredient kibble containing high levels of legumes or potatoes and/or exotic meat proteins such as kangaroo, alligator or bison. Such formulations have proliferated on pet-store shelves and many US veterinarians consider them to be “fashionable” and not a source of better nutrition.

Another way digital communication promises to change the face of veterinary medicine is through telemedicine. This is the delivery of care remotely, through conventional computers or mobile devices, using audio and video tools. In September 2018, the American Association of Veterinary State Boards (AAVSB) enacted a revised model practice act. It incorporates new guidelines for what is considered the appropriate use of telehealth technologies by veterinarians and their clients. One problematic question that the revision confronted was whether a veterinarian-client-patient relationship (VCPR), a relationship essential to appropriate treatment, can develop remotely. The AAVSB decided yes: the VCPR may sometimes be established online and without a hands-on physical exam. The position conflicts with the position of the AVMA, which maintains that a face-to-face visit is necessary. Because the AAVSB practice act is a model, it is now up to the states to decide whether and how much of the model to adopt. That’s an issue for 2019.


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