Saturday, May. 25, 2024

Part 2: New Approaches To Emergency Coverage

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This is Part 2 of “Equine Practitioners Are Becoming An Endangered Species,” an exclusive in-depth look at the current state of the equine veterinary industry that originally appeared in the May 8 & 15, 2023, edition of the Chronicle. Read Part 1 and Part 3 here.

The biggest burden to practitioners, and the biggest hurdle to having a life outside of work, is emergency coverage. In small animal medicine, the phones get turned off at the end of the workday and over the weekend, with a recording directing pet owners to call the local emergency clinic in a crisis. The veterinarian your dog or cat sees annually for its vaccinations isn’t the person you call when the pet needs to be seen urgently at 3 a.m.

“Emergency coverage, I think, is cited along with compensation as pretty high on the list of things that are driving people away from joining the profession,” said Michael Erskine, DVM, DABVP, director of the Virginia-Maryland College of Veterinary Medicine’s Marion duPont Scott Equine Medical Center in Leesburg,Virginia. He’s also co-chair of the American Association of Equine Practitioners Commission on Equine Veterinary Sustainability’s subcommittee on emergency coverage.

“To me, compensation and emergency coverage are the two big-ticket items that need to be addressed, and they’re somewhat related. [And with] emergency coverage also comes hours worked,” Erskine said. “So I think that compensation lagging a bit, hours worked being higher, and then the disruptions to work-life balance and family life [that come with] after-hours on-call responsibilities, as well as the disruptions that occur during the day with emergencies—you are scheduled to be finished by 5, but because of a daytime emergency, it’s 7 or 7:30. And so that is a challenge.”

The biggest burden to practitioners, and the biggest hurdle to having a life outside of work, is emergency coverage. Frank Sorge For arnd.nl Photo 

The 13-member subcommittee is currently in the data collection phase, Erskine said, conducting surveys and speaking to an extensive network of colleagues to get a sense of the challenges that emergency coverage presents to different practices and in different regions of the country.

“That’s probably the first big recognition, is that the challenges vary from practice to practice and region to region,” Erskine said. “A small one- or two-person practice has a different set of challenges than a larger, multi-person practice. And a rural practice might have a whole other set of challenges than a more heavily concentrated horse population practice.”

The subcommittee identified a number of different models that are being tried, Erskine said, from practices joining forces and forming emergency co-ops, which increases the number of veterinarians on emergency rotation, to emergency-exclusive practices.

Even the Equine Medical Center is experimenting. They’ve just started an emergency service, Erskine said.

“We’ve just begun that this year, to sort of decouple the emergency responsibilities from an elective scheduled appointments and procedures schedule. So if you’re on call, then you wouldn’t also be seeing regular appointments,” he said. “I think that will benefit the practitioners from the standpoint of having them commit to the on-call without also being committed to scheduled appointments that can be disrupted during the day for daytime emergencies, or work all day, be on call all night, work the next day, just that sort of fatigue that that causes.”

Jessica Martin, DVM, is an associate veterinarian at Mountain Pointe Equine Veterinary Services in Long Valley, New Jersey, and a member of the emergency coverage subcommittee, where she shares insights about her practice’s experience withan emergency co-op.

In a co-op, practices join forces and share emergency coverage duties across a particular area so that each individual veterinarian spends less time on call. Mountain Pointe Equine formed a co-op with B.W. Furlong & Associates in January 2022, and each practice’s veterinarians rotate through evening and weekend emergency coverage.

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“Compensation and emergency coverage are the two big-ticket items that need to be addressed, and they’re somewhat related.”

Dr. Michael Erskine

Prior to forming the co-op, Martin and her boss, practice owner and founder Michael Fugaro, VMD, DACVS, split the on-call duties 50-50. “I was on call every Tuesday, Thursday, and then every other weekend, which would be Friday night through Monday morning,” Martin said. “That doesn’t necessarily mean that you’re always working; you may not get a call one day, or you might get five calls, it’s hard to say. But it does dictate how you live your life because you have to kind of be ready in any event that there is something going on.”

Now Martin is generally on call two weekends per quarter and one weeknight per week.

“So it’s substantially improved quality of life, just because now those nights that you’re not on call, you can let your guard down a little bit; you don’t have to always be ready,” Martin said. “We have a relatively small practice compared to some other practices in the area. But it was definitely demanding to be on call 50% of your life, and I think anybody can kind of agree with that.”

Clients still call the same number they’ve always called for an emergency, but the vet who responds might be from the other practice. The responding practice takes payment at the time of service, and if it’s not the client’s primary practice, records are transferred the next business day to their routine veterinarian, who resumes care.

Martin said they worked hard to prepare their clients for the change.

“We’re a relatively small practice, and we have a lot of clients that we’re very close with, and we were a little bit worried that they were going to be upset that they weren’t going to get one of ‘their’ veterinarians, so to speak,” Martin said. “And that’s very much a concern, because when there is an emergency, that’s when the clients are the most stressed out.

“We kind of talked to them very honestly about the statistics in the equine field and that we’re losing equine practitioners faster than we are gaining them,” she added. “And we asked them what their opinion was on the formation of the co-op and how it would work and what their concerns would be.”

She said most of the clients were supportive. “They really wanted us to also have a quality of life. I mean, I have my own horse I compete on, and that’s very important to me outside of being an equine vet,” she said. “And a lot of those people understand that, and they can really relate to it. So it went better than we thought.”

Other practices are trying to eliminate on-call responsibilities altogether.

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“I think there are veterinarians that are very interested in emergency medicine, and so to find opportunities for them, so that the emergencies are being managed by people who that is their interest and passion, that’s emerging as an opportunity,” Erskine said.

North Carolina State University’s College of Veterinary Medicine is about to try that model, bringing on two new veterinarians to staff an after-hours ambulatory emergency service.

Callie Fogle, DVM, DACVS, is a clinical professor of equine surgery at NC State and assistant head of the department of clinical sciences. She’d read an article about an emergency service launched by James Beckman, DVM, who owns Gas Light Equine Veterinary Practice in Prospect, Kentucky, along with his wife, Kerry Beckman, DVM, DIPL ABVP (Equine). The Beckmans established an independent, two-doctor ambulatory practice, Bluegrass Equine Emergency Service, that provides after-hours care for Gas Light Equine and other local practices.

Fogle was intrigued by the idea and brought it up during one of the quarterly meetings that the veterinary school holds with its referring veterinarians. The concept wasn’t entirely new; NC State had discussed launching such a service a couple of times over the previous decade.

“There was some interest in those early discussions but not really ever enough for us to create a financially sustainable model,” Fogle said. “I think the perspective from the administration of the CVM was that it didn’t necessarily need to make money, but it needed to at least break even. And with those earlier discussions, we were really struggling to develop a model with enough veterinarian participation to break even. What changed about this most recent discussion is this idea of having a standalone emergency service that is operated by the veterinary school but supports local practices that are willing to participate in the subscription service.”

“The practitioners that are partnering with us on this absolutely feel like this is the way forward; this is where the future of equine veterinary medicine is headed.”

Dr. Callie Fogle

The subscription fee improves the financial picture, Fogle said, but the level of interest has also increased. “As associates become harder and harder to find, people are more motivated to try things that are outside of the box. I think the practitioners that are partnering with us on this absolutely feel like this is the way forward; this is where the future of equine veterinary medicine is headed. So if anything, they’re probably even more passionate about this than I am.”

They hope to launch the service within the next six months, serving practices within a certain radius of the university. “Initially, we’ll roll it out on a smaller scale, just for a few local practices that have indicated their willingness to pay a monthly subscriber fee,” Fogle said. “And this fee, plus the emergency fees of the emergency cases themselves that would normally be seen by those practitioners, that income would then be used to fund two salaried veterinarians and a technician and emergency truck with all the bells and whistles to see emergency cases in the field.”

As Martin mentioned, practitioners are always a bit concerned about how their clients will react to a new arrangement. “The clients that the practitioners have talked to, and the horse owners that I know that may or may not be impacted by this service, have all received the news of this service concept as a very positive thing,” said Fogle. “I think clients are in support of veterinarians having a well-balanced life and developing solutions that allow them to be the best veterinarian they can be during the day, which means getting sleep at night.”


This article appeared in the May 8 & 15, 2023, issue of The Chronicle of the Horse. You can subscribe and get online access to a digital version and then enjoy a year of The Chronicle of the Horse and our lifestyle publication, Untacked. If you’re just following COTH online, you’re missing so much great unique content. Each print issue of the Chronicle is full of in-depth competition news, fascinating features, probing looks at issues within the sports of hunter/jumper, eventing and dressage, and stunning photography.

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