Citing financial barriers, a growing number of pet owners are either declining veterinary care or avoiding it altogether. Dr. Jules Benson, chair of the Veterinary Innovation Council board, sees the introduction of veterinary professional associates as part of the solution, arguing that the profession must shift its focus from quality of care to access to care.

Jules Benson, BVSc, MRCVS

Dr. Jules Benson, board chair of the Veterinary Innovation Council and principal of Tapetum Lucidum Consulting, is a veterinary industry innovator who blends his background as a practicing veterinarian with nearly two decades of experience as an animal health executive, marketer and strategist. He’s motivated by a desire to use data to improve the lives of pets, pet families and veterinary healthcare teams.

The debate over the creation of a veterinary professional associate (VPA) role in our profession is understandably complex. As a veterinarian who hasn’t been in practice for many years, the last thing I want to do is minimize the genuine and valid concerns of my colleagues. After all, the rollout of nurse practitioners and physician assistants in human medicine has been plagued by poor communication, massive crossover issues and corporate greed. Moreover, I fully agree that credentialed veterinary technicians are chronically (and lamentably) underutilized.

And yet I can’t help wondering if our protectionist proclivities are making our profession more vulnerable, while simultaneously limiting our ability to serve more pet families.

Many veterinary practices are operating from a scarcity mindset: There’s a limited number of patients available, and introducing midlevel practitioners would only shrink the client pool. But from my perspective, adding VPAs could actually help expand it.

Something’s gotta give: PetSmart–Gallup State of Pet Care Study

Data from the PetSmart Charities–Gallup State of Pet Care Study released this past April lends crucial context to this discussion. The study found that 52% of U.S. pet owners have skipped needed veterinary care in the past year, including those who declined one or more care recommendations (37%) and those who avoided the vet altogether (15%).

Predictably, cost was the biggest barrier to care. Seventy-one percent of U.S. pet owners who skipped veterinary care did so for financial reasons. But here’s where it gets a bit more surprising (and worrisome): Even the highest-earning households are feeling the financial squeeze. Fifty-three percent of pet owners with annual incomes of at least $90,000 have opted out of care, with 44% of them saying the care wasn’t worth the cost and 33% saying they simply couldn’t afford it.

These are sobering numbers, but they don’t necessarily substantiate the belief that the patient population is shrinking or even in danger of doing so. Instead, they reveal that a growing segment of the population needs other options, and I see a clear opportunity to get creative and design different care models that could serve the pet families who aren’t receiving care. But doing so will require another perspective shift: from focusing on quality of care to access to care.

The Iron Triangle of healthcare: Balancing quality, cost, and access

The Iron Triangle of healthcare is a health policy model consisting of three components: access, cost and quality. The model recognizes that we live in a world with infinite needs but finite resources. Any changes we make, consciously or unconsciously, to one corner of the triangle necessarily comes at the expense of at least one of the other two. For example, if we prioritize providing the highest levels of care (i.e., increasing quality), it stands to reason that cost of care will be affected as a result. Practices are constantly making choices and judgments about which corner of the triangle deserves the most attention, whether they know it or not.

Generally speaking, for the past few decades, veterinary medicine has prioritized providing the highest quality of care. This has been both well-intentioned and seen as good business, but the PetSmart Charities–Gallup data reveal how the other corners of the triangle—cost and access—are suffering. It would be wonderful to live in a world in which we could provide the highest level of care to all patients at the lowest cost, but that’s not the world we live in. And with the current veterinary model pricing out a significant portion of the population, we find ourselves in a position of both ethical quandary and innovative opportunity. What changes in mindset and culture must we embrace to move the needle on access?

Our profession is understandably hesitant to compromise on quality, and when most veterinary education and marketing resources provide clinical teams with a hammer that reads “providing the highest level of care is always the best solution,” then we can be forgiven when every case looks like a nail. The reality is that quality is a nebulous term, one that is assessed across multiple axes, such as medical outcomes, client perception and patient safety.

One of our most profound near- and mid-term opportunities as a profession is to provide data-driven guidance around medical outcomes. Without evidence-based data and tools, veterinary teams are unable to properly contextualize the clinical options available to pet families and veterinary healthcare teams. (And without those tools, the logical default is to recommend the most advanced diagnostics and care available.)  

A logical extension of monitoring medical quality is to ensure we understand the impact of who is providing care. For example, it has been encouraging to watch the RCVS Knowledge Canine Cruciate Registry in the UK gather data on the level of both formal and experiential training, and assess the impact on client-reported outcomes. What would it look like to apply this kind of approach to the clinical work undertaken by VPAs? Would this help veterinarians and new practice models make pragmatic assessments of where a role like VPA could have the most impact?

The PetSmart Charities–Gallup study identifies that nearly three-fourths of U.S. pet owners who turned down care due to cost were never offered a more affordable option. And another 46% said they weren’t provided with a treatment plan that better fit their pet’s practical needs. Could new practice models leverage VPAs to provide a level of mutually acceptable (and affordable) medical quality to serve these pet families? To me, both the need and the potential are too great to ignore.

Not a cure-all, but a piece of the puzzle

Many of the specifics around the VPA role have yet to be determined. Important questions still need to be answered, such as the scope of care VPAs can provide and what client communication and informed consent should entail.

We must also honestly ask (and answer) what problem we’re hoping to solve with their addition. What is the ultimate goal? Are VPAs a “tool” veterinarians can use to expand access to care, or is the main goal to expand revenue? Is the central aim to help veterinarians avoid burnout? Or are we expecting them to spend even more one-on-one time with their patients? As with the Iron Triangle, where we place our focus will have benefits as well as consequences.

I don’t think midlevel practitioners are the only answer to improving access to care. Rather, I see them as one of many potential tools in our structural and cultural armamentarium to start closing the current care gap.