General equine practice has always required round-the-clock emergency coverage that clients can depend on for their horses’ urgent health care needs. An AAEP survey of horse owners and trainers in 2012 revealed that the availability of emergency care 24/7/365 at their horse’s residence was one of the top three criteria for their choice of a veterinarian.
More recent studies exploring the reasons behind the low numbers of new graduates entering equine practice and the high numbers leaving the field in their first five years of practice have revealed emergency duty as a strong negative factor in attracting and retaining practitioners. Positions in companion animal practices rarely require emergency duty, as most areas have emergency hospitals dedicated to urgent and critical care of small pets.
In the United States, over 50% of equine practices have two full-time equivalent (FTE) veterinarians or less. The number of solo practitioners, as measured by AAEP membership demographics, is consistently about 35-40%. The demands of emergency coverage born by a single individual or even by two individuals may understandably lead to exhaustion and burnout.
According to Dr. Amanda McCleery in her presentation at the 2021 AAEP Annual Convention, “with the majority of current equine veterinarians being female, the current working conditions required of equine practitioners may simply be untenable for many professionals who are disproportionately burdened by more hours of household work and childcare.” Even in larger practices where the on-call responsibilities are shared among many, the larger number of clients means that each emergency shift will be busy.
The current paradigm in traditional equine practices is for those doctors who are on emergency call to have a regularly scheduled workday before and after their night on duty. Not surprisingly, this can be exhausting. When a veterinarian is seeing emergencies all through the weekend, they may work 12 days straight without a break. It is no wonder that many are choosing a different path.
Alternative models for providing emergency coverage include emergency service cooperatives, referral hospitals with emergency departments, restricting emergency service to those who are clients, restricting emergency service to those who will haul the horse to the practice facility, emergency-only equine practices, and the use of relief veterinarians.
The establishment of emergency cooperatives is becoming much more common in areas where there are multiple small practices and cooperative rather than competitive relationships among colleagues. These co-ops allow a better work-life balance while still providing an important service for clients because they alleviate the demand for providing round-the-clock emergency care, which requires a veterinarian to be available and ready to work at all hours.
For parents of small children, this can be difficult if both spouses must work the following day, and for single parents, it can be impossible to arrange for emergency childcare in the middle of the night. The uncertainties make planning completely infeasible.
In 2020, a working group of the AAEP Wellness Committee created an Emergency Coverage Survey, which had a little over 800 respondents. At that time, 8% of those polled utilized a cooperative model for emergency coverage. There were many reasons given for not using such a group to reduce the burden of emergency duty. They included:
- Fear that their clients would be angry
- Not enough local practitioners to form a group
- Treatment of other species would be required
- Being such a large practice the burden was already distributed
- among many doctors
- Concern over the level of care or diagnostic skill provided by
- their local colleagues
- Concern they would need to cover too large of a geographic
- region
- Concern over loss of clients to other practices
- Concern over loss of needed revenue
- Concern about other practices’ fees – too high or too low
In some rural areas that are veterinary care deserts, practitioners struggle to find colleagues with whom to partner in providing emergency care. Absorbing the cost of regular relief services is often the only option. Alternatively, if there are referral hospitals within a few hours, this may be a solution.
When there are only a few large animal practitioners available to partner with, the value of having time away from emergency duty may be worth learning to deal with the most common ruminant and porcine emergencies from your colleague. However, for some, this is a deal-breaker. Concerns about the skills of other veterinarians, whether you worry that they will harm your patients with their deficits or steal your clients with their strengths, are often unfounded.
Consistent communication with the cooperative members through monthly dinner meetings, case discussions, and hand-offs of cases seen on each shift can help alleviate these fears. Ultimately, having a chance to take time away from your practice is a value that usually exceeds these anxieties. If you become burned out and leave practice, your clients will not have you to treat their horses anymore during the day or night.
While you may feel worried about the loss of emergency revenue, in most cases, your improved quality of life allows you to be more productive on the days when you are working. If you find the majority of your income is from emergencies, rolling out an emergency-only practice could be a good pivot
for you.
The fee structures of other practices are not your concern. Each practice has different expenses and so may set different fees for the same service. What seems to work best for most cooperatives is to have each doctor responsible for getting payment from any client/patient they see for an emergency visit.
Then, each of the clients’ primary practitioners is updated on cases seen at the end of each on-call period. The update on the case to the regular veterinarian is given by their preferred method of a phone call, text message, or email, and the medical records are emailed.
With fewer equine practitioners available, most horse owners are grateful to have care and appreciate you, but some are needy and even unreasonable. If you are joining or forming a cooperative, having a seminar to introduce all the veterinarians to the group of clients being served will help them feel more comfortable.
This rule of customer service is not to surprise or confuse your customers. Good communication with clients as you roll out the new emergency method is critical. Many equine practitioners are restricting emergency services to current clients who utilize the practice’s well-care services for their horses. This could be defined as having vaccines, a fecal, and a dental exam within the last twelve to twenty-four months. By confining care for emergencies to horses that have good preventative care, the number of urgent visits can be reduced. However, horses without such care may be left in need. Many practices leave the decision about providing care to a non-client up to the doctor on call. If that practitioner has not been terribly busy, they may want to help that animal.
An increasing number of practices, some of which have fewer doctors on staff after losing associates to positions in companion animal practices, are either no longer offering emergency services or are limiting them to those who can transport their animals to the practice’s facility. Others provide urgent ambulatory service until late in the evening, and then refer all cases to a regional referral hospital or veterinary school. Some states mandate that each veterinary practice make a provision for emergency care for their patients, but this can usually be a referral to another practice.
To address the burden of emergency care, the companion animal sector has created a model of emergency care specialty hospitals. Such a model has rarely been adopted by equine practitioners in the United States, but in recent years more emergency-only practices have emerged in areas with robust equine populations. Some of these practices are supported by subscriptions for emergency coverage from local practices, with those fees covering some of the expenses of the business. Other emergency-only firms rely on busy nights and weekends of emergency care that is robustly priced to support the
practice. In this instance, local practices direct clients to call the emergency practice for after-hours care. Some equine referral hospitals employ emergency-only clinicians and have a separate emergency division. Some relief veterinarians in the equine field regularly provide coverage for small practices to allow their doctors some downtime. A variety of options are developing in response to increased needs.
Many equine practitioners have chosen to specialize in services that rarely require emergency care such as integrative care, dentistry, or sports medicine. This segregation of services is not unlike the segregation of emergency services in specialized ER practices.
Especially during the pandemic, many practices implemented after-hours telemedicine appointments to triage potential emergency cases. While some need to be seen immediately, others can wait until the next day. By decreasing the number of cases that need an ambulatory visit outside of normal
hours, this technological solution can decrease stress and the associated burnout. Careful consideration of state regulations is necessary and can be found at the Veterinary Virtual Care Association at https://vvca.org/.
Although emergency care for our nation’s horses will always be needed and appreciated by their owners, new solutions to the burdens of this care are being implemented every year. Creative ways to give equine veterinarians more time for life and better compensation are bubbling up every day in innovative minds.
This article was originally published in EquiManagement.
About the Author
Nathan Slovis, DVM, DACVIM, CHT
Dr. Grice was an ambulatory equine practitioner in the Hudson Valley of New York for over 25 years, serving as the managing partner of the thirteen-doctor equine referral hospital in Rhinebeck, NY. At the end of 2014, she retired from clinical practice to concentrate on veterinary business consulting, and moved her residence to Virginia City, MT. She received her BA in Biology from Wellesley College in Massachusetts and completed her veterinary education at the University of Pennsylvania’s School of Veterinary Medicine in 1990. She earned her MBA with a concentration in Ethical Leadership from Marist College School of Management in 2014.
Dr. Grice is a member of the American Association of Equine Practitioners, where she served on the Board of Directors from 2015-2018, and is currently serving as treasurer (2021-2023). She is also a member of the AVMA Economic Strategy Committee (2018 – present). Dr. Grice is a frequent speaker at educational seminars for veterinarians across the country, as well as the founder of Decade One, which leads networking groups for equine veterinarians early in their careers. In addition, she consults with a diverse range of veterinary businesses and collaborates with industry partners to bring business education to veterinarians. Dr. Grice aids with transitions of ownership, strategic planning, financial projections, and other solutions for private practitioners.