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The Globe and Mail: Opinion – The Crisis in Veterinary Medicine

October 18, 2024

Published in the Globe & Mail, online as “All Vets Are Off” on Sep 27, 2024, and in print as “Pet Peeve” on Sept 28, 2024.)

Philipp Schott is a veterinarian and author whose books include The Battle Cry of the Siamese Kitten and How to Examine a Wolverine.

Psychologists call them “flashbulb memories” -- events we remember so vividly that we can visualize every last detail, as if we were holding a photograph of that moment in our hands. I have been a veterinarian for 34 years -- during that time I’ve treated dogs, cats, rabbits, snakes, hamsters, you name it -- but this is one memory which really stands out when I think back on my career.

It was around noon on Friday, March 20, 2020. I had gathered all the doctors and staff in the treatment room of our Winnipeg veterinary clinic for an important meeting. COVID had been declared a global pandemic the week prior, and Manitoba had declared a State of Emergency that morning. We were going to have to close our doors to the public. I fought back tears as I promised my colleagues that we’d do our utmost not lay anyone off. I assumed we’d be down to seeing a trickle of emergencies for I didn’t know how long -- probably months and months.

What happened instead was that the phone did not stop ringing. We, and our colleagues worldwide, invented “parking lot medicine” on the spot. The pet owners would wait out in their cars while we brought the patients into the clinic for examination and treatment. We were overwhelmed by the demand. What’s more, emergencies only made up the tiniest fraction of the visits. People were suddenly spending a lot more time with their pets, meaning they were noticing potential issues they had not noticed before. In the early part of the pandemic, it seemed like people only left their houses to do two things: buy toilet paper and go to the vet. This is when I really knew that something fundamental had changed in veterinary medicine.

I’d already sense something was shifting. In the preceding few years, the demand for appointments at my clinic, which I had been working at since 1990 and managing since 2000, had been steadily increasing, along with an interest in procedures and treatments once considered unrealistic for pets, such as cancer chemotherapy or advanced reconstructive surgery. Owners were more knowledgeable about, and more engaged with, the available medical options. The pandemic laid bare the underlying forces at work. In the span of a generation, we had, as a society, moved pets into the centre of our lives. They have become family members.

My own journey into veterinary medicine was unusual. Unlike the great majority of my colleagues, including my wife, I only decided to become a veterinarian when I was already in university. I was interested in research and teaching, possibly in the biomedical sciences. I went through the alphabetically organized course listings, rejecting one program after another until at the very end, I landed on v for veterinary medicine. This looked intriguing. My faculty advisor was enthusiastic, explaining that the veterinary colleges were keen on training veterinarians to ultimately join their research and teaching faculty.  With this in mind, in 1986 I joined 71 other students from across western Canada at the Western College of Veterinary Medicine (WCVM) in Saskatoon. The intensity of veterinary school took me by surprise. It was a full-on immersion experience. It was exhausting. By the end, I decided I needed a break from school for a couple years. Then I would go back and pursue graduate studies. I never did. I fell in love with the pets of Winnipeg, their challenging medical problems, and their astonishing relationships with their owners.

When I graduated from WCVM in 1990, the use of child-parent language by clients to describe their relationship with their pets was unusual. When someone did refer to themselves as, say, “Blackie’s mom,” when referring to a Labrador retriever, it was often accompanied by a chuckle or an embarrassed smiled. That’s not the case anymore. The majority of clients now speak this way automatically and instinctively. Now, for those of you rolling your eyes, let me be clear that nobody (ok, almost nobody) means it literally. They understand the distinction. It’s just that the English language is limited. “Owner” is technically and legally correct, but only reflects one small aspect of the relationship. “Guardian” comes closer, but also has a distant, overly legalistic, flavour to it. So, “mom” and “dad” it is. No other words come closer to what people feel in their hearts for their pets. My cat, Lillie, is the first – and sometimes only - living being who greets me when I come home. My dog, Orbit, passed away last December and I still think about him multiple times every day. So, I get it.

With this shift in the relationship came a shift in the expectations for medical care. People who were willing to brave the scary early days of the pandemic to get a lump checked on their shih-tzu are people who expect a lot more from their veterinarians than their parents might have 40 years ago with the old farm dog. This means more appointments – in our practice, we have been seeing 5-10 percent more patients a year over the last several years – and it means more options discussed during those appointments. Over the course of a given year, the average pet is spending more time with their vet than ever before.

And there are more pets. Many more pets. Everyone has heard about the “pandemic puppies.” That was not a media-created phenomenon. In my practice, we saw twice as many new puppies in 2020 than in 2019. You’ve probably seen news that some of these COVID pets were subsequently surrendered to shelters when their owners realized they couldn’t look after them, but this is proportionately a small number. The shelters are indeed full for a variety of reasons, but the great majority of pandemic pets are still with their people. COVID just accelerated what was already a growing trend. Many of these people would have gotten a pet soon anyway. Anecdotally, almost everyone I spoke to at the time said they had long been planning on it and thought that the free time offered by the lockdown was the perfect opportunity to train a puppy. Train? Yes. Socialize? No. But that’s a separate story.

In 2020 the Canadian Veterinary Medical Association (CVMA) conducted a labour market analysis that found  the number of dogs who received regular veterinary care had increased from 4.5 million to 7.1 million since 2007. (Incidentally, this alludes to another issue – pets who do not get regular veterinary care, something that is especially common with cats.) That’s a 58 percent increase in 12 years. And that was before the pandemic puppy surge.

More pets needing more care means that more veterinarians are required. The number of newly graduated veterinarians has not kept pace with this demand. In 2019, the five Canadian veterinary colleges graduated about 350 students. This came close to covering attrition from retirement, but this did not address the surging demand for veterinarians. Half of the clinics surveyed were looking to hire a new veterinarian. The class sizes are steadily increasing, but the number of retirements is also increasing, fueled in part by growing burnout and by corporate buyouts of independent practices. While more foreign veterinarians are being accredited, and the CVMA forecasts that by 2040 the veterinary work force will grow by 27 percent, this is still not good enough. The study also estimates that the population of dogs alone will increase by 45 percent. We’re falling further behind. (My examples are all drawn from pet practice, but a similar, and some ways worse, crisis is also hitting my farm practice colleagues.)

This crisis in the veterinary labour market is spawning another crisis – a crisis in the accessibility of veterinary services. In that same 2020 study, a fifth of clinics reported that they had scaled back their hours because of a lack of veterinarians. That number is surely higher now. In my own practice, we recently had to take the unprecedented step of no longer accepting new patients, at least for the time being. Many procedures that we used to be able to schedule for your pet within days or a week are now booking out months ahead. It sounds like the human health care system, doesn’t it? There are many aspects of human medicine that veterinarians are happy to emulate but wait lists and an inability to find a “family doctor” are not among them. The city of Regina (population 230,000) recently found itself temporarily without overnight veterinary emergency services due to staffing issues. People had to drive two-and-half hours to Saskatoon with their severely injured or dying pets cradled by a family member in the back seat.

There is also a growing crisis in affordability. Since 2001 the cost of veterinary services has increased at a rate above the consumer price index. By 2014 it was 50 percent higher than the CPI. Since then, anecdotally, the gap has become even wider. In my clinic, the cost of a routine medical examination was around $70 just a few years ago. Now it’s almost $100. The root causes are beyond the scope of this article, but this compounds the stress people feel when trying to access veterinary care for their pets. 

What are the solutions?  The most obvious one is to graduate a lot more veterinarians. Expanding and building veterinary colleges requires the expenditure of scarce public funds. This can be a difficult sell, given the competing demands to address the parallel crisis on the human side, but some governments are beginning to recognize the need. For example, Alberta is funding a doubling in the number of seats at the University of Calgary Faculty of Veterinary Medicine.

Another solution is to streamline the accreditation process for foreign graduates. A barrier is the variation in the quality of veterinary education worldwide, especially when it comes to modern pet medicine. In many places the focus is on food producing animals which require a different skill set and knowledge base. Nonetheless, more can be done to get properly qualified foreign trained vets out of Ubers and into clinics.

Thirdly, we need to continue to look at expanding the scope of practice for veterinary technologists, who are the veterinary equivalents of nurses. They already do far more than when I graduated, and they can do more still to free up the veterinarian’s time for those aspects of care where a doctor is truly needed. There is also an argument to be made for something resembling the nurse practitioner model, especially in rural and remote areas.

And finally, there is something you, the pet owner, can do to help. Be kind to your veterinarian. Be patient. Trust that they are doing their best under what have become much more demanding circumstances. As mentioned earlier, the burnout rate is growing. Far worse still, veterinarians have the highest suicide rate among all job categories. Unbelievable, isn’t it? But it’s true.

I don’t want to end on that note. I want to end by telling you that we love helping your animals, we really do. And that despite all the foregoing, it can be a wonderful profession. It’s just facing some challenges right now. There’s no reason we can’t overcome them.

I often think back on the moment when I decided that I wanted to stay in private companion animal practice after all. I was about to open the back door of the clinic at the start of my shift. While I was fishing for my keys, I pictured my first patient. I knew it was Cody, a cocker spaniel with a terrible middle ear infection that I had seen a week before. He was scheduled for a recheck. His owner, Mr. Thompson, would be sitting in the waiting room with him. He was always early. He was a widower, and Cody was his only companion. They so clearly loved each other. In that instant, I had an epiphany. I knew that I did not want to go into research. I knew that I wanted to keep seeing Cody and, year after year, help him and Mr. Thompson enjoy their lives together.

I know I speak for veterinarians across the country when I say that’s all any of us want to do -- crisis or no.