Position Statements

Access to Veterinary Care in Canada

December 11, 2024

Factors influencing access to veterinary care are complex, inter-related and highly dynamic and will evolve beyond the publication date of this position. Currently (2024) the veterinary profession and the general public are becoming increasingly aware of the existence of barriers impeding access to veterinary care. Although strategies to address the current situation are under development, a greater concerted effort is required by stakeholders to implement improvements in access. Meaningful change is expected to take years. The Canadian Veterinary Medical Association (CVMA) advises readers to keep apprised of progress on efforts to enhance access through reputable information sources including national and provincial/territorial veterinary associations and regulatory bodies.

Background

1. For the purposes of this position statement, the CVMA defines 'access to veterinary care’ as the sustained condition of having “the economic, physical, social, mental, and emotional resources necessary…to secure, communicate with, and benefit from the services of a trusted veterinary service provider…as needed to optimize the health and welfare of animals .....................” (1).
2. Veterinary care is critical to One Health and One Welfare (2) and helps mitigate risks and optimize benefits to human, animal and ecosystem health as well as the welfare of humans and animals (3), including domestic as well as free-ranging and captive wild animals. National and global food production and food security rely heavily on adequate access to veterinary services for commercial and small-holder food producing herds and flocks, and provide critical support for local, regional, and national economies (4).
3. The United Nations’ Sustainable Development Goals rely on ambitious and urgent action by multiple sectors to sustain and protect animal health and welfare which are critical contributors to addressing the challenges associated with achieving the 17 named goals (5).
4. Canadian provinces and territories joined the World Veterinary Association (WVA) and the World Organization for Animal Health (WOAH) in recognizing veterinary care as an essential service during the COVID-19 pandemic (6,7).
5. Access to human healthcare in Canada is critically inadequate, with long surgical wait times, overcrowded emergency rooms, and many families unable to find a primary care provider (8). Access to veterinary care is similarly inadequate and critical, with many individuals, families, and entire communities in Canada unable to access care for their animals when needed (9).
6. Access to veterinary care is recognized as a ‘wicked’ (10) or complex problem with multiple and inter-related contributors to the degree and nature of accessibility an individual, population or community might experience. Many veterinary professionals experience marked stresses within their current scope of practice in the face of relative or absolute workforce shortages. As a result, the CVMA recognizes that efforts to improve access equity cannot add pressure to veterinary professionals already overburdened in their work. Strategic approaches to manage both the current pressures on veterinary professionals and the complex barriers to accessible care facing animal caregivers across Canada are imperative.
7. Companion, exotic and farm animal species cared for by humans require veterinary services to protect and maintain animal and human health and welfare, and to protect the safety and security of Canada’s food supply (11). Whether animals are cared for in homes, institutions, shelters, or collectively in communities, access to veterinary services is frequently determined by the income level, living situations, geographic and cultural contexts of human caregivers (12). The CVMA recognizes the need to consider these varied factors when framing and implementing access to care initiatives.
8. Individuals and communities experiencing marginalization through systemic oppression frequently express intense connections to their animals, (13-16) often citing the life- preserving nature of the human-animal bonds in their lives (17,18). The health impacts of barriers to accessing veterinary care for oppressed populations are compounded by the disproportionate effects of climate change and other environmental or systemic phenomena on these groups (19,20). The CVMA recognizes the critical role of veterinary professionals in addressing climate change and access equity strategically to mitigate cumulative detriments to the health of marginalized populations (21).
9. The CVMA holds that the changing structures of veterinary care delivery and practice models provide opportunities to address access to care in a collective and multi-modal fashion. The introduction of telehealth, telemedicine and teletriage services enables individuals living in remote areas to access some services and develop relationships with veterinary clinics in the absence of locally available care. Practice groups in rural areas may improve the affordability of pharmaceuticals for farm animals through membership in large-scale buying groups. The non-profit and animal welfare sectors have long been at the forefront of working to improve access to care, often relying on donor dollars and short-term grants to do their work. Practice groups serving companion animals increasingly include community outreach and philanthropic engagement in their business models, enabling wider distribution of products and services to individuals, populations, and communities underserved by the profession. This expansion of socially accountable veterinary care into the for-profit sector is encouraging and has the potential to contribute to meaningful change in access equity in Canada.
10. The CVMA considers the factors below as important barriers to accessing veterinary care. Most are presented alongside opportunities that CVMA suggests should be considered in efforts to address them.
    1. Veterinary-dependent barriers
       1. Veterinary College and Veterinary Technology Student Selection: Multiple authors identify that increased diversity amongst veterinary professionals may mitigate trust-based or cultural competency-based barriers in accessing veterinary care for racialized or other marginalized populations (1,9,22,23). Admission requirements for veterinary and technical colleges in Canada invariably include demonstrated experience working with animals and observing the practice of veterinary medicine. For individuals whose families cannot regularly access veterinary care, this requirement may be difficult or impossible to achieve (24). Rural, mixed and large animal veterinarians are in critically short supply, and current trends in employment for newly graduated veterinarians indicate a significant preference for urban and/or companion animal practice paths (24,25). Diversification of selection requirements to target improved access to care in rural, mixed and large animal practices has recently been implemented at some veterinary colleges (25). Expansion of this approach to select candidates more likely to work in other underserved communities, regions and neighbourhoods could dramatically improve access to care in Canada.
       2. Workforce Shortage: Canada’s current shortage of veterinary professionals is not globally unique, and with a competitive market for veterinary professionals worldwide, Canada must address the national shortage on an urgent basis. Literature suggests that the current shortage is expected to become more pronounced and be sustained over the coming years (26-29). Veterinary professional shortages are both relative and absolute, with some supply- demand mismatches related to the changing nature of veterinary practice to a more client-centered approach, resulting in more time spent per visit and fewer patients per practitioner (30). Underutilization and undervaluing of the skillsets possessed by Registered Veterinary Technicians/Technologists (RVTs) also contributes to relative shortages in many practices (31,32). Additional pressures are felt by farm animal practitioners who increasingly must drive longer distances to reach their clients.
       3. Increased Companion Animal Patient Load: Increased acquisition of pets during the COVID-19 pandemic has led to increased pressure on existing clinics, contributing to more experiences of inadequate access to care even in areas with locally available services (33).
       4. Workforce Wellness: Veterinary professionals are widely recognized to experience a high prevalence of occupational stressors and hazards which can contribute to mental health injury and illness including chronic stress, moral distress, empathy fatigue and burnout (34,35). These issues are recognized as contributors to absenteeism, disability, and attrition, which further exacerbate workforce shortages (36,37). Working in environments with unavoidable hazards, including frequent dilemmas around the cost of care and dealing with patients that are difficult to handle, can deplete individual and collective mental health and increase risks of physical, mental, and psychological injury and illness (38-40).
       5. Practicing Contextualized Care: Not all practices or clinicians are trained or equipped to offer treatment options along a broad spectrum of care, leaving some clients unable to access the limited treatment options they are offered either financially or practically. Spectrum of Care (SpoC) refers to the range of acceptable, evidence-based diagnostic and therapeutic options available for any given patient or presentation (41). Practicing SpoC can mitigate barriers to accessibility otherwise present if a narrow approach to care is favoured (41,42). At least one provincial licensing body has adopted an accessibility statement: “Adaptability and flexibility in the practice of veterinary medicine is essential to ensuring that the public has continued access to safe and competent veterinary care” (43).
       6. Communication and inter-cultural barriers: Veterinarians may not be proficient in effective communication with a range of clients, which can affect the accessibility of the care provided. Veterinary professionals require training and skills in clinical communication basics and inter-cultural connection to improve the provision of individualized, context-appropriate care (41,44). Clear demonstrations of empathy and commitment to a relationship-centered approach amongst veterinary teams improve functional accessibility of care for a range of clients (23,45).
       7. Scope of Practice: While veterinary colleges in Canada graduate professionals capable of working with multiple common species, veterinary scope of practice often ends up narrowed to the species commonly encountered in an individual practice setting. As a result, it is rare for clinicians to demonstrate expertise or comfort in treating species outside their typical patient population (46,47). When veterinarians are not equipped or not comfortable to treat animals outside their normal species of focus or are restricted by the conditions of their licensure from doing so, barriers to accessing care are present even if local services are available for other species.
       8. Availability of After-Hours Care In some areas, access to veterinary services may not be available outside of normal business hours thereby creating barriers to care (48) for both large and small animals. Client experiences of being unable to access care at certain times of day or on certain days of the week reflect a mismatch between the expectations of clients; the health care needs of animals; and the need for veterinary professionals to have a sustainable work-life balance.
       9. Regulatory barriers: Veterinary medical regulations are critical for the protection of the health and welfare of animals, the public and the environment. In Canada regulations fall under the jurisdiction of each province and territory and therefore vary across the country. While many regulatory bodies have advocated for flexibility in how regulations are applied within their jurisdictions, some regulations can still contribute to barriers to care by limiting the scope, setting, and context of care provision outside of traditional practice settings. The CVMA encourages regulatory bodies to consider their role in reducing or eliminating barriers in access to veterinary care through regulatory and policy change. For example, consideration should be given to supporting flexible alternative care approaches including use of technologies such as telehealth, telemedicine and teletriage; lay vaccinator programs; temporary remote companion animal practice initiatives; in- community short term clinics; and expanding the role of RVTs. In addition, CVMA suggests that the role of sporting or special event oversight bodies should be critically examined with regard to the preventing of provision of care by veterinary professionals outside of the membership of these organizations.
    2. Community or Individual barriers
       1. Financial: The cost of veterinary care is consistently identified as the most important barrier to accessible care for companion animals (1,9,49) and the cost of care in Canada has exceeded inflation annually since 2007 (30). Trends such as the expansion of advanced diagnostics and therapeutic approaches and the growth of specialist practice contribute to increasing costs and shrinking access to care (50). Beyond the cost of care, individuals living in poverty face additional and cumulative barriers to accessing veterinary services, emphasizing the need for wider acceptance of and regulatory support for alternative models of care provision (9,12).
       2. Geographic: Geographic remoteness and distance to a veterinary clinic is a significant barrier to accessing veterinary care, and extensive areas of the country are sparsely populated with no local or even regional veterinary services available. Even in the absence of other barriers, geographic remoteness and/or lack of transportation constitute core challenges in accessing services (9,12,51). Geographic barriers can be partially overcome if establishment of a VCPR via telemedicine technologies is permitted by provincial regulators, allowing practices to more effectively use these approaches to improve access to care.
       3. Health Literacy: Animal caregivers’ degree of health literacy influences not only their awareness of the importance and role of veterinary care, but also their ability to understand the recommendations made by veterinarians if they do utilize available services (9,14,23,45).
       4. Language, Culture and History: In Canada, animal caregivers whose first language is not English or French may experience barriers to care if they cannot access services in their primary language (14,23,45). Given the cultural and racial homogeneity of veterinary professionals in North America, (52,53) animal caregivers from diverse racial, religious, cultural or other backgrounds may experience tension between their individual values and practices around animal caregiving and those deemed acceptable or adequate by veterinary professionals (9,14). Canada’s history of colonialism and systemic oppression of Indigenous peoples may present further barriers for this population in accessing veterinary care, related to mistrust of healthcare providers and other outsiders, and both perceived and real lack of self-determination within the healthcare system (9,12).
       5. Inadequate on-Farm Facilities: Veterinarians serving farm animals face frequent threats to personal safety due to the lack of suitable handling and restraint facilities or equipment on-farm. Associated injuries and stressors
       6. contribute to reduced workplace wellness and absolute workforce shortages due to absenteeism (54).
11. Advice for Veterinary Professionals
    The CVMA offers the following advice to veterinary professionals, including veterinarians and RVTs, and institutions that support the veterinary profession.
    1. Veterinarians should work with their professional associations and relevant governing bodies to address the ‘veterinary-related’ barriers listed above.
    2. Veterinary practice owners and managers are encouraged to foster and sustain environments that promote positive work-life balance and a psychologically safe and healthy workplace culture to promote workplace wellbeing, retain employees and reduce professional attrition
    3. Veterinary practice owners and managers are encouraged to support effective use of RVTs across the full scope of their professional skill set.
    4. Prioritizing mentorship and providing opportunities for veterinarians and RVTs to engage in outreach activities within their scope of paid work is encouraged.
    5. Regulatory bodies and educational institutions are encouraged to continue exploring creative licensing pathways for internationally trained graduates to bolster the veterinary workforce.
    6. Federal and provincial/territorial legislators should increase their awareness of and concern for the public health impacts of inadequate access to veterinary care and act within their purview to reduce or eliminate barriers.
    7. Veterinary professionals are encouraged to seek out opportunities to engage with underserviced populations and communities through knowledge exchange and service provision to build relationships with and pathways for these groups to veterinary professionals and other animal health service providers.
    8. Telehealth, telemedicine and teletriage may support improved access to care, and are especially effective if veterinary-client-patient relationships can be established remotely where appropriate (55). Veterinarians are encouraged to develop relationships with organizations providing care to remote communities.
    9. Veterinarians should practice, accept, support, and promote a variety of care models across the SpOC and emphasize the importance of preventive care with all clients.
    10. Veterinarians should seek out professional development in areas that can reduce barriers to access to care, such as cultural humility, trauma-informed care, spectrum of care, and conflict resolution.
    11. Veterinary practice owners and managers are encouraged to familiarize themselves with the National Standard of Canada for Psychological Health and Safety in the Workplace (56) and implement strategies according to their current circumstances.
12. Advice for the public
    The CVMA offers the following advice to the general public, including animal caregivers:
    1. Animal caregivers experiencing barriers to accessing veterinary care should seek out relationships with veterinarians and veterinary clinics and explore potential avenues for improving access.
    2. Members of the public affected by or concerned about accessibility barriers should reach out to local municipal and provincial /territorial political representatives to advocate for meaningful change.
    3. Clients are encouraged to act proactively to utilize the advice of veterinary professionals to enhance their animals’ health over their life span and decrease the need for emergent or intensive care for preventable health conditions.
    4. Animal caregivers should recognize that a valid veterinary-client-patient relationship, in alignment with local regulations, must be in place prior to receiving veterinary care. In many jurisdictions in Canada this can be achieved through telemedicine technologies.
    5. National food animal producer associations are encouraged to contact provincial and federal authorities to emphasize the importance of accessible veterinary care and veterinary health products to the health and welfare of food producing animals in Canada.
    6. Members of the public with the means to do so should consider supporting nonprofit and public entities that provide veterinary care to families, individuals and communities experiencing barriers.
    7. Animal caregivers are encouraged to consider the purchase of animal medical insurance coverage early on in an animal’s life to improve the financial accessibility of veterinary care, particularly for when emergency or unexpected care is needed.

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