Colleges grow with satellite clinics

Ventures breed hostility from private sector in some cases

October 21, 2009 (published)
By Timothy Kirn

Satellite clinics might be key to a veterinary school's vitality and its continued ability to expose students to a broad range of cases, reports Dr. Michael Kotlikoff, the dean of the Cornell University College of Veterinary Medicine.

With that assertion, Kotlikoff revealed that Cornell is in the exploratory phase of considering where to open its own satellite clinic. Proposals include the New York City area and Connecticut.

The move by some veterinary medical programs to expand outward seems to reflect the growth of veterinary medicine and specialty referral hospitals, in particular. Twenty years ago, patients brought their pets to teaching hospitals, and general veterinarians referred to them. Now the majority of urban areas have their own specialists while most veterinary schools are in rural areas. 

These dynamics leave veterinary students without enough routine care experience and schools “run the risk of becoming irrelevant,” Kotlikoff said.

While it is unclear whether a nationwide movement to build satellite clinics is afoot in academia, a number of veterinary medical programs have opened satellite facilities in recent years or have current plans for them. Some argue that a veterinary medical program's expansion of services in areas already populated by private practitioners, especially specialists, smacks of unfair competition. After all, publicly funded satellite practices vie for the same patients needed to fuel private practices, without the tax burdens shouldered by small businesses.

Aware of the potential for such criticisms, Kotlikoff met with private practitioners in New York's Westchester County to get a feel for local attitudes concerning the veterinary college's proposed move to the area. But without concrete plans, he said it is hard to talk seriously about the topic. He characterized veterinary education's need to open satellite clinics — specialty and primary care — as a way to be “much closer to the action."

Much like Cornell's plans, the University of Illinois opened a primary care and specialty practice in Chicago a few months ago. Kansas State University runs a specialty practice in Omaha.

Oregon State University’s veterinary college did not open a satellite clinic, but it created a partnership in 2007 to get students more hands on training in spay and neuter by partnering with the Oregon Humane Society. The program allows every student to do a rotation at the animal shelter in Portland.

Perhaps the most recent example of a satellite expansion comes from Mississippi State University (MSU), where officials expect to soon open a specialty referral center in Jackson, more than two hours away from the veterinary college's Starkville campus.

The greater Jackson area has a population of slightly more than half a million people — roughly twenty times the population of Starkville. Yet for all its size, Jackson has had no veterinary specialist in residence in the area. That is why a group of about 35 local veterinarians asked the veterinary college to establish a specialty referral practice there, said Dr. Kent Hoblet, dean of MSU's College of Veterinary Medicine..

Those local veterinarians opened an all-night emergency clinic and wanted someplace to send their serious cases. Now they're relocating the emergency practice to a 5,200-square-foot building slated for completion this fall, and MSU officials have reportedly purchased land adjacent to the site for the specialty referral practice. A full-time surgeon has been hired and the university’s specialty facility is expected to open in February.

Hoblet said the practice will, for the most part, run separately from the school and its hospital, at least initially. Students and residents will have the option to do an elective rotation there, and the practice may become more integrated into the curriculum and research as time goes on.

“We think there are a lot of upsides to the clinic and our being in Jackson,” Hoblet said. It will “increase opportunities for students. We’re not a big school.”

Larger in size is the University of California, Davis School of Veterinary Medicine (UC Davis), which opened a specialty clinic and small-animal hemodialysis center in San Diego three years ago. It is the only dialysis center in the region. But unlike in Jackson, the clinic is not the only specialty practice in the area, and local practitioners objected to it.

Many still are unhappy, stating that it's unfair for a private practice to have to compete with one that receives public funds. Some believe that local resentment is a major and common consequence of the satellite operations.

“UC Davis clearly stated that they were not going to come to the area to compete with existing specialists,” said Dr. William Herndon, Dip ACVIM, a cardiologist who practices near the UC Davis practice. But “clearly by duplicating existing specialties and residencies at UC Davis-San Diego, UC Davis was being dishonest about their intent to directly compete with private industry.”

The plan for the UC Davis facility in San Diego was initiated in 1998, when the state Legislature decided to address a shortage of veterinarians in California and voted to fund the venture. At the time, there was a perceived absence of veterinary specialists in the southern part of the state. Herndon estimated that fewer than 15 specialists practiced in the area then.

Now there are at least 95, Herndon said.

Those specialists cannot compete against a practice that operates tax free and is supported by tax dollars, he added.

The presence of the UC Davis clinic “has caused a decline in case load” at Herndon's specialty group practice. “In fact, my hospital has had to decrease the number of specialists employed,” he said.

For its part, UC Davis officials spoke with people in the area as the school's plans developed and consciously decided to focus the practice on behavior, nutrition and hemodialysis to minimize its competition with local practices.

But conflict may be unavoidable. As more specialists work in private rather than university-based practices and congregate in urban areas, the schools get fewer of their traditional referrals, which translates to fewer patients. That's prompted veterinary medical programs to expand to urban areas in a quest to stay viable.

As Cornell’s Kotlikoff said, if veterinary medical schools do not branch out and evolve, their teaching hospitals could become obsolete.

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