Letter: Telemedicine is a vital tool for veterinarians

Traditional in-person exams can be augmented by remote care

October 30, 2023 (published)
From Madeleine Cosentino

The VIN News Service article Veterinarians divided as telemedicine advances (Sept. 28) features comments from practitioners who frame telemedicine as a commercial prospect, implying that its advocates are predominantly corporations and animal welfare organizations. As a veterinarian who works for multiple telemedicine platforms, I find this misleading. Many veterinarians are supportive of telemedicine, and its benefits to the profession go beyond revenue generation.

I practice in Ontario, Canada, where the remote establishment of a veterinary-client-patient relationship, or VCPR, has been permitted since 2017. In contrast to some U.S. jurisdictions, regulations in Ontario have dissuaded many direct-to-consumer telemedicine companies from doing business in the province. Veterinarians who offer remote care in Ontario must be associated with an accredited veterinary facility in the province, but their physical presence at the facility is not mandatory when practicing telemedicine. Direct-to-consumer telemedicine providers looking to dispense medications to patients in Ontario must undergo registration as a pharmacy and secure the required accreditations following an inspection. Additionally, veterinarians are responsible for providing after-hours medical support to their patients, whether it involves responding to on-call services personally or directing them to a nearby emergency clinic. This has led to the rise of after-hours remote care services that collaborate with existing practices.

Telemedicine will never replace the value of an in-person physical exam, which is a vital component of any animal's care. However, the current veterinary shortage makes it impossible to see every patient face-to-face. Canada's vast terrain and population spread present challenges in care accessibility that are strained by the shortage of veterinarians. This particularly impacts our northern territories and Indigenous communities. Some communities do not have enough veterinarians, and new patients have been turned away by overwhelmed practices. These veterinarians care about animal welfare but cannot see every sick or injured pet. In these instances, telemedicine can offer some relief. I cannot vaccinate a patient virtually, listen to their chest or run diagnostics, but I can provide parasite control or empirical therapy for allergies and osteoarthritis, and offer medical advice.

Telemedicine services help relieve the strain of overburdened emergency hospitals — a problem in both Canada and the U.S. — because it provides an opportunity for animals to be assessed virtually by a veterinarian who can determine whether immediate attention is needed. In many cases, we work collaboratively with the patient's primary veterinarian or a local hospital to get the patient medication if the situation warrants. This helps reduce unnecessary emergency room visits and alleviates the strain on primary care hospitals that might be booked for weeks.

Many of my patients are exotic animals, and their access to care is even more constrained because not all veterinarians treat them. Some of my patients have no access to care, other than what I provide. I have been able to collaborate with colleagues across the province to help these patients, including offering access to humane euthanasia when appropriate. (Many owners of exotic animals struggle to access euthanasia services if the animal does not have a regular veterinarian.)

I resent the implication that I work in telemedicine because I want to sit at home on my couch for better pay. I work a full-time, in-person job as an associate veterinarian and offer my telemedicine services outside of those hours. Most telemedicine veterinarians I know are in the same scenario.

I'm frustrated by the assertion that telemedicine will degrade care because veterinarians will blindly prescribe medications. There will always be veterinarians who practice suboptimal medicine for an easy dollar. However, like most of my colleagues, I dispense medications at my discretion, based on my clinical judgment and reasoning.

I know not every veterinarian will be comfortable with telemedicine, and it has limitations, but I think it is a vital tool for helping as many patients as we can and needs to be integrated into the profession as part of the spectrum of care. We are struggling to meet the demands of a growing pet population, and telemedicine, when used appropriately, can help address that. Each of us practices medicine in our own way. We can and must work together to help pets in need. Telemedicine veterinarians want to work with in-person care providers, not against them.

Madeleine Cosentino, DVM, practices at Abernant Veterinary Hospital, a brick-and-mortar practice, and Cosentino Mobile Pet Services, an online-only practice that offers weight loss programs. She also works with Vetster, a telemedicine platform that enables veterinarians at physical clinics to provide their patients with remote care, and SmartVet, a telemedicine clinic that offers after-hours triage and virtual care for veterinary clinics in the province.

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