Inside a spay-neuter clinic

If private practitioners work with spay-neuter clinics instead of against them, it can be a win-win for everyone involved: pets, clients and the profession.

June 9, 2014 (published)
By Margaret Ferrell, DVM

Editor's note: After publishing an article about regulators questioning medical, ethical and business aspects of high-volume spay and neuter surgeries, the VIN News Service invited a shelter veterinarian to share her perspective. Dr. Margaret Ferrell works at the Alabama Spay Neuter Clinic in Irondale. This commentary is not published outside the Veterinary Information Network (VIN), a private online community, because it speaks to tensions familiar to veterinarians but possibly unfamiliar to the general public.

Dr. Margaret Ferrell
HQHVSN stands for high quality/high volume spay-neuter. It’s a term veterinarians are becoming familiar with as spay-neuter clinics spread across the country.

The public embraces the clinics, but veterinarians who think their businesses might be threatened are not pleased to have one nearby. It becomes a public relations nightmare for private practitioners who want a successful practice but cannot afford to lower their spay-neuter prices. If veterinarians complain, clients perceive them as greedy or apathetic about pet overpopulation and the welfare of homeless animals.

That's typically not the case. Rather, many private practitioners believe nonprofit spay-neuter clinics receive tax breaks and donations that beget unfair competition.

But do HQHVSN clinics really compete with private practices? Consider three types of clients in veterinary medicine:

  • clients who pay anything and follow your recommendations 
  • clients who can pay but won’t
  • clients who can't pay

Private practices serve clients in the first category, whereas HQHVSN clinics primarily serve clients in the latter categories.

These pets will not present to a full-service clinic for spay-neuter surgery and typically live outdoors, having multiple litters. Consultants at continuing-education (CE) conferences often lecture veterinarians about failing to charge enough, suggesting that they raise prices. This advice further alienates our profession from a growing faction of the U.S. population: Americans who are living paycheck-to-paycheck and have little savings.

Suddenly, spay-neuter surgery has to take a back seat to putting gas in the car and food on the table. The pet comes into heat and gets pregnant while the family saves for an elective procedure.

If a female and her unaltered offspring continue to reproduce, 66,000 puppies or kittens could be born in just six years, by some estimates. If those animals end up in a shelter, they have a scant chance of being adopted, and most will be killed. Millions of healthy, adoptable dogs and cats are euthanized in the United States each year simply for being homeless. Homelessness kills more pets per year than any disease. It's the primary reason HQHVSN clinics are sorely needed.

The clinics are either free-standing or incorporated with local shelters. Shelter medicine is one of the fastest-growing fields in our profession, according to the Association of Shelter Veterinarians. On April 11, the American Veterinary Medical Association's Executive Board unanimously approved the American Board of Veterinary Specialties' recent decision to recognize Shelter Medicine Practice as a new specialty. (Officials with the new specialty will start accepting applications for credentialing in September. The first exam is expected in 2015.)

Challenges shelter veterinarians face often involve
too many animals and not enough money. To give a pet its best chance of finding a forever home, it needs to be in top condition. Owners don’t want to adopt a pet and then spend hundreds of dollars on medical care, so shelter veterinarians do what they can or are able to — treat skin and dental concerns, vaccinate, sterilize and microchip the pet. It is a tireless uphill battle to save all you can. Each life is a battle with unknown certainty. Compassion fatigue is a daily challenge.

Performing spay-neuter surgery is a bright spot in shelter medicine. Veterinarians are rewarded daily for knowing they are making a small difference in pet overpopulation and saving countless lives in the process. HQHVSN surgeons perform a high volume of surgery — 25 to 40 per day — and are trained to do so. Some veterinary schools incorporate these techniques in their curriculum. The Humane Alliance, a nonprofit organization in Asheville, North Carolina, teaches HQHVSN techniques. Veterinarians can go for CE and one-on-one training, which focuses on small, proper incision placement as well as the efficient use of instruments and suturing. HQHVSN methods are proven to be as safe and effective as traditional spay-neuter techniques but are much faster to perform. The patient requires less anesthesia, reducing anesthetic risk. Patients seem more comfortable with smaller incisions and clients are pleased with the results.

Private practitioners willing to learn and implement HQHVSN techniques stand to gain a valuable commodity — time. Time equals money. If a cat spay can be safely performed five or six minutes or a dog spay in six to 12 minutes, why not do it? Surgery is never rushed. Speed comes with repetition and perfect practice. There is no compromise in quality. Patients receive pre-operative screening and ill or injured patients are declined and referred to a full-service clinic for treatment. Patients that are good candidates for surgery receive pain medication, proper monitoring, aseptic surgical technique and careful post-op monitoring and supportive care.
While there is no HQHVSN specialty, these surgeons develop from repeated practice with difficult sterilizations such as spays on obese or pregnant animals, spay of animals with uterine infection (pyometra), and castration of animals with retained testicles (cryptorchidism).

The most difficult aspect of being an HQHVSN veterinarian is feeling isolated and perceiving a lack of support from colleagues. Some clinics have been well-received, but others have found themselves undesirably involved in politics and controversy. Veterinarians in Alabama and South Carolina have tried to pass legislation that would either implement client means testing and/or limit the services HQHVSN clinics or shelters can perform. Restricting services forces veterinarians to be in a position where they may not be able to practice best medicine. HQHVSN veterinarians have a veterinary license like any other veterinarian and should be able to use all of their skills, knowledge and judgment to treat pets. Additionally, means testing would prevent financially strapped owners who do not receive government assistance from using the clinics. This includes feral-cat caretakers, people who have strays dumped on their property and private rescue organizations. To deny this resource to them would only exacerbate pet overpopulation.

Another argument veterinarians often make against HQHVSN clinic are standard-of-care issues. Clinics and the veterinarians working in them are held to the same standards as private practice clinics. The licenses, premise permits and inspections are granted by the same individuals that provide them for private practices. If a veterinarian is not implementing and upholding standards of care, then state regulators should take appropriate action to protect the public. However, performing a high volume of quality surgery does not equate to substandard care.

If substandard-care allegations are untrue, where do they come from? This is a mystery, given that some critics of HQHVSN have never visited a spay-neuter clinic. Perhaps veterinarians base their concerns off of a case they saw or heard about. None of us is infallible. Most of us would want the opportunity to know something went wrong and have the chance to correct it, but please don't spread quality-of-care concerns that are unsubstantiated.

Many veterinarians believe that spay-neuter clinics should provide only sterilization and rabies inoculations. How is it good medicine to prevent another practicing veterinarian from diagnosing and treating as he or she deems necessary? The argument that nonprofits have an unfair advantage because they receive grants, donations and tax-breaks is fallacious. Grants come from private or corporate donors, not tax dollars. Yes, nonprofits do not pay taxes on their profits, but profits earned are invested in the business. Nonprofits pay taxes on supplies and payroll. Employees of the nonprofit all pay taxes, too. Could it be possible that everything boils down to the almighty dollar? If being a nonprofit is so advantageous and lucrative from a business standpoint, why don't more private practices become nonprofit entities?

It seems the profession is at an impasse. How are we to get along?

The solution is for veterinarians to reach out to one another by visiting nonprofits and vice versa. This might help private practitioners develop confidence that spay-neuter clinics are held to the same standards as any other clinic and foster positive relationships. Those who do, stand to gain referrals from HQHVSN veterinarians. Spay-neuter clinics are unequipped to address the long-term health needs of pets.

We all became veterinarians, in part, for our love of animals. HQHVSN veterinarians care about their patients as much as any other veterinarian. Spay-neuter clinics and the veterinarians who support them will continue to defend their existence. Too many lives hang in the balance. If private practitioners work with spay
-neuter clinics instead of against them, it can be a win-win for everyone involved: pets, clients and the profession.

About the author: Margaret Ferrell received her DVM in 2009 from Auburn University’s College of Veterinary Medicine. She has been an HQHVSN surgeon at Alabama Spay Neuter Clinic, Inc., since 2010 and has performed over 22,000 sterilization surgeries. She has a passion for teaching and sharing her knowledge of HQHVSN techniques with interested colleagues and veterinary students. She hopes to be a career spay-neuter surgeon, pay off her student debt and travel on mission trips to spay and neuter animals in poor regions of the world. She keeps her fingers crossed that she will one day be asked to speak at conferences to present fun, educational presentations to colleagues. She is blessed to be married to Clark, the man of her dreams, for 12 years. They are raising three young daughters and a son. The family shares a home with four cats and a Labrador retriever. Margaret’s hobbies include quality family time, heavy weight lifting, playing the French horn, piano, singing and reading great books.

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