One thing constant about veterinary medicine in 2018 was the inevitability of change.
Whether in practice ownership, cannabis laws or almost everything else, the past year brought upheaval to the profession, making it a microcosm of the world at large.
In one major aspect, 2018 wasn't much different from recent years: Business consolidation once again was in full swing.
Coming off its multibillion dollar buy in 2017 of the second-largest veterinary hospital chain in North America — VCA — Mars Inc. continued shopping for more practices. In June, it picked up Linnaeus Group in the United Kingdom, adding 87 locations; and AniCura, owner of some 200 hospitals in seven continental European countries. (Practice brands Mars owns in the United States are Banfield Pet Hospital, BluePearl and Pet Partners, along with VCA.)
Mars was one of multiple shoppers in the U.K., where the pace of practice buyouts seemed particularly frenetic. The nonprofit Federation of Independent Veterinary Practices estimated that no more than half of practices in the nation remained independently owned.
As the year wound down, signs arose that the trend might be slowing there, however. Pets at Home, one of the U.K.'s biggest veterinary companies, disclosed in late November that 55 of its 471 practices were struggling to survive and it was considering closing up to 30 of those hospitals. About the same time, a second large owner of practices, CVS Group, told investors that its network of 498 practices was not doing as well as anticipated.
In the United States, as private equity investors fueled consolidators' search for lucrative pet hospitals, veterinarians began speaking out on how to even a lopsided competitive field. During a meeting of the American Veterinary Medical Association House of Delegates in January, practitioners lamented the ways in which large corporations not only have greater buying power but get price breaks, to boot, on expenses such as association dues.
Pushing back on the wave of bigger owners, the Independent Veterinary Practice Association was born to advocate for the interests of independent, locally owned practices.
With investor cash flowing into the veterinary-practice sphere, interest in opening more veterinary schools also remained high. As the 29th and 30th veterinary schools in the U.S. — Midwestern University in Arizona and Lincoln Memorial University in Tennessee — graduated their inaugural classes, three other universities pursued plans to establish programs of their own.
The University of Arizona, rebuffed in an earlier attempt to score provisional accreditation for a new program, persisted, hiring a consultant and beginning its quest anew. An AVMA Council on Education team is scheduled to visit the campus May 12-16.
Texas Tech University, which also had encountered setbacks to its plan for a veterinary school, likewise pushed ahead. It is on the COE's calendar for a consultative site visit April 14-18.
Long Island University Post, a private school in New York State, applied this year for COE consideration, was visited by an accreditation team in August and is expected to learn the outcome in spring. It hopes to enroll its first class of students next fall.
Measures of distress and discontent
Research by the U.S. Centers for Disease Control and Prevention released late in the year corroborated long-held concerns that veterinarians are more likely than the general population to die by suicide. The study, conducted in collaboration with the AVMA, found that during 1979 through 2015, veterinarians were two to three-and-a-half times as likely as someone in the general public to end their own lives.
Another troubling sign of the emotional state of the profession came in the form of answers to a major survey, which found that a majority of veterinarians don't recommend the profession.
The survey findings were the basis of a study conducted by Brakke Consulting in collaboration with the AVMA and independent researchers. It was named the Merck Animal Health Veterinary Wellbeing Study after the pharmaceutical company that sponsored it. Results were made public in February.
In a measure of their well-being, survey respondents were classified as flourishing, getting by or suffering. Among younger male veterinarians, younger female veterinarians, older female veterinarians and older male veterinarians, only one group was found to be flourishing: male veterinarians over the age of 45.
While the survey didn't definitively determine the reason for the disparity, there were indications that financial pressures could be part of the problem: Two-thirds of respondents rated high educational debt as a critically important issue.
Commenting on the survey findings, psychology experts hypothesized that high levels of psychological distress stem from the growing prevalence of large corporate practices, which presumably put a greater emphasis on production; a greater sense of competition in school, for internships and for residencies; and social media — both from the pressure to use it as a practice-promotion tool and from its use as a platform by bullies.
On the positive side, the study found the rate of serious psychological distress among veterinarians to be comparable to that in the general population — contradicting an earlier study that suggested veterinarians experience psychological distress at greater-than-normal rates.
One sign of workplace discontent — and an attempt to address it — came in the form of a new labor movement. Support staff at two West Coast hospitals voted this spring to join unions; a third hospital followed in July. The affected practices were VCA specialty hospitals in San Francisco and Clackamas, Oregon; and a BluePearl emergency hospital in Seattle — all owned by Mars.
While new veterinarians and veterinarians-to-be tend to bear more pressures and stressors than their older colleagues, they proved to be a rich source of ideas for solutions to the profession's challenges. More than 100 veterinary students entered the first annual "Solutions for the Profession" essay contest sponsored by the VIN Foundation. The winners tackled the high cost of veterinary education and student debt; mental health issues; and the disproportionately low number of women in professional leadership positions.
In another example of veterinary students thinking beyond their school years, the student-run Veterinary Business Management Association established an alumni branch in hopes of building a lasting network with the thousands of former VBMA members who are now in active practice.
Developments in disease and drugs
As has become common in the age of global travel, emerging infectious diseases made headlines. Canine influenza, at one time considered a minor illness, gained a more virulent potential as a deadlier second subtype entered and spread around the United States and Canada.
That subtype, H3N2, was first seen in the United States in 2015. Researchers traced the outbreak, in Chicago, to a virus circulating among dogs in South Korea. This year, H3N2 entered Canada after a greyhound rescue group based in Detroit unwittingly imported two infected dogs from South Korea. The dogs had foster homes on both sides of the U.S.-Canada border.
In the U.S., H3N2 broke out this year in locations from coast to coast, including the San Francisco Bay Area, New York City, and parts of Minnesota and Nevada.
The more benign version of canine influenza, H3N8, which was the first subtype to be identified, appears to have petered out in the U.S.
A deadly, highly contagious disease in domestic rabbits called rabbit hemorrhagic fever virus 2 appeared in the United States for the first time, in September, in rabbits living on a farm in Ohio. RHFV2 struck in British Columbia, Canada, in March. The viral subtype was first recognized in 2010, in France.
Another disease to capture national attention this year was a heart condition in dogs, dilated cardiomyopathy. DCM in dogs normally is seen in certain breeds that are genetically predisposed, but veterinary cardiologists began noticing the condition in dogs of other breeds. A characteristic common to many cases was an exclusive diet of grain-free or otherwise limited-ingredient kibble containing high levels of legumes or potatoes and/or exotic meat proteins such as kangaroo, alligator or bison.
Such formulations have proliferated on pet-store shelves; many veterinarians consider them to be faddish and not a source of superior nutrition.
Late in the year, another diet-related issue arose in the form of a rash of dog-kibble recalls due to excessive vitamin D. About a dozen brands were recalled in November and December. The FDA said many had a common contract manufacturer. In that respect, the problem echoed the melamine debacle of 2007, when numerous brands of wet pet food, including some of the biggest names in the industry, shared a manufacturer that unwittingly used contaminated ingredients.
On the treatment front, preliminary research results emerged on the potential of cannabidiol, or CBD, to ameliorate conditions such as epilepsy and osteoarthritis in dogs. With continued loosening on cannabis laws at state and national (in Canada) levels, interest among people to try CBD on their ailing pets grew apace. In September, California became the first state in the U.S. to explicitly authorize veterinarians to discuss cannabis use with their clients. Other states' laws are silent on giving marijuana as medicine to pets, leaving veterinarians unprotected legally.
Technology's lengthening reach
While countries and societies grappled with data breaches at Facebook and its ilk, the value of electronic data from veterinary practices and commercial interest in harvesting the information came to light, as well.
An announcement that Henry Schein Animal Health and Vets First Choice would merge and meld into a third company to be named Vets First Corp. alluded to the value of practice data to outside companies. Schein is a major distributor of veterinary supplies and owns several practice information management systems. Vets First Choice acts as an in-house pharmacy to participating practices.
"By bringing together the power of data analytics, digital communications, practice management software, and supply chain expertise into a multi-channel platform, Vets First Corp. is expected to improve health outcomes for the benefit of pets and their owners, while driving increased demand for products and services for the benefit of veterinary offices and manufacturers," according to a press release.
The prospect of large volumes of electronic data flowing freely out of practices into the hands of third parties for oblique purposes began making veterinarians uneasy. Their worry is that information such as client purchasing records, for example, are being sold to or shared with businesses such as online pharmacies that will directly market to pet owners, effectively cutting veterinarians out of the picture. Veterinarians also could be held responsible for obtaining client consents for the sharing of data or blamed for data-privacy breaches.
Schein and Vets First Choice aren't unique among veterinary companies actively gathering practice data. In a lawsuit filed in August by Idexx Laboratories Inc. against Vets First Choice and two of its employees, Idexx describes one of its activities as "aggregat[ing] large swaths of data pertaining to buying trends, purchasing history, treatment history, and consumer engagement with various product manufacturers and product types."
Idexx is best known as a major veterinary diagnostic company but it, like Schein, also sells practice management information software. Originally developed to enable practices to shift from paper records to computer records, practice software connected to the internet is recognized now as a portal to valuable information collected by veterinary hospitals.
As with digitized and Web-connected information of all sorts, a leading question for the future is, who owns and controls the data?
Another way digital communication promises to change the face of veterinary medicine is through telemedicine — the delivery of care remotely, through conventional computers or mobile devices, using audio and video tools.
In September, the American Association of Veterinary State Boards enacted a revised model practice act that incorporates new guidelines for what it considers the appropriate use of telehealth technologies by veterinarians and their clients.
One difficult question that the revision tackled was whether a veterinarian-client-patient relationship — a relationship essential to proper treatment — can develop remotely. The AAVSB decided yes: The VCPR may in some instances be established online and without a hands-on physical exam.
The position is at odds with the stance of the AVMA, which maintains that a face-to-face visit is necessary.
Because the AAVSB practice act is a model, it is up to states to decide whether and how much of the model to adopt. That's an issue for the months ahead.