Students examine a cat
Photo by Dr. Greg Wolfus
During an appointment in spring 2019, veterinary student Travis Grodkiewicz (center) examined a cat with assistance from high school student Kelsey Tollko (left) and veterinary technician Kate Zukowski.
When Tufts at Tech Community Veterinary Clinic was founded in 2012, some hard questions swirled around its opening. As a nonprofit partnership between Tufts University and Worcester Technical High School providing subsidized care to needy pet owners in the community, it was the first of its kind, leading some to wonder: Would it compete unfairly with surrounding businesses? Could it provide adequate service with a staff of mostly veterinary students and high school student assistants? Was a subsidized clinic even financially possible?
Now, eight years later, Tufts at Tech clinic director Dr. Greg Wolfus believes the program has answered those questions, and then some. The clinic is going strong well into its first decade of operation and has become a model for more high-school-based nonprofit clinics around the state.
There's Angell at Nashoba, a partnership between Angell Animal Medical Center and Nashoba Valley Technical High School in Westford, opened in 2016.
There's Monty Tech Veterinary Clinic, opened last September at Montachusetts Regional Vocational Technical School in Fitchburg.
And there's Angell at Essex, another Angell partnership, this one with Essex North Shore Agricultural and Technical School in Danvers, opened in December.
Tufts at Tech takes a multipronged approach to veterinary education and companion animal medicine: It exposes high school students to veterinary practice and provides on-the-job-style training in roles ranging from receptionist to veterinary assistant. It provides veterinary care to pets whose owners otherwise would struggle to afford it. And it provides clinical training for veterinary students that includes creating flexible treatment plans to accommodate clients with tight budgets.
"We want, first and foremost to teach best practices of medicine and surgery," Wolfus said. "But we also want to teach our students to be compassionate caregivers and help our clients to overcome barriers to ... access to veterinary care."
How it works
The small animal outpatient clinic occupies 2,200 square feet at Worcester Technical High School, a 15-minute drive from the Tufts veterinary school in North Grafton. Services include microchipping, vaccinations, spaying and neutering, surgery and dental care.
The services are significantly discounted — Wolfus said prices are targeted at below 25% of the national and local fee average. To qualify, pet owners must be eligible for the Supplemental Nutrition Assistance Program or the Women, Infants and Children program; or be Worcester Housing Authority residents; or attend Worcester Technical High School (100% of students are eligible for federally subsidized meals). At every appointment, clients must show proof of qualification and attest that the animal needing care is theirs.
Twenty to 30 high school students are accepted to the program each year; a waiting list is usual, according to Patricia Suomala, the school's director of career vocational technical education.
The high school pays for their classroom instruction, while Tufts pays for veterinarians and clinical staff. During freshman and sophomore years, the students learn everything from medical terminology to animal restraint to interpersonal skills to dog and cat breeds before entering the clinic starting junior year.
All Tufts fourth-year veterinary students must spend at least three weeks in the clinic, and may spend another three to four weeks as an elective.
The clinic is supported partly by donations from foundations and individuals, grants and gifts of equipment. Clinic revenue contributes 75% toward the $700,000 operating budget, Wolfus said.
Two full-time and one part-time veterinarian are employed there; several more volunteer. There are two full-time veterinary technicians and one part-timer, a receptionist and a veterinary assistant. Ten veterinary students and 10 to 12 high school students round out the staff at any given time.
The clinic is always busy, with 20 to 30 patients and two or three surgeries a day, said Dr. Kayla Sample, a former clinic intern who went on to help establish the clinic at Monty Tech and now serves as a liaison between the programs.
Patients are seen by a veterinary student, who obtains the pet's medical history from the owner, examines the animal and talks to the client about any concerns. The student then takes the patient to a licensed veterinarian and presents an opinion on diagnostics and treatment, while the veterinarian asks questions about the case. Once the veterinarian and student agree on a plan for the patient, along with a secondary plan in case the first is not financially feasible for its owner, the student returns to the client, discusses options, and orders medications and diagnostics as necessary.
Sample said the clinic is unusual in the amount of authority given to veterinary students. "This is one of the few places where the students are truly treated as the doctor," she said.
High school students assist in reception work, collecting patient histories, inventory and stocking, cleaning and maintenance, and restraining animals during procedures. They are allowed to watch surgeries and help set up X-rays (but not administer them).
The things they learn
In interviews, Sample and Wolfus expressed the joy of teaching the teenaged students. "They’re really excited about all the cute puppies and fun, squishy things," Wolfus said, "and they [also] encounter really difficult things, so sometimes we have to support them as they're encountering some of these difficult things, whether it be dying animals or dealing with euthanasia or seeing something gross for the first time."
Dr. Kayla Sample
Photo by Dr. Greg Wolfus
Dr. Kayla Sample, who arrived at Tufts at Tech in 2018 as an intern with a passion for not only animals but their communities, is shown finishing a tooth extraction. Sample helped set up a similar clinic last year at another vocational-technical high school about 30 miles away. Previously, she worked in California at a clinic dedicated to serving pets of homeless people; and in Minnesota, caring for pets in Native American communities.
Sample described a moment during an amputation when a high school student, filled with wonder, felt a blood vessel pulsing with the patient's heartbeat. "Just to see her face and see how excited she got about what we were doing, and how much better that animal was going to feel, was a really exciting teaching moment," she said.
Betsy Hensley, a veterinary technician and head of the school's Animal Science Department, said the students are "empowered, not just with veterinary knowledge, but with job skills. So they're answering phones, they’re making appointments, they're taking cash payments, they're giving cash back, they're educating clients, and in this generation of cellphone kids, these are new skills that make them highly employable.
"When we ask them as sophomores, 'What are you most afraid of going into the clinic?' it’s not big dogs or scary cats — it's talking on the phone. It’s people. And so we give them those life skills, too," Hensley said.
Addressing concerns of unfair competition
Understanding that tension between for-profit and not-for-profit veterinary practices exists in some quarters, Wolfus said that when the clinic was first established, he called every veterinary practice within 20 miles and offered to meet with them. He wanted to avoid being labeled competition, since Tufts at Tech would pitch itself expressly to clients with financial need.
"By building these relationships and having these relationships beforehand, we put ourselves in a position whereby if veterinarians do have that client who has that need for service but lack of resources, and that client qualifies for our clinic, we're actually a referral outlet," Wolfus said.
Dr. Laurence Sawyer was in private practice in the next town over when Tufts at Tech opened. She recalls that unfair competition was "absolutely a concern" among area veterinarians at the time. "In fact, there was a board of local veterinarians set up to advise Tufts at Tech regarding that specific issue," she said by email. "As it turns out, it's a non-issue."
Today, Sawyer is medical director of Angell at Nashoba, the first clinic to follow the Tufts at Tech model. "When I heard Angell was interested in doing something similar ... I wanted to help create this clinic and bring a lot of the good things that Tufts at Tech does well," she said.
Regarding competing with for-profit practices, Sawyer said, "What we found both at Tufts at Tech and Angell at Nashoba is that clients we are helping with their pets are having to make difficult life choices, such as how to afford food and clothes for their family, as well as afford medical care for their beloved pet. Most of the low-income owners would barely be able to afford an office visit at regular prices, much less surgical or medical care for sick animals."
Providing financially feasible care, she said, "helps reduce animal surrender or euthanasia and keeps animals who are important to the families' physical and emotional well-being with them."
One common criticism of subsidized veterinary care is that it encourages pet ownership among people who can't afford it. Hensley at Worcester Tech had that opinion once.
"Being a crusty old technician, there’s been a time in my life where I would have said, 'If you can't afford a pet, you shouldn't have one,' " she said. "I do not feel that way at all now, and I can't believe I ever felt that way. ... Pets mean so much to so many people. It doesn't matter how much money you have — pets are family. Pets are sometimes the only living being that this person has."
That's why it's important to provide some sort of care, she believes, even if not the gold standard.
Diversifying the profession
Another impact of the clinic, Wolfus said, is encouraging students who might not otherwise be exposed to veterinary medicine to consider it as a career.
"We as a profession do have to confront and accept that we are the whitest profession in America, and there’s a number of different reasons for why that is," he said. "But if we're not exposing youth from other cultures, other economic backgrounds, other people, [to] this profession and all the amazing rewards that it has to offer for the individual and for society, then we're not really trying to combat that problem very well."
U.S. Bureau of Labor Statistics data show that while the veterinary profession is no longer the whitest occupation in America, as it was in 2013, it remains among the whitest, at nearly 90% in 2019.
Most Worcester Tech students are people of color. The single largest ethnic group is Hispanic, at 37%, according to Massachusetts Department of Elementary and Secondary Education data. Half of all the students speak a language other than English as their first language; 43% are economically disadvantaged.
Another way the programs can promote diversity is through employment, said Sample, who is Hispanic. "Particularly as a female and a person of color, I think it's really important that the high school students can see me as a role model and see that they could be a veterinarian if they chose to," she said. "One of my main goals ... is to help diversify our profession, and I want the students to be able to see what it's like to be in veterinary medicine early, and hopefully get their interest enough so that they continue in this field."
About 800 veterinary students and 130 high school students have experienced Tufts at Tech so far. Some high school alumni have gone on to work at other veterinary clinics in the state, Wolfus said, and two have been accepted to veterinary school. Others pursue related fields.
Shayla Roman is an example. A 2019 graduate, Roman is studying animal science at the University of Connecticut. She recently began working in a laboratory that's doing COVID-19-related research, and is considering a career in human medicine.
The high school clinic "really prepared me for working with different types of people ..." she said. "People with their pets, it’s like they’re their kids, so dealing with having to let them know some hard news, as well, too, it helped me work ... with a lot of personalities in the workplace, and just being prepared to really be kind and serve the clients first-hand and always put the animal’s health first."
Roman added, "Tufts at Tech definitely helped me grow into the person that I am today."
Some 30 miles from Worcester Tech, leaders at Montachusetts Regional Vocational Technical School in Fitchburg began fundraising for their own clinic about seven years ago. Students from the high school built the facility, from plumbing to electrical wiring to cabinets.
Sample said she joined the program at the request of VCA, which sponsors her salary. VCA, owned by Mars Inc., is one of the largest veterinary practice chains in the U.S.
Unlike Tufts at Tech, Monty Tech is not formally partnered with the veterinary school but does receive students who elect to serve a rotation there. The clinic has three veterinarians, including Sample.
Creating a program from scratch was challenging, Sample admitted. Adequately preparing high school students to work in a clinic, building a team, and establishing relationships between high school students and veterinary students were all hurdles.
"I was so glad that I had Tufts at Tech as an example of what it was like to run a successful clinic … " Sample said, "because I don't know if I would have told you that this sort of thing would have been possible without already seeing it in action."