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Vet Protectionism and Ancillary Services
Posted: December 15, 2010, 2 p.m., EDT
By Patty Khuly, VMD, MBA
Big dog’s got a bone. When a little one comes around he snarls and growls, showing off those big white teeth and prodigious hackles.
No way does he plan on sharing.
So it goes with veterinarians and the army of pet care providers who offer ancillary services such as chiropractic, massage and acupuncture. If the provider is not a licensed veterinarian or under the direct supervision of a veterinarian, our profession is staunchly opposed to these layperson practices.
Because no way do we plan on sharing.
I got to thinking about this perennial issue after one of my blog’s readers posed a question:
“Every now and then I see [an] attempt to pass legislation that will outlaw common husbandry practices by anyone except a veterinarian. Here is an example of the fallout: [A case in which a popular equine floater was asked by veterinarians to cease and desist her services.]
“This has to do with floating teeth in horses, but the law is so vague it could apply to other things as well, even to dog trainers. I have a great deal of respect for veterinarians, but I don’t think they are the experts in everything to do with animals, so I am concerned about attempts to take over husbandry. Do you have any thoughts on this issue?”
Why, yes, I do.
No-Go in Missouri
But first, some basic background on this case, one that pits a trained, experienced floater, Brooke Gray, against the Missouri Veterinary Medical Board. According to what appears to be her legal counsel’s website:
“On Sept. 9, 2010, the Attorney General’s Office filed a lawsuit accusing Mrs. Gray (the offending floater) of practicing veterinary medicine without a license. The Veterinary Medical Board, the plaintiff in the case, invoked the authority of a 1992 law that makes it a criminal offense for any non-veterinarian other than an owner or the owner’s full-time employee to change an animal’s physical or mental condition. Violation of the law is punishable by a fine of up to $1,000 and a year in prison for each separate animal involved.
“The breadth of this law is truly astonishing,” said Dave Roland, the attorney who has taken up Mrs. Gray’s defense. “The law offers no exceptions or narrowing definitions, meaning that if it chose to do so, the board could prevent non-veterinarians from providing such common services as horseshoeing and cattle branding, or even dog grooming and training.”
The page offered no link to the statute, nor could I find it after much searching, but if the claim with respect to its language is correct, this example offers more of the same kind of professional protectionism that veterinarians have become increasingly willing to engage in—and for good reason in many cases.
Here’s the party line:
Given our culture’s seemingly inexorable drive toward a more enlightened appreciation of animal welfare, and with more of the same barn-to-backyard-to-bed evolution to look forward to in the pet sector, it only makes sense that the public would demand higher quality care for all animals.
An Exclusive Club
Meanwhile, our profession has responded to these social pressures by ramping up production of specialists, drugs, procedures and specialty facilities, among other niceties. In so doing, we’ve sought to enact restrictions on the degree to which non-veterinary service providers may commercially offer procedures that veterinarians now consider worthy of greater quality care.
In other words, the prevailing veterinary sentiment goes like this: Animals deserve better care and that means veterinarians should provide it.
The point here is all about ensuring that our animals are treated with a high standard of care and not at all about making sure veterinarians are the ones to reap the available economic benefits of floating, chiropractic, rehab medicine, acupuncture, etc.
But is it really?
In many cases, I’ll hasten to agree. Our animals deserve the higher quality of protection afforded by the kind of work that only a licensed practitioner can provide. But is it always necessary? Is it always best?
Despite the reasonableness of the claim to pre-eminence on the front lines of everything animal, it’s been convincingly argued that such an aggressively protective stance is born of a kind of political and economic defensiveness. Sometimes it deserves to take a back seat to more pressing concerns—namely, when it comes to making animal health care more accessible (read: more economically feasible and geographically available).
By way of example, reference the act of equine floating vs. veterinary dentistry. We’re not talking about dental extractions or drug administration. Here we’re referring to the skilled practice of floating teeth with the added benefit of a trained eye keeping tabs on oral health for referral to a regular veterinarian when appropriate. A solid floater, just like any great tech or judicious groomer, is golden.
This, I believe. And so say many thousands of happy horse owners across the U.S. The fact that it costs less means she can afford to have it done more often, says one of my caprine clients.
This, she sheepishly explains, is also why she now gets the farrier to trim her goats’ hooves, too.
Not Brain Surgery
Which is something I can absolutely get behind. After all, it’s not brain surgery. And I’m willing to bet the farrier does a far better job of it than I ever could and at half the price.
Which, of course, frees me up to talk vaccines, mastitis and parasites, right? Sure, if she wants the trim, I’ll do it. But much like taking money for flea and tick products at the hospital, it’s a convenience item––decidedly not my bread and butter.
Traditional medicine and surgery? Yes, that’s way different. That is what we do best, after all.
Increasingly, however, ancillary services are making their way up the veterinary food chain as a result of owner demand. Chiropractic, acupuncture, rehabbing, floating and farrier work? The first three I question, the latter two not so much.
So, too, do hoof, claw and beak trimming seem outsourceable. How about grooming, training and behavior work? Why are these considered so eminently doable by outsiders? Why have we not laid claim to them?
I guess the difference comes down to what veterinarians actually consider physically therapeutic. Never mind that behavior work is arguably more lifesaving than what many of us dedicate our lives to.
Yet many of these para-veterinarians are exceptionally competent providers of services in which those who practice lots of it will almost always do it better.
While attention to medical issues is critical to many of these animal practices, they’re all amenable to the kind of schooling these trade groups know how to offer.
The trouble, however, is that few providers of increasingly sought-after animal services have the organizational and financial wherewithal to take a stand, argue their case and further their para-profession. Instead of enjoying the luxuries of continuing education and formal collegiality, they are treated to veterinary push-back.
So back to the original question: Is it fair to let veterinarians take over husbandry?
Of course not. Veterinarians should not be the de facto boss of all things related to animal care. Nonetheless, if veterinarians are charged with standing up for what’s best for animals’ health care, is it not our role to try and raise husbandry standards across the spectrum?
I think so. The trouble comes when instead of lending our related trade groups a hand with training, certification and adoption of higher standards, we prefer to snarl and growl and bare our teeth. That helps animals not at all.
Dr. Khuly is a mixed-animal practitioner in Miami and a passionate blogger at PetMD.com /blogs/FullyVetted.
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