Dr. Ernie Ward's Tales from the COVID-19 Veterinary Front Lines
Note: These reports were originally published in Today’s Veterinary Business
May 10, 2020
Record Veterinary Revenues versus Record US Unemployment:
What Does the Future Hold for Veterinary Professionals?
“We’re working overtime!” Every veterinary clinic I spoke with this week reported “higher than expected” appointments and revenues. This was in stark contrast to the Department of Labor reports that 14.7% of American workers were not working at all. What does this economic dichotomy mean for veterinary professionals during the upcoming months?
Temporary Demand for Veterinary Services?
In-clinic veterinary visits will likely see an increase in the next few weeks as pent-up demand peaks. Once this initial wave of visits subsides, expect to see a gradual slowdown in the third quarter. If a second, severe US outbreak of COVID-19 occurs in the fall, I think the rest of 2020 will be in economic jeopardy and continue until we have a fully-deployed vaccine. If we don’t experience a significant second coronavirus wave, and a vaccine remains on schedule for the first quarter of 2021, I believe we’ll begin to experience real economic recovery during the first half of 2021.
Increasing Price Pressure
Cash-strapped, underemployed, and unemployed pet owners will desperately seek deals and discounts if unemployment persists more than another few weeks. Annual visits, immunizations, and preventives may take a hit as families are forced to choose between food and heartworm medication. Manufacturer rebates and discounts will likely be needed to keep these pet parents administering basic endo- and ectoparasite preventives over the next several months.
It’s hard to make up these financial losses. American families will have to make spending cuts somewhere, with discretionary expenses such as dining out, vacations, and preventive pet care some of the first to go. Overall, I think we should expect to see general practice veterinary revenues down at least 10% in 2020. I’d consider that a huge economic win for the veterinary profession.
Waves of Good and Bad Economic Times
Those of us in the veterinary and pet industries need to be prepared for waves of good and bad economic times over the next two years, with various sectors disproportionately affected. The early winners will be online sales and services and the losers will be legacy business models based solely on in-person transactions and over-priced offerings.
Shift to Online and DTC
There will be a continued shift toward online purchasing of all pet supplies, including pharmaceuticals and food. This means in-clinic and in-store sales will suffer and expect more companies to further decrease their reliance on selling through the traditional veterinary clinic channel.
Over the next six months, we’ll begin seeing more pharmaceutical and food companies offer their products direct-to-consumer or through strategic acquisitions or alliances with online retailers. How long can Zoetis, Boehringer Ingelheim, Merck, or Mars delay partnering, acquiring, or starting an online DTC channel? I think the market will soon force them to be more aggressive in these growth opportunities as consumer demand expands.
ER and Specialty Stay Strong
ER visits will likely increase as pet parents delay preventive care and lose contact with general practitioners. Specialty clinics will thrive because higher-income earners, many shielded from pandemic economic impacts, will continue to be able to afford their servings.
Pet insurance will also be an essential element of future general veterinary medicine success. The coming direct-to-pet parent, in-home diagnostic test boom will also compel veterinarians to shift how we interact with clients and could catalyze in-clinic diagnostic growth if we message and frame it correctly.
There will be unimaginable opportunities to innovate and grow during the next couple of years. Times of resource scarcity serve as the best pressure cookers to create amazing new recipes for success. Stay safe and take this chance to reinvent how you practice veterinary medicine. Good luck!
May 3, 2020
“Back to work!”
“We’re getting back to work!” All across the country, veterinarians I spoke with were eager “to get back to normal.” As many state and local agencies began easing work restrictions, the question shifted to how to keep staff, clients, and pet patients safe from SARS-CoV-2 infection in a busy veterinary clinic.
Most veterinary clinics I spoke with said they would continue providing curbside service “for the foreseeable future.” One veterinary owner said she was advertising “valet service” for pet parents who would rather wait in their car.
While curbside service has worked well during this initial pandemic phase, I don’t see this as a practical long term solution for veterinary care. Inclement weather, rainstorms, heat waves, and the lack of interpersonal communication and worries that their “fur baby” is alone and scared, hurting, or frightened will likely result in pet parents seeking other forms of care. For many cat owners, the stress and anxiety associated with curbside service is even worse, leading many to skip well visits.
Many human parents fear their child will pick up an infection from a sick child when visiting their pediatrician. The CDC recently released data that an alarming number of toddlers are missing essential childhood immunizations during the pandemic due to these suspicions.
Many pet parents share the same worry. Some cat owners are beginning to say they’re more anxious about their cat getting COVID-19 when visiting their veterinarian than themselves.
Perhaps the most obvious strategy to help allay these fears is staggered patient scheduling. In simplest terms, the clinic books well visits in the morning and sick patients in the afternoon. The rationale is that the clinic environment will be most aseptic in the morning after cleaning the previous evening. By reserving time periods before any potentially infectious patients enter the building, we reduce the risk of environmental contamination. This protocol is utilized in many human medical facilities, especially pediatric practices. Separate exam rooms and waiting areas for sick and healthy pets is another strategy to calm concerns.
Many of you have seen grocery stores using directional arrows on their floors and at checkout to guide shoppers and encourage safe social distancing. Consider applying this tactic in your clinic. Blue arrows direct healthy pets, red arrows guide those with sick pets, and black lines indicate where to wait.
I believe we’ll see innovation in protective plexiglass barriers for use in clinic lobbies and exam rooms. In addition, veterinary clinics should be actively pursuing online ordering, home delivery, touchless payment options, and self checkout.
Many minor medical visits can be safely and effectively transferred to telemedicine, and I encourage my colleagues to continue expanding these services.
The demand for mobile, on-demand, and in-home veterinary services will grow, especially in multi-cat households. This continues to be an area ripe for innovation and development.
April 26, 2020
Busy Veterinary Practices
“Busy!” was the word I heard most last week to describe veterinary practices.
From coast-to-coast, nearly every veterinary professional I spoke with shared stories of parking lots full of pet parents waiting inside their vehicles for curbside services. One practice owner joked, “I know I’m supposed to tell you how bad things are, but the truth is we just had our best week ever!” She shared that despite discontinuing spays and neuters (“Except for a few special cases.”), her clinic was essentially, “providing the same level of care” as pre-pandemic.
Most veterinarians responded that annual and puppy/kitten vaccines were the top appointment requests, followed by dermatological and gastrointestinal conditions. Nearly every veterinary professional I interviewed estimated their pandemic-period revenue was down “about 10 to 20% overall.”
Few revealed supply shortages other than certain PPE, notably masks and gowns. Several mentioned deliveries were running smoothly, “although a couple of days slower.”
Almost all veterinary professionals I spoke with were using “homemade” or cloth face masks and reusing gowns and shoe covers “until the arms and soles wear out.”
I observed an increasing number of veterinarians expressing frustration with mandated stay-at-home orders and business closings last week. Veterinarians in states that were beginning to lift restrictions overwhelmingly felt it was “the right thing to do,” and others worried that their state was “moving too slowly to get back to work.” A couple of veterinary professionals in California and New York said they “didn’t understand the rush to open everything until we better understand COVID-19.” and worried about a “relapse later this year.”
My main conclusion was that US veterinarians were largely back to work and many were finding ways to thrive despite this unprecedented situation.
When I asked about a potential economic recession or depression, most replied, “Who knows?” No one I spoke with believed the recent stimulus checks were responsible for pet parents seeking pet services or supplies.
This week a few states will end business restrictions. As the nation closely watches for surges in new COVID-19 cases in these areas, veterinarians anxiously await approval to return to the work they love: caring for pets.
April 19, 2020
Street Talk: “90% Normal” and “We’re Almost Done”
A swell of “pandemic puppies” is helping to keep veterinary clinics afloat during the coronavirus crisis, according to my conversations with veterinary professionals last week. Many practice owners are telling me “they’re 90% normal” and seeing a surge in new puppy visits and spay/neuter requests. Almost everyone I spoke with is “trying to resume normal operations” as quickly as possible. Some cite providing services is based on a low number of COVID-19 case reports in their area, while others stated, “If I don’t see their pet, someone else will.”
In general, veterinary services have been classified as “essential services” by state and local agencies and allowed to remain open for business. There is widespread consensus that the intent of these safeguards was to provide uninterrupted emergency veterinary medical services while reducing the risk of spreading SARS-CoV-2 to vulnerable populations. In application, many veterinary clinics initially reduced their service offerings due to decreased demand or staff shortages; however, as the pandemic wore on, many have resumed providing “routine” or non-emergency veterinary services. In fact, one owner remarked, “this April is beating last year [in revenue] so far, maybe because of this pandemic.”
Most of the veterinary professionals I encountered believe the current stay-at-home orders will begin to ease by the end of May. The responses tended to break based on geography: west coast, New York, and Illinois state veterinary professionals indicated restrictions would be lifted in the fall; southeastern and northeastern states by the end May; and midwestern veterinary professionals believed “by May.”
When asked what safety measures clinics had implemented for their staff, the overwhelming majority offered “curbside service, limiting clients in the building and social distancing between clients and staff.” Most were asking their staff to wear surgical masks when working with pet patients or interacting with clients, but few required them to be worn at all times. About half were using gowns and gloves, and only a few advocated face shields or eye protection. None offered anything to clients other than hand sanitizer and occasional surgical masks.
On a personal note, I was disappointed to hear that only about a quarter of the veterinary clinics I surveyed were offering telemedicine to their clients.
Instead, many utilized videoconferencing only with clients waiting in cars while they examined the pet in the clinic. Almost all were refilling prescription medications and supplies “over the phone” with some using an online store and most asking clients to pick up purchases at the clinic after prepayment.
The resounding sentiment was “the end is near” and “we’ve almost made it.” The fear and pessimism of four to five weeks ago has been largely replaced with cautious optimism.
While I’m concerned this may prove to be a premature declaration of victory and that prolonged unemployment and economic recession may become apparent over the coming months, there was no denying the feeling among my veterinary peers of “we’re almost done.” I pray they’re right. I fear this is far from over.
Stay safe and give your pets a hug from me. We got this. It just may take a little longer than we want.
April 12, 2020
Anger, Frustration, and Anxiety
Anger, frustration, and anxiety were the feelings I encountered from many of my veterinary colleagues this week. I could begin to see cracks in the brave faces of some of my most positive and optimistic friends as the COVID-19 pandemic drags on.
In general, most folks in my network are asking two questions, “Why?” and “How long will it last?” The answers are beginning to create some negative responses.
Anger was a new emotion I observed this week. Many veterinarians and veterinary support staff are angry at the general stay-at-home situation, angry at hostile clients demanding nail trims and bosses and managers relenting to them, and angry that there is still so much uncertainty about SARS-CoV-2. I’m hearing increasing stories about clients acting more aggressively and insisting on being seen for non-essential services, including bathing and long-overdue vaccines. Clients are also reported to be quick-tempered when being asked to wait in cars while their pet is taken from them into the clinic.
Of course, there are also many tales of compassionate bosses doling out “hazard pay bonuses” and pet parents dropping off food deliveries in appreciation of their service. It’s these tiny acts of gratitude that nurture us during stressful times.
Frustration with state and federal government economic recovery programs is another sentiment colleagues are sharing. What was supposed to be a fairly straightforward disaster assistance program has morphed into a convoluted and complicated application process with new limitations announced nearly daily this week. Many veterinarians complained that they doubted if they or their staff would see much financial assistance if any at all. Hopefully over the next few weeks will see the much-publicized and promised economic recovery funds helping our professional peers.
Anxiety is also creeping into the conversations I’m having with veterinary professionals around the country. Most of the anxiety is centered around when will we resume “normal business?” and “What will my practice revenue be once this is over?” While no one has a clear answer, I believe we’ll begin to see glimmers of positive economic news by the end of the year. Historically, veterinary services and pet supplies have better withstood economic downturns than other sectors of our economy. My observation is that the surge in “pandemic pets” (pets adopted during the COVID-19 crisis) will provide a boost to overall veterinary and pet revenues in the second half of 2020.
My advice is to continue to put the proverbial one foot in front of the other each day. Some days will seem “almost normal” while others seem downright apocalyptic. That’s okay and perfectly understandable. We all feel that way. By staying in touch with each other we can realize that we’re not alone in this or unique in our emotions. This is real life, pandemics and all. Stay safe, and give your pets a hug from me. It’s good for us all.
April 5, 2020
Practice volumes plummet, online sales boom, veterinary staff stressed and worried
Last week we definitely observed veterinary practice revenues take a beating as pet parents hunkered down in most of the country. While some clinics reported service demand remained high, most expressed revenue and transactions suffered due to decreased appointment requests and limited staff resources. Many clinics have reduced staff hours by 20% to 50% and often only have one veterinarian on active duty at a time. Curbside care has become the norm while only allowing clients inside the clinic for procedures such as euthanasia.
It’s no surprise that online shopping for pet medications and preventives, food, and supplies continues to boom. Chewy, Amazon, PetMeds, Covetrus (VetsFirstChoice), and VetSource have all seen surges in pet-related sales. I believe many of these “stay-at-home” purchase habits will persist beyond the pandemic, indicating a potential softening of veterinary pharmaceutical sales in the future.
I’m also hearing many veterinary technicians and support staff complain that they’re being put at undue risk for “nail trims, anal glands, and past-due distemper vaccines.” Staff stress seems to be escalating, with worries about contracting COVID-19 at work, job security, and overall lack of concern from management and owners topping the list.
This is the time for management and owners to focus on the needs and worries of their staff, and treat them with utmost respect and appreciation. The practices that truly make their staff a priority during this crisis will be rewarded with incredible loyalty and improved productivity once business returns to normal. The practices that rule by fear (“You’ve got to come to work or we’ll go out of business!”) or shame (“Are you afraid of getting sick? You’ve got to be kidding. You’re healthy. You’ve got nothing to worry about.”) will see a continued deterioration of staff morale and will likely see decreases in efficiency and productivity as resentment grows.
These are the times to build a legacy. Will you be known as a leader who puts people first, innovates veterinary care, and is remembered for how you supported others during this crisis or will you be remembered as uncaring, unempathetic, and focused only on money? Crises bring out our best and worst traits; be sure to focus on bringing your best each day in the coming weeks. Stay safe and give your pets a hug from me!
March 30, 2020
This is the week COVID-19 mutated from “inconvenience” to “existential threat” for many veterinary professionals
Veterinary clinics across the nation are now facing mandatory restrictions imposed by health authorities limiting services to emergencies and critical follow-up care. While many clinics are utilizing curbside care, the initial surge of demand over the past two weeks is beginning to slow down as pet parents become increasingly worried about their jobs and personal finances. In addition, many support staff are telling me they are worried about contracting COVID-19 from clients or co-workers and cite the lack of adequate PPE and training as their biggest complaints. Others question the ethics of being told by their boss to call past-due clients to come in for annual immunizations when their county or state is instructing people to stay at home. In general, I’m hearing a large number of worried support staff who fear they must choose to risk coronavirus infection and potentially transmitting it to loved ones or their job.
I think the coronavirus response spectrum continues to be polarized within the veterinary community, reflecting what we’re seeing nationwide. Some veterinary clinics view this as a “big city” problem that isn’t affecting their rural community and they’re open for business, albeit with a few new protocols. Others have voluntarily closed their clinics in an attempt to slow the spread of COVID-19 nationwide and reduce risk to their support staff and clients.
What’s surprising is that despite being nearly four months since the COVID-19 outbreak began in the US, there still doesn’t seem to be a unifying consensus of the scope, depth, or response within the veterinary profession. This has created a nationwide patchwork of recommendations, with some clinics continuing to perform nail trims while others delay treating all but life-threatening conditions. Veterinary medicine cares for a tremendous number of species, hosts a variety of specialties, and bears significant responsibility for public health. I believe COVID-19 can help remind the public of the value and importance of veterinarians around the world if we take bold stands for both the present and future responses in the name of One Health.
Finally, all US small business owners, including veterinary practice owners, should take full advantage of the Federal CARES act stimulus offerings that begin April 1, 2020. I’m being told this will be on a first-come-first-served basis, so I advise all owners to contact their accountant or financial advisors immediately. In essence, this is a two-month “financial gift” that could cover staff salaries, benefits, and rent as long as you maintain 90% payroll during the pandemic period. There are many details yet to emerge, but my best advice is to get started on determining if you qualify for the CARES act or Families First Coronavirus Response Act (FFCRA) today.
The following two weeks will see veterinarians scramble to duct tape together a telemedicine strategy. Along with many others, Many of us are working and advocating for a telemedicine solution to help US and UK veterinarians.
I believe one of the lasting legacies of this pandemic will be the widespread deployment and acceptance of veterinary telemedicine. In the short-term, it will help clinics bridge the relationship- and care-gap and maintain revenues. In the long term, it will redefine what a patient-doctor relationship can be and expand the reach of veterinary medicine to a larger client and patient base.
March 22, 2020
Now is the Time to Over-Communicate with your Staff and Clients
Direct email to clients is perhaps the best way to stay connected during this crisis. Social media posts are helpful at relaying hours or operation or changes in the scope of services, but nothing beats a personal email from veterinary providers. Many pet parents will be working from home, making emails more likely to be read and opened, especially if it’s from a trusted source of truth.
I advise veterinary clinics to send out weekly updates citing local news and announcements, along with steps the clinic continues to take to prevent the spread of Covid-19 while preserving the health of their pet patients. Be sure to include how your team can be reached, whether by phone, text, website, or messaging service.
This is also an excellent time to have pet owners conduct at-home health checks such as teeth and oral exams, weight and body condition, skin and fur, lumps or bumps, and behavior. Pet parents are interested in doing things with their pets while working from home, so I encourage veterinary clinics to provide them with activities to do with and for their pets.
You also need to inform your clients about what to do in an emergency. Provide quick links and telephone numbers to available local emergency clinics.
Texting and direct messaging can also serve as a lifeline between your veterinary practice and clients. Text can be especially helpful in coordinating curbside veterinary care, pet drop-off, or pickup of medications or food.
It’s essential that all veterinary clinics keep their Google Business profile current. Operating hours need to be updated to reflect changes as they happen. Nothing is more frustrating than an owner expecting your clinic to be open, only to find you’re closed.
You should be in contact with your clients at least weekly or as major developments occur. Veterinary clinics should strive to be the trusted source of information for their clients during this time. If pet parents aren't hearing from their personal veterinary team, they’ll turn to the internet and social media for advice. This crisis presents an opportunity to bond with your clients by providing updated and personalized information and advice on keeping your pet patients healthy and happy during tremendous stress.
Be clear with your messaging to avoid further confusing pet parents overwhelmed by information. A recent example of a well-intended message gone bad was made by a group of popular Instagram veterinarians. They posted a meme with the message, “Your pets are at no risk from coronavirus.” Dogs have at least two documented coronaviral infections and cats are famously infected withe coronavirus that causes deadly FIP. Pet parents were understandably confused.
Under intense scrutiny, the group then deleted the “coronavirus” and replaced it with “Covid-19,” only to come under additional criticism because dog and cat fur can serve as a mechanical vector or fomite for SARS-CoV-2 transmission to humans in the same way as contacting a contaminated door handle or handrail. The fact is that there is currently no evidence that SARS-CoV-2 can cause active infection in dogs and cats or that pets can actively spread Covid-19 to pets, other than accidentally. This type of unclear messaging potentially creates more doubt and distrust when the pet-owning public desperately needs accurate information in order to keep their pets and human family members safe.
(Note: see my article and video published over two weeks before the meme mentioned was shared: https://www.drernieward.com/blog/coronavirus)
Practice Tips during the Pandemic
1) To ensure the safety and wellbeing of both veterinary healthcare staff and the public, veterinarians need to reduce or eliminate all non-emergency care during the Covid-19 pandemic. Minor medical conditions such as skin allergies, arthritis, and recheck appointments should be conducted by telemedicine whenever appropriate and possible. Home delivery or curbside pickup of medications, pet food, and supplies should be standard practice during this crisis.
2) (See my article on this here: https://www.drernieward.com/blog/2020/3/17/the-coronavirus-catalyst-for-telemedicine) My advice to veterinarians during this crisis is to begin experimenting with telemedicine. You’re likely going to experience days with few appointments, and many clinics are already discouraging routine or non-emergency visits. This is an excellent opportunity to offer remote consultations and virtual minor medical checkups for existing clients. Within the current VCPR rules, most states allow that if a client and pet have visited you within the past year, you can offer telemedicine if you deem appropriate. Skin allergies, osteoarthritis, many minor medical and follow-up visits can be safely and accurately conducted by videoconference. If you determine a pet’s condition is more serious or complicated and needs to be seen in your office, you can do that, too.
3) Curbside veterinary care is a lot simpler and potentially safer than having pet parents enter your clinic during mandated this pandemic. Schedule a time for the pet parent to be in your parking lot by phone or text. Whenever possible, instruct the client to bathe their pet immediately prior to departing for your clinic. this is especially important if the household has a family member diagnosed with Covid-19 or is experiencing symptoms. Have them call or message you as soon as they arrive.
Staff members should wear proper personal protective equipment (PPE) including N95 respirators (keep in mind that studies show common surgical masks do little to prevent SARS-CoV-2 infection), eye shields, and gowns. While this may seem excessive, the concern is that the Covid-19 virus can remain viable on a pet's skin and fur for 24 hours.
Veterinary personnel need to be careful to avoid physical contact with pet owners when accepting their pet. If possible, the staff member should perform as much of the examination or treatment outside the veterinary clinic. Touchless payment using online services should be encouraged instead of handling cash, checks, or even credit cards.
4) If a pet parent must accompany a pet inside the clinic, limit to one person. Ideally, have the client disinfect their skin before or immediately upon entry and provide a facemask if possible to reduce the chances of the client transmitting the virus to your team. Be sure to ask if the client or anyone in their home has been diagnosed with Covid-19 or is experiencing any symptoms. If your community is severely affected, consider checking the body temperature of staff and clients before entering your facility.