Among myriad consequences of the COVID-19 crisis, one is particularly difficult for veterinary practice owners: turning away business.
Due to social distance recommendations, shelter-in-place orders, and some more extensive directives from state governments, practitioners are forced to consider each appointment on a case-by-case business and ask the question: “is this essential?”
A Financial Burden
“If you’re a veterinary practice owner, the right thing to do is to cut your revenue extensively because you should not be doing anything that is not truly essential,” says Dr. Beth Davidow, DVM and president-elect of the American College of Veterinary Emergency and Critical Care. “States are defining essential veterinary services in different ways (see the AVMA’s state-by-state spreadsheet), so it’s confusing to figure out what that is, and there are lots of cases that are unclear. But even if you say I’m not going to do anything that’s truly elective right now, that affects your business, ability to pay your employees, and loans. Trying to navigate doing the right thing and not go out of business is a huge challenge.”
Mark Cushing, founding partner of the Animal Policy Group and former litigator, is tracking the state-by-state regulations, which can change quickly. He recommends keeping daily tabs on announcements from your state government and state VMA.
“In the peak crisis states—New York, and so forth—you are starting to see governors and mayors step in and say: ‘veterinarians, here are some things you can’t do. Don’t do spay and neuters if they can be delayed. Don’t do wellness exams if they can be delayed. Don’t do non-emergency dental procedures.’
“(But) they still leave it to the practitioner to determine what’s medically necessary. That’s a good thing. You don’t want a politician to tell a trained veterinarian with a 4-year-old cocker spaniel in front of her what the medical needs are. But you have veterinarians in those states trying to figure out: OK, if I’m making the call of what is an emergency, and there’s a breed of dog with a lifespan of 6 to 8 years, you may view that annual wellness exam as absolutely necessary.”
Cushing suggests evaluating each case by considering: “Can we postpone this 3 months and still be all right?”
Potential Repercussions
With the discretion being left to practitioners, they may be feeling the pressure of social responsibility and potential legal ramifications with each decision. Cushing urges veterinarians keep things in perspective.
“It’s hard to stay calm right now,” says Cushing. “But don’t worry that when the COVID crisis slows down the state is going to be sending out letters and subpoenas and making phone calls saying, ‘We heard a rumor that you did this procedure on April 13. That wasn’t right. Come in and give us your license.’
“There’s a certain mentality that’s afraid of that. I understand, but that’s not what’s going to happen here. Ultimately, there’s more discretion allowed than people may think.”
In order to help veterinarians make tough decisions, NAVC Chief Veterinary Officer Dana Varble, DVM, developed a decision tree based on a few key distinctions: whether telemedicine can be used, whether the case is an emergency or preventative, whether the animal is food-producing or a companion animal, and more.
For practitioners in areas with active COVID-19 cases, the AVMA advises that “serious consideration should be given to limiting in-person patient care to acutely ill animals, urgent cases/emergencies, and cases/procedures having public health implications.”
The “discretion” that Cushing cites as a good thing because it puts medical decisions in the hands of trained professionals also creates unavoidable ambiguity. For additional tools and resources, see the provided articles and tools below.
Essential Procedure Resources
• NAVC Essential Procedure Downloadable Decision Tree