Emergency Care Not There?

Hospitals Work to Meet Care Challenges with Alternative Approaches

When 10-year-old Max vomited and had diarrhea on the Saturday before a long holiday weekend, his owners rushed him to their local veterinarian. The dog was stable after being given intravenous fluids and antibiotics. A blood test did not indicate a problem, but a further workup was not possible as the hospital was closing. The owners planned to return when the hospital reopened Tuesday.

However, when Max’s signs returned early that Tuesday morning, they contacted the local emergency hospital only to find it closed for the holiday. When they reached out to another emergency hospital about 40 minutes away, they found it was open but at capacity. Not aware of any alternatives, the owners were left to comfort Max at home until he passed away at 5 a.m.

The veterinary industry’s challenges could see more pet owners face such heart-breaking situations.

Mars Veterinary Health, for example, currently operates 75 VCA hospitals and 103 BluePearl hospitals, according to Molly McAllister, DVM, MPH, chief medical officer. However, as of May 2024, only 59 VCA hospitals and 49 BluePearl hospitals offered 24/7 emergency services.

“The industry is facing a chronic shortage of veterinary professionals, and this includes emergency veterinarians and support staff,” McAllister said. “Across our US practices alone, we have hundreds of emergency veterinarian openings, along with 1,200-plus open credentialed veterinary technician positions, many of which are in our emergency hospitals.”

Veterinary candidates want work-life balance and flexibility, so positions where they work evenings and weekends are less sought after, explained McAllister. However, emergency situations have prompted some alternative approaches to arise.

Relationships Matter

Tracy Nyberg, DVM, owns Stuga North Veterinary Care in Marquette, Michigan. She said it is the expectation in this small, tight-knit community on the shores of Lake Superior that hospitals have a veterinarian available for emergencies.

But rather than be a detriment, Nyberg sees these often-stressful cases as having molded her “into the capable clinician I am today. In order to obtain the trust and relationship with clients that we value so much, offering this additional care is a necessity.”

With the closest 24/7 emergency hospitals 170 and 180 miles away, she said, “clients are very appreciative and willing to pay for emergency services. Whether it’s just talking through an issue on the phone or coming in for a full workup or surgery, clients are reassured someone is always there for them.”

When she opened the practice in fall 2020, she was the only veterinarian. She set up a separate emergency number and put it on business cards, magnets, and invoices to let clients know that she was available after hours and rotated weekends with another solo practitioner. When two associates joined, they shared the after-hours calls and rotated weekends with another local hospital. She has talked with other hospitals about setting up other rotations but has not yet figured out the logistics.

“Giving doctors one day off a week while making sure there aren’t too many on-call days in a row has been a healthy trend,” Nyberg explained. They also educate clients about when to call an emergency number and about the strain offering emergency care can place on an already-stressed veterinary team.

“Trying to keep an open communication with my associate veterinarians and giving them the autonomy to refer or say they can’t help nonclients is key to making sure we don’t burn out. All three of us have young children and struggle tremendously with the work-life balance. We talk about this openly and regularly and try to carry extra weight for each other when we need to and show each other a tremendous amount of respect and trust.

“We may be a unicorn clinic/ community up here but, after almost four years open with no turnover, I think we are doing something right. Greater cooperativity in a small community like ours or a 24/7 emergency hospital would be ideal,” said Nyberg.

A Nonprofit with Committed Leaders

When the emergency veterinary hospital in the Rochester, New York, area reduced services and availability before closing in late 2023, pet owners had to make the hour-plus drive to Buffalo, Syracuse, Albany, or Ithaca emergency hospitals in the middle of the night with their pets. Some of those pets reportedly did not survive the trips. Three local veterinarians decided to take action.

Brenda Buck, DVM, owner of Animal Hospital of Rochester; Bruce Ingersoll, DVM, a professor in Genesee Community College’s Veterinary Technology program and co-owner of York Animal Hospital; and Isadora Marion, DVM, founder of Doorbell Vet, founded Rochester Emergency Veterinary Service (REVS), a 501(c) (3) nonprofit.

They got the ball rolling in October 2023, and thanks to hundreds of donations, REVS opened the first week in February 2024, according to Adam Edwards, CEO of the nonprofit. As of May 2024, the organization was seeing about 20 patients a night, focusing on those in critical need.

“We have already seen plenty of patients that would not have been able to survive the hour-plus trip,” said Edwards, “so I’m hoping fewer people will need to experience the losses our community had to face before REVS opened.”

The hospital accepts new cases 7 p.m. to 7 a.m. weeknights and 24 hours Saturdays and Sundays. If a patient is hospitalized and requires care outside of “open” hours, there is staff working 7 a.m. to 7 p.m. weekdays to ensure needed 24-hour care.

How are they able to find staff for weekend and overnight shifts? Several factors figure in, explained Edwards:

• Staff members who had worked at the now-closed hospital preferred and were happy to again work those shifts.
• A core value of the nonprofit is treating employees fairly so they can maintain a good work-life balance.
• The organization offers competitive pay and benefits and additional overnight and weekend pay differentials.

Filling veterinarian positions, however, has been “a little more difficult,” said Edwards. As of mid-May, most day shifts were worked by Buck and most overnight/weekend emergency shifts by Ingersoll—both committed to long workweeks until a full team is aboard.

“We offer competitive pay, benefits, and mentorship opportunities to all doctors, whether they are per diem or full-time; a limited number of required weekend shifts in a month; generous CE allowances; and flexible time off and scheduling,” he said. “We want our staff to enjoy working with us. We know that the work our staff does is physically, mentally, and emotionally draining at the best of times so we’re committed to open communication channels and transparency.”

While REVS shares a facility with Buck’s hospital, the plan is to move into its own larger location to provide true 24/7 emergency care at a volume the area needs and eventually offer specialty services and develop an internship program to bring more students and new graduates to the area.

“We hope to become, and remain for many years, a pillar of support for the greater Rochester area. We don’t want the community to face the loss of local emergency care again,” said Edwards.

Pet Owner Education

Max’s owners wished their long-time veterinarian had prepared them for what he might experience and what they might be able to do; had told them that the after-hours emergency hospital that clients were supposed to use would not be open; and had told them about any other 24/7 options in the area.

Bobbi Conner, DVM, DACVECC, president of the American College of Veterinary Emergency Critical Care (ACVECC), said that those are great suggestions for veterinary hospitals. “Pet owners should absolutely speak with their veterinarians about their pets’ specific conditions and what kinds of things could indicate an emergency,” Conner said. “It’s also great to know where you might bring your pet if that were to happen.”

Conner, a clinical associate professor and service chief of emergency and critical care at Virginia-Maryland College of Veterinary Medicine, said owners also should have the basic details— diagnosis, medications and dosages—readily available for an emergency team.

Veterinary hospitals might even suggest that pet owners take a pet first aid course or have a pet first aid kit available specific to the individual pet, which can provide some reassurances for pet owners regarding what does and doesn’t constitute an emergency, said Conner. The American Red Cross, for example, offers a cat and dog first aid online training class and a pet first aid app for smartphones. Conner herself developed an online pet first aid class for ProPetHero, part of ProTrainings.

That class teaches first aid to address common cat and dog emergencies, explains how to notice abnormalities and detect early warning signs, and teaches life-saving techniques for when immediate action can make all the difference. While Conner said it is “generally a good thing that general practitioners are creating boundaries for themselves and not making themselves available 24/7,” she said that they should have a plan in place “for what their clients should do and who they should turn to during the inevitable emergencies.”

Triage or Urgent Care Services

When many veterinarians turned away pet owners during COVID, Lamoille Valley Veterinary Services (LVVS) in Hyde Park, Vermont, was starting triage services for same-day problems and emergencies.

“The hospital started the service so we could at least get them in and have a veterinary technician or higher-level assistant get a history and take vitals,” said Katy Weigel, LVVS practice manager. “Depending on how the animal is doing and our schedule, we can then offer an estimate for diagnostics and possible treatments.

“Once they’ve gotten permissions, staff can run bloodwork. Once the diagnostics are done, the pet will go to an available doctor who will review the case and diagnostics, examine the pet, review with the owner, and come up with the treatment plan. The doctors are freed up to see more patients with the technicians doing the preliminary workup.

“Sometimes if the doctors are at capacity, we still see the triages and, if stable, will schedule an appointment with the doctor for later. Or we may send them to the emergency clinic if necessary,” said Weigel.

Staff are scheduled to triage 8 a.m. to 4 p.m. Monday through Friday. From 4 p.m. to 8 p.m. Monday through Friday and 8 a.m. to 8 p.m. weekends, visits are considered emergencies with patients seen by a doctor.

While the hospital no longer offers the 24-hour emergency services it had for years, it has a staff member present 24/7 for hospitalized patients to provide needed treatment and to answer emergency calls. A doctor also is on call if there is a question, if needed to come in for hospitalized patients, or to refer a client to emergency hospitals an hour or more away.

Weigel said LVVS also offers its clients guidance on how to deal with various conditions and what to watch for in chronic illnesses.

Teletriage and Teleadvice

If no local care is available and/ or the after-hours/emergency hospital that clients are referred to is closed, at capacity, or long hours away, teletriage and teleadvice are alternatives. They fall under the overarching term of telehealth that describes virtual care between patient/client and veterinarian with both parties in different geographic locations.

The services, however, are not part of telemedicine, which requires a veterinarian-client-patient relationship (VCPR). Teletriage is deciding whether a pet’s condition is a medical emergency with immediate referral to a hospital needed. Teleadvice is giving advice to a client regarding their pet, explained Shadi Ireifej, DVM, DACVS, founder and chief medical officer of VetTriage.

VetTriage has been a 24/7 global provider of bilingual veterinary telehealth services since 2019. It allows pet owners to connect via video chat from any computer or mobile device so VetTriage veterinarians can view a live stream of their pet. In a VetTriage encounter, for example, the veterinarian troubleshoots and constructs a plan to keep the pet as comfortable and stable as possible until the client can access care.

At a minimum, teletriage and teleadvice offer the pet owner a level of education and understanding regarding their pet’s ailment, he said. The services may also help avoid unnecessary emergency visits that can be stressful and expensive and could involve long, torturous rides if far from a hospital. In addition, preventing nonemergency cases from presenting themselves to the hospital allows for pets with critical or life-threatening conditions to be seen in a more timely manner.

“Frequently hospitals are understaffed or reach capacity and are unable to intake patients, even critical ones. Some facilities leverage us because they have very long emergency wait times and others will leverage us during inclement weather. Whatever the reason, access and spectrum of care to pets is available 24/7,” said Ireifej.

A partnership with VetTriage is at no cost to the veterinary hospital, he said, explaining that the pet owner pays a flat fee to access the services of one of the more than 70 US-licensed DVMs who have been interviewed and trained by him.

Working to Address the Need

ACVECC’s Conner said she does not think there will be enough new graduates to meet the demands, even though she has seen “strong interest from current veterinary students and recent graduates to pursue both emergency medicine broadly as a career as well as emergency and critical care specialization.” She said the ACVECC is currently working with leaders from specialty and general veterinary organizations to address the shortage. McAllister said Mars Veterinary Health also is working to address the shortage. Among its efforts:

• Strengthening career pathways through training and mentorship programs like BluePearl’s EmERge™ Emergency Veterinarian Training and innovating care delivery through VCA Urgent Care and Banfield Virtual Petcare and Pet Chat™.
• Supporting mental health and wellbeing through MVH4You.com and “ASK – Assess, Support, Know” and in-house mental health professionals, Spring Health, Lyra, and Headspace.
• Promoting inclusion through partnerships such as the Diversify Veterinary Medicine Coalition.
• Building a bigger talent pipeline through youth engagement such as Banfield Pet Academy, sponsorship of the Purdue University College of Veterinary Medicine’s League of VetaHumanz, and academic partnerships and scholarships.

“As pet owners increasingly view their pets as family members and not just pets, we are seeing owners looking for more extensive and higher-quality care,” explained REVS’ Edwards. He encourages veterinary hospitals to consider expanding into that service if there is a need, noting that “you can see the immediate positive difference you’re making with each patient you see.”

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