Happy in the Country, Part Two

In Part One of this article, we looked at three AAHA-accredited practices, one each in the southern US, the midwestern US, and in rural Ontario. This time we’ll revisit practices in the southern and midwestern US, and add in a new rural locale, New England. These practitioners have different backgrounds and different reasons for being where they are, but they all share one thing in common: a love for the countryside and a love for their chosen profession.

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Small Town Veterinarians Thinking Big

by Constance Hardesty, MSc

Note: This is Part Two of a two-part series profiling veterinarians in rural areas. Part One appears in Trends, Nov. 2021.

In Part One of this article, we looked at three AAHA-accredited practices, one each in the southern US, the midwestern US, and in rural Ontario. This time we’ll revisit practices in the southern and midwestern US, and add in a new rural locale, New England. These practitioners have different backgrounds and different reasons for being where they are, but they all share one thing in common: a love for the countryside and a love for their chosen profession.

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Paula Yankauskas, VMD

Paula Yankauskas, VMD

Owner, Lamoille Valley Veterinary Services, Hyde Park, Vermont

The Lamoille River Valley is nestled among northern Vermont’s trees, rivers, lakes, and mountains. In its midst is Hyde Park, the shire town of Lamoille County, with its core population of about 3,000 people ranging from old families with more than 200 years of history to those who moved here to establish their own stories, with students and summer people cyclically adding to the area. Tourism is a central industry, so tourists and visitors are seen year-round.

Paula Yankauskas, VMD, owner of the AAHA-accredited Lamoille Valley Veterinary Services (LVVS), is a transplant who moved to the area almost 40 years ago because “the man I married wasn’t leaving.” As a young veterinarian, Yankauskas was “mixed-animal all the way. I loved it for the first ten years of my career,” she said. “Circumstance forced the small-animal hand, but it’s not a problem; I discovered that I love that too,” she added with characteristic resilience.

Fairly early in her career, she decided to open her own practice. “I started practicing out of my living room,” she remembered. Her husband’s parents owned a snack bar in town, and when Yankauskas suggested converting it to an animal hospital, they agreed, as they were feeling the effects of the passing years.

The practice became even more of a family affair when Yankauskas’s younger sister, Valerie, joined her as an associate veterinarian in 1987, a role she holds to this day. “It was a little rocky at first because, you know, sisters,” Yankauskas said, and in the next breath added, “It’s been a joy to have my sister here and working with me nearly this whole time.” You know, sisters.

The classic image of the small-town veterinarian belongs to a bygone era, Yankauskas said. “When I started in Vermont 40 years ago, doctors were lifelong icons of their communities. Over the years, that’s changed. There’s been significant turnover in the practitioners around here.”

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The classic image of the small-town veterinarian belongs to a bygone era.

“Veterinary medicine is imploding,” she said. “Right now, there is not enough capacity to handle the demand—and this is worldwide.”

The increase in pet ownership, particularly during the pandemic, meant an unforeseen new case load for many practices. “We had problems for a while,” Yankauskas said. “For the first time ever, we stopped taking new clients as a temporary strategy to survive. You can’t have staff burning out.”

After-hours care is an intransigent problem. “When I became a vet, being on-call was part of the job; it was expected. Now it’s different. Professors advise their students to decline a job if there’s on-call obligations because it will affect their life adversely,” she said.

“I can see the burden side, but there is also a real joy in helping people in times of extreme and scary need— they are boundlessly grateful, and you feel the satisfaction of making a difference. And because the burden back then was shared by so many, you could get to those moments and bypass feelings of resentment more easily.”

Yankauskas recalls a time when veterinary practices collaborated to provide after-hours service. Then ER hospitals became more common. “That sounds great, because you can send all of your after-hours work to them,” Yankauskas said. Now, however, “I know many ER practices that are constantly trying to find people who want that work.”

With ER capacity diminished and a staffing shortage at her own practice, “we’re sending people to six-to-eight-hour waits in parking lots [for emergency care]. It breaks your heart because some animals are not getting care. The compassion side is getting really challenged,” she said. When her practice recently lost an associate veterinarian, it suspended any on-call service from 8 p.m. to 8 a.m. (It had been limited to cases meeting certain criteria prior to that.) Yankauskas considers that unacceptable on many levels, and she intends to attempt creating an after-hours service separate from the daytime practice in the near future.

“As I looked into this, [I found] out about the shortage of ER personnel, both veterinarians and support staff,” she said. Meanwhile, to care for hospitalized patients, she keeps the practice staffed 24/7. The overnight crew includes assistants who monitor any animals present, answer the phone, and clean and prep the facility for the following day.

Yankauskas can pinpoint when the veterinary shortage hit Vermont. “Back in the day, if I lost a practitioner I could replace them in two months. In 2013 it started taking longer, up to 18 months,” she said. Now, staffing shortage is reaching a crisis point where the situation is dire even for nonurgent appointments. “We have to book them six weeks out or tell them no,” she said. “Staff on the phone get screamed at by angry clients, and a lot of it is frustration speaking.”

“We’re working hard on a solution, and we have hope on the horizon—an experienced veterinarian is joining LVVS, and we are adding carefully recruited support staff and training them as well as those still with us with the goal of building a dream team, she added. “The need is certainly broader—the veterinary industry won’t be sustainable if things continue as they have been—but at least we are getting things started in our corner.”

“I am on the Vermont Board of Veterinary Medicine, and at times I find myself becoming concerned about what we can actually expect of people,” Yankauskas concluded. Despite the stresses and strains, the doctor keeps work-life balance firmly in hand. A swimmer since childhood, at the age of 64 she completed the Triple Crown of long-distance open water swimming: the English Channel (2016), the twenty bridges swim around Manhattan (2017), and Catalina Island to California (2018). She’s currently training to swim a double Lake Memphremagog (50 miles) and may attempt further ultra-marathons if it goes well. Attending to her wellbeing makes a difference. “The staff notices when I don’t swim enough,” she said.

Practicing in a small town is no more amenable to achieving work-life balance than working anywhere else. “What works is how you integrate all the things you care about into your life,” Yankauskas observed. “Love your work but live fully outside it. I learned a lot from marathon swimming, [such as] to accept the unexpected, as you are going to deal with whatever it is anyway. Skipping the drama helps everyone, especially oneself.”

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“What I enjoyed most was the variety. Work was different every day.”

—DARREN TAUL, DVM

Darren Taul, DVM

Owner, Animal Hospital of Danville, Kentucky

With a population under 20,000, Danville is a small college town tucked deep in Kentucky’s famed horse country. About an hour from the two larger cities of Lexington and Louisville, it is far enough away from major metro areas to have a personality of its own. “It is very attractive for people looking for small town amenities. Apparently, it is attractive to veterinarians as well,” said Taul. “There are four other veterinary hospitals within four miles of my practice!”

Taul started out as a mixed-animal veterinarian in the even more rural setting of Lancaster, Kentucky. “I have a farming background raising crops and livestock (cattle and hogs),” he remembered. “That was my first exposure to veterinary medicine. It wasn’t the pet exposure that attracted me to this profession. I enjoyed mixed-animal practice. I was exposed to dogs, cats, horses, and cattle mainly, but also treated some llamas, alpacas, and even some ostriches, emus, and rheas along the way.”

“What I enjoyed most was the variety. Work was different every day. I also got to get outdoors and met several very nice people,” he said. Any practice owner will recognize some of Taul’s headaches, but others were unique to mixed-animal practice. “I started out as a solo practitioner and owner, so I had to handle everything: management, staffing, scheduling, HR, as well as the client-patient interaction and practicing medicine and surgery,” he said.

He also had to balance hospital and farm call appointments. “As my practice grew, it became more challenging to balance everything. During the peak of my mixed-animal career, it wasn’t uncommon for me to start at 6:30 a.m. and finish my day after dark,” Taul noted. “I would eat lunch—if I was lucky—driving between farm calls or back to the hospital. If I was really lucky, I wouldn’t have an emergency call that night.”

Converting to a small animal–only practice was both a business and lifestyle decision.

“It is very difficult to do both large animals and companion animals as it splits your focus; you can’t give 100% to each,” he explained. “Lifestyle certainly played a major role as well. It took me longer to recover from some of the physical hard knocks I took on the large animal side!”

Once the decision was made, it took some time to implement. Taul managed the conversion in three stages, giving up livestock work and then equine patients. “The horses were the hardest to let go,” he said. “In 2017, I purchased a small animal practice in Danville and practiced out of both hospitals. Finally, in 2020, I sold my mixed-animal practice and became small animal exclusive at Animal Hospital of Danville, which is where I am today. There are some things I miss greatly about large animals: the outdoors, the people, and specifically the equine work,” he added.

Rural veterinarians don’t have as large a pool of nearby potential clients as practices in large cities do. That’s why, Taul said, client retention is fundamental. Maintaining his client base is all about personal relationships. And that means face-toface time with clients.

“Ironically, despite our efforts to offer telehealth during COVID and other times, we rarely get any request for that. I think small town veterinary medicine will continue to be largely relationship-oriented,” he observed. “Our clients want to have face-to-face interactions, and they prefer seeing the same doctor.”

And, as in any practice, they demand good service. Taul finds AAHA an invaluable ally in that. “I earned accreditation in both hospitals because I wanted to be the best I could be,” he added. Taul was president of AAHA in 2018–2019. For Taul, rural practice is about living well. “My personal lifestyle does not fit with urban life,” he said. “I like to come home to our “mini-farm” and be outdoors, enjoy the night sky, and watch and listen to the wildlife.”

“Wherever you are, you can thrive. The medicine, the surgery, are the same.”

—MARK THOMPSON, DVM, CCRP, MBA

Mark Thompson, DVM, CCRP, MBA

Owner, Country Hills Pet Hospital, Eden, Wisconsin

Eden, Wisconsin, is a town of 950 people set in a sea of green fields. Just after Highway 45 takes a sharp turn north, you’ll find Country Hills Pet Hospital. And just up the way, you’ll find Country Hills Animal Health.

Wait, Country Hills Pet Hospital is next door to Country Hills Animal Health? Well, yes, and that’s a story.

Country Hills Animal Health (a consultancy to dairy herds) was once the mixed-animal practice that brought Thompson to Eden. “Four large animal vets had built a nice building, and they thought they would do small animal on the side,” Thompson explained. “When I arrived in 1997, the companion animal side of the practice was as bare-bones as could be. They had hired several vets before me, but I was the one who stayed.”

“I told them when I was hired that my number-one goal was to become AAHA accredited,” he added. “I wasn’t even sure mixed practices could have the small animal part accredited. I had to call and see if it was possible. To justify accreditation to my partners, I said, ‘This is where the practice needs to go. It costs money, but everything worthwhile does.’ I convinced them to let me take the reins and do what I was hired to do, which was to develop the practice,” he said.

The practice became accredited in 2000, the same year Thompson became a partner. Eight years later the partnership dissolved, and Thompson opened Country Hills Pet Hospital in the same building. The practice was named 2018 AAHA Practice of the Year.

For Thompson, as for many rural veterinarians, practicing in a rural setting was a return to his roots. Sort of. “I grew up on a dairy farm, but it wasn’t at all typical. We had sheep,

goats, pigs, chickens, and dairy cattle. So, I grew up with a lot of different animals. All of which had names. We named all the cows, and when they had calves, we named them. I didn’t realize that was unusual,” he recalled. “When I started vet school, I thought I would be a large animal vet with some small animal practice. The large farms, with thousands of cows, were not what I imagined. How would I remember all of their names?” After one year as a small animal veterinarian in a suburb of Milwaukee, Thompson relocated to Eden. He has thrived ever since.

“Wherever you are, you can thrive,” he believes. “The medicine, the surgery are the same. You need to have direction and a good foundation. You need to do a good job. That said, growth is slower in rural areas,” he added. “In the whole year of 1997, the small animal practice grossed about what we gross in two weeks now. One year our receipts tripled, but of course that’s rare.”

The practice even offers physical therapy, including underwater treadmill, whirlpool, therapy laser, therapeutic ultrasound, and soundwave therapy. In the rural setting, this unique part of the practice is doing well.

Still, growing a rural practice takes patience because your reputation needs time to evolve. “Pay attention to quality,” Thompson advised. “People will pay for it. We have one of the highest exam costs in the area, and that’s a shoppable service. I have lots of people traveling good distances to this practice. My client base is a 25-mile radius,” he added. “It’s about quality care, and that’s where AAHA comes in. Before I was accredited, I thought I was doing the best job I could do. You don’t know what you don’t know,” he noted. Thompson currently serves on the AAHA Board of Directors.

For Thompson, as for other rural veterinarians, the greatest reward is the lifestyle. He married his high school sweetheart, and the move to Eden was the perfect fit for them. “Everyone knows who you are. I literally have to take extra time if I’m going to the grocery store because I get stopped three or four times,” he said. “When I practiced in a suburb of Milwaukee, no one at the grocery store recognized me.”

“Good relationships and community are why I practice in Eden.”

Constance Hardesty
Constance Hardesty, MSc, tells stories about the people, medicine, and technology serving our animal companions.

 

Photo credits: Photos courtesy Lamoille Valley Veterinary Services; Photo courtesy of Darren Taul; Photo courtesy Lamoille Valley Veterinary Services; Photo courtesy of Darren Taul; monkeybusinessimages/iStock via Getty Images; Photo of Mark Thompson in surgery courtesy of Country Hills Pet Hospital

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