See the Full Issue
September 2024
Veterinary Care Deserts: Unique Challenges
In the US alone, about 20 million pets experience poverty with their families and 70% of these animals have never seen a veterinarian, according to the HSUS. Some organizations have been working for years on these access-to-care problems but now awareness by others is growing. The awareness has even prompted the suggestion of a term for it: “veterinary care deserts.”
Unique Challenges in Access, Affordability, and Availability
You live near a veterinary hospital but can’t afford its products or services. Veterinary care is available an hour away but you need to find a car to borrow and money for gas.
You are disabled or elderly and unable to use public transportation to bring your only companion in for care. Most pet owners don’t face such hardships. But, in the US alone, about 20 million pets experience poverty with their families and 70% of these animals have never seen a veterinarian, according to the Humane Society of the United States (HSUS).
Some organizations have been working for years on these access-to-care problems, but now awareness by others is growing. The awareness has even prompted the suggestion of a term for it: “veterinary care deserts.” In a 2023 research report, Laura Bunke, DVM, with the San Diego Humane Society (SDHS), proposed the term and defined it as a geographic area where accessible, affordable, and available veterinary care is limited.
“It is currently a hot topic within veterinary medicine and nonprofit work,” she said, noting that naming the problem allows everyone to have a shared understanding. “Awareness is required before solutions can be formulated, tested, measured, and adapted to create change.”
In order to address the issue, the SDHS has been assisting pet owners in its service area who fall on hard times or need extra support to access veterinary care. Between June 2022 and June 2023, that meant 40,655 vaccinations, 3,926 veterinary vouchers, and 2,338,970 pet meals.
It also recently established a Community Veterinary Program to offer area families an affordable veterinary care option.
“We are excited to see what the future holds as we work on building out our on-site public hospital and obtaining a mobile unit,” said Bunke.
Other groups that work with veterinary care deserts shared insights about what they have experienced. Their comments reveal both the bad news and the good news. The bad: Problems are more complicated than they might appear on the surface. The good: People, animals, and communities can be resilient and resourceful.
Access to care … is almost never a matter of just one barrier but involves layers of barriers and challenges that go beyond just cost of care.Windi Wojdak, RVT
Senior Director, Humane Society of the United States’ Rural Area Veterinary Services
Rural Area Veterinary Services, Native Nations
The HSUS Rural Area Veterinary Services (RAVS) program has worked for more than 20 years to expand access to animal health resources in underserved Native Nations communities in the western US, according to Windi Wojdak, RVT, senior director of RAVS.
As of May 2024, that translated into veterinary services for more than 175,000 animals. For these tribal communities, she explained, the closest veterinary care may be 50 miles away with limited appointment availability and no after-hours emergency services. The elderly, families without transportation, and those with disabilities or other challenges can find it nearly impossible to get needed pet care. Those struggling with food or housing insecurity also have a hard time affording pet food.
“Access to care in these communities is almost never a matter of just one barrier but involves layers of barriers and challenges that go beyond just cost of care,” said Wojdak.
Through its field teaching clinics, up to 40 veterinary staff, volunteers, and students set up hospitals for one to two weeks to care for companion animals and to mentor students. In 2023 alone, they provided veterinary care with a value of more than $1.8 million for more than 9,600 animals across 12 partner communities.
The teams are invited and hosted by tribal agencies in each community and have built long-standing relationships. One such community is the San Carlos Apache Tribe in Arizona, an active partner since 2003.
“Our work with the San Carlos community has evolved,” explained Wojdak, including supporting the formation of the San Carlos Apache Animal Care Network. The network shares information and resources, helps identify community needs and priorities, provides support for collaborative care events, and helps coordinate efforts for greatest impact.
For that community in 2023, RAVS provided wellness and preventive care, emergency medical care, and surgery valued at more than $400,000 for 1,947 animals. In addition, it delivered 345,000 pounds of donated pet food and 200 pallets of supplies valued at $1.5 million. To extend its support, and reach more animals in the community, RAVS teams have also begun door-to-door outreach.
WisCARES, Madison, Wisconsin
Wisconsin Companion Animal Resources, Education and Social Services (WisCARES), which has been operating for 10 years, is a veterinary clinic and resource center for families experiencing poverty and homelessness and a part of the University of Wisconsin School of Veterinary Medicine.
It sees about 3,000 appointments annually—wellness, urgent care, surgeries, and dentistry— and, at the same time, teaches veterinary students how to be better communicators and decision makers.
“In our city, people can live 10 minutes away from a veterinary clinic by car, but it may take them an hour or more to get to a clinic by bus. And even if they live next door to a veterinary clinic but can’t afford it, they are also isolated from receiving care,” explained Kelly Schultz, DVM, WisCARES clinical instructor and medical director.
Finances, transportation, and disability are intertwining factors that impact the veterinary care desert there.
“When we started ramping up our full clinical services, it was very common to see animals that hadn’t been to a vet for five years, mostly for financial reasons,” said Schultz. “Many of our owners experience poverty and disability simultaneously. The two tend to go hand in hand, and having a bond with a companion animal has so many benefits to those with disabilities. They give folks a reason to get out of bed and can provide a constant source of support during rough times. Unfortunately, many folks with disabilities also struggle to or are unable to drive so getting to us is difficult.”
The clinic’s full-time social worker—a second is being hired— runs its boarding and fostering program. With that, the clinic can house animals for clients who have recently been evicted, need to seek their own medical care, or have other short-term needs relating to their stability.
For most of their appointment, clients work with fourth-year
veterinary students. The students take their work very seriously, said Schultz, “actively learning about the medical conditions they encounter, transferring that knowledge to pet owners, and digging into details about what interventions might be most manageable for each family.”
NECO, Saskatoon, Saskatchewan
In 2014, Jordan Woodsworth, DVM, PhD, worked with community partners to create the Western College of Veterinary Medicine’s Northern Engagement and Community Outreach (NECO) program.
They initially started with a small spay-neuter clinic in the tri-community area of La Ronge, Air Ronge, and the Lac La Ronge Indian Band in north-central Saskatchewan. She said that defining a veterinary care desert in the college’s partner regions— Saskatchewan, Manitoba, British Columbia, and Canada’s territories—is complex.
“In Saskatchewan and Manitoba, many communities have no access to veterinary care within more than 250 kilometers,” Woodsworth said. “Some communities do not have road access and are fly-in only. This means that, even if the closest clinic ‘as the crow flies’ is only about 300 kilometers away, access is far more complicated and expensive, not to mention time consuming.”
She noted that in Canada’s vast territories there are few veterinarians, and many small communities are far away from care.
“While some remote outreach programs exist, such as Veterinarians Without Borders’ Northern Program, they only have the capacity to serve a few communities a few times a year, leaving many entirely without any veterinary care at all,” she said.
Impacts on veterinary care deserts there, she said, include navigability of any roads; availability of facilities in which to provide care; availability of veterinary professionals, many of whom are typically providing services for free; and funding, as many communities have high rates of poverty.
Additionally, said Woodsworth, there are often policy-related barriers, including extra red tape required by some veterinary licensing bodies to gain approval to practice outside of areas with existing practice standards.
I have been surprised at how difficult it can be to relayKelly Schultz, DVM
the importance of the human-animal bond to human
health care workers outside of veterinary medicine.
Clinical Instructor, Medical Director, Wisconsin Companion Animal Resources, Education and Social Services
PetSmart Charities
PetSmart Charities has recognized that there are not only proximity barriers to veterinary care but other challenges: financial, linguistic, transportation, and hours of operation.
Often, veterinary care deserts exist in regions where the social vulnerability index is also high and people lack access to social services, explained Kate Atema, director of community grant initiatives. Since its inception in 1994, the nonprofit has granted more than $600 million to fund animal welfare in North America.
That comes after looking closely at the needs, assets, and gaps of each community to assess what, if any, veterinary care is available and how accessible it is. In 2023, PetSmart Charities made a commitment of $100 million over five years to support increasing access to veterinary care for pets in need of basic services.
Atema explained that the charity also is finding innovative ways to deliver services such as telemedicine to reach remote regions and a pilot program for veterinarians to offer payment plans for pet parents. According to Atema, PetSmart Charities’ portfolios address many veterinary care issues:
• Incubator program: Identifies regions that have been historically excluded from the veterinary care system and cocreates solutions with community input.
• Accelerator program: Supports capacity for expanding or launching low-cost clinics in regions that may include veterinary care deserts.
• Support for higher education: Supports higher education to promote veterinary programs to minority students, scholarships that support current veterinary students aspiring to do community-based work, and an endowed chair role that promises to advocate for accessible veterinary care across the nation.
Among its grantees from PetSmart Charities of Canada is the University of Saskatchewan and the NECO project. It began its partnership in 2023 with a $405,000 grant to launch a three-year pilot program for increased outreach and expansion in Saskatchewan communities. In January 2024, it awarded $860,000 over the next four years to look at the wider issues regarding access to veterinary care in Saskatchewan, Manitoba, British Columbia, and Canada’s northern territories.
PetIQ
PetIQ provides mobile veterinary services “in an environment without judgment” at more than 2,900 mobile community clinics across the country.
According to Sarah Cutler Tew, PhD, PetIQ Vice President of Medical Services, the company’s clinics are set up to provide preventive care services in accessible urban, rural, and suburban locations that pet parents already visit to meet other needs.
The company evaluates many factors when setting up clinic locations, including access to care, which can be impacted by transportation, economics, or availability of professional services. In partnership with the Veterinary Care Accessibility Project, PetIQ identified counties where their mobile clinics are held in communities without any permanent full-time veterinary services and found operations across Texas, Arizona, West Virginia, Florida, Kentucky, North Carolina, and Michigan.
PetIQ also partners with local organizations on various philanthropic initiatives such as last spring’s mobile clinic in Hobart, Indiana. When a local student wrote to PetIQ seeking help for local pet parents, PetIQ partnered with the Humane Society of Hobart to provide free core vaccinations and flea and tick prevention—critical services in a county designated as having a “difficult to access” Veterinary Care Accessibility Score.
It needs to be an industry-wide commitment that considers both ends of the leash. Together we can start moving the needle to help serve our whole communities.Laura Bunke, DVM
San Diego Humane Society
Complex Problems with Broad Impacts
Work on these veterinary care deserts continues to expose other factors at play. “Our clinic has always incorporated social workers and resource assistance for both pets and their humans,” explained WisCARES’ Schultz. “We knew this would be important, but it only becomes more evident with every passing year. I have been surprised at how difficult it can be to relay the importance of the human-animal bond to human health care workers outside of veterinary medicine.
“However, every day we see people who are kept afloat by their pets. On the flip side, we also see people whose housing can be jeopardized by pet incontinence, fleas, or behavioral issues. We also see people whose own medical trauma turns into anxiety and aggression in the veterinary clinic, so having trained staff around to de-escalate is very helpful.”
In some of NECO’s target communities in Canada, there are other pressing issues beyond the high prevalence of infectious and parasite-borne illnesses.
In the far north especially, explained Woodsworth, rabies is a significant risk and is made even more so due to climate change and associated changes in wildlife migration patterns, leading to increased contact with human settlements and domestic animals.
Dog populations that are not well controlled in northern, remote, and Indigenous communities in Canada are another concern.
“Roaming dogs that are unvaccinated and not sterilized pose dangers to community members, particularly in areas where resources are already scarce,” she explained. “In First Nations communities where there is no funding available for fences, dog houses, dog pounds, and animal control personnel, children, elders, and other community members are often fearful of spending time outside. This then exacerbates many of the challenges already reported to influence negative health and wellbeing
outcomes for folks living there.”
Industry-Wide Commitment, Creative Thinking Needed
The irony that exists, said Schultz, is that many veterinarians and veterinary nurses are leaving the field because of insufficient compensation. To address this problem, pet owners need to be able to pay more for services, but there is an ever-increasing need for financially accessible pet care. For Bunke, there is not one solution or organization that can mitigate veterinary care deserts.
“It needs to be an industry-wide commitment that considers both ends of the leash,” she said. “Together, we can start moving the needle to help serve our whole communities.”
Woodsworth said she doesn’t believe veterinary care deserts will ever be eliminated, so there is a dire need to critically evaluate the options available.
“Currently, we are without standardized tools to assess the degree and nature of underservice, and this creates challenges around providing justification for prioritizing resource allocation to these situations,” Woodsworth said. “There is still a widespread belief that, particularly when it comes to companion animals, it is the responsibility of the individual, as opposed to the collective, to ensure they are well cared for. As we move towards a more general recognition of animals as sentient beings deserving of minimum standards of care, we have to begin considering the provision of that care as a collective responsibility.”
According to Woodsworth, creative thinking is needed about which services must be provided by veterinarians and which can be delegated. She suggested expanding the roles of RVTs and offering programs that enable community members to become trained as lay vaccinators, which, at the same time, could also provide a crucial link to animal health professions.
“We need everyone to join the conversation and work together to help build systems that will bridge the gaps in care to promote animal and human health and wellbeing,” said Wojdak. “There will be no quick fix and no single approach that will solve the underlying disparities. It will take real shifts in philosophies, policies, and practices and ongoing commitment and collaboration across sectors.”
Fortunately, noted Schultz, there are a growing number of people trying to figure out how to make pet care more accessible. “I tell my students that we need some smart, systems-oriented veterinary brains out there to solve these problems. So if they enjoy policy, epidemiology, and economics, then accessible veterinary care may be the place they would want to specialize in.”
“The human-animal bond runs deep,” noted Wojdak. “Despite the multiple complex barriers they may face, folks employ tremendous creativity, resilience, and resourcefulness to provide the best possible care for their animals. They express much gratitude for the opportunity to provide the care they want and need for their animal family members. And often they express relief as the emotional burden of worrying about a beloved animal is lifted.”