The Pet Care Access Crisis That Telehealth Could Help Solve: A Veterinarian’s View

Penny Ellison [00:00:00]:

Welcome back, Advocates. So we’ve been talking about access to veterinary care from the perspective of pet owners, especially those who can’t get the help they need and might have to end up surrendering their pets because of it. Today we flip the script and hear from a veterinarian who’s made it her mission to work toward tearing down those barriers.

Welcome to the Animal Advocate, where we arm animal lovers with the information and inspiration you need to become effective advocates. I’m your host, Penny Ellison, and I’ve taught animal law and advocacy at the University of Pennsylvania since 2006. If you’ve ever thought someone should do something about that, I’m here to guide you on your journey to being that someone. You can find us on the web@animaladvocacyacademy.com and that’s where you’ll find show notes and resources and you can send us your comments on episodes and ideas for topics you’d like to hear on future shows. So onto today’s topic.

Penny Ellison [00:01:12]:

If you caught our last episode on Veterinary telehealth, you heard how outdated laws are blocking millions of pet owners from accessing basic vet care. We talked about the veterinarian client patient relationship or VCPR and how the legal requirement for starting that relationship with an in person visit is keeping the people who need telehealth the most from getting help. If you missed that episode, it’s number 17 and you can find it at animaladvocacyacademy.com/17 and it’s really worth a listen because it sets the stage for today’s conversation. And today I’m talking with Dr. Lauren Hughes of Heal House Call Veterinarians. Dr. Hughes brings over 20 years of veterinary experience, having practiced in six different states including Michigan, Connecticut, Pennsylvania, and she’s currently practicing in North Carolina.She also holds a graduate certificate in veterinary forensics from the University of Florida. What makes Dr. Hughes’ perspective so valuable is she’s not just talking about access problems, she’s trying to solve them. Not only is she traveling to people’s homes to provide care, her practice is partially funded by a grant that includes an angel fund and that allows her to bring veterinary care directly to low income pet owners who otherwise couldn’t afford it. We’re going to dig into why veterinary care has become so expensive, how telehealth can change the game for underserved communities, and what it really takes to make veterinary care accessible to everyone. I hope you enjoy our conversation. Welcome. Dr. Lauren Hughes. Thank you for joining us.

Dr. Lauren Hughes [00:03:00]:

Oh, thank you for having me.

Penny Ellison  [00:03:03]:

So can you tell us a little bit about. I know you’ve been practicing for a while –  What kinds of vet practices you’ve worked in and what your practice looks like now?

Dr. Lauren Hughes [00:03:12]:

Yeah, I’ve been a veterinarian for over 20 years and practice all over, pretty much the east coast, mostly in general practice. Done some volunteer work in shelters, a few veterinary missions in Honduras and I did a house call practice briefly in Philly and now I run a house call practice here outside of Raleigh, North Carolina.

Penny Ellison [00:03:32]:

What made you go into house call work exclusively?

Dr. Lauren Hughes [00:03:37]:

I’ve always loved house call. Ever since I was trying to get into vet school. I shadowed someone and I thought that this just looks like the thing for me. And since I’ve been doing it, I love it. I, I get to be very personable with people. I get to help them. The other day I helped a lady charge her phone. She didn’t know where it was and, and how to charge it and also get something down from a shelf for her.

Penny Ellison [00:04:01]:

You’re a full-service veterinarian.

Dr. Lauren Hughes [00:04:03]:

And that’s kind of the service we offer.

And you know, the animals are much less stressed in the house, especially the cats, and they just tend to do better overall. So. And I really can provide access to care to a variety of people.

Penny Ellison [00:04:17]:

So … Access to care is an issue that’s top of mind for me always. You know, I think about animal shelters and watch their intake going up and look at the reasons people give for surrender. And some of those reasons have to do with access to veterinary care. Like what kind of, you know, we can talk about money, which is easy, but you know, what kind of obstacles have you seen and why are the prices of vet care where they are now?

Dr. Lauren Hughes [00:04:43]:

Well, I should start by saying that my practice is funded for three years by a grant from the David and Cheryl Duffield Foundation and through Petopia, it allows me to provide access to care to people who could otherwise not afford it. And it helps me start a practice. So I also see private clients, but I have a very large angel fund for them. So I do work at the women’s shelter. I do a lot of low income senior housing and then I get some referrals from a nonprofit that in the area as well. The cost of care. That is a little bit more of a loaded question. And I think it’s my opinion that the cost of veterinary care has gone up substantially since COVID And I think part of it is due to the fact that we have been underpaying our staff for years.

And I mean underpaying like our veterinary nurses or veterinary technicians go through the same nursing program like a human nurse does, but they get almost minimum wage. And veterinarians as well do not come out. Our income to debt ratio is opposite of what human MDs come out with and our debt load is pretty much the same. I think like average student… the study that I looked up said in 2020 the average debt was $157,000. I think that sounds really low. So part of it is students are coming out of vet school with higher debt than they used to be. We were talking, my interest rate is two and a quarter and the average interest rate now is like 8%.

Dr. Lauren Hughes [00:06:12]:

You have underpaying staff, you have a very high debt load for students. And then with COVID you also have corporations coming in and finding out that veterinary hospitals are kind of recession proof and pandemic proof. They’re still going on. So let’s invest in these. And then you’ve got another hand in the pot which also drives up prices. I think it’s a combination of different things. And then also the cost of everything has gone up. You know, just IV catheters and vaccines and gloves and whatever else.I mean needles. All those things cost more than, than they used to.

Penny Ellison [00:06:46]:

So I think you’re right. It’s obviously it’s a combination of factors that has gotten us where we are. You know, everything costs more, which also of course means your inputs cost more. One of your inputs is your cost of your staff, which I think you’re saying historically were underpaid. But maybe lately salaries have been going up and that’s driving up the cost of care.

Dr. Lauren Hughes [00:07:04]:

Exactly. I mean you have to pay people living wage, you know, really big thing. A lot of people left the practice and during COVID because it’s just not worth minimum wage to them to, to be still working when this crazy thing was happening.

Penny Ellison [00:07:17]:

Right. And you mentioned, you know, a lot of. I think probably most listeners have seen local vet practices get bought up by larger corporations which has a variety of effects including seemingly making it more of a profit driven model. Not that everybody didn’t always want to make a profit, but I think it’s made it harder to get vets that work on a sliding scale or will help out rescues with a discount because it’s more of a larger corporate business model.

 So we’ve talked about what has driven costs up and the fact that you are now serving some low income clients through having this angel fund and being able to get to people who might not otherwise be able to access care, which is great. Let’s talk about what your home practice is like. Obviously there are some problems that you can treat there and some that you can’t. How does that visit work?

Dr. Lauren Hughes [00:08:10]:

So I can do pretty much anything that you would do in a practice minus things like X rays and surgery. There are two practices in the area that can do that. One of them I used to work for is Mobile Laser Vet and they will come out and help out, but that’s just one practice. So in general, if I can get them to come out, for whatever reason, I have to refer them to someone. And it’s really hard for people to get out there because if I’m seeing them, especially my grant people, it’s because they can’t afford the vet and they physically can’t get to the vet. They don’t have a car. It’s tricky. So what do I do? I do the best I can.

Dr. Lauren Hughes [00:08:50]:

I mean, honestly, I tell them, I think that you need X rays, but since we can’t, I’m going to try this antibiotic and this treatment and do what I can. I talk to my colleagues and I’m like, please give me ideas on how to treat this dog with heartworm disease. It cannot be confined to an area because the owners are homeless. Like, how do I treat this and still give them the best care? It’s a challenge. It really is. It’s a different level of medicine that I think as a new grad I wouldn’t have been able to practice. But I have to think outside the box as to how to make it work for them.

Dr. Lauren Hughes [00:09:24]:

There are some issues with something like telemedicine, which I do offer to my clients, but I have to have seen them to have the valid VCPR, which is a valid client patient relationship. If I’ve seen them within 12 months, then I have a valid relationship. And then if it’s something like the ears are really bothering them again, I can prescribe a medication with the caveat that if they’re walking like they’re drunk and they’re acting weird, there could be something going on with the inner ear and just stop the ear medication and let me know. Or, you know, she’s urinating frequently, we can’t get a urine sample. I’m like, here’s an antibiotic. If it’s not better in 72 hours, it’s probably something else. I need to see the dog or whatever it is and go from there.

Penny Ellison [00:10:06]:

You brought up telemedicine, which is of course what my mind was going to. When you’re talking about seeing patients in their homes and them being more relaxed and then getting over the transportation problems, that’s great with a home visit, but home visits don’t scale as well, I think, as telehealth does. So there are not a lot of people doing what you’re doing. A lot of veterinarians going into people’s homes. So I do want to get into this telehealth, which is a topic that has come up recently as we think as lawyers and advocates about how we can get people better access to care. So every state regulates veterinary practice and they define what you refer to the VCPR, which is the veterinary client patient relationship. And most states define that as needing to be established during an in person visit. There’s about I think I came up with nine states who have revisited that and actually changed their law so that a VCPR could be established by video. You’ve done that and has that worked well?

Dr. Lauren Hughes [00:11:09]:

Yeah, I think so. I mean, I started doing it in during COVID because I was at home homeschooling three kids and I needed to not lose my mind. And I wanted to help people and I thought it was weird at first, but honestly, like these people, they were like, I am at home with COVID I cannot leave the house and my dog is itching, you know, scratching his ears. And I’m like, let’s try this ear medication. There’s been a lot of behavioral questions I’ve had, you know, inappropriate elimination, a lot of behavioral stuff, which is more talking anyways.

Penny Ellison [00:11:39]:

By that you mean maybe easier even to address through video than it might be in an office?

Dr. Lauren Hughes [00:11:44]:

Yes, exactly. When I’m doing them, it’s a video. So the telehealth visit s an actual video so I can see the patients and sometimes if they’re on their phone, I would have them take me around the house so I could see like where’s the litter box is placed and, and how clean it was and say, hey, you know, this is too close to the washing machine. This might be why your cat isn’t using it. Also, you should be scooping it, you know, xyz … basic husbandry stuff that doesn’t need to come into the clinic to see. And you’re not going to know it if you don’t do it via telehealth. But do triage.

Dr. Lauren Hughes [00:12:14]:

Some of them, people get worried about telehealth, that they’re going to miss something or that they’re not going to get the appropriate care. I did have one dog with a wound. And like, it was a very small bite wound. I’m like, you really need to go to the emergency. And they’re like, it’s not possible. I’m like, okay, this is what we can do. I want you to shave it and clean it. I’ll prescribe antibiotics, but please go as soon as you can. And I mean, that’s the most you can do. It’s better than them not getting help or worse than trying to read something on the Internet and do it themselves.

Penny Ellison [00:12:42]:

Right. I’ve heard of people trying to neuter their cats with things they felt on the Internet. So yeah, that’s. That’s a problem.

Dr. Lauren Hughes [00:12:48]:

Oh, Lord, that’s not good.

Penny Ellison [00:12:50]:

But for the AVMA, so it’s The American Veterinary Medicine association takes positions on this and I believe their position is still that you need the initial VCPR to be established in an in person visit. Is that right?

Dr. Lauren Hughes [00:13:05]:

It is. And I was really sad when they started rescinding  that  for the different states that I had my license in at the time, Michigan and Pennsylvania, and now that I live in North Carolina, I still have to see the patient in person. And I do think it does a disservice to the animal especially, maybe you don’t have the… I think a visit for me was $55. And if you go to the emergency clinic, it’s like $175 just to walk in the door, whatever. They don’t have that money and it may not have been something that they need to go there for. So I don’t think it’s helping the animals out to not allow that.

Dr. Lauren Hughes [00:13:42]:

I think the AVMA needs to trust the veterinarians more to make the right calls about how to practice medicine and let us, with our boots on the ground, decide what needs to be seen and what doesn’t and at least trust us to make the recommendations. You know, obviously I can’t diagnose a heart murmur via telehealth. I can say, well, your dog is coughing. It’s a breed that’s predisposed to a heart murmur. It’s concerning. I want you to watch the respiratory rate. You really need to go see a vet. And there may not be much more I can do for that, but at least they, they always felt comfortable and happy that they actually talked to someone.

Dr. Lauren Hughes [00:14:19]:

Everybody always felt really relieved after speaking. I’m like, okay, maybe I really do need to see the vet. But I’m glad that you talked me through and like, now I know what to expect. And I did get some follow up from people and they said, yeah, what you said was exactly what happened.

Penny Ellison [00:14:32]:

And, well, that’s so perfect because that’s. It seems like, you know, there’s a role for telehealth. There’s an apprehension on the part of the AVMA and others about what it would lead to and whether it affects care or not. But I think that what you brought up about trust is really the answer. A veterinarian is not going to do something that they’re uncomfortable with or feel is unethical or is not in the best interest of the animal. And there has to be that level of trust because you can’t spell out every possible circumstance that might happen in a law.

Dr. Lauren Hughes [00:15:05]:

You can’t. Medicine is a practice for a reason. And to make things black and white is very difficult. And in this day and age, with the cost of care, with everything going on, like, we need to make it more accessible to everybody to get good care.

Penny Ellison [00:15:20]:

And telehealth solves really the two biggest problems that you and I have both seen in practice, which is money and transportation.

Dr. Lauren Hughes [00:15:27]:

Yeah, absolutely. I will say even my elderly clients, they can do telehealth. They all have cell phones. They can do it.

Penny Ellison [00:15:36]:

Oh, you haven’t had anybody who couldn’t figure out how to click the link?

Dr. Lauren Hughes [00:15:43]:

 Well, when they approach you for telehealth, like, they actually already..they looked you up. When I did telehealth, even my homeless clients had cell phones. Like, everybody has a cell phone. It’s crazy. They don’t have a car, they don’t have a roof over their head, but they have a cell phone.

Penny Ellison [00:15:57]:

Well, there’s your answer to accessibility then. The one thing that pretty much everybody has is that thing that can give you access to a vet, at least in triage mode, to say, let’s see what’s going on, whether it’s behaviorally or medically, and give you next steps at very low cost and without needing to get anywhere. It’s amazing because some people, you know, we talk about, you’ve mentioned having homeless clients, but there’s also people who maybe have some money, but they’re in the middle of the veterinary desert and the closest Veterinarian is 150 miles away

Dr. Lauren Hughes [00:16:28]:

For sure. Talking to someone, even if you have the money, it doesn’t matter if there’s no one around you to go see you. It’s tough.

Penny Ellison [00:16:36]:

Some of the things that I’ve seen became an expensive problem because they weren’t treated early. So maybe on that point, go ahead.

Dr. Lauren Hughes [00:16:45]:

Yeah, absolutely. But if you don’t get your dog spayed, your dog has an incredibly high chance of getting something called pyometra, which is an infected uterus, literally fills with pus. Right. And if you don’t remove this pus filled organ, they will die. And that surgery now is probably going to cost $3000 to $5,000, depending where you are and how sick they are when you bring them in. If you had spayed that dog way before then, then that wouldn’t have happened. If you don’t have a uterus, you can’t have pyometra. That’s an easily preventable problem.

Dr. Lauren Hughes [00:17:17]:

Another easily super, easily super frustrating disease for veterinarians to see is parvovirus. It’s a disease of dogs and it’s transmitted in the feces, highly contagious. It can live in the soil up to theoretically up to two years. And you might adopt a dog and moved into a new house and have not known that it was in that soil and your dog gets it. If you have your dog vaccinated, starting as appropriately vaccinated, starting as a puppy, the chances of them getting parvovirus are significantly less to none. I mean it’s not a hundred percent, but I don’t see vaccinated puppies with parvovirus

Penny Ellison (00:17:45)

And I’ll see unvaccinated puppies bringing parvovirus into the shelter. Because we have backyard breeders that don’t give vaccines.

Dr. Lauren Hughes [00:17:57]:

 The reason that they will die from it is dehydration and sometimes sepsis because they just cannot keep anything in there. There are new treatments out there that are really hopeful and doing great, like helping the dogs, but it’s incredibly expensive. I think it’s $700 for something or other. So the rescues are using it. So Parvo isn’t as deadly as it used to be, but it still can be depending on when you catch it. You know, if they come in, someone can’t afford the vet and they have a telemedicine and they’re like, I have a dog and he’s 12 weeks old and he just has had diarrhea for three weeks now. And I’m like, well, is he vaccinated? No, we haven’t been to the vet yet. You need to go to the vet like right now. Like you know, if they or he’s had diarrhea for like a week versus waiting and waiting and then the dog is barely moving and then they come in and you’re like, well, we gotta hospitalize them.

Penny Ellison [00:18:48]:

And the bottom line, humane education point of that in terms of saving on vet bills, is what did the vaccine cost versus what is treatment going to cost?

Dr. Lauren Hughes [00:18:57]:

Preventative care is always going to save you money in the long run. Absolutely. Yeah. The treatment is always way more expensive than the vaccine. And with vaccine clinics these days, if people had a better understanding of medicine in general I think that would help reduce a lot of those issues that we see as well. Heartworm is another one that’s super easily preventable. That one. You have to see a vet once a year to have that VCPR get that heartworm prevention.

Dr. Lauren Hughes [00:19:25]:

And they’re not going to get heartworm disease if they’re on heartworm prevention. And for people who don’t know, heartworm disease is a disease transmitted by mosquitoes. Mosquitoes bite the dog. They transmit these microscopic worms that grow to be about a foot long. And they get dozens of them, kind of like based in the heart, and it’s paid off. Left untreated, they will die from heartworm. Super easily preventable with heartworm prevention.

Penny Ellison [00:19:45]:

So it sounds like we’re coming around to, I think, at least a two pronged approach, which is permitting veterinary telehealth in appropriate situations and trusting veterinarians to know what those appropriate situations are. And a community health program that gives owners the knowledge that they need and the basics like vaccine protection that would prevent a lot of these big costs down the road.

Dr. Lauren Hughes [00:20:08]:

Absolutely.

Penny Ellison [00:20:09]:

And stop people from buying brachiocephalic puppies. Did I pronounce it wrong?

Dr. Lauren Hughes [00:20:13]:

I mean, squishy face dog. You can just say that too. You’re fine. Education is definitely key. I mean, prevention is. Prevention is key. I could go on and on, and I do when I first meet clients about the things that I want them to do. So I want to see them, but I only want to see them when their pet is healthy once a year.

Like that’s my goal.

Penny Ellison [00:20:32]:

Well, thank you. Thank you for explaining veterinary telehealth to our audience and thank you for doing what you do to help people who need it. And I can’t wait to have you back to talk about some more issues. You’re welcome.

Dr. Lauren Hughes [00:20:43]:

I am very happy to do it. Thank you for having me.

Penny Ellison [00:20:46]:

You’re welcome.

Penny Ellison [00:20:53]:

Thanks so much to Dr. Lauren Hughes for sharing her real world insights on breaking down barriers to veterinary care. What strikes me most about our conversation is how solvable these problems really are. If we’re willing to advocate and if you’re here, clearly you are.

Dr. Hughes showed us that telehealth works. She’s proven that there are ways to reach underserved communities, and she’s demonstrated that when we remove barriers, pets get better care at lower cost and avoid expensive problems down the road that can lead to surrender. But she can’t do this alone, and neither can the handful of other veterinarians trying similar approaches. So we made it easy for you to take action. I’ve created a toolkit that’ll guide you through everything you need to advocate for veterinary telehealth reform in your state. You’ll get template letters to contact your veterinary board and legislators, key talking points for your advocacy, and examples from states that have already reformed their laws successfully. The toolkit will help you find out what your state’s current telehealth policies actually are, whether you’re in one of those states that allows virtual veterinary relationships or if you’re stuck with outdated regulations that block access.

Penny Ellison [00:22:10]:

Either way, you’ll know exactly what to do next. Download your free advocate’s toolkit at animaladvocacyacademy.com/telehealth-laws,com  and start making a difference today. Because the barriers to veterinary care aren’t inevitable, their policy choices and policy choices can be changed when enough people like you demand it. Your voice matters.

Let’s use it.

That’s it for today.. The Animal Advocate is brought to you by the Animal Advocacy Academy. You can find the episodes and show notes@animaladvocacyacademy.com you can listen to episodes you missed, leave a comment, and start a discussion there. And if you’re to ready. If you’re really interested in learning more about protecting animals, subscribe to the show so you can get every episode right when it comes out. If you have any questions on this or any other topic related to animal law, go ahead and email them to me@podcastnimaladvocacyacademy.com and remember, compassion is great, but compassionate action is infinitely better. Look forward to speaking with you next time. Take care.