Do We Need More Vets?

Hello, Summarians!

Vets. What makes a good one? How many do we really need? These are big questions with complicated answers. These two studies try to make sense of some of the information available out in the big world.

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Preventative Health Care Communication

Preventative healthcare (PHC) appointments are essential for animal health and welfare, providing veterinary teams the opportunity to share crucial information with pet owners to enhance pets' well-being and longevity. Despite most pet owners believing in the value of in-person veterinary examinations, there has been a steady decrease in client visits and an increase in lapsing patients between 2021 and 2023. This suggests that many owners are avoiding or postponing veterinary visits. Several reasons have been proposed for this decline, including cost, accessibility, cultural and language barriers, poor veterinarian-client relationships, and a disconnect regarding the importance of PHC. 

Effective communication skills, particularly the ability to convey empathy and trustworthiness, are fundamental to building positive veterinarian-client relationships and ensuring successful veterinary care. While previous studies have examined communication during PHC visits and owners' knowledge and perceptions of vaccinations and parasites, there remains a need to understand pet owners' perceptions and information-seeking behaviors regarding PHC within a broader context. Additionally, no studies have explored the association between the dissemination of PHC information and owners' perceptions of veterinarian empathy and trust. 

This study aimed to address these gaps by exploring dog owners' knowledge and interest levels, as well as their primary sources of information for 13 specific PHC topics. It also examined the predictive value of owners' satisfaction with how their veterinarian communicates about PHC and their perceptions of veterinarian empathy and trustworthiness. The findings revealed that owners felt most knowledgeable about the importance of mental engagement and assessing their dog's quality of life, yet most still wanted to learn more about these topics. This suggests that these issues are of utmost importance to owners. 

When asked about their primary source of information for PHC topics, owners ranked their veterinarian or veterinary team highest for most topics, indicating a strong reliance on professional advice. A significant majority of owners preferred to receive PHC information from veterinarians rather than other sources and trusted veterinary advice more than information from other avenues. Despite the abundance of pet-related health information available online and through AI platforms, owners still prefer their veterinarian for PHC guidance. Additionally, a large proportion of owners expressed a desire for veterinarians to be proactive in reminding them about their dog's PHC needs. 

The study also found that owners' satisfaction with how their veterinarian discusses PHC predicted their perceptions of the veterinarian's empathy and trustworthiness, as well as the reported frequency of PHC visits. These results suggest that effective communication about PHC offers extensive positive effects, including enhancing trust and empathy in the veterinarian-client relationship, which can lead to increased adherence to veterinary recommendations and more frequent PHC visits. 

However, barriers such as concerns about being perceived as profit-driven and time constraints can make PHC discussions challenging for veterinarians. Some owners indicated that knowing their veterinarian is paid on commission would impact their trust in recommended testing and treatment. Time limitations during consultations may prevent veterinarians from thoroughly discussing PHC topics, leaving owners with unanswered questions. To address these challenges, veterinarians can utilize supportive methods like providing written materials or recommending reputable sources of information, ensuring that owners receive the desired amount of information without extending consultation times. 

The study acknowledges limitations, including potential biases due to self-selection and a lack of demographic diversity among participants. Future research on PHC would benefit from a more heterogeneous sample in terms of pet types and owner demographics. In conclusion, the dissemination of PHC information not only directly improves animal health and well-being but also indirectly does so by enhancing owners' perceptions of their veterinarian's trustworthiness and empathy. This strengthens the veterinarian-client relationship and promotes better healthcare decisions for pets. 

Kogan, L. R. (2024). Dog owners and preventative healthcare: knowledge level, interest, and impact on perceptions of veterinarians’ trustworthiness and empathy. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.24.07.0438 

Bottom line — Discussion of preventative care builds empathy and trust.

Cancer Rates for Older Pets

Cancer screening in human medicine effectively detects cancers early, improving patient outcomes by allowing treatment before symptoms develop. This requires reliable tests that detect cancer prior to symptom onset and evidence that earlier intervention leads to better results, while also balancing potential harms like false positives or overdiagnosis. 

In veterinary medicine, there's a growing interest in cancer screening due to cancer being the leading cause of death in older dogs. However, determining the prevalence of undiagnosed cancer in dogs is challenging because of the absence of national veterinary cancer registries, which is necessary for calculating the positive predictive value of screening tests. 

To address this knowledge gap, researchers conducted a study on 902 healthy middle-aged to older dogs being screened for a cancer prevention clinical trial. They aimed to determine the prevalence of previously undiagnosed malignant tumors and identify the diagnostic methods used. The study found that the prevalence of occult malignant neoplasia ranged from 2.7% to 6.0%, with the higher figure including dogs suspected but not definitively diagnosed with cancer. 

Most tumors were identified through physical examinations and confirmed using fine-needle aspiration and cytology. This underscores the importance of routine physical exams and the cytological evaluation of accessible masses. Notably, dogs diagnosed or suspected of having cancer were statistically older, with median ages of 8 years compared to 7 years for those not suspected. 

The study highlighted the critical role of thorough physical examinations, including rectal exams, in early cancer detection, particularly for tumors like mast cell tumors and apocrine gland anal sac adenocarcinomas. Limitations of the study included the potential under-detection of cancers not easily identified without clinical signs, such as bone or central nervous system tumors, and the specific inclusion criteria of the clinical trial, which may not represent the broader canine population. 

Additionally, factors like breed restrictions and minimum weight requirements could have influenced the study population, potentially affecting the prevalence estimates. Despite these limitations, the prevalence of occult cancer found aligns with previous reports and is lower than some estimates used in positive predictive value calculations for canine cancer screening tests. 

In conclusion, the prevalence of occult malignant neoplasia in healthy middle-aged to older dogs appears to be relatively low. Many cancers can be effectively detected through comprehensive physical examinations that include procedures like rectal exams. This finding emphasizes the fundamental value of routine physical examinations in veterinary practice for the early detection of cancer in dogs. 

Burton, J. H., Vail, D. M., Willcox, J. L., Al-Nadaf, S., Adrianowycz, S., Biggs, D., Hayim, R., Magee, K., McMahon, R., Mok, I., Picone, A. M., Ralston, J., Smith, B. M., Uyehara, R., Willis, A. L., Johnston, S. A., & Thamm, D. H. (2024). Low prevalence of occult cancer diagnosis when screening healthy, higher-risk, middle-aged to older dogs. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.24.07.0463 

Bottom line — Low prevalence and most detected by a complete physical exam.

Estimated Demand for Vets.

Following the onset of the COVID-19 pandemic, the demand for veterinary services in the United States surged, contrasting sharply with the period of "excess capacity" and low wages for veterinarians that followed the Great Recession. This rapid increase highlighted the need for better forecasting models to inform decision-making among veterinarians, business owners, professional associations, and educational institutions. 

In response, the authors modified a commonly used approach to identify the best forecasting model suited to the available data. By employing this improved model, they generated forecasts and prediction intervals for veterinary labor market conditions up to 2035. Their approach removes subjectivity, accommodates model refinements, and acknowledges the inherent uncertainty of future predictions. 

The findings indicate that both supply and demand indicators for veterinary services are expected to continue growing. Importantly, the study did not find statistically significant or consistent differences in the growth rates of supply and demand, suggesting that the veterinary labor market is functioning competitively. This contradicts previous studies that anticipated a continued shortage of veterinarians; the data do not support such an expectation. 

The authors also identified areas where improved data resources and methodological advancements could enhance understanding of the economic conditions facing veterinarians. Factors influencing the labor supply include demographic changes, industry consolidation, local shortages, support staff utilization, technological efficiency, and faculty availability in veterinary education. 

They recommend adopting adaptive forecasting methods that can adjust to new data and evolving market conditions. Emphasizing the use of mainstream econometric models, the authors argue that these approaches typically yield better-performing forecasts and facilitate open discussions about the direction of veterinary labor markets. Future efforts should focus on expanding data resources, researching potential market failures, and considering the impact of technological advancements and the expansion of veterinary colleges on the long-term labor market. 

MacLachlan, M. J., Volk, J., & Doherty, C. (2024). Incorporating model selection and uncertainty into forecasts of economic conditions in companion animal clinical veterinarian labor markets. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.24.09.0624 

Bottom line — No long term shortage estimated.

Just putting things in perspective …