Transcript

Mia Cunningham: We are joined by David Foley, executive director for the American Association of Equine Practitioners. David has served in this role since 2000. And we’re very happy to have him join us today. Welcome to the show, David.

David Foley: Thank you. Glad to be here.

MC: All right. Well, let’s jump right in, if you wouldn’t mind just sharing with our listeners a little bit more about your background and your role at AAEP.

DF: Sure. I’ve I’ve spent almost my entire professional life with the association. I, I went to the University of Kentucky and graduated with a bachelor’s science in agricultural economics and then started working with the AAEP in 1988. It was my second job out of college and I was hired as the convention manager initially, and we were much smaller then, and I managed our convention and trade show for a number of years. And then as we grew, I my responsibilities grew as well and took on membership. And then we started a sponsorship program and, and various things and, and, and then in 2000 I was promoted to executive director. So I’ve been there, I guess, what, 34 years? Something like that. So, long time.

Krysten Bennett: You come highly recommended from our executive director Jack Advent.

DF: Great guy! Love Jack.

KB: We do, too, but unfortunately he’s leaving us this fall.

DF: I’m sure he’ll be missed.

KB: Today, we want to talk about the equine veterinarian shortage. I think we know by now the whole veterinary industry is kind of feeling the pinch of a staffing shortage. But today we’re going to focus on specifically equine vets. So to get things started, can you give our listeners a 30,000 foot view of the problem, how it came to be and what areas of the country are being particularly affected?

DF: Sure. We do exit surveys and we have for a number of years for members that don’t renew their membership. And most of the of the reasons that we have been finding or said they had, they had left equine practice and gone to small animal practice and mostly citing salary and lifestyle as the reason. And so we’d kind of seen this coming.

And then a couple of years ago, I think it began to hit a crisis point. We started hearing from member practices that they couldn’t find associates or interns or things like that. And so, you know, we always precede our strategic planning cycle with a general membership survey. And that sort of came out big on that survey. And so when we went into strategic planning in 2019, we made this a priority to really dig in to what about salary and lifestyle specifically where some of the leading factors.

And and so, you know, we’ve been on this journey now for about two years. It’s not necessarily specific to one area of the country. In fact, it’s a global challenge. We network a lot with other equine veterinarians associations around the world, particularly in Europe, and it’s all they’re talking about, too. So it’s a it’s a global shortage. It’s not necessarily limited to the United States or a particular area of the country.

MC: This problem certainly didn’t happen overnight. And, you know, as you just addressed, there’s no single cause. But what are some of the major contributors outside of, you know, salary and lifestyle?

DF: Well, the first thing that we did was we formed a task force on retention and we identified a few key stakeholder groups: students, recent graduates and then practice owners. We spent the better part of about 10 months gathering research and doing a lot of interviews with these different sectors to figure out kind of what the pain points were with each of them, and then what the gains would be, what they desired in their profession. And we came up with a pretty good list. And from that we, we developed last year the commission on Equine Veterinary Sustainability. And within that commission, there are five subcommittees that sort of speak to each of those pain points. And the first would be compensation, the second would be student outreach, the third would be internships, the fourth would be emergency coverage, and then the fifth would be practice culture. And so we’ve had our subcommittees working in these areas for for a little over a year now, developing member resources and information to try to help people change the model of equine practice.

KB: So we’ve got a variety of issues kind of coming together to create this problem. But is there one in particular that has had the most impact in your opinion and should maybe be addressed first?

DF: I think one of the biggest reasons is the after-hours emergency coverage. That’s a killer, because you’re never off. You never feel like you’re off. And so the emergency coverage subcommittee within our commission is really trying to address this head on. There there are a number of practices throughout the country that have figured this out. And so we’re trying to highlight those groups and get, you know, let them share their stories of how they created emergency co-ops.

Some practices don’t handle emergency coverage anymore. They have send you to the the nearest veterinary hospital. Some practices even do emergency only. And so they can handle the emergency coverage for the other practitioners in the area.

So this committee has developed about 10 different models of how practices can handle emergency coverage, including sample scripts on how to have those conversations with your clients. If you’re changing your emergency coverage model, how tos, you know, different things like that. They won’t all work for everyone. But I think the emergency coverage piece is really big.

KB: Another one of the contributors that you mentioned is compensation. It’s been reported that new graduates going into equine medicine make around $24,000 less on average than their counterparts in small animal medicine. In your research, have you found this to be the case?

DF: Compensation is different in equine than it is in small animal. It’s reported as lower, especially for new graduates. The first thing that the compensation subcommittee did was was do a survey to get our own numbers, because a lot of our practice owners really couldn’t believe the numbers that were being reported, particularly by the AVMA. And so we did our own study. AVMA’s study was prospective, and ours was retrospective: The low starting salaries cited by the AVMA were were what people had been offered to take a new job, whereas in our study, we said, okay, what was on your W-2? How much money did you make in the previous year, which included production, which included emergency coverage fees, and things like that. And we found it to be much closer to $90,000 a year. It still doesn’t match small animal, but we’re a lot closer than earlier reported. That was one of the things sort of to myth bust a little bit, that we felt like we needed to do to address the salary issue. And so that group is kind of mining that survey to try to produce a little more information to help people and help practices.

They’re also looking at how they can help improve fee structuring. And with collections, accounts receivables, a lot of times equine practitioners carry a large accounts receivable where they don’t necessarily do that in small animals. So if you collect on those and you’re able to pay your people more. So that’s one piece of it.

KB: You mentioned post-grad internships. These are really valuable for new veterinarians, so getting rid of them altogether probably isn’t the best solution. But on the other hand, the traditional model of internships is not sustainable. Can you talk about this a little bit?

DF: Most—not all; you don’t have to—but most equine veterinarians go to a one-year internship upon graduation to hone their clinical skills and to feel more practice ready. You know, the internship experience is supposed to be an educational experience, and that’s why these individuals go into that and are willing to take less money; it’s because they’re expecting an educational experience out of it.

The internship year is a tough year. It’s, you know, many, many hours a week. The internship in some cases can just grind somebody up. And so we’ve had this subcommittee really focused on trying to create guidelines and a better framework for practices that offer internships. We have a database on our website where practices can enter their information, and prospective interns can go in and complete some application information as well, and then try to match up with practices to do an internship with, based on what they’re looking for, what the students looking for as well.

KB: It’s also been reported that a relatively small number of students choose to focus on equine medicine. And of those, the ones that do go in to an equine practice upon graduation, many of them leave within the first few years. 

DF: They do. 

KB: Have your subcommittees discuss strategies for getting more students interested in equine medicine?

DF: Yeah, you know, when we first talked about this initiative, we kind of said, “okay, do we focus on recruitment, or do we focus on retention?” And we initially decided that we would focus on retention, because we thought if we could fix many of the challenges in equine practice, that recruitment might take care of itself.

That being said, we have done surveys and most people—and I’m sure it’s the same a small animal—most people that go into veterinary medicine decided they want to be a vet when they were kids. They had a veterinarian in their town that they looked up to, or a clinic that they liked, or rode with a vet in middle school or high school. And so at some point, we will expand this initiative with our student group to reach back into undergrad and at least high school areas.

That’s seems, you know, fairly daunting to try to to try to do that. And what is what’s the strategy for that? And so I don’t really know yet. I think at some point they’ll probably start a phase two thing. We will do that to try to increase the pipeline. I don’t think the pipeline of students entering veterinary school that want to be equine practitioners—I will I won’t say it’s sufficient, but it’s not that bad. I think many of them tend to leech out during school and decide to go another way. And then when they graduate, we have about 5% that go into practice. About 3.5% of them do an internship. About 1.5% of them go straight into practice without doing an internship. And then, according to our data, about 50% of them have left within the first five years. So we’ve always kind of dubbed that our at-risk group, and we’ve known that for a while. And it’s like I said earlier in the podcast, it’s just kind of gotten to a crisis point.

KB: Do you do any student outreach during vet school?

DF: We have student chapter in every veterinary school in the U.S., Canada, and Caribbean; one in Dublin; and one in London. And so we have chapters in a lot of places, and w’re trying to work with the chapter advisors at the schools, trying to send practitioners who are enthusiastic about being equine practitioners to the schools to talk to the students about kind of day in the life and and do that as well as workshops that we’re doing on clinical skills to help them get some additional training that they’re maybe not getting in school. So that’s an important piece. You know, we just have kind of an all-hands-on-deck approach to trying to fix this. And I think we are.

KB: It’s going to take time to implement these strategies. But one thing that isn’t changing is the veterinary student loan debt. So are there any programs or initiatives that are helping specifically equine students and vets handle their debt while their compensation is being addressed?

DF: The AAEP has a foundation—it’s called the Foundation for the Horse—and one of the key pillars of that foundation are, you know, our students scholarships, mentoring, scholarships. And so we have a pretty robust scholarship program, where we’re giving out probably in excess of $400,000 a year in scholarship money through a lot of sponsors and some generous donors. I mean, that’s a drop in the bucket, but it’s something. And so that’s it’s an area of focus for our foundation.

MC: And do you have an average number of students that you guys help annually?

DF: It’s probably in the neighborhood of 50 to 60. Most most of the scholarships are about $10,000; that is kind of the baseline. But then we have the Coyote Rock Ranch Scholarship, that’s a $75,000 scholarship, but there are only three of them given each year. So that’s the bulk of it. The rest are much smaller, but every little bit helps.

KB: I want to go back to this idea of forming emergency co-ops, because sharing business with competitors sounds maybe a little counterintuitive. Can you dig into that a little bit more? You know, how might an emergency co-op be beneficial and in what cases might it not work?

DF: Yeah, emergency coverage co-ops have been around for a while. There have been practices, particularly if they’re in a one- or two-doctor practice in a similar area—they just work out an arrangement, you know, that allows some doctors to go leave the practice and go to the AAEP convention or take a vacation or, you know, any other kind of opportunity. And somebody is there to cover for them. It’s not going to work in every situation; in some areas of the country where it’s it’s more competitive, it may not be as collegial. That may not be a solution. But in many parts of the country, it’s working. This subcommittee, I think they have maybe eight or 10 different models. You have to see what will work best for you.

I think they all kind of come together because they’re all dealing with the burnout of emergency coverage work. And so what the subcommittees try to do is spotlight these different models of coverage, and then they create a how to establish an emergency coverage co-op, how to have conversations with your clients about this. And so it’s going to be a turnkey solution for a lot of practices that are maybe sitting out there thinking, “Well, that’d be a great idea for me, but I’m really not sure how to get started. “All that’ll be on our website and much of it’s there already.

MC: Can you talk to us a little bit about telemedicine and incorporating that?

DF: Yeah, that’s a that’s one of the strategies that the emergency coverage subcommittee is is exploring further. I don’t have a lot of data on that, but I think there are members that are using it. I don’t know how many are using a formal platform for telemedicine; I think a lot of it is just on your phone at this point. I’m not aware of a lot of practices that have taken that to another level. So I think that’s an opportunity and I think it really it fits well with equine practice because of the rural nature of practice. 

One aspect of this initiative that I that I haven’t talked about was messaging to horse owners, and so making sure horse owners know what some of the crisis is. And part of that is making sure it’s really an emergency when you call your veterinarian out after hours, and not just more convenient for you. And I think that, you know, the use of telemedicine in that sense can really help a lot.

KB: I think in many ways, being an equine vet is more demanding than, say, being a small animal practitioner, just in terms of the physicality, potentially the rural remote locations, the hours that you have to work. Do you think that inherent nature of equine medicine is prompting people to choose a different field or even to leave the field?

DF: I don’t know for sure if that has anything to do with it much, because I think most people that go into equine practice predominantly, they have a horse background, they come from a farm or ranch background. So I don’t know that there are a lot of surprises there. Not every case, of course, and you don’t have to have that background to go into equine practices. Many very successful equine practitioners did not have any equine experience when they were younger.

I mean, there certainly is a physical aspect to it, but I think it’s almost somewhat of a lifestyle as well. Equine veterinarians form relationships with their clients, and they’ve serviced a particular client or particular farm sometimes even through generations. And so they become friends, and it’s a very relational and less just transactional type of arrangement. And so, you know, from that standpoint, you know, you work outside, no two days are the same, and I think there’s an aspect of that lifestyle that’s attractive to many people. We just have to improve the other areas—the emergency coverage, the compensation, you know, some of those things.

MC: So, David, as we’re thinking about, you know, the general population and a large portion of vet workforce is approaching retirement, this may be even more noticeable in the equine field. And adding to that, the fact that a relatively small number of new graduates are choosing to go into equine medicine, we may have a pretty big crisis approaching. What are the ripple effects that we can anticipate seeing if these positions are filled?

DF: Well, I think the big picture view is it has a negative impact on equine welfare. If they can’t find veterinary services, then it can have a long-term impact on the welfare of the horse, which is a big picture view that we’re very concerned about as well. This is probably the biggest priority and the biggest initiative this association has has ever undertaken, so we really are sparing no resources to try to turn the tide. It didn’t happen overnight, and we won’t fix it overnight—but we are seeing signs of progress. We’re hearing from practices out there that have taken advantage of some of our resources and changed things, been able to keep associates on and are being able to do it. But there are still folks that are leaving, of course.

KB: The final factor that you mentioned as impacting this shortage was practice culture. What kinds of things go into practice culture and how might a practice improve its culture to better retain staff?

DF: You know, the culture of the equine practice kind of wraps up a lot of aspects under one bucket: work schedules and how many days—you know, a lot of small animal veterinarians are working four days a week. That’s harder to do in equine, but some practices are figuring out how to make that work for them. And so work schedules, better technician utilization, just, you know, all the aspects that make up the culture of a practice. And they’re putting together a very comprehensive guidebook for practices to use as a resource to take down how they might improve the culture of their practice and and keep their associates. There are a lot of solutions that are being put out there and and some of them are working right now, and some of them are still in development.

KB: Are you’re going to be talking about this at your annual conference in December?

DF: It’ll be all over the conference at the end of November through the first part of December. It’s in San Diego and it will be featured throughout the conference. We have small group roundtable discussions where members can participate and give feedback on what they’re hearing and committees can take input as they develop their work. It’s going to be, you know, from the main stage in the opening session, you know, highlighting some of the early work that’s being done and some success stories that we’re hearing about. And so, yeah, it will be all over the convention.

KB: Well, I think that is everything that we wanted to ask you specifically, but is there anything else that you wanted to touch on before we let you go?

DF: I don’t think so. I really just wanted to to highlight the work of our of our members that are serving on these subcommittees. We have 12 to 15 members on each one, and they really have been doing a lot of hard work trying to help the profession. And so I just want to thank them.

We’re at it and we’re trying to do our part to to fix this crisis. And I’m optimistic about the future, actually, with just seeing some of the early results that we’re getting and seeing and hearing about across country.

KB: That’s great. Thank you so much, David, for hopping on here and chatting with us.

DF: My pleasure. Thanks for having me.