Andy Roark DVM MS

Dr. Emily Tincher joins us to discuss the rising costs of veterinary care and how they impact pet families. Dr. Andy Roark and Dr. Tincher dive into her co-authored book chapter on cost, access to care, and payment options, highlighting key factors driving price increases, such as staffing costs, practice economics, and the cost of consumables and drugs. Dr. Tincher also shares insights on effectively communicating with pet owners about these costs and the importance of understanding their preferences.

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

This episode is brought to you by Nationwide!

LINKS

Nationwide’s Most Common Claims: https://news.nationwide.com/041824-dermatitis-gastroenteritis-most-common-conditions-prompt-vet-visits/

Cost of Care, Access to Care, and Payment Options in Veterinary Practice: https://www.vetsmall.theclinics.com/article/S0195-5616(23)00156-0/abstract

Spectrum of Care: www.spectrum-of-care.com

Open Door Veterinary Collective: https://opendoorconsults.org/

Pyometra Peer Reviewed Article Referenced: https://avmajournals.avma.org/view/journals/javma/260/S2/javma.20.12.0713.xml

ABOUT OUR GUEST

Emily M. Tincher, DVM, is Senior Director of Pet Health at Nationwide. A second-generation veterinarian, she is co-author of a chapter in Veterinary Clinics of North America: Small Animal Practice, “Cost of Care, Access to Care, and Payment Options in Veterinary Practice.” Dr. Tincher is a member of the Board of Directors for the Veterinary Leadership Institute and has become a sought-after speaker, most recently on spectrum of care topics, presenting at major veterinary conferences across North America.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome, everybody, to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark guys, I got a great one for you today. It is all about cost of care, pricing in veterinary medicine, what the options are to keep care affordable for pet owners. This is a really good conversation that I, I really enjoyed and I sat with for quite a long time.

This is with my good friend, Dr. Emily Tincher. For those who don’t know her, she is the Senior Director of Pet Health at Nationwide and uh, she is a deep thinker on the spectrum of care. She’s got a lot of good insight. I always enjoy, uh, kicking things around with her. We don’t always agree. I think today we’re pretty much in alignment.

We might have gone back and forth about a couple of points, but anyway. Um, it’s a, it’s a, I always take away fresh ideas from my conversations with her. She is really, really, really, sharp. Anyway guys, uh, this is a great episode. I’m so glad to have her here. Let’s get into it. And let me just say this episode is made possible by our friends at Nationwide.

Let’s get into it!

Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark. 

Dr. Andy Roark: Welcome to the podcast, Dr. Emily Tincher. How are you?

Dr. Emily Tincher: I’m doing great. Thanks so much for having me back on. Excited to see you and chat about some interesting topics.

Dr. Andy Roark: I, I love having you on. I love having you on for a number of reasons. Number one, you and I have known each other since veterinary school, and we were business nerds together in vet school. And then two, you were one of the most beautiful polished, elegant speakers that I get to work with. You can just, I aspire to, to present

like, I said, I, um, and I’ve done like 700

Dr. Emily Tincher: Just setting me up to fail here. I see what’s happening.

Dr. Andy Roark: I know, I really, just sitting, just absolutely fluff it, fluffing you up.

That’s a very kind nonsense to say. Uh, I, I very much appreciate it. I have loved watching and learning from you speak. Uh, with the energy and, and ability to connect to audiences. I just, I really love watching people that I admire and learning from that.

Dr. Emily Tincher: So that’s, that’s a very kind thing to say.

Dr. Andy Roark: You are amazing. Um, you have got a lot of stuff going on. My friend, you are doing a lot of stuff. I’ve had you on the podcast a number of times to talk about different aspects of spectrum of care and keeping care accessible and cost of care and things like that. You have got a new book chapter that is out is in a book called Veterinary Clinics of North America: small animal practice. Um, your chapter is with, um, with, with our mutual friend, uh, Dr. Jules Benson. It’s called, uh, the chapter is called Cost of Care, Access to Care, and Payment Options in Veterinary Practice. And you told me the chapter was edited by our other friend, Dr. Peter Weinstein. It’s like this meeting of the minds.

That’s, that’s amazing. Um, let, let’s go ahead and start to talk about this one of the points that you make in the chapter that that I’ve I’ve thought a lot about over time is you make the comparison of that prices to overall inflation. Like the price of the price of living is going up, at least in the States, and to me, that’s that’s very clear at the grocery store, like every for a while, every time I went to the grocery store, it cost significantly more than it had cost before, and so life is just getting more expensive, expensive to live Day in and day out and and obviously the cost of veterinary care going up as well, but you you point to data that shows our our price increases are are not in line with inflation overall.

Why don’t we just start there and you can kind of start to unpack that for me

Dr. Emily Tincher: And just first a huge thank you to Dr. Peter Weinstein for inviting Jules and I to co author this book chapter together. It was an experience. It was our first book chapter to write. Um, it was enjoyable, but also challenging. Um, but I appreciate getting to collaborate with Jules on a number of things. So just a thank you to both of them for the chance to do that and the collaboration.

And, uh, it was a great opportunity. The, the part that to start with is, um, how our costs changing and I think why, why should we care about that primarily? What effect does that have on the pet families that we serve every day? And by extension, how does that change our conversations or, or the emotions that we may be feeling in those conversations?

And so we think about, um, just looking at the consumer price index. So, um, from the U S bureau of labor statistics, um, over a 20 year time period, all goods inflation rate has gone up, um, 61 percent less than the veterinary services bucket that they measure as one of those, uh, components of the all goods.

And so, that says, over that 20 year time period, our pure inflation. So just the cost of doing the same thing, um, pet families are experiencing that compared to, uh, you know, buying a dozen eggs at the store when they come to see us for, you know, a wellness exam and some vaccines, but they’re seeing a significant difference simply in the cost, uh, before we start to look at.

What is the care that’s actually being provided? I think I really felt this on a personal level recently. I got a puppy, his name is Sprout. He’s really cute. And, um, I’m really spoiled. So I, I being the daughter of two veterinarians. I didn’t know for a long time on that personal level what it was like to pay for my own veterinary care until I till I was adult. While I saw them deliver estimates all the time I wasn’t personally doing it, but they were my veterinarians for a very long time. Taking Sprout in for a wellness exam a round of vaccines a fecal and a microchip was um in an awesome practice.

I had a fantastic experience. No complaints. So, so hear me when I say, um, I don’t begrudge us at all, but it was about $400. Uh, and when I think back to growing up with that looked like in, in a, uh, you know, a different environment, mixed animal practice in rural Kentucky versus. You know, here in Colorado, um, that was, you know, just probably closer to 150 maximum.

So that, that change is in just the cost component is one that, um, sometimes can feel shocking to pet families if they’ve, especially if they’ve had pets longterm, not understanding why they’re seeing the changes that they are.

Dr. Andy Roark: Yeah. Oh, I think you’re, I think you’re spot on. I think whenever we start to have real conversations about pricing and medicine, we have to insert some nuance, right? The worst thing in these conversations is people, people go to extremes or we don’t allow people inside of our own profession to say, hey, We, we are quote unquote worth the money that we’re asking for.

And also your average American doesn’t have a thousand dollars in savings full stop. And it’s, and it can be hard for them. And, and I just, I think a lot of times people want you to pick a side. You’re either pro, pro Your team pet owner who doesn’t think this, who doesn’t think this is fair and, and, and people are jerks.

Or your team vet med, which is people should see our value and happily write us checks for what we ask for. And like, neither of those things is, is really realistic. You know, the, the truth is in the middle. I, I want to ask you a little bit about sort of public perception and kind of where, where you see this.

I’ve seen um, There’s been a number of sort of flare ups recently on the social medias, which I try to stay away from, but I’m not, I’m not completely removed from there’s, um, the, the most, the most recent one I saw was there’s this guy and he’s got, um, he’s got blood work and he’s ranting about how veterinary clinics will double the cost of blood work that goes to the lab.

Can you believe this? What a scam. And of course there was a huge reaction, of course, from the vets because they’re like, first of all, that’s, that’s ridiculous. You know, that’s like, um, that’s like criticizing lawyers for marking up the paper that they write on. It’s like, I’m sorry. Uh, you know, I have no idea what the carpenter paid for his hammer, but that’s not what you’re paying for now.

And so anyway, it’s, it’s that it’s, um, But there’s a big reaction around that and so I look at that and sometimes it feels like there’s this big debate and vets are charging way too much and blah, blah, blah. But I also know that, you know, the four drivers of engagement on social media are negativity, emotional, and moral language.

Tribalism and extremism. Those are the four drivers. And so I know that messages… 

Dr. Emily Tincher: It’s usually a meeting of like having meaningful conversation and trying to meet in the middle, right?

Dr. Andy Roark: Exactly. And so I don’t think that I I don’t think that what I’m seeing online is an accurate reflection of probably how your average pet owner perceives our prices. What are your thoughts on that? And what do you think that the average pet owner is sort of Do they have a strong emotional reaction? Do they notice that prices are creeping up?

We see with the, um, the VHMA surveys that come out, which are, which are excellent. We sort of talk about, you know, year over year, we see the number of visits go down, but profitability stay or go up because we’re raising prices. But, but I don’t really see accurate reporting of how pet owners perceive this trend in our industry.

Do you, what are your thoughts?

Dr. Emily Tincher: Well, we’re we’re raising prices, but then we’re also the number of goods being added to each invoice so the number of light item details are also increasing so the those components of simple cost increases, but also some of the other drivers of increasing cost of care is Is Advancing level of treatments too.

And we can maybe talk more in detail about that. But, um, I think it’s a really interesting question that we don’t know the answer to that much. I think I would advocate that what pet families do we understand the best in veterinary medicine? The ones who see us, right? The ones that come in, we have the best understanding about them because

we we see them in an exam room setting they’re often the ones that are included in market research. And those who are already accessing veterinary care are the ones that we know the most about but we’re not necessarily asking them how they feel about price sensitivity. We are seeing trends to to your point from VetSource Uh, there are other other references, but I like the VetSource, AVMA Um, weekly free report that that comes out via email if you like it.

Um, that shows us to your point, visit visits are down, but average client transaction revenue is up. So we tend to mostly talk to those who come in to see us, but we don’t ask them necessarily maybe when they’re not feeling that emotional component of, of having just received their, their invoice. I will say there’s a communications component to that, that we

sometimes do really well at and sometimes probably could have some room for improvement on when we have asked as a profession veterinary Asked pet families. How do you want to be communicated to around money? One of the big no no’s we’ve discovered is that It shouldn’t be a surprise when the pet family goes to the vet to pay for their bill, how much they’re going to be paying.

And I can tell you that I’ve had recent, um, multiple different places, um, experiences with my horse who’s lame right now, unfortunately, um, experiences with my new puppy and, um, a couple of months ago, some experiences with my cat, uh, for some monitoring blood work that, um, for just keeping track of HCM that his two brothers have, um, um, None of those cases, and maybe they’re interacting with me differently because I am a veterinarian, but in none of those cases, and we do have some data available to us, that still pretty frequently, it’s a surprise to people.

So, so that’s one level up that we could all do is to help. Make sure that we’re informing, informing pet families, what, what the costs associated with care are, and then have that, that opportunity to, to discuss the value associated with that, bring those two things together. But we don’t, we don’t do a good job.

I I’m, and I put this on all of us. I’m like, we don’t do a good job of asking pet families what truly they’re looking for, how they’re perceiving the changes in costs and the changes in care, what they want. And we also don’t do a good job of of talking to pet families that are not routinely coming in to see us for veterinary care, to ask why?

What, what is it that we’re not fulfilling for you? Is it primarily financial? There’s some evidence from the access to care coalition that, that financial barriers are a big one. Um, but what are the other barriers and how could we potentially make sure that you have the health literacy conversation about why it’s important, but also the, um, you know, different potential methods of increasing access to care?

That might come from that conversation.

Dr. Andy Roark: Yeah, it, well, it’s survivor bias. You know, when we talk about who we’re talking to. It’s the classic, it’s the classic example of like when the military would look at planes that came back from combat, and then they would look at where the bullet holes were in the planes, and they were like, oh, we have to put more armor here.

And then finally someone pointed out, we, we’re looking at the planes that come back. We need to look at the planes that come back. Don’t come back and see where they got hit, because that’s where we need more armor. And the same thing is here, too, is like, we talk to the people who come back and try to adjust to their, to their desires, but we’re not talking to the people who didn’t come back, who have, you know, have a, have a significant complainer perspective and something like that.

I think that, I think that’s true. I really like your point about surprises. I think, I think people are innately good, but I also think that we, Like to be comfortable. And I think that if you said to me, Andy, would you like to go and let this person know that they’re going to spend $675 for their two labs today?

Or would you just like to let the front desk do that? I’d be like, well, you know, I mean, it’s just about me. Then I would like to let the front desk do that, but that’s, that’s the outcome is not, is not positive. And I think that’s why we have such huge turnover at the front desk is tasks like that of surprising people with bills.

Dr. Emily Tincher: that and potentially pay discrepancies for for how challenging that that role really can be. I mean, there’s great evidence, peer reviewed evidence, that involving the entire healthcare team from veterinarians, receptionists, to our licensed technicians, all the way through, all being on the same page about costs and discussing them is really important for buy in from the client.

So, um, There are some, there are reasons to do, to do that, to have that training and conversation with the team. I do want to briefly mention, because we brought up as a problem, not, not addressing, uh, and talking to pet families and asking them what they want. That is, that is something that we tried to do.

Uh, at Nationwide with a research study that was, will hopefully be published, uh, later this year. We’ve been talking about for the last couple of years to, to ask, what are, what are the preferences that you have surrounding, um, and, and we didn’t necessarily do a straight survey because we know that there’s a lot of emotional bias for pet families.

Um, but, Asking what are what are the motivators? And we’ve talked about this before on a podcast, but I think it’s worth just briefly mentioning again that, um, we identified relatively independent of demographics that their motivators are cost, choice, and convenience. And that those different groups of people want to be talked to differently, um, in relation to, to their preference for how they’re going to choose the care that they choose.

So we’re, we’re trying to help solve that challenge that we’ve identified, but I do think it’s a, a, a larger one industry wide that we can continue to ask pet, ask pet families and involve them in the conversation for how care is evolving and how delivery of healthcare is evolving. So that we. Have that kind of, uh, service and product market fit.

Dr. Andy Roark: Yeah, I’ve, I’ve thought about that since we, since we first discussed it. I, I have found it helpful to look at PetOwners some of the time and just kind of ask myself, Is this a cost based client? Is this a convenience based client? Is this a, a choice and understanding education based client? I think, I think that that’s an interesting way to kind of

parse people apart. Again, it’s never perfect, and it’s always a mixture of things, but, but it does, it definitely helps to sort of, it’s helped me get my head around it. I want to jump back real quick. We were talking about about rising costs of pet care. You know, I, you, you’ve talked before about sort of three, I’m curious how How much weight you put on these?

Obviously, there’s a lot of reasons for the cost of care to be going up, but you, you want to kind of call out specifically staffing costs, adapting to changes, to changing practice economics, and then increased costs of consumables and drugs as kind of your big three. Do you see those as the primary drivers or are they three that you think kind of slip under the radar?

Dr. Emily Tincher: I think there are three of the main drivers, to your point, we could continue to, and, and veterinary, uh, economists have delved into further areas, but I think three of the big drivers that we’re seeing recently, and, and as we wrote about in the book chapter, Um, three big changes, uh, and, and maybe, um, there are, there are constants and there are, these things seem to be maybe accelerating right now are part of, are contributing to that, um, feeling we all have of costs seem to be rising quickly right now.

So staffing costs, I think is a really interesting one. Um, it’s really important and needed. We have needed to increase salaries, not just for veterinarians, but for more so, frankly, for our support staff for a long time, we still have some room to grow there, um, potentially considering different incentive methods.

What does it, what does it look like for, um, there to be different methods of compensation that involve the whole health care team having a, uh, production type incentive, there, there are things to be considered that are outside of my realm of expertise. But what we did talk about in the book chapter is the staffing costs of rising salaries that we need to recruit and retain

the people to do the work in a practice, in a clinical setting, um, there’s nothing bad about that. We, that, that has been needed. However, it’s important to remember that it, there are also results that, that come from that. And pet families are, uh, kind of, you know, Helping to carry that greater financial burden because we have to accordingly rise, uh, raise prices to help pay for those staffing costs.

So it’s not, again, not a bad thing that we’re doing that. It’s a good thing, but it’s also something to know that’s one of the drivers that the ultimate feeling of that, um, is being seen in invoices being and care plans being discussed.

Dr. Andy Roark: Yeah. Um, when you talk about adapting to changing practice economies, the way I took that, I want to see if I’m right here, to me, these are the sort of the changing of the landscape that we’re facing. So, for example, if a practice started to have less pharmacy business because of online pharmacies that their clients were using or things like that, that would be sort of a changing economy.

If they were introducing new services. Um, you know, they’ve got a, um, they’re doing their own ultrasound scans or they’re, they’re shifting around doctor schedules to offer telemedicine or sort of things like that. Those are all different ways of working that are being offered as services to the pet owners, but they are affecting how we price our services and what people are sort of leaving the clinic having paid.

Is that correct? Mm.

Dr. Emily Tincher: It is. I, I think that, uh, if we just look at examination fees, for example, I think exam fees is something that we’ve seen change relatively significantly in many practices over the last, since COVID. And, uh, essentially it was, we, we see less production coming from, um, pharmacy, uh, a trend, uh, that we are seeing across vet med is rising exam fees.

to, to go along with it. Now, I’m not saying causation or that that’s purposeful in every case, but it is one that, um, you’ll, you’ll hear consultants talk about, for example, as increasing your exam revenue to kind of make up for that. And again, there’s nothing inherently bad about doing that. Ultimately, we are a, uh, what are the things that we as veterinarians can, and veterinary healthcare teams can exclusively do

you know, in this case, we’re talking about an in person setting and that’s use our brains and, and have, have services, the pharmacy stuff. It, it is an opportunity for pet families to, um, say, save some money in one area. Uh, if that’s possible. You know, potentially ordering online or, or going to a Walmart for a prescription.

Dr. Andy Roark: Talk to me a little bit about your idea that we’re seeing a decrease in access to intermediate care. I think that that’s an interesting idea. Can you, can you sort of lay out what you mean when you sort of put that forward?

Dr. Emily Tincher: Yeah. So as we consider the concept of a spectrum of care, what is, what is something that most of us can do in clinical practice to increase access to care, we can provide options and, and they have to be specific to the setting that we’re in. Uh, but we can provide a range of options. And, um, you know, at the high end of that, if we consider, We recently, in April, we released our annual, um, most common claims at Nationwide.

Uh, we can attach that in the show notes, the, the press release from that for, I don’t know, many, many, many years running straight for dogs. The most, common claim yet again is skin allergies and skin infections related to skin allergies. It’s top 10 for cats as well, but not the number one spot. So why don’t we think about it that way for a skin allergy case?

Um, the most advanced level of care may be, especially for cases more chronic as they tend to become maybe to go see a dermatologist. Um, okay. But that is an option. Pet family should know that it exists. Um, in this case, there’s a lot that we can do and do frequently on a day to day basis, um, as general practitioners for treating skin allergies, uh, where we are.

That is pretty different when we think about some of the surgical things that are out there. Um, I think from a skillset perspective and, and one, just going back to the skin allergies. It’s more common than it used to be to refer to see that dermatologist. There’s a lot more access to referral care than there was even 10 years ago, much less 20 years ago or beyond.

And so again, that’s a, that’s a good thing. Um, and at the same time, having, uh, more referral, that increased level and access of care, uh, we’re sometimes managing less than how sometimes more likely to refer. Um, which is a great fit for some families and not, not as good of a fit for others from a true skill set perspective.

Sometimes, um, I think we ended up talking about surgery a lot and whether that’s a, it’s a combination of so many factors, much, much like the cost of care and rising and the why. The why for, for having, um, less experience or less, less of a skillset and general practice settings to perform intermediate level surgeries, whether that’s, you know, the, um, a lateral suture for a cruciate ligament or a perineal urethrostomy for cats.

Um, so even foreign body surgery, many, many, uh, of our, especially younger veterinarians are, are not, um, comfortable performing that surgery. Okay. Because of the mixture of, I think, fear sometimes of learning that skill set after we graduate, and there’s a lot less surgery experience while you’re a student than maybe there used to be, there’s just less of a mentorship culture, uh, and ability to continue building that skill set, especially comfortably, um, than we used to have.

Um, resulting in, you know, some, some folks simply cannot go, they, they could afford to pursue surgery with us in a general practice setting. Um, but that’s not always going to be the case and certainly hasn’t, hasn’t been when I’m providing estimates at an, at an emergency specialty hospital, not always the case that that’s an option to move forward in the, a specialty referral environment.

Dr. Andy Roark: Yeah, I, I completely buy that. I really, I was intrigued when you said that. I’ve got this idea, Emily, that, um, part of sort of the path forward as we let our support staff work at a higher, like, at the top of their licenses, I think that we can continue to, to, to pay them better and let them have more autonomy. I think that general practice veterinarians are going to have to move up more towards the top of our licenses, which means I think we can see a lot more of our basic wellness services being handled by, by our, you know, by our technicians or, um, I don’t know if a mid level practitioner will, will appear or not, and I’m not trying to, to stoke that, but, um, but, but if, if that were to happen, I could see a lot of

basic service being provided by those people. And then what would happen is general practitioners would move up more towards a management role of providers. And then also that intermediate level care. But I really do think, and I know I’m a perpetual optimist, I really do think that there’s so much fertile land there for us to cultivate.

You know, there’s just so much opportunity for us to start retaining cases that we’re, that we’re punting that maybe we don’t need to. I think surgery is a great area for that. But, but, but we’ve got it. We’ve got to get some mentorship and some growth in educational, uh, pathways so that people feel comfortable getting there.

But I, I completely agree when, even when I started in vet school, you know, 15 years ago, uh, more than that, there was, there was a lot of stuff that we did in practice that I just don’t see being done that much anymore. It goes to the specialty hospital. I, and again, it’s not. It’s not bad, but it has cost ramifications.

Let’s,

Dr. Emily Tincher: think I think that the other, you know, the, the way forward may not be the way backwards sometimes. And so one of the other interesting things that I’m seeing, and you have to have a certain population density probably for something like this, but there are now some general practice level surgery, surgery only practices cropping up.

And so I think that’s a great example of what are the new ways of, of modeling practices that may, um, more suit our current environment. So how could you efficiently have dental only practices, have general practice level surgery only practices? Um, if doing that in the general practice setting, um, uh, of my parents, you know, um, my, and the way that I grew up may not be the path for everyone.

Could it be that you were working more within a community setting of You know, my, my, I, I cannot do surgery. I don’t, It’s been a long time,

Dr. Andy Roark: Ha ha

Dr. Emily Tincher: uh, since I’ve done a spay much less, um, at this point, it’s limited to laceration repairs when I still pick up ER shifts sometimes. And I think like having. An option like that to say, like, we, there’s a practice nearby that during working hours, they, it’s not a specialist and the costs are, uh, some of them transparently like sitting on the website.

Exactly. This, this is what the cost is. If you come in to see us, um, I think it’s a really cool way forward, creative and innovative way forward for evolving some of our models. If you’re not one that says our general practice is going to be mid level surgery capable.

Dr. Andy Roark: yeah. I, I, I completely agree. I think, I think, um, I think the future of vet medicine is fragmentation. I think that’s, I think that, I, I think that’s great. You know, my, my biggest piece of career advice for people for a long time has been figure out what you enjoy doing and what you’re good at and figure out how to do more of it.

And I just, I think that, that’s great. I think there’s so many more opportunities to do that. When you say like a dental only practice, some people would just cringe away. And some people’s eyes light up of like, Oh, that would be if I could just do teeth all day, like that would be amazing. And just, I don’t know, I, I see that it would just such an optimistic lens of like, this is going to be, this is going to be great.

I think charting your own courses is, um, it’s something we’re going to be able to do in ways we haven’t done before. Talk, talk to me a little bit more. So, okay. So we’re talking, uh, we’re talking about sort of, how do we, Given that we have these drivers upwards of, of pricing and we talked about, you know, staff wages and things.

I don’t, I don’t think that those are bad things and I think that we agree, you know, they’re, and again, offering people a higher level of care. That’s not, that’s not bad or innately bad in any way, shape or form. I don’t, I really don’t think that people are, I don’t know that we get, you know, Treated fairly sometimes especially about angry people online but but I don’t think anyone’s the bad guy here. At the same time going back to our nuanced approach from the very beginning It’s challenging for people to have pets If they have limited resources, and I think that a lot of us we can get- it’s funny. We’ll get fired up and say well we you know we deserve this money or we’re worth this or this is why the price is what it is And then if you say to that same person, well, do you think that people who can’t afford that shouldn’t have pets?

And they’re going to go, you know, no, I don’t, I don’t want that to be reality. And so how do we, how do we start to find the middle ground, Emily? Like, what is, what does that path look like?

Dr. Emily Tincher: I think the, um, the question that you almost touched on there is like, is our pets a privilege? And,

Dr. Andy Roark: Oh, I almost asked that question. And then I backed away from it.

Dr. Emily Tincher: Well, it, it’s, it’s an important one to talk about. I, I see it sometimes that I think when our, in our hardest moments, in our most challenging days, that it can be tempting to say, if you don’t have the financial planning to fix the foreign body, Um, then you shouldn’t be able to own a pet, but the reality is that 60 percent of Americans live paycheck to paycheck.

And the most Americans would struggle to come up with more than 400 for an emergent situation. And so if we’re going to say that most Americans should not have a pet, I think we have to step back and say, first of all, the human animal bond is so incredible for the value it provides to us. As humans or mental and physical health development of children that that’s not we have to back away from that.

That is, we cannot understand the value of the human animal bond and at the same time believe that pets are privileged that only the wealthy should have available to them. And we have to acknowledge that no one’s asking us for our permission

Dr. Andy Roark: Right. Yes. a good point. Like, this is people like, let’s see what the vets say about whether or not we should have a pet. Like that’s not

Dr. Emily Tincher: yeah, it was, I don’t remember who said it was a comment at the American Association of Veterinary Medical Colleges a couple of years ago, um, just kind of stood up in a spectrum of care forum and, and, and mentioned that. And I, I, that’s really stuck with me of like, Yeah, no, no one’s asking us for, for our permission to add a pet to the family.

And so even coming back to a One Health perspective, then we, we have to find some way to work together with pet families for, to prevent zoonosis minimally. But then also to the, the level up from that is to protect and promote the human animal bond. And so I don’t believe that pets are a privilege. I think that

you know, that we do have to provide them a level of at least a basic level of care. Um, and how do we engage with that? How do we as, as that healthcare teams, um, say what, what can I do on an individual level, maybe a community level. And I think spectrum of care is a great one of the solutions, but, but increasing access to care requires all of us to work together and it requires a lot of different solutions layered over each other.

Financial planning resources are I think another really important one, um, to, to both help pet families say yes to the care that we’re recommending. Um, even as we come back to that idea of advanced level care and what is, what is the right, what is the right care and, and, um, and having a lot of really good conversations with how do we define best care?

Dr. Andy Roark: Yeah, I agree with 

Dr. Emily Tincher: I used that to maybe define it as like the most advanced level or the gold standard, a term that I’m desperately trying to avoid except calling out that it’s not, not very helpful. Um, the best care, in my opinion, is the care that meets pet family needs. So the pet gets what they need, but also acknowledges some of the resource and budget constraints that we’ve talked about why those are popping up today.

I 

Dr. Andy Roark: Yeah, I think for me, because I’ve thought about this as well. So for me, defining best care is still a little bit nebulous in my mind. But basically, three requirements are for me. Best care has to get done. It’s not best care if it doesn’t get done, because then it’s no care. And so best care has to get done.

It should be care that the pet owner feels good about. Like they feel good about what they provided, and it should be, uh, care that the practitioner feels good about as well. And I think if you have something that actually gets done, and the pet owner feels good about it, and the provider feels good about it, probably, you’re probably pretty close to best care.

I don’t know. Maybe that’s too low a bar. I don’t know. I have to keep working on it, but I think, I think there’s some, there’s something there.

Dr. Emily Tincher: I think that it’s, it’s really important to, you know, we’re, we’re applied scientists and the amount of evidence based medicine that we have, peer reviewed medicine that we have, it’s not as much as we might like, um, having more opportunities to measure the outcomes of care will really help us move forward in feeling good about different levels of care that are available.

Unfortunately, right now there’s more, there’s not a lot of outcomes based medicine, but there’s more evidence that’s available to support more advanced levels of care. Um, I think there’s some really great examples of, um, more intermediate level care being studied, especially through the ASPCA. We talked about some of those in the past, um, um, pyometra and timing example, in timing of that surgery, not requiring instant intervention or the pet will die.

Um, we can link that paper in the show notes too as well. I think it’s a really important one. Um, But know that I, we, we’ve talked, touched just a little bit on advancing level of care. It’s not a bad thing. And I think because when we’re talking about increasing access to care, sometimes, um, specialty or really advanced levels of care might feel like they’re getting beaten up.

Um, but I think that’s because we already, we already see the value in that and, and it might be that, um, it’s very, very likely that in most cases, if we consider nothing else but the medical outcome, in most cases, probably the most advanced level of care would be the best option. But since that’s not in line with resources that are available, and frankly, that’s not always what people want, especially when we’re considering chronic or end of life care.

Um, we have to, we have to consider some of those other options and, and bring them in.

Dr. Andy Roark: yeah. Emily, thank you so much for being here. Where can, uh, people find more information on Spectrum of Care, you have done so much with this. You’ve got so many resources and things like that. We’re gonna link up, uh, the resources you already mentioned, but, uh, where’s your favorite people for, uh, where’s your favorite place for people to go and learn more?

Dr. Emily Tincher: Yeah, there’s a couple of places I would recommend. So we have, uh, Nationwide put together, um, spectrum-of-care.com um, that’s some, just some basic awareness and we’re adding some additional, uh, resources to that over the coming months. Uh, we can find, find me on, uh, webinars or writing often about, um, or at conferences writing about spectrum of care.

Um, the other place that I would recommend, especially for some financial resources would be to go to the open door veterinary collective, which is a nonprofit, um, trying to build to kind of multi factorially look at how do we increase access to care, um, especially by re rethinking a little bit. How do, how do we, um, consider the financial options that are available to us?

Of course, of course, pet insurance, you know, work for Nationwide, a pet insurance company, is one of them. It’s an important one, but we need a lot of other, um, support methods to, to make a, a wide and lasting impact.

Dr. Andy Roark: Yeah, I agree. Thanks so much for being here, Emily. Thanks for tuning in, everybody. Take care of yourselves, gang. We’ll talk to you later. And that’s it. That’s what I got for you guys. I hope you enjoyed it. I hope you got something out of it. Thanks to Emily for being here. Thanks to Nationwide for making this episode possible and sharing tons of resources in the show notes. Gang, take care, be well, I will talk to you soon.