A willingness to adapt and contribute to advancing standards of veterinary care and a desire to improve clinical outcomes could be considered prerequisites for taking the veterinary oath – to continuously improve the health and welfare of animals under our care. As the spectrum of care extends ever forwards, following trends in human medicine, vets are presented with more options to improve patient outcomes, but these often come with challenges associated with the implementation and affordability of advanced care. Thankfully, there are an increasing number of smart solutions to bridge this gap and ensure more animals are receiving the optimum treatment for their situation.
A willingness to adapt and contribute to advancing standards of veterinary care and a desire to improve clinical outcomes could be considered prerequisites for taking the veterinary oath
Opportunities
1) Perception of pets
Owners are increasingly identifying as “parents” to their pets and integrating them into the heart of the family. There is a growing appetite to bridge the gap between human and pet healthcare options. Average spending on pets continues to grow to nearly double what it was a decade ago (Bedford, 2023), and many owners are prepared to pay more for advanced care options.
2) Research and development
Advances in technology have enabled a huge acceleration in drug discovery, with artificial intelligence (AI) being used across a growing array of disciplines – from identifying gene targets to prediction of protein-folding, data collection and analysis and response modelling.
There is huge potential for a wave of new therapies to improve patient care to be developed at lower cost and be released to market in a much shorter time frame.
3) Diagnostics
Technology is also impacting the field of diagnostics, speeding the process, increasing accuracy and reducing costs. Cytology and histopathology can be interpreted by machine learning algorithms much faster and more completely than humans (Giarnieri and Scardapane, 2023).
AI has also proved a useful tool in disease prediction, such as the typically complex diagnosis of Addison’s disease in dogs (Reagan et al., 2022). It may also reduce the cost of diagnostics, for example mapping MRI findings to photographic images of dogs’ heads to aid diagnosis of pain associated with Chiari-like malformation and syringomyelia without the need for MRI, as seen in the Head Space Project (Rusbridge et al., 2023).
All of these tools could lead to cheaper, less invasive and earlier diagnostics and treatment of painful or life-threatening conditions.
4) Advanced imaging
Advanced imaging with computed tomography (CT) and magnetic resonance imaging (MRI) to aid diagnostics are increasingly available in first opinion practice. Flexible options, including rental or visiting peripatetic machines, present more possibilities for practices wanting to provide these services for their clients. With teleradiology services, imaging studies can be sent directly to remote radiologists to provide imaging reports, negating the need for on-site expertise for the interpretation of advanced modality studies.
Flexible options, including rental or visiting peripatetic machines, present more possibilities for practices wanting to provide [advanced imaging] services for their clients
VetCT’s global teleradiology team not only provide detailed, clinically focused reports around the clock but also welcome discussion with the clinician to answer any questions. In addition, VetCT provides guidance and training on optimising image acquisition and bespoke in-house training programmes on CT use for practice teams.
5) Treatment
Alongside accelerating drug discovery, AI is the “data genie”, and the three wishes it may grant veterinary practice include data collection/extraction, standardisation and analysis beyond our current imagination – think how the modern smartphone has developed capabilities most of us never imagined!
The insights we can potentially glean from response to treatment will hopefully lead to a revolution in evidence-based veterinary medicine.
6) Referrals
In the UK, there has been a rapid rise in the number of private and university referral hospitals in the last decade. For geographic areas that remain underserved by specialist centres, there are increasing options for virtual access to specialist care within primary care practices. Remote specialists can also support physical referral centres to supplement in-house disciplines, provide second opinions and even act as virtual locums to cover illness or absence.
7) Teleconsulting
Teleconsulting or the provision of remote specialist-to-vet advice has been common practice for decades through informal “ask-a-friend” channels. With both first opinion and referral practitioners increasingly time-pressured, formalising this process through innovative technology platforms enables the time for clinical discussions to be fitted into the working day and ensures the safe transfer and storage of patient data and clinical conversations.
Virtual services open the gateway to the globalisation of specialist advice, democratising access to specialist care and enabling 24/7 support from specialists working in different time zones.
Challenges
Many of the opportunities to provide advanced care can seem like a distant prospect in daily practice life. With the financial downturn, workforce pressures and challenges in keeping up with – let alone implementing – change, advancing care for patients may feel like an uphill battle.
1) Workforce issues
Time and workforce pressures can lead to reduced confidence and learning opportunities, and skills loss. In addition, the veterinary workforce is getting “younger”, with the median age range of UK-practising vets reducing from 46 to 50 years old in 2010 to 36 to 40 in 2020 (RCVS, 2010, 2020). With an increasing number of experienced vets leaving the profession, this reduces the opportunity for mentorship, supervision and training in practice.
2) Client issues
While the perception of healthcare costs has always been an issue with access to the NHS, the addition of cost-of-living concerns leads to increasingly difficult discussions and decisions with owners. They want better care for their pets, but cost is a barrier and pet insurance can be an early victim of spending cuts.
3) Change
When faced with the rapid pace of development in the varied fields across genetics, diagnostics, treatment, operations and communications, it can be challenging to keep up with the pace and breadth of change.
Changes – both clinical and operational – require an investment of time and resources to train and implement within teams
The increasing volume of veterinary knowledge and scope of veterinary medicine can make it a challenge to stay up to date. Changes – both clinical and operational – require an investment of time and resources to train and implement within teams. The ever-present unknown of what the future holds can also result in reluctance to engage and invest in changes that may be outdated before they are even fully implemented.
Supporting advanced care in practice
Despite barriers to providing advanced care, the ever-resourceful profession is rising to meet these challenges:
- Shifting mindset – while we all want to provide the best care possible to our patients, we have seen a welcome mindset shift away from “gold-standard” care, which implies everything else is sub-standard, to a spectrum of care or care options. This acknowledges that optimal care is dependent not only on the clinical picture but also on practice factors (such as equipment, skills and location) and owner preferences and limitations (such as cost, home-care requirements and ability to travel)
- Virtual specialist support – remote specialists are now able to integrate seamlessly into first opinion practice through technology platforms. Further, services such as teleradiology and teleconsulting provide assistance with diagnosis and case management. VetCT’s services can be accessed via desktops and an app for on-the-go use. The whole practice team can view all the case reports from the practice, helping to provide continuity of care as well as enriching learning opportunities. Virtual specialists can also provide remote mentoring and supervision, building confidence, enhancing skills and providing in-house training opportunities for less experienced vets
- Point-of-care learning – access to curated information at the point of need is increasingly facilitated through modern CPD options, including bitesize videos, curated microlearning and patient-side advice
- Cost of care – while we wait for conclusions from an investigation of the veterinary industry by the Competition and Markets Authority, some practices are trying innovative pricing models, such as all-inclusive subscription models. Virtual specialist services also provide an avenue for expert care for those unable to travel or afford physical referral
- Change management – coaching leaders and teams in embracing change is helpful to enable a culture of agility and adaptation in practice, which will be increasingly valuable as the pace of change continues to accelerate
Conclusion
In summary, providing cost-effective, advanced care options in general practice across an extending spectrum of care may seem daunting when we consider the current situation – with resources squeezed by time, finance and staffing constraints. However, barely a decade ago, we could not have imagined holding powerful supercomputers in our hands that enable us to do pretty much anything.
By becoming more agile, embracing what technology and innovation can do for veterinary practice now, helping our teams to feel confident and supported to provide more advanced care options and contributing data to research, we can help to drive the continuous improvement of veterinary care
By becoming more agile, embracing what technology and innovation can do for veterinary practice now, helping our teams to feel confident and supported to provide more advanced care options and contributing data to research, we can help to drive the continuous improvement of veterinary care. In turn, this should not only benefit patient outcomes but also boost team motivation and morale through a more enjoyable, rewarding practice life.
