Transcript Future of Veterinary Teaching Hospitals

Future of Veterinary
Teaching Hospitals
Mimi Arighi, DVM, MSc, DACVS
Director, VTH
Veterinary Teaching Hospital Missions
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The unique challenge of the Veterinary
Teaching Hospital is to:
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Remain financially viable while
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enabling teaching and research,
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all the while providing veterinary medical
services to the public.
Jim Lloyd
History
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Internships began in 1950-60’s, residencies in 196070’s.
Board certification became the norm for entry level
clinical faculty positions in the 1970-80’s
Clinical Departments began to divide responsibilities
into academic & hospital, and Hospital Directors
began to be hired in the 1980-90’s, and have
continued to be hired in the 21st century.
Veterinary Colleges became more dependent on
hospital income in 1990-2000’s.
Discussion Forums on VTH Issues
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AAVMC meeting – March, 2004
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AAVMC Forum at AVMA meeting – July, 2004
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AAVC/AAVMC/NAVCA meeting March 12, 2005
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AAVC Meeting – Atlanta, April 2005
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AAVC Forum at ACVIM Annual Meeting– June 1, 2005
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AAVMC Meeting – March 11, 2006
Problems Identified at these meetings
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Difficulty in faculty staffing of VTHs due to
attraction of private specialty practices
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Future funding for VTHs is up in the air –
revenue and gifts are probably the best future
source of funding since an increase in central
core funding is not likely
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Decreasing of state subsidies, and an increase in
the competition for cases and potential faculty
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Many faculty/specialists find that there is too much redtape in universities.
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Research, teaching, and service – hard to be good at all
three, can be in direct conflict with each other. Some
think there is also a 4th mission – to teach the business
aspect of veterinary medicine
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Increased reliance on tuition and fees, stagnant VTH
revenues in some areas
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State revenue as a % of total revenue for vet schools has on
the average decreased from 55% to 33% over last 10-20 years
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Average # of state-funded faculty positions has been
static at most schools, some increase in non-state
funded positions (from donation dollars or revenue
dollars), at same time as increase in # of students
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Decreasing to static applicant pool for vet students,
increase in number of veterinary schools to choose
from
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Suboptimal distribution of caseload (need more
primary cases for teaching, too many tertiary cases)
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Perception of faculty – stretched to limit with
multiple balls in the air.
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Where will next generation of clinical professors
come from?
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Are we graduating an entry-level veterinarian?
Do they get enough hands-on experience?
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Do off-shore students dilute the learning
experience for U.S. students?
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In private practice, a vet earning $65,000 should
produce at least $300,000 in revenue, but the
VTH is not a typical practice so the faculty do
not typically produce that amount of revenue.
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Practice owners want from graduates: veterinary
knowledge, communication skills, people skills,
business skills, how to manage workload
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Adequate caseload is not always there in
academia for teaching and research needs
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Specialists are finding that the VTHs have a lack of
money, equipment, and new space, are inefficient,
and that some are located in nondesirable locations.
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The faculty feel like they have a loss of control over
the work day; too many goals; long days and
weekends; and they have found that they now can
teach in private specialty practices and not just in
academia.
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Present faculty can be poor role models for interns
and residents – show unhappiness and frustration.
The Need to Change
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The SVMs and VTHs must be willing to
change to accommodate the above issues,
prioritize the missions of their clinical
programs.
Potential Solutions for the VTH Issues
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Balancing the mission – teaching, research,
service, and hospital as a business
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Balance the mission as dept. not each person
Have enough support staff to support the faculty
Perhaps teach some of DVM curriculum by nonspecialists
Money generation should not be the prime reason
for the VTH
2 services running simultaneously, one for service
and one for teaching might help - Minnesota
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Recruitment/retention of Clinical Faculty
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Look for donors for new equipment/facilities,
donors for new faculty positions, and to
augment faculty salaries
Look to share specialists with private
specialty practices
Need to offer part-time or full-time clinical track
positions to specialists, but must not be a 2nd class
position – need longer term contracts, sabbaticals,
voting privileges, etc.
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Work with University to get more competitive
salaries for specialists, maybe signing bonuses
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Develop Incentive Plan – part of revenue goes
back to individual faculty or their section of the
hospital for their use
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Develop satellite practices so as to augment
money generated and improve 2° type cases
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Offer consulting time to faculty or increase it
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Improve culture in the VTH/SVM so there are
attractive reasons for faculty to stay, and
market academic lifestyle internally so faculty
want to sell the benefits to potential hires.
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Augment a resident’s salary if that person will
commit for certain number of years as a
faculty member after completion of residency
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Select residents that want to stay in academia
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Maintaining and Enhancing Case load
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Develop good relationships with RDVMs,
establish a Practitioner’s Advisory Board
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Hire a Referral Coordinator(s) to deal with
RDVM issues
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Hire a Marketing Manager for the VTH to market
to RDVMs and the public
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Carry out client and RDVM surveys - to identify
areas where improvement is needed
Make clinicians and staff realize they are
competing against private specialty practices for
caseload, so must give better service
Bring in an outside consultant to help identify
how the VTH could be more efficient
Need new faculty to introduce themselves or be
introduced to RDVM population by giving CE
seminars, and going to local veterinary meetings.
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Enhancing Operations of VTH
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Work on alleviating bottlenecks in the VTH
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Hire a Development Officer who is assigned
directly to the VTH
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Have treatments of hospitalized cases carried out
by technicians, not students – might improve
efficiency and let students learn more
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VTHs might need to start hiring a Hospital
Administrator/Director with a MBA, MHA, or
similar training.
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VTHs need to have a strategic plan, establish
benchmarks, have a good financial reporting
system.
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Clinical Track faculty – good move to hire them
but who should pay for them? VTH, Clinical
depts.?
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Suggestion is to take charging away from clinicians,
put technicians in charge of billing, but get faculty
involved in budget process to increase understanding
of where revenue dollars are going to.
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Spend less time on student rounds and start
admitting cases sooner in the day (earlier than 9:30
or 10:00 am.)
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Community Practice Service – good way to get
primary care cases, but probably needs to be run like
a private practice, not like the rest of the VTH.
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Partner with private specialty practices to hire
specialists
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Should residents be trained at private specialty
practices? Or should it be a joint endeavor with
universities?
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Specialty colleges have to be careful that too
many restrictions for training residents are not
placed on specialists/colleges. That is happening
now in some situations.
Next Steps That were Taken
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A VTH Task force (AAVMC, AAVC, NAVCA) was
created in 2004 that worked to prepare a “white
paper” addressing concerns for future of VTHs –
thought that this paper could be used for local
support, consultant backgrounding, and accreditation
standards.
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A Benchmarking Task force was also created in
2004/2005 – (AAVMC, AAVC, NAVCA) to develop
benchmarks that all VTH’s can complete annually
and use to determine efficiency of their own model
compared to others.
White Paper – Present and Future
Problems for VTHs
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The vast majority of the advances in veterinary
medical care to date have occurred because of the
existence of Veterinary Teaching Hospitals.
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The convenience and high quality of private
specialty practices impacts the caseloads of the
VTHs and has the potential to compromise the
education of veterinary students and postgraduate
veterinarians and the generation of knowledge
through clinical investigation.
John Hubbell
White Paper continued:
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The resolution of this crisis will require broad
participation and cooperation. New alliances must
be formed to foster clinical education and
investigation at the professional and postprofessional levels.
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The profession must be engaged because the solution
will involve universities, specialty colleges and
practices, private practitioners, veterinary students,
and organized veterinary medicine.
Conclusion
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Dr. Robert Marshak wrote in 2005 that
there are serious disadvantages to any
arrangement for clinical training that is not
firmly centered and concentrated in the
school's large and small animal hospitals.
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If we agree with this statement then we all
must work together to preserve our
hospitals in whatever way we can.