Practitioner Issue 4, 2023 by FVMA

The Practitioner Published by the Florida Association of Equine Practitioners, an Equine-exclusive Division of the FVMA

Issue 4 • 2023

USING REGENERATIVE MEDICINE TO Improve

Healing in Soft Tissue Injuries

Kyla Ortved | DVM, PhD, DACVS, DACVSMR | Page 4

REALITY OF Equine

Practice in 2023

Amy L. Grice | VMD, MBA | Page 12

The President's Line Dear fellow practitioners,

EQUINE COUNCIL RUTH-ANNE RICHTER

BSc (Hon), DVM, MS

rrichter@brandonequine.com

ADAM CAYOT DVM

adamcayot@hotmail.com

SALLY ANNE DENOTTA

Thank you to all who attended our 2023 Promoting Excellence Symposium (PES) in October. I hope you gleaned valuable information from the excellent speakers. Now, I want to take a moment to talk about some important topics: membership and advocacy. As our profession experiences a decline in practitioners, we need to rally together to increase membership – not just maintain it. Your membership does more than provide you over $1,000 in discounts and savings, it supports youth and educational eﬀorts to encourage the growth and sustainability of the profession. Recently, we helped sponsor a student appreciation day for UFCVM students in Ocala. For the day, students got ﬁrst-hand experience in what it means to be an equine veterinarian as they rotated between four private veterinary practices to participate in key procedures. We were proud to have multiple council members lead instruction and help organize this event.

DVM, PhD

s.denotta@uﬂ .edu

COREY MILLER DVM, MS, DACT

cmiller@emcocala.com

While we are currently in the legislative oﬀ season, we’re gearing up for January and will be addressing three major topics. We are: proposing proper veterinary telemedicine legislation that supports the veterinarian-client-patient relationship (VCPR); supporting our veterinary technicians by drafting bill language allowing licensure for those qualiﬁed; and changing the drug class of Xylazine to match that of federal law. Please keep an eye out for emails on this! I know we’re all getting ready for the busy season, but I hope we will all take some time to support our community and profession.

ANNE L. MORETTA

VMD, MS, CVSMT, CVA

maroche1@aol.com

JACQUELINE S. SHELLOW DVM, MS FVMA PRESIDENT

jackie@shellow.com

JIM NAUGLE

EXECUTIVE DIRECTOR AND EDITOR IN CHIEF

jim.naugle@fvma.org

P.S. Ocala Equine Conference (OEC) will be returning this January – so if you didn’t get your CE at PES, please join us at the World Equestrian Center in Ocala for more incredible CE! Enjoy your holiday season! Armon Blair, DVM FAEP Council President Ocala Equine Hospital abeqdoc@gmail.com FAEP Mission: Support our members’ professional development and educate them on issues aﬀecting the equine industry as well as methods for improving equine welfare in Florida.

Opinions and statements expressed in The Practitioner reﬂect the views of the contributors and do not represent the oﬃcial policy of the Florida Association of Equine Practitioners (FAEP) or the Florida Veterinary Medical Association (FVMA), unless so stated. Placement of an advertisement does not represent the FAEP’s or FVMA’s endorsement of the product or service. FAEP | 7207 MONETARY DRIVE, ORLANDO, FL 32809 | PH: 800.992.3862 | FAX: 407.240.3710 | EMAIL: INFO@FVMA.ORG | WEBSITE: WWW.FVMA.ORG

2 The Practitioner

Issue 4 • 2023

Become an FAEP MEMBER As a member of the Florida Association of Equine Practitioners, you can save big on continuing education, professional services, financial products, and more.

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Regenerative Medicine USING REGENERATIVE MEDICINE TO

Improve Healing in Soft Tissue Injuries Kyla Ortved | DVM, PhD, DACVS, DACVSMR New Bolton Center, University of Pennsylvania, Kennet Square, PA

Equine athletes of all disciplines are prone to soft tissue injuries. Common injuries include superficial digital flexor (SDF) tendonitis, deep digital flexor (DDF) tendonitis, suspensory ligament desmitis, collateral ligament desmitis, and meniscal tears and degeneration. Unfortunately, soft tissues including tendons, ligaments, and menisci, have limited intrinsic healing capabilities. Resultant repair tissue is often biomechanically inferior to native tissue leaving the animal prone to degeneration and re-injury. Traditional therapies for soft tissue injuries include systemic non-steroidal anti-inﬂammatory drugs (NSAIDs), intralesional injections with corticosteroids, cryotherapy, rest, and lengthy rehabilitation programs. More recently, regenerative medicine has been incorporated into standard treatment regimens for soft tissue injuries with the goal of decreasing inﬂammation and promoting healing through the delivery of cells and/or cytokines and growth factors to the injured tissue. Orthobiologics are aimed at producing an end product that more closely resembles native tissue. Currently, platelet-rich plasma (PRP), autologous conditioned serum (ACS), autologous protein solution (APS), stem cells, and amnion are the main orthobiologics used in equine soft tissue injuries.

PLATELET-RICH PLASMA Platelet-rich plasma (PRP) is an autologous blood-derived product deﬁned as a volume of plasma with a platelet count above that of whole blood. PRP can be prepared patient-side following centrifugation or gravity ﬁ ltration of autologous

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blood as platelets are smaller and less dense than RBCs and WBCs. Several commercial systems are available including Arthrex ACP® (Arthrex, Naples, FL), GPS® III (Zimmer Biomet, Warsaw, IN), Magellan® (Arteriocyte, Hopkinton, MA), Harvest® SmartPrep® (Terumo BCT, Lakewood, CO), Restigen PRP™ (Owl Manor Veterinary, Warsaw, IN), V-PET™ (Pall Medical, Port Washington, NY), and others. There is significant variability in platelet and WBC concentration across products which has the potential to affect efficacy. The therapeutic effect of PRP is due to the degranulation of platelet α-granules which release high concentrations of growth factors including PDGF, TGF-β, FGF, VEGF, and EGF, amongst others, that help modulate the inflammatory and healing response in damaged tissue. PRP also promotes healing by enhancing cell migration, proliferation and differentiation, improving matrix synthesis, and stimulating angiogenesis.¹ Several equine experimental and clinical studies have found that PRP treated tendon and ligaments have improved strength and elasticity compared to control and that re-injury rates are decreased.²-⁵ In an experimental model of SDF tendonitis, tendons treated with PRP, when compared to saline treated tendons, had improved quality of repair tissue histologically, significantly more collagen and GAG content, and superior

Issue 4 • 2023

preparation for injection into the patient. Additional aliquots can be stored at -20 oC for future injections. IRAP II (Arthrex Vet Systems) and Orthokine (Dechra Veterinary Products) are two commercially available products. ACS is most commonly recommended for use in inﬂamed joints; however, a recent study found that tendon lesions treated with intralesional ACS in horses with naturally occurring tendinopathies had signiﬁcantly smaller cross-sectional areas on serial ultrasonography and better collagen alignment following treatment compared to controls.¹⁰

AUTOLOGOUS PROTEIN SOLUTION

The Angel® System (Arthrex) used to prepare platelet-rich plasma (PRP). This system allows precise control over platelet and cell concentrations in the final PRP product. Image courtesy of Kyla Ortved

Autologous protein solution (APS), or Pro-Stride, is touted as a combinatorial product as it contains concentrated platelets (PRP) and increased concentrations of IL-1Ra, similar to ACS.¹¹ The two-step centrifugation process does not require incubation such that it can be used patient-side. Few studies have evaluated the eﬀect of APS on soft tissue injuries. A recent study demonstrated that collagenase-induced SDF tendonitis treated with intralesional APS had a higher elastic modulus and signiﬁcantly decreased expression of collagen type 3 twelve

neovascularization. Perhaps most importantly, improved biomechanical properties, including higher strength at failure and elastic modulus, were demonstrated in PRP treated tendons.²-³ Several reports have also described successful clinical outcomes following the treatment of horses with SDF tendonitis and desmitis of the suspensory ligament, including lesions in the origin, mid-body, and branches.⁴-⁹ Despite seemingly positive clinical outcomes, the lack of a large randomized controlled trial must be considered when interpreting the results of PRP treatments. PRP can be used in the acute phase of soft tissue injuries because it is available patient-side. Ultrasound-guided intralesional injections can be performed at three-to-four-week intervals until healing is satisfactory.

AUTOLOGOUS CONDITIONED SERUM Interleukin-1 receptor antagonist (IL-1Ra or IRAP) is an endogenous protein produced by immune cells, mainly monocytes. It is a competitive antagonist of interleukin-1 (IL1), which is a central mediator of inﬂammation. Autologous conditioned serum contains high concentrations of IL-1Ra in addition to other immunomodulatory cytokines. ACS is made from the horse’s own blood and requires a 24-hour incubation period during which blood is stored in a specialized syringe containing borosilicate (glass) beads that stimulate the production of IL-1Ra from white blood cells. Following incubation, the serum with concentrated IL-1Ra, is collected in

Sterile collection of blood in order to prepare a hemoderivative or autologous blood-based product. Image courtesy of Kyla Ortved

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source of MSCs used in equine medicine as they can be easily obtained from the sedated, standing horse. Specifically, bone marrow can be harvested from the sternum or tuber coxae and adipose can be harvested from either side of the tail head.¹³-¹⁴ The therapeutic effect of stem cells is attributed to their ability to promote healing and limit scar tissue formation, modulate the inflammatory response, and stimulate tissue regeneration.¹⁵

Autologous conditioned plasma (ACP) prepared in the Arthrex ACP® Double-Syringe System prior to injection into a soft tissue lesion. Image courtesy of Kyla Ortved

weeks after treatment compared to controls.¹² More research is needed on the eﬀect of APS in soft tissue injuries, especially in horses with naturally occurring disease.

AMNION Equine amnion-based products are available for the treatment of tendon/ligament injuries (AniCell Biotech). Amnion is collected and decellularized such that an oﬀ-the-shelf bioscaﬀold is available. At this time, support for the use of amnion is mainly anecdotal.

STEM CELLS Stem cells are undifferentiated cells that are capable of selfrenewal and able to differentiate into different cell types (potency). The potency of stem cells varies from totipotent (able to give rise to all cell types e.g. early embryonic cell), pluripotent (able to differentiate into any of the three germ layers e.g. embryonic- and early fetal-derived stem cells), multipotent (able to differentiate into a number of closely related cells e.g. adult-derived stem cell), to unipotent (able to give rise to only one cell type e.g. progenitor cell). Adult-derived mesenchymal stem cells (MSCs) are used most commonly in equine regenerative medicine as they have the ability to differentiate into osteoblasts, chondrocytes, myocytes, and adipocytes i.e., they are multipotent. Adult MSCs can be obtained from a variety of sources including but not limited to bone marrow, adipose, synovium, umbilical cord blood and tissue, tendon, and muscle. Bone marrow and adipose are the most common

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Following the collection of bone marrow or fat, MSCs can be immediately concentrated for subsequent use, or they can be culture-expanded in the lab. Bone marrow aspirate concentrate (BMAC) and adipose-derived stromal vascular fraction (ADSVF) are produced without any culture expansion. BMAC can be generated patient-side via centrifugation, while ADSVF requires collagenase digestion of fat prior to concentration. ADSVF is commercially available through VetStem Biopharma. The major downside of these techniques is the limited number of cells that are present in the final product such that many clinicians choose to culture-expand MSCs in a dedicated lab. A two to four-week culture period will typically yield > 100 million cells, which can be frozen and re-expanded as needed. Experimental and clinical studies support the use of MSCs for SDFT and suspensory ligament injuries, with most studies showing improved tissue architecture, biomechanical function, and decreased re-injury rates.¹⁶-¹⁹ Tendon and ligament lesions are best treated in the acute phase when a hypoechoic lesion is present on ultrasound. Chronic lesions with increased echogenicity are difficult to inject and likely too fibrotic to remodel effectively. Tendon and ligament lesions can be accurately injected under ultrasound guidance. The number of cells injected varies tremendously with most lesions being injected with ~10-50 million cells. The injection can be repeated every three to four weeks until adequate fi lling of the lesion is appreciated on ultrasound. Extensive lesions in the SDFT or suspensory are sometimes treated with regional limb perfusion of MSCs, instead of direct injection.

ALTERNATIVE STEM CELL SOURCES Dental pulp has been described as a relatively non-invasive source of stem cells in humans and horses, with cells being isolated from the pulp chamber of extracted teeth,²⁰-²¹ although very few studies have evaluated the regenerative potential of equine dental pulp. Recently, Bertone et al. investigated the eﬀect of injection of an oﬀ-the-shelf product Pulpcyte® (VetGraft, Columbus Ohio) in horses with osteoarthritis and tendonitis or desmitis.²² This commercially available product, described as dental pulp connective tissue particles by the

Issue 4 • 2023

REFERENCES 1.

Collection of bone marrow from the sternum of a horse in preparation for culture expansion of autologous MSCs for future ultrasound-guided injection into a tendon lesion. Image courtesy of Kyla Ortved

authors due to the scarcity of cells and relative abundance of ECM, was associated with improved lameness scores following intra-lesional injection. Despite the reported benefit of dental pulp products, further research is required before they can be recommended. Embryonic-derived and induced pluripotent stem cells (iPSCs) are also being investigated for potential benefit in musculoskeletal healing. Equine iPSCs cells have been described, although these cells have not been used clinically yet.²³-²⁴ Additionally, much interest lies in using allogeneic cells because these would be a patient-side product with no lag time for culture expansion. At this time, it is uncertain whether allogeneic cells are effective or safe due to recognition by the host immune system.²⁵

CONCLUSION Orthobiologics are being used with increasing frequency and pre-clinical and clinical data continue to be promising. Many diﬀerent therapies are available with selection often dependent on the injury. Overall, regenerative therapies can improve the body’s natural healing ability such that a superior end product is produced.

Textor J. Autologous Biologic Treatment for Equine Musculoskeletal Injuries: Platelet- Rich Plasma and IL-1 Receptor Antagonist Protein. Vet Clin North Am Equine Pract. 2011;27(2):275-298. doi:10.1016/j.cveq.2011.05.001 2. Bosch G, van Schie HTM, de Groot MW, et al. Effects of platelet-rich plasma on the quality of repair of mechanically induced core lesions in equine superficial digital flexor tendons: A placebo-controlled experimental study. J Orthop Res. 2010;28(2):211-217. doi:10.1002/jor.20980 3. Bosch G, Moleman M, Barneveld A, van Weeren PR, van Schie HTM. The effect of platelet-rich plasma on the neovascularization of surgically created equine superficial digital flexor tendon lesions. Scand J Med Sci Sports. 2011;21(4):554-561. doi:10.1111/j.16000838.2009.01070.x 4. Waselau M, Sutter WW, Genovese RL, Bertone AL. Intralesional injection of platelet-rich plasma followed by controlled exercise for treatment of midbody suspensory ligament desmitis in Standardbred racehorses. J Am Vet Med Assoc. 2008;232(10):1515-1520. doi:10.2460/ javma.232.10.1515 5. Georg R, Maria C, Gisela A, Bianca C. Autologous conditioned plasma as therapy of tendon and ligament lesions in seven horses. J Vet Sci. 2010;11(2):173-175. Accessed July 25, 2017. http://www.ncbi.nlm.nih.gov/ pubmed/20458161 6. Zuffova K, Krisova S, Zert Z. Platelet rich plasma treatment of superficial digital flexor tendon lesions in racing Thoroughbreds. Orig Pap Vet Med. 2013;58(4):230239. Accessed February 25, 2018. http://www.nephrotech. gr/estar/Zuffova et al, 2013. Platelet rich plasma treatment of superficial digital flexor tendon lesions in racing Thoroughbreds.pdf 7. Torricelli P, Fini M, Filardo G, et al. Regenerative medicine for the treatment of musculoskeletal overuse injuries in competition horses. Int Orthop. 2011;35(10):1569- 1576. doi:10.1007/s00264-011-1237-3 8. Castelijns G, Crawford A, Schaffer J, Ortolano GA, Beauregard T, Smith RKW. Evaluation of a fi lter-prepared platelet concentrate for the treatment of suspensory branch injuries in horses. Vet Comp Orthop Traumatol. 2011;24(5):363-369. doi:10.3415/VCOT- 11-01-0001 9. Argüelles D, Carmona JU, Climent F, Muñoz E, Prades M. Autologous platelet concentrates as a treatment for musculoskeletal lesions in five horses. Vet Rec. 2008;162(7):208-211. Accessed February 25, 2018. http:// www.ncbi.nlm.nih.gov/pubmed/18281627 10. Geburek F, Lietzau M, Beineke A, Rohn K, Stadler PM. Effect of a single injection of autologous conditioned serum

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(ACS) on tendon healing in equine naturally occurring tendinopathies. Stem Cell Res Ther. 2015;6(1):126. doi:10.1186/s13287-015-0115-0 11. Linardi RL, Dodson ME, Moss KL, King WJ, Ortved KF. The Effect of Autologous Protein Solution on the Inflammatory Cascade in Stimulated Equine Chondrocytes. Front Vet Sci. 2019;6. doi:10.3389/fvets.2019.00064 12. Gaesser AM, Underwood C, Linardi RL, et al. Evaluation of Autologous Protein Solution Injection for Treatment of Superficial Digital Flexor Tendonitis in an Equine Model. Front Vet Sci. 2021;8. doi:10.3389/FVETS.2021.697551 13. Kasashima Y, Ueno T, Tomita A, Goodship AE, Smith RKW. Optimisation of bone marrow aspiration from the equine sternum for the safe recovery of mesenchymal stem cells. Equine Vet J. 2011;43(3):288-294. doi:10.1111/ j.2042-3306.2010.00215.x 14. Adams MK, Goodrich LR, Rao S, et al. Equine bone marrowderived mesenchymal stromal cells (BMDMSCs) from the ilium and sternum: are there differences? Equine Vet J. 2013;45(3):372-375. doi:10.1111/j.20423306.2012.00646.x [doi] 15. Caplan AI. Review: mesenchymal stem cells: cell-based reconstructive therapy in orthopedics. Tissue Eng. 2005;11(7-8):1198-1211. 16. Godwin EE, Young NJ, Dudhia J, Beamish IC, Smith RKW. Implantation of bone marrow-derived mesenchymal stem cells demonstrates improved outcome in horses with overstrain injury of the superficial digital flexor tendon. Equine Vet J. 2012;44(1):25-32. doi:10.1111/j.20423306.2011.00363.x 17. Van Loon VJF, Scheffer CJW, Genn HJ, Hoogendoorn AC, Greve JW. Clinical follow-up of horses treated with allogeneic equine mesenchymal stem cells derived from umbilical cord blood for different tendon and ligament disorders. Vet Q. 2014;34(2):92-97. doi:10.1080/0165217 6.2014.949390 18. Smith RKW, Werling NJ, Dakin SG, Alam R, Goodship AE, Dudhia J. Beneficial effects of autologous bone marrowderived mesenchymal stem cells in naturally occurring tendinopathy. PLoS One. 2013;8(9):e75697. doi:10.1371/ journal.pone.0075697 19. Burk J, Berner D, Brehm W, et al. Long-Term Cell Tracking Following Local Injection of Mesenchymal Stromal Cells in the Equine Model of Induced Tendon Disease. Cell Transplant. 2016;25(12):2199-2211. doi:10.3727/096368916X692104 20. Gronthos S, Brahim J, Li W, et al. Stem Cell Properties of Human Dental Pulp Stem Cells. J Dent Res. 2002;81(8):531535. doi:10.1177/154405910208100806 21. Ishikawa S, Horinouchi C, Murata D, et al. Isolation

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and characterization of equine dental pulp stem cells derived from Thoroughbred wolf teeth. J Vet Med Sci. 2017;79(1):47-51. doi:10.1292/jvms.16-0131 22. Bertone AL, Reisbig NA, Kilborne AH, et al. Equine Dental Pulp Connective Tissue Particles Reduced Lameness in Horses in a Controlled Clinical Trial. Front Vet Sci. 2017;4:31. doi:10.3389/fvets.2017.00031 23. Breton A, Sharma R, Diaz AC, et al. Derivation and characterization of induced pluripotent stem cells from equine ﬁbroblasts. Stem Cells Dev. 2013;22(4):611-621. doi:10.1089/scd.2012.0052 [doi] 24. Nagy K, Sung H-K, Zhang P, et al. Induced Pluripotent Stem Cell Lines Derived from Equine Fibroblasts. Stem Cell Rev Reports. 2011;7(3):693-702. doi:10.1007/s12015011- 9239-5 25. Pezzanite LM, Fortier LA, Antczak DF, et al. Equine allogeneic bone marrow-derived mesenchymal stromal cells elicit antibody responses in vivo. Stem Cell Res Ther. 2015;6(1):54. doi:10.1186/s13287-015-0053-x

Kyla Ortved,

DVM, PhD, DACVS, DACVSMR Dr. Kyla Ortved is an associate professor of large animal surgery at New Bolton Center, University of Pennsylvania in Kennett Square, PA. She received her DVM degree from the University of Guelph in 2006 and completed her large animal surgical residency training at Cornell University in 2010. Kyla became boarded with the American College of Veterinary Surgeons in 2011. Following her residency, Kyla went on to obtain a PhD in gene therapy for equine cartilage repair at Cornell. In February 2016, Kyla became boarded with the American College of Veterinary Sports Medicine and Rehabilitation. She joined the large animal surgery faculty at New Bolton Center in 2016 as an equine orthopedic surgeon and was named the Jacques Jenny Endowed Term Chair of Orthopedic Surgery in 2019. Her research program focuses on understanding the pathophysiology of equine osteoarthritis and developing gene and cell-based therapies to improve cartilage repair and prevent osteoarthritis.

Issue 4 • 2023

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10 The Practitioner

Tnibar, A., Schougaard, H., Camitz, L., Rasmussen, J., Koene, M., Jahn, W., Markussen, B., An international multi-centre prospective study on the eﬃcacy of an intrarticular polyacrylamide hydrogel in horses with osteoarthritis: a 24 month follow up. Acta Vet Scand. 2015; 57: 20-27.

Issue 4 • 2023

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State of the Industry THE REALITY OF

Equine Practice in 2023

Amy L. Grice | VMD, MBA

When thinking about the current state of equine practice, it is important to consider a broad survey of data from both the world in general as well as the equine and equine veterinary industries. Current global and national economic conditions strongly inﬂuence current conditions in equine practice.

The economic impacts of inflation, pharmaceutical supply chain issues, and global recession could all affect equine veterinary practices. Declining horse numbers, changing owner demographics, and corporate acquisitions of equine practices will impact the strengths and weaknesses of the equine world. High educational debt, changing student demographics, compensation issues, and family needs of equine veterinarians are also altering the landscape. There are significant challenges but many opportunities in equine practice. While some economic indicators are currently worrisome for the equine world, others remain positive. Equine practice is highly dependent on horse owners feeling wealthy. When stock prices drop, people typically feel less financially confident, even if they only have long-term investments that they do not utilize for ordinary expenses. Last year undermined many investors’ portfolios. Unemployment rates typically rise in recessions but are currently low. In addition, unemployment rates among college graduates are usually significantly lower than for those with less education. Since most horse owners are in the educated segment, this bodes well for continued spending in the equine veterinary sector. When looking at real average household income over the last fifty years, those in the top 20% have seen significant

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Image courtesy of Canva

gains, while those in the other quintiles have remained flat. As most horse owners are in the top 20% of national income brackets, this means they have more disposable income to spend on luxuries like horses.

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number or more horses in 2022, according to a survey done by American Horse Publications in 2021. Fewer than 10% of respondents expected to own or manage a smaller number of horses in 2022 than they owned or managed in 2021. According to the American Horse Council’s 2017 Study, 1.3% of the U.S. population-owned horses, 29.2% of American household members participated in equine-related activities but did not own a horse, and 13.2% spectated at horse events but did not own or participate. This means that in 2012, almost a third of U.S. households owned horses or participated in some way in the equine world, which is very good news for the industry.

Image courtesy of Canva

THE COVID-19 PANDEMIC WAS KIND TO EQUINE PRACTICES.

The median age for horse owners at that time was 38 years old, for participants, the median was 22 years old, and for spectators it was 36 years old. Among non-owner horse activity participants, 38% were children less than 18 years of age, so there is a new group of potential owners in the wings for the future. Among horse owners, the study found that 22% had incomes of $100,000 - $149,000 and 28% had incomes over $150,000. The AHC is currently conducting a new survey, and the results will be important in predicting future conditions for the equine veterinary industry.

Most practices reported increased revenue in 2020 compared to 2019, with continued growth in 2021. Prepurchase exams increased along with horse sales. Many practitioners were much busier in the number of hours worked as well as emergencies seen. However, this increased workload also increased exhaustion and burnout among veterinarians.

EQUINE PRACTICES DEPEND ON HORSES REMAINING POPULAR AND NUMEROUS. It is estimated that the number of horses in the U.S. has decreased by 23% in the last 10 years. Recent estimates of the U.S. equine population are 6 million (Brakke study 2014), 8.9 million (AVMA AAEP Equine Economic Impact Survey 2016), and 7.2 million (AHC Study 2017). However, the 2017 AVMA Pet Ownership & Demographics Survey suggested that pet horse numbers have fallen by 61% since 2012. The AHC study indicated that horses are located all around the country, with the top three states in order of horse population, being Texas, California, and Florida. Although the costs of keeping a horse have risen, over 90% of horse owners expected to continue to own the same

Image courtesy of Canva

HORSES ARE INCREASINGLY VALUED BY THEIR OWNERS AND SOCIETY. The 2017 AVMA Pet Ownership & Demographics Survey showed that 42% of horse owners considered their horses to be pets, 47% considered them as family members, and just 11% considered them as property. The increasingly

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WITH THESE DEMOGRAPHIC CHANGES COME CHALLENGES. One of the most stressful and alienating aspects of equine practice is the need to provide emergency care 24/7/365. This need contributes to high attrition in the field, perhaps because new female entrants often have more family responsibilities. The 2012 AAEP Owner Trainer Survey showed that one of clients’ top priorities in choosing a veterinarian is the availability of on-the-farm emergency care. In the last 20 years, about 50% of new graduates who were AAEP members have let their membership lapse within five years of graduation. The number of new graduates entering equine practice has also been decreasing. From a high of 5.7% in 2003, this number fell to 1% in 2019 before rebounding to 1.4% in 2020 and 2021. In addition, 97 new graduates entered equine internships in 2021. Generally, about 100110 new graduates enter equine internships each year.

THERE IS CURRENTLY A SHORTAGE OF VETERINARIANS TO FILL AVAILABLE JOBS IN ALL SECTORS. Image courtesy of Canva

common societal view of animals as sentient beings worthy of humane care is impacting equine sports. Social license to operate is defined as “an intangible, unwritten, and nonlegally binding social contract whereby the community gives the industry the right to conduct its business.” In the U.S., the public is currently concerned and attentive to horse racing, particularly – catastrophic breakdowns, track surface, racing of two-year-olds, aftercare of retired racehorses, raceday medication, doping, and whip use. This broad public concern is likely to extend to many aspects of equine sport as social media shines a light on negative practices. Because veterinarians benefit monetarily from some of these issues, this can cause a loss of credibility with the public.

EQUINE PRACTICES ARE WIDELY VARIED IN SIZE AND SCOPE. According to AVMA 2022 statistics, equine veterinarians are a small fraction (4.1%) of the total number of private practice veterinarians, representing 3,785 of 78,717 total veterinarians. Of those, 65.7% are female veterinarians. Veterinary students are now 85% female on average. Of the members of the AAEP, 49% are over the age of 50 years. In 2016, 52.8% of equine practices had just one to two full-time equivalent veterinarians, while just 20.6% had six or more.

14 The Practitioner

In 2021, the AVMA reported that there were 18.5 jobs for veterinarians per veterinarian jobseeker. Salaries, work hours, and emergency service requirements are more attractive to many young graduates in the companion animal sector than in the equine sector. Veterinary unemployment climbed to 1.8% in 2021, up from 0.7% in 2020, according to the AVMA census. This means that 1.8% of veterinarians were looking for employment, enrollment in an internship, residency, or working outside of veterinary medicine. In addition, the AVMA 2021 census study revealed that 44% of veterinarians have considered leaving the veterinary profession, up from 38% in 2020. Moreover, 39% of veterinarians said they have considered leaving the veterinary profession within the last five years and 23% said they have considered leaving within the last year. Approximately 26% of veterinarians in 2021 indicated they want to work fewer hours, citing such reasons as better work-life balance and mental health issues, including stress, anxiety, and burnout, followed by feelings of being overworked and issues relating to childcare and childbearing. In a recent study of AAEP membership, associates are among those most likely to be considering a career change. In fact, four out of 10 associates are considering leaving equine medicine, primarily due to lifestyle and/or income concerns.

Issue 4 • 2023

The Bureau of Labor Statistics has projected veterinary employment to grow 19% percent from 2021 to 2031, much faster than the average for other occupations, with 16,800 veterinarians projected to be added. Geographic maldistribution is likely to remain a problem in the profession, which could leave some areas underserved.

Horses make us better. Together, we make them better, too.

As the U.S. population increases, the pet ownership percentage is forecast to remain stable, so demand will continue to increase. Regarding job listings throughout the veterinary industry on the AVMA Veterinary Career Center and other job sites, the AVMA reported that 70% come from corporate or consolidated practices, and 30% percent from independently-owned practices. About 35% of veterinary associates are employed by corporate practices, while the remainder work for independently owned single or group practices.

Image courtesy of Canva ASERVO ® and EQUIHALER ® are registered trademarks of Boehringer Ingelheim Vetmedica GmbH, used under license. GASTROGARD ®, EQUIOXX®, MARQUIS ® and SURPASS ® are registered trademarks, and the Horse Head logo™ is a trademark of Boehringer Ingelheim Animal Health USA Inc. PRASCEND ® and VETERA ® are registered trademarks of Boehringer Ingelheim Vetmedica GmbH, used under license. ZIMECTERIN ® is a registered trademark of the Boehringer Ingelheim Group. ©2021 Boehringer Ingelheim Animal Health USA Inc., Duluth, GA. All rights reserved. US-EQU-0199-2021

VETERINARY SCHOOL GRADUATES STRUGGLE WITH EDUCATIONAL DEBT. Financial professionals state that a debt-to-income (DIR) of < 1.4 is reasonable for those in the medical field. In 2021, the DIR for recent graduates entering full-time equine practice was 3.7. According to the AVMA 2022 State of the Profession Report, the average debt of those with debt was $186,430 in 2021, with 11.3% having debt levels at or over $300,000 and 1.4% having debt levels at or over $400,000. Those who attended offshore veterinary schools were more likely to have high amounts of student loans. About 30% of equine-focused graduates had no debt compared to about 20% of graduates entering companion animal practice. Graduates with no debt numbered 16%. The combination of growing attrition, high educational debt, emergency service requirements, lower compensation than companion animal positions, and intense work hours in equine practice is a significant challenge to the industry. Fortunately, the strength of the equine industry, despite the current economic downturn, allows continuing opportunity.

Our profession will likely continue to have robust demand and can continue to stay strong into the coming decades through the adoption of new paradigms. Practices are increasingly embracing the changes needed to keep equine veterinarians in equine practice. Through flexible work schedules, improved practice cultures, shortened work weeks, emergency service coalitions, stronger boundaries between work and personal life, and higher compensation, the tide is turning on the loss of exceptional talent that we have been experiencing. These new paradigms allow our changing workforce to have the flexibility and support that they need while still keeping practices financially healthy. Embracing the changes will keep the equine veterinary industry strong for the future. This article originally appeared at https://equimanagement. com/articles/the-reality-of-equine-practice-in-2023

Amy L. Grice

VMD, MBA

Dr. Grice was an ambulatory equine practitioner in the Hudson Valley of New York for over 25 years, serving as the managing partner of the thirteen-doctor equine referral hospital in Rhinebeck, NY. At the end of 2014, she retired from clinical practice to concentrate on veterinary business consulting, and moved her residence to Virginia City, MT. Dr. Grice received her BA in Biology from Wellesley College in Massachusetts and completed her veterinary education at the University of Pennsylvania's School of Veterinary Medicine in 1990. She earned her MBA with a concentration in ethical leadership from Marist College School of Management in 2014. Dr. Grice is a member of the American Association of Equine Practitioners (AAEP), where she served on the board of directors from 2015-2018, and is currently serving as treasurer (2021-2023). She is also a member of the AVMA Economic Strategy Committee (2018 – present). Dr. Grice is a frequent speaker at educational seminars for veterinarians across the country, as well as the founder of Decade One, which leads networking groups for equine veterinarians early in their careers. In addition, she consults with a diverse range of veterinary businesses and collaborates with industry partners to bring business education to veterinarians. Dr. Grice aids with transitions of ownership, strategic planning, financial projections, and other solutions for private practitioners.

16 The Practitioner

Issue 4 • 2023

Treating metabolic horses in your practice? Don’t miss this special sunrise session!

Equine Metabolic Syndrome: Past, Present, and Future Where: Ocala Equine Conference When: January 21, 2024: 7:00 – 7:50 a.m. Coffee and breakfast treats provided.

Gain new insights into metabolic disease in horses from an award-winning instructor: Jane Manfredi DVM, MS, PhD, DACVS-LA, DACVSMR Equine, PG Cert Vet Med Education Associate Professor, Michigan State University College of Veterinary Medicine As an FEI-level dressage rider, Dr. Manfredi has research interests including treatments for osteoarthritis, rehabilitation of the performance horse, saddle and bridle fit, and the pathophysiology of metabolic syndrome. Sponsored by Kentucky Performance Products, makers of InsulinWise®

KPPvet.com

KPPusa.com FAEP 23-IV (2) General

It’s just who we are.

We know horse people because we’re horse people. And like you, the love and respect we have for horses is unconditional. Everything we do is for their benefit. If we do right by the horse, we’ll never do wrong.

Bryant W. Craig, DVM

www.fvma.org |

thefaep |

@thefvma | The Practitioner 17

January 19-21, 2024 | O C A L A , F L Returning to the World Equestrian Center (WEC), the 60th Ocala Equine Conference (OEC) brings integral members of the equine veterinary care team together for the most up-to-date, scientific, and clinical knowledge available. This is a fantastic opportunity for equine professionals to gather in Florida’s horse country for their CE and to network with colleagues as well as with representatives of the industry sector who will showcase their products and services. This year’s exciting conference is set during the same time WEC will be hosting a Grand Prix, part of the 2024 Winter Spectacular Show Series, oﬀering 12 weeks of world-class hunter/jumper competition sanctioned by U.S. Equestrian (USEF), five of which will also be internationally rated by the Fédération Equestre International (FEI). Come to OEC for CE lectures in the morning and stay for the Grand Prix under the lights at WEC! The competition is free to attend and takes place Saturday evening in the Grand Arena, after the cocktail reception.

25 HOURS OF CE S AV E YO U R S E AT ! AAVSB/RACE Information

This AAVSB/RACE program #20-1092718 will be approved for 25 continuing education credits. Veterinarians may earn up to 17 hours from continuing education sessions and veterinary technicians may earn up to 14 hours from continuing education sessions. Veterinarians who attend the comprehensive equine ultrasound wet lab may earn an additional 8 hours of continuing education credit, for a total of 25.

CONFERENCE VENUE World Equestrian Center NW 87th Ct Rd Ocala, FL 34482

Welcome to World Equestrian Center – Ocala, the largest equestrian complex in the United States, nestled in the Horse Capital of the World on 378 acres of state-of-the-art arenas. The world-class facility oﬀers a unique blend of sophistication and capacity, featuring multiindoor and outdoor arenas equipped with cutting-edge amenities. Hosting the 2024 Winter Spectacular Show Series from January 3 to March 24, 2024, with over $6.5 million in prize money, WEC caters to equestrians and spectators of all levels. Whether you're a seasoned competitor or a passionate spectator, WEC – Ocala provides a competitive and enjoyable environment for all horse enthusiasts. Explore the onsite restaurants like Filo's Mexican Cantina, Miss Tilly's Lollipops, Viola & Dot's Italian Kitchen & Pizzeria, the Yellow Pony Pub, Stirrups Restaurant, and more, oﬀering quick access and stunning views of the Grand Arena. Additionally, indulge in world-class shopping for all your equestrian needs. Join us for an unparalleled equestrian experience at WEC – Ocala!

Thank you to our

E D U C AT I O N A L PA R T N E R S A N D S P O N S O R S

EQUINE DIVISION

THANK

you!

EQUINE

8 CE

Ultrasound

Credit Hours

WET LAB WHEN

Friday, Jan, 19 | 8:00 a.m. - 4:00 p.m. WHERE

Equine Medical Center of Ocala ( E M C O ) Get hands on at our highly anticipated wet lab, a learning experience crafted specifically for equine veterinarians seeking to elevate their ultrasound expertise. Rotate through five anatomical stations where you will practice with ultrasound probes while guided by each station instructor. A bronchoalveolar lavage demo will also be held during one of the scheduled breaks. Your registration includes meals and transportation to/from the hotel and the wet lab venue.

EQUIPMENT S P O N S O R E D BY:

With C O N C E R E N C E P A S S : W E T L A B Only:

$730 $930

Buy a pass for just the wet lab – or add the wet lab onto your conference pass TO SAV E $ 2 0 0 !

Wet Lab I N S T R U C T O R S HIND SUSPENSORY LIGAMENT

PA STE RN (CIRCUMFERENTIAL APPROACH)

THORAX AND ABDOMEN

Aric Adams

Matt Durham

Laurent Couëtil

DVM, DACVS

DVM, PhD, DACVIM

DVM, DACVSMR

D I G I TA L F L E X O R T E N D O N S H E AT H , FORE, AND HIND LIMB

Caitlyn Horne DVM, DACVSMR

TA R S U S

Suzan Oakley

DVM, DACVSMR, DABVP (Equine), Certified Member ISELP

Please note that the stations are subject to change. This wet lab is for veterinarians only.

Practice Marketing THE SOCIAL MEDIA ADVANTAGE

in Equine Medicine

Jillian Sinclair | Marketing Communications Specialist

In today's digital age, where information is just a click away and our daily lives are intertwined with the online world, the importance of social media cannot be overstated. This holds true not only for individuals but for businesses as well, including equine veterinary practices. While the concept of using social media might seem out of place in a profession rooted in tradition and hands-on care, the benefits it oﬀers are undeniable.

FIRST IMPRESSIONS In a world where convenience and accessibility are paramount, the role of social media in acquiring new clients cannot be underestimated. According to recent statistics, a staggering 41% of potential clients will check out a practice's social media pages before deciding to schedule an appointment.¹ Th is means that your social media presence serves as your online calling card. It's the ﬁrst impression you make, and it can be the diﬀerence between gaining a new client and losing one to a competitor.

BUILDING TRUST Another reason equine veterinarians should embrace social media is the power it has in building trust and compliance. Research suggests that nearly 9 in 10 consumers are more likely to buy a product or service from a company they follow on social media.² By maintaining an active and engaging online presence, you create a direct line of communication with your clients and potential clients, which fosters trust and loyalty. Th is trust, in turn, can lead to higher compliance rates as clients are more likely to follow your treatment recommendations when they trust your expertise.

22 The Practitioner

Image courtesy of FAEP

Issue 4 • 2023

INTRODUCING VETSOCIALEQUINE To help equine veterinarians harness the full potential of social media, the FAEP offers a valuable member benefit: VetSocialEquine. Th is innovative platform provides an entire library of veterinarian-vetted social media posts specifically created for equine practices.

REFERRALS IN THE DIGITAL AGE Social media has become the new word of mouth. A simple "share" of your social media post is equivalent to a digital referral. Each share extends your reach, potentially connecting you with new clients who may never have come across your practice otherwise. Th is viral nature of social media can signiﬁcantly expand your client base.

EDUCATING CLIENTS Equine veterinarians are not just healthcare providers; they are educators and advocates for the well-being of horses. Social media provides a powerful platform to proactively educate horse owners. By sharing informative posts, articles, and tips, you can empower your clients to take better care of their horses. Whether it's insights on barn safety or signs of common equine ailments like arthritis, your social media presence can be a valuable resource for your clients.

With VetSocialEquine, you can easily select a post, add your practice's logo, and schedule when you want it to appear on your social media pages up to 30 days in advance. It's a timesaving tool that eliminates the need to search for articles or write content. Plus, you can customize and brand each post to match your practice's identity. The platform even oﬀers an image editor, allowing you to create your own custom posts. VetSocialEquine covers a wide range of topics, from barn safety to equine health, enabling you to educate your clients and build trust. Social media has evolved into a powerful tool for equine veterinarians. It can help attract new clients, build trust, facilitate referrals, provide education, and strengthen both client and employee relationships. With the introduction of VetSocialEquine, you can maximize your social media potential while saving time and eﬀort, allowing you to focus on what matters most – the well-being of horses and the success of your practice. Embracing social media is not just a modern trend, it's an essential component of a successful equine veterinary practice.

CLIENT AND EMPLOYEE RETENTION Maintaining an active presence on social media is an excellent way to keep your existing clients engaged and informed. It acts as a subtle prompt to schedule services, keeps your practice's name "top of mind," and strengthens the bond between your practice and your clients. Happy and informed clients are more likely to stay with your practice and recommend your services to others. Don't underestimate the impact of social media on employee retention. By spotlighting your employees and demonstrating that they are valued, you create a positive work environment. A happy team is more likely to stay, which, in turn, contributes to better patient care and practice success.

Image courtesy of Canva

RESOURCES ¹ Information taken from Medical Advantage TDC Groups' The Ultimate Guide to Social Media for Healthcare & Medical Practices (2021) ² Information taken from The 2023 Sprout Social Index™ Report

www.fvma.org |

thefaep |

@thefvma | The Practitioner 23

PRACTICE TYPES Besides deciding to become a veterinarian, the most important career decision a veterinarian will make is what practice type they will pursue. There are multiple paths a young veterinarian could pursue and many ways to combine the various business structures available.

The crux of experiencing diﬀerent practices will occur during veterinary student rotations, and most veterinarians will have chosen their practice type by the time they graduate. However, veterinarians should not feel railroaded as they grow into their veterinary career.

TYPES OF VETERINARY PRACTICE

� PUBLIC/CORPORATE

� GENERAL PRACTICE

� INDEPENDENT/BUSINESS OWNER

� EMERGENCY

� ACADEMIA

� SPECIALTY CLINICS

� GOVERNMENT/MILITARY

Sports medicine, rehab, dentistry, etc.

� SHELTER � RESEARCH/LAB ANIMAL � ZOO Additional opportunities include working for nutrition/drug companies or administrative roles working in organized veterinary medicine groups such as the AVMA.

24 The Practitioner

� MOBILE � BRICK-AND-MORTAR Variations include walk-in, appointment-only, urgent care, ambulatory, ER.

Issue 4 • 2023

“Time spent volunteering can be valuable even if it is not directly related to veterinary medicine,” Dr. McLendon says. “Spending time involved in the day-to-day workings of a zoo, for example, may give you insight into whether or not exotic medicine is something that interests you.” Dr. Amy Grice, an equine ambulatory veterinarian of 25 years and now a veterinary business consultant, points out that rotations are the prime time to put what was learned through externships and shadowing into real practice.

Image courtesy of Canva

EXPLORING PRACTICE TYPES Some may know exactly what they want and jump right into that. For others, what they end up enjoying most may surprise them. Pre-veterinary and veterinary students are in a prime position to explore various practice types through school and should take every opportunity to experience these by using the summers before veterinary school and after the first and second years of their veterinary medical education to work in veterinary practices, research facilities, the pharmaceutical industry, or by undertaking a series of externships. Externships are an invaluable way to get hands-on experience in the day-to-day life of a practice type. Dr. Taylor McLendon, a young equine veterinarian who recently bought her own practice, encourages veterinarians to utilize that time to decide if the lifestyle, workload, environment, team, and more are right for them. She points out that being a large animal veterinarian would not be the right path for someone who would doesn’t enjoy being outdoors and in the elements, just like an industry position may not be a good choice for someone who doesn’t fi nd fulfi llment in creating interpersonal relationships and networking. Dr. Marci Kirk of the American Veterinary Medical Association (AVMA) encourages those planning to pursue externships to explore a variety of experiences. Th is will help better prepare candidates to understand what they are looking for in their ideal job. If the time commitment of externships is not suitable or a student is looking to gain experience in a field prior to veterinary school, shadowing or volunteering is another great way to learn more about a field.

“During rotations left open for externships in their clinical year, students should experience a number of different practices that are in the veterinary space they have earlier identified as their preferred niche,” she says. Dr. Kirk and Dr. Annie Chavent, assistant director of student initiatives at the AVMA, encourage young veterinarians to push themselves to visit practice types that they haven’t considered previously as they may be surprised by what they enjoy. Dr. Kirk always believed structured, set schedules were better for her. However, when an emergency would come in and the schedule got thrown off – by a lot – she found it challenging to cope, especially if she had plans outside of work that day. She says the current practice she now works in on Saturdays is a walk-in, and she has found she loves it. “I just go down the charts in the order they come in, and it has helped me stay more present and focused,” she says of this previously unexpected choice. Dr. Chavent also experienced a change of heart. “I planned on pursuing an equine sports medicine residency after my internship, but during my job search, I also did a ride along with a solo, ambulatory practitioner at the suggestion of a mentor. I always thought I would specialize,” she says, “but I learned that I really enjoyed the close personal connections that farm calls foster, the rhythm of ‘life on the road,’ and the variety of cases.” Dr. Chavent ended up joining that practice as its first associate and stayed for three years. “Finding out what works best for you includes what suits your work style and your personal preferences. It's important to also explore how the team works together, the culture of the organization, the expectation of the clientele and what is best for you at your current stage of life.” Dr. Kirk says.

www.fvma.org |

thefaep |

@thefvma | The Practitioner 25

When it comes to a job, Dr. Grice recommends giving any potential path a minimum of two weeks in order to have a balanced view of typical practice at that location.

THE ‘RIGHT’ CHOICE With so many paths available, it can feel overwhelming. How can a practitioner make the ‘right’ decision? “There isn’t a ‘right’ or ‘wrong’ decision as long it aligns with your current goals and you have done your due diligence," Dr. Chavent says. “Each practice type choice you make along the way gives you valuable feedback on your likes and dislikes for your career. One of the amazing things about the veterinary profession is that there are so many diﬀerent options, so you don’t need to worry about picking the ‘right’ or ‘perfect’ one right after graduation. Learn from your experience, and it will help you make more informed decisions.”

Image courtesy of Canva

As veterinary students and veterinarians navigate various practices and clinics, it’s important they engage with the institution on all levels. Speaking to as many people as possible at diﬀerent practices, including the customer service team, assistants, veterinarians, technicians, interns, and even veterinarians who may have left the practice, will provide valuable insight. All perspectives form the picture of that practice and that practice type so it’s easier to see whether or not it aligns with what is desired from a practice and an individual’s career.

When it comes to choosing a practice, Dr. Kirk recommends breaking it down to the things you currently prioritize most, perhaps this is location or salary or working hours. Having this initial criteria provides a basis to learn what works as you grow and as life outside of practice changes. Over time, your priorities may change and that may mean that the organization will adapt with you, or it may be time to explore other opportunities in the profession. For those like Dr. McLendon with a ﬁrm vision, the choice only became clearer with time. Having grown up around horses, she was always very involved in the equine industry. Th is

GIVING IT TIME When it comes to opportunities like externships, Dr. Kirk encourages everyone, when possible, to give it a minimum of a full working day to see the practice’s flow, with two days and two separate visits being even better. "When you are considering different practice types, it is helpful to explore different experiences to determine what will fit your current professional goals," Dr. Kirk says. Dr. Chavent echoes the two-visit approach as it gives an extern a clearer vision of the practice and provides more opportunity to talk with a variety of team members. Multiple visits are for more than just the extern too as it sends a clear message to the practice that the individual is serious about the opportunity.

26 The Practitioner

Image courtesy of Canva

Issue 4 • 2023

made her decision to pursue equine medicine very organic. As she navigated her journey through veterinary school, she was exposed to the business and management side of veterinary medicine, which allowed her to quickly identify a passion for this aspect and led her to pursue practice ownership. No decision is guaranteed to be the ‘right’ choice, but Dr. Grice points to key positive signs to look for to know if the path chosen will be a good ﬁt. These signs include being excited to go to work, feeling motivated to learn as much as possible about cases, and feeling supported by the practice team in an environment of psychological safety.

When it comes to those 'sweet' sign-on/retention bonuses, Dr. McLendon advises veterinarians to always read the ﬁ ne print and be wary of deals that won’t provide a good worklife balance. Both veterinarians hold that self-reﬂection is a crucial step in the decision-making process, as it is essential to identify key factors that are important.

COMMON CHALLENGES

When it comes to addressing challenges, Dr. Grice stresses that new graduates need to feel comfortable advocating for themselves and asking for what they need – without being afraid to turn down an oﬀer. No matter where they are in their career, veterinarians shouldn’t be afraid to speak to management about what might be possible, and if it is unsustainable, other opportunities should be sought.

It is not unusual to feel overwhelmed by all the possibilities of veterinary medicine. There are so many diﬀerent directions that it is almost impossible to experience them all, and, once in the workforce, there are many competing interests and issues that veterinarians may encounter.

“Once a non-solicitation/non-compete clause is signed and employment begun at a practice that is a poor ﬁt, a new veterinarian has signiﬁcantly limited their options,” Dr. Grice says. “‘Fit’ includes shared values and a healthy culture. It is the most important aspect in choosing a home for a career.”

In 2022, the average educational debt for veterinary graduates who borrowed was more than $179,000.¹ Th is makes fi nancial well-being a key issue for recent graduates as there’s a concerning gap between educational loans and compensation. Different practice types have different earning potential, and there is variability among practices in each type as well. Researching potential earnings and asking about salary and benefits when visiting practices of interest will help set expectations, and, therefore, help ensure that income, lifestyle, and debt obligations are all aligned.

MAKING A CHANGE

To tackle this issue, Dr. Chavent recommends working with a trusted professional such as a certified fi nancial planner to look at the full fi nancial picture and help explore various options.

While decisions about practice are important, they aren’t permanent. If a place doesn’t suit, it’s time to do some investigation to determine if it is the practice or the practice type. Dr. Grice points out that the former is very common. “Practices in each sector vary widely within the sector,” she says. “If ﬁt has been very bad, a new veterinarian may have lost conﬁdence as well as their excitement about veterinary medicine. Reaching out to mentors and taking a short period

“Talking about ﬁ nances can be intimidating, but setting yourself up for success early will save you from unnecessary added stress in the future,” Dr. Chavent says. “Th ink of it as self-care for your future self!” Another big challenge can be veterinarians fully understanding what their goals are for personal time and personal quality of life. Th is leads to issues with work-life balance that can be exacerbated by corporate-owned practices tempting young veterinarians with large sign-on bonuses, which can stray a new graduate into a position with which they are unhappy. For work-life balance, Dr. Kirk recommends reﬂecting on what is working well and what can be even better yet.

www.fvma.org |

Image courtesy of Canva

thefaep |

@thefvma | The Practitioner 27

of discernment may be the best approach before making big decisions.” If work unhappiness persists, there shouldn’t be a fear of changing it up. Veterinarians invest a lot of time and money into their education, so staying in a position that doesn't make them happy doesn’t make sense. A good job doesn’t mean counting down the minutes until work starts, but day-to-day life should be enjoyable. “If you're in a position that doesn't ﬁt your lifestyle or makes you unhappy, it is better to make a change now rather than continue down the same path for years,” Dr. McLendon says. “There is never a convenient time to make a major life change, but sooner is always better. As veterinarians, we work way too hard to not enjoy what we do!” It’s normal to feel disappointed if things don’t work out as hoped, but seeking a change shouldn’t be seen as a negative. “I don’t believe framing it as the wrong decision is very helpful,” Dr. Kirk says. “I believe we make decisions with the information we have on hand and as we experience things and grow, we learn about ourselves, and we learn about more opportunities in the profession, so we can make even better, informed decisions moving forward.” Initiating change is a great time to rely on mentors and the veterinary network. Talking to people who are in the same practice type, and also who are in the practice type(s) being considered, will help clarify things and may even lead to new career opportunities. “Change can be scary, but there’s no reason to feel ‘stuck’ longterm,” Dr. Chavent says. “There are too many options available to veterinarians for that. The key is discovering which options are the best ﬁt for you at your current career stage. Then take the leap!”

SHAPING YOUR FUTURE When it comes to shaping one’s future, Dr. Grice stresses that self-awareness is critical. “Answering the question ‘What do you want your life to look like in ﬁve years, professionally and personally?’ is a start,” she says. “Understanding where [your] passion in veterinary medicine lies is critical. By imagining the life you want to lead, this provides a destination that can guide all further decisions, and help [you] create [your] desired future.”

28 The Practitioner

Image courtesy of Canva

Dr. Kirk encourages young veterinarians to think about their non-negotiables and what they might have more wiggle room on. “Speaking to people in current roles you think you would enjoy and asking about the challenges and rewards to get a better understanding can be extremely helpful,” she says. “Spending as much time as you are able in a variety of practice types is also helpful. Th is will help you make the best-informed decision you can. Remember it is more than the contract or practice type, it is the culture of the practice, the people you work with, the community you will be serving, and the experiences you will have outside of work that are also important.” Like Dr. Kirk, Dr. McLendon recommends you have a list of non-negotiables. “Identify the factors that are most important to you,” Dr. McLendon says. “If a certain industry or individual practice does not meet those standards, then you know that may not be the practice type for you. If working in high-stress, fastmoving situations with a variable schedule gives you anxiety, then emergency medicine is not for you!” She also points out that when sitting down to interview with a practice, it isn’t all about them interviewing you – you are also interviewing them. Interviews are a great opportunity to see the ins and outs of daily operations, ask questions, and gather as much information as possible to make an informed decision. It can be a process to emerge into the profession, but once that first job is accepted, it’s important to take time to reflect on what is working well and what could be even better. Dr. Kirk describes how her first job in small animal private practice

Issue 4 • 2023

offered a great location and great mentorship, but also on-call shifts and surgery — two things she didn’t enjoy or thrive on. “I thought perhaps that practice wasn’t for me,” Dr. Kirk says, “but rather than leave all altogether, I switched to a different small animal clinic where I did not have to do surgery or on-call shifts.” She says that worked well for her until her personal goals changed. “I reflected again and made another career shift ,” she says. “These points of reflection are critical to ensure we are making informed decisions about our personal and professional goals. It can be easy to get lost in the day-today, so set regular check-ins with yourself.” Regardless of the practice chosen, establishing a support system is key to success. There are a variety of ways for veterinarians to expand their network and career opportunities. Networking can come from attending veterinary conferences, alumni meet-ups, or leadership/mentorship programs. What’s most important to remember is that a long career awaits. There is no ‘right’ or ‘wrong,’ and careers will grow and change alongside the practitioner as their life, needs, and wants develop over time. Recognizing these changes and adapting to these needs are part of how all veterinarians will continue to thrive.

REFERENCES 1.

https://www.avma.org/blog/chart-month-good-newsstudent-debt

CAREER RESOURCES POWER OF TEN https://fvma.org/fvma-programs/fvma-power-of-ten/

MENTORVET CONNECT avma.org/Mentor

STARTING GATE https://www.decadeonevet.com/starting-gate/

DECADE ONE https://www.decadeonevet.com/

Winning in their blood. in their joints. (Hyaluronic Acid/Chondroitin sulfates C4 & C6/ N-acetyl-D-glucosamine Sterile Solution) CONSULT YOUR VETERINARIAN

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Veterinary Use Only. Patent Nos.: 6,979,679 / 7,485,629 / 8,455,458. CAUTION: This device is restricted to use by or on the order of a licensed veterinarian. WARNING: Do not administer to animals that are to be slaughtered for use in food. Keep out of reach of children. Polyglycan ® is a registered trademark of Bimeda, Inc. All rights reserved. © 2023 Bimeda, Inc.

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thefaep |

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Break free

Help your equine patients by controlling the clinical signs associated with osteoarthritis •

• •

The only FDA approved pentosan polysulfate sodium injection

Convenient; only 4 intramuscular injections required Not limited to use for specific joints1

To learn more about Zycosan®, please scan the QR code or visit go.dechra-us.com/zycosan 24-hour Veterinary Technical Support available: (866) 933-2472 Nonurgent Technical Support available: support@dechra.com

Important Satefy Information As with all drugs, side effects may occur. For intramuscular use in horses only. Not for use in humans. Pentosan polysulfate sodium is a weak anticoagulant. Caution should be used when administering Zycosan if you are taking an anticoagulant. In case of accidental self-injection, seek immediate medical attention. If product comes into contact with skin, rinse skin thoroughly with water and seek medical attention if needed. Horses with hypersensitivity to pentosan polysulfate sodium should not receive Zycosan. Do not use Zycosan concurrently with other anticoagulant drugs. Do not use in horses with clotting disorders or within 24 hours of surgical procedures. Caution should be used when administering this drug before or after strenuous activities. Caution should be used when NSAIDS are administered concurrently due to the anticoagulant effects of Zycosan. If Zycosan and NSAIDS are used concurrently, horses should be monitored for hemorrhage or other clinical signs of abnormal bleeding. The safe use of Zycosan has not been evaluated in breeding, pregnant, or lactating horses. The safety of long-term repeat use of Zycosan has not been evaluated. The most frequently reported adverse reactions are injection site reactions, prolongation of coagulation parameters (activated partial thromboplastin time (aPTT) and prothrombin time (PT). Refer to the prescribing information for complete details or visit www.dechra-us.com. 1. Zycosan® Freedom of Information Summary NADA 141-559

Zycosan®

(pentosan polysulfate sodium injection) 250 mg/mL

For intramuscular use in horses only.

Brief Summary (For Full Prescribing Information, see package insert) CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian. DESCRIPTION: Zycosan contains pentosan polysulfate sodium, a semisynthetic polysulfated xylan. It is a pale yellow to brownish yellow, clear, sterile solution. INDICATION: For the control of clinical signs associated with osteoarthritis in horses. CONTRAINDICATIONS: Horses with hypersensitivity to pentosan polysulfate sodium or any of the inactive ingredients in Zycosan should not receive Zycosan. Do not use Zycosan concurrently with other anticoagulant drugs. Do not use in horses with clotting disorders or within 24 hours of surgical procedures (see Warnings and Precautions). WARNINGS AND PRECAUTIONS: User Safety Warnings: Not for use in humans. Keep out of reach of children. Pentosan polysulfate sodium is a weak anticoagulant. Caution should be used when administering Zycosan if you are taking an anticoagulant. In case of accidental self-injection, seek immediate medical attention. If product comes into contact with skin, rinse skin thoroughly with water and seek medical attention if needed. To obtain a Safety Data Sheet (SDS), contact Dechra at (866) 933-2472. Animal Safety Warnings and Precautions: Zycosan has been shown to prolong coagulation parameters up to 24 hours after injection, therefore caution should be used when administering this drug before or after strenuous activities (see Target Animal Safety). Due to the anticoagulant effects, this drug may exacerbate Exercise Induced Pulmonary Hemorrhage (EIPH).

The concurrent use of NSAID with Zycosan has not been evaluated. Due to the anticoagulant effects of Zycosan and known anticoagulant effects of some NSAIDs, caution should be used if NSAIDs are concurrently administered. Horses concurrently treated with Zycosan and NSAIDs should be monitored for hemorrhage or other clinical signs of abnormal bleeding (e.g., petechiae, ecchymosis, or epistaxis). The safety of long-term repeat use of Zycosan has not been evaluated. Pigmentary changes in the retina (pigmentary maculopathy) have been reported in human patients following long-term oral use of pentosan polysulfate sodium. It is not known if a similar finding occurs in horses. The safe use of Zycosan has not been evaluated in breeding, pregnant, or lactating horses. Other Warnings: Do not use in horses intended for human consumption. ADVERSE REACTIONS: Injection site reactions were the most frequently reported adverse reactions in the field study. Injection site reactions were associated with clinicopathology changes in some cases. Other adverse reactions reported in more than one horse were prolongation of coagulation parameters (activated partial thromboplastin time (aPTT) and prothrombin time (PT)), lethargy, behavior changes, and colic. To report suspected adverse events, for technical assistance or to obtain a copy of the Safety Data Sheet (SDS), contact Dechra at (866) 933-2472 . For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or online at http://www.fda.gov/reportanimalae. STORAGE CONDITIONS: Store at room temperature 68-77°F (20-25°C), with excursions to 59-86°F (15-30°C). MANUFACTURED FOR: Dechra Veterinary Products

7015 College Boulevard, Suite 525 Overland Park, KS 66211 USA

Approved by FDA under NADA # 141-559

Zycosan is a trademark of Dechra Limited. R 01 2023

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