keystone
veterinarian
OFFICIAL PUBLICATION OF THE PENNSYLVANIA VETERINARY MEDICAL ASSOCIATION
VOLUME II, 2012
www.pavma.org
pvma
pennsylvania veterinary medical association
advancing animal welfare and human health while ensuring the vitality of the profession
12_Vol_2_cover.indd 1
7/17/2012 4:09:44 PM
12_Vol_2_cover.indd 2
7/17/2012 4:09:47 PM
pvma
pennsylvania veterinary medical association
pennsylvania veterinary medical association
8574 paxton street hummelstown, pa 17036
advancing animal welfare and human health while ensuring the vitality of the profession
phone: 888.550.7862 fax: 717.220.1461 email: pvma@pavma.org website: www.pavma.org
what’s featured 14
Who Knows What's Best For Mother Sow?
22 6th Keystone Veterinary Conference
in this issue 7
Letter to the Editor: Crisis in Veterinary School Education: A Call For PVMA Support
9
PVMA Hosts Annual Legislative Day and Friends of Veterinary Medicine Reception
2012 EXECUTIVE COMMITTEE
16
Employee Discounts: Do You Know the Rules?
Robert P. Lavan, DVM, ACPVM President
20
The Ongoing Debate Over Feral Cats
30
Register Now For the 2013 Winter Seminar Vacation to Antigua
Kenton Rexford, VMD President-Elect Sherrill Davison, VMD, Vice President Ronald M. Kraft, DVM Secretary-Treasurer E. Mark Fox, VMD Immediate Past President Mary A. Bryant, VMD AVMA Delegate Charlene Miller Wandzilak Executive Director
12_Volume_2.indd 1
ON THE COVER: The photo on the cover of this issue of keystone veterinarian is from Samantha Bucher, the 9TH grade winner of PVMA's 2012 Digital Photography Contest. Congratulations, Samantha!
7/17/2012 4:45:17 PM
Quarterly Columns 6 Observations
by Heather Berst, VMD
“Animal Welfare and Veterinary Medicine Go Hand in Hand”
8
The President’s Two Cents
"Value For Money: It's a Necessity in the Current Economy”
10
From Where I Sit
“A World Without PVMA”
by Robert Lavan, DVM, ACPVM
by Charlene Wandzilak
12
Practice Pearls
"Pharmacy: Revenue Stream or Profit Drain?”
by David McCormick, MS, and Sherry Everhart, BS, RVT
19
Veterinary Technology Corner
"Understanding the Pain Score"
28
Penn Vet Connection
34
Member News
36
What’s Happening
40
The Grand Finale
by Jamie DeFazio, AS, CVT, VTS-EVN
"Congratulations to the Penn Vet Class of 2012" "Welcome New Members" “Events and Education”
Advertising Index 11
Atlantic Coast Veterinary Conference
6 AVMA-GHLIT 39 AVMA-PLIT 35
Burzenski & Company, PC
7
DoveLewis Emergency Animal Hospital
3, 29
Drexel University College of Medicine
IRC Highmark 39
Nate Lynch & Associates, LLC
4
On-Hold Specialists
34
Pfizer Animal Health
5, 17
PulseVet
IFC pvmaAssure Insurance Agency, Inc. 11
ScoDen, LLC
32
Simmons Veterinary Practice Sales & Appraisals
5
Transfirst Health Services
37 VetCor 38
12_Volume_2.indd 2
Classifieds
7/17/2012 4:45:18 PM
12_Volume_2.indd 3
7/17/2012 4:45:20 PM
keystone
veterinarian
2012 Board of Trustees (A= Alternate Trustee, T=Trustee)
District I Adam Hoover, VMD, Trustee Karen Martin, VMD, Alternate
District II Lloyd Reitz, Jr., DVM, Trustee Stacia McMahon Gilbert, DVM, Alternate
District III Robert Bishop, DVM, Trustee Mary-Lynn McBride, DVM, Alternate
District IV Henry Croft, Jr., VMD, Trustee John Showalter, DVM, Trustee Michael Q. Bailey, DVM, DACVR, Alternate
District V Bill Croushore, DVM, Trustee Dan Zawisza, VMD, Alternate
District VI Andrea Honigmann, DVM, Trustee John Simms, VMD, Trustee Trent Lartz, DVM, Alternate Jeff Steed, DVM, Alternate
District VII Christina Dougherty, VMD, Trustee Jim Holt, VMD, Trustee Casey Lynch Kurtz, VMD, Trustee Theodore Robinson, VMD, Trustee Kimberley Hershhorn Galligher, VMD, Alternate Kim Kovath, VMD, Alternate Steven Prier, VMD, Alternate Tom Garg, VMD, Alternate
Editor: Heather Berst, VMD Staff Editor & Graphic Designer: Lori Raver Staff Editor: Charlene Wandzilak Editorial Correspondence Letters to the Editor should be sent to PVMA, Attn: Lori Raver, 8574 Paxton Street, Hummelstown, PA 17036, fax 717.220.1461, or by email at lraver@pavma.org. Advertising keystone veterinarian is published quarterly by the Pennsylvania Veterinary Medical Association. Inquiries about display advertising should be directed to Lori Raver at the address and phone number listed above. Advertising information is also available on our website, www.pavma.org. Contracts and insertion orders should be sent to the address listed above by the appropriate submission deadline. Submission Deadlines All articles, classifieds, and display advertisements must be received by the deadlines listed to be considered for inclusion in the respective issue: Volume III, 2012—August 21, 2012 Volume IV, 2012—October 1, 2012 Subscriptions keystone veterinarian is mailed to all PVMA members at no charge as a member benefit. Subscriptions are available to non-members for $30 a year or $10 for a single issue. Notice to Readers Neither this publication nor PVMA assume responsibility for material contained in articles and advertisements published, nor does publication necessarily constitute endorsement or approval of the advertiser, product, service, or author viewpoint by the keystone veterinarian, its editors and publishers, or the Pennsylvania Veterinary Medical Association. In addition, neither this publication nor PVMA guarantee the accuracy, reliability, or completeness of any facts, views, opinions, recommendations, information or statements contained within this publication. Reproduction in whole or in part is prohibited without the permission of the Pennsylvania Veterinary Medical Association. Copyright 2012: Pennsylvania Veterinary Medical Association.
District VIII Mike Barnett, DVM, MBA, Trustee Ferdinand Visintainer, VMD, Trustee Susan Ackermann, DVM, Alternate
AVMA Alternate Delegate Mike Topper, DVM, PhD, DACVP
Academic Veterinarian At-Large Vacant
Veterinary Student At-Large Lauren A. Aldinger (V’12)
Production Animal Practice Veterinarian At-Large Darcie Stolz, VMD
Equine Veterinarian At-Large
On-Hold Specialists We specialize in customized veterinary on-hold messages starting at just $79. We are proud to be the only on-hold provider for PVMA! Is your current on-hold program outdated? Need a complete system? Visit our veterinary section online at www.onholdspecialists.com and click on “place an order” to create your script. Ask about group, multi-location, and PVMA member discounts.
Vacant
Public and Corporate Practice Veterinarian At-Large Jules Benson, BVSc, MRCVS
Veterinary Technician At-Large Karla Carlisle, CVT, RLATG
12_Volume_2.indd 4
No contracts, no monthly fees. Call us today! 1.888.546.3949
7/17/2012 4:45:22 PM
12_Volume_2.indd 5
7/17/2012 4:45:24 PM
observations
Animal Welfare and Veterinary Medicine Go Hand in Hand By Heather Berst, VMD, Editor
M
ultiple news articles, social media posts and commentary regarding veterinary medicine and animal welfare have recently been in the news. The horse slaughter issue has been reported in many media posts. I first became aware of the most recent controversy after seeing a plethora of Facebook posts regarding horse slaughter in the US. I read several articles posted about the horse slaughter on Facebook and went to the AVMA website to read their position. I then shared the AVMA’s comments and thoughts on horse slaughter with several friends. I grew up riding and went on to track equine in veterinary school, so the horse slaughter issue always strikes a cord with me. While shopping in my local supermarket, I noticed there are meats with animal welfare ratings on their packaging. I wondered what it meant. A few months later, I was speaking with a friend who is a veterinarian in Virginia. She had just become certified to give welfare ratings to farms and referred me to one of a few organizations which certify family farms. The website for the Animal Welfare Approved (AWA) Program states, “The Animal Welfare Approved program audits and certifies family farms raising their animals humanely, outdoors on pasture or range. Farmers who earn the AWA seal benefit from having a third-party verification of their highwelfare practices and consumers benefit by knowing that the humane label means what it says.” The interesting thing about this rating is the people who are certifying the farms do not have to be veterinarians. It just happened that my friend was a veterinarian and had an interest in it. Readers of keystone veterinarian are going to have varied opinions on the animal welfare ratings on meat packaging. I want to say two things about it. First, people are looking at these ratings on their meats and willing to pay more for humanely raised meat. Secondly, who would be the best people to certify these farms? Veterinarians! Food for thought … literally. Both of these stories peaked my interest in new issues with veterinary medicine and animal welfare. I did an online search on veterinary medicine and animal welfare. I found out about the new American College of Animal continued on page 28
6
VOLUME II 2012
12_Volume_2.indd 6
keystone veterinarian
WWW.PAVMA.ORG
7/17/2012 4:45:25 PM
Letter to the Editor
Crisis in Veterinary School Education A Call for PVMA Support By Robert Marshak, DVM, DACVIM
W
hile the veterinary profession as a whole is experiencing the sting of a prolonged recession, many American veterinary schools, faced with massive divestment by state governments, are struggling to maintain their qualitative edge by judiciously downsizing personnel and by increasing tuition and class size. Veterinary graduates, meanwhile, most with horrendous debt burdens and seeking entry level employment in a diminishing, relatively low-paying job market, find themselves in a dangerously unsustainable situation. Yet despite these ominous circumstances as well as a persistently flat national veterinary school applicant pool (only 2.1 applicants for every available seat) and growing evidence that we are at or approaching a surplus in the largest sector of the profession, the AVMA Council on Education (COE)—originally recognized by the United States Department of Education as the accrediting agency for schools of veterinary medicine in the United States and Canada—has recently granted full accreditation to a rash of foreign schools and one American school that, in my opinion, fail to meet the COE's clearly articulated standards for accreditation. Four schools—the Western University of Health Sciences, College of Veterinary Medicine (WUCVM), the National Autonomous University of Mexico, School of Veterinary Medicine, St. George's University, School of Veterinary Medicine, and Ross University, School of Veterinary Medicine—appear to me to lack the resources, programs, and scholarly milieu to deliver quality education in a field as intellectually demanding as veterinary medicine. Two examples follow.
see, Utah State University, Midwestern University in Arizona, and possibly at Southern Arkansas University, is related—in part—to extreme relaxation of COE standards. Recently, another Caribbean veterinary school, St. Mathew's University in the Cayman Islands, has received AVMA listing and will be seeking full accreditation. In justifying the decision to establish new veterinary schools, universities (eg: Lincoln Memorial and Midwestern) often cite a critical need for more large animal veterinarians when, in fact, national data show that while areas of need do exist, there are virtually no shortages of large animal and/ or mixed practice veterinarians wherever there are sufficient numbers of livestock and/or horses to provide a good, secure livelihood. It is ironic, as Lincoln Memorial University prepares to take its first veterinary class, that Tennessee leads the nation in the loss of working farms. Whereas the Liaison Committee on Medical Education, the agency responsible for accrediting medical schools, refuses to accredit for-profit medical schools or medical schools outside the United States and Canada, the AVMA-COE appears to welcome applications from foreign continued on page 33
The Western University Veterinary College, the first of this group to be fully-accredited, impressed me during two visits as an operationallylow cost, high-tuition ($44,000) vocational-type institution interacting with an apprecticeship system. Lacking strength and depth in basic science and clinical disciplines, the college relies heavily on a coursebased learning system that expects first and second year students, largely on their own, to extract and internalize the essential basic science knowledge and concepts that upderpin science-based clinical medicine. On-campus clinical training is centered in a Banfield-built facility using the Banfield management system. There are no oncampus facilities for large animals or herd health or production medicine programs and no advanced research or graduate level training programs as the standards require. For much of their clinical training students are outsourced mainly to private practices, many with scant college oversight. Thus, I strongly believe that by granting full accreditation to WUCVM in 2010, the AVMA-COE had essentially abandoned its much heralded "gold standard," setting course down a slippery slope into a trap of its own making, ie: how could the COE now refuse to accredit other substandard schools without facing costly lawsuits? The Ross University Veterinary School, a for-profit, free-standing institution, fails to meet the requirement (standard 1) that a veterinary school "must be part of an institution of higher learning." This absolute requirement is aimed at safeguarding academic freedom, encouraging free expression, fostering a spirit of inquiry and discovery, and assuring high standards for faculty appointments and promotion. I find it hard to avoid the perception that the imminent proliferation of new veterinary schools, eg: at Lincoln Memorial University in TennesWWW.PAVMA.ORG
12_Volume_2.indd 7
keystone veterinarian
VOLUME II 2012
7
7/17/2012 4:45:26 PM
the two cents thepresident’s president’s two cents
Value for money:
It's a Necessity in the Current Economy By Robert Lavan, DVM, MS, MPVM, DACVPM, President
M
y wife and I started funding our retirement several years out of veterinary school, after we had finally retired our school loans. Since then, this small nest egg grows slowly. I have been told to be patient and appreciate the power of compounding interest. I pray quarterly that we stay healthy for a long, long time because the retirement fund will not be able to support us for a long, long time ! That said, I find myself asking if I spend my non-investment money in the right places. Do we need these magazines? Do we take a vacation this year and how far away do we go? In this economy, everything is open for discussion. That's why I believe that one of your best investments, right now, is your PVMA membership. You are a loyal member and pay the fee annually, but you may not be aware of what this buys you.
The Power of Legislative Foresight!
There are a lot of people who think they should have a say in how you practice veterinary medicine. Year in and year out, PVMA defends our veterinarians through legislative action. By working with our lobbyists and other stakeholder organizations, PVMA fights bad legislation and encourages legislative efforts that support our veterinary school, our diagnostic labs and our ability to practice medicine. Here are a couple pieces of legislation that are challenging us right now: 1. The City of Philadelphia has approved a new law which requires veterinarians to act as dog licensing agents for the city. They realized that dog license fees were an untapped source of revenue and they want to force veterinarians to collect the newly increased fees for them. I took a couple of excerpts from the law for your information. a. “Service providers must verify an animal’s license before providing service.” b. “…the dog service provider shall require the owner of the dog to complete an application for a dog license for the dog, and pay the required fee..” The expectation is that if the City of Philadelphia can mandate veterinary participation in license fee collection, other localities statewide can do this also. PVMA worked on behalf of Philadelphia-area veterinarians to identify ways to assist including meeting with city officials to clarify the law's intent and offering assistance in educating and promoting the new law. 2. The PA Senate recently passed legislation restricting the methods of animal euthanasia. The sponsors of this bill do not believe that a veterinarian, using his or her training and experience, is the best person to determine how best to humanely end an animal’s life. This law is being considered in the PA House of Representatives as we speak, and PVMA is working with leaders to ensure that the law is favorable to animals and veterinarians.
Great Insurance at a Great Price!
PVMA is developing the capability to be our own insurance brokerage. We are a full service broker for health insurance and offer PVMA exclusive dental and vision plans, as well as group and individual life and disability programs and business property and casualty (workers compensation, business owners' property and contents, general liability, professional liability), as well. Over the next year, we will offer other products including and personal property and casualty insurance. As your partner, pvmaAssure would like to help you navigate through the complexities of the insurance world from understanding what options and carriers are best for your budget and your needs, to serving as your advocate and liaison with insurance carriers, and assisting with billing and coverage questions and problems. PVMA will be here every step of the way so you can do what you love best—veterinary medicine. Ask for a quote and see if PVMA can get you better insurance, better service and save you money, at the same time.
Great CE!
Have you taken a look at the caliber of speakers at the four regional PVMA meetings? It is on par with other national meetings. Attendance has grown each year, and you don’t need to pay for airfare and expensive hotels. Still coming up this year is Keystone Veterinary Conference (August 16-19 in Hershey) and 3 Rivers Veterinary Symposium (November 3-4 in Pittsburgh). This is just a smattering of what PVMA does every day on your behalf. For a full benefits cost analysis, see page 18. Take advantage of what PVMA offers. If you have the time, make it better by joining a committee. If you don’t have the time, consider helping to support the political action committee (PVPAC), making a donation to the PVMA Building Campaign to pay off the mortgage on the headquarters building, or simply providing feedback on how we can best serve you. PVMA is here for you and is a great investment for your time, talents, and coin. l 8
VOLUME II 2012
12_Volume_2.indd 8
keystone veterinarian
WWW.PAVMA.ORG
7/17/2012 4:45:27 PM
A Look at the Issues PVMA Hosts Annual Legislative Day and Friends of Veterinary Medicine Reception
O
n May 8, PVMA hosted its 7th Annual Legislative Day in Harrisburg. 29 PVMA members attended the day’s events which included an educational session, capitol visits, and our Friends of Veterinary Medicine Reception co-hosted with the University of Pennsylvania, School of Veterinary Medicine (Penn Vet). The day’s events kicked off with a welcome from PVMA President Dr. Bob Lavan who also introduced our honored speaker Senator Elder Vogel, Majority Chair of the Senate Agriculture and Rural Affairs Committee. Senator Vogel spoke to attendees about the importance of advocacy and building relationships with legislators. Following the Senator’s remarks, Dr. Tom Garg, PVMA Legislative and Regulatory Affairs Committee Chair, provided an overview of key issues which the Association is actively working on and advocating for or against passage (see side panel). We were pleased to also welcome Teresa Lazo, Esq., General Counsel for the State Board of Veterinary Medicine, who spoke on current regulatory proposals and statistics on veterinary complaints considered by the Board. Following Ms. Lazo’s presentation, Stacy Gromlich, PVMA’s lobbyist, provided an overview of the legislative process and PVMA’s advocacy efforts. At the conclusion of the session, attendees broke out into groups and headed to the capitol where they participated in visits with legislators and their staff. Top photo: Senator Elder Vogel receives his Distinguished Veterinary Service Proclamation. Middle photo: PVMA Past President Dr. Dave Wolfgang received the 2012 George B. Wolff Legislative Leadership Award. Bottom photo: Senate Agriculture and Rural Affairs Committee Executive Director Mike Rader received a PVMA President's Award.
Senate Bill 768 (Senator Stack) This bill would have amended the Veterinary Medicine Practice Act in order to require veterinarians to provide a client information sheet whenever a drug is dispensed. PVMA opposed this legislation based both on content and the fact that the Practice Act would have been reopened. We worked with the prime sponsor’s office to demonstrate that veterinarians already have an obligation to educate clients about the risks of medication. The sponsor’s concerns were addressed and this bill has not come out of committee.
Senate Bill 769 (Senator Stack) This bill would have amended the Veterinary Medicine Practice Act to require veterinarians to perform any and all laboratory testing suggested by the manufacturer before dispensing a medication. PVMA opposed this legislation and actively worked with the prime sponsor’s office to demonstrate that veterinarians are obligated to adhere to the standard of care and that past precedence demonstrated that, within reason, this is standard of care. This bill has not left committee.
Senate Bill 443 (Senator Leach) This bill would ban use of certain antibiotics in production animals. The bill remains in committee and there is reportedly little interest in further addressing this issue at the state level. PVMA opposes this bill and has provided testimony on multiple occasions on the use of antibiotics in livestock.
House Bill 1651 (Representative DiGirolamo) This bill would require veterinarians to report every time they dispense a controlled drug. Reporting would be required through a web based system within three days of dispensing the medication. PVMA’s Legislative and Regulatory Affairs Committee’s recommendation was to oppose this legislation as proposed because some veterinarians may not be able comply and because this would impose a significant hardship if drugs like Tramadol become controlled. The PVMA Board of Trustees approved opposition to this bill. We are working to have the language of the bill amended to exempt veterinarians from this as has been done in other states with similar requirements.
Senate Bill 1329 (Senator Dinniman) Later that afternoon, PVMA and Penn Vet, co-hosted our 8th Annual Friends of Veterinary Medicine Reception in the east rotunda of the capitol building. During the reception, PVMA and Penn Vet took the opportunity to honor Senator Elder Vogel with the Distinguished Service Proclamation for his many efforts on behalf of the veterinary profession, agriculture, and animals in Pennsylvania. As the Chair of the Senate Agriculture and Regulatory Affairs Committee, Senator Vogel has demonstrated thoughtful leadership when considering legislative proposals and an appreciation for the unintended consequences of well-intended legislation. Senator Vogel looks to PVMA as a trusted resource on a regular basis for scientifically based information on animal welfare and health, public health, and food safety issues and values our partnership. Dr. Lavan also presented a PVMA President’s Award to Michael Rader, Executive Director for the Senate Agriculture and Rural Affairs Committee. The President’s Award is presented annually to a person or organization for outstanding contributions or achievements but does not qualify for other PVMA awards. In a relatively short time, Mike Rader impressed our association by his leadership, willingness to partner and learn continued on page 36 WWW.PAVMA.ORG
12_Volume_2.indd 9
This bill would ban the use of certain euthanasia methods and require that the method of destruction be by the administration of an overdose of a barbiturate, barbiturate combinations, drug or drug combinations approved for this purpose by the Federal Drug Administration. However, nothing in this act would prevent a person or humane society organization from destroying a pet animal by means of firearms. This bill was developed in response to constituent complaints after an animal control officer euthanized animals by carbon monoxide from an automobile tailpipe. The use of carbon monoxide from a gasoline engine is not an acceptable method of euthanasia per AVMA guidelinesn or does PVMA condone this unproper and inhumane use. This bill was previously introduced as Senate Bill 969. It was reintroduced this year as Senate Bill 1329. PVMA worked with the sponsor, Senator Dinniman and the Senate Agriculture and Rural Affairs Committee to develop the bill such that it would be acceptable to our profession. PVMA opposed the bill as written because of certain language in the bill. However, did support a ban on carbon monoxide usage in shelters. We sought the following: continued on page 35 keystone veterinarian
VOLUME II 2012
9
7/17/2012 4:45:29 PM
from where I sit
A World Without PVMA By Charlene Wandzilak, Executive Director
F
or those of you who are loyal PVMA members, the title of my article probably causes some alarm. I am here to reassure you that there is no cause for alarm … yet. However, this is a call to action. According to The End of Membership as We Know It author Sarah Sladek, there are several societal trends that will impact how associations like PVMA operate and ultimately survive in the next 20 years. Ms. Sladek’s points are in line with Race for Relevance by Harris Coerver (subject of another one of my columns) and other association publications that are all anxiously evaluating these trends and what associations need to do to gear up to remain relevant. Here are a few of the trends that motivate me even more than my natural inclination to do what’s best for you, our members: 1) One of the biggest trends is that from now until 2030, every eight seconds someone will turn 65. This is the largest shift in human capital in US history and with that comes changes to what associations look like. Because baby boomers have historically been the largest contingency of members, our programs and services have been tailored to this group. 2) Trends like technology, work-life balance and societal movement away from conformity are all impacting how associations do business and how we meet your needs as members. 3) According to the US Census Bureau and Bureau of Labor Statistics, by 2015 (only three years from now!), baby boomers will cede the majority of the workforce to Generation Y. This is the largest shift in our history. 4) Some simple equations and computations that take into account the retirement of baby boomers, retention rate of members, and the recruitment of others makes it a realistic possibility that if we don’t address the need to evolve and to help you in a meaningful way, PVMA could be gone in as little as one decade. Yes, friends, ten short years. What would that mean to you as a veterinarian or member of the veterinary team? Well, that is largely going to depend on you, what you value, and how you help us shape this organization moving forward. However, for starters, I can tell you that the following would cease: 1) Having someone on a daily basis looking out for you and this profession in Pennsylvania. Most people don’t realize the importance of this until something happens that is potentially detrimental. Each day, we serve as the only advocate for Pennsylvania’s veterinary profession. This translates into us being at the table for discussions with other stakeholders, agency leaders, regulatory bodies, and the legislature; helping them to see the ramifications of decisions, being a resource, sharing information, and making sure that veterinarians are valued for their unique contribution to the world. Animal health and welfare measures are weighed with unbiased and expert input so that your practices can remain viable. Without PVMA, no one watches what is going on while you are busy earning your living. 2) Continuing education—I know that we are certainly not the only continuing education provider in the state nor the country. There are many other choices you have for CE. What I can assure you is that we have 3-4 major conferences right here in your backyard, and you would be hard pressed to find better quality speakers and topics at the biggest and supposedly best conferences, all of which you have to fly to and spend tons of money. Not finding something you like at one of our conferences? Tell us! We are always willing to try new ideas. 3) Benefits and services—This is an evolving concept for PVMA but one that is central to our existence for you. It's also one that can and should be largely influenced by your input and what you need to help you succeed. I could name all of the benefits and services but they are promoted throughout this magazine. I will say that I had an “a-ha” moment one day when preparing for a presentation about our insurance agency, pvmaAssure. It dawned on me in a meaningful way that there are providers of services everywhere: insurance brokers, CE providers, etc., and for the most part they are equal, including PVMA. What distinguishes PVMA is that we strive to provide the highest level of services, not because of our bottom line, but because of you. This is your organization. When you pay to attend a conference of ours, when you use one of our benefits or services, or when you choose us as your broker for insurance needs, you are investing not only in yourself but also the entire profession in Pennsylvania. Why? Because all profits and monies go directly back into PVMA, moving veterinary medicine forward and to serving you, our members. Serving our members is our business model. It is central to everything we do and why we exist. “So what” you might say. You can be assured that the PVMA leadership, management team, and I will not let that happen. We care for this organization immensely and for our members. However, it is imperative we change, and for that to happen, we need you to help and to care. This is where my call to action comes in. Take a look in the mirror. I’ll wait while you find one. Are you ready? See that person staring back at you? That person is why we exist. I need you to help us shape PVMA. Therefore, I am urging you to take this call to action seriously and engage in as many of the following ways as possible: 1) Member needs assessment—You will be receiving instructions on how to complete a survey during the first week in August. Please take a break from work, outdoor chores, and other activities to grab yourself
continued on page 32
10
VOLUME II 2012
12_Volume_2.indd 10
keystone veterinarian
WWW.PAVMA.ORG
7/17/2012 4:45:29 PM
WWW.PAVMA.ORG
12_Volume_2.indd 11
keystone veterinarian
VOLUME II 2012
11
7/17/2012 4:45:31 PM
practice pearls
Pharmacy: Revenue Stream or Profit Drain? By Sherry Everhart BS, RVT, and David McCormick, MS, Simmons Mid-Atlantic, Boalsburg, Pennsylvania
o
ne of the hot management topics this year is the pharmacy. Many practice owners are concerned as to the future of their pharmacy sales and whether they should even continue providing pharmaceutical services. Industry data shows that as a percent of overall revenues, average product sales is beginning to show evidence of decline. At the same time, the average product costs are doing the opposite. Historically, it was common for the cost of drugs and medical supplies to fall in the range of 17 to 21% of revenues. This is no longer the case for most practices. It is increasingly common to observe these inventory costs exceeding 25%. Because inventory costs are the second largest expense for most general veterinary practices (behind labor costs), this trend has had a significant negative impact on practice financial health.
Should You Keep Your Pharmacy? Yes, for many reasons. If you can commit to actively managing your pharmacy inventory, it can play a positive role in your practice’s financial health. ‘Actively managing’ is the real issue here. Even though most practice management software systems include extensive inventory management capabilities, all too frequently they are not understood and therefore, they are under-utilized. Many practice owners are still using the same ordering, monitoring and pricing procedures for inventory that they used when they started their practice. The veterinary product sales market is rapidly changing. In the midst of a floundering economy, veterinarians today are facing the challenges of increased internet competition, the expansion of veterinary products on super mart shelves and the highly advertised offering of low cost generics through human pharmacies. Failure in appropriately responding to these challenges has many veterinarians possessing a very inefficient inventory investment. Below are some of the more challenging issues in inventory management that, when not addressed properly, are leading to pharmacy sales effecting a decline, rather than a boost, in a practice profitability.
Price Matching With the Competition Many owners feel it necessary to offer products at the same price that clients can purchase them on the internet. When an owner chooses to go this route, they need to do it with the understanding and awareness that they are matching prices with a company whose likely biggest costs are shipping and advertising. These companies do not have the costs associated with keeping a highly educated staff, providing health care services with specialized equipment and maintaining a hospital facility with patient record oversight. They receive and ship. That is it. If you decide to price match, dependent on your other costs, you may need to accept that very little or no profit from these sales will reach your bottom line. It is a service to the client that has no benefit to your practice. The decision to match prices should include an analysis of how much profit will you lose from the loss of sales to a competitor versus the profit lost from reducing prices on an entire product line. As an example, let’s say a product line’s unit costs are $25,000 annually. After careful analysis, the practice appropriately decides to price the product to achieve $47,500 in sales revenues. This provides the practice $22,500 to cover the additional costs (see below) and to earn a profit. Later, to avoid losing sales to a perceived competitor, the practice owner chooses to reduce the product line’s price and now can achieve only $40,000 in sales. This adjustment leaves only $15,000 for the practice – the associated costs do not change. Only the profit is reduced. In this example, if the practice did not change it original pricing structure, it would had to have lost 1/3 of its sales in order to equal the consequence of the reduced pricing strategy. Would they have lost 1/3 to the competitor? Not likely.
12
VOLUME II 2012
12_Volume_2.indd 12
keystone veterinarian
WWW.PAVMA.ORG
7/17/2012 4:45:33 PM
If you choose to price match and you want to maintain your practice’s financial health and profitability, you should intentionally make up the shortfall somewhere else in your fee schedule.
Incorrect Ordering/Stocking Quantities The ongoing pharmacy struggle seems to be deciding the appropriate quantity of each drug to have on hand. Being able to treat each patient’s health issue with immediacy often leads to having numerous product lines and larger stock quantities than what is truly necessary. Ordering habits are hard to change, especially when the person responsible gets caught up in their ongoing daily schedule of tasks and interruptions. Your pharmacy has costs built into it that are on top of the unit costs of the drugs sitting on the shelves. Taxes, insurance, storage, and regulatory costs also are incurred. Inventory on hand is also tying up a significant amount of capital that otherwise could be invested to generate an income. When quantities on hand are in excess of managed levels, you risk additional costs that are associated with product obsolescence, expiration losses, and theft. These are referred to as “holding” costs. These hidden costs can frequently cost a practice an additional 8-20% of a product’s unit cost. An in-house pharmacy also incurs “ordering” costs. These are the labor costs related to the ordering of products, un-packaging and stocking, entering inventory in the computer (and adjusting fees), payment of invoices, and any accounting costs. When a practice has too little inventory on the shelves, it incurs higher ordering costs. Employees have to place more frequent orders, shipping costs may increase, and there is an increase in the number of shipments and invoices that need to be dealt with. Over-ordering has other expenses and profit drains. Overall, the subtle ordering costs can add an additional 15-20% of a product’s unit cost. On top of the holding and ordering costs, a practice may also experience lost sales due to stock outs and possible dissatisfied client if treatment of their pet is delayed. Because holding and ordering costs are inversely related (as holding costs go up, ordering costs will decrease and vice versa), a balance is needed. Your practice will incur the least total inventory costs by ordering each product at a level where ordering and holding
WWW.PAVMA.ORG
12_Volume_2.indd 13
Make the time to review what you are currently doing for your stock and ordering. Is it what you really want to have happening? costs are balanced. This balance point is called the Economic Order Quantity (EOQ). The EOQ process is beyond the scope of this article but it is excellent for using on your top product seller and all high cost, low margin items. Many veterinary management texts provide EOQ details such as Practice Made Perfect by Marsha Heinke or Blackwell’s Five Minute Veterinary Practice Management Consult. In most practices, 80% of your sales revenue will come from 20% of your products. At a minimum, these should be identified and their orders, stock quantities and pricing should be tracked regularly. Make the time to review what you are currently doing for your stock and ordering. Is it what you really want to have happening?
Inadequate Pricing Strategies Pricing is a frequent frustration point for many practices and there has been much written on the “correct” method to price products. This has resulted in much confusion in the terms and their use: mark-up pricing, margin pricing, pricing minimums, prescription fees, etc.
Margin Pricing vs Mark-up Pricing In Margin Pricing, the “margin” is technically the profit from the sale. It is not the difference between your cost and the client’s cost. Margin pricing involves setting a price based on the costs that should be included (professional and lay staff costs, administrative costs, etc.) plus the profit that you want/need to get from the sale. This can be a very effective method for pricing but the challenge to this method is knowing what costs need to be included in the calculation before adding on the desired profit margin. Mark-up Pricing is simply adding a set percentage to the product cost to get to the selling price. For example, a product that costs $10.00 and it will be sold for $18.00 has an 80% mark-up. The challenge isn’t in the method; both margin and mark-up pricing methods are
fairly easy mathematically. The challenge is knowing what pharmacy costs must be accounted for in order to determine a sufficient margin or mark-up. It is not uncommon for practice owner to completely disregard the ordering and holding costs discussed above when deciding their pricing strategy for their pharmacy sales.
Insufficient Minimum Prescription Fees—(aka Dispensing fee) Prescription fees are separate fees that are added to each dispensed prescription. This is intended to cover the fixed costs of maintaining an in-house pharmacy. A Minimum Prescription fee is a ‘practice specific’ fee that should be charged to each client purchasing a prescription regardless of how few pills are dispensed. Minimum Prescription fees vary greatly among practices and appropriately so. Determinants for a minimum prescription fee include pharmacy size and facility costs which are unique to each practice. Contrary to what some staff believe, prescription fees are not to cover the bottle that the pills are dispensed in. It should not be waived just because the client brought their previous bottle in for a refill. The most frequent issue observed in most practices is not including enough of the hidden costs in their pricing. For example, a 100% mark-up is insufficient for most practices to cover costs (i.e., there is no margin left over) – especially if the item counts toward your veterinary production compensation. As a start, review how your top 20 products are priced. Is it a default mark-up or are you deliberately setting a fee to cover costs and include a margin – and possibly extra margin to make up for what you might be losing on other items?
Not Performing Inflationary Fee Increases Many practice owners are pretty good at increasing a product’s price when they notice the unit cost has gone up (which we
keystone veterinarian
continued on page 33
VOLUME II 2012
13
7/17/2012 4:45:33 PM
Who Knows What’s Best For Mother Sow? By Thomas Parsons, VMD, PhD, Associate Professor of Swine Production Medicine, Department of Clinical Studies, University of Pennsylvania, School of Veterinary Medicine, New Bolton Center, Kennett Square, Pennsylvania
M
ay we live in interesting times is a fabled ancient Chinese curse that swine farmers, their veterinary advisors, and many executives of companies in the pork supply chain might think has been cast upon them of late. Recent and rapid changes to marketplace expectations of how gestating sows are raised foreshadow the possibility of sweeping changes on swine farms, have created uncertainty for those in the pork business, and perhaps spawned more questions about sow welfare than answers. Mother sows give birth to the piglets that will be raised and slaughtered to provide the bacon, chops, and loins found in the grocer’s meat case. Greater than 90% of these gestating mother sows in this country are raised in a gestation stall or crate. The 14
VOLUME II 2012
12_Volume_2.indd 14
gestation stall was widely accepted by swine farmers about 35 years ago as it provided a solution to many of the vexing challenges related to the development of social hierarchy when sows were housed in groups. Dominant animals garnered all the limited resources, such as feed, and became over-conditioned while the more timid sows suffered from malnourishment and were at risk of career-ending injuries resulting from aggression and fighting associated with development of the social hierarchy. In the gestation stall, farmers found the unprecedented ability to provide gestating sows with both individual animal nutrition and individual animal care. In hindsight—and especially when viewed through the optics of today’s society—the decision to make individual animal housing for gestating sows seven feet long and only two feet wide was perhaps unfortunate. The narrow width of the standard gestation stall prevents the sow from being able
keystone veterinarian
to turn around for the entirety of the near four months that she is pregnant. Many people today find that restriction on her movement and limits to other natural behaviors as untenable. These welfare concerns have driven efforts to ban this form of sow housing from farms. The winds of change to sow housing in this country have been churning for some time. In 1997, the European Union banned gestation stalls, leading to a 15-year phase out of this husbandry practice that is mandated to be complete in all member states by December 31, 2012. To date in the United States, Florida, Arizona, and California have banned gestation stalls through voter referendums, and Maine, Michigan, Colorado, Oregon and Ohio have passed similar laws through traditional legislative means—the latter often coming to pass in the face of a ballot initiative threat by animal advocacy groups. The phase-in WWW.PAVMA.ORG
7/17/2012 4:45:34 PM
period for implementation of these measures varies from state to state and ranges from 7–15 years. The longer the phase-in period, the less costly are changes in sow housing as they can be more readily incorporated into normal depreciation/recapitalization plans. Beyond the phase-in timeline, very few additional specifics of the transition are detailed in these different state bills, and this is in contrast to the situation in Europe where over a 150 pages of European Union (EU) regulations are devoted to the description of raising pigs in a welfare-friendly manner. Taken together, the eight states that have banned gestation crates represent less than 8% of the six million sows in the country as only Colorado, Michigan, and Ohio are in the cadre of top 20 pork producing states. With most of the legislative low hanging fruit harvested, those advocating change on farms evolved their tactics. The remaining states either lack ballot initiatives, as is the case in Pennsylvania, and/or often have a well-established agricultural lobby to counter conventional legislative efforts. Thus, the last year has seen a shift in emphasis to the marketplace. A series of undercover video exposés depicting questionable welfare practices on farms have appeared, but moreover these reports specifically targeted brand names such as Hormel or the retail entities including Wal-Mart, Costco, HyVee, Kroger, and Safeway that were supplied by the farms under scrutiny. Ongoing discussions between retailers and animal advocacy groups such as the Humane Society of the United States (HSUS) also have helped motivate change in the marketplace. Furthermore, animal advocacy groups have become stockholders in many publicly-traded food companies and regularly put forward proposals at annual stockholder meetings to require suppliers to ban gestation crates. All of this has come together in the last several months to trigger a flurry of announcements highlighting changing welfare expectations by retailers. Smithfield and Hormel, both suppliers of branded pork products, have committed to eliminating gestation stalls on their farms. In the food service sector, the Compass group and Bon Appetit have announced plans to eliminate the use of pork produced from animals housed in gestation stalls. However, perhaps more importantly, the big three in fast food—McDonald’s, Wendy’s, and Burger King—have all announced that they will require their suppliers to phase out the use of gestation stalls, with Burger King stipulating that it must be accomplished by 2017. McDonald’s has appointed a task force that is codifying its expectations and has promised a final report in May. McDonald’s alone annually uses about 1% of the total pork produced in the US. However, recognizing that they use only selected cuts from the carcass that represent a fraction of what any individual animal yields, and thus the number of sows required to supply, McDonald's—with the pork products they need—could be as much as 10% of the country’s inventory. Clearly, significant changes to today’s swine industry will be needed to meet these burgeoning expectations for crate-free pork in the marketplace. In a move contrary to all other retailers who have weighed in on the topic of sow housing, shareholders of Domino’s Pizza—at the recommendation of their board of directors—recently voted not to require their pork suppliers to eliminate gestation crates. The board stated that how pigs are raised is an issue that should be addressed directly with producers and suppliers, not customers. This action raises the important question of who should decide what is best for mother sow. Farmers? Veterinarians? Animal scientists? Animal advocates? Food purveyors? Legislators? Consumers? Non-consumers? All, and perhaps others, have a stake in the argument but, to date, only legislators and registered voters have had the opportunity to decide how a mother sow is raised. The question of what is best for the gestating sow is complicated by the fact that there is no single housing system that guarantees good animal welfare. Scientific investigation has highlighted how different sow housing systems address different welfare concerns and is perhaps best summarized by the American Veterinary Medical Association (AVMA) taskforce on sow housing. This report concluded that no one housing system is clearly better than others under all conditions and better than others with respect to all welfare criteria. Stalls provide animals with freedom from injury and malnourishment at the expense of the freedom to express natural behaviors whereas group housing often is the converse. Thus, the decision of retailers, which was driven by consumer concerns about gestation crates, cannot be simply justified with existing science. WWW.PAVMA.ORG
12_Volume_2.indd 15
The question of what is best for the gestating sow is complicated by the fact that there is no single housing system that guarantees good animal welfare. Changes in the marketplace have been driven by the fact that sow welfare in the popular media often has been incorrectly reduced to the issue of whether or not the sow can turn around. For me and others who have been working with alternatives to the gestation stall, we recognize that there is more to the sow’s welfare than simply whether she can turn around. In the past 10 years, we have helped at least 35 farms across the country transition away from gestation stalls. We now have over 60,000 sows or about 1% of the sow inventory living crate-free in a form of sow housing that we prototyped at the University of Pennsylvania, School of Veterinary Medicine (Penn Vet) swine center. While using an almost identical design and physical layout for these farms, we have seen animal welfare range dramatically from excellent to unacceptable and productivity vary from below to above industry standards. The varied degrees of success on our farms with crate-alternatives reinforce the notion that a sow’s life is not necessarily improved by the simple ability to turn around. On the other hand, our experience has documented that there are commercially viable, crate-free farms out there where the welfare of sows is undoubtedly improved. In these situations, the farm staff has quickly responded to champion the new challenges associated with pen gestation such as managing the untoward effects of the social hierarchy. In most cases, management does evolve to the point where risk of physical injury is minimized, individual animal care can be accomplished, and animal welfare improved. The results from these farms emphasize that it is the people and not the housing system that is the major determinant of animal welfare. So the overarching question is how to go forward in a world where the marketplace has cast aside the sow gestation stall, and perhaps more importantly, who takes ownership of the sow’s welfare in this new world where crates are banned by retailers? There are many alternatives to the stalls, some better understood than others and some with better possibilities to improve animal welfare than others. Are all acceptable as long as it is not a gestation stall? It would be tragic for farmers to adopt gestation stall alternatives that might ultimately not be acceptable. Or do there need be other minimal standards that the alternatives must meet such as a per head space allowance requirement as is offered in the EU legislation? How should these minimal standards determined? Would it be hypocritical to use science-based criteria for determining minimum standards for cratealternatives when the original decision to ban stalls was not scientifically justified? In reality, there are large gaps in our scientific knowledge about all the alternatives and there is not likely the research capacity nor support to generate this information within the aggressive timeline for change proposed by retailers. Or, like the original decision, do alternatives also need to be deemed acceptable by the consumer and thus this question is fodder for focus groups and other market research tools? Or, will each retailer in the name of brand differentiation define its own set of welfare criteria? In conclusion, it is unclear who knows what is best for mother sow. While alternatives to the gestation stall do exist that are both welfare-friendly and economically viable, it is unclear if they will be adopted. It also is presently unclear who will decide and how the decision will be reached regarding how mother sow lives in the future. However, what is clear is that all this uncertainty is creating angst and turmoil for those whose business it is to raise pigs and supply pork products to our nation’s retailers. Given the challenges to successfully implementing crate-alternatives on the farm, particularly with regard to retooling management practices, there should be unprecedented opportunity for the veterinary profession to help mother sow and her owners with the transition. l keystone veterinarian
VOLUME II 2012
15
7/17/2012 4:45:35 PM
Employee Discounts: Do You Know the Rules? By Lorraine Monheiser List, CPA, CVA, Owner, Summit Veterinary Advisors, LLC, Littleton, Colorado
L
ike most practices, yours probably offers discounts to employees on veterinary services and products. Although the amount of the discount varies widely from practice to practice, this is a very common fringe benefit in the industry. Many owners offer discounts as a way to provide valuable benefit to their employees, and since most practice employee have pets, no doubt this is truly appreciated by those employees. Seems logical, doesn't it? But like many other good ideas with tax implications, this one is full of traps. What's set forth below is one of the least known tax rules, and one which is not widely understood in the veterinary profession. But here is what our current tax law says about employ-
ee discounts. In order for the discounts not to result in taxable income to the employee (with resulting payroll taxes for both the employee and the employer), these discounts cannot exceed the following amounts: For services, 20% of the price you charge clients for the same service. For sales of products, your average gross profit percentage for the prior year times the price you charge clients for the same products. What's a gross profit percentage? If a product costs you $10, and you charge your clients $25 for it, then your gross profit is $15 ($25 sales price minus $10 cost) and your gross profit 16
VOLUME II 2012
12_Volume_2.indd 16
percentage is 60% ($15 gross profit divided by $25, the sales price). If you had the same gross profit percentage on all your product sales in the prior year, then the maximum discount you could offer an employee is 60%, or $15, which is 60% of $25. A much simpler way to think of this (though when was our tax law ever simple?) is that basically you can sell products to employees at cost, or $10 in our example. You must offer the same discount to all of your employees, or at least to a group that is large enough not to favor highly compensated employees. Anyone who owns more than 5% of the practice is automatically a highly compensated employee, as are employees who earned over $11,000 in the prior year (based on 2010 rules). You can ignore that second test if the employee was not in the top 20% of employees (ranked by pay) in the prior year. I know you're now saying one (or more) of the following: • That's ridiculous! • But everybody gives employees bigger discounts than that! • Why didn't anybody ever tell me this before? • If we work on employees' pets when we're not busy, why does the IRS even care? • If the IRS doesn't limit the discounts I give my clients, why do they want to control employee discounts? If you view this from the IRS' perspective, without such a rule employers could choose to pay employees less salary or smaller wages and then give them sizable discounts on goods and services, with the net effect that employee wages would be less, the employee's income taxes would pay less in payroll taxes. These rules don't just apply to veterinary practices—they apply to all businesses. So what happens if the discount given to employees exceeds these guidelines? The discounts become taxable wages which must be included in the employees' W-2's at year end, and payroll taxes must be withheld from the employees and matched by the employer as with any other compensation. Here's how the rules work. For any discount or other fringe benefit to be excludable from an employee's wages, it must fall in one of a handful of specific categories in the tax law.
• Services Provided to Your Employees at No Additional Cost to You. The example generally given is excess capacity services,such as airline, bus, or train tickets for transportation workers or hotel rooms for hotel employees. At first blush, you would think you could treat the employees' pets during slow periods and exclude the value of the services under this rule. But there are a couple of problems. First, highly compensated employees as discussed above are automatically not eligible for this benefit. Second, the IRS counts any lost revenue as a cost. Therefore, they could argue that the time spent treating employee pets was time not available for treating other patients, and it would be up to you to prove that there was no lost revenue. Could you prove that? Finally, the rules also say that you are considered to incur substantial additional costs if you or your employees spend a substantial amount of time in providing the service, even if the time spent would otherwise be "idle" or if the services are provided outside normal business hours. • De Minimis (Minimal) Fringe Benefits. These are described as property or services that have so little value (taking into account how frequently you provide similar benefits to your employees) that accounting for them would be unreasonable or administratively impractical. Examples include use of the practice's copy machine (as long as at least 85% of the use is for business), occasional company parties or picnics, occasional typing of personal letters by a company employee, etc. It seems highly unlikely that veterinary products or services could be squeezed into this category with any success. • Working Condition Benefits. These rules apply to property and services you provide to employees to enable them to do their jobs. Examples include use of a company car for employees who travel on company business (if adequate documentation is provided) and attendance at work-related classes paid by the employer for the training which maintains or improves job skills or is required to maintain the current position. Providing services and selling products for employees' personal pets don't fall into this category. continued on page 40
For purposes of this discussion, the relevant categories are:
keystone veterinarian
WWW.PAVMA.ORG
7/17/2012 4:45:37 PM
12_Volume_2.indd 17
7/17/2012 4:45:40 PM
$ $ $ VALUE what's the
of Your PVMA Membership
?
educational discounts (based on non-member vs. member veterinarian full conference registration rate) • Winter Conference—$50 • Spring Clinic—$50 • Keystone Veterinary Conference—$75 • 3 Rivers Veterinary Symposium—$65 • EVE Webinars—$85-$510
Total Potential Annual Educational Discount Savings: $50–$750
additional savings for practice owners! • Energy Plus Buying Group average annual energy savings for practices—$506 • Discounted on-hold messaging systems—$25-125 • Discounted bank card processing services—$200-1,000+ • Website hosting and design services—$100-1,000+
other benefits • keystone veterinarian (official publication of PVMA)—$30 • 20% discount on display ads in keystone veterinarian—$45-385 • Free classified ads in keystone veterinarian—$35-300
• Insurance savings through pvmaAssure, PVMA's insurance full-service, in-house agency—$500-$1,000 + (includes employee benefit packages)
Additional total savings for practice owners: $1,331–$3,631
• Free VetBytes bi-monthly e-newsletter—$100 • Free Around the Capitol weekly e-newsletter—$200 • Discounted legal services/consultation—up to $500 (10% discount up to $5000 in services annually) • Free new graduate employment contract review (within first three years of graduation)—$300 • Free classified ads for relief veterinarians on website—$35-300 • Discounted classified ads on Veterinary Career Network— $25-200 • Reduced Cost Book Program with Priority Press— $14-55 (includes: Contracts, Benefits, and Practice: Management for the Veterinary Profession, Legal Consents for Veterinary Practice, Law and Ethics of the Veterinary Profession, and Job Descriptions and Training Schedules for the Veterinary Team)
keystone veterinarian is going
• Insurance savings through pvmaAssure, PVMA's insurance agency—$50-$500+ (includes long-term care, disability, and term life) • Energy Plus Buying Group average annual energy bill savings for home-owners—$222 • Discounted Hersheypark tickets (average savings for family of four)—$48 • Discounted custom imprinting for cards and stationery (10% discount)—$25-100+ • 24/7/365 exclusive advocate to represent you and your interests with the legislature and regulatory agencies and with you in mind in everything we do!—PRICELESS
Total Potential Other Discount Savings: $1,619– $2,290
FULL COLOR in 2012. Why not use your 20% member discount on display ads to make your business shine? 18
VOLUME II 2012
12_Volume_2.indd 18
keystone veterinarian
If you have questions regarding any of the benefits or services listed or have an idea for a new benefit, contact Charlene Wandzilak at cwandzilak@pavma.org.
WWW.PAVMA.ORG
7/17/2012 4:45:41 PM
veterinary technology corner
Understanding the Pain Score By Jamie DeFazio, AS, CVT, VTS-EVN, President, Pennsylvania Veterinary Technicians Association, Kennett Square, Pennsylvania
What is a Pain Score?
A
s everyone in the veterinary medical profession knows, we have one of the largest communication challenges in healthcare. Even though animals can present with signs depicting pain, it is sometimes hard to put those signs into an appropriate category or to interpret the exact level of the pain. Human patients vary in pain tolerance much like animals, but whereas a man, woman, or child can verbalize their pain score or point to the smile or frown face that best resembles how they feel, we have to be more creative in our assessments. In equine medicine we are paying more attention to pain management, and in order to do that are tracking certain metrics and behaviors that are likely to be linked with pain. As I mentioned before, animals, much like people, have different tolerance levels. We see this variance between breeds as well as gender. For example, an older Belgian broodmare may have a severe colon torsion and show very mild signs of colic, whereas a young thoroughbred colt could be violently in pain and unresponsive to analgesics with an impaction. Even though my background with the pain score is within equine medicine, the same basic applications can be applied to small animal medicine. Some of the parameters will have to be changed or altered, but the same basic principles stand. Dogs, like horses, are still likely to become tachycardic and tachypnec when in pain, but where horses might sweat when in pain, dogs would pant. When evaluating an animal for pain score assessment, it is important to tailor an evaluation criteria based on an area of injury. An animal undergoing treatment for an orthopedic repair is going to be monitored for some specific signs that may not be pertinent to the colic patient, ophthalmic patient, or even the animal suffering from respiratory distress. The largest focus right now seems to be geared towards the orthopedic pain assessment and—even more specifically— the animals battling laminitis in large animal medicine. As I mentioned earlier, tailoring an assessment that is specific is very important as many of the pain signs are different.
WWW.PAVMA.ORG
12_Volume_2.indd 19
What is Evaluated as Part of the Pain Score? In any pain assessment, heart rate and respiratory rate are important because any increase can indicate pain. Evaluating the appetite is also important as it is sometimes noted that painful animals will fall off feed. Observing the animal’s demeanor can also be a good indicator of the animal’s pain level because animals experiencing pain are likely to become withdrawn and dull and sometimes appear irritable. Every animal is different though, and sometimes the animals will show signs of significant pain without an increased heart rate or going off feed. Tracking with consistency is a big component in accurate pain assessment, and the paperwork used should be easy to understand and well-defined. If at all possible, the same personnel should be responsible to tracking an animal’s progress. Some more specific pain assessment areas evaluated in the orthopedic or laminitis case include location in stall, head and ear position, digital pulses, recumbence, as well as subtle indicators like the shifting of weight or hoof lifts per minute. Even though these are geared towards horses, they can still be used with small animal patients and used to track movement and overall demeanor. Metrics are used as a way to track measurable data, and this includes heart rate and respiratory rate. These metrics can be used to track comfort level over time and also the animal’s response to analgesia. Blood pressure has also been used as a measurable metric in many cases but may not be the best or easiest metric to use due to variables such as movement. Tracking metrics, as well as other observations, on a chart or spreadsheet is often helpful when comparing data over a span of days and looking for trends. Recumbency and location in the stall or cage, as well as overall demeanor are good assessments to monitor. Horses, for example, tend to be creatures of habit; any change in their routine could indicate that something is wrong. The same rule applies to behavior, as horses tend to keep a fairly consistent temperament. An average horse should be standing much more than lying down and is less likely to spend much of the time down in lateral recumbency. Horses are more likely to sit sternal, and be facing the front of the stall. Usually painful animals are found lying lateral, facing a back wall or corner. Horses should
also have an alert demeanor, and found to be taking in their surroundings. Horses should have their head up when just standing, should be moving their ears, and be bright, alert, and responsive. Horses experiencing signs of pain are likely to have a lowered head carriage, still ears, as well as a dull or disinterested demeanor. Horses may also become manic with pain and appear aggressive or mad, or just the opposite and appear sedate. With orthopedic or laminitis cases especially, it is important to know if they are favoring a limb, especially one opposite the limb in treatment. Some ways to track if they are favoring a limb include measuring the number of hoof lifts or weight shifts per minute. Hoof shifts can be a very subtle and even early detection that there is a problem. By palpating digital pulses, you can also detect problems with a specific limb(s). It is once again important to review the assessment along with analgesic treatment, because it may aid in letting you know if the analgesic support is appropriate. It is also important to note any procedures that were performed. These procedures vary from farrier treatments, to bandage or cast changes, to repeat surgical procedures under anesthesia. Appetite can also be a useful tool in assessing pain, as animals that are painful are less likely to eat as readily as those who are comfortable. On average, a horse will eat all of the concentrate feed that it is offered in about 15-30 minutes, and should eat hay steadily throughout the day. A change in appetite can be seen regarding both concentrate and hay meals. With small animals, appetite can also be easily assessed using both meals and treats offered throughout the day. The Modified Obel Lameness Score can also be used as an evaluation tool, and focuses on how the animal moves around the stall. The Modified Obel looks at willingness of the animal to move around the stall, it’s willingness to stand if recumbent, as well as the willingness to lift feet. A normal horse should rise when asked, pick up all four feet when asked, and be willing to move around the stall, even in a circle. A painful horse may be reluctant to stand, even with significant coaxing, may not be willing to be led around the stall, and may be reluctant to pick up the opposing foot of the painful limb, as to not want to bear more weight on a compromised limb. You may also use a scale of 1-10 to evaluate the overall visual assessment based on the data collected.
keystone veterinarian
continued on page 32
VOLUME II 2012
19
7/17/2012 4:45:42 PM
Euthanize Them? Keep Them?
The Ongoing Debate Over Feral Cats By Bryan Langlois, DVM, Medical Director of the Humane League of Lancaster County, Lancaster, Pennsylvania
PART 1 OF A 2-PART SERIES:
P
ests. Nuisances. Sweet kitties. Strays. “Nonnative” species. For every person one asks about feral cats, they get a different response. No one knows exactly how to classify them or how to effectively deal with the problem. When I was asked to write about this topic, I figured it would be an easy task. 45 minutes of staring at blank screen later trying to figure out exactly how to attack it, I realized just how much of a hot button and passionate issue this is for both the public and veterinarians alike. After looking over some current research and opinion on the subject (including conversing with a classmate of mine who works in wildlife management and medicine), it has become clear to me the issue is just as mind-boggling as it was when we first began to attack the problem. One thing I think everyone can agree on is that there is no simple answer to the problem of feral cats. I also have found there are two set camps that oppose each other on the issue. The first are conservationists who are pointing to study after study to claim how wildlife is being decimated because of feral cats. The other group is those in the animal welfare/animal rights camp that work more from anecdotal evidence as well as their own studies to say
20
VOLUME II 2012
12_Volume_2.indd 20
keystone veterinarian
killing is not the answer. I think the truth lies somewhere in between the two. Oddly enough, you will find groups that you think are on one side actually supporting the other. For example, PETA is pro-euthanasia of feral cats and against trap/neuter/release (TNR) claiming cats should not suffer outdoors at all. Some wildlife scientists who are concerned about the effect of the cats on native species actually feed feral cat colonies. The other issue is that when proponents or opponents of the feral cat issues talk about their findings, they talk about both true feral cats and cats that are allowed to roam free by their owners as one entity when describing the effects on wildlife, bird populations, or TNR. I’m not sure there is a true way to separate these groups, but there is a difference between a feral and a stray. So, what exactly is a feral cat? This, too, sometimes leads to debate and disagreement. I personally like to consider a feral cat as one that is non-domesticated. That clears everything up, doesn’t it? A feral cat is one that both has no owner and is not habituated to humans. So, is a barn cat feral? Maybe. Is a stray cat a feral? Could be. Can a stray cat then become a feral cat? Possibly. Can a feral cat be tamed down and adopted? Potentially. Are kittens born to stray cats that never see humans feral? To me, yes. It all depends on how one looks at it. Some will point the blame for current feral cat numbers to irresponsible
WWW.PAVMA.ORG
7/17/2012 4:45:43 PM
owners who dump intact cats on the street to reproduce. I do believe there is an element of this but not as much as some people make it out to be when talking about true “feral cats.” So how did the feral cat even come to be? The answer lies in the species we like to refer to as Homo sapiens. Cats have been around for centuries from the days of the desert cats in Africa. About 10,000 years ago, they actually “domesticated themselves” when they began congregating in the areas that humans began setting up as farms. The grain the humans grew and stored attracted rodents that basically gave the cats a nice reliable food supply. From that point on, cats just “hung around” us enjoying the reliable food supply, either through thrown away scraps or people actually feeding them. The idea of the indoor only cat really only came to be around the 1940’s with the introduction of the cat litter pan. With feral cats being such a hot button issue in today’s world, I feel it is important for veterinarians and their staff to be informed about them and the concerns out there. They should also be informed as to how to properly work with ferals in a spay/neuter clinic setting. Admittedly, being one who is a proponent of TNR, I will attempt to give an unbiased overview of this very complex problem and the solutions that exist out there. Perhaps the biggest issue facing feral cats in today’s world is they do not fall under any jurisdiction in the laws of most states or municipalities. As such, when people turn to government for answers, the answer usually is “they are not covered under any statute, so they are not our problem. Contact your local humane society.” Humane societies would have no choice but to just euthanize these cats, since they cannot be tamed for adoption (with few exceptions, most notably kittens in the proper socialization period and some stray/abandoned cats that wander into an area). This is contrary to the mission of most humane societies who are striving to reduce their euthanasia numbers, and—as such—refuse to take in feral cats solely for the purpose of euthanizing them. In today’s economic climate, I would not be counting on the government to be stepping up to the plate any time soon. In Pennsylvania, the Game Commission has really backed away from the whole issue. The only rule they will enforce is that cats are not to be turned loose on state game lands, and they will prosecute for this offense. Some cities or municipalities
WWW.PAVMA.ORG
12_Volume_2.indd 21
Perhaps the biggest issue facing feral cats in today’s world is they do not fall under any jurisdiction in the laws of most states or municipalities. have their own ordinances in place regarding the feeding of feral cats or caring for them. Some outright ban the practice of feeding any outdoor cats. Some will only enforce ordinances if neighbors complain about a nuisance being created by the cats. It is important to know what the rules are in your area before embarking on any program dealing with feral cats. Some say that having feral colonies around promotes the dumping of unwanted cats in those areas by owners who can’t keep or don’t want them and feel they are doing the next best thing by dumping them there rather than just anywhere. I think this is true, however the only solution to that problem is better surveillance and potential prosecution of offenders. Again, finances play a role in how feasible these solutions are, and increased enforcement may only lead to people finding a new place to dump the cats. That now leaves the issue of what to do with all the ferals. The options out there have basically been boiled down to three main ones. The first is mass round-ups and euthanasia. The second is trap and relocate. The third is trap/neuter/ return (TNR). Each has their proponents and opponents as well as their pros and cons. Before looking deeper into how to deal with ferals in an ethical and responsible manner, let’s look briefly at why feral cats are around peoples' homes in the first place. The answer to that question can be summed up in one word: food! Just like the way to man’s heart is through his stomach, the same is true of a feral cat. When people ask me or the Humane League that question, the answer is always the same: someone is providing them a food source. Feral cats are not stupid. They are not going to repeatedly hang out in a location hoping to get fed. They are hunters and are going to seek out food. Often this means a neighbor on the block is providing food or there is a dumpster or other food source nearby. Take away the food source and the cats will go away. Not always so easy though, since we don’t want things turning into the Hatfields and the McCoys out there over who is feeding and not feeding feral cats. In addition, some feral cats and feral cat colonies can have a large territorial range. This means the food source could be a few blocks away. This is not common though since the cats are going to remain relatively close to where the food source and decent shelter is.
Ok, eradication. That will work. Just make sure someone can supply about 300 million cc’s of euthanasia solution, 150 million cat traps, and a location where you can properly dispose of about one billion pounds of carcasses that are now technically a biohazard because they have a deadly chemical inside them. I will be honest, eradication would work if you could form a force of people and traps large enough to trap and euthanize every cat in a large enough area. However, just looking at those basic numbers, it is not practical or possible in the real world. This is the answer wildlife conservationists are clamoring for, however, I am not sure how many are willing to go out and perform this task over and over again, day after day to do it the proper way to ensure every cat in an area is gone. It would take its toll on any veterinarian or other official certified in humane euthanasia. Trapping and killing in any other way (ie: gassing, drowning, poisoning, or shooting) is not ethical and should never be endorsed by a veterinarian in my opinion. In addition, it has been proven that if you don’t do eradication completely it simply leads to the “vacuum effect.” Basically, if you take all the cats out of an area by eradicating them, more cats will just inhabit the area now that there is room and food. If the food source is still there, even more will show up. Finding and trapping every cat in an area is also basically impossible, and if you miss even one or two, in a few months you might be back to square one. So while there are those out there that say “just kill them,” you can see how that is not feasible. Some people claim the “vacuum effect” is just a myth created by animal welfare proponents and cat lovers. They say that even with stable colonies through TNR, the cat numbers increase as well. I agree some studies do show that, but it is a small increase. I don’t think the data is really conclusive when you look at all the variables of the issue, such as people then dumping new cats in the area or other strays finding their way into the colony. Those numbers also need to be compared to the number of new cats and kittens in that same area had they not been altered. I have personally seen the “vacuum” effect demonstrated though in colonies that we had to eradicate because of FeLV/FIV infections. Within a year the numbers of the colony were back to previous levels.
keystone veterinarian
continued on page 37
VOLUME II 2012
21
7/17/2012 4:45:43 PM
6th Keystone Veterinary Conference
August 16-19, 2012 Hershey Lodge, Hershey, PA
26
HOURS OF APPROVED CONTINUING EDUCATION
Faculty
Toxicology: • Tina Wismer, DVM, DABVT, DABT
COMPANION ANIMAL
Anesthesia: • Ann Weil, DVM, MS, DACVA
Internal Medicine: • Richard B. Ford, DVM, MS, DACVIM, DACVPM (Hon) SPONSORED BY • Dennis Chew, DVM, DACVIM
Emergency/Critical Care: • Claire R. Sharp, DVM, BVMS, DACVECC • Elizabeth Rozanski, DVM, DACVIM, DACVECC
Calf Scours and BVD: • Belinda Thompson, DVM Creating a Sucessful Practice: • Charles Gardner, DVM
EXOTICS
SPONSORED BY
Nutrition: • Lisa P. Weeth, DVM, DACVN
Small Mammal: • Jeffrey L. Rhody, DVM
• Debra L. Zoran, DVM, PhD, DACVIM-SAIM • Daniel Joffee, DVM, DABVP
SPONSORED BY
PRACTICE MANAGEMENT
SPONSORED BY
VETERINARY TECHNICIAN
Practice Management Topics: • Denise L. Tumblin, CPA
Ophthalmology: • Rachel Allbaugh, DVM, MS, DACVO
Surgical Patient Management: • Danielle Browning, LVMT
Effective Communication: • Bash Halow, BA, CVPM, LVT
Integrative Medicine: • Narda Robinson, DO, DVM, MS, FAAMA • Shelley R. Epstein, VMD • Michelle Tilghman, DVM, CVA, CCRP
Emergencies and Anesthesia: • Alison Gottleib, BS, CVT, VTS (ECC)
Endocrinology: • Duncan C. Ferguson, VMD, PhD, DACVIM, DACVCP
Purchase Examinations and Lameness: • William Moyer, DVM, ACVSMR
Drug Testing in Equine Athletes: • Lawrence R. Soma, VMD, DACVA
SPONSORED BY Cardiology: • Andrea C. Lantis, DVM, DACVIM (Cardiology)
BOVINE
Neurology: • Richard A. LeCouteur, BVSc, PhD, DACVIM (Neurology), DECVN VOLUME II 2012
12_Volume_2.indd 22
EQUINE Integrative Medicine: • Narda Robinson, DO, DVM, MS, FAAMA
Senior Care: • Peter Kintzer, DVM, DACVIM
22
Soft Tissue Surgery: • Howard B. Seim, III, DVM, DACVS
Improving Dairy Herd Reproductive Performance: • Darren Remsburg, DVM
Field Necropsy and Diseases: • Daniel Scruggs, DVM, DACVP SPONSORED BY
keystone veterinarian
INTERNET MARKETING AND SOCIAL MEDIA WORKSHOP • Bash Halow, BA, CVPM, LVT • Brie Messier, MBA • Brenda Tassava, CVPM, CVJ • Phillip Barnes
ANIMAL WELFARE/SHELTER MEDICINE • Cathy Anderson, DVM • Philip Bushby, DVM, DACVS • Bryan Langlois, DVM • David McRuer, DVM, MSc • Michael Moyer, VMD
WWW.PAVMA.ORG
7/17/2012 4:45:45 PM
Registration Hours Thursday, August 16—8:00am–4:30pm Saturday, August 18—7:00am–4:00pm
Friday, August 17—7:00am–4:00pm Sunday, August 19—8:00–10:00am
FULL INFORMATION AND REGISTRATION FOR KEYSTONE VETERINARY CONFERENCE IS AVAILABLE ONLINE AT WWW.KEYSTONEVETCONFERENCE.ORG.
Want to Earn Some Cash? If you are willing to moderate sessions during KVC you could earn up to $100 each day! Moderating includes arriving at the session room 20 minutes prior to the start time, introducing the speaker, reading announcements, and staying for the duration of the sessions to address concerns with lighting, audio-visual, etc. You will be sent a moderator packet prior to the conference which outlines your duties and provides all supporting information. Please check the appropriate box on the registration form if you would like to take advantage of this opportunity. If you moderate a half-day session (3-4 hours), you will receive a $50 refund; if you moderate a full-day session (5+ hours) you will receive a $100 refund. Your check will be mailed to you following the conference.
More CE For Your Money! Did you know that the Keystone Veterinary Conference offers over 168 hours of continuing education credit to choose from and each attendee can earn up to a total of 26 hours of CE credit? However, you must attend all offerings (ie: Lunch and Learn and Lunch With the Expert). If you register for individual days, the CE hours are as follows: Thursday—6 hours ... Friday—6 hours Saturday—6 hours ... Sunday—6 hours This program offers veterinarians and veterinary technicians licensed in Pennsylvania a total of 26 hours of approved CE by the Pennsylvania Veterinary Medical Association. Please note that the Pennsylvania State Board of Veterinary Medicine does not recognize practice management courses for CE eligibility. This course has been submitted for 26 hours of continuing education credit for veterinarians and technicians in jurisdictions that recognize AAVSB’s RACE approval.
Online Conference Proceedings Conference proceedings will be made available online to all registrants. Registrants will receive a password with their confirmation email enabling them to access lecture handouts on the conference website, www.keystonevetconference.org. Attendees are encouraged to print the handouts for the lectures they plan to attend and bring them along to the meeting. Limited quantities of printed proceedings will be available onsite for a fee of $40 per copy. If you would like to pre-order a copy of the printed proceedings, please check the appropriate box on the registration form. You will be guaranteed a copy, and it may be picked up onsite when you arrive at the meeting.
Visit the following websites for more information: www.hersheypa.com www.padutchcountry.com www.experiencepa.com WWW.PAVMA.ORG
12_Volume_2.indd 23
What Makes Hershey Fun?!
The Hershey area offers a wide range of entertainment and recreational activities. You may visit www.hersheypa.com to find out what awaits you during your visit. While you are in the area, check out: Hersheypark (featuring the Boardwalk Water Park with two new attractions—a lazy river and wave pool), The Hershey Story Museum, Zoo America, The Chocolate Spa at The Hotel Hershey, Hershey’s Chocolate World, Hershey Gardens, and much more!
Special Offerings During the 6 Keystone Veterinary Conference th
THURSDAY Lunch and Learn: Dr. Daniel Joffee—1 extra hour CE credit Animal Welfare Forum: Raining Cats and Dogs–Working Together to Overcome Pet Overpopulation
FRIDAY Penn Vet Alumni Reception Hall of Fame Dinner
SATURDAY Junior Hall of Fame Breakfast Healthcare Reform Breakfast New Member Luncheon Healthcare 101 Lunch Forum PVF Appreciation Luncheon PVMA Annual Membership Meeting PVTA Annual Membership Meeting Practice Managers Roundtable Luncheon
SUNDAY Lunch With the Expert: Dr. Richard Ford—1 extra hour CE credit Social Media For the Veterinary Professional Workshop
keystone veterinarian
VOLUME II 2012
23
7/17/2012 4:45:46 PM
Meeting at a glance Thursday, August 16, 2012
Friday, August 17, 2012
8:00–9:00am Continental Breakfast 8:00am–4:30pm Registration 12:15–1:45pm Lunch & Learn with Dr. Daniel Joffe
7:00–8:00am Contintental Breakfast in the Marketplace 7:00am–4:00pm Registration 8:00–9:30am Corporate Partner Appreciation Breakfast 9:00am–5:00pm PVF Silent Auction 12:00–1:30pm Friends of PVF Appreciation Luncheon 5:30–6:30pm Penn Vet Alumni Reception 6:30–9:00pm PVMA Hall of Fame Dinner
SPONSORED BY
5:00–6:30pm Exhibitor Appreciation Reception in the Marketplace 8:00–10:oopm ZooAmerica After Dark 9:00–5:00pm Animal Welfare Forum: Raining Cats and Dogs—Working Together to Overcome Pet Overpopulation
THURSDAY SCHEDULE 8:00–9:00am Continental Breakfast 9:00–9:55am Session 1 10:05–11:00am Session 2 11:15am–12:10pm Session 3 12:15am–1:45pm Lunch 1:45–2:40pm Session 4 2:50–3:45pm Session 5 3:55–4:50pm Session 6 5:00–6:30pm Reception in Marketplace
FRIDAY SCHEDULE 7:00–8:00am 7:00–8:00am 8:00–8:55am 8:00–8:55am 9:05–10:00am 9:05–10:00am 10:00–11:00am 10:00–11:00am 11:00–11:55am 11:00–11:55am 11:55am–1:30pm 11:55am–1:30pm 1:30–2:25pm 1:30–2:25pm 2:35–3:30pm 2:35–3:30pm 3:30–4:15pm 3:30–4:05pm 4:15–5:10pm 4:05–5:00pm
Continental Breakfast Continental Breakfast Session Session 1 1 Session Session 2 2 Break in Marketplace Break in Marketplace Session Session 3 3 Lunch/Visit Marketplace Lunch/Visit Marketplace Session Session 4 4 Session Session 5 5 Break in Marketplace Break in Marketplace Session Session 6 6
Friday, August 17, 2012
SMALL ANIMAL NUTRITION
SMALL ANIMAL CLINICAL PHARMACOLOGY
SMALL ANIMAL SURGERY EXOTICS
Evidence-Based Therapy: Truth or Consequences? FERGUSON
Managing Canine Cystic and Urethral Calculi SEIM
What’s Up Doc? Rabbit Medicine 101 RHODY
SESSION 2 Hyperlipidemia to Pancreatitis: When Good Fat Goes Bad WEETH
Update on Endocrine Therapies FERGUSON
Managing Feline Cystic and Urethral Calculi SEIM
Go With Your Gut: An Insider’s Look at the Rabbit GI Tract RHODY
SESSION 3 Dietary Management of Intestinal Diseases WEETH
Therapeutic Drug Monitoring: Why Do It? FERGUSON
Surgical Management of Abdominal Trauma SEIM
Which Way Is Up, Doc? Vestibular Disease in the Rabbit RHODY
SESSION 4 Current Concepts in Uroliths Prevention WEETH
Rational Glucocorticoid Therapy in Small Animal Practice FERGUSON
The 20-Minute Gastropexy and the 3-Ligature Splenectomy SEIM
Sex and the Spayed Ferret and Weak Weasels: Ferret Adrenal Gland Disease and Insulinomas—Part 1 RHODY
SESSION 5 Osteoarthritis: New Treatments for Old Joints WEETH
Current Anti-Inflammatory Therapies FERGUSON
Intestinal Anastomosis: Tips to Make It Easier SEIM
Sex and the Spayed Ferret and Weak Weasels: Ferret Adrenal Gland Disease and Insulinomas—Part 2 RHODY
SESSION 6 Supplements for Health and Disease: What to Keep on the Shelf WEETH
Clinical Pharmacology Case Study: Putting Principle Into Practrice FERGUSON
SESSION 1
Pet Food Facts and Fiction: Commercial and Home-Prepared Diets WEETH
SPONSORED BY
24
VOLUME II 2012
12_Volume_2.indd 24
keystone veterinarian
Putting Things in Order Rodentia: A Look at Histrichmorphs (Guinea Pigs, Chinchillas) and Myomorphs (Rats, Mice, Hamsters, Gerbils) RHODY
WWW.PAVMA.ORG
7/17/2012 4:45:48 PM
Thursday, August 16, 2012
SMALL ANIMAL INTERNAL MEDICINE
Thursday, August 16, 2012—Animal Welfare Forum Raining Cats and Dogs—Working Together to Overcome Pet Overpopulation
SMALL ANIMAL SENIOR CARE
SMALL ANIMAL CARDIOLOGY
SMALL ANIMAL OPHTHALMOLOGY
INTEGRATIVE MEDICINE
Chronic Kidney Disease (CKD): Diagnosis and Initial Management CHEW
Diagnosing and Managing the Complicated Senior Patient— Part 1 KINTZER
The Coughing Dog With a Murmur LANTIS
Don’t Do This at Home ALLBAUGH
Introduction to Veterinary Homeopathy with Clinical Applications—Part 1 EPSTEIN
SESSION 2 Chronic Kidney Disease (CKD): Further Management CHEW
Diagnosing and Managing the Complicated Senior Patient— Part 2 KINTZER
Management of Asymptomatic Mitral Valve Regurgitation LANTIS
Management of Common Orbital Diseases ALLBAUGH
Introduction to Veterinary Homeopathy with Clinical Applications—Part 2 EPSTEIN
SESSION 3
Case-Based Internal Medicine Update For Practitioners— Part 1 KINTZER
Diagnostic Approach to Subclinical Feline Heart Disease LANTIS
Management of Common Adnexal Diseases ALLBAUGH
Introduction to Veterinary Homeopathy with Clinical Applications—Part 3 EPSTEIN
SESSION 1
Idiopathic/Interstitial Cystitis in Cats (FIC): Diagnosis and Management CHEW
11:00am–1:30pm
When Less is Best: Lowest Effective Dosing-Optimizing NSAID Protocols and Client Compliance
SESSION 4 Idiopathic/Interstitial Cystitis in Cats (FIC): Further Management CHEW
Case-Based Internal Medicine Update For Practitioners— Part 2 KINTZER
Management of Congestive Heart Failure in Cats LANTIS
Management of Common Corneal Problems ALLBAUGH
SESSION 5 Treatment of Routine and Recurrent Urinary Tract Infections CHEW
Diagnosing the ADR Patient— What Might You Be Missing— Part 1 KINTZER
What is NT-proBNP and How Do I Use It? LANTIS
Management of Common Intraocular Problems ALLBAUGH
SESSION 6 Hypercalcemia in Dogs and Cats: Diagnosis and Management CHEW
Diagnosing the ADR Patient— What Might You Be Missing— Part 2 KINTZER
What Should I Use Pimobendan? LANTIS
Management of Common Feline Ophthalmic Issues ALLBAUGH
SPONSORED BY
5:00–6:30pm
EQUINE
JOFFE Introduction to Veterinary Homeopathy with Clinical Applications—Part 4 EPSTEIN
Current Issues in Veterinary Medicine
SPONSORED BY Exhibitor Appreciation Reception in Marketplace
BOVINE
PRACTICE MANAGEMENT
INTEGRATIVE MEDICINE
VETERINARY TECHNICIAN
Avoiding Risk in Prepurchase Examination—Part 1 MOYER
Field Necropsy: What Practicing Veterinarians Need to Know to Achieve the Best Results SCRUGGS
Six Strategies to Protect Your Practice TUMBLIN
The Science and Evidence of Acupuncture ROBINSON
Anesthesia 3 Steps – Part 1 GOTTLEIB
Avoiding Risk in Prepurchase Examination—Part 2 MOYER
Leptospriosis and Hardjo-bovis: The Disease and Deciphering the Diagnostics SCRUGGS
Financial and Accouting Essentials for Practice Managers TUMBLIN
The Science and Evidence of Manual Therapy ROBINSON
Anesthesia 3 Steps – Part 2 GOTTLEIB
Examination of Interpretation of BVD: The Disease, UnderstandFoot Problems in Horses—Part 1 ing the Diagnostic Tests and Prevention MOYER SCRUGGS
Matching Patient Care With the Client’s Pocketbook—Part 1 TUMBLIN
The Science and Evidence of Laser Therapy ROBINSON
Anesthetic Emergencies GOTTLEIB
Examination of Interpretation of BVD Risks in Dairy Herds: Case Foot Problems in Horses—Part 2 Examples MOYER THOMPSON
Matching Patient Care With the Client’s Pocketbook—Part 2 TUMBLIN
The Science and Evidence of Botanical Approaches ROBINSON
Common Emergencies – Part 1 GOTTLEIB
Chronic Laminitis and Commonly Occurring Foot Problems in Ambulatory Practice—Part 1 MOYER
Protecting Your Pharmacy TUMBLIN
CAVM - What Doesn’t Work and Why ROBINSON
Common Emergencies – Part 2 GOTTLEIB
CAVM - What’s Downright Dangerous ROBINSON
CPR GOTTLEIB
Neonatal Enteritis Work-Up THOMPSON
Examination of Interpretation of Neurologic Disease Work-Up Foot Problems in Horses—Part 2 THOMPSON MOYER
WWW.PAVMA.ORG
12_Volume_2.indd 25
keystone veterinarian
VOLUME II 2012
25
7/17/2012 4:45:49 PM
Meeting at a glance
Saturday, August 18, 2012
SMALL ANIMAL INTERNAL MEDICINE
SMALL ANIMAL INTERNAL MEDICINE
SMALL ANIMAL CRITICAL CARE
SMALL ANIMAL NEUROLOGY
SESSION 1
2012 Vaccines and Vaccination: The Facts vs. The Fiction—Part 1 FORD
Diagnosis and Management of Chronic Diarrhea in Cats—Part 1 ZORAN
Initial Patient Assessment SHARP
Basics of Neuromuscular Diseases LECOUTEUR
SESSION 2
2012 Vaccines and Vaccination: The Facts vs. The Fiction—Part 2 FORD
Diagnosis and Management of Chronic Diarrhea in Cats—Part 2 ZORAN
Fluid Therapy ROZANSKI
Spinal Cord Disorders of Small Breed Dogs LECOUTEUR
SESSION 3
2012 Vaccines and Vaccination: The Facts vs. The Fiction—Part 3 FORD
Chronic Weight Loss in Old Cats ZORAN
Surgical Emergencies: Tips for Success SHARP
Brain and Spinal Cord Trauma LECOUTEUR
SESSION 4
Infectious Disease Update FORD
The Long Term Diabetic: Managing the Ups and Downs—Part 1 ZORAN
Thoracic Trauma ROZANSKI
Inflammatory Brain Diseases LECOUTEUR
SESSION 5
Chronic Cough in the Dog FORD
The Long Term Diabetic: Managing the Ups and Downs—Part 2 ZORAN
Abdominal Trauma SHARP
Seizures and Epilepsy LECOUTEUR
SESSION 6
Feline Viral Upper Respiratory Disease: Why It Persists FORD
Chronic Recurrent Constipation ZORAN
GDV: What Is New? ROZANSKI
What to Do When Phenobarbital Fails LECOUTEUR
SPONSORED BY
SATURDAY SCHEDULE Saturday, August 17, 2012 7:00–8:00am Continental Breakfast in the Marketplace 7:00–8:00am Christian Veterinary Mission Breakfast 7:00am–4:00pm Registration 8:30–10:30am Junior Hall of Fame Breakfast 9:00am–2:00pm PVF Silent Auction 12:00–1:00pm PVMA New Member Lunch 1:00–3:00pm PVTA Board of Directors Meeting 3:00–4:00pm PVMA Annual Business Meeting 3:00–4:00pm PVTA Annual Membership Meeting 3:30–430pm Kids’ Cookie Decorating 4:15pm PVF Silent Auction Winners Announced 4:15–5:30pm Silent Auction Items Picked Up
Sunday, August 19, 2012 7:30–8:30am Continental Breakfast 8:00–10:00am Registration 11:45am–12:45pm Lunch 11:45am–12:45pm Lunch With the Expert—Dr. Richard Ford 3:45pm Keystone Veterinary Conference Adjourns
26
VOLUME II 2012
12_Volume_2.indd 26
keystone veterinarian
7:00–8:00am 8:00–8:55am 9:05–10:00am 10:00–10:45am 10:45–11:40am 11:40am–1:00pm 1:00–1:55pm 2:00–2:55pm 3:00–4:00pm 4:05–5:00pm
Continental Breakfast Session 1 Session 2 Break/Visit Marketplace Session 3 Lunch/Visit Marketplace Session 4 Session 5 Refreshment Break, PVMA Annual Business Meeting, and PVTA Annual Membership Meeting Session 6
SUNDAY SCHEDULE 7:30–8:30am 8:30–9:25am 9:35–10:30am 10:45–11:40am 11:45am–12:45pm 12:45–1:40pm 1:50–2:45pm 2:50–3:45pm
Continental Breakfast Session 1 Session 2 Session 3 Lunch Session 4 Session 5 Session 6
WWW.PAVMA.ORG
7/17/2012 4:45:50 PM
EQUINE
BOVINE
PRACTICE MANAGEMENT
VETERINARY TECHNICIAN
INTEGRATIVE MEDICINE
Acupuncture for Equine Back Pain ROBINSON
Creating the Successful Practice GARDNER
Effective Communication HALOW
PSS: Portosystemic Shunts BROWNING
Acupuncture: What’s the Point—Part 1 TILGHMAN
Large Animal Reproductive Issues and Acupuncture ROBINSON
Getting Your Staff on Board GARDNER
Reducing Intra-Office Bickering and Conflict HALOW
The Technician’s Role in Upper Airway Disease BROWNING
Acupuncture: What’s the Point—Part 2 TILGHMAN
Equine Chiropractic—What Does Research Tell Us? ROBINSON
Providing Value and Getting Paid GARDNER
Resolving the Front vs. Back Problem HALOW
Collapsing Trachea: When and How to Intervene BROWNING
The Trigger Point TILGHMAN
Advances in Drug Testing and the Pharmacology and Elimination of Therapeutic Drugs in the Horse—Part 1 SOMA
Improving Reproductive Performance of Your Dairy Herds—Part 1 REMSBURG
Don’t Do As I Do, Do As I Say and 9 Other Disasterous Management Practices HALOW
Aseptic Technique for the Surgical Patient BROWNING
The Longitudinal Muscle— Part 1 TILGHMAN
Advances in Drug Testing and the Pharmacology and Elimination of Therapeutic Drugs in the Horse—Part 2 SOMA
Improving Reproductive Performance of Your Dairy Herds—Part 2 REMSBURG
Standard of Care—Part 1 HALOW
Basic Wound Management BROWINING
The Longitudinal Muscle— Part 2 TILGHMAN
Advances in Drug Testing and the Pharmacology and Elimination of Therapeutic Drugs in the Horse—Part 3 SOMA
Utilizing Technicians in Bovine Practice: A New Opportunity? REMSBURG
Standard of Care—Part 2 HALOW
Bandages, Dressings, and Drains BROWNING
The Longitudinal Muscle— Part 3 TILGHMAN
Sunday, August 19, 2012
SMALL ANIMAL CRITICAL CARE
SESSION 1
Traumatic Head and Brain Injury SHARP
SMALL ANIMAL SMALL ANIMAL ANESTHESIOLOGY TOXICOLOGY Anesthesia for Patients Decontamination of with Cardiac Disease the Poisoned Patient WEIL WISMER
SESSION 2
Feline Respiratory Distress ROZANSKI
Anesthesia for the Emergency Patient WEIL
SESSION 3
Top Ten Tips for Surviving Sepsis SHARP
SESSION 4
PRACTICE MANAGEMENT
INTEGRATIVE MEDICINE
VETERINARY TECHNICIAN
Social Media For the Keeping Dogs Young— Veterinary Professional Part 1 Workshop—Part 1 TILGHMAN HALOW, TASSAVA, MESSIER, BARNES
Zoonoses … How Real the Threat? FORD
Why So Agitated? Nervous System Stimulants WISMER
Social Media For the Keeping Dogs Young— Veterinary Professional Part 2 Workshop—Part 2 TILGHMAN HALOW, TASSAVA, MESSIER, BARNES
Zoonoses … How Real the Threat? (cont’d) and Small Animal Vaccines and Vaccinations FORD
Anesthesia and Respiratory Complications WEIL
Why So Depressed? Nervous System Depressants WISMER
Keeping Dogs Young— Social Media For the Veterinary Professional Part 3 TILGHMAN Workshop—Part 3 HALOW, TASSAVA, MESSIER, BARNES
Small Animal Vaccines and Vaccinations (cont’d) FORD
Practical Approach to Anemia ROZANSKI
Anesthesia for Cesarean Section and Neonatal Resuscitation WEIL
Why So Yellow? Liver Toxicants WISMER
Social Media For the Veterinary Professional Workshop—Part 4 HALOW, TASSAVA, MESSIER, BARNES
SESSION 5
Infectious Disease SHARP
Perioperative Use of Dexmedetomidine WEIL
Why No Pee? Renal Toxicants WISMER
Social Media For the Veterinary Professional Workshop—Part 5 HALOW, TASSAVA, MESSIER, BARNES
SESSION 6
Transfusion Therapy ROZANSKI
Cat Anesthesia and Why So Blue? Cardiac Analgesia: What’s New? and Respiratory WEIL Toxicants WISMER
WWW.PAVMA.ORG
12_Volume_2.indd 27
Social Media For the Veterinary Professional Workshop—Part 6 HALOW, TASSAVA, MESSIER, BARNES keystone veterinarian
VOLUME II 2012
27
7/17/2012 4:45:50 PM
penn vet news
Congratulations to the 2012 Class of the University of Pennsylvania, School of Veterinary Medicine!
Allison Brooke Adams Lauren Ashley Aldinger Ellison Dee Aldrich Edward Lee Aller Matthew Morris Arkans Stephanie Jane Arrison Maral Avetian Julie Ann Balko Curtis Ray Beidel Ellen Antoun Bishai Richard Gregory Bogle Caitlin Elizabeth Botes
Natalie Marie Fickel Monique Marcella Garcia Amy Lotring Gates Shana Ella Gilbert-Gregory Zachary Creighton Glantz Elinor May Grassie Jose Luis Guevara Lauren Anne Hakkinen Andrea Lauren Halko Ian Sean Hannigan Nathan Dale Helgert Meredith Erin Henry Hillary Anastasia Herendeen Joanelle Hernández López Tamara Jenise Herron
Olivia Lorello Joanna Ruth Marlow Parr Alice Flanders McCormick Erin Elizabeth McGowan Kerry Elizabeth McLaughlin Emily Susan Frost McNally Danielle Erica Mendelsohn Dennis Eric Michels Alex Matthew Miller Megan Anne Minchin John P. Moscony III Dana Schwab Mosher Elizabeth Anne Mutter Metcalf Smita D. Namjoshi Takumu Niino
Kathleen Aine Spillane Natalie Marie Stabenow Holly Lynn Stewart Erin Caroline Stough Erika Kathryn Sweigard Michael James Takacs Rachel Schwartz Thornton Megan Angela Tiffany Katherine Mary Todd Christopher John Torre Laura Elizabeth Tracy Bradley James Turek John Oliver Tuttle Ersin Michael Ulke Jonathan Robert Van Blarcom
Gillian Carlé Braden-Weiss Dara Brown Jacob Michael Brown Breanna Marie Caltagarone Sarah Anne Cannizzo Yoon Suk Chay Curt Anthony Ciarleglio, Jr. Hope Aynne Coleman Rebecca Ann Csomos Abigail Donahue Lizette Olga Durand Michele Lauren Edelmann Rebecca Lynn Ehrlich Victoria Renee Eiss Paul William Eppes Michelle Lynn Erney Mahmoud Yasser Esmail
Kelsey Ruth Hilton Audrey Joy Hitz Daniel Paul Hoffman Susan Lynn Ivy Ashley Megan Johnson Megan Nicole Jones Courtney Lea Katsur Amanda Ashley Kilby Catrina E. King Lauren Nicole Klutchka Rachael Elizabeth Kreisler Carine Meredith Laporte Travis Laver Fiona Frances Lee Jessica Wen-Chi Lee Sarah Christine Lehman Jennifer Kate Keown Linton
Nathanael Allen Oster Matthew Carl Ottoson Karuna Patil Laura Rae Proietto Ilan Guy Rachleff Gregory D. Rak Angel Israel Ramos Torres Virginia Ellen Reed Yolanda Jose Revilla Danielle Lori Rutherford Barri Nicole Sarowitz Jenna Marie Scibilia Eileen Carol Seage Victoria Shekk Spencer Stephen Shelly Michael George Sheruda Amelia Claire Sinkin
Lauren Ann Vierheilig Jennifer Vlasaty Alvarez Karie Lynn Walton Sarah Emily Ward Bridgette Wells Jacqueline Alexandra Wilhelmy Schuyler Legendre Winstead Allison Mary Wolosz Jonathan Harold Wood Michelle Kathryn Wood Rebecca Erin Wood Kathryn Briggs Wulster Kathryn Elizabeth Wyckoff Yao Yao Angela Marie Youello Sarah Marie Young Zosia Emma Zawacki l
PVMA wishes sincere congratulations to Pennsylvania's newest veterinarians—the class of 2012!
and where news stories speed around the internet, this specialty could benefit veterinarians.
Observations continued from page 6
Welfare. The American College of Animal Welfare is in the process of applying to be recognized as a speciality by the AVMA. Their mission is to, “advance animal welfare through education, certification, and scientific investigation.” They will be responsible for educating the general public as well as general practitioners. In a world that is more aware of animal welfare issues, with urban globalization occurring
28
VOLUME II 2012
12_Volume_2.indd 28
keystone veterinarian
Veterinarians need to have answers about animal welfare issues. Our clients and the general population look to us for advice on these issues. Veterinarians need to think carefully about our opinions on animal welfare and voice our opinions. I am looking forward to further advances in this arena. l
WWW.PAVMA.ORG
7/17/2012 4:45:51 PM
Cal for
When clients ask the question “What more can
my child do to get into veterinary school?” refer them to...
The Animal Science Programs at Drexel University College of Medicine Post-Baccalaureate Pre-Professional Education
Veterinary Medical Science Program (VMS) • An intensive one-year certificate program • Designed to help students enhance their GPA and applications to veterinary school • Students take first-year medical school courses and graduate-level animal science courses
Master of Laboratory Animal Science (MLAS) • Only requires a second year of coursework and performance of a summer practicum after completion of the VMS program • A master’s degree will greatly enhance a student’s veterinary school application • Provides an alternative career option in the rewarding field of laboratory animal facility management • Many students elect to enter the MLAS program directly
Call 215-762-4692 or email medicalsciences@drexelmed.edu for more information, or visit our website: www.drexelmed.edu/ims WWW.PAVMA.ORG
12_Volume_2.indd 29
Philadelphia Health & Education Corporation d/b/a Drexel University College of Medicine is a separate not-for-profit subsidiary of Drexel University.
keystone veterinarian
VOLUME II 2012
care • community • research • teach
29
7/17/2012 4:45:51 PM
a u g i t An
2013 PVMA Winter Seminar Vacation to FEBRUARY 9-16, 2013 St. James Club Resort
About the Resort
T
he deluxe all-inclusive St. James’s Club Resort located on the Caribbean side of Antigua will be the site of the Annual Winter Seminar Vacation. A wonderful place to bring your family and friends just when the winter is coldest at home, Antigua has it all. Pristine beaches, great fishing, champion golf courses, horseback riding, nature tours, scuba diving and snorkeling, kayaking and much more. The food is delicious and you can drink the water from the tap. English is the spoken language and the natives are friendly, courteous, warm and helpful. The St. James’s Club Resort, located just a short ride from both the airport and St. John’s (the capital if Antigua) is a magnificent resort where you are free to be as active or inactive as you wish. This renowned resort hugs a private 100 acre peninsula with panoramic ocean views and has two beautiful white sand beaches flanked by either the calm Caribbean Sea or the Atlantic Ocean. The resort has four restaurants, four bars, Jacaranda Lounge, spa and beauty salon, tennis complex and pro-shop, six swimming pools, fitness center and jacuzzi, full service marina and yacht club, a kidz klub for children, laundry services, daily afternoon tea and room service. Each air-conditioned guest room has satellite TV, telephones, room safe, showers and deep soaking tubs and private terraces. The St. James’s Resort is an all-inclusive resort. Included are all meals, unlimited drinks by the glass, including liquor, Caribbean beer, tropical coolers, house wines, soft drinks, all non-motorized water sports, fitness club, tennis, award winning Kidz Club, and all resort taxes, gratuities and service charges are all included at no extra cost. Internet access, golf, fishing, motorized water sports, scuba, spa activities, horseback riding, tours, yachting and many other activities are all available at the hotel at an extra charge. A European-style gambling casino is nearby. The hotel is minutes away from the famous and picturesque Nelson’s Dockyard National Park at English Harbour. There, one can step back in time and explore the only active original Georgian dockyard in the world.
About the Seminar A total of 26 seminar hours approved through the Pennsylvania Veterinary Medical Association will be offered. The first speaker is Randall C. Thomas, DVM, DACVD. Resident in Dermatology, Department of Small Animal Clinical Sciences, University of Florida, Gainesville FL. Veterinary Dermatologist; Owner, Southeast Veterinary Dermatology and Ear Clinic, Mt. Pleasant, SC. Lectures will include new and exciting advances in Clinical Dermatology. Subject areas covered Canine Atopic Dermatitis, the Pruritic Cat, Resistant Otitis, Malassezia Dermatitis in the Dog, Recurrent Pyoderma in the Dog and Updates from World Congress of Veterinary Dermatology. The second speaker will be Andrew J. Rosenfeld, DVM, DABVP. Dr. Rosenfeld is graduate of Cornell University and the founder and president of Veterinary Team Education Courses (VTEC). Subjects covered will include Building a Wellness Program, Elements of Emergency Care Diagnostics, Evaluating Endocrine Disease, Evaluating Liver Damage and Dysfunction, Monitoring the Acute and Chronic Renal Patient and Diagnostic Evaluation of the PU/PD Canine Patient. Our third speaker is John C. Godbold, Jr., DVM. A graduate of Auburn University. Dr. Godbold has pursued a special interest in surgical and therapeutic lasers and the use of laser modalities in small animal practice. The lecture fully covers the use of Class IV therapy lasers in small animal practice. continued on page 36 30
VOLUME II 2012
12_Volume_2.indd 30
keystone veterinarian
WWW.PAVMA.ORG
7/17/2012 4:45:54 PM
PVMA 2013 Winter Seminar Vacation Registration Form FEBRUARY 9– 16, 2013 St. James Club Resort
Name
a u g i t An Email Address
Address
City
State
Home Phone
Zip
Office Phone
Fax Number
Please list any special dietary requirements
Would you like us to make your flight arrangements?
q Yes
q No
If yes, from what city?
Your credit card information will be needed in order to purchase airline tickets. q Visa
q MasterCard
Name on Credit Card
Card Number
Expiration Date
3-Digit Security Code
Billing address if different from above address
Full names of all persons (including children’s ages) in your party
Names of people attending the lectures
Passport Numbers Please make
reservations for the 8-day (7 nights) Winter Seminar Vacation to Antigua.
q Club Waterview Room
q Premium Waterview Room
q I would prefer king size bed
q Two queen size beds
q Beachfront Room
q I am enclosing a check (deposit of $750 per person) in the amount of $ made payable to: Unique Seminar Destinations. Please note on check “PVMA 2013 Winter Seminar”.
Please forward this registration form and deposit check to: Unique Seminar Destinations for the Veterinary Profession PO Box 814, Richboro, PA 18954 215.357.6820 PH; 215.357.4847 FX Email address: fandr@voicenet.com
PLEASE READ THIS AS IT LIMITS OUR RESPONSIBILITY The Pennsylvania Veterinary Medical Association (PVMA) and Unique Seminar Destinations and/or its agents act only as agents for the client in all matters pertaining to travel. They assume no responsibility nor liability in connection with the service of any train, vessel, carriage, aircraft, motor, or other conveyances which may be used, either wholly or in part, or in the performance or its duty to the passenger. Neither will it be responsible for any act, error, or omission, or any injury, loss, accident, delay, or irregularity which may be occasioned by reason of any defect in any vehicle or through the neglect or default of any company or person engaged in conveying the passenger, or for any hotel proprietor, or hotel service, or for any other person engaged in carrying out the purpose of which tickets or coupons are issued. In the event it becomes necessary or advisable for the comfort or well-being of the passengers, or for any reason whatsoever to alter the itinerary or arrangements, such alterations may be made without penalty to the operators. Additional expenses, if any, shall be borne by the passengers; conversely, refund will be made to the passenger if any savings is effected thereby. The right is reserved to withdraw any or all tours should conditions warrant, also to decline to accept or retain any passengers as members of the tour. All fares are subject to change do to space availability, fuel surcharges, tariff regulations, currency fluctuations, final itinerary, and departure taxes.
WWW.PAVMA.ORG
12_Volume_2.indd 31
keystone veterinarian
VOLUME II 2012
31
7/17/2012 4:45:56 PM
From Where I Sit continued from page 10 something cold to drink, find a nice cool spot with your computer, and give your association 20-30 minutes of your time. Only through your feedback can we meaningfully change our association and make it better. Please take the time to do it. It’s probably the single most important thing you could do for PVMA and your dues investment right now. 2) Help us recruit new members—Personally invite someone to be a member. If you are a practice owner, pay for your associates to become members. Generation X and Y members, help me recruit your colleagues. The organization is ready to be your oyster and to have you be an integral part of our success. To do that, I need to hear from you, for you to remain or become members, and for you to help us make a difference. 3) If you have not paid your dues yet for 2012, please do. I cannot stress how important this is to the future of our organization.
Retention of you as members is key to our success and it is truly an investment in you and the veterinary profession. 4) Get involved—Give us ideas, volunteer time, or serve on a committee. Believe me, I know time is precious. I am just like you and honestly don’t know how to juggle everything at times. However, we can all give something back—provide an idea, share a concern, come to an event, recruit a member, or join if you haven’t already. If everyone would do just one thing, the association could be its very best. You have our promise to keep evolving and working hard to be the very best, to bring you value, to meet your needs, and to be your association. Will you do your part and do the four things I asked? All in all, it’s probably only about an hour of your time to the equivalent of 1 day over a year. If you accept this call to action … and I hope you will, it will not only make a world of difference, it will mean that we will never have to face the possibility of a world without PVMA. l
Pain Score continued from page 19
and they are still showing signs indicating pain, then maybe pain management should be evaluated and adjusted.
What Happens With the Collected Data?
In some mild cases of pain, the animals may be managed with NSAID’s, and in some other cases where there is more intense pain, opiods may be necessary. The pain management regiment should be well thought out; dosages are usually increased gradually and additional medications added only if there is poor response to the current therapy. There should be a plan of what to try if there is no response, as well as an equally important plan for weaning an animal that is doing well. l
Data collected from the pain assessment sheets should be evaluated by the senior veterinary provider. Every part of the veterinary team can help to score the patient, but that collective data is what shapes the overall pain picture of the animal. If the animal seems to show an improvement around the time analgesic medications are administered, then that is a positive response to treatment. If there does not seem to be a change in the animal's comfort level, 32
VOLUME II 2012
12_Volume_2.indd 32
keystone veterinarian
WWW.PAVMA.ORG
7/17/2012 4:45:57 PM
Practice Pearls continued from page 13
hope was noticed right away and not a month or two later!) But what about the more subtle increases in cost of pill vials, syringes, applicators, reconstituting fluids, etc.? How do you account for the increase in these foundational pharmacy costs? Here is a relatively quick (and simple once it is set up) process to account for the inflationary creep: • Keep a list of the top 50 disposable/consumable items used in your practice (eg: syringes, gauze, pill containers, etc.) Also record the typical quantity ordered. • At least annually or semi-annually, price check these 50 items and compare them in total to the previous check point. If/when it has increased, calculate the percent increase over the prior period. • Apply this percent increase to all applicable services, treatments and products. Making this a regular routine will keep your pricing current with your costs that are built into it. This is a fair and reasonable increase. Also, because it can be the staff that performs the analysis they learn that the costs increase so there is less pushback on the fee increase.
Imbalanced Service/Product Sales Ratio Beyond the expense side, it is also good to look at where your revenues are coming from. How significant is your pharmacy revenue stream relative to your other revenue streams? If you find that a significant portion of your revenues are product based, it may be time to re-organize. For practices whose total revenues from referral lab, pharmacy, food, flea/heartworm products and vaccines exceed 40%,
Letter to the Editor continued from page 7
and for-profit veterinary schools, most of which seek accreditation in order to compete for higher tuition paying American students. As a result, during a severe and prolonged economic recession and diminishing job market, we are witnessing what I believe is a proliferation of new, substandard veterinary schools and subsequent rapid growth in the number of heavily indebted, marginally-educated entry level graduates. Defending accreditation decisions, AVMA officers insist that only COE members—in a highly-confidential process—have enough information from self-study documents and site visits to judge whether or not a school merits full accreditation and that granting accreditation means that a school has met all eleven "non-negotiable" COE standards. That this is patently untrue I believe should be apparent to anyone capable of reading plain English even when allowing for reasonable flexibility in the interpretation of standards. A doctrine of infallibility ill suits a secular professional organization. What matters most are outcomes, not process or good intentions, and outcomes can be judged by anyone with sufficient background and interest. Moreover, I believe there is good reason to doubt that the COE enjoys appropriate independence from AVMA political and special interest pressures. I believe that the proliferation of fully-accredited substandard, high tuition, vocational type veterinary schools is an alarming development that should concern every sector of our profession as well as society at large. As such, schools saturate the job market with marginally trained veterinarians, they derail decades of momentum in improving the WWW.PAVMA.ORG
12_Volume_2.indd 33
there is a good chance the practice’s financial health (i.e. profitability) could be compromised. Simply put, it is harder to be profitable if you are product centered as opposed to service centered. Product revenues come with substantial costs and less real margins relative to service revenues. It is also your products that tend to be more susceptible to outside and online competition. Can you increase the service revenue portion of your practice? This may require a change in pricing strategy and team education to focus on pet health. Many veterinarians have an imbalanced Service/Product sales ratio because they are still guilty of undervaluing their services. This can also be a chance to investigate what opportunities are available to expand services. Efforts in improving compliance for services (dentistry, medical progress exams, etc.) will do much more at improving your bottom line than efforts in improving product compliance.
Wrapping It Up Well-balanced sales and effective inventory management is essential to the financial health of today’s veterinary practice. The foundation for management is collecting good data. Knowing what percentage of your sales is coming from pharmacy is imperative in recognizing how much risk the pharmacy poses to the practice if inventory is not adequately managed. It’s equally important to be tracking the costs of those sales. As the total of these costs increase into the 22-24% range, so should your attentiveness to your inventory management. As mentioned above, your practice management software may have tools that can help but have not yet been fully investigated. It may be worth taking a second look. l David McCormick and Sherry Everhart are veterinary practice appraisers and practice management consultants at Simmons Mid-Atlantic. They can be reached at 888.881.7084 and by email at DMcCormick@TMcCG.com and SEverhart@TMcCG.com.
quality of veterinary education, cheapening the DVM/VMD degree, and potentially destabilizing schools that endeavor to produce veterinarians that fulfill research, academic, and specialized clinical roles. As more schools come online while the applicant pool remains flat or diminshes even further, substandard schools may be obliged to accept unqualified students in order to fill a class and remain solvent. The growing influx of new graduates from accredited substandard foreign and domestic schools, and from growing numbers of other accredited foreign schools (eg: in the UK, Australia, and Western Europe) could have a profound and destabilizing effect on the economics of private practice, particularly during a weakening economy. We already know that since 2002, despite an increase in the nation's pet population, the number of patient visits remains unchanged. Moreover, it is now glarlingly evident that the debt burdens of far too many entry level graduates, even those who succeed in finding average paying jobs, are unsustainable. Finally, there is something that can be done if veterinary associations like the Pennsylvania Veterinary Medical Association (PVMA), in concert with academic leaders, petition the United States Department of Education (USDE) to withhold recognition of the AVMA-COE as the accrediting agency for schools of veterinary medicine until they have undertaken and completed a comprehensive review of COE standards, policies, procedures, and composition. An opportunity to weigh in in writing and/or orally will present itself in the fall of 2012 when the USDE conducts its next review of AVMA-COE's eligibility for continuing recognition. Because such reviews only occur at five year intervals, it is an opportunity that should not be missed. l keystone veterinarian
VOLUME II 2012
33
7/17/2012 4:45:57 PM
member news
Welcome New Members P
VMA welcomes the following new members and thanks them for joining PVMA! (March 20–July 16, 2012)
Active Members Robert Henry, Jr., DVM, Somerset, PA Craig Hill, DVM, K. Vet Animal Care, Greensburg, PA Jonathan Anderson, DVM, Pittsburgh, PA Patti Brandt, DVM, Annville, PA Steven Findlay, DVM, Shrader Veterinary Hospital, North Huntingdon, PA Danielle Frost, VMD, Whitelands Animal Hospital, Malvern, PA Danielle Reinhardt, VMD, Trooper Veterinary Hospital, Norristown, PA Amy Dickinson, DVM, Pittsburgh Veterinary Specialty and Emergency Center, Pittsburgh, PA
Penelope Iliff, DVM, Somerset Veterinary Hospital, Somerset, PA Nicole Twigg, DVM, Waynesboro Veterinary Clinic, Inc., Waynesboro, PA Anna Edling, VMD, Horsham Veterinary Hospital, Horsham, PA Kevin Byrne, DVM, Allergy Ear and Skin Care for Animals, Bensalem, PA Chevy Welsh, DVM, Waynesboro Veterinary Clinic, Waynesboro, PA Kendra Mikoloski, DVM, PVSEC, Pittsburgh, PA Carla Douple, Landisville, PA Michael Cohen, VMD, Center City Veterinary Hospital, Philadelphia, PA Teresa Martinez, DVM, Jonestown, PA Greg P. Leck, DVM, Leck Veterinary Hospital, Pen Argyl, PA
2012 Graduate Members
Sara Walker, DVM, Hanover, PA Danielle Vought, DVM, Meyersdale, PA Zachary Glantz, VMD, Philadelphia, PA Lisa Goin, DVM, Bala Cynwyd, PA Amy Gerhardt, DVM, Dover Area Animal Hospital, Dover, PA Donald Sunday, DVM, Dover Area Animal Hopsital, Dover, PA Michael Handke, DVM, Greenfield Veterinary Hospital, Pittsburgh, PA Noelle Bergman, DVM, PVSEC, Pittsburgh, PA Jennifer Daly, DVM, Pittsburgh, PA Krystal Price, DVM, Ambridge, PA Andrew Sowders, DVM, PVSEC, Pittsburgh, PA
Recent Graduate Members
Andrea Peda, DVM, West Chester, PA Amanda Della Penna, DVM, Gibsonia, PA Jessica Manning, VMD, Northeast Veterinary Referral Hosptial, North Abington Township, PA Jennifer Lyle, DVM, Fredericksburg, PA Amanda Witsil, DVM, Northeast Veterinary Referral Hospital, Plains, PA Nicole Hart, DVM, Reading, PA Tracey Lettich, VMD, Dickson City, PA Brad Bates , VMD, Philadelphia, PA Richard Lang, III, DVM, Cochranton Veterinary Hospital, Meadville, PA Kelly Brooks, DVM, Scranton, PA Lindsey Martell, DVM , Allentown, PA Christina Abramowicz, DVM, Lebanon, PA
Practice Manager Members
Julia Newman, Langhorne, PA Casey Dubbs, Animal Medical Hospital, State College, PA Judy Sutliff, Pocono Peak Veterinary Center East, Stroudsburg, PA P. O'Rourke, CVT, Bloomsburg Veterinary Hospital, Bloomsburg, PA Laurie Resele, Animal Care Center, Danville, PA David Peck, Cummings Veterinary Hospital, LLC, Easton, PA Rebecca Sullivan, Southtown Veterinary Hospital, Montrose, PA Barbara Hull, Always Compassionate Veterinary Care, Pittsburgh, PA Tiffany Killion, Gilbertsville Veterinary Hospital, Gilbertsville, PA Theresa Ryan, Mt. Airy Animal Hospital, Glenside, PA Lisa Brzezicki, Newtown Veterinary Hospital, Newtown, PA Jennifer Monroe, Animal Emergency & Referral Center of York, York, PA Michael Warren, Shiloh Veterinary Hospital, York, PA Diane Hanlon, Gilbertsville Veterinary Hospital, Gilbertsville, PA Bash Halow, CVPM, Halow Consulting, Wyalusing, PA Justine Black, Gwynedd Veterinary Hospital, Lansdale , PA
Student Members
Catherine Claxton, Blacksburg, VA Sarah Lehman, Churchville, PA Mary Ann Kaine, Columbus, OH Gretchen Verheggen, Zionsville, PA l
34
VOLUME II 2012
12_Volume_2.indd 34
keystone veterinarian
WWW.PAVMA.ORG
7/17/2012 4:45:59 PM
A Look at the Issues continued from page 9
• An exemption for veterinarians in private clinical practice when compliant with the AVMA Guidelines and the standard of care. • An exemption for normal agricultural activities. • Creation of a euthanasia technician and a mechanism for shelters to obtain euthanasia solution. The bill was revised when it was determined that the state did not have the authority to allow shelters to order controlled substances. Because of political pressure, the bill was quickly revised. When revised: • Euthanasia technicians removed. • Exemption for veterinarians removed. • The only two mechanisms available to shelters are the use of euthanasia solution or the use of firearms. This bill passed in its current form in the Senate (48-0). It has been referred to the House Agriculture and Rural Affairs Committee for review. PVMA actively opposes the bill as written. We are working to address our issues with the House Agriculture and Rural Affairs Committee so we can support the bill.
City of Philadelphia Dog Law
Philadelphia has a very low level of compliance with dog licensing laws. It is estimated that 4% of dogs are licensed with the city. The Dog Law was updated in order to address this issue. All veterinary practices in the City of Philadelphia received notification of these changes in January 2012. The new law would require veterinarians to verify that dogs are licensed before providing service. If they cannot prove that the dog is licensed, they have two options: 1) veterinarians can sell a license and
WWW.PAVMA.ORG
12_Volume_2.indd 35
collect the fee for that license on behalf of the city and 2) if the client declines to buy a license, they must provide written notice to the client explaining that it is required, have the client sign that notice. The veterinarian must then provide that signed document to the city. PVMA wrote to the City of Philadelphia to raise concerns about the financial and administrative burden it places on veterinary practices which can only charge $2 per license as an administrative fee. Another concern is that this new law will create interference with veterinarian-client-patient relationship. Clients who choose not to comply with the dog law (licensing or spay/neuter requirements) may elect to go to a veterinarian outside of the city or may choose not to go to the veterinarian therefore, impacting the health of dogs. In addition, shelters providing veterinary services can be exempted from the requirement to verify licensure even though they are more predisposed to be exposed to unlicensed animals. We also questioned who specifically is covered by the law. Because this law is already passed and there is little we can legally do, we decided to approach the City to ask for clarification on these issues and to determine what, if anything, could be done to assist veterinarians in Philadelphia with meeting the new requirements. PVMA worked with a group of Philadelphia veterinarians and the University of Pennsylvania to develop our position and requested a meeting. We met with City officials and the meeting was very positive. PVMA offered to assist with the distribution of materials and information on this and other issues moving forward. The officials assured us that they wish to work collaboratively with veterinarians and would be doing follow up education on the new requirement with Philadelphia veterinary practices. Their intention is to raise awareness about dog licensure and increase the number of licensed dogs for public health reasons. To that end, they would like veterinarians to promote licensure, ask if dogs are licensed, and provide the materials to clients if their dog is not licensed. l
keystone veterinarian
VOLUME II 2012
35
7/17/2012 4:46:00 PM
what’s happening
Events & Education august 2012 August 16-19, 2012 6TH Keystone Veterinary Conference, Hershey Lodge, Hershey, PA The Keystone Veterinary Conference (KVC) will be back at the Sweetest Place on Earth for 26 hours of continuing education credit with a helping of family fun on the side. Full details and online registration are available at www.keystonevetconference.org.
november 2012 November 3-4, 2012 5TH 3 Rivers Veterinary Symposium, Omni William Penn Hotel, Pittsburgh, PA PVMA will be returning to Pittsburgh for the 5TH 3 Rivers Veterinary Symposium. 12 hours of continuing education credit will be available in a variety of tracks including companion animal, bovine, and more. Full details on program, hotel, and registration will be available next year at www.pavma.org.
february 2013 February 9-16, 2013 St. James Club Resort, Antigua Just when winter is the coldest, PVMA is heading to Antigua for the 2013 Winter Seminar Vacation. 26 hours of continuing education credit will be available in a from three speakers. The resort also boasts endless amenities and Full details on the program, resort, and travel arrangements are available in a downloadable brochure at www.pavma.org. l
Legislative Day continued from page 9
about issues, and his desire to ensure that legislation which is reviewed and passed by his Chairman’s Committee is reasonable and the best interest of animals and stakeholders . PVMA honored Mr. Rader in recognition of the important and much appreciated role he plays in the advancement of veterinary medicine, public health, food safety, and animal welfare within our great Commonwealth. The final award presented during the reception was the 2012 George B. Wolff Legislative Leadership Award. Three years ago, we created this award to recognize leadership among our members in the legislative advocacy arena. The recipients of this award display true dedication to PVMA and its legislative efforts on behalf of the profession and epitomize the heart of grassroots advocacy. The award was presented to Dr. Dave Wolfgang for his dedicated service, commitment and
Antigua continued from page 30
Participants will learn how diode therapy lasers operate, how to use them safely, and how Class IV laser light interacts with tissue to reduce pain, reduce inflammation, and accelerate healing.
Cost 8-Day All-Inclusive Package Per person double occupancy: $1995 Club Waterview Room $2079 Premium Waterview Room $2149 Beachfront Room $2399 Royal Suite (2 people maximum) 36
VOLUME II 2012
12_Volume_2.indd 36
keystone veterinarian
passion to the veterinary profession and PVMA’s advocacy efforts. Dr. Wolfgang has served as PVMA’s President and currently serves as Chair of the project Pennsylvania Coalition, a member of the Pennsylvania Alliance for Livestock Care and Well-Being, and as an advisory member of our Scientific Program Committee. He embraces his responsibilities wholeheartedly and has been willing to do what it takes to ensure that PVMA is at the table. No matter what the request or the timeframe, he always gives 110%. Dr. Wolfgang has participated in legislative visits, assisted in preparation for legislative hearings, and has provided testimony on antibiotics in livestock. In his various capacities of involvement, he has brought tremendous passion and committed belief to ensuring the legislature understands the shortage of veterinarians in Pennsylvania, the difference between animal welfare and animal rights, antibiotic resistance in livestock, and the critical role that the veterinary profession plays in public health and food safety. l
$899 3rd person sharing room (over 11 years of age) Club Waterview Room $999 3rd person sharing room (over 11 years of age) Premium Waterview Room $ 1099 3rd person sharing room (over 11 years of age) Beachfront Room $349 Children 2-11 years of age sharing a Waterview or Beach front room with two adults (max 2 children) $50 Children under 2 years of age go for the price of transfers $3359 Single occupancy Club Waterview $3449 Premium Club Waterview $3575 Single occupancy Beachfront $4089 Single occupancy Royal Suite l WWW.PAVMA.ORG
7/17/2012 4:46:01 PM
Feral Cats continued from page 21
Relocation is another option. Relocating an entire colony of cats is also next to near impossible. It is more feasible and realistic than eradication, but it also has major hurdles. First among those is you still have the potential “vacuum effect” to deal with when the cats are removed. Second is the issue that relocating cats properly is a major undertaking that requires a lot of patience and time to commit to it. It is not just picking the cats up and dumping them somewhere else. Remember feral cats have large territorial ranges, and dumping a cat a mile or so away in the woods or on a farm is not going to work. You are also exposing the cats to great stresses doing this, hence the reason it must be done right. This solution is possible for the person that has one or two confirmed ferals in their area and wants to get rid of them. The location they are going to has to be far enough away and also has to be willing to except the cats. Ideally, any cat that is relocated should be altered and vaccinated against rabies before being released into new area. Trap/neuter/return has become probably the most popular method of dealing with feral cats in the animal welfare realm. It is based on the principle that instead of trying to decimate cat numbers in an area by eradication, stabilizing the group or colony actually leads to a decrease in population numbers over time. By having a colony of cats that are all altered and are watched over by one or more caretakers, there is no increase in population from litters being born and new cats that come into contact with the colony are often driven away by the established members. In addition, the cats are all vaccinated for rabies and ones suffering from obvious illness or that are FeLV/FIV positive are euthanized to help prevent the spread of disease. The cats all have their left ear tipped while under anesthesia to permanently identify them as altered. This method of dealing with feral populations has had mixed results depending on who you talk to and what research on it you read. It obviously will not solve the problem of feral cats immediately or provide people with a quick “out” to get rid of ferals on their property. However, in places where it has been practiced properly for a period of at least a few years, most see a positive result.
A thorough examination of the issue of feral cats for this part of the article cannot be completed without at least looking at the effect of feral cats on wildlife. I have spent some time looking over some arguments that wildlife conservationists and veterinarians make about the impact that feral cats have on both the environment and native species of birds and small mammals. Their research points to almost a direct correlation between the number of feral cats in an area and a decrease in the aforementioned species numbers. I am not in disagreement with them on this point. There is an effect these cats have on those animals, it cannot be denied. However, the exact impact is still somewhat hazy in my opinion. Most places where feral cats are in their highest numbers are urban or suburban areas. They obviously follow the people. More people in urban areas also mean more cats that may be “owned” but just roam outside or are turned loose by their owners. How much of this effect on species is due to habitat loss from urbanization vs. just the cats probably remains to be seen. Between that issue and what is truly a “feral” cat it is murky as to some of the wildlife conservationists claims. In addition, they often say that emotion and not science is driving the push fortrap/neuter/release acceptability in townships and other jurisdictions. Since cats are considered pet animals, people vote with their hearts instead of looking at the cold hard facts. I also agree there is a truth to this in some situations. However, it is obvious the wildlife conservationists and veterinarians are also passionate and emotional about the animals in their field, so to say it is just emotion vs. pure science to me is a little hypocritical. Anybody else need an Excedrin or two yet from the complexity of the issue? Feel free to grab one or two dozen and digest all of this. In part two of this series, I will look at the more medicinal aspect of things in running a successful and proper trap/neuter/release clinic. l
One method of judging its effectiveness is to look at humane society or animal shelter intake numbers of both feral cats and newborn kittens before and after at trap/neuter/release program has started. While some may show a decrease in both (indicating the program is working) many shelters also may change their admission criteria or policies during that time, so the data may not be completely reflective of the program. I can say from anecdotal experience that over the past 4-5 years that the Humane League of Lancaster County has been doing the TNR program that we have seen a decrease in the number of kittens and cats from areas we normally did see high feral numbers from. I would hope this is true evidence of a difference being made in Lancaster County since over that time we have done close to 15,000 feral cat spay/neuter surgeries. Over the past two years, with a generous grant from PetSmart Charities, the Humane League has been able to target the area of Lancaster city and their feral cat issues by offering free spay/neuter to the feral cats in those jurisdictions. As we come to the close of the 2-year period, I can say I really do feel it has made an impact as we no longer have a waiting list of feral cats from those areas that need to have surgery. To me, this demonstrates that the populations are stabilizing in this area and as such less kittens are being born thus necessitating less surgeries. Is it working perfectly? Probably not. Does it have its opponents who claim it is not worth the effort and that the cats are still a nuisance? Yep. However, I think on the whole it has been a very beneficial program for the city and helped control their feral cat issues better than any other alternative out there. WWW.PAVMA.ORG
12_Volume_2.indd 37
keystone veterinarian
VOLUME II 2012
37
7/17/2012 4:46:02 PM
Classified Ads
Animal Hospital of DuBois, 5114 Shaffer Rd., DuBois, PA 15801, Attention: Dr. Melissa Miller.
Veterinarians
ASSOCIATE SMALL animal veterinarian wanted to join our team in south central PA. Experienced long term staff and manager, opportunity to develop skills, and enjoy life with a full time job and competitive salary. Email drstt@comcast.net or call Schuylkill Veterinary Hospital at 570.622.1098.
ASSOCIATE VETERINARIAN needed for full or part-time in well-established practice. New graduates are welcome to apply. The practice includes 2 busy offices—1 is a new 11,000 sq ft hospital with up-to-date equipment and good support staff. Practice is strictly small animal, primarily dog/cat. Focus is preventive and general medicine, general and orthopedic surgery. We offer a competitive salary and good benefits package. Located in beautiful north central PA. Many recreational and cultural opportunities are available. Please send or fax resume to: Adrian Carlin, VMD. 12043 Route 287, Middlebury Center, PA 16935, fax 570.376.2936, or email to: wsahvmc@ptd.net. THE VETERINARY REFERRAL Center in Malvern, PA, is seeking four (4) experienced internshiptrained Emergency Veterinarians, as well as two (2) residency-trained Critical Care Veterinarians. Several years of post-internship experience working in a specialty hospital with board-certified critical care specialists is strongly preferred. VRC Emergency offers a highly competitive compensation package with an excellent benefits program. Please email a resume and cover letter to the attention of Dr. Dietrich Franczuszki, President and Chief Medical Officer at info@vetreferral.com or mail to his attention at: 340 Lancaster Avenue, Malvern, PA 19355. VETERINARIAN NEEDED: Ludwigs Corner Veterinary Hospital and its affiliate, Coventry Animal Hospital, are full-service small animal practices located in north central Chester County. Our goal is to provide optimal progressive care in a comfortable, personal environment. 45 minutes from arts and entertainment of Philadelphia, 30 minutes from Valley Forge National Park and minutes from first-rate specialty referral hospitals. Looking for a personable, team-oriented associate veterinarian. Part-time hours available immediately with the expectation of full-time for the right person. Grow with us as we expand the number and quality of services we offer. Visit us at www.coventryanimalhospital.net and www. ludwigscornervet.net. Contact Richard Marchetti, VMD at coventryanimalhospital@yahoo.com with interest. PART-TIME VETERINARIAN desired for 2-doctor practice near Lancaster, PA. Practice offers ultrasound and acupuncture, along with basic orthopedic and dental services (including digital dental radiograpahy). We have an Abaxis lab, and employ 2 certified and 2 non-certified technicians. Hours include some Saturday mornings but no after hours emergencies. Please contact Dr. Stephen Young at Animal Hospital of WIllow Street, 2611 Willow Street Pike, Willow Street, PA 17584. Phone: 717.464.4755; fax: 717.464.1068. PROGRESSIVE, 1.5-DOCTOR small animal practice in west central PA looking for an associate to fill a full or part-time position. We offer mentorship, a knowledgeable staff and plenty of room to grow. Our practice stresses effective client communication, preventative care and thoughtful work-up of cases. There is a potential for a 6-figure income. We will assist with relocation costs, and offer a generous benefits package. Send a cover letter and resume to
38
VOLUME II 2012
12_Volume_2.indd 38
Veterinary Technician
VETERINARY TECHNICIAN: full-time/part-time, certified, experienced. Utilize your skills to the fullest! Competitive salary and benefits. Email or fax resume to: avah@dejazzd.com or 610.779. 6079.
Relief Veterinarians
SAFI CHAND, DVM. Compassionate, productive small animal veterinarian, strong interpersonal, medical and surgical skills, >5 year experience in referral/ER,exotics, available weekends, weekdays and nights. 413.636.9209; safi_c2000@yahoo.ca. DEBRA DRAPER, DVM. Experienced, competent, personable small animal veterinarian available with a broad spectrum of availability in the greater Philadelphia and outlying area. Ideally, I am looking for a permanent, long-term, full-time position. I will happily work short or long-term relief; days, nights and weekends as needed. References gladly provided upon request. Please email debdraper@hotmail.com or call 407.256.6834 if I may be of service. BONNIE J. MILLER DVM. Veterinarian with 25+ years experience in small animal, pocket pets, avian, reptile and exotics. Licensed in MD and PA. APHIS certified and have a current DEA certification. Proficient in surgery as well. York, Lancaster, Gettysburg, Harrisburg, and surrounding areas in PA. Northern Baltimore County and some parts of Hartford and Frederick Counties. 717.739.8400. DONALD W. STREMME, VMD. Experienced veterinarian (35+ years) available for small animal and exotic (birds, pocket pets, reptiles) relief work in Philadelphia area and South Jersey. Will consider other areas where licensed, too. Licensed (including DEA and USDA-APHS) in PA, NJ, NY, FL and CA. Email to CCACDWS@aol.com. KATHRYN WEST, DVM, UF ‘94. Small animal and exotic/non-traditional pet work, including sx. Central and SE PA. kswdvm@comcast.net. DR. KIMBERLEY HERSHHORN GALLIGHER, Willistown Veterinary Services, is available for relief services. Contact 610.721.6634 or kimvmd@ hotmail.com for more information. EXPERIENCED VETERINARIAN, 1987 Penn grad seeks part-time employment within 30-45 minutes of the Pottstown/Quakertown area. Special interests in surgery, diagnostic imaging, exotics. Professional, reliable, neat appearance. Call Jacqueline Burke, VMD at 610.754.1155 or email jacquib@dejazzd.com.
keystone veterinarian
LOOKING FOR relief: Veterinarian needed for Tuesday and or Thursday evenings. Approximate hours are 4 hour weekly with opportunity for further relief (vacations) Contact: Providence Veterinary Hospital, Chester, PA. 215.620.2407. MJ POTTER, UP 97. Experience in small animal internal medicine, critical care, oncology, and general surgery. Available for long or short term relief in Delaware, Chester, Lancaster, and surrounding counties. 610.357.5275 or drmjpotter@ hotmail.com. WILLIAM KEER, DVM, Wisconsin ‘99 Providing veterinary relief services and improving colleagues’ quality of life in eastern Pennsylvania. Please contact me via email at bkeer@ptd.net or phone at 484.560.4338 for more information. THE VISITING VET! Experienced relief veterinarian available for quality coverage in Chester County, Northern Delaware, southern Lancaster County and southern New Jersey. Small animal and pocket pets. Soft tissue surgery and emergency coverage. Licensed three states and DEA current certificate. One day or regular short-term part-time. References available. Contact: Sandra Fargher VMD '91, at 610.299.8593 or sandraatmillrd@aol.com. HOW DO you spell relief? Jerry Godfry, DVM! I have been a veterinarian for 38 years and have owned my own practice in Chester County for the past 30 years. I have sold my practice recently and I am currently available to work as a relief veterinarian in Philadelphia and the surrounding areas. I am an experienced, reliable doctor that would fit your needs. My experience ranges from cats and dogs to birds and reptiles. I am licensed and accredited in PA as well as federally accredited. I work well with new staff and am able to work a busy schedule. Available for day and evening shifts in addition to Saturdays and some holidays. Will travel 45-1 hour if needed. Please contact if interested. 610.506.6494.
Auction
REAL ESTATE Auction: September 20, excellent location for veterinarian, originally a doctor’s office. Off-street parking, high visibility and traffic area, great curb appeal, well-maintained, six office spaces, efficiency apartment, visit www.kappsauction.com for info and photos.
Practices For Sale
FOR SALE: Well-maintained 2007 Chevrolet Silverado with 99,983 miles. Very Clean. Auto windows/ locks, stereo with c/d, air conditioning, 4WD, GM Onstar Capabilities. Triple Crown Porta-Vet Unit included, features day/night heater with thermostat, compartment lights, thermostatically controlled 25 gallon heated water tank and electric pump and hose. Call 717.226.5012 with questions or to see. SOUTH JERSEY Shore: 1 to 1.5 DVM small-animal practice in Atlantic County, NJ. Leasehold, 3 exam rooms, grossed 600K in 2011, high net. Practice has been valued by Simmons. Motivated seller; contact vetpracticesale@hotmail.com. continued on page 40 WWW.PAVMA.ORG
7/17/2012 4:46:02 PM
12_Volume_2.indd 39
7/17/2012 4:46:04 PM
the grand finale
Laughter Is the Best Medicine
Dogs' Letters to God
Dear God, How come people love to smell flowers, but seldom, if ever, smell one another? Where are their priorities? Dear God, When we get to Heaven, can we sit on your couch? Or is it the same old story? Dear God, Excuse me, but why are there cars named after the jaguar, the cougar, the mustang, the colt, the stingray, and the rabbit, but not one named for a dog? How often do you see a cougar riding around? We dogs love a nice ride! I know every breed cannot have its own model, but it would be easy to rename the Chrysler Eagle the Chrysler Beagle! Dear God, If a dog barks his head off in the forest and no human hears him, is he still a bad dog? Dear God, Is it true that in Heaven, dining room tables have on-ramps? Dear God, If we come back as humans, is that good, or bad?
Dear God, When we get to the Pearly Gates, do we have to shake hands to get in? Dear God, We dogs can understand human verbal instructions, hand signals, whistles, horns, clickers, beepers, scent IDs, electromagnetic energy fields, and frisbee flight paths. What do humans understand? Dear God, Are there dogs on other planets or are we alone? I have been howling at the moon and stars for a long time, but all I ever hear back is the beagle across the street! Dear God, Are there mailmen in Heaven? If there are, will I have to apologize? Dear God, Is it true that dogs are not allowed in restaurants because we can't make up our minds what not to order? Or is it the carpets thing, again? l
Dear God, More meatballs, less spaghetti, please.
final words of wisdom MYTHS THAT NEED CLARIFICATION: No matter how many times you see the Grand Canyon, you are still emotionally moved to tears. False. It depends on how many children the out-of-towners brought with them, who kicked the back of your seat from Phoenix to Flagstaff, and who got their gum caught in your hair.
— ERMA BOMBECK
Employee Discounts continued from page 16
Because these rules are so stringent, far and away the safest and simplest approach is to offer employees no more than a 20% discount on services and require them to pay at least the practice's cost of any products which they buy. In addition, the practice's employee manual should state these rules in some details and they should be applied uniformly among all employees. Finally, the practice should track the amount of the employee discounts using a separate code in the practice management software for discounts on services and another code for discounts on products. This would provide evidence to the IRS that the discounts have been limited as defined in the law and still allow practices to track and manage the dollar amounts they are investing in the health of their employees' pets.
Classifieds continued from page 38 FOR SALE: Shoreline six cage (size 24"x24") bank with platform. Excellent condition. Located in eastern PA. $1960. For further information, contact dtr1@ptd.net. NW PA near Ohio line. Small animal practice Grossing over $600,000 in very nice facilities. Hospital is well equipped and quite profitable. Practice and real estate offered @ $655,000. Contact Dr. Kurt Liljeberg of Total Practice Solutions Group at 800.380.6872 or Kurt@tpsgsales.com. 40
VOLUME II 2012
12_Volume_2.indd 40
keystone veterinarian
Alternatively, if you want to offer larger discounts to employees than these rules allow, you can certainly do so. You must, however, include the value of those discounts in the employee's wages for payroll tax purposes and include them on Form W-2 for each employee for the year. You are, however, given some flexibility in terms of when you treat these wages as being paid. It can be done as infrequently as once a year, although to avoid penalties for failure to deposit, the related payroll taxes must be deposited in the same deposit period as the one you chose for the wages. In case this discussion hasn't been depressing or alarming enough, you can read more about this topic in Publication 15, Circular E. Employee's Tax Guide published by the IRS every January and sent to all employers. There's a more complete discussion in Publication 15-B, Employer's Tax Guide to Fringe Benefits available at www.irs.gov/pub/irs-pdf/p15b.pdf. l
WHEN BUYING or selling a veterinary practice, count on the experience of Total Practice Solutions Group. See our display ad this issue. Contact Dr. Kurt Liljeberg for a free consultation, 800.380.6872, or kurt@tpsgsales.com.
PS BROKER, INC.: Our services include Seller Representation, Buyer Representation & Practice Valuations. Give us a call for a free & confidential conversation to discuss your needs. We currently have listing Nationwide! Bookmark our website to view new listings! 800.636.4740; www.psbroker.com; info@psbroker.com. l WWW.PAVMA.ORG
7/17/2012 4:46:04 PM
12_Vol_2_cover.indd 3
7/17/2012 4:09:50 PM
PVMA 8574 Paxton Street Hummelstown, PA 17036
PRSRT STANDARD US POSTAGE PAID HARRISBURG, PA PERMIT NO. 533
Delivering service, loyalty, and commitment.
pvmaAssure Insurance Agency, Inc. PVMA's Own Full-Service Insurance Agency to Better Serve You PVMA is pleased to announce the launch of its own in-house, full-service insurance agency, pvmaAssure Insurance Agency, Inc. pvmaAssure can help you protect everything that is important to you with its full range of products. Contact us today to see how we can serve you. Our promise. Your health.
AVAILABLE TO PVMA MEMBERS • Employee Benefit Programs — health, dental, vision, and group life and disability insurance • Business Property and Casualty Insurance
Scan this code to request information online immediately.
contact
US 12_Vol_2_cover.indd 4
— professional liability, building property and contents, and worker's compensation • Individual Life and Disability Insurance
pvmaAssure
717.220.1502 PH; 717.220.1461 FX
8574 Paxton Street
info@pvmaAssure.com
Hummelstown, PA 17036
www.pvmaAssure.com
7/17/2012 4:09:51 PM