The decline in veterinary visits-a look at the big picture (Proceedings)

Many reports have indicated that the US recession of 2007-2009 had a negative impact on the business volume and revenues of a large number of companion animal veterinary practices. But there is substantial evidence in studies conducted by the AVMA, AAHA and others that erosion in patient visits began well before the start of the recession.

The prospect that dog and cat visits may be declining at a time when the pet population is rising raises several concerns about the care pets are getting and the impact on the economic health of the veterinary profession. The Bayer Veterinary Care Usage Study was conducted to address these issues; specific goals were to confirm the decline in patient visits, identify the factors responsible for the decline, and to identify specific actions that companion animal practitioners could take to encourage more frequent veterinary visits for dogs and cats and to reverse the trend.

The study was conducted by Brakke Consulting, Inc., in cooperation with the National Commission on Veterinary Economic Issues (NCVEI) and sponsored by the Animal Health Division of Bayer Healthcare. Ipsos-Forward Research was retained to conduct the fieldwork. Stages of the research included an extensive review of literature on practice trends, a series of in-depth interviews conducted with companion animal practice owners across the US, qualitative interviews with pet owners and a national online quantitative survey of 2,188 US dog and cat owners. In conducting the online survey, a detailed quota plan based on AVMA pet ownership statistics was developed to ensure that responses were representative of all regions and demographic groups. Statistical margin of error for the entire sample at the 95% confidence level was ± 2.1%; margin of error at the species (dog or cat) level was ± 3.0%.

In designing the Bayer Veterinary Care Usage Study, Bayer, Brakke and NCVEI consulted with several business management experts with research experience in the veterinary field. These included John W. Slocum, PhD, professor emeritus of the Cox School of Business, Southern Methodist University, William Cron, associate dean, M. J. Neeley School of Business, Texas Christian University, and a team of professors from Kansas State University – David M. Andrus, PhD, Kevin Gwinner, PhD, and J. Bruce Prince, PhD.

Why are visits declining?

The Bayer Veterinary Care Usage Study identified six factors that contributed to declining visits. Each of these is discussed in more detail below.

     • The recession

     • The fragmentation of veterinary services

     • The intrusion of the Internet

     • Inadequate understanding of the need for routine examinations

     • Cost of veterinary care

     • Feline resistance

Impact of the recession – Without doubt, the US recession of 2007-2009 has had a negative impact on companion animal veterinary practices. The recession has exacerbated the problem of declining visits. In interviews with practice owners, the recession was far and away the number one concern mentioned. The recession was also top-of-mind among pet owners. In pet owner focus groups, it was clear that fears about potential job and income loss amplified concerns about the rising cost of veterinary services.

Fragmentation and expansion of veterinary services – The second most common concern on the minds of veterinarians was competition for veterinary services. Pet owners have more, and more different types, of services available than ever before. Practice owners feel squeezed not just by competition from other traditional veterinary hospitals, but especially from other types of services that have become far more prevalent in recent years. These include veterinary clinics located in pet stores, mobile vaccination clinics, veterinary services provided by animal shelters and rescue operations, and specialty referral practices.

Pet owners responding to the Bayer Veterinary Care Usage Study survey reported that 24% of pets were acquired from animal shelters or pet rescue operations. This is an all-time high. Shelters typically only adopt pets that are spayed or neutered, fully vaccinated, and have received any necessary tests such as heartworm tests. Many of these services have traditionally been the "starter services" that veterinarians have provided after a client has acquired a new puppy or kitten from a breeder, friend, relative or other source. So in effect, traditional veterinary hospitals lose out on these first year services for pets adopted from shelters and, perhaps, more importantly, lose out on the opportunity to bond with pet owners and educate them about the need for ongoing veterinary care.

Growth in use of the Internet by pet owners – With the ready availability of information on the Internet, pet owners depend less on their veterinarian. That was a key finding of the in-depth interviews among both veterinarians and pet owners, and verified in the national survey of pet owners. In the quantitative study, 39% of pet owners said they somewhat or completely agreed with the statement that they look online first if a pet is sick or injured, and 15% agreed that because of the Internet they rely less on their veterinarian.

Need for exams not understood – When conducting in-depth interviews with pet owners during focus groups, it became apparent that many pet owners associated veterinary care with vaccinations, and did not understand as readily the necessity of examinations. This was confirmed in the quantitative survey. There, 36% of pet owners somewhat or completed agreed that were it not for "shots" they would not take their pet to the veterinarian. Similarly, 24% somewhat or completely agreed that routine checkups were unnecessary.

Pet owners perceived that some animals need less routine veterinary care than others. Study respondents with pets that live primarily indoors were less likely to have taken their animal to the veterinarian within the last year. Likewise, pet owners with older animals were less likely to have visited within the past year. The fact that many geriatric animals visited the veterinarian less often than younger adults was alarming to the research team.

Given the pet owner's association of veterinary visits with vaccines, changes in vaccine protocols has no doubt has an impact on veterinary visits.

Cost of care – In the pet owner focus groups, one of the frequently mentioned obstacles to veterinary visits was the rising cost of veterinary care. As one pet owner said:

"All of a sudden, the price just skyrocketed. You could go when it was 60 bucks, now I can't get out for less than $150."

This finding was confirmed in the quantitative survey. Among respondents, a whopping 53% somewhat or completely agreed with the statement that veterinary costs are usually much higher than expected. Further, 26% somewhat or completely agreed that they were always looking for less expensive veterinary options, and a similar percentage said that they would switch veterinarians if they found a less expensive one.

The Bayer Veterinary Care Usage Study also measured pet owner satisfaction with their regular veterinary hospital on a large number of attributes. Overall, veterinarians and their staff scored very high, with 50% indicating that they were completely satisfied with no room for improvement, and an additional 40% saying they were very satisfied. Veterinary practices scored highest on friendliness of the veterinarians and staff, and on the range of services offered. Where veterinarians scored lowest was on value of services and payment options.

Feline resistance – In the pet owner focus groups it quickly became evident that cat owners find taking their animal to the veterinarian highly stressful to both the animal and themselves. Survey data demonstrates the significance of the problem. Among respondents, 91% of dog owners but only 83% of cat owners said their animal had a primary veterinary clinic. Of those animals taken to the veterinarian, dogs had visited an average of 2.3 time within the last year; cats 1.7. In measuring pet owner attitudes towards taking their animal to the veterinarian, cat owners had more negative ratings than dog owners in every attribute, including such things as "Would not take my pet to the vet if vaccination not needed," and "My pet hates going to the vet".

What can be done to reverse the trend?

It quickly became clear during in-depth interviews with practice owners that many veterinarians do not routinely monitor patient visits. For purposes of this study, a "visit" was defined as the presentation of a dog or cat at the veterinary practice for examination or treatment. This definition was completely consistent with how veterinarians said they perceived a "visit." Many veterinarians recognized apparent symptoms of declining visits such as too many open appointments on the calendar but they had not checked visit numbers. Most veterinarians interviewed also indicated they were not taking any specific actions to increase visits. Therefore, the first step veterinarians and practice managers need to do is set up systems to monitor visits and the success of various programs designed to increase visits.

In the quantitative survey, pet owners were asked under what circumstances they would take their pet to the veterinarian more often. The same four attributes scored highest among both dog owners and cat owners, although in slightly different order:

     • If I knew I could prevent problems and expensive treatment later

     • If I was convinced it would help my pet live longer

     • If each visit was less expensive

     • If I really believed my pet needed exams more often

All four of these attributes rated significantly higher than others listed, including friendliness, convenience and pleasantness of the veterinary practice, shorter appointments, less stress on the animal and other factors. In short, in order to visit the veterinarian more often, pet owners need to fully understand the health implications for their pets, and the economic benefits to themselves.

Specific actions that veterinarians could take to increase patient traffic were also discussed during the in-depth qualitative interviews with veterinarians and pet owners and then tested in the quantitative survey. They included the following:

     • A full-year health program for your pet developed by your veterinarian. This would outline what your pet needs, when you should visit the veterinary clinic, what things to look out for, how to keep your pet healthy.

     • A payment plan where you would be billed in equal monthly installments for a year's regular veterinary services. This would cover all of your pet's routine health care for a full year, qualify you for certain discounts or free visits and eliminate large invoices at the time of visit. It would not cover unexpected visits for sickness or injury.

     • A web site for your pet's clinic that allows you to see available appointment times online and book an appointment.

     • A special, password-protected page on your veterinarian's website that has all of the information and medical records for your pet.

     • Extended business hours for appointments. This would include both availability of earlier and later appointments each day, as well as appointments on the weekend.

     • The ability for you to drop off your pet in the morning and pick them up after their appointment.

     • Certain days or hours reserved for cat-only or dog-only appointments to avoid encounters between cats and dogs

     • Separate waiting areas for dogs and cats.

     • Information about financing programs for veterinary care such as installment programs, pet health insurance, or special financing for emergencies or larger-than-ordinary costs.

     • Prices for products (flea & tick products, specialty pet foods, supplements) that are competitive with what you find elsewhere.

     • A kids play area with toys and/or games for your children

More than 50% of all dog and cat owners rated eight of the concepts somewhat or extremely valuable. The only ones that were rated as valuable by less than 50% of pet owners were: certain days or hours reserved for cat-only or dog-only appointments, separate waiting areas for dogs and cats, and a kid's play area with toys and/or games.

In short, the majority of pet owners would find most of the services attractive. To evaluate the concepts further, the study asked respondents to identify which three of the services would most likely motivate them to take their pet to the veterinarian more often. The same four services were identified by both dog and cat owners, only in slightly different order; these were the full-year health program, the monthly payment plan for wellness services, competitive prices for products, and extended business hours. Again, those concepts that contribute to convenience, economy and predictability garnered the most favor among pet owners.

While some of the findings in the study were disturbing (there are clearly areas in which veterinary practices need to improve); the study also provided clear guidance about the changes practices need to make. None of these changes are outside the reach of the vast majority of practices.