DVM Newsmakers' Summit: Consumer expectations, standards of care are changing, panelists say

Editor's Note: Understanding consumer behavior can help you as a clinician and business manager. DVM Newsmagazine asked five veterinary market leaders to join this year's DVM Newsmakers' Summit at CVC East in Baltimore. Following is the second of three excerpts from the panel discussion; the final one will be published next month.

They include: Jim Flanigan, AVMA; Dr. John King, Minnesota state board; Howard Rubin, Brightheart Veterinary Centers; Dr. Richard Timmins, Association for Veterinary Family Practice; Dr. James F. Wilson, consultant and attorney; and DVM Newsmagazine Editor Daniel R. Verdon.

Verdon: In the past year, AVMA and other groups have put together some groundbreaking research on consumer attitudes. Jim, could you help us build a profile of veterinary medicine's most loyal clients and least loyal?

Flanigan: The people who are most loyal are the people who go to a veterinarian who communicates well. The bottom line is, if the client believes that the veterinarian has explained to them why certain procedures are necessary, the client is more likely to be more loyal. If the veterinarian has explained to the client what the potential outcomes are, if the veterinarian interacts well with the pet and if the experience at the clinic is one of value in which the client perceives that the people are compassionate and communicative, then the client will be loyal. Clients don't expect veterinarians to be high-tech — just high-touch. Those are the people who are going to be most loyal.

It has nothing to do with their capacity to pay. It does have something to do with the human-animal bond.

James F. Wilson, DVM, JD

People who are most bonded to their pets and who found a veterinarian who's willing to share that concern for their pet are the people who are most loyal. Loyalty's important, because loyalty leads to compliance. The more loyal a person is, that person will be more compliant with the recommendations of the veterinarian. Ultimately this increases the quality of care that a pet receives.

People with higher incomes have greater disposable income and therefore spend more on veterinary care. That's true. However, it's the bonded owners who actually spend more. When you compare people even at the lowest levels of income ($20,000 or less annually), those people spend more on veterinary care per year than unbonded owners or people less bonded with their pets (who earn $60,000 or more per year in income). The human-animal bond is a critical component of that.

Where do we see the greatest bond? We see it in families with children. Very high percentages of families with children own pets, and most of them own dogs. Most of the spending in the United States for veterinary care for companion animals is for dogs. But we do a disservice to the veterinary profession if we said there's this target market you really need to be going after.

Jim Flanigan, American Veterinary Medical Association

One of the interesting things that came out of the Brakke study years ago asked veterinarians to make medical recommendations to clients. The only difference was how the client was described to the veterinarian. Medically, there was essentially no difference between the cases presented. Based only on the client description — that the client was unable or unwilling to pay — veterinarians made different recomendations. I wouldn't want to suggest that, based on certain demographic factors, veterinarians simply tailor their recommendations to a low-cost or high-cost solution. In reality, a bonded owner may come from any income group, either gender, he or she may have children, may be single, may be divorced, may be older or younger. The fact that they're bonded to that pet means they're looking to the veterinarian as a source of information and a source of care for that pet.

Wilson: We keep talking about the veterinarian. The truth of the matter is that it isn't just the veterinarian, it's the veterinary staff. It's the entire experience at that place. One of the biggest problems I see is related to inadequate staff training, staff longevity or staff who don't have the same level of empathy as maybe their doctor. Often these are underpaid veterinary staff who can't afford to pay the bill themselves. Because they could never afford to pay it, they wonder how clients could afford to pay that same kind of bill. We have to stop talking about the veterinarian. We've got to talk about the veterinary experience, including the entire aesthetics and the staff, staff training and staff attitudes.

Verdon: Has the veterinary profession responded adequately to changing consumer expectations? I wonder if each of the panelists could offer his perspective on practice, and whether it's true for technicians, state boards and veterinary schools?

Flanigan: Any time a study was done between what the veterinarian thought the public wanted and what the public wanted, there was a disconnect. There's an ongoing, long-term disconnect between consumer expectations and what veterinarians believe consumers want.

Wilson: One of the toughest things our profession is facing is defining standards of care. It's such a moving target. We found this out in Minnesota.

What is the standard of care in rural Minnesota vs. urban America? From secondary-care centers to primary-care centers? I thought I understood it as a veterinarian with a law degree and a lot of experience. The truth of the matter is that only recently have we begun to develop "guidelines," as we call them. We have guidelines for parasite control. We talk about guidelines for pain management. So we finally have guidelines that in court will be interpreted as standards in all likelihood.

But what we finally are now beginning to coalesce is what's expected of a quality practice. AAHA, AAFP — I give them a lot of credit for trying to develop some of these standards. I think that the more we can do that, the more we can hold the veterinarian more accountable. The problem becomes, at what point does it become the standard? As soon as 52 percent of the veterinarians use pain management on every declaw, does that become the standard of care? Or is it when 60 percent of veterinarians do that in practice? We're talking about what's applied out there in practice. Well, if 60 percent are within the standard of care, then 40 percent are below it. How do we communicate to the veterinarian what that standard is that is getting more in tune with what the clients are perceiving or are seeking out there? It may be a standard they're hearing about off-handedly from other pet owners.

Timmins: We need to pay attention to the Internet, too. The guidelines that you're describing are available to the general public. The expectations for clients, no matter if they're in a rural or suburban community or urban America, are going to start to coalesce as they begin to become aware of these guidelines. I think we're making a positive step by establishing the standards, and I'm very excited to see that we have pain-management standards. AAFP came out with recommendations to care for the senior cat. We have more guidelines that our clients are going to be familiar with, which means the veterinarians need to be familiar with them, too.

Flanigan: I'd agree that the consumer is much more educated and exposed to what those standards or expectations are. Usually through the Internet, they can find some source that will support their beliefs, whether it is a standard or not. Unfortunately, it's assumed that if they found it on the Internet, it must be true and that is what the standard is. As people use that tool, they have higher expectations. It is important that a veterinarian go to continuing education, and is aware of what is in the industry and what expectations consumers have of them.

Timmins: You made a really good point in that availability of information to us throws the responsibility on veterinarians in making sure we take the lead in having those standards and guidelines available on veterinary Web sites. That does become the standard as opposed to the standard somebody decides to come up with in Southern California.

Wilson: I would maintain that there are a lot of veterinarians who don't even know those guidelines exist. There's a fair number who don't go to CE on a regular basis. We deal with this a lot in the Paw and Order program and the Companion Animal Parasite Council and some of those recommendations. There was a lot of ignorance about standards. It's going to behoove us to assure veterinarians that, "Hey, maybe you ought to post these on your Web site." Or certainly you ought to be aware of what those standards are.

Rubin: I'll bring us back to Dan's original question. Has the profession responded well to changing expectations? There's been terrific movement. Not only do we talk about guidelines, as has been addressed here by the panel, but also expectations around communication skills. It's not just an education for veterinarians who are in school or as part of their continuing education once they're in practice or on a career path. It's a combination of skills that are important in order to be effective no matter what you do. We've seen changes with that.

We've seen the veterinary schools begin to recognize that great veterinarians know how to balance great life skills, communication skills, leadership skills, as well as science and technology so that we can deliver what's being expected from our consumer base. We've made some progress. We have a long way to go. I think there's been a lot of recognition over the last five to seven years with balancing of technical guidelines, skill sets and other factors to drive meeting the needs of our clients.

Verdon: There's been a longstanding tenet as long as I've been observing this market that companion-animal medicine has been recession-proof. I wonder if each of the panelists could comment on the state of the economy and whether that may potentially impact the amount of care provided?

Wilson: It's fascinating right now. I've got clients all over the country. When I'm not teaching, I'm consulting, and they're calling and asking how veterinarians are doing. A whole bunch of veterinarians are saying business is down. But it's very easy to look at the recession as a big cop-out on why things aren't going so well. I'd be curious to hear whether any of you think there are weather-related downturns, too.

Flanigan: Fleishmann-Hillard, a public-relations firm, did a small study of a few hundred pet owners at the end of last year. The survey talked about recession but we may not have felt the full effects of it. Consumers were asked to identify where they would cut back during a recession. Not surprisingly, the top things were spontaneous purchases and luxury items. Eighty-three percent were likely to cut back on pet supplies. People were more likely to cut their grocery bill, household goods and clothing than they were for pet supplies. When you dig down deeper, they're more likely to go without pet toys and pet fashion, thankfully. Veterinary visits and preventive medications were least likely to be cut. Twenty-five percent of consumers said they're likely to cut back on those things.

In the case of companion-animal medicine being recession-proof, I think in the larger picture, probably yes. But for the 20 percent or so of the public that is price-sensitive or somebody who is not able to make their mortgage payment, or somebody who's out of a job, certainly, that's going to be one of those things they're going to cut back on. But it's also likely to be on regular care, preventive care as opposed to something that's acute or needs to be addressed in the short term, because they don't want to lose the bond they have with that pet.

Timmins: Comments I've heard from veterinarians, particularly in California, are that clients are not cutting back on services. But they're hearing more complaints.

Rubin: It's interesting because we're hypersensitive to it. When we think about specialty medicine, it's different because the prices are bigger. When we talk about wellness or standard of wellness protocols, we're talking about being in the hundreds of dollars vs. procedures and illnesses that generate thousands of dollars' worth of veterinary bills. We have many practices that are routinely issuing bills between $5,000 and $7,000 for care. What's fascinating to us is that it comes down to fewer issues about their ability to pay. Not that you never have the conversation, but it's more about understanding what needs to be done. That echoes what Jim has said. If you describe it well, people will want to do the right thing for their animals.

ABOUT THE PANEL:

MODERATOR

Daniel R. Verdon is editor of DVM Newsmagazine.

PANELISTS:

Jim Flanigan is the American Veterinary Medical Association's (AVMA) director of marketing. He oversees the association's promotional, branding and strategic marketing initiatives.

John King, DVM, is executive director of the Minnesota Board of Veterinary Medicine. He became executive director of the Minnesota board in 2002 and also owns Veterinary Ventures, an ambulatory, primarily equine practice.

Howard Rubin is chief executive officer of BrightHeart Veterinary Centers, a national network of advanced-care veterinary facilities, based in Armonk, N.Y.

Richard Timmins, DVM, is president of the Association for Veterinary Family Practice. He is the director for the Center for Animals in Society at the University of California-Davis School of Veterinary Medicine.

James F. Wilson, DVM, JD, owns Priority Veterinary Management Consultants in Yardley, Pa., and teaches the subjects of veterinary law, ethics, business management and career development at 18 to 20 U.S. veterinary schools each year. Dr. Wilson authored six books and more than 130 articles in various veterinary journals.