Have ophthalmologist? Will hire

Veterinary ophthalmologists are never unemployed, especially in the Midwest,concedes Dr. Kerry Ketring, owner of the All Animal Eye Clinic in Cincinnati,Ohio.

"How many people do you know that were raised somewhere else thatchoose to live and work in the Midwest?" says Ketring, DVM, Dipl. AmericanCollege of Veterinary Ophthalmologists. "Ophthalmologists can get ajob anywhere. A lot of them ski; a lot of them like water. Unless you'refrom this part of the country, the likelihood you'll come back is very slim."

Ketring is an exception. Born and raised in Fairborn, Ohio, he openedhis first clinic in 1977 in Springdale, just north of Cincinnati. He recalls12 other private practices in existence nationwide at that time, with mostremaining veterinary ophthalmologists practicing at universities.

The total number of eye specialists has tripled since 1977 in the UnitedStates. Today about 75 percent of the 220 diplomates are in private practice.Such growth might seem heartening, suggesting healthy competition and increaseddemand by pet owners.

But Ketring, 53, faces good and bad news. On one hand his business -one of only four private practices in Ohio - is thriving; he has met upto 95 clients in one day. At the same time, it is becoming difficult toservice such high volumes consistently.

"He's probably one of the busiest in the country as an individual,"says David Wilkie, DVM, Dipl. ACVO of The Ohio State University's (OSU)Ophthalmology Service in the College of Veterinary Medicine.

"Ophthalmology is an exceedingly busy specialty," says Wilkie,who has collaborated with Ketring on cases for 16 years. "There arenot enough veterinary ophthalmologists to deal with the demand. All of ushave more business than we can handle. The average wait at the universityfor cataract surgery is six to eight weeks."

A typical day for Ketring starts at 8 a.m. He begins seeing clients,who, between 9 a.m. and 6 p.m., wait on church pews in one of two exam rooms.Pet owners can pass time by viewing poster-sized photographs - taken byKetring, an accomplished photographer - of various ophthalmic diseases.His surgery room is in full operation on Wednesday and Thursday afternoons,and on Wednesday he remains open for clients into the evening.

Ketring once operated clinics, on a part-time basis, in Kentucky, Daytonand Indianapolis, while operating his full-time Cincinnati facility. Ofthe four locations, only the Cincinnati and Dayton facilities remain open,although, as Ketring confesses, "I see more clients than I've everseen." His philosophy - "I see the case" - leaves no roomfor the word "no."

The clients, usually referred by general practice veterinarians, hailfrom southern Ohio, Kentucky, and as far away as West Virginia and the Tennesseeborder.

In 2000 the clinic serviced 9,300 total clients, of which 2,009 werenew. All Animal Eye Clinic averages 40 clients a day. The practice in 2000was up 14 percent from 1999, according to Ketring.

Time not on his side

Because of an extremely busy clinic, says Ketring, "There are someaspects of ophthalmology that I don't have time to develop an expertisein. Instead of slowing down to do things I want to do, I don't have time."

With his booked schedule, Ketring still services a group that handlesRaptor birds, animal welfare leagues and regional shelters. He used to maintainstanding Monday appointments for Save the Animals Foundation, which rescuesstray cats. Time constraints and increased business have limited this volunteerwork.

Outside the office, Ketring served as past president of the AmericanSociety of Veterinary Ophthalmology and maintains membership in the AmericanVeterinary Medical Association, and the Cincinnati Veterinary Medical Associationfrom which he received a service award for initiating guide dog and policedog clinics. He initiated the guide dog clinic in 1986, and it has sincebecome a service dog clinic as dogs for the hearing impaired and the likeare also screened for health problems..

With more time Ketring could prepare more lectures in addition to hisscheduled 2001 presentations at venues such as the Michigan Veterinary Conference,the American Animal Hospital Association annual meeting and Western VeterinaryConference.

He says he would perfect his hobby of photographing numerous animal casesand converting them into slides to share with clients. Without the photos,Ketring guesses he would not be able to write books, such as two atlasesco-written with the assistance of Dr. Mary Belle Glaze at Louisiana StateUniversity.

"Having books to show the clients is very beneficial," he says."If you're coming in here and your dog has an eye problem and I canshow you a picture of the dog's eye problem - giving some examples - thatadds credibility to what I'm doing."

Making eye contact

Cataracts are likely the most "popular" procedure Ketring handles.Occasionally, if business is too heavy, he forwards some of these casesto OSU.

Wilkie, of OSU, has collaborated with Ketring on cataract lens implantcases and cases that need CAT scans or MRIs, for example. OSU then typicallyrefers cases back to Ketring for follow-up.

"I don't think we view each other as competition - we really havea fairly collegial attitude," says Wilkie.

Other cases for Ketring include corneal grafts and intra-ocular prostheses(artificial eyes) for dogs who have end-stage glaucoma. The artificial eyesuse medical silasticon, best described as a black rubber ball. The entireprocedure costs about $650.

Difficult, tedious procedures, says Ketring, are "in the eyes ofthe beholder. People are always impressed with prosthesis and cataract surgery.Corneal grafts are more difficult. Cocker Spaniels, ShihTzus and diabeticdogs are likely candidates for prostheses or corneal grafts."

His list of sight-impaired suspects includes many common breeds of dogsand cats. More unusual "visitors" include zoo animals, such aswhite tigers, elephants, gorillas, bongos, antelopes and a koala bear.

One unusual animal case sticks with Ketring. Some time ago he took ahuman retina specialist with him to a zoo to examine a gorilla. While theytranquilized the animal, the human specialist began examining it. Keep inmind, says Ketring, that the gorilla can still move.

"He's looking at the gorilla, and the gorilla starts to raise hisarm," he says. "It scared him to death. He ran out of the cage,but forgot to take off his head gear." The specialist has not beenback.

The human retina specialist is not alone in his misunderstanding. Ketringrecalls a female lecturer at a veterinary conference who told the audiencethat when dealing with aggressive dogs, never make eye contact. Ketringraised his hand, "What happens if you are a veterinary ophthalmologist?"She proceeded to the next question.

Heart of the matter

Ketring admits he would love to have one of today's 220 specialized practitionersworking in his 1,600 sq. ft. office, even though he is very pleased withhis two veterinary technicians, Tammie Wells and Mary Carlotta.

"If I knew someone in town or in the Midwest who wanted to be aveterinary ophthalmologist, that would be my best bet. No fledgling ophthalmologistis coming up with plans to open in Cincinnati," he says.

What worries Ketring though, is not so much the "missing" veterinarian,but that there aren't enough specialists available. Despite the apparentgrowth since the '70s, more students could be choosing veterinary ophthalmology.However, he says universities rarely have enough veterinary ophthalmologistson staff to train them.

Once students complete their DVM, says Wilkie, competition for employmentis between a university or private practice. The bulk are going into private,he says, where the business is lucrative.

Ketring's steady business reaps profitability, but at a cost. "Whatreally suffers is the client communication," he says, in referenceto the number of clients in his office each day.

Ketring is usually unable to spend more than 10 minutes with clients,barring surgeries. His technicians, Wells and Carlotta, come to his aidby spending time explaining potential procedures, while Ketring moves on.

Wells says she and Carlotta brief clientele on various emotionally-involvedprocedures, including eye removal. Wells shows a photo album with examplesof healthy dogs that have undergone various procedures. Additionally, sheexplains how to apply medications and fields many questions.

Both technicians assist with animals and owners that may have drivena long distance for an animal emergency. In advance, the clinic sends outemergency packs of medications to such clients. For example, Crumpet, aHound Dog, was diagnosed with glaucoma and is swiftly going blind. The clinicsent the owner a pack to help reduce high pressure. Otherwise if the waitexceeds 12 to 15 hours, dogs can go blind, she says.

Ketring has tried to free up time by trimming his number of rechecks,sending patients to veterinarians, or talking to veterinarians on the phone.Even when Ketring leaves the office, he takes his cellular phone with him,which never stops ringing.

Eye technology

Ketring recently jumped the Internet bandwagon by launching the clinic'sWeb site in mid-2000, in part due to client persistence.

However, target audience for the site at www.allanimaleyeclinic.com isthe veterinarian or ophthalmologist. Ketring purposely chose not to posttreatment protocols for different diseases, preferring to see clients toexplain procedures firsthand.

Despite this decision, Ketring says, "I get clients that come inwith stacks of paper containing information they got off a Web site. ButI spend a great deal of time explaining why I disagree with some opinions,"he says.

The site recently added an informational section called "News andFacts." Future plans for the site call for illustrations for felinediseases.

Additionally, All Animal Eye Clinic has invested in high-tech equipment,valued at $100,000. Equipment includes a CO2 laser, $22,000 ultrasound,a surgical suite, operating microscope, ERG, several indirect ophthalmoscopes,several $2,900 Tonopens, which measure pressure in glaucoma patients, andseveral medical cameras.

Looking ahead

After Ketring locates a technician and veterinarian to hire, he sayshe would expand his facility.

And further down the road, Ketring, who maintains his license in Michigan,says someday this would be the prime spot to retire.

But don't say that word too loud.

"One woman had a fit when she heard me mention that I would somedayretire. People were quite upset when I closed prior practices. I want tofind an associate, but I have almost given up hope. The practice is toobusy for one person."