The Crisis Facing After-Hours Emergency Care

The Crisis Facing After-Hours Emergency Care

By Justin Toth, DVM, GVMA Immediate Past President

Dr. Justin Toth

During the pandemic, caseloads have increased exponentially for veterinarians throughout the country. Many hospitals are so overwhelmed that they are not accepting new patients. To make things worse, the labor shortage is also affecting many hospitals.

During this time of increased demand, emergency clinics are also feeling the strain. Many emergency hospitals are reporting a 5+ hour wait for emergencies that are deemed as not life-threatening. In the past few years, two of the emergency hospitals that service the northwest metropolitan area of Atlanta have either closed their doors or reduced operating hours to weekend only. The closure of these facilities has increased the burden for all of the surrounding veterinary emergency community.

Recently, a group of concerned veterinarians from the affected area formed a task force to determine the best method to reestablish local after-hours emergency care as quickly as possible. Our hopes are to encourage veterinarians, technicians, and assistants within the local veterinary community to cover 1-2 shifts per month at the existing facility. If enough people agree to participate, emergency services could be operating at a normal volume before the end of the year.

The GVMA is fortunate to have an emergency clinician serving on our Board of Directors, Dr. Jennifer Pittman, DACVECC, a Critical Care Clinician at BluePearl Pet Hospital in Sandy Springs. Dr. Jo April Brown (the owner of Rivertown Veterinary Emergency in Columbus) has also agreed to provide her input on the matter.

What has been your experience over the last year working in Emergency Medicine & Critical Care?

Dr. Brown: The problems that we faced as emergency practitioners during the first year of the COVID-19 pandemic (initial mass hysteria, overwhelming demand for services due to frequent general practice shut-downs, increase in medical “emergencies” due to the inability (or unwillingness) of owners to seek annual preventative veterinary care for their pets, and general financial uncertainty of both clients and our own small businesses) have now spawned a whole new set of frustrations. In this second year of the pandemic, not only has the number of pets per household increased, but the demand for veterinary care has sky-rocketed. General practitioners continue to be overwhelmed in an attempt to make up the deficit in veterinary care from the previous year, while addressing the needs of newly acquired pets, causing a backlog of cases needing prompt veterinary attention. Inevitably, emergency practitioners were expected to fill in the gap, servicing the needs of pets that were unable to schedule an appointment to see their regular veterinarians, as well as being expected to continue to manage actual emergency cases that could not wait for an appointment.

Dr. Pittman: The past year has brought a significantly increased caseload and an overall staffing crisis (in all components of our industry). The stress of this, coupled with the additional stressors associated with the continual flux of circumstances within their homes and communities, have left many in our profession facing burnout, leaving the profession, or requiring extended time-off.

What have the additional challenges been and why are they occurring?

Dr. Brown: Emergency veterinarians are now forced to limit services to only those with “life-threatening” conditions, and refer those with minor issues (skin, ears, eyes, nails, allergies, or more benign chronic ailments) back to general practitioners to manage as best they can. The fear and mass hysteria from the initial onset of the pandemic has now turned into an atmosphere of frustration and anger, as clients frequently belittle, verbally abuse, and intimidate staff members in an attempt to demand service for their animals (whether they are actual emergencies or not). Many of us have adopted “Zero Tolerance” policies regarding profanity, verbal abuse or violence of any kind directed at our staff. We are forced to remind clients that we are all doing our very best to provide them with excellent service and often find ourselves thanking them ahead of time for respecting our right to an “abuse-free” workplace. We are not unlike many of our emergency counterparts nationwide, in that we have had to involve law enforcement on multiple occasions, increase security, and implement additional measures to protect our staff during this new culture of volatility. By far, our biggest enemy throughout this pandemic has become social media, as “armchair activists” and “cyberbullies” (whether they are involved in a situation or not) have chosen to lash out online in an attempt to sabotage the morales and the livelihoods of those of us who continue to be on the front lines, despite our exhaustive efforts to alleviate some of the backlog as best we can.

Dr. Pittman: Many of the challenges we are facing revolve around the skyrocketing caseload and a decrease in staffing due to the nationwide labor shortage. Emergency clinics are now seeing nearly twice as many cases as they did prior to the pandemic. Pet ownership drastically increased over the past 18 months creating an unprecedented rise in the number of pets who need treatment. We also have intermittently undergone supply issues, becoming resourceful in many ways to ensure we have the equipment and medications to perform our daily jobs.

What effect is the labor shortage having?

Dr. Brown: The labor shortage has affected us primarily in our attempts to hire new employees, as many applicants are motivated by the prospect of filing for unemployment benefits after working for only a few months. We are fortunate that Georgia is an “at will” employment state, and affords us the opportunity as business owners to combat fraudulent unemployment claims with supporting documentation when appropriate. For our practice in particular, we recognize that our most valuable practice asset is our staff, and at the onset of the pandemic, we instituted “COVID pay” by increasing the pay rates of our employees by $2.00/hr. This pay raise eventually became permanent as the pandemic persisted, and as small business owners, my partner and I made the necessary sacrifices to join the 1% who continued to pay their staff during two separate shut-downs (without any government assistance), reimbursed employees for COVID testing, and continued to pay employees who were quarantined in their homes for the safety of the rest of our staff. We maintained employee incentive programs, bonuses, and monthly prize drawings, and have been rewarded by a staff that has been both loyal and appreciative as we continue to fight alongside them on the front lines. Our courage to implement a “Zero Tolerance” policy for the well-being of all of our employees has made a lasting impact on staff retention, and continues to promote an environment of support and encouragement from the top down.

Dr. Pittman: The labor shortage has led to the need to temporarily suspend services in many emergency clinic locations across the nation. These temporary service pauses or closures result in decreased access to emergency veterinary care and referral opportunities for millions of pet owners.

What advice would you give general practitioners to help ease the burden and/or make sure there is a good transfer of care?

Dr. Brown: As the only remaining after hours emergency facility in our area, we long for the day that general practitioners are open on Saturdays once again, and have been fortunate that the majority of our colleagues continue to call us ahead of time when they need to transfer a case for overnight or weekend care. We pride ourselves on being a cooperative practice that does not compete with our colleagues, as we do not practice regular medicine, offer preventative care or perform elective surgeries. This has served us well in the community, and has allowed us to promote one another and provide continuity of care throughout our region.

Dr. Pittman: Communication is key – providing us with case information and allowing emergency clinics to provide information about services and expectations
for pet owners before their arrival.

What are you doing for sustainability?

Dr. Brown: Our practice is owned by two full-time DVMs, who have BOTH been working 120+ hours a week, 365 days a year, for 3 years now. After the first year of this pandemic, we stopped accepting patients after midnight, due to staff safety concerns. We just recently began closing one night a week in an effort to alleviate the exhaustion of our veterinarians and our staff, and are doing the best we can to avoid “burn out” so that we might keep our promise of providing the best emergency veterinary care we can to the community we serve.

Dr. Pittman: For doctors, we continue to maintain a robust house officer program, training both interns and residents to help build our profession. In addition, we have a strong focus on the EmERge program in which new graduates are rapidly trained to be skilled Emergency clinicians by advancing their skill set, helping them gain confidence, and receiving higher pay more quickly than traditional training programs. We have also made significant investments in our entire paraprofessional staff, launching programs
to provide them additional training and compensation opportunities.

Taken from the winter 2021 edition of “The GA Vet,” a GVMA member benefit!