Seeking the quick fix––cheap

From ANIMAL PEOPLE, April 2000:

Honolulu––Proponents of a Hawaii Department of Health Vector Control Division plan to ban feeding feral cats claimed at January public hearings that neuter/return practitioners who rely on feeding to lure cats into cage traps couldn’t possibly raise funds enough to fix all the half million cats whom state wildlife biologist Fern Duvall estimates are at large on Maui alone.

Veterinarian Sabina M. Wenner, founder and president of the Animal CARE Foundation (Hawaii), fixed that objection on February 23. Calling a press conference at Kakaako Beach State Park, where the ongoing dispute between kill-the-cats and fix-thecats factions has been most intense, Wenner announced receipt of a $10 million grant from an anonymous out-of-state donor.

“Wenner said it has not yet been decided how much money will be allocated to other Animal CARE Foundation (Hawaii) programs,” reported Pat Gee of the Honolulu S t a r – B u l l e t i n, “but said the focus will be to prevent cat deaths, by trapping them, neutering them, and returning them to an appropriate environment. Some of the funds would be used to set up facilities” to do neutering, and to provide care for cats who cannot be returned to the sites where they were caught.

Some cats may have chronic conditions requiring special attention; others may come from locations where they might be tempted to hunt endangered birds.

Funds would also be used “to reeducate people about abandoning an unwanted animal,” Gee said.

Wenner indicated to Gee that using all of the $10 million is conditional on raising matching funds. Enough money, however, is apparently available now to fix as many feral cats as volunteers can capture.

Another major Animal CARE Foundation (Hawaii) program assists animals who are injured by cars, and tries to identify roadkilled pets. Twenty-one veterinary clinics participate throughout Hawaii.

Because Wenner is a veterinarian herself, and already maintains regular liaison with many other vets, she may not run afoul of an intensifying global shortage of veterinarians who are willing and able to become neutering specialists and do shelter work.

The problem goes well beyond longtime veterinary fears that low-cost neutering and vaccination clinics will undercut private practice incomes.

But such fears persist, despite reams of data to the contrary. American Veterinary Medical Association statistics show that since 1987, coinciding with rapid expansion of low-cost neutering and vaccination programs nationwide, the percentage of U.S. dog owners who seek regular vet care is up 13%, to more than 85% overall, and the percentage of U.S. cat owners who seek regular vet care is up 17%, to nearly 70% overall.

The total number of pet-keeping households increased by more than 10 million over the same time, while veterinary expenditure per pet-owning household more than tripled, keeping well ahead of inflation.

The advent of low-cost neutering and vaccination thus appears to have been very good for the veterinary profession, as well as for millions of low-income Americans and tens of millions of dogs and cats who otherwise might never have come to a clinic.

Supply and demand

No veterinary jobs were lost. The number of working vets in the U.S. has increased from 45,000 circa 1990, of whom barely 20,000 mainly handled small animals, to more than 64,000 today, including about 32,000 who mainly handle small animals. Approximately 2,000 newly trained vets begin practice each year, according to USDA figures, while older vets are tending to delay retirement––partly because business is booming, partly because even with all the new vets coming into the field, there is an unforseen scarcity of younger vets ready to buy and take over a successful private practice.

Traditionally, vets started out as junior partners in a private practice. If they couldn’t find enough work alongside a senior partner, they doubled as relief vets or did allnight emergency treatment. As they developed a clientele, they either took over the practice upon retirement of the senior partner, or branched out on their own.

But that is no longer necessarily the career choice of most young vets.

“We have a generation of vets who don’t aspire to owning their own hospital,” lamented American Animal Hospital Association president Michael Paul last year to Jennifer Heldt Powell of the Boston Herald.

Growing demand for veterinary services of all kinds has created an unprecedented number of options which may be more lucrative and/or less risky than entrepreneurship.

Relief and emergency work, for instance, are now well-paid full-time specialties for many vets––and enable others to make a living while having more time off.

Franchised clinics are an increasingly attractive choice for vets who seek a stable income and don’t necessarily want to become clinic owners. Begun in 1986, Veterinary Centers of America had 160 clinics nationwide and now has more than 190––and is only one of the top franchised competitors for talent.

The veterinary public health field is also rapidly expanding, with increasing recognition of the frequency of zoonotic [animal-tohuman] disease transmission.

Even VetSmart, operating clinics in PETsMART stores, can’t find enough help.

 “We are very familiar with the shortage of vets,” VetSmart spokesperson Alex Schrage recently told Detroit Free Press staff writer Kim North Shine. “There is more demand than there is supply,” Schrage confirmed, adding “I don’t think it is temporary.”

The Michigan Humane Society seconds that. Executive director Gary Tiscornia strongly advocates neutering animals before adoption. The three MHS shelters all have inhouse full-service veterinary clinics whose work is divided among neutering adopted pets, treated injured strays, and treating animals for the paying public. The paid work subsidizes the rest. But the neutering clinics at the MHS Westland and Rochester Hills shelters shut down in mid-1999 because departures left just 11 vets to fill 15 positions. The available vets were concentrated at the Detroit shelter, which handles the highest volume of traffic and does the most free and low-cost work.

“I’ve been involved with this agency for 17 years, and we have never faced a veterinarian shortage like this,” Tisconia told Kim North Shine.

The Humane Society of Macomb County, also in Michigan, had just two vets to fill six positions.

“We could be in trouble if we don’t find people soon,” director George Fox said.

The MHS Westland and Rochester Hills shelters returned for six months to the neutering voucher system they used 15 years earlier, before the in-house clinics opened. Through October 1999, MHS was on pace to fix 13,000 animals, just under the 1998 pace, but it ended up fixing only 10,000.

Enough new vets have now been hired that MHS expects to be back to pace by the peak of the 2000 kitten season.

In Grand Rapids, Michigan, however, the Ottawa Shores Humane Society in March 2000 suspended a four-month attempt to neuter all pets before adoption.

“This decision was based on one thing,” executive director Celeste Jordan told John Tunison of the Grand Rapids Press. “Dr. James Bader could simply not to all of the neutering. I thought we would find more help than we got,” Jordan said.

According to Tunison, “The policy met resistance from several Ottawa County veterinarians who said they worried it could discourage pet owners from seeking further veterinary care.”

Global effect

The U.S. vet shortage is causing a ripple effect worldwide. Veterinarians are emigrating to the U.S. faster than foreign veterinary schools can train replacements, especially in specialty subjects.

“If we had a bovine encephalopathy crisis in Australia, we would most likely have to import veterinary pathologists,” Australian Veterinary Medical Association president Geoff Niethe warned in 1998, decrying “a drain of talent as result of cuts” in government veterinary training and research budgets.

The most extreme example of the effect of veterinary drain may be India, Veterinarians of Indian origin are abundant in the U.S., and include the entire veterinary staff of the Pennsylvania SPCA. Yet the ratio of veterinarians to domesticated animals in India is believed to be the lowest in the world. Specialists practically don’t exist.

The Indian veterinary shortage has emerged as the biggest obstacle to reaching the national goal of ending population control dogkilling by 2005––and to maintaining the nokill policies in Mumbai, Chenai, Visakhapatnam, and other cities which have already introduced such policies, contingent upon humane societies neutering and vaccinating enough street dogs to prevent rabies outbreaks and mauling by ill-behaved packs. Political outcry against the no-kill policies is constant, not only because street dogs are an easy target but also because capturing and killing them creates patronage jobs.

Ironically, much of the Indian veterinary community is reportedly standing back, afraid––like too many ill-informed U.S. vets––that high-volume low-cost neutering and vaccination will hurt their incomes.

Since the going rate for neutering by Indian vets in private practice is only $6.50, some well-placed U.S. or European foundation grants could go a long way toward alleviating Indian veterinary fears and getting the dogs fixed. But such help has so far been too small and too sporadic to make a major impression.

Unable to find needed help at home, Indian animal rescuers are recruiting abroad, without much success.

Maneka Gandhi, Indian cabinet minister for social justice and empowerment, has for more than a year been unable to find enough qualified wildlife vets to attend the animals coming into sanctuaries as result of her ministry enforcing a national ban on the use of tigers, lions, bears, other large carnivores, and monkeys in traveling shows.

Gandhi has also had difficulty finding vets to visit from the U.S., Europe, and Australia to teach Indian vets how to do earlyage and high-volume neutering.

Bonny and Ratilal Shah, operating a private sanctuary near Dallas and starting a sanctuary for donkeys near Bombay, are similarly frustrated in seeking an equine specialist to work at the Indian facility, or even to go there for long enough to teach a general practitioner all there is to know about donkeys.

Help In Suffering, operating hospitals in Jaipur and Darjeeling, and the Visakha SPCA, in Visakhapatnam, have used Help In Suffering director Christine Townend’s extensive foreign contacts to bring veterinary staff from Europe and Africa.

Spay/USA, sponsored by the North Shore Animal League, is sending vet Jeff Young to teach high-volume and early-age neutering to the staff of the Blue Cross of India hospital in Chennai.

Spay/USA addressed dog-and-cat overpopulation in eastern Europe during the past several months by bringing to the U.S. for advanced training Austrian vet Amir Khalil plus five other vets who work with him––two Romanians and three fellow Austrians.

Khalil directs street dog neutering clinics in Bucharest, Romanaia; Budapest, Hungary; and Sofia, Bulgaria. Each clinic serves half a dozen or more local aid-and-rescue projects.

Khalil and associates studied earlyage and high-volume neutering at the People for Animals clinic in Hillside, New Jersey; the Humane Alliance clinic in Asheville, North Carolina; and Jeff Young’s home base, the Planned Pethood Plus clinic in Denver.

Veterinarians willing to work for low wages can be found in the former Soviet Union and satellite nations. They tend to be former agricultural vets, however, who have been displaced by economic transition, and have few of the skills expected of shelter vets.

The International Fund for Animal Welfare anticipates that training––or retraining––vets will be among the major expenses associated with putting Moscow’s first mobile neutering clinic on the road this year.

The February IFAW mailing that announced the Moscow project also announced that IFAW and the Animals Asia Foundation are working “to help fund the spaying, neutering, and vaccinating of stray dogs,” aspects of humane work almost totally neglected by other international organizations making a show of working in Taiwan.

Vet techs

As the basic neutering operations for dogs and cats are simple, veterinary technicians could do the routine surgery––if veterinary regulators would allow it. Laboratory technicians already neuter tens of thousands of lab animals per year in the U.S., with only distant veterinary supervision, and farmhands with no formal training or supervision whatever neuter millions of cattle and pigs.

But even if veterinary regulators could be persuaded to let vet techs take more of the action, the demand for vets extends to techs as well. Vet tech pay barely kept pace with inflation during the 1980s, leading to a 5% decrease in the number of applications to two-year vet tech degree programs.

Simultaneously, veterinary schools experienced a surge of female applicants, belatedly following court decisions that opened all U.S. veterinary schools to women after 1970. As of 1969, only 5% of U.S. veterinary students were female. Today, about a third of all practicing vets are female––and women make up as much as 75% of the current vet school student body.

Excluded from many vet schools, or from the student loans they needed to attend, some female veterinary candidates might previously have just become vet techs. Others already are vet techs, who decided to improve their skills and increase their opportunities.

Vet tech school admissions are up again, but the openings for vet techs are still increasing faster than the supply.

Scrambling to hire from a depleted veterinary talent pool, animal shelters and nonprofit neutering-and-vaccination clinics are learning that to succeed, they must offer attractive facilities, capable support staff, and fulltime jobs at competitive pay.

Paying vets

Scarcity is now driving both veterinary and vet tech incomes up, fast. Animal protection organizations that a few years ago budgeted to hire vet at $45,000 a year are often finding that vets willing to work in that pay range are simply unavailable. Shelter vet techs earned under $18,000 a year, on average, as recently as 1997, according to Society of Animal Welfare Administrators salary surveys ––but vet techs in private practice now start at $20,000 and up. Experienced vet techs make $26,000-$35,000.

Veterinary incomes currently range, by AVMA-determined median, from $59,000 per year for all-animal general practitioners up to $76,000 per year for equine vets, large-animal general practitioners, and veterinarians at university research facilities. Shelter vets fall among the middle range: higher on the coasts, lower in the midwest and south. Chiefs of veterinary staff at big-city shelters and neutering clinics now commonly command salaries of $100,000 and up, depending on experience.

Mobile clinic pioneers Arnold Brown, John Caltabiano, Peggy Larson, Hugh Whier, and Jeff Young, early-age neutering pioneer Leo Lieberman, and high-volume neutering pioneer Marvin Mackie developed their now widely emulated approaches while usually working for much less than other vets earned. That was part of the price of breaking ground.

But some younger vets who have learned their methods are making more money within just a few years than any of the pioneers ever did––and they say they must, since the cost of getting a good veterinary education is also sharply up.

The salaries that neutering specialists and shelter vets now command can shock organizations expecting to save money as well as save lives and prevent animal births by adding an in-house clinic or mobile unit.

Neutering all adopted dogs and cats before they leave the shelter does save lives, by ensuring that the job gets done before the animals breed, and having a mobile clinic to fix feral cats wherever they are can make a marked dent in “kitten season” shelter intake, but either an in-house clinic or a mobile clinic can actually cost more per surgery––much more––than subsidizing neutering done by private practice or franchised vets.

Hidden costs include the price of building sterile surgery and recovery facilities in older shelters which were never built to be much more than death camps for dogs. The facilities not only must be adequate; they must look adequate, to satisfy an increasingly critical clientele.

Traditionally, activists have fought to get shelters to start neutering animals on site, but last winter in Orange County, California, activists fought to keep the county animal control agency from introducing on-site neutering, claiming––amid a deadly distemper outbreak––that the facilities and personnel were not up to the job. Shelter veterinarian Richard Evans resigned in January.

Savings come only if the nonprofit facility handles significantly more animals per day than most private practice vets can.

Volume, assisted by vet techs who do everything a DVM does not absolutely have to do, is the secret of success for Animal Foundation International, whose 10-year-old Las Vegas clinic is the most widely emulated example of how to do what founder Mary Herro calls “assembly-line” neutering.

Volume, accomplished by more than 100 cooperating local organizations and fixed-site veterinary clinics whose people help to get cats assembled and ready for surgery, is also the secret of success for the Vernon A. Tait All-Animal Adoption, Preservation & Rescue Fund. The late Mr. Tait’s estate has enabled John Caltabiano’s Tait’s Every Animal Matters mobile clinics to neuter more than 30,000 cats since 1987 in Connecticut and upstate New York.

Caltabiano takes no salary, but pays other vets six-figure salaries plus bonuses to meet volume targets; pays vet techs as much as some vets made when first Arnold Brown and then Caltabiano introduced mobile neutering to New England in 1979-1980; and equipped his current 28-foot neutering van with a $1,300 stereo system in hopes, he told ANIMAL PEOPLE, that it would help keep his staff happy during long days on the road.

SNAP

Among the most ambitious neutering projects in the U.S. is Spay/Neuter All Pets, founded and directed by Sean Hawkins, of Houston, sponsored from 1994 until mid-1999 by the Fund for Animals. Now independent, SNAP has fixed-site clinics in Houston and Dallas, mobile clinics in Houston and San Antonio, a mobile clinic serving Native American communities, and a mobile clinic scheduled to begin work with the Sociedad Protectora de Animales in Monterrey, Mexico, this spring.

“For calendar year 1999,” Hawkins told ANIMAL PEOPLE, “the SNAP Houston clinic performed 13,322 neutering surgeries and provided wellness service to 10,583 animals. SNAP Dallas performed 8,059 neutering surgeries and provided wellness service to 1,053 animals. SNAP San Antonio performed 4,201 neutering surgeries and provided wellness service to 1,830 animals. The SNAP Houston mobile unit performed 4,016 neutering surgeries, and the SNAP Indian Nation Mobile Clinic performed 1,068 neutering surgeries,” but didn’t even begin until late in the year.

Altogether, SNAP neutered 30,566 animals in 1999, and treated 44,032.

The SNAP Houston hospital “performs 40-50 surgeries seven days a week, year round,” Hawkins said. “It is usually booked two to three weeks in advance.”

Since 1993, Houston-area shelter intakes have held steady at about 110,000 animals per year––but the Houston-area human population has increased by about one million people. Shelter killing per 1,000 Houston-area residents has dropped by a third.

After expanding the Dallas hospital, “and adding a Spay Shuttle program to transport animals to and from the clinic for those who need such service,” Hawkins continued, “SNAP will provide direct care to more than 50,000 dogs and cats in 2000,” on a projected budget, exclusive of construction costs, of $3.5 million.

About 4,000 to 5,000 neutering surgeries will be done in Mexico, all for free, by Mexican vets––the first authentic high-volume neutering program anywhere in Latin America.

“Besides setting an example, hopefully to be followed by others in Mexico, we hope our program helps to elevate the status of animals in Mexican society,” Hawkins said, going on to describe how Mexican rabies control facilities are “basically catch-and-kill operations, with no adoptions or reclaims,” where animals are caged without food until enough are bunched that they can all be soaked with a hose and electrocuted with “a device similar to a battery charger. It is the most horrifying experience I have witnessed,” Hawkins added.

SNAP is also hiring a vet to visit rabies control facilities, euthanize injured animals, and––Hawkins hopes––do whatever is necessary to coax the authorities to replace electrocution with killing by lethal injection.

Life on the road

Private practice vets often claim mobile clinics cannot perform neutering with the same assurance of medical safety as fixedsite clinics––a seemingly trivial concern considering that if mobile clinics were not neutering the animals they serve, millions more would suffer deprivation and cruel death.

Mobile practitioners counter that mobile clinics run by vets who know what they can and can’t do have just as good a record as any. Private practice clinics on average lose about 4% of their animal patients in surgery, chiefly due to complications of anesthesia, but Caltabiano lost just eight of the first 18,000 cats he handled.

Jeff Young and the mobile Flathead Spay and Neuter Task Force, however, were hauled before the Montana Board of Veterinary Medicine in January 2000, after neutering 5,500 animals at 31 clinics on Native American reservations since 1997.

Directed by Jean Atthowe, as a project of the Montana Spay/Neuter Task Force, the Flathead work is credited by Mission Valley Animal Shelter executive director Linda Crawford with cutting intakes at her facility in Polson by about a third, and shelter killing by about two-thirds.

Flathead Reservation animal control officer Darcy Maiers told Ginny Merriam of The Missoulian that he killed 600 homeless puppies in 1998, before Young came that November, but had to kill only 26 in 1999.

Lesley A. Colby, DVM, of Christiansburg, Virginia, first volunteered to assist Young at a two-day clinic in Kalispell during September 1999, and then formally accused him of “illegal, unethical, and unhealthy practices,” including allowing a vet tech to castrate from four to six cats.

The Montana Board of Veterinary Medicine heard Colby out, but unanimously dismissed the complaint.

“Mobile clinics will never be able to safely and efficiently perform the volume of surgeries that stationary clinics can perform,” Hawkins told ANIMAL PEOPLE. “Mobile clinics are great for addressing a specific problem in a specific area, such as large metropolitan areas where many people lack transportation, or rural areas with people who cannot drive long distances to access care. In Houston we have both. The city itself occupies more than 700 square miles––so there is a need for both mobile and stationary clinics.”

However, Hawkins believes, “Stationary clinics will have to be relied upon to dramatically reduce numbers.”

The SNAP mobile units work four days a week, with the staff working 10 to 11 hours per day.

Staffing mobile units sufficiently to keep them on the road for more time, doing more surgeries, would be disproportionately costly. Young, Hugh Whier, and Peggy Larson are known for their willingness to stay on the road, but most vets don’t care to live like truckers.

Equally important, the scarcity of vets and cost of hiring them means that nonprofit organizations need to make sure the vets they hire spend their time operating, not driving. A nonprofit organization can buy three or four vans and hire three or four drivers to shuttle animals to and from a fixed-site clinic for less than it costs to run one mobile clinic. Shuttling can also be done by volunteers.

Low-cost neglected

Save Our Strays author Bob Christiansen recently spent six months on a sales tour of the U.S. sponsored by the mobile clinic builder LaBoit Inc. As a former shelter director, Christiansen was sold on mobile clinics even before he began selling them.

But his major finding at a series of town meetings hosted by humane societies to discuss pet overpopulation, he told ANIMAL PEOPLE, had little to do with clinic options per se. Rather, it was discovering “How little we are doing to provide neutering assistance to qualified low-income people. The fact is,” Christiansen said, “this segment of society has more animals and more intact animals than any other. It’s not a question of whether these people should have pets; they do. The problem is that they can’t afford to have them altered. This should be the primary work of animal social service agencies,” as Christiansen likes to describe humane societies.

“I thought providing economic assistance to people who could not afford neutering had become commonly accepted,” Christiansen continued. “What I found, to the contrary, was that discounts averaging about 20% were the norm. Even neutering clinics run by shelters primarily offered discounted service, not real low-cost sterilization. There is a difference. To low-income individuals,” below the U.S. poverty line, “if it costs over $10, it is too expensive. Oh, if people asked and pleaded and begged, these shelter clinics might alter an animal for free, but free services are not aggressively promoted, nor did I find any city doing significant amounts of free neutering. Why? Because a low-cost spay/neuter program is an expense; a discount spay/neuter program is revenue.”

Trying the hard way

For humane organizations not fortunate enough to be backed by an anonymous donor of $10 million, lack of money is still an ever-present obstacle, and the rising price of vets only stands to make it worse.

Corinne Wolpe, executive director of the Humane Society of the Yukon, in Whitehorse, described the sort of neutering arrangement that ambitious shelters typically try when they cannot afford a vet.

“Dogs outnumber people here,” Wolpe told ANIMAL PEOPLE, “mostly I think, because we have so many dogsled teams. We cannot afford to spay and neuter all animals coming into the shelter, but our adoption fee confers the cost of neutering free of charge at a local veterinary clinic. We actually have a pretty high rate of sterilization amongst adopted animals,” Wolpe claimed, “but there are just so many out there. In addition, we have a rather large segment of the population who, if I may be blunt, belong in the dark ages in terms of attitudes towards animals.”

The Yukon policy is essentially the same that came to prevail around the U.S. after Los Angeles introduced a low-cost neutering voucher system in 1973. Surveys of the success of voucher systems have rarely found neutering compliance rates exceeding 70%; 55% is approximately average.

From the voucher approach, the animal care-and-control and humane communities have gone two different ways. One is attempted legal compulsion, through high license fees for unneutered pets and/or aggressive catchand-kill policies directed at feral cats. It has been tried in one form or another in countless places. It has achieved sharp reductions in the numbers of animals killed at shelters only in Calgary, Alberta, Canada, where citizens seem unusually inclined to obey the law.

Edmonton, Alberta, just adopted similar ordinances. So did Los Angeles. New York City and Berkeley, California, have been debating such ordinances for months.

High license fees usually do little because relatively few dogs and cats are licenced in the first place––just 24% of Los Angeles dogs, estimates L.A. Department of Animal Services manager Dan Knapp.

Kill-the-cats does less, since cats rapidly breed back to the carrying capacity of their habitat.

Kathy Lindeman, animal control officer for Wallingford, Connecticut, told the city ordinance committee on February 17 that the only visible effect of a catch-and-kill mandate adopted there in 1998 has been that “Cat euthanasia rates have skyrocketed.”

But the city council in Prosser, Washington, on March 7 began considering a similar ordinance.

Going the other way

The other approach is finding out where unwanted dogs and cats are coming from, and why people don’t neuter their pets. The latter is inevitably a combination of cost considerations and lack of access to veterinary service, with a small element of acculturation. Programs must then be formed to respond directly to the need, including the need to neuter feral cats as well as owned cats.

That’s what the San Francisco SPCA did, to lower the rate of shelter killing in San Francisco from above the U.S. norm 25 years ago to just 3.9 per 1,000 residents in 1999–– less than a quarter of the U.S. norm, and 10% of the norm in the South.

But it doesn’t take a big-city SPCA to achieve comparable results. Dick and Jean Wilson of Flagstaff, Arizona, started Plateauland on the desolate Navajo Reservation in 1995.

“At first it was just a homemade trailer hauled with a truck,” Dick Wilson told Associated Press last December.

Incorporated to raise funds as the Robert T. Wilson Foundation, Plateauland neutered 3,300 animals and vaccinated 9,000 in its first four years––and inspired Indian Health Service nurse Mary Jo Parys and Father Menard of St. Jude’s Catholic Church in Tuba City to start the Tuba City Humane Society.

In a region with just one vet for hundreds of miles around, an inspired initiative has gone a long way.