See the Full Issue
March 2023
Telehealth Increases Accessibility—and Visibility—of Veterinary Care
A conversation with Cherice Roth, DVM, MS
A Conversation with Cherice Roth, DVM, MS
Telehealth had its place in veterinary medicine prior to COVID-19, but it was after the world went into quarantine that most practices realized they needed to find creative ways to reach their clients when they couldn’t be in the same room. Since then, debates have simmered over how we can best and most responsibly use telehealth, what constitutes a valid veterinary-client-patient relationship (VCPR), and whether our overstretched teams can handle juggling one more thing.
Cherice Roth, DVM, MS, chief veterinary officer of Fuzzy Pet Health, talks about telehealth in a way that just might give us all reason to rethink how we’ve previously seen it. In Roth’s words, “This is where we get to turn the page and start a new chapter in veterinary medicine, and I think the very first line of that chapter absolutely has to be about this being accessible to everybody—and the way that you start that is by telehealth.”
Cherice Roth: [COVID] was kind of the forcing function, but for telehealth in general, we’ve talked about it as a way of expanding practices and offering this as a nice-to-have in certain populations of people, but I think it can be so much more than that.
Katie Berlin: Everybody jumped on the [telehealth] bandwagon as soon as the pandemic hit, and we were doing consults over Zoom and FaceTime and Skype, and whatever platform we could get our hands on that our clients would use, and scraping together a telemedicine program because we had to.
“I’ve had pet parents in video consults where I get on the screen, and they’re like, “Are you the doctor?” And I’m like, “I’m the doctor.” And they just light up.”
—CHERICE ROTH, DVM, MS
CR: The part that was missing, and why I think we started to see it start to drift away, is that so much of telehealth is communication, and the training of those clinicians or of the veterinary [technicians and assistants needs to be] not just in the art of medicine, but in the art of being able to communicate the value of what you’re doing. We had great clinicians that [could] talk to you about a CBC, no problem. But being able to explain that remotely through a screen while relaying that you actually care is much more of an art form than we gave it credit for.
KB: Any holes that we had in our exam room communication could be swept under the rug because clients expect a certain experience when they’re in an exam room. But so much of it gets concentrated in that little screen when suddenly cues you didn’t even know you were giving become really important. Like, oh wait, I do that with my face when I’m listening?
CR: Oh, my God. That’s me.
KB: Yeah, same. It’s very difficult for me to hide what I’m thinking. Masks were a gift in that way. But we never got that escape over telemedicine. So we were masked in the exam room, masked with our friends, and then on the screen with this near stranger, potentially trying to get them to believe that we care, and there’s nowhere to hide.
CR: I think that the part that’s so cool about it is we started seeing clients that we’ve never seen before. Suddenly, people that may have to ride the bus to get their pet to a vet clinic could now show up for an appointment. Or people that can’t take time off work […] still could get care for their pets. It opened this small glimpse into a population of pet parents that care so deeply about their pets, and now they can also access the care that their pets deserve.
KB: One thing you had started to allude to before is that a lot of the higher touch practices who have continued to use telehealth are using it sort of as a concierge service. Their clients expect a certain level of service, and they’re providing it as a differentiating factor from the clinic down the road. But I haven’t heard many people talking about telehealth as an access-to-care tool. That maybe other practices, who don’t have that type of clientele, can benefit from telehealth also.
CR: We get this beautiful cross section of pet parents that come through Fuzzy; it’s all layers. We have pet parents that use us that are homeless, and we have pet parents that use us on a daily basis when their pet’s going through chemotherapy, which we know is not cheap.
And there are things that are nonnegotiable. Every single one of them, regardless of where they are socioeconomically, deeply cares for their pet. I think that there’s a layer there that we can tap into, with several aspects. The first is definitely making this more affordable. There is economically less overhead to running a telehealth practice than there is for an in-person practice. Now, it doesn’t get you out of having to have good partnerships, running great diagnostics, or doing the work medically. But what it does is it allows you to open the door to educating these pet parents that may not know the value of flea and tick prevention and how it keeps not just their pet safe, but also their family, and also the kids and the other animals that may be on their property. And then it can become more of a priority.
We’re running 24/7, so we get to see this as something that fits into the life of every pet parent, regardless of whether or not they make a ton of money. Maybe they’re night shift, and that’s the one time they’re awake. A lot of practices that aren’t doing that are missing out on that portion of it. That being said, it’s difficult to suddenly decide you’re going to run your practice 24/7. There’s a practical side to that too. And so that’s where really [it pays to partner] with a telehealth partner or use telehealth groups to help offset some of that—not just the operational costs aspects of it, but the life costs. I mean, who wants to be up 24/7?
Using that way to expand also gives you an ability to have different clinicians interface with different types of pet parents. I grew up a different way than most veterinarians, and I can identify and feel deeply for the families that are struggling to make ends meet and struggling to make sure that their pet is healthy. And it helps you to understand that care looks different from family to family.
KB: As you were talking about that, I was just thinking about how curbside totally separated us. You had no idea who was at the other end of the phone: what they looked like, where they’d been, what their environment was like, and even their facial expressions while you were talking to them if you were talking on the phone. And this is sort of the opposite—you can be so personal with a client who may not be used to seeing a person who looks like them or a person who they feel like can identify with their situation.
CR: I’ve had pet parents in video consults where I get on the screen, and they’re like, “Are you the doctor?” And I’m like, “I’m the doctor.” And they just light up. And not only that, their children get to see this level of interaction that they can have with a veterinarian, and say, “I remember when we talked to a veterinarian, and she looked like me.”
KB: That’s such an important thing that’s so often overlooked when we talk about this subject.
CR: There are 100 million pets right now in the US without care. Our definition of care—that is, walking into a clinic, getting hands put on the pet—there’s 100 million critters. And those families are all going to look different. They’re going to have all different backgrounds. And by opening the door to telehealth, you’re allowing those families to fit veterinary medicine into their life. And when you do that, you’re able to interact and say, “Hey, here’s the value a veterinarian could provide.”
My very first dog died in my backyard when I was little. I’m the oldest of five kids. The dog was not short on love. We absolutely loved Ebony. We did not know how sick she was. We did not know that she couldn’t wait until the weekend for my mom to be able to take off work. We were fully intending to find her a doctor. She didn’t make it. There are moments in these telehealth conversations, and it happens every day, that my team gets to be that voice for that pet in that moment: “Hey, I see you, you care so deeply for this dog, you’ve found us. Here we are, let’s meet you where you are, and then let’s get that pet to where they need to go, if they need to go somewhere.”
[We can also use telehealth] as a way to recruit more people to veterinary medicine: “Oh my gosh, that’s a thing? I can be an animal doctor? Let me go do that. Let me start now.” As we continue to build this field into what it is going to be in the future—I’m so stoked. This is the moment. This is where we get to turn the page and start a new chapter in veterinary medicine, and I think that the very first line of that chapter absolutely has to be about this being accessible to everybody, and the way that you start that is by telehealth.
KB: I think the first time you and I had a conversation, you said something like, “Veterinary medicine is an amazing place to be right now because there’s so much opportunity for change.”
CR: Absolutely.
KB: I feel like I learned a lot about you in that sentence, and that’s how I feel about being at AAHA right now. This is a time where we have the ability to make changes that really matter and that are going to affect the profession for the rest of time. And this is such a big one: how do we get out of our ivory tower bubble and make sure that we are providing the care that we can provide to as many pets and people as possible? But I don’t often hear about telehealth as a key factor in that.
CR: There’s [also] this whole other side to work-life harmony that telehealth can provide for the people in the field. We have this huge bank of doctors and [support team members] that have been physically fatigued, physically broken down, injured, that still have this beautiful mind and this deep heart that are willing to care for patients. Those are our people. [Telehealth is] how you extend into other homes and into other families, and so in the future, there’s a clinical experience where maybe you’re a doctor two days a week in clinic, and maybe you’re a doctor two days at home in your PJs.
I’m so freaking excited to be a veterinarian right now because the people that I surround myself with get a chance to not just let it survive, but to really have veterinary medicine blossom into something that we want it to be and that works for everybody that’s in the industry.
KB: Am I correct in understanding that what you’ve been talking about is often like a teletriage service where you don’t necessarily have a veterinary-client-patient relationship, but are able to provide at least some guidance via an online channel?
CR: I am absolutely on a mission for us to be more thoughtful in how we assign veterinary-client-patient relationship, and the value behind the knowledge that we’re able to bring and get from pet families, and so yes, for now, in a lot of states, it is limited to that teletriage aspect of it. I do foresee a future though, where we’ve got to do better. Our patients deserve better. The previous model in veterinary medicine that really hasn’t changed, arguably in 100, 150 years, has to shift. We know more, we can do better.
“The previous model in veterinary medicine that really hasn’t changed, arguably in 100, 150 years, has to shift.”
—CHERICE ROTH, DVM, MS
As that VCPR starts to shift, we’ll start to see these very real studies around how to assess a patient remotely. My entire last lecture was strictly how to do a digital physical exam. How do you get the information that you need to be able to make clinical decisions about a patient without your hands on them, knowing that you can segue into in-person care if you need to?
We’ve made progress…, but I think we really have to push to have these conversations at the highest level of veterinary medicine and [be] absolutely willing to not just have the conversation, but act on what we learn.
KB: Are there ways that people, regardless of [their] role in their hospital, can make moves toward increasing access to care or to changing attitudes of the hospital where they work?
CR: I love this question. I’m all about empowering people to do the thing. My CEO of Fuzzy, Zubin, will tell you, “I am a huge fan of managing up.” What that means is speaking up for the culture that you see around you, for the needs of your fellow coworkers. And he listens, but there are definitely clinics where it can be difficult.
I routinely hear, “Oh, I don’t think my technicians or my receptionist will want to do one more thing.” But here’s what I know about CSRs and technicians and veterinary assistants: they will do anything for their patients, absolutely anything, even if that means one more thing. And that’s the part I think they can help to relay: “If you’re willing to pay for it, I’m willing to learn it.” And I think that’s the conversation that has to start happening for telehealth to take hold in all of these individual practices.
A lot of the push back is, “Dr. Roth, we’re so busy.” And it is so true. But I also know the hearts and the minds of the support staff and the veterinarians that serve these pet families. We took an oath, and we will make it happen for these families [and] these pets. You have to verbalize that you’re willing to make it happen.
Catch a new episode of Central Line: The AAHA Podcast every Tuesday on all major podcast platforms, YouTube, and aaha.org/podcast. Send us feedback or questions anytime at [email protected].
Cherice Roth, DVM, MS, is a graduate of Texas A&M College of Veterinary Medicine. Before veterinary school, she earned a master’s degree from the University of North Texas Health Science Center in Biochemistry. She is currently the Chief Veterinary Officer of Fuzzy Pet Health as well as an advisory board member for Multicultural Veterinary Medical Association (MCVMA) & Veterinary Professionals Instilling Black Excellence (VIBE). Roth is also the author of children’s books What’s a REAL Doctor? and What does a REAL Doctor look like? |
Photo credits: Kiwis/iStock via Getty Images Plus, Drazen Zigic/iStock via Getty Images Plus, PIKSEL/iStock via Getty Images Plus, PeopleImages/iStock via Getty Images Plus