Keystone Veterinarian Summer 2022 by Hoffmann Publishing Group

Keystone

Summer 2022

Official Quarterly Publication of the Pennsylvania Veterinary Medical Association

Get Hooked ON

FISH Medicine p. 30

Tired of Looking for Staff That Won’t Stay? p. 14 Summer Time Tick Review p. 16

Comprehensive Specialty & Emergency Veterinary Care Founded in 1972, VRC (Veterinary Referral Center) was one of the first specialized veterinary hospitals in the country to offer advanced orthopedic surgery. Today, we offer a multidisciplinary team of specialists who are skilled at performing a range of sophisticated diagnostic, medical and surgical procedures.

Our comprehensive services include: • 24/7 Emergency & Critical Care • Advanced Diagnostics & Radiology • Anesthesiology & Pain Management • Avian & Exotics • Cardiology • Dentistry & Oral Surgery • Internal Medicine • Medical Oncology • Neurology with on-site MRI • Opthalmology • Physical Rehabilitation

We’re always looking for the best doctors and nurses to join our team! Visit vrcmalvern.com/careers for more information.

• Radiation Oncology • Specialized Surgery To refer a client or consult with a specialist, please call 610-647-2950, email reception@vrcmalvern.com, or visit our website at vrcmalvern.com.

HERE WE GROW AGAIN! And we have YOU to thank for it

Since we opened our doors in 2019, we have experienced consistent growth due to your confidence in us for the care of your patients. For that, we profoundly thank you. Our clients come from all walks of life and many from miles away. But what they all have in common, is a beloved pet with oral cancer or significant dental and anesthetic needs. We are honored to help, and our consistent 5-star online reviews show our commitment to concierge-level care and service. To accommodate our growth, please join us in welcoming our new team members: • Kelly Saverino, DVM, DAVDC

• Becca Feuer, VMD, Dentistry Resident • Melanie Jarrett, DVM, DACVAA

VDS is the only referral practice in the nation dedicated to advanced dentistry and oral surgery for pets where a full-time board-certified veterinary dentist and a board-certified veterinary anesthesiologist are on staff to ensure the safest and most comfortable experience… and the best possible outcome.

John Lewis, VMD FAVD, DAVDC

Marissa Berman, DVM (Residency Trained in Dentistry)

Kelly Saverino, DVM DAVDC

Becca Feuer, VMD Dentistry Resident

Melanie Jarrett, DVM DACVAA

455 Old Baltimore Pike | Chadds Ford, PA 19317 | (484) 775-0557 | chaddsford@vdsvets.com | vdsvets.com Practices also in Mount Laurel, NJ and Katy, TX

A revolution in chronic elbow OA pain management

1 simple treatment relieves OA pain up to 1 full year.

For easy, enduring relief of chronic OA pain, recommend Synovetin OA®. • Long-lasting relief: Up to 1 full year of OA pain relief • Consistent effectiveness: 92% (12/13) in mild to moderate elbow OA1, 71% (10/14) in severe2 • Non-systemic: No systemic adverse effects3

Find a treatment center to refer to:

synovetin.com/treatment_centers

• Convenient: 1 simple, targeted procedure 1. Aulakh KS, Lopez MJ, Hudson C, et al. Prospective clinical evaluation of intra-articular injection of tin-117m (117mSn) radiosynoviorthesis agent for management of naturally occurring elbow osteoarthritis in dogs: A pilot study. Veterinary Medicine: Research and Reports. 2021;12:1-12. 2. Donecker J, Fabiani M, Gaschen L, Aulakh KS. Treatment response in dogs with naturally occurring grade 3 elbow osteoarthritis following intra-articular injection of Sn (tin) colloid. PLoS ONE. 2021;16(7). e0254613. https://doi.org/10.1371/journal.pone.0254613. 3. Lattimer JC, Selting KA, Lunceford JM, et al. Intraarticular injection of a Tin-117m radiosynoviorthesis agent in normal canine elbows causes no adverse effects. Vet Radiol Ultrasound. 2019:1-8. doi: 10.1111/vru.12757.

Homogeneous Tin (117mSn) Colloid] Veterinary Device for Use in Dogs NAME: Synovetin OA® Tin (117mSn) stannic colloid in ammonium salt. It is supplied as a 2–4 mCi (74–148 MBq)/mL suspension for intra-articular (IA) injection. NET QUANTITY Vials contain a prescribed dose up to 6.0 mCi (222 MBq) at the date and time to treat one dog.1 mL of suspension contains 2–4 mCi (74–148 MBq) of tin (117mSn) stannic colloid in ammonium salt at the date and time of end use. PRODUCT DESCRIPTION Synovetin OA® is a conversion electron therapeutic veterinary device comprising a colloidal, sterile suspension with a pH between 6.5 and 9.0 where at least 90% of the particles have a size between 1.5 μm and 20 μm (HORIBA light scatter instrument). The 117m Sn emits monoenergetic conversion electrons (significant energies 127–158 keV; emission probability 113%) and imageable gamma radiation (159 keV, 86% abundant). Accompanying low-energy emissions are Auger electrons (<22 keV) and X-rays (<30 keV). The half-life of 117mSn is 14 days. 117mSn decays by isomeric transition to stable 117Sn. Excipients include ammonium carbonate ((NH 4) 2CO3), ammonium chloride (NH 4Cl), ammonium iodide (NH 4I), iodine (I2) and trace tin (Sn) salts. MECHANISM OF ACTION Synovetin OA® is a veterinary device consisting of a homogeneous tin colloid which emits discrete (<300 μm) low-energy conversion electrons confined to the joint space. The colloid is composed of microparticles (1.5 μm to 20 μm) that are retained in the joint space of the dog. The particles are absorbed and retained by synoviocytes and macrophages in the synovium, resulting in apoptosis and reduction of inflammatory cells. Elimination of the pro- inflammatory cells reduces inflammation of the joint synovium, thereby reducing pain associated with synovitis. The data, including radiographic evidence, supports use in Grade 1, 2, and 3 osteoarthritis (OA) of the elbow joint. CAUTION Federal law restricts this device to sale by or on the order of a licensed veterinarian trained in the use of radioactive veterinary medical products. Use of this product is restricted to facilities with a compatible Radioactive Materials (RAM) license. INTENDED USE Synovetin OA® is intended to reduce synovitis and associated pain of canine elbow joints afflicted with osteoarthritis. WARNINGS Do not exceed 6.0 mCi (222 MBq) of radiation activity per dog per treatment. Not for use in humans. Keep this and all medications out of reach of children. Consult a physician in case of accidental injection or ingestion by humans. PRECAUTIONS Injection should be performed only by a licensed veterinarian skilled in the delivery of intra-articular (IA) injections who is located at a facility that has a RAM license. Rigorous aseptic technique must be ensured during injection ROUTE OF ADMINISTRATION Intra-articular injection. The product must NOT be administered by any other route. Confirmation of needle placement is recommended, whether by anatomical landmarks, fluoroscope, C-arm, ultrasound, or radiography.

DIRECTIONS FOR ADMINISTRATION Dogs should be appropriately anesthetized or deeply sedated prior to administration to prevent vocalization and resistance to dosing. A 22-ga. needle can be used to inject Synovetin OA® directly into the elbow joint. Pain during and after treatment may occur. Administration of non-steroidal anti-inflammatory agents at the labeled dose may help any post-treatment pain. FREQUENCY OF ADMINISTRATION If needed, Synovetin OA® can be readministered to a previously treated elbow at least 12 months after the last treatment. DURATION OF EFFECT FROM ADMINISTRATION Effectiveness has been shown to last up to 12 months following a single treatment of dogs with naturally occurring OA of the elbow. MAXIMUM ANNUAL DOSE Total radiation dose per joint should not exceed 3.0 mCi/joint, with the total body dose not exceeding 6.0 mCi (i.e., two elbow joints during a 12-month period). ADVERSE REACTIONS Dogs participating in clinical studies to evaluate safety and effectiveness (n=74 dogs, 97 elbow joints) exhibited no significant adverse reactions when administered Synovetin OA®. Discomfort in the treated elbow has been rarely reported in some dogs up to 72 hours after treatment. If adverse events are observed or suspected, please report them by calling Exubrion Therapeutics® Customer Service at 1-833-942-1247. POST-INJECTION CARE Following administration of Synovetin OA®, the dog can recover with other post-operation animals in the general clinic population. Once the dog has fully recovered from anesthesia, it can be discharged to go home with the approval of the facility radiation safety officer or authorized user. All treatment site policies and license requirements should be observed. OWNER INSTRUCTIONS FOR POST-TREATMENT CARE When the level of radiation is determined to be below the established levels for release, the dog can be discharged. The dog will, however, retain a low level of radioactivity in the treated joint(s) for a short period of time. Specific written instructions based on the post-treatment radiation dosimetry for care and proximity to the treated dog will be provided by the radiation safety officer (RSO) or authorized user (AU) of a radioactive materials (RAM)-licensed veterinary hospital to the dog owner. These instructions include information on limiting proximity to the dog in the post-treatment period. If in the judgement of the veterinarian, the dog owners are not likely to comply with the release instructions, the product should not be administered. A RAM-licensed veterinary hospital RSO or AU should contact Exubrion Therapeutics® if there are specific questions. Apart from the proximity requirements to protect people there is no requirement for restraint of the dog itself, and it can resume its normal level of activity subject to the distance requirements. MANUFACTURED BY Theragenics Corporation for Exubrion Therapeutics® Manufacturer’s contact information: Theragenics Corporation 5203 Bristol Industrial Way Buford, GA 30518 Customer Service Phone: 833-942-1247 info@exubrion.com STORAGE INSTRUCTIONS Store in the shipping container at controlled room temperature (10°–30°C or 50°–86°F) until ready to use.

Printed in USA.

June 2022

EXN-SYN-190

Summer 2022

Keystone

Official Quarterly Publication of the Pennsylvania Veterinary Medical Association

Subscriptions: The Keystone Veterinarian is mailed to PVMA Members at no charge as a member benefit. Subscriptions are available to non-members for $30/year or $10 for a single issue. Please contact Editor@PaVMA.org if you’re interested in receiving the Keystone Veterinarian magazine.

Notice to Readers: Neither this publication, Hoffmann Publishing, nor PVMA assumes responsibility for material contained in articles and advertisements published, nor does publication necessarily constitute endorsement or approval of the advertiser, product, service or author viewpoint by the Keystone Veterinarian, its editors and publishers or the Pennsylvania Veterinary Medical Association. In addition, neither this publication nor PVMA guarantees the accuracy, reliability or completeness of any facts, views, opinions, recommendations, information or statements contained within this publication.

6 8 11 14 16 19 23

A Message from the PVMA Executive Committee PVMA Team Talk PVMA Statements Tired of Looking for Staff Who Won’t Stay? Summer Time Tick Review Save the Bees Practice Pearls

Sherry Bolinger 610-685-0914 x202 Cell: 717-979-2858 Sherry@Hoffpubs.com

30 32 36

District 2 – Jody Kull, DVM District 3 – Andrea Carr, DVM

8574 Paxton Street, Hummelstown, PA 17036 717.220.1437 | Info@PaVMA.org | PaVMA.org EXECUTIVE COMMITTEE

For Advertising Information & Opportunities Contact:

District 1 – Katie Sharp, DVM

The Pennsylvania Veterinary Medical Association is dedicated to ensuring the vitality of the veterinary profession by promoting excellence in veterinary medicine, advancing animal health and welfare, and protecting and enhancing human health.

Hoffmann Publishing Group Inc. 2669 Shillington Road, #438 Sinking Spring, PA 19608

New Best Friend: A Medical Transcriptionist Utilizing CVTs to Improve Efficiency Mentors-R-Us Get Hooked on Fish Medicine Member News Classified Ads

BOARD OF TRUSTEES

Reproduction in whole or in part is prohibited without the permission of the Pennsylvania Veterinary Medical Association.

w w w. H o f f p u b s. co m

24 Your Veterinarian’s

President Pro Temp Dawn Fiedorczyk, VMD President-Elect Kate Boatright, VMD Secretary/Treasurer Lloyd Reitz, Jr., DVM Immediate Past-President Delinda Zehner, DVM Board Chair Darcie Stolz, VMD

EDITORIAL CORRESPONDENCE Editorial correspondence should be sent to Editor@PaVMA.org.

District 4 – Sean Smarick, VMD, DACVECC District 5 – Jennifer Koehl, VMD District 6 – Darcie Stolz, VMD District 7 – Marisa Brunetti, VMD District 8 – Kristin Fisher, DVM Veterinary Support Staff At-Large – Nicholas Rivituso, CVT, VTS (ECC) Academic Veterinarian At-Large – Dana Clarke, VMD Production Veterinarian At-Large – Rhett Proctor, DVM Equine Veterinarian At-Large – James Holt, VMD AVMA Delegate Tina Dougherty, VMD AVMA Alternate Delegate – Kate Boatright, VMD Veterinary Student At-Large – Allessandro Lamachia MAGAZINE STAFF Senior Editor: Jaime Markle Editor: Kate Boatright, VMD Editorial Assistant: Julie Myers

A Message from the PVMA Executive Committee

Dear PVMA Members, As you are probably aware, the leadership of the PVMA has undergone some recent changes. In May, Ms. Jennifer Keeler, our Executive Director of the last two years, resigned to pursue a new opportunity. Shortly after this, our 2021-2022 President, Dr. Erica Wolbramsky, stepped down for personal reasons. We wish them both all the best in their future endeavors and thank them for their service to the PVMA. This rapid change in leadership combined with the large number of changes our organization has seen over the past few years has left some wondering where the PVMA is heading. As your Executive Committee, we would like to take this opportunity to update you on the new faces leading the PVMA and our plans for the future. Dr. Dawn Fiedorczyk will serve as President Pro Temp until the Member Meeting in July 2022, at which time she will officially move to the position of President. Dr. Kate Boatright was appointed to fill the Vice President position in the fall of 2021. Dr. Lloyd Reitz continues to serve as Secretary-Treasurer and Dr. Darcie Stolz as Board Chair. We are proud to serve the veterinary professionals of Pennsylvania and look forward to a stronger future together. The Board of Trustees continues to work hard in service to our Membership during this time of transition. The Board recognizes that the organization is facing challenges with the changes in leadership. Just as we recommend regular wellness examinations for our patients, we feel it is in the best interest of the PVMA to perform a “wellness check.” We have elected to bring in a third-party association consultant to help with this and our plan for the future. We are excited to work with Professional Management Associates (PMA) for this endeavor. PMA is familiar with veterinary association management and works with the National Association of Veterinary Technicians in America (NAVTA), the American Association of Feline Practitioners (AAFP), and our neighbors at the New Jersey Veterinary Medical Association. We would like to extend a special thank you to Dr. MJ McNamee, long-time PVMA member and chair of our Legislative and Regulatory Affairs 6 | Keystone Veterinarian

Committee (LRAC), who was appointed as our Interim Executive Director during the transition period for May and June. We wish her the best in her new role with the Animal Health Institute in Washington, D.C. Going forward, we will work with PMA to determine the best strategy for filling the Executive Director position. We would also like to thank our dedicated PVMA staff for their work during this transition time. They ensure that the PVMA continues to provide excellent Member services and programming. Our fall calendar will include ACPA’s Bark in the Park in October and the return of the in-person Three Rivers Symposium in November. Our organization’s legislative agenda remains strong. The PVMA Board has recently approved official position statements on the Veterinary Nurse Initiative (VNI) and Telemedicine, which were presented to the PA Board of Veterinary Medicine in late May. We continue to advocate for Senate Bill 907, an act that will create an Animal Welfare Board. This legislation was introduced by PVMA with the sponsorship of Senator Gene Yaw. We encourage you to contact your legislators in support of this bill, watch for legislative action alerts from the PVMA, and contribute to the PVMA’s Political Action Committee to support our legislative work in Harrisburg. We look forward to a bright future with the PVMA thanks to the hard work and dedication of volunteer leaders, staff, and Members throughout Pennsylvania. Please reach out to your local Trustee, the Executive Committee, or the office with any questions or concerns. This is your association and we want your input as we make plans for our future. Sincerely, The 2021-2022 Executive Committee Dr. Dawn Fiedorczyk, President Pro Temp Dr. Kate Boatright, Vice-President Dr. Lloyd Reitz, Secretary-Treasurer Dr. Darcie Stolz, Board Chair

FROM BEGINNING TO END, YOU WERE HERE FOR THEM

Providing small-animal veterinary cremation services to animal hospitals and veterinary clinics in Central Pennsylvania. The employees of Allied Veterinary Cremation, Ltd. understand the importance of providing humane and dignified after-death care for animal companions. Excellent customer service for all our veterinary clients, regardless of size or corporate affiliation.

(717)665-1730 1966 Mastersonville Rd. • Manheim, PA 17545

www.alliedvc.com

Your clients depend on you to help guide them throughout their pet’s lives – as well as at the end of it. As a Paws & Remember provider, you benefit from our specialized staff training, quality education material, dignified cremation services, and memorial items that are tailored to the needs of the pet owner and their pet. These resources will help your clients cope with their loss and remember their beloved companions in a way that is meaningful to them. Contact us for more information about how we can help you create a more personal memory for your clients.

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Pennsylvania Veterinary Medical Association | 7

Team Talk By Corinne Tolan

Attributes of high importance to employees and those on which the practice needs to improve low

As the Marketing Data Analyst at PVMA, I love getting in the weeds with data. Let me share with you two of my favorite analyses and how I would apply them to two common business challenges that veterinary practitioners face.

Attributes of low importance to employees and those on which the practice needs to improve

Although creating the map is the fun part, the real meat and potatoes of any analysis is determining actionable insights. What attributes fell into the upper right quadrant? These are the attributes that are important to your employees and where you are performing well. Take a minute to pat yourself on the back! What attributes fell into the upper left quadrant of your map? This is your growth or opportunity area. These attributes are important to your employees, yet your practice is not meeting these expectations. Talk through an action plan with 8 | Keystone Veterinarian

high

maintain

low

Employee retention is a large idea comprised of many attributes. A way to visualize how your practice measures up could be an Importance vs. Performance (IvP) map, easily created with a scatter plot in Excel. For an IvP Map, you’ll need paired questions: one question asking about how important a concept/attribute is and a matching question asking how your practice performs on that concept. Answers should be captured with a Likert agreement scale. I suggest using a 7-point scale for a wider distribution since people working in Veterinary Medicine tend to be more compassionate and positive. Then, after looking at the distribution, choose either the top 2 or 3 box scores (T2B, T3B, respectively) and determine which percentage of respondents fall into each category. In Excel, make Importance your x-axis and Performance your y-axis, create a paired score scatter plot, and voila! There you have it, a visualization of how your practice is meeting employee expectations.

Attributes of high importance to employees and those on which the practice is performing well

Performance

No Attention

Employee Retention/Satisfaction

win

high

Needs attention

If your office has lost good talent to this trend, read on! Surveys are a way to capture a concept of interest and analyze the variation within that concept. They are more than finding out whether the room is too cold, or the food is too hot. The science of surveys has evolved, and PVMA has some useful tools for you to use to leverage the power of data collection and surveys to improve employee retention and increase patient satisfaction.

Importance

It’s that buzzword: the Great Resignation. Has it affected your practice?

Attributes of low importance to employees and those on which the practice is performing well

your leadership to address these opportunities. Address each opportunity one at a time and re-do the survey in 3-6 months to see if your opportunity has moved into the “Win” quadrant. Here is a sample Employee Satisfaction Survey, with bonus questions that give you an opportunity to run a linear regression. If you do decide to run a regression, one or all of the bonus questions will be your dependent variable, and the performance questions will be your independent variables. More instructions on regression techniques in the next section. On a scale from 1-7, with 1 being do not agree at all and 7 being agree completely, how much do you agree with the following statements? Importance Metrics: •

It is important to me that I have a work/life harmony in my career.

•

It is important to me that I develop friendships with my coworkers.

•

It is important to me that I have an opportunity to grow in this practice.

•

It is important to me that I have enough income to pay my bills.

•

It is important to me that I have only one job to cover my expenses.

•

It is important to me that my work is meaningful.

•

It is important to me to be recognized and appreciated for my work.

•

It is important for my job to offer good benefits.

Performance Metrics:

Calendar of Events Check out these upcoming PVMA events! Local PVMA District Meetings are currently being confirmed. Please visit our Calendar of Events page for the most up-todate information and times. Summer of CE Webinar Series June - August, 2022 | Online Event Visit the website for dates and times as they vary. Metro Philadelphia Region* Dinner Meeting August 2022 Save the date. Details to come.

•

{Insert Practice Name Here} gives me a good work/life harmony.

•

I have developed friendships with my coworkers at {Insert Practice Name Here}.

* This region, previously known as District 7, includes the following counties: Bucks, Chester, Delaware, Montgomery, and Philadelphia.

•

I feel that I have opportunity for advancement at {Insert Practice Name Here}.

•

{Insert Practice Name Here} provides enough income for me to pay my bills.

North Central Region* Dinner Meeting September 21, 2022 Details coming soon.

•

{Insert Practice Name Here} provides enough pay for me to only need one job.

•

My work is meaningful at {Insert Practice Name Here}.

•

{Insert Practice Name Here} recognizes and appreciates me for my work.

•

{Insert Practice Name Here} offers good benefits.

Bonus Questions for a Linear Regression (Key Driver Analysis) •

How likely are you to recommend working at {Insert Practice Name Here} to a friend?

•

How likely are you to work at {Insert Practice Name Here} until you retire?

•

How likely are you to recommend a friend to bring their pet to {Insert Practice Name Here}?

* This region, previously known as Districts 2, 3, and 8, includes the following counties: Berks, Bradford, Cameron, Carbon, Clinton, Columbia, Lackawanna, Lehigh, Luzerne, Lycoming, Monroe, Montour, Northampton, Northumberland, Pike, Potter, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, and Wyoming.

Bark in the Park: 5K, 1-Mile Dog Walk & Pet Costume Contest October 23, 2022 | Harrisburg, PA Register at BarkinthePark5K.org 3 Rivers Veterinary Symposium November 12-13, 2022 | Mars, PA

Patient/Client Satisfaction Much the same as Employee Retention, Patient/Client Satisfaction is a huge umbrella containing many attributes. Since your patients can only use body language to tell you how much they appreciate all you do for them, we’re going to rely on pet parents to tell us how we’re doing. For this, I would suggest my favorite analysis: a regression! In marketing, we call this a Key Driver Analysis, because it lets us know what is driving the behaviors behind an action, and with survey data we keep it simple by doing either a linear or logistic regression. Determine the attributes that pertain to your practice and turn them into survey questions that are captured on an ordinal scale (7-point Likert scale is my recommendation). These will become your influencer metrics, or independent variables. I like to ask my outcome metric (dependent variable) on an ordinal scale, since it can easily be turned into a binary categorical variable using either T2B or T3B scores and recoding into a new variable. That way, you can decide if you want to look at influence (linear) or probability (logistic) in your analysis.

Scan the QR code or visit PaVMA.org for the most up-to-date list of events.

Pennsylvania Veterinary Medical Association | 9

PVMA Team Talk

R Square: Model Fit Metric

continued from page 9 If you don’t have statistical software, you can run a multiple regression in Excel by adding the “Analysis ToolPak.” When you’re ready to run your analysis, go to the Data Tab and select “Data Analysis” on the far right. Select “Regression.” Choose one outcome metric for your Y Range, and your columns of independent variables as your X Range. Excel will automatically put the output in a new sheet.

Model Significance Test

Sample Patient/Client Satisfaction Survey Questions: On a scale from 1-7, with 1 being do not agree at all and 7 being agree completely, how much do you agree with the following statements?

Beta Scores

Independent Variables

Beta/Coefficient Significance Test

•

{Insert Practice Name Here} is in a convenient location.

•

The cost of the service is reasonable for the quality of care provided.

standardized beta score (coefficients) or the Wald and beta scores, respectively. Now, you can draw insights from the data! What attributes are driving patient satisfaction and how can you capitalize on this?

•

I can schedule an appointment at a time of day that is convenient for me.

Make this survey part of your quarterly or yearly benchmarking and track your patients’ satisfaction as you would their health.

•

The office staff is friendly.

•

The staff is knowledgeable about what is best for my pet.

•

The staff treats my pet like family.

•

{Insert Practice Name Here} offers high-quality services.

Of course, you can read Google reviews, and copy/paste the reviews into a Word document to create a word cloud. This will give you a good pulse check on the sentiment about your practice, and how your business is perceived online. For me, it’s just not as fun as survey data, so I choose a survey every time.

•

My veterinarian is friendly.

•

The staff is committed to finding the right treatment for my pet.

On a scale from 1-7, with 1 being do not agree at all and 7 being agree completely, rate your likelihood for the following questions. Dependent Variable(s) •

How likely are you to recommend {Insert Practice Name Here} to a friend?

•

How likely are you to return to {Insert Practice Name Here} for another visit?

•

{Insert Practice Name Here} is the vet clinic I prefer above all others. (Agreement scale, include with other agreement scale questions above, but treat as a dependent variable if desired.)

For most scientific research, the model fit metric should be .7 or higher to have good explanatory power, but not so in social research. If your model fit metric is .3 to .4 or higher, you can still accept the results of your regression. You still want your P-value to be <.05. This can sometimes be an iterative process, so once you’re pleased with your model fit, and have checked to make sure you don’t have highly correlated independent variables, it’s time to peek at the coefficients. Which attributes are statistically significant? Depending on whether you did a linear or logistic regression, you’ll either pay attention to the 10 | Keystone Veterinarian

A caveat to survey data: Often data analysis confirms what you already believe to be true and can uncover insights that may not have been as obvious. Sometimes data can be misleading and is often prone to bias, so if you get a result that doesn’t make sense, it could be for a few different reasons. Either do more research or trust your instincts. Data analysis is just like the scientific method: It’s an iterative process and often uncovers more questions than it answers. If you have questions, I can be reached at CTolan@PaVMA. org. I look forward to meeting you at the next PVMA event and hearing your feedback about our programs.

About the Author: Corinne Tolan has been serving as the Marketing Data Analyst since 2021. As a current student of Penn State Smeal College of Business, she is pursuing a Masters in Marketing Analytics and Insights. Corinne was inspired to change careers from sales to marketing analytics after a consulting firm hired by her previous employer, Lifetouch, was able to link sales metrics with photographic quality. She has always had a passion for numbers and the scientific method, and is excited to merge her undergraduate degree in Fine Arts with analytics to tell a visual narrative with data. Corinne’s hobbies include kayaking, knitting, and yoga, although currently the only hobby she has time for is grad school.

Statements PVMA has been hard at work to provide our Members with policy statements and position statements. We recently published two statements regarding Telehealth and the Veterinary Nursing Initiative. As PVMA adds more policies and statements to its library, Members can access them at bit.ly/PVMAstatements. Policy Statement on Veterinary Telehealth Background and Context: In recent times, our profession has experienced unforeseeable challenges in delivering veterinary services. The problem is complex and multifaceted. Many veterinary nurses / CVTs dropped out of the workforce due to family obligations and other financial considerations. Other support staff members have had to juggle these same challenges. In addition to diminished capacity for patient care, veterinary practices have had to cope with decreased efficiency. Operating hours, in many cases, have necessarily been reduced to meet the challenge of staffing shortages. Concurrently, reliance on referral hospitals has resulted in longer waits for much needed emergent and specialty care. [“Are we in a veterinary workforce crisis?” JAVMA News, Sept. 15, 2020, AVMA.org.] These issues overlay an already existing problem in the adequacy of delivery of veterinary services to underserved communities. In many rural areas, veterinarians are few and far between. Those veterinary hospitals that exist are overtaxed and worn thin. Specialty care, in the cases of referral or emergency, may necessitate driving several hours. A veterinary shortage that began prior to the 2020 COVID pandemic has become increasingly problematic. Complicating this stress, veterinarians who are struggling with high educational debt-to-income ratios must be able to competently and efficiently manage the demand for optimal veterinary care while balancing the expectations of clients experiencing their own financial strains. Studies have proven that veterinary professional and personal wellness is diminishing and burnout is expanding. [“Merck-AVMA Veterinary Wellbeing Studies” 2018, 2020, 2022] At the same time, veterinarians and CVTs are concerned professionals who strive to provide exceptional care for clients and patients, whenever feasible. We truly accept the lifelong obligation to continually improve our professional knowledge and competence affirmed in our oath. Therefore, we work cooperatively with specialists to give relief and to ease the pain of our patients. We seek out continuing educational

opportunities that add value to our ability to improve the health and longevity of our patients.

Defining Telehealth and the Veterinary-Client-Patient Relationship (VCPR): For decades, our profession has used telehealth as an aid in delivering veterinary services, starting with phone triage, expanding to digital images that are texted or emailed, and extending to AI platforms. Smart devices, electronic records, and digital imaging platforms have revolutionized the ease and speed of our ability to communicate with clients and with our colleagues, allowing information, advice, and education to flow into and out of a patient’s treatment plan. We recognize that these technologies are improving by the moment and embrace how they may augment the practice of veterinary medicine now and in the future. At the PVMA, we support technologies that aid in improving the quality and quantity of veterinary care. However, there is no substitute for a thorough, hands-on physical exam. Equally as important is the one-on-one discussion with the client. These are integral aspects of the art of the practice of veterinary medicine. They ensure optimum patient and client safety. The delivery of veterinary services, whether it is prescribing medication, performing advanced imaging, or making treatment recommendations through the formulation of a treatment plan, must be predicated upon this solid foundation. Furthermore, the Pennsylvania Practice Act requires a VCPR for a veterinarian to diagnose, prescribe medication, or otherwise treat an animal. [63 P.S. Sec 485.3(15)] Under the VCPR, the veterinarian assumes responsibility for making medical judgments and ensures that he or she has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis. In addition, the VCPR establishes that the veterinarian is available to follow up or make further recommendations regarding the patient’s continued care based on examination of the animal or medically appropriate and timely visits to the premises where the animal is kept.

Pennsylvania Veterinary Medical Association | 11

PVMA Statements continued from page 11

Policy Position: PVMA supports a balanced approach to telehealth, that: 1. supports technological advancement while stressing the importance and necessity of the veterinarian/client/ patient/relationship, and that 2. promotes the position that telehealth should only be conducted within an existing and valid VeterinarianClient-Patient Relationship (VCPR) Additionally, PVMA promotes the following ancillary concepts: • The Pennsylvania Veterinary Medical Association opposes telehealth services that are offered directly to the client/ public when the intent or outcome is to diagnose or to treat the patient in the absence of an established VCPR. • PVMA asserts that the VCPR cannot be established through telemedicine. • PVMA agrees with the American Veterinary Medical Association that emergency teletriage, including poison control services and emergency triage, are an acceptable exception, as these are potentially fatal circumstances where time is of the essence. • PVMA supports telehealth efforts that result in the delivery of specialty services that would otherwise not be available to the patient. A Pennsylvania veterinarian with a valid VCPR should have the professional discretion to consult with specialists and/or to conduct three-way consultation with the client, primary veterinarian, and the consultant. In this case, the veterinarian with the PA license is determined to have the VCPR with client and the patient. While the specialist or consultant may not hold a license in PA, he or she must be legally authorized to practice veterinary medicine in another state. • PVMA recognizes that telesupervision of other credentialed veterinary professionals, such as veterinary nurses / CVTs, may be useful in underserved areas, particularly in the agricultural realm. This improves the utilization of education, knowledge, and experience of the entire veterinary team. • Clients should be informed of the teleprovider’s identity, location, and state licensure status, and made aware of privacy and security issues involved in accessing veterinary services through telemedicine. • The PA licensed veterinarian should obtain the client’s owner consent and be aware of any underlying legal liabilities. Additionally, platforms for communicating and sharing medical information must be secure thereby safeguarding privacy. • Issues pertaining to enhancing license portability should be addressed as permitted, within the PA Veterinary Practice Act and the Veterinary Regulations. • Reflected in PVMA’s requested changes to the Rules of Professional Conduct for Veterinarians, submitted to the Pennsylvania Board of Veterinary Medicine, September 2021, which are as follows: 12 | Keystone Veterinarian

Telehealth – given the surge of veterinary corporate medicine’s efforts to market and sell veterinary products, including pharmaceuticals, without an established veterinarian/client/patient relationship (VCPR), the following language additions are proposed. (a) “Consultation” definition in 31.1 – added language is in bold. “Consultation – a deliberation, in person or electronically, between two or more licensed veterinarians or a licensed veterinarian and other licensed professional concerning the diagnosis of an animal’s condition, the care to be provided and the proper management of the case. The veterinarian seeking consultation is licensed and under jurisdiction of the Board, pursuant to the Act (63 P.S.) and maintains the valid VCPR and the practice of veterinary medicine occurs where the patient is located at the time of the consultation.” (b) Addition of Veterinarian/Client/Patient Relationship (VCPR) to 31.1 Definitions sections, as it is specifically referenced in 31.21 Rule of Professional Conduct for Veterinarians, Principle 7. “Veterinarian/Client/Patient Relationship – also known as VCPR, as defined by the Act (63 P.S. 485.3) and that a valid examination must be physical and in person in order to establish the VCPR. A VCPR is not established solely through veterinary teleconsultation.” (c) For consistency, the following changes to “Indirect veterinary supervision” in 31.1 is also proposed (in bold): “Indirect veterinary supervision – A veterinarian is not on the premises but is acquainted with the keeping and care of the animal by virtue of a physical and in person examination of the animal or medically appropriate and timely visits to the premises where the animal is kept and has given written or oral instructions to the certified veterinary technician/registered veterinary nurse for treatment of the animal patient.”

Position Statement on Veterinary Nursing Background and Context: In 2017, NAVTA launched the Veterinary Nurse Initiative in part to address the ongoing credentialed veterinary technician shortage present in Pennsylvania and the rest of the country. NAVTA’s leadership proposes that standardizing the title to “veterinary nurse” enhances public awareness about the role of the CVT/RVT/LVT, as well as providing clarity about the role within the profession. One of the significant issues with the title “veterinary technician” is that over the past several decades, it has been used to refer to virtually any employee of the veterinary practice, who is not the veterinarian, with no regard for that person’s education or licensing. This has been detrimental in the following ways: • CVTs have not been utilized to the extent of their education/training.

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• Unlicensed people have been permitted to perform procedures for which they are not adequately trained or supervised.

Contributions can be sent to:

Pennsylvania Veterinary Political Action Committee (PVPAC) 8574 Paxton Street | Hummelstown, PA 17036

• The public has been confused and misled by the random use of “vet tech.” • CVTs continue to leave the profession in large numbers citing low wages, lack of public recognition, underutilization, lack of opportunity for advancement, and compassion fatigue. • Based on information and statistics provided by the Center for American Progress and the Bureau of Labor and Statistics, high turnover rates and job satisfaction issues for CVTs are likely increasing the costs for delivery of veterinary care. • Employers continue to increase the number of advertised positions for veterinary nurses across the country in response to increased numbers of applicants for these positions. NAVTA strongly recommends that the title “veterinary nurse” only be used by those who hold credentials as a CVT, RVT, LVT, or LVMT. (NAVTA | NAVTA: The Job Title of “Veterinary Nurse” Should Be Reserved For Credentialed Technicians) A 2016 NAVTA survey showed that over half (56.7%) of the respondents had changed their place of employment within the first five years. According to the AAHA’s Compensation and Benefits, the current rate of turnover for veterinary technicians is 23% annually. The Center for American Progress calculates the cost of turnover to be about 20% of each employee’s annual salary for workers earning less than $50,000.

PVMA’s Position and Professional Support in the Commonwealth: In 2020, the Pennsylvania Veterinary Medical Association surveyed membership and found that 96% of respondents supported the Veterinary Nurse Initiative (VNI) and favored PVMA making a statement of support of the VNI. [PVMA Keystone Veterinarian Spring 2020 [32 - 33] (nxtbook.com).] PVMA supports the VNI, and the goals of NAVTA for the change in title to lead to greater job satisfaction for veterinary nurses/ CVTs, increased longevity in the field, and greater public awareness of the high level of care vet nurses provide to their patients. PVMA also recognizes that the title of “registered veterinary nurse” (RVN) assists in improving public awareness of the role that CVTs provide in the delivery of veterinary services, and that improving the title may help to retain much needed CVTs/RVNs within the profession. Furthermore, this shift toward “veterinary nurse” is seen across the state in credentialed educational programs. Over the past three years, three of the seven Pennsylvania programs fully accredited by the AVMA, transitioned from veterinary technology programs to “veterinary nursing” programs1. A significant number of CVTs entering the workforce in Pennsylvania each year are graduating with degrees in “veterinary nursing,” and want to be recognized as such in the workplace. On the national level, in addition to NAVTA, the AVMA also recognizes the term “veterinary nurse.” The AVMA Board of Directors released the following position statement on terminology regarding veterinary technicians/nurses:

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The AVMA recognizes efforts by the National Association of Veterinary Technicians in America (NAVTA) and others to use the term “veterinary nurse” in place of veterinary technician within the profession and in criteria for credentialing purposes. The AVMA further recognizes ongoing efforts to promote adoption of the term “nurse” in state practice acts. The AVMA will continue to use the term veterinary technician in its polices and communications; however, will recognize credentialed veterinary nurses as being equivalent to credentialed veterinary technicians. PVMA requests the recognition of the title “veterinary nurse” in addition to “certified veterinary technician” within the Veterinary Regulations. Just as the Board of Veterinary Medicine recently updated the Regulations to include the use of the title “veterinary assistant” to replace the previously used “non-certified employee,” PVMA asks that language be added, clarifying the title “registered veterinary nurse (RVN)” as equivalent to “certified veterinary technician (CVT).” [See recently submitted request, September 2021.]

References: Harcum College - Veterinary Nursing Degree Veterinary Nursing Johnson College of Technology Veterinary Nursing | Wilson Edu 1

Pennsylvania Veterinary Medical Association | 13

Tired of Looking for Staff

Who Won’t Stay?

By Ashley Elliott, CVT

In a time when it can be so difficult to find and hire qualified, quality staff, now is the time to think outside the box on ways to attract applicants and keep them long term. What sets your hospital apart from other hospitals in your area? What can you put in your employment ad that will make your hospital more attractive than the next? Remember that your ad is their first impression, so make it reflective of the most attractive attributes of your hospital and/or staff. Consider listing all the benefits you offer, including the intangible, but equally as important, ones. Maybe you’re offering a large sign-on bonus or a shorter work week. In a time when there is a greater focus on mental health and wellbeing, be sure to show your applicants how much you value your staff both inside and outside of the hospital by adopting a strong work-life balance and a companyprovided EAP (employee assistance program). When interviewing, be sure to exemplify your company’s culture. Discuss your entire benefits package, leaving no stone unturned. Think of the things that will make your hospital and team stand out in a good way, like your brand new digital dental radiography machine or your monthly off-site happy hours. From my experience, applicants are interested in a lot more than just their wage. They want to know about the culture of the team, how the hospital shows the staff that they are appreciated, potential growth opportunities, and how they will be able to be utilized and contribute. Training new employees can be a challenge in a fast-paced and likely short-staffed environment. I have found premade notecards and checklists to be very helpful for learning new skills and assessing progression. Utilize your already trained staff to help show your newbie the ropes. This will actually kill two birds with one stone: Train your new employee faster and with a well-rounded approach, while also allowing the more senior employees to feel important and show off their skills.

14 | Keystone Veterinarian

So how do you retain your new staff? It’s important to establish an open line of communication with your new employee. I like to meet with new employees every 30 days for at least the first 90 days. This allows the opportunity for the new employee to share any concerns or ask questions in a private setting. It also allows you to provide constructive, real-time feedback. Provide the employee with some positives or areas that you see as strengths, areas you’d like to see improvement, and some goals for them to achieve over the next 30 days. This will keep the employee engaged and hopefully make them feel like they can share feedback with you too. These one-on-one interactions are vital because it’s when you are most likely to receive honest feedback. Regular, genuine interaction is so important for employee engagement. Your staff, like you, want to feel valued and appreciated and like you are in it with them, not towering above them. Take an interest in getting to know them and the job that they do. This will connect you to them and they will likely respect and value your input more. I want to say this loud so the people in the back can hear it: • Publicly praise them and privately coach them on the negative stuff as much as possible. • Put yourself in their shoes before reacting when possible. • Stick to your words from the interview. If you said you have a good culture, show that by continuing to cultivate it. • Let your staff know how valuable they are to you and to the team often and regularly with both your actions and words. • Listen to their concerns and address them within a reasonable amount of time.

Say what you mean and mean what you say. If you tell your employee that problem A is going to be addressed by a specific date, make it happen or be prepared to follow up with an updated plan. Don’t make them approach you again for it. It leads to resentment and loss of respect. Relationships are built on mutual trust and respect, and the veterinary hospital is no exception. My last bit of advice on staff retention is to not be afraid to show them who you really are. There will always be a layer that separates you from them, but it doesn’t have to be a thick one. Engage with them. Loosen up and have fun with them sometimes. They will respect and value you more if they feel like you are relatable and genuine. If you’re struggling to retain staff, or losing an employee unexpectedly, consider conducting exit interviews on the resigning staff member(s). Sometimes you will receive your most honest and unfiltered feedback then. It may provide insight into an area you didn’t know was a problem and give you the opportunity to prevent additional loss. About the Author: Ashley Elliott, CVT, is the practice manager at the Animal Hospital of Chester County, located in West Chester, Pennsylvania. She was the 2021 PVMA Practice Manager of the Year. She has had a well-rounded career in numerous areas of veterinary medicine including academia, general practice, and specialty and emergency medicine. Her current focus is on building team relationships and growing as a leader.

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Pennsylvania Veterinary Medical Association | 15

Summer Time Tick Review Anyone who has spent time participating in outdoor activities in Pennsylvania knows ticks can be a common hazard. Ticks carry bacteria, viruses, and parasites that cause several tickborne diseases in humans. As the weather warms, ticks emerge and we will be spending more time outdoors, making tick bites more likely and making us more likely to be infected by the diseases they carry. Although we tend to focus on the tickborne disease risk to humans, many of these diseases can affect animals as well. Ixodes scapularis, or deer ticks, are found throughout Pennsylvania, even in green spaces in cities. Dermacentor species, or dog ticks, are also common in Pennsylvania. Lone star ticks (Ambloyomma americanum) and Asian longhorned ticks (Haemaphysalis longicornis) are emerging species in Pennsylvania. These tick species can all carry pathogens that can affect animals. The most common tickborne disease in the United States and Pennsylvania is Lyme disease. Lyme disease is caused by Borrelia burgdorferi bacteria carried by deer ticks. B. burgdorferi infected ticks are found in every county in Pennsylvania. Pennsylvania frequently reports more Lyme disease cases in humans than any other state. Lyme disease is also the most common tickborne disease in dogs. Symptoms in dogs may include a high fever, fatigue, lameness, swollen joints, and loss of appetite. Kidney complications may also occur in dogs and can be identified by vomiting, diarrhea, and weight loss. This stage of disease is often fatal. Signs and symptoms of Lyme disease may occur months after infection. Summer is the season when most Lyme disease infections occur, but dogs may not exhibit symptoms until the fall. A Lyme disease diagnosis is made with serologic testing to measure antibodies to B. burgdorferi. Very early on in the disease, the testing may be negative in a dog that does have Lyme disease as the antibody levels may not be detectable yet. Polymerase chain reaction (PCR) testing may be conducted, but is less reliable for Lyme disease. Blood and urine tests can assess kidney function. Lyme disease is treated with antibiotics, most commonly doxycycline. Dogs can be re-infected with Lyme disease. Although cats have been shown to get Lyme disease in a laboratory setting, cats are not believed to be susceptible to Lyme disease in general.

16 | Keystone Veterinarian

By Leah Lind, MPH

The second-most common tickborne disease in companion animals, also carried by deer ticks, is anaplasmosis caused by the bacteria Anaplasma phagocytophilum. Both dogs and cats can be infected with anaplasmosis. Symptoms may include fatigue, fever, loss of appetite, and lameness. Vomiting, diarrhea, coughing, and breathing difficulties are less common but may occur. Seizures are rare. Blood abnormalities such as low platelet counts can be a sign of anaplasmosis. Antibody testing can determine if the pet has high antibodies to Anaplasma species. PCR testing may be conducted. Point of care tests to diagnose Lyme disease and anaplasmosis are available. Treatment with two to four weeks of doxycycline is effective and most pets will recover quickly and fully. Ehrlichiosis, caused by the bacteria Ehrlichia canis, can be transmitted by brown dog ticks in the United States. Ehrlichiosis can affect both dogs and cats. Ehrlichiosis is more common in the southern and southwestern states. In the early acute phase of disease typically exhibited where the animal was infected, symptoms include fever, weight loss, swollen lymph nodes, respiratory distress, and spontaneous bleeding. Neurologic symptoms like meningitis may occur. The next phase is the subclinical phase of disease and the animal exhibits no symptoms. The animal may eliminate the infection or move on to the final stage of disease, clinical ehrlichiosis. Clinical ehrlichiosis signs and symptoms include anemia, bleeding, lameness, hemorrhages in the eyes, neurologic symptoms, and swollen limbs. Clinical ehrlichiosis can be fatal. Ehrlichiosis diagnosis is through antibody testing for Ehrlichia species. However, in the early stages of disease, the antibody levels may not yet be detectable. Therefore, in an animal suspected of having ehrlichiosis, especially animals that have recently been in endemic areas of the country, testing should be considered a few weeks later. PCR testing may also be considered. Doxycycline is an effective treatment for ehrlichiosis. Some animals may need transfusions due to blood loss and anemia. Rocky Mountain Spotted Fever, caused by the bacteria Rickettsia rickettsii, can cause illness in dogs. The bacteria are transmitted by the American dog tick. Dogs may experience lack of appetite, muscle or joint pain, fever, coughing, gastrointestinal symptoms,

and swelling of the face or legs. Hemorrhages in the eyes and gums and nose bleeds may occur. Neurologic symptoms such as hypersensitivity and wobbling when walking may be present. Severe cases can result in necrosis and gangrene in extremities. Blood testing may show low platelet, red blood cell, and white blood cell counts. Testing for Rocky Mountain Spotted Fever involves a blood sample taken at the onset of symptoms and a convalescent sample taken several weeks later. The samples can be sent to a diagnostic testing lab for testing for R. rickettsia antibodies. Rocky Mountain Spotted Fever is treated with doxycycline. Early treatment generally results in full recovery, but delayed treatment may be less successful. Although not common in the northeast area of the United States, including Pennsylvania, parasitic Babesia species can cause illness in dogs. In other areas of the United States, B. canis is carried by Rhipicephalus sanguineus, the brown dog tick, and B. gibsoni is transmitted by H. longicornis in Asian countries. As H. longicornis is emerging, this may be a concern for dogs in Pennsylvania. Babesiosis may also be transmitted from dog to dog through bites and rarely through blood transfusions. Symptoms may include fever, weakness, and enlarged spleen and lymph nodes. Anemia and thrombocytopenia may be apparent in blood tests. Treatment includes antiprotozoal drugs.

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In cats presenting with symptoms consistent with tickborne diseases, consider other potential tickborne diseases in cats such as hemobartonellosis, a bacterial illness potentially transmitted by ticks, and cytauxzoonosis, a rare parasitic tickborne disease, which may cause anemia, fever, and rapid breathing. Cytauxzoonosis is often fatal. Prevention of tickborne diseases is key in companion animals. Dogs may receive vaccinations for Lyme disease. Lyme disease vaccinations are effective but may not prevent all Lyme disease infections. Dogs may also take oral acaricides that will kill any ticks that bite. Collars containing acaricides are available to prevent tick bites. Pet owners should be reminded to do tick checks on their pets, just as they would themselves or family members. This not only protects the health of the pet by removing ticks that may be carrying pathogens, but ticks that have not yet attached to pets may bite humans in the home. The risk of tickborne diseases and infections is high in Pennsylvania. Pet owners should be advised of these risks and the steps they can take to prevent infection in their pets and in their family members from ticks their pets carry in.

About the Author: Leah Lind, MPH, has worked for the Pennsylvania Department of Health, Bureau of Epidemiology, since 2004, working on tickborne diseases since 2018. She received her Master’s degree in public health from the University of Pittsburgh and her Bachelor of Science degree from Virginia Tech. She enjoys spending time with her family and outdoor activities like hiking, running, and tennis.

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Pennsylvania Veterinary Medical Association | 17

happy

Teams

Increase

lead the pack in hiring & retaining top talent.

Revenue Streams

Here’s how...

PVMA Practice Memberships allow you to offer your entire team an employee benefit that provides industry tools and resources to help them grow in the profession. Decrease turnover, increase morale, and build team aptitude to provide a better client experience!

PLUS...

Get exclusive discounts & access to programs!

Visit PaVMA.org/PracticeMembership and receive a custom quote today!

Save the

Bees

Best practice is to eliminate pesticides, but if you must use them, be sure to follow targeted directions.

Be a lazy gardener. Have a yard not a lawn. Mow less. Let the dandelions and other flowers come up in the yard. Leave stems and leaf debris in flower beds in the fall. This is where many native pollinators stay during the winter. Sow pollinator-friendly plants.

Do not get a honey bee hive unless you really know how to manage it on a weekly basis, year round.

About 70% of honey sold in the US is adulterated in some way.

Honey sold

70%

Honey bees (Apis mellifera) are not native to the Western Hemisphere, but were originally from Europe, Africa, and Asia minor.

20B

Honey bees are a 20-billion-dollar industry in the US (pollination service and hive products).

and other Pollinators

Queen bees can live up to 4 to 5 years.

years

4-5 6

There are about 2.8 million honey bee colonies in the US. Their annual numbers have been relatively steady over the last several decades and they are not going extinct.

2.8M

Male honey bees, called drones, cannot sting.

Honey Bees

facts about

There are about 400 native pollinators in the US that are endangered.

endangered pollinators

400

Most of the bees in a honey bee hive are female. These worker bees do all the tasks of the hive.

Veterinarians were brought into honey bee medicine in the US largely due to concerns with antibiotic resistance since some beekeepers may use antibiotics on their honey bees.

miles

A foraging honey bee can typically fly over a 2.5- to 3-mile radius around her hive.

12 3

This graphic was designed specifically for PVMA Members and is available for download in the Member Portal at PaVMA.org.

5 | 220 705

141

Honey bee medicine and veterinary involvement is new to the US and began in 2017.

In the peak of beekeeping season, a queen bee can lay 1,500 to 2,000 eggs per day.

eggs per day

2K 13

Beekeepers can maintain colony numbers by “splitting” colonies in the spring.

2017

Honey bees are facing more disease challenges than ever before, which makes successful beekeeping more difficult. Beekeepers lose on average about 40% of their hives over the winter.

Hives lost

Honey bees are agricultural animals that are managed by farmers (aka beekeepers). However, the majority of honey bee colonies in the US are managed by commercial, migratory beekeepers. These beekeepers collectively truck 2 million plus hives all around our country every year to help pollinate our crops, or about 1/3 of the food we eat.

Hives in USA

40% 9

2M+ 8

Research and buy truly local honey. Your best bet is to go to a honey bee farm where you can see the hives and the rest of the operation.

Donate only to local organizations whose work you can observe personally and directly.

Email: _____________________________________________

Phone: ____________________________________________

Address: ___________________________________________

Clinic/Doctor Name: _________________________________

If you have questions about honey bees or bee medicine, please ask your veterinarian.

Questions?

5 Ways 5 ways you 4 You Can canHelp help!

Written by Tracy Farone, DVM, BS, Professor of Biology at Grove City College, PA. More information about Dr. Farone and her teachings can be found at GCCBeeProject.com. Graphics provided by PVMA. References available upon request.

By PVMA Partner, FocusHRO

Save

Bees

Practice Pearls

the

Turn the Great Resignation into the Greatest Retention!

Let’s talk about it. The ugly “Great Resignation.”

• • • • • • • • • • • • •

Employee Satisfaction Workplace Environment Employee Compensation - Is it competitive with market data? Communication Mentoring Teamwork Professional development opportunities (promotions) Training opportunities Benefits Workplace Flexibility Employee’s career plan Source of employee’s stress

Do not get a honey bee hive unless you really know how to manage it on a weekly basis, year round.

Voluntary • Benefits (Vision, Dental, Life, Long/ Short term disability insurance) • Health Insurance • 401K and Retirement Opportunities • Paid Parental Leave • Flexible Workweek • Employee Assistance Programs • Signing Bonuses • Tuition Coverage • Prepaid Child Care • Streaming Service • Subscriptions • Grocery Perks • Tickets to local events

You don’t need any more scary statistics, because as a veterinarian – you’re living it. We’re preaching to the choir here, so let’s just get down to it and talk solutions. How do you go about boosting employee retention? Your HR department (in many cases, you) should be developing solutions to help retain and attract employees. The two most actionable items for you are company culture and employee benefits.

Best practice is to eliminate pesticides, but if you must use them, be sure to follow targeted directions.

This gives you a place to start. Identify some potential issues within your company culture, and make changes that create an environment that employees want to work in. Answers and solutions could vary greatly, don’t be afraid to get creative!

benefits you offer. Employee Benefits are a function of your HR department, and there are ways to be creative here too (without breaking the bank)! Consider these options to combat the work-benefit issues you and your employees may be facing:

American companies are facing the issue of how to retain employees and remain an attractive employer to today’s modern workforce. It’s a problem for all industries, and veterinary practices are certainly among those being affected. The average turnover for veterinarians is twice as high as it is for physicians in medical practice. And veterinary technicians have one of the highest turnovers of all health care positions. According to the Society of Practicing Veterinary Surgeons (SPVS), 52.3% of veterinary businesses are short of veterinary surgeons, and the veterinary profession has also seen a rise in vets leaving the industry entirely, with around 9.5% citing that they planned to jump ship soon.

By PVMA Partner, FocusHRO

Company Culture:

Use the issue at hand to talk to your employees about what they want out of their work. What are their needs, what is missing, what can be better? Have an open door communication policy that encourages new ideas. Perhaps develop an Employee Attitude Survey that addresses topics like:

Employee Benefits:

The biggest benefit you offer your employees is their pay, and many vets feel there is a discrepancy between the demands of the job and the compensation offered. According to the BVA, around 33.8% of vets were considering leaving their job because of this discrepancy. Unless practices can create a better work-benefit balance, this is sure to be a persistent problem in the future. The obvious solution is to raise wages — doing so would certainly help counter inflation, but there are other opportunities to explore. Considering the financial strain of raising wages, you may consider taking a look at the other

Like your company culture, there is no ‘single solution’ for your benefits package. But even on the tightest budget there are options you can explore to increase employee retention and attract the best employees. It’s one of our specialties at FocusHRO, and we’ve teamed up with PVMA as their preferred HR partner. Our experienced team will take the time to learn about the issues you face and the resources you have to solve them – developing and offering solutions you may not have known about, or didn’t think possible! We’re here to assist you with all things HR. Visit FocusHRO.com/PVMA to get started.

About FocusHRO: Your PVMA Membership gives you and your practice access to FocusHRO’s best programs and pricing. They’ve created “Business in a Box,” which takes the guess work out of running your veterinary practice and lets FocusHRO handle all your insurance, HR/compliance, accounting, and web/IT needs. These services help keep your veterinary practice running smoothly. Visit FocusHRO.com/PVMA or call 717.980.3330 to get more information. Pennsylvania Veterinary Medical Association | 23

By Boomer Pearsall, CVPM

Your Veterinarian’s New Best Friend:

A Medical Transcriptionist

Lebron James, Patrick Mahomes, TJ Watt, Dr. Kate Boatright—quiz time: Please pick the one who is not like the rest! This shouldn’t take long to answer, right? We are living in an era where the demand for veterinarians is so EXTREME that they are being coveted like five-star, blue-chip athletes coming out of high school or college. As a private practice owner, you have no choice but to woo them with lavished visits, dinners, and accommodations to even garner a new graduate’s attention. Obviously, one of the biggest reasons for this extreme demand is simply lack of supply. We are still seeing a staggering number of veterinarians needed nationwide with no ability or pipeline to produce enough of them even with new vet schools opening. Secondly, private practices are finding it extremely challenging to hire and retain veterinarians due to the influx of capital into our industry by corporate entities. This injection of capital has led to the drastic increase of both the average and starting salaries of veterinarians, which has been long overdue. As cited by Malinda Larkin, the 2021 mean starting salary was $106,053 for new graduates going into corporate practice.1 Furthermore, 66% of those corporate offers included a signing bonus that averaged $11,738, whereas only 31% of private practice offers included a signing bonus that averaged $6,596.1 Most private practice owners view the rise of corporate entities as the villains who are driving up prices, reducing the

24 | Keystone Veterinarian

chances of hiring associate veterinarians, and hurting the industry in general. As a private practice owner, I clearly have been frustrated with the new challenges facing us due to the rise of corporate powers, but I also believe the industry was in desperate need of their injection of capital to finally accelerate the rise of veterinarian compensation. Yes, it has obviously created a much more competitive hiring market, but in return, it has also given private practices a little more confidence in charging for our services more appropriately, but I will leave this idea for another article. So, the ultimate question is what can a private practice owner do to win over a new associate and set themselves apart from corporate clinics? We have already exhausted options like higher salaries, signing bonuses, and moving allowances. Now what? Have you thought about creating a new position at your hospital that will be “your veterinarian’s new best friend”? AKA: their very own medical transcriptionist, or medical assistant as we call it in our office. Yes, I understand there are software programs for this, but can you ever truly replace an actual human working alongside your veterinarian transcribing, invoicing, and updating patient reminders in real time? Imagine your next job advertisement when seeking an associate—under benefits, you can list and highlight that your veterinarian will have their very own assistant! How can that not sound like music to a new associate’s ears?

Evolution of a Medical Transcriptionist After opening in 2009 as a solo-doctor practice, we started tinkering around with staff members helping our doctor with medical notes during appointments to save time and reduce stress on our solo DVM. I am sure most solo doctors have tried this using a technician in the room transcribing. As time progressed, we felt this was not the right fit for our hospital since our DVM liked to spend a good amount of time post-exam with the owner discussing treatment options and diagnostics. We soon found out that we were completely wasting a technician’s skill and time just standing in the room alongside the doctor. By 2015, the position evolved into a full-time position. The caveat was the assistant was now completely separated from the exam room, listening to the DVM as she discusses exam findings and treatment plans with the owner. For clarity purposes, there are small microphones and speakers located in the exam rooms while the assistant listens with headphones and transcribes. For legal purposes, we recommend consulting with your attorney and reviewing your state laws on recording consent. Our practice has multiple signs posted to make clients aware of the presence of microphones and the fact that conversations are being recorded. Furthermore, we have client consent forms to establish a letter of mutual consent if a client questions this method.

Utilizing the Full Potential of a Transcriptionist As of today, this position has become the foundation for workflow efficiency at our hospital. In addition to taking strain off the veterinarians by formatting and transcribing medical records in real time, our medical assistant helps with directing traffic in the treatment area. As our medical assistant hears clients give verbal consent for diagnostic testing to the DVM in the exam room, she can instruct the technicians to start these tests while the DVM continues to discuss the plan with the client. As you can imagine, this drastically decreases the wait time for the pet owner while they sit worrying what the outcome of the diagnostics will hold for the future of their fur-baby. Not only does it help move cases along faster, but it also frees up more time for the veterinarian to have face-to-face interaction with the client, allowing them to address all concerns without them feeling rushed. It is an absolute win-win for everyone! For 10 years, I managed a solo-doctor practice doing everything in my power to make us the most efficient practice I could, but without a doubt, the medical transcriptionist position drastically increased our ability to see more patients on a daily basis, driving revenues through the roof. In 2019, I was faced with a new challenge when the practice added our first associate. I had to solve the puzzle of two doctors utilizing one transcriptionist. As the practice worked through some

trial and error, we finally figured out how to schedule appropriately where both doctors benefited from using the same transcriptionist. My personal recommendation is that for every two doctors, you should hire one full-time medical transcriptionist. If your practice has three doctors, you could possibly stretch the work output of one full-time transcriptionist depending on how many exam room hours each doctor works. But in my opinion, three full-time doctors would probably require 1.5 medical transcriptionists. Obviously, you can see one downfall of this position is the availability of the employee for a multidoctor practice, making this a much easier model to apply in smaller practices. In addition to this, another challenge is to find the right type of person who is willing to sit and focus on listening to an exam room doctor for hours on end. From all the personnel mistakes I have made in my career, my recommendation is to find candidates who are veterinary technicians who do not want to work on the “floor” anymore but still love veterinary medicine. I know, I know, it is way easier said than done, especially in this market. But I promise you that once you find the right person, you, your staff, and especially your doctors will never regret this hire!

Reference: Larkin, M. Increase in veterinarians’ starting salaries long overdue, economist says. JAVMAnews. Accessed May 8, 2022. Available at bit.ly/3vmDTJA. 1

About the Author: Boomer Pearsall, CVPM, is originally from New Castle, PA, and returned to Western PA to start Penn-Ohio Veterinary Services, LLC, with his wife, Nicole, in 2009. Boomer graduated with Nicole at La Roche College in 2003 with a double major in Biology and Chemistry. After graduation, he furthered his studies in Biological Sciences at Duquesne University, where he graduated in 2005 with his Master’s degree upon completion and successful defense of his thesis. After opening the clinic, Boomer went forward and completed his certification in Veterinary Practice Management from Purdue University, which aids him in his daily tasks of being a successful Practice Manager of Penn-Ohio Veterinary Services, LLC. Boomer recently passed his board exam through the VHMA in April 2021 to officially become a Certified Veterinary Practice Manager (CVPM). utside of work, Boomer likes to live a very active O lifestyle by working with his horses and also competing in Olympic weightlifting.

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By Kate Boatright, VMD

Utilizing CVTs to Improve Efficiency

As a doctor, when was the last time you drew blood on a patient? Placed an IV catheter? Restrained a patient for radiographs? If these are things you’re doing on a regular basis, you may not be fully leveraging your support staff. With the high caseloads experienced in practices, maximizing efficiency can improve patient outcomes, reduce staff stress, and increase staff satisfaction, retention, and practice revenue.

What Can Your Technicians Do? The easier question to answer is what they can’t do. Based on the Pennsylvania Veterinary Regulations, credentialed veterinary technicians, also known as veterinary nurses, and veterinary assistants are only prohibited from doing five things: perform surgery, diagnose, prognose, prescribe, and attest to health status.1 What tasks they can do in the clinic depends on the level of veterinary supervision provided. The PA Regulations define three levels of supervision: indirect, direct, and immediate. Only credentialed veterinary technicians—which I will refer to as CVTs or veterinary nurses for the purpose of this article—can operate under indirect supervision. This means the veterinarian does not have to be on site but has given written or oral instructions for a case they are managing. This can include administering vaccinations and injectable medication, placing IV catheters, performing diagnostic imaging, and applying bandages. Both CVTs and assistants can operate under direct supervision. Direct supervision means the veterinarian “is on the premises and quickly available to assist.”2 Some duties performed by unlicensed veterinary assistants must be performed under immediate supervision, which requires the veterinarian to be in both visible and audible range. CVTs are never required to

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operate under immediate supervision. The administration of anesthesia, establishing an airway, and performing basic and advanced life support can be done under direct supervision by CVTs but require immediate supervision for noncredentialed staff. Both can perform dental prophylaxis under direct supervision.

How CVTs Can Improve Efficiency in Practice CVTs are a vastly underutilized resource in veterinary clinics. These highly trained professionals are required to complete a 2- to 4-year AVMA-accredited program, pass a national licensing examination, and maintain their license through continuing education. Individuals who pursue this education want to apply their skills and knowledge. Here are some ways that CVTs can be utilized in practice:

• Perform patient diagnostics, including all sample collection for urine and blood specimens.

• Place intravenous catheters for hospitalized patients, surgery, and euthanasia.

• Perform in-hospital treatments and administer medications, including after-hours care or when the veterinarian is not in the clinic, provided there are clear written instructions.

• Induce, monitor, and recover patients from anesthesia. • Place bandages on postoperative patients or perform bandage changes for ongoing care with veterinarian assessing healing progress.

• Schedule technician appointments for nail trims, ear

cleaning, anal gland expression, suture removal, vaccination

boosters, and laboratory tests. Ensure that these are occurring within a valid veterinary-client-patient relationship (VCPR).

• Take a leading role in client communication, including

answering basic medical questions, triaging patients, and assisting with call backs for outpatient test results once the veterinarian has reviewed them.

• Play a central role in client education, including preventive care, management of chronic disease, surgical discharges, and teaching clients to perform at-home treatments from the administration of oral medication to injections.

Just as the veterinarian should prioritize performing tasks that only they are qualified to do, CVTs should be given the ability to focus on tasks they can perform under less veterinary supervision than their unlicensed colleagues. This will improve efficiency and maximize job satisfaction for these individuals.

Example Appointment: A Team Approach Poppy, a 10-year-old female spayed Shih Tzu, arrives for her annual wellness appointment. She is greeted and checked in by the client service representative (CSR) at the front desk. A few minutes later, a veterinary assistant leads her to the examination room, records weight and temperature, gathers a history, and reviews the vaccinations and preventive care items for which she is due. The veterinarian performs a physical examination with the help of the assistant and discusses Poppy’s dental disease with her owner. The veterinarian recommends that Poppy be scheduled for a Comprehensive Oral Health Assessment and Treatment (COHAT) and recommends a senior laboratory panel be sent out as a preoperative screen. While the assistant restrains Poppy for sample collection for the laboratory testing and vaccine administration by a CVT, the veterinarian is free to work on medical records, review other patient test results, perform the next examination, or speak to a concerned owner by phone. Before Poppy leaves, the CVT reviews the estimate for the COHAT with Poppy’s owner and answers questions about anesthesia preparation. The assistant

or a CSR can complete the appointment by scheduling the procedure and checking out Poppy and her owner. When the laboratory results arrive the next day, the veterinarian reviews them. Finding only a mild elevation in the ALP, the vet outlines recommendations and passes a message to the nursing team to call and discuss the results with the owner.

Team Players Every member of the veterinary team plays an essential role in ensuring smooth operations in the hospital and maximizing each client and patient experience. By narrowing job duties of each position to the tasks that are specific to that position, clinics will improve efficiency and revenue. This is not to say that a veterinarian will never draw blood or restrain for a radiograph. Nor does it mean a CVT will never restrain a pet during an examination, clean a kennel, or answer a phone. What it means is that each member of the clinic team will have the time to focus on their primary job duties, allowing others to do the same.

References: 49 Pa. Code § 31.31. Full text available at https://bit.ly/PA-CodeChapter31 1

49 Pa. Code § 31.1. Full text available at https://bit.ly/PA-CodeChapter31 2

About the Author: Kate Boatright, VMD, is a 2013 graduate of the University of Pennsylvania, and is an associate veterinarian, freelance speaker and author in western Pennsylvania. She is actively involved in the AVMA House of Delegates as well as the current Vice President of the Pennsylvania Veterinary Medical Association. She is a former national officer of the Veterinary Business Management Association. She can be reached at Hello@WritetheBoat.com or visit WritetheBoat. com for more information.

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By Tim Ireland, VMD

Mentors-R-Us If you are like me, you would have graduated at a time when no one really talked about mentorship very much at all. Virtually all internships were for those interested in an academic track. Private practice internships were rare and, for the most part, were a path to higher case volume than general practice. They were for those who really wanted to ramp their skills up more quickly but were more interested in general practice than specialty and wanted to get paid a little more than their academic counterparts. In either case, the word internship signified long hours for half the pay in exchange for experience, support, and some level of oversight or, if you will, “mentorship.” In the past decade, I have hired two post-internship associates who spent their first solo night in the ER during the first week of their internship! They were given the number of their “on-call” backup, but it was made very clear that they should not ever call them. I, on the other hand, jumped directly into general practice after graduation. I was one of two full-time doctors and worked more than 2 months before I was left in the building completely alone. Granted, my boss’s version of oversight of my first enucleation on my very first day in surgery was to ask me if I knew how to do an enucleation, discuss the procedure, and say, “Sounds good! I will be upstairs if you need me.” My point is it worked for me. I had a mentor in every sense of the word. He may not have stood over me, but I knew he was always there for me. What my mentor gave me is only half of the equation. My boss/ mentor was leaving for the PVMA’s Committee Day. He would be 2 hours away, which back then meant “unreachable” since no one had phones they carried with them. He did his best to prepare me for various cases and some of the personalities that would come attached to those cases. He probably turned to leave three or four times, each time remembering one more thing to share. The final time, with his hand on the knob of the half-open door, he turned and said, “I have had a lot of vets work here. I have never worked with someone before. It is really nice working with you!” It was that moment, just 2months on the job, that I realized that I had already given him something. Mentorship may take many forms but, in all cases, it is most successful when the gift flows both ways.

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The Changing Landscape of Mentorship I started with the title “Mentors-R-Us” because I’ve had so many mentors during my career. My support system was wide. Classmates, instructors, colleagues . . . the list is long. There was not much talk back then about mentors or mentorship; it was just what we did. It was what we all did, or at least that’s what I thought. Veterinary medicine for many of us is a vocation, not a job. I would like to think that everyone who shares my vocation also shares my passion and commitment to furthering my profession and supporting all its members. I feel a responsibility to help, an obligation to elevate. I have never been an employer who felt new additions to our profession needed to “pay their dues.” If there was a way to spare them from some of the growing pains I experienced, why wouldn’t I do that? The fact that “mentorship” has become such a buzz word being sought out by so many new and recent grads combined with the formation of organizations now offering mentorship for a fee has forced me to come to terms with the reality that not everyone views mentorship in the same light as I. That “Mentors-R-Us” may not hold true across our profession. But should it? Does it need to? For this to hold true, I would have to support the idea that a bad mentor is better than no mentor at all. Let’s face it, not everyone is built to be a good mentor. Not everyone wants to be a mentor or a mentee if we are being honest.

How to Be a Mentor, or a Mentee Do you have what it takes to be an effective mentor or mentee? Can a solo practitioner be a mentor or mentee? Sure! Can someone be a mentor to someone across town or across the country? You bet! All it really takes is a willingness to help, a willingness to listen, and a willingness to learn. In my opinion, the traits are the same for the mentor as they are for the mentee. The relationship can be short term or long term, in person, over the phone, or in writing. The commitment can be a single contact, a defined term, or lifelong. The agreement can be unspoken, poorly defined, or structured and written into a contract. The variations are endless, the benefits immeasurable (to both parties!). I have mentored students via e-mail, colleagues over the phone, and countless associates in person—from new graduates to those interested in starting their own practice. I have been mentored in veterinary medicine and surgery, practice management, organizational leadership (thank you, PVMA), and more recently veterinary dentistry and practice culture. Anyone who wants to grow can benefit from mentorship. Anyone with skills or knowledge to share and a willingness to listen and learn can be a mentor. How do you get started? Find someone who knows something you want to know more about and ask them. If you are interviewing for a new position or hiring, talk about it! If you don’t know where to start, reach out to the PVMA or one of the organizations offering mentorship and they will help you find

someone who meets your needs. The only thing you do not want to do is assume. I don’t believe internship = mentorship. If you are just starting your career and think that school hasn’t prepared you to go into private practice, YOU ARE NOT ALONE. Frankly, none of us were, but we could take a history, perform a physical exam, and dial a phone. Don’t think that you must know it all. After 32 years, I am still learning. Don’t think that pet owners expect you to have all the answers, and most important, don’t be afraid to say to an owner, “I don’t know but this is what we are going to do to get the answers we need.”

What Mentorship Looks Like in Practice The mentor-mentee relationship can take many forms. What has worked for me? As a mentor in a busy practice, it can be challenging at times. We start our new doctors with extended appointment times (at least double a normal slot). This gives them time to ask questions, do research, and when they finish quickly, shadow me or one of the other doctors to see how we manage our cases. Initially, they always share a surgery day with me so that they can scrub in with me, I can scrub in with them, or simply so that I am available if they need me. This gives them the opportunity and confidence to push their limits and try new things, knowing they will not be alone. Whether the cases get scheduled with the mentor or the mentee is based on informed consent. If a mentee wants to learn a new procedure they have never done before, look for owners who can’t afford your normal fees and offer them an “educational discount” to have your mentee stand in as primary surgeon then be there to support them. Schedule an hour every week when you can commit to sit down and go over cases. With dedicated time, your mentee can hold nonurgent questions instead of running to you with everything in the moment. Most important, even when you are crazy busy, remember what it was like when you first started and encourage your mentee to think through the case instead of just blurting out your answer or approach (this is often the hard part for me!). I do understand that I am writing to an audience overwhelmed by our current caseload. Many practices (including mine) are short one, two, or even three full-time doctors. I am sure some are reading this thinking, “It is way too much time that I don’t have!” “They need to generate revenue!” “I can’t afford all that!” I would say that for the future of your practice and our profession, you can’t afford not to. For those truly overwhelmed or who think they would make a terrible mentor, consider paying someone else to mentor your next associate. It will be well worth the investment! About the Author: Dr. Tim Ireland is the owner and medical director of Newtown Veterinary Hospital, LLC. After 27 years of marriage and raising three children, he remains a husband and father first. He is proud to be a father of a VMD-to-be, class of 2026. He holds multiple roles in veterinary medicine including a veterinarian of 32 years, practice owner of 29.5 years, mentor, and mentee. A long-standing Member of the PVMA, he served as the 2005 president of the organization. He also coaches high school track.

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Get Hooked ON

FISH Medicine By Christopher Lopresto, VMD, CertAqV Aquatic animal medical practice is a unique endeavor with its own challenges and curiosities. For anyone interested in adding fish to their patient list, here’s what you need to know. Fish—why? Because some of us came up working in a pet store that sold fish and we “caught the bug.” Maybe some of us like being unique and doing unique things that set us apart, making us feel, I don’t know, unique. Or maybe some of us value life in all its forms, regardless of classification or category, and see an unmet need to care for creatures that too often suffer at the hands of human ignorance, vanity, and neglect. Sorry, too heavy? Uh, how about the fish-slapping dance! (Has to be a top 5 Monty Python sketch, right!? I mean, there’s the parrot sketch, Spam, etc.) Aquatic animal medical practice carries both small animal and large animal dynamics. Some fish come with names—often very unique, like Mac-n-Cheese, Jackie, or Badump—and are regarded as family members, connected by strong human-animal bonds. Some are prized, highly-valued individuals that folks have invested in. It’s routine for certain saltwater fish to sell for hundreds of dollars or more, and when it comes to koi, make that $1,000 or even $10,000. Some other fish are simply a prize from the fair that didn’t die, or one of the 30 fish that were in the pond when the people bought the house two years ago. So, as the veterinarian, you may be asked to do the best you can on a narrow budget for their daughter’s betta; to figure out why a $20,000 koi died, and you better keep the other three that are left from also dying; or to perform “herd health” necropsies and diagnostics for a trout nursery. And all sorts of things in between. A typical “general practice” fish case starts not when the problem starts, but when—or if—the fishkeeper decides to call about it. This is likely a familiar theme for most veterinarians, albeit a bit more extreme when it comes to aquatic ectotherms; it’s not uncommon for fish to be experiencing symptomatic disease for weeks to months—even years— before veterinary care is sought. And, no surprise, veterinary care is not commonly sought for most fish (I see many of you nodding your heads in agreement). The do-it-yourself atmosphere for fish healthcare is strong, including over-the-counter (OTC) access to antimicrobials that are prescription only in most other settings—oxytetracycline, minocycline, metronidazole, praziquantel, all fair game. And for folks who are serious about it, clove oil can be used as an at-home sedative to perform basic procedures like wound debridement, or also maybe some not-so-basic procedures. There aren’t all that many ways to be a sick fish. The symptoms tend to be nonspecific. Some of the most ubiquitous clinical signs are anorexia, lethargy, body swelling and distension, eroded or ragged fins, and respiratory rate changes.1 Adding to the confusion, some of these general symptoms are referred to by their own colloquial fish-trade terms, giving the impression that they are diseases unto themselves. Dropsy, for example, is the common term for coelomic distension, more specifically ascites, but dropsy is not its own disease— there are [insert a number that’s impressive but not absurd] potential underlying causes for coelomic distension and ascites in fish. Similarly, fin rot (referring to eroded, irregular, or traumatized fins) is often stated as a standalone condition, and there are even OTC medications that 30 | Keystone Veterinarian

are specifically marketed to treat fin rot. But, again, there is a bevy, a cornucopia, a bonanza of differentials for fin erosions and damage. It’s a distinction we’re all used to making—defining what is happening versus determining why it is happening. Some less vague clinical signs include skin ulcers (usually bacteria are involved) or stuff growing on the fish, which at least allows you to narrow down your list to stuff that grows on fish, like external microbial infections, parasite infestations, and epidermal tumors. Perhaps the most frustrating symptom, though, is the dreaded buoyancy disorder. You know, a fish stuck floating at the top or sunk to the bottom, constantly tilting to the side or upside-down—buoyancy disorder. Sure, it can focus you in on the swim bladder2 as the affected structure, but rarely is it as simple as just a swim bladder problem. Even more specific clinical signs tend to be secondary to some other underlying primary cause. The clinical evaluation of your fish patient doesn’t necessarily start with the fish, but rather the water. Water quality is the single most important bit of husbandry when it comes to aquatic animal wellness and disease, so water quality testing3 is where the evaluation starts. As for the patient, the same principles of physical examination that apply to familiar terrestrial vertebrates, such as dogs, also apply to fish. Except, you know, there’s that whole “underwater” thing. This means a large portion of the exam is visual, though some amount of palpation and handling can be done with more docile species like goldfish. Even so, a thorough examination—or any exam at all with pointy, bitey, or poisonous critters—requires sedation. Tricaine methanesulfonate (MS-222) is the drug of choice. It’s a powder that you add to the water (along with baking soda as a buffer), but you’ll also come across protocols for using propofol and alfaxalone as waterborne sedatives. The basic, and essential, diagnostics for a typical fish case include skin scrapings and gill sampling. A microscope cover slip is used to scrape along the skin at a few areas, primarily to assess the mucous coat and screen for parasites. Gill sampling can also be done via scraping over the gill filaments but a biopsy is preferred. Take a small, sharp set of iris scissors, lift the operculum to expose the gill filaments, and (to paraphrase Mel Brooks) snip the tips! Those snipped tips are then looked at microscopically to assess architecture and screen for pathogens. Seemingly, every other diagnostic in the context of day-to-day fish practice could be considered “advanced.” Whether due to cost, availability, or feasibility, cases often proceed without the benefit of blood work, radiographs, or ultrasound. Bacterial culture and susceptibility testing from ulcers or wounds can be useful, but one must be particular with sample collection as aquarium water is not sterile— are you culturing the lesion or just environmental contamination? Computed tomography (CT) and magnetic resonance imaging might be ideal imaging modalities for fish, but you guessed it, not many clients elect to pursue these costly tests. And that’s if there’s even a place that will do it and someone available to read it—how much training do you think radiologists get on interpreting CT images from green terror cichlids?

One diagnostic that many aquatic practitioners must turn to is necropsy. Because antemortem diagnosis can be elusive and because it’s often a group of fish that is affected by infectious disease or improper husbandry, figuring out what happened to the deceased can aid in diagnosis and treatment of the living, not an unfamiliar principle. Also, in some instances, mortality may be the first sign that there’s a problem. Fish autolyze very quickly, though, so timing is paramount— and refrigerate, don’t freeze.

granted. Most people are so appreciative and relieved that there’s someone out there to provide care for their fish, that details and expectations over outcomes tend to slip into the background. People care about their fish and need help; what matters is that you’re there to help. It may not be conventional, overly practical, or financially impressive, but practicing fish medicine is a decision anyone can feel good about—you just have to decide.

When it comes to treatment, antiparasitics/antimicrobials and sedatives/analgesics are the most commonly used categories. The options for medicating a fish come in three: waterborne, oral, or injectable. Everyone feels comfortable tossing some stuff into the water, but prolonged immersions or bath treatments (as they’re called) are often the most variable and least aggressive. That said, there are multiple pharmacokinetic studies supporting the use of, say, enrofloxacin as a waterborne medication in multiple species. Oral medications can be administered directly—no, it’s not ridiculous; folks can pill their koi and give a liquid to their goldfish if so desired, with zero risk of aspiration, may I remind you. However, most oral medicating is done through medicated food, either by using a gelatin-based diet or by “top dressing” onto the existing diet. Injections are, by far, the most direct, consistent, and aggressive means of administration, similar to other cold-blooded species. Referencing enrofloxacin again, injections can be administered every third day, which makes this approach kind of practical, albeit outside the comfort zone of every rational human being—no normal person, ever, at any point in life, has spent time considering: “What if I have to give needles to a fish?”

Author’s Notes:

Being ectotherms, fish are slower to get sick and slower to get better. Some cases require weeks to months of recovery; however, many fish bounce back surprisingly quickly with appropriate treatment and husbandry corrections. And rarely are the efforts taken for

Fish respire and, therefore, have a respiratory rate. It can be counted by watching the opercular rate—the operculum is the flap that covers the gills.

Bony fish (not sharks and rays) have some version of a swim bladder, which is a blimp-looking hollow sack-like organ at the dorsal aspect of the coelom, and it inflates or deflates to adjust the fish’s position in the water column (i.e., buoyancy).

The most basic water quality testing should include pH, ammonia, nitrites, and nitrates. Temperature should be monitored continuously with a suitable thermometer.

About the Author: Christopher Lopresto, VMD, CertAqV, graduated in 2008 and completed a rotating small animal internship the following year. He worked in small animal general practice until 2020, maintaining a strong interest in exotics and wildlife, especially fish. He currently works as a certified aquatic veterinarian while completing a residency in veterinary dermatology. Both personally and professionally, he doesn’t quite know what he’s doing.

Pennsylvania Veterinary Medical Association | 31

MEMBER NEWS Welcome New Members Brea Afflerbach Chelsea Agostinelli Nicole Alexe Jalissa Allen Keri Anderson Jessica Aungst Dr. Jillian Austin Deborah Bacha Julie Bair Kristen Barwell Dr. Robert Berry Jr. Rachel Blayle Dr. Anne Bolind Donna Bosworth Dr. Jennifer Burroughs Maureen Carroll Diane Cassarly Dr. Lisay Chizmar Tessa Cluck Judy Colburn

Colleen Cook Alece Coulman Jessica Cover Dr. Amber Crow CJ Dail Nicole Defibaugh Eric Detrick Devin DeVoue Fahne Dietz Meagan Duck Mackenzie Dundor Dr. Heather Ellis Kayla Emley Kathleen Faddis Dr. Melissa Fisher Amanda Flowers Dr Ann Freeman Garrett Fry Dr. Kurt Fuller Nour Gabr

Kaitlynn Gordy Dr. Kelly Gruber Santina Gutshall Dr. Molly Hajec Debra Hall Felicia Hansen Dr. Elizabeth Harr Ashley Hartung Dr. Lesley Hlatky Dr. Catherine Illuzzi Gianna Izzo Samantha Johnson Brittany Kepple Bonnie Kerlek Dr. Erica Kim Lori King Danielle Krawcheck Gabrielle Leonard Brianna Lipko-Dewitt Dr. Benjamin Luksic

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Lori Shanko Raymond Shroyer Jess Sible Taylor Snyder Ashley Stiefler Kate Strohecker Miriam Swartley Brooke Taylor Tara Taylor Courtney Temple Sabra Tierney Melanie Wiener Angelia Williams Sara Winemiller McKenna Yaudes Lorrie Young

Dr. Vishal Murthy is a board-certified veterinary neurologist and a faculty member at Washington State University. He’s been doodling his whole life and loves to incorporate art in vet med — whether that is in the form of medical illustrations, or cartoons and comics. He can be found at vetcartoonist.com and vetmedillustrations.com.

If you have something you want to share with Members, whether it’s a doodle, a drawing, a funny story, a puzzle or something else, we want to hear from you. Email your idea to Membership@PaVMA.org. 32 | Keystone Veterinarian

Obituaries In memory of... Dr. Michael P. Comalli (excerpt from lammandwitman.com) Dr. Mike, a son of the late Peter E. and Claire B. (Johnson) Comalli, was born in Worcester, MA. In addition to his wife, he is survived by three children, David M. Comalli, husband of Christina E., Shawna L., wife of Alex Weinberg, and Kimberly C. Comalli, fiancé of Nick Shenk; a brother, Gregory J. Comalli, husband of Jeannie; a sister, Lisa Comalli, wife of Ramiro Murillo; five grandchildren, Willow, Parker, Greyson, Myla, and Peter; a brother-in-law, Val Vinogradof, and his beloved dog Jet. He was preceded in death by a brother, Paul Sheehan; and a sister, Lynda (Comalli) Malone and his treasured hunting dogs, Rocky, Chance, and Ben. For the past 30 years, both he and his wife worked as veterinarians at Conrad Weiser Animal Hospital, the business they started together. The lives of the pets he saved and bettered was a major piece of how he impacted the community. He was also heavily involved in philanthropy, including his work with the Robesonia Lions Club. He was an avid outdoorsman who was an expert archer and fly fisherman; he took as much joy in guiding friends and family to game as bagging the game himself. His love of the outdoors included hiking, kayaking, and photography. He leaves a legacy of many outdoor apprentices including friends, siblings, children, and grandchildren. He was also an accomplished martial artist.

PVMA Events

SUPPORTING FUTURE VETERINARY PROFESSIONALS PVMA awards a Certificate of Achievement to high school seniors who complete the Veterinary Assistant Program at Dauphin County Technical School (DCTS). This 4-year educational program prepares students for working in the veterinary industry as a Veterinary Assistant through theory and hands-on learning to develop the knowledge and skills necessary for taking care of small and large animals. Students are afforded the opportunity of working with live animals daily and complete over 1,380 hours of classroom instruction. Each senior receives at least 100 clinical hours; however, some exceed that number. Seniors will have the opportunity to become nationally accredited as a Veterinary Assistant by NAVTA (National Association of Veterinary Technicians in America). Upon graduation, students can be working in a veterinary facility as a Veterinary Assistant or have the opportunity to continue their education in a veterinary technology degree program or pre-veterinary degree program. According to instructor Tiffany BG Houtz, CVT, there were 10 seniors this year and all 10 received the PVMA Certificate. “At this point, we have 4 students going into a pre-veterinary or veterinary nursing program in the fall,” Houtz stated. “Other students are seeking full time employment with the hope of attending a veterinary nursing program for the following school year.” PVMA is proud to partner with DCTS in promoting quality veterinary professionals in Pennsylvania.

PVMA DISTRICT MEETINGS: LET’S EAT, DRINK, AND EDUCATE These dinner meetings are your chance to interact with colleagues, receive an update on current initiatives within PVMA, and earn continuing education credit. There is no charge for PVMA Members to attend. PVMA Trustee Dr. Jody Kull welcomed members of District 2 on April 6 to hear Dr. Jen Roberts present a Continuing Education session titled “360-Degree Coverage: A Comprehensive Approach to Udder Health.” Thank you to our sponsor, Boehringer Ingelheim Animal Health, for supporting our initiatives!

PVMA is dedicated to the veterinary professionals in Pennsylvania and beyond. Below are some recent activities in support of our Members. Thank you for the opportunity to serve you! ONE HEALTH On April 2, PVMA and the Dauphin County Medical Society cohosted “Animals and Infections: A Dangerous Intersection.” This collaborative event included presentations from physicians and veterinarians throughout the Commonwealth of Pennsylvania.

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Dr. Darcie Stolz hosted the District 6 Dinner Meeting on May 5. “A One Health Approach to Zoonotic Disease” featured Dr. Kevin Brightbill, Director of the Bureau of Animal Health and Diagnostic Services at the Pennsylvania Department of Agriculture; Dr. Jonathan Nunez, an Infectious Disease Specialist in Hershey; and Dr. Elizabeth Lennon from the School of Veterinary Medicine at the University of Pennsylvania as well as Lennon Laboratory of Mucosal Immunology.

KEYSTONE VETERINARY CONFERENCE 2022 RE-CONNECT To “RE-CONNECT” was the objective of PVMA’s Keystone Veterinary Conference 2022; with 27 speakers providing CE in 20 tracks, over 350 veterinary professional attendees, 50 exhibitors, and 9 sponsors, we certainly achieved our goal of re-connecting! There were scientific education sessions, a happy hour in the Marketplace with exhibitors and sponsors, games, chair massages, and time to celebrate all types of moms. Learning and Laughing. Educating and Entertaining. Relaxing and Re-Connecting.

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ALES FOR TAILS SERIES FUNDRAISING The next time you visit your local brewery, ask the owner to “hop” on board this fundraising opportunity! Ales for Tails supports ACPA’s “The Last Chance” program, providing CARE grants for PA animals that cannot afford life-saving veterinary care. The brewery selects one of its craft beers to feature, then picks a TLC recipient to highlight on the label. We coordinate a date and promote through social media. We provide the artwork for the label and flyers. The brewery wins by having an amazing event that supports animals in need, and TLC wins by having a percentage of the sales of the featured beer donated to this program. Don’t forget that YOU WIN by patronizing a local business AND helping animals in need. Together we can make a difference!

Animal Care PA’s Our Bark in the Park 5K and 1-Mile Dog Walk celebrated its 12th year on October 24, 2021! This event is one of Animal Care PA’s largest fundraisers and it is because of the amazing participants, veterinary hospitals, PVMA Members, and volunteers that we are able to continue funding our community-based programs that FEED & CARE for animals all over PA.

SAVE THE DATE

October 23, 2022 We hope to see you again this year!

2021 HIGHLIGHTS:

View the entire album on Facebook @barkinthepark5k

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314 total participants (5K: 142; 1 Mile: 172)

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Online registration raised: $8,250

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Sponsors: 22 total sponsors raised $11,650

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Raffle items raised $625

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Direct donations: $1,661

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Volunteers: 40

Classifie d Ads VETERINARIANS Covenant Veterinary Care | Full OR Part Time / Marietta, PA Experience preferred. Established house call practice has expanded to include a freestanding clinic in historic Marietta, PA. Our two veterinarians and dedicated staff promote a professional and collegial culture dedicated to supporting and preserving the bond in covenant partnership with pets and their owners. At Covenant Veterinary Care we are truly “Partners for Health and Partners for Life.” In addition to home visits, we now offer expanded on-site care in our clinic featuring fully equipped surgical and dental suites, in-house diagnostics, and digital X-ray. Compensation commensurate with qualifications and experience. Contact: Respondents please email cvcmgt@gmail. com. Mercersburg Veterinary Clinic | Full OR Part Time / Mercersburg, PA Searching for an energetic, compassionate ASSOCIATE VETERINARIAN to join our medical team. You will enjoy practicing high quality medicine with a team-oriented support staff in a fully equipped custom built clinic, including: IDEXX Lab, GE Logiq V5 ultrasound, digital radiography, digital dental, CO2laser surgery, therapeutic laser, stem cell therapy, paperless records, efficient and organized clinic environment with heavy focus on good life/work balance. Enjoy flexible work schedule. No emergency duty. Flexible schedule. Salary commensurate on experience. Generous benefits package. Signing and relocation bonus. Contact: Please call Allyson Grove, DVM at 717.320.2696 and/or email agrove@mercersburgvetclinic.com. Ridgeview Veterinary Clinic | Full Time / Derry, PA Well established and growing veterinary practice in southwestern PA seeking FT or PT associate veterinarian. Beautiful rural setting, 90% small, mixed animal. Highly trained CVT, VA and Customer Service staff. Friendly, bring your pet to work, stress free atmosphere. Digital radiography, dental, ultrasound, therapeutic laser, small animal reproductive services, in house blood

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lab, routine surgeries. We fully support life outside of work. No required afterhours call. Occasional Saturday a.m. office hours. Competitive salary. CE budget. Paid: Vacation, sick days, disability, liability, life insurance and health insurance. New grads are welcome, mentoring available. Contact: Please call Hollie McDowell or Mellissa VollStouffer, VMD, co-owners 724.694.4244 (private line), or email: fieldofdreams_ hollie@aol.com.

Companion Animal Hospital | Full Time / Mount Joy, PA Veterinarian opening in Mount Joy, Pennsylvania. No Emergency or on call. Companion Animal Hospital was founded in 1995, and it has continued to grow and serve the community ever since. We are a staff of 8 doctors, 15 veterinary technicians as well as qualified receptionists and veterinary assistants. We provide a broad range of veterinary services including wellness care, acupuncture, in house laboratory, digital radiology, nutritional counseling, orthopedic surgery including tplo., reproductive health and services, and a canine rehabilitation program. We see dogs, cats, pocket pets, chickens, potbellied pigs and work with the local wildlife rescue. Contact: Please call Kelli Dowhaniuk at 818.309.3709 and/or email Kelli.Dowhaniuk@nva.com. VetCheck Pet Urgent Care Center of York | Full or Part Time / York, PA VetCheck Pet Urgent Care Center of York is opening late summer/ early fall in beautiful south central Pa. We are hiring Ft and Pt Veterinarians. This is a privately owned practice. We will be offering a benefits package including health insurance, 401k with match and CE allowance. Contact: Please call Sabrena at 443.676.8132 and/or email sabrenavt@aol.com. Animal Hospital of Millville | Full or Part Time / Vineland, NJ The Animal Hospital of Millville, NJ is a phenomenal hospital (with a gym on site) and seeks a full-time or part-time associate veterinarian who values a hands-on honest approach to veterinary care in a loving team setting. This position will provide a diverse and exciting small-animal practice

position for an experienced veterinarian or varied general practice experience and mentorship to a new graduate seeking a career learning experience following graduation. The Animal Hospital of Millville is a state-of-the-art facility providing expert medical services for small and exotic animals. Contact: Please email Tarron@ vetsbestfriend.com.

Animal Clinic of Buena | Full or Part Time / Vineland, NJ Animal Clinic of Buena is a beautiful hospital seeking a full-time or part-time associate veterinarian who values a hands-on honest approach to veterinary care in a loving team setting. This position will provide a diverse and exciting small-animal practice position for an experienced veterinarian or varied general practice experience and mentorship to a new graduate seeking a career learning experience following graduation. Animal Clinic of Buena is a state-of-the-art facility providing expert medical services for small animals. Contact: Please email Tarron@vetsbestfriend.com. Hillmount Animal Hospital | Full or Part Time / Carlisle, PA Hillmount Animal Hospital in Carlisle, PA seeks a full-time or part-time associate veterinarian who values a hands-on honest approach to veterinary care in a team setting. This position will provide a diverse and exciting small-animal practice position for an experienced veterinarian or varied general practice experience and mentorship to a new graduate seeking a career learning experience following graduation. Hillmount Animal Hospital is a state-of-the-art facility providing expert medical services for small animals. Established in 1989, Hillmount is a wellknown and respected practice in the community. Contact: Please email Cheryl@vetsbestfriend.com. Chester County Cat Hospital | Full or Part Time / West Chester, PA Seeking a candidate for part time or full time work at a feline exclusive hospital in beautiful Chester County, PA. We have a completely remodeled facility with new equipment. I am looking to fill some additional shifts, but I also would love to

Interested in placing a classified ad? Visit PaVMA.org/Classified-Ads for information on all classified ad placement opportunities. discuss full time opportunities too. Ideally, a candidate would be interested in feline dentistry and surgery. Thanks and best wishes. Contact: Please call Dr. Stadler at 215.859.1648 and/or email rachel.coyer@ gmail.com.

Golden Mile Animal Clinic | Full Time / Pittsburgh, PA Veterinarian sought for Golden Mile Animal Clinic. Well-established and wellequipped (complete lab, surgical, dental, imaging, endoscopy, laser Rx). Golden Mile has been a haven for pets and owners for over 30 years. A full-time veterinarian with experience (although new grads also considered) can expect a starting salary of $120-130,000 with a $15,000 signing bonus. Benefits include: health and liability insurance, 401K, licenses and fees, CE allowance, etc. There is buy-in potential. Contact: Contact Dr. Schowalter at 724.325.2661 or rkschowalter@gmail.com. River Hills Veterinary Hospital | Full or Part Time / Conestoga, PA Full or part-time veterinarian for 2-doctor privately-owned small animal practice in Conestoga, PA. Small town atmosphere, minutes away from the popular cultural hub of Lancaster City. Highly skilled staff and wonderful clients. Our hospital is a happy, supportive environment. Excellent salary and benefits, no after hours emergencies, flexible hours, no weekends. Contact: Please call 717.872.8920 or email riverhillsvet@ comcast.net or deblandis@yahoo.com. Best Friends Animal Hospital | Full Time / Chambersburg, PA Managing Veterinarian opening in Chambersburg, PA, a modern city with a small-town feel. Best Friends Animal Hospital is a 2-doctor, well-established, full-service, small animal veterinary hospital providing comprehensive medical, surgical and dental care. We value cooperation and teamwork along with comradery and collaboration. As our Managing Veterinarian, you will be responsible for providing medical leadership for a team of collaborative veterinarians and crafting an environment that fosters teamwork and quality medicine. Offering a generous signing bonus, relocation assistance,

and retention bonus. Joint Ownership is an option for those interested but not a requirement. Contact: Please call Kelli Dowhaniuk at 818.309.3709 and/or email Kelli.Dowhaniuk@nva.com.

Delmont Veterinary Hospital | Full Time / Delmont, PA We are looking for a third veterinarian in our practice. We have an in-house laboratory, digital x-ray, ultrasound, EKG, dental x-ray, and cold laser therapy. We are strictly a small animal hospital with about 5500 patients. We are offering a competitive salary, benefits i.e.: hospitalization, dental, eye care, dues and memberships, continuing education allowance, conference time off, professional license fees, paid vacation days and sick days. We are open Wednesday and Thursday 9:00-7:00, Monday, Tuesday, and Fridays, 9:00-5:30. Contact: Please call Jan Langlois at 724.468.8000 and/or email janl. dvh@windstream.net. Animal Wellness Clinic | Full or Part Time / Gettysburg, PA Privately-owned, AAHA-accredited Small Animal Clinic conveniently located along Route 30, 8 miles west of Gettysburg has the following openings: Urgent Care Veterinarian 3- or 4-day work week (including weekends). Weekend Wellness Clinic Veterinarian for Saturday, Sunday or both. House Call Veterinarian with flexible scheduling. Associate Veterinarian, 4day work week. These openings are new positions created to expand our services. We look forward to discussing these positions with you. Contact: Please call Dr. Deborah Flake at 717.337.2785 or email animalwellness@embarqmail.com. Camboro Veterinary Hospital | Full Time / Edinboro, PA Managing Veterinarian / Medical Director opening at Camboro Veterinary Hospital located near Erie, PA. We are looking for an experienced Veterinarian who is a good communicator, a team player who enjoys collaboration and contributing to the growth of our team through sharing knowledge and teaching. This is both a clinical and non-clinical position some of which involves surgery, dentistry, providing excellent medical leadership,

creating an environment of teamwork, managing Associate veterinarians and assuring regulatory compliance relating to the practice of veterinary medicine. We are a team of 5 FT and 2 PT veterinarians. Progressive clinic with lots to offer. Contact: Please call Kelli Dowhaniuk at 818.309.3709 and/or email Kelli.Dowhaniuk@nva.com.

Lewisburg Vet Hospital | Full Time / Lewisburg, PA Our small animal practice is located in the beautiful town of Lewisburg, Pennsylvania, home of the prestigious Bucknell University. We have the tools you need to practice, an excellent support staff whom we cherish and all the standard perks of the job. Last year our 3 associate veterinarians grossed an average $186,000 and that is working 4-5 days a week, no weekends, no on-call, no overnight. Consider scheduling an interview with us, all expenses paid, so we can tell you what’s in it for you. We look forward to hearing from you! Contact: Please call Kim at 570.523.3640 and/or email lvh@dejazzd. com. Countryside Animal Clinic | Full Time / Mechanicsburg, PA Countryside Animal Clinic in Mechanicsburg, PA is seeking a veterinarian. Located on 11 beautiful acres, our work environment is upbeat & enjoyable. We are a busy, family-oriented one-doctor practice, rapidly growing into two doctors. My staff is great and our team is highly reviewed by our clients. If you desire a good work-life balance, we are a great fit! Our practice has digital x-ray, in-house Abaxis lab, Ultrasound, & is well-versed in dentistry & most surgeries. Mentoring is available if desired. Most weekends and evenings off unless you want the opportunity to see emergencies. Check out our website! Contact: Please call Amanda at 717.697.6747 and/or email at krusenvet@gmail.com. Troy Veterinary Clinic | Full Time / Troy, PA Mixed animal practice, located in the beautiful northern tier of Pennsylvania, seeking a small animal practitioner for full time employment. Our recently remodeled facility is equipped with all the necessary work space and diagnostic tools to provide continued on next page >

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quality services to our clientele. Our team strives to work together and promote a cohesive, family-friendly attitude. Salary negotiable based on experience. Other benefits include assistance with relocation expenses, 3% matching simple IRA retirement plan, health insurance benefits, CE allowance, assistance with organization dues and opportunities for productivity bonuses. Contact: Please call Seanna or Marsha at 570.673.3181 or email marosanelli@gmail.com.

Banfield Pet Hospital | Full Time / Springfield, PA Banfield Pet Hospital is seeking Veterinarians! Sign-on bonus available at select locations! Are you looking for industry leading compensation and benefits, cooperative and collaborative teams, comprehensive coaching and mentorship, and tremendous growth opportunities? Look no further, because Banfield Pet Hospital is hiring! Contact: Jackie.Griffith@banfield.com today to learn more. Banfield Pet Hospital | Full Time / South Philly, PA Banfield Pet Hospital is seeking Veterinarians! Sign-on bonus available at select locations! Are you looking for industry leading compensation and benefits, cooperative and collaborative teams, comprehensive coaching and mentorship, and tremendous growth opportunities? Look no further, because Banfield Pet Hospital is hiring! Contact: Jackie.Griffith@banfield.com today to learn more. Banfield Pet Hospital | Full Time / Mechanicsville, PA Banfield Pet Hospital is seeking Veterinarians! Sign-on bonus available at select locations! Are you looking for industry leading compensation and benefits, cooperative and collaborative teams, comprehensive coaching and mentorship, and tremendous growth opportunities? Look no further, because Banfield Pet Hospital is hiring! Contact: Jackie.Griffith@banfield.com today to learn more.

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Banfield Pet Hospital | Full Time / Fairless Hills, PA Banfield Pet Hospital is seeking Veterinarians! Sign-on bonus available at select locations! Are you looking for industry leading compensation and benefits, cooperative and collaborative teams, comprehensive coaching and mentorship, and tremendous growth opportunities? Look no further, because Banfield Pet Hospital is hiring! Contact: Jackie.Griffith@banfield.com today to learn more. Banfield Pet Hospital | Full Time / Christiana, DE Banfield Pet Hospital is seeking Veterinarians! Sign-on bonus available at select locations! Are you looking for industry leading compensation and benefits, cooperative and collaborative teams, comprehensive coaching and mentorship, and tremendous growth opportunities? Look no further, because Banfield Pet Hospital is hiring! Contact: Jackie.Griffith@banfield.com today to learn more. Banfield Pet Hospital | Full Time / Caste Village, PA Banfield Pet Hospital is seeking Veterinarians! Sign-on bonus available at select locations! Are you looking for industry leading compensation and benefits, cooperative and collaborative teams, comprehensive coaching and mentorship, and tremendous growth opportunities? Look no further, because Banfield Pet Hospital is hiring! Contact: Jackie.Griffith@banfield.com today to learn more. Banfield Pet Hospital | Full Time / Parma, OH Banfield Pet Hospital is seeking Veterinarians! Sign-on bonus available at select locations! Are you looking for industry leading compensation and benefits, cooperative and collaborative teams, comprehensive coaching and mentorship, and tremendous growth opportunities? Look no further, because Banfield Pet Hospital is hiring! Contact: Gregory.Spunt@banfield.com today to learn more.

Banfield Pet Hospital | Full Time / Pittsburgh, PA Banfield Pet Hospital is seeking Veterinarians! Sign-on bonus available at select locations! Are you looking for industry leading compensation and benefits, cooperative and collaborative teams, comprehensive coaching and mentorship, and tremendous growth opportunities? Look no further, because Banfield Pet Hospital is hiring! Contact: Gregory.Spunt@banfield.com today to learn more. TECHNICIANS

Allegheny Veterinary Associates | Full Time / Pittsburgh, PA Allegheny Veterinary Associates is a privately owned small animal clinic located north of Pittsburgh. We are seeking a Certified Veterinary Technician for our growing clinic. Candidates must have a minimum of one year experience, able to read medical records and record procedures/treatments, understanding of medications, placement of IV catheter, draw blood, X-Rays, surgical preparation, administer anesthesia, monitoring surgery, in house lab processing, injections, animal restraint, interact professionally with both pet and owner. Knowledge of Avimark system a plus. We offer a 401K, 10 paid vacation days, Monday through Friday work week, major holidays off, medical, dental. Starting yearly salary is $50,000.00. Contact: Send resume to Elizabeth at alleghenyvetes79@yahoo.com. practices/Equipment For sale

York County, PA Two-doctor small animal practice housed in a free-standing building, located on a main road with abundant parking. Practice and real estate for sale. $500,000-$600,000 per year take home to owner over the last 3 years with a 3/4 work schedule. Can easily become a three-doctor practice. Associate veterinarian and staff have been employed long-term. Many equipment and building upgrades recently. Owner ready to retire and will help with the transition. Contact: Email pavetsale@gmail.com.

Pittsburgh, PA Microscopes for sale. All were serviced last year and have not been used since. They are Revelation III LED microscopes Jorvet/LW scientific. Here is the information. Pictures are available: $400/scope. Contact: Call Korin D’Ascenzo at 484.553.8181 or email drkorinmediate@gmail.com. Bucks County, PA Wanted: Medically and surgically confident veterinarian ready to grow net worth sufficiently to reduce educational debt to rubble! How? By purchasing and growing a thriving small animal practice with real estate in Bucks County, PA. Owner willing to stay on as mentor and part time associate. Experienced practice manager interested in becoming co-owner to minimize startup business headaches. Contact: Please call Dr. Wilson at 215.321.9488 and/or email jfwdvmjd@verizon.net. Berks County, PA Snyder Manufacturing light blue cage sets with casters for sale. One set of four measuring 46.75 inches width by 35.875 inches height. Second set of five cages measuring 69.75 inches wide by 54 inches height. Gates hinged on left card holders. Used but still in excellent condition. Must arrange transportation. Listing at $2,200. Price is negotiable. Contact: Please email fetaalfredo@aol.com if interested. Berks County, PA Small animal practice with limited avian and pocket pets. Real estate includes a craftsman style, renovated, freestanding 2265 sq. ft facility with parking to accommodate 15 cars. Practice has served Berks County for 26 years. Currently a 1-Doctor practice, but has excellent potential for growth. Current owner planning to relocate. Real estate, all equipment and client base included in potential sale. Contact: Serious inquiries only with complete confidentiality required. Email owner at fetaalfredo@aol.com. Penn Hills, PA Small animal, single-Doctor practice on 4 acres for sale in the eastern suburbs of Pittsburgh. Office building and a house situated behind with property, intend to sell for less than $300,000. Practice and equipment to be sold in a separate contract. Practice value yet to be assessed, but gross

income for 2022 expected to be $370,000 or greater. Contact: Serious inquiries please email Blaine Messenger at puttenskippies@verizon.net.

Boyertown, PA Equine Breeding mount for collecting for AI. Excellent condition. Very strong, single pedestal, sleeve for which must be buried in the ground. Adjustable. No defects on it. $1000. Contact: Please call Sherilyn Allen at 610.367.6446 and/or email sallen5898@ comcast.net. Eastern Suburbs of Pittsburgh Small animal, single doctor practice on 4 acres for sale. Office building and a house situated behind with property, intend to sell for less than 300k. Practice and equipment to be sold in separate contract. Practice value yet to be assessed, but gross income for 2022 expected to be 370k or greater. Contact: Serious inquiries only, email puttens-kippies@verizon.net. Bedford, PA 2021 F-250 STX 6.2L gas, extended cab, 4709 miles, New bowie platinum 8 unit. Ceramic coated bumper to bumper, tinted windows, sprayed in bed liner, undercoated, mud flaps, front seat covers and floor mats. $65,000 obo. Contact: Call 814.381.1905. South Central PA Established two-doctor practice (canine, feline) in South Central PA. Growing population with multiple doctor potential, if one desires. Attention Medical Directors: Want to work similar hours/responsibilities and earn 3-4 times your current salary? Practice the way you want to and earn what you deserve. Pleasant, conscientious, and reliable staff. Updated IT, digital radiography (human grade) and in-house laboratory machines. Business and freestanding real estate for sale. Average Gross Revenue over 3 years: 1.4 million (2021, 2020, 2019). Owner ready to ride off into the sunset. Contact: Inquiries to vetsale22@gmail. com. Please no corporate inquiries.

relief veterinarians

David J. Henzler, DVM, PhD / Dauphin, Lebanon, Berks, Schuylkill, Lancaster, Lehigh and York Counties RELIEF VETERINARIAN with 15 years of clinical practice experience, including 3.5 years as a full-time 24-hour emergency doctor. PhD in Veterinary Science. Serving small animal and exotic practices in Dauphin, Lebanon, Berks, Schuylkill, Lancaster, Lehigh and York counties. Available anywhere in Pennsylvania for one-week or longer periods to cover vacations, illness, maternity and other needs. Energetic with a professional appearance and excellent communication skills. Integrous, dependable and detailed. “I treat your practice like my own!” Contact: Call 717.341.4357 or email henzlerdvmphd@aol.com. Erin K Murphy, DVM / Berks, Lancaster, Lebanon, Lehigh, and Schuylkill Counties Outgoing, energetic and professional veterinarian in search of small animal practices where I can utilize my 24 years of clinical experience. I enjoy surgery, internal medicine, dermatology, wellness visits, and participating with the human-animal bond. Excellent communication skills, active listener, compassionate, and empathetic. Contact: Email ekhj07@gmail.com. Relief or Part-time Veterinarian Needed / Elkton, MD Seeking relief vet for Elkton, MD, easy commute from PA or DE. Excellent compensation and work environment. No after 6 hours. Contact: email neah1771@ comcast.net.

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Keystone Veterinarian Summer 2022

Articles inside

Classified Ads

Get Hooked on Fish Medicine

A Message from the PVMA Executive Committee

Practice Pearls

Mentors-R-Us

Tired of Looking for Staff Who Won’t Stay?

PVMA Team Talk

Your Veterinarian’s New Best Friend: A Medical Transcriptionist

Utilizing CVTs to Improve Efficiency

PVMA Statements