In the [almost] ten years since I started working at this practice (it’ll be exactly ten on May 1st), we’ve been through a variety of changes in how we handle the basic wellness care of our patients. Here’s a timeline:

1998: Yearly exam with physical, annual DHLPP vaccine for dogs, annual FVRCP vaccine for cats, annual FeLV vaccine for indoor/outdoor cats, annual rabies vaccine for all, fecal and heartworm check, with CBC, chemistry, thyroid hormone and FeLV/FIV tests optional. We charged a package price for the core (non-optional services).

2000: Same as 1998 with a change in canine annuals: CBC and brief chemistry worked in for the same price as last year’s annual package (we found a great deal with a local lab). Regular dentistry highlighted as crucial for optimum wellness, particularly in susceptible breeds and geriatrics.

2002: Same as 2000 with both Senior and Junior packages for dogs. Senior packages for dogs include thyroid screens and full chemistries.

2003-2005: Same as 2002 with a gradual diminution in vaccine frequency for geriatrics and low-risk dogs and cats (every two to three years). Minimization of Leptospirosis vaccine usage. Increase in dentistry recommendations. Explicit discussions on the increasing focus on physical examination as central to optimum wellness.

2006: Same as 2002 with rabies and DHPP vaccines now scheduled at every three years. Leptospirosis administered only a case-by-case basis. Increased usage of full chemistries and thyroid profiles for susceptible non-geriatrics.

Fast-forward to 2008 and now we find ourselves explaining why the physical examination is so crucial to what we do, rather than assuming owners understand this most basic principle. Owners of geriatric patients are encouraged to seek six month physicals and bloodwork, which is a requirement for those using medications on a regular basis (we will not refill prescriptions without it).

Dentistry is more important than ever to our wellness programs. Our reminder service is geared up to add six-month wellness checkups for the oldies and dental reminders for the chronically afflicted.

While all of these changes seem to work smoothly enough with most of our clients, we’ve started to hit some now-noticeable bumps in the road. While all of our clients are pleased about the attenuated vaccine schedule, a surprisingly large percentage are starting to balk at the need for annual visits, asking instead for the Miami-Dade County license—sans check-up.

That’s a problem. Most importantly, that’s because the physical exam is by far the most important element of our wellness program. While I’ve underscored that fact every year—especially carefully once I identified this as a future issue a few years back—it’s not made a difference to some of our clients. No vaccine and no illness = no need to see the vet at all.

Too bad for the pets. And too bad for our bottom line, too. It’s a harsh reality for many vet hospitals. Taking the higher road on fewer vaccines doesn’t just hurt the big pharma producers who have long lobbied against this change, it affects vets on the front lines more than you might think—and the pets whose owners fail to see the need for preventive medicine.

Arguing that fewer annual vet visits might inadvertently result from the lower frequency vaccine schedules experts increasingly recommend, critics continue to administer annual vaccinations—some vets (including national chains) even advocate the use of vaccines every six months for non-core vaccines like Bordetella (kennel cough) or Corona virus, despite a pet’s low risk status.

In fact, fewer than 5% of Miami-Dade County vets have adopted the new standards (by my recent, admittedly unscientific poll). Even progressive vets here have eschewed the new protocols after hearing vets elsewhere complain of the wave of annual visit non-compliance.

Many also cite the “standard of care” issue, worried that Miami’s warmer weather conspires to foment diseases less prevalent elsewhere. In this case, they argue, are we at a higher risk of a lawsuit if an animal does contract the diseases others vaccinate more frequently against?

It’s clear to me—now more than ever—that education is the key to compliance, though my explanatory methods have seemingly failed in some clients’ cases. While it’s certainly a depressing conundrum, we have no plans to change the protocol. Hopefully we’ll be able to convince the doubting Thomases [understandably hoping to hold tight to their hard-earned money] that annual physicals are the key to saving it in the long run.

So today I’ve resolved to go online and check out the Veterinary Information Network’s recommendations on this front. Their pool of vets is always progressively looking for ways to get the best for their patients. After all, I’m a firm believer in the axiom that says “what’s best for the patient is what’s best for the practice.”