Sustaining emergency and critical care services through an equine veterinary crisis

This is the second part in a series of articles on the Equine Crisis facing veterinary medicine and the response by the profession and Virginia-Maryland College of Veterinary Medicine.

It has been widely known in the equine community in recent years that students in veterinary colleges throughout the country are choosing to steer away from equine veterinary medicine. 

In 2021, the American Association of Equine Practitioners highlighted this plight, sharing that only a small percentage of veterinary graduates were entering the equine profession. Even more disturbing is the fact that 50 percent of these graduates will leave the equine profession within five years. 

This issue has caused some serious outside-the-box thinking at the Virginia-Maryland College of Veterinary Medicine as well as other veterinary colleges and private equine practices throughout the country that wish to sustain emergency and elective services that they currently offer to clients.

Michael Erskine '84, DVM '88, the Jean Ellen Shehan Professor and director of the Marion duPont Scott Equine Medical Center (EMC), is acting co-chair on a subcommittee of the American Association of Equine Practitioners' Commission on Equine Veterinary Sustainability, which focuses on the demands of emergency coverage. At the recent 2022 association convention in San Antonio, Texas, Erskine moderated a roundtable and presented a lecture on this topic. 

Since the equine medical center opened its doors in 1984, its clinicians have been expected to offer outpatient and elective treatments and cover 24/7 emergency and critical care services. This expectation causes clinicians and clinical support staff enormous stress and fatigue, affecting not only their work-life balance, but also their ability to cover daytime scheduled appointments in a timely, efficient way. Due to the continuing increase in the emergency and critical care caseload, this is not a sustainable situation.

The equine medical center has seen a substantial increase in emergency and critical care cases in recent years. In fiscal year 2022, emergency cases increased by 21.5 percent over the previous year, amounting to 739 emergency cases treated during the 12 months. There has been much discussion as to how to continue offering the current high level of emergency while being supportive of the expectations levied on clinical staff.

“To sustain emergency services at the EMC, we are planning to create a dedicated emergency and critical care team,” Erskine said. “This team will be focused around specially trained equine clinicians who have completed advanced training in both emergency medicine and surgery."

Clinician Emily Schaefer, clinical assistant professor of internal medicine, will complete a fellowship in equine emergency and critical care this summer. EMC Advisory Council Vice Chair Shelley Duke and her husband, Phil, made this fellowship possible through their generous sponsorship. 

The fellowship, a collaboration with the Ohio State University College of Veterinary Medicine, spanned three years and will culminate in Schaefer being board-certified by the American College of Veterinary Emergency and Critical Care. Schaefer will fill one of two new faculty positions generated by the program alongside Sarah Dukti, clinical assistant professor of emergency and critical care, who joined the equine medical center in March. 

Philanthropic support was sought to cover three-year bridge funding to launch the emergency and critical care team. Schaefer and Dukti, both emergency-focused and highly trained clinicians, will be on-call day and night to cover emergency and critical care services and will be supported by the center’s clinical staff. This dedicated team will allow clinicians to focus on outpatient appointments and elective surgeries, mitigating sometimes lengthy wait times for these services.  

A generous and committed supporter of equine medical center shared her desire for all equine-focused veterinarians to have a sustainable work-life balance. Her passion encouraged her and her husband to commit support for the initial three-year bridge funding of $1.5 million to stand up the service, which is expected to be self-sustaining by the end of the three-year term.

The donor explained her  reasons behind her decision to support the field of equine emergency and critical care “Emergency equine medical care is at the epicenter of the crisis in veterinary medicine. I have watched with increasing dismay, then alarm, as our horses’ finest care providers have left equine medicine for saner, more predictable, better-paid small animal practices or positions in government. 

“Constant on-call demands with no let up on daily duties leave new (and not so new) veterinarians emotionally drained and physically exhausted, too often questioning their choices. Equine veterinary medicine is a calling for the practitioners I know, and they are leaving the field with regret. As a client, as the mother of a veterinarian, I can see that we need radical new thinking about the structural context that sets up emergency medicine not only for successful outcomes but for successful and sustainable careers. 

“I am so proud of the work EMC has done to reimagine this context, and of the courage Mike Erskine and his team have shown in their willingness to lead the way to make emergency medicine the exciting career choice it should be”. 

As part of the Virginia Maryland College of Veterinary Medicine, the equine medical center’s mission is to offer excellent and compassionate clinical services to horses and their owners while still focusing on the education of veterinary students, clients, and equine veterinary professionals. Introducing the emergency and critical care team will allow the center to continue to fulfill this challenging mission.   

Related

• Veterinary college joins national effort to address emergency and critical equine care services.