Solving the crisis in rural practice

What is the future for vet practitioners in the country areas of Australia? Will small practices survive? How can graduates be attracted to rural work, and do they have the skills needed to be successful? I asked three well-known and active rural vets to tell me how their practices have changed over recent years, and what they see as the way forward for young vets looking to a rural practice.

The three vets who agreed to answer my questions were Matt Makin, Past President and now Vice President of the Australian Veterinary Association; Coonamble vet Scott Parry, and Jim Smith, Treasurer of the Rural Practitioners group of the South Australian Veterinary Association,

Timboon-based Makin has a practice in southwest Victoria, mostly servicing the dairy industry for a radius of about 70 km. Apart from dairy, the remainder of the practice is beef cattle, equine and small animal. The practice has 10 vets, operates over two locations, and approximately 90% of its services are orientated toward the dairy industry. There are five partners, five employee vets, four receptionist/veterinary nurses and a soon-to-be-appointed general manager.

Smith’s practice at Naracoorte, not far from the eastern border of South Australia, covers an area of approximately 100 km in diameter. It has four full time vets, and when he and his partners bought the practice 20 years ago in 1985, the large animal share was about 80%. Demographic changes and the end of government disease control programs such as for TB and brucellosis have seen that drop to about 30%. Now the numbers are dropping because of the drought.

Parry’s Coonamble Vet Surgery is on the central-northwestern plains of NSW, in a beef cattle, sheep and grain growing district. There are three full-time vets. The practice derives 50% of its income from production animals — 42% beef cattle, 8% sheep. The balance is from horses and dogs, for the most part working animals.

The practice itself covers a far-flung territory in a radius of at least 200 km from the clinic. It reaches about 250 km to the north to the Queensland border, and westward as far as the Darling River about 400 km away. The more far-flung work is almost exclusively animal production and management work — pregnancy testing, bull testing, disease investigation etc.

cows at Beemery
“The focus has moved from the individual animal to optimising the health of the entire herd and enhancing production”

All three agreed that rural veterinary practice has changed radically over the past 10-15 years. “Veterinary practice has changed significantly over recent years in both the type and complexity of the work, which is a reflection of the changing nature and demands of the dairy industry,” Makin says. He points out that farmers are quite capable of treating their own animals for conditions that were the domain of the veterinary surgeon 10 or so years ago.

“The problems being addressed have moved away from the individual animal, and are now frequently focused on the optimising the health of the entire herd and enhancing production. Over the last decade, herds have also continued to get larger, and we have seeing a move toward corporate farming which faces its own unique animal health and production challenges.”

Parry says that surprisingly, despite the six-year drought and commodity prices (beef, wool, milk etc) that really haven’t increased a great deal, his practice is busier than it was 14 years ago.

“I think that is partly down to the fact that there are less practices providing a full veterinary service to remote areas. Consequently we travel further and further afield for large animal work (particularly production animal work) and draw small animal clients from an ever increasing geographical area.”

Like Makin, he sees the move from “the traditional view of the vet as some aloof ‘Herriot-like’ figure that is a healer of sick (individual) animals” to “contractors who form part of a whole enterprise management team”. Production animal services, particularly herd health style services, have continued to grow, and vets are expected to be more efficient than in the past.

“Ten years ago, a station running 800 breeding cows would probably pregnancy test them over four days, doing 200 per day. Nowadays we are much more likely to do all 800 in a day, and preferably by no later than early afternoon, so that cattle can be vaccinated, drenched, drafted, walked back to paddocks, calves weaned etc in as short a time as possible. Much of this relates to the fact that on farm labour is harder and more expensive to come by and the producers need to get the best bang for their buck from vets and contact musterers alike.”

Smith has seen major changes over the 22 years since the end Brucellosis/TB testing, which had provided a steady income through government contracts. “As the BTB came to an end, it was taken back by the government veterinarians, who at the same time became unavailable for previously subsidised herd visits. The net effect was the end of paid government contracts and the need to suddenly convince farmers that it was necessary to pay for herd visits that had previously been a free service.

“After a few more years the subsidised laboratory fees also were dropped, and given the many hundreds of dollars in pathology needed for many investigations, farmers became even more reluctant to use veterinary services,” he says.

Competing with vets are the new ‘paraveterinary’ providers – ultrasound pregnancy testing, equine dentistry etc. “The net effect of this is that the large animal work has largely stagnated while small animal work has, if worked upon, gone ahead in leaps and bounds,” Smith says.

“Rural veterinarians who have ignored the potential of growth of their small animal business may well have shot themselves in the foot.”

Other notable changes have been the growth in technology, improvements in medicines and surgical practices, particularly for small animals. Parry points to the improvements in equipment and working conditions.

“It is unusual for most rural practices not to have 1 – 2 ultrasound machines, a pulse oximeter, isofluorane anaesthetics etc. Thirteen years ago it was a much more spartanly equipped profession, particularly in the bush.

“These days employees and clients just expect a higher level of service and amenities from their local vet practice. They need only jump on the internet to see what is available out there.”

Yet some things remain the same. Smith says that technological advances in food producing animal medicine are very limited.

” ‘Arms up backsides’ is still a huge proportion of the work. Facilities are, of course, reliant on the farm owner, not the practice — and many have not changed in 20-odd years. OHS&W concerns are of great concern.”

Arms up backsides

‘Arms up backsides’ is still a huge proportion of a rural vet’s work

The three are undecided as to whether the overall effect is better or worse, as there are too many factors to consider. The consensus is “different”.

“A clinic like ours has gone from 80% income from sheep and cattle in 1985 to 75% income from dogs and cats in 2006. The small animal clinic is able to provide a comfortable and professionally challenging environment for the veterinarians and nurses, essential in my view for the attraction and retention of staff,” Smith says.

On the downside, he lists reduced monitoring of livestock diseases on properties leading to less information about disease prevalence, bureaucracy and paperwork, the GST, OHS&W. “The dreaded ‘accreditation’ plague where graduate and experience skills and training are devalued by the necessity of achieving sterile paperwork qualifications to perform routine tasks.”

Makin also sees it as both better and worse. “One positive from the changes in both the dairy and veterinary industries has been the gradual move away from the vet being a technical professional toward being very much a specialist animal health and production advisor,” he says.

“This has, I think, created many opportunities for vets to re-equip themselves with new and interesting skills, capable of maintaining their enthusiasm, increase their incomes, improve their lifestyles and allow them to move away from those activities that are physical and technical.”

At the same time this could be considered a negative, he says, as veterinarians have had to “take a strategic look at the services they provide, spend time on their business operations, and re-equip themselves academically to remain relevant to the modern dairy farm.

“Failure of vets to change with the industry and provide services of greater financial benefit to the farming sector has and continues to threaten the future of rural veterinarians.”

For Parry, the answer is positive. “I would have to say that it is definitely better for me. But that is partly biased by the fact that I am now a practice owner and not an employed vet!” He is not so convinced about improvements for other practitioners.

“I am not convinced that graduates get the same quality of experience that they got 10-15 years ago. Undoubtedly they are now better paid and have much better working conditions and are much more conscious of their rights, but I can’t help but feel that they are missing out on something. But that just may be me being an old bastard…”

Struggling: small and single practices

“I really feel that single vet practices in particular are going to slowly disappear over the next 10 or so years,” predicts Parry. “For many of the reasons already discussed, they will find it increasingly difficult to cope.”

He says “there is little or no lifestyle” associated with these practices, as vets are either on call or at work. Even if they try to employ a second vet, it is hard to attract anyone to work with them. They are also hard practices to sell as few people want to buy this sort of lifestyle, as it is difficult for these vets to get away to conferences or holidays.

“Unfortunately the demise of single vet practices in small towns will mean that some towns will be left without a full time vet service.”

Smith says small practices, both rural and metropolitan are coping “with difficulty – a lot.” He points out that small practices have all the same requirements as a larger clinic, without the benefits.

“All the licenses, bookwork, accounting requirements (staff, computers etc), and the need to provide a 24 hours service, but with little support. The prospect of attracting veterinarians to such a clinic would be daunting. The prospect of attracting a purchaser of such a practice for succession is even worse.”

Makin is a strong advocate for practice consolidation. “I feel the one or two man veterinary practice has a very uncertain future.” Larger vet practices offer a range of benefits that single ones cannot: fewer after hours demands, greater collegiate and professional support, greater opportunity to seek further education and specialise within each discipline, able to provide broader more relevant services at a high standard to the faming sector, easier and more efficient training of new graduates and easier succession when someone leaves as an employee or business owner.

“Fewer but larger veterinary practices will solve many of the issues of concern with the rural veterinary crisis,” he says.

What would attract young graduates to rural practice?

Smith is succinct: the right employer/workplace, the right clientele, and the right community

“Employer and workplace — professional support, facilities enabling the veterinarian to keep current (professional development), reasonable hours and after-hours load..

“Clientele — to provide a range of work to keep the veterinarian challenged and interested. Modern expectations of services (clients should not be expecting services and charging from the mid 1980s).

“Community — active social prospects, respecting the free time of the professional. An off duty veterinarian does not want to be questioned about cases every time he enters the club house at the golf course!”

Makin agrees. He lists “more friendly working hours, less after hours, greater remuneration, greater opportunity for further training, professional and collegiate support, a team-focused working environment and access to a social network.”

Parry’s list is identical. He adds, “In a nutshell, we need to make rural practice an attractive, desirable place to be. We need to provide as much of the varied experience that we received 10-15 years ago (as they still want to work hard and learn), but with more generous allowances for income and lifestyle.”

He is concerned, however, that graduates are not getting as wide a range of experience as they should, because, “everyone is more litigation conscious — even in rural and remote practices.

“Consequently I think that we are all much more cautious trying to attempt weird and wonderful procedures. We are also very careful in letting our graduates loose on the clientele until we are very confident in their abilities. “

Graduates also seem to expect this higher level of support and protection from employers, he says. “Ten years ago we were probably more gung ho in our approach to practice (and life) in general.”

What is deterring graduates from the rural practice?

All three agree: Long working hours, two or three nights a week on call, poor remuneration, poor professional support and loneliness, both professionally and socially. Parry sums it up: “No career structure — employers treating them like slaves to be worked hard, taught nothing and cast aside after a couple of years.”

Makin and Parry disagree on the levels of skills graduates bring with them to rural practice, but they both agree on the need for more and continual training, as does Smith. Graduates enter the profession with a wide variety of skills and are extremely capable individuals, Makin says. But, “the reality is that a successful veterinarian needs to commit to a career that is predicated on continual training.

“The range of services that are demanded and are relevant to the rural sector is well beyond those taught at an undergraduate level. Hence extra training in areas of business management, financial analysis, animal health economics, epidemiology and most importantly, animal production systems are critical to success of veterinarians into the future.”

But Parry does not have such a high opinion of graduates’ abilities.

“Graduates badly need to graduate with more basic manual skills that allow them to be more useful on day one in practice. Realistically these skills are usually mundane, but they are very important in getting graduate confidence up and making client acceptance more forthcoming. The skills I’m referring to include pregnancy testing, obstetrics, anaesthesia, basic surgery and the like.

“You can go on all you like about needing students to be better trained in business management, communication skills, herd health and epidemiology, brain surgery etc. But the simple fact of the matter is that if they can’t preg test a cow/pull a calf/spey a dog/stitch up a horse and look confident and competent when they do it, they will never get the opportunity to progress to this next level of service.”

Smith says the aim of ongoing training for any professional – not just vets — “needs to concentrate on producing a functional professional rather than a technically sound one with no idea of life in business/hospital/school.”

However, looking at the problem of attracting graduates to rural practice, he says specific answers are needed, not merely trying to make a “better” veterinarian at vet school.

“Selection of country-originating students will, at best, have a marginal effect — they will still go where the grass is greener, but at least they will have a better idea of country life. I also feel that bonded graduate programs, TEAS rebates for rural veterinarians etc, are not addressing the problem, and would cause resentment rather than retention. You can’t pay someone to like something.

“The current graduate WILL look at a rural position, but only if that position competes well with positions found in metropolitan, industry or international job markets.”

Undergraduate clinical training that exposes students to rural practice falls short of giving them a true understanding of what the job is currently like and what it will be like into the future, Makin says.

“It is ultimately up to the Universities, the AVA and veterinary businesses to ensure undergraduates understand rural practice, and that they are given the tools and knowledge to ensure they are capable of pursing a rewarding career in the field post graduation. Universities in particular are largely responsible for crafting student perceptions of rural practice, and must firstly understand the future of rural practice to ensure the educate students accordingly.”

Parry says it’s not enough to expect the universities to promote the idea of rural practice. “Rural vets need to get into the universities and promote themselves as great places for under-graduates to do prac work and get them out there experiencing life in the bush. We need to make sure that they get positive experiences while they do prac work in rural areas — make it interesting for them and get them involved in the social side of the community.”

All three hope that government assistance of some sort will be provided. Makin says government assistance “in the form of financial training incentives would greatly assist, and allow for new graduates to improve their knowledge and skills at a rate that would improve their ability to deliver relevant services to the farming sector sooner after graduation.”

Smith says re-introduction of government funded disease investigation programs may be a possibility, and would be particular helpful for small or one-person clinics.

“It would be nice to think that there may be some governmental assistance in
the form of HECS relief and scholarships for graduates that choose to go
into rural practice,” says Parry. “But I wouldn’t hold my breath on that for too long.

“This may come in time with increased awareness of the importance of vets in biosecurity for our country.”

© Sue Cartledge

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