I grind my teeth as I hear the phrase "stat triage" repeated over the intercom. I make eye contact with the ICU nurse, who glares back at me as he performs the impressive feat of a solo blood draw from the tiny vein of a sick cat. He’s the only intensive care unit nurse for 10 patients. And he’s going to kill me if I admit any more patients tonight.
But what am I to do? Staffing shortages have shut the only other emergency hospital in Brooklyn tonight, so I’m the only veterinarian seeing cases in the borough until another vet relieves me in four hours. Every sick animal in Brooklyn is showing up at our door. How can I ethically send away patients that desperately need our care, make sure the ones we already have are getting the care they need, and prevent my fantastic ICU nurse from walking out?
Meanwhile, the three new triages are a cat near death from being unable to urinate, a dog that has been seizing for 30 minutes, and a puppy so dehydrated from vomiting and diarrhea that it may die. And while this is all going on, I’ve just given a young woman terrible news that we have to euthanize her cat.
Unfortunately, veterinarians have become the de facto experts in rationing care.
The clamor about overwhelmed human hospitals has been the regular drumbeat of the news for the past two years. But none of us in the veterinary world saw this coming.
What exactly is going on? First, the veterinary industry was already growing. American spending on veterinary medicine increased from $13.01 billion in 2010 to $29.3 billion in 2020, according to Veterinary Practice News. In addition, there has been a general trend toward treating pets as family members. People are willing to spend more on veterinary care, and pets are increasingly insured. The market for pet insurance rose at an average annual growth rate of 24.2% from 2016 to 2020, from $836.6 million in 2016 to $1.986 billion in 2020 in gross written premiums, according to the North American Pet Health Insurance Association. Finally, regular veterinarians have been limiting hours during COVID-19, putting more pressure on ERs to see minor problems like ear infections on top of our sicker patients. And just about everyone got pandemic puppies.
Before COVID, the typical ER wait time was an hour or two. Suddenly, people were waiting six to eight hours, or more. Angry clients started treating us badly.
Burnout set in and nurses and veterinarians began to quit. Average turnover for veterinarians is twice as high as for physicians, and veterinary nurses have the highest turnover among nearly all health care positions, according to the American Veterinary Medical Association. Those of us left have had to pick up the slack.
This last COVID wave has worsened the crisis. Much of our workforce has been sidelined by the virus, while the number of patients needing care remains the same. Animals are dying because our hospitals are short-staffed.
I’m not sure what the solution is. Training more veterinarians and veterinary technicians is a long-term answer. In the short term, we must ensure better quality of life and pay for the people already in the field. What keeps me going is reminding myself every day of why I do this: to help save animals’ lives.
So be kind to the people who take care of your pet. We’re trying really hard to keep our heads above water.
This guest essay reflects the views of Jessica Fragola, an emergency veterinarian practicing in the metropolitan area.