Following the recent Royal College of Veterinary Surgeons (RCVS) Council decision to redefine “Under Care” to allow vets to prescribe remotely, VetSurgeon.org conducted an online survey to find out what veterinary surgeons thought of the decision.
Six-hundred and ninety-two veterinary surgeons took part in the survey; 88.7 percent of which worked in practice, 8.7 percent worked elsewhere and 2.6 percent were retired.
Of the 692 participants, 42.4 percent worked in corporate practice, 42.4 percent at an independent practice, 9.6 percent locum and 2.6 percent at a charity. Ninety-four percent worked in first opinion practice, 5.7 percent in referral practice.
When asked: “Do you agree with the RCVS Council decision to allow veterinary surgeons to prescribe medication without having seen / examined the animal in person?”, 78.2 percent said “no”, 13.6 percent said “yes” and 8.2 percent said “ambivalent”.
This raises an interesting discussion about the role of RCVS Council, which the College has long said is “representative of”, but not there “to represent” the profession in self-regulating, observed Arlo Guthrie, VetSurgeon.org publishing editor. By any measure, this decision was not “representative of” the wider body of opinion.
He said: “It could be argued that electorates vote for representatives to make more informed decisions than they themselves are able, and certainly MPs have voted in ways that are not representative of the wider body of public opinion.
“But this is the veterinary profession. MPs have to represent a wide cross-section of society, some groups of which might struggle to field one working brain cell between them.
“By contrast, veterinary surgeons are a highly intelligent, highly educated subset of the population, who you might assume are better qualified to make decisions on matters such as these.
“So why this level of disagreement? We asked respondents to select any benefits and drawbacks they think remote prescribing will bring, from a list but with the option for them to write in any we hadn’t thought of.”
When asked to select benefits of remote prescribing:
- 70.9 percent selected “reduced cost to the pet owner (driving/parking, etc)”
- 39.3 percent said it would bring an improvement to vets’ quality of life through more flexible working
- 27.5 percent said animal welfare would be improved through increased access to veterinary services
- 14.3 percent said it would bring an “improved client/vet relationship”
Of those people who selected a benefit, 49.9 percent said the biggest benefit of remote prescribing is a reduced cost to the pet owner (driving/parking etc).
Other benefits highlighted in the comments section were:
- Animals will receive care when physical exam is not possible, such as client illness or remote areas
- Ease of some chronic conditions if owner stressed by attending clinic
- Easier access to prescription flea and worm treatments
- Environmental benefit of not driving to vets unnecessarily
- For fearful animals that need pre-visit meds
- Frees up clinical time
- If only used for existing clients, can improve relationships by offering better access
- Improved time management so better work life balance
- Legitimises present working practices
- Mitigation of veterinary recruitment gap
- Not having to examine the psychopaths
Notably, in the comments section for the benefits of remote prescribing, out of the 104 comments, 33 commented “no benefit'” or negatively.
When asked to select the drawbacks of remote prescribing:
- 94.3 percent selected “harm to animals caused by misdiagnoses and missed diagnoses”
- 68 percent said “worsened client/vet relationship”
- 60.6 percent said it was a threat to independent practice (corporates funnelling clients from online consults to their practices)
Other drawbacks identified by respondents were:
- Abuse of drugs (getting drugs from multiple sources with the same animal and selling them on)
- Deskilling of new graduates
- Antibiotic resistance
- “Us and them” in the profession
- Clients demanding remote prescription of inappropriate drugs
- Reduced continuity of care
- Devaluing a consultation
- Will increase costs to owner
- Increased stress for vets
- May make in-house out of hours less viable.
- Loss of trust in the profession as clients get different advice from vets online than off
- Overprescribing
- Reduced compliance for follow up tests
- Reduced status and respect for the profession
Among the written drawbacks, the biggest themes concerned abuse of drugs and antimicrobial resistance.
When those who had selected a drawback were then asked which was the biggest, 83.3 percent said “harm to animals caused by misdiagnoses and missed diagnoses”.
So in simple terms, when weighing up the pros and cons, it’s between the reduced cost to the owner on the one hand, cited by 70.9 percent, and harm to animal welfare on the other, cited by 94 percent.
When weighing up the pros and cons, it’s between the reduced cost to the owner on the one hand, cited by 70.9 percent, and harm to animal welfare on the other, cited by 94 percent
The harm to animal welfare was selected by significantly more vets as the biggest concern, than reduced cost was selected as the biggest benefit.
In other words, vets think remote prescribing will make veterinary care cheaper, but at the overall cost to animal welfare.
British Veterinary Association President Malcolm Morley said: “New technology presents many opportunities to enhance existing veterinary services, with potential benefits for vets, clients and patients.
“However, we recognise there are concerns within the profession, particularly around the potential unintended consequences of the RCVS’s revised guidance on ‘under care’ in relation to animal welfare and access to veterinary services.
“This survey echoes these concerns as well as supporting the British Veterinary Association’s call for the RCVS to commit to a post-implementation review.”
