Connecting with animals and people through a spectrum of care

Eva Clements did not plan to pursue a career in veterinary medicine. 

“I took what I thought was going to be a fun summer job at Animal Humane Society as a kennel technician, scooping poop and cleaning out kennels,” said Eva, now a fourth year student in the University of Minnesota’s (U of M’s) College of Veterinary Medicine. “I realized that veterinary medicine was so much more than just working with animals. Really, the ability to help people through the profession is what drew me in.”

Eva has since returned to Animal Humane Society (AHS) as part of the U of M’s Community Medicine clinical rotation for fourth year students. In addition to providing shelter medicine for animals in their care, AHS also offers a low-cost veterinary center, where students in the rotation develop hands-on skills with animals and relationships with their caregivers. The center offers affordable standard fees with additional income-based discounts. 

“We see healthy pets, first time puppy and kitten visits,” said Dr. Lindsey Knox, assistant professor in community medicine and point person for the AHS rotation. “We see everything, essentially, that is not an emergency.”

Students, Eva said, lead appointments by taking an animal’s history, completing a physical exam, making a treatment plan, and collaborating with clients, all under the supervision and guidance of Dr. Lindsey and the staff at AHS. Each year, around 50 students have the opportunity to participate in clinical rotations at AHS.

Dr. Lauren Bernstein describes the spectrum of care using an analogy nearly all students find relatable: pizza. 

“The gold standard is flying to Naples, Italy to get the OG pizza,” said Dr. Bernstein, an assistant professor in community medicine. “That’s the model against which all other pizzas compare. Standard of care is dough, sauce, cheese: you’ve got all of the essential ingredients. Every average, reasonably prudent, competent pizza maker has the ability to cook that and call it pizza. Spectrum of care is the menu of pizza options. Contextualized care is the option that best meets someone’s needs (like gluten-free crust), limitations (like only being able to afford a single slice versus a whole pizza), or preferences (like deep dish).”

Students are trained to have conversations with animal caregivers about the options that would work best for them. Treatment options consider potential barriers like time constraints, transportation, income limitations, or the physical ability to administer a medication, for example, and all recommendations are evidence-based.

“The classic question that we always get is, ‘What would you do if this was your pet?’” said Dr. Knox. “The way that I help coach students to address that question is to say, ‘I’m not going to give you an option that I wouldn’t pick for myself.’” 

The spectrum of care approach indirectly addresses another issue in the field: veterinarian shortages. According to a study by Animal Health Economics, retirements and veterinarians leaving the profession have resulted in a workforce shortage that is expected to increase sharply. At the same time, demand for companion animal health services is increasing by roughly 6% each year. An estimated 55,000 new veterinarians are needed to meet demand by 2030.

“I think mental health is a big reason [people leave the profession] and has been for a long time,” said Dr. Bernstein. “Long hours, not always great support, sometimes you’re in a region without enough veterinarians … I think we are a group of people who want to fix things and to control an outcome or have an answer, and we don’t always have the luxury of a good outcome. And that’s something that’s really hard for us.” 

Dr. Bernstein has also noticed that for students interested in community medicine, the desire to serve can take an additional toll – especially for students leaving veterinary school with large amounts of student loan debt. 

“These are students who say, ‘My heart is in community medicine. My heart is giving services away for free because I believe that every pet and every family deserves care.’ And they sort of have this crisis of conscience,” said Dr. Bernstein. 

The U of M’s Community Medicine model is uniquely integrated throughout the curriculum for all veterinary medicine students, work launched in part with support from Margaret A. Cargill Philanthropies (MACP). All veterinary medicine students learn about social determinants of health, care delivery in resource-limited settings, personal and professional identity, and spectrum of care, among other topics. Student response, says Dr. Bernstein, has been overwhelmingly positive. 

 The three-year grant from MACP also supported programs like the clinical rotation at AHS, Student Initiative for Reservation Veterinary Services (SIRVS), and Veterinary Treatment Outreach for Urban Community Health (VeTOUCH). MACP’s funding helped at a time of transition for the student volunteer-led programs to be supported by Community Medicine faculty members at the time the program launched.

Each program represents a unique community partnership and supports the wellbeing of companion animals – a focus of MACP’s Animal Welfare domain. Between 400-450 students are involved in at least one of VeTOUCH’s 14 annual clinics. And 200-250 students volunteer with SIRVS, which offers six to eight clinics each year. For student Eva Clements, VeTOUCH provided even more meaningful opportunities, both as a student board member and in direct interactions with clients, many of whom are struggling with housing or may qualify for income-based assistance programs. Utilizing a warehouse and pet food pantry space at The Bond Between, VeTOUCH students set up a monthly, MASH-style clinic that offers basic diagnostics, ear swabs, and urinalysis.

“The most unique service that [VeTOUCH] offers is just a lot of face time and client education, both from the students and the [supervising] doctors who are there,” she said, noting that those relationships with clients keep her interested in the field. 

After graduation, Eva will once again return to AHS, this time for a year-long internship in shelter medicine. And one day each week, she will return to AHS’ low-cost veterinary center as a fully credentialed veterinarian. 

“I would miss out on the client interaction,” Eva says of returning to the clinic where she completed her own community medicine rotations. “Dr. Lauren and Dr. Lindsey have really helped me build my confidence in client interactions and helped me see the joy in those interactions, which I’m thankful for.”