An examination of US pet owners' use of veterinary services, 2006-2018.

OBJECTIVES: Examine US consumer pet-related and veterinary service expenditures and factors influencing US households' use of veterinary services. METHODS: Descriptive analysis on pet-related and veterinary service expenditures and regression analysis on pet owners' use of veterinary services, using data from the US Bureau of Labor Statistics Consumer Expenditure from 2006 to 2018, with the sample size of 257,836 households, of which 73,593 had pet expenses. RESULTS: From 1980 to 2018, the proportion of households with pet-related and veterinary service expenditures increased. Since 2010, the percentage of pet-owning households using veterinary services has increased substantially. Household characteristics were examined and significantly affected the probability of both pet and veterinary expenditures. Non-White and Hispanic groups had increased pet ownership, but the likelihood of veterinary service use has not surpassed White and non-Hispanic pet owners. CONCLUSIONS: Understanding the effects of household sociodemographics, particularly race and ethnicity, on using veterinary services provides insights for optimizing strategic planning for the pet industry and veterinarians. Reviewing the implications helps adjust and fine-tune strategies and influence the sustainability of the veterinary service sector by attracting different racial and ethnic groups. Future research might focus on other social and cultural factors influencing the utilization of veterinary care. The veterinary service sector can then effectively address pet care disparities, bridge existing gaps and improve economic viability.

The Economics of Small Animal Veterinary Practice.

Recent economic cycles and unique factors like the COVID-19 pandemic have all affected small animal veterinary practice, changing both demand and supply-side factors. One-time events exacerbated cyclical macroeconomic factors, increasing the highs and worsening the lows. Behind the perceived labor shortage, the mental health concerns, and the challenges of staff turnover in the profession's daily work to meet client expectations and provide the best possible medical care lurks a productivity problem. The good news is that veterinary practices can take steps to improve productivity and resilience in the face of these challenging trends.

The unintended detrimental effects of pursuing a professional vocation: The case of veterinarians.

Pursuing one's life calling can be personally fulfilling and professionally rewarding, but it also requires sacrifice. We provide evidence of a strong vocational drive using veterinary students as a case study and find that they willingly contribute higher monetary donations for helping animals relative to students in other fields. We also find a significant reduction in the cognitive performance of veterinarian students when exposed to an animal-in-need manipulation. The performance of non-veterinary students in the cognitive task is unaffected by the manipulation. Our results highlight the need for programs to address the economic, financial, and mental health well-being of students and professionals to promote sustainable vocational career commitment. "You owe it to all of us to get on with what you're good at." W.H. Auden.

Nonveterinarian staff increase revenue and improve veterinarian productivity in mixed and companion animal veterinary practices in the United States.

OBJECTIVE: To determine the contributions of veterinarians and support staff to revenue and veterinarian productivity (ie, number of patients seen/full-time-equivalent veterinarian/wk) in private mixed and companion animal practices in the US and identify staff-to-veterinarian labor ratios (SVLRs) that maximized these 2 practice outputs. SAMPLE: 409 owners of mixed and companion animal practices who participated in the 2020 AVMA Practice Owner Survey. PROCEDURES: Data regarding owner demographics, practice characteristics, labor (defined as mean total hours worked/wk), and gross revenue in 2019 were obtained from participating practices. Multivariable ordinary least-squares regression was used to identify factors associated with revenue and productivity as well as the SVLRs at which revenue and productivity were maximized. RESULTS: For each 10% increase in total veterinarian hours worked per week, revenue increased by a mean of approximately 9%. A 1-unit increase in total number of technician hours used to support 1 hour of veterinarian work was associated with a 20.5% increase in revenue but with no change in productivity. The same increase in total number of nonmedical staff hours was associated with a 17.0% increase in revenue and 14.4% increase in productivity. In terms of revenue, the optimal SVLRs for veterinary technicians and nonmedical staff were 9:1 and 8:1, respectively. In terms of productivity, the optimal SVLR for nonmedical staff was 10:1. CLINICAL RELEVANCE: Findings confirmed the important role of nonveterinarian staff in revenue and veterinarian productivity in mixed animal and companion animal practices and may be useful for making evidence-based staffing decisions.

The Economic Cost of Burnout in Veterinary Medicine.

The purpose of this study is to estimate the economic cost of burnout in the veterinary profession and highlight the financial reasons why the industry should address the burnout crisis from an organizational perspective. Using data from 5,786 associate veterinarians in private practice, information was obtained using employment information related to compensation, work hours, hour preferences, and job turnover. Burnout was measured using the Professional Quality of Life Scale and used to calculate conditional probabilities on turnover and reduced working hours due to burnout. Lost revenue from each outcome (turnover and reduced working hours) was then used to calculate the economic costs to the veterinary services industry. The attributable cost of burnout of veterinarians to the US industry is between $1 and 2 billion annually in lost revenue, though there is a large amount of uncertainty. The cost is dependent on whether veterinary technicians are included in the analysis. The highest economic cost per veterinarian is among food animal practitioners, while the lowest is among equine. This study demonstrates that there are significant economic costs due to burnout among veterinarians and veterinary technicians. We suggest pursuing organizational interventions as these have shown the most impact in decreasing burnout and increasing satisfaction among human health physicians.

Characteristics of and comparisons between US fourth-year veterinary students graduating with and without educational debt from 2001 through 2020.

OBJECTIVE: To characterize and compare fourth-year students of US veterinary schools graduating with and without related educational debt (ie, DVM debt) from 2001 through 2020. SAMPLE: 45,756 fourth-year veterinary students who participated in the annual AVMA Senior Survey from 2001 through 2020. PROCEDURES: Survey data were summarized for variables hypothesized to be associated with DVM debt. Multivariable modeling was used to investigate associations between these variables and the likelihood of graduating with DVM debt. RESULTS: Mean DVM debt increased fairly steadily from $56,824 in 2001 (n = 1,587) to $157,146 in 2020 (2,859). Of 45,756 students, 6,129 (13.4%) had no DVM debt. Attending Tuskegee University and having children (both men and women) were associated with an increased likelihood of DVM debt. Attending certain other veterinary schools and more recent survey year were associated with a decreased likelihood. For 2020, the likelihood of DVM debt decreased with increasing percentage of tuition paid by family and increased with increasing percentage of tuition paid by educational loans, being a woman with children, and increasing total cost of attendance. No association was found with state cost of living index or per capita income. CLINICAL RELEVANCE: Results suggested a growing rift between US veterinary students who cannot afford tuition and fees without accumulating financially concerning levels of debt and those who have the financial ability or family situation to fully fund veterinary school. Efforts should be undertaken to recruit across socioeconomic statuses and provide meaningful scholarships to students with greatest financial needs to support diversity, equity, and inclusion in veterinary medicine.

A census of veterinarians in the United States.

Analysis of the AVMA's electronic membership database provided information on 113,394 veterinarians living in the United States in 2018. At 39%, Millennials represented the highest percentage of the US veterinary workforce, and women (61.7%) outnumbered men (38.2%). Mean age at the time of graduation has increased since 1975, raising concerns that career length for veterinarians may be decreasing, potentially exacerbating veterinarian shortages. Overall, 83.9% of veterinarians were in private clinical practice, and substantial increases between 2008 and 2018 were seen in the numbers of veterinarians in emergency and critical care medicine and in referral or specialty practice.

Employment, starting salaries, and educational indebtedness of year-2018 graduates of US veterinary medical colleges.

Mean full-time starting salary among all types of employers combined (private, public, or corporate practice and advanced education programs) was $65,896 in 2018. Excluding salaries for graduates pursuing advanced education, the mean full-time starting salary was $82,425. Mean educational debt accumulated during veterinary school for all respondents (n = 2,758) in 2018 was $152,358 (median, $159,000). Mean educational debt among the 82.7% of respondents who had debt (n = 2,280) was $183,014 in 2018, an increase of 9.8%, compared with the 2017 value.

Critically important antibiotics: criteria and approaches for measuring and reducing their use in food animal agriculture.

Globally, increasing acquired antimicrobial resistance among pathogenic bacteria presents an urgent challenge to human and animal health. As a result, significant efforts, such as the One Health Initiative, are underway to curtail and optimize the use of critically important antimicrobials for human medicine in all applications, including food animal production. This review discusses the rationale behind multiple and competing "critically important antimicrobial" lists and their contexts as created by international, regional, and national organizations; identifies discrepancies among these lists; and describes issues surrounding risk management recommendations that have been made by regulatory organizations on the use of antibiotics in food animal production. A more harmonized approach to defining criticality in its various contexts (e.g., for human versus animal health, enteric diseases versus other systemic infections, and direct versus indirect selection of resistance) is needed in order to identify shared contextual features, aid in their translation into risk management, and identify the best ways to maintain the health of food animals, all while keeping in mind the wider risks of antimicrobial resistance, environmental impacts, and animal welfare considerations.

Antimicrobial-resistant bacterial infections from foods of animal origin: understanding and effectively communicating to consumers.

Consumers are increasingly interested in the attributes of the food they consume. This includes what is in the food and how it was raised; and at least some consumers are willing to pay a premium for products with specific attributes. However, the current plethora of labels on the market does not adequately address this issue; rather than providing actionable information, most labels add to the consumer confusion. In addition, there is a tendency toward "absence labels" that can contribute to a negative consumer perception of conventional products that may or may not include the attribute in question. Communication with consumers about the complex and highly technical issue of antimicrobial resistance (AMR) is challenging, and experiences from communication efforts about food safety-related issues demonstrate exactly how challenging this is to communicate clearly. General lessons learned from the science of risk communication can help guide efforts to communicate about the challenging issue of AMR. There are efforts underway to chart out a new approach. A new labeled animal production certification program is under development to provide choice for consumers, while reducing consumer confusion, which mandates antibiotic stewardship practices.

Raised without antibiotics: impact on animal welfare and implications for food policy.

This study assesses the impact of broilers raised without antibiotics and the information gap that exists between consumer perception and production methods. Specifically looking at risk of eye burns, footpad lesions, and airsacculitis, key indicators of animal welfare, bird-level data are collected on the occurrence and severity of each disease state by the type of antibiotic program: no antibiotics ever, nonmedically important antibiotics, or medically important antibiotics. Odds ratios and marginal effects are calculated to understand how the occurrence and severity change with access to medicine. Broilers never given antibiotics had a higher likelihood of disease states investigated, and with greater severity. In some cases, access to nonmedically important ionophores mitigated the risk of occurrence and severity of the conditions. The finding indicates that the growing trend of raising broilers without antibiotics may negatively affect animal welfare. This stands in contrast to existing consumer research showing that consumers purchase poultry raised without antibiotics because they believe that it promotes healthier animals. Therefore, a significant consumer information gap exists which needs to be addressed. JEL Codes: Q130, Q160, Q180.

Consumer response to media information: the case of grapefruit-medicine interaction.

This study measured the effect of media exposure on grapefruit/grapefruit juice consumption changes, in particular grapefruit-medicine interaction. Respondents' attitudes about health news on television and the internet were measured to account for consumers exposed versus not exposed to such information. Results of a sample selection model show that consumer attitudes toward health news were significantly related to exposure to media information. Also, news exposure about grapefruit-medicine interaction has a tendency to result in reduced grapefruit consumption. Consumers who are directly affected by the medication interaction significantly react to the news, and the effect varies by age. Even though consumer's age was positively related to the probability of increased grapefruit consumption, when consumers took the medication, consumer's age was negatively related to the probability of increased grapefruit consumption.

The effects of a soft drink tax in the UK.

The majority of the UK population is either overweight or obese. Health economists, nutritionists and doctors are calling for the UK to follow the example of other European countries and introduce a tax on soft drinks as a result of the perception that high intakes contribute to diet-related disease. We use a demand model estimated with household-level data on beverage purchases in the UK to investigate the effects of a tax on soft drink consumption. The model is a Quadratic Almost Ideal Demand System, and censoring is handled by applying a double hurdle. Separate models are estimated for low, moderate and high consumers to allow for a differential impact on consumption between these groups. Applying different hypothetical tax rates, we conclude that understanding the nature of substitute/complement relationships is crucial in designing an effective policy as these relationships differ between consumers depending on their consumption level. The overall impact of a soft drink tax on calorie consumption is likely to be small.

Altruism, efficiency, and health in the family.

PURPOSE: The chapter investigates: (1) Do married parents efficiently allocate time to children's health care? (2) Are parents willing to sacrifice consumption for health improvements at an equal rate for all family members? (3) How does family structure affect health trade-offs parents make? (4) Are parental choices consistent with maximization of a single utility function? METHODOLOGY: A model is specified focusing on how parents allocate resources between consumption and goods that relieve acute illnesses for family members. Equivalent surplus functions measuring parental willingness to pay to relieve acute illnesses are estimated using data from a stated-preference survey. FINDINGS: Results provide limited support for the prediction that married parents allocate time to child health care according to comparative advantage. Valuations of avoided illness vary between family members and are inconsistent with the hypothesis that fathers' and mothers' choices reflect a common utility function. RESEARCH IMPLICATIONS: Prior research on children's health valuation has relied on a unitary framework that is rejected here. Valuation researchers have focused on allocation of resources between parents and children while ignoring allocation of resources among children, whereas results suggest significant heterogeneity in valuation of health of different types of children and of children in different types of households. SOCIAL IMPLICATIONS: Results may provide a justification on efficiency grounds for policies to provide special protection for children's health and suggest that benefit-cost analyses of policies affecting health should include separate estimates of the benefits of health improvements for children and adults.

The built environment and obesity among low-income preschool children.

In spite of the evidence that adult obesity is influenced by environmental factors, the influence of the environment on childhood obesity remains under-investigated. This paper examines the association of the built environment with the prevalence of obesity in low-income preschool children. Built environment indicators include measures relating to food choice and physical activity. The relationship of the environment with childhood obesity is further stratified by urban-rural location. Overall, the built environment is associated with the prevalence of obesity in low-income preschool children, although the impact of the environment is affected by urban-rural status. Results imply broad-scope for community-level interventions.

Obesity and diabetes, the built environment, and the 'local' food economy in the United States, 2007.

Obesity and diabetes are increasingly attributed to environmental factors, however, little attention has been paid to the influence of the 'local' food economy. This paper examines the association of measures relating to the built environment and 'local' agriculture with U.S. county-level prevalence of obesity and diabetes. Key indicators of the 'local' food economy include the density of farmers' markets and the presence of farms with direct sales. This paper employs a robust regression estimator to account for non-normality of the data and to accommodate outliers. Overall, the built environment is associated with the prevalence of obesity and diabetes and a strong local' food economy may play an important role in prevention. Results imply considerable scope for community-level interventions.

Inequalities in diet and nutrition.

The inequality of nutrition and obesity re-focuses concern on who in society is consuming the worst diet. Identification of individuals with the worst of dietary habits permits for targeting interventions to assuage obesity among the population segment where it is most prevalent. We argue that the use of fiscal interventions does not appropriately take into account the economic, social and health circumstances of the intended beneficiaries of the policy. This paper reviews the influence of socio-demographic factors on nutrition and health status and considers the impacts of nutrition policy across the population drawing on methodologies from both public health and welfare economics. The effects of a fat tax on diet are found to be small and while other studies show that fat taxes saves lives, we show that average levels of disease risk do not change much: those consuming particularly bad diets continue to do so. Our results also suggest that the regressivity of the policy increases as the tax becomes focused on products with high saturated fat contents. A fiscally neutral policy that combines the fat tax with a subsidy on fruit and vegetables is actually more regressive because consumption of these foods tends to be concentrated in socially undeserving households. We argue that when inequality is of concern, population-based measures must reflect this and approaches that target vulnerable populations which have a shared propensity to adopt unhealthy behaviours are appropriate.

Effects of beverage alcohol price and tax levels on drinking: a meta-analysis of 1003 estimates from 112 studies.

AIMS: We conducted a systematic review of studies examining relationships between measures of beverage alcohol tax or price levels and alcohol sales or self-reported drinking. A total of 112 studies of alcohol tax or price effects were found, containing 1003 estimates of the tax/price-consumption relationship. DESIGN: Studies included analyses of alternative outcome measures, varying subgroups of the population, several statistical models, and using different units of analysis. Multiple estimates were coded from each study, along with numerous study characteristics. Using reported estimates, standard errors, t-ratios, sample sizes and other statistics, we calculated the partial correlation for the relationship between alcohol price or tax and sales or drinking measures for each major model or subgroup reported within each study. Random-effects models were used to combine studies for inverse variance weighted overall estimates of the magnitude and significance of the relationship between alcohol tax/price and drinking. FINDINGS: Simple means of reported elasticities are -0.46 for beer, -0.69 for wine and -0.80 for spirits. Meta-analytical results document the highly significant relationships (P < 0.001) between alcohol tax or price measures and indices of sales or consumption of alcohol (aggregate-level r = -0.17 for beer, -0.30 for wine, -0.29 for spirits and -0.44 for total alcohol). Price/tax also affects heavy drinking significantly (mean reported elasticity = -0.28, individual-level r = -0.01, P < 0.01), but the magnitude of effect is smaller than effects on overall drinking. CONCLUSIONS: A large literature establishes that beverage alcohol prices and taxes are related inversely to drinking. Effects are large compared to other prevention policies and programs. Public policies that raise prices of alcohol are an effective means to reduce drinking.