After more than four decades as a veterinarian, Epicur® advisor Bob Murtaugh offers a wealth of knowledge, helping veterinary hospitals and clinics stay current on upcoming trends and regulatory compliances like the USP 800 standard for safe handling of drugs. We spoke with him to learn more about what’s next for the industry.
Hi Bob, thank you for joining us today. Could you start by telling us about yourself and your work in the veterinary industry?
I’ve been a veterinarian for a little over 40 years now. I’ve participated in a number of endeavors through the years, including being a faculty member at Tufts University, running the Dove Lewis Emergency Animal Hospital in Portland, serving as the Regional Medical Director for VCA for 10 years, practicing in academics, and running a private practice. Most recently, I have been working as Chief Medical Officer for Pathway Vet Alliance. They are a consolidator company based out of Austin, Texas, with around 400 hospitals across the country. I’m not practicing directly in the exam room currently, but managing several hundred veterinarians and making sure they’re doing the right thing on a daily basis.
What trends are impacting the veterinary industry?
I see a lot of stress on hospital teams regarding curbside and COVID-19 inefficiencies. Our specialty and emergency hospitals are overloaded. General practices aren’t able to see the number of cases they used to because of new regulations and the limit on walk-ins. General practices are booked out for extensive periods of time. This forces pet owners to go to emergency services even though their case could be handled by their regular practice. Some ER veterinarians are seeing more cases where they put patients to sleep rather than operating to save them—that’s not an easy night.
The good news is that veterinary medicine is strong in a world that’s upside down. People love their pets and are paying more attention to them, and we’re seeing adoptions from shelters at record pace. A lot of good things are happening, but I get a little concerned about the resiliency of our workforce because they’re busy and under stress. Staffing is already our number one challenge in veterinary medicine, so current circumstances are taxing the limits.
What are the bright spots for veterinarians through all these changes?
The industry will eventually find its way back to a normal pace and there are certainly opportunities to create a better work-life balance.
Back in the 2008-2010 recession, veterinary medicine specialties backslid. Oncology was probably hit hardest; many oncologists lost their jobs. None of that’s happening these days. I think COVID-19 is provoking better utilization of pharmacy services, which would include Epicur® Pharma and Stokes Pharmacy. The continued strength of the industry has opened up opportunities for an improved standard of care, such as the single dose chemo approach as an alternative to in-office compounding of chemotherapy in a USP 800-compliant chemo room. The USP 800 regulations set the standard for safer handling of hazardous drugs to minimize risks of exposure to personnel, patients and the environment. Prior to this standard, chemotherapy, for example, might have been mixed right in the exam room, increasing risks for everyone involved. With Epicur’s introduction of the single dose chemotherapy, we can broaden the reach of therapy and improve its efficacy.
Have veterinarians made changes to achieve USP 800 compliance?
It’s sort of an honor system currently, I’m not sure it’s been enforced. We haven’t had anyone come to inspect our hospitals according to USP 800 specifications. We are trying to follow the rules and do it right, but the reality is, there are probably veterinarians out there who are still doing it the way they used to.
Some of it could be due to lack of awareness, but there is also a lack of urgency. Veterinarians who have been practicing a long time have done things a certain way for 20+ years and nothing has gone wrong – so there is the sense of ‘why change it?’. I think they all take reasonable precautions but aren’t necessarily following the guidelines of USP 800.
I would like to see the USP 800 standard be more broadly known and used. Right now, I think we’re limiting ourselves with regard to our ability to provide care to cancer pets.
How could veterinary hospitals move towards compliance in a way that’s good for their practice?
Many places aren’t going to spend $80,000 on a USP 800 chemo room, so looking for alternatives is important. Veterinarians want to do things the right way, but I think there’s a sensitivity to pricing in veterinary medicine. It’s a limiting factor, but we should leave those decisions to our clients. USP 800 compliance is an opportunity to move the profession forward, and it opens the door for better standardized drug availability from 503B manufacturers like Epicur. With more availability, it also broadens the number of veterinarians who can safely conduct this treatment. Every practice could conceivably do it.
Do you expect standardization to ultimately drive down the cost of care?
I don’t see the cost of providing pet care going down. I think that the more options you have, the better clients are able to make choices that are right for them and for their pet. I think I would look more at augmenting a standard of care and making it available so that clients have the ability to choose.
Are there concerns around the fact that any practice could handle chemo drugs?
The main issues with chemotherapy handling relate to the mixing, pulling it into the syringe, and creating the dose. If it already comes to you in that prepackaged form, all you have to do is administer it, but precautions still need to be taken. It doesn’t necessarily require a chemo hood or something like that. A chemo room requires reasonable precautions to make sure that it stays sealed and goes into the patient, not the environment.
There are cookbook formulas for how much of a dose to give. You don’t have to be an oncologist to give chemotherapy, but you may need to be an oncologist to think about what’s the best treatment to give to a patient. I think most veterinarians could get a consult if they needed some help. They also need to be concerned with maintaining a schedule and ensuring drug availability.
How limited is the shelf life window on a drug like this?
Depends on the drug – some only have a 24-hour shelf life, so there are some limits to what can be done as far as reconstitution and shipping. Most drugs are stable enough to be reconstituted at the pharmacy level and shipped to the end user and still be effective.
It’s been a year with a lot of change. What’s next for this industry?
I’m hopeful that telehealth can become a consistent and valuable part of veterinary medicine. If you don’t have to meet somebody face-to-face before you can have a veterinary/client/patient relationship, that would be helpful. I think that trend will come with pressure on state boards to amend their approach and provide better guidance.
Also, I’m hopeful that we can work to create a mid-level practitioner, comparable to a nurse practitioner in human medicine. This type of health care professional in veterinary medicine would help alleviate burnout and the issues around wait time and lack of care providers, which is only going to increase as pet adoption rates increase.
Thank you for your time, Bob!re
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