Episode 31: How Telepet is Changing the Face of Veterinary Medicine with Animal Policy Group Founder and CEO Mark Cushing

Find out about the growing market for “TelePet,” which is telehealth for pets

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In this episode you’ll discover:

  • How TelePet has evolved over time

  • What challenges currently exist

  • What need TelePet fills in veterinary care

  • What stakeholders can do to help expand access to TelePet services

Learn more from Carrie and Rebecca: 

Healthcare insights (monthly email) | Telehealth/Virtual Care Mgmt Update (biweekly LinkedIn update)

Website | Carrie on LinkedIn | Rebecca on LinkedIn | NGL on LinkedIn

 
 

Read the transcript here:

Kaitlyn O'Connor (00:17):

Hello everyone, and welcome to a very special episode of Decoding Healthcare Innovation. My name is Kaitlyn O'Connor and I'm going to be guest hosting this episode with my colleague Reema Taneja. I'm senior council at Nixon Gwilt Law. Reema is council, and we've been working together on building a veterinary telehealth or telepet practice within our firm. We're really excited to be here. We've got a really exciting guest to share with you as well. But before we kind of dive into the substantive topic, Reema, do you want to sort of kick us off and set the stage?

Reema Taneja (00:52):

Yeah, definitely. Thanks Kaitlyn. And hi everyone. I'm Reema, as Kaitlyn mentioned. So today we'll be talking about veterinary telehealth or telepet, as we call it. As we all know, telehealth has exploded in recent years due to the Covid-19 public health emergency, although it has been around for a number of years. Similarly, telepet is also currently growing at a rapid pace, however many states are not yet aligned with each other regarding what services can be provided virtually and what needs to happen before telepet can be provided. So during this podcast, we'll be speaking with an expert and leader in the telepet space to talk to us about how telepet has evolved, what challenges currently exist, and what stakeholders can do to help move the needle along to expand access to telepet services. Back to you.

Kaitlyn O'Connor (01:46):

Thank you. Yeah. So when Reema and I first got started in this space, we just started reaching out to a bunch of people, trying to learn who we should be talking to, where we should be, what was happening, and just trying to get a sense of the overall landscape. And everyone we talked to and everywhere we looked without fail, the same name kept coming up as the person to talk to in this space, the absolute expert. So I am really excited that we are actually joined by this person today. And so if everyone will please welcome the founder of the Animal Policy group, author of Pet Nation, the Love Affair that Changed America, and all around telepet policy guru, Mark Cushing. Welcome, mark.

Mark Cushing (02:27):

Thanks, Kaitlyn. Thanks Reema. Nice to join you to excellent lawyers and good to see lawyers taking the lead on this topic, so look forward to the conversation.

Kaitlyn O'Connor (02:37):

Yeah, thank you. And we know you're a lawyer too. So I started off, I mentioned a fraction of the many hats that you wear. So can you kick us off by just telling us a little bit more about your background and your current work and how you got to where you are today?

Mark Cushing (02:55):

Happy to. I'll try to be brief. So I'm a former business litigator. I've tried a lot of cases in Portland, Oregon and around the west for the first 12 years of my career. And then I noticed that we were moving towards mediation and settlement and arbitration and nothing like having 12 anonymous jurors sitting in a jury box, which is what I loved. So I made a transition as I had success getting someone elected governor in Oregon, and it pulled me into the political realm. And as all political routes steward ended up in Washington DC where I was a partner in what's now a large international law firm and got a phone call as I was boarding a flight Ottowa Canada, because I was mainly representing Canadian interests in the US and it was from the founder of Banfield Pet Hospitals, still the largest pet hospital group in the world, then owned partly by Mars now owned a hundred percent by Mars Inc.

(03:57):

As part of the Mars Veterinary Health Organization and this coalition that's never been reassembled because I'm not sure everybody gets along well enough to be in a coalition, was involved in an issue about microchipping of pets, which seems like decades ago. And the US is still not exactly a leader in that field. And with my team, I made significant progress in solving the problem through Congress and figured I was done. It was fun, good, a good fee. Lawyers enjoy moving on to the next challenge. And then my phone started ringing from animal health interests and veterinary interests, animal welfare groups and sometimes success fools people into thinking you're talented and they should use you for something else. So I was a beneficiary of that. That was back in 2006. Since then, I've built now what's called the Animal Policy Group. Have eight, a team of eight that work with me.

(04:56):

We're all virtual and we basically focus on regulatory and legal issues, not as a traditional law firm like yourselves. I'm not saying you're traditional, but you're, you're a law firm as such. So I'm the only lawyer in the group focus on regulatory issues involving the industry, which are primarily in the states. The federal government thankfully is not paid much attention to veterinary or pet related issues. And I'm not encouraging that though it might increase my business, but I think it's good as it is. Also very involved in building industry coalitions like the Veterinary Innovation Council, which I formed with the leader of the NAVC group in 2016, which kicked off telemedicine for the veterinary space. And then the Veterinary Virtual Care Association, which I started with a good friend in the early stages of Covid to try to build a smaller but a veterinary version of the American Telemedicine Association. Because like a lot of things a lot of issues I've spent 15 years now looking at human healthcare and wondering why we don't adapt successful models to veterinary care, telemedicine being the first. The other one that's very important that I'm actively involved in right now are creating mid-level professionals like PAs or nurse practitioners, which perhaps sometime we'll talk about. So through all that, I've built a lovely stable of clients across the veterinary animal health, telepet if you will, sector both pharmaceutical nutrition practices and so forth. And do not the scope of work that your firm does with clients, but really focus on veterinary practice acts, state veterinary medical boards with whom I've built extensive relations over the years. State veterinary medical associations, which are kind of the policy making advocacy bodies inside the states as this sector has become sexy and interesting from a backwater, if I can say so, 16 years ago, and that was the subject of my book Pet Nation. So that's me. And I have three Bengal cats, which qualifies me as crazy. Nobody has three Bengals if you know what that breed does. And a little papillon puppy. So I kind of practice what I preach a little bit. There you go.

Kaitlyn O'Connor (07:19):

Love that. Love that. I'm waiting for my copy of Pet Nation to come in. I was going to try to read it before we talk today, but Amazon was being slow this weekend, unfortunately.

Mark Cushing (07:29):

Yeah, I wish I hope it's demand for my book. But anyway, appreciate, you.

Kaitlyn O'Connor (07:34):

I'm Sure, I'm sure

Mark Cushing (07:34):

Hope, I hope you enjoy it it's chockful of facts and hopefully will help you in your practice.

Kaitlyn O'Connor (07:40):

I'm looking forward to it. All right, Reema, I think you're up first with a question.

Reema Taneja (07:46):

Yes. So let's dive in. So Mark, as we know, you've been in this space for a while, since the beginning. Can you talk to us a little bit about how you saw telepet being implemented at the start and where it is now, how it's evolved, how the services changed, what does that look like to you?

Mark Cushing (08:03):

Great question. Human medicine, while it has a huge federal overhang, obviously with Medicare, Medicaid, HHS, and all the above it's regulated at its state level in terms of what doctors can and can't do. For the most part, there's exceptions. And so to start with, when I looked at that, it was driven by a Wall Street Journal journal article in January of 2015. The headline was, your smartphone will see you. Now, I read the article, I think you were 50 paragraphs, and I tried to see if any paragraph couldn't apply to veterinary medicine and there wasn't one, there was no rationale that veterinary medicine couldn't adopt telemedicine, particularly the origin of human healthcare telemedicine, which were states like Kentucky and Oklahoma with significant rural populations that simply couldn't access care. So why not use existing technology to link a doctor with a patient like we're linking ourselves today being in three different parts of the country.

(09:06):

So we got started, and I knew it'd be state by state, but you had to build the rationale. And the group, the Veterinary Innovation Council was formed not just to look at this, but took that on as its first issue. A diverse group included a former AVMA president, a current Dean of Texas State and other industry leaders. And we quickly reached a consensus that it made sense. And the issue, which I'm sure we'll talk about that is the divisive issue or the hot issue on it still is sadly six years later, is a question of can you begin a relationship with a pet and their pet owner or parent the same way you can in the human space between a doctor and the patient? Can you begin that relationship through a remote but live engagement? And there was strong, were strong feelings then and now by the leading trade association in veterinary medicine, which is the American Veterinary Medical Association, the AVMA.

(10:09):

And they then felt and have since reaffirmed it that no, you have to have an in-person visit. Presumably the pets in your clinic, on your exam table, you can look at it, touch it, do whatever you want. Well, these were the same issues that human healthcare dealt with. And there was a battery of folks, which is why it took 20 years and some cases to get states to adopt a view that no, that's one way to do it and maybe it's a good way to do it, and I'm not challenging that. But you can use a remote engagement, particularly when the in-person contact isn't realistic, it's not going to happen. So aren't we better? And that, I've always made that argument, and I use the example of having been in DC for a long time. I don't live there now but I remember the apartments in Bethesda, Maryland, just outside the DC border.

(10:57):

And picture a 75 year old woman on the eighth floor of an apartment with two cats. She is never going to go under her bed, pull the cats out, suffer the scratches, put 'em in cages, walk to the elevator, go downstairs, get a cab, get an Uber, go to a clinic. So are we better off that she receives no veterinary medical guidance for the care of her cats? So because she can't have an in-person visit, and I've never heard anyone, I've had people attempt to, but I'd never anyone make a credible argument why that would be the case. And as a trial lawyer, you pick examples that are somewhat extreme, that corner your opponent to make sure they can't disagree with you. But on that one, there was pretty broad consensus. So that issue has been the heart Kaitlyn and Reema of the debate for now six years.

(11:51):

So the Veterinary Innovation Council, the first thing we did, we had a chance to speak to the collection of all the state veterinary boards in the country. There's an organization, AAVSB annual meeting, and actually AVMA had a representative and one other person and it myself. And we debated the topic and then we sat with the members for an afternoon of workshops about the issue. And my table was swamped, not because I was some rockstar, but because I had taken the view that and made the case why it made sense not to replace in-person visits when that's realistic and practical or if that's the preference of the pet owner, but allowing at least a person to begin a relationship. And it was always anchored in one principle. And I know you've seen that in human healthcare, that principle is the veterinarian.

(12:41):

She has to make a judgment that she's comfortable beginning a relationship virtually, FaceTime, zoom, whatever it might be. If she says, you know what? I can't see your pet. I can't see enough of your pet. I'm not comfortable. Conversation's over as far as beginning to provide medical care. So the AAVSB as well as our innovation council anchored the viewpoint with that proviso, the veterinarian has to be comfortable. But once you've done that, and by the way, the patient has to be, the pet owner has to be comfortable. If they begin talking to you and say, you know what? I want to come in and see you conversation's over, that's fine. So it's actually a negotiated agreement, which frankly I like because it gets the pet owner more engaged in how serious and important veterinary care is rather than just take it for granted.

(13:35):

So that debate has continued for six years. The number of people that favor adoption in the veterinary space of the human model, which obviously I I'm on that side, has grown and grown and grown. But because of the scope and reach of the American Veterinary Medical Association we only have seven states out of the 50 states plus DC. So the 51 jurisdictions, I'm not calling for the DC statehood here. I'm just pointing out that we know there are pets inside DC. We only have seven states where the VCPR, the veterinary client patient relationship may be created virtually. That's going to grow. But I wish I could say to you two, it's going to grow in a hurry because it takes one state after another. And there there's a core group and there's different reasons why and we can talk about that. But there's a core group that say kind of hell no to that. And so that's where we are. Let me just stop there. That's a long answer to a really good question.

Reema Taneja (14:44):

I was just going to say that that's very insightful and I think the key here is that many industry folks who might not be on board yet are forgetting that veterinary telehealth or human telehealth is not meant to serve as a replacement for right in-person care, rather a supplement to when it's not realistic or reasonable or doesn't make sense especially given the example that you mentioned of an elderly pet owner who might not be able to get themselves to the veterinary practice or I think especially in cases of emergency care where sometimes pet owners think their pet is suffering from an emergency, you get on a telehealth consultation, it might be the case that their other options and then they don't have to go to the room, the emergency room and wait for hours and hours. So yeah, I think that's definitely a great perspective.

Mark Cushing (15:36):

Well, yeah, and you have right now twin issues and they're not mirrors of each other, but they're first cousins if not family members, one being access to care. And that tends to become an issue for lower income or rural or diverse Americans over here. And you have the shortage right now that's acute, it's chronic of veterinarians. And so how do those two relate? Well, the fewer veterinarians, obviously, the fewer clinic openings are for somebody to bring in their pet and just talk to anybody right now with a pet in this country, rural, suburban, urban, doesn't matter, east, west, north, south, wherever you are, you're being told, can't see you right now, can't see you today, maybe see you in two days. I know a CEO of a major pet related company, global company who couldn't get his dog in and his community for four days.

(16:32):

I told him that's impossible. I mean, not that you get special privileges, but you obviously know how to work the veterinary system. So what a tool telemedicine is to simply get you in touch with a professional to talk about what's going on, where they can look and see your pet. And that professional could be a veterinarian if you want true medical advice and care. It could be a vet tech or vet nurse. If you just want some information, you want to talk to somebody that understands dogs, let's say, and knows eating behavior and so forth, and might explain to you what could be going on with your pet. So that's the shortage side. The access to care is if you're not able to get to a veterinarian, if you haven't had a relationship and they're not taking new clients. And we hear that all the time in other fields, psychiatric and others, sorry, we're just not taking new patients.

(17:30):

The VCPR is no good to you. I mean, it is to say, get inside and see a vet. I've tried can't get in. So why wouldn't you use the providing of advice and opening the possibility of care to a vet who says, I want to do that. I'm happy. By the way, a lot of vets work from home. They actually want to do this. Why not? Why don't expand that and make that normal? And I, I'd love to get to this topic, so I'll kick it off to you. We have the benefit of a perfect laboratory, an actual laboratory of four years of allowing telemedicine, the telemedicine VCPR in Ontario, the province in Canada that has Toronto just north of Michigan, 15 million people, fifth largest state in the US if it were in the United States. Very sophisticated love pets the same way anybody in Michigan does or the rest of the country.

(18:27):

And they've not had a single complaint. I've shared this with you two when we met. There's not been a single complaint filed with the governing body in in Ontario from any pet owner of harm to their pet due to telemedicine. So I've asked the question of all the vet med boards in this country and have not received one example. So I don't want to hear the theoretical, hypothetical fears without saying, well, let's just actually look at the data. And we have one place with four years of data. They legalized it in June of 18, very carefully worked it up since 2014. They've expanded it, veterinarians support it, pet owners like it. It's not hurt practice revenues, which is the underlying fear that many opponents have. I'm going to lose money. Okay, that's fair. No, veterinarians should support something where they think they're going to maybe cut their own income. I'm up promoting that idea, but guess what? It doesn't work that way. So is there some difference at the Canadian border? I don't think so. I don't think people in bad climates like telemedicine and good climates.

Kaitlyn O'Connor (19:35):

Yeah, I think that it's really interesting because when you first shared that example about Ontario, I was surprised I hadn't even heard of it. And all of the things that you're talking about remind me a lot of the same conversations that we have in human telemedicine. And it's all, that's why I think it's so important that we keep drawing that parallel and looking at those different examples because it's so poignant In human telemedicine. We talk about access to care all the time. We talk about the rural patients that don't have access to providers very easily. And so they wait until they're in an emergency situation and then the emergency rooms become overcrowded because that's the only place for people to go when they need care. And the same thing happened to me last year. I was in the veterinary emergency room for probably eight hours for something that didn't end up being emergent, but I didn't know and I couldn't get ahold of my vet, and my dog was acting very sick.

(20:34):

So my only option was to go to the emergency room and sit there for eight plus hours during a pandemic when I don't really want to be in an overcrowded space anyway, so we ended up sitting in my car for eight hours, which is just uncomfortable. So I think those parallels are so important. And it kind of brings me to my next question, which is similar to I think what you're getting at, which is what are the current challenges? Because we've seen a lot of challenges we overcome in human telehealth when it comes to the government starting to act at the federal level to reduce some of the restrictions around telehealth and some of those same conversations. And so I'm interested, one of the things that you mentioned at the beginning of the call as well is companies like Banfield and Mars, who are these really large players actually supporting telehealth or getting into the telehealth space. I actually think that's very different than human telehealth. That's the one area where I think it sort of diverges where at the beginning, the large players and who are human telehealth weren't actually very interested in adopting this new technology. So I'm interested, as we draw those parallels, what are some of the challenges that you see and maybe some of the differences where we have actually more opportunity in veterinary telehealth to move it forward more quickly than we have on the human telehealth side?

Mark Cushing (21:57):

Well, we kicked off the discussion after a slow three or four years during covid. So covid spotlighted the need, and many states in 19 had emergency orders that lifted the in-person VCPR requirement. So that became another set of laboratories. And so yeah, we've looked at those states. Again, same question. Any problems, any harm to pets, any injuries or God forbid, any deaths to pets, not any. So it's hard to make the case that it doesn't fit with pets in the legislative battle. We have underway in Michigan, a member of the house committee asked a very simple question, if it works for people and it's legal for people, why not pets? And there's no rationale. And because if somebody quickly said, well, pets can't talk, we have this thing called pediatric medicine and one-year-olds a lung or a heart or a urinary issue and so forth.

(22:58):

So come on. And pediatric society strongly endorses and has published reports on the value of telemedicine for human pediatric patients. So that's number one. But here are the challenges. We do have now large practices endorsing telemedicine that sponsors of the VBCA include Mars. But when the largest trade association, the largest body of organized veterinary medicine, the AVMA, opposes it as strongly and frankly defiantly as they do this one issue it makes it hard. It puts companies at some risk, not legal risk, but it's awkward for them to be opposed to the national body. Now, we know as lawyers <laugh> how little attention individual lawyers pay to the American Bar Association, no offense, ABA, but you don't really pop up every day and nobody stops and thinks, how does the ABA feel about this? Unless it will, It's even changed now as far as their opinion about a Supreme Court judge, it used to really matter how the A reacted to a nominee, even less important if totally unimportant now.

(24:13):

But the AVMA is powerful. Now they have their reasons for opposing it. I'm not going to challenge their reasons. I just think the conclusion's wrong. But that is the primary challenge alongside one other that's very practical in a period of acute shortages, which means you don't have enough staff, which means that people working in your clinic don't get breaks. They work long days, they don't get time off. They feel the pressures. They see people waiting to get in, and they have to say to them, you can't. And none of them went to vet school to tell people you can't get care for your pet. And it really hits veterinarians hard, and it's a profession already singled out as having the highest suicide rate of any profession in the country, partly because veterinarians on a weekly basis deal with something called euthanasia if cared for a pet for 10 years.

(25:07):

And unlike a human doctor, have to actually manage the process of saying, we're putting your cat down, and nobody does that with a thick skin and goes home and forgets about it. So you add all those factors up, and there are a lot of veterinarians that have shared with me, mark, I don't have any time to think about telemedicine. I don't really know how to do it. I don't have any extra staff that volunteered to be technology wizards. Now there's an answer to that. You can outsource it, which is the case in human medicine. The same in telemedicine, your law firm, myself, we represent various telemedicine providers, but even then, you've got to take some time. You've got to vet them, you've got to decide which of the five that want your business and all those issues. I get it. And that's not an excuse as much.

(25:55):

It's just a real world practical impediment. So I work on both challenges. I work on the shortage of veterinarians all day every day right now, and that connects to telemedicine. But I'm just, that's really been a very keen focus of mine, and that needs to get solved along the way. But part of it is, as you both know, you can start small. You don't have to transform your practice. You don't have to get a new software system, all those things that would make you go, please go to the clinic down the street, leave me alone. You don't have to do that. But that's a real world problem. So I think we've got to get, we've got a program coming up at the AVMA conference in two weeks in Philadelphia. This isn't sponsored by AVMA, but they've kindly made space available, and we're putting on a three hour program to really give people the first look at what, tell us how it worked in Ontario, Canada.

(26:52):

Bring the woman down. She's a government employee. She has no stake in any company. She's not making money off telemedicine. She just managed the process. Her name's Jan Robinson and she's she's going to spend an hour just explaining how it worked. I think when people hear that they're going to go, there's nothing about that experience that wouldn't apply in my state. So yeah, I told Jan, get ready for some consulting contracts because you're going to be asked to come into, I hope a lot of states and talk about it. Then we're going to bring in two platform companies that are telemedicine providers, and just take questions from the audience. How does it work? How do I start with you? What do you do? Tell me your legal, prove to me you're not doing something unethical. All those suspicions cover that. And then our virtual care association the co-chairs and founders of me, but those two are going to present the model telemedicine regulations that we favor, which have protections built in. As you two know that the states like New Jersey and Michigan are currently employing. There's no state that just says, do whatever the hell you want. We don't care. Try not to hurt anybody. So then you reassure people, and I think getting that, we'll get it broadcast hopefully, and then streamed and do all the things you can do to have people just watch this and see if it doesn't calm you down and give you some confidence.

Reema Taneja (28:13):

Yeah, that's excellent information. So keeping these challenges in mind, so we know VCPR is a roadblock. We know the AVMA is also has its opposing views. So what would you recommend for stakeholders who are in this industry and trying to expand access to tele, how would you recommend that they advocate for expansion and what can they do to help move the needle along?

Mark Cushing (28:40):

I think a couple of things, and part of it is having firms like your own involved in the work that I do, but number one, be active in the seven states that allow it and build up experience and expertise in those states that become as reference points, no law in America and any state that doesn't begin with one state. And then people go, wow, California, usually it's California doing something that half the country thinks is outrageous. And the other half thinks this is not a bad idea. But the point is, you start somewhere and then you build. And so number one is take advantage of the seven states and build up expertise and comfort where their regulators can say what this works the same way Jan Robinson from Ontario is going to say, that's number one. Then you need to have the organized retention of law firms, regulator regulators regulatory advocates, lobbyists like myself and our firm get engaged as we're engaged right now in Michigan, for example, where the Michigan AVMA is trying to undo their progressive board laws. And it could have happened and easily would've happened, but for us getting involved. So you've got to get your hands dirty, so to speak, not illegally, but just you've got to get into the political process. This is not to its credit, a highly political profession, veterinary medicine, they've existed for years outside the realm of much political attention. Nobody ran for the legislature in any state to fix veterinary medicine. So

Kaitlyn O'Connor (30:27):

I would vote for them if they did. If somebody in Virginia ran on that platform, I'd vote for them in a heartbeat.

Mark Cushing (30:32):

It's changing right now, Kaitlyn. You're right. It is changing with frankly, the whole phenomenon of Pet Nation. Little plug for my book there. But that's true. People care a lot more about those issues, but you've got to get engaged in the political process and you don't have what you have in human healthcare. You don't have major companies that have bank rules to say, we'll hire lobbyists because it's not inexpensive. Things don't happen fast. So telling a veterinary company, it's going to take two or three years, it's going to cost you X amount of money a month. You're going to get roughed up, you're going to be called names. You're going to have your motives called into question. The political process particularly right now is no place that probably anybody wants to dive into, but that's how it changes. And we won't really have federal law being our beneficiary here or being our ally.

(31:28):

So it's going to have to take the pressure of shortages, access to care, examples of how it works for people to say, this makes no sense to fight it. And I always tell people, any practice that doesn't want to use it, don't use it. Don't worry. Yep. Don't use it. Just tell people we don't do that. You don't even have to tell people where to go. Just say, we don't do that. So I think over time, and I've already seen in the two years that virtual care association's been in effect. I've seen temperatures lower. I've seen people say, you're right. We'll try it when we get some time and have some room to maneuver right now. But I think you've got to understand it Reema to your question. So real quickly, understand it. Use it where it's legal, tell the story about it. Get involved in your own state AVMA saying, take a look at this.

(32:26):

Don't just listen to what you're being told that ideology should or shouldn't be. Actually talk to vets to try it. And that was the case in Michigan. We had some very impressive veterinarians that hadn't used it before that basically came in and testified that what my practice would've died, but for telemedicine, and now I can't stop using it because my clients like it. It's so convenient. And right now with the price of gas, with all the challenges, the idea of going to a vet clinic and waiting which was never a happy experience. You've got a cat, you've got three dogs in the chairs next to you, your cat's going completely berserk. Dogs are stressed out. I mean, there's reasons why millennials have said continually. They'd rather manage the care of their pets remotely, unless it absolutely is critical to go in to see the veterinarian.

(33:18):

That's a logical, that's not some extreme view. Those are real pets saying it's just not a fun experience, let alone trying to find the time, let alone now trying to find a vet that can see me. So you add all that up. Well, we had a good example. Atlantic Monthly, a large national magazine mainstream media. They hate to be called mainstream, but I think they are. And they ran the story last week about we don't have enough veterinarians to take care of America's pets. Huge coverage in the veterinary space. I mean, I have people blast me with this article? Cushing, can you believe it? We just saw, I said Amen sister, great. Because now it's the Washington Post, it's New York Times, it's Wall Street Journal. I mean, they're talking about this, and that changes it for people. It's not just an insular veterinarians issue. And that just gets to the other point, human healthcare has experimented so successfully with innovations that are driven by one factor, give people the style and form and means of having healthcare that they want.

(34:26):

Yes. I mean, that seems like an obvious idea, but it's not. When the veterinary space, it's always been shaped by how do veterinarians want to practice veterinary medicine? All the models from 1970s, eighties, nineties, two thousands, all of that, the vet school curricula, it's all focused on a veterinary centric, a veterinarian centric model of healthcare, and nobody cared. And then all of a sudden that blew up. All of a sudden, millennials became the biggest players at the table.They own more pets along with Gen Z's than anybody, and they're like, you see this thing called my smartphone, how my world works for everything and don't tell me when I get the pets, I have to turn off my phone. Yeah. There's that happening too. And the idealist in me says, at some point, all these things converge. We get to 15 states now we're approaching half of them. But I'm going to tell you something, it's hand to hand combat beyond the first seven. It really is. So it's not home free by any stretch.

Kaitlyn O'Connor (35:32):

Yeah. I think that this is sort of to kind of round out the conversation. One of the things that we talk about with our clients all the time, I'm sure you talk about with your clients, and we actually are still having these conversations on the human side of healthcare as well, which is if you want to be a successful business in this space, you have to be willing to take risk. Things are changing very slowly, and we need companies to be willing to take some of that risk, collect the data, maybe go out into Ontario, collect that data, come into the US, and do it the right way so that we can show other states how successful telehealth can be for in the veterinary space. But that doesn't come without risk, because like you said, even in Michigan where the board has been more progressive, they're now walking that back or trying to, so even when we think things are moving in one direction, there are going to be roadblocks or bumps along the way that you've got to be prepared to handle and manage those risks sort of accordingly. So yeah, I think this has been really helpful. I think it's really, this is just kind of scratching the surface probably of everything we could talk about in this conversation but I really appreciate you sharing your perspective. I think that hopefully some of these challenges, like you said, are something or things that we're going to be addressing over the next couple of years, and we'll be working together to do that.

Mark Cushing (37:04):

Happy to collaborate, and I, I'm optimistic, but yeah, it's just measured by, you can take 50 issues in our lifetimes, mine longer than yours so far, I'm sure of where you just watch how it goes slow, and then the pace just picks up, and then suddenly people go, why don't we do this? Why? Why'd it take us so long to shift on so many social issues? So I think we'll get there. And part of it's generational, honestly.

Kaitlyn O'Connor (37:35):

In some ways, I hope that the public health emergency has been a little bit of a kickstarter for veterinary telehealth and for other forms of technology in the human healthcare space where now that we've gotten a taste of it, now that I have a veterinarian and a vet tech that I can access, I have an app on my phone I use, I don't know if anybody is familiar with it, but now that I have that app, so now that I have that app and I can access a veterinarian through my phone, I want that. I don't want to go back to the old way of doing things where the toothpaste is out of the tube, or all of those sayings that people say we're the, we're heading down that path already, and I don't think there's much going back. So I'm optimistic as well. I'm glad to hear that you are. As we wrap up the conversation, I want to make sure you get a chance to tell people where they can buy Pet Nation. Also, if you want to share the VVCA website and the VIC website, I think all of those are important resources for our listeners. So let us know that, and then maybe let's start planning our next conversation.

Mark Cushing (38:46):

Love to do that. So Pet Nation, you can get it online, obviously through Amazon, Barnes and Noble, and the usual places. There's a paperback, which is slightly updated to the original which wisely has a cat. It's a graphic cover, not a pictorial cover, and it has a cat, not just a dog. I've friends of mine have pointed that out, that <laugh> a little slow to learn there. Number one vet Virtual Care Association is vvca.org, and it has a map that a lot of people use daily, which explains to you in every state what the law is and how things work. Animal Policy group, my organization's, just animalpolicygroup.com. It's a mouthful, but if you can spell it right one time, you can go from there. And you had another one, another suggestion. I don't think I mentioned it. What was that?

Kaitlyn O'Connor (39:37):

Oh, I think I mentioned VIC, the Veterinary Innovation Council.

Mark Cushing (39:39):

Yeah. Vet veterinaryinnovationcouncil.org. And that's part of the largest media and continuing education group in the country called NABC and that's that org. This, right now, we're taking on access to care and really diving into access to care. So each year or two, VIC takes a new issue by itself and says, let's just hone in on that for some time. The last one was techs and creating mid-level professionals, which has led to the opening next month of the first veterinary version of a mid-level professional at the Lincoln Memorial College of Veterinary Medicine, which is a client of mine in East Tennessee. Very innovative school. So yeah, these things lead to change. And now more than one school's looking because Lincoln Memorials shared their curriculum with everybody and say, here, take a look at it. It's a pilot. We're going to tell you how it works. So that's, that's going to be the spirit of telemedicine. It's just to just keep sharing with people until they look at it and go, all right, I give up. You're right. Let's see if we can try it. So good luck to you too, and we'll find ways to collaborate. I'm sure we'll talk again.

Kaitlyn O'Connor (40:47):

Yes, for sure. Thank you so much, mark. We really appreciate it.

Mark Cushing (40:50):

We'll see ya.

TelemedicineNixon Gwilt Lawtelepet, veterinary telemedicine, mark cushing, animal policy group