The Gruesome Twosome, Joe and Emily, discuss what a Veterinary Client Patient Relationship is and what it means as we approach June 2023, when over-the-counter antibiotics will no longer be available.
Hosted by members of the University of Minnesota Extension Beef and Dairy Teams, The Moos Room discusses relevant topics to help beef and dairy producers be more successful. The information is evidence-based and presented as an informal conversation between the hosts and guests.
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[cow mooing]
Joe: Well, welcome to The Moos Room, everybody. Today, we are without Bradley. He is at the Minnesota Organics Conference, not something he can miss. Understandable, disappointing, but that does mean you are stuck with the gruesome-twosome today.
Emily: Oh, yes.
Joe: [barking]
Emily: Gruesome-twosome.
Joe: Today, I'm still on paternity leave. Everything's going fine, she's teething, so that's challenging, and not napping super well, but we're working our way through it. Probably, another short episode today, as I'm not supposed to be working at all anyway.
Emily: Well, a short episode, but an important one, I think, and one that's going to have a lot of relevance very, very soon. I think it's a good thing that we are talking about. In some past episodes, we have covered some various changes and guideline changes for antibiotic use. This is following up to the Veterinary Feed Directive in, insert year here.
An important part of both the Veterinary Feed Directive, and now that antibiotics are not going to be available over the counter the way they used to be, is you need to have a VCPR, otherwise known as a Veterinary Client-Patient Relationship. Now, obviously, we have somebody here who is an expert in that, Dr. Joe, and somebody here who doesn't know a ton about VCPRs, and what that really means, me. [chuckles]
We're just going to dive in the first question, I mean, yes, I know VCPR means Veterinary Client-Patient Relationship, but what really is that? What does that relationship mean? What does having an established VCPR mean for a producer, Joe?
Joe: Really, it's an agreement. It's an agreement between a veterinarian and a producer, or a client. It's not with an individual, usually, it's with a clinic, and it's an agreement that goes both ways. The veterinarian is agreeing to certain things. and acknowledging that they know about your operation, and can make decisions based on what they know, and it's going to be correct, and they're going to be available for follow-up.
The tricky part of the VCPR conversation is that, it changes from state-to-state. Each state is a little different, and that's something for vets to keep track of, if they are working in different states. What does A VCPR really mean in the different states? In Minnesota, it's pretty clear, you know the farm well enough to make clinical judgments about animals and you have, basically, general knowledge enough to be able to do that, or provide protocols that allow the farmer to make decisions, and you're available for follow-up like I said, and continued questions, or care, or treatment of those animals.
You're maintaining patient records in some way if that's part of the deal. If the veterinarian is there actually treating an animal, they have records of the treatment itself. The client side, the client is really-- You're agreeing that this person or this veterinarian, this clinic is the veterinarian of record for your farm. You agree to keep records and follow veterinarian instructions, that's really what the agreement is about.
It's a working relationship. Sometimes it's formalized in a document, and I think that we're moving more and more towards that, because there's a lot of programs out there, especially, on the dairy side of things, where they want a formalized written document for this. That's what we're moving towards a lot, and we're seeing a lot more private practitioners and clinics move to having a signed document that both parties signed that agrees to what I just said, all these things. There's a lot of more intricacies to it, but that's the overview.
Emily: Yes, and to me it sounds a lot having a primary care physician on the human health side. I have the main doctor I see, but I'm a patient of that clinic, so if my doctor's not available, I can see another doctor there, they can pull up my chart, they can still provide me care, and so I think of it that way. Really importantly too, I take some medications. That's how I get those prescriptions, is from my main clinic. Again, if my doctor is out, another doctor there can send a prescription refill.
I think that that's a really important piece here to think about that prescribing power, because that is something people are going to need, with these upcoming guideline changes on antibiotics. I know, again, we've done an episode about this, but Joe, do you want to give the 30-second rundown on when those guideline changes are happening, or if they already happened, I can't remember. [chuckles] Just the quick 30-second overview.
Joe: Yes, so, we did cover this, and if you want to go back and listen, it's episode 140, talking about over-the-counter antibiotics, and how they're going away. That's going to be happening in June 2023. This year, coming up fast. All over-the-counter antibiotics are going away. All of them, if you used to get stuff at Fleet Farm, or anywhere else like that, not going to be available.
No penicillin, Oxytet, no sulfa, nothing. You're going to need to have a relationship with a veterinarian to be able to get those medications, because they're going to be prescription. This whole VCPR thing becomes more and more important, and you need to take care of it now. Getting a VCPR on record will save you hassle later when everyone's trying to get one in June, when all of a sudden they can't get antibiotics that they want.
I think the big misconception with the things that I hear, at least, as far as questions that regarding what does all this mean? It doesn't mean that a veterinarian has to be there to see the exact animal that's getting treated every time. That's not what it means. It means that the veterinarian has to be there one to two times a year to overview your system, go over everything with you. establish protocols for the use of these antibiotics, so that when they prescribe them, they are comfortable that they're going to be used properly.
It doesn't mean that you have to call the veterinarian for every animal that needs to be treated. They don't even have to have ever seen that animal ever, it just means that they need to know your system, trust that the protocols are going to be followed, and that these antibiotics are going to be used in a responsible manner.
Emily: For example, on a dairy farm, you have high somatic cell counts, and maybe you've done a culture with your veterinarian, and so they know what it is. They know you have a staph aureus issue. Yes, if you have a just fresh cow, and a little bit into her lactation, she comes down with staph aureus, you need to treat her. For your veterinarian, they already know that that's something you've treated for in the past.
They already know that that's something that you are actively treating for, or dealing with on your farm. Yes, I think that that's a really important thing, Joe, but with that, what you said too, that doesn't mean you can just call a vet clinic and go, "Hey, can I have a VCPR with you, so you can fill my scripts?" There is some upkeep, some maintenance to a VCPR like Joe said.
You do need to have a vet out there, somewhat regularly, once or twice a year. If you don't have a VCPR right now, you are going to have to have an initial visit. A vet is going to have to come out to your farm, but then, again, then it's just that maintenance piece, keeping them in the loop, having them out every six months, that is really all it takes.
That might not sound super simple, but with the change in the guidelines, they're still trying to make these drugs accessible to people, and so it's not taking away access, it's just regulating access a little more. That's what we're looking at here. Joe, my next big question, well, I guess it's kind of there's two questions that oppose each other. The first question is, how do I know if I have a VCPR? Can I just ask my vet?
Joe: In most cases, like I said it's not required to be written down, but in general, a VCPR is a dedicated visit that is not an emergency, that's very clear for most clinics. I can't, and I don't want to talk about your system, and all your cows at 2:00 in the morning, while I'm trying to do a C-section. I want to spend some time to get to know your system, so that if you have a question, or if there is a problem, I can answer that, and provide a solution that actually is going to work, rather than trying to fit in some generic answer to your system that may, or may not work.
That's the reasoning behind it, and you will know because most clinics are documenting it. You should have a copy of your VCPR form, the date, so you know when it expires. It's a dedicated visit once a year. It can happen when you're already seeing the vet anyway for preg check, or something else, but it needs to be dedicated time to make sure that you walk through your system, so the vet is aware of what's going on. Knowing, you should be able to ask your clinic, if you have one and if it's up-to-date, but you also, in most cases, will now have it documented in your records that you have one.
Emily: That leads to the next question, which part of it's a little obvious. There are people out there that don't maybe have a lot of animals, so they don't really use regular veterinary work. They don't have a clinic. There's probably people that know they don't have VCPRs. I'm thinking of-- Okay, I'm going to use my brother as an example, just to make it easier. This isn't necessarily a true story.
My brother raises some beef cattle on our family's dairy farm, and these are cattle, they're all raised for slaughter. He only buys steers. They're all terminal animals. He doesn't really have regular vet work that gets done, because he's just raising them, feeding them, butchering them, done. One time, there was a steer that had some sort of issue, say pink eye. Well, obviously you want to get pink eye under control.
My brother calls the vet, a vet comes out, treats the pink eye, what have you. That doesn't necessarily constitute a VCPR. I guess my question for you, Joe, is if you are a producer that has that like, "Oh, I've called this clinic, they've done a couple of emergency things for me," or what have you, or, "This is the vet I take my dog into to get their rabies shot." Something like that.
Is that a matter of just contacting a vet clinic, especially, if you have maybe worked with them once or twice, and asking if they can take you on? How does that work, if you're not really sure if you have a VCPR, or you're not really sure where to start with that?
Joe: I guess it comes down to each producer, and how they want to manage it, and how the veterinarian is going to manage it. I don't want to put anybody on the veterinary side on the spot either, as far as how they're going to handle it, but if you want to have things on hand, then, yes, you have to reach out to a veterinarian, and get that taken care of.
In that hypothetical situation, you can ask when you call in, and say, "Hey, I've got an animal with pink eye. I don't have anything on hand. I need it treated. Can you make sure that when you schedule someone to come out and treat it and look at it, that we also update my VCPR?" That's how we did it when I was in practice. We're more than happy, as long as we know upfront that it's going to be something where we sit down up for.
It doesn't have to be long, if you don't have that many animals, but it can be really helpful, let's say, if you have a feedlot like that to know how many animals you're getting in, what weight they are when you get them in, what time of year, when you sell, where you sell them to, what do you feed? All those kind of things, because then if you do need something, I don't have to ask all those extra questions.
I don't have to come out and see your place again to make sure everything's going well. We just need to know, usually, ahead of time that it is a VCPR visit as well. Some clinics are probably going to be potentially a little more lax on it and to say, "Yes, if I've been there in the last year, and I know the system, then we have valid VCPR," but that's going to be up to each veterinarian.
I would suggest everyone reach out ahead of time. I think that's really going to be the way to go. Especially, if you're in an area where, potentially, there's a lack of access to a veterinarian. There's lots of things that's going to become an issue with this, and with over-the-counter antibiotics going away, but I think that's Episode 137 where we talk about what to do if you are in the area, where there's a little bit of access issue to a veterinarian. Because I think it's going to bring a lot of this to head when people need a vet, and they might not have one right down the road.
Emily: Yes. You know, Joe, and I think that's an important thing too, is if you have a vet, one you regularly work with, whatever, just give them a call and check. As producers, we need to do our due diligence on this as well. We can never just assume, especially, with things like this. Yes, like you said earlier too, get on this now. This is coming in June, and we know it's been coming, and it's not going to be a situation where people get grandfathered in.
It's June 2023. Yes, have those conversations, or if you do have regular herd health checks, you can even just say to your vet when they're out, like, "Hey I know those antibiotic changes are coming in June. Is everything good on our end with VCPR and that?" Most likely, they're going to say, "Yes. Nope, that's good." They might go, "Oh, actually, our clinic wants to get these in writing now, so here's a thing for you to sign."
Just ask. That's just Emily's personal philosophy in life. Just ask, so that you know for sure there's no guesswork. All right, Joe, is there anything else on VCPRs that you think it's important for people to know, especially, as we barrel towards June?
Joe: I think the key is that VCPRs need to be in place. You need to have a veterinarian of record that handles almost everything, and can prescribe and knows your system well. Now, that doesn't mean that no other veterinarian could ever come to your farm. That's not what it means. There's ways to be a little more creative with it. If you want to have someone do your regular repro work, preg-checks, do most of that kind of thing, and have someone else handle emergencies, that's fine.
You're going to have to know that, for most things, you're going to have one vet that does most of the prescribing, sets up protocols, does all these things. It doesn't mean that you're tied to only that vet clinic. It's good to keep that in mind as well, because things change. Not everything works out, but you need to have a primary clinic that knows enough about your place to be able to make recommendations, and prescribe these medications, and then they have to have faith in you as a producer to follow the instructions and protocols, and use things in a responsible manner.
Emily: This is definitely a two-way relationship. I think we've hit that point home. [crosstalk]
Joe: Yes. I guess the only other thing I'll say when I talk to producers is, it's an awkward conversation to have sometimes, but I think it's really important to have a conversation right away about what the relationship is going to be. Especially in areas like Northern Minnesota where vets are spread really far apart, some producers are spread really far apart, but if you have that conversation, and get it out of the way, break the ice, get over how awkward it is, and say, "Hey, I'm more than happy to talk to you on the phone, answer questions. I know your system well enough. I've been here once a year, I'm going to be able to do this, this, and this, and I will do my best to be there for emergencies, but it's going to be a while. You're going to have to wait."
That's going to save so much strife later on if everyone's really upfront and clear. I think almost every producer I've ever talked to, as long as you're clear, and everyone's honest about what they want out of the relationship, and what's possible, everything is fine. I think there's a lot that can be done just by having that conversation right away, and it can prevent so many head headaches and frustration later on.
Just be really, really open and honest about what each side of this relationship expects, and what's possible and reasonable, and find some way to compromise on everything to make it work.
Emily: Yes, that's some really great advice there, Joe. Do you have anything else, or should we wrap it?
Joe: Let's wrap it there. I am talked out for today.
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Emily: All right, so we are going to wrap it there. If you have questions, comments, or scathing rebuttals about today's episode, you can email those to themoosroom@umn.edu.
Joe: That's T-H-E-M-O-O-S-R-O-O-M@umn.edu.
Emily: You can also call and leave us a voicemail with your questions, comments, and scathing rebuttals, or questions you would like to have answered on a future episode of the The Moos Room by calling 612-624-3610. You can find us on Twitter @UMNMoosRoom, and online at extension.umn.edu. That is the gruesome-twosome signing out. Bye.
[barking]
[cow mooing]
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