December 16, 2017

NY Vet: Incorporating Exotics Into Your Practice

Broadening your patient base beyond dogs and cats can expand your clientele and generate additional revenue for your practice.
By Maureen McKinney
Exotic pet ownership in the United States is growing by leaps and bounds, and people are increasingly seeking care for these pets, according to Don J. Harris, DVM, owner of Avian & Exotic Animal Medical Center—Miami, Florida’s first exotics-only veterinary hospital. That’s why he believes that adding exotics to an existing caseload offers a tremendous financial benefit for many veterinary practices. “Most practices already have much of the equipment required to care for exotics, and the additional equipment that you need to purchase pays for itself over and over again,” he said. “The facility is already in place, the staff is there, the microscope is there, and the x-ray is usually there. Add a couple of pieces of equipment and you can generate substantial additional revenue.”

American Veterinarian® sat down with Dr. Harris at the New York Vet Conference in New York City to get his take on exotic animal practice today and what exactly is required of practices that want to open their patient registry to exotic animals.

How did you get started in exotic animal medicine?
Don Harris, DVM: I graduated from Louisiana State University School of Veterinary Medicine in 1980 and started out in companion-animal practice. Quickly the exotics caseload became overwhelming, and I really enjoyed it, so I became more selective with my canine and feline cases. I opened an exotics-only practice about 20 years ago (see Box 1).

How prevalent are emergency exotics cases?
That depends on your reference point. Probably one-third of all sick exotics come in as emergencies. The emergency clinic next door to my practice handles after-hours cases, and they probably see 20 or 30 small animals a night, plus 2 or 3 exotics. I guess you could extrapolate and say 10% of presentations in an emergency clinic might be exotics. Every emergency facility should be able to manage exotics at least on a triage basis because they invariably will get the cases.

What type of training is needed for dealing with exotic animals?
The training required to handle exotics in any practice is largely about just that—being able to handle the animals. You can go to a formulary and pick a drug, and if you have the x-rays and the diagnostics you can find an interpretation, but physically handling, restraining, and sedating the animals requires the majority of the training. In fact, most of my clients who come in for second opinions are people who are dissatisfied with how other veterinarians handled their pet. It had nothing to do with the diagnosis; it was the physical handling of the animal (Box 2). It becomes really clear very quickly to the owner if the handler is not competent, confident, and comfortable.

The Fear Free trend is actually quite significant when it comes to handling exotics. About 2 or 3 years ago Marty Becker and I were having a conversation about how modern pharmaceuticals virtually eliminate the need to traumatize an animal. There are enough agents available today that I can administer to my patients so they relax and chill, sometimes doze, and when they wake up, they’re unaware that anything happened to them. Most of what I do is aimed to be Fear Free. I won’t trim the nails on a patient if I think it’s going to traumatize them.

What special equipment is needed to care for exotic animals?
Much of the equipment is the same as what’s used for dogs and cats. Beyond that, 2 things come to mind. First is a simple gram scale. You can’t weigh hamsters and finches on a baby scale that’s accurate to the nearest pound. The scale must be accurate to the nearest gram. Second, digital x-rays are hugely valuable because sometimes you need to repeat a series rapidly to get the appropriate views.

One of the things that I don’t just advocate, I mandate, is performing diagnostics with exotics. You need to collect the samples, so you need to take blood. I think venipuncture in exotic animals is grossly underestimated. There are right ways and wrong ways of taking blood from different species, especially birds and some small mammals (Box 3). If someone came to me and asked, “How do I start in managing exotics? ” I would say, “First, learn how to restrain them safely, and second, learn how to take blood.” If you can’t do either of those, then you shouldn’t be seeing exotics.

I also believe strongly that practices that see exotic patients should do diagnostics on site. You have to be able to treat a parakeet with the same care and comprehensiveness that you would a macaw—a hamster the same as a cougar—and that means sample size. Only 1 instrument on the market can manage sample sizes that small, and that’s the Abaxis VS-2. It can do a full chemistry profile on just 0.10 mL of whole blood, whereas most analyzers require that for 1 analyte.

How important is it for staff to be on board?
If a practice owner is interested in managing exotics, then the staff must have an interest in or at least a sense of intrigue about exotics. These animals require more attentiveness than dogs and cats. A postsurgical avian patient needs close monitoring, and the diet for an exotic patient isn’t simply a scoop of food in a bowl every day. Employees need to be conscious of and attentive to these differences. They can’t be afraid of diverse animals, either. I had one staff member who would handle a cobra with no problem but was scared to death of butterflies.

Do you find that owners of exotic animals are willing to spend more on pet care than cat and dog owners are?
My initial response would be yes. I think taking care of a sick parakeet is just more expensive than caring for a sick dog, because you can’t experiment. You might try an antibiotic in a dog, and if it doesn’t work, you might get a second chance. That doesn’t happen with exotics. If they don’t get better the first time around, you likely won’t get a second chance. We usually have to go all out from the onset, which can be expensive, and most people will do it. I don’t know what would happen if every dog and cat owner was presented with an elaborate workup. The exotic pet owner is usually aware of the cost going in.

Can you give some advice on charging clients for exotic pet care?
Rates need to be higher simply because many cases require higher levels of skill and attentiveness. When I have an animal recovering from anesthesia or a case that’s postop, I watch it closely. I assign a technician to remain by the animal’s side until the animal is stable, and I come back every 5 minutes, listen to the heart, make sure the pet is OK. The time I spend with these patients is more than I would spend with dogs and cats.

Regarding skills, it’s largely about supply and demand. Not everybody can take blood from a canary. When everyone can, then maybe I won’t be able to charge as much, but until then, I charge more for those skills that I’ve developed over time. Then we go back to the whole concept of handling the animals, knowing what needs to be done, following through on the diagnostics—it’s more labor intensive than caring for dogs and cats.

So, I think it’s completely justified to charge from 20% to 50% more than you would with dogs and cats. I charge 300% percent more in some cases. I don’t know the going rate for nail trims in dogs and cats, but my average is $90. I do nail trims on fractious animals under anesthesia.

[In my lecture at the conference] I showed some examples where a hospital that has the equipment can earn a 1200% return on investment for running a basic profile. I can charge $600 for a profile in which the materials cost me $25 to $30—that’s about a 2000% return on investment.

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