This article was originally published in Maclean’s magazine on May 12, 2008. Partner content is not updated.Dr. Danny Joffe is only half joking when he says that if he'd fallen asleep on the last day of vet school in Saskatoon and woken up some two decades later in his current workplace, he would not have believed it was an animal hospital. Joffe is one of 11 specialists at the C.A.R.E.
Veterinary Care Faster Than Health Care for Humans
Dr. Danny Joffe is only half joking when he says that if he'd fallen asleep on the last day of vet school in Saskatoon and woken up some two decades later in his current workplace, he would not have believed it was an animal hospital. Joffe is one of 11 specialists at the C.A.R.E. Centre, a 28,000-sq.-foot palace of veterinary medicine built two years ago in Calgary by a consortium that owns 23 vet clinics and animal hospitals across British Columbia and Alberta. It has four operating theatres, a $100,000 CT machine, two ultrasound machines, a digital X-ray unit, an endoscopy centre, a lab and 16 examination rooms. Its intensive care unit boasts 20 cages and eight dog runs, staffed 24/7. "It's just like an emergency centre at a tertiary care human hospital," Joffe says.
There is almost no pet illness that can't be treated here. For eye problems, C.A.R.E. provides ophthalmologists who perform cataract surgery. Orthopaedic surgeons do hip replacements or arthroscopy - minimally invasive surgery on joints. To treat cancer, a surprisingly common disease in dogs and cats, says Joffe, "Our oncologist can offer intricate chemotherapy protocols and our surgeons can do very extreme and elaborate surgeries, including mass removals, amputations and bone transplants from cadaver dogs." As for MRIs, C.A.R.E. has a standing two appointments a week booked at a private human facility in the city. "For you or I it might be a several-month process," says Joffe of getting an MRI. "We get it done in a week or less."
Between the ER and the referral practice, C.A.R.E. sees some 8,000 pets a year, a staggering number for a place that has no primary medical care and specializes in delivering the kind of medical services people find at a hospital. This fall, when Canada's fifth vet school opens at the University of Calgary and C.A.R.E. becomes part of its teaching hospital, its referrals are likely to grow even more. Premium vet care may be an easier sell in a booming Alberta, Joffe says, but money isn't the bottom line. "If someone sees a friend get a hip replacement, they demand that for their pet," he says. "They want what people can have."
Trouble is, when it comes to medical care in Canada, our pets are often getting what we get - and a whole lot more besides. And they're getting it faster too. Using just about every machine known to human health care - CT scans, MRIs, ultrasounds, lasers and scopes of all sizes - animal cardiologists and oncologists, ophthalmologists, dermatologists and orthopaedic surgeons are offering a level of service so high that it rivals - some say surpasses - human medicine's. Vets can identify every pet problem from bowed tendons to blocked urethras to arthritic hips, and set to work fixing them immediately.
That's where millions of Bootses and Buddies and even Dobbinses have a decided advantage over their human owners in this country. If you are going to be sick in Canada, you are much further ahead being a beloved dog or cat. Even pet horses have far better prospects for healthier lives now than they ever had before. And where care for our dogs, cats and horses puts our own system to the greatest shame is in the domain of wait times and access to specialists. Our pets may not be able to talk, but they can get an appointment with a primary care vet within 24 hours and a specialist within the week. "I have a friend who had a dog with cancer and it got treatment within two weeks," says Tina Kelly, an IT buyer in Waterloo, Ont. "For something like that in a human, I bet the response would've been 10 times as long."
And how. There are just 10,800 vets in this country compared to over 62,000 human doctors. But try, as a human, to get an appointment with a specialist. Try, for that matter, getting a GP - five million Canadians, about 15 per cent of the population, don't have one, while 15 per cent of those who do still report trouble receiving routine care. And a referral from your family doctor to a specialist puts you in store for a new ordeal. According to the most recent edition of "Waiting Your Turn: Hospital Waiting Lists in Canada," the Fraser Institute's annual survey of wait times across the country, the number of weeks people waited to see a specialist rose from a median of 8.8 in 2006 to a median of 9.2 weeks in 2007. The journey from specialist to actual treatment took a median of nine weeks after that.
Or try getting a CT scan. The median wait in Canada in 2007 was 4.8 weeks, a little less than that in Ontario, Alberta and elsewhere, but a median of eight weeks if you were in Manitoba, the lengthiest delay in the country. An MRI scan? The median was just over 10 weeks, though in Newfoundland and Labrador you waited a median of 20. Got a bad hip? Try and find a comfortable position on the couch, you'll wait a while - ranging from a median of 15.5 to 80 weeks from the time you see a specialist to the time you get a new hip, depending on where you are (half of Canadians received treatment within the provincial wait times benchmark of 26 weeks or less, still an awfully long slog, and still longer than doctors would like to see their patients wait, whatever the benchmark).
You waited a median of 13 weeks in Alberta for cataract surgery in 2007 (the median now sits at seven weeks, though most wait 23 weeks, according to provincial numbers), 12 in B.C. (current provincial numbers shave that down to a median of eight), but as long as 24 weeks in some parts of Canada. Meanwhile, your friend Fluffy likely got cataract surgery in just a few days - provided you paid for the privilege.
Between the time a woman books a date with an oncologist in Alberta for breast cancer and the time she is finally seen, she'll wait a median of two or three weeks, according to Alberta Waitlist Registry data for the 90 days preceding Feb. 29 this year. She'll wait a median of a week between then and when she actually begins chemotherapy, too. If you're looking for a radiation oncologist, pencil in a date between two and 10 weeks from now just to have an appointment, then prepare to wait a median of as much as six weeks to start radiation therapy. Those prospects would make Ginger howl with despair; duller canines might just grin and bear it.
As for cost-per-procedure - though in most provinces you're not allowed to pay - finding out how much the province shelled out for your hip replacement or cataract surgery puts us on treacherous ground. "Nobody knows what the cost is," says Rick Baker, founder of Vancouver-based Timely Medical Alternatives Inc., which seeks the best prices for private medical procedures across North America for Canadian clients. (He operates a similar business for Americans.) "Why do they not know? Because they don't need to know," says Baker. Hospitals in Canada are funded on an annual basis, not according to the number of patients they see and what ailments they treat, as in the realm of animal hospitals. "All they know is they get $50 million per hospital from the government. If you ask about a specific procedure, they wouldn't have a clue."
Determining how much a physician charges for a hip replacement, say, doesn't help either. Doctors' fees for a hip job ranged in 2006 from $697.10 in Nova Scotia to $1,160.94 in New Brunswick, according to "Physicians in Canada: Fee-for-Service Utilization, 2005-2006," a Canadian Institute for Health Information (CIHI) report. But the total cost of the procedure also includes an anesthesiologist's fee, nursing and various other hospital expenses, a median in Canada of $8,777 without the physician's charge, according to "The Cost of Hospital Stays: Why Costs Vary," released this year by CIHI. Confused? You're not alone. Indeed, costing individual procedures in Canada is such a Kafkaesque puzzle that when Baker actually quotes his cheapest price for a new hip - a grand total of $14,000 at a U.S. facility - it's a bit of a relief. (Baker delights in listing his latest finds: $4,200 to remove a testicle, $2,500 to remove a cataract, $16,000 for a coronary bypass.)
The cost of not knowing what procedures at Canadian hospitals are worth is systemic sloth. "Under global budgets, you really don't find complete cost accounting because there really isn't an incentive to do it," says the Fraser Institute's Nadeem Esmail, co-author of "Waiting Your Turn." "It really does affect efficiency because you can't tell precisely where the inefficiencies are." Adds Canadian Medical Association president Dr. Brian Day: "We have excessive costs of administration and we have excessive costs of wait lists." Wait lists create new expenses because deferred treatment produces a greater risk of complications, says Day. And sick folks who can't work because the health system makes them wait also sap the economy, he says. When Canadians do make it to hospital, they end up languishing in aging buildings operated under lumbering bureaucracies and suffering paralyzing staff shortages.
And our pets? They get shiny new facilities and all the doctors they could ever hope to sniff and sharpen their claws on - and doctors know it. As recently as 2005, when he was still just medical director of the privatized Cambie Surgical Centre in Vancouver, Day used the pet paradigm to defend the notion of a Canadian parallel private system for humans - the same kind that exists in countries like Japan, Germany and Switzerland, all of which retain universal health care but don't have wait-times troubles. "When you have a parallel private system, it helps the public system," Day said then, during a television appearance. "This has given patients across the country the same rights of access that your pets have."
Day doesn't mind reiterating the comparison today, even if he is head of the CMA. "This is a country in which pets, with respect to the ability to purchase private health insurance, have more rights than their owners do," he told Maclean's. "People can and do spend money on their pets - but if it's their own body, they have to join a lineup and wait for that care unless they leave home and go to another province or country." The vet community doesn't argue. "The reason animals have faster and better care is that vet care is a private enterprise," says Dr. Bernhard Pukay, CEO and senior partner of the state-of-the-art Alta Vista Animal Hospital in Ottawa. "And people are prepared to pay." As for himself, Pukay recently needed an MRI; faced with a six-month wait, minimum, in Ontario for the diagnostic, he skipped over to Quebec - along with B.C., one of two provinces where loopholes permit some private health care procedures - and had one done right away, for $1,000. "Should we try to make the human system closer to the veterinary system?" he asks. "Which is broken? I think the veterinary system works just fine."
Just ask Bailey, who's never experienced anything like physiotherapy in her life. Still, within minutes of hobbling into the 404 Veterinary Hospital in Newmarket, Ont., she has been coaxed into a three-foot-by-seven-foot underwater treadmill and is ready for her first session. Inside the $35,000 tank, Dr. Tara Edwards, a canine rehabilitation therapist, holds the seven-year-old black lab steady while an assistant starts the treadmill and turns on the water that will buoy her 77 lb. as she walks. Off to the left, near a $65,000 16-foot-by-eight-foot therapy pool with a hydraulic lift, Joanne Fagnou, a vet with a special interest in animal acupuncture and pain management, watches Bailey's progress with an approving smile. A natural-born water dog, Bailey only gets anxious if her owner, Mike Thrush, moves out of her line of sight. She is handling the therapy well, Edwards reports. "All it takes is a little patience."
Well, it takes that and a lot more. Bailey is Mike Thrush's best friend. He bikes with her, takes her swimming and plays hide-and-go-seek with her in the woods near his Scarborough home. Earlier this spring, during a cottage weekend she spent galumphing through the ice and snow, Bailey damaged a ligament in her left hind leg. That Monday, Thrush's family vet recommended a consultation with Dr. Kevin Isakow, a surgeon and founding partner with Edwards and Fagnou of the 404 vet hospital. Bailey saw him the following day. Nor was there any time spent in the waiting room. "At our clinic we pride ourselves in not making clients sit with their pets for more than five minutes," says Isakow. Hovering above Bailey in the operating room just days later, Isakow repaired what is known as a torn cruciate ligament. It was fiddly work, but the follow-up is even more extraordinary. Says Thrush, "When I saw that room meant for animals, I was in awe."
Physiotherapy for pets, given by veterinarians educated and certified in the U.S., is still new in most parts of Canada. Fagnou sees some 10 animals a day - mostly dogs, though she's had one cat in that underwater treadmill - and performs feline acupuncture for tense muscles. Without such treatment, Bailey, for one, would have languished at home for months after the operation while Thrush struggled to stop her from reinjuring herself. With it, she is almost guaranteed to be as good as new in a matter of weeks (in this regard too, people fare less well: according to a national Canadian Physiotherapy Association survey conducted in January, a third of Canadians currently in need of physio will wait a month or more for an appointment, and pay between $40 and $70 a pop, depending on how they're insured; patients referred by a physician to a hospital physiotherapist are generally covered by provincial health plans).
Thrush, who runs a lawn care company, couldn't be happier. He broke his hand once, he says, and never got this much attention. And although he paid about $3,000 for Bailey's surgery and $550 for six physio sessions, he says, "I would do anything for my dog. I never thought in my wildest dreams that she would be getting this care."
Horses don't number in the millions like the Baileys of this country, but they may soon. In the past 10 years in Ontario, the herd has jumped 28 per cent, to nearly 380,000 animals, about 45 per cent of all the horses in Canada. "They are almost the new dog," says Dr. Melissa McKee, co-owner of McKee-Pownall Equine Services, a practice in the heart of horse country near Toronto. McKee and her partner, veterinarian and master farrier Mike Pownall, run four clinics with a total of 10 vets and 30 support staff. "People adore their horses," McKee explains, and there is no lack of treatment to keep them shuffling along well into their late 20s or early 30s. Modern veterinarians like McKee not only offer checkups, which they now call wellness exams, they come armed with fluoroscopes and endoscopes, portable ultrasound machines and digital radiographs.
And to even more accurately diagnose hoof and leg problems, especially fractures, McKee-Pownall recently bought Canada's first standing MRI machine. It's a test that is done on mildly sedated standing horses and is much less onerous than the big vet hospital machines, which require the 1,000-plus lb. animals to be anaesthetized and laid on their sides. McKee says plenty of owners are willing to pay $2,000 to have it done. "We notice people pulling in with an old pickup truck. But the horse and the trailer are gleaming," she says. "I think they look after the horses better than they do themselves."
There is no waiting either. The MRI can be booked within days, and the results are back in 48 hours. Says McKee, "My brother Michael is an orthopaedic surgeon in downtown Toronto, and we have conversations about this all the time: people have to wait six months for an MRI or jump the queue and go to Buffalo. He can hardly get his mind around it."
To hear an equine veterinary surgeon tell it, many horses that would have been dead a decade or two ago can now be saved, quickly and competently. Last year Dr. Bruce Watt, who runs the Caledon Equine Hospital near Toronto, operated on over 200 horses and treated about 225 more. He saw a miniature horse, for example, that had been stepped on by a draught horse while their new owner was trying to load them both into a trailer. The mini's hind leg was badly broken, almost dangling, the kind of injury that in old Hollywood westerns is cured with a bullet. Dr. Watt cast it and put pins through the cast and the bone to secure it. Today the mini is as good as new, he says, and the owner is happy as can be. And since he operates with a vet tech who runs the anaesthetic, he can move quickly, any time of the day or night.
But in Ontario, he says, the human health care system is "slow as molasses." If he sees a horse that needs an MRI, he sends it to the Ontario Veterinary College in Guelph, and "I can have it over there within a week, easily." In veterinary medicine, Dr. Watt says, there are not only new techniques and knowledge and equipment, "There's a huge private-industry motivation that just does not exist in the human health field."
Laura Simmermon can attest to that. She and her animals have been to Dr. Pukay's Alta Vista Animal Hospital in Ottawa often over the last several years. Simmermon works for the Treasury Board, and in her spare time she's a greyhound aficionado. It is a love affair fraught with heartbreak: greyhounds are more likely to get cancer than almost any other dog breed. In the spring of 2005, her male, Bocuse, began to act logy. At first, the specialist at Alta Vista thought it was a tick-borne disease, and sent samples to a specialty lab in the U.S., but that wasn't it. The vet also did an ultrasound, which determined only that the dog had an enlarged spleen. Then a second dog, Clover, started to limp. In the meantime, Simmermon found Dr. Guillermo Couto, a greyhound cancer specialist at Ohio State University.
Pretty soon, Couto and two Canadian vets, including the specialist at Alta Vista and Simmermon's primary care doctor, were exchanging information. Simmermon was heartened by the level of co-operation and the quick turnaround time, even for complicated procedures. "I never had any delays," she says. "Bocuse saw the oncologist at Alta Vista the same day we brought him in."
Ultimately, she paid about $14,000, probably more than she would spend on herself, Simmermon says, to have her two dogs treated. Sadly both died. But the quality of care and the team approach made Simmermon feel that everyone had tried to do their level best to help. Simmermon switched vets three times before she found her primary health care vet - something humans often can't do - and now, she says, "I have a better relationship with him than I do with my doctor. I only go to my doctor when I absolutely have to. With my vet, it's a partnership."
In modern veterinary medicine, the animal-human bond has now extended to vets who have grown in the public's estimation from mere animal doctors to trusted oracles, say experts. "Vets are the people who once only existed in human medicine," says Dr. Tim Ogilvie, dean of the Atlantic Veterinary College (AVC) at the University of Prince Edward Island in Charlottetown. "They are highly regarded." And it's not all about what he calls "the fancy gizmos" either. In the vet business, he says, there is a lot of experiential learning, a lot of "sage wisdom" to go along with the knowledge explosion. Vets are like old-style doctors, the kinds of avuncular figures who, satchel in hand, turn up for house calls today only in grainy old films.
But here the wise old doc is high-tech. AVC is currently pioneering a revolutionary new treatment for horses with tendon and ligament injuries. Dr. Laurie McDuffee, an AVC equine surgeon and scientist, is working with a bio-sciences company called VetCell in England that has developed a way to grow healthy stem cells from bone marrow in a horse's sternum. She is travelling across the country to teach vets how to take the samples they will then send to her lab, where she will isolate the stem cells and expand them, typically to 10 million, and ship them back to the local vets. With ultrasound machines to guide them, they will implant the cells into the site of the injury. "What the stem cells are supposed to do is promote regeneration of normal tendon tissue so that the function is ideal and reinjury is decreased, by half," she says. The treatment is so revolutionary, it may be used on people in the near future.
Bells and whistles and pioneering treatments aside, vets are also in the pain-management business, where there's been a revolution. As recently as 2001, cats came home after being spayed or neutered with no pain medication at all. Vets thought pain would keep them quiet long enough for the stitches to heal. Now veterinary students are taught more about pain management than medical students or nurses in training, according to a survey of health science faculties in 10 major universities across Canada - and four vet schools. The study, done last year for the Canadian Pain Society by Judy Watt-Watson, a professor at U of T's Bloomberg Faculty of Nursing, discovered that in medical schools, students were taught 16 hours of pain management; in nursing schools, it was 31 hours. But vet students received 87 hours of pain management instruction, on average.
Dr. Cathy Hooper at the Glendale Veterinary Hospital in Brampton, Ont., is using a new tool to treat pain. It's a non-surgical low-level laser with diode light that helps dogs and cats that are arthritic. "It can take the pain away without the need for drugs," she says, "and help to heal wounds." Her low-level laser is hand-held, and delivers laser light through the skin surface. It works by stimulating the body's ability to heal itself at the cellular level. Best of all, the cat feels nothing. "Lasers are being used in remarkable ways," she says. "They're not common here, but I am very proud to say I have one."
When Melissa McKee, 33, talks about her patients - horses with heart problems and lamenesses, digestive troubles and breathing difficulties - she manages to sound upbeat and happy. When her brother Michael, a 45-year-old orthopaedic surgeon at St. Michael's Hospital in Toronto, talks about his patients, he sounds like he has a two-ton weight on his shoulders. Michael specializes in upper extremities and trauma. He does shoulder replacement, elbow replacements, fractures and post-fracture reconstruction. His special interest is handling fractures that don't do well and that have to be fixed after another doctor's initial attempt, something that happens fairly frequently.
As a specialist, seeing Michael McKee normally takes about six to eight months. "Between the time I saw you and the time you had surgery done would be another six to seven months," he says. He is locked in a system with no wriggle room. "St. Mike's is pretty decent about giving me operating room time, but I need more and I can't get more," he says. Although they are both dedicated, there is a big difference between Michael and Melissa. "She is very good at what she does and she has more and more demand for her services, so she expands," he says. " I have the same thing - an overwhelming demand, but I can't expand. I work at a hospital that is one of the most efficient in the province, but our beds are fixed and our operating room time is fixed."
If a person had money? "If a person had money, they could go to Buffalo or New York and if they know you are coming, you could go get your consultation, get your MRI the same afternoon and your surgery the next day. As long as you can afford it, the turnaround time might be a week."
Kind of like animals? "Yes," says Michael.
Both vets and doctors have more to offer than they have ever had before, but doctors don't have the resources. Says Michael McKee, "The veterinary industry looks for business and caters to a market that wants to be looked after. Me? I spend most of my time actively deflecting as much as I can." Brian Day diagnoses the problem in part as a symptom of how Canada's ministries of health fund our hospitals. Rather than having hospitals seek new patients with better care, and expanding in response to greater demand, Canadian hospitals are funded with fixed yearly budgets. "The money does not follow the patient the way it does in the animal health system," says Day. "If you go to a veterinary hospital, you're bringing revenue to the hospital. If you go to a hospital in Calgary, you are using up the block funding that it gets each year."
In Winnipeg, Dr. Gordon Goodridge, a man who was instrumental in bringing one of Canada's first MRIs for animals to the vet school in Saskatoon, is astonished when he considers the change in animal medicine over the 33 years he's been in practice - but not all of it is good, in his opinion. In 1975, he remembers, most owners would opt for euthanasia if they were faced with a $300 bill. Then, about 15 years ago, he says, "Our staff started referring to the owners of animals as mom and dad." Now it is just assumed that people are the stewards of their pets, responsible for every bit of their health care, no matter the extent or the cost. "We have to be careful that we don't guilt people into feeling that they have to do all these things," he says.
But the point is, they can if they want to. Anyone who has watched a loved one limping for a year before they get a knee operation, or has seen an aging relative languish in hospital, knows what a helpless feeling it is. With pets, people are free to spend their money - and even if the animal can't be cured, they know that everything that could be done was done. Says Goodridge, "At least pet owners get peace of mind." It's hard to accept that when it comes to our human loved ones, Canadians can't always get the same.
Maclean's May 12, 2008