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Introduction to Herd Production Medicine

Version 2.4     Updated April 01, 2009

Contents:

• What is veterinary production medicine?
• What specialized skills and knowledge are required?
• What are the basic differences between production and traditional veterinary medicine?
• How does one get there from here?
• Dr. Al Leman's perspective
• Some considerations
• Selected Production Medicine References

The following are definitions of veterinary production medicine extracted from selected sources appearing over the years. Note the common themes across authors and species.

During the previous decades, veterinary services for dairy cattle differed little from services to companion animals, which are focused on animal care. Now there are three concurrent and sometimes conflicting goals: Animal care, owner profit and consumer safety.

Three factors become paramount on large dairy farms: Specialized labor, purchasing and marketing clout due to volume, and an emphasis on schedules and constancy. With specialized labor, the guiding principle is that each task will be delegated to the lowest-paid person who can competently perform the task.

This includes tasks traditionally performed by the veterinarian.

Cow health problems that were seen twice a year on a 50-cow dairy are now seen weekly on a 1,300-cow dairy. This routine observation of now common problems gives managers and farm labor the confidence to diagnose and treat most dairy cow health problems that were once the province of the veterinarian.

Traditional medicine is focused upon diagnostic and therapeutics of the individual animal with the assumption that if all the sick animals are handled properly, a healthy herd will result. Production medicine is focused upon the underlying herd management system with the assumption that if the production system that produced the problem is fixed, a healthy herd will result.

If a group of cows are examined, pregnancies recorded, abnormalities treated, heats predicted, and left at that point, the reproductive program is traditional medicine directed at correcting the problems of many individual animals.

If herd performance is summarized and charted, allowing management to make herd-based decisions, the reproductive program is production medicine.

[Note the many scoring systems and  forms Nordlund's group has developed to perform the assessment and monitoring tasks]

Dairy management assistance services include any informational services that assist the herd manager in analysis, control, and decision making. Opportunities for providing these services include:

• Training and monitoring of the performance of sick pen personnel
• Nutrition management including ration formulation, inventory management and feedstuff price monitoring
• Mastitis management including milker training and milking system analysis
• Reproductive monitoring and projecting replacement heifer, lactating cow, and dry cow inventories based on reproductive records.
• Consultation on facility design and maintenance
• Expansion advice

Penn State Dairy Production Medicine Certificate Program (2002)

• Herd performance medicine, as opposed to the more traditional individual animal care that most people learn in veterinary school
  • Emphasis on such areas as nutrition, herd management, cow comfort, farm personnel, and herd profitability.
• To make the greatest impact on animal health and farm profitability, veterinarians need to be more proactive and prevent problems or eliminate production-limiting conditions. Typically, these involve interactions between the animals and their environment, nutrition and management.
• Dairy producers reported fewer unscheduled veterinary visits and reported the greatest progress in forage evaluation, milk quality analysis, records analysis and improvement in animal environment.

DO Rae (1989) (U Florida Beef Clinician)

The veterinarian will continue to be the producer's front line resource for health management services and information. How can we best serve the beef producer? Traditional delivery of services has included: 1) care of the sick cow or calf; 2) emergency intervention; 3) elective procedures; and 4) regulatory procedures. Fire-engine medicine and surgery! Can the veterinarian offer a service which will help the producer better meet his needs, pressures and goals? Can we do it at a price that is bearable or preferably cost effective and income producing for the producer and veterinarian? Can we accomplish these things by offering the traditional veterinary services alone? I think not.

What type of service are we going to see then? 

• Key: One with a more purposeful involvement in health and production management, not just an occasional fix-up or patch-up.
• Aim: Help the beef producer optimize his profit!

WM Guterbock (2001) (former dairy practitioner, currently large dairy manager)

What Ive learned about Veterinary Medicine Since Becoming a Dairyman (full pdf - 34^th AABP Convention Proceedings, 2001)

1. The cows are the most important creatures on the dairy, but there is a lot more to running a large dairy than managing cows
2. Veterinary emergencies are not really emergencies
3. Veterinarians need to stop thinking about per cow averages
4. On large dairy farms most traditional veterinary tasks are not being performed by veterinarians
5. The cases we brag about generally have bad outcomes
6. Its a lot easier to give advice than to take it
7. We arent the only smart people out there

Smart producers will make use of services that help them and their employees improve performance and profit. The question is not whether the services are needed but who will provide them.

UCD VMTRC Faculty (1999)

What is Dairy Production/Performance Medicine?

Production medicine is the utilization of many facets of production, e.g. nutrition, environment, genetics, and health, into a well-managed program monitored by records (Herrick 1990).

The five main areas where a veterinarian can interact to help the dairy farm become more profitable are:

1. Reduction of somatic cell count (SCC) through mastitis control and prevention
2. Increase dry matter intake (DMI) through nutrition and improved cow comfort
3. Improve reproductive efficiency of the herd
4. Decrease the age at first calving through heifer management programs
5. Advise on management to improve effective labor and facilities utilization

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Veterinarians practicing herd health and production medicine should have:

• The skills to implement and to operate herd health and production management protocols.
• A broad knowledge and interest in:
  • The functional structure of dairy farm management and the convergence of operational farm management functions in relation to health, productivity, economy, animal welfare and environment.
  • The pathophysiology, dynamics, diagnosis and prevention of diseases and production deficiencies at the herd level to distinguish the abnormal from the normal and the suboptimal from the optimal.
  • The utilization and interpretation of diagnostic tests.
  • Basic computer handling and data processing techniques.
  • Communication and client education that enable the veterinarian to stimulate and motivate the farmer in record keeping, improvement of management procedures, and adoption of recommendations.
• A basic understanding of epidemiologic principles, including test characteristics and observational surveys.
• The skills to interpret not only clinical and subclinical disease but also production data and environment related observations in an epidemiological way.
• The skills to serve both as a source and a critic of new information delivered to the farmer.
• The ability to be a sentinel and advocate for the welfare of cattle.
• The ability to intermediate between primary farm production and public health interests.
• Computer facilities.
• A farm file of reports, analyses, conclusions and recommendations.
• A strong and current base of scientific information on dairy farm management and on the sciences related to herd health and production medicine services.

"Dairy Production Medicine" involves developing skills in multiple areas of dairy practice. Of the many challenges faced by the dairy practitioner, the need to positively influence dairy producers for change can be pivotal. Among other traits, the ability to listen and to clarify ideas is critical if the production medicine practitioner hopes to make much of an impact.

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What are the basic differences between production and traditional veterinary medicine?

How does one get there from here?

• Major in Animal Science, production option, at a school with a strong program in your species of interest. Problems in animal husbandry are at the root of many livestock disease problems and preventing these usually requires farm-specific interventions.
• Take all of the livestock nutrition classes that you can; get a Master of Science degree in it if you can. Animal feed is the major cash expense of most livestock operations and nutrition problems are a component of many livestock disease problems.
• Take all the reproduction classes that you can and learn artificial insemination.
• Take upper division classes in applied farm-level agricultural economics and farm management. The really important herd-wide decisions in which the veterinarian is involved almost always involve economics and risk. The veterinarian that does not understand the economic implications of decision alternatives is of much less use to managers making these decisions than one who does. Veterinarians are becoming more involved in establishing procedures and in the hiring, training and monitoring of employees responsible for those procedures. To do this, veterinarians need to understand the principles of labor management including training, monitoring and motivation.
• Become familiar with the emerging discipline of agroecology, particularly as it relates to soil biology. Improving and maintaining soil productivity is increasingly important and improving the integration of livestock into farming systems to improve soils is a key component of agroecology.
• Spend at least one summer working with the labor on a large-scale operation in the area of your interest, such as a 2,000+ lactating cow dairy or a 10,000+ head feedlot
• Master information literacy, particularly how to manage and analyze data with spreadsheet software such as Excel
• Learn agricultural Spanish

While in veterinary school:

• If you have not, develop your conversational ability in Spanish as a significant component of the agricultural workforce is Hispanic.
• Learn how to use the production accounting systems (e.g., dairy - DairyCHAMP, DairyComp 305, beef - CHAPS, CowBoss, CowCalf5, swine - PigCHAMP) and how to do "barnyard epidemiology" on the data from them efficiently. Learn to use readily available tools such as Microsoft Excel and EpiInfo to establish cohorts, to calculate risk of occurrence and relative risk between exposures, and to create summary tables and plots. For additional information in this area, see WWWeb Epidemiology & Evidence-based Medicine Sources for Veterinarians and Guide for Herd Problem Investigations.
• Take advantage of the elective blocks offered at other schools with strong applied programs in your species of interest. Even consider scheduling some of these as part of your vacation time. To make sure they have a place for you, you will need to begin arranging these months in advance of when you would like to go. Many of these will allow you to take their blocks for free if you are paying tuition at another North American veterinary school and they have space. Some examples are the following. The Great Plains Veterinary Education Center has clinic rotations for fourth year students interested in beef cattle practice. The Veterinary Medical Teaching and Research Center, Tulare, CA, of UC Davis and the University of Wisconsin have clinic rotations for fourth year students interested in dairy cattle practice.
• Consider specialized internships and residencies, such as the Large Dairy Herd Internship at Michigan State or the Dairy Production Medicine Residency at UC Davis.
• If you didn't major in animal science and take the capstone division livestock nutrition and reproduction classes, obtain the textbooks for these and become familiar with the material. Feed is approximately one-half of farm operating cost and feed and feeding problems are a major cause of production diseases.
• If you didn't have upper division classes in applied farm-level agricultural economics and farm management, obtain the textbooks and become familiar with the material. The really important herd-wide decisions in which the veterinarian is involved almost always involve economics and risk. The veterinarian that does not understand the economic implications of decision alternatives is of much less use to managers making these decisions than one who does. Veterinarians are becoming more involved in establishing procedures and in the hiring, training and monitoring of employees responsible for those procedures. To do this, veterinarians need to understand the principles of labor management including training, monitoring and motivation. Finally, the veterinarian's allied industry "competition" usually has this background and level of academic training.

Identify the competencies expected by practitioners, your future employers, and begin achieving these:

• Kustritz, MVR, PJ Chenoweth, A Tibary (2006). Efficacy of training in theriogenology as determined by a survey of veterinarians, JAVMA 229(4):514 -521.
• Miller RB, LE Hardin, RP Cowart, MR Ellersieck (2004) Practitioner-defined competencies required of new veterinary graduates in food animal practice. JVME 31(4):347-365.
  • combined list  pdf  xls
• Morin DE, Morin, PD Constable, HF Troutt, AL Johnson (2002). Individual animal medicine and animal production skills expected of entry-level veterinarians in bovine practice JAVMA 221(7):959-68.
• Morin DE, Morin, PD Constable, HF Troutt, AL Johnson (2002). Surgery, anesthesia, and restraint skills expected of entry-level veterinarians in bovine practice JAVMA 221(7):969-974.
  • combined list (both Morin papers) pdf  xls
• Practitioner Competency Input (2008) - pdf (long)

Obtain experience outside of school:

• Identify progressive practitioners doing what you think you want to do and go see how they do it. Arrange to spend at least a few days, preferably a week or so, with each one during your school vacations. In several days of riding, you can see how they interact with clients, what their practice philosophy is and you can seek their advice on how one prepares themselves for that type of practice. Rather than concentrating on one region or one practice, I recommend going to different areas to see different ways of doing things, both on the veterinarians' and the producers' sides. To find these people, ask around. For example, ask the technical service veterinarians who come to your school; they make it their business to know the practitioners in an area. Ask the veterinarians you ride with to identify other leading veterinarians doing what they do. Identify the area practitioners who have participated in a certificate program, such as those offered by California, GPVEC, Guelph or Pennsylvania. The business buzzword for all of this is "networking".
• Seek out veterinarians who are successfully managing large, modern livestock operations. These individuals have the unique perspective of both knowing what training you are obtaining as a veterinary student and knowing the actual day-to-day production aspects of the industry very well. If it can be arranged, spend some time with them on their operation. Michigan State University is offering a "Large Dairy Herd Internship" based on such dairies. Large intensive livestock operations such as large dairies or feedlots are very complex operations with huge investments in facilities, equipment, feed and livestock and with employees having specialized tasks that have to be done repeatedly and well with consistency.
• Through veterinarians and other allied industry personnel, identify progressive operations and contact the manager to ask if you could spend some time on the operation to see how it works and shadowing key personnel as they carry out their jobs. If you have not, spend one summer working with the labor on a large-scale operation in the area of your interest, such as a 2,000+ lactating cow dairy or a 10,000+ head feedlot, preferably with a veterinarian familiar with the herd acting as a mentor
• Join the professional organizations (AVC, AABP and AASP) as a student member and attend their annual meetings; the dues are essentially the cost of postage to mail you their meeting proceedings and other materials
• A special source of ideas are the "Practitioners of the Year" or their equivalent that are selected annually by the practitioner organizations such as AVC, AABP and AASP. These individuals are usually quite active in and knowledgeable of the profession, are progressive and innovative, are highly respected and well known by their peers, and are intensely scrutinized by an award selection committee after their nomination. To see the AABP awardees, on the AABP website left menu click "About AABP" then "AABP Grants/Awards", "View awards and past recipients" and then click on the individual awards for a complete list of the recipients.

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Dr. Leman grew up on his family's swine operation in Illinois, obtained his DVM from the University of Illinois in 1968 and later a PhD. After 6 years as a swine extension veterinarian at the University of Illinois, he joined the University of Minnesota in 1975 and rose to full professor of swine medicine and first director of the very successful University of Minnesota Swine Center. During this period, he mentored many graduate students, was editor of several editions of the text "Diseases of Swine", was president of the American Association of Swine Practitioners, was a member of the Board of Directors of the Society for Theriogenology and received numerous leadership and research awards. In 1987 he left the University of Minnesota to become a partner in Swine Graphics, Webster City, Iowa, and to expand his own swine operation, which became one of the dozen largest in the United States at that time. Cut down in his prime, he died in his late forties of heart disease while attending an international meeting on swine in 1992.

Leman, AD (1988). Diagnosis and treatment of food animal educational diseases. JAVMA 193:1066-1068. (bolding mine)

From his perspective as a former academician, a swine clinician and a swine producer, Dr. Leman addressed what he perceived as the gap between the training that veterinary schools were delivering to veterinary students and what he perceived as the needs of the agricultural animal industries. Although written over a decade ago, this paper is still pertinent and thought provoking. I encourage you to read the full version; the following are edited excerpts:

• The shortage of food animal veterinarians well equipped to provide profitable services to livestock farms will grow because of the dearth of adequately prepared new graduates.
• The "cult of coverage" in veterinary schools . . . results in graduates who are "one mile wide and one inch deep"; unfortunately the food animal clientele wants depth and often fails to find it.
• Veterinary education and diagnostic services are largely directed at the pursuit of the germ. . . The reality is that germs have little primary importance in livestock production. With few exceptions, germs are opportunistic and cause secondary problems. . . . our graduates are not prepared to search for noninfectious risk factors that cause suboptimal production and trigger infectious disease.
• The greatest single challenge is the need to daily question personal beliefs and assumptions about causal relationships. Because we are heavily steeped in the germ theory of disease, we almost always say the the presence of a germ is the cause of the other event. As a group, we need to exercise far more critical thinking when establishing causation.
• In mature industries like food animal production, to survive production units must produce food at less than average cost of production for the industry because in a mature industry, the average supplier will enjoy little or no profit. Profitable producers will be those with the lowest costs. Therefore, the essential veterinary question, which the veterinarian must seek the knowledge to answer, becomes "What can I do to lower clients' cost of production?"
  • Does adding more biologic or therapeutic products reduce production costs?
  • Does adding ingredients or nutrients to the rations decrease production costs?
  • Does adding more or better labor reduce production costs?
  • Does remodeling farm buildings reduce production costs?
  • Does adding a better information system reduce production costs?
  • Does using more expensive breeding stock lower production costs?
• Veterinary practice is largely a matter of information technology. Information and its management are revolutionizing food animal production and, thus, food animal practice.
• Veterinary students . . . lack experience in the art and science of debate and objective scientific interchange.
• Veterinary schools . . . fail to produce graduates who search eagerly and effectively for new information. This search may involve the library; it most certainly involves using the scientific method and the quest for farm-specific answers to production problems.
• Veterinary students must be capable of managing and interpreting information from simple field trials. They must become critical readers of the research reports of others.
• The curriculum should:
  • Emphasize health and production, not disease.
  • Teach information systems and management.
  • Offer training in farm management economics and risk assessment.
  • Nurture and reward reliability, thoroughness, efficiency, critical thinking and creativity. Do not reward memorization.
• Specific techniques for self-directed learning:
  • Veterinary support groups: With a group of 10 or fewer peers, host a meeting on a rotating basis, visiting a farm served by the host practitioner and candidly assess the farm productivity and services provided by the practitioner.
  • Organize producer support groups.
  • Establish training programs for hired managers.
  • Join the information age.
  • Rank your clients' farms. Meaningful rankings are powerful motivators for change.
  • Buy a livestock farm.
  • Concentrate on reducing farm costs. Partial budgeting, cash flow analysis and other economic tools are useful in making these judgments.
  • Broaden disease control options beyond nutritional, biological and pharmaceutical products.
  • Become a systems analyst:
    • What are the factors that limit maximal productivity of this farm?
    • Which of these factors can be most easily changed?
    • Which of these factors respond most quickly to change?
  • Develop the courage to say "The best action in this case is to take no action."
  • Become an advocate of animal welfare.
  • Develop paramedical skills:
    • Read widely outside the field of veterinary medicine.
    • Study literature on farm management and risk assessment.
    • Learn partial budgeting and cash flow analysis.
    • Learn how to manage people effectively.
    • Take business courses.

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Successful agricultural animal veterinarians' style of practice range from the traditional called as-needed individual animal approach only to regularly scheduled reproductive program visits to strictly consulting only. Across clients, individual veterinarian's style may cover the full spectrum with a different mix for each farm. How a practitioner balances this spectrum depends upon their interests, skills and opportunities. I've witnessed situations on large farms where one veterinarian did only the sick cow work, another did the regularly scheduled reproductive work and another did only monthly consulting with the herdsman. None of the three were in the same practice.

In the overall mix, the traditional individual animal work appears be declining and the herd production medicine work increasing, at least in the western dairy areas. Evidence of this shift is the following. Some large dairy practices that used to start new graduates on sick cow work with the intent that these individuals pick up regularly scheduled herd work as they became more confident of their skills and became established in the dairy community and the regular herd work became available no longer have sufficient sick cow work to justify this approach. Several reasons may account for this shift. As enterprises get larger, they can afford to hire and train employees to specialize in the routine tasks that used to be done by veterinarians, such as routine rectal palpation for pregnancy, displaced abomasum treatments and difficult calvings. With enough animals present, these employees do enough volume of work to become proficient at this skill and do it for a lower cost than the veterinarian. Veterinarians can have a role in training, monitoring and motivating these employees, a role that initially developed in the feedlot industry. In larger herds with sufficient replacements, it appears that the decision may be more likely to cull an animal than to attempt treatment. Finally, with better understanding of the relationship between animal management and subsequent disease problems, the herd production medicine approach reduces the proportion of clinically affected animals in a herd. On the other hand, the problems that used to be sufficiently infrequent on smaller dairies that little progress could be made in understanding and thus preventing the problem now become economically significant as dairies increase in size and producers want them solved.

For a description of the history of the transition from reproductive herd health to herd production medicine, see Noordhuizen, JPTM (2001). Changes in the veterinary management of dairy cattle: threats or opportunities? Veterinary Sciences Tomorrow, Issue 2 May 2001.

This transition to herd production medicine is not easy for the veterinarian, particularly the new graduate. Many clients still perceive the veterinarian's package of services as falling more toward the traditional. Outcomes from traditional services are much easier for the client to judge (Did the cow recover or not?) than are herd production medicine services. Historically, veterinarians have charged piece rates for delivered "hands-on" services and recovered part of their compensation through markups on drugs sold. Moving to charge for "knowledge work" rather than hands-on skill work is difficult, particularly when the "knowledge work" of others appears to be free or low cost. For example, some nutritionists appear to charge low monthly consulting fees but recover most of their compensation by selling a ration component, such as a mineral mix, through the feed mill mixing the herd's ration where its cost is hidden in the mill's monthly feed bill. The feed mill is happy with this relationship because it helps secure the herd as a customer.

There will always be small enterprises that require traditional individual animal services at a higher rate per cow than larger farms. In some regions, cultural and religious practices lead to the maintenance of small herds that are not subject to the economic pressures or tax benefits that drive other enterprises to increase in size. For example, a significant proportion of beef herds are established because of the rural lifestyle a "ranch" affords and off-ranch income supports the "hobby farm". Some families make the decision not to expand, knowing that the farm will cease to exist as an enterprise when the current operators retire and the children have left the farm for other occupations. Often, this trajectory is the consequence of a decision made decades earlier not to undertake the risk of investment in expansion. This decision is often made unwittingly at the time and the consequences are not recognized until years later after the relentless march of a commodity industry down the long run cost curve, mentioned by Dr. Leman in his paper, renders the physical plant of that farm virtually worthless for sale for further use in that industry. In the meantime, these farms are often consumers of traditional veterinary services at a higher rate per cow than larger farms.

Some thoughts on related issues and trends:

• Agricultural Animal Opportunities (VM 394 - ppt pdf)
• The Perfect Storm? (BCVMA, 1/09 - ppt pdf)

Radostits, OM, ed. (2001). Herd Health: Food Animal Production Medicine 3^rd ed. WB Saunders, 884 pp. ISBN: 0721676944. This book is on reserve in the Vet Med Library (SF745 .R33 2001) Amazon

The best core book on the principles of production medicine for the major ag animal species. I recommend that students interested in production medicine buy a copy of this book first and read it from cover to cover. As this edition has chapters by authors different than the 2^nd ed., those same chapters in the prior edition may be worth reading for a different perspective.

Brand, A, JPTM Noordhuzien, YH Schukken, eds. (1996). Herd Health and Production Management in Dairy Practice. Wageningen Pers. ISBN 90-74134-34-3 366 pp. pprbk. This book is on reserve in the Vet Med Library (SF239 .B73x 1996 ) Amazon

Written by 30 authors, including 10 from the US, this is an excellent book for people whose interest is limited to dairy.

Chenoweth, PJ, MW Sanderson, eds. (2005). Beef Practice: Cow-calf Production Medicine, Blackwell Publ. Amazon

Written by 11 authors, this text is an outgrowth of the Great Plains Veterinary Education Center's Beef Cattle Production Management Certificate Program. This is an excellent text for people whose interest is limited to beef cow-calf.

Gardner, CE, ed. (1989). Dairy Practice Management. The Veterinary Clinics of North America: Food Animal Practice 5(3) Nov 1989. WB Saunders. (Vet Med Reserve)

Although dated, this issue contains several chapters relevant to dairy production medicine. Most of the chapters were written by well known dairy practitioners practicing dairy production medicine in the east and mid-west. Example chapters:

• Herrick, JB. Marketing dairy practice. 457-469.
• Nelson, AJ, HW Redlus. The key role of records in a production medicine practice. 517-552.
• Nordlund, KV. Developing the production medicine practice. 501-515.

Noordhuizen, JPTM (2001). Changes in the veterinary management of dairy cattle: threats or opportunities? Veterinary Sciences Tomorrow, Issue 2 May 2001.

Stokka, GL, ed. (1998). Feedlot Medicine and Management. The Veterinary Clinics of North America: Food Animal Practice 14(2) July 1998. WB Saunders. (Vet Med Reserve)

• Lechtenberg, KF, RA Smith, GL Stokka. Feedlot health and management. 177-197.

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