What is veterinary production medicine?

DC Blood (1985)

Dr. Blood, originally at the University of Guelph and later Dean of the School Veterinary Science at the University of Melbourne, was one of if not the primary originators of the concept of the herd approach and production medicine. In a conference held in honor of his retirement, it was stated that "he has provided leadership to the scientific and farming community by expounding the concept that sub-clinical disease was of greater economic importance than clinical disease and that major financial gains for the farmer could accrue through planned animal health and production programs which identify and limit the effect of subclinical disease in livestock." (KL Hughes, ed. (1985). Proc First Intl Conf Vet Prev Med Anim Prod, Univ Melbourne, Melbourne, AU, Nov 25-29, 1985. Aust Vet J). He was the lead author of the first editions of Veterinary Medicine, a textbook for large animal medicine, and of Herd Health, a textbook of production medicine, and others.

• The serious deficiency in (the traditional) approach of disease management as the sole contribution of veterinary science to animal agriculture is that it fails to recognize adequately the strong relationship between disease management and production management, especially the effects of disease on management programs and the contribution to disease that particular production management programs can make.
• The principal objective of (production medicine) programs is the reduction of wastage due to diseases which have management errors as major components of their cause.
• The secondary objective of production medicine programs is the reduction of wastage due to failure to attain optimum production, optimum in the sense of being most cost-effective.
• The principal thrust of any attempt to promote production medicine programs must be to change the behavior of farmers; change behavior in the sense of having him/her actually modify his/her management practices rather than simply become aware of the need to change them.

Over-riding all of these complexities is the need to consider the cost-benefit relationships at all levels of interaction.

The only worthwhile advice is that based on profitability.

Preferred terminology: Animal Health and Production Management

A Brand, C Guard (1996) (Herd Health and Production Management in Dairy Practice)

The complex of integrated veterinary and animal husbandry activities, centered around regularly planned farm visits, and based on a protocol approach.

• This role is in addition to and not a substitute for traditional practice activities.
• Instead of being focused solely on the clinically diseased animal, the comprehensive concern is for the herd and the entire farm enterprise.
• Requires broadening beyond the traditional boundaries of thought and practice.

The primary objectives of herd health and production management services are aimed at the optimization of:

• The health status of the herd by prevention of health, reproductive, and production problems.
• The productivity of the herd by improving management practices.
• The production process in relation to animal welfare and ecological quality of the environment.
• The quality and safety of dairy and meat products.
• The profitability of the dairy enterprise, either by increasing farm income or reducing costs.

Preferred terminology: Herd health and production management

RA Curtis (1985)

(Production medicine) is concerned with determining the distribution and causes of the status of health in animal in animal populations, and with the development, implementation and evaluation of programs for the purpose of maintaining health and for optimizing production and quality of products under humane circumstances.

To be able to offer (production medicine) programs to their clients, by graduation we want our graduates (of a residency program, I presume) to be able to do the following:

• Clearly outline priorities and objectives for the farm
• Draw up targets of production and action plans to achieve them
• Predict the effect of a suggested course of action in both physical and financial terms
• Monitor the effects of these plans and assess progress
• Investigate shortcomings in performance compared with planned objectives.

Preferred terminology: Health management

T Fuhrman (1993 Western Large Herd Management Conference)

Production Medicine in Large Dairy Herds (pdf - edited below)

"Dairymen are in business for profit. So are veterinarians. When dairymen and veterinarians work together to manage animal production for profit, their mutually beneficial working relationship is called production medicine."

• Production medicine is an outgrowth of preventative medicine but is not the same.
• Preventive medicine is characterized by reproductive programs in which veterinarians routinely palpate cows for two purposes: 1) to identify postpartum uterine infection and treat it; 2) to verify pregnancy after insemination.
• The production medicine approach toward reproduction has the objective of developing the most profitable means for providing future replacement animals for the dairy herd while maximizing milk production for profitability now.
  • The veterinarian still palpates fresh and bred cows, but does so to monitor people and animal performance rather than identifying which animals require treatment.
  • Monitoring assures that fresh cow care, heat detection, breeding, dry cow nutrition and fresh cow feeding are done correctly to maximize herd reproduction.
  • Reproductive records are also analyzed to assess the fertility status of the herd as a unit and to track the status of individual cows.
  • Programs and staff performance are modified when results dont meet targeted goals.
• Production medicine is comprehensive herd health integrating all areas of health and productivity on the dairy farm, focusing on whole herd profitability by maximizing outputs from efficient inputs.
  • Outputs are the expression of each animal's genetic potential. For lactating cows, this is pounds of milk, butterfat and protein per day of lactation. For calves, rate of gain, livability and disease resistance. For growing heifers, height and weight growth rates.
  • Inputs are the resources provided for animals to enable them to produce including facilities, equipment and feed.
  • Inputs are almost always controlled by people; their stockmanship is a critical input which may either limit or magnify each animals' productivity,
  • Management causes problems by failing to establish clear requirements and perpetuates those problems by not setting and maintaining a clear performance standards
• In production medicine, the veterinarian assists the owner/manager in determining the most profitable (not necessarily the greatest) animal output from the correct and most efficient use of resource inputs by:
  1. Organizing a management scheme
  2. Establishing performance goals for each subunit of the dairy
  3. Providing farm staff with programs and resources to achieve the goals
  4. Monitoring animal and people performance
  5. Responding to performance assessments appropriately

CE Gardner (dairy practitioner; column in April, 1996 DVM News Magazine FA section)

Quoting (bolding and italics mine):

My best client does almost all of his own palpations, toggles his own displacements and treats 98 percent of his sick animals without any professional intervention. So what do I do for this particular client to earn my fee when he has decided he doesn't need me or other practitioners for the routine services? The following is a list of what he and I agreed summarizes my role on his farm:

• Monitor and review herd performance
• Help determine changes needed to correct deficiencies found above 
• Provide input on job descriptions, goal setting and labor management 
• Provide traditional veterinary services as needed 
• Be a source of new ideas 
• Provide input on financial planning and debt management 
• Prescribe and supervise use of prescription drugs

... I spoke on practice management at a state veterinary association meeting. Afterwards, a young man approached and identified himself as a veterinary student. He stated that he had managed a dairy farm for five years and decided to attend veterinary school in part because he was frustrated with the level of service he received from veterinarians. "All they had to do was treat. They never spoke of prevention, or tried to teach us better methods of management. My nutritionist taught us a whole lot more about disease control and good management than the vets ever did."

Our background in veterinary medicine gives us some of the skills we need, but we must continue to learn new ones. We must change our approach to how we serve clients. Future opportunities will likely involve more time teaching and less time doing. I truly believe we have a bright future, if we can set aside old paradigms and approach each farm by creatively asking, "What can I do to help this client in a valuable manner?"

CE Gardner (column in January, 2003 DVM NewsMagazine)

. . . . production medicine services are those that impact herd management vs. individual animal management. In general, reproductive exams are not production medicine, as the results of a palpation usually impact that cow, but not overall management. The same principle applies to sick animals, surgeries, dehorning, etc. By contrast, record review, discussions of timed insemination programs, ration balancing, milking equipment evaluation and housing discussions impact the entire herd, and fall under production medicine.

CE Gardner (column in February, 2004 DVM NewsMagazine)

The trend to larger, more efficient farms continues its relentless march. This trend represents both a threat and an opportunity to dairy practitioners. Whether it is the former or the latter depends mainly on our willingness to change.

Winds of Change: All dairy farms have needs which veterinarians are uniquely suited to meet. In some cases our training and experience make it easy for us to meet those needs. In other cases, we must add to our existing knowledge, but we are still the best candidates. The key to remaining involved with today's dairy client is to recognize his or her unmet needs, and do what is needed to meet them. In most cases, this requires changing from "hands-on" mode to teaching, evaluating, reporting and communicating.

Herd 1 . . .  has learned to perform traditional veterinary service internally . . . they are very interested in outside input on herd management. At this time, no private veterinarian is offering that type of service to them. So, the net result is that our profession is losing them, as they pass private practitioners by in terms of having their needs met. 

Herd 2 . . . had a training session scheduled with their veterinarian, where he would be teaching protocols for treating clinical mastitis. . . . they depended heavily on this doctor to work with them on management, even as they used him less and less to do routine procedures. Clearly, this practitioner has learned how to meet the needs of a farm that will be part of the dairy industry for a long time.

Herd 3 . . . a key member of his management team was his veterinarian, and that his veterinarian did his ration balancing. . . they still used their veterinarian to do reproductive exams and to perform surgery. This doctor was successfully serving them in both traditional and production medicine roles. In other words, he was meeting their needs on several fronts, and in doing so ensured himself a role on the farm and revenue from the farm.

No two herds are alike, and there is no one set of veterinary services that will meet the needs of all dairy producers. The challenge and opportunity that faces every practitioner is to identify each clients needs, and then to be proactive in meeting those needs. There is plenty of opportunity to survive and grow if we take that approach.

CE Gardner (Cargill Animal Health, practice consultant, column in February, 2006 DVM NewsMagazine)

    Teacher or technician: exploring the DVM's changing role (edited, bolding and italics mine):

• As herds get larger, lay staff carry out many of the duties performed by veterinarians. Many farms now do their own pregnancy exams, with or without ultrasound.
• Like it or not, lay people can learn to competently perform many routine tasks that once were our responsibility. The veterinary role has changed. We are the teacher instead of the doer when our clients perceive an advantage to performing procedures internally.
• Communication is important to attaining a positive outcome, and I suggest being pro-active. Ask clients if they have interest in doing more procedures that you currently perform. Most will decline, believing they are stretched too thin already but they will appreciate you for asking.
• For the few clients who are interested, have a more extended discussion sharing the pros and cons of paying you to perform the procedures versus farm staff doing them. Recommend the best choice for their operation, but let them know you will support whatever decision they make.
  • With this last group, you are now the teacher. Schedule a time to meet with the relevant staff, and review how to accurately diagnose the condition, teach what complications need to be considered and when the procedure is not indicated. Finally, review the actual procedure, stressing the do's and don'ts.
• This places you in the role of an ally who is trying to help them succeed rather than a disapproving authority figure from who they must keep secrets. Which role is more appealing to you?
• Once a client decides to perform procedures, there are at least three possibilities:
  • The role simply diminishes.
  • More commonly, clients become frustrated with their performance and turn the job back over to you. The client has new respect for your abilities, enhancing your position of importance to the operation.
  • The most satisfying outcome is spending just as much time with the client and earning as much or more income, but spending time in a consulting role rather than a technician role. Hours previously devoted to palpating cows are now spent reviewing records, rations and protocols. Staff meetings or training sessions are on the agenda instead of three displacements. This outcome represents the true win-win scenario we should seek.
• The real key to a secure future with all of your clients is to know their needs, but more importantly, know their wants. They will make decisions based on what they want. They might want to avoid writing you a check for repairing displacements, or they might want to see their calves dehorned at an early age. They might have to rationalize to convince themselves that their wants are truly needs.
• Our challenge is to learn what they really want, and then be the resource that fulfills it.

CE Gardner (column in January, 2007 DVM NewsMagazine)

. . . technology decreases the producer's dependence on veterinarians. This continues a long-standing trend that began with lay sales of animal health products many years ago. Larger herds have typically been better positioned to replace veterinarians with lay staff . . .. In any case, the dairy practitioner continues to face challenges as he or she seeks to remain a valuable resource to clients.

I believe the best response is to serve the best interests of your producers. If using blood testing to identify open cows will help your clients, then you should be the one who tells them about it. Keep yourself in the loop. Tell them the pros and cons, and let them make the decision.

. . . there is a world of opportunity for private practitioners to be more proactive in herd management consulting. This is often referred to as production medicine. . . . review herd records and discuss herd performance . . .. be involved in the nutrition program . . . look at the rations, look at the feed in the bunk, evaluate manure, cud chewing, body condition, bunk space, . . .  help your client assess udder health, herd fertility, transition cows, calf health, heifer growth, ventilation, stall comfort and vaccination programs. . . make suggestions that improve performance or reduce costs and have a positive impact on the bottom line.

Sell yourself. Will all of this be easy? No. The best way to begin is to work on your listening skills. Learn to find out what things are of concern to your clients. Then position yourself as the best source of solutions.

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

What I've 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 aren't 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.

WM Guterbock (2010) (Manager, Columbia River Dairies)

. . . I believe that the sustainable model is the full service practitioner who knows the client and the employees, knows local conditions, and lives close so s/he can drop in and check on how things are going and fine tune the program. This means that the practitioner needs to expand his/her knowledge base beyond what s/he learned in school. S/he needs to understand the industry and the economic constraints faced by the client, understand the production system, understand nutrition, and realize that recommendations ultimately have to pay for themselves in more milk (or beef) or lower costs. Routine work, be it emergencies, preg checking or chute work, gets you on the place so you can observe, builds the client's trust in your abilities, and gives you a chance to talk to the client. But if you give the routine stuff priority and don't take the time to delve into your clients' problems (at first you may have to do this for free!) don't be surprised if all they call you for is the routine stuff. If they are having calf raising problems, you have to make the time to observe what is going on and help them improve. You can't just tell them to send a calf to the dx lab and drive off to your next call. Or use it as an opportunity to sell medicine or vaccines without addressing the real problem. On most big dairies there are huge opportunities in improving the calf program and the diagnosis, treatment, and management of the hospital and fresh cows. But you will have to "give away" part of your knowledge by training the dairy people to do their work better, maybe even teach them the right way to roll and toggle a DA, and you may have to write protocols that seem like you are reducing sick cow work to a formula.

The Wife of Bath, in Chaucer's Canterbury Tales, defended her infidelities by saying that your candle does not have any less light if you allow another to light his candle from it. The same applies to client education. Your knowledge does not lessen if you share it. On the contrary, you only learn something well when you have to teach it, and you only understand a problem when you work at trying to solve it.

. . . many of the visitors seem to have a mental image of the ideal dairy and proceed to ask questions and make recommendations based on the image, rather than on the bottlenecks on my farm.  It is easy to come up with a list of 101 things you need to do to be a great dairyman.  The hard part is prioritizing the list and then helping the client see how the goal can be accomplished.  As producers we get tunnel vision and sometimes think that we are unable to change things until someone shows us the way to do it.  The consultant, to sell the idea, needs experience of past success, understanding of the constraints on the farm, knowledge of the people involved, and the ability to persuade without hurting the producer's pride.

JB Herrick (1989)

Before his retirement, Dr. Herrick spent many years as the beef extension veterinarian for Iowa. He was one of the early promoters of preconditioning programs for beef calves going to feedlots. Dr. Herrick is a tireless advocate of agricultural animal veterinary medicine and has written a great deal on the subject.

The food animal veterinarian must change his image in the mind of the producer from one who diagnoses ailments and offers treatment to one who is an integral part of the overall management program.

A veterinarian's goal is to make his client successful.

"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, UCD-VMTRC)

DF Kelton (2006) Epidemiology: A foundation for dairy production medicine. Vet Clin Food Anim 22(1):21-33.

Dairy production medicine . . . whereby we strive to optimize production through the elimination and control of disease and the implementation of management practices that promote animal health, welfare, productivity, and profitability.

programs . . . include the setting of performance goals, the gathering of data to assess current performance relative to those goals, the development and implementation of actions to move the herd closer to the goals in instances where they are not being met, and the continued assessment of continuously available data to verify that progress is being made.

Dairy production medicine is ultimately concerned with identifying problems or bottlenecks on dairy farms and developing strategies to relieve those bottlenecks.

AJ Nelson (1989) (Dairy production medicine clinician):

An individual with a special interest in dairy cattle management who assimilates and organizes essential dairy management information from several sources and then efficiently and effectively conveys to the owner or herd manager the management performance and its economic implications.

PURR production medicine program (ranked by time to benefit)

• Production management
• Udder health and milk quality
• Reproduction programs
• Replacement management

Without question, the most critical factor to the success of the program is the dairyman. The most sophisticated, technical information in the world, with the most competent veterinarian in charge of the program, will not make one iota of difference in the management performance of a herd if there is not an interested, competent, motivated dairyman to make the necessary management adjustments to effect positive results.

If the client lacks the motivation to alter his or her management habits and procedures, the records information is useless, and program will not succeed. ... Changes in dairy management must be consistent with the owner/manager's self-image or they will not be permanent.

1999 Note: Some have extended PURR to PURRDEA

PURRDEA:

• Production management
• Udder health and milk quality
• Reproduction programs
• Replacement management

KV Nordlund (1989) Food Animal Production Medicine Program, University of Wisconsin

Dr. Nordlund was for many years a dairy practitioner in Minnesota before moving to the faculty of the University of Wisconsin.

Production medicine programs include the following components:

• Production record analysis
• Reproduction management
• Nutrition assistance
• Parasite control
• Animal environment counseling
• Mastitis control
• Vaccination programs
• Genetic selection
• Replacement rearing programs

When judged by their impact upon production, the component programs are seen to be interdependent. This interdependence is the inherent cause of weakness when a single component program is pursued by itself. Yet this same interdependence is the inherent cause of strength of a production medicine program.

... none of (this) is executed by the veterinarian. Success is dependent upon our ability to take complex ideas and make them so clear and compelling that they cannot be ignored by the client.

We become motivators, not doers.

... it is important that everyone who works at the dairy understand it - this includes the lowest paid labor. ... Failure to recognize in each person his potential for good almost guarantees that we will someday acknowledge his potential for harm.

Many of the components of production medicine programs fall outside of state veterinary practice acts, and they may be delivered in competition with other businesses and agencies.

KV Nordlund (1998) (Bovine Practitioner 32:58-62. - full pdf)

What specialized skills and knowledge are required?

Extracted from various sources, the following identify the skills and knowledge beyond the traditional individual animal curriculum that are required for successful veterinary production medicine. Again, note the common themes across authors.

D Bechtol, S Lewis, A Hentschl (Bovine Veterinarian, 10/98) Feedlot Consultants

Participate in continuing education for knowledge and contacts to maintain a cutting edge advantage in the industry. Our feedlot managers are becoming more knowledgeable so they're right behind us in the information. If we left some of these (professional) organizations (e.g., AABP, Academy of Veterinary Consultants) and didn't get the information, our clients could pass us up.

• Understanding the culture of the industry.
• Latest in diagnostics and treatment of disease.
• Understanding of the basics of business practices, accounting, cash flow.
• Understanding cattle industry risk management and economics.
• Computer skills
• Understanding manure management, human resource management, financial evaluations, quality control, farm gate food issues.

DC Blood (1985)

Education for veterinary production medicine:

Epidemiology Nutrition Genetics Breeding Management

Economics Veterinary Information Management Production Monitoring Systems Analysis

A Brand, C Guard (1996) (Herd Health and Production Management in Dairy Practice)

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.

PJ Chenoweth, MW Sanderson (2005) Beef Practice: Cow-Calf Production Medicine

• beef cattle production, management and economic strategies
• nontraditional veterinary areas including:
  • critical thinking
  • business and financial management
  • statistics
  • risk analysis
  • epidemiology
  • applied animal breeding
  • nutrition
  • data management and analysis
  • communication skills

RA Curtis (1985)

• Epidemiology
• Animal production
• Animal nutrition
• Applications of the computer

Although 25% to 30% of the curriculum should be devoted to the health management stream, it is not intended to weaken the foundation on which our profession is built. Our graduates must be able to examine an individual animal, make a diagnosis, institute proper treatment and, if necessary, develop a control program. Veterinarians who do not have this expertise will never gain the confidence of their clients - the confidence so necessary for a sound health management program.

RO Gilbert (1998)

nutrition housing farm economics

industry economics decision analysis product quality assurance

JB Herrick (1989)

... A veterinarian involved in food animal production must learn as much as he possibly can about:

• Production management
• Environmental engineering
• Genetics
• Nutrition
• Business acumen in profitability analysis

This will not be part of a veterinary student's training; it must be acquired after graduation [or before and during - JMG]

The greatest damage to a practitioner's reputation can be caused by making recommendations that are not in concert with those made by resource people in other disciplines. (Nutrition PhD's, dairy scientists, ...)

R Morris (1995) (Prev Vet Med 25:77-92)

Expanding on Herrick's note above:

". . . we still have important educational goals to meet in ensuring that veterinarians understand the epidemiological viewpoint. This is very difficult to achieve with undergraduates, who lack the experience of complex problems which are necessary to appreciate the value of epidemiological methods for solving such problems."

AJ Nelson (1989)

Competence and expertise must be developed in the basic areas of:		Competence and expertise must be   developed in the adjunctive areas of:
Nutrition Mastitis control Reproduction Replacement raising Epidemiology		DHIA record analysis Computer skills People skills Goal setting Psychology Statistics Economics

K Nordlund (1998)  (Bovine Practitioner 32:58-62.)

To serve as a herd management advisor, the veterinarian will need knowledge of:

• dairy record and monitoring systems
• disease management including some statistical and epidemiological analysis techniques
• dairy finance including cost of production determinations and of partial budgeting

WR Pritchard (1989) (JAVMA 195:171-174.)

• Economics of production
• Clinical epidemiology
• Nutrition
• Housing and environmental management
• Reproductive performance
• Control of infectious diseases
• Marketing aspects of the industry

OM Radostits, KE Leslie, J Fetrow (1994) (Herd Health: Food Animal Production Medicine)

Becoming  a species specialist with a comprehensive understanding of the industry is the only hope of mastering the knowledge and skills required to provide a health management service to a livestock producer.  . . . a thorough understanding of a particular livestock species or class of livestock, and the industry with which they work.

• Animal production
• Animal disease
• Production economics
• Systems analysis
• Information management (computer literacy)

Veterinary epidemiology has become a major influence . . . . Epidemiological techniques have become important tools for developing health management programs. The collection and analysis of farm data for the implementation of health plans and actions, as well as the ongoing monitoring of performance outcome, inherently imply the use of these tools by veterinary practitioners. In order to accomplish these activities, the computer has become a major factor in the application of epidemiologic principles to herd problems.

Problem-solving skills are a major asset. Be able to:

1. Identify the problem. (He who identifies a problem usually gets to be first in line to solve it)
2. Access a body of relevant knowledge (personal, fellow professionals, printed, computerized databases).
3. Apply the information to the solution of the problem.
4. Evaluate the response.

DO Rae (1989) (U Florida Beef Clinician) Beef Health Management Prospects for the 1990's

This will require a change in philosophy and education. The beef practitioner will be better trained to meet the needs of the producer. This will include not only surgery and medicine, but also:

health management production nutrition environmental engineering

economics marketing statistics computer literacy epidemiology.

More importantly, the development of sound problem solving skills and client interaction skills

Roger Saltman (2001) Dairy technical services veterinarian

"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.

Bob Smith (2007) Veterinary Research and Consulting Services in July 07 Bovine Veterinarian

. . . management is more valuable than what comes in bottles, so today’s veterinarian must be well-versed in:

We must be good trainers, educators, and motivators so that feedlot employees know their job, and have fire in their belly to ‘get ’er done,’ even when the days are long and the weather severe.” The veterinarian must also know enough about cattle feeding to communicate with the nutritionist, as nutrition and health go hand-in-hand.

Alberta Feedlot Management Guide, 2^nd ed (2000) TOC - People Management - Working with Your Veterinarian

Feedlot production programs, although now prevalent throughout the industry, vary widely in the services delivered and the degree of ongoing veterinary involvement. Areas that may be addressed in a health management program include:

• diagnosis and treatment protocols for sick animals
• vaccination strategies/risk analysis
• post-mortem examinations as part of an ongoing disease surveillance program
• assistance in managing day to day problems (e.g.) unusual medical conditions, minor surgeries
• parasite control programs
• implant programs
• nutritional management
• implementation and monitoring of health and performance records
• employee training and evaluation
• carcass quality issues
• marketing strategies
• animal welfare concerns
• food safety/quality assurance
• in-house research projects

Handouts:

• Evidence (and Opinions) on the Future of Ag Animal Practice (pdf)
• Basis of Marketplace Economics (pdf)
• Ownership Costs and Capital Budgeting (pdf)

Production Medicine vs. Traditional Individual Medicine:

Veterinarian's Role:

• Herd management adviser vs. Hands-on veterinary practitioner (direct application of technical skills)
• Information evaluator (problem solving skills) vs. information applier ("hands-on" skills)

Farm Visit Trigger:

• Regularly scheduled visits by calendar date vs. Call from the producer on as-needed basis ("fire engine")

Usual Primary Focus:

• Health and Production (management) vs. Disease (infectious agents)
• Prevention and Optimization vs. Treatment (Salvage)
• Prevention of potential loss vs. Reduction of impending loss

Unit of Consideration:

• Whole farm system and groups of animals as well as Individual animal system
• "Physical exam" on herd in addition to physical exams on individuals

Detection of Problem and Initiation of Resolution:

• Veterinarian detects suboptimal performance vs. Producer observes clinical case
• Record-based detection of performance problem vs. Visual detection of illness
• Sub-clinical & sub-optimal problems (earlier) vs. Clinical problems (later in disease process)

Disease or Problem Manifestation:

• Spectrum of problem present in group of animals (from performance affected only to clinical) vs. Single cases (usually clinical)
• Problem defined by "barn yard epidemiology" (who, when, where) beyond physical exams of clinically affected individuals

Application of Interventions:

• Producer or their employees implement intervention vs. Veterinarian implements intervention
• Producer or employees trained to treat routine cases (standard protocols) vs. Veterinarian treats the case
• Veterinarian establishes protocols and monitors person performing protocol vs. Veterinarian does it

Evaluation of Outcome:

• Economic performance vs. Health state
• Effects are most often not visibly discernable (e.g. additional 25 lbs. on 950 lbs. animal) vs. Visible difference (healthy vs. sick or dead)

Basis of Comparisons between Normal and Abnormal:

• Herd contemporary (Eliminates biases due to different genetics, environment, management, ...) vs. Literature or historical comparisons
• Performance objective vs. Visible health objective

Quantitative Analysis of Herd Data (Herd Production Accounting Records):

• Use of numbers, rates, time trends, comparison of cohorts vs. Sample of one
• Risk of occurrence (number affected / number at risk)  vs. Number affected (dangling numerator)
• Opportunity for controlled within herd trials for decision making (e.g., best Rx, Px) vs. Only external (outside of herd)  information used for deciding which treatment or preventative to use

Economic Impact of Interventions:

• Potential for great impact (entire group is impacted) vs. Salvage value or reduction of loss from a clinically affected individual animal

Level of Confidence in or Trust of Veterinarian that Producer Requires before Applying Intervention:

• Very high (scope of impact is across herd) vs. Low to moderate (scope of impact is treated individuals)

[Return to Contents List]

Optimize your learning ability and skill development:

• Excelling requires investing considerable time in deliberate practice to develop skills and time on task to develop knowledge. Some 50 hours of deliberate practice are required to develop a skill set, such as rectal palpation for pregnancy or piloting an airplane, to entry level competence.
  • Ericsson, KA (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic Medicine, 79:S70-S81 (pdf - article begins on page 4 of prepublication proof on USC website)
  • Two popular books addressing this are Malcolm Gladwell's Outliers: The story of success (2008) and Geoff Colvin's Talent Is Overrated: What really separates world-class performers from everybody else.
• Increase the power of your thinking process
  • The 5 Elements of Effective Thinking (EB Burger, M Starbird, 2012) - Amazon
  • Smart Thinking: Three essential keys to solve problems, innovate, and get things done (A Markman, 2012) - Amazon
  • Thinking in Systems: A primer (D Meadows, 2008) - Amazon
• Maximize your return on time invested in learning from coursework, particularly in increasing your recall
  • Learning to Learn (Wirth & Perkins, 2009 - doc)
  • Temporal Spacing and Learning (Observer 19(3), H Pashler, D Rohrer, NJ Cepeda)
    • Increasing Retention Without Increasing Study Time (Current Directions in Psychological Science 16(4):183-186 pdf)
    • Pashler video
  • Test-Enhanced Learning in Medical Education (DP Larsen, AC Butler, HL Roediger, Medical Education in-press, pdf of draft)
• Develop the important extra-curricular skills, competencies and literacies.
  • Richard St. John's "8 to be great" keys to success - video list - video
    • 8 Traits - Passion / Work / Focus / Push / Ideas / Improve / Serve / Persist
    • 6 Skills - Creative / Management / Computer / People / Analytical / Technical / Specific career & field skills
  • 10 Things Employers Want You to Learn in College: The know-how you need to succeed, Revised (William D. Coplin, 2003) - Amazon
    • The Ten Skills - pdf
    • author's guide - pdf

If you are not yet admitted to veterinary school:

Acquire general skills and knowledge:

Less than half of the skills and knowledge required for success in most jobs are in the specific academic domain associated with that job, whether accounting for the accountant, veterinary medicine for the veterinarian, engineering for the engineer, or medicine for the physician. Many of these other skills are not part of academic curriculums, require active learning and experience to acquire, and many of these are classified as "soft skills." Evidence of this is that outside of academia and some government positions, few potential employers evaluate transcripts or grade-point averages, relying instead on references, interviews, and internships.

Understand and achieve:
• Communication literacy: Excellent speaking and writing skills are essential for teamwork, reports, educating and motivating farm employees, and communicating with managers.
• Economic literacy: Economic factors drive the trends in input and output prices and consumer and producer decisions. Understanding microeconomics is essential to understanding the consequences of supply and demand of both inputs and outputs.
• Financial literacy: Everyone borrows and invests money; understanding risk and the time value of money are essential to both success and avoiding being defrauded. Much of agriculture involves operating loans and loans for facility investments to improve health and production.
• Information (digital) literacy: (wiki) Obtaining information and converting data to information is critical, particularly managing and analyzing data with spreadsheet software such as Excel, accessing and evaluating the literature, and how to use your own literature database using programs such as Zotero.
• Marketing and salesmanship literacy: Selling is a part of everyone's life, whether selling yourself, your ideas, your services, or a product but few understand salesmanship sufficiently to do it well
• Quantitative literacy: Math is everywhere from determining drug dosages based on metabolic weight to evaluating ration adequacy to comparing performance
• Statistical literacy (wiki): Understanding variation is essential to extracting signals (information) from biological information, for interpreting results of research studies and on-farm trials, and to avoid misleading yourself and your clients.
• Books with general advice for undergraduates (buyer beware; this is not an endorsement):
  • How to Become a Straight-A Student: The Unconventional Strategies Real College Students Use to Score High While Studying Less (Cal Newport, ) - Amazon
  • Major in Success: Make College Easier, Fire Up Your Dreams, and Get a Great Job, 5th ed. (Patrick Combs, 2007) - Amazon

Acquire specific animal industry skills and knowledge:

If you are already in practice:

• Consider the points above and implement those you can.
• If you can step out of practice for several years, consider doing a residency in a strong program that is targeted toward your area of interest. The pay isn't good but if you are a self-directed self-starter you will likely have lots of freedom (and the time) to develop deep expertise in your areas of interest, such as applied ruminant nutrition. For example, the UC Davis VMTRC offers a ABVP board eligible dairy production medicine residency combined with an MPH or MBA.
• If you can't or don't want to step out of practice for a residency, consider the specialized certificate programs offered by several institutions that require attendance for short periods across several years. For dairy, these include the Guelph Dairy Health Management Certificate Program, the UC Davis VMTRC FACEP: Food Animal Continuing Education Program, the Ohio Dairy Health and Management Certificate Program, the Penn State Dairy Production Medicine Certificate Program and for beef the Great Plains Veterinary Educational Center Beef Cattle Production Management Series and the Kansas State Certificate Program in Feedlot Production Management.
• If you don't want to make the time and monetary investment required for the certificate programs, consider taking the pre-convention seminars offered by the AABP. These special seminars on narrow topics are taught by academic and practitioner experts from around the nation and are targeted at practitioners who wish to gain those skills. Many veterinarians practicing bovine production medicine got started in these seminars.
• Consider pursuing American Board of Veterinary Practitioner Certification in your area of interest. Doing the required reading will get you a long ways toward your objective.
  • Beef Cattle
    • Beef Cattle Practice Study Guide/Reading List
  • Dairy Practice
    • Dairy Practice Study Guide/Reading List
  • Swine Health Management
    • Swine Health Management Study Guide/ Reading List
  • Food Animal Practice
    • Food Animal Study Guide/Reading Lists
  • European College of Bovine Health Management
    • recommended readings

Note to Students: The study guide / reading lists provide an excellent guide as to what leading practitioners in those specialty areas consider are the most important sources of information to excel in that area of practice.

• British version: Royal College of Surgeons Certificate in Cattle Health Production (pdf - note that this link moves with the year; old exams are also available on the site)

• Several successful production medicine practitioners have developed private seminars on bovine production medicine.

Dr. Al Leman's perspective (An "out of the box" thinking former academician, swine clinician and large hog producer)

Some considerations:

"Once a new technology rolls over you, if you're not part of the steamroller, you're part of the road."  Stewart Brand

[Return to Contents List]

Selected Production Medicine References:

(A more complete list is in In-Print & On-Line Production Medicine Information Resources)

Having 26 chapters authored by 24 authors, "This comprehensive book integrates new technology and concepts that have been developed in recent years to manage dairy farms in a profitable manner. The approach to the production of livestock and quality milk is multidisciplinary, involving nutrition, reproduction, clinical medicine, genetics, pathology, epidemiology, human resource management and economics. The book is structured by the production cycle of the dairy cow covering critical points in cow management." (publisher's description)