When Linwood based veterinarian Ken Metzger stood before a College of Veterinarians of Ontario hearing last December, police officers were on hand to control the overflow crowd crammed into the court room at the college's Guelph office. Spectators, including 130 Amish and Mennonites, who came by bus, took shifts so all could have a peek at the proceedings. The 34-year-old Metzger had developed quite a following since he set up practice in 1991. Working with three other vets, Metzger Veterinarian Services built a client list of 1,700 spread across eight counties. Clients ranged from large-scale dairy farms to purebred swine breeders to Mennonites running mixed farms.
How did Metzger get so big, so fast? He's been credited with introducing competition to the marketplace and cutting the price of drugs and vaccines. But he also broke the rules. A month after the throng turned out to hear Metzger's defence, he pleaded guilty to four charges brought against him by the college, his professional governing body. The charges included failure to maintain adequate records, and failure to develop a proper veterinarian-client-patient relationship before selling prescription drugs to animal owners.
For his efforts, Metzger received six months' probation and up to a year's suspension. For now, he continues to work under the watchful eye of a senior veterinarian chosen by the college. Metzger pays his costs.
Several of Metzger's clients contacted by Farm & Country praised him for top-quality, cost-efficient service that meets farmers' changing needs. Whether vets such as Metzger will be able to meet those needs will be dealt with in a coming task force review of
 | Popular Waterloo region veterinarian Ken Metzger shook up the establishment, and now his colleagues are looking at longterm solution |
But the Metzger case has both farmers and vets talking about the future roles vets should play on Ontario livestock farms. Farmers say they don't need to call a vet every time they need to give a needle. On that much, vets and farmers agree. But when it comes to prescription medicines, there is less agreement. Many large animal vets say they can't survive without prescription dollars, while others say the future is in consulting and herd management. Farmers who want the service at the best price, including drugs, anxiously await the solution.
Dr. Harvey Grenn, who served as college registrar from 1982 to 1990, says there is often a conflict of interest in any self-regulated profession.
"A lawyer will tell you that it is a conflict of interest to prescribe a drug and sell it for profit," Grenn says. But there is no way a vet would go to a farm to see a sick animal, and write a prescription to the farmer who would have to drive into town and get it from the pharmacy, he says. "The pharmacies would like it."
Quebec has dealt with the problem and both farmers and vets appear satisfied. In that province, a crown corporation has been set up, creating a central warehouse that distributes drugs at a fixed markup. All farmers must get drugs from a vet, who receives a supply from the warehouse, thus eliminating the need for livestock medicine outlets.
In Quebec, Grenn says, vets sought input from consumer groups, which were concerned about food safety and drug residues. "It is seen as a better system than what is prevailing in Ontario," he says.
But what would happen to the 800 licensed livestock medicine outlets in Ontario? They can sell drugs directly to farmers, and there is no vet needed to give advice or guidance. The drug is merely sold over the counter.
What made Metzger's approach to drug dispensing so attractive was price and service, says Listowel dairy farmer Nick Terpstra. Metzger was familiar with Terpstra's animals; he could place an order with Metzger before 10:00 a.m. and was assured that the prescription would be delivered before 5:00 p.m. the same day. Terpstra says Metzger's large client base allowed the vet to make volume purchases and sell at 20 per cent below the cost of medicine outlets.
But the fact that Metzger didn't have a proper veterinarian-client-patient relationship with all his clients led to his suspension. "He was selling to people he didn't know," Terpstra says.
Vets compete with livestock medicine outlets. They also compete with "reasonably knowledgeable farmers," Grenn says. Grenn says it's obvious that the Metzger case signifies that farmers are knowledgeable in many veterinarian practices and are telling the veterinarian community that they know what they're doing and will call the vet when necessary.
Grenn says the problem with the Code of Veterinary Practice, which all vets must adhere to, is that it was adapted from human medicine. Under the code, vets, like physicians, must know their patients before dispensing drugs. He says it works with pets or so-called "companion animals", but it's difficult to make it work with farm animals. "I don't think the rule is practical for reality in this day and age," he says.
Grenn admits that a change to a Quebec-type system would mean the death of medicine outlets. "The outlets would likely lobby like hell the other way."
A report produced in the late 1970s for then-Agriculture Minister Bill Stewart was supposed to have been the basis for a new animal health delivery system, but after Stewart was replaced by Bill Newman, the report gathered dust.
"I hope the college is serious about this [review]," Grenn says. "They don't have to start from square one, in my view....Just look at Quebec."
Arkona purebred Yorkshire breeder Doug Nethercott says he hopes veterinarians quickly sort out the mess because farmers have to get on with business.
"Vets have to realize we [farmers] can't be paying for the politics," Nethercott says. He feels the college of veterinarians, like farmers, has to take a leap in to the future. "When a guy like Metzger comes along and does something different, they don't like it....As much as there is a need for guidelines, they [Metzger] weren't doing anything wrong....They are offering a great service."
Service is the name of the game, but large animal vets can't survive unless they can sell drugs, says Cambridge veterinarian Tom Wheal. "I can't bill enough referral time into my day to bother being a veterinarian," says Wheal, who recently went out on his own to deal strictly with dairy cattle.
"If I don't have some pharmaceutical sales, I don't make enough professionally to be bothered."
The fact is, Wheal says, a small animal practitioner makes two to three times as much as a food animal vet. He says his income on his tax return for 1995 was less than his income in 1985. "A beef vet now without the pharmaceutical sales is up the creek," Wheal says.
Wheal admits that the average farmer is capable of doing many chores that were the sole domain of vets 10 years ago. The dairy industry is changing rapidly, and it's all for the advancement of farming, he says.
"The average producer is well educated and almost capable of doing anything....Part of it is good management of genetics. The AI industry has done a great job cutting down calving problems," he says.
"Hats off to the industry for growing heifers" bigger so they don't have the calving problems, he says. Nor is there the milk fever, calving, or the ketosis digestion problems of a decade or even five years ago. "All these things that were fillers in the day for me are now gone."
| Guelph veterinarian and professor Ken Leslie, shown consulting with Ponsonby research dairy herd manager Dennis Little, thinks this scene will become more common- place, as vets exchange their stethoscopes for clipboards |  |
But Wheal can't get by without drug sales. He says the number of dairy farmers in the province, estimated at 8,000, will likely shrink to 6,000 by 2000. That means demand for vets will decline, but it won't change how they make their money. "I would have to close up shop tomorrow if I didn't have pharmaceutical sales."
Without drug sales, vets would be forced to increase service fees, says Ripley-Huron Veterinary Clinic's Ken Bridge. He was scheduled to testify as an expert witness on Metzger's behalf at the college hearing before Metzger pleaded guilty. His partner, Alec Martin, will act as chairman of the task force on drug dispensing.
Bridge says a lot of farmers would balk at increased service fees. "It's tough enough getting vets to have a go at large animal practice without hamstringing them."
Bridge doesn't deny that there's money to be made selling pharmaceuticals, but the debate is whether this should continue. "I can work [within the system] as it is now," but it's the veterinarian-client-patient relationship that throws the tilt into the playing field, he says.
"We need a definition of who can sell what drugs to whom. When it's clear in everyone's mind, we can go forward," Bridge says.
Alec Martin says the task force will give all interested parties an opportunity to state their case and will be seeking unanimous support for any recommendations submitted to the CVO and the Ontario agriculture ministry.
Ken Leslie, a practising vet and professor of population medicine at the Ontario Veterinary College, says the troubleshooting, drug dissemination role of vets will diminish in the future, and the overall consultant, management-type role will increase as livestock farming evolves.
He cites U.S. models in New Mexico and California, whereby vets evaluate "protocols", and says it will come to Ontario, as herd sizes grow.
He says there's money to be made, and the vets who own their own businesses, and are into the herd management area, can make as much as companion animal vets.
When posing for cover shots for Farm & Country, Leslie drove home the point by saying he'd rather be photographed with a clipboard than a stethoscope.
"Dispensing for the most part becomes part of a herd program... whether it's anti-microbials to put in a footbath for foot disease, or whether it's dry cow treatment," Leslie says.
"This type of activity will grow. The dealing with the individual animal will more and more, in my opinion, fall under the terms of a protocol....This is happening in Ontario."
Leslie knows a vet in Albuquerque, New Mexico, who is involved in a 4,000-cow operation. "He runs that herd on the basis of protocol....When certain cardinal signs occur, such as for clinical mastitis, the protocol is reviewed."
In this operation, the veterinarian spends more time "looking at the incidence rates of cases that are falling into that protocol...and also the effects of the therapy from the protocol."
But will vets be poorer if they're not treating individual cows?
"It's not going to be money out of our pockets because, as this happens, there will be an evolution to the fact that people will come to pay for the process of evaluating and making protocols.
"A food animal practitioner that has adopted this approach and has a good client base and is good at it, can have close to the lifestyle of a companion animal practitioner, and can make as much or more money. It all boils down to ownership. It's the owners of the practices that make the money."
(With files from John Muggeridge)