1.1 Challenges Faced in Feline Practice
Every 5 years, the American Veterinary Medical Association conducts a national survey to track trends in pet ownership. In 2012, the number of owned cats exceeded the number of owned dogs in the United States by over four million [1]. Yet despite their growing popularity and the increased perception that cats are members of the family, cats remain underserved when it comes to veterinary care [1–4].
By their own admission, cat-owners are less likely than dog-owners to pursue annual wellness examinations. According to the Bayer Veterinary Care Usage Study, a four-phase analysis of companion animal practice, only 37% of cat-owners over a 12-month period visited a veterinary clinic for routine examination [2]. Indoor-only [2, 5] and aged populations [6] were at increased risk of escaping veterinary medical attention. The former were perceived as being less likely to succumb to illness [2], and the overall value of the veterinary wellness visit was lost on cat-owners, 83% of whom believed their cat to be in “excellent health” [2]. Were it not for vaccinations, many cat-owners would not pursue routine veterinary care at all [6].
The Bayer Veterinary Care Usage Study concluded that cat-owners’ reluctance to seek veterinary medical care is multifactorial [2]. One major driving force is lack of owner education [2, 6]. Many cats are unplanned acquisitions: “I didn’t necessarily find the cat, the cat found me” [2]. As a result, cat-owners may receive limited, if any, initial guidance as to when to pursue veterinary care [2]. By contrast, dog-owners tend to plan the introduction of a new pet into the household and are more likely to seek out instructions on proper care from breeders and shelters.
Many cat-owners are unaware that routine wellness care is essential [7]. Further compounding the issue is that cats effectively mask subtle signs of illness. Cat-owners often find it difficult to determine when their cat is sick [3, 8]. When cat-owners do recognize illness, over one-third of them look to the Internet for veterinary medical advice rather than pursue veterinary medical attention [5, 6].
Of those cat-owners who do perceive value in preventive medicine, the toll that veterinary visits take on the cat and cat-owner alike represents a significant barrier to follow-up care [2]. Cat-owners view the veterinary visit as an ordeal, the stress of which begins well before the client and cat ever set foot in the clinic [2, 6].
Owners must first capture the cat, which is easier said than done. The cat may hightail it at the sight of a cat carrier or aggressively resist being confined to it. As a result, cat-owners look forward to this aspect of the veterinary visit the least [6], yet of those surveyed, only 18% had been instructed by the veterinary team on how to decrease transportation-associated stress [2].
Once confined to the cat carrier, the cat may vocalize for the duration of the journey to and from the clinic. Upon arrival to the clinic, cats become visibly stressed in the waiting room, especially when their space is encroached upon by other patients. When they finally reach the examination room, their tolerance may be sufficiently limited [6].
To summarize their veterinary experience, the Bayer Veterinary Care Usage Study asked 1938 cat-owners to create a collage representing their veterinary experience. The majority of cat-owners used pictures from horror films [2]. Fifty-eight percent of cat-owners described their cats as hating veterinary visits [9].
This perception of the veterinary experience adversely impacts the profession’s ability to attract and retain cat-owners and to provide consistent, high-quality medical care. The veterinary visit is undoubtedly a source of feline stress, the net result of which may be provoked aggression. When cats are fractious, the veterinary team is unable to examine them thoroughly. Feline stress may artificially create abnormal physical examination findings such as tachycardia and tachypnea. The intensity of the stress response may also induce abnormalities in routine screening and other diagnostic tests. Stress hyperglycemia is common, and can be challenging to differentiate from diabetes mellitus without additional testing. If stress is not recognized as the culprit for these abnormalities, the veterinary team may use the test results to support a diagnosis that is inaccurate. This places the patient at increased risk of being subjected to irrelevant or inappropriate treatment plans [10, 11].
Of equal concern is that cats’ behavior in the home appears to be altered for some period of time after the veterinary visit. Cats may become standoffish after visiting the clinic, and this may last for several days [6]. In addition, the residual effect of the veterinary visit may transiently impact inter-cat dynamics in multi-cat households. The hospital-goer is not always welcomed back into the fold with open arms, and inter-cat aggression may ensue.
As a result of the many challenges that cat-owners face when committing to a veterinary visit, most prefer to avoid the clinic altogether [6]. This, combined with feline resistance, represents two significant obstacles to cats receiving veterinary care.
1.2 The Emergence of Feline-Friendly Practice
As a result of feline and owner resistance, cats are a largely untapped resource for the veterinary profession: between 2001 and 2011, annual feline visits decreased by 14% [2].Hence cats represent a rich opportunity area to increase veterinary revenue. Practice management tools may help to capture this underrepresented population through the use of social media and by relying upon business metrics more effectively to identify patients with lapsed appointments [9]. However, without addressing cat-specific issues surrounding the veterinary visit, marketing campaigns focused strictly on data may not be as effective.
The concept of feline-friendly practice emerged from the realization that the burden is on the veterinary profession to adapt to cats, not the other way around. Cats are not small dogs. Cats have different behavioral, physiological, medical, and psychological needs. Furthermore, owners hold different expectations when it comes to their care [6]. The American Association of Feline Practitioners developed the Cat Friendly Practice program to cater to this distinct population of companion animals [12]. Although practitioners are not required to participate, those who do are provided with the tools necessary to adopt a feline-centered practice philosophy [12]. It is hoped that participating institutions will elevate their approach to feline care in order to attract, medically manage, and retain cat-owning clientele.
