Editor's note: First in an ultrasound series
Jill Colloton, DVM, Bovine Servcies, LLC, Edgar, Wis., is turning down potential dairy clients who want ultrasound services almost weekly. Why? Because she is already too busy to meet the demand for ultrasound services by dairy producers in her area.
"The popularity of ultrasound among veterinarians seems to lag behind the demand from producers," Colloton explains. "Producers see the value of early and accurate pregnancy diagnosis, determination of fetal viability, diagnosis of twins and accurate ovarian diagnosis."
Craig DeMuth, DVM, Truxton, N.Y., agrees. "The demand for ultrasound services by producers has, in part, driven the popularity of ultrasound," he says. "Veterinarians have also recognized that ultrasound is a far better diagnostic tool than rectal palpation."
So why haven't more dairy veterinarians embraced this technology? Probably for the same reason many of us don't embrace new technology: They are concerned about the cost of purchasing a unit, and the time it will take to learn how to use it.
Photo Credit: Jill Colloton, DVM
Today's ultrasound units have a host of uses and features that surpass the units of five or 10 years ago. The biggest improvement has been portability. Colloton spent five years with a 22-lb. ultrasound unit on a cart connected to a 20-lb. battery. "Now I have a 7-lb. machine that I can easily wear on my person all day," she says.
The image quality with many of the new portable units is amazing, she adds. Depending on the unit, viewing options may include a screen, a binocular goggle set or various monocular viewing devices. "Some of our bovine veterinary units are better than those in the offices of most primary care physicians," says Colloton.
DeMuth adds that there are good quality units and there are bad quality units on the market today. "One needs to purchase a unit with enough resolution to provide accurate diagnosis," he suggests. "Some of today's bovine units have fewer ‘features" than units manufactured a few years ago."
And for the general bovine practitioner, often simpler is better. You can fetal age, fetal sex, and do many other diagnostics without "pushing a lot of buttons," says DeMuth.
Look at the economics
A very good portable ultrasound machine can be purchased for $9,000-$12,000. "You can pay double this figure, but it may not double your performance in the field," says DeMuth. "You might also pay half this amount, but beware sometimes bargains are not bargains." DeMuth explains that sometimes a "bargain" may display very poor-quality images. "There is no bargain if you cannot see what you need to see."
Colloton, who offers hands-on ultrasound training to veterinarians, recommends that people try several units and select the one they like best, regardless of price. Image quality is the most important criteria. Personal preference for features and viewing options are the second most important. One should also consider the reputation of the manufacturer/distributor and turn-around time for repairs.
A veterinarian needs to calculate how he/she can use ultrasound in practice to make it worthwhile. "Unless a veterinarian doesn't charge a little more for ultrasound or never takes the unit out of the truck it's almost a no-brainer," says Colloton. "Most veterinarians find charging 25% more than regular services is well-accepted by clients because they understand the benefits of more units of information."
Fees for services vary for veterinarians within the bovine industry. "Bovine reproductive ultrasound should be regarded as a very high-quality service when considering compensation for service," says DeMuth.
Calculating the economic return on providing ultrasound services can be difficult to do in some cases. "One must also consider how aggressive he or she will be in committing to learning ultrasound, and in marketing those services to clients," says Brad Stroud, DVM, Stroud Veterinary Embryo Services, Weatherford, Texas. "Also, veterinarians must consider the business they may lose by choosing not to acquire an ultrasound unit."
The Veterinary Economics Summer 2001 special edition had a model to calculate the potential return of any large purchase, and Colloton uses that to create a sample calculation based on her first year of owning an ultrasound unit:
First-year ultrasound use
Hourly fee above regular fee: $25 ($100 regular, $25 more for ultrasound)
Cost of machine: $12,000
Hours used per year:780 (at 15 hour/week)
Revenue per year: $19,500
(hours x hourly fee above regular fee)
Yearly cost of loan: $3,000 (5 years at 8%)
Other operating expenses: $500 (primarily insurance)
Veterinary compensation at 25%: $4875
(assuming someone is hired to perform this service)
Cash flow per year: $11,125
Payback: 1.1 years (amount invested/cash flow)
ROI (cash flow/amount invested): 92%
"If a veterinarian can do better than this in the stock market, then he or she is in the wrong profession," says Colloton.
Training is key
Learning how to competently use an ultrasound unit is crucial to being able to offer services. "Would you buy a car before learning how to drive?" DeMuth asks. "I would hope not. Basic training and proper unit selection can make a huge difference when integrating bovine reproductive ultrasound into a practice. For experienced palpators, mastering ultrasound scanning is not that difficult. However, when you are demonstrating your new purchase to clients, for best results the veterinarian should look adequately skilled in ultrasound."
When Colloton purchased her first ultrasound unit she took a university course. "It was helpful, but there was very little hands-on, personal training," she explains. "Access to a smaller, more practical course would have shortened my learning curve significantly."
As a result, Colloton started teaching ultrasound courses for veterinarians throughout the year through her own practice. "I started my courses because veterinary colleagues wanted to visit my practice to learn how to scan. That was fine, but I charge my clients by the hour, so I couldn't slow down to help a colleague. The solution was to arrange very small, hands-on courses outside of my usual practice."
"Training assistance is essential or the veterinarian will purchase a unit and likely toss it in the corner after becoming humiliated after a few sessions," adds Stroud. "Personally, I had zero help when I learned ultrasonography back in the mid-1980s. Training DVDs and/or wet labs would have saved me literally hundreds of hours, especially on topics like fetal sexing."
If you don't, who will?
Lay people and dairy personnel are starting to take over many of the health tasks on the dairy that veterinarians have traditionally done. Will ultrasound be one of them? In some states this is not a big issue because practice acts prohibit laypersons from providing diagnostic ultrasound unless they own the cows or are W-2 employees of the farm.
In Colloton's practice there are several excellent herdspersons who could certainly learn ultrasound. "However, these people have enough duties already," she says. "For most dairies it's cheaper and more efficient to hire a competent veterinarian for a few hours a week to provide a very high-quality service quickly. Most good producers see the value of ‘face time" with their veterinarian, and reproductive herd checks have traditionally been one of the best venues for that."
"If veterinarians don't step up to the plate and provide ultrasound services for their clients, I have no problem with a layman learning to do ultrasound as long as the person complies with state veterinary practice acts," adds Stroud.
Colloton believes that in states that do allow laypersons to scan, veterinarians need to be proactive by providing the service. "If a producer understands the value of ultrasound and his veterinarian does not provide it, he or she will find another option."
Next: Ultrasound for diagnosing the dead fetus and fetal abnormalities.
For information on hands-on ultrasound courses, contact:
• Craig DeMuth, DVM, at 315-729-2670 or firstname.lastname@example.org .
WHAT CAN YOU USE ULTRASOUND FOR?
Ultrasound isn't just for pregnancy diagnosis anymore. Jill Colloton, DVM, says in the hands of a proficient operator, ultrasound is as fast as palpation per cow, but more units of information are obtained with ultrasound. "Palpation can tell if there are cardinal signs of pregnancy, but ultrasound is far better for assessing pregnancies less than 35 days, fetal viability, twins, uterine pathology and ovarian structures. And, of course, palpation isn't much use for fetal sexing."
Craig DeMuth, DVM, sees the biggest application for ultrasound as maximizing results from timed AI programs. "Accurate earlier open diagnosis and accurate diagnosis of ovarian structures will be keys in timed AI in the future," he says. "You cannot diagnose life by rectal palpation. Some veterinarians are excellent and very rapid at palpation, but a good scanner is as fast if not faster. Ultrasound is more accurate than rectal palpation. I never thought of any bovine reproductive work as easy, but I have to admit some of those ‘very uncooperative" cows are easier to scan than palpate."
Colloton offers this list of services that can be offered using ultrasound on the dairy:
Early pregnancy diagnosis.
Twinning. Producers can manage cows differently when they know twins are coming.
Early embryonic death. At least half the cases of embryonic death seen on ultrasound still have palpable cardinal signs of pregnancy. The fetus can remain in the uterus for weeks following death.
Ovarian structure diagnosis. Ultrasound is considerably more useful for finding small corpora lutea, staging the cycle based on follicular waves and differentiating luteal versus follicular cysts. This can be especially important for herds using timed AI programs because certain stages of the cycle are better than others for starting Ovsynch.
Fetal sexing. Contrary to popular belief, fetal sexing isn't just for registered herds. Commercial herds find the information useful when making cull decisions on marginal or sick pregnant cows. They also like being able to predict herd inventory. It can save labor for Johne's control -- stay up all night if she's due with a heifer, but go to bed if it's a bull.
Uterine pathology. Palpation is quite inaccurate for the diagnosis of subclinical metritis (25% specificity, John Mee, World Buiatrics Coungress, 2006). As little as 2mm of intrauterine fluid can be visualized with ultrasound. Intrauterine and peri-uterine masses can be differentiated with ultrasound. Abscesses look different from tumors.
Fetal anomalies. Though rare, it's sure nice to find a schistosomous reflexus or two-headed calf before term.
ULTRASOUND FOR BEEF HERDS
Reproductive ultrasound is increasing in dairy herds, but beef cattle veterinarians have been slower to adopt it. However, its popularity is on the rise for three reasons, says Brad Stroud, DVM. "The first is the value-added information it provides both the veterinarians and cattle owners," explains Stroud. "Secondly, veterinarians are finally beginning to feel pressure by producers to undergo the steep learning curve necessary to become competent ultrasonographers. Wet labs and training DVDs are available to greatly reduce the learning time." Third, ultrasound units are becoming more portable and less expensive.
Reproductively speaking, fetal sexing and early pregnancy diagnosis are the two biggest applications for ultrasound use in beef herds. Early pregnancy diagnosis is extremely accurate at Day 27 post-breeding, and it takes two to five seconds to make the diagnosis. "Palpation at 35 days can take me 30 seconds to a minute, depending on the nature of the cow's tract."
Depending on the clients" situation and facilities, Stroud sometimes charges by the hour, by the head, or a combination of hourly and per head charges. "Clients with good facilities and plenty of help to move cattle through the chute get an hourly charge, which makes ultrasound cost less per head and more affordable," he explains. "Clients with poorly designed facilities and understaffed get an hourly charge, plus a per head cost."