An in-house practice means adapting in the location to do a complete wellness examination.Photos courtesy Eric Vitale Photography I did not know then what I know now, when I first started my house call practice in 1992. I started it out of necessity and out of my back pocket, so to speak. Today, my practice sees roughly 15 pets each day in their homes (or offices, hotels, even movie studios) and rule number one is never to compromise our standard of veterinary care. Given we develop an intimate relationship with our patients and clients, I believe we can provide a more unique overall veterinary experience than a brick-and-mortar hospital can. I had been an associate at a Manhattan hospital and was—at the request of the owner—in discussion about purchasing the practice. On my fourth work anniversary, when I had been promised a celebratory dinner, the owner instead fired me summarily and told me to leave. This was a shock. All night I thought about what to do. The next morning my home phone rang, and I had my answer. The call was from a client whose West Highland White Terrier, sick with lymphoma, was scheduled for chemotherapy at the hospital. Learning I was “gone,” she called and insisted I “just do it at my house,” and so I did. That day I made two house calls and the next day, four. Despite lots of discouragement, I persevered and my house call practice, City Pets, was up and running. Life as a mobile vet House calls have been highly rewarding. Seeing my patients and their humans in their “natural habitat” yields critical information about the animals, resulting in a greater understanding of what affects the pet’s welfare daily. For example, I often throw out lilies (toxic for cats) and shut windows in high rises, and I witness behavior and practices a hospital doctor cannot. I develop a more substantial relationship with the pet and owner than I ever could from meeting them in an l exam room, resulting in better awareness and communication. I see the cycle of life of both my patients and their families, with added bonuses, like holding off ringing Billy Joel’s doorbell so I could just listen while he played the piano. I would not want to work any other way. Mobile veterinary practice is not new, being common in large animal practices and there are small animal veterinarians who travel to their clients with fully-equipped vans that are essentially hospitals on wheels, particularly in suburban and ex-urban areas. The patient is brought into the van for both examination and treatment. My model is different. I do not call myself a “mobile” veterinary service. I do not have a mobile clinic; instead, I am a mobile veterinarian. The pets do not come to me, I go to them. I practice veterinary medicine where my patients spend their days. This is well-suited to dense areas–I practice in Manhattan–as density provides an efficiency that cannot be had in sparsely-inhabited areas. Making it work There was a steep learning curve in the practice while maintaining the highest-quality medicine delivered safely, efficiently, and compassionately when going to more than a dozen locations a day. As problems surfaced, there was always a solution, which I am told is the essence of entrepreneurship. For me, constant problem solving has been one ingredient of my practice’s secret sauce, for without the myriad problems I have faced and overcome, it would not have developed its successful structures and processes. Back in 1992, my veterinary technician and I ate lunch every day at one of the city’s Ray’s Pizzas and traveled by walking, taking buses, subways, or taxis while lugging our medical gear. After one particularly rainy day, when a dangerous taxi trip literally took my breath away, I had a premonition that I was going to die in the back seat of a cab (this was pre-Uber … and cell phones). Though my practice could not afford a driver, I followed the adage, “It takes money to make money,” and placed an ad. I hired a driver who remained with the practice for 19 years. Having a car and driver means I have a mobile office. Going from appointment to appointment, I am always on the phone with clients, specialists, and my office. We spin blood in the car and deliver it to the lab. I check test results online. My driver makes deliveries and picks up lab samples while we are at an appointment and then navigates us to the next call. Today, we brown bag lunch in the back seat—no more Ray’s. The uniqueness of the practice While we adapt our technique for each home and location, a complete wellness examination can be done on a kitchen counter or a living room floor. Solving the unique problems of making veterinary house calls in Manhattan has made the practice run efficiently, which our clients—often highly successful and well-known individuals—appreciate. While we cannot control obstacles like street shutdowns from parades, presidential visits, and the fall opening of the United Nations, much less snow, our logistics crew, working with online data and visual maps of our Manhattan zones, schedules appointments around the known interruptions and gets us where we need to be on time. The team starts the day at our midtown Manhattan office where we discuss the scheduled cases and marshal the equipment needed for them. While we do not have specific equipment for house calls per se, our equipment is often of the latest technology and therefore portable. A printout of each patient’s recent medical records, diagnostics, vaccine history, and personalized lab forms is included with the gear. The road team spends the day servicing appointments and “add-ons.” To streamline things, we take upstairs what is needed for each call, and the rest of our supplies remain in the car. The administrative team answers phones, schedules appointments, does billing, and supports the road team. When setting the appointment with the client, they ferret out all a pet’s issues and simultaneously view the pet’s history, noting special issues and doctors’ notes, such as about vaccines or continued treatments. The quality of care is never compromised for the sake of a house call. Do not think for a minute that there is no overhead in a house call practice—it is just mostly invisible. A few limitations What we will not do in-home is essentially surgeries and true emergencies, e.g. difficulty breathing, profuse bleeding, seizures, apparent fractures, and the like, which are sent directly to the ER. If there is concern as to whether a case is appropriate for us or may be an emergency, a nurse or doctor will speak with the client to determine if the pet should instead be treated at a hospital. If this is the case, we make the arrangements and maintain the patient as our case. We arrive fully equipped to perform not only the routine procedures that a veterinarian normally does in an examination room (a complete physical; blood, urine, and fecal samples; blood and intraocular pressures; cryosurgery, vaccinations, treating common illnesses, and performing euthanasia humanely), but we also provide ultrasounds, therapeutic laser treatment, chemotherapy, and surgery follow-ups. Animals are generally more relaxed at home and there is no anticipatory stress that comes from being locked in a carrier or sitting in a waiting room with other often-ill animals, so some diagnostics prove to be more accurate when performed at home. Setting up space As each place we go to is different, we first find the ideal location to work. For small dogs and cats, the preference is a sturdy table in a well-lit area. Since good lighting is not always possible, we wear head lamps. Any surface we use is covered with a flexible rubber mat comfortable for the pets to stand on and prevents furniture damage. While I discuss the patient with the client or their staff, gleaning yet more information, my tech sets up the standard equipment, such as a transilluminator and lens for the ophthalmic exam, an otoscope, a stethoscope, a thermometer, cotton swabs, alcohol, syringes, blood tubes, and a scale. We encourage the clients to watch as we work, but I warn them before I do anything with needles because most clients do not want to witness injections. New clients often report they appreciate that we work so openly since their imagination of what happens in “the back” of an animal hospital is more unsettling than what we actually do. I cannot tell you the number of children who have watched me practice medicine on their pets year after year and then grow up wanting to be a vet or even a human doctor. Overcoming hurdles The pandemic was tough. Keeping staff, clients, their families and their pets safe was my primary concern, and we did it. Our protocol has become less rigorous since then, but we still mask 100 percent of the time. The pandemic pet boom, coupled with people seeking safer options, heightened demand for our house-call services, which surged by 40 percent over the past two years and shows no sign of abating. We just reached our 7,000th client, which we celebrated since we reached 6,000 clients only a short time before. Together, my associate and I review cases regularly, and for the first time it is occasionally difficult to recall all the new faces. Today, the rise in the number of clients and Manhattan traffic present new challenges to maintaining efficiency and high-quality medicine. Nonetheless, our in-home practice will tackle them as always–with even better organization, more staff input and ever-sophisticated technology in our equipment and the software we rely on, and so I expect that at this rate we will soon reach client 8,000. I will confide that while having a unique, thriving practice is wonderful, for me, it is still all about the animals. Amy Attas, VMD, founded City Pets to provide the highest quality veterinary care in the comfort of pets’ homes, disrupting the veterinarian business model. The innovator is a graduate of Barnard College with a VMD and an MA in Animal Behavior from the University of Pennsylvania and serves on the school’s board of advisors. Dr. Attas was selected for a prestigious internship at Animal Medical Center in Manhattan. She has received the Award of Merit and the Outstanding Service to Veterinary Medicine by NY’s Veterinary Medical Association.
