Blending “spectrum of care” and One Health for sustainable vet med (Dr Kristin Jankowski)

Veterinary care isn’t one-size-fits-all. While “spectrum of care” has become a growing conversation in vet med, Dr. Kristin Jankowski, VMD, CCRP encourages us to think of it as contextualized care, care that adapts to the needs of the patient, the family, and the situation at hand.

In this episode of Vet Life Reimagined, Dr. Jankowski shares her perspective from years in general practice, academia, and community health. Dr. Jankowski didn’t tire of being a general practitioner because she was an active learner and found many ways to make an impact for her patients, clients, and community. She’s the founder of One Health Delaware, a program that connects human and animal health providers to serve families more holistically, and she’s also a leader in the AAVMC’s Spectrum of Care Initiative.

We talk about how contextualized care reframes the conversation and the exciting ways One Health and the spectrum of care can work together to improve outcomes for people and animals alike.

Resources:

• Episode on YouTube
• Dr. Jankowski's publication on One Health Delaware 
• AAVMC's Spectrum of Care Initiative 
• Open Door Veterinary Collective

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Transcript

Kristin Jankowski: [00:00:00] We need to offer a care option that makes sense in the context in which that animal and person live together.

If we can switch our training focus to challenge-based, hopefully we'll have a lot more satisfied practitioners.

Megan Sprinkle: Welcome to Vet Life Reimagined. What does it really mean to provide the right care for each patient? In veterinary medicine, you might be hearing and seeing the phrase spectrum of care, but our guest today invites us to think about it as contextualized care that is patient specific. Family specific and rooted in real world circumstances, and we challenge that this shift will enhance patient wellbeing, client relationships, and our own job satisfaction.

I'm joined by Dr. Kristin Jankowski, a veterinarian who spent 25 years in general practice and community health and is now at UC Davis. . When she was in private practice, she helped start One Health Delaware, a program that connects human and animal healthcare to [00:01:00] serve families more holistically.

And today, she's also a leading voice in the AAVMC's Spectrum of Care initiative. Helping veterinary schools and practitioners alike reimagine what accessible, sustainable, patient-centered care can look like. Not everyone in our profession is familiar with spectrum of care, yet it's still a growing concept across general practice, specialty medicine and academia.

But Dr. Jankowski's perspective and stories bring it to life, showing how contextualized care empowers veterinarians. Strengthens relationships and expands what's possible for both pets and people. If you've ever wrestled with balancing gold standard medicine and real-world constraints, this is an episode for you.

So let's get to the conversation with Dr. Kristin Jankowski.

When did you know that you wanted to get into veterinary medicine?

Kristin Jankowski: I was one of those kids that knew right away. I think I was about six, and that's all I wanted to do [00:02:00] was with the animals and study the animals. And in fact, I still have this piece of paper that my mom gave me with a bunch of questions about like, what do I wanna be when I grow up? That was what I put on there to be a veterinarian, so I knew very young.

Megan Sprinkle: So you have proof that

Kristin Jankowski: Yes, I have written proof. Yes. Still in a frame. Mm-hmm. Yep.

Megan Sprinkle: Oh, I love that.

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: very cool. Well, you know, I, I just think, you know, childhood and, and where we come from is a big part. , That's a great story in, in

Kristin Jankowski: Yeah.

Megan Sprinkle: but is there another story that kind of comes to mind, , before you actually get to vet school? Like, is, is there something that kind of maybe solidified that, yes, this is the path, or, or just something that's like a fun story.

Kristin Jankowski: Yeah, I mean definitely my whole childhood I think was prepping me for this. 'cause my mom was a wildlife rehabilitator and she was also a teacher that worked teaching math in underserved communities. So I think I brought [00:03:00] all of the love of those types of things together. But when I went off to college, I wanted to be sure.

, That it was what I wanted to do. 'cause I'm like, I'm pretty sure, and I've thought I've wanted to do this since I was six. So I think about my third year in undergrad, I decided to work both at New Bolton Center, which was University of Pennsylvania's large animal hospital. And I did night shift, foal sitting.

And then I also worked for the DuPont company doing, um, I was a chemistry major in college, so I did chemical engineering experimentations and things as an intern. So I did them both at the same time and nothing against the DuPont company, but that really cemented, I was like, wow. Working directly, doing the one-on-one with the animals for sure was what I wanted to do.

So that summer was super helpful.

Megan Sprinkle: Yeah, it is hard to beat foals, so.

Kristin Jankowski: It is hard to beat foals. I mean, and I, I became a small animal practitioner, but I still have the love of horses and still do that when I can with my, with my own time, so, [00:04:00] yeah.

Megan Sprinkle: Fantastic. And you know, I think those types of experiences are so important from young age to vet school

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: I think we don't always know what we don't know. So

Kristin Jankowski: Right.

Megan Sprinkle: went into vet school, did you think Vet Life would look one way for you? And did that change at all as you went through vet school?

Kristin Jankowski: A hundred percent. 'cause I definitely, I started out wanting to be an equine practitioner. I was just a horse crazy girl that begged, borrowed and stole to do anything with horses, But then once I got into it, I realized that I truly love the companion animal medicine, and I still want to keep the horse thing as a hobby and a love.

But to do the medical workups and surgery, I got to do a larger range of things with small animals. So I found that that was my professional love and I could still keep my horse love as the hobby. Yeah.

Megan Sprinkle: Very cool. Well, any particular memory from vet school too, 'cause I [00:05:00] think

Kristin Jankowski: Hmm.

Megan Sprinkle: we all have some fun memories from vet school and those are also fun to share and bond over. Any

Kristin Jankowski: Yeah,

Megan Sprinkle: you that pop up?

Kristin Jankowski: I mean, definitely I went to school at the University of Pennsylvania, so I think I was really lucky to experience a huge range of clientele and patients and things. Being in West Philly, , we saw all kinds of things from, gunshot wound victims to infectious disease, to chronic disease. And I think just being in a big city had a huge caseload.

, I definitely remember some of the medicine cases and loving those, but always looking for an angle for how we could provide, even at that time, more care, , wondering did we need to do all the tests or did we really have enough information?

Just from a small sampling of tests and our exam and our history and you know, all those things. So , I even remember those instances of just thinking through like, could I do more for folks that couldn't do all of the highest technology options? And then I also really [00:06:00] loved just, I remember getting called in for a pyometra in the middle of the night and just how formative that was to be able to really get in there and do pretty complicated surgery.

But that is considered, you know, it's a routine surgery really. So, and just the making it like, no, this is a routine surgery. The uterus is just bigger, but yep, we're doing it in the middle of the night. 'cause this one's a little critical. So, yeah. So, I think just normalizing those things too. Like, yeah, you can do it, study up, do it with someone who's helping you first, and, you know, make sure you've, you know when to ask questions and when to ask for help.

And then you need to be bold, you know, so. I remember a bunch of those things of just having those opportunities during vet school to do that, which was, I'm really appreciative. 

Megan Sprinkle: you know what we talk about today that a lot of vet students just get this ivory tower perspective

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: like, this is, do all the tests and all of the things, because people who come to the vet school, they've been prepared [00:07:00] for that and I mean. Back in my day, you know, I still

Kristin Jankowski: Yeah,

Megan Sprinkle: that we had diverse cases that not

Kristin Jankowski: for sure. Yeah.

Megan Sprinkle: everything. So that's good that you were starting to see that and see the empowerment from a general practice standpoint as well, which is where you ended up going and were for a very long time.

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: you, you told me that you feel very lucky that you. Found a practice that continued that culture and that mindset

Kristin Jankowski: Mm-hmm. 

Megan Sprinkle: of working your cases and not referring everything. So, do you mind sharing how you got your first job as an associate veterinarian and your experience there?

Kristin Jankowski: Yeah, so my first job was like many where I went into a, a super busy group practice, which was awesome 'cause we saw lots of cases, it was a super crazy schedule, But saw lots of things with great mentorship. So, I had good [00:08:00] mentorship for doing just general surgery and stuff at that time.

But I did find that I really loved the interpersonal part of it right away, and I wanted to have more connections and see my clients more regularly versus seeing a ton of clients and never seeing the same one again. And so, I sort of quickly transitioned by, A friend of mine from vet school had an opportunity.

She was older than me, and she reached out. She's like, Hey, we have an opening in our practice. We would love to have you, are you interested in coming up? And, and then I got to start to work in some of those long-term relationships. And over the years I ended up at a practice like that where I really loved, uh, I was there for 13 years.

Um, just knowing my clients really well, , being able to know the pets really well and I feel that that was super formative and then just having the mentorship to keep studying, keep doing more, go to those labs, you know, going to dental labs and being more comfortable with dental surgery mean we, you know, have a lot of capacity to do that, which is, we know is a [00:09:00] huge need in our profession and, and I just kept learning. I loved always doing more learning, but still bringing that back to my companion animal practice. So, I think that combination of mentorship, camaraderie, keeping the schedule manageable was also good. And the balance where I had kids along the way, so they were super accommodating. I was like, Hey, now I need to change my schedule because my kids have this activity or that pickup time.

And I was super lucky to have them be able to say, we hear you and we want you to be happy, so let's work with what you need. And we know you're gonna work really hard when you're here and. I was also super lucky that my husband was a veterinarian, and so he was a small animal surgeon so we could juggle our schedules.

'cause the veterinary world was really complimentary to that, where we didn't work every day of the week. You know, sometimes we would work a 12 hour day and my husband would manage the kids or vice versa. [00:10:00] So I think we were really able to keep a work life balance, family balance that was.

So doable. And I think that kept me really going through the years and always inspired me to still wanna do more rather than pulling back. I was like, what can I do next? You know? And so that was, I think, made it. Fun. And I feel lucky to have been in a time where we were encouraged to do more and like if you're, you know, if we were gonna refer something along, make it a good referral.

But, you know, offer the clients to do as much as you feel comfortable with and you know, tell them together, like, we need to look at this together and I need to look into more things if you don't know, you know, just being really upfront and including them in all the decisions. So, I was lucky to have that. 

Megan Sprinkle: first of all, it's always great that you feel safe and comfortable to ask for those things,

Kristin Jankowski: Mm-hmm. 

Megan Sprinkle: I don't know if all cultures maybe, help people feel that comfortable to say,

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: Hey, I have kids. Can we be flexible? What? What

Kristin Jankowski: Yeah.

Megan Sprinkle: [00:11:00] think could work? Right?

Kristin Jankowski: Right. And I would tell the younger associates when they would come in that all the time, I was like, you need to, to try to find that balance, but speak up for what you need in a way that's fair. You wanna be like, I'm all in and I can give you. 110% of my attention in whatever range of time that you can work.

And then, you know, if you need to be checked out and, you know, on home duty or whatever it is that you do in your other times, sticking to that do you know, and, just establishing boundaries that feel fair, like you said, and feel safe. And I was just super lucky to have that ability. And I think, I hope that still is a culture in many places today.

But, when I worked at Limestone Veterinary Hospital in Delaware for many, many years and I was able to, to have that awesome relationship there. And I think when, when people do speak out for what they need, in a way, it's just like any relationship, you know, you need to use communication, whether it's with your.[00:12:00] 

Your sister, your husband, your, you know, whatever you'd need to speak from the heart with what you need, and then listen to what they need and truly pause and then come to something that's in agreement that both of you like, so,

Megan Sprinkle: Yes. the other thing that I heard that stood out to me as well, is that personal growth part of it

Kristin Jankowski: Hmm. Yeah.

know 

Megan Sprinkle: what you need, right.

Kristin Jankowski: Yeah. 

Megan Sprinkle: home 

Kristin Jankowski: Yeah.

Megan Sprinkle: if you're interested in something, really encouraging people because . It's always fun to hear people's perspective, right.

Kristin Jankowski: Mm.

Megan Sprinkle: from general practice

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: you know, not too long ago I heard, ah, you know, general practice, it was dental, dental, vaccine, vaccine, dental vaccine that, you know, and they got bored and it's like, well, you know, did you feel like you had the opportunity to go and grow and learn and, and do different things and, and like you said, keep your cases so you're

Kristin Jankowski: Yeah,

Megan Sprinkle: Dentals and vaccines, but you

Kristin Jankowski: [00:13:00] right.

Megan Sprinkle: and confident to keep your own cases so it is more stimulating and things like that. any thoughts around that?

Kristin Jankowski: For sure. , Fast forward a bit, and I'm sure we'll get to this. When I was at uc Davis teaching primary care to students, I would encourage them all the time. I was like, just if you keep growing and learning, general practice is. I think one of the most challenging and rewarding things out there, because of the range of of work we get to do, you know, you can spend more time learning about oncology and offer your clients if they wanna do the lymphoma patients with you, and if they feel comfortable with that and , the next referral oncologists might be two hours away, so they might wanna keep it with you and, and then keeping that relationship good with your oncologist so that.

When you give them a good referral when they need it and you offer your clients options. So I mean, 'cause we have the range of doing everything from, you know, like we said, internal medicine, oncology, dermatology, surgery, and you know, we [00:14:00] never wanna do more than we feel we're competent with. But if you continue to study, it's amazing what competence you can gain.

 and then just keep your relationships with your specialists so you can say, Hey, this one's outta my comfort zone. I'm gonna refer to you, what can I do to help make it a good referral? Like, what else do you need before I send them to you to make it so you're not stuck doing things you don't wanna do?

And they're like, great, do this, this, and this. I'll handle the rest. Perfect. you know, so I think you can make it as challenging and exciting as you want, but also you have the opportunity to make it boring. And we're like, that's your choice. But I wouldn't do that. You know, like there's, there's no need.

I mean, when patients come in and they're there for a vaccine appointment. You often will find other things or just talking about preventive care. You know, like talking about if you start brushing your dog's teeth now you may save thousands of dollars on a dental and a lot of discomfort for your pet.

And you know, the student's like, oh, I never even thought just a simple [00:15:00] conversation could really help my clients and the pets. Avoid a lot of things that are super negative, do you know? And just the power of all those conversations that we can have about keeping your pet a healthy weight and how they can live two years longer and isn't that so cool?

And, , if you just think, well, they're just here for the rabies vaccine, but you don't address that, it's a body condition score of seven out nine, you've missed an opportunity that makes your day more interesting. Number one, that helps your client understand a little bit more and give them the power of choices.

And of course, helping the patient is the ultimate goal. So there's always some sort of preventive care to be discussed, even if you don't have a problem based appointment. , Not that you have to spend hours on it, you know, you need to move on to the next patient. And I totally get that. you've gotta be efficient.

But I think just even those inquiries of just rather than rushing through, taking a moment to be like. What other questions do you have for me? And then just truly waiting and saying, because a lot of things will bubble to the surface. Like, well, I, I did notice that my [00:16:00] dog has been scratching more in this one spot and I, I didn't wanna bring it up 'cause I kind of forgot until you asked me a little bit more.

So, you know, really allowing the conversation to evolve will provide better care and, and it's more fun. It's honestly just a lot more fun.

Megan Sprinkle: Well, I know that when people think about getting more education, they might think reading papers or going to conferences. What were some of the ways that you got additional. Education that you enjoyed and, and maybe even anything unique or something that you did that maybe not many people would be thinking about to kind of grow themselves and their knowledge.

Kristin Jankowski: I think the things that really helped me the most were doing some of the interactive labs that you can do. They either can be offered sometimes through university. I did a dental lab on even just doing local nerve blocks and, basic extractions just to get better technique. And then I did some like sports medicine labs at [00:17:00] um.

Was NAVC, but is now VMX. and that really got me interested in. Rehabilitation and then that spurned on a whole additional chapter of my life where I got certified a canine rehab. So I think just finding those things, like following your passions, like, you know, I was super interested in sports medicine and pain relief, and I was like, oh, there's a thing you can do with that, with rehab , you know, most places where you're gonna have continuing education funds, pick something that seems exciting to you and then just keep going. And then certainly finding things that are free. I went to like every free sponsored, you know, industry sponsored specialty center sponsored CE event.

Free food chat with your friends. Oh, I learned something. Do you know? And, and then sometimes that learning something really was like, wow, that was fascinating. You know, the new studies on, you know, pemobendan extending life , when you select it for the right patients. So I, I still actually remember learning about that and I was like, that is so cool.

So. I just really [00:18:00] enjoy learning. And I think most people that go into veterinary medicine do, I mean, that's just, we're self-selected for that. So I don't think I'm so unique. and it, it keeps it more fun. It's like anything. I, I like to do that with my hobbies too.

I'm always like continuing to get, you know, training on whatever I'm doing because it gets boring if you're doing the same thing. So, a little bit of challenge keeps it fresh. And there's actually studies that our brains work that way, that we need it to be different, to be engaging and fun. , And then for me it was translating that then to students when I was doing teaching and, and working, even with our own practice, I was frequently the one to set up t raining seminars for our technicians. Like, do you wanna learn how to read ear cytology’s better if we had a slow day. let's do that. And they were like, this is fun. You know? And so paying it back too. So, in your practice, if you really enjoy the trainings, providing those, even if they're on the fly, you know, like, let's look through this radiograph together.

Like I know we could send it off to the radiologist and we might still send it off to the [00:19:00] radiologist, but before we send it to the radiologist. Let's look through it together and see what we find. Because if we start resting on our laurels and sending everything out to some technology site to do it, you'll lose that skill.

And that's something that A, is once again, is enjoyable to have skills that you can use. And technologies sometimes fail us. The computer gets shut down or you can't get to your radiologist with your connection or whatever. So, you don't wanna lose skills. 'cause I think that is valuable to your client, patient and you as a provider.

So,

Megan Sprinkle: Nothing is a hundred percent. So, it is

Kristin Jankowski: right. You gotta, yeah. Be ready. Yes. Mm-hmm.

Megan Sprinkle: sure? Yeah, exactly. Well, and then you, you mentioned this, that you are already starting to. Notice your interest in access to care and

Kristin Jankowski: Mm-hmm. Mm-hmm.

Megan Sprinkle: but , you also were, , exploring like one health [00:20:00] and other things as well, , as you were in practice. What other things did you start to do to get more involved in that side of things?

Kristin Jankowski: Yeah. So, as I mentioned, when I went back and I was doing the canine rehab for a little while, I was working in general practice, and I was working especially practice doing rehab. And at the same time I also started to get involved with my local animal shelter, and they asked for me to be on the board and help out.

And, and then that's where, , I was in a, , community outreach group and we were charged with trying to see what we could do to help our community. And it was. Actually coming from a specialty center appointment where I was dealing with, , rehabilitation of, I think a post-surgical, uh, issue and with very, you know, high income clients and then driving through the lowest income part of our state to get to the board meeting and realizing like, wow, there really is a lot of disparity in the health opportunities.

And I thought, if it's that way for [00:21:00] animals, it's gotta be magnified for people. And, and that's when I started to get more interested in how could we connect these things? How could we connect opportunities for people and pets? We know people really, , care deeply about their pets and the general practice I was working in, uh, served a huge range of clientele and I had several episodes where clients came in and said, I have this medical need for myself, but I'm putting it aside because I need to address my pet's health first as my first priority.

And I was like, wow. You know, that's, that's a hard decision for people to make. And I, you know, although I can't tell them how to make their own decisions, I was wondering, could we offer situations where people weren't forced into? That decision process, so couldn't we have them have opportunities for themselves and their pets?

And that's where I kind of came up with the One Health idea. And then just with a huge team effort, we managed to get a one health clinic off the ground with lots of collaborators who also thought the idea [00:22:00] was interesting. , And it was just so amazing to see the power of that human animal bond and then, , have people start to talk a little bit more about their own stories of health and then have the nurses kind of help, , intervene.

So, it was really a fascinating chapter, and it taught me a lot about how. Uh, healthcare, it's for, for pets, we really need to contextualize it, right? Like we need to offer a care option that makes sense in the context in which that animal and person live together. And sometimes those contextual things are related to finances, but not always.

It can be. Lots of other things. So, I think that was a very eye-opening experience for me. And it not only brought in that part, but it brought in where I was doing more teaching with the students from University of Pennsylvania where they were joining the project and University of Delaware was in on the project and the nursing students from Wilmington University.

So, it was a big discovery for me that not only could I provide access to care, helping people and pets together, but [00:23:00] I could teach at the same time, which was incredible. And so. That was, that was like, okay, that's gonna be the next chapter if I have anything to do with it. So, and that's what I started looking into.

Megan Sprinkle: Yeah, definitely opened up your network for sure. But

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: your. Your perspective on that, your ability to look around and and see needs and be creative on what could we do here?

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: I

Kristin Jankowski: Yeah.

Megan Sprinkle: special and you know, looking at the dates, this was 2017 to 2020,

Kristin Jankowski: Hmm.

Megan Sprinkle: lot of people think about more of that. Oh, people start putting their. Pets above themselves was kind of like a pandemic thing, but I, you know, I don't think so that

Kristin Jankowski: No. Mm-hmm.

Megan Sprinkle: inflated the, that they were home more together. But, but, you know, I, you know,

Kristin Jankowski: Yeah.

Megan Sprinkle: perspective, has been growing, I think for a long time, just getting stronger and stronger over time and.

you've gotten this, but I love stories and [00:24:00] I just see a potential opportunity

Kristin Jankowski: Mm-hmm. Mm-hmm.

Megan Sprinkle: your time there, was

Kristin Jankowski: Yeah.

Megan Sprinkle: case that you still kind of carry with you today?

Kristin Jankowski: There are, were so many, but one that I really hold dear to my heart, and I would share it regularly with the uc Davis students in primary care because of how much it meant to me was where a mom and her. Son and their dog came to the one health clinic as mostly for preventive healthcare like they were presenting for.

And then she also mentioned that the dog was having some limping and trouble getting around and, you know, so we did an exam and we could palpate some decreased range of motion in the joint. You could palpate a little crepitus in the front limb. And so it was cool to even just talk to the students about like.

What you can learn from an exam. You know, we didn't have radiographs or anything on site, but kind of offering opportunities for, you know, what are you getting from the history exam? She's telling us [00:25:00] about the dog having trouble going down the stairs. You know, we're palpating crepitus, decrease in range of motion in a front limb.

You know, you can say, pretty likely you've got some osteoarthritis there and certainly you, you know, need to rule out neoplasia, other things like that. But, you know, we explained to her, we didn't have radiographs, but we could offer some non-steroidal pain medication. We didn't have full lab work, but we could run a urinalysis and check a urine specific gravity, you know, so we could do all the low tech things that.

Truly give us actually a lot of information. And so, we sent the dog home with some carprofen and honestly, I didn't think too much of it, and we were like, that was cool. And on the next thing until she came back the next month. And she pulled me aside and she said, I just wanted to tell you that my dog is doing so much better and that I was really distraught because I didn't know how to help my dog.

And I felt really just tied. She's like, I'm a nurse, [00:26:00] but I had lost my job and that's why I'm here. Because I didn't have opportunity for care. And she's like, actually my son. Is autistic. And so I was really struggling to deal with my personal issues and my son's issues until I could get my dog to be pain free.

And she's like, and the fact that you all really listened and kind of went over and beyond and then offered something that truly helped alleviate pain. I could think about the rest of the stuff in my life and start to deal with those issues and I couldn't before. I was like, wow. Like that was like, it seemed so simple what we were doing, but really just provided a whole new avenue for this lovely woman.

To feel empowered and make some changes. That really helped her for such a tiny thing. So, I would tell the students like, look how small your effort was in that. But it was super meaningful. Like you didn't say like, well, I can't do radiographs. I don't know what's wrong and see you later. You know?

It's like, well, we [00:27:00] really had to think through the case and give her a lot of options using that relationship centered communication and truly listening and checking in and all those bits. But it was so powerful for something. So minimal. And I, had another story where a client, we were just doing a routine exam and checking in on how the dog was doing, and the nurse was hanging with us, the human nurse, and they just started asking.

We, one of our history questions was whether anyone in the house smokes, or with the, if the pet is exposed to any secondhand smoke. And then, then immediately started them to share a story how they had started smoking again after they lost their son in a car accident. And it has been a really rough time.

But they were, they're like knowing now that it affected their dog negatively, they're like, we would love resources 'cause we wanna know how to stop smoking and feeling like we're getting our dog healthy again. Makes me feel like we made them feel like they wanted to keep that [00:28:00] trajectory going and then help themselves.

And so, the nurse was able to kind of just be there for them and say, Hey, I'd be happy to help you with some resources. Like what a powerful moment, you know, for them to be like, to be vulnerable enough to say Our lives have been really hard and it made us pick up habits again that we wish we didn't have.

And because we're all here together as healthcare providers. We could facilitate something that didn't feel so scary, do you know? It didn't feel like, oh, I've gotta go and tell my doctor I'm smoking again and admit to that. And now I've got, you know, gotta fill out five forms or eight web pages later I get to a resource versus someone being right there.

So, I mean, and I have like a zillion stories, but those are some of the ones that come to mind when you first ask. But that's what's amazing. I think when you take and really listen to your clients, and it can involve the one health piece, it can be truly magical. What can happen when professionals can come together, to serve the client patient, pair [00:29:00] in a more unified way as a, you know, as they are, they're a pair, right?

Megan Sprinkle: Very much so and, and my vet school is coming back to me where they said the history and the physical exam or your bread and butter, right?

Kristin Jankowski: Yeah. Yeah. There so much value. Yep. Mm-hmm.

Megan Sprinkle: that, I mean, your education gets you that. And so

Kristin Jankowski: Yep.

Megan Sprinkle: simple after all that education and that you can offer is some pain management.

And that

Kristin Jankowski: Right?

Megan Sprinkle: The world of difference for the

Kristin Jankowski: Yep. Exactly. I mean, how easy is that?

Megan Sprinkle: listening to these stories. How can you say general practice is boring? No,

Kristin Jankowski: Right. I mean, and that's the thing, right? It's just over and over every day is like that. A new, a new exciting opportunity. I mean, I know. I just, that's the way I feel about it. So. But I think when you start to really get into it like that, you're like, oh, it can be like that. Like it can be, every day is a new opportunity.

And [00:30:00] I still remember my mom, she would still ask me, she's like, what are you gonna do at work today? I was like, I don't know. And that's kind of the cool part. I don't know. You know, like it's gonna be a mystery and I'll figure it out when I get there. Do you know? And so I think if you are a person that really enjoys challenge, and they're doing a lot of interesting study about that now, actually in the UK where they're studying, like, are we training our students to be challenge focused? Which then you're like, oh, cool, it's a puzzle each time and I'm gonna try and figure out the best option for this particular client, patient pair, and me as the provider. Versus are we training them to be diagnosis focused where you must get a single right answer and if you, if we're training them to get the single right answer, then it can be really frustrating.

If for whatever reason your client doesn't have the resources or your patient can't tolerate the testing or whatever, and you have to just narrow it down and get to a, to a plan that seems reasonable and, you [00:31:00] know, use your evidence-based medicine whenever possible. But still, you might not get the exact answer.

Do you know? So, if we're, so, if we're finding that we're, if we can switch our training focus to challenge-based, hopefully we'll have a lot more satisfied practitioners who are like. You know, I don't know what today's gonna bring kind of challenge, and I'm gonna do the best I can with what I have in the situation within.

Where I am today that will help with longevity of those in our profession? Like if you have a challenge focus, so they, you know, it's, they call it professional identity and how we're, you know, taking in all the pieces that form our identity. And, um, that's one piece of it, the challenge versus diagnosis focus.

So, I think general practice really embodies that. If you are, if you love the challenge, focus.

Megan Sprinkle: Yeah. And you know, back to job satisfaction and, and feeling like you're making that impact is that mindset of every case. There's potentially multiple answers [00:32:00] right there.

Kristin Jankowski: Right.

Megan Sprinkle: possibilities and. Again, thinking of it that way, it's like what are the possibilities? What are, you know, the, the challenge and, and how can we work together with the pet parent to make sure that we are coming up with a good solution that everybody feels pretty okay with, uh, you

Kristin Jankowski: Yeah.

Megan Sprinkle: home.

So you feel okay when you go home too.

Kristin Jankowski: Yeah. And that's where it loops back to kind of what I've gotten into more recently is working with the AA VMC and the Spectrum of Care initiative with the task force. There's veterinarians from all around the world who are. Coming together to try to see how we help schools to have this type of focus on, contextualizing care and making it as a spectrum and, and helping support veterinary teaching programs on how to teach that.

Which has been fascinating 'cause it's a process to make change in higher education for sure. , But there's a lot more evidence to back it up and a lot of tools. [00:33:00] That are coming outta that. So it's, it's been an exciting project.

Megan Sprinkle: Yeah, so let's tell that story. It's very evident a lot of this comes up with examples of you teaching,

Kristin Jankowski: Mm-hmm. Yeah.

Megan Sprinkle: you seemed to really enjoy. And so, I think there was an opportunity to, I think you said your husband was at a point, I was like, we can 

Kristin Jankowski: move

Yeah. Yep. Yes.

Megan Sprinkle: And you're

Kristin Jankowski: So he's right. I wanna teach. Yeah. So, when he sold his practice in, we finally had the opportunity to move and I said, I want to teach. And I had already done some work with UC Davis consulting with them when I was trying to start One Health Delaware. And I loved it and thought that that would be an amazing place to be.

So, a job came up in the primary care teaching. It was called a community practice at the time, and I was lucky enough to get the job and came out. So, I was, you know, very involved with kind of everything we've talked about, just teaching students how to be practical and challenge based and, and still.

Very much interested in providing access to [00:34:00] care. So I started doing more with that and I was lucky that the university was starting to realize that that was an important field to, to get involved in. And so, they gave me some little additional time to work on that. And fast forward a few years and then I was invited to join this, AAVMC's group on Spectrum of care.

'cause I was very much curious about spectrum of care, and I could notice that our students seemed, stressed honestly when they didn't have all the technology to go the next steps. And, and I think it was just the evolution of kind of what happened in our field that these higher technology options were out there.

And so, they're exciting and then a part of the teaching and then what's happening at the universities are. You know, like you mentioned earlier, is that clients are seeking out that higher technology care coming to a university. So, this, they're sort of self-selecting and then the students aren't seeing the range.

So, they're not seeing the clients that [00:35:00] are coming in with a range of, you know, finances, ability to travel, language differences, things like that.  So the educational system just got a little narrowed. And I think coming in as an outsider, it was. Easier to see that. 'cause I had been in, in general practice for 25 years seeing just sort of normal quote unquote clients.

You know, not seeking tertiary level care every time. And so I was, able to, to notice like, wow, we're not maybe meeting all the needs of the students. We're teaching them fabulous stuff about research and high technology, but maybe we're not meeting their needs across a, a range of care.

And I think there were a handful of other people around the world noticing the same thing at the same time. And that's where the AAVMC got involved .  They received a grant from the Stanton Foundation to sort of explore this and like, why is it happening and how can we help institutions.

Provide a range of care options. It's been amazing to be part of that group 'cause we are [00:36:00] really wide with our backgrounds. and it makes it, everyone brings a different flavor to the table, which has been super helpful. and just working to help institutions. Learn how to provide care across a range.

So, there's a lot of wonderful things happening out there, and there's a lot of schools that could use more resources in that area. They just, you know, need more community and help, you know, to get there. So, it's been a fun process to do that. And we're excited to see the changes that are happening at universities.

And we're actually just now starting as a group to do some research to measure like, where are we now? In the vet schools? Like what do students feel comfortable with? And so that we know of these new things that we're trying to add. Where did they go? And along the way I got involved with a group called Open Door Veterinary Collective, where.

Our main aim is how to teach practitioners and veterinary students how to provide access to care and spectrum of care and still remain [00:37:00] financially sustainable, which is also a big driver of the AAVMC's group. Like we don't want people to think that you have to give everything away to provide a range of care.

Like we know that veterinarians need to get paid for their time. They have high student loan burdens. Just the cost of living for everyone is high. So, we want to have everyone gain knowledge on how you can meet people where they are and still keep your practices financially sustainable.

Professionals deserve to be paid for sure. It's not as though we should be giving away everything we do, but we want things to promote more health equity and be attainable. And that's what's been really fun is showing people there are tools to how to do this so you can go home at the end of the day and feel really great about what you're able to do for that client patient pair.

And you feel proud of your work and you were able to get a good paycheck all at the same time. So that's, I think, been a struggle as things have gotten a little trickier and in our profession, there's been a little more [00:38:00] divide between the clients and the providers.  As there's been frustration with fees and services and things like that, and so we're trying to dial that back to reduce the moral distress of our profession.

Provide more care options and Keep everything more, so we're gonna stay in it. Eventually, those of us that have been doing it for a long time, we wanna retire. So we need, like, you know, we need the next generation to come along and be as enamored and in love with the profession, and feel that they can pay their bills as they go.

I mean, that's the ultimate goal, to be like, this is the coolest job. I can pay my bills and still meet clients and patients where they are. So, we're working on it.

Megan Sprinkle: You painted that perspective very well, and there are resources, and as you said, they're long, but it's because there's so many parts to that and, it's important to also talk about. Like you can still do very well

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: this a, a fruitful career, both as a rewarding career from a heart [00:39:00] place, but also a financial place and it.

I I haven't thought about this example in a little while, but there was a case that was presented at one of the Veterinary Innovation Summits. This has been at least two years, if not longer,

Kristin Jankowski: Mm.

Megan Sprinkle: it was the same Veterinarian two different clinics in two different parts of the city.

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: was a low-cost clinic. And he even designed the clinic to, uh, you walk in and there's like a menu of items. There's like vaccines

because he knew his clients in

Kristin Jankowski: Mm-hmm. Mm-hmm.

Megan Sprinkle: his other one was more, um. They come in, there's a lot of options. They want to do all the tech, like that's what the

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: want. And so, he has that and they both were highly profitable practices. Like they, he knew how to know his clients and provide what they needed. And still have a thriving business. So I, I can be [00:40:00] profitable, I can feel good at the end of the day that

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: people of all different places that, you know, we are making a difference in the lives of pets and the pet parents and like, this sounds so. Fun.

Kristin Jankowski: Right.

Megan Sprinkle: And it, but like, you know, as we discussed, like there, there's lots of moving parts. It's definitely possible. I am curious to learn about what you find out in your, , research on where are students currently, because I love that we're starting with students, but there's also people in practice that.

Also, may feel uncomfortable doing a lot of different things in practice. They may still heavily refer, and that there's potential resources for all of those scenarios. So do you mind sharing a little bit about what you're working on, the resources that are currently available, and then maybe the, the next few things that you're, you're really excited that might be coming that people can look forward to.

Kristin Jankowski: Happy to share. There's a few different kind of [00:41:00] categories of resources. As I mentioned at Open Door Veterinary Collective. We're a nonprofit group. Designed to develop resources for practitioners and for veterinary students. And so we have everything from just kind of learning about what spectrum of care is about to short learnings on, you know, the spectrum of care approach to canine heartworm disease that we just co-produced with the American Heartworm Society.

So, kind of taking those guidelines and then making them actionable, and providing a range of care options for prevention, diagnosis, and treatment of heartworm. We have courses on parvovirus management, pyometra, uroliths, and we're coming out with more. So those are very actionable and designed for practitioners to have resources they can use right away as soon as they take them. And they're done in a really, I think, a fun way where we include a lot of subject matter experts, , and really interactive technologies that go well beyond, , my ability to, to be the [00:42:00] ones to create those other, we have our educational specialists who brings in all the cool technologies, which make it the learning really interactive and .

Has been shown to make it more, it sticks more, right? Like if you are exposed to the content in different ways. So. That's been really fun. And Open door will have a membership coming. And then the A-A-V-M-C, the spectrum of Care, they have an implementation strategies guide, which we briefly touched on, which the group that I've been involved with, with that took us, I dunno, about a year and a half to develop that.

And it's a really broad guide, which although is designed mostly for schools. I think it's an excellent thing for practitioners to know about. Because it's really cool to see what is being introduced in the schools, which is honestly what a lot of practitioners are doing. But we're trying to encourage the practitioners to feel proud of what they're doing.

Like you are doing this amazing spectrum of care work, and now the students are learning about that before they get to your practices, and that's awesome because now there are terms for it and there's [00:43:00] research behind it, and we have evidence-based protocols and there are specialists who are saying that this is a great option.

So I think even though the guide is, you know, academic focus, there's a lot of different things that practitioners could pick out of there. So, if you go to that guide on the AAVMC’s Spectrum of care initiative site. I encourage you to look through the table of contents and look for something that resonates with you, what your practice needs or what you feel you wanna just get a little more information about and use it in bits and chunks.

It can be a little overwhelming if you try to do the whole 140 page document, but, , there's a lot of actionables in there. It's the same way with the open door content. Like pick something that you think is gonna. Work for you. You know, if you need your RACE CE you might do one thing, if you just want a quick micro learning about evidence-based pyometra care and you wanna get that done in 15 minutes or less, we have those too.

So we tried to make it so the content in all of both guide, you know, the spectrum of [00:44:00] care guide and the open door stuff, which actually is. Partly, , recognized within the AAVMC's guide is usable for all different folks. Do you know like everyone's gonna have a different need and a different interest?

And so, I think the more content that's out there, the better. And we have colleagues that are doing great things too. So, it's not like we're the only game in town. It's been super exciting to see more and more publications coming out. , Some friends from Canada just published a spectrum of care toolkit that's in JAVMA and there's a value matrix guide about guiding your, it's also in a JAVMA article.

I've been excited and a little bit concerned about the rate, uh, things are coming out 'cause we're trying to make sure we stay up to date on all of it. But it's honestly, it's just plain old exciting 'cause people are starting to, to realize that, . If you look at it as patient specific care and you stop calling it spectrum of care, then it resonates with everybody.

Like, everyone's like, well, of course we should have it be specific to the patient and then their client, you know, that goes with [00:45:00] them. And that's what we're hoping for, and good medicine. So, if coming up with patient specific care that feels good for client, patient, provider can start to replace the quote unquote gold standard, I'll feel that we've done something. Do you know? 'cause I, I think the highest technology option that suits some people, and that is patient specific care for some, but not for everybody. So, I think we just need to rethink what success means.

And, you know, kind of like we said, keep going back to that challenge-based way of getting to things.

Megan Sprinkle: Yeah. A couple things I wanna make sure that we hit on one. These resources are for so many individuals, whether they're schools, students, people in practice. When I say people in practice, not just veterinarians,

Kristin Jankowski: Yeah.

Megan Sprinkle: this is a team effort. This is something that you and I talked about

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: Where this is something that we as a team, I think need to embrace. And one of the most powerful things that you and I, I think [00:46:00] talked about I is around, I mean, critical thinking is important. We talked about

Kristin Jankowski: Mm.

Megan Sprinkle: mindset of,

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: it's not necessarily one right answer.

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: at everything as a, a challenge and opportunity. Like what, how can we go in this? But the other thing is around our attitude, and we talked about being able to learn empathy.

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: an not be judgmental. Right.

Kristin Jankowski: Yeah.

Megan Sprinkle: And the reason why, again, I, I think this is so important, is one important to spread that across the team

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: we need to make sure that. Everyone is in that mindset to kinda keep us accountable and keep us in that positive open mindset. 'cause you never know

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: you, like, you may not have known that that nurse just lost her job. Or

Kristin Jankowski: Right?

Megan Sprinkle: don't know what is going on in these people's lives.

It's human nature to kind of fill in the gaps, but, , to make sure that we keep that. Mindset because I think it is so important for our own mental [00:47:00] health

Kristin Jankowski: Mm-hmm. It absolutely.

Megan Sprinkle: assume, if we are empathetic, if we're not judgmental, that we're going in with, , curiosity. And I think that is just a powerful tool, beneficial for every, everyone involved.

Kristin Jankowski: I really agree with that and I love how you phrased that. 'cause I know we talked about that before 'cause we coach the students a lot about approaching every situation with curiosity and without assumption. And if you do that like, like you mentioned, A, it's just healthier and B, it's so much more fun and you're gonna be able to, to create care plans, diagnostic plans that work for that client, patient, provider, trio, , you can come up with something, really something for everyone and. You might be surprised what that something is, but if you approach it that you, you know, have no judgment of past decisions, care options, opportunities, but just like, [00:48:00] I'm so glad you're here today.

Let's talk about what your goals are and what I can do to help you. And even if that list of things that you can do to help is more limited for some clients, that's okay. We just need to rethink what excellence means, and excellence, I think means finding a good fit for that client patient pair in the moment.

So, I think the potential for practitioners and the whole team, like you mentioned to feel better, so starting from the front desk, you know, if the CSR approaches, like, I am so glad you're here today. Even just starting the money conversation early, would you like to hear about payment options we have available at our clinic, like right from right outta the gate?

Do you know? So, it's not like, Ooh, I'm so shameful about the money talk. , Nope. Our open door courses are coaching people on, everyone needs to start to get comfortable about talking about finances because it's just the elephant in the room. And, and it'll just feel better to talk about options rather than you [00:49:00] get all the way to the end of the exam, and then the estimate's presented the first time, and then that's the first time it comes up. You know, that's way late because then there's a lot of anxieties often built up by the client versus, you know, if it comes about with no shame, you know, we're trying to take the shame out of it, and I, I bring it up as like when you go to the orthodontist, , there's money talk right away, but in a nonjudgmental way. Like, you know, here are the general costs for the braces and we have this pay overtime and this pay up front and to any of these interest to you, or would you like to look at something else? You know? And it's, it's not just like, Ooh, you can't pay at the time of service.

Like, that's, that's bad. You know, it's, no, that's not bad. Let's just talk about options. You know? So I think taking the shame out of that having the whole team really embrace that mentality of, I'm so happy you're here today. What can we come up with together that's gonna work for you? When we go out after work, it'll be for fun rather [00:50:00] than commiserating together.

Do you know? And not to say that everything's gonna be, you know, rainbows and unicorns 'cause they're always are gonna be hard situations. So just. Finding, , ways to handle those in a healthy way too are really helpful. We actually have a full-time social worker on staff at Open Door, and so we're working to create content for veterinary practices on social work related solutions. Like if you don't have a social worker at your practice, which most of them don't, we would all love to have that, but we don't. So like tools that you can use for your whole staff to deescalate rough situations. All kinds of things. Everything from dealing from euthanasia to dealing with a, a client who's upset about A, B, or C.

And so we're in the middle of working on that. so, practices have more options 'cause. Uh, Our job is hard, right? I mean, you can have all the challenge base and all the financial options, but still there are gonna be hard days. So, if we can come up with healthy ways [00:51:00] to, an easy ways to deal with them, do, you know, it can't be like, oh, I've gotta take this 12 hours CE course to learn how to manage it.

Like, no, we're gonna give you some actionables that you can use today. , And if you wanna take the 12 hour thing course, great if it exists somewhere, but there needs to be a range of choices, for your, for your care team to, to use little tools and tricks that can help them feel good at the end of the day.

So, I love that that's all being considered in spectrum of care. Do you know the health of the provider to, and how we need to, to keep working on that and how we can stay happy.

Megan Sprinkle: Yeah, I, I mean, going back to the, the mindset of curiosity, taking care of ourselves so that we can show up and

Not worried about eating or going to the bathroom or something

Kristin Jankowski: Yep.

Megan Sprinkle: Like those things will impact our conversation with the owner

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: able to be more curious and open with the owner. Builds better relationships with people,

Kristin Jankowski: Yep.

Megan Sprinkle: the [00:52:00] things people say, drive them nuts are

Kristin Jankowski: Yep.

Megan Sprinkle: the, the relationships with the pet parents. And so if we can work on those components, that's, you know, starts to solve these little things. And I say little, they're not little, but you know, the, these.

Kristin Jankowski: They add up. 

Megan Sprinkle: that add up

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: make it hard to enjoy our job

Kristin Jankowski: Yeah.

Megan Sprinkle: we can't do our job right. So, I love that there's a holistic approach, like you said, that there's so many different experts that are coming together

Kristin Jankowski: Mm-hmm.

Megan Sprinkle: uh. I think as, as you said, that

Kristin Jankowski: Yep.

Megan Sprinkle: a, a lot of very practical resources for people. And uh, like you said, there's a, there, I think there's a focus here. A lot of people are leaning in, and so not to be overwhelmed by the options, just pick one,

Kristin Jankowski: Yep.

Megan Sprinkle: and, and start to learn and build these tools. , I'm also excited for what you are doing, so I'm very excited to share this with everybody.

Kristin Jankowski: Amazing. Yeah, I love that you mentioned just the pick one [00:53:00] 'cause it any new. Skill development can be overwhelming. And so we often encourage people just to pick one thing that resonates with you and try that with your, with your whole team at work today, or even just start with you and then spread it out to your team once you feel comfortable.

, 'Cause change is hard and we get that. But if you start slowly, I think you'll be amazed at how you start to feel. And if our clients feel better, we feel better. Do you know 'cause. That's gonna reflect back on you. So, and then of course we always want the patients to feel better 'cause we're all, you know, in it for the animals first.

So I think that's gonna be a win all around.

Megan Sprinkle: Absolutely. And I always love to end the podcast with asking about gratitude. So

Kristin Jankowski: Mm.

Megan Sprinkle: thing that you're really grateful for that comes to your mind?

Kristin Jankowski: I'm so grateful to have the opportunity that. Like you and other groups like you are [00:54:00] interested in talking about this? Honestly, for on a professional level, that's what I'm very grateful for is that the topic is becoming more widely something of interest. And then in general, I'm really grateful for my, my human and animal family and how they put up with me and make me smile and laugh every day, even when the stuff that sometimes I'm working on is hard 'cause because making change is hard, but they keep me laughing. Keep me adventuring and that's what truly matters. And so, we want all the practitioners out there and,

teams to know, like, we get that you're gonna focus on what really matters too. Don't spend all your time learning about veterinary medicine.

You know, because we're all grateful for those other times, and that helps to, recharge us and refill our buckets so we can go back again. So mostly I'm grateful for that. 

Megan Sprinkle: A lot of resources for this episode. They are linked in the show notes, including more about the [00:55:00] AAVMC'S Spectrum of Care initiative. A few takeaways from today's conversation, spectrum of Care, or better said, contextualized care is about tailoring medicine to the unique circumstances of each patient and family.

And when we bring Spectrum of Care together with One Health Thinking, we open doors to more connected, accessible, and sustainable ways of practicing medicine for us, our clients and our patients. A special thank you to Dr. Kelly Cooper for supporting our ability to use the Buzzsprout platform. And if you found value in today's discussion, please follow the podcast, leave a review and share it with a colleague.

And as always, let's keep reimagining what's possible in veterinary life.