From Anesthesiologist to Accessible Veterinary Care (Dr. Emily McCobb)

Do we need to reimagine veterinary medicine?

The career path of Vet Life Reimagined guest, Emily McCobb, DVM, MS, DACVAA  is all about reimagining; it's about animal welfare, openness, and compassion; about exploring new models of accessible care for pets and of education for veterinary students that creates competent, confident, and happy veterinarians. 

Dr. Emily is a board-certified veterinary anesthesiologist whose passion for animal welfare led her to support shelter medicine in academic settings and later inherited student-led community initiatives, opening her up to a whole new career path. Dr. Emily worked at Tufts for many years, but in August 2024, she accepted a position at UC Davis as the inaugural PetSmart Charities Endowed Chair of Accessible Veterinary Care, where she brings her expertise to foster innovation of new models of accessible veterinary care across the US. 

Resources:

• Episode on YouTube
• Press Release of "Endowed Chair in Accessible Veterinary Care Named at UC Davis"
• 2024 AAHA Community Practice Care Guidelines for Small Animal Practice

Transcript

Emily McCobb: [00:00:00] We need to radically reimagine the field of veterinary medicine because we have not been serving all of the animals in the country that need care.

I got interested in accessible veterinary care again because my students kind of dragged me kicking and screaming into it.

Megan Sprinkle: Welcome to Vet Life Reimagined. How does a boarded veterinary anesthesiologist become a faculty advisor for a student led community veterinary care program? And now in an access to care role funded by the largest grant in the history of PetSmart Charities. I'm excited to share my conversation today with our guest, Dr.

Emily McCobb. One. Her journey is full of serendipity, which I always find fun and fascinating. She quickly learned what she liked and didn't like in her internship at Angel after vet school. Yet she was open to experiences that led her down a path she wouldn't naturally go, and you will see how grateful she is now,

as she is in a one of a kind [00:01:00] opportunity as the inaugural PetSmart Charities endowed chair in accessible veterinary care. I met Dr. Emily because she was recommended by a previous guest, Dr. Jules Benson, who met her at the Veterinary Innovation Summit and said he was very impressed by her and her unique perspective in spectrum of care.

And he was right. Emily has always had a heart for animal welfare and she shares how specializing in anesthesia allowed her to follow that interest and how through twist and turn, she is now advocating that we need to reimagine the veterinary profession. We discuss what accessible care really means, how we can evolve our approach to teaching and practice, and why the next generation of veterinarians might just hold the keys to the future of our profession.

I hope it's another conversation that reminds you to stay curious with your career. And highlight how many ways there are to make an impact in veterinary medicine. So [00:02:00] let's get to the conversation with Dr. Emily McCobb.

when did you know that you were interested in veterinary medicine?

Emily McCobb: Oh yeah, this is a good story. I tell my students this story all the time, so I remember being around 12 years old and I was like, I need to decide what to do with the rest of my life. I was like, well, I like animals and I like science. So the two things I could think about doing was being a veterinarian or being a dog trainer. And I was like, well, I kind of like science, so I guess I'll go be a veterinarian. And then from that point on, I was kind of on a systematic path to just be a veterinarian.

Megan Sprinkle: Yes. And I remember you telling me, luckily, even though those were the only two options, you knew about the time you were, you, you're happy with your career path that you went that direction. Is there anything else that you can remember from growing up or, you know, before we get to college and vet school that you remember fondly?

It just [00:03:00] maybe something that stands out that kind of says a little bit about who you are as a person or kind of foreshadows a little bit of anything in your career. 

Emily McCobb: know, I was lucky that I could start working at a vet clinic from the time I was 14. And when I talk to young people now, a lot of times they don't feel like those doors are open to them. And I used to do stuff like. Wipe down the chairs in the waiting room that kind of stuff.

But it was just good to like be part of it. So I encourage young people to try to take advantage of those opportunities. And the other thing I remember from being a kid is that back then it wasn't like today where people really had their animals in every aspects of their lives. Like my family, usually the dogs were outside.

We would feed them like by scraping the plates and then the dogs would eat that. And I was always outside with the dogs while everyone else was inside, especially on holidays and things. So that was probably the foreshadowing.

Megan Sprinkle: It was meant to be. So, [00:04:00] uh, love that. Well, so let's go fast forward just a little bit. As you are, you know, college and getting into vet school, um, is there anything that you remember about thinking about getting into vet school and maybe what you thought your career might look like one day, and then did that evolve over the time of vet school?

Emily McCobb: Yeah, not so much in vet school, but after vet school, I remember like very systematically going through the process, like documenting the hours of clinical experience I needed to have in order to apply. Back then, you know, the dream was to come to UC Davis, and they had a requirement for 400 clinical hours. so did that, and you know, we had books on how to get into vet schools before, like the web or anything like that. So there was this thing called the pre veterinary Planning Guide, and there was another book that had every school listed and all the different requirements. So you would actually look in the [00:05:00] book and then figure out what schools you could apply to. , But then coming to vet school, I thought I wanted to be an internist because I really, really liked, um, physiology, and I thought that was the best way to like get to do physiology is to do medicine. Um, so that was kind of the path that I was planning and I actually really had a hard time in my internship because that's when I realized that. It was not like it was in the books, you know, like a lot of the animals wouldn't do what the book said. You know, I would like, I, I did the things I read about this disease, I put 'em on prednisone and it didn't get better. And I found that really frustrating. Like that, that whole like, you know, medicine is an art form that was really hard for me.

I'm very, I'm very black and white when it comes to medicine, which is, and I think what drove me eventually into anesthesia, because it's much more simple in that regard. It is kind of like cooking, like there's recipes. You follow the recipes and usually have good results.

Megan Sprinkle: I think that's so good to start [00:06:00] to learn about yourself though. 'cause I mean, despite a lot of similar characteristics to individuals coming into veterinary medicine, there's still a lot of diversity and how we think and how we prefer to live, you know, one day to the next or one patient to the next. And so that's really good insight.

And so when, when you were describing, you know, your experience before vet school, it sounded like a lot of general practice work. So where did you realize that there was specialty medicine? 'cause I know a lot of people who go in, it's like "there's specialties?!" So how did you get kinda exposure there?

Emily McCobb: Yeah. I think I graduated in 2000, so that was kind of the right when all the specialties were really taken off. You know, even back then there weren't any anesthesiologists in private practice at all.

Megan Sprinkle: Oh.

Emily McCobb: Um, so specialists were really the domain of university, and it was not something that I ever thought I would go into. And I wasn't even planning to do an internship. I really was planning to go into general practice or [00:07:00] do you know, medicine. And then I remember, and this, this will become important when we talk about what I do now, I specifically remember a faculty member coming up to me and saying, you have to do an internship or you're gonna be a terrible veterinarian and you have to do it at Angel. And at the time there was a phenomenal faculty that we had worked with who had just gone to Angel. So that, I think the angel bit mostly came from that faculty. So I went to Angell and it turned out to be really impactful for my career because. That hospital, um, as most people know, is owned by the M-S-P-C-A.

So it was where I first got involved in shelter medicine. It's where I first worked in a shelter where I met one of my early friends and mentors, Dr. Martha Smith Blackmore. She was there, um, just a few classes ahead of me and a lot of the things that went on to influence what I studied in terms of animal cruelty and the balancing law enforcement and dealing with clients that didn't have economic resources.

A lot of [00:08:00] those were based on early experiences I had on my internship in Boston and I loved it at Angell. I still love Angell. It's one of the most amazing hospitals. I tell the students to go to Angell. But I hated being a veterinarian. and everyone said, oh, it's just 'cause you're at Angell and you're working a hundred hours a week.

And I was like, no, I really hate being a veterinarian, and so I kind of had this crisis of, you know, what have I done? I've been have been on this plan since I was 12 and I absolutely hate it. And people was like, well, you, you know, you didn't know what you were getting into. I was like, no. I was, I've been a technician, you know, I

Megan Sprinkle: Yeah.

Emily McCobb: since I was 14. I knew what this is. I just personally. Was really overwhelmed with clients that were relying on me and really frustrated with myself when I didn't know the answers. But when I was happiest, I was with the anesthesiologist. So I really looked up to that person. I think that's what a lot of students do, you know, they meet a specialist or a faculty member that inspires them and they kind of wanna model their career on that, which is why it's so [00:09:00] important for our students to be with general practitioners if we want students to go into general practice That's kind of when I first started thinking about specialty. But in between, I went to graduate school and did research on stress and cats and started working more in shelters. And I worked in private practice for three years and eventually I went back into anesthesia because it was a way to get into animal welfare.

It's a very animal welfare center discipline, but also with my personality. I don't have the patience for that art form. The sort of like communication, the guidance, all of that that you need to do to help somebody with their animal through a complicated medical condition. I love where anesthesia's like you give it to me.

I hopefully don't break it, keep it alive, I give it back to you and I go on to the next thing. And I love kind of the big picture organization. It's almost like being an air traffic controller where you're kind of, you know, mapping out everything that happens. I love protocols and helping [00:10:00] people think through cases, but in that sort of short window of time.

So for me it was a great specialty and it really was a launching point to be able to work in academic medicine. But I love the journey that I took. I don't know if I would've done the same thing now. And I'm excited that there's so many opportunities for students now that they don't necessarily have to specialize to be in academic medicine or, um, there's so many more options now than when I was coming up.

Megan Sprinkle: Yeah, which is why we have this podcast. So, um, this is fascinating 'cause the other thing is, reflecting on what you do now and 'cause you work with access to care, which to me, you know, how we're trying to approach this, it's more of a contextualized care requires the art, uh, of practice.

So this will be interesting to like tie, tie this all together. So for people who are, you know, thinking more like you and how this can all tie in together into [00:11:00] a very similar mission. So I wanna go to something you, you said about anesthesia and you said that it's a very welfare focused specialty. Can you elaborate on that?

And, and maybe for people who aren't as involved with understanding a career in anesthesia, how that is so aligned with welfare.

Emily McCobb: I mean, a couple of things. So one is kind of being that advocate for the patient. And so, especially if you're working in a hospitalized setting, a lot of times, you know, we're not the primary doctor. And our job is to kind of facilitate what happens to the patient if it needs imaging or surgery or whatever reason they're having anesthesia and, and then safety. So we're often the one that's really kind of guiding that patient through its journey in the hospital and making sure it kind of, all the steps are made. You know, sometimes it's multiple services are working on the animal, [00:12:00] so we have to coordinate all those conversations.

We have to really think ahead, , if the surgeon's gonna need a certain thing to be done, it's our job to make sure that, you know, we get it where it needs to go. We like do this in a timely fashion. , But we're also the ones that are thinking about comfort and pain and positioning and how we carry the animal, , keeping the animal warm, all of those types of things.

So it's very impactful as far as how we can influence the impact in these kind of, you know, sort of small ways, but then, um, or the outcome, sorry, but then. The other thing is, , I always used to call it kind of a selfish specialty, which again, it's ironic now with what I do because I used to struggle a lot with, , coming up with a treatment plan that would work for the owner. And anesthesia never has to do that really because someone else has already had those really difficult conversations, right? And so by the time it comes to me, all I have to do is do my best to take care of the animal and make sure everything goes well. Now I also did, you know, chronic pain [00:13:00] management and palliative care and things like that when I was in practice as an anesthesiologist.

So that was a little bit, you know, more where you're really, again, maintaining patient welfare, keeping them pain free and all that. But in a hospital setting, the anesthesiologist is mostly shielded from the really tough conversations. And so I think, for me, that was, with the training I had, that was probably what I needed for my mental health was to just kind of not deal all that tension. But now I can use those, , struggles that I had as I teach students about, you know, if I had, I had had training in spectrum of care and had training about these different options and we were more comfortable with contextualized care, I don't think I would've had as a hard time in practice as I did. , So I'm glad I was in practice because it gave me a lot of insights that I can share with the students and help them decide. And I love the fact that I've worked in all the, those different types of settings. I've worked in a shelter, I've worked in a regular private practice, I've worked in a specialty private practice, I've worked in an academic hospital, , and I've worked in a [00:14:00] low cost clinic so I can meet the students where they are as far as them getting all those experiences and understanding kind of the rich fabric. You know, most of the time when we talk about spectrum of care, we're talking about options for that patient. But I also think spectrum of care is the full spectrum of things that we can do in our field. So that to me is spectrum of care too. The fact that we have all these different settings and we need, you know, kind of to your point, different skills and expertise and experiences and passions. And that is something that I learned is that there is a niche for everyone. You may not know what it is when you start off. It may not even exist when you start off and it will change over time. You know, people reinvent themselves, so every 10, 15 years you can go and do something else. And there's plenty of space in that big spectrum for that. , And everything you bring with you from your last, you know, sort of vision of yourself just adds richness to what you do the next phase.

Megan Sprinkle: [00:15:00] Exactly. Just like someone said you had to go to Angel and, , probably for a very different reason that you now say Angel is a, is the place to go. And I actually, I don't think I had connected the ownership of Angel. So for those who aren't familiar, it's, it's a ginormous hospital and I think they now have another location maybe,

Emily McCobb: They used to have one in Springfield, mass. Now they have it in, I think it's in Walham Mass.

Megan Sprinkle: okay.

Emily McCobb: it's a, it's a satellite, to Angel. Yeah. But they've always been owned by the M-S-P-C-A and they've always had animal welfare at the heart of their mission. , And it's funny because I always tell the students now. you should never feel like you have to do an internship or you have to go any specific place. Like, I think if we haven't trained the student that they can be in general practice, then we're not doing our jobs in veterinary education. , But I'm kind of glad someone said that to me because of course I love my experience at Angel and it was such a door opener for me and I want, you know, people to have that if they want. But also when we started [00:16:00] thinking differently about it, I, you know, I know it's true when students say like, they felt pressure to go in a certain direction.

I, hundred percent know that that's true, that they do get that pressure and, , I think it's better if we can help the students figure out where they're gonna do best for themselves rather than put that pressure on them.

Megan Sprinkle: Yeah. Contextualize care for the students. Yes. I like that. Uh, well, so this is again fascinating. , You also said at this, uh, or at least when you were starting a, a lot of this specialty medicine was very heavily academic, uh, especially when it comes to anesthesia. , When you went to Tufts, do you mind, , sharing your career journey, getting you to Tufts?

'cause you did a lot there and I'd love to kind of dive in there.

Emily McCobb: well I went to Tufts, , for veterinary school and I did end up getting into uc, Davis, but I ended up going to Tufts because my husband, , wanted to be in a bigger So we went to Boston 'cause it was better for him, and then, , was at [00:17:00] Angel. Then I went back to Tufts and I have a Master's in Animals and Public Policy, which is a unique program that they have there that really starts to bridge animal welfare and veterinary medicine together. and then, , from there I was in private practice. , And then when I came back to Tufts for my anesthesia residency, I was working with some faculty in welfare related projects while I was there. And then when I finished my residency, I had two job options. I could either. Uh, assuming I was hired, , apply for a job in, , Montreal, which would've been a university type anesthesia job. but the problem was it would've had to been in French. Um, and my French at the time was reasonable, but I didn't think I could teach in French. , And now I could not do that. Um, and the other option was Tufts was opening a private specialty hospital in Walpole, mass, which is, um, kind of near Foxborough, where the Patriots, the [00:18:00] football team play. , And so they basically hired my entire residency class. So the first couple internists, the first surgeon, the first anesthesiologist, , and then some of the ECC people, um, were all residents at Tufts had trained, and then they opened this, specialty hospital. So that was kind of the next step. And it turned out really good for me because I learned how to build a service from the ground up.

So the surgeon and I, , you know, we had to hire the technicians and figure out what would the training for the technicians be and what would, you know, what would it be like when they were on call And even, like, what would we order to make the pacs and all of that? , And I, at the time I knew of, um. One, I think one other anesthesiologist in private practice at the time. , But since then, , I think while I was at Tufts, we trained, I think 12 anesthesia residents. And, many of them are in private practice. You know, two of them are at Angel and, so it, it's just, there's just a lot more options.

They, when they graduate [00:19:00] from their residencies now they have way more than two job possibilities.

Megan Sprinkle: Yes. I was so lucky that when I was an intern, it was a, a private referral practice in Chattanooga and towards the end of my internship we got , an anesthesiologist on staff. That was the best thing ever because anesthesia terrifi terrified and terrifies still, I, I can, uh, think back to it.

Um, so it was so fantastic to have them as, as part of , the team and uh, you know, just going back and picturing that air traffic controller, 'cause you're right, it's a lot of. A lot of things need anesthesia. It's, it's not just surgeries, right? Like it's, um, you know, pain management, a sedation that's, you know, for other things that the, the pet may need.

, So there's a lot of opportunity to overlap with lots of different specialties. So, yes, , I'm sure a lot of different opportunities now, and it's just grown, [00:20:00] so I'm still trying to connect the, you know, you're, you're setting up a service and probably realizing that there's a lot more detail than you ever thought that went into starting a service.

How did you keep your, , actions and interests involved around like, shelters and, and this interest around, access to care and all of that?

Emily McCobb: Yeah, well the next thing that happened, well this, so this hearkens back to my residency. So the next thing that happened was while I was a resident, we had a faculty member who had family in Nepal. And so for years they sent students to Nepal on various projects. They worked with elephants, they did a bunch of different things, but she got involved in rabies control efforts in Nepal. And you know, in India and Nepal, they still have a lot of rabies in the free roaming dog population. And all over the world they have this problem. Um, and in India they've had some very successful, what they call [00:21:00] animal birth control or A BC programs where they set up spay neuter clinics in these urban settings and they spay, neuter and rabies vaccinate the community dogs. And there's some good data out of, you know, iPhone I, icam and some different other agencies over, you know, the past 20, 25 years where they've demonstrated if you have these programs, you can drive the rabies r ates down, um, and the lots and lots, I forget the numbers, but it's like thousands of children, , are infected by rabies through dog bites.

And so it's really important for human and animal welfare to, control rabies. So anyways, at the time, the, , vet school in Nepal was interested in, sort of learning how they did this in India. So we got sent over myself and one of the surgeons to help the vet school in Nepal set up a training program for dogs, for spay. , Because most of the veterinarians at the time, they would work with poultry or they'd work with water buffalo. Not that many of them would work in [00:22:00] small animal. And if they did do small animal, they were in the city. so they just didn't have enough vets who were trained in small animal. They wanted to get trained, they had to go to Japan. so we went and we actually brought the first, , anesthesia machine that was used in veterinary school in Nepal, in our luggage. , It was very big. It was, it was a tabletop machine, but it was heavy. And I remember reading that the, , 'cause you had to fly to Kathmandu and then you had to take another plane to Chiwan where the vet school was, and I remember reading that the most common cause of airplane crashes in Nepal was, , overloaded luggage. And if you've ever flown with me, you know, I'm a very nervous flyer. So that was not a great thing for me to be reading. but anyways, so that was, you know, over 20 years ago now, and we went and we had a great time with the students there helping them. we had two, , teachers who came from India where they worked in a, the clinic in Raan who taught us how they worked with community dogs. [00:23:00] And then we worked together to create a program there. as we were going through, like, teaching these students about sterility, about gowning and gloving, about, you know, putting packs together, the surgeon and I looked at each other.

This was in 2004, and we were like, you know, we don't, we don't do this in the United States. We don't teach our students how to do this stuff. and that kind of got things started for us. And so she started a surgical rotation for students in fourth year where they would get to do spays and neuter.

'cause you could graduate. And in fact, you still can graduate from, , many vet schools with only spaying two dogs. You know the students at Tufts, they spay two dogs and anesthetized two dogs. I was just talking to someone at University of Pennsylvania today. I think they spay less than that. You know, Ross University, they spay one and a half dogs. Davis, they spay and neuter. They do about nine procedures, I think in their third year. But it's from zero to nine is what they'll do in [00:24:00] third year. And then the fourth year is kind of all over the map. So we're still not quite where we need to be for surgical training. , But that led to us really scaling up what we did in our on-campus spay neuter clinic at Tufts, which led to our founding, our larger, , shelter, medicine and community medicine program. And our sort of last step at Tufts for community medicine was a full service, , access to care clinic. , So we opened that in 2012. So that's kind of how I went from anesthesia to spay, neuter to, and, , I had always been involved in shelter med. , And so , we worked as a group, , I was, , kind of representing the spay neuter side, but had a colleague in the medicine side and the surgery side to try to respond to our local animal welfare community to do more for teaching the students. , And then it's, it's been amazing to come to UC Davis, where Kate Hurley and the Koret Shelter medicine program are, which is one of the leading shelter medicine programs in the [00:25:00] world. And this is where that discipline as an academic discipline arguably, , first started, like the first residents trained in shelter medicine were trained here. , So it's been kind of an interesting full circle to get back here.

Megan Sprinkle: Yeah. Well that is so exciting. And, and yes, I have heard of the, the Tufts clinic. It sounds like such a good experience. And I came from one of those schools that you had to spay. I think you said like one and a half and I'm, I'm assuming the half is like you switch in the middle of it. Right. O okay.

I was kind of like that. Oh, one and a half. Um. Yeah. Right. Yeah. But, , you know, the other thing I haven't really asked you about too, and, and I, again, we did talk about that the career path options seemed narrow in, in academia was, was one of the big ways to go.

But especially hearing you talk and knowing a little bit about you, you seem like you also have a really big heart for teaching. [00:26:00] So where did, like, did you kind of figure that out or you develop it? What, where did that kind of come in as well?

Emily McCobb: it's a great question. And now there's so much more emphasis on teaching and academics but you know, we weren't taught to be teachers. I remember when I was applying for residency, there was questions about teaching and I remember writing how I wanted to teach and work with the students, but it almost was like, it's something, you know, you have to say that you wanna do.

And I do find a lot of residents don't think deeply about that, although they enjoy teaching and the students love, , interacting with their residents and the interns 'cause they're closer to their age usually, and their at least closer to their level of experience. And so, you know, we have this whole population of folks that do a ton of teaching. , And so I think it's just the joy of, you know, getting to share your knowledge with other people. But. Honestly, when I first was an anesthesiologist, I wasn't really motivated by [00:27:00] teaching. I was motivated by animal welfare. So I wanted to do the best for my individual patient. And then what happened was I got involved with the primary care veterinary educators, which is a sub, it's a subgroup under the A-A-V-M-C, which is the group that sort of oversees all of the schools. And they, they started having an annual conference in like 2008 or 2009. And this is when they would bring general practitioners who taught primary care at all the vet schools to gather for one conference. And when we first started going, it was really small. There was only like maybe 20, 25, 30 of these educators out there. , And when they sent the invitation to Tufts, they had asked the nutritionist, Dr. Lisa Freeman, who's pretty famous in nutrition, to come and give a talk. They said, bring your primary care people. And she was like, well, we don't have primary care. She's like, Hey, Emily, shelter medicine's kind of like primary care.

Why don't you come? So there were a [00:28:00] few schools that were like that, that didn't really have primary care for whatever reason, had sent their shelter people. And I was like, oh, this is a really great meeting. Like I had never been to a meeting that was really focused on supporting these faculty and being better educators, teaching 'em about teaching. , It was a hard job because they were rare as non-specialists teaching. And a lot of times they had struggles. You know, they felt like they were looked down upon. Some schools, they're not allowed to be faculty. They don't get promoted as much as the other faculty.

They don't, they're usually on clinics 90 to a hundred percent of the time, which means that they don't have as much time to like do research and other things that faculty get evaluated on. Now fast forward, , what is that? Oh, almost 20 years later. , It's an international group. It's got hundreds of members.

Most of the primary care teams at the schools are much bigger. We have some schools like RVC and the, schools in the UK where they've flipped their [00:29:00] percentages. So instead of spending the majority of their time in the specialty teaching hospital and a little bit of time in practice, they have to spend, I think it's 60% of their time in first opinion practice.

So there's a way more general practitioner educators over there. And so you're definitely seeing a lot more emphasis on education and teaching and whatever. and then I was like, oh, , 'cause then by that time, Tufts had their own primary care. , And our primary care team goes to this meeting now I thought, you know, oh, are they gonna kick me out now?

Because I'm like the specialist kind of like hiding under the desk. but I kept going 'cause it's such a good meeting. And what I realized was having this understanding of general practice and wanting that to be a career option for students. You know, we wanna have a better balance. Like we can't, we can't send the majority of our students into specialty practice and expect to have a veterinary medicine that clients are gonna be able to afford. Like we really have to balance that out [00:30:00] where we are celebrating. It's kinda like family medicine in human healthcare. Like we really need to celebrate the family medicine, the general practitioners, the people that can do a little bit of everything because that's the way that we can keep the cost to be lower.

And that's really, it's really fun for people that like to do surgery and medicine and you know, all a little bit of everything dentistry. So anyways, that was kind of an epiphany I had, but also I realized that I was a much better anesthesiologist as an instructor when I started thinking less about my goals and my goals for the animal and more about the students' goals.

Not that I don't worry about the animal and the animal welfare, I still care about that. But I also wanna know from the student, , what is it that you wanna do in your career? Where do you see yourself the year after graduation? And how can we take this case? And usually it's a crazy case with like four or five, you know, it's something that the regular vet, the referring vet, did not want to anesthetize. So it's here for some, either it's having something [00:31:00] crazy that, you know, normal people don't do. , Or there's something crazy wrong with it or both. And you know, so that's why the students come out terrified 'cause they're like, it is terrifying. But I say, what from this crazy case is it might be relevant to whatever your path is.

You know, sometimes the students would say. They're gonna be a pathologist. I'm like, it's a lot harder for me to come up with something relevant, but the ones that are going to practice or the ones that, you know, wanna be whatever they wanna be, there's something we can talk about with the case that's gonna help them grow their skills. Um, and I, if I had not gotten involved with the primary care team, I don't think I would've started to think in that way about kind of that whole system.

Megan Sprinkle: Yeah. Well, and it sounds like it's a big part of what you're, you're interested in, and you speak about too, it is the educational component of our future veterinarians. Uh, and so I'm curious now that you ask them that question, like, where do you see yourself? What are they saying? , Do we have a lot of people that are [00:32:00] saying general practice?

Do we still have a lot of people leaning specialties? Like, I'm curious, what, what are, what are you hearing?

Emily McCobb: I think it depends. I think at Tufts we were really proud of the fact that , we got the students, um, ones that felt like they needed to do an internship, we lowered that percentage and that was like a point of pride for us. , And some of that is the Tufts at Tech experience where we really try to, , show them what it's like to be in practice and celebrate, bring in practice and empower them. Um, but, you know, and some of it is the economy and just different things like that. You know, there's a lot more students now saying they wanna go into mixed animal practice. I think people really enjoy the variety of species and getting to do a little bit of large and small, especially if they wanna go to like a more rural part of the country. and so I try to be open to the students and their passions and, I try not to shape them in those conversations, but I do tell them that [00:33:00] my job is to make sure that they feel ready to graduate and be in practice. And so I tell 'em, if you wanna do an internship, that will never hurt.

You know, it'll hurt you financially, , but it will never hurt you as far as giving you a lot of clinical experience in a really short amount of time. So I think it's a really useful training experience. It's really useful if you want additional mentorship, but we're seeing now lots and lots of private practice also build in mentorship, and we're trying to model that in community and shelter medicine where we want to put together mentorship opportunities so that we don't lose students who want to work in our space, but fear not having mentorship. So the idea is that they're prepared and then they can choose based on what they wanna do and not because they feel like they're not ready. That's the big thing that we've, we've been working really hard to try to change both at Tufts, but at a lot of the other schools, was we really want the students to be competent and confident when they graduate.

Megan Sprinkle: Yeah. So what do you think are [00:34:00] opportunities, maybe, maybe something you're currently working on, but maybe some additional opportunities that could improve? The ability for our new grads to feel more competent and confident going out.

Emily McCobb: The thing that Tufts does that, and this is Dr. Greg Wolf is, is responsible for this and his whole team there, they are the best at really putting the students in the driver's seat. So the students are the ones that the made conversations with their clients, uh, really have to come up with a treatment plan and on their own with support and then perform all of the diagnostics and treatments that are needed. And that is what empowers the students, I think, to really have that competence and confidence. And so. When we think about our educational experiences, I think there's just a limit to what a student can learn by watching and talking. We [00:35:00] we more and more, you know, you, if you find the student, they're like the one on the computer in the corner, and I wanna put the student, I want the instruments in their hands.

I want the hands of the student on the animals. So. Really working to make our rotations as hands-on and as empowering as we can do. , And a lot of us that have more traditional clinical training programs have a lot of work to do in that regard to make that possible. So we're working on opportunities with partners, , with different types of externships, different types of placements, and then also trying to work more with the future employers to understand, know, what are your, , challenges when you have newer graduates coming into your workforce.

You know, what are they not prepared to do that you need them to do, and where are the sort of pain points that we need to work on, , so , that they're able to kind of hit the ground running.

Megan Sprinkle: Yeah. You know, I have heard an example. It's not veterinary medicine. I think they're [00:36:00] actually, , airline engineers or is one of the specialties of this particular school. And every year they bring in some of the leading employers of these groups and they update. They're like, okay, so what, what type of skills do you need for them to learn?

And it's so neat because they are very agile with the way that they train to make sure that the candidates are relevant and ready to jump in and make a really good living, um, confidently and, and competently, like you said. So I, I think that's a, a really neat opportunity to also stay very connected with reality, both on the, the teaching side, right?

, But also to get the students ready for those, . And, and again, I think working in the, the low cost primary care clinic there I think is a great time. I've heard that people feel like they get a lot of hands-on experience. ' , the students feel like they have primary care. , Responsibility. , And then the other thing about, the low cost care [00:37:00] clinic is, I mean that's also an opportunity for them to start understanding the range of options that contextualize care that we keep talking about.

And that is a growing hot topic. and you know, you mentioned that you're now at uc, Davis, and you are the, the PetSmart Charities Endowed chair In A ccessible Veterinary Care. So do you mind sharing a little bit about maybe that transition, but then I, I would love to dive in and into more on your thoughts around accessible veterinary care and how that's gonna impact the future of the profession, but also the, the future of the professionals that's involved.

Emily McCobb: Yeah, absolutely. Um. this is a lot,

Megan Sprinkle: I know, sorry, that was.

Emily McCobb: Um, so one thing I would quickly say just before I lose it is that, , I do encourage anybody that wants to get involved, all the schools are really needing [00:38:00] practitioners to help them with their small group teaching PBLs case-based learning or volunteering in the clinics.

So anyone that. Especially, , if people are feeling, you know, in a rut, like a great way to remember how passionate you were about vet Med when you started is to go hang out with students. It's the best. So I would highly encourage anyone to do that if you get the opportunity and the schools need that.

And it's great way, as you said, to kind of have that flow of ideas and influence the next generation, but also have a good understanding of, you know, what we're working with. For myself. Yeah, I, I, this has been a, , an amazing, like once in a lifetime opportunity. , So I got interested in accessible veterinary care again because my students kind of dragged me kicking and screaming into it. So I had some students, Karen Roy was one of 'em, and Aziz was another who are both, leaders now. But, way back in 2008, Karen and her classmates were going by one of the high rises in Worcester and [00:39:00] which is a town in Massachusetts. And they were like, oh, look at all those people and little dogs, like maybe we could, do some vaccines there. And so they worked really hard for a number of years to figure out how to do an outreach program. So by the time I was finished at Tufts, we were in every public housing agency in the city of Worcester that allowed pets. And we would go once a week and we would provide exams and basic, vaccines to folks that were in , low income housing. And then that kind of aligned around the same time that, Tufts was thinking about trying to partner with the high school and set up their clinic. And it kind of opened our eyes to the fact that, there were just a lot of animals that weren't getting care. And we'd seen that in spay neuter. You know, there was some early studies around. How often do folks that are using low cost pay neuter go to the vet after that? Is it like an opening the door and, you know, we were hearing from folks that they weren't going because either, their animal wasn't sick, so they didn't perceive the value of, you know, wellness, which is [00:40:00] always a problem with everyone. But mostly it was because they, they didn't have the financial means. and this happens a lot, this is in any sort of program. If you talk to them, the spay neuter vets are like, oh yeah, you know, people have tried to come back to us for years. People would come back to us for euthanasia because in our, in their mind, like we were their vet and, and you're like, I spayed your animal 12 years ago. But like, we're their vet. And so we've really kind of started to form relationships with communities. And once you have that relationship, , pet owners everywhere are the same. They want the best for their pet. They want them to live long and happy lives, regardless of what their circumstances might be at that moment. And so, we've just taken this on more and more as a profession. So PetSmart Charities has put in an, an enormous investment into this. , They've put, you know, millions of dollars, into trying to move the needle for accessible veterinary care. And they have a number of really cool initiatives, but one of them was setting up an endowed chair at uc Davis.

So they committed $6 million, which is the largest [00:41:00] gift that the vet school, here , had gotten, , , that they, you know, that they had given any vet school for sure. , And what it does is it gives me the freedom to focus on accessible veterinary care in a way that I wouldn't have to do if I was, you know, writing grants and whatnot for my salary. And we're really just starting on this beginning of this field development. So what does the field of accessible veterinary care look like? What does that mean, , and how does that impact how we need to practice? And I, and I say often when we need to radically, reimagine, the field of veterinary medicine because we have not been serving all of the animals in the country that need care. and we're, we've all been part of this system. This is the system that we were brought up in. We sort of have this prevailing, you know, moral belief that pets were a luxury. And if you had a pet, , it was your obligation to be able to pay for veterinary care, which you know, I mean, I, I probably used to talk like that too.

You know, that, [00:42:00] that is what we thought and it came from our sort of profound compassion for animals and, sort of belief that, you know, we needed to do the best for them, but. It, it sort of belies the reality that, you know, 60 plus percent of Americans own pets and that's regardless of their financial circumstances. And if we say that we are a profession that protects animal welfare, , that needs to extend to all animals that we come into contact with. And so we really need to then figure out better ways of delivering services and it impacts everyone if, if animals don't have care. And then the other thing too is that, , we haven't been trained as veterinarians.

Most of us have not been trained in understanding the sort of systems and society that lead to things not being fair, that like lead to some having more than others and resources not being allocated [00:43:00] justly across groups. And so, trying to figure out, how to teach veterinarians about social justice and, you know, it's not like we can solve poverty as veterinarians or we can solve housing insecurity, but there is a lot that we can do better if we understand that, , we always as humans, I always think about Kimberly, Pope Robinson and she always goes to like the blame and shame and that's what we do as people.

And so we, we tend to blame people when they have challenges or when their animal has challenges rather than understanding these root causes. It is not a fair playing field. And if we don't, get away from that and just kind of meet people where they are, , there's no way out of it. So it's, it's really empowering once you start to learn these things and realize the harm that we've caused and how we can sort of undo some of these oppressions and try to do better.

And it does create some tense conversations. It creates some interesting, , alignments we tend [00:44:00] to define in veterinary medicine. Um, you know, right now, especially with the economy, all the talk is about door swings are being down and visits are down and everybody is worried about this. so we're defining, need by demand. So who's willing to pay for care? And that's demand and that's the economic definition of demand. But you know, that doesn't necessarily equal who needs care, who can afford care. And so I think where we run into problems though, is that. Because we're all super compassionate and we, none of us really feel good about this.

And we, as it is, we struggle to charge for our time and feel like, you know, how do we balance being a business while also wanting to do animal welfare? So we tend to put all this on ourselves, like, oh, it's my fault that all this is happening. It's like, no, this is a societal problem. This is a problem that our industry needs to confront.

So as an industry, we need to [00:45:00] solve the problem. I'm not saying that like each individual, veterinarian needs to offer low cost care, but the industry needs to figure out ways that we can have care at every different price point so that we can have care, for anyone that needs it.

Megan Sprinkle: Yes. And before I forget it, I wanna go back to something that you said, and you said that you got into access to care kicking and screaming because of students. So I feel like there's a story there I that I, I don't think we talked about. Do you mind backing up a little bit and explaining that comment a little bit?

Emily McCobb: remember, I'm an anesthesiologist at this point, so I, the idea of like going and standing in somebody's lobby where they usually play bingo and doing vaccinations not my cup of tea. but as in that time, my job was to oversee shelter medicine. And so I inherited this outreach program that the students had started with my predecessor. and I was like, all right, and you know, you, it, you just kind of, you realize [00:46:00] the impact you can have. These are the most, , devoted clients that I've ever worked with my whole career. And they so love their animal , and I think this happens with older Americans, regardless of where they live, like their world gets really small. , I see this with my mother-in-law who lives with me. Her world is very small, the things that she talks to me about. It's not as large as it is when you're working and you're going outta the house and things like that. And, and just imagine the role of the pet in that context. Their pet is their everything. So the opportunity to keep folks with their pets in their homes and keep them healthy is it's magic. , And the students just come alive in the environment. They're so excited to have conversations, to do this kind of care. You know, it's just very basic stuff. So yeah, it totally changed the whole path of my career. , And, uh, yeah, emotional thinking about it, but it wasn't anything I ever planned to do. But, you know, [00:47:00] we, we sort of learned, we learned from our students. I always say the best ideas that we've ever had, , come from the students. And I've been lucky to be at schools where, where they listen to the students.

Right. And when the students have a great idea, we're like, okay, let's try that. So that's been, that's been amazing.

Megan Sprinkle: Aw, that, that is amazing. , And I, you know, hopefully that's encouraging to people too, that we, we need to look multi-generational across our whole industry. , But, it's so good to hear that they saw the impact that they were having, , and they were not. Doing every x-ray ct, you know, all the things that a lot of times vet students are surrounded in academia.

Emily McCobb: Yeah.

Megan Sprinkle: the other thing you had said earlier was that, , when you were younger and you found it very challenging to talk to pet parents because of that, like it was their [00:48:00] stressful conversations. And if you had understand, understood this, that you might have been less stressed when having those conversations.

And here you are having conversations with, uh, pet parents or teaching kids or kids, sorry, vet students. Sorry, I'm old so you're all now

Emily McCobb: them kids too because they could be my

Megan Sprinkle: I know, right? Uh, so, you know, teaching vet students how to do this and, and so it's so neat to see this, the circle, , back here. , And I think it's a good point too because you said we're very compassionate and that we worry that on a moral level, is it okay to do this? And it was something that you had said in our, our pre-call and, and you said, doing your best in that contextualized care situation is not just okay, right? that is, , you're making a difference. . And so coming back to that comment about this is an industry [00:49:00] concern, we need to reimagine how we practice.

, So you can, if you wanna elaborate more on the industry level, but , what, what can we do on an individual level to contribute to that?

Emily McCobb: Well luckily there's a great new resource that just came out, which is the AAHA Community practice guidelines, that kind of talks about this. And they talk about a couple of things that any veterinarian can use. So one of the things that's in there is family centered care paradigm. So just this idea that, we wanna set it up as a family system and that, , anything that impacts any family member is gonna impact the rest of the family members, and the more we can get ourselves thinking that way, but also our allied professionals, right, in nursing and social work and those other disciplines, thinking that way too, t he better job we can do of taking care of folks. The other thing it talks about is community networks. So just, just even knowing what's in your community.

So if one of your clients can't afford services at your hospital, where could they go Or what services are available [00:50:00] for them? And then of course, thinking about the treatment plans and meeting clients, , where they are. That's another way too. And so, yeah, you're exactly right. It's something that industry has to do as a whole.

So we, we need to sort of collectively decide that we have a moral imperative to ensure that all the pets get care, but then each individual veterinarian doesn't necessarily have to change everything they do, right? Because there's a niche for them. But just being aware. The one thing that I think we really, really all need to change is we need to agree that some care has got to be better than no care. There's this idea now that if you cannot do what you think is the standard, like the high standard of care, that you don't have anything to offer the animal. And sometimes, you know, we don't have a choice, like our practice price point is such that, you know, we just cannot do anything at that point.

, And of course, you know, there are animals that there's nothing we can do 'cause their prognosis is grave or just the [00:51:00] resources is beyond, you know, what we can do. But most of the time there's something we can do in terms of palliative care, pain medicine, you know, simple treatment things. and I think that trying our best to help is always gonna be better than offering nothing.

And there's, there was a recent survey that PetSmart Charities did. They partnered with Gallup to do this survey of pet parents and how they were doing. And they found that for clients that declined a treatment option because of financial reasons, seven out of 10 said their veterinarian didn't offer them anything else. So just right there is something that like all of us can think about how we can change a little bit to help clients in those situations. I'm not saying that you need to lower your prices. I'm not saying that you can help every situation, but is there something that you can do for the budget that the client does have?

Or do you know someone in your community that can offer something at that budget? Or do you really think they should be considering euthanasia? And being honest and saying that, you know, I, [00:52:00] I think we struggle with this all the time, is how to have these hard conversations. But I do tell clients, , I would not feel like that it would be wrong to euthanize your animal and, and that unfortunately, euthanasia is always on the table for us.

I mean, I say unfortunately, but it's actually fortunate, right, that we have a tool to end suffering. , And just, you know, really putting that back on the client. So it's not our fault, it's not our fault as people, that the clients don't have resources or that our prices are what they are. But it's our job to help the client figure out what's best for them.

So if it's euthanasia, if it's an expensive treatment option, if it's a cheaper treatment option, if it's. if it's palliative care for a few days while they decide, you know, whatever their circumstances are, that's what contextualize care really means is that they decide, we don't decide. And the beauty of letting the client decide, I think, is that it frees us from the guilt of, 'cause what happens now is we offer something, client can't afford it, we [00:53:00] either don't do it, and then we feel bad, or we do something that we don't think is as good and we feel guilty.

We feel like we're bad vets because we didn't do the best for them. , And instead it's like, no, actually the client decided this. We worked it out. This is what's best for them in this circumstance. And then you can feel better about it. And kind of to where you started, I think if I had understood that better and didn't feel so responsible, and allow allowed the clients to really guide the treatment decisions, I probably would've had an easier time in practice. Ironically.

Megan Sprinkle: , Well, and, and yes, , we let the client ultimately decide, but it's not like we just like. Completely dump it and back off, right? Like it, it's working together so that that client has that educational background that we can provide and we are listening to the client to know between the client and the, and the individual pet.

Right? Like what actually makes sense. ' cause

Emily McCobb: exactly,

Megan Sprinkle: we used, we used to talk about this all the time [00:54:00] with, with senior pets and anesthesia is a great example, right? If you have an older pet, there's more risk to certain anesthetic procedures. And so you have to re evaluate what really makes sense for that individual.

 that's not a new concept, right? We, I've, we've been talking about that for a long time anyway, so to be able to overall, , start to think that way, I think is really exciting. We're about out of time, but what is something that you're really looking forward to right now?

'cause this is a, a little bit of a new, , opportunity for you. So anything specific that you're really excited about for your personal career and what you're working on?

Emily McCobb: , I'm just excited to get to kind of put some of these things, you know, into practice and just the fact that, you know, uc, Davis and other schools are recognizing this as a legitimate practice area and. I kind of wanted to end with something that you said, which is that this is not a new concept.

And a lot of times we call this [00:55:00] like back to the future medicine because I think that anybody that's been in practice for any length of time develops these skills, right? You sort of learn these things. You learn to work in partnership exec, like the way you described it was so beautiful. , And so I think what we're trying to do is figure out if there's like a shortcut.

Is there a way to get the students thinking like that faster and sooner so that they can get that sort of wisdom, sooner. , And, you know, we're still working on what that might look like, but I think getting them out there and getting their hands on cases, is a way to do that.

Megan Sprinkle: Yeah. Well that's wonderful. I can't wait to continue to follow the work that you're gonna do. , The last question I'd love to end on, , on a personal note, , and this can go beyond career, but love to ask, what is something that you're really grateful for right now?

Emily McCobb: Oh, grateful for. I'm just grateful for so, so many things like I'm, I'm, I'm mostly grateful about of my colleagues. The best part about this job is [00:56:00] being here with the most amazing veterinarians anywhere. , They're so smart, they're so accomplished, they're so inspiring. But also my colleagues at all the other schools, my favorite part of this job is getting to work with other faculty at other schools, and they lift me up and inspire me, you know, every day. , So that is what I'm grateful the most, just being part of this community. 

Megan Sprinkle: While some of Dr. Emily's journey she described going , kicking and screaming, her story is still a great example of how compassion and willingness to say yes to unexpected opportunities can lead to a meaningful and rewarding career. And she's in a position to do some incredible things to reimagine veterinary medicine as she is calling the profession to follow.

Not everyone needs to follow her specific focus, but we are a profession that advocates for animals and can provide resources to support each animal that comes to us. So we can serve animals and the people who love them in many [00:57:00] ways, whether it's like Dr. Emily through anesthesia, shelter medicine, or shaping the future of accessible care, there's room in veterinary medicine for creativity, innovation, and heart.

She also highlighted something crucial to the profession, the importance of helping young veterinarians become competent, confident, and happy in their work. That is my hope in creating a profession that truly thrives. A big thank you that. To Dr. McCab for sharing her story and insights and to Dr. Jules Benson for the wonderful recommendation.

You can find links to Dr. Emily's work at uc, Davis, and other resources in the show notes. I also wanna thank our podcast fan, Dr. Kelly Cooper, who contributes to the podcast platform that allows us to host this podcast that I love doing so much. If you enjoyed this episode, please follow the podcast, leave a rating and review, and most importantly, share it with a friend or colleague who might need a little inspiration on their own [00:58:00] veterinary journey.

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