The rapid expansion of medical knowledge and technology following World War II led to the belief that a 4-year curriculum was no longer adequate for physician training. Postgraduate residency training in clinical specialties became the norm, and specialist certification became associated with increased prestige and was required to obtain hospital admitting privileges. The resulting dramatic decrease in the number of general practitioners led to the development of family medicine as a distinct specialty. Even to this day, however, family medicine garners less prestige and generates less income than do other physician specialties. In general, primary-care physicians earn less, take more appointments, and work longer hours than do other specialists, and the US Government Accounting Office reports that by 2020, demand for primary-care physicians will exceed supply.¹

Health-care research has shown that primary care is more cost-effective than other types of health care and that preventive care, coordination of care for the chronically ill, and continuity of care—all hallmarks of family medicine—result in improved patient outcomes. In response, the human medical profession has begun to develop a greater interest in the concept of the patient-centered medical home (PCMH).² The term was first introduced by the American Academy of Pediatrics in 1967, and a PCMH was originally envisioned as a central location for archiving a child's medical record.² The term now refers to a team-based health-care delivery model that provides comprehensive, continuous medical care to patients, with the goal of maximizing health outcomes. According to a set of joint principles² developed by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association, a PCMH offers the following benefits:

• • Facilitates partnerships between patients, providers, and families.

• • Provides a route for receiving preventive, acute, chronic, and end-of-life services in one place.

• • Provides for a personal physician of choice who has a comprehensive knowledge of a patient's medical conditions and coordinates care within an expanded health-care system.

• • Allows the practice to advocate for the patient to achieve optimal, patient-centered outcomes.

• • Encourages the practice to engage in relationship-centered care.

Currently, the veterinary medical profession appears to be following much the same path the human medical profession took during the middle part of the last century, with ever-increasing numbers of veterinary college graduates pursuing specialty certification. In addition, the veterinary medical teaching hospitals have become tertiary referral institutions, with the result that students graduate with a knowledge of and an appreciation for the most advanced diagnostic and therapeutic medical techniques. Given this awareness of the many levels of care available to clients and their animals and mindful of their own lack of experience, many new graduates become fearful that any attempt on their part to address medical and surgical diseases, beyond providing baseline diagnostic testing and treatment, equates to practicing below the standard of care. Students graduate with a bias toward early referral, with resulting impacts on the economics of veterinary care for both pet owners and general veterinary practices and on the level of care patients receive. The challenge for the veterinary profession, then, becomes how to drive competency and confidence in general veterinary practice to improve patient outcomes by emphasizing preventive care, coordination of care, and continuity of care.

The 2010 Bayer Veterinary Care Usage Study³ examined factors contributing to the recent decline in the number of veterinary visits in the United States, which began before the global recession of 2009. Three factors from that study³ are pertinent to this discussion: a lack of understanding of the value of an annual health evaluation, fragmentation of options available for clients seeking veterinary services, and concerns about the cost of veterinary care.

For many decades, veterinarians used annual vaccination as a method to induce owners to have their pets examined on a yearly basis. With the recent shift in protocols, however, vaccination is no longer a driving force for annual health evaluations, and veterinarians have not adequately conveyed to owners the benefits of an annual health evaluation, including, most importantly, a full physical examination and, in terms of wellness care, zoonotic disease management and preventive health screening.

Owners concerned about the costs of veterinary care have naturally turned to vaccination clinics and other low-cost vaccination options, resulting in fragmentation of veterinary care and further de-emphasizing the importance of an annual health examination. Improvements in animal shelter facilities have led many of these facilities to offer enhanced care, including spaying or neutering and pediatric wellness services, but this may hinder the establishment of a long-term primary-care relationship.

The growth of multidoctor veterinary practices may allow veterinarians to provide higher-quality medical care overall, but may also further fragment veterinary care options. Clients have a definite preference for seeing the same veterinarian during multiple visits,⁴ and an inability to develop a relationship with a single veterinarian in a multidoctor practice may adversely impact patient care.

Finally, client perceptions regarding the cost of veterinary care and recent increases in the cost of care have contributed to the decline in the number of veterinary visits.³ As a profession, we have succeeded in the goal of charging for what we do, but failed to convey the value of what we charge for. As a result, we must now scramble to generate an understanding of the value of veterinary care, particularly in regard to the value of preventive health care in keeping overall health-care costs down.

Both the history of human medical care and the Bayer Veterinary Care Usage Study³ provide evidence that the status quo in the veterinary profession is not sustainable over the long run. How then do we convey the importance of preventive care, both economically and in terms of enhancing the human-animal bond; coordinate the care provided to individual animals, including care provided by specialists; and facilitate continuity of care throughout an animal's life?

If the experiences of the human medical profession are any guide, we should combine the concepts of veterinary family practice (VFP) with the idea of relationship-centered care into a model similar to the concept of the PCMH. This requires more than just providing high-quality, evidence-based medicine with a customer service mentality; it also entails ensuring that every pet has a primary-care veterinarian who would seek to develop and maintain a comprehensive knowledge of that pet within the context of its life and medical conditions.

Our goal should be to educate veterinary students and veterinarians about the value of VFP and the skills required to practice at this level. While traditional clinical skills are certainly a part of this, a wide variety of other related skills, including client communication, team coordination, patient-centered care, and relationship-based care, will also be required. The veterinary profession has the knowledge and technology to substantially extend the lives of pets. Moving toward a strong concept of VFP will enhance our ability to use that knowledge and technology while ensuring that we are meeting the needs of our clients and their pets.