The Ohio State UniversityCollege of Veterinary MedicineVeterinary Medical CenterSustainable Rural VeterinaryPractice in Jackson, Ohio

IndexTab A – Background and Context A White Paper: Establishing a Sustainable Rural VeterinaryPractice in Appalachian OhioTab B – Sustainable Rural Veterinary Practice providing full-service preventive,production, routine and emergency veterinary services for farm animals,horses and companion animalsTab C - Sustainable Rural Veterinary Practice providing full-service preventive,production, routine and emergency veterinary services for farm animalsTab D – Sustainable Rural Veterinary Practice providing limited-service preventive,production, routine and emergency veterinary services for farm animals

Tab A – Background and Context

Sustainable Rural Veterinary Practice in Jackson, OhioBackground and ContextBackground and ContextAppalachian Ohio consists of 29 counties located in the east-central, southeastern andsouthern areas of Ohio. Most of the counties in this region are considered economicallydistressed and people there live in poverty with an average per capita income of 18,009. The federal and state governments recognize the unique challenges ofcommunities in this area and have allocated resources to support economicdevelopment efforts in the region. The Governor’s Office of Appalachia (GOA) wascreated in 1988 to promote economic development in the Appalachian region of Ohiothrough advocacy and financial partnership. Its formation came roughly 20 years afterthe creation of the Appalachian Regional Commission (ARC) in Washington D.C., whenOhio officials realized that Appalachian Ohio needed a central office to coordinate itseconomic development and partnership endeavors.Veterinarians play a vital role in the social structure of rural communities and work at theinterfaces of human, animal and environmental health. These interfaces are constantlychanging due to a number of factors including alterations in land use; climate andenvironmental changes; interactions between domestic livestock and wildlife; creationand operation of large terrestrial and marine food production systems; microbial andchemical pollution of land and water resources; the development of antimicrobialresistant bacterial pathogens; and emerging infectious zoonotic diseases. The loss orabsence of veterinarians and veterinary practices in rural areas has a significant anddetrimental impact upon the community as a whole. Although veterinarians contributeto communities in many ways, one way that is particularly relevant to the AppalachianOhio community is by working to improve food animal production systems ensuring asafe food supply, facilitating livestock bio-security, and safeguarding from foreign animaldiseases. The safety of our food supply begins on our farms and healthy animalsproduce healthy food.Ohio’s number one industry is the 107 billion agricultural industry and it is a vitalindustry in Appalachian Ohio where there are many small family farms with livestock. Inthese 29 counties there are a total of 16,780 farms with an average of 579 farms percounty and an average of 144 acres per farm. The total number of animals (foodanimals, companion animals, horses and birds) in these counties is 11 million andaccording to the American Veterinary Medical Association, there were only 28 foodanimal veterinarians in these counties in 2008. Certain counties including Jackson andits surrounding counties appear to be underserved by the veterinary profession.Understanding the economic challenges that communities in the Appalachian Ohioregion face, and the significance the agricultural industry is to this region, livestockproducers approached the Ohio State College of Veterinary Medicine (CVM) with arequest to expand veterinary care in this region of the state. Subsequent to thismeeting, constituents from a variety of backgrounds, including producers, areaveterinarians, business, civic and community leaders, state and local governmentleaders, governmental agencies, were contacted and broader discussions were heldamong this group. In response to the request by these constituents, a White Paperi

Sustainable Rural Veterinary Practice in Jackson, OhioBackground and Context(See Appendix D) was prepared by the CVM in August 2011 in which a proposal waspresented to further explore two specific options to establish a sustainable ruralveterinary practice as a satellite of the Veterinary Medicine Center in Appalachian Ohio.The first option was to acquire an existing practice in the region and make the requiredrenovations to this facility or to renovate existing facilities in Jackson County currentlyoperated by the Ohio Agricultural Research and Development Center (OARDC). Thesecond option was to build a new stand-alone facility near one of the University’sextension offices.In November 2011, the CVM engaged John Schroepfer to assist with the preparation ofa business plan for the proposed veterinary practice to be established at the existingfacilities in Jackson County operated by OARDC. The business plan was developedthrough a process that utilized a variety of people and resources. The CVM providedMr. Schroepfer with resources to support the development of the business planincluding statistical data related to farm and pet animals and veterinarians in the 29Appalachian counties of Ohio. After speaking with veterinarians from rural practicesand reviewing travel times to county seats near the Jackson facility, it was determinedthat nine additional counties were serviceable from the OARDC facility in JacksonCounty. Most of the economic and market data for the 10 Appalachian counties weretaken from reports by the US Dept. of Agriculture, 2007 Census. The CVM providedcontact information for seven veterinarians practicing in rural communities of Ohio andtwo livestock producers in the Jackson County area. The following veterinarians werecontacted to provide practice recommendations for the business plans:1. Dr. Craig Miesse (rural mixed-animal practice in Mercer County)2. Dr. Scott Pendleton (mixed-animal practice in Harrison County – Appalachianregion)3. Dr. Doug Wiley (mixed-animal practice in Columbiana County – Appalachianregion)4. Dr. Jon Ellis (equine and farm animal practice in Greene County)5. Dr. Angie Dahse (primarily equine and farm animal practice in Gallia County –Appalachian region)6. Dr. Harold Kemp (rural large animal practice in Belmont County –Appalachian region)7. Dr. Valerie Anderson (rural primarily mixed animal practice in Jackson County– Appalachian region)Each of the veterinarians had established successful mixed animal practices or largeanimal practices in rural communities of Ohio and many were practicing in theAppalachian Ohio region. These veterinarian practitioners provided valuable insight intothe unique aspects of a successful rural veterinary practice and provided specificsuggestions regarding development of a sustainable practice in the Appalachian regionof Ohio. Their recommendations are the basis for the practice concepts included in thebusiness plan. The producers contacted to provide suggestions for the business planincluded:ii

Sustainable Rural Veterinary Practice in Jackson, OhioBackground and Context1. Jim Phillips – beef cattle, herd size of approximately 24 producing cows2. Dale Neal – beef cattle, herd size of approximately 20 to 25Producers were engaged to test key aspects and assumptions of the early drafts of thebusiness plan. Concepts from early drafts were discussed and modified based onfeedback from producers. The CVM also provided historical financial and census datafor the large animal practice in Marysville, Ohio which served as a basis for the revenueand expense projections of the proposed satellite facility in Jackson County.A meeting was convened on February 2, 2012 with a large and diverse group (see thelist below) of people with an interest in economic development and in theagricultural/commodity industries where discussions led to a better understanding ofseveral larger and significant issues impacting the Appalachian region, includingdeficiencies and gaps in the supply chain in the livestock and food production industry inAppalachian Ohio.Some of the key points that emerged during these discussions included: Veterinarians play a vital role in rural communities, such as serving topromote the health and well-being of animals and people, a resource forinfectious diseases in people, role models, professionals, community leaders,and mentors to motivate and inspire children, among others. Although not an exhaustive list, some of the deficiencies or gaps identifiedin Appalachian Ohio included a rather widespread lack of the uses,processingplants,freezers/coolers and other facilities), which limits the growth of the livestock orfood production industry in this region. There are real business opportunities related to livestock and agriculturalindustries in Appalachian Ohio.o The land in the Appalachian foothills is ideal for producingdifferentiated or value-added foods such as organic, locally grownfoods that can fill niche markets and/or open new markets. The Snowville Creamery in Pomeroy, Ohio is a fine example.o It is important to capitalize on the unique strengths of this region,including some of the finest pastures for growing pasture-rearedlivestock, including grass-fed beef and lamb, free-range meats such aspork and goat, and free-range poultry and eggs. Participants of the meeting discussed the need to better understand theculture and livestock rearing practices of the Appalachian Ohio area, and tonurture relationships, build trust among different constituents, and worktogether toward a common goal.o Pasture-reared meats using rotational grazing and othersustainable practices are aligned with goals of appropriate treatment ofanimals, the production of high quality food, which provides for goodhealth, and that can benefit the producers and region economically. Effective solutions will require an integrated approach to animal health thatincludes but not limited to plant and soil sciences, crop production, nutrition,reproduction, and veterinary medicine among others.iii

Sustainable Rural Veterinary Practice in Jackson, OhioBackground and Context Finding solutions to the complex and interconnected problems associatedwith the Appalachian Ohio region will require a bold, visionary andcollaborative (private-public partnership) approach among the broad anddiverse constituencies that are impacted by and/or impact economicdevelopment and agricultural/food production systems and industries.The participants in the meeting on February 2nd included the following:1. Lonnie King, DVM, Dean, OSU College of Veterinary Medicine2. Rustin Moore, DVM, Associate Dean, OSU College of Veterinary Medicine3. Evan Blumer, DVM, New Harvest Ventures4. David Wilhelm, Woodland Venture Partners and Hopewell Ventures5. Jason Wilson, Director, Ohio Governor’s Office of Appalachia6. Tony Logan, State Director, USDA Rural Development7. Jeanne Wilson, Regional Representative, Senator Brown’s office8. Warren Taylor, Owner, Snowville Creamery9. John Cary, Shawnee State University10. Bill Dingus, Director, Lawrence County Economic DevelopmentCorporation11. Valerie Anderson, DVM, Animals Unlimited, (Practitioner)12. Brad Mitchell, Senior Director, Battelle for Kids13. John Schroepfer, Principal, CFO Partners, LLC14. Thomas Parkinson, Partner, Hopewell Ventures15. Angie Hawk Maiden, Director, ACENet Ventures16. Michelle Decker, Director, Rural Action17. Lisa Jollick, Ohio University George Voinovich School18. Karen Griffith, Founder, Southeast Ohio Animal Science and VeterinaryTechnology CenterThree business plans have been developed for CVM to consider. Each plan should bereviewed and considered independent of others since each business plan has differentservice offerings and, therefore, varying types of professional capabilities and capitalresources required to establish and operate the practice. Prior to further pursuing anyof the three options presented, it is recommended that CVM engage in discussions withseveral large producers to 1) confirm the need for veterinary services in this region andto 2) more accurately understand the veterinary services that are in demand byproducers in the region. The three plans are presented in Tab B (full-service veterinarypractice for farm animals, horses and companion animals) Tab C (full-service veterinarypractice for farm animals) and Tab D (limited-service veterinary practice for farmanimals). There are notable differences in the capital required in each plan as well asthe required professional capabilities of the veterinarians in each of the business plans.The differences are summarized below.The full-service veterinary practice for farm animals, horses and companion animals willrequire external capital resources of approximately 2.0 million for infrastructure andfacility costs and an additional 200,000 for start-up and operating expenses during theiv

Sustainable Rural Veterinary Practice in Jackson, OhioBackground and Contextfirst four years of operations. It is also important to note that this business plan requiresa wide spectrum of professional veterinary capabilities since the plan assumes a fullservice practice for farm animals, horses and companion animals. The full-serviceveterinary practice limited to farm animals requires external capital resources ofapproximately 2.0 million for infrastructure and facility costs and 175,000 for start-upand operating expenses during the first three years of operations. Although not asbroad as the previous business plan, this full-service practice will also require a widerange of medical and surgical veterinary skills to treat farm animals. The limited-serviceveterinary practice will require external resources of approximately 150,000 for limitedinfrastructure improvements and construction of a modest facility and an additional 125,000 for start-up costs and operating expenses during the first three years ofoperations. Relative to the previous two plans, this plan requires the narrowest range ofveterinary skills.The business plans presented in this document are not intended to address the largerissues or other deficiencies or gaps discussed during the meeting. The business plansare however, presented to address the apparent lack of available veterinary care forfarm animals in the ten county region surrounding Jackson County in Appalachian Ohioand is a proposed solution to only one of several significant issues discussed during thismeeting.v

Sustainable Rural Veterinary Practice in Jackson, OhioBackground and ContextA White Paper: Establishing a Sustainable Rural Veterinary Practice inAppalachian Ohiovi

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Tab B – Sustainable Rural VeterinaryPractice providing full-service preventive,production, routine and emergency veterinaryservices for farm animals, horses andcompanion animals

The Ohio State UniversityCollege of Veterinary MedicineVeterinary Medical CenterSustainable Rural VeterinaryPractice in Jackson, OhioProviding full-service preventive, production,routine and emergency veterinary services forfarm animals, horses and companion animalsBusiness Plan April 11, 2012

The College of Veterinary MedicineFull-Service Mixed Animal Veterinary PracticeApril 11, 2012Executive SummaryIn the summer of 2010, The Ohio State University’s College of Veterinary Medicine wasapproached by livestock producers in southeast Ohio seeking improved, expandedveterinary care in their region of the state. When farmers and producers in this regionneed veterinary assistance for their animals their options for experienced veterinarycare for large animals are limited. The College of Veterinary Medicine (“CVM”) wasasked to consider establishing a satellite rural veterinary practice and clinic in theAppalachian region of Ohio to serve these communities and citizens. The JacksonAgricultural Research Station, an existing facility operated by the Ohio AgriculturalResearch and Development Center (OARDC), has been identified as one possiblelocation for a satellite veterinary clinic.Producers have requested that OSU’s College of Veterinary Medicine establish aveterinary practice in this region with a focus predominantly on service to large animalproducers. Although the practice in Jackson will serve predominantly large animalproducers, service revenue from treating equine and companion animals will berequired to help cover operating expenses of the practice and help supplement the lessprofitable food animal practice. A mixed-animal veterinary practice established by CVM,located in the Jackson Agriculture Research Center should leverage its excellenteducation and research reputation with large animal producers and other animal ownersin the region. The practice will be staffed by faculty and staff veterinarians withexperience and knowledge of large animal and companion animal medical, surgical,preventive and production medicine issues. Our clients will include dairy farmers, cattleand swine producers, equine owners, camelid clients, small ruminant herd owners, andpet owners.Given the apparent lack of available and affordable veterinary care in this region,producers have learned to make herd health decisions based on information they learnfrom farm journals or discussions with other producers. Most producers are skeptical ofthe economic benefits a large animal veterinarian can provide. They may not beinformed about appropriate alternatives suitable for the condition of their specific herd.If producers are educated about new veterinary drugs and techniques available thatprovide a clear economic benefit, producers may be more likely to use the services ofthe Jackson County satellite facility. There are a significant number of horse and smallanimal owners in this ten county region and approximately 15 licensed veterinarians toprovide veterinary services. It is anticipated that horse and small animal owners wouldalso benefit from a practice established by the CVM.Like most other service providers, veterinarians must develop a bond of trust with theclients they serve. Engaging food producers with seminars or other educationalprograms with content that is relevant to livestock producers is one way to build trustand develop confidence in the information and services the veterinarian provides.Two pricing models for food producers will be developed. The first model will providecontinuing incentives to clients to utilize veterinary services through a scheduledi

The College of Veterinary MedicineFull-Service Mixed Animal Veterinary PracticeApril 11, 2012program. The second model for livestock producers will reflect higher pricing basedupon a combination of time and procedures performed.Since there are a few practitioners in the area competing for large animals, it will beimportant to the practice to remain as non-disruptive as possible to these practitioners.Practitioners in the area will view The Ohio State University CVM practice as a seriousthreat, and it will be important to take steps to minimize their concerns. Pricing forequine and companion animal services will be priced at a slight premium to pric