Bethany Mosher's 18-year-old cat, Booga, was diagnosed with gastrointestinal cancer last winter.
In June, when Booga’s quality of life suddenly declined, Mosher called the Pittsford practice where her cat was a regular client.
"I believe it was on a Wednesday, and said, 'He hasn't eaten for a couple days. I think we're at the point where he's at the end of his life here,' and they said 'We can't get you in until next Tuesday.'"
The vet's office told Mosher that they sometimes have cancellations and to call back the next day.
"So I called every morning for the rest of that week," she said, "asking if they had cancellations and they didn't."
But they did have emergency hours on Saturday, starting at 2 p.m. Mosher said she arrived a few minutes early and the parking lot was already packed.
Because of COVID-19 restrictions, all of those people couldn’t pile into the animal hospital at once, so Mosher and Booga had to wait their turn.
They were in her car for three hours before the vet was able to euthanize the cat.
"I liked that I got that one-on-one time with him in the car, but just the anticipation of knowing this was going to happen ... it was hard," she said. "To sit there, sort of waiting for him to die was, I think, the hardest part."
Mosher’s story is a particularly heartbreaking example of the fallout from a crisis in veterinary medicine.
As jobs go unfilled in a number of fields, veterinary medicine is experiencing its own labor shortage. There is greater demand for services than most practices can meet.
"It's hard to tell people no, but at the same time, you can only see so many pets in a certain day," said Dr. Mark Will, president of the New York State Veterinary Medical Society. "Otherwise, you quickly get burned out."
He said the COVID-19 pandemic fueled a perfect storm of circumstances: A labor shortage, staff turnover, and temporary limits on non-essential care that created a backlog of appointments.
"Emergency medicine is probably hit the hardest," Will said.
He blames that, in part, on the fact that emergency vets are expected to work nights, weekends, and holidays and it’s become harder to find people who want to do that.
In his own practice in the Mohawk Valley, Will said his staff veterinarians work four days a week and they’re never on call.
"If I wanted to hire doctors here and say, 'You're going to be on call,' I would never have a doctor apply," he explained. "Doctors aren't expecting to do on-call anymore."
And in the current labor market, they can demand more work-life balance.
Recent ads seeking critical care veterinary specialists on Long Island were offering signing bonuses of $30,000 and $50,000.
Veterinarians are in demand in the Rochester area, too.
Dr. Susan Cousins works as a fill-in consultant at a number of local practices when they need the extra help.
She’s noticed a change in her profession over the last 5 to ten years.
"The whole interaction between people and their pets and the human-animal bond, pets becoming more like family members."
Cousins said it's wonderful that people are more committed to their pets' health, but that translates to more demands on veterinarians’ time.
"It's difficult to see animals in a 15-minute appointment slot anymore, so a lot of practices have extended appointment times, even before COVID, to 20- and 30-minute appointments, so you take fewer appointments, fewer staff, and all of a sudden, you're running out of room," she said.
Cousins is concerned that some pets aren't getting the care they need.
"There are some practices that are even suggesting people go to Buffalo or Syracuse for emergency care, or Cornell, for that matter," she said.
Erin Gwara of Greece never had trouble getting her veterinary appointments for her pets until this year. Gwara has two dogs and three cats.
In May, when she adopted Bella, the yellow Labrador retriever had an ear infection.
That's normally something a general practitioner would treat, but Gwara's primary veterinarian couldn't fit her in the schedule for more than a month, so she took the dog to an urgent care.
"They took her blood, they made sure they got a urine sample," Gwara said, ticking off a list of procedures. "(That) was great, but you don't expect to spend three hours at the vet appointment."
And emergency veterinary care does not come cheap. Gwara said it cost $95 just to be seen and Bella required a follow-up visit because once again, she could not get an appointment with her general practitioner for weeks.
Still, Gwara may have been lucky to get her dog seen by a specialist at all.
Those who work in emergency veterinary practices say a nationwide shortage of veterinarians and veterinary technicians has been a growing problem for several years, and it's only gotten worse since the start of the coronavirus pandemic.
According to the American Animal Hospital Association, the turnover rate for veterinarians is twice as high as that of physicians in medical practice and veterinary technicians have one of the highest turnovers of all health care positions.
"Emergency medicine right now, it's in crisis," said Dr. Maureen Luschini, a medical director and criticalist at the Veterinary Medical Center of Central New York.
Until this past summer, Luschini chaired a statewide task force to address the situation. She had to give up the leadership role because she was too busy just trying to keep up with her work.
Luschini believes the high case volumes, long shifts, and irregular hours all contribute to the fact that more people aren’t practicing emergency veterinary medicine.
But she also points to New York's licensing requirements. She calls them antiquated.
"We have these great doctors who are teaching at AVMA (American Veterinary Medical Association)-accredited academic institutions for years who actually can't work in New York state because they don't have a bachelor's degree from a U.S. school," Luschini said.
She said others are leaving the profession because of burnout and compassion fatigue.
"Despite all the good that you do during your shift, you're leaving worrying about the patients you couldn't see," she said.
The task force, created by the Veterinary Emergency Critical Care Society and the American College of Veterinary Emergency and Critical Care, is looking for solutions, including ways to develop more mentorship for veterinary school graduates who want to transition into emergency medicine.
One proposal is to offer an advanced certification for senior critical care practitioners who can serve in that role.
Will believes low pay is driving many veterinarians out of the field. “I would think that veterinary salaries probably need to double over time to make them closer to what the dentist and M.D. salaries are now," he added, saying he was speaking as a business owner and that his view is not necessarily shared by the NYSVMS.
According to the U.S. Bureau of Labor Statistics, the median annual wage for veterinarians was $99,250 in May 2020.
The median wage for veterinary technicians was $36,260.
Luschini does not believe money is a driving factor in emergency medicine, though. "It is really the hours and stress of the shifts," she said. "When ER vets leave the profession, they often say, "No amount of money could keep me."
Luschini doesn't know if staffing shortages can be solved any time soon. In the meantime, she urges pet owners to practice preventive care.
She said delayed vaccinations have led to a surge in infectious diseases in the animals she treats, including the highly contagious and potentially fatal parvovirus in dogs and panleukopenia in cats, which was once a leading cause of death before the development of a feline distemper vaccine.
"Keep (dogs) on a leash," she recommended. "Do not allow them to get heated outdoors. If they're not vaccinated, don't take them to the dog park."
Cousins stresses the importance of noticing subtle changes in pets’ health so they can be addressed before they require emergency intervention.
"If you open the door and just let the dog go out in the backyard, you may not know if they're having diarrhea," she said, "I don't mean to be gross, but they can't tell you."
Having an established relationship with a veterinarian is also more important now than ever.
Will said about two-thirds of the emergency cases that he sees are pets that have not seen a vet in a year or more.
"I think the days of, 'I need a vet right now and I can't find one' are kind of over," he said. "If you don't have that relationship with a veterinarian, it's going to be really hard to access veterinary care."
Some Rochester-area practices are using telehealth services to assess a pet's condition if they can't get an in-person appointment right away.
Will said it will pay off if people schedule their pets' routine appointments well ahead of time. He said that might mean adjusting expectations.
"If you compare getting an appointment with a veterinarian to getting an appointment with your own medical doctor," he said, "I know that if I don't schedule six months out, I don't get an appointment."
That makes sense to Gwara, but she wonders if people will be able to keep up.
"Sometimes they don't even take care of their routine things for their own health, you know?," she said. " It's sad because the animals will be the ones suffering."