Recommendations For Flea, Tick, And Heartworm Prevention.....2015 Update

The last time I specifically wrote about my personal recommendations in parasite prevention was several years ago.  In fact, it was about four years ago!  A few things have changed since then, so I thought it would be a good time to update what I recommend to clients.  While I stand by every one of my recommendations, realize that they are my opinions and I know vets who might disagree.

Heartworm Prevention

Personally, I really love ProHeart.  This is an injectable heartworm prevention for dogs that lasts for six months with a single shot.  From what I understand, outside of the US it is frequently used at a higher dose and lasts for a full year.  I wish we had that here!  I love this prevention because you only have to worry about it twice a year.  It's so easy for people to forget a monthly pill, and this keeps that from happening.  Veterinarians can include this in their preventative care reminders, easily contacting clients when another dose is due.  This is the preventative I give to my own dogs. 

If ProHeart wasn't available I would use Trifexis.  I think this is a very safe product, despite the unwarranted media and internet hype about it.  I like the fact that it covers heartworms, fleas, hookworms, roundworms, and whipworms.  It's the only product on the market to do all of that (Sentinel doesn't count....it prevents flea eggs from hatching but doesn't actually kill adult fleas...and it has the same heartworm preventative found in Trifexis!).

There are a plethora of monthly pills similar to Heartgard.  Iverhart, Tri-Heart, and several others use the exact same combination of ivermectin and pyrantel to protect against heartworms, roundworms, and hookworms.  All of them are equally effective, only differing in cost and brand name.  There is nothing wrong with any of them, and they are still an important staple of heartworm prevention.

I'm not huge fan of Advantage Multi and Revolution because they are topical and therefore have the potential to be less effective with frequent bathing.  But for people who don't bathe their dogs more than 1-2 times per month they can still work well.  I just think that there are better options.  However, for cats I love both!  Revolution is my choice for my cats but I think that Advantage Multi works just as well.  These are the best options for heartworm prevention in cats because you don't have to give a pill orally.  These two products are also great for ferrets, who do get heartworm disease, though neither are officially approved for this species.

The bottom line is that no matter which product you chose, please use an approved heartworm preventative year-round in all dogs, cats and ferrets!  This is a completely preventable disease so there is no reason why any pet should ever have to suffer from it.

Flea & Tick Prevention

There are many more choices in this category, and it can get very overwhelming.  Do a search on my blog for "fleas" and you will get lots of details that I've written over the years on proper flea control.  This time I'm focusing on specific products.  But PLEASE read some of my other posts, as no product will be 100% effective, and there are many, many things that can lead to a persistent flea problem even if the product is working well.

As I mentioned above, I'm a big fan of Trifexis.  In my case since I'm using ProHeart for heartworms, I use other products to control fleas and ticks.  I really like Comfortis, which is the same flea control ingredient found in Trifexis.  Dermatology specialists tend to like this product for dogs allergic to fleas since it kills so fast and so thoroughly.  The only downside to Comfortis is that it doesn't do anything for ticks (neither does Trifexis).  If your dog really doesn't go near places with ticks, this is an excellent choice.  If you worry about ticks as well, I'd recommend something else.

My favorite topical products are Advantage (fleas only), K9 Advantix (fleas and ticks), and Vectra 3D (fleas and ticks.....sold under the brand name FirstShield Trio in the Banfield Pet Hospital chain, but is the same product).  Currently I'm using Vectra on my dogs, but I think that the Bayer products work as well and am happy to recommend them to clients.  Advantage has been shown to be safe in most small animals, so it can actually be used on rabbits, ferrets, and guinea pigs (though this is "off-label" and not officially approved for these species).  The products combined with heartworm prevention (Advantage Multi and Revolution) are just as effective against fleas as the non-heartworm equivalents.

A newer product is the Seresto collar, made by Bayer.  I have not personally used this, but I have been hearing many good things about it.  Several of my clients use it and have been extremely happy.  I've also spoken to some veterinary colleagues who use it and recommend it.  The technology behind Seresto is very unique and is unlike any other flea and tick collar ever made.  Do not think this is just another collar!  In fact, I haven't recommended flea collars at any point during my career (18 years at this writing) until Seresto came around.  It is supposed to last for eight months, which if true is a huge advantage for it.  Do NOT buy other collars!  They are simply not effective and are a waste of money.

Frontline is an old reliable topical product, and since the patent ran out you can find cheaper brands containing the same active ingredient (fipronil).  When it first came out it was a huge benefit in the fight against fleas and ticks.  However, I've seen it fail more than other products over the years, and there is anecdotal evidence that there may be some resistance developing to it.  I don't think it's a bad product overall, and many people are still using fipronil products with good success.  However, because there are much more effective products on the market I don't generally recommend it.

I would never use any other topical products currently on the market!  I just don't think that the Hartz and Sergeants products are effective and I've seen some cases of toxicity with them.  Please stay away from them.  Yes, they're cheaper, but in this case you're going to get what you pay for.  Don't throw your money away on them.

Also stay away from flea shampoos.  Yes, they will kill fleas, but they give you no residual protection.  Within a day of you rinsing off the shampoo any new fleas in the environment will be right back on your pet.  Use a product that lasts at least a month in order to get good flea control.

Capstar is a great product for what it does.  There really isn't anything else that kills fleas as quickly!  Within 30 minutes of giving it the fleas will start falling off!  I've seen it happen in my own clinic.  If you want a rapid flea kill, this is a great choice.  The big downside is that it doesn't last for more than a day.  For spot control, such as if you're bringing a new pet home, I love it.  But you won't get lasting control.

There are a couple of newer products on the market this year, Nexgard and Bravecto.  Honestly I don't know anything about them other than what I've read in journals and veterinary forums.  I have no personal experience with them so I can't attest to their effectiveness.  I'm eager to try out Bravecto, as it controls fleas and ticks for three months, and there is growing anecdotal evidence that it can treat demodex mites with a single tablet.  But for now I'll leave those recommendations to other vets who have actually used them.

Okay, I think that covers most of the current products!  As always, check with your own veterinarian if you have questions about anything I write.

Aids For Reading Pet Food Labels

It seems that pet nutrition is a common topic in the profession nowadays.  Just a couple of weeks ago DVM 360 posted an article on how to read and interpret pet food labels.  Along with the article they posted a couple of great client handouts on the topic.  I can't attach the files on Blogger, but here are direct links to the handouts.  I would encourage everyone to check them out.

The Pet Food Guessing Game  (information on what different words and phrases on a label really mean)

Forget The Packaging, Read The Ingredient List  (definitions of different terms in the ingredients)

Read Carefully....Corn Isn't Bad And Vets Haven't Sold Out

I've blogged a lot about nutrition in pets, especially the big myth that corn is a bad, worthless ingredient.  I still revisit these issues because I've developed a real interest in nutrition and because there is still so much misinformation out there about pet food ingredients.  For those who may not have read my previous posts, I would strongly recommend going back and doing so at the following links:

Nutrition Mythbusting
Nutrition Week #1
Nutrition Week #2
Nutrition Week #3

Veterinary Food Conspiracy?

Today's post was stimulated by a recent email from Kevin.

I've always been told that corn is bad for cats and as a good daddy I want nothing but the best for my furkids as they are my babies and part of my life. My Vet of Six years nows put one of my boys on Hills Science Diet Prescription for urinary tract issues with struvite crystals in his urine. I've read their label and corn gluten meal is the second ingredient after brewers rice and the protein from chicken is like 5th or 6th on list. I don't feel comfortable with feeding my boys this food but my Vet who I believe has sold out to Hills as.she carries nothing but Hills products says that she's had good results with this food from other clients that she's had on this food. It also states on the bag that it is clinically tested to dissolve struvite stones and crystals. Marketing hype I imagine but if it works my boys will be much better off as I don't have 3 to 4 thousand dollars to throw at a blockage including hospital stays and surgery and such and would likely have to say goodbye to my boy. Would you say that this is a good formula to try being that you've had first hand experience with urinary tract issues with cats and dogs I presume being a Vet and all. If you could take the time to answer my questions I would be most appreciated by my boys as well I myself. I have one other choice of food that my boy likes and its by Royal Canin Urinary so and he liked the samples that this other Vet gave him last week when his regular Vet was all booked up I was referred to this other Vet and this is the food that both the Lady Vet and the guy Vet recommended for him. Don't know if you've had any experience with Royal Canin brand food but Chion liked it and his other brothers like it as well and that's what counts with me.

Let me begin by once again speaking against the issue of corn being bad.  CORN IS NOT BAD.  It is NOT filler, it IS digestible, and both dogs and cats DO get benefit from the protein in it.  Seriously!  Years ago some people started espousing the idea that corn was a horrible ingredient, and that has taken hold in the collective consciousness of the American pet owner.  Some food companies have continued to perpetuate this myth (Blue Buffalo, I'm looking at you!).  It is a complete fallacy and there is no scientific basis to that belief that I can find.  In fact, I can find quite a bit of evidence to the contrary.

Here's some specific data from Small Animal Clinical Nutrition, 5th Edition, Hand et al, 2010. 

Protein Digestibility, Dogs
Beef and bone meal--82.4% (25% crude protein in food)
Chicken and chicken by-product meal--85.1% (33% crude protein in food)
Lamb meal--79.7% (20% crude protein in food)
Poultry by-product meal--80.1% (20% crude protein in food)
Beef, fresh--89.8% (20% crude protein in food)
Corn gluten meal--84.7% if 15% crude protein in food; 87.8% if 20% crude protein in food; 90.3% if 30% crude protein in food

Protein Digestibility, Cats
Fish meal--78%
Meat meal--91%
Chicken and chicken by-product--83-88% (different studies represented)
Chicken meal--86%
Corn gluten meal--70-86% (different studies represented)

You can clearly see that the protein in corn gluten meal is just as digestible as in various meat sources, and even more than some of them.  Corn meal absolutely IS digestible! 

From the same text a table summarizes protein quality of common pet food ingredients (Table 5-17 if you want to find a copy of this book).  Corn gluten meal is listed as "good" quality, the same as beef, lamb, pork, chicken, liver, fish meal, meat and bone meal, and lamb meal.  Corn meal IS good quality protein!

I'm not going to take the time to write down many studies referenced in these tables,  but there are around a dozen of them from multiple scientific journals and covering time periods from the 1980s through the early 2000s.  All of the studies that lead to this data are peer-reviewed and accepted by the scientific community and veterinary nutritionists.  There is NO reason why corn gluten meal should not be used in pet foods or why it should be considered inferior to animal protein sources.  I challenge anyone who thinks that corn gluten is a poor protein choice to present a similar list of scientific studies proving their point of view.  I'm sure that you'll get many opinions, but without true scientific studies and data.

Okay, so now on to the next concern...selling out.

Currently there are four major companies making therapeutic diets for pets in the US:  Hill's Science Diet, Royal Canin, Purina, and Eukanuba/Iams.  All of them have their pros and cons and while I don't think any of them are "bad", I do have personal preferences.  Those preferences are based on experience, and I'm sure that other vets have great experience with foods I don't favor.  The bottom line is that all of these companies put a ton of money into research on the quality and efficacy of their foods, and I have no problems with any of them.  Also, all of the companies have comparable diets for different conditions.  For example, each of these companies makes diets for gastrointestinal disorders, kidney disease, and diabetes.  While the forumulations and methods of treatment will vary somewhat, they all do the same basic thing.

A vet has to pay to stock food in their practice, and if the food doesn't sell it comes out of their pocket.  A vet simply doesn't have the space or money to stock food from each of these companies.  Some vets may stock two companies, possibly because they prefer one company for treatment of certain disorders but another company for different illnesses.  But it's impossible for a vet to stock all of them and give people the choices.  Therefore most vets chose a single manufacturer to sell.  That doesn't mean that they've "sold out".  They just have to make a practical, realistic decision as a business owner, and they chose a food that they believe is high quality, will treat necessary illnesses, and be cost-effective to them and the client.  Hill's Science Diet was one of the first companies to make therapeutic diets, and they're still the biggest and most well known, so it's not surprising that a vet would chose them over the other brands.

As an aside, I personally prefer the Royal Canin diets for most disorders.  I base that on personal experience with using the foods compared to Hill's, palatability, their high involvement in nutritional research across the world, and their strong ethics, especially regarding research animals.  I do really like Hill's Metabolic diet for weight loss and overall think they have high quality foods.  I just lean more towards Royal Canin as a personal choice but wouldn't at all advocate against Hill's.

Now that I've spent a lot of time on generalities, let me specifically address Kevin's concerns.  I absolutely and strongly believe that Hill's urinary diets do what they say they will do.  Their C/D and S/D are good foods and will do what the vet says they will.  As I said before, I personally prefer Royal Canin Urinary S/O for these conditions, but honestly it's a matter of degrees as opposed to Royal Canin being significantly better.

Kevin, I hope that answers your questions!

Injuries To The Vet

One of the things many people don't realize about being a vet is the very real risk of personal injury. Many of the patients we see every day have the ability and desire to hurt us.  While we take precautions and are good at avoiding most injuries, sometimes it's just going to happen.  

Here are some photos of my arms after a recent tussle with a dog.

These are scratches from the dog's nails, which happened while I was trying to restrain him.  While they aren't fun, these are minor compared to some I've had and will heal quickly.

Over the years I've been bit by dogs, cats, horses, birds, snakes, hamsters, guinea pigs, lizards, ferrets, and just about every kind of animal I've worked with.  Some of the injuries have required me to go to a doctor for treatment and antibiotics.  I know vets who have been mauled by patients, had their back broken by a cow's kick, and other serious incidents.  No matter how careful we are and how well we read body language or chose to use sedation, injuries will happen from time to time.  In fact, the risk of injury is one of the bigger stressors in my job and has been one reason why I've wanted to get out of daily practice.

This ain't an easy job!

Super-Vet!

Lately I've been toying around with different design options for this blog, wanting to change things up a bit.  One of the things I wanted to do was have something related to superheroes, as comic books have always been one of my biggest interests.  I searched for free clipart and even considered purchasing some images.  Then I became reintroduced to a web-based program called HeroMachine.

Years ago I played around with an early version and had fun making different characters.  The latest iteration is a bit more robust than what I previously used and is surprisingly flexible.  My artistic abilities aren't great, and I was able to create an image that was surprisingly good.

So here I am....Super-Vet!

I'm not completely sure what I'll do with it in this blog, but it was a blast to make.

Mega-Geeks Working Together Is Bad

It should come as no surprise that I consider myself a major geek.  I love comic books, sci-fi, fantasy, animation, and most things that would be considered geeky.  If you start me talking on one of those subjects be prepared for a long discourse filled with bits of random and obscure trivia, all presented with great passion.  When I'm with my fellow geeks in my private life we have a lot of fun.  But it can be distracting at work.

 

The practice I work for has several satellite clinics in the area.  I work at and manage one of them, and spend the vast majority of my time there.  Some of my staff are relatively geeky, and we may have discussions about TV shows or movies, but typically it's a brief conversation with them asking me a lot of questions for clarification.  Thankfully we can still go about our day with only minor delays for such things.

 

Recently I was asked to help out at one of our sister clinics, and the hospital manager there is just as big of a geek as I am.  When we work together, all bets are off!  My own hospital manager talked to him yesterday and asked if he was working with me today.  His reply was "Well, if you call it work."  He knew how distracted we can get!  When I arrived this morning he was already there, and immediately we began talking.  For the first 20 minutes I was in the clinic, we did nothing but talk about the season finales of The Flash and Arrow, along with the extended trailer for the new Supergirl TV show.  We both had to force outselves to stop talking and get down to the business of seeing patients!

 

I have fun hanging out with him (his name is also Chris) and talking with equal passion about comic book titles, shows, creators, and so on.  He's one of the few people I know who can match me in my knowledge, and even then I can sometimes stump him (today I got him with a random trivia question....who was created as Ultron's wife?  Go ahead and Google it....it's not in the recent movie).  I love having someone with equal knowledge to my own, as we can talk depth and details that I can't with other people.

 

But we get very little done!

 

Chris trained at my own clinic before moving to our sister location permanently.  While he was there I would constantly be distracting him from his work and my hospital manager had to keep telling us to stop talking so he could focus.  I joked with her that maybe I'd see if he could work at our location.  She said "Well, then nothing would get done around here."  I'd have to agree with her!

It would be fun to have someone like this all of the time, and he and I definitely have a "bromance" going on.  But I also think that it's good that I don't have someone to distract me from my patients, and that I can get through my case load efficiently. 

Don't Wear Good Clothes To Veterinary Work

Something I've learned in this profession is to not invest in nice clothing if I'm going to wear it to work.  I was reminded of that this week.

A regular patient of mine had received a nasty laceration about ten days ago, and I had to suture it closed.  He came in for a recheck today and was overall doing well but there was a lot of swelling around the wound.  After feeling it I concluded that it was a simple seroma.  This can happen when there is open space under the skin after an incision or wound.  Serum and a little blood builds up in the "dead space", sometimes resulting in a fluid-filled pocket.  His wound was in his left armpit and therefore had a lot of movement so it didn't surprise me that this had happened.

I had started removing stitches and was looking at the condition of the laceration when suddenly it burst open, spraying me with a copious amount of serum and blood.  This is a big dog so I was on the floor with him standing.  My position put his wound just in front of me, and as the liquid spurted out my legs were the first thing they it.  Before I had a chance to scoot out of the way I had about 20-30cc of fluid covering the insides of my legs.

There isn't much that can be done in situations like this.  I grabbed a towel and some gauze and expressed the remaining amount of the fluid.  The wound had opened up about a half-inch so I left the remaining sutures in place and put some skin staples in to close it again.  I was tempted to put in a drain tube, but we'll see how he does since it did have a chance to drain.

Some vets have learned to keep a pair of scrubs or a change of clothes with them just for situations like this one.  I'm not that smart or wise, and only had the one pair of pants.  I live 35 minutes from work, so there wasn't an easy way for me to run home and change.  Instead I ended up letting it dry and wearing those pants for the rest of the day.

I typically buy my shirts, pants, and shoes at Wal-Mart, Target, and thrift stores like Goodwill.  I just can't imagine paying $30 or more on a pair of nice slacks since I know that in the course of a day I'll get blood, pus, feces, urine, and who knows what else on them.  My shoes are typically inexpensive ones that can be replaced cheaply and easily.  I've also had clothing torn during struggles with pets, again discouraging me from investing in costly shirts or pants.  Many of my colleagues were scrubs during their day because of these very concerns, but I've never found scrubs all that comfortable.  My work-clothes look nice and are professional, but I also consider them somewhat disposable considering the fluids and materials I contact on a daily basis.

If you love nice clothing and want to work in the veterinary profession, have a second set of clothes that you wear to work.  I would hate to see someone who bought a designer-label shirt or blouse for $100 end up getting it covered with urine from a struggling dog.

On the positive side I certainly give my dogs some entertaining scents when I get home from work!

C = DVM

I received this email last month and wanted to share it in my blog because I think it can give some perspective to those going through similar circumstances. 

 

My daughter finished her second year of vet school. She missed a "C" in a Large Animal GI class by 0.5.  With that, and because her other grades are "B"s and "C"s, they told her she must repeat the whole year.

We are all sick over this. My daughter was hoping she could just repeat this class or do something over summer to earn the half of a point.  Interestingly, we know for a fact some professors round up as much as two points in various classes, so she was hoping. But this Large Animal prof said she doesn't round up. So here's where we are.

Now, home for the summer, my daughter is devastated, depressed and sick. She and I can hardly make it through the day. Perhaps we are in shock.

At any rate, what should she do? Repeat a year and eat more debt, or step out and use it as a chance to do something else?
 

Vet school is tough.  Heck, saying "tough" is an understatement of epic proportions.  Going through a veterinary education was the hardest thing I've done in my life, including writing a Master's thesis.  The amount of material you have to learn in four years is overwhelming, and it's difficult for even the most intelligent and studious person to do well.  Yes, there are people who make straight-A's in vet school, but they are certainly the minority.  Even though the students accepted into school are the best and brightest available, it goes beyond even their abilities at times.  In a way it's surprising that more people don't end up doing poorly.

I was not the smartest or best in my class.  I graduated with barely a 3.0 GPA and was right at the 50th percentile in my class.  I had friend who made straight-As, but that wasn't me.  I got mostly Bs with occasional As and a few Cs.  For us driven over-achievers, these grades are difficult to accept, but they're quite acceptable. 

One of my classmates was in a similar situation to the young woman mentioned above.  He received a couple of Ds and was given the choice of dropping out or repeating a year.  He decided on the latter and joined the class coming up behind us.  Several years after graduating I ran into him at a conference and learned that he did graduate and had become a successful and well-respected vet in Las Vegas.  While I'm sure it was difficult for him to go through that year again and join people that he didn't know as well, he pushed through it and came out fine on the other end.

Here's a secret that I don't think many professors will tell you.  When you're interviewing for a job, nobody is going to ask you what your grades were.  I did in-person interviews at about a dozen clinics when I graduated, and not one of them inquired about my GPA.  Once you receive your degree, your grades simply don't matter!  You do have to worry about them in school, but low grades are not a stigma in your career. 

There are a couple of sayings that I've heard and used over the years.

"C = DVM" 
Yep, many vets graduate with healthy C averages.  And that's okay!  A vet student could get nothing but Cs and graduate, pass their board exams, and go on to great success.

"Q:  What do you call the person with the lowest GPA in the graduating class?
A:  Doctor."
Somebody has to have the lowest GPA, just as somebody has to have the highest.  But the person with the lowest GPA is just as much a doctor as the Valedictorian. 

Let me take a moment here and assure clients that just because someone received a C average in vet school doesn't mean that they're a second-rate doctor.  School is hard!  And it's filled with many things in which we may have little interest, or cases we may rarely see.  Fully half of my training was on anatomy, physiology, and diseases in large animals and livestock, yet I haven't dealt with any of these animals or cases in 18 years.  Even back then I knew I wasn't going to go into that aspect of medicine, so those courses and rotations were more difficult for me.  There are also disorders and surgeries I learned that I will never see or do in my career, chosing to refer those cases to specialists who are far more capable in those areas than am I. 

Practice is also the great equalizer.  After just a couple of years in practice I understood my cases far better than I ever did in school.  My first spay in school took me over two hours, my first few in practice were 45-60 minutes, and now I can do one in about 15 minutes.  I can diagram and describe the causes and treatments of Cushing's disease without hesitation, yet I barely understood it during my classes.  Getting out and seeing the patients in real-world settings cements the knowledge in your head and makes you far better at your job. 

Those are the reasons why your grades in school really don't matter one tiny bit after you graduate.

If financially feasible (and it may not be), repeating a year isn't the end of the world, and when you graduate and interview for jobs, nobody will ask or care.  They will only care that you have your degree and your license, and then will look at your personality and other merits.  And if you do end up repeating, at least this time you'll have a better idea of what to expect.

Mangled Kitty, Happy Kitty, Little Ball Of Scars

For those of you who aren't fans of the TV show The Big Bang Theory, my title is derived from a famous, recurring song on the show.  Go to YouTube and type in "Soft Kitty" and you'll see what I'm talking about. 

But the kitty I'm posting about today isn't exactly soft.  He was very sweet, but has a face that only a mother could love.  Years ago he had been in a bad fight with another cat and one side of his face was mauled.  There was permanent damage to his ear and eyelid and the scarring was extensive.  As you can see from the following photos he ended up with a rather startling appearance

Yes, that's one of my veterinary assistants photobombing in the last picture.  Everyone say hi to Asia (her name)!

I've been trying to imagine how these injuries looked when he first received them.  He must have looked horrible!  And considering the damage to his left eyelid, he's lucky that he didn't lose the eye.  Thankfully he recovered, and though he has some extensive permanent scarring, he will go on to life a normal ife.

Vets Seek Non-Clinical Practice

Recently I ran across an interesting survey on the Veterinary Information Network (VIN).  For those not familiar, VIN is a long-running website forum dedicated to veterinary professionals.  Vets and technicians from all over the world interact, share cases and experiences, participate in educational webinars, get advice from specialists in various fields, and generally interact with colleagues.  The site posts polls frequently and the most recent one caught my interest.

"Do you have, have you had, or have you seriously considered a career in a field of veterinary medicine other than clinical practice?"

The answers were the most interesting part of the survey. 
 

I am in clinical practice and have never worked outside that field nor have I considered changing...39.14%

I have considered switching to a non-clinical field, but I am currently in clinical practice...47.48%

I am currently actively searching for a non-clinical position...2.3%

I have worked in a non-clinical field, but I am now in clinical practice...4.82%

I have worked in clinical practice, but I am now in a non-clinical field...2.19%

I have jobs both in clinical practice and a non-clinical field...2.19%

I have always worked in a non-clinical area of veterinary medicine...0.11%

I am not currently employed, but I am searching for a clinical position...0.11%

I am not currently employed, but I am searching for a non-clinical position...0.55%

The main result of the survey is that about 50% of veterinarians currently in clinical practice would rather not be in clinical practice.  They would rather be teaching, working in research, or working in industry (such as for a food or pharmaceutical company).  And I'm one of them!  If it was up to me I'd leave clinical practice and become a full-time teacher in a heartbeat.  Unfortunately well-paying teaching positions require advanced degrees or speciality certifications, neither of which I have the stamina and desire to acquire.  I've taught at the college level, but I was making a fraction of what I make in clinical practice so I had to go back to working full-time as a vet.

I don't think there is anything inherently bad about a vet no longer wanting to be in clincal practice.  It's a hard job and you risk injury every day, as well as having to deal with the disgusting parts of medicine and cranky clients.  A vet can still use their knowledge and skills in other capacities, and typically will be paid much more in industry or academia than they will in private practice.  There are many benefits to not being a clinical vet, even though this is what people typically imagine when they think of someone in this profession.

It also doesn't mean that a vet is doing a worse job because they don't want to be in their clinic.  This survey suggests that when you go and see your regular vet there is about a 50/50 chance that they would rather be doing anything else.  Yet that same vet probably greeted you cheerfully and gave your pet great medical care.  While I'd rather be teaching than practicing, I also give my clients, patients, and staff the best attitude and care that I possibly can.  A vet who would rather work for a pharmaceutical company isn't automatically disenfranchised and disinterested in their daily job.

For me it's just nice to see so many other colleagues who feel similar to me in this regard.