No More Homeless Pets Forum
December 15, 2003

Mobile Spay/Neuter

Celeste Crimi

Could a mobile spay/neuter van be the answer for your community? Celeste Crimi of the Oregon Neutermobile and Stewart Gollan of No More Homeless Pets in Utah's Big Fix will answer your questions about running a successful mobile spay/neuter clinic.

Introduction from Celeste Crimi:

Oregon Neutermobile (ON) is a grassroots endeavor that's managed and led completely by volunteers. Since our inception the past year, I've been given the fun and welcome responsibilities of fundraising, grant writing, program and policy formation, public and veterinary relations, coordinating with fellow organizations, supplying the RV with equipment and supplies, finding and keeping superb surgical teams, and pretty much dealing with all the details that need to be addressed wherever a mobile spay/neuter surgery unit is established. (Lots of others help me, but I've been actively involved in it all.)

In other words, I'm looking forward to your nitty-gritty questions, because every aspect of starting up and running a mobile clinic is fresh in my mind. I'm hoping that more and more projects like ON continue to crop up all over, so expect detailed, specific replies that you can translate into direct action.

Introduction from Stewart Gollan:

Mobile spay/neuter clinics can be an effective vehicle (pun intended) for providing low-cost spay/neuter services to many communities. While mobile operations are often not as cost-effective as stationary clinics when providing services to areas of high population density with an ongoing need for low-cost spay/neuter services, they can provide a cost-effective model for providing services to geographically large and low-density communities. They can also efficiently deliver services to an area comprised of multiple communities, none of which has sufficient demand for low-cost spay/neuter services to warrant a full-time stationary spay/neuter clinic of its own.

The Big Fix, No More Homeless Pets in Utah's spay/neuter clinic, allows us to provide services to smaller, rural areas where the high capital cost of establishing a stationary spay/neuter clinic makes it impractical and the local veterinary community is either unwilling or unable to provide low-cost spay/neuter services. Our mobile clinic also allows us to provide services to urban areas where the demand for low-cost spay/neuter services exceeds the current supply.

While our mobile clinic has been an effective tool for delivering low-cost spay/neuter services to communities in need, the program has posed many challenges. I look forward to providing you with assistance in finding an appropriate spay/neuter solution in your community.

Questions

Getting a vet to purchase controlled drug substances for a mobile van
Handling feral cat surgeries on a mobile van
Mobile vans vs. high volume MASH events
Top mistakes and successes in starting a mobile spay/neuter van
Finding vets to do spay/neuter surgeries and not to get burned out
Approaching vet boards and getting vet support of mobiles
Are mobile vans the best option?
Marketing for Neutermobile vans
Should small groups attempt to own their own van?
Finding space for pre and post op
Fundraising to keep the van running
How to find vets who want to do spay/neuter and can do ferals and pediatric
Post-op care and emergencies
What equipment is needed for a mobile van?
Who to offer services to and how to track success

Getting a vet to purchase controlled drug substances for a mobile van

Handling feral cat surgeries on a mobile van

Question from Sharon:

How do you do feral cats on a mobile van? In particular we are interested in knowing how many you can schedule since you won't know the sex breakdown in advance, if you use a different anesthesia protocol on them than you would on pet animals, and how you do recovery since there is such limited space to put the traps? Also how do you do the feral overnight recovery? Most of our caretakers don't have the space to bring the cats into their homes, and we have nowhere to keep them safe and warm until they can be released.

Response from Stewart:

We don't differentiate between feral and pet cats when we do intake because-- while ferals do take longer than other cats, they are less of a concern for us than female dogs in terms of the time they take. We don't usually get very many, because in addition to our mobile clinic, we also have a feral cat voucher program, which allows people to get ferals fixed for only a $10 co-pay. As a result, most people utilize our voucher program to get ferals fixed; so feral cat volume isn't really an issue on our mobile clinic. We don't schedule appointments on our clinic. Everything is first come first served. We simply take in animals until we are full.

Of course, if we take in fifteen 80lb female dogs, we have to take in fewer other animals but we don't usually need to set a pre-determined ratio of males to females. Once we are full, we offer everyone we can't get in a spay/neuter voucher application and a copy of the mobile clinic schedule for the next month. When we do our cat only Super Cat Fix events, we do set a ratio of 95 males to 65 females taken in for the day. We pre-print 65 pink intake forms for the females and 95 blue intake forms for the males. When we begin intake, we immediately pass out the pink forms to the people in line with the first 65 female cats, then tell everyone else that we cannot accommodate them. We can usually accommodate all the males.

We do use a different anesthesia protocol for ferals, because our standard anesthesia protocol is administered IV. It isn't practical for ferals since you can't easily hit a vein. Also, unlike for owned animals, we administer a reversal agent after surgery so they are completely awake once we discharge them. For ferals we administer .004mg/lb Domitor IM .004 mg/lb Buprenex IM and 2.5mg/lb Ketamine IM. Because it is given IM, we can inject the cat without removing it from the trap. The injection only knocks them down long enough to get them out of the trap, get them intubated and then put them on isoflurane gas. After surgery, we administer .003mg/lb Antisedan IM as a reversal agent to wake them up. This protocol has worked well for us. They wake up quickly and, since most of the anesthesia is due to the isoflurane gas, they aren't groggy by the time we discharge them.

We don't do overnight recovery, so I can't be of much help there. We discharge every animal at the end of the day. Our anesthesia protocol results in fast recovery times, so animals are awake quickly enough to allow us to watch and examine them prior to discharge. Once we release them to their caretakers, some keep them overnight at their homes and some release them the same day.

Response from Celeste:

I can tell you've been lying in bed at night trying to work this all out - and the cats will thank you! Let me answer piece by piece (this is going to be lengthy)...

Scheduling:
About determining gender: Sometimes scheduling personnel can get a pretty darn good estimation from feral caretakers about who the toms and queens are. We train our schedulers to inquire if any of the cats are calico/tortoiseshell, since males of those colors are so statistically rare. Incidentally, the former adage about orange tabbies almost always being male is not so true anymore.

Also, often the areas we visit have colonies that have been developing for several years, and caretakers have figured out by the process of elimination: who's what; if they've had kittens, they're intact queens.

For kittens 3 months and under (who are usually handleable), I've given ridiculously detailed instructions over the phone on how to determine sex. There are lots of diagrams on the internet that spell it out, but the short of it is, "You know the hole where the pee comes out? Boys have dots and girls have up-and-down dashes, and the girls' dashes are closer to their tail."

For anyone who we can't tell if they're boys or girls, we just assume 1/2 and 1/2, and use the following (although it's not perfect) point system (the text below is excerpted from our Scheduling Procedure Document):

We operate on a 'point' system of 75 points per surgery day (5 minutes per point).
Queens (female cats) = 3 points each
Toms (male cats) = 1 point each
Bucks (male rabbits) = 2 points each
Does (female rabbits) = 4 points each
Others (ferrets, rats, hamsters, etc) = 4 points each
So, for example, a full surgery day would be 18 queens, 17 toms and a doe; or 18 queens and 21 toms; or 15 queens, 24 toms, a buck and a doe. For the very first day that ON visits an area, it might be wise to only schedule on a 60-point day, to give us some slack for errors. If the gender of a patient is not known (as for some feral cats), assume 2 points per unknown.

Note: We accept canine patients as well, but I'll leave them out of this question.
Anesthetic protocol:

Our surgeons use the same protocol for each of their cat patients, whether or not they're tame.

Recovery logistics:
Space considerations: To save wear and tear on volunteers' legs, and to keep the patients organized, we usually have Check In, Pre-Surgical Waiting Area, Post-Surgical Recovery Area, and Check Out all take place in one room (or 2-car, heated garage, or retail space in the mall....)

To keep Pre- and Post-Surgical patients clearly delineated, we set up large, sturdy folding tables, usually 3 tables in a U shape, with the volunteers in the middle and the patients facing the volunteers. That way it's easy to keep track of who's where.

Pre-Surgical patients go UNDER the tables (ferals with their traps/carriers completely covered with towels/sheets/blankets to reduce stress and cage trauma). Note: first we put down a thick layer of newspaper to insulate against possible chill and to soak up urine). They are grouped by male, female, and unknown.

When a patient comes off the RV for Post-Surgical (Recovery) Observation, they're placed ATOP the tables, which are also newspaper-lined. This helps keep them warm, clearly marks them as ALREADY FIXED, and puts them at eye level with volunteers, for ease in monitoring.

We use one table for new arrivals, one for recovered patients, and one for patients we want to keep a close eye on (slow to wake up, too cold, surgeon advisory, etc). As the day marches on, we stop transferring patients and just let the tables fill up. That's really plenty of room for as many cats as a single surgeon can handle in a day.

Note: We're not opposed to stacking a trap and a carrier (you know, the hard plastic kind), or two carriers, but we never stack two traps (in case one cat pees and it leaks down on the other, and to help prevent disease transmission). Also, we never stack more than 2 high, in case we need to get the bottom cat out in a hurry during a medical emergency.

Overnight logistics: We don't leave our patients unattended until they are safely awake in their traps/carriers. In other words, when they'd be ready to go home if they had a home. They need to be sternal, which means able to maintain themselves upright, and have full awareness of their surroundings (no erratic, jerky movements, walking backwards or hallucinatory behavior).

If necessary, they can stay at the clinic site, on the table right where they've been, until the morning, as long as it's okay with the building owners, and as long as the area can be adequately heated. A few sites have had separate areas to house 'slumber parties'. Note: This can be a nice option for tame patients whose guardians have busy mornings or impossible evenings; they can drop off the evening before or pick up the morning after.

I have to say, though, a lot of caretakers just think they don't have space at first. Further prodding unveils a spare bathroom or garage that can be heated for the night.

Whew! Is anyone still with me?!

As an addendum about where to put feral cats post-op:
I hope everyone will take an opportunity this week to really explore our website, which has several pages of all sorts of helpful information.

Even I forget all the great pictures featuring scenes from Neutermobile clinics and animals that were spayed/neutered, even juvenile patients.

Anyway, there's a picture at that sort of shows the U table shape I mentioned in a previous email, Handling feral cat surgeries on a mobile van. The volunteers are standing in the middle of the U. Some of the feral patients are covered up, because they're fully recovered and should be kept calm until their return to their caretakers.

Mobile vans vs. high volume MASH events

Question from Julie:

I'd love to hear the thoughts of both guests on the advantages and disadvantages of self-contained surgery vans vs. high-volume events that are staged in a fixed space, like a school gym. As an example, a multi-day spay/neuter event with the goal of spaying 1,200 to 1,500 pets over a five day period was recently held in rural South Dakota.

According to a story in the Bismark Tribune, five vets gathered from other states to participate in this event. I know that the local spay/neuter van in my own city has a target of 20 pets a day. They're doing wonderful work, but at that rate the low-end surgery goal set for the Montana event would take 2 months to accomplish, assuming the van was at full capacity, seven days a week. Of course the real equivalent total is far greater, if one includes all the new puppies and kittens born to those 1,200-1,500 pets in a 2 month period.

The goal numbers for the South Dakota event seems pretty tempting, but what are the drawbacks? Assuming we can locate (and hire, transport and house) vets with the skill level required to fix that many pets in one day, find the necessary support staff... get 1,000 low income pet owners to appear roughly on time, and find a way to pay for it all. How do events like this differ from a mobile van event? Is this something that works best in rural areas, or has it been done successfully in low-income suburban or urban areas too?

Response from Stewart:

I don't have any direct experience with high volume one-day events like the one in South Dakota that you offered as an example so I may not be able to offer very much useful information. No More Homeless Pets in Utah did once try to sponsor such an event using volunteer vets in a local multi-purpose center and received a lot of resistance from the local veterinary community. They had significant concerns that we would be unable to provide a sterile environment, since the building was not designed as a veterinary clinic, used many highly porous building materials and lacked a proper ventilation system, etc.

We also had difficulties getting a large number of veterinarians to commit. Our mobile spay neuter clinic averages 40 surgeries per day with one vet and performed over 8,000 surgeries in our last fiscal year. To accomplish 8,000 surgeries in a year through the Montana model would require such an event approximately every two months which strikes me as a difficult goal to achieve.

Also, while the Montana event seems to have had very high per vet productivity (200 to 300 surgeries per vet over several days), I would expect that per hour productivity per vet is usually lower in such an event when compared to an ongoing mobile or stationary operation because the vets must work in an environment not designed as a clinic and which is unfamiliar to them. However, a mobile spay/neuter operation only makes financial sense as a long-term project, because the initial capital required is high. For a one-time or occasional event, the South Dakota event's model or an event like Operation Catnip probably makes more sense.

Response from Celeste:

Having not operated a low cost s/n clinic of the scale you've described, and only really being familiar with Oregon's demographics, I'll just do the best I can here...

Let me just say that it seems like there are a LOT of advantages to doing en masse spay/neuter in a tiny timeframe, as has occurred in Montana and South Dakota. Some that come to mind are:

- Hopefully get ahead of the reproduction curve in a single breeding cycle.
- Inspire communities with exciting results
- Charge up volunteers instead of slowly bleeding out their enthusiasm
- Lower vehicle insurance rates to insure a van that carts around surgical equipment, than an RV that has all the bells and whistles.

Some challenges might be:

- Purchasing sufficient surgery tables, anesthesia machines, oxygen tanks, etc to support that many surgeons at once.
- Recruiting sufficient volunteers, especially in the rural areas that often need help most, to staff such an intense event.
- Having inexperienced coordinators/leaders taking on such a huge project at once

I'm in total awe of the work Jean Atthowe, President of the Montana Spay/Neuter Task Force, has coordinated, which I believe you're referring to when you talk about multi-surgeon, high volume projects. Probably the reason we didn't follow her MASH-style model is because we found this great little RV that had already been converted to a veterinary surgery unit at an unbeatable price. Our next step is definitely to look into 'franchising' out into MASH-style operations.

I would suggest borrowing the equipment to put on a trial, mini-clinic with just one surgeon, see how it feels, then start adding more surgeons as your comfort level increases.

As an addendum, I forgot to say that the key determining factors of success have to do with helping the most animals that wouldn't have been altered otherwise, as safely as possible, in as short a time period as possible.

So, if a MASH mega-event is the only time a meaningful number of surgeries is going to happen, then that's the obvious choice.

If the MASH project accomplishes lots of surgeries occasionally, but the total number of animals helped over a year's time is exceeded by a mobile unit that plugs away, day after day seeing only 20 or so patients, then slow and steady wins the race.

Top mistakes and successes in starting a mobile spay/neuter van

Question from Charlene:

If you were starting over again, what would you say are the biggest things you would do differently and what are the things you think you did right on the first time? It's always nice to learn from others experience so we don't have to repeat the same mistakes!

Response from Celeste:

Yikes! That's a biggie! Can I get back to you after I ponder this one for a week or so? Okay, mistakes....

Make sure policies, procedures, guidelines, forms, charts, etc are on paper and are clear, concise and proofread before clinics start.

Also, we burst out of the starting gate at full stride. Our first event was disorganized, because volunteers weren't completely trained in advance, and the 'strong leadership', which I was supposed to be, was tied up on the RV because we were shorthanded. Now, we're still creating and honing support documents.

One great change is we've learned to hold a detailed volunteer orientation at least one day before the actual clinics start. New volunteers' relief is palpable when they feel like they know what they're doing and have the information they need to properly assist the animals. Next in line is a training video.

And, we've added spaces on the volunteer waiver that each volunteer signs, so they can fill in their mailing address and email. That makes sending thank you cards so much easier!

What did we do right the very first time?

Well, we showed up, in a community that really needed us. I'm trying to say that just getting started was right, having the oomph to launch. I feel like 'starting is half the battle.'

Also, we learned, researched, volunteered, shared, networked and brainstormed a lot. So, we had lots of good ideas that pre-existing clinics modeled for us (like the point scheduling system, like only offering spay/neuter and no other care, like what equipment we'd need to handle ferals on the RV, etc).

We were able to help 247 animals within our first 9 days of operation, even though we had to turn away about 10 female dogs due to an anesthesia machine glitch. Those first days were even more exhausting, emotional, and logistically challenging than our usual experience, but I'm still glad they happened.

What got me through our first weeks was remembering other major events I'd planned for and survived (like getting married). And... just like a wedding, something ALWAYS goes wrong, but not usually wrong enough to 'stop the band.'

P.S. Remember to make sure your vehicle and equipment are in good working order before heading' out, and leave plenty of time for setbacks at first.

Response from Stewart:

Not Scheduling Appointments:
When we began we scheduled appointments for all clients. This proved to be inefficient because we needed someone to schedule all of the appointments, which were time consuming. Also we would often have more no-shows than expected, and would therefore not operate at full capacity. Switching to a first come, first served system has reduced the workload on our staff and has allowed us to operate at capacity nearly every day.

Adding a third anesthesia machine in the prep area:
Our clinic was originally outfitted with only two anesthesia machines, both of which were in the surgery room. Adding a third, allows for one animal to be induced, while one is prepped, while another is undergoing surgery. When the vet finishes with one animal, he/she can move right on to the next without having to wait. Having three machines also allows for less experienced veterinarians to be more effectively trained into high volume spay/neuter.

Parking the clinic at local animal control agencies:
At first, we tended to park the clinic at parks, shopping centers, and other high-traffic areas. This worked fairly well, but had some drawbacks. One of these was a negative response from the Utah Veterinary Association, who felt that having us at non-animal related sites tended to "cheapen" veterinary medicine. The decision to begin parking at animal control shelters has been helpful for a number of reasons:

Laundry. Most animal control shelters have laundry facilities.

Advertising. Many shelters advertise heavily that The Big Fix is making a stop in their town.
We give the shelter exposure and bring people to the shelter who may be potential adopters or volunteers.
We enhance our working relationship with the shelters, most of which are very appreciative of our efforts.
We usually fix 3-5 shelter animals for free each day.

Offering vaccine clinics only in underserved areas:
When we began, we set aside time each day for walk-up vaccination clinics for non-surgery patients. Although it was a great source of revenue, it caused a lot of friction with local veterinarians. Vaccines are veterinary practitioners' bread and butter. Now we only offer vaccines to non-surgery patients if there is not a local vet within 40 miles. By not directly competing with them, we are eliminating a large concern of private veterinarians.

Offering staff bonuses:
We offer both daily and quarterly bonuses to the staff of the big fix. There is a bonus for reaching the daily revenue goal and a smaller bonus for each $100 in revenue brought in over the goal. After the bonus system was implemented the staff became more inclined to work harder and our productivity increased markedly. Astonishingly, the complication rate also decreased significantly after the bonus system was implemented.

Having the truck winterized:
The truck was outfitted in Houston and the climate in Houston is nothing like the climate in Utah. Though it is a great vehicle from many points of view, our truck was not good in cold weather, to put it mildly. We had frozen pipes with resulting floods and ice-covered floors. We also had difficulty in keeping it heated during the nights and weekends, which is essential for the biologics and chemicals used on the van. Our winterization enables us to heat the vehicle when it is not in use and it has eliminated our frozen water problems. We are now able to keep the refrigerator running at all times, not just when the generator is running, or when it is plugged in. Despite some bugs we are working out we are quite happy with the winterization.

Finding vets to do spay/neuter surgeries and not to get burned out

Question from a member:

How do you find vets that are willing to do spay/neuter every day for such long hours? We are afraid the vets will get bored or burned out on surgeries. Many of the local vets have told us that spay/neuter is very boring and not why most vets got into the field. What arrangements do you have with vets? Do you use ones as volunteers from the community you are in or is your vet a paid employee of your organization? If so, is it an independent contractor or employee with benefits?

Response from Celeste:

You know, in addition to Stewart and my comments, pioneer, expert high volume s/n surgeon (and my hero) Dr. Bob Mackie has addressed your questions in detail.

Please, anyone who's even thinking about any kind of spay/neuter project on an ongoing basis, check out what Dr. Mackie has to say (although we've found it to cost a bit more than he projects, he's been right on the nose in every other area).

Now, as to the Neutermobile: we pay our independently contracted surgeons a modest amount (job descriptions and pay options on our website).

They usually work about 6-8 hours daily, altering 20-45 patients, depending on species/gender, which is not so long. The part that takes some real sacrifice is that they'll travel to wherever the Neutermobile's parked, and usually stay in that town for the entirety of the 3-5 day clinics. They'll bunk down each night either in the sleeping compartment of the RV, or at a volunteer or technician's house. Then they return home for the remainder of the week, to start the traveling all over the following week. Incredible!

It is true that no matter what the pay rate, most vets will not be 'into' s/n as a career. So make the ones who are, feel as special as they are! Those vets are probably not in it for the money as much as to follow their life's calling, just like you are, so you've already got at least one thing in common.

Response from Stewart:

We have been incredibly fortunate to find two veterinarians, one full time and one part time, which are extremely talented and extremely dedicated to ending pet overpopulation. The success of our program has largely been due to the dedication of our veterinarians and their willingness to continually improve their skills and increase their productivity. If you are able to attract skilled and dedicated veterinarians do everything you can to keep them, because they are essential to developing an efficient and successful program.

Our veterinarians average 40 surgeries per day on our mixed dog and cat days and typically work for six to eight hours. When we do special cat only events five or six times a year both veterinarians work at the same time and put in 10 to 11 hours doing 130-160 surgeries together. The clinic operates 18 days of every four week cycle. One vet covers 12 of those days and the other covers six. Our full-time vet is a salaried employee who gets full benefits. In addition to performing surgeries, he manages all of the other medical staff and is responsible for overseeing scheduling, supply ordering and all other logistical aspects of the operation. Our part-time vet is paid a daily rate for working on the clinic. Both our veterinarians are paid at rates similar to what they would earn working in a private clinic.

In my experience, you are correct that most vets don't want to do primarily spay/neuter for their entire career. Our full-time vet was practicing emergency medicine prior to joining our team and he still works one weekend a month in an emergency clinic to keep his skills current. He doesn't want to do spay/neuter for the rest of his career and is planning to return to emergency someday. This will be a difficult day for our program and I hope it comes later rather than sooner.

Approaching vet boards and getting vet support of mobiles

Question from Katherine:

We are hoping to start a mobile spay/neuter clinic in the next year or so, and have a few basic questions: How did you approach your state vet boards? Did you have a vet speak to them? Were they receptive? How difficult is it to get a mobile clinic licensed?

Sorry for so many questions, we are still in our information gathering stage and have so many questions.

Response from Celeste:

We-e-ell, umm, actually we didn't approach our state vet board to ask permission for our very existence.

Our surgeons have every right, as private contractors, to do ethical work for us, just as a private practice veterinarian has a right to go to someone's house and see patients.

We did contact the Oregon Medical Veterinary Examiner's Board (OVMEB) to get exact details on requirements on making sure the surgery area was properly hygienic, etc. We found out - and check with your state's board for specifics in your area - that the guidelines are pretty vague. Pretty much, as long as care is taken to keep the surgery area as clean as possible, including the air around the patient, there's a lot of 'poetic license.'

And, we contacted 2 different (volunteer) lawyers, one familiar with animal issues, and one familiar with employment issues, and got their approval in writing before proceeding. The animal issue lawyer contacted OVMEB and the OVMA (Oregon Veterinary Medical Association) to make sure that we were 'allowed' to independently contract out our surgical teams, etc.

So, to clarify, we are not licensed. We simply provide the facility for our independently contracted surgical team (who are, obviously, licensed veterinarians) to practice their medicine. See the distinction?

Also, to stay in good graces with local vets as much as possible, and to attempt to raise the level of care of a community's pets, we take the following steps:

- Make sure local clinics are notified in advance of our impending arrival (we started with fancy, super considerate letters via snail mail, and settled on faxing a 'let us know if the answer is no' blurb)
- If existing clinics don't object (none have), our post-surgical care sheet that we pass out to each client lists the names and contact info of each clinic in the county we're visiting, and the sheet directs clients to their local clinics for any additional or follow up care. We also verbally tell/underscore our referral to each client
- Only, only, only, only offer spay/neuter surgeries, and refer clients to their local clinics for anything else, even collars to keep them from licking the incision site, even health tests, vaccines, parasite control, etc. Our premise is to save the client so much that they have some left over to spend at their local clinic.
- It seems like everywhere we go, we have one clinic that's our guardian angel and is very supportive. There's one that only grudgingly accepts our presence, occasionally even spreading rumors about our quality of care, with the rest of the clinics being neutral. That is, in the places we've been that have veterinary care at all!

Response from Stewart:

When we began we expected to encounter resistance from the local veterinary community. So we initially formed a veterinary liaison committee made up of several local veterinarians to try to come up with ideas and policies to make relations with local veterinarians and our state veterinary association go smoothly. We also hired a veterinarian to act as a liaison. He contacted and met with local veterinarians to listen to their concerns and to try to address them. While his meetings improved relations markedly with some veterinarians, it didn't prove to be terribly successful with others.

We found that several veterinarians opposed to our program, including some very vocal members of the state veterinary association. They were clinic owners concerned primarily with eliminating perceived competition and not with making low-cost spay/neuter services available. It became clear that they would only be happy if we discontinued our mobile clinic program, which we were unwilling to do. As time has passed much of the resistance to our program, particularly by veterinarians in the urban areas of our state, has abated.

Some vets have simply gotten used to us and have begun to reluctantly tolerate us while others have discovered that we are not competing for the clientele they want to serve. We also run countywide spay/neuter promotions during which veterinarians in a county offer the same discounted spay/neuter prices charged on our mobile clinic. We pay them an additional $25 for every surgery they perform during the promotion. We advertise the promotion and the participating clinics and focus on attracting low-income pet owners. Many of the participating veterinarians have commented that they have difficulty selling additional services to the clients that take advantage of the promotions, and that those clients rarely return for vaccinations, annual exams, etc.

As a result, many of these veterinarians have become willing to let us serve low-income pet owners while they focus on middle to high-income pet owners. There are still a few veterinarians, mostly from rural areas, who are adamantly opposed to the mobile clinic, and who view the program as unfair competition that threatens their income.

Regarding licensing requirements, Utah doesn't require a license for the mobile clinic itself. We only need to have a licensed veterinarian. When we hired our veterinarians they were already licensed so we didn't need to apply for a license ourselves. Also, veterinary licensing is handled by our Division of Professional Licensing, a division of the Utah State Department of Commerce. The state association set the licensing requirements, but is not involved with issuing individual licenses.

We do need city or county business licenses to operate in some locations in our state. In one community local veterinarians had, at one time, successfully petitioned the city council to deny us a business license. Eventually, the local animal control agency convinced the City Council to issue us a business license and we are now able to operate there.

Are mobile vans the best option?

Question from Ann:

I was at the No More Homeless Pets conference in Philadelphia and some of the speakers said they would not recommend getting a mobile van because of the cost of upkeep, maintenance, costs to keep it running, etc. They mentioned how the Utah van had broken down and had to be towed. We have been looking at getting a mobile van but were concerned about the costs. How much does it cost to start up and operate a van annually and would you recommend a mobile van to others?

Response from Stewart:

While I have little first hand experience with stationary spay/neuter clinics, the research I have done comparing the two leads me to believe that the per surgery cost is typically lower for stationary operations than for mobile operations. However, there are situations where a mobile clinic can provide services to communities when a stationary clinic or clinics would be impractical. Generally, I believe that if your goal is to provide services to areas of high population density with a high demand for low cost spay/neuter services, a stationary clinic will be more cost effective because it avoids the cost associated with travel, mechanical breakdown, vehicle maintenance, etc.

However, if you are trying to serve a large geographic area with low population density a stationary clinic has drawbacks. You must either get clients to bring their pets to you which may be difficult if they live a long distance from your clinic or you have to pick up their pets and return them. Very successful spay/neuter operations are being run which use this model. The Humane Alliance Spay/Neuter Clinic in Asheville, NC has one such program.

However, like mobile spay/neuter clinics, such operations incur transportation costs and are subject to vehicle breakdowns. Because our goal was to provide services to underserved pet owners throughout the entire state of Utah, we serve communities as far away from Salt Lake City (where we are based) as four hours drive. A transportation program using vans to bring animals to a central stationary clinic is impractical at those distances. You would need to add sixteen hours of driving and the involved costs to pick up and return animals. In addition to our mobile clinic we administer a spay/neuter voucher program which utilizes local veterinarians to provide services. This works well in communities where moderate cost spay/neuter services are already available. In these communities low-income pet owners can use our discount voucher at their local vet and receive a low-cost surgery for their pet.

However, there are many communities that we serve where there are few or no moderate or low cost spay/neuter options, and low-income pet owners cannot afford to have their pets fixed even with the assistance of our discount voucher. Many of these communities are rural and geographically distant from urban areas. Our mobile clinic gives us with an efficient tool to provide services there.

We have also found our mobile clinic to be an effective tool to deliver low cost services to urban communities where the demand for low-cast spay/neuter services exceeds the current ability or desire of local veterinary clinics to provide low-cost services. The unserved demand in such communities may not warrant the establishment of a full time stationary spay/neuter clinic either because it is sporadic or simply of insufficient magnitude to support a full time clinic. A mobile clinic can be effectively used to fill the gaps.

The initial cost of purchasing a clinic can be high. Our clinic was purchased for $153,728 and we initially spent $10,533 for supplies and equipment to stock it. There are other options available so some research may be helpful.

Our budgeted expenditure for our current fiscal year is $426,000. That includes $279,912 in staff salaries and benefits, $32,236 in vehicle related costs, $54,500 for medical supplies and equipment, $17,104 in hotels and meals and $42,249 in other costs. Our budgeted income for our current fiscal year is $426,000. That includes $245,000 in client fees and $181,000 from grants, donations and other sources. The Mobile Spay/Neuter Clinic Operations document prepared by Paul Berry contains a wealth of information on various mobile clinic programs, their budgets and their business models. There is a link to it on the main forum web page.

Response from Celeste:

Wow, aren't the No More Homeless Pets conferences awesome?! I attended in Seattle a couple of years ago and it changed my life. It's not an exaggeration to say I probably wouldn't be where I'm at today if it wasn't for all I learned from NMHP.

As for mobile vans, I believe our efforts should be fun, and snowball, and feel guided by a sense of purpose. That is, coincidentally, how our group ended up specifically with an RV.

We decided to look into a mobile unit (school bus, van, old ambulance, we didn't care), and the manager of a local animal control mentioned that he'd visited an RV that had already been converted to a veterinary surgery unit by the selling veterinarian. It was going for $13K, had low mileage, and included a surgery/wet table and anesthesia machine! It turned out to be the vehicle for us, and it cost about $7K more to buy all the remaining necessary equipment and supplies (large dog scale, used autoclave, etc). That's a really, really good deal, and we're happy!

We're just now starting to think about 'franchising out', and we'll probably go with either trailers (less initial startup costs, hauling vehicle can be switched out in case of mechanical problems, etc), or with MASH setups (the surgery table, anesthesia machine, autoclave and other equipment are set up in an existing facility, surgery is not performed on a vehicle). That is, unless another bargain pre-owned RV comes our way!

As for operational costs of the RV, here are some to consider:

Insurance: the more the vehicle's worth, the higher insurance (again, see Guidebook to Mobile Spay/Neuter Clinics, which details insurance costs to each featured group).

Gas, maintenance, repairs, etc: the more the vehicles moved, the more expensive this all will be. We only relocate ours about every 3 months, these days. You may also consider that plan; we'll go a needy area and just stay there with the surgical team & volunteers making weekly forays to the RV, week after week. By the way, we get 6-8 miles per gallon.

Electricity, water, etc. inside the RV: we really don't use the generator, since we plug into an existing building, and we use their sinks and toilets generally, as well. So, costs are negligible.

In other words, because we're so not-fancy, and because most of our mechanical repairs and maintenance has been done by volunteer mechanics, costs have not been bad at all. Maybe $3-4K last year including insurance, the flat tire, the towing bill, and a few other incidentals, like tire chains and roadside safety triangles.

The greatest chunk of our expenses is paying the surgical team, and paying for supplies and pharmaceuticals, and that's going to happen for mobile and freestanding clinics.

In summary, about whether or not I'd recommend a mobile to other groups, I recommend a high volume of targeted (feral, or pets that wouldn't have been altered otherwise) spay/neuter in a short period of time, followed up by an effective amount of surgeries to maintain high sterilization rates.

If that can happen by using existing veterinary facilities, then great. If mobility/flexibility is required, then you may need to go mobile. We needed to go mobile 'cause Oregon, like Utah, has one Big City, and then low population density everywhere else. All those smaller communities don't have the draw to pull in adequate low-cost spay/neuter vets and clinics on a permanent basis. So we needed to be able to come to them.

Note: One area was toying with having us visit. They had 2 clinics in the area, neither of which offered low cost spay/neuter. When they conferred with the existing clinics about our possible arrival, one of the local clinics offered to start doing much-discounted spay/neuter so we would stay away. We consider that cause for celebration! Maybe vets all over the country would be willing to work out an alternative where THEY get the low-cost spay/neuter business instead of having a mobile unit that they perceive as competition arrive.

Marketing for Neutermobile vans

Question from Chris:

Can you give some ideas on how you do marketing? How do people know you are coming to their town and where to be and what time? Do you partner with the local shelters and rescues and how receptive are they to you?

Response from Stewart:

We do a lot of direct mail. Most of the rural places we visit only require that the address on a postcard simply has to state "rural route", the name of the town and the zip and the post office will put one in every P.O. Box in town. In urban areas we also mail out postcards, but the postage costs force us to carefully select those to whom notices are sent. For urban areas we also had to purchase a mailing list from a list broker to get addresses, which was costly.

In rural areas we place display ads in the local newspaper. This is too costly in urban areas, so we rely on classifieds. Whenever possible we place ads in utility bills, city newsletters and community calendars. In some areas we also have volunteer community coordinators who distribute flyers around town. In Salt Lake City, one local news program also lists our upcoming locations at the end of their news broadcasts.

Whenever possible we do partner with local shelters that promote our upcoming visits as much as they can. In fact, local shelters are our preferred place to park. For the most part, animal control shelters and their staff are huge fans of the program and are extremely welcoming and willing to help.

Response from Celeste:

We don't just partner with local help for animals; we'd be useless without them! For more information about the symbiotic partnership model we follow, please visit www.all4animals.org/neutermobile/download.html

They contact us, generally, not the other way around, and then our designated Host Support volunteer, Lisa Wahl, answers their questions. She keeps everybody's hosting ducks in a row. The response has been incredibly overwhelming, to understate. There seems to be no end to the animal teams who are willing to work really, really hard to bring us to their county for demanding, lengthy visits.

Most groups hear about us through the 'animal people' grapevine, by surfing the Internet, or are on our email list. We periodically send out progress updates.

As far as marketing to the community we're visiting, the hosts mainly handle that. We provide templates of press releases. This works out well because hosts usually already have a relationship with the local media.

Most of our initial clients come to us, because they read about us in their paper. But as the weeks and months marched on, we started seeing an increasing number of clients that have been personally referred by 'customers' of ours. And, we have lots of repeat 'business'. For example, someone will bring us their pet cat, then get so excited by the positive changes in their pet, that they later bring us the strays in their neighborhood, as well!

Some marketing ideas we've heard about or our hosts have tried to good success are:

- Big banners/signs drivers see as they're entering/exiting a community (few words, big lettering do best)
- Feature articles, pictorials, and bulletins (in community events/calendar sections) in local papers are all free and very effective. Be sure to include good, digital photos to the paper. Most papers have trumpeted our success not just before, but also during our visit. Animal care is big news!
- Radio and TV appearances have been less effective, but we'd still never turn them down.
- Advertising on utility bills, we've heard from Best Friends, is free and very effective.
- Fliers/posters have been good as long as they're short and to-the-point, with large font. Graphics are helpful.
- Networking with any existing, local animal groups has been great. They can point folks our way. Also, many rescuers patronize us to get their adoptables, including puppies and kittens, altered before placement.

Our Director of Marketing (also Lisa Wahl) had the idea to have local volunteers go through the phone book calling people with an 'informational study' asking if the household pets had been altered, at what age, if they'd ever reproduced, etc. If it turned out intact pets were at the address, call volunteers could let them know about the Neutermobile's visit, costs, and a number to call to set up an appt. Sneaky, but probably effective. We haven't had a chance to test this one out yet.

In closing, let me just reassure you that you'll probably have so many clients that you'll be beating them back with a stick!

Should small groups attempt to own their own van?

Question from a member:

My group held its first spay/neuter event this fall, and it met with moderate success. We paid a local spay/neuter van from a city 2 hours away to come out and do the clinic. With their estimated costs of buying a van (which is way beyond our budget), we concluded that it was more cost effective in the next 5-10 years to pay them to come out as often as we can raise the money. What is your feel on this? Should a very small group such as ours attempt to fundraise to the goal of owning our own van or should we continue as we have?

Response from Stewart:

This is a difficult question to answer without having more detailed information about your group's budget. The initial cost of acquiring a mobile clinic can vary widely so you may want to investigate options. One of the first questions you determine is whether or not the community you intend to serve has sufficient demand for low-cost spay/neuter services to support a full time mobile clinic. If you make a large initial capital investment, you would want to make that investment pay off in as short a term as possible.

Extending your projections many years into the future makes things a lot less certain... Questions that become much harder to answer are will your group still exist, will it have the same mission, etc. I typically like to look at three to five year cycles for making detailed financial plans. If you determine your community can certainly support 35,000 surgeries over five years then investing $150,000 to acquire a mobile clinic will amount to less than $4.50 per surgery over that time. If, on the other hand, you could only deliver 5,000 surgeries over those five years your investment over the next five years would be $30 per surgery and would probably make less sense financially than continuing with your current arrangement.

Since you describe your group as "very small", making the investment in a mobile clinic is also probably not your best option, because the initial capital cost of buying a clinic is high and you already have the ability to provide services by contracting a clinic to come to your area. Our clinic was built by General Truck Body in Texas and cost over $150,000. There are less expensive options available but the most of the ones I have seen trade reduced cost for reduced utility and durability.

However, I have only limited knowledge of what is available so investigating lower cost options would be a good idea. You would have two options if you chose to acquire your own clinic. You could wait to purchase the clinic until you had raised sufficient funds to pay for it outright. Assuming the cost of your clinic would be comparable to ours; this scheme would only be practical if you could raise at least $25,000 to $50,000 per year that you could dedicate to purchasing your own mobile clinic. Otherwise, the time it would take for you to acquire a clinic would be so extended that the delay in offering spay/neuter services would have a huge opportunity cost.

Alternatively, you could also raise funds for a down payment and then get a loan for the balance. For this to be feasible your group would need to be able to qualify for a loan or would need someone to personally guarantee the loan. You would also need to be reasonably confident you could make the loan payments once you purchased the clinic. You would need to figure out your expected revenue stream for the program and your projected total expenditures, including making the loan payments. If you can't put together a realistic budget plan, which provides sufficient revenue to both operate the program and pay the loan, then you probably don't want to purchase your own clinic. You would make the biggest impact in your community by continuing as you have. Putting together a budget plan will require figuring out a lot of the details of how you will structure your operation and financial model. Paul Berry's Mobile Spay/Neuter Clinic Operations manual contains a huge amount of information that may be helpful. There is a link to it on the main forum page.

Sorry, without specific knowledge of your group's financial situation it is difficult for me to give you more a more specific answer.

Response from Celeste:

I think it's great to cooperate with other groups, as you have done. Congratulations to you and to the mobile owners, who showed a lot of trust and respect by sharing.

I can think of a few factors to consider:

What do you mean by, "Moderate success?" How did that first spay/neuter event feel for you and the rest of the participants? I mean besides nerve-wracking, tiring, and overwhelming? Did it also feel energizing, purposeful, rewarding and repeatable? How often - and how soon - can y'all pull this off again... and again?

And are there any other affordable, accessible, attractive (the 3 A's) spay/neuter options in your region that can supplement your efforts?

Here's my strong opinion, based on information from Robert Smith, published in Animal People magazine Sept. ' 02. In order to see the population growth rate plateau (which means the birth rate lines up with the rate at which adopting households become available), to address the overpopulation issue, 70% of an area's animal population needs to be sterilized.

In order to be more efficient and effective, this would ideally be accomplished in a single breeding cycle (that means in 6 months or less).

That's a tall order, and the good news is that even if you don't reach those percentages to address overpopulation, any spay/neuter performed at least helps the individual animal and the people who care for that animal.

So, my suggestion is for you all to pull your heads together. Take a big picture view, if you haven't already, and figure out all the ways to squeeze as many spay/neuter surgeries that wouldn't have happened otherwise out of your community, in as short a time frame as possible, whether or not a mobile unit is the primary resource. Really go, go, go, try hard giving maximum effort and concentration. Think creatively and use your options to get results. Then relax, celebrate, and slow down the pace to maintenance.

Did you already carefully review the links that Aimee referred to at the beginning of this week's forum? Good! That will give you just some idea of all the great options available.

For anyone who is even mildly contemplating looking into purchasing a mobile unit, the "Guidebook to Mobile Spay/Neuter Clinics" is a must-have. It's now free and can be downloaded.

If purchasing your own unit ends up being the best option for you, remember that you can later put it on the market. Hopefully you will recoup some of your costs with resale proceeds once it's served its purpose. You'll lose some money, as vehicles have poor resale returns compared to the high cost of purchasing new, but it might help just to know you're not making a now-or-never, forever & ever decision when you acquire a mobile.

Finding space for pre and post op

Question from Member:

We are using a unit that cannot house pre- and post-op patients, thus we must find a second location in cold weather to keep the animals warm. This is proving to be a bit difficult for many reasons. We cannot advertise a full calendar year of clinic dates, since we are having difficulty in nailing down locations. Would it be worth it to sell the one we have and purchase a larger unit?

Response from Celeste:

We are in the same boat, and have found agreeable sites (local hosts help us with the task).

We don't advertise a full calendar year, either. I'm not sure why this is needed, since we always book out so quickly, anyway.

Park as close as you can to the building, because anesthetized patients can chill very easily, and wrap them in a warm towel, maybe with a hot water bottle in the carrier, before transfer. Cover the carrier of small animals with a warm towel to ward off drafts, too.

Here are some ideas for existing buildings to use:

- Church facilities
- Youth centers when not in use
- 2-car garages
- Warehouses
- Empty mall storefront
- Community center
- Meeting room
- Hotel conference room
- Play theater
- Lions or elks club space
- Someone's house

Get creative, and get it donated!

Response from Stewart:

It is difficult to answer your question without knowing some details about your current clinic, your available financial resources, and what sort of clinic you intend to buy. I would begin by determining what you can expect to get if you sell your existing clinic. Then determine what the cost would be for acquiring a new clinic with additional cage space. Once you figure out the net cost you can determine if being able to operate through the winter is worth the additional cost or if the money could be used to accomplish more surgeries with some other type of program.

Other options would include a voucher program utilizing local vet clinics, establishing a stationary clinic, large MASH style events, etc. I don't know what type of clinic you currently have but you may also want to investigate the possibility of modifying or retrofitting your existing clinic with additional cage space. We were able to add 12 additional shoreline cages to our clinic for a relatively moderate cost by working with a custom truck fabricator. Another option would be buying a second vehicle or trailer that would just house animals pre- and post-op. An additional vehicle would require additional staff or volunteers to monitor animals during recovery, so this may be costly in the long run.

The Spay USA guidebook to mobile clinics (pdf) that Celeste Crimi referred to in response to an earlier forum's question would be useful in figuring out what the cost would be for a mobile clinic with additional cage space.

Fundraising to keep the van running

Question from Janet:

How much of the van is supported by fees from clients and how much is supported by other fundraising? How tough is it to fundraise and do any of the local humane groups support you when you come into their area? We are in the process of trying to get a mobile van and are thinking about asking each City to sponsor a day where they pay. Have you ever heard of that working or tried it yourself?

Response from Stewart:

Our budgeted revenue this fiscal year breakdown as follows:

Client Fees $245,000
Direct Aid from Best Friends Animal Society 144,000
Corporate Sponsorship 15,000
Private Donations 22,000
Total $426,000

We have not tried to get cities to sponsor us but, if you can make it work, it sounds like a great idea. If you are successful, you will be developing relationships that will aid you in future efforts, and will be fostering a commitment to spay/neuter efforts in those city governments.

Response from Celeste:

Please see the lengthy email I just sent in reply to Veronica's question, which will shed some light on your questions, as well.

When you say 'van' I'll assume you mean project operations, not just vehicle costs. How tough it is to fundraise varies from County to County. Also, our different hosts have different levels of fundraising ability. They're the ones who are really charged with day-to-day fundraising responsibility.

We did the initial work to raise funds for the unit itself and we have gotten a few grants that we've passed on to help subsidize needy spay/neuter in areas we're visiting, to help out. There are fundraising ideas on our website.

This works out well because, before we starting requiring heavy local involvement, it seemed like everyone in the state had their hand out, but they weren't helping to pitch in sufficiently. I mean, a statewide project needs statewide support, right? Now the areas that are benefited are the areas that are working hardest, and that seems fair.

As far as each city having a day where they pay, who pays the rest of the time? Or do they pay when the van comes to their area, period? That sounds the least open-ended to me....

By the way, we're also looking at trying out a pilot policy where, instead of the hosts compensating us $30 per patient, we'll charge a flat fee of probably $800 daily, and let them have as many patients as the surgeons will allow on any given day (as an incentive to have full days). Then give the surgeons a bonus per patient altered above a baseline.

How to find vets who want to do spay/neuter and can do ferals and pediatric

Question from Michelle:

We are having a really hard time finding a vet not only who wants to do spay/neuter, but who can do pediatric and is willing to do ferals. We have had one vet interested. But, she was in her first year out of school and was very slow, so we wouldn't be able to do many surgeries in one day. Any ideas on where we can advertise for vets and what would be a good rate of pay?

Response from Celeste:

First, how to find a good surgeon:

One of our surgeons, I knew because she filled in as a relief vet for a time at the stationary, full service clinic where I work. So, we were acquaintances, and we both shared a passion for spay/neuter. We stayed in touch occasionally via email after she'd moved. So, in other words, we found her 'through the grapevine'.

We also put an ad in the AVMA newsletter (American Veterinary Medical Association). Mostly, this stirred up new grads (who haven't developed the surgical deftness required to see about 30 patients a day of multiple species and genders) or vets who were casually looking for some light work, not real go-getters. Except, it did produce one excellent and well-loved surgeon for us, so it was a good idea.

And we've had another doctor do a good job of doing some geographically convenient relief work for us, which has been a real help, and she was contacted by one of the local groups in her area. As you see from our website, we work closely with local groups to bring ON to a community. So, again, personal connections.

Since 2 out of our 3 surgeons came from somebody knowing somebody, I'd strongly suggest some friendly head-hunting.

Most of us rescue types know all the vets at our favorite rescue-friendly clinic. Ask one of the part-timers or relief vets if they want to pick up some extra hours working with you!

Or send a fax to each of the local clinics asking for quick, safe surgeons to pick up some shifts. If they're right for the field, they'll get hooked and be regulars!

Or, hang out where there's a high probability of striking up a conversation with vets who are interested in animal welfare, and are skilled surgeons.

For example, is there an event that makes use of volunteer veterinarians anywhere in your region? Be sure to attend! Hang out by the refreshments (where the surgeons will be when not in surgery, you hope. Ask if they're interested in finding out more about helping needy animals as a career, since they enjoy the occasional volunteer event. Or ask the event coordinators if they'll pass out cards/info to the volunteer vets.

Also, ask local shelters that practice (good for them) neuter before adoption. Which surgeons do they turn to again and again? Maybe those same doctors want to expand their practice!

Whatever you do, it's best to advertise for a surgeon who can handle the particular volume you're looking for. Every vet seems to think they 'do a pretty quick cat spay,' even if that means 45 minutes). So, you can either specify, "10 minute cat spay, 20 minute dog spay, 10 minute dog neuter" or for brevity's sake, "20/30/40 sx/day". Whatever volume is your goal. Sx stands for surgery in medical shorthand - there, now you're really an insider!

Now, helping vets embrace juvenile spay/neuter and feral cat care:

Understanding is half the battle. Present your vet with a video made for vets (www.avar.org has one on juvenile spay/neuter), and say, "Please let me know your thoughts/reaction to this..."

Or, ask all the vets in your area for a tea party, show the video, and address questions/concerns. You'll need to do some research beforehand to hold your own!

If you know even one vet who's in favor of ferals/juveniles, ask them to conspire with you to find ways to bring up the topic in casual conversation with other vets, just to remind them those options are out there.

If there's a volunteer event where juveniles/ferals are altered, ask as many vets as possible to attend, even if it's just to drop by and visit. They may just be scared of the unknown. Once they see something done, it's more acceptable.

As for ferals, it's mainly the techs who act differently to anesthetize ferals, not the vets (once they're asleep and scrubbed for surgery, a feral tummy looks and acts just like a tame tummy). The typical technique is for the tech to give the cat anesthetic drugs with a tiny needle, usually right through the trap. Make sure they've seen a video, at the least, on fractious animal handling, so they can stay calm, safe, and non abusive.

Make sure they have the equipment needed: a small fishing net to snare escapees, thick welding gloves that come up the arm to ward off bites, and a 'squeeze cage' that can be purchased for less than $100.

If the techs are on your side for ferals, the vets will probably not object. You may also offer to pay an extra $2-5 per feral surgery, for the first few months, to get them used to it.

Good luck; changing minds is hard work, but worth it!

Response from Stewart:

We were lucky enough to find an excellent vet through our previous vet so we haven't needed to advertise. I would try the traditional locations like the newspaper, your website (if you have one) and also look into placing an ad in veterinary publications like the AVMA newsletter and the AVMA website.

If you have veterinarians in the community who support what you are doing I would let them know that you need a veterinarian. They may have colleagues who would be interested. Pay rates are variable from place to place, so it is hard for me say what a good pay rate would be for your operation. I would find out what vets typically earn when working in a local clinic and try and be competitive. We pay our full time vet a rate that is only slightly less than he earned when he worked full time in an emergency clinic.

This is higher than he would earn doing spay/neuter in another clinic, but he performs up to 65 surgeries per day. If we were to hire a vet who could only do 20 surgeries per day and paid them one-third less, our revenue would be reduced by more than we would save in salary. So, if you hire a vet who cannot do a large number of surgeries per day you may want to consider paying them on a per surgery basis. This way they have an incentive to increase their productivity and their compensation grows as their skills improve.

Post-op care and emergencies

Question from Debbie:

What do you do about post-op emergencies? We do a MASH clinic and we get a lot of people calling us afterwards. Many times it is with questions we can easily answer over the phone that are not emergencies. But what would you do if you had an emergency? Have you had a lot? Do you have local vets on call, and if so, how hard it was to get the local vets to agree to do that?

Response from Stewart:

We give each client instructions to call us directly with questions or concerns after surgery. The medical staff carries a cell phone 24 hours a day. Most of the calls can be handled over the telephone, but if there is an emergency we ask people to immediately bring their animal to us if we are still in town. Our vet has an extensive background in emergency medicine, so he is equipped to handle most situations.

If we have left town, we direct people to go to their local vet and we either pay the vet directly or reimburse the client. We do not have agreements with local vets, but do have a list of vets around the state people can use if they don't have a vet of their own. Since they are being paid at their usual rates, we have only ever had one vet be unwilling to see a patient from our mobile clinic who required after care.

Last year we performed 8,618 surgeries and we referred 11 people to local vets. One of these was found to have distemper and one tested positive for parvo. The veterinary costs for treatment of these two animals were covered by their owners. For the other nine, we covered just under $2,000 in vet bills for after care. We also had a few cases of incisional licking after dog neuters when the client declined an e-collar. We charge $5 for an e-collar and strongly recommend them for all dog neuters. If the client refuses to purchase an e-collar, we inform them that we will not cover the cost of any veterinary care required due to excessive incisional licking or biting. In addition to the 11 referrals previously mentioned, I believe we had four or five cases last year of excessive incisional licking that required a visit to a local vet for antibiotics and an e-collar.

Response from Celeste:

Ah, the question on everybody's lips!

Well, we actively refer people to go to their local vets, whenever there is one, for ANY supplemental or aftercare.

The good news is that we have a surprisingly low complication rate, even though some of our patients don't get the, umm, royal treatment when they go home. Out of about 2,000 patients, we've had a few mishaps, most of which have been taken care of by our own surgeons. There were a handful of dogs (it's usually a neuter) ripping out their stitches afterward, a few female dogs bleeding post-op (that was addressed before they ever were released from our care), and a couple of infections.

If we've left the area and a complication occurs, a local vet sees the patient. Sometimes we've picked up the tab for it (never been more than $100 or so). The client pays if they're not low income, or the host does. We've handled it on a case by case basis.

Most of these places don't have state of the art, 24-hr emergency facilities, but that's not going to stop us. Better than not coming at all.

What equipment is needed for a mobile van?

Question from a member:

I've read the Spay USA book on model mobile vans. But I'm still having trouble figuring out all of the equipment we would need to purchase a mobile van, where to get supplies from, and how much it will cost. Did you have any luck getting any supplies donated? How did you figure out what you needed for the van? We don't have anyone with a medical background in our group so trying to learn all the machines and supplies has been quite a challenge!

Response from Celeste:

I was hoping someone would ask this question. Thank you!

If you haven't worked in the veterinary field and don't have a good idea of what's needed, then ask a vet or tech to make a list for you. A vet went through the RV we purchased before we made an offer. Recommendations were that we rip out some carpeting to make the space more sterile, that we redirected some A/C vents so they wouldn't blow particles down on the surgery table, and detailed supplies we'd need.

First, let's talk about major equipment (pieces that cost more than $1K apiece are usually referred to as 'capital equipment'). I'll list the item, then possible sources:

Surgery light (dental supply, surgery supply outlet)
Anesthesia machine - wall mount best (pre-owned through internet, surgery supply outlet)
Surgery table - think simple (pre-owned through internet, surgery supply outlet, auction)
Autoclave - nice to have 2, using 1 for backup (pre-owned through internet, surgery supply outlet, auction)
Electric walk-on scale for weighing large dogs (we found a new one on the internet for $500, normally closer to $1K, which is the best price we found, and it works great, from Fairbanks)

Now, that's the main equipment needed. But you'll also need lots of consumable supplies and smaller equipment investment. The Guidebook and Dr. Mackie's article can help with your questions for both equipment and supplies. When purchasing seems overwhelming, try to break the day down into steps and visualize what's needed for each step.

For Pre-Surgical Exams: small-animal/baby scale, exam gloves, thermometers, cleaner, K-Y jelly, paper towels, stethoscope, jar to hold cleaner/cotton balls for cleaning thermometer between uses.

For Surgery Prep: 3 cc and 1 cc size syringes, with lure locked needles attached; sterile gauze pads (also called sponges); surgical scrub (Chlorhexiderm is popular); surgical solution (Chlorhexidine is popular); container for holding gauze soaked in scrub solution; iodine; hydrogen peroxide; isopropyl alcohol; electric/cordless hair clippers that hold a #40 size blade, with at least 1 backup blade; mineral oil or eye lubricant; nail clippers, if desired; trash can.

For Surgery: at least 12 (15-20 is better, but these are expensive) packs of spay instruments, with at least 24 fenestrated drapes, about 2'x2', and at least 24 pack wraps (solid cloth to parcel the drape in); 24 huck towels if surgeon uses; surgical masks, caps, and gowns for surgeons (get their preference); sterile surgery gloves (surgeons know their size and whether they like powdered or not, and if they have a latex allergy); suture (your operation will probably want absorbable/dissolvable - get the suture sizes, needle size and style, color, and filament style your vets prefers); sterile scalpels (typically size 15 or 20 will do nicely); hemostats; metzenbaum scissors for cold tray; cold tray of some sort; 'mayo' stand (those are the trays on wheels on which the surgeon places his/her instruments); trash can; container for holding 'sharps' like used scalpel blades and suture needles; tattoo pen, if desired; anti-clotting agent for tipping ears of feral cats; tissue; adhesive, if desired; IV catheters; IV drip sets; Vetrap adhesive medical tape.

For Aftercare: heating pads; empty plastic beverage containers/exam gloves for filling with warm water; space heaters; heating lamps, if desired; thick, warm towels and blankets; newspaper; cleaner; spray bottles; rags and paper towels; laundry receptacle; saline solution in IV bags; size 18 gauge needles for administering fluids (some prefer other sizes); simple drip sets.

For supplies, we like Medcare Products (great sense of humor) and MVI, where we got our German-made surgery packs on sale for only $99 each (usually $199, or $300+ anywhere else). They are the best; you don't want anything else. For feral handling equipment, we like Animal Care Equipment and Supplies.

No matter what, you'll need a vet or experienced tech to look over all your supplies and make sure nothing's been left out before opening day. Another great idea is to purchase a used veterinary technician handbook or textbook, and read it all, jotting down notes and supplies needed as you go.

For the very first time, we asked one of our surgeons to order supplies for us. That way we knew for sure she got what she wanted, and then we used the packing slips to refer to the next time we placed an order for her. That took out some of the scary guesswork.

I remember worrying a lot about having everything just so, but things just sort of 'worked out' for a lot of these supplies. Like, one of the doctors picked up our drug locker, some clippers, and a large heating pad to put under patients on the operating table, all at a pawn shop. And our trash cans are just old plastic buckets with trash bags in them. A lot of stuff also came from Goodwill, like the Rubbermaid containers we use to hold gauze and the cold tray solution/instruments. Make sure your autoclave comes with a service warranty, 'cause they need tinkering about as often as an old Harley Davidson.

As far as getting things donated, we've had varied success. There have been a few bright points, but we mainly have gotten expired, damaged or 'weird' stuff - like the Irish green surgery gloves! Basically, I'd just order supplies needed, and then anything donated is a bonus.

Human hospitals have surplus warehouses that will sometimes donate things like operating stools, surgery lights, mayo trays, canisters for holding cotton balls and the like. So make sure to ask.

Good luck, think 'easy' and have fun learning about all the possibilities out there. Don't be afraid to ask for help from someone in the veterinary field!

Response from Stewart:

I would work with the vet you plan on hiring to perform surgeries to determine what supplies and equipment you need. Vets have preferences for equipment types and brands. Having the vet who is developing your protocol consult with you on supplies and equipment will help you make sure that you have what you need. You will need to set up accounts with several medical supply distributors. And, you will need a licensed veterinarian on your account.

Check out www.capsulenet.com. Once you set up an account, they let you shop several distributors for the same items to keep costs low. The Spay USA Guidebook to mobile clinics that Celeste Crimi recommended is an excellent resource. It has information on what sort of costs to expect for various types of operations, as does Paul Berry's survey on mobile clinics.

We initially spent $153,728 on our clinic itself, $10,533 for additional supplies and equipment to stock it. Currently we spend $54,500 on medical supplies and equipment annually. The costs vary significantly from clinic to clinic and operation to operation. If you check out the aforementioned documents you will get an idea of the range of costs. While we had little success in getting supplies donated, others have had great success so it is definitely worth trying.

Who to offer services to and how to track success

Question from Veronica:

My questions are about how whom you offer services to and how you track your success. Are your services only for low-income, and if so, do you screen? If not, is it open to anyone who wants to come in and wouldn't that upset the vets who would feel it is competition? How do you decide what area to go into next? How are you tracking your results to see if you are making a difference with impound numbers and euthanasia's?

Response from Stewart:

When we began we struggled with how to screen our clients to make sure we provided services to only low-income pet owners. Ultimately, we chose not to screen. We target our advertising to low-income pet owners whenever possible, but we do not screen for a couple of reasons. In Utah the LDS Church has a welfare/assistance program for their members. Church members are encouraged to seek assistance from their families first, the church second. Then, only if they cannot get the assistance they need from these sources, to then turn to government public assistance programs. As a result, there are a significant number of working poor in the state who are not receiving benefits from any public means tested program. Therefore, they do not have any way to prove they are low-income.

Doing our own means testing for each client is not practical. Additionally, we get a number of clients who are clearly financially able to afford to have their pet fixed, but who don't see it as worth spending much money on. They are willing to get it done at the price level we offer but not at the prices charged by their local vets. Our mission is to motivate pet owners to get pets fixed who otherwise wouldn't. Consequently, we view it as a success when they get their pets fixed regardless of whether the impediment was true financial inability or simply not considering spaying or neutering their pet important enough for a significant investment.

Since our clinic operates on a first come first served basis it is not unusual for people to line up an hour before intake starts. So getting your pet fixed at our clinic requires a certain amount of inconvenience, which most upper-income pet owners just looking for a better deal are unwilling to endure. It is worth it to them not to have to stand in line, to be required to pick up their pet between five and six, etc.

When we began, many vets did feel we were competition and strongly criticized our program as "unfair competition" and our price levels as "under-valuing veterinary medicine". We also run a program called the Super County Fix, in which we invite the vets in a county to match the prices on our mobile clinic. We pay them an additional $25 for each surgery, and we handle all of the advertising and promotion. These promotions have been extremely successful and have developed into strong partnerships between our organization and local veterinary practitioners.

However, many of the vets that have participated in these promotions have commented that the clientele they attract have never visited a vet before, that they don't buy additional services and that they rarely return as regular customers. As a result, most of the vets in urban areas have become content to participate in our promotions once or twice a year, and to have us handle these clients the rest of the time, while they focus on middle and upper income pet owners. There are still several vets who think we are unfair competition and that offering any sort of discounted veterinary services undervalues the profession and the value of the services provided.

Their first priority is keeping the price of services high, and our first priority is increasing spay/neuter. Based on experience, we believe that the most effective way to do this is by offering low-cost services. We strive (with a good deal of success) to find ways to offer low-cost services that include the local veterinary community as partners. However, we are unwilling to stop providing low cost services to pacify a minority of clinic owners who feel that keeping fees high should be our first priority.

As part of our overall program, No More Homeless Pets in Utah gathers monthly statistics from 54 shelters across the state. Each shelter fills out a monthly report that contains information about their impounds, redemptions, transfers and animals euthanized. We analyze this info and attempt to figure out what impact our spay/neuter programs are making. It is complicated and as much art as science. But we have seen reductions in shelter intake in at least one major area on which we focused heavily. We do take the euthanasia numbers in an area into account when we choose locations. We also look at past success in that area, availability of other low-cost services, advertising options, and community participation.

When clients pick up their animals, we ask them to fill out an exit survey which asks questions about their income, how they heard about us, if they have a regular veterinarian, if they own a car, etc. We analyze these to determine the demographics of our client base and to figure out what advertising media are most effective.

Response from Celeste:

Geesh - you sound like some of those grant applications that always make me a little nervous.

Here's how we work: We are dependent (unless one of those big grants falls from the sky) on partnering with local volunteers before we can set up and operate a mobile unit. Again, please see the documents on hosting.

Those partners are responsible for compensating our expenses, which we've worked out to be $30 per animal. Note: when we first started out, we thought it was going to be $20 per patient, based on Dr. Mackie's figures, which is why I say they're overly optimistic. We got the $30 figure by periodically dividing our expenses to date by animals helped. It's really about $25-27 each, but we need a little for development, as well. If they want to pay less, they can find a volunteer vet/tech, and knock a little off each surgery. At least in theory; while a few groups have found a volunteer for a day or so, most surgical teams need some sort of compensation to be able to give up so much of their time and expertise to us.

They can charge whatever they want to the 'regular' client, as long as they charge clients with proof (I underscore) of being on public assistance only $10 per patient. If they bring in 5 patients in one day, then it's only $5 for each of those patients. And, shelters and registered nonprofits are only charged $30 to encourage neuter before adoption.

Our fee schedule has been strategically set up to encourage low-income caretakers, as well as create a sense of urgency in the consumer; reward those who work to bring in quantities of patients; and facilitate alteration of shelter and rescue animals.

FYI, the fees our hosts set for non-discounted clients is usually $30 per cat, $50-60 per dog, and $50 per rabbit. Ferrets, rats, etc we haven't booked yet due to lack of demand, but we're willing, ready and able. Anything over and above $30 goes into the pot to pay for subsidized ($5-10 price) spay/neuter. Get it?

This system frees our local hosts, who have a good sense of their area, and fundraising possibilities, and 'the market' to be able to see the ratio of regularly paying clients that they need to pay for all the low-income surgeries. Some hosts have been very successful at using ON's arrival as a fundraising impetus and have been able to help a very high ratio of low-income/ferals.

If we leave it completely up to chance, it still varies widely from week to week. Our Statistician (also Lisa Wahl) tells us that about 20-40% of our clientele are publicly assisted.

Our initial plan was to do only low income, and this was the compromise we found to get us started and on the road while we waited for our financial ship to come in. And it's worked out great!

Does this upset existing vet clinics? I'm sure it does, a few. But most just sigh, grin and bear it, and refer their clients to us for spay/neuter if they're asked. They know those clients be back in their clinic for the rest of the pets' lives.

Let me just say here that we have a to compete with local clinics. We do it as non-invasively as possible. We truly care about their success, and we want the animals to have a relationship with their local clinic.

BUT, we also don't have to feel like monsters; these areas we serve have a tremendous backlog of clients who have not gotten their pets (and generations of offspring) fixed for years, because of a perceived price barrier. And they quote to us how much less we are than their clinic. I'm talking here about the patients that have a regular vet; there are lots more who've never seen the inside of a vet office. Which means they're interested in spay/neuter, they even asked the questions, and it was too much to them.

People want to spend money on their animals. That's why after they come to us; both Animal Control and local clinics have reported an increase in business and licensing.

Yes, we were very surprised by the increase in licensing. You see, many counties charge a higher licensing fee for intact pets. But, the guardians felt they couldn't afford the usual high cost of sterilization, so they also couldn't afford the higher cost of licensing their still-intact pet. When they were able to get their pet fixed, they could then also afford the reduced licensing fee. Very interesting!

But, back to our right to compete: When a new Planned Parenthood opens up, you can bet your bottom dollar they don't go tiptoeing around hoping the HMOs won't get mad at them for offering reduced cost birth control. And they wouldn't dream of worrying about the HMOs and private clinics shutting them down. Why should we!

Now, on to how we decide where we're going next: Well, groups from new counties of the state are contacting us all the time, wanting us to come visit. Our Host Support keeps track of them all. We go to the next place geographically convenient, usually, to the place we've just been. When we first started, we went where a host was ready for us, regardless of geographical convenience, but now demand has really picked up, and we're booked at least through the summer. Yikes!

About tracking results: This is a very hard one for us to back up with hard data. That's because sometimes, where we go doesn't have a shelter at all, let alone anybody to keep baseline statistics. And many of the places we do go don't have reliable statistics reporting. So, basically, we'll keep coming back to an area until we get less than 20 patients, 2 days in a row.

In other words, when demand peters out, and the local hosts stop telling us, "There are just 5 more cat colonies to TNR, and we'll have 'cleaned up' the area." And we don't take it lying down. If we ever suspect demand is dropping, we'll hit the streets, going door to door, looking for intact pets and strays to be potential patients, handing out fliers. Or, we'll call previous clients and ask them if they know of others to bring in. Or, we'll start announcing to customers that we don't know how much longer we'll be there unless they can help us round up some more intact animals. This works well - people don't want us to leave, and will work hard to keep us. Usually our 'last week' has a lot of walk-ins, people with their cat in their arms, desperate for a fix!