Monday, July 26, 2010

VCA VRA History

Steinberg and Cowell


A convergence is most commonly used in astronomical circles, when a series of unrelated events coincide in a unique manner. The seventies were host to a convergence of sorts that was to become Veterinary Referral Associates, Inc., one of the first referral-only veterinary hospitals in the world.

In 1971 Dr. Jacques Jenny died of cancer. Although many well-known veterinarians are associated with the term “pioneer”, the term truly applies to Dr. Jenny. He defined the biology of bone healing using intramedullary pins, Kuentscher nails, in fracture treatment and was the first to bring the compressive ASIF plating system to America and improved upon this system, teaching it to others for many years. He worked alongside human orthopedic surgeons and in the fifties and sixties carved out a place that was equal to his counter-parts in human medicine. He created many unique surgical treatments that he applied with equal skill to horses, dogs and cats. Dr. Jenny chaired the organizing committee for the college of veterinary surgeons and served as its first president.

1971 was also the year that Dr. Peter Ihrke graduated from veterinary school. Peter was destined to become a world famous veterinary dermatologist who has spent most of his career at the University of California in Davis. Upon graduation from Penn, Peter stayed on at Penn as an Associate in Dermatology under the tutelage of Dr. Bob Scwartzman. There were no formal training programs and although there were a few dozen internships, one could become an academic specialist, virtually the only kind of specialist at the time, without one.

1974 was the year that four young energetic veterinarians decided to try something completely new. Dr. Ken Cowell, an Auburn graduate, completed a veterinary internship at South Shore Animal Hospital. This hospital would later become VCA/South Shore in South Whalen, Massachusetts. Dr. Steve Steinberg, a University of Pennsylvania graduate, completed an internship at Henry Bergh Memorial Animal Hospital in New York City. Dr Anne Chiappella, a California native and Davis grad, completed an internship at The University of Pennsylvania. Dr. Clark Dickinson, a seasoned practitioner, was just looking for something new.

1974 was the year Peter Ihrke tried something new. At the request of local practitioners, he started coming to the Washington, DC area once per month to see dermatology cases. The local practitioners loved him and he was an immediate success.

Because of the tremendous legacy of Dr. Jenny, the University of Pennsylvania had established various avenues that would carry his name forward and hold it as a beacon for future generations. In 1974 the Veterinary School through the foresight of Dean Bob Marshak decided to try something new and adventurous, training programs for the teaching of young veterinarians heading into veterinary specialties. They called these programs “residencies” to mimic similar programs that had been the mainstay of training in human medicine. Clark Dickinson became the first Jacque Jenny Honorary Orthopedic Resident. At the same time Ken Cowell became the second orthopedic resident, Steve Steinberg the first neurology resident and Anne Chiapella the first internal medicine resident. Since there wasn’t an established program, these residents were in a kind of free-form adventure where they became best of friends and were supportive of each other. Because there weren’t established programs, these residents also worked alongside contemporaries in training programs who were called instructors, associates, fellows etc. The lines for education in specialties were poorly drawn.

All of the residencies were of two years duration and in 1976 Steinberg stayed on at Penn as an Associate Instructor, Cowell went on to a surgical practice, Chiapella stayed at Penn as an instructor in medicine and Dickinson went on to a private practice in New Jersey.

In 1976 some innovative and congenial veterinary practitioners formed a partnership and opened one of the first emergency hospitals in the country in Rockville, Maryland. Peter Ihrke worked at several of the partner’s practices on a once a month basis. Metropolitan Emergency Animal Clinic (MEAC) still thrives today.

Three of the MEAC vets determined that specialization could be the wave of the future. The emergency hospital was unused during the day and therefore would be a great place to have specialists. It should be understood; the emergency hospital and the idea of private practice specialization were virtually unheard of at that time in 1976.

In February of 1977, Dr. Dick Weitzman, Dr. Sandy Karn, and Dr. Suzanne Jenkins set up a meeting through Peter Ihrke with Steve Steinberg and Ken Cowell. Peter Ihrke had emphatically stated over and over that if Steinberg and Cowell, who had become best of friends, were serious about private specialty practice, the Washington, DC area was the best place for “instant success”.

What Steve Steinberg and Ken Cowell didn’t realize at the time was that they were so poor they would have a hard time recognizing failure. In 1976 each had made an annual salary of $7000. Steve Steinberg and Ken Cowell went to the First American Bank of Maryland with a business plan in March of 1977. It was the seventies and both were wearing suits and both were not wearing a single piece of clothing that they had not borrowed (see picture). Steve Steinberg shaved off his “afro” sized hair and removed his earring. They were soon to be businessmen. A loan officer at the bank, Jack Issacson, loved the idea and without collateral allowed the pair to borrow $13,000. They eventually had to borrow a total of $33,000 to get stated.

On October 1, 1977, H. Steven Steve Steinberg, V.M.D. and Kenneth R. Cowell, D.V.M., A Professional Corporation, was formed. The name was a dull mouthful and they were instantly known everywhere as “Steinberg & Cowell”.

On November 1, 1977 they opened their doors at MEAC and were an instant success. The first year they grossed $125,000 and they each received $ 17,000 in compensation. They were wealthy but only by their previous standards. They fortunately had made a pivotal decision, that they would keep all of their equipment separate from that of MEAC’s. Everything they owned went into cardboard boxes at night and was locked up in a closet including unhooking and wheeling the film processor into the closet so the emergency hospital could tank develop their films at night. A film processor in private practice was unheard of in those days. All of these supplies had to be wheeled out each morning. This allowed them to understand and control their own inventory, hard for neophytes, but a very valuable lesson.

Steinberg & Cowell were growing by leaps and bounds and it was hard to get the MEAC partners to realize that unless they could expand they would have to move on. Each of the partners had their own practices to run and didn’t really have the time to understand the specialist’s predicament.

In 1980, Steinberg was driving up what was a small two-lane road, Route 28( today a multi-lane highway). He passed one of the most unique structures in the county, the old Garrett Farmhouse and Barn. Mr. Garrett gave up farming when his wife died and sold a small 6-acre plot with the farmhouse and barn to Dr. Denham, a veterinarian. Dr. Danny Denham had come to the Washington area through the Army eight years previously. He had been stationed at Walter Reed Army Hospital and had turned the Garrett Barn into a veterinary hospital. Denham was leaning on the fence talking to a local large animal practitioner. Steinberg knew Denham through referrals and stopped to talk. When Steve Steinberg complained that Steinberg & Cowell was bursting at the seams Denham said, “Well, I’m moving to Oklahoma, so why don’t you buy my place.”

The move occurred in 1981 to what people refer to throughout the country as “The Barn”. Dr. Anne Chiapella was added as an internal medicine specialist and Dr. David Saylor was added soon after as the soft-tissue surgeon. Dr. Saylor is the current Medical Director and Dr. Chiapella has her own practice nearby in Virginia.

In 1984, Ken Cowell, after eight years, left veterinary medicine, truly at the top of his game, to try his hand at one of his many other interests. He has never returned to veterinary medicine. With the transition in ownership to Steve Steinberg, the hospital changed names to Veterinary Referral Associates, Inc. (VRA).

With the new name came a surge of new specialties many yet to have their own certifying college many yet to have been seen elsewhere. The practice had frequent national notoriety, with articles and stories appearing throughout the country. Many specialists in the US and Europe have spent time studying the hospital and in some cases training there. Dozens of famous figures have come through VRA’s doors and a change in administrations always marks a wave of new and old politicals changing addresses.

In 1995, being one of the largest and most progressive referral hospitals in the country, Steinberg was approached by five separate and unrelated groups to purchase VRA. For the first time Steve Steinberg stood back and wondered if this thing he built was really something that someone would want to buy.

In May of 1995 Dr. Bruce Ilgen and Mr. Bob Antin came to Gaithersburg and met with Steinberg for lunch. Because Steve Steinberg had heard the other pitches first and they were all the same he was unimpressed. One group flew Steinberg to Maine and made their offer in conjunction with laying out his future with their company. When Bob Antin heard of this, he called and said Steinberg had to come to Santa Monica (VCA’s home in those days) and see their operation. VCA owned 64 hospitals at the time, less than a half dozen east of the Mississippi. Steinberg flew to Santa Monica the day after his Maine trip.

Steve Steinberg and Bob Antin immediately connected and spent most of two days together, comparing notes, sharing stories, talking family.

February 1, 1996, VRA became VCA/VRA.

Tuesday, July 6, 2010

Veterinary Medicine: It's All in the Journey

I was blessed by a great beginning to my veterinary neurology career. I became hooked on the nuances of a vast, complex system that was an enigma to most, but a rather straight journey through every neuron and pathway that controlled an animal's body, envisioned and shared through the eyes of a great teacher, Dr. Skip Averill.

This journey, though, didn't solidify until I was exposed to a mentor who was truly in awe of what he didn't know and what at the time was unknowable. A mind that was able to avoid the pitfalls of oversimplification but with an efficiency of language on the edge of the sacred, he produced short concise sentences that avoided faithfully an unknown or unproven thought. This, my greatest teacher, mixed language skills and knowledge in a way that made those in his presence self-conscious of their own communications. This ability was lost on most and incomprehensible for many. In a setting, where too many were in awe of what they knew, this was a fresh way of projecting knowledge that was too unique for many to grasp. This was my second teacher Dr. Sheldon Steinberg (no relation to me).

The slide from studying and grasping the intricacies of what was known to the arena of appreciation of what wasn't known, ignited a passion in me to try to recognize the truth when available and feel the power of what wasn't understood on a continual basis. I have yet to put my arms around these topics with clear and efficient language but the groundwork for the thought processes is strongly in place. Every known becomes shrouded in the uncertain. Every diagnoses is challenged. Every truth is held up to the light, looking for that crack that shows its insides to be different than expected.

Many think that we in veterinary medicine are hamstrung by patients that can't convey by language the simplest of facts but this is a total misconception. Our history taking skills are well honed, our powers of observation must be strong, our hands must be determined, our senses on edge but ask any veterinary clinician if they miss verbal communication with their patients and they will invariably state that they hadn't even noticed it was missing.

The "toys of medical science" have brought a new dimension to our quest to discover but have not hardly replaced our most basic of tools. In this state of transition we have made some serious missteps. We often confuse the paperwork with the patient. We often convince ourselves that we have a diagnosis when we may be simply close to one. We often believe the patient recovered because of us, when in fact it was in spite of us.

Mastery of a skill, it has been said, takes about ten years. Those of us who are in the hands-on professions know what dues have to be paid to become skilled, but there are few joys that can compare with holding a beloved pet in ones hands and through skilled manipulation determine the most productive next direction and from that step determine the most productive treatment options and from that step see the most beautiful gaze of thanks from an owner and their animal friend, who now have a diagnosis and hopefully a successful treatment ahead of them.