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Illustration by Sol Volute

Two decades ago, a lawyer named Mark Cushing received a call that spurred his ascent as one of the veterinary community's most formidable — and, some would say, polarizing — political strategists.

On the line was Dr. Scott Campbell, who was chief executive of Banfield Pet Hospital, then the largest chain of veterinary practices in the United States. Campbell wanted Cushing's help.

The company was under fire for using Swiss identification microchips, which, although widely recognized as the global standard, were incompatible with the scanners used by many U.S. clinics and shelters. The mismatch led to some pets going unidentified, reportedly resulting in the accidental euthanasia of at least one puppy, and prompting calls for a ban on chips from Europe.

Cushing, a seasoned trial attorney and lobbyist who'd sharpened his political savvy running several gubernatorial campaigns, didn't disappoint. Representing the Coalition for Reuniting Pets and Families, an alliance of nonprofits and corporations including Banfield, he successfully lobbied Congress. As a result, lawmakers tasked the U.S. Department of Agriculture with promoting a mandate for universal microchips and scanners despite strong opposition from domestic manufacturers. 

Impressed by the maneuver, Campbell made a suggestion in late 2006 that would change Cushing's career — and, some would argue, key elements of the veterinary profession. "I told him, 'You really ought to think about starting a practice that only deals with veterinary issues,' " Campbell recalled during an interview with the VIN News Service.

Heeding the advice, Cushing established a consultancy, Animal Policy Group. Based in Scottsdale, Arizona, the 12-person firm aids companies, veterinary schools and other organizations in navigating their political and commercial ambitions.

Today, Cushing is at the epicenter of numerous transformative shifts within the veterinary realm. His involvement spans so broadly and deeply that it evokes a sense of being "everything everywhere all at once," to borrow a popular movie title.

He is at the forefront of controversial efforts to ease restrictions on veterinary telemedicine. He is working to establish a midlevel role in the profession akin to physician assistants or nurse practitioners in human medicine. He is engaged in getting numerous proposed veterinary schools off the ground. And recently, his name came up as a possible advocate for foreign veterinarians facing a challenging process to practice in the U.S.

The 71-year-old attributes his career successes to enthusiasm and tenacity, portraying himself as a friendly yet imposing former trial lawyer with a knack for tactical thinking.

"I don't have a medical mind or a scientific mind, and my wife would tell you I can't fix anything," Cushing told VIN News. "But my mind does work strategically, especially when I'm focused on persuading a decision-maker — whether it's a court, a jury, an accrediting body — to make the right decision. It's what I like to do and know how to do. That's who I am."

Many of the causes Cushing champions have a common theme: easing access to veterinary care by increasing the supply of practitioners or redefining how they do their jobs. He often clashes with the American Veterinary Medical Association, which asserts that his initiatives threaten to erode professional standards in favor of corporate interests that could worsen working conditions for its 100,000-plus members.

According to AVMA President Dr. Rena Carlson, Cushing and the association "don't seem to see eye-to-eye" on telemedicine and what she describes as an "unnecessary and ill-defined" midlevel role. But she avoided criticizing Cushing directly, instead speaking generally about the AVMA's activities on those two provocative topics, saying by email that the organization "fully understands the risks of these proposals, is working hard to ensure others do, as well, and is supporting a regulatory and operating environment that puts animal health, public health and public trust first."

Others more directly question Cushing's role and motivations. Dr. Joshua Sosnow, a practitioner in Scottsdale, Arizona, for example, has raised concerns about a nonveterinarian like Cushing having sway over the profession's future. "His motives likely do not align with practicing veterinarians, particularly practice owners," Sosnow wrote last fall in a message board discussion on the Veterinary Information Network, an online community for the profession and parent of VIN News. "As a lobbyist, he advocates for those who compensate him."

That's no secret, Cushing said: "I get paid to persuade people and win. I don't get paid to look good losing." 

Letters

From Dr. Uri Burstyn, Aug. 22, 2024

Advocating for remote care

Among the most significant recent developments in the veterinary profession is the adoption of telemedicine to evaluate patients remotely. Although the benefits of telemedicine are well recognized, there is fervent debate over the prevailing rule that a hands-on exam must occur to establish a veterinarian-client-patient relationship (VCPR), which is the foundation of all care.

Advocates for change, including Cushing and some of his clients, contend that allowing a VCPR to be established remotely enhances access to care for pet owners in far-flung places or with mobility challenges. To support this cause, Cushing co-founded the Veterinary Virtual Care Association in 2020, which is backed by corporate donors.

Opponents, including the AVMA, insist that an initial in-person exam is indispensable, given that nonhuman animals cannot describe their symptoms in human language. They also are concerned that commercial entities pushing for change want telemedicine platforms to be able to expand their offerings into areas such as prescription drug sales. A move like that could lead to overprescribing and "pill mills" that jeopardize animal health, the AVMA says.

Cushing has lobbied on behalf of some of those companies, Chewy and Dutch Pet among them. He also has a personal financial investment in at least one telemedicine provider, Petfolk, which offers traditional, mobile and remote care services across four southern states.

Cushing sees no problem with having a financial stake in a company that's a client. "It's not a conflict of interest because the companies I'm aligned with, I share their interests, and I think they're important," he said.

In Cushing's view, the real issue lies with the AVMA's stance on telemedicine, which he perceives as a strategy to shield its members from competition. His advocacy is yielding results: Arizona, California and Florida are among a handful of states that recently passed legislation allowing the remote establishment of a VCPR.

The victories cannot be attributed to Cushing alone. For instance, the American Society for the Prevention of Cruelty to Animals has vigorously campaigned to ease VCPR standards. And a decision in the United Kingdom last year to relax its telemedicine rules suggests a broader trend that extends beyond Cushing's influence.

However, many consider Cushing to be a vital behind-the-scenes force stateside. One is Dr. Robert Murtaugh, former chief medical officer at the practice chain Thrive Pet Healthcare, who remembers meeting him for the first time in 2020.

"We hired him as a consultant, and initially, I thought he was kind of brash and seemed egotistical, like a lot of lawyers I know," he recalled. Murtaugh's view of Cushing evolved as they worked together to relax veterinary telemedicine regulations.

"He's smart and effective," he said, adding, "Some people may not like what he has to say, but he knows how to get things done."

Mark image 1

VIN News Service photo

Mark Cushing is a regular speaker at the annual Banfield Pet Healthcare Industry Summit (pictured), where industry leaders hobnob. When he was new to the veterinary community, Cushing recalled, he'd settle at tables in prominent view at conferences to attract conversation. "I bought a lot of glasses of wine for a lot of people just to meet them," he said.

Expanding education

Since leaving Thrive last year, Murtaugh says he speaks with Cushing weekly about Murtaugh's new role: founding dean of the Rocky Vista School of Veterinary Medicine in Billings, Montana.

Cushing is assisting in the establishment of the program and guiding other new veterinary schools in Arkansas, Florida, Georgia, Indiana and Maryland. All six are expected to open within the next three years. "I admit, it's a lot," Cushing said.

There are signs of unease about his influence. Last fall, the AVMA Council on Education, the U.S. accreditor for veterinary programs, barred consultants such as Cushing from accompanying evaluators during their visits to programs — a privilege he previously enjoyed. "I accept the policy because, you know, there's only one accreditor, so that's the way it goes," he lamented.

The notion that the U.S. needs so many new veterinary schools — 12 are in development nationwide — isn't universally accepted. Sosnow, the veterinarian in Arizona, cautioned that an increase in graduates could lead to workforce saturation and lower salaries, which would benefit chains like Banfield, now owned by Mars, Inc., the world's largest owner of veterinary practices.

"If you follow the money, you'll always find Mark Cushing," Sosnow said in an interview. "His every action is geared toward commercializing veterinary care."

Cushing's expertise in school approvals dates back 15 years to when he helped universities in the Caribbean and Mexico earn U.S. accreditation from the AVMA. He's also led accreditation efforts at Lincoln Memorial University in Tennessee and the University of Arizona.

Those early achievements, Cushing posits, cemented his reputation as a changemaker. "That's when many people started to associate me with major successes — tough things that got my name out there."

Dr. Eleanor Green, a senior adviser at the Animal Policy Group and dean of the nascent veterinary school at Lyon College in Arkansas — one of the half-dozen institutions under Cushing's stewardship — recalls meeting Cushing on a bus in 2009. They were on the island of St. Kitts, where Cushing was aiding Ross University in its quest for U.S. accreditation by inviting leaders in veterinary academia to observe the strengths of the program. Green was in attendance as a new veterinary school dean at Texas A&M University.

Recalling her first conversation with Cushing, she said, "We just got to know each other, laughed and had a great time. But we also got to talking about important things." Green added: "I don't know anyone on the planet who can get done what Mark has done."

According to Green, Cushing excels at navigating diverse interests and embracing unconventional approaches with an open mind. "For anything that looks like change, we often see the threats first," she said. "But Mark looks at things with a global view. He certainly considers the veterinarian in everything he does, but he also considers the animal-owning public and what they want. And I think that's where a lot of the tension comes."

A defeat

Not all of Cushing's projects have ended in victory.

In 2017, the Animal Policy Group broadened its client base beyond corporations and schools when Cushing became a legislative strategist for the National Association of Veterinary Technicians of America, a member-supported trade group. The assignment: Convince legislatures in all 50 states to adopt the title "veterinary nurse" in place of "veterinary technician" so the technician's role could be more easily understood and valued by the public.

Liz Hughston, a long-time NAVTA member, remembers hearing about the initiative in 2016 as a fait accompli.

"Mark Cushing had come to the NAVTA board and said, 'We are going to work on title change, and you're either going to get on board with us, or you're not,' " she recalled. A board member present in discussions remembered feeling backed into a corner.

Asked about these accounts, Cushing said, "The Veterinary Nurse Initiative never operated without NAVTA support, and I wouldn't have made what sounds like a threat."

At the time, he predicted it would take five to 10 years to accomplish the title change. But four years later, no state had adopted the veterinary nurse title, and Cushing had moved on.

He attributed the defeat to nurses' associations, which fought to restrict the nurse title to human medicine; the AVMA, which took a neutral stance on the initiative; and lackluster fundraising.

Finding financial support for the initiative was one of Cushing's responsibilities, according to a February 2017 engagement letter between the Animal Policy Group and NAVTA, a copy of which was provided to VIN News. The letter set out a fee schedule that would have totaled more than $400,000 if it ran to the end of 2020. NAVTA has publicly reported raising more than $360,000 and spending more than $250,000 on the effort in 2021.

Critics of the title-change push have questioned the decision to spend so much on a long-shot effort, especially for an organization that tax documents show had operated at a deficit.

Garnetta Santiago, a former board president of the New York State Association of Veterinary Technicians, expressed concerns in 2017 that the initiative would only deepen existing confusion over the patchwork of technician titles. In a recent interview, she wondered "how much further down the road the profession would be today if that $300,000 was used on a nationwide public education campaign elevating awareness around who vet techs are and what we do?"

Hughston said the title-change attempt was not a complete bust, in that it may have helped "show technicians that they need to stand up for what they believe. It showed a direction for advocacy."

Looking back, Cushing acknowledged, "[It] will always be for me, I'm going to predict, the most disappointing outcome of anything I've worked on."

Shaking up clinical teams

Even as Cushing and NAVTA parted ways, the Animal Policy Group was plunging into another initiative focused on clinical team members: creating a midlevel position.

The concept of a midlevel team member has been floating around the profession for decades to no avail, in part due to the staunch opposition of the AVMA.

But in the past four years, the idea has gained traction among veterinary schools, corporations and animal welfare organizations. Cushing has been instrumental in this shift.

He brought the idea for a master's degree aimed at technicians to LMU in 2020, according to its dean, Dr. Stacy Anderson. LMU positions the degree as extended education for technicians, though many see it as a future educational pathway for an as-yet-undefined midlevel role.

Anderson, who was tasked with developing the new program, said that Cushing "worked behind the scenes to promote the degree" and engage stakeholders in its creation.

Establishing a midlevel position, also called a veterinary professional associate (VPA), would mean changing state practice acts, necessitating a lobbying campaign not unlike what was envisioned for the failed Veterinary Nurse Initiative.

Early hints about who will fund such an effort surfaced this year when a first-ever bill to create a VPA was introduced in Florida. The primary lobbyists for the bill were supported by the Coalition for the Veterinary Professional Associates (CVPA), an advocacy group that Cushing helped establish last year.

Murtaugh, who chairs the group's industry liaison committee, told VIN News that most of its funds for lobbying come "from within the organization, from the members." There is no public list of the members, but the committees are populated by professionals from animal welfare groups, academe and veterinary companies. Many have ties to other Cushing ventures.

The Florida bill passed the House and has been held over in the Senate until next year. Elsewhere, CVPA has provided some support for a citizen's initiative in Colorado that would create a VPA in state statute. Petitions with signatures supporting the initiative were submitted yesterday. Should the secretary of state verify these signatures, it will be on the November ballot.

It's too early to see how far the burst of momentum will take the VPA push. Dr. James Lloyd, a veterinarian and economist who worked with Cushing to gauge industry support for a midlevel position, suggested it might not be an uninterrupted journey.

He described the lawyer as perceptive — knowing when to support a potentially disruptive idea and when to back off. "[He can say,] 'That's an important thing that we've highlighted ... but it looks like we aren't going to gain traction right now. Let's move on to something else until somebody else might pick that up or until it seems like a better time to move that forward.' "

The one and only?

That apparent instinct for knowing when to pick a fight could be tested by a conflict brewing over how hard it is for foreign veterinarians to practice in North America.

A number of overseas-trained veterinarians are unhappy that a backlog to take an equivalency exam administered by the AVMA is leaving candidates in limbo for months, even years. 

They are demanding the AVMA ease the bottleneck — possibly with help from a certain someone.

"His name is Mark Cushing, and he represents some of the largest veterinary corporations in the country," Dr. John Cavalcanti, a Brazilian-educated veterinarian leading the effort, posted in April to a Facebook group for foreign-trained practitioners.

"There's no one else that can move the profession the way Mark can," Cavalcanti said later in an interview, explaining that he came to know Cushing while working for Banfield.

Cushing said he's prepared to help. However, Cavalcanti has yet to secure the $30,000 he says is needed to hire the Animal Policy Group. He hopes corporate donors might lend support. 

However things pan out, Dr. Andrei Tarassov, a veterinarian from Ukraine who once helped manage the foreign-entry exam, sees Cushing as in the game for himself. "Mark is an opportunist," Tarassov said in an interview. "He isn't doing this for the profession."

It's unlikely such criticism will dent Cushing's resolve. Dr. Jim Wilson, a lawyer and veterinarian who operates a consultancy in Pennsylvania, notes that Cushing has long had detractors — including when he was advocating for more veterinary schools in the aftermath of the 2008 financial crisis, a period when the job market was decidedly sluggish.

"Mark was always marching to a drum that was modestly off-center from the veterinary profession," Wilson said.  

It's a drumbeat that one colleague believes is unique.

"Mark has made a huge impact on the veterinary industry despite not being a veterinarian," said Anderson, the dean at LMU. "I often think to myself, who would do what Mark does if he retires? I can't think of anyone who would readily fill that role." 

— Lisa Wogan contributed to this story.