Quality in Veterinary Medicine

Quality in Veterinary Medicine: the ultimate goal

What is perhaps most disturbing is the absence of real progress toward restructuring health care systems to address both quality and cost concerns, or toward applying advances in information technology to improve administrative and clinical processes. Despite the efforts of many talented leaders and dedicated professionals, the last quarter of the 20th century might best be described as the “era of Brownian motion in health care.” Mergers, acquisitions, and affiliations have been commonplace within the health plan, hospital, and physician practice sectors (Colby, 1997). Yet all this organizational turmoil has resulted in little change in the way health care is delivered.” – From Crossing the Quality Chasm  , 2001

I’ve spent most of my blog so far talking about ownership and community.  The reason I care so much about ownership is because my ultimate goal is to help continuously improve the quality of veterinary medicine.  The sentiments expressed above by the Institutes of Medicine about human healthcare in 2001 apply very much to where veterinary medicine sits today: too much Brownian motion, not enough forward momentum to truly improve care and outcomes for pets and their people.

The wakeup call on the human side occurred in early 1990s when a series of articles was published, documenting the number of deaths occurring due to preventable adverse events in hospitalized patients  http://www.nejm.org/doi/full/10.1056/NEJM199102073240604, http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(98)24009-8/fulltext.  The Institutes of Medicine formed the Committee on the Quality of Health Care in America in 1998.  The committee was charged with developing a ten-year strategy to substantially improve the quality of health care. The committee performed a detailed review of quality of care literature, which used workshops to identify strategies for raising the awareness of the public and key stakeholders. They also identified environmental forces that influenced efforts to improve quality; developed strategies for fostering greater quality accountability; and identified important future areas of research.

In 2000, the committee published some of their findings in  To Err is Human: Building a Safer Health System .  They confirmed the huge toll of medication mistakes and estimated that between 44,000 and 98,000 Americans died each year as result of these errors. Their research showed that faulty systems, not faulty humans, needed to be addressed in order to decrease the incidence of mistakes.

Their second publication in 2001 was Crossing the Quality Chasm: A new health system for the 21st Century  In this , they made specific recommendations to begin addressing not only safety but also other quality concerns in medicine.  They recommended that true quality care should to be judged on six key metrics recognized by the acronym STEEEP:

  • SAFE – no harm to patients in hospitals
  • TIMELY – ER care and test results should not be delayed
  • EFFECTIVE – people need the right treatment for the right disease, with evidence-based recommendations put into practice quickly
  • EFFICIENT – systems need to avoid duplication of testing and need to aim for the right diagnosis quickly
  • EQUITABLE –all people no matter their class or race should be cared for equally
  • PATIENT – CENTERED –the patient’s needs and wants should be always at the forefront

All of these can and should be used to develop a road map for quality in the veterinary field as well.  However, instead of our industry being PATIENT-CENTERED, I would argue that we must be PET FAMILY CENTERED.

My definition of quality veterinary medicine is: safe, reliable, and effective healthcare that puts pets and their families first.

The Tax Relief and Health Care Act of 2006 requires that all hospitals accepting Medicare payment report the incidence of severe adverse events.  This law, and the above mentioned publications have led to concerted efforts to find ways to prevent errors and to catch mistakes. Work over the last 10 years has led to overall system improvements in human healthcare. From 2010 to 2013, there was a 17% reduction in hospital acquired conditions. In addition, it is now possible for customers to find published data on outcome from common diseases at different hospitals.This is crucial as improvements in outcomes have not been consistent across hospitals so prognosis varies widely by which hospital you go to. Detailed studies comparing hospitals has shown that those with the best outcomes were the most likely to have cultures that emphasized communication, interdepartmental coordination, continuous learning, and overall engagement in quality improvement.

No large studies have been done in veterinary medicine but we all know that mistakes do happen, with medications, with equipment, with secondary infections, and with a variety of things that no one might expect.  In 2008, our hospital decided to pursue AAHA specialty accreditation.  One of the criteria was tracking adverse events and we instituted reporting in our hospital.  The value of tracking and then discussing even minor errors was that we discovered SYSTEMS that needed to be fixed.  As we learned how to discuss errors without blame, we learned how to engage all of our staff in our journey toward quality.

To truly change the trajectory of veterinary medicine, we need to rise above the “Brownian motion,” and start really looking at the care we provide.  We need to work together, universities and large private practices, to define and publish appropriate outcome statistics so we can use evidence to choose the best treatment plans. We need to recognize common medical errors, talk about them openly, and look for SYSTEM changes to prevent them.  We need to become a profession that understands improvement science and embraces it.

In the coming weeks, I hope to not only continue the conversation on ownership and community but also to continue providing thoughts and ideas on how we can use what we’ve learned on the human side to improve the care we all provide to pets and their families.

What Veterinarians Should Learn from Independent Bookstores

 

What Veterinarians should learn from Independent Bookstores

A great local bookstore http://www.phinneybooks.com/

One of the best things about the neighborhood where I live is the locally owned independent bookstore.  The window display has a different theme every month highlighting interesting books in a colorful array.  The warm feel of the shop, high wood bookcases, welcoming environment, and the neighbors I frequently see, all make it a great place to go.  I appreciate the expertise of the owner and staff and I often get great recommendations.

When Barnes and Noble and Borders came on the scene, the end of the independent bookstore was prophesized.  Remember Meg Ryan and Tom Hanks in You’ve Got Mail?  Then along came Amazon, and those chains were in trouble also.  The E-reader meant many predicted the end of paper books and the brick and mortar stores that provided them.

My family was an early adopter of e-readers.  My husband is a book junkie and so I was thrilled to think E-readers might be a way to decrease the amount of space books take up in our home.

But like many others, we have realized that there is something about not looking at a screen in bed at night that is valuable.  We also realized there is tremendous value in a recommendation from someone who is passionate about books and reading.  In addition, the small size of some of these independent stores is an advantage because they filter out the bad books and focus on books that are a joy to read.  Because they are local, these stores can also tailor selections to the region and local interests rather than trying to be all things to all people.

While the total demise of the independent bookstore was predicted, that actually hasn’t happened.  Interestingly, Amazon’s growth contributed to Borders going out of business in 2011.  However, according to the American Booksellers Association, between 2009 and 2015, there was actually a 35% INCREASE in the number of independent bookstores.

A business professor from Harvard, Ryan Raffaelli, set out to study what led to this resurgence through interviews, visits to numerous bookstores, and analysis of many publications.  His key findings support some of the feelings of my family.  Here is his summary (the full publication of his research is expected later this year):

Inside Phinney books

1) Community matters and the “shop local” movement has had an impact.

2) Curation.  As I mentioned above, people value someone who can tailor a recommendation specifically to what they are looking for.  By stocking up and coming authors and not just best sellers, people feel as if they have found and purchased something special.

3) Convening. Independent bookstores have served as centers for people gathering.  Bookstores may sponsor lectures, book clubs, or children story times.  Our local bookstore works with our local elementary school every year to do a Book Fair.

4) Finally, the non-profit American Booksellers Association, helped work to shape and promote an identity of independent bookstores with sharing of ideas and best practices.  The support of a national group to craft a message has been a real asset for the independent side of the book industry.  This group is similar to the National Community Pharmacy Association (ncpanet.org) mentioned in one of my earlier blogs –https://vetidealist.com/independent-pharmacies-part-one/

I believe the best local independent veterinary hospitals have a great deal in common with community bookstores.  They are pleasant and welcoming.  The waiting areas match the style and attitude of their neighborhoods.  The bulletin boards and information are relevant to the local community.  The medical recommendations from the veterinarians are specific to the diseases and problems of their region.  While veterinarians have often not used their spaces for public convening, participation in local events, sponsorship and teaching of pet first aid classes and helping in schools all contribute to convening and community.

However, independent veterinarians do not currently have a national group helping to craft a message to the public of the value of local veterinary ownership.  This is worth considering if it is something our profession wants to preserve.

For several years it appeared that independent bookstores would not survive.  The story bookstores tell us is that trajectories can be changed.  Watch this great short video on Ryan Raffaelli’s research for a story of hope: https://hbswk.hbs.edu/item/why-independent-bookstores-haved-thrived-in-spite-of-amazon-com.

What happened to Brightheart and other stories of private equity

In 2012, my partners and I ran the largest 24/7 multispecialty hospital within the city limits of Seattle and also operated a second growing 24/7 facility about 25 miles south of the city.  We had opened both our hospitals as startups and had weathered not only a tough learning curve but also the 2008 recession.  We had tried to sell 20% of our hospital to some of our associates in 2010 prior to opening our second location, but were only able to sell 6%.  We were starting to anticipate needing a new facility and were also looking at succession planning.  Around that time, we started receiving unsolicited offers to buy our practice.

The interesting thing about these offers is that they were not from VCA or NVA.  They were from private equity firms, many of whom knew nothing about the veterinary market except that pet industries overall were growing and that veterinary medicine is an almost entirely cash business.

Being veterinary owners without business degrees, we had no real idea what private equity was.   As I talk to veterinarians around the country, I realize that very few have heard of this segment of capital that is reshaping of our profession.  Understanding private equity is key to understanding what happened to both fuel and also end groups such as Pets’ Choice and Brightheart.

What is private equity?  Private equity is money from funds and investors used to directly invest or buyout companies.  The money is from individuals who are wealthy enough to be considered “accredited” (https://www.investopedia.com/terms/a/accreditedinvestor.asp) or from institutional investors that invest for others.  These individuals or investors have money they want to grow but are looking for an alternative to stocks, bonds, real estate, etc.  Private equity firms have a short term horizon and are often looking to buy businesses, improve them with investments in needed equipment, improve their operations, and increase their net profit margin.  The ultimate goal is to maximize the return on that initial investment and re-sell the business for a profit within 5 to 7 years.

Pets’ Choice, who I worked for from 1996-1999, was one of the early private equity funded buyers of veterinary practices.  Over their 9 years in existence, they grew to 46 hospitals in 5 states and had revenue of close to $70 million.  They merged with VCA in July, 2005. (http://investor.vcaantech.com/releasedetail.cfm?releaseid=248798) Why did they merge?  After 9 years, they were past the 5 to 7 year comfortable window for private equity investors.  The only ways to pay out the investors were to: 1) Have an initial private offering (IPO) and go public, 2) Sell to a different larger private equity firm, or 3) Sell to a larger organization.  Due to market conditions at that time, an IPO was not feasible so a sale was inevitable.

Brightheart was another private equity backed consolidator of specialty practices.  Brightheart started in 2007 with stated lofty goals. ( http://veterinarybusiness.dvm360.com/new-corporate-practice-player-brightheart-veterinary-centers)  However, it needed a number of private equity investment partners to achieve their growth (http://www.andersenllc.com/case-study-brightheart.php, https://www.businesswire.com/news/home/20080125005116/en/LLR-Partners-25-Million-Equity-Investment-BrightHeart).  Thus, like Pets Choice, they had a limited time to grow fast and provide a return to their investors. Brightheart sold to VCA in 2011 after accumulating 9 large hospitals.

My partners  and I spent quite a bit of time trying to understand the motivation of the private equity groups that approached us. Our understanding led us to ultimately join a  group that was not backed by private equity at that time.

Why should all veterinarians care and learn about private equity?  There are several reasons:

1) Private equity is one of the factors driving both increasing non-veterinary ownership and consolidation in the veterinary industry. This is a summary of some of the private equity players in the industry: (http://www.providenthp.com/wp-content/uploads/2016/07/Q2-2016-Veterinary-Newsletter.pdf).  Some consolidation may be valuable in providing economies of scale and ability to buy needed equipment.  However, as the daughter of an anti-trust attorney, I strongly believe that competition is good for consumers, in this case, pet owners.  Furthermore, research in human healthcare has shown that regional hospital mergers in fact lead to higher prices without measured improvement in quality of care (https://www.brookings.edu/testimonies/health-care-market-consolidations-impacts-on-costs-quality-and-access/)

2) If private equity partners are the majority owners of the business, their primary obligation is maximizing return on investment for their investor group.  That means they need both growth in revenue but also improvement in cost control.  Because the single biggest cost in a veterinary hospital is support staff, minimizing this cost becomes a priority.  Many independently owned hospitals that have sold to non-veterinary owned consolidators have seen this pressure to reduce staff numbers and minimize staff wage increases first hand.

3) If you are signing a contract to work for any practice, you should know how likely it is that you will work for a different entity in the coming years. It is appropriate to ask and understand who is the controlling owners of the business. You especially need to understand the consequences to your contract if there is a sale or merger.  If one of the majority partners is a private equity firm, there is a real possibility that a sale could occur within a several year window.

For more information:

https://www.investopedia.com/terms/p/privateequity.asp

https://www.investopedia.com/articles/financial-careers/09/private-equity.asp

https://www.investor.gov/introduction-investing/basics/investment-products/private-equity-funds

Faces of Veterinary Medicine

Class of 2017 Louisiana State University

As of 2016, there were 108,000 veterinarians in the United States – 63% were women.  In 2017, more than 80% of all veterinary students were female.

CEOs of the largest veterinary chains – overseeing more than 3000 hospitals**

“Not everything that is faced can be changed.  But nothing can be changed until it is faced.”  – James Baldwin

 

**These images are not meant in criticism of any individual. They are presented to illuminate the current state of our industry and provoke a discussion about its future.

 

Lessons from James Herriot

James Herriot’s practice in Yorkshire – 1989

In 1989, while in college, I was lucky enough to have a semester abroad in England.  While there, I decided I needed to make a pilgrimage to James Herriot’s clinic. I had always wanted to be a vet, I loved his books, and the life he led spoke to me.  It turns out it was less easy to find his clinic than I anticipated as the name of the town in his books is a pseudonym.  However, with some investigative work (this was pre-Google), I figured out where in Yorkshire he was located and took the train.   I didn’t want to bother anyone so I just found the hospital, took a picture, and enjoyed a day being in the community that I had read so much about.

So why do so many of us love these books and find them so inspiring?  What is it that appeals?

For me, I have always loved 4 main things about veterinary medicine: pets, their people, being part of a community, and the actual science.  James Herriot’s stories show his passion and love for all of these as well.  His ability to laugh and appreciate human foibles and interesting characters is as important as the pets he loves.  I believe that when people think about a career in veterinary medicine, if they don’t value all 4 of these, that they will struggle both with school and with practice.

As we think about James Herriot and what gave him a rich life as a veterinarian, we have to remember how rooted he was both in his care for pets and as a member of the community in which he worked.  In a recent JAVMA article , Charlotte Hansen, a statistical analyst at the AVMA Vet Economics Division, reported research that shows increasing numbers of veterinarians with low compassion satisfaction.  Low compassion satisfaction is defined as decreased gratification drawn from work.  While she hypothesized that these might be due to high educational debt and declining real income, I believe that losing sight of WHY we do what we do and not realizing the importance of being rooted in our community are other additional players.   It is easy to get caught up in Yelp reviews, keeping up with your emails, performance conversations about production goals, and forget why you joined the profession in the first place.

The reality is that we can never go backward and most of us will never live in Yorkshire.  I also spent enough time working with friends at their mixed practice in Idaho to all know how really hard rural veterinary care can be.  However, re-connecting with our passion and building community can and should occur wherever we practice.  How do we become re-energized and more connected? Here are 6 actions to consider:

  • Write down WHY you went to veterinary school. Use that why to figure out what you would like to do more of in 2018. Post it by your desk or computer for inspiration.
  • The next time something crazy happens at work, think about how you would make it into a good story if you were writing a book. Looking at situations as a storyteller often lets you either find the humor or find perspective.
  • If you are a practice owner or medical director, ASK the veterinarians that work for you WHY they are veterinarians and what goals they have for professional development. Then, support them in getting there!  Professional goal setting annually can be an incredible way to motivate yourself and others to concentrate on what matters most.  It can also be how you find a new avenue to pursue in your practice.
  • Join your local veterinary medicine association and attend a meeting. Getting to know your colleagues in your community and having in person friends in the trenches to talk to is a great way to get support and also just make things more fun.   In addition, our local, state and national associations are critical in advocating for the rules and laws needed to make our jobs doable and our independent practices viable.

    Planting trees on Earth Day
  • Have your practice find a local group or charity to support. This might be building a relationship with your local shelter or sponsoring a kids’ softball or baseball team.  You could plant trees on Earth Day or have a clinic team do a group run to raise money for a community organization.  Picking an organization to support consistently over time will allow you to build connections that will be meaningful for both sides.
  • Give a talk at your kids’ class or any local school on veterinary medicine. Bring a pet and a stethoscope, bring gowns and masks for dress -up, or maybe radiographs of funny things pets eat.  One year I brought our guinea pig and a portable ultrasound so the kids could see a teeny heart beating. The smiles you get will remind you why you joined this profession.

What Veterinarians Can Learn from Successful Independent Pharmacies – Part One

As consolidation ramps up in the veterinary field, it is worth looking at other industries to help understand the drivers of this phenomenon and also to look for private ownership bright spots.

The pharmacy industry has seen tremendous changes over the last 40 years. In the early 80s, there were over 40,000 independent pharmacies.  However, in the 1980s, grocery stores and discount department stores realized that by adding a pharmacy, they could increase traffic into their stores.  These grocery and department stores were not only very convenient for customers (one stop shopping) but because of their pre-existing buying power, they could negotiate for better deals on medications, increasing profit margin and providing more cash for expansion. Unlike veterinarians, pharmacists have not traditionally developed strong relationships with their customers.  In addition, pharmacists have not been as good at explaining why their specific individual knowledge base is important directly to consumers. Thus, research in the pharmacy field showed that most customers choose a pharmacy based on location and convenience, not pharmacist, brand, or chain.

One of the biggest players in the market, Walgreens, actually started as a single pharmacy in Chicago that Charles Walgreen purchased in 1901.  Walgreen was very ambitious and grew the chain to 100 stores by 1926 and the company became public in 1927.  In the early 1980s, Walgreens was 1000 stores and 10 years later, they had doubled to 2000.    Realizing that convenience was very important, Walgreens diligently only opened on corner lots to allow for easy access to their businesses (See Good to Great by Jim Collins) and were one of the first to do drive up pharmacy pick up.

By 2000, the number of independent pharmacies was dramatically reduced to 25,000.  Three main chains, all publicly traded, dominated, and continue to dominate, the market – Walgreens, CVS and Rite Aid.

Despite this consolidation, today there are still approximately 22,000 independent pharmacies. These independent businesses employ over 250,000 people and account for $80 billion in revenue. (Data from www.ncpanet.org)

What has allowed these independent pharmacies to survive in the era of grocery store pharmacies, big chains, and consolidation?  This article described several tips from successful pharmacy owners.  Pharmacy is a very different industry than veterinary medicine with much more reliance on sales than service and different regulatory pressures. However, I think these tips are relevant to locally owned veterinary practices.

Find your niche:   Many of us have used independent pharmacies that concentrate on compounding.  There are some pharmacies that have specifically found their niche serving the veterinary community. Other pharmacies have concentrated on treating and helping people with certain specific diseases such as high blood pressure or diabetes.

Some of the most successful privately owned veterinary practices I have seen have been very clear about which niche of clients they are trying to serve.  It is very hard to be all things to all people.  Deciding you are going to be a fast-paced outpatient walk-in clinic is a different niche than an appointment always with the same doctor type of hospital.  Both are important and can be successful but it may be more challenging if you mix models.  As a veterinary practice owner, it is really important to have a clear picture of who you most want to serve and what you want to provide.

Consider new revenue sources: Many of the innovative growth areas in veterinary practice are coming from small independently owned practices.  It is easier to innovate when you are small, have the freedom to try new things, and can build time into your work to think creatively. Rehabilitation services, pain management clinics, home palliative care, transfusion services, and more recently, after-hours telemedicine services, are just some of the innovative ideas we have seen in the last 20 years.   In pharmacy, working hard to synchronize medications (working with clients so that they schedule their medications for ease of administration and also have all their refills due at the same time) is leading to better satisfaction, compliance, and also revenue as refills are not missed (see http://www.mckesson.com/blog/top-five-independent-pharmacy-trends-for-2017).  This is a worthwhile consideration for us especially with pets with heart disease, liver disease or multiple health problems. As a practice owner, it is important to watch trends in the industry and also to ASK our clients what they wish we provided.

Be convenient: More families need two incomes to support their families and their pets today than in times past.  That means it is harder to make an appointment between 9am and 5pm during the week, especially on an ongoing or chronic problem. Part of the growth of big box pharmacies had to do with convenient locations and hours.

I am not saying every practice should be open every night.  However, thinking about efficient drop offs, how to handle urgent care needs, how to make your Saturday hours most efficient, and contemplating one later night a week could really help.  It also means that if you are planning a new hospital, you should be very focused on convenient location.

In addition, people are less likely to want to spend time on the phone and are looking for ways to schedule and confirm appointments that use text, email or online forms.   You are most likely to capture phone appointments if you can make it the first time they call.  Voicemail is your enemy.

Educate your customers: The more we show that we actually do have more information than the dog breeder or Dr. Google, the more clients will come to us for help.  Don’t be afraid to have a section in your lobby that highlights your education and the education of your staff.  We need to explain our diagnoses clearly, provide written information about diseases and care, and find ways to make sure our clients understand their pet’s illnesses and how they can best participate in care.

Keep it simple: One of the best ways to improve your business is to have a clear focus on getting rid of steps that waste time and don’t add value.   It is also important to realize that you can’t be all things to all people.  Figuring out clearly what your mission is, where your passion is, and who you most want to serve will help target which equipment it is most valuable to have in your practice.  Looking at your processes from how you admit patients to how you process lab work and trying to get rid of steps not only makes you more efficient but also makes your medicine safer, improving both quality and your bottom line.

I am not so idealistic to believe that running your business effectively is all you need to do to run a long term sustainable (existing with local ownership for more than one generation) veterinary practice given current pressures.   Next up, I’ll profile an interesting pharmacy group that found an innovative way to both support local ownership but also leverage buying power for increased profitability– stay tuned!

Why women veterinarians should own practices

Last year was interesting in the veterinary profession.  A single family now owns a sizable percentage of the veterinary market (MARS – VCA, Banfield, Pet Partners, BluePearl).  The transaction to purchase VCA was so large that the Federal Trade Commission reviewed the deal and only allowed it after a forced sale of 12 practices in cities where they deemed a monopoly would otherwise exist (http://news.vin.com/VINNews.aspx?articleId=46420&callshare=1).  Throughout the industry, private equity and financial players are quickly purchasing practices.  This consolidation is occurring as new veterinary graduates are finishing school with high debt loads and finding job prospects with tightening production contracts and non-competes.

I entered veterinary medicine as an idealist.  I’ve wanted to be part of the profession since I was seven.  After working for an early corporate practice in the late 1990s, I learned that despite my youth and inexperience, I could do it better.  I started a practice with a partner and we grew it to two locations and 150 employees.  After 10 years, despite a strong profitable business, we thought we could do more with additional partners and merged with a larger veterinary owned group.  Four years later, the landscape is dramatically different, and I am once again looking for a path for an idealist.

As a woman, wife, mom, veterinarian and a business professional, I hope this blog will start a candid conversation about the challenges our profession faces and innovative ideas for the future. My hope is to use my experiences to offer ideas and thoughts around existing opportunities and potential new blue oceans.

Today, I want to address and refute some of the myths that lead people, especially women, to not consider ownership. Women now make up 56.6% of veterinarians in private practice (market research statistics 2016 – https://www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-veterinarians.aspx) and thus to keep practices in the hands of veterinarians, more women must be convinced they can and should own their own practices.

Here are 5 myths I regularly hear from women.

Myth #1: I can’t be a good parent and own a business.  There will be too many demands on my time.

My business partner and I opened our 24/7 veterinary emergency hospital when my daughter was 10 months old.  Was is tiring and exhausting?  Absolutely.  However, as one of the bosses, I could design my own schedule.  I was able to bring my daughter with me on clinic purchasing trips (lots of trips to Costco the first couple months of being open).  I could help design a meeting schedule that made the most sense for all the parents, allowing call ins for some meetings to increase time at home for all of us.  Although I worked full time, I was able to work longer days and shorter days which allowed for me to go on almost every single field trip during my daughter’s elementary school years.   Because other veterinarians on staff also had kids, we prioritized together so that everyone could make the events that were most important to them.  Being an involved parent and a boss meant not only was I there for my kids at important times, but I also helped other parents be there for their kids.

One other related myth that no one tells you is that babies don’t miss you as much as your tweens so buy early and get the busy sleepless nights done all at once.   Toddler naptime can be a great time to look at financials or review an equipment contract.   Think of your business as one more child in the mix!

Myth #2: I’ll do fine financially if I just work for someone else.

In the initial stages of your career, stability and benefits are important.  However, current veterinary salaries alone will not pay down your debt effectively over the long haul.  On the other hand, profits from well managed veterinary practices can range from 10-30%.  While some of those profits go for taxes and capital purchases, if you own the practice, this profit is additional income available for debt reduction.  Yes, you will have some duties other than just working as a veterinarian.  But you will also have some say in pay structures and benefits long term.  Many veterinarians at retirement age now hope to sell their practices to their colleagues.  Taking the leap and stepping up will be the best way to both keep practices veterinary owned and assure success for yourself and for your family long term.

Myth #3: I don’t know enough about business to own a business. 

I believe basic business courses should be part of the offerings in veterinary school.  However, there are a TON of resources out there to help you.  Many banks offer free small business seminars for their clients.  Community colleges have inexpensive classes.  Proceedings articles, VIN, and other parts of the internet provide a wealth of knowledge (https://www.sba.gov/business-guide).   Veterinary Management groups (VMG) – (http://www.veterinarystudygroups.com/) is a great resource in helping share best practices. If you can buy into a practice with a present owner, you have built in mentorship to start you on your journey.  Networking with your local colleagues is also a great way to discuss and learn from challenges we all face.

Myth #4: It is too much stress to own a practice.  I don’t want to talk to angry clients.

Sometimes the reason there are angry clients has to do with structures and flow within practices, many of which the folks working on the floor know how to fix if they were asked.  Sometimes there are quality issues you can see but you don’t have control over.  Local ownership allows for faster fixes to problems and often less client issues.  In addition, if you hire a good practice manager or have partners, you are not in this alone.

The flip side is the amazing gratitude from your community that you will find everywhere if you run a good business.

Myth #5:  I have so much debt there is no way I’ll qualify for more.

Interestingly, banks do realize that veterinary practices are a good investment.  They are refinancing and consolidating student loans to facilitate practice ownership.  See (https://www.avma.org/News/JAVMANews/Pages/171115e.aspx, Roberts, LC. “How to Heal Veterinary Student Debt” https://issuu.com/cornellvetmed/docs/scope_spring_2017_lores, pp 14-21), and   https://www.youtube.com/watch?v=vH6rk4JfMmQ&feature=youtu.be. It is important to look carefully at the terms and fine print but the option is not off the table.

We are at a cross roads in the veterinary profession.  We can continue to put our head in the sand, proceed as we are, and watch increasing non-veterinary ownership of our profession.  The alternate future is looking for new ownership models, creating truly sustainable ways to pass on practices locally while simultaneously rethinking appropriate costs and compensation for a veterinary degree.  On an individual level we need to refocus on those things that in the past have made veterinarians one of the most admired professions – local ownership, community involvement, and a face to face commitment to our staff, patients, and families.  Veterinarians know best what veterinary professionals, patients and clients really need and thus we need to own and control our destiny.  Women must lean in and be part of veterinary ownership of the future.