Saving the Soul of Veterinary Medicine

I just returned from Ithaca, New York, having celebrated a veterinary college reunion (45th!) Dean Warnick blessed us with three days of perfect weather during which old memories and old acquaintances were renewed and revisited in all their youth and splendor. While the class of ’77 is now in their early 70’s, I could only visualize classmates through the eyes of a mid-twenty year old—and why not?

Before, during, and since that glorious weekend, I have enjoyed ample opportunity to ponder my veterinary career with all its twists and turns, what-ifs, and why-nots. More so, I have spent many moments reflecting on our profession as a whole; where it started for me, and where I see it now.

It saddens me, in no untold terms, to proclaim that veterinary medicine is quickly losing its soul. I choose this word, “soul” because for me it denotes a life-sustaining spirit, an inner force of sustenance, a vibrant, glowing core.

For four decades plus, I have always viewed veterinary medicine as the most singular profession one could describe. As practitioners, we treat animals and care for owners. Yes, “we care for owners.” Our patients do not arrive on their own. The arm of a human is at the end of a leash or upon the handle of a carrier. Our VCPR relies as much upon the “C” as it does upon the “P.” And the “C” and “P” don’t have a chance of finding fulfillment and the finest care with the “V” unless a sound foundation of trust has been established.

I rarely hear or see the word “trust,” when studying the journals, webinars, and lectures of veterinary medicine. How do we establish this fundamental cornerstone as we navigate through our daily examinations, treatments, and practice? In my opinion, the sine qua non for gaining trust is first, and foremost, forging a personal relationship—a one-on-one caring, empathetic, honest, and human touch. And after all of these years in practice where would I first look to discover this foundation of trust, this genuine outreach of caring? With certainty, the answer is the independently owned, smaller-sized, community-based veterinary practice. Yes, the life and blood and soul of veterinary medicine lies in that long established, solo owner, hometown animal clinic. And sad to report, they are quickly disappearing as the black hole of corporate ownership, investment venture capital, and super-sized juggernauts consume and dominate the present and future of veterinary medicine.

Just in case you have never worked in a ‘smaller’ clinic such as mine, allow me to draw you a picture:

• the receptionists greet each client by their first name—because they know and remember their first name.
• the receptionists greet each pet by their name—because they know and remember their name.
• appointments are booked within 48 hours of request.
• emergencies are seen that day.
• appointment requests for specific veterinarians are gladly accommodated.
• there is frequent conversation in the exam room regarding family and all the health updates and milestones that accompany such personal conveyance. There is no shortage of bad and sad news; however, we find the time, and we find the concern.

More examples which define the “soul”:

• the veterinary staff and the non veterinary staff has negligible turnover, averaging 10 years or longer. In fact, more than half of the staff has worked 20 years.
• financial concerns and limits are addressed as case-by-case issues, allowing for discounted care when the pet needs immediate attention. If we know the client, late payments may be arranged.
• we see our patients from youth to euthanasia.
• we see our clients age as children to adults…and then their children.
• while appointments are scheduled at 15 minute intervals, they often go over….and we do not mind.
• callbacks are made the next day for every surgery and for most ‘sick’ visits. We often suggest rechecks immediately if something is not quite right.

I cannot view an episode of All Creatures Great and Small without breaking into tears. My wife will tell you that I sob like a baby. Silly….right? But this is exactly what our profession is losing. These vignettes of a practice, which is also a family, point straight to the soul of our profession. No, I do not have a Mrs. Hall who answers the office phone 24/7 and cooks all of our meals. What I do have is loyal employees who genuinely know many of the clients as not just pet owners, but as friends. The staff is not just staff. We are a family as well. Having known each other for so long, we truly care for each other above and beyond the norm. Now don’t get me wrong. A large corporate practice will certainly check some of the boxes above, and I applaud them, however, it is my firm belief that the small, independent practice will check all—if not most—of those boxes.

I talk about veterinary medicine losing its soul. As of late, the profession is experiencing a terrible trend. Many, many baby boomers who have owned their solo, independent, small town practices are reaching retirement. For many other reasons, some pre-boomers are also looking to exit. But the devastating news is that they cannot find a buyer for their up-and-running, profitable, established, bustling, vibrant practices. I speak to such veterinarians weekly who are now contemplating closing the doors and simply walking away. They have reached the end of the line and they are done! Time is not their friend. I am talking about practices which generate often $500,000 to $900,000. I am describing practices which have provided incomes for many, many, years; incomes which have purchased homes, paid bills, put kids through college, established substantial IRAs and 401Ks, paid off student loans, and which have provided a comfortable, happy existence.

In another date and time, these practices would be in demand. They would have associates eager to buy in. The owners might run an ad and not wait long for the phone to ring. Simple word of mouth would send someone inquiring. No longer the case. There are many theories and many new forces at work, but that is a topic for someone else. As these practices close and exit, both small and large animal, the impact is widespread and devastating:

• veterinarians lose a fortune that was taken for granted as possible retirement income.
• longtime staff are jobless.
• clients are forced to start over with a new facility.
• towns lose a clinic and in some cases the next animal hospital is far away.
• a community loses a long established partner.
• veterinary medicine loses another fiber of its soul.
• as these practices close, the clients are now pushed to the existing larger facilities where the wait time already is literally three hours or more.

Please spare me the discussions of EBITDA, no load, and cash flow. I speak to veterinarians who have great numbers but because of proximity to another clinic, the mood of the broker, the high payroll percentage, and a million other excuses….they cannot even attract a serious broker.

Is it too late? I say “no”!

Organized veterinary medicine has a habit of looking at other medical professions for ideas and answers. On occasion, the dental profession has been inspiring. Regarding this very topic, they lend some hope. The dental profession has done a remarkable job of maintaining the non-corporate, smaller-sized, ‘traditional’ community practice. In fact, dentists are quite successful at passing on their facilities to associates and other buyers as they move into profitable retirement.

Where veterinary medicine now approaches 25% corporate ownership1 , and projections can only increase the percentage more down the road, the dentists come in much lower at 15%2 , and they may in fact, see a modest leveling off.

Let me drill down further (sorry). The ADA (our AVMA) has a formal initiative called ADAPT (ADA Practice Transitions) which addresses the topic of preserving the independent and smaller dental office. This program has a step-by-step process by which buyer and seller are connected. Advisors and counseling are provided to facilitate the transitions. Simply put, the ADA has decided to play an active role in preserving the soul of their profession.

Perhaps our AVMA would consider a detailed study of the dental profession’s trials and errors with ADAPT. Can such a program be of value for the veterinary profession? The AVMA has 400+ volunteers from every corner of expertise, a professional staff which is surpassed by none, an Economics Division, and even a Veterinary Economics Strategy Committee. I would hope that if our Association studied this dental initiative and plugged in the unique algorithms of veterinary medicine, we might in fact construct our own program.

Considering the present disaster of our disappearing practices, I would hope that an AVMA response to ADAPT would offer significant incentives to encourage and attract the reluctant, prospective buyers we will need. I would suggest considering:

• discounted sale prices (would a retiring practice owner jump at receiving 80% of practice value compared to no compensation/buyers when selling at full practice value?)
• the options of a personal loan carried by the seller with a minimal amount down at closing or
• providing a list of reputable financial lenders who would be willing to consider the necessary funding.
• no commissions for either party (but presumably some type of ‘service fee’ collected for the Association).
• advisors/counseling for both parties.
• a discussion of practice management options with the seller.
• an additional incorporated program where a prospective buyer first works at the practice alongside the owner, essentially relieving him/her, and then buying in over a period of time, or in whole.

Another thought. Can we talk more at veterinary colleges and in our media about the pros of independent, ‘solo’ ownership and give the cons a respite? I am thinking:

• being your own boss.
• running a profitable business.
• holding a recession proof job.
• more wealth.
• paying down student debt quicker.
• creating tangible equity.
• choosing your own schedule.
• hiring family.
• amassing a sizeable IRA/401K
• becoming a community partner
• mental well being derived from personal stability and gratifying self achievement.
• saving the soul of veterinary medicine.

I was an associate veterinarian for six years. I have been an owner for 4 decades. I am much happier being an owner! I occasionally wonder how many years I would have stayed in the profession full time had I remained an associate. Certainly not more than 20 or 25 years. And would I have found the success, stability, and wellbeing that I now enjoy? We are all different, and the answers to these questions will vary. However, I am not alone when I laud the advantages of ownership.

I would be foolish not to admit that there are impressive benefits that accompany employment at a large corporate facility:

• flexible schedule.
• good pay.
• health insurance.
• paid vacation.
• ample CE.
• mentoring.
• HR support.
• fancy state of the art equipment (MRI).

I would also be the first to admit that all of these benefits are standard fare as a practice owner—with the exception of the MRI. At this point, I will jump off script and simply state that the best veterinary diagnosticians that I ever knew were peers and mentors that I worked with some 40 to 50 years ago. That was pre-ultrasound! Do we all need the MRI?

One question which intrigues me, and I have no definitive answer, is ‘how many associate veterinarians have ever seriously considered practice ownership?’ Put differently, ‘would you like to own your own practice?’ If one considers that the AVMA boasts 100,000 members, and of that number possibly 75% are in general practice….that gives us approximately 75,000 veterinarians in general practice. Now, if only 10% of this number are youthful associates who have considered practice ownership—-that is a sizeable population that we must encourage and support.

Here is my elevator speech to our future, the saviors of our soul.

• talk to your accountant/financial advisor about practice ownership and its benefits for you.
• talk to some practice owners, classmates, friends of classmates about the benefits of practice ownership.
• if you already work at a non corporate practice consult the owner about the possibility for buying in.
• reach out to the ‘maturing’ veterinarians in your town, in your county, in your state. Broach the topic of what their exit plan might be. don’t be shy. You might gain some brand new friends quite fast.
• attend your local and state VMA meetings and spread the word that ownership is in your future planning.
• don’t forget the drug reps as a source for who is looking to sell. They know everyone.

So what keeps you up at night? Many of us will admit that we are haunted by random worries, periodic nightmares. For me, I cannot shake two recurrent demons:

• why can’t the Mets score runs?:
• when will veterinary medicine reach its tipping point with regard to corporate ownership? if our profession continues on its present course we will never see the likes of small private ownership again. simply put, without new blood our soul will slip away never to be seen again. just look to our friends in human medicine and their overwhelming corporatization. I would contend that they lost their soul a long, long time ago.

When I left my 15 years of AVMA volunteer service, I promised myself two projects on behalf of the profession. First, write an inspiring book for veterinarians of all ages. That was easy. Within a year I scribbled down The Happy Veterinarian. Second, and a whole lot more difficult, start a nonprofit which serves to save the soul of veterinary medicine. I founded Veterinary Practice Transition (veterinarypracticetransition.com). The mission of this project is to encourage younger veterinarians to consider practice ownership while providing the older ‘boomers’ an option for selling their practice (perhaps, their only option). The nonprofit discusses personal loans with low interest rates, a 10% reduction/discount in the sale price, and no commissions for either the seller or buyer. For sure, the nonprofit is a work in progress, a challenge, and a source of personal gratification. However, I cannot succeed alone. The profession as a whole needs to address the impending doom.

In closing, let me return to my reunion. As my classmates of ’77 gathered in upstate New York and regaled each other with tales of conquest and ‘dragon-slaying,’ I found myself gazing upon so many glowing, beaming faces. What I saw was the immense, reflected energy of careers which served them all so well, but more so, careers which served so many others with compassion and empathy, caring for the animal and its owner. What I also observed, and will never forget, was veterinarians who reached out as family and friend, fostering the trust that defines the soul of our profession.

Mark Helfat, D.V.M.