Is mixed animal practice becoming obsolete?
Spring was in the air and he welcomed the emergence of the daffodils on the hillside next to the small barn in the back of his clinic property. Metropolis doesn't live up to its billing. It is a small town in a very rural area of Indiana.
J.D. walked into the office and was greeted by Millie. Millie had been with Dr. Biggs for more years than J.D. could remember. In fact he wouldn't remember if asked.
Betsy, J.D.'s wife, was busy in the back of the clinic helping to open the practice for another day's work. Betsy had helped open the clinic for as long as anyone could remember. Betsy and J.D. were married while he was in veterinary school in the early '60s. Betsy and Doc have weathered many storms that have hit the practice and the family over the past 40 years.
After veterinary school J.D. had agreed to come to work in Metropolis for Hans Gruenig who had graduated in 1940's from the now defunct Chicago Veterinary School. Hans had practiced through the halcyon years of the '50s when hog cholera subsidized hundreds of practices in the Midwest. Hans retired a wealthy man and sold the practice to J.D.
Dr. Biggs proceeded to put his life into the practice with a Herculean dose of blood and sweat especially in the formative years during the '60s and '70s. J.D. was now seeking an exit strategy so that he and Betsy could finally have time to spend with grandkids. J.D. had recently been musing about what could have gone wrong in the long process of owning a veterinary clinic. He had often worked 70-hour weeks for 40 years and loved every minute of it. Doc had hired an associate, Dr. Joseph Brown, in 1970 to help him with the load of caring for the livestock end of practice that was substantial. Small animal practice was an afterthought. He and Joe, like most mixed animal practitioners at the time, viewed small animal practice with a touch of disdain. Small animal practice was a side event of little import to the practice of veterinary medicine in general. Doc and Dr. Brown did well and got along until the late 1970's when the livestock in the county began concentrating in other parts of the state. Dr. Brown resigned and moved to an area with higher livestock concentrations. J.D. picked up the load and went on.
J.D. started to realize in about 1980 that his practice was turning to small animal practice more and more in order to survive.
The farms raising livestock in the county were disappearing like so many small lights that dim and finally go out with little fanfare.
He tolerated small animal practice but at the state meetings, he always went to the large animal seminars as a rule.
In the '80s, J.D. bumped into his former associate, Dr. Brown, at a regional meeting in Illinois. Dr. Brown was now mostly small animal. They both reflected on the irony of it all and had inappropriately laughed outloud during a quiet moment of a swine disease presentation. J.D. watched the other vets in his area go through the same process-seeing them at large animal seminars knowing they were longing for the good old days.
In J.D.'s county, farmers were gradually getting out of livestock and moving primarily into cash crops. Fences and fencerows disappeared and crops were planted right up to the roadways all over the county. Farmers who stayed in livestock were beginning to buy drugs for their livestock from non-professional sources. The farmers that remained segregated into two groups-those who were buying up land and getting bigger and those who were hanging on while taking a second job wherever they could find one.
In 1989, J.D. had hired another associate. She was a wonderful small animal practitioner and could hold her own in a muddy pig lot or in the one drafty dairy barn left in the county. Everyone in town loved her, including the farmers. J.D. had hoped to sell the practice to her in the mid '90s.
After seven years at the practice, her husband was transferred to Columbus, Ohio. Now she was working in an emergency clinic near Columbus. J.D. has been without an associate ever since. He had scoured the journals, veterinary schools and meetings for years but could find no one to even consider interviewing for the position. He finally just gave up.
In his mind, however, things had been looking up. J.D. had gradually increased his prices over the past several years and was hoping that would help propel the sale of this practice. That is until he had a practice valuation done in January. The gentleman hired was professional enough and had a DVM and MBA to boot. The problem was this: he told J.D. that there were no excess earnings in the practice and that essentially the business itself was worth only what the equipment could be sold for-40 years of labor and not one square inch of 'blue sky," J.D. had thought to himself. Although J.D. had upgraded his small animal equipment to a minor degree, he also owned a substantial amount of large animal equipment that was essentially unused and certainly not sellable, even on E-bay.
The appraiser also told J.D. to get a real estate appraiser to value the land and building. Unfortunately, a new four-lane highway around town now bypassed his land and building, which had once been on the main road leading into town. He had trouble understanding the concept of "excess earnings." He thought the practice was enough to provide a nice living for someone willing to work the hours necessary.
J.D.'s situation is far from unique and is a combination of problems. Most mixed animal practitioners are caught on the horns of a dilemma with no horns-cattle horns that is. The problem is not just a veterinary problem, but a rural problem in general. Let's look at the various dilemmas that are occurring:
·The livestock numbers are mostly unchanged but livestock are gradually concentrating in geographic pockets of the country, leaving many practitioners high and dry.
·Farm numbers are declining and the farm population in this country is under 2 percent.
·Students entering veterinary schools are primarily from urban areas with little desire to locate to rural areas.
·Lifestyle expectations after veterinary school preclude 70-hour workweeks.
·Farms are increasingly larger and more integrated. The trend is to corporate farming or large family farms due to economies of scale.
·Livestock prices continue to be very low with no relief in sight.
·An over-reliance on drug sales in the past has led to serious and chronic undercharging for professional services leading to valueless practices.
·Industrialized farms tend to systematize disease control issues leading to less and less veterinary oversight.
·Small farmers, the heart of livestock practice in the past, are living close to poverty.
·There are few remaining advocates for general livestock practice. The advocate agencies out there are species-specific.
·Existing practices cannot fill available associate positions due to generational differences and an unwillingness or inability to locate to certain rural areas of the country. The ultimate question is how can this be corrected.
Is this a problem for the small animal practitioner?
You bet. This is a problem for the whole profession not just the livestock sector. Mixed animal practitioners (too often with economically naïve attitudes about fee structure-myself included) have for two decades slowly converted to small animal practice. These practices are now competing with all other practices in the area (including suburban) for the pet owning dollar. This has led to fee stagnation and practices with little or no value.
What about the small animal suburban mega-practices far removed from the rural dilemma? These practices suffer indirectly in two significant ways:
Students who desire to practice large animal medicine but need to follow the job of a spouse are sidetracked into small animal practice and are in and out, turnstile fashion, through various practices or are lost to practice all together. These valuable practitioners could be a loss to the profession.
Mixed animal practices on the fringes of suburban areas that are slowly converting to small animal practice can and often do put downward pressure on fees.
Out of the box
It starts with the student of today. Many are interested in large animal practice but a practice model that would include them does not currently exist.
The current student may not be able to commit to rural life for a variety of reasons. The most obvious reason is that many are from an urban/suburban environment where family and friends beckon.
In addition, today's workplace for other professions requires mobility. Most new grads are married or intend to marry soon. We now live in a world where both spouses work. Therefore, when a spouse moves the other moves, too.
The old model
People have been modeling away for years and I'll throw my two cents in.
The old model consisted of one veterinarian in a county serving the needs of all the livestock and small animal denizens as well. This could be thought of as a sort of franchise. Veterinarians guarded their county faithfully from the intrusion of some interloper-especially some veterinarian from out-of-state that didn't respect the rights of the county vet system in place statewide. Then some fine young chap right out of vet school would apprentice at the county vet and would eventually take over the model. The model then would perpetuate itself. This model worked until about 50 years ago.
The broken model
This model succeeded the old model that worked.
This model tried to unsuccessfully compete with feed companies and animal drug traffickers (perfectly legal) for the farmers' scarce resources while the livestock farming community was in great transition to the current farm model (see sidebar). Professional fees were and are low. This is the current model.
New grads and seniors accept training in nutrition, economics and production medicine as an intensive eight-week winter tract taught by practitioners from the private sector on site at veterinary offices or on corporate farms (or at a designated university with dorms.) This is out-sourced with oversight by the extension departments of universities.
This model saves the university money. This type of training would cost the university dearly in order to hire appropriate staff and create the emerging industrial model. On campus the current industrial model would hemorrhage money. This tract could be taught by the private sector between Christmas and spring break. If carefully planned it could be entirely underwritten by drug companies. This model will not work unless the universities realize that the current model is broken and that production medicine will be completely lost (including all its grant money) to the neighboring animal science department.
Private sector veterinarians in the livestock industry have suggested this student-tracking model in the past. Universities stonewalled it. It is now time for the sake of the whole profession for the universities to embrace this out-sourcing concept for a portion of its veterinary program. The profession has changed and the university cannot economically handle this part of the program simply on campus. I predict that the first university with this type of program will be a student and practitioner magnet.
Universities also need to do economic trend analysis and promote a large practice model (10 practitioners or more) within those areas where the livestock industry is growing to serve both the large livestock family farms and corporate farms. The university needs to work with consultants and other universities and associations to promote a workable new practice model. This needs to be multi-discipline in nature.
The private sector needs to promote the large practice model to allow today's students and tomorrow's new grads to integrate into a private sector model that accommodates the needs of the industry on one end and the needs of their families on the other. Consolidation
Practices need to consider consolidating several practices into larger practices to accommodate the needs of today's practitioners. What have they got to lose-these practices are worth very little anyway.
Practice consolidation and mergers will not happen on their own. They need to be pushed by savvy consultants and entrepreneurs working in harmony with each other to attain this goal.
Students and young veterinarians who expect to participate in large animal practice of the future should plan now to:
·Move wherever the livestock industry exists.
·Learn a great deal about the industry ahead of time.
·Create an entrepreneurial vision for their career beyond the confines of medicine and surgery.
If things go as they are, we can expect to eventually have the practice of livestock medicine absorbed by other professionals. There is precedence for this in the poultry industry where less than 100 veterinarians serve an enormous, but closed sector of commerce.
The future of veterinary medicine and whether it will eventually turn into a "pet only" profession is unknown. Let's just hope that we can create a new livestock model for the next generation. Otherwise, Will the last mixed practitioner please turn out the light in the cow barn?