High-volume veterinary clinic slashes prices

High-volume veterinary clinic slashes prices

Not-for-profit practice in Missouri neuters cats for $20, serves approximately 100,000 animals per year.
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Sep 24, 2015

A nonveterinarian’s business philosophy—the best quality at the lowest cost—is what drives Angels Vet Express, an affiliate of M’Shoogy’s Emergency Animal Rescue in Savannah, Missouri, to treat approximately 100,000 animals a year.

Operating as a not-for-profit 501(c)(3), Angels Vet Express is a clear departure from the traditional veterinary clinic. Clients bring in approximately 60,000 patients annually, and the clinic treats another 40,000 animals at cost or for free with the goal of improving animal welfare in the region, says Gary Silverglat, a local entrepreneur who started the clinic with his wife, Lisa.

The appeal of Angels Vet Express to pet owners is simple—it offers low-cost services. Spaying a pet cat costs $35, and neutering costs $20 (the procedures for strays brought in by members of the community cost $25 and $15, respectively). Spaying a dog starts at $45 and neutering at $30, depending on size. The treatment for heartworm infection runs $180 to $350. The clinic will spay a cat, give rabies and feline leukemia vaccinations, and deworm it for $67, Silverglat says.

An Angels Vet Express team member assists a client. The not-for-profit clinic in Savannah, Missouri, cares for both rescued animals and pets in the community, providing low-cost spays and neuters and other veterinary services as well.The Angels Vet Express clinic is not a business venture, Silverglat tells dvm360. It was started in 2002 as a division of M’Shoogy’s (a variation on Yiddish slang for “crazy”), a no-kill animal sanctuary founded by the Silverglats 30 years ago. Originally, Angels Vet Express was intended to treat rescued animals at M’Shoogy’s and offer low-cost spays and neuters for the community.

 

But Silverglat says he soon recognized that many people were unhappy with the veterinary profession because of cost. “People started coming and coming and coming because we had low prices for spays and neuters. … We started realizing that we could do more with a veterinary clinic than we ever could just rescuing animals,” Silverglat says. “You could have 10,000 animals next door [at M’Shoogy’s] and not make a difference in the animal world, so we realized that we could [spay and neuter] as many animals as we possibly could and provide all these services because people couldn’t afford all these services.”

 

 

The majority of clients visit from the Kansas City metro area, Silverglat says, which is slightly below national income levels. Kansas City’s median household income from 2009-2013 was $45,275, and 19 percent of its population was below the poverty line during the same period, according to census.gov. Those figures compare to $53,046 and 15 percent nationally.

The veterinary clinic has grown 3,000 square feet every two years, and it adds approximately 1,000 new clients a month, Silverglat says. It expects to run 24,000 heartworm tests and perform 10,000 spay and neuter procedures this year. The clinic has approximately 30 employees with five full-time veterinarians and two part-time. Its staff members make an average of 30 to 40 exam room visits a day. The clinic has four small exam rooms for routine care, four larger exam rooms for additional services, a pharmacy, an isolation ward, three workup rooms with wet tables for small nonsurgical procedures, and two surgery suites.

Silverglat designed the clinic’s aesthetics to evoke a rustic Ozarks atmosphere. The waiting area plays bluegrass music, and red mailbox flags mark occupied exam rooms. “We don’t want you coming into a vet clinic,” Silverglat says. “We want you to come into a fun place.”

Gary SilverglatThe clinic provides care for approximately 40 animal rescues in the area and aids with the city of Cameron’s animal control efforts. Approximately 1,000 animals a year are adopted from the clinic, Silverglat says.

Angels Vet Express uses its high volume as leverage with distributors to get better bargains on products. “If they’re getting our business and making a profit off us, they’re going to give us a better deal because we’re doing all of this good work,” Silverglat says.

The clinic hasn’t broken even since it opened in 2002 because it provides some of its services for free or at cost, but 2015 could be the first year it does, Silverglat says. “The cause here isn’t to make a lot of money,” he says. “The cause here is to take care of and save animals.” The clinic receives some donations but is intended to be self-supporting, Silverglat says.

The clinic aims to keep paying its doctors and staff well, but it must maintain its high volume in order to meet employment and overhead costs. “All we try to do here at the clinic is break even. Just break even,” Silverglat says.

The clinic’s popularity hasn’t come without backlash. It has been the subject of rumors that it didn’t employ real veterinarians, Silverglat says, and a website hosted on angelfire.com titled “The Real M’Shoogy’s” makes allegations that associate Silverglat with drug use and suggests poor conditions for animals on the property. Silverglat says these are unfounded attacks by veterinarians who lose business to the clinic. The site is state-inspected, employees are constantly cleaning and the public is invited to visit and take tours, he says.

Patients at Angels Vet Express.Veterinarians at traditional practices often suspect that high-volume clinics cut corners or jeopardize patient safety for efficiency, and Angels Vet Express is no exception to these suspicions. Silverglat insists patient care is the clinic’s top priority. “If a person paid $1,000, they couldn’t get a better spay or neuter than we do,” he says.

The clinic takes a long time (sometimes as long as a year) to hire a new veterinarian and interviews up to 200 candidates to find the right fit, Silverglat says. Compassion is the key quality he says he searches for in applicants. “It’s not a job, really. It’s a cause. They want to be a part of it,” Silverglat says. “They get the freedom of practicing veterinary medicine uninhibited. They get to do whatever they want to do. If they need something, we do it.”

The clinic features digital radiography, applanation tonometry, blood pressure monitoring, eight isoflurane machines and heated surgery tables. The clinic uses eight autoclaves and ultrasonic cleaning so it can use a separate surgical pack for every procedure.

Stacy Hoffman, DVM, Angels’ head veterinarian, says she joined the clinic three years ago because she was attracted to the high-volume model. Growing up in New York, she was accustomed to pet owners paying for expensive care and didn’t know how many people didn’t have the luxury of paying large veterinary bills. “I realized that a lot of people weren’t able to keep their animals as healthy as they want them to be simply because they didn’t have that much money,” Hoffman says. “When I came here to interview, one of the things that attracted me to it was that we could treat animals with high-quality medicine at a discounted price.”

Stacy Hoffman, DVMHaving once logged 82 exam room visits in a day, Hoffman holds the practice’s record. The staff saves time by tailoring questions for the client according to the pet’s history and function. “Based on the repetition and the amount that you see here, the doctors get very good at condensing what they’re going to say,” she says.

 

However, Hoffman says it’s a misconception that her practice rushes clients. “We always give them the time that they need. That’s what a lot of our clients love about us. They don’t mind waiting that time because they know they’re going to get handled properly,” she says. “It’s not that we move them in and out and push them out like cattle.”

Although critics of the high-volume model may argue that it edges out traditional veterinary practices, Angels Vet Express is not immune to competition. “We’re not just facing doctors around here locally,” Silverglat says. “We’re facing 1-800-PetMeds and stuff like that. It’s a real threat to the whole veterinary business.”

But no one is guaranteed the right to succeed in business, he says, and competition is inevitable. “You better be trying to be the best and try to fight for your customers because someone is going to try and put you out of business,” Silverglat says.

Silverglat, whose background includes retail and cattle buying, says he thinks many professionals in veterinary medicine are not suited for business. “Most veterinarians are doctors—they haven’t been trained in business,” Silverglat says. “They just think they open the door and put a sign out, and they can get by and people are going to just come because they see a doctor, and they’ll make a lot of money.”

Although the high-volume model isn’t the norm in the profession, the success of Angels Vet Express demonstrates that veterinary medicine faces a changing landscape as clients enjoy more choices when seeking care for their animals.

High volume clinic

Mr Silverglat appears to be confusing his nonprofit mission with a legitimate profession. Nonprofit agencies serve their purpose, and "doing good" for the community, especially for those at the low end of the financial spectrum fills an important need. It should not, however, supplant professionals doing a professional job. Every business cannot operate as a nonprofit. Perhaps that is Mr Silverglat's view, but nobody in the real world has made that work. When Mr Silverglat states that he has never made a profit, he implies he has an independent source of income on which he depends. Perhaps he inherited wealth, or has another business that provides him the resources to provide his non-profit services. Most veterinarians have no such luxury. This IS our profession, and to feed our families, we need to make a profit. No apologies necessary. Would you ask an MD, a DDS, or lawyer to provide all of their services below cost? That would make for a lot of out of work professionals. And if they are out of business, how are they going to help anyone?

Actually, Mr. Silverglat, all veterinarians are doctors

No one with a business background is going to consider not breaking even in 13 years a successful business model. Using metrics like practice square foot growth and simply new clients per month is not going to help guide any size business. What about client retention and repeat visits per year? The absurdity of talking about high quality medicine at the same time bragging about rediculously high daily exam room visits is what took this article over the top for me. These two things just don't go together. Telling clients just what they need to know to get them out the door plays to this. I'm concerned the socioeconomic level of the clients this practice is serving doesn't know enough to ask the right questions and would actually benefit from more client education. I was also somewhat appalled at the list of "clinic features." I would certainly hope they have anesthetic machines and autoclaves, but what about CBC and blood chemistry machines, anesthetic multimonitors, dental x-rays, or even an ultrasound machine. I'm sure based on what is described here, pet owners could get a SAFER spay for a little over $45. I'm certain this clinic is doing an admirable job for a large number of rescues, but it is likely running well managed veterinary hospitals out of business by providing economically unsustainable medical care in that community.

Veterinary Medicine Should Be About Quality, Not Quantity

I agree with Petvetk below. This idea works well in theory, but not in practice. The lead veterinarian saw 82 appointments in one day? I went to their site. Their longest day is 8.5 hours. That means she saw 1 appointment every 6 minutes all day long if she didn't take any breaks. That's not good for patients or clients, nor is it good for the veterinarian; that's how we end up getting compassion fatigue and burnout. I love the idea of a low-cost clinic, but it promotes competition among clinics - and not in a good way. This type of price slashing sends the message that we're all money-grubbing monsters who are just in it for the cash. And don't we deal with that stereotype enough already?

Sounds like a really

Sounds like a really enjoyable way to make a living. In this day and age of staff members demanding a work/life balance, have to wonder about the turnover rate. A former employer once told me you either have time or money; sometimes neither, never both.

wow. do the math. 82 exam

wow. do the math. 82 exam room visits. Was that a 8 hour day? 12 hour day? bathroom break? 1 pet per visit? All tractable easy to examine patients? I'm sorry, but quantity never equals quality. Yes there is a market. There will be a lot of neutered pets out there. But they won't be getting what anyone could compare to true quality medicine. Or time for true owner education. And unfortunately the skim the cream mentality will service pets the first wham-bam do everything visit, then they won't return until they are 12 with rotting teeth and kidney/cardiac/neoplastic disease for euthanasia.
Welcome to Walmart veterinary style. And don't wonder when the esteem of veterinarians deteriorates to arrow shooting vets, Dr.Pol and budget big box. Makes me sad.