For many in veterinary practice—and maybe in any business—there can be an instinctive urge to get bigger. We’re taught that size is a measurement of success, and society often frowns on anyone who's simply content to make a comfortable living doing what they love.
In veterinary medicine broadly, there are good reasons to want growth. Here are some reasons bigger is better in equine practice ...
• More staff. More team members means more opportunity to care for more patients and more efficiency in doing so. Period.
• More services. The larger a general practice gets, the more opportunity there is or the veterinarians to get experience in providing specific types of care. Within equine practice, that might include a doctor focused on dentistry, another focused on reproduction, and a third focused on imaging. The list goes on, but there’s no denying that growth can mean sustainable focus areas that enable specialization.
• Better hours. Most equine practitioners don't have an emergency-only practice for after-hours referrals, so most equine practitioners (solo or not) end up providing 24-hour care to the best of their ability. That’s mentally and physically draining and can damage the home life of a practitioner who's constantly working. The typical answer? Grow the practice to spread those duties among a larger pool of veterinarians and team members.
• An exit plan. A larger practice may all but ensure that one or more associates will show an interest in taking over the business someday. While I can’t speak for the entire country, the area of Oregon in which I work is heavily populated with amazing veterinarians who have given their heart and soul to the practice but have yet to find a candidate to keep their hospitals alive when they retire.
So, what's the problem with growing into a larger practice?
Doctors come in halves
In my experience, projected growth tends to come in 0.5-full-time-equivalent doctor needs, but potential associates usually come whole. There’s no secret as to how or why this happens—a single practitioner allows growth to “pile on” until he or she is doing roughly 50 percent more work than a normal schedule would accommodate, which seems to be the point when most will finally throw in the towel and put out an ad for help. When the brand new shiny associate arrives, he or she finds a practice that can only keep them busy about half the time, at least at first. The period of time that has to elapse before the practice can sustain two full-time-equivalent practitioners is often the time it takes for the new associate to get frustrated with boredom and low production.
Another strange rule of growth? It took the solo practitioner a lot less time to develop the first 50 percent of business above and beyond a single doctor schedule than it will take the new associate to develop the next 50 percent needed to reach a sustainable two-doctor schedule. Why is that? One need look no further than the familiarity and trust the original practitioner built with clients—that takes years to develop.
This 50 percent doctor problem is a recurring problem for many practices—from two doctors to three, from three doctors to four, and so on, and so on. For many practitioners, growth is still the right decision, but it rarely comes without a cost. So, should you do it?
Why you should go solo
There are a few good reasons to grow (see the previous page), but there are countless reasons not to. Most of them aren't clearly evident until it’s too late ...
• Employees are hard to manage. Contracts need to be negotiated and re-negotiated, on-call schedules need to be debated, practice culture needs to be taught ... and on and on. Solo equine practitioners are often their own practice managers and their own human resource managers, but tend to be experts at neither, and why should they be? On top of all of the personnel management challenges that come with new employees, if the new addition is a recent graduate DVM, you can slap the label of mentor/trainer on yourself as well. It’s all a big commitment.
• Your costs go up—immediately. Unlike growing a brick-and-mortar small animal practice, adding equine practitioners to a mobile practice usually means immediately replicating day-to-day equipment, inventory supplies and support staff. So you’ve decided you can afford to add $65,000 to your practice ledger and pay another doctor? Not so fast. That number needs to include a vehicle, a vet box, another digital radiography machine, another ultrasound, another set of dental tools, another set of hoof tools and a whole lot of consumable supplies. Unless they’re working alone, add on the cost of another technician. Once again, for the equine-only practice, this isn’t a one-time addition of expenses—this will be repeated each time you expand and add another doctor.
• You need to find associates ... and then keep finding associates. Oh, you hired an equine associate? Fantastic. Here's the problem: Only a fraction of new veterinarians stick with equine practice once they tire of the long hours and impact on their home life. With a challenging pool of candidates, it's tempting to just avoid that process altogether and work solo. Perhaps one of the most difficult realities is what to do once you’ve grown the practice to include associates and one or more of them leave. Unless you plan to leave clients hanging, you’ll be working longer and longer hours.
• As a solo practitioner, you might not even have to do all your emergencies. While the lack of associates to share after-hours duties with is a downside, regional call groups can alleviate this problem. (Read my take on it at dvm360.com/equinecallgroup.) You’ll never be on the receiving end of a call from Mrs. Smith complaining that your new doctor doesn’t palpate the way you do, and you’ll never have to make excuses to your support staff during the “get familiar with the practice” stage that seems to come with every new doctor.
Failing to grow can hurt your business, but don't walk blindly into a larger equine practice without knowing the drawbacks and planning for them. Whether you grow or not, make sure you're ready for the growing pains.