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Was it really 43 years ago, in Ithaca, New York, that my veterinary classmates and I stood up en masse before thousands of perplexed graduates, parents, and guests, waving our rectal sleeves and spelling 

? My career has whisked by so fast that I have to occasionally remind myself of the endless litany of transitions that our profession has experienced, for better or for worse.

Whether it be technology, education, demographics, economics, marketing, communications, practice, ethics, well-being, or culture, I have witnessed and experienced so many changes over the years that I applaud myself and my peers for maintaining any form of sanity and stability as the kaleidoscopic landscape has evolved.

But of all the twists and turns that I have indexed over the decades, my greatest concern and worry is the state of practice ownership. Forty-three years ago, it was virtually every veterinary graduate’s dream to eventually purchase their own practice and experience this profession through personal proprietorship, but so much has changed. Our profession is at a true crossroads. I fear that the not-so-distant future holds a dismal collection of predominantly expansive and expensive corporate-owned practices, a vastly diminished number of locally owned smaller practices, and a dwindling quantity of large animal practices.

The explanation for the decrease in smaller practices is multifaceted but not complex. On one hand you have the baby boomers who have retired or whose health (or other issues) persuaded them to leave the profession. Many people in this group who own the large “million dollar–plus” facilities have already sold, or will sell, to the corporate suitors. Congratulations! That leaves a huge number of vibrant, local, smaller practices (both small animal and large animal) for which the owners will have to find buyers. The options for finding a buyer are somewhat limited. One might consult a broker, but the small size of the practice or the sales commission might pose obstacles. Perhaps there is an associate, but are they interested or can they afford it? What now? Does the owner close the doors and walk away?

With student debt looming over so many graduates, can younger veterinarians even afford to borrow more money in pursuit of a practice? Also, personal and professional lifestyles for Gen X, Y, and Zers may certainly put practice ownership on the back burner or take it totally off the stove top. Is it more convenient to remain an associate? And with regard to the large animal world, statistics point to a dwindling population of entrants into this sector of the profession, despite the fact that many veterinary school entrants look forward to large animal practice upon graduation.

Add up both sides of this buyer/seller equation and the future looks bleak for the smaller-size practice, and, in my opinion, that is a devastating loss for our profession. Veterinary medicine has a long history of flourishing practices that may have just 10 or fewer employees (and that includes the veterinarians). Are we now observing the elimination or extinction of this species? What a shame. These practices have been the backbone and pride of our profession for so many years and for numerous understandable reasons. For one, they are part of the community. They are also owned by someone who lives down the street—a real person! This person is also on the school board, or their child and yours are in the same class at school or are best friends, or you both attend the same place of worship. There is a real connection.

Additionally, the veterinary care that these local owners provide is essential. If they were too close shop, who would replace them? The next practice might be 10 miles away or much further, and clients might not feel comfortable starting all over at a new place. With regard to the large animal practice, the neighboring practice might be 50 miles away!

These practices also provide good jobs and careers for our locality. They hire our friends, our neighbors, and our children.

Finally, we always see the same faces, and that is so comforting. “Dr Helfat has been my vet for 25 years. He gave my Sophie her puppy shots, and 15 years later, he was the one who gently helped her pass on” or “Every time I call, Sue answers the phone and fits me in” or “Brenda is the only one who I will let near JoJo when it is time for a nail trim.” I could go on.

So here is my pitch to the younger generations who may be reluctant to own a practice—a shout-out to preserve these smaller but vibrant clinics and hospitals that are desperately looking for their next owner.

First, practice ownership is enjoyable. Believe me, I would not have made it 40-plus years as an associate. Owning a practice has given me stability, a unique sense of success and purpose, and many other intangibles that promote a healthy mental well-being, and isn’t this so important and desperately needed at this time in our profession?

Second, owning a practice has contributed enormously to my nonveterinary life. As a fixture in the community, I am recognized and greeted warmly by so many strangers who apparently know me.

Third, I do not profess to be an economist or business advisor, but compare “associate” and “owner” and tell me who is better off financially in the end. It is the owner who has a practice worth hundreds of thousands, the valuable real estate, an enviable pension, and decades of tax write-offs. In fact, the American Veterinary Medical Association (AVMA) has occasionally advised that practice ownership should seriously be considered as a means toward paying off student debt faster.

Fourth, practice ownership allows you to practice in your own comfort zone, make all the business decisions, live your dream, buy your own equipment, and control your professional life. Again, I could go on.

Is there a solution to this impending demise of the small practice? I say yes! The younger veterinarians who might courageously contemplate practice ownership should take a look around. Where are some of these practices in the general vicinity or, perhaps, in a different region that might be more appealing? Get to know the owners and send them a letter of inquiry. Possibly give them a call or send an email. Attend local VMA meetings (and join!) or put your quest in the ear of a sales representative you know. Plant the seed. From my experience, just starting a conversation often opens the door to further discussion.

One cautionary note: It is so much easier to buy an existing practice than to start one anew. I have done both. Would you rather walk into a business with thousands of existing clients and their files or wait 5 to 10 years until they slowly arrive? Surely there are exceptional cases, but not many.

The other part of the solution lies with the seller. There must be financial incentives to make this work, such as the following:

A personal loan/note for the sale of the practice (but a standard bank mortgage for the real estate)

The survival of the small practice relies upon initiative, incentives, compromise, and a desire to keep on dreaming. I have personally made an effort to support my comments above by recently starting up Veterinary Practice Transition (veterinarypracticetransition.com), a nonprofit that seeks to bring the seller and buyer together in an easy, straightforward manner and with a process that appeals to both parties.

I wish you all the happiness and success that I have experienced and still do. Do not let the flame die out!

Mark P. Helfat, DVM, is the founder and owner of Larchmont Animal Hospital in Mount Laurel, New Jersey.

Articles

A veterinary practice owner explains how the younger generation of veterinarians can help preserve small local practices

Commentary:The impending demise of the small veterinary practice 

Our team at dvm360.com and Firstline magazine asked practice manager Emily Shiver to answer your questions about life in practice for managers, technicians, assistants, client service receptionists and more. Got a question for her? Email us at firstline@mmhgroup.com.

Let’s face it. Many clients are extremely emotional— especially about finances— often making discussing treatment plans an arduous task. Here are some proven tips that will help you present these plans like a pro:

Familiarize yourself with the treatment plan before discussing it.

Sit next to or kneel beside the clients so that you are at eye-level with them.

Use terms the clients will understand and be descriptive with your explanations.

Once you finish discussing the plan, ask the client if they have any questions or concerns.

In a perfect world, the pet owner would respond positively, sign the treatment plan, and allow you to begin treating their pet. 7 out of 10 times— this is 

 the case— especially in an emergency situation. However, don’t panic—all is not lost. Instead of being intimidated, be empathetic. Let them know that you are committed to working through the treatment plan with them.

Here are some common client concerns about treatment plans and what to do about them.

Review all payment options with clients. (CareCredit, ScratchPay).

Prospectively, the doctor can have a Plan A or Plan B.

Be transparent about additional costs throughout treatment duration and the potential for recurrence. I do caution you at this step. I say this in my practice weekly—a feline urinary obstruction is a lot different than a laceration repair. If the client scrapes together the money to catheterize and hospitalize their pet, there is no guarantee they won’t be dealing with this same issue in 4 to 6 weeks. Make sure you have this conversation with them 

 moving forward with the initial treatment.

Walk them through the steps of the treatment in detail.

Try saying the following empathetic statements to calm you client’s fears:

“I know this is a hard decision, I am here to support you.”

“I share your concerns about Taylor. I will provide all the information you need to make an informed decision.”

“It sounds like you are overwhelmed with the options I have presented to you. I am committed to being by your side as you make this decision. How can I help?”

Additionally, if euthanasia is a humane option, then include it in your treatment plan options.

Presenting treatment plans with empathy and compassion helps to eliminate some of the stress of this delicate discussion. It also potentially erases the “all you care about is money” connotation. Remember to never pressure or guilt your clients into making a decision. The goal is to work together to achieve the best possible outcome for their pets.

Emily Shiver, CVPM, CCFP, is practice manager at Cleveland Heights Animal Hospital in Lakeland, Florida

My veterinary team is very uncomfortable going over treatment plans. What tools can I give them to be more successful?

Ask Emily: How to discuss treatment plans

With Thanksgiving only days away and COVID-19 cases spiking around the country, it's more important now than ever to keep you up to date with the latest pandemic news and our coverage of the veterinary industry.

, the first drug specifically approved for weight loss management in cats with chronic kidney disease (CKD).

Bond Vet, which launched its first clinic in June 2019, recently raised 

$17 million to open 10 or more veterinary clinics 

Second-year veterinary student Mariacamila Garcia Estrella shares her 

dos and don’ts for communicating with Latinx veterinary clients

News wrap-up: This week's headlines, plus how to communicate with Latinx pet owners 

There’s been a lot of talk in the veterinary profession about telemedicine, particularly since the start of the coronavirus disease 2019 (COVID-19) pandemic. But does it really live up to the hype? According to telehealth expert, Aaron Smiley, DVM, chief of staff at Devonshire Veterinary Clinic in Anderson, Indiana, and President of the Indiana Veterinary Medical Association, it does.

While veterinarians are good at offering free telemedicine services, they aren’t so good at monetizing their remote expertise, Smiley said at the 

 virtual conference. But incorporating telemedicine into your practice not only saves you time, it generates new revenue and makes clients happy.

During his lecture, Smiley outlined the benefits and explained how to incorporate paid telehealth services at your clinic, using real data to support his claims. (To learn more about how veterinarians are utilizing telemedicine during COVID-19, check out 

With so many people fostering and adopting pets during COVID-19, teams at many veterinary clinics are burning the candle at both ends to match the high demand, said Smiley. But how can you take care of clients who have been with you forever 

 accommodate new ones with this large influx of patients? Smiley says the answer is asynchronous, paid telemedicine.

Asynchronous telemedicine involves interacting with your clients conveniently and efficiently via a telehealth app like 

, and others. Instead of being glued to your computer, clients are sending you images, videos, and messages at different times throughout the day, allowing you to juggle other appointments and work-related tasks.

“Most of the time, we think of telemedicine as being synchronous, sitting down at a computer and doing a video consult with a client,” said Smiley. “But veterinarians do not have to do consults this way. On the human side, insurance companies require synchronous telemedicine for reimbursement but veterinary medicine does not have that constraint.” If you’re looking to convert to paid telemedicine, use asynchronous telemedicine, he advised. Don’t schedule time for live telemedicine video chats, he explained. “Veterinary patients do not ‘perform’ well on-demand, clients are busy, and most veterinarians do not have extra time in their calendars to block out synchronous telemedicine appointments."

About half of Smiley’s daily cases load is managed via telemedicine. “That’s a big chunk of my practice that’s remote,” he said. “Telemedicine is a supplement to traditional practice and will never replace a physical exam but it does help us to meet the needs of many of our clients and patients.” Asynchronous telemedicine is also efficient for your front desk staff. Instead of your receptionist going back and forth with clients on the phone about medical concerns that they cannot directly answer, asynchronous telemedicine allows clients contact the doctor directly.

Veterinary telemedicine is not new. It has been offered and proven to be a vital tool by generations of veterinarians, said Smiley. Our profession has been offering telemedicine to our clients and their animals since the advent of the telephone. Here are some specific medical recheck issues where Smiley utilizes paid telemedicine:

 We offer to interpret glucose curves via paid telemedicine.

Ask owners to send you a message/video of any seizure after you start medical management.

Monitor arthritis therapy with a video of the animal moving in its “natural” environment.

Ask the owner to send a video of the animal breathing to appreciate the resting respiratory rate.

Seasonal allergies can be reevaluated with pictures and videos of the animal.

Recheck the animal with a video or picture of the infected area to confirm that therapy is effective.

Sometimes, when veterinarians discuss diagnosing patients remotely, there is a fear of the worst-case scenario. Smiley calls this the “what-if” game.“What if I miss something? What if I need a diagnostic test like blood work?” “What if the client doesn’t tell me everything I need to know? ”Smiley’s argument is that he uses the same medical knowledge for a remote and an in-person exam. He collects a history, observes the pet, talks to the owner, and then uses those building blocks to create the most appropriate plan for that patient.“ If you’re going to play the what-if game for virtual exams, you have to ask the same questions of yourself for the in-person exam,” said Smiley, adding that the complexity of treating a live animal ensures that veterinarians will never be able to fully satisfy every “what-if” question, regardless of the type of exam or number of diagnostic tests.

Smiley examined 2560 telemedicine cases with clients with whom he has an established veterinarian-client-patient-relationship. Here is the breakdown of the types of cases they were:

10%: Courtesy tele-triage with technicians/nurses

“This is what you are doing in small animal practice every day,” said Smiley.

Here’s a look at some of the conditions Smiley diagnoses remotely:

The dog is bright, alert, and the owner has a history of feeding something they ought not too, said Smiley

 A video with the flash on typically allows good visualization of the vertical ear canal. If a cytology is needed, you can ask the owner to schedule a nurse/technician appointment and have the results sent back to the doctor and owner through the telemedicine app.

 “I think veterinarians can diagnose arthritis (especially feline) better when the exam is done remotely because animals are more comfortable at home and do not hide their pain as often,” said Smiley.

 A picture of caudal dorsal alopecia is almost pathognomonic for fleas.

Telemedicine consults can seem like a huge time sucker, but remember, it’s all asynchronous, said Smiley. The average length of 1 of his consults is about 271.65 minutes. That may sound like a lot, but it equates to him sending about 12 messages and the client sending 9 messages. Again, these messages aren’t always back to back and might be stretched out over the course of a few days, he explained. It depends on how busy the client is and how busy you are. Additionally, Smiley receives an average of 1.5 videos and 2.5 photos per telemedicine consult.

The biggest impediment to paid telemedicine is that veterinarians don’t always realize that they’re worth it, said Smiley. “When veterinarians forget their worth, they become blinded to the high value animal owners place on their medical expertise. Veterinarians revert back to the misconception that a client will only pay for services when they are rendered in-person,” Smiley said. “But it’s not true. You are worth it, and your clients are willing to pay for it.”

Using data from more than 2500 cases, Aaron Smiley, DVM, explains how adding paid telehealth services improves veterinary practice workflow, increases revenue, and boosts client satisfaction.

Monetizing veterinary telemedicine: It can be done

Bond Vet, which launched its first clinic in June 2019, recently raised $17 million to open 10 or more veterinary clinics by the end of 2021. The New York-based animal health company says private investment firm Talisman Capital Partners will pay for the expansion after a Series A funding round.

“We’ve seen more than 13,000 pets since we launched our very first clinic, and it’s clear that there is consumer demand for a new kind of veterinary experience," says  Bond Vet cofounder and chief executive officer Mo Punjani. “This round of funding will help us to continue realizing our mission to elevate and enhance the veterinary space.”

Since its initial launch last year, Bond Vet has provided both urgent 

 primary care, according to a company release. Additionally, walk-ins and scheduled appointments are welcomed in most of their locations without the need for membership.

With the veterinary profession notorious for 

high burnout rates, compassion fatigue, suicide, and depression

, Bond Vet says it’s also dedicated to the wellbeing of its employees—which, in turn, allows them to provide exceptional care to their patients.

“To date, we’ve built an incredible team of veterinarians, nurses, veterinary assistants, and care coordinators with a new, differentiated approach, making us one of the largest veterinary employers in New York City," says cofounder and chief veterinary officer of Bond Vet Zay Satchu. Satchu also vows to develop exceptional staff and patient care by hiring, cross-training and utilizing the company’s robust continuing education program.

“We believe the best way to drive a best-in-class experience for pets, pet parents, and our team members is to do it from the ground up. The Bond Vet team has done exactly that, and we’re excited to expand our impact in the industry,” says Matt Bennett, a partner at Talisman Capital.

The animal health company plans to open at least 10 clinics by the end of 2021.

Bond Vet raises $17 million towards veterinary hospital expansion

The US Food and Drug Administration (FDA) announced last month the approval of Elura, the first drug approved specifically for weight loss management in cats with chronic kidney disease (CKD).

Cats with CKD may begin to lose weight prior to diagnosis and typically continue to lose weight as the disease progresses, thus worsening their prognosis and shortening their lifespan.

“Capromorelin is a ghrelin receptor agonist known to increase appetite and weight gain and is approved as 

 for appetite stimulation in dogs. Elura is the second product that the FDA has approved for the management of unintended weight loss in cats,” according to the 

Elura’s safety was evaluated in a 56-day study in which the drug was administered to cats with unintended and documented weight loss and a history of CKD. Researchers found that cats receiving Elura had gained weight and cats in the control group had lost weight.

Additionally, a 6-month safety study of healthy domestic shorthair cats dosed with water or Elura at 1, 3, or 5 times the labeled dose of 2 mg/kg once daily, found that Elura caused weight gain in all treatment groups. Additionally, cats in groups given 3 and 5 times the labeled dose of Elura consumed more food than cats in the other groups.

The most common adverse reactions associated with Elura in both studies were vomiting and hypersalivation—both were seen more frequently in male cats.

Elura is available by prescription only, as it should be administered only by veterinary personnel with the expertise to ensure safe use of the drug, assess the patient for contraindications and monitor for adverse reactions. The drug is supplied in 15 mL bottles with an oral dosing syringe.

Elura increases appetite and weight gain in cats suffering from chronic kidney disease.

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