Mixed animal practitioners caught on the 'horns of dilemma'
J.D. Biggs could smell the humus of the earth as he walked around the side of his clinic in Metropolis, Ind.
Spring was in the air and he welcomed the emergence of the daffodilson 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 veryrural area of Indiana.
J.D. walked into the office and was greeted by Millie. Millie had beenwith Dr. Biggs for more years than J.D. could remember. In fact he wouldn'tremember if asked.
Betsy, J.D.'s wife, was busy in the back of the clinic helping to openthe practice for another day's work. Betsy had helped open the clinic foras long as anyone could remember. Betsy and J.D. were married while he wasin veterinary school in the early '60s. Betsy and Doc have weathered manystorms 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 Metropolisfor Hans Gruenig who had graduated in 1940's from the now defunct ChicagoVeterinary School. Hans had practiced through the halcyon years of the '50swhen hog cholera subsidized hundreds of practices in the Midwest. Hans retireda wealthy man and sold the practice to J.D.
Dr. Biggs proceeded to put his life into the practice with a Herculeandose of blood and sweat especially in the formative years during the '60sand '70s. J.D. was now seeking an exit strategy so that he and Betsy couldfinally have time to spend with grandkids. J.D. had recently been musingabout what could have gone wrong in the long process of owning a veterinaryclinic. He had often worked 70-hour weeks for 40 years and loved every minuteof it. Doc had hired an associate, Dr. Joseph Brown, in 1970 to help himwith 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 animalpractitioners at the time, viewed small animal practice with a touch ofdisdain. Small animal practice was a side event of little import to thepractice of veterinary medicine in general. Doc and Dr. Brown did well andgot along until the late 1970's when the livestock in the county began concentratingin other parts of the state. Dr. Brown resigned and moved to an area withhigher livestock concentrations. J.D. picked up the load and went on.
J.D. started to realize in about 1980 that his practice was turning tosmall animal practice more and more in order to survive.
The farms raising livestock in the county were disappearing like so manysmall lights that dim and finally go out with little fanfare.
He tolerated small animal practice but at the state meetings, he alwayswent to the large animal seminars as a rule.
In the '80s, J.D. bumped into his former associate, Dr. Brown, at a regionalmeeting in Illinois. Dr. Brown was now mostly small animal. They both reflectedon the irony of it all and had inappropriately laughed outloud during aquiet moment of a swine disease presentation. J.D. watched the other vetsin his area go through the same process-seeing them at large animal seminarsknowing they were longing for the good old days.
In J.D.'s county, farmers were gradually getting out of livestock andmoving primarily into cash crops. Fences and fencerows disappeared and cropswere planted right up to the roadways all over the county. Farmers who stayedin livestock were beginning to buy drugs for their livestock from non-professionalsources. The farmers that remained segregated into two groups-those whowere buying up land and getting bigger and those who were hanging on whiletaking a second job wherever they could find one.
In 1989, J.D. had hired another associate. She was a wonderful smallanimal practitioner and could hold her own in a muddy pig lot or in theone drafty dairy barn left in the county. Everyone in town loved her, includingthe 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. hasbeen without an associate ever since. He had scoured the journals, veterinaryschools and meetings for years but could find no one to even consider interviewingfor the position. He finally just gave up.
In his mind, however, things had been looking up. J.D. had graduallyincreased his prices over the past several years and was hoping that wouldhelp propel the sale of this practice. That is until he had a practice valuationdone in January. The gentleman hired was professional enough and had a DVMand MBA to boot. The problem was this: he told J.D. that there were no excessearnings in the practice and that essentially the business itself was worthonly what the equipment could be sold for-40 years of labor and not onesquare 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 owneda substantial amount of large animal equipment that was essentially unusedand certainly not sellable, even on E-bay.
The appraiser also told J.D. to get a real estate appraiser to valuethe land and building. Unfortunately, a new four-lane highway around townnow bypassed his land and building, which had once been on the main roadleading into town. He had trouble understanding the concept of "excessearnings." He thought the practice was enough to provide a nice livingfor 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 withno 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 thatare occurring:
·The livestock numbers are mostly unchanged but livestock aregradually concentrating in geographic pockets of the country, leaving manypractitioners high and dry.
·Farm numbers are declining and the farm population in this countryis under 2 percent.
·Students entering veterinary schools are primarily from urbanareas with little desire to locate to rural areas.
·Lifestyle expectations after veterinary school preclude 70-hourworkweeks.
·Farms are increasingly larger and more integrated. The trendis 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 seriousand chronic undercharging for professional services leading to valuelesspractices.
·Industrialized farms tend to systematize disease control issuesleading to less and less veterinary oversight.
·Small farmers, the heart of livestock practice in the past, areliving 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 positionsdue to generational differences and an unwillingness or inability to locateto certain rural areas of the country. The ultimate question is how canthis be corrected.
Is this a problem for the small animal practitioner?
You bet. This is a problem for the whole profession not just the livestocksector. Mixed animal practitioners (too often with economically naïveattitudes about fee structure-myself included) have for two decades slowlyconverted to small animal practice. These practices are now competing withall other practices in the area (including suburban) for the pet owningdollar. This has led to fee stagnation and practices with little or no value.
What about the small animal suburban mega-practices far removed fromthe rural dilemma? These practices suffer indirectly in two significantways:
Students who desire to practice large animal medicine but need to followthe job of a spouse are sidetracked into small animal practice and are inand out, turnstile fashion, through various practices or are lost to practiceall together. These valuable practitioners could be a loss to the profession.
Mixed animal practices on the fringes of suburban areas that are slowlyconverting to small animal practice can and often do put downward pressureon fees.
Out of the box
It starts with the student of today. Many are interested in large animalpractice but a practice model that would include them does not currentlyexist.
The current student may not be able to commit to rural life for a varietyof reasons. The most obvious reason is that many are from an urban/suburbanenvironment 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 worldwhere 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 centsin.
The old model consisted of one veterinarian in a county serving the needsof all the livestock and small animal denizens as well. This could be thoughtof as a sort of franchise. Veterinarians guarded their county faithfullyfrom the intrusion of some interloper-especially some veterinarian fromout-of-state that didn't respect the rights of the county vet system inplace statewide. Then some fine young chap right out of vet school wouldapprentice at the county vet and would eventually take over the model. Themodel then would perpetuate itself. This model worked until about 50 yearsago.
The broken model
This model succeeded the old model that worked.
This model tried to unsuccessfully compete with feed companies and animaldrug traffickers (perfectly legal) for the farmers' scarce resources whilethe livestock farming community was in great transition to the current farmmodel (see sidebar). Professional fees were and are low. This is the currentmodel.
New grads and seniors accept training in nutrition, economics and productionmedicine as an intensive eight-week winter tract taught by practitionersfrom the private sector on site at veterinary offices or on corporate farms(or at a designated university with dorms.) This is out-sourced with oversightby the extension departments of universities.
This model saves the university money. This type of training would costthe university dearly in order to hire appropriate staff and create theemerging industrial model. On campus the current industrial model wouldhemorrhage money. This tract could be taught by the private sector betweenChristmas and spring break. If carefully planned it could be entirely underwrittenby drug companies. This model will not work unless the universities realizethat the current model is broken and that production medicine will be completelylost (including all its grant money) to the neighboring animal science department.
Private sector veterinarians in the livestock industry have suggestedthis student-tracking model in the past. Universities stonewalled it. Itis now time for the sake of the whole profession for the universities toembrace this out-sourcing concept for a portion of its veterinary program.The profession has changed and the university cannot economically handlethis part of the program simply on campus. I predict that the first universitywith this type of program will be a student and practitioner magnet.
Universities also need to do economic trend analysis and promote a largepractice model (10 practitioners or more) within those areas where the livestockindustry is growing to serve both the large livestock family farms and corporatefarms. The university needs to work with consultants and other universitiesand associations to promote a workable new practice model. This needs tobe multi-discipline in nature.
The private sector needs to promote the large practice model to allowtoday's students and tomorrow's new grads to integrate into a private sectormodel that accommodates the needs of the industry on one end and the needsof their families on the other. Consolidation
Practices need to consider consolidating several practices into largerpractices to accommodate the needs of today's practitioners. What have theygot to lose-these practices are worth very little anyway.
Practice consolidation and mergers will not happen on their own. Theyneed to be pushed by savvy consultants and entrepreneurs working in harmonywith each other to attain this goal.
Students and young veterinarians who expect to participate in large animalpractice 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 theconfines of medicine and surgery.
If things go as they are, we can expect to eventually have the practiceof livestock medicine absorbed by other professionals. There is precedencefor this in the poultry industry where less than 100 veterinarians servean enormous, but closed sector of commerce.
The future of veterinary medicine and whether it will eventually turninto a "pet only" profession is unknown. Let's just hope thatwe 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?