Stationary vs. ambulatory: Your place or mine, Doc?


Consider two crucial factors when you're deciding between an ambulatory or stationary equine practice.

Oh, the joys of being an equine ambulatory practitioner. You're out in the fresh air, enjoying the scenery, working at a leisurely pace, and basking in the solitude as you reflect on the day's events in an empty barn or field or truck. Those are the pros—but there are cons, too. Your volume of daily client visits is limited by your driving time. There's a higher risk of getting injured on the job. You may not have what you need in the truck that day. So is the mobile life for you? Or are you better suited to a haul-in practice? Can you do both?

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A lot of it comes down to personal preference. Some doctors like to work in a well-stocked clinic with space for surgery and recovering horses. Others prefer to work in the field, alone or with a technician. Beyond personal considerations, however, two major factors will impact your decision: the cost of driving and the cost of real estate. Weigh these issues before taking the leap either way.

The driving dilemma

In tough economic times, more clients seem to prefer ambulatory practitioners. They're looking to conserve resources, and driving a horse to a haul-in clinic costs a chunk of change in gas or diesel. The trip also ties up farm equipment and personnel. So the savings clients realize by hauling a horse to your building are not as much of an influence as they were before.

That means the pendulum is swinging to the ambulatory side. ? Mobile equine practice seems to be recession-proof. Horses will always find ways to get colic or step on the only nail in the pasture and grow lame from an abscess. When that happens during a recession, clients are more willing to pay for you to drive to the horse than they are to pay to drive to you. But that means you'll need to manage your time better to make it work.

Know thy neighborhood

The best way to be efficient is to schedule proactively with horse owners. Set up a wellness program and call clients to book appointments instead of waiting for them to call you. You'd be surprised how many clients appreciate you calling them, rather than the other way around. Break up your practice area into regions and bunch nonemergency calls on specific days of the week. Here's an example: "Hi, Frank. I noticed Geronimo is due for his Coggins test and a dental exam, and I'm going to be in your area Tuesday afternoon. What if I stopped by around 3 p.m.?" After all, gas costs you money, too, so you need to be more strategic than ever to keep expenses under control.

But let's not ignore the benefits of a haul-in practice. Your equipment, your supplies, your team, and the shelter of a building during less-than-favorable weather conditions are all guaranteed. And although some horse owners want the veterinarian to come to them, others have a large truck and trailer at the ready and are willing to come to you.

Do you have a blue-collar client base of price-sensitive and time-strapped farmers? Or is yours a high-end client base that wants the specialty services they can only get at a haul-in facility? Conduct a demographic study to better understand your local population of horse owners. A consultant can help you perform this study, or you can go to the local extension service and ask for the most recent horse census for your county and neighboring ones. Also, take some time to attend area horse shows and observe people while asking questions. You'll get a great idea of what local horse owners want just by rubbing shoulders with them.

Real estate realities

A second factor to consider is the cost of real estate in your area. If a seller or landlord doesn't think an equine practice is the "greatest and best use" of the property, he or she may ask for a higher rent or sale price than you can afford. Sometimes the best location for a haul-in facility is not what you might think of as prime property, but a site that's a little bit off of the beaten path. For example, my practice was near two interstates and off a main road but four miles outside of the city. It was easy to find, but it wasn't on a busy city street with starts and stops that make the drivers of six-horse trailers crazy.

Before investing in land and buildings, decide how you plan to use your clinic. Will it be an office with a work area and a few stalls, or will you include a sterile area for surgeries? If your dreams are big, consider building in stages. Remind yourself that the building and the associated costs of maintaining it can be awfully expensive, especially if you're not promoting and using it. If you're going to be the only doctor performing venograms on laminitic horses, host an open house and demonstrate the new service to your clients, and explain why it's important and how it can help.

Almost all equine practitioners at some point in their careers think about owning a small haul-in facility to house sick or recovering horses or to perform surgery. And then many of them put pencil to paper and realize that their case volume isn't enough to justify the investment. But planning gets their creative juices flowing, and many find alternatives. For example, you could rent stalls from a client and use them as needed. Or you could join forces with another practice with a facility.

In the end, deciding between a haul-in or mobile practice comes down to your personal preference and your clientele. Investigate local horse owners' needs and wants, along with their available income and how many of them there are. Enlist an advisor to help in making this decision. Keep your goals and motivations in mind, and don't be afraid of change. Just because you're driving around now doesn't mean you can't set up permanent shop, and just because you're looking out the window of a building doesn't mean you can't hit the road. Just be savvy and strategic about your choices, and you'll find success.

Veterinary Economics Editorial Advisory Board member Dr. James Guenther, MBA, CVPM, is a partner in Strategic Veterinary Consulting in Asheville, N.C. E-mail comments or questions to or post your thoughts on the community message board.

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