Saving The Soul Of Veterinary Medicine by Mark Helfat

 Saving the soul of veterinary medicine

An appeal to practitioners to sustain small, independent clinic ownership

February 15, 2023 (published)

By Mark Helfat

Photo by Scott Nolen

The author, Dr. Mark Helfat, snuggles his dog, Simply Irresistible Giselle.

Last June, I attended my veterinary college reunion (45th!) in Ithaca, New York. Over three days of perfect weather, old memories and old acquaintances were revisited and renewed in all their youth and splendor.

Before, during and since that glorious weekend, I have enjoyed ample opportunity to ponder my veterinary career with all its twists and turns, what-ifs and why-nots. I have spent many moments reflecting on our profession — where it started for me and where I see it now.

It saddens me to conclude that veterinary medicine is quickly losing its soul. I choose this word "soul" because, for me, it denotes a life-sustaining spirit, an inner force of sustenance, a vibrant, glowing core.

For four decades plus, I have viewed veterinary medicine as a singular profession. As practitioners, we treat animals and care for owners. Yes, "we care for owners." Our patients do not arrive on their own. The hand of a human is at the end of a leash or upon the handle of a carrier. Our veterinary-client-patient relationship, our VCPR, relies as much upon the C as it does upon the P. And the C and P don't have a chance of finding fulfillment and the finest care with the V unless a sound foundation of trust has been established.

I rarely encounter the word "trust" when studying veterinary journals, webinars and lectures. How do we establish this fundamental condition as we navigate daily examinations, treatments and client interactions? In my opinion, the sine qua non for gaining trust is forging a personal relationship — a one-on-one, caring, empathetic, honest and human touch.

Where would I look first to discover this foundation of trust; this genuine outreach of caring? With certainty, the answer is the independently owned, smaller-sized, community-based veterinary practice. The life and blood and soul of veterinary medicine lies in the long-established, solo-owner, hometown animal clinic.

So I'm sad to see that these clinics are disappearing, as corporate ownership, investment venture capital and super-sized juggernauts consume and dominate the present and future of our profession.

If you have never worked in a smaller clinic such as mine, allow me to draw a picture:

• The receptionists greet each client and pet by name — because they know their names.
• Clients never wait more than 48 hours for an appointment.
• Emergencies are seen that day.
• Appointment requests for specific veterinarians are gladly accommodated.
• There is frequent conversation in the exam room regarding family and all the accompanying health updates and milestones. There is no shortage of bad and sad news; however, we find the time and we have the concern.

More examples of characteristics from my practice that define the soul:

• The veterinary staff and non-veterinary staff have negligible turnover, with tenures averaging 10 years. More than half of the staff has been in place for 20 years.
• Financial concerns and limits are addressed case-by-case, allowing for discounted care when the pet needs immediate attention. If we know the client, late payments may be arranged.
• We see our patients from youth to euthanasia.
• We see our clients age as children to adults, and then we see their children.
• While appointments are scheduled at 15-minute intervals, they often go over — and we do not mind.
• Callbacks are made the next day for every surgery and for most visits involving sick patients.

I cannot view an episode of All Creatures Great and Small without breaking into tears. Silly, right? But the life depicted in the series — which you probably know is based on books by James Herriot, pen name of a 20th-century British animal doctor — is exactly what our profession is losing. These vignettes of a practice that is a family point straight to the profession's soul.

I do not have a Mrs. Hall who answers the office phone 24/7 and cooks all of our meals but I have loyal employees who genuinely know many of the clients as not just pet owners but as friends. The staff is not just staff. We are a family. Having known each other for so long, we truly care for each other.

Don't get me wrong. A large corporate practice will certainly check some of the boxes above, and I applaud them. However, it is my firm belief that the small, independent practice will check more — if not all — of the boxes.

Beyond the trend of large corporations buying up practices is a newer, and in some ways more terrible, trend: Many baby boomers who own solo, independent, small-town practices are reaching retirement. For various reasons, some younger practice owners also are looking to exit. But they cannot find a buyer for their established, vibrant, profitable practices. I speak to such veterinarians weekly who are now contemplating closing the doors and simply walking away.

I am talking about practices that annually gross $500,000 to $900,000. These practices have for years provided incomes that have purchased homes, paid bills, put kids through college, funded substantial IRAs and 401Ks, paid off student loans and provided a comfortable, happy existence.

At one time, these practices would be in demand. They would have associates eager to buy in. The owners might run an ad, and soon, the phone would ring. Simple word of mouth would send someone inquiring. No longer. Why? There are many theories and many new forces at work, but that is a topic for someone else. As these practices serving both small and large animals close, the impact is widespread and devastating:

• Veterinarians lose funds they had counted on for retirement.
• Longtime staff are left jobless.
• Towns lose a clinic, and the next nearest animal hospital may be far away.
• Clients are forced to start over with a new facility where wait times may be much longer.
• A community loses a pillar.
• Veterinary medicine loses another fiber of its soul.

Disclosure: I am among the veterinarians frustrated in trying to sell my practice. But my individual situation is not the problem. The issue is that this phenomenon is affecting a broad swath of clinics.

Please spare me the discussions of EBITDA, no-load and cash flow. I speak to veterinarians who have great numbers but because of proximity to another clinic, the mood of the broker, the high payroll percentage and a million other excuses, they cannot attract even a serious broker.

Is it too late? I say no!

Organized veterinary medicine has a habit of looking at other medical professions for ideas and answers. On occasion, the dental profession has been inspiring. Regarding this very topic, it lends some hope. Dentists have done a remarkable job of maintaining the noncorporate, smaller-sized, traditional community practice. In fact, they are quite successful at passing on facilities to associates and other buyers as they move into profitable retirement.

Where veterinary medicine now approaches 25% corporate ownership and is projected to rise, dentists in recent years have come in much lower, around 15%, judging from a 2021 article in Dental Products Report.

To drill down further (sorry): The American Dental Association — dentistry's counterpart to our American Veterinary Medical Association — has a formal initiative called ADA Practice Transitions (ADAPT) that addresses preserving the independent and smaller dental office. The program has a step-by-step process by which buyers and sellers are connected. Advisers are provided to facilitate the transitions. Simply put, the ADA has decided to play an active role in preserving the soul of their profession.

Perhaps our AVMA would consider a detailed study of the dental profession's trials and errors with ADAPT. Might such a program be of value for the veterinary profession? The AVMA has 400-plus volunteers from every corner of expertise, a professional staff that is surpassed by none, an Economics Division and even a Veterinary Economics Strategy Committee. I would hope that if our association studied this dental initiative and plugged in the unique characteristics of veterinary medicine, we might, in fact, construct our own program.

Considering the present disaster of our disappearing practices, I imagine that an AVMA counterpart of ADAPT could offer significant incentives to encourage and attract reluctant prospective buyers. Among such incentives, I'd suggest including the following:

• discounted sale prices (would a retiring practice owner jump at receiving 80% of practice value compared with nothing?)
• the option of a personal loan carried by the seller, with a minimal required down payment
• providing a list of reputable lenders willing to consider providing the necessary financing
• no commissions for either party (but presumably some type of service fee collected for the association)
• advisers for both parties
• a discussion with the seller of practice management options
• a program in which a prospective buyer first works at the practice alongside the owner and later buys in, either over a period of time or in whole

I would be foolish not to admit that there are impressive benefits that accompany employment at a large corporate facility:

• flexible schedule
• good pay
• health insurance
• paid vacation
• ample continuing education
• mentoring
• human resources support
• fancy, state-of-the-art equipment (read "MRI")

But all of these are standard fare for a practice owner, with the exception of the MRI. Do we all need the MRI?

Here are the benefits of independent ownership:

• being your own boss
• running a profitable business
• holding a recession-proof job
• more wealth
• paying down student debt more quickly
• creating tangible equity
• choosing your own schedule
• hiring family
• amassing a sizable IRA/401K
• becoming a community partner
• mental well-being derived from personal stability and achievement
• saving the soul of veterinary medicine

I was an associate veterinarian for six years. I have been an owner for four decades. I am much happier being an owner! I wonder how many years I would have stayed full-time in the profession had I remained an associate. Certainly not more than 20 or 25 years. And would I have found the success, stability and well-being that I now enjoy?

We are all different, and others' answers to this question will vary. However, I am not alone in lauding the advantages of ownership.

When will veterinary medicine reach its tipping point with regard to corporate ownership? If our profession continues on its present course, we may never see small private ownership again. Without new blood, our soul will slip away, never to be seen again. Just look at our friends in human medicine and their overwhelming corporatization. I contend that they lost their soul a long, long time ago.

One question to which I have no definitive answer is, "How many associate veterinarians have ever seriously considered practice ownership?" If one considers that the AVMA boasts 100,000 members, let's say that 75% are in general practice. That would give us approximately 75,000 veterinarians in general practice. If just 10% are youthful associates who have considered practice ownership, that is a sizable population that we must encourage and support.

Here is my elevator speech to our future, the saviors of our soul:

• Talk to your accountant/financial adviser about practice ownership and its benefits for you.
• Talk to some practice owners, classmates and friends in practice about the benefits of practice ownership.
• If you work at a noncorporate practice, consult the owner about the possibility of buying in.
• Reach out to the "maturing" veterinarians in your town, in your county, in your state. Ask what their exit plan might be. Don't be shy. You might gain some new friends fast.
• Attend your local and state veterinary medical association meetings and spread the word that ownership is in your future planning.
• Don't forget the drug reps as a source for who is looking to sell. They know everyone.

When I finished 15 years of volunteer service on the AVMA House of Delegates and Board of Directors, I promised myself two projects on behalf of the profession: First, write an inspiring book for veterinarians of all ages. That was easy. Within a year, I scribbled down The Happy Veterinarian. Second, and a whole lot more difficult, start a nonprofit that serves to save the soul of veterinary medicine. I founded Veterinary Practice Transition in 2020.

The mission of the organization is to encourage younger veterinarians to consider practice ownership while providing the older generation an option for selling their practice. The nonprofit offers personal loans with low interest rates, a 10% reduction/discount in the sale price, and no commissions for either seller or buyer. The effort is a work in progress. I cannot succeed alone. The profession as a whole needs to address the impending doom.

In closing, let me return to my reunion. As my classmates of '77 gathered and regaled each other with tales of conquest, I saw the immense, reflected energy of careers that served them all so well, but even more, careers that served so many others with compassion and empathy. What I also observed were veterinarians who reached out as family and friend, fostering the trust that defines the soul of our profession.

Mark P. Helfat graduated from Cornell University College of Veterinary Medicine in 1977. He owns and practices at Larchmont Animal Hospital in Mt. Laurel, New Jersey. He has volunteered for veterinary organizations and institutions for most of his career (New Jersey Veterinary Medical Association, American Veterinary Medical Association, Cornell University College of Veterinary Medicine, Virginia-Maryland College of Veterinary Medicine). Mark and his wife, Mendy, commissioned the sculpture "Shilo" that howls on the Virginia-Maryland College of Veterinary Medicine campus. The couple share their home with four beagles and many cats.

Cheers to you Dr Helfat. Here's to the rest of us working so hard to preserve the many souls vetmed is built upon.

My Circus.... Not Always My Monkeys

There never is adequate seating, nor food, at these venues. Convention halls designed to cluster crowds, and starve you. Their bathrooms hold the same predicament. What they can do well is seat a football stadium of vets on metal folding chairs with towering 100 foot ceilings cocooned by cement erected from framed steel and sheet metal. Veterinary continuing education venues, what we call CE, are almost and without exception (save for the uber-exclusive Swiss chalet-ed "escape" venues no one I know can afford), are inhumanely impersonal, and disastrously like a teen-boy-band concert spread over 4 days. Straggling zombified bodies following a river-like funeral procession, snaking into-out-of-and-around a convection hall labyrinth of gauntleted vendors offering pens, stress balls and poop bags, to-from-and within the stomach of lecture rooms as boring as they are blue carpet and oversized light fixtures humming a electric static lullaby. For all licensed professionals in the medical field they are a necessary endeavor based on a solar calendar.

Saffie, our clinic cat. Midday naptime.
Her story; she had been returned for urinating outside of the litter box three times.
She has now found her home. She is also perfect now that she has us as her humans.

I pack a breakfast, water, coffee and spare square toilet paper bag, along with a spare phone charger, (it takes a blood hound to find an outlet in these places and you don't get reception anyway), and remind myself this is a necessary evil until my prince pays for that plane fare to the land where hot chocolate and banks add an 'e' at the end for that extra panache. And have I yet mentioned that they are also a freezing cold reminiscent of a basement meat locker?

Among the 5,000 fellow vets at this years annual CE event, I found two classmates from my vet school that long 18 years ago. They were best friends at school and not surprisingly, remain so to this day. One of them is a towering giant at over 6 feet. She was, and still is, easily recognized by her ability to be the only face in the crowd above the peppered-hair sea. The periscope face singularly visible anywhere within the swimming crowd. Alongside her was the girl I knew better. The more talkative of the two. The girl who I always personified as an Afghan dog, yet upright. She moved like a slender, Rapunzeled sloth. Slow, yet graceful, waves of long curled blonde hair willowing to and fro, and a look as if drawn to a far off light only she could see. She was sweet, always smiling, and as I will always remember her, had this impressively captivating way of standing in a necropsy lab of 20 or 30 of us listening to the professor drag on and on, answer a question you weren't sure was intended to be asked of the crowd, (always correctly I might add), and then seamlessly slip back into her upright slumber. We, like the geniuses our 20 year old mind were, had diagnosed her with narcolepsy long before she went off and had a single species biped label her. 

Willow,, the face of the Amish puppy mills. Disposable because not sell-able.
She has been adopted via a local rescue. (Have I begged you not to ever buy a pet yet?)

Their vet career paths have run in parallel to their personal lives. They married, had kids, and bought their practices separate and yet in tandem. They have what so many of the rest of us do not; a never ceasing sounding board, experience well, and partnership that is both envious and formidable.

We met over our provided venue boxed lunch. Mine of the vegan variety as it was both preference and provided the only guaranteed availability of anything outside my knapsack smuggle. We, like all old friends, picked right up where almost 20 years had left us. 

We had built lives over the amassed days. They families, and us; collectively three independent vet practices. Which based on the trends of the profession and the newbies of millennials swarming in our convention hall pool, was remarkable. 

Hamilton.
Paralyzed from the waist down,,
and yet remains always a glass half full kinda guy

We started there. The talk of owning our own practice. More intimate than how their children mirrored them was their description of the clinics that they had built. The details of how these buildings, and all of the personal detail it enveloped defined who we are, and had become. Small businesses, and I would nominate; especially those created for animals or children, are exactly like this. A vision that manifests out of passion and empathy. A lifetime of desire to help those without ability to construct independently, and love. We didn't talk about income, profit margins, or retirement/exit strategies, we talked about what that building meant to us in our life long dream of being a veterinarian. We talked about our practices as if they were our professionally status defining custom built luxury yachts. 

The flagship.
Jarrettsville Veterinary Center

I am 10 years older then they are. The prodigal girl who entered vet school a decade later than the rest of my class. The girl who took a 10 year detour into another profession before her compass called her back to where her heart lay. When you are 32 and the rest of your vet school class is 22 that decade delta has significance. I was, for those years at vet school, the older, seasoned classmate. Here cross-legged on the convention floor eating a veggie wrap, I remained such, although even these small differences were quickly fading into insignificance.

The engine. Our treatment and surgery area

"My best piece of advice?" they had asked...was to "be careful for what you wish for, and be ready to have your heart broken." We all want/need an extra vet, or two, (three for me, please), to fall out of the sky and into our laps, but, I paused,,, "no one will break your heart more in vet med than an associate." Eighteen years in, and 12 vets who have come and gone later, and yes, some of them have absolutely broken my heart. "And your staff, well, they can crush you just as hard." We are a profession based on emotional ties. You know your patients won't live forever, but, for some reason you expect your staff to be there always. You cannot build a house around a purpose, with a bleeding heart full of good intentions, and a desperate hope for it to survive both from and after you, without feeling hurt when those people you hand the keys to your yacht to, abandon it, and you,  to leave all of your passions afloat in an ocean of wet noses that need antibiotics and a list of clients trying to make same day appointments cause the ER's are full. 

my circus,,, not always my monkeys.

I wish us all well.

Seraphina.. because there is a heart and a soul,, she reminds me to treasure and protect both

For every journey there is a vessel to carry you. A crew to guide you, and an anchor to help weather the storms. Here is a small tribute to the people at JVC I call my anchors;

The heart of every institution is the crew that guides the way. To all of my peeps at JVC I am so proud of you, who you are, what you work so hard for, and for being as much the inspiration as the joy that makes it all possible. XOXO Krista

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Veterinarian, FT or PT

Jarrettsville Veterinary Center

 

Details

Posted: 04-Oct-22

Location: Jarrettsville, Maryland

Type: Full Time

Salary: Based on exp.

Categories:

Private Practice

Occupation:

Veterinarian

Species:

Canine

Feline

Salary Details:

We are open to discussing whatever you need.

Required Education:

DVM or equivalent

Additional Information:

2 openings available.

You will find loads of ads offering a myriad of shiny objects to lure you in. The quintessential bowerbird with the nest of flashy, shiny objects. Haven’t we all learned that the courtship only really counts when the days are long and daunting? Haven’t we all figured out that the relationships that matter are the ones built upon trials and trust? Let’s be honest, we all struggle. All of us on the floor, in the trenches, not the executives lurking from above, counting our collection of Brownie badges. 
The real-life vet life happens in the darkest corners of the most heartbreaking days with the cases we lose regardless of how hard the battle was fought. This is where you find yourself the hero of attempts and the victor of intentions that matter. Your greatest triumphs will find you in the most unlikely places and often with the cast of characters you spend your long hard days at work with. This is who we are; small, hometown vetlife America, still fighting for the underdogs of the lost, forgotten, overlooked and voiceless. The heart of vetmed. The general practice that James Herriot made famously spellbinding. I can pitch all the shiny bells and whistles. All the same the corp venture capitalists dangle, but the grit of our success lies in who we are while we struggle. We are a family built on the dreams of saving the lives of the four-legged cats and dogs of Northern Maryland. 
We are a 5 doctor, sa practice w/ amazing staff and never a case we will not help. If you want a shoulder to lean on, a team to support you, and an ever-abundant sleeve to wear your heart on then please consider us. We are looking for a veterinarian to join our purpose. Flexible schedule, you decide what works for you and we will make it happen. No non-competes, and a slew of never heard of before benefits the corp behemoths wouldn’t even conceive of offering. 
We offer a sign-on, relocation, health, 401k, CE, excursion, ownership, no on call, or after hours emergency, and support for whatever makes you you. Come visit, stay as long as you like. We are here for you as much as we are for our patients. 

DVM or equivalent

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About Jarrettsville Veterinary Center

We are a small animal private practice where compassion comes first. We are a safe and happy workplace where innovation, accessibility and empathy rise above all else. Tell us what you need to practice the medicine you have always dreamed of. We have an excellent benefits package, full transparency, flexible schedule, and excellent pay. Modern hospital with digital radiography, ultrasound, CO2 and cold laser, digital dental, behavior, acupuncture, Reiki, puppy socials, boarding, and an active supportive community that allows us to do things others think are impossible. For example, financial assistance for care, free boarding in inclement weather, adoption services for when clients can no longer care for their pets, or pass away, and a pet food pantry. We do not provide declaws, cosmetic surgeries, nor economic euthanasia. Think it isn't possible? Come visit and see for yourself. We are here to support you so you can care for our patients. Seeking big hearts and compassionate souls.

Want to know what the independent practice owner are up against? 

Listen to these podcasts;

Freakonomics. Should You Trust Private Equity To Take Care Of Your Dog?

Freakonomics. Do You Know Who Owns Your Vet?

and read about the flashy incentives being dangled in front of vets to try to find an available associate.

Want to know what I think? I think that if you go to a veterinary clinic you NEED to know who owns it? What their motive to be in this space is? And ask your vet if they took a sign on bonus? What has it cost them? What is it going to cost you? What about your pet? 

And when you can't get a life saving surgery, or emergency care done for less than $3,000 to $20,000 ask yourself if you are a part of the problem? If there weren't vets seeking only high ticket items, and clients (knowingly or not) patronizing these platforms (and lets talk about Chewy, online pharmacies and big box stores selling all sorts of pet stuff at below what we can get it for) then maybe your pets "replacement value" is the correct negotiating tool for pet care?

My parting words; Nothing in the history of veterinary medicine is going to claim more lives than corporate take over of vet care. (not any disease, natural disaster, etc. It will be at the hands of pet loving parents having to euthanize their treatable pet because corporate take overs have fixed the prices so high that almost no one can afford them. Talk about breaking a soul. Kill the light of someone's life.