Originally published in the December 2015 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today! In today’s environment of ever-larger veterinary practices, corporate ownership and increasing levels of specialization, the idea that a rewarding and progressive practice can be conducted on a far smaller scale may seem antithetical to some. However, in spite of similar trends, small practices are something of the norm in equine medicine. According to a 2011 American Association of Equine Practitioners membership survey, approximately 40 percent of equine veterinarians practice alone and 24 percent with one or two other practitioners. And there’s no reason to think that the pattern couldn’t spread to small animal medicine as well. While larger, more lavishly equipped practices can provide services that are beyond the reach of many solo practitioners, ambulatory practice offers unique advantages. Mobile practitioners are uniquely positioned to thrive in a competitive economic environment and provide personalized, caring service in a way that large practices cannot. Advantages of a Mobile Veterinary Practice Ambulatory practice affords veterinarians the autonomy to practice medicine as they see fit. Solo practitioners can make their own rules and work independent of supervision. There are no managing veterinarians or owners to persuade, no partners to convince, no convincing superiors to buy into new choices or directions. There is a sense of ownership that may be impossible to develop in a group practice. Staffing flexibility is another advantage of small practice. Employees may be full- or part-time, or one can choose to have no employees at all. In an intimate small-practice setting, employees may take a more personal interest in the business since a good deal of the responsibility for its success falls on them. The fact that there’s no set daily schedule is a very appealing aspect of mobile practice. It is often possible to take children to work, affording them the opportunity to see their parent in action as she takes care of important responsibilities and, in so doing, teaches valuable lessons about compassion and communication. In ambulatory practice, patient scheduling is largely under the control of the practitioner. One final advantage of small practices is they tend to produce strong doctor-client bonds. Being appreciated for the medicine one practices is an emotional bonus that is earned from consistent, caring interactions with clients. Emotional satisfaction with practice is one of the keys to avoiding burnout. Emotional satisfaction helps in coping with practice demands and pressures and directly influences one’s general psychological well-being. Ambulatory practitioners are the equivalent of family practice doctors, and, over time, may be able help their clients through a variety of emotionally taxing situations (sometimes including those not involving animals). Many clients want a sense that they have a personal veterinarian. They want to see their doctor. In mobile practice, the doctor they call is the one they get. As such, over years, clients can become friends, and their animals can become familiar companions. What are the Disadvantages? One major issue disadvantage of ambulatory practice is call coverage when one decides to take time off. Happily, particularly in small animal practice, the existence of emergency clinics helps obviate some of these problems. Still, in mobile practice, one must be more or less constantly available. This may be comforting to clients, but it can be draining to some practitioners, who may find that trying to take a weekend off is stressful or that even a modest vacation requires significant concessions. Of course, days off come at the expense of no pay. This is not unique to veterinary practice, of course; the opportunity cost of time spent away from one’s business is significant for everyone who is self-employed. The perceived expense of opening an ambulatory practice may be daunting to some. However, careful planning can help with decisions such as purchasing equipment, setting fees, managing accounts and controlling inventory. Maintaining an ambulatory practice need not be expensive, and practicing high-quality medicine in an ambulatory setting is a very achievable goal. Small-practice veterinarians lack advantages offered by internal economies of scale. In ordering drugs, supplies and equipment, large veterinary practices may take advantage of decreased cost per unit of product ordered. However, the cost savings offered to larger practices can be somewhat offset if ambulatory practitioners keep inventory to a minimum. Of course, offsetting this is the fact that ambulatory practitioners generally do not have the considerable overhead costs carried by larger practices. Billing and collections offer significant challenges for mobile practitioners. Fixed costs such as rent, accounting, computers and billing systems can be difficult for solo practitioners to maintain, particularly when clients may have priorities besides paying their veterinarian. Larger practices, with sophisticated billing systems and full-time personnel dedicated to financial management, may offer a comforting alternative to having to make sure the bills are both collected and paid. One other issue that may dissuade veterinarians from ambulatory practice is the perceived professional isolation. When in veterinary school or in a large practice setting, veterinarians are essentially always surrounded by eager students, colleagues in residency training and older practitioners with a wealth of experience. Journal clubs, conferences and patient rounds provide ample opportunities for bouncing questions off of peers. This is not just a theoretical problem; studies in human medicine have shown that solo and nonurban practice, failing to belong to a professional group and aging are all associated with underperformance and may also be indicators of professional isolation. While cutting oneself off from the intellectual support of colleagues may increase professional isolation, many of the advantages of ambulatory practice may be significant enough to make taking the chance worthwhile. Conclusions Mobile practices allow one to practice high-quality medicine and surgery without the overhead and expense of a large clinic, and on a personal level that may not be available in larger practices. Ambulatory practitioners certainly face challenges, but they also have opportunities to establish and secure a good future. What to Carry in Your Ambulatory Veterinary Practice Some equipment and supplies commonly used in equine ambulatory practice: Mobile communications device Mobile printer Vaccines Anthelmintic agents Sedatives Local anesthetics Short-term general anesthetics (e.g., ketamine hydrochloride) Antibiotics (systemic, topical, ophthalmic) Nonsteroidal anti-inflammatory drugs Corticosteroids Bandage materials Suture materials Surgical packs Emasculator (for castration) Syringes and needles (various) Radiographic equipment Ultrasound equipment Ophthalmic equipment (e.g., light source and transilluminator) Rectal sleeves Water soluble lubricant Light mineral oil Disinfectant soaps or solutions Isopropyl alcohol Stethoscope Digital rectal thermometer Laboratory supplies (blood tubes, culture swabs, glass slides, etc.) Nasogastric tubes (assorted sizes) Pump for delivery of oral medications Intravenous fluid bags and associated equipment (e.g., catheters and extension sets) Hoof equipment (shoe pullers, hoof nippers, hoof knife, hoof testers) References St. George, IM. Professional isolation and performance assessment in New Zealand.J ContinEduc Health Prof 2006; 26(3):216-221.
