Originally published in the March 2015 issue of Veterinary Practice News? Not a subscriber? Subscribe today!
I became a practice owner last October.
As I’ve confessed on this back page before, I came to this decision only reluctantly, knowing as I did that practice ownership would demand a considerable lifestyle change –– temporarily, at least.
Several months in I’m finally starting to feel the ground back under my feet. That’s in no small part because I made the considered decision to take on my practice manager as a business partner.
After all the you-this-me-that back-and-forthing and the stressful sign-on-the-dotted line, not to mention the drain on every last bit of financial reserve I held dear, I can finally say it’s the one decision that's kept me halfway sane over the past 10 months.
Indeed, her unwavering awesomeness probably explains why I did a double-take when at a recent party a colleague inquired whether I had concerns about “getting into bed” with a non-veterinarian.
I could have done without the unwelcome insinuation that there’s something dirty about co-owning a practice with someone who doesn’t possess a veterinary degree. But what really impressed me was that the legality or ethics of such a wholesome arrangement should merit collegial concern –– especially in this day and age of corporate practices and other far more questionable veterinary business structures.
At the time, I wondered (all the while restraining my tongue firmly) why anyone would question a practice manager’s financial stake in a veterinary practice. What’s so magical about a veterinary degree that renders its bearer inherently more capable of carrying our profession’s torch?
But as I later considered under less exasperated circumstances, maybe that liberal perception simply reflects my own prejudice as a Floridian. After all, here in Florida we’ve never placed any restrictions on who can own a practice.
What’s more, I further mused, my experience as an employee of several non-veterinarian-owned practices would seem to support the bias against them. (Oh, the ironies!)
Though I’ve been stably employed at my current practice for almost 16 years, I’ve held other veterinary positions before and since.
Among these, I can count three corporate practices (including two of the biggest), places where veterinary ownership is far more of a flimsily held concept than a palpable reality. I’ve also been employed as the medical director of a fully non-veterinarian-owned practice, a practice structure that isn’t legal except in a handful of other states.
As such, I believe I can say I’ve had plenty of experience working for practices that are either explicitly non-veterinarian-owned or implicitly so –– much of it negative. In fact, at all but one out of four of these hospitals I felt that financial gain, not scientific evidence, was at the core of any medical controversies (and there were many).
By contrast, I’d be hard pressed to recall any significant medical disagreements at practices where veterinarians ran the show. Individual practitioner discretion has always seemed the default setting at veterinarian-owned practices in my past.
With all this reverse-nostalgia in evidence, you’d think I might be re-thinking my liberal stance with respect to practice ownership. Though she could have chosen a nicer way to say so, perhaps the colleague who raised this issue should be forgiven for her candor after all?
Hmmm … not so fast.
When I finally stopped to investigate this issue further, I headed first to the source, the practice acts for each state and the section that addresses the question: “Are non-veterinarians allowed to own practices?”
Ever the Floridian, I was surprised to learn that “no” was the most common answer. But those big corporations own practices in almost all states. How is that possible?
Turns out that in some states minority ownership is allowed. In these cases up to 49 percent of a practice can be owned by non-veterinarians. But even in states where minority stakes by non-vets aren’t deemed acceptable, non-vet individuals and corporations can own practices if they make special arrangements to own the administrative portion of the business alone.
Theoretically, this means the ownership of the practice is divided so that the veterinary decision-making component of the enterprise is left up to the veterinarians and the administrative stuff to the administrators.
But as anyone who’s worked at any sort of professional service establishment can attest, the dividing line between “administrative” and “professional” is always gradual and way blurry. Hence, how “practice protocols” at human and animal hospitals can supersede even the most basic tenets of evidence-based medicine when it’s in the administrator’s financial best interest to do so.
No, you don’t have to look too far to find examples where administrators and veterinarians got into it over what’s best for patients. And, despite what the practice acts may say, veterinarian say-so doesn’t typically win out over corporate protocol when profitability is factored into the mix.
But corporate medicine is beside the point, you say. At issue is the fundamental principle of professional integrity.
I can understand the rationale that prohibiting non-veterinary ownership of veterinary practices helps protect our independent judgment and keeps the corporate cogs from exerting any undue influence over our practice standards and professional mores. But after looking further into this issue, I’d argue vehemently that it has done no such thing.
In fact, it seems to me that all our efforts at regulating who gets to own practices have all but backfired on us. Instead of keeping those who care more about profits than animals from influencing our care, it has codified a system whereby those who have the resources to manage our legal machinery can do so.
Sadly, this system is also made for an additional unintended consequence: It has given these well-heeled corporate players a big leg up against people just like my practice manager.
In another state, I couldn’t have sought the partnership of a non-vet and, consequently, might’ve bowed out of a purchase. In that event, a corporate sell-out would have been the most viable alternative for its former owners.
So much for free and fair competition.
So much for offering those who’ve long labored in our profession a a fair slice of what they’ve poured their souls into. So much for our professional integrity. So much for those who really care about patients.
It’s time, I’d argue, for broadening our traditional ways of thinking when it comes to non-veterinarian practice ownership.
It’s time we realized that much of what our intransigence and protectionism on this issue have garnered us comes down to less financial flexibility for owners, buyers and inheritors, fewer independently owned veterinary practices, less innovation in practice, a narrower selection of services for pet owners, less upward mobility for our key employees and a lower level of job satisfaction for us all.
Given the alternatives, I’ll happily cuddle up with my practice manager, thank you very much. It’s one time I can honestly say I’m proud to live in Florida!