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Look at what we've done over the past 20-30 years
- Our team members have more schooling than ever before. Most of ours have associate or bachelor's degrees and/or technician/nursing credentials. They're fully dedicated to this profession, and it shows behind the scenes, not just in their more performative pet-kissing, client-pleasing behavior.
- The equipment is spectacular these days. Digital imaging, ultrasounds, echos, access to a CT on site, pathologists and radiologists that review images within an hour, minimum databases within 20 minutes, surgical tools unthinkable 30 years ago, and anesthetic monitoring that would knock their socks off, not to mention ready access to a full range of specialists within a 10-mile radius.
- Sure, we like more space. Don't you? More space means more comfort for the animals. We now have a separate cat hospitalization ward; a much larger, divided lobby for each species; and larger, glass-fronted runs for dogs. Moreover, a comfort room provides greater privacy during euthanasia, and more exam rooms means shorter wait times.
- The meds are better than ever. Just try and find itch- or pain-relief for yourself that rivals some of our canine contenders. Not to mention the efficacy of parasiticides, antiemetics, anesthetics, chemo drugs, and cardiac meds.
- You have access to pet insurance and pet payment plans nowadays. Back in the day, euthanasia was your only option. Now you have alternatives and resources for financing pet healthcare.
What's not to love?
The truth is there's plenty not to love. While some of us ardently believe the price-griping affordability problem is inherently and exclusively a client concern, I beg to differ. "Affordability" is not just a dirty word we've recently seen associated with the indolent and the irresponsible. This is a very real systemic issue we'd be stupid not to grapple with sooner rather than later.
Here's the biggest factor, as I see it:
Pet healthcare would cost a whole lot less without industry-wide consolidation. If we weren't paying corporate middle managers a collective mint for products and services, we'd have more food to put on our own employees' tables. Feeding them instead of my team's wouldn't hurt as much if I knew we weren't also stuffing corporate CEOs and private equity investors' garages with Ferraris on a surplus that could easily end all unnecessary shelter deaths in a day.
In fact, some of my more financially astute clients (including one a black-card-wielding top dog at a private equity firm) think private equity doesn't belong in healthcare at all. They're appalled at the perverse incentives it provides and how adversely it's affected healthcare writ large. They know it's skewed the money so that it disproportionately flows uphill. They're also astounded that standard anti-trust laws haven't blown the oligopolies to bits. Furthermore, since it's happened so quickly, there's almost no chance of un-boiling this particular frog.
What's that got to do with prices?
Explaining the effects of corporate practice ownership on prices isn't easy. For starters, private practice sellers (and their teams) don't have a financial or social incentive to disclose their sales. Why would we even broach the subject? Here's what we all deserve to know (bear with me, since I'm sure this will come as no shock to most of you):
- Our vet programs cost too much. Corporate forces and government cuts (corporate forces) have conspired to make veterinary medicine out of reach for all but the wealthiest or the least financially motivated true believers. However, as much pain it costs us as professionals, the cost of higher education is but a sliver of the source of our industry's price hikes and a mere straw man in this debate.
- Corporate practice investors have every incentive to keep prices as high as the market will bear, using any excuse (including the cost of higher education) to justify them. This is out of step with our profession's historical culture (the source of our once-higher level of respectability), as some of you will remember.
- Widespread and growing consolidation of vet practices comes with reduced competition, which leads to higher consumer prices.
- Extreme consolidation among our suppliers (labs, drugs, distributors, etc.) and vertical integration of corporate practices with these suppliers means disproportionately higher supplier prices than for our services, thereby limiting practice-level provider incomes while dramatically increasing the cost to the consumer.
- Our professional culture has changed. While it comes from a strong desire to practice highest quality care, the notion of a sliding scale of services has seen erosion in recent years—more so since the pandemic, I've noticed, where an almost adversarial team-client tone increasingly holds sway. That's the price and there's the door if you don't like it.
- Veterinary teams are holding their ground more firmly on policies, procedures, and prices. For example, sending a patient away with an untreated UTI because their people refused a culture. Adamantly refusing to perform routine dental cleanings without complete imaging. The list goes on; that's not cool, IMO, but it's who we're becoming.
You may disagree with my take. Yet many of you know in your hearts our policies and our prices are not easily defended to our clients—largely because they're not always defensible.
Sure, it's complex, multifactorial, and not any one individual's doing. I get this, but I absolutely believe it will be our profession's undoing. Moreover, it'll happen partly because we as veterinary professionals have all been at least a little guilty of willingly participating in the process.
That doesn't mean it has to last forever, right? There's still a non-zero chance we can re-imagine our profession so we can all get back to the practice of more honorably defending our prices.
Patty Khuly, VMD, MBA, runs a small animal practice in Miami and is available at drpattykhuly.com. Columnists' opinions do not necessarily reflect those of VPN Plus+.
