22 Aug 2015
The future can look like a scary place. A huge amount has been written in the veterinary press in the past few years, meetings have been held to look at the “challenges facing the profession” and the BVA and the RCVS have convened a working group called VetFutures to look at some of the issues. Lots of noise, but not a lot of light.
Some say the problem is work/life balance or financial viability while others ponder the rise of corporates or feminisation in the profession, not to mention the rising costs of providing good quality clinical or client care.
However, the point of this article is not to divine which of these issues is the most important, it’s about presenting a new model that could revolutionise the face of veterinary care and the way we work together.
The major issues facing our profession have been discussed and analysed many times. In addition to those already mentioned, we can add a few of our own; the need for business skills for vets, student debt, lack of leadership, excessive regulation and legislation, evidence-based veterinary medicine, competition from non-vets, online medicine retailers, mobile veterinary clinics, legions of unqualified internet experts, the rapidly-rising cost of offering a comprehensive service, rising client expectations… The list goes on.
No matter what you regard as the killer issue, there is a little-discussed model that has, in fact, been around for quite some time. It’s based on a fundamental economic concept: stick to what you do best. Why? Because that’s where you can not only be happiest and most fulfilled, but provide the best service, add the most value and, happily, make the most money.
For the purposes of our illustration, let’s accept that China produces fish cheaper and better than America. And that America produces beef cheaper than China. It makes sense for America to produce only beef and for China to produce only fish, and for the two to trade with each other.
However, let’s say China can produce both fish and beef cheaper than America. Its fish factories are the envy of the world in terms of productivity and cost control, while its beef is merely very good. America produces both, too, and is more efficient at beef farming than fish, but still not as good as China at either one.
In this new scenario, it still makes sense for China to stick to fish, but for it to allow America to produce beef. By sticking with what each does best, both countries benefit to the maximum degree. This theory isn’t new. It was first offered by Daniel Ricardo in 1817 – nearly 200 years ago.
Vets are trained to cure disease. It’s the “clinical curative model” of health care. We diagnose the problem in the individual animal, offer a range of treatment options to the client together with our advice, and then set about making the animal better. It’s all about disease prevention and cure. We don’t talk much about promoting health.
Of course, we also spend time talking about healthy diets, exercise, oral health and so on. In small animal practice, however, most of our time is spent preventing or curing disease. That’s where we get to use our diagnostic, therapeutic and surgical skills, that’s what our clients write us thank you letters about, and that’s largely where our revenues lie.
Very few people pay us for a weight clinic, puppy party or dental nurse visit – but they do pay a range of paraprofessionals for similar services. Just think of behaviour modification, obedience training or physiotherapy.
To compound our problems, we’re on an ever-rising escalator of technological advancement and the costs that go with it. The ultrasound machine we bought three years ago is no longer any good, our assistants tell us; we need a new one. Digital radiography is very convenient, but can we charge more per exposure? Laparoscopic spays are very snazzy, but once you factor in the cost of the equipment and training, the little bit more we can charge for these could make it a dubious investment. But we often feel we have to move with the times and be able to offer the full range of services to keep our clients and staff happy.
In essence, we look at the quality of care in terms of the depths of disease we’ve treated, not the heights of health we’ve promoted.
We all have parts of our job that we enjoy and other bits we’d rather avoid. In a practice with a few vets, it quickly becomes clear who likes the dentistry and who likes orthopaedic surgery, who likes consulting and who prefers to pour over the figures. That practice will, sensibly, play to its vets’ strengths and allow each one to do the parts they do best, even referring to each other internally. Just what Ricardo suggested 200 years ago.
If we take that up a level, this is what we see in the relationship between a main clinic and its satellite branches. The main centre may have a great ultrasound machine, blood machines and digital radiography while the branches are equipped to a more basic standard. The main centre is probably also the place where the more specialised vets work, able to take on ophthalmology or dermatology cases for the branches and then refer the cases back out again. This, too, makes sense, and is an extension of that same theory of competition.
So how do we apply that to what we’ve traditionally perceived as our competitor practices?
Fifty years ago, the thought of practices sharing out-of-hours work was anathema. Today, it’s commonplace. Practices can choose to work together to share the load and that’s not the only benefit: the nights that are on call are much busier than before, resulting in improved income. Everybody wins, including the client.
The relationship most practices have with their referral centres is another example of this idea – or a partial one. While practices routinely refer work “up” to the specialist centre, little or nothing is referred back “down”. For example, if you send a cat with a corneal laceration to the ophthalmologist and it turns out it needs enucleating, could the specialist not refer that case back down to you?
It’s possible to apply this dynamic more widely. A breeder could refer her puppies to a local vaccination clinic or small satellite branch of a larger practice. They do the vaccination, but send the puppies to a larger practice for x-rays when they’re lame. In turn, the larger practice sends its inoculations to the vaccination clinic or small satellite, and they refer clients who want to buy puppies back to the breeder. If the x-ray shows the puppy needs a pubic symphysiodesis, the dog will be referred to a specialist centre – and that specialist centre will send its routine lump removals to the referring practice, and its vaccines to the satellite branch. And everyone can direct potential owners back to the breeder.
If that sounds like an unachievable veterinary utopia, perhaps it is. But these principles are already being applied internally by some larger veterinary practices.
So, what’s to stop you working with your competitor? You could, for example, support their investment in an MRI unit and they could support you developing laparoscopic surgery. You both win.
Our model proposes enhancing how practices collaborate and integrate their services. It could be expanded to those outside the profession: suppliers, consultants and even clients could be involved.
By specialising in what each party does best, costs are reduced and financial viability is enhanced.
Those who do what they love doing have no problems with work/life balance – and working hours can be adjusted around a chosen specialisation or generalisation. This addresses the question of feminisation, too; hours can be adjusted around childcare, for example.
Corporates aren’t a threat here, they’re part of the solution in terms of focusing on their core strengths.
It’s also easier to develop business skills for a narrower range of services than for a much broader one, and allows those interested in business and management to focus on their core skill, too.
Non-veterinary competitors become part of the solution, sending work the profession’s way when appropriate and having work sent to them in turn.
Rising costs are controlled due to the same narrower focus, and evidence-based medicine is enhanced by sharing outcomes, via VetCompass or one of the other tools, with a group with similar interests.
Our utopia may be a long way off. But there are simple, practical steps that we can take right now to make our lives more professionally fulfilling, less stressful and more financially rewarding.
