Challenges for small animal medicine

I had the privilege of participating in the 26th Biennial Conference of the Caribbean Veterinary Association in Jamaica in November 2010. As a part of a very interesting and informative program, Dr. Steve Ettinger spoke on “Small Animal Medicine — Present Realities, Future Challenges.” He identified the following as concerns for the veterinary profession: commoditization of services, cost of care, the changing composition of the veterinary profession, student debt, and the rise of corporate veterinary medicine.

In a recent blog on commoditization, Ross Dawson remarked that “A commodity is quite simply a product or service for which the customer sees only one significant difference between what’s on offer: the price. The drive toward commoditization is perhaps the most powerful force in business today” (1). Dr. Ettinger noted that commoditization of veterinary services involves the offering of services by other groups and organizations, including big box stores.

Veterinary practices need to ensure that they have sound management, impressive appearance of clinics and hospitals, and more continuing education and training for all staff. Dr. Ettinger observed that the average number of active clients per full time DVM has been decreasing and the number of visits has been dropping. Especially in a downsized economy, people are going elsewhere such as online pharmacies for drugs and a variety of stores for pet foods. There are online organizations that ship medicines at reduced prices and send reminders to clients about the need for medication. Dr. Ettinger reminded the audience of a saying attributed to E.M. Statler of Statler hotel fame: “Life is service. The one who progresses is the one who gives his fellow human beings a little more, a little better service.”

The increasing cost of veterinary care was suggested to be a major concern for the veterinary profession. He wondered whether clients could continue to pay for veterinary service and he thinks that insurance services will be needed to help clients.

Dr. Ettinger highlighted several changes in the veterinary profession, such as the increased number of graduates, more specialization, and the switch to a predominantly female veterinary student body. He believes that the increasing numbers of graduates are attributable primarily to the need of veterinary colleges to generate more income in the face of declining state support. A higher percentage of graduates go on to achieve specialization: private practice grew by 20% whereas referral and specialty practice increased by 173% over the past few years.

The small number of men in the profession leads to the questions, “Why are there so many women veterinarians, and Why do men not want to become veterinarians today?” He referred to an article “Harvard Prof Wonders: Why Are There So Many Women Veterinarians?” in the January 4, 2010 Wall Street journal (2). In the article, Harvard economics professor Claudia Goldin suggested that part of the reason is that educated women are attracted to professions that provide flexibility, permitting a combination of career and family. She observed that 30 years ago only a very small percentage of veterinary graduates were women but today 77% of new veterinary graduates are women. She noted that 41% of young medical doctors are female but higher percentages of women are found in specialties such as public health, dermatology, and psychiatry, compared with specializations such as surgery and cardiology, which offer less flexibility in scheduling. In veterinary medicine, small animal clinics with minimal evening hours and no emergency hours have proliferated and allow for part-time and flexible work. Law, medicine and pharmacy have all seen an increase in female students but the shift has not been as dramatic as in veterinary medicine. Dr. Ettinger stated that, consistent with this desire for flexible, part-time work women veterinarians are less likely to become involved in management.

It seems to me that having a large number of women veterinarians with a desire for flexible part-time work has a number of positive features. Not the least of these is that it helps alleviate concerns about the increasing numbers of veterinary graduates.

Student debt is a major concern. That debt is increasing at a 60% higher rate than the rate for starting DVMs. He suggested that annual debt payments should not exceed 10% of annual income.

Dr. Ettinger remarked that corporate veterinary medicine constituted less than 8% of practices in the Untied States and that the trend was to buy existing practices rather than build new ones. He suggested that corporations did not “eat up” independents and that selling a practice to a corporation often made good economic sense.

These areas of concern are the ideas of a thoughtful leader of the profession and are worthy of the attention of individual veterinarians and our professional organizations.