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Does profit-making damage the veterinary profession’s reputation?

In this month’s blog, a former President of the British Small Animal Veterinary Association and the Veterinary Practice Management Association argues that practices should be more ‘business-minded’ when it comes to managing their resources.

John Sheridan, who is now a management and business consultant to the veterinary profession, argues that veterinary practices are over-reliant on generating profit from sales of medicines and that they should be seeking to make more from their professional services.

This is in line with one of the objectives identified during the first Vet Futures Group meeting in January 2015 which said that ‘practices should be less focussed on margins from medicine sales’.

John says: “My experience over the years as a management consultant to the profession indicates that the margin generated by the sales of medicines and other products after allowing for an appropriate share of establishment, overhead and staff costs is modest but certainly not excessive – whilst the margin generated by the sale of professional time and expertise hovers around nil and, in many practices, is negative.”

He says that, at a time of increasing competition and greater corporatisation, veterinary practices must be viable to thrive and points out that, based on available data, the amount of profit generated by independent practices is poor and declining in contrast to corporate groups.

While some independent practices may be concerned about their reputation and relationship with clients if they charge more for professional services, John argues that, with high trust levels in the profession (as demonstrated in our recent survey), vets should not be afraid of having a greater business focus – something he believes should be encouraged from vet school onwards.

“That reputation is our brand. It has been slowly built over many generations by veterinary surgeons and their practice teams up and down the country, every day of the week, dealing first hand with practical animal welfare challenges and delivering professional, caring and compassionate services for their owners.

“Will it continue? Of course it will – but only if veterinary practices continue to be viable businesses generating the revenue necessary to enable them to thrive, cover all their costs and, when judged appropriate by their owners, to offer professional services on a pro-bono basis for wild animals, stray animals and those belonging to individual owners in need,” adds John.

Overall, he argues that “better business is essential for the delivery of better medicine” as it allows for investment in facilities, equipment and skills.

In relation to John’s blog, this month’s poll asks ‘Can veterinary practice embrace the urgent need for better business skills without damaging its well-earned reputation as a compassionate profession primarily concerned with the welfare of the animals under its care?’

Last month’s poll looked at issues around the growth of palliative and hospice care in the veterinary profession and asked if this should become a standard part of practice. This was based on a blog written by former veterinary surgeon Kath Dyson arguing that additional expertise in end-of-life care could help the profession better provide lifelong care to their animal patients. A slim majority (56%) of the 193 people who took part in the poll argued that hospice care should not become a part of standard practice – 28% said it should, while 16% said they were not sure.

Does a business approach to veterinary practice management damage the profession’s reputation for care and compassion?

John Sheridan was President of the British Small Animal Veterinary Association (1974-1975) and first President of the Veterinary Practice Management Association (1993-1996).

The list of goals identified by the first Vet Futures Group meeting included an objective that ‘practice should be less focused on margins from medicine sales’.

To my knowledge this is a message that has been promoted by the profession for at least the last 40 years. Conventional wisdom suggests that, for too long, vets have relied on generating profit from the sale of medicines to sustain the viability of veterinary practice, because they have been fearful of charging properly for their professional services.

After all those years, what has changed?

Not a lot!

However practice owners measure the success of their own business (animal welfare, client satisfaction, client/patient database growth, stable motivated employees, market share, professional standards, personal income etc), each one of those ambitions depends on the ability of the business to generate a healthy return on investment for the owner/investor and sufficient profit to finance growth and continuing investment in practice resources.

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John Sheridan

The limited income and expenditure benchmark data relating to the independent veterinary practice sector in the UK suggests, however, that the median real profit (after owners’ remuneration) generated by independent veterinary practices is poor and declining (circa 7% or less), when many ‘corporate’ groups are seeking and achieving 18% or more.

My experience over the years as a management consultant to the profession indicates that the margin generated by the sale of medicines and other products after allowing for an appropriate share of establishment, overhead and staff costs is modest but certainly not excessive – whilst the margin generated by the sale of professional time and expertise hovers around nil and, in many practices, is negative.

The problem is not confined to the UK and recent studies such as the VetPartners/National Commission on Veterinary Economic Issues /Bayer Animal Health North America study in the United States found that:

  • There was a clear link between the use of a range of business practices with practice profitability
  • 61% of study practices generated poor or negative levels of profit
  • Veterinary practice profits were lower than six other professional groups
  • Veterinary earnings were lower than seven other professional groups
  • A steady decline in client/patient database per veterinarian
  • A steady decline in median number of transactions per veterinarian
  • Six key factors that limit client visits to veterinary practice – four of which are under vet control

I suspect that a comparable study in the UK would result in similar findings. All this at a time of major challenges for veterinary practice owners grappling with the impact of:

  • More vet schools
  • More graduates
  • More practices
  • More competition in a demanding marketplace
  • Declining footfall
  • Shrinking client database
  • Downward pressure on veterinary salaries
  • More regulation
  • Growth in the ‘corporate’ sector and decline in the proportion of independent practices
  • Declining profits, practice values and pension investment
  • Growing stress

The literature review conducted by the Vet Futures team (January 2015) highlights a number of these and other issues and points towards some of the ways in which better business skills can address them.

What is the risk to the reputation of veterinary practice?
One of the cultural shifts that is expected to shape consumer behaviour, and identified by the Vet Futures literature review, concerns the growth of ‘mindfulness and the importance of ethical responsibilities’.

The good news is that vets are amongst the most respected professions and that 86% of Britons surveyed had a ‘great deal’ or ‘fair amount’ of respect for vets (Angus Reid Public Opinion 2014). More recent data from an omnibus survey carried out by the Vet Futures team amongst the GB public showed that 94% of the population trust veterinary surgeons generally or completely.

That reputation is our brand. It has been slowly built over many generations by veterinary surgeons and their practice teams up and down the country, every day of the week, dealing first hand with practical animal welfare challenges and delivering professional, caring and compassionate services for their owners.

Will it continue? Of course it will – but only if veterinary practices continue to be viable businesses generating the revenue necessary to enable them to thrive, cover all their costs and, when judged appropriate by their owners, to offer professional services on a pro-bono basis for wild animals, stray animals and those belonging to individual owners in need.

Will it continue? Of course it will – but only if the vet schools, our regulatory and professional bodies and the leaders and members of the practising arm of our profession, acknowledge that business expertise is as important as professional skills in the provision of veterinary services in a demanding marketplace.

Inadequate information leads to poor decision making and our professional bodies are currently ill-equipped to support the commercial needs of their members in practice or respond to adverse reports in the media about practice profits, veterinary fees and so on.

A major problem for the associations that represent the interests of the practising arm of the veterinary profession is that they simply don’t have any/sufficient generic information about the economic health of the practices that are owned by their members or where their members are employed.

Only when that information is readily available will the profession be in a strong position, backed by the evidence to prove it, to promote the message that:

  • Better business is essential for the delivery of better medicine
  • Veterinary fees are costly – so they should be. It’s simply not possible to offer comprehensive professional veterinary services on the cheap
  • In well-managed practices, however, vet fees represent excellent value for money and the payback in healthy pet animals and livestock kept commercially is substantial
  • A business-like approach to practice management is not a question of feathering the veterinary nest but of providing the facilities, the equipment, the skills and the commitment necessary to deliver the standard of professional expertise demanded by animal owners and by the profession’s regulatory bodies.

John Sheridan was President of the British Small Animal Veterinary Association (1974-1975) and first President of the Veterinary Practice Management Association (1993-1996). He was joint founder of Veterinary Practice Initiatives, the first veterinary corporate consolidator in the UK, and was Chief Veterinary Officer from its launch in July 1998 until he retired from the company executive team in 2003. John Sheridan now offers part-time management consultancy to the veterinary profession. He has spoken widely on veterinary practice management issues in the UK and overseas for many years, publishes the VeterinaryBusiness.org practice management resource and presents a new episode of the Veterinary Business Video Show every two weeks.

Read more about John Sheridan →

The views expressed here are those of the author and do not necessarily reflect those of either the RCVS or the BVA.

94% of British public says “We trust you, you’re a vet”

A national opinion poll, commissioned by the Vet Futures project and carried out by ICM, of more than 2,000 members of the public has found that 94% of the general public trusts the veterinary profession generally or completely. This puts veterinary surgeons above GPs, dentists, and head teachers in terms of how well the key professions are trusted in Great Britain.

In a list of key professions the veterinary profession came third in terms of overall trust. Vets are just behind opticians, who attracted a 95% trust rating, and pharmacists, who took the top position with 97%.

The survey also found that 78% of people using veterinary services are satisfied or very satisfied with the level of service they receive. This puts veterinary surgeons in the middle of the field ranging from 87% of people satisfied with the service they receive from pharmacists to 55% satisfied with the service from accountants.

Finally, the survey found that 70% of those who use veterinary services rate the value for money offered by their veterinary practice as fair, good or excellent.

Commenting on the findings Stuart Reid, President of the RCVS, said: “Throughout the Vet Futures project we have been listening closely to the hopes and fears of the veterinary profession and heard a lot about how veterinary surgeons and nurses perceive themselves. To complete the picture, RCVS and BVA felt it was essential that we also gain a deeper understanding of how the general public perceives the veterinary profession.

“The results are extremely encouraging; particularly in relation to how well the public trusts members of the profession, including both animal owners and non-animal owners.

“But it is also clear that there is more to be done in relation to public perceptions of value for money. We will explore these issues further as the Vet Futures project progresses and we are keen to hear ideas from all members of the veterinary team.”

John Blackwell, President of BVA, added: “The veterinary profession sets itself very high standards and we know from our own member research that vets are particularly concerned, and sometimes worried, about how their clients – and wider society – perceive them. So it is particularly heartening to learn that the general public holds the profession in such high regard in relation to trust.

“Vets also score well in relation to the levels of satisfaction experienced by clients, and practices constantly strive to improve the service they deliver to their patients and animal owners.

“Through the Vet Futures project we hope to raise awareness of the very wide range of essential roles carried out by veterinary surgeons from clinical practice with livestock and pets to groundbreaking research, and from safeguarding the food we eat to upholding and promoting the very best animal welfare standards. Vets should be proud to be part of one of the most trusted professions in Britain.”

Guest blogger asks if palliative care will become mainstream in veterinary medicine

May’s topic of the month blog asks if, now that hospice and palliative care has become mainstream in human medicine, a similar development might be occurring in veterinary medicine.

Kath Dyson, a former veterinary surgeon who qualified from Glasgow in 1989, writes that veterinary palliative care, while a relatively recent phenomenon, has been growing in stature, particularly in the United States with symposia and conferences on the subject as well as webinars and chapters in text books.

Kath says that an increasing number of UK vets offer hospice care. However, she also notes differences between palliative services offered in human and veterinary medicine as well as debates within the profession over the advantages and disadvantages of palliative care versus euthanasia.

“In animal hospice it is the pet’s owner who takes on all the financial, practical and emotional costs involved, whereas human patients have a lot more support available. Euthanasia is always an option in veterinary medicine, and indeed euthanasia of an animal can legally be carried out by anyone, so long as it is done humanely,” she writes.

On the euthanasia debate she adds: “Some regard euthanasia as more of a last resort, with hospice assisted natural death being seen as more preferable and only a minority of patients requiring euthanasia. Others feel that euthanasia is more often likely to be the preferable outcome of a period of hospice care in the animal patient, even though they do not rule out a natural death.”

Overall she argues that additional expertise from veterinary surgeons in end of life care will help the profession be “even better able to provide truly lifelong care to all their animal patients”.

To accompany Kath Dyson’s article our poll this month asks if hospice care will become a standard part of practice.

Last month’s poll asked if vets are given adequate information, guidance and support on ethnic and cultural diversity in relation to a blog written by a British Asian vet about prejudice he encountered from a client.

The vast majority (90%) of the 118 people who responded to the poll thought that the profession was lacking in support when it came to diversity. Diversity in the profession and how to increase it has been a key topic identified by the project and it will be one of the issues addressed in our final report published later this year.

Is there enough guidance for the profession on ethnic and cultural diversity?

With the majority of veterinary surgeons and veterinary nurses coming from a white British background, this month we ask if there is enough information, guidance and support with regards to ethnic and cultural diversity in the veterinary profession.

In the first meeting of the Vet Futures Group, a consultative group which includes representatives from a range of veterinary and veterinary nursing organisations, encouraging greater diversity was identified as one of the priorities that the profession should aim to meet by 2030.

In this month’s blog the writer, who wishes to remain anonymous due to the sensitive nature of the subject, recounts his mainly positive experience of being one of the few vets from an ethnic minority background in a profession that is otherwise overwhelmingly white.

However, he also cites an occasion where he felt that a client was hostile to him on the basis of his ethnicity and he was not adequately supported by his practice. The position he found himself in damaged his confidence, affected him mentally, had a negative impact on his personal life and left him feeling isolated.

He writes: “I know we can’t change clients’ attitudes towards ethnicity and culture overnight but we must be united and an example of a forward-thinking profession to the public.

“For example, the NHS, dentists and lawyers all have committees, advice and guidance for colleagues in my position and I feel the veterinary profession should also go forward in this way.

“In my opinion there should be more education at undergraduate level which is supported with further guidance, training and support for qualified veterinary surgeons.”

He argues for ‘ethno-cultural empathy’ on the grounds that more tolerance and understanding between professional colleagues will help avoid bigotry and discrimination.

So, with this month’s poll we want to know if you feel that vets, vet nurses and other members of the practice team are given adequate information, guidance and support regarding ethnic and cultural diversity.

Last month’s poll asked if vets working in non-clinical settings were considered ‘second-class’. Over half of the 151 respondents (57%) did not agree.

We can’t change attitudes towards ethnicity and culture overnight but we must be united and forward thinking

Due to the sensitive nature of the topic the author wishes to remain anonymous. 

Ethnocultural empathy is an interesting term which I am sure many of you have not come across. By the end of this blog, one will hopefully understand why this term is important for the future of the veterinary profession. It all started with a personal situation I unfortunately had to deal with. I ended up feeling isolated and my professional integrity was damaged due to inaction, a lack of knowledge and support.

Being from an ethnic minority background, I am aware of differing attitudes to diversity in this country. I have experienced occasions where people have acted inappropriately towards me but thankfully this has been very uncommon. I chose to be a vet due to my love of animals and even though the profession is mainly made up of white middle class British graduates, I have rarely had a problem. The vets I have met and studied and worked with have been nothing less than amazing. The clients I have also encountered have occasionally had suspicions at the beginning but have been very welcoming and friendly. I always feared I would encounter a client who would dislike me purely for my ethnicity and unfortunately this fear was to become reality.

It was a Sunday on call when I got a phone call for a calving from one of our clients. As I was on my way, one of my bosses phoned me to say he had been rung directly and they wanted him instead. The client had refused to have me on his farm for no good reason and would rather have any other vet from my practice, even a new graduate who had just started. The farmer tried to prove his innocence to my boss but unfortunately this did not make sense. I had previously attended the farm for two successful calvings. The farmer had previously ignored me in front of my colleagues and acted rudely on other occasions towards me. It was suggested by one practice partner that the farmer may have some issues with my ethnicity.

When requesting help from my practice partners, I was not appropriately supported. It seemed that the requests of the client were more important than the issues I faced. I tried the Royal College of Veterinary Surgeons, British Veterinary Association and Veterinary Defence Society for advice but was again unsuccessful. Vetlife was very sympathetic but unfortunately none of the vets had any experience in this area.

It was agreed with my boss that I would not go back to the farm, after weeks of trying to get some support from my practice. This left me in a position of isolation and made me question my ability in farm animal practice. Mentally I was very affected and this adversely affected my personal life. It was after a few months, I decided to try again and raise this issue with the professional veterinary bodies to try to increase awareness and support thus preventing this situation adversely affecting other vets in the future.

Of those responding to the RCVS Survey of the Veterinary Profession 2014, only 3% identified themselves as from an ethnic minority. Also as of July 2014, out of 26,439 registered veterinary surgeons, 7,835 (approximately 30%) qualified from outside the UK, which leads to a large cultural mix. This will only increase in the coming years with the change in the population demographic and appeal of the profession in the UK. I know we can’t change clients’ attitudes towards ethnicity and culture overnight but we must be united and an example of a forward thinking profession to the public. For example, the NHS, dentists and lawyers all have committees, advice and guidance for colleagues in my position and I feel the veterinary profession should also go forward in this way. In my opinion there should be more education at undergraduate level which is supported with further guidance, training and support for qualified veterinary surgeons.

It is becoming clear that in order to build a profession that is successful at improving conditions and resolving problems, we need to understand and support the many cultures working in the veterinary profession. As educated members of any community, veterinary surgeons should be expected to exercise tolerance and understanding and to help avoid harmful bigotry and discrimination. This is where ethnocultural empathy, the understanding of feelings of individuals that are ethnically and/or culturally different from one’s self, is key to future progression.


The views expressed here are those of the author and do not necessarily reflect those of either the RCVS or the BVA.

Vet Futures roadshows – join the debate where you live

Vet Futures will be hitting the road over April, May and June with a series of regional events in which vets, veterinary nurses and other members of the practice team are encouraged to give their views about where the profession is heading.

The initiative, which is run jointly by the RCVS and the BVA, aims to help the profession prepare for and shape its future and we would like you to come along and share your hopes and fears for the future of the veterinary team.

There will be a total of six free events taking place across the country. These are:

  • Belfast, Dunadry Hotel, 16 April, 6.30pm – 10pm
  • Exeter, The Devon Hotel, 20 April, 6.30pm – 10pm
  • Cambridge, Menzies Cambridge Hotel and Golf Club, 21 April, 6.30pm – 10pm
  • Manchester, Novotel Manchester West, 18 May, 6.30pm – 10pm
  • Edinburgh, Scottish Parliament, 5 June, 8am – 10am
  • Swansea, Village Hotel, 17 June, 6.30pm – 10pm

If you attend the event you can hear about the latest Vet Futures research as well as having the opportunity to discuss your ambitions for the profession with colleagues from across your region.

All the events, with the exception of Edinburgh, start at 6.30pm with a buffet meal; the Edinburgh meeting includes breakfast. All the meetings are free to attend but please make sure to confirm attendance at least a week in advance for planning and security reasons.

Please make sure to visit our events page to register.

roadshow

Guest blogger asks if vets not working in clinical practice are viewed as ‘second class’ vets?

In this month’s Vet Futures guest blog Javier Dominguez Orive, the Food Standard’s Agency’s Veterinary Director and Head of Foodborne Diseases Control Unit, asks if veterinary surgeons working outside clinical practice are considered ‘second class’ vets by the rest of the profession.

To tie in with the blog, this month Vet Futures is asking members of the profession whether vets are considered to be ‘second class’ vets if they work outside of clinical practice.

Javier Dominguez Orive suggests that veterinary surgeons in the UK can add value to society by using their skills and knowledge in non-clinical work, such as in the food processing industry or for the Government working on food safety policy.

He writes that veterinary surgeons, for instance, are best placed with their understanding of animal physiology, health and production to help prevent and control diseases by maintaining high standards of food and animal safety.

He says, however, that vets in other regions of the world, such as continental Europe, the USA, South America and Australia, are valued and recognised more for their non-clinical work than vets in the UK. He says it is widely accepted and encouraged in these regions that many veterinary graduates will pursue a career outside of clinical practice.

“Are we preparing the next generation of vets for these possible roles? Or are we creating yet another generation of veterinary surgeons who won’t consider these careers because they will be viewed as ‘second class vets’?,” he asks.

This month’s poll asks: Would you agree that vets working in non-clinical roles are considered ‘second-class’ vets? We encourage members of the veterinary team and the public to take part in the poll so that we can generate debate on the issue of non-clinical veterinary careers.

February’s poll asked members of the profession whether they agree that VAT should no longer be levelled on vet fees? A majority – 62% of the 107 respondents – thought that VAT should no longer be levelled on vet fees. Leaving 38% or 41 respondents believing that VAT should still be charged on vet fees.

 

Should VAT on vet fees for pets be dropped?

Charging VAT on vet fees is a barrier to owners registering their pets with a veterinary surgery. This is the view of Stuart Winter, the Sunday Express small animal columnist and a campaigner to end VAT on pet fees.

This month we are asking you to consider whether VAT should be removed from vet fees. Owning a pet, argues Stuart Winter in our third guest blog, is not a luxury to be taxed when they need medical intervention but owning a companion improves the health and wellbeing of its owner.

Stuart Winter writes that removing VAT on vets’ fees for domestic animals, or at least reducing it to five pence in the pound, would improve the nation’s animal welfare. It would allow low-income families to seek medical attention earlier, he argues, while allowing more owners to afford and take out pet insurance.

He says that shifting Government thinking on the subject might be a Herculean task, but that doesn’t mean we shouldn’t campaign for its removal. “No Chancellor delights in losing revenue.  Treating, curing and caring for sick and injured animals is nothing more than a service and services are ripe to be harvested.

“It is time for a counter argument. Pet ownership is not a luxury. It is more than a privilege. Is it not a human right? Welcoming animals into our lives makes our lives more fulfilled and more civilised.”

This month’s poll asks: Would you agree that VAT should no longer be levelled on vet fees? We encourage members of the veterinary team and the public to take part in the poll so that we can generate debate on the issue of VAT and better understand the full consequences if it was removed.

NB the views expressed in the blog are Stuart’s own, and not necessarily those of the RCVS or the BVA.

Ambitions for the profession take shape after first Vet Futures Group meeting

Greater diversity, a truly integrated One Health approach and zero veterinary suicides were just some of ambitions for the profession discussed at the first meeting of the Vet Futures Group, which took place on 26 January 2015.

The first meeting of the Group included veterinary surgeons from a range of backgrounds, including small animal, equine and farm animal practice, food hygiene, research, education and industry, as well as members of the veterinary nursing profession and animal owner groups.

The purpose of the day was to discuss the first tranche of research carried out by the project team – based on interviews and focus groups with vets and vet nurses, BVA and RCVS Council members, animal owners and other users of veterinary services, and also a literature review.  This has provided a snapshot of the issues facing the profession in the UK today and what is known about their likely future impact.

The literature review identified possible drivers for change, including demographic factors; economic forces; the increasingly competitive market; client behaviour; food supply and global imperatives; and, mental wellbeing.

Both research reports are available in the Resources section.

The Vet Futures team challenged delegates to identify goals for the profession to achieve by 2030. Discussion was wide ranging, with suggestions including:

  • The veterinary profession providing a one-stop shop for all information, advice and support on animal welfare issues, and adapting the community care approach of human healthcare to animal welfare
  • A more structured profession with clearer entry requirements and career development opportunities
  • Vets and VNs active and effective in a wider range of activities
  • A ‘green’ profession
  • Less stress and improved work-life balance
  • Practice to be less focused on margins from medicines sales
  • A portfolio career to become the norm
  • Zero veterinary suicides
  • A valued role for the vet and VN in owner education
  • A truly integrated One Health approach with parity for the veterinary and human medical professions
  • Omnipotential not omnicompetence
  • The most trusted profession in the country
  • Playing a key role in food security
  • A significant improvement in the ‘if you had your time again, would you still be a vet/VN’ score on the RCVS Surveys of the Professions
  • Eradication of rabies
  • Greater diversity
  • Less anthropomorphism – treating as far as we should, not as far as we can

The two pieces of research discussed at the meeting, together with feedback from the delegates, will inform the next phase of the Vet Futures project, which will include a survey amongst BVA Voice of the Veterinary Profession Panel members, a larger survey amongst the whole of the veterinary and veterinary nursing profession, and a series of roadshow meetings across the UK.

The third and final phase of the project will be the development of a report and action plan to be launched towards the end of this year.

Resource Items