Every once in a while (OK so more often, recently) I like to write about veterinarians in my specific employment circumstance. That is, I get a hankering for telling stories out of school on the realities of working for a practice I don’t own. But it’s not always all about me. To that end, here’s a post with larger patient care concerns in mind. Read on…
Increasingly, vets are graduating from school with a clear understanding that they’ll never own a practice…primarily because they reason, who would want to?
Veterinarians of years past rarely questioned this too much. They assumed that if they were going to practice veterinary medicine they were damn well going to make sure they could do so on their terms with the maximum financial benefits their education could confer. I other words, veterinary graduates who planned to practice almost uniformly planned on owning their own place, too.
Not so nowadays. Ask your average senior vet year student about practice ownership and the answer is often equivocal, at best. (We’ve talked before about the reason behind this so I won’t get too technical today about what’s behind this trend but you can go read about it here if you’re interested.)
But how does having an associate (employee) vet treat your pets for the entirety of his or her career affect the way veterinary medicine is practiced? After all, employee-driven veterinary medicine represents a potentially dramatic shift in the way your pets receive their veterinary services.
…or does it?
Here are some emerging truisms that apply to associate vs. pracice-owning vet-dom for your consideration:
1-Associate vets work fewer hours and enjoy more flexible schedules than their hospital-owning colleagues. Our overall work life stress tends to be less than that of our employers.
2-Armed with a better sense of ourselves as permament “free agents,” we tend to hop from hospital to hospital more often than associates did in the past…when we were more likely to be making employment decisions and selecting workplaces based on buy-in potential or future ownership.
3-Associate vets experience greater frustration at being unable to control certain aspects of our work life, particularly when it comes to quality of patient care and staff management (generally considered the two most critical elements to our job satisfaction levels, discounting the issues of free time and compensation). Practice owners enjoy more of the simple satisfactions that come with greater control over one’s immediate environment.
4-Employee vets are, on average, less financially stable than their practice-owning counterparts. We know what the trade-off is and we accept it. But that doesn’t mean we don’t experience the stress that accompanies the long-term financial aspects of associate-ship.
5-Associates have the luxury of directing our continuing education efforts more completely towards medicine relative to practice owners. We also tend to have more time to digest journals and generally focus our professional selves on the science and practice of veterinary medicine instead of the time-consuming managerial side of practice life.
6-Practice owners are in a better position to take a more holistic view of veterinary medicine. It’s not just the medicine, the clients and the animals that drive them. It’s the bigger issues of economic forces and government policy that also stimulate curiosity and build interest in their profession as a whole.
Having made these black and white distinctions in a decidedly gray world, it bears mentioning that vets do run the gamut. For example, there’s no doubt this employee vet-author is drawn to the big-picture dynamics of the profession. As for free-time to read my journals…yeah, that happens when the stack builds up and I have to run through them all with a highlighter on one Sunday afternoon a month. And you never know…there’s no law that says a career associate might no change her mind someday.
In general, however, these six points do draw a broadly recognizable line between these two kinds of vets. But the question is not how such differences affect the individuals. The key is to attempt to project them onto the wider screen of the entire profession…and to its holy grail: patient care in general.
Your thoughts?
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One thing that comes to mind... While common sense would suggest that an employee vet would have less investment in customer care, there is at least one thing going for them. Salary employees are less likely to decrease care or commit fraud based upon the business' bottom line during tough times.
In other industries, people on salary RARELY cook the books or do under handed things like swapping out the expensive booze for the cheap stuff. Those things are mostly done by those seeking "maximum financial benefits" i.e. the owner/managers instead of employees who aren't likely to exact direct benefit.
Salary employees who are more mobile are also more likely to be canned if they're crap. If you own the place and are your own boss, this isn't as apparent.
Also, in sports, players who are up for free agency (instead of in the early part of a long contract) also perform better. So in that sense, mobility is better despite losing touch with patients who don't or can't move with you.
Christopher Landauer November 19th, 2008 02:56:21 PM
Christopher: Interesting final point. On the others, check out my post on how vets are paid.
Dr. Patty Khuly November 19th, 2008 03:58:28 PM
Gosh, this one is a toughy for me. And at first glance, I would agree with Christopher's statements...but I have found that not to be the case. I have gone to two owner-practioners and two employee vets. Actually, I found both owner-vets to be concerned with client satisfaction, both availing themselves beyond work hours, not rushing through appointments, and perhaps a bit more personable to outside human issues. They have a stake in that the clinic runs well all the way around. I guess I can't make generalities here, because on the flip side, if a "crappy owner" is running the clinic, employees are likely to get the same "I-don't-care" attitude, anything goes. Or even worse, be dictated to "that is part of the job". Personal ethics, skill, and personality are either there or not, regardless of position.
Barbara "Pocket's Story from NH" November 19th, 2008 06:38:12 PM
As a pre-vet student (who just got word of an interview for vet school yesterday) currently I plan to enroll in a DVM/MBA joint degree program (ala CSU, A&M, etc). Meaning that I do hope to own my own practice some day. The only thing that bothers me, and you touched on this, is the litigious side (keeping all the law changes straight).
It seems the general trend over the years, and this may be just me paying more attention to it over the years, is to have one 'lead' vet (the owner of the clinic) who has 2 or 3 vets working under them versus the one vet - one practice mentality of yesteryear.
Personally this seems like a much better system. Not near as much competition and if you don't want to deal with the overhead, you don't have to. But if you want to increase your income or just do things 'your way' then you've that option too.
Do you know anything about how much a practice owner makes versus those they employee? Have there been many studies into that? I know that counting the money at the practice I worked for that we'd make a few thousand every day, but I'm not sure of the distribution of that money. We had three vets (two asociates and the owner) to pay as well as the various diagnostic machines/medicine/other expenses.
Aaron November 19th, 2008 07:15:11 PM
Regarding the free agency bit, though.. if you're the practice owner, I would think that you would have more incentive to perform because you're the one who sets the tone for the place, and you're the one who ultimately stands to lose everything if the practice isn't successful.
Ramen Connoisseur November 20th, 2008 12:52:26 AM
Aaron: Welcome to the DVM/MBA club! (Though I'm a VMD/MBA--I did the dual-degree program at Penn/Wharton). Interestingly, I never thought I'd ever enter practice at all, much less own a practice. My plans were consulting/pharmaceutical/agribusiness oriented. So much for plans...pregnancy took care of that one in my case (and veterinary practice has been much more rewarding than I ever expected it to be). OK, 'nuff personal disclosure.
On the stats: They're out there. I think they were published in DVM Newsmagazine earlier this year. Check out dvm360.com for this info. I'll try to hunt it down if I get a little more time later on today.
Dr. Patty Khuly November 20th, 2008 08:17:00 AM
from my experience as a pet owner, i think one drawback of the rise of the "permanent free agent" vet is that it makes it harder to develop a long-term relationship w/ a vet. (yes, sometimes people can follow their vet to a new practice, but it's not always so simple for various reasons i won't go into here.)
but i hasten to add that this is not meant as a criticism of those who choose this path--it's what i would do too. it's just frustrating that long-term continuity of care isn't as easy to achieve as it should be. come to think of it, it's probably even worse for human healthcare, sigh...
sooj November 20th, 2008 07:57:30 PM
Barbara -
I don't disagree with anything you said. In fact, my experience mimics yours. My chosen vet is a second generation family owned practice. And I have certainly experienced the "go out of their way" effort that isn't likely to come from someone you've just met. My vet actually cried when I put my dog down and that's exactly the thing I wanted... when it came time to put down the previous dog, I hadn't been to a vet in years and when it came time to put Jack down, I cried all the way to the Humane Society and was told that I couldn't stay for the proceedure. I wasn't exactly in the right frame of mind to load Jack back into the car and go searching for a vet who would let me stay. And I regret that. I wanted to be there and I didn't realize how much until I had all day to think "has it happened yet?"
It also helps with vet conflicts when you already have a relationship. I brought a dog in for limping, vet missed the thorn buried in the paw, I found it a day later and when I came back in I got charged for a second exam. It was probably an oversite... routine billing practice, but when I brought it up (why should I pay for a second inspection in 2 days when the first one was a failure and the second was unnecessary?) charges gone.
And the social pressure goes both ways. My mom sees the senior vet's wife socially, and so I keep up on being a good dog owner because lapses on my part lead to potential embarasement.
My points before were just that... points to add to one column. I don't think I said that they outweighed anything else.
No matter how your vet gets paid, I think the wise thing to do is remind them how much your dog means to you and get them to commit to doing their best. I've noticed that people who plead with me to be extra careful, get me to be extra careful. So when one of my dogs go under the knife, I always get the vet to promise to not screw up. Although it's a little bit pedantic and awkward, I'd rather be those things than have a dead dog.
Christopher Landauer November 20th, 2008 11:49:04 PM
Re "Although it's a little bit pedantic and awkward, I'd rather be those things than have a dead dog."
<p>
Christopher, thanks for saying you do that. Even after what I've been through, I still feel weird asking my vet to be extra careful (after all, this particular vet has never screwed up and if I'd never moved from Virginia where she was our vet and subsequently switched, the bad thing would never have happened, I know that for a fact). But I've also learned that it doesn't hurt to remind them you want all precautions taken, and I really can't help but display my level of concern and nervousness especially when my pets are going under. I worry that it might cost me in terms of them "liking" me but as you pretty much said, I'd rather have them find me annoying but take that extra precaution, than swallow my words and later half to worry "IF ONLY I'd said something MAYBE they would have been more careful . . ." In this life we worry too much about people liking us and we only realize what it costs us later.
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