Practice groups consisting of locally owned hospitals with a few satellite clinics have been around for a long time, and the larger ones may blur the lines with corporate practice, but I'm not talking about them today. What I'm talking about started in 1986 when Veterinary Centers of America (now Veterinary Clinics of America, or VCA) was founded in California and began buying private practices and practice groups across North America one by one. VCA now owns over 800 animal hospitals directly in 43 states and 5 provinces, and it operates another approximately 1000 (!) under it's Banfield brand name, which it acquired in a 2017 merger. VCA is a publicly traded company listed on the NASDAQ stock exchange (under the cloyingly cute stock symbol "woof"). Other corporations include National Veterinary Associates with over 400 clinics and Vet Strategy with close to 100 clinics.
Winnipeg is always the last place for any trend to hit. We were the last to get Starbucks, the last for the microbrewery revolution and we are the last major market to be targeted by corporate veterinary medicine. Up until very recently all the practices in Winnipeg were locally and privately owned. Then two years ago a large corporation began to buy clinics, owning four now and with a rumoured fifth deal in the works.
Change can be good, change can be bad and change can just be change. On the good side corporations bring deep pockets to the profession that make it easier to upgrade to the newest technology and to present sparkling, professionally decorated practices, but with ample respect and affection for my colleagues who now work for corporate, I am going to argue that this particular change is on balance bad for the profession.
The fundamental problem is that large corporations solely exist to make money. Of course small private practices also have to make money, but the difference is that if my clinic has a bad year financially we tell ourselves that it was bad luck, or the weather, or the economy and we'll hope for a better year next year. We only answer to ourselves, not to shareholders or investors. In contrast, if revenue drops in a corporate practice, management from Los Angeles or Toronto or wherever will put pressure on the veterinarians they employ to meet quotas, or else. Some corporations track remarkably specific metrics. For example, in the US one looks at the number of xrays a veterinarian should take relative to the amount of respiratory disease they see. The corporations do not dictate the management of specific cases - that would actually be illegal - but they will set general benchmarks for numbers of specific tests and procedures and they certainly make specific financial goals clear to their employees. On one hand more tests can be "good medicine" and, as in the above example, it can be hard to argue against precautionary "just in case" xrays for a cough, but on the other hand this does diminish your pet's doctor's freedom to use their professional judgment and make sensible decisions without having to worry about what management is going to say about their numbers at the end of the quarter.
Another problem is vertical integration. Mars Corporation has recently bought a controlling interest in VCA. Mars is massive. It had $33 billion in sales in 2015, and only a fraction of that was chocolate bars. It is now the world's largest provider of pet health products and services. In addition to VCA it owns Royal Canin food, with their prescription diet line, and a whole series of non-prescription pet food brands, such as Pedigree, Whiskas, Eukanuba, IAMS, Nutro and more. It also owns the largest chain of veterinary specialty and emergency centers, the second largest veterinary laboratory company, one of the largest veterinary ultrasound companies, and the number one canine DNA analysis company. Oh, and a chain of 130 boarding and doggie daycare facilities. All that's missing from their portfolio is a pharmaceutical company. The fear here is that veterinarians will be increasingly required to use only the products and services under the same corporate umbrella rather than picking and choosing from all the options based on their professional judgment of their patient's needs. I mostly love Royal Canin foods, but only mostly. I would not tolerate being told that that is the only prescription diet I can offer my patients.
At the end of the day the important relationship is the one between you and your pet and your veterinarian. Who your veterinarian works for is hopefully not all that relevant most of the time. It's just sad for us within the profession to see the freedom and independence we enjoyed gradually be eroded. And it's sad to think about the coming generations of veterinarians who will have less opportunity to enjoy the sense of pride that comes with owning your own practice and making all your own decisions.
Postscript:
Since posting this I have been asked how these corporations have been able to buy clinics. There must be willing sellers. Of course there are. I should explain this and introduce some balance to this story. The large veterinary corporations can offer older veterinarians a relatively straight-forward way to ease into retirement. Moreover, they are able to make these offers very generous. I am fortunate in that I have younger veterinarians working for me who are keen and financially able to buy into the practice, so when my time comes I will be able to sell to them without any trouble. This is not the case in every practice. Sometimes willing buyers are just not that easy to find. Sometimes junior veterinarians prefer to not to take on the responsibilities of ownership and management. Corporate practice therefore fills a previously unmet need and some of my colleagues are grateful for that. And as much as I might personally wish it to be otherwise, veterinary medicine is ultimately not immune to the laws of economics.
