“Please don’t be a terminal illness, please don’t be a terminal illness,” I thought over and over. Across the phone, my friend’s voice started to crack. I could tell he had been winding up to deliver some heavy news. He started by apologizing for seeming a bit withdrawn recently and then explained he had been working through something for the past few months. I heard his wife in the background encouraging him to say the words. Finally, he blurted it out. “Last month, I … I sold my practice to corporate.”
“It seems you feel really guilty about this,” I told him. In the background, his wife shouted, “He does!”
I’ve never been a priest or even Catholic, but as I later put down my phone, I thought I knew how sitting in a confessional booth feels.
Viva la Resistance!
The next day, I pondered my friend’s feelings as I scrolled through Instagram. I came upon a female practice owner talking passionately into her phone from the front seat of her pickup truck. “If you are a veterinary practice owner who sold your practice to a corporate, you should be ashamed!” she said.
As I watched her intensity increase over the course of the video, I couldn’t help but remember the freedom-fighter videos I saw on the TV news during my childhood. Yes, she was sitting in a pickup truck with a stethoscope instead of inside a bunker with a rifle, but her defiant (and almost desperate) tone felt the same. I understood then why my friend, the former practice owner, might feel like he let people down.
How Change Happens
When I was looking for my first job in 2007, Banfield had several hundred hospitals and had just been acquired by Mars Inc. Banfield’s growth had bothered a lot of people in veterinary medicine, and the concern was that “cookbook medicine in big-box retail stores” would destroy us all. My friends and I listened to the rumors and looked down our noses at those who considered taking a job there.
Then, something fascinating happened. My class graduated in 2008, right into a recession. Jobs were not guaranteed, especially if you wanted to work in a particular geographic location. Suddenly, all my classmates had friends working at Banfield. Do you know how it went? Just fine.
The kind, caring, hardworking people we went to school with were still the same people. Many liked their jobs, while others didn’t (just like at independent practices). Some enjoyed the structure they found at Banfield, while others chafed and longed for a bit more chaos. We saw each other at conferences and kept up on social media. Some of my friends went to Banfield as a first job and have stayed. (They strongly oppose the idea that their medicine is “cookbook.”)
As time passed, the initial fears that “cookbook medicine in big-box retail stores” would destroy veterinary medicine were replaced by fears of too many veterinarians — remember that? — and “vaccine trucks doing medicine in parking lots.” And so on.
The idea of veterinarians declining to take on-call responsibilities was controversial at one time. Similarly, the entry of women into veterinary medicine once caused quite a stir. While initially shocking and unsettling to many, those developments eventually became the norm and are now recognized as beneficial. That is how change typically unfolds.
In every innovation cycle, an initial wave of fear slowly subsides as familiarity takes hold. We have repeatedly seen the pattern since the beginning of our profession. We are going through it now with corporation-owned clinics.
Where the Guilt Comes From
When I asked my friend who sold his practice how the transition was going, he replied, “Great.” The purchasing group had a good plan for communicating the company’s goals, values, employee support and so on to the team. My friend stayed on as the medical director, and the experience was better than he had hoped.
Still, he felt guilty because he had valid concerns about veterinarians having less influence in the profession. Also, he wanted to sell his practice to veterinarians he had mentored, but those doctors didn’t want to be business owners. He worried that, by selling, he somehow let those people down and sentenced them to a lifetime of unhappiness.
None of those concerns are unique or unusual.
At this point in my career, I have worked with around 500 independent veterinary practice owners and over 1,000 medical directors and practice managers in corporate organizations. I’ve seen the highs and lows in both environments, and I think I have a good perspective on what life is like in both worlds.
I didn’t want to tell my friend he had nothing to worry about, because that’s not true. Corporate life has its stressors and headaches. I also don’t think the “Resistance!” woman on Instagram was on the right track with her belief that independent practices are locked in a battle for survival. What I tried to tell my friend is what a lot of people in our profession might need to hear. It’s this:
Corporate medicine is not going away. It will not dominate veterinary professionals who don’t want that life. So far, corporate practices have pushed our profession to raise prices, not lower them in a way that kills mom-and-pop clinics. They have raised support staff salaries and normalized things like taking legally mandated breaks. (Seriously, we needed that.)
Some things about corporate medicine are good, some are bad, and some are messy. In laying out these things, I hope to help people in the trenches move from the fear phase to the acceptance phase. I hope to provide a perspective that is pro-reality rather than pro-corporate. Here we go.
The Good Stuff About Corporate Medicine
Whenever anyone starts to talk about what corporates or independents do, I feel compelled to respond with this caveat: The variability between veterinary hospitals owned by different corporations is as great as the variability between different independently owned practices.
Just as the medical quality, clinic culture and operational efficiency are all over the place with a few randomly selected independent practices, the same is true with randomly selected corporate practices. Also, we have independent practices that overly focus on revenue generation and corporate practices that are truly mission-driven. Grouping practices based on who owns them does not give you two non-overlapping practice styles. It gives you two messy pools that are much more similar than they are different.
Arguing about the corporates versus the independents doesn’t make much sense in a lot of ways. Also, when do independent practice owners become corporations? Is it when they own three hospitals? Seven? Sometimes, knowing where one ends and the other begins is hard. Some of the most adamant attackers of corporate medicine I have met are independent practice owners who own multiple clinics and want to start or acquire more. I tried to express this overlap to my friend to help him get past the idea that he was wrapped up in a clearly defined battle between good and evil.
I told him, “Earlier today, I spoke to a young, bright-eyed practice manager for a corporate hospital. She was put in charge of a second hospital and was asking for advice. You would have loved to hear how excitedly she talked about her first practice and the wonderful culture her team has. You also would have been happy to hear her strategize how she can make the second hospital just as great of a place to work.”
People working in corporate practices are just like those in independent practices. They have a passion for pets and dreams for the future and generally want to make the world a better place. The people we imagine mentoring and developing in our independent hospitals are just as wonderful when you find them in a corporate environment.
I told my friend about a corporate medical director who received one day a week to leave her hospital so she could support other medical directors in her region. She goes to different clinics to answer questions, scrub into surgeries, and generally do whatever she can to grow and develop the doctors in her area. My friend heard this and said, “That sounds like a job I’d like to have.”
Corporate medicine has the potential to provide resources, formalized mentorship, medical training and professional development opportunities that are hard for independent practices to match, as well as job opportunities that never existed before. I know corporate veterinarians who do nothing but educate veterinary teams. I know others whose job is primarily mentoring new veterinary school graduates in their first two years of practice. Still others oversee the management of hospital groups around the world. Those aren’t jobs for everyone, but it’s undeniable that corporate medicine provides a greater potential for diverse experiences and upward mobility than small, independent practices will ever be able to provide.
Finally, research published in 2023 in the Journal of the American Veterinary Medical Association found that “Veterinarians working in corporate practice were more likely to report receiving insurance (health, dental, life and short-term disability), mental wellness programs (e.g., counseling), wellness mobile apps, VIN membership, and continuing education paid by their employer than those working in privately owned practices.”
Corporate veterinary hospitals have a lot to offer people who choose to work there or are already employed at an acquired practice. While some people will never enjoy working in a corporate structure, it’s a stretch to claim that selling a clinic to a corporation is inherently unfair to employees based solely on their anticipated work experience.
The Bad Stuff About Corporate Medicine
All that said, people like my friend who sold a practice to a corporation have some hard pills to swallow. One that pains former practice owners the most is the lack of understanding of what it means emotionally to sell a clinic you spent your life building.
Many owners desperately want to believe they can sell their practice to someone else and still have influence over the decisions made in and around the clinic. Please hear me when I say this: Regardless of what someone tells you when you sell your practice, it no longer belongs to you. Not even a little bit. Think of it like a pet you loved that you needed to rehome. Once it goes to a new house, your pet food preference no longer matters, and your insistence will only cause irritation.
Let me pause here and say this is not a “corporate” problem. I have seen veterinarians bend time and space to sell their practice to another veterinarian, only to have that doctor soon sell it to a corporation for three times the price. Regardless of the buyer, the No. 1 pain point former practice owners seem to have is not understanding how they will feel when someone else doesn’t want or need their input. Having the medical director title is different from being the practice owner. Do. Not. Forget. That.
Let’s also recognize and remember that corporations are not people. Companies do not have beliefs or character. They are simply a legal representation of the current stakeholders and organizational decision-makers. The agreements you make with corporations are only as good as the humans you make them with, and those people might not be there in a year. In fact, the people responsible for acquiring practices in corporate groups are generally not the same people who will run the practices.
As another friend recently put it, “Corporations will never love you back.” His sentiment reflects the reality that business-focused corporations might not operate with the same personal touch as mom-and-pop clinics. My friend had recently been let go from a job he had worked for a decade. He had gone above and beyond to try to make the world a better place. At some point, however, his views conflicted with upper leadership’s, and he was removed from the team. An attempt to reconcile, negotiate or “meet in the middle” never happened. His service was no longer needed, so he was terminated. Experiences like that are much more common in a corporate structure than in most independent clinics.
Dealing with people who are strictly about business is not a bad thing if we truly understand the nature of the relationship. Mom-and-pops often seem to think they are dealing with an entity that mirrors their small business sensibilities, but that is often not true.
Also, it’s undeniable that corporations prioritize revenue generation, as these are capitalist ventures. That approach often clashes with veterinary teams, who tend to have non-monetary priorities, leading to emotional challenges during the transition to corporate ownership. According to the JAVMA report, employees in corporate practices are more likely to report feeling pressure to generate revenue and see more clients than those in private practice. That shift can be jarring, and some employees may leave rather than adapt to the new mindset. That complaint is the most common one I have heard from clinics that went from independent to corporate.
Finally, businesses operate differently when a longer chain of command exists. Frustrations often arise around:
- How long decisions take.
- How medical initiatives are handed down from outside the practice.
- How people not familiar with the practice make management decisions.
- How guidelines and standards are leveraged to increase consistency of care across multiple practices.
All those frustrations are understandable, and they are unavoidable to some degree. Turning a battleship (a multipractice organization) takes longer than a speed boat (a three-doctor practice with the owner standing there).
Again, none of these challenges is guaranteed to happen to my friend or anyone else who sells a practice, and every corporate group is different. Still, speaking in general terms, that is where I see the most pain around corporate life.
The Messy Stuff About Corporate Medicine
“What will you do with the money from the sale?” I asked my buddy. Immediately, his tone brightened. “I’m going to send all of my grandkids to college!”
My friend and his brother were the first people in his family to go to college. Then, he spent 40 years cleaning kennels, mopping floors, managing employees and sweating the bills. Now, in his 60s, he has the chance to retire and travel the world while he’s physically able to do what he wants. How can anyone blame him for his choice to sell?
If you’re a veterinary clinic owner who, for whatever reason, decides you do not want to continue being a clinic owner, selling to a corporate group is almost certainly your most lucrative option. Yes, you might find other doctors to sell to, and I hope you will consider that, but most of us either can’t find excited buyers or can’t justify leaving on the table the extra money we could make from a corporation. This reality isn’t good or bad. It’s just the messy truth.
And here’s another messy truth: While corporations have bought a lot of veterinary practices, most of today’s clinics are independently owned. Furthermore, there has never been a better opportunity for veterinarians who want to own a business. Just think about the recent explosion in house-call practices, in-home euthanasia practices, mobile ultrasound practices, mobile surgeons, relief veterinarians and clinic start-ups. If someone wants to be their own boss, I don’t think you can convince me that they don’t have opportunities in veterinary medicine.
The Future of Medicine
While the rise of corporate practices is undoubtedly affecting our profession’s trajectory, the future of veterinary medicine is not one dominated by corporate groups. It is too easy for independent veterinarians to start a business. Also, according to the JAVMA piece, people working in independent practices are more likely to be satisfied with the feeling of being known as individuals by upper management and with the hospital culture, the ability to fire difficult or abusive clients, and mentorship. For a lot of doctors, the cultural pieces are must-haves.
Corporate practices deliver tremendous benefits for our profession and the veterinary professionals who want to work there. Our independent practices also have some fabulous perks. We must continue to support and mentor those who want to develop in a corporate environment and those who wish to become business owners.
The point I hope everyone will take away is this one: Corporate veterinary practice is here to stay but no one is being drafted into it. One of the most beautiful parts of our profession is our flexibility in choosing where and how we want to work. The future is one of diversity and opportunity. It’s not one of warfare between “the oppressors” and “the resistance.” We need to accept that fact and get to work creating the careers and career paths that we want to see.
FOR SALE
According to a 2024 report by the advisory firm Transitions Elite, “Corporations are paying anywhere from 8 to 13 times EBITDA for veterinary practices, but this can vary depending on several factors. … If you’re running a smaller practice, especially in a rural area, you might see offers closer to 4 to 5 times EBITDA.”
OTHER FINDINGS
A 2023 JAVMA study of private and corporate veterinary practices, posted at bit.ly/3X3uvZb, revealed similar levels of employee satisfaction in these areas:
- Standard of medicine (92% vs. 91%)
- Practice management software and medical record system (59% vs. 59%)
- Ability to acquire new smaller equipment (80% vs. 76%)
- Ability to practice the way you think is most appropriate for each case (92% vs. 91%)
- Collegiality between doctors (90% vs. 87%)
- Management support for dealing with difficult clients (70% vs. 68%)
- Hours per week worked (78% vs. 76%)
BE A BETTER LEADER
Dr. Andy Roark has partnered with VetFolio to release the Uncharted Leadership Essentials Certificate. The program provides training appropriate for anyone who leads or manages others. The topics covered include setting a team’s vision and values, building trust, achieving team buy-in, delivering feedback, understanding communication styles, setting priorities, delegating effectively and managing time. Learn more at bit.ly/Uncharted-VetFolio.
STORY ARCHIVE
Veterinarian and award-winning columnist Dr. Andy Roark has contributed to Today’s Veterinary Business since 2017. Among his articles are these:
- “You’re Fired!” go.navc.com/bad-clients-TVB
- “Grading on a Curve,” go.navc.com/2020-TVB
- “Trying to Keep Everything in Balance,” go.navc.com/balance-TVB