I\u2019ve been fortunate to wear various hats in my career \u2014 hospital manager, veterinary association business manager, adjunct faculty member, consultant and small animal practice owner. The first one, which I\u2019ve never removed, is the now-weathered, dusty, black felt Stetson of a mixed animal practice owner. That\u2019s why I cringe every time I hear someone say, \u201cYou can\u2019t make a career out of mixed animal practice.\u201d I\u2019ve heard it from burned-out practitioners as well as veterinary students who had been told there\u2019s no future in mixed animal practice. Don\u2019t get me wrong, though. The model of rural practice needs to evolve, but I don\u2019t believe that those employed in it are doomed to fail.<\/p>\n
I\u2019m not here to discuss the philosophical merits of rural mixed animal practice. Instead, I\u2019ll dive into the practical lessons I\u2019ve learned and the strategies for creating a viable, sustainable mixed animal business. Whether you\u2019re an aspiring or current mixed animal practice owner or even a small animal hospital owner, I hope you\u2019ll walk away with actionable tips. So, let\u2019s start by defining what a viable and sustainable practice is not.<\/p>\n
I spoke with a mixed animal practice owner \u2014 let\u2019s call him Dr. Smith \u2014 from the Pacific Northwest. He was at the tail end of a long career as a solo practitioner serving a small community and outlying areas. He had spent nearly three decades building relationships and meeting the need for large and small animal services. He hadn\u2019t planned to retire (\u201cI\u2019ll work until I die.\u201d), but health issues and unexpected living expenses necessitated a sale.<\/p>\n
Unfortunately, Dr. Smith, his four team members and their hospital are a prime example of the traditional model of rural mixed animal medicine \u2014 that is, trying to be everything to everyone and doing it all on a budget. Dr. Smith was lucky to have built a good team, and everyone made a decent living. But sadly, nominal profit margins and the poor chance of recruiting an associate veterinarian, even in a region qualifying for student loan repayment, meant that Dr. Smith most likely would sell the assets and his hospital would be no more.<\/p>\n
Practice owners like Dr. Smith exist from coast to coast. They found a rural area needing veterinary care but failed to create a business that would live on after they quit.<\/p>\n
Fortunately, we don\u2019t have to be in Dr. Smith\u2019s shoes. The first hospital where I worked was a seven-doctor mixed animal practice in Colorado. After a few years there, I threw caution to the wind and partnered in a one-doctor mixed animal hospital in rural Nebraska. We were almost 50-50 small and large animal, primarily beef cattle and ranch horses. When the seller handed us the keys, he cautioned: \u201cThe small animal work \u2014 farm dogs and barn cats \u2014 gets us through the seasonality of large animal medicine. People don\u2019t care to spend much on those pets, and even if they did, there isn\u2019t much money to be spent.\u201d<\/p>\n
I often tell that story to veterinary students and say that when we bought the Nebraska hospital, its gross annual revenue was just under $500,000, with a small animal average doctor transaction (ADT) of $93. One year post-purchase and without touching our fees, the gross revenue grew to almost $750,000, with an ADT of nearly $197. All in an area where, we were told, \u201cPeople don\u2019t care to spend much on\u201d farm dogs and barn cats.<\/p>\n
The experience lit a fire in me and incited my desire to explore how viable and sustainable mixed animal practices could have a lasting impact on the rural areas they serve.<\/p>\n
Over the past several years, in addition to remaining in mixed animal practice, I\u2019ve worked under the direction of Dr. Melinda Frye and her team at Colorado State University as part of a federal Veterinary Services Grant Program. The team and I surveyed several hundred rural mixed animal practices across the Rocky Mountain and Plains states. We accessed financial records and learned about staffing and business models.<\/p>\n
The results were encouraging. Our survey confirmed my belief that the mixed animal hospital isn\u2019t a thing of the past. Indeed, it is alive and well from coast to coast, operated by those willing to evolve their business model, their medicine and, probably most important, their mindset. For anyone considering a career in mixed animal practice or currently in it, and for those watching from afar, I present these five discoveries.<\/p>\n
Whether you\u2019re considering a start-up or hoping to hire an associate veterinarian or seeking to join or buy a hospital, understanding the difference between need and demand is essential. In laymen\u2019s terms, which fits my level of comprehension, need is based on a population of animals, small or large, that needs veterinary care. Many rural areas have the need. On the other hand, demand relates to a client\u2019s willingness to spend enough money to meet that need so that we, as veterinary professionals, can make a living and build a business. Often, the need exists, but the demand is absent or is undermined by our animal care philosophy and assumptions.<\/p>\n
The American Veterinary Medical Association\u2019s handy Market Share Estimator (bit.ly\/3G8oWi4<\/a>) can help you assess the need and demand. While primarily small animal- and equine-centric, it\u2019s a valuable tool. Aspiring mixed animal practice owners can use the resource, in conjunction with cattle numbers from the U.S. Department of Agriculture, to test the waters. In addition to good old boots on the ground (speaking with and surveying producers), a veterinarian can determine the need and demand for services in general and run a litmus test on adding any.<\/p>\n The seller of my former Nebraska hospital was a prime example of that principle. He didn\u2019t particularly enjoy working with dogs and cats, and it was reflected in the thoroughness of care, how he trained his team and how he scheduled his workday. The same is true when large animal patients are secondary.<\/p>\n My current mixed animal practice in southeast Idaho faced the same challenge before I came aboard as a partner. The two seasoned, predominately large animal veterinarians had little interest in small animal medicine, so their attitudes reflected the protocols, level of care and client experience. Over time, as the doctors aged, the hospital swung from large animal predominant to small animal predominant as new associate veterinarians preferred the lifestyle, production and schedule of pet care. What was once a vibrant mixed animal hospital had become more of a small animal business.<\/p>\n Upon joining the team and renewing the practice\u2019s commitment to mixed animal medicine, I helped assess the need and demand for large animal services and used the information to take a measured risk and make a series of investments. We hired a large animal predominant veterinarian to complement our mixed animal veterinarians and upgraded the equipment and facilities. The new associate, fueled by a passion for large animal medicine and armed with the resources she needed \u2014 medical, marketing and staffing \u2014 grew our large animal revenue by over $100,000 in her first six months.<\/p>\n The lesson? I am not suggesting that practitioners suddenly become passionate about something that doesn\u2019t get them going. Instead, whether your preference as a mixed animal practice owner is small or large animal medicine, you owe it to your community to assess the opportunity. Then, if the results are favorable, invest in the people and resources to grow your business, unencumbered by your preference or mindset for how much a client should spend on a dog, cat, horse or cow.<\/p>\n You\u2019ve heard that line from small animal colleagues, and it applies to mixed animal practice, too. In this case, I\u2019m not talking about the type of patients you see, but the type of client. Being in rural practice<\/a> attuned me to practice owners who say they can\u2019t practice thorough medicine because of the demographic they serve. Like the rest of the country, Rural America has A, B and C clients. If you want a high-volume, low-touch hospital that provides basic, affordable care, it\u2019s generally possible in mixed animal practice. If you want a hospital built on relationships, thorough care and a consultative approach, it\u2019s possible as well.<\/p>\n My old Nebraska hospital was in the county with the highest number of people on welfare in the entire state. That reality presented a significant challenge for us, but it didn\u2019t sway our commitment to the level of care we wanted to offer or the role we wanted to play in the community.<\/p>\n Last summer, I was leading a veterinary student externship in eastern Kentucky when we visited a hospital in a county with a median household income 39% below the state\u2019s already low median income. But guess what? The hospital\u2019s compliance rate on preventives was four times the national average, and its prices were in line with national benchmarks. Will the hospital expand to five or six full-time veterinarians and gross millions upon millions of dollars in the near future? Probably not. However, it\u2019s a multidoctor hospital with respectable and sustainable gross revenue and profit margins.<\/p>\n The externs were shocked at the hospital\u2019s success. The two DVM owners shared that when they moved back to the area, they decided that not every client was right for their mission. They focused on consistently offering and delivering the highest quality of care in the area. That helped them build a thriving, rural mixed animal practice.<\/p>\n Whether you\u2019re in mixed or small animal medicine, a practice owner or an associate, consider your personal \u201cwhy\u201d and ensure that the economics work. Then, focus your time, team and medical philosophy on your targeted clientele.<\/p>\n2. When a segment of patients, small or large,\u00a0is an afterthought, the quality of care, client experience and hospital viability suffer.<\/h3>\n
3. You can\u2019t be everything to everybody.<\/h3>\n
4. Prepare two profit and loss statements.<\/h3>\n