What if COVID hadn’t happened

What would veterinary medicine look like had COVID not happened? 

Several weeks ago, I was on an airplane watching episodes of “For All Mankind,” a TV series based in an alternate universe where the Soviets beat the U.S. in the space race of the 1960s.

It caused me to mull, think, and consider: “What if there had been no pandemic? What would veterinary medicine look like today?”

I started asking others about this during general conversations or on podcasts. It was interesting to hear what they thought. The following is my take on the veterinary world in 2024 if we had just kept doing things as we had pre-pandemic.

Where we’ve been

In March 2020, the world changed. For the first two months or so, veterinary practices were on the brink of shutting down as pet owners were afraid of the pandemic and veterinary hospitals were unsure of how to deliver care. In June, everything changed. Veterinary practices took off from a busyness standpoint, which was great for business, but maybe not so great for the people running the business. For those owning veterinary hospitals at that time, workforce shortages led to a need for higher salaries to both attract and retain all levels of staff. Concurrently, various products from cages to cephalexin became more difficult to access and more expensive to buy. National corporations saw their practices’ revenue growing, leading to a feeding frenzy at very high multiples of what were deemed successful practices. Hundreds of overnight veterinary millionaires were created.

Here is an incomplete list of the shifts that occurred as a reaction (more so than in response) to the world turned upside down by COVID-19:

• Curbside check-ins
• Greater awareness of telehealth
• Workforce issues worsening with respect to veterinarians and credentialed technicians
• Difficulties retaining or recovering all staff
• Growth in salaries for all employees, signing bonuses for new hires
• Supply chain issues
• Longer wait times for basic veterinary care; even longer for specialists
• Elevated costs for care
• More veterinary schools were discussed
• Difficult clients
• Many independent sellers called it quits – sold their practices
• Many practices decreased their hours

This is not to say that before the pandemic we weren’t dealing with certain issues, but the pandemic amplified some inefficiencies that have long existed.

Without the pandemic, we would still have some workforce issues, but they may not have been as exaggerated. With that in mind:

• Would the moving expenses, signing bonuses and salaries have escalated as much as they did?
• Would we have had greater retention of veterinarians who left the profession because of the pandemic and haven’t come back? (Same question for credentialed technicians and other team members.)
• Would the cost of care, which was elevated to cover payroll and supply chain cost increases, have elevated as much?
• Would there be as many new veterinary schools on the horizon?

If revenue hadn’t grown so quickly during the pandemic because of people being at home and having no expenses and having government support, would:

• National companies have paid as much as they did (escalated multipliers) during the hospital sale feeding frenzy that occurred?
• If the multipliers had remained at around 8-12 times, would some associates have had a better chance of buying in?
• Would slower sales have allowed for the purchased practices to more rapidly work into the concept of being owned by a third party?
• Would there be as many young millionaires who are now starting new hospitals since their contractual agreements are up?

If we didn’t have to deal with all the inefficiencies of curbside, stress of a fatal virus, attrition of existing staff, difficulty in finding new staff, and increased stress from demanding clients, would:

• The mental health of the profession be better (burnout)?
• The financial health of the profession be better (profitability)?
• We have lost as many clients as we did because we couldn’t see them?
• Cases that practices were too busy to see end up in ER and urgent care or specialty worsening the caseload … trickle up veterinary medicine?

What would – and wouldn’t – have changed

If we continued on our pre-pandemic path, I anticipate we would have many of the same issues that we had, but we would be four years down the road. Much of what came out of the pandemic was a reaction to different external and internal variables impacting the profession. Reactions are frequently without thought in contrast to responses.

Many of the outcomes that we saw could still have occurred, but we might have had time to respond to them rather than react. The veterinary profession tends to resist mammoth change or to change very slowly; the pandemic just escalated the change. The speed of change wasn’t a bad thing, and it did help to move the profession forward, but not without leaving some damage in its wake.

In my opinion, without the pandemic, telehealth would have had a slower ramp up and practices might have figured out how to integrate into a more normal practice life.

Without the pandemic, veterinary salaries would not have escalated as much as they did. Salaries needed to go up. But will they be sustainable as we have started to see a normalization of caseload and a proposed increase in enrollment and new veterinary colleges on the horizon?

Without the pandemic, the workforce issues which were exacerbated by being inefficient and busy would have continued. However, there would have been time to focus on improving efficiency and there would be a slower growth of veterinary school class size and new schools. I don’t think we would have lost as many doctors and staff to the pandemic related stressors with many of those leaving not coming back. In its recent Retention Study, AAHA estimates that 30% of veterinary healthcare workers are leaving the profession with 50% of them taking non-clinical roles and 90% of those never to return to clinical practice.

The cost of veterinary care would have still been a problem without the pandemic. It was a problem before the pandemic. It escalated as practices raised fees to cover increasing salaries, inventory and decreasing profitability. Across the board fee increases were commonly used as a barrier to decrease demand. This may or may not have worked. But it did create a deeper chasm between those who can afford veterinary care and those who can’t.

Without the pandemic the current trends to decreasing client visits and increasing negotiating by clients that we are currently seeing would not be as dramatic. Spectrum of care and access to care, which were in the vocabulary pre-2020, are now mainstream topics because of the pandemic.

Without the pandemic, we wouldn’t have fired as many clients as we did. The pandemic worsened an already uncomfortable mental health situation in our country. Online reviews have become a tool for people to whine, moan and complain about anything and everything. Veterinarians were a target because we as a profession have not done enough to educate the pet owners about all we do and the associated costs. Not having a pandemic would not have kept the relational problems away, but curbside interactions with clients certainly didn’t help the matter. Our practices had enough stress going on that a hot-headed client was fuel to a burning ember.

In my opinion, without the pandemic, we would have more slowly adapted to many of the new technologies that came out in response to the operational challenges that we faced. These new technologies have been beneficial to practices by streamlining activities, whether it is an online pharmacy or home delivery of food or automated online access to an appointment book and greater use of email and texting for communication. Technology is a needed adjunct to what we do every day, not a substitute for the relationships that we thrive on. The growth of technology was greatly sped up as a result of the pandemic and that was and is a good thing.

Without the pandemic, we would have gone along quietly doing what we did and worked to find responses to the chronic, ongoing issues, that plague veterinary medicine:

• Lack of leadership
• Poor communication skills
• Workforce issues with retention and acquisition
• Training to retain and trust
• Inefficient business models because we don’t train and delegate
• Client awareness of the great things that veterinarians do
• Wages and salary issues within the profession
• Well-being issues

The pandemic called attention to our issues; now we have time to focus on them and create long-term cures. Let’s do that!

Photo credit:

istockphoto.com/lemono

istockphoto.com/lemono

Dr. Peter Weinstein owns PAW Consulting and is the former executive director of the Southern California Veterinary Medical Association and the former chair of the American Veterinary Medical Association’s Veterinary Economics Strategy Committee. He teaches a business and finance course at the Western University of Health Sciences College of Veterinary Medicine.