Veterinary medicine has gone through lots of changes over the last decade. We sit at an interesting inflection point for the veterinary industry, facing issues such as rapid corporatization and consolidation, an acute labor shortage, declining rural veterinary care access, exorbitant veterinary medical student debt, and an ongoing crisis of declining mental health within the industry. As we look back at the many changes and challenges of the last ten years in veterinary medicine, it begs the question:
What comes next? In this AVP blog, I’m pulling my trusty crystal ball out and making a few more predictions.
An explosion of new veterinary schools will correct, and eventually over-correct, the shortage of veterinarians.
Rather than rehash all the well-articulated data and conclusions of Dr. Eric Fish in this article that he wrote for his platform, All Science Great & Small, I encourage you to read it yourself. I have been of the opinion for many years now that our profession was too slow to prepare for the clear societal and generational tailwinds of growth in demand for veterinary services, resulting in the current acute shortage of veterinarians in the US. This shortage was predictable and preventable. However, I share Dr. Fish’s concern that we are now on a path of overcorrection.
As we all know, effective medicine is as much in the dose as it is in the choice of drug, and the correct answer to one imbalance is rarely to create another.
While I am probably in the minority of veterinary corporate leaders in this viewpoint, as an oversaturated job market for providers is favorable to employers, as a veterinarian I have deep concerns about how this impacts the ability for future clinicians to enjoy financially rewarding careers and service their student loan debt related to the ever-ballooning cost of a veterinary medical degree.
The large increase in the size of the veterinarian workforce over the next decade also begs the inevitable follow up question: Who leverages them? Adding a flood of more veterinarians to the workforce doesn’t address the concurrent acute shortage of credentialed veterinary technicians. It is no secret that the most successful veterinary teams focus on leveraging veterinary technicians and allowing them to contribute to the top of their credentials. I therefore find it confusing and concerning that so much of the discourse around the shortage of veterinary care in our country has centered on the shortage of providers and not on how we can maximize the vastly under-utilized, under-appreciated, and under-compensated nursing workforce. While I don’t often recommend that we look to human healthcare for inspiration on how to operate, understanding the critical role of nurses in the delivery of effective and efficient care is something that I think our counterparts on the human side do much better than we do. I do think our profession is capable of walking and chewing gum at the same time, and addressing the veterinarian shortage doesn’t preclude us from concurrently addressing the technician shortage. However, I do think that attempting to address the former without addressing the latter is not a path aimed at success.
I predict that over the next decade we will see the planned significant increase in the size of the total graduating class of veterinarians, paired with improvements in the efficiency of delivery of care such as AI (more on that later), will result in an overcorrection of the current shortage of veterinarians.
A softening job market and rising anti-corporate sentiment will drive a wave of entrepreneurship in veterinary medicine.
One of the most common refrains I hear is “young vets today aren’t as entrepreneurial as previous generations”, a sentiment that I (especially as a younger veterinarian and entrepreneur myself) strongly disagree with. Rather than a lack of will, I think the lukewarm attitude among many younger veterinarians towards ownership largely originates from their perception that the risk-to-reward ratio of practice ownership has shifted in four critical ways:
- Buying veterinary practices has never been more expensive than in recent years. Private equity-driven consolidation has significantly increased practice valuations relative to historical norms. While this is great for current owners, higher valuations for a buying veterinarian means more risk: Paying more, and therefore taking on more risk, for the same amount of cash flow means taking the plunge will be appealing to fewer vets. Starting a practice from scratch is still an option but is a fundamentally different entrepreneurial journey compared to buying an already-established business and isn’t for everyone.
- Getting a veterinary degree has never been more expensive. While lenders typically don’t care about a buyer’s student loan debt when deciding whether to underwrite a loan for a business purchase, as they simply care about the ability of the business itself to support the loan. Existing personal debt is still an important part of the individual calculus that any aspiring business owner must consider as they stray off of the “safe” path of being an employee with a stable paycheck and jumping into entrepreneurship.
- Corporate competition has stacked the deck against independently owned practices, especially in the recruiting market. Corporate groups can lean on dedicated recruiting teams and a greater ability to weather near-term expenses (signing incentives, high starting salaries for new graduates, etc) to put their thumb on the scale. In a tougher competitive environment where the necessary labor required to grow is scarce, independent ownership becomes a more intimidating prospect.
- Rising compensation has made traditional employment, or other entrepreneurial methods of practice such as relief/locum work, more enticing. When jobs are plentiful, highly compensated, and stable, the “reward” aspect of entrepreneurship is diminished relative to the risks.
As discussed above, the employment landscape in the profession is likely to dramatically shift over the coming decade as these 11 new veterinary colleges begin to pump out graduates. As open jobs potentially become less plentiful and less lucrative, entrepreneurship becomes more appealing. There is also a growing tide of anti-corporate sentiment around the industry as a growing proportion of the veterinary profession now has experience working for large, traditional corporate groups. Many of these corporations rely on a supply of people willing to ask themselves “how bad could it really be?” as they sign a non-compete agreement (for the record, AVP is proud to not require associates to sign non-compete agreements) to work with one of those groups. The workforce’s sentiment towards the business practices of these large corporations continues to sour, and industry thought leaders such as Paul Diaz have been working hard to increase awareness of their tactics like the predatory utilization of non-compete agreements. As many of these companies have found, there’s only so long you can outrun a bad reputation!
I predict that over the next decade we will see a renaissance of young veterinarians considering independent practice ownership, or pursuing co-ownership models with smaller, values-driven companies, rather than pursuing employment as associates with large corporations.
The middle innings of veterinary consolidation will include IPO of several large players.
2023 was an eventful year for veterinary medicine in the public market, with many more eventful years likely to come. Private equity giant JAB split their NVA veterinary holdings, shifting their 145 specialty and emergency hospitals into a separate business, Ethos Veterinary Health, and stated their intention to take both companies public in the next 2-3 years. They followed up this move by selling VetPartners to EQT, divesting themselves from those practices in Australia and New Zealand, seemingly another step in their plan to streamline the holdings of NVA and Ethos in preparation for eventual IPO.
Chewy, a publicly traded company, has announced their entrance into veterinary general practice operations with Chewy Vet Care, showing a clear appetite among public investors in the ownership of GP veterinary practices.
I predict that JAB’s intentions for NVA and Ethos represent the vanguard of a wider push among mid- and large-scale veterinary consolidators to explore the public market over the next decade. Investor enthusiasm for at-scale veterinary groups remains high, as well-constructed networks present risk-mitigated investment exposure to what they perceive as a stable and growing industry with strong demographic tailwinds. It would behoove veterinary practice owners as they weigh their exit strategy options to continue to consider whether a large, private equity-backed corporation aligns with the culture and values that they’re seeking for their team and clients. However, this looming trend of IPOs adds an extra wrinkle, where practice owners contemplating sale must also recognize that those private equity firms may very well have their own eyes on the exit door in the next couple of years and can’t reliably speak to how their network will or won’t change after they change ownership to being publicly traded.
Artificial Intelligence isn’t taking anyone’s jobs in vet med…at least not yet. However, it will be impactful, and we need to build a robust ethical and legal framework to prepare for it.
To quote the innovative founder of Digitail, Sebastian Gabor, on a recent episode of the Veterinary Innovation Podcast
“AI will never replace anyone in practice. However, someone using AI may.”
At its core, the delivery of veterinary healthcare is about humans interacting with humans, and I have no expectation that will change in the next decade. Veterinary healthcare is not just about the medical/scientific exercise of the prevention, diagnosis, and treatment of medical issues, but also is an important extension of the human-animal bond as pet parents seek compassionate, empathetic care that acknowledges the role of pets as members of their family. Regardless of how technology advances, there will not be a real threat of AI replacing the jobs of veterinarians and their care teams unless that becomes something that clients (the customer) actually want. Demand defines all markets, and a genuine relationship with their veterinarian and veterinary healthcare team is a core pillar of the demand for veterinary healthcare services. What I do think we will see over the next decade is a growing gap between veterinary the healthcare teams who effectively use this new technology as leverage to work more efficiently and provide higher-quality care and those who do not.
As of now, AI is “just” a tool – a more intuitive and powerful tool than many, but regardless is limited to being something that a person utilizes towards a specific purpose and looking for a specific output. However, the “I” in “AI” belies a goal for artificial intelligence to become much more than that. Intelligence is a characteristic that we associate with living beings: the ability to learn, iterate, reason, understand abstraction, plan, and think critically. However, both the laws and the consensus rules of ethics that govern the veterinary profession do not account for a non-human entity being able to do those things. As AI advances to a point where it is no longer just a supplement to practitioners, but potentially able to independently perform some of the tasks that our laws and ethics only contemplate being performed by a practitioner (not just a fantasy scenario, but already seen in some AI-driven tools for diagnostic imaging and pathology), we’re left with a troubling lack of accountability. When a human, licensed veterinarian malpractices or breaches the ethical standards of the profession, there are clear paths to hold that individual accountable – whether via actions against their license, civil penalties, or in rare and severe situations through the criminal justice system. No such systems of accountability are present or possible to hold an artificial intelligence accountable. As a profession, we will need to think ahead on how regulation and oversight of these systems can be implemented as AI becomes capable of doing more to help practitioners and patients. We will need to find a healthy space in between blind excitement and irrational fear as this new technology likely revolutionizes many of the ways that medical care is delivered to animals in the coming years.
I predict that over the next decade artificial intelligence will change the way we practice, including how we schedule, keep records, communicate, order goods, and even how we diagnose and prescribe. It will never replace the role of the veterinary healthcare team in delivering direct care and as an important part of the human-animal bond that clients share with their pets.
AVP is committed to being the partner of choice for veterinary practices and teams. We are proudly vet-founded, vet-operated, and not private equity-backed.
If you’re a practice owner interested in finding out more about opportunities to partner your practice with AVP, or a veterinarian interested in becoming a co-owner, please contact me at bill@associatedveterinarypartner.com.
Dr. Bill
#yourvetpartner