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John Innes BVSc, PhD, CertVR, DSAS(Orth), FRCVS
RCVS Fellowship Day 2017
Report of presentation
The structure of veterinary practice is changing so quickly that it is hard to keep up with developments, said John Innes, Referrals Director at the veterinary corporate CVS(UK) Ltd.
Approximately 32% of the UK veterinary practice market was under corporate ownership, and this could rise to as much as 70% over the next five years. All types of practice were owned by corporates, as well as out-of-hours services and veterinary laboratories. Corporate ownership was growing in the UK, and across Scandinavia and northern Europe and the USA.
Because the traditional model of independent ownership of veterinary practices had been in place for a long time, many practitioners felt uneasy about corporate ownership and feared losing their independence. However, he said, this independent practice structure resulted in a fragmented veterinary market, which brought both advantages and disadvantages. For example, there could be great variability between practices in terms of standards and levels of investment, but small, independent practices could also be flexible and adaptable to change.
Addressing some of the issues around corporate practice, he noted that no corporate veterinary group was perfect, and all were still learning as they developed.
Regarding the loss of ownership potential within the veterinary market, he pointed out that not all corporate groups worked on an employment model; some offered a joint venture structure. Vets also had concerns about a loss of clinical freedom within corporate practice, but he argued that clinical freedom could be both positive and negative. To offer the optimal service, all vets should be aiming towards evidence-based best practice and many corporates were driving this. Dispelling the myth that corporates were run by accountants and financial directors, he said that, while very talented at their jobs, they did not drive clinical decision-making – it was the vets that did this. All corporate groups had clinical governance committees that were helping to drive up standards.
Other advantages of corporate groups included their structure and scale, which could influence the dynamic between manufacturers, suppliers and practices. Corporate companies were also investing in the infrastructure of practices.
For older vets wanting to retire, corporates offered an exit strategy, while for younger vets they were opening new career paths, whether that was postgraduate education, or heading up various committees, or looking after new graduate schemes. As the major groups spread more widely in Europe, Australia, New Zealand and North America, vets would be able to relocate, leading to the globalisation of veterinary practice.
However, he pointed out that the corporate groups were not immune from some of the issues affecting the profession more widely, such as Brexit and recruitment.
There was an acknowledged shortage of veterinarians in the UK, the workforce was continuing to change, and student debt was a major factor. The veterinary degree was expensive, and the earning potential at the end of it was a concern, particularly if a vet was working part-time.
Veterinary nursing was another issue, with high attrition rates being seen. He welcomed the RCVS review of Schedule 3, saying that veterinary nursing needed to be allowed to be more interesting and technical.
All of these areas were causing ‘serious headaches’ for the profession, not just the large groups, but he believed that the large groups could help the sector get through some of them.
Turning specifically to veterinary career development, Professor Innes said that career progression had traditionally been thought of in clinical terms, from new graduate to intern to resident and then, potentially, to RCVS Recognised Specialist status. However, progressing through this structure did not necessarily mean increasing levels of income at every stage, and he believed that the profession had a serious problem with the way it treated its younger members.
It was common to hear existing RCVS Recognised Specialists say that they had had to ‘sacrifice everything’ to achieve their status. He had no problem with this when talking about sacrificing time and effort, but did not feel that it should also mean sacrifice in terms of income. Why could it not be progression on all fronts?
The specialist examinations process in some areas was also an issue. For one European College, the first time pass rate was only about 10%, he reported. This meant that 90%of those who had undertaken a structured training programme over three-to-five years, and had accepted the detriment to their income that this entailed, would be failed at the end of it. What sort of message was this sending? He suggested that there may be ‘a little bit of protectionism’ going on, and he did not believe this was right.
He also felt that the route to specialisation was narrow and rigid and not particularly fit for the modern workforce. Many practitioners who might be interested in becoming specialists felt unable to commit to the training because they had other commitments, such as families and mortgages. The specialisation process needed to be more flexible and modular to allow younger vets to participate.
He concluded by emphasising the need for the profession to accept that younger vets no longer wanted the same things as earlier generations had. More vets were being trained, but more were also leaving the profession. This, he said, was a big issue and a great shame.