Practice inefficiencies compound veterinary stress

As children, many veterinarians dreamed of growing up and becoming an animal doctor. Yet an alarmingly high number of veterinarians are saying they are giving serious thought to leaving their dream job for reasons unrelated to retirement.

It was a much-discussed topic during the AVMA Veterinary Business and Economic Forum, held virtually Oct. 14-16, where the AVMA’s Frederic Ouedraogo, PhD, described the trend during his presentation on the U.S. market for veterinary services.

“You grew up eager to help animals, and you entered veterinary college—sometimes making big sacrifices—and then you embraced the veterinary career. And this is where things can get a little bit complicated,” said Dr. Ouedraogo, an assistant director in the AVMA Veterinary Economics Division.

Citing the 2021 AVMA Veterinarian and Practice Owners Survey, Dr. Ouedraogo said an estimated 44% of private veterinary practitioners reported they are thinking of exiting veterinary medicine before retirement. The proportion of disaffected veterinarians varies by type of practice, Dr. Ouedraogo added, with equine veterinarians at the top (49%) and mixed animal veterinarians at the bottom (32%).

Disaffection among veterinarians varies by generation. For example, 43% of baby boomers (born between 1946 and 1964) say they are considering leaving the veterinary profession, compared with 47% of Generation Xers (born between 1965 and 1980) and 43% of millennials (born between 1981 and 1995).

“The most intriguing fact,” Dr. Ouedraogo observed, “is that over 40% of practitioners who graduated during the last 10 years are thinking of leaving the profession. They cited mental health (33%) and work-life balance (27%) as their top reasons.”

Dr. Ouedraogo identified three additional trends that require a “reimagining” of the veterinary profession to meet the economic and social expectations of its members.

First, millennials have overtaken Gen Xers as the largest generation of the veterinary workforce. Women account for 78% of the U.S. veterinary population. Among women, 72% are under 52 years old, meaning they could still have child-rearing obligations.

“This is equivalent to 46% of the entire workforce,” Dr. Ouedraogo said. “Obviously, looking at these statistics, something must be done to accommodate the need of these specific groups.”

In a second trend, well-being remains a serious issue for veterinary professionals. Some studies have identified animal health care providers as having a high prevalence of burnout, depression, and secondary traumatic stress disorders, according to Dr. Ouedraogo.

“In a study that we conducted here at the AVMA,” he said, “we found that associate veterinarians were twice as likely to develop feelings of reduced job satisfaction relative to practice owners. We also found that associate veterinarians are more likely to experience higher burnout compared to practice owners.

“When we factor in the declining rate of ownership, one could argue that this situation could affect the professional quality of life at the industry level. In fact, the rate of practice ownership has declined from 45% in 2013 to 36% in 2020.”

In a third trend, practice performance has not followed the expected expansion curve. As Dr. Ouedraogo explained, in 2007, when the typical practice employed 1.7 full-time–equivalent veterinarians, hiring an additional veterinarian increased practice revenue by $410,000. Fast forward to 2020, when the typical practice employed 2.4 FTE veterinarians. Hiring an additional veterinarian led to an additional revenue contribution of $530,000.

When considering the revenue contribution of hiring one additional credentialed veterinary technician per veterinarian in a practice, the contribution was $120,000 in 2007 and $122,000 in 2020.

“Clearly the revenue contribution of credentialed veterinary technicians has barely moved. The problem is that the number of veterinarians per practice has increased, but the number of credentialed veterinary technicians per veterinarian did not increase enough to allow for an expansion in productivity,” Dr. Ouedraogo said.

This gets at the underlying problem of chronic inefficiencies with the delivery of veterinary services. Efficiency, Dr. Ouedraogo explained, refers to how well resources are used, and should not to be confused with productivity, which measures the output per unit of input.

He cited a 2021 efficiency study of companion animal–exclusive practices. Highly inefficient practices scored 0, while highly efficient practices scored 1. Just 1% received a score of 1; 34% scored 0.3 or less; 59% had an efficiency score of 0.4 or less; and 73% received a score of 0.5 or less. Between 2017 and 2021, at least 60% of surveyed practices were found to have severe inefficiency problems.

Dr. Ouedraogo described the differences between an efficient practice and an average practice: An efficient practice has an average of 4,500 active clients a year, compared with 4,300 at an average practice. An efficient practice can process eight patients per hour, while an average practice can process five. An efficient practice can handle 4.7 patients per veterinarian per hour, an average practice 2.2. In terms of value of production and productivity, an efficient practice grosses on average $1.4 million a year; an average practice grosses $1.2 million. An efficient practice could reach $1 million per veterinarian per year and over $400,000 per employee per year, while an average practice only makes $580,000 per veterinarian and $130,000 per employee per year.

“We can see that there is a high cost associated with being inefficient,” Dr. Ouedraogo said. “If we fail to address the issue of well-being in our profession, if we do not address the problem of low efficiency and low productivity in our practices, we could see more veterinarians leaving the animal health care sector, and we could witness an increase in production and service costs. We can face challenges in making veterinary health care affordable and accessible—the most common reasons why pet owners in the U.S. do not visit veterinary clinics, according to our own pet owners survey.”