Category Archives: Veterinary industry

Is severe under-capacity the reason behind vet scams to boost revenue?

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“Under-capacity” is probably not a phrase that comes up in your daily conversation.

But if you’re a dog parent who’s heard some of the growing plethora of stories about scams that veterinarians engage in to boost their revenues, here’s some data regarding capacity measures at veterinary clinics that adds a new hint of the motivation behind these scams.

In 2013 the American Veterinary Medical Association (AVMA) released an article that summarizes the findings of a study that showed there are about 11% more veterinarians on the market than demand would require.  Key excerpt (emphasis added):

[T]he report indicates that the supply of veterinarians in the United States in 2012 was 90,200, and that supply exceeded the demand for veterinary services by about 11,250 full-time equivalent veterinarians.

The excess capacity estimated in the report does not mean that 11,250 veterinarians were unemployed during the study period, but that 12.5 percent of veterinarians’ capacity to provide services was going unused. If current conditions continue, the study projects that this is likely to persist into the foreseeable future.

A veterinary workforce survey used as a part of the study asked respondent veterinarians working in clinical practice to characterize their local veterinary market and their practices’ capacity and productivity. Fifty-three percent of those surveyed said that they believed they were working at less than full capacity.

See the full report, “2013 U.S. Veterinary Workforce Study: Modeling Capacity Utilization,” here.

The result is that the average veterinarian’s annual earnings is falling – sharply.  From page 9 of the report:

Declining vet annual earnings

And a chart (from page 12) that shows 53% of veterinarians claim their clinics are not working at full capacity:

Vet clinic working at less than capacity

No one wants to believe that veterinarians would do anything except provide only the services and counsel that your dog really needs for her happiness, health and longevity – right?  I certainly didn’t.

But as the deeply-researched and documented articles on Shayna’s List show, there is no longer any doubt that many veterinarians – not just the oddball here and there, but a significant swath of the industry – are engaging in shameful practices that use deception, guilt, manipulation and outright lies in order to boost their revenues, even if it means risking the health of our four-legged best friends.

Caveat emptor, fellow dog-parents.

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The ABC “20/20” expose: “Is Your Veterinarian Being Honest With You?”

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This segment, from ABC’s “20/20” program, caused quite a stir within the veterinary community.

I wouldn’t have believed any of it when I became a first-time dog parent, in 2002.  But since then, I’ve come to realize that this is merely the tip of the iceberg, as I document elsewhere on Shayna’s List, and I discuss in my book.  Also, see below the video for an excerpt from a veterinarian who is trying to stand up for basic ethics, and is waging a very lonely fight.


See more US News from ABC|ABC World News

You can learn more about Dr. Andrew Jones at: http://www.veterinarysecretsrevealed.com/

And through a Google search, you can find lots of veterinarians assailing Dr. Jones personally (some with legitimate points), and trashing ABC, but almost none address the basic points he made.

Two vets offer dissenting opinions on the 20/20 piece

It’s for this reason that an article by Emily Jefferson, DVM is so refreshing – because she acknowledges there are serious problems within the veterinary profession, and that if vets don’t clean it up, someone else (eg Shayna’s List) will.  Excerpt:

You probably know that 20/20 aired a segment on alleged dishonest practices within the veterinary field.  A veterinarian named Dr. Andrew Jones (who had left the profession) tried to discuss some issues I’ve addressed over the last 3 years in Ethical Veterinarian.  Among these were over-vaccination, “upselling” of unnecessary procedures, and the potential for veterinarians to put business interests above animal well-being.

Firstly, I never expect a media piece to report accurately on science topics.  This was obviously a shaming attention-grabber, not the effective educational piece it could have been.  Any compelling scientific comments that the interviewed vets made, if they existed, probably ended up on the cutting room floor.  Let’s face it, they wouldn’t have been alluring to the average TV viewer or easily interpreted by a TV journalist.

So yes, trying to incriminate a vet for recommending a dental cleaning, of all things, was lame.  Conducting an undercover investigation was also lame…we’re not the mafia or an illegal prostitution ring. And since I do not know Dr. Jones personally, I can’t even say with certainty what his motive was for doing the interview.

But I have to point out that throughout the segment, 20/20 did say that “some veterinarians” engage in unethical business practices.  It never generalized this to the entire profession. Nonetheless, this approximately 7 and 1/2 minute piece still incited the biggest emotional uprising of veterinarians I’ve seen for any reason.  A factual correction or two about dental cleanings and lumps would have sufficed. However, an astounding number of vets were galvanized to start reactionary blogs, or at least their posts seemed to be shared like never before.  Contained in these posts was an overflow of outrage, defensiveness, melodrama, self-validation and calls for professional solidarity.  It was as if a national tragedy with pervasive loss of life had occurred. […]

[O]ur defensive backlash still irked me more than anything about the 20/20 piece itself. Why? Because it was the same unproductive, in-unison, knee-jerk reaction vets seem to show whenever someone else implies they may be wrong.  After the segment aired, vets immediately set to work trying to refute everything about the 20/20 segment, even the parts that were accurate or could have been legitimate in certain instances.

Also, I’ve been expecting a TV expose on the vet industry for years, so I’m not on board with the shock. (I knew it was coming for sure when the plaintiff in the Corpus Christi cat vaccine case personally contacted me. After losing the life of her beloved cat and the case, the flabbergasted plaintiff stated, “I lost my veterinarian lawsuit because “if all veterinarians adhere to the same standards then it’s not negligence.”)

I never wanted to see veterinarians tossed into the sensationalist media ring, but that’s why I and a handful of others in the field have been working to engage vets in a professional, internal setting on these potentially explosive issues—for years.  I would have never taken my concerns to TV news. But, on the other hand, can I tell you what response I’ve gotten from other vets using professional appeals rather than the silly mainstream media? Almost nothing.  A frustrating, empty silence.  One closed-minded VMA after another.  An ongoing belief that the veterinary status quo will be just fine—permanently.  An insistence that we don’t have to evolve at the pace of society in our decisions about animals.

Dr. Jones said he needed to say things that “weren’t being said.” Again, I think he used some examples that were too vague and situational to be considered valid. But his sentiment was justified – there are problems in this profession that it refuses to address internally. Business practices that conflict with animal (and veterinarian!) welfare are among those. You quickly hit a wall inside this profession if you disembark from the collective view, even with compelling evidence in hand. If you’re a vet and don’t think so, maybe it’s because you’ve never disembarked from the collective view. Have you? I’ve done it, both as an associate and as a practice owner, and you should see the juvenile behaviors I’m met with. They shock me much more than the 20/20 piece.

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Here’s one more kernel of acknowledgment contained in an article from another vet, Patty Khuly, VMD, MBA, that otherwise scorches both ABC and Dr. Jones (emphasis added):

Our track record on vaccination policy is embarrassing. According to some vaccine manufacturers, including Dr. Mark Kimsey, senior brand manager for canine biologicals with Boehringer Ingelheim, a full 60 percent of us are still vaccinating our patients annually in spite of long-standing evidence-based recommendations to the contrary. (Ignore your coop’s foxes at your own peril.)

At the risk of incurring the 60 percent’s wrath, I say it’s high time we abandoned our protectionist ways with respect to vaccination protocols and accepted that vaccinating annually makes us look like turnip-trucking idiots who care more about our bottom lines than our patients’ well-being.

I don’t care why you do it––whether it’s because you think you won’t get your patients in every year or because AAHA and the AVMA give you a wink and a nod in the name of “veterinary discretion” (for shame!)––you should just stop doing it already.

It makes us all look stupid when we ignore reams of evidence because it’s more expedient to do so.

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The truth is coming.  And it’s not going to be pretty.  But it is long overdue.  And Shayna’s List will be taking a leading role in arming dog parents with the facts necessary to make informed decisions on how to judge veterinary care – and inoculate them against the manipulation and subtle bullying that can lead them to make bad decisions.

And it will be done in Shayna’s name – because her dog friends deserve much better than what they are now being subjected to.

Shayna-at-UVa3

Shayna at the University of Virginia, September 11, 2006. 

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What is driving your vet’s recommendations for diagnostics?

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Or more precisely, what is the dominant motivating factor in your veterinarian’s recommendation to perform diagnostic testing – imaging, lab work, or other – on your dog?

If you are an unsuspecting (normal) dog parent, there is only one answer: because your vet believes there is or may be something wrong with your best friend, and the only way to determine this for sure is to perform a specific diagnostic test (or multiple ones).

The reality, unfortunately, may be far different.  And what you’re about to read is just one indication of what I referred to here as the really ugly, unseen underbelly of the veterinary profession.

Take a look at this article by DVM360, a leading veterinary industry publication (click to enlarge):

DVM360 article on diagnostic revenue targets

Let’s start with the title:

How diagnostics drive success in veterinary practice (Sponsored by IDEXX Laboratories Inc.)

Diagnostics “drives success” in veterinary practices?  Does that mean that by providing diagnostic services for dogs and cats whose care and conditions indicate it, one can be more successful?  Nope.  The article begins with what is presumed to be a question posed to a veterinary clinic owner, by his or her professional financial adviser – then two such individuals, Karen E. Felsted (CPA, MS, DVM, CVPM) and Fritz Wood (CPA, CFP) provide the “answer.” (Ed.: Emphasis added)

“Q) What percentage of gross revenue should you expect from diagnostic testing?

“Wood: I would like to see your diagnostic income approach 20% to 25% of your total gross income. And I’d like to see it grow on an annual basis. (See Figure 1 for a chart showing laboratory revenue in well-managed practices.)

“Felsted: If you look at the three published studies out there,1-3 it’s currently somewhere between 13.5% to almost 18% of revenue. If a practice is producing less diagnostic revenue than that, management needs to focus on this area.“

Stop and think about that.  A normal person – and pet parent – would assume that a veterinary clinic’s revenues for diagnostic services are generated because the vet(s) have examined the animals under their care and, based on what they observe, advise that certain diagnostic tests be performed.

Now, re-read those “answers.”  They have nothing whatsoever to do with animal welfare – only with a desire to increase the veterinary clinic’s revenues.  Then, imagine you are an honest veterinarian, reading this article.  These professional financial advisers say that if your clinic’s diagnostic revenues don’t measure up to their recommended targets, that you should “focus on this area” – implying, convincing pet parents to authorize diagnostics that their best friends may not need.  Finally, the financial adviser who is listed as a veterinarian (Felsted) says your revenue should be higher than the other’s recommended target – and that this figure should “grow on an annual basis.”

Laughing mechanic

No one wants to envision their veterinarian acting like this. How sad that it is veterinarians themselves who are giving us solid reasons to view them like this.

Think about all that.  Imagine this wasn’t a veterinary publication, but say, one targeting auto service centers.  Now, imagine the publication featured a column by auto service industry financial advisers who openly state that “shock absorbers should constitute 20-25% of your annual revenues,” and that that figure should “grow on an annual basis.”  How soon would it be before a governmental consumer protection agency, or an enterprising investigative journalist, would be sending in undercover customers, to see how many times service centers who subscribe to this publication follow its implied advice – and was recommending that unsuspecting customers pay to have new shocks installed on their cars, whether they needed them or not?

Yet here we have this advice, being openly given on a medical website, DVM360.com, that claims to be “the (veterinary) market’s best read and most respected publications” (hover over the “Publications” circle at that link, or click here for screencap).  It is published by Advanstar Veterinary, which claims DVM360.com is “the leading news website in terms of reach and engagement, serving the entire universe of 155,000 unique veterinarians and teams each month.”

And as an added punch line, the article is sponsored by IDEXX Laboratories, which just happens to be a leading maker of veterinary diagnostic technologies.

Conclusion

So basically, what we have here is an advice column for veterinarians that:

  • Counsels them to (a) aim to generate 13-25% of their annual revenues from diagnostics – regardless of whether their patients actually require these tests – and (b) work to make this figure grow on an annual basis.
  • Is sponsored by a company that just happens to make certain diagnostic technologies, and therefore stands to significantly profit if vets actually follow the advice in this column.

Certain honest veterinarians are now openly stating (example) that if the veterinary profession doesn’t clean up its own act, someone from the outside is eventually going to pull back the veil, and expose the outrageous, profit-driven shenanigans that are being perpetrated by some within it.

News flash: Shayna’s List is going to be that external force that exposes this kind of shameful nonsense.

Do you have a story of similar outrageous conduct by veterinarians, or those who counsel them?  Email me.