I think we're likely to see an increase in mobile one-man-band vets. They'll have a vehicle kitted out for all routine stuff, and will work in conjunction with a referral practice for anything more complicated. Without the cost of a bricks-and-mortar practice and staff they'll be able to keep costs down, and being mobile will make them very welcome in areas with a high population of elderly folk who find it hard to get out to visit a vet.
Although I envisage this being primarily a small animal service, there are already equine specialists operating in this way.
I know of small animal vets who, disillusioned with the current system, are setting up in business in this way, or are seriously considering doing so.
An interesting concept, but one I think is in the main fundamentally difficult to see succeeding in the global picture.
Some of my reasons based on experience are as follows:-
1) The very significant difference in mind set between a SA vet and an Eq/ LA vet. The SA vet is unused to having to adapt to “environmental” conditions / variabilities - although COVID improved this! But there is already a “dropping back” with the younger cohort coming through that were not exposed to those challenges in the clinical sense. Your average SA vet wants all the facilities available to undertake their job.
2) Surgical facilities will be very challenging to provide, the vast majority of SA procedures are carried out under General Anaesthesia, and the provision of this under mobile conditions would be difficult, particularly when considering non routine ops, even dentals due to the kit involved would be problematic.
Due to anatomy, eg the “stay apparatus” which enables a horse to stand whilst “sleeping”, and the advancement of sedation / surgical techniques the number of operations that are carried out on the equine species under standing techniques is significant. This has also been driven by the cost of GAs in horses, and the significant risk of complications both during induction, maintenance and post anaesthesia.
Similarly for the LA vet the use of Local anaesthesia techniques, handling facilities and very different mindset of both client and vet mean that relatively few ops are performed under GA.
3) Ultimately the services that a mobile unit are going to be able to provide are going to be limited in comparison to the norm SA practice, and clients want a one stop shop. How often have you been frustrated by going to see your GP, and then not even the basic procedure of taking blood being able to be facilitated by that GP??
4) The Royal College of Veterinary Surgeons (RCVS) themselves. By this I mean the legislation / professional conduct requirements that they set that veterinary surgeons have to abide by. Although ironically the CMA investigation will potentially enable change of some of the outdated and unworkable legislation that is currently in existence, and this is actually welcomed by the vast majority of vets that are aware of these “failures”.
What do I mean by RCVS requirements precluding easy provision of such widespead mobile services?
For example - a veterinary surgeon or business who provides a service even a simple vaccine is legally obliged to ensure that there is emergency cover for a period of 48-72 hours after the event. Something that often these pop up bargain vaccine clinics often do not actually have, and clients taking up this vaccine service are unaware that should be available to them.
How are these mobile one man band services going to provide this? Remember point 1) above - mindset difference - the vast majority of SA vets do not wish or expect to provide an Out of Hours service - that boat has already sailed believe you me!!
2nd example - there is such a thing called a Practice Standards Scheme that currently is voluntary - unless you are a Veterinary Hospital where it is compulsory. This scheme WILL. become compulsory for all “practices”, and this may preclude the mobile truly service providing SA vet - simply because of the kit and administration requirements that they will be “forced” to ensure they can provide.
5) Cost of consultation - by this I mean with an Equine or LA vet if they are “ billing” 4 hours out of 8 then they from a business sense are doing well - an ultimately a veterinary practice has to be a business to survive.
Hence in terms of Eq or LA practice you have a visit fee and then either a consultation fee or minimum time charge. So to actually get my horse seen / examined it will cost me x+y - and this does not include treatment costs, and ultimately x+y will be more than your average walk in SA consult.
If you are about to suggest that they will operate from a designated site then this will attract licence fees / rent etc which implies increased costs.
6) You mention referral centres taking up the more complicated procedures, or those that cannot be done out on the road. A lot of the media hype has actually been driven by the charges that these referral centres are charging - rightly or wrongly, and that is a whole different conversation.
These charges have ultimately been driven by the wish of both veterinary individual and the client to offer the very best service to the animal, and this comes at an obvious cost.
Yes, a vet can and should offer a more cost conscious option or tailored to clients expectations, but this will come at the understanding by the client that things may not “go to plan” and therefore there is an inherent risk of either further treatment and, from a worsening clinical picture, or even the consideration that the animal will need to be put down.
Now society’s attitude has changed in the last 20 years, - everyone is entitled to everything, ownership does not with responsibility, and it is always somebody else’s fault.
And this increase in risk of something not going to plan is something that an ever increasing number of the public are not “able” to accept.
Never mind Lord forbid, discussing with the client that really due to animal status and indeed client financial capabilities the animal should be put down. “How dare you suggest I should put Fido down, I am going to report you!”
Remember that to most owners these animals are a member of the family- indeed despite the subject matter and tone of this thread numerous contributors have said they could not put their own dog down.
7) These “referral” centres will not necessarily be what we know as your typical referral centres today, but much like ourselves a very high standard first opinion practice with additional referral services attached.
Indeed, we have seen these mobile services pop up from time to time and indeed have “supported” them with the very arrangements you have suggested, even providing the OOHs emergency service back up while they simply operate during the comfortable hours of 9am - 5pm; and each one of these mobile services have fizzled out after a couple of years due to a variety of reasons such as client dissatisfaction with the mobile service, economic viability of the mobile business, and indeed the mobile vet’s expectations of service provision.
8) Those practices providing this additional back up, will also obviously lose some of the bread and butter work that financially supports some of the less productive or indeed financially loss making aspects of the business. If this reaches a critical mass then, those services will be scaled back or indeed a financial levy placed on the mobile business which in turn will be passed on to the mobile vet’s clients.
And by loss making I will give you an example from ourselves- the OOHs.
We are the only practice in a very wide area that provides our clients with this service, and as mentioned we lose money on it and have extreme difficulty in recruitment and retention, because we require our clinical teams to work provide this cover; and that is despite time off in lieu the next day, and or before the night duty, and additional payment for undertaking the duty on top of their hourly rate.
It is a service that we feel passionate in providing for the benefit of our clients, and something we are now gratefully seeing on some of the usual social media bashing threads where there is a thread about our “costs” and then the replies that yes they they are not cheap but ……… provides their own OOHs services for which I as a client of theirs am grateful for.
Recognition of this type by even a few clients makes an unbelievable difference to our teams in this day and age of often unwarranted and at times downright lies that are peddled on some these different social media site threads where the posters simply do not have to take account of their words.
This service is something we have fought tooth and nail to provide over the last 2-3 years post COVID and at a massive cost both financially and in human terms. If we stopped our OOHs I can guarantee our recruitment and retention difficulties would be solved overnight!
So with these difficulties why should practices such as ours just pick up the “difficult” end of the stick??
And in the case of our clinical teams I will publicly thank them here and now for their loyalty and dedication to our clients.
All of the above are just a few of the difficulties in provision of a good service to the client by such mobile services. Ultimately it comes down to the expectations of service by todays clients and the expectations of the “modern” clinician.
So as an old fashioned duty bound vet, that has spent enough time with this, I am now going out in the garden.
If you have read all of this thank you and I apologise for any typos - fat fingers and IPad syndrome!
ATB,
HL
)
