drferox:

legalist217:

drferox:

Mate, I have many potent, insider opinions about GreenX and the rise of corporate medicine. I have been considering writing on this topic for a while, but now seems as good a time as any.

But first, full disclosure of where I stand within the veterinary industry. I am an associate veterinarian, which means I work in a practice but don’t own it, and I work two jobs. My full time job is in private practice owned by a single vet who actually works there. My casual job is at an emergency center, owned by GreenX. I have also done relief work at a GreenX clinic.

And frankly, the more I work for GreenX, the more it makes me cheer on worker-owned co-ops.

GreenX is just one of the multi-practice corporate vet chains which are popping up not just in Australia, but overseas. GreenX is just the largest and is actually on the stock exchange. You can buy shares in GreenX. That means GreenX is accountable to its shareholders and expected to make a healthy profit.

GreenX owns large numbers of vet practices across Australia, but also owns all the Animal Emergency Centers, all the Petbarn brand pet stores, an external veterinary diagnostic laboratory, at least one crematorium, a number of specialist hospitals and runs the admin side for at least one university teaching hospital.

It also currently operates a ‘Healthy Pets Plus’ program, where for just $450 a year you can get free consults, and is working on bringing out its own pet insurance line.

How are you feeling about this? A little uneasy?

I have concerns about a monopoly, because in my neck of the woods GreenX owns the 4 closest 24 hour emergency vet clinics, in addition to all the others around the city, so I don’t really have much of a choice where to send my patients. They also own quite a lot of the general practices in my local region, so that’s hard to compete with.

For a few years there, they also sent a letter to my boss every year offering to buy his practice. Just a form letter, which I assume they sent out to lots of practices in a similar way.

They pay for all their vet employees to be Australian Veterinary Association members, which grants us all a voice and vote in relevant matters, but not to receive the Australian Veterinary Journal. I don’t know whether GreenX gets corporate discounts for signing up so many members. This makes me uneasy because Banfield in the USA, which is owned by Mars, financially rewards its employees for taking up leadership positions with the various representative organizations over there. Which means if it ever comes up, corporation is paying for a lot of people to be there if an important vote ever comes up…

I mean, I’m not a conspiracy nut, but I’m not exactly happy.

But that is the corporation side, the people on the ground are not the corporation. They are by and large decent vets and nurses hamstrung by the corporate rules they’re obliged to follow. For some this works out fine, particularly in their early years. They have a structured training plan and can see where to advance in the corporation. It provides a willing buyer for a practice owner who might otherwise have been unable to receive the price they were seeking (another issue for another day). It has removed some of the management stress from vets in many clinics and dispersed it, allowing a pool of locums to be drawn from to fill in absences.

Doing so has added a lot of middle management and a lot of red tape. They are frequently recruiting at industry events, and promoting their chain at events like the Dog Lovers Show.

Working on the ground as one of their casual emergency vets I am profoundly dissatisfied. Considering we are supposed to be a top of the line intensive care clinic some of my complaints and concerns have included:

• The introduction of Healthy Pets Plus robbing the clinic of its emergency consult fee ($165) and crediting only $10 to our ‘income’ for that month.
• Then having the gall to turn around and say that because we are not making as much money this quarter as we used to, our budget is reduced.
• Not offering staff a worthwhile wage to do night shift, so unable to retain them very long.
• Not paying emergency nurses anything above the award wage (minimum wage for the industry), even if they have been employed at that practice multiple years.
• Nowhere to advance unless you pursue a position in management.
• Not granting even a cost of living pay rise (in line with inflation) despite meeting expected profit targets for three years.
• Telling employees they are not allowed to discuss their wages with each other, which I’m pretty damn sure is illegal and is definitely shady.
• Not paying superannuation properly.
• Not paying vets and nurses in management positions their backpay in a timely manner.
• Making it ridiculously difficult to access your payslips to see if you were paid properly.
• Needing to get approval months in advance to order extra stock for busy times of year
• Watching the sheer stress of being a manager at these clinics wear good people down to the bone or brink of madness.
• Once GreenX has bought into a practice, it’s nearly impossible to get rid of them.
• Acquiring a practice and promising ‘nothing will change’, that all the things we like will stay the same. Only to change those things, slowly, over the following 3-5 years to match the other clinics in the chain.

Mandatory tea break.

I have also listened to management-types of GreenX make arguments for having unpaid internships in general practice for newly graduated veterinarians, for 12 weeks.

And just about lost my banana over it.

Unpaid. For Twelve weeks. Straight after graduation where they’ve qualified as veterinarians.

Oh hell no.

Interns typically get paid less anyway, and a new grad vet wage isn’t all that much. But they wanted to pay nothing for the first 3 months.

Why? Because new graduate vets are not profitable at the start, they typically cost the practice money as they get themselves established. Everyone knows this, it’s part of the deal when you take on a new grad.

Having to work 3 months straight out of uni for zero pay is insane, it’s almost murderous, and it’s simply evil. This plan was ripe for abuse.

It was also vocally shouted down at the PANPAC conference where it was suggested, thankfully, but these are non-vet, corporate types of people trying to run a series of vet practices for profit.

I just want to be the friendly neighborhood vet on the corner, you know? Just local, quality service where I can get to know the pets over time, and schoolkids aren’t afraid to bring in an injured bird if they find one in the playground. To be part of that community.

And this is what most vet practices have been. You own your job, you don’t need to make a massive profit, just enough to keep doing what you want to do.

But now GreenX has shareholders. The business owners are not on the ground with the rest of us. I have concerns and I don’t like it.

That is not to be negative to those working for Greencross, the boots on the ground that are probably not being treated as well as they should, but need a job to keep the lights on. For some the structure suits them. For some it’s just a job. It is the team on the ground that is the only reason I started working for them in the first place, and stayed.

But do I wish it was something other than GreenX? Yes.

UPDATE: I’d like to contribute in this discussion some ‘advice’ that was shared on Facebook. Members of this particular group are warned to be careful what they post as it’s not a private group and anybody can take a screenshot, so I think that’s fair game.

I do not like this. I do not like this at all. I can’t even tell if it’s satire or trolling, because it’s too close to the truth.

Not only does it make it look like it’s now all about the money (which it is, for the shareholders) it reduces veterinary medicine to a numbers game. By this metric, a ‘good vet’ is one that earns $300 per consult, and twice as much of their billing comes from lab fees as consult fees. They also admit almost a third of their consults.

Doesn’t matter if clients like them, if they solve cases or achieve good medical outcomes. All the qualitative stuff is gone, just the dollar values.

(Oh, and if you meet those metrics, you’re in no way guaranteed to get a pay rise. From experience).

Now it is entirely possible to meet those metrics just by working your cases appropriately and seeing a lot of them, but thinking like this pushes vets, especially young vets who want a pay rise so they can afford their own car, home, etc, to be thinking of the dollars and not the animal or client as they practice.

Maybe I am old fashioned or a dying breed during the rise of corporate veterinary medicine, but I am profoundly uncomfortable with this. Worse, it leaves a bitter taste in my mouth, and a strong feeling of this is not my veterinary medicine.

I am heartened to see most of the comments on that thread from angry, like-minded vets insulted at being reduced to ‘trained monkeys’ and focusing on these metrics instead of patient outcomes and client satisfaction, but as GreenX picks up more and more young vets, training them to fit its mold, I am afraid of more of them being modeled into what GreenX wants, or becoming disillusioned and leaving the profession early.

So, I work in the States in human health insurance–so big disclaimers about how much this may or may not be helpful. Still… your bullet points about the emergency clinic STRONGLY resemble what has already played out with human preventive medicine. 

Without sounding like a conspiracy theorist myself, it seems like there’s three groups: providers, members, and the insurance company. You can pick two (2) to satisfy with the arrangement. The way it shakes out right now is great for the insurance company and the member but necessitates the provider eating preventive service costs. And then when it’s subsidized by the government, this gets looped back into taxes… I’ll stop there, but that’s what it sounds like GreenX is directing y’all into.

As to the facebook post, that’s what drove me to write this out. I don’t know what the legal status of pet insurance is in Australia or anywhere else for that matter. I’m somewhat assuming it’s still the Wild West. Reason being? In USA human medicine, a provider who “works up” cases so that there’s twice as much lab fees for every dollar of consultation–when done deliberately in human medicine in the USA, it’s considered at best waste or abuse, at worst outright fraud. Here’s a link to the official fraud prevention training from Medicare, if anyone’s deeply curious. 

Your instinct is absolutely right. Honestly, it makes me happy that you didn’t have a buzzword response for it, though, because maybe that means it’s not common in veterinary medicine. I want y’all to be able to be good family pet doctors, too. Best wishes going forward, hope this at least reassures you that you aren’t getting old and crotchety. (Question tax, even though this isn’t one: Came and stayed for the thoughtful perspective on a world I don’t see on account of not having pets. Thanks for being a pleasure to follow.) 

So, ‘Medicare’ in Australia is the name of our system to provide free health care to citizens, I’m not sure how USA Medicare runs, but there are some interesting parallels.

GreenX clinics absolutely do self-refer. If I’m in emergency and I have a patient that needs a specialist, I’m supposed to send it to the GreenX owned hospital 30 minutes away, not the independent one down the road, unless the client specifically requests it. Which leads me to telling them they need to request it.

If a client doesn’t have a regular vet, we’re supposed to encourage them to see a GreenX clinic too. We were supposed to use the GreenX owned labs. I’m just waiting for them to buy a wholesaler. They are accumulating an entire supply chain of vet services.

I should also mention that GreenX is also rumored to be developing it’s own Pet Insurance.

I am worried because I don’t think I’ll be able to buy my own workplace when my boss wants to retire. I am worried I will run out of employment options in independent clinics.

These posts are not meant to drive people away from GreenX and similar corporates, by the way. I was just asked what I thought.