Busting out the big questions on medical protocols, patient care and client satisfaction: Is it better or worse in corporate?

Pardon me, I'd like to ask a question ....The dvm360.com editors analyzed data, mined our shared market knowledge and had many long (like really, really LONG) meetings about how we'd address the issue of corporate medicine, especially in light of recent events.

This was created as part of the dvm360 leadership challenge: Go your own way. For more articles in this package, click the icon above.In the end, we decided it was best to ask our "brain trust" for their real-life experiences and perspectives. We created a panel made up of regular contributors, new faces and industry veterans, who together create a spectrum of voices that represent the many angles of this issue. Three elements kept rising to the top of our minds: corporate-mandated medical protocols, patient care and client satisfaction. So we asked our panel to discuss it all-here are their opinions. (P.S. Got beef with any of this? Tell us. Email vetted@ubm.com.)

Do you think patient care suffers or is improved in corporate practice?

Private practices interested in successfully competing against corporations should stop dismissing the medicine and client service that corporations provide as inferior. Corporations don't recruit their employees from some 'evil vet professional' pool. The people working in corporate veterinary practices possess the same compassion, integrity and concerns for patient and client well-being as those that work in private practice.

-Bash Halow, LVT, CVPM

Being part of a corporate practice has advantages. One is lower overhead and greater purchasing power, providing that practice a higher profit margin. This allows the practice to purchase additional medications to stock for the clients, new diagnostic tools, cheaper in-house blood work, in-house ultrasound machines, or new CT or MRI for specialty hospitals. These savings allow for better medical care.

-Garret Pachtinger, VMD, DACVECC

Patient care improves. I don't think there's room for it to suffer. You can't really be a big player, [with] five, 10, 20 hospitals or more, without being pretty careful about the level of care you provide. You could argue that quality of care suffers if the staff morale suffers [after a corporation buys a private practice]. If you don't have the same positive vibe as before, that's a possibility.

-Jeff Rothstein, DVM

Overall, in my experience at corporate practice, patient care suffered.

-Kat Hodes, DVM

In practices with mandated medical protocols (speaking directly about corporate practices that do this)-What is the effect on patient care practices?

Opponents to mandated medical protocols argue that they don't allow the veterinarian and the client enough wiggle room to negotiate a treatment plan that's best for the pet and the client, but I think we should do more to help clients understand the value of prevention and to prepare for its expense, rather than negotiate our standard of care down to accommodate concerns about price or pushback.

-Halow

If the protocols are essentially checklists designed to help a veterinarian with their history taking and consistently perform a thorough physical examination, then I think such practices are necessary. If such protocols are designed to require a veterinarian to make certain diagnostic or therapeutic choices on algorithms, not backed by evidence-based criteria, then such practices could-and likely do-contribute to poor patient care (excessive, unnecessary, expensive and potentially harmful) while minimizing the training and experience of the clinician.

-Dave Bruyette, DVM, DACVIM

The expectations at Banfield are intended to help the doctor ensure the pet's safety in providing gold-standard care. I had a devastating experience during my time in private practice. The pet stopped breathing during surgery, but because the necessary precautions weren't in place before anesthesia, we weren't able to revive that pet. If anything, standards of care in this case could have helped us avoid the lapse in judgment and state of panic that ensued-and ultimately could have prevented this particular pet's death. From my perspective, expectations and guidelines in any type of practice help doctors exercise sound judgment when compromised.

-Kimberly-Ann Therrien, DVM, VP of Veterinary Quality at Banfield Pet Hospital

The quality of patient care is directly tied to the individuals providing the care. I know some in independent practice have an idea of corporate practice as cookbook medicine, and I guess that's OK as long as the cookbook is complete and the patient's needs are applicable. Now, if we consider what some might call 'cookbook medicine' as putting some degree of minimum standards in place on somewhat of a national level, I believe this is a good thing. As long as professional judgment is guided by evidence and the scientific method, it ought to be employed on a daily basis. Short of this, judgment can be a tricky thing, depending on who's employing it.

-Ryan Gates, DVM

Protocols can be helpful if based on sound scientific evidence and best practices. Professional judgment kicks in when things are not responding as they should. So, evidence-based medical decisions are much more valuable than our own professional judgments, which have been shown to be wrong much more frequently than we would care to admit.

-Greg Nutt, DVM

Working in a BluePearl practice, now Mars Petcare, my position is not defined by a set of protocols. With that said, being in a larger network of practices with numerous specialists, we've created protocol designed to minimize risk for our patients. For example, if a protocol is established for a patient that requires anesthesia, this is a guideline or checklist to reduce patient risk. These guidelines have been used in human medicine for some time to reduce patient risk and hospital liability in a medical setting. These have been created by specialists in the field after experience and research. It does not cloud or change my judgment. I am free to practice medicine. But I am supported by others and by created protocols to improve all care to our patients.

-Dr. Pachtinger

Do you think clients have a different overall experience in corporate practice vs. independent practice? Is it better or worse, and why?

If you compare well-run, up-to-date practices, both private and corporate, I think most clients feel more of a connection to the private practice-those who have skin in the game and are committed to the community.

-Dr. Nutt

Having previously worked at a large corporate practice and now seeing former clients and patients of theirs in my role in private practice, I think the client experience is OK, but not great. And the doctor turnover there is probably the worst part for client experience-they never can count on seeing the same doctor.

-Dr. Hodes

I do think that veterinarian-client time can be limited [in corporate practice], especially in the cluster scheduling model. It's hard to focus in an exam room when you know you have three more rooms that are waiting for you.

-Sarah Wooten, DVM

As an independent practice owner, I never see the clients who are thrilled with the corporate experience. I do, however, see the clients dissatisfied with the corporate experience. I've seen the client who has, through a "plan," purchased tests, treatments and vaccines that the patient doesn't need. I've seen the potential client who wants a second opinion but doesn't want to pay for it because they've already paid for a health plan elsewhere. And I've seen the client who just wants the personal feel of a small, community-oriented healthcare team.

-Dr. Gates

Our panel includes:

Bash Halow, CVPM, LVT, a partner with Halow Tassava Consulting, a frequent speaker at the CVC conferences and a regular contributor to dvm360.com and Firstline Editorial Advisory Board member.

Garret Pachtinger, VMD, DACVECC, an emergency and critical care clinician at Veterinary Specialty and Emergency Center in Levittown, Pennsylvania, and Philadelphia, Pennsylvania. He is also the chief operating officer for VetGirl.

Jeff Rothstein, DVM, MBA, president of the Progressive Pet Animal Hospitals and Management Group in Michigan.

Kat Hodes, DVM, an associate veterinarian at KC Cat Clinic in Kansas City, Missouri. 

David Bruyette, DVM, DACVIM, Medical Director at the West Los Angeles Animal Hospital and CEO of Veterinary Diagnostic Investigation and Consultation.

Kimberly-Ann Therrien, DVM, vice president of Veterinary Quality at Banfield Pet Hospital.

Ryan Gates, DVM, owner at Cuyahoga Falls Veterinary Clinic in Cuyahoga Falls, Ohio.

Greg Nutt, DVM, owner of Riverstone Animal Hospital in Canton, Georgia. 

Sarah Wooten, DVM, an associate at Sheep's Draw Animal Hospital in Greeley, Colorado. She contributes frequently to dvm360.com and also speaks at the CVC veterinary conferences.

Jessica Goodman Lee, CVPM, a practice management consultant for Pinnacle Integrated Veterinary Solutions.

Elizabeth Noyes, DVM, an associate veterinarian in Winchester, Virginia.

Ori Scislowicz, BS, LVT, a team leader at CVCA - Cardiac Care for Pets in Richmond, Virginia.