When I first came to Los Angeles for my internship and surgical residency at the California Animal Hospital (CAH), the California Animal Hospital was without a doubt at the time the preeminent general practice specialty facility in the Los Angeles area. Our cases would draw from San Diego to Santa Barbara to Las Vegas and Arizona and just about everywhere in-between, and the case load and the extent to which cases were worked up and successfully treated with state of the art medicine and surgery were unrivaled in the California area, if not in the United States.
Over the years, however, as there has been a steady influx of veterinary specialists into private practice, the unique nature of the CAH began to fade. It became apparent to many veterinary practitioners that it was difficult to refer cases hundreds of miles to a specialty facility. This is what they were used to, which is why the CAH enjoyed such preeminence for such a long period of time. There was a collection of specialists under one roof that rivaled any university. Because general practitioners were used to sending cases to the university teaching hospitals, there was no reluctance to do so when California Animal Hospital became one of the foremost privately owned general practices outside of the university setting to provide these services.
The success of California Animal Hospital, however, prompted other entrepreneurial veterinarians to look to employ board certified specialists leaving the universities at their private practice facilities, and for that reason, hospitals following the CAH model would spring up in places like Santa Barbara, San Diego, Las Vegas, Phoenix, etc. Certainly, this decreased the drawing power of the CAH and the case load eventually diminished. This was one of the biggest fears of the university teaching hospitals; they realized that as they would turn out board certified specialists, they would leave for the private sector, because of the greater freedom emotionally and financially that the veterinarians would have with regards to practicing veterinary medicine and surgery. In addition, those that did not have specific research interests or teaching interests would flourish there.
I’m happy to say that the internship and surgical residency that I had completed at California Animal Hospital was the first conforming surgical residency program outside of the university setting in the United States. So, in some way, shape, or form, I know that I had a profound influence on the success of this type of a training program and the eventual incorporation of training and employing specialists at private practice facilities. This absolutely had an impact on the landscape of the veterinary medical field. As more good, solid general practices added specialists and teaching and training interests to their faculty and staff, it resulted in a phenomenal access of specialty care to the general public quickly and easily, and with great accessibility that previously was unheard of, in light of the fact as mentioned previously, one would have to travel hundreds of miles more often than not to a veterinary teaching hospital for these very same services.
It is for this reason that there are a number of excellent veterinary specialty practices throughout the greater Los Angeles area, including those in Ventura, Glendale/Pasadena area, San Diego region, as well as a number of specialty facilities here within the West L.A. region. It’s interesting to note that a number of the specialty facilities within the West Los Angeles area were basically disciples of the original California Animal Hospital system. This occurred because the powers that be at the California Animal Hospital made the business decisions that it was worth letting some of the specialists that they trained to move out and establish their own separate referral facilities, myself included, rather than to continue to keep us on in their employ to continue the tradition.
This is one of the reasons why, in my opinion, the California Animal Hospital has become over the years nothing more than a glorified general practice with nowhere near the prestige or referral center status that it had enjoyed during its hay day. The reason for this migration of a number of specialists from the CAH is not the purpose of this discussion. I just point it out as a matter of fact, because it does play a role in the eventual development of veterinary services as provided in the Los Angeles area.
As much as the training and employment of veterinary specialists in the private practice sector has influenced veterinary medicine, the one other major change in the veterinary field has been the emergence of corporate medical practices. In the Los Angeles area, the origin of the corporate practice was the incipience of VCA (Veterinary Centers of America) originating at the original West Los Angeles Veterinary Medical Group. WLA VMG was CAH immediate neighbor and competitor, so to speak, but it was competitive, once again, in my opinion in name only – not in reputation.
The corporate managers of VCA initially made offers to the partners at CAH to become their flagship corporate veterinary hospital, but were declined. The owners of WLA VMG, however, saw things differently and did indeed decide to incorporate with VCA. Over the years VCA has become an entity of three hundred plus veterinary hospitals across the United States. When it began roughly fifteen to eighteen or so years ago, the question was would corporate veterinary ownership survive? Obviously, the answer is a resounding – yes! In fact, while there are other veterinary corporate groups out there, VCA is certainly the first and foremost regards to sheer numbers and delivery of service.
While there are numerous independently owned veterinary hospitals across the country, it’s projected that anywhere between thirty to maybe even forty percent of the practices will be under some degree of corporate management over the course of the next ten to fifteen years, therefore, tremendously changing the landscape with regards to the delivery of veterinary medical care.
Over the last few years, as mentioned previously, other corporate veterinary medical groups have emerged seeking to copy the VCA protocols – not all of them successfully. It’s interesting to note that eventually California Animal Hospital became a corporate entity along with twenty other hospitals in California under the group known as ‘Pet Doctor.’ Also, as mentioned previously, not all of these corporate ventures were as successful as the VCA. In fact, recently, in light of the economy and perhaps over expansion or other factors at which I could only speculate, the Pet Doctor Group was struggling and in fact, was recently acquired in its entirety by the VCA. I know somewhere the board of VCA is smiling smugly that although many years have passed since their initial offering to those in charge of CAH, that eventually they have now come to own them ‘lock, stock, and barrel.’
Now, what does this history lesson of the practice of veterinary medicine in the Los Angeles area have to do with today’s current state of delivery of veterinary services mean? Veterinary specialty facilities or mini-specialty niche practices have always advertised to individual veterinary practices throughout their region directly. By this, I mean that they would call on the owners of these independent facilities, tell them about the services that they provided and why they were the best group out there for cases to be referred to them for treatment. As you could imagine, as more and more of the better, well managed independent veterinary hospitals are being swallowed up by corporate entities, the cases from these facilities are being directed to the corporate veterinary medical center regional specialty facility.
This means that there are less potential cases available for referral to these individual privately owned specialty facilities. In other words, there just aren’t as many cases coming in, similar to the situation that occurred years previously at the university level when the notion of private practice specialty hospitals first came into existence. This is one of the reasons why specialty only veterinary facilities that are independently owned are facing a huge financial crisis and why there are downsizing of many of these as exemplified with the release and downsizing of their specialty staff; there just aren’t enough cases to keep them growing at the rate they were as in the past. Certainly, the current economic climate plays a role as well. However, as recently as this last week, the American College of Veterinary Internal Medicine was meeting in Anaheim. On their job posting board, there are eight job openings in the entire United States that are being advertised to be filled by internal medical specialists. In years past, people would pin postings on top of other postings, on top of other postings in order to just be able to get the word out that they were interested in hiring specialists in private practice. The fact that only eight such positions are even being offered in the United States at this point in time is testimony to the fact that these individual facilities are no longer growing at the rate that they were and are in all probability stagnating at their current level or in fact, shrinking.
The implication is that the old model of a veterinary specialty facility advertising its services to individually owned practices in order to generate referrals is no longer applicable. The greater and greater incorporation of practices under a corporate umbrella has changed the playing field, such that the majority of cases are now being seen by corporately owned veterinary specialty facilities and the independent specialty facilities will likely see rocky roads ahead with regards to their economic health.
How does this relate to the Animal Medical Center of Southern California? Well, in the years that have passed since I went out on my own, after having left CAH, I had the opportunity to be engaged in a multi specialty facility. I made the decision a number of years ago that rather than become a large independently owned veterinary specialty facility, that I would rather pursue a route of being an excellent veterinary facility providing twenty-four hour emergency and critical and intensive care as well as general practice, boarding, grooming, and specialty services. I’m delighted to say that we have achieved these dreams. The AMC is one of only a very few facilities that is independently owned and operated and is not under a corporate umbrella that provides this wealth of services. Rather than relying on other general practices to send us their referral cases, we have relied more on high levels of personal service and care and reaching out to the general pet owning public for their patronage and support. This has obviously proved to be an intelligent and rewarding pursuit as we have continued to grow even in the current economic climate and the emergence of corporate care and multiple specialists being employed in the private practice domain.
Has it been easy? No! There are many doctors in the Los Angeles area that specifically prefer not to refer cases to our facility because we perform and practice general veterinary and emergency care. They are concerned that once one of their clients experiences the level of care and service that they receive at our facility, they will stay on for continued general veterinary care rather than returning to the original hospitals from whence they came. This, of course, is ludicrous. Every time a patient is specifically referred to us by another doctor in the area, the cases are absolutely referred back to them for continued veterinary care once the management of our part of the case has been completed.
Cases, however, are consistently presented to us not from a direct referral, but through word of mouth from clients who have had excellent services rendered to them and as everybody knows, people who own animals usually know other people who own animals and they talk to each other. If one person has a positive experience at our facility with regards to a dog who had a fractured limb, a torn out knee, a herniating disc, a tumor in the chest, or a foreign body stuck in an intestine, and then has a friend ask them, “What do you think I should do? My dog has a similar problem, I’ve been told to go to this hospital?” Usually, they’re going to say, “Don’t go there, and go to this place. Go to the Animal Medical Center. Their service is great, they’re there twenty-four seven, and they provide an excellent level of technical expertise.” They’re going to come to us.
The general practitioners in the area who were loathed to refer to us in the first place, now will play victim – “Oh, I knew it. You see, a case goes to Alan and I don’t get it back.” What they don’t realize is that if it were a direct referral, it would go back to them. But, if they’re not supporting us and these people want to be treated at our facility (because of clients from our facility having referred them to us), we’re more than happy to take them on. If we weren’t good at what we do, they would not want to stay with us. In my interpretation, this is not a ‘me’ problem, it’s a ‘you’ problem. What I mean by ‘you,’ are those facilities that were hesitant to refer to us in the first place. There’s a reason why the clients want to stay at our facility and not go back. It’s a combination of the excellent technical veterinary care that they get as well as our having our own twenty-four hour emergency, critical care, and intensive care treatment facility available and having specialists under one roof in order to take care of all types of advanced problems, as well as provide general practice. In other words, you’re getting board certified specialists and their depth and breadth of knowledge applied not only to specialty cases, but to everyday, general cases. And trust me, that makes a big difference in the level of veterinary care that your dog or cat is receiving.
Rather than see the light and amend their general services or delivery of services to their clientele, they would rather see me as the evil empire. What they don’t realize is that I’m nothing more than something the size of a smart car coming at them head-on. They are totally missing the fact that there is a freight train known as corporate medicine approaching from the rear that is about to wipe them out. If they continue to run their practices the way that they have, they might as well line up right now to become taken over by a corporate medical group.
Why don’t these other practices provide this level of service to their clients? Why don’t they make it easier on their clients by having twenty-four hour care, so that in the event of an emergency, the client does not have to travel back and forth with their pet to and from an emergency facility each night or even once? That’s a great question. I guess you’re going to have to ask them. But obviously, they don’t feel the need to provide these types of services for their existing clientele; but, all it takes is one word of mouth referral to these clients to point out the fact that obviously their patronage isn’t appreciated and so they seek out a facility that will indeed provide it to them. A facility like the Animal Medical Center.
So, that begs the question – why is it preferable to go to a facility like the Animal Medical Center rather than a big corporate medical practice? I think the answer to that question is intuitively obvious. If you really think that corporate medicine provides the best delivery of health care possible, then you would be satisfied and delighted at the current level of delivery of medical services to people here in the United States. Obviously, becoming the Kaiser of the veterinary field does not necessarily ensure that you will be consistently delivering personalized high quality care. More and more physicians in the United States are abandoning the corporate medical delivery system and opting to provide what is known as ‘concierge care,’ which is in a nutshell, being extremely attentive to their clients needs as well as providing a multitude of services in order to be able to personally administer extremely high levels of personalized care.
The advantages of being a client of the Animal Medical Center is being able to take advantage of this consistently personalized care in an emergency, general practice, and specialty setting without having to roam all over the city to be able to have your pet’s needs attended to. The consistency and longevity of the staff of veterinarians and technicians that we have working for us attests to the fact that the model is working well and translates into a much more pleasurable experience for you and your pet as you know you’re a member of our family, because we’ve gotten to know you so well over many years. This is certainly not the norm at corporate medical practices, but it is in fact the norm at our facility.
If you’re looking for excellence beyond the standard of care with attention to detail and personalized service for you and your pet, we would like to extend this invitation and welcome you into our facility and look forward to a long and healthy relationship with both you and your pet. As a practicing veterinarian for over twenty-seven years in the Los Angeles area, more of twenty of which have been as a board certified specialist, I welcome the opportunity to work with you and your pet to ensure their health and well-being.