The text Veterinary Medicine & Practice -- 25 years in the Future -- and the Economic Steps to Get There provides these options in much greater detail and discussion. Here we want to summarize the diversity that may be encountered in the coming years.

The new millennium saw the average practice size as two-point-six doctors, and about four staff per doctor in the better companion animal practices. This is called statistical bias. The fact was that most metroplex communities had a proliferation of one-doctor storefront practices, who were unwilling to pay major future earnings for the right to practice in their own community. In metroplex communities without emergency practices, multiple doctors were often employed, in lieu of the even more rare certified technician, to reduce the evening call demands. In smaller communities, rotaries were used, when the practice did not fear each other, and, therefore, doctor proliferation was not required before its time.

As we entered the new millennium, veterinary schools continued to graduate large classes, regardless of the AVMA/AAHA/AAVMC 1999 Mega Study findings. The major public corporation had started going private, then went back into a second initial public offering (IPO). (Do you even wonder if they are it for the money?). Some of the remaining public players had started franchise-type programs to restore stability in the revolving door of their veterinary practitioner employees. These public players always talked about an economy of scale in their consolidation effort, but had never proved it could produce true net at the venture capitalist level of expectations, as in greater than twenty-five percent return on investment per year. Investors wanted their return on investment (ROI), so the income stream share for practice enhancements could not occur as in the traditional, privately-owned, veterinary facility. Clients, who desired a dependable practice bond, had proven elusive to these consolidator practices, which could not seem to find the formula to keep a quality veterinary professional leadership in each practice. These factors make the options primarily a factor of personal decision for practicing veterinarians, rather than depending on association or legislative action.

The options for the future range from no change to radical changes include:

 One-doctor practices in affiliation with urgent care.

 Two to three-doctor practices in affiliation with a specialty group.

 Urgent care and emergency Practices, plus or minus specialists.

 Improved facility, better flow, and expanded practices.

 Staff-owned hospitals.

 Veterinary extender hospitals, with staff-enhanced gatekeepers.

 Specialty practices.

 Merged/affiliated practices sharing resources.

 Virtual practices or unseen horizons.

The Small Fish Playing in a Small Pond

The small, one-doctor, companion animal veterinary practice, can be very profitable as an outpatient facility, if facilitated with a central inpatient facility. The clients of veterinary practices are already comfortable with their family practitioner using specialists and central hospitals, imaging facilities, and reference labs, so this step is a natural sequella. A companion animal outpatient facility can generate fifty to sixty percent net. Most companion animal practices generate seventy percent of their income from outpatient, for about thirty percent of their overhead.

The Small Fish, Who Keeps Moving

The one-doctor ambulatory veterinarian comes in two basic flavors: the mixed animal doctor and the companion animal house-call veterinarian. Sometimes the one-doctor ambulatory clinicians are those who like to work with horses, and if there is a backyard horse population being supported, it is seldom a highly profitable endeavor. Although as a second income, it is adequate. The companion animal house-call practice is an emerging economic entity, especially as shut-ins and home elder care increase. Since the overhead is kept minimal in either case, the practice can be profitable. If affiliated with a fixed facility for inpatient care, as in option six above, veterinary extender hospitals, with staff-enhanced gatekeepers, a full scope of services are available to the clients.

The Small Fish, Playing in a Larger Pond

The outpatient practice affiliation with a central inpatient facility could be by referral, or could be by rental of space, which is a new, but not atypical, situation. In some cases, the outpatient facilities may even build a central hospital for joint use. This has already happened in a few communities, but goes astray, when the owning practices do not understand effective rules of governance. The worst case scenario is the store-front practice, which does not refer. This forms a "stagnant pond", and the level of oxygen provided for life is minimal.

The Desirable Fish, Who Brokers Her/His Ability

The one-doctor relief veterinarian, called "locums" in Canada, will become a "brokered" resource. The one and even two-doctor practices need relief from the twenty-four-seven daily grind, and will seek relief practitioners to give them this needed break from their practice. They will pay a premium for relief doctors, who would not be paid as an associate, until they realize that adequate associate pay for part-time professional support would allow a better continuity of care. Relief doctors needs to know how much they are producing, since they deserve about twenty-five percent of their production, as they are independent contractors.

The Virtual Fish

The next decade will see legal rulings that will permit remote telemetry to replace the doctor-client-patient physical encounter. A new style "virtual veterinary practice (VVP)" will emerge, initially linked to an existing veterinary facility in a major metroplex, but eventually becoming an Internet-based VVP. Regardless of location, metroplex or mountain top, pet owners will be able to hook their companion animal to key "home vet kit" instruments, which check pulse, temperature, blood pressure, vet scan imaging, etc., transmit the pictures to the virtual reality (VR) veterinarian by video link, and have an eye-to-eye discussion.

The Contented Two Fish in a Small Pond

For the Gen-X and Gen-Y graduates, we are seeing two doctors open a one-doctor practice, and each works three-and-a-half days a week. They do not want larger, they want a secure quality of life and a balanced lifestyle. They require a full set of specialists and an emergency practice in referral proximity. They do not try to overlap their duty hours and are highly flexible. If they use veterinary extenders effectively, and keep great medical records based on common standards of care, the client never perceives a loss of continuity.

The "Old Style" Single-Owner Practice, with Associates

The smaller size, full-service, companion animal veterinary practice can offer a better quality of life, if the two doctors or three practitioners shift to four-day work weeks. It will never be as profitable as a pure outpatient facility, nor a well-managed community-based, multi-doctor practice. But it can provide enough money to ensure there is personal capital for outside investments. A full-service, unaffiliated, companion animal facility generates about thirty percent of the income from inpatient, for about seventy percent of their overhead.

The "New Style" Single-Owner Practice, with no Doctor Ownership

This was coming for a long time. Texas had a "widows and orphans regulation", allowing two years of family practice ownership, after the old Doc dies. (If you notice the "sexist" nomenclature, it was just a design of the times, when it was written.) We have seen virtually all state regulations fall to the Federal Trade Commission (FTC), and exclusive veterinarian ownership has been ruled restrictive, except in the State of Oregon, which had it in the law, rather than as a regulation. Some corporate structures enhance the non-veterinarian ownership capability. Even Oregon is working on an affidavit, where a non-veterinarian owner can willfully subscribe to the practice act, and give the state board some leverage to protect the consumer. In these practices, the hospital is run by the paraprofessional staff, not owners!

Practice Affiliations (Non-Binding Cooperation Agreements)

The potential practice affiliations that can add "overhead savings" with other facilities could be for high-priced equipment utilization, where advanced diagnostics are done by referral , such as 500 mA radiology, ultrasound, endoscopes, integrated ECG systems, etc. These practices may also become "gatekeepers" to the specialists in the community. They may also become the "primary diagnostic resource" in the client's mind, similar to the family physician, on the major healthcare insurance programs, in identifying the need, then pointing the client to the best specialist in the expanded veterinary healthcare community.

The Rural Practice

The two to three-doctors mixed animal practice will still be common in the early years of the new millennium. Doctors could continue to do their own thing off the back of their trucks, and share emergency calls to add to their personal quality of life, without having to compromise their practice habits. The economy of scale for procurement will still be minimal, due to competition for drug sales on the farm, not only by the white truck selling drugs, but due to pinpoint delivery of Internet sales. The practice vehicles will still be most cost-effective as individually owned trucks, since the insurance consequence of one vehicle mishap raises all the protection cost of vehicles in the fleet. The capital expense equipment procurement, such as a mobile chute, will allow a small economy of scale, but these acquisitions generally take many years to reach their ROI threshold. When these practices decide to develop a haul-in philosophy, the economy of scale will take on a new perspective, with more emphasis on companion animal.

Upscale Rural Practices

The haul-in mixed-animal veterinary facility, with handling chutes and working stock corrals, which support equine and production animal practices, will evolve to a paraprofessional operation. Road expenses will increase, so the bang-for-buck production response will be to haul-in and save the trip fees. [Note: A recent eight-doctor mixed animal practice had five-and-a-half doctors committed to large animal work, and two-and-a-half doctors were committed to companion animal work. However, as consultants, we showed them that only nineteen-point-nine percent of their gross came from large animal, so a new delivery modality was needed]. The equine and companion animal aspects will be tracked, treated, and operated differently from the "pennies-per-hundred-weight: (cwt) of production animals. They will likely use different managers to ensure the systems are maintained as separate entities, reducing the impact of the veterinarian as a managerial decision maker.

The Control Freak, Wanting to Keep Control

These are the full-service, companion animal, veterinary practice owners, who usually refuse to hire qualified managers, pay for quality nursing staff, or leverage their time and facility by "training to trust" all the resources available. This will be a dead-end-career practice, with one owner trying to control it all, trying to make all the decisions, and sacrificing a personal quality of life for a practice yoke of "I will do it all myself". We call these people professional curmudgeons, old-school control freaks, and/or "Poor Doc". This variation will never offer a better quality of life, but will still be selected by those who cannot (or will not) become leaders of a caring staff of paraprofessional experts.

There are some practice managers, who were raised under this format, who are worse than the doctors. They are afraid of change and more afraid of sharing. They usually ascended to their position by tenure and attrition of all others, so they do not want to release the process control, in fear of losing their positional power. They put down new graduates, because the new generation is not like their tried and true, old curmudgeon, old-school, control-freak, original doctor(s). This is a culture, where there is often a high turnover of paraprofessional staff, and the manager knows it is because of a "poor pool of applicants". They have also convinced the old warhorse practice owner that it's the candidates, not their lack of leadership that has the practice in turmoil. We can change these dynamics, but it is usually under pain and anguish of the core practice management team

The Over-Built Traditional Facility

The fewer doctor-count size, full-service, companion animal veterinary practice can leverage its time and facility by leasing space and staff to a house-call practitioner or ambulatory mixed animal doctor for inpatient service support. This variation will offer a better quality of life, if the doctors share the emergency call rotation. These practices may also become "gatekeepers" to many of the specialists in the community, and become the "primary decision maker" in the client's mind for advanced veterinary healthcare need identification, just like the family physician on the major healthcare insurance programs. In some cases, adding bathing and boarding can use the extra ward space. But it is better to use the staff to bring clients in more often, even for courtesy nursing consultations in nutrition, parasite prevention and control, behavior management, or even dental follow-ups, so the facility becomes more effectively used.

Build a Better Facility and They Will Come

Another option, which will appear in the next couple decades, is facility-based. It is the development of a full-service, companion animal veterinary staff in a larger facility, which many practitioners can access and use. It will be as profitable as the management can derive from economy of scale, due to a single, highly trained staff, who can support many veterinary doctors. A full-service community hospital capitalizes on potential practice affiliations that made the human healthcare delivery model cost effective for family practitioners. These facilities can offer "overhead savings", while consolidating human resource development and training, as well as for high-priced equipment utilization, where advanced diagnostics are available, such as 500 mA radiology, ultrasound, endoscopes, integrated ECG systems, etc.

Ancillary Services as Practice Expanders

The ancillary services, boarding and grooming, as well as pet supply stores, feed stores, and boutiques will expand. One-stop shopping is an American dream. These functions add to the gross, but decrease the total net, so it is best to keep them as separate businesses, while keeping a cross-sale potential. The standard grooming and boarding operations see about twenty-three percent of their guests needing some form of veterinary services. The bathing and boarding usually have a net income component when NOT done by skilled nursing staff. But grooming will probably never be a significant net income source, due to the shortage of quality groomers and the cost to keep them. The economy of scale for boarding will likely remain about thirty-three guests for each animal caretaker FTE eight-hour day, and less in the high people-contact VIP suite areas. The forty percent occupancy during non-holiday seasons will likely stay a reasonable planning number, because increased numbers of people will take their pets on vacation. The new millennium saw fifty percent of the dog owners taking their pets on vacation.

VIP Ancillary Services as Practice Expanders

The VIP pet resort operations have a higher income-to-operating expense ratio, and the larger VIP suites (eight feet by eight feet and eight feet by six feet) will become more common in the next two decades. The staff ratio is higher. It requires about one guest relations/camp counselor/animal caretaker for each sixteen animals in residence. New services will be needed to be further differentiated: exploration zones, yappie hours, people time, Internet visitations, evening chilled canine-yogurt treats, and a host of other innovative service-based offerings, will become mainstream. We even support a facility that has a large stock tank for the water dogs to swim in daily, and another with a one acre play yard. The animals are matched in the training room for harmony, before allowed out to romp and play in the grassy field.

The "Super" Facility

This facility will draw clients by the facility's reputation of fast access to quality veterinary healthcare that is value-based. A spectrum of services will be available, when the client desires access, and the individual provider will become less critical in the decision process. It will draw the "immediate gratification required" by client and patient. The "retail space" probably has become staff-run departments, such as "Bathing Boutique", "Nutritional Center", and "Behavior Center", establishing cute client stories that lend to practice positioning in the community. The mission will have four key elements:

 Ensure the delivery of quality veterinary healthcare services.

 Ensure proper remuneration for the facility and providers.

 Ensure a career progression for the paraprofessional staff of the facility.

 Ensure the establishment of a community market niche.

Multi-Owner Veterinary Complex Options

The most common facility in larger communities will be a multiple-owner, mega-facility, caused by affiliation, junior partner buy-in, or a merger. It will provide an economy-of-scale for fixed facility, a shared paraprofessional staff, and a more effective use of high-cost diagnostic equipment. It may include ancillary services as a new client access source, but will not depend on them, due to a twenty-four-seven service image within the community. For effective operations and staff harmony, this type practice must have an administrator and a governance board, and not have a practicing veterinarian in operational control of management. Veterinarians will have returned to medicine and surgery exclusively. See the text Veterinary Management in Transition: Preparing for the 21^st Century.

Specialists, Perceived or Real

The evolution of specialists and the cost of diagnostic equipment will make diagnostic specialty centers become a necessity. One obvious example is the newer radiology systems that do not use film, just computer plates, which can be "dialed-in" for extra resolution. These systems have dropped from $1 million to $100,000 or less, and in the next two decades will become a viable option to the "heavy metal" radiographic films. In these imaging centers, the newer ultrasound machines and endoscopy services will be concurrently offered. MRI and CT scan services will become available in many of the centers, as well as iodine therapy and chemotherapy programs, which require specialized waste control procedures to meet environmental protection standards.

Specialist-Specific Centers

Veterinary surgery centers will emerge, as surgery specialties become delineated, and as the microsurgery devices proliferate. This will bring lateral specialties into the veterinary surgery centers, such as ophthalmology and neurosurgery. Day surgeries will increase, as well as the use of the specialized surgical augmentation materials, which will be rapidly emerging. Due to the cost and surgical skill requirements, these specialty services/materials will not usually be available to the general practitioner, and case referrals will increase in the new millennium, as specialist-specific centers emerge.

Specialist and Specialty Practitioners will Cluster

The academic-based veterinary teaching hospitals' specialists' effect on the profession will be replaced by private practice specialists as the emerging majority of the advanced veterinary healthcare delivery systems available for referral from the private practice. Since the universities are now so heavily involved in tertiary healthcare delivery and research, the current veterinary students have shown a propensity toward advanced education and specialization, when they come out of these veterinary teaching hospitals. The only place they can go, after academia is filled, is into a private specialty practice setting, which requires them to learn "profit center" management, something never included in their education.

Communication skills will become the success differentiation for these new specialists, be they effective communications with their referring hospitals (RDVMs) or caring communications with the steward of the animal. The healthcare administrator will evolve as an essential element in these practices. These private practice specialists will realize that practicing medicine and surgery is far more profitable than trying to be managers of people and cash flow, and they will finally invest in trained administrators. See the text Veterinary Management In Transition: Preparing for the 21st Century, with eleven self assessment tools to identify if the reader is ready, willing, and able to let go of the "adminis-trivia" process.

The Metroplex Specialty Practice

This is a potential growth area in veterinary medicine, based on outside investors building the facility, and leasing space to specialists. The Veterinary Emergency and Critical Care Society (VECCS) states fifteen thousand square feet is small. The common areas (client receiving), joint use areas (treatment rooms, radiology, wards), and exclusive use areas (surgical suite, endoscopy room, etc.) will have varying costs associated with their use, thus forcing specialists to reconsider their academic "turf" bias and paradigms. Governance systems will become critical elements for harmony and decisions, and skilled veterinary-specific consultants will be needed to guide the professionals in learning these new policy and precedent skills.

The Fast-Entry to Practice Ownership

This is the storefront, or leasehold, practice, probably occupying multiple bays of a complex, but it has built its community reputation based on the efforts of the professional and paraprofessional providers. This is a practice with telephone receptionists, who know how to make appointments and route phone calls to the nursing staff or voice mail system. They may even have Internet appointment capabilities by utilizing high-density scheduling that allows appointments, walk-ins, and emergencies to be integrated into one doctor's multi-consultation room schedule. Client access has been made easier, and compassionate care is the watchword of every member of the team. "High touch" has been a required element of the new "high tech" delivery modalities.

The Fast-Mortgage of Practice Ownership

This is the stand-alone facility, either mixed animal or general companion animal practice. It probably occupies four thousand to ten thousand square feet, depending on the ancillary service philosophy of the owners. They have built their community reputation based on the efforts of the professional and paraprofessional providers, plus their involvement in civic activities, such as church, Rotary, Scouts, etc., are higher than most. This will be a "contemporary feeling" practice, with its use of colors, initial image, ambiance, etc. There will be high-density scheduling of the consultation rooms for nurses and doctors, rather than linear-scheduling of only doctors. It is the healthcare team approach to quality healthcare delivery. They will also have telephone receptionists, who know how to make appointments and route phone calls to the nursing staff or voice mail system. They may even have Internet appointment capabilities by utilizing high-density scheduling that allows appointments, walk-ins, and emergencies to be integrated into one doctor's multi-consultation room schedule. Client access has been made easier, and compassionate care is the watchword of every member of the team. "High touch" has been a required element of the new "high tech" delivery modalities.

Smart Testing of the Waters -- Affiliations

This is the affiliation of multiple facilities, combining storefront (leasehold) outpatient practices with a central hospital. The storefronts may be operated by owners, partial owners, or employed staff, but they are committed to leveraging the diversity and community-based support capabilities of the outpatient facilities, with a consistent provider. The transfer of cases to the central facility will be done by internal ambulance transport or client transfer, depending on the municipality demographic expectations.

 This is a practice complex with centralized telephone receptionists and client relations staff, people who know how to do follow-up, as well as make appointments at any of the facilities. They also route phone calls to the appropriate nursing staff or voice mail system.

 Client access has been made easier "close to home", and compassionate care is the watchword of every member within the complex team. "High touch" has been entrenched as a required element of the new "high tech" and diversified delivery modalities.

 There are no legal documents at this point. This is a "train to trust" situation for practice owners.

 This system will have Internet appointment capabilities by utilizing high-density scheduling that allows appointments, walk-ins, and emergencies to be integrated into one doctor's multi-consultation room schedule.

 Each of the facilities will have managers, with one administrator as the mentor and developer of the integrated system. The managers will operate each facility with a client-centered focus, patient advocacy, and quality of life concern for all staff. During duty hours, the veterinarians are only touching animals, talking to clients, or accessing professional consultations on the Internet.

 The administrator will have an advanced degree, or outside healthcare set of leadership skills. The managers and coordinators will be skilled paraprofessionals, probably with CVPM or equivalent designations of training expertise, or in some stage of active acquisition of these credentials.

Change from Being a Manger to Becoming an Uncommon Leader

The uncommon leader is emerging, and career progression within a veterinary staff is starting to become a reality in the progressive practices:

 The veterinarian(s) have hired and trained the "zone coordinators" to operate the hospital with a client-centered focus, patient advocacy, and quality of life concern for all staff. During duty hours, veterinarians are only touching animals, talking to clients, or accessing professional consultations on the Internet. The zone coordinators are skilled paraprofessionals, probably with CVPM or equivalent designations of training expertise, or in some stage of active acquisition of these credentials.

 Client greeters, patient escorts, and/or more open architecture are replacing the "front counter". Quiet one-on-one interviews in the consultation room, or at a small desk, are replacing the sit-down-over-there-and-complete-the-forms-on-this-clipboard mentality.

 Workstations are emerging, not only for Internet research of inventory, tele-medicine case studies, and literature reviews, but for continuing education and degree completion from distance learning sources.

 Nurse practitioners will emerge, facility and software formats will be modified, and initial access cases will be scheduled as a primary caseload, first in wellness care and later in preventive medicine areas.

 Glass walls and interior windows are becoming commonplace in treatment rooms and work areas, so one doctor can monitor and support multiple inpatient nurse workstations concurrently.

 Facilities are starting to add "externship" departments, so students can have an economical opportunity to experience practice in a real primary care facility.

 Storage rooms are being replaced by vendor support, where the practice pre-commits to an annual procurement for "best price", and vendor representatives inventory the shelves at three to four-week intervals and ensure resupply and segmental invoicing occurs.

 Resort managers (aka kennel masters) are getting their own workstations and check-in exam tables to admit boarding guests.

 Hydrotherapy suites, hyperbaric chambers, oxygen therapy units, and alternative therapy services are changing the floor plans.

 The "high touch" requirements in the ever-increasing "high tech" delivery modalities are increasing the ambiance of the client area, by adding plants, expanding the size of consultation rooms, augmenting white sound with water falls and trickling water, enhancing the visual distractions, and using new techniques and service in client comfort stations.

Affiliation/Merger/Specialty Induced Mega-Practices

Emergency practices, if they want to "stand alone", are a specialty that best affiliates with twenty-six or more general practice doctors. They can reduce the referral network density, if they co-locate with specialists, who use the facility and share the overhead, with their daytime practices. When co-locating with specialists, it is very common for emergency practices to become ICU and CCU practices in the day time, thereby becoming a twenty-four-seven mission to serve the greater community. However, most general practices have not yet embraced the need for a referral ICU and CCU support system referral, but they will learn this in the near future. Most daytime specialists, such as surgeons, internal medicine, dermatology, oncology, etc., need about one hundred referring doctors to keep their specialty practice busy. These referrals are the most informal of affiliations, since referral is only made by trust, and no other form of agreement can alter that reality in healthcare delivery.

 In Canada, this already exists as buying co-operatives, usually province-specific, and with recurring "locums", who are trusted extensions of healthcare delivery in a given practice. In the United States, this model will likely first be forced by technology, rather than intellectual or economic need.

 The newer radiology systems that do not use film, just computer plates, which can be "dialed-in" for extra resolution, have dropped from $1 million to $100,000 or less, and in the next two decades, will become a viable option to the "heavy metal" radiographic films. The dental digital X-ray processor is about $5,000, and no general practice should be without one.

 MRI and CT scan services will become available in many of the centers, as well as iodine therapy and chemotherapy programs that require specialized waste control procedures to meet environmental protection standards.

 A larger format practice facility can cause or accept an affiliation with a one-doctor ambulatory veterinarian, either a mixed animal doctor or a companion animal house-call veterinarian. Since the ambulatory overhead is kept minimal in either case, the ambulatory practice can be profitable. If it is affiliated with a reputable fixed facility for inpatient care, a full scope of services will then be available to the clients.

 The fixed facilities that seek these affiliations can make their inpatient facility more cost effective, since a greater inpatient caseload becomes available, when compared to the traditional outpatient-to-inpatient ratio of a self-contained practice entity.

 In some cases, progressive practices will operate their own fleet of ambulatory vehicles, or merge with existing practices that have a "home care" outreach program, to share the combined strength. Meanwhile, the more traditional practice owners will establish a leased-space, or referral cost, relationship with ambulatory practices to muddy the income flow waters.

Consolidated Veterinary Practices

The 1990s saw consolidators enter veterinary medicine, with Veterinary Centers of America (VCA) and VetsMart/PetsMart leading the charge in the publicly traded sector. Many venture capital funded systems emerged at the edge, hoping for a successful progression. The reality of the new millennium has been that the original concepts were not profitable enough, and new formats are being sought. VCA went private, then went public a second time. The second IPO had less fanfare, but was a good profit-based decision. VetsMart separated from PetsMart as a business venture, became Banfield, and started to franchise in an attempt to find a better formula for success. They have found a way to proliferate, and they have changed their name. That is called evolution in our profession.

The management structures of each have not yet learned the secrets of consolidation for increased profit, but the deeper pockets are still searching for the formula. There are models of success in human healthcare, but they have not yet been translated to veterinary medicine. The ability to build the individual delivery unit's net cash flow will become paramount, and that will need to be based on quality healthcare delivery in the future veterinary markets. In the near future, the consolidators will discover that the power is in the people, not in the monthly financial statements, and practice empowerment will increase.

Non-Practice Growth Areas

The demand for veterinarians in allied areas will increase, according to the AVMA/AAHA/AAVMC Mega Study on the current and future market for veterinarians and veterinary medical services (see "Executive Summary", July 15, 1999, JAVMA). The study included employer projections for increases in demand of:

 Sixty-nine percent in the use of new scientific, medical, and computer technology.

 Sixty-five percent with the public concern for food safety.

 Seventy-three percent in animal welfare areas.

 Sixty-nine percent biomedical science/research.

 Sixty-six percent in animal drug regulations.

 Sixty-two percent in the use of clinical research tools.

The veterinarian is often the most educated professional in the rural community, and in suburbia or metroplex communities, the one with the broadest base of scientific knowledge. Not only are industry leaders and veterinary medical vendors recognizing this skill resource, so are public health departments and welfare agencies. The operational challenge is that many of these potential fields require either a business-based or not-for-profit knowledge level that has not been in the traditional training development pattern. These are the cases where advanced training is essential and adds knowledge and credentials that these allied areas are willing to pay for to get the diversified expertise. This field will expand in the new millennium. The veterinary associations, representing both community groups and special interests, have lost participation and support, so must evolve to a new format in the next twenty years or perish. Business as usual cannot be the operational parameters of associations that want to represent this rapidly changing veterinary profession.

The Scariest Future

The scariest future is the one where we do not change. It is always an option, and in many corners of this profession, it appears the favorite of many veterinarians. University veterinary teaching hospitals still accept students with no animal experience, just grades. Practice owners still try to hire new graduates at poverty wages. Staff is still overworked and underpaid. Fee schedules are increased, without concurrent increased perception of value with the client. Doctors still do technician work, and technicians do animal caretaker work. Client relations staff is hired for cheap money, rather than their client bonding skills. We have been slow to adopt pain management and intra-operatory fluids. Because of short staffing in some practices, symptomatic treatment is still used, in lieu of diagnostic excellence. Many practices still use injectable cocktails instead of truly reversible pre-anesthetics and gas anesthetics. Some practices still try to compete on price, rather than develop their own market niche. These things must change!

If you have a hill to climb, waitin' won't make it smaller. - Montana Rancher

The "Virtual Practice" Systems

The Internet explosion holds some of the unique excitement and innovation for the next twenty-five years. The veterinary dot-coms that appeared, as we entered the new millennium, were most often only shallow pet food and supply sales systems. A few were "second opinion" or general client information sources. These "wisps of hope" dot-coms proliferated in the race for IPOs, and in the last few years, they merged, died, or otherwise were reduced to less than a half dozen survivors.

Veterinary Information Network (VIN) has proven they are stayers. Their business philosophy is based on service to the veterinarian, rather than a get-rich-quick, flash-in-the-pan. When someone centers on service, rather than the dollar, survival rates improve.

The real future lies in the virtual practice and virtual veterinarian, two entry-level Internet systems, with a very small development profile as we entered this new millennium, but will explode in the next two decades.

The veterinary profession must get over its Internet phobia before rapid advances can be made. Veterinary practice Internet access is about one-fourth of that found in the community they support.

The dot-com vendors must stop "scamming" the practitioner with slick words and a "beta-test" excuse mentality, "burning" those trying to get early entry. Distrust will cause a slower than profitable veterinary evolution into the Internet age.

The professional horizons for computer savvy veterinarians have more potential than our schools are training, or our associations are promoting. The Mega Study states, "Seventy-one percent of non-private practitioners surveyed felt that public concern would increase demand (for veterinarians) in food safety, over half saw increased concern in animal welfare, and others", including:

 Transgenic plants.

 Hybridization,

 Xeno-transplantation.

 Aqua-culture.

 Innovative reproductive technology.

 Unique solutions to environmental problems.

 Transgenic animals.

 Community work.

 Laboratory animal medicine.

 International assistance.

 Pathology.

 Toxicology.

 Food safety.

 Epidemiology.

 Zoonotic diseases.

 Public health.

 Critical thinking skills.

 Industry cited a need for additional skill sets required for veterinarians entering the public arena, which included:

 Speaking/writing.

 Business, administration, personal management.

 Sales/marketing.

 Financial and computer skills.

You kin talk sense to a smart man but not a fool. - Ranch Foreman