S2 Week 2: Trauma Imaging, Navigating Finances, and Exploring Practice Ownership
Week 2 in the books! This was a short week academically since we had Monday off to honor Martin Luther King Jr.
Tuesday began with a review session hosted by our block leaders. This was a free hour where we had the ability to go over any concepts that were covered in the prior week. We then dove into some osteology imaging which consisted of looking at countless radiographs and calibrating our minds to understand what “normal” looks like. If you don't know what's normal on a radiograph it is going to be hard to figure out what is abnormal! This was exciting because we were able to apply more of our knowledge of the skeletal system from the prior week and put that to use while looking at radiographic images. After a few hours of imaging lectures we dove into bone adaptation and remodeling. The afternoon was spent with our cadaver dogs dissecting the main muscles of the neck, trunk, and extrinsic muscles of the thoracic limb.
Wednesday started off with learning about functional myology and skeletal mechanics. In short, these lectures focused on the biomechanics of the musculoskeletal system and explained why animals move the way they do. These lectures tied in our knowledge of the skeletal system along with some imaging practice. Instead of seeing “normal” images, most of these images showed some sort of abnormality. We then went into a discussion session where we were presented with different cases and practiced describing the abnormalities we observed. The last lecture of the morning focused on the bone’s response to traumatic injury. This was a super interesting lecture that explained different types of fractures as well as their potential causes. One key take away from that lecture was the description of Salter Harris fractures which are physeal fractures meaning they involve/go through the growth plate.
Salter Harris fractures can fall into one of five categories. *Reference: Dr. Brian Murphy
SH I: Complete separation of the physis (growth plate), also referred to as a “slipped epiphysis”
SH II: The fracture plane travels through a portion of the growth plate and then diverges through the metaphysis. This is the most common physeal fracture of dogs, cats, horses, and humans!
SH III: The physeal fracture extends from the physis and then diverts through the epiphyseal bone, involving the joint surface (articular cartilage). *Worse prognosis since a joint surface is involved
SH IV: The fracture line extends from the metaphyseal bone, through the physis and through the epiphyseal bone and articular cartilage. *Even worse prognosis than SH III since the growth plate is crossed and the joint surface is involved!
SH V: Compression fracture of the physis that can lead to premature closure of the growth plate
Dr. Murphy gave us a little mnemonic to remember these types of fractures: SALTeR (Slip, Above, Lower, Through, Rammed)
Here is a drawing for reference
Thursday was packed full of more imaging lectures that focused on trauma, clinical fracture healing, developmental disorders, and degenerative bone/joint pathologies. These lectures were super fascinating since they covered different disorders that are commonly seen in practice. It was a lot of information to take in all at once, but over the course of four hours it was obvious how important it is to understand these disorders and know how to diagnose them. I found it interesting to learn about the change in terminology regarding Hypertrophic Osteodystrophy (HOD) to Metaphyseal Osteopathy (MO). MO is a disease with an elusive etiology that can affect the distal metaphases of the radius and ulna (most common location, but other areas can still be affected) in large breed dogs. Affected animals may be painful, lame, lethargic, unwilling to eat, and have metaphyseal swelling.
That afternoon we got to hang out with our cadaver dogs again and dissect the muscles of the shoulder and brachial region!
Friday was a shorter day class-wise and consisted of a problem-based learning session. We were presented with a case involving a puppy with a gnarly fracture along with a brief history from the client. Our goal for the first session was to classify the fracture and then create a list of things that we wanted to dive into and research. We will be presented with additional information on the case next week and discuss our individual findings as to why this fracture could have occurred and any additional information that we found pertinent to the case. This was a fun way to culminate the past week of lectures and test our knowledge on a case as a group.
Since we were done for the day, I took advantage of the afternoon and was able to get a long bike ride in before the weekend storm!
Saturday consisted of some quality time with Churro, hot yoga some studying and a few VBMA webinars. VBMA is the Veterinary Business Management Club and this weekend there was a virtual Western Summit. I attended two of the talks and gained some valuable information on financial literacy for veterinarians as well as private practice startup/ownership in a corporate-dominated world. Here are some recaps from those two talks if you are interested!
Talk 1: Five Tips to Help Navigate Your Veterinary Financial Life by Dr. Darby Affeldt
Dr. Affeldt is a veterinarian and financial advisor that works with veterinarians to help them succeed financially. She has experience working with new graduates and gave us her top 5 tips for being financially smart.
Here are her five tips:
1. Emergency reserves, debt, and risk management
2. Start early, accumulate money systematically
3. Build a portfolio to match your “personal profile”
4. Strategies to reduce risk / enhance potential returns
5. Minimize the impact of income taxes
She emphasized the fact that a majority of veterinary students graduate with a significant amount of debt and that is OK! The most important thing you can invest in is yourself so spending money on an education that will pay off in dividends is not a bad thing. The thing that is important to keep in mind is being smart financially so the debt does not get to a point were it controls your life. She noted that a lot of people have the mindset of saving whatever is “left over” after their monthly expenses are covered but the problem with this mindset is that if saving is not something on the forefront of a person’s mind, there might not be any “left-overs” at the end of the month. Make it a habit to save now, even if it is only a little bit because it creates a habit and will add up in the end. She also focused on the importance of budgeting and controlling debt to the best of our abilities while in school. This means living below your means (within reason) and investing in your future self.
Dr. Affeldt highlighted the importance of preparing for life after graduation by thinking about they type of veterinary medicine we want to practice (practice ownership, specialty, academia, shelter med, industry, research, etc.). Each of these routes provide different financial opportunities so it is important to do some research on expected salaries and the lifestyle that you wish to achieve.
She also emphasized the importance of focusing on the things that you can control right now. These include your behavior and mindset towards finances as well as your spending, saving, and budgeting habits. It is also important to set some specific goals that can be referenced to make sure that you are on track with where you want to be.
The last part of Dr. Affeldt’s talk focused on insurance. The most important thing to protect is yourself so having solid insurance is key to financial stability and long-term success. A starteling statistic that she shared during her talk was that 1 in 4 people will experience some sort of disability before the age of 65 and the average dyability lasts roughly 2 years! If you make 120K per year, over the course of your career you will make roughly 9.4 million dollars. You want to make sure you have insurance so that you are covered incase of an emergency.
Wrapping up her talk, Dr. Affeldt reminded everyone that regardless of how much debt you graduate with, you will be ok as long as you are financially educated. This takes discipline, patience, and commitment because becoming debt-free is a marathon, not a sprint. That being said, it is also important to remember that you can still have a great life while being in debt, just be smart about it.
Talk 2: Breaking Ground: Launching your Independent Veterinary Practice in a Corporate Landscape By: Dr. Saum Hadi
In this talk, Dr. Hadi explained the corporate takeover of veterinary medicine as well as the pros and cons to starting a practice from scratch vs acquiring a practice. 10 months ago he started his own practice and has had great success.
Here is a brief overview and a few stats on the corporate aspect of veterinary medicine
Corporate
· Quickly overtaking vet med
· Following the route that human medicine took, then dentistry soon followed
· 33% of all clinics are now corporately owned, over 50% of all visits pets take are to corporate *Corporate is buying the large clinics which is why 50% of visits are with corporate while they only own 33% of the clinics
· Advantages: Nice benefits, growth beyond working as an associate, HR
· Disadvantages: non-compete contracts, culture, more profit-driven
In the world of veterinary practice ownership are a number of acquisition groups. These groups are buying hospitals that are already established. These key players include VCA animal hospital >925 hospitals, NVA: >700 hospitals, VetCor: >340 hospitals, Southern Vet Practices: >90 hospitals, and Mission Veterinary Partners: >50 hospitals.
On the other hand, there are a number of start-up groups which are groups that start clinics around the nation instead of buying preestablished clinics. These key players are Modern Animal, VEG, and Banfield (Banfield has acquired some clinics but a majority of their hospitals are start-ups).
Dr. Hadi then dove into the main differences between acquiring a practice and starting one from the ground up.
Acquiring a practice can happen in multiple ways but a common way is when the practice owner is looking to retire and they sell the practice to a veterinarian they know that is interested in practice ownership. Some of the advantages of acquiring a practice include an initial lower risk. The practice is already established so there is less of a chance that the business fails. The practice also has an established clientele and revenue stream. This is often reassuring and takes some of the initial stress of advertising and promoting the clinic out of the picture. Another benefit is that acquiring a practice is generally less work than starting one from scratch. The branding is already established, building contracts are delt with, and there is an established community presence. This is generally a safe way to jump into practice ownership with relatively little risk.
That being said, established owners are facing challenging decisions when they come to a point where they want to sell their practice. The two options are to sell to corporate, or to sell to an associate doctor etc. Selling to corporate is going to be much more profitable because they have more resources to offer however, if the practice owner is against the corporate culture, they can formulate a deal with the new owner or create a multiple year payment plan that benefits both parties.
Starting a practice from scratch is a slightly different ballgame. It has the potential to have a higher payout but also has a mildly higher risk than practice acquisition. It was noted that a newly started clinic on average has a 25% increase in revenue for the first 5 years compared to the 6% per year for an established clinic. Over time this can be a significant difference in practice worth and overall revenue which relates to the owner’s income. Some of the benefits of starting a practice include building your team from scratch. You get to determine the work culture and standard of care, there are no inherited issues from another practice that needs fixing. You also get the freedom to build your own hospital, choose the layout and equipment as well as the exact location of the practice. You get to customize your brand and make the practice exactly how you want it from the bottom up. The last benefit is that you avoiding bidding against corporate for a practice. Corporate can pay practice owners way more than a single individual which is why it is not a fun game (nor in your favor) if you are trying to bid against them.
Both of these options are fantastic ways to get into practice ownership and the way that someone enters this business depends on their personality and overall goal for the clinic. Return on investment can be much higher for start-up companies vs acquisition practices because there is usually more room for growth and on top of that, corporate is driving owners towards the start-up route due to their high bids.
Overall, both of these talks were interesting and are definitely things to keep in mind as I go through school and figure out what I want to do.
Sunday was spent studying, hanging out with Churro, and prepping for the upcoming week!
The UC Davis Class of 2028 was sent admission offers last week! If any of you are reading this, congratulations and welcome to the family!
I would also like to shout-out one of my amazing friends, Amanda Corey! She was accepted into Colorado State University for vet school for the class of 2028!! Congratulations on this amazing accomplishment!
Quote of the week: “It’s very uncommon for a dog to fracture two bones (different limbs) at once but if it belongs to a vet student, it happens” -Dr. Po-Yen Chou SACVS-SA
Loved seeing Churro's green ball. Remi says "Hello."