[fsn4dN69ey]

Disclaimer: My partner works as a small animal surgeon, and I'm honestly appalled by seeing some of the comments asking for more government intervention in here.

Private equity scooping up veterinary practices makes sense - it's a good investment. It's the same way PE firms will pool together a bunch of discrete dentist offices. I see many posters in here talking about how it's "rent-seeking" behavior, but frankly, these services are in demand and consolidating them is an increase in market efficiency. It's still good business to open up new clinics, even if the end goal is getting bought out (the standard practice for 95%+ of companies for which everyone here works for or is the beneficiary of).

If people are willing to spend more, then nothing really changed. If anything, goods and services were mispriced beforehand. If they raise the prices too high, nobody can afford the vet services and they will go out of business. If they make prices too low, we end up in a UK-style NHS situation where your dog's cancer is in line to get treated 8 months after they die, and they go out of business. Prices going up is natural for a restricted supply of extremely skilled labor (yes, you still need surgeons, anesthesiologists, nurses, drugs, human-tier equipment) and growing demand for the services (people having more pets in lieu of children in western countries). People were getting "better deals" before and are now being priced appropriately.

A big trend here is the increase in desire to spend on pets, particularly in the US, the richest country in the world. Yes, consolidation is one part of it, but we have to look at demographic trends as well. More and more people are spending more and more money on pets (in lieu of children). And yet, the increase in supply of skilled veterinarians has not increased nearly as much. Obviously, investment firms need their cut, but prices go up while owned by an investment firm does not make it evil, nor does it not make sense or outrageous. What might actually be considered outrageous around here is spending $20k on surgery for a domestic pet (common occurence as far as I can tell in a metropolitan area).

Lastly - there's actually a competitive healthcare market here! I have enjoyed being able to peek behind the curtain and look at what procedures of this scale should really cost, e.g. we still need the same training, people, equipment, and time relative to human medicine (arguably with a much lower tolerance of risk), but the prices are...... reasonable. $10-20k for a crazy surgery would be highly affordable for a human, and these PE firms are actually competing with each other for clients for these expensive procedures. It makes me wish for a similar competitive pricing landscape for humans - even if they are PE owned.

The last thing anyone needs when caring for their pet is a government bureaucrat handing out human-medicine style hospital monopolies to a "partnered provider" knighted by the government which will force a 100x billing charge to bill the govt and make it illegal to not have pet insurance while driving your premiums up 100x over the next 30 years.

[ryandrake]

> The last thing anyone needs when caring for their pet is a government bureaucrat handing out human-medicine style hospital monopolies to a "partnered provider" knighted by the government which will force a 100x billing charge to bill the govt and make it illegal to not have pet insurance while driving your premiums up 100x over the next 30 years.

Do you really think this is what people want when they call for increased government regulation?

    Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith.

Government regulation can take many forms, not all of them dystopian, and many of them leading to better outcomes. Sadly there are a lot of people, even here in the comment section, for whom, when you say "government regulation," their imagination jumps to the worst possible form of government regulation they can think of, and they project that imagined scenario on the person who said it. There are no doubt many ways the government can rein in the excesses and abuses of private equity without leading to hospital monopolies and forced purchases of pet insurance.

[fsn4dN69ey]

Unfortunately, I think I'm in that boat. Truly, I appreciate the discourse.

However, whether or not that's what people want, that's the reality. Next time you get a medical charge, even with insurance, ask for an itemized bill. Compare the bill you receive to the one you receive when you tell them "I'm paying with cash". When I pay cash with a third party provider, they "magically" reduce the amount I owe by orders of magnitude, even for simple bloodwork (United States, major metropolitan area).

Again, in good faith, what am I supposed to expect when I hear regulation in animal medicine? People like my partner are studying and training for years to do this work. People are leasing or buying real estate for these facilities.

They are buying equipment, they are hiring trained surgeons, nurses, and practitioners who have been committing at minimum a decade of their life for this - what am I supposed to expect with "calls for regulation" a la human medicine style (the only comparison we have), especially when prices are ACTUALLY competitive, as I believe the human medicine market should be?

I can be convinced of any position, but it has to make sense. What prices or charges, even with private equity-funded veterinary firms, do you consider egregious and need a non-opt-outable mandatory third party oversight for? Has there been a good or a service you feel was only available at a specific provider that they gouged you on? Again, not being aggressive, just genuinely curious.

[ryandrake]

For the record, I am more in favor of the government regulating Private Equity (in particular, the use of leveraged buyouts, LBOs): 1. more scrutiny of their own business practices, and 2. limitations on their ability to buy up companies from a community, plunder them, and then leave the community strip mined. I really don't think regulating the operations of veterinary hospitals is going to solve the problems brought up in this comment section.

[SoftTalker]

> people having more pets in lieu of children

This is the weird thing to me. When I was a kid, a pet was more or less a thing. You took care of it, but if it got really sick or badly injured you put it down and maybe got another one.

The idea of people spending 5 or 6 figures on pet health care is rather mind-boggling.

[fsn4dN69ey]

In total, for a 15-year old cat, I have spent $8,000+ USD. He plays a large emotional part in my life and I don't think I would spare any expenses given the opportunity. It is worth it.

[bootlooped]

> If people are willing to spend more, then nothing really changed. If anything, goods and services were mispriced beforehand. If they raise the prices too high, nobody can afford the vet services and they will go out of business.

I don't agree with this theory or pricing when the purchase decisions are often made under duress, and the market is opaque. The last time I called around for quotes for getting my cat's teeth cleaned, nobody would give numbers over the phone, they all wanted me to come in for an exam first, and the next exam opening wasn't that week, it was in like 2 or 3 weeks. If a person is at the vet for something relatively urgent, they don't have much of a choice.

[snapetom]

Married to a boarded vet of over 20 years. She's been through the era of working for privately owned clinics and now the PE-dominated landscape. 100% agree with you. The comments here range from short-sighted to plain-old stupid, especially those complaining about costs.

What many fail to realize is that vet care went through a professionalization in the 80's and 90's. Boards and specializations that humans had like dermatology and cardiology cropped up and really exploded in the past 20 years or so. Along with that was quality of care, and along with that, cost.

What frequently happens is this: If you go to a clinic with an old-school vet, he'll charge $300 for a dog spay. Down the road with the younger vet, she'll charge $600, but that's because she's running a wider blood panel with a course of anti-biotics. She won't do the surgery without it because research shows that course improves survivability by 50%.

Which are you going to choose? Don't kid yourself in thinking the quality of care is the same. Business and veterinary schools have researched this to death. You can't cheap out and get the same care.

Maybe you'll find a young vet that's willing to skip the extras, but many won't. The worst thing to happen to vet care is Yelp and Dr. Google who emboldens self-righteous hacks to complain to state boards at every little thing they think the vet did wrong.

Finally tons of people flat out belittle the cost of labor. Vets go to school a minimum of 4 years post college. They can practice right out of vet school, but many go through an internship these days. If you go to a specialist, that's an extra 1-2 years of internships and another 2-3 years of a residency and a board exam, too. On top of that, many states require veterinary assistants to be licensed, which is equivalent to an AA. In practice, most have bachelor's these days and we've known a few with master's degrees.

Meanwhile, people bitch and moan here for $500 a night of emergency care, ignoring the fact you're hiring a team of highly trained and educated people to take care of your precious Fluffy.

[romanows]

50% survivability increase, but is that going from 2/10000 to 1/10000 deaths? My impression is that spaying is relatively safe, so how much are we willing to spend to get more 9's?

Edit: deleted distracting details that the comment below rightfully calls out.

[snapetom]

> for healthy animals

this is the key part of your statement. Many animals for many diseases appear healthy but don't until a work up in done.

[romanows]

My fault, I shouldn't have mentioned that because it's not my key point. Given animals that come in to be spayed, say in a large US city, how risky is spaying? Is it worth everyone paying $300 more to reduce it by a very small absolute percentage? Should vets actually be more up front about this than the ones I'm familiar with are?

[snapetom]

I get you're saying it's not the key point, but in practice, it really should be.

The spay and cost numbers were just examples. In general, yes, spays are safe, but it is anesthesia. There's a risk of death and it gets much more complicated with a huge variety of factors - age of the animal, species, whether she is in heat, and of course like we mentioned - pre-existing conditions that do not obviously present itself without a clinical workup. The last one is huge. There are plenty of values that are indicative of organ failure that would not be obvious to an owner. A dog can't tell you it's been having a nagging pain on its side for the past week.

[fsn4dN69ey]

Thanks! Glad to see someone else with similar experiences. The other issue I think people are overlooking is... 20 years ago you would present to your local, low-cost veterinarian, and they wouldn't know what the issue was (or they knew and couldnt treat it), and your animal would just die.

Now we have a ton more information, a ton more training, and an issue now that would be game-ending prior is now treatable, but it comes at a cost. We see the same patterns in human medicine too. A lot of it has to do with demographics and cultural shifts in my opinion, as well as the supply/demand factor of trained practitioners.