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Keeping vets employed and motivated…

by
01 April 2015, at 1:00am

GARETH CROSS checks on who does out-ofhours work these days before continuing his theme of employment and learning about one expanding group’s hub-andspoke system of operation

VETERINARY employment is this year’s theme for this column. One employment issue that is of major interest to vets in the UK is out-ofhours (OOH) work, another is the globalisation of the jobs market.

Talk to any practice owner about this and you will find it’s not easy to recruit vets to work an OOH rota, and there is a perception that overseas graduates are more likely to accept working OOH than UK ones.

I asked the RCVS to drill down into its survey figures and find out if there is any truth in this. So I am reporting here some new findings that are not in the published RCVS survey, but drawn from the raw data. Thanks to the RCVS for doing this.

The answer the College came back with was: “It doesn’t appear that there is any proportional difference between the number of UK graduates and overseas graduates who personally engage in any out-of-hours work.”

Asking UK graduates (i.e. any vet working in the UK who graduated from a UK university) if they worked OOH, 65.2% said yes and 34.8% said no. The question put to overseas grads working in the UK gave 66.5% yes and 33.5% no.

Putting the question the other way round and looking at OOH workers, 71.5% were UK grads and 28.5% overseas, and in the non-OOH workers 72.6% were UK grads and 27.4% were overseas. [N = 2,873 UK grads surveyed and 1,508 overseas grads.] You heard it here first!

Over the last few surveys the proportion of vets working their own OOH has reduced slightly but seems to be staying at around 60%. The proportion of non-UK graduates working as vets in has increased.

Currently, it has been proved above that UK and non-UK vets are no more nor less likely to be found working out-of-hours. Personally, I think these figures represent a baseline or year zero and it will be interesting to see how this develops, as the anecdotal evidence seems to suggest that finding younger vets to do OOH is very difficult and you are more likely to get someone who is not a UK graduate to do it.

Moving away from that, it’s back onto the question of how to manage and provide quality veterinary services to the pet-owning public and keep vets employed and motivated throughout their careers.

We have looked at private practice (January) and joint ventures (Febuary). This month we will be looking at a different model: the “hub-and-spoke” partnership one used by Medivet. Adi Nell from Medivet tells us more…

What is Medivet?

Medivet is a large partnership. At last count we had over 70 partners and 110 branches. We’re based in the southeast of England but have practices as far north as Liverpool, as far west as Faringdon, down to the Dorset coast and all the way over to Southend-onSea and Canvey Island.

We’re also the country’s only veterinary multinational – we’ve got several branches in Israel, too!

Medivet started about 25 years ago as a collaboration between three vets in just three branches. The model has grown and developed over time, but the core principle of partnership and joint effort has remained intact.

That’s a pretty simple principle, but the actual operations of the group have become ever more complex and involved, so we now have an 80-person support centre dedicated to supporting our teams on the ground.

What’s the difference between Medivet and a standard JVP?

The difference stems from that one word: partnership. Medivet is a very traditional partnership. It’s what you imagine when you talk about being in partnership with someone: shared costs, shared risk, shared profit. That’s subtly but importantly different to the JVP model used in other companies.

Our partnership is a true collaboration. We don’t charge fees to our partners: we share costs. We don’t take a percentage of turnover or a fixed charge as a management fee: we share profits. And, if we want to expand a practice and its equipment, from a new dental elevator to an MRI or CT unit, we share the risk.

It’s a very simple concept: turnover minus costs equals profit, then the profit is shared between the branch partner and Medivet.

The branch partners all own equity in their branches. That can be sold to a new partner, and many have sold and moved on – so far, always at a healthy profit!

So how does ‘huband-spoke’ work?

The physical structure is based on a hub-and-spoke system. Medivet has six 24-hour centres, five of which are RCVS-accredited veterinary hospitals. These are the hubs in our system.

Our branch practices offer first opinion services to their clients and patients, with some offering more advanced work too. These branches are the spokes. They’re equipped to a good standard and are able to do most routine work: elective surgeries, radiography, laboratory work, dentistry, etc.

They operate during normal veterinary consulting times and are deeply rooted in the communities they serve. The vets and nurses tend to live locally, take part in community events and are well known to their local areas.

Each 24-hour centre, too, does routine first opinion work for its local clients and pets, but it will have a much higher level of equipment available, as well as vets who are skilled in using these. That includes blood for transfusions, laparoscopic kit, ultrasound, orthopaedic equipment or blood gas analysers, all the way up to MRI and CT scanners at our Hendon hospital.

The beauty of this for our branch partners is that they don’t have to carry the cost of this kit. It’s held at the main centres and branches simply pay a small “rental” fee to use it. They also get the benefit of colleagues at the hospitals who use this equipment all the time, making them very skilled in interpreting results or doing procedures. This gives great economies of scale, as well as improved standards of care.

And, at the main centres, that care is available 24 hours a day, 365 days a year. Cases can be sent over to the main centre for specialised procedures or investigations and kept there until they are ready to go back home – there’s no to-ing and fro-ing to an external out-of-hours service. That’s better for the patients, better for the clients and better for the vets and nurses involved, too.

The partnership

Our structure is very flat as far as veterinary staff is concerned. We have three groups: employed assistants, branch partners and senior partners. That’s it! There are almost no layers to get through: if an employed vet wants to discuss a problem or suggest an idea, she or he can ring any of the senior partners directly. We’re here for help and support.

Most branch partners own 50% of their clinic with Medivet owning the other half. Any Medivet branch without a partner in it is available for purchase. That’s currently a little under half of our branches. We’re also delighted that about half our branch partners are women – we must be doing something right when it comes to balancing working life with the rest of our partners’ lives.

What do the partners do?

Our branch partners are clinicians. They look after the day-to-day running of their practices, focusing on their clients, their patients and their staff. Medivet does the back-of-house work: accounting, maintenance, HR, recruitment, legal support, IT and so on. We’ve got teams of specialists for each of these functions, so the vets on the ground can get on with doing what they do best.

All of our branch partners can join the senior partnership – just like I did. The senior partners play a wide range of roles. Some of us are still in day-to-day practice, while others fill more specialised roles in strategic planning, marketing, HR, finance, IT development or practice acquisition and development. We each have our strengths. For many, we’ve chosen to get out of clinical work and add value elsewhere.

In many ways, Medivet is a very ordinary practice, but we achieve extraordinary things. We’ve an Investor in People Bronze Award, we invest in new technologies and treatments, many of our vets are on certificate courses or other specialisation, we offer a career path in ownership and our vets can pursue a clinical or non-clinical route. And our hub-and-spoke model offers real benefits to our patients, our clients and our staff. A true partnership, on many levels.

  • Adi Nell joined Medivet as a branch partner in Hayes, Middlesex, in 2002. His practice was part of the Richmond hub-and-spoke system, giving him the confidence that his cases were being as well looked after at night and at weekends as they were during the day. In his role as senior partner, Adi moved to Oxford in 2005 to head a group of practices there and to develop a new 24-hour centre in Woodstock.

He was the lead vet at the centre and oversaw the growth of the Oxford region from four practices in 2005 to 16 branches today.

Adi says, “I have a dermatology certificate and ran a referral practice for several years, as well as spending time in academia. I have high expectations of the level of care my patients should receive out-of-hours, and the standards of service we deliver to clients and animals alike. Seeing the Woodstock branch become Medivet’s first RCVS-accredited veterinary hospital was a very proud moment.”

Adi serves on Medivet’s planning and steering committee as well as its HR and marketing committee and is also involved in operational management.