CGU? Not Line of Duty.....

RE: CGU? Not Line of Duty.....

Thomas Johnson — Fri, 18 Jun 2021 14:13:36 GMT

[quote userid="10402" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230824#230824"]

like Helena, we find the approved drugs list restrictive, it can change without notice so we suddenly have to change what we order. Having to fill out an exceptions form for some generic drugs that are needed by a particular patient is a headache. We have recently had to change from having daily stock deliveries to twice weekly, which is inconvenient and means clients now have to wait longer for drug orders. There is an approved supplier for absolutely everything (down to teabags and toilet paper!) so we can’t shop around. We have targets for selling Purina food (which I think is bordering on unethical) having been promised originally that such targets would not be introduced.

I find the level of interference really intrusive, and I have not enjoyed being CD at all. Luckily, I am currently in my notice period and will shortly be leaving (a 6 month notice period too - inhumane!)

[/quote]

It's probably not a good idea to get into a lengthy discussion on a public forum about how IVC run their practices, but when I look at most of the requirements from IVC they feel like an appropriate way to control the costs of the business, but as you say my experience in another part of the country may be different to yours. The change to twice weekly stock deliveries has taken some getting used to, but I previously worked for an independent hospital practice that only had 2 deliveries a week so it's something I'm used to.

The 6 month notice period was the one line in the contract that I was unsure about when I signed it, and looking back I wonder if I should have tried to negotiate it down, but I didn't so I'll have to put up with it when the time eventually comes when I want to leave. From their point of view I can completely understand why they put it in, leaving a practice without a clinical director would be difficult.

RE: CGU? Not Line of Duty.....

Gillian Mostyn — Thu, 17 Jun 2021 08:33:39 GMT

[quote userid="10402" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230824#230824"]I find the level of interference really intrusive, and I have not enjoyed being CD at all. Luckily, I am currently in my notice period and will shortly be leaving (a 6 month notice period too - inhumane!)[/quote]

I agree. However, you must have signed the contact?

When we sold to CVS and stayed on, we changed a lot of the employment contract as it was far too restrictive. I think too many people don't read it - or get proper legal advice- before signing these things. They do have to be agreed to on both sides, or you can ask for it to be changed. Obviously that may impact on whether you get the job, but in the current climate the power is all in the hands of the employee!

RE: CGU? Not Line of Duty.....

Clive Ansell — Thu, 17 Jun 2021 07:17:08 GMT

[quote userid="6297" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230792#230792"]The management of IVC practices is the responsibility of the clinical director(s) and practice manager. My experience as a clinical director of an IVC practice is that they have no involvement in the day to day running, and I see this as a good thing. We are responsible for pricing, recruitment (as long as it is within our budget), rotas, etc. We have clinical freedom to decide how we manage cases.[/quote]

[quote userid="10402" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230824#230824"]t’s really interesting that you have had that experience - because my experience, also as CD of an IVC practice has been the opposite. Perhaps it is area dependent?[/quote][quote userid="10402" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230824#230824"]I find the level of interference really intrusive, and I have not enjoyed being CD at all. Luckily, I am currently in my notice period and will shortly be leaving (a 6 month notice period too - inhumane!)[/quote]

The Feedback I have had from 2 IVC CD's I know well matches that of An-on's. They report that they feel micro-scrutinised and micro-managed at every point. Both in the process of leaving too.

RE: CGU? Not Line of Duty.....

An On MRCVS — Wed, 16 Jun 2021 22:40:14 GMT

[quote userid="6297" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230792#230792"]My experience as a clinical director of an IVC practice is that they have no involvement in the day to day running, and I see this as a good thing. We are responsible for pricing, recruitment (as long as it is within our budget), rotas, etc. We have clinical freedom to decide how we manage cases.[/quote]

It’s really interesting that you have had that experience - because my experience, also as CD of an IVC practice has been the opposite. Perhaps it is area dependent?

our prices are continually pushed up and up, to the point where I now think a lot of our prices are unreasonable. I have had meetings with them about this and have requested to adjust some of them but have not been allowed to. We are not allowed to do our own recruitment, everything has to go through the recruitment department and we have no say over where or how they advertise our job.

RE: CGU? Not Line of Duty.....

Helena Rymaszewska — Wed, 16 Jun 2021 18:26:53 GMT

Interesting……I find ,as an employee, we are quite restricted in certain areas. Only one named laboratory is to be used for all submissions. Several drugs are not allowed and these can change suddenly without warning. Certain off licence drugs ,even if prescribed initially by a referral practice, have to be applied for to the ‘ exceptions’ department ,which then gives permission (more online form filling).Need to repeat monthly so in the end we just provide the clients with a prescription. A named veterinary wholesaler has to be used ,only delivers twice weekly.
A lot of clients dislike the text/email messaging they get ref feedback after each appointment .However. If they want to have appointment reminders ,they can’t unsubscribe to these.
On the other hand,I have really enjoyed sitting through hours of health and safety videos on my day off…….

RE: CGU? Not Line of Duty.....

Thomas Johnson — Wed, 16 Jun 2021 08:31:58 GMT

[quote userid="5012" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230759#230759"]The only corporates I have worked for are IVC, Medivet and very occasionally Vets4pets. None of them seem well run, they seem chaotic, and management seem distanced from reality, cumbersome and inflexible. [/quote]

The management of IVC practices is the responsibility of the clinical director(s) and practice manager. My experience as a clinical director of an IVC practice is that they have no involvement in the day to day running, and I see this as a good thing. We are responsible for pricing, recruitment (as long as it is within our budget), rotas, etc. We have clinical freedom to decide how we manage cases.

RE: CGU? Not Line of Duty.....

Anthony Todd — Mon, 14 Jun 2021 17:29:11 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230764#230764"]Of course it is designed to make us money.[/quote]

Who, the vet? I'm sure most vets cringe at the waste and stupidity, although the entire profession seemed to accept it with little demur!

I might accept it if there was even ONE instance where OOD drugs caused a problem, certainly not back in the daay of 100ml ~Pen strep etc.

And it was just a lazy copy and paste from the human regs by the EU where they use single dose "snapules", which really aren't suitable for multiple use and never are!

RE: CGU? Not Line of Duty.....

Cool — Sun, 13 Jun 2021 09:17:00 GMT

''I think it is utterly crazy to use the same legal standards for a dog as for a human. And disastrous for animal welfare. I am not aware of any vet thus far being subject to this, and I think it is quite dangerous to suggest they might be without very good evidence, because one risks frightening people unnecessarily and in this case compounding the problem of increasing prices (if vets now think they are going to be sued unless they give every animal the highest standard of treatment, we're in a lot of trouble, whether or not it comes to pass)''.

Sadly Arlo a lot of new grads already think this way. They are very scared of being sued or taken to the RCVS. I have seen so many and what breaks my heart is that it cripples the vets from working freely and enjoy the decision making process of managing a case. On the other hand I am not sure if we can blame them. We live in a blame culture and these things are drummed into them in vet school. It is also hard not to sometimes have this play on your mind particularly if you have endured a 2-3year long RCVS investigation

RE: CGU? Not Line of Duty.....

Bob Russell — Sat, 12 Jun 2021 09:00:37 GMT

I see nothing particularly wrong with 100% mark-up's. It is not that unusual in business.

We have a slant on this and tend to mark up on drug turnover.

A medicine that is in, sold and paid for before the bill gets paid can be stocked profitably with a lower mark-up. Something we need urgently but may sit on the shelf for some time is going to be 100%.

The medicines we need in emergency but once in a blue moon and may go out of date are now marked up higher.

Bottles opened to be binned with little chance of a second patient needing the drug may well be sold as a bottle. I have offered partial refunds on Tardak before now because a second patient has needed the injection.

Of course it is designed to make us money. We are not a charity. We do like to approach pricing with a degree of fairness.

The insurance market is already controlled. How many people are now paying 20% of the final bill? We had an insured patient where referral was declined because the 20% was not affordable because they are moving house in the near future.

RE: CGU? Not Line of Duty.....

Clive Ansell — Fri, 11 Jun 2021 19:48:55 GMT

[quote userid="6897" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230748#230748"]Where does that end?[/quote]

Yep, I often wonder what will happen if or when the insurance funded referral gravy train slams into the buffers and is brought to an abrupt halt.

RE: CGU? Not Line of Duty.....

Clive Ansell — Fri, 11 Jun 2021 18:32:42 GMT

[quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230744#230744"]In my experience, there is very little difference between how practices are run, regardless of ownership. The quality of the practice and the service it provides is purely down to the personnel on site.[/quote]

True to a point. It would be wrong to say corporates are bad and independents are good; in fact I have worked in corporate practices that seem very good, and in some shocking independent practices.

The only corporates I have worked for are IVC, Medivet and very occasionally Vets4pets. None of them seem well run, they seem chaotic, and management seem distanced from reality, cumbersome and inflexible.

[quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230744#230744"]In most 'corporates' the person running the practice is still a vet or RVN[/quote]

I've worked in many corporate practices that have no permanent vets or RVN's on site, they rely solely on one short term locum after another. Consequently, no one cares or has their finger on the pulse at all. Shambolic to say the least.

RE: CGU? Not Line of Duty.....

Clive Ansell — Fri, 11 Jun 2021 18:21:18 GMT

[quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230744#230744"] In most 'corporates' the person running the practice is still a vet or RVN with the same ethics and standards as they would have if they owned the practice lock, stock and barrel.[/quote]

Not really,

I good friend of mine, and someone I've locumed for for 15 years, sold out to Medivet 2 years ago. He is now employed as clinical director, but takes orders and is micromanaged from above. His personal ethics and standards are of course the same, but he feels constricted and limited in what he can do. He seems to spend most of his time chasing targets and filling in management spreadsheets.

RE: CGU? Not Line of Duty.....

Anthony Todd — Fri, 11 Jun 2021 16:15:33 GMT

[quote userid="7811" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230750#230750"]Corps are not buying up independent practices because they love animals so much[/quote]

The clue is in the name "venture" capitalists, and in lockdown what would you invest in?

Speaking personally I'd guess alcohol, takeaway foods and "badly sized" female clothing.......................

And how would they, not a vet or anyone with the slightest interest in any living being, not be just interested in "return on investment"!?

PS and they're anonymous!!! No moaning owners complaining, no staff "issues" etc.etc. .... the list is endless!

RE: CGU? Not Line of Duty.....

Julie Innes — Fri, 11 Jun 2021 15:52:07 GMT

[quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230744#230744"]I think that's a little unfair Julie. In most 'corporates' the person running the practice is still a vet or RVN with the same ethics and standards as they would have if they owned the practice lock, stock and barrel.[/quote]

Sorry, Gillian. I meant the top management, not the vets on the ground! But as this thread is about vets as CGUs, I think its fair to say that the bigger Corps are not buying up independent practices because they love animals so much!

RE: CGU? Not Line of Duty.....

bob lehner — Fri, 11 Jun 2021 15:10:21 GMT

[quote userid="5012" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230739#230739"]; I had an MRI scan on my spine last week, £250, and this referred a dog for a head MRI at almost 10 times the price (£2250) - I know that includes a consultation and general anaesthesia, but part of me feels it is overpriced.[/quote]

I've wondered about that - and the popular press has recently been having a go at vets for high charges on MRI scans.

I think part of the problem surely must be that human MRI units have a massive throughput of cases as compared to the veterinary sector and therefore the cost per patient is proportionally going to be lower.

With so many veterinary referral centres popping up all over the place and competing for a fixed pool of patients - and all equipped with highly expensive diagnostic gizmos - there must be a point where recovering the huge capital investment can only be achieved by ever-increasing the charges.

Net result - fewer clients, other than the wealthy or well-insured can afford these fees. Insurance premiums constantly rise faster than inflation, eventually reducing the pool of those who can afford to insure. Leads to fewer cases using the facility - so fees need to go even higher to cover their costs.

Where does that end?

RE: CGU? Not Line of Duty.....

Anthony Todd — Fri, 11 Jun 2021 14:27:31 GMT

[quote userid="2457" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230744#230744"]I saw in small independents[/quote]

Not at all surprised at that, my experience of large organisations is they have many rules and regs just to ensure that management are not exposed to any accusation of any "fault" remotely connected to themselves, which overrides actual risk or lack of actual evidence.

RE: CGU? Not Line of Duty.....

Anthony Todd — Fri, 11 Jun 2021 14:10:19 GMT

I am not sure, as I have said, when vets are paid based on a ratio of turnover.

Are there any examples of harm after, so called, OOD drugs? Is there any data that OOD actually proves that OOD had any relevance at all, ie plus a day, a week, a year?

Is it just a massive earner for manufacturers based on little or no evidence?

It was a straight copy and paste from humans where open vials are a totally different matter!!

RE: CGU? Not Line of Duty.....

Gillian Mostyn — Fri, 11 Jun 2021 13:53:50 GMT

[quote userid="7811" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230743#230743"]I think clients don't want Corporates because they understand that , while the individual vets working there care about their pet, the person running the practice only cares about their money- they don't want their pet's health to feel like a business transaction. [/quote]

I think that's a little unfair Julie. In most 'corporates' the person running the practice is still a vet or RVN with the same ethics and standards as they would have if they owned the practice lock, stock and barrel.

In my experience, there is very little difference between how practices are run, regardless of ownership. The quality of the practice and the service it provides is purely down to the personnel on site. But the worst cases of penny pinching, using OOD drugs, poor investment in new equipment and, occasionally, poor clinical practice, I saw in small independents!

RE: CGU? Not Line of Duty.....

Julie Innes — Fri, 11 Jun 2021 13:11:22 GMT

[quote userid="5012" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230739#230739"]I think if any wants to set up their own independent practice, the time is nigh. [/quote]

absolutely, 100%. I would love to see the majority of veterinary practices run by vets again!

I think clients don't want Corporates because they understand that , while the individual vets working there care about their pet, the person running the practice only cares about their money- they don't want their pet's health to feel like a business transaction.

[quote userid="5904" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230711#230711"]Still waiting for someone to challenge or even discuss my "hit rate" as an indication of the value of further exams.labs, bloods, Xrays ultrasound etc.[/quote]

I'm not sure what you mean by "hit rate" - do you mean the number of times we or you have missed something ? Or the number of times further investigation was unwarranted? Or the number of times the animal got better by itself regardless of a wrong diagnosis or a lack of further investigation?? Agree with Gillian and Joyce- very few vets (even my eager 2 years graduated young vet!) automatically work their way through all tests available! We examine, we get a history, we discuss possibilities- with the client and each other- and come up with a plan of action. That may or may not involve further investigation, depending on many factors.

I know, Anthony, that "back in the day" further investigation was often unfeasible (5 minute appointments/ blood samples took 4 days for results to be FAXED back! CT and MRI was hardly heard of, certainly not for dogs and cats.) And many things DID get better with best-guess treatment. A bottle of dex and a bottle of beta LA did certainly seem to be the way to treat many things and lots got better. But back then people's expectations were lower. Farmers laughed at the idea of anyone PAYING to treat a cat (one nearly wet his pants when I told him someone had paid me to treat a rabbit..) Owners were grateful that you had tried, pets didn't live as long and people accepted that. There was no social media- the worst they could do was to moan about you in the newspaper shop, but they didn't. They knew you knew what you were doing, trusted you, and accepted the outcome without a murmur.

CHANGED DAYS!

Now everyone has already Googled their diagnosis before they call, and God help you if you don't agree with them! they challenge everything, google it some more, speak to Sandra on Facebook (who's had Bulldogs/ Bichons/ Chihuahuas all her life), go on their breed forum, where Katie from Middlesex tells them that HER Jackihuahua had that and it was THIS, and their vet is a moron, and they need a test for XX. If you "have a go" at some surgery or other (as i did frequently when younger!) and it doesn't go 100% as planned, the VDS will ask if you offered referral and if not why not? Everyone knows the misery of being investigated by the RCVS (not personally, but through other people's stories) and noone wants to risk the hassle of that- why would you? People are more savvy (they feel more imformed, but are often misinformed!!), pets are more valued, trust is thin on the ground. Trying to do as little as possible to save the client a few quid is a dangerous practice, and usually comes back to bite you on the arse!

RE: CGU? Not Line of Duty.....

Clive Ansell — Fri, 11 Jun 2021 07:28:25 GMT

[quote userid="7269" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230738#230738"]We are independent and have gained a lot of clients in the past year from (mainly) newly corporate neighbouring practices. Partly lots of staff changes and not much continuity, partly cost, and partly that MOP have realised that they are corporate, and for some they don’t want that, they want a smaller local practice.[/quote]

In 2 of my regular and independent practices, and prior to the covid pandemic, I was beginning to notice that more new clients were registering having moved away from a corporate practice. They have started asking "are you a corporate". All for the same reasons that you cite. Both of these practices are flourishing and have now closed the books to new clients.

I think if any wants to set up their own independent practice, the time is nigh.

[quote userid="7269" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230738#230738"]Do I think we as a profession are all getting too expensive? [/quote]

I think there are 2 elements to the answer.

Are we too expensive? probably not. We are now able to offer and do so much more, and that costs money. If anything some of our fees are too low. I do wonder if some of the fees for referral medicine are very high though; I had an MRI scan on my spine last week, £250, and this referred a dog for a head MRI at almost 10 times the price (£2250) - I know that includes a consultation and general anaesthesia, but part of me feels it is overpriced.

Are we becoming more unaffordable? yes probably. Much of my regular work is in poor areas and many of the clients are living on the breadline either being on benefits or in low paid employment. Modern veterinary care, and certainly referral, is just simply out of their reach.

RE: CGU? Not Line of Duty.....

Joyce Whitehead — Thu, 10 Jun 2021 19:22:47 GMT

I’m just coming on to say I could have written almost all of what Julie Innessaid, and agree wholeheartedly. And Anthony, don’t believe everything you read, we don’t all do loads of tests as soon as we see an animal. As Gillian says, the routine things aren’t posted here and are treated generally just as you might have done. Treat the signs and see if they improve in many cases.

We are independent and have gained a lot of clients in the past year from (mainly) newly corporate neighbouring practices. Partly lots of staff changes and not much continuity, partly cost, and partly that MOP have realised that they are corporate, and for some they don’t want that, they want a smaller local practice. We also do our own OOH which appeals too. I do think the public are more aware of who they go to, and seek out what they want. Having said that we are in a very middle class area with fewer clients who really struggle to pay.

Do I think we as a profession are all getting too expensive? Generally not. I think we are finally getting to a stage where we are charging for what we do in a more realistic manner. And hopefully can start to afford to pay our staff better too. Yes the referral network and insurance has had a major effect on costs, but also on very high quality treatment too.

RE: CGU? Not Line of Duty.....

Sarah Keir — Thu, 10 Jun 2021 10:49:56 GMT

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230654#230654"]it was standard to take images periodically (which seems pretty reasonable to me) to check everything was ok.[/quote]

Screening happens more and more frequently as we try to pick up disease earlier and earlier. For example at the opticians for a sight examination, I had a retinal scan done.

RE: CGU? Not Line of Duty.....

Gillian Mostyn — Wed, 09 Jun 2021 20:33:26 GMT

[quote userid="5904" url="~/001/nonclinical/f/life-in-practice-discussions/29824/cgu-not-line-of-duty/230713#230713"]Quote: Eg- "your dog has vomited 3 times today. I can't see" any immediate cause for concern on abdominal palpation/ clinical examination. I am happy to try some treatment (anti-emetic) then reassess tomorrow,[/quote]

How many times do you need telling? 99% of vets would do the same!

RE: CGU? Not Line of Duty.....

Anthony Todd — Wed, 09 Jun 2021 19:37:20 GMT

Quote: Eg- "your dog has vomited 3 times today. I can't see" any immediate cause for concern on abdominal palpation/ clinical examination. I am happy to try some treatment (anti-emetic) then reassess tomorrow,

Just the presentation I'm talking about, [and I haven't seen what happened!

I am totally of the view that, given this history, further examination or tests are totally unnecessary [and I don't think the outcome is mentioned].

You may consider yourself a dinosaur, but what is/was your hit-rate? How often should you have Xrayed [after your experienced nuanced palpation KFC corn cob!??]]

Ii'll bet you weren't embarrassed often, if at all...............Hit rate +-, perhaps 100%!! ie never wrong!

RE: CGU? Not Line of Duty.....

Anthony Todd — Wed, 09 Jun 2021 17:19:29 GMT

Still waiting for someone to challenge or even discuss my "hit rate" as an indication of the value of further exams.labs, bloods, Xrays ultrasound etc.

That is a further test or exam which confirms or discovers a problem not disclosed or suspected after a thorough history and clinical exam.

i reckon the differences between vets and practices [via pay rates] may be staggering.