Introduction

Traditionally, veterinary practices have been privately owned and operated by an individual veterinarian or a small group of veterinarians.¹ However, in recent years, a number of large corporations have purchased and consolidated numerous independently owned veterinary practices, thereby changing the face of veterinary medicine.² Corporate involvement in veterinary medicine began in 1987 when Veterinary Centers of America Inc (VCA) purchased its first independently owned veterinary clinic. Shortly after, Banfield/Medical Management International Inc entered a partnership with PetSmart and began opening veterinary clinics in PetSmart stores. Mars Inc followed, entering the veterinary field in 1994 when it bought Banfield Pet Hospital, then BluePearl in 2015 and VCA Inc in 2018.³

Acquisition and consolidation of veterinary practices appeals to large corporations because it offers a safe, lucrative investment for corporations looking to diversify and make a profit. There are now over 60 veterinary consolidators,⁴ and most CEOs of these consolidators are not veterinarians.⁵ Approximately 75% of specialty and emergency clinics and 25% of all first-opinion clinics in the US are owned by corporate consolidators,^5,6 and estimates suggest that consolidators control around 50% of all US veterinary hospital revenue.⁶

There are approximately 126,000 practicing veterinarians in the US; 75,000 work in private practice.⁷ These veterinarians are increasingly faced with the decision of whether to work in a corporate-owned or a privately owned practice. One frequently touted positive aspect of working for a corporate-owned practice is the benefits package, including health insurance, paid vacation time, continuing education reimbursement, retirement, and paid sick leave.^8,9 It has been suggested that consolidation can save money, thereby enabling corporations to offer more and better benefits. Yet the ability of corporations to increase employee benefits has not always translated into a reality, with some veterinary professionals reporting worse benefits after their practice transitioned to corporate ownership.¹⁰

Corporate hospitals have also been perceived as a good option for veterinarians who want predictable hours and manageable workloads, better mentoring, and the ability to move to other hospitals within the corporate umbrella.^1,8 It has also been suggested that corporate hospitals offer career opportunities and professional growth not always available within privately owned hospitals.⁴ Other noted advantages of corporate ownership include the ability to upgrade aging hospitals, often with state-of-the-art equipment⁴; have business and administration tasks managed by people trained in these tasks¹¹; and be able to buy in bulk and therefore pass savings on to pet owners.^1,12

On the other hand, much has been written about the potential negative aspects of corporate hospitals. These factors include the risk that consolidated hospitals may not be as responsive to employees’ opinions when compared to privately owned hospitals,⁸ decreased ability of employees to have a role in practice management and animal healthcare policies, and difficulty in communicating concerns or ideas to upper management.^1,12 The culture may be less “family friendly” and offer less flexibility pertaining to working conditions.¹¹ Additionally, there may be prolonged approval processes for new equipment or changes in protocol. Another common criticism of corporate hospitals is an overriding focus on making a profit, creating an atmosphere of pressure to increase profit margins.¹

Despite these purported benefits and detriments, we know of no studies to ascertain the views of veterinarians working in corporate hospitals compared to those working in privately owned hospitals. Given the growing number of corporate hospitals, we felt it important to assess differences in how veterinarians view their workplace to help clinicians make educated decisions about employment options. Therefore, we compared and contrasted the views of participants working in corporate hospitals to those working in privately owned hospitals about benefits and general work conditions. Our overarching research question was whether there are differences in the views of veterinarians working in corporate versus private practices pertaining to their workplace and, if so, where these differences lie. The study design and survey items were based on 2 organizational behavior theories. The human relations management theory suggests that employee productivity, motivation, and satisfaction can be increased through positive social connections in the workplace and acknowledgment of the employee as a unique individual,^13,14 while job demands–resource theory postulates that burnout and work engagement may be the result of excessive job demands coupled with inadequate resources.^15,16

Methods

We created an online survey and distributed a link to the survey via email to veterinarian members of the Veterinary Information Network (VIN), an online community for veterinarians (n = approx 43,000). Participants could anonymously access the survey from January 12, 2022, through February 6, 2022. A follow-up message was sent 2 weeks after the initial invitation. We included data only from respondents who stated they currently worked in clinical practice either in a brick-and-mortar private practice (ie, not mobile, shelter, academia, or relief/locum) or a corporate practice and were not currently in an internship or residency program. We defined private practice as “brick-and-mortar private practice (ie, not mobile, not shelter, not academia, not relief/locum, not owned by a corporation)” and corporate practice as “corporate practice (eg, Banfield, VCA, Blue Pearl, etc).” Because we wanted to assess the perceptions of practitioners working in private or corporate practice, the decision was made to exclude respondents who work as academic, shelter, mobile, or relief veterinarians. Furthermore, because several of the survey questions pertained to benefits, we limited our sample to associate veterinarians who categorized their work as full time. The study was categorized as exempt by Colorado State University’s Institutional Review Board. The survey was administered directly via the VIN data collection portal, and branching logic was used to display only relevant questions to each participant. The body of the survey consisted of demographic questions including full- or part-time status, eligibility for benefits, type of practice (eg, first opinion or emergency medicine, specialty [referral] medicine, or other), current role (associate or owner/partner—for private practice only), currently in a leadership position, and future interest in leadership positions or becoming an owner or partner. Personal demographics included gender and veterinary school graduation year.

Participants were asked to indicate, from a list of possible options, all the benefits they currently receive and their satisfaction level (using a 5-point Likert scale, with 1 = very unsatisfied and 5 = very satisfied)¹⁷ with the benefits they receive. They were also asked to indicate their satisfaction (using a 5-point Likert scale with 1 = very unsatisfied and 5 = very satisfied) with several items pertaining to their hospital (eg, standard of medicine, hospital flow, and administration) and personal aspects (eg, feel your voice is heard, ability to change health-related protocols, and work schedule) of their work. They were then asked to report (using a 5-point Likert scale from none to extreme) how much pressure they feel from management regarding generating revenue, seeing more clients per shift, working longer hours, not referring cases, and following specific protocols for disease diagnosis and treatment.

Lastly, participants were asked to indicate their preference (or no preference) for private noncorporate versus corporate practice. A final question at the end of the survey allowed for free-text entry for any comments participants chose to make about why they preferred private or corporate practice. Because the survey focused on benefits received and satisfaction level, only associate veterinarians (not owners or partners) who reported working full time were included in the analysis (Supplementary Material S1).

Descriptive statistics and χ² tests were performed with SPSS Statistics (version 28; IBM Corp). Because of the categorical nature of the data, χ² tests¹⁸ were used to test for differences between private practice and corporate practice for the questions pertaining to benefits (available and satisfaction level) and satisfaction level with items pertaining to their hospital and personal aspects of their work. To determine whether personal demographics could predict current type of employment (private or corporate practice), logistical regression was used to predict current type of employment on the basis of participants’ gender and year of veterinary school graduation. The χ² test¹⁸ was also used to assess the relationship between participants’ preference for private noncorporate or corporate practice and whether they currently work in private noncorporate or corporate practice. Due to the number of analyses, significance level was set at 0.005.

Results

Discussion

Our study highlighted differences in perceptions surrounding veterinary employment in corporate and private practices. Although corporate practice employees reported receiving more benefits, a greater proportion of participants indicated a preference for working in private practice (55%) compared to corporate practice (12%), with no differences in preference based on gender or years since graduation. Veterinary employees were equally satisfied with the benefits they received. However, those in private practice expressed greater satisfaction with multiple hospital environment factors. This suggests that the desire of many veterinary employees to work in private practice, if they could, appears unrelated to benefits but more likely a reflection of corporate work culture and environment.

Somewhat surprisingly, we found that recent graduates were more likely to report working in private practice. With the unemployment rate for veterinarians at a record low of 0.5% in 2022,¹⁹ recruiting and retaining veterinarians has perhaps never been more important. Yet despite the fact that corporate practices have over 3 times the number of job listings as private practices, the number of veterinarians going into corporate practices does not match the available jobs.¹⁹ In fact, since 2019, the percent of veterinarians going into corporate practice has been trending slightly downward,¹⁹ meaning that even though the number of job opportunities for veterinarians within corporate practices continues to rise, many veterinarians are making other choices. This may be due in part to the number of younger veterinarians interested in entrepreneurial and intrapreneurial (entrepreneurial behavior within a business not owned by themselves) opportunities.²⁰ In addition, in terms of retention, studies suggest that 33% to 50% of new graduates leave their first employment position within their first 2 years, most commonly due to a lack of support or a toxic work environment.^21–24 Unfortunately, to our knowledge, a comparison of attrition rates between corporate and private practice has not been conducted; a study of this nature would be helpful in further illuminating potential differences between the 2 types of practices.

Several positive features are often mentioned in relation to corporate practices, one of which pertains to better benefits. Our study supports the premise that corporate practices offer more benefits to their employees than private practices. Participants in our study working in corporate practice were more likely to report receiving insurance (health, dental, life, and short-term disability), mental wellness programs (eg, counseling), wellness mobile apps, VIN membership, and continuing education paid by their employer than those working in privately owned practices. There were, however, no differences between the 2 groups in satisfaction levels for any of the benefits received. Yet, for many veterinarians, the availability of insurance, and especially health insurance, is an important consideration when seeking employment.

In addition to more benefits, it has been suggested that corporate practices offer more predictable hours and manageable workloads.^1,8,12 However, we found no differences in satisfaction levels between those working in corporate or private practices for any of the survey items pertaining to schedule (ie, hours per week, length of shifts, ability to leave work at the scheduled time, or flexibility to personalize) or personal case load.

It has also been proposed that corporate practices are able to run more efficiently because business and administration tasks are handled by those trained to complete these tasks^11,12 and, because of increased capital, corporate practices can invest in better facilities and equipment.² Nevertheless, we found no differences in participants’ responses based on working in a corporate versus private hospital in terms of their ability to acquire smaller equipment (and, in fact, those in private practice reported an easier time acquiring large equipment) or in their ability to get treatments or diagnostics done, hospital flow, physical space to examine and treat animals, or practice management software/medical record systems.

Furthermore, despite corporate practices’ additional capital, participants from corporate practices reported feeling less satisfied with wages for technicians/nurses, reception and other support staff, and veterinary production-based remuneration. They also reported less satisfaction with turnover rates among all employees (ie, technicians/nurses, reception and other support staff, and veterinarians).

For veterinarians seeking leadership roles, it has been suggested that corporate practices may offer more opportunities.¹² Although we found that participants in leadership roles were more likely to be working in a corporate setting, we found no difference in current work setting based on future interest in obtaining a leadership position. Given the large number of veterinary students interested in leadership roles within veterinary medicine, as well as intrapreneurship opportunities,^20,25 it might be helpful for corporate practices to better communicate to potential and employed associate veterinarians about leadership opportunities and pathways to achieving expanded roles.

When we assessed differences in satisfaction levels for several work-related factors reported by veterinarians working in private versus corporate practices, we found several elements that may help explain the preference we found for private practice. Participants in private practice reported higher satisfaction with feeling known as an individual by upper management, hospital culture, the ability to fire difficult or abusive clients, and mentorship. In addition, those in corporate practices reported feeling more pressure than those in private practice to generate revenue and see more clients per shift. Together, these elements suggest that participants working in private practices feel more supported than their colleagues in corporate practices.

Importantly, these elements can have significant effects on veterinarians’ well-being and feelings of burnout. Previous studies have found that several items assessed in our study (eg, interpersonal work relationships, workload, work schedule, etc) are associated with burnout.²⁶ Yet by their very nature, corporate practices have unique opportunities to implement wide-reaching systemic changes in these areas that can significantly impact the field of small animal practitioners by decreasing burnout and increasing job satisfaction.

Burnout, defined as a work-related syndrome characterized by emotional exhaustion, depersonalization, and a sense of reduced accomplishment resulting from chronic workplace stress,^27,28 is a common problem in many healthcare professions^29–31 including veterinary medicine.^26,32–35 Burnout is associated with reduced productivity, high job turnover, and early retirement,^36,37 affecting not only the mental health of veterinary professionals but the economic viability of hospitals.³⁸ Primarily due to turnover and reduced working hours,³⁹ the cost of burnout in annual lost revenue among veterinarians in the US has been estimated to be $1 billion to $2 billion.³⁸ Distressingly, the prevalence of burnout appears to be increasing.⁴⁰ In 1 recent study,³⁵ 87% of US veterinarians reported moderate to high burnout, and in the 2022 Merck Wellbeing study,⁴¹ 31% of veterinarians reported high burnout, which was especially prevalent for veterinarians younger than 45 years of age. Furthermore, a recent AVMA study¹⁹ found that 40% of veterinarians are considering leaving the profession, with the top reasons including a lack of work-life balance and mental health challenges. Unfortunately, despite an increasing number of well-being resources available, fewer than 33% of veterinarians indicate accessing these types of resources.⁴¹ In our study, we found that participants in corporate settings were more likely to report having mental wellness programs and wellness mobile apps, but we did not inquire as to their usage. It is possible that although they have these benefits, they are unable or unwilling to access them.

While traditionally, the responsibility of managing burnout has been left to the individual veterinarian, and certainly individual choices and behaviors can decrease burnout and emotional stress,⁴² interventions at the organizational level have been found to be more effective at decreasing burnout among healthcare professionals^{29,30,43–46} and should therefore be a top priority in veterinary medicine.⁴⁷ There is growing evidence that workplace interventions solely targeting the individual may not be effective,⁴⁸ suggesting the need for systemic changes in addition to individual-level intervention.⁴³ Corporations, perhaps even better than privately owned hospitals, are well suited to implement systemic changes to combat burnout and other significant challenges within the field.

One fundamental component of systemic change includes assessing and, when necessary, changing hospital culture. Organizational culture is a dynamic, evolving collection of values, expectations, and practices that guide and inform the actions of all team members.^49,50 A negative work culture is detrimental to all involved—the veterinary team, clients, and patients.⁵¹ There are several key elements in creating a healthy workplace culture, including good communication and fostering a strong sense of team and a high degree of trust.⁴¹ Part of good communication involves making sure people have a voice.²⁹ Our study found that veterinarians working in private practice felt more satisfied that their voice was heard when compared to those working in corporate practice. Feeling listened to and having the ability to shape their hospital’s culture—including decisions about their jobs, hours, and tasks—are important to many veterinarians. Younger generations in particular prefer a democratic work structure and want to work at places where they feel that their opinions are wanted and valued.⁴² They gravitate to employment opportunities in which decisions are not made solely from the top down but instead are made from a more bottom-up and democratic system.⁵² Democratization in the workplace enhances employee commitment and reduces turnover.⁵³

A focus on workplace culture offers a plethora of opportunities to implement organizational solutions to alleviate burnout. By focusing on individual, team, and environment factors, practices can reduce burnout and increase job satisfaction.⁵⁴ Making these changes requires effective leadership. Good leadership is a key component to alleviating burnout and stress among employees.^55–57 The key elements of leadership that are important in improving morale and well-being include good communication skills; seeking suggestions and input pertaining to hospital culture and protocols; providing mentoring and frequent, timely feedback; and recognizing and rewarding quality job performance.⁵⁷ To this end, we suggest that corporations focus on creating leadership training to help potential and current leaders improve and excel in these areas.

There were several limitations to this study. Our sample consisted of a small percentage of VIN members and the only demographics we collected were gender and graduation year, so caution is suggested when generalizing to other veterinarians since we cannot be certain that our sample represents the overall veterinary population. Moreover, because VIN membership is often a benefit offered by corporate-owned practices, this may have biased our results.

Potential response bias was another limitation. It is possible that individuals who feel strongly about corporate-owned practices, either positive or negative, might have been more likely to respond to the survey. Furthermore, because of the multitude of nuances within the categories “private” and “corporate” (eg, some single-doctor–owned practices are incorporated, some corporations are privately owned), it is possible that some participants may have been unclear as to what option to select. Additionally, we did not inquire about the usage of benefits, only whether they were received and the satisfaction level.

In summary, corporate-owned veterinary hospitals are quickly becoming the norm. There are pros and cons to corporate-owned hospitals when compared to privately owned practices, yet corporate hospitals are well suited to make instrumental changes on a large organizational level that can improve the lives of not only individual veterinarians but the overall well-being of the field of veterinary practitioners.

Supplementary Materials

Supplementary materials are posted online at the journal website: avmajournals.avma.org

Disclosures

The authors have nothing to disclose. No AI-assisted technologies were used in the generation of this manuscript.

Funding

The authors have nothing to disclose.