On Thursday 23rd May the UK’s Competition and Markets Authority announced that they were launching a “Market Investigation Reference”. In other words, an investigation into competitive practices and (indirectly) pricing in the veterinary sector. But this has given rise to some serious problems that need addressing; with a lot of vets, representative bodies, and even the regulator and the CMA expressing concern over the risk for abuse of individual veterinary professionals as a result. But has this really happened?

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What is the CMA investigation?

The Competition and Markets Authority is investigating the UK Veterinary sector (that’s important, we’ll come back to it!) over a number of issues, but primarily they are:

  1. Whether pricing and options are as transparent as they should be. For example, relatively few veterinary practices list routine prices on their websites (which is one reason we set up the VetHelpDirect Price Comparison for vets!) – although that is slowly improving.
  2. Whether the large corporate veterinary providers are providing fair competition – for example, how easy is it to tell that your vet practice is no longer owned by the vets you see, but by private equity and shareholders, or a larger conglomerate such as Mars? 
  3. Whether animal owners are paying too much for medicines (always complicated, because the sale of medicines is highly restricted meaning that we’re actually banned from using the obvious ways to save money, such as using generic human versions or buying from a cheaper retailer).

You might expect me, as a vet, and one who has spent many years defending my profession, to be opposed to this. But actually, you’d be wrong.

I wholeheartedly support this investigation

And I’m not the only one! Almost all the vets I’ve spoken to do as well. Emma’s* response is typical – “I think my colleagues all welcome the review.” There are several reasons for that.

The veterinary world has changed a lot in the past decade or two

There have been dramatic changes in practice ownership, with the majority of vet practices now owned (at least in part) by one of six large corporates. But unfortunately, regulation hasn’t really kept up. At the same time, there are serious questions about whether the big integrated corporates might in some cases be engaging in anti-competitive behaviour, generating local monopolies, or diverting referrals, prescriptions for medicine, and even cremations to their own subsidiaries. 

I don’t know if that’s true or not. But if it is, I think we need to know about it, and the CMA are best placed to find out.

I also think that there are problems with transparency around pricing

While it’s true that it’s very difficult to quote prices accurately for veterinary treatment (sick animals are notoriously variable, with a remarkable percentage not having “read the textbook” in my experience!), that’s no reason not to publish routine prices.

Medicines laws are complex and often anticompetitive

I understand the good intentions behind the prescribing Cascade and the wholesale dealers restrictions. The Cascade sets down when vets are (or, more frequently, are not) permitted to prescribe an unlicensed or human medicine (and we are banned from using it for reasons of cost), and is intended to safeguard the pipeline of safe, tested and effective medicines for animals. The wholesale dealership regulations prevent vets from buying from other retailers (e.g. online pharmacies) and reselling.

However, these rules also act to restrict the availability of cheaper medicines, and push prices higher. In some cases, veterinary medicines may be identical to a human version (perhaps even made in the same factory) but cost five or ten times as much. And when online retailers can bulk-buy medicines and sell them (with VAT) more cheaply than most vets can buy them in, something has gone wrong.

So I’m all in favour of the CMA investigating the regulatory burdens around supplying veterinary medicines!

BUT…

None of the issues raised are anything to do with the vets, nurses and receptionists you see at the practice. In the vast majority of cases, they are all employees. They don’t set the prices or the policies. They just have to try and work within the law and within the terms of their employment contracts, to help your pets.

So is the CMA investigation leading to more abuse?

I posted a poll in one of the UK’s biggest veterinary online forums. 54% of the respondents reported that they had been subjected to verbal abuse in the clinic that referenced the CMA report. 15% had received written complaints and 13% had received online abuse relating to it. 

I must add that 25% of the responses related that people had received support from their clients. And 17% said that no-one had mentioned it positively or negatively.

These are truly shocking figures. 

Your veterinary staff are trying to help but the fixed costs have dramatically risen this year. This means that the practices need to charge about 16% more for their energy bills and 12% more for drugs. And with so many vets leaving the profession, salaries are rising just to keep people in a workplace where they face constant stress, sometimes limited support, and ongoing abuse.

It’s also counterproductive. If you abuse your vet because the bill is high and they leave, the next vet you see (if your practice can even find one!) will probably have to charge you a higher fee

So why is this happening?

The CMA report itself probably is a trigger rather than the cause. It’s certainly true that the reporting in the media, using terms like “rip off vets” and worse, has been profoundly disappointing. 

Veterinary care – like any health care – is expensive. All vets are trained in giving a wide range of treatment options, and I’m sure most of us do. But unfortunately, in many cases, the more expensive options have the highest likelihood of a good outcome. 

But different practices will offer different services and price points. Colin Whiting got in touch to say that “At Beacon VetCare we’ve shared and promoted a post welcoming the investigation, clearly stating our independent ownership, and attaching our price list for a wide range of routine fees together with details of our Community vet health care discount scheme, and including our prescription fee which it appears is pretty low by general comparatives… Since we opened, there has been a move amongst competitors to cut some of their prices dramatically towards our fee levels too. So we are seeing general positive impacts from Competition for other practices clients too.

So this move from CMA, and especially aspects to be open and transparent about pricing and ownership, has if anything further cemented clients respect for us and encouraged more to join us.”

What do vets think?

Most of the people who responded directly to me cited serious misunderstandings over veterinary pay and conditions. And compared them negatively to our counterparts in human medicine:

“The public believe we are all absolutely minted,” Emma goes on to say. “Genuinely, every person I ever tell how much we actually earn has been gobsmacked. The great British public also love to jump on the ‘doctors’ wages are far too low’ bandwagon. I don’t understand how they’re so sympathetic to doctors when in fact they’re paid triple what we are and they charge 3 times more. It’s all about narrative and perception and our story just isn’t being told. I think if more of them understood this, we might have an easier time of it. And if they understood that the money they pay doesn’t go to us.”

A lot of people cite Indeed which claims an average vet is on £85k. The amount of laughter I’ve had when I’ve quoted that figure to vets and nurses in practice! In actual fact, the average basic salary is apparently about £51k outside London. But this disguises a lot of variation with younger vets and assistants (i.e. the vets you’ll probably see who aren’t running a practice) on substantially less. So it’s a very comfortable wage, but certainly not as much as our medical colleagues (especially if they do a lot of private work).

Erica* reports that “My husbands cardiologist said he could understand with all the things wrongs in the world why they felt the need to go after the vets. His cardiothoracic surgeon told me he thoughts vets were really expensive moments after recommending a £160k surgery.”

We’re really lucky we don’t usually have to deal with the prices of complex care, due to the NHS in the UK.

The bottom line

I doubt the CMA has caused a surge in “vet bashing”. But I think the way it has reported has, sadly, emboldened people who are already angry.

Veterinary care is expensive – but that doesn’t mean you’re being ripped off. From the other comments, that people didn’t want to be published, I think it’s clear that a lot of vets are struggling at the moment. Most practices are understaffed, the workload is immense, and vets tend to be perfectionists at the best of times. Abuse of your vet is never OK – especially if you still want there to be vets there!

That said, it doesn’t mean you have to just accept the prices if you think they’re too high. Always talk to your vet about the costs, and let them know what your budget is. I assure you, I much prefer an honest “I have this much to spend” than the people who say “I’ll pay anything!” then complain about the cost. 

If you feel your practice is too expensive, check around to compare vet prices in the area. Consider moving practice, or write to the practice owners. Don’t abuse the staff who are there trying to help!

*Names have been changed because, sadly, many of my colleagues fear a personal backlash.

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