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The Future of Veterinary Medicine ____________________________________________________ Scenario Planning Symposium, 2019 Pharmacy, Dentistry and Optometry An analysis of how comparable professions are managing challenges faced by the veterinary sector ©2018 Arcus Group Inc | The Veterinary Leaders’ Table | College of Veterinarians of Ontario | 091018 Common Trends A summary of unifying themes in the professions of optometry, dentistry and pharmacy and how these sectors are addressing some of the challenges that are relevant to the veterinary profession. Trend 1: Consolidation, Corporatization & Integration Trend 2: Technology Trend 3: Demographics Trend 4: Affordability Common Trends Corporate acquisitions Reputations and Social Media Increasing costs Pricing and Online retail Lower margins Cost efficiencies and IT Vertical integration Regulation and patient data Changes in scope of practice Consolidation Technology Access to patient records Demographics Affordability Work-life balance Lack of insurance coverage Retiring boomers Wage inflation Density of urban practices Technicians’ scope of work Gender ratio Online competition Trend 1: Consolidation, Corporatization & Integration • Individual practices are on the decline and group practices are growing because of expectations of younger generations for more time off, market shifts towards shared expenses, larger client lists and better insurance coverage. • Increasing costs and lower margins are changing business models with a focus on collaboration, better alignment of expertise with job responsibilities and vertical integration. • Corporate acquisitions are accelerating in all sectors driven by the need to contain costs and impending retirements in private practices. • Greater integration of care delivery systems presents an important streamlining opportunity for the professions in areas such as post surgery care and medication dispensation. • As scope of practice expands and evolving patient needs are identified, the readiness of technicians to manage these changes is becoming an important consideration. Trend 1: Consolidation, Corporatization & Integration Example: Optometry In October, 2017, an optometry thought-leader panel hosted by Canadian Eye Care Business Review shared their views on the future of independent optometry in Canada and 6 critical issues on the minds of Canadian optometrists. 1. The impact of supplier side consolidation and its potential effect on independents. 2. The reasons why ODs are selling practices to larger retail groups. 3. How optometry can avoid being swept up in the general sea-change in retail. 4. Importance of the “customer experience” in practice success. 5. The risks to solo practitioners in today’s environment. 6. The commercial opportunity for optometric medical services vis-à-vis retail dispensing. The panel said the most important factor affecting Optometry is the growing competition for independent Optometry from larger consolidated entities. Trend 2: Technology • The internet is driving change in multiple dimensions- social media is impacting reputations, online retail is gaining market share and patient awareness is recalibrating expectations. • Electronic transfer of records for consultation between specialists and use of the Internet to send reports is augmenting patient care co-management. • With the goal set on increased efficiency, cost reduction, and higher patient satisfaction, professionals are focusing on implementing modern IT solutions in their everyday practice. • Regulatory frameworks are struggling to keep up with the fast pace of change in technology offerings in areas such as patient data privacy, treatment options and materials. • As practices implement new technologies, the integration of health care provider records and the emergence of patient-controlled or viewable health records are important areas of transformation in all sectors. Trend 2: Technology Example: Pharmacy As pharmacies develop improved technology, the integration of health care provider records and the emergence of patient-controlled or viewable health records are important areas of health care transformation. The planned national e-prescribing system will improve patient and provider access to more complete medication records and serve as a platform for many functions beyond medication management, such as e- referrals, patient bookings and inter-clinician messaging. Trend 3: Demographics • New generations entering professions have greater work-life balance expectations leading to the need to transition individual practice business models into group practices. • Succession planning is a challenge. Retiring boomers are creating an urgency for business transitions just as the cost of acquiring practices is becoming prohibitive for new graduates. • Urban areas are attracting more young professionals and foreign-trained professionals leading to an increase in competition for patients. • Gender ratios are changing. In Ontario, the gender ratio for dentistry, optometry and pharmacy is 38.3%, 50.0% and 57.6% female respectively. However, there are large differences by age category. Older professionals are far more likely to be male than female, whereas younger professionals are more likely to be female. • Technicians in all sectors are predominantly female. For example, over 95% of dental hygienists are female. Trend 3: Demographics Example: Dentistry Population growth has not kept pace with the increase in the number of practicing dentists. Rising practice prices are simply a function of supply and demand, says the Canadian Dental Association. Current work-force data suggests that there is an oversupply of dentists throughout most regions of Canada, and the current supply of dentists will continue to significantly outpace population growth. The problem is particularly acute in Canada's big cities, where the density of dentists "is now roughly three times that in rural areas“, according to the Association. Trend 4: Affordability • Affordability of products and services is a significant barrier to greater access to services in all sectors. For example, while a majority of Canadians enjoy relatively good dental health and two-thirds of Canadians see a dentist annually, 32% have no dental insurance. • Wage inflation is being driven by the minimum wage hike putting a further squeeze on practice operations. While most office staff and assistants to professionals are paid more than minimum wage, many are seeking a pay increase to keep up with a rising cost of living. • Many jurisdictions are looking to technicians to take over some of the traditional distribution and dispensary-related work, to allow professionals to focus more on providing patient care and clinical services and to lower staff costs. • Online competition in all sectors has provided consumers with access to lower-cost products and greater convenience. However, clinical services have not been impacted as much as pricing of products. While patients are concerned about affordability, they have some concerns about migrating online for clinical interactions. Trend 4: Affordability Example: Dentistry Up to a third of Canadians have no public or private coverage and visit the dentist infrequently. With universal coverage, 4.3 million more Canadians could seek dental care each year, according to the Parliamentary Budget Office of the Government of Canada. The primary reason for the remaining third of Canadians not seeing a dentist is affordability of dental care due to lack of insurance coverage. To reach more patients, dentists have been expanding their service offerings, for example, with a greater emphasis on cosmetic dental procedures such as braces, veneers and teeth whitening. However, this thrust has focussed on premium value-added services and not basic dental care. .

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