Who Decides? Corporate edicts, clinical judgment, and the changing soul of vet med (#530)

Last week I read that National Veterinary Associates (NVA) had banned elective declaw procedures across its 1,400 hospitals.

My first reaction was simple:

Well done NVA!

Declawing has always troubled me. Removing the distal phalanx of each digit for “convenience” never sat comfortably beside the oath most of us took to relieve suffering.

If fewer cats undergo that surgery, that is almost certainly a humane step forward.

But my second reaction lingered longer.

Not about the procedure, but about:

Who made the decision.

It wasn’t a state veterinary board. It wasn’t the AVMA. It wasn’t a consensus statement debated in committee rooms by practicing veterinarians.

It was a corporate policy.

An edict from a boardroom.

And that gave me pause.

Because when I trained, and for most of my career, decisions about what veterinarians could or could not do belonged to three places:

• Licensing authorities,

• Professional associations, and

• Individual clinical judgment.

Now there is a fourth voice at the table.

Corporate ownership.

And it is speaking more loudly every year.

When I started, clinics were small worlds

When I graduated, most veterinary hospitals were owned by the veterinarian whose name was on the sign out front.

Medicine was local. Decisions were local.

If a practice stopped offering a procedure, it was because that veterinarian had thought deeply about it, argued with colleagues about it, maybe changed their mind a few times and finally decided what felt ethically right.

Messy. Human. Imperfect.

But it was ours.

Today, thousands of hospitals belong to groups like NVA, VCA, Banfield, BluePearl, Ethos, and others.

One memo can change practice in 1,000 clinics overnight.

That kind of scale simply didn’t exist before.

And scale changes everything.

The case FOR corporatization

To be fair corporate medicine is not some cartoon villain twirling its mustache.

There are real advantages. I see them when I talk to younger colleagues.

They tell me:

• “I don’t want to run payroll.”

• “I don’t want to negotiate leases.”

• “I don’t want to manage inventory or marketing.”

• “I just want to practice medicine.”

Corporate groups can offer:

• Stable salaries and benefits,

• Maternity leave and health insurance,

• HR departments,

• CE budgets,

• Expensive imaging equipment,

• Specialists under one roof, and

• Administrative support.

For a new graduate with six-figure debt, that stability is not trivial.

In many cases, it is lifesaving.

Large systems can also standardize things we should standardize, such as anesthesia safety, pain management protocols, and infection control.

And yes, sometimes they make ethical decisions faster than our professional bodies do, as with declawing.

So, the story is not black and white.

It never is.

The case AGAINST corporatization

This is where the unease creeps in.

Because alongside those benefits comes something subtler. Something harder to measure.

Loss of autonomy.

I hear it in the hallway conversations.

• “I’m not allowed to…”

• “Corporate says we can’t…”

• “We have targets to hit…”

• “We’re encouraged to…”

Encouraged. Required. Discouraged.

These are not words we used much when I was a young veterinarian.

Back then it was simply:

“What does this patient need?”

There is a difference between clinical guidelines and business directives.

Between: “Here’s the evidence,” and “Here’s the policy.”

When medicine starts flowing from spreadsheets instead of stethoscopes, something fundamental shifts.

And veterinarians feel it.

The deeper question isn’t declawing.

Declawing itself is almost beside the point.

I agree with the outcome.

But the mechanism matters.

Because today it’s: “No elective declaws.”

Tomorrow it could be: “Only these suppliers,” “These pricing structures,” “These service bundles,” and “These revenue expectations.”

Some of that is harmless efficiency.

Some of it is not.

The worry many of us carry quietly is this:

When does corporate guidance become corporate control?

When does a helpful framework become a constraint on professional judgment?

When does a veterinarian become an employee first and a clinician second?

That, to me, is the thin edge of the wedge.

We’ve seen this movie before

Human medicine went through this decades ago. Large hospital systems. Private equity. Insurance networks. Administrative layers. Physicians slowly trading independence for employment.

Some of it improved care.

Some of it created burnout, moral injury, and distance between doctor and patient.

Veterinary medicine is now walking that same road - just twenty years later.

We would be naïve to think we’re immune.

And yet…

I try not to romanticize the past.

Independent practice was not paradise.

We had:

• Exhausted owners,

• Financial fragility,

• Poor benefits,

• Inconsistent standards

• Little mentorship, and

• Plenty of questionable medicine.

Autonomy does not automatically equal quality.

And corporations do not automatically equal greed.

The truth, as always, lies somewhere in the middle.

What really matters

Ownership structure is not the heart of the issue.

Professional integrity is.

A corporately owned hospital can still practice excellent, compassionate medicine if veterinarians retain genuine clinical authority.

An independent clinic can still cut corners if ethics are weak.

So perhaps the real dividing line

is not

corporate vs independent,

but

medicine-led vs business-led.

Who has the final say? The spreadsheet or the veterinarian?

If the answer remains “the veterinarian,” we’re probably okay.

If not, we have a problem.

My own quiet hope

I find myself hoping for something simpler.

Not a return to the past.

Not rejection of corporate models.

But a profession that remembers who it is.

A profession where:

• Policies are shaped by veterinarians,

• Welfare trumps revenue,

• Autonomy is protected, and

• Business supports medicine, not the other way around.

If a corporation bans declawing because it’s the right thing for cats, I applaud.

If it ever tells a veterinarian to treat an animal against their better judgment because of quarterly targets, I worry.

That’s the line.

And we should guard it carefully.

Because once professional judgment erodes, it is very hard to rebuild.

Rick’s Commentary

In the end, this isn’t really about corporations or independence.

It’s about something older. Something quieter.

The small moment in an exam room when a veterinarian places a hand on an animal and asks:

What is best for you?

Whatever system preserves that moment.

That’s the one worth defending.

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