Veterinary Nurse Versus Technician: the Pros and the Cons

The Veterinary technician profession has been subjected to variability since birth. Today, it faces a new, and hopefully positive, change with discussions about modifying the profession’s title to “veterinary nurse”. A movement lead by the National Association for Veterinary Technicians in America (NAVTA) has illuminated differing opinions between those in and outside of the profession.

Veterinary Technician History

The profession began in 1908 when the Canine Nurses Institute made its first organized effort to train English “Veterinary Assistants”. Over the next eighty years, the profession grew. First, the American Association of Laboratory Animal Science created three different levels of “animal technician” certifications at research institutions. Next, the US Army, Purina, and State University of New York (SUNY) established “animal technician” training programs in the 1960’s, which the AVMA then began regulating in 1967. The AVMA waited until 1989 to adopt the term “veterinary technician”, feeling until then that people would be confused with the “veterinary” modifier.

Michigan State University and Nebraska Technical Colleges were the first animal technical educational programs accredited by the AVMA. There are now 230 AVMA accredited veterinary technician education programs. Of these, 21 offer four-year degrees and nine offer distance-learning (online) options. Even before the AVMA adopted the term, the North American Veterinary Technician Association (now called the National Association of Veterinary Technicians in America) was formed in 1981. It works alongside the AVMA to protect the profession and encourages veterinary technician specialty developments. However, the profession has not grown uniformly across the United States.

In the United States, 37 states have established “veterinary technician” licensure, 10 states have non-profit organizations that implement voluntary credentialing, and 5 states/territories do not have any credentialing systems. This means that being a veterinary technician today could mean that either the state government regulates your credentialing, you are privately credentialed, or someone gave you the title “veterinary technician” when you started working at a veterinary practice and there is no credentialing system in your state.

Pros of “Veterinary Nurse”

The profession is fragmented by more than their state’s accreditations. Depending on their location, Veterinary technicians currently have varying titles. There are 19 states that use “certified veterinary technician”, 15 states that use “registered veterinary technician”, 14 states that use “licensed veterinary technician”, and Tennessee uses “licensed veterinary medical technician”. With this amount of fragmentation within the profession, how do we as veterinary professionals expect the general public to understand or trust a veterinary technician’s job description? As such a close-knit profession, we forget the foreignness of our commonly-used terms. Most clients underestimate the value of their veterinary technician simply by not knowing the education process. In fact, in a NAVTA survey to human nurses, 71% did not know the difference between veterinary assistants and technicians. Yet, we are baffled when we find that credentialed veterinary technicians are repeatedly unhappy and facing low income, compassion fatigue, lack of recognition and career advancement, underutilization of skills, and competition with individuals trained on-the-job. Due to this culture, the profession has incredibly high turnover rates despite its increased demand by the growing veterinary industry; veterinary technicians are projected to grow 30% by 2022.

How can we, without spending incredible amounts on advertising, uplift our veterinary technicians in the public (and practice’s) eye? Many have suggested using the familiar and applicable “nurse” title. The word “technician” implies an individual who has mastered veterinary science and technology, while “nurse” incorporates caring for animal patients into the description. Heather Predergast, RVT, CVPM, SPHR, a specialist with Patterson Veterinary Supply, Inc., discussed the need to abolish the profession’s fragmentation. She noted that “there has long been a need for common credentialing in this area. The responsibilities and job tasks of a veterinary technician have evolved over time and are inaccurately described by the term ‘technician’, implying a definition of their identify based on technical tasks. The term ‘veterinary nurse’ will incorporate the art of caring for patients from a patient-centered perspective, in addition to the science and technology.”

For these reasons, NAVTA has launched the Veterinary Nurse Initiative in an action to unite a single title, set of credential requirements, and scope of practice. This movement would hopefully provide recognition to the profession and elevate its credibility by requiring further education. Like human nurses, differing titles would recognize individual’s efforts for further education. To distinguish associate and bachelor’s degrees, NAVTA has proposed designating Registered Veterinary Nurse for associate degrees and Bachelor of Sciences in Veterinary Nursing for bachelor’s degrees.

Australia and the United Kingdom have already changed the name to “veterinary nurse” with large success. As the movement poses potential in the States, many academic institutions and corporations, such as Purdue, Midmark Corporation, and Patterson Veterinary Supply Inc. have published endorsements for its change; however, the initiative does face fair opposition.

Cons of “Veterinary Nurse”

Many veterinary technicians still opt to keep their current title. When questioned in a 2016 NAVTA survey, the majority of veterinary technicians (54%) favored the term “veterinary nurse”, over a third (37%) wanted to keep the title “veterinary technician”, and the remaining surveyed were undecided. Most of the pro-technician responders attributed their answer to disbelief that it will be possible to change the title. Some current veterinary technicians have voiced unease at their unsure futures after working their entire careers in a state that does not require licensure. Another similar situation arises for those that have passed the veterinary technician national examination but have not graduated from a school accredited by the AVMA committee.

While, ideally, this veterinary nurse initiative works to unify the profession and ensure quality standards, we must realize that we may be alienating a population of technicians at the end of their careers that would be offended if required to pay for an accredited teaching program and learn alongside new, inexperienced future technicians. Another important consequence to consider is liability. Currently, liability for veterinary technicians falls to the veterinarian on all cases; however, human nurses have their own liability to practice under their license governed by a separate board. This is a consideration essential to address as we raise the accountability of veterinary nurses.

The Veterinary Nurse Initiative has faced opposition outside of the profession as well. In fact, the veterinary technicians initially opposed to changing the name also noted conflict with human nurses in any past attempted title changes. The Veterinary Nurse Initiative investigated this further by sending a survey to three nursing groups. Two of the three declined to even acknowledge the survey, potentially indicating apathy for veterinary-related topics. Of the one group that did complete the survey, 66% did not object to “veterinary nurse”; however, regardless of whether or not they were opposed to the title change, almost all of the responders incorrectly assumed a veterinary technician’s educational requirements. An analysis of the opposed responses to the nurse title found that the objectors believed technician education was subpar to human nursing and the title was not deserved by veterinary technicians. It suggests that the human nursing profession worries about maintaining the quality of its own title and hopes to avoid misrepresentations.

In the past, other professions, not similar in scope to human nurses, have attempted to claim a “nursing” title. For example, a Christian medical community attempted to title their “spiritual healers” as “nurses”; however, they did not share nearly the same amount of education rigor. When confronted with a potential title change in the veterinary profession, human nurses mistakenly worry that the term “veterinary nurse” will also encompass veterinary assistants. This confusion highlights the need for public awareness of technicians – if the closest human counter-part profession does not understand a technician’s role or certification, how can we expect the general public to know any differently? The veterinary profession must raise awareness to the public about the differences between its assistants and technicians.

Currently, as the veterinary nurse initiative gains a foothold in Ohio, the Ohio Nurses Association and its 170,000 members have fought its new legislation, arguing that the state legally defines the term “nurse” as caring for humans and that no other person or profession may insinuate that they practice as a nurse. With similar nurse title protection in about 24 other states, the veterinary nurse initiative is likely in for its fair share of conflict as it continues to grow.

The debate over the title of veterinary technicians remains controversial both in and outside of the veterinary community. As with any impending change, it is important to recognize its potential benefits and shortcomings in order to formulate the best strategy to improve the profession. If the Veterinary Nurse Initiative ends up being successful, the change will likely empower today’s veterinary technicians and reduce the profession’s current high turnover rates.

 

Buy-Sell Negotiations: Ethical Disclosures or Buyer Beware

Buying or selling a veterinary practice generally is a long and arduous process. Preparation and a good lawyer are key to smoothing the bumps along the way.

I. PLANNING

How well you plan determines whether you will control the process or vice versa. Beyond identifying what is to be sold and the purchase price therefore, here is an overview of the main planning issues:

A. What Seller should be doing. Future retirees should note that it can take a decade to properly prepare a practice for sale.

  • Tax. Find out how the sale price will be taxed. Tax planning may require transformation of the practice legal structure and long waiting periods to optimize tax on sale. Bear in mind that the buyer may not accept the structure you wish to use for the transaction (e.g., he may prefer to buy assets rather than an interest in the practice entity.)
  • Practice Appraisal. To increase practice profitability and sales price, it may be worthwhile to get an appraisal. Implementing the appraisal’s recommendations may take several years. From the buyer’s perspective, a purchase without an appraisal may mean the practice does NOT have the cash flow to fund the purchase payments. If the buyer defaults on the payments, seller may have to take back practice, long after retirement.
  • Cleaning Up. Consult with your lawyer to see if there are any liabilities that should be taken care of before the sale (e.g., settle a claim). You also need to address any personal guarantees you have given to the business, and third party claims on any assets to be transferred (such as spouse and secured lenders). If the practice entity owns the real estate, you may need to divest it (at what tax cost?) back to yourself or another entity you own because the buyer may be unable to afford to buy both.
  • Financing. Many potential buyers can’t afford to pay cash and can’t get bank loans on acceptable terms. Consider whether you should provide financing by taking buyer’s promissory note (secured of course) for a portion of the purchase price.

B. What Buyer should be doing. Buyer’s planning phase usually is much shorter than seller’s. Try to minimize preparation expenses until you are reasonably sure that you have a deal with the seller. If the deal is aborted, you want to be as little “out-of-pocket” as possible.

  • Hiring Counsel. When hiring counsel, trust your instinct. If you don’t feel comfortable with him or her, get another one, there are plenty around. You find a good lawyer the same way you find a good doctor: by word of mouth. Your lawyer should be at least as smart as you are. Avoid lawyers that not nothing about assisting buyers purchase medical practices.
  • Tax. Find out how the sale can be structured to minimize taxes down the road for the new owner(s) and the practice, including taxes when you sell or withdraw from the practice. (Remember every buyer is destined to be a seller.)
  • Due Diligence. You don’t buy a house without visiting it, nor a car without a test drive. Buyers need to spend time at the practice to “kick the tires.” One of the most important goals of due diligence is to make sure buyers are not picking up hidden or poorly identified liabilities. Due diligence allows early detection of potential problems, so that the parties can address them…or separate. Not infrequently, good due diligence leads to a reduction in purchase price.
  • Financing. If you can’t pay cash, you need to line up financing (or be prepared to ask the seller for same) well before the sale.
  • Co-Ownership Issues. If you are just buying a portion of a practice or joining with other partners to buy a practice, there are many co-ownership issues that need to be addressed. Like marriage, co-ownership works a lot better if the principal terms governing the relationship before getting hitched. At least as much time and effort should be allocated to properly establishing and documenting your relationship with your partners, as to the purchase itself.
  • Investment Vehicle/Practice Structure. Unless you are buying into a pre-existing structure, consult with your lawyer to find the investment vehicle or practice structure best suited to fulfill your tax, financing and (co)ownership goals. (In making this choice, do not omit to factor in you succession or exit strategy.) Even if buying into a pre-existing structure, be aware of the consequences. For example, stock purchases are riskier than asset purchases because all of the liabilities of a corporation automatically are transferred with the stock, whether or not such liabilities were disclosed to buyer.

C. What Seller and Buyer should be doing Together.

  • Employees. The practice’s employees constitute its most valuable asset by far and it’s in the interest of both parties that the transition take place smoothly. For the buyer, smooth transition is critical, since the departure of one or more key employees can cripple the practice. While legally (to avoid trailing liabilities), the buyer will insist that all employees be terminated prior to the sale (and to the extent the buyer wants to retain them, rehired after the sale), it is up to the parties to work together to ensure that the ownership change disrupts the employees as little as possible.
  • Contracts. In asset sales where contracts are to be transferred (e.g. real estate and equipment leases), the consent of the other party to the contract is required. Obtaining such approvals is often easier when both buyer and seller approach such other party together (although as a contractual matter, it is almost always the seller’s responsibility to get these consents).

III. NEGOTIATING THE DOCUMENTS

A. Preliminary Documents. At some point during the preparatory stage, the parties usually negotiate some form of preliminary document which can range from: (a) a short letter of intent, pursuant to which the parties agree to negotiate in good faith with each other (in some cases exclusively) and confidentiality; to (b) a detailed memorandum of understanding detailing the process for going forward; to (c) an at least partially binding detailed letter of offer which sets forth the main terms of the deal. The parties should make absolutely sure they understand to what extent these documents bind them to go forward, and what liability, if any, a party will incur if he withdraws from the deal.

B. Purchase and Sale Agreement. While the preliminary documents set forth an intent, a process or a framework, the purchase and sale agreement (called stock or asset purchase agreement depending upon the transaction) is the contract in which the buyer binds himself to purchase the practice and pay the price, and the seller binds himself to sell the practice, in each case subject to a limited number of conditions precedent to closing the deal. Some conditions precedent are applicable to both parties obligation to close (e.g. no litigation exist challenging the transaction). Some are applicable to only one party (such as buyer obtaining satisfactory bank financing).

Other than the price and conveyance language, the most important clauses of the purchase agreement are seller’s representations and warranties, pursuant to which seller makes a series of declarations about the business (there are no hidden liabilities, there is no outstanding litigation against the practice; all inventory is saleable in the ordinary course, etc.) These provisions are designed to protect the buyer in case the practice isn’t what it appears to be, but the devil is in the wording, and both parties should make sure that they are comfortable with the language.

Another key clause is the non-competition provision (a.k.a. restrictive covenant) which prohibits the seller from competing with the practice for a certain period of time (e.g., five years) within a certain radius (e.g., 15 miles). This is an important provision to protect the practice’s goodwill.

III. TOWARDS CLOSING

Signing the purchase agreement means that the parties commit to consummate the transaction once all of the conditions to closing have been satisfied. Closing the transaction means actually transferring legal title to the shares or assets and paying the purchase price. Between these two dates, the parties and their lawyers do what is necessary to ensure that the closing conditions in the purchase agreement for which they are responsible will be satisfied by the closing date. (For example, buyer may have to obtain bank financing and seller get certain third party consents to the deal.)

In many cases, the signing of the purchase agreement and the actual closing of the transaction take place simultaneously, in which case there are no closing conditions.

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The preceding was merely a simplified overview. It seems that there are a billion issues and details that seller and buyer must keep track of when selling and buying a practice. That’s why competent legal advice is crucial. But if you feel overwhelmed, just ask yourself how you’d behave if the transaction involved a house or a car. Usually the solution will come to you as if by magic.

PRACTICE ENTITY-WHICH ORGANIZATION IS BEST FOR YOU AND WHY IT MATTERS

Choosing the correct structure for your veterinary practice is an important decision with consequences reaching far into the future. Selecting your practice structure is definitely not a “do it yourself” project. Substantial tax, legal and accounting expertise is required. Veterinarians nevertheless need to stay active in the process to ensure the experts’ narrow technical proposals get folded into a coherent plan that reflects your needs and goals.

  • It’s Mostly About Tax. Tax considerations are the primary drivers in choosing a legal structure for a veterinary practice. The two key aspects are taxation of income/profits and taxation upon the sale or transformation of the practice. Don’t paint yourself into a corner by choosing a business structure without establishing a succession or exit strategy. Exit strategies should focus not only on your richly deserved retirement, but also on contingencies such as death or disability). Since the transformation of an existing business structures in anticipation of a sale or the buy-in of a new partner usually triggers adverse tax consequences, it is usually better to choose an initial structure with the necessary flexibility to handle new arrivals, departures and divestitures at minimum fiscal cost.
  • Liability Shield. In some structures such as partnerships, the owners are personally liable on their individual assets for the debts of the business. In others their personal assets generally are not at risk. Business structures, however, do not insulate veterinarians from liability arising from malpractice claims. But the shield works for almost all other claims, which in our litigious society are increasingly frequent. Unless you are an equine or food animal veterinarian, you generally have greater exposure to claims from your client’s “slipping and falling” in your hallway, than malpractice.
  • Flexibility and Formalities. Some structures allow more management flexibility and/or are less burdensome to administer than others. Veterinarians generally tend to ignore formalities which is a serious mistake. Courts regularly have looked past the liability shield and held owners personally liable when the owners have failed to observe the formalities separating their personal affairs from those of the practice entity.

AN OVERVIEW
The accompanying table compares the more common business structures from a liability, management and formality perspective (in simplified form). Following is a brief and much simplified overview of the tax characteristics of each entity.

1. Sole Proprietorships. Since sole proprietorships are not legally separate from the single owner, there is no separate tax return. The practice’s profits are included in owner’s total income and are taxed at his ordinary income tax rate. In addition to federal and (if applicable) state income tax, the owner must also pay self-employment tax equivalent to the payroll taxes due as if the owner were an employee of the practice.

Upon the sale of the sole proprietorship practice’s assets, the IRS will recapture all depreciation/amortization deductions taken by the owner/seller thereof and tax such amount at the seller’s ordinary income tax rates. In the unlikely event that any gain remains on the assets (after adding back any depreciation/amortization to their respective “bases” ) they will be taxed at the lower 20% long term capital gains rate (assuming the relevant holding period is met).

The buyer receives a “step-up” (increase) in his basis in the assets proportional to the amount of (purchase price allocated thereto) allowing him to re-depreciate/amortize them. Thus, asset sales usually are a better deal tax-wise for the buyer than for the seller, and all other things being equal, buyers will prefer to purchase assets rather than stock (in a C corp).

2. Partnerships. Partnerships are “pass-through” or “flow-through” entities for tax purposes, meaning that each partner includes in his own taxable income the profits (or losses) of the partnership, which are taxed as ordinary income at the partner’s individual rate (much like the owner of a sole proprietorship). Note that each partner’s share of partnership income is taxable each year, whether such share was distributed to the partner or retained in the partnership. If the latter, then the partner may not have the cash to pay the tax.

A consequence of the pass-through principle is that the sale of partnership interests are treated for tax purposes similarly to the sale of the underlying assets of the partnership (i.e., the assets are subject to depreciation recapture as in sole proprietorships).

3. Corporations. All corporations must file separate tax returns.

  • “S” Corporations. “S” corporations are corporations that elect to be taxed as a partnership. As “pass-through” entities, profits will be taxed in the hands of the shareholders whether distributed or not. An advantage of S corporations is that shareholders may take a portion of their profits as “S corporation profit,” free of payroll or self-employment tax (i.e., subject only to income tax). Profit corresponding to what the veterinarian shareholder would have earned as an employee is subject to payroll taxes in addition to income tax. (Sole proprietorships on the other hand must pay self-employment tax on all profits.) S corps are popular with veterinarians for this reason.
  • “C” Corporations. “Plain vanilla” corporations (called “C” corporations to distinguish them from “S” corps) are not “pass-through” entities and are subject to corporate income tax, usually at the 35% rate for veterinary practices. Distributed profits (dividends) are taxed as ordinary income in the hands of the shareholders. This “double taxation” discourages the distribution of C corporation profits. On the plus side, C corp profits are not taxed until distributed, pension plan contributions are not subject to the S corp limits, and employee-shareholders’ health benefits are not taxed. Veterinarians wishing to maximize their benefits will choose a C corp over an S corp.If the holding period requirement has been met, the sale of C corporation stock is taxed at the favorable 20% long term capital gains rate. The buyer does not receive a step-up in the basis of the underlying assets since he is buying the corporation stock. (The buyer can under certain circumstances elect to treat the transaction as an asset sale for tax purposes (a.k.a. a Section 338 election).)

4. Limited Liability Companies. Limited Liability Companies are very quite tax-wise. Single member LLCs can elect to be taxed either as a C corp or a sole proprietorship. Multi-member LLCs can elect to be taxed either as a C Corp or a partnership. Unfortunately, not every state allows veterinarians for form LLC (ie, California).

5. A Word Regarding Real Estate. If the practice owns its own real estate it’s better placed in a separate entity held by the owner(s) or held individually by the practices owner(s). This allows the owners to receive rent (which will be deductible from the practice’s income). Moreover, placing the real estate and the practice in the same legal entity frequently leads to problems because the buyer can’t afford to buy the real estate in addition to the practice.

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Choosing the correct business structure for your practice is important. Don’t treat it lightly.

SIMPLIFIED PARTIAL COMPARISON OF DIFFERENT BUSINESS STRUCTURES
(Ex tax issues)

 

Structure or Entity Type\Issue Liability Formalities/Flexibility
Sole Proprietorship

No entity; business co-mingled with personal assets

No liability shield

 

None. Just open your door and you’re in practice!
Corporations (“C” or “S” Corp) A Professional Corporation (“PC”) is identical to a C Corp in all respects except that only members of the same profession (e.g., vets) can own its shares

 

Shareholder not liable for debts/liabilities of corporation (unless “corporate veil is pierced” because shareholders fail to separate their personal affairs from corporations (e.g. by ignoring formalities) Must file documents with state secretary of state. Formalities are the most cumbersome of all entities. Less formal flexibility re management/profit sharing issues
Limited Liability Company (LLC)

(Created to provide more management flexibility than S Corp and “pass through” tax treatment )

Member not liable for debts/liabilities of LLC (subject to piercing corporate veil doctrine) Must file documents with state secretary of state; but management, profit sharing can be flexible.
General Partnership[i] Partners liable for debts/liabilities of Partnership; no liability shield Must file documents with state secretary of state, but management; profit sharing can be flexible.

 

[i] Limited partnerships are different from general partnerships. An LLP generally is formed among several limited partners who are normally passive financial investors and one general partner responsible for managing the enterprise. Limited partners normally are not liable for the debts/liabilities of the LLP, whereas the general partner is. Contrary to the motion picture business, real estate or oil and gas exploration, LLPs may not be appropriate for a veterinary practice where all the members are actively engaged in the enterprise.