Yeah now they just have to deal with the boundless joy of being managed by a purely profit driven management layer - sounds great.
Seems like there's a market for innovating in the business management sector. Maybe some PE company can buy up all of the back office productivity software and rent it to these suffering small business owners to spare them the bureaucracy.
> now they just have to deal with the boundless joy of being managed
I did a start-up. I’ve worked for companies big and small. There is no single equilibrium here. Being able to cash in your paycheque and not give a fuck come 5PM is a luxury in itself.
There are literally dozens of companies selling practice management software for vets/doctors/dentists/etc, including many options that can be rented through a SaaS model. Y Combinator has even funded a few. That's not the main problem (although software licenses and training can be expensive).
What is a problem are compliance costs driven by overlapping layers of local, state, and federal rules. Plus if they take insurance payments then they have to deal with myriad different coverage policies and billing requirements. Some of this can be outsourced, but only to a limited extent and at a high cost.
Insurance is a minor issue for vets, essentially none of the population has animal insurance. It's also not a super big deal for dentists, as I understand it, though I don't know as much about the back-end of dental practices (wife is pharmacist, sister-in-law is a vet tech, so I know those businesses pretty well). Insurance reimbursement from the monopoly PBM's (three of them control 80% of the drug insurance market) are what is killing independent pharmacies- you have to be one of the national chains to have the scale to effectively negotiate against the PBM's, otherwise reimbursement rates are routinely below your wholesale price.
From talking to my wife it's not really compliance and government regulation in the pharmacy space (which is far more regulated than the vet space, naturally) that has forced consolidation. For the most part the regulations haven't changed that much in decades. What's changed is heavily reduced insurance reimbursement rates from those monopoly PBM's plus one other factor: educational debt. The idea that our intrepid young vets/pharmacists/dentists/doctors graduate with a huge pile of educational debt (200k or more), then have to take out massively more debt to start up a new business(1), at the same time they are also in prime child-bearing/rearing/caring age, that's a really hard sell for most. That's why being an employee is such an attractive thing.
1: And those loans have to be much bigger than before, because drugs are more expensive so your inventory costs are higher, people want nicer places offering more amenities, etc. They also need to be able to pay off those software licenses, which may not be individually expensive but are another new cost that wasn't present 30 years ago that has to be paid on the reduced reimbursement rates from the PBMs.
Seems like there's a market for innovating in the business management sector. Maybe some PE company can buy up all of the back office productivity software and rent it to these suffering small business owners to spare them the bureaucracy.