Retention of equine veterinarians in practice is a substantial challenge for our industry. We will examine the data on retention and detail the available evidence behind the loss of equine veterinarians to other areas of veterinary practice. There are examples of creative ways to address the most cited challenges—let’s review how to incorporate them into practice.
INTRODUCTION
There is no denying that the equine veterinary profession is at an inflection point, and creative solutions will be required to ensure that veterinary care continues to be available to horses across the U.S. The American Association of Equine Practitioners (AAEP) has taken this concern seriously and established efforts to both better recognize the causes of practitioners leaving equine practice and identify solutions that can improve interest and retention. As this work continues, we can begin to apply the findings of their research to individual practices in need.
As a starting point, some of the issues reported by newer DVMs in equine practices include lack of mentorship, on-call schedules that leave no time for family and personal interests, lack of adequate support staff , struggles with setting boundaries, feelings of isolation, sexism or a “boys’ club” environment, low income and pressure from employers not to take time off .
Practice owners report the following challenges: difficulty hiring and retaining Doctors of Veterinary Medicine (DVMs), fear of raising prices, struggles with staff communication, reluctance to set boundaries with clients, high accounts receivable with poor collection process, difficulty paying attractive new graduate salaries, struggles to establish shared on-call and competition from lay practitioners.
The concerns of both practice owners and newer associate DVMs are all legitimate, and resolution of retention and practice success issues will require addressing most or all these concerns.
Practice owners report the following challenges: difficulty hiring and retaining Doctors of Veterinary Medicine (DVMs), fear of raising prices, struggles with staff communication, reluctance to set boundaries with clients, high accounts receivable with poor collection process, difficulty paying attractive new graduate salaries, struggles to establish shared on-call and competition from lay practitioners.
SOLUTIONS
As a starting point, it is important for existing and long-standing practices to examine their culture. DVMs leaving equine practice have reported that some practices are not supportive of their need for a life beyond work and have expectations of excessive workload since “that’s the way we’ve always done it.” For many experienced equine practitioners, they were trained and have worked in environments that expected 24/7 devotion to the practice—this is not a healthy approach to work, and younger practitioners recognize that fact. More experienced veterinarians can benefit from the perspective brought to practice by newer DVM graduates and use this perspective to improve the quality of practice life for all staff.
Develop a practice identity in lieu of individual doctors bonding to clients. Th is allows easier interchange between doctors if clients don’t expect to always see the same practitioner. This requires eff orts from the reception and phone staff , doctors and technicians to establish a culture in which clients can expect to receive the same excellent care regardless of which doctor is coming to their farm. When more senior doctors and long-standing office staff voice strong support for the “new docs”, then clients will more easily accept the new face. Doctors are better able to protect their time and take appropriate time away from practice when clients are happy to see another doctor in their absence.
Identify ways to reduce the on-call burden for doctors. Constant on-call stress and burnout are among the most substantial reasons for equine practitioners to leave practice. Th e old model of a single doctor being available to clients on a 24/7 basis is no longer acceptable and likely contributes to poor mental health outcomes for our colleagues. For group practices, this can include truly equal sharing of the on-call duties and ensuring that we support one another in allowing time off to be truly “off.” In single- or two doctor practices, reducing on-call time requires more creativity and collaboration but is still very achievable. Sharing on-call responsibilities with nearby practices can be an extremely rewarding solution that balances between maintaining a solo practice identity while also working together to support each other’s emergency needs. A truly collaborative approach is required for this type of arrangement to succeed – ensuring that communication between all DVMs is routine and open helps prevent problems from becoming insurmountable challenges.
Establish clear expectations at the outset about which calls will be seen (what constitutes a “current client”), how follow-up will be provided and how the primary DVM will be updated on the case. Concerns about losing clients to a colleague after they care for your client in an emergency are a minor issue compared to the value gained from truly being “off-call” as a solo doctor – the time off is worth far more than a couple of clients that might shift primary doctors within the group.
Also consider the use of locum veterinarians (or technicians!) when coverage is needed for family or medical leave and longer vacations. This will support the staff who are not on leave and ensures that everyone maintains a healthy balance even in periods of temporary short-staffing. Maintain positive relationships with colleagues who leave your practice or another local practice may be ideal sources of locum assistance in the future. Resources are also available from the AAEP and several private staffing companies that focus on locum DVMs. As we increase demand for locum equine DVMs, the market will respond by providing additional resources in that area.
The model of emergency-focused doctors or practices is also a model solution that has proven successful. These practices or solo doctors focus solely on providing emergency care during after-hours windows. By establishing strong relationships with referring DVMs who understand that the clients will return to them for follow-up and routine care, this business model can both fill a need for local veterinary practices and allow for unique working schedules that may appeal to doctors in need of non-traditional work hours for family or other reasons. It is important to structure these models so that compensation for the emergency DVM is not solely dependent on caseload, to retain a long-term position.
Encourage doctors and staff to establish boundaries around their personal time. Clients have come to expect their doctors to be available to them 24/7 via personal phones. While excellent client service is important, we can also train clients to understand what constitutes an emergency and what does not. Using telemedicine and charging for it can allow us to provide the level of availability some clients desire while also being compensated for the associated time. Further, fostering a “practice identity” instead of individual doctor-client bonds (as discussed above) also serves the purpose of shifting emergency needs onto the on-call doc instead of spreading them out among all doctors. Establish communication methods that run through the practice instead of directly to each doctor, making it harder for clients to reach doctors that are off duty.
Finally, practice financial policies may need adjustment to support strong profitability and allow for fair, competitive compensation for all staff. Equine veterinarians are notorious for allowing large accounts receivable balances and relaxed billing practices that contribute to missed charges. These habits reduce business income generation and decrease funds for potential salary and wage increases. Establish and update financial policies to require payment at time of service and communicate this clearly to clients before care is provided. Portable billing technology has made payment processing and collection at remote appointments much easier and faster than in the past. Additionally, charging a fair and adequate amount for time spent by practitioners on care and patient assessment will also generate funds that support employees. Over the long run, appropriate and adequate revenue generation will sustain equine DVM salaries and practices into the future.
There is no fast and simple solution for attracting and retaining veterinarians in equine practice. As a professional group, we will need to consider creative solutions, as well as learn to adjust our own expectations about practice life in ways that may ultimately also benefit existing practitioners. We will all likely have improved practice trajectories by implementing needed changes in work and career expectations for equine DVMs.
About the Author
MARTHA MALLICOTE, DVM, MBA, DACVIM
Martha Mallicote completed her undergraduate work at College of Charleston, a Master’s of Business Administration at University of Florida, and is a 2006 graduate of University of Tennessee College of Veterinary Medicine. Since graduation, she has worked in both ambulatory and referral hospital settings, including an internal medicine fellowship at Rood and Riddle Equine Hospital. In 2012, Dr. Mallicote completed her residency in large animal internal medicine at University of Florida and joined the faculty at UF. She was named to the Weeks Endowed Professorship in Veterinary Medicine in 2018 by colleagues at the University of Florida. Her professional interests include endocrinology, neonatology and veterinary business management.