Editor's Pick

Written by Martha Mallicote | DVM, MBA, DACVIM | UF College of Veterinary Medicine

Retention of equine veterinarians in practice is a substantial challenge to our industry. We will examine the data on retention and detail the available evidence behind the loss of equine vets to other types of veterinary practice. There are examples of creative ways to address the most commonly 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 AAEP has taken this concern seriously and established efforts to both better recognize the causes for practitioners leaving equine practice and identify solutions that can improve interest and retention. As this work continues, we can start 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 also report multiple challenges, including difficulty hiring and retaining DVMs, fear of raising prices, struggles with staff communication, reluctance to set boundaries with clients, high accounts receivable and poor collection processes, difficulty paying attractive new graduate salaries, and struggles to establish shared on-call and competition from lay practitioners. The concerns of both practice owners and newer associate DVMs are all legitimate. The resolution of retention and practice success issues will require addressing most or all of these concerns.

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.”

Many experienced equine doctors were trained and have worked in environments that expected a 24/7 devotion to the practice – this is not a healthy approach to work, and younger practitioners recognize that fact. More experienced doctors 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 with clients. This allows easier interchange between doctors if clients don’t expect always to see the same practitioner. This requires efforts from the reception and phone staff, doctors, and technicians to institute a culture where clients can expect to receive the same excellent care regardless of what doctors come 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 more easily 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 is among the most substantial reasons for equine doctors to leave the practice. The old model of the single doctor being available for their client 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 consist of true 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 possible to achieve. Sharing on-call responsibilities with area practices can be an extremely rewarding solution that balances the need to maintain 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 – making sure that communication between all doctors is routine and open helps to prevent problems from becoming insurmountable challenges. Establish clear expectations at the outset about what calls will be seen (what constitutes a“current client”), how follow-up will be provided, and how the primary doctor will be updated on the case. Concerns about losing clients to a colleague after they care for your client in an emergency are a small 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 amongst the group.

Also, consider the use of locum veterinarians(or technicians!)when coverage is needed for family/medical leave and long vacations. This will support the staff that is not on leave and ensure that everyone maintains their healthy balance even in times of temporary staff shortages. Maintaining positive relationships with colleagues that leave your practice or another local practice may help them become ideal sources of locum assistance in the future. Resources are also available from the AAEP and several private staffing companies that focus on locum veterinarians. As we increase demand for locum equine veterinarians, the market will respond by providing additional resources in that area. The model of emergency-focused doctors or practices is also a novel solution that has been successful. These practices or solo doctors focus only on providing emergency care after-hours windows. By establishing strong relationships with“referring DVMs” who know that the clients will be returned 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 with compensation for the emergency veterinarian that is not solely dependent on caseload in order to retain them in the position long-term.

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 about what is an emergency concern and what is not. Using telemedicine (and charging for it!) can allow us to provide that level of availability that 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 also need adjustment to support strong practice profitability and allow for fair and competitive compensation for all staff. Equine veterinarians are notorious for allowing large accounts receivable balances and lax/delayed billing practices that encourage missed charges. All these practices will reduce business income generation and decrease available funds to support salary and wage increases.

Establish and update financial policies to require payment at time of service and communicate this clearly to clients in advance of care being provided. The technology available for use on the road has made the process of billing and collection at each appointment much easier and quicker 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 veterinary salaries and practices into the future. There is no single or quick solution to the issues of attraction and retention of veterinarians in equine practice. As a professional group, we will need to consider creative and novel solutions as well as learn to adjust our own expectations about practice life in ways that will also benefit existing practitioners. We will all likely have improved practice trajectories by implementing needed changes in work and career expectations for equine veterinarians.

About the Author

Martha Mallicote completed her undergraduate work at the College of Charleston in South Carolina, completed a master of business administration degree at the University of Florida, and is a 2006 graduate of the 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. Mallicotecompleted her residency in large animal internal medicine at the University of Florida and joined the faculty. She was appointed to the WeeksEndowed Professorship in Veterinary Medicine 2018 by colleagues at the University of Florida. Her professional interests include endocrinology, neonatology, and veterinary business management.

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