Veterinary medicine is more than just medical management. Behind every successful clinician is a toolkit of skills in organization, time management, communication and finance. This lecture provides guidance for achieving success in these important non-clinical aspects of veterinary life.
TIME MANAGEMENT AND ORGANIZATION:
To maintain longevity in equine practice, it is incredibly important to establish boundaries around personal time. Ideally, these boundaries are reinforced by the practice culture and are put in place at the outset. Clients have come to expect their doctors to be available to them 24/7 via personal phones. While excellent client service is important and highly valued by our clients (this is proven by market research), we can also train clients in what is an emergency and what is not. Using telemedicine allows us to provide the level of availability that some clients desire, while also being compensated for the associated time.
Fostering a “practice identity” instead of “individual doctor-client bond” allows for greater flexibility in emergency situations for the on-call veterinarian, instead of spreading them out among all doctors. Establish communication methods that route through the practice instead of directly to each doctor, making it harder for clients to reach off -duty veterinarians.
There are many communication apps now available (Weave, Otto/Televet, OpenPhone, Grasshopper and Google Voice) that can shield doctors’ cell phones but still allow full communication means (calls, texts) via the app – this trains or in some cases, retrains the client to utilize practice phone numbers, instead of personal phone numbers, for communication. Th ere are many additional benefits to these means of communication, including easy documentation of communication, and transmission of electronic payment methods. Travel time is perhaps the single biggest frustration and inefficiency in mobile practice, in terms of both time and cost.
Focus on scheduling by region: Allow the reception team to dictate options to the client based on your location, instead of letting the client dictate the schedule. Obviously, emergencies can upset these eff orts, but this strategy can make a big difference on non-ER days. Proactively plan days for each practice region on a weekly or biweekly basis and then contact clients that are due for care to fill in the holes on each of those region days. The cheapest client to acquire is the one you already have.
Use forward booking, reminders and callbacks to keep your clients on track with their needed preventive and recheck appointments. Existing clients have already chosen you, so do your best to keep them on schedule with their all-important preventative care and encourage them to see you at least twice annually. By staying ahead of their needs and scheduling them when you’re already in the area, you can provide more care and do it more efficiently. A four-day work week is becoming increasingly popular in small-animal practices, and many large-animal operations have also adopted this strategy for their doctors and support staff.
Equine practitioners who have adopted this strategy often report no drop in revenue by this reduction in workdays, as they are more efficient on the days that are scheduled and typically see all their same clients in one less workday per week.
Even if the springtime schedule won’t allow for a four- day work week, consider testing this during the fall season, when it’s slower to allow everyone to rest and recharge.
COMMUNICATION
Excellent client communication improves patient outcomes and quality of care, while also protecting veterinarians from legal and licensure complaints. Miscommunication and difficult client expectations can lengthen the workday and have a negative impact on patient outcomes. First impressions are incredibly important, and proactively organizing a “introduction action” to use with every client is a good way to establish a relationship and manage expectations, although this will vary from person to person.
While cultural expectations can vary, most Americans wish to be addressed by name and prefer the clinician to introduce themselves. Appropriate touch, often a handshake, is expected and eye contact should be maintained. Th ese two non-verbal components of the introduction are most likely to contribute to a client’s assessment of connectedness with their veterinarian. Nonverbal awareness is key to both accurately delivering communication to clients and properly interpreting the client’s responses to our discussions. About 80 percent of communication between individuals is nonverbal, and these behaviors are generally involuntary. Th is means that important information that cannot be hidden is constantly being exchanged from client to veterinarian, and from veterinarian back to the client.
Luckily, using nonverbal communication does not require extra time; the doctor simply needs to pay attention to these messages and respond accordingly. Open-ended questions are key to gathering all the necessary information, but veterinarians do not always use them effectively. Failing to gather all necessary information is a missed opportunity to collect complete diagnostic details and can impair the ability to make an accurate diagnosis. Active listening presents an excellent opportunity to fully understand a case and build an essential rapport with the client. Focus on the client and use nonverbal cues to show you’re engaged. Reflect the client’s words back at them for confirmation.
An expression of empathy is also an important step in building strong client relationships. Empathy is most useful when e client is having an emotional response to information about their pet’s condition and can be expressed as an acknowledgment that the client’s reaction is reasonable and expected in that situation. Empathy is the single most important skill in building client relationships, yet it is often absent. In one veterinary study, empathy statements were expressed in only 7% of appointments.
Finally, about half of all client-doctor encounters end with the client unable to repeat the plan of action for their animal. It is essential to confirm that the client agrees with and understands the plan, making tools that ensure client comprehension critical.
Communication is always a two-way interaction and a series of verbal procedures. Like other veterinary procedures, communication tasks vary in difficulty, and our clinical skills improve with deliberate practice.
While we cannot eliminate the need for challenging communication skills, the way we communicate can make the process easier for both clients and us.
FINANCE
Make sure to prioritize personal finance strategies that minimize stress and maximize the ability of the practitioner’s financial well-being. This includes creating a personal budget (it doesn’t have to be hard), establishing methods to save for retirement and personal goals, and maximizing the value of compensation available through the practice. Many practitioners feel more comfortable seeking advice from a financial planner, which can be very valuable, but it’s also important to source a planner that fits the needs of the practice.
A certified financial planner (CFP) has a fiduciary duty to provide advice tailored to your financial situation as part of their licensing requirement, which is an important component of selecting the advisor. Additionally, using a fee-only advisor that charges their time, instead of being paid as a percentage of funds invested, can lower costs and also ensure that the advisor prioritizes your interests. For smaller practices, there are a variety of unique retirement savings options (SEP-IRA, SIMPLE IRA) that allow for very advantageous retirement contributions that are considered a business expense.
An important note about CFPs is that they don’t have much expertise in student loan repayment strategies, so seeking additional guidance on managing those loans specifically may be beneficial. The VIN Foundation has several student loan resources on it’s website and there are also recent American Association of Equine Practitioners (AAEP) proceedings that cover this topic.
The practice’s financial strategies are also key to supporting strong profitability and providing competitive compensation for all staff. Equine veterinarians are known for allowing large accounts receivable balances and relaxed billing practices, which often result in missed charges. These issues reduce business income generation and decrease available funds to support salary and wage increases.
Establish and regularly update financial policies that require payment at the time of service and communicate this clearly to clients before care is provided. Mobile technology has made billing and collection processes at each appointment much easier and quicker than in the past. Laptops with Wi-Fi access to medical records make preparing the bill at the time of appointment straightforward and payment can be collected through a variety of mobile platforms that integrate with your accounting systems. Additionally, it’s important for practices to focus on charging a fair and adequate amount for the time practitioners spend on care and patient assessment.
The old model, which charged our expertise in exchange for high medication and supply charges, is no longer sustainable, especially with competition from internet pharmacies. It is common in non-equine large animal practice to charge clients by time. This is a reasonable option to consider implementing some equine practices. It is increasingly common for practices to pass along at least a large portion of the emergency response (ER) fee charged to clients directly to the practitioner.
This approach increases practitioner compensation, values their work on emergency calls, and can improve morale around handling those cases. While there is a minor administrative cost to the practice, it is well worth the doctor’s goodwill it generates.
About the Author
SALLYANNE DENOTTA | DVM, PhD, DACVIM
Sally DeNotta is board-certified by the American College of Veterinary Internal Medicine and is a member of the clinical faculty at the University of Florida College of Veterinary Medicine. She currently serves as the chair of the AAEP Infectious Disease Committee. Originally from the rural Oregon coast, she received her DVM from Oregon State University and spent time in private practice in Oregon and Colorado before completing an internal medicine residency and PhD at Cornell University. She joined the UF faculty in 2018, where her clinical interests include equine infectious disease and clinical neurology.