Practice Management News and Views from around the World - February 2009
A video advertisement for a US veterinary practice
Elephant in the Room 2
The second meeting to discuss the two major issues facing veterinary practices in North America
was held during the North American Veterinary Conference (NAVC) in Florida during January.
The first sessions of the programme included an introduction by Colin Burrows, Chief Executive
of the NAVC, a review of developments during the last twelve months, the findings of a recent
survey of 940 veterinary students at U.S. Schools of Veterinary Medicine evaluating the awareness
of their business acumen and an update by Dr James Wilson on the remarkable and costly changes
for students in the educational lending market between the spring and fall of 2008.
The Dean of the University of Pennsylvania's School of Veterinary Medicine presented the
findings and key points from their September 15, 2008 JAVMA Special Report article entitled
'Trends In Gender, Employment, Salary, and Debt of Graduates Of US Veterinary Medical Schools
And Colleges' and a panel of three VetPartners Association members led by Dr. Bill Kearley
presented an open discussion of several myths in the profession that need to be broken.
The myths included the following:
Students who graduate with high debt numbers cannot obtain loans to purchase or start veterinary
practices
Most new graduates seem to have a poor work ethic
Mergers of individual veterinary practices will not work as a means of making private practice
ownership more profitable and
As a graduating senior, I cannot ask for what I think I'm going to be worth as an associate
veterinarian without doing an internship
The programme continued with an open discussion and conversation session in which the
participants functioned in tables of ten people each rotating from table to table every 40 minutes.
VetPartners and VBMA students were assigned to lead the discussions and the participants were
allowed to pick the table topics of their choice. The themes included:
Sharing Best Practice including;
What are some veterinary practices effectively doing to generate profits for their businesses
and adequate salaries for their new graduate technicians and veterinarians?
What new/innovative business models could allow the profession to support new graduate debt
levels?
What can veterinary students do to minimize or mitigate student loan debt?
How can veterinary colleges/schools best share their best practices (programs and curriculum
ideas) with each other?
Equipping Students for Success including
How can we work cooperatively with our colleges/schools of veterinary medicine to enhance
students' business education and the life skills necessary for personal and professional
success?
What strategies might help new graduates to hit the productivity ground running when they enter
the workforce?
How can we help prepare students to be economically productive in their jobs and
What can a student do to bring skills to the job that makes it worth paying them more?
Creative/Alternative Sources of Funding/Financing including
What could be the role and impact of 3rd party payers on efforts to increase revenues for
companion animal veterinary practices?
How do we become more effective with the profession's political involvement in order to improve
funding of higher education and student loan programs and
What can be done to raise the awareness throughout the profession of this impending crisis?
A report of the meeting and a summary of the results will be published online on the
http://www.tnavc.org website at - search for 'Elephant'
UK Small Animal Practice for the period to October 2008
data adapted from MAI consolidated data report
Simplifying the rota process
Last year AT Veterinary Systems launched a new product designed to simplify the process of
creating and managing staff rotas. Rota Manager is described as the first product of its kind
to take on the complex but essential task of veterinary staff management.
Its objectives are to improve staff efficiency; slash the time it takes to produce rotas; make
life easier for those charged with producing rotas; reduce the mountains of paper generated by
manual rotas; and ensure a rota is immediately available on every computer screen in a practice.
The most recent Management Analysis Indices (MAI) figures produced by AT show wide variations
in the total fees earned per vet even in practices charging similar amounts.
The firm says that closer investigation reveals a multitude of causes for this but a significant
factor is how staff rotas are managed, indicating that those practices with lower turnover
figures may benefit from implementing improved time and rota management systems.
A survey carried out by the MAI team also shows that the typical management time taken for
creating staff rotas for vets, nurses and receptionists can vary immensely. In larger practices
(with 30 plus staff) it is not unusual for over 600 management hours per year to be spent on
creating and managing staff rotas. This figure does not take into account time spent on making
follow-up changes to it.
The survey also indicates that as a practice gets larger, the number of man-hours it takes to
create the staff rotas increases almost exponentially, owing to the multiple complexities
involved with accommodating additional staff preferences and so on.
The stats are further supported by feedback from the survey; many vets, practice managers and
head nurses described staff rota writing as a "chore", "headache", "a nightmare of a job", and
"a thankless task".
You can
click here for further information about Rota Manager
Three cheers for the team
by Kathy Estrada LVT
originally published in Veterinary Economics
Here are three ways we recognize our team members' efforts at Michigan Veterinary Specialists:
Public displays of appreciation. Each time a co-worker, supervisor, or manager notices a
team member going above and beyond, he or she writes up a STAR (service, teamwork, attitude,
respect) card and posts it on the STAR board located outside the break room. Each week we take
these cards down and randomly draw one from the bunch. The winner receives a certificate, a star
pin, a bag of candy, and a $25 gift card. At the end of the month, we put all of the cards in a
box and draw one for the monthly STAR award, which is a $50 gift card.
"Paws down, you're doing a good job." When a team member goes the extra mile for a
fellow employee or a client, another co-worker or manager can nominate him or her for a Paws
card. Team members accumulate these cards--each is worth one credit--and redeem them for a gift
card, pet care, food, or boarding here at our hospital.
Break the routine. We spend up to $175 for monthly staff appreciation celebrations.
A different department plans a unique celebration for the whole hospital each month. We've had
cider and doughnut day in the fall, taco day, soup and salad day, pie day, ice cream sundae
day, and so on. It gets the whole team involved, and everyone looks forward to what the next
month will bring.
Kathy Estrada, LVT is the technical services manager at Michigan Veterinary Specialists in
Southfield, Mich.
Dr Wilson presented a comprehensive paper during the NAVC meeting in Orlando 2009 in which
he outlined the advantages and disadvantages of salaries for employee veterinarians that are
based on their individual revenue production. The presentation also highlighted the key issues
to be addressed and included many examples of remuneration packages ranging from total production
based (prosal) models to those based on a fixed salary component plus a performance based
component.
The following notes summarise some of the advantages and disadvantages of percentage based
remuneration for veterinarians included in Dr Wilson's presentation.
Advantages
Motivates veterinarians to work hard and produce income because they know the harder they work
the more money they will make
Emphasizes the medical and business aspects of veterinary practice
Provides remuneration for veterinarians' successful efforts and skills "selling" high quality
veterinary services
Allows veterinarians who work hard and generate above average income for the practice to
control (and increase) their traditionally low salaries as employed veterinarians.
Provides a constant measure of productivity for each veterinarian. Goals that get measured
get done, including the goal of increased productivity.
Extra income for the employed veterinarian at the "20% with benefits" or "25% without
benefits" compensation level leaves 75% to 80% of practice revenues left over for the practice
owner(s).
Properly defined, drafted, and implemented, both parties should end up as financial winners.
Disadvantages
Changing the paradigm in a practice can make staff and associates focus on money and production
instead of high quality medicine, compassion, and client satisfaction
Tends to overemphasize the business side of practice; can lead to claims of client "gouging"
or "padding of bills"
Too many veterinarians in the practice or inadequate case load to keep all vets "busy" can lead to case
hoarding
Discourages percentage-based employees from engaging in any practice activities that do not
generate income
Stimulates unhealthy competition between veterinarians for complicated or expensive cases in
the practice leading to excessive individualism at the expense of team harmony
Creates an atmosphere for doctor distrust of receptionists based on claims of favoritism -- "How
come they give all the big or difficult cases to Dr. X" mentality. However, it also allows for
strong value in "receptionist bonding" between veterinarians and the receptionists who fill the
appointment schedule. Clearly, of utmost importance here is that receptionists are convinced
that clients like and respect the bedside manner and competence of some associates more than
others.
In order to appropriately capture charges and calculate production, the practice's computer
system must be set up correctly to calculate and tally production for each veterinarian and the
support staff must be appropriately trained to enter data correctly.
The quality and quantity of support staff, especially technicians, have a big impact on
income-producing capabilities of the veterinarian. Employed veterinarians at understaffed or
poorly managed practices will suffer considerable losses in productivity and personal
income.
Recent experience has shown that some veterinarians on this system appear to be promoting
and "selling" increased volumes of expensive prescription drugs at the expense of promoting
professional services contrary to the requirements of the clinical protocols agreed by the
practice
Production compensation can discourage collaboration between veterinarians
Touch base with clients regularly to ensure that you're offering a positive experience
when they visit your practice - originally published in Veterinary Economics Feb 2008
by Bob Levoy
It's probably hard to believe there's anything about your practice that irritates your clients
that you don't already know about. But consider this recently discovered problem at Montefiore
Medical Center in New York City. It started with a survey that hospital administrators gave
to patients when they were sent home from the hospital.
The survey asked about a range of topics, from doctors to food to housekeeping. Of all those
things, the patients' number one complaint turned out to be the high level of noise in the
hospital. Management had completely overlooked--or underestimated--the impact of the cacophony
of beeping monitors, ringing telephones, squeaky medication and meal carts, blaring intercoms,
loud TVs, and late-night conversations among staff members in the halls. To combat the
problem, Elodia Mercier, RN, the administrative nurse manager on Montefiore's fifth floor,
initiated a noise reduction program called Silent Hospitals Help Healing (SHHH). The walls
along the floor of her unit are filled with "SHHH" signs and workers wear buttons that show
a nurse with her finger to her lips.
As a result, overall decibel levels fell significantly. On Mercier's unit, noise levels had
been as high as 90 decibels, comparable to that of a busy street. Today, the fifth floor
maintains decibel levels of about 65, on par with a typical library. The effects have been
remarkable, says Mercier. "Within two weeks, patients said they were sleeping better, and
staff members told us they were less stressed," she says.
Lesson learned
In the day-to-day rush of seeing clients and patients, it's easy to lose track of the
little things. Periodic feedback from clients is essential. Brief client surveys, focus groups,
and follow-up phone calls to selected clients will help you assess their satisfaction.
Food for thought: Might there be a similar complaint in your practice that you
could solve with a few simple changes in work habits?
Who should join?
