Karen E. Felsted
CPA, MS, DVM, CVPM, CVA
Take Charge columnist Dr. Karen E. Felsted is the founder of PantheraT Veterinary Management Consulting. She spent three years as CEO of the National Commission on Veterinary Economic Issues.
Read Articles Written by Karen E. FelstedPeter Weinstein
DVM, MBA
Dr. Peter Weinstein owns PAW Consulting and is the former executive director of the Southern California Veterinary Medical Association and the former chair of the American Veterinary Medical Association’s Veterinary Economics Strategy Committee. He teaches a business and finance course at the Western University of Health Sciences College of Veterinary Medicine.
Read Articles Written by Peter Weinstein
In March 2020, as the world started to shut down because of the coronavirus pandemic, nobody could envision that COVID-19 would still be a part of our lives more than three years later. From an immunological standpoint, the virus killed millions and sickened many more, leaving some with persistent neurological issues. As for the veterinary field, COVID had short- and long-term effects. “Short COVID” resulted in:
- Operational changes, such as the launch of curbside check-ins and checkouts.
- A greater need for personal protective equipment and more stringent cleaning protocols.
- Growth in online pharmacies and online pet food delivery.
- Heightened interest in telehealth.
- Staffing shortages.
- Skyrocketing demand for veterinary care.
- Significant worsening of mental health issues.
Veterinary practices did great adapting to short COVID, but as the virus’ effects wane, what will long COVID look like? In other words, how has the pandemic changed the delivery of veterinary care into the future, and how can practices deal with the accompanying challenges? Some of the critical areas to explore include:
- Workforce issues
- Practice (in)efficiency
- Corporate practice and exit-strategy options
- Mental health
- Access to veterinary care and the cost of care
- Technology
- Clients
Workforce Issues
Veterinary professionals have discussed, argued and leveraged this one continuously. Everybody agrees about the need for more team members at all levels of general practice and in specialty and critical care. However, a source of great consternation is how many we need and how to find them.
The time when practices can once again easily hire veterinarians, technicians and other team members is far in the future. Therefore, we must focus on:
- How to snap up the few available job candidates.
- How to improve productivity with the employees on hand.
The two most critical considerations are:
- Compensation: Is what you pay doctors and team members competitive?
- Practice culture: Do people want to work for you?
Obviously, compensation depends on the type of practice, its location and other factors. Good luck finding a full-time doctor willing to accept an annual base salary of less than $100,000. And that’s before a five-figure signing bonus, which is common, and flexible fringe benefits and work schedules.
If you’re unsure of your practice’s competitiveness, gather as much local market information as possible. Review help-wanted ads seeking veterinarians and staff members, and monitor online conversations. All job seekers see the same information, so they’re unlikely to consider a position that pays below the market rate.
Also, examine your practice’s doctor and staff situation. Don’t assume that employees paid less than the market rate are OK with it. Businesses of all kinds are seeing a lot of quiet quitting these days, so your veterinarians, technicians, assistants, receptionists and managers might not hesitate to leave abruptly when a better offer comes along.
While money is essential to any employee, market-range salaries might not be enough to keep someone in today’s hiring environment. Your practice must be a place where people want to work. Your clinic’s culture influences much of that desire. Remember this:
- A “good” culture isn’t one-kind-fits-all. What works well at one practice might be rejected at another hospital.
- A practice lacking a “bad” culture doesn’t necessarily have a “good” one.
The first step in building a good culture or improving one that is only adequate is to weed out the toxic elements. These influences include:
- Bad bosses.
- A lack of core values.
- Little or no understanding of what employees want.
- Constant drama and confusion.
- A lack of communication.
- A “policies over people” attitude.
Hiring and keeping people is impossible without a good culture, no matter how much you pay them.
Practice (In)efficiency
COVID pulled back the curtain on the inefficient delivery of veterinary medicine. The curbside model added more steps to a profession in which 10,000 steps is a morning workload. Client wait times, especially in emergency settings, sometimes were hours long during the depths of the pandemic. However, most practices saw fewer pets despite the feeling of busyness. Those doctor-centric, underleveraged practices were on roller skates as their teams tried to keep their balance and get through the day.
On the other hand, in-car and online checkouts and the greater utilization of staff members for client communication were tremendous additions. But what will happen as curbside interactions subside?
Pre-COVID, veterinary practices dealt with efficiency issues by hiring more people. Since that isn’t an option anymore, hospitals must focus on doing more with less. And, of course, that requirement doesn’t just entail telling people to work harder.
Doctor productivity depends heavily on how management runs the practice, which means the environment, staff training and resources must be just right if you expect all team members to be more productive. The areas to focus on include:
- Understanding the specific skills someone must possess to deliver outstanding patient care and client service.
- Hiring effectively to find and keep employees who have the necessary skills and attitudes.
- Providing high-quality, ongoing training programs for current and new team members.
- Ensuring high levels of employee retention. Understand that revolving-door team members aren’t around long enough to become efficient or effective.
- Designing and implementing efficient policies, procedures and systems for getting things done.
- Scheduling staff members, appointments and surgeries so that they sync with each other.
- Scheduling employees in ways that reduce the need for overtime pay.
- Delegating effectively so that tasks are performed by the most capable, lowest-level person.
- Monitoring staff activities frequently. Your employees stay busy doing something, but what they do is crucial. Is it the most important activity at the moment?
- Providing the culture and focusing on mental health to keep everyone happy and wanting to come to work. Tired, stressed employees aren’t productive, and they make more mistakes.
- Comparing staff compensation and employee-to-doctor productivity. The issue might be low doctor productivity, not poor staff efficiency.
- Reviewing staff utilization metrics regularly.
Corporate Practice and Exit-Strategy Options
During COVID, corporate acquisitions of veterinary practices created a lot of multimillionaires as the busyness and rapid revenue growth had investors hunting for the most profitable hospitals. Practice purchases by corporate groups have slowed in recent months, and the prices paid have fallen, too.
Corporate-owned practices suffer from the same issues as the independents: employee shortages and increases in the cost of labor and supplies.
What’s next for independent practice owners looking to sell and for corporations? No question, the market remains healthy, but corporate buyers are more risk averse today and focus as much on practice operations as the acquisition. As a result, sellers whose hospitals enjoy strong profitability and are well-run are most attractive to buyers and will command higher prices.
Mental Health
A profession faced with substance abuse and suicide issues even before COVID is now thick in the middle of employee burnout and quiet quitting. Unfortunately, mental health issues have gotten worse. Luckily, those suffering and those trying to help are discussing the problems and, in many cases, working together to identify and implement answers.
How can practice owners and managers contribute? Here are a few ways:
Read up on well-being and mental health in the workplace. It isn’t just a veterinary medicine issue; employers everywhere are dealing with it. Recognize that different people want different things, and practices trying to find and keep employees must offer an attractive environment.
- Support your employees’ life outside work and their mental health, both in what you say and how you run your practice. Set a good example personally.
- Provide competitive wages and benefits.
- Transform your practice into one where people want to work.
- Improve efficiency and productivity so your team can handle caseloads more easily.
- Invest in technology to make things easier for your clients and team.
- Build short stress breaks into the workday.
Access to Veterinary Care and the Cost of Care
The stay-at-home pandemic produced millions of new pet owners and a greater awareness of pet behavior and medical issues needing attention. However, veterinary fees rose to accommodate pay increases, supply-chain problems and economic inflation. Meanwhile, many clients couldn’t get appointments because of government health restrictions and staff shortages. The escalating price of veterinary care challenged some pet owners.
Access to veterinary care, the cost of care and the term “spectrum of care” have moved from out of the shadows to the front and center. Ask yourself:
- How can we make seeing a veterinarian easier for clients?
- How can we help pet owners afford the rising cost of care?
- What can we do if clients can’t afford the best care possible? What are the alternatives?
As we move farther from the pandemic, we’ll see some normalization of the busyness of veterinary practices, opening appointment slots that at one time might have been unavailable for weeks. Additionally, as efficiency improves and we leverage our teams more, clients will see their primary care clinician more easily.
Another outcome of the pandemic was the rapid growth of urgent care clinics. These locations picked up the slack from general practices and some emergency hospitals. As our clogged appointment books start to unclog, urgent care will remain an option for clients needing veterinary services as soon as possible.
The escalation in fees also widened the gap in affordable veterinary care. Among the solutions we can present to clients are pet health insurance, third-party financing and wellness plans. In addition, membership plans can make the cost of care more predictable.
Pet owners have even more choices when we communicate the spectrum of care, which focuses on the idea that clinical recommendations and options exist along a continuum. At one end is the most extensive, most expensive and often most invasive diagnostic and treatment option. At the other end is the less expensive, least extensive and least invasive possibility. Between the two is a range of choices a client can select to find the best fit. That “best” choice will satisfy a patient’s medical and quality-of-life needs within the owner’s limitations and goals. At the same time, veterinarians maintain their moral, ethical and legal obligations to pets and clients.
As veterinary prices rise, we must be more sensitive to client needs and demands so that we don’t see even more pet owners avoiding a veterinarian entirely.
Technology
The influx of new technological resources is amazing. Whether clinical or management based, a plethora of new tools are ready to help patients, clients and practice staff. From online appointment books and automated social media marketing to handheld dental radiology units and GPS wearables, technological growth didn’t slow during the pandemic.
As we embrace technology, don’t forget that we also must embrace clients and their pets. Going too far technologically can take veterinary medicine from a relational profession to a robotic one. Efficiency might improve, but will the technology deliver puppy kisses?
As a technological option, telemedicine generated more interest during the pandemic, reducing the need to see patients physically and, in some cases, making care more affordable. The regulatory environment is clarifying how and when our profession can use telehealth, and veterinarians and their teams are figuring out how it fits into their practices. However, the option shows we can offer more veterinary care, lower costs, leverage our team and improve efficiency.
Whether we’re talking about interactive appointment books, online pharmacies or text updates, pet owners desire veterinary practices that offer the same level of technology used to book an Uber or order a home-delivered meal. Keeping up with clients’ wants and needs isn’t possible if we don’t meet their digital demands.
Digital tools must enhance the client experience without harming the relationship we long to create. Therefore, during long COVID, you must be high tech and high touch.
Clients
As the pandemic challenges taxed everybody emotionally, some highly anxious pet owners displayed flat-out bad behavior at veterinary practices. Whether the trigger was curbside restrictions, costlier care or cabin fever, too many clients went off the deep end. As a result, practices fired more clients in three years than in the prior 20.
Within hospitals, employees were pushed to the breaking point, leading some to leave the practices and, in some cases, the profession.
The battle between clients and practices isn’t healthy. We need each other. How can we put out the fire and bring back the hugs?
Veterinary medicine wasn’t the only business impacted by the pandemic from a client-service standpoint. Many companies dealt with angry, upset and frustrated consumers. What veterinary medicine must reconcile is that we are a service industry first and a health care provider second. This means your practice must focus on the client experience. It also means pet owners will make more and more choices about the type of experience they want.
Making every client happy is impossible. Trying to do it increases the stress on yourself and your team. We must balance what we want to do in our practices with what we must do to operate successfully.
Many of the issues with client dissatisfaction involved miscommunication. We must work on clearly sharing our expectations of pet owners and understanding and appreciating what they expect. Think of it as a bill of rights for clients and practices that defines things both ways.
In the end, we’re not saying every practice must keep every client. But, going forward, decide what your optimal clients look like. Then take care of them the way they desire. Recognize that you don’t have to take care of everyone, but you should take care of enough of them to make your practice as financially successful as you want.
The neurological impact of long COVID on people includes a lack of mental clarity, poor concentration, memory problems, difficulty multitasking and “brain fog.” Its impact on the veterinary profession is the antithesis. Change, adaptation, resilience, flexibility, persistence and future-think were necessitated by the pandemic’s infiltration into our relatively consistent and staid business models. To quote Albert Einstein, “In the middle of difficulty lies opportunity.”
Long COVID dramatically affected veterinary medicine by providing us with a previously untapped level of opportunity. Let’s grab it and hold onto it. We’re in for an exciting ride.
BETTER MENTAL HEALTH
Merck Animal Health’s third comprehensive veterinary well-being study — learn more at bit.ly/3Mf1ftY — looked at U.S. veterinarians and non-doctor team members. The study recommended that employees support their well-being and mental health by:
- Having a healthy technique for dealing with stress.
- Maintaining an appropriate balance between work and non-work.
- Engaging a financial planner to manage debt and reduce financial stress.
Veterinary practices can do their part by offering continuing education programs designed to help employees obtain those tools.
TAKE A BREAK
Everyone needs time away from their job, so respect your team’s work-life balance. For example, a 2021 Veterinary Hospital Managers Association survey found that 65% of the respondents “always” or “usually” checked work emails outside of work hours. In addition, 95% said they answered work calls or text messages after they left, and many performed work duties on the weekend or during vacation.