Practice Management News and Views from around the World – February 2009

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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 change 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’

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UK Small Animal Practice for the period to October 2008

data adapted from MAI consolidated data report

Jan-2009-MAI-image-1

Jan-2009-MAI-image-2

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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

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Three cheers for the team

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.

You can click here to visit the DVM360 website

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Pros and Cons of Precentage Based Compensation

by James F. Wilson, DVM, JD

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 convince 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
  • You can click here to visit the NAVC website

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    Are your clients annoyed?

    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?

    You can click here to visit the DVM360 website

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