Guide to Implementing Veterinary Telemedicine: How to Create Seamless Virtual Experiences for Pet Owners

Guide to Implementing Veterinary Telemedicine:

How to Create Seamless Virtual Experiences for Pet Owners

Veterinary Business Advisors, Inc.

 

Abstract

In the face of the COVID-19 outbreak and the associated social distancing, there is a rapidly increasing demand for digital transformation to bridge service gaps. In both human and animal health care, telehealth has become a gold-standard solution to optimize the delivery of medical care to patients. This paper will discuss the impact COVID-19 has had on veterinary medicine, the current telehealth market, and the distinctions between telehealth and telemedicine. A step-by-step guide to implementing a telemedicine service into the clinical workflow is provided to help veterinary teams offer their clients a seamless virtual experience and improve patient outcomes.

Keywords: COVID-19, animal health, technology, telehealth, telemedicine, veterinarian-client-patient relationship, implementation, clinical workflow

 

 Introduction

Humans and animals are closer than ever. This is especially relevant in today’s social climate where the entire world is dealing with the impact of COVID-19. Fortunately, the pet care industry has been recession-proof since the Great Recession and it’s been proven that this pandemic is no exception.1 According to Morgan Stanley Research, it is expected that pet ownership will increase by 14%, and annual household spending per pet will nearly double by 2030. Unsurprisingly, the most rapidly growing subsegment of such expenditures is veterinary care.2 As medical knowledge advances, so do the technological developments in delivering animal healthcare.

The unique aspect of a pandemic that’s not shared by other substantial economic events like terrorist attacks, natural disasters, and financial crises is the inevitability of prolonged social isolation, hindering pet owners from visiting veterinary hospitals. Luckily, however, there was an excellent solution to overcome this issue that had been underused for many years before COVID-19 hit the U.S.—telehealth. Data from the ASPCA Pet Health Insurance programs shows a nearly 380% increase in submitted claims for telehealth services in one year, from March 2020 to February 2021, compared to the same time frame in the prior year.3 While no one knows what the future holds, it is evident that telehealth can continue to grow as long as there is a public need for remote access to veterinary care.

 

Veterinary Telehealth

 What is Telemedicine?

 The American Veterinary Medical Association (AVMA) defines telemedicine as “the use of medical information exchanged from one site to another via electronic communications regarding a patient’s clinical health status.” This is a subset of telehealth, an umbrella term encompassing all means of remote exchange of health-related information using technologies. According to the AVMA, telehealth includes, but is not limited to, telemedicine, teleconsulting, teletriage, teleadvice, telesupervision, telecommunication, telemonitoring, electronic prescribing, and mobile health. Telehealth does not always involve patients directly. For example, teleconsulting is a tool used by general practitioners to virtually gain insights and advice from specialists to ensure appropriate care for their patients.5

In human healthcare, the application of telehealth and telemedicine have been prevalent for decades, which is much longer than in veterinary medicine. However, when telemedicine was introduced, it was used on a non-human animal. Before Yuri Gagarin became the first human ever to travel into space during the Space Race, the U.S. and the Soviet Union had to answer whether the absence of gravity would impede cardiovascular and pulmonary functions. They launched multiple test flights with animals attached to medical monitoring systems that were capable of telemetering biometric data to Earth to answer this question.4

Veterinarian-Client-Patient Relationship

 The AVMA’s policy on telemedicine states that “veterinary telemedicine should only be conducted within an existing Veterinarian-Client-Patient Relationship (VCPR), with the exception for advice given in an emergency until that patient can be seen by a veterinarian.” Veterinarians are not allowed to diagnose, prescribe medication for, or treat an animal without an established VCPR under most state laws and Principles of Veterinary Medical Ethics by the AVMA.6 Veterinarians are, however, still allowed to engage in teletriage, which is the assessment of urgency to determine the need for immediate referral to a veterinarian, and tele-advice, which is the provision of guidance and recommendations not specific to the patient, both of which must be performed without rendering a diagnosis, prognosis, or treatment.5,7 Establishing a VCPR for each case is extremely important, especially since pets cannot verbally convey their medical issues to veterinarians. A physical examination is an essential step in understanding the patient’s condition.

In the U.S., the following conditions must be satisfied to establish a VCPR:7

  • The veterinarian has assumed responsibility for making clinical judgments regarding the patient’s health, and the client has agreed to follow the veterinarians’ instructions.
  • The veterinarian has sufficient knowledge of the patient to initiate a general or preliminary diagnosis of the patient’s medical condition. This means the veterinarian is personally acquainted with the keeping and care of the patient through a timely examination of the patient by the veterinarian or medically appropriate and timely visits by the veterinarian to the place where the patient’s care is managed.
  • The veterinarian is readily available for follow-up evaluation or has arranged for veterinary emergency coverage and continuing care and treatment.
  • The veterinarian provides oversight of treatment, compliance, and outcome.
  • Patient records are maintained.

In addition, according to the U.S. Food & Drug Administration (FDA), “the federal VCPR definition cannot be met solely through telemedicine.” However, given the current situation, the FDA has suspended some of the regulations amid the COVID-19 outbreak. Veterinarians now do not require a VCPR for prescription of extra-label drugs and issuance of Veterinary Feed Directives as of January, 2022.6,8

Veterinary Telemedicine Market

According to Grand View Research, the veterinary telehealth market was valued at $119.6 million in 2021, globally. Among different telehealth types, teleconsulting held the majority of the revenue share of 29.1 % due to more general practitioners seeking consultations from the specialists, followed by telemedicine, which still accounted for more than 25% of the share. These services have successfully reduced the burdens on veterinarians, and the initiatives to promote virtual care pushed by industry players, including telehealth service providers, are expected to keep driving this trend forward. Thirty-seven percent of global revenue came from North America in 2021. This can be attributed to factors that include long-tail investment in the animal health care industry driven by retailers with scale and the burgeoning pet insurance industry in the region. The veterinary telehealth market is anticipated to expand at a compound annual growth rate of 16.8% in the U.S. and 17.6% globally from 2022 to 2030. 2,9

There are many key industry players around the world today contributing to this rapid growth in the veterinary telehealth market. They strategically collaborate with major animal health companies, corporate consolidators, and university hospitals to develop new products and services and scale their businesses. For example, Zoetis, the largest global animal health care company (that used to be a subsidiary of Pfizer), has partnered with Airvet, one of the major telehealth service providers, to promote two free months of service amid the COVID-19 pandemic.9,10 Furthermore, Televet, another primary telehealth service provider, partnered with Cornell University’s veterinary teaching hospital, Hospital for Animals, to deploy its first virtual care platform for its veterinary telehealth operations. These collaborations effectively extended the service providers’ market growth.9,11 Other market-leading veterinary telehealth service companies include PetDesk, FirstVet, Petriage, BarbelBark, and PawSquad, among others.9

 

Implementing Telemedicine

Service Models

The AVMA introduces different service models for telemedicine, indicating it is customizable and should be used to fulfill the specific needs of each practice to uniquely augment its clinical services. Once a VCPR is established, telemedicine can be utilized to facilitate care delivery in various ways.12

  • General consultation: It has been common practice for veterinarians to give their clients general advice via a quick phone call, email, or text, free of charge. By utilizing telemedicine and systemizing such a process, they can get adequately compensated for providing the same service. Telemedicine will become a whole new revenue stream and even become an opportunity to attract new clients willing to pay extra money for convenience.
  • Urgent care: Not every veterinary practice has an emergency service while every animal has the potential to become critically ill after hours. In such an urgency, 24/7 access to veterinary care would mean the world for the owner. Implementing telemedicine would enable every practice to have a system to address this issue and fulfill client expectations and patient needs while also allowing veterinarians to manage their work-life balance.
  • Post-surgical recovery: Veterinarians usually just need to hope for the best when it comes to post-surgical care. However, telemedicine can enhance continuity of care by allowing access to the patients’ health status after they leave the hospital. Not only does telemedicine allow veterinarians to monitor patients to ensure seamless recovery after surgery remotely, but it also enables them to support their owners through the process and improve client compliance.
  • Palliative care: Telemedicine can also aid in optimizing the quality of life of senior patients with already deteriorating health. When it comes to palliative or hospice care, there are times in which clients forsake a veterinary visit due to the additional stress that the veterinary environment may cause. This is especially the case for feline patients. Veterinarians can evaluate those patients’ conditions remotely through telemedicine and guide any change in treatment plans and whether an in-person visit would be necessary.

It may be surprising to some veterinarians to hear that they may have already been utilizing telemedicine unknowingly. Many tend to think that telemedicine always needs to involve a video component that allows for virtual face-to-face interaction; however, if they are engaging in any of the above services remotely, they are providing telemedicine. Again, telemedicine is any virtual clinical service given after VCPR has been established. Therefore, not only video- but also telephone-, text-, and email-based communication with existing clients regarding their pets’ health can be considered telemedicine. It is up to the practitioners how extensive those technologies should be integrated into their workflow.12

 Step-by-Step Guide

Since email, phone calls, and texts are already used widely to provide telemedicine and are much more straightforward when it comes to implementation, the focus in this section will be on video chat.

Here are the nine steps in implementing telemedicine into clinical workflow:13,14

  1. Understand the rules

Before formulating an implementation plan, it is essential to know how a VCPR can be established and to differentiate telemedicine from the other types of telehealth services, as explained earlier. In addition, there are mainly two crucial licensure considerations about telemedicine and the VCPR that have not been discussed. Those considerations are as follows:9

  • When conducting telemedicine across state lines, the veterinarian must be licensed and legally authorized to practice in both states.
  • While telemedicine for specialty consultation does not require the specialist to have a VCPR if s/he is working with the patient through the consultee who has established a VCPR, if the specialist starts treating the same patient independently, a separate VCPR and a license to practice in the patient’s state become mandatory.

It is also essential to review the state-specific requirements, especially regarding the veterinary practice act, pharmacy act, patient confidentiality, and record retention. Failure to follow these regulations can result in disciplinary proceedings, which involve steps that include a hearing with a board subcommittee dedicated to veterinary liability and the corresponding punishment if the veterinarian is criminally liable. In severe cases, these proceedings can lead to license restrictions and even revocation.15

  1. Identify needs

The first step in planning is identifying what can be addressed and improved by implementing a telemedicine program and by prioritizing issues that align with the team’s strategic goals. Problems that need to be addressed can include revenue loss, disruption in continuity of care, low compliance, veterinarian shortages, and socioeconomic barriers to in-person visits. It may be helpful to look for practices that are similar in size and client demographic—and have executed the implementation—and seek out their help. It would be beneficial to ask earlier adopters about what problems they could overcome by incorporating telemedicine and their challenges throughout the process. It is also a good idea to start considering the cost of implementation and an anticipated return on investment at this point. This will help justify the project and incentivize the team to move forward with the plan.14

  1. Define success

Once the issues are prioritized and the needs are identified, it is time to set specific short- and long-term goals. These goals should have measurable metrics that will guide the process and help the team track the progress. The metrics will also become helpful in the post-implementation phase when the team is ready to evaluate the success of the telemedicine program. Examples of the metrics include improved client experience, increased access for patients, and reduced no-show rates.14

Here is an example of steps taken when defining success:14

  • List solutions the program can bring to the patients, clients, and practice.
  • Reevaluate limitations from financial, legal, and operational standpoints.
  • Identify three to five of the most important goals for the practice that dovetail with the anticipated solutions.
  • Decide on success metrics that are most appropriate for assessing progress.
  • Establish specific checkpoints to collect data and track progress.

Document each step of the process along the way and define baseline metrics in each success metric before implementing the telemedicine program. This will later help the team to demonstrate how the program has contributed to its long-term goals and evaluate how genuinely impactful it is from a big-picture perspective.14

  1. Check the liability

While implementing a telemedicine service usually does not require additional liability coverage, it is still worthwhile to double-check for any additional recommendations.13

  1. Evaluate options

Depending on what telemedicine service is being used, there are unique hardware, software, and back-office support requirements. Therefore, choosing the right service type to fulfill the specific needs becomes essential in achieving durable solutions. There are mainly two options:

  • Using a common application: Application software like Zoom, Skype, and Microsoft Teams have become prevalent in everyday life amid the COVID-19 outbreak. Some veterinarians may feel more comfortable using familiar technologies that they have been using for communication with their family members and friends. They are accessible for the practice to implement and straightforward when it comes to client education. However, since they were not originally developed as telemedicine tools, they often lack additional functionalities that are provided by telemedicine-specific applications, such as the ability to be integrated into practice management software with secure messaging.13
  • Outsourcing a telemedicine service: There are many third-party partners specializing in veterinary telemedicine as mentioned earlier. The use of vendor resources can simplify and expedite the implementation process. However, it is critical to perform thorough due diligence and know exactly what they are offering as not every service is compatible with every practice. Understanding their business model, and their ability to integrate with the information technology landscape of the practice, usability, and level of support available through customer service is the key. These are some ways to evaluate a vendor to determine if they are worthy of a long-term relationship:13
  • Ask for word-of-mouth referrals from experienced practices early on and research third-party reviews.
  • Discuss any value-added services, such as staff training and client engagement management.
  • Ask for case studies and referrals and schedule live demos.
  • Discuss how vendor resources and infrastructure can provide scaling support within an expected timeframe.
  1. Design the workflow

After deciding on what type of telemedicine service to implement, it is time to consider how to incorporate telehealth appointments with the least amount of workflow disruption. This is important in the seamless introduction of the new technology into the practice. This is when a clear understanding of the capacity of each team member—both clinical and non-clinical—is important to identify any barriers the team might encounter once the program is rolled out. Plus, here are some of the technological and workspace needs to consider:14,16

  • Location within the practice dedicated to telemedicine services that can provide privacy to avoid distraction and background noise and has adequate lighting for quality communication with clients
  • Equipment that provides the foundation for a high-quality consultation and allows for projection of a professional demeanor to clients

Appropriately furnishing and focusing on the space’s appearance is important when setting up the location to convey a professional atmosphere. If partnering with a vendor, ask about any additional equipment needed to support the service fully. Also, keep in mind that, while modern equipment with high-resolution audio and excellent video capability is preferable, it is also essential to consider how comfortable each team member is with novel technologies. 16

Visualizing workflow with the team is extremely important to streamline the process as much as possible. The workflow should be practice-specific, and every team needs to set clear expectations to avoid missteps. Some critical factors to keep in mind pre-, intra-, and post-visit are as follows:14

  • Before appointments:
  • Educating clients on the type of services being offered and proper appointment standards
  • Identification of appropriate clinical use cases and triage questions to ask clients during an appointment scheduling, including pet insurance coverage
  • Determining when telemedicine appointments will fit in the schedule and updating the calendar
  • During appointments:
  • Communicating with clients on how to involve patients throughout the process, depending on the clinical area and service model
  • Supporting troubleshooting on both ends in case of technological difficulties
  • Integration of other technologies like AI-assisted diagnostics
  • After appointments:
  • Referring clients to specialists (in the case of general practices) or advising them to take their pets to emergency services
  • Understanding what codes are available for telemedicine visits

 

  1. Train the team

Once the workflow is determined, the next step is to provide technical training on the telemedicine platform, new workflow, triage protocols, and patient education materials. It is essential to keep in mind the existing responsibilities of each team member.14

  • Consider developing a script for the team to use during client communication, especially when setting up an appointment. It would be helpful if every team member used the same professional language.
  • Discuss any available training material with the vendor and ask them if they would offer any training sessions for the team.
  • Formulate a standardized process for onboarding new staff in the event of turnover.
  • Conduct internal test visits and demonstrate how it is supposed to be done before officially launching the program; this will also be an opportunity to identify any problems and friction in the workflow.

 

  1. Engage clients

Now it is time to create marketing materials to advertise and promote the new services to existing clients and potential clients in the area. There may be pet owners, for example, who are not visiting a practice because of long distances involved. A telemedicine program will undoubtedly help the practice attract those clients and give it an edge over competitors around the area.14

Marketing methods include in-hospital displays, email messaging, displays on the practice website or patient portal, and social media promotions. It is also good to advertise the service in person during appointments. Again, implementation is only successful when clients know what the service entails and are incentivized to utilize it. Showcasing the benefits of telemedicine, such as increased access to care and reduced cost, is a must.13,14

  1. Launch

It is finally time to put the workflow to the test. Once a telemedicine visit is scheduled, the clients need to be educated about the process. This should be made as straightforward as possible since not every client is fluent in technology. Walk the clients through downloading the application, the check-in process, and the payment and billing process. If possible, create online guidelines with links included.14

Consider technology access and savviness. If a client does not have the technology needed to conduct a telemedicine visit, make sure to identify community-based resources and places where they might have access, such as schools and internet cafes, so they would be able to facilitate the visit. For those clients who have a more challenging time adjusting to the new service, have the team host a brief training session to help them prepare.13,14

It would also benefit the team to get feedback from the clients, especially during the first few months. If there are any issues or complaints, make sure to address them and adjust the process, as necessary. Ensure that the success metrics set during the Define Success step are being tracked so the team can evaluate success later.14 

Pricing

Determining the pricing model is not one-size-fits-all. To set yours, understand how the telemedicine service fits your overall workflow and the needs and interests of the clients and the practice. Ultimately, the goal is to develop a strategy specific to the practice. However, there is no need to decide on only one pricing model. You could offer multiple models, for example, to let clients decide how they want to pay. Consider how much in-person consultation would be taken away by implementing telemedicine services, whether clients would be willing to pay more for telemedicine visits than in-person visits, and whether sequential in-person visits after a telemedicine visit should be bundled.17

Here are pricing models to consider as suggested by the AVMA:17

  • Pay-per-use/time: This model is for practices that consider telemedicine visits as a separate service. It may be beneficial to use this model if the practice plans to incorporate telemedicine visits for after-hours and emergencies. This is most flexible for clients and should be offered along with other plans.
  • Bundled pricing: This allows for bundling a telemedicine visit with existing plans the practice already offers, such as wellness and senior plans, as a value-added service.
  • Subscription pricing: If the team is dedicated enough to implementing telemedicine as an integral part of the practice, this model is a great option.

If the practice is partnering with a vendor, it is important to understand how the vendor structures the service fee in detail. In these situations, the vendor will take a percentage of the revenue earned from conducting a telemedicine visit, so know how much of the consultation fee the practice keeps and set up a pricing plan for clients accordingly. The fee arrangement with the vendor also needs to comply with state-specific laws on fee-splitting and kickbacks. Moreover, it would be good to find out how the pet insurance companies recommended by the practice are handling fees associated with virtual care.17

Conclusion

Veterinary telehealth and telemedicine are here to stay. COVID-19 has permanently changed the social landscape, and new digital solutions are being developed to cope with the new reality. The public has already started adapting to a much more technology-driven work culture, and there is no going back—and animal health care is no exception. With the increasing number of pets and stronger human-animal bonds, lawmakers and industry leaders recognize the strong need for reforming regulations and systems around pet care to adapt to its changing landscape. Not only is the pet care sector experiencing a significant surge in market value, but it is also affecting veterinary medicine, including the telehealth industry. Many believe telehealth and other innovative digital solutions will become indispensable in optimizing care delivery to our beloved companions. Some even think that veterinary telehealth will establish itself as its own pillar and be recognized as an individual discipline. Whether desired or not, veterinarians need to gear themselves toward the “new normal” by understanding what resources and infrastructures are required to successfully implement virtual care into the clinical workflow.

References

  1. Seidman, A. (2020, April 16). Coronavirus is a new challenge for the ‘recession-proof’ pet industry. https://www.inquirer.com. Retrieved January 15, 2022, from https://www.inquirer.com/economy/coronavirus-recession-pet-industry-20200415.html
  2. Pets: A long-tail investment trend? Morgan Stanley. (n.d.). Retrieved January 15, 2022, from https://www.morganstanley.com/ideas/us-pets-investing-trend
  3. Crum & Forster Pet Insurance Group. (2021, July 27). The ASPCA® Pet Health Insurance Program’s data shows increased telemedicine usage. The ASPCA® Pet Health Insurance Program’s Data Shows Increased Telemedicine Usage. Retrieved January 15, 2022, from https://www.prnewswire.com/news-releases/the-aspca-pet-health-insurance-programs-data-shows-increased-telemedicine-usage-301342421.html
  4. Baldwin, C. (2020, March 27). A brief history of NASA’s contributions to telemedicine. NASA. Retrieved January 16, 2022, from https://www.nasa.gov/content/a-brief-history-of-nasa-s-contributions-to-telemedicine/
  5. Veterinary telehealth: The basics. American Veterinary Medical Association. (n.d.). Retrieved January 15, 2022, from https://www.avma.org/resources-tools/practice-management/telehealth-telemedicine-veterinary-practice/veterinary-telehealth-basics
  6. Telemedicine. American Veterinary Medical Association. (n.d.). Retrieved January 18, 2022, from https://www.avma.org/resources-tools/avma-policies/telemedicine
  7. Telehealth and the VCPR. American Veterinary Medical Association. (n.d.). Retrieved January 18, 2022, from https://www.avma.org/resources-tools/practice-management/telehealth-telemedicine-veterinary-practice/telehealth-and-vcpr
  8. Medicine, C. for V. (n.d.). CVM guidance for Industry #269. U.S. Food and Drug Administration. Retrieved January 22, 2022, from https://www.fda.gov/regulatory-information/search-fda-guidance-documents/cvm-gfi-269-enforcement-policy-regarding-federal-vcpr-requirements-facilitate-veterinary
  9. Veterinary telehealth market size report, 2022-2030. Veterinary Telehealth Market Size Report, 2022-2030. (n.d.). Retrieved January 22, 2022, from https://www.grandviewresearch.com/industry-analysis/veterinary-telehealth-market
  10. (n.d.). Retrieved January 22, 2022, from https://www2.zoetisus.com/species/equine/covid-19
  11. CUHA telemedicine information. Cornell University College of Veterinary Medicine. (2021, March 22). Retrieved January 23, 2022, from https://www.vet.cornell.edu/hospitals/clients/cuha-telemedicine-information
  12. Service models for veterinary telemedicine. American Veterinary Medical Association. (n.d.). Retrieved January 23, 2022, https://www.avma.org/resources-tools/practice-management/telehealth-telemedicine-veterinary-practice/service-models-veterinary-telemedicine
  13. Steps to implement telemedicine services in your practice. American Veterinary Medical Association. (n.d.). Retrieved January 24, 2022, https://www.avma.org/resources-tools/animal-health-and-welfare/telehealth-telemedicine-veterinary-practice/steps-implement-telemedicine-services-your-practice
  14. AMA Telehealth Implementation Playbook. (n.d.). Retrieved January 25, 2022, from https://www.ama-assn.org/system/files/2020-04/ama-telehealth-implementation-playbook.pdf
  15. , A. R., & McGee. (1970, January 1). Full title name:  overview of veterinary client issues. Animal Law Legal Center. Retrieved January 25, 2022, from https://www.animallaw.info/article/overview-veterinary-client-issues
  16. Technology and workplace needs in telemedicine. American Veterinary Medical Association. (n.d.). Retrieved January 26, 2022, https://www.avma.org/resources-tools/practice-management/technology-and-workspace-needs?check_logged_in=1
  17. Pricing Models for Veterinary Telemedicine. American Veterinary Medical Association. (n.d.). Retrieved January 27, 2022, https://www.avma.org/pricing-models-veterinary-telemedicine?check_logged_in=1

 

 

Client Service Representative Etiquette

Client Service Representative Etiquette

Veterinary Business Advisors, Inc.

 

Abstract

Being the first impression of a clinic to clients, there is no doubt that client service representatives (CSRs) play an integral role in the logistical function of clinics. In addition to that role, CSRs are also the liaison between the client and the main medical staff. Consequently, veterinary CSRs are more strategically involved with patient care than clients or even some veterinary staff realize. This creates a need for a guide towards CSR etiquette. Who should be selected for the position and how should they be trained during their time at a veterinary clinic in order to optimize their position in patient care, client education, and positive veterinary visits for both the patient and the client.

Introduction

A basic and typical veterinary practice operates with four main roles – management, veterinarians, veterinary technicians, and client services representatives (CSR). Other roles such as kennel staff, grooming, contractors, etc. depends on additional functions a practice might integrate. While much attention and training are focused on the medical staff, CSRs are often forgotten in the crucial role they play in a client’s and patient’s veterinary experience. Considering they are often the first people in contact with a client during either appointment scheduling/walk-in and the last to bid a client goodbye after checking out, they are an integral piece in the process of client communication and patient triage. By focusing more resources and time in CSR hiring, training and follow through, veterinary clinics can practice better medicine, enhance practice efficiency, and cater a more pleasant client experience. In these sections, we will primarily focus on recruiting high-quality candidates and their subsequent training in order to operate in tangent with the medical staff on patient care.

CSR Roles and Their Importance

  1. CSR Roles and Duties

At the fundamental level, CSRs are expected to answer communications to the clinic (phone, email, social media, etc.), schedule appointments, handle billing, provide basic veterinary education, and maintain the appearance/order for the reception area. Through these roles, CSRs are the first to meet a client and their pet and “create the critically important first impression” for the practice. While their job description might sound simple, CSR’s roles are wildly more impactful to a practice than a typical reception position.

  1. Patient Care and Follow Through

CSRs are the first to triage a patient whether an owner calls the clinic or walks through the door. Asking the right questions and visually gauging a patient’s condition skillfully is imperative in assessing the urgency of that patient’s needs. By accurately fielding that patient to the correct medical professional and/or scheduling the patient accordingly trickles down to the type of medical care that patient receives. This role is especially important for clinics that expect any level of emergencies to come in.

CSRs are also important for patient follow through so that sick patients receive the attention they need. Not all clients are aware of the value of rechecks, so CSRs play a role in client education along side the veterinarian and technicians. As a result of the impact they have on patient care, CSRs should have basic medical knowledge as well as training to reflect the types of situations they might encounter.

  1. Practice Efficiency

CSRs manage the flow of the clinic through scheduling and managing the front desk area. By ensuring the schedule is reasonable without situations such as uneven distribution of patients among doctors, excessive overbooking, and correct time allotment for appointments (wellness vs. sick vs. specialty treatments), the day flows much better. This plays a role in creating a better working environment for the clinic staff as well as imparting a better experience for the client and patient. Having hectic days might give the client the impression that this clinic is disorganized. It can also add to the stress of an already stressed-out patient making delivering patient care more difficult.

  1. Building Client Relationships

CSRs are integral in earning trust and loyalty from clients through conveying a desire to help and engaging with the clients during scheduling and check-out. Just by making an effort to connect with the client during phone scheduling and check-in can make a huge difference as the client feels valued and that their pet is treated as an individual as opposed to one in thousands of patients the hospital helps. Leaving that personal touch helps create goodwill.

The Hiring Process

  1. Who makes the best candidates?

Usually, employers think people with veterinary experiences will make the best CSRs since they already have an understanding on how clinics functions and even some basic medical knowledge. However, think about the bulk of a CSR’s job – it is costumer service wrapped neatly with a lot of multi-tasking and organization. To hire the best candidate for the position, clinics must look for the candidates with adequate experiences in those areas. Previous experiences such as working in restaurants, fast food, being a flight attendant, etc. are helping. People who have worked these jobs understand how to work with various personalities, multi-task, and maintain an positive attitude. The knowledge base details can be imparted through training. It is easy to teach someone all the options for heartworm control, but it is not easy to teach someone how to maintain a calm front desk area with two phones ringing and clients waiting to be helped.

  1. The hiring process before the interview

This process should look very similar to how other positions are recruited; however, it is important to go through the steps thoroughly. Create of list of skills and characteristics that are of value to you and your practice and separate them into “must-haves” and “nice-to-haves”. Pay special attention to phone screens even if it is just calling them to schedule an interview. Based on how they conduct themselves over the phone and/or what their voicemail sounds like can say a lot about a candidate. This is especially since they will be spending much of their time on the phone with clients. If you leave a message, their promptness in returning your call can also be an indicator of professionalism although this should not be read into too carefully if the overall candidate is spectacular. Be sure to check references as they can be the best way to gauge your candidate from someone else’s experience working with them. It is a step that is commonly skipped but can add value to your hiring process. While it might take time to call managers, it will ultimately save time since less hours are spent interviewing lackluster candidates or hiring someone who is not a good fit.

  1. What questions should you ask during the interview?

Since hiring might take place out of industry, it is important to gauge the candidate’s willingness to work with animals, medicine, and all the comes with veterinary medicine. Asking a simple question such as “why do you want to work in an animal-care facility?” can tell you a lot about if the person sitting across from you truly loves animals. On the extreme end, it is important to know that this person is emotionally equipped to handle euthanasia. Gauging their experience is important as CSRs are part of the team who consoles an owner after they lose their pet. If they personally have not experienced euthanasia but are ethically in-line and willing to take on the consoling role, then this candidate has a good foundation after some experiences and training. One basic question is asking what their opinion on euthanasia is.

Next, are the technical questions. CSRs should be proficient with the computer, phone, and be able to learn how to operate equipment such as printers, fax machines, and various newer technologies such as headsets, etc. The bottom line is that they should be able to handle technology, be able to multitask between them, and learn new technology. Simply asking about their experience with these modalities can elucidate useful information. Additionally, CSRs sometimes hold a social media role in some practices. If this is the case for your practice, asking if they are familiar with popular platforms such as Instagram, Facebook, and YouTube.

Arguably the most important are the soft skills. Examples include being multitasker, organized, compassionate, understanding how to de-escalate situations, prioritization of tasks, etc. The best way to gauge these skills are experience questions (“Tell me about a time…”) and case scenarios (“How would you respond if…”). You might want to gauge how they would handle an angry client, a person in need of accommodations, non-English speakers, clients with financial difficulties, etc.

Lastly, seeing how the candidate presents themselves during an interview can be the most telling portion. Do they make eye contact? Do they speak well? Do they smile? How did they greet you and your staff? These are all representative to how they will interact with your clients in the future. Once you have hired someone who will excel at being the face of your practice, next is training them to be able to contribute to patient care.

CSR Training: Patient Triage

  1. Emergency calls

Whether triage is done over the phone or in-person, the CSRs primary job is to first differentiate a true emergency from something that can wait. If any of the following situations are mentioned, the client should bring the pet to the closest emergency room immediately:

  • Non-stop bleeding
  • Difficulty breathing
  • Severe vomiting/diarrhea
  • Toxin exposure
  • Seizures, altered mental status, or collapse with noticeable behavioral change afterwards or inability to stand-up
  • Inability to urinate
  • Severe pain
  • Ingestion of inedible foreign material followed by vomiting, constipation/diarrhea, lethargy and/or pain

If the situation has been determined to be non-immediate, more time can be taken to gather information about the patient and their situations. It is important to note that it is not the CSR’s job to diagnose the disease; therefore, communication should be strictly information gathering. Important information include:

  • Patient signalment (species, age, sex, breed, reproductive status)
  • When did the symptoms start and how long have then been going on for?
  • How is the pet doing in terms of eating, drinking, urination, defecation, and behavior?

It is important to ask open-ended questions. Simply starting off with the question “tell me what’s going on” can help get a good preliminary view of the situation. More specific questions can be asked when the exact problem is known and as CSRs gain medical experience to know what questions are helpful to ask. Once all the information is gathered, an experienced technician or a doctor should make the judgement call of how urgently the patient should be seen. However, at the end of the day, a physical examination by a veterinarian should always be offered.

Patient triage for a CSR can be very similar to a technician taking a history. This is especially true if all the technicians are busy, but a client/patient is in distress and needs help quickly. This provides an opportunity of team building where technicians and CSRs can be trained together or an experienced technician can train CSRs. As a part of this training, new CSRs should have the opportunity to observe a technician or doctor take a history from a client to understand what to ask and how to ask.

  1. Sick appointment visits

CSRs can contribute to medical care of sick patients by identifying potential infectious diseases. Animals that observed to be coughing, sneezing, and puppies with diarrhea should be place in a room immediately to prevent spread in the lobby. Before the appointment, sick patients can be triaged similarly to emergency visits to ensure there is not something going on that the owner is not aware of.

  1. Wellness appointment visits

Annuals and semi-annuals do not require so much patient triage for CSRs; however, it is important that clients are made aware to bring/send records if the practice does not already have them. This will greatly expediate appointments.

CSR Training: Client Education  

Client education does not just happen in the exam rooms. They happen when the client makes the first call. CSRs are in the unique position to communicate the value of veterinary physical exams and diagnostics. Spending a few extra friendly minutes with a new client can ensure a booking a potential lifelong patient. Even better, if the owner mentions that their pet is anxious during veterinary visits, this is their first vet visit, their pet is animal/people aggressive, or any other information, the CSRs can provide guidance in catering the most stress-free visit possible.

After the appointment is finished and the client is checking out, CSRs have the opportunity to schedule the client’s next exam. This is a chance to communicate how important yearly visits or rechecks are. Unbelievably, clients tend to confide in CSRs asking if the diets, medications, or overall treatment plans really work or ask them questions they were too shy to ask the medical team. Having basic medical knowledge can go a long way in educating the client when the veterinarian or technician is not even in the room. The added benefit is that the CSRs can most easily relay the information in layman’s terms. While veterinarians and technicians are trained to communicate well with clients, jargon tends to slip out especially if appointments are rushed and overbooked.

Working as a Team

With CSRs being in the front of the house and technicians and doctors being in the back of the house, there is literal physical distance between the two teams. Additionally, some clinics might be familiar with frustrations CSRs and technicians might have with each other that ultimately stems from miscommunication. This begs the question of how the teams can work together?

Medical training for CSRs

One common complaint technicians often have is that CSRs rely too heavily on the medical team to answer simple questions or that something was done incorrectly because of a lack of medical knowledge. While it is unreasonable to expect CSRs to be as medically knowledgeable as technicians, increasing the staff’s overall medical competencies will only help patient care and client education. Therefore, CSRs should sit in on technician training, be offered CE opportunities, as well as have opportunities to train as a technician if they decide they want to be more involved with patient care. This allows for mobility within the clinic and help cater to individual future career goals (technician/veterinary school). Veterinarians often bring a head technician with them to conferences in hopes that this technician will be able to train the rest of the team. CSRs should be treated in the same way so the entire front staff can grow together.

Technology

Living in the twenty first century with millennials quickly becoming the main workforce, technology cannot be ignored. Often when there is disagreement or discord, it is due to a lack of communication. With widely available and relatively cheap cost for Bluetooth earpieces and walkie talkies, the front and the back staff can easily communicate without having to walk back and forth which takes time and energy. Anyone can contact any one person or everyone in a certain area to ask a question, ask for help, or give updates. Additionally, computer systems like Instinct which tracks inpatient care helps everyone understand how a patient is doing, what treatments have been done, as well as updates. CSRs can simply search this information from a computer as opposed to doing the dance of finding an available technician. Team members can leave notes to each other as well through this software.

CSRs in Telemedicine

Telemedicine is certainly gaining more traction, especially after a historic pandemic. Even as society moves back to normal, some trends from 2020 are left to stay, and this includes the ability to provide more services via an online format. Especially since millennials are quickly becoming the largest market, virtual care is in demand.

While telemedicine is new to the veterinary field, CSRs can help facilitate its process. Luckily, from a CSR’s standpoint not much is different from in-person care. CSRs will need to be diligent in their organization in knowing which appointments are telemedicine and which appointments are in-person. Which telemedicine appointments are for a technician and which appointments are for doctors? This is especially important since they will be responsible for sending out information regarding how the client can log in and what materials/information they should prepare. After the practitioner and client is finish with the appointment, it is the CSRs job to handle payment. The easiest way to handle this is to ask the client to provide a credit card ahead of time. This effectively “cuts the middle man out” by allowing the practitioner and client to join the call and leave the call without needing CSR involvement unless another appointments needs to be scheduled.

References

  1. Conrad, B. C. (2017, October 18). How to hire, train receptionists better. DVM 360. https://www.dvm360.com/view/how-hire-train-receptionists-better
  2. Donnelly, A. (2021, June). The Gift of Gab. Today’s Veterinary Business. https://todaysveterinarybusiness.com/csr-communications-training/
  3. Donnelly, A. D. L. (2016, December 29). Three Ways Client Service Representatives Can Build Client Loyalty. DVM 360. https://www.dvm360.com/view/three-ways-client-service-representatives-can-build-client-loyalty
  4. Driesse, Jess. Personal Communication (2021)
  5. Ekola, K. (2021, June 15). 5 Steps to Improving Veterinary CSR Efficiency. Vet2Pet. https://vet2pet.com/2021/04/5-steps-to-improving-veterinary-csr-efficiency/
  6. Felsted, K. F. (n.d.). Critical Aspects of Effective Hiring. Today’s Veterinary Practice. Retrieved June 18, 2021, from https://todaysveterinarypractice.com/practice-building-critical-aspects-of-effective-hiring/
  7. Frederick, C. E. (2014, October). The Art of Telephone Triage. Clinician’s Brief. https://www.cliniciansbrief.com/article/art-telephone-triage
  8. JOB DESCRIPTION for Customer Service Representative (CSR) . Manchester Veterinary Clinic . (n.d.). https://www.manchestervetclinic.com/sites/site-6369/documents/CSR%20MVC%20Job%20Description.pdf.
  9. Miller, L. R. J. (2005, April 19). Simple forms can help train new hires. DVM 360. https://www.dvm360.com/view/simple-forms-can-help-train-new-hires
  10. Rowe, R. C. (2020, April 28). A starting guide for new receptionists. DVM 360. https://www.dvm360.com/view/starting-guide-new-receptionists
  11. Stafford, D. (n.d.). Emergency and Critical Care – Receptionist tips. VSPN. Retrieved June 18, 2021, from http://www.vspn.org/Library/Misc/VSPN_M02367.htm
  12. Veterinary Practice News Editors. (2017, July 24). 7 Interview Questions for Veterinary Receptionists. Veterinary Practice News. https://www.veterinarypracticenews.com/7-interview-questions-for-veterinary-receptionists/
  13. Veterinary receptionists: Anticipate clients whens, whys, and hows. (2016, June 8). DVM 360. https://www.dvm360.com/view/veterinary-receptionists-anticipate-clients-whens-whys-and-hows
  14. Veterinary receptionists’ vital role in emergency medicine. (2018, November 20). DVM 360. https://www.dvm360.com/view/veterinary-receptionists-vital-role-emergency-medicine

Sharing The Windfall

Sharing The Windfall

Veterinary Business Advisors, Inc.

In today’s landscape of veterinary practice sales, corporate acquisitions are far outnumbering private sales. One major reason for this is that the dollar amounts of corporate buyout offers greatly exceed those of any associate or other private interest buyers, often yielding a cash windfall to the seller. The associate veterinarians who remain at the practice, though, typically receive no supplementary compensation of any sort, and any previous hopes that an associate may have had of buying the practice are off the table. An argument can be made, then, that these associates accordingly deserve a new signing bonus. This session aims to decide upon an appropriate value for such an associate’s hypothetical signing bonus offer.

In the current arena of veterinary practice sales, it is impossible to ignore the intense interest in practice consolidation by corporate entities, but it should be noted that this trend is not brand new. Corporations have owned veterinary practices for over 30 years, tracing back to when VCA Animal Hospitals first bought a small animal practice in 1987. Other corporate entities eventually caught on, as VCA’s success led to the formation of several regional and national chains, such as Banfield, NVA, and VetCor. Analysts now place the number of corporate veterinary practice groups at over 40 and growing. In just the last three years, though, the landscape has drastically changed. Multi-billion-dollar deals are not unheard of, such as Mars, Inc. purchasing VCA for $7.7 billion in 2017, or the very recent purchase of Compassion First Pet Hospitals by JAB, Ltd. for $1.22 billion. As another factor to consider, private equity firms, which see veterinary practices as relatively safe investments, are now funding many of the acquisitions by corporate groups.

According to the 2017 AVMA Report on the Market for Veterinary Services, the number of small animal veterinary practices in the USA ranges from 28,000 to 32,000. Brakke Consulting estimated in 2017 that about 3,500 practices were owned by corporations.  Companies own roughly 10 percent of all general companion animal practices and 40 to 50 percent of all referral practices. John Volk, an analyst with Brakke, explains, “What happens is a larger company comes in and buys up the smaller companies and builds a bigger firm.” This is called “roll-up,” a common business strategy applied to many industries made up of multiple, small, independently-owned companies, and has become the new model for veterinary practice sales.

Contrast that with the traditional model for practice sales, in which an owner sells to one of his or her associate veterinarians, likely groomed from day one to eventually take the reins, or where the owner might sell the practice to another veterinarian who was not employed by that practice. Either way, that is no longer the case for most small animal practices. Owners have now found themselves in a seller’s market, where large corporations will pay top dollar for a thriving practice, with corporate windfall offers typically vastly exceeding those of any associate or other private interest buyers. A windfall is defined as “a piece of unexpected good fortune, typically one that involves receiving a large amount of money,” with synonyms being a bonanza or jackpot, or pennies from heaven. Corporations, now routinely providing such payouts to sellers in nearly unbelievable but carefully calculated offers, are doing so for the following reason: a corporation is ready and able to take a hit on a practice’s purchase price as long as its long-term profitability and growth prospects appear satisfactory. Many veterinarians have made a fortune out of their practices this way, often making two to three times what they would have made by selling to an associate. It can be hard to refuse a corporate buyout when the seller has offered such terms. Plus, a corporation can buy almost immediately, typically with a cashier’s check for the full purchase price in pocket, versus associates for whom the seller will very likely have to finance some or all of the purchase themselves, and for a fraction of the corporate purchase price.

Now we return to the subject of associate veterinarians. Although circumstances differ in each sale, one cannot deny that a significant reason that corporations are offering large cash windfalls is often the presence of the associate veterinarians. Corporations want to buy thriving practices that are operational from day one of purchase, with veterinary and support staff in place. A veterinary practice does not exist without veterinarians, and buyers generally have no intention of replacing associates. Furthermore, associate veterinarians usually do not wish to leave when practice ownership changes hands.

Here’s another reason why associate veterinarians are typically off the playing field. The typical associate sometimes cannot afford to be a practice owner. This often stems from the mass amount of veterinary student debt that they have accumulated and may be paying off for many years. According to results from the AVMA’s 2015 annual survey of senior veterinary students, of those students who graduated from the 28 US colleges and schools of veterinary medicine, 89% had educational debt at the time of graduation, with average debt for veterinary students being $142,394. Approximately 68% of the 2015 graduates had debt between $50,000 and $221,000, with 5% having debt greater than $300,000.

These are staggering figures, but what may be even more disturbing is the discrepancy in associate veterinary wage increases versus their debt. The current debt load of veterinarians is rising by $4,900 per year while average salaries are only rising by $700 per year. In 2017, $76,130 was the average salary for a veterinarian, while the mean debt was $141,000. This rising debt-to-income level is unsustainable and is one of the major factors making this profession less attractive than in the past. In fact, a recent Merck veterinary wellbeing study showed that only 41% of veterinarians overall and only 24% of veterinarians younger than 34 years old would recommend pursuing a career in veterinary medicine, citing that student debt coupled with low income was the top concern contributing to emotional stress. Furthermore, between standard and extended loan repayment plans, veterinarians on the average spend 15 to 20 years paying off their student debt. Hence, it is increasingly difficult for an associate to qualify for lending from a bank in order to compete with a corporation on a purchase price, with very little chance for the associate to be able to match the cash windfall offered by a corporation.

In this current climate, it is easy to see why so many practices are sold to corporations. But, while the seller receives the cash windfall for the sale, the remaining associates typically receive no supplementary compensation of any sort—the same associates who often helped to build the practice and who are integral for its revenue, often contributing 30% or more to the overall practice gross. This begs the question, then: Is it not fair for the associate veterinarians to share the windfall?

As stated, the corporation is buying a thriving practice, one not possible to operate at a similar capacity in the absence of associates. So, as an industry, should we not be sharing some of the profit from sales with the associates whom are so integral to the sale itself? Upon practice sale closure, associates are terminated by the original employer and then typically rehired by the new owner. An argument can be made that the associate accordingly deserves a new signing bonus, as they are technically a new hire and should be incentivized towards employment.

In order to decide upon an appropriate value for an associate’s hypothetical signing bonus offer, one could develop a calculation based on actual numbers. The prototype calculation herein requires basic information regarding time and revenue, including the following factors: the number of years the associate has worked for the practice (a minimum of five years of employment), the number of years the seller has owned the practice, the associate’s average gross revenue over the last five years, and the practice’s current gross revenue. With this information, we establish the Employee Leverage Factor (ELF), a figure which, when applied to the purchase price, yields the appropriate signing bonus. The calculation is as follows:

If, for example, an employee has been working for ten years at a practice that has been under current ownership for 35 years, and over those last ten years the employee has been bringing in an average of $700k while the practice brings in $2.1M, the equation would follow as such:

If the practice sold for $4.5M:

In this example, the seller still nets $3,620,000.00, cash in hand, over 1.7 times the gross of the practice.

Thus, we have established a fair and reproducible calculation of an offer that reflects the associate’s contribution to the “windfall” price received by the seller. The calculation should only apply in the case of a major windfall, in our estimates at least 1.5 x gross revenue and all cash. The calculation could be adjusted as the seller sees fit but, as it stands, it is a fair representation of contribution. It is based on the associate’s average gross revenue over five years, and also only applies if the associate has worked at least five years. So, if they have worked 5.5 years, but did not gross nearly as much in the first two years, those initial lower numbers are factored in. For example, if that associate had an average gross of $400k:

If the associate had worked for ten years, as in the first example, it is justified that the signing bonus offer is greater because that associate likely helped significantly more in building the practice, contributed more to the practice’s gross revenue, and thus made the package more appealing to the corporate buyer.

But, should there be a factor that weighs the windfall itself? The previous examples are based on a flat payout in a high windfall. But, if the windfall is of a lesser amount, then the associate’s share should be weighted as less, accordingly. If we use a maximum sale price as 3x the practice gross, we can incorporate a factor that includes the actual sale price over max gross, thus weighing the windfall.

The seller still nets $3,000,375.00 after receiving a lesser windfall for the sale.

A large share of the windfall could be enough to make the associate take the money and run, leaving the practice high and dry. To offset those odds, the signing bonus could be offered instead as a retention bonus, with part of the sum paid up front to the associate and the remainder paid over the agreed length of employment. Or, keeping in mind the high amount of student debt that most associates have, the calculated bonus can in whole or partially be assigned towards debt payoff. Thus, sharing the windfall would secure loyalty and stability for the future of both the associate veterinarian and the practice itself, meriting strong consideration.

The signing bonus offer would come out of the purchase price, and hence may not appeal to the seller. But we must remember that the long-term associates who would benefit from this process are the same ones who helped to build the practice to its current capacity, potentially contributed a high percentage to the practice’s gross revenue, and made the package more appealing to the corporate buyer, thus contributing to the windfall itself.

Without such a bonus, the associate otherwise gets nothing out of the deal. In their eyes, their future with the corporation is uncertain. They may have a new or broader non-compete agreement. They may not have wanted to work for a corporation at all. Furthermore, when they inevitably find out the size of the seller’s windfall, they may feel cheated after putting so much time and effort into the practice and getting no reward. This negative outlook may be compounded tremendously if they had otherwise hoped to someday buy or buy into practice ownership, with this disappointment added on top of the debt and stress they are likely already under. We also cannot disregard the real and unfortunate rise in the suicide rate among veterinarians in the face of issues such as emotional stress, debt, and compassion fatigue. That is the world in which the associate veterinarian lives in. We must therefore ask ourselves, is it moral as an industry to not include our associates in the windfall from corporate sales?

While the corporate consolidation trend will inevitably slow down, it is currently encompassing the world of veterinary practice sales, far and wide. As industry leaders, we must bear in mind the circumstances of many of our peers as associate veterinarians and the effects that our decisions to sell to corporate entities may have on them. The concept and application of sharing the windfall via the associate veterinarian signing bonus would secure a high degree of financial and thus psychological stability in the associate. Furthermore, it would create security for the future of the practice itself through the loyalty it instills in the associate, ensuring that they feel appreciated as the assets that they truly are.

References:

  1. Davidow, B. Who is Buying Veterinary Hospitals? The Veterinary Idealist. Mar 2018. https://vetidealist.com/who-is-buying-veterinary-hospitals-update/
  2. Veterinary practice trends webinar highlights further industry consolidation. Veterinary Practice News. Aug 2018. https://www.veterinarypracticenews.com/veterinary-practice-trends-webinar-highlights-further-industry-consolidation/
  3. Larkin, M. Who’s buying? Who’s selling? Journal of the American Veterinary Medical Association. Oct 2014. https://www.avma.org/News/JAVMANews/Pages/141015a.aspx
  4. Allen, C.J. Consolidation nation: Why veterinarians who hate corporate ownership end up selling out. DVM360 Magazine. Jan 2018. http://veterinarynews.dvm360.com/consolidation-nation-why-veterinarians-who-hate-corporate-ownership-end-selling-out
  5. Nolen, R.A. The corporatization of veterinary medicine. Journal of the American Veterinary Medical Association. Dec 2018. https://www.avma.org/News/JAVMANews/Pages/181201a.aspx
  6. Harrell, J. Fishing for acquisitions: 12 things corporations look for in a veterinary practice. DVM360 Magazine. Apr 2017. http://veterinarynews.dvm360.com/fishing-acquisitions-12-things-corporations-look-veterinary-practice?pageID=2
  7. Salzeider, K. 17 differences between selling to a corporation and an associate. Mar. 2017. http://veterinarybusiness.dvm360.com/17-differences-between-selling-corporation-and-associate
  8. Felsted, K. How to sell to an associate for a corporate price. Veterinary Economics. Aug 2017. http://veterinarybusiness.dvm360.com/print/450884?page=full
  9. King, D. Selling Your Practice – Private vs Corporate. Simmons Veterinary Practice Sales & Appraisals. https://simmonsinc.com/wp-content/uploads/2017/11/Selling-Your-Practice-_-King.pdf
  10. Davidow, B. Thoughts on Rising Veterinary Debt: In-state and out-of-state tuition. The Veterinary Idealist. Oct 2018. https://vetidealist.com/veterinary-debt-and-tuition/
  11. Bain, B., Dicks, M.R. Are veterinary students accumulating unreasonable amounts of debt? Journal of the American Veterinary Medical Association. Aug 2016. https://avmajournals.avma.org/doi/full/10.2460/javma.249.3.285
  12. Williams, R.B., Benson, A., Bain, B., Dicks, M.R. Factors affecting student load debt accrued by graduates of US veterinary medical colleges. AgEcon Search. Feb 2016. https://ageconsearch.umn.edu/record/229834/
  13. Verdon, D. Debt crisis looms for veterinary students. DVM 360 Magazine. Oct 2011. http://veterinarynews.dvm360.com/debt-crisis-looms-veterinary-students
  14. 14. Fender, K.R. Merck study: Veterinarians have normal mental health but poor well-being. DVM360 Magazine. Feb 2018. http://veterinarynews.dvm360.com/merck-study-veterinarians-have-normal-mental-health-poor-well-being

 

Pay Raise Requests: How to Make Them and How to Respond

Pay Raise Requests: How to Make Them and How to Respond

Kellie G. Olah, SPHR, CVPM

 

Veterinary practices, like many other businesses, often award pay raises in connection with an annual employee review. It’s a logical time to do so since that’s when employers provide performance-related feedback to their employees.

As an employee, you may feel that you deserve a raise, even though it’s outside of the normal timeframe for your practice to award one—perhaps, for example, you’ve taken on extra duties during the pandemic. If so, how should you approach your supervisor? As a manager, how should you respond to such a request? This article takes a look at both sides of the equation.

 

Employees: Preparing to Ask

If you’ve decided to ask for a raise at a time when one typically isn’t awarded, then it’s important to be prepared. Make a list of accomplishments you’ve achieved, quantifying them whenever possible, and writing down how these accomplishments have benefited the practice. In other words, what is the business value of what you’ve done? If you’ve won any awards, received a letter of praise from a manager or customer, or otherwise gotten concrete evidence of your performance, gather that information together for when you ask for a raise.

It can help to have data on hand about the average wages of a person who is doing your job in your geographical area. Where does your paycheck fit in? If yours is less than the average amount, it may be easier to build your case for a raise than if yours already matches or exceeds that figure—but you can still share information about why you feel you’re worth the dollar figure you’re requesting if you feel your case is strong enough.

Ask to privately meet with the appropriate manager and practice how you’ll present your request. During the meeting, make it clear that you’re asking for a raise that goes beyond the one you’d typically receive during your annual performance review.

Be prepared for a range of responses from your manager and know how you would respond to each of them. If, as one example, your manager says that they would love to give you a raise, but it just isn’t financially feasible right now, ask what you would need to do to earn that raise and a date when this topic can be revisited.

 

Employers: How to Respond

As a manager, you may be taken aback when an employee asks for a raise during a time when your practice doesn’t typically give them. Perhaps you have the authority to make the decision or maybe you need to discuss it with a human resources manager. Whether you are surprised or not—and whether you have the authority to decide or not—the savvy response is typically the same. Ask for more information and avoid reacting immediately. Listen carefully and take down notes. Once you feel that you have enough information, it’s perfectly fine to ask to schedule a follow up conversion. In either case, thank the employee for bringing this information to your attention and remain pleasantly professional and neutral.

Then it’s time to evaluate the case that the employee has built for this request, as well as to talk to other people in the practice who would have input into this decision-making process. What is your practice’s policy, in general, on giving raises? If you don’t have a policy already created, how have such requests been handled in the past? Is your practice’s philosophy that you only give raises during a certain time of year or do you consider each request on its own merits?

Compare that person’s wages both internally and externally, and doublecheck data they’ve given you. This involves looking at where this employee falls on the practice’s payroll. Do they receive a wage that’s comparable with other people performing the same work and who have been at the practice for a similar amount of time?

It also involves verifying what this employee might receive at other practices in the same geographic area. Also consider how important it would be to retain this person at your practice.

In some instances, the answer may be clear. The person may not have demonstrated a good case to get a raise or their job position may not warrant a higher pay rate. Or it may be that the employee asking for the raise successfully took on a big special project but doesn’t necessarily perform at a higher rate, overall. In that case, a one-time bonus or extra time off could be a good compromise.

If, though, this employee has made a good case for a raise, it can make sense to pitch the idea to others in the practice who would need to approve the pay increase. In a sense, you’d be preparing for the ask in the same way that the employee did with you. During this conversation, you can also focus on the high costs of recruiting and training new employees, with a focus on not being penny wise but pound foolish.

 

Sticky Situations

Sometimes, the situation can get more complex. These can include the following:

  1. An employee threatens to quit if not given a raise
  2. You do give one employee an off cycle raise; other employees hear about it and they want one, too
  3. A star employee gets an offer from another practice

In the first scenario, an employee might literally threaten to quit (“If I don’t get this raise, I’ll need to leave”) or it may be implied (“The new practice in town pays more and they’re hiring”). If this happens, the process—at least at first—can be the same. Listen carefully to your employee’s request and then set up a follow up conversation, which gives you time to think about how to respond. Consider the merits of the employee’s request, as before.

This time, though, you may also want to consider whether this employee uses the “I’ll quit” card in general, as leverage, or if this may be a genuine statement from the employee—meaning that, if they don’t get a raise, they’ll financially need to find a job elsewhere. Does that change your decision?

Will this situation trigger a revision of your policies about raises, perhaps limiting them to a certain time annually? No matter what you decide, assume that other employees will hear about it, regardless of any company policies that require salaries to remain confidential. How will you handle the situation when other employees ask to also get a raise? There is no one size fits all solution. The idea, here, is to look beyond the specific request being made by a specific employee. Instead, place this employee’s request into an overall context of the practice and make decisions that make sense for all employees.

In the third scenario—one where an employee gets another job offer—was that employee job hunting or did the offer come, unsolicited? If your employees are being recruited, it may confirm to you that you have a great team without necessarily indicating that those employees are unhappy. In other cases, employees may be putting out feelers to see what they’re worth in the job market—and, in other situations, those employees may be dissatisfied in their current position.

If an employee asks if you would match an offer from another practice, it can help to determine if they really want to stay. If they are unhappy with aspects of your practice, they may well leave the next time they get a job offer. If they do want to stay, how valuable are they to your practice? How difficult would they be to replace? If you do give that particular employee a raise, what impact would that have on other employees? Again, no one right answer exists.

 

Sidebar: How to Deny a Raise Request

Sometimes, you’ll need to turn down a raise request from an employee. If so, set up a private meeting and then tactfully yet honestly get to the point. If there is a performance issue, share some specifics about how this employee could work towards getting the desired raise. If it’s a financial issue, say that. This isn’t a time to get into exhaustive detail. It is, however, an opportunity to encourage the employee, if possible, and let them know what you appreciate about them.

Through this process, you may discover holes in your practice’s policies about giving raises. If so, now is the time to fix them so that more clarity exists for everyone, going forward. If this process uncovers disparities (such as pay differences based on gender), then this is crucial to prioritize and address. Update your employee manual and share specifics.

 

Read the article originally posted in Today’s Veterinary Business HERE.

Employee Performance Coaching and Setting Goals

Employee Performance Coaching and Setting Goals

Charlotte Lacroix, DVM, JD

Veterinary Business Advisors, Inc.

Whitehouse Station, NJ, USA

The overall objective of any Performance Management Program (“PMP”) is to ensure a Practice and all of its subsystems (processes, departments, teams, employees, etc.) are working together in an optimum fashion to support achievement of the overall strategic and operating performance goals.   In simpler terms, a Performance Management Program strives to ensure the right people with the right competencies are in the right jobs at the right time.  An effective PMP will also look to achieve the following objectives:

·        Shape the culture and reinforce the core values of the Practice

·        Facilitate communications between supervisors and subordinates

·        Motivate and reward superior performance

·        Effectively manage unsatisfactory performance

·        Identify opportunities for personal growth and development

·        Link pay to performance

·        Stimulate individual and collective productivity

 

Why PMP’s Fail

While Performance Management Programs have been utilized for many years, they are not universally considered an effective management tool.  In some cases, performance management is more about checking a box than about aligning employee performance and development.  Instead of viewing the performance review as a valuable communication and recognition tool, many Practices think of it as a necessary evil; a paperwork exercise that managers love to hate.   Exacerbating this feeling of disdain is the fact that supervisors often spend a majority of their time focusing on the small minority of employees that do not meet expectations and not enough time giving appropriate praise, recognition and appreciation for those who do.  Even your best workers can be better, but if you don’t give them the guidance they deserve, then they will never reach their full potential.  Some of the more common shortcomings of a PMP include:

  • Individual goals are not tied to the strategic direction of the Practice
  • Senior management is not fully committed or invested in the process.
  • Performance objectives are only looked at every six or 12 months and not on a continuing basis.
  • Performance appraisals are not included as part of a larger employee development initiative.
  • Little or nothing is done with the actual appraisal results.
  • Management fails to develop and administer a coaching and improvement plan for any employee who is not meeting expectations.
  • There is a lack of clarity in the link between pay and performance.

 

Developing a Performance Management Program

When creating, institutionalizing and communicating a PMP effectively, it is a valuable resource for a supervisor to help employees identify and develop needed skills, knowledge and abilities.  However, if used inappropriately, a PMP can demoralize employees, frustrate managers and expose a Practice to potential legal risks.  Therefore, several questions must be addressed when developing a PMP.  Who will be involved in the performance review process – will the review be horizontal, vertical or a 360°?  How much time can each contributing party commit to the PMP?  Will the review focus on objective results and/or subjective perceptions?  How often should the reviews be performed?  Who will oversee the PMP to ensure it is being used properly?  Who will provide training to the reviewers?  What will be done with the results of the reviews?  And, most importantly, how will the success of the PMP be measured?

 

Conducting the Performance Evaluation Review

Prior to meeting with an employee to conduct the performance evaluation review, it is advisable to have the employee complete a self-evaluation form.  Give the employee approximately 1 week to complete the performance evaluation form and return it to his/her supervisor 1 week in advance of the performance evaluation review date.  Only after the supervisor has completed the performance evaluation form for the employee, should the supervisor review the employee’s self-evaluation form and rating.  Following this process will help ensure the supervisor performs an independent performance evaluation that is not biased by the employee’s perceptions of how he/she performed.   Other important points to consider when preparing for and conducting a performance evaluation review include:

  • Be sure to deliver the performance evaluation review at the designated time-giving the review after the date can leave an employee feeling slighted, anxious and devalued. It also sends the unintended message that the performance evaluation review cannot be that important to you or the Practice.
  • Be mindful of overrating an employee- rating an employee higher than is warranted may be an easier message to deliver, but it can create other problems. For one thing, it may give failing employees a false sense of security and make it difficult to administer needed discipline.
  • When discussing a performance issue with an employee, be sure your verbal and written comments support your rating and always use specific examples that clearly demonstrate the level of performance.
  • Be sure you are rating the entire performance evaluation review period – supervisors often fall into the trap of rating only the most recent activities and actions. If an employee is being evaluated annually, the performance evaluation review should consider everything, good or bad, that has occurred during the past twelve months vis-à-vis the employee’s performance.
  • Ask for feedback-there may be mitigating factors and circumstances that affected the employee’s performance during the review period. It is critically important to provide an employee the opporunity to discuss and present an explanation of any factors and influences that may have contributed to his/her performance.  Encouraging this two-way dialogue ensures “everything” is considered when developing the performance rating.

 

Developing Performance Goals

Another key piece of a PMP involves developing performance goals and expectations.  Goals are written statements that clearly describe certain actions or tasks with a measurable end result.  Goals should be well-defined, detailed declarations of specific actions to be taken during the upcoming review period for which measurable outcomes are expected.  Each goal should be specific enough to let the employee know what is expected to be accomplished, why it is to be done, and the target date for accomplishing it.  The following acronym is often used to assist supervisors in developing goals for their employees:

 

S        Specific-answers what, why and when actions or activities should be accomplished.

M       Measurable–clarifies how to determine if the goal has been achieved.

A        Agreed Upon- both the employee/supervisor should agree on what is expected to successfully complete the goal.

A        Aligned-supports the Practice’s mission and overall objectives.

R        Realistic-ensures goals are doable but with a stretch challenge.

T        Time Specific-establishes deadline for completion.

 

To Sum It All Up

In order to determine the effectiveness of a Performance Management Program, it must first and foremost support achievement of the Practice’s mission and goals.  It should help employees understand what is expected of them and against what measurement criteria their performance will be assessed.  If the program is utilized properly, a welcomed byproduct of the PMP is improved communications between supervisors and subordinates.  As the PMP evolves, a Practice should begin to notice a stronger link between pay and performance.  Rather than giving arbitrary increases to all employees, the PMP will provide justification for differences in salary increases and rewards.  Finally, documented differences in performance should help identify employees able to assume additional responsibilities as well as those individuals requiring additional development and/or discipline.

How Practice Managers Can Keep Up with Changing Employment Laws

How Practice Managers Can Keep Up with Changing Employment Laws

By: Kellie Olah, SPHR, SHRM-CP

Although it has always been challenging for many small business owners to keep up with evolving employment-related legislation, COVID-19 has made this situation even more problematic. Legislation is being rapidly passed, containing new and sometimes confusing information. It can be hard for your practice to keep up but it’s worth the effort because when you don’t have access to the most current information or you lag in compliance, this can lead to numerous problems. The consequences can be as serious as litigation against your practice.

As a general approach, it can be helpful to gather a list of trustworthy resources that you can regularly check. This includes reviewing the most current information on topics ranging from healthcare and injury/worker’s compensation to paid time off, unemployment, retirement, and much more. Once armed with the foundational knowledge you need, you can then determine which tasks you can handle within your practice and which ones require help from an expert, such as an employment attorney.

 

Employment Law Resources

At a federal level, the U.S. Department of Labor (U.S. DOL) provides information on a comprehensive range of employment issues. As just one example, here is their resource page that helps employers and employees to address the impact of the coronavirus. The DOL also provides a newsletter, along with contact information for your state labor office so that you can stay up to date with state-level laws and pending legislation. Subscribe to receive email updates from both a federal and state level (for each state where you practice).

If you come across a legal term that is new to you, or one where you need clarification, the Cornell Legal Information Institute has provided a wiki-style legal dictionary and encyclopedia. You can also find human-resource-related legal advice at NOLO’s free employment law center. NOLO has been publishing legal guides since 1971 and has developed into a trusted website.

You can also glean helpful information from the Society for Human Resource Management (SHRM) website, including free tools and information. This organization has a mission to empower people and workplaces by advancing human resource practices and maximizing human potential.  If you find the free content provided by SHRM to be valuable, you can also consider becoming a paid member.

The National Federation of Independent Business (NFIB) is also a helpful resource, with a small business legal center that provides information to small business owners. Plus, NFIB monitors relevant legislation and advocates for small business interests in courts. You can also find state-related employment law news and, if you need more in-depth information about issues that are specific to your practice, you can become a paid member. With that membership, you can call the legal center to ask questions.

Another in-depth resource is HR-Business and Legal Resources. There, you can find state-specific information on a variety of employment topics. There is a reasonable amount of free content with more available for members. To see if the premium content would be valuable for your practice, you can sign up for a 14-day free trial.

What we’ve provided isn’t a comprehensive list of available resources, but they are some of the most commonly used and trusted ones. If you find another credible source that provides the employment law information you need, share it with the rest of your practice.

 

Next Steps

Once you’ve identified resources for your practice to use and you have signed up for newsletters, email alerts, and so forth, what’s next? These steps can include:

  • deciding who at your practice should monitor all the information that’s coming in; if you have a discrete human resource department, that answer may be easier than if multiple employees are wearing the HR hat
  • concluding which sites and resources end up being the most valuable to your practice; it can make sense to start out by receiving and reviewing information from a larger number of organizations and then focusing more on those that provide the targeted information you need
  • determining which message format works best for you; for example, your practice might find watching videos of employment law updates is the best use of everyone’s time
  • attending relevant online trainings; these may come with a cost, but they’re likely to be much less expensive than traveling to a location where trainings are being held—and, because of the COVID-19, online resources are more practical and becoming more prevalent

Although online trainings may not allow for the in-depth personal networking that can take place over, say, a weekend-long event at a training center, they’re more affordable; can fit within busy schedules (especially if you have access to the videos after a live event); and can be ideal for practices where in-person trainings aren’t often available nearby.

As you learn new information and as employment law evolves, it’s important to review your policies and procedures; update what’s needed; and share the revised information with your practice team.

 

When to Talk to an Employment Law Attorney

The ideal situation would be to have an employment law attorney on retainer— one you trust, and who understands the legal issues that veterinary practices often face, as well as your practice’s unique workplace culture. If that’s not possible, then the next best option is to choose an attorney with expertise that dovetails with your practice needs and consult with him or her when issues of significance arise, or you need clarification on areas of employment law.

Examples of when it can make sense to consult with an employment attorney include, but are not limited to, when:

  • firing an employee; ideally, you always run employee firings past your attorney, but especially if you believe an employee might sue the practice, perhaps because of an employment contract or because he or she is in a protected class
  • an employee files a complaint or sues your practice
  • creating a contract or agreement
  • creating or updating your employee manual
  • bringing in or buying out a practice partner

 

Choosing the Right Employment Attorney

If you don’t have one yet for your practice or you’re looking to switch attorneys, be clear about what you want the attorney to do. If you want him or her to regularly update you on employment law changes, for example, then that’s different than if you want someone available when you want to address a specific issue at your practice.

Consider asking other practices and small businesses for recommendations. Ask what they like about the attorney and if they’ve had any problems with their choice. You can read online reviews of recommended attorneys, but remember to take them with a grain of salt because it’s hard to find an attorney of substance with no unhappy clients. You can also use lawyer directories such as those available through the American Bar Association, and other similar websites.

Once you have a short list of candidates, interview each one. Many attorneys, but not all, offer a free initial consultation so you can get to know one another. This can help you make the right choice. You’ll want an experienced attorney who is well versed in the laws of your state, someone you feel comfortable with and who communicates well without reverting to jargon that can be confusing. By the end of your initial conversation, you should be able to determine if that individual has a personality that you would enjoy consulting with, and has the knowledge base to successfully assist you with managing your veterinary practice.