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How to Create a Holistically-Managed Practice

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Like many veterinarians, I derive energy from learning, healing and integrating multiple modalities into my practice. It is significantly more challenging to find the energy for managing office problems. Daily pressures and interruptions related to the business aspects of our profession can negatively impact work-life balance, detracting from the joys of client interactions and patient healing.

After 30 years in practice, I own three practices all within 16 miles of one another. My practices are financially successful and show consistent growth.

I have arrived at a place where I accept that serenity and peace in daily practice must be cultivated from within. I recognize that systems like the ones detailed in this article help create more predictability and order amid the chaos that can accompany veterinary practice. My definition and view of success is constantly changing as I examine the quality of my personal and family time, and the many facets of practice and home life from varying perspectives. I believe that continued success requires regular analysis, and ongoing learning. We must all keep refining our systems to keep pace with evolving needs and our individual development.

Having a trusted MBA practice manager and a separate hiring/ training manager, who take care of the big picture, allows me to practice more efficiently. I have more personal time to travel for pleasure, take weekends off and spend more time with my family. My schedule includes three short days of office hours, two longer days with evening hours each week, and a half day three Saturdays per month.

My practices employ a core nucleus of 11 team members who have been with the clinics from anywhere between six and 20 years, and they provide consistent and committed staffing. They also train and support the hires who have quicker turnover, including the many pre-vet and veterinary students we mentor and those assistants and receptionists who decide to raise families after a shorter time working with the practice. There are 30 team members who are cross-trained in all positions, and in all offices. This allows flexible positioning for vacations and illness.

This is in sharp contrast to my first years of practice ownership, when I worked approximately 90 hours a week and had difficulty hiring and retaining staff. There was no time for family and every seven days spilled into the next seven without end. The worst part was that I saw little financial gain for all my efforts.

Unfortunately, veterinary education provides minimal business training, even though our profession requires us to develop business acumen, salesmanship and client hospitality protocols. Our combined roles of salesperson, business manager (even associates need to manage caseloads, payment considerations and staff) and medical professional can overwhelm us with challenges, including:

  1. Overtime, causing conflicts with personal and family life
  2. Inconsistent client numbers/revenue to support the employment of additional staff
  3. High staff turnover or difficulty hiring/training or retaining qualified team members
  4. Client communications interrupting office hours
  5. Staff training communication problems
  6. High debt or unpaid client accounts
  7. Low client numbers or difficulty obtaining new clients
  8. Poor cash flow
  9. Overwhelming paperwork, regulatory and HR demands on the business side of the practice
  10. Feelings of burnout and/or compassion fatigue
  11. Competition with online pharmacies, corporate clinics and low cost clinics that impact revenue
  12. Inventory management headaches.

Veterinary conferences offer management tracks that address these problems, while the American Animal Hospital Association, AVMA, Veterinary Information Network, and online publications like DVM360 provide professional resources for dealing with business issues. Increasing numbers of practice management consultants offer services to help us define and create successful practices.

Over the past 30 years as a veterinarian, I’ve built five practices and worked in large and small animal medicine, emergency and shelter medicine and integrative veterinary medicine. The practice of medicine has been rewarding, but until I gained a recognition of and solutions for business conundrums, there was little time or money to enjoy life outside the clinic. Over the years, the diagnostician in me had to seek solutions to these problems, which changed depending on the economy and availability of human and other resources.

Cash flow, rapid growth followed by recessions (three times), employee theft, staffing (both associate and support staff), attracting new clients, team training, marketing through social media, and identifying with/motivating employed younger generations (including millennials), are just a few of the issues that have required creative problem solving.

We all need to find personal motivators for tackling problems and my early ones were:

  1. Financial necessity (my first employer had been embezzled from, requiring me to start my own practice sooner than planned)
  2. Desire to provide for clients, patients and a financially burdened community.

My mentors imparted lessons that illuminated the need for a holistic approach to the business of veterinary medicine, beyond simply treating patients. I learned from their examples that clients want to be heard and have someone to identify with. Understanding the range and expression of human emotion, developing empathy, and communicating well creates a strong foundation for bonding clients and establishing a thriving practice. I developed a clear vision of my life and practice goals from working with others.

PROFESSIONAL AND PERSONAL PLAN

Many factors are required in creating a thriving business that supports the emotional and financial abundance necessary for long term practice, as well as mental and emotional health. Providing for patients, our communities, staff, families, and ourselves as veterinary professionals requires a well thought out and written plan. I suggest writing out both a personal and professional plan, complete with your vision, mission statement, financial plan and budget, and then scheduling frequent reviews of those plans.

The hard part is scheduling time to create these plans. My advice is to just block out the time and lock your office door. Not doing this will be more devastating to your practice evolution and success than skipping CE attendance.

The good news is that many of us have family, friends and clients with business training. They can help guide us through the creation of these plans once we get through the initial stages of writing out our goals for both our lives and practices.

After roughing out what you want to create in life, you can move on to writing a mission statement. Your mission statement can be modified at any time, so feel free to refi ne it as needed.

MISSION STATEMENTS

Mission statements include the healing you are bringing to patients, the financial exchange you require between yourself and your clients, your role in the community, and the involvement of your staff. Here’s an example of my mission statement:

“Our exemplary staff offer more options for health, happiness and hope to pet owners for the enjoyment of their companions through integrative veterinary medicine. We provide enrichment for our community through education, and develop loyal clientele who refer others and pay their bills on time. We strive to improve our practice with medical advancements and the development of an enthusiastic staff team.”

As you plan for more enjoyment of your practice, along with increased prosperity, write your own mission statement including your vision for your clients and patients, as well as for your staff. Include this information in employee manuals and at the staff entrance to your practice, so everyone in your clinic will be reminded of your joint goals. Staff will shift from merely wanting to help animals to understanding their roles as part of a larger vision. An abbreviated mission statement could be shared with the public in your client education materials, interviews, waiting room and more.

BUSINESS MODEL

The next step to solving practice headaches is to think about your practice as a business entity, with only one part being your treatment of patients. Regardless of the size of your practice, you can create a better business model simply by identifying which areas of your practice are in need of attention/modification.

Consider your practice as you would a sick patient. The first thing you need before diagnosing problems and creating a treatment plan is a clear understanding of the fundamental elements of business structure – this is the anatomy of the business.

During early years in practice, I rated my practice’s success based on the number of happy clients and patients I was seeing. This rather narrow view did not produce a healthy lifestyle, nor did it support me financially.

After two years of working seven days a week with little time off, a lack of funds for adequate staffing, and no savings, I began taking business courses. Those courses helped me shift my views about my role as a practice owner. I began recognizing that many of my business problems resulted from unidentified and unfilled positions in the company.

After I began looking at business models in successful corporations, I saw how far my practice was from being run as a real business. My solution was to copy these models and mimic organizational charts in my own office. This approach really helped me shift and expand my thinking about the clinic, the role it played in the community and how important it was for everyone to create expectations for clients and staff.

Problems decreased as we became proactive. Within a year of creating organizational changes, revenue for practice growth and additional staff became available, and I had more time for professional growth courses and for my family. My clearer vision also meant I no longer experienced guilt when clients wanted to shift their lack of compliance or their financial irresponsibility onto me and the practice.

In order to create a more holistic system of managing your practice, my suggestion is to identify and break down all jobs into separate departments, represented by pages or poster boards, vital to a well-run business. The following examples are not all-inclusive in the business area. You will also want to create a similar list of all medical and healing-related job duties.

Maro practice chart-3 Maro practice chart-2 Maro practice chart-1

  1. Human resources and internal communications
    a) Hiring, recruiting, staff training, reviews
    b) IT, communications and all communications equipment
    c) IT consultants
    d) Scheduling staff
    e) Scheduling clients
  2. Marketing
    a) Internal marketing programs
    b) External marketing
    c) Social media integration
    d) Website development and maintenance
  3. Finance department
    a) Accounts payable
    b) Accounts receivable
    c) Payroll
    d) Accounting
    e) Budget creation
    f) Tax filing
    g) Bookkeeping
  4. Veterinary medicine: service delivery/pharmacy and product sales
    a) DVMs and their duties
    b) Technicians, assistants, kennel staff and their duties
    c) Energy workers and subcontractors who work within your clinic
    d) Consultants (veterinary, such as traveling radiologists and off-site consultants)
    e) Equipment and building maintenance
    f) Inventory control, ordering
    g) Controlled substances control and record keeping
    h) Safety and OSHA
  5. Public Relations/community work (these efforts raise awareness of your presence and are not designed to produce a high financial return on investment)
    a) Adult community civic presentations
    b) Schools
    c) Shelter support
  6. Patient retention and follow-up (quality control)
    a) Check out questions at the desk
    b) Follow-up calls and surveys
  7. Planning and executive board (creation of short term and long term business goals, budgets, policies and procedures)
    a) Ownership and executive board (if you are a sole owner, this is you)
    b) Consultants
    c) Attorneys
    d) Accountants
    e) Banking/bankers

Take time to list each job; this is needed to create a fully-functioning department. In small practices with five or fewer employees, you may have as many as 40 individual jobs in each department with names repeated many times. I suggest creating an electronic file, so you can keep modifying as your business grows and adds staff. Ask your practice manager and staff members to list every job they do.

Most practitioners who use this organizational chart will end up adding staff after they realize how many duties a few team members are being burdened with. Often, this recognition leads to fee analysis and adjustments, so the practice can budget for additional team members.

Improving organization, filling important roles and acknowledging the value of team members brings esteem to the entire practice and will aid your ability to charge competitive fees for your services. These steps will increase prosperity for your entire team.

Preventing burnout and compassion fatigue

  1. Identify what is causing feelings of stress/fatigue.
  2. Target the causes by seeking support and outside motivation.
  3. Make policy/procedural changes.
  4. Get staff on board to change situations causing energy depletion. If they won’t change, then change staff.
  5. Know you are not alone; every practitioner goes through emotional ups and downs. Use wisdom/advice from colleagues.
  6. Find ways to recharge on a daily basis: family, humor, meditation, motivational recordings. They are all around us and easily available. Build breaks into your schedule. If you’re too busy to take a break, review your fees and your timewasters.

If practice is not bringing joy to you, your clients, patients, staff and/or family, adjust the demographic you are attracting, eliminate the people who drag you down, and find time for family, travel and hobbies to bring more happiness and abundance into your life.

Dr. Cynthia Maro owns Ellwood Animal Hospital, Chippewa Animal Hospital and Cranberry Holistic Pet Care, which incorporates acupuncture, animal chiropractic, rehabilitation, myofascial and physical therapies, veterinary NAET, animal massage, herbology, homeopathy, Bach Flowers and essential oils. She graduated from Ohio State University College of Veterinary Medicine in 1987, is a member of the AVMA, AHVMA, AAVA, IVAS and AVCA, and served on the AVCA Board from 2002 through 2007. She mentors veterinary students and speaks to several colleges' integrative veterinary medicine organizations. Dr. Maro writes a bimonthly column for the Beaver County Times and Ellwood City Ledger, has been a contributing writer for several Pittsburgh publications, and has appeared on the KDKA Morning Show, WQED and WPXI (ellwoodvet@msn.com).