Veterinary medicine is becoming a competitive sport. Too many veterinarians are graduating. Pressure from online retail sales and low-cost spay/neuter and vaccine clinics are driving veterinary practitioners to seek new business model options, but these new models are generally not in the best interests of overall patient health and wellness. More pet owners are only seeking acute or emergency care from veterinary clinics, and not just because of financial constraints. They have not been educated about the importance of a veterinary/ client/patient relationship, and about mitigating problems before they start through professional care.
Recently, I made the jump from lowly associate to practice owner. I left an affluent conventional small animal practice before it was sold to a major corporation. I decided it was time to develop a practice of my own, where I was free to practice the type of medicine that actually put my patients’ needs first. My main goal was to introduce a focus on health and preventive care into my community, while balancing patients with nutritional approaches and strengthening the human/animal bond between owners and their pets. It has been a challenging transition, but now I feel able to practice honest medicine. I can also support my newly-added associate in her efforts to practice medicine the way she sees fi t for each client and patient.
Starting a fully integrative veterinary hospital was no small endeavor. It was a giant leap of faith. Faith that I could get a loan to start a business (while being a few hundred thousand dollars in debt from veterinary school alone); faith that I was tough enough to endure the bombardment of decisions I must sort through to make the basics of a veterinary practice happen; faith that I was doing the right thing; faith that my family would support me and that as a soon-to-be-first-time mother I would have the time and energy to get things up and running; and, of course, faith that the community would support our novel practice concept.
Originally, I started writing this article with the intent to educate readers on the process of opening an integrative clinic; however, anyone with enough ambition can open a clinic. Location, design, finances, staffing, and inventory are all key factors you must take into consideration when opening a business anywhere. There are many types of practice model to consider: house call, clinic setting, barn setting, limited-service hospital, full-service hospital, or a larger referral service hospital. A practice owner must have a good sense of their overall practice goals before embarking on this journey, and a good idea of where they see the practice growing and expanding into the future.
My choice was to be a full-service veterinary clinic, not just an alternative practice. We slowly purchased the best equipment on the market. From x-ray to surgery to kennel space, there is a lot of equipment needed, at a high cost. By starting off with the basics of what we thought we would need for day-to-day diagnostics, and staying well within our budget, we slowly grew and added equipment as we became busier. Adding in-house laboratory equipment allowed us to see urgent care and emergency cases and initiate treatment more efficiently and quickly.
As an integrative practice, we use five different pharmacies:
- General conventional medications
- Prescription diets
Juggling a broad inventory is risky – the more that sits on the shelf, the more dollars are wasting away. It is really frustrating when products expire before they sell. Keeping a minimum stock of products is important since each distributor has minimum orders for which shipping rates vary greatly. We can also special order and often dropship herbals and supplements.
This decreases inventory and allows us to supply clients who travel great distances and may not have full access from their local clinics to some of the products we prescribe. We have trained our clients to give us advance notice of refill needs in the event products need to be special ordered.
It’s very difficult to be prepared for everything that walks through the door and I have been known to call other local clinics and emergency facilities to obtain medications we didn’t start out with (for example, the first week we opened we had a rodenticide toxicity and I had neither vitamin K nor Yunnan Bai Yao on hand).
We keep prescription diets to a minimum, but still stock them as they may need to be utilized when clients refuse other treatment options. One problem with all five pharmacies is that some clients seek lower-priced but often lower-quality products on the internet or elsewhere. This can lead to treatment failures and poor clinical outcomes.
Our schedule varies and currently alternates through the week. To be a full-service hospital, you must be open full-time. We do surgery two mornings a week on the days we are open later in the evening, to accommodate later discharge times. We try to limit our new acupuncture consultations to two or three a week, and schedule acupuncture consults and re-check appointments at about 40 to 60 minutes. We do try to receive records prior to visits in order to get better case histories for patients.
Because new client alternative medical consults and rehabilitation consults take up so much time, we give clients a “one strike” notice – if they no-show-no-call for their appointment, they must pre-pay for the next scheduled appointment. Most clients understand they are paying for our time and consultation (usually second or third opinions on cases) and are willing to do so.
Embrace change. I originally built out a 3,500 square foot lease-hold clinic with four exam rooms, a private surgery suite, dental area, separate day-kennel spaces for dogs and cats, and a low-stress private recovery/ICU area for intensive care, post-surgical and hospitalized cases. We do no boarding. In just over a year-and-a-half, I feel we have outgrown our “little” space and our plans are to expand into an additional 1,500 square foot space within the next year, and utilize more room for rehabilitation, water therapy, exercise classes, lecture and meeting space, and more.
We offer discount packages for cases that are going to be repeat clients for laser, acupuncture, spinal manipulation and rehabilitation. We try to fit in general wellness and regular sick appointments where we can. We stagger the schedule slightly so there is some time for emergencies and lunch. On a general day, we stay fairly busy. I expect my clients to trust me and follow my directions if I ask them go directly to the local emergency facility if I am not able to handle a case or fit them in promptly.
I owe our success to the community that has so openly welcomed our practice model. While we have not “miraculously saved” every patient that has walked through our doors, we have educated many clients on the ability to take better care of their pets through diet, nutrition, and use of vaccine titers or very customized schedules. We individualize medicine and don’t require everything of every pet that walks through our doors. We have helped pets by looking deeper into their pathology before merely treating symptoms with drugs and surgery. We reduce drug therapy by using the vast array of modern diagnostics and alternative medical approaches that fit each case.
Clients have realized that medicine shouldn’t be just an in-and-out-the-door process and that their pets are thriving because they have a deeper understanding of what it takes to keep their animals healthy. We often get to the root of the disease process and interrupt the disease pathway before it develops into something more severe. In this way, we are truly practicing more preventive medicine and improving clinical outcomes.
Integrative practice isn’t easy, and it takes quite a bit more effort than I ever remember putting into conventional practice. I utilize more of my whole brain and not just the logical side. We strongly practice evidence-based medicine but stay open to treating cases with alternative therapy approaches. I’m still fascinated when something truly puzzling walks, crawls, or is carried through our doors. Being able to utilize energetic treatments such as acupuncture and herbals and/or watch the energetic pathways patients experience when treated with conventional medications, as well as taking a deeper, more thorough and complete history from the owners, we are often able to provide a more comprehensive diagnostic and treatment plan.
I can’t imagine practicing any other way. I do not think I will ever give up on conventional medicine, as I feel it still has its place in the world, but the more alternative techniques I encounter and learn, the less I seem to need conventional medical approaches and the healthier my animal patients become.