the practice

Managing an Integrative Veterinary Practice

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The veterinary profession has grown by leaps and bounds over the decades, and I have personally seen many exciting changes over that time. We’ve gone from traditional stark white veterinary hospitals in the 1970s, to state-of-the-art facilities in the 1990s, to new and colorful integrative practices that are increasing in number all over the country in the 21st century.

In order to be successful and prosperous, you must have a well-educated staff and clientele, and a management style that keeps everyone happy and healthy. Having enjoyed a very successful integrative veterinary practice for over 20 years, I can tell you that maximizing the use of your technicians is one of the keys to a thriving practice.

EDUCATION

In my opinion, education is of the utmost importance. Education for the doctors on staff as well as all employees in the practice is the only way you can stand apart from other practices in your surrounding area. And because clients are truly the key to our success in keeping their animals healthy (and our practices successful), they must be educated in the different modalities you offer so they can make the best informed decisions for their beloved pets. Remember, people bring to us their cherished and loved animals for our expertise and opinion. We owe it to them to give the best care we can.

The doctor(s) at your practice decide which modalities they would like to use, so it is up to the entire staff to become educated on the “who, what, where, when and how” of newly added treatments. The number one way to get staff to understand what you are offering in the practice is to have their own pets experience it. Allow the staff to be part of the process and they can then answer almost any question clients may have, with certainty and authority.

The front office staff are the “gatekeepers” and “orchestrators” of the practice’s flow on a day-to-day basis. An educated and confident front office staff member is invaluable to a practice. They are answering the phone and listening to the concerns of clients, so if they are well-educated on each modality as you introduce it in the clinic, they will suggest options to your clients. Many clients hear about treatments from friends or the internet, and call to request that treatment even if it is not necessarily the most beneficial for their pet. The well-educated receptionist can gently guide these clients, rather than merely scheduling an appointment. Clients appreciate this interest in their individual needs, and the subsequent bond of trust and caring will ensure success for the lifetime of the relationship.

Having periodic educational staff meetings can ensure that every member on the team understands what is being offered and why. This should also be a safe place for the team (staff and doctors alike) to ask questions without judgment. It is during these meetings that every person can become clear on what his or her role will be in utilizing each modality of integrative medicine offered at the clinic.

Educational opportunities (conferences, CE, courses) for staff to further their training and knowledge can also be discussed. Many companies will be happy to have “lunch and learn” meetings at your facility to help make sure all members of your practice fully understand what you are offering. Instructors of every modality will often hold training sessions at your clinic, in your town or by Skype.

UNIQUENESS OF AN INTEGRATIVE PRACTICE

I have been blessed to work in a variety of veterinary facilities and have experienced many styles of practice.  An integrative medicine practice does have some very unique, positive and negative management issues that must be considered.  Receptionists and technicians have key roles in managing these issues.

Gone are 15-minute appointment times. Holistic medicine takes time and many questions need to be asked and answered in order for the doctor to decide what modality they would like to use. Time is also needed to review all medical records, perform additional diagnostics if needed, formulate a treatment protocol, start the treatment, and eventually prescribe at-home care. This is why time management is so important. The initial phone call to book the appointment, the time in the exam room, the discussion of findings and explanations before the client leaves, payment of the bill and making the follow-up appointment all need to be flawless.

  1. Initial appointment booking

Several key areas include services to be scheduled, length of the appointment, and bill estimates. New client calls can be especially challenging, so having well-educated front desk staff is critical. You may even want one or two people whose main task is scheduling appointments.

Services: New clients may have an idea of what services they would like – for example, they would like a massage appointment. In listening to the history being given by the client, the receptionist realizes the animal may need radiographs and has not had a complete physical exam in two years. They would then suggest a full veterinary exam before the massage is given. So front office staff members need to know hospital policies, such as which services will only be done if there has been an exam within the last year. If a new client has been merely using conventional services (with your hospital or another) and is calling with a medical issue, the receptionist would be able to suggest the holistic approaches now available, and of course allow the client to schedule for whatever they wish. The doctor may be able to encourage holistic approaches more easily because this was already introduced to the client. Returning clients will need less coaching, but the receptionist may still suggest one of the newer services – for example, “Did you know we now offer ozone treatments that may help heal Fido’s ear problems?”

Timing: Integrative medicine practice appointments run anywhere from 30 minutes to an hour in duration. This should give the client all the time they need from the initial assessment to diagnostics and treatment. A suggestion I give for all first time appointments is that any records and diagnostics be sent in ahead of the scheduled appointment so the doctor and technician have ample time to review them, at their convenience, and try to formulate a treatment strategy. This has greatly helped my practice keep appointment times on schedule, which keeps the flow of the practice smooth and waiting times in reception to a minimum.

Cost estimate: The front office staff should be able to give a rough estimate of costs over the phone, so when the client leaves they are prepared for the bill. I would suggest always “over-estimating” costs, since the front desk team are not doctors and do not know definitively what is going to be done. I always instruct my staff to state something to this effect: “I am aware that your regular doctor has done blood work, but if our doctor needs current lab work the charge would then be….”

In the 23 years I have had our practice open, we have had no receivables. We have never had anyone unable to pay for services rendered because we gave them thorough estimates over the phone ahead of time, and there were no surprises for the client. This is very important for the health of a practice. In order to keep the facility open and employ educated staff there must be more profit than loss.

  1. Exam room and treatments

The better trained a technician is in each holistic modality (just as they need to be trained in passing a catheter), the more successful your practice and the happier the RVT as they assume more responsibility. If they are attuned to Reiki, the client and animal will be more receptive to the treatments offered. If they know to offer calming essential oils, flower essences or Tellington TTouch, the happier the animal will be. While taking the initial TPR, techs can be introducing clients to new ways of thinking about holistic approaches, or increasing the knowledge of those more experienced in thinking holistically. Listening to the client’s successes and failures with prior treatments may help technicians make useful suggestions to the doctor.

After the doctor is finished, technicians can spend a lot of time making sure the client understands the selected modality, answering any questions, and underlining what the doctor says about possible healing reactions. Technicians also need time for the critically important task of training clients for home care: doing acupressure, administering homeopathic medicines, massaging carefully, etc.

Follow-up appointments: Technicians can make sure the client realizes how important follow-up appointments are when using holistic approaches, since the goal is deep healing, not merely symptom relief. They can actually walk them out to the front desk and make sure an appointment is made. If no appointment is made, the tech can let the doctor know so follow-up phone calls can be scheduled. Statistics show that if a client makes a follow-up appointment at the end of the initial visit, they will be more apt to call and reschedule if they cannot keep it.

CLIENT EDUCATION

With an educated clientele, your practice will continue to grow at a pace everyone can enjoy. There are many ways to educate our clients. We have already mentioned that the initial phone call is number one. The role of the receptionist is not merely to schedule an appointment. By suggesting possible treatment options, the receptionist may prompt clients to do some research before the appointment. Compliance improves when a client is directly involved in choosing approaches to care. The technician will continue that education. This is where it is imperative for your staff to have had direct involvement with the modalities offered at the practice, so they can help guide and make suggestions to the client based on personal experience.

Client education evenings are another way to educate your clients, staff and anyone from the community. We have been having client education evenings for years. We pick a topic and invite our clients and their friends and family for an evening of learning. We charge a nominal fee and supply coffee, tea and pastry. We have hands-on lab, if appropriate, supply our guests with a written handouts, and leave a large portion of time for questions and answers. This is a good way to have your trained staff involved, and give them the opportunity to head up an education talk with something they are trained in and feel passionate about.

Dog clubs, cat clubs, horse shows, newspapers and social media are all further ways to educate the public. Many clubs have a budget for education so you can charge a nominal fee and potentially gain new clients. My thought is, the more educated our clients are, the better our team approach for bettering patient care, which is why we are doing what we do!

In conclusion, integrative medicine has kept my passion for my career alive. Working in a practice that offers such exciting modalities is beyond a dream come true. Being able to combine treatments and modalities has allowed us to be successful and get results we did not see when we only had conventional treatments. Many cases deemed untreatable are made comfortable with all the choices we now have at our fingertips.

A healthy practice makes for a healthy staff – and most importantly, our patients are also kept as healthy as possible.


References

Marchall Liger LVT, CVPM. “How Integrative Medicine can Change your Veterinary Practice”. Veterinary Practice News, 2015.

LA Times. “Why Vets are Adopting Non-traditional Approaches to Healing your Pet”. California Life and Style, 2015.

Allen M. Schoen MS, DVM. “Clinical Applications of Holistic Medicine for Veterinary Technicians” (proceedings), DVM360, 2009.

“Working in Alternative Veterinary Medicine”, veterinarytechnician.com.

“Scope of Practice: Complementary and Alternative Veterinary Medicine (CAVM) and other practice act exemptions”. AVMA.org, 2016.

Vet Tech Career Guide; The Truth about Vet Tech Burn Out. Indeed.com, 2013.

Let’s Talk Veterinary Technology, Veterinary Technicians; Don’t Let Burn Out Bring you Down, 2013.

Amanda L. Donnelly, DVM, MBA; AAHA. 101 Veterinary Practice Management Questions Answered.

7 Essentials for a Happy and Fulfilling Career, Forbes.com, 2013.

Catherine Jessen. The Muse; 37 Ways to be Happier at Work