"Veterinary telemedicine—140 years and going strong," says Aaron Smiley, DVM, chief of staff at Devonshire Veterinary Clinic in Anderson, Indiana and Geist Station Animal Hospital in Indianapolis, Indiana. 

Veterinarians and telemedicine are a natural match, Dr. Smiley says, because we're very good at customer care. What we are not as good at, he admits, is monetizing the experience.

Dr. Smiley has been engaging in telemedicine for profit for about three years, and he reports that clients are "more than happy to pay" for the service because they understand the value of the veterinarian's expertise.

If you're wondering what you should be diagnosing, treating or monitoring using telemedicine, Dr. Smiley recommends the sister-in-law test. 

"I always tell veterinarians: You can diagnose things that you would diagnose for your sister-in-law," he says. In other words, consider what you would do for a family member via text or phone as a guide for what you would do for a client. You're not going to offer subpar care to your relatives, so use that same barometer for your clients, he adds.

In the video below, Dr. Smiley explains what makes veterinary telemedicine different from human telemedicine and how veterinarians can put it to good use in their practice right now.

Videos

The need for social distancing during the COVID-19 pandemic has created fertile ground for the use of telemedicine in providing veterinary care. Here's what you should know.

Veterinarians, telemedicine and COVID-19

As always, the facilities that earned high honors in this year’s dvm360 Hospital Design Competition boast features that improve hospital efficiency, offer an excellent patient and client experience, and are just plain gorgeous. But building or remodeling a veterinary hospital is no easy task, as these practice owners have learned. We asked the owners some of these award-winning hospitals what advice they would offer other veterinarians who are considering building or remodeling. Here’s what they had to say.

“The best piece of advice we can give is to conduct a thorough research process,” says Michael Foster, DVM, owner of merit award winner 

, in West Saint Paul, Minnesota. His team also found feedback from peers and the community during the design and construction process to be especially helpful and encourages other clinics to seek as much advice as possible.

“An effective hospital design comes from the heart, and the ability to engage with other professionals, including at the 

, gave us a chance to express our story through the design of our hospital,” he says.

“Be sure you have a robust and realistic budget that considers all categories of the project,” adds Jonathan Kaufman, DVM, owner of 

in Baltimore, Maryland, one of two runners-up in the over-8,000-square-feet category. “Rather than relying solely on the architect or bank for complete cost estimates, do your own research on potential expenses from start to finish so you’re thoroughly prepared before you present a budget to the bank.”

Determine specifically what products and equipment you want to incorporate, says Samuel J. Kopman, DVM, owner of merit award winner 

 in Vancouver, Washington. “There are a lot of decisions to make and having a good idea of what you want will make it go easier,” Dr. Kopman says. Another piece of advice: Have a good working relationship with your architect and contractor. “We had weekly meetings with our contractor during the building process,” he says.

We’ll be sharing design and build details for all of the veterinary hospitals that earned awards in the 2020 Hospital Design Competition. Look for articles in future issues of 

 magazines. For a list of all the winners, click 

Many of this year’s Hospital Design Competition winners echo the advice of father and daughter Dale S. Lonsford, DVM, and Charmel Rodick, DVM, who own merit award winner 

 in Deer Park, Texas. “We strongly advise using an architect and builder that have experience and expertise in designing and building animal housing facilities, Dr. Lonsford says. They also recommend having a solid grasp of your budget and letting the architect and the builder know you are serious about staying within it.

Keneth Skinner, DVM, co-owner of the over-8,000-square-feet award-winning 

 in Prescott, Arizona, agrees. “A professional veterinary hospital architect will guide you and keep your project going in the right direction. They know what you need, and they know about the things you did not know you needed,” he says. “They help all of your ideas make it to the blueprints and they make every step of the way a little easier. To have a project partner that understands your vision from the beginning is the only way to build.”

A veterinary-specific architect will know the most about animal-specific facilities and materials, says Steve Hotchkiss, DVM, who owns 

 in Fort Worth, Texas, the second runner-up in the over-8,000-square-feet category.” Believe [your architect’s] estimates for pricing,” he advises. “I was sad that they were right on target. I thought I could build it for less.”

Robert Mankowski, DVM, co-owner of merit award winner 

 in Mount Laurel, New Jersey, offers this excellent advice. “Communicate well with your staff regarding updates and progress, and thank them for their patience while building excitement for the new facility,” he says. “Expanding and renovating your practice is a huge adjustment,” he adds, “so expect at least a year to settle in and build protocols.”

When asked what advice she would offer to other hospitals embarking on a new build or remodel/expansion, Marion Sewell, DVM, owner of merit award winner 

 in Ruston, Louisiana, suggests looking at and visiting as many veterinary hospitals as possible, and paying close attention to materials and floorplans. But above all, she says, “Have fun!”

Articles

Words of wisdom about building or remodeling a veterinary hospital from some of the 2020 dvm360 Hospital Design Competition winners.

Winning advice for veterinary hospital design

Every veterinarian has their own origin story, whether their first word as a baby was “hyperadrenocorticism” or they made a last-minute, self-loathing decision to go through four more years of schooling following undergrad. One constant is that we are not unfamiliar with sacrifice. We chose an underpaid, underappreciated, often misunderstood, amazing, rewarding, pure profession because, above all else, we love to help those who cannot help themselves.

Instead of graduating from college and going out into the workforce to pay off our sizeable debt, we veterinary students decided it’s best to double down and let that mound grow into the Mount Everest of debt because “hey, we’re doing what we love.” Those years in undergrad were no cake walk either; you took the hardest science classes available because veterinary schools required it to even apply, let alone to get in. To do that you needed more than just a stellar GPA; you did externships, research, volunteer work, extracurriculars … anything to make your application stand out. You did it and made all the hard work worth it, because you, my overachieving friend, got into veterinary school.

The next four years simultaneously felt like a lifetime and flew by in the blink of an eye. You learned to cram more information into your brain than you thought possible. You singlehandedly funded your local Dunkin Donuts (because Starbucks is way too expensive for your $0 annual salary) so you could stay up late and learn a few more facts for the exam that was going to kick your ass anyway.

You did this for three years, each year flying by faster than the last, until you finally got to clinics. You were given your white coat, thereby inducting you into the profession to which you have dedicated your life. Your journey finally is starting to make sense. Just one more obstacle to overcome: the dreaded North American Veterinary Licensing Exam—six hours of mind-numbing questions you swear you’ll never have to answer again in your life. No one leaves that test feeling like they’ve passed. The months go by and you finally get your email: 

! Nothing can stop you now! No more tests, no more stress. Your clinical rotation has been going smoothly and you’re enjoying your first taste of what you’ve been working toward for the past eight years.

You hear murmurs of a terrible virus outbreak overseas, but you don’t have time for distractions … until it is no longer just a distraction. You hear about the first U.S. case, then the first outbreak. At this point, foresight tells you that the last few months of your final year will be affected (clearly foresight was being modest). Over the next few days the situation evolves from cancellation of international externships or research, to transition to online classes for underclassmen, to outright cancellation of clinical rotations “until further notice.” 

The hardest four years of your life are … over? Other than a few online classes, vet school has effectively come to an end. In-hospital labs and advanced clinical rotations are canceled, any shred of hands-on learning is done and any semblance of a graduation or hooding ceremony will be drastically different than you pictured, if it happens at all. A smart cookie you are indeed, because a week later you are notified that graduation is officially canceled! An anticlimactic, disappointing, frustrating ending to an educational marathon that you wouldn’t trade for the world.

I remember what it felt like coming back to school to clean out my locker. It had only been a few days since rotations had been canceled, but I felt immediately like I didn’t belong. The warm smiles that usually greeted me were no longer there, the busy halls typically filled with clinicians and technicians rushing to see patients or go to their next procedure were empty, and the faint smell of urine … well that was still there—finally something that hadn’t changed.

There were so many people I wanted to thank for molding me into the doctor I would become, to show my appreciation for the extra mile they went on a daily basis to help me, but I couldn’t. There would be no “Class of 2020” banner hung across the hall, no celebratory fourth-year breakfast, no idealized pep talks to the third years reflecting my new-found pearls of wisdom obtained from a whole one year of clinics, and no hooding ceremony where my closest friends and family could celebrate me achieving my lifelong dream.

Why did this have to be the year that everything got screwed up? Any of the other 20 years of school would’ve sufficed. It’s easy for us to feel sorry for ourselves. But if we wanted easy, we wouldn’t have chosen this field. If we wanted easy, we wouldn’t have decided to treat patients that can’t talk to us. If we wanted easy, we wouldn’t have joined a profession that pays its doctors a fraction of what MDs make, despite the same amount of schooling and student debt. Isn’t this just par for the 20-years-in-school course?

We got into this profession to help. In fact, we took an oath to do just that: “I solemnly swear to use my scientific knowledge and skills for the benefit of society … the promotion of public health and the advancement of medical knowledge.” These are not just words we recite during our graduation ceremony and then promptly forget. Rather, they are what defines our calling to this profession. Four years of schooling have given us the knowledge to educate our friends and family about the importance of quarantine and isolation, to disseminate accurate information to the public about the risk to their pets and to debunk myths and promote healthy behavior in people.

A ceremony doesn’t authenticate our education, it doesn’t give merit to our words and it certainly does not validate our journey or experiences. We will beat this pandemic, and hopefully the world will learn a few lessons along the way: that we should stay home if we’re sick and feel accountable for the health of others, that global problems require global solutions (*cough* global warming, world hunger *cough*) and that it’s important to wash our hands! So, let’s do our part to make this world a better place

 We are doctors after all, and our work’s just begun.

Danny Sack is a DVM candidate at Cornell University College of Veterinary Medicine with a special interest in surgery and rehabilitation. He is set to graduate in 2020. Upon graduation he will begin a small animal rotating internship at the Animal Medical Center in New York City.


In case you were wondering what it’s like being a veterinary student on the brink of graduation during the COVID-19 outbreak, I can tell you this: It sucks.


When a virus pulls the rug out from under graduation

The Hospital Design Competition judges praised Tustin Legacy Animal Hospital in Tustin, California, for a nicely detailed interior, great finishes, and a solid, efficient plan. Owners Drs. Celine Hayek and Kristin Negvesky noted that they had “complementary styles and ways of thinking about things,” which combined to create a winning formula for this startup hospital.

Drs. Negvesky and Hayek first found a realtor to help them choose a site. Never having owned a business before, the two say they had a steep learning curve. Thankfully, their real estate agent “had a lot of experience with veterinary hospitals and was a huge help.”

Securing loans and handling financing proved challenging for these newbies, but they say Bank of America was a big help.

“Our main goal was to design a place that gave people a really good vibe when they walked in the door,” says Dr. Negvesky. For them, “client service is No. 1, and we wanted our hospital to feel approachable, with a clean, fresh style.” The pair wanted an easy-flowing plan, with plenty of sunlight, where they were “able to see the back of the hospital from the front.”

There was also one more must-have: “A chandelier, a big one!” says Dr. Negvesky. The doctors got their chandelier and the fresh, clean vibe they wanted throughout their 2,685-square-foot practice, which houses four exam rooms and separate dog and cat waiting areas.

The doctors did want two-door exam rooms, but they had to scrap that idea because it took too much space away from their tight floor plan. Another strategic choice: To focus on practicing medicine, the pair decided not to offer boarding and grooming services as they had originally planned. “We had heard a lot of stories of things not going well for others, and it seems that a lot of negative reviews online stem from boarding and grooming, which should not be a reflection of your medicine,” says Dr. Negvesky.

For help with getting the right vibe for the practice, Drs. Hayek and Negvesky hired an interior designer. They outlined the colors they wanted (blues and greens), the style they were looking for (upscale yet inviting), and the requirement of a chandelier in the reception area, and the designer ran with it.

A week before the practice officially opened, the doctors held a grand opening event to introduce themselves and get to know the community they would be serving. Food trucks, activities, raffles and hospital tours brought in about 100 people, who toured the practice and got to know the owners.

To help start off the first day of business in their new space, they scheduled an 8:30 a.m. appointment with someone whose pet they knew. “We were super surprised, though, when someone we didn’t know walked in at 8 a.m.,” says Dr. Negvesky.

Tustin Legacy Animal Hospital has grown steadily since that first unexpected appointment, no doubt because the two young practice owners started off right and have adjusted course as needed along the way.

For more details about the design of this hospital—and lots of photos—click 


If you’ve got big dreams of building a practice of your own from the ground up, take it from the winner of the dvm360 Hospital Design Competition in the “less than 8,000 square feet” category: It can happen for you.


Six steps to success in building a new veterinary hospital

Every veterinary team member is feeling the impact of COVID-19 differently, which is why flexibility among practice leaders is so important right now. Coming together during a crisis is what helps us get through it, says Kristina Guldbrand, CVT, BS, CSP.

“Community is the most important resource we have when dark times hit," she says. “It connects us, it makes us feel like we’re not in this alone." The keys for leaders, Guldbrand says, are to promote positivity and recognize that "everyone is doing the best they can right now."

Guldbrand offers three tips for veterinary leaders in the face of the pandemic:

Involve the entire team in devising solutions for modifying practice protocols.

In this video, Guldbrand explains how to put her tips into action.

Certified leadership and wellness coach Kristina Guldbrand shares some tips to help you keep your veterinary team connected during these challenging times.

How to lead your veterinary team during COVID-19 

” in the February 2020 issue of dvm360, I would—and do—operate differently from Dr. Stone. I am a practice owner in upstate New York and I have worked for owners like Dr. Stone. These owners want their technical staff and associate veterinarians to tolerate bad behavior from clients until the client is irate and belligerent. In my opinion, that is waiting way too long before protecting your staff.

I agree with Dr. Stone’s associate: It is not too much to ask to be treated with respect. At my hospital, if a client shows disrespect, gives attitude, is impolite or challenges my or my staff’s competence in a rude way, I fire the client with a polite, professionally worded letter informing them of the termination of service. The mental health of my staff and me outweighs the costs of letting clients go from the practice. In my area there is an abundance of pets and clients. As veterinary professionals, we are providing help and care. There is no reason to have to deal with unpleasant, mean-spirited people who return our kindness with a miserable attitude and ingratitude. If more veterinary professionals protected their staff more aggressively, respect for the veterinary profession would only increase.

I agree with Dr. Rosenberg. We are professionals when we step into the exam room and we need to be professional to convey our message to the client so that the necessary patient care is implemented. I also agree that there is no reason to escalate a confrontation with a client as this will not help with patient care.

But I agree and disagree with Dr. Rosenberg’s statement that “the key to successfully helping our pet patients depends on our successful interactions with their owners.” I have interacted with clients for 15+ years as a professional doing exactly as Dr. Stone and Dr. Rosenberg would have it. It does not make clients nicer or cause them to respect me or my staff. It just sends a clear message that bad behavior will be tolerated and they have the green light to behave poorly any time they feel like it.

I am all for professional behavior, but once a client shows that they are going to be rude, nasty, disrespectful and impolite on a consistent basis it is time to let the client go.

—Dr. James David Nickel, Whitesboro, NY


The title of this article really caught my attention. I have been the practice manager of a five-doctor practice for 37 years and we face this challenge every day.

We are in an affluent area just west of Boston, and the clients we serve have very high expectations of us and our hospital. We know that, and we try every day to meet these expectations. For a practice to be successful, we need to win over our difficult clients. We do try to kill them with kindness. If someone is unhappy, we try to find out why and let them know that we understand. It is a first reaction to lash out at bad behavior, but you should never stoop to their level. Remaining calm and cool in these situations is the answer.

That said, I do think there is something very important missing from this answer by Dr. Stone: We only occasionally have clients angry or lashing out at the doctors or technicians. I know from much experience that it’s the front desk staff that is hit the hardest in this area. The doctors do not understand how the front desk team members are treated. I find it very easy for a doctor to say “develop a thicker skin” when they rarely are the ones subjected to this behavior.

Difficult clients are an everyday occurrence at our practice, and I do try to have a manager or supervisor take over if a team member is being verbally abused. We practice tolerance and respect, but I truly believe sometimes the doctors have unreal expectations of how much abuse should be tolerated.

Moira A. Guigno, practice manager, Wellesley-Natick Veterinary Hospital, Natick, MA

I would like to offer a comment about a recent letter in dvm360 (‘

Whitest profession in America’ inappropriate

’). The facts are relatively straightforward: Over 90% of veterinarians are white in a country where about 81% of the workforce is white. Imagining this is an accident rather than the result of systemic racism is naive or disingenuous. Acknowledging an injustice is critical to rectifying it, and we cannot shy away from clearly and directly describing an unjust reality if we seriously hope to change it.

It is not unusual for white people to feel personally attacked or accused of racism when white privilege and discrimination against people of color are discussed, but it is an unfortunate and unnecessary reaction. I have been lucky in having friends patient enough to explain the difference between acknowledging the systemic factors that favor white people in American society and accusing individual white people of being undeserving or racist. White privilege doesn’t mean white people have not had to struggle or face adversity as individuals. It simply means that our skin color has been an advantage rather than an added obstacle in our life’s journey.

As a relatively old, white, male veterinarian, I can acknowledge the injustice that has favored those like me without feeling that the effort and struggles I endured to get where I am are being invalidated. I may be good at my job and even deserving of it as an individual, but so are many who have not had the same opportunities I’ve had. It does not diminish me to acknowledge this, but it does engender a responsibility to contribute to a more just future.

Rather than getting upset about the word “white” or open discussion of white privilege, I think it more useful to try and be part of the solution. The article Dr. Clemente responded to (‘

Institutional change in the whitest profession in America: Veterinary medicine

’) offers specific, appropriate steps to improving diversity and inclusion in veterinary medicine, including “leveraging power and privilege to advocate on behalf of others.” I find nothing at all objectionable in that.

—Brennen McKenzie, MA, MSc, VMD, Los Altos, CA, skeptvet.com


Several readers wrote to share their opinions about recent articles in dvm360. Here are three of them.
