As for many veterinary professionals, my job as practice manager at Cleveland Heights Animal Hospital in Lakeland, Florida took a crazy turn two weeks ago when we changed our workflow completely to offer curbside service. We did this, of course, in an effort to increase social distancing as a way to mitigate the spread of COVID-19.

Like every other veterinary practice, we to want keep our team safe while continuing to serve our community. In case it helps other practices iron out new protocols, here is a rundown of how we’ve implemented curbside service.

We made the decision early on to stop elective procedures and ancillary services (e.g. grooming, boarding) and currently are providing only outpatient services and emergency surgeries. With the exception of euthanasia appointments, no clients are permitted in the building.

We also split our team in half to better isolate ourselves from each other. Our practice is open Monday through Saturday from 7 a.m. to 7 p.m. Now, team 1 works Monday through Wednesday and team 2 works 12-hour shifts Thursday through Sunday; the next week the teams alternate workdays.

Here are some other things to consider putting into place before radically changing the way you offer service:

Coordinate with your merchant service provider to offer alternate forms of payment. We are now emailing invoices to clients and taking payments via phone.

) to free up phone lines and keep clients out of the hospital.

Post signs in each space in your parking lot that indicate the parking spot number and a phone number for clients to call or text when they arrive.

Designate one or two “runners” who will go out to clients’ cars to retrieve patients and distribute prescribed medications or purchased supplies. These people should be outfitted with personal protective equipment (i.e. cloth surgical gown, gloves, mask with face shield [dental masks]).

Assign the rest of the team specific duties, such as room technician, discharge technician, client service representative, etc.

Today, all client communication—from estimates to diagnostic results to treatment plans—is done via text, phone or video chat. If time allows, we call the client before the appointment to obtain as much history as possible. This saves time for the practice and the client. Here’s how we are handling appointments:

The client calls or texts upon arrival and identifies what parking spot they are in.

A runner goes to the vehicle to get the pet, leaving the leash, collar and harness behind. If the pet is in a carrier of any sort, the carrier is wiped down with an approved disinfectant before it is brought inside.

The pet is taken directly to an exam room where a technician and doctor are waiting.

Payment is secured via an emailed invoice.

The pet is brought back to the vehicle by the runner when the appointment is complete.

Don’t forget to take care of your team!

Create stability in your practice’s new normal.

Implement daily meditation or yoga at your practice.

Praise your team during this very stressful emotionally, mentally and physically taxing time.

Send a runner to bring the prepurchased item to the owner’s vehicle. If your practice doesn’t have an online pharmacy, offer to ship prescriptions to clients who call for refills.

Just as we saw with toilet paper, clients immediately started trying to stockpile their pet’s prescriptions and food. We didn’t even think twice about limiting prescription refills to a 30-day supply. Clients were trying to buy four to five bags of food at a time. Letting clients know that they cannot return products due to bulk buying has cut back tremendously on overbuying.

We have the capability to switch to telemedicine but have chosen to fine tune our new workflow instead of adding an additional complexity at this time. We consider telemedicine as an ace up our sleeve. As of today, clients are still comfortable visiting our practice.

Don’t expect everyone on your team to embrace the swift changes that we are having to navigate. Have some grace and make the team part of the solution.

Coach your team on how to deal with clients who are understandably stressed and also don’t like change. We should all have a plan in place for dealing with 

During these uncertain times, most practices can’t afford to turn clients away. I have pulled my lodging and grooming team to help my outpatient team—more hands on deck means we can see more patients.

Everyone scheduling appointments and receiving phone calls should make sure to explain the new process with clients so they are not surprised when they arrive to an entire new experience.

We will get through this difficult time and will have learned new and innovative ways to take care of our clients and staff.

Articles

This is uncharted territory for all of us. Here’s how one practice manager has changed her hospital’s protocols to continue providing excellent service while keeping people as safe as possible.

Coping with COVID-19: notes from a veterinary practice manager

The past few weeks have presented new challenges to veterinary practices all over the world. Many have switched over to curbside care, others are using telemedicine and limiting wellness visits. To help you adjust to these trying times, we will continue to keep you informed as best we can. Here's the latest on the novel coronavirus and other veterinary news.

Veterinary accounting consultant Dr. Marsha L. Heinke provides guidance on money management, employee communication and 

updated laws to help you navigate the COVID-19 crisis

A symptomatic cat in Belgium tests positive for the novel coronavirus, but experts reiterate that there is 

no proof that animals can transmit the disease

Dr. Aaron Smiley, chief of staff at two Indiana veterinary hospitals, shares some advice on 

Kristina Guldbrand offers some tips to help you keep your veterinary team connected

Danny Sack, a DVM candidate at Cornell University College of Veterinary Medicine, 

shares how he feels about his interrupted graduation plans

California house-call veterinarian Dr. Patrick Mahaney 

discusses some of the changes he’s implemented during the COVID-19 pandemic.

A new study reveals that small businesses that allow clients to pay for services using a variety of methods earn 

29% more revenue than those that offer fewer payment options.

The U.S. Food and Drug Administration (FDA) is 

temporarily easing telemedicine requirements for veterinarians.


Want to be in the know? Check out the veterinary news highlights from this week.


Weekly news wrap-up: More COVID-19 news, plus why you should consider mobile payment options

The nuts and bolts of pet health insurance

Pet health insurance benefits for pets and owners

Pet health insurance: Talking with veterinary clients

Pet health insurance and veterinary team mental health

Why get pet health insurance? A pet owner’s story

How to recommend pet health insurance to your clients

Videos

An overview of pet health insurance, including its history, market value, types of insurance, average premiums and deductibles, as well as the most common conditions for pet insurance claims.

Harnessing the Power of Pet Health Insurance

"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.

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!”

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.
