A culture of no: When regimented rules stunt practice growth

Sure, it's hard to say yes all the time, but some experts say it's the key to practice growth.

Dr. Smith owned a practice in an affluent East Coast suburb. His clientele were well-informed and able to provide cutting-edge solutions for their pets. Before becoming a veterinarian, Dr. Smith was in the military for eight years. He believed that the regimentation he learned in the Army helped him run his veterinary clinic effectively.

There were three veterinarians, eight technicians and four receptionists in Dr. Smith's practice. He was proud of how efficiently they worked together as a group. As is often the case in upscale suburban areas, there was a good deal of competition from other veterinary hospitals in the community. Eventually Dr. Smith noticed that his income and practice growth were stagnating. His practice offered excellent veterinary care, competitive fees and efficient customer service-why were the neighboring practices beating him?

Dr. Smith decided to retain a veterinary consultant to assist him in making changes that would increase practice growth. He was skeptical of the value of a consultant because he believed that no one knew his practice better than he did, but Dr. Smith was at his wits' end.

The consultant spent two weeks at the practice and then scheduled a meeting with Dr. Smith to discuss his findings and recommendations. At the meeting, the consultant confirmed what Dr. Smith already knew. The medical care was excellent, the fees competitive and the staff delightful.

However, the consultant also stated that team members were too comfortable saying no to pet owners. For example, when clients asked for a single heart worm preventive pill, they were told the product could only be purchased in packages of six. When a client called late in the day wanting to be seen right away-anxious about her dog's non-emergency issues-the staff said the dog could only be seen the next day at the first available opening. When a client called and asked that Dr. Smith return his call, the staff responded that Dr. Smith would not be in for two days but that another doctor would be glad to speak with him.

Dr. Smith pushed back a bit. All of the responses his team had given were appropriate and necessary for fairness among clients and staff alike.

The consultant defended his critiques, stating that a private veterinary practice succeeds only when excellent medicine is combined with excellent customer service. He recommended that the practice's “culture of no” be changed.

It was true, the consultant allowed, that this would require some inconvenience to the team and unorthodox exceptions to the rules. But, he continued, it was the little things that would make the difference between a practice fighting to maintain the status quo and one that continued to grow.

Dr. Smith listened but disagreed. He believed his clinic must have equitable rules or things would become chaotic. He thanked the consultant for all of his hard work, thinking to himself that consultants were overrated. How could a consultant know his practice better than he did? Adjusting his fees and working harder were the solutions he chose to implement.

Do you agree with Dr. Smith or did the consultant find his practice's Achilles' heel? Let us know at dvmnews@ubm.com.

Dr. Rosenberg's response

As I have said many times, veterinary practice is a true hybrid between the practice of compassionate medicine and the running of a competitive small business. When a human hospital is the only option within 25 miles and must abide by third-party insurance dictates, rules are set in stone. In veterinary practices where clients have many options, flexible rules and excellent customer service are invaluable tools.

When you say no to a client with a reasonable explanation, they still hear the word “no.” The examples pointed out to Dr. Smith by the consultant all could have had “yes” responses. Sure, they would have been inconvenient and a small burden to Dr. Smith and his staff, but those positive answers would have ultimately resulted in satisfied clients. I would go so far as to prohibit clinic staff members from saying no to clients. If the occasion arises when “no” must be the response, consultation with a supervisor should be required to resolve the situation.

It is truly the little things that shape the affection and allegiance of veterinary clientele. If a veterinarian is unhappy with practice traffic and growth, he or she should look at the little things. Remember, we are not doing pet owners a favor when they call for an appointment and are told that we can “fit them in at 3:30.” I think that until Dr. Smith understands this, he will continue to be frustrated by his practice's growth.

Marc Rosenberg, VMD, is director of the Voorhees Veterinary Center in Voorhees, New Jersey. In his private time, he enjoys playing basketball and swing dancing with his wife. Although many of the scenarios Dr. Rosenberg describes are based on real-life events, the veterinary practices, doctors and employees described are fictional.