Individualized care helps your veterinary practice grow


Don't squeeze everything into one visit-build a bond over time for patient care and client compliance

There is plenty of room in the veterinary service market to grow the annual services per pet (ASPP). And growth doesn't have to be built on an unwavering mandate of twice-a-year visits or a ton of different strategies to drive up average client transactions (ACT).

Yes, we know that dogs and cats age faster by our standards. But will a twice-annual complete work-up really result in better and healthier long-term care? Or will this approach be perceived by clients as an attempt to squeeze out more revenue? I've heard stories of some practitioners admonishing clients for not providing the kind of care that they believe patients should be receiving.

I think this issue becomes a question of what is appropriate for the patient based on its health, physical condition and life stage.

I find it interesting that the medical profession, as outlined recently in the Harvard Medical Newsletter, is moving in the opposite direction. In fact, they are doing fewer major work-ups and gravitating toward screening. Younger healthy men—say, those under 40—may only get an "annual" exam every 10th year. Humans probably need an aortic desiccation ultrasound every 15 years. The list seems to be endless.

And consider our profession. As our average client transactions (ACT) have risen, client visits have declined. This has been the trend in many, but not all, practices.

Are these trends inter-related and linear? Can we argue that the declining numbers of visits has been caused by rising costs associated with veterinary care?

It happens in other industries, why not ours?

If the ACT declines, will clients visit us more frequently? Data from other industries suggest it will. So, how do we grow our ASPP?

There was a time when we could change our car's oil, the air filter, the fuel filter, and the spark plugs, set the timing chain and adjust the points in the carburetor. But most of us can't do that anymore. Cars have become too complex.

So has our understanding of diseases. Consider how far dental care has come in the past few decades. We've gone from being laughed at when recommending "teeth cleaning" to a complex understanding of oral pathology—periodontics, endodontics, orthodontics and reconstructive surgery—that grows every year at events like the Veterinary Dental Forum.

When you stop to think about it, this complex trend in medicine has occurred in every body system. And it's our job to educate our clients. Why? Today's consumer is much more sophisticated than in decades past. They have greater access to information. They desire to know why. We need to start thinking about individualized care. Some clients don't need to visit us twice a year, but other clients may need to see us 10 times a year. Our recommendations should be based on a plan that is appropriate for each patient.

Steps to grow ASPP

So, how do we do it? I've outlined five steps you can take to grow your annual services for pets:

1. Consider each patient as an individual. Build its care around the family's desires, wishes and priorities. Yes, we need our protocols and templates, but be flexible and try to accommodate each situation.

2. Think onions. Build your health program one layer at a time. The first layer might be a rabies vaccine. Administration of other core vaccines might constitute the second layer. Weave in behavior problems while working toward "family planning" (spay and neuter).

Dental care education can be introduced with the administration of the first vaccines and cultivated as the pet ages. Start client education about geriatric topics while patients are still puppies. Lay the foundation of education regarding arthritis, weight management, heartworm prevention, oncology, cruciates and other internal medicine topics.

When pets are required to visit the veterinary hospital more frequently, take it as an opportunity to build the layers—clients comply when you've built the bond over the years.

3. Don't do everything during one visit. This trend is counterproductive. Sometimes we want to do everything today. I think we should resist that temptation.

Most patients will have three medical issues to address during each visit. Be reasonable. Today they came in for a tick to be removed. Address this topic, charge a reasonable fee and then start talking about the other issues, e.g. geriatric screening, weight management and the dead canine tooth.

The human healthcare system has trained clients to think in small bites. You can use the same strategy.

4. Improve peak-time management. Daily bottlenecks in your practice diminish patient care, frustrate clients, limit practice growth and hurt your practice finances.

When we're busy, we tend to gloss over education and are less attentive to individual care.

Clients expect to wait 15 minutes. If they wait longer, they'll delay future visits or find a place that services them more efficiently.

The daily bottleneck is like a "rate-limiting step in a chemical reaction." The daily bottleneck limits the number of patients we can see during working hours. The clients we turn away or who just receive triage care depress cash flow.

Make small adjustments every week until bottlenecks are a thing of the past. During peak traffic times:

> Eliminate spurious interruptions.

> Improve infrastructure activities to process patients more efficiently.

> If possible, schedule diagnostics for the next quiet time in the day.

> Create an appointment schedule to use quiet times for elective procedures.

5. Everybody gets an "N!" today. The N! has two parts: the Next Visit Recommendation from the veterinarian and, before they leave, their Next Visit Appointment.

Stay tuned for future articles on ways to grow your ASPP.

Dr. Riegger, dipl. ABVP, is the chief medical officer at Northwest Animal Clinic Hospital and Specialty Practice. Contact him by telephone or fax (505) 898-0407,, or Find him on AVMA's NOAH as the practice management moderator. Order his books Management for Results and More Management for Results by calling (505) 898-1491.

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