It's true: Walmart can be a veterinary practice builder

Let's make Walmart's $4 pharmacy policy a win-win-win-win situation. Here's who wins: pets, clients, your practice and Walmart. So what do you think? Interested?

It all comes down to focusing on services over products. My wife, an interior designer, used to garner her income from product sales commissions. But then the interior design model shifted, and now she sells information and assessments on an hourly basis. This change scared her at first, but she had her best year ever five years after the industry changed. The same can be true for veterinarians who figure out how to shift their focus accordingly.

In the human medical profession, it's considered unethical and downright illegal for physicians to sell pharmacy drugs because of conflict of interest implications. And headwinds from the veterinary licensing boards indicate that the same thing may be blowing our direction. For example, Arizona veterinary statutes state, "The animal's owner or the person responsible for the animal shall be notified that some prescription-only drugs may be available at a pharmacy and a written prescription may be provided to the animal owner or the person responsible for the animal if requested." We're also seeing statutes that require prescriptions to be provided without prescription-writing fees. Of course, this process is legally mandated to take place within a legitimate veterinarian-client-patient relationship. In Arizona this means that a veterinarian who prescribes a drug must possess sufficient knowledge of the pet based on a preliminary diagnosis derived from having recently seen the animal. In other words, we must be reasonably confident that the prescription holds some promise of efficacy while not harming the patient.

The premise

Trust me: Walmart's $4 prescription model is good news for veterinarians, and those who embrace it can expect practice growth. How? It allows you to practice better medicine and provide better client education.

An improved relationship with clients begins with focusing on medicine and surgery services and then helping clients find the lowest pharmacy fees. This is what we do in my practices. Cephalexin is a $4 human drug available to pet owners via prescription. When we give our veterinary clients the option of where to purchase, they usually choose the $4 Walmart product over our $40 script. And they're thankful for the assistance.

Of course, embracing Walmart's role in our practices means we must be highly precise in our clinical assessments—we can no longer say, "Let's try this and see if it works." And once we select a course of therapy for a patient, we must engage in sufficient follow-up to ensure that it's doing its job and doing it safely. Ketoconazole is a great drug for yeast conditions in the ear, but it can take weeks or even months to be fully effective, so monitoring liver values is essential. A set of follow-up guidelines is essential to monitoring prescription drug effectiveness and safety—as well as keeping your clients happy and patients healthy.

The 11-step plan

Here are ways you can start to work with Walmart in your practice.

1. Gather baseline data. Get as close as you can to a definitive diagnosis. Review patient history comprehensively and collect and document a thorough physical exam.

2. Avoid the empirical.We often make empirical choices in clinical medicine. Danger lurks. Be careful not to take shortcuts to diagnosis.

3. Make a rule-out list of five items. Make sure that your differential list has five rule-outs when you begin the hunt for a specific diagnosis.

4. Confirm with testing. Appropriate diagnostics are necessary to confirm your suspected diagnosis and establish metabolic parameters so you can begin therapy.

5. Help clients find the $4 prescriptions. Do it. You're helping your clients save some treasured coin. As a result they will be more receptive to your services and recommendations. In my practice, I have a team member who knows where all the cheapest human generic drugs are.

6. Track initial outcomes. Make sure you schedule a follow-up visit and make phone contact to monitor the patient's response—or failure to respond—to treatment.

7. Plan long-term follow-up. Once therapy has begun, establish an appropriate follow-up care plan with the client. Consider adopting a set of uniform follow-up guidelines for each common condition your practice sees.

8. Consider age. Age-related diagnostic screening can also be included in your practice protocol. Create a set of testing guidelines for each age group within each species according to disease risk and prevalence in various populations.

9. Guard those refills. When a client makes a refill request, call him or her and review your practice's follow-up guidelines before authorizing the refill. This step instills confidence in you as a veterinarian and assures the client that care is proceeding as hoped and expected.

10. Balance the art of medicine with a dose of humaneness. Within these rules are exceptions we must contend with and adjust to. Take, for example, a client who is considering euthanasia for his feeble and arthritic 15-year-old Labrador. The client does not want any geriatric testing. The dog is suffering. In this case, I would be comfortable providing the client with a conservative dose of tramadol for a period of time.

11. Establish boundaries. You will encounter clients who want prescription drugs without the valid veterinarian-client-patient relationship and who offer comments like, "Quit bending me over the table, Doc." In this case, stand your ground with a simple statement such as, "I am not comfortable providing this drug under these circumstances."

The result

My practice has been following these steps since Walmart came out with its $4 prescriptions more than five years ago. We've seen this strategy work. Follow the 11 steps above and you'll start to notice things like greater client appreciation, better compliance with your recommended testing and assessments, improved patient care, more professional fulfillment as you focus on medical services and a boost to your business as service revenue rises and pharmacy costs drop.

Dr. Michael Riegger is chief medical officer at Northwest Animal Clinic Hospital and Specialty Practice in Albuquerque, N.M. Contact him by telephone or fax (505) 898-0407, Riegger@aol.com, or www.nwanimalclinic.com. 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.