Keys to success in rural practice (Proceedings)

There is a perception that a rural practitioner has a much harder time achieving "success" than if that same doctor had gone into small animal practice in the big city. The first question that begs to be answered is, "What is Success?" There is not a universally agreed upon answer and for this seminar we are going to be a bit vague in its definition. Many would include components such as: enjoyable work, comfortable lifestyle, great colleagues/staff, financial reward, variety of tasks, intellectual stimulation, sense of accomplishment, "making your mark," appreciative clientele . . . we could go on and on. The key is that you need to define success for yourself. Write down your definition of success and look at it in each quarter.

I think for most of us in rural practice, the definitions of success that include things like sense of accomplishment, appreciative of clients and great colleagues/staff are the easy ones. Subjects such as finances and enjoyable work after you've just replaced a prolapsed uterus at 3:00 am may not be as easy to get you all nodding yes when we're defining success.

The most important aspect of having a reasonable expectation for your income is that you must believe what you are doing has monetary and social value. You must also believe that it is ethically responsible for you to be financially successful.

Most of you have some misconceptions. Among these are: Feed stores, catalogs, manufacturers and distributors are impossible to compete with; clients won't pay for veterinary medicine; clients only want the product at the cheapest price.

The truth is that the veterinarian is considered the best source of information and the best place to buy products. Producers would rather buy from veterinarians if they are priced competitively.

My foundational keys to success are

1) Practice excellent medicine,

2) charge a fee that reflects your excellence,

3) if you don't do #1, you can't do #2,

Never forget that clients want VALUE. Almost no one complains about price, but if you don't' provide VALUE, many will complain (or go elsewhere).

I preach to my students to join an excellent practice because you will become the practice. If that is a scary thought then we have real concerns. The bottom line is that your future economic success depends on . . . YOU!

What is the outlook for food animal practice? The demand for service is high, U.S. meat consumption continues to be high and the U.S. population is now over 306 Million. All we seem to hear are doom and gloom while all of these factors are positive for our future.

Table 1

Types of food animal clients

• 4-H and hobby farm clients

• Family farms with livestock interest

• Larger livestock production unit that use conventional markets

• Integrated livestock businesses that market food directly to consumers

Big practice changes 30 years

• Antibiotics improved

• Vaccines improved

• Reproductive management programs

• Herd health

• Paid for consultation

• Ultrasound

• Internet

• Selection for meat quality

Keys to success

• Live where you can thrive in practice (this may be more than 5 miles from home!). Driving time is not in the best interest of your BUSINESS.

• Practice efficiency

o LA – driving, specialists, guying groups

o SA – office visits, wellness, surgery

• Who is in charge of your BUSINESS?

Table 2

Philosophy statement

"Our task as the herd health veterinarian is to take a history, perform a physical exam on the animals and on the business, analyze the research and then make the best recommendations based on these facts.

The owner's task is to take our information and make the 'best' decisions."

Do not forget that we are only making recommendations and do not become disenchanted when the producer does not do everything you suggest. Do you do everything your physician suggests?

More philosophy

"It's my job to tell the client he's not doing things quite right, he needs to change his behavior, he needs to pay me for that and he needs to invite me back again.""I don't deserve any money until I can figure out how to get them to implement the change."

Bob Larson, DVM, PhD

"Determine what services your clients need and position yourself to deliver those services"

John Groves, DVM

Goals of production medicine

We will spend much time describing a mindset of production medicine instead of discussing every single situation. Production medicine is more of a mindset of how you do things, and the most important thing that we can do is to find the weak links in the production chain. We want to find the most important factors that are hindering a farm's success. Maybe the farm is already having success, but wants to improve even more, so we're going to help find those things that are holding it back... the weak links of the chain... the first domino to fall... that kind of concept.

As we look at the entire beef enterprise, we want to focus on three goals:

• Decrease the cost of production

• Increase the value of the product being sold

• Do both of the above with less labor

An overarching goal for production medicine is to have the producer see the veterinarian as an asset to the operation. We have to be someone that is perceived in a very positive light. The producer needs to see us as someone to ask about any aspect of his or her business. We won't have all the answers, but we need to know who to ask for the answers. A key to your success as a production medicine veterinarian is if you are able to build a 'team' of experts to assist your clients. You must know who in your area is the grazing specialist and the best nutritionist. After you find out, get them on your team. When a farmer challenges us with a problem and if we say "I don't know," it should always be followed by, "But, I will find out." One of my favorite sayings is "don't just do something, stand there. . . and think". I think too many times in medicine, veterinary medicine included, we have the opposite: "Don't just stand there, do something." I'd rather think about it for a while, and because of thinking instead of just acting, have a greater chance of doing the right thing. We do a lot of thinking, listening and asking questions in production medicine.

In production medicine, we are primarily dealing with cattle owners that see themselves as running a business. In consulting type practice, in production medicine, in herd health, you generally end up dealing with the very high-end clients rather than the very low-end clients. We are looking for clients that are already "hitting triples" but want to be "hitting home runs". We tend not to end up working with clients that consistently "strike out" and at best just want to "hit a single".

"Agriculture in general and the [beef] industry in specific have a long history of insufficient or incomplete record keeping. The time has come for the beef industry to operate more like other businesses and make decisions from the best available information." Dan Kniffen, NCBA

Attributes of a herd health specialist

1) Ability

2) Accountability

3) Availability

4) Affability

5) Enthusiasm

6) Business attitude

We need to have these attributes if we're going to be a herd health specialist.

Ability

First of all we must understand the enterprise. You must know very much about beef cattle, beef production, and have knowledge of the business of raising beef cattle, no matter if it's cow-calf, stocker, or feedlot. The veterinarian needs to be an expert in that field; he/she needs to be more than just the average veterinarian out there that's treating sick calves and palpating cows. You need to provide service over-and-above what the average veterinarian is going to be providing. You need to be involved in client education. The clients you work with are expecting much from you, and you need to give them a higher level of service. I found in practice that our client education meetings and newsletters were excellent ways to develop more herd health or production medicine clients.

Accountability

Professionalism. You need to be seen as a professional. This does not mean acting like you are better than someone by being arrogant, but being professional in every way; the people you deal with... the animals you deal with. When you speak at a producer meeting, you talk about cases, not clients. You dress professionally when you are the speaker and arrive early so you are well prepared.

Give unbiased recommendations. We all have our biases, and we need to hold these in check when we are doing consulting work. You always need to do what is the very best for that individual farm or ranch. My father told me to treat all clients as I would my parents. This has served me well for 24 years.

Responsible for the outcome. When you make recommendations, you must have excellent assurance that your recommendations are going to be positive for that herd. You follow up with your clients after you've made recommendations for change and you assess the results. If the outcome is not desirable, take responsibility and learn from the negative.

You get paid for advice and consultation. You do not have to sell something to someone to make a living. You do not have to do a procedure on an animal. You do not have to treat them with a medicine if you don't think it's necessary. The owner looks at the bill and sees that he paid for "X" amount of advice and he has no problem with that, because your advice made him a profit. Your work was positive for his business.

You get paid for knowledge. You've read the research. You've studied the reports. You formulate a plan for the specific herd that is best for them.

Lastly, you do not give opinions. Anyone can do that. We have to know or we find out. We base our recommendations on research and facts and previous experience. We do not guess. When an owner asks us we say, "This is my recommendation". If you're not at least 90% sure say, "I don't know, but I'll find out."

Availability

Take care of the client. The client is #1. If you don't have clients, you don't have a business. We don't see the client as an interruption to our work because the purpose of our business is to serve the client. We are in a service business. I do not mean that you are available 24/7. The clients need to know that you need time for yourself, your family, friends, civic activities, etc., but when you're on call, expect to be called. It's not an interruption. I tell a story on myself of how I was on call one weekend early in my practice career and I had other things to do that day. Someone called me and it just turned out to be a really negative situation mostly because I went to the farm with a bad attitude. I guarantee you that if you have a bad attitude when you're on call; things are going to go south. Expect to be called. If you are at a party and you get called away and you go out there with a bad attitude, nothing good is going to happen. You might as well look at it as, "Hey, I'm glad I've got clients. Otherwise, I wouldn't have a job!" Be glad you are getting called and see it as an opportunity for your business. Most of us don't have numerous emergencies and the more production medicine you do the less emergencies you have because these clients learn to do the simple things themselves. They only call you on emergency for the really tough problems. We are definitely in a service business and we have to remember that. I think that we have to balance it but, again, we have to remember that the client is the reason we are in business.

Affability

A research report showed that 68% of our customers stop doing business with us because of dissatisfaction of the attitude of the personnel at the business – 68%. You're goal in practice should be for the client to have had a better day because they have interacted with you or someone on your staff. Your front office people can make or break you. The person that answers the phone should be smiling when they answer the phone.

Positive attitudes are infectious. Most people like being around positive people. People don't like being around negative people. It's no harder to be a positive person than a negative one. Now some days are going to be harder to be positive, but you just have to forget those things and don't take things out on your clients. Have a good day every day.

Enthusiasm

You need to be enthusiastic about you're doing. The owner needs to see you as someone that enjoys what they're doing and has a love for their work. Enthusiasm is like attitude; it's contagious. Those of us that have a passion for our careers tend to attract more and better clients.

Business attitude

By this I mean we treat our business, our veterinary business, and our customer's business, the cattle business as a business. Too many veterinary businesses and cattle businesses are not run like a business. I like the quote, "Farming as a business is a wonderful way of life. Farming as a way of life is a terrible way to run a business." It's the same for the veterinary business. How can you tell a client how to run a business if you don't approach yours as a business?

Where are we? → Records

Where will we go?→ Targets

How do we compare → Benchmarking

How will we get there?→ Analysis

As I view what a business attitude means, I'm reminded of what a client said to his consultant one time. The client asked, "How will you and I know when I'm doing the job you expect me to do?" I think that's a great quote. The owner was asking the consultant for some kind of measurement. In other words, some records, some targets, benchmarking against others in the industry, and analyses of his records after all those first three things were done. That's the way we have to approach our business (our veterinary business) and our client's businesses.

The veterinarian's role

What is the veterinarian's role? To be

• a leader

• knowledgeable and respected

• a "partner" in the client's business

• trusted and reliable

Table 3

How do we charge for our services?

This is a question that's been debated by business people (veterinarians) for years. I have gone to meetings and heard veterinarians give various ways to charge and they can all be very successful. I'm going to give three examples:

Hourly rate. This is what we did in practice on everything. Everything we did we charged at an hourly rate. We thought this was very good for our business and very efficient for our client's. When we went out and did consulting work the owners were paying us for our time and they knew that. Even when we were working cattle, we were getting paid by the hour. This rewarded our clients with excellent facilities, and encouraged our clients with poor facilities to improve them. It made my job a lot better and it kept my ulcer from flaring up frequently. If we got to a farm and someone wasn't quite ready for us and we waited for 15 or 20 minutes, the owner was paying us for waiting and they knew that. They also knew that if we said we would be there at 8:00 am, we were going to be there at 8:00 am.

By the cow. If you're doing some herd work and you want to say "I'm going to provide you with this program and it's going to cost $5 per cow, $7 per cow, $10 per cow", or whatever, I think that is fine if that is going to work for both of you.

By the herd. You do this by looking at how many cows the person has and what they expect you to do for that herd and you give them a figure for the entire year for the consulting work. This would not include sick cow calls but it may include things like pregnancy palpation, vaccination of calves, nutrition consultation, preconditioning of calves, record evaluation, etc. You could include anything that you wanted. You could actually have different levels of your production medicine programs for herds with differing needs. Each level would be at a separate cost.

A bit of advice for recent grads: Don't expect to walk out of veterinary school and become a veterinary consultant. It just doesn't work that way. If you join a practice that already has a consulting focus, then you can start to do that fairly quickly after you get out of school. However, if you join a practice that is more of a traditional practice, it's going to take years to gain the confidence and trust built up from the owners, and it's also going to take years to change the mindset of the clients on how they see the veterinarian. It will also likely take you a few years to really learn enough to do consulting. If it is a traditional practice and they are calling you mostly for emergencies, they see the veterinarian as "the healer of the sick". It is likely that very few clients will think about the veterinarian as a "the preventer of disease". That has not been the veterinarian's role in the past. It will take time, so be patient.

Marketing your services

Marketing the production medicine program can be a difficult task. I found that it took a few years of discussing production medicine topics in our newsletter along with discussions of specific concerns right on the farm before I was ready to initiate our "Total Beef Herd Health Program". It's good to have a meeting for some of your most progressive clients that you expect might be interested in your program. The way that we marketed our program is that we explained to the owners that really this program was free. If, for example, the program was going to cost $8 per cow per year to be on the records and consultation part of our program, we would show them how they could make at least $8 more per cow in increased income. Then we would also show them how we would be able to save them at least $8 per cow in reduced expenses. We guaranteed the program would be cost-effective to the owners IF they gave us their short and long-term goals AND they implemented the changes we suggested.

After looking at financial figures, many times the first year on the program produced significantly more than twice their investment. We had herds that increased revenue up to eight times what they paid us for one year of the program, so that was very exciting. My grandfather always told me, "There are two ways to increase profit in a business: Lower your cost of doing business or increase the value of the product you're selling. Always do both". I have always remembered that. The herds that decrease their cost of production along with integration of new production and management technology to increase revenue have the greatest chance for success.

If you want to be hero with your clients, in addition to helping them decrease their cost of production and increase the value of their product, have them do both with less hours of work devoted to the enterprise. Tell me who else has these goals for the producer? The answer is no one.

With what clients are we dealing?

Production medicine programs tend to deal with the high level clients that see their operations as a business. Be ready to be challenged working with these clients. They expect you to add to their business.

Competence of veterinarians

"It has been suggested that there is a shortage of food animal practitioners who can provide profitable veterinary services to primary livestock producers. It is thought that this shortage may continue because of the shortage of adequately prepared graduates. 'Food animal veterinary practice serves food animal producers and consumers and must respond to the forces that influence the clientele it serves'. (Leman, 1988) Food animal practitioners need to be more knowledgeable in the areas of health, information, and farm management and must be effective communicators and good problem solvers. If they do not have these skills, herd health programs cannot be developed." Otto Radostits, DVM

"The veterinary profession will serve increasingly as a source of information for cattlemen on numerous topics. Veterinarians will be prepared to provide valuable advice on genetics, nutrition, reproduction, marketing and other beef production areas." Harlan Ritchie, PhD

So, what are the keys to success in rural, food animal practice? My number one is to embrace production medicine. Are you a "cow fixer" or a "herd health veterinarian"? There is a big difference.

What are the benefits of Production Medicine? A few I can list are: you get to work with "A" & "B" clients; your clients are glad you are there because you are an asset to the business; the client sees you as a partner in the business; you have less emergency work and clients keep asking for more.

The negatives of production medicine include: it does not have the immediate "WOW" factor of traditional medicines so there is delayed gratification; you are not judged by calling a 40 vs. a 43 day pregnancy and no one talks about your dehorning prowess. Another potential negative is that clients keep asking for more (did you notice that was also on the benefits list?)

What are the critical success factors for beef herds?

• Knowing your cost of production

• Becoming a low-cost, high-profit producer

• Reducing feed cost for the cow herd

• Making the cows work harder

• Don't fight nature

• Learning to optimize not maximize

• Doing 100 things 1% better, not 1 thing 100% better

How to structure beef consultation program

• Herd Health

• Fertility

• Nutrition

• Genetics

• Environment

• Records