Launching technician appointments and other services at your practice (Proceedings)

It isn't uncommon to find practices that, either formally or informally, offer technician appointments; i.e. patient visits in which certain services are provided to the pet and pet owner by a credentialed veterinary technician instead of by a veterinarian. The types of services provided vary but include blood draws for multiple kinds of tests (pre-anesthetic, medication levels, etc), surgery admits, microchips, vaccinations, discharge instructions, nail trims and anal gland expressions, SQ fluid administration, etc.

There are clear benefits to formalizing this option in many practices. Some of them include:

1. Increased productivity—it doesn't make sense to use doctor time for things that technicians are legally allowed to do and can do well (maybe even better than doctors!) Improved staff utilization is a more critical element of successful practices now than ever before. Practices that want to become more profitable can no longer just count on fee increases to achieve this goal. Improved profitability must come from improved business practices. Practices who delegate duties to appropriate staff members through technician appointments or as part of veterinarian appointments are able to see more clients and generate more gross revenue and profits. This increased profitability is essential to providing good quality medicine and surgery and to continual investment in team members in the form of increased salaries and benefits and increased continuing education.

2. Happier employees—Team members (technicians or other) who are allowed to use their current skills as well as learn and grow at work are generally happier in their jobs and more likely to stay with the practice than those who are only allowed to do less interesting tasks. A practice that elects to use technician appointments is also clearly demonstrating to its technicians that it has confidence in them and values their contributions.

3. Happier clients—Clients are busier than ever and they want their needs taken care of now. If they are having to wait several days to get an appointment with a veterinarian for something a technician can do, they aren't going to be as happy with the service aspect of the practice as they could be if seen earlier by making an appointment with a technician. The same goes for walk-ins—if the client has to wait an hour for a doctor when a technician could have seem them immediately, again, they aren't going to have the same sense of client satisfaction as if they'd been seen immediately. Clients are more concerned then ever about money and if they can get their needs met at a lower cost (for example, without being charged an exam fee or by being charged a lower fee), they will appreciate the opportunity. No one is suggesting that clients shouldn't be charged a fair price for the service but instead that fees should be appropriate to the service. And not all services need doctors to do them.

4. Increased bonding of clients to practices—One of the reasons that clients stay with a particular veterinary practice is that they have a relationship with it; this really means that they have a relationship with the people in the practice. If the client only has a relationship with one person in the practice, for example, with the veterinarian, then if that doctor leaves, the ties with the client have been weakened. If the client has a relationship with multiple people in the practice (including one or more technicians), then the bond is stronger. Technicians and other staff people are often very effective as well in reiterating the doctor's recommendations and clients are sometimes more comfortable asking clarification questions to a non-doctor, preferably, someone they have an ongoing relationship with.

5. Increased revenue—if the clients were going to come in anyways for the service, whether or not it was done by a technician or a veterinarian, having technician appointments might not increase the revenue of the practice. However, tech appointments can increase revenue under some circumstances. If the practice is very busy and doctors are doing things that techs could be doing, then having the technicians take over the things they can do can definitely increase revenue because more cases are seen during a given time. And if clients are more likely to come in for nail trims or anal gland expression because they know they can make an appointment or will be seen quickly, more revenue may be generated due to the increase in the number of these services performed and because the techs will have a chance to look at the pet and see if there is anything a doctor should also take a look at.

While practices may recognize the benefits of adding technician appointments, there often are some specific concerns that may have to be addressed in order to make more technician appointments a reality.

1. Legal issues

     • Get a copy of the state veterinary practice act and make sure everyone is on the same page about what technicians can and can't do

     • Technicians must also be well trained in appropriate communication—what should they say if they find something wrong with the pet? They must be very careful not to diagnose and to know how to recommend to clients that they see a veterinarian

2. Disruption to the way things are done now

     • Specifically identify what technicians do now. Do they ever see clients on their own or only in conjunction with a doctor? Do they see clients on their own for walk-ins but clients don't make formal appointment with them? What kinds of services do they provide on their own to clients?

     • What will have to change with the receptionists? Obviously they will have to know what kinds of services can be booked for technicians, who will handle the technician appointment on any given day, what to communicate to clients and how to handle the scheduling

     • What if the techs need help during the appointment from an assistant? Who will be available?

     • How will the techs be scheduled? Will one technician be in charge of tech appointments (both scheduled and walk-ins) on a particular day?

3. Communication and medical skills of technicians

     • The doctors in the practice will, of course, have to be confident not only about the tech's ability to handle the specific reason for the appointment but also their ability to answer questions from clients unrelated to why they are there and know when its time to bring in a doctor

     • And technicians must have good communication skills, not only to talk to the clients about what they are doing during the appointment, put the clients at ease and engage them in conversation and know how to handle an appointment that needs to transition into a doctor visit

4. What will the role of the technician be in these appointments?

     • Will they simply do the service they were booked to do?

     • Or will they be more actively involved in the pet's medical care—i.e. update the pet's history, weigh the pet, check eyes, ears, skin, etc.?

5. Cost concerns by clients

     • How will the client be charged for the tech visit? If the client is being charged the same price for say, a nail trim, as they would have been charged if the doctor did it; there probably won't be any push back

     • If the client is being charged a specific fee to see the technician in addition to the service performed, clients may be more resistant, particularly if they haven't had to pay this before

          o What will be communicated to the client about the reason and the value behind the fee?

          o How will the fee be handled if the client ends up needing to see a veterinarian and has to pay for a full exam?

     • On the other hand, if the client is paying a smaller, technician exam fee instead of a doctor exam fee, they may be very happy

6. Concerns by clients about the skills of technicians

     • The practice, of course, must be very up front with clients that they are seeing a technician, not a doctor, and about why this is a benefit to the client

     • Clients must be educated about the skills and training of technicians

     • If the clients haven't been used to seeing technicians do things to their animals, it may be necessary to start this process gradually. For example, during appointments with a doctor, the technician could take the temperature.

Why are some practices reluctant to have technician appointments and what can be done to drive this change? Change is hard—people naturally resist for one or more of the following reasons:

     • "Selective perception"—we see what we want to see and not what could be different

     • Habit—too hard to do things differently

     • Fear of the unknown—the idea might be a big bust

     • Economic factors—the practice will bring in less money or it will cost to much to make the change

     • People's personal comfort zones get impinged on—employees become concerned their job expectations or rewards might change and they won't be able to succeed

     • Business culture doesn't promote—nothing has every changed in this practice in 25 years, why start now?

These are some of the issues that will have to be dealt with in making significant change in the practice; some tactics for dealing with resistance include:

     • Education and communication—share and communicate the logic behind the proposed change and how it will impact the practice positively

     • Participation—talk to others who will be impacted and allow them to make meaningful contributions to the idea and how it will work; for example, what will the receptionists have to do differently? What do they think about that?

     • Facilitation and support—consider bringing in an outsider who can offer an objective view and assist with the entire process

     • Negotiation—exchanging something of value for lessening the resistance—if your owner isn't comfortable with technician appointments for medical issues, start with nail trims and anal gland expressions

As with the addition of any service, the likelihood of success is very dependent on the preparation that goes into it.