Making time for equine in a mixed veterinary practice
Long-time dvm360 magazine and Firstline contributor Kyle Palmer, CVT, is hospital manager for VCA Salem in Salem, Oregon, as well as a practice management consultant for a number of other hospitals.
When it comes to equine scheduling in a mixed animal practice, be the hero your equine specialists need.
Photo: Getty ImagesMany veterinary professionals would agree that one of the biggest headaches in practice is the arduous process of making the scheduling of appointments efficient and productive. It's a challenge for companion animal practices, it's a challenge for equine practices and it's a huge challenge for mixed equine and companion animal practices. Both internal and external forces are at work on a daily basis to make this an issue that needs specific and deliberate attention, but many of them can be overcome with proper management.
Equine clients are just different
After 25 years of trying to figure out why, I've just decided to put this fact into the “what we know” category and respond accordingly. Equine clients are not more (or less!) bonded to their horses than their companion animal counterparts, but for some reason they need a different approach.
In part, and certainly at the practice I manage, the equine “anchor” is a longtime practitioner with a great reputation and a very long shadow. When he's not available, any one of our shorter-tenured but still-capable associates would be the obvious next choice. Still, regardless of any previous experiences with our associates, many clients are quick to select an option B from outside of our practice.
It's my assumption that the dynamic is influenced by the sheer number of other veterinarians nearby that have a length of service comparable to our equine doctor. In short, they're not turning away from our associates, they're turning toward an alternative that has 40 years of experience as well. Likewise, we often have requests for clients to see our much tenured equine doctor instead of scheduling with the associate(s) at their regular practice.
With few exceptions, our companion animal clients (who greatly outnumber our equine clients) are perfectly happy to take an appointment with an associate in our practice whom they've never met before. I could shuffle a majority of our daily companion animal appointments and reinstall them in our schedule under any doctor's column and feel little or no risk of upsetting a client. It's an action that is necessary on an occasional basis to equalize the schedule and make sure each of our doctors seeing outpatient appointments share a similar workload. Of course, specific doctor requests are always honored for companion animal appointments; they're just not as common as equine calls.
Not all horses can drive
More to the point, not all horses are able to be driven, meaning that ambulatory work is still in demand regardless of the well-equipped haul-in facility you may have created as part of your practice. On top off all of the expected challenges to good scheduling, ambulatory equine appointments demand a comprehensive knowledge of geography, travel networks and daily traffic fluctuations. Additionally, when companion animals are brought in for an outpatient visit in most clinics, you are in firm control of the time and pacing of the visit. Not so with an equine appointment.
For example, at Mrs. Nawtreddy's farm, you could be subject to waiting while she looks for a lead rope, catches her horse in the pasture, struggles to control the horse and remembers-at the last minute-that her checkbook is in the house. A comprehensive knowledge of the equine clients and their normal behaviors in this regard become valuable tools in properly scheduling the doctor.
How can it work?
In the typical mixed practice, I believe there should be separation between those staff in charge of equine matters and those handling companion animal issues. All equine messages should be referred to a designated staff member who can then ensure their proper routing-particularly general questions that are not for a specific doctor. If not approached this way, an anxious client-calling a second time because he or she has not received a call back yet-might be routed to another doctor by an unsuspecting staff member.
It's just not reasonable in most mixed practices to expect that the entire staff can be properly in tune with the demands of equine clients and appointments, and the risk of having those wires get crossed is a big issue. It's difficult to find mixed animal practitioners and just as difficult to find a CVT, assistant or customer service staff member who can be an expert in both areas. It's time to stop looking and start dividing the duties.
That designated staff member-and there should be a few trained unless you have someone happy to work every open hour-should have all equine messages sent to her inbox first, after which she will forward on to the appropriate doctor. All calls for appointments should be directed to the same staff member so she can make sure exams get scheduled appropriately. As I mentioned above, equine clients tend to bond to their veterinarian, and companion animal clients tend to bond to the practice. Knowing which client should be scheduled with which doctor will help achieve success in the long run.
Additionally, there may be specific services that are not equally offered among the various equine veterinarians. For example, sending a practitioner out for a complicated lameness when his strength is dentistry or reproduction is a recipe for disaster, or at the least an experience that the client won't feel as confident about.
Finally, and this is a big one, under no circumstances should equine records be copied, mailed, emailed or faxed unless someone who understands that area has signed off on them. This is an age of almost constant requests for records, and companion animal clients are most often building their own file, seeking a second opinion or leaving the area. Equine clients seeking records, however, are not infrequently investigating a potential purchase or being nosy about the horse stalled next to theirs at the local barn. Both have happened periodically in our practice, and the risk of providing something without the seller's permission makes this a very sensitive area.
While it's possible that your practice employs multiple people who understand the details of equine practice, it's still very important to keep one designated person each day. Switch that position at times due to days off or vacations, but make sure it's just one person at a time. At first, members of our staff had trouble with this structure-some felt like it was a statement of their inability to perform the job well; others felt like it was territorialism on the part of the person selected to fill the role.
Neither were true, of course, but it was a normal reaction. Two things aided in the resolution of those feelings: a very open and frank discussion with the staff (always a good idea regardless of the policy), and the fact that every once in a while, due to vacations, our “third in line” staffer has to take over. She finds it so frustrating and challenging that her statements to the rest of the staff have gone a long way to make sure they wouldn't take the job if they were offered it.
Limiting the number of cooks in the proverbial kitchen also ensures that the very important questions get asked at the time the appointment is made. This includes the proper address and cross streets, a phone number where they can be reached if needed prior to the appointment (many horses don't live at home or nearby the landline in your files), the horse's vaccination and worming history and-don't ever forget this one-anything else they may need the doctor to do while he or she is out for the visit. On a regular basis, the lack of these questions (or rather answers) represents our doctors' biggest frustration while on the road, and almost every time something is missing we can draw a line back to some other staff member sneaking into the process.
In many practices, equine veterinarians are still on the road alone and without computer support, two things we take for granted while in our facility. Doing everything possible to help their day move along smoothly will make you their hero and will result in a client with expectations that were at least met and probably exceeded. You'll be much happier if you pick one person to take the lead in that effort.
Kyle Palmer, CVT, is a Firstline Editorial Advisory Board member and a practice manager at Silver Creek Animal Clinic in Silverton, Ore.