Posts Tagged ‘vet practice management’

The Double Edged Sword of Choice in Veterinary Practice

Thursday, August 12th, 2010

pet owners can be confused by choiceOver on the Vetpol.co.uk community site a thread posting got The Hamster Wheel Department of Thought all fired up. The post went along the lines of this…

“…everyone is more questioning of the professions these days, more able to price-compare and the reticence about discussing money is long-gone. Our practice ethos is to involve the client with the range of treatment options for their pet…”

Which is management speak for, ‘we offer our clients choice’. Which in theory is a wonderful thing to do. But in practice can have a damaging outcome for both pets and business if not done well.

Choice – the double edged sword

Before we go further (and the hate-mail rolls in) let me state that I am a fan of choice. I like to be able to choose the colour of my car. I like to be able to choose what to write on this blog and when. There are many people of planet earth who don’t have the luxury of choice. So ‘choice’ is fantastic.

In the veterinary field choice can also be a useful tool, and it sounds great in the practice brochure. Provided you are a skillful communicator with plenty of time and have an intelligent, trusting client in front of you, choice is just dandy. But let’s be realistic.

1. Many surgeries operate with ten minute appointments, often running late.
2. How many vets are truly gifted or trained communicators or sales people?
3. How many clients, intelligent or not, “get” what it is we are trying to say?

Since when was third best good?

The mantra of choice is in theory good. But in practice I have a suspicion that it is being abused. I suspect that frequently we vets are not offering choice in the pure way management types talk about. That’s the type of choice made when the options are fully and clearly understood well enough to allow a truly informed decision.

If it were then why is the uptake of basic treatment options like de-scaling a mouth with progressive periodontal disease so poor?

Instead, what is happening is that we are offering two or three options with little in the way of useful qualification for each. And that will inevitably lead the client to make a decision on what they understand best – price.

If option A cost £2000, option B £1000 and option C a mere £500. Then, in the absence of an overwhelmingly persuasive reason to choose A or B, I’m going to opt for C.

But how many clinical situations (come to think of it any situations) are best resolved by the third best option?

Consider the example. The vet finds dental disease (a progressive condition which needs treatment) in a dog. Next she offers the client three choices.

1. Undergo a relatively expensive de-scaling procedure to correct the problem.
2. Try a course if antibiotics.
3. Review things in three months because they aren’t really bad just yet.

As a client what I’m hearing is that things can wait. Because if it really needed doing then wouldn’t the vet just tell me clearly to get on with it?

As this recommendation isn’t clearly made, I assume that things are OK and since that’s the case I’ll go for the easy/cheap/safe option of reviewing things in the future. Which we all know means next vaccination. If I bother to come in for that…

Choice as abdication of responsibility

Some (typically those short on confidence – new graduates are a good example) use choice to make the client decide, and hence move the responsibility for decision making from vet to owner. How many times do you see “client declined X-rays”, defensively written on the clinical notes. When in reality the client chose a different option based on a poor understanding of the situation because they weren’t given enough guidance. ‘Client declined’ and ‘client didn’t choose’ are not the same thing.

The vomiting dog that might have a life threatening intestinal obstruction, but might also just be gastritis, is a good example. The options:

1. Admit for bloods and an x-ray
2. Admit for observations
3. Medicate and review in 12hrs (tomorrow morning usually)

If the vet really thinks there’s a foreign body then there is only one “optimal” choice. But I’ve heard all three given together regularly with little guidance and guess which one wins out when no clear direction is given? You got it – the cheap one (that also places the animal at risk).

An alternative viewpoint on choice

My viewpoint on choice changed slightly after seeing so many consults where the best option for the pet was not the one selected.

Nowadays I train vets to clearly think through the choices in their head, then select the one they feel is in the best interests of the pet’s health at that time and make that recommendation on it’s own. I recommend using persuasive language like “what we need to do here is…” it’s proactive and motivating and you’re not giving mixed signals that confuse clients.

If, after some discussion, the client does not want to follow this option then I respect that and offer plan B. And so on and so forth until what we do is agreed and understood.

Most of the time however this isn’t necessary because I’ve made a clear initial recommendation and explained why this is the optimum way forward.

Choice and the Royal College

“But the college says we must offer options” you howl. Yes they do, and I’m not advocating reducing those options, merely presenting them in a way that makes it clear which option I believe (in my professional, highly trained vet mind) is in their pet’s best interest.

That’s not limiting choice, merely reframing it to help client understanding. Trust me, no one is going to leave my consult room without a plan that suits.

Dave’s Tuppence-worth

Vets are not a naturally gifted bunch when it comes to communicating and selling procedures. They are honest, hard working, committed to their patients and thoroughly altruistic. All of which are awesome characteristics to be admired, fostered and protected.

Unfortunately, in spite of what people may believe from the Medivet madness, vets are also chronically uncomfortable with price.

Choice offered against this backdrop is open to misuse by vets and misinterpretation by clients. The result is that many animals are not receiving the best care possible at the time they need it. Which happens to impact not just on them, but also on your bottom line as well.

You may think your vets are offering choice and you’re probably right. But is choice working for or against the pets in your practice? And how are you measuring it?

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Defusing Your Practice Debt Bomb – Part 1

Thursday, July 8th, 2010

mischevious debt bombIn the past year the UK has seen unemployment rise and wages fall. What this means for your practice is that clients may not be in as strong a position to pay or they may not be in as much of a hurry to pay.

Also, don’t forget the psychological impact that the recession may be having on your front line staff who (even at the best of times) can struggle to feel justified in charging a ‘reasonable’ fee.

In this week’s blog, we look at steps you can take to reduce practice debt and keep your cash flow healthy. The old medical adage that ‘prevention is better than cure’, certainly applies here.

Give Clients Accurate Estimates

Implement and enforce an estimates policy. By giving out written estimates, you are forcing a client to face up to the financial reality of a procedure before they commit to it. This also gives you a significant advantage should things get ugly later.

Take A Deposit Upfront

This seems to upset vets when I recommend it. But think about it, what other business that has a large bill at the end doesn’t take a deposit? Hotels? Builders? Travel agents? Don’t forget all online payments are made upfront these days so people are used to paying in advance.

I guarantee you that the only people who will object (other than your team members initially – but they’ll get over it), are the ones who weren’t going to pay anyway. So you’ve lost nothing.

Time Management

Having your vets frantically typing up a bill, minutes before the client arrives for their appointment means at best they’ll make costly mistakes. At worst, if the bill isn’t ready, they might just let the client leave without paying. Discipline and team training are essential. Can someone else do the billing? Should your busiest vets be delegating work out to quieter colleagues to help with time pressures?

Make Payment A Cultural Norm

Adopt a practice wide culture of payment at the time of treatment. Don’t just have the terms and conditions stuck invisibly to the wall. Share the information that cash flow is king. Build it into your training programs. Also, I’d advise against having a salary structure that rewards turnover alone. It has to reward profit or penalise debt to change behaviour.

Monitor the Debt

Make sure you monitor the debt like your nurses monitor an anesthetic. OK perhaps checking every few minutes might be a bit paranoid, but at least check it monthly. Things can get out of shape quickly and the bigger your practice the quicker this can happen.

Dave’s Tuppence-worth

Cultural changes can take time to settle in but if you clearly explain the reasons for change and share a little information about why you need to address problems then there will be few who can reasonably argue back.

If this has been useful to you then good luck with making some changes. If you’ve got any other tips to add then pipe-up and drop me a comment.

Next week we’ll look at what to do if you already have a debt bomb ticking – before it blows up the business.

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Six Ways To Run A Veterinary Practice Really, Really Badly

Thursday, May 27th, 2010
head for oblivion

Onward! To financial oblivion.

The economy is on the mend. And we can’t have that – what will all the journalists and bloggers like me have to write about? So it’s time to do your bit and push the world back towards financial oblivion.

Since credit has largely dried up you can’t possibly get into more personal debt. And since the government has largely removed any responsibility from the big boys, it’s time for us small and medium enterprises to enter the fray. It’s time to ensure that your practice contributes absolutely nothing to GDP this year.

Be strong people. Do your bit and follow these tips on how to run your practice so badly that it won’t ever make a penny, cent or peso ever again.

Step 1 – Don’t make any attempts to get customers through the door.

Don’t advertise. Don’t train your staff on phone techniques. Don’t maintain your buildings or appearance. And under no circumstances engage in any ‘high-falutin’ social media marketing activity. Dangerous stuff that.

Step 2 – Try not to find any problems with pets.

Don’t employ the best vets – go for the cheapest. New grads all the way! Do not waste money on continuing education courses for staff.  Actively discourage using new skills or individual development in your practice.

When your vets are using vaccine consults as ‘catch-ups’ take no action. After all the pet’s teeth will still be bad next year and that niggling lameness will probably get better on it’s own. Found a lump? Probably just a lipoma – no need for a time consuming aspirate.

Step 3 – Stop selling them solutions.

If your vets (pesky lot) absolutely insist on looking for medical problems, all is not lost. Since most of them haven’t a clue how to effectively persuade a client to take the right action this doesn’t represent a big issue. To keep it this way, do not try to teach them communication skills or sales techniques. That would be disastrous in your efforts at avoiding profit.

Step 4 – Sink yourself with pricing.

Ah-ha! Double opportunity to fail here. Firstly, make sure your prices are so low that there is no way you could ever make a profit. Secondly, don’t tell your staff what’s expected of them when it comes to billing. They’ll make it up as they go along and almost certainly lose you a fortune. Good job!

Step 5 – Try not to collect money.

OK, healthy cash flow is not the same as profit but it does mean your business keeps trading. This in itself means you are a risk to economic meltdown. Therefore, try not to worry too much about asking clients for cash. It only makes the vets feel awkward and annoys clients. Everyone will be happier if you just ignore this bit and let clients wander out the door before paying.

Step 6 – Don’t pay bills.

Now you wouldn’t be doing your bit unless you helped pass the pain up the supply chain. So, to make sure no-one else has any money to pay bills or encourage growth keep all of your bills in a pot on the shelf, wait until they are all final demands, then (and only then) select one randomly and pay it.

And while you’re at it, make sure you’re paying top whack for all of your stock, can’t have the margins creeping up now.

Dave’s Tuppence-worth

If you follow these tips folks then within a few months you’ll be guaranteed to be lining up….at the job centre, claiming back some of that money you gave the government in last year’s tax bill. Now, job done…doesn’t that feel better?

Or there is another way…. ;-)

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Posted in Uncategorized, global financial crisis, recession, social media, training, vet HR, vet business, vet management, vet practice management, veterinary business, viral marketing | 1 Comment »

Mentoring Is the ‘Miracle Grow’ for Your Business

Wednesday, October 21st, 2009


In my first “proper” blog from the bottom of the earth (no that isn’t meant to be offensive to my Australian colleagues). In fact, from what I’ve seen in my short time here so far, there is much us “Poms” can learn from the Aussie approach. But that’s for another day.

I’ve begun a new role with a new set of challenges. A practice with a small but very enthusiastic team, eager to deliver. The practice isn’t big and flash – in fact I’d call it a rough diamond. To the untrained eye, it would be easy to dismiss as another two-man band, which isn’t going places.

But if you thought that, you’d be making a mistake, for beneath the unpolished surface, is a practice of huge potential.



The equipment is surprisingly good. The ultrasound machine, for example, is better than those I’ve seen in top tier Royal College of Vet Surgeons (RCVS) accredited UK hospitals. And how many two man practices do you know that have both a video endoscope and a rigid otoscope? No, I don’t know any others either.



The location is great. A leafy, well-to-do suburb of Sydney called Double Bay. If I’ve learned one thing recently, it’s that if you get your service level and fees right, then location is probably more important than parking. Double bay is one of those locations (like the wealthy London suburbs of Hampstead or Blackheath) people fight over to operate in.

But good as these two factors are, they aren’t what really excite me about working in this practice. No, the best bit is the potential of the team. A youthful and gloriously enthusiastic group of vets, nurses and owners. And a really refreshing lack of damp-spirits, gripes or moans. This is a group that is eager to learn, move forward and do the very best for the clients of this area.



So teach, mentor and coach I will. And you just watch. With the right influence and leadership – the skills, location, enthusiasm and equipment will come together in this team and drive the practice forward.

So that’s the theme of today’s blog. Mentoring and the benefits it can bring to all of our practices.

Reasons to Mentor

1. The Gift That Money Can’t Buy

You might think that what your staff really wants is more money. But you’d be wrong. Sure they wouldn’t say no, but what young vets and nurses want is to get better at their jobs, and to be recognised for the work they do.


So mentoring is the training that money can’t buy. What do I mean? Well you can pay A LOT of money for external courses (remember it’s the course fees and the additional fees paid to cover that individual’s shifts, plus the lost revenues as regulars won’t come in to see the other vet or locum).


When you bring it in house you save these cost. But, more importantly when you involve your team in personal one to one training, it send a very strong signal that you are interested in and care about their development. That’s a massively motivating and powerful message. Wouldn’t you rather have a happy motivated team?


2. You’re Running Out of Time


No matter how good you are, you only ever have 24 hrs in one day. So you will always be limited by time constraints. However, if you are willing to live with a short-term loss in your personal productivity, then pull back from the front line and training your staff. Only then can exciting things start to happen. Train your team and watch their skills and productivity increase. The numbers stack up well; consider the following example.

You employ two vets both delivering annual revenue of $300,000 (I’m in Oz now so I’ll use the local currency). You on the other hand are generating significantly more, say $500,000. Total practice turnover of $1,100,000.

Now let’s say you step back a little from clinical duties to train your team in a new clinical technique each week, or better still some selling skills in the consult room. Perhaps you might make time for some of the formal pricelist training you always meant to do?


The net effect is that although your personal turnover drops by 10% to $450,000. If you get the training right, the combined impact of the new skills and motivation your team has developed could easily bring in 20% more per vet. That’s $120,000 dollars total.

 The overall effect is that without spending a penny on capital equipment, you have earned a net of $70,000 per annum.

Not bad eh? And these figures are absolutely not made up. They are perfectly achievable, plus if you have more vets then the benefits keep stacking up.

3. Don’t Be the Hamster!

In our ever more competitive marketplace medical service levels and client expectations are being driven ever upwards. A good example is the use of MRI. Just five years ago this was still a largely unused technology for vets. Now there are several hospitals worldwide equipped with MRI units.

Such competition demands that your, once safe/easy to run, veterinary business is now at threat unless you begin to manage it. ‘But how do I do that?’, I hear you ask. “I’m already working all the hours god sends, I feel like a hamster on a wheel.”

 Exactly my point. You can’t do it as long as you are completely engaged working IN your business.

That’s where coaching and mentoring comes in.

Train your team with new skills, and then delegate your old ‘working in’ roles. Do this effectively and you’ll have a team thriving on the challenge of their new responsibilities. While you have time to sit down (away from the practice) and plan your strategy. Working ON your business is a change, it’s fun and reinvigorates you helping keep you enthusiastic.

4. Everybody Wins



If things go well then it is natural that the team will want to share of the spoils. That, in my book, is fair and to be expected. By looking after your team’s development and working on the business rather than in it, you will be working effectively to build the value of your practice. This hopefully means you will also be generating more profit. More profit = more money for, among other things, rewards to keep your team happy. (It also means a better eventual sale price)

This, in my opinion, is the correct way to run a business. Build your team’s skill to make more cash – then reward them. Rather than leave the business stagnating and the team to wither. And that just plays into the hands of those that want to add more bureaucracy to our already red tape tangled small businesses.



5. Succession Planning

Unless you are super human, you won’t be able to keep going at the pace you first began. At some point you will want to sell your business and that is likely to be to a large corporate group (a move many vets view as selling out). Or you will need a succession plan; the more traditional route of grooming a talented individual from within your business to one day take over the reigns as you slip off into the nirvana of a golfing/surfing/horse-riding retirement.

Dave’s Tuppence-worth



The old adage of ‘you reap what you sow’ is absolutely true. Whatever stage in your ownership career you are at, it’s never too late to start taking an interest in the development of your team. The more you put into it, the more it will benefit everyone in the end.

If you want any tips or advice on training your team then feel free to contact me.



Next Time

How social media could leave egg on your Facebook.

Published on Wed 28th October.



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Posted in hamster, mentoring, training, vets | 1 Comment »