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Scheduling Weeks Out? Implement Forward Booking

Scheduling Weeks Out? Implement Forward Booking

Scheduling Weeks Out? Implement Forward Booking

By Wendy S. Myers, CVJ, Communication Solutions for Veterinarians

A practice manager told me her hospital doesn’t have any checkups available for four months. Clients feel frustrated and patients aren’t getting timely preventive care. If your practice is booking checkups two or more weeks out, you need to implement forward booking as a long-term solution.

Have clients schedule pets’ next checkups during today’s appointments. While dental practices aim to schedule 75% of patients in advance, only 11% of veterinary hospitals forward book six- or 12-month checkups.[1],[2] When clients schedule months in advance, you will have ample appointments available. Here are four success factors to implement forward booking: 

1. Pre-block checkups in your schedule template.

Build your schedule 12 months out. Pre-block four checkups in each doctor’s daily schedule:

  • First appointment of the day: Doctors are confident about preventive care, which creates a positive mindset for the day.
  • Appointment before lunch: Because checkups are predictable and more likely to finish on time, the outpatient team can enjoy well-timed lunch breaks.
  • Appointment after lunch: A checkup after lunch starts the afternoon on time.
  • Last appointment of the day: Wrapping up the day with a checkup ensures the outpatient team goes home on time. 

Don’t worry if veterinarians’ schedules change. Doctors will request time off in advance for vacation and conferences, especially if booking travel. Simply contact clients whose appointments need to be moved.

2. have the outpatient team personally schedule future appointments.

In dental practices, hygienists have greater success with pre-appointing patients than scheduling coordinators at checkout.[1} By the time patients reach the checkout counter, they want to leave and may dismiss staff’s attempts to schedule. 

Here’s how to apply this strategy to checkups, pediatric exams, and progress exams:

Checkups: Having technicians and assistants initiate conversations about future checkups emphasizes the importance of preventive medicine. Compare the pre-appointment strategy to dentists’ offices, which clients already experience. Use the yes-or-yes technique to lead pet owners to commit. Say, “Just as your dentist has you schedule your next appointment at checkout, we do the same to proactively manage your pet’s health. By scheduling today, you will get your first choice of doctor, day, and time. Do you prefer <date, time 1> or <date, time 2>?” The first choice is the same day of the week and time as today’s appointment. The second choice is a different day of the week and time of day (morning vs. afternoon).

When procrastinators won’t commit, use benefit statements. Say, “I understand you don’t know your schedule 12 months from today. By scheduling now, you will get your first choice of doctor, day, and time. You will get a confirmation today and reminders as the date nears. If you need to change the appointment, just reply to the text/email. Does this same time and day typically work for you?” If the client agrees, recite the time and date out loud to reaffirm the decision. Say, “Fantastic, let’s schedule you for this same time on <date>.”

If your hospital has computers in exam rooms, having outpatient teams schedule future appointments and collect payments is the most efficient. If clients will pay at the front desk, client service representatives (CSRs) can use these same scripts. Always guide clients to pre-appoint before paying for today’s services because appointment reminders will print on receipts and trigger confirmations. Follow the best practice of “Schedule First, Pay Last.”

Pediatric exams: If you’re booking three weeks out, puppies and kittens risk missing timely immunizations. During the first pediatric exam, forward book the remaining series of appointments. If a client visits today with an 8-week-old puppy, say, “Your puppy will need exams and vaccinations at 12 and 16 weeks of age. We need to provide timely exams to monitor <pet name>’s growth and development and vaccines for ongoing protection. We will schedule your puppy’s next two appointments today, so you will get your first choice of time, day, and doctor. Let’s set the next appointment when your puppy will be 12 weeks old. Do you prefer <date, time 1> or <date, time 2>?” Once the client agrees, say, “Great, we will see <pet name> on <date, time> for the 12-week-old appointment. Now let’s book the 16-week visit. Do you prefer <date, time 1> or <date, time 2>?” Let the client know to expect confirmations.

Progress exams: If patients need progress exams, schedule today to ensure timely follow-up care. Seeing the same veterinarian builds client confidence that the medical problem will be resolved and supports exam efficiency. A different doctor will need more time to review the medical record to learn the previous veterinarian’s diagnosis and treatment.

Use words that work. Replace the wiggle word of “recommend” with the action word of “needs.” “Progress exam” communicates that follow-up care is medically necessary, and you are moving forward in resolving the health concern. “Recheck” may be perceived as free and optional. Say, “Dr. <Name> needs to see <pet name> in two weeks for a progress exam for the ear infection. Do you prefer <date, time 1> or <date, time 2>?”

3. implement a confirmation protocol.

Dentist found that patients who leave with appointments are statically more likely to show up.[3] Only 10% of dental patients cancel or no-show, while two-thirds skipped booking because they don’t want scheduling hassles.

Likewise, you can save clients future tasks and make preventive care easier when you forward book. Veterinary hospitals experience 11% no-shows.[4] Text and email confirmations significantly lessen cancellations and no-shows. 

In my online course on Everything You Need to Know About Scheduling, I advise sending four confirmations with actions that improve practice efficiency (https://csvets.info/scheduling). Confirmations should include hyperlinks to online forms based on the reason for visit. Use emojis to increase open rates and clients’ understanding of appointment instructions. A pile of poo will grab clients’ attention and boost compliance for intestinal parasite testing. Here is the series of text confirmations:

Immediately upon booking: <Pet name> has an appointment at <time, date>. Complete patient history form at least 24 hours ahead, which is required to guarantee your appointment. Bring a stool sample 💩 that is fresh within __ hours. Download our app to pay after the exam. Reply C to confirm or RS to reschedule. 

Two weeks prior: <Pet name> has an appointment at <time, date>. Please confirm this still works for you. Complete patient history form at least 24 hours ahead, which is required. Reply C to confirm or RS to reschedule. 

Four days prior: This is a friendly reminder that <pet name> has an appointment at <time, date>. Remember to complete patient history form at least 24 hours ahead, which is required. Reply C to confirm or RS to reschedule. 

Two days prior: We will see <pet name> for an appointment at <time, date>. Complete patient history form, which is due TODAY by X p.m. and is required to keep your appointment. Bring a stool sample 💩 that is fresh within __ hours. Download our app to pay after the exam. See you soon! 

If clients have not confirmed or submitted online forms two days prior, call them. Say, “We have reserved an appointment for <pet name> at <time, date>. We are experiencing increased appointment requests and have other patients on a waiting list. We need your confirmation and online form submitted by X p.m. today or <pet name>’s appointment will be released to another patient in need. Please text/email/call us with questions.” 

When clients fail to respond, call them after your deadline and send backup texts or emails to inform them that their appointments have been cancelled. Text: “We regret that we have not received your confirmation and/or online form, which is required to guarantee your pet’s exam. Your appointment on < date, time> has been released to another patient in need. Book online or download our app to reschedule.

4. make having future appointments the norm, not optional.

Dentists don’t give patients a choice. Their pre-appointing strategy has been successful for decades. Veterinary practices can implement forward booking to ensure timely preventive care, future hospital revenue, and fewer scheduling phone calls.

WANT TO LEARN MORE? 

Enroll your team in the COURSE: HOW TO MASTER FORWARD BOOKING.

About the Author: Best known as the “Queen of Scripts,” Wendy S. Myers, CVJ, has taught communication and client service skills for more than two decades. As founder of Communication Solutions for Veterinarians, she teaches practical skills through online courses, onsite coaching, and conferences. Wendy was a partner in an AAHA-accredited specialty and emergency practice. Visit CsvetsCourses.com to learn more.

References:

1. Faustino A. How to Improve Dental Recall with These Tips. Available at: https://capforge.com/how-to-improve-dental-recall-with-these-tips/. Accessed Feb 6, 2024.

2. Forward Booking: How Forward Booking Leads to Better Patient Care. AAHA and Partners for Healthy Pets. Available at: https://www.aaha.org/globalassets/04-practice-resources/Forward-booking. Accessed Feb 6, 2024.

3. 6 Metrics That Determine the Success of Your Dental Practice. ThriveCloud. Available at: https://mythrivecloud.com/6-metrics-that-determine-success-dental-practice/. Accessed Feb 6, 2024.

4. What Pesky No-Shows Actually Cost Your Veterinary Practice. PetDesk. Available at: https://petdesk.com/blog/what-pesky-no-shows-actually-cost-your-veterinary-practice/. Accessed Feb 6, 2024.

8 Ways to Find Time for Training

8 Ways to Find Time for Training

8 Ways to Find Time for Training

By Wendy S. Myers, CVJ, Communication Solutions for Veterinarians

While attending a conference, a veterinarian got a text from his hospital manager that a client service representative (CSR) had just resigned. More than half of veterinary front-office staff last under two years in their jobs.[1] The doctor asked me, “My manager already posted the job opening online. How can we train a new CSR to quickly get up to speed?” 

With practices’ current busyness, finding time for training can be challenging. Here are eight ways to ensure training happens:

1. Create onboarding checklists.

On their first day of employment, new hires get a checklist of skills to learn, training resources, and deadlines for completion. Set them up for success because the cost of turnover is 16 percent to 20 percent of an employee’s salary.[2]

In Jump-Start Your New Receptionist: 6 Courses, I share an onboarding checklist and six hours of online courses to achieve fundamental skills in phone techniques, scheduling, difficult clients, and client service (https://csvets.info/jumpstart). Assign mentors to teach skills and sign off on testing. At the end of each week, the CSR team leader checks in with the new hire to confirm progress and answer questions.

2. have staff create practice-specific training.

If you don’t have standard operating procedures (SOPs) in writing, start creating them with the help of new hires and their mentors.

Let’s say a mentor is teaching a new CSR how to create an electronic medical record in your practice-management software. Have the new hire write down each step while learning the process. Turn the document into a SOP for others to follow. While the mentor demonstrates step-by-step clicks, make a screen recording to accompany written instructions. Upload videos on your hospital’s private YouTube channel where employees can access tutorials that answer, “How do I…?”

3. identify training resources.

Gather internal and external sources that employees and managers can use such as:

4. block learning time in work schedules.

This may seem obvious, but you’ll guarantee that employees have dedicated time to learn. New hires will have lots of lesson time blocked in daily schedules while seasoned employees may get two hours a month. Supervisors can coordinate training dates and times so teams continue to work efficiently. For example, a surgery technician might have training time set aside from 2 to 3 p.m. after morning procedures finish and a lunch break. Putting training on staff schedules makes it official, like meetings that employees can’t miss.

You also will get better results when employees complete training at work. Too many interruptions happen at home. A manager told me her CSR submitted three hours of payroll to watch a one-hour course at home. Distractions of kids, dinner, laundry, and homework also may cause employees to retain less of what they learn. Expecting employees to put in extra time to learn at home tells them you don’t value their personal time or them. Have staff learn at work where you control the surroundings.

5. create a positive learning environment.

Provide a quiet nook such as a desk in the employee break room, conference room, phone cubby, or shared office. Place a basket of snacks, fruit, water, notepads, and pens next to the computer or tablet. Have headphones so employees can listen without distracting background noises.
 

6. make training part of your culture.

After new hires complete their 90-day introductory period, keep growth going. Identify which skills they need to learn and become proficient in performing. Set expectations and learning goals with deadlines during performance reviews.

7. set a ce requirement for all staff.

Veterinarians and credentialed technicians must complete a certain number of RACE-approved CE credits to remain licensed or certified throughout their careers. In Florida, veterinarians need 30 credits every two years while certified veterinary technicians need 15 credits every two years.[3] Set a CE requirement for CSRs and veterinary assistants employed at your practice such as eight credits every two years, which is half the number of CE credits required for technicians. Consider accepting a mix of RACE-approved CE credits as well as participation in lunch-n-learn sessions from vendors and certificates of completion for online courses.

Employees should submit training requests that require funding. At Mount Laurel Animal Hospital in Mount Laurel, N.J., every employee gets $350 per year for education and can request additional funds. Employees may use educational funds for dues, conferences, online courses, books, college, and other training. Certified veterinary technicians (CVTs) get annual CE allowances of $1,000. The National Association of Veterinary Technicians in America (NAVTA) offers Veterinary Technician Specialty (VTS) certificates in more than 16 specialties from dentistry to behavior (https://navta.net/veterinary-technician-specialties/). Mount Laurel Animal Hospital’s technicians with a VTS certification get $1,500 for CE annually.

8. tie training to job advancement.

Create job levels with skill checklists. Adobe Veterinary Center in Tucson, Arizona, has four job tiers for CSR positions. Level 1 CSRs learn 55 skills, ranging from appointment scheduling to creating and maintaining electronic medical records. Employees get training through online courses, SOP manuals, mentors, and hands-on instructions. Tests confirm they have become competent in skills. Wages increase as employees move up through job tiers. Once CSRs reach Level 4, they have become proficient in 94 skills. Discover how to create job structure in my course on Career Paths: A Guide to Implementing Job Levels (https://csvets.info/careerpaths). Employees who see clear upward opportunities with your practice are more likely to stick with you longer. 

Companies that offer ongoing skill development are seven times more likely to retain their employees.[4] Teammates who spend time learning at work also are less stressed and more productive. Finding time for training will get your employees and practice growing.

WANT TO LEARN MORE? 

Enroll your team in the training bundle: jump-start your new receptionist: 6 Courses.

About the Author: Best known as the “Queen of Scripts,” Wendy S. Myers, CVJ, has taught communication and client service skills for more than two decades. As founder of Communication Solutions for Veterinarians, she teaches practical skills through online courses, onsite coaching, and conferences. Wendy was a partner in an AAHA-accredited specialty and emergency practice. Visit CsvetsCourses.com to learn more.

References:

1. How to Help Your Veterinary Front-Desk Team with Burnout. Available at: https://whiskercloud.com/blog/help-your-veterinary-front-desk-burnout#:~:text=How%20bad%20is%20reception%20turnover,two%20years%20in%20their%20role.&text=According%20to%20the%20AAHA%27s%202020,was%2023%20percent%20on%20average. Accessed March 18, 2024.

2. Hansen M. How to Get Employees Excited About Training: 10 Ways to Motivate Them. Available at: https://www.edgepointlearning.com/blog/get-employees-excited-about-training/. Accessed March 18, 2024.

3. Frequently Asked Questions About Continuing Education. Florida Veterinary Medical Association. Available at: https://fvma.org/continuing-education/about-continuing-education-ce/. Accessed March 18, 2024.

4. Hilgers L. How to Help Employees Make Time for Learning at Work. Available at: https://www.linkedin.com/business/talent/blog/learning-and-development/how-to-help-employees-make-time-for-learning-at-work. Accessed March 18, 2024.

4 Mistakes Conference Goers Make

4 Mistakes Conference Goers Make

4 Mistakes Conference Goers Make

By Wendy S. Myers, CVJ, Communication Solutions for Veterinarians

You earned continuing-education credits, shopped the exhibit hall, met new friends, and reconnected with classmates while attending conferences. Now you’re back to the daily grind. Your investment of the registration fee, travel, meals, and time away from your practice could be costly if you make these four post-conference mistakes.

1. Filing and forgetting conference notes

You picked up new medical knowledge, efficiency ideas, and revenue growth strategies at the event. Without implementation, these gems are worthless. Before you leave the conference, dedicate 20 minutes in the quiet of your hotel room or on your return flight to write the top three ideas you will implement when you return to your practice.

When determining goals, ask these questions to prioritize which choices will have the greatest impact on your practice:

  • How will this idea improve client experiences?
  • How will this idea enhance employee productivity and job satisfaction?
  • How will this idea improve patient care?
  • How will this idea increase hospital revenue?

Let’s say you attended my session on how to use technicians as physician assistants. If you follow my advice on shifting up to 20% of appointments from veterinarians to technicians, you will increase appointment availability, which makes clients happy. Technicians will work at the top of their licenses and skillsets, which makes employees happy. Delivering more technician appointments will improve patient care and generate revenue, which makes practice owners and managers happy. All four criteria are in sync, so this goal is a winner.

Michael Hyatt, founder and chairman of Full Focus and bestselling author, advises to make your goals SMARTER:[1]

  • Specific: Identify exactly what you want to accomplish.
  • Measurable: Quantify the result so you know whether you hit the goal.
  • Actionable: Start with action verbs of “increase,” “grow,” or “improve” instead of dreamy to-be verbs of “be” or “have.” A weak goal is “Be better at recommending early detection screens,” while a strong goal is “Increase compliance for early detection screens by 20%.”
  • Risky: A goal should make you stretch to the edge of your comfort zone but not be impossible. You’re not thinking big enough if you want to increase compliance 5%.
  • Time-keyed: Assign a date to every goal. A goal without a deadline is just a dream. Your goal would be to “increase compliance for early detection screens by 20% by June 30.”
  • Exciting: You need to be excited about achieving the goal. Otherwise, you won’t have the motivation necessary to keep pursuing the goal when you encounter unexpected challenges.
  • Relevant: Goals should be aligned with your practice and personal values and other goals. As a hospital manager, don’t aim to earn your certified veterinary practice manager credential and get a master’s degree in business administration the same year. It’s too much, and you risk failing at both. Do one or the other.

When writing goals, Hyatt advises to review them regularly. He does this weekly. Ask, “What’s the next step I need to take to move toward this goal?” When you review goals, they should inspire you to populate your daily task list with action steps.

2. not following up with new connections

You sat next to a hospital manager in a session about onboarding new hires. During the break, you talked about your phase-training checklists, exchanged business cards, and promised to email each other. Six months later, you discover a handful of business cards buried in the bottom of your backpack. You sort through the cards but don’t remember which manager had the awesome onboarding checklist you desired.

Write notes on business cards about your conversations and follow-up actions. At the end of each day, put a note on your calendar or digital planner with a reminder to follow up on a specific date. Send follow-up emails when most conference goers will have been back at work for two days. Your email should include who you are, what you discussed at the convention, and suggest next steps such as setting up a meeting, connecting with a colleague, or buying a service or product.

If your follow-up conversation merits a call or virtual meeting, book a date and time with your colleague before leaving the conference. Let’s say you’re a practice owner and meet an associate veterinarian candidate during seminars. Grab dinner together at the conference or schedule a post-event video call for a job interview. Because many practices are hiring, quality prospects may get snatched up quickly.

3. missing deadlines on show specials

You’ve been yearning for another dental unit and find the equipment you want in the exhibit hall. Better yet, a show special offers exceptional savings. You tuck the flyer inside your backpack and head down the next aisle of vendor booths. When you return to work, you discover that you missed the deadline and will now pay full price. 

Be decisive at the conference. If you’ve got the funds and tingle with excitement over the equipment purchase, buy it today in the exhibit hall. If you need to check with your accountant or corporate practice office, send an email today with the information and upcoming deadline. Purposefully deciding before the deadline will let you enjoy savings and delight your team when you return and explain, “I bought a new dental unit at the conference, and it will arrive Friday!”

4. Not sharing what you learned

You’re the practice owner and have four associate veterinarians. You attended sessions on internal medicine and orthopedic techniques and are excited to use your new knowledge. Besides benefiting patients, this know-how could help your associates. Schedule a doctors’ meeting to discuss your favorite pearls. Upload conference proceedings along with your notes on a shared drive or practice server where other doctors, technicians, and assistants can study the information, too. 

If doctors decide to update a protocol or introduce a new service based on what they learned at conferences, schedule a staff meeting to discuss details with employees. Explain the “why” behind the protocol change, share a written standard operating procedure, and create scripts of what to tell clients. Getting everyone on the same page before you roll out a new service or protocol will ensure its success. Whether you attended sessions on medicine, management, or client service, knowledge gained needs to be shared. 

Your practice invests thousands every time a doctor, manager, or support staff member attends a conference. Set aside time to write goals and engage your team in understanding and implementing ideas. Your strategic approach will pay rich dividends on continuing education.

WANT TO LEARN MORE? 

Enroll your team: ALL ACCESS PASS 100+ Courses

About the Author: Best known as the “Queen of Scripts,” Wendy S. Myers, CVJ, has taught communication and client service skills for more than two decades. As founder of Communication Solutions for Veterinarians, she teaches practical skills through online courses, onsite coaching, and conferences. Wendy was a partner in an AAHA-accredited specialty and emergency practice. Visit CsvetsCourses.com and YouTube.com/csvets to learn more.

Reference:

1. Hyatt M. The Beginner’s Guide to Goal Setting. Available at: https://fullfocus.co/goal-setting/. Accessed Jan. 8, 2024.

HOW TO CHARGE FOR TECHNICIAN APPOINTMENTS

HOW TO CHARGE FOR TECHNICIAN APPOINTMENTS

HOW TO CHARGE FOR TECHNICIAN APPOINTMENTS

By Wendy S. Myers, CVJ, Communication Solutions for Veterinarians

is your practice struggling with doctor shortages?

Using technicians as physician assistants is a solution. Your practice could shift up to 20% of appointments from veterinarians to technicians. Better yet, you can charge for technician appointments.

which appointments to reallocate to technicians

Consult your state’s guidelines on technician and veterinary assistant duties and whether veterinary supervision must be direct or indirect (https://www.avma.org/advocacy/state-and-local-advocacy/veterinary-state-board-websites).  

After reviewing your state’s policies, identify types of appointment that technicians and assistants may see. Create scheduling guidelines with appointment lengths and reasons for visit for client service representatives to follow. Consider a standard of care that patients must have a veterinary-client-patient relationship and a physical exam from a veterinarian within 12 months to be eligible for technician appointments.[1]

Shift four appointment types from veterinarians to technicians and assistants:

1. Preventive appointments. Let’s say a veterinarian examined an adult dog today and gave the first Leptospirosis vaccination. When the dog needs a Leptospirosis booster in a few weeks, schedule an appointment with a technician rather than a doctor. Forward book the technician appointment today to ensure timely immunization. Schedule recurring technician appointments for patients on weight-management programs so technicians and assistants may assess patients’ progress and provide nutrition counseling to clients.

2. Diagnostic appointments. Technicians and assistants can collect samples and perform lab tests for drug monitoring, early detection screens, preanesthetic testing, blood pressure checks, glucose curves, and more.

3. Treatment appointments. Technicians and assistants can change bandages, administer subcutaneous fluids, perform laser therapy, trim nails, clean ears, and more.

4. Instructional appointments. Teach clients about home care such as giving insulin injections and subcutaneous fluids. Have clients record videos on their smartphones of patient care that they will need to do at home.

Let’s say the client schedules a technician appointment to get her dog’s ears cleaned. Ask the client to record a video on his smartphone as you clean the right ear and verbalize instructions. After you finish cleaning the right ear, have the client clean the left ear while you coach him. Clients will better understand homecare instructions after watching, doing, and recording videos for future reference.

use distinct terms

To help clients understand the difference between duties performed by a veterinarian and technician, choose different service names. Use “exam” when a veterinarian performs a physical exam. Used in the human nursing profession, the term “health assessment” is when a technician or assistant evaluates patient health.[2] Download my history questions for checkups at https://csvets.com/historyquestions/.

A health assessment performed by a technician or assistant includes three activities:

  1. Get patient’s vital signs (i.e., temperature, pulse, respiration, weight)
  2. Ask history questions
  3. Update medical record 

Veterinarians should define which patients will need health assessments during technician and assistant appointments. Here are services that may merit health assessments:

  • Change bandages
  • Clean ears
  • Express anal glands
  • Administer subcutaneous fluids
  • Provide laser therapy
  • Administer vaccines
  • Check weight and provide counseling
  • Remove sutures

A health assessment may not be medically necessary for certain services such as:

  • Trim nails
  • Collect urine or blood for lab tests
  • Place microchip

how to set health assessment fees

Clients will pay for services and health assessments performed by technicians and assistants. Let’s say a client books a technician appointment for a nail trim. Charge for the nail trim service but a health assessment is not medically necessary. Another client schedules a technician appointment for her dog’s bandage change. Charge fees for bandage change services and a health assessment, which is medically necessary.

When setting fees for health assessments that technicians and assistants will perform, consider two options:

Option 1: Percentage of doctor’s exam. Let’s say your veterinarian’s exam fee is $60. Charge half the doctor’s rate if a credentialed technician provides the health assessment or $30. If an assistant does it, charge a third of the doctor’s rate or $20. 

Option 2: Create a per-minute rate. Identify three figures:

  • Average hourly wage: Calculate the average hourly wage for your credential technicians and veterinary assistants. The 2022 average hourly pay for a technician was $19.60, according to the U.S. Bureau of Labor Statistics.[3] Veterinary assistants averaged $16.58 per hour.[4]
  • Benefits: Benefits are typically 32% of an employee’s wage.[5] Benefit expenses include all costs associated with health, dental, worker’s compensation, and other insurances; retirement benefits; the owner’s portion of employment taxes; uniform reimbursement; continuing education; discounts or allowances for veterinary services; and paid vacation, holidays, and personal days.
  • Staff costs as a percentage of revenue: Total staff expense with benefits in a financially healthy hospital is kept below 23% to 25% of revenue.[6] Support staff includes all non-veterinary employees, managers, and custodial personnel. About 16% to 19% of income is allocated to staff wages while 5% to 8% is for benefits. 

Here’s the per-minute formula: Take the average wage per hour with benefits ($19.60 technician hourly wage + 32% for benefits = $25.87 per hour) and divide by 23% staff costs as a percentage of revenue. A technician will need to generate income of $112.48 per hour to meet profit goals. Divide $112.48 income per hour by 60 minutes for a per-minute billable rate of $1.87 for technician time. Use a similar calculation to determine a per-minute rate for services that veterinary assistants will deliver.

Rather than the tedious task of setting a stopwatch every time a technician sees an appointment, set fees in blocks of 10, 20, 30, and 40 minutes with a minimum amount charged. For example, a 10-minute technician appointment is $18.70 plus fees for additional services delivered. If the task only takes 5 minutes, still charge the 10-minute technician fee because it’s the minimum amount and starting point for fees.

Here are examples of technician appointment fees based on blocks of time:

Length of technician appointment

Health assessment fee

10 minutes

$18.70

20 minutes

$37.40

30 minutes

$56.10

40 minutes

$74.80

communicate value to clients

If you don’t charge for technicians’ time now and will implement a health assessment fee, host a staff meeting to explain the “why” behind the fee to your team. Technicians and assistants will appreciate that you value their time and expertise and want to charge clients for services they deliver.

Write a script of what to tell clients. You want employees to answer clients’ questions confidently and consistently about the new fee.

Say this, “Our veterinarians have determined which patient treatments need health assessments from technicians and veterinary assistants. Our health assessment includes getting your pet’s vital signs of temperature, pulse, respiration, and weight, along with asking you history questions and updating your pet’s medical record with this information. For this nursing care, we charge a health assessment fee of $XX and fees for additional services provided during the technician appointment. For example, an appointment to change a pet’s bandage would include a health assessment to check that the wound is healing properly along with fees for the bandage change service. I am confident that you will find value in the nursing care that our technicians and assistants provide.”

Doctors need to transfer trust. When veterinarians perform exams and give immunizations, tell clients what to expect for the next booster vaccinations. Say, “<Pet name> will need a booster vaccine on <date>. You will schedule an appointment with my technician, who will conduct a health assessment, give the booster vaccine, answer your questions, and update your pet’s medical record. We take a team approach to preventive care. I value the contributions of our nursing team.”

Communicate value at the start of technician appointments. Set client expectations upfront. The technician or assistant will explain, “I’m <name>, the certified veterinary technician who will perform <pet name>’s health assessment and give the Leptospirosis booster vaccine. I will get <pet name>’s vital signs, including temperature, pulse, respiration, and weight. I will ask questions about your pet’s health and update <pet name>’s medical record with the vital signs and information we discuss. What questions may I answer before we get started?”

When your practice utilizes technicians like physician assistants, technicians will work at the top of their licenses, improving job satisfaction and employee retention. You will increase appointment availability for clients, which is advantageous with today’s overloaded schedules.

WANT TO LEARN MORE? 

Enroll your team in the training bundle: Confident Exam Conversations: 6 Courses.

About the Author: Best known as the “Queen of Scripts,” Wendy S. Myers, CVJ, has taught communication and client service skills for more than two decades. As founder of Communication Solutions for Veterinarians, she teaches practical skills through online courses, onsite coaching, and conferences. Wendy was a partner in a specialty and emergency practice. Visit CsvetsCourses.com and YouTube.com/csvets to learn more.

References:

1. The Veterinarian-Client-Patient Relationship (VCPR). American Veterinary Medical Association. Available at: https://www.avma.org/resources-tools/pet-owners/petcare/veterinarian-client-patient-relationship-vcpr. Accessed Jan. 3, 2024.

2. Guide to Good Nursing Practice Health Assessment. Available at: https://www.nchk.org.hk/filemanager/en/pdf/health_assessment_e.pdf. Accessed Jan. 3, 2024.

3. Occupational Outlook Handbook, May 2022. Veterinary Technologists and Technicians. U.S. Bureau of Labor Statistics. Available at: https://www.bls.gov/oes/current/oes292056.htm. Accessed Jan. 3, 2024.

4. Occupational Employment and Wages, May 2022. Veterinary assistants and laboratory animal caretakers. U.S. Bureau of Labor Statistics. Available at: https://www.bls.gov/oes/current/oes319096.htm. Accessed Jan. 3, 2024.

5. Woodruff J. Benefits as a Percentage of Wages. Chron. Available at: https://smallbusiness.chron.com/benefits-percentage-wages-14587.html. Accessed Jan 3, 2024.

6. Tips to Help You Manage Veterinary Staffing. Simmons & Associates Inc. Available at: https://simmonsinc.com/can-you-manage-veterinary-practice-staff-expenses/#:~:text=The%20total%20support%20staff%20expense,23%2D25%25%20of%20revenues. Accessed Jan. 3, 2024.

How to get more exam rooms

How to get more exam rooms

How to get more exam rooms

By Wendy S. Myers, CVJ, Communication Solutions for Veterinarians

“I have too many exam rooms,” said no veterinarian ever.

Veterinary hospitals have an average of three exams rooms.[1] A practice needs 2 to 2.5 exam rooms per veterinarian.[2] Chance are, your hospital is short one or more exam rooms. Animal Arts, a veterinary architecture firm in Boulder, Colo., agrees, “You can never have too many exam rooms!”[3]

Renovating to add exam rooms is a smart business decision. Each exam room averages $342,312 in annual medical revenue.[4]You’ll spend about $130 per square foot to renovate an existing building[2]. A 200-square-foot exam room will cost you about $26,000 to remodel—but where can you find the extra space?

shrink your food room.

Look at the footprint that food storage consumes at your practice. Management consultants estimate practices pay 28 percent to 40 percent of the product cost to manage the inventory.[5] Food also has lower markups of 39 percent for therapeutic diets compared to 65 percent for preventives and 107 percent for prescription medications.[6]

Lead more clients to home delivery through your online pharmacy and pet food partnerships such as Purina’s Vet Direct, which lets clients get direct shipments while revenue sharing with your practice (https://www.proplanvetdirect.com). Auto shipment programs often include free shipping and rewards for clients.

Only stock starter cans and bags at your practice. When changing a patient’s diet, bring the product into the exam room and explain food transition instructions to the client. Say, “Here’s your starter bag. Let’s get you signed up for home delivery and place an order today. Your first auto shipment will arrive on your doorstep in three to five days. Recurring refills will arrive every four weeks so you never run out of food!” Home delivery appeals to busy working families, seniors who struggle to carry heavy items, and millennials who order lots online. Hospitals save on inventory and free up part the square footage for new income-generating exam rooms. Another reason to lead clients to auto shipments: Compliance for therapeutic diets skyrockets to 10 bags per year compared to less than two bags sold at the hospital.[7]

GO OUTDOORS.

Star of Texas Veterinary Hospital in Austin, Texas put a southern flair on being a Fear-Free certified practice with three outdoor exam spaces on a 4-acre wooded lot (https://staroftexasvet.com). Each 20-by-20 foot outdoor exam space has an 8-foot wood privacy fence, tent, picnic table, locking supply box, and locking gate. “Backyard appointments” help the four-doctor hospital promote its Fear-Free methods. About 15 patients per day are seen in the three outdoor exam spaces. Star of Texas Veterinary Hospital spent less than $2,000 on fencing, picnic tables, and supplies.

Weather is the only limitation. “When it’s 112 degrees in the summer, clients can only book 8 a.m. appointments when it’s cooler,” explains Hospital Administrator Dana Wile, CVBL. “We move tents around as the sun moves. Clients and dogs love our outdoor exam spaces. It’s like going to the dog park for a walk.” Her only regret is not covering the tops of outdoor exam spaces. An affordable solution might be a carport canopy. Next, Wile is planning an outdoor “catio” where cats can enjoy a fully enclosed outdoor exam space.

Drive-thru service. Marty Greer, DVM, JD, opened the world’s first small animal drive-thru wellness center, Checkout Veterinary in Sun Prairie, Wis. (https://www.checkoutvet.com). The hospital has four garage bays where clients can drive in, and pets are isolated from other patients. Care can be delivered in garage bays or in adjacent exam rooms with Dutch doors where clients can see their vehicles.

reclaim part of your lobby.

Reduce your waiting space. Clients will appreciate being escorted immediately into exam rooms instead of passing time in a noisy, high-traffic lobby. At Fetch Specialty and Cancer Centers in Bonita Springs, Fla., clients enjoy a comfortable and welcoming waiting porch.

Scrutinize your seating arrangement. Have small group seating areas rather than long rows of chairs that make the lobby look cluttered, advises Jeff Clark, AIA, ICC, principal of MD Architects in Indianapolis, Seattle, and Boston.[8] Bench seating welcomes clients of all body types.

Use free-standing kiosks instead of traditional reception desks, Clark recommends. Untether your client service representatives (CSRs) with wireless headsets and tablets. CSRs can greet clients at the front door and escort them to exam rooms for in-room check-in. Veterinary assistants or technicians can wrap up visits with exam room checkout, reducing payment time from the seven to 10 minutes for traditional front-desk checkout. Ask your practice-management software provider about securely stored credit-card information in its platform, compatible apps for payment, and credit-card terminals in exam rooms.

Phones can be answered nearby in a cubby or consider remote CSRs who answer phones and schedule appointments from home (Read “Is Remote Work the Secret to Keeping Staff,” https://csvets.com/remote-workers/).

Repurpose retail space. Run a sales report of your annual retail revenue. Convert the space into one or more exam rooms. Shift sales of collars, leashes, and retail products to your online pharmacy.

RECONFIGURE DOCTORS’ OFFICES.

Forgo traditional doctors’ offices that practices had in 1985. Veterinarians can have private spaces for calls and recordkeeping, but money-making exam rooms take priority. Animal Arts suggests having a shared glass fishbowl workstation adjacent to the treatment area, which is an efficient use of space and controls noise. Build one or two phone booths for additional privacy where doctors and support staff can participate in Zoom meetings and webinars or conduct telehealth visits. A large, shared doctors’ office now becomes smaller work cubbies, and you get the extra exam rooms or dental suite you’ve been dreaming of. 

Ideally, exam rooms should measure at least 10-by-10 feet to allow space for medical staff, patients, and clients.[9] Exam spaces don’t require much storage. Mobile carts can contain supplies, make restocking easier, and be tucked away when not in use.

Think creatively. Where could you find 10-by-10 feet of space—inside or outside? Reward yourself with a new exam room that can be used for doctor and technician appointments as well as a multi-purpose room for consultations, euthanasia, and other medical services.

WANT TO LEARN MORE? 

Enroll your team in the training bundle: Confident Exam Conversations: 6 Courses.

About the Author: Best known as the “Queen of Scripts,” Wendy S. Myers, CVJ, has taught communication and client service skills for more than two decades. As founder of Communication Solutions for Veterinarians, she teaches practical skills through online courses, onsite coaching, and conferences. Wendy was a partner in a specialty and emergency practice. Visit YouTube.com/csvets and CsvetsCourses.com for more.

References:

1. Mattson K. A Blueprint for Veterinary Spaces. JAVMA News. Available at: https://www.avma.org/javma-news/2021-04-15/blueprint-veterinary-spaces. Accessed Dec. 7, 2023.

2. Hoeksema A. Opening a Profitable Vet Clinic: Numbers You Need to Know. ProjectionHub. Available at: https://www.projectionhub.com/post/opening-a-profitable-vet-clinic-numbers-you-need-to-know. Accessed Dec. 8, 2023.

3. The ABCs of Veterinary Hospital Design. Animal Arts. Available at: https://www.animalarts.com/the-abcs-of-veterinary-hospital-design/. Accessed Dec. 8, 2023.

4. Hawn R. Hospital Considerations: Expand or Build New? AmerisourceBergen. Available at: https://www.mwiah.com/our-insights/hospital-considerations. Accessed Dec. 8, 2023.

5. Brown J. Deliver the Goods. Today’s Veterinary Business. Available at: https://todaysveterinarybusiness.com/deliver-the-goods/. Accessed Dec. 8, 2023.

6. AAHA Veterinary Fee Reference. AAHA Press 2020: 229, 228.

7. Garrison G. No Place Like Home (Delivery). VetAdvantage. Available at: https://vet-advantage.com/vet_advantage/no-place-like-home-delivery/. Accessed Dec. 8, 2023.

8. The Power of First Impressions at the Vet. MD Architects. Available at: https://www.mdarchitects.com/the-power-of-first-impressions-at-the-vet. Accessed Dec. 8, 2023.

9. Animal Hospital Design Strategies for Better Care. AAHA. Available at: https://northamerica.covetrus.com/docs/default-source/landing-pages/equipment-new-build/midmarkhospitaldesignstrategies_small.pdf?sfvrsn=40b16d73_2. Accessed Dec. 8, 2023.

 

Enough! When to Fire Clients

Enough! When to Fire Clients

Enough! When to Fire Clients

By Wendy S. Myers, CVJ, Communication Solutions for Veterinarians Inc.

After firing eight clients for crabby behavior in one month, a hospital manager hung a poster in the lobby notifying clients, “We have zero tolerance for aggressive and abusive behavior.” Fed up with entitled jerks, more managers are initiating “kindness policies” and notifying clients through mass emails, social media, and new client registration forms. Managers don’t want employees to fear for their safety or psychological well-being.

Define which behaviors merit firing

Hospital leaders should define reasons to fire clients such as:

  • Threatening or aggressive behavior and/or language
  • Physical violence
  • Discriminatory behavior
  • Failure to honor hospital policies
  • Refusing to pay for services and/or having outstanding balances
  • Three or more no-shows for appointments and/or procedures

Schedule a staff meeting to learn and practice conflict-resolution techniques so employees can react appropriately when situations arise. Professional in-the-moment responses may correct clients’ bad behavior and set expectations for future interactions.

correct bad behavior the first time

In my course on What to Say When Clients Challenge You, I teach how to change behavior from combative to collaborative. Let’s say Mr. Friendly mutates into Mr. F-Bomb. Explain the expected behavior and how it will result in a solution. Isolate the client by taking him to a private area such as an exam room, doctor or manager’s office, or employee break room. Reducing his contact with an audience of other clients will de-escalate the situation and communicate your desire for immediate resolution. Stand up so you and the angry client are on the same eye level. If you are seated and the client is standing, he is in the dominate position. Walk and talk as you guide the client to a private area for further discussion.

SAY THIS: “So you may have my complete attention and we can find a solution together, let’s step into an exam room.”

To correct foul language, state benefits of respectful behavior.

SAY THIS: “If I hear that language again, I won’t be able to help you and your pet. We need to find a better way to communicate so we may find a solution together.”

The word “language” is neutral compared to “If you don’t quit cursing,” which may be perceived as confrontational and lead to more negative words. Use “we” to show collaboration rather than “you,” which blames the client. “Solution” communicates you want to resolve the issue. If bad language continues, ask the client to leave the building or explain you will hang up if it is a phone conversation.

how to eject bullies

Don’t be bullied by clients who shout expletives. If unruly behavior continues, follow five steps to eject a bully from your hospital:[1,2]

1. Assess the potential danger of the confrontation. Employees should seek support from a manager or veterinarian when a client becomes verbally abusive. The right words instruct the client to immediately correct the behavior. 

SAY THIS: “I understand that you are frustrated. We both need to be calm and work together to resolve this situation.”

If a client appears to be under the influence of alcohol or drugs, offer to call a taxi. If the client is with others, ask a sober person to drive the offender home. If the impaired client insists on driving, get a description and/or photo of the car and license plate and call police with that information. You also may have security cameras that record the incident.

2. Explain why you’re asking the client to leave. Abusive behavior will not be tolerated. 

SAY THIS:

  • “While you have a right to voice your concerns, you do not have the right to be abusive to our staff.”
  • “As a manager/veterinarian, it’s my responsibility to protect my team, other clients, and patients so I must ask you to leave the hospital now.”
  • “If you don’t leave our hospital voluntarily, I will call the police to protect my staff, other clients, and patients.

3. Escort the client out of the hospital. Use body language to reinforce your ejection of the client. Walk toward the exit and ask the client to follow you. Keep walking towards the door, even if the client doesn’t initially follow you. Remain at the door. This firm body language communicates your request to leave is final and non-negotiable. Watch the client drive out of your parking lot. If the client sees you immediately leave the door, he or she may return inside.

4. Don’t put your hands on the client. Touching an irritated person could get a violent reaction.

5. Call the police if necessary. Call the police if the client is threatening physical harm to you or others, breaking a law, or damaging hospital property.[3] Don’t be timid. Look the client in the eye and explain, “Please leave the hospital immediately, or I will call the police.” You are telling—not requesting—that the client must leave now.

Because clients will always challenge you, teach your team what to do before situations occur. Like any good relationship, open communication and clear expectations will build trust and respect.

sample “You’re Fired” Client Letter

If you decide to end a client relationship, send a “You’re Fired” postal letter by a traceable method to confirm delivery and receipt. A client may easily delete or overlook an email or text. 

Terminate the use of all services, from veterinary care to boarding. If you let the client continue to use ancillary services, you suggest the behavior was acceptable. 

Enclose medical records for all pets in the household. You don’t want the troublesome client returning to pick up records and causing another scene in your lobby.

Use firm statements such as “This letter severs our business relationship.” You are done communicating. Period. 

Have a doctor or manager sign the termination letter. The client needs to know this decision is final and comes from the top. 

The day you send the postal letter, immediately inactivate the client’s record to stop future reminders and prescription refills. Put an alert in your practice-management software so all employees know the fired status in case of future contact. 

Notify employees the same day you fire a client. Send an email, call a huddle in the treatment area, or post the letter with the client’s address blacked out on an employee bulletin board. Employees need to know when client relationships have been terminated. You’ll likely get high-fives and respect from staff who appreciate when leaders stand up for them. 

Dear <Client Name>: 

<Your Veterinary Hospital> takes pride in its compassionate, professional staff. We expect mutually respectful relationships with our clients. You’ve indicated displeasure with either our services or our healthcare team <list specific instance sticking to facts>. 

Because of your interactions with our team, <Your Veterinary Hospital> will no longer provide veterinary, boarding, or grooming services for your pets. OR Because we are unable to provide you with satisfactory service, we can no longer retain you as a client. 

For your convenience, I have enclosed medical records for <pet name> so you may seek services elsewhere. We are confident you will find another veterinarian who can accommodate your requests. 

This letter severs our business relationship. Any future communication to <Your Veterinary Hospital> should be directed to me.

Sincerely,
<signature>
Doctor or manager name 

Enclosures: Medical records for <pet name> 

WANT TO LEARN MORE? 

Enroll your team in the online course:  What to Say When Clients Challenge You

About the Author: Best known as the “Queen of Scripts,” Wendy S. Myers, CVJ, has taught communication and client service skills for more than two decades. As founder of Communication Solutions for Veterinarians, she teaches practical skills through online courses, onsite coaching, and conferences. Wendy was a partner in a specialty and emergency practice. Visit YouTube.com/csvets and Csvets.com for more.

References:

1. Patrick M. How to Deal with a Client Who Is a Bully. Chron. Available at: https://smallbusiness.chron.com/deal-client-bully-25567.html. Accessed Dec. 12, 2022.

2. Ejecting a Customer. WikiHow. Available at: https://www.wikihow.com/Deal-With-Aggressive-Customers. Accessed Dec. 12, 2022.

3. At What Point Do You Need to Call the Police? Angry Retail Banker. Available at: http://www.angryretailbanker.com/2015/05/11/at-what-point-do-you-need-to-call-the-police/. Accessed Dec. 12, 2022.