The keys to a preferred practice

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by Bo Brock

What makes people choose the veterinarian whom they will trust with the health and well-being of their animal? My mind drifted back to 1990 and my first job as a veterinarian in Clarendon, Texas. Dr. Chuck Deyhle was my mentor and had been in practice for 40 years. To this day, I consider him to be one of the best practitioners I have ever known. His pointed words came back to me, conjuring memories of his unique way of weeding out the adjectives. It seems that people who really understand a subject can tell you about it in a few simple sentences that manage to cover all the relevant stuff. Some of Dr. Deyhle's last words to me as I left for Lamesa to open my own practice were, "Bo, there are three reasons people choose a veterinarian: better service, better prices, or they just like the doctor and the staff." I left Clarendon with that on my mind and did my best to take it to heart.

In the intervening 16 years, I have been to countless practice management seminars and paid professionals to evaluate our practice to help us identify how to make it better. No matter how they put it, it always came down to the same three things: people, places, and prices. If you really look into practices as an unbiased observer, you will find that thriving practices are in tune with these three things. Struggling practices, on the other hand, lack at least one. It is consistent enough to be scary.

We are subliminally conditioned during our education to seek rewards. For example, we start school in August, are given a syllabus that tells us everything that is about to happen, are given a series of tests, and are rewarded, one way or the other, with a grade. All of us mastered this lifestyle; otherwise, we never would have gotten into veterinary school, much less graduated. So what happens to us when we get out and go to work? Without clearly defined rewards, such as quarterly grades, we have no scale to tell us how we are doing.

I was so tied to this way of thinking that I couldn't get away from it when I started my practice. I never knew whether I was making an A, B, C, D, or F. So I decided to make my own grading scale based on how well I thought I'd done with each client. I actually wrote my grade on the medical record at the end of each client transaction and then gave myself a grade for the day. Here's the scale I used to grade my performance:

  • A = The client actively tells people I'm a good veterinarian.
  • B = If asked, the client will say I'm a good veterinarian.
  • C = If asked, the client will simply say they use me.
  • D = If asked, the client will say I'm a bad veterinarian.
  • F = The client actively tells people I stink.

By the end of most client transactions, I found that I could tell which grade I'd earned. My ultimate challenge was to get an A even when an animal died or a surgery went badly, and I did my best to earn the high grades that I never got in school. In most cases, studying for tests was a whole lot easier.

People

Clearly, the personality of a practice reflects more than just the veterinarians who work there. In fact, the old adage "You only get one chance to make a first impression" couldn't be truer than when new clients walk into a veterinary practice. They see and hear everything, making the attitude and priorities of the staff far more important than when work is going on behind closed doors. For a practice to get an A in this area, the client has to leave wanting to actively tell others that the people at your clinic are wonderful. If you own a practice, you know this is a tough one. It is hard to be happy all the time. It is hard to tell the story of heartworm infection 12 times a day. It is hard to work 60 to 80 hours a week and still be fun to be around on Saturday. In fact, I don't think it's even possible. But I do know that we need people around us who can be happy when we aren't. We need people who are proud of the practice where they work and can't wait to brag about it when the chance arises.

The more people there are in a practice, the harder it is to have a positive atmosphere. It is a constant struggle that evolves with new people and old personalities. No veterinary clinic can be truly successful without wonderful employees. The veterinarian cannot do it alone, and a wise veterinarian knows that credit for success has to be shared. Practices require teamwork, and everyone should be praised when things go well.

How does this team respond to success or, more important, failure? Persistence in the face of failure measures the character of the people in a practice. Clients pick up on this as they observe how the people in a practice deal with their animal.

I analyzed the group of people who make up our clinic and tried to use the grading scale to see how we were doing. Look at your team: If you wrote grades on the medical records of each client transaction, how would you score at the end of each day? 3.5, 2.7... 4.0? Practice isn't pass or fail.

Places

One of the essentials for a growing practice is services — the place. I think this area includes technical merit, the overall character of the practice, attention to continuing education, and reinvestments into the practice to keep it modern and innovative. Take a look at your facility. Is it clean and modern? Does it offer innovative technology? Are patients well cared for and handled with compassion? Are the doctors perceived as being on the cutting edge of their fields of interest? How much time does each client get, and how many follow-up phone calls are made? It boils down to an image that the place portrays of what is meaningful. Clients observe these things and feel either confident that the team is qualified to give the most advanced care possible or skeptical and consider looking elsewhere.

Take a look at your practice through the eyes of your clients. How would your clinic be graded in these areas? Are you behind the curve or setting the pace for veterinary medicine in your area?

Prices

For some reason, veterinarians don't want to admit that prices make a difference. Recently, we wondered how our pricing schedule compared with other practices in our geographic area. So we called around and got a price range of $69 to $312 to spay a 20-lb dog! Believe it or not, great service does not always overcome exorbitant prices, and lots of people have a tight budget. I have seen more veterinarians go broke from high prices than from anything else.

Decisions about pricing reflect the philosophy of the practice. Do you want to see a huge volume at low prices or a small volume at higher prices? Do you want to cater to the upper crust or the middle-class masses? Do you feel that by not charging enough, you are insulting your ability and level of education? Do you continually find yourself comparing the fees you charge with the costs of similar procedures done by medical doctors and becoming disgusted?

People often make choices simply based on price. This is especially true when it comes to elective procedures or drug sales. Is your practice healthy on the pricing side of things? This is an area that money-oriented "practice analyzers" love: They want you to analyze everything as a return on investment.

It is a natural progression to charge more for something either as we get better at it or as we become tired of doing it. If you don't like doing a cesarean section on a cow with an emphysematous calf, you charge more. The theory is that if you charge enough, nearly any job can be fun. The problem with this approach is that eventually, almost every task becomes boring and, the next thing you know, no one can afford you.

There is a fine line between charging enough to make a good living, being able to sleep at night because you feel right about what you have been paid for what you have done, and becoming greedy. With a bit of time, you'll recognize when you've crossed that line.

What grade would your clients give you for their perceived value of the services you rendered today? Are they going to go out and actively tell others that it was a good experience?

I thought about the three clinics I passed on my way home. I wondered what grades they'd earned on their latest client report cards and whether they even cared or were perhaps past caring.

I am happy to say that by the time I got home, I was feeling a bit better about the day. Our little clinic is healthy and growing and making a difference in the little slice of Texas we call home. We don't have a 4.0 grade-point average, but we are studying hard and trying our best to get there.

Veterinary clinics are complex beasts that can develop personalities of their own. This is why it is important to occasionally step back and truly evaluate what is happening throughout your practice. It is also why each of us needs a personal grading scale to help us identify areas we need to work on. Take a look at what you do each day, evaluate your performance through your client's eyes, and see if business doesn't pick up a bit as you focus more on improving your overall grade-point average.