Productive Management For Practice Owners, Office Managers and Staff

Gerry Snyder VMD

Our Schedule

•  Why are we not succeeding in making our practices more profitable?

•  Overview of veterinary economics.

•  Productive Staff Management for Optimum Productivity.

•  Increasing ethical medicine income with enhanced communications.

The Surgeon General cautions you �

Taken properly, the recommendations of this seminar could increase your practice's net revenues by 50-90% within 90 days.

The Average American Practice Is Losing 20-30% of potential, ethical income each and every day, week month and year!

In a $450,000, two doctor practice, bottom line loss is $120,000/year

Look Around You !!

Statistically, one in three animal hospitals may fail in practice by 2005 or earlier.

Do You Know Why ??

Veterinarians will fail to achieve their full success potential for one reason only.
Somebody will talk them out of doing what they need to do!

"The Average American Practice Is 27 Days Away From BANKRUPCY"

"No Cash Reserves" ... Bank of America

Rough Ride ?

The Bad News

•  Pet populations are stable (NO GROWTH).

•  Number of vets in private practice rising.

•  Number of pets per veterinarian decreasing.

•  New technology keeps pets healthier longer = fewer visits to our hospitals.

Most Practice Owners Believe �

•  The majority of pet owners are poor people.

•  Mongrels deserve less than the best care.

•  Clients are the best judge of what pet needs.

•  Fact: The majority (54%) of your clients make more than their veterinarian!

The Best Pet � What Is It?

•  Goes where you go!

•  Eats what you do!

•  Never needs vaccinations!

•  Keeps you slender!

•  Eliminates bowels/urine in convenient place!

•  Needs no exercise!

•  No grievance counseling needed when dies!

The Worst Pet � What Is It?

12 Most Common Veterinary Exercises

•  Jumping to conclusions.

•  Climbing the walls.

•  Throwing their weight around.

•  Dragging their heels.

•  Going over the edge.

•  Picking up the pieces

•  Beating around the bush.

•  Wading through paperwork.

•  Bending over backwards.

•  Running around in circles.

•  Putting their foot in their mouth.

•  Starting the ball rolling.

Healthy Practices

•  Grow 15% annually in gross revenues

•  ATF grows 10-15% annually

•  Receivables less than 3 weeks gross

•  No bills left over at month's end

The Average American Practice Has 5-15% fewer client transactions this year!

Today's two doctor "productive practice," generates $679,000/year and nets $273,000 working 40-45 hours/week.

In a $450, two doctor practice, bottom line is $143,000. loss is $120,000/year.

Prosperity Until 2008 Then ?

•  76 Million Baby Boomers begin to hit 55 in 2001 (kids grown & gone) will place 80% of extra earnings in stock market.

•  2009 will begin the reverse trend as retirees draw down their funds for living expenses.

Drug Prices Are Rising

Labor Costs Are Rising

Fewer Plan To Expand

Sales Are Slipping !!

Did You Know?

In any given area, the top 54% of clients earn more than their veterinarian.

Major Changes Yet To Come

•  70% reduction in Vaccination income

•  Insurance Plans (Good!) HMO (Bad!)

•  Increased Demand for Staff

•  Benefit Plans

•  Associate Shortage

•  13% client loss/year is normal, but not being replaced

AVMA Job Market Study

•  "Small Animal Practices Deliver Services Very Inefficiently With Respect To Overhead, Staff Utilization and Investment."

•  "Veterinarians Lack The Skills To Maximize Economic Success."

•  "There Are Too Many Veterinarians Competing and Driving Fees Down."

•  "No Increase in pet ownership last five years."

•  Veterinarians Have Lower Self-Esteem Than Needed To Fulfill Their Potential.

•  Pet Spending Will Exceed The CPI By 196% From 1998-2015.

•  Spending In Real Dollars Will Increase 8.9% Annually.

•  Vet Salaries Will Remain Low Until 2015.

•  What about staff salaries ????

"Most Veterinarians are introverts and do not have well developed people skills. Yet, their ability to relate to clients is the single biggest determinant of their success!"

Show Sincere Interest in Client

We are not in the pet business �
We are in the people business.

The most important tool is to take an interest in people.

Show a sincere interest and harvest an immediate expansion in your level of fulfillment.

Average Net Income

•  Dentists net an average of $128,000

•  Optometrists net an average of $89,000

•  Veterinarians net an average of $59,000

Why the Huge gaps ???

•  These other professions more fully utilize the skills, talents and abilities of their health care team members.

•  They leverage and delegate.

•  Veterinary fees are woefully inadequate.

Multiply Yourself

•  The number of eye exams per Optometrist has increased 50% from 1,413 to 2,123

The Most Successful Veterinary Practices Have 3.5 or more FTE per Veterinarian

The average veterinary practice has only 2.96 FTE .

Staff Per Veterinarian

•  0.156 Certified Technician

•  1.3 Assistants

•  0.85 Receptionists

•  0.1 Office Managers

•  0.15 Others

TODAY 2.55 staff/Dr.

Impact of Hygienist* Leverage

•  Additional patient visits per week  23

•  Number of work weeks per year  50

•  Additional patients per year  1,150

•  Average Transaction Fee  $122

•  Increased gross income  $140,300

•  Increase in NET income  $84,180

*  Read as exam room technician

We Are A Fixed Cost Business

•  Maximize capacity utilization.

•  Maximize use of scarce or finite resources.

•  Leverage and delegation are critical.

•  To increase profits, focus on the top line.

•  You cannot save yourself into affluence.

•  Managing seasonality is critical.

Many pets don't get best care because their vet is not a pet advocate.

Don't think about sales! Think only about the fate of this patient, if you are unable to convince the Pet Owner to treat the disease!

Many veterinarians see themselves as craftsmen who just want to work on the pet.

They do not see themselves as leaders of a staff team who, in turn, give them an opportunity to practice their skills.

The veterinarian does not have to be the leader of the business !!!!

The veterinarian does, however, have to understand the system for managing the practice and monitoring its progress.

To Increase Demand For Services

•  Increase the pet population.

•  Increase the number of pet owners.

•  Increase the number of pets receiving regular veterinary care.

•  Expand services to existing clients.

Veterinary Market Study

Pet owners said that they would pay an average of $92/month ($1,104/yr) to keep their pet healthy.

Every Practice Needs A Manager

Every manager needs to report to the veterinarian weekly on the status of the practice.

1.  Status of staff performance and morale.

2.  Status of staff training programs.

1.  Steps being taken to resolve any staff problems.

2.  Unresolved client issues and proposed solutions.

1.  Positive and negative fluctuations in practice vital signs.

Burnout

Burnout is a zillion little things acting up!!

We can't stand early clients, late clients, walk-ins, re-schedulers, no-shows, clients unable to pill, clients and pets who piss and crap in the exam room!

Stress and Burnout

Self Fufillment is the only prevention of burnout!
Waiting for a few days vacation to take away the accumulated stress of a year never works.
A vacation which includes a meeting is not a vacation!
Take mini-vacations daily.

Why Work Saturday?

•  53% have taken time off when pet is sick.

•  56% have taken off 1-2 days for pet illness.

Saturday is Sick Pet Day

•  Most practitioners lose money on Saturday.

•  Patient exams are poorest on Saturday.

•  ATF and Profit is lowest on Saturday.

•  Best clients are not Saturday appointments.

•  Practices net more when closed on Saturday.

•  Very rare is the sick Saturday pet!

•  Practicing on Saturday usually a disservice to pet.

•  Staff needs weekend rests too!

•  Saturday should be a holiday schedule.

•  Practicing on Saturday usually a disservice to Doctors and staff.

Veterinary Productivity Mission Statement

When you combine professional improvement and progress with personal fulfillment, you begin to create what most veterinarians and staff would consider a dream life.

Pet Ownership

1960-1995 3% Annual Growth
No Increase in Pet Ownership for 5 yrs

Look Around You ...

•  Economic environment has great potential

•  Lowest inflation except Medical (Double)

•  Interest Rates Still Lower than a decade ago.

•  Steady growth in GDP

•  Full employment (lowest labor pool)

•  Strong Housing Market

•  Stock Market Winners and losers

Changes 1996-1997

Productive Practice Survey

•  DHLPP  70%  62%

•  RABIES  52%  48%

•  BORDETELA  49%  45%

•  LYMES  75%  70%

•  FeLV  69%  60%

•  FIP  66%  63%

•  CORONA  43%  44%

•  FVRCP  58%  48%

Dog  2.9 - 2.7 (-7%)  Cat 2.45 - 2.2 (-10%)

The Better Reminder Card

Because We Care... It's that time again! Time to come and visit our hospital.
In the last human year, at least four of your pet years have elapsed.
Check our chart below for your equivalent human age.

It's now time to check you all over.
While you are here, we'll renew your immunity to keep you healthy and able to play with your adopted human family for as many years as possible.

Ask your parents to fill the enclosed specimen bags on the day of your appointment. This will help us make sure that you don't have nasty pets of your own, living inside you and also help detect other common diseases, before they are too late to cure.

Looking forward to hearing from your parents to schedule your appointment, so we can see you soon and continue keeping you healthy,

Pet Ownership Style

Chihuahuas and Chow Chows A Hairy Revolution

•  7 out of 10 TV ads involve pets

•  60% of pet owners feel guilty about leaving their pet at home alone.

•  400,000 dog bites in 1998 but no bad press

The Bond

•  Spending on pet increases 9% annually. (93-97)

•  Online pet supplies will hit $800 million (2000.)

•  60% of Households own a pet.

•  40% of Households own more than one pet.

•  80% are female 2/3 are married.

•  70% of households have no children <18.

•  78% greet pet before spouse or children.

How Do Your Fees Compare?

•  Canine OHE  439%

•  Canine Neuter  365%

•  Feline OHE  324%

•  Feline Neuter  199%

•  Chem Panel  195%

•  X-Ray Study  352%

•  CBC  94%

•  Urinalysis  79%

There are three rules that veterinarians must never be allowed to forget!

Rule #1

Clients will never pay a consultation fee that approaches even 1/3 of the worth of our education, experience, investment and devotion.

Rule #2

Our fees for services need bear no relation to economic rules or profit center analysis.

Our fees are merely a reflection of our clients totally inappropriate perceptions of relative values as required to compensate for the damage caused by Rule #1.

Rule #3

•  Because our fees are the composite formed by past medical history and current physical examination, it is impossible to correctly determine a fee for service without examining the patient.

•  Therefore, no estimates can be given over the phone.

Change Is Not An Option !!

Click image to view enlarged version.

Click image to view enlarged version.

Comprehensive Medicine

•  Diagnosis must be based on laboratory, and radiology. Guesswork is out!!!!

•  Most patients lost unexpectedly were not evaluated thoroughly!!!

All Clients Are Not Equal

•  "A" 75-80% of all profits come from 25% of your clients (Those with 3-5 visits/year.)

•  "C" Middle 30% provides only 20% of our profits. (1-2 visits/year)

•  "D" Bottom 45% provides only 5% of our profits. (0.87 visits/year)

•  Limit "D" Client Appointments to give yourself 45% more time with "A+C"

Are You Currently Asking?

•  Any recent vomiting?

•  Any listlessness?

•  Any weakness?

•  Any lameness?

•  Shaking of the head?

•  Coughing?

•  Sneezing?

•  Scratching? Where?

•  Scooting?

•  Lumps or bumps?

•  Bad Breath?

•  Diarrhea?

•  Constipation?

•  Stiffness?

•  Behavioral changes?

•  Seizures?

Your Examination Form

•  Must be two part to save minutes and hours.

•  Must go home with client for family review.

•  Acts as their conscience ! ! ! !

•  Increases client compliance by 35-40%.

•  Keeps you keyed to thoroughness.

•  Brings associates into conformity.

•  Loved by clients who "finally understand."

Incomplete Exams

•  Misdiagnosis.

•  Missed diagnosis.

•  Loss of client confidence.

•  Client discrimination.

•  Poor exams = poor net profit !!

•  More mistakes made by not looking than by not knowing !

Clients retain only 20% of what they hear � but 80% of what they see!

Perceived Exam Thoroughness

•  Instrumentation = "STOP" = Stethescope + Tonopen + Otoscope + PAM.

•  Verbalization during exam.

•  Client observation.

•  Pet Exam Report Card.

Coat & Skin Mouth & Teeth

•  Appears normal

•  Scaly

•  Infection

•  Matted

•  Itchy

•  Dry

•  Tumors

•  Parasites

•  Appear Normal

•  Tartar buildup

•  Loose Teeth

•  Periodontitis

•  Painful

•  Tumors

•  Pyorrhea

•  Abscessed

The Thorough Practice is the Most Profitable Practice

The only effect of trying to compete with pet stores is to increase your inventory costs, and decrease your profit margin.

Make medical decisions...
Not financial decisions !!!

There is enough pathology present today to keep all of us busy working overtime for a lifetime !

Clients Have Options

•  Accept your recommendation.

•  Think about it.

•  Get another opinion.

•  Talk to their spouse.

•  Reject the recommendation.

•  Procrastinate and do nothing.

Your Client Does Not Care How Much You Know �. Until �..They Know How Much You Care

Clients have to know �

•  What's wrong.

•  What caused it.

•  Probable outcome untreated.

•  What can be done about it.

•  Will it hurt.

•  How long will it take.

•  How much will it cost.

Do You Believe?

•  That dental disease is bad for a pet's health?

•  That absorbed bacteria from the mouth is the cause of liver, kidney & heart disease?

•  That dental disease causes oral pain?

•  That dental disease can shorten a pet's life?

•  That dental disease is preventable?

•  That you are communicating these facts?

Dentistry Script

"Mrs. Jones, Fluffy has problems! Her mouth is sore and infected! The pus is being absorbed, spreading to her heart, liver and kidneys! This will really shorten her life! We need to borrow her for a few hours to get rid of the infection and the pain, then we'll show you how to prevent this from coming back!"

Make A Believer Of Your Client

Your Inventory Sales Today

•  Prescription Drugs  21%

•  Heartworm  26%

•  Flea and Tick Products  9%

•  Non-Prescription Pet Foods  38%

•  Pet Supplies (shampoos, collars)  6%

Say Foodbye to 53% of Inventory Sales

Non-Vet Market Share

•  Premium foods  95%

•  Flea control  50%

•  Heartworm prevention  52%

Best Defense ---- Become An On-Line marketer

Shopping On-line

Provide your clients with the ability to order heartworm or other products with a quick phone call. Charge to their credit card on file.
Add PRIORITY shipping. $4.00

Your Services Today

•  Laboratory 14%

•  Radiology 5%

•  Out-Patient Examinations 15%

•  Hospitalization 12%

•  Non-elective Surgery 13% Other 13%

•  Vaccines 26%

•  Non-Medical Services 11%

•  Say goodbye to 50% of service income.

A + B must = C

A  =  profit from services performed

B  =  profit from inventory sold

C  =  profit required to maintain salaries

Staff and Facility Determine 60-80% of A Clients �

•  Liking your animal hospital.

•  Ever returning for another visit.

•  Ever referring a friend.

•  Staff even helps clients in their determination of the quality of the medicine practiced and how much the veterinarian seems to CARE.

Your First Time Client ... You don't know their background, education, Peronality or ... current mood.

They form their opinion based on �

•  Parking lot

•  Landscaping

•  Building

•  Signs

•  Front Door

•  Initial eye contact

•  Floors

•  Walls

•  Art

•  Colors

•  Odors

•  Documentation

•  Receptionist's uniform

•  Staff personality

•  Doctor personality

•  Fairness of bill

What's your reception area like?

•  Dog screaming in the back producing psychosis!

•  Your idea of a high quality reception area is one that can be hosed down?

•  Little old lady with un-declawed cat next to a 200 pound Bull Mastiff read to rip her lips off!

•  Pit Bull Tryig to mate with your drapes?

Developing Loyal Clients

•  Hallmark Syndrome.

•  Dress professionally to enhance compliance.

•  Be Consistent. Everyone hates change.

•  38% never return after the 1st visit (Avg).

•  Retention efforts increase profits 25-100%.

•  Current clients represent over 60% of your future business and produce 2.81 x ATF in net profit each year.

Client Retention

•  High cost of acquisition.

•  Replacement cost is high.

•  After break-even point, average client adds 12.1 x ATF in pure profit over 4.3 years. (1.58x2.2x4.3x0.81)

•  Disenchanted clients have big mouths.

What would you do if you found out that syringes were no longer being manufactured ???

You would take utmost care to preserve the syringes you now have. You would train your staff in conservation methods and personally oversee their care.
Are existing clients any different?

It is 6 times more expensive to attract a new client than to retain a current client.

99.999% of households receiving the yellow pages directory will never bring a pet to you!!! Yellow pages display is a waste of your marketing dollar.

Increase client bonding �

•  Explain consumer benefits.

•  Send a welcome note.

•  Send a newsletter.

•  Telephone progress reports.

•  Recheck everything.

•  Survey satisfaction.

•  Invite for a 6 month checkup.

Ask For Referrals

•  Plaque in every exam room asking for referrals � Please send us your \friends.

•  Veterinarian must give out referral cards personally.

•  Reward referrals with a thank you note and a gift at their next visit. "This is just our way of thanking you for referring Mrs, X and her new puppy. (No discounts!).

What Clients Really Want �

•  Burdens lessened.

•  Time saved.

•  Correct answers to questions.

•  Do business with friends.

•  Shop from home.

•  Less stress.

Clients don't want Veterinary Medicine
They want freedom from needing Veterinary Medicine

Most Important Client Errors

•  Taking client for granted.

•  Using technical jargon.

•  Speaking too fast.

•  Giving short clipped answers.

•  Not reacting proactively to problem.

•  Not showing that you care about a complaint.

•  Being preoccupied by other tasks.

•  Interrupting the client or no longer listening to them.

•  Making snap judgements about the client's ability to afford services.

•  Arguing with client.

You gain more clients in 2 months by becoming interested in them than in 2 years trying to get others interested in you!

Do Whatever It Takes To Help Your Client Have The Most Rewarding Relationship With Your Hospital

Most Veterinary Staff Are Not There For The Money!

We must make their participation in our hospitals as rewarding as possible.
We must develop a thriving business to generate the profit needed to pay them well.

65% Of Hospital Staff Is Negatively Motivated?

•  To do less than they are capable of due to �

•  Insufficient Training

•  Deficient aptitude

•  Insufficient Positive Rewards

•  Undefined goals/priorities

•  Personality Factors (self-esteem)

•    �Lack of practice (Role playing)

It is 1000 times easier to criticize than to offer help or train...

Role Playing Tells You �

•  Quality of telephone skills.

•  Level of ENTHUSIASM.

•  Application of specific knowledge.

•  Clarity of answer.

•  Degree of practice and Doctor promotion.

Unclear Goals/Priorities

•  Owners seldom set goals.

•  No task priorities.

•  No regular mini-meetings to reinforce concepts.

•  No monitoring of staff performance of tasks.

Provide clearly written goals and priorities. Explain why goals benefit them, clients and you. Hold staff accountable but assign responsibility.

Staff Training Errors

•  Not taking personal responsibility

•  Not developing Leadership

•  Control Vs. Influence

•  Using I vs. WE

•  Treating everyone same

•  Tackling problems Vs. SOLUTIONS

•  Not Results Oriented

•  Buddy Vs. Leader

•  No Minimum Standard

•  Failing to TRAIN

•  Retaining Incompetents

•  Not rewarding leaders

•  Tolerate attitudes

•  Fail to LISTEN

•  Nepotism

•  NO ACCOUNTABILITY

Provide Realistic Rewards

•  Emotional Rewards

•  Monetary Rewards

•  Time Off

•  Profit Sharing

•  Advancement

•  Help with personal growth (C.E.)

•  Freedom is its own reward

•  Reward with fun

Your Staff Limits Your Practice

Doctors expect the practice to grow without growing the staff's abilities in client service.
Fixed Staff Skills  =  Zero Growth!
Client education begins with Staff education!

On the Job Training

Is only as good as the trainer wants it to be.
Expensive and wasteful! Trainer time is expensive and trainer cannot perform regular duties and train too!

Training Your Staff

Schoolteachers study for years!
We expect staff to train new employees without any kind of education training.

This is the appointment book!
Input the invoices!
We vaccinate annually!
The shampoos are in the corner over there!

Use professional training videos
Send staff to conferences
Let computer vendor train
Bring in Outside Educators

5 Critical Skills

1  Communication

2  Persuasion

3  Telemarketing

4  Telephone courtesy/Techniques

5  Excellent Customer Service

Staff Effect

Eliminate the energy vanpires

The Employee's prayer:

Help me to always give 100% at work.

12% on Monday
23% on Tuesday
40% on Wednesday
20% on Thursday
5% on Fridays

Snyder's Rules

•  Rule of 48
6 people rated "8" will out-produce
8 people rated "6."

•  Rule of 45
The maximum a practice can budget for veterinarians (includes owner) and staff is 45% of gross revenues.

Business Plan � Staff

•  Minimum/veterinarian = 2.5 (Rcpt + Tech + � Kennel).
•  Minimum hours open per week = 50.
•  Average minimum total cost/hour $10.00.
•  Cannot spend more than 20% for staff.

2.5 staff x 50hrs x 54 weeks x $10.00 = $67,500
$67,500/0.2 = $337, 500
282 working days per year
337,500/282 = $1,196 gross revenues needed to pay staff cost each day

Part Time Makes Sense

•  Large pool of ex......

•  Apartment or Car Syndrome.

•  Cheerful Full Shift.

•  Auto-substitution.

•  Adaptable - Tolerant.

•  Less benefits Needed (Spouse already has).

How To train

•  Tell

•  Sell

•  Participate

•  Delegate

•  Monitor

Animal Care Training Videos  (800) 357-3182
AVLS Reception Training  (800) 444-3634

Situational Leadership

Supervisors should not give their opinion without asking staff opinion first!
Study their answers ... Ask "Why?"

Most Practice Owners

•  Fail to promote teamwork!

•  Fail to listen and respond to staff!

•  Fail to effectively reward!

•  Fail to hold staff accountable!

•  Practice Nepotism!

Ask Staff How They Feel?

•  What do you like best about your job?

•  What do you like least about your job?

•  What causes you stress and frustration?

•  How could we improve your job performance?

•  Do you concur with your job description?

•  How would you change your job description?

When You Are All In The Same Boat.
Does It Make A Difference Which End Of The Boat Has The Leak!

Practices Should Reward

•  Autonomy

•  Risk Taking

•  Customer Service

•  Health

•  Cleanliness

•  Good Attitude

•  Common Sense

•  Simplicity

•  Good Ideas

•  Frugality

•  Timeliness

•  Innovation

Penalize Employees Who ...

•  Don't meet deadlines!

•  Cause conflicts!

•  Make excuses!

•  Refuse to learn new skills!

•  Drain your time and energy!

•  Have a bad attitude!

•  Challenge supervisor's authority!

Both Are Very, Very Wrong!!!

Many staff work just hard enough not to get fired. Some practices pay people just enough that they won't quit.

Click image to see enlarged version.

Click image to see enlarged version.

Do You Have????????

•  Chronic complainers on your staff ??

•  Staff who use gossip, manipulation or have temper tantrums ??

•  Staff that "love animals more than people" and show it, with poor client service??

Well Paid Staff

•  Works to hold down expenses.

•  Works for recognition as well as money.

•  Won't tolerate mediocre employees.

•  A "10" will not work with a "6."

•  A staff trained to handle client and patient's needs handles problems according to policies w/o Doctor.

Maximum % Staff Salaries

Attitude and Performance

•  Performance and Bonus are Linked.

•  Evaluate quarterly - bonus monthly!

•  Initial Passing Score 60-70%.

•  Increase Passing Score 5% each quarter to 80%.

Review Meaningfully

Performance Reviews Matter!!

In general, how do performance appraisals effect your level of motivation at work??

Group Bonus  4 FTE Staff

Failure to receive a personal bonus means improvement is required. All staff is not created or performaing equally. Staff alone determines their bonus share. They are not children. They must learn there are consequences to poor performance.

From $37,000 to $43,000

•  No additional rent, utilities, labor (fixed)

•  Only cost of the $6000 is drugs/supplies!

•  Drugs and supplies are 15% of expenses!

•  $6000 x 85% profit is $5,100 profit

•  10% staff bonus is $600.00

•  Net to bottom line is $4,500/mo =$54K/Yr.

$43,000 Month (-$37,000 (prior high) leaves $6,000
10% of $6,000 increase = $600 shared staff bonus

$600 / 600 hours = $1.00 per hour but...

$600 Staff Bonus  

Staff Radiates Self Esteem

•  Staff uses recommended products

•  Staff has dentistry for own pets

•  Check records on staff owned pets

•  Staff works hard to educate clients

•  Staff knows fees are justified by quality

•  Staff visits other hospitals

•  Marketing starts with your staff !!!!!!!

Knowledgeable Receptionist

•  Has to know more than client about pet care!

•  What educational tools do you have to train your staff?

•  Are they learning old mistakes as on the job training?

•  200 Questions?

200 Questions Most Frequently Asked by Clients And... 200 Answers Your Receptionist May Give Without Involving The Practice In Legal Liabilities
Free with 2 Yr subscription to Veterinary Productivity

Guidelines for Turning Knowledge Into Action

•  Teach the why before the how!

•  Action counts more than planning.

•  There is no doing without mistakes!

•  Fear fosters knowing - doing gaps. Drive out fear!!

•  Serve clients without internal competition!

•  It matters what the boss does. His/Her job is to get entire staff to know and do their jobs.

Client's Bill Of Rights

•  Every client has the right to a unique and pleasant greeting.

•  Every client has the right to receive competent medical service by a professional who shows interest in their welfare and the comfort of their pet.

•  Every client has the right to receive FAIR fees for the services performed.

•  Every client's pet has the right to in-date pharmaceuticals administered in a caring atmosphere.

•  Every client has the right to complain about anything and have their complaint resolved by a concerned staff.

•  Every client has the right to a 100% clean hospital.

The Client Is Always Right!

They communicate their displeasure to 5-15 others within one week. Many never complain � just won't be back.

Who Can Blame New Graduates?

I owe $63,800! I'm earning $38,000
I pay $8,800 taxes and $9,700 debt service
If I work 45 hours a week, I net $8.71/hour
How Can I Afford To Work Here?

Associate Compensation

•  Signing bonus (with completion clause).

•  Maximum % compensation of associate plus other staff cannot exceed 45%

•  No compensation on refills. (diet, Hx, Rx)

Interceptor 40 [x], [ ] Furosamide 12.5 mg, #60 [ x] [x ] [ ] [ ]

•  Percentage covers everything except employers social security & medicare 7.65%

Associate Common Sense

•  2 Year Contract

•  Liquidated Damages

•  Minimum Standard ATF = 3 x Office Visit

•  Self-renewing

•  Limits Turnover

•  Maximum Freedom

•  Most Successful

Associates On Percentage

•  15% more take home.

•  Practice increased 26%

•  38% less turnover.

•  Less future competition.

•  Greater partner conversion = exit strategy

Associate Contract Should Include

"This contract shall be terminated immediately at such time as the associate fails to achieve a passing score (80%) on his/her quarterly performance evaluation for two consecutive quarters

Reasonable Performance

•  Performs fair share of the workload

•  Leaves personal problems at home

•  Does not make repetitive errors in work

•  Adheres to approved fee schedule

•  Demonstrates concern about patients

•  Alert to safety hazards

•  Protective of staff

The Productive Associate

•  $400,000 in 1999 ($341,500 in 1996 Study)

•  $320,000 in Dr. Revenue $80,000 non-Dr.

•  Working with 1.8 exam room technicians.

An Associate With $10 less ATF Loses $37,500/year

$10/transaction x 75 clients/week x x 50 weeks = $37,500

Percentage Compensation

Paying an associate flat salary is inviting them to leave and compete with you!

I don't work for you! I work for myself at your hospital. Treat me right!!! If I think I can earn more somewhere else, even competing with you... I'm gone!

I'm a professional too! I may not have your experience, but I'm better trained than you! I'll do it your way for only so long. Respect me and my opinions or get ready to say goodbye!

Having Trouble Hiring An Associate???????

Recent graduates need a hiring bonus. They cannot afford to move without it!!!!
Don't bother offering less than $46,000!

Mission Statement

Our mission is to be the best pet care facility in our community as judged by our staff, clients and peers, measured by client satisfaction and consistent with fiscal responsibility

Appointments make sense!!

•  4 appointments per hour

•  5 minutes for second de-worm or sutures

•  10 minutes for re-exams

•  20 minutes for sick pet exams

•  25 minutes for new client pet exams

Laboratory In-House Vs Out-House

•  Increases lab usage by 55-65%.

•  Third party builds client confidence.

•  Treat by diagnosis ... Not guesswork.

•  Normal screens repeated in 24 hours often indicates diagnosis.

•  Daily progress can be monitored.

Lift Tables

•  Average practice has tech holding pet for doctor or another tech 3.7 hours per day.

•  Average tech costs practice 11.80/hour.

•  11.80 x 3.7 x 300 days = $13,098/year.

•  Lift table costs less than $3000 lasts 10+ Yrs.

•  Savings over 10 year period $127,980.

•  Technidyne Elsam Table 800-654-8073.

How Old Is Your Pet Really ?

How Long Would You Like Your Pet To Live ?

Old Way - Geriatric Work-ups

•  Cannot sell more than 3-6% by mail.

•  EKGs and Chest X-Rays are secondary.

•  Dental Anesthesia Profiles do the job.

•  No anesthesia >5 Years without lab.

•  Don't skimp on profile ($6)

•  Thyroid test all skin cases.

Add Up To Four Years To Your Pet's Life !!!
Longevity Enhancement Program

New Way... Longevity Enhancement

•  Longevity Enhancement Lab Profile;

•  Antirobe 5 mg/# for 1st 5 days of month;

•  Pain relief trial for effect; 20% need it!

•  Oxyglobin prior to surgery or during illness;

•  Semi-annual liver & kidney screen;

•  Semi-annual hematology;

•  Radiographs & EKG as indicated.

Early Detection Life Saving Program

•  ___________ has just completed a physical examination. To detect diseases early enough to intervene and save your pet's life, we offer a complimentary physical examination during the period of January 15- January 30, 2001.

•  There will be no fee for this service. In the event that the examination reveals the need for diagnostic or therapeutic procedures, fees will be discussed before services are performed.

  6 months

Diagnostics save hospitalization time

Cost is much less important when terms are offered

Rewards of In-house Lab

•  Patients treated sooner and better.

•  Early diagnosis = Early resolution.

•  Increased volume = Increased Income.

•  Less stress. More investigative style.

•  Greater Staff sense of accomplishment.

•  Second Opinion is always valuable.

Diagnostic Blood Screening

Your pet has undergone a pre-anesthetic health screen to identify any underlying health problems that were not evident in the initial physical examination. Here is a brief description of the tests and some causes for abnormal values.
SEND HOME A COPY OF LAB RESULTS

To Increase The Quality and Thoroughness of your Practice ...
If lab and radiology were used for this type of problem in your veterinary college clinics and you do not use these diagnostics...
You are under-diagnosing

Antech Canine Study (90 dogs)

•  2% confirmed with Cushings Disease.

•  8% hypothyroid.

•  12% urinary tract infection.

•  3% diagnosed with pyelonephritis.

•  7% had liver disease or electrolyte imbalances.

Antech Feline Study (100 cats)

•  9% azotemic.

•  6% hyperthyroid with no clinical signs.

•  4% confirmed renal failure.

•  1 cat had a urinary tract infection.

•  1 cat confirmed diabetic.

•  15% had eosinophilia.

•  7 cats had mild to moderate other problems.

Your Most Dispensed Drug

•  Antirobe = Longevity

•  Antirobe = $$$$$$$$

•  The tooth of the matter s that Dentistry transforms a practice!

•  There is no better disease prevention than dental care

•  Antirobe Pulse Rx

•  5 mg/lb. S.I.D.

•  Dispense 6 mo supply.

•  Recall @ 6 months for dental check-up and refill Antirobe.

•  Pets live longer and healthier.

Vaccinations �
Going Going Gone !!!!

Are We Crazy?
Do you really know that Mrs. Schmidt's Yorkie is PROTECTED?

At The Time of Annual Exam

•  27% of dogs were not protected Vs. Parvo (had less that 1:80 titers by vaccine makers)

•  21% of dogs not protected Vs. Distemper (had less than 1:96 titers by vaccine makers)

•  The only way a veterinarian can make a recommendation for an individual pet is to perform vaccination titers.

  McCaw, et al.

Mrs. Schmidt, I know that you are concerned about protecting "Turdy," and so are we. Some dogs have enough protection but at least one out of four would probably die without the vaccinations.
Let's send out a test and see just how much protection Turdie has!
In the meantime we'll just vaccinate for Bordetella, Coronavirus and Rabies

Spay and Neuter Fees

•  If you have a spay/neuter clinic nearby, do not compete!

•  Most spays you are now performing are not on pets of first time clients.

•  It is better to make a $50 profit on 5 spays a week than no profit on 10 spays a week.

•  Increase spay neuter fees by 20% per month until results show first decline in elective surgeries.

Manitoba Study

80% of practices charging the lowest fees thought that their fees were among the highest in their area

Your Average Transaction Fee

•  Is your most powerful economic tool.

•  Is the basis for fee setting.

•  Allows peer review within a practice.

•  Allows OTC review by receptionist.

•  Must grow 9% per year.

•  More important than individual fees.

3 Checks For The Veterinarian

•  Salary as an employed veterinarian (25%).

•  Salary as a landlord (15% of appraisal).

•  Salary as a general manager.

Fair ATF Calculation

Increasing Non-Shopped Fees

Effect of Decreasing ATF

Effect of Increasing ATF

Increase Service & ATF

Compare and Decide!!

Break-Even Point Generalization

•  Revenues less than $350,000 (solo) are less than 25% profit.

•  Revenues above $350,000 are 80% profit.

Outpatient Economics
$76.35

Average Cost of a TRANSACTION (2001)

Factors Overcoming Price

•  Vet is kind and gentle to pet.

•  Vet is respectful and informative.

•  Reputation for high quality Care.

•  Wide range of services.

•  Location within 3 miles.

•  Convenient Hours.

•  Recommended by friends or neighbors.

Bond Your Clients

Dear Mr. & Mrs. Forshitski,

Thought of Silky when I read this article � thought you might like a copy

  Dr. Al Mostsincere

Shopper Psychology 101
Marketing Triangle

Profitable Practices

•  Increase Net 10% over inflation annually.

•  Dentistry minimum 5% of transactions.

•  Radiology 7% of revenues.

•  Laboratory exceeds 15% of revenues.

•  Don't confuse fair rental with fair salary.

Clear Fee Policies

•  Written Estimates

•  50% deposit

•  Payment Plans

•  M/C, Visa, Discover, AMEX

Fee Psychology

•  $100 and $200 fees receive 12 times more complaints than $115 and $215.

•  Replace $5, $10, and $15 with $8, $13, $22

•  Office Visits $26.70 never $26 or $27

Pet Health Insurance VPI

•  Increases client expenditures.

•  Utilizes current database.

•  Increases frequency of visits.

•  Increases acceptance of diagnostics.

•  Increased sophisticated services.

•  Increases quality of care.

•  TOTALLY financed by client.

Veterinary Pet Insurance

•  Staff First

•  Eliminate other plans

•  No co-pay for staff

•  Up to 2 pets/person

•  Allows specialist

•  Paid vaccinations

•  Allows newest care

•  Staff will sell clients

•  Clients can afford $20 per month to cover vaccinations and illnesses.

•  Liberal benefit schedule.

•  Insured pets are seen 70% more by you!!

VPI Well Care Benefits

$213 Annual Well Care Benefits

VPI Staff Insurance

•  Invoice staff at full client fees.

•  Mail invoice to VPI - Check in two weeks.

•  Staff pet fully covered at your hospital.

•  Staff pet covered at specialist (with co-pay).

•  Costs staff $0.00 out of pocket.

•  Staff will convert clients to insured.

•  Insured clients seek more services.

VPI Insurance

Pet Indicent Benefit Maximum  $2,000
Annual Benefit Maximum  $7,500
  800-USA-Pets

VPI Benefit Schedule

Staff Pet Breaks Leg

•  Old way

Practice repairs fracture and bills staff member cost @ 30% of $874 =$262.20.

•  Practice covers bare costs.

•  Staff still suffers loss of $262.20.

•  VPI way

Problem Or Is It ???

•  Veterinary staff adopts worst cases. Lame, Neurologic cases, Problems owners refuse.

•  Don't submit pre-existing conditions without expecting request for records.

•  Very simple half page form for submission.

Look Around You !!!!

Zero Interest
No Money Down
No Payments till 2001

Click image to view enlarged version.

Clients Spend 30% More When Credit Is Available!

Your Choice� Financing or Discounting

The more you make your services available, the more you will be requested to do.
Credit card users spend 1/3 more.
Require sufficient deposit to cover hard costs.

Realistic Credit Policies

•  Controlled by Easi-PAY.

•  35% of estimate Deposit MANDATORY.

•  Balance over 60 days per $300 ($150/MO).

•  No release without payment in full or hold checks to cover complete bill.

Easi-PAY

•  3 checks � hold two for 30 and 60 days.

•  97-98% are good.

•  No service charges if paid on time.

•  Held check form must be signed.

•  Need Social Security Number!

Do Not Quote Fees On Telephone!!!
Just A Minute Madam, Let's not Spoil Everything By Starting Out Talking Price

Silly Economics !!!!!

•  Cat Fee Vs. Dog Fee

•  Odd Numbers $13 better than $10

•  In-hospital Injection Sale

•  Second Catheter Sale

•  Full Moon Fee

•  Annoying Client Fee

Anesthesia

•  3.0 X Office Visit Fee.

•  90% of cost is in 1st 10 minutes.

•  Same fee up to 90 minutes.

•  We are charging for skill ... Not gas!

•  Gas Vs Injections.

Let's Rid Ourselves Of LOUSY ESTIMATES

Time/Complexity Based Fees

Efficient Estimate

	Pre-Surgical Examination	$25.80
	Anesthesia (Induction/Maintenance)	$67.30
	Anesthesia Monitoring	$4.70	$24-26
	Sterile surgery Pack/Gloves/Drapes	$8.15	Office Visit
	Flush with PVP Iodine	$2.10
	Position and suture Penrose Drain	$11.55
	Close Surgical Wound	$7.80
	Antibiotic Injection	$15.8	5
	Hospital Ward/Nursing Care	$9.70
	Oral Antibiotics Dispensed	$16.60
	Standard Supplies and Services	$164.10
	Surgical Procedure"B"	$205.15
	Total of Support + Procedure	$369.25

Surgery Fee By Time ??

•  Packaging Fee Covers Basic Setup $40.00.

•  $240.00 per hour

•  Example: � hr or 0.5 Hr + $40 pkg fee = $160.

•  Example: 12 min surgery or 0.2 Hr + $40 = $84.

•  Example: 1.5 Hr surgery = $400.

OR �.

Laser Surgery Makes $$ and Sense

•  Costs $10 -$11 per procedure to buy.

•  Clients pay $40 to $80 additional for laser option.

•  Iffy for two doctor hospital.

•  Economical for three doctor hospital.

Most Practices Lose Money On Their Pharmacy

If you can't make a profit, write a prescription.
Transfer the loss to the drug store.

Prescription Overhead Fee

Pills in a vial

Ophthalmic

Creams Lotions

or Solutions

$15.55

Prescription Dispensing

30 tablets cost you 10 cents each = $3.00

Practice Pharmacy Overhead = $15.55

•  Double pill cost means losing $15.55.

•  Triple pill cost means losing $12.55.

•  Doubling Cost plus $15.55 for $21.55 fee profit = $3.00 (14% profit)

OTC Marketing

2.6 x Cost

Advantage^TM Heartguard^TM are competitive

Never Purchase More than 15% of LAST month's gross revenues.
Never Purchase More Than One Month's Supply Without Delayed Billing!

Injection Fees 60% of office visit fee plus �.

•  Up to 40 pounds add $4.00

•  41-60 pounds, add $6.00

•  61-80 pounds, add $8.00

•  81-100 pounds, add $10.00

•  Over 100 pounds add $12.00

Laboratory Fees

Double your outside laboratory fee to you and add $15.55

Fees For Fluids

•  Packaging fee for fluids $13.00/day *

•  I.V Catheter $9.35

•  Fee per 100 ml $4.00

•  Example 500 ml IV $13 + $9.35 + 500(.04)= $42.35

•  Example 200 ml SQ $13 + 2 x $4.00 = $21

* Includes Administration set

Standard Ratios

•  Minimum Anesthesia is 3.25 x O.V.

•  2 View Radiographic study is 3.25 x O.V.

•  ATF should be 3.25 x Office Visit

•  Doctor ATF should be 4.3 x O.V.

The Unexamined Dog Is Not Worth Boarding

$1.65 in medical fees for each dollar of boarding fees.

Hazardous Waste Fees

•  Recoup your taxes on occupational licenses, premise permits, X-Ray licenses etc.

•  Outpatient (Non-vaccination visit) $1.85.

•  Hospital Days $3.45 per day.

•  Surgical waste disposal $4.65 per procedure.

Hospitalization Fee

•  Doctors treatment plan and monitoring. (1/2 OV).

•  Ward occupancy (your standard boarding fee).

•  Nursing Care ( equal to hourly technician wage).

•  Hazardous waste disposal ($2.65/day).

•  Plus Injections, enemas, treatments.

Effective Adjuncts & Trials

•  Pain relief with every surgery (Option). Cats 1ml Torbugesic in one ounce VAL 1cc/10#.

•  Osteoarthritic trials.

•  Fingerbrush after cleaning (with OHE etc).

•  Lab every 6 months w/ chronic medications.

Senior Citizen Discounts

We offer Senior Citizen Discounts for appointments on Tuesday and Thursday 9AM - 12PM

Breeder Discounts

We are pleased to offer reduced fee castrations to any client calling himself a breeder.

Average client has 1.58 pets.
Average pet visits 2.2 times per year. Average client stays 4.3 years.
New client profit is 81%.

Excellent Practice

1.  Can I rate our staff as Excellent?

2.  Does our staff understand overhead.

3.  Is our staff Client Oriented.

4.  Is our staff is highly trained in Customer Services. (Will not run to the doctor).

Time Audit Leaks

•  Doing unproductive things from sheer habit.

•  Keeping too many unnecessary files/papers.

•  Performing "low return on investment tasks."

•  Making unnecessary visits or phone calls.

•  Exam room "over-socializing."

•  Too few barriers to interruptions.

•  Doctors performing technician tasks.

Laws of Business

•  You will grow or You will decline! Whatever you sell today will be out of vogue or run out by tomorrow!

•  Whatever you sell today, someone else will sell for less tomorrow!

Business Cycle In A Profitable Practice

In A Profitable Practice

An Office Manager is not an option!
Monthly analysis is not an option!
Long Term Success is seldom an accident!
Management systems increase profitability by 30-100%

Result Of ATF Management

Results of Management

Consulting Clients Complaint

You have made us too busy!

Profitable Practices

•  Only works with high quality medicine plus highest client communication techniques.

•  Only works with highest grades for hospital and staff appearance and WOW client service.

Successful Practices Monitor

•  ATF ATF/MTD ATF/YTD

•  ATF per Doctor

•  ATF per receptionist

•  Transaction Numbers

•  % Dentistry % Radiology % Laboratory

•  Percentage Above by Doctor

•  Staff Cost (15%) Drug Cost (18%)

STOP

75% of your PROFITS Come From the top 25% of Clients!!
Middle Groups provides 20% of profits
Bottom 45% gives only 5% of profits!!

Post Seminar Seminar

Because every seminar sets its own pace by the questions asked by participants, the following is included for take-home study

Staff Properly

Impact of Well Trained Exam Room Tech

Educate Your staff

•  Impossible to market what they don't know.

•  Best salesperson is "sold" on the service.

•  Train in marketing as well as in service.

•  Must know the "Whys" as well as the "Hows."

•  Require their pets to be current on recommendations.

Staff Must Know �
When and How To Offer . . .

•  Annual Health Maintenance Examinations.

•  Dentistry Examinations.

•  Pre-Anesthesia Laboratory Examinations.

•  Pharmaceutical Renewal Lab Exams.

Educate Your staff

Need pre-refill lab on chronic medications . . .

We Must Learn To Delegate

•  Blood Collection

•  Pre-anesthetic Administration

•  Induction of Anesthesia

•  Radiographs

•  EKGs

•  Explaining Surgical Procedures To Clients

•  Grief Counseling

•  Explaining Medications

•  Puppy Kitten Care

•  Nutritional Counseling

•  Client Call Backs

•  Staff Meetings

•  Product Sales

Marketing Pre-anesthetic Lab

•  Renal failure can occur in young pets.

•  Hypoglycemia increases risks.

•  Dehydration has serious complications.

•  Liver disease occurs in young pets.

•  Thrombocytopenia must be tested.

•  Clients want peace of mind.

•  Serves as a baseline for future.

•  Renal failure can occur in young pets.

•  Hypoglycemia increases risks.

•  Dehydration has serious complications.

•  Liver disease occurs in young pets.

•  Thrombocytopenia must be tested.

•  Clients want peace of mind.

•  Serves as a baseline for future.

Team Steps To Increase Compliance

•  Receptionist

Determine pet's age in "human" years from age and weight charts and explain to client. Provide client with Comprehensive Medical History Form To Complete.

•  Technician

Discuss Healthcare considerations for pet's age. Review pet medical history for completeness. Preliminary physical w/ emphasis on mouth.

Note areas of concern for DVM

Provide Client Education Materials.

Veterinarian

•  Review Medical History and Significance.

•  Thorough Physical Examination ST²O²P.

•  Request Laboratory Specimens/ Radiology.

•  Make Appropriate Recommendations

  Your pet needs �

•  Discusses Nutritional Recommendations.

•  Answers Client's Questions.

•  Compliments and Thanks Client.

•  Reinforce Veterinarian's Recommendations.

•  Dispense appropriate medications / diet.

•  Demonstrate how to medicate.

•  Schedule procedure or next appointment.

•  Comfort client's positive decisions.

•  Place non-confirmed procedures in recall.

•  Advantages to pet.

•  Advantages to Pet Owner.

•  Advantages to doing NOW!

•  Potential consequences for waiting.

•  Advantages to others.

•  Importance of the veterinarian in maximizing quality of life as pet ages.

•  Need for increased frequency of examinations as pet ages.

•  Importance of quality nutrition.

•  Importance of Preventive care recommendations.

•  Owner observation of changes in pet's health.

Team Steps To Increase Compliance

Receptionist/Technician Must Show

•  Importance of the veterinarian in maximizing quality of life as pet ages.

•  Need for increased frequency of examinations as pet ages

•  Importance of quality nutrition

•  Importance of Preventive care recommendations.

•  Owner observation of changes in pet's health

Role Playing Tells You...

•  Quality of telephone skills.

•  Level of ENTHUSIASM

•  Application of spedific knowledge

•  Clarity of answer

•  Degree of practice and Doctor promotion

We Are A Fixed Cost Business

•  Maximize staff utilization.

•  Maximize use of scarce or finite resources.

•  Leverage and delegation are critical.

•  To increase profits, focus on the top line.

•  You cannot save yourself into affluence.

•  Managing seasonality is critical.

The veterinarian does not have to be the leader of the business !!!!

The veterinarian does, however, have to understand the system for managing the practice and monitoring its progress.

To Increase Demand For Services

•  Increase the pet population.

•  Increase the number of pet owners.

•  Increase the number of pets receiving regular veterinary care.

•  Expand services to existing clients.

What would you do if you found out that syringes were no longer being manufactured ???

You would take utmost care to preserve the syringes you now have. You would train your staff in conservation methods and personally oversee their care.
Are existing clients any different?

It is 6 times more expensive to attract a new client than to retain a current client.

99.999% of households receiving the yellow pages directory will never bring a pet to you!!! Yellow pages display is a waste of your marketing dollar.

Increase client bonding �

•  Explain consumer benefits.

•  Send a welcome note.

•  Send a newsletter.

•  Telephone progress reports.

•  Recheck everything.

•  Survey satisfaction.

•  Invite for a 6 month checkup.

Meaningful Client Education
One Picture every 30 seconds in Reception and 8 exam rooms

My pet is a Very Important Pet at Elsewhere Pet Hospital

Priority Appointment 555-1212
This number is for priority pet owners only. Please do not share it with others.
Priority pets receive a complimentary wellness and dental checkup six months after their annual wellness examination.

Congratulations

Your Pets are Very Important Pets At Turdy Pointe Pet Hospital
This phone number 555-122-3434 is a special unlisted, private direct line for Priority appointments and is exclusive to our VIP pet companions
(Please do not share this number with others.)

Why?

Mean Annual Income, 1998

Physicians and Surgeons  $102,000
Dentists  92,350
Lawyers  75,890
Chiropractors  67,420
Optometrists  65,470
Pharmacists  60,090
Physical Therapists  57,190
Veterinarians  57,130

The Brakke Study 2000
Objectives

•  Identify characteristics and behaviors responsible for the financial success of individual veterinarians.

•  Determine which ones can be influenced.

•  Use the information to help the profession.

Hypotheses

•  Veterinarians with greater financial knowledge earn more income.

•  The use of common business practices positively influences income.

•  There are certain personal characteristics associated with lack of financial success.

10 Things We Learned.

1.  It's not who you are, it's what you do.

Behavior v. Personality

•  In veterinary medicine, income shows a much higher correlation to business practices than to personal characteristics.

2.  Learning good medicine isn't enough.

Management Knowledge

•  The majority of practice owners don't understand financial terms, and don't use many standard business practices.

Measure of Financial Acumen

•  Select correct multiple-choice definition for:

•  Revenue performance

•  Pre-tax profits

•  Cash flow

•  Return on assets

•  Return on equity

Financial Acumen

19 Standard Business Practices Used

•  Monitor client loyalty

•  Encourage referrals

•  Reward clients for referrals

•  Client retention programs

•  Measure client satisfaction

•  Lost client analysis

•  Solicit client feedback

•  Client focus groups

•  Complaints solicited

•  Suggestions solicited

•  Measure employee productivity

•  Promote employee longevity

•  Measure employee satisfaction

•  Reward employees for client loyalty

•  Practice logo

•  Client welcome letter

•  Client Newsletter

•  Brochure

•  Calculate lifetime value

3.  Your employees are a big factor in your success.

There's Money in HR

•  Of the 19 standard business practices measured, the three demonstrating the largest impact on income are staff resource related.

4.  Veterinary medicine isn't just a profession; it's a service business.

People, Not Pets, Pick Vets

•  Clients can't judge your medicine, but they can, and will, judge your service.

•  "Low client waiting time" was one of the factors most associated with high incomes.

•  Clinic "atmospherics" also showed a significant relationship to income.

Client Waiting Time

"Atmospherics"

•  This practice's external physical environment (e.g. building, landscaping and parking) convey a positive image consistent with this practice's objectives.

•  This practice's physical environment is designed to provide the client with information to enhance their satisfaction with the service experience.

•  This practice's interior d�cor reinforces the beliefs and positive emotional reactions that the pet owners seek for their pets.

•  Clients are given the opportunity to occupy their time (e.g. reading material) while waiting for their pets to be seen.

5.  It doesn't pay to pre-judge your clients.

Clinical Scenario

A successful young professional, who has been a client of yours for some time, brings in a 12-year-old female terrier because the pet isn't feeling well and has been vomiting. After your initial exam and in-house tests, you diagnose advanced kidney failure. You discuss your diagnosis and the prognosis associated with such a diagnosis.

The client is obviously grieved by your findings and the prospect of losing the pet, a valued companion. You know from experience that the response to treatment is unpredictable and the pet may respond to therapy, may fail to respond, or may die, no matter what you attempt.

Two Versions

•  A successful young professional . . .

•  An elderly widow of modest means . . .

Treatment Alternatives

1)  Referral to a specialist

2)  Best in-house care with IV fluids, hospitalization, frequent lab monitoring, critical care, etc..

3)  Next best in-house care with SQ fluids, hospitalization, symptomatic treatment

4)  Least - SQ fluids and send home for out-patient care

Your Recommendation?

42% of veterinarians would bring up the subject of euthanasia as an alternative to treatment before letting the client bring it up.

Only 21% would recomment treatment over euthanasia.

Why?

•  Honestly don't think its going to do well even if you treat it?

•  Don't think the owner can afford to treat it?

•  Conditioned to anticipate that the owner won't want to treat it due to cost, age or whatever?

•  Don't recognize the real value this pet has to the owner?

Experience Makes A Difference

An Interesting Comparison

Typical U.S. 6-doctor practice
5-6 euthanasias per week.

Typical Japanese 6-doctor practice
1-2 euthanasias per year

Some Issues

•  What message are we sending to our clients?

•  What opportunities are we giving up to practice sophisticated medicine?

•  What present and downstream income are we foregoing unnecessarily?

6.  It doesn't pay to pre-judge your patient.
7.  Where you practice makes a difference.

Location, Location, Location

•  Size and socio-economic level of the community in which a practice is located have a direct impact on veterinarians' income.

•  "Practice where the pets are."

8.  If you think you can succeed, you probably can.

Personal Characteristics Measured

•  Self-esteem

•  Cognitive orientation (thinking/logical v. feeling/emotional)

•  Fear of negative evaluation

•  Empathy

•  Need for interpersonal control

•  Judging v. perceiving personality

Two Characteristics Correlate With Income

•  High self-esteem

•  Overall, 4th highest correlation

•  Top 3: Years in Practice, Gender and Ownership

•  Self-esteem improves with age, experience

•  Fear of negative evaluation

•  The lower the fear, the higher the income

•  A measure of confidence

Student Results

•  First-year veterinary students measured higher on self-esteem than fourth-year students.

•  First-year students also showed less fear of negative evaluation than four-year students.

9.  You won't get there unless you try.

Pay Satisfaction
A Word About Gender

•  Female veterinarians earn about 30% less than male veterinarians

•  Relationship holds true, even after adjustments for years of experience, hours worked.

•  Is low expectation a serious problem?

•  Issue: Increasingly, women will define the possible income level and perceived value of the profession.

10.  Whoever told you that you can't make money in veterinary medicine lied.

Veterinarians Can Earn More

•  Optimizing business practices measured in the Brakke study increases income 45% Based on average owner's income $99,210 v. $68,188

•  Safari Animal Animal Care, Houston, Texas

•  2 Veterinarians

•  1,500 sq. feet

•  3 exam rooms

•  Annual Revenue: $2.1 million!

•  Associate veterinarian earns $100,000+

•  Veterinary Technicians earn up to $60,000

What if?

Mean Annual Income

10 Things We Learned

1.  It's not who you are, it's what you do.

2.  Learning good medicine isn't enough.

3.  Your employees are a big factor in your success.

4.  Veterinary medicine isn't just a profession; it's a service business.

5.  It doesn't pay to pre-judge your clients.

6.  It doesn't pay to pre-judge your patient.

7.  Where you practice makes a difference.

8.  If you think you can succeed, you probably can.

9.  You won't get there unless you try.

10.Whoever told you that you can't make money in veterinary medicine lied.

What You Can Do

1.  Set your sights high.

2.  Realize that high goals are achievable.

3.  Practice great medicine � and charge for it.

4.  Learn how to manage your practice.

5.  Don't let Veterinary Medicine become a second-class profession. You are the best and greatest hope for the profession!

6.  Don't condition students or prospective students to think that they can't make any money in veterinary medicine.

7.  Develop a way for veterinary students to learn business skills - either during, before, or after the four-year professional program.

8.  Adapt good business practices in the management of your hospital.

•  Address the self-esteem and fear-of-negative-evaluation issues

•  Determine if they decline during vet school

•  Find ways to build self esteem and reduce fear of negative evaluation during the formative professional education years.

•  Spend time in a well-managed, profitable practice; observe the inseparable relationship between good medicine and good business.

Do Your Expectations Set Your Fees?

Your own dog has to go to a specialist who will not give you a discount.
How much is too much?

Successful Practices Monitor

•  ATF ATF/MTD ATF/YTD

•  ATF per Doctor

•  ATF per receptionist

•  Transaction Numbers

•  % Dentistry % Radiology % Laboratory

•  Percentage Above by Doctor

•  Staff Cost (15%) Drug Cost (18%)

Veterinary Productivity

Every practice needs a management system that helps to accelerate and maximize everyone's fulfillment.
Having an outisde consultant constantly monitoring and measuring the progress and implementation of your mangement systems is what creates the most successful practices.

80% of all human thought is negative!

Act swiftly to make reversible changes

The only way to find the limits of the possible is to go beyond them to the impossible!

This seminar is just the first step in reforming your future!

The only way to find the limits of the possible is to go beyond them to the impossible!

4 Ways To Change Your Vet

•  Long Term Psychotherapy.

•  Trauma.

•  Lobotomy.

•  Pay a consultant to come in and implement the changes you need to make.

Our Problems Derive From

•  Carelessness

•  Laziness

•  Indifference

•  Forgetfulness

•  Procrastination

•  Fear of Failure

To really Change

•  Do it NOW!

•  Get ORGANIZED!

•  Improve your practice APPEARANCE

•  Dress Professionally

•  Be CHEERFUL!

•  Be OPTIMISTIC!

•  Greet EVERYBODY!

•  Say something NICE!

•  Show you are CARING!

Our Office Manager just came back from another seminar! Let her rant on ... In a week, she won't remember anything!

1.  Explain what you want and why.

2.  Explain how you're going to measure Phone Numbers

3.  Explain the consequences of failure.

4.  INSPECT what you EXPECT.

5.  FOLLOW UP.

Phone Numbers

Dr Snyder:  800-292-7995
FAX:  561-220-4355
e-mail:  vethelp@gate.net

Owens Systems (Forms)  800-634-1876
AVLS Reception Room  800-444-3634
Animal Care Training  800-357-3182
Tonopen (Glaucoma)  888-TONOPEN
Vetroson Laser Surgery  732-933-0800