This summary text is a result of the unsung champions of patient advocacy, the staff members of the modern veterinary practice. They have labored at below-average wages, with minimal benefits, because they love animals and the veterinary profession. The interesting perspective is that in this staff-based model, the veterinarians are part of the staff, and have committed to a career known for substandard wages with minimal benefits and long hours, because they love animals and the veterinary profession. While these economic conditions do not have to continue, it is the caring and nurturing that we pray never disappear from our veterinary healthcare delivery models.

Now to shock some of your paradigms -- It ain't about the money, folks! In every comparison to other healthcare professions, our associations have used the almighty dollar. Yet in reality, they needed to compare the time leveraging of staff to primary provider. The lack of reality has limited this profession we love from success for decades, and it is time someone shine a spotlight of reason on the comparisons. As veterinarians, associations have told us of the "earnings" of other healthcare professionals. For example, the American Medical Association reported in 1999 that the average physician compensation dropped from $154,000 to $151,000 income, plus generous benefits, due to capitation and managed care. They concurrently reported that after prepaid benefits, including malpractice insurance, the general practice physician made about $86,000 a year, while a board-certified family practitioner earned about $136,000 a year. We provide this insight because the AVMA, AAHA, and the Association of American Veterinary Medical Colleges (AAVMC) released the KPMG International "Mega Study" in 1999 and used statistically valid, yet slanted and biased, numbers to make its point.

In most every comparison made by our associations, they highlighted money and forgot what creates the money. Seldom are we told of the multi-tasking principles being used by physicians and dentists. To do this would tell veterinarians that their linear-thinking days are numbered, and control-freak, doctor-centered practices are condemning them and their teams to limited income potentials. This means leveraging the doctor's time, which effectively utilizes the skilled paraprofessional staff surrounding every provider, NOT as animal holders, but as healthcare delivery team members.

 The physician concurrently uses four to five consultation rooms, with a strong support staff of medical assistants, who are called "nurses" for client comfort.

 In another healthcare system, the dentist concurrently uses nine chairs, with a strong support staff of dental hygienists, and schedules thirty-six to sixty-five appointments per doctor per day. Dentists enjoy a compensation package commensurate with a physician.

 Even Chiropractors now use multiple treatment tables concurrently.

 In most acupuncture programs, it is only multiple treatment tables, with concurrent patients being treated, that allows integrating Eastern and Western medicine at affordable prices.

As veterinarians, ask yourself, "Why are we so linear?" Answer: We were raised by wolves and follow the pack. Our origins stem from a pick-up truck, driving from farm to farm. The most linear of our habits come from our heritage. Our thesis is that for those practices still using linear thinking, your days are numbered. And for the control-freak, doctor-centered practices, they condemn themselves and their teams to limited income potentials.

There is a demand for revolutionary change in the modern veterinary profession, in education, in our associations, and in community practices across the country. In 2004, the AVMA, with the financial and service support of Fort Dodge Animal Health (FDAH), rolled out their wellness surveillance initiative (go to www.npwm.com). They specifically asked Tom Catanzaro to be the spokesperson to roll out the program for practices.

The President of the AVMA, Jack Walther, was the visionary who put this partnership together and the driving force to take the message directly to the pet parents of America. He was also the one who identified Catanzaro as the best person to represent the practices, as Walther knew Catanzaro & Associates Inc., had done exactly these type wellness initiatives for years. To date, only fourteen thousand practices have accessed the free training kits offered by AVMA/FDAH, a poor testimony to supporting the evolving veterinary healthcare delivery desired by pet parents.

Universities still teach curative medicine and surgery, which is a front door access demand of less than thirty percent for most veterinary practices. Wellness drives access two-to-one in most all locations, yet the support for the AVMA/FDAH initiative has been less than stellar.

Some copycat speakers and writers have translated wellness surveillance into dollars, and have made it an economic quest. This has received some attention by the veterinary masses, while alienating some staff during the delivery. There is a professional and bio-ethical foundation that must be addressed, when embracing wellness surveillance. It often starts by realizing that wellness care is husbandry (staff-based services) and needs to be delivered at lower prices than doctor-based acute care. The dentists learned this long ago, where accessing dental cleaning procedures by hygienists are far more affordable, on a minute-price comparison, than dental restorative care by the dentist. For example, $120 for a thirty-minute cleaning versus $500-plus for a thirty-minute cavity repair.

There has not been a single, integrated, comprehensive model developed for veterinary medicine. It does not fit the "sound bite" requirements of our journals or the short-presentation sequences of our professional meetings. At Catanzaro & Associates, Inc., we have been developing the new integrated delivery systems for over a dozen years, and have watched many try to copy it in part or parcel without a guide. We now have a time-proven, team-based, veterinary healthcare delivery model that has worked from the swamps of Georgia, to the plains of western Canada, to California's Orange County population density, to the capital cities of Australia and New Zealand. It is based on cherishing the hospital staff, having a strong client-centered delivery focus, and being a patient advocate when determining "needed" care. It also recognizes pet parent awareness training and consistent standards of care, in lieu of "compliance" initiatives. It includes the practice owners being "doctors", when on the hospital floor; a commitment to leadership principles, rather than management habits; and the practice staff becoming accountable for running the healthcare facility. The systems are based on trust, personal tenacity, and inviolate core values.

These systems are not an overnight miracle cure for the veterinary liquidity problems. Those have been caused by our follow-the-pack mentality. Linear thinking was critical in production medicine. We could only drive from farm to farm. We needed to use the word "recommend" to the producers, since they had economic factors bearing on healthcare decisions. In discussing healthcare with companion animal owners, the word is "need", as has been done by pediatricians with mothers for years. We have become the other family doctor.

The programs and concepts offered in this text have been developed and tested in practices around the world over the past two decades. They are time-tried and practice-proven systems of new thought and healthcare delivery for companion animals. There are similarities to human facility delivery models, but are not based on the capitation and managed care limitations of the existing American system, or the socialized systems we see in Canada or New Zealand. We have integrated the best of all the healthcare professions, then married them to the strengths of the current veterinary delivery systems, the staff and doctors who have entered this profession as a calling.

It is our hope that the reader will not "cherry pick" ideas, but rather, sit down and discuss the concepts and systems with one's own staff. It will be important to leave old habits behind, divide the ownership policy and precedent demands from the doctor duties, and train staff to a level of being trusted. What guarantees success?

 It is based on zoning the hospital operations, maximizing the facility resources, and respecting the zones in scheduling.

 It utilizes self-directed training, and it recognizes the value of addressing and nurturing the intangibles of team development and motivation.

 It capitalizes on multi-tasking training techniques (mt³), and facilities resources multi-tasking by a well-trained and trusted healthcare delivery team.

 We believe in the long-run benefits of centering on training and retention, rather than hiring and firing.

 It is changing from managing people to coordinating training, and adding leadership at the staff level, as well as demanding it at the doctor level.

 We believe success lies in enhancing income production systems and extending their client/patient impact with staff, rather than emphasizing cost controls.

 It is developing people through work, rather than getting work done through people. The zones of a hospital belong to the staff members, and entering doctors' work should be done through the zone coordinators, never around them.

 We believe the doctors should diagnose, prescribe, and do surgery, when in the practice, moving from zone to zone without sucking staff members along in their wake. If they are not with a patient or client, they are costing the practice precious dollars.

 We believe future success lies in developing improvements in quality healthcare delivery, thereby causing net income to increase, rather than continuing to compare just gross and average client transaction rates.

It is our wish to give the veterinary profession an option to "business as usual", and give the staff and doctors a reasonable living wage, so they can continue in their chosen calling to tend to the animals of this land.

Just a Little Background

In January 1996, Tom Catanzaro walked into the North American Veterinary Conference©, and stepped into a management seminar. The consultant was exposing the audience to "his current research", and while he did not reference the source, he was quoting from Mike LeBouef's 1985 text, GMP*: The Greatest Management Principle in the World. It was over ten years since it was published, and it was this consultant's "current research".

So, Catanzaro moved on to the next management speaker, stepped into the back of the darkened room, and there at the podium stood another traditional consultant, beating the same old drum about the compensation philosophies we had heard for twenty years. When will we learn that if we only pay peanuts, we will only attract monkeys.

Some of us remember the days of Dr. Ross Clark conducting management seminars. He always gave his sources and stayed within the most contemporary literature, then translated it to veterinary applications. We really needed his open style to be embraced in the mid-1990s, but Ross was a one-of-a-kind leader to this veterinary profession.

Self-proclaimed consultants are easy to spot. They usually say "in my practice. Often, they have no education or certification beyond DVM, and some do not even have that.

One notable exception to this "observation" of non-veterinarian consultants has been Owen McCafferty, CPA, whose self-development efforts have been outstanding and noteworthy. Owen has done his veterinary practice homework, understands this profession, and has donated his time and reputation to representing this profession to the IRS, media, and publications. Owen was a forerunner of consultants from lateral professions. Ed Guiducci, JD, has done a similar amount of homework and pro bono support to bring legal understanding into transactional work during this millennium.

The truly dedicated consultants have earned an advanced degree, a board certification or the Certified Veterinary Practice Manager (CVPM) designation from the Veterinary Hospital Managers Association. Truly committed consultants have given up their veterinary practice to dedicate their consulting business to their new client, the veterinary practice owner.

So, following that fateful NAVC meeting, Catanzaro vowed to make a difference. He returned home and pulled out the syllabus and participant notes from the 1995 Seminars @ Sea©, which the Catanzaro & Associates, Inc., team had just conducted aboard an Alaskan cruise. The seminar's premise had been the application and integration of the fourteen basic leadership skills. He sent the syllabus and notes to three respected technical veterinary presses. Iowa State University Press© (ISUP©) came back within seventy-two hours and said they wanted publishing rights for that text and the next two, also which were listed as future courses in the participant notes. The stage was set for a three-text deal.

Catanzaro's writing went to the next level immediately. The first Iowa State University Press©. (now Blackwell Press©) text was "Building The Successful Veterinary Practice: Leadership Tools", first edition 1998. This first leadership text moved the bar up so high, many people, including our own consultants, said that one must read six others before one can go back and understand what Catanzaro was trying to say.

The reason Catanzaro started publishing texts was for the rest of our professional colleagues. As a veterinary profession, we were drowning in the old school of management, and someone had to start moving to the next level. Those who closely assessed our systems called it revolutionary and long past due. In reality, what we have published has been adopted and adapted by most of the veterinary consulting profession, often without the recognition of the source documents or original thesis.

We do not mind the plagiarism and copying. That is the ultimate compliment. We have done this for our clients, one-by-one, so we might as well do it for the consulting profession and veterinarians who read and try to do it for themselves.

To believe we can raise the bar of the veterinary profession alone could be the work of an impractical idealist. Yet, the team of Catanzaro & Associates, Inc., and now Veterinary Consulting International® (VCI®), have taken the emerging philosophies to heart, adapted them to their own practices in their own ways, and while we share them in print, in seminars, and in consulting, they are always tailored to the individual practice's needs and community.

Following are six separate and unrelated e-mails or personal contacts from practices/doctors with whom Catanzaro & Associates, Inc., have consulted. The terms "Tom Cat" or "TC" refer to Tom Catanzaro's nicknames.

 T. H. in Florida: Only problem was that the overhang had been cut off and the waterfall went inside. The dog food room, pharmacy, and lab and cat ward was an instant wet and wild theme park. The entire staff dropped what they were doing and without a cross word, started the evacuation. What a thrill. It was better than a ropes course. All I could think of was "catch them doing something right". Everyone was happy, wet, laughing, and excited that they were saving the hospital from the flood. We have a motivated, bonded and trustworthy staff. That would not have been the case in pre-Tom Cat days. Thank you for everything.

 D. C. on Long Island: You have touched my life and changed me. I thought I practiced good medicine until you visited in mid-May, now I am practicing better medicine than ever before. I am having fun again in practice, I am a full time doctor, and besides, May was the best month we have ever had. The one doctor we gave a last chance to has decided to move on, and I have found a new doctor who has already accepted our core values and standards of care. Thank you for making my profession fun again.

 R. B. in Texas: I had a great leadership background in the Navy, or so I thought, before the consultant arrived from Tom Cat's team. I had fallen into the "veterinarians trap". I was trying to control the staff and facility operations as if it was case management. We started on a new trek, and in the second quarter, Tom Cat himself appeared at our door. The team had shook out in the first 90 days, and started to fester. Tom Cat re-calibrated the changes and flow, and we began to self-heal. We lost some deadwood, and found some gems, and have already added another doctor. Last December, over two years after the first visit, we were 60 percent above the previous December, which was 25 percent above the December before Tom Cat and his team started mentoring us. We continue to grow and continue to find new ways to leverage the doctor's time. I have more time off than ever before, and we are more profitable than ever before. Now we are looking at a new facility, and we will design it around our new zoned systems and schedules habits.

 K. W. in Saskatchewan: Before TC came into my practice, I was isolated and believed that I was probably one of the two weakest practices in the Province. My personal confidence in medicine and surgery, for horses, dogs and cats, was about average, and I felt I was making the right recommendations, but my practice had stalled, I was spending more hours, and had less money to spend every year. Then I was introduced to Standards of Care, how to use the word "need" instead of "recommend" when speaking for what the animal deserved and expanded my wellness surveillance programs to most of what Tom Cat wrote in his transition plan. A year later, my practice income had doubled, I was spending less time at the practice and more time with my family, and I truly believed I was one of the two best practices in the Province. As I continued with Catanzaro & Associates, Inc. , we continued to grow, and my confidence and feeling of self-worth grew, to the point that I started to become active in organized veterinary medicine again and would readily share my views and help my colleagues see the need for new paths. When I became President of the Province VMA, the feeling was reciprocated by my peers. It felt great!

 B. C. in Ohio: We had our problems this past year, and I understand there was a problem in my training and leadership. We are adding another doctor, and she has not yet been Catanzaro-ized, but she will be. We now wait for the right attitude within a person before they are allowed to join our team, and after adequate training, we pay them appropriate to their production. With the staff we have built, and their leveraging of the doctor's time, there is almost NO CEILING on what someone can earn, staff or doctor alike. Practice has become a way to share success with those around me. Thank you.

 M. S. in California: When you first came into my practice, I thought you were a radical....but we followed your plan, and in six months, when I had an IRS audit, your programs had created the wealth to save me from a forced bankruptcy. I should have learned. You always give me more to think about than what I call about, and sometimes, I can even do something with the ideas. Remember last year when you counseled me on making the commitment to balance my life and cherish my wife? I wish I would have listened to you. She has just been diagnosed with Lou Gehrig's disease, and her locomotion is already effected. Please Tom, make people listen to your message, and do not give up the quest.

These are the type of feedback missives that have kept Catanzaro writing at "the next level". Some doctors and consultants, who do not want to change, say:

 "They cannot understand Tom Cat's writing."

 "It is confusing."

 "No one can implement what you write."

This is a form of self-protectionism, and that is okay. If the only thing you know is a skateboard, an eighteen-wheeler is both confusing and intimidating.

Catanzaro sends about one postcard a month to some consultant, who has plagiarized our works, and all it says is, "Thank you for upgrading your references." To some of the renown plagiarists of our veterinary consulting field, we do not send postcards. Just their attempt at using our forms, adapting our literature, or even using our text directly is all the compliment we need to keep this firm going. This new electronic text, "The Practice Success Prescription: Team-Based Veterinary Healthcare Delivery", marks a new era, for Catanzaro & Associates, Inc., and for management/leadership text publishing.

Catanzaro says this is the last book he plans to author in veterinary medicine. It's number thirteen. He's "flooded" the veterinary market with texts over the last eight years, something early in his consulting career Catanzaro said he would never do. Books go out of date too fast, which is why Catanzaro & Associates, Inc., planned to only publish quarterly Update© newsletters and the VCI® Signature Series© Monographs (www.drtomcat.com). They are dynamic instruments of assistance to practices.

Now that you've seen where we've all been, let us move forward to where we all can be.