You have to find something that you love enough to be able to take risks, jump over hurdles, and break through the brick walls that are always going to be placed in front of you. If you do not have that kind of feeling for what it is you're doing, you will stop at the first giant hurdle. - George Lucas, Film Director

It was a seven-day Caribbean seminar cruise sponsored by the Chicago Veterinary Medical Association, and they had asked me to attend and conduct eighteen hours of seminars. This was a "no-pay" gig, but they provided room and board. I had never done a seven-day cruise, only four-day excursions with the Hill's Consultant Cruises, when they were trying to liquidate PSI and re-establish Pet Nutrition as an income center. So it was an acceptable experience. Then, when we were on the cruise, thirteen meals a day directly relates to one pound a day rate of gain. So it was also an expanding experience. Now on our VCI® Seminars at Sea©, there are eighteen meals a day, but we have discovered no one makes you eat them all. But that is another story for another time.

Aboard this cruise was a couple looking for a place to park their own boat, when they retire. He had been practicing forever, had migrated from mixed animal to companion animal in a small practice in Wisconsin, not far outside Milwaukee, and he was pushing seventy. He had this beautiful wood cabin cruiser, which he loved to take out on Lake Michigan, so he thought he could sell his practice, invest in a bigger boat in the Caribbean, and retire to that boat with his wife and cat. By the end of the seminars, he said, "Tom, I think I need you into my practice before I sell it."

So we set a date, and I went to Wisconsin. I walked into the front door of the clinic, and the first thing that struck me was a series of red commode seats on a white plywood box. The second thing that struck me was the very small format, about nine hundred thirty-two square feet. His staff was happy and friendly, and the smell was clean. A closer look at the commode seats showed they were in fact oval butt-fit rings, with an oval back, both attached to the wood base, but there were no holes under the seats. The one exam room was decent sized, the radiology and surgery was a single nook across from reception, and the pharmacy was a second nook on the back wall, and it even had a window.

The lot dropped off greatly in the back, so you could see all the way to the creek, over one hundred fifty yards away, where big cottonwood trees lined the bank. It was a pretty lot, and very deep. He had a veterinary architect design him a new hospital, and had the plans, with a construction cost pro forma of over $490,000. He had never grossed more than $160,000 in any year, and the property was worth more as a rental house than a veterinary clinic, so he had never proceeded with the construction.

This practice was sleepy, did not have a computer of any kind, and had the old five-inch by seven-inch Visi-records, used since his ambulatory days. They worked for him, so why change?

We started with a medical record audit of one hundred clients, which is something I still do today, as the first impression with every consult, since that is the business we are in, and what we are really selling to the next veterinarian.

I then proceeded to determine what he liked to do. He liked surgery, but was embarrassed by the "nook", rather than having an aseptic surgical suite. He also knew he wanted a treatment room, so he did not have to scrub or do dentistries in his X-ray/surgery nook. I looked behind a door in the surgery nook and discovered a stairway going downstairs. There I found a kennel and the washer and dryer under the building, in a plywood-wall enclosed space, which used to be the carport under the clinic.

Step one was to walk down the street in his town to a small business that would build a computer to our specifications. The mission included finding him the cheapest ethical veterinary software on the market. If he was computer savvy, we could have given him the Access Bible (about $50), with the Mountaineer Veterinary Clinic on the practice CD-ROM. In a week he could have tailored it to his own practice. But this guy was not computer savvy, and we knew he needed a computer to help the "image" of the practice.

Step two was to share some basic wellness medicine concepts that I had, following the medical record audit, as well as some embarrassing sequences of diagnostic neglect:

 How often did he want fecals and other parasite screening?

 How many animals deserved a dental score in the medical record?

 What was required to put a body condition score behind the weight?

 Which cases deserved pre-anesthetic blood screening?

 Which age group required additional mid-age lab/X-ray screening?

 Which cases needed to be brought back for recheck?

 Which cases needed recalls?

 What was his reminder system for wellness?

 Could we see the assessment of the initial client concern on the Progress Notes?

 Where was the Master Problem List?

 Where was the wellness screening?

These discussions caused a personal commitment to change his style of curative medicine and symptomatic treatment. Empirical treatment protocols are fine on a pennies-per-hundred-weight (cwt) backyard steer, but not for companion animals. They do not weigh enough to measure the cwt impact. Besides, they seldom are sent to slaughter for resale. Nonetheless, we now had a solid start. In the next twelve months he went from a level five-year income to over a forty percent growth.

The other thing we did was design a forty-foot by forty-foot "box" on the back of the building, on I-beam stilts and frame, so it would connect at the one window on the back wall by the pharmacy. There was a header above the window, so blowing out the brick below the window would not cause major problems. The back left corner was a surgery suite, with picture windows looking across the backyard to the cottonwoods and creek. The front left corner, against the back wall of the building, was radiology. There was a hallway between surgery and x-ray, which went to an outside door, a second means of egress. We made it a bit extra wide, so that it was also used for pack-prep and surgeon scrub. On the back wall of the box, from surgery to the wall on the right, we put a giant bank of cages, with transom windows above, so the whole back wall cascaded light into the open center. Then we added a window wall in front of the bank of cages, so the sound would be controlled. There were two treatment tables. The one closest to the surgery was a sink table. There was even a linen chute from treatment to the washer and dryer below.

He contracted with a low-bidder local guy, so the construction took a bit longer than planned, but when we opened the window to become a portal into the new treatment room, the practice was transformed. The old surgery nook became another consultation room, and the computer was humming along, sending reminders for many new wellness screening items. With the extra money during the first year, we also sent him and his wife to Puget Sound for a vacation, asking him to rent a boat and sail the Sound. This is the guy who had been sailing Lake Michigan all his life, and I believed he forgot how much he liked "seasons", especially since his wife had the best Christmas shop on the eastern border of Wisconsin. When they came home, he had rediscovered America, and now his goal was to retire and get a boat, park it at San Juan Island, and live on it, happy in retirement.

Long story short, it was not hard to sell the practice. It had turned around, it had good growth, medical records were friendly to the buyer, the facility felt modern and functional, as now it was about twenty-five hundred square feet on the main floor, and he found the perfect boat in San Francisco for only $150,000, before overhaul. He found someone to skipper it up to Roche Harbor, San Juan Island, Puget Sound.

But this is not the end of the story. It is just the beginning of the new perseverance coming into this doctor's life. Within a year of his retirement, we were talking on the phone, because we wanted to help the people coming to his boat for veterinary advice. We discussed the "practicing without a license" consequences, and in a hope to defer his generosity, told him he needed to take the Washington state boards before he could give advice. To my surprise, he took the boards. To his surprise, he failed them. We were talking again, and I asked him what sections he failed. He had never asked, so an inquiry was made. He had failed the large animal sections. This surprised me, with his ambulatory background. He said, he did not complete that part of the test, as he was only going to do small animals, which on the islands, include potbellied pigs, pygmy goats, and milking goats. He retook the boards, answered all sections, and passed! Here he was, seventy-two years old, and he passed the boards. Atta-way!

The first thing he wanted to do was help people with diets for their pets, and I said, "Use Waltham."

He had never heard of them and wanted to stay with Hills. I sent him the Waltham literature, asked him to compare, and then we would talk. Talking a week later, he had discovered what I wanted him to see. Hills had a "ferry fee", while Waltham would drop-ship for free in any area where they did not have a distributor. He also thought the digestibility and quality was compatible, so he made the decision to pass the savings on to his clients. He found the results from Waltham premium diets as good as anything he had found, and loved the fact that drop shipments went direct to the homes of his clients. Then he advanced to vaccines, also easy enough from the back of his boat.

Now he tells me he wants to open an actual facility, a full service clinic, and I tell him not to invest at his age. He is retired! He tells me the other veterinarian on the island has a nice facility, but has been prohibited from doing surgery by the state board, so he thinks there is a niche if he can start cutting again. He perseveres and says he will not do it without me, but wants me to come out and help find a building and design the facility. So within a month, a seaplane is landing me at Roche Harbor, and they are waiting for me.

They are so excited; I do not get to unpack. We race down the island to Friday Harbor, where all the ferries arrive, so I can see the buildings they are considering for clinics. The one that seemed like the best location was across the corner from the library, on the uphill side. We like people who can read! There was an eight-foot-high deck, with stairs to reach the front door, but that bothered his wife, as well as him, due to downed animals, not to mention Americans with disabilities issues.

I walked into the facility and saw the potentials, but told Roy, our doctor, that there were three requirements before I helped. He agreed without hearing them. So I walked him through the building from the back door, which was under a well-constructed arbor, at grade. One step inside, I pointed to the right and said, "That is not a dining room, it is a waiting room."

Then I pointed to the left across the breakfast bar to the kitchen and said, "That is not a kitchen. This is the reception counter and reception staff and records behind."

A few more steps down the hallway we stopped, I pointed to the right and said, "That is not a bedroom, it is a consultation room."

Then I pointed left across the hall to the bathroom and said, "That is not a bathroom, this is the dark room in the tub and half-bath for clients and staff."

We went to the front of the house, where the living room had a door to the front deck and overlooked the library, city, and out towards Mount Saint Helens. The family room on the other front corner opened to the front deck with some side windows. I pointed out that the living room was a perfect surgery, since it had windows like his last expansion, and the family room was large enough for a spacious treatment room. I added, "And the clients will see the big sign that says SURGERY above this door, when they walk-in, and know that this practice is better than the other veterinarian's practice."

The windows of the front corner closed the deal in Roy's mind, but then his wife Barb asked, "What are the three requirements you mentioned?"

"First item," I said, "is that it must be a Pain-Free practice."

They asked why, and I continued. "This island house has minimal internal insulation, and you do not want to sink the money into it for retro-fit insulation. So make it pain-free and it will differentiate your practice, as well as reduce the animal anguish noise". They bought into that idea immediately.

"Second item is that you cannot exceed the VPI reimbursement prices."

"Why are you putting a limit on our fees you have always said we price too low?" Roy asked.

I showed them the VPI Gold/Superior Plan and said, "This is your new fee schedule."

Again, this shocked them, but as Roy looked at the schedule, he said, "I cannot charge people this much, Tom. Many of these are double or triple what I used to charge."

I then showed Roy the Standard Plan and said, "The compromise is you cannot charge less than this VPI schedule."

He looked and said, "Why are you doing this to us?"

I replied by handing him the island demographics. It showed that the millionaires and billionaires totally ruined any standard form of assessment by community income. The island was loaded with millionaires and billionaires.

"Roy", I continued, "the VPI 'risk sharing' fee schedules were just what the gardeners and chauffeurs, who brought in the pets, needed to see to tell these rich recluse residents that the fees were a bargain."

They agreed, this time with trepidation.

"What is number three?" Barb asked.

"The third thing is that you must sell the practice within three years. You can remain the landlord of the facility, but you cannot continue to own the practice. You are in retirement and need to get back to retirement."

To this one Barb agreed immediately, and Roy started hemming and hawing about how long it took to get his first practice ready to sell. Agreeing, I just added that he had wanted me here, the island people knew no bad habits he had entrenched, so if he flew straight, it would not be a problem. He finally agreed.

The first week, armed with his VPI-driven fee schedule, he had a $1000 day, with only five patients. Roy was amazed. We changed his hours early on, to Monday, Tuesday, Thursday, Friday, and once-a-month on Saturday morning. This allowed him to be "off yesterday" or "off tomorrow", except for one Friday each month. Even as a retired person this was almost the right schedule, until we got him to go home and nap at 3:00 p.m. each day. Now we were there with Roy's schedule, 8:00 a.m. to 3:00 p.m. Monday, Tuesday, Thursday, and Friday, and one Saturday morning a month. The $1000 dollar-plus days continued for two-and-a-half years, thank you VPI!

At three-and-a-half years, he offered it for sale, and had buyers almost immediately. He sold the practice at 2. 6 years of development for significantly more than he sold his previous thirty-plus-year practice in Wisconsin. Roy and Barb still had the landlord income coming in from the veterinarian he had selected as buyer, as well as relief clinical salary, and sale price payments. Roy and Barb were very happy, and took a four-month vacation in New Zealand to celebrate. Roy's perseverance, with Barb's support, has paid them to be retired, twice. All it took was personal perseverance and using the resources he knew he had available around him.

Post Script

Barb and Roy invited me to dinner in 2007 at the Western Veterinary Conference. We had not seen each other for a couple years. They now have a winter home on the California-Arizona border south of Nevada, and the boat in Puget Sound for summer life. Roy wanted to go back into practice again. People still seek him out as "Doc", and he wants to help. Barb and Roy have even adopted an entire community of underprivileged people near their winter home, providing "life safety" needs to anyone in need. These are special people.

This time, I introduced Roy to VetCentric, so he could use his Washington state license to order drugs and pet food as he desired for people in need. This new mail order system would allow him to operate independently, wherever he was. I also got him interested in writing a "veterinary insight column" for the local newspapers in both locations. This will allow him to use his knowledge and give to many without causing the demands of a full-time practice to grind him down.

There are alternatives in life, and there are very special people who want to do more than the average. Roy and Barb have some very good friends from past veterinary medicine adventure continuing education experiences, and some from boating weekends on Lake Michigan. Roy and Barb are now happier than most any of those past acquaintances, mainly because they keep on giving, keep on sharing, and keep celebrating life together. These are special people and I am so fortunate to be able to count them as friends.

Related Works

1.  Design the Dream: A Veterinarian's Preconstruction Primer, Iowa State University Press, May 2003.

2.  Veterinary Medicine and Practice -- 25 Years into the Future -- and the Economic Steps to Get There, Iowa State University Press, 2002.

3.  Beyond the Successful Veterinary Practice: Succession Planning & Other Legal Issues, Iowa State University Press, 2000.

4.  Building the Successful Veterinary Practice: Leadership Tools, Iowa State University Press, 1997.

5.  Building the Successful Veterinary Practice: Programs and Procedures, Iowa State University Press, 1998.

6.  Building the Successful Veterinary Practice: Innovation and Creativity, Iowa State University Press, 1998.

7.  Design It Right -- A Pre-architect Primer for Planning Your Veterinary Facility Flow, Fourth Edition, AAHA Press, 2006.

8.  Healthcare of the Well Pet, co-authored with Caroline Jevring, BVetMed, MRCVS W. B. Saunders Company LTD, 1999.

9.  Promoting the Human-Animal Bond in Veterinary Practice, Iowa State University Press, 2001.

10. Veterinary Management in Transition: Preparing for the 21st Century, Iowa State University, 2000.

11. Veterinary Healthcare Services: Options in Delivery, Iowa State University Press, 2000.

12. Veterinary Practice Management Secrets, Hanley Belfus (Lippincott), 2000.

13. Practice Guidelines and Employee Resources Handbook -- includes first draft, which you modify, a retype of your changes/additions, and a final copy presented bound, loose, and on CD.

Available from Veterinary Consulting International^® Monographs (including those pending):

1.  Administrator's Guide to Veterinary Practice Efficacy (includes CD with tools and appendices).

2.  Building the Bond Centered Practice (includes bond-centered program files on CD).

3.  Client Relations Zone Operations (includes Preferred Client Program on CD).

4.  Compensation Strategies for a Client-Centered Quality Healthcare Delivery Team (includes sample contracts, benefit options, and more on CD).

5.  Conflict Resolution, Negotiations, & Other Problem Solving Methodologies (includes self-assessment tool kits on CD).

6.  Feasibility of the Veterinary Specialty Practice (includes sample business plan on CD).

7.  Fundamental Operations of a Critical Care Practice (includes CD with basic operating plan and QuickBooks^® file).

8.  Fundamental Money Management for the Veterinary Practice (includes CD with QuickBooks^® Chart of Accounts and sample budgets).

9.  Futurology: Through the Looking Glass (includes CD with strategies for managing expectations and other key VCI forms).

10. Governance Guidelines: Managing Multi-Doctor and/or Multi-Owner Practices for Maximum Effectiveness & Harmony (includes CD with checklists and self-assessment tools).

11. High Tech-High Touch in Program Delivery (includes CD with sample tools).

12. Inventory & Maintenance Management for the Veterinary Facility (includes CD with maintenance checklists).

13. Keeping Controlled Drugs Under Control (includes CD with self-inspection checklist and sample forms).

14. Leadership Action Planner (includes CD with action planning forms).

15. Leadership Principles & Skills (includes CD with leadership forms).

16. The New Level of Renewed Leadership (it's more than gimmicks and numbers!).

17. Marketing: Selling "Peace of Mind" (includes CD with customizable client communication tools).

18. Models & Methods That Drive Breakthrough Performance (includes CD with project planning worksheets).

19. Practice Growth & Business Operations (includes CD with application tools).

20. Professionalism, Bio-ethics & Image (includes CD with bio-ethics scenarios).

21. Profit Center Management (Revised 2006, includes CD with budget planning template and ten essential charts to track critical information).

22. Staff Performance Planning and Goal Setting (includes CD with sample performance plans).

23. Staff Training and Orientation (includes CD with orientation checklists and sample job descriptions).

24. Standards of Patient Care in the Bond-Centered Veterinary Practice (includes CD with key VCI forms).

25. Strategic Response & Practice Positioning (includes CD with mission focus tools).

26. The Unknown Road Ahead: A New Veterinarian's Survival Primer (includes CD with sample employment agreement and other key VCI forms).

27. Veterinary Medical Records for Continuity of Care & Profit (includes CD with sample medical forms for customization).

28. Zoned Systems & Schedules for Multi-Doctor Practices (includes CD with high-density and sample schedules).

29. Coming Soon: Nursing Zone.

Miscellaneous

1.  Contributing author, Pet Connection, CENSHARE, University of Minnesota, Minneapolis, Minnesota, 1984.

2.  Contributing author, Steps to Ownership, a compilation of original articles to serve as a primer for veterinarians seeking practice ownership, from AAHA Press, pp127-130, 2002 release.

3.  Contributing author, Universal Kinship - The Bond Between All Living Things, the Latham Foundation, published by R&E Publishers, Saratoga, CA, 1991-92.

4.  Contributing author, Veterinary Medicine, Boy Scout merit badge book, BSA #35004A, 2005, 2006 Printing.

5.  The Veterinarian: The Other Family Doctor, narration of personal stories and principles of the healthcare delivery applications of the human-animal bond to the family members we call "pets", a free, one-hour audio tape funded by CareCredit®, www.carecredit.com, released late 2001.