How to thrive in practice

A thriving practice is like a thriving garden. A practitioner does not need to have five practices to be successful, just as a gardener does not need to have five gardens to be skilled. A single lush, green, healthy, and fruitful garden can be enough.

Dr. Rob Swinger, a veterinary ophthalmologist from Florida, made this analogy during an AVMA roundtable of thought leaders on "Thriving in Clinical Practice." Dr. Bridget Heilsberg, an equine practitioner from Texas, added that a garden has to thrive in its environment. She said veterinarians can get bogged down with looking at what is working for the top 10% of practices, by business measures, but they have to be OK with doing things differently.

The AVMA held the roundtable March 27 at Association headquarters in Schaumburg, Illinois. Participants discussed the definition of thriving in practice; potential solutions to problems in practice, such as the problem of the cost of care; the client-focused approach; innovation in practice; and what the AVMA might consider starting, stopping, or continuing to do. Throughout, participants considered the dynamics of practice teams—emphasizing a need for leadership and leadership training.

The 14 thought leaders were veterinarians in small animal, feline-only, mixed animal, and equine practice; a veterinary radiologist and a veterinary ophthalmologist; a consultant in practice management; the chair of the AVMA Veterinary Economics Strategy Committee; and representatives of the Ontario VMA, National Association of Veterinary Technicians in America, and Veterinary Hospital Managers Association.

Perspectives on practice

To define thriving in clinical practice, roundtable participants spoke in terms of satisfaction, adapting, passion, well-being, and achieving goals.

"I'd say a lot of people don't actually take the time to sit down and think about what thriving is from their own perspective," said Dr. Link Welborn, owner of five small animal hospitals in Florida. "We're so busy doing what we do all day long."

Dr. Corale Dorn, owner of a mixed animal practice in South Dakota, built on the garden analogy, saying: "The comfort zone is a beautiful place, but nothing ever grows there. And so, when we think about thriving and being able to grow, we have to embrace that there are going to be challenges and growing pains."

Dr. Peter Weinstein, chair of the AVMA Veterinary Economics Strategy Committee, said practices must move from survival mode to a model of thriving and success.

"Do veterinarians need to be taught to accept change?" asked Dr. Michael Q. Bailey, assistant medical director for telemedicine at Idexx Laboratories Inc. and a member of the AVMA Board of Directors. Drs. Weinstein and Heilsberg said yes.

Dr. David Granstrom, AVMA assistant executive vice president, said thriving also means being present in the moment. Dr. Dorn said her team shares positive outcomes during all-staff meetings. Kara Burns, immediate past president of NAVTA, said the small things are what really help teams with well-being.

Roundtable participants said members of practice teams should work together to set goals. Most practices have ownership, Dr. Weinstein said, but ownership doesn't equal leadership.

"In veterinary medicine, it was a doctor-centered business," he said. "It still is, way too often, as opposed to a team-centered business, where the team builds the culture and the doctor lives with the team, instead of the team living at the behest of the doctor. So leadership training, to me, is foundational," for the doctor and the team.

Among the participants in the roundtable were Drs. Stephanie Jones (left), a small animal
practitioner from Florida, and Bridget Heilsberg, an equine practitioner from Texas.

Solution discovery

The roundtable participants agreed that lack of leadership is a top problem facing the profession, while the cost of care is another. They broke into two groups to come up with potential solutions.

Specifically, a lack of effective or appropriate leaders or leadership could lead to a loss of control of veterinary medicine by veterinarians, said Dr. Heilsberg, summarizing the discussion by the first group. The group suggested the following potential solutions:

• Change admissions criteria for veterinary colleges to select for people who are leaders.
• Encourage veterinary students in leadership rather than asking them to be conformist in how to practice medicine.
• Provide practice teams with education on leadership.
• Promote involvement in organized veterinary medicine.

The cost of veterinary care could lead to veterinary care becoming a luxury, said Dr. Bailey, summarizing the discussion by the second group. The group suggested the following potential solutions:

• Conduct outcome-based analyses of veterinary care.
• Deliver this information to clinicians to present to clients.
• Expand pet health insurance, payment options, and prepaid wellness plans.
• Emphasize the importance of preventive care in ways that don't make clients feel nickel-and-dimed to death.
• Identify other opportunities for revenue streams, perhaps selling pet foods or offering grooming services.
• Make sure everyone in veterinary medicine understands virtual care.

The client-focused approach

Roundtable participants again broke into two groups to discuss the client-focused approach.

According to the first group, organizations such as the American Association of Equine Practitioners and Ontario VMA and companies such as Banfield Pet Hospital and Idexx have worked on identifying client needs. Practices can identify their clients' needs by asking their client service representatives or just asking their clients.

For prospective clients, practice teams should build the practice for the clientele that the team wants to serve. What about a dog-only practice? Then the team can target advertising to that clientele.

How often to engage clients depends on factors ranging from the clients' age and income to the practice model. Some clients desire frequent contact via social media, and some don't.

To gather feedback from clients, practices can conduct surveys or focus groups. To gather feedback from prospective clients, practices can try tactics such as conducting surveys of the community, visiting the dog park, or going on social media.

According to the second group, practices can identify services at which they excel by trial and error, comparing themselves to industry benchmarks, and soliciting client feedback. Practices can identify service opportunities by sharing ideas with colleagues, looking at pain points and top client questions, and attending industry events and continuing education.

Marketing to prospective clients could involve digital advertising, providing informational resources, and building community relationships. Additional ideas for gathering feedback from clients include reading online reviews or using a mystery shopper.

Innovation in practice

Matthew J. Salois, PhD, director of the AVMA Veterinary Economics Division, asked roundtable participants, "What does innovation look like?"

Doug Raven, CEO of the Ontario VMA, said the AVMA could look into creating an app for virtual care in veterinary medicine similar to the app for virtual care in human medicine from Babylon Health, a company in the United Kingdom.

Dr. Gary Marshall, owner of a feline-only practice in Washington state, said the linchpin for telemedicine in the veterinary profession will be to define the veterinarian-client-patient relationship. The AVMA and the American Association of Veterinary State Boards have policies on the VCPR as it relates to telemedicine, Dr. Bailey noted. The AAVSB policy allows for the VCPR to be established remotely, while the AVMA policy does not.

Dr. Bailey said states are defining the physician-patient relationship in human telemedicine, which might impact veterinary telemedicine. The federal government also has its own definition for the VCPR. Dr. Bailey said, "Right now, I'd say most practices really do not know what telehealth is."

Before the roundtable, many participants had indicated that unique practice models were an important topic for discussion. Dr. Weinstein envisioned a new practice model to improve retention, team building, delivery of what practice owners want, staff utilization, and finances. He said veterinarians could create a life-balance model, or they could create smaller moving parts instead of being jacks-of-all-trades and masters of none.

Burns advocated for better utilization of veterinary technicians. She said the AVMA and NAVTA are working together on the issue. In January, the AVMA House of Delegates recommended convening a working group to design a plan to improve utilization. In April, the AVMA Board of Directors formed the AVMA Task Force on Veterinary Technician Utilization.

Dr. Granstrom suggested that the AVMA and VHMA should work together to develop a cadre of professional practice managers.

AVMA start, stop, continue

Roundtable participants concluded the day by breaking into three groups to consider what the AVMA should start, stop, or continue doing.

The first group suggested that the AVMA should start to be more aggressive in leading the veterinary profession, get stuff done faster, promote or show how the Association is answering member needs, disseminate information industrywide instead of just through AVMA channels, promote the profession to the public, offer resources to determine what pet owners want on a local basis, and provide mystery shoppers to evaluate practices.

The second group suggested that the AVMA stop any programs with little or no impact, stop limiting everything to members only, stop thinking it's only about veterinarians, and stop trying to be all things to all veterinarians. Follow-up suggestions from the entire roundtable included that the AVMA should start improving awareness of programs and consider stopping the paper version of JAVMA and the AVMA Convention, the last because other organizations offer conferences.

The third group suggested that the AVMA should continue the PLIT and insurance products other than professional liability insurance, potentially to include health insurance again through AVMA Life; political advocacy, such as through the Congressional Advocacy Network and the AVMA Political Action Committee; the AVMA Veterinary Economics Division and a focus on economics; serving as a home for the collection and distribution of professionwide metadata; and the American Veterinary Medical Foundation.

Additional suggestions from the entire roundtable included that the AVMA should continue providing cyberbullying resources and the relationship with Bernstein Crisis Management, the focus on well-being, and the AVMA Convention and the AVMA Veterinary Leadership Conference, as being distinct from other conferences.

More about virtual care

Two weeks after the roundtable, the AVMA held the Veterinary Virtual Care Summit on April 11 at Association headquarters. The summit featured presentations on what's here and what's coming in the landscape of human and veterinary virtual care, what to be mindful of in veterinary virtual care, and an update from the AAVSB on virtual care. Participants broke into four groups to brainstorm. Coverage will follow in the June 15 issue of JAVMA News.

Related JAVMA content:

Telehealth poses new possibilities, problems (March 1, 2018)