A recent survey published in EquiManagement reported that equine practices have been much busier in the last two years, and hiring veterinarians for associate positions has been difficult.
Many equine veterinarians have taken positions in companion animal practice because of higher salaries, lower work hours and no emergency duty. These factors have left practices with more work to be done by fewer doctors.
Increasing efficiency is essential to help lower stress and support veterinarians in equine practice. In addition, when a practice is efficient, profitability often rises because staff can complete more work in a shorter amount of time, making more robust revenue possible.
Making Travel More Efficient
Ambulatory practice often involves many hours driving from client to client or farm to farm. As service providers, veterinarians have only their time to sell, and travel is not profitable time. These hours can be made more efficient with an assistant or technician. If the employee is driving, the veterinarian can prepare laboratory submission forms, finalize invoices, look up history for the next call, schedule appointments or make callbacks. If the doctor prefers to drive, a well-trained assistant can accomplish most of these tasks. When driving time is productive, the workday shortens because veterinarians have less to do at the end of the day.
Practice staff can reach out to clients with appointments scheduled for the following day to review services needed, remind the client of the appointment, and offer expectations for the time of arrival and an estimate of the cost. If the client requests additional services that were not previously noted, the doctor can then modify his or her schedule in advance. If dispensed items are requested, the veterinary team can be sure to have them available during the visit
and even add them to the invoice in advance. This ensures each veterinarian is fully prepared for the day and has the necessary equipment and supplies.
Having technical staff available and utilized to the best of their capabilities will markedly increase efficiency both on the road and in the hospital. Licensed veterinary technicians can be scheduled independently to go on calls to draw blood, change bandages, remove sutures or recheck patients. If questions or concerns arise, they can easily send photos or video to the primary doctor for immediate follow-up.
Even without an independent schedule, well-trained technicians can significantly increase efficiency by setting up for procedures, doing aseptic preparations, taking radiographs or performing other imaging such as bone scans or MRI studies. Veterinarians can then limit their participation to examinations, diagnosis, medical and surgical procedures, and creating treatment plans, many of which the technical staff can then carry out. Technicians can often handle follow-up communication after uncomplicated visits and document it in the medical record.
Some busy equine veterinarians have two technicians assisting them so one can capture medical record information, create an invoice or assist with procedures while the other sets up, cleans up or takes radiographs if needed. When veterinarians are performing multiple lameness exams or seeing many horses for routine work such as vaccines and Coggins tests, this strategy can be very helpful in using time more efficiently.
Establishing Regular Rounds
Another strategy for efficiency in ambulatory practice is the scheduling of calls in geographically segmented areas on an unvarying routine basis (e.g., north on Tuesday, south on Thursday). This allows less driving time and sets expectations for clients as to when you will regularly be in their region. You can even reduce the trip charge by a small amount and still increase total revenue by seeing more clients in an area in a single day rather than spending time crisscrossing the practice territory. Because emergencies can upend this strategy, it is often more successful for multidoctor practices.
In a multidoctor practice, having a “float doctor” to do daytime emergencies each weekday can keep the other doctors on schedule so they can finish at their anticipated time. Veterinarians arriving on time also increases client satisfaction.
By creating a “hard stop” for scheduled workdays by not scheduling any routine calls to start after 3 or 4 p.m., the doctors that are not on emergency duty can limit the length of their workdays. In addition, by sharing the work rather than each doctor operating as a silo, everyone can benefit from reduced exhaustion and increased productivity.
The Haul-In Model
Because driving from client to client is so time-consuming, having the horses come to the veterinary practice can increase efficiency, especially when a call involves only one or two horses or geographic area days have not been established. However, it is important that the veterinary facility be used regularly to offset the additional costs involved in maintaining a physical building.
In some areas of the country, trailer ownership is common, and haul-in facilities are the rule rather than the exception. This can markedly increase efficiency and productivity if multiple appointments can be made in a single day. At some practices, availability for appointments with certain doctors is limited to haul-in visits. Other practices designate certain days of the week for haul-in appointments only.
In areas where ambulatory service at the farm is the cultural expectation, retraining of clients to a haul-in model must focus on the benefits outpatient appointments at a central location will bring them. By raising farm trip fees, practices can charge less for haul-in appointments than for farm visits. Staff can also communicate to clients other advantages such as having access to more specialized equipment and more comfortable, temperature-controlled surroundings. Obviously, with boarding barns that have large numbers of horses that need care, an ambulatory visit will be more desirable.
Some equine practices are moving to providing emergency service limited to haul-in. This can be much more efficient and comfortable for equine veterinarians, as they can work in a well-lit, climate-controlled space with their supplies and equipment close at hand and no driving time. Because this model requires training clients to purchase a trailer or develop a transportation plan before an emergency occurs, it is very important to communicate clearly and not surprise or confuse horse owners. Obviously, some cases will require a visit to the horse’s location, such as when a horse is down or cannot ambulate. Because of the inherent inefficiency of these cases, the fees must be adjusted accordingly.
Creating appropriate medical records and accurate invoices can take a significant amount of time. Purchasing practice management software that creates an invoice in the background when the medical record is being written increases efficiency.
As noted, having an assistant produce the invoice rather than the veterinarian also increases efficiency. Having two sets of eyes on the invoice also helps prevent failures to get all service items and dispensed medications or supplies on the invoice. For routine calls, the medical record entries and invoices can be created while driving to the farm and any additional comments added before the invoice is closed. Using templates for common examinations and procedures can increase accuracy as well as efficiency. While it takes some effort to set them up in a way you desire, once made, they can save you a lot of time.
At the conclusion of the visit, you can easily email the invoice, a copy of visit records and treatment instructions from most software. When clients’ credit cards are on file, you can charge them automatically for the visit, saving other staff members the time they’d spend inputting card numbers or preparing bank deposits from paper checks.
Thinking about the amount of billable time in a typical workday can be a wake-up call. Most ambulatory practitioners spend no more than 50% of their time at work performing billable services. They spend much of their time communicating, driving and performing tasks that could be better done by technical staff.
About 35% of AAEP members are solo practitioners. Sixteen percent of equine practitioners have no staff of any kind. Having a staff member to package laboratory submissions, restock the truck, complete paperwork and manage diagnostic equipment can be a significantly positive factor in reducing the number of hours the veterinarian must work. In this time of increased demand for services and a decreased supply of providers, it’s smart business to limit your activities to those that require a veterinarian, charge appropriately for your time and hire staff members to assist with the other functions.
Televisits and Client Portals
Telemedicine is here to stay. During the pandemic, many human medical providers began using virtual appointments, and patients as well as physicians have judged them very positively. Research shows 50% of patients would change doctors if their care provider did not offer telemedicine. Now that people are familiar with this technology and look at it favorably for convenience and time savings, they will increasingly desire the same option from their veterinarians.
Using telemedicine in equine practice can increase efficiency, but practitioners must charge for it appropriately. In a recent survey, 75% of those using telemedicine did not charge for it. While this service increases efficiency dramatically, it certainly is bad for a practice if it is given away for free. Medical record-keeping and payment solutions are available through telemedicine apps. Exploring these options can provide a seamless way to incorporate these transactions into your practice.
In addition, client portals that allow payment of invoices online and downloads of laboratory results and medical records can help reduce the time spent fulfilling client requests for information. Technology is a helpful way to increase efficiency in many aspects of your practice.
With the current environment in equine veterinary practice, increasing efficiency is important for reducing time pressure on veterinarians. Non-veterinarian staff members are key components of building a more efficient practice. Using technicians to their fullest capabilities enables practices to do more work in less time. This might include independent work not unlike that of physicians’ assistants in the human medical field.
Efficient scheduling will also help reduce work hours and minimize nonbillable time. Decreasing travel by implementing a haul-in business model can have many benefits for both routine and emergency services.
Enhancing the use of technology through practice management software, telemedicine applications and other available innovative solutions can spur additional improvement in time management. Adopting new ways of practicing can boost efficiency and, in doing so, improve the lives of equine veterinarians.