The Power of One: Solo Practice Management Tips

For the 40% of AAEP members who are solo practitioners, here is advice from some of your independent colleagues.
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Veterinarians tend to be independent-minded people, so it is not surprising that many equine practitioners prefer to form a solo practice, going it alone. This can be exhilarating for its autonomy, yet challenging for the sheer quantity of work.

Dusty Perin

Over the past 30 years, Wally Liberman, DVM, has built a state-of-the art equine clinic, Panorama Equine Medical and Surgical Center, in Redding, California, that he currently runs as a solo practice. “When starting out,” he advised, “It is important to define your practice goals and how you want to operate.”

Liberman reminded us that clients spread information about the practice’s focus via word of mouth. “When I went solo, I clearly identified that I could not do all emergencies. While this may have lost me some clientele and some income, what I gained was my sanity.

“By focusing on a particular special interest rather than pursuing general practice, I found it greatly reduced the number of emergencies. If you wish to solicit emergencies, then that’s what you get,” he added.

Solo practitioners choose to operate in either an ambulatory or clinic environment; in some cases, some will do both. No matter which form of practice you pursue, one of the biggest challenges to a solo practitioner is finding strategies to minimize fatigue. It is tempting to try to take on every call that comes your way, to pack each day and evening full of veterinary medicine. “Each practitioner should define what they are capable of doing and stick to that framework,” urged Liberman. “This means that you’ll want to lay down the ground rules for your clients by defining your services and your limitations.”

Liberman elected to reduce windshield time by building a hospital into which his clients haul directly. “The advantage to the hospital setting is that working in a clinic is more conducive to uninterrupted thought process and concentration, as compared to working at a horse owner’s property with many people and distractions.”

No matter whether a vet is working at farm calls or in the clinic, Liberman said, “A good technician is indispensable. That person is always a little ahead of me, moving the horse through the examination process, getting set up for the next step. As a registered veterinary technician, my assistant often has fresh ideas to add to the horse evaluation. She is also able to chat with the horse owner and gain information about the case that an owner may not feel comfortable telling directly to the doctor. Efficiency is improved in all ways.

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“Increasing competition in my area has changed the practice landscape,” added Liberman. “However, because I’m willing to take the time to work up a tough case, such as a persistent lameness, clients avail themselves of my equine veterinary services. With the constantly improving imaging capabilities in veterinary medicine, we better understand the complexity of orthopedic problems and have an improved ability to achieve an accurate diagnosis.

“My clients come to my clinic with the expectation of getting answers to their horse’s problem,” he explained. “Investment in excellent imaging equipment has helped me provide this service. It may take the better part of a day to work through one exam, but I have a system that keeps a horse moving through the clinic to each appropriate area—for the exam, for imaging, for injections.”

He reported that this provides a comfortable environment for horse and owner, noting, “Each client has my full attention, without interruption. Seeing the same doctor each visit ensures consistency in understanding the horse’s history. Horse people value and like this kind of relationship and are willing to pay for such individualized service.”

The same approach can be applied by an ambulatory practitioner. Excellent communications are paramount to a good practice; paying special attention to a client’s concerns is another strategy that helps to retain client loyalty.

Keeping a Fresh Viewpoint

We often hear the term “burnout” applied to many veterinarians, especially those in solo practices. Our natural disposition makes us want to jump up and tackle every case that comes before us, no matter how fatigued we may feel. But Liberman has a different vantage point on this.

“Burnout is a luxury,” he stated. “I see burnout, i.e., being sick of work, as originating from a personal or life problem rather than a problem with the job. The personal problem then creates problems in the business workplace.”

He emphasized, “If a practitioner constantly stimulates him or herself by embracing the concept of improving oneself as a better doctor, then the work stays interesting. Filling each day with study as well as thinking about how to improve the handling of every case keeps veterinary practice stimulating.”

Rather than viewing job dissatisfaction as burnout, it is probably more appropriate to direct attention toward how to avoid the pervasive ailment of fatigue. Liberman advised that it’s important to take breaks—just leave and go do something for yourself, with your family, anything away from the work environment. Don’t schedule appointments every day; leave yourself some free time.

“If you maintain your own good health by eating well, exercising, getting good sleep and balancing free and work time,” said Liberman, “then you’ll be able to think clearly and come in every day with a good attitude. The best advice is to pursue work that keeps you happy along with taking time out from work and striking a balance between work and a personal life.”

He added, “I arrange with a local practice to cover emergencies when I need to be gone or am not available. Network with local practices; establish a good working relationship with these folks.”

Leaving for vacation or pursuit of continuing education usually means a solo practice stops its operation. While the answering service is instructed to hold calls and direct clients to a local practice for care, rather than closing up his practice entirely, Liberman has a staff member present at the clinic during business hours.

“While this is an operating expense, it is important to provide this service so the clinic remains accessible to clients,” he said. “In addition, my cell phone keeps me available to my staff and to clients with ongoing cases.

“Seeking knowledge expands oneself as a better practitioner and inspires you to improve every day,” he said.

“Continuing education, and in particular the AAEP annual convention, can’t be replaced!” he said.

“At these venues you are exposed to new ideas, and that gets you recharged,” he stressed. “For veterinarians who don’t attend such conferences, their practice is likely to remain self-serving because it’s easy to convince yourself that you are doing things right without seeing other options. By attending veterinary conferences that present cutting-edge information, it is then easier to step aside from your ego, admit to mistakes, and be willing to change and improve your way of doing things. CE encourages a practitioner to go forward with a new approach, while also making everyone accountable to their peers.”

Liberman counseled the solo practi-tioner in particular: “Be involved in professional organizations; this is the only way to expand yourself and your knowledge and to network with other vets. Face time at meetings develops relationships, making it much easier to pick up the phone or send an email to discuss difficult cases. I have found that attending the annual AAEP meeting has helped me form a group of ‘go-to’ practitioners who I can call at any time to learn from their expertise.”

The Solo Practicing Parent

As women have come to comprise a large proportion of the equine practitioner population, they are becoming more nimble at juggling the starting and raising of a family with pursuing a professional career. Charlotte Obermeier, DVM, of Boulder and Beyond Equine in Boulder, Colorado, has been in solo ambulatory practice for a decade while raising two boys, now ages 8 and 11. Her first child was born during her junior year in veterinary school, and the second son arrived a year following graduation. She cautioned would-be mothers: “It’s easier to have a baby while in vet school than to have older kids during your educational process.”

One big challenge is how to manage your kids and your practice life when the inevitable off-hour emergency occurs. Obermeier suggested, “Now, I always have a family member or someone take the kids when I need to go on emergency calls. When the kids were infants, I often had to take one along. I used to keep my infant in a front pouch while I worked, and in hindsight this probably isn’t the best idea.”

She added an appropriate piece of advice: “Prior to going on an emergency call, I always tell the client that I will have my child in tow—this gives the client a choice of having me come with a kid, or calling someone else.

“I found that in many cases, clients actually enjoy entertaining my child while I attend to their horse.”

Obermeier stressed one key point: “A word of advice: I never take two kids together to a farm call.”

She said that another option is to hire a nanny to accompany the children on ambulatory calls. “While this is costly, it is often less expensive than day care and allows the parent veterinarian to spend time with their child,” said Obermeier. “As the kids get older, they can entertain themselves with books or video; often they want to come on calls with their mom.”

She noted that while some kids are resentful of a busy practitioner’s work demands, as the kids grow up, they seem to better understand that they actually see more of mom (or dad) than if the parent has an office job.

Liberman’s clinic is located on the same compound as his home, with his wife an active participant in running the practice while his kids were growing up. This meant that mom and dad were physically present and available to the kids all hours of the day rather than commuting elsewhere to a job. This enabled Liberman to develop a deep relationship with his three daughters while also enjoying family time.

The Nuts and Bolts of Business Management

Running a busy solo practice is not just about balancing work and personal time; it’s also about financial stability. To keep a business solvent, Liberman feels it’s important to review income and expenses every day, and to reassess fees daily. Regardless of whether a solo practitioner is “chief cook and bottle washer” doing everything alone or has hired office assistants or technicians, to keep a business running smoothly relies on diligent attention to details.

“It is essential for a solo practitioner to be responsible and knowledgeable about every line item in the general ledger, paying attention to invoices, deposits and fee schedules,” he said. “In this way, nothing gets by you. And it is less likely that you will be embezzled by a disgruntled employee.”

Dusty Perin

The task of running a business is time-consuming and tedious and must be added to the hours of demanding full days of seeing clients and equine patients. Liberman offered a sage piece of advice: “One of the smartest things I ever did was to hire an independent bookkeeper who comes in weekly to handle paying bills, dealing with tax payments and requirements, and in general keeping the business running straight. She is not an employee, which keeps her observant with an objective perspective on the business. In addition, our agreement is that any mistakes she makes, she covers out of her pocket. This motivates her to pay diligent attention to details and do everything correctly.”

Inventory can be a financial drain on a practice if not monitored closely. Liberman noted, “The days of keeping every conceivable item on hand are over. Lost income from expired or overstocked medications or money tied up in inventory that sits idle on a shelf or in a truck makes no practical business sense. I recommend tightening up on inventory, only having on hand appropriate quantities of what is needed for active case loads. I also use Excel spreadsheets to track orders as well as costs and retail pricing.”

In most cases, it is possible to order something from your distributor and have it here the following day, which eliminates the need to keep large stocks of supplies on the shelf or in the truck.

Besides the enjoyment of working with horses and practicing quality med-icine, one big motivator of a business person is to get paid for your efforts. Cash flow is critical to a solvent practice. Liberman said, “The best policy for managing accounts receivable is to not have them in the first place. Rather than offering credit through the business, I expect payment in full at the time of service. This can be as check, credit card, cash or through Care Credit. Ambulatory practices have more of a problem with immediate collection, but this can be overcome by maintaining an active credit card on every client’s account.”

Obermeier agreed that collection of fees at time of service is important. She said, “I don’t think it’s a bad thing to be a vet who gets paid at time of service. As you build clientele, you could decide to be more flexible in extending short-term credit to known, good-paying clients. Credit cards are helpful to ensure being paid, particularly for emergencies. The Intuit-Go payment scheme (and other similar services) swipes a card on a cell phone and is a great asset to fee collection.”

Both Liberman and Obermeier emphasized, “Don’t forget to charge for your knowledge.” As veterinarians, we have an expensive and lengthy education in addition to ever-increasing expenses and costs of doing business. When we value our time and expertise, clients will do so as well.

Liberman further considers the natural evolution of a vibrant practice that grows beyond the capacity of one person to do the job. He said, “It is tempting to bring on partners or other practitioners to help take advantage of expensive equipment and to share the load. Many solo practitioners tend to want to micromanage, but this tendency needs to be balanced by giving appropriate free rein to colleagues.”

As for how to find compatible, yet offsetting, individuals to work with, Liberman advised, “Don’t make hiring or partnership decisions emotionally. Rather than looking upon potential colleagues or assistants as friends, treat them as a business relationship, complete with legal contracts defining agreeable compensation and commitments.”

Take-Home Message

Besides being an astute business person, a solo practitioner must bring to his or her daily practice an upbeat outlook and good “bedside” manner coupled with excellent professional expertise. The way to accomplish this is by keeping your body active and fit and your mind stimulated while choosing to do specific equine work that you find satisfying and fulfilling. There is nothing that says you can’t say “no” to client demands on your time. Define your practice goals and the services you choose to offer at the onset of building your business, and educate your clients about your expectations for them to be a welcome part of your practice.

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Letter to the Editor

Dear Editor,
After reading the article “The Power of One: Solo Practice Management Tips” in the Fall 2013 issue, I found myself rather offended by Dr. Liberman’s comments on burnout in our profession. In fact, I strongly suspect that not only has he not experienced burnout, but he does not truly understand the definition of burnout or its cause.

I know all too well that it is the physical and mental consequences of being overworked, often with a nice dose of compassion fatigue. It does not “originate from a personal or life problem,” unless you consider it a personal problem that one cannot work 24/7 without sleep.

As a young vet and new practice owner, I have experienced burnout at least once or twice a year. I don’t find it to be a “luxury.” In fact, to me, it is a luxury to not have to deal with burnout. Unlike Dr. Liberman, I can’t just leave my practice, referring emergencies to other local clinics, or refuse to take emergencies that don’t fall into my area of interest. And hiring on a relief vet has proven to be not only cost-prohibitive for a new practice, but complicated due to the ambulatory nature of my practice.

During my time here, there was an almost one-year period [during which] I was the only large animal vet in my area. Could I just leave my area unattended? Could I just refuse emergencies that didn’t interest me? No. Or at least not if I wanted the few hours of sleep I got each night to be restful.

For the first three years of my professional life I busted my butt, taking EVERY call, every emergency I could possibly get. In my first year, I got stomach ulcers twice. Why would I do this to myself? So that I could grow the practice to the point that it would support another vet! This July, I hired my second vet (a surgeon, actually), and we have plenty of business to share between the two of us, and only half of the emergency calls for each. She is able to concentrate on the type of calls she likes, as am I. And in doing so, we are together providing a much higher quality of medicine to our clients than I could alone.

So, instead of cautioning solo vets to turn away business (who can do that in this economy and with $100K+ of student loans?!), I think one should encourage other vets to put a hard day’s work in, pay their dues and understand that true hard work will eventually lead to a better work-life balance. Honestly, I truly do not believe that a solo vet can completely fulfill both him/herself and his/her clients forever without something suffering eventually. Why not aspire for something more? THIS is better work-life balance—I am not disappointing my clients in any way, and I have a much higher level of career satisfaction!

Karen Bolten, DVM
Myrtle Beach Equine Clinic
Myrtle Beach, South Carolina