The concept of billable time is one that is well established in the professions of accounting, law and architecture but is rarely considered in veterinary medicine. Veterinary medicine can be highly inefficient in some sectors. Ambulatory equine veterinarians often struggle to achieve even 50% billable hours of the time they spend working. Since there is no way to add more hours to the day, the number of billable moments is finite, and as a medical professional, you only have your time to sell.
One of the ways to determine your efficiency is to track your time in 15-minute intervals throughout a typical workday or two during each quarter or month of the year. You simply create two columns—Billable and Not Billable—and put a check mark in the appropriate box for each 15-minute period of the time you spend at work that day.
Billable activities are those for which you will write an invoice—services such as exams, performing diagnostic tests or giving treatment. Non-billable time does not increase your revenue, and it includes things like client communication, driving, cleaning up after services, restocking your truck or attending practice meetings.
Because most ambulatory veterinarians charge a “trip fee,” some feel that windshield time is a billable item. But since trip fees are generally used to offset the cost of maintaining fleet vehicles, it is debatable.
Using a third column designated Travel can help ambulatory practices determine what percentage of their time is spent behind the wheel.
The importance of understanding your efficiency cannot be overstated. You can increase your practice revenue and decrease the number of hours spent working if you can find new ways to maximize your billable time. You can adjust your fee structure for billable services to account for the necessary time spent on activities for which you cannot charge.
Regularly scheduling calls in certain geographic zones on certain days of the week can limit the time spent driving between farms, and clients will quickly become accustomed to when you are normally in their specific area. Using a driver can free you to make callbacks, write medical records and prepare laboratory submissions while traveling. This can bunch multiple non-billable tasks that are then done simultaneously, saving you time later. Employing a veterinary assistant can help with efficiency in a similar way.
The nature of veterinary medicine makes efficiency challenging, because every day is different, emergencies often interrupt the flow of the day, and doctors have a lot of different roles that they might be juggling (veterinarian, practice owner, parent, caregiver, spouse, etc.). Medical knowledge is always changing, compliance with OSHA and DEA regulations has to be considered and technology innovations develop at lightning speed. Simply keeping up is hard!
In addition, attracting and retaining more graduates in equine veterinary medicine will likely require higher compensation. The only ways to generate the increased revenue needed to support salaries more comparable with companion animal practitioners are to increase the number of patients seen, increase the number of services provided per patient, and/or charge more for professional time. Practices that are highly efficient can more readily achieve these three.
Use of Technology
One way to increase efficiency is to use technology to help with communication, collection and marketing. There are a number of outside companies and apps that simplify these functions.
For example, creating a payment portal on your website can make payment of invoices convenient and simple for those horse owners who are not present at the time of your visit. Use of a phone solution such as Grasshopper can simplify routing calls, allow better boundaries and minimize cost. Even setting automatic text replies on a smartphone can set expectations for clients as to when they can expect you to reply.
Employees and Delegation
When a veterinarian has staff members, efficiency is maximized when he or she is comfortable with delegation. Many doctors have difficulty with letting go and trusting someone else to complete tasks, but that is necessary in order to build a better work-life balance.
When hiring employees, it is important to look for shared values and a positive attitude. When everyone is on the same team, trying for the “win,” efficient operation is much more possible. A team member who fits the practice culture will outperform a person with outstanding skills who does not. Having friction between people is a significant obstacle to efficiency.
To ensure the best performance from employees, training needs to be ongoing to increase competencies and allow the doctors to “offload” responsibilities that do not require a veterinary degree. Utilization of staff to the fullest extent of their abilities raises revenue, job satisfaction and productivity. Everyone benefits.
Reduce Clutter and Chaos
A simple way to reduce the time your work takes is to increase your organization and reduce clutter and chaos.
Having a place for everything and putting everything in its place after use is paramount to working efficiently. Handling paper and searching for paper documents consumes a lot of employee time, according to research. IDC’s Information Worker Survey revealed that workers spend five hours per week searching for documents.
Consider having a well-organized electronic file of documents to share with clients by e-mail. These documents could include post-care instructions for certain conditions, an informational “what to expect” FAQ or an event invitation. Laboratory submission forms can similarly be filed on your computer so they can be filled out while driving. The key is to organize materials in files and name them consistently.
Choice of Time Spent
One of the pleasures of practice is the interesting people that fill our days. Over a career, veterinarians often develop close relationships with clients and co-workers, watch their families grow up, and share many experiences.
It is easy and pleasurable to spend time chatting and socializing. Unfortunately, that time eats into efficiency and can readily fill even a not very busy day. Many veterinarians allow a “slow” day to fill as many hours as a very busy day, as they enjoy slowing their pace. This might be exactly what the doctor needs, but it is important to be mindful that it is a choice of how to spend this time.
A challenge that most equine veterinarians face is the lack of control over their time due to emergency duty obligations. Unfortunately, many practices also expect their doctors to be available to clients nearly all of the time, even when they are not on call, as a demonstration of their dedication.
In order to manage their time so that they have opportunities for lives outside of practice, development of personal boundaries is critical. Setting boundaries is essential, because without them you will likely start to feel undervalued, under-appreciated, disrespected or worse. Without this space carved out, your work can become all-consuming until you have nothing left to give.
Equine doctors who join emergency service cooperatives can often achieve more time away from work obligations. This is of particular benefit to solo practitioners. The collaboration and networking that are needed to do this successfully take time, but very little compared to the endless weekends on call that would otherwise result.
Utilizing a four-day work week can help equine veterinarians carve out time for other professional needs such as reading journals, practicing new techniques or pursuing specialized education. Alternatively, the “extra” day could be used for personal activities that decrease stress, increase well-being and improve happiness. It is no surprise that the productivity of doctors who are rested, less stressed and experiencing joy in their lives is higher than those without these things. Even simply incorporating a “hard stop” to the day for doctors not on call can be achieved by not scheduling any appointments past mid-afternoon.
Having the self-discipline to allow oneself this freedom can be challenging for some. The traditional work ethic of equine veterinarians is to be available all the time. By challenging this paradigm, doctors might feel they do not belong “in the family” of equine veterinary medicine, are “not enough” or are “unworthy.”
Time management really becomes self-management. It is necessary to take responsibility for creating the life you want to lead. While this can be difficult, it is ultimately rewarding.
You Can Lead a Vet to Water …
Finally, there is growing research showing the effects of hydration on cognitive performance and mood. Being well hydrated helps our memory, attention to detail, motor skills and emotional state.
Drinking liquids throughout the day is an easily missed component of time management and efficiency. Optimal hydration increases energy, improves brain function, reduces stress, improves mood and prevents many headaches. It is easy to just keep working and forget this simple piece of self-care, but what a positive difference it can make!
Take-Home Message
Time management and efficiency are important concepts for veterinarians. However, if you’re feeling overwhelmed and stressed, time management strategies might not help. In fact, constantly trying to improve your efficiency can make things worse if, as you become more efficient, you make room for even more tasks and feel even more pressure.
When you’re feeling overwhelmed, you are better served by attacking the root cause: the sheer volume of tasks. This means learning to delegate tasks that others can do and being honest with yourself—and others—about what you can actually commit to. Remember that saying “no” is sometimes the lifeline you need.
In summary, seeking data to illustrate your current level of productivity is the first step toward improvement of your efficiency. Envisioning your desired work outcomes can lead to hiring compatible staff members or improving the training and utilization of those already on your team.
Increasing trust and delegation can free up time. Utilizing technologic solutions, embracing a tidy and organized workflow, and being open to new paradigms are all ways to enhance your time away from work and maximize your efficiency. Then be sure to use the time you free up in ways that enhance your well-being.
