Scenario: You have been sent on a call to a client who owes your clinic around $1,000 for work you did nine weeks ago. Your receptionist told the client that you would go on the call only if the client agreed to discuss the outstanding balance with you.
Discussing overdue invoices with clients can be difficult, and this job is unappealing to many practitioners. For the veterinarian, conversations regarding outstanding balances can create feelings of anger, frustration and guilt, as well as being undervalued by the client.1 For the client, these discussions can be stressful and cause defensiveness. When possible, prevention of the scenario is the best approach, which means discussing cost and payment of a service with the client before the service is provided. This will help decrease the number of clients who are surprised by an invoice, or who agree to having work done that they cannot afford.
Regardless of the effort and energy expended in reducing the number of clients who do not pay their bills, it is a certainty that it will happen. When it does, it’s valuable to have tools that can help you during the sometimes “awkward” conversation.
Tools You Can Use
In situations that are emotionally charged for one or both parties, particular attention should be given to non-verbal cues—both those that we are sending out and those we receive from the other individual. This is because cues about our feelings and emotions are sent primarily through our nonverbal and paraverbal (i.e., vocal tone and speed of speech) cues.2
When you arrive at the client’s farm and before getting out of your truck, think of something that puts a smile on your face and visualize a positive outcome for the conversation. Doing so will help to shift your mindset and facilitate the demonstration of neutral non-verbal cues. Make an effort to have an open body posture, which means relaxed arms and shoulders, and give “soft” eye contact. (Think of the difference in your eyes when you are giving “that look” to your kids or dog when they do something wrong compared to when you want them to come play with you.)
A signpost is a statement that suggests the direction of the conversation or interaction.2 Finding a way to bring up the money owed can be one of the most difficult aspects of the interaction. The use of a signpost can help decrease one’s anxiety about engaging the client in a conversation about cost. It also benefits the client by allowing him to prepare himself for the conversation, which can decrease the chance of a defensive response. Further, using a signpost provides the client with an opportunity to offer an explanation or payment.
“I know we need to take a look at Crosby. Before we do that, I’d like to chat with you about the invoices from the work we did last month.” “The office asked me to check in with you about the balance on your account.”
It is important to find out from the client why he hasn’t paid his invoice, as it will bear strong relevance to the resolution. The best way to invite the client’s story in a non-judgmental and welcoming fashion is to use an open-ended question or inquiry. An open-ended question is one that cannot be answered with a “yes” or “no”;2 it requires a thoughtful response. In this situation, a brief statement before the question can help you sound less accusatory when asking the client why the invoice remains unpaid.
“It’s not like you to have an balance owing on your account; what’s been going on?” “I’ve noticed you haven’t paid for Simon’s lameness work-up last month. Can you tell me what happened?”
The way one behaves when a client answers an open-ended question is critical. It is important to react in a way that continues to demonstrate interest and caring in the client’s story. This can be accomplished through using the tools of active listening, which include paraphrasing statements and pausing.2 Paraphrasing statements are those in which the client’s thoughts are echoed back to him and which clearly acknowledge what the client has said. The use of pausing, where one simply waits a few beats before responding, can encourage the client to continue speaking and allows time for the information the client has shared to soak in.
After you’ve gained an understanding of the client’s perspective, and hopefully the reasons behind his lack of payment, it is time to make a plan to resolve the outstanding balance. While it is tempting to jump to this step first, if the earlier steps are skipped, there is increased risk the conversation will become adversarial and a decreased likelihood that an acceptable plan will result.
“It’s important to me that we figure out a plan that works for both of us. How do you think we can move forward?”
Veterinarians want to practice good veterinary medicine. They don’t want to be bill collectors. But getting paid for what you do is part of the unspoken contract that you have when you provide services to your clients. In an ideal world, we would never have clients who don’t pay their bills on time, but that is unrealistic. So instead of getting angry or defensive when this happens, use good communication skills to open a non-judgmental dialogue that can resolve the issue.
Dr. Colleen Best graduated from the Ontario Veterinary College in 2009. After completing an equine internship, she practiced equine ambulatory medicine in Ontario, then returned to pursue her PhD in equine veterinarian-client and referring veterinarian-specialist relationships.
1. Coe, J.B.J.; Adams, C.L.C.; Bonnett, B.N.B. A focus group study of veterinarians’ and pet owners’ perceptions of the monetary aspects of veterinary care. J Am Vet Med Assoc. 2007; 231:1510-1518.
2. Silverman, J.; Kurtz, S.M.; Draper, J. Skills for Communicating with Patients. Abingdon, Oxon, UK; New York: Radcliffe Medical Press, 1998.