In 2023, the Marion duPont Scott Equine Medical Center at Virginia Tech, in Leesburg, Virginia, reorganized its emergency services by hiring emergency-only clinicians. “We hired two Emergency & Critical Care (ECC) diplomates to be the foundation of our emergency service,” said Mike Erskine, DVM, DABVP, Equine Medical Center director. “The ECC faculty members cover 37 weeks per year as part of their 80% clinical effort assignment. The other faculty members (ACVIM and ACVS) cover the remaining 15 weeks of emergency coverage per year. We are decoupling emergency responsibilities from elective (scheduled) responsibilities; i.e., the ECC clinicians have no elective case responsibilities.”
University Hospital Emergency Model
He explained that the emergency service clinicians work 24-hour shifts, with either a four-day workweek or a three-day work weekend, and alternate their schedule monthly. Therefore, they work an average of 3.5 days per week and receive a full salary. As ECC diplomates, they are trained in both emergency medicine and surgery, so only one clinician is on call at a time, in contrast to practices that must have both an internal medicine clinician and a surgeon on call together. The ECC clinicians admit all emergencies and manage their patients until the next business day, when their patients are transferred to the appropriate service (medicine or surgery) for continued inpatient care.
The most important advantage with this change, said Erskine, is that “decoupling emergency from elective service responsibilities has allowed our clinicians to be fully engaged and dedicated to their assigned responsibilities.” Improved workflow efficiencies and fewer disruptions during business hours result in fewer delays, fewer cancellations, and less stress. “Our other faculty can then focus on and expand their elective caseload because they do not have to reserve time and energy for emergencies.”
One of the biggest challenges in implementing this change was recruiting clinical staff to support the emergency service due to the tight labor market. Also, “because an emergency caseload is unpredictable and can be very high at times, our other faculty have had to provide backup emergency support on occasion,” said Erskine. In addition, case transfers can occasionally be challenging, but “our faculty spend considerable time and effort ensuring case continuity and that client and referring DVM communications occur at the highest level.”
Private Equine Practice Emergency Model
In a private practice setting, Allegheny Equine in Murrysville, Pennsylvania, took a different approach for decoupling emergency service from elective work. Each of the veterinarians dedicate a small percentage of their compensation to a pool that supports the base salary for each of them to have one week in turn on emergency duty only, from 5 p.m. to 7 a.m. Monday through Thursday, after which they have a three-day weekend off. Each doctor continues to receive full base salary no matter how many or how few emergencies they see and earns 100% of all emergency fees. During their four days on emergency duty, they have no scheduled calls, and the rest of the team does all the elective work. This team approach helps train clients to see the practice’s veterinarians as equally talented, and if they prefer a particular doctor, they can wait for a week to see them.
The regular weekend emergency schedule has been as few as one in seven weekends for each veterinarian, and these never follow the week of on-call duty. According to Jim Zeliff, DVM, MBA, founding partner at the practice, they initiated this change in 2022, and the doctors have embraced it. “The advantages include eliminating the times where a doctor sees emergencies all night and has elective appointments the next day,” he said. “Doctors that take less emergency duty (mostly due to family commitments) pay into a fund that compensates the individuals who are covering call. Difficulties have been minimal, but a few that we have encountered include having doctors struggle with being off of the routine schedule for their emergency week, having enough veterinarians on the team to make the schedule work during the times when numbers are down due to vacations, injuries, or maternity leaves, and the potential for reduced personal revenue production during the slow season when there are less emergencies, potentially reducing bonus compensation.”
Related Reading
- AAEP Commission on Veterinary Sustainability: New Paradigms in Equine Emergency Coverage
- AAEP Commission on Veterinary Sustainability: New Frontiers in Emergency Service
- The Business of Practice: Emergency-Only Practices
Stay in the know! Sign up for EquiManagement’s FREE weekly newsletters to get the latest equine research, disease alerts, and vet practice updates delivered straight to your inbox.
