Pervasive inefficiency in veterinary clinics
Linda, a technician at Allison Veterinary Hospital, tapped the counter. She'd been at the hospital since 6:30 a.m. managing patients. It was now 9:30 and the first appointment of the day hadn't shown up, so the staff were waiting for the next.
Linda's boss, Dr. Cynthia Allison, was growing impatient. She asked about Ms. Amanda Potts and Buster and Muster, the two Boston terriers due at 9:30.
"They're not here yet, but Mr. Hammond and Jake just walked in the door," Linda said. Jake, a golden retriever, was losing weight and Dr. Allison was worried about cancer.Dr. Tim Watson, a new grad with an interest in orthopedic surgery, was off today. When he was in the practice, he often spent hours online and with his nose in a book, looking forward to doing his first TPLO.
By 10 a.m., the front desk receptionist, Jan Kirkpatrick—who had been answering the phone nonstop since 8 but had made no appointments—answered questions and handled refill requests. She finally looked up and told Mr. Hammond he could take Jake into an exam room. She noticed that Mr. Hammond's eyes were red and puffy.
Just then Ms. Potts burst through the front door amid a cacophony of barking. "I know, I know, I'm late," she announced above the clamor as her charges wound around her ankles (and the nearby plant stand). In a blink, half a gallon of potting soil and African violets were distributed throughout the waiting area. Ms. Potts didn't seem to notice. Jan ran around the counter with a folding chair for Amanda to sit in while untangling her ankles.
"What a morning already!" thought Jan as she looked frantically for a broom. But then she realized it wasn't really that atypical—just a bit different in a familiar sort of way.
In the exam room Linda was trying to talk to Mr. Hammond about Jake over the din in the waiting room. It seemed that Jake was worse. In a few minutes Dr. Allison walked in and started to review Jake's history. It was a difficult conversation. After explaining what that problem might be, Dr. Allison gave Linda a list of tasks—blood tests, radiographs, urinalysis and a call to the university. It was a lot of work and the other technician had called in sick this morning. Dr. Allison hoped the CBC machine wasn't acting up.
In the meantime, Ms. Potts, eager to talk about her list of concerns about Buster and Muster, grew tired of waiting and walked into an empty exam room without instruction from the hospital staff. Her dogs tracked in residual potting soil.
Dr. Allison entered the exam room with Buster and Muster as Linda carted Jake off to the back. In the reception area, three more people were now waiting—two were expected and one was not. Then the phone rang. The caller was a frantic, longtime client who wanted to know if she could drop her cat Willie off in a few minutes—she thought he was plugged again.
Jan glanced at the time: 11:15.
What's wrong with this picture?
With no-show or late clients, open time slots and a lack of traffic, it's possible for a veterinary clinic to pull in zero profit between opening and noon on any given day. The hours may be busy, but the time is spent with few clients.
This is the crux of the problem in veterinary practices today—there are multiple inefficiencies in the delivery model. If you ask your team members whether or not they're busy, they'll invariably say yes. The phone is ringing; there are tests to run. But the phone calls aren't resulting in appointments, just a lot of questions and refill requests. An honest practice owner will ask, "If we're so busy, why am I struggling to pay the bills?" The more appropriate question to ask is: "Am I productive?"
Veterinary medicine is productive at times, but it's haphazard. If a practice is unprofitable or has too much capacity, does that mean there are too many veterinarians or too many veterinary clinics? The answers have eluded the leaders of our profession for years, and so we conduct studies.
The economics of our profession are complicated and ambiguous. The American Veterinary Medical Association (AVMA) and other groups have conducted economic studies for more than two decades and arrived at contradictory conclusions. But the most recent investigation, the 2013 AVMA Workforce Study, indicates that there is excess capacity in the profession—the ability to provide services beyond the quantity demanded at a price that consumers are willing to pay—in certain geographic areas and sectors of the veterinary profession. The study also suggests that this excess capacity will persist through 2025.