“If we always do what we have always done, we will always get what we have always gotten. —Unknown
Most practices stop growing from within. Yes, there is a tendency to blame other issues for stagnation—the competition, economy, uncaring clients—but it is often us.
In our chemistry classes, we learned that the product of a chemical reaction chain of events is limited by the rate-limiting step. The same principle applies to veterinary practices. If a practice’s infrastructure is set up for a veterinarian to see 10 to 12 patients a day, that’s what will happen. On the days when 20 patients show up, the practice’s business plan crumbles, patient care gets sloppy and clients wait and grumble.
To grow and prosper, we need to provide good service. Clients expect to wait about 15 minutes, so making clients wait excessively is a practice killer. Yes, the client in the exam room might be thinking, “Oh, the doctor has all the time in the world for me.” But the client waiting for two hours is questioning everything about the practice. And many of those clients will end up at another practice.
How we develop
Another factor that plays into the practice growth cycle is the traditional practice development process. Most practices start with a basic template: a veterinarian with a couple of staff members and a simple equipment package. As the hospital’s reputation spreads, the client list grows. Pretty soon the practice is grossing half-a-million dollars and has a veterinarian and four staff members. The practice then grows to two veterinarians and eight staff members and grosses $1 million. At this juncture, the typical practice pretty much stops growing. Why?
First and foremost, confusion takes over. Get 10 folks under one roof ¬seeing 20 to 30 patients a day and the directives and duties overwhelm the place. Stagnation is the result.
There are also practices with 10 veterinarians and 40 staff members that are grossing less than $450,000 per full-time equivalent veterinarian. Again I ask, why?
“We have always done it this way” is the typical response.
In addition to these examples, there are also many practices with one veterinarian and 10 staff members that gross more than $1,000,000. How do they do it?
These veterinary hospitals are using an interpretation of the Triangle System.
The Triangle way
To improve productivity, we must learn new skills. Good management is a skill. In veterinary medicine, the Triangle System is a way for veterinarians to focus on their core duties and to delegate non-veterinarian duties to staff members. And this system exists in most productive industries.
My hospital’s veterinary licensing agreement states that doctors’ responsibilities are to diagnose disease, prescribe treatment and perform surgery. All other patient services can be delegated. The typical veterinarian grossing an annual services per pet of $250 provides $500,000 of revenue and spends just 25 percent to 35 percent of the day diagnosing, prescribing and performing surgery. The balance of the day is spent doing the duties of a veterianry team member. That’s lost production time.
A stark reality that we fail to fully appreciate is that when we veterinarians do the work of assistants and technicians, we get paid as assistants and technicians. And technician salaries will not retire $150,000 in student loans. Using the Triangle System, we can work—and get paid—as veterinarians. Technicians and assistants can work at their jobs too.
In the Triangle System, a technician and an assistant work together to provide the patient care laid out by the veterinarian in the medical record while the veterinarian focuses solely on his or her responsibilities. In other words, you, the veterinarian, perform the patient assessment (diagnose) and put together the plan of action (prescribe treatment or perform surgery). The staff then accesses the medical record for duties to be performed.
An important note: Because the medical records must be completed by the veterinarian before the staff duties can begin, real-time medical records are essential if a practice wants to use the Triangle System.
Patient duties are finished more efficiently when two staff members work on them while the veterinarian moves on to assess the next patient. Since this method is more efficient, a practice using the Triangle System can serve more clients, which means growth.
So what is the ideal number of staff members when using the Triangle System? Each veterinarian needs at least one technician or veterinary assistant for hands-on patient duties, and an equal number of team members performing so-called soft-hand duties. They include greeting clients and patients and attending to phones, handling invoices, billing recalls, troubleshooting computer-related issues and government-required paperwork.
Stagnation is not inevitable. We can all improve productivity and grow our practices with the Triangle System.
NOTE: This article and the Triangle System in general address middle-market small-animal hospitals. Other niches will have their own paradigm.
Dr. Riegger, Dipl. ABVP, is the chief medical officer at Northwest Animal Clinic Hospital and Specialty Practice. Contact him by telephone or fax (505) 898-0407, [email protected], or northwestanimalclinic.com. Order his books Management for Results and More Management for Results by calling (505) 898-1491.