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So I'm a doctor ... now what?

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Apr 01, 2010

Nineteen months ago, I started my first job as a veterinarian. It's a position where I split time between a large general practice, an emergency hospital and a one doctor start-up practice. This is the time I'd thought I'd unleash all of the great ideas I had in veterinary school about how things should be done in private practice.

As you can imagine, that's not exactly how it turned out.

After I graduated from veterinary school, I amassed a modest amount of medical knowledge, endless enthusiasm and a desire to use my soft skills and business acumen to be immediately successful. I hit the ground running and unleashed cutting-edge management techniques on the unwary support staff. I printed off checklists, called for meetings and wrote almost weekly proposals to my bosses (a project known to my employers as "the Roark Report").

Overall, this approach was almost a complete flop. While I was quite possibly the most prolific proposal writer ever produced by an accredited veterinary program, my ideas consistently fell flat. When they didn't fall flat, they ticked people off. It was certainly not the entrepreneurial explosion that I had hoped for.

Without abandoning my commitment to the soft skills and my deep passion for the business side of our profession, I was forced to step back and look closely at what other doctors were doing successfully. It was my great fortune to be surrounded by a lot of successful general practitioners who had widely varying styles and approaches. I set out to adapt my strengths and interests to the techniques that they were using effectively. In the end, three specific themes seemed to correlate very strongly with success. The more I focused on these areas, the greater my happiness and productivity became. We'll start with the most important:

1. Communication

I have always viewed myself as good communicator, but I made a mistake early on in this vital area. I explained things well to clients, but tried to be the person that I thought my clients wanted me to be: extra polite, almost overly sensitive and always extremely tactful. Because of this approach, I don't think my clients saw me as genuine, and it hurt my chances at building trust.

A few months into my career, a pair of very difficult clients helped me realize that if I do my best to educate and advocate for what's best for the pet, it's up to the clients to decide if they like me or not. I can't be all things to all people, so I decided I might as well just be myself and be comfortable with it.

This epiphany, probably more than anything else, made me happier in practice. I still explain those medical conditions, but my explanations come with a southern drawl and colorful candor. Amazingly, I seem a lot more popular these days than I ever did when I was trying to come across as "Dr. Perfect."

Clients have real relationships with me now and because of the trust these clients put in me, I am more confident, more relaxed, and I don't feel the need to "sell myself" for the first five minutes of every visit. I can focus more of my time and effort on educating the clients and providing the best treatment for the pet. I've also found that strong relationships and good communication mean better compliance, and that opens the door to offering great medicine. (Note: I believe that great medicine results in a healthy patient, a happy client, a feeling of satisfaction and the ability to make student loan payments.)

2. Efficiency

In my experience, a focus on communication has been critical to building the tiny client base that I currently enjoy. Sacrificing quality time with the client and patient to stay on schedule is obviously not a good idea. However, running behind all the time has proven to be a poor choice too. The answer is to balance these two evils. I learned how my hospital works, and how I should work within it.

Every hospital has a different system for providing medical care. For example, at the emergency hospital where I spend half my time, there are often a dozen technicians and assistants working in and around our treatment room. The most efficient way to get a dog taken care of here is to get him/her out of the exam room and into the treatment room where the technicians can go to work like a NASCAR pit crew.

At the one-doctor practice where I spend the rest of my time, the only people in the hospital are myself and a technician... And she comes into the exam room with me. If we take a pet from the exam room into the treatment room, we are the only two people there. We had to walk 30 extra feet, and now we have a second area to clean up. Providing services in the examination room makes significantly more sense.

These two hospitals showcase radically different, equally effective, systems for providing care. To be successful in either one, you have to gain an understanding of the system and build a strategy for working efficiently within that system. The development of this stratagem ultimately allowed me to maintain my relationships with clients, stay on schedule, keep better records, make management happy and live a (slightly) lower-stress lifestyle in the workplace.

3. Complete Care

Since my first day in practice, I wrestled with the desire to increase my ACT (average client transaction) while protecting my integrity and the trusting relationships that I have built with my clients. How do I offer our full range of services without looking (and feeling) like a used-car salesman?

When I started my job, I noticed that my boss never talked about ACT. He talked about "completeness of care." It was probably six months before I understood why this was his focus.

Complete care is all about doing a good physical examination and work up, and then educating clients on what you found, your judgment on the best course of action and why. I feel like, if that is my approach, then I am being entirely honest with clients. It also lets your clients choose their own course of action. The client and I are a team in the care of this pet. When the client makes informed decisions, then I am building this trusting relationship, practicing great medicine and going home feeling satisfied. My ACT benefits from this approach too.

I definitely did not come out of veterinary school at the top of my game, and I really had no idea how to put my interests and skills to work for me in private practice. I know I made as many mistakes as anyone (maybe more - enthusiasm can be dangerous that way), but I have since settled into a personally, professionally and financially rewarding career thanks largely to a focus on communication, efficiency and complete care. If my experience can help even a single associate veterinarian or new graduate be happier and more productive, then this column will be worth the effort (and far more valuable than any edition of "The Roark Report").

Dr. Roark is an associate veterinarian in Leesburg, Va.