Types of Practice

Veterinary Business Models or Segmentation of Private Veterinary Practice Models with Emphasis to VetPlan Implementation

We have identified five practice models that represent a structural spectrum of business models from the agrarian where the veterinarian is the only producer of value to the team center where the business structure supports team members as co-producers of client value. As with all generalizations there will be some crossover and difficulties in drawing fine lines between these models; likewise these models are useful in discussions and in planning how to take them to the next level in their development.

1. Agrarian
2. Vet Center
3. Ego Center
4. Client Center
5. Team Center

The Agrarian Practice Model or “Traditional Veterinary Practice”

The Agrarian Approach to Medicine

In veterinary practice there are large animal vets which historically practiced on horses, cows and farm animals. This mode of practice involved only the vet, usually traveling to the farm. As such the diagnostic and therapeutic tools were limited and the vet also had to work within the economic limits of the farmer which were a considerable constraint. The unwritten assumptions for this mode of practice have been carried over to small animal practice where they no longer apply creating the Agrarian Type of Small Animal Practice described below.

• This practice model focuses on the work to be done more than excellence in veterinary medicine or surgery.
• The practitioner develops a standard way of treating most everything and the focus is on therapy more than diagnostics..
• “Shotgun” medicine is practiced when treating meaning that the vet might use a combination of drugs on a pet in hopes of hitting the therapeutic target.
• The choice of these drugs is based on physical examination and history and educated guesses.
• Some practitioners are remarkably efficient at this mode of medical approach but it differs greatly from a more modern approach of “diagnose before you treat.
• This vet thinks that the vet should just know what is wrong without fancy diagnostic tests and it is only the young or less experienced doctors that need these tests.
• In this approach to medicine if the pet does not respond, another combination of drugs is tried until the pet responds, the pet succumbs or the client tries another vet.
• This vet is more interested in treating the ill pet and therefore tends to be more reactive than proactive and less interested in wellness programs or products.
• This vet feels and will tell their clients that anesthesia is dangerous, or the pet is too old for procedures such as dental cleanings, or the risk of sedation is too high for radiographs.
• Euthanasia is a large part of this vets approach to difficult cases.

The Agrarian Attitudes to Practice

The veterinarian has the “If you want it done right you must do it yourself.” Therefore, there is usually only one vet in this mode of practice.

Staffing in the Agrarian Practice

• The typical staff is usually receptionist-technician combinations that are more mature and works full-time.
• These staff may be retired, married and are techno phobic but good communicators with strong client relationships.
• Occasionally there will be a “practice superstar” with multiple skill sets who the clients love and the doctor cherishes as much as their “right arm”.
• The staff roles in this hospital vary from answering the phones, to cleaning and helping the doctor.
• The staff understands how long and hard the doctor works and how dedicated they are to the practice and therefore they are usually very loyal and very protective of the doctor.
• This practice cannot afford a practice manager or certified technician or accountant.
• Any other staff is part-time cage cleaners.

Clients in the Agrarian Practice

The location of the practice is typically rural and therefore the clients fall into the lower socio-economic status. The rural or farming based community or community is typical or the community where the factory has moved is also common.

• The client is perceived as being more price sensitive and this may be an accurate perception, but, it is impossible to tell which clients are sensitive.
• This generalization is no longer valid for all clients. It is common to hear the following comments.
  • “My clients will not pay for this stuff.”
  • “My clients cannot understand all this stuff.”
  • “My clients cannot afford all this stuff.”
• This practice may only have walk-in scheduling and there are no formal communication tools used for client information.
• All communication is verbal from doctor.
• Nevertheless, there will be intense client loyalty as they have become friends with the doctor over the years.
• This practice has a very casual style with regards to all client interactions, usually using first names and so on.
• The clients are usually allowed to have credit that is very flexible and is a holdover from the barter system of economics.

Business Practices of the Agrarian Practice

There are no explicit financial standards in the hospital. The financial records are scarce to non-existent and the vet is usually not reporting cash sales to the IRS. This is a fact of life for this practice and is a high barrier to computerization.

• The computer forces recordkeeping.
• The computer is therefore absent in many of these clinics and may only be used for reminders when present.
• The medical records are of the card style with abbreviations for therapy.
  • There is No SOAP based medical records indicating the doctor’s thoughts.
  • The only record is that which shows the medications that were administered to the patient.
• The revenue generation is lower than normal because of the low prices and slack credit policy and lack of reporting.
• Usually this practice will generate less than $200k in gross sales per year.

Outcome of the Agrarian Practice

This doctor cannot sell this practice because the practice is the embodiment of the doctor and it is commonly said that these doctors “die with a needle in their hand”. This means they literally work until they die with no hope of retirement.

The practice usually folds when the vet dies as there is no business system for producing value in the absence of the vet.

VetPlan Implementation in the Agrarian Practice

This practice does not have the desire to implement VetPlan. When the desire is present as it has been rarely in the past, it is impossible to change the Vet who has practiced the same for 30 to 40 years. This practice should be avoided as it will likely fail. Exceptions include the son or daughter who enters the practice either as vets or managers and transform it despite the owner’s habits and the owner is allowed to retire.

Prevalence

Uncommon today

The Veterinarian Center Model or “Just Be the Vet”

This model of veterinary practice occurs as a result of the vision set in veterinary school with very little modification after school. After graduation, the veterinarian has a tremendously pent up need to practice medicine. This veterinarian is tired of school and does not need any further training yet has no experience in practice when they start.

Nevertheless, it is an unwritten rule that every vet should have the freedom to practice his or her own brand of medicine even if they are not sure at first what their brand is. In other words one vet should not advise another on how to practice; therefore many of these vets can practice in the same building using very different medical philosophies developed through their “practice” at practice.

• These vets are not interested in practice management only in the application of their destiny to “Just be the vet”.
• They do not utilize staff members because they were not shown how to in school.
• They think it is their job (preordained destiny) to do all functions from talking the phone calls to collecting all the history, to reading the previous medical history to doing the exam and shots to entering all the charges to writing in the records and escorting the client to the front desk.
• They want to check the client records for each pet, and decide on all the wellness for the client and be the only one who is smart enough to talk to the client.
• They are overly focused on “High Quality” medicine and surgery when, in reality, they do not practice either.
• They are not great at the finer nuances of high quality medicine and surgery as this requires further training and they do not have the time or desire for this.
• The unstated purpose of this practitioner is to react to what is placed in front of them or to do a complete examination on an apparently normal pet and find more things wrong so that they can be corrected. Usually correction involves minor surgery.

The Veterinarian Center Model Attitudes

• This vet may have moderate surgical skills and is usually very efficient with his own time but does not fully utilize the staff.
  • “A chance to cut is a chance to cure”
  • “Fix what is broken”
  • “Find what is broken”
  • “Trust no staff”
• The veterinarian in this model thinks it is their job to tell the client what to do instead of asking the client what they think.
• It is pretty much a black and white world to these vets where "bad" clients do not do what they are told to do and were the vet may feel a victim of the circumstances they find themselves in.
• This practitioner may therefore tend to have “fits” of frustration as they may not like being a vet, and typically they do not manage conflict well.
• The practice is more of a method of making money or satisfying the needs of the veterinary ego than caring for pets or people who own pets.
• These vets will want to do the following tasks to make sure they are done correctly.
  • Morning Treatments
  • Do Surgery
  • Call Clients
  • Update Records
  • Check in Surgery Clients
  • Give Quotes
• While there may be several vets in this practice they will rarely consult with each other and all will practice their brand of medicine. This causes stress on the staff having to adapt to a different practice style with each vet shift change.

The Staff in the Veterinarian Center Model

In this practice model the staff as a whole is younger and more likely to be part-time. As such, the staff is more focused on what is best for them not what is best for the practice or even the pet.

• Many of these receptionists are paid so poorly that they may have two jobs.
• The receptionist’s job is to record the clients wishes but are not educators.
• The typical staff member in the veterinary centered model is fearful of client discussions because they have been made to fee stupid in the past by the doctor.
• The receptionists are at odds with technicians and have the tendency to turf client problems to others (vet or practice manager) instead of taking personal responsibility.
  • The receptionists are afraid that they will not be able to answer the phones and do VetPlan at same time because they do not expect help from any other team members in telephone answering.
  • The receptionists are thought to not be able to leave the front desk as this is their post.

• The technicians in this practice model are ranked based on what they know how to do not what they know.
  • In general the technicians do not answer phones.
  • Do not give quotes to clients.
  • Are not used to being alone in the exam room with the client.
• A typical statement is “I like the pets, not the clients”.
• The purpose fulfilled by most technicians is to serve the vet by holding the pet and to wait for orders from vet but not to talk to clients.

• Superstar technicians represent a small subset of technicians.
  • There is usually one per practice.
  • They are multitalented individuals who usually are good communicators and who generally do not trust any of the other staff to complete tasks.

• Overall the staff in this model are not used to do any of the things such as perform tests, do radiographs, give injections, communicate with the clients that might help the work load on the vet.
• There is very little professional development or training of the staff in this model of practice.
• Staff members are considered expenses the cost of which needs to be minimized.

The Client in the Veterinary Center Model

This practice model is usually supported by a “blue-collar” middle class clientele who may equate pet medicine with car repair expecting exact outcomes and a guarantee of results. The veterinary center practice may adopt this mode of service where the health of the pet is the measure of client service. In this view if the pet dies it is not uncommon to give the money back and if the pet survives an illness it is not uncommon to overcharge. The practice equates pet health with client service. In other words if the pet is healthy the client is happy. Most client communications are verbal and the client is thought to not need or want excess information.

• Appointments are scheduled for most clients with compressed scheduling becoming more common.
• The prevailing attitude is "Get them In and Get Them Out“.
• There may be an over concern about clients having to wait.
  • This is usually due to the single file veterinary bottleneck that occurs.

The Veterinarian Center Model Business Practices

This practice has very few “practice” standards. All doctors tend to practice their own brand of veterinary medicine causing confusion with the clients and the staff.

• The pricing in this practice is based on what other practices are charging.
• The medical records are in full sized file folders which are written in only by the doctor.
• The computer system is usually outdated and was purchased as the cheapest available.

• The revenue in this hospital is marginal and usually depends on the individual veterinarian’s ability and the number of hours worked but usually averages about $350K in gross revenue production.

Prevalence of the Veterinarian Center Model

This is the most prevalent practice model. Most practices have two to three doctors which will have total gross sales slightly over one million dollars.

Outcome of the Veterinarian Center Model

Vets will come and go from this highly chaotic revolving door practice. In some cases this practice model is owned or managed by the owner vet who usually does not practice but acts as the practice manager. The more vets working the more money this owner makes.

• Paradoxically this practice model finds it easier to adopt the structure and standards that VetPlan represents.
• This is because there is very little structure in the practice to begin with.
• There are very few stable long term employees to change and all would agree that this practice is too chaotic.
• The younger more adaptable staff are more likely to see benefit in VetPlan and there will be little objection by the doctors who are begging for some relief and looking to make more revenue.

The Ego Center Practice Model

The Practice is an Extension of the Veterinarian The ego center veterinary hospital focuses on relatively high end medicine and surgery and also gives wellness high values but rarely acts on this value.

• These practice owners are excellent communicators, gregarious extroverts with high energy.
• They pride themselves in illness diagnostics differentiating them from the veterinary center practice previously described where surgery is their forte.
• They have a charismatic orientation and paternalistic style which usually serves them well in managing conflict and maintaining a loyal staff.
• The general hospital attitude is that client is important and wellness issues are important.
• One doctor who is usually owner generates most of the good will of this practice and other veterinarians who have much less personality will work in this practice producing a fraction of the owner.

The Staff in the Ego Center Practice Model

The staff in this hospital generally mimics the attitudes of the owner doctor. *They are friendly helpful and client service oriented.

• They enjoy client interaction on a social basis and may even communicate wellness recommendations as well.
• Yet there is still the conflict that occurs with differing priorities of the front desk and the technician staff as in the veterinarian center model above.

• Registered technicians are be allowed to perform certain functions such as start I.V.'s and monitor fluid therapy and perform planned therapy for hospitalized pet.
• These functions along with routine diagnostic tests enable the veterinarian to spend more time in the exam room therefore increasing the capacity to see clients.

• The assistants in this practice are pulled in too many directions.
  • They must be able to serve both the doctors and the technicians.
  • They must do all the cleaning.
  • They also run errands or act as and as an all purpose helper.
  • The assistants are the ones who clean the cages and walk the dogs.
  • They are also the custodians of the practice.

• There usually is a practice manager in this practice who is generally a promoted technician.
  • Their purpose is to deal with things the vet does not like to deal with such as upset client issues or manufacturers reps.
  • This practice manager serves the role of buffer between staff and vet, between upset clients and vet and between supplier and vet.

The Client in the Ego Center Practice Model

The client is usually upper middle class because of the chosen location of this practice. The service and attention to this client base is much higher and there is as much focus on the client as the pet with longer hours and friendlier more customer service oriented staff.

• This practice still schedules by doctor with 20 to 30 minutes per visit and the client communications are still orally delivered by the Vet.
• Canned handouts are common as are notes to the client on the computer invoice.

The Ego Center Practice Model Business Practices

This is the first practice model to have professional standards in place.

• These standards will include:
  • Customer service
  • Cleanliness
  • Appearance of the facility
  • Appearance of the staff
• The doctor usually wears a tie to work.
• These standards reflect those of the owner.

• The pricing strategy reflects the value that is being delivered.
• In general this practice overcharges for wellness items such as vaccines and spays and neuters.

• This practice will usually have a modern computer system.
• Equipment in the practice including laser, endoscopy, ultrasound.

Prevalence of the Ego Practice

Prevalence of this practice type is second most common and they are top producers and generally thought highly of. They may own a million dollar practice.

Outcome of the Ego Practice

This practice model finds it difficult to change because the practice is a direct extension of the owner and would require substantial changes in the owner’s value systems for transformational change to occur.

• This owner has difficulty allowing the staff to take credit for client relationships.
• This owner is also reluctant to trust the knowledge level of the receptionists as a member of the team.
• There is great opportunity for this practice if they demonstrate the leadership necessary for the implementation of VetPlan but there is about only a 50:50 chance that this leadership will be present.

• Outcome of these practices is eventual burn out because the practice owns the doctor.
• If you take the personality out of the practice the practice will implode. *This is because of the client interaction as well as the ability of this person to paternalistically manage conflict.
• This practice may sell to a consolidator or another personality vet or be dissolved when the vet has an affair with the nurse which is very common.

Client Center Practice Model

The veterinarian and the team are focused on client service. This practice may have more females in it than males and they support high quality modern medicine and surgery but would rather refer the difficult cases to a specialist.

• The customer service orientation of this practice is accomplished through team building.
• Husband and wife teams may also be the owners of this practice type.
• They feel that the purpose of the practice is to educate the client and to be the advocate for the pet.
• This practice will have wellness plans, plans for geriatric pets and celebrates pet dental month etc.

• The conflict resolution is usually provided through a paternalistic or maternalistic member of the ownership of the practice.
• This practice will have between one and three vets.

The Staff in the Client Center Practice Model

• The attitudes of the staff are that they serve the practice.
  • They embody the value system of the owners.
  • This practice usually has a strong value system of doing the right thing even if it costs more money.

• The reception roles include:
  • Client communication about wellness
  • Pet advocacy
  • Making sure more than vaccines are administered and reminded for.

• The technicians understand that the clients are important:
  • They are proud that they have a subset of the clients that come to see them.
  • The technicians routinely do “puppy raps” and may go over surgical releases.
  • Registered technicians also give shots, induce anesthesia, perform radiographs, write in medical records, enter charges, fill out forms.

• The assistants hope to one day become a technician.
  • Because this looks like a cool job.
  • The culture of the practice distributes the cage cleaning, dog walking duties and custodial duties across all staff.

• There is usually a practice manager in this practice type although it may be a spouse of the vet.
• This practice understands that successful business is about vision and people and the practice manager usually is managing people.
• The practice manager is usually also the customer service manager as well as the financial advisor to the practice.
• This may be the first model to have actual financial reports used to manage the practice.

The Client in the Client Center Practice Model

The clients in this practice vary from middle class to upper middle class. Education level of the clients may be a more important indicator for this practice model than the socio-economic status. The practice is commonly located next to a university or technology center area where highly educated clients live. The practice provides for the high service expectations of upper middle class or upper class clientele.

• Scheduling of this practice is still by vet but may also schedule “technician” visits as well.
• The technicians are considered a valuable part of the practice.
• The practice has weekly team meetings celebrating client service.
• The practice has regular training for staff members and supports staff professional development.
• The practice standards are higher with uniforms present that are usually not just “greens”.

Client Center Practice Model Business Practices

This practice uses information tools to create client information handouts themselves. Their standards are higher than the typical canned information brochures available. This practice is waiting for the VetPlan software and system to take them rapidly to the next level.

The exam rooms are used for technician exams, going over prepared release instructions and there is usually more than one exam room per vet. The medical records are excellent in this practice will all staff members able to contribute to them. The computer system is usually updated and current. This practice may have computerized medical records.

• Revenue is high but profit is lower than expected because of high standards and high staff expenses.
  • They are usually using antiquated work-flow and scheduling models which limits their capacity to serve their clients.

Prevalence of the Client Center Practice Model

This practice is uncommon with the prevalence of less than 5%

Outcome of the Client Center Practice Model

This practice is striving to be the next level. Systems are in place and there is a chance with the right associate vets and systems that the strong value systems and team will help this practice actually become a business on its own. But using VetPlan can be their best destiny.

Team Center Practice Model

The main difference between the team center practice and the client center practice is the work-flow placing the team members in direct contact with the clients. This increases the capacity so that the vet can become more educated with regard to medicine and surgery and will also allow for increased investment in medical equipment.

Veterinary Attitude in the Team Center Practice Model

• The vet in the team centered model is focused on how to grow people.
• Client service is addressed more effectively and efficiently through staff empowerment.
• There is more capacity for wellness issues to be discussed.
• This practice generates more revenue than other practices which enables the team to be paid more and for the attainment of higher quality team members.
• This practice has a culture of knowledge sharing and support which creates a more stable system.

The Staff in the Team Center Model

Team training, team support and team client contact are all attributes of this practice model.

• There are weekly team meetings where the basic tenets of client interaction and customer service are reviewed.
• These are followed by weekly formal training on all aspects of wellness and husbandry.
• The team members have communication standards, client service standards, standards of appearance, care and conduct that guide them in becoming “Ladies and gentlemen serving ladies and gentlemen”.
• These team members consider their job a career and work to get better at it each day.
• All team members support each other because they all are responsible for ensuring a great client experience.
• This is their goal and because they are focused more on the client than on themselves the typical interpersonal conflict is minimized.

• Culturally, the team manages its own interpersonal conflict through dissolution of issues through common dialog about what is best for the client.
  • These team members have learned to sacrifice what is best for them for what is best for the client, the pet and the practice.
  • They trust that this is the path to what is best for them.
  • They know that if the practice wins so will they.

The Client in the Team Center Model

The client is typically middle class or upper middle class with good education. These clients select this practice because it provides the level of service and concern that they are seeking for their pets.

• The client is assumed to be the guardian of the pet, or the caretaker of the pet.
  • Proactive client communications and pet care advocacy are designed to allow the educated pet owner to choose the level of diagnostic tests, preventions and other care for the pet.
  • These communications use the risk factors of the pet in evaluating the need for tests or services.
• Client relationships are maintained throughout all levels of the staff.
  • All staff are trained in communications and are supported in the client education effort by the doctors.
  • “He who has the smartest client – Wins”

The Team Center Model Business Practice

The business systems in place are created and modified each week through staff involvement. The team members are an integral part of the client visit experience enabling a multi-tasking work flow.

• This business model resolves conflict through the team meetings with the idea that there are no “bad” employees or “bad” clients, only bad systems for dealing with them.
  • Their job in these meetings is to actively participate in the developing of new systems that support their mission. “Creating Smart Clients”
  • This practice does not take for granted that the client knows what their pet needs and is proactive in making recommendations which drives better pet care, longer pet lives and increased sales. T
  • he members of the team work together to facilitate this level of client communications, in a multi-tasking, role sharing environment where the client journey is the only focus of the visit.
  • Every client should have knowledge of the wellness recommendations, the examination findings and the doctor’s recommendations before the end of the visit.

• This multi-tasking work-flow enables more clients to be serviced in a day resulting in more revenue production and better overall client experiences.
• All these factors work together to enable this practice to pay their staff more, have more equipment, have more continuing education opportunities and a better less stressful practice life.
• This practice will share financial results with all team members, share management concerns and practice future visions with the team members.
• All team members will feel a part in the direction and success of the business.
• All team members will know and understand how their actions affect the success of the business.

Prevalence of the Team Center Model Business Practice

This practice type is very rare less than 1%.

Outcome of the Team Center Model Business Practice

The outcome is retirement of the vet but with retention of ownership and residual income. VetPlan is what makes this practice a possibility.