The First Steps Toward More Optimized Staffing
“I believe, looking through a lot of records at the time, in the mid-1950s, less than 5 percent of veterinarians actually had a building like a hospital that they operated out of,” says Clayton Mackay, DVM, president/CEO of Mackay Veterinary Consulting and distinguished life member of VetPartners. If they did have something like that, Mackay relays, it was “part of their home or part of their farm or part of their barn area. My dad built a hospital in 1957 and it was staffed by family, so my mother and my brother and I were the staff. He only paid us an allowance. He didn’t get his first employee until 1964 or 1965.”
After Mackay graduated from veterinary school in 1970, his dad’s practice still only had one employee plus his mom. “I went from one doctor, one employee, and my mom when I started practice, and by the time I left practice— I still owned it for another eight or nine years—I had six doctors and 30 employees. So, totally different. You had to learn an entirely different way of dealing with things.”
Mackay suspects that today’s small practices aren’t all that different than early companion animal practices, except they work from a small plaza location (700–1,000 square feet) rather than from a spot connected to a home, and they have access to the practice technology now in use.
So how do you make the most of veterinary medicine as it exists in 2019, while providing top-notch pet care and protecting the mental health of veterinarians and other professionals in practice, an issue which is gaining recognition and importance?
Here are several considerations:
- Look for ways to create client behavior patterns that help smooth out the ebb and flow of appointments and provide greater predictability
- Plan for seasonal and off-season needs accordingly
- Monitor your scheduling data for patterns that require staffing adjustments and flexibility
- Audit and optimize staff roles to avoid scope creep
If you can only think about one thing in terms of optimizing your staffing, work toward more forward booking of appointments. It’s likely to have the greatest impact. Dentists are genius at this, and veterinary practices can be too. Whether it’s a shorter-term recheck appointment or the next planned routine visit, get it on the schedule before clients leave.
“Once you get that appointment book filled,” Mackay says, “then you can make far better choices about how you’re going to staff.”
Make concerted efforts to get each individual client to forward book before leaving the practice. But also think about how wellness plans, with their set number of included appointments, can help map out not just the next month or next quarter, but even the whole year. What if every wellness plan participant went ahead and booked all appointments for all of their pets when signing up for the plan? Imagine how that could anchor your appointment schedule well into the future, especially thanks to clients with multiple pets.
People might also be encouraged to sign up for plans if you pitch the forward booking as a wellness plan member benefit—clients get exclusive first pick of appointments, premier access to prime spots in the schedule, or however you want to make the idea of planning ahead sound extra special. Sure, forward booking helps you, but show clients how it helps them too.
"If you can only think about one thing in terms of optimizing your staffing, work toward more forward booking of appointments. It’s likely to have the greatest impact."
Seasonal trends and off-season decisions
Certain times of the year remain busier than others. Of course, when you’re busy depends on your clients’ lifestyles, average incomes and typical family travel patterns, as well as your local climate and parasite prevalence.
I remember interviewing a veterinarian who had moved from the deep south to my home state of Colorado, where fleas are practically non-existent. She joked about wondering what on earth she would do all day, and then she started seeing injury after injury from the extremely active lifestyles of dogs that live or visit here.
Your busy season and reasons for being busy may be quite different from a similar practice in another state or another type of community. However, there is a reason dental health month falls in February.
Use your practice management software to pull data or create charts that show a heat map of your days, weeks, months and year; then use that to categorize different kinds of days and how you might adjust staffing to handle days that are 100 percent booked versus 60 percent, 40 percent, etc.
Also monitor the mental and emotional strain you see in your practice team and track the dramatic days—even if it’s simply putting a dot with a certain color of marker on a paper calendar. See if you can figure out cycles or trends. Do these high drama days correlate with your seasonal heat map days? Do they seem to be associated with certain combinations of team members or types of cases?
Try this for at least one quarter and see what you can learn from tracking the emotional temperature in the practice that may show you spots where staffing plans need to be adjusted.
If you can, using your management software, pull data on cancellations as well and see what patterns you can glean. What happens before or after major holidays? When do local schools start in the fall or get out for summer, and how does that affect your appointments and cancellation rates? Are certain days of the week riper for cancellations?
Also, keep in mind that there is a good chance that you’re seeing a higher rate of cancellations or no shows from younger clients, and it isn’t your fault. As we noted in an April 2018 Messenger article about generational differences in veterinary clients, Alisa Agozzino, PhD, APR, associate professor of public relations at Ohio Northern University, says, “From what I have observed in the classroom and working with Millennials, as a whole, they tend to not hold appointments or commitments with authority. There is no remorse for having to cancel/reschedule last minute and potentially putting others out because of their lack of follow through.”
Think about ways you can pivot with suddenly empty slots if this generational difference manifests as a major factor in your scheduling and staffing.
It’s also important to audit how your veterinarians and various team members are using their time. You may need to have them track their efforts for a few weeks or even a month to check and see if people in the right roles are truly doing the tasks formally assigned to them, or not. It’s easy for talented, motivated people to allow scope creep where they take on more and more responsibilities. It isn’t necessarily a bad problem to have, but there is a good chance your higher dollar people may be burning too much time on things better and more affordably done by others. This is especially true when veterinarians can better use their time on things only they can do—diagnose, prescribe treatments and medications, and carry out surgery.
You may also find that some people remain perfectly content with a back-of-the-hospital role. Some people only want to work with patients and not have any significant contact with clients. That too can be okay, if they understand how those limitations can limit practice profitability and even their own income growth, in some cases. Mackay had a veterinary technician who made this choice, and it worked out fine, but he recommends recruiting staff with strong client-contact skills as well as technical skills.
As you consider how best to schedule and staff your days, you or your team may begin to sputter about how unique veterinary work is and how such optimization efforts are too hard or won’t work. Go ahead and feel those feelings, then take a fresh look because most teams can plan better, be more efficient and can make the most of every talented person in the building.
In addition, every practice can increase their understanding and predictability of the appointment schedule. “There is no such thing as veterinary business. It’s only business,” Mackay explains. “Veterinarians always want to tell you it’s different in their place, and it’s not like anyone else, but it’s no different than a dentist, doctor, lawyer or anyone else. You only have so many hours you can charge your time for, so get over all that stuff that says, ‘My clients are different. They’re never going to do that.’ Well, they will.”