Dr. Joanne M. Roesner, DVM DABVP

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SURVIVOR - DVM
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A Day in the Life of a New Grad
Cartoon by M. Pye
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SURVIVOR - DVM

• Picking A Practice
• Managing Your Time and Anxiety
• Bonding to Clients and Staff
• Management Must-Knows
• Promotion, Education and Sales
• Difficult Clients
• BE HAPPY!

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Thank you to our sponsors
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AAHAABVPGVMA, other state VMAs
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Picking A Practice
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A well managed practice is NECESSARY to meet your
financial, medical and ethical goals
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Picking a Practice

• Make a list of your needs, wants and desires and
  evaluate each practice in light of this.
  Prioritize
• All practices will have positives and negatives
• Consider corporate culture and ethics in
  evaluating fit

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TIPS for Practice Selection

• Call Specialists in the area and ask what clinics
  they like.
• Plan on visiting hospitals you are interested in
  multiple times. Evaluate different days and
  shifts.
• Consider utilizing a secret shopper to gain
  insight (see Opperman Form)

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• EVALUATE MEDICAL RECORDS
• Type of cases
• Standard of care
• Technological capabilities
• Charting expectations
• EVALUATE APPOINTMENT BOOK
• Fill Rate
• Complexity of case load
• Preferential scheduling
• Efficiency of scheduling

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Cont.

• Corporate culture
• new patient exam (10 minute vs. 40 minute)
• Sanity of scheduling

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• EVALUATE STAFF TO DVM RATIO
• (If not tracked then eyeball them during a
  visit)
• EVALUATE STAFF
• Are they Trained?
• Happy?
• Do they go to CE?
• What do individuals get excited about in their
  jobs?
• Look at Customer Service and Animal Care staff,
  NOT just the nurses.

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• EVALUATE CLINIC MANAGEMENT TEAM
• If possible, go to a staff meeting
• How often do meetings occur?
• What is management hierarchy?
• Who manages DVMs?

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• EVALUATE DRUG BOX
• Does it contain what you need?
• Are drugs handled legally?
• (See my lecture Death Institutions or
  Recovery at ABVP Booth)

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• EVALUATE TECHNOLOGY
• What was the last piece of equipment purchased?
• When was it purchased?
• Compare practices based on existing not promised
  technology

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• EVALUATE MARKETING
• Ask about a marketing plan
• What is done internally to ethically promote
  products by staff?
• What is done to attract new clients?
• What is done to retain old clients?
• What are practices expectations of you for
  marketing?

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• EVALUATE FEES and CHARGING POLICES
• Are fees similar between to surrounding practices
  with same standard of care?
• How do fees compare with income levels in the
  community
• Is GAT 3.2 3.4 times exam fee?
• How does a clinic discount (on invoice or just
  not charged for)

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Cont.

• How often does the clinic discount fees?
• Are associates allowed/expected to do discounted
  services?

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Ask about practice financials

• confidentiality agreement
• revenue of associates
• GAT of associates
• How do you know I can pay you
• especially critical in percentage based
  compensation

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Managing Your Time and Anxiety
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Remember

• Basic human needs to be heard, validated, in
  control of their pet, to feel important
• Expectations - Set yourself up to exceed them
• Poise
• Detatch dont personalize
• Avoid power struggles
• Manage time

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Time Management

• 3x5 card with drug doses
• 3x5 card with anesthesia protocols
• Protocols for 10 worst fear cases
• Your reference volumes in your office or trunk
• Turn over exam rooms
• Day case (know book stores, coffee shops in the
  area! Consider observation time)

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Cont.

• Multiple problems - set recheck have client chart
  symptoms
• POOPLOG

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Managing Poise

• Stethoscope trick
• PE in back
• Preview appointment book the night before
• Breed related problems in 1st puppy visit
• Breath
• Say I dont know with confidence and a game plan
  to find out

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Cont.

• Sit even if only for 30 seconds
• Shake hands
• Give estimates

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Exam Room Strategies

• 3x5 history card
• Humor me for info screeners or divergent
  talkers
• Recap Hx and ask if accurate
• Respectfully ask client not to edit (humor me,
  looking for multiple problems)
• Pet back to owner ASAP

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Cont.

• Exit startegies
• Staff rescue if you are being held hostage
• Pleasant diversions while waiting over estimate
  time

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TURN OVER EXAM ROOMS!
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• Strategies for day casing
• Give clients handouts to read in the waiting room
  on the problem if they insist on waiting
• Give them a kitten to play with
• Give reasonable to long estimate on time and then
  exceed the clients expectations by returning pet
  sooner

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Misc.

• Never give date ranges
• Prepare client for staff call backs
• Schedule compensated recheck when ever possible
  to go over labs (e.g. Bx results and suture
  removal at post surgical recheck appointment)

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Cont.

• Leverage staff including customer service and
  kennel (introduce by first and last name)
• Show clients abnormalities on PE. Give copies of
  lab work

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Bonding to Clients and Staff
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Bonding

• Bonding to staff and clients is YOUR
  responsibility. It will not happen with out
  effort.
• The benefits of bonding are many
• compliance
• loyalty
• warm fuzzies
• referrals
• increased education and awareness

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• Manage and EXCEED expectations
• LISTEN
• RESPECT
• BUILD TRUST
• BOND TO TEAM

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• Staff hate new associates rite of passage
• Treat staff as human beings and valued team
  members
• Listen
• Introduce all staff (First AND last name)
• Defer when assisting
• Do not hover
• Listen to ideas (Celebrate Praise)
• (e.g. ham to CHF from dog ward attendant)

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• BUY PIZZA Remember Front Office and Kennel
  staff
• Give time for adjustment and change (acceptance)
• Pick your confrontations carefully

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NO INVISIBLE STAFF !!
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Client Bonding
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• Greet and love the pet
• Convey trustworthiness eye contact, decent
  handshake
• Bonded clients are more compliant
• Express interest in their lives (Notes on
  Computer)
• Convey concern for emotional as well as physical
  well being of pet and owner (PE in lap)
• Include children

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• Honor Client concerns and fears
• LISTEN, VERBALIZE
• Honor questions
• Notebooks
• Fax backs
• Give a forum
• Leverage/intro staff member

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• Removing Pet from Owner
• Honor Fears verbalize
• Overestimate time (then EXCEED expectations!)
• Assure client you will stop if pet is stressed
• Assure client they are in control and you wont
  do anything without permission
• Have staff member check back with client
• If their pet vocalizes, have staff member go back
  in and tell client (also if not their pet)

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• WORK THE WAITING ROOM TO BOND WITH NEW CLIENTS

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Management Must Knows
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• Dont distain Management!
• Good Practice Management
• stable human and financial resources
• Good Management Knowledge
• better ability to evaluate potential practices
  and negotiate better packages

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• Pre-Tax vs. Post Tax Income
• Revenue Produced to justify salary expense
• Bench marketing WTA, AAHA, Vet Econ and others
• (See my lecture Compensation and Employment at
  ABVP Booth!)

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• Gross Revenue per Provider
• Gross Average Transaction
• What are they?
• How are they used?
• What do they mean to you as an associate?

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• Staff Leveraging
• How to make it palatable to clients and staff
• Why it is important

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Misc.

• Client retention
• New client numbers
• DVMSTAFF ratio
• Accounts receivable

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Promotion, Education and Effective Sales
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Selling

• Effectively convincing clients to purchase goods
  or services in the best interest of pets!
• Education!
• Not cheesy or about getting over on clients
• Approach lifetime of pet, educate clients on what
  to expect, how to prevent or recognize

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Sell Benefits NOT Features

• DO NOT assume you know a clients answer, ASK.
• Offer goods and services uniformly. DO NOT be a
  bigot and judge clients
• Respectfully explore client objections (Can I ask
  what your objectives are to checking a thyroid
  level today?)
• Determine what is limiting clients ability to
  comply and help solve it. EDUCATE (e.g. timing
  and care credit HWP 40 years ago, relatives
  experience with chemo TX)

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• Know WHY you want to run a test or prescribe a
  treatment and communicate it!

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• Set clients up to celebrate if results are
  negative.

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• Share your experience personally
• E.g. The Memi plan of care
• My cat Fish
• Toodles

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• Effective promotion involves the whole team

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• Use visual aids
• Let clients touch masses
• Send home (or give while taking x-rays, ect.)
  reading material (Life Learn Handouts)

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• Consider community services as a form of
  advertising
• Promote your practice personally. (My LHAC
  t-shirt at the gym or greenway)

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Difficult Clients
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• All humans have needs to be valued, to feel
  important, to feel validated and to be heard.
• Honor these needs!

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• Complaints about fees are often an issue of
  perception of value or lack of communication
• Determine the real issue

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• Listen with an open mind (step back and join the
  client)
• Communicate you are listening (eye contact, nod,
  ect.) and ask Is that accurate? at the end
• Do not presume you know what a client wants as a
  solution ASK
• What would you consider as a solution here?
• What can I do to help you?
• Enroll yourself as the clients ally
• I hear your concerns and am trying to help you
  here.

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• Understand that there are legitimately dishonest
  and unpleasant people in the world but they are
  uncommon

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• Do not overcompensate for your newness to
  practice.

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• If you are not the person who can solve a
  problem, be responsible for getting it to the
  correct person. Follow through and own problems.
• In cases of omission or error, own it tactfully
  and with dignity. Make amends and move on.
• Do not prostrate yourself. Learn
• Be truthful and clear, dont obfuscate!
• If any doubts exists on how to proceed, call AVMA
  Professional Liability Carrier. They are on our
  side.

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• Client confrontation as a tool
• Needy clients VS truly difficult clients
• The best defense against self doubt and criticism
  are defined values and consistent behavior
  (integrity)
• Solicit feedback from your support community
• See BE HAPPY! section

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BE HAPPY!
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• Happiness is not a passive gift which will fall
  from heaven
• It is a state which must be cultivated and
  nurtured
• Joy is attainable by all and involves a choice to
  acknowledge the positive
• Pain is inevitable, suffering is optional

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• Realize you make choices about your time and
  actions
• Time diary as a tool
• Pro and Con list
• Evaluate consequences of your choices and own them

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• Figure out why you work
• Figure out what YOU LOVE and want in your life
• These answers allow you to pursue appropriate
  choices and understand your emotional responses
  (e.g. me and approval)
• MISSION/VISION STATEMENT

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Acceptance

• Necessary before you can move on, learn or grow
• Accept deficiencies in training, become a life
  long learner
• Adopt an attitude of curiosity and enthusiasm not
  lethargy and shame for not knowing
• Accept you will make errors

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Cont.

• Perfectionism is grandiose and arrogant
• Groveling is self serving
• Life is very gray, people have many effective
  methods and styles

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• Build community invest energy in personal and
  professional relationships
• Get feedback and support in times of uncertainty
  or criticism

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• Pursue excellence in CE
• Feed your professional passions

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• Take time to bond with animals
• Room of woobies

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• Find tools that help you center and ground (e.g.
  imagery, visualization, books, ect.)

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• Establish rituals of self care
• Embrace Activity
• Spirituality

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• Maintain humor and a larger perspective
• How important is this moment in a 40 year
  veterinary career or an 80 year life?