The Balance of Power
Cooperation is better than conflict, so engage an associate veterinarian in respectful conversation to achieve the practice’s objectives.
When non-DVM practice managers are tasked with supervising associate veterinarians, determining who holds the authority in certain circumstances can be tricky. Above all else, managers and associate DVMs must develop a working relationship built on trust, respect and boundaries. Their different skill sets and perspectives present opportunities to create synergy instead of competition, ultimately achieving the most desirable results.
Here are a few common conflicts between managers and associate veterinarians and possible solutions.
Business vs. Medicine
Conflict: A manager understands that stocking just one or two options in each pharmaceutical category garners the best prices, better client compliance and highest profit margins. The associate DVMs cannot agree on a preferred product and want access to all options. They promise to use everything, but the manager fears low product turnover, higher overhead and expiration waste.
Solution: Work with the associates individually to understand why they like or dislike certain products. Gather objective data for comparison’s sake, and call on technical services veterinarians to help answer medical questions. Collectively decide which products make the final cut, and if an agreement is impossible, allow the medical director to decide. Promise to revisit the issue after everyone experiences the changes for a while.
Also: Reduce low-demand products by completing an annual ABC analysis of all inventory items. Ideally, your inventory should achieve 12 turns a year. Set a minimum turn threshold that aligns with your practice’s strategy — I use four —and reevaluate any floundering products. Discuss those items with the doctors during a departmental meeting. Should the products be stocked for urgent needs or special-ordered in particular cases? Can something else on the shelf achieve the same desired results?
Employee vs. Colleague
Conflict: An associate veterinarian has a history of arriving at work late, taking excessive days off or spending too much time on personal tasks. The manager does not tolerate such behavior from non-DVM employees but hesitates to intervene with the associate because of the uncertain authority.
Solution: First, ensure that the manager’s oversight of associate veterinarians is clearly defined and articulated. If the responsibility falls under the umbrella of the practice owner or medical director, the manager should bring the associate DVM’s conduct to their attention, highlighting how the support team perceives the behavior. A conversation might be uncomfortable but is necessary if a manager oversees an associate’s work conduct.
Also: Before reprimanding the doctor, ensure that the standards are applied fairly to all associates, and consider the privileges they might deserve because of their significant responsibilities. Just like a practice manager might have more flexibility than an hourly employee, a veterinarian might be best handled with less micromanaging of the work schedule. When an associate’s actions negatively impact the team or business, however, correction is necessary. Like any conversation about personal conduct, ensure that the expectations are clearly understood and that adherence is enforced uniformly.
Consistency vs. Autonomy
Conflict: A practice manager wants to implement standard operating and treatment protocols to improve workflow, leverage the support team more effectively and provide consistency for clients. An associate DVM craves the autonomy to assess patients as individuals and tailor treatment plans accordingly, resisting a cookie-cutter approach.
Solution: Medical protocol conversations should begin with a discussion of best medicine and the clinic’s patient care objectives. Ask associate DVMs for examples of when a standard might be inappropriate and their proposed alternatives. Approaching the conversation from a medical rather than business management standpoint likely will be better received.
Also: Wellness recommendations should be standardized within a practice. The frequency of core vaccinations and testing, prevention protocols, and pet lifestyle-based services should not vary from one doctor to the next. From such a strategy, reminder systems can be built, the support team can communicate treatment plans to clients without first consulting a doctor, and clients gain trust and confidence in the entire team. When addressing injury and illness, however, consider giving associates the latitude to use their best judgment. Minimum standards should be communicated and agreed upon to ensure that essential corners aren’t cut. Collaboration among associates should be encouraged.
Productivity vs. Headspace
Conflict: An associate DVM’s appointments often run longer than expected. The doctor rejects requests to see additional patients, citing the need to provide appropriate care for the existing patient load. Driven to serve clients, patients and the business, the manager thinks the associate should be willing and able to see more patients each day.
Solution: A common associate concern like this can often be alleviated through improved scheduling, delegation and automation. Work closely to understand how the doctor’s time is spent and to identify bottlenecks.
Also: Consider implementing a daily schedule that alternates between wellness and illness appointments and does not stack mentally challenging cases. Schedule time in a doctor’s day, outside of the lunch hour, to catch up on records, callbacks and research. Ensure that the support team is thoroughly trained and has sufficient time to take on the bulk of routine client and patient tasks. Leverage technology to automate fees, recordkeeping and client communication.
Charging vs. Charity
Conflict: A manager is alarmed by the frequency of intentionally missed charges and price overrides, knowing that the fee schedule is designed to satisfy the practice’s financial needs. Associate DVMs are uncomfortable when they charge full price in various situations and want to reduce or waive charges when they perform the work.
Solution: Understand the scenarios that lead to an associate’s desire to discount. Strive to educate the team about the fee structure and its direct impact on wages, equipment purchases and hospital updates. If particular services or products cause collective price sensitivity, consider transferring the margin to another profit center to achieve the same result.
Also: Some level of discounting and charity should be incorporated into a practice’s financial plan. Team members are passionate about helping an animal in need, and allowing them to care for those patients regardless of the cost could improve job satisfaction. Additionally, charitable acts can strengthen a client’s bond to the practice. Consider giving each associate or team member a budget for discounting.
Finally, in all situations of perceived conflict, begin the conversation with the assumption that everyone is working with the best of intentions. Be curious and maintain a desire to learn. Together, managers and associates can agree on sustainable solutions for the betterment of the practice.
Take Charge columnist Abby Suiter is co-owner of Waltz Animal Clinic in Madison, Indiana, and a former Charleston, South Carolina, practice manager. She has spent nearly her entire life in the industry, earning her keep in her parents’ clinic before advancing into the world of veterinary management. She holds undergraduate and graduate degrees in business and is a certified veterinary practice manager.
The Veterinary Hospital Managers Association asked its members about employee surveys and whether the team is asked to weigh in on changes in workplace policies or procedures. The September 2021 “Insiders’ Insights” report found that 69% invite comments.