Chapter 2: Tales from the COVID-19 front lines
More clients are waiting outside as veterinary teams bring pets into the clinic for exams and treatment.
This week: Signs of strain are beginning to appear at veterinary practices — not all of them — as the COVID-19 pandemic takes a firmer hold on society and shelter-in-place orders spread. Today’s Veterinary Business asked industry professionals to talk about what they’re seeing and hearing.
Veterinary industry consultant Karen E. Felsted, DVM, CPA, MS, CVPM, CVA
The greatest challenge right now is the uncertainty of what’s going to happen next and the rapidity with which things are changing. What may have been a reasonable way to operate a practice three days ago is not today. Literally, as I write this, my county has issued a “shelter in place” order.
Many practices continue to be very busy, but others are starting to see a decline in visits. Many employees are scared about their jobs. This includes veterinarians and non-veterinarians — anyone who lives paycheck to paycheck, has a lot of debt, is the primary breadwinner or otherwise has financial challenges. Practice owners aren’t immune to this either.
One of the most important things practice owners and managers can do now is understand and acknowledge the fear and do what they can to preserve employment. Revenue, cash and jobs can’t be plucked from the air, but involving employees in some of the hard decisions about cutting hours and staying on top of resources available to laid-off employees, such as mandated paid sick leave and unemployment benefits, can go a long way.
I don’t see how the COVID-19 pandemic cannot result in a recession, but that is sort of a moot point. We won’t know until the fall whether we technically are in a recession — it’s defined as two quarters of negative GDP growth — but if revenue and profits are down, hours are being cut and jobs are being lost, then it’s a personal recession now for many people regardless of what the government says.
Staying on top of the federal, state and local government mandated changes in how businesses can operate is another critical area practice owners and managers must focus on. Veterinary practices should definitely be considered to be essential businesses, and they seem to be thought of that way today.
A harder decision practices are facing is what services should be provided and how. Critical issues to be considered include:
- Providing essential care to animals.
- Minimizing the use of PPE.
- Protecting the public health.
- Operating in a way that reduces people-to-people contact.
- Improved cleaning and sanitation procedures.
- Communication with pet owners about the risk to their pets and the appropriate degree of concern over whether pets are fomites for this virus.
No doubt there will be more.
Overall, I think we’ll get through this and it won’t be as bad as some of the projections, but it’s really scary. While we all need to keep up with what’s happening, for our own mental health, we also need to focus on reputable resources and limit the time we spend looking at endless comments and opinions.
Stay safe, do something fun each day, play with your pets and spend time with your loved ones, even if that means electronically.
The Vet Recruiter founder and CEO Stacy Pursell, CPC, CERS
What I have seen that is different over the last one to two weeks is that many of our clients have gone to video-based job interviewing. We had one veterinarian tell us she did an interview through a drive-through window at a veterinary practice. We are also seeing job offers go out after video interviews without an in-person interview.
Practices are telling us they are having clients drop off pets, or they are coming to get the pets from the cars and are not letting clients in the door.
One practice told us that the temperature of all team members is taken before they come inside the building.
Cary Consulting CEO and change agent Mia Cary, DVM
I’m surprised by the number of people who still are not taking the reality of COVID-19 seriously, including ignoring the six-foot physical distancing requirements. This is due partially to lack of leadership outside of the veterinary profession at the very beginning of this crisis. A simple explanation of how this six feet of physical distance can help keep us healthy, curb transmission and thus minimize the impact on our overburdened health care system could have done the trick.
On the upside, I’m not at all surprised by the remarkable response from the veterinary profession and those we serve. Veterinary professionals are pitching in to help their staffs, clients and communities make the best of these very challenging times.
Curbside concierge service is becoming the norm for most veterinary practices including The Animal Hospital at Lake Brandt in Greensboro, North Carolina.
Experts within the veterinary profession are also pitching in to keep a focus on the facts and share answers and solutions. A few examples include the Veterinary Telemedicine Community on Facebook, launched by Dr. Jessica Vogelsang over the weekend, and upcoming events such as the Veterinary Medical Association Executives member town hall, the VetPartners member town hall, AVMA chief veterinary officer Dr. Gail Golab’s Bridge Club webinar and a client communication webinar by Eric Garcia. These are just a few of the many free, virtual events that will help us stay connected and focused on solutions, and provide community conversations as we manage our way through COVID-19.
A final and important note. During a recent virtual press conference, Dr. Maria Van Kerkhove of the World Health Organization encouraged us to begin using the phrase “physical distancing” instead of “social distancing.” One benefit of this change is the focus on the importance of six feet of physical distancing to help prevent virus transfer. The other benefit of the change is that it stops associating being “social” with something negative.
Van Kerkhove reinforced that remaining physically distant is “absolutely essential” but that “it doesn’t mean that socially we have to disconnect from our loved ones, from our family.” Human beings are social beings and avoiding social isolation is paramount.
Cheers to the veterinary profession for virtually sticking together and helping all of us to keep moving forward and, as Anna would say, doing the next right thing.
Norwalk, Connecticut, veterinarian and speaker Sue Ettinger, DVM, DACVIM (Oncology)
From an owner’s perspective, having a pet with cancer is so stressful and there is so much uncertainty. And now, we have the added the stress and uncertainty of COVID-19. By changing the way we are able to interact with clients, I worry about the ability to communicate effectively with owners.
On March 18, our hospital went to a patient-only policy. When clients arrive in the parking lot, they call instead of coming in and they hand the pet over to my oncology technician. Joe gets a history over the phone, and I do my consults over the phone after I examine the pet.
I am a huge advocate of good communication skills with a collaborative approach in the exam room with the client. This is also known as the Frisbee technique and allows the doctor to build relationships, improve trust and improve client satisfaction. This is best done in person, face to face. But right now, we cannot be in the exam room as we are social distancing. I do believe it is more important to not delay cancer treatments, like with Ginger, the 3-year-old boxer I met last week who has T-cell lymphoma.
I have done phone consultations over the phone before, but it was different last week. Maybe it was the newness of the coronavirus situation, but it emphasized to me the importance to have a video option set up for a telemedicine option. We hope to get this set up this week.
As I spoke to Ginger’s owners, I was aware that I missed seeing my clients, especially at new consultations — to make eye contact, lean in, put a hand on their elbow or offer a hug. But I can still use empathy and give chunks of info and check for understanding. I also suggested they watch my YouTube channel on their cancer topic as a review and to get to know me better. As I emailed Ginger’s discharges to her family, I added a link to my lymphoma and chemotherapy playlists.
For my ongoing chemotherapy cases, I know the clients and drop-offs seemed to be less challenging, as I have the existing relationship and trust with the clients. But chemotherapy graduations without hugs and owners just do not seem the same. I know what is most important is that my patients who need oncology treatment get treatment, but we also must make sure owners have the best communication experience in these unusual and stressful times.
Veterinary nurse and National Association of Veterinary Technicians in America President Kenichiro Yagi, MS, RVT, VTS (ECC) (SAIM)
I’ve personally been in quarantine due to being on an out-of-country trip to put on some “RECOVER CPR” instructor training, so what I’m seeing are voices and challenges out in the field, especially from the veterinary technician/nurse and the ECC community perspective.
The first wave of changes came in the form of CE events, which we’ve become so accustomed to having an abundance of, being canceled or postponed. This quickly led to concerns from veterinary professionals, including veterinary technicians, being concerned about meeting CE requirements for license and credential renewal since most credentialing boards specify the proportion of the CE that needs to be done in person.
Organizations like NAVTA, the American Association of Veterinary State Boards and state organizations sent correspondences to credentialing bodies, and many have decided to implement changes that either removed the limit on online CE that can qualify or provided extensions. Similar changes are being considered by various veterinary technician specialist academies that handle VTS certifications.
Concerns in meeting requirements extended to students of veterinary technology and veterinary nursing programs. While educational institutions shifted their focus to taking their courses to a virtual or online format for didactic content, the physical clinical hour requirements became difficult for students to meet, making students possibly fail courses and at times be unable to graduate. All of the educational institutions are thinking of their students first to implement solutions, including waiving, extending deadlines or utilizing the “incomplete” grade mark, thus allowing makeup work.
In each of these situations, online education providers are stepping up to provide much-needed, ready-to-be-used online content. I particularly belong to the RECOVER Initiative, which aims to internationally standardize veterinary CPR based on an evidence-based guideline that opened up online courses to academic institutions at no cost. So far, we’ve received requests from 134 institutions totaling access for 10,491 students, which is $550,000 being given for free. Students, especially those graduating, have had to cut short the last months of saying their goodbyes and thank-you’s, having bittersweet moments, and kindling both hard and warm memories that stay with them for a lifetime. Our hearts ache for them.
Veterinary technicians and nurses out in the field rally as they continue to answer the call for our patients and community. We’re pulled in many different directions as pet owners try to prepare their pets for the long haul, increasing demands while infection-mitigation protocols slow down the hospital workflow, and all the while state agencies are calling for non-essential functions to cease. The human medical field needs resources redirected to them, and staying home is what can blunt the effect of the pandemic.
I hear concerns on both ends of the spectrum where people have had their hours reduced or have been laid off as practices closed, making an already financially strained veterinary technician’s life harder. A few technicians fear for their safety at practices that are “business as usual” and haven’t implemented infection-control protocols.
In all of this, we are seeing the veterinary and human health care community come together as we struggle to keep up with demands. The American College of Veterinary Emergency and Critical Care has started a ventilator registry as equipment such as ventilators and PPE are asked to be rerouted to human health care.
Volunteers at organizations like NAVTA and the Veterinary Nurse Initiative are working tirelessly to keep individuals updated, highlighting kindness and strength as veterinary and human health care professionals continue to put themselves on the front lines and offer everything they can to help. They are the heroes we need in this modern era.
Veterinary industry consultant Debbie Boone, CVPM
In management since 1985, I have never seen such a rapidly changing landscape. In the last week, I worked with my clients to develop and message their new parking lot protocols to clients as the increasing severity of the COVID-19 situation seemed to move in waves across the country.
I have been a fan of telemedicine since it was proposed as a tool for veterinarians, but last week I jumped on calls with providers to expand my knowledge to better guide my clients. Dr. Jessica Vogelsang opened her Veterinary Telemedicine Community Facebook group and had over 400 members in 24 hours. Practices are even patchworking their own platforms with Facetime or Zoom, Google Calendar or Calendly and PayPal.
My clients are still busy as work-from-home pet owners find free time to schedule their pets’ pending services, although the work is shifting to urgent care as PPE becomes scarce and more states mandate shelter in place.
Cloth masks are being sewn and exam gloves are being conserved by using Playtex rubber gloves and buckets of bleach water. Surgical gloves are being autoclaved. Excess supplies are being donated to our human counterparts as they battle COVID-19 on the front lines.
We must give a big shoutout to all the social media managers who not only are keeping clients informed but are also putting out content to keep them entertained as they shelter at home. Now is the time to build our relationships for the time when the dust clears.
What I see in veterinary teams is what I always see: a willingness to do what it takes to care for patients. Teams are volunteering to cover shifts. Many are splitting shifts so that the risk of exposure of the entire team is reduced. Those with weakened immune systems or underlying conditions are being sent home for their safety.
I have seen practice owners vow to waive personal compensation in order to pay their staffs, and then I have seen their associates volunteer to temporarily cut their salaries in half to keep the business afloat.
Veterinarians and their teams are pulling together, and they will come through this.
Crum & Forster Pet Insurance Group assistant vice president of veterinary relations Wendy Hauser, DVM
COVID-19 has reshaped how we think about work, how we do our work and how we live our lives. As this perfect maelstrom was forming, I was actively engaging our senior vice president about how we could become a 100% work-from-home company and how we would support our hourly workers.
It is critical that our pet owners talk to a live human to get answers to their insurance questions, especially in this time of uncertainty and fear. I am proud of our company for creatively solving the myriad challenges involved in making a 100% remote workforce a reality and continuing to provide the personal touch to pet owners and veterinary teams.
I would encourage veterinary hospitals to think strategically about how they can capitalize on building and maintaining client bonds during this scary time. Leverage employees that need to work from home for these tasks:
- Enhance your social media presence. While it is important for owners to learn about COVID-19, what else can you share? Reassurance is important during times of stress. What great personal-interest stories can you share, like pictures of the team persevering through the challenges of providing care in unusual ways? Consider sharing daily occurrences that make your staff grateful. For me, it is the welcome sound of songbirds returning to the Colorado landscape, especially as I walk my dog in the mornings. This has a double benefit; as you ask your staff about what they are grateful for, it is a reminder to your entire team about what is right in the world.
- Given that preventive care services are delayed in most hospitals, craft a message for clients about the importance of preventive care, with tips about what they can do to help keep their pets healthy. This could include tips about how to brush their pet’s teeth, healthy treats to give their dogs, and if appropriate, the value of regular, socially appropriate exercise. Remind pet owners to continue to give their pets heartworm preventive and flea and tick medications, too.
- Have work-from-home employees call your elderly clients. Many recent articles have highlighted how this crisis is different from recent past crises. As humans, our tendency is to pack together during times of anxiety. Due to the need to socially distance, isolationism is harmful to our psyches and even worse for those who are alone. Reaching out to clients is a great way to show that you care about them, further reinforcing the client-hospital bond. It also helps your employees to feel connected and helpful to you and enables them to continue to earn some income.
HR Huddle columnist and Veterinary Business Advisors human resources consultant Kellie G. Olah, SPHR, SHRM-CP
Last week we went from seeing clients make contingency plans to being forced to put those plans into action. We have been consulting with clients to help them make heart-wrenching decisions — from which employees to lay off to which pet owners can or cannot be inside the clinic with their pets.
We are being asked if veterinary services are considered essential businesses, what procedures are considered electives and who qualifies for government assistance. The one thing that has been consistent is that each day is different — new laws, new rules and new decisions to be made. The other thing that has been consistent is how resilient our clients and the veterinary industry is. As a whole, the industry adapts, perseveres and is an example of hope.
Veterinary industry consultant and speaker Louise S. Dunn
During this crisis, veterinary practices are taking a multimodel approach. In other words, practices are paying attention to patient care, client service and team performance, and not ignoring one in favor of the other.
For the patient, practices are open to see the sick and injured. As stated on so many discussion boards and webinars, what’s taking place is that pets are being picked up from the owner’s car, entry into the hospital is being limited to one owner per patient, and pets are being wiped down with a sanitizing wipe. Some practices are reducing the office visit fee so that people who are out of work during the COVID-19 crisis can still obtain health care for their pets.
Some practices are reporting that clients seem unphased and continue to show up. It is up to the veterinary team to enforce safe distances and protocols. Many practices are implementing telehealth services to continue providing care to their patients. And there continues to be heavy use of alternative payment plans.
Of course, every team is asking staff members to not come to work if they are sick and to take voluntary leaves if work hours need to be reduced. Some team members are setting up a makeshift classroom for employees’ children who accompany their parents to work.
Many practices are implementing the rationing of medical supplies — in particular, gowns, masks and gloves. The recipe for reusing gloves is to wash the gloves after use, apply powder, inflate the gloves to blow off excess powder, turn them inside out, wrap in a paper towel and then a drape, and autoclave. This works about 10 times before the gloves are not usable. Sterilizing methods are also being used to conserve needles and syringes. Clean with alcohol, check needles for burrs and autoclave.
Plans continue to evolve for businesses as the government institutes policies for unemployment, small business loans and relief packages. Practices are expanding their paid-time-off benefits and paying team members to work on long-term and housekeeping projects, such as things that were placed on the back burner during busy times.
Veterinary industry consultant and Southern California Veterinary Medical Association executive director Peter Weinstein, DVM, MBA
The common questions I am seeing from veterinarians include:
- Will we ever be able to get more personal protection equipment? If we run out of PPE, we put our staff at risk.
- If veterinarians are considered essential businesses and can deliver services, which services should we deliver? Emergency only, any wellness care? What about cases that the owner thinks are emergencies but can wait?
- How are we going to survive this financially?
- I have twice as many staff as I need right now. A large portion is reluctant to work for fear of exposure and the others are gung-ho and ready to go. They all need their jobs. What should I do?
- How can practitioners meet CE requirements in states where the amount of continuing education allowed online is limited?
- How are specialty referral practices choosing what is emergent and what can wait?
There is a lot of panic — more about the team’s health and the practice’s ability to remain solvent. There are no easy answers.
Right now we need leaders, communicators and innovators to lead the profession through the current challenges.
Veterinary industry consultant and speaker Karyn Gavzer MBA, CVPM
My heart goes out to my colleagues, especially those in states that have instituted COVID-19 stay-at-home policies. While self-isolation is necessary to stop the spread of the virus, “stay home” directives also upend child care, close schools and cause many to lose their jobs. Staff members are at risk when they interact with pet owners, and other staff members cannot work because they can’t find child care. Clients who are not working worry about their ability to pay for pet care. It’s a bad situation, and yet I am encouraged by the resiliency of veterinary health care teams.
Do you remember only five short years ago when dogs were getting sick from a new, highly infective respiratory coronavirus similar to COVID-19? It was called H3N2. Today, we know that H3N2 existed for at least a year before it first flared on the national radar in March 2015, when it devastated boarding facilities, doggy day cares and more in the Chicago area. By the end of that year, the virus had spread to 25 states. The veterinary profession in March of 2015, like human medicine today, had no vaccines or medications to treat it. By November 2015 of that year, two vaccines had been developed and were quickly put into widespread production to protect dogs. In the meantime, veterinary teams on the front lines learned how infectious H3N2 was and that they could carry it on their shoes and clothes and infect their own pets at home. They ramped up isolation and instituted rigorous hygienic practices to contain the virus and stop its spread.
How I wish human medicine had paid more attention to what happened in the veterinary profession. We would have been better prepared for COVID-19. But no matter what, I have all the confidence that veterinary teams will rise to meet this new challenge and find their way through.
Just remember who you are. And stay healthy.
North American Veterinary Community chief veterinary officer Dana Varble, DVM
Veterinarians in some states are being asked to send extra PPE — masks and gloves — to human medical facilities in some states. The conundrum is no one knows if they will be compensated for this or not. Also the definition of “extra” gets a bit difficult. What do we keep at the clinic as essential vs. doing the right thing for public health.
Also as a rhetorical question: Does this change our standard of care? Many studies show that masks are not particularly effective or necessary in surgical settings, but if the surgeon is ill does that change things?
San Diego veterinarian, author and speaker Jessica Vogelsang, DVM, CVJ
In the space of just a few weeks, veterinarians have had to change their mindset from “Telemedicine is something I might consider at some point down the road” to “Telemedicine is something I need to implement yesterday.” I can’t think of any practice change this huge that has happened this quickly ever in the history of the profession. It’s overwhelming.
Many people in the profession have been working on telemedicine for a long time, so even if it’s entirely new to you, there are others in the field who can help you with all your questions. The American Veterinary Medical Association has had working groups on this for years, but even with all of the best practices already outlined, there’s still a lot of details to be ironed out. We no longer have the luxury of time to do that. Clients are already very accepting of telemedicine for themselves, so really, it’s the profession that has to steel itself to jump off the diving board and into the deep end.
Both the blessing and the curse is that you have infinite options for how you want to introduce telehealth into your practice. Do you want to bring in a turnkey telehealth platform? Do you want to piece together options using Zoom and PayPal? How and when do you charge? What are appropriate-use cases? There aren’t cut and dried answers, but no matter your comfort level, someone can help you figure it out.
I started the Veterinary Telemedicine Facebook Community to remove as many barriers as possible to these essential conversations. I am humbled and overwhelmed that in the space of a matter of days, the entire international community — from leadership, practice owners, associates, platform developers and anyone who cares about this issue — have all assembled in this virtual room, pushed up their sleeves and said, “How can I help?”
Getting Technical columnist, practice management consultant and Patterson Veterinary University instructor Sandy Walsh, RVT, CVPM
Things have changed over the last few days. With many communities on “safer at home” status, the traffic in and out of veterinary hospitals has dropped dramatically, partly because our clients are afraid of exposure and also because practices have put plans in place to minimize the risk by limiting the services provided. I am still seeing practices postpone most routine wellness services, but puppies and kittens completing their initial vaccine series are being accommodated.
When clients need to come to the hospital, they are being asked to call from the car when they arrive. Technicians are then going out and either bringing the pet inside for the exam or escorting the client and pet into the practice while adhering to social-distancing guidelines.
Doctors are doing more telemedicine for the appropriate cases. Facetime and Skype are being used for medical progress exams, when possible.
Staffing has been affected as there is less need for kennel help because boarding requests have decreased. Routine grooming has decreased dramatically as well.
Practices have enhanced cleaning protocols. Sanitization of all touched surfaces or items is happening.
We are encouraging use of online pharmacies for prescription refills. Some hospitals have been more flexible with refills of preventives when an exam isn’t possible, sending home a month at a time until the exam can happen.
Clients have been very understanding and supportive of the efforts that practices are making to protect them from COVID-19 exposure.
With many schools closed, staff members are struggling with child care issues. We are seeing the best in our teams through their flexibility and willingness to change schedules to help co-workers.
We’re going to get through this. We just all have to work together.
Cara Veterinary co-founder and President Peter Brown, DVM
Navigating through this unprecedented event has been challenging. Focusing on what is best for the community, the team, our clients and the pets is the driver for all decisions that are being made. I have found that everyday is bringing on new challenges and requiring strategy changes.
In the last week, many businesses have been closed, including all restaurants and bars. Our Washington State organization has recommended we stop non-essential visits, and we are on the verge of a complete “shelter in place” statewide. Veterinary medicine has been deemed an essential service, so our doors will remain open.
Rapid spread of COVID-19 and the enhanced and enforced sick policies is creating some labor challenges, and I know many clinics in the area that have started decreased hours of operation. A 10-fold increase in cases, as predicted by some, will certainly have an impact to all.
A high percentage of hospitals have gone to 100% curbside pickup to prevent the gathering of people within the clinic walls and hopefully decrease the risk of the team being exposed as well as the non-clinical team member exposing the client. Many clinics are also in the process of offering or have started telemedicine services. There are still many restrictions on telemedicine due to state laws.
A major effect of the viral pandemic is the impact to the economy. With unemployment skyrocketing, retirement portfolios crashing and an increase in overall fear of the future, we will start to see an affect on client ability and desire to pay for some veterinary services. The increase in the human-animal bond, further enhanced by more people working or staying at home, will help counteract the potential drop in disposable income. For many of us, veterinary care for our pet is not part of disposable income, it is in the same bucket as rent and food.
Another impact I am seeing is that many corporate acquisition groups have placed a halt on purchasing veterinary hospitals. With fewer players in the marketplace, we will likely see a drop in the price of clinics. It is too early to tell what the exact impact of COVID-19 and the likely upcoming recession will have on the long-term market.
Overall, I have been very proud of my team through this challenging time. They have showed great resilience and leadership while potentially exposing themselves to take care of the pets we all love and dedicate our lives to. We are part of an amazing profession and are serving our communities at a challenging time. Pets are providing emotional support during social distancing and will be an important part of our world recovering from COVID-19.
My best advice to all is to focus on your team and the clients and pets we serve, be flexible, adapt to daily changes, keep smiling and have a positive attitude.
Beyond Indigo Pets president and Today’s Veterinary Business editorial adviser Kelly Baltzell, MA
Last week was an intense roller coaster for all of us on a personal and business level. The universal struggle is that nobody knows when the next “hit or adjustment” is going to happen, and we have no time to adjust. Cities and states go into lockdown in the matter of hours. The wording for what is an essential business is not always clear. Some of my clients have called their county to receive clarity on the rules.
My company is helping hospitals to connect the latest rules with their pet owners. What we have focused on is being the marketing center that hospitals do not have but need to get the message to clients. To that end, we recommend:
- Quickly updating clinic hours on the practice’s website and Google My Business and Facebook pages.
- Informing pet owners about the current situation in newsletter blasts and website pop-ups.
- Setting up telehealth services and home delivery of meds.
I have heard of non-Beyond Indigo clients — competitors of our clients — just shutting down and riding out the virus.
Mentally, business owners are in shock. Period. My team and I have had multiple phone calls with doctor owners to discuss action plans for reaching pet owners. My message is that practices need to reach out to pet owners more, not less, during the COVID-19 pandemic. Be in front of them with every change in their area. A service that you don’t think might help, such as pet boarding, could be important. The message to clients could be, “Let us help essential workers like you while you are saving lives.”
[Check out Kelly Baltzell’s Facebook Live sessions at 1 p.m. EDT March 25 and 27 at https://bit.ly/2xmdsZC. The first session will cover client communication and the second will be an overview of the week.]
Socially Acceptable columnist and IT and digital strategist Eric D. Garcia
My clients report that veterinary visits still seem to be trending close to what they were at the same time last year. However, they’re preparing for the trend to backslide. It is important to note that this might not be true for everyone.
Most practices are now having clients wait in their cars while their pets are cared for in the practice. Some practices will bring clients in to the exam rooms one at a time instead of waiting in the lobby.
I’m now seeing all pharma and industry companies going completely virtual and prohibiting their sales forces to travel to practices. My colleague Dr. Jolle Kirpensteijn of Hill’s Pet Nutrition says he’s booked solid for the next two weeks.
Dr. Rick DeBowes, a professor at the Washington State University College of Veterinary Medicine, told me that “The seniors were told they were now graduates of the College of Veterinary Medicine, there would likely be no graduation, their requirements were completed and … they were free to go. … Definitely bittersweet this year.”
Megan Brashear, small animal veterinary nursing manager at Purdue University, told me that “Many staff members are nervous for a multitude of reasons, mainly just potential exposure but also the ethical quandary of personal protective equipment and if they should be preserving it only for human medicine. All elective procedures at Purdue have been postponed to June 1 or later. Since school and day care closures have been in effective, many team members are having to stay home with their kids. As a result, staffing has come with its own set of challenges. Many patients are being triaged over the telephone ,and only pets are being allowed in the building. … We’re reacting to the hourly changes at the national and local levels and trying to plan ahead.”
Austin, Texas, practice manager and VetPartners President Deb Stone, MBA, Ph.D., CVPM
The practice leadership continues to watch the progression of COVID-19. Austin is seeing an increase in COVID-19 positive cases, and we continue to keep our team and clients up to date and be as transparent as possible.
Here are other updates:
- Practice leadership regularly monitors local and national websites in order to keep up with announcements that may impact our team, clients, and practice processes.
- We continue weekly town halls to open the discussion for any team member regarding questions or concerns.
- The practice continues to provide medical care and product sales, but now our doors are locked so that clients cannot enter. We also conduct almost all communication electronically, including patient admittance, discharge and payments.
Our clients have been very grateful that we are still able to provide patient care and client service while also taking precautions to avoid exposure for all stakeholders.
As far as caseload and revenue, the practice remains very busy and has a full schedule. We have experienced a very slight drop in revenue as we extended our standard 30-minute appointments to 40 minutes in order to account for the steps our veterinary technicians must take in collecting patients from the car and returning them.
Our next steps this week will include forming two health care teams, with two separate shifts, so that we minimize the number of team members present in the practice at the same time. Team members who don’t provide patient care or client service will be asked to work remotely, again to minimize the size of our teams present.
We also welcome more opportunities for telemedicine with clients with whom we have a valid VCPR.
Concerning VetPartners members, we are sharing information with each other via online forums and will have one of our first COVID-19 town halls this week.
Fearless columnist and Chicago practice co-owner Natalie Marks, DVM
Every morning I wake up and hope that what we’ve experienced these last few weeks has just been a bad dream, but then I look at our deserted street and my stir-crazy children and closed Starbucks and I know my new normal is still there. Life in general practice is continually evolving.
We went from having a full team at work to now small teams rotating on three 12-hour schedules. We went from clients coming in to pick up medications and food refills to calling us over the phone, paying and then having team members in gloves bring their refills to the car.
I went from a full day of surgeries to cancelling all elective procedures. We went from generous supplies of PPE and masks to rationing out one per staff member per day. We went from a vibrant, incredibly busy, 10-doctor practice to having only essential personnel in the building and a much reduced caseload.
We are very concerned about the mental well-being of our teams. We are putting together theme days to encourage them, buying lunches, being available to talk and offer support, and being flexible with scheduling for child care as much as possible.
The one very positive aspect has been client feedback. With very few exceptions, our clients have been more patient, more grateful and more thankful that we have stayed open and that we have been transparent, creative and empathetic. While this doesn’t always calm our fears and worries, it does reinforce why we are all here in the first place and that we are respected as a profession.
We have to keep reminding ourselves that we are the bridge between animal and human health and that we still have the very important role of being the protectors of public health.
Veterinary industry consultant and Today’s Veterinary Business editorial adviser Fritz Wood
The practices I talked to last week were still on track. Business was steady.
Preparedness is key to continued success. Is liquidity a potential issue for you? If you’re not already projecting cash flows over the next one, three and six months, start now. Make sure spending is in line with accounts receivable. Extending credit to clients is much riskier than only 30 days ago.
It’s uncomfortable and counterintuitive, but I encourage you to communicate early and often with your lenders to avoid surprises. Same with your suppliers and landlord. What’s your plan if client traffic stops entirely? For example, will you quickly deliver an ambulatory/mobile service and telemedicine consults, and aggressively sell gift cards? Have you thought about adjusting your inventory to account for supply chain disruptions?
As a side note, those who heavily endorsed wellness plans early — including the largest corporate groups — are looking smart today as they enjoy more level cash flows.
North Carolina veterinarian, speaker, consultant and Today’s Veterinary Business editorial adviser Ernie Ward, DVM, CVFT
Direct email to clients is perhaps the best way to stay connected during this crisis. Social media posts are helpful at relaying practice hours or changes in the scope of services, but nothing beats a personal email from a veterinary provider. Many pet owners will be working from home, making an email more likely to be read and opened, especially if it’s from a trusted source of truth.
I advise veterinary clinics to send out weekly updates citing local news and announcements, along with steps the clinic continues to take to prevent the spread of COVID-19 while preserving the health of their pet patients. Be sure to include how your team can be reached, whether by phone, text, website or messaging service.
Now is also an excellent time to have clients conduct at-home pet health checks, such as teeth and oral exams, weight and body condition, skin and fur, lumps or bumps, and behavior. Pet owners are interested in doing things with their pets while working from home, so I encourage veterinary clinics to provide them with suggested activities.
You also need to inform your clients about what to do in an emergency. Provide quick links and telephone numbers to available local emergency veterinary clinics.
Texting and direct messaging can also serve as a lifeline between your veterinary practice and clients. Text can be especially helpful in coordinating curbside veterinary care, pet drop-offs, or pickups of medications or food.
It’s essential that all veterinary clinics keep their Google Business profile current. Operating hours need to be updated to reflect changes as they happen. Nothing is more frustrating than an owner expecting your clinic to be open, only to find it closed.
You should be in contact with your clients at least weekly or as major developments occur. Veterinary clinics should strive to be the trusted source of information for their clients during this time. If pet parents aren’t hearing from their personal veterinary team, they’ll turn to the internet and social media for advice. This crisis presents an opportunity to bond with your clients by providing updated and personalized information and advice on keeping your pet patients healthy and happy during tremendous stress.
Be clear with your messaging to avoid further confusing pet owners overwhelmed by information. A recent example of a well-intended message gone bad was made by a group of popular Instagram veterinarians. They posted a meme with the message, “Your pets are at no risk from coronavirus.” Dogs have at least two documented coronaviral infections, and cats are famously infected with the coronavirus that causes deadly FIP. Pet owners were understandably confused.
Under intense scrutiny, the group then deleted “coronavirus” and replaced it with “COVID-19,” only to come under additional criticism because dog and cat fur can serve as a mechanical vector or fomite for SARS-CoV-2 transmission to humans in the same way as contacting a contaminated door handle or handrail. The fact is that there is currently no evidence that SARS-CoV-2 can cause active infection in dogs and cats or that pets can actively spread COVID-19 to pets, other than accidentally. This type of unclear messaging potentially creates more doubt and distrust when the pet-owning public desperately needs accurate information in order to keep their pets and human family members safe.
Creative Disruption columnist and WellHaven Pet Health chief medical officer Bob Lester, DVM
Dickens’ “A Tale of Two Cities” nailed it: “It was the best of times; it was the worst of times ….” Two weeks ago, our WellHaven Pet Health practice had its best week ever in our short 30-month history. We helped more pets and enrolled more families in our subscription wellness plans than ever, our revenue comparison to the previous year was well over 20%, our newly built AAHA/Fear Free practices were performing especially well, our doctor hiring needs were largely met, we’d just received a batch of AAHA client satisfaction surveys showing that over 90% of clients surveyed would strongly recommend us, and as if that were not enough, Forbes magazine notified us that our WellHaven practice is the No. 1 vet/pet startup employer of 2020! What could go wrong?
Well, we all know what could go wrong. Over the last two weeks, like all in this noble profession, we are doing everything in our power to safeguard the health of our teams, clients and the pets in our care. We’re down a few team members who have wisely self-quarantined — no COVID-19 test positives so far, thank goodness. We’ve very effectively executed curbside check-ins, we’ve further enhanced already-strict biosecurity measures, we’re employing telehealth modalities, we’re figuring out new PPE conservation strategies and our morale has never been higher. The testimonials from team members thankful for the opportunity to continue to care for pets, to serve their purpose and to receive a paycheck in these troubling times is heartwarming, as is the gratitude of so many clients grateful that we have remained open to care for their beloved fur babies.
This past week, our hospitals were energized, our clients were thankful, and our practice business was down a little — still up compared with last year, but off a little.
It’s critical for our profession to pull together, share best practices and help one another. I’ve been on the phone and email with colleagues all over the world — independent practices, group practices, academics, association and regulatory leaders — and have not been surprised to learn that every one of them has been eager to share what they do and don’t know. Our patients, doctors, nurses, staff and clients deserve our best, and they are getting it. We are members of a remarkable profession.
Our WellHaven Pet Hospital teams are determined to continue to perform the essential service our society requires, now more than ever. We continue to fulfill our veterinarian and veterinary technician oaths and care for pets in need. Stay well. What we are doing is important.
Politics & Policy columnist, Animal Policy Group founding partner and Today’s Veterinary Business editorial adviser Mark Cushing, JD
The week of March 15 saw America wake up to the potential scale of the COVID-19 crisis and take unprecedented steps to cope, contain and hopefully turn the tide. Veterinary medicine engaged in policy and operational debates and decisions at all levels. The profession and industry focused on ensuring that governmental designations of “essential services or business” include veterinary clinics and preserving supply chains for personal protective equipment.
Now comes the really hard part on two fronts as COVID-19 continues to spread rapidly and human health care faces the threat of running out of supplies and beds, and perhaps health care providers.
Also consider these two points:
- Can alternative sources of personal protective equipment be provided for veterinary procedures when and if governments declare that all available traditional types of PPE be made available to human hospitals and clinics? Ultimately, we won’t win an argument with policymakers that veterinary needs trump human health needs. In fact, the risk we run is that governors might reconsider veterinary medicine’s designation as an essential service if we claim we cannot operate our clinics without existing sources of PPE. We must be able to assure decision-makers that veterinarians do many things for pets that do not require all manners of PPE and that we have other sources of protective gear to enable us to perform important procedures.
- Human medicine is shouting from the mountaintops that telemedicine is and will remain available. Useful care can be provided through telemedicine tools, which don’t require people to travel to clinics or hospitals and risk exposure to COVID-19, exacerbating the situation. West Virginia, Oregon and Texas veterinary medical boards and the Rhode Island Department of Health have stepped up and encouraged veterinarians to use telemedicine for the same reasons. Oregon, West Virginia and Rhode Island even temporarily waived rules prohibiting the creation of a veterinarian-client-patient relationship through telemedicine. A number of state boards that will go unmentioned, along with veterinary medical associations, have taken it upon themselves to declare over social media and websites that veterinarians must be reminded that they cannot create a VCPR, even in these unprecedented and complex emergency circumstances, through telemedicine. That means veterinarians cannot treat a pet or help a pet owner over the phone or through texts if they haven’t seen the pet. Was it really necessary to warn trained, licensed professionals in the middle of a complex crisis that unfolds by the hour?
How do you think the public reacts to this stark contrast between the emergency response of human medicine and veterinary medicine? Do people really believe that America’s pets are better off with pet owners receiving no medical advice in the midst of the COVID-19 emergency because they cannot travel to a clinic or are afraid to? All state veterinary medical boards need to follow the lead of West Virginia, Oregon and Rhode Island, waive existing VCPR requirements and do so quickly.
Thrive Affordable Vet Care director of learning and development Claire Pickens, CVPM, SHRM-CP, CSSGB
Over the last few weeks, the flow of information to the masses about COVID-19 has meant massive necessity for rapid process change. Typically in change management, careful thought and ample pre-planning is done before major process flow changes are made. In this case, as an industry and a society, we are adapting and changing on the fly. Through this, the single most important aspect of change management has been making sure the hospital team feels supported and heard.
Being part of a scaled organization meant training over 80 locations and nearly 700 team members rapidly on process flow to help them reduce contact with the customer while still maintaining high levels of customer service and patient care. This meant the coordination of job aids, instructional videos and standard operations procedures to help teams navigate an ever-changing environment. This was then delivered through live, remote training sessions nationally to all locations over the course a couple of days.
During the first training sessions, the questions in the chat box clearly expressed emotions related to how the pandemic was impacting our teams. As the training sessions continued and more of their questions could be immediately answered, there was a noticeable sense of calm. As the teams began to implement these new processes, the importance of a strong and supportive leadership team became the highest priority.
Most clients responded very well and were thankful for the organized and very proactive approach to reducing contact. Some clients, responding out of their own emotions, weren’t as understanding of change. Some staff expressed concerns about their own close contact with each other. Every day has presented a new reason to be supportive to the teams through something none of us have experienced before.
Whether you work at a small hospital with less than 10 team members or for a large company with thousands, expressing care and concern for those providing patient during this pandemic is of the highest importance. This is especially important as many of our team members grapple with the concept of remaining at work to be an essential caregiver for the community.
Emotions are raw and self-protective feelings are heightened. Now more than ever, it is essential that leaders understand their roles. While we all aren’t in the hospital, all of us in the veterinary field play a vital role. And that is to ensure our hospital teams are cared for, appreciated, informed, heard and supported.
Talk the Talk columnist, veterinary industry consultant and Today’s Veterinary Business editorial adviser Amanda L. Donnelly, DVM, MBA
What I’m hearing from my clients is that they have all gone to curbside service. All pets are examined while clients wait in their cars, or they are admitted for the day and picked up later. I love the use of the term “concierge” service as it sounds more professional and value-added.
Some hospitals have reported that a few clients are anxious about being separated from their pets, but most are understanding and appreciative of the service. Interestingly, some clients are reporting very positive client experiences as a result of teams that are friendly and clearly catering to their needs. These pet owners are still getting to talk to the doctor and don’t find waiting in their car objectionable.
With this new service model, I am making the following client communication recommendations:
- Now is the time to focus on phone skills training for the entire team.
- As appropriate, I encourage doctors to try to put in an appearance at the car to talk to clients rather than only talking on the phone.
- Use Facetime or a similar app so clients can see the doctor and the exam.
- Hold daily standing meetings to keep the team focused and informed on how to best serve clients and patients.
During this crisis, I advise practice owners and managers to remember to think strategically and focus on business planning. This means being flexible and adaptable as well as avoiding reactionary decisions that aren’t well thought out.
For businesses experiencing slow times in the months ahead, now is the time to work on business development and projects that may have been put on hold due to a lack of time. For example, team training should be a focus. I encourage practices to take advantage of the opportunity to do communication skills training and utilize online learning platforms.
We want to hear from you: How has the COVID-19 emergency affected you, your practice or your veterinary business? Email editor Ken Niedziela at [email protected].
Did you know a subscription to Today’s Veterinary Business is free to qualified veterinary professionals? All you have to do is sign up here (and renew each year). You also can sign up to receive the Today’s Veterinary Business weekly e-newsletter.