We all know that inventory and support staff are the two expense categories we have the most control over in a veterinary hospital. One major factor affecting support staff expense is scheduling. A delicate balance exists between having too many employees on duty and too few. Therefore, most practice managers view scheduling as a less-than-desirable task.
A concept known as leveraging can be helpful here. Leveraging is the number of team members scheduled per full-time doctor. When calculating the number, look at the total hours that support staff is scheduled — include your receptionists, veterinary assistants, technicians and kennel attendants — and then divide the number by 40. Then do the same for your doctors and look at the ratio of full-time support staff to full-time doctors.
In a typical practice, the ratio is 3-to-1. In a leveraged practice, it could be 5-to-1. The net effect of leveraging your team is to improve doctor efficiency and thus increase income production.
How many tasks might your doctors handle that could and should be done by a technician or veterinary assistant? In a highly leveraged practice, a veterinarian would not place IV catheters, take or assist with X-rays, run laboratory tests, or give clients the flea speech in the exam room. I would delegate these and other tasks.
Yet it is not enough to simply schedule more team members. Instead, the answer is to have more team members trained to perform specific tasks. In a highly leveraged practice, a veterinarian can produce $300,000 to $500,000 more annually than a doctor in a non-leveraged hospital.
Team scheduling is critical if we are to improve practice profitability.
First Steps
When creating a team schedule, I look for opportunities in the doctors’ office hours and surgery schedules. For example, I was looking at one schedule and noticed that although the practice had four full-time doctors, they were not taking outpatient appointments from noon to 2 p.m. An entire complement of team members was present then, but no doctors. However, by overlapping the doctors’ schedules, we added four hours a day to the appointment schedule without increasing the number of team members. At a professional transaction average of $280, that change could generate an additional $8,400 a week, or $420,000 annually, when accounting for paid time off.
Another opportunity involves the doctor’s appointment schedule. One veterinarian might be booked to see patients from 9 a.m. to noon and 2 to 6 p.m., but the first appointment might not be scheduled until 9:30 or 10 a.m., or maybe the last patient is scheduled for 4:30 or 5 p.m. An hour here and an hour there add ups weekly and yearly.
The same holds in surgery scheduling. A veterinarian might be set to do surgery from 8 a.m. to 1 p.m., but if the patient doesn’t get on the table until 9 or 10 a.m., the doctor will do fewer procedures over time. If surgery is scheduled for 8 a.m. to 1 p.m., the patient must be on the table at 8. Bloodwork, surgical prep and other preliminary tasks should happen before 8.
Titles, Not Names
Once you have an efficient doctor schedule, make sure the team schedule complements it. The doctor schedule should be the template for the team’s.
I’ll give you an example. Let’s say I have a doctor scheduled for office hours. At that point, I know I need a client service representative, exam room assistant, pharmacy/lab tech and possibly a veterinary assistant. If another doctor is scheduled for surgery, I’ll need a technician, two veterinary assistants and possibly another CSR. The concept is, of course, to leverage the doctor and allow the veterinarian to be as productive as possible but also allow team members to do what they are trained and desire to do.
When I create a team schedule, I use titles such as veterinary assistant and CSR rather than employee names. The reason is that I possibly know that Kim, my CSR, cannot come in until 10 a.m. because she needs to drop off her child at day care. If my priority is to schedule around the needs of my team, I’ll never have an effective schedule. Instead, the schedule should meet my practice’s needs first. Once I have one, I attempt to match team members to it.
Sometimes the strategy works perfectly, but more likely than not, you have to adjust the schedule. You also might need to hire additional team members or look for individuals who can work different hours. I prefer that about half of my team work part time and the other half full time, giving me much more schedule flexibility.
A Technical Assist
Many tools can help with scheduling. Programs such as WhenToWork (whentowork.com) and When I Work (wheniwork.com) are popular and simple to use. They provide critical information such as the total payroll cost, the hours team members work and the ratio of support staff to doctors. Some programs allow employees to access their schedules online and request schedule changes.
For practice managers, using an employee scheduling program can be invaluable. One advantage is you can ascertain the cost of a schedule before posting it. For example, you might prepare September’s schedule and learn that the total payroll adds up to $33,000. If your payroll target is 20% of gross revenue and you anticipate September revenue of $166,000, then you know you’re on target. However, if you forecast support staff costs of $40,000, you have a problem and should explore adjusting the team schedule.
Too many managers look at payroll and revenue numbers after the fact. You can’t do anything about controlling support staff costs once the month concludes, but you can if you use a program that calculates the costs in advance.
Manage the OT
Another problem is overtime pay, one big reason support staff costs are too high in some veterinary practices. I find that many employees who routinely earn overtime aren’t the most productive people but instead know how to use the clock.
I suggest having a written overtime policy and ensuring a doctor or practice manager preauthorizes the extra work. Another idea is to schedule full-time employees for 36 or 38 hours a week, thus allowing them to work up to 40 hours at regular pay. Also, having half your team scheduled part time allows for flexibility and can help control overtime costs.
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Just 19% of practices surveyed by the Veterinary Hospital Managers Association reported that their doctors are “very efficient” and couldn’t possibly handle more cases.