Chapter 10: Tales from the COVID-19 front lines
“Now is the time to make lemonade out of the lemons we’ve been handed.”
This week: Curbside care is still the norm as veterinary practices think about a post-COVID world and the future of telemedicine.
Creative Disruption columnist and WellHaven Pet Health chief medical officer Bob Lester, DVM
We’re three months into a pandemic that we’ll be telling our kids and grandkids about. We’ll all be glad when this is behind us.
Now is the time to make lemonade out of the lemons we’ve been handed. What good can come from our experience? What have we learned that will make us stronger? What should we keep doing post-COVID, and what can we stop doing post-COVID?
KEEP DOING POST-COVID
- Leading. Veterinary professionals across the profession have risen to the occasion. It’s been remarkable how many have stepped up and how well they’ve led.
- Client connections. Text, video, websites, Facebook, Google, emails, telephone, curbside. Given the obstacles presented, we’ve done a remarkable job maintaining relationships with pet parents and each other.
- Drop-offs. They work! Maybe not for every appointment but for many. Those who questioned the value of the drop-off have witnessed first-hand the resulting client convenience and hospital efficiency. Let’s keep doing drop-offs.
- Cloud-based PIMS. Duh. Medical records available anytime and anywhere.
- American Animal Hospital Association. Always of value. The additional attention to biosecurity has been especially beneficial.
- Human-animal bond. Who knew it could get even stronger?
- Preventive care. A renewed focus on the importance of zoonoses and proactive care.
- Checkouts. In exam rooms, lobbies, parking lots, treatment rooms and living rooms. Improved client convenience and team efficiency.
- Delegating. Veterinarians historically struggle to delegate, the result of generations of John Wayne-like individualists who insist (wrongly) on doing everything themselves. The crisis has forced us to delegate. Keep it up!
- Telemedicine. It has broken down barriers to care, it’s convenient, clients love it, it allows for further nurse empowerment, it drives revenue through consults and resulting brick-and-mortar visits. It’s here to stay, except maybe in California.
- Contactless payments. Why not?
- Record pet adoptions. Society is further recognizing the value of pets in families.
- Empty shelters. How cool is that?
- Fear Free. It worked before, it works now, and it’ll keep on working.
- Team engagement. Hospital teams have rallied like never before. When faced with a common enemy, we’ve come together and accomplished so much. Post-COVID, let’s continue to work together.
- Team health. Physical and emotional. We’re looking out for one another.
- Efficiency. New client flows, new communication modalities, new facility utilization, new adoption of technology, new marketing means. Let’s not lose the efficiencies we’ve discovered.
- E-commerce. Online pharmacy and home diet delivery. We dabbled pre-COVID. We’re all in now.
- Spending more time with my loved ones. Two- and four-legged.
- Exercising. Ten thousand-plus steps a day!
STOP DOING POST-COVID
- Obsessively monitoring CDC, WHO, AVMA, state VMA, state board and gubernatorial COVID directives.
- Packing a lunch. I can’t wait to go out again.
- Stressing. I look forward to returning to something resembling the good old days of just 10 weeks ago.
- TV binging. I’m hooked on “Billions.”
- Eating too much when stuck at home. A self-inflicted side effect of the COVID-19. Sometimes referred to as the COVID 10.
What are you and your team going to keep doing and stop doing post-COVID? I have no doubt we’ll all be stronger as a result. When life hands you lemons, get some tequila.
Cara Veterinary co-founder and President Peter Brown, DVM
Overall, things are going very well here in the Northwest. How the state of Washington will phase back to normal is still not clear; the time frame is pending.
Supplies of personal protective equipment are fine — no concerns at this point. Curbside appointments, telemedicine and home delivery are the new normal processes we are experiencing. The efficiencies of these processes are still improving as more time is required on the phone and more steps are needed to get the pets to and from the parking lot. I do worry about the lack of contact between doctor and pet owner decreasing the relationship and level of trust with new clients.
In general, the change from normal throughout society has led to increased anxiety, depression and frustration. I have seen more grumpy and impatient people than ever. I find it challenging to interact with people wearing masks. Eye contact and body language help, but we learn a lot about how people are feeling based on their smiles and smirks. I believe this will be a fascinating sociological study.
The future of our society has been changed because of the pandemic. More work from home, less business travel and more online schools will likely occur post-COVID. These changes might affect our profession because of increased pet bonding, less boarding, less day care, more behavioral issues and many more shifts that I am not aware of.
Veterinary teams are doing a great job. Being an essential worker has its challenges and risks, especially if a colleague is carrying for an older or immunocompromised family member. Business is very strong, and pets are doing OK overall without having daily breaks from us humans.
Crum & Forster Pet Insurance Group assistant vice president of veterinary relations Wendy Hauser, DVM
As more states begin to relax restrictions, the ability of veterinarians to provide more “normal” services is increasing. My sense in talking with many veterinary professionals is that leading practices at this point in the COVID-19 pandemic is filled with anxiety and confusion. When should we allow clients in the hospital and what will it look like? How do we continue to provide safe work environments for our teams while servicing clients? How do we operate efficiently and with compassion?
I encourage all hospital leaders to remember the value of training. Coach your teams to have relational interactions with clients.
In attempting to be efficient when time is short, veterinary staff slip into a transactional interaction style, where the team member involved is merely going through the needed steps to complete the interaction. These interactions are devoid of personal connections. In a curbside check-in, it might sound like: “Hello! Is this Fluffy Smith? I have your paperwork right here. I will take Fluffy into the hospital, where he will be examined. Dr. Jones will call you with the findings and her recommendations in about 15 minutes.”
Work with your teams to establish relational interactions. These communications are established when a team member builds rapport with clients, identifying the clients’ needs by eliciting their perspective. The clients feel that the team member, and by extension the hospital, truly cares about them and their pets. Because clients are being excluded from the physical examination, curbside and telephone relational interactions are more important than ever.
A relational interaction during a curbside check-in would sound like this: “Hi, Mrs. Smith. I am Samantha, and I will be taking care of Fluffy today. Oh, he is so handsome! I have your completed paperwork here. It seems that Fluffy has been scratching at his right ear a lot over the past two days and is now crying when he scratches it. Poor boy! Anything else that is worrying you about Fluffy?”
This is a short example of how empathy, summarization and open-ended questions can help to create a partnership with clients. By taking the time to invite Mrs. Smith’s perspective, you gather the information you need while recognizing and acknowledging her beliefs, expectations, feelings and opinions. Clients feel valued, understood and satisfied with your compassionate care. This client perception has never been more critical to hospital success than during these unusual times.
Veterinary industry consultant and Southern California Veterinary Medical Association executive director Peter Weinstein, DVM, MBA
Mother’s Day has passed. Graduation is next. For the Class of 2020, the sound of “Pomp and Circumstance” will be played through their iPhone or a Zoom broadcast. The nervousness of trying to cross the stage and not trip. The anxiety of receiving a hood and diploma and shaking with the correct hand. This year will be truly unique for our newly minted colleagues.
Not only were the last three months of their fourth year disrupted by COVID-19, but their uncertainty about the continued existence of a job offer has to be nagging them. Anxiety, nervousness and uncertainty — conditions that are innate to new graduates in their first job —are now a component of the of their veterinary school careers.
Congratulations to the Class of 2020. Congratulations on your dedication to your education. Congratulations on your determination to get a veterinary degree. Congratulations on your perseverance to get through the last few months. And congratulations on joining the greatest profession. I hope our paths have crossed in the past few years during my veterinary school visits. I am honored to have you as a colleague.
To my current colleagues, here is your chance to influence the future. This class of veterinary students as well as those currently matriculated experienced stressors unlike what we ever had. They have shown resiliency. It is time for my current colleagues to be real mentors, leaders and influencers. Take extra time communicating and working with your new hires. They entered the second half of their senior year with one vision and have graduated into a completely reimagined and less predictable world. Give them a stable and secure work environment (whatever that might be or look like) and set them up to be successful. You and your team will be rewarded if you just spend a few extra minutes with your new teammates and give them the peace of mind they need.
As for current veterinary students, their externships and summer opportunities are totally bolloxed up. Our future colleagues need work experience and clinical experience to supplement their classroom training. Do what you can to give them summer work experiences. You will be amazed by the knowledge, skills and abilities that many bring to the table. Many of these veterinary students worked for you while trying to get into veterinary school. They might not be able to go to Costa Rica and do spays and neuters, but they can scrub in with you at your practice. Many of these veterinary students are living at home as they complete their semester work.
Graduation marks the end of one long trek and the start of another. Let’s celebrate their maturation and give the future of our profession the best chance possible to succeed.
To the Class of 2020, we are proud to have you join us and welcome you with open paws.
San Diego veterinarian, author and speaker Jessica Vogelsang, DVM, CVJ
In California, the debate over the use of telemedicine during the pandemic rages on. Last week, the California Veterinary Medical Board agreed to ask for a waiver from the Department of Consumer Affairs that would allow telemedicine to be used with patients if a current veterinarian-client-patient relationship is in place. To be clear, this was how most veterinarians used telemedicine before the pandemic, so it’s not quite groundbreaking, but it’s something.
During the meeting, each board member got to voice his or her opinion, and to me that was the most interesting part. One member stated that 90% of her ability to diagnose resulted from the physical exam, so she couldn’t see how telemedicine could ever be useful. This opens up a different discussion as to how we relate to clients. On the human side, the shift to patient- centered care with a focus on establishing a relationship and rapport with the patient is directly correlated with positive outcomes, and that tracks with my experience as well. Telemedicine forces us to develop the communication skills we should have been using anyway, but many of us don’t because we’ve been trained that gathering the physical data is the most important goal in our time with the patient.
A lot of colleagues continue to see telemedicine as an either/or situation. Either you are in the room with the patient gathering data or you are in another building and collecting the same data but with subpar results. If that’s how you approach it, I can see why people are dubious. However, when you speak to clinicians who are successful in the telehealth space, most of their time is spent expressing empathy, asking questions and educating. When the client arrives at the clinic, they are prepared for what’s coming and ready to approve the diagnostics. Telemedicine and in-person visits are beautiful complements to one another. The idea that telemedicine means a disengaged clinician sitting in a chair 100 miles away and willy-nilly writing antibiotic prescriptions isn’t how people are using it. Let’s give each other a little credit.
To that end, the Veterinary Virtual Care Association is planning its first Virtual Summit, which will dive into all of this in much greater detail. Telemedicine is here to stay, but instead of looking at it as something to fear or something that will result in poorer clinical outcomes, we need to start looking at the possibilities. It is an incredible opportunity to help more pets, engage more owners and elevate our ability to improve patient outcomes.
The Vet Recruiter founder and CEO Stacy Pursell, CPC, CERS
My firm is busy with veterinary practices all over the country that still need to hire veterinarians. We get multiple daily requests to find doctors, and we continue to place veterinarians in practice and in industry. We are also placing non-veterinarians in industry. Two outside sales reps we placed will go through the training and initially work as inside sales reps until they can travel for their jobs.
I am seeing veterinarians and non-veterinarians who want to leave states like New Jersey, New York and California and move to states that are more open, like Florida and Texas. Just this morning, we placed a veterinarian who is moving from New Jersey to Florida. One lady stated that she was concerned about her child not being able to go to school in person in the fall in New York and that she believes a move to Florida will allow her child to attend in-person classes. We also are hearing from veterinarians in New Jersey and California who are having a hard time hearing from their state licensing boards about license questions.
We still have plenty of people interviewing for jobs, both through video and in person. People continue to get more comfortable with doing face-to-face interviews.
People I speak with talk less and less about COVID-19 and more about either their business needs or their career goals. In a number of cases last week, COVID didn’t come up. Most people I talk with seem more optimistic, especially in states that are opening up.
I have not seen salaries impacted by COVID-19. I continue to see strong job offers being made.
My state, Oklahoma, is open, so I have been out and about. I ate on a restaurant patio over the weekend.
Beyond Indigo Pets president and Today’s Veterinary Business editorial adviser Kelly Baltzell, MA
The veterinary field is insulated somewhat due to the nature of our services, but pet owners come from all walks of life. Now with U.S. unemployment at 36 million (give or take) and restaurants and other small businesses throwing in the towel and closing, what will this do to the veterinary space?
As we learn more about the long-lasting mental health impacts of the lockdown, how can we navigate the next phase of COVID-19? Here are some ideas:
- Show gratitude every day. If you are a doctor or practice owner, thank your teams and clients. [Read “7 Scientifically Proven Benefits of Gratitude” at bit.ly/3g0rNwm.]
- Add mental health care to your hospital’s employee benefits plan. Happy team members will practice better medicine and will want to stay employed.
- Find ways to give back to the greater community to help people and their pets and to increase brand recognition. [Learn how Androscoggin Animal Hospital is leveraging community involvement and outreach during the COVID-19 pandemic at youtu.be/MoNjq26UK5o.]
- Recommend one or two pet health insurers. Clients who lose a job can use the insurance to offset the cost of Fido’s care.
Many hospitals are busier today than they were a year ago, which is the fantastic news. Keep the momentum going and find time to plan ways to keep the tails coming through your door.
Veterinary industry consultant Debbie Boone, CVPM
I was curious to see whether the mitigation tools that veterinary teams are using are effective, so I launched a team survey last week. So far, we are doing a good job protecting ourselves from COVID-19 infection as only three out of 100 respondents said they became infected from a client. I will continue the survey until May 25, so if you would like to participate, please visit bit.ly/2ZdmL9Q. I will share the results.
I, along with several prominent speakers I know, presented at virtual conferences this past weekend. The format can be an effective tool for teaching. The attendees were engaged and responsive, with one even sharing that she was folding laundry while listening. As a speaker, I miss my face-to-face audiences, and I know my peers do, too. We at least have a way to creatively connect with people who desire to learn, and for that I am grateful.
My attendees affirmed that clients are still grumpy and impatient on occasion. Such behavior is not surprising as our human desire to collaborate with others is being disrupted.
As Congress begins negotiations on the next economic stimulus package, accountants, bankers, business owners, consultants like me, and the unemployed wait anxiously. Time is of the essence as the choices between human health in relation to COVID-19 and human well-being in relation to job losses, mental anguish and hunger are addressed. Hopefully, our government finds the correct answers.
As someone who grew up near LabCorp’s North Carolina headquarters, I know from friends who work there that business is down 50% over the last eight weeks as non-emergent human care ceased. Another friend, whose company makes school supplies, has laid off over 300 employees, yet one division is flourishing as it produces cleaning solutions for those same schools. Distilleries are making hand sanitizers, and restaurants have become meat markets and pop-up produce stands. I hope all this pivoting and creative thinking can sustain these companies until the public is confident that the risk of infection is gone and once again starts to spend money and power the economy.
Many laid-off workers and struggling business owners are our veterinary clients. I am concerned that pet care will be something they see as a luxury if the economy is uncertain. As a practice manager during the 2008 recession, I saw animals come in sicker than normal because owners couldn’t afford an earlier visit. They postponed seeking care until the case became urgent and, of course, cost even more to treat. What will be of utmost importance is for veterinary practices to encourage payment options, telehealth triage, subscription care plans and pet health insurance.
Behaviors will most certainly change going forward. Practices should investigate touch-less payment systems, going to online history forms, keeping plexiglass barriers at the front desk, stepping up disinfection routines, and training teams on American Animal Hospital Association biohazard guidelines. [Check out the “2018 AAHA Infection Control, Prevention, and Biosecurity Guidelines” at bit.ly/367XHTl.]
I also see hospital design changes in response to new safety measures. These include small private cubbies for client waiting, or lobbies replaced with exam rooms entered from the parking lot. And what about creating spaces for telemedicine appointments — soundproof booths and shades that shut during virtual exams? Things are going to change, and those who accept and adapt will flourish.
Veterinary nurse and National Association of Veterinary Technicians in America President Kenichiro Yagi, MS, RVT, VTS (ECC) (SAIM)
Veterinary professionals have been wondering how the lifting of restrictions during states’ phased reopenings will affect our work lives. Will practices resume elective procedures? Will clients understand that even if restrictions are lifted, it is not going to be business as usual? Will the animosity that some business owners have experienced from people who do not see the virus as a threat lead to continued aggressive behavior? As the response to COVID-19 becomes formulated, a new batch of uncertainties, questions and fears can arise.
The pandemic has had a huge financial impact on members of our profession. Many people have applied for unemployment benefits or relief funds.
In response, Hill’s Pet Nutrition, Zoetis and the National Association of Veterinary Technicians in America partnered to create a $200,000 relief fund for veterinary technicians/nurses and assistants through the American Veterinary Medical Foundation. Unfortunately, the program quickly ran out of money, showing the level of demand for financial assistance. More partners are being sought. [Learn more at bit.ly/AVMFrelief.]
The easing of restrictions could bring hope to the unemployed, but we know that public health and safety precautions will need to be diligently followed to prevent a COVID-19 setback.
Getting Technical columnist, practice management consultant and Patterson Veterinary University instructor Sandy Walsh, RVT, CVPM
I want to start by thanking the front-line staff members who come to work every day and put themselves at risk for exposure to COVID-19 and, more importantly, to the increasing client demands. We are getting worn out by both.
I don’t typically work on the floor, but I have taken one shift a week on the front lines to help one of my hospital teams. I don’t think I could do this every day. Last week I saw first-hand the increasing physical and emotional fatigue that the technical staff and receptionists are under. The doctors are working their tails off, but they benefit from the staff serving as the client buffer. The support team is answering the phones, running back and forth from the parking lot, and directly interfacing with the clients. In the practice where I work and in many others, staff members are calling in sick, not because of COVID-19 but because of headaches, fatigue and stomach issues. The stress is getting to them, and the teams are short-handed.
Curbside care is still the norm. Phones are ringing off the hook as clients get out and about, especially as some restrictions are lifted. Wellness and routine care are happening again, and practices are booked out several days. It’s going to get more difficult this week as shelters resume adoptions.
I am seeing an interesting trend involving the hiring of support staff. With unemployment benefits so lucrative now due to the CARES Act, finding a job candidate who is serious about working is difficult. I have never had as many interview no-shows as I did last week. And these were phone interviews! My suspicion is that applicants are going through the required job-search motions in order to continue with unemployment benefits and have no intention of actually taking a position. I hope I am wrong as this dynamic will make ramping up to a business-as-usual status very difficult.
On the bright side, veterinary practices are cautiously optimistic about plans to allow clients back inside the clinic and to return to some sense of the old normal. Practice owners are using their Paycheck Protection Program loans to pay bonuses to hard-working employees. We aren’t in this profession for the money, but bonuses are a great way to show appreciation for the work everyone is doing. We need to continue to show our appreciation and take care of each other.
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].
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