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Chapter 12: Tales from the COVID-19 front lines

“The clinics weathering these stressful times relatively well are those that have looked innovatively at how technology can improve efficiency.”

Chapter 12: Tales from the COVID-19 front linesThis week: Dr. Jessica Vogelsang on technology, Dr. Whit Cothern on his handy crystal ball, and more. Read other installments in this series: Chapter 1  Chapter 2  Chapter 3  Chapter 4  Chapter 5  Chapter 6 Chapter 7  Chapter 8  Chapter 9  Chapter 10  Chapter 11  Chapter 13  Chapter 14  Chapter 15
San Diego veterinarian, author and speaker Jessica Vogelsang, DVM, CVJ Now’s the time when the rubber hits the road. We know that clinics are expecting a 20 to 30% uptick in veterinary services demands as postponed procedures and wellness appointments start to reschedule. We also know that many clinics are continuing to use curbside contact as COVID-19 continues to be a risk across the country. While this is the right choice from a public health perspective, clinics are reporting that staff members are more stressed and overtaxed than ever as they struggle to manage the inefficiencies and bottlenecks posed by curbside procedures. The clinics weathering these stressful times relatively well are those that have looked innovatively at how technology can improve efficiency. While the majority of conversations surrounding telemedicine continue to revolve — somewhat bafflingly, at this point — mostly around the utility of live video, the runaway technological success of the past few months has been in the use of two-way messaging. Those who have embraced it never plan to go back. Those who continue to route all or most communication through their phone lines have resorted to cutting and pasting a quasi-viral post on Facebook asking clients to be nicer to them. (It never works.) Everyone is short on patience these days, but to blame clients for reacting to problems we haven’t made any real attempt to solve isn’t going to make the summer go any more smoothly.
White House, Tennessee, hospital managing partner Whit Cothern, DVM In May, after searching fruitlessly for my copy of “A Guide to Managing Your Veterinary Practice During a Global Pandemic,” I turned my gaze to the crystal ball that comes free with every purchase of a veterinary clinic. After saying the magic phrase “Ettinger and Plumb and Herriot, oh my!” three times, I was able to stare into the future and discover how to plan for the month of June. Here’s what my crystal ball told me (and what it didn’t).
  • Crystal ball said we could further relax entry into the hospital on June 1. Pet owners can now check in at the front desk or by phone. If they choose to come inside, they are directed to an available exam room. To maintain social distancing, however, we continue to care for pets in the treatment area.
  • Crystal ball did not mention that on one day, 75% of pet owners will come inside, thus drastically easing demands on our phones and CSRs. But then the next day, 75% of pet owners will decide to remain in their cars and our phones will return to DEFCON Level 3.
  • Crystal ball hypothesized that many pet owners are tired of being at home. That combined with the busy summer season, money saved from not going out as much, and extra money from increased unemployment benefits could create a surge in demand.
  • Crystal ball failed to point out that every citizen in a 15-mile radius would decide to take their pet to the veterinarian. Haven’t been to the veterinarian in 10 years for more than a rabies vaccine? No problem, now’s the time to catch up and agree to every service and product missed this past decade. Say you don’t have a pet? Why has there ever been a better time to spend $5,000 on a breed that will cost you more than that on an annual recurring basis?
  • Crystal ball was adamant that I make sure to closely follow the Paycheck Protection Program loan-forgiveness guidelines since our eight-week “forgiveness period” expires at the end of June. Monitor those FTEs, pay out as much in wages as you reasonably can, and be sure to watch every webinar that comes along about the forgiveness process.
  • Crystal ball clearly isn’t aware of Washington, D.C. With some “ayes” and the stroke of a pen, all of that eight-week stuff no longer really matters. Unless, of course, one has been closely following that eight-week stuff for 6 weeks already.
Now as I plan for July and beyond, I again stare deeply into my crystal ball. Through the fog, I am just able to make out what appears to be a single question that I’m sure will answer all of mine: “Have you had any luck finding your copy of that guidebook you mentioned earlier?”
Veterinary industry consultant and Southern California Veterinary Medical Association executive director Peter Weinstein, DVM, MBA I have witnessed a slow, very slow return to normal in Southern California. In the last two weeks, I was able to get a haircut and eat out at a restaurant. The gym opens this week. And I booked a couple of days away in a local hotel for a change of scenery. I continue to receive questions as to whether veterinary practices can start seeing patients in the exam rooms and have clients in the lobby. So, I guess the question that is being asked by So Cal veterinary hospitals, as well as those I read on Facebook and other connected communities, is this: Is it safe to go inside, yet? First off, to answer that question, you need to know your state’s regulations and health department and governmental edicts. Note that this could be different from county to county. If your state, county, city or town says it is OK to see clients in your business, you still have other guidelines and concerns to deal with. For my haircut, each station was separated by plexiglass. My temperature was taken and noted. I had a mask on. The stylist had a mask on. Many of the usual amenities were not available. As I was leaving, I watched everything get sprayed down, washed, wiped or discarded. (Note: Every stylist station was occupied while I was there.) At the restaurant, the host station, which is normally inside, was outside. There was no wait and plenty of tables. I was asked for my name (never done before when there wasn’t a wait). I was asked for my phone number (never done before when there wasn’t a wait). The menus were in a large plastic box labeled “CLEAN MENUS.” When we sat down, I noticed that the menus’ plastic-covered pages felt wet. Only about 40% of the tables were able to be used. The other 60% were blocked off with blue tape. All servers, as well as the host, wore masks during my entire visit. Just about everything else was pretty routine. I look forward to the gym opening, but in watching the video on the website, it is going to be very limited access and also only for a limited amount of time. I guess I’ll still be riding my bicycle on some days. Why am I noting my experiences? Because each and every one of these small businesses developed systems and processes to ensure the safety of the staff and clients. Each of them is licensed and overseen by a governmental agency that they answer to, similar to veterinary practices. So, when is it safe to go inside your veterinary clinic?
  • When you have developed systems and processes to protect your staff and clients.
  • When your staff has fully accepted those standards and has the opportunity to weigh in with any concerns.
  • When your clients, who we know can be demanding, have been fully advised of your guidelines and standards and accept them without question.
For those of you already seeing clients inside, great. Be safe. For those of you looking forward to seeing clients inside, develop and document a plan of action before you find yourself in a world of chaos and concern. There is no rush to see clients inside. There is every reason to be safe rather than sorry. Enjoy your haircut, your meal, your workout, your vacation. Enjoy the new normal, but don’t rush to get there. Do it right like all my experiences were.
Getting Technical columnist, practice management consultant and Patterson Veterinary University instructor Sandy Walsh, RVT, CVPM Ready, set and go! Restrictions are starting to lift and clients are slowly being allowed back inside the hospitals. We’ve been planning this for weeks and making preparations for a smooth transition. Veterinary practices have set plans in motion to move clients in and out of the hospital with minimum staff or other client interaction and exposure, and it can’t happen soon enough. Plexiglass partitions have been installed to protect the staff at the front desk, and the floor has been marked in six-foot increments. Waiting room chairs have been removed or blocked to limit the number of clients inside at one time. Even with these precautions, some clients are not ready for close contact and are more comfortable with curbside service. It’s going to be a while before we get back to anything close to the way it used to be, if ever. Curbside is here to stay for some. On a sad and frustrating note, practices are having to deal with progressively grumpy and demanding clients who are losing their patience with the COVID restrictions. They are taking it out on the team members who are doing their best to serve clients. Technicians and receptionists are dealing with clients who won’t follow directions and who yell if they can’t get an appointment immediately. They have lost their patience with waiting in their cars even though they can clearly see the technicians running from car to car to get pet histories or bring out food and meds. It’s taking a toll on employees. I’ve never had so many hospitals willing to fire clients who are behaving badly. On the bright side, revenue is up and practices are very busy. The recent extension of the Paycheck Protection Program loan-forgiveness period has helped relieve stress on hospital owners, and many are rewarding the teams’ hard work by giving appreciation bonuses or additional compensation. We need to continue to be kind to each other. We’re all in this together.
Veterinary industry consultant Debbie Boone, CVPM If veterinary teams feel like I do, we are wondering what else in the world can happen. Our clients must be feeling the same pressure because “Clients are so mean!” is a universal theme in my social media veterinary groups. One manager posted a first: A client told his CSR to “take a bath in gasoline and stand in front of a train.” Wow. To say that nerves are frayed is an understatement. Several managers have taken a proactive stance and emailed or posted statements asking clients for “kindness, patience and grace.” Hopefully, doing that will help people understand that we are all suffering in our own ways. Veterinary teams are still working in overdrive and clients are still demanding services. The good news is that pet owners are willing and able to pay for veterinary care without much complaining or pushback. Managers whom I’ve spoken with seem to believe that people staying at home but still working are not spending money on what they typically would. Starbucks, eating out, shopping at lunch and dry cleaning are all unnecessary if you work at home (not to mention gas and auto expenses). Then, the stimulus money and extra unemployment pay are a bonus for some people. It is possible that this extra disposable income is being redirected to the pet. It would be glorious if it lasted. My practice clients are booked weeks out for routine care and are seeing unusual upticks in sick cases. Perhaps clients are just paying more attention. Last week, technician Walter Brown posted a hysterical rant about a client who brought a “side floating” goldfish to his ER. His comment, “People, quit staring at your pets!” was truly a sign of our times. Check out bit.ly/2zC5ayc for a good laugh. We can all use it.
Veterinary industry consultant Karen E. Felsted, DVM, CPA, MS, CVPM, CVA We’re months into the pandemic, and while we’ve been operating in a new-normal vibe, things are opening up in communities and practices are starting to think about or make small moves in that direction. And yet, many states continue to see a very large number of COVID-19 cases, so it’s unclear how this will all end up two months or six months or a year from now. Here are some of the changes that stand out right now:
  • Some practices are overwhelmed with cases and the teams are exhausted and burnt out. That can’t last forever, but how do you turn down pets that need to be seen?
  • Other practices aren’t doing as well. Data published last month by the Veterinary Hospital Managers Association (sample size of 638 practices) showed a median decline in revenue of 14.6%, but practices ranged from a decline of 88% to an increase of 279%! Those at the high end are clearly those that are exhausted and burnt out. Visit numbers were similar — a median decline of 19.9% with a range of minus 90% to plus 280%.
  • It is still unclear which practice changes, such as scheduling, curbside and telemedicine, will stick. Until we can see how our society is going to change on a more permanent basis, this probably won’t be known.
I still think it’s going to get worse before it gets better. Veterinary medicine is in a bubble now. The official recession scorekeepers at the National Bureau of Economic Research have said the U.S. economic expansion ended in February and we’ve been sliding into a recession since then.  Most practices didn’t see revenue declines until the week of March 22, although some states such as New York and Washington started feeling the impact the week before. Practices have generally been improving since then, but can that continue as Paycheck Protection Program and unemployment money runs out, pet owners have more places to spend their money, all these residual pet problems get fixed and jobs are harder to find? Do everything you can to prepare for harder times in our field.
The Vet Recruiter founder and CEO Stacy Pursell, CPC, CERS I recently published an article, “The Current State of the Veterinary Profession = Plenty of Opportunity,” here on my website. I talk about how much has happened in the overall employment marketplace, and specifically in the veterinary profession, since the start of 2020. Before the pandemic hit, the job market was candidate-driven. Then, COVID-19 arrived and the national unemployment rate soared. Fortunately in the veterinary profession, job losses were not as great as in the overall marketplace. Practice owners have told me their business is up between 15% and 50% since the pandemic began. I recently looked at the American Veterinary Medical Association website and saw around 2,500 jobs posted. I know those are not all of the open jobs in the profession; there are many more. My firm has many jobs to fill for veterinarians and other animal health and veterinary professionals. The veterinary job market is still strong. Practices are recruiting and hiring, and many practices are still having challenges in finding doctors, just like before the pandemic. I just accepted my first search for a full-time telemedicine veterinarian at a small group of veterinary practices. This person will work from home. I imagine we will see more searches like this. The good news is that 2.5 million jobs were added to U.S. payrolls during May. As a result, the national unemployment rate fell from 14.7% to 13.3%. These numbers defied expectations and could be a step in the right direction in the job market and recovery. According to the Bureau of Labor Statistics, veterinary jobs are expected to grow by more than 18% between 2018 and 2028. This translates into approximately 15,000 more jobs within the profession. There is opportunity in the veterinary profession due to the rise in pet adoptions. Even through the unemployment rate has fallen does not mean everyone can afford to pay for veterinary care. The number of pet owners unable to pay is increasing, but veterinary practices are informing them about options, including extended payment plans and deferred payments. All in all, there is good news in the veterinary profession in terms of job opportunities, but the challenge is still in hiring talent. We will have to meet these challenges with creative solutions.
Today’s Veterinary Nurse editor-in-chief and NAVC director of veterinary nursing Kara Burns, MS, MEd, LVT, VTS (Nutrition) As June 2020 continues, our world continues to change, and this change leaves a lasting impact on each of us. From a tenacious global pandemic to protests bringing light to systemic injustice to an economy that is tenuous at best, we are feeling weary and anxious. However, what I am seeing is hope. Veterinary teams have approached this new normal using determination, solidarity, strength, shared purpose, humanity, kindness and resilience. We recognize it is not easy — so much is coming at us day after day — but as I speak with my colleagues, I hear that they want to continue to help pets and the people who love them in the smartest and safest manner possible. I have begun to see an increase in return to work from colleagues who were furloughed, which is positive and needed progress. The majority of veterinary teams and veterinary hospitals are continuing to provide curbside service and have become efficient and proficient in the new client and disinfectant protocols that have evolved from the pandemic even as restrictions ease and hospitals get back to providing full care. These protocols have become the new standard for patient care. This takes courage, and the veterinary profession has demonstrated courage throughout the past four months. The Rev. William Sloane Coffin stated: “Courage is a crucial virtue. Will we be scared to death or scared to life?” The veterinary profession has taken that fear and embraced new ways of thinking, of practicing medicine and of facing the many challenges that are seen in our world. I believe we are “scared to life.” Many hospitals across the nation have taken a cautious approach as restrictions begin to ease. This approach is courageous. Veterinary teams want to protect each other and pet owners. Leadership is exemplified through having courageous conversations with team members, through listening and by providing community. I have witnessed the need for veterinary teams to act in service to the community, to help their fellow humans against injustice or to provide the best medical care for animals while keeping their colleagues and pet owners safe. This matters. This is leadership. We have a long way to go; however, even among all the constant change, veterinary teams have been resilient and wanting to make a difference, while taking care of pets and pet owners. Remember, we are all in this together. Be kind to one another.
Creative Disruption columnist and WellHaven Pet Health chief medical officer Bob Lester, DVM Practices are reviewing and reinforcing what’s working well in our new COVID-19 world. Examples include telemedicine, drop-offs, e-commerce platforms and cloud-based PIMS. All are gaining fans during the current crisis. What I’m not hearing much about, and has been remarkably powerful in navigating the new normal in our WellHaven Pet Health network, is subscription preventive care plans (aka wellness plans). These plans were developed in past hard economic times, allowing clients to budget necessary care. Thousands of pets, pet families, hospital teams and practices are benefiting every day. These plans are simply a way to deliver needed preventive care, with compliance approaching 100%. They are packages of annual veterinary services designed to keep pets healthy, for which clients pay a monthly fee. These plans typically include office calls, nutrition and behavior counseling, dental care, parasite prevention, and all necessary immunizations. They are not a loyalty or discount program — they are a fundamental way of approaching your practice with a laser focus on preventive care, allowing the pets in your care to live longer, healthier and happier lives. Millennials, our primary workforce and majority client, are especially enamored of subscription programs. Think Blue Apron, Dollar Shave Club, Amazon Prime, Spotify, Netflix, Hello Fresh, BarkBox, Kindle Direct, Stitch Fix. The case for subscription models is clear. Given our world’s COVID-19 economic crisis, these plans have never been more powerful. Imagine how much better your practice would have managed the last several months, and perhaps the coming months, with the annuity of hundreds of loyal clients providing the financial stability to keep your team employed, as well as the peace of mind afforded your clients knowing that their pets’ care is already budgeted. The benefits of a subscription model preventive care plan include pets living longer, happier lives, clients enjoying the knowledge that their pets are taken care of, teams having a more satisfying relationship with pet owners who visit on average four times a year, and the improved recession-resistance and financial health of your practice. As you review learnings from our current challenge, I would encourage you to look at subscription models of preventive care. They work for everybody. They are one more way to emerge from COVID stronger than ever.
Crum & Forster Pet Insurance Group assistant vice president of veterinary relations Wendy Hauser, DVM Over the past two weeks, the cyclical nature of the COVID-19 pandemic has become apparent, with many states seeing a resurgence in infections as lifestyle restrictions are lessened. True to the adaptability that defines the veterinary profession, veterinary hospitals nationwide are finding ways to meet the surging demand for services in unique ways. Many hospitals are also recognizing they need help, not only on their front lines by hiring additional team members, but also in creating more efficient and resilient businesses. In my experience and in talking with other consultants, there has been a significant increase in inquiries about how to create more supportive and healthy hospital cultures, design more effective leadership teams, and create a cushion to buffer against another economic downturn.  As mentioned in several of my prior contributions, this is the time to plan for the future. Here are three things to consider:
  • COVID-19 won’t last forever, and neither will the need to exclude or limit clients in our hospitals. If your hospital is located in a leased space, this is the perfect time to engage a tenant representative to help renegotiate your lease. Tenant representatives work for your hospital but are compensated by the landlord. These great negotiators help to attain favorable lease terms and can often obtain credits toward facility improvement, like repainting and new flooring.
  • Establish a culture that supports psychological safety. This is a shared belief that a hospital is a safe environment where employees can comfortably ask for help, apologize to others and take risks, like contributing ideas. For more on this concept, please read my article “How Is Your Hospital’s Culture?”
  • Reevaluate veterinarian compensation. This has been a tough time to be an associate compensated on production. The uncertainty of not being able to work or work normally might create friction between hospital management and associate veterinarians, which can result in distrust, lack of engagement and even schisms. Consider other strategies to compensate associates, beyond only production and salary options, by learning about a salary plus merit-based bonus approach. Check out my article “A Prescription for Change.”
Overwhelmed and don’t know where to start? Please join me for a free webinar, “Practice Management in Uncertain Times: 5 Ways to Survive and Thrive,” on June 23. Register here.
Politics & Policy columnist and Animal Policy Group founding partner Mark Cushing, JD COVID-19 showed us one thing and taught us another. Both are powerful and positive messages for the pet health care community. The pandemic demonstrated the incredible strengths of the foundations of pet health care in the United States. What do I mean? First, the pet population actually grew across the country. People adopted and acquired pets during quarantines, and many shelters were emptied. Who saw that coming? The human-animal bond is alive and well regardless of external circumstances, and it’s not going away. This is the brightest light shining on the future path of pets in America. Second, while March was tough on all practices (Iarge and small), many if not most practices rebounded spectacularly in April and May. When I say spectacular, I mean year-over-year growth from 2019. In March, who saw that coming? People value veterinary care and they will find a way to take care of their pets, pandemic or not. What lesson was taught during COVID-19? Veterinary virtual care (telemedicine, teletriage) works. Pet owners value the delivery of care that met them where they were, stuck at home, and practices were able to provide care otherwise not available. Pets received treatment and social-distancing restrictions were respected. Is every veterinarian convinced about telemedicine? Of course not. Some may never be. But do a majority of practitioners understand now how virtual tools can supplement their in-clinic offerings? Yes, and we’ve just started. This is why a group of leaders launched the Veterinary Virtual Care Association. We will hold our virtual care summit on Aug. 18, and I hope you will consider attending virtually. There’s no charge. Details to follow.
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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