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Chapter 7: Tales from the COVID-19 front lines

“Overall business is very strong — fewer patients seen, but we are seeing almost 100% sick patients and a higher average ticket charge.”

Chapter 7: Tales from the COVID-19 front lines
Veterinary hospitals are mandating parking lot drop-offs and pickups because of the COVID-19 pandemic.
This week: Stay-at-home orders haven’t discouraged pet owners from seeking veterinary care during the COVID-19 pandemic. At some hospitals, caseloads are up and revenue is down a bit. One hospital found 200 new clients in one month. Another plus: Practice owners are still hiring. Read other installments in this series: Chapter 1  Chapter 2  Chapter 3  Chapter 4  Chapter 5  Chapter 6 Chapter 8  Chapter 9  Chapter 10  Chapter 11  Chapter 12  Chapter 13  Chapter 14  Chapter 15
North Carolina veterinarian, speaker, consultant and Today’s Veterinary Business editorial adviser Ernie Ward, DVM, CVFT “Busy!” was the word I heard most last week to describe veterinary practices. From coast to coast, nearly every veterinary professional I spoke with shared stories of parking lots full of pet parents waiting inside their vehicles for curbside services. One practice owner joked, “I know I’m supposed to tell you how bad things are, but the truth is we just had our best week ever!” She shared that despite discontinuing spays and neuters — “Except for a few special cases” — her clinic was essentially “providing the same level of care” as pre-pandemic. Most veterinarians responded that annual and puppy-kitten vaccines were the top appointment requests, followed by dermatological and gastrointestinal conditions. Nearly every veterinary professional I interviewed estimated their pandemic-period revenue was down about 10 to 20% overall. Few practices revealed supply shortages other than with certain personal protective equipment, notably masks and gowns. Several mentioned deliveries were running smoothly, “although a couple of days slower.” Almost all veterinary professionals I spoke with were using homemade or cloth face masks and reusing gowns and shoe covers “until the arms and soles wear out.” I observed an increasing number of veterinarians expressing frustration with mandated stay-at-home orders and business closings. Veterinarians in states that were beginning to lift restrictions overwhelmingly felt it was “the right thing to do,” and others worried that their state was “moving too slowly to get back to work.” A couple of veterinary professionals in California and New York said they “didn’t understand the rush to open everything until we better understand COVID-19,” and they worried about a “relapse later this year.” My main conclusion was that U.S. veterinarians were largely back to work and many were finding ways to thrive despite this unprecedented situation. When I asked about a potential economic recession or depression, most replied, “Who knows?” No one I spoke with believed the recent stimulus checks were responsible for pet parents seeking pet services or supplies. This week, a few states will end business restrictions. As the nation closely watches for surges in new COVID-19 cases in these areas, veterinarians anxiously await approval to return to the work they love: caring for pets. [Check out Dr. Ernie Ward’s video, “Comforting Cat Owners’ Coronavirus Concerns,” at https://bit.ly/2YcvWH8.]
Cara Veterinary co-founder and President Peter Brown, DVM Hard to believe that we are only seven weeks into stay at home. Our teams are doing great and have adapted to the new processes well. Overall business is very strong — fewer patients seen, but we are seeing almost 100% sick patients and a higher average ticket charge. Behavioral issues have increased, or at least pet owners are noticing more. Personal protective equipment is holding up, and I have heard encouraging words about future supply changes. The biggest challenge we are facing is dealing with the emotional aspect of being an essential worker. It is great that our hospitals are open and seeing patients, but the fact remains that our team is potentially being exposed. It hit home this past weekend as one of our doctor’s husbands tested positive for COVID-19. Thankfully, she is feeling great; her test is pending. She is on an extended self-isolation. This event brought to light what our teams are risking coming to work. None of the safeguards eliminate the risk completely. I feel very blessed to have such a dedicated group of individuals that show up every day with a great attitude. A lot of my focus has shifted to preparing for post stay at home. It is important to make sure we have enough appointment slots and room for all those dentals that have been postponed. Also, it is not known what the economy will look like in a few months. How do we ensure best care for pets during a time of high unemployment and uncertainly? All indications are that we are at the top of the curve. The unknown is how long the top will be and what will happen if we go back to normal too quickly. The resilience and dedication of my teams has been inspiring. It is amazing what a great role pets are playing for all of us.
Getting Technical columnist, practice management consultant and Patterson Veterinary University instructor Sandy Walsh, RVT, CVPM The biggest change I saw over the past week was with the support staff and some of the doctors. Those who have been on the front lines the whole time are getting cranky and a little tired. The teams that took safety seriously, though, are staying healthy. Those who chose to or had to stay home want to come back to work. Unemployment payments are not happening fast enough, making it hard for many people to make ends meet, especially if they didn’t qualify for the additional paid sick time. With clients home all day, more attention is paid to the pets. Veterinary teams are seeing lots of skin and ears issues, limping, and lumps and bumps. Even when wellness services are limited, practices are busy, although revenue is still down. Clients have been understanding for the most part and are willing to postpone routine services. Practices are still reporting that some clients ignore signs and protocols and walk into practices that have a strict curbside policy. Practices that do allow clients inside are requiring that masks be worn. I’m not seeing major shortages of personal protective equipment. What I am seeing is some really well-made, homemade masks being donated to practices by clients and community members. Employers need to do right by their employees. That means flexible scheduling, additional compensation where appropriate, and providing necessary PPE. It’s a difficult time for all of us. The main thing I tell my practices is to take care of each other and communicate. We made it through another week and are all looking forward to things shifting back to normal. Whatever new normal that is.
Creative Disruption columnist and WellHaven Pet Health chief medical officer Bob Lester, DVM Books, speeches, dissertations and case studies analyzing changes to our society brought about by the COVID-19 pandemic will be presented for years to come. In the world of disaster response, they have the saying “Build back better.” That’s a nice approach to our current situation. One thing we know for sure is that we won’t be returning to the veterinary practice model we embraced just seven weeks ago. Consumer behavior is forever changed. What will we do as a profession to build back better? A few early thoughts on Veterinary Medicine 2.0 post-corona. My top 10:
  1. Technology. Cloud-based PIMs, e-commerce platforms, digital marketing platforms, online scheduling, texting, apps, upgraded websites, social media outreach, telemedicine, telehealth, teletriage — our profession is finally entering the 21st century. It’s about time; our clients have been waiting for us.
  2. Technology-supported client connections. As we move from primarily face-to-face interactions to a variety of virtual client connections, I’m seeing that closer relationships can result. PetGen, or millennials plus Gen Zers, loves it. We are successfully enhancing our connection to clients by connecting through the modality they prefer, by connecting more often and by moving to a more personal connection. How is virtual more personal? Virtual conversations are starting with “How are you?” or “Is your family OK” or “How are you weathering this crisis?” Personalism and professionalism are a powerful combination. Our connection to clients has the potential to be stronger than ever.
  3. Workflows. Drop-offs are not going away. Telemedicine is here to stay. Asynchronous virtual connections are maximally efficient. We’ve further empowered veterinary nurses. We’re texting and utilizing other digital enhancement. All are improving our day-to-day flow.
  4. Workforce. Fortunately, our profession is somewhat resistant to the current economic storm, but people will lose jobs. Recruiting will get easier and compensation might flatten for a time.
  5. Change. As a profession, we’ve been resistant to change. We’ve proven over the last seven weeks that we are capable of change. My hope is that we continue to innovate and maintain the current entrepreneurial spirit. Wishful thinking? I hope not.
  6. Human-animal bond. It has never been stronger. Society recognizes now more than ever the physical and emotional benefits of sharing our homes with a four-legged family member. How cool is that! Not to mention the record number of pet adoptions.
  7. Practice sales. Hospital owners waiting to sell their practice will be motivated to test the sales waters only to find that valuations are down.
  8. Student education. Veterinary academia will look dramatically different. Distance learning will further supplant classroom learning and bring about better and more cost-effective content delivery. Hands-on distributed models of clinical education will continue to grow, while traditional veterinary teaching referral hospitals will struggle. State-subsidized legacy schools will receive less aid from their legislatures and thus will cut positions and programs, and sadly continue to raise tuition. Online educational delivery platforms like Penn Foster will thrive.
  9. Client finances. Subscription wellness care works especially well in tough economic times. The value of budgeted care through challenging periods provides peace of mind to pet parents, great care to pets and economic stability to practices.
  10. Commitment or compliance. The power of a commitment culture versus a compliance culture continues to prove its worth. Veterinary practices with a focus first on people, second on pets and third on practice are thriving. Trust between leaders and teams has never been stronger. In times of crisis, authentic, honest, communicative and transparent cultures thrive.
Our profession will emerge from this crisis more respected and stronger than ever. Despite our current challenges, there’s still never been a better time to be a veterinary professional. Together let’s build back better. I’m looking forward to Veterinary Medicine 2.0.
Beyond Indigo Pets CEO and Today’s Veterinary Business editorial adviser Kelly Baltzell, MA During the past week I heard from a few hospitals that had a moment to think through their procedures and focus on the future. That was the first time I heard the word “future” used in terms of planning for what’s next. We are starting to crunch some numbers of how hospitals are preforming during COVID-19. One hospital was seeing 400 new clients a month before the pandemic and now they have 200 new cases a month. The hospital thought 200 wasn’t a great number, but in reality it is. Two hundred new clients a month! Other data:
  • One client had more conversions this quarter than any other quarter since August 2017.
  • Another client brought in more conversions than it had since joining Beyond Indigo in the last quarter of 2017.
  • One client tripled the number of conversions in the first quarter of this year.
  • One client had 445 phone calls in March 2020 alone, a 51% increase from last year.
  • Another client had a 127.27% year-over-year increase in new client form submissions. This resulted in an estimated value of $7,500 in new business for the practice.
To see other results, visit https://bit.ly/2VHO5uJ. Last week, my guest speakers provided a few insights as well:
  • Deb Stone from Brodie Animal Hospital — one of the many hats she wears —discussed how much gratitude her team is seeing from pet owners. Learn more at https://bit.ly/3eUWAdE.
  • Craig Spinks from Veteos discussed how YouTube viewing is up and suggested that hospitals make sure to create YouTube videos. Check it out at https://bit.ly/3f5ue0q.

San Diego veterinarian, author and speaker Jessica Vogelsang, DVM, CVJ Last week, a meeting of one state’s regulatory body threw into sharp relief the divide between the past and the future. Here in California, the Veterinary Medical Board issued a guideline April 9 saying that the veterinarian-client-patient relationship, long understood to be valid for a specific period of time after an initial in-person exam, needed to be reestablished in person for every new medical concern. In doing so, the board neatly excised one of the most valuable use cases in veterinary telemedicine from the toolbox of practitioners already struggling to provide safe and effective care for their patients. With no communication with California veterinarians outside of this one statement on the board’s website, an assorted group of practitioners, animal care advocates and pet owners descended en masse upon the board’s webcast meeting on April 23. Over 50 people patiently waited one by one to plead their case to the board as to why telemedicine should be allowed for any patient with an existing VCPR. Some argued even further that the VCPR should be allowed to be established remotely during the pandemic, as it is in many other states. A physician discussed the very real public health concern surrounding unnecessary trips to the clinic. A person who works with the elderly shared how many of her clients lack transportation at all. Others, living in urban areas without cars, are concerned about the safety of public transportation. It was a passionate and compelling wave of protest against what many perceived to be a direct impediment to protecting animal and human health. At the end of the calls, the board members thanked everyone for speaking and closed the meeting to the public. Over a month into widespread shutdowns, practitioners in other states are plowing full speed into telemedicine appointments, showing it’s safe to say that the long-held fears over telemedicine are proving to be just that: fears. Practitioners report feeling very comfortable differentiating between appropriate use cases for teleconsults versus patients that need to be seen at the clinic. Clients are extraordinarily grateful for the ability to stay home when appropriate. It’s a learning curve filled with missteps and occasional frustrations, but no major changes to the practice of medicine are ever easy.
Today’s Veterinary Nurse editor-in-chief and NAVC director of veterinary nursing Kara Burns, MS, MEd, LVT, VTS (Nutrition) This past week saw the announcement of two pet cats in New York testing positive for SARS-CoV-2, the virus that causes COVID-19. Additionally, the Wildlife Conservation Society, the non-profit organization that runs New York’s Bronx Zoo, announced that seven additional big cats tested positive for COVID-19. These cases caused concern for many pet owners, and veterinary teams saw an increase in questions regarding their pets: Can they contract it? Can they spread it? What should they do? Veterinary teams should continue to reinforce that infectious-disease experts, along with U.S. and global human and animal health organizations, are still learning about SARS-CoV-2, but there remains no evidence that pets play a role in spreading the virus. Consequently, veterinary teams need to reiterate that there is no justification in taking measures against companion animals that may compromise their welfare. Many veterinary nurses across the country saw the announcements and took to a variety of social media outlets to discuss with colleagues the best communication and education methods to work with anxious pet owners. As calls to veterinary hospitals increased, the sharing of concerns and communication points increased. I did not see one complaint: All the posts were talking of best practices to ease clients’ fear. Veterinary nurses have stepped up during this pandemic, from donating PPE and making their own, to going to work every day as policies and protocols change each day, to facing their own anxieties while they ease the anxieties of pet owners. Each week, each day, brings a new issue, and my colleagues are rising to the challenge that each day brings. Most importantly, many of us are doing this together while maintaining social distance. I am so proud to be a veterinary nurse.
The Vet Recruiter founder and CEO Stacy Pursell, CPC, CERS There still appears to be a shortage of veterinarians. Every day last week I continued to receive calls from veterinary practices all over the country that need to hire veterinarians and can’t find them. I spoke with one practice owner who said that business is up at two practices and he needs to hire four additional doctors. Practices from California to Florida to Texas to Michigan to Oregon told me they need to hire doctors and cannot find them. Practices continue to conduct video interviews, but when both parties are comfortable, some do face-to-face interviews. We have candidates wanting to move out of places like New York and trying to get to places like Florida and Texas. Those candidates can’t interview in person right now, so they have done a video interview and are waiting until they can travel to visit the facilities. We still have clients making offers after video interviews alone, but some practices and candidates want to meet in person, so they are in a holding pattern. Overall, people I spoke with seemed more optimistic than in previous weeks. I see companies operating in two camps: operating from a position of boldness or operating from a position of fear. Bold companies are adapting and plowing ahead. They are being innovative and creative, and using technology — for example, telemedicine and video interviewing. Fearful companies will have a more difficult time coming out of this than those that are learning to pivot and adapt to changes in the marketplace. Warren Buffett said, “Be fearful when others are greedy and greedy when others are fearful.” I have thought about that quote recently. The future is always uncertain. No one has a crystal ball. Don’t operate from a position of fear and act cowardly. Operate from a position of strength. Be bold, move your business forward, adapt to changing conditions and lead during these times.
Crum & Forster Pet Insurance Group assistant vice president of veterinary relations Wendy Hauser, DVM In prior postings, I talked about veterinary industry feelings of resignation moving toward acceptance. In the past two weeks, I have seen feelings take a new direction, from resignation to impatience tinged with fear. Many questions are being asked by hospital leadership teams about how to best move toward the new normalcy, such as “What are your protocols for allowing clients back into the hospital, including a timeframe?” and “When can I begin to schedule employees normally again instead of splitting them into scheduled teams?” As hospital leadership struggles with these decisions, remember to invite all team members into the conversation. Using insight gathered from team members throughout the past seven weeks and from these end-of-the-week autopsies in Today’s Veterinary Business, you have a mechanism to understand what is working well and to create a plan. As you create this pathway, remember the following: 1. Create your narrative with messages consistent to your culture. Why does your organization do what it does? How can communicating your new way of working reinforce why your hospital exists and why each team member’s actions are vital to that mission? 2. Reflect on recent Gallup research, which found that team members have these four needs:
  • Hope for the future. While it will look different, how can these changes create better ways of working? During a recent conversation I had with one of my consulting clients, the manager said, “We are doing great and just as busy. One of the best parts is that we are leaving on time every day.” What is different about this new way of work that is creating time efficiencies?
  • Trust in the hospital leadership to make the best choices for them. This includes business continuity, job security, and physical and psychological safety. Moving into this new work paradigm, how will leaders show their teams the “why” behind these new work practices and how they will support employees in these changes?
  • Compassion in this time of change. Uncertainty is scary; we are looking for the old normal and things we can control. Good communication is critical at this juncture to enable teams to stay the course and reject impatience.
  • Stability in the face of overwhelming change. Transparency in communicating what is consistent in business operations helps to foster a sense of normalcy. Employees need to be reminded that the things that worked well with the business will continue, such as the focus on client relationships and teamwork.
[Join Dr. Hauser at 7 p.m. EDT Thursday, April 30 to explore “Practice Management in Uncertain Times: 5 Things You Need to Know to Survive and Thrive.” To register for this free webinar, visit https://bit.ly/3cRmOvB.
Veterinary industry consultant and Southern California Veterinary Medical Association executive director Peter Weinstein, DVM, MBA Time to say, “Thank you.” Thanks to all of the human health care workers who are on the front lines in major cities and small country towns, fighting to keep infected people alive and uninfected people uninfected. What a challenge it has to be everyday to deal with not only the physical demands but the emotional and psychological demands. The pressures exerted on our health care workers requires superpowers to survive. As a veterinarian, I fully recognize the insurmountable challenges that every day brings. And for that, we all admire you, honor you and humbly thank you. And thank you to all of our veterinary health care workers who are on the front lines of providing veterinary care to the plethora of animals and their related humans. For a profession that was pretty glacial in its willingness and ability to change until COVID-19 arrived, the manner in which we deliver veterinary medicine has astronomically changed and at Mach speed just in the last seven weeks. From a profession where certainty was pretty much embedded in concrete, uncertainty has now become the norm. The stressors that our teams are being subjected to has gone from fractious animals and grumpy animal owners to exposure to a lethal virus and its impact not just on themselves but also on their families. Before COVID-19, risk management was bites, scratches, slips and falls. Now, risk management is sufficient personal protective equipment, social distancing and all of the above. In spite of exaggerated change and exaggerated risk, what gets us up in the morning, our reason for being, our “why” hasn’t really changed — to protect and enhance the human-animal bond. We see patients in gowns, masks and gloves, through car windows and iPhone screens, to give people peace of mind that their pet is going to be OK, to let people know that we care about them and their four-legged friends, and that their pet’s health, now more than ever, is extremely crucial for their own mental health. There is no time like the present to prescribe pets more than pills for the stress and challenges that people are dealing with. Sheltering in place, being confined to the house, a lack of human touch and emotions — imagine that without the comfort of animals. So, to all of you getting up and going to work each day and having to adapt to a new way of doing things, who have to sweat in PPE, who deal with stressed animals, stressed animal owners, stressed hospital owners, stressed teammates, stressed family members and personal stress, and who have shown the ability to help others above yourself, I say thank you. I honor you. I admire you. I respect you. And as much as the human health care workers are out there doing an amazing job, I want to recognize all of you in the veterinary profession, on the front lines, focusing on the why: the animals, the people and the human-animal bond. I look forward to when we get together at a meeting sometime, someplace, somewhere, and give the entire veterinary profession a group high-five and, hopefully, a group hug! Thank you.
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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