Hannah Lau, DVM, knew what was wrong the minute she saw Scratchy, a purebred bulldog who had been her patient for two years. Dr. Lau watched as Scratchy scratched obsessively and listened as his owner explained what she had observed over the past few weeks. Dr. Lau diagnosed flea allergy dermatitis, discussed flea prevention, prescribed treatment, and sent the owner and Scratchy (who soon would be much less scratchy) to a client service representative to check out. Then, Dr. Lau scooped a cat out of her lap, got up from her computer chair and walked from her living room to the kitchen, where she made a cup of tea. Her day was half over, and she was still wearing pajama bottoms.
Dr. Lau is a veterinarian who works full time from her Virginia home for Adobe Animal Hospital, a practice with two locations in California’s Bay Area. She’s not alone. Today, Adobe has a team of 24 remote employees, including two full-time veterinarians and multiple veterinary technicians and client service representatives.
Going Remote
Dr. Lau had been working at Adobe’s Los Altos hospital when her veterinarian husband was offered his dream job in Virginia. Dr. Lau notified Adobe, and within a few weeks, the couple packed up and headed across the country. Dr. Lau spent about a year struggling to find her place professionally, but in early 2019, she had a crazy idea.
“I emailed one of the owners of Adobe and told her, ‘I can do a lot of work for you, even though I’m not physically in the hospital.’ I wrote up a proposal, fully expecting her to laugh and say no,” Dr. Lau recalled. “But she responded right away and said she had been trying to start a telemedicine program at Adobe and didn’t know how. So, we decided to do it together. We started to see clients through virtual appointments a couple of months later.”
A few months before Dr. Lau’s proposal, Adobe operations manager Christina Freeman and her musician husband decided to move their three children to North Carolina.
“I approached [Adobe’s leadership] and said, ‘I’ve loved every moment here, and I don’t want to leave, but I need to do this,’” Freeman recalled. “They told me that if I stuck with them remotely, I could help them create something new. So, I said yes.”
When Dr. Lau joined the effort, Adobe’s “remote dream team” started to make things happen. The first order of business for Dr. Lau and Freeman, now the remote manager: Get Adobe’s live website chat operation up and running.
Dr. Lau started to see patients virtually, and soon, other Adobe team members needed to move for various reasons. The hospital’s owner asked Dr. Lau and Freeman what they thought of keeping everyone on remotely.
“That’s how we grew the initial core team,” Freeman said. “Adobe was very forward-thinking in keeping their people and trying to create opportunities for them.”
In 2021, Freeman spearheaded the launch of Adobe’s Virtual Client Representative (VCR) program.
The Inside Story
The Los Gatos hospital is startlingly different from the typical veterinary clinic. When clients walk in, they’re greeted by a large video monitor showing a real human working remotely, smiling and ready to check them in. Then, when they’re prepared to check out, they do it from inside the exam room on a video monitor with another VCR. There’s no wrangling the pet into the lobby and standing in line at the front desk.
“I talk to so many clients who are leaving the Bay Area, and they are afraid that their new veterinarian isn’t going to offer the same level of virtual care that Adobe does,” Dr. Lau said. “I tell them to make an appointment right before they leave so that they have a full year of VCPR [veterinarian-client-patient relationship].”
While Adobe’s telehealth program is evolving, the practice has proven that veterinary professionals can successfully work remotely. According to Ali McIntyre, a Veterinary Virtual Care Association board member, more veterinary professionals work exclusively remote today than ever before.
A Day in the Life
Dr. Lau is online Tuesday, Wednesday, Thursday and Saturday from 9 a.m. to 7 p.m. Pacific time. “I’m an East Coaster who works on California time, so my day begins and ends a bit later,” she said.
She starts her days with “a barrage of emails to answer and a lot of prescription approvals.” She also has client callbacks, her own clients to follow up with and a schedule of 30-minute video visits.
“I talk with clients, write up a SOAP and medical record just like a regular appointment, and prescribe what needs to be prescribed, which the client can pick up at the hospital, or we can ship directly to their home,” she said.
Who can schedule a virtual visit with Dr. Lau? “Anyone whose pet has been seen by an Adobe doctor in our building in the last 12 months,” she said. “They’re within our VCPR, so I can do telemedicine, give them specific advice and prescribe medications.”
Dr. Lau also helps monitor the practice’s live chat feature. Remote team members set aside for her questions they can’t answer, such as “My dog ate chocolate. Should I come in?” and “This medicine isn’t working for my pet. What can we do?”
“My multitasking has gone through the roof since I started working remotely,” she said.
The Technology and Equipment
When Adobe was setting up its telehealth program three years ago, veterinary-specific telehealth platforms weren’t as numerous as they are today. After researching the options, Dr. Lau chose a startup company, and the platform grew with Adobe as the practice’s needs changed.
“We’re always trying to streamline, and we’re always asking for new features,” Dr. Lau said. “It’s like we’re doing one big experiment together and figuring out the boundaries of what we can do. Sometimes we call them and tell them what we need, and they often tell us, ‘Give us three to six months and we’ll add that feature for you.’”
In addition to an excellent telemedicine platform, what else do remote veterinary professionals rely on?
- Office equipment: Remote employees need a computer, webcam, speakers, phone, desk and chair. (Freeman has three monitors.) Adobe avoids virtual backgrounds, so each VCR’s home office has a backdrop that looks like the hospital’s front desk.
- Practice information software: Remote employees must access the hospital’s PIMS from home.
- A team communication tool: Adobe’s remote team uses Google Hangouts to communicate in real time. “If I’m working the front desk and have to go to the bathroom, I send a message via Google Hangouts to the remote team, and someone else covers while I’m away from my desk,” Freeman said.
- A virtual payment platform: Adobe worked with its telemedicine provider to add wireless terminals in each exam room so that clients can pay before they leave. Virtual home visits are paid online.
- Video and audio equipment: Each hospital exam room has a video camera, computer monitor and speakers so that clients can check out with the VCR.
The Necessary Skills
Remote work requires different talents — or “webside manner,” as the Veterinary Virtual Care Association’s McIntyre called it.
“You have to be able to connect with someone online, look into the camera, understand body language and understand how you’re articulating things,” McIntyre said. “If you aren’t a great communicator … and can’t project your voice or develop that trust and empathy over a screen, this wouldn’t be a great fit.”
Expressing emotions accurately and genuinely and having some remote experience is vital, Dr. Lau said.
“Learning how to triage and advise in a remote capacity is its own ballgame,” she said. “That’s not to say that if you’re a new grad you shouldn’t be doing any virtual care, but maybe not 100% of your time.”
The Pros and Cons
Remote patient care benefits veterinary hospitals in these ways:
- Better employee retention: “There are technicians who can’t do their job anymore on the floor because of injury or some other life change,” Freeman said. “Working remotely, they can keep using their skills in a different way.”
- Save time: “We used to have our pharmacy staff track down doctors in the hospital between appointments to ask them to look at and approve prescriptions, which was a huge time suck,” Dr. Lau said. “Now, all those go on a list, and I do a lot of them every day.”
- Improve efficiency: “Traditionally, when you’re answering the phone, you’ve got one client at a time,” Freeman said. “With live chat, you can help several at once.” She estimated that Adobe’s remote program saved the two hospitals from having to answer 60,000 phone calls over the past three years.
- Attract new team members: Hospitals offering innovative programs appeal to high-quality candidates.
- Increase the continuity of care: “Adobe has been hit with staffing issues like a lot of hospitals across the country,” Dr. Lau said. “A lot of clients that I didn’t meet in person when I was in the hospital have become my clients anyway, fully remotely. Having remote employees gives your clients more continuity of care.”
- Better client experiences: At one point, Adobe clients waited on hold for 20 minutes or more by phone because the front desk was overwhelmed. Now, remote team members answer calls in a fraction of the time, which relieves the in-clinic staff of a huge burden and provides a much better client experience.
- Improve personal well-being: “Having a remote team helps the whole staff — in-person and remote — with burnout, stress and well-being issues,” Dr. Lau said.
“For hospitals that [can’t] support an entire independent remote team, even offering some in-hospital days versus remote days can be life-changing for people’s work-life balance.”
For remote employees, the benefits are just as many.
- Live anywhere: “The Bay Area is a very expensive place to live in, and that’s our main issue with staffing,” Freeman said. “As a remote employee, you can live anywhere with internet.”
- Stay safe: “If you are immunocompromised, have underlying conditions or have physical [limitations], remote work is a great option,” Dr. Lau said.
- Flexibility: A remote position provides another job option for new moms and dads and someone taking care of an elderly relative.
- Save time and money: No more commuting means more time with loved ones and less money spent on gasoline and vehicle repairs.
- Be comfortable: Who wouldn’t want to work in their slippers all day?
- See pets in their element: “I’m no longer the scary doctor in the scary building,” Dr. Lau said. “All my patients are relaxed. They are comfortable displaying the signs the owner sees at home, and they’re not clamming up and hiding the signs from me. I also get a much better idea of their environment, which is great for behavior consults.”
- Connect with clients differently: “One thing I feared with the VCR program was that it would feel impersonal, but it doesn’t,” Freeman said. “We get to spend more time with clients. The connection is closer even though we’re farther apart. And clients don’t feel like this is an impersonal call center. They recognize our faces, and they know we’re actual people just working more creatively.”
The drawbacks for hospitals are twofold:
- The upfront investment: Launching a remote employee or team means spending money to get everyone set up at home with the right technology and equipment.
- A potentially disconnected team: “It’s an interesting experience trying to form the sense of teamwork and camaraderie that you ideally want in a hospital,” Dr. Lau said. “You have to be intentional about it when you have a remote team.”
The downsides for remote employees include:
- Boundary issues: “You must have strong boundaries because your work is your home,” Dr. Lau said. “I struggled with that my first year.” She recommends setting a work schedule and sticking to it. For example, work during work hours and avoid working during off hours.
- Being hands off: Veterinary professionals typically get into the field because they love animals. Remote employees can’t hold the adorable puppy coming in for vaccines.
- Isolation: Just like hospitals need to work at creating a cohesive team when some members are remote, far-away employees need to stay involved with the team. Adobe’s in-clinic and remote teams bond during virtual social events.
The Pay
Dr. Lau and Freeman are full-time Adobe employees, and their compensation and benefits packages didn’t change because they no longer work on-site.
“Adobe pays its doctors a salary, not on production,” Dr. Lau said. “One thing we have to hammer out in virtual care is the production-based compensation model prevalent in the field, because it doesn’t translate well when you’re remote.”
For example, during a 30-minute video consult, a remote veterinarian might discuss a pet’s need for a dental cleaning, which leads to the client scheduling one at the hospital. However, the procedure is performed by an on-site veterinarian, so who gets the credit?
“This is something we need to figure out because most hospitals giving virtual care a try are experiencing financial gain,” Dr. Lau said. “Adobe’s salary compensation model encourages a sense of collegiality between DVMs. We’re quick to cooperate on cases. It’s not a competition.”
Dr. Lau said more practices should follow Adobe Animal Hospital and allow team members to work remotely and provide virtual care.
“I hope veterinary hospitals consider implementing virtual care into their day to day. It’s better for patients. It improves access for people who are differently abled and pets who have physical or behavioral difficulties,” Dr. Lau said. “Some people believe that by not offering virtual care, they’re protecting themselves and making sure they only practice gold-standard medicine.
“But with the discussions in the field about offering the spectrum of care, I would argue that you can’t have a true spectrum of care without virtual care. You have to make things easier for clients and pets.”
Dr. Hannah Lau spends her days helping pets from the comfort of her home (and rarely putting on real shoes).
UH-OH, WHAT JUST HAPPENED?
Adobe Animal Hospital’s remote team runs into the occasional technical issue.
“Sometimes the software is down, or the client is in a spot with poor internet,” said remote veterinarian Hannah Lau, DVM. “I have a phone line in my computer, so sometimes I’ll just call people the old-fashioned way if the video doesn’t work.”
If the internet goes down at the hospital and the VCRs (virtual client representatives) can’t check clients in and out remotely, an on-site veterinary technician steps in to help.
How do pet owners handle the technology-heavy experience?
“I thought my older clients would have trouble with the technology, but that’s not the case,” Dr. Lau said. “There are certainly people who are more technologically challenged, but I’ve found that age has no bearing on that. A lot of older clients are used to talking to their families this way now.”
BRING IT ON
Veterinary clients want virtual care. A December 2020 online survey of 1,843 British cat and dog owners conducted on behalf of Vet AI found:
- Nearly 80% of the respondents would use an online veterinary service provider if it reduced pet stress.
- 60% would consult with a qualified online veterinarian who could prescribe any necessary medication.
- 70% agreed that consulting an online veterinarian for a diagnosis would be faster and more convenient.
LEARN MORE
What virtual veterinarians can and can’t do legally sometimes is difficult to pin down.
“State practice acts are hard to read and understand, and they’re updated more often than anyone knows,” said Veterinary Virtual Care Association board member Ali McIntyre. “You have to know where to look and what to watch for.
“The VVCA and the Animal Policy Group study practice acts all the time,” McIntyre said. “We have a ton of resources in the resources section of the
VVCA website. And at vvca.org/telemedicine-map, we’ve created an interactive regulatory map where practitioners can find information for their state. We have the snippets you need to read and the links to all the practice acts.”