Ethics is "in" and must have its day. So did the pursuit of witches in New England and heretics in Spain. Both were embraced by leaders, who were positive that they were uniquely qualified to oversee the morals of others. They were also so positive that they were right that they had no qualms about inflicting excruciating pain on others, always, of course, to make them better people and the world a better place. When we put advertising, marketing, or merchandising into the world of ethics, are we really trying to protect the community, or are we looking after our own practice protection?

When you attempt to legislate ethics, you shoot at a moving target. The AVMA has pondered for years what to do about leg-hold traps. Does that mean they are encouraged, permitted, or have limited use, or does it mean politics and economics are being mixed with physiological pain and fear factors in feral animals? Or what about a basic concept like "conflict of interest". At one end of the spectrum it is easy, pure black. You don't take bribes. You go to jail if you do. It has been a crime since humans first relied on a handshake to seal a deal.

It gets greyer. Ethically, you can't take a vendor's donation in exchange for a promise to approve an unproven product, but how about a promise to consider something? To keep the options open? To listen to the ideas of the future? This is the bio-ethics of using an unproven product for personal gain before efficacy.

At the other end of the spectrum it is almost pure white. Veterinary medicine offers constant "conflicts of interest". Do you consider first, on any given case, your conscience, your client's pocketbook, the patient's well-being, the practice profit, or the time before the next client? The easy answer is that you never let self-interest interfere with the delivery of quality healthcare. That is not always the easy action. You will find these scenarios again, plus two others, and related questions to ask yourselves in Appendix Q of this text to start these discussions.

Our Colleagues

You did not enter the profession of veterinary medicine to become a police officer. The previous example happens on a regular basis to the unsuspecting. Have you ever wondered why your practice doesn't price shop more often? You were not trained to peek through windows or even how to "appear ethical". The staff needs to have the example set in action, as well as in what is said about colleagues down the street or across town. Preoccupation with another practices' ethics often prevents your own practice from developing its own line of services. It takes too much time and effort from the creative energies of a practice. Even worse, these types of efforts create an atmosphere within our profession of suspicion, bitterness, personal dislikes, and private vendettas. These attitudes make cooperative efforts to establish professional ethical standards increasingly difficult. When shared with clients or staff, it colors our profession in an adverse manner. That is serious.

Ethics is not as great a problem today as is courage. Ethics rules have emasculated the profession, especially with the Federal Trade Commission's help. Any veterinary practice that communicates its care for patients and client concern can compete in today's marketplace. Any practice that feels it must mass market its wares deals in a downward spiral, a posture that must be perpetuated to maintain cash flow. Price wars and coupons are self-limiting in the long term, while being profitable for the short run.

The veterinary practitioner of today needs the courage and conviction to tend to his or her own practice. Advertising or merchandising does no harm to the animal health or welfare status in the community. Let the state board sit on questions of inappropriate healthcare, and let the community members select their own level of professional veterinary healthcare delivery. Practitioners must trust in their own ability to attract and keep clients, and let the bias about methodologies of others die the death it deserves.

The very perfection of man is to realize the imperfections.

The search for the perfect staff member or associate is the real "unending story" of our professional life. A never-ending story, maybe even a fairy tale, is the reality of the desire for a perfect match or "clone". Diversity must be celebrated, not feared. It is amazing to me why so many practices expect a perfect match of personalities and practice philosophies, while they concurrently avow that every practice is different. If we define this utopia out of existence, like we often do with other practice problems that are ill-defined, then we can address the specific pivotal issues at hand, which should be evaluated whenever we select a new team member, even veterinarians:

1.  Team compatibility: Always hire for attitude, even doctors.

2.  Practice needs: Must be aligned with standards of care.

3.  Qualifications of individual.

4.  Salary.

5.  Client/patient needs.

6.  Professionalism/community image.

The Basic Parameters

Salaries are a form of non-verbal communication at the core level, and should be based on experience and income potential, as well as being regional and practice-dependent. The variability is too great for the scope of this section.

Let us assume that this "average practice" generates in excess of $400,000 per veterinarian per year, that the expenses are within acceptable limits, that the facility team in general annually generates over $250 per square foot, and that the new associate is being hired to help expand the practice's level of client service. The initial salary base for a new graduate is usually $60,000-plus, with a verifiable benefits package, but should only be "guaranteed" for the first year, while the associate learns primary care, usually for the first time. At contract renewal, compensation should become twenty percent of the previous year's personal production, divided across twenty-four pay periods at mid-month and end of month. This provides a guaranteed monthly salary of the graduate's own making, then the practice adds the benefits package, productivity pay, or a combination of these and other factors. For the new graduate, the personal production for the second six months times two could be the annualized production for a contract renewal computation of the subsequent year base pay. With "tenure" comes increases in the compensation derived from increased personal productivity. I prefer the guaranteed base at twenty percent of the previous year's personal production, then a productivity-based override, based on practice variables.

Staff salary starts at a "training wage" for unskilled staff, about $0.75 per hour above your local McDonald's for the non-productive phases. The transitions to shadow/solo work, after about three weeks, provide a $0.75 per hour raise to denote going solo. At the end of the ninety-day orientation and training program, defined as being trained to competency levels in greater than eighty percent of the duty zone skills needed to achieve mission focus outcomes, an annual wage is set based on competency, productivity, team fit, and contributions to present. We would like key people to be at the J.C. Penney's assistant manager level of income at their first anniversary.

Managers and Coordinators are a bit unique, based on their "software" and "hardware" attributes:

 Software equals practice-specific understanding of mission focus, supporting the inviolate core values and standards of care, and embracing the protocols.

 Hardware equals formal training and technical knowledge of the foundation skills of business, human resource management, and fiscal management.

Almost no one starts with both attributes. In veterinary medicine, developing people from "within" is a software development technique, whereas seeking academically qualified individuals is a hardware acquisition process. In either case, there is a critical demand for developing the "entire package", compatible and tailored hardware and software. In the range of 2006 dollars:

 A home-grown "software-based" manager is worth $35,000 to $40,000 a year.

 A home-grown "software-based" manager, with a Certified Veterinary Practice Manager from the VHMA, is worth $45,000 to $55,000 a year. Some "coordinators of coordinators" in larger practices are worth this level of compensation, and have just not been given the opportunity to achieve the CVPM.

 A "hardware-based" knowledge and skills individual, with a self-funded degree already earned, is worth $50,000-plus to most larger practices.

 The budget guideline for a mature, well-managed, practice is that about three-and-a-half percent of gross can be spent for compensating the administrative team.

Hospital needs should be identified in terms of complementing the existing practice strengths, not matching them. Mission focus means scheduling the facility to meet the needs of clients, not the desires of staff. All too often hospital needs are translated to mean the person is willing to work for only what is being offered within personal assessment of salary or time constraints. Unlike other service businesses, such as dry cleaners, day care, McDonald's, grocery stores, etc., the business schedule of most veterinary practices is often changed, based on employee school requirements, day care requirements, or other staff-defined limitations, rather than shifts based on client access needs. In most cases, another associate doctor means the practice needs to expand the client access to the practice. The options here are many, but invariably no one is "willing to work" those hours. The operational schedule generally needs to be addressed first, as in "surgery block-out" times becoming "appointment hours", extending the evening hours by sixty minutes, or Saturday access expansions. What should really be assessed is "the hospital's niche" in the community. Review the following questions:

1.  What are the demographic trends for the next three years?

2.  Is the quality of life adequate for existing staff?

3.  Are the practice hours serving the needs of the community?

4.  Has the scope of services been kept current with the state-of-the-art?

5.  What are the existing community veterinary services?

6.  What is the practice's philosophy for staff utilization?

7.  Is there a need for a feline, reptile, or avian practice?

8.  If someone is unwilling to work the shift needed, are their hours reduced?

The staff-to-veterinarian ratio dictates some delivery modalities, but these are only symptoms of the practice philosophy that concern staff utilization and empowerment. There are enough graduates, so practices that desire to mold an associate in their own image can generally find someone to assume that style of learning opportunity. The hospital "needs list" should also include evaluating:

1.  Potential for buy-in, to be determined in twenty-four months.

2.  Succession or transition planning of leadership projections.

3.  Part-time associate needs for evenings/weekends.

4.  Associate with special skills, such as surgery.

5.  Expanded service capabilities within existing programs.

6.  Any physical plant limitations to expansion projections.

7.  Scheduling relief for existing staff, so less hours are required at the practice by everyone.

Qualifications of the individual are far more than the skills and knowledge on the resume! People need to be hired for attitude, when expanding a team. This concept has been addressed in detail in each of the three leadership texts referenced throughout this book: Volume 1, Building The Successful Veterinary Practice: Leadership Tools; Volume 2, Programs & Procedures; and Volume 3, Innovation & Creativity.

Granted, doctors must have graduated from an accredited school, passed national and state boards, and have a valid license to practice, but that only means they are qualified to learn the practice's programs and procedures. In today's new graduates, the odds are they have not treated a broken nail, a cat bite abscess, a cracked pad, or even done a dental. Some have not done a castration or ovariohysterectomy, although they might have done a kidney transplant, placed a pacemaker, or even an external fixation orthopedic appliance, and are well versed in EEG interpretations. For both doctors and staff, hire for attitude, retain for aptitude, and commit to training additional skills and increasing their practical knowledge on a recurring basis. By the second half of the employment year, the diagnostic ratio, as discussed in Chapter 4 of Building The Successful Veterinary Practice: Programs & Procedures, should be coming into alignment with the practice. For example, diagnostic sales: pharmacy sales equals a one-to-one ratio in the average companion animal practice, a two-to-one ratio in an exotic/avian practice, and a one-to-four ratio in a mixed animal practice, etc.

Team compatibility requires that specific alternative attributes be assessed, when looking at the new associate, as required to meet the "hospital needs". As stated above, after state licensing, the two most critical qualifications of a new associate are attitude and team fit. If the applicant's attitude is positive and progressive, then almost anything is possible, if the practice is willing to spend the time training and developing the individual and team. If the new graduate treats the staff as expendable, as they were probably treated in school, a veterinary healthcare team will not be formed, ever! Look at the existing practice staff. Their attitude can make the team fit occur faster or make it impossible. No one was hired because someone liked a poor attitude. We hire good people, but then often promote a poor attitude by limiting the staff member's development or contributions.

Community image includes a practice image, a professional image, and an image of caring. Healthcare providers need to assess what they are doing on a daily basis, to improve that community image. In recent management literature, a "buzz phrase" often emerges: "moments of truth". It was coined by the CEO of SAS Airlines, Mr. Carlzon, and simply means "an opportunity to influence a customer, to create an appropriate image." In every encounter with every person, at least one moment of truth occurs. Generally, more than a single moment occurs in each encounter to make an impression. In each instance, impressions and values are established, based on impressions and perceptions. In a veterinary practice, these moments of truth are often the difference between a client becoming a five-times-per-year friend or a once-in-three-years visitor.

"He who knows much about others may be learned, but he who knows himself is more intelligent. He who controls others may be more powerful, but he who has mastered himself is mightier still." - Lao Tsu