Thomas E. Catanzaro, DVM, MHA, FACHE, Diplomate American College of Healthcare Executives
We came from the pick-up truck (a UTE in Australia), scraped the dirt off our boots, and started looking at 'small animals' as needing some form of veterinary care. We carried with us the habits of production medicine. That pick-up truck could only be at one farm at a time, so the appointment log had one column per doctor, and when we did small animal consults, we had one room per veterinarian. Worst of all, we kept the same vocabulary. In production medicine, we only 'recommend' things to the producer, who weighs the milk check or calf crop against the veterinary costs; it is pennies per hundred weight balancing act. We talked about 'annual' vaccines, and inflated the prices to offset our time commitments in the consultation room (we had not yet learned to change for sharing and applying our knowledge). It was not until the 1990s that the term companion animal started being accepted by our profession, and most universities have yet to change. In Australia, the pet is still a "smallie" to many veterinarians, and for most of the VTH programs, it is still 'small animal' medicine & surgery.
Your successful dentist uses 5 to 11 chairs for dental cleaning services by dental hygienists, and has only two or three chairs for his restorative work. Your physician has staff loading exam rooms, performing blood pressure, pulmonary function tests and even ECGs before he/she enters the consult, and turns it over to staff for injections, laboratory blood draws, and imaging. Even chiropractors and podiatrists use multiple consultation rooms. Yet our paradigm was to build a very linear healthcare delivery operation in companion animal medicine, centered around the doctor, being in only one place at a time.
Most veterinary practice facilities have not been built to accommodate multi-tasking team-based healthcare delivery scenarios. It wasn't until 2003 that the American Animal Hospital Association (AAHA) changed their accreditation standards to embrace team concepts when describing quality healthcare programs (350 standards have now become 900 standards, mostly quality care, protocol, and team-based issues). We designed the first team-based companion animal facility in Australia, and it opened in August 2007; we are getting there!
A2 = G2
If you Always do what you have Always done,
You are going to Get what you have always Got.
"Recommend" is for the producer, 'need' is for the companion animal's pet parent.
"Annual" is for the calendar, "next visit" is for the life cycle surveillance of the companion animal (think twice for life [2xFL] is a minimum, www.npwm.com)
Wellness surveillance is most often a husbandry program, and therefore a staff function, so we can use affordable/appropriate pricing to ensure there are minimal fee barriers to returning more often.
The secret is not is the size of the average client transaction, it is the number of return visits per year per pet (the value of the pet per year).