CV M A VO ICE
OF NOTE Continued from previous page We are facing what he calls “the perfect storm” driven by our poor appreciation of the true epidemiology of community pet animal healthcare needs and the following factors: • Stereotypic vision of the pet healthcare consumer • Cost of care on the rise • Expectations by clients • Complete lack of financial accountability by consumers (e.g., multiple pets) • Education system devaluation of the GP • Veterinary culture and the “gold standard” • New grad debt / salary and skills minimal • Generational and gender impact The profession needs to think about community healthcare needs, including preventive medicine (vaccines/parasites), spay/ neuter, wellness, urgent care, surgical care, and end-of-life care. There needs to be an acknowledgment of the realism in the pet healthcare consumer demographics. While everyone wants the “ideal” veterinary client, there is a huge range of pet owners out there that need to be acknowledged and served. Dr. Forsgren then shared his clinical success strategies: invite them all to the party, case management based on financial reality, leadership within the community on animal issues, access to care by bending around the financial issues, and love animals and love people. He urges practitioners to forget about the fear of lost revenue and do something proactive. In his words: “Open the flood gates and start bailing.” James Wingert, DVM Broadview Animal Clinic | Denver Dr. Wingert purchased Broadview in 1983 and later constructed a new clinic, which received the Merit Award by Veterinary Economics for hospitals built during that year in the U.S. In June of 2016 in preparation for his retirement, he sold the clinic to NVA, but remains on board as Broadview’s managing doctor. Dr. Wingert has always had a commitment to providing affordable healthcare for animals. Dr. Wingert focused his presentation on how he built a successful business model by removing as many barriers (cost, hours, appointments) as possible to clients seeking and receiving care. His clinic takes 50% appointments and 50% walk-ins, seeing 400 to 500 new clients a month (220 to 250), and prices are set on what it costs to run the clinic plus a fair profit. His practice currently has six doctors, compensated from $140–$350K. When he bought his practice in 1983 it was generating $52,000 in revenue; last year was $5.5 million—with a 21 to 23% profit margin. A great veterinarian who is a bad business person will not be successful, he says, so either become one, or have one on staff. Success takes common sense and good models, and you have to know your costs and profit and loss. Plan for equipment purchases and labor costs, and don’t rush into making purchases. Make changes incrementally. Try new ideas for growth and profit. A lucrative model allows for removing barriers to care for those that need help. And you have to select a business model that’s compatible with your philosophy.
When he sold his practice, he found a corporate buyer that would not change his model, ensuring he would still be able to serve his clients and patients in a way he believes in and has great success with. Bruce Louderback, DVM Mission Viejo Veterinary Hospital | Aurora Dr. Louderback established Mission Viejo Veterinary Hospital in Aurora in 1976 and has served his profession in many ways over the years. He was appointed by Governor Bill Owens to sit on the Colorado State Board of Veterinary Medicine from 1999 to 2007. His contributions to the state board led to involvement with the American Association of State Veterinary Boards, where he has served as director, secretary, treasurer, and president. Dr. Louderback opened with how pricing and the cost of veterinary care is driving more clients into the underserved market. Is the standard of care affecting the cost of care and driving it up? The standard of care in human medicine is easily figured out because it’s set by the insurance company and the legal system. In veterinary medicine, multiple factors enter in, including state boards, veterinary schools, production medicine, industry, specialists, etc. State boards are political appointments, and the standard of care can fluctuate based on current board members and their perceptions of standard of care. There is also a lot of discussion about geography—for example should a rural practice be held to the same standard as an urban practice? He went on to discuss veterinary programs and how NAVLE questions are increasingly being written by specialists. Is that affecting the standard of care? AAVSB, through meetings and RACE, help board members establish the standard of care (for example, how to handle standard of care using telemedicine). In turn, then, is veterinary education keeping young veterinarians from pursuing cases because they are unsure of their competency? Dr. Louderback proposes that an academic veterinarian be required to practice in general practice for two years before being allowed to teach clinical medicine. Another factor driving standard of care is production compensation. If the medical director or practice owner is pressing the associate veterinarian for higher average transactions, could this drive behavior? And with industry—lab machines, digital x-ray, infusion pumps—there’s always something that advances the standard of care. Is a high performing veterinarian one who is a good veterinarian or good at production? Emergency clinics almost invariably follow the gold standard of care. While there is nothing wrong with the gold standard if you can afford it, it limits access by underserved markets and results in euthanasia. Specialty clinics are great, but where are the veterinarians who are willing to handle a tough case for someone with limited resources? In his practice, Dr. Louderback uses “practice by waivers” to gain consent for the veterinarian providing the best effort based on what a client can afford. This allows the doctors to provide less-expensive options that can still provide a good outcome for the patient. Underserved markets are in need of care, he concluded, and will find it somewhere. Let’s not use the standard of care to price them out of that care. Underserved continued on page 16 CVMA Voice 201 6 : 4 | PAG E 1 5