Phone Calls Gone Bad: Coaching Receptionists (Kindly) with Recording Brian Conrad, CVPM Meadow Hills Veterinary Center Kennewick, WA

A ringing telephone in a veterinary clinic is a beautiful thing. I tend to laugh when I hear doctors and staff make a statement that they could get some work done if that damn phone would stop ringing. I wonder if they hear themselves speaking. What they fail to realize is that damn phone is the critical factor to them having an income and a job. We have to create a culture that wants the phone ringing off the hook. A culture where we train all of the staff to professionally answer the phone and take care of the clients efficiently and confidently. 99% of the time the ringing telephone is a client with a need or a want. This could be a phone shopper, a client wanting to schedule an appointment, a boarding reservation, checking on lab results, a perceived emergency, medication refill, patient status update and we could go on and on with the list. But again, the fact the phone is ringing is a great thing. When answering the phone, don’t be fake. Let your staff’s personality come out in a professional and consistent manner. Assure they are welcoming and inviting but more importantly confident and efficient. We don’t need each phone call to last 10 minutes because we are unsure of ourselves or do not know how to control the phone conversations. The phone call should have some type of resolution. The phone voice should be pleasant and enthusiastic. It should sound focused and interested with switching of tones etc. What we don’t want is a nasally monotone raspy voice that makes us want to hang up and call another veterinary practice. There are service companies that give far more training to their staff for the phones than we ever do in the veterinary industry. I would encourage you to highlight 5-8 of the top categories on why clients call in and then set specific training for each. The categories could be Phone shoppers, Estimates, Pharmacy Refills, Euthanasia Requests, Complaints, Scheduling of Appointments, Boarding Reservations, and Lab Requests. Create a list of everything someone answering the phone might need to know about each category and then train the staff on them. Continue the training with observation training. Have each staff member watching specific procedures in your hospital. Consider have them observe a spay, neuter, wellness exam, and dental. They are going to be working with clients or potential clients on the phone. Having observed first hand these procedure they will be able to more confidently describe and educate the clients on why they would want to choose your clinic. After the observation training is complete, move into role playing. Guess what? No one ever likes to role play but it can be extremely effective. Think of the person answering the phone as the face of the company. When you start to think the person talking on the phone is responsible for your entire image, you’ll agree to conduct a little more role playing to assure our message and dialogue sound professional and smooth will be well worth the time. It is important to note it used to be if a client received poor phone service, they would shrug their shoulder and realize there is nothing they can do about it. Today, this has changed. We are seeing the use of social media as a way for clients to vent about their frustrations and describe their sometimes comical encounters with service employees. Don’t find your clinic on YouTube or Facebook with a ranting client playing an imitation of what your un-trained team member sounded like on the phone. Don’t be the next viral blog by a story of your staff being uncaring or insensitive to a client or potential client who appeared to of had an urgent matter. Work with your staff to understand they are on stage at all times when on the phone and you never know where the client will take the information and interaction or who they will tell. Err on the side of caution and assume each conversation is going to be blasted all over the web. It might not seem fair but this the technologically connected world we live in. After all, people post pictures of their dinner plate on Facebook. A juicy unprofessional phone interaction with your staff will really give them some substance for a post. It is important to remember 99% of our phone calls are a client or potential client with a need or want. If they are making the effort to call, then they are wanting effort from the veterinary clinic to take some type of action. Many times, clients will call with a medical concern. It is important for the staff to realize their number one objective is to get the client into the clinic. Furthermore, the support staff needs to remember they are not doctors nor should they try to play the part. Their job is to alleviate fear from the client by confidently communicating to them they want to get the pet owner some answers. The best way to do that is to have the veterinarian do a nose to tail exam. Plan for other scenarios that relate to the phones. Create some type of policy when family and friends call for doctors and staff. Create a system the staff understands and make sure it is not abused. We create a list for our doctors to identify when they want to be interrupted out of an exam room. For some it is when their spouse or children call for others it is when a specialist or referral doctor is calling. Communicate to the staff and it will alleviate a lot of missed opportunities on the phone. Make sure your messages are complete and accurate. This should include client name, phone number, client ID, date, time, message and initials. Many of us think our phone call etiquette is above average. Let the clients decide. This should be part of your regular feedback from your clinic surveys. Ask the clients to rate how well your staff are on the phone. Ask specific questions such as “Do you feel

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like all of your needs and wants are taken care of when you call into ABC Veterinary Clinic?” “Do you feel the staff to be knowledgeable and efficient when calling into ABC Veterinary Clinic?” “Would you agree you are taken care of in a timely manner when dealing with our staff on the phone?” “Do you feel your messages are returned in a timely manner when calling in?” Simply having the client rate your phone skills on a scale of 1-10 is going to do very little in giving you direction on where to improve. Work with your staff and create a culture where a ringing telephone is viewed as a great thing and not a hindrance. Train the staff to be knowledgeable and professional. Create a culture where everyone jumps to answer the phone after they have been trained and checked off. Having untrained and unprepared staff answering the phone may do more harm than if the phone call was never answered. Now go turn up the volume on your clinic phones and wait to hear that beautiful sound.

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Clear! Shock Your Team to Life with These Energizing Strategies Bash Halow, LVT, CVPM Halow Tassava Consulting New York, NY

Start with a sense of mission Everyone wants to feel as though they are part of something great. Paint that picture for them. ‘See’ the great business that you want to build. Help others to see it. Show your existing and prospective employees how they can be a unique and important person in your vision of the future. Dove Lewis, an emergency referral center in Portland Oregon, has already established itself as an exemplary center for care, but they continue to bait their employees to push past previous goals and grasp for new heights. Their current vision statement, ‘To have a global influence on the emergency and specialty veterinary profession…’ challenges everyone from the CEO down to revisit everything that they do, to improve themselves and to improve their organization. Dove is embarking on the equivalent of a moon launch: dangerous, but with an exhilarating prize, the first steps on a new world. Take a look at your Mission statement. If it puts you to sleep, put it to sleep. Write what matters most to you. Say what you mean, not what you think you should sound like. Kick its tires. Make sure it can handle whatever kind of terrain lies ahead.

Partner don’t parent Stop holding the hands of your adult workers. If you have employees still in the toddling stage, then send them back to nursery school where they belong. Your clients, patients and coworkers don’t feel like working with them and neither should you. You are not your employees’ daddy or mommy. If you feel like being a daddy or mommy, don’t open a veterinary clinic to serve your needs; invite a friend over for dinner and wine and do it the old fashioned way. Everyone wants to feel special and everyone wants to win. Figure out a way for every member of your team to uniquely contribute to the goals of the practice and then partner with them to make sure that it happens.

Assist your employees’ development Getting in the way of your team members success can be issues with self doubt, jealousy, negativity and so forth…. probably a lot of the same things you’ve faced (and hopefully overcome) in your professional journey. Help team members clear these hurdles. Think of yourself as a personal coach watching someone workout. Give them a tip to lift the weight or do the squat in a way that leads to the best outcome. Teaching people how to be better, without shame, captures loyalty.

Nurture effective forums Throttle up your meetings. Try standing and brainstorming for 10 minutes instead of sitting and chatting for 60. Break your practice up into small working groups where small issues are discussed, thought through, and solved. Keep the sessions energized and moving. Cue the exit music for anyone who talks more than 3 minutes. Sometimes people have to talk to hear themselves think, but more than 3 minutes of thinking out loud kills the energy of the group. Abbreviate your agendas to one or two items. Energy, interest and meeting effectiveness drops off substantially after 20 minutes or more. Pick a problem, engage the group in thought and discussion, brainstorm solutions, and leave with an action plan. Wake up people’s heads with a drawing exercise at the start of the meeting. Research ‘ice breakers’ that push employees to do something physically or mentally that turns on the creative (and hopefully fun) side of their minds. Remember that all of the chitchat that meetings eventually devolve into is a natural need for all groups. We require social time. So let’s find a way for team members to socialize without shutting the practice down, feeding everyone pizza and wasting valuable meeting time. Sending people on breaks in groups, if the schedule allows, gives people a chance to talk, get to know one another and enjoy each other’s company. Have a budget for ‘drinks on us’ that’s available to any group of employees that wants to spend off-work hours gathering for lunch, dinner, drinking, bowling or whatever. Encourage them to invite team newbies along for the ride and include them in the fun. Some of our world’s most innovative business ideas (think Apple, Zappos, etc.) were cooked up over drinks in some bar long after everyone punched out.

Terminate poor performers Get rid of the deadwood. Fire poor performers and affirm that the additional effort and energy that star performers give your organization matters.

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Feedback and celebration Remember how we keep calling our employees team members? So name a team where the coach sits in the field house and weighs in on the team member’s performance once a year. Managers should get out of the office and on the floor where they can witness and applaud your team members’ success. Collect objective data on your business and share it with your team, and then use it as a jumping off point for a discussion on how everyone can improve. Take your most positive reviews (not your negative ones) and drill down into the particulars of each. Closely explore how you won, not how you lost, as a way to underline the behavior and actions that work and as a way to teach other team members how to better succeed. Consider celebrating team members on social media (with the proper permissions, of course). A public celebration of employees (provided it feels warranted and sincere) feels great for everyone involved.

You If you’re not jazzed, your team members aren’t going to be jazzed. You are and will always be instrumental to your team’s sense of excitement and accomplishment at work. Hire all the practice managers or sub managers that you want, your role as chief visionary and figurehead can’t be outsourced. I’m not asking you to spend 7 days a week in the building, but if you can only punch in for one, make sure it’s a whopping good one.

I’ll leave you with a story Picture it. I’m at a practice that’s undergoing complete reconstruction. The interior is a disaster. It’s 9pm and the only veterinarian working, the owner, is quietly washing his hands after treating a patient. I watch him rub the soap on his hands and mark how peaceful he appears. What makes him happy? What makes him happy is this: he has created and continues to create a place where he can grow, self-actualize and win. Find a way to help others find themselves in the same position. Help them find themselves contentedly washing their hands, amidst a practice strewn with hurdles and caution signs, feeling happy and thinking that they’ve finally discovered just how great they really are.

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Creating Better Expectations for Interpersonal Behavior in Practice Bash Halow, LVT, CVPM Halow Tassava Consulting New York, NY

Healthy workplace interaction isn’t achieved by more policing on your part (and anyway…can you imagine how onerous such a job would be?), but achieved by individuals who take responsibility for how they think and behave with their coworkers. The best way to understand how to help others to become more self-aware is to work on your own self-awareness and to study how you repeatedly error when it comes to healthy interaction. Journaling is an excellent tool to explore one’s strengths and weaknesses. Quiet time allows for effective time with one’s thoughts. Take a walk with the dog and take one question with you, ‘why do I react the way that I do?’ Understanding how you tick will help you coach others off their hamster wheel of misguided thinking and interacting. Begin to teach others how to interact by working on your own interactions and understanding what helped you to change your ways.

Underline the value of positive workplace interactions Unhealthy workplace interaction is so demoralizing, so deflating, and so destructive that management teams should have systems in place to avoid it in their business. Use civility rules These are written tenets by which everyone is expected to behave (greet everyone when you arrive to work, don’t ostracize team members, respectfully share your concerns with others, etc.) It seems silly: written rules that can be found on the bulletin board of any grade school, but our busy lives and the filter of social media have inured us to the feelings and thoughts of others. Major companies throughout the U.S. have added civility rules to their employee manual because they understand the major impact that rudeness (or perceived rudeness) can have on productivity and culture. Give equal weight to fairness Leaders that show favoritism create fertile ground for animosity between employees. Provided you have respect and fairness as a foundation in your business and that you are sufficiently self-aware, you can use the following techniques to help your team improve the way that they interact with coworkers.

Create an environment of accountability and responsibility It’s hard for coworkers to swallow the importance of kindly interacting with team members that don’t follow through with what they say they will do or who do slip shod work. Don’t avoid difficult conversations. Make it clear to all employees that if they say they’re going to do something, they should do it or communicate otherwise. Part of respect is staying true to your word.

Stimulate thought You don’t have to always be the guy or gal brave enough to share your thoughts on how others can improve. Help team members wake up to who they are and how they behave with online emotional intelligence tests (just Google them). Allow them to take a Myers Briggs test. Invite your Zoetis rep to your practice to conduct a DISC training class. These are excellent tools to stimulate self- reflection and hopefully self-awareness.

Create opportunities to get acquainted The more time your team has to learn about one another and find trust, the more likely they’ll behave better with one another. I’m not a big fan of bowling nights or after work get-togethers simply because so many team members are parents and need to spend time with their children, but why not organize some continuing education off campus with a select group of people? Time in the car or eating lunch with one another is a great way for everyone to get better acquainted, and because it’s CE related, it won’t feel like a superficial sacrifice of time.

Inculcate a sense of team Employees that feel part of a team are more likely to interact better than those that feel as though it’s every man or woman for him or herself. When hiring, allow your employees to participate in the selection process. Remember that a big factor in working ‘as a team’ is enjoying the people that you are working with. Expecting employees to work well with people that they don’t enjoy being around isn’t wholly realistic. During the hiring process, allow team members a chance to sit and talk with candidates (OFF the floor) so they can determine if they are a good match.

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How to Accomplish Goals in Practice Without Losing Your Cool Bash Halow, LVT, CVPM Halow Tassava Consulting New York, NY

Why are you angry? My business partner is a serene employer. She can weather employee and business set backs with a level head and calming demeanor. Boy, she ticks me off. For whatever reason, things that don’t bother others infuriate me. A lifetime of ranting and anger outbursts have characterized me as entertaining, obnoxious, a know-it-all, unbearable, destructive, brilliant, and bullying. I think it’s safe to say that my often-negative outlook on things has undermined nearly all of my efforts to be as successful as I could have been. After years of cycling on this hamster wheel of outward and inward destruction, I decided to stop and take a moment to examine why I was angry. What I discovered was the key to curtailing the behavior, improving my success as a leader, and most importantly, increasing my personal happiness. Why do you get angry when you or your team falters or fails at goals? If you are like me and the many other veterinary professionals with whom I work, it’s because you take your responsibility of caring for animals and their owners very seriously and to fail at it feels like a reflection on your character and your commitment. Not always bad, anger can be a sign from a perceptive and invested individual that something is off. Directed constructively, anger can lead to enormous positive change. The appropriately named not-for-profit MADD, which stands for Mothers Against Drunk Driving, has an annual budget of 45 million and has done enormous good in the world simply because one woman found a positive way to direct her anger into a venue for change. We attend these conferences, circle a few fifty-minute presentations, and hope to emerge with a checklist of things that we can go home and plug into our practice for an immediate improvement on things. In this class, we’ll underline a short list of takeaways, but one looms especially large: the answer to this question, ‘why do you get angry?’ Take the dog for a walk and spend some time meditating on the question. Challenge yourself to ask others for their thoughts. Your wife and children probably can answer the question easily, but ending your outbursts doesn’t begin with changing others, it begins with changing you.

Limiting your chances of anger As I mentioned above, anger doesn’t have to be a monstrous side of you. It can be your intelligence and perception shouting, ‘Hey, something isn’t right!’ You and your employees are trying to pursue a goal and nothing happens, or all the wrong things happen, and you’re angry. Well…maybe there is some merit to your feelings.

Planning One reason why goals don’t often go as planned is because we leaders have spent an insufficient amount of time planning how they should be achieved. It’s okay to enter a meeting with a vague idea of what you would like accomplish, but it is your job as a leader to make sure that the details of the idea unfold as the group and you work forward. One strategy that I have found enormously helpful is to play with the idea myself before I introduce it to others. Tinkering around with a new concept or protocol…beta testing it if you will…gives me a chance to figure out what I actually want. With a clearer understanding of what I’m trying to accomplish and build, I am much better at directing others to replicate the process and more likely to get a good outcome.

Training I have hired, coached and supervised many kinds of people in my life: all ages, all socio-economic backgrounds, all intelligence levels. I believe that communicating a vision of what you want accomplished to others is fraught with crossed wires and static. A clear idea of what you want to accomplish and a systematic approach to uploading others on how you want things done improves your chances of success. It’s time consuming; it’s a drag... especially when you’re already swamped with work... but methodical training is essential.

Talk Feedback is important to team members, but it can be overwhelming, especially for new hires. There’s an art to correcting employees in their first weeks of employment or their work on the latest project. Look for signs that you may be overwhelming your employee. If today isn’t the best day to hone their behavior, another time with present somewhere down the line. Rome wasn’t built in a day.

Let it go After you are dead, the world of veterinary medicine will go on. Even now, veterinary medicine gets accomplished all around without a syllable of input from you. Take a leap of faith. Give a little elbowroom to those that are also working on whatever project is at 613

hand. It might not get done to your satisfaction today, but with time, you and your team can sort through additional details and ultimately shape a product that meets or even exceeds your expectations. Additionally, because you’ve allowed others to own the project and work on it more autonomously, you are more likely to capture their interest and discretionary effort.

Bullets for managing your anger I once interviewed a PHD and renowned expert on the topic of workplace anger. I asked, ‘What advice do you have for those of us that tend to blow up at work?’ His answer, after a lifetime of education, research and work on the topic was, ‘Try counting to 10’. I could have killed him. But he’s right. Taking 10 seconds before you respond (well in my case, I need 24 to 48 hours to cool off) can improve your chances of keeping your cool. In my case, a night’s rest is all I require to emerge with a whole other perspective. ‘What was I so upset about?’ is often my morning-after thought. We require time to center, an increasingly challenging prospect in an age that insists on drowning out every thought in our head with a cellphone alert, with banal background music, insipid public alert messages, talk show blather, Internet pop ups, and so forth (huh-oh, who is getting angry again?) I figure, we already have a dog; we should walk it. We have a cat. We should plop it in our lap and love it and spend some time to remembering that when we’re not ticked off, we’re kind of remarkable. When we’re not intent on kicking over sand castles, we’re capable of creating a lot of joy for others. The fact that we get angry is a sign of intelligence, perception, and a passion to pursue what’s right, but let’s agree that letting it get the best of us only worsens the very thing we were upset about to begin with.

Express it Find a way to express your anger constructively. Make sure you’re calm (for me this means taking a waiting period to cool off), give the person that you are talking to the benefit of the doubt (in my experience, they are rarely clued into how a particular thing is making me feel), and share your thoughts. In such interactions I regularly self-check. I ask myself, ‘Am I building a relationship here or am I just being right?’ We avoid delicate situations because we’re concerned that conflict will spoil our relationship (i.e., the employee will quit!). I suppose the employee may quit, but most times, people appreciate that you care enough to be honest. Relationships aren’t always happy. Occasional conflict and the resolution of that conflict create a sense of trust that the relationship is tested and true. Just try to share your feelings without being nasty or disrespectful. I’ve been in anger recovery now for about 7 years with numerous relapses. In retrospect, the 4/5ths of my life I’ve spent shouting hasn’t demonstrated my power or my strength, it has underlined my mediocrity, my weakness and my fear. In the past, a project went south, and I got mad because I thought the failure was a reflection of who I was. In fact, it wasn’t the failure, but my reaction to the failure, that demonstrated to others how inferior I really was. Anger has never helped me get a goal accomplished (unless I used the anger to fuel constructive action on my part) and has never provided the lasting catharsis that I thought it would (blow ups only feel good for about 20 seconds before leaving you feeling gross and toxic). Take time to think about why you get mad. Reflect on whether or not such a feeling has helped you to succeed or to move your goals forward. And enjoy the walk with the dog. Exercise is good for the soul.

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Trends Shaping Veterinary Practice and Careers by 2020 and Beyond Bash Halow, LVT, CVPM Halow Tassava Consulting New York, NY

Consolidation, technology and an eroding middle class (Pew Research Center, 2015) are reshaping the future of veterinary medicine. The animal health landscape of 2020 and beyond includes very successful, well-managed, private practices; a significant number of publicly-held and corporate practices that focus on affordability; and a dwindling, beleaguered, collection of low margin practices that have failed to plan in the face of obvious warning signs. Veterinary healthcare leaders interested in a long, lucrative and successful career should plan for change now and take a proactive position in leading their hospitals and the profession. In this paper, we’ll look at the most significant factors that will define our future marketplace; what the career of a veterinary manager will look like in such a world; and changes that practice managers can undertake now for themselves and for their practice that will ensure optimum success. The future of veterinary medicine will be influenced by the following trends: • Better informed, more devoted pet owners with less money than the pet owners of today • Consolidated groups of practices, both publicly and privately owned, and an increase in low margin, bare-bones practices • An increase in fixed and non-fixed business expenses that drives down margin and that most significantly impacts non- consolidated practices • Increased veterinary management acumen and better leadership in general • Credentialed technician and talent shortages • A widening technology gap between large companies and small businesses that puts the latter at a note-worthy disadvantage

More devoted pet owners with less money More pet owners consider their pets to be members of their family than ever before. In a 2011 Psychology Today article Do We Treat Dogs the Same Way As Children In Our Modern Families? Author Stanley Coren PH.D, F.R.S.C. writes: A new online survey by Kelton Research, involving about 1000 people, shows that the status of dogs as family members is changing. It appears that in the minds of the Americans who responded to the survey, dogs are becoming more important as family members, particularly as children. Most recognize that this represents a change in attitude since nearly 60% believe that their dogs are currently more important in their lives than were the dogs that they had during their childhood days (Coren, 2011). (Coren, 2011) According to the AVMA, 51% of pet owners allow their pets to sleep in the same bed, another 31% buy their pets holiday presents, and an overall 63% of pet owners think of their pet as family (AVMA, 2012). According to a study that was conducted by the Pew Research Center in 2010, 85% of respondents said that they considered their dog to be a part of their family and 78% considered their cat to be one (Pew 2015). Wall Street, taking note of the exploding popularity of sites like LOLcats, Corgi tumblrs and social media outlets alive with pet photos also recognizes an American populace that loves, if not adores their household companions (Or, 2014). However according to the AVMA Pet Ownership and Demographics Sourcebook the number of pet owners taking their pet to the veterinarian decreased by 8% for dogs and 24% for cats in 2012. Between 2007 and 2012 there was a nationwide 13.5% decrease in veterinary cat visits. One reason respondents cited for not going to the veterinarian? Money (AVMA, 2012). Today’s American is worth far less than they were in 2003. According to The Atlantic: Median net worth has declined steeply in the past generation—down 85.3 percent from 1983 to 2013 for the bottom income quintile, down 63.5 percent for the second-lowest quintile, and down 25.8 percent for the third, or middle, quintile. According to research funded by the Russell Sage Foundation, the inflation-adjusted net worth of the typical household, one at the median point of wealth distribution, was $87,992 in 2003. By 2013, it had declined to $54,500, a 38 percent drop. And though the bursting of the housing bubble in 2008 certainly contributed to the drop, the decline for the lower quintiles began long before the recession—as early as the mid-1980s.” (The Atlantic, 2016) According to the Social Security Administration, as of 2014, 67.2 percent of wage earners had net compensation less than or equal to the $44,569.20 raw average wage. By definition, 50 percent of wage earners had net compensation less than or equal to the median wage, which is estimated to be $28,851.21 for 2014. In 2014, 75 percent of Americans earned $55K a year or less (SSA, 2014) To put all of that in perspective, the U.S. Department of Health and Human Services draws the poverty line for a family of four at $23,850.00 (Univ. of Wisconsin Institute for Research on Poverty). If the American public continues to humanize pets in the future, there will be a solid demand for veterinary care, but it must be affordable to a growing population with less money than it has today.

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The opportunity in consolidation is dramatically changing our industry Veterinary consolidation is trending up. According to the 2013 AAHA Pulsepoints, 6.9% of respondents identified themselves as being a part of a multipractice group, three times the percentage reported in 2011 (AAHA, 2014). In 2014, Summit Partner’s NVA, with a run-rate earnings of 69 million dollars, was purchased by Ares Management for an estimated 920 million dollars or 13.3 times

EBITDA (Or, 2014). That’s more than double the 4-6 times multiple seen in most sole practice sales. In March of 2016, VCA agreed to buy an 80% share in CAPNA (Companion Animal Practices of North America, a group of 56 free standing veterinary practices) for 344 million dollars or 10.7 times a 2016-projected EBITDA (The Fly, 2016). This is significant. How does a 60-something veterinarian turn away from an offer that’s double what he or she would otherwise be offered? Alternatively, how do younger veterinarians, potentially saddled with debt, but eager for a chance at ownership, compete with the prices that buying groups can and are offering? How does acquisition change a practice’s culture and its management’s autonomy? Since the sale of NVA and CAPNA, Vetcor Inc. and PetVet Care Centers could be next. With only 5.5% of veterinary revenue being produced by VCA, Wall Street views consolidation of veterinary practices as a big opportunity for private equity investment (Or, 2014). Consolidation will likely reshape a significant part of the veterinary landscape of the future and while that’s not necessarily bad, it’s certainly very different from what exists today.

The rise of on demand veterinary services In May of 2016, a congress of professionals met at the University of Michigan to discuss an alarming fact: today’s recently-graduated veterinarians have a 2-to-1 debt to income ratio (Williamson, 2016). Some of these veterinarians, looking for ways to take control of their debt and gain autonomy over their lives, are taking a fast track into business ownership and/or independence. They’re hiring a single, on-demand employee and taking their practice mobile (Cummings School of Veterinary Medicine, 2014). In some cases, a central office dispatches the veterinarians, lowering the veterinarian’s time invested in managing client load and scheduling. Central offices, or the young veterinarians themselves, leverage facile digital marketing skills to outcompete brick and mortar vets for premium online visibility These practices’ low-cut pricing structure puts additional competitive pressure on stand-alone practices. Sites like Petcoach pay veterinarians on a case-by-case basis to answer online veterinary questions. Their aggressive marketing means that Dr. Google just added one more associate to a list of veterinary resources that will outcompete your practice for top search engine results and the next new client. It means that sole practitioners can completely eliminate the need to own a brick and mortar facilities or even the infrastructure to book appointments.

An increase in fixed and non-fixed expenses Comparing practices in the AAHA Pulsepoints 4th and 8th editions (2006 and 2014 respectively), 25% of veterinary practices saw an increase of expense-to-gross ratio by 5.1% or greater (AAHA, 2014) with decreases in surgery, sedation and anesthesia, hospitalization, euthanasia and other medical income. Additionally average transactions, active clients per veterinarian, and new client numbers were all lower than the 2011 averages (AAHA, 2014). Surprisingly Pulsepoints reports that expenses for web presence, online reputation, and digital communication and marketing account for 1 to 1.5% of a practice’s annual gross revenue, roughly the same amount of money we used to spend in the old Yellow Pages days (AAHA, 2014), but I can’t imagine that that is true and I expect as we get better at calculating the money we’re investing for visibility and marketing, including payroll hours, we’ll determine that our expense in this area is much higher. Decreases in revenue may have something to do with the increased expense-to-gross ratio. Online price shopping forces practices to lower margins on what used-to-be more profitable pharmacy and over-the-counter products. The rise of low-cost, spay-neuter clinics and other not-for-profit (and some times publicly funded!) facilities providing low cost veterinary care have impacted our service sales. Additionally, there is the aforementioned decline in veterinary visits. It’s important to point out that when one looks at overall net profit as a percent-to-gross revenue, AAHA Pulsepoints indicates that 25% of practices earned 5% more (or greater) in 2014 than they did in 2006, while 25% of all practices in the same study had a 5% decrease (or greater) in net return between 2006 and 2014. But there is also an indication that overall non-veterinarian staff per FTE veterinarian is down. If practices have reduced the size of the staff in response to the recession or if practices are swopping out hard- to-fill credentialed nurse positions for non-credentialed personnel, (Wu, 2015) that could indicate that higher net returns are due to austerity (AAHA, 2016).

Credentialed technician shortages DoveLewis Emergency Animal Hospital, a provider of veterinary professional education (On the Floor @Dove), recently discussed their decision to include non-credentialed employees as members of their professional nursing team as a response to an acute, ongoing shortage of credentialed technicians.

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“The shortage for credentialed and licensed techs is widespread and while some states have not been affected, most have been. The BIG issue – the industry is simply not retaining technicians. Their career span is a short 5 years. We lose them to other careers, commonly they go to human healthcare nursing where they can make significantly more.” (Maxwell, 2016) Anecdotally, Kenichiro Yagi, BS, RVT, VTS (ECC, SAIM), a familiar face on the speaking circuit, says he frequently hears audience members expressing concern about technician shortages. According to the Bureau of Labor Statistics, veterinary technicians or technologists with a 2 or 4-year degree respectively, earn a mean pay of $15.30/hour or 32K a year. That’s at least 10K dollars per year less than the starting pay of a registered nurse (BLS, 2016) Tech shortages mean higher payroll costs to retain credentialed staff, retention issues as valuable team members migrate to practices with better benefits and opportunities (consolidated groups), and/or increased training responsibilities for the practices as they struggle to cobble together nursing teams from non-credentialed team members.

Increased veterinary management acumen Our future’s successful veterinary practices won’t owe their staying power to dumb luck. Though some practices with strong leaders will fail, none will succeed that don’t embrace effective, informed leadership as part of their business model. Leaders in these practices can be former client care representatives, assistants or technicians, but they won’t be without a passion for leadership or a solid education in veterinary management through organizations like the VHMA. The days of winging it are through (indeed have been for some time). Tomorrow’s practice managers won’t be in training wheels. They will be informed, experienced business leaders proactively responding to market pressures.

A widening technology gap Today’s small business must manage an increasingly large web presence that includes online reputation management (reviews), SERP (Search Engine Rank Position) and an ongoing dialogue with clients on social media. Additionally Google, the web’s most popular search engine, primarily ranks websites by original, popular content forcing businesses to regularly update their websites. I think most would agree that those online responsibilities alone are a formidable obligation, yet a new responsibility looms on the horizon: leveraging online user data. In a NY Times article titled, Facebook Is Using You, the author states: ‘Facebook made $3.2 billion in advertising revenue last year, 85 percent of its total revenue. Yet Facebook’s inventory of data and its revenue from advertising are small potatoes compared to some others. Google took in more than 10 times as much, with an estimated $36.5 billion in advertising revenue in 2011, by analyzing what people sent over Gmail and what they searched on the Web, and then using that data to sell ads. Hundreds of other companies have also staked claims on people’s online data by depositing software called cookies or other tracking mechanisms on people’s computers and in their browsers. If you’ve mentioned anxiety in an e-mail, done a Google search for “stress” or started using an online medical diary that lets you monitor your mood, expect ads for medications and services to treat your anxiety’ (Andrews, 2012) As online users, we have a profile we create, but data-aggregation companies like Google and Facebook are creating one for us based on what we search for, what we write in emails, who are online friends are, what we buy, what we search for, and literally every key stroke we make on the computer, tablet or smart device. This information is used to create the world’s most effective marketing tools to be sold to the highest bidder. Not a bad world to live in... unless you can’t be the highest bidder. If you thought it was hard to keep up with posting on Facebook, look out. The next wave of marketing options available to you will be the most effective selling tools in the history of the world, but they will cost money and small veterinary practices, already cash-strapped and challenged for time and expertise in this area, will find it hard to both keep up and pay up.

The veterinary practice manager in 2020 and beyond Scenario 1: Success Five years from now you will be directly responsible for a practice that is consistently growing and financially healthy. You will have achieved this by reviewing the internal and external forces at work on your business and on the market and made successful, confident, proactive business decisions. You will have grown the business to keep pace with your growing talent and your increased salary demands. You will have built a vertical pathway for yourself and many members of your team. Yes, your clients will have less money, but you will have put together some payment strategies for them that put great care within reach. After all isn’t that what these people who think of their pets as ‘family members’ want? Yes, you will have higher expenses, but your leadership skills will have honed a team that puts forth its best effort. Clients will pay the additional money; they’ll wait the additional time; they will elude the online ads of your corporate competitors because you matter when it matters most: face-to-face, in the lobby, in the exam room, and on social media (Wu, 2014). As one veterinarian recently said to me at a conference, “No one can compete with what I do for my clients in the room”. You will be successful because you will have actualized your team to be a walking, talking billboard of your mission statement. Technology is all well and good, but no future, however bleak, will dethrone client connection as reigning supreme. 617

You’ll be known in the community through your presence online, through your practice owner’s (and your own!) charismatic leadership. You’ll be thought about, talked about, and connected with as a personality, not a practice. You’ll be happy. So will your team members. In general, happy people are a magnet. Happy people in a business are a business magnet. As a leader, you’ll pay attention to your workplace culture. In a highly competitive world, the need to constantly inspire employees will change the perception of what inspires. Leaders will realize that fresh, changing environments with powerful, authentic stories on the walls is more inspiring than expensive art collections. In the future, more attention will be paid to marketing and branding internally to connect employees to the company’s mission and the impact employees have on their customers. Including individual employees in the brand story and allowing them to become a part of history in the making will be an effective employee engagement strategy. (Roby, 2015) You’ll be on a constant look out for opportunity. You’ll have hooks in the stream to catch the best employees, the best new clients, the best deals, the best opportunities for your team to learn. When people ask you what an entrepreneur is, you’ll tell them that it’s a business person that trusts their gut and takes big risks and you’ll reference a few stories from your own practice and your own career as a way to expand upon that definition. It is likely that your practice will be part of a loose union of similar practices that share proprietary management strategies and pricing information, broker buying deals, and potentially collude on exit strategies for some if not all of the members of the group. A portion, if not all, of your future practice management continuing education will come from within the group or from outside parties that structure education (and its cost) to specifically meet your group’s demands. Your group will scratch the backs of preferred vendors and they’ll scratch yours, but because of your group’s size, your ‘scratch’ will cover more ‘back’. The future education for you and your team will be more effective, specific to your needs, and in part bank rolled by vendors eager to do business with you and your group.

Scenario 2: Your practice will have been purchased and you’ll come with the package You may be one practice in a group of a dozen or so, or part of a larger company that includes 50 or more practices. Your practice’s owner may or may not have shared his intent to sell with you and on the day of the transition you may have been completely caught off guard. Don’t hold a grudge against your former boss. This was his or her chance at retirement and a way to ease him or herself out of the veterinary work schedule over a few years. Your salary was sustainable so the new owners kept you in place. Besides, the new owners wanted to make sure that the transition went smoothly and there was as little disruption to business as possible. You may be asked to focus more closely on things like payroll and inventory costs and asked to take more aggressive measures to reduce both. In this new world, decision-making will likely be more collaborative and time consuming. You may have easy access to hard-to-come-by resources like HR and legal advice, marketing materials, and the support of other managers of your caliber and experience level. As a part of a larger group of practices, you will attend regional or district meetings where you’ll find inspiration and reaffirmation of the company’s goals. Such meetings will provide you a chance to shine and grow in entirely new ways and be the first step to a larger, more influential position within the company.

Scenario 3: Fading into the sunset Another scenario is that we wake up in 2020 and find you growing transparent. Waiting for the future to happen to you, then reacting to it, will put you and your company in a constant position of catch up. Choosing to focus on the day-to-day without ever proactively planning and leading towards a better future is an abdication of your real role and a PTS pathway for your practice. Choose to coast along as though it is business as usual means that both you and your practice will fade off into the sunset, will mean that hundreds of thousands of dollars worth of business value will spill through your fingers, means that you will have donated your market share to your competitors.

Scenario 4: New horizons There’s also a chance that you will be pressured to retire or that you will work yourself out of a job. Practices of the future will be pinched between a universe of online price shopping that stymies price increases and growing expenses. Businesses are trending towards the lean in mean. In an article published in the Seattle Times, the author writes, “A decade ago, (new businesses) in Washington (State) employed five or more people. Now, they’re hiring only about three workers, according to Bureau of Labor Statistics data.” Martinez, 2014) Your future employer may love you, but they may not be able to afford you. With your tremendous experience, knowledge base, and education, a position with a larger private or corporately-owned veterinary practice may be possible, but competition for the salary that comes along with such a job is likely to be stiff, not only from within the ranks of organizations like the VHMA, but from outside our industry, as young talented MBA graduates scour the job scene for work.

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Possible Career Options. Where else if not in a veterinary practice? During the conference, we’ll have a panel of former and existing veterinary practice managers, who have tested the job-market waters outside of the practice walls, and who will report back their thoughts on the switch. You’ll hear stories of those that have gone onto veterinary business ownership, financial management, veterinary business acquisition, ‘consulting’, bookkeeping, website design, online support, team training, and sales for veterinary supply, communication, equipment, and pharmacy companies. But graduating, or perhaps better put, shifting into fields adjacent to veterinary management will not be an option for everyone. If the salary for such jobs is high, it’s likely that the applicant pool will be very competitive and the screening process extensive (Wolfe, 2016). In America, those with advanced educational degrees earn more than Americans without advanced degrees. Older men and women without advanced degrees are more likely to be challenged to find well paying work and are more likely to withdraw from the employment pool altogether (Strause, 2012). It’s not entirely necessary to know what line of work you will be in five years from now should your practice management position go away, but you can still prepare for a potential new career by completing your college degree, earning a more advanced one, or finding ways to assist practices with their online presence, marketing, online security, recruiting, training and work culture needs (Uzialko, 2016). There’s very good chance that you will cobble together a workweek as an on-demand laborer. Successful businesses of the future, small and large, will adopt the ‘Hollywood model’ of getting work done. They’ll assemble smart, expert teams around a short list of goals, and then when the work is finished, disband the group (The Economist, 2015). Businesses of the future will need to take advantage of the wealth of competitive advantages that lie in analytics, collaboration, marketing and online presence (including cyber security, cloud-based services, mobile adaptiveness), but their ‘lean and mean’ models will look to on-demand outside resources for help in this area; a boon for the skilled manager that not only understands how to make adaptations and updates in these areas, but who can do so in the context of the specific needs of the veterinary practice (Uzialko, 2016). You may be part of America’s vast number of sole proprietors numbering in the millions. You’ll be your own boss, helping practices here there and everywhere with things like bookkeeping, financial oversight, software support, marketing, training, inventory and so forth all by way of the Internet. You’ll work from home with a load of laundry turning in a nearby room or a chicken roasting in the oven for when the kids get back from soccer. You’ll also be responsible for constantly looking for work, paying all of your education and business expenses out of pocket, and forced to face the same small business pressures you once had as a practice manager.

The impact on professional organizations Organizations like the AVMA, State VMAs, the American Animal Hospital Association, and even our beloved VHMA itself exist to bring lobbying efforts, consistency, camaraderie, and high standards to the profession. Up to this point, these organizations have been clear leaders of the industry. However, if the future includes more consolidated groups of practices that are self-determining, with their own thoughts on standards, their own lobbying efforts, and their own tracks of continuing education pointed specifically at internal goals, do the membership demographics of professional organizations change? If consolidated groups of practices leverage their size to capture hard-to-come-by sponsorship dollars for their own purposes, does that impact how professional groups are funded? Today’s professional organizations have tight budgets and are staffed with small crews. Will these organizations be able to meet the demands of their future members or will their efforts be eclipsed by the support and training that comes from within consolidated practice groups? Will large vendors, eager to hold the attention and loyalty of their clients, develop their own manager groups, continuing education, and on-demand medical and management resources? Will there be other certificate programs for practice management, leadership and so forth that come, not from our Industry’s standby organizations, but from veterinary, for-profit companies?

The way forward It’s not all Sturm and Drang. Nimble, smart, privately owned, well-managed practices will always be a part of our future veterinary landscape. Why? Because great service and genuine care will never go out of style and people who consider their pets to be family will do whatever it takes to make sure that they are well. These gifted practices have already begun to structure tomorrow’s success. Here is a list of what they are doing today.

Identity andgoals Success begins with a clear idea of what you want to be and how you’re going to be it. Future, privately owned practices won’t be run- of-the-mill; they’ll stand out. They will exemplify great service, overt caring, and expertise. The teams of these practices will be smart, engaged and engaging. Leaders of these practices will ask one question and answer it thoughtfully, ‘What are the defining and distinguishing elements of our practice?’ This question is often explored, but too-often incompletely answered in the mission statements we have written for our businesses. 619

Plan Once you have a short list of clear goals, work with all members of your team to develop a written plan for how you will achieve it. Practice owners and leaders shortchange themselves when they assume that strategic planning is onerous or unnecessary. Emphatically, it is neither. A short list of what is vitally important to work towards is freeing for a taxed management staff and liberating for a team that can often feel pulled in too many directions. Use the strategic planning tools at www.halowtassava.com for more help in undertaking the straightforward and enjoyable task of planning.

Build a team As a child, I was scrawny and picked upon. One summer’s eve our neighborhood’s favorite dad called together a game of flag football and much to my complete delight, he not only singled me out to be on his team, but called me into a private huddle where he uploaded me on a strategy of how we were going to win. Before each scrimmage, he directed me to go to a particular place in the field where he threw the football to me and I, to my sheer amazement, caught it. Subsequent to that, I was tackled merciless, but I got up from the dirt smiling more broadly than I had in my entire life. That man had given me a chance to noticeably and successfully contribute to the efforts of a winning team. That’s a dynamic that exists in all teams in which members work with their heart and soul and it’s one that will exist, on some level, in your successful practice of the future. Team building is straightforward. Hire people you want to see succeed and then provide them training, individual attention, and caring oversight to help them shine. The problem is that that responsibility is time consuming, emotionally draining and sometimes a trial of one’s patience. Nonetheless, there is no way around it. Build into your plan for the future a methodology by which you accomplish the above, not by which you search for an easier, but ultimately unsuccessful, workaround.

Learn and leverage the online world The online world provides small businesses an unprecedented, cheap, extremely effective way of engaging existing clients and capturing new ones (Dugas, 2012), but it requires an investment of time and skill. It’s very likely that leaders will have to outsource this responsibility to someone in the future, but that will not absolve them of understanding enough about how effective online marketing works to oversee the process. Future practices will have tighter budgets, so it’s essential that their online marketing dollars be efficiently spent. To that end, all practice managers should hold their breath and take a plunge into learning how to build an effective online presence. Practices should shift the way they search for new team members to best connect with affordable, young talented people almost all of whom can be found online. Find ways to celebrate and highlight your team’s efforts through social media. Consider buying help- wanted ad space on social media sites. Film short videos of your practice team in action as a way to inspire young people to join your force.

Clear patient and client care standards Your team members’ job isn’t client education; it’s client connection. Education is secondary to stopping, listening, empathetically reacting, and then making a straightforward recommendation to the client based on your standards of care. Your future practice will distinguish itself because each of your team members, in their own, individual way, will be a caring mouthpiece of your practice’s expertise, organization and experience; but most importantly each member of your team will be a source of connection, an extension of the kind of relationship every practice owner wants to cultivate with his or her clients.

Boots on the ground It is said that George Washington returned from some battles with more than 17 bullet holes in his waistcoat. One of our greatest leaders in American history didn’t bark out orders from his office in Mount Vernon, but mounted his horse, rode amidst the troops, and fought alongside all of his men. Get out of your manager’s chair and onto your feet. There is work to be done at your desk, but the more important work is happening in the lobby, and exam, treatment, surgery and kennel rooms. Get to it.

Look in the mirror On some level, you’re a contributing reason why your practice growth efforts stall. Insight into how you may be holding your team (and yourself) back are critical to your practice’s (and your) long term success. Find a way to gain insight into who you are and why you do what you do. In all seriousness, you might try a therapist. They’re trained to help people ‘see’ themselves and to figure out why they do what they do. That kind of knowledge is essential if you are going to improve.

Face facts You may have problems as a leader, but you’re not the only reason why your team’s efforts stall. Many of you know of one, two or several members of your hospital that drag the entire place down. You’re not crazy. Those individuals really are a wrong fit. Terminate them. 620

Act Your story and the story of the business that you run is an unfinished manuscript the last page of which has today’s date on it. Take up your pen and decide where this story is going to go, which characters you’ll introduce and which ones you’ll kill off; how you’ll behave and where you’ll be in this brave new world of tomorrow. Success in the movies follows a familiar pathway: the main character loses everything; a defining moment when the same character commits to change, a montage of images showing the character’s short-term triumphs, and finally the last five minutes of the film where the character lives happily ever after. Real life seems much different. Your future success is inevitable if you stop gauging it by material accomplishments. Think of adversity and failure, not as setbacks, but as part of a path forward and upward, because, indeed, they really are. You can be the weakest person on the team and still catch the football; you can eat a mouthful of dirt and still stand and smile. Even stumbles launch you forward. Real life is better than the movies. In real life, we have the lead role, we understand everything that the main character thinks and feels, the photography is amazing and the audio is in Sensurround. Best of all, the popcorn and soda are much, much cheaper. Just do the part where you choose to change. Commit. Choose a path. Act. The future doesn’t have to happen to you. You can happen to the future.

Bibliography (n.d.). AAHA. (2014). AAHA Financial & Productivity Pulsepoints Eight Edition. AAHA. Lakewood: AAHA. AAHA. (2014). AAHA Financial & Productivity Pulsepoints Eighth Editions. AAHA. Lakewood: AAHA. AAHA. (2006, 2014). AAHA Financial & Productivity Pulsepoints Fourth and Eighth Editions. AAHA. Lakewood: AAHA. AAHA. (2016). AAHA Financial & Productivity Pulsepoints Fourth and Eighth Editions. AAHA. Lakewood: AAHA. Andrews, L. (2012, 2 4). Facebook is Using You. Retrieved from NY Times: 1. http://www.nytimes.com/2012/02/05/opinion/sunday/facebook-is- using-you.html) AVMA. (2012). U.S. Pet Ownership and Demographics Sourcebook. AVMA. AVMA. AVMA. (2012). U.S.Pet Ownership & Demographics Sourcebook. AVMA. AVMA. Bureau of Labor Statistics. (2016). Registered Nurses. Retrieved from Bureau of Labor Statistics: http://www.bls.gov/ooh/healthcare/veterinary- technologists-and-technicians.htm Coren, S. (2011, 5 2). Do We Treat Dogs The Same AS Children In OUr Modern Family. Retrieved from Psychology Today: https://www.psychologytoday.com/blog/canine-corner/201105/do-we-treat-dogs-the-same-way-children-in-our-modern-families Cummings School of Veterinary Medicine. (2014, 10 24). When Choosing Between Mobile Vet and Traditional Veterinary Office. Retrieved from Cummings School of Veterinary Medicine: http://www.tuftsyourdog.com/issues/20_10/features/When-Choosing-Between-Mobile-Vet-and- Traditional-Veterinary-Office-59-1.html) Dugas, C. (2012, 11 12). Small Businesses Get Personal With Social Media. Retrieved from USA Today: http://www.usatoday.com/story/money/business/2012/11/11/small-business-use-social-media/1692851/ Martinez, A. (2014, 3 27). New Businesses Run Leaner Holding Down Job Growth. Retrieved from Seattle Times: http://www.seattletimes.com/business/new-businesses-run-leaner-holding-down-job-growth/ Maxwell, M. (2016, 6). Adapting to the Technician Shortage. Retrieved from @Dove: https://www.atdove.org/blog/the-technician-shortage Or, A. (2014, 8 21). Who Could Be the Next In Vet Deals. Retrieved from Wall Street Journal Blog: http://blogs.wsj.com/privateequity/2014/08/21/who-could-be-next-in-vet-deals/ Pew Research Center. (2010, 11 4). Gauging Family Intimacy The Family Dog and the The Family Cat. Retrieved from The Pew Research Center: http://www.pewsocialtrends.org/2006/03/07/gauging-family-intimacy/61-2/ Pew Research Center. (2015, 12 9). The American Middle Class is Losing Ground. Retrieved from Pew Research Center: http://www.pewsocialtrends.org/2015/12/09/the-american-middle-class-is-losing-ground/ Roby, G. (2015, 10 15). 5 Key Issues that Will Impact Your Future Workplace . Retrieved from Great Place To Work: http://www.greatplacetowork.com/events-and-insights/blogs-and-news/3107-5-key-issues-that-will-impact-your-future- workplace#sthash.nE3jAZOE.WXybvV2G.dpbs Social Security Administration. (2014). Wage Statistics for 2014. Retrieved from Social Security Administration Online: https://www.ssa.gov/cgi- bin/netcomp.cgy?year=2014 Strause, S. (2012). The Connection Between Education, Income Inequality, and Unemployment. Retrieved from Huffington Post: http://www.huffingtonpost.com/steven-strauss/the-connection-between-ed_b_1066401.html The Atlantic. (2016, 5). The Secret Shame of Middle Class Americans. Retrieved from The Atlantic: http://www.theatlantic.com/magazine/archive/2016/05/my-secret-shame/476415/ The Economist. (2015). http://www.economist.com/news/briefing/21637355-freelance-workers-available-moments-notice-will-reshape-nature- companies-and. Retrieved from www.economist.com: http://www.economist.com/news/briefing/21637355-freelance-workers-available-moments- notice-will-reshape-nature-companies-and The Fly. (2016, 02 29). VCA to Acquire Majority Stake in CAPNA. Retrieved from The Fly: http://thefly.com/permalinks/entry.php/id2336111/WOOF-VCA-to-acquire-majority-stake-in-CAPNA-for-M University of Wisconsin Madison Institute for Research on Poverty. (n.d.). What are Poverty Thresholds and Poverty Guidelines. Retrieved from Poverty Research Center: https://www.ssa.gov/cgi-bin/netcomp.cgi?year=2014

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Uzialko, A. C. (2016). 50 Small Business Trends and Predictions for 2016 . Retrieved from Business News Daily: http://www.businessnewsdaily.com/7605-business-trend-predictions.html Williamson, C. (2016, 4 27). Vet Student Debt and Mental Health. Retrieved from Michegan State University College of Veterinary Medicine Online News and Events: cvm.msu.edu Wolfe, I. (2016). Business News Daily. Retrieved from 50 Small Business Trends and Predictions for 2016: http://www.businessnewsdaily.com/7605- business-trend-predictions.html Wu, T. (2015). Small is bountiful. Retrieved from The New Yorker: http://www.newyorker.com/business/currency/small-bountiful-small-business- craft-beer

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Client Compliance Builder Workshop: Inspiring Ideas to Drive Medical Services Bash Halow, LVT, CVPM Halow Tassava Consulting New York, NY

Why compliance? A year ago, I was in an AAHA meeting. An attending veterinarian raised his hand and pronounced, “No one can compete with what I provide my clients in the exam room.” The attendee was onto something. He knew that his strength wasn’t in what he sold, but who he was.

Mission Nearly everyone that works in veterinary medicine knows that they personally care about clients and patients, but do they believe in their practice’s collective ability to provide valuable care? Do you think it would be more or less difficult to get clients to comply with your recommendations if everyone on your team genuinely understood your practice’s value? Mission statement discussions typically signal to the audience that it’s time to nap. It’s no wonder. Look at them. We here at Critter Care Animal Clinic vow to provide the very best medical care and professional service possible to our clients and patients while offering our employees a fair, safe and respectful place to work and by being an upstanding member of our community and the veterinary profession as well as a resource of compassion and support for the stray population of Rockville.

What??? When writing your mission statement, don’t let high-falutin trump meaning and sincerity. Missions are meant to concisely define who you are and inspire your team members and clients to join with you on a journey. They should provide all leadership a pocket-sized way of measuring all actions and all decisions. The internal mission statement of one of the world’s top human hospitals; a hospital that cares for more than 1 million patients every year and has consistently ranked top in human health for more than 25 years is anything but pretentious. It’s, ‘Care that you would want for your mother’. Do you think that this mission selects for people that have respect for quality care? If you were applying for a job at this practice and you knew this mission, would you have a better understanding of how hard you needed to work at this business? Don’t merely write the mission statement, live up to it. Fire employees that slack off. Do you have any idea how insincere you look as a leader when you allow substandard employees to half-shoulder a mission that the rest of your team passionately carries forth? Soul search for your unique value. Don't bother sending it off to the trophy store for engraving, write it on your guts and live it.

Build a relationship Your clients call your practice, sit in your waiting room, or enter into an exam room with a creature that they believe is a member of the family. Price matters to them, but care is just as important and many times more important. They want to believe that you have this creature and their best interest at heart. They don’t want you to sell them something other than sincere help. They can smell a sales pitch a mile away regardless of how good you think you are at pitching it.

Direct recommendations Take time to listen to the client, demonstrate that you hear them, examine the patient, and directly tell the client what you believe is best. Veterinary professionals regularly push back on the notion of direct recommendations because they believe that the client will perceive them as pushy. I have watched hundreds of veterinary professionals talk to clients in the exam room. Veterinary professionals who demonstrate that they are listening, believe in the value of what they do, and then tell clients what they sincerely believe is best are better liked, have higher transaction rates, have higher compliance rates, and enjoy their jobs more. More education and more options do not improve compliance. More education and more options make the services you offer sound like you’re ‘supersizing it’. You sound like you’re turning a discussion about an animal’s health into a transaction. Stress relationships with your team members, not sales.

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Digital media can dramatically help Social media provides practices an enormous, affordable (and too often untapped) chance to strengthen relationships and keep the dialogue with clients alive. We’ll discuss this more at length during our class, but here are the things I would like you to work on with your web developer and your team.

Website Websites are the first interaction that your clients have with you. Use your website as a tool of engagement, not as a billboard. Build your site using platforms like WordPress that allow for regular updates and changes. Make sure that the content is easily viewable on a mobile device.

Write original content I say blog and everyone goes to sleep. I read them and understand why. So many of you are purchasing blog content from outside providers. Do you read it? If you aren’t, do you think that your clients are? Don’t write content like you’re in vet school. You are your client’s doctor, that’s true, but you’re also their friend, their neighbor, a fellow animal lover, and fellow pet owner. Write in that voice. You don’t have to be cute. You just have to be you…and interesting.

Leverage social media Don’t use social media to sell. Use social media to be social. Someone at your practice has to look at your business page’s feed. Someone has to be responsive to posts in a timely manner. Someone has to write like a human, not like an organization. Health campaigns…dentistry, senior wellness…all the things with which you want to have higher compliance can be communicated on your website, on social media, through e-blasts and newsletters. Additionally, today’s technology allows you to target this message to clients to whom the message will matter the most. This kind of work is not a walk in the park, but it’s not a climb up Everest either. Take the cold days of January to map out four big goals for your practice and build out a plan for content and marketing to help you promote them. Three months advanced warning is ample time to build original engaging content and to figure out how you will get it in front of clients.

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From Veterinarian to Beterrinarian: How I Improved My Production Jeremy Keen, DVM Desoto County Animal Clinic Southaven, MS

Being an associate veterinarian (especially for a recent graduate) can be stressful at times. As a new graduate, you may be concerned that you are not efficient enough, spend too much time on surgeries, or that you do not communicate well enough with clients, and so on. There is also the feeling of being on your own and practicing veterinary medicine for the first time. This feeling can be overwhelming; however, with good communication skills and a desire to learn, the practice of veterinary medicine can be very rewarding. Another concern is that of paying off school loans after graduation. The loan repayments that our new graduates are faced with are at an all time high, and these numbers are most likely only going to increase in the future. So, despite the anxious and scary feelings of being a new associate veterinarian, these new graduates must also seek for positions that will compensate them well enough to survive. Young veterinarians are always looking for ways to increase their gross production so that they may reap the benefits of a possible raise or even a bonus at the end of the year. There are numerous "small" ways to increase an associate's gross production. It is as simple as practicing great medicine. The following are a few suggestions for helping to increase your gross production:

Ear cytologies An ear cytology should be performed on every patient that is shaking his or her head, has red and inflamed ears, or just a large amount of dirt in the ears. This test is very simple to perform and only requires a few minutes. They allow us to determine if we are dealing with a yeast or bacterial infection and also guide us to the best treatment for the current condition. For example, the average price for an ear cytology is $18.00, and one of the most common issues we see in veterinary medicine is diseases of the ear. Therefore, if you see just 5 ear cases per day and perform 5 ear cytologies, this will create $20,700.00 in gross production if working 4.5 days per week. Ear cytologies serve to practice good medicine and, at the same time, are great income builders for the practitioner and the practice.

Fecal examinations A fecal examination should be performed on every newly acquired pet and should be recommended annually as a good preventive measure. This examination should also be performed on every patient with vomiting, diarrhea, or weight loss. It only requires a few minutes and supplies us with a large amount of information concerning the pet's current gastrointestinal health. If intestinal parasitism is diagnosed, the fecal examination will guide us to the type of deworming agent to use. Fecal examinations are not only great diagnostic tools, but also great income producers. For example, on average, I see 15 cases per day in which I perform a fecal examination, and the cost for this test is $16.00. Therefore, this will create $55,200.00 in gross production if working 4.5 days per week. It is much more satisfying to be able to explain to a client exactly what we are treating (intestinal parasites, bacteria, etc.) after performing a fecal examination than just placing the patient on an antibiotic without knowing what exactly is being treated. It is money well spent and the client's respect us much more if we can give them a diagnosis.

Annual wellness blood work Annual wellness blood work should be performed in all of our middle aged to geriatric patients, and should be recommended in all patients. It is so much easier to diagnose a chronic disease (liver/kidney) if we closely monitor the numbers. This close monitoring allows us to initiate the proper treatment at the ideal time. Also, if blood work is performed at a young age, we will obtain a good "base line" to compare to in the future. It is so nice to have the opportunity to catch acute or chronic conditions before it becomes too late. Also, clients appreciate it if we diagnose their pet's condition (s) before it is too late. From an income standpoint, I see an average of 5 senior pets per day and the wellness blood work costs $75.00. By doing this every work day, once again with a 4.5 day work week, you will create $87,750.00 in gross production for the fiscal year. Annual wellness blood work is a great practice builder, very good income producer, and, once again, it is great medicine.

Chronic medication blood work Any patient that is on a chronic medication (NSAID's, steroids, immunotherapy, seizure medications, etc.) should have blood work performed every 6-12 months.

Supplements Another great therapy we have in practice today is that of supplements. There has been some controversy on how well these supplements work and if they are improving our patient's health. These include joint supplements (Glucosamine/Chondroitin Sulfate), fatty acid supplements (Omega 3 Fatty Acids), liver supplements (Denosyl, Denamarin), and many others. I personally

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believe greatly in these supplements and that they have the potential to increase the health and longevity of our furry friends. We should all be discussing the use of them in our exam rooms. When presenting the research of these supplements to clients, coupled with the long term results, they are very appreciative. As far as joint supplements are concerned from an income standpoint, my clinic sells the glucosamine/chondroitin supplement by the bottle. A bottle lasts, for most patients, 5 months and we sell it for $61.00 per bottle. I recommend this supplement for all of my patients, but especially large breed dogs, small breed dogs with orthopedic abnormalities, and middle aged cats that hide their arthritic pains so well. I do not have an exact number of patients for you, but if you have 1,000 patients on this supplement daily, you will be selling 2.5 bottles per year at $61.00 per bottle. This creates $152,500.00 in gross production for the fiscal year. Having said this, I do not recommend marking up supplements very much since they are a long term product and not a medication. My clinic routinely increases the client cost by 30% over clinic cost. These supplements are perfect for our patients' health, great practice builders, and, most importantly, serve to build the doctor-client-patient relationship and the human-animal bond.

Weight loss plans If you are like me, about 60-70% of the patients you see are either overweight or obese. This is becoming a huge (no pun intended) trend and it does not seem to be slowing down much. The pet will be fed the same foods the humans eat, over fed the treats and regular food, and not allowed enough exercise. I have begun formulating personal weight loss plans for my overweight patients. In these weight loss plans, I discuss the pet's current weight, ideal weight, and the amount of daily calories to feed in order to obtain the ideal weight. I break the plan down on a monthly basis and set weight loss goals for each month. I have the clients bring the pet in every month for a weight check. During the initial visit, I will discuss how to determine the current body conditioning score. I will first ask the client how he or she feels about the pet's weight (underweight, ideal, overweight, or obese), and then give my professional opinion. This is the best way to spark the conversation. It is wonderful to see the smiles on the client's faces when their pet comes in wagging his or her tail, happy as can be, and has lost down to the ideal weight. One of the best ways to increase your gross production, and your success as a veterinarian, is to find your own niche in daily practice. I have found this through focusing a good bit on weight loss and formulating the weight loss plans. I have found that if I just go one extra step to discuss the weight issue and formulate a plan, my clients are so much more satisfied and they become a client for life.

Healthy treats A healthy treats list is something that all veterinarians should have available. Our clients come to us for diet and treat recommendations and we should all be educated on what diet and treats are going to be best for our patients. My healthy treats list consists of many fresh fruits, vegetables, and yogurt (list compiled from Chow Hounds by Ernie Ward, DVM) and they are low calorie and fun for clients to feed their furry friends. All of my clients are amazed when I present them with the list. The best time to present and discuss this list is during puppy or kitten visits. It is always a good idea to get our clients and patients started out on the right path as far as nutrition is concerned. It is much easier to start a good, healthy habit than to change a bad habit. Educational handouts Our clients are presented with good news and bad news every day, and hopefully the good outweighs the bad. We see many different types of issues on a daily basis. One of the most important and valuable pieces of information a veterinarian or staff member can present the owner with is an educational handout. These handouts can be originals formulated by yourself or you may find many through veterinary software companies. They should give a brief description of the condition that has been diagnosed and the treatment plan involved. Handouts mean so much more to the client than we could ever imagine and they also allow us to save time and remain efficient in the work place. Client callbacks The most important lesson for a veterinarian to learn and master is that of client communication. This is what makes or breaks a practice. If you are not a good communicator, you will never be seen as a good veterinarian in the client's eyes. This especially applies to our surgery patients. On a routine day, most of us perform a number of surgeries that we consider routine. However, in the client's eyes, no surgery is routine because their baby is being put under sedation or general anesthesia for the procedure. Most clients are usually on pins and needles while awaiting the results. One of the best clientele builders for a young veterinarian is client callbacks following a surgical procedure. All young veterinarians should take a few minutes to call their patient's parents following surgeries. This allows us the opportunity to communicate with the client, put them at ease by letting them know that all went well prior to, during, and after surgery, and shows the client that you are concerned with their pet's well being and safety.

Update your clients We have hospitalized patients and drop-off patients every day. This is routine for us, however, we must always remember that it is not routine for our clients. We need to update our client's on their pet's status at least 1-2 times daily. The easiest way to remember this is to treat every patient as if he or she was your own pet and that you would like to constantly know how that pet is doing. This

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involves a simple, short phone call for us, but means so much more to the client. A great, successful veterinarian is one who communicates very well with his or her clients.

Euthanasia Euthanasia is the toughest part of our job. We are faced with many situations in which the pet is very ill and the clients are emotional wrecks. The most important lesson for all veterinarians to learn is that of preparing ourselves for these situations and never allowing ourselves to get into a rush during this trying time in the client’s life. The way we handle euthanasia deeply impacts our client's view of us as veterinarians. I recommend offering services such as cremation, clay paw prints, and even something as simple as shaving some of the pet's fur off to send home with the client. These small services, in conjunction with a compassionate attitude from the veterinarian and staff, mean so much in our client's eyes that most of them will never want to leave your practice. So, you are probably catching onto a trend here with all of the previous tips. These are great tips to help any veterinarian increase his or her gross production (the numbers speak for themselves) and loyal clientele. If you just remember that practicing great medicine and possessing good communication skills equals good income production, you will be a successful veterinarian. Once again, it is as simple as practicing great medicine.

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How to Rock ‘n’ Roll with Your Staff: Getting it Done Jeremy Keen, DVM Desoto County Animal Clinic Southaven, MS

To be a great veterinarian and to offer the best medicine possible, it all boils down to YOU...... Not Really! You may be a great practitioner and practice great quality medicine, and you may own a beautiful, fancy practice, but, if you don’t know how to treat and motivate your staff, what’s the point? You will never be successful unless your entire team is successful. It is very important to teach your staff all the technical aspects of the job and how to communicate with clients, but these are just tiny little bits and pieces of what brings success in a practice. In order to rock n’ roll with our staff, we must get to know them and learn what makes them tick.

Be a great CEO We would all love to be the CEO of our own company, right? But what does this truly mean? To me, CEO stands for “Chief Energy Officer.” In the book, The Energy Bus, Jon Gordon describes how our emotional energy defines our own lives as well as those of us who work around us. If you bring dull, lifeless energy to work everyday, that is exactly what your company will be...... dull and lifeless. If you bring excited and enthusiastic energy to work, then your company and those around you will most likely share the same outlook towards their daily jobs and tasks. Your energy sets the tone, so make it a good one.

Define the roles for your staff We all want to have a purpose in our life and in our jobs. It is easy to call each staff member either a technician or a receptionist, but that is SO BORING !! We need to be on the lookout to see which of our employees are leaders and which are followers. Who are the ones that are always stepping in to lend a helping hand, the ones that are always bringing new ideas to the table, and the ones that learn a task and then teach it? These are our leaders and we need to reward them. These priceless employees need to be given special roles such as head technician and head receptionist. They need to be given some authority over the other staff members. This allows them to know that their hard work has not gone unnoticed. This also takes a huge weight off of the veterinarians.

Social butterfly In today’s world, everything is about technology. Our businesses are all over the internet and social media sites and there are often times numerous client reviews that, in a way, “define” our practices. Social media can be great for your practice but you have to keep up with it. When it comes to our staff, we usually have rules agains cell phone use and computer use during work. However, some of our staff members are so attached to their phones and social media sites that this can become very tough to monitor. Instead of reprimanding this staff member, you should place them in charge of managing your clinic’s social media presence. They are already good at it and, by doing this, they will receive more satisfaction out of their job and most likely become a more enthusiastic employee.

Find a common Ground One way that I Rock n’ Roll with my staff is by, literally, rocking n’ rolling with them ! We constantly play music in our clinics. Music has been proven to provide a more calm and soothing working environment. It also allows for employees to sing along and, on many occasions, forget where they are and begin dancing in very embarrassing ways. This constantly provides for a comical work environment for all of our staff. Our staff constantly remains focused, but we also enjoy a fun and mostly stress free work environment. Certain types of music have also been proven to lessen the anxiety level in pets while in the hospital.

Make it personal We are always looking for ways to celebrate in our clinics. Whether it be a birthday, engagement, the birth of a child, or a staff promotion, we always make it a personal celebration for that particular staff member. It does not cost a lot of money to show that you care about the lives of your staff. It can be as simple as providing a cake or a small gift certificate. The lasting effect of doing this for your staff far outweighs the cost.

What’s the incentive? We all offer special events in our practices such as dental month, senior wellness month, and so on. During these events, we tend to be a little bit busier and our staff must work that much harder to make them a success. Once these events are over, how do we show appreciation to our staff for all the hard work, or do we? Of course we could all say, “wow, we had some great success during this promotion and we would just like to say thank you for the hard work,” but is this really enough. I am a firm believer that a true “thank you” goes a long way but there are many ways to show our appreciation even more. The best way to do this is to offer incentives. During dental health month, you could set different goals to achieve and offer incentives once each level is passed. If you staff performs 50 dentals, then you could provide lunch or a gift card and if they perform 100 dentals, you could take them all out 628

to eat. There are so many ways to do this and it just makes your staff even more enthusiastic about the event or promotion that is being offered.

Make time for and listen to your employees You may be in the clinic all day with your employees but are you actually spending quality time with them and listening to them? Many of us require our staff to obtain a history and vital information from our patients prior to our exams but do we really do a great job of providing quality listening time to all of their hard work. This is so easy to do but is also hard to do at times, especially if we are busy with multiple rooms. However, if we are going to ask our staff to work hard at communicating with the clients and performing a brief exam on the pet, we need to make sure to provide a listening ear to all their hard work. We also need to make time for them and experience how successful they are becoming in our practices. It is not enough to just be present in the building, we need to provide quality interaction with our staff throughout the day. Yes you are a veterinarian and you may even be the owner or the one in charge, but you must realize, you do not always know what is best. Your team interacts with the clients and pets just as much as, if not more than, you do. A great staff always listens to clients and they look for ways to improve a client or pet’s experience in the clinic. They also listen to what the clients like about our clinics and what originally brought them there. By doing this, our staff are able to come up with unique ways to reach to existing and potential clients. These ideas often become some of the most successful practice builders in our clinics.

Servant leadership Our staff are not our servants, they are our team. We need to serve them more than they serve us. We need to help each staff member discover his personal strengths and then provide opportunities for them to implement these strengths for the better of the practice. We need to help our staff do what they do best, but first, we must figure out what that is.

Sometimes you just have to let go No matter how hard you try, you will never be able to please everyone. We are all going to experience times in our practices during which we have a “toxic” employee. These employees will ruin your practice and staff morale faster than you could ever imagine, and the majority of the time it is not on purpose. These “toxic” employees become this way because they were never a great fit for your team. It may hurt to let someone go but it is better for you, your team, and for the “toxic” employee. There are many ways to rock n’ roll with your team and make sure that you are all on the path to practice success. First off, you must remember that you, as the veterinarian, set the energy of your staff and if this energy is constantly one of enthusiasm and success, your team will thrive. We need to treat our teams like family and celebrate all successes, no matter how great or small. Let’s all get ready to Rock n‘ Roll !!

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Oh, Those Clinic Smells! What Your Clients’ Senses are Telling Them Jeremy Keen, DVM Desoto County Animal Clinic Southaven, MS

We have potential clients hunting for us everyday. They probably are not dressing up in camouflage and loading up their rifles, but they do go to internet sources and “word of mouth” sources. These potential clients use their five senses to decide where to take their beloved pet for the best care. So get ready, these pet owners have you in their crosshairs and are using the following senses to decide if your practice is worth the shot:

Sight This day in age, the first source these clients will use is the internet. It has never better served a business more to have a website than it does today. However, just because you have a website, does not mean it is going to bring in the business. When searching for a veterinarian, a potential client wants to get the quick overview. Our websites must be informative but also clean and professional. It is great to have a clinic tour or pictures of your patients on your site, but not on the home page. When a person visits your site, there are just a few very important pieces of information for which they are looking. The primary aspects of the site that need to be seen are the clinic’s logo, the contact information and address, and your business hours. Secondly, they will be looking for an “About” page that will discuss our practice philosophy, our doctors (pictures and bios), and possibly a clinic tour and client reviews. Upon winning over the potential client with our website or by client “word of mouth,” the next step is the “meet and greet” as I like to call it. The client and pet(s) will come to visit. The first eye-catcher should be a professional appearance, which should include a clean facility, nicely dressed and well groomed staff and doctors, and educational exam rooms. By this I mean educational posters and models in the exam rooms or, at best, interactive screens to keep the clients entertained and to help them learn more concerning the health of their pet.

Hearing Those exam room doors are wonderful to have while preparing for the patient on the other side. You and your team can get everything together without ever being spotted by the patient or client; however, what many people do not realize is that the sense of “hearing” is at its strongest during this part of the clinic visit. This sense is 100% alert for the client and the patient. As far as the clients go, they can hear everything the staff may be discussing whether it pertains to the client’s pet or to random subjects. Many staff members do not think before they talk when it comes to this scenario. We must strive to keep our staff aware of this and to keep a positive attitude at all times in the clinic. Of course there will be days when we have team members that are “in the dumps,” and when this occurs, we must have a plan set in place. I recommend having an “in the dumps” protocol. What I mean by this is having a plan of action or an escape route for these particular situations. This escape route should include a “quiet place” for these team members to escape to, whether it is an office, a quiet break room, or a quiet, outdoor sitting area. This will also help to keep the team morale at its highest. As far as the pet goes, each and every one is different. We see some pets that are as happy as they can be at our practice, however, many of our patients are shaking in their fur boots. The sense of hearing is off the charts during this time. Every drawer that is slammed, every bark and purr that occurs, and every word that is uttered, sends these pets into a frenzy. We all need to strive to make every effort in keeping these pets calm. We have 2 options by which we can do this. We could install all padded, sound proof walls in our exam rooms, or we could just always keep the mentality of putting ourselves in their furry boots to serve as a reminder of the pet's feelings at the time. I think the latter option would be the easiest and most economical.

Touch How does your clinic touch its clients and patients, especially first time visitors? Upon entering, do they receive a warm welcome or a bitter hello? It all starts with our receptionists. Every receptionist needs to introduce themselves by name and, if at all possible, welcome the client and pet by name. At the same time, if an appointment has been scheduled, the receptionist needs to reiterate the reason for the visit or the client’s concern. We also need to take an up close and personal visit to our own waiting rooms at least twice a year. During this time, we need to sit in the chairs and feel how comfortable they are. We need to look around at the scenery and pictures/ads that may be visible, and we need to scan the floors and walls for any surprise stains that my have been left behind. I also recommend having an area where a client can receive a cold bottle of water and maybe even a snack. The next step for the client is the exam room. What is the overall feeling in the exam room? Does it provide comfortable seating and plenty of room for the patient and client to interact with us? We also need to strive to have educational exam rooms. Upon completion of the exam, we need to have a knowledgeable technician discuss all aspects of the exam and make sure the client fully understands any treatments that are given and that he or she leaves with no unanswered questions. Upon check out, the receptionist 630

needs to go over an itemized list of services rendered and medications given and then ask if the client has any questions before checking out. Having said all of this, in my opinion, one of the best ways to satisfy the sense of touch, is to offer a clinic tour. This allows the client to get an inside look at where and how their pet will be treated.

Smell Of course we are always trying to make sure our clinics have a good smelling environment, however, after working in the clinic for so long, we can sometimes become immune to smells and they may no longer offend us, but they may blow up the noses of our clients. Nothing is more offensive to a client or visitor than a malodorous clinic area. Also, I guarantee if someone asks a client about your practice, he or she may say you are the best veterinarian in the world, but the subject of the bad smell will definitely surface. This factor will drive more clients away than you could ever imagine. On a more personal note, when I was interviewing for my first position out of veterinary school, one of the first aspects of the clinic that I noticed was the smell when I walked in the door. If it was a malodorous clinic, it did not matter how the interview went from there, I was guaranteed to turn any offer down. So believe me, when it comes to this area of concern, this doctor NOSE what he is talking about.

Taste You are currently saying to yourself, how in the world can a client taste my practice. Well, figuratively speaking, they can. The sense of taste refers to our clients leaving with either a good taste or a bad taste in their mouths. In order to successfully pass this sense of clinic hunting, you must combine all of the other four senses together. If we successfully meet the senses of sight, hearing, touch, and smelling, I guarantee your clients will always leave with a good taste in their mouths, figuratively speaking. So, how does your clinic rate according to the 5 senses of clinic hunting? I recommend you write the 5 senses down somewhere that can be seen by all of your team members and have each of them give opinions in each category. If you realize that your clinic passes all 5 senses with flying colors, then I guarantee that every new client will keep you in their crosshairs and never hunt elsewhere again. If we strive for excellence when it comes to the five senses, we will have more clients than we can handle in no time.

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5 Things You Must Ask Before Your Boss Retires Kathryn Primm, DVM Applebrook Animal Hospital Ooltewah, TN

Life is inevitable. We all grow older and we retire. We know the day will come that we will retire, but it is more of a concept than a reality. But many veterinary professionals work for practice owners who are closer to retirement than they are. If you have a boss that is older than you, there are things you need to know before his/her last day!

1. What does the practice owner have in mind for the practice? Odds are there is no official plan in place. Your boss may have just seen his/her exit from the practice as an ambiguous idea that is now looming as a reality. Very few veterinarians that own a practice already have a plan in place. At the very minimum, it is a great idea to have an estate plan to allow the practice to continue in the event of the owner’s death. It is reasonable and important for an associate vet or practice manager to find out this type of information. Ask if you can plan a regular meeting to discuss planning and health of the practice, just like any relationship, this one requires communication. It is wise to discuss if the owner’s departure and plan for it if possible. According to David McCormick, MS, CVA, most practice sales take 3-4 months to complete once terms are agreed to. Many times the staff will not be aware of the transfer until the final days. No matter what you decide to do, you will need to know a rough idea of what the owner plans so that you can plan for yourself. Departures can be sudden, slow transitions, or even have the previous owner stay on as an associate. Sometimes departures are due to death or injury and if the conversation has been opened, everyone at least has a starting point to try to honor the owner’s wishes.

2. Do I want to be a practice owner? Think about your own personality and situation. Practice owners shoulder a lot of responsibility above and beyond those associated with being a vet or practice manager. An owner is a veterinarian, an HR person, an accountant, a marketer and more. He/she decides wages and staff and ultimately, all profitability (or lack thereof) can be attributed to the owner’s choices. Owning a business is an excellent investment since the owner gains not only his/her salary, but also builds equity in the practice, increasing net worth. Business leaders possess certain traits, according to Forbes. Consider each of these honestly and make sure possess or are willing to grow these traits. • Passion- a strong sense of purpose and the idea that you are on a mission for a reason • Resilience- Bad things will happen, but good leaders can shake them off and never stray from the purpose • Strong Sense of Self- successful business owners have the confidence that if they work hard, their mission will succeed. • Flexibility- Being able to make changes on the fly and come up with ideas that are “out of the box” is a very valuable trait for practice owners. • Vision- Successful business leaders see opportunity everywhere. I would add persistence to this list. The ability to try innovative ideas (and know how to monitor and test the success or failure abandoning them when they fail or doubling effort when they succeed) over and over and never stopping is a trait that is essential to a successful practice owner.

3. How do I figure out if I want to buy this practice? Perhaps the owner thinks that his/her practice is worth more than it truly is. Most owners do. The old adage goes that something is worth only what you can sell it for. The practice you are considering might not be the best investment for you. There are professionals that can help you know, taking into account growth and cash flow. If words like “growth, revenue and cash flow” make you feel sick, you might want to reconsider practice ownership. Once you have decided that the practice is something that you want to consider for purchase, you should look into financing. This should not be frightening for you because a solid practice pays for itself and allows you as the owner to continue to have income and grow equity. Financing is easier than you might think. If you are a veterinarian with at least 3 years experience and good credit, you will need only a relatively small down payment to finance a practice purchase. Again, a good practice pays for itself.

4. What will happen to me if I do not buy this practice? If you are not interested in practice ownership, you should understand that buyers are mostly interested in maintaining the current staff as much as possible. They hope for a seamless transition. On the day that the loan closes, all contracts are terminated and must be renegotiated. You will have a new boss and eventually, a new practice culture and structure. New is not always bad (but is not always good either) and the new owner will be interested in making the investment work.

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Many large practices are purchased by corporations. Again, the new owners will be interested in keeping the staff and veterinarians that are currently working in the practice. They have defined it as successful enough to purchase and you are a part of the success. Some practice owners decide to close their practice. In this case, the practice was likely not profitable anyway or the present owner would want to cash out on the investment. If your owner plans to shut down at his/her retirement, this is something that you surely want to know.

5. What is stopping me from acting, either to pursue purchase or to solidify my future with the practice in another way? Fear- If you want to buy a practice, seek information. You will find that there are more resources and opportunities out there than you think. A profitable practice is a good investment for someone who wants to be an owner. If not your current practice, then there is another. Embrace your vision and your persistence. You can find a way to make it happen for you. Do not be afraid of the unknown and remember all the resources available to help you. Ignorance- There is a difference between ignorance and stupidity. Ignorance is a lack of awareness and stupidity is lack of intelligence. Make yourself aware. Explore your own traits and your goals for the future. You never have to fly blind with all the resources out there. Don’t be afraid to ask questions. You have every right to know. If your answers reveal to you that you might excel at practice ownership, take advantage of the resources provided here. No one wants to see colleagues fail and odds are the owner wants to feel good riding off into the sunset knowing that the practice is in good hands and everyone is happy.

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Finding New Clients isn’t Match.com, but You Still Want a Good Fit Kathryn Primm, DVM Applebrook Animal Hospital Ooltewah, TN

As a veterinary professional, you may not be looking for Mr. or Miss Right, but you are looking for Rights-Right clients. Just like every person that you ever dated, not all clients are right for your practice. Relationships take work and even some planning. Dating apps and websites have capitalized on compatibility. Guess what? You need compatibility too! Incompatible people are not a good match. You don’t want clients that are destined to be unhappy with you. You want clients whose basic ideas align with yours so you can find happily ever after.

So start with your own questionnaire but for yourself What do you want? Some people who are dating aren’t really interested in a long-term, committed relationship. Some people truly seek their soul mate and have specific goals for the relationship. Neither of these people is wrong. But if you tried to match a “player” with someone seeking marriage, it would be a recipe for disaster. They see the future in different ways and their life goals are different. That match would end in a parting and it might even get ugly. An ill fated match like that for a veterinary facility could end ugly too, with bad reviews and bad word of mouth. It’s important that you understand yourself and know which kind of relationship you seek before you ever fill out that online dating survey or go on a date. Expecting a good outcome from a poorly matched couple is like expecting oil and water to blend. What kind of practice do you have—or what kind of practice do you want to have—and how do you tailor your search for the clients that are right for you? Wham bam, thank you ma’am Some veterinary practices aren’t seeking committed clients. Their goal is to see the maximum number of patients in a given time and perform the minimum care. These practices provide a valuable service to owners matched to that model. Many pet owners want the minimum care that will meet state laws and that will cover the most basic preventable diseases and parasites. These practices cover their overhead with sheer volume. This is a valid business model, especially if you’re the type of person who thrives in a fast-paced, “low touch” kind of workplace. The staff and veterinarians at these practices focus less on making clients feel “warm and fuzzy” because they know the attraction for the relationship was based on the “basic needs only” plan. Doctors, managers and team members can get a warm and fuzzy feeling themselves because they know they’re helping a large number of animals get crucial care that they would have missed. In this type of practice, it must very clear that it is basic minimum care, so that owners do not misconstrue what they received and expect unreasonable outcomes. Communication is your best friend (again) in managing expectations. As veterinary students and staff members, we’ve been told to think we must provide state-of-the-art care to every client and patient no matter what. But if the entire profession follows this practice culture (and charges appropriately for it), there is an entire segment of the population of pet owners that will be underserved and some pets will get no care at all. There is a place in this world for minimum, quick care. Just be sure that the owners know that minimum quick care is what they are getting. Put a ring on it? Practices that strive for a committed relationship for the life of a pet are the ones whose focus is on building a strong healthcare partnership with their pet owners. These doctors and team members want to ensure a long and healthy life for the pets and a happy family with a strong human-animal bond. This type of practice is harder logistically, requiring longer appointment times and highly trained and highly motivated staff members who are aligned with these big goals for pets and clients. Time is needed with each client to address every facet of pet healthcare. These are the practices making extra effort to minimize patient stress and are more likely to need a large, well-appointed facility. Not every client wants or is willing to pay for this level of care. This type of practice covers its overhead by charging more per transaction because the overhead is high. Again, you must communicate with pet owners at every opportunity to make sure that you are on the same page with your expectations. A treatment plan should be presented prior to treatments and staff must be trained to explain every item with pros and cons. A passing fancy Some people in the dating scene have very specific quirks or visions for what they want in a relationship above all other factors. Maybe they like only brunettes or restrict their candidates to certain religious groups or political parties. These clients might prefer you if you fit the bill for their unique needs, maybe a cat only clinic or a specialty clinic. If your “getting to know your practice” survey revealed that you have something that might be attractive to niche clients, promote it. Make sure the world knows that you fill the bill where this area of interest is. Do you love to treat reptiles? Advertise it. Are you a behavior specialty? Your dating pool must

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include vets, trainers and other pet professionals as well as owners, but dating success may mean the pet responds to your treatment and is released. Settling down Many practices are a hybrid of the extremes above. Most of them have business models that work, and when properly managed, all can show profit. But just like dating, you have to ask yourself: What makes you happy? Does playing the field make you feel empty because what you really long for is a committed partnership? Is all the effort to build a relationship tedious because you just want to help lots of pets and then go home? Think about who you are and who you want to be in your practice. Make the necessary changes to your mindset and that of your staff to reflect your practice culture. If yours is a “Playing the field” practice, make sure everyone knows it by advertising discounts and specials. People may not want to admit it, but they know deep down that they get what they pay for and they should not be expecting comprehensive care from a low-cost spay and neuter practice, for example. If you’re a “Committed relationship” practice, highlight special, long-term pets and clients on your website. Make sure your staff is customer-focused. Practice and recommend the best medicine. Manage your schedule so that appointment times are never rushed. Spare no expense in making your facility look and smell perfect. Offer tours any time. Plan events and open houses. You’re looking for a long-term commitment from these clients—show them what you have to offer in every way. Lavish them with attention! And don’t worry too much about which practice model you decide is right for you right now. As life happens, you might change your mind. The bottom line is, for your happiness and success, you need to know what type of practice you have and what you’re really looking for from the entire client interaction. With some thinking, some planning and some intention to find the right client partners for you, maybe you can fall in love with veterinary medicine all over again.

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How to Grow- Not Fight- with Local Competitors Kathryn Primm, DVM Applebrook Animal Hospital Ooltewah, TN

Whether we like it or not, veterinary medicine is a business and business means competition. We are all in this wide world together and ethics dictate that we not succeed by virtue of the failure of others, but by our own merit. Knowledge is power and you can find your own way in this capitalist world by carving out your place and finding your niche. Learn all you can. Not because you want to "one up", but because you want to establish your own niche or way to stand out. Gone are the days where one vet makes every client with every species from all walks of life and demographic happy. We are no longer alone in our markets in most part of the world. James Herriot's world is past and we can't be everything to all people and animals. It makes us wistful, but comes with advances in all things. Dr. Herriot was the only vet in his community. He had no competition and he saw everything in the community, all sorts of animals and people. But he worked grueling hours and traveled far. He didn't need to make his niche because his niche made him. Our world is different.

Who is your competition? Define a radius around your practice that you feel most of your clients come from. From your software, print your top accounts for the previous fiscal year. You can use your cell phone from your office. Select your top clients (because these are the ones that are happy with you and you want more like them) and Google map the distance from their address to your facility. How far does the farthest travel to see you? Print out a page and draw dots of your furthest drivers. Grab your protractor and starting at their address make a circle around them that surrounds them with the distance they drive all the way around their home. Are there other vets in these circles? If so, these are your competition. Sometimes people will drive further to see you if they love you, but in reality, things have to be convenient for modern consumers. If there are other vets within the circles you have made, they are your local competition for your best clients. Now you know who they are. Get to know their practices. Make a list of those practices that are in the circles and sit down with your computer. Google search each one and find their websites. If they do not have a website, they have removed themselves from your competition group since many new clients come from internet searches and in today’s world, not having a website is a sign that they are behind in marketing. Make sure you have a website for your practice as well or you are the one behind! Check each clinic’s website for their mission and focus. In today’s online world, there are no secrets. You can easily find out all you need to know about the competition with a click. Try to meet the vets at the competing practices. They are friends and not enemies. You are all trying to make a living doing what you love and most vets are decent and hardworking. Developing a rapport can be helpful if you need to borrow items sometime or even discuss clients you have both seen. Attend local VMA meetings. These groups are designed to promote the entire profession and you will likely find the opinions and discussion of other veterinary staff is valuable to you. You can get to know what has worked in areas outside your coverage area too. Networking with other professionals is invaluable.

Species? For example, if your competitor spends time treating exotic animals, do you want to? Depending on the population in your area, there may not be enough exotic pets to justify your expense in tailored products and pharmaceuticals for more than one practice. Initiate a conversation with him/her about the ROI he sees on these patients. If he has a specific desire to treat them, refer calls at your practice to him and discontinue your treatment of them. If you are the one who loves them, make your case for why he should send calls your way. If your competitor tells you he has more than he can see, perhaps you can redefine which species you each prioritize.

Services? No one can be everything to every client. Does your neighbor offer all the services that you do? Is there overlap? One of my close neighbors does not offer boarding at all. I have an entire building for kennels. He is not interested in boarding at all and finds it a hassle. I adore having my boarding (for known clients only) as a an added value service for my clients. We are both happy with our offerings on this front.

Grooming?

Surgery? Maybe your neighbor loves orthopedic surgery, but you do not. Could you work something out where he could do the procedure and return the pet to you? Remember, if your clients are happy with you, they will not stray to a competitor just because they spent time there.

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Dentistry? Do you have any equipment you could offer access to? We have digital dental radiology, but some of our neighboring practices do not. We have communicated that we have this technology on our front sign and occasionally my competitors will send a patient in for a dental radiology consult. I am happy to act as an imaging center in these cases and return the pet to their care with diagnostics in hand.

Hours? My area is not typical. We have learned that our clients do not take advantage of our Saturday hours very often, so we tracked them for a year and based on that data decided to only offer Saturday hours one day per month by appt. The two geographically closest vet clinics have discovered things about their own clients which ironically are very different from mine. One offers only Sunday hours and is closed on Saturday. The other swears that he does more business on Saturday than any other day. So we all coexist. Occasionally my clients will see one of them on weekends, but they seem to always return to me and we all feel good about our hours. My clients have gotten used to my hours and I believe it is a quality of life issue for my staff and since most Saturday hours failed to cover overhead, it was an easy choice.

Culture? You have probably heard mention of the practices around you. You should never take what disgruntled clients say as the whole truth, but it might give you a hint about their practice culture. Do clients complain about wait time or feeling hurried? Maybe they are a low touch, high volume practice (which could indicate you should be different) Many times the website description will give a hint to the mission and culture of a practice. For example, if the text says, "We make extra time at each appointment to be sure that all your questions are answered." Then you may surmise that (at least in theory), the practice wants to be higher touch and lower quantity. Sometimes the answer lies in what they don't say or even show. Remember, if a clinic does not have a web presence at all, you might think that they have not kept up with current trends. Let’s examine some examples of web sites and see if we can surmise the practice culture.

Any special initiatives? Is your neighbor promoting some initiative, like being Cat Friendly or is she trying to grow her dental practice? If so, it doesn't mean that you can't pursue similar initiatives, but you might highlight differently. Play to your strengths and let them play to theirs. Are their initiatives something that redefines the standard of care for your area? Things like Fear Free and your lack of participation could make you look like you do not care about fear. Seeing how hard your neighbor promotes their enterprises can help you decide how you will handle yours.

What about products? Some of my local competitors offer products that I have elected not to. Some clinics have no inventory and some find that they move a lot of products. In the world of PetMeds, you have to decide for yourself what you will carry and how much. Find out from your competition what they offer. Do they offer an online store? It should be obvious and readily available through their website, so you can find out.

Reputation Read the reviews for their practice and your own. Can you make sure that you are meeting the needs of those that are not satisfied with them? Find themes among the reviews and make sure that your practice does not have similar complaints. Don’t forget that not all reviews are honest and some are disgruntled through no fault of the clinic, but you can learn from the review and learn. See if they respond to their reviews. This is something that should be happening. If they are not, be sure that you are. Be kind and non reactive. Try to direct the complainer to contact you personally for a resolution.

Do your homework Maybe communication and cooperation could benefit you both. At the very least, knowing what you are up against will benefit you in the long run and help you be the best you can be. Even if your competition is formidable, no one can be everything to every client. You can find ways to balance offerings and fill gaps so that you can both survive and thrive in your local jungle.

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Paid Social Media: The Art of “Pay to Play” on Social Networks Bill Schroeder InTouch Practice Communications Scherervilee, IN

When the Internet was first developed it was wide open space much like the wild west. In those days when a website made claims about being the best or the most convenient business, the search engines often responded by positioning that website high when web users requested that information. As the web became more congested and competing websites made similar claims, the search engines needed to develop algorithms that sorted authentic content from that which was less than genuine. I like to describe this situation to be very similar to a piece of electrical conduit. When empty, it is very easy for an electrician to push a piece of wire through the metal pipe. As more wires are introduced to the pipe it becomes incrementally more difficult to introduce additional wires. As a result, wire lubrication, additional force, and/or alternative conduit needs to be installed in order to deliver the wire. Do you see the connection? Often, special effort needs to be paid towards getting your practice’s message on top of other practices that are ranking organically. When you combine this crowded factor with the fact that the search engines need to monetize their efforts through paid advertisements, it should be quite easy for you to realize how paid search was born. Over the years web users have grown accustomed to seeing a combination of organic and paid search results when using search engines like Google, Yahoo, and Bing. As social media became more popular, those channels found themselves in exactly the same position as they are mainly free services that need to monetize and have particular usefulness for businesses like your veterinary practice. Social channels also have a unique interest in limiting the amount of advertisements that a personal user will be exposed to at any given time so as to limit the possibility that the user will abandon the channel because of very frequent advertisements. From the very beginning of social channels like Facebook, YouTube, and Twitter, users have been sharing information about their personal habits, likes, dislikes, locations, age, gender, relationship status, profession, and many other aspects of their personal lives. This information has been tracked and stored as a part of each user’s profile. Advertisers benefit by being able to properly target those and channel users who best fit their target market. This situation presents a very unique opportunity because ads can be presented to those social media users without the user searching for keywords or phrases that traditionally drive organic and paid search within the search engines. It is a true "push" environment that serves up relevant information to users who fit the advertiser’s demographic. Social channels have been known to only serve ads that get the most traffic and ultimately convert well for the advertiser. This prevents advertisers from blanket marketing across the network and flooding the space with irritating ads. In order to be effective in social advertising, you must realize that those who are exposed to your ads are probably not in the mindset of your product while they are browsing their social channels. For that reason, your ad needs to be "disruptive" and hard- hitting. By disruptive I mean that it needs to stop the social user in his or her tracks and immediately shift their attention from being a casual social user to one who is now interested in your practice’s offering. During the lecture we will take a deeper dive into the actual creation of disruptive ads and provide some understanding of exactly what it means to stop hey social user and cause them to change direction towards your practice. Before you embark on any paid search plan through the search engines or social media, it is extremely important that you conduct great keyword research. Many successful practices engage the services of SEO firms at this point. Professional analysts are capable of conducting research into your practice’s market and determining which keywords and phrases are most valuable. With this information in hand you are more prepared to create copy that will effectively engage social users. High-quality imagery, videos, and motion overall have all been known to be extremely important when developing effective social media advertising. Take a moment and scroll through your favorite social media channel and notice the advertisements that cause you to stop what you're doing and pay attention to their message. More than likely they are advertisements from firms that are within your field of interest and provide a different view or look than the typical post within your feed. This is disruption. My experience is that you have less than one second to stop a user from passing your ad. During the lecture we will take a look at several good and bad social media ads so that you are most comfortable with effective techniques. After you have created your ad and have launched it on your social channel, it is important that you understand the value of properly receiving someone who clicks the ad. I am referring to the specific treatment of the landing page designed to receive this user. It is extremely important that the landing page created is customized for this particular user and immediately addresses the subject matter at hand. Imagine a situation where you are shopping for a television. Through a Google search you are directed to a television manufacturer’s website. In the first scenario you are directed to the television manufacturer’s homepage and then exposed to their entire brand. In the second scenario you are directed to the section of their website that deals exclusively with televisions. On this

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page you are allowed to select which features apply to your current need. I ask you…which scenario is the most useful? I suggest the latter is more beneficial as you will spend less time searching for the information you need and more time actually drilling down into the feature set that this manufacturer offers. Your website and practice is no different. When utilizing social pay per click advertising, you must create dedicated and custom landing pages that are focused on the subject matter of the ad and provide information for the web user that directly addresses the problem and remedy demonstrated in the social ad. During the lecture we will take a close look at the journey a social media user takes and demonstrate the different feeling created by a custom landing page as opposed to directing a social user to your practice’s homepage. Advanced pay per click users understand the benefit of retargeting their website visitors so that they have additional chances to have impact upon them. This strategy involves identifying the people who have visited your website, noting the reason they visited, documenting their actions while they were on your page, and creating additional ads that are custom developed around those facts. This technique is known as retargeting and can benefit practices by circling back and re-engaging with prospective clients who have not converted during their initial visit. This is a true second, third, or fourth chance at influencing the prospective client with enticing ads well placed within social channels and internet search. I am certain that you have been exposed to retargeting yourself. Just the other day I was shopping for a tent for my daughter's birthday present. I did not make a purchase the first time I was on the sporting goods store website however I spent a considerable amount of time reviewing the features of one particular tent. In the days that followed that experience I was served up advertisements offering additional incentives if I clicked that ad and continued my journey down that website’s consumer funnel. The ad contained a picture of the tent I was looking for, a list of the main features, and the call to action that included a 5% discount if I utilized that link at that time. Well, the end of the story is that my daughter now owns a tent. During the lecture we will examine how retargeting works, discuss some best practices for utilizing retargeting in a veterinary practice’s plan, and allow you to set up a plan for successful retargeting your previous website visitors.

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Protecting Your Practice with a Great Social Media Policy Bill Schroeder InTouch Practice Communications Scherervilee, IN

Most successful business owners understand the value of creating great policies for they become a guiding light that allow the business, its employees, and even its customers to operate efficiently under known and predictable circumstances. If done correctly these policies can help form procedures and ultimately the flavor and brand that pet owners become accustomed to when relating to your practice. With the rise and huge popularity of social media, I am forever amazed by practices who fail to realize and implement effective policies and procedures for social media behaviors. Please understand that I am not an attorney, nor should any portion of this content be taken as legal advice. Instead, utilize this information as inspiration towards creating social media policies and procedures that best fit your practice climate. I strongly suggest that you involve your legal counsel and/or human resources advisors when creating your social media plan as they will have specific understanding of your local laws as well as previously developed Human Resources policies that are already underway at your practice. The purpose of these proceedings and lecture are to facilitate a conversation about social media policy, highlight some situations that should be addressed or considered within your practice, and ultimately provide you with the understanding of how important it is to have a social media policies and procedures handbook within your practice. Anytime I discuss creating policies or procedures for my business I feel that it's necessary to mention how important it is to utilize metrics that are easy to track, contain reasonable goals, and are ultimately enforced on a unilateral basis. For example, creating a policy whereby employees need to respond to all social media posts within 30 minutes of the post being made may be unreasonable and unenforceable. Your legal counsel or human resources advisor can help you craft language around effectively addressing time frames for social media response. When speaking of enforcing the policy and applying consequences towards failing to follow the established policy, you must be careful utilizing language that you are not willing to enforce in all instances. Meaning, if you say that an action will result in an employee's termination, you must be willing to enforce the policy with your most valuable staff member as well as the person who makes the same mistake but is much less valuable to your practice's success. While this is very basic human resources guidebook creation advice, I felt it was necessary to mention considering my recent exposure to several social media policies and procedures manuals that were created at the practice level. It appears as though many practices have allowed social media managers without proper human resources and policy creation experience/training to develop social media policies that are applied inappropriately to the practice environment. This is obviously a very serious situation that should be guided by conversations and documents like this but ultimately developed and approved by professional human resources and legal advisors. My experience within this space and lecturing on this topic has allowed me to understand the value of group discussion. For that reason, I have created a list of items that many practices should consider when developing a social media policies and procedures manual. You will be in a lecture hall with many of your peers. I will facilitate a conversation that will include experience based dialogue involving audience members, utilizing my experience running a small business within the veterinary space, and working with many practices across the country. This approach will highlight situations that other practices have experienced and allow you to create a series of questions or "what if” scenarios that can be organized and properly presented to your legal and human resources advisors. In doing so, you may experience great savings by being efficient with time and effort attempting to imagine obvious and less than obvious scenarios with an attorney who charges by the hour. While I plan on addressing all of the below questions during the lecture, it should be understood that this guided, yet free flowing conversation may lead the conversation along the path of the room’s most important issues. I will guide the conversation through the experience and assure that many needs are addressed and met as possible.

Topics for our lecture conversation • Will you allow your employees and practice owners to be “friends” on social media? • How will you handle employees who want to befriend clients on social media? • Who will post on your practice social pages? How often will they post? • What content will be posted on your social pages? Where will it come from? • What are the consequences for using content that the practice does not own? • Who will approve the content? Will there be a process for review? • How will your practice respond to positive and negative reviews left online? • When will you seek legal advice? • How will you handle extreme circumstances created by social media.

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• Has anyone in the lecture been bullied online? How did you handle the situation? • Is it possible to create a policy that prevents employees from commenting about your practice? • Can you insist that an employee make their personal social profiles public or private?

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Why Should Corporations Have All the Fun? Use Logo and Colors to Create a Memorable Experience Bill Schroeder InTouch Practice Communications Scherervilee, IN

I'm sure that most veterinary professionals will agree with me that the average pet owner does not know the difference between good or bad veterinary medicine. With that said, I often struggle with the common approach or message that many veterinary practices utilize to market their businesses. All too many of our peers make statements like "we practice the highest quality medicine in the tri- state area" and expect pet owners to be able to understand what that means and somehow differentiate that message from the exact same message that practice down the street is utilizing. While pet owners are not veterinarians they are consumers who are accustomed to experiencing other brands and businesses that they don't understand. Often times, they do so by making decisions confidently out of emotion and overall comfort with the way a brand makes them feel. Many of us have had the opportunity to share the experience of Disney theme parks with our children. While there we were greeted with smiles, happy thoughts, pleasant music, tasty treats that might not be readily available back at home, and overall fantasy like experiences set in a very pleasant climate. As we walked down Main Street, heard the songs play over the speakers, and watched the characters interact with us, we were being subjected to their branding plan that had much greater impact than the immediate space we were within. These pleasant feelings were tucked away and saved once we got on the airplane and headed back home. Then, when our children popped in the Disney videos or when commercials are shown for products Disney offered, those familiar sounds and images brought back pleasant memories that made us feel good by remembering the experience we had in their theme park. Making a purchase outside of the park supports that positive feeling and ultimately keeps us closer to the Disney brand. There have been many studies done about the massive world brands that are Disney, McDonald's, and Nike. Countless numbers of marketing students have dissected those brands and have identified overt and covert techniques utilized by their marketing agencies to affect their consumer base. In the end, the game of influencing their target market becomes a much more psychological game than expected. Please understand that this talk is not about attempting to "Disney up" your practice. The resources required to do so would never be covered by the revenue experienced. Besides it's not necessary for you to do so because the market you are looking to affect is much smaller. With that said, it is important that you understand the value of creating a brand, doing so consistently, and relating that branch to your current and prospective pet owners so that they can develop feelings about your practice that are share worthy and memorable. In doing so, you will build a relationship with your client base that is less likely to be penetrated by less sophisticated competing marketing messages. Often times when I begin a conversation with a current or prospective client about branding they lean towards color palette and logo. This is a great place to start, however at the very beginning of this conversation, I feel it necessary to pause and establish the understanding that it goes much deeper than appropriate selection of color and making certain that the logo demonstrates that you're a veterinary practice. It involves creating a culture and feeling that parallels the experience a pet owner will have when visiting your practice and creates a Disney like memory. Simply put, when they are reminded about your practice by exposure to your logo, veterinary related issues, or their pets, you have supplied them with enough historical and emotional information that they can immediately recall the experience they had while in your practice. This is far from a quick fix approach. It is a long term culture shifting process that requires you to perform a great deal of self- examination and process building so that your brand becomes unique and recognizable. During the lecture we will discuss some very common branding techniques, ways that you can learn about who you are and who you want to be, and how your staff can help you develop and support those branding feelings that have a great impact on your current and prospective customers. For the purposes of this talk we will spend a considerable amount of time focusing in on one of the most obvious, easy to understand branding techniques: logo design and color selection. I should caution you though that while this makes an extremely good visual presentation, it is very difficult to explain using the written word. I find myself creating these notes and being in a position that is very much like describing the color blue to a blind person who has never had the opportunity to experience color. So, with that said we will discuss some logo best practices here and will save visual demonstrations for the actual lecture. When creating a logo for your practice you must focus on customization. It is extremely important that you not utilize stock clip art images or those images found on Google when creating your logo. Issues revolving around copyright infringement and other brands being able to utilize the same image or design for their business can cause legal issues or market confusion. This is an example where you should always seek professional assistance when developing your logo. Unless you are a graphic artist, you are not a graphic artist. The adage of not knowing what you don't know certainly applies here and can cause great additional expense if your logo is not done properly. 642

I recently was exposed to a practice that had a friend develop their logo. This friend utilized imagery that was readily available through Google search and actually developed a pretty good design. The practice took this logo, created business cards, brochures, lobby signage, and a very large lit sign for the street in front of the practice. All of these pieces contained their new logo. Part of their redesign was to launch a new website. After a few months they received a letter from a very well-known graphic artist that found her artwork as being a part of that practice’s the logo and insisted upon having the logo removed or a fee of $25,000 paid for use of her artwork. The practice elected not to pay the fee, removed the logo from all print work, signage, and their website and took a loss in that they had to re-create a new logo and all of the supporting materials I previously mentioned. Being as though I have first-hand experience with this case I am extremely confident that the friend of the practice meant no harm. In fact, she had no knowledge that she had done anything wrong for the images she used were readily available on Google search. Her mistake, and the mistake of the practice, was purely a lack of knowledge and experience. Over the years I have been honored with the experience of helping many practices envision, develop, and produce affective logo design. Very often these ideas stem from simple conversation or epiphany like moments that demand “pen to napkin” design. While this grass roots, very raw approach is extremely appealing to me, it is very important that you understand the impact of converting those napkin or sketchpad designs over to a digital format. Many practices do not have a digital copy of their logo and are restricted buy the quality and flexibility of a flat, unchangeable logo design. While working with a professional designer you should have the ability to receive all art components in a digital format so that they can be manipulated for future use. If done properly, it is very easy for adjustments to be made to a logo’s colors or size because many components are saved as individual layers that can be separated and manipulated independently. If you are currently in the position where you do not have a digital copy of your logo, please seek the services of a professional design firm that more than likely will have the ability to convert your logo over to a digital format and provide you a crisp, very flexible version for future use. Responsible logo design involves looking at your logo project from many different angles. At the time of the logo creation you should always consider how your logo will be used and seen on different mediums. One great place to start is with color. I highly recommend that you insist that the graphic artist deliver the first versions of your design without any color being applied. This will allow you to experience the logo without any influence of color and demonstrate that it will be able to stand on its own when utilized in a black and white fashion. Failing to do so can easily put your project in jeopardy as similar or blending colors used in a logo can cause images to be unrecognizable when only "grey colors" (black and white) are available. After proving that your logo can stand on its own without the assistance of color, I suggest that colors are applied and tested. When speaking of color, it is important that when you establish a color palette for your practice, that the artist or agency you work with provides you with the color codes that match the colors you selected for your brand. These codes lead future designers and printers to the exact color match so that brand consistency is possible. In the design and print space, these colors are referred to RGB and CMYK color codes. Next, focus on size. Choose designs and fonts for text that are as easily readable on a business card as they are on the sign in front of your practice. All too often I come across logos that are developed and approved by practices in a large format but when shrunk down to the size of a business card, they become unrecognizable globs of ink that actually make the practice look less than professional. During the lecture we will take a deep dive into logo design. I will run through some logo best practices, give examples of logos that clearly demonstrate a business’ purpose, and will demonstrate common mistakes made when creating a practice logo.

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Online Pharmacies: Take in the Good, Get Rid of the Bad Denise Tumblin, CPA Wutchiett Tumblin and Associates Columbus, OH

“Many online pet pharmacies are reputable. Some, however, may be businesses breaking Federal, State, and sometimes, International laws. These illegal online pharmacies may sell medicines that are counterfeit, outdated, mislabeled, or incorrectly formulated. The medicines may not contain the actual drug or may contain incorrect amounts of drug. Some may not work as well if the product is old/expired or has been stored in conditions that were too hot, cold, or humid. Others may not have the proper directions for use. If you are unhappy with the products you ordered, you may not be able to get your money back from an illegal online pharmacy”, Protect Yourself and Your Pet, Be A.W.A.R.E US Food & Drug Administration, Animal and Veterinary, Online Pharmacies Medical products are a key part of patient care and client compliance. They may not realize it, but clients receive amazing benefits if they purchase medications like heartworm, flea, and tick products from you rather than a pet specialty store or Internet pharmacy. Your job is to educate them about these benefits. Emphasize your quality control for handling and storing drugs. Share information about manufacturer guarantees. Highlight the convenience of purchasing necessary medications during client visits or ordering from your practice’s on-line pharmacy. Plus – and this is very important – be sure clients know that your products are comparably priced. Many national retailers claim that they’re less expensive, but often it’s simply not true. Clients, however, don’t realize this unless you point it out. The potential impact on revenue from lost product sales is significant, and many Well-Managed Practices® are feeling the pinch. See Figure 1 for a year-to-year comparison of self-reported changes in pharmacy revenue. In a 2015 study conducted by Vets First Choice of 2.3 million transactions for 263,000 dogs analyzed over a 12-month period across 99 practices, the study found that heartworm compliance was just 25% and flea/tick compliance was just 16%. The financial impact of clients walking out without a recommended prescription is huge – the opportunity cost per practice in the study was $400,000 a year. A 2003 study by AAHA showed that compliance rates for therapeutic diets was even worse – canine compliance was just 19% and feline compliance was just 18%. Dr. Bob Beede, co-owner of Intermountain Animal Hospital in Meridian, Idaho, refuses to let that income go without a fight. “We must take action or lose market share,” he says. “We could keep our heads in the sand until we have no product sales, or compete by offering our own online pharmacy. We’ve chosen to compete. We tell our clients that, in this economy, we’re trying to help them,” Dr. Beede says. “We can sell the products online from our trusted sources at a lower cost, since we’ve eliminated our handling costs. The clients understand this and give us kudos for caring about them.” According to Marsha Heinke, DVM, EA, CPA, CVPM, inventory ordering costs alone can amount to 8% to 15% of the product cost. These costs include all the tasks to determine the inventory needed, meeting with representatives, placing the order, receiving, documenting and putting the order on the shelf, and then documenting the order for bookkeeping purposes. An additional 25% to 40% of the product cost must be added to include the cost of the capital tied up, property taxes, insurance to guard against damage, theft, or other loss, spoilage, and time and paperwork to meet OSHA standards. “The holding and order costs, combined, comprise 25% to 40% of the total unit cost depending on the amount of time the inventory is on the shelf, the success of discouraging pilferage, and the efficiency of purchasing,” says Heinke. Key objectives and observations from Benchmarks 2016 Well-Managed Practices® related to their online pharmacy include: • Use an online pharmacy to improve practice operations and internal functions • Leverage the use of technology to increase efficiency and productivity by better using the online pharmacy and helping clients set up auto-refills • Use auto-prescription refill reminders and auto-ship refills from the online pharmacy to increase efficiency • The online pharmacy is one technology “thing” that has provided the biggest ROI Using a digital prescription management platform that includes a way to pre-authorize, and/or recommend, approve, and renew prescriptions, a way for clients to purchase the recommended products online and receive automatic shipments where applicable, and a dashboard to prompt action and document and track performance can significantly improve client compliance. A January 2017 white paper published by Vets First Choice reported results from a 10-practice Pharmacy Study Group (PSG). The practices identified the following major benefits they’ve received as a direct result of their digital prescription management platform: 1. Improved compliance including for diets. 2. Gives the practice the ability to offer more products without the capital investment required to stock them in house. 3. Allows the practice to have more visibility and control over compounded medications.

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4. Enhanced client convenience making their lives easier. 5. Allows the practice to shift in-practice product inventory to higher margin products. 6. Frees up cash to invest elsewhere in the practice. 7. Allows staff time to focus on caring for clients more vs. handling inventory. 8. Helped grow practice revenues. 9. Did not cannibalize in-house sales or profits. 10. Allowed the veterinarians to focus on medicine while being more productive. The PSG reported the following aggregate revenue performance results: • Total practice revenue increase of 8% ($1.8M) • Service revenue increase of 8% ($1.3M) • Lab revenue increase of 15% ($756K – part of the service revenue) • In-house product revenue decline of 4.5% (-$257K) • Online product revenue increase of 59% (734K) Net gain $477K • The per veterinarian growth results in the PSG were: • Total practice revenue increase of 14% ($88K) • Service revenue increase of 14% ($65K) • Lab service revenue increase of 21% ($30K – part of the service revenue) • In-house product revenue increase of .5% ($800) • Online product revenue increase of 67% ($60K)

Get started with your own practice on-line pharmacy Start small As with anything new, start small and start easy. Make a few select products or product categories available online. Preventive medications, medications for chronic conditions and therapeutic diets are great opportunities to establish success. Look for situations where a client maintained your recommendations for a short period and then stopped. Help the client set up the pet’s prescription in your on-line pharmacy. Get staff buy-in Hospitals that are using digital prescription management platforms successfully have the support of the entire practice team. Take time to discuss with your staff how your online pharmacy enables you to practice better medicine and provide better service. Motivate your employees to promote your online pharmacy by creating contests for capturing walkouts (clients who leave without their prescribed medication), establishing team targets or goals, or by simply asking team members to fill prescriptions for their own pets through your online pharmacy. Once your staff has experienced the convenience themselves, they’ll be your biggest advocates! Talk it up Discuss the practice’s online pharmacy capabilities everywhere: in the exam room, during discharge, and on the phone. Let clients know your clinic’s on-line pharmacy means they can purchase their pet’s medications from you online, at competitive prices, and be assured that the drugs have been handled and maintained properly and are labeled for use in the United States with the manufacturers’ guarantees in place. And, their money stays local. Most clients using direct-to-consumer pharmacies do so out of convenience and may not know you offer an online pharmacy too. Get peer input There are clinics all around the country that have embraced digital prescription management and can help you understand the process and benefits of the online approach. Ask how they implemented their practice online pharmacy. Ask staff to keep their ears open What prescriptions do clients ask you to send to outside pharmacies? Add those items to your online pharmacy for client convenience and to retain the revenue for the practice. Create a script for staff members to follow when they receive requests to forward prescriptions to outside pharmacies. If you pay attention to what clients want, you’re more likely to keep their business. And don’t forget to educate your clients about the benefits of supporting locally-owned businesses. Multiple studies show that buying from locally-owned businesses keeps more money in the community. • A 1995 landmark study of new Wal-Mart stores conducted by Iowa State University professor Kenneth Stone found that 84% of Wal-Mart’s sales simply shifted dollars away from existing local merchants versus creating new sales in the community. • A study conducted by Civic Economics found that approximately 73% more money stays in the community when consumers choose locally-owned and independent businesses. • And The New Economics Foundation, an independent economic think tank based in London, England, compared what happens when people buy produce at a supermarket versus a local farmer’s market or a community-support agriculture program and found that twice the money stayed in the community when folks bought locally. 645

Here are five reasons to patronize a locally-owned veterinary practice. 1. Employment opportunities - small, locally-owned businesses are the largest employers in the U.S. Veterinary practices employ your family, friends, neighbors, and family and friends of friends. While sales in the 500 largest corporations grew 700% in the past 20 years, they are now net dis-employers – firing more people than they hire despite record profits. 2. Client service and patient care – locally-owned veterinary practices hire people with specific skills and continue to develop their expertise, thus strengthening employees’ abilities and providing better service to clients. Locally-owned veterinary practices focus on developing healthy, long-term relationships with their patients and clients. 3. Investment in the community – the owners of locally-owned veterinary practices live in the community, are less likely to leave, and are more invested in the future of the community. Veterinarians and their staff volunteer, serve on boards of non-profit organizations, support local schools, support and participate in community activities, and donate to worthy local causes. 4. More money stays in the community – local veterinary practices purchase from other local businesses. Buying local goods and services helps grow other area businesses and speeds the circulation of money in the community. If money circulates more quickly and passes through more hands, more people have the benefit of the money and what it purchases for them. 5. Maintain a unique community character – people are attracted to communities that preserve their one-of-a-kind businesses and distinctive character, but often forget their survival depends on our patronage. A marketplace of small businesses is the best way to ensure innovation over the long-term. Veterinarians are painfully aware of the cost of inventory, the importance of having the necessary inventory items when they’re needed, and the importance of preventing loss from shrinkage and out-of-date drugs. However, many practices lack the time, manpower, or processes to effectively manage inventory. If you haven’t yet developed a solid inventory management program, it’s time to get started. Don’t be shy about asking for help. Many management consultants, veterinary distributors, pharmaceutical manufacturers, online pharmacy platforms, and practice management software companies offer guidance to help practices establish an effective inventory management program. It’s never too late (or too soon) to get started! Take steps today to protect your pharmacy. Communicate the benefit of buying from you and supporting locally-owned businesses. Pay attention to your medical standards of care and monitor consistency between the doctors. Track and monitor compliance to identify opportunities for additional, necessary care. Establish your own online pharmacy, and stock products in house from your trusted sources. Proactively market your practice to educate clients and your community about the services your offer. Follow up on unsatisfied reminders for appointments and prescription refills and take responsibility for getting necessary appointments scheduled and the prescription refilled. The results will be worth the effort!

Figure 1 – Slipping product revenue How much has your volume of medication dispensed declined in the past two years because clients are using other sources to purchase their products? 2005 2007 2009 2011 2013 2015

No change 19% 15% 13% 13% 23% 9% Less than or equal to 5% 65% 63% 52% 48% 34% 41% 6% to 10% 12% 27% 28% 32% 38% 25% 11% to 20% 4% 3% 5% 7% 5% 5% More than 20% 0% 1% 2% 0% 1% 3% Our volume has increased 17%

Source: Benchmarks Well-Managed Practice Studies by WTA Veterinary Consultants and Veterinary Economics

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The Elusive 20% ROI: Can it be Done? Denise Tumblin, CPA Wutchiett Tumblin and Associates Columbus, OH

As a practice owner, you’re well-versed in the risks and rewards of owning a business. You may even have days when it feels like the risks and hassles outweigh the rewards by a large margin. Owners of Well-Managed Practices tell us their biggest challenges are maintaining efficiency, productivity and profitability. If you’re nodding your head in agreement, read on. It’s a fact: Downward pressure on profit continues. Well-Managed Practices now have an average owner return (ROI) of 12 percent. That’s what’s left for the owner after all operating expenses are paid, including variable expenses, fixed expenses, staff compensation, facility costs, associate and owner doctor compensation and owner management compensation. That’s low. Declines in profitability impact your ability to pay the bills, offer competitive wages and benefits, buy new equipment and protect the investment value of your veterinary practice. It’s time to improve profit. Aim for an ROI 2 to 4 percent higher than last year. Aim for a 16 to 20 percent ROI within the next three to four years. See Figure 1 – How to Get to 20% ROI. Seem impossible? Suspend your disbelief just for a moment and stick with me. Instead of, “We can’t do . . .” or “That will never work because . . .,” open your mind and explore the possibility of, “What if we could do . . .” or “How can we make a change in . . .?” A profitability turn-around takes planning, focused attention and changes to your processes to boost efficiency and productivity. Some of the required changes may be painful. You’ll possibly encounter resistance along the way. Persevere and encourage your staff to hang in there because the results will benefit everyone. Watching what you spend may come naturally in your practice. You work with a practice budget, compare your numbers to the WellMP benchmarks, and adjust your spending when necessary. If so, kudos to you and your staff! But if you’re not quite where you’d like to be when it comes to taking charge of your expenses, now’s the time to put your expenses on a diet. Rather than adopting the “starvation” approach to accumulate the extra cash, start with these Five Easy Slim Downs and these benchmarks to help you pinpoint where your spending is a little heavy. Then get started with your practice slim down to save that extra $10,000 to $20,000 and boost your ROI to 16% or above. 1. Pare down your drug inventory. If your shelves are looking a bit bloated, it’s time to eliminate the excess. Veterinarians have many wonderful drugs to choose from to treat patients. But carrying every wonderful medication that’s available ties up a lot of cash and creates confusion for the staff and for clients. Doctors – unite! Create a list of the medications that you believe in the most. Conduct a scientific comparison of the duplicate products you have on your shelf. Consider the pros and cons, safety, and efficacy of each. Make your case scientifically and medically and come to a consensus among the doctors about what’s your best and second choice. Then eliminate any other redundant items from your shelves. a. Tip: Stock $10,000 to $16,000 of drugs and medical supplies per full-time equivalent doctor, or about one month’s supply. This includes heartworm, flea and tick products and excludes diets. b. Tip: Spend 8% to 9% of revenue on drugs and medical supplies. Spend 4% to 6% of revenue on heartworm, flea and tick products. c. Tip: Move infrequently-used medications and large bags of diets to your on-line store. 2. Evaluate your labor cost. What one or more things could you do differently to increase efficiency and productivity in your hospital? It’s not unusual for different practices to have the same level of staff support, but significantly different levels of doctor production. I’m currently working with two practices, each with a 4 to 1 staff-to-doctor ratio; one generates about $440,000 of medical revenue per FTE doctor and the other generates $670,000 per FTE doctor. What accounts for the $230,000 difference? Explore the following opportunities to rev up your practice’s productivity. a. Do more with less. Bump your pay scale to attract more skilled and efficient employees. We’ve all experienced the employee who seems to get twice as much done in half the time as two other employees combined. You might find that an employee who merits $18 an hour could easily complete the work of two, less productive $12 an hour employees. The result: an annual savings of $10,000 to $12,000 depending on the benefit package. b. Streamline your processes. It’s easy to get into the routine of “that’s the way we’ve always done it.” Take a fresh look at your protocols – are you doing things the easiest, most efficient way, or could you streamline the process? Are staff members duplicating efforts? Eliminate the redundancies. Are you taking extra time to track information that no one is using? Then stop. c. Tip: Hold a contest for your staff. Ask each staff member to submit one or two ideas to improve efficiency throughout the hospital (reception, exam rooms, treatment, surgery, boarding, etc.). Give awards for the top

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four ideas (first, second, and third place, and honorable mention). Be sure your awards are meaningful and compelling. For example, first prize gets a paid day off; second prize gets a gift certificate for a local spa; third prize a gift certificate for a favorite local restaurant; and honorable mention gets tickets to the movie of their choice. Or, you could let the winners choose which award they would like out of your offerings. d. Get organized. Clutter and untidy work stations add to the chaos of busy days. Spend a day eliminating the mess. Move frequently used items to more accessible parts of the hospital to eliminate wasted steps. Move rarely used items to storage. Get rid of items in storage that you haven’t used for a year or more. Adopt the creed: reduce, reuse, recycle. The hospital will look better, and the doctors and staff will feel better and be more productive! e. Convert under-utilized space to a medical purpose. Some hospitals have idle or under-used space that’s begging for use as a medical area. For example, convert a food storage space to another exam room. Convert an under-utilized retail space to a patient discharge room. Convert an under-utilized storage space adjacent to treatment to a dental suite or a procedures room. f. Tip: Hold a contest for your staff to solicit their ideas about under-utilized areas of the hospital that could be converted to medical use. Give awards for the top ideas (see suggested prizes above). 3. Bump up your use of technology. Update and/or replace hardware to reduce wasted time waiting for the computer to process or recovering from a crash because the system can’t handle the hospital’s current needs. Update your software to the latest version. Replace your software if the company hasn’t provided updates for years or their support is poor. Convert to electronic medical records to eliminate wasted time searching for lost or misplaced records. Technology saves time and reduces frustration when used well. a. Tip: Hire a trainer from your practice management software company to spend a day with your staff teaching them more about your software’s capability. Staff members know the basics. But they may not be aware of all the shortcuts that help streamline their work, or the options that help enhance client service and patient care. The return you’ll receive will be much greater than the cost of the training. Example: One veterinary practice estimated that the knowledge they gained from the training saved three staff members an hour a day, which amounted to an annual labor savings of about $15,000. 4. Revisit your administrative costs. It’s easy for fixed overhead spending to creep up without realizing it. Don’t let the word “fixed” change your mind about giving these expenses another look. a. Use e-mail for reminders, newsletters, educational materials, and other client correspondence instead of the U.S. postal service. Postage adds up and clients may actually prefer to receive information via e-mail. b. Take stock of your office supplies. Organize your inventory in one central location so everyone knows what you have on hand before requesting and ordering more. Change reorder points to minimize the amount of inventory you have on the shelf before placing a new order. c. Evaluate employee health insurance. Talk with your insurance agent about health insurance policies with higher deductibles and co-pays. Sometimes the premium savings is greater than the difference in the deductible, so you can offer to pay part or all of the difference in the deductible and still lower the practice’s cost. Ask your agent to research other policies with lower premiums and similar coverage options. Consider having employees cover part of their health care. d. Assess your Workers’ Compensation Insurance rates. Coverage managed by a private insurance company, if an option in your area, might offer better rates than a fund managed by your state. e. Conduct an energy audit in your practice. A professional energy audit gives you a clear picture of where your practice is losing energy and what you can do to save money. Possible resources to conduct the audit include your state or local government energy or weatherization office or your electric or gas utility company. Per www.energy.gov, you can save 5% to 30% on your energy bill by making the recommended upgrades. Visit www.greenyour.com for an energy audit checklist. f. Investigate the possibility of refinancing your debt. If you’ve got any high-rate loans, act now to see what your options are for getting into a more favorable rate. 5. Think twice before investing in equipment. Do the math to determine if the equipment purchases you’re planning will pay for themselves in a reasonable timeframe. Investing in equipment helps you enhance patient care and client service, and grow your practice. But fabulous equipment rarely used, is a poor investment. Take the time to evaluate how often you’ll use the equipment and the revenue potential before taking the plunge.

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Figure 1 – How to get to 20% ROI Gross Revenue 100%

Variable Expenses 23% Fixed Expenses 7% Staff Compensation 22% Facility Expenses 8% Total operating expenses (60%)

Amount Available for Associates and Owner 40%

Doctor Compensation 17% Owner Management Compensation 3% Total Doctor Compensation (20%)

Owner Return on Investment 20%

Reinvestment – Equipment 3%

Remaining Amount Available to Owner 17%

Compare your expenses to these benchmarks Variable Expenses (as a % of total revenue) Top 10% Drugs and medical supplies (includes radiology, surgery and hospital supplies but excludes food, shampoos, etc.) 9.9% 8.4% Heartworm, flea, and tick products 4.3% 4.0% Laboratory 4.1% 4.0% Diets (therapeutic and retail) 3.0% 3.0% Over-the-counter retail products (e.g. toys, collars, shampoo) 0.4% 0.4% Credit card fees 1.6% 1.6% Bad debt, collection fees 0.1% 0.1% Cremation, care of remains 0.6% 0.6% Sales and use tax 0.7% 0.7% Medical waste disposal/radiation badge monitoring 0.1% 0.1% Practice vehicle expense 0.1% 0.1% Total 24.9% 23.0%

Fixed Expenses (as a % of total revenue) Top 10% Accounting services 0.3% 0.2% Advertising and promotion 0.8% 0.6% Bank charges (monthly maintenance fees) 0.1% 0.1% Business consulting services 0.4% 0.3% Business gifts and flowers 0.1% 0.1% Business meetings 0.1% 0.1% Charitable contributions 0.1% 0.1% Continuing education, meetings, and travel 0.6% 0.5% Entertainment 0.1% 0.1% Equipment repairs, maintenance, and support contracts 0.5% 0.4% Franchise tax and other taxes 0.1% 0.1% Health insurance 1.8% 1.6% Laundry and uniforms 0.1% 0.1% Legal 0.1% 0.1% Liability insurance 0.1% 0.1% Licenses and permits 0.2% 0.1% Miscellaneous 0.2% 0.1% Office and computer supplies 0.9% 0.7% Payroll service costs, retirement plan administration fees 0.2% 0.1% Personal property tax 0.2% 0.1% Postage, freight, and delivery 0.2% 0.1% Printing 0.1% 0.1% Professional dues and subscriptions 0.3% 0.1% Technical (IT) support contracts 0.4% 0.3% 649

Telephone, answering service, internet connection 0.5% 0.3% Workers’ compensation insurance 0.6% 0.5% Total 9.1% 7.0%

Non-doctor Staff Compensation (W2 wages as a % of total revenue) Wages 21.6% 20.0% Payroll taxes 2.5% 1.5% Retirement contributions 0.6% 0.5% Total 24.7% 22.0%

Facility Expenses (as a % of total revenue) Annual rent or mortgage payments 5.1% Utilities (gas, water, electric) 0.9% Janitorial, housekeeping, and garbage 0.4% Facility repairs, maintenance, lawn care, and security monitoring 0.8% Property insurance 0.3% Real estate taxes 0.5% Total 8.0%

Reinvestment Medical equipment 0.8% Computer equipment 0.4% Facility improvements 0.8% Total 2.0%

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The Inside Skinny on Boosting Revenue Denise Tumblin, CPA Wutchiett Tumblin and Associates Columbus, OH

Making your practice more profitable and positioning it for continued success isn’t about luck. You don’t roll the dice and hope to meet your medical and financial goals for the year. Being profitable is about playing the right hand at the right moment and making changes in your practice that maximize your strengths. Try these tips to ensure your practice will be flush with success.

Tip #1 – Make strategic fee changes Instead of annual, across-the-board increases, review fees quarterly and determine the ones you’ll increase, the fees that won’t change, and in some rare situations the fees you’ll reduce. Monitor the quality of your patient care and client service to ensure both continue to reflect your fee structure (and vice versa). Teach and mentor your staff to boost everyone’s comfort and confidence with talking about money and communicating your value. • Competitively price shopped services. A market-based approach is best for price-sensitive services such as vaccinations and elective surgeries. Conduct a Community Survey to gather market data. How do you stack up compared to others? The range of fees in the market place and your target client demographic will guide your pricing decisions. • Price inventory items based on cost. The median markup on medication dispensed through the in-house pharmacy is 150%, and through the on-line pharmacy it’s 100%. The median markup on heartworm, flea and tick items is 95% in- house and 80% on-line. Markups on drugs for chronic conditions are 100% in-house and 85% on-line. Apply the markup to the cost, including shipping and sales tax, and add a handling/dispensing fee of $6 to $12. Example: In-house pharmacy cost $10 Markup – 150% $15 Handling fee $10 Final price to client $35 If you make bulk purchases to get a better price, keep the savings versus passing it on to the client. • Employ variable pricing in select situations. There may be times when you want to influence client behavior, reward a client or patient demographic, or increase business during certain times of the day or days of the week with modified pricing. Examples of variable pricing include a discount on dentistry during February, senior citizen discounts, Preventive Wellness Plans at a lesser cost than the ala carte price, concessions for humane or rescue organizations, and price concessions during a block of time that is traditionally slow in the practice. Variable pricing can be an effective tool, but carefully consider all the factors and keep your price concessions under 15%. • Price doctors’ non-shopped services based on value. Published resources like WTA’s Benchmarks Well-Managed Practice Study and AAHA’s The Veterinary Fee Reference provide insights about pricing value-based services. A client can see the tangible benefits of your services in a happy, healthy pet. Continue to look for other opportunities to influence clients’ perception of value. What’s most important to them and keeps them coming back? What’s a turn-off? If you don’t know, ask them. Does your external and internal “visual” match your price? People think and hear with their eyes, so make sure your image and value match. Consumers want reliable, predictable, familiar service. Be consistent, so clients know what to expect every time. • Reduce a fee if there’s no other solution. For any service or product you hesitate to offer (or don’t charge for) because you think it’s over-priced, consider lowering the fee. Take this approach only after you’ve exhausted all other efforts to change the practice’s internal perception of the value of this item. Talk with your staff to explore why the item is priced at this level, and calculate the true cost of providing it. If you still believe the item is over-priced, then lower it. Reducing the fee might help make your team more comfortable offering the service every time it’s appropriate. Plus, charging something is better than nothing.

Tip #2 – Re-energize your practice’s compliance efforts If your team has run out of steam on compliance, perhaps it’s time to change the word we use to describe “patients receive the healthcare necessary to ensure a long, healthy life in harmony with our medical protocols.” I like the word harmony, but feel free to choose your own, favorite word. In the book If Disney Ran Your Hospital, author Fred Lee describes four levels of motivation – the first, compliance, is defined as “doing what someone makes me do,” which isn’t very motivating! Mr. Lee suggests we instead need to move through the other levels of motivation – willpower (doing what I believe I should do), imagination (doing what I want to because I feel like it) and habit (doing what comes naturally). So let’s change what we call “compliance” to move clients to the “habit” level of motivation.

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Not sure where your practice stands when it comes to client compliance? Here’s a quick and easy project to find out. Choose three critical preventive wellness components of care your patients need, but not all are getting. Meet with your team and set daily, weekly, monthly, and annual goals to increase the number of times you provide this necessary care. Monitor your progress, discuss the results, and make any adjustments necessary to hit your goals. Example: a practice chose fecal testing, dentistry, and senior wellness testing as the areas they wanted to improve patient compliance with. This practice has 6,000 active patients with the following age distribution: less than 3 years of age – 25%, or 1,500 patients; 3 to 6 years of age – 25% or 1,500 patients; more than 6 years of age – 50% or 3,000 patients. The doctors and staff set the following goals: ------Percentages------Goal Actual Opportunity Fecal testing, 90% 50% 40% Senior wellness testing 90% 40% 50% Dentistry - pets 3+ years of age 50% 20% 30%

------Number of occurrences------Goal Actual Opportunity Fecal testing, 5,400 3,000 2,400 Senior wellness testing 2,700 1,200 1,500 Dentistry 2,250 900 1,350 They set a weekly goal of doing 46 more fecal tests, 29 more senior wellness tests, and 26 more dental procedures. They will track and monitor their progress and make any necessary adjustments to hit their targets.

Tip #3 – Spark growth with a new service Adding new services to your repertoire creates fresh energy and enthusiasm for the entire team. New services are another opportunity to differentiate your practice, expand the offerings for existing patients, and attract new clients. Rehabilitative therapy topped the list for Benchmarks participants in the past 2 years, followed closely by laser therapy. Behavior counseling made the list of future additions in the next 2 years. Dr. Richard Vesper, owner of Avery Animal Hospital in Hilliard, OH has been providing behavior counseling for 10 plus years. Yet it never quite took off in the way he had envisioned. With the assistance of his technician, Gretchen Latham, they’ve reworked their approach and are seeing good results. If you’re looking for a new growth center, or a new campaign to improve client compliance with previous recommendations, check out dvm360.com/toolkit. The packages there on dentistry, parasitology, dermatology and more feature client handouts, team member handouts, staff meeting ideas, Facebook posts and tweets, audio and video clips and more to help you educate and inspire.

Tip #4 –Use the marketing technology you pay for Boosting revenue requires an effective marketing plan. And there are lots of companies that offer lots of options to help craft your marketing plan. Do you know how many marketing tools your company has purchased, or which technology software does what? Do they overlap? Have you kept up on the latest technological innovations for use in and for veterinary hospitals? Is your hospital even using all of the “stuff” you’ve bought? Does it work? Do your clients like it? Does the team like it? If your hospital’s like most, you probably don’t know the answer to all of those questions. To start, gather what you need for an overview. Think of this as a treasure hunt. Pull current invoices for the marketing and technology services you subscribe to, including your website, digital marketing, print ads, Yellow Pages (or other directories) and any other marketing you engage in. Make sure you know what each service does; call the provider to ask if you’re not completely sure. Are new services being added? Can the price be lowered now? Create a spreadsheet so you can compare the services you’ve subscribed to side-by-side. The goal of this exercise is to narrow the list to services and technology you’re actually using and find the value amongst all of those must-haves you purchased through the years. Kelly Baltzell, President and CEO of Beyond Indigo Pets recommends including the following information in your spreadsheet:

Product or service – what is it? Do you use it? Is it duplicated elsewhere? When attending a convention or inspiring meeting, you hear about the latest, greatest, next best thing and sometimes buy it or sign up for it on the spot. The practical need for the service may not be clear. Plus even with the best of intentions and some utility at the time, as the years pass, technology changes. For example, some practice management software now offers text and e-mail reminders, so a secondary service with the same services may now be redundant.

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Is it meeting your goal? If you don’t know the answer, or the service is sitting unused, that’s a red flag. Marketing services should make happy clients and keep the door swinging. Technology needs to be useful to the staff, the pet owners, or both. Measurement should be in ROI – both financial and in happy clients! How much does it cost? What’s the monthly cost of the service and technology? Can the price be lowered? What’s included in the cost? Is it a “want” (this is so cool!), a “need” (our clients expect this), or a “must-have” (we can’t get by without this)? We’ve all made impulse purchases based on emotion in our personal and professional lives. This spreadsheet is the perfect opportunity to step back and see if that e-mail reminder system or website optimization company is something your business really needs. Over time, a need may change to a must-have and a want into a need. But it goes the other way too. Some must-haves slowly fade away (Yellow Pages, anyone?). Once every product and service is in the spreadsheet, the decision-makers in your hospital should be able to see how useful they are. Talking to everyone in the team will help too. Are there any needs or must-haves missing from the list? If there are, those items would be the next ones to research and purchase. In Benchmarks 2016: A Study of Well-Managed Practices, Bill Schroeder, owner of InTouch Practice Communications, explains how to dig through online reviews and SEO to manage your on-line reputation – an important part of your marketing plan. He recommends: • Step 1 – set up Google Alerts at google.com/alerts to receive notifications when certain words or phrases are indexed by Google (like about your name and your practice name). • Step 2 – establish accounts with Yelp, Google, and Facebook, and then let clients know that you appreciate review comments on those channels. • Step 3 – set up a service to automatically send electronic surveys after each appointment so that reviews can be gathered, organized and positioned properly on the practice website.

Tip #5 – Implement patient-calming, patient-friendly techniques Is it worth it to calm and quiet the practice, to gently handle patients, to treat and distract for exams, and to teach clients about stress in their pets and how to teach them another way? Yes! Practices using low-stress techniques are seeing revenue growth and believe these techniques lead to better medical care. To enhance your team’s knowledge (or if you haven’t yet begun), get certified through AAHA’s Fear Free certification program (fearfreepets.com). Visit www.dvm360.com/lowstress for free handouts, videos, galleries, how-tos and general advice about low-stress veterinary visits. Attend specialized tracks on behavioral health of pets and low-stress veterinary visits when attending conferences like NAVC. And for extra help with your feline patients, the American Association of Feline Practitioners provides fantastic guidelines about how to ensure your feline patients leave your practice calmer, and visit catvets.com/cfp/veterinary-professionals.

Tip #6 – Create a sales culture The word “sales” can conjure up negative stereotypes of the used car salesperson who says whatever is necessary to get you into that old clunker. It’s time to change that misconception and define the true meaning of selling: education that allows clients to make informed decisions. A sales culture benefits all stakeholders. Clients receive the peace of mind that comes with making the best decisions for their pet’s well-being. Pets receive complete care. Staff members take pride in knowing their expertise is directly benefitting pets. Practice owners feel that same pride and see the increase revenue that leads to better team pay, a healthier bottom line, and a stronger business to sell down the road. Resolve this year to make your practice the definitive source of pet well-being in your area by building a practice where all staff members provide the education and recommendations necessary for optimal patient care. Dr. Michael Watts, owner of Clevengers Corner Veterinary Care in Amissville, Virginia, says he, his associates, and his staff got into veterinary medicine to help pets, not for the money. This is also very likely for you and your practice. However, Dr. Watts notes that the money serves as a good measure of how well you’re doing in reaching the goal of best serving patients and clients. In fact, he chooses to share sales figures with his staff. He creates a culture where sales are a measure of compliance, and compliance is a measure of how well pets are getting the care they deserve. Dr. Brent Cook, owner of Kingsbrook Animal Hospital in Frederick, Maryland agrees. He says they’ve gone through phases where they talked about sales and revenue with all the staff, but most of the time that didn’t work well for their practice. “Most of our staff members are not in it for the money – they would give up the clothes on their back to help an animal in need. As a result, if we bring up too much about sales and revenue, they start to think that all we care about is the bottom line and not our patients. But that’s easy to fix from both sides. Good medicine is profitable. So we educate our staff and our clients about what is best for their pet, and the sales and revenue take care of themselves.”

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Dr. Cooks says he does talk about revenue with the doctors and managers, but it’s always in conjunction with a discussion about making sure consistently good medicine is offered to patients no matter which doctor they see. Rather than look at sales of professional services, they look at a specific item, like tonometry, and see how many tonometries each doctor completed relative to the number of patients they saw. If they are all consistently practicing the same quality medicine, then this value should be about the same for all of the doctors. Sometimes it is, sometimes it’s not. “If it’s not,” says Dr. Cook, “we discuss why it’s different. Sometimes we find that a doctor just wasn’t educated on the service, sometimes the other doctors offer a better way for them to word it to clients. The key is the discussion that gets everyone on the same page. Nobody gets defensive because their numbers aren’t as good. After our discussion, they want to increase “sales” because it’s better medicine, not because it’s more profitable. But, better medicine is more profitable, so it’s a win-win.”

Tip #7 –Join a WMP management group These groups of 20 high-quality practices meet twice a year and discuss anything and everything related to managing a veterinary practice. From financials and fees to marketing, staff development and transition planning – strategies and insights are willingly shared by the members. Group member Dr. Dean Tyson says, “We always return from our WMP Group Meeting energized and excited about bringing the information back and implementing it. We are thankful to have partnered with the WMP Groups, are grateful for our achievements thus far, and look forward to continuing the journey.” Member Dr. Peter Fisher adds, “Membership in our WMP Group has transformed the way I manage our hospital and how it functions on a day-to-day basis. I feel better about how my practice operates and have a new understanding about our finances.” Contact Wutchiett Tumblin and Associates or visit wellmp.com to learn more about our WMP Management Groups.

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Essentials of HR: Compensation Monica Dixon Perry, CVPM Veterinary Management Consultation, Inc. Evergreen, CO

Niqole Varani, DVM, CVPM Veterinary Management Consultation, Inc. Evergreen, CO

Essentials in compensation A checklist on what you need to know • Explain what drives wages o Overhead o Skills o Specialization o Productivity o Team communication o Longevity? o Job Market • Have an Offer Letter • Have a Compensation Statement (page 6) • Wage and Hour Division - DOL (FLSA) o Exempt: . Outside Sales . Must Be Paid Over $23,600/year * - law pending Guaranteed Regardless of Hours Worked . Some Exceptions (leave, suspension, business closed) - Non-exempt: . Entitled to Overtime Pay . Most Employees Covered by FLSA Assess Duties

Understand how to calculate work hours Commuting time must be paid if the employee is required to another work site other than their normal work-site. They must also be paid when requested to go back and forth from the work-site for emergency situations at their normal place of employment. On Call – If you require the employee stays on work-site while waiting for work assignments, they must be paid for the time. If the employee can use the time for their own enjoyment off the premises, it is not payable. If the employee has little control over the time, that is payable. Sleep Time – If you require an employee to be at work for over 24 hours or more you must generally count sleep time as payable. Lectures, meetings, and training – if you require the employee to attend you pay for the time, travel time included if it is not at the normal work-site. The only time you don’t have to pay for the time if ALL these points are met: • The employee attends a meeting outside of regular work hours. • Attendance is voluntary. • The instruction is not directly related to the employee’s job. • The employee doesn’t perform any productive work during the instruction session. Meal and rest breaks – You don’t have to pay for an ACTUAL meal period. The employee must be completely relieved of duty so the employee can enjoy a regularly scheduled meal. This counts for scheduled breaks as well. Some states have specific rules over the federal law, be sure to check. Many employees expect a paid meal break during an 8 hour or longer shift. Such breaks may increase productivity and team satisfaction. Record keeping requirements 1. Name, Address, Occupation and gender 2. Birth date if under 19 years old 3. Hour and day when workweek began 4. Total hours worked each work day 5. Total daily or weekly earnings 6. Regular pay rate for any week when overtime was worked 7. Total overtime pay for work week

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8. Deductions and additions to wages 9. Date of payment and pay period covered Garnishments 1. Wage attachment 2. Know what your state requires 3. Payment Agreement (page 6) Health care coverage • Do shop this out yearly • HSA’s – a trend of the future • Increase coverage with longevity • COBRA – Consolidated Omnibus Budget Reconciliation Act – o 20 or more employees and you offer health insurance . Termination under all cases except gross misconduct. . Their hours have been reduced. . They are eligible for Medicare . Allows for continued coverage by the worker up to 18 months on average. Vacation/personal time • Migration to PTO – build up a bank of time (page 68 in Employee Manual section) • Increase with time • Caps • Watch your STATE LAWS o Defined more by State than Federal Law • Explicit Policy Other benefits • Consider your package carefully • Cafeteria Style • Discounts • Bonuses o Attendance o Training o Performance • Employee Assistance Program (EAP) o Emotional o Family o Substance Abuse o Work or Financial Concerns o Relationship Issues o Simple o Unexpected o Reinforcement o Fair

What about employment contracts • Separate arrangement • Wage – production – ProSal • All benefits outlined • Dues/licenses • Continuing Education • Restrictions • Standards of conduct • Termination or non-renewal

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Trends in benefits & compensation • Same Sex Partner Benefits • Sports • Community Activity • Tuition Reimbursement • Choice Models on Health Insurance • Discount Arrangements • Service Awards

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Practice Letterhead

DATE

NAME ADDRESS CITY, STATE, ZIP CODE

Position: [insert title of position] Preferred Start Date: [insert preferred start date]

NAME, I’m pleased to offer you a full-time position as our JOB POSITION at [Practice Name].

As we move forward, my goal is to ensure that you have the tools and resources to be successful in our thriving veterinary practice. We are excited about having you start at the hospital, particularly with the skills and creativity you will bring to our team.

In becoming a [insert title of position], your ultimate goal will be to assure quality care to patients, exemplary service to our clients and to be a valued member of our team. You will be key to the growth of our services for patients and clients, and critical in the development of our practice.

Your compensation package will include a starting wage of [wage], as well as the benefits included are attached with this letter. Or. We have agreed upon compensation of twenty-three percent (23% of production. Compensation is subject to all taxes and withholdings are required by law or the policies of [Practice Name]. Look this over carefully, we trust that you agree this is a very fair offer and you pleased with the total compensation being provided to you.

You will receive your full benefits package after a 90-day introductory period. Afterwards, medical, dental, and vision insurance plans are provided as well as paid time off (PTO) and paid sick time as defined in the hospital employee manual. On your first day, we are scheduling you to speak with our Human Resources Team Leader who will guide you through all the benefits available as a valued team member here at the practice.

In accepting our offer of employment, you certify your understanding that your employment will be on an at-will basis, and that neither you nor any employee of the [Practice Name] have entered into a contract regarding the terms of the duration of your employment.

Your start date is [insert preferred start date], and you should ask at the reception desk for me. Please come dressed in [describe dress] with the appropriate footwear. Everyone at the practice is very excited to meet you and there will be a reception in your honor at [time].

Please sign and reply to this email to let us know that you have accepted the position. If you have any questions, then please let me know through [email address] or by contacting me by phone at [phone number].

5180 R2017JAN [Practice Name]

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Year end total compensation statement Example after formatting Prepared for: Dr. Hope Smith Effective Dates: Mar 15, 2015 through Mar 14, 2016

As a valued team member, Brown Veterinary Hospital is pleased to present you with your Total Compensation Statement. This statement shows the pay and benefits that were afforded to you as part of your total compensation package over the past year. Please contact Dr. Brown or the Hospital Administrator if you require additional information about your compensation package.

Hospital's Annual Cost Salary/Wages Your gross earnings for the year were $72,658. As stipulated in your employment contract, you were afforded a guaranteed base salary of $65,000 for the year. Your actual earnings based on production exceeded this amount by $7,658 (or 12%). $ 72,658 Pension Plan The practice matched contributions of 3% to your SIMPLE retirement plan. $ 2,180 Health Insurance The practice paid 50% of the premium for health insurance coverage $ 6,870 Dental Insurance Dental insurance through our group policy was provided through ABC Dental Insurance Co. You paid 100% of the premium for this coverage. $ ‐ AFLAC Supplemental Insurance Supplemental condition‐specific coverage was provided through AFLAC. You paid 100% of the premium for this coverage $ ‐ Life Insurance The practice paid 30% toward the premium for a term life insurance policy $ 3,780 Disability Insurance Disability coverage was provided through AFLAC. You paid 100% of the premium for this coverage $ ‐ Continuing Education You used $923 of the $1,500 provided for your continuing education $ 923 Professional Dues, Memberships and Licenses Annual Cost License renewal $ 125.00 Professional medical association dues $ 385.00 Total Professional Dues, Memberships and Licenses Paid by the Hospital $ 510.00 $ 510 Additional Benefits Annual Cost Travel/meal reimbursement $ 285.00 Uniform allowance $ 138.00 Total Additional Benefits Paid by the Hospital $ 423.00 $ 423

Total Compensation $ 87,344

Brown Veterinary Hospital also paid the following expenses based on your wages: Hospital's Annual Cost Social Security/Medicare This is the government‐required portion paid by the hospital for your social security/medicare $ 5,558 Workers' Compensation The amount paid by the hospital for workers' compensation $ 1,875 State Unemployment Insurance The amount paid by the hospital for state unemployment insurance $ 240 Federal Unemployment Insurance The amount paid by the hospital for federal unemployment insurance $ 56

Total Paid by Hospital for Workers Compensation and Federal/State Taxes $ 7,729

Hospital's Annual Cost Total Cash Compensation...... $ 72,658 Total Retirement Contributions...... $ 2,180 Total Paid for Health Benefits...... $ 6,870 Total Income Protection...... $ 3,780 Total Miscellaneous Benefits...... $ 1,856 Total FICA, Workers Comp., & State/Fed. Unemployment...... $ 7,729 Total Cost to the Hospital $ 95,073

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The compensation shown above includes time off from work during which the hospital paid your wages. The cash value of paid time off afforded to you during the year is shown below. Hospital's Annual Cost Paid Holidays You were paid for 7 holiday days during the year. $ 1,956 Paid Time for Continuing Education You were paid for 3 days spent attending continuing education. $ 838 Paid Time Off (PTO) You were paid for 85 hours of P.T.O. $ 3,960

Estimated Benefit Included in Totals Above $ 6,754

This document depicts estimated compensation and benefits and is not a guarantee of benefits, compensation or future employment. Nothing in this document is intended to alter the at-will nature of the employee/employer relationship.

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Essentials of HR: Employee Manual Monica Dixon Perry, CVPM Veterinary Management Consultation, Inc. Evergreen, CO

Niqole Varani, DVM, CVPM Veterinary Management Consultation, Inc. Evergreen, CO

Employee manual Why? • Introduces ______

• Provides ______

• Shares ______

• Informs ______

• Explains ______

• Contributes ______

Information provided in the Employee Policy and Procedures Manual draft is for informational purposes for [Practice Name] to use as a guide to prepare its own, personalized employee manual. Every effort has been made to offer veterinary practices the most current, correct, clear, and accurate information possible. State and federal laws are constantly changing and it is the veterinary practice's responsibility to review the manual for accuracy, completeness, timeliness, and validity of any information that will be used. In view of the possibility of human error or changes in laws and regulations, neither VMC, Inc., nor any other party that has been involved in the preparation or publication of this employee manual warrants that the information contained herein is in every respect accurate or complete, nor shall they be responsible for any errors or omissions or for the results obtained from the use of such information. All information is subject to change without notice. VMC, Inc., excludes and expressly disclaims all express and implied warranties not stated herein. VMC, Inc., assumes no liability for the use of any of these policies and procedures.

VMC, Inc., does not provide legal advice. [Practice name] should have the finalized employee manual reviewed by legal counsel to ensure that all information contained in the final employee manual is in compliance with current state and federal laws directly relating to the size of the practice.

Employee manual checklist Components to include in your employee manual 1) FOREWORD ......

1) Welcome ......

2) GENERAL CLINIC INFORMATION ......

2.1 Organizational Structure ......

2.2 Our Motto ......

2.3 Mission Statement ......

2.4 Hospital Philosophy ......

2.5 Hospital History ......

1) DIVERSITY ......

1) Equal Employment Opportunity Commitment to Diversity ...... 661

2) Anti-harassment Policy and Complaint Procedure ...... 1) Individuals and Conduct Covered ...... 2) Non-retaliation ...... 3) Complaint Process ......

3) American with Disabilities Act ......

4) Immigration Law Compliance ......

2) EMPLOYMENT ......

4.1 Employee Classification Categories ...... 4.1.1 Nonexempt employees ...... 4.1.2 Exempt employees ...... 4.1.3 Introductory Period ...... 4.1.4 Full-time Employee ...... 4.1.5 Part-time Employee ...... 4.1.6 Volunteer (optionally, Observer) ......

4.2 Internal Transfers/Promotions ......

4.3 Nepotism, Employment of Relatives and Personal Relationships ......

4.4 Misconduct ......

4.5 Counseling, Discipline and Performance Correction ...... 4.5.1 Progressive Disciplinary Process ...... 4.5.2 Disciplinary Process ...... 4.5.3 Appeals Process ...... 4.5.4 Performance and Conduct Issues Not Subject to Progressive Discipline ......

4.6 Separation of Employment ...... 4.6.1 Separation of Employment ...... 4.6.2 Return of [Practice Name] Property ......

5.1 WORKPLACE SAFETY ...... 5.2 Drug-Free Workplace ...... 5.1.1 Introduction ...... 5.1.2 Consequences of Alcohol/Drug Abuse...... 5.1.3 Required Testing ...... 5.1.4 Follow-up ...... 5.1.5 Consequences: ...... 5.1.6 Crimes Involving Drugs: ...... 5.1.7 Inspections ......

5.3 Workplace Bullying ......

5.4 Violence in the Workplace...... 5.3.1 Prohibited Conduct ...... 5.3.2 Reporting Procedures ...... 5.3.3 Risk-Reduction Measures ...... 5.3.4 Investigation ...... 5.3.5 Corrective Action and Discipline ......

5.4 Weapons-Free Workplace (optional) ......

5.5 Fire ......

5.6 Tornado or Other Severe Weather Conditions ......

5.7 Accidents ......

5.8 Hazardous Materials ......

5.9 Dosimeter Badges ......

5.10 Safety Equipment ......

5.11 Safety ...... 662

5.12 Smoke-Free Workplace ......

5.13 Injury and Illness Prevention Program (optional) ......

5.14 Internal Investigations and Searches ......

6 WORKPLACE EXPECTATIONS......

6.1 Confidentiality and Hospital Records ......

6.2 Conflict of Interest ......

6.3 Outside Employment ......

6.4 Solicitations, Distributions and Posting Materials......

6.5 Conflict Resolution ......

6.6 Attendance and Punctuality ...... 6.6.1 Punctuality ...... 6.6.2 Disciplinary Action ...... 6.6.3 No-Call/No-Show ......

6.7 Attire and Grooming ...... 6.7.1 Jewelry and Tattoos (alternative) ...... 6.7.2 Uniform Allowance ...... 6.8 Electronic Communication and Internet Use ...... 6.8.1 Cellular Phones ...... 6.8.2 Computer, E-mail, and Internet Usage ...... 6.8.3 Blogging and Social Networking Policies and Guidelines ...... 6.8.4 State of Social Media ...... 6.8.5 Responsibility ...... 6.8.6 Reporting Violations ...... 6.8.7 Discipline for Violations ...... 6.8.8 Topic matter guidelines ...... 6.8.9 Inaccurate or Defamatory Content ...... 6.8.10 Off-Limits Material ...... 6.8.11 Social Media – Acceptable Use ...... 6.8.12 Right to Monitor ...... 6.8.13 Restrictions on Employee Camera Use ...... 6.8.14 Hospital Monitoring ......

6.9 Employee Personnel Files ...... 6.9.1 Employee File Access (verify state requirements) ...... 6.9.2 Release of Employee Information ...... 6.9.3 Genetic Information Nondiscrimination Act (required if 15 or more employees) ......

6.10 Meetings ......

6.11 Personal Notebook ......

6.12 Telephones ......

6.13 Parking ......

6.14 Hospital Keys and Alarm Codes ......

6.15 Hospital Property (Optional) ......

6.16 Personal Property (Optional) ......

6.17 Personal Work Area ......

6.18 Media ......

6.19 Ethics ......

6.20 Political or Public Activities and Contributions ......

6.21 Treatment of Patients ......

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6.22 Honesty ......

6.23 Client Management ...... 6.23.1 Professional Knowledge ...... 6.23.2 Professional Courtesy ...... 6.23.3 Advising Clients ......

6.24 Team Requirements and Expectations ......

7 COMPENSATION ......

7.1 Performance and Salary Review ......

7.2 Payment of Wages ......

7.3 Time Reporting ...... 7.4 Overtime ......

7.5 On-Call Pay (non-exempt employees) ......

7.6 Employee Travel and Reimbursement ......

7.7 Work Schedules ......

7.8 Forced Closing and Severe Weather Conditions ......

8 TIME OFF/LEAVES OF ABSENCE ......

8.1 Holiday Pay ......

8.2 Vacation (Option to PTO) ......

8.3 Sick Leave (Option to PTO) ......

8.4 Personal Leave (option to sick leave) ......

8.5 Paid Time Off (option to vacation/sick/personal leave) ......

8.6 Family and Medical Leave (FMLA)(over 50 employees) ...... 8.6.1 General Provisions ...... 8.6.2 Eligibility ...... 8.6.3 Type of Leave Covered ...... 8.6.4 Amount of Leave ...... 8.6.5 Employee Status and Benefits during Leave ...... 8.6.6 Employee Status after Leave ...... 8.6.7 Use of Paid and Unpaid Leave ...... 8.6.8 Intermittent Leave or a Reduced Work Schedule ...... 8.6.9 Certification for the Employee’s Serious Health Condition ...... 8.6.10 Certification for the Family Member’s Serious Health Condition ...... 8.6.11 Certification of Qualifying Exigency for Military Family Leave ...... 8.6.12 Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave .. 8.6.13 Recertification ...... 8.6.14 Procedure for Requesting FMLA Leave ...... 8.6.15 Designation of FMLA Leave ...... 8.6.16 Intent to Return to Work from FMLA Leave ......

8.7 Personal Leave of Absence ......

8.8 Maternity/Adoption Leave (check # of employees and state requirements) ...... 8.8.1 Benefits during Leave ......

8.9 Child Care Leave (optional, identify state law) ......

8.10 Bereavement Leave ......

8.11 Jury Duty ......

8.12 Voting Leave ......

8.13 Military Leave of Absence ......

8.14 Lactation/Breastfeeding ...... 664

9 BENEFITS......

9.1 Health Insurance ...... 9.1.1 Medical and Dental Insurance ...... 9.2 HIPAA ......

9.3 Civil Unions and Domestic Partners ......

9.4 Life Insurance (Optional) ......

9.5 Disability Insurance (Optional) ......

9.6 Retirement Plan (401K) (Optional) ......

9.7 Workers’ Compensation Benefits ......

9.8 Veterinary Services at Reduced Rate ...... 9.8.1 Veterinary Services at Reduced Rate (Option 1)...... 9.8.2 Pet Health Insurance (Option 2) ...... 9.8.3 IRS Guideline ...... 9.8.4 Employee-Owned Pets ......

9.9 Employee Incentive Program (Optional) ......

9.10 Continuing Education ......

9.11 Team Entertainment and Education Functions ......

9.12 Employee Benefits Program/Package ......

10 SUMMARY ......

10.1 Summary of Hospital and Team Policies ......

11 Acknowledgements ......

11.1 Acknowledgement of At-Will Status ......

11.2 Acknowledgement of Practice Policies ......

11.3 New Employee Orientation Checklist ......

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Essentials of HR: Hiring Monica Dixon Perry, CVPM Veterinary Management Consultation, Inc. Evergreen, CO

Niqole Varani, DVM, CVPM Veterinary Management Consultation, Inc. Evergreen, CO

How to develop a team of “10” health care team members Creating a resource pool of applicants • In house posting • Okay, steal them • Print (not much) • Internet • Employment agencies??? • Employee Referral Program • Other o Veterinary or Technician schools, Associations o Internships o Scholarships o Marketing – Who are you? Three step interview process • Initial Interview - pre-screening checklist - page 2 o Overall impression o Match candidate to position – qualifications - How? o First impressions Creating a resource pool of applicants • In house posting • Okay, steal them • Print (not much) • Internet • Employment agencies??? • Employee Referral Program • Other o Veterinary or Technician schools, Associations o Internships o Scholarships o Marketing – Who are you? Three step interview process • Initial Interview - pre-screening checklist - page 2 o Overall impression o Match candidate to position – qualifications - How? o First impressions

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SCREENING INTERVIEW CHECKLIST

[Practice Name] INTERVIEW SCREENING

Applicant's Name: Date

Application Component to review Notes:

Cover letter rating:

Resume rating:

Best method to contact applicant 1st 2nd cell:

Review the resume. Note any gaps or inconsistencies, Ask for any additional skills the candidate may have that are not listed.

Does the applicant have general work experience? Overall - YES NO Animal Oriented: YES NO

__ Veterinary practice __ Personal Pet Care __ Boarding __ Pet Store __ Other ______

< 1 year relevant experience >1 year relevant experience

Little or no experience

Employment stability One job 2-3 yrs. Steady job in last 1-2 yrs. Questionable explanation of gaps Current student Unexplained gaps, many jobs in last 5 years

Certifications or Degrees or Level of education required for this position

Advise the candidate will have to produce proper verification later in the interview process

PHONE INTERVIEW ASSESSMENT Date: Time:

Discuss the philosophy of the practice and ask the applicant to share information about the philosophy at their last place of employment.

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Confirm employment record point by point. Review reasons for leaving each position. Make sure all gaps have explanations.

Position desired and schedule (discuss position requirements and give them a copy of the position's schedule). Do they have any restrictions in being able to work this schedule?

What are the most important qualities to have for this Get their answer and then explain your expectations position?

What did you like best about your post position? Best:

What did you like least? Least:

Relevant classes taken (list them) Are you able to provide proof of the highest education level completed?

Not to limit you to a certain wage, but what is the minimum salary you would accept for the position?

Describe your perfect job.

Why should we hire you?

What are the pros and cons of working with a team? Pros:

Cons:

Are you willing to agree to have a drug test, a criminal Ok to check references: ___ Yes ____No If no, why? background check and a reference check appropriate for the position?

If applicant was referred by another employee, get that employee's name

Explain the interview process and ask them what questions would you like to ask me?

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Background check: Make sure applicant knows that a background check will be performed (they must sign the form to acknowledge the check).

Personal traits and interaction Attentive Interested Dull responses Enthusiastic Knowledgeable Articulate Listener Disjointed Confused

Timeliness

Understanding of position 5 - Superior 4 - Very Good 3 - Average 2 - Below Average 1 - Not Acceptable

Overall rating ___ Set up for next interview ___ Send Regret letter

Recommendation

Additional Notes

Screener's signature

Second interview • In-depth • Interview Report form - page 7 • Tour of practice – observe responses Observational interview • Purpose • Observational Interview Release form - page 8 • Train team on objectives

Reference checking • Pre-Employment Questions to Avoid • Issues with standard references • Electronic background screening • Options o Employee background investigations 669

o www.ebiinc.com - background check whitepapers o Accredited • Pre-employment testing o Job knowledge o Math o Language o Integrity? o Cognitive ability? o Emotional intelligence? Why electronic background • Accuracy • Detail • Verification • Required Information

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INTERVIEW - FIRST IMPRESSION

Name of Applicant:

Date: Evaluated by:

Rate each category: 1=Poor, 3=Average, 5=Great! Circle rating and check appropriate boxes.

1. APPEARANCE 1 2 3 4 5 Neat Sloppy Lack of Well groomed Grooming Appropriate Attire Dressed for: ____

2. ATTITUDE 1 2 3 4 5 Enthusiastic Lack of Interest Interested Dull Inquisitive Monotonous

3. PERSONAILITY 1 2 3 4 5 Assertive Arrogant Confident Presumptuous Reserved Shy, Timid Good eye contact Poor eye contact

Should we schedule an interview? Yes No

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INTERVIEW REPORT

Name ______Date ______Position Desired

Check the appropriate box in each category, then make additional comments below.

JOB APPEARANCE BEARING EXPRESSION MOTIVATION PERSONALITY KNOWLEDGE  Indifference to  No bearing,  Uncommuni-  None as pertain  None,  Unpleasant attire & grooming lacks confidence cative, confused to this position apathetic, sloppy, unkempt slovenly posture thoughts, poor indifferent vocabulary disinterested

 Careless in  Often appears  Poor speaker  Will need  Doubtful  Slightly attire, poor uncertain, poo hazy thoughts considerable interest in objectionable grooming posture ideas training position

 Functional  Holds self  Speaks well  Basic, but will  Sincere desire  Likeable attire, neatly well, seem expressed idea learn on the to work groomed confidence adequately job

 Well groomed  Sure of self  Speaks, thinks  Well versed in  Strong interest  Pleasing reflects clearly, with position, little in position confidence confidence training needed asks question

 Immaculate  Highly  Exceptional  Extremely well  Highly  Extremely attire and confident speaks clearly versed, able to motivated pleasing grooming inspires others concisely wit work without eager to work charming asserts presence confidence, idea further training asks many individual well thought ou questions

Overall Impression:

Unsatisfactory Marginal Satisfactory Very Good Excellent

Should we interview further? Yes No

(Interviewer)

(Date)

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OBSERVATIONAL INTERVIEW RELEASE FORM

(Date) Observer: ______

TO: [Practice Name]

Address

Address

It is understood and agreed that my presence at (Practice Name) is strictly on an observation basis with no remuneration associated with the activity. I am neither an employee nor an agent nor am I associated with the (Practice Name) in any capacity other than as an observer for potential employment and therefore, hold the (Practice Name) and its associates harmless and free of any and all claims which may arise as a result of my observational interview.

Witness Applicant

(Signature) (Signature)

(Print Name) (Print Name)

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How to recognize potentially great health care team members before you hire them… • They put family first, before work. • Money is important, but job satisfaction is their number one concern. • They tend to work long hours and take pride in their work. • They have a well-defined sense of their role. This can be detected in the manner in which they dress for the interview. They have a lot of energy that can be directed in a positive way. • They are emotionally mature. This is evidenced in their concern for others, financial judgement, and length of time previously employed. • They are compatible. Remember, you’ll have to work long hours with these individuals, so trust your feelings about getting along. • They are motivated based on family destiny. Ask about father’s and mother’s occupation, type of education planned for family, and how the candidate relates to other members of the family. • They can channel hostilities. Hire someone with enthusiasm, not a rebel willing to jump on any bandwagon. • They want a boss they can respect as being competent. • They consider accuracy a crucial element of the job. • They have a need to finish a task once it’s started.

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JOB DESCRIPTION – – RECEPTIONIST

Classification: This is a nonexempt position under the Fair Labor Standards Act (FLSA)

Reporting Structure: The receptionist works under the direct supervision of the receptionist team leader/office manager and/or veterinary practice manager, who will indicate general assignments, limitations and priorities. Recurring assignments are performed independently. Deviations or unfamiliar situations are referred to the supervisor. Completed work is reviewed for technical accuracy and compliance with established procedures.

Revision Date: 6/28/2016

Receptionist Objectives: The purpose of this position is to serve as receptionist at [Practice Name], to perform record keeping duties, to perform clerical duties related to patient care and treatment, and to provide miscellaneous support to the veterinary practice manager and health care team. These service functions include, but are not limited to, reception (visitor and telephone), maintenance of veterinary medical records, accounts maintenance, cash processing, data entry, word processing and mail service. This position requires a practical knowledge of hospital organization and services, the basic rules and regulations governing visitors and animal patient treatment, data transcribing, word processing, and a practical knowledge of the standard procedures, veterinary records and terminology used in the hospital. Regular attendance and timeliness are an essential function in order to fulfill the requirements of this position.

Position type and expected hours of work: Full or Part-Time 8 hour Shifts Monday – Friday for Full-Time Weekend shifts required Overtime may be required

Education and Experience: High school diploma or equivalent Veterinary experience preferred

Essential functions Clerical • Schedule appointments, obtaining all necessary data concerning the patient and owner. Prepare all required forms in advance when possible. • Prepare to receive appointments by retrieving client records, preparing needed forms in advance of clients’ arrival. Complete required forms such as new client form, patient visit form, client report, consent forms, estimates, payment agreements, etc. and obtain all necessary information. • Assure that all financial obligations are met by owners. Collect client fees, make change, process credit card transactions and assist in making count of cash drawer, run end of day transactions. • Assist in the updating of client files; prepare and mail thank you cards and “welcome aboard” cards, reminders. Follow- up with clients when clinic records indicate no recent visits. • Perform a variety of clerical duties, receiving, sorting, distributing mail, sending out mailings, cleaning, organizing reception area, type memos, correspondence, reports and other documents. Assist in the ordering, receiving, stocking and distribution of supplies. • Collect client fees, post and record payments, make change, process credit card transactions and run end of day transactions. • Ensure the cleanliness and organization of the reception area. Open and close practice Customer and personal service • Provide friendly, quality client care to the patients and clients of [Practice Name]. • Professionally administer all phone calls - answering client inquiries in a prompt and friendly manner, scheduling appointments, recording messages. 675

• Requires strong communication and client service skills. Considerable tact and diplomacy is required. Ability to greet clients in a professional, friendly, hospitable manner - check clients in, discharge patients. • Receive incoming calls, screen those that are handled by other health care team members and take care of routine calls. The routine calls include those seeking information about veterinary services (“telephone shoppers”). Provide knowledgeable sub-professional advice concerning the care and treatment of animals. • Check clients in - Greet clients in a professional, friendly, hospitable manner.

Veterinary polices/Procedures • Follow established hospital policies and procedures in referring clients for immediate treatment of their pets when requests are accompanied by complaints of acute symptoms. Determine nature of injury/illness and attempt to reassure distressed pet owners. Determine whether immunizations and/or tests are current. Recommend update of necessary immunizations and/or tests to clients when applicable. • Discharge patients. Review charts of patients being discharged from the clinic for completeness of information, make new appointments or note changes in patient status as necessary. Enter charges and set up future reminders in system. Present clients with medications, instruction. • Perform over-the-counter selling of specialty merchandise comprised of pet grooming aids and sundry veterinary items. Exercise technical knowledge of products sold and demonstrate salesmanship abilities. Explain and demonstrate products, answer questions concerning products purchase/ use. • Fill veterinary prescriptions with appropriate medication; provide routine instructions to owners concerning prescriptions for medications. • Collect lab specimens from pet owners, match patient record to the sample and submit samples to veterinary technician or nurse. Computer As required, enter data into the computer system, retrieve and modify computerized records. The practice management software includes, but is not limited to, such areas as reminder list of patients for periodic notifications, receipt and/or invoicing to update medical/financial records; accounting to include the general ledger, accounts payable, accounts receivable, billing and aging of accounts, income distribution, inventory control, client records, pet records, medical records, payroll; word processing to produce letters for general correspondence and special mailings to clients, etc.

Competency Basic skills • Possession of strong organizational skills. • Knowledge of hospital procedures and operating instructions for making appointments, assembling patient medical records, recording test results, relaying information regarding patient’s condition, and compiling and submitting data on patients treated. • Knowledge of the spelling and meaning of commonly used terminology of veterinary medicine to accurately record results of tests and file veterinary medical reports according to alpha, numeric or subject matter headings. • Understanding the implications of new information for both current and future problem-solving and decision-making. • Performs other duties as assigned. Ability to multi-task Communication skills • Excellent verbal and written communication skills. Possess exceptional interpersonal communication skills. • Requires strong client service skills. Personal contacts are with pet owners affected by a variety of problems, visitors and other healthcare team members. Considerable tact and diplomacy is required. Must accurately relay owner’s account of the medical complaint(s) of the pet(s) involved to the healthcare team member who will be involved in treating the patient(s). • Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. • Requires active listening skills, giving full attention to what other people are saying, taking time to understand the points be made, asking questions as appropriate and not interrupting at inappropriate times. • Requires telephone conversations Requires use of electronic mail • Requires writing letters and memos • Requires face-to-face discussions with individuals or team members Social skills • Work well with all employees and ensure that your actions support the hospital, the doctors, and the practice hilosophy. • Ability to work independently on assigned tasks as well as to accept direction on given assignments.

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• Monitoring/Assessing performance of yourself, other individuals or the practice to make improvements or take corrective action. • Ability to adjust actions in relation to other’s actions • Teaching others how to perform a task Actively looking for ways to help others • Being aware of others’ reactions and understanding why they react as they do. • Requires dealing with unpleasant, angry or discourteous people Technical skills • Knowledge of computers and relevant software applications including MS Office (Word).

• Perform routine maintenance on equipment and determine when and what kind of maintenance is needed.

Physical demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Amount of Time Spent on Task Task None Less than 1/3 1/3 to 2/3 More than 2/3 Stand X Walk X Sit X Use hands to finger, handle, or feel X Climb or balance X Stoop, kneel, crouch, or crawl X Talk or hear X Taste or smell X The job requires the following lifting requirements and/or exerted force be performed on the job.

Amount of Time Spent on Lifting Amounts

Lifting Amount None Less than 1/3 1/3 to 2/3 More than 2/3

Up to 10 pounds X Up to 25 pounds X Up to 50 pounds X Up to 100 pounds X (with assistance)

More than 100 pounds X (with assistance)

Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust to focus.

Work environment • While performing the duties of this job, the employee is exposed to hazards associated with aggressive patients; hazards associated with infected animals and controlled substances; exposure to unpleasant odors and noises; exposure to bites, scratches and animal wastes; possible exposure to contagious diseases. • Follow federal and state animal health laws and regulations including OSHA and DEA. • This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. • Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

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[Practice Name] is an equal opportunity employer. It is the policy of the practice to prohibit discrimination and harassment of any type and to afford equal employment opportunities to employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetic information, gender identity or expression, or veteran status. The practice will conform to the spirit as well as the letter of all applicable laws and regulations. The practice will take action to employ, advance in employment and treat qualified Vietnam era veterans and disabled veterans without discrimination in all employment practices.

I have read and understand the Receptionist Job Description.

Employee Signature: Date:

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Essentials of HR: Motivation and Retention Monica Dixon Perry, CVPM Veterinary Management Consultation, Inc. Evergreen, CO

Niqole Varani, DVM, CVPM Veterinary Management Consultation, Inc. Evergreen, CO

What is motivation? • Motivation vs. “Fear”

Factors that must be present in order for a person to be motivated • Fulfillment of one’s basic needs • Healthy work environment • Security in one’s employment • Knowledge and ability to do the job required o Effective hiring and training procedures • Knowledge of the practice’s employee policies and procedures o Employee manual

Is money a motivator? • Can money be used as a motivator? • Six Factors That Can Outweigh Salary (page 4)

Motivational techniques • Basic tenet: “Treat employees in the same manner as you would wish to be treated.” • Positive reinforcement o The strongest motivator you have at your disposal o Verbal o Non-verbal o Frequency • Negative reinforcement o Is this a motivational technique? • Job enrichment • Continuing education o In-service meetings o Educational seminars • Involve staff in the decision-making process o Incorporation of new projects into the practice • Open door policy o Effective communication o Understanding an employee’s position • Twenty Low-Cost Activities to Boost Staff Morale (page 5) • Six Commonly Ignored “Secrets” for Keeping Employees Motivated (page 6)

Delegation: A key to success • Why is delegation so important? o Must we delegate to be effective managers? • Delegate, don’t abdicate o Delegate for efficiency o Selectively delegate . Tasks That Should Not Be Delegated (page 6) • How to delegate effectively

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o Make sure individual has knowledge and ability to do the job o Individual must have interest in doing the job o Explain task to be accomplished o Make the project their project o Provide support and reference material o Define and state authority necessary to do the job o Establish time table o Provide adequate time to perform the job • Institute automatic feedback controls o Follow-through o Never undermine a delegated responsibility o Use positive reinforcement • Why do some staff members resist having responsibilities delegated to them? o They do not wish to make the necessary decisions involved o They are not sure how much authority they have o They do not feel equipped to handle the work and believe that they do not have enough information or direction o They are not prepared to accept responsibility o They do not see what is in it for them o They have made mistakes in the past that have embarrassed them or made you angry. o They are not aware that you have actually delegated something to them. o They feel that they already have too much to do. o They think the task is inappropriate for their job category or temperament. • Some Common Reasons Why We, As Managers, Fail to Delegate o You feel that you must do everything and think that no one else can do it as well. o You may lack confidence in your staff. o You might be a perfectionist. o You might not like change. o You may have an inferiority complex. • Must We Delegate For Success? o Positive results for effective delegators o Negative effects • How Do You Rate As a Delegator? Answer the questions with a yes or no 1. 6.

2. 7.

3. 8.

4. 9.

5. 10.

[ ] I am very effective at delegating [ ] I am not delegating as much work as I should [ ] I am an ineffective delegator and must work on delegating many unnecessary chores that are slowing me down.

Job features Do you know what your employees rank #1? Here’s an interesting test you and your employees can take to determine if you share the same values regarding work. Ask staff members to rank the following items according to the importance they attach to them. Then, rank the items according to the importance you think your staff attaches to them. Compare and discuss.

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(1 = most important; 8 = least important) STAFF JOB DOCTOR RANKING FEATURE RANKING

Interesting Work ______Credit for Work Done ______

______Interesting Work ______

______Fair Pay ______

______Understand/Appreciate ______

______Counsel Problems ______

______Promotion on Merit ______

______Good Work Conditions ______

______Job Security ______

Six factors that can outweigh salary • Agreeable Working Conditions • Recognition • Fringe Benefits • Lifestyle • Challenge • Fulfillment

Twenty low cost activities to boost team morale 1. Send a Letter of Commendation to a Staff Member for Performance Above and Beyond Normal Expectations 2. Provide Lunch for All Employees on the Last Working Day Before a Holiday 3. Provide Staff with Fresh Fruit or Other Foods for Snacking During Breaks 4. Buy Corsages for Staff on Special Occasions 5. Send a Card to All Staff Members on Their Birthdays 6. Invite Part-time Employees to All Staff Social Events 7. Write Personal Messages such as “Thank You” or “Happy Birthday” on Payroll checks 8. Work Side-By-Side with Staff Once a Year (Or More Often) on a Community Help Project 9. Personally Introduce New Hires to Each Staff Member 10. Greet Each Staff Member at the Start and End of Each Day 11. Send a Card to Each Staff Member on His/Her Anniversary 12. Hold Morale Building Meetings to Inform Staff of Your Practice’s Successes 13. Reward Staff Who Miss One Day or Less During the Year Due to Illness or Injury 14. Buy a Vase for Your Business Assistant’s Desk and Provide Fresh Flowers on a Surprise Basis 15. In Each Month That New Patients Exceed an Established Figure, Take All Employees Out for Dinner 16. Hold an Annual Staff Appreciation Party 17. Give a Small Gift to an Employee Each Time a Patient Makes a Positive Comment about Him/Her 681

18. Plan a Staff Social Event at Which You Do the Cooking and Serving (Picnic, Barbecue, Etc.) 19. Give a Reception for Every Employee Who Retires 20. Design an “Employee of the Month” Plaque for your Reception Area

Six commonly ignored “secrets” for keeping employees motivated • Never Oversell A Job • Keep Assistants Informed • Keep Vertical Channels of Communication Open and Clear • Keep Jobs Challenging • Encourage Self-improvement and Create Opportunities for Advancement Finally, Make Sure Employees Know Exactly What is Expected of Them

Tasks that should not be delegated • The Signing of Business Checks • The Final Word On Collection • Spot Checking On Financial Or Personnel Records • All Patient Related Duties • Making The Final Decision On Major Management Policy

The essentials in retention • Know What the Employee Wants • Know What The Practice Needs • Long Term and Short Term Results • Variation • It Starts With What You Say • It Continues With What You Do

Reasons for turnover • Poor communication • Unskilled supervisors/managers • Unsatisfying job responsibilities • Problems with working conditions • Pay below market levels • Inadequate benefits • Insufficient recognition • Lack of advancement opportunities • Interpersonal conflicts • Personal problems (family, health, etc.) • Wealth of external opportunities

Checklist of employee retention tools • Employee Relations Tools - non-compete agreements, focus groups, exit interviews, etc. • Compensation Tools - sign-on and retention bonuses, merit and incentive pay, etc. • Benefits Tools - expanded benefits, unique services, annual benefit statements, etc. • Scheduling Tools - flexible scheduling, sabbaticals, telecommuting, etc. • Workplace Enhancement Tools - casual dress, career pathing, timely performance appraisals, etc.

25 ways to increase team retention today 1. It starts with 4 quarters – Put 4 quarters in your left pocket and each time you make a genuine complement to a team member, move a quarter over to your right pocket. Your goal is to have all the quarters, every night in your right pocket. 2. Involve the team in decisions that affect their position. 3. Celebrate it – Celebrate each team member’s anniversary with the practice, not just their birthday. 4. Ask them – Make it a point to ask team members what they like best and then do more of it!

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5. Set clear expectations – Satisfied team members know what is expected of them every day at work. Very few people are mind readers. You have to share the information to expect results. 6. Hold a quick 2 minute meeting in the morning and share with the team the goal for the day and any special issues that they need to know about to make everyone successful. 7. Set practice traditions, like every morning, each team member has to tell one other person something good the happened the day before. 8. Encourage feedback from your team – Ask for ideas and then talk about how that helps patients, client service, overall benefit to the team and the practice. Show respect and appreciation that your team member took the time to share with you what they believe will help the practice. 9. Make sure your wage is based on performance, not just longevity. 10. Give out a surprise incentive. If you see a team member pick up the dirty paper cup when they were walking through the parking lot into work, how about coming up and asking them to trade that cup for the two movie tickets you have in your hand? 11. Make sure wages are comparable with other jobs in your area and tell your employees what they need to do to get a raise. 12. Have new employee training mapped out so that it helps the employee succeed. Don’t just throw them into the practice and hope for the best. 13. Treat everyone with respect and do not allow individuals to not observe this point. 14. It’s okay to have fun. Let team members know you appreciate their sense of humor and look to add a little humor to the day. Create a smile board with funny pictures, silly stories and happy faces. Put it in the treatment area so everyone can enjoy it. How about taking digital pictures of people in the clinic, posting them and then have a contest for the funniest caption? 15. Praise for attempts to do it well. Let team members know you appreciate the effort. 16. Never criticize is public. 17. Share information promptly and clearly. Don’t let it leak out to the team. If they need to know it, tell them right away. 18. Actively listen to what your team tells you. They want to be heard. 19. Provide regular training; get the team involved in deciding what they want to learn. 20. Promote from within whenever you can. 21. Train your supervisors well; they can be the leading element in keeping good team members. 22. Consider offering retention bonuses or increasing vacation for team members who stay long term with the practice. 23. Make sure team members have the equipment and supplies they need to get the job done. 24. Know why team members stay and know why they leave. Your problem may not be the employee; it may be your hiring process. 25. Change your mindset – The most important thing that you do is support the team that serves your clients. Without them, you have no practice.

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Essentials of HR: Performance and Termination Monica Dixon Perry, CVPM Veterinary Management Consultation, Inc. Evergreen, CO

Niqole Varani, DVM, CVPM Veterinary Management Consultation, Inc. Evergreen, CO

Disciplinary process Disciplinary actions • Employee Performance Agreement (page 6) • Employee Performance Agreement Review (page 7) Firing • Make a decision and act upon it—do not procrastinate—indecision is detrimental to you and to your practice • Document your employees actions • Atmosphere in which to conduct discharge - Termination Meeting Checklist (page 9) • State practice’s position and factual evidence • Approaches: o Try to present so employee realizes he/she would be better suited in another position o Direct approach • Do not keep a discharged employee in the practice • Exit interview (page 10) • Questions to be asked during an exit interview • Termination Checklist and Letter (page 13 & 12) • Fear of Failure: How to recognize it and what to do about it • How to Become an Effective Leader

Receptionist performance evaluation Name: Date: Date of last review: Date of Employment: Person preparing review:

Rating guide Excellent- Almost always exceeds expectations; quality of work is highest caliber; 9-10 points greatly exceeds required job criteria. Very Good- Performance almost always meets expectations and exceeds expectations 7-8 points on occasion; always above average work; fulfills job criteria very well; requires minimal supervision. Adequate- Performs to expectations most of the time; satisfactory most of the time; 5-6 points fulfills job criteria adequately. Needs Improvement- Does not perform to expectations; satisfactory only on occasion; significant improvement should be achieved to fulfill job criteria; 3-4 points requires more than normal amount of supervision. Unsatisfactory - Almost never performs as expected; lacks any proficiency; major improvement is required in order to fulfill job criteria. 0-2 points If improvement is not met in specified time period, job termination may result.

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1. PUNCTUALITY: Demonstrates punctuality and dependability. Is consistently on time for all work periods and returning from breaks. Works scheduled hours and is rarely absent. Clocks in and out appropriately.

Rating Points

2. JUDGEMENT: Able to discern when a pet should be seen and when verbal information will solve the problem.

Rating Points

3. CLIENT COMMUNICATION: Personable. Greets team members and clients with an upbeat, positive tone and a smile. Maintains a positive, friendly attitude. Conveys warmth and caring. Treats all clients and patients with the utmost respect and care.

Rating Points

4. HOUSEKEEPING: Work area is always presentable and neat. Watches waiting area to assure that it is neat, clean and odor- free.

Rating Points

5. SCHEDULING: Schedules appointments, following practice guidelines, after obtaining all necessary data. Prepares any necessary forms, sends out new client information.

Rating Points

6. INITIATIVE: Assists in identifying and solving various problems related to how the hospital is run. Brings ideas to the supervisor. The employee searches out new tasks and expands his/her abilities professionally and personally.

Rating Points

7. TELEPHONE SKILLS: Professionally answers the phone in three rings or less. Uses the appropriate greeting. Has a pleasant and cooperative phone voice. Never places a call on hold without the caller’s permission. Returns to calls holding with updated information on how much longer the wait will be. Skillfully answer telephone shopper inquiries following the hospital procedures for phone shoppers.

Rating Points

8. COMPUTER LITERACY: Shows great proficiency in handling the various computer operations required on a daily basis. Enters information accurately. Runs reports, retrieves information, and updates client records timely and accurately.

Rating Points

9. ACCOUNTING SKILLS: Is accurate in handling monetary transactions and making change. Is able to complete the daily sheet, deposit slips and records accurately in the computer.

Rating Points

10. KNOWLEDGE: Possesses the necessary veterinary medical knowledge to be able to answer most client questions. Knows and understands hospital policies and protocol.

Rating Points

11. ATTENTION TO DETAIL: Employee is a detailed individual in all aspects of his/her job. Small details do not escape his/her attention. Is able to remember low priority items and do them during slack times. Can prioritize job duties well.

Rating Points

12. PROFESSIONAL ATTITUDE: Possesses strong client service skills. Is able to handle irate clients with relative ease. Remains calm in crisis situations.

Rating Points

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13. ACCURACY: Demonstrates accuracy, thoroughness, neatness and dependability. Writes legibly. Records correct information on records as well as controlled substance log. Files records accurately.

Rating Points

14. DRIVE: Shows a real desire to achieve excellence in every aspect of job area. Desires to make the job exciting and fulfilling. Is eager to learn new procedures/techniques and is open to change.

Rating Points

15. TEAMWORK: Works well with all team members and ensure that your actions support the hospital, the doctors, and the practice philosophy.

Rating Points

16. AUTONOMY: Employee works independently on assigned tasks as well as accepts direction on given assignments.

Rating Points

17. HOSPITAL PROCEDURES: Follows hospital policies regarding patient admittance, immunizations, discharges, etc. Provides proper instructions, medications and enters reminders into system.

Rating Points

18. CLERICAL DUTIES: Employee is able to accurately and proficiently perform a variety of clerical duties, mailings, cleaning, organizing reception area, run reports, type correspondence and other documents.

Rating Points

19. MARKETING: The employee is effective in marketing to and educating the client about vaccinations, parasite control, and other services and products that we provide. Exercises a technical knowledge of products sold.

Rating Points

20. APPEARANCE/GROOMING: Presents self as professional and dress reflects that presentation to clients. Is always clean and well groomed and wears appropriate uniform/clothing in accordance with job requirements.

Rating Points

OVERALL RATING _____ TOTAL POINTS _____

Comments/Recommendations/Goals to attain

This individual has demonstrated positive performance of growth and development in the following areas:

Areas where improvement in performance and effectiveness can be shown by this individual:

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Additional Comments:

Future Goals for Employee:

My employer and/or supervisor has reviewed this evaluation with me. I understand the criteria on which I have been judged and my reviewer has discussed my goals for the future.

Employee Signature: Date:

I have completely reviewed this evaluation with my employee.

Supervisor Signature: Date:

Employer Signature: Date:

Employee performance agreement

___ Counseling ___ Warning ___ Final Written Warning

Name/Title of employee: Name/Title of direct supervisor:

Summarize the situation and its implications. Define performance objectives for the employee, outlining what the employee is responsible for doing to correct the situation. Check the appropriate availability of supporting documentation. Review job description to clarify expectations.

____ Supporting documentation is available and attached ____ Supporting documentation is not available

Outline the supervisor's responsibilities; what the supervisor will do to assist the employee in meeting the objective(s).

If this is a formal warning and this is marked, the employee's employment status is considered probationary, making the employee ineligible for pay increases, vacation usage, or promotions.

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Describe how the supervisor will determine if objectives are met. Outline the consequences if objectives are not met

If the above stated objectives are not met, further disciplinary action up to and including termination may result.

This performance agreement will be reviewed on _____/____/____ on page 2 of this form (Employee Performance Agreement Review).

Employee comments*:

Employee's Signature:______Date:______

Supervisor's Signature:______Date:______

Witness’ Signature: ______Date: ______

Employee performance agreement review Follow-up to: Counseling or Warning, dated: ____/____/____

Name/Title of employee: Name/Title of direct supervisor:

Progress Review—summarize the employee's actual performance compared to the objectives outlined on the Performance Agreement. Highlight areas of improvement and/or areas of continued concern. Check the appropriate box regarding availability of documentation. Review job description to clarify expectations.

____ Supporting documentation is available and attached ____ Supporting documentation is not available

Overall evaluation of the performance: ____ The employee has met all performance objectives. ____ The employee has made progress toward the completion of performance objectives or has met some objectives. ____ The employee has not made any progress toward completion of performance objectives. ____ The employee's performance in noted areas has declined.

Recommendation: ____ The objectives were met and the performance agreement has been fulfilled. ____ The employee has made some progress, but improvement is still needed. Performance agreement will be revised or time frame to meet objective(s) extended to ______/______/______(date). Attach new/revised agreement.

____ Performance did not improve to stated performance objective(s). Further action is warranted (see attached documentation): ___Warning (new review date ____/____/____) ___Suspension ___Demotion ___Transfer ___Termination ___Other

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Supervisor Comments (include consequences the employee may face if the situation precipitating the Performance Agreement should reoccur):

Employee Comments* (please use the back of this form for further comments):

Employee's Signature:

Date:

Supervisor's Signature:

Date:

Witness’ Signature:

Date:

Termination meeting checklist Conduct the meeting in sequence as follows: 1. All documentation or performance/disciplinary issues have been completed. 2. Tell the employee the purpose of the meeting. Although the reason for termination should be communicated, there is no need to go through a step-by-step analysis of the documentation supporting the reason for discharge. 3. Advise that the decision is final and cannot be reversed. 4. Where appropriate; advise that alternative in-house positions were explored. 5. Emphasize that all relevant factors were reviewed. 6. If applicable, stress that everyone involved in management activities agreed to the decision. 7. Tell the employee the effective date of the termination. 8. Review with the employee a written summary of benefits. Where applicable, this summary should include severance pay, compensation for vacation and sick time, continuation of health and life insurance benefits, other benefits and re- employment assistance. 9. Have final paychecks ready. If the employee is to leave immediately, have any final checks, benefits or vacation payments prepared and inform the employee how to collect his or her personal belongings and leave the premises. 10. End the interview by saying that the employee will be notified of any other matters that must be dealt with, such as COBRA continued health coverage. 11. Wish the employee good luck and express confidence in his or her future. 12. Stand, extend your hand and remain standing until the employee has left the meeting site. 13. Check your state laws regarding the requirement of providing a standard service letter. In these states the employee must request verbally or in writing a letter verifying the employee’s dates of employment, type of services provided and reason for conclusion of employment

Employee exit interview Practice Name TO:

FROM:

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I would appreciate it if you would take a few minutes to respond to the questions below. All Answers will be held in strict confidence. Thank you.

How long were you employed with our practice?

Job classification?

Why are you leaving?

Would you describe your working relationship (with respect to both your particular job and your relationship with fellow team members) as pleasant or unpleasant? Please rate on a scale from 1 to 10.

1 2 3 4 5 6 7 8 9 10 Poor Excellent Comment: ______Do you feel that your particular job was important and significant in the overall operation of the practice?

Are there any particular practices or working conditions that either led to your decision to resign or that you feel are detrimental to a satisfactory working relationship? If so, have you any suggestions on how to eliminate them?

Are there any particular practices or working conditions that you feel are particularly beneficial to an effective working relationship and that should be maintained?

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Would you care to make any other comments?

The above information is true to the best of my knowledge, information and belief

Signed: Date:

Termination letter example Dear Mr/Mrs/Ms,

Further to our meeting of (date), I confirm that your employment with (Company) is terminated with effect from (date).

As stated at our meeting on (date), the reason for termination your employment is as follows;

2 Reason 1 - e.g. summary of redundancy reasons. 3 Reason 2 - summary of gross misconduct or poor performance and what steps had been taken, and when, to enable the employee to rectify the situation. 4 Reason 3 - etc

Clearly state individual requirements such as return of company car, equipment, submission of expense claims etc and any other administrative details.

Clearly state actual leaving date, and details of notice period, holiday pay, general pay and pension or other benefits, plus redundancy settlement if appropriate.

Clearly state how the employee can appeal to the decision - the employee’s rights, the appeal process and appeal time frames.

Please sign, date and return this letter as confirmation of receipt of this letter and any attachments/ enclosures.

Yours truly,

Name Position

Termination checklist Employee Information

Employee Name Employee position Term Date If termination is involuntary [ ] Documentation of performance issues and disciplinary action is in employee file.

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Before employee’s last day of employment Human Resources Accounting/Finance [ ] Prepare COBRA Letter [ ] Final paycheck is being prepared. [ ] Schedule exit interview [ ] Check for final balances on employee account, make arrangements for payment.

Office Coordinator/Facilities [ ] Cancel voicemail account effective employee’s last day. [ ] Request to have employee’s network access closed effective employee’s last day. [ ] Cancel password for security access and collect any keys Last day of employment

[ ] Provide COBRA letter & explain 2 60 days to elect coverage 3 45 days to send in premium for all months since coverage ceased 4 Premium due 1st of the month [ ] Non-Disclosure Agreement 2 Provide copy 3 Explain Non-compete 4 Retrieve any confidential information [ ] Last paycheck (please check one) [ ] Provided at exit interview OR [ ] Mailed after termination date [ ] Provide 401(k) Withdrawal Form [ ] Address Changes Verified

[ ] Collect or verify computer system(s) or equipment [ ] Collect security card [ ] Collect cell phone [ ] Collect phone card [ ] Collect corporate credit card [ ] Exit Interview Questionnaire [ ] Departure is communicated to staff [ ] Eligible for rehire? Yes_____ No ______[ ] Terminate status in the HR system

After the employee’s last day [ ] Check for any additional amounts owed [ ] Mail final pay stub to former employee if necessary. [ ] Complete and submit benefit forms to stop coverage with Insurance. [ ] If former employee submits a request for COBRA coverage, re-enroll using Insurance enrollment forms. (Refer to COBRA process document.)

Reason for leaving

______

______Employee Signature Date

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Essentials of HR: Training and the First 90 Days Monica Dixon Perry, CVPM Veterinary Management Consultation, Inc. Evergreen, CO

Niqole Varani, DVM, CVPM Veterinary Management Consultation, Inc. Evergreen, CO

New employee orientation checklist • can vary from state to state - • Provide employee with personal storage space. Discuss protection of personal property at work • Tour the hospital. Provide a detailed hospital tour which points out emergency exits, eye wash stations, employee restrooms, employee break room, bulletin board and work schedule. Identify the exam rooms, kennel, surgery/treatment area, pharmacy, radiology, etc. and what each area is used for. • Show Employee designated parking area • Introduce employee to doctors and other team members. Identify trainee’s immediate supervisor • Complete the following required forms for your personnel record: New Hire Reporting for state requirements: http://www.sba.gov/content/new-hire-reporting-your-state Verify Completion of Application 2.6 W-2 2.7 I-9 or E-Verify (Complete in entirety within 3 days of employment) 2.8 Verify Social Security card & driver’s license as required by I-9 2.9 Complete all required new hire forms 2.10 Direct Deposit Approval 1 Proof of current vehicle insurance (if driving personal auto for hospital) 2.11 Give employee an empty notebook for training notes 2.12 Present employee with [Practice Name]’s employee manual Review the hospital’s hierarchy chart (management structure) 3) Present At-Will Employment acknowledgement and have employee sign and place in their personnel file 4) Review benefits and effective dates 5) Discuss practice dress code and present employee with uniform 4.1 Review hospital schedule for meals and breaks Review the payday procedures and overtime policy

4.2 Employee to sign review and understanding of employee manual and place in their personnel file. 5 Present employee with [position] job description 1 Review general expectations for the position, as well as protocol for annual review 2 Present employee with a blank performance evaluation form 3 Review the veterinary technician duties to be completed daily 5 Learn the location and operation of time clock software. 1 Discuss timeliness and attendance expectation 2 Show employee the proper protocol for submitting a request for days off form and how work schedules are presented and posted. 6 Present employee with copy of phase training document. Explain protocol (trainee to sign off on each phase, if trainee has questions – ask, etc.) The phase training document should be carried on their person until training is completed in its entirety.

Employee Signature:

Management phase training checklist and instructions • The phase training program is to assist your new or existing team member with success in their position and requirements of the hospital. • All team members should have an up-to-date job description which closely matches the phase training program. • The phased training program should be provided to the team member after completion of the New Employee Orientation Checklist.

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• Management phase training checklist [Practice Name] The team member should be instructed that the goal over the next 90 days is to make sure that they are properly trained by their supervisor or their designated trainer and signed off on the lists of skills and knowledge tasks. • The phased training program keeps the trainer, trainee and practice manager abreast of the training status and gives them an open line of communication. • The phased training programs are excellent risk management tools to alleviate training oversights. • The phased training programs can be useful during performance reviews or if performance issues should arise. • Practice Managers should complete the checklist below for each team member using the phased training program. This checklist will ensure that the Practice • Manager is tracking the compliance of the team members’ training progress. • Team leaders should complete and sign off on the respective position before advancing to the Team leader phased training program. For example: the Receptionist Team Leader will complete and sign the Receptionist phased training program before moving to the Receptionist Team Leader phased training program.

Date: ______

Employee Name: ______

Position: ______

Employee’s Immediate Supervisor: ______

Complete New Employee Orientation checklist before presenting phase training to new employee. Employee to sign completion of checklist.

Verify that all required documents from the New Employee Orientation checklist are completed and signed.

Assign Trainer to each task before presenting to new employee

Inform trainer(s) that they will be assisting the new employee with their training. Ensure that the current schedule will accommodate the training times and needs.

Assign Due Dates to probable duration

Set up personal reminders to check progress of new employee with trainers

Set up personal reminders to verify with new employee status of phase training and that tasks are being completed in a timely manner.

Inform the team member to write down something new they learned or any changes, updates or addition that need to be made to the phase training document. Set up a time to discuss with the team member if needed.

Once new employee has completed a Phase, review with employee and sign off completion

Management Phase Training Checklist and New Employee Orientation [Practice Name]

Receptionist phased training program Employee (Trainee) Name Hire Date

Purpose: The purpose of this program is to introduce the Receptionist to the practice and bring them into the hospital’s philosophy of care and service. Through this program, the new Technician will become familiar with the day-to-day operations, management, and standards of care within our hospital

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The first column of the table below is the Skill/Knowledge and the Trainer that is assigned to the task for training the employee. The second column are the tasked that need to be trained and the third column is where the trainer initials that the training is complete and the date of completion.

Although a probable duration is stated for each phase of training, these are meant only as a guide and neither the trainer nor the trainee should sign off on a phase until they feel that they fully understand and are comfortable performing all the job tasks listed.

Phase I - Welcome to our practice!

Probable Duration: One Day - Two Days (Due Date ______)

New Employee The Employee has signed and completed the New Employee Initials/Date Orientation Checklist Orientation Checklist OSHA Training Conduct OSHA training. Explain OSHA standards, MSDS sheets, etc. Initials/Date Give employee handout regarding safety and complete OSHA test. Inform team member what they are to do if an OSHA officer shows up and ask for a tour of the practice. Make sure they know the practice OSHA safety officer’s/coordinator’s Trainer: name

Observation Trainee to observe (senior) receptionist. (1 hour) Initials/Date Trainer:

Telephone Show proper way to: Initials/Date Procedures  Answer phone, Trainer:  Take messages Place callers on hold Route messages to doctors and other team members Watch LifeLearn training CD “Enhancing your Telephone Skills.” Note to practice: This CD can be purchased at www.lifelearn.com

Basic Animal  Learn basic animal handling principles. Before signing off, trainee Initials/Date Handling must demonstrate proper animal handling with at least two patients. Trainer: Conclusion of Phase 1 Review of Phase I of training program. Trainee is asked if he/she has any Initials/Date questions or needs further training on any part of Phase I.

Phase I of training complete My signature below signifies that I have completed Phase I of the Receptionist Phased Training Program and that I fully understand all concepts covered and I am comfortable in my knowledge and ability to perform the procedures introduced in Phase I of this program. Supervisor signature below signifies that employee has successfully completed Phase I and has answered all pertinent questions.

Employee (Trainee) Date

Supervisor Date

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Phase II

Phase II Duration: One Week - Two Weeks (Due Date ______) Reference Materials Present trainee with materials to review. Initials/Date Present Trainee with the Common Medical Terminology handout. Other client education materials  Other ______Review: Review above presented materials with trainee Trainer:  Other ______Scheduling Explain: Initials/Date Basic appointment scheduling procedures. Scheduling guidelines and special circumstances (heartworm season, etc.). Trainer:  Fecal test Logging On/Off Demonstrate how to log on and off the computer properly. Initials/Date Review company policy regarding computer use and password Trainer: maintenance/usage. Software  Complete veterinary software training module Initials/Date Trainer:

Greeting Clients  Explain the proper way clients and their pets are to be greeted Initials/Date Trainer: and treated when they come to the practice.

Obtain client  Review obtaining all necessary data from clients to prepare forms Initials/Date information i.e. new clients, consent forms, medical care plans (ie, estimates). Trainer: Obtaining a weight  Demonstrate how to obtain a weight on a pet. Initials/Date Trainer:

Wait Time  Demonstrate how to handle situations where there is an Initials/Date Trainer: extended wait Alert Assistant About  Explain outpatient protocol -- the assistant is to be alerted that Initials/Date Visit the client and patient are ready. Trainer: Controlling Odors  Explain procedure for controlling odors and maintaining a neat Initials/Date and tidy front desk. Discuss danger in using bleach and that Trainer: bleach should NEVER be mixed with ammonia. Noise Pollution  Explain procedure for minimizing noise pollution. (e.g. barking Initials/Date dogs are escorted to a private area or an exam room) Explain Trainer: proper use of ear plugs. Pulling Forms  Show how to retrieve forms & the filing/computer system. Initials/Date Before signing off, trainee must demonstrate the ability to Trainer: properly handle. Checklist  Demonstrate how to use and/or create a checklist. Initials/Date Trainer:

Messages  Review the proper way to answer the phone and take messages. Initials/Date Trainer:

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Confirmation Calls Explain procedure of calling clients the day before their Initials/Date Trainer: appointments to confirm their appointment.

Surgery Quotes Explain the proper procedure for quoting surgery prices Initials/Date Trainer:

Medical Care Plan Demonstrate how to use the Medical Care Plan Book and the Initials/Date Book appropriate way to go over a medical care plan. Trainer: Fax, Copier, Phone Demonstrate the use of necessary office equipment. Initials/Date System Trainer: Mail Explain how to take out and pick up the mail. Initials/Date Trainer:

Vaccination Due Dates Explain how to check vaccination due dates. Before signing off, Initials/Date Trainer: trainee must demonstrate the ability to handle this task properly.

Conclusion of Phase II Review of Phase II of training program. Trainee is asked if he or Initials/Date she has any questions or needs further training on any part of Phase II. Trainee signs off on Phase II.

Trainee Comments - Phase II Use this area for any comments you have concerning this phase of your training. This will help us to improve our training systems and ensure that adequate training is provided to you. Your comments will be read by the management of the practice and kept in your confidential employee file.

Phase II of Training Complete My signature below signifies that I have completed Phase II of the Receptionist Phased Training Program and that I fully understand all concepts covered and I am comfortable in my knowledge and ability to perform the procedures introduced in Phase II of this program. Supervisor signature below signifies that employee has successfully completed Phase II and has answered all pertinent questions.

Employee (Trainee) Date

Supervisor Date

Phase III Probable Duration: One Week (Due Date ______) Adding New Client  Demonstrate how to add a new client. Initials/Date Trainer:

Entering Charges  Demonstrate the correct procedure for entering charges into Initials/Date the computer. Before signing off, trainee must demonstrate Trainer: the ability to correctly enter charges.

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Payments from Clients Explain the process of accepting payment from clients Initials/Date  Credit cards  Cash  Check Trainer:  Care Credit Fee schedule  Demonstrate how to print a list of charges. Initials/Date Trainer:

Team Meeting  Review recent team meeting minutes and the protocol for Initials/Date Trainer: reviewing minutes if employee is unable to attend a meeting. Hospital Tours  Explain protocol for client tours or when clients are allowed to Initials/Date Trainer: visit patients in boarding or the hospital. Treatment Board  Demonstrate how to properly use the treatment board. Initials/Date Trainer: Contagious Soak  Demonstrate the procedures followed for a contagious soak. Initials/Date Trainer:

Vaccine Protocol  Demonstrate a working knowledge of vaccine protocol. Initials/Date Trainer: Appointment  Demonstrate basic appointment scheduling. Initials/Date Scheduling Trainer: Surgery Appointment  Demonstrate the ability to schedule surgery appointments. Initials/Date Scheduling Trainer: Hospital Organization  Explain the organization of the hospital and workflow. Initials/Date Trainer: Surgery Forms  Demonstrate how to correctly fill out surgery forms. Initials/Date Trainer: Collect Laboratory Collect laboratory specimens from pet owners: Initials/Date Specimen  Match patient record to the sample Submit the samples to veterinary technician or nurse Trainer:  Present clients with medications and routine instructions Assign Bloodwork  Demonstrate the proper way to assign bloodwork within the Initials/Date (In-Hospital) practice. Before signing off, trainee must demonstrate the Trainer: ability to handle this task properly. Outside Labs  Explain the procedure for calling outside laboratories. Initials/Date Explain the procedure for outside laboratories results Trainer

Communication with Learn hospital guidelines for communicating with clients in Initials/Date Clients different types of situations such as general queries, scheduling appointments, routine and non-routine medical Trainer: questions, patient emergencies, prescription refills Medical Recalls Demonstrate the procedure to follow when recalling clients. Initials/Date Before signing off, trainee must demonstrate the ability to Trainer: handle this task properly. 698

Cleaning Exam Rooms Explain how to properly clean and disinfect an examination Initials/Date Trainer: room. Boarding Forms Explain how to complete boarding forms Initials/Date Trainer Boarding Reservations Explain how to make a boarding reservation. Initials/Date Trainer

Cancel Boarding Demonstrate the ability to properly cancel a boarding Initials/Date Reservation reservation. Trainer: Admitting Boarders Demonstrate the correct procedure to follow when admitting Initials/Date boarders. Before signing off, trainee must demonstrate the Trainer: ability to handle this task properly. End of Life Explain how end of life appointments are scheduled and how Initials/Date Appointments greeter should anticipate and prepare for these types of Trainer: appointments. Checking out the Demonstrate how to check-out a client Initials/Date Client Review charts for completeness  Make new appointments Note changes in patient status Trainer:  Enter future reminders Marketing Discuss marketing to clients Initials/Date Discuss how to promote the practices products, programs and services. Explain the use of passive marketing Ensure that employee gains a technical knowledge of products Trainer: sold Conclusion of Phase III  Review of Phase III of training program. Trainee is asked if he Initials/Date or she has any questions or needs further training on any part of Phase III. Trainee signs off on Phase III.

Trainee comments - Phase III Use this area for any comments you have concerning this phase of your training. This will help us to improve our training systems and ensure that adequate training is provided to you. Your comments will be read by the management of the practice and kept in your confidential employee file.

Phase III of training complete My signature below signifies that I have completed Phase III of the Receptionist Phased Training Program and that I fully understand all concepts covered and I am comfortable in my knowledge and ability to perform the procedures introduced in Phase III of this program. Supervisor signature below signifies that employee has successfully completed Phase III and has answered all pertinent questions.

Employee (Trainee) Date

Supervisor Date 699

Phase IV Phase IV Duration: One - Two Weeks (Due Date ______) Opening and Closing Demonstrate the procedure for opening the hospital Initials/Date Trainer: Demonstrate the procedure for closing the hospital

Surgical Charges Demonstrate how to check surgical charges. Review the Initials/Date Trainer: travel sheet. All services rendered should be highlighted. Price Quotes Explain how and when the Trainee is to quote prices. Initials/Date Trainer:

Client Transaction Demonstrate how to prepare a Client Transaction Report. Initials/Date Reports Trainer: Vaccination Present trainee with vaccination protocol handout and Initials/Date Protocol Handout explain how to use. Trainer: Correspondence Demonstrate how to communicate with clients regarding Initials/Date medical status, medical instruction, itemize and review the client statement, inform clients about hospital policies, payment and credit policies Trainer: Demonstrate how to print client correspondence i.e. reminders, thank you notes, new client letters Bank Deposits Explain how to prepare the bank deposit and complete the Initials/Date Trainer: deposit slip.

Credit Cards Explain the correct procedure to follow when batching Initials/Date Trainer: credit cards. End of Day Explain the End of Day procedures. Before signing off, Initials/Date Trainer: trainee must demonstrate the understanding of this task. Returning Products Explain which products can be returned Initials/Date Trainer: Demonstrate the correct procedure to handle returns. Coupons Explain how to handle coupons. Initials/Date Trainer:

Bounced Checks Explain the procedure to follow when a check bounces. Initials/Date Trainer

Accounts Receivable Explain the procedure for handling accounts receivable Initials/Date Trainer: issues.

After Hours ER Fee Explain the after hour’s emergency fees. Initials/Date Trainer: Prescription Filing Demonstrate how to correctly fill a prescription and the Initials/Date Trainer: expectation that all prescriptions should be proofed.

Controlled Demonstrate the correct procedure used when dispensing Initials/Date Substances controlled substances. Trainer: Recognizing an Discuss referring clients for immediate treatment of their Initials/Date Emergency pets when the requests are accompanies by complaints of

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Trainer: acute symptoms

Heartworm Testing Explain the practice's philosophy and established protocol Initials/Date & Prevention for heartworm testing and prevention. Trainer: Flea Prevention 101 Explain basic flea prevention protocol. Initials/Date Trainer:

Client Complaints Explain the procedure for handling client complaints. Initials/Date Trainer: Displays and Retail Explain how to restock and arrange the retail and point of Initials/Date Trainer: purchase display areas

Refreshment Area Demonstrate how to restock and maintain the refreshment Initials/Date Trainer: area Office Supplies Explain the protocol for ordering inventory and office Initials/Date Trainer: supplies

Clean Front Area Demonstrate how the front desk and printer should be Initials/Date Trainer: cleaned.

When in Doubt Assure the employee that whenever he or she is in doubt or Initials/Date needs help, they are expected to seek assistance and guidance.

Conclusion of Phase Review of Phase IV of training program. Trainee is asked if Initials/Date IV he or she has any questions or needs further training on Trainer: any part of Phase IV. Trainee signs off on Phase IV.

Trainee Comments - Phase IV Use this area for any comments you have concerning this phase of your training. This will help us to improve our training systems and ensure that adequate training is provided to you. Your comments will be read by the management of the practice and kept in your confidential employee file.

______

______Phase IV of Training Complete My signature below signifies that I have completed Phase IV of the Receptionist Training Program. I believe that I fully understand the concepts covered and I am comfortable in my knowledge and ability to perform the procedures introduced in Phase IV. Supervisor signature below signifies that employee has successfully completed Phase IV and has answered all pertinent questions.

Employee (Trainee) Date

Supervisor Date

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Financial Tools that Can Get Clients to Say ‘Yes’ John Volk Brakke Consulting Chicago, IL

Cost is a proven obstacle to veterinary care for many pet owners. Often, it’s not the price of services itself, but the fear of the “big bill,” according to the Bayer Veterinary Care Usage Study conducted by Brakke Consulting. Financial tools and communication can help minimize this barrier, improving client satisfaction while at the same time improving compliance and revenue for the veterinary practice. The tools include pet health insurance, preventative care plans, medical credit cards and written financial policies.

Pet health insurance Research conducted by the North American Pet Health Insurance Association (NAPHIA) showed that the majority of veterinarians wish all clients had pet health insurance. The NAPHIA research also showed that significantly more pet owners would purchase pet health insurance if their veterinary practice actively recommended it. NAPHIA is a trade association representing virtually all of the companies that offer pet health insurance in the US and Canada. Veterinarians responding to the NAPHIA survey identified three key areas in which pet health insurance contributes to patient health and practice revenues. Insurance increases: • Compliance on recommendations • Purchases of veterinary services • Overall health expenditures on pets In addition, the research demonstrates that clients with insured pets visit the veterinarian more often. Clients spent 29% more per year on veterinary care if their dog was covered by pet health insurance, and a whopping 81% more on cats. The increased lifetime value of patients covered by pet health insurance is dramatic. Most pet insurance is purchased within the first year of ownership and/or after the pet’s first visit to a veterinarian. In addition, the people most likely to take a strong interest in pet insurance are first-time pet owners, and experienced pet owners with a new pet. Targeting new pets, new pet owners and new clients helps the practice team focus on those clients most likely to be receptive to the information. It’s also the ideal time for clients to benefit most from the coverage. Again, educating clients about pet health insurance and recommending one or two specific companies can pay big dividend in increased visits, revenue and patient health. Veterinarians recommend many things they don’t sell: Regular exercise. Safe environments. Behavior training. All benefit the pet’s health and wellbeing, and make pet ownership more enjoyable and rewarding. Pet insurance fits in that same category.

Preventive care plans Preventive care plans, also called wellness plans, also help clients manage their pet care expenses. The Bayer Veterinary Care Usage Study published in 2011 showed that pet owners would visit the veterinarian more often if: (1) veterinarians provided a health plan for their pet, and (2) pet owners could pay for routine veterinary services in monthly installments. Preventive care plans satisfy both objectives. To determine the impact of preventive care plans on practices, Brakke interviewed corporate and independent practices that offer wellness plans. The independent practices included Bigger Road Veterinary Clinic in Kettering and Springboro, OH; Doral Centre Veterinary Clinic in Doral, FL; and Lansing Veterinary Clinic, Lansing, IL. National Veterinary Associates, a privately held corporate owner of veterinarian practices, has installed Pet Annual Wellness (PAW) Plans in 129 of its practices, with more than 40,000 active plans. All practices found that wellness plans increased visits and revenue, expanded and improved patient care, helped attract new clients, and strengthened the practice-client bond. “Wellness plans make preventive care more affordable” was a common theme among all practices interviewed. NVA found that professional service visits of those purchasing plans increased 69% compared to the period before purchasing plans, from a mean of 3.3 visits per year to a mean of 5.5 visits per year. Lansing compared the number of visits before and after purchasing plans, as well as the number of visits by plan participants compared to non-plan patients. Clients with wellness plans visited nearly twice as often as those without plans, and much more frequently than they did prior to purchasing plans (Fig. 1).

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Fig. 1. Lansing visits/Year with and without plans Life Stage Ave Visits, All Ave. Visits for Plan Ave. Visits, Clients with Pet Clients Clients, Prior to Plan Plan Senior 2.8 4.6 7.5 Adult 2.1 4.2 4.7 Juvenile 2.4 n/a 4.5 Both NVA and Lansing found that annual revenue per patient increased significantly for patients with wellness plans compared to those with no plan. In Lansing’s case, clients with wellness plans spent much more on veterinarian services than they did in the year prior to starting the plan. They also spent substantially more than those clients without plans (Fig. 2).

Fig. 2. Lansing revenue/Patient/Year with and without plans Life Stage Ave Spend/Pet, All Ave. Spend Plan Ave. Spend, After Pet Clients Clients Prior to Plan Purchasing Plan Senior $356.30 $366.88 $783.40 Adult $264.30 $342.80 $518.30 Juvenile $233.80 n/a $564.10 Similarly, NVA found that the mean amount spent annually per patient for medical services increased 57%, from $389 to $613. NVA found that expenditures on non-medical products and services outside of the plans increased 29% as well, from a mean of $223 to $286. So the total “lift” from wellness plans was $287 per patient per year. Bigger Road Veterinary Clinic’s experience was similar. Its records showed that clients spent an average of 65% more in the year after purchasing wellness plans than they did the prior year. The practices typically offer 10 to 15 plans, including plans for both dogs and cats. Prices varied. Many “standard” plans were in the $25-$35 per month range, but some were as high as $45/mo. Premium plans, which typically include spay/neuter for juvenile pets and dental prophies for adult pets, typically cost $10-$15 per month more. Some practices offer a third level, or “advanced” plan, with added services typically recommended for senior pets. Plans sold for dogs far outweigh plans for cats. $30 per month seems to be the sweet spot for standard plans, especially for dogs. At that price most pet owners find preventive care very affordable. Both NVA and Lansing discount services 35% to 40%. Part of the rationale is that wellness plans provide for a much more comprehensive package of services than clients typically buy, including such things as twice-a-year wellness exams and fecal tests. In addition, clients rarely utilize all the services included in the plan, so some of the discount is “recouped” in un-used services. The combination of a more robust services, services paid for but not used, plus additional outside-the-plan purchases, add up to substantially increased revenues per patient – as well as a higher level of veterinary care. Bigger Road Veterinary Clinic does almost no discounting from regular prices, but it does include at no cost a small number of inexpensive services such as nail trims. Yet it has sold more than 500 plans in a little more than a year. All practices referenced in this presentation charge a one-time enrollment fee, generally $45-$50. The enrollment fee helps gain a commitment to the plan from clients, and helps offset the deferred cash flow due to receiving revenue in monthly installments. Most plans include free visits. NVA PAW plans include up to four visits per year. Bigger Road plans include three visits and Doral plans five. Lansing offers unlimited free visits.

Medical credit cards Having emergency credit available can make a huge difference both to pet owners and the veterinary practices that serve them. The most widely used credit service is CareCredit, a financial services firm serving several medical professions. In 2011, Brakke compared data for the years 2007 through 2010 from the practice management systems of more than 500 veterinary hospitals, including approximately 100 practices that use CareCredit and 400 that don’t. In addition Brakke analyzed data from more than 350,000 pet owning-clients of approximately 120 veterinary practices that use CareCredit and compared the behaviors of clients that use CareCredit to pay for veterinary expenses to those who were non-users. The analysis showed that the use of CareCredit had a substantial impact on client spending, and a significant, sustained and positive impact on veterinary practice income. Specifically: • Clients that used CareCredit spent 93% more per year and 47% more per pet at their veterinary practices than clients without CareCredit. • Veterinary practices that offered CareCredit generated 19% more medical revenue and 17% more total revenue than practices that did not offer CareCredit. • Practices that were more active users, defined as practices with at least 25 client applications or $50,000 in total CareCredit charges per year of CareCredit generated 31% more medical revenue and 26% more total revenue annually than non-users.

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• The impact of CareCredit was immediate. Veterinary practices that enrolled with CareCredit generated 11% more medical revenue within the first 12 months following enrollment than in the 12 months prior to enrollment.

Written financial policies Perhaps the most important financial tool is communication. That is, making sure that clients know and understand the practice’s financial policies, and the tools available to clients. It is important to have those policies in written form. Share them with new clients, and periodically with established clients.

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How Pet Owners are Changing and What It Means to Your Practice John Volk Brakke Consulting Chicago, IL

When talking about pet owners, its easy to picture in our head the typical pet-owning family: Dad, mom – white of course, two children, a dog, maybe a cat or two. While in many cases that might be a reasonably accurate description of some clients, it’s really a stereotype. Or maybe wishful thinking. The fact is, there are important but subtle changes taking place in the pet owner population, and those changes can easily impact whether they purchase services from you, and if so under what circumstances. As we talk about these changes, it’s important to remember that all retail business is local. So some may potentially impact your practice more than others. The key is to think about which ones may be happening in your neighborhood, and how you can address them among your clients.

Single-parent families The percentage of households with two parents is declining. In fact, by 2014 only 69% of household had two parents, down from 87% in 1960. Not only are 25% of households headed by a single mother, in an additional 15% of households, the mother is the sole or primary provider. In most, but not all of those households, mean income is lower than those in which men are the primary breadwinners. Implications: In single-parent households, time – and often money – are challenges. Offering convenient hours, such as evening or weekends, can make it easier for them to fit in veterinary care. Also, be sure your clients are aware of drop-off services offered by your practice.

Reduced home ownership Home ownership in the US is declining. Adults living with parents is the highest it has been since the 1940s. In 2015, 43% of men 18-34 years of age were living with parents or relatives. In addition to adult children living at home, there has been a shift from owning to renting, such that home ownership is at the lowest level it has been in years. Pet population tends to follow household formation, and household formation took a big hit during and immediately following the Great Recession. Another, unrelated trend that is bearish for pet population is the aging population. Pet ownership tends to start declining when adults reach 50 to 55 years of age and declines to very low levels by the time people reach 70 or older. And guess what? The 55 and older cohort is the fastest growing population group in the US. Implications: If you’re not seeing a lot of new clients, the stagnation of the pet population may be a factor. That means you have to work all the harder to attract new clients. More people are sourcing pets from shelters and rescue groups than ever before. Work with these organizations, as well as breeders and welcome organizations to identify people that may have a new need for veterinary services.

More millennials Now I’ve got better news. Currently those in the 25 to 29 and 30 to 34 age cohorts are the third and fourth largest groups in the US. However, by 2020, those two groups will be the largest population groups. This age range is when people are most likely to purchase a home, get married, have children and acquire pets. In fact, many of them are deferring having children and acquiring pets instead. They are partly responsible for an uptick in the number of households owning pets. While millennials are favorable to owning pets, keep in mind that they aren’t exactly like their parents’ generation when it comes to pet care. Brakke Consulting conducted a study recently and learned that millennials are less dependent on veterinarians for pet care advice, and are more open to purchasing healthcare products and services from non-conventional sources. They are also more likely to outsource services than their parents, so they are heavier users of daycare, boarding, and grooming services (Fig 1, 2, 3).

Figure 1. Loyalty to veterinarian by generation Millennials GenX Boomers I completely trust my veterinarian's recommendations 64% 70% 78%

I generally comply with my veterinarian's recommendations 67% 70% 79%

I feel a sense of loyalty to my vet 55% 59% 63%

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Figure 2. Product sourcing by generation Millennials GenX Boomers

Want choice in where to fill scripts 62% 54% 45%

Visiting vet less often 17% 12% 12%

Figure 3. Pet care outsourcing by generation % Having Used Millennials GenX Boomers Daycare 32% 20% 7% Boarding 34% 23% 15% Grooming 65% 48% 41% Dog walking 30% 17% 4% In-home pet sitting 33% 24% 13%

Implications: If you offer daycare, boarding and/or grooming, this is an excellent target for your services. In addition, keep in mind that many of these are first-time pet owners, so it is worth your while to spend extra time educating them about proper pet care, including proper veterinary care.

Changing ethnicity Every year, the US becomes less white. In fact, within 50 years all of us, regardless or race or national origin, will be minorities. In recent years, the greatest influx of immigrants has been Hispanic. The tide is turning, and increasingly Asians will be the predominant immigrant group. Today 87% of pet-owning households are white. By 2025 – less than 10 years from now – only 60 percent of pet- owning households will be white. Keep in mind that different races and ethnic group have different approaches to pet ownership and pet care, as well as the different levels of resources to fund them. Implications. Make sure you are reaching out to all the potential constituencies in your trade area. If you have a large Hispanic or Asian population in your area, reach out to them through their community organizations and religious institutions. The schools are often a great place to reach various ethnic groups as well.

Financial stress One of the things the Great Recession taught us is that financial pressures impact veterinary care. But while the recovery from the recession seems pretty much over in most areas, that can be an illusion. It’s important to recognize that financial pressures haven’t gone away. Median earnings for men in the US haven’t changed significantly since the 1970s. Women’s earnings have improved about 25% over that time, so that has helped in two-parent households. We’re still a long way from getting back to where we were before veterinary visits started declining in the early 2000s. But wait, you say. Business was rocking and rolling in the early 2000’s. Maybe visits weren’t increasing rapidly for many of us, but business was good. Here’s why. Remember the housing bubble? Home values were increasing rapidly. It was easy to sell your house and get a mortgage on a bigger one. From 2001 to 2006, American’s pulled $5 trillion – yes trillion – dollars out of home values and spent it on things like big screen TVs, cars, restaurant meals, vacations and, yes, veterinary care. That’s about $17,500 for every man, woman and child in the US. That money is gone, and it won’t return any time soon. For one thing, the housing bubble is over. For another, people are saving more than they’ve saved in a long time. That’s a good thing for their financial security. But it does mean that they are spending less on veterinary care and other discretionary items. The recovery hasn’t occurred evenly across the economy. It has heavily favored the well educated. In Chicago, for example, median earnings are still way below 2007 levels in all categories except those with graduate degrees. Underemployment is still rampant, especially among those with less than a college education. The result of all this is a declining middle class. Since 2000, the middle class has declined from 54% to 50% of the population. And exactly what is the “middle class”? A family of four with annual household income of $44,000 to $132,000 is considered middle class. The lower socio-economic levels have increased, from 27% of the population to 29%. There has been a similar gain, from 18% to 21% in the upper groups. If you practice in an upscale neighborhood, those trends may well be favorable to you. In the last 30 years, the only demographic group that has experienced an increase in net worth is the upper class! If you service the 80% not in the upper class, recognize that there’s still a lot of financial pressure on your clients.

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Implications. This continued financial stress has a lot of implications for veterinarians. First, it will make it more difficult to continue to raise prices. There’s evidence that inflation in the cost of veterinary services is driving pet owners away and causing continuing declines in veterinary visits. That’s a lose-lose proposition for you your clients, and the patients you care for. So look for ways to managing pricing, especially for shopped and routine services. Try to improve value, not price. Also look for ways to make it easier for clients to pay for your services. Things like monthly paid wellness plans, pet insurance and medical credit cards like CareCredit. We’ll talk more about those in the next two hours. Again, what’s going on in your neighborhood is what matters most. But changing demographics can sneak up on you. Be alert to financial pressures of your clients, or to shifting racial or ethnic cohorts in your trade area. Don’t just target the same group of clients you’ve always targeted. Those new groups need care for their pets, too. But they may buy differently than the clients you’ve traditionally served.

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How to Make Pet Insurance Your Practice’s New Best Friend John Volk Brakke Consulting Chicago, IL

Research demonstrates that veterinarians are highly supportive of clients having pet health insurance. In fact, 56% of veterinarians in the US (85% of Canadian veterinarians) wished all their clients had pet health insurance. In related research, 50% more pet owners said they would purchase pet health insurance if their veterinarians actively recommend it. What the studies show is that having brochures from a few insurance companies available in the waiting area isn’t enough to communicate “recommendation” to pet owners. There are many other, easy and more proactive steps that practices can take to increase client interest in pet health insurance. Two research studies were conducted by the North American Pet Health Insurance Association (NAPHIA). One survey, in October 2015, was among a sample of 626 US and Canadian adults who had primary or shared responsibility for pet care. The second, in January 2016, was among 505 US and Canadian companion animal veterinarians in private practice. NAPHIA is comprised of pet health insurance (PHI) organizations from across Canada and the United States. NAPHIA’s membership makes up over 99% of all pet health insurance coverage in effect in North America. It’s easy to see why veterinarians prefer patients to be covered by pet health insurance. When asked their expectations of pet health insurance, as well as how well those expectations were met, veterinarian list the following as high priorities on which pet health insurance delivered the most: • Produces increased compliance on recommendations by current clients • Increase purchases of veterinary medical services • Produces increased expenditures on pets by current clients. There is tremendous medical and financial value to increased use of pet health insurance. According to the studies, dog owners with pet health insurance spent 29% more annually for veterinary care; cat owners 81% more. Mean annual expenditure on veterinary services for insured dogs was $324 v. $251 for non-insured dogs. Mean annual expenditure for insured cats was $264 v. only $146 for non-insured cats! Contrary to an opinion sometimes voiced in veterinary circles, the vast majority of veterinarians do not fear that increased use of pet health insurance would lead to managed care. Ninety-five percent of veterinarians surveyed did not agree with the statement, “Pet health insurance companies will have too much influence in the veterinary profession if it becomes commonplace.” For pet owners, especially those who were less familiar with pet health insurance, a recommendation from either their veterinarian or a veterinary practice staff member was highly influential in whether or not they would purchase a pet health insurance policy. According to the research, pet owners don’t necessarily expect their veterinarian to be an expert on policy costs and coverage. Rather, what they are looking for is reassurance that the veterinarian believes pet insurance is a valuable component of responsible pet ownership. Interestingly, most pet owners who buy pet health insurance aren’t doing it for strictly economic reasons, according to the research. Rather, they are buying it for peace of mind, and a sense of security that they are doing the best for their pet. Among those pet owners who had pet health insurance, the most common reasons were: • Is helpful to pet owners (59%) • Shows you love your pet (55%) • Shows you are a responsible owner (53%) • Provides peace of mind (49%) • Is a good investment (48%) • Helps avoid the need to make painful choices about care (42%).

So how can veterinary practices foster more use of pet health insurance by their clients? Here are 10 ways. Select one, or at most two, pet insurance companies to support Pet owners are looking for a recommendation, not a whole catalog of choices. If there are brochures from four or five companies in the waiting room, the client won’t pick up any. Designate one or two key staff members as the pet insurance liaisons, or go-to persons Typically these would be full-time receptionists, hospital administrators and/or practice managers. These individuals could be the ones that research the various companies and pick one or two for the practice to recommend. Regardless, the designated pet health insurance liaison should be familiar with the recommended companies and able to answer basic questions.

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Provide pet health insurance policies for one or more pets of the staff liaisons This will insure that they are familiar with the company’s policies and claims submission forms. It also provides a perfect answer when the client asks, “Which company do you use?” Many pet health insurance companies provide discounted policies for veterinary staff members, and many practices insure at least one pet for each staff member. Provide a link on the practice website to the pet insurance company or companies recommended by the practice. This makes it easy for the client to obtain more information, and makes the practice the gateway to more information about pet health insurance. Determine which clients already have pet health insurance Each time a client schedules an appointment or visits the practice, ask if the pet has pet health insurance. Note in the patient’s record that it insured. Over time, this will provide a census of how many patients are insured. It will also help measure if the practice’s efforts to increase use of pet health insurance are gaining traction. For uninsured pets, hand the client a brochure and encourage them to find out more Tell them that the practice recommends that the owners of all healthy pets at least explore pet health insurance, and which company(ies) the practice recommends. Offer to answer any questions once the client has read the brochure and perhaps visited the website. Sick or injured pets may or may not qualify for pet health insurance until they are fully recovered and healthy once again due to preexisting conditions. Note pet health insurance company and claim number in patient record Recording that a patient is covered by insurance informs veterinarians and staff that treatment costs may qualify for reimbursement. This can facilitate decision-making when discussing options with the client. It’s also convenient to keep copies of claims forms with the pet’s policy number in the patient file. Your clients will appreciate the personal touch. Submit claims Practices that have the best success in fostering the use of pet health insurance volunteer to submit claims on behalf of clients. This is an added level of service deeply appreciated by client, and its makes it much more likely that claims will be filed in a timely manner. Further, when claims are submitted at time of service, its highly likely that the client will be paid promptly, in many cases before a credit card bill comes due. By working closely with just one or two pet health insurance companies, submitting claims can become routine and takes only a minute or two. Recommend 30-day non-cost trial policies Where allowed by state Departments of Insurance, some pet health insurance companies offer 30-day no-cost introductory policies. Clients like them. Veterinarians clearly like them too. If the pet insurance company you recommend offers no-cost trial policies, be sure to inform clients, especially new clients or existing clients with new pets. There may be time sensitivity, too. Generally, no-cost trial policies must be activated within one or two days of a veterinary visit to get full benefits. Consider having clients activate the introductory policy from their smartphone before they even leave the practice. Engage the whole practice Every employee from owner and associate veterinarians to kennel attendants should be enlisted in the campaign to increase use of pet health insurance. They need to be educated about the value of pet health insurance to their work and income, as well as the practice’s reasons for supporting pet health insurance. All should be encouraged to recommend pet insurance to clients when opportunities arise. Veterinarians and their staff members are the information resources most valued by pet owners. By actively recommending pet health insurance and providing a high level of service, every practice has the opportunity to increase the number of insured patients. While it may not be possible to get every client to purchase pet health insurance, each and every policy makes a positive impact on the pet’s health, the client’s compliance and peace of mind, and the practice’s success.

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5 Things Associates Should Be Doing Now Sarah Wooten, DVM Sheep Draw Veterinary Hospital Greeley, CO

Level up your confidence: Identify the imposter voice and own your successes Women professionals often exhibit lower confidence levels and the selection, training, and working environment of clinical veterinary medicine can encourage a sense of being an imposter and sabotage confidence. There is always someone close by who is more accomplished and successful than you (at least on paper). This lack of confidence leads to behaviors that further undermine achievement, and the behaviors that follow are significant barriers to women achieving “work-life balance” and leadership positions within veterinary medicine. More women veterinarians need to step up to the leadership table and recognizing the way in which the imposter syndrome may be affecting you—and how dealing with it can be one big step towards realizing your full potential.

Develop emotional resilience and combat compassion fatigue: Learn the difference between using your heart and your head 8th century Scottish philosopher Adam Smith and 19th century British anthropologist and sociologist Herbert Spencer wrote about perspective-taking as a "cognitive, intellectual reaction" and empathy as a "visceral, emotional reaction".It is important to understand that perspective-taking is exclusively the process of taking an alternate point-of-view, and has nothing to do with taking on the feelings of others. Because this differentiation is commonly overlooked, perspective-taking is frequently confused with empathy. For this reason, the use of perspective-taking and empathy as synonyms is frequent within the scientific literature. The two are not the same, however. You can have empathy but be lousy at perspective taking. If you find your perspective taking skills are lacking, you may find clients argumentative, uncooperative, and uncompliant. For example, one can perspective-take a fellow individual’s thoughts and feelings. However, the perspective-taking process does not necessarily lead to feelings of empathy. Rather, that determination may be made after the perspective-taking process has finished. When veterinarians deal with so many emotions from so many people on a daily basis, it is critical to decide which client emotions you decide to get involved with, as you only have so much room in your psyche for all your own challenges and emotions plus that of others. By reducing your power within an interaction, you can sharpen your perspective. When you’re in an encounter, assume you’re the one without power — because the research shows an inverse relationship between power and accurate perspective taking. Second, don’t confuse perspective-taking with empathy. Both are important. But perspective-taking is very much a cognitive skill. You do it better by thinking about another person’s interests, not only understanding what emotions they’re feeling. Furthermore, too much empathy can submerge your self interests and that of the pet. Perspective taking is understand the needs, wants, desires, and core values of the client. Empathy is feeling those feelings. Learn the difference.

Eradicate procrastination and take control of your life Most of the time, it’s not lack of experience that is holding us back, but rather the lack of determination to do what we need to do to be successful. We can put so much energy into coming up with distractions or excuses as to why we can’t be, do, or have the things we want - what if we used that energy to go for what we want instead? When we say we are unqualified for something, or don’t have time, what we are really saying is that we are too scared to try or it isn’t a priority. Procrastination is one of the easiest and sneakiest forms of self-sabotage. Tips to live by 1. You know more than you give yourself credit for (no more imposter voice!) 2. You are drawn to things you are naturally good at. 3. Necessity is the best teacher. 4. Done is better than perfect. 5. Passion is stronger than fear. 6. Notice where you stop - and unblock! • Mindfulness isn’t for Sissies: how meditation changed my life, and tips for developing and practicing meditation • Mental Toughness: Tips from the Navy Seals and Long Distance Triathlon

Bite by bite, the elephant is gone How do you eat an elephant? One bite at a time. Faced with a daunting task we feel overwhelmed, fight, flight, or freeze sets in, and we stop before we have even started.

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Navy SEALs and triathletes break down any large task: divide the elephant into neatly digestible parts and eventually it will be gone. Triathletes focus on the next immediate objective — the next point in the horizon — and prevent their minds from passing to the entire race.Veterinarians can learn to use this technique to take on any large challenge - take it one tiny step at a time. Break down any daunting ask into immediate, bite-sized objectives. Ideally, these tasks should be able to be accomplished in a day - if you can’t finish it, make the task smaller, focus only on completing one at a time. To avoid the overwhelmed feeling, do not think about the whole project or task.

Visualize success In a certain study, basketball players improved their free throw accuracy by 23% from just visualizing the free throws. Players who practiced actual free throws only improved by 24%. That’s only a 1% difference! Helpful visualizations have the following qualities: • Vivid and detailed. Imagine the particulars. Make it as real as possible. Imagine it so it feels good. • Replay the image or scenario repeatedly, and try to go longer than a minute. • Make sure you are focused on the positive aspects. For example, if you want to have a successful surgery, don’t say ‘I don’t want there to be complications.’ Instead, go for positive: ‘I want to control bleeding in this 10 year old pyometra and have the patient wake up routinely. Do not envision yourself failing. Instead, repeatedly envision yourself in a state of effortless success. Application: The next time you have a big, stressful event coming up, use visualizations to imagine yourself succeeding.

Emotional intelligence In times of great stress, stress hormones - adrenaline, cortisol, and norepinephrine - can boost focus, energy and potentially save our lives. However, when these hormones stay elevated for long periods when we are stressed all the time, it affects immune function, motivation, mood, and sleeping. We basically turn ourselves into cushingnoid dogs. The SEALs simple solution is something called the 4 by 4 for 4 to turn off stress hormones: • Breathe in for 4 seconds • Breathe out for 4 seconds • Repeat for 4 minutes Application: This helps if you do meditation already, but the next time you catch yourself feeling stressed, stop and take several deep breaths. Bestselling author Tim Ferriss recommends stopping everything and taking a simple 3 breaths before going on with your day.

Nonreactivity We have more control than we think. We can’t control what happens in our clinics, but we can control our interpretation of it. This is called ‘reframing’. Take one possible belief or worldview, discard it, and reach for a more positive one. What could have been interpreted as a negative situation could now be interpreted as positive. Application: Take an active look at how you are interpreting external events. Once you recognize it, challenge that view. Try to reframe any negative views into more positive ones. Reach for any thought that gives you a sense of relief or positivity.

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Pimp My Brain: A Crash Course in Perspective Taking Sarah Wooten, DVM Sheep Draw Veterinary Hospital Greeley, CO

No matter how brilliant of a veterinarian you are, if you cannot understand the perspective of your clients, what motivates them, their core beliefs and fears, their generational values, then you can’t attain compliance, client loyalty, build your business, or practice successfully. So how do we know who we are dealing with in the exam room? How do we find out what their needs, wants, and desires are? How do we deal when we have a totally different perspective of what the pet needs than the client? The first step is to gain and respect the client’s perspective, and the best way to do that is develop a multi-dimensional perspective, which is the purpose of this session. In the session, we will play the ‘E Test’, which is a fun way to determine an individual’s ability to take perspective in a complex social situation - like the exam room, right? Perspective taking should be pretty simple - take the opinions, ideas, and thoughts of others to be more important than your own, and you will automatically find it necessary to listen more carefully and take their point of view into consideration. It’s easier said than done, however, especially when you are very smart and have a ton of knowledge, and even harder when you are considered to be the expert. When it comes to perspective taking, smarts actually becomes a curse, because it becomes more difficult to take the perspective of the other when you already know the answer. In this session, we will learn strategies on how to develop a multi-dimensional perspective to get inside your client’s head, and see the situation from his/her eyes. Understanding the client’s perspective better will help you understand why they are in your office, what their goals for the visit are, and most importantly, how to move them to action. Furthermore, we will be using three video case studies to demonstrate our new found perspective taking skills. To learn more about the skill of perspective taking, I recommend reading ‘To Sell is Human’ by Daniel Pink. Also visit www.drsarahwooten.com for free handouts and exercises to try back at your hospital.

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Sharpen Your Soft Skills, Change Your Life Sarah Wooten, DVM Sheep Draw Veterinary Hospital Greeley, CO

When communicating with clients, there are subtle changes you can make in your delivery that can have big payoffs in increased compliance, better client retention, and increased new clients. If you use the right words, the word gets around. In this session, we are going to identify barriers to compliance, and simple communication tweaks that will strengthen your confidence, reduce confusion in the client, and instill a sense of goodwill between client and veterinarian.

The goals of the session: Review the AAHA compliance studies • Teach small communication changes that will have big impact, for example: o The client and veterinarian need to be on the same page. Make sure the client understands what you are saying. Finish with ‘does this make sense?’ o Learn to say ‘your pet needs’ vs. ‘I recommend’. o Draw parallels to human health issues to make the issue relevant and better understandable for the client. o Acknowledge the difficulty of the situation right away – establishes empathy and instills loyalty. o Learn to recognize fight, flight, and freeze in your clients and deal appropriately with each reaction. o Learn client needs for autonomy, certainty, and empathy. o Learn to compromise on a diagnostic or treatment plan, i.e. only offer the best, and if the client declines, don’t give them a second option that may be more palatable to them. o Stop using big words. o Use discharge instructions and handouts. o Give explicit and easy to understand reasons for follow-up. o Be sympathetic to client concerns for affordability, and learn to work with the client. o Develop your best euthanasia best-side manner. A good end inspires incredible client loyalty, and for good reason. This is hard. o Don’t assume that every client wants an in depth explanation. o Dpn’t assume that the client is not doing his/her best. o Give praise and positive affirmation to the client.

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