If you always do what you have always done, you always get where you have always gone. This is a slight variation of Einstein’s definition of insanity. Let’s explore how this unfolds within the realm of veterinary team utilization. Your veterinary team is made up of people with various passions and talents. Each team member brings great depth and breadth to the services provided to the client and patient. Clearly defining their roles, expertise, and scope of practice improves the delivery of veterinary care. You may recall the 1999 Mega Study1 commissioned by the American Veterinary Medical Association (AVMA), Association of American Veterinary Medical Colleges (AAVMC), and American Animal Hospital Association (AAHA) entitled “The Current and Future Market for Veterinarians and Veterinary Medical Services in the United States.” The study defined six critical issues to be addressed for veterinary medicine to succeed moving into the next millennium: 1) Veterinarian’s income 2) Economic impact of large numbers of women in the profession 3) Global demand for all categories of veterinary services 4) Inefficiency of the delivery system 5) Supply of veterinarians 6) Skills, knowledge, aptitude, and attitude of veterinarians and veterinary students Let’s briefly address the other categories before delving into the insanity of underutilization. The first one seemed to be an “easy fix.” Veterinary hospitals tended to jump on the bandwagon and evaluated their pricing of services. Once fees were adjusted, the veterinarian’s income was affected directly. While starting salaries for veterinarians continue to climb, there remains a salary gap between gender pay. Over the last six years, the percentage difference gap has closed from nine percent to three percent; however, the mean starting salary for men is still approximately $3,000 higher than women.2 And it seems this gender pay gap grows over time, especially once reaching the higher income brackets.2 One factor in explaining this discrepancy is that despite women making up roughly 60 percent of the population of current practicing veterinarians,3 around 59 percent of practice owners are male.2 The demand for veterinarians and their services continues to remain high and veterinary unemployment is below the national level.4 There are more jobs than there are applicants and there are more veterinarians wanting to work fewer hours for less compensation, preferring to focus on well-being.4 Regarding the skills, knowledge, and aptitude (number six in the Mega Study), veterinary colleges have been assessing their admissions applications and interviewing process. There is evidence to support that personal characteristics, such as communication skills, sound judgment, and empathy, should be considered rather than just academic ability.5 Delivery system inefficiency “Excess capacity remains a substantial challenge for veterinary practices,” states Frederic Ouedraogo, PhD, an assistant director in AVMA’s economic division. “Excess capacity describes a practice that—for a number of reasons, including failure to fully use examination rooms or veterinary technicians—is producing less than it potentially could. Just over half of all private veterinary practices are characterized by excess capacity.”4 While there are many contributing factors to “excess capacity,” we will focus specifically on the underutilization of the veterinary team. Perhaps Pareto’s 80/20 principle applies when considering the utilization of veterinary teams. That is, 20 percent of practices are doing a good job, while 80 percent could utilize their team better. Using this simple idea, the 20 percent that are doing a good job understand the roles and formal education of their team members. In this model, veterinarians are leveraged to their max in performing the services they are trained to do, which are: 1) Diagnose 2) Develop treatment plans 3) Prescribe 4) Surgery The rest of the veterinary team is then properly leveraged for everything else within their scope of practice. In a well-managed practice, teams work like a Swiss watch: efficient, punctual, consistent, and dependable.6 What does it mean to offer team-delivered veterinary care? It means all team members seek to understand the needs of the client and their pet(s), then fulfill the need together. It means developing a team that is trained, trusted, and empowered to work together in a systematic manner, offering extraordinary client experience and the highest standard of veterinary care. It means the client and patient receive the best possible care from an efficient team.7 When meeting with veterinarians at various gatherings throughout the U.S., we are baffled by the number of those who are unaware of the resources at their fingertips by fully utilizing their team members. For a summary of state laws on veterinary technician and veterinary assistant duties, see AVMA’s “Duties and Task List.”8 Another way to define delegation of duties is by understanding the definitions of direct and indirect supervision (these may vary by state). The following definitions are from AVMA’s Model Practice Act.9 Direct supervision: a licensed veterinarian is readily available on the premises where the patient is being treated and has assumed responsibility for the veterinary care given to the patient by a person working under his or her direction. Indirect supervision: a licensed veterinarian need not be on the premises. Instead, he or she has given either written or oral instructions for treatment of the patient; is readily available by telephone or other forms of immediate communication; and has assumed responsibility for the veterinary care given to the patient by a person working under his or her direction. Training starts early While still in college, veterinary students will benefit from learning how to appropriately utilize their veterinary teams. Veterinary programs focusing on creating a team-delivered approach to care may set their students up for success. When new veterinarians reach their highest potential and promote team talent, economic and job satisfaction also will soar. In support of the profitability a veterinary practice can achieve by leveraging members of a veterinary practice, a survey conducted in 2008 found that for every credentialed veterinary technician a practice employed, the clinic generated $161,493 more in gross revenue.10 The study attributed the increase to the freeing up of the veterinarian’s time by allowing qualified technicians to complete tasks veterinarians traditionally performed. At the Banfield Summit in Portland in September 2018, team utilization was a hot topic. Daniel Aja, DVM, senior vice president and chief medical officer for Banfield Pet Hospital, suggested veterinarians are getting in the way of veterinary technicians not being utilized.11 During the summit, Veterinary Nurse Initiative (VNI) rolled out the chart seen above.11 Team utilization and leveraging is not a new concept (as outlined in the 1999 Mega Study). Yet managers and veterinarians may not have knowledge of the training veterinary technicians and assistants receive from colleges. Keeping the simple formula outlined above, veterinarians diagnose, prescribe, design treatment plans, and initiate surgery. Credentialed veterinary technicians, assistants, receptionists, and managers perform all other tasks in delivering team-centered veterinary care. Now is the time to evaluate your veterinary delivery system, to leverage your team to its max, and to further define your team’s role in the efficient delivery of care. By identifying team members’ abilities and maximizing their potential, a greater depth of services can be provided to the client and patient. Only in this way will the insanity circle be broken. Rebecca Rose, CVT, director of possibilities at CATALYST Veterinary Practice Consultants, has a diverse background in the veterinary community, working in and managing clinics, collaborating with industry partners, and facilitating engaging team workshops. Denise Mikita, MS, CVT, CATALYST’s manager of possibilities, brings extensive knowledge in practical clinic experience, organizational management, and team dynamics. Combined, the authors have more than 50 years’ experience in elevating veterinary teams. In addition, they have sat on veterinary councils, led state and national professional organizations, and have volunteered for animal welfare groups. Rose and Mikita can be reached via getCATALYST@CATALYSTVetPC.com. References 1 The Current and Future Market for Veterinarians and Veterinary Medical Services in the United States Executive Summary. May 1999 John P. Brown, PhD, and Jon D. Silverman, PhD. KPMG LLP Economic Consulting Services. bit.ly/2GSUkqq 2 Mind the Pay Gaps. JAVMA. November 2018. bit.ly/2s8SzLs 3 An Investigation into the Starting Salaries of Male and Female Veterinarians. Jane Frances Weiss. Thesis Fall 2017. Colorado State University, Fort Collins, CO. bit.ly/2R3AJs0 4 Market for Veterinarians Still Strong. JAVMA. November 2018. bit.ly/2R5g8DD 5 What Should We Be Selecting For? A Systematic To Determining Which Personal Characteristics to Assess For During Admissions. November 2012. bit.ly/2BZJOrx 6 Win with Veterinary Team-Delivered Care. bit.ly/2F66ny3 7 Hands and Heart in Team-Delivered Veterinary Care. bit.ly/2SAkjUK 8 AVMA Duties of Veterinary Technicians and Assistants. AVMA. Last updated October 2018. bit.ly/2P4KhRQ 9 AVMA Model Practice Act. MPA 2017 bit.ly/2s6nqIm 10 Utilizing an Underused Resource; Veterinary Technicians. Veterinary Business Advisors, Inc. 2013. bit.ly/2LN5P1m 11 Prime Issue for Veterinary Technicians: Underutilization. JAVMA. November 2018. bit.ly/2F75c1p
