Best practices for managing part-time clinicians at multidoctor practices

Veterinary practice is a team effort, requiring commitment and dedication from all staff members to provide optimal care for each pet, keep clients happy, and maintain profitability. Within a multidoctor practice, this team effort can be put to the test when some of the clinicians work part-time. Why choose part-time? Veterinarians who choose to work part-time do so for a variety of reasons, such as pursuing a second career. Laura Hoffman, DVM, who works as the sole part-time veterinarian in a multidoctor practice and teaches in the pre-veterinary medicine/veterinary technology department at Murray State University in Murray, Ky., knew full-time veterinary practice was not for her. Doing part-time veterinary work gave her “the ability to have another career while staying current with medicines, treatments, and diagnostics in veterinary medicine,” says Dr. Hoffman. Karen Todd-Jenkins, VMD, who works as a part-time veterinarian at two veterinary practices and is a medical writer, has been doing relief and part-time veterinary work for more than 15 years. This type of work “gives me the variety and schedule flexibility I need,” she says. “I don’t think I’d be nearly as happy or fulfilled working full-time.” Other reasons veterinarians choose part-time work include raising children or caring for a loved one. Management challenges Managing part-time clinicians presents several challenges for a veterinary practice, one of them being the continuity of care. So what is continuity of care? Continuity of care “The number one challenge is the difficulty in providing continuity of care for clients and patients,” says James Wilson, DVM, JD, founder of Priority Veterinary Management Consultants. In the event a part-time veterinarian is unavailable to complete a case, the full-time veterinarians or practice owners are burdened with significant amounts of follow-up that include interpreting lab results, approving refills with limited knowledge of patients’ conditions, and communicating directly with clients they don’t know. Hoffman agrees maintaining continuity of care can be challenging. “Walking in and picking up in the middle of a case is harder when you’re not there as often,” she says, adding it can take longer to get up to speed on the case details. “Similarly, when I’m covering sporadic relief shifts, there is very little continuity with clients,” says Dr. Jenkins. Scheduling and caseload management Scheduling is a challenging task in any veterinary practice. Difficulties can arise when the scheduling requires a balancing act between full and part-time veterinarians. “The part-time veterinarians may not be available to work the shifts a practice needs,” says Amanda Donnelly, DVM, MBA, owner of ALD Veterinary Consulting, LLC. These availability gaps place an extra burden on a practice’s full-time veterinarians and create a logistical challenge to ensure adequate caseload coverage. For veterinary practices with only full-time veterinarians and a heavy caseload, a rush decision may be made to bring on a part-time veterinarian to do relief work without first setting clear expectations about how the part-time veterinarian will be managed. This could lead to miscommunication and disappointment down the road, Dr. Donnelly warns. Transitions in availability What happens when a full-time veterinarian wants to transition to part-time? The full-time veterinarian may want to work only on certain days or during certain hours, but this may not match up with the practice’s needs for caseload coverage, Donnelly explains. Solutions Identifying and implementing practical solutions is important for managing part-time clinicians effectively within a multidoctor practice. Job sharing One management solution is a concept called job sharing. As Dr. Wilson explains, job sharing is when two part-time employees work together to cover 40 hour work weeks as one full-time employee (FTE). Often, the job sharing amounts to more or less than 40 hours. For example, for a job-share between two part-time veterinarians, one may work 20 hours and the other 10 to 30 hours, amounting to 0.75 to 1.25 FTEs. Job sharing has several advantages for veterinary practices, one of which is that the job-sharing veterinarians rely upon each other for case follow-up and hold each other accountable for completing all case-related tasks. “Job sharing has been one of the few ways to get part-time veterinarians to take the burden of case responsibility off the shoulders of the practice owners and full-time veterinarians,” Wilson says. In addition, part-time veterinarians within a job-share are expected to, and can fill in, for each other when the other is not available, again removing pressure from the full-time veterinarians. Wilson noted he has also seen some very effective job-sharing agreements with associates working part-time at two different practices. From a benefits perspective, job-sharing veterinarians are paid as employees, rather than independent contractors, thus avoiding the risks of being misclassified by tax authorities. To encourage long-term employment, they receive pro rata benefits, which are based on the average number of hours worked per week. For example, a part-time veterinarian who works 20 hours per week as part of a job-share would receive 50 percent of the benefits a full-time employee would receive. “My experience has been that long-term, part-time employed doctors generate a happier, more committed staff than shorter term relief doctors who receive no benefits and are paid as independent contractors,” Wilson notes. Rather than having the practice owner try to sell the idea of job sharing, Wilson suggests part-time veterinarians proactively approach practice owners with a job-sharing plan that encompasses caseload management and case follow-up. “The practice owner may be willing to pay more if the part-time veterinarians already have a plan,” he says. Maintaining continuity of care Although job sharing can address many challenges associated with managing part-time veterinarians, other solutions can be implemented. To ensure continuity of care, Donnelly recommends phone communication between the part-time veterinarian who started the case and the veterinarian taking it over. This call could take place either at the end of the day or first thing the following morning. It is imperative medical records by all doctors be comprehensive and complete, so that in cases where a phone call is not possible, continuity of care is maintained, Donnelly advises. Medical records should be completed by the end of the shift. “I try to write detailed medical record entries so it’s easier for another doctor to take over a case I started,” says Jenkins. Other than phone calls and detailed medical entries, Jenkins mentions she also corresponds through email and text message regarding cases. For Hoffman, who does the bulk of her clinic work during school breaks, the full-time veterinarian and other staff keep her updated on certain cases, particularly those on which she worked closely. When she returns to the clinic, she is able to pick back up where she left off and reconnect with her clients. Managing the schedule and caseload To minimize scheduling snafus and ensure adequate caseload coverage, expectations must be clearly set at the beginning of the working relationship regarding the hours and days the part-time veterinarians will work. For example, part-time veterinarians need to specify whether they will work on Saturdays, can or cannot work evenings, or if they need to leave before the close of business. “Because I’m a contractor, the practice lets me know what coverage they need, and I let them know my availability, and we work out the schedule. It’s pretty straightforward,” Jenkins says. This scheduling, she notes, usually occurs a few months in advance. Hoffman has a similar scheduling protocol with her practice. “Some days, I may come in to work extra if the schedule seems busy or another doctor is sick or on vacation,” she adds. Transitioning to part-time To ensure a smooth transition from full-time to part-time work, Donnelly emphasizes the need for a plan that details how the veterinarian’s caseload will be reduced and how the cases will be transferred. Ideally, the full-time veterinarian who is transitioning to part-time will introduce their clients to the veterinarian who will be taking over their cases. In addition, the veterinarian will work with the practice owner to reduce their caseload in a way that will not negatively affect the practice’s needs. Other management considerations Although not necessarily a challenge, finances are an important consideration for veterinary practices with part-time veterinarians. A veterinary practice’s finances encompass production and profitability, Donnelly explains. Each veterinarian, whether full-time or part-time, is responsible for contributing to the financial health of the practice. As Donnelly notes, each veterinarian within a practice needs to be equally committed to growing the practice and maintaining client communication and loyalty. She also advises a part-time veterinarian’s compensation be commensurate with their productivity and hours worked. Another management difficulty is the level of engagement provided by part-time veterinarians. Given their hours and work schedule, they may not have the opportunity to be fully integrated into the practice or become fully familiar with its policies and protocols. To address this potential lack of engagement, Donnelly suggests practices implement an orientation program as part of the onboarding process for their part-time veterinarians. Orientation programs foster a close working relationship between an organization and its employees, thus facilitating higher levels of employee engagement. Bringing it together Part-time veterinary work can be rewarding on an individual level. “I feel privileged that this is an option that works for me. I wouldn’t trade it,” Jenkins notes. However, part-time work presents management challenges in a multidoctor practice. Fortunately, there are practical solutions, such as job sharing, that veterinary teams can implement to keep a practice running smoothly while ensuring pets receive the best care possible. Whether a veterinary practice is open to job sharing or other management solutions, clear expectations should be set from the beginning and a team effort is essential. As Donnelly says, “It is a team effort so that everyone is communicating on behalf of the clients and pets.” Hoffman echoes the value of a team effort. “I feel very lucky to be working at the clinic where I am because they are an amazing support system and team,” she adds.

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