GettyImages/AldoMurillo It is common to hear veterinarians (especially young ones) grumbling over their practice manager’s directives. They want us to push more dentistry and in-house lab work and close more parasite control sales, for example. When our monthly numbers dip on sales parameters, they are the first to bring it up: “Dr. Khuly, have you noticed your invoicing stats are lower this month?” The ‘hands-off’ method Every practice is different, of course. When I ran my place, we rarely had cause to discuss an associate’s revenue stats openly. My practice manager and I did our best to avoid this, preferring our associates to work at their own pace and comfort level, with nudges enacted in the guise of percentage-based compensation. Private conversations were a last resort, employed only if an associate was not pulling their weight (financially speaking); in this case, we would eventually re-work our compensation agreement at the end of the contract period. In all practices, associates who do not pay for themselves in some way do not merit a continuation of employment. I do not consider these doctors slackers or underperformers—not as a rule. I reckon they more likely do not match their current practice’s vibe and are probably destined to practice more successfully elsewhere. In all cases, my own underperforming doctors moved on voluntarily, underscoring my theory that financially underproductive vets are those who are not working in a best-fit scenario. There was probably not very much I could have said or done to motivate them any more than I had already tried to. What’s more, I expect they are more happily and effectively employed elsewhere. The “proactive” approach In contrast to mine, some practices take a more proactive approach. They hire practice managers (like the one in the opening paragraph) who routinely urge veterinarians to bring in more revenue than they currently do. “Add a urinalysis with every senior patient,” they will suggest. “Offer X-rays and an extended fecal PCR on every GI case.” “Why didn’t that cytology go to the lab?” Perhaps they will suggest an EKG on every cardiac case or an LDDST on every elevated ALP. They are forever trying to push our cases to their financial limits and are not shy about letting us know when we seem to be missing their preferred targets. These practices tend to let associates know how they are doing in sales month to month. In the name of motivation, they might even hand out benchmark targets and each veterinarian’s stats (sometimes quite publicly). The pushback It is not all snow cones and bunny rabbits at practices where owners and managers take it a tad too far with their “motivational” tactics. However well-intentioned, not all team members respond well to more direct methods. Strategies designed to confront individuals with their production stats do not always come across as virtuously as managers think they might. When it comes to team members who mark success in clinical outcomes rather than sales, talking money is a surefire way of turning them off. Managers who make the mistake of constantly couching motivational conversations in dollar terms—or worse, transparently admonishing under-producers—can kiss goodbye any chance of ever reaching those who might have otherwise warmed to the practical charms of fiscal responsibility. They will never change hearts and minds with that approach. This is when associates start to balk en masse, sniping among themselves: “I didn’t go into veterinary medicine to become a used car salesman.” Or, “I’m here to help animals, not to make money for a company whose under-educated middle managers just want to see a bigger bonus.” Love is not enough It should be pretty obvious, though, a for-profit business cannot run on love alone. Helping animals is the goal, but let’s be honest, these are businesses we are talking about. Even a not-for-profit organization cannot make a go of it without finding ways to bring in enough money to keep the lights on and fund the annual raises employees expect. There has to be a middle ground. My approach was quite simple. I was super-transparent about demoralizing business blunders and impressive successes alike. When the practice was going well, I shared the wealth. As the owner, no one was around to tell me I should be more careful about divulging company “secrets” or distributing too many handouts. Sure, I was taken advantage of on more than a couple of occasions, but I also kept my team engaged. The practice was a labor of love that helped animals and the people within its walls. Was my laissez-faire approach to associates the right one? Probably not. I should have steered associates toward more complete workups on plenty of occasions. I should have kept better tabs on them, identifying their shortcomings in cases that required more diagnostics and patients that would have been better off hospitalized than transferred or discharged. Instead, I chose to take my more hands-off approach, preferring to completely respect my experienced associates’ individual practice styles. However, there is a middle ground for enhancing associate production. It does not have to be the hard-nosed, monthly list of misdemeanors or the complete free-for-all of my confrontation-averse approach. There is an in-between that better serves the practice and the patients in our care. The middle ground What I have always told my associates and attempted to ingrain in my mentees is the following: A veterinary practice is, first and foremost, a business. It needs to financially support itself and its employees. The practice is a retail establishment offering a service for a fee and its goal is to offer services at a good value. You are a salesperson. As such, your job is to convince clients your services are necessary for a patient’s well-being and you offer this service at a good value. There is no shame in selling. It is easy to be a good salesperson if you believe in the quality of your work and the value you offer. It may hurt to get rejected—as when clients decline services for financial reasons—but that should not reflect on you or your work product. When associates understand all of the above, they are much more comfortable with the concept of sales. I ask them if there is anything they are uncomfortable selling and then why. Typically, it is the “stuff” they balk at, such as products they can get at a better price online. However, the services? It is never an issue—unless they are being told they need to sell more, which is like telling them they are not practicing an adequate standard of care. Of course, that is going to come across as insulting (especially coming from a practice manager). Given so many young associates have already been burned by corporate practices whose in-your-face attitude towards production did not sit well with them, I believe the middle ground approximates the hands-off more than it does the proactive. So, what do you do if the associate is not producing? If corrections are in order at any point, they should come from a veterinary colleague, not a practice manager. After all, if an associate is not making production, either the prices are not high enough, the volume is untenably low, or the medicine is lacking. Only the last on this list is in the associate’s control and it is never a non-veterinarian’s role to address it. Patty Khuly, VMD, MBA, runs a small animal practice in Miami, Fla., and is available at drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.
