Nine tips for tidying up our practices this yearApril 17, 2019If it doesn't bring you joy… throw it out. It's an inexplicably alluring (if slightly depressing) code to live by. Championed by professional organizer Marie Kondo in her wildly successful book, The Life-Changing Method of Tidying Up, the eponymous KonMari approach to organization urges us all to examine the impulses tethering us to things that don't really matter. Among other human urges that define spring as a season (procreation comes to mind), the drive to reestablish control over our lives plays a prominent role in our culture. Maintaining our homes and workplaces clean, tidy, and ordered represents a psychological thawing of our winterized brains and a resurrection of our normal daily activities. We as veterinary professionals experience much the same as it applies to our workplaces. As the busier seasons approach, many of us take stock of what we have and seek to improve our environment. Tidying up à la KonMari, with an eye toward getting rid of what doesn't serve us, is how I'm managing my life this year. To that end, here are this year's things to tackle and tips for tidying, as I seek to tame the chaos that inevitably builds over the previous year. 1) …
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Fire employees and hire stakeholdersApril 12, 2019Which one of the following scenarios is more likely to take place at your practice? Scenario 1 John needed to makes copies of the anesthesia log. He placed the document in the copier, pressed the "start" button and… nothing happened. He walked away, cussing at the stupid piece of (junk), and ended up using the last copy of the anesthesia sheet. "Somebody should finally do her job and get us a new copier," he mumbled. Scenario 2 At a different clinic, Joy wanted to make copies of a consent form. She positioned the master copy in the machine, pushed the "copy" button and… nothing happened. She went to the practice manager and reminded her that, according to the repairman, it was time to get a new copier. Two days later, a new copier was installed. The good news: it was on sale. The bad news: it was a terrible choice. Receptionists hated it. Technicians hated it. Doctors hated it. People complained about it for years. But the practice manager felt good about doing her job. Scenario 3 At yet another hospital, Mary had to photocopy the travel sheet. She put the document in the copier, pressed the green button …
Digital cytology: The future of clinical pathologyApril 12, 2019It's Friday afternoon and Mr. Rush is in your practice again with Smoosh, his nine-year-old boxer who has been lethargic for the past month. Last week's blood work revealed mild lymphocytosis, mild non-regenerative anemia, and high-normal calcium. During today's follow-up, you palpate bilaterally enlarged submandibular lymph nodes. Not surprisingly, Mr. Rush is short of time and patience. You collect lymph node aspirates, tell him you'd like to take a look under the microscope, and return to the treatment area to stain the slides. Looking through the scope, you see the cells are relatively homogeneous. Most of the lymphocytes appear smaller than normal and are darkly stained; however, a fair amount of plasma cells and neutrophils are present. The blood work, breed, and lethargy are worrisome for lymphoma, but Smoosh is getting older and he is long overdue for a dental. Should you push for flow cytometry or a lymph node biopsy? Or are you overreacting, just like the lymph nodes? The cytology doesn't seem normal, but it's a tough call. It looks as though you have two choices: one, push for a bigger workup, or two, send the slides to a pathologist. You wonder what Mr. Rush will say when …
Cornell to offer new veterinary business programApril 5, 2019Cornell University College of Veterinary Medicine has launched a new interdisciplinary program called the Center for Veterinary Business and Entrepreneurship (CVBE) to grow research, training, and outreach in veterinary business. "I'm thrilled to announce the launch of the Center for Veterinary Business and Entrepreneurship in collaboration with the Cornell SC Johnson College of Business," says Lorin D. Warnick, DVM, PhD, the Austin O. Hooey dean of veterinary medicine. "The center is the culmination of extensive needs-based assessments and planning, and will answer the urgent need in the veterinary profession to provide essential training for students, faculty, and alumni to launch, manage, and succeed in a business or organization of any kind." The CVBE will focus on four pillars: education, economics research, entrepreneurship, and intrapreneurship. The center will offer a new DVM certificate program, a postgraduate executive education, and an assortment of educational programs. Through a faculty hire and collaborations with Cornell's Charles H. Dyson school of applied economics and management, the center will launch a veterinary economics research program. "It's exciting to embark on an initiative of this scope," says associate dean for education, Jodi Korich, DVM. "We are confident this new center will position our graduates for success in …
Five trends in pet medical insuranceApril 3, 2019The human-animal bond is evolving, and pet parents want their canine and feline family members to live longer, healthier lives. As human life expectancy and quality increase, we want our loyal companions with us well into their/our senior years, because, let's face it, those years come far too soon. Veterinary medicine, in parallel with human medicine, has advanced leaps and bounds over the years. As a result, veterinarians can now routinely detect and treat disease before clinical signs of illness ever appear. Pet parents are expecting and demanding their pets are treated as family. But more often than not, budgeting is problematic. With human-quality medicine comes the cost of care for advanced, though, routinely available diagnostics, such as digital X-rays, ultrasound, and blood chemistry analysis. Yet, six out of 10 Americans don't have $500 in savings for an unplanned expense.1 The widespread budgeting challenge became even more evident for federal workers (including veterinarians) with the government shutdown earlier this year. Many pet owners and veterinarians are quickly realizing quality medical insurance can help fill the financial gap so their pets can have access to the treatments recommended by their trusted family veterinarian. Yet, just as the human-animal bond is evolving, …
How nurses can grow your revenueMarch 29, 2019What is the difference between an under- and top-performing health-care team? Let's say you schedule appointments every 30 minutes. In an eight-hour workday, one doctor sees 14 patients and has an average transaction of $160, generating $2,240 in revenue. Your average doctor transaction should be 3.2 to 3.5 times your exam fee, according to the Well-Managed Practice Benchmarks Study.1 If you leverage your nursing team and schedule time based on the reason for the visit, you could see 21 patients per day, producing $3,360 per veterinarian and averaging three patients per hour. Revenue rises when you add dental income that nurses deliver. How can nurses help you grow revenue? Follow these steps: Check your staff-to-doctor ratio Every employee feels the hospital is short-staffed. Chances are you may have the right number of employees, but are using them inefficiently. Aim for a staff-to-doctor ratio of 4.7 team members per full-time veterinarian, according to WTA Consultants in Columbus, Ohio.2 This support staff includes two nurses, one veterinary assistant, one receptionist, and 0.7 managers. Assign doctor-nurse teams Designate daily which staff will be outpatient nurses (exams) and inpatient nurses (treatment area). Assign two nurses or assistants to each veterinarian. This medical team …
Telehealth and telemedicine and teletriage… Oh my!March 29, 2019The idea of implementing telehealth within a veterinary practice may be confusing or even downright scary to some. However, when there is understanding of what it is and its governing laws, it can become exciting. We hope to clear some muddy waters for veterinary team members who are eager to support and participate in the delivery of telemedicine to clients. Believe it or not, you're probably already doing some of it. Just by picking up the phone and checking on the status of a patient, you've delivered virtual care. Further, incorporating telemedicine's tools and technology allows the veterinary team to provide even more services and care. Today's pet owner wants more than just the traditional veterinary hospital experience. The best advice is to first understand your own state's veterinary board (i.e. examiners) and the federal laws governing telehealth. Some of these are newly applied laws that are taking effect at different times in various states. Teams are encouraged to discuss, as a group, the hospital's philosophy related to virtual care, the importance of a veterinarian-client-patient-relationship (VCPR),1 and the different roles when offering the services and care. We want your experience in providing these new benefits to be a great …
Why LGBTQ-friendly is business-friendly and good karma, tooMarch 22, 2019I'm one of those people whose hatchback is decorated with pet-themed bumper stickers—everything from Malinois silhouettes and silly cat faces to a cheeky "pugs not drugs" decal. To wit, my collage has never elicited anything but positive commentary in parking lots and driveways. It was only when I added one simple "equal" sign (you know the one, yellow on blue) that my cute and cuddly spread attracted any negativity. It happened in a Target parking lot during the holidays. The guy put his pickup in park behind my vehicle, exited his car and brachiated his disapproval––up close. "Learn how to drive, you f-ing liberal!" (For the record, he used the whole uncensored expletive along with a degree of hostility I hardly deserved.) Now, I may or may not have taken the parking space he was hoping I'd overlook, but that kind of thing only happens when you've touched more than just the "girl-got-your-spot" nerve. This guy probably does not like gay people––or anyone who likes gay people, for that matter. Which got me to thinking about my practice. At each of our two glass-doored entrances, I've affixed a similar gold-on-blue sticker next to our Yelp decal and the one …
Must you pay your staff for being on call?March 19, 2019Suppose you operate a 24-hour emergency hospital. In this tight labor market for veterinary technicians, you are faced with a staffing shortage for the night and overnight shifts. It occurs to you that requiring existing technicians to be on call from time to time may be a way to help solve the staffing dilemma. But how would this affect your budget? More specifically, would you be required to pay your staff for being on-call even if they are not actually called in to work? What is considered compensable? Well, that depends. Under the federal Fair Labor Standards Act (FLSA), employees in on-call status must be paid if they are "engaged to wait," but not if they are "waiting to be engaged." Hmmm. How does this obtuse rule of thumb work in the real world? The key is whether the on-call time is predominantly for the practice's benefit. The more the employee is under the practice's control, the more likely it is the on-call period will be viewed as benefiting the practice and, in turn, as being compensable. Requiring technicians to remain on the premises during their on-call time will almost certainly render this time "hours worked" under FLSA. In …
CT or MRI? When to use each and whyMarch 15, 2019Use MRI for meningitis, encephalitis, fibrocartilaginous embolism, malignancy of liver tumors, muscle tears and strains, and cranial cruciate rupture, says Tony Pease, DVM, MS, DACVR, chief veterinary medical officer of the Western Veterinary Conference Oquendo Center in Las Vegas, Nev. For fragmented medial coronoid processes, dental disease, 3-D reconstructions, and small bone fractures, use CT, he advises. "In general, MRI can see more medically treated lesions, but CT and MRI can see lesions that are amenable with surgery," Dr. Pease says. "However, gastrointestinal lesions are questionable. The motion of the gastrointestinal tract makes large artifacts, as does metal (e.g. microchips), which is not a factor with CT as opposed to MRI." MRI is preferred whenever disease of the central nervous system is suspected, says Nathan C. Nelson DVM, MS, DACVR, clinical associate professor of radiology at the North Carolina State University College of Veterinary Medicine. "MRI has excellent ability to image soft tissue structures and is able to differentiate gray matter, white matter, nerves, and cerebrospinal fluid to a much greater extent than CT," Dr. Nelson says. "In any case, where brain disease is suspected—such as the acutely seizing dog or the dog with sudden behavior change—MRI is the …
