Learn This And Be A Life SaverMay 7, 2012If you saw an adult suddenly collapse and become unresponsive, would you know what to do? The old way to do CPR involved alternating chest compressions and mouth-to-mouth breathing. The American Heart Association (AHA) has moved away from this mantra and now recommends a simple, two-step protocol: • Call 911 (or have someone do it) • Hands-only CPR (a.k.a. continuous CPR) This new technique is easier to learn, easier to perform and more effective than traditional CPR. It’s also simpler for 911 operators to explain to people. In fact, the chances of survival are approximately doubled with hands-only CPR (23 percent vs. 14 percent). The “new” CPR concept was developed by Gordon Ewy and Karl Kern, two cardiac researchers at the Sarver Heart Center and professors at the University of Arizona College of Medicine in Tucson. Here is how they describe the technique: • Quickly place the person on their back, on a hard surface • Check for responsiveness by “shaking and shouting” • Put the heel of one hand in the center of the chest (between the nipples) • Put your other hand on top of the first • Very importantly, lock your elbows • Put your shoulder directly over the …
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Let Staff Play, And They Will StayMay 4, 2012 Over the weekend I had the pleasure of joining a large veterinary practice on their annual retreat. It was in Oregon/Washington, up in the wilderness in the pine woods and hills, and it was fantastic! They had invited me to present a day-long workshop on burnout and compassion fatigue, my favorite topics! Two of their team members had seen me present on these topics at SWVC (yes, they came down from Oregon to San Antonio), and took the topics back to their leadership. A long winding road up into the hills, and six hours later, we ended a wonderful day of interaction and positive energy. (By the way, I don’t do very well on long winding roads, so I was a bit green when we arrived up there. I was smarter on the way down, and pre-medicated myself appropriately!) But enough about me; let me tell you the most fantastic part of the story. This practice, which has a long history in the Portland area, holds this staff retreat every year. They change locations from time to time, and being in Oregon, they have the luxury of having one in the hills or one at …
Equine Practice: What Clients WantMay 2, 2012Equine practitioners constantly face diagnostic challenges. Without hesitation they invest in the knowledge, resources and equipment needed to meet these challenges, because it is their passion. But very few practitioners take the time to diagnose the health of their business. Good business and good medicine must work together for practices to truly succeed. One important component of good business and client service is to understand and implement an effective services marketing plan. Sample 1 The services marketing mix considers seven P’s: product, price, promotion, place, participants, physical evidence and process. When marketing veterinary services, all seven P’s should be considered. To put this into familiar terms: • Determine the service products horse owners want; • Set the price for those services; • Promote those services; • Decide where services will be offered (in the field, clinic, race track, etc.); • Manage the participants (clients and staff); • Provide physical evidence of these services; and • Control the process of service through procedures and flow of activities Sample 2 Beyond a “Gut Feeling” One of the most important of the seven P’s is product, and in the case of veterinary medicine, services are the products sold. In …
Construction Loans On The RiseMay 1, 2012 Lenders dedicated to the veterinary community say construction loan requests are up in the first quarter of 2012—in some cases double that from the first quarter of 2011. This increase is in part attributed to veterinarians’ need for additional space and lack of existing practices for sale. Not only are more veterinarians asking about loans, but more banks are willing to lend. While criteria for loan approval differ among lenders, experienced veterinarians able to prove a potential for profit are given consideration. “The down economy has forever altered the criteria by which veterinarians are approved,” says Annemarie Murphy, senior loan officer for Live Oak Bank of Wilmington, N.C. “A big difference is that lenders previously willing to give practitioners who filed bankruptcy a second chance, now are not. But strength of the individual to pay bills that would be acquired with a new practice on the amount of revenue currently generated is a good start.” Murphy says some who filed bankruptcy in the past but were given another loan again filed bankruptcy when practice revenue dropped. This is a risk banks are no longer willing to take. Interest Rates Lenders say interest rates for …
How To Ensure A Successful BuildMay 1, 2012 Before any successful commercial construction project begins, an “A Team” must be assembled: lender, architect, contractor and, of course, the owner. The team will work together to ensure a successful project and support the owner in decision-making. Some critical elements of all construction financings include sufficient capitalization and budget, timelines of the build-out, and the quality and strength of the contractor and architect. When the lender “builds” the project, a number of questions must be answered. Is the contract inclusive? An experienced lender checks contingency, permits, scope of work. What is and is not included as part of the project? Landscaping, security systems and phone generally are not included in the contract. Is the property properly zoned or does it need to be subdivided? What are the timelines on zoning and permits? What fees must be paid? Many municipalities require monies up front to review drawings, go through the planning process and issue permits. What is the deadline for closing on the land or building? Many times, a lender will provide a “bridge” loan to carry the project until the permit is issued. How many months will construction take? An experienced lender will add additional …
Change Is Inevitable; Profitability Is OptionalMay 1, 2012 The only constant in life is change; witness the veterinary profession over the past 50 years. Change has involved all facets of practice from species to quality and scope of medications and available treatment modalities. Reluctance to stay abreast of changes results in an increased chance of becoming obsolete in today’s competitive environment. This is especially true with the relative stagnation generated by an increased number of practices vying for the same limited pet population. To understand today’s problems, one must look back to the inception of veterinary medicine in the United States. Initially the profession’s minds and hands were not emphasized when price was placed on veterinary services. Most pets relax during laser therapy. Often, there was no charge for the diagnosis, only for the treatment. Compounding this problem, there was no charge for the treatment except for the medication. In other words, the profession was saying our time and expertise are worthless but the medication is worth far more than a reasonable markup. In essence, we became a store from the onset. Back in the early ’90s, we emphasized the sale of products. We marketed the practice as “one stop …
Helping Clients Afford To Say ‘Yes’April 5, 2012 No one better understands the value of the human-animal bond than veterinarians. But as small-business owners with considerable overhead invested, veterinarians know that good practice management calls for responsible fee collection. Technological improvements increase pet owners’ expectations for good outcomes, though advanced procedures and care demand additional equipment and training, which also add to costs. This is where third-party financing can help boost a veterinarian’s bottom line. Practices can make financing available so that patients who don’t have insurance, cash or credit lines, or choose not to use them, can select and pay for the optimal treatment. “The ability of veterinarians to care for pets has grown exponentially with the advancement and availability of technology,” says Mary Beth Leininger, DVM. “We can fix things we couldn’t fix before.” Dr. Leininger is vice president of veterinary relations for ASPCA Pet Health Insurance, a subsidiary of the Hartville Group, with headquarters in Canton, Ohio. “People have a strong connection to their pets,” she says. “They consider them members of the family. So when the pet needs treatment, it is not so much that we have to talk them into the procedure and the cost. …
Digital Radiography Is Becoming NormApril 5, 2012 Remember when Caparsolate was used to treat heartworms? When halothane was the most common inhalant anesthesia? Or when X-ray film was developed by hand-dipping a metal frame into tanks of solution in a darkroom, then hanging it to dry? New veterinary graduates may have to Google “Caparsolate” and “halothane,” and in the near future they may have a hard time finding a veterinary practice that still develops X-ray film. Digital radiography, which eliminates the darkroom, chemicals and manually filed plastic film, moseyed into veterinary medicine in the early 2000s, hit its stride around 2004, and today is galloping full-tilt into mainstream use. “The technology has gotten better, the software has gotten better and the prices on the client side have gotten better,” said Seth Wallack, DVM, Dipl. ACVR, who practices in San Diego. “The time of the early-adopter of digital is over, and now it’s more mainstream. It’s becoming the norm.” Digital technology is much faster than conventional radiography, and the software allows adjustment of brightness, contrast, zoom and pan on a single exposure. As long as the patient is positioned correctly, most everything else can be fixed by the machine’s controls. “Digital radiography …
Is This Town Too Small?March 30, 2012 Remember the old westerns, where the good guy (or bad guy) would say, “This town ain’t big enough for the two of us.” Something similar is happening in veterinary medicine. The “guys” are boarded specialists versus non-boarded but highly experienced generalists, and I’m not sure which one is the bad guy and which is the good guy. Actually, I’m not convinced that the town is too small for the two of them. Recently at American Animal Hospital Association in Denver, I hosted a table called “Building Referral Relationships,” where up to 10 people who registered in advance got the opportunity to come brainstorm, share and learn from each other about a topic they selected. As people gathered at our table, silly me thought that I needed to find out whose camp they were in, the referrers or the referring. Turns out most of them wore both hats. Several were generalists who may refer a patient on to a specialist in some instances, but they were also highly experienced (particularly orthopedic surgeons) so they received referrals from the community based on their reputation. Quite an interesting discussion took place. It actually reminds me of the struggle the …
The Pitfalls Of A Practical ProfessionMarch 28, 2012 My parents are both educated as architects. However, neither one of them practices architecture except when the stray job materializes or when willing-to-impose daughters like me ask them to design their new house. It’s not that they’re not impressively talented with awards and accolades to show for their progressively green brand of minimalist architecture. Neither have they lapsed into early retirement. Rather, it’s more to do with how the rug’s been pulled out from under their profession’s foundation over the past 30 years. Let that be a lesson to our profession. Indulge me as I explain how: In the ’80s, the architecture profession underwent a transformation with the rise of the technical, specialized architect. This new breed was distinct from the traditional architect, formerly schooled in overseeing the conception and construction of a structure from start to finish in a holistic sort of way (think Antoni Gaudí, Frank Lloyd Wright and Louis Kahn, among other 20th century luminaries). The advent of this highly specialized architect, fueled in part by the computerization of the profession via AutoCAD, was attended by a concurrent decline in the perceived need to educate architects broadly as artists, craftsmen, theoreticians, engineers …
