Do other practice owners and managers hate the inventory circus as much as I do? It is a constant game of checking products, expiration dates, what is moving, what is not, what is new, and what is losing favor. I opened my practice from scratch nearly 20 years ago, and while I have gotten better at inventory control, it remains a giant pain. Choosing inventory and then controlling it is not a science; it is an art form. Everyone has their own style, taste, and abilities. Your inventory can be a wonderful asset, but it can also ruin you. There is no easy way to learn how it should and will work. If there was a class about it in veterinary school, I must have taken a “mental health” fishing day, but I bet there was not. I have worked with inventory experts and sat in on countless CE opportunities, but they are focused on keeping up with what you have, not aiding you in what you should be carrying. One thing I know is you cannot have everything, and you should not. I have made plenty of inventory mistakes, so let my experience help you think through what will work best for you. After all, I have earned this gray beard. The prevention paradox First off, there are so many preventative options for our four-legged friends. It is ridiculous when you really try to take them all in. The flea and flea and tick preventatives, heartworm products, combination products, and mega combos that seem to prevent everything except an emergency visit. Walk through your local pet store or farm supply and take in all the over-the-counter products. It is crazy. Most of these are similar products, with the same active generic ingredients packaged with trendy new names, just hoping for new life. I recommend practice owners or managers walk through those stores and evaluate what is available and what price point you are competing with. Then, check out the online competition and look at what you are up against, too. There are several OTC products that may work well in pets with no underlying issues if used correctly. For more years than I would like to admit, I have carried several of these OTC products. The same ones clients could buy right up the street in the big stores that have much longer hours than my office. Then one day, I decided there had to be a better way, and I took a different direction in my office. I decided not to pick fights I could never win. Those products that could be bought without a prescription somewhere else, they could have them. Nothing was more frustrating to me than throwing out preventatives because they expired. I would no longer worry about the low profit they provided when trying to compete. Plus, if we lost any stock due to dating, that profit was gone anyway. Yes, there are companies that give us rebate pads and “deals” only we veterinary offices can get, but I always felt they were just trying to keep me in the game. “Making rash or emotional decisions after a tough case, a lunch and learn, or a CE event can be extremely costly. Do your due diligence when adding medication to the cabinet, and do not be afraid to decide something is not working out.” Photo courtesy Dr. Cade M. Wilson At this time, I decided a more scientific approach was needed for what my hospital would have on hand. Given where my practice is located, what would best suit my clients and patients? I think sometimes we get carried away with what is available and neglect to evaluate what should be available. In my area, depending on where my patients reside, we have nearly all the North American parasites: heartworms, fleas, ticks, hookworms (even the resistant variety), roundworms, whips, tapes—the list goes on and on. There is an obvious need to carry several products, but which ones? The evaluation was of my clientele, the patients, and their varied habits. We have apartment dwellers where pets hardly ever touch the actual earth, family pets that go for neighborhood walks and dog parks, to farm pets that get into everything. This was not going to be a one-size-fits-all situation. Other things I continually evaluate are my clients’ abilities. Some of my clients, especially in the older generation, have a difficult time administering oral medications for their pets. While my personal belief is oral medications seem to be more effective, especially over a long period, I want the patient to be on something. If the pet’s health warrants it, then topical medication it is. In the exam room setting, I talk with each client about their pet’s lifestyle and point out the potential threats to their pet. This helps the owner understand why certain medications would be the best solution. It also gives ample time to generate questions and talk through choices. A great example here in my office is that we carry three possibilities for pets concerning flea/tick/heartworm prevention. We have an oral combination medication covering all three, a topical combination option, a separate flea/tick oral, and a heartworm/deworming oral. Will these options cover every single pet we see as a patient? No, but it covers well more than 95 percent of them, and the stock turns over in a timely fashion. When we get a patient with specific needs not covered in-house, we script them out. Do not fall into the trap of having something on hand and ready to go for every single patient. You cannot please everyone, so use those online pharmacies to your advantage. The products we have on hand have evolved over the last several decades and will continue to change. I continue to stick true to my three options: an oral combo, a topical combo, and a split option. I recommend you evaluate that idea. In-house ‘phunny’ pharm Antibiotics, NSAIDs, and the like are not different from preventative scenarios. When I placed my first medication order for my hospital shelves, it was one part experience and multiple parts hope and prayer. It was an educated guess on medications I liked and a guess of how many patients I would need before those products expired. Now, those orders are much more scientific, but the knowledge earned is why my hair is now gray. My recommendation to those beginning or trying to rein in the crazy would be very simple: Work through the most common ailments, illnesses, and procedures your hospital sees or performs, and make sure the necessary medications are on your shelves. Those products will be your bread and butter. The next tier is for semi-common issues. These are your hypothyroid and seizure patients, the FIC cats, and the like. Does your patient load warrant having specific medications on hand for those, or should those be scripted medications? Only your hospital can answer that. There is no one answer that will fit all. In-house pharmacies can be a place where hospitals hold tens of thousands in a holding pattern of hope. Making rash or emotional decisions after a tough case, a lunch and learn, or a CE event can be extremely costly. Do your due diligence when adding medication to the cabinet, and do not be afraid to decide something is not working out. Throwing out hundreds or even thousands of dollars in expired stock is not a fun experience. Use local or online pharmacies to evaluate if something new is going to catch on with your practice style before putting that bottle in your cart. You will thank me eventually. "Do not fall into the trap of having something on hand and ready to go for every single patient. You cannot please everyone, so use those online pharmacies to your advantage." Photo courtesy Dr. Cade M. Wilson Veterinarians are people pleasers. We want to be efficient and make things easy for everyone, except maybe for ourselves sometimes. Most of us in this field have had zero business training, and it can be rough learning through the school of hard knocks. A previous mentor once stated about his business experience that he “wasn’t a businessman, he was just a man in business.” How true that statement has felt to me through the years. What pharmaceuticals your practice keeps on hand is a very personal and important decision. Work through it diligently, have a reason why you order, and have your staff understand that, too. This should be no different than hiring new staff members. Would you keep more staff than you have work for? No, you would not. So, why are you keeping multiple products that do the exact same thing? At the front desk, would you have multiple receptionists sitting around, hoping to check in a client or answer the phone? No, that would be crazy. Then why do we have duplicate preventatives that do the same thing up there, as well? These products could very well be the first impression of your practice. Having a professional answer to why you use them is paramount and will leave a lasting impression on new individuals who grace your lobby. Make great decisions for your specific practice and let those products work for you. Doing so makes it easy to control your pharmaceutical inventory and not let it control you. Cade M. Wilson, DVM, is a practicing veterinarian and a three-doctor mixed-animal practice owner in Ardmore, OK. Dr. Wilson has been practicing small animal medicine for the last 20 years and has been a practice owner for the last 17 years.
