Limberg clinic

Photo by Marlo Kipke

Receptionist Tara Loughrige hands a bag to a client at the drive-up window of Dr. Robyn Limberg's Michigan practice. Limberg said the building previously housed a bank and had a drive-through window that she removed. "Now we're using a different window in the same way!" she said.

Dr. Robyn Limberg describes herself as a talker. After practicing for 25 years in St. Clair, Michigan, she has many clients who are also friends, "so there are often conversations and chats that go on that aren't necessarily related to the situation at hand," she said. As a result, her appointments routinely run long.

Or they used to, before COVID-19. These days, pet owners aren't allowed in the clinic. That means no chance for gabfests, and Limberg stays on schedule. It's a win for efficiency – 2020 was her highest-grossing year — but the veterinarian misses the one-on-one time and opportunities for client education.

The advent of curbside pickup and dropoff for pet patients has transformed the way veterinary practices function. To mitigate the spread of the coronavirus, clinic staff wearing personal protective equipment collect patients from clients who wait outside or in their cars; communication happens mostly by phone.

Seventy-seven percent of veterinarians answering a January quick poll by the Veterinary Information Network, an online community for the profession, said they were offering curbside service. It was the most widely adopted COVID-19 prevention measure cited by the 2,269 respondents.

For many veterinarians, the approach has been an evil born of pandemic necessity. They describe it as inefficient, impersonal and putting too much strain on staff. The new protocols have drawn complaints, too, from clients, including Mark Opperman, a veterinary practice consultant, who went public with his displeasure over his dog's care during a curbside appointment in October. (His complaints did not go over well with his veterinarian client base.)

Over time, though, some veterinarians have discovered advantages to curbside service. One fan who asked on a VIN message board in January, "Anyone like it this way?" attracted more yeses than nos. Proponents said having less direct interaction with clients allowed for quicker, smoother appointments. Some said they are considering adopting aspects of the new intake model long-term.

Efficiency is in the eyes of the beholder

Dr. Thom Haig, a VIN practice management consultant and full-time practitioner in Powell, Tennessee, said in an interview that he was "surprised" to hear that some veterinarians found the curbside system more efficient.

"If you're going to maintain the same production levels, you actually need more staff for curbside service," he said.

If a practice normally allows owners to hold their own dogs in the exam room, he said, that practice will need a staff member to hold the dog in the owner's absence. Also, phone traffic likely doubles or triples, which ties up another staff member.

Some veterinarians in the message board discussion echoed Haig's views. They also cited other problems, including clients waiting longer than usual; veterinarians' inability to ask pet owners quick questions or to get them to pinpoint areas of concern on a pet's body during the exam; having to track down a pet owner to approve diagnostic tests; the frustration of communicating by phone without the help of nonverbal cues; and increased workload for reception desk personnel.

Tied-up phone lines have been a challenge at Dr. Margaret Hammond's Renton, Washington, practice. The clinic has three lines, all of which are busy several times throughout the day. Also, some of her older clients struggle to hear clearly on their cellphones. She misses in-person conversation and bemoans how truncated phone communication can be.

Still, Hammond counts herself among veterinarians who feel curbside has distinct benefits. In contrast to Haig's view, she believes her practice is just as efficient as ever, if not more so.

The exam process often moves quicker, she said, because the pet owner isn't present. "I have [an assistant] holding the patient who not only knows how to hold them but can hold them in a way that keeps the patient from getting wound up and freaked out," she said.

She also appreciates that under the new system, the building is quieter. "I like the fact that the door chime isn't chiming every two minutes with somebody going in or out," she said. "The checkout process is a lot more streamlined. There's a lot less chaos in the building."

That's good for the animals. "I'm finding that my nervous patients are a lot less nervous," she said. "I don't know if that's because they spend less time in the building, [or] the building's quieter. I don't know what to attribute it to … but I'm loving this."

The majority of her clients, too, appear to be onboard. With the exception of a few who refused to bring in their pets if they couldn't enter the clinic with them, Hammond has heard few complaints.

Limberg, the practitioner in Michigan, reports that her clients are about fifty-fifty on the new regime.

"Some miss the face-to-face interaction with me," she said. She still tries to educate her clients via email and Facebook Messenger. Limberg is deaf, so she does not make phone calls.

"Many love the increased efficiency and the ease of sitting in their car while [their] pet is being cared for," she said. "Elderly clients like it, especially during our cold Michigan winter. And parents with babies like it for the same reason, not having to come out in the cold."

Bigger is better?

Through her experience as a relief veterinarian, Dr. Allison Ward has seen the good, the bad and the ugly of the curbside model.

During the pandemic, she has moved among six clinics in southeast Florida, ranging from a single-doctor to a four-doctor practice. Her takeaway: Larger practices with staff members doing specific jobs are faring best.

"The doctor does doctor duties, and the technicians do the blood draws, the X-rays, invoices, estimates, all that kind of stuff," she said, adding that in the best-case scenario, one staff member stays with a patient through every step of the process.

The inverse is also true, according to Ward. Understaffed practices that rely on the doctor to cover veterinary technicians' duties face an uphill battle with the added pressures of curbside. 

"Curbside has really kind of highlighted the good things about [well-managed] practices," she said. "If it's done well, I love it."

Pandemic or no, she believes not every appointment needs a face-to-face in-person visit. "I think we can accomplish a lot — not everything, but we can accomplish a lot through curbside," she said.

The future is hybrid

Dr. Alison Stambaugh, who practices in Northern California, sounds a lot like Ward.

"I don't really see us staying entirely curbside, but I think it could be an option for certain types of appointments," she said in a comment on another VIN discussion, "Keeping curbside permanently?" in February. She offered veterinary technician appointments as an example: "Maybe the client waiting for their dog's vaccine booster or anal gland expression, which happens in the treatment area anyway, can wait in the car instead of the lobby."

Stambaugh also suggested that owners need not always be present for appointments such as ear rechecks, suture removals and routine blood work. "Those can happen more efficiently if the dog is brought straight to the treatment area," she said. "Food and med pick-ups can have the option to pay over the phone and have it brought out, so there are fewer people hanging out in front of reception."

Rethinking intake protocols is just the beginning, according to Dr. Beth Fritzler, a VIN practice management consultant and a partner at a Seattle clinic.

"Curbside service has prompted the profession to examine its processes," Fritzler said. She suspects that many practices will come out of the pandemic with a greater level of productivity because of this questioning. Her own clinic has implemented new practices, such as telemedicine, online payments and, of course, curbside service.

"It allows us to deliver more care to more people and more pets because it gives people options," she said.

Fritzler identified a few conventions that streamline patient dropoff and pickup service at her practice, including numbering parking spots so staff know exactly where to go; emailing forms to clients to fill out before an appointment; talking to clients through video calls; emailing a detailed record of the appointment afterward; and offering online payment and prescription-ordering.

Fritzler imagines using a hybrid approach in the future. Repeating a perception voiced by other veterinarians, Fritzler said the animals have been calmer overall with shorter wait times in the clinic and limited interaction with their owners and other pets. She might continue to ask clients with nervous pets to wait in their cars until exam time.

The pandemic has changed Fritzler's view beyond intake-protocols and practice systems.

"I think pets are more important than ever; our profession is more important than ever," she said. "We've developed some things that I think going forward can be really positive, despite all the negatives of all of this. There've been more silver linings than I would have ever thought."