A steady flow of appointments is a natural aim for most veterinarians, but determining when a practice becomes too busy reflects personal preferences and raises the question:
How many patients can be medically cared for in an average workday?
A veterinarian who sees 40 patients a day might examine one pet every 15 minutes for eight hours with no break. Another who prefers a slower pace with longer appointments might see half as many pets.
Given such variability, one might expect quality-of-care to suffer with shorter exam times and more patients waiting. Not so, said Dr. Michal Harris, who averages 40 to 50 patients a day.
“Our profession wants to say if you do high volume or lower cost, that has to mean you have lower quality, and you can't possibly be doing both high volume and high quality,” said Harris, a solo practitioner in Jacksonville, Fla., who gets help from an associate once a week. “The truth is that if you intend to do the volume, it is entirely possible to keep the quality at a high level.
"In fact," she added, "we have found that the increased revenue stream has allowed us to add equipment and procedures that raise the quality even higher. You have to be prepared and efficient.”
During her career, Harris has shaped the way she likes to practice and leverages her staff of 11. Her technicians wear radios with headsets, and every couple of hours they huddle for five minutes to talk about what is happening in the practice. To allow the system to work, Harris needed to let go and trust her staff.
“We think we're using our staff and oftentimes we really aren't," she said. "You have to be willing to pay them well, and have them trained. If you're fixing to hand over the reins of explaining wellness lab work or why spay/neuter is important, they have to be able to have direct conversations with clients and relay information accurately.”
For example, Harris works on Saturdays with five staff members and a groomer. She schedules two receptionists, one technician who only does lab work, one technician who stays by the veterinarian's side, and one technician who loads rooms and educates clients. By the time Harris walks into the examination room, her staff has taken most of the history. They do lab work, take X-rays and perform any other job task that Florida law permits.
"Most importantly, I do not do (the technician’s work). I fully expect that when I show up they will wind me up and point me in a direction, and they will tell me what to do next," Harris said. "Whatever is right in front of me gets my complete attention while I'm there. The techs present estimates to clients, get approval, and get the diagnostics done once I order them. Then I review them, and get a treatment plan. It’s important that veterinarians don’t get stuck drawing blood because there is only one tech, and she doesn't have someone to restrain the animal for her."
Harris is a self-described "freak" about her schedule.
Her day often consists of 15-minute appointments for routine examinations. Sick patients are scheduled for 30 minutes, and walk-ins are seen during an established time of day, unless it's a life-threatening emergency.
Harris's associate joins the practice on surgery day. Spays and neuters are performed on Tuesdays, and with 25 or so patients, there's no time for average appointments. Elective but non-routine surgeries such as growth removals are slated for half days. Anything deemed complicated is scheduled for when both veterinarians are working, if possible.
Harris believes that tight schedule control begets efficiency, and establishing a routine makes it easier for staff to perform their best. She credits her team with allowing the practice to function well at a high-speed pace.
“I tell them up front there are a lot of places that are easier to work for where you wouldn't have to hustle and run around like a chicken with your head cut off,” she said, noting that turnover at her practice is low. “You have to be capable of working on your own and being self sufficient."
She added: “I love what I do; I love seeing all the people and pets. I do have a very quick mindset, I assess things, I ask what I need to ask, I do the physical exam and move on. I thrive on being busy.”
Harris's high-volume approach makes some people's heads spin.
"I would mess up or kill something if I had to see any many patients as you are," wrote Dr. Julie Bartz of Scottsdale, Ariz., on a message board of the Veterinary Information Network (VIN), an online community for the profession. The statement was offered in response to the post of another VIN member who practices much like Harris.
Bartz is a practice owner with one part-time associate who typically works 30 hours a week during the winter, when northerners migrate to the area, and 20 to 25 hours a week during summer months.
Bartz sees less than half the number of patients that Harris does. A recent Monday involved 14 appointments, one of which was an hour long. Her schedule provides half-hour appointments for wellness exams and routine issues such as ears, skin problems and diarrhea, but patients with non-routine issues get more time, and Bartz often uses it to educate her clients.
"It doesn't mean that we don't get busy and have to double book sometimes," she said. “We don't schedule between noon and two and we try to catch up then. We have drop-offs, too. I utilize my techs, but I still feel it's really important for my client and patient to spend time with the doctor. That's how I like to practice."
Bartz considers herself fortunate to work in an economically well-off area, which allows her to charge appropriately for her time. She understands that many veterinarians must rely on volume to stay in business but points out that the cost of medical care is an issue no matter where a practice is located.
Her practice style is an extension of her personality. Bartz describes herself as a people-oriented person who enjoys the in-depth discussions that sometimes occur during longer appointments.
Like Bartz, Harris believes that the way she likes to interact with people dictates her preferences for how to practice medicine.
“Part of me would love to have 10 people a day and triple my prices, but I don't have the personality for that kind of practice,” Harris said. “I'm not going to have a rapport with the type of clients that seem to prefer that level of attention. Most people I know would not want to spend 45 minutes in a vet's office being lectured; they tend to see it as trying to sell them something. In my neck of the woods, that kind of clinic wouldn't be supported because the economic status just isn’t there. If your community was badly hit by the economy, the first thing I would do is lower prices, and roll up my sleeves, and hire more staff, and create more jobs. If you aren't adequately meeting the needs of your community, someone else will step up and do it.”
Dr. Craig Datz, a professor at the Department of Veterinary Medicine and Surgery, University of Missouri, noted that he once worked on a military base where he saw as many as two patients every 10 minutes — 12 per hour — from 10 a.m. to 4 p.m. Most were wellness visits, but a few needed health certificates, blood draws for rabies titers, treatments for ear infections, skin problems, and so on.
That schedule is opposite the one adopted by the veterinary college where he teaches.
“At the vet school, outpatients are scheduled every 30 minutes, but it takes one-and-a-half to three hours (sometimes longer) from door-to-door,” Datz said. “We see two or sometimes three patients in each time slot. Most of the time is spent teaching and letting students work on cases, and most students are slow and inefficient.
"If I were in private practice," he added, "I would try to do high-volume, high-efficiency with leverage of staff. That is, unless there was a way to have a boutique practice where all the clients were affluent and didn't mind spending more money to have longer appointment times. With today's fast-moving society, I think many people want fast service and not have to spend a long time at the vet. Of course, retired people or those who don't work outside the home might want/expect longer visits.”
A 2011 VIN survey asking members to relay how busy they are in practice revealed that most veterinarians polled clock 20- to 30-minute appointment times. Of the 2,800 VIN members who responded to the survey, 34 percent scheduled 20-minute appointments; 28 percent scheduled 30-minute appointments; 19 percent scheduled 15-minutes appointments; and 1 percent logged appointment times of an hour.
On average, the veterinarians surveyed worked 43 hours per week.
Harris appreciates that her profession allows people to practice the way they want to.
“I'm a practice owner; it's the ultimate production-base pay,” she said. “But I totally respect that not everyone wants to do that. The way I practice fits my lifestyle and work ethic. I wouldn't say anything bad about anyone who wants a more leisurely pace.
"That's the cool thing about vet med," Harris added. "Practice style and methodology can be totally diverse, and if a client doesn't like my practice with less face time with the vet, there will always be vets who will spend 40 minutes with the clients.”
VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email firstname.lastname@example.org.