What disrupts your schedule?

A perfectly planned day rarely stays that way. Clients are late or early or they don't show up at all. Emergencies happen. The list goes on. Firstline wants to help you find solutions to your biggest schedule disrupters. In order to do that, we want to hear which situations get you and your team members most of track and flustered.

Our appointments run from 10am to 1pm, then again from 3pm to 7pm.

We schedule every half-hour, leaving space for those same-day appointments that always call first thing in the morning, as well as some walk-in appointment space. Appointment slots are typically 15 minutes, although we will block off 30 to 45 minutes if we're anticipating an extensive work-up or euthanasia. We try to schedule only 3 appointments per hour so as to leave us catch-up our emergency appointment space.

Our team is typically one doctor, one LVT, one assistant, one receptionist.

We have two exam rooms, one large pet, one small pet, although we will use the large pet room for a small pet if we have to.

The thing that really ties up the day is the unexpected work-up.  This is a case that is either a walk-in "second" opinion, the emergency, or a case that even if they had an appointment, the client didn't realize, or was not able to confer to the receptionist how sick the pet actually is, so that we could schedule them for a 30 minute slot instead of a 15 minute slot.

Even with passing off most of the work-up to the LVT and Assistant (rads, bloods, etc.) these cases still tie up at least an hour, to hour and a half, of the DVM's time with reviewing treatment options, waiting for results, getting the work-up done, going over results, all the estimate "negotiations," the clients having to confer with family in order to make decisions, actually preforming treatment, etc.  We have a small office, and don't have any place private where clients can do this except in an exam room.  With only two exam rooms, it is fustrating that they will take up an exam room for that long, as well as almost monopolize the DVM's time while other appointments start to back up.  The LVT and Assistant are also tied-up doing all the lab work, which means they aren't available to assist the DVM in an appointment that he might be able to squeeze in while the work-up is being done.

Sometimes it feels even if we left the whole day completely opened, these unexpected work ups would still put the team into their lunch time, or into staying later.

How do we cope? We DO NOT have the budget to hire more team members.  We couldn't even give our current team raises this year.  Hirering more help cannot be an option.

I would love to hire extra help.  One "outpatient" team and one "treatment" team.  That way one team can concentrate up front on assiting the DVM and clients, while the other team does work-ups and monitors in-house patients.

Unfortunately, if we hired more team members after already telling our current team not to expect raises, there'd be a whole lot of dissatisfaction and grumbling, thus undoing the whole team.

After all, if we have the money for new team members, why don't we have the money to reward those who have been faithful and have stuck-it-out in this sucky recession?

We have an semi open-book policy with our team.  Each month I post monthly gross revenue goals.  My team know how much overhead the practice has, how much we spend each month on non-fixed costs, and what our monthly payroll is (without disclosing what everyone makes individually).  They see that we aren't even making minimum monthly expenses, and what debt is getting carried-over and eating away at their next month's goals.  In order to get 10 cent raises, they need to be at least $40,000.00 gross above fixed montly expenses.

They've only achieved that goal once so far.

I understand how you have to invest money to make money, and that investing in more team members would certainly make patient flow more effiecent, thus allowing the DVM to see more patients per day (if we could actually book them), but how do I do it without loosing the people who we already rely upon?

We typically operate with 2-3 of our Veterinarians in the building (one is typically doing ambulatory work, and one may be off for the day).  We run appointments from 8:30-12:00 and 1:00-close with one Doctor, and schedule surgeries all morning for the other Doctor, who sees a second column of appointments and/or ambulatory calls in the afternoon.  Those Doctors have 2-3 receptionists, 2-3 techs, 1 assistant, and a couple of floaters.  Walk in clients, early clients, late clients, or unforseen workups....those we can easliy deal with.   What is almost always the cause of disruption is when we need to do a "quick" (no such thing, unless it's scheduled to be long) procedure. 

We strive to schedule such needed procedures either later in the day (the patient is admitted), or on another day when applicable, but we frequently "need" to do it right away anyway.  When that happens, not only do some clients end up waiting, but our staff is pulled away from what they were assigned to do, and before you know it, the day is a mess.

Another source of disruption is the telephone.  Doctor messages are screened by a manager and handled a number of ways.....resolved without Doctor involvement, resolved after a quick question or discussion with a Doctor, or given to a Doctor for a callback (but only then when they can actually sit down and do it without getting behind).

We'd be in pretty major trouble (and probably out of business) if we set aside 60-90 minutes for a workup.  All diagnostic tests are performed by staff and only interpreted by a Doctor.  Optimally, our Doctors only do a few things....perform physical exams, do surgery, administer vaccines, and come up with a diagnosis.  When they are allowed to do those things exclusively, profitability goes up, even if staff payroll is a little higher.