Our policy at the practice has always been "Walk-In welcomed, appointment preferred." The front desk team is instructed to inform all walk-ins of the following:
1) There is a seperate walk-in office visit fee that is $20.00 more than our normal office visit fee.
2) There is a wait, and that all on-time appointments are seen first
3) There is an open appointment slot later that day, or if the pet is only there for a wellness visit or some non-immediate emergency, tomorrow, etc, and would they like to return later when there would not be a wait.
So, as related to me by my husband, the following really made him almost loose his cool yesterday.
Ms. Smith walks into the office with two carriers. Two new cats she wants to add to her ever expanding colony, and they need to be seen right away.
The front desk team informed her of the above, and she flipped her lid. "What do you mean there is a walk-in fee!? There's no one in the lobby right now, why can't I be seen now!?"
The team politly explained that they were waiting on the arrival of the next appointment, which was pretty imminate, and that Ms. Smith was more than welcomed to wait and see if the next appointment arrived on time (which was in 10 minutes). If it did not, then she was welcomed to that appointment slot, but it would be a wait, and that there was still the walk-in fee.
Disgruntled and complaining loudly in front of the other client being discharged, Ms. Smith pretty much accused the team of all those awful pet-hating things that most disgruntled clients accuse a veterinary team of. During the rant, the next appointment arrives on time and is escorted into an exam room before Ms. Smith, thus furthering her ire.
She did schedule an appointmen for the weekend before she left.
What would you have done? Would you have just seen Ms. Smith's two cats with unkown histories anyway, and just charged your regular exam fee? Would you have made some other sort of accomodation?
With respect to the policy of "Walk-in welcomed, appointment preferred," why wouldn't the policy just be "Appointment preferred"? I think most would agree that walk-ins cause disruption, so mentioning them as part of a policy only increases the possibility that a client would do so. As the saying goes...printing the bad news only makes people remember it.
As for actually seeing a walk in, our practice is as accomodating as possible, asking first if they have an appointment, then explaining that we need to check in the back and see how our schedule is going, including surgical procedures (addresses the "no one in the parking lot" problem). If there is going to be a wait, it's mentioned so that the client is prepared, and free to select an open slot later if they wish (drop off's are also an option, and one that increases efficiency as appointments can be handled more quickly).
Our approach is that a walk-in client is an appointment client in-training. Better that then becoming the client of our competitor. As for an extra fee - which is essentially a nuisance fee - we're careful never to charge a fee that can't be associated with a corresponding expense on the part of the practice. Client (most of them) are not stupid, they know they are being "punished" with the extra fee, and would make the natural connection at a later date that some of their other fees may not be based on any actual service that was provided.
To answer the question, Ms. Smith would have been happily told that we would love to see her two new cats and that we could get started right away, though depending on how our scheduled appointment is running, there could be a slight disruption with her visit as we would honor the impending appointment that was scheduled before finishing.
In this economy (and at any time, really) a business should be delighted to be chosen by a client to provide a service despite the fact that they may not always be able to jump through our hoops.
Just to make sure I have your advice clear:
1) Stop advertising that we accept walk-in appointments...even though in today's economy advertising we do so might make the difference between us and down the road. Alot of our walk-ins are people who could not get a same day appointment with their usual place down the road. We try to work closely with our neighbors so that they'd be willing to return the favor for our clients. Yes, it is a cut-throat competition around here, but we don't steal clients. We fax over records to other clinics on a regular basis if we've seen a client of theirs' as a walk-in, and always recommend they schedule with their regular vet for the re-check.
2) Do away with the walk-in appointment fee, and just charge our normal exam fee.
3) Inform walk-ins that there is a wait. Then continue about our schedule until we have an accomodating moment.
4) Schedule walk-ins to actual appointment slots later in the day or week, thus alievating the client's wait.
5) Offer drop-off options to walk-ins.
3 & 4 are already part of what we do. Many clients decline to schedule later in the day or week because the mindset is "we're already here, might as well stick around" because they don't want the inconvience of having to schelp their pet home and back again. We do try to "sqeeze" these appointments in where-ever in our schedule possible, but if our appointments are running on-time, how fair of it is to make the on-time client wait for someone who walked-in? Do we risk bad karma with the appointment client by making them wait, and possibly leave us...or satisfy the disgruntled client without an appointment, who was informed of the wait time, and is upset at us for inconviencing them with the wait even though we are the ones in the lurch to accomodate them? What would satisfy such a client? A discount? A free service? As much backside-kissing as possible? How often do you get disgruntlement when a walk-in has been waiting an hour, or is turned away because they cannot be accomodated?
5 is unfortunately not an option for us. As a solo-practioner clinic, we simply do not have the "double staff" or space to maintain boarding facilities for animals that are not the day's surgical cases.
And the biggest drop-off appointment concern expressed by our doctor and team are the liablities that we go ahead with treatments that a client is not present to sign-off for. How have other clinic's dealt with this issue?
The objections to drop-off walk-ins made by our team were that we could play phone tag with a client all day, and make treatments much more of a hassel than need be if the client is actually present. In surgical cases, the client has already had a full pre-surgical work up, signed a permission slip, and therefore is aware of what services will be provided (dental, spay, tumor removal, etc barring any emergency) and has an estimate for the charges. With a walk-in case, we don't have that type of established relationship with the client, and therefore need the client present so that they understand we are doing no more or less than what they request, and we can get immediate approal/denial without worrying whether the client is home or that they are getting cell phone service where they are. If the case requires more of a work-up, certainly it becomes an in-patient where the client can sign-off and pick up the pet later, leaving the team to work up the case at their "leissure." But without that initial examination, which is what the client walked-in and is waiting for in the first place, we can't generate an estimate or provide treatments.
What fees do you assess for drop-off patients? Do you charge hospitalizations or boarding fees and overnight-hospitalization fees, and how have your clients responded to these charges? Do you charge a "stat" procedure fee when you have a "left over" case to work up in the morning that is now going to set your surgery times back?
I could see having a drop-off client sign a permission slip allowing for an innital examination, and making sure they see it in writing when they take the slip home that we won't be responsible for any lack of communication on their part.
When you have these drop-offs...do you schedule discharge time at the end of your day, thus taking up appointment time in your schedule? It would be as if the client actually made the appointment for later in the day to speak with the DVM, it is just that the work-up is already completed. Or is the discharge a "walk in" as well?
I really, really wish we could hire more staff, I really do. Our area was hit hard by the resession, and we're still dribbling clients who move out-of-state because they can no longer afford to live in our area.
The reasons I'm asking so specifically because I really, really need to build a solid case with my team if I'm going to encorage drop-off appointments. You're right, we really are not that busy during the day that one or two drop-offs will be a serious disruption. It is when the walk-ins happen during our busiest hours, which are the "after work" hours for most of our clients, that things get messy. I would love to board these animals overnight so that our team will have something to do in the morning if there is no surgery scheduled.
Absolutely, we charge a "cage fee." We have a Day Cage Fee, and Overnight Cage Fee, and likewise, a Day Boarding Fee and an Overnight Boarding Fee. The distinction usually is if the patient needs to be in the hospital because of a condition, or because of owner convenience. When the fee was first instituted, some clients complained, but once they understood that we have to own the cage, clean the cage, and clean the laundry, dishes, food, etc. it starts sounding like a bargain. A continuing point of confusion is the "short term" drop off. Clients need to understand that all of the above overhead costs are no different for a 10 minute cage stay then for a 5 hour cage stay.
Typically, adding a procedure that requires us to start a little earlier the next morning is not a huge deal, WHEN we know about it the day before. When I say start a little earlier, I mean become productive earlier........very unusual to have staff actually come in earlier. What I'm really talking about is a little less time with the coffee cup, etc. In this economy, we've seen a spike in no-show surgeries or last minute cancellations, so having a little extra has rarely become an issue.
We ask drop off's to answer specific questions about what services (if any) beyond the exam that they authorize in advance. Sticky subject, since it can be tempting for a staff member to venture into a diagnostic conversation while they think they're being proactive. By the way....every one of our admits and discharges are handled by staff. Every client is offered the option to see a Dr, if need be at discharge, but otherwise, the Doctor-client contact is over the phone in the case of drop offs.
I really believe that Doctors only make money for a practice doing a few things....surgery, diagnosis, prescribing treatments, etc. - every state practice act will spell that out. When Doctors do the other things, you're losing money.
One tech in our practice could have a schedule like this: 7:30-8:30 process hospitalized patients, perform treatments, communicate with Dr on condition of patients; 8:30-9:30 help admit surgery patients; 9:30-12:00 process drop offs and supervise hospitalized treatments; 1:00-3:30 process drop offs and supervise hospitalized treatments; 3:30-5:00 discharge surgery and drop off patients; 5:00-5:30 perform end of day treatments. Throw in a few anal gland expressions, nail trims, and suture removals and you've filled a whole day for a tech, and freed alot of Dr. time.
A second tech is in surgery with Dr. or doing scheduled appointments with Dr, and they share an assistant to help restrain, etc.
Every practice is obviously different, and this is only one model, but I think that in every case, leveraging Dr time by using staff is a vital way to manage resources in this economy.
Sorry it took me awhile to reply to this, life happens.
I wanted to thank you for your advice. I showed my practice owner this entire thread, and his response was that Ms. Smith was pretty much an exception to the rule, and that a vast majority of our clients have no problem with paying a "walk in" fee, and seem to understand that if they want to be seen as soon as possible, that they would incure an extra charge just as they might for an emergency.
Perhaps I should simply change the fee to state: "Same day non emergency" and "Same day emergency." I know sometimes wording is everything.
Our practice owner said he was not sorry to see Ms. Smith go, as she was a high maint client, exceedingly difficult and abusive at every appointment, and had once insulted him with the statement of; "I know more about the medical needs of my cats than you do" one day to his face during a "discussion" on what medication one of her cats should be prescribed.
I am a little sorry to see such a client leave us, as I know that to sometimes satisfy such difficult clients can develop more loyalty than making every easy client satisfied.
But perhaps the only reason they are loyal is because they know us as "push overs" and that they would not be able to "get away" with their abusive behavior anyplace else. Every time we bend the rules for such a client, I wonder how often this is the case.
Seems like an easy one, you've got 10 minutes before your next appointmen
Exactly...
To answer the question, Ms. Smith would have been happily told that we would love to see her two new cats and that we could get started right away, though depending on how our scheduled appointmen
In this economy (and at any time, really) a business should be delighted to be chosen by a client to provide a service despite the fact that they may not always be able to jump through our hoops.
I have read these feeds with interest. I would have to respond with this: there is no 'right' answer. The problem is-each scenario is never going to be the same. Good client, bad client, new client, time of day, time of night, busy, slow, drop off, wait--how can you say what is appropriate? No matter what you do, above all things: be professional, be nice, be honest about what you can or can't do at that time. Hopefully your staff is trained well enough to assess the situation, and either prioritize or post pone. And if in doubt--to offer to check with the other senior staff members or doctors. And you aren't refusing t see them; just refusing to see them at that moment. The one thing I wish I could voice aloud to clients is this: Would you treat your regular doctor this way? What does my lady doctor say? Poor planning on your part does not constitute an emergency on our part.
As for the thought of charging an extra fee...I have seen and participated in many such discussions. But how many of these walk in clients are your 'good' c lients? I would say that 8 out of 10 walk in are either 1) newer clients who 'just don't realize' or 2) clients who have no money anyway and just 'rush right in'--usually during your lunch hour. You charge one client a fee and credit the client who was inconvenienced. What does that show? One client learns you will 'just do it' when they come in, and one client may feel that they are not important to you even with a credit on their bill. Which client do you really want? I know who I'd pick.
This will be an interesting topic for years to come.
