Practice Management

Sustainability Strategies Eliminate Turnover, Increase Profit

By Tom Rosenthal

An equine general veterinary private practice had profitability increases of more than 20% in each of 2 succeeding years after changing its workplace culture, which eliminated high turnover caused by professional burnout, Becky Tees, DVM, said in a presentation at the 2023 AAEP convention.

“Since 2020, we have been able to completely eliminate veterinarian turnover within our clinic,” said Dr. Tees, an associate veterinarian at the sports medicine practice, Energy Equine Veterinary Services near Calgary, Alberta, Canada.

The practice has also had an 18% overall reduction in staff turnover, she said.

Prior to implementing the sustainability program, the practice was experiencing a 50% veterinarian turnover rate, which was due to burnout tied to excessive workloads, uncompetitive salaries and low job satisfaction, among other factors, Dr. Tees said.

After implementing the sustainability initiatives in January 2021, “We’ve been able to expand our practice from 3 to 8 veterinarians. Our clinic profitability has increased year over year, on average 20.4%.”

In 2019, the AAEP cited veterinarian retention as its top priority and in 2022 created a commission to address an equine veterinarian shortage (https://aaep.org/ news/aaep-creates-commission-alleviate-equine-veterinarian- shortage).

Burnout is estimated to cost veterinarian practices in the United States between $1 billion to $2 billion a year, according to a 2022 study that Dr. Tees cited.

Dr. Tees, a 2018 University of Calgary graduate, said the practice had hired Novus Global, a coaching company to increase profitability, but it evolved into what she described as “more of a journey on sustainability.”

Acknowledging that there is no-one-size-fits-all rubric for veterinarian practices, Dr. Tees said the starting point for them to implement a sustainability workplace culture to tackle burnout and turnover was to ask each veterinarian 2 basic questions:

  • What changes would make you absolutely thrilled to come to work each day?
  • What changes would alleviate your biggest stressor?

The answers produced several changes the practice implemented, Dr. Tees said, telling the audience at her presentation, “This might give you guys some ideas of what could work for your practice.”

Compensation
Interns and first year associates now receive an annual salary, Dr. Tees said. The priority is that first-year veterinarians develop performance procedures with which they are comfortable doing, while building client relationships and becoming well-rounded clinicians without financial stressors, she explained.

“We want them to perform their job well and enjoy doing it,” she said.

“After that first year, veterinarians will transition to a base salary and bonus compensation model,” Dr. Tees said. “Veterinarians receive production-based compensation once their billings tip over $250,000 a year, and then they move on to a bonus model. Then in our third year, we transitioned to a straight commission model.”

Since the practice adopted this “graduated-compensation model,” no veterinarian has lost income year over year, she said, adding that veterinarian technicians “are paid quite generously compared with the industry average, which has seemingly helped with their employee retention.”

Dr. Tees added, “and all of our staff at the clinic receive a quarterly bonus, which is a percentage of the clinic’s net profits for that quarter divided evenly among all the staff members.”

4-Day Work Week
“All of our associates and technicians in our practice have moved to a shortened 4-day work week,” Dr. Tees said. “The option to work the 5 days remains available, but nobody really jumps for that, surprisingly,” she quipped. “Our interns do continue to work 5 days a week, however, to maximize their case exposure,” she said, noting this has worked well.

Shared Caseload
“There’s a general philosophy at our clinic that clients are shared between senior and junior veterinarians as much as possible,” Dr. Tees said. Senior veterinarians don’t perform certain procedures, such as vaccinations, Coggins wellness exams or gastroscopies, leaving newer practitioners to handle that caseload, she said.

“This is a nice way to introduce clients to those younger practitioners and harvest new relationships,” Dr. Tees said. “It also keeps the younger veterinarians’ schedules booked and builds their skillset.”

Having clients comfortable with different veterinarians also eases the burden of managing larger farms or facilities, she said. “If their usual preferred veterinarian is not available for some reason, there’s likely another vet that they’ve seen before that can step in and provide services to that client.”

Desired Caseload
The practice implemented a Desired Caseload policy in which 60% of each veterinarian’s weekly caseload are procedures they want to perform, she said, noting that is a statistic followed closely at weekly staff meetings.

“I love doing lameness exams and gastroscopies, but I don’t really love doing a ton of dental floats,” she explained so under this policy she gets to do the work she enjoys more.

“We try really hard to make sure our veterinarians are seeing a majority of cases that will essentially fill their cup and make them thrilled to come to work each day,” Dr. Tees said.

Development Time
Each veterinarian gets 1 morning or afternoon a week for development time. “This is basically free time to catch up on callbacks, medical records, do some CE case research, or you can even fit in some personal appointments if you would like,” Dr. Tees said.

Cell Phones
“Our clinic has really moved away from the old mindset of constant availability to our clients,” Dr. Tees said. “We have set some really strong boundaries around accessibility of our veterinarians during their time off.”

Prior to 2020, there were no client or clinic boundaries, and veterinarians were constantly available for clients to reach by text or phone or for the clinic to reach a veterinarian on their day off, she said. “This was a major sticking point for us because we felt like we could never truly get away from work.”

The solution was to provide all the veterinarians a company cell phone for client communication and emergency on-call use, Dr. Tees said. “These are used during business hours or on-call only. All clinic communication with veterinarians is through these company cell phones. “

Emergency On-Call
Emergency on-calls are divided evenly among veterinarians, including all interns, who have a senior veterinarians help them with emergencies during their first 2 months, Dr. Tees said, adding that after that 2-month period, a veterinarian remains available to help an intern.

“Veterinarians at our practice get the Monday off after their on-call weekend,” she said. “If they work, on-call for a long weekend, they get 2 days off.”

By taking and supporting positive change, clinics can find sustainable solutions for their team, which would be the first step in improving all equine medicine, according to Dr. Tees.

For more information:
Neill CL, Hansen CR, Salois M, et al. The Economic Cost of Burnout in Veterinary Medicine. Front Vet Sci. 2022 Feb 25;9:814104. doi: 10.3389/fvets.2022.814104. eCollection 2022
https://www.frontiersin.org/articles/10.3389/fvets.2022.814104/full