Success in Equine Practice
How can we define, measure and increase success in our profession, when it encompasses not only favourable clinical outcomes, but also personal and professional confidence for every practice member, in addition to having strong, profitable businesses? The Annual Congress in September was used to launch a new dimension in BEVA’s CPD range, aiming to qualify, quantify and enhance the nebulous parameters of “Success in Equine Practice”.
The course was led by experts in the field of equine business development and professional lifestyle.
David Bartram, from the Division of Clinical Neurosciences, School of Medicine, University of Southampton, began by outlining the evidence for elevated levels of psychological distress in the profession.
The suicide rate in this profession is four times higher than that of the general population, and twice that of other healthcare professions. In the course of his work, David surveyed a representative sample of 3200 vets to explore their mental health and well-being and some of the potential influencing factors. Approximately 3.9% of the general population will admit to having suicidal thoughts in the previous 12 months, whereas the figure for vets is over 20%. The factors reported to make the greatest contribution to veterinary surgeons’ stress included the number of hours worked, making professional mistakes, and client expectations. In comparison to a representative sample of employed members of the UK general population, vets reported a much lower level of support in the work place, and found that demands placed on them were seen as less favourable. Equine practitioners scored after hours on-call duties to be a greater source of stress than such duties among other respondents.
The three things that gave equine vets the most satisfaction included good clinical outcomes, client satisfaction and intellectual challenge or learning.
The second speaker was Dr. Warwick Vale, from Bullsbrook Veterinary Services in Western Australia. He discussed the measures of personal success as seen through the eyes of a young vet taking the first steps up the ladder of his or her professional career. These included not only such recognisable factors as remuneration, improving clinical skills, lifestyle, variety of work and charity or welfare work, but also, equally important and too frequently lacking, abstracts such as praise, recognition, reassurance and guidance. The lack of these simple courtesies, in itself, adds significant stress to the new graduate. Yet some practices would, mistakenly, consider these luxuries, and it is these practices that could be enhanced by concerning themselves with the professional confidence, and thereby happiness, of their associates. Career guidance and mentoring ensure that the young vet is less likely to make mistakes, or even drop out altogether. When asked, 70% of equine vets would be equine vets all over again, so, once through the maelstrom of practice, the memories are generally good ones.
A successful practice will strive to create a better overall environment for its young vets, so that these vets stay with the practice, improve in knowledge and confidence with the practice, and ultimately end up buying into that practice as partners. It has become clear that young equine vets undergo somewhat of a reality shock, as the discrepancy between what they were expecting, and what the actual reality of practice is, sets in. Their career status perception starts high and then falls rapidly in many cases. Furthermore, as their responsibilities increase, the stress also increases. Add to the melting pot the generational differences, and it is no wonder that a smooth integration into the real world of equine practice can be a bit bumpy for some people. The young vets of “Generation Y” tend to have different lifestyle expectations, including a strong sense of immediacy, and a different approach to problem solving, which often includes a high degree of technological competency and more of a group-based approach, than their older, more insular counterparts. Practices are advised to keep up with the advances in technology, and to have a degree of flexibility with respect to how new assistants are trained and treated.
The highly competitive procedure through which students must go to gain acceptance at veterinary school tends to select perfectionists and high achievers. By their very nature, perfectionists suffer more stress than high achievers, since they are more self-critical, and perfection is virtually unobtainable in the real world of day to day practice. In order to decrease the amount of stress felt, they must try to decrease the desire for perfection. Dr. Warwick Vale had several useful tips on this, such as learning to deal with setbacks and criticism (particularly difficult for Generation Y, who have been raised on almost constant praise), taking smaller steps, enjoying “the journey” (“...It is a marathon, not a sprint...”), dwelling on the positive outcomes rather than the negative ones, and to see mistakes as positive experiences too. He also recommended doing a cost-benefit analysis on achieving goals, for example obtaining a certificate or diploma, as to whether it would really be worth it at the end of the day.
Dr. Vale also had some very sensible advice on how to help deal with those unavoidable long hours. He blamed a depletion of “brain fuel” for the exhaustion that may lead to depression, which in turn may lead to suicide. The long working hours cause a decrease in the brain’s serotonin levels, and these must be replenished fully. In order to recharge one’s own internal batteries, he stated that it was necessary to take holidays as large blocks, e.g. three to four weeks, and to just totally walk away, with no interruptions from mobile phones, emails, etc. He advised never to go more than twelve months without a holiday, and not to burn the candle at both ends, i.e. it may be necessary to limit one’s social calendar from time to time. He also pointed out the benefits of proper meal breaks and rest breaks during the day, and to stay physically active. Although this sounds unrealistic in today’s hectic world, he added that the practice principals that worked over 60 hours per week in their businesses tended to have the lower profit businesses - harder work does not always mean higher financial reward.
Another source of stress are client complaints. Dr. Vale appreciated that these are unavoidable, but that they should actually be embraced, since if there really is something wrong, it must be brought to the notice of the practice and then it can be attended to before the problem worsens. Clearly, complaints about services and clinical issues should be minimal, and must decrease with time, but complaints about fees and charges should be a welcome reminder that fees are being set at appropriately high enough levels. Dr. Vale enjoys getting complaints about his fees charged, as it lets him know that his fees are set correctly - no complaints indicates that fees are too low. He suggested that listening to, and empathising with clients can go a long way to resolving an issue, whether perceived or real, and help to limit the extent of the problem. Indeed, if this is done well, the complainants can go on and ultimately become very good clients. It is important to just listen initially, in a face to face situation, and allow the client to vent his or her frustration with the situation. Dr. Vale insisted that the vet must “...walk in the client’s shoes...,” even if the client’s opinions seem unreasonable, and that it is important to settle such issues quickly, not allowing them to fester. If the client thinks the bill is excessive, it was suggested that the vet ask the client what he or she would consider reasonable - since often the vet would discount more than the client would have suggested! Litigation often seems to arise from poor communication, so the more open these channels can be kept, the better.
Dr. Warwick Vale encouraged the young vet to remember that the veterinary profession involves not only clinical skills, but also provision of a caring and empathic service to the client too, and that self-improvement in this area will provide a greater level of customer service and client satisfaction, and therefore provide the practice with a more valued assistant. He commented that employers want loyalty, flexibility, enthusiasm and confidence from their employees.
The next speaker was Professor Pat Wall, who is both a vet and a doctor, and is the Associate Professor of Public Health at the University College, Dublin, School of Public Health and Population Science. He stated that it was not the hard work of being a vet in practice that was the problem per se, it was the stress that arose from the feeling of not being in control, and that it was the unpredictability of each day that fuelled this feeling. This could be worsened by being outside one’s sphere of confidence. The nature of working in isolation, as is often the case in equine practice, can also be particularly stressful for some people. Professor Wall indicated that a certain amount of stress was generated when people were unable to grasp what their exact role was within the practice, or were unclear about their career trajectory. Those vets that were too accessible to their clients, e.g. by mobile phone, felt unable to relax and therefore suffered more stress.
Professor Wall continued that your health is the most valuable asset, both mentally and physically. This would inevitably suffer if the vet was too busy or too available for clients, and would continue to deteriorate with the stress of putting clients before your own family. Due in part to the fact that vets work such long hours, all too often clients form a major part of the vet’s friendship base, so this results in there being no real separation between work and relaxation. He stressed the importance of blocking time off in the appointment diary to allow time for yourself and your family, for health and relaxation. Professor Wall noted that it was reasonable to provide, or be provided with, a realistic job preview and feedback, to keep open the channels of communication between employer and employee, and that it was crucial to continue competence and personality development.
The next presentation, again by Dr. Warwick Vale, was aimed at the more established practitioner, and gave advice on how to encourage a young vet to stay with, and eventually buy into, his or her practice, thereby ultimately allowing retirement of the existing partners in turn. This often overlooked issue is known as “Succession Planning”, and is important since it ensures the longevity and continuation of the practice, and provides an effective realisation of the investments, both of capital and goodwill. It is the desire to create a win-win scenario for the business, the partners, the staff, the clients and the entering or exiting vet. It is a crucial part of the business plan, and is often overlooked or postponed. Meanwhile, the associate may become disheartened and demoralised, and leave the practice, resulting in the established partners plodding on until they, almost, “die in harness”.
Dr. Vale stressed that each new associate hired must be viewed as a potential partner, and strong consideration given to not only their clinical aptitude, but other characteristics such as affability, leadership, personality, ability to communicate and integrate, enthusiasm for sports and other activities that demonstrate a well-rounded personality. Dr. Vale himself asks each applicant to undergo a personality test when applying for a position with his practice. The new assistant must then be trained and mentored in management and as a service provider. Dr. Vale’s motivational strategies include not only remuneration, but also decision-making within the business. As the younger partners progress to making more of the decisions on a day to day basis, and are allowed to make some wrong decisions, the business is slowly and gently passed on.
Clearly, the business must be attractive in terms of lifestyle offered, financial returns, career enhancement and status offered. The incoming vet will want to buy into a good business, not a liability. Dr. Vale stated that the boss must have a good attitude, with a positive outlook, and be a mentor and leader, and that his or her enthusiasm would become infectious within the practice. He indicated that the price per se was not as important as the intrinsic value. He said that good business management should be team-based, with a parity in commitment, and also emphasised outsourcing administrative duties. The practice must retain a flexibility of lifestyle, especially as so many of its staff will be juggling professional commitments with the raising of families.
Dr. Vale then compared and contrasted two sets of data, the first from practices with a high profit:return ratio, and the second from practices with a low profit:return ratio. Both sets of practices were very busy, and had happy clients. However, the more profitable practices had lower staff turnover, multiple partners and more holidays. Those practices with a lower profit:return ratio tended to have a single owner, have a high staff turnover and very few, or no, holidays for the practice owner. The implication drawn from this is that practices should charge more for their services. This is one of the hardest things for vets to do, particularly if their careers were started in a practice with low self-esteem.
Dr. Vale stated that a lot of vets leave “succession planning” too late. It can be made even more problematic if the practice is based in the home, since even if the vet thinks he will rent out the premises to the practice after he retires, the remaining partners may not be willing to have the ex-boss as their landlord for a number of reasons. He recommended that when, for example, three vets are working at capacity, then this is the time to bring on a fourth vet, to be trained and rewarded on an incentive basis. Dr. Vale added that it was a mistake to wait until two vets are doing the work of three before hiring another associate. He suggested expanding by one vet per year approximately, adding that the “most profitable” size for a veterinary practice, in Australia, is a six vet practice with two owners. As an equine vet, he also sees profit increase when each associate has a technician/nurse in the truck with him or her. He also said that in Australia, he tries to gather about twenty horse practices together that are not in competition with each other, to have meetings to exchange ideas and to benchmark their financial performances, with follow-up meetings to check on improvement the following year, and that these have proved very successful.
Dr. Vale concluded with several points that must be attended to in order to improve equine practice. These included a review and action plan to address the status of suicide and depression, an increase in safety levels at work, effective role models and an increase in the status of equine vets, the use of business management consultants, a change in the workplace culture to stop throwing new graduates “in at the deep end”, and overall to strive to make equine practice better for the next generation.
Clearly, “Success in Equine Practice” includes so many different aspects, and is so fundamental on a day to day basis, that education in this emerging field is sure to be both highly interesting and extremely useful.
