1. PRACTICE
• P rimary concerns
• R egulatory concerns and
government
• A dvertising
• C ash
• T ime for Family and Friends
• I nventory
• C ulture of your practice
• E mployees
P epcid
R eglan
A lcohol
C rying
T axes
I buprofen
C omputer Crap
E nergy (or lack
thereof)
1

2. The eight things attorneys,
accountants and practice managers
don’t tell you about practice
ownership
Part 2
Raymond J Ramirez DVM
University of Illinois 1986
ray@ramirezdvm.com
Ramirezdvm.com
Slideshare.net/rayjramirez
2

3. PRACTICE
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P rimary concerns
R egulatory concerns and government
A dvertising
C ash
T ime for Family and Friends
I nventory
C ulture of your practice
E mployees
3

4. 4

5. PRACTICE
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P rimary concerns
R egulatory concerns and government
A dvertising
C ash
T ime for Family and Friends
I nventory
C ulture of your practice
E mployees
5

6. Time for family and friends
– Repeat after me:
–Staff are not your friends
– You are held together by a paycheck, and
caring for each other not saying bad,
6

7. Time for family and friends
• Maslo Hierarchy
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8. Time for family and friends
• Remember George Bailey?
– Always Building and loan
– Erupted in GBS
We don’t have Frank Capra
Or Clarence or…
8

9. Time for family and friends
• This thing all things devours:
Birds, beasts, trees, flowers;
Gnaws iron, bites steel;
Grinds hard stones to meal;
Slays king, ruins town
And beats high mountain down. nizations
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10. Time for family and friends
• Find friends outside of work.
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Civic organizations
Church
Children’s school friends parents
Colleague from neighboring town (outside of
competitive area)
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11. Time for family and friends
• Friends will keep you grounded.
• Things like this (convention) are great…
– Need ongoing – more than every 12 months.
– Maybe Skype/ Google Hangout sessions
– Some significant time should be talking face to
face
11

12. Time for family and friends
• When friends are from civic world after
ownership
– Cautionary tale
• They do not always distinguish between problems
with staff/ issues you have and how good of a
Doctor you are.
12

13. Time for family
• Set aside time with husband / wife
• Schedule it – if not on schedule, will not
happen.
– Guard it like a dog guarding a bone
• What to schedule?
– Carefree timelessness
13

14. Time with family and friends
• They don’t care how much you know, until
they know how much you care…
• What would your family say you care about
by proof of ‘wasted time’?
• Set boundries
– Even if home for only 30 min
14

15. Time with Family
• Ideas: go to children events, even if you
don’t like
– Dad-daughter dance
– Bowling
– Driving to, from practice – even if middle of
day
15

16. Time for family and friends
• Questions?
Avoiding…
Pepcid
Reglan
Alcohol
Crying
Taxes
Ibuprofen
Computer Crap
Energy (or lack thereof)
16

17. PRACTICE
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•
•
•
•
•
•
•
P rimary concerns
R egulatory concerns and government
A dvertising
C ash
T ime for Family and Friends
I nventory
C ulture of your practice
E mployees
17

18. Inventory
• Two basic concepts:
– Just in time
– Bulk buy
18

19. Inventory
• Do nothing because I said so
• Look at Fortune
500 companies..
• How do they
manage
inventory?
19

20. Inventory
• 95% of those companies manage the highest
cost inventory with ‘just in time’
– Dell pioneered in computers
– McDonalds in food
– FedEx makes it’s living helping manage JIT
20

21. Inventory
• Just in time
• How looks in practice:
• Instead of ordering minimum of Frontline in 2010,
we ordered 70% from a special in February.
• Market was saturated with ads in Menards, many
other places, and despite our proof of ‘just as low’
price, clients purchased elsewhere, and still had
inventory 18 months later.
21

22. Inventory
• Not saying there may not be some things
that would be wise to order.
• But bought practice in Dec 2007,
• In June 2013 purchased first order of
medication vials!
• Money sitting on shelf, not in your bank
account
22

23. Inventory
• Get online pharmacy partner
• Many out there – to me, no reason to have
to pay a fee.
– USE them. Our solo doctor practice averages
3-5 approvals through our pharmacy / week.
– We do not stock Vetmedin (3 patients on) or
Soloxine,
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24. Inventory
• What we do stock
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1 NSAID – others are scripted
1 Heartworm preventative – choose favorite
1 flea preventative - we switched in 2012
1 flouroquinolone
1 ‘penicillin’ tablet
24

25. Inventory
• Questions?
Avoiding…
Pepcid
Reglan
Alcohol
Crying
Taxes
Ibuprofen
Computer Crap
Energy (or lack
thereof)
25

26. PRACTICE
•
•
•
•
•
•
•
•
P rimary concerns
R egulatory concerns and government
A dvertising
C ash
T ime for Family and Friends
I nventory
C ulture of your practice
E mployees
26

27. Culture of your practice
• Establish a culture is critical to your
enjoyment of practice.
• Word association
– Two different industries
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28. Culture of your practice
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29. Culture of your practice
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30. Culture of your practice
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31. Culture of your practice
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32. Culture of your practice
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33. Culture of your practice
There is no right or wrong..
Just make sure you are not out of place for
your niche
Could do same with restaurants
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34. Culture of your practice
What do you want yours to be like in the following
scenario:
An annual exam
Sick pet outpatient
Surgery
bring in ‘drop off’
going home
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35. Culture of your practice
We need to know what culture we want
Need to talk about daily, and model.
Need to correct when not doing
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36. Culture of practice
• If person not do procedure correctly
– 1st time wrong, assume I (trainer) did not give
directions clearly
– Second time, start to think did not hire correct
person
– Not everyone is fit for every practice, and
culture.
– How many think the Ritz Carlton would hire a
Motel 6 employee?
36

37. Culture of your practice
• This is not an OHE process: set up and
done.
• More like riding a bicycle: always
correcting and balance
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38. Culture of practice
• The 1,000,000 question with no lifelines
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39. Are you willing to
ask people to leave,
even if they were
with the practice a
long time?
X
50:50
X
X
A: No - valuable
C: No- know everyone
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9
8
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6
5
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3
2
1
$1 Million
$500,000
$250,000
$125,000
$64,000
$32,000
$16,000
$8,000
$4,000
$2,000
$1,000
$500
$300
$200
$100
B: Yes
D: No only
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computer person

40. Culture of your practice
• Changing culture is difficult, and takes
time, and must watch with EVERY hire.
• Practice purchased in 07. From colleague
thought was mid level price.
• Turns out was low cost, high volume
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41. Culture of practice
• Staff said wanted to change
• But no enthusiasm for phone, new clients.
• At recent staff meeting, current staff went
out of way to mention first staff WERE
NOT friendly.
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42. Culture of Practice
• Have friends borrow a pet and mystery shop
your clinic.
• If not test, can not improve.
42

43. Culture of your practice
• Want to find folks who naturally want this type of
service, not where it is a ‘stretch’.
• One receptionist interview mentioned would have
client come in for Exam if not ‘too expensive’…
when asked what is proper fee, said: “I don’t know
not been a receptionist for while, maybe $30”
• Point is not if receptionist is right or wrong, may
not be right fit for your practice, if your OV is
$55, or maybe great fit if yours is $25.
43

44. Culture of your practice
• Questions?
Avoiding…
Pepcid
Reglan
Alcohol
Crying
Taxes
Ibuprofen
Computer Crap
Energy (or lack thereof)
44

45. PRACTICE
•
•
•
•
•
•
•
•
P rimary concerns
R egulatory concerns and government
A dvertising
C ash
T ime for Family and Friends
I nventory
C ulture of your practice
E mployees
45

46. Employees
• Management expert Glenn Shepard recently
shared an experience of second worse day
of veterinarian in MN life was day came in
and fired everyone.
• He asked what was the worse?
– Every day of the 3 months leading up to that
day.
46

47. Employees
• Some of this may sound like some things
we hear from management consultants
• But with new owner, we will focus on 3 that
are critical
• Changes from previous protocols
– Training staff to handle correctly
• Training and reviews
• Hiring
47

48. Employees
If not purchased clinic yet:
Make sure of following legal protocol:
All staff are fired as of last day of previous
legal entity that is XYZ Animal Clinic…
And rehired by “new improved XYZ Animal
Clinic”
• Restarts clock
• No one has seniority
48

49. Employees
Changes from previous protocols
– Training staff to handle correctly
– All your protocols should be written down.
• If some you did not think ‘needed’ to be written down, have a
staff member be your scribe, and start a Word document and
tell them “type this up for me, and have it printed before end
of day”.
• Do NOT let go on for more than 24 hr.
• Ask if understand protocol, ask them to repeat it back.
• “See one, do one, teach one”
49

50. Employees
Changes from previous protocols
• Never correct in front of co-workers –
always in private – either office or exam
room.
• Always use the ‘sandwich’ method of
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Praise one thing they are doing
Correct protocol we need to correct
Ask them to repeat back so they understand
Praise a second thing you are appreciative of.
50

51. Employees
Changes from previous protocols
• You have to read body language like you
would a patient
– Is this person really telling me the truth about
this?
– If you ave a key person who is not on board,
they can do a lot of sabotage of your changes
– Finding out if they are not ‘on board’ is much
harder when you are the boss, vs when you are
a fellow employee.
51

52. Employees
Changes from previous protocols
• Habitforge.com
– Motivated person takes 3 weeks to make a
change
– Unmotivated person…. Unsure if ever will
change.
• May look at you with blank stares, or
nodding
52

53. Employees
Changes from previous protocols
• What happens if your ‘favorite’ staff
member, when you correct them about
protocol for the third time, says “I
forgot”?
• Get over your fear of ‘I can not do this
without them’!
• No one is indispensable.
53

54. Employees
• Training and reviews
• Not common in Veterinary medicine, to
have a phase training schedule – and need
to do with your ‘existing’ new employees.
• Weekly review of how week went,(for new
trainee) things they were supposed to learn,
remember, memorize for job.
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55. Employees
• We started with a Wendy Myer’s training
list and added/ subtracted to it.
– Don’t’ take time to reinvent the wheel – use
others wheel and tweak it – saves time and
money in long run because not making all the
same mistakes.
55

56. Employees
Training and reviews
Review of job done
How many here have had a review in their life?
I had never had a review prior to my giving reviews
to my staff
Some places I had worked 5-7 years
As an associate, worked 1 yr, and 2.5 yr – no
review
Doing relief work, called every clinic to get
review of how I could do better next time.
56

57. Employee
Reviews
• How often is recommended?
• Glenn Shepard says annual are on way out
– NONE are related to ‘raise’
• At least q 6 months
• One manager to reduce turnover, instituted
monthly reviews
• Turnover went from 150% to 20%
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58. Employee Reviews
• Why reduction?
• Know what is expected.
• Know how to improve
58

59. Employee Review
• One note on reviews:
• Do not give a 1-5 review
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Why?
How many give perfect score?
How many give lowest score?
Just made a 3 point scale out of 5 point
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60. Employee Review
• Use a 1-10 scale
• Several online to look at things you want to
address:
• Punctuality, doing things not want, follow
directions, do weekly, biweekly, monthly
cleaning list, prep for sx next day…
60

61. Employee
Hiring
It is not a badge of honor to never have to
hire, or never have fired someone.
• From business ‘best practices’ model:
• Get as many people as you can involved in
decision
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62. Employee: hiring
•
•
•
•
Create a process to start – you may tweak
We have 3 step process
Phone interview
Onsite Interview
– Reference and previous employer check
• Extended ‘job shadow’ interview
62

63. Employee: Hiring
• Know your standards – back to Culture
• Don’t compromise.
– If won’t follow to try to get job, they will not follow
when on the job
• Example: If you have a policy of only 2 stud type
earrings, we mention during phone interview:
“We have a policy of only stud earrings, no hoop
earrings, or hoop necklaces for your safety with
excited dogs” and they come to interview with 7
hoop earrings….
63

64. Employee: hiring
• Common best practices axiom:
• Hire slowly, fire quickly.
• People can fake it for a while to ‘get’ a job.
• We do it all the time, with our clients!
64

65. Employees
• Now you can sit on top of world!
Questions?
Avoiding…
Pepcid
Reglan
Alcohol
Crying
Taxes
Ibuprofen
Computer Crap
Energy (or lack thereof)
65

66. Practice
P rimary concerns
R egulatory concerns and
government
A dvertising
C ash
T ime for Family and
Friends
I nventory
C ulture of your practice
E mployees
Avoiding…
Pepcid
Reglan
Alcohol
Crying
Taxes
Ibuprofen
Computer Crap
Energy (or lack thereof)
66