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How would you run a clinic?

Discussion in 'Pre-Veterinary' started by Golden10, Feb 20, 2012.

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  1. Golden10

    Golden10 CVM 2016!!!

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    I have been a long time lurker to this site but I finally made an account and I have a question I have been thinking about for months!!

    I applied this cycle and I am waiting on an acceptance letter. I have a pretty good shot at getting in which made me think about my future as a veterinarian. Since around half of veterinarians own there own practice I decided to post here for some good advice, since a lot of you may be interested in running a business.

    So I have a few questions. I have worked at a few different vet clinics doing kennel work, and the main problem I see is not enough job satisfactions especially with the techs. They are all living pay check to pay check and barley scrapping by. Needless to say, being educated people, they leave the profession for a higher paying job. So one of my questions is why don't vets let techs work off commission? The more that the sell the more money they make- an incentive that would allow them to make more money. How much should we be paying our vet techs because I don't feel like 14$ an hour is enough!! Should your head vet tech make more? How much more? Half of what your vets make? I think that they are extremely under appreciated since they are so essential to running a practice. The happier the techs are, and staff overall for that matter, the better your business will run. And in turn the more money you will make. I think that having good techs come and go is extremely bad for business. You have to constantly be re-training and no one has stuck it out long enough to actually be an "expert" for that clinic.

    It does not make sense to me why a x ray tech, for example, starts at 50,000 a year and has the ability to move up into higher positions and our vet techs start at 23-25K. Same amount of schooling. Much different pay. I understand that clinics don't make a ton of money, which is why working on commission would be the better option for our vet techs. Thoughts?

    My second question. If you lower your prices of routine visits and procedures would this ultimately increase your revenue since you will be probably getting more clients? I am not saying lower the quality of medicine, just have prices set lower then the competition around you. I got this idea when my mom called 14 vet clinics to find the cheapest one for just annual shots. The vet was great and my dog got her shots. That vet got our business, not because he is great, but because he was the cheapest. And the reason he keeps our business is because he practices good medicine.

    It is my dream to own my own small animal vet clinic one day and I really enjoy the business side of the profession. When I am working in kennels I watch how the clinic is run and think about all the ways we can make it better. Of course, I don't express my opinion to the vet, after all I am just a kennel worker, and probably more under appreciated then the techs!
  2. iwantbatteries

    iwantbatteries

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    lower revenue, and higher costs are not (usually) an effective business model. Either you cut costs, and offer lower cost services, or you change for the premium service you are offering. High volume doesn't help if that volume is at a loss.
  3. Golden10

    Golden10 CVM 2016!!!

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    If you business ran better, you would hypothetically make more money, correct? Techs working on commission won't change any of your revenue. If anything I think it would increase.

    And I think high volume would also create more revenue. There are some days at my clinic where we have half the day free and the clinic next store is booked solid!
  4. bunnity

    bunnity Penn 2014

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    1) I've worked at a place where techs got commission on top of their base salary (so did the vets), so that's certainly possible. I agree with you that happy techs do a great deal of good for a practice, and I think they should be paid as well as the practice is able. However, like any other job it is not about what is "fair" for what people get paid. Vets get paid less than physicians; teachers get paid less than NFL players. It's about supply and demand, how much the overall business is making, if unions are involved, etc. There are also many other aspects of happy employees besides how much they are paid: treat them well, listen to them, allow them to continue their education and have intellectual growth.

    2) There are plenty of places that do high volume, low cost work: take any shelter-run clinic or spay/neuter clinic as an example. It can work out fine as a business model, but it requires that you spend less time with each patient. It will probably require that you maintain a very narrow focus for high efficiency (for example, I've worked at shelter clinics that do mainly sterilization and vaccination). Something has to be cut somewhere, and I would caution you against choosing a vet solely on price. I'm not knocking low cost at all and I intend to work at a shelter when I graduate. I'm just saying that that low cost needs to be offset with something: nonprofit status, donations, narrow focus / high efficiency, OR the possibility of cutting corners (less surgical monitoring, less time spent with patients, etc).
  5. DVMDream

    DVMDream Gone, Adios! Gold Donor

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    Money does not equal happiness or happy techs there are so many more stresses in the job of vet tech that makes people leave. I can tell you from techs I have known that quit that money was the last thing that caused them to quit. usually it has to do with drama amongst employees or other stresses of the job.
  6. Golden10

    Golden10 CVM 2016!!!

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    Just to clarify, I am not saying pay them 50K starting salary. Just pay them enough so they don't have to struggle as much. Even teachers get paid a average starting salary of 33K.

    Another thing with this, I have talked to vet techs that have been working in the field for 20+ years and there starting salary was 14$ an hour and there current salary is 16!! I'm not saying lets just throw money at them, but I don't think that THAT low of a salary can even be close to fair.

    And for your second point, I am not saying become a low cost clinic. Just find out what your competition is charging and charge a little less. Not exactly low cost clinic, but low enough for people to choose you over your neighbor. Even if they are just saving 20$.
  7. Golden10

    Golden10 CVM 2016!!!

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    But a lot of the stress comes from paying your bills, supporting your children, and living comfortably. Its why a lot of really great techs at my work quit.
  8. DVMDream

    DVMDream Gone, Adios! Gold Donor

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    I am currently a vet tech, have been for 7 years, $14/hour would be nice. I barely make that when working overtime.
  9. Trematode

    Trematode

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    Yes, but the most expensive vet clinic in my hometown cuts corners. Go by word of mouth. Then, once you choose the clinic, make sure you are comfortable with the staff and the clinic.

    Also, it is not very fair to compare x-ray techs to vet techs. X-ray techs work in an industry that is subsidized by the government (perhaps more-so north of the boarder, where health care is free and wages are still high) so don't their higher wages have something to do with that?
  10. Golden10

    Golden10 CVM 2016!!!

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    Oh wow. That is crazy. Are you certified too?
  11. Golden10

    Golden10 CVM 2016!!!

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    IDK, it was just an extreme example of a profession with the same amount of schooling.

    But I have met a tech at a convention that got paid as much as the vet! Because they worked on commission and they were highly respected and grossed just as much as the vet. But I have never experienced this in an actual practice. I was just curious what other people thought/ experienced!
  12. bunnity

    bunnity Penn 2014

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    Yeah, good point - I've seen some crazy stuff at higher end places too. It just makes me nervous to see people price shop when a lot of people don't always consider whether low prices are due to low quality or not.
  13. August West

    August West solar powered

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    I'm a bit unclear about this policy. What types of services would the tech sell? Would the veterinarian diagnose the presented patient and then the tech would enter the dialogue and try to sell the treatment to the owner? Or would the tech just sell basic services without the veterinarian's instructions like dental cleanings? What am I missing here? I just don't see how veterinary technicians are in a position to sell services that they themselves are not qualified to designate as necessary for a patient.
  14. bayarea15

    bayarea15 someday super vet

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    the tech's at my work all make different amount of money...as do the receptionists. it's based off experience. but no one has had a raise the past 36 months. but we are getting remodeling done soon. the lowest paid tech is $11, the highest paid is like $19. my friend that has done kennel for five years get's paid $10. everyone is broke...but the doctors are also as well. the prices are pretty astonishing--bad. but the clients will wait 1-2 hours...before they are even seen. not the best time management going on. but they all have 1-2, sometimes 3 patients going on at a time, and it's a multi dr hospital so they are busy. i take my pets there because the best dr i've met in my life is there, and also it's the place of my employment. however, otherwise i would be happy to take them to the guy who owns his own practice 2 miles away for 70% cheaper, and has been in business since the mid 70's. no frills. in, out, done. too much crap at my hospital, imo. too many cooks in the kitchen...always obsessed with this and that, basically trying to run the place like it is a human medical center. everyone is pressured to push diagnostics, flea prevention, and promote the idea that online pharmacies are horrid. i dunno. i hope i never see people as numbers and $$. i know it's a business, but it's also a place created to save lives. just my two cents.
  15. bayarea15

    bayarea15 someday super vet

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    at my work the receptionists have to do sales talks for E & D, and push the folks to use a certain pet cremation service.

    techs at my work push vaccines, heartworm prevention, flea prevention.

    dvm push dentals etc.
  16. bayarea15

    bayarea15 someday super vet

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    i know some pharmacy tech's that work for the VA and are making a crapload, i think the amount of schooling with ratio to salary theory has gone clear out the window.

    could also argue why do vet tech's not make 1/2 as much as RN's, or even LVN's, and so forth.

    it's never gonna happen.
  17. libster06

    libster06 Crank a wank!

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    I don't always think that when techs quit because of the money, it's because they can't live off the salary without concern... I think it is the uneven coupling of low wages with grueling, stressful work. If the job wasn't as stressful and demanding, for some, it might not be as noticeable that they are working for chump change. But when your busting your cans day in and day out with little to show for it, your incentive and desire inevitably dwindles.

    It's not always (and probably for the most part) about "fairness". It's not like veterinarians are paid handsomely while their staff are getting shafted. Clinics can only afford to pay techs according to how much revenue the clinic is bringing in. I've NEVER been paid $14 an hour, even at a specialty practice. If the clinic you work at is in a more affluent area or has a lot of business come through, you generally are paid more as a tech, because the vets have the money to spend.

    And truthfully?? I really don't feel like $14/hr starting off in any job that does not require a degree to obtain is that bad. $30,000-$36,000 a year give or take is an average salary for any job not requiring a degree. It's not a lot, but considering many other unrelated jobs pay the same, good luck finding a salary you deem adequate to live off of. However, with other jobs, the work isn't always as physically exhausting on any given day.

    Being a tech is a thankless job to begin with. If you're a technician, you know that (or you figure it out really quick). You always feel overworked, and underpaid, no matter what salary you have. Secondly, veterinarians aren't trying to shaft the techs, because they know that they won't ever be able to keep good techs if they don't attempt to offer a decent salary for them. What IS bad is not increasing a worker's salary appropriately with time. Perhaps decreasing your starting salary so you can afford to reward those for hard work and dedication over time is a solution....
    Last edited: Feb 21, 2012
  18. lostbunny

    lostbunny

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    just decided to erase this b/c I can't put my thoughts into words. I agree with bunnity.
    Last edited: Feb 21, 2012
  19. moocow1987

    moocow1987 Cornell c/o 2016

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    Just to respond to the one of the original questions.. I think the real issue with simply lowering costs and trying to provide the same quality service is that in the end it does several things. You DON'T in fact end up providing the same quality service because you have to schedule twice as many appointments to make up for lost revenue per appointment. You also end up attracting clients that are not ideal, i.e. they will bring their pet for vaccines once every three years, and that's it. I'm not saying that is the case with EVERY client, but that is basically what you're going for if you utilize that kind of a business model. A practice that has fewer clients who spend MORE money per pet ends up being a healthier, more profitable practice than one who goes for lots of clients who spend only the bare minimum. It also gives practice owners a lot fewer headaches.

    In the end I think lowering costs to increase quantity of customers is a very slippery slope. People are people and nothing will ever be low enough until it is free. Increase quality and you'll get the great clients who appreciate what the vets and the rest of the staff do. Plus you save the receptionist from having uncomfortable, hostile discussions when it comes time for settling the bill.
  20. moocow1987

    moocow1987 Cornell c/o 2016

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    PS I'm a vet tech, and $14/hr :eek: Yes please.
  21. OH Bunny Girl

    OH Bunny Girl Ohio State 2016

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    ditto!
  22. Tense

    Tense

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    From my clinic, the people who have left haven't entirely left for the money. All three of us were there for around 6 years, the money had been the same for a while. It was the change in management, the drama that suddenly popped up and hasn't left, and feeling like we weren't respected as employees that made us leave/look for somewhere better.
  23. sumstorm

    sumstorm

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    Let's think about this a bit more. Let's say the average cost for a basic exam in my area is $40 (these are all theoretical numbers.) Now, lets say the next nearest practice from me is 10 miles away. I know they charge $40....how much do I need to charge to convince folks to come the extra 10 miles? Well, with gas prices now and a population that drives SUV's, I'm going to guess at least $5 less, or $35. Now, lets say I want to work an 8 hour day and see 3 patients an hour.

    At $40 * 3 exams * 8 hours = $960/d in exam fees
    At $35 * 3 exams * 8 hours = *840/d in exam fees

    Oh, gee, that isn't good. What do I need to do to make up that income? The different is $120/d. At $35 I need to do 4 extra exams a day. I can either work an extra hour a day (how does that sound when you are probably already working extra hours to finish records, study up on problems, continueing eduction, reading journals, etc), or I can shorten my exams. If I shorten my exams, my clients may feel like they aren't getting the same attention and maybe I miss a service or issue that affects the pet's health and increases our income.

    Have you ever, as a tech, approached your boss with an idea to generate more income for the practice and asked for a small slice of that (since it will still take space, time, and energy) in the form of a raise? Many of the things techs can really sell on commission aren't major money makers and I don't necessarily want techs pushing on clients because I don't want them to feel that we are constantly diving into their pockets. Having said that, if a tech started noting down all the folks that have issues with nail trims and regularly contacting them and getting them in for an EFFICIENT nail trims (ie doens't take forever) and are able to promote it as a value added service for the health of the dog and the convenience of the owner, I'd be more likely to talk about increasing thier income. If a tech approached me (in a state where techs doing dentals is legal) about getting advanced training (on their dime) to improve the ability of the clinic to offer dentals, I'd consider paying them more if they also had a plan for increasing the business. I know I want to have a tech with advanced training in behavior issues because I don't want to dedicate the time those require but I consider it an absolutly necessary service and want to work with someone that has a passion for it within the clinic.

    I do know techs that make a good chunk of money that don't have any degree beyond a HS diploma. Their skills with clients and the working team and the patient are amazing and they are loyal and understand business and have solid techniacal skills. Often techs are very good at one or even two aspects of the veterinary business, but lacking in other areas. Also, techs often shift from one business to another rather than working to improve the business they are in. That helps keep the income down. Additionally, very few techs have the risk to investment that a vet owner has.

    I'd add that the folks I want to provide vet med for are far less concerned with exact costs and far more concerned with the care their animal recieves (including handling, professionalism, the ability to provide options and explain complex concepts.)
  24. Dsmoody23

    Dsmoody23

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    I work at a clinic that pays substantially higher than most in the area. From talking with the owner, I'd say it's definitely part of his business model to keep the staff financially secure. He pays well, offers good benefits, and isn't stingy with overtime and bonuses.

    Our politics differ pretty significantly; he's a very vocal fiscal republican. But I have to admit that the argument for his economic view is proven by the ease of our day to day operations. If more employers were able to rationalize higher hourly pay with happier employees and a healthier business, I think the republicans would have less of an issue with labor.

    The majority of staffing problems and turnover, that I've seen, result from a marginally unhappy employee (due to workplace drama, stress, etc.) coupled with financial stress. By removing as much of the financial stress from the equation as possible, the workplace issues rarely escalate to a level that someone quits. We have crap days, and there's plenty of grumbling, but it never becomes the kind of poisonous atmosphere that I've seen at other clinics.

    So that's my suggestion. Suck it up and pay your employees a competitive wage. It's an expense that factors into the bottom line, but the financial gains you'll get from happy employees who are invested in your business and maintaining your client base will more than make up for it.
    Last edited: Feb 21, 2012
  25. nordicat

    nordicat Mizzou c/o 2016 Gold Donor

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    :thumbup:
    Would love to C & P this to my boss-man...
  26. Reader19

    Reader19 CSU c/o 2016

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    Speak the truth! :p
  27. libster06

    libster06 Crank a wank!

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    I think that is pretty much EVERYONE except for the person above....
  28. Dsmoody23

    Dsmoody23

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    I'm right around that pay grade too, uncertified. Our CVT's make several bucks more.

    And given that wage, relative to what's normal around here (~8.00-9.00$/hr for uncertified techs,) I'd definitely have to make a pretty big lifestyle change to switch jobs. And I'm very conscious of making sure I do my work in a way that reflects to my employer that I appreciate the way they do business.
  29. August West

    August West solar powered

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    Just over half of all veterinarians actively track business metrics of their practices, according to the AVMA. This must change. At the end of the day, it is a business. There is no way around that fact.
  30. libster06

    libster06 Crank a wank!

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    That was a point I made above, that veterinarians who want to keep their staff aren't trying to screw them, but as I also said, the vets may want to pay competitive wages, but they just may not be able to pay something like $14, depending on how much money they're bringing in.
  31. August West

    August West solar powered

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    Sorry, what is E & D? And do the receptionists really get commissions for getting a client to use a particular cremation service upon the passing of their pet? I find this a bit disturbing. Besides, how much could they stand to make on such a commission? A few bucks?

    The veterinarian is the only one that can prescribe and decide when treatment with vaccinations and other medications are advised. I still don't see why there is any need for the "hard selling" of such services nor why a tech would be further compensated for passing along the doctor's diagnosis and treatment plan to the client. Are techs really being commissioned for persuading pet owners to buy Frontline or Advantage when a patient comes in with fleas? Seems a bit silly, in my opinion.
  32. August West

    August West solar powered

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    Well said. :thumbup::thumbup::thumbup::thumbup::thumbup:
  33. libster06

    libster06 Crank a wank!

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    I don't know that she said they are "compensated", she said they "push" them. As in, the receptionist have the responsibility of X, techs are responsible for Y, and doctors Z. I don't think she was saying techs are paid extra to "sell" heartworm prevention, but rather as a tech, part of their job there is to educate clients on HW and flea prevention, and try to get clients on board with it (which ultimately requires them buying the HW and flea prevention). Not to mention, it's not like trying to sell clients flea and HW prevention is a gimmick, or an unnecessary product.... they need to be educated and sold those things.
  34. August West

    August West solar powered

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    Can you expound on what the republican way to run a veterinary clinic involves. I am intrigued. :eyebrow:
  35. libster06

    libster06 Crank a wank!

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    Hi. Welcome to Banfield.

    :bang:
  36. August West

    August West solar powered

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    I understand what you are saying. However, my previous comments were specifically directed to this concept of techs receiving a commission for selling services or products to clients. I am still a bit unclear on how this would work. Merely suggesting certain products is a far cry from getting paid to solicit their use to clients.
  37. August West

    August West solar powered

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    :laugh:

    No thanks, if that is the case. And yet the company seems to be doing quite well. :rolleyes:
  38. libster06

    libster06 Crank a wank!

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    Meh, I don't know. At every clinic I've ever worked at, techs have never been given extra compensation for something every tech should be doing anyways, so I'm not sure. I truthfully didn't know that was possible, or that that ever happened.
  39. libster06

    libster06 Crank a wank!

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    That was a huge issue for me working there.. the "selling" stuff aspect. I'm with you on the point that I don't understand selling stuff to people, and I felt VERY uncomfortable "selling" plans and treatment to customers and also virtually letting them pick and choose which specific parts of the treatment plan they wanted to do for their pet, as if they themselves were the veterinarian. I always felt like I needed to disclaimer myself to them before starting in with my schpills that I really didn't want to be selling them stuff but I was forced to :/ I'm not a salesman I'm a tech. I don't like to be hounded by salesman and I sure don't like to hound... thus why I will never work in retail again!
  40. DVMDream

    DVMDream Gone, Adios! Gold Donor

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    I have seen at a couple clinics that if you "upsell" something to a client, this simply means if you get them to do something they had not originally come in for such as updating pets vaccines or getting them to do hw test/prevention then they give you something for doing that like a $1 for each client you get to do that something else. I see pros and cons to this, but I don't really like it. It seems like you are trying to pressure clients into something instead of honestly educating them and letting them make their own decision.
  41. Dsmoody23

    Dsmoody23

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    I'm sure you've witnessed situations where a treatment plan is accepted or deferred by a client based on the manner in which the doctor presents it. It's not as much sales as it is client communication.

    As techs, we 'sell' preventatives because they're in the best interest of the patient, and the revenue they generate keeps the practice rolling. We also 'push' core and optional vaccines. There's nothing insidious about adding a little casual pressure to ensure a client makes a positive decision about care. Commissions help keep that basic level of preventive care emphasized for support staff, who are often the point person in regards to client communication.

    Equally, making a 0.25 cent commission on a box of frontline may seem inconsequential, but an employee who 'sells' 4 per hour has effectively given him/herself a dollar raise. It adds up.

    Sure, in a perfect world, every client would walk in educated and financially prepared to care for their pet, but in many cases they need a bit of a push to help them get there, and it doesn't matter if it's the doc or the tech giving it to them.
  42. August West

    August West solar powered

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    Appreciate the insights. Veterinary medicine is a very peculiar industry in some regards. The conception I hear from most on here and elsewhere is that we are a profession funded by discretionary income. Yet, that would make us the only profession that I can think of based on discretionary spending that does not feel the need to advertise, market and promote their services to the public. As if we expect clients to just file through the door with their pets out of necessity. A bit of a philosophical contradiction in my mind. Are we just around the corner from seeing a daily Groupon deal offering 50% off 3 examinations at the local animal clinic? I think we as a profession need to contemplate and consider which direction we want to head in when looking to the future. Do we focus on creating more marketable business value to access additional discretionary dollars from the pockets of pet owners? Or spend our time trying to better communicate that preventative veterinary care is a necessity and not to be seen as discretionary spending for those that accept the responsibility of caring for a pet? A little of both? Interesting topic, in my opinion.
  43. August West

    August West solar powered

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    Yeah, I don't think the potential environment this could create in my clinic would be worth any added value or revenue. :thumbdown:
  44. Dsmoody23

    Dsmoody23

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    "Hands off' in terms of wage controls, health care, benefits etc.

    In most jobs, 'hands off' means you'll be making the lowest possible wage, with no functional job security and minimal benefits.

    In this situation, based on his politics, he pays above the industry standard for good work and validates the employee as more than a transitional commodity that can be replaced at any time. The benefits aren't mandated; they're provided because they increase the health of the business through improved morale.
  45. August West

    August West solar powered

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    Doctor should recommend all treatment plans, including preventatives like heartworm and flea medications. Techs should pass along and communicate these decisions to the client. That is their job. I would not run my practice in the manner you described. Just not the environment I would want to foster. At the same time, I would do my best to make sure my employees are compensated adequately for the work they do. Just my preference I guess.
  46. August West

    August West solar powered

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    This sounds like the Republican business approach.

    This does not. :D
  47. Dsmoody23

    Dsmoody23

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    I don't see that working out in the best interest of anyone involved, as well as being pretty reductive to the role nursing plays in the industry.

    Client X comes in for a visit. The doctor recommends 5 different treatments, in increasing degrees of cost and complexity with absolutely no additional input from the staff. What happens?

    9 times out of 10, in my experience, the client chooses the cheapest possible option unless the doctor or nurse emphasizes the benefit of something more expensive. If you have had a different experience, I'd be curious to hear about it.

    Without the staff demonstrating preference for preventatives, vaccines or treatments, I think the client will end up with a less healthy pet. Additionally, the business will be less successful. It's lose-lose.
  48. Dsmoody23

    Dsmoody23

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    That's my point.

    The whole 'rising tide lifts all boats' angle the republicans have been working for the last 30 years only works if the employer is willing to share in success. Which most of them are not.

    Hence the unique nature of my employer.
  49. August West

    August West solar powered

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    I have never experienced such a policy. I agree that veterinary technicians perform many of the same duties for a veterinarian that a nurse would for a physician. And I have never had a nurse try to sell me on any treatment when I see my doctor. Nor have I ever seen a job description of a veterinary technician that included expressing a preference for one treatment or medication to any other. This is more in tune with my understanding of the tech's role:

    'Veterinary technologists and technicians typically conduct clinical work in a private practice under the supervision of a licensed veterinarian. Veterinary technologists and technicians often perform various medical tests and treat medical conditions and diseases in animals. For example, they may perform laboratory tests such as urinalysis and blood counts, assist with dental care, prepare tissue samples, take blood samples, and assist veterinarians in a variety of other diagnostic tests. While most of these duties are performed in a laboratory setting, many are not. For example, some veterinary technicians record patients' case histories, expose and develop x rays and radiographs, and provide specialized nursing care. In addition, experienced veterinary technicians may discuss a pet's condition with its owners and train new clinic personnel. Veterinary technologists and technicians assisting small-animal practitioners usually care for small pets, such as cats and dogs, but can perform a variety of duties with mice, rats, sheep, pigs, cattle, monkeys, birds, fish, and frogs. Very few veterinary technologists work in mixed animal practices where they care for both small pets and large, nondomestic animals.'

    http://www.bls.gov/oco/ocos183.htm
  50. August West

    August West solar powered

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    This is too squishy for me. Maybe we should just leave political affiliations out of the equation. :shrug:

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