It’s complicated…

During our time in Botswana we have sterilized 413 dogs and cats, vaccinated 441 animals, preformed 3 limb amputations, several minor surgeries and one blood transfusion over a period of 25 working days. While these numbers look good on paper, and  of course it feels good to do something rather than nothing (For the love of dog), it still feels like a drop in the ocean, so overwhelming is the need. Despite this, I suspect some of you might also be asking yourself the obvious question:  “why travel abroad to provide free veterinary care when there are plenty of animals in need in your own , backyard?” My response?  It’s complicated.

Although many of you know me as a veterinary practice owner and hospital manager, I was not always “the boss” and during my years in the profession I have had the opportunity to work as both an associate veterinarian (employed vet) and a locum veterinarian (relief vet). I have experienced different management styles and a variety of working conditions, from a militant, fear based approach to controlling employees, to the extreme hands off approach where the “monkeys run the circus”. I have worked with vets who will never say no and whose sense of self worth is dangerously linked to the need to be loved by every client. I have watched teams suffer low pay and burnout because the practice owner gave away services leaving them unable to compensate the team fairly and invest in the practice infrastructure. And as a young veterinarian, I have considered leaving the profession due to abuse and a lack of mentorship and support.

We purchased our own practice partially out of need (a baby was arriving in a month and we needed an income) but also out of a desire to provide a stable and positive workplace for our staff.  The reality is, a veterinary practice is a small business. It needs to be profitable, your team deserves competitive salaries, benefits, to feel valued and be treated with respect. This does not happen on its own.  It takes effort and has an associated cost.  Profitability in a veterinary practice allows a practice owner to take care of their team as well as maintain software, invest in new equipment and improve the quality of care your pet receives. Unfortunately, some in our profession and the public at large, think the word “profit” somehow makes us a less noble profession. “Don’t you do it for the love of the animals? Shame on you that you want to make a good living too!” What they fail to see is the link between the profitability of a veterinary practice and the level of job satisfaction and happiness of the employees working in that practice.

Over the years we have often discussed the 80:20 rule with our team, the law of the vital few or as it is properly termed, the Pareto principle. Named after an Italian economist, Vilfredo Pareto, who who observed that 80% of income in Italy was received by 20% of the Italian population, this principle can be applied in a wide range of situations from management practices to lifestyle choices. At its core, the Pareto principles states that most of the results in any situation are determined by a small number of causes. 80% of the result come from 20% of the causes. Or, for example, 80% of your profits come from 20% of your clients or at home you spend 80% of your time in just 20% of the your rooms or despite having 35 apps on your smart phone, you use 20% of them, 80% of the time.   I love this principle and it’s wide reaching applications but for the point of this article, lets focus on the Pareto principle’s as it applies to client complaints in veterinary practice. Although it may not feel like it some days, the truth is, a small number of your clients are unhappy, complain and make your life as a vet unrewarding and stressful.  The majority of clients are great to deal with, appreciative and are the reason we love our jobs as veterinarians.  As long as you recognize the 80:20 rule, it’s all good.  The problem develops when you start to believe the comments from the 20% and base your management decisions on the complaints of this vocal minority.  For some, your fees will never be low enough, your clinic never clean enough, your hours never accommodating enough and your caring and compassion never altruistic enough.

I have been told “you don’t care, you’re only in it for the money” more times than I care to recall and while I understand the emotions behind this response, it is the most unoriginal way to berate your vet.  Trust me, if we were just in it for the money, we would not be veterinarians.  So the question still remains, how do you manage a successful and profitable practice while still giving back to the community?  How do you choose which clients deserve a discount or charity and which do not? Just because a veterinary practice is profitable, does not mean they do not give back to their clients and community. Often the discounts, free exams, free treatments and rehoming of pets and donations to local charities is not advertised and goes unnoticed by the public.  In fact, profitable practices are often able to give far more.

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Veterinarians often believe they need to be all things to all pet owners.  Inconsistency and trying to please everyone is a dangerous path, especially when you recall that 20% of people will be unhappy with your service regardless of your best efforts.  Human nature is interesting and I have worked in practices where fees were waived for clients who could not afford veterinary care and this “free care” now becomes the expectation on future visits. The challenge is to find a way to help meet the patients needs, within the owner’s budget rather than just giving a handout.  For the health of our profession, we need to educate people that pet ownership is not your right, but a privilege. A privilege that comes with a cost. Handouts can quickly become a future expectation and I have more than once, witnessed a client once grateful for a discounted or free service quickly turn nasty once the handout was discontinued.  Allowing this situation to develop in your veterinary hospital affects the culture of your practice and things can quickly spiral out of your control, resulting in a team suffering from burnout and compassion fatigue fuelled by negativity, demanding clients and a lack of profits.

The idea of giving a hand up instead of a hand out can also be applied to volunteering with a project abroad. I have spent time pondering this question: by providing free veterinary care in a developing country are we actually helping or are we devaluing the service of local veterinarians and the sustainability of the project? Are we teaching the local people that we will take care of them for free and in doing so, taking work away from a local veterinarian?  It is a question I struggle with but the reality is, in many of the countries we visit, the veterinary education and training is vastly different than a veterinary education in countries like North America, the UK, Europe, Australia and New Zealand. Veterinarians in many countries are either not qualified or not interested in spay and neuter programs and the yet in these areas the need for these programs is great.

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Outreach clinic in Shakawe Botswana for MAWS

For many the world is black and white and the answers to these questions are obvious.  How simple things would be if this were true for myself. Instead, I see the world in shifting shades of grey and I find the answers are often elusive. All I can do is try to leave my judgement at home, ask questions and hopefully find my own answers in the many shades of grey.