寵物養(yǎng)護(hù)與美容第四章寵物美容

寵物養(yǎng)護(hù)與美容第四章寵物美容VeterinaryTeachingHospitalMissionsTheuniquechallengeoftheVeterinaryTeachingHospitalisto:Remainfinanciallyviablewhileenablingteachingandresearch,allthewhileprovidingveterinarymedicalservicestothepublic. JimLloyd第二頁，共51頁。2HistoryInternshipsbeganin1950-60’s,residenciesin1960-70’s.Boardcertificationbecamethenormforentrylevelclinicalfacultypositionsinthe1970-80’sClinicalDepartmentsbegantodivideresponsibilitiesintoacademic&hospital,andHospitalDirectorsbegantobehiredinthe1980-90’sVeterinaryCollegesbecamemoredependentonhospitalincomein1990-2000’s.第三頁，共51頁。3DiscussionForumsonVTHIssuesAAVMCmeeting–March,2004AAVMCForumatAVMAmeeting–July,2004AAVC/AAVMC/NAVCAmeeting-

March12,2005AAVCMeeting–Atlanta,April2005AAVCForumatACVIMAnnualMeeting–June1,2005AAVMCMeeting–March11,2006第四頁，共51頁。4ProblemsIdentifiedDifficultyinfacultystaffingofVTHsduetoattractionofprivatepracticeFundingofVTHs–revenueandgiftswereprobablythebestfuturesourceoffundingsinceanincreaseincentralcorefundingwasnotlikely,Decreasingofstatesubsidies,andanincreaseinthecompetitionforcasesandfaculty第五頁，共51頁。5Toomuchred-tapeinuniversityformanyspecialistsResearch,teaching,andservice–hardtobegoodatallthree,canbeindirectconflictwitheachother.Somethinkthereisa4thmission–toteachbusinessaspectofveterinarymedicine Increasedrelianceontuitionandfees,stagnantVTHrevenuesinsomeareas第六頁，共51頁。6Staterevenueasa%oftotalrevenueforvetschoolsdecreasedfrom55%to33%Average#ofstate-fundedfacultypositionshasbeenstatic,someincreaseinnon-statefundedpositions,atsametimeasincreasein#ofstudentsDecreasingtostaticapplicantpoolforvetstudents,suboptimaldistributionofcaseload(needmoreprimarycasesforteaching,toomanytertiarycases)第七頁，共51頁。7Perceptionoffaculty–stretchedtolimitwithmultipleballsintheair.WherewillnextgenerationofclinicalprofessorscomefromArewegraduatinganentry-levelveterinarianDooff-shorestudentsdilutelearningexperienceforothers第八頁，共51頁。8DoallthestudentsgetenoughhandsonexperienceInprivatepractice,avetearning$65,000shouldproduce$300,000inrevenue,buttheVTHisnotatypicalpracticePracticeownerswantfromgraduates:knowledge,communicationskills,peopleskills,businessskills,howtomanageworkload第九頁，共51頁。9SpecialistsarefindingthatVTHshavealackofmoney,lackofequipment,lackofnewspace,lackofcontroloverworkday,toomanygoals,longdaysandweekends,notefficient,poorlocation,andthattheycandoteachinginotherplacesPresentfacultycanbepoorrolemodelsforinternsandresidents–showunhappinessandfrustration.Adequatecaseloadisnotalwaysthereinacademiaforteachingandresearchneeds第十頁，共51頁。10TheNeedtoChangeSVMsandVTHsmustbewillingtochangetoaccommodatetheaboveissues,prioritizemissionsofclinicalprogram.Univ.ofMinnesota–Triedsomenewideas:clinicalspecialistmodelandincentiveplan;replacedstudentlaborwithtechsResults–increasedcaseload,increasedrevenue,tenuretrackfacultycouldfocusmoreonresearch,andteachingimproved第十一頁，共51頁。11PotentialSolutionsforVTHIssuesBalancingthemission–teaching,research,service,andhospitalasabusinessBalancethemissionasdept.noteachpersonHaveenoughsupportstaffPerhapsteachsomeofDVMcurriculumbynon-specialistsMoneygenerationshouldnotbeprimereasonforVTH2servicesrunningsimultaneously,oneforserviceandoneforteaching第十二頁，共51頁。12Recruitment/retentionofClinicalFacultyLookfordonorsfornewequipment/facilitiesandtoaugmentfacultysalariesLooktosharespecialistswithprivatespecialtypracticesNeedtoofferpart-timeorfull-timeclinicaltrackpositionstospecialists,butmustnotbea2ndclassposition–needlongertermcontracts,sabbaticals,votingprivileges第十三頁，共51頁。13WorkwithUniversitytogetmorecompetitivesalariesforspecialists,signingbonusesDevelopIncentivePlan–partofrevenuebacktofacultyorsectionofhospitalfortheiruseDevelopsatellitepracticesoastoaugmentmoneygeneratedandimprovesecondarytypecasesOfferconsultingtimetofaculty第十四頁，共51頁。14ImprovecultureinVTH/SVMsoarereasonstoattractorretainfaculty,marketacademiclifestyleinternallysofacultyunderstandandsellthebenefitsAugmentaresident’ssalaryifthatpersonwillcommitforcertainnumberofyearsasafacultymemberSelectresidentsthatwanttostayinacademia第十五頁，共51頁。15MaintainingandEnhancingCaseloadDevelopgoodrelationshipswithRDVMs,establishaPractitionersAdvisoryBoardHireaReferralCoordinatortodealwithRDVMissuesHireaMarketingManagerforVTH-tomarkettoRDVMsandpublic第十六頁，共51頁。16ClientandRDVMsurveys-topointoutareaswhereimprovementisneeded,likecommunicationMakecliniciansandstaffrealizetheyarecompetingagainstprivatespecialtypracticesforcaseload,mustgivebetterserviceBringinoutsideconsultanttohelpmakeVTHmoreefficientNewfacultyneedtointroducethemselvesorbeintroducedtoRDVMpopulation,alsogiveCEseminars第十七頁，共51頁。17EnhancingOperationsofVTHWorkonalleviatingbottlenecksinVTHHireDevelopmentOfficerwhoisassigneddirectlytoVTHHavetreatmentsofhospitalizedcasescarriedoutbytechnicians,notstudents–mightimproveefficiencyandletstudentslearnmore第十八頁，共51頁。18VTHsneedtohireaHospitalAdministrator/Director–MBA,MHA,orsimilartraining.IfnotaDVM,mustreporttoaDVM(AVMAaccreditationrules)VTHsneedstohaveastrategicplan,establishbenchmarks,havegoodfinancialreportingsystem.ClinicalTrackfaculty–goodmovetohirethembutwhoshouldpayforthemVTH,Clinicaldepts.第十九頁，共51頁。19Suggestionistotakechargingawayfromclinicians,puttechniciansinchargeofbilling,butgetfacultyinvolvedinbudgetprocesstoincreaseunderstandingofwhererevenuedollarsaregoingto.Orspendlesstimeonstudentroundsandstartadmittingcasessoonerintheday(earlierthan9:30or 10:00am.)CommunityPracticeService–goodwaytogetprimarycarecases第二十頁，共51頁。20PartnerwithprivatespecialtypracticestohirespecialistsShouldresidentsbetrainedatprivatespecialtypracticesOrshoulditbeajointendeavorwithuniversitiesSpecialtycollegeshavetobecarefulthattoomanyrestrictionsfortrainingresidentsarenotplacedonspecialists/colleges第二十一頁，共51頁。21NextStepsHelpfacultyunderstandtheproblemsandembraceabusinessplan,createaVTHTaskforce(AAVMC,AAVC,NAVCA)in2004thatwillworktopreparea“whitepaper”addressingconcernsforfutureofVTHs–useforlocalsupport,consultantbackgrounding,andaccreditationstandardsDevelopbenchmarksthatallVTH’scancompleteannuallyandusetodetermineefficiencyoftheirmodel–createdBenchmarkingTaskforceforthis–AAVMC,AAVC,NAVCA.第二十二頁，共51頁。22BenchmarkingTaskForcemeeting–Aug.24,2005TaskforcemetinSchaumburgwithHowardRubin,developerofNCVEIbenchmarksforprivatepractices.ThisgroupstartedworkingwithhimtodevelopsomethingsimilarforVTHsthatwouldbemorehelpfulthanAAVMCannualinfothatiscollected.Utilizebenchmarkingforinternalandexternalcomparisons.第二十三頁，共51頁。23VTHTaskForcemeeting–Oct.24,2005TaskforcemetinColumbus,OhiotodiscusswhattodonextAskedDr.Hubbelltocreatea1page“whitepaper”thatoutlinedtheproblemsVTHsarefacingGroupdiscussedtheorganizingofaconferencetodiscusstheFutureoftheVTH’s第二十四頁，共51頁。24Dr.Hubbell’sWhitePaper–PresentandFutureProblemsforVTHsThevastmajorityoftheadvancesinveterinarymedicalcaretodatehaveoccurredbecauseoftheexistenceofVeterinaryTeachingHospitals.TheconvenienceandhighqualityofprivatespecialtypracticesimpactsthecaseloadsoftheVTHsandhasthepotentialtocompromisetheeducationofveterinarystudentsandpostgraduateveterinariansandthegenerationofknowledgethroughclinicalinvestigation.第二十五頁，共51頁。25Dr.Hubbell’sWhitePaperTheresolutionofthiscrisiswillrequirebroadparticipationandcooperation.Newalliancesmustbeformedtofosterclinicaleducationandinvestigationattheprofessionalandpost-professionallevels.Theprofessionmustbeengagedbecausethesolutionwillinvolveuniversities,specialtycollegesandpractices,privatepractitioners,veterinarystudents,andorganizedveterinarymedicine.第二十六頁，共51頁。26FutureofVTHs–Conference,Nov.10-11,2006,KansasCityInvitedpeoplefromallwalksoflife–DVMsfromprivatepractice,specialistsfromprivatepractice,specialistsfromacademia,representativesfromspecialtycolleges,NAVCA,AAVC,andAAVMCreps,repsfromveterinaryorganizationslikeAAHA,AVMA,etc.WethoughtitwastimetohaveothersdiscussproblemstheVTHsarefacingandheartheirideasonpossiblesolutionsbesidesjusttheacademicians.第二十七頁，共51頁。27FutureofVTHs–Conference,Nov.10-11,2006,KansasCityMs.SusanBakerspokeonmanagingtheexpectationsoftheclientEveryonethatmeetsaclientshouldintroducethemselvesincludingreceptionistswithfullnameandtitle,shouldalsoaddressclientandpetbyname1stimpressiontoclientsveryimportantClientswanttoberespected第二十八頁，共51頁。28FutureofVTHs–Conference,Nov.10-11,2006,KansasCityDr.MaryAnnVandeLinde–VeterinaryManagementConsultingspokeon“ClientExpectationsforVeterinaryCare”Topreasonwhyaclientleavesavethospital–indifferenceorpoorattitudeofstafforDVMsMinimalwaitingtimeConsistentmessagefromoneareatoanotherWanttobetreatedwithrespect,clarity,andconsistency第二十九頁，共51頁。29FutureofVTHs–Conference,Nov.10-11,2006,KansasCityWanttobecommunicatedwithontermstheycanunderstandWanttheexamstobethoroughbyaDVMandnotrushedAllinteractionwithclientmustbeimproved–fromreceptiondesktostudenttostaffandfaculty第三十頁，共51頁。30FutureofVTHs–Conference,Nov.10-11,2006,KansasCityDr.ColinBurrows,SADept.headatUniv.ofFloridaspokeon“MeetingtheExpectationsofReferringVets”WhyRDVMsrefer–uncomfortablewithcase,lackskillsorequipment,lackoftime,liability,goodexperiencewithreferralhospital,knowspecialist,cannothandlediagnosisoremergency第三十一頁，共51頁。31FutureofVTHs–Conference,Nov.10-11,2006,KansasCityWhyDVMsdon’trefer–Geography(toofar),cost,thinktheycandoitall,previousbadexperiencewithreferralhospital,poorfeedbackfromclients,don’tpersonallyknowspecialist第三十二頁，共51頁。32FutureofVTHs–Conference,Nov.10-11,2006,KansasCityWhatRDVMsexpect–knowledgeofservicesbeingoffered,goodquickresponseto1stphonecall,efficientcommunicationfromstaff,protectrelationshipbetweenclientandRDVM,timelycommunicationduringandafteranimalisreferred,donottreatotherdisordersthanwhatanimalhasbeenreferredinfor,follow-upwithRDVMwhenanimaldiesoriseuthanized.第三十三頁，共51頁。33FutureofVTHs–Conference,Nov.10-11,2006,KansasCityRDVMsareourmostimportantclientsandweallneedtorealizethat.Needtoperhapsdomoremarketingtoincreaseourreferralbase.Floridahasdone:RDVMAppreciationDayHospitalNewsletterPracticevisitstolocalpracticesLocalassociationvisits第三十四頁，共51頁。34FutureofVTHs–Conference,Nov.10-11,2006,KansasCityClientandRDVMsurveyHospitalAdvisoryboardWebSiteforRDVMsHospitalToursforClientsandRDVMsPressreleasesReferralfaxcovers–newsornewclinicalstudiesaddedtofaxcoverClientsadvocates-volunteers第三十五頁，共51頁。35FutureofVTHs–Conference,Nov.10-11,2006,KansasCityEducatecliniciansonbusinessissuesRemindcliniciansofreferralprotocolandifdonothaveone,createone(howandwhentocommunicatewithRDVMs,whatisexpected)ClinicianincentiveplanTakecliniciansoutofthechargingbusinessTollfreenumber第三十六頁，共51頁。36FutureofVTHs–Conference,Nov.10-11,2006,KansasCityDr.JohnAlbersfromAAHAspokeon“FutureofSpecialtyPractice”1996–18%ofnewvetgraduatesweredoingadvancedstudies(internships/residencies)2006–increasedto33%withmostofthosewantingtopursueboardcertificationWhyspecialtypracticeswillcontinuetogrowInsurveydone,74%ofclientswouldpay>$500totreataseriousdiseaseintheirpet52%wouldpay>$1000,15%wouldpay>$5000第三十七頁，共51頁。37FutureofVTHs–Conference,Nov.10-11,2006,KansasCity61%ofthosepetownersthatthoughtoftheirpetasamemberofthefamilywouldgotoaspecialistiftheirvetrecommendedit.RecentgraduateshaveahigherpropensitytoreferthanvetsthathavebeenoutforawhileLenderswilllendmoneytostartaspecialtypracticeatagoodrateManufacturersofexpensiveequipmentofferthesepracticesgoodrates第三十八頁，共51頁。38FutureofVTHs–Conference,Nov.10-11,2006,KansasCityDr.DavidLee,HospitalDirectoratMinnesotaspokeonthe“VTHasaProfitCenter”anddiscussedtheuseofaprofessionalcallcenter,theuseofareferralcoordinator,dischargeinstructionsfaxedimmediatelytoRDVM,havingaCasemanager/section,hiringaHospitalist(aDVMthatwouldhelptomovecasesthroughthehospital)第三十九頁，共51頁。39FutureofVTHs–Conference,Nov.10-11,2006,KansasCityDr.CharlesMacAllisterfromOklahomaState,spokeonCooperativeArrangementsforTrainingSpecialists82%oftheresidencyprogramsareinuniversitiesasof2006Needtorecruitresidentsinterestedinacademiaasacareer.Plentyofapplicantsforpositionsinallspecialtiesexceptforanesthesia.第四十頁，共51頁。40FutureofVTHs–Conference,Nov.10-11,2006,KansasCityOklahoma–growingownfacultybypayingotherinstitutionstotakethemonasanextraresident(payfortheirsalaryandbenefitstotheinstitutiontrainingthem).MustcompleteaMSdegreeandworkforatleast3yearsatOklahomavetschoolafterfinishresidency.Costof$140,000/residenttohomeinstitutionforaresidenttobetrainedelsewhere第四十一頁，共51頁。41FutureofVTHs–Conference,Nov.10-11,2006,KansasCityDr.RubenMeredith,anophthalmologistinahugemulti-locationprivatespecialtypracticespokeon“OphthalmologistinPrivatePractice.”6locationspresentlywherehavepracticesandresidents,have12activeresidentsonboardrightnowandtendtokeepmostofthemonascliniciansaftertheyfinish(self-trainthem)AllschoolsshoulddoaSWOPTanalysisonceayear.第四十二頁，共51頁。42FutureofVTHs–Conference,Nov.10-11,2006,KansasCitySWOPTanalysis–strengths,weaknesses,opportunities,andproblemsandthreats.PrivateSpecialtypractice(PSP)Strengths–residencytraining,largecaseload,commitmenttoresearch,board-certifiedstaffMultiplecentersenvisioned.Weakness–internalcommunication,stafftraining,inventorycontrol,employeeaccountable,communicationwithclientsandRDVMs,lackofuniformoperatingsystem,lackoftrainedtechs,inefficientfacilities.第四十三頁，共51頁。43FutureofVTHs–Conference,Nov.10-11,2006,KansasCityVTHsStrengths-Vetstudents,faculty,benchresearchfacilities,universityresources,fundingforresearchWeaknesses-abilitytopaycompetitivesalaries($200,000forophthalmologist),budgetarycontrol,universityrestrictions,etc.第四十四頁，共51頁。44FutureofVTHs–Conference,Nov.10-11,2006,KansasCityPrivateSpecialtyPractice’s(PSP)strengthsareourweaknesses–location,salaries,flexibility,budgetPSP’sweaknessesareourstrengths–researchpossibilities,futureclinicians(students,internsandresidents)VTHsandPSPsmustworktogetherandcooperate,formdirectpartnershipswithPSPs第四十五頁，共51頁。45FutureofVTHs–Conference,Nov.10-11,2006,KansasCityDr.RichardValachovicfromtheAmericanDentalEducationAssociationspokeonthesimilaritiesbetweenwhatthedentalprofessionandtheveterinaryprofessionarefacingThereare56dentalschoolsintheU.S.andthereare400openfacultypositions,themeanageofthefacultyis52yrs,faculty<30yrsoldmakeuponly3%ofthetotalfaculty,averageof5vacantpositionsperdentalschool,and10newschoolsinthepipeline.第四十六頁，共51頁。46FutureofVTHs–Conference,Nov.10-11,2006,KansasCitySalarydiscrepancyisthebiggestreasonforopenpositions