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Veterinarian Technician October 2007 (Vol 28, No 10) Focus: Practice Management

Management Matters: Specialty Practice Management and Its Role in the Triangle of Pet Care

by Katherine Dobbs, RVT, CVPM, PHR

    Author's Note

    During my years in general practice, the veterinarians referred clients to the specialty hospital when their pet needed specialized care. The specialty hospital was a mysterious place, with more advanced equipment and procedures. Then, when I began working at a referral practice, I realized how all the different aspects of patient care fit together. The best pet health care can be described as a triangle — the three sides being the pet owner, the general practitioner, and the specialist, if and when needed. Each side has a unique role. The owner provides unconditional love and companionship to his or her pet and seeks preventive or attentive health care as needed. The general practitioner provides overall care throughout the pet's life, including vaccinations and nutritional and dental care and preventive medication to protect the pet from such dangers as heartworms and parasites. The specialist provides additional care, which cannot be provided by the general practitioner, during an illness or tragedy. This triangle is key to providing the best care for the pet.

    A pet benefits from each side of the triangle of care — the owner, the general practitioner, and the specialist — because each side is responsible for a certain aspect of the pet's care. Owners tend to take their pet to a clinic where they trust the staff and feel that their pet is receiving the best care possible. Therefore, while providing routine and preventive care for the pet, the general practitioner usually forges a one-on-one relationship with the owner that strengthens over the years. When patients are referred to a specialty practice, a new aspect of care is introduced. The specialty practice becomes the third party in a relationship that has already been established. Therefore, specialty practices are in a precarious position because instead of a one-on-one relationship with the owner, they have two client bases — the pet owners and the referring veterinary practice. This role can be challenging because specialty managers must act in the best interest of both parties.

    Marketing a Specialty Practice

    The referring veterinary practice should be familiar with local specialists and able to educate clients about choosing specialty care for their pets if needed. When a pet requires specialized care, clients often ask their veterinarian to recommend a specialist rather than find a specialist on their own. For that reason, most marketing efforts in a specialty practice are aimed toward the referring practice. The specialty practice can use the following methods to market its services to general practices:

    • Announcements: Mail or email announcements to introduce specialists to the practice, to explain new services, or to discuss en­hance­ments to client service or communication protocols.
    • Educational materials: Send educational materials, such as updates on medical issues (i.e., canine influenza, rabies outbreak, new medications for a common condition), to the general practice to help build a relationship between the two practices.
    • Open house: Invite general practitioners and their staff to an open house so that they can tour the facility, learn more about the available specialty services, and observe the hospitality that the specialty practice extends to its clients.
    • Staff training: Offer staff training to members of the general practice staff. For example, a technician can shadow a specialty practice technician or learn specific techniques that he or she can take back to the practice. The technician then can use these skills to assume a greater role in the follow-up of the mutual patient. Receptionists can learn additional front office skills or how to better prepare clients and patients for a visit to the specialty practice.
    • Personal visits: Have specialty practice personnel visit referring practices to inquire about the practices' satisfaction with the specialty services. Visiting the referring practices provides the specialty practice with an opportunity to find out whether the general practice has received comments from mutual clients or has suggestions to help improve communication between the practices.

    Welcoming New Clients

    Before a new client walks through the door, the specialty practice should obtain a referral from the general practitioner. This referral is typically called in by the general practice ahead of time, but occasionally even a specialty practice will have "walk-in" clients. "Walk-in" clients may have noticed the hospital when passing by or may have previously brought a sick pet to the facility. Sometimes, the specialty practice may be the first one that comes to mind when clients need to get immediate care for their pet during an emergency. In those cases, the specialty practice should initiate a call to the general practitioner to explain the situation and discuss a referral. If a client calls before the referral is received from the general practice, the specialty practice can redirect the client to his or her general practitioner to facilitate the referral, or the specialty practice can call the referring practice to ensure a referral is intended.

    Certain steps can be taken by the specialty practice staff to allow an easy transition for the client, the patient, and both practices:

    • Provide client brochures: Create an informational brochure for the referring practice to give to clients whose pets need specialized care. The brochure should include a list of specialists and a short biography that highlights their area of expertise or interest; contact information, including Web site address and directions to the practice; and general information regarding the referral and consultation so that the client is adequately prepared for the first visit.
    • Document the referral: Establish a centralized way to record referral phone calls or faxes so that the client does not have to be asked if he or she has a referral. The client is often unaware of whether the referring veterinarian has made the telephone call. Referrals can be recorded in a variety of ways. A hard copy form can be filled out during the call and filed alphabetically for easy access, or the referral can be documented on an electronic form on the computer and placed in a network folder that is easily accessible during the phone call. The receptionist should look up the client's name at the beginning of the call to determine how to proceed. Sometimes referrals are made for clients who fail to keep the appointment. These referrals should be kept for a designated period, generally 1 to 2 months.
    • Obtain the patient's history: Ensure that the most important information — the patient's history — is obtained from the referring practice. This information can be faxed or the client can be instructed to bring the information to the first visit. If possible, however, obtain the patient's history before the first visit, and call the referring practice if the information is not received by the day before the appointment. Establish a good recordkeeping protocol so that the patient's history is not misplaced.

    Dealing with Client Complaints

    Specialty practice managers often deal with complaints about care or services from pet owners and complaints from the referring practitioners. Sometimes these complaints involve the same patient. Often, when pet owners are dissatisfied with the specialty practice, they may be uncomfortable expressing their concerns directly to the specialty practice manager; instead, they express their concerns to the general practitioner. Therefore, the general practitioner serves as a voice for the client and becomes the party making the initial complaint. Sometimes, however, clients tell the specialty practice that they are unhappy with the care or services that their pet received. In this case, the specialty practice does not know if the referring veterinarian is aware of the client's dissatisfaction. To ensure that all complaints are handled appropriately, specialty practice managers should follow some basic guidelines:

    • Obtain as many details as possible from the complaining party without making any judgments, comments, or decisions. Listen with an open mind and collect the information. Take notes so that there is a written record of what was discussed.
    • Investigate all concerns. This may include speaking to the attending specialist and reviewing the patient's medical records if the complaint is about services or comparing the final invoice with the initial estimate and subsequent financial updates regarding the patient's treatment if the complaint is about the cost of services.
    • Try to follow up with the pet owner if the referring veterinarian called in the complaint and ask to follow up with the referring veterinarian if the client initiated the complaint. If neither party allows someone to contact them, the specialty practice must respect their wishes and support the relationship between the general practitioner and his or her client.
    • Send thank-you notes after the complaint is resolved, unless it seems completely inappropriate. For example, it would not be appropriate to send thank-you notes if the specialty practice and the pet owner were not able to reach a mutually agreeable resolution or it seems disrespectful based on the circumstances of the case. In most cases, it is appropriate to thank the client and/or the referring practice for their time and for the opportunity to make improvements based on their feedback.

    Teaming Up with the Referring Practice

    Pets that are referred to a specialty practice are often diagnosed with a serious, ongoing problem that will require continuing treatment, including further care from the referring veterinarian. Therefore, it is important that both practices work together to provide the best follow-up care for the patient.

    The specialty practice should make future treatment recommendations clear, in writing. This information, including the need for recheck appointments, follow-up laboratory tests, and bandage changes, should be given to the client and forwarded to the referring veterinarian.

    A plan should be established to communicate how the patient will be mutually cared for by the two practices. Veterinarians from both practices should decide who will conduct laboratory tests and interpret the results and who will determine future care, including medications, changes in treatment, and follow-up. They must also discuss situations in which the services of the specialist may be needed again.

    To further respect the relationship between the general practice and its client, the specialty practice should explain to the client how it will be involved in the continued care of the patient. In general, when a pet is diagnosed with an illness or condition, the specialist remains involved. The client can be informed that the specialist will continue to monitor and care for the existing problems. However, any new problems should be investigated by the general practitioner to determine whether specialized care is necessary. In this way, the client understands that he or she should not call the specialty practice for every new issue that develops. If and when these phone calls are made, the staff at the specialty practice should redirect the client back to the general practitioner.

    The specialty practice should also explore ways to involve the staff of the referring veterinary clinic in the continued care of the patient. For example, specific training sessions or handouts can be used to show the importance of administering mutual care to patients that are diabetic and require ongoing treatment, monitoring patients that have been sent home with bandages or that have surgical incisions, caring for patients that are discharged with feeding tubes, and providing information regarding why certain prescription diets are necessary to treat specific conditions or diseases. If the ultimate goal is to provide the triangle of care to every patient, then the relationship between the two practices can evolve in many different ways.


    Because specialty veterinary medicine is becoming more common, pet owners welcome the opportunity to seek a second opinion and to choose advanced medical care for their animals. Pets need the type of preventive health care that is provided by a general practitioner as well as his or her expertise to determine when advanced care is necessary. At the same time, the general practitioner wants to be able to form long-lasting relationships with pet owners and be able to recommend specialists — another feature that the practice can offer to clients. In the middle of the triangle of care is the pet that benefits from all three parties looking out for its best interest and good health.

    NEXT: On the Cover: A Talk with Katherine Dobbs, RVT, CVPM


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