首页分享宠物养护与美容第四章

宠物养护与美容第四章

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1、Future of Veterinary Teaching HospitalsVeterinary Teaching Hospital MissionsoThe unique challenge of the Veterinary Teaching Hospital is to:nRemain financially viable whilenenabling teaching and research,nall the while providing veterinary medical services to the public.Jim LloydHistoryoInternships

2、began in 1950-60s,residencies in 1960-70s.oBoard certification became the norm for entry level clinical faculty positions in the 1970-80soClinical Departments began to divide responsibilities into academic&hospital,and Hospital Directors began to be hired in the 1980-90soVeterinary Colleges became m

3、ore dependent on hospital income in 1990-2000s.Discussion Forums on VTH IssuesoAAVMC meeting March,2004oAAVMC Forum at AVMA meeting July,2004oAAVC/AAVMC/NAVCA meeting-March 12,2005oAAVC Meeting Atlanta,April 2005oAAVC Forum at ACVIM Annual Meeting June 1,2005oAAVMC Meeting March 11,2006Problems Iden

4、tifiedoDifficulty in faculty staffing of VTHs due to attraction of private practice oFunding of VTHs revenue and gifts were probably the best future source of funding since an increase in central core funding was not likely,oDecreasing of state subsidies,and an increase in the competition for cases

5、and facultyoToo much red-tape in university for many specialistsoResearch,teaching,and service hard to be good at all three,can be in direct conflict with each other.Some think there is a 4th mission to teach business aspect of veterinary medicineoIncreased reliance on tuition and fees,stagnant VTH

6、revenues in some areasoState revenue as a%of total revenue for vet schools decreased from 55%to 33%oAverage#of state-funded faculty positions has been static,some increase in non-state funded positions,at same time as increase in#of studentsoDecreasing to static applicant pool for vet students,subop

7、timal distribution of caseload(need more primary cases for teaching,too many tertiary cases)oPerception of faculty stretched to limit with multiple balls in the air.oWhere will next generation of clinical professors come from?oAre we graduating an entry-level veterinarian?oDo off-shore students dilu

8、te learning experience for others?oDo all the students get enough hands on experience?oIn private practice,a vet earning$65,000 should produce$300,000 in revenue,but the VTH is not a typical practiceoPractice owners want from graduates:knowledge,communication skills,people skills,business skills,how

9、 to manage workloadoSpecialists are finding that VTHs have a lack of money,lack of equipment,lack of new space,lack of control over work day,too many goals,long days and weekends,not efficient,poor location,and that they can do teaching in other placesoPresent faculty can be poor role models for int

10、erns and residents show unhappiness and frustration.oAdequate caseload is not always there in academia for teaching and research needsThe Need to Change oSVMs and VTHs must be willing to change to accommodate the above issues,prioritize missions of clinical program.oUniv.of Minnesota Tried some new

11、ideas:clinical specialist model and incentive plan;replaced student labor with techsoResults increased caseload,increased revenue,tenure track faculty could focus more on research,and teaching improvedPotential Solutions for VTH IssuesoBalancing the mission teaching,research,service,and hospital as

12、a businessnBalance the mission as dept.not each personnHave enough support staffnPerhaps teach some of DVM curriculum by non-specialistsnMoney generation should not be prime reason for VTHn2 services running simultaneously,one for service and one for teachingoRecruitment/retention of Clinical Facult

13、ynLook for donors for new equipment/facilities and to augment faculty salariesnLook to share specialists with private specialty practicesnNeed to offer part-time or full-time clinical track positions to specialists,but must not be a 2nd class position need longer term contracts,sabbaticals,voting pr

14、ivilegesnWork with University to get more competitive salaries for specialists,signing bonusesnDevelop Incentive Plan part of revenue back to faculty or section of hospital for their usenDevelop satellite practice so as to augment money generated and improve secondary type casesnOffer consulting tim

15、e to facultynImprove culture in VTH/SVM so are reasons to attract or retain faculty,market academic lifestyle internally so faculty understand and sell the benefitsnAugment a residents salary if that person will commit for certain number of years as a faculty membernSelect residents that want to sta

16、y in academiaoMaintaining and Enhancing Case loadnDevelop good relationships with RDVMs,establish a Practitioners Advisory BoardnHire a Referral Coordinator to deal with RDVM issuesnHire a Marketing Manager for VTH-to market to RDVMs and publicnClient and RDVM surveys-to point out areas where improv

17、ement is needed,like communicationnMake clinicians and staff realize they are competing against private specialty practices for caseload,must give better servicenBring in outside consultant to help make VTH more efficientnNew faculty need to introduce themselves or be introduced to RDVM population,a

18、lso give CE seminarsoEnhancing Operations of VTHnWork on alleviating bottlenecks in VTHnHire Development Officer who is assigned directly to VTHnHave treatments of hospitalized cases carried out by technicians,not students might improve efficiency and let students learn morenVTHs need to hire a Hosp

19、ital Administrator/Director MBA,MHA,or similar training.If not a DVM,must report to a DVM(AVMA accreditation rules)nVTHs needs to have a strategic plan,establish benchmarks,have good financial reporting system.nClinical Track faculty good move to hire them but who should pay for them?VTH,Clinical de

20、pts.?oSuggestion is to take charging away from clinicians,put technicians in charge of billing,but get faculty involved in budget process to increase understanding of where revenue dollars are going to.oOr spend less time on student rounds and start admitting cases sooner in the day(earlier than 9:3

21、0 or 10:00 am.)oCommunity Practice Service good way to get primary care casesoPartner with private specialty practices to hire specialistsoShould residents be trained at private specialty practices?Or should it be a joint endeavor with universities?oSpecialty colleges have to be careful that too man

22、y restrictions for training residents are not placed on specialists/collegesNext StepsoHelp faculty understand the problems and embrace a business plan,create a VTH Task force(AAVMC,AAVC,NAVCA)in 2004 that will work to prepare a“white paper”addressing concerns for future of VTHs use for local suppor

23、t,consultant backgrounding,and accreditation standards oDevelop benchmarks that all VTHs can complete annually and use to determine efficiency of their model created Benchmarking Task force for this AAVMC,AAVC,NAVCA.Benchmarking Task Force meeting Aug.24,2005oTask force met in Schaumburg with Howard

24、 Rubin,developer of NCVEI benchmarks for private practices.This group started working with him to develop something similar for VTHs that would be more helpful than AAVMC annual info that is collected.oUtilize benchmarking for internal and external comparisons.VTH Task Force meeting Oct.24,2005oTask

25、 force met in Columbus,Ohio to discuss what to do nextoAsked Dr.Hubbell to create a 1 page“white paper”that outlined the problems VTHs are facingoGroup discussed the organizing of a conference to discuss the Future of the VTHsDr.Hubbells White Paper Present and Future Problems for VTHsoThe vast majo

26、rity of the advances in veterinary medical care to date have occurred because of the existence of Veterinary Teaching Hospitals.oThe convenience and high quality of private specialty practices impacts the caseloads of the VTHs and has the potential to compromise the education of veterinary students

27、and postgraduate veterinarians and the generation of knowledge through clinical investigation.Dr.Hubbells White PaperoThe resolution of this crisis will require broad participation and cooperation.New alliances must be formed to foster clinical education and investigation at the professional and pos

28、t-professional levels.oThe profession must be engaged because the solution will involve universities,specialty colleges and practices,private practitioners,veterinary students,and organized veterinary medicine.Future of VTHs Conference,Nov.10-11,2006,Kansas CityoInvited people from all walks of life

29、 DVMs from private practice,specialists from private practice,specialists from academia,representatives from specialty colleges,NAVCA,AAVC,and AAVMC reps,reps from veterinary organizations like AAHA,AVMA,etc.oWe thought it was time to have others discuss problems the VTHs are facing and hear their i

30、deas on possible solutions besides just the academicians.Future of VTHs Conference,Nov.10-11,2006,Kansas CityoMs.Susan Baker spoke on managing the expectations of the clientnEveryone that meets a client should introduce themselves including receptionists with full name and title,should also address

31、client and pet by namen1st impression to clients very importantnClients want to be respectedFuture of VTHs Conference,Nov.10-11,2006,Kansas CityoDr.Mary Ann Vande Linde Veterinary Management Consulting spoke on“Client Expectations for Veterinary Care”nTop reason why a client leaves a vet hospital in

32、difference or poor attitude of staff or DVMsnMinimal waiting timenConsistent message from one area to anothernWant to be treated with respect,clarity,and consistencyFuture of VTHs Conference,Nov.10-11,2006,Kansas CitynWant to be communicated with on terms they can understandnWant the exams to be tho

33、rough by a DVM and not rushednAll interaction with client must be improved from reception desk to student to staff and facultyFuture of VTHs Conference,Nov.10-11,2006,Kansas CityoDr.Colin Burrows,SA Dept.head at Univ.of Florida spoke on“Meeting the Expectations of Referring Vets”nWhy RDVMs refer unc

34、omfortable with case,lack skills or equipment,lack of time,liability,good experience with referral hospital,know specialist,cannot handle diagnosis or emergencyFuture of VTHs Conference,Nov.10-11,2006,Kansas CitynWhy DVMs dont refer Geography(too far),cost,think they can do it all,previous bad exper

35、ience with referral hospital,poor feedback from clients,dont personally know specialistFuture of VTHs Conference,Nov.10-11,2006,Kansas CitynWhat RDVMs expect knowledge of services being offered,good quick response to 1st phone call,efficient communication from staff,protect relationship between clie

36、nt and RDVM,timely communication during and after animal is referred,do not treat other disorders than what animal has been referred in for,follow-up with RDVM when animal dies or is euthanized.Future of VTHs Conference,Nov.10-11,2006,Kansas CityoRDVMs are our most important clients and we all need

37、to realize that.oNeed to perhaps do more marketing to increase our referral base.Florida has done:nRDVM Appreciation DaynHospital NewsletternPractice visits to local practicesnLocal association visitsFuture of VTHs Conference,Nov.10-11,2006,Kansas CitynClient and RDVM surveynHospital Advisory boardn

38、Web Site for RDVMsnHospital Tours for Clients and RDVMsnPress releasesnReferral fax covers news or new clinical studies added to fax covernClients advocates-volunteersFuture of VTHs Conference,Nov.10-11,2006,Kansas CitynEducate clinicians on business issuesnRemind clinicians of referral protocol and

39、 if do not have one,create one(how and when to communicate with RDVMs,what is expected)nClinician incentive plannTake clinicians out of the charging businessnToll free numberFuture of VTHs Conference,Nov.10-11,2006,Kansas CityoDr.John Albers from AAHA spoke on“Future of Specialty Practice”n1996 18%o

40、f new vet graduates were doing advanced studies(internships/residencies)n2006 increased to 33%with most of those wanting to pursue board certificationoWhy specialty practices will continue to grow?nIn survey done,74%of clients would pay$500 to treat a serious disease in their petn52%would pay$1000,1

41、5%would pay$5000Future of VTHs Conference,Nov.10-11,2006,Kansas Cityn61%of those pet owners that thought of their pet as a member of the family would go to a specialist if their vet recommended it.nRecent graduates have a higher propensity to refer than vets that have been out for awhilenLenders wil

42、l lend money to start a specialty practice at a good ratenManufacturers of expensive equipment offer these practices good ratesFuture of VTHs Conference,Nov.10-11,2006,Kansas CityoDr.David Lee,Hospital Director at Minnesota spoke on the“VTH as a Profit Center”and discussed the use of a professional

43、call center,the use of a referral coordinator,discharge instructions faxed immediately to RDVM,having a Case manager/section,hiring a Hospitalist(a DVM that would help to move cases through the hospital)Future of VTHs Conference,Nov.10-11,2006,Kansas CityoDr.Charles MacAllister from Oklahoma State,s

44、poke on Cooperative Arrangements for Training Specialistsn82%of the residency programs are in universities as of 2006nNeed to recruit residents interested in academia as a career.nPlenty of applicants for positions in all specialties except for anesthesia.Future of VTHs Conference,Nov.10-11,2006,Kan

45、sas CityoOklahoma growing own faculty by paying other institutions to take them on as an extra resident(pay for their salary and benefits to the institution training them).Must complete a MS degree and work for at least 3 years at Oklahoma vet school after finish residency.Cost of$140,000/resident t

46、o home institution for a resident to be trained elsewhereFuture of VTHs Conference,Nov.10-11,2006,Kansas CityoDr.Ruben Meredith,an ophthalmologist in a huge multi-location private specialty practice spoke on“Ophthalmologist in Private Practice.”n6 locations presently where have practices and residen

47、ts,have 12 active residents on board right now and tend to keep most of them on as clinicians after they finish(self-train them)nAll schools should do a SWOPT analysis once a year.Future of VTHs Conference,Nov.10-11,2006,Kansas CityoSWOPT analysis strengths,weaknesses,opportunities,and problems and

48、threats.oPrivate Specialty practice(PSP)nStrengths residency training,large case load,commitment to research,board-certified staffnMultiple centers envisioned.nWeakness internal communication,staff training,inventory control,employee accountable,communication with clients and RDVMs,lack of uniform o

49、perating system,lack of trained techs,inefficient facilities.Future of VTHs Conference,Nov.10-11,2006,Kansas CityoVTHsnStrengths-Vet students,faculty,bench research facilities,university resources,funding for researchnWeaknesses-ability to pay competitive salaries($200,000 for ophthalmologist),budge

50、tary control,university restrictions,etc.Future of VTHs Conference,Nov.10-11,2006,Kansas CityoPrivate Specialty Practices(PSP)strengths are our weaknesses location,salaries,flexibility,budgetoPSPs weaknesses are our strengths research possibilities,future clinicians(students,interns and residents)oV

51、THs and PSPs must work together and cooperate,form direct partnerships with PSPsFuture of VTHs Conference,Nov.10-11,2006,Kansas CityoDr.Richard Valachovic from the American Dental Education Association spoke on the similarities between what the dental profession and the veterinary profession are fac

52、ingoThere are 56 dental schools in the U.S.and there are 400 open faculty positions,the mean age of the faculty is 52 yrs,faculty 700 clinical specialists in academia over the next 3-8 year.If we continue to deliver 3 out of 4 graduating residents each year to private practice,then we will need to t

53、rain 2400 diplomates over the next 8 years to meet our academic needs.Our current production rate is 200 diplomates/yr or 1600 over the next 8 years.How will we supply our total needs?ConclusionoDr.Robert Marshak wrote in 2005 that there are serious disadvantages to any arrangement for clinical training that is not firmly centered and concentrated in the schools large and small animal hospitals.oIf we agree with this statement then we all must work together to preserve our hospitals in whatever way we can.owww.aavmc.org