Logistics behind Ambulatory Work

Occasionally, we have ride-alongs or people doing job shadows, usually students ranging from high school to vet school. For those considering a career in veterinary medicine or future ambulatory vets, it is an interactive, uncensored day-in-the-life experience. The types of questions I did not really expect to get were regarding commuting and driving. The questions I get asked most often include:

  • How big of an area do you serve? What are the logistics behind scheduling appointments? Who determines the route? How do you know how much to charge for a farm call?
  • How much time do you spend in the car on average per day? What is the longest you’ve ever driven to one place? What do you do in the car all day?
  • Does getting car sick mean you can’t be an ambulatory vet?
  • Does the truck ever break down? Have you ever gotten in an accident with the work truck?

I’ve received these questions often enough that I decided to write a couple posts about this side of the profession from my personal experience.


The Realm

Our service area (which I refer to as the realm) is vast, one of the largest I’ve seen. From where our office is located, we service up to an hour and a half in every direction…meaning our call radius is 1.5 hours, not factoring in traffic. The realm ends up being a large part of the western side of our state. While the majority of our work is North, an emergency an hour South of our office could mean a 2.5 hour drive from one end of our range to the other. Most practices I’ve spent time with service a 40 minute radius around their hub.

As for navigating the realm? I have to give a shout out to navigation apps. All of this would be a lot more difficult without today’s smart phones, GPS etc. I consider myself very fortunate to practice in a time when this technology is easily available. Not afraid to admit that I cannot imagine the farm call experience before Google maps existed. For the vast majority of our navigation, we use Google maps and Waze, which do a great job 95% of the time.


Scheduling

Luckily, our front office staff are all locals with an excellent knowledge of the cities/towns and road system. Equally important is knowledge about traffic. The commute to a particular barn in the morning could be well over an hour, while the same route could take 30 minutes if its around lunch time.

Efficiency requires concise, well-planned routes, the front desk carries the heavy burden of scheduling. And they are phenomenal at avoiding the big scheduling mistakes, which off the time of my head are:

  • Return trips (same barn more than once in a day)
  • Same stops (different doctors to the same barn in a day)
  • To-and-fro (alternating near and far locations like North  South  North  South …vs. starting north and working south throughout the day)
  • Localizing (keeping all farms in a particular direction, vs having calls at complete opposite ends of the service radius)

I have full respect and appreciation for the skills of the front desk staff, because I dabbled in scheduling at my previous job and found it to be a pain-staking, hair-pulling mess.


The Financial Side

Minimizing drive time is essential, as our farm call fees (ranging from $80-140) over times barely cover the overhead and wages one way…not to mention if the next call is equally far at the other end of our range. Often times, the company actually loses money as the basic, rough example below shows:

Farm call 40 miles from office, 1 hour drive time

  • Farm call fee charged to client: $100
  • Gas: $10
  • Vehicle wear and tear, mileage, licensing, insurance: $25
  • Assistant’s time (company cost): $25
  • Doctor’s time (company cost): $60
  • Total cost to company for farm call (one direction): $120

Not a precise or perfect example, but easy to see why scheduling and routes are so important. And after all the effort is made into tactfully planning an efficient day, there comes an emergency call that changes it all…and even if the call is at the other side of the realm, traveling in peak traffic hours, those facts don’t register because the focus shifts to getting there safely and as soon as possible, so that we can do what we joined this profession to do- care for our equine patients and the clients attached to them.

VET LIFE STEP BY STEP – HOW TO LOSE A CLIENT

I unintentionally discovered one method for ensuring you will not have repeat business from a client. And for the sake of showing my humility, while sharing my mishaps, I created a simple step-by-step guide on how to lose a client.


HOW TO LOSE A CLIENT IN 5 SIMPLE STEPS

1. Ask client if they would be willing to move their appointment up to an earlier time, preferably if it will involve them rushing or canceling previously made plans. Schedule them for this earlier appointment time.

2. Show up 1 hour late.

3. Promise you can accomplish all the appointment goals by a particular time.

4. While they are helping hold your patient in preparation for a dental float, spray them directly in the face using a dosing syringe full of dirty water from the horse’s water bucket.

5. Finish the appointment 30 minutes later than you promised so that it interferes with the plans they had to rearrange in order to meet you at the time you requested.

 


When my boss couldn’t make it to her appointment at a nearby barn, I offered to step in and help carry some of the appointment load. Not only was this my first time meeting the client, but it was also the same barn that I had visited earlier in the morning for an emergency colic appointment. This client had one horse scheduled for a dental and two horses scheduled for vaccines. Having been on emergency calls all night, and reporting to the Colic first thing in the morning, I never had time to get vaccines. When I agreed to take the appointment (Since I was already at the barn), I also realized I was out of tetanus, West Nile and flu/rhino vaccines. While my office staff arranged for the client to come to the barn at 11 am instead of 2pm, I embarked on what I thought was going to be a quick trip to the office for more vaccines. But phone calls, questions, client drop-in and various other events resulted in my taking an hour longer than I had hoped.

By the time I showed up at 12pm, the client had already called my boss to see what the deal was. She let me know what her wait time had been, and I apologized profusely. With a riding lesson scheduled at 1, she was skeptical I could get everything done in an hour. Determined to regain her trust and confidence, I promised I’d have it done.

I set up my dental equipment, vaccinated the horses and got ready to sedate the gelding for his dental. “Oh yeah, he doesn’t sedate well just so you know. He’ll look like he’s about to fall over asleep, but as soon as you start working on him he’s wide awake.” Let’s just say she knew exactly what she was talking about. And after I felt confident in his sedation level, I filled a large dosing syringe full of water from his dirty bucket. I put the tip of the syringe in his mouth, and as I shoved with all my might on the plunger…he almost reared up. It was perfectly coordinated and timed, and instead of the water going into his mouth…the water shot full-force straight into the client’s face.

Basically, she got a power-wash to the face and was soaked. She did not laugh. She looked absolutely pissed and annoyed. I told her I was mortified, and that I was sorry. To which she responded, “I’ve had much dirtier and nastier things on my face.” I laughed, and went to work.

What would’ve normally been a 15 minute dental float was a 45 minute struggle between a horse’s buckling knees and his frantic swinging head. By the time I was done, the client had her own client waiting to begin the riding lesson. Embarassed, mortified and disappointed by the multi-modal failure, I left one more apology with her before I drove off to the next appointment.

As soon as a left the barn driveway, I was dialing the office to give them the step-by-step account, and share my new found method to ensure that I’ll never be the vet she requests to work on her animals. We all had a good laugh before the office manager said, “Well, I doubt it cost us any money. She’s had an outstanding balance of over 3 grand for the past couple years and refuses to put a dime toward it.” She paused. “Maybe after spaying her point blank in the face, she’ll get the hint that we kinda want to be paid for our previous services.”

Despite her account delinquency and bad attitude in general, I still felt horribly unprofessional and foolish…though after talking with the Office manager, I felt a little less guilty.
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