COVID-19: putting the team first
Veterinary practice is being challenged as never before with the COVID-19 pandemic...
Published 20/05/2020
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Unique problems may require unique solutions, but to survive during the COVID-19 pandemic it is necessary for every veterinary practice to take a long hard look at minimizing costs and also to consider ways in which income can be maintained during this difficult time.
In the toughest weeks of the current pandemic veterinary practices can expect to see a significant drop in their income, which if sustained could threaten their very existence.
In terms of minimizing fixed costs, aim to reduce payroll costs by roughly the same proportion as the degree of revenue lost from providing veterinary services.
Since lockdown will result in a clinic’s caseload decreasing considerably, it is important to limit revenue loss by maintaining, and if possible increasing, the average transaction value.
A combination of common sense, generosity, creativity and service orientation may greatly affect how a practice copes during and after the crisis.
The authors express their thanks to Antje Blättner and Susie Samuel for their contribution to this article.
When facing a crisis such as COVID-19 we need to deal with uncertainty. At the time of writing neither the magnitude nor the duration of the pandemic is known – but it is already obvious that the virus has had a very rapid and violent impact on the economics of veterinary business. Hopefully, it will be relatively short-lived. However it is apparent that during this period veterinary practice owners will experience a dramatic drop in revenue, so it is essential to reduce costs in order to minimize losses and avoid a financial crisis. Unfortunately, given the timeframe of the present pandemic it is impossible to fully adapt expenditure in proportion to income because of the importance of fixed costs. This paper offers a blueprint to help maintain a practice through these difficult next few weeks or months, and Table 1 offers a summary in the form of a priority action grid (Figure 1).
Time frame | Primary goal | Priority actions |
---|---|---|
1 month |
Stop the bleeding
Ensure liquidity |
Postpone all outgoings as much as possible. Freeze all investments
Limit stock levels
Enroll in all public programs supporting credit lines and financial aids to small businesses
|
2-3 months |
Adapt to the new scenario
Minimize financial losses |
Negotiate with the team and adjust team size to new situation
Start revenue-stimulating initiatives (e.g., telemedicine) |
4 + months | Prepare for the post-crisis recovery |
Write a business plan with 2-3 recovery scenarios (different speeds of recovery) and the corresponding team size that will be needed
Adapt service offerings to the new situation (e.g., telemedicine, home delivery, etc.) |
Table 1. Priority actions to consider based on time frame.
Most of the costs for any veterinary clinic are fixed, such as premises, equipment and (the main one) the team. The adjective "fixed" does not mean that such costs cannot be changed, but it implies that they cannot be adapted quickly or easily. For instance, there is almost nothing that can be done about premises costs within a short period of time. In terms of equipment, it is of course possible to postpone non-essential investment in new kit, but other than this nothing more can be done, given that staff will need all the necessary equipment to continue offering the same level of service during the lockdown period.
Pere Mercader
The most efficient target when managing fixed costs during the crisis is to focus on team management, because although it is a major fixed cost it is the one that can be – to a certain extent – most easily adjusted. Basically, we should aim to reduce the payroll by roughly the same proportion as the loss in revenue, or (to be more specific) the revenue obtained from services (rather than goods sold). Table 2 shows the impact of a decrease in income on the profit and loss account from a typical first opinion small animal practice, keeping the core assumptions that were made in the “Intensive financial care” paper. It demonstrates that if revenue drops by 30%, damage to the profit margin (EBITDA) can be significantly mitigated if there is a corresponding reduction in staff costs.
Pre-crisis situation | -30% revenue without staff adjustment | -30% revenue with staff adjustment | |
---|---|---|---|
Revenue | 100 | 70 | 70 |
Merchandise & Supplies (variable costs) |
25 | 18 | 18 |
Payroll (partners & employees) (fixed costs) | 45 | 45 | 35 |
Overheads (e.g., premises, administration) (fixed costs) | 18 | 18 | 18 |
EBITDA* | +12 | -11 | -1 |
Table 2. The impact on the bottom line depending on whether or not staff costs can be reduced when income drops (all figures %).
* EBITDA (Earnings Before Interest, Tax, Depreciation and Amortization) is a measure of a company's overall financial performance and is often used to represent the profit in a business.
First of all, although the impact from the pandemic has been brutal, if we expect the crisis to be relatively brief the most important thing to keep in mind is to protect the clinic’s ability to rebound quickly and efficiently when everything is resolved. Therefore a clinic’s owners or partners must not overreact. Do not think that it is immediately necessary to cut the payroll, either by firing people or by ending the trial introductory period for new staff members, especially if it was difficult to recruit them. The key point here is to think about the post-crisis period: business will restart, and the upturn may be very fast, so staff will be needed to handle the recovery.
In most European countries – and elsewhere – governments are providing various legal frameworks to allow companies alleviate staff costs without firing people. The most widespread system is partial unemployment, or "furlough". The principles of this system are worth noting:
This system is a good way to quickly relieve the burden of wage costs from a business. In countries where such an option does not exist then unpaid leave (which keeps the employment contract intact) may be considered, but this is much more harmful for employees and can be used only for a short period of time. Essentially, if it is available, it is crucial that a veterinary practice implements the furlough system as quickly as possible, although only after careful consideration of its staffing needs.
Another option to consider is to ask staff members to take accrued holiday during the lockdown when the full team is not required. Although this will not actually cut wage costs (because it is paid holiday entitlement) it will allow the clinic to avoid a shortage of employees after the confinement period when the workload increases.
From a financial management perspective it is important to review and reorganize team members and rotas at least once, if not twice, a week, in order to determine the correct team structure (for both veterinarians and support staff: receptionists, technicians and nurses) to cope with the caseload. Being in lockdown does not mean that the level of service usually provided to clients and their animals should decrease, so it is essential to maintain the optimal human resource. There is no doubt that the confinement will result in a drop in the clinic caseload, but it is important to bear in mind the necessity of limiting the loss in revenue, and consequently at least maintaining, and if possible increasing, the average transaction value (ATV) (Figure 2). In fact, given that clinics are likely to treat a higher percentage of complicated or severe cases in these difficult times (because most routine preventive procedures are postponed) this should help increase the ATV. Therefore we need to have enough people at work.
Philippe Baralon
It is obviously very difficult to forecast the amount of work that will come into the practice each day, and it is likely that the team will either be overloaded with work or have some spare time. Although it may appear counter-intuitive, it is strongly advised that, in order to offer the best quality of service, it is better to have a slight excess of veterinarians and nurses than a shortage. Consequently, the solution here is to recall some staff members as soon as the workload exceeds the capabilities – although this must be with regard to the national furlough regulations. During days when demand is slow, it may be worthwhile to take the opportunity to retrain employees (for example, by using webinars), or to progress the implementation of new services that have been previously postponed (for example, setting up work sessions on wellness plans or the management of chronic diseases). This is a good way to prepare for the restart when the lockdown will be eased or lifted, and at the same time to bring a positive message to the team.
It is undeniable that the COVID-19 crisis is having a serious economic and emotional impact on veterinary practices; with very few exceptions, practices can expect a decrease in income of anywhere between 15 and 50% of normal revenue, at least in the toughest weeks of the pandemic. Given this frightening scenario, it is understandable that the first impulse of any practice owner is to find quick ways of cutting fixed costs (which will inevitably be salaries) and postponing any payments to suppliers. However, just as we would do in a clinical situation, once the patient (i.e., the practice) is stabilized in the intensive care unit (by payroll adjustment and cash management measures), we need to identify ways of improving the general well-being in order to facilitate recovery. This is where revenue management comes in: the practice needs to identify how to minimize the expected reduction in client activity. In order to obtain good results, we need to use a diverse selection of tools; a combination of common sense, generosity, creativity and service orientation can make a real difference.
Lucile Frayssinet
Do be aware that these are very emotional times, and consumers in general (including pet-owners) are very vigilant about the roles played by governments, corporations and brands during the crisis. Veterinarians should be extremely careful with their client communications during this period: there is a very thin line between being perceived as friendly, committed and service-oriented, and being seen as opportunistic, commercially aggressive and insensitive to your patients and clients’ real needs. When evaluating potentially new or creative revenue-generating initiatives to put in place, it is advisable for the practice management to first perform the following “control check-list”:
With this checklist in mind, here are a number of ideas that could be considered by the practice team.
During the weeks of public confinement or lockdown there will already be a number of pre-booked appointments in the diary of every practice. In some cases the clients will automatically assume that these events are cancelled; in other cases hesitant clients may call to ask what is happening (or expect to be called!), whilst some clients may simply forget about the appointment altogether. It could be a good idea to proactively telephone all of these clients and (depending on the reason for the appointment) either directly suggest a rebooking (i.e., “we will book you and Rocky for the same day and time 4 weeks from now, and don’t worry if the lockdown is extended, because we will call you again a few days beforehand and suggest a new date”) (Figure 3). When dealing with vaccinations, it may be appropriate to follow a different approach, especially with puppies and kittens – for example, telling the owner to keep the appointment but reassuring them about the safety measures implemented in the practice to minimize risks.
If the workload is less than usual, invest some time in mining the practice database to identify patients or owners who would benefit from a follow-up call from us. Some of these calls – apart from generating a very positive reaction from clients – may also end up generating revenue in a natural way:
This could be a convenient and welcome option for many owners who may be confined to their house or who prefer to stay at home themselves, while at the same time enabling their pets to receive the medical attention they require without delay.
Telemedicine is now definitely a service (both in human and in veterinary medicine) that is here to stay. If used properly (i.e., where the patient is already known to the practice, and within the correct context) it can be a great asset for most practices. The legal framework for veterinary telemedicine varies from country to country, but it is becoming better understood – and accepted – by most national veterinary bodies which normally require a pre-existing veterinary-patient relationship for it to proceed. There are now a variety of new commercial solutions in many countries that can offer on-line appointment booking, video-consultation and fee collection, all integrated with the clinic PMS (Practice Management Software).
If we have the team, the knowledge, the technology (there are now plenty of software products for video-conferencing) and the time, why not organize thematic webinars? These can be targeted, whereby you selectively invite maybe 20, 30 or 50 clients with a mutual pet profile (such as the same breed, same clinical condition, or a common interest) to participate (Figure 4). Alternatively consider doing a webinar on a relevant topic of more general interest, such as “behavioral adaptations of dogs and cats during and after confinement”. This could be a great way of maintaining the bond with clients and – very likely – lead to revenue opportunities, a real cross-selling opportunity.
For practices that have clients enrolled in wellness plans, now may be the time to take some positive steps. For instance, an e-mail to your entire database (and/or a statement on your website and social media pages) announcing that you have decided to extend the duration of all current wellness plans by (say) one month, at no additional charge, as a courtesy to your clients. This could seem like a way to lose or delay revenue, but it will probably have a positive return, both in terms of goodwill and in the form of increased renewal rates in the wellness plans that finish in the coming months.
To conclude, all the propositions presented should be considered depending on the time frame. It is of paramount importance that all practice owners take early, appropriate and considered action in order to come through this unprecedented storm and recover from it in a form that is ready to move forwards and upwards. Whilst no business can expect to emerge unscathed from this global threat, the better prepared a practice is, the more robust it will be to withstand the problems this pandemic poses.
Philippe Baralon
Dr. Baralon graduated from the École Nationale Vétérinaire of Toulouse, France in 1984 and went on to study Economics (Master of Economics, Toulouse, 1985) and Business Administration (MBA, HEC-Paris 1990). Read more
Pere Mercader
Dr. Mercader established himself as a practice management consultant to veterinary clinics in 2001 and since then has developed this role in Spain, Portugal and some Latin-American countries. Read more
Lucile Frayssinet
Dr. Frayssinet is a French veterinarian who graduated from the École Nationale Vétérinaire of Toulouse in 2019. Read more
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