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Tuesday, June 30, 2009

Quantity vs. Quality

Today I saw the most pets I have ever seen in one day...47! Considering that an average doctor should see 20-25 pets per day that's a pretty crazy number. Probably 40 of those I saw between 2:00 and 7:00, which averages 7-8 pets per hour. Again, that's a crazy amount to see. My practice has a policy that we will see any pet that needs to be seen. We simply don't turn people away. For the most part I agree with this, as it keeps pets from having any delay in diagnosis and treatment when they need it. However, at some point I think that pet care potentially suffers.

It's a question of quality versus quantity. And it really makes me wonder which people want. When I'm seeing almost 8 pets per hour, that averages to spending less than 10 minutes per pet. For a routine puppy booster vaccine this may be enough. But for a sick pet it definitely isn't. Personally I would rather give fewer patients better care. It would also improve client service, as I had several clients wait over 2 hours to be seen. Now, they were warned of the wait and they were happy to sit around, but I still don't like doing that to them.

So it's a bit of a conundrum. Do I turn some people away? The ones I turn away might need only minor care, or might turn out to be a serious case that needs immediate evaluation. Turning people away might mean better care for the pets I do see, but might mean denying care for other pets. Honestly, I've never worked at a location this busy before, so I've never been faced with this dilemma. It's great for business in the short run, but I also need to put aside the business at times and concentrate on being a doctor and providing the best care possible.

So now you can see the challenges of being a doctor and a hospital manager. I am continually weighing the business versus the medicine, trying to find a balance between them. And that brings me to my first ever poll! Look on the top right and let me know what you would prefer.


  1. I'm actually not really sure which choice to take in the poll...I have a few cents (probably more than two, haha) to add on the subject.

    How common is it to have people wait an hour or more? If I'm usually seen in 15-30 minutes, but sometimes there's a longer wait due to emergencies, I'll gladly wait 2 hours and then pay full price for my visit. If for some reason I can't wait that long, I'll cheerfully reschedule for another time, no hard feelings. It's because I know that if/when MY pet is the emergency, I'll have the same standard of care as the others did on that day.

    Likewise, if I'm the "fit-in" appointment, I am happy to wait as long as necessary for the peace of mind that I get from being able to bring my pet in quickly when something unexpected crops up. I understand fully that I'm disrupting the schedule to bring my pet in at the last minute, and so if that means I have to wait, I'll do it gladly, and pay full price. (The caveat is, I expect that when you have so many "fit-ins" you triage them somewhat to make sure that the obviously severe cases are treated first, so that my pet doesn't sit for hours and then die on my lap. Of course, for my part, if I suspect my pet is that severe, I will probably go straight to the ER anyway, but still.)

    Now, if EVERY time I come in, no matter what the time of day, I wait 2 or more hours to be seen...well, it will depend on whether I feel the individual vet is worth it. I may start to consider going elsewhere if I sit in the waiting room that long on a routine basis, especially if I'm only there for something simple and brief. Or if the wait means that when my pet needs urgent care, s/he is unable to get it, that too would be a problem. But short of that, I'm generally happy to wait AND pay full price for my care.

    So, in summary - if this is happening every day, yes, you may need to do more detailed triage on the phone and try to figure out who can wait until tomorrow. But if it only happens sometimes, you may not need to change your policy at all.

  2. I wonder if maybe you could have rescheduled the puppy vaccine/check-up appointments, since those were not necessarily urgent, but sick pets needed to be seen. Could you have sent some to your (I know, we don't even want to think about this option) competition in the interest of making sure that everyone received the care they needed? How close is the nearest Banfield could you have sent some of your load over there? Honestly, I know that you are a fantastic doctor, and there is no other person I would take my pets to, but if you were swamped and concerned about the quality of care you were giving to peoples' pets and asked me to visit the animal hospital down the street this one time, I would do it and come back to you next time. (As long as you made it clear that the reason was because you could not give every pet waiting the proper care because of the large number of animals in that day.) I know that makes it harder to coordinate a pet's care if you do that, but if it becomes a question of being able to give an animal the care they deserve, would that even be an acceptable compromise? I don't know. It's a tough question. I think that Christina had it right when she said that if this type of thing only happens occasionally, then it's probably nothing to worry about. Most people recognize that there are days when there is heavy traffic, and days where the traffic is light. This is life. And if you make it your policy to give people's pets the best care you possibly can, people recognize that too.

  3. That's a lot in 1 day! I think appointments should be needed and sick walk ins will be worked in at the next time slot or sooner if emergency. Well pets for vaccines or other minor conditions will be scheduled for another day or put in at the next available slot if they want it and there is one available. We also save some time slots so we can fit in sick animals at the last minute without throwing too much of a wrench in our day.

  4. Christina, I wish all of my clients were that understanding! I tend to be the same way you are, but I also understand what can happen "in the back", so I'm more forgiving.

    Thankfully this is not a frequent occurrence, though it's becoming more common. We're working on bringing in another doctor part-time to help us handle the flow better. That way we can still see 40-50 pets in a day, but each doctor is only seeing 20-something. Much more reasonable!

  5. Another thing that he failed to mention, was the fact that two times a week they have wellness hours where people would not have to pay an office visit. I think that is another reason that it gets crazy and people don't mind waiting, is that they feel like they might be getting a bargain and want to wait for it. These days many people feel that it is worth the wait to save a little money. So just another thing to consider in this whole picture. I just hate it that it usually makes him really late coming home from work.


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