6 ways any veterinarian can rock the exam room-and beyond

Being an associate veterinarian (especially for a recent graduate) can be stressful. You may be concerned you're not efficient enough—you spend too much time on surgeries, you don't communicate well enough with clients or you aren't conducting the right diagnostic tests on patients.

Your other big worry is probably paying off school loans. The loan repayments we face are at an all-time high, and every year they get bigger. That means young veterinarians are often looking for ways to increase gross production—the only way they can guarantee a possible raise, a year-end bonus or a big golden egg of production-based pay.

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Here are a few ways I increase my gross production. Some of them are extremely common, but you might be missing other chances to boost both patient health and production.

1 Offer educational handouts

Whether you create one or snag one from a manufacturer, a veterinary association or a website like dvm360.com, the best handouts give brief descriptions of conditions diagnosed and treatment plans involved.

As veterinarians, we can spend an hour in the exam room explaining our diagnostic findings and the disease process to the client in full detail, but the client will still likely leave the room with questions—and a little confused. Handouts mean more to the client than we could ever imagine because having that knowledge educates and empowers them. Handouts also allow us veterinarians to save time and remain efficient in the workplace. Here are some examples:

> If I'm diagnosing diabetes or another condition that needs immediate treatment, I explain what the treatment does and how to administer it right then and there.

> For all chronic diseases, I send my clients home with a handout that covers the long-term estimated cost of treating the condition.

> When I diagnose a patient with a treatable condition in which the initiation of treatment can be slightly delayed (e.g., heartworm disease, or patellar luxation), I briefly discuss with the client what's going on and treatment options. I send the him or her home with a handout to look over. I'll make another appointment (phone or in-person) with the same client one or two days after the initial appointment so we can discuss the issue in detail, answer questions and initiate treatment.

2 Give clinic tours

If you're allowed, offering clinic tours to clients is a great business builder and works wonders for the doctor-client-patient relationship. At our office, our manager usually conducts the tour. We begin by showing clients the treatment area, where pets are taken to collect diagnostic samples. Seeing this for themselves makes clients feel more comfortable when it's time for pets to be brought to the treatment area (not "the back"—I hate that term) for blood or fecal samples or radiographs.

Then we show the kennel area, the surgical recovery area, the hospitalization area and ICU. Clients tend to feel better when they've seen exactly where pets are being treated.

Because of these tours, we've not only seen client benefits but also an increase in business—for example, when people are shown the kennels, they find out we offer boarding at our clinic and they're more likely to bring pets in to us next time they go on vacation.

3 Seek out ear cytology

I do ear cytology on every patient that shakes its head, has red and inflamed ears, carries a lot of dirt in the ears or has any slight ear canal abnormality. The test is simple to perform and only takes a few minutes. Typically you'll find common yeast or bacterial infections and be guided to the best treatment for the condition.

If the client is willing, often I let him or her look at the ear cytology with me under the microscope. Then, after two or three weeks of treatment, I bring the client back in to see the infection either almost or completely eliminated under the microscope. This not only helps with client education but also allows clients to see that their money has been well spent.

Ear cytology is also a great benefit to the associate because not only is it a necessary diagnostic tool to effectively treat an infection, but it can also help your bottom line. It costs pennies to perform while still contributing a significant amount to gross production.

4 Find out with fecal exams

I perform fecal examinations for every newly acquired pet as well as every pet with vomiting, diarrhea or weight loss. I also recommend them annually as a preventive measure.

The test takes a few minutes and supplies us with helpful information. For example, if intestinal parasitism is diagnosed, the fecal examination guides us to the right deworming agent. And it's much more satisfying to explain to a client exactly what we're treating (e.g., intestinal nematodes, Giardia) after performing a fecal examination than it is to put the patient on a medication without the client knowing exactly what condition is being treated.

I've rarely treated a GI case without performing a fecal examination. Here's an explanation why: I have seen cases in which a puppy is given a wellness examination, a set of puppy booster vaccinations and a deworming agent without receiving a fecal examination. Within a week or two, the puppy returns with diarrhea, a decreased appetite and sometimes vomiting. A subsequent fecal examination reveals difficult-to-diagnose Coccidia. Treatment requires a deworming agent that is completely different from the routine ones we use. This is an infection that could have been diagnosed initially had a fecal examination been performed, and the client would not have had to return so quickly with a sick pet.

I explain the need for fecal tests by saying we need to determine whether there are parasites that may be causing the problem so we can properly treat the pet.

The only exception I will make is with long-term patients of mine that have a history of GI problems that have been diagnosed through multiple diagnostics. In these cases, I am usually so familiar with the patient that I can recognize the signs and I will treat the same way that I have treated in the past, as long as a fecal examination has been performed within the past four to six months.

5 See the sunny side of supplements

I'm a strong believer in veterinary supplements, even though there's some controversy about whether they really do improve patients' health. I have given supplements to numerous patients that were either born with a developmental issue (orthopedic, liver, etc.) or had a surgery early on in life, and they seemed to help.

Examples I use in practice include supplements for joint health, which have been helpful in patients with chronic cystitis, as well as fatty acids (omega-3s), which can do wonders for skin, brain, joint, liver and kidney health, and many others.

6 Promote healthy pets

If you're like me, 60 to 70 percent of the veterinary patients you see are overweight or obese. The best way to avoid this in the first place is starting healthy habits from the beginning of pets' lives.

A healthy treats list is something that all veterinarians should have available for clients and is best presented during puppy or kitten visits. My list consists of fresh fruits, vegetables and even yogurt. (It's a list compiled from Chow Hounds: Why Our Dogs Are Getting Fatter—A Vet's Plan to Save Their Lives by Dr. Ernie Ward.) Most clients are wowed not only by the everyday foods that appear on the list but also the affordability. I always tell clients that the cost of a bag of carrots is nothing compared to a box of dog biscuits—and the nutritional value is exponentially better. Once the clients see they could be saving a lot of money as well as feeding their pets more healthy treats, they're thankful we took the time to talk through the list.

For pets already experiencing weight issues, during the exam I explain to clients how to determine a pet's current body condition score. I ask how he or she feels about the pet's weight (underweight, ideal, overweight or obese) and then give my professional opinion.

I've also joined other veterinarians in formulating personalized weight loss plans for my overweight and obese patients (see "Keen on weight management" below).

If you take only one thing from these tips, it should be this: One of the best ways to increase your gross production—and your success as a veterinarian—is to find your own business niche in daily practice. Mine is focusing on pet health and formulating weight loss plans for my patients. I've found if I go the extra mile to really work with my clients to come up with a solution, they are more satisfied and more loyal to the practice.

Keen on weight management

In my weight loss plans, I discuss the pet's current weight, ideal weight and the amount of daily calories necessary to get to the ideal weight. I have a document that I use to quickly input the data and calculate the calorie needs based on the selected diet.

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I set monthly weight loss goals and ask clients to bring the pet each month for a weight check. I also schedule a reassessment appointment for one or two months.

I definitely recommend charging a small fee for the weight loss plans because you're using your own personal time to create them. When I practiced in North Carolina, I only charged $10—but first I discussed it with my boss. For associates whose bosses are hesitant to charge for the plans, here's a recommendation: Propose that the associate keep a certain percentage of the client charge—this can either go straight into the paycheck or go towards production—and the business gets the rest. Keep in mind that these plans are a great bond builder as well as a unique niche for an associate to pursue.

To see one of Dr. Keen's original weight loss plans, head over to dvm360.com/keenplan.

Dr. Keen is an associate at the two-practice group of Jackson Animal Clinic and North Madison Animal Hospital in Jackson, Tenn.