DVM Newsmakers: 'Remember theTitans;' Big practice, big medicine: Is the standard of care changing?

It's considered the largest privately-owned veterinary practice in the country tipping the scales at 58,631 square feet. For Dr. Anthony J. DeCarlo and partner Dr. Thomas S. Trotter, the distinction wasn't even part of the design.

The building, on the other hand, was "a result of what kind of practice we wanted to have," DeCarlo tells DVM Newsmagazine. "Our goal was never to be bigger than the next guy; it was to design a building that met our needs, and this was the end result."

This project was the culmination of about $15 million in total costs and five years of planning, initially soured with a frustrating financing deal that ultimately was sweetened by the courts.

DeCarlo, who focused his practice on neurology before becoming a full-time hospital director, was asked about this project, his practice philosophy, client demand and the changing sophistication of medicine.

"Even from day one, which was in a 800-square-foot dumpy little building, this practice was built around an attitude. The attitude was about being professional and offering the best service we can to clients."

The attitude grew, and so did its staff.

The new practice employs about 240 people — 40 veterinarians, 85 technicians and a slew of support staff. DeCarlo and Trotter also own South Jersey Emergency Service and a physical rehabilitation facility (add another 30 people).

This general and specialty-service combination offers an array of specialties, including cardiology, neurology, dentistry and oral surgery, internal medicine, oncology, ophthalmology and surgery, and a suite of state-of-the-art technology, including MRI, CT, digital radiography and radiation.

Marching orders for Red Bank Veterinary Hospital staff are simple: Base medical decisions on the best interests of clients and patients. "One thing we all learn at a point in our life is that everything we do as veterinarians is about people. I always cringe when I hear people say I want to be a veterinarian but I don't like people,"says co-owner Anthony J. DeCarlo, DVM.

Complex structure, simple mandate

DeCarlo admits that his guiding management principles are simple.

Take care of your staff and your clients, and you will succeed.

It's the intellectual capital in the practice that makes it move, he says. When you strip away the 280 tons of structural steel or the 24,000 square feet of marble panels or even the 3,000-gallon salt-water aquarium in the reception area, it's the practice's staff who ultimately determines success or failure.

"That is the exciting part, putting a good group of people together who like working together. It is also the challenge. As you get more and more employees, it becomes a bigger and bigger challenge. There is no question the biggest challenge in running any business should be your staff."

DeCarlo asks all of his managers to watch the movie "Remember the Titans". "There is a really good line in that movie: 'Attitude reflects leadership'. I really believe that.

"You learn over the years to divide people into a lot of different ways. One of the ways is that there are people who just move ahead and others that might analyze things to death and not do anything. We are kind of the first. From the day we opened the business, we never thought about how much money we would make; we thought about getting to work and making each day better."

While the professional trend is to upscale existing facilities, it doesn't always translate into what clients really want, says Dr. Anthony J. DeCarlo.

The philosophy has garnered the practice a 20-percent growth rate every year since its birth in 1986.

Interestingly enough, DeCarlo doesn't worry so much about the financial aspects of the business. He and Trotter hired a chief financial officer to help keep them on track and figure out new ways to offer more benefits to employees.

His longstanding guiding ethos is that all of the practice's decisions are based on what's in the best interest of the patient and client, not the bottom line.

Though he declined to comment on its practice gross, one can imagine that maintaining such a large facility is an expensive proposition. Just consider these monthly expenses:

• Electric: $3,750

• Gas: $2,500

• Water: $2,000

• Health insurance and dental: $39,000

• Most expensive piece of equipment: linear accelerator, $180,000.

"When you move into a 58,000-square-foot building, the cost of garbage pails is pretty astounding to put in perspective," he laughs. They spent $2,500.

Anatomy of a giant

The reality is, this practice needs patients. And they are getting them. Close to 130,000 animals will move through Red Bank Veterinary Hospital doors a year. Client numbers are estimated at 300 to 400 outpatients each day.

Management mistake No. 1, DeCarlo says, is to look at gross revenue as a barometer of success. "That's not the way I look at things. My feeling is that if you start looking at how much you have to make, you are making some bad decisions. As long as you hire the right people, offer the right services, the rest happens."

To prove the point, DeCarlo and Trotter foster an enriched environment for staff and clients. It's paid off. During a 19-year period, the practice has only lost six permanent doctors. To keep morale up, extras where built into the facility, such as a fitness center, a catered kitchen and a spread of employee benefits. For clients, he offers valet parking, among other things.

And even though he and his partner built this massive hospital, DeCarlo says bigger hospitals don't always translate into delivery of better medicine; it's about the people in the hospital no matter what size.

Changing market

While practices are consolidating and growing in size, DeCarlo says it would be a professional detriment if personal client attention gets lost in the transition — a quality attribute he bestows on more traditional practices.

He readily admits that the trend might be to build upscale multi-doctor hospitals, but it is not always reflective of client wants. Remember that about 70 percent of the profession is based on the model of a two- to three-doctor practice size, he says. "One of the problems in this country is that businesses don't really consider the needs of the average consumers. There are clients who love two-to-three doctor practices, and the only reason they come here is to get a certain level of specialty care and equipment. They will go back to their practice because that is their style."

With that said, DeCarlo says many external forces work to change the level and sophistication of medical delivery — from malpractice claims and new government mandates to the changing expectations of pet owners. There also are extremes in the quality and level of medical delivery in this country, he says.

"There are many challenges in the way veterinary medicine is delivered from the country doctor, to university-level medicine to the level of training veterinarians receive while in school. Is someone or some outside group going to dictate the standard of care? I don't have an answer, but it is a huge question," he adds.

But as this level of sophistication grows, it might push practices into further consolidation just to keep pace with pet owner needs and technological developments.

Sophistication comes with a price.

Tough road

When DeCarlo and Trotter sat down to plan out the elements of their new hospital, it was based on a mutual decision to take their practice to the next level.

"We had really kind of overfilled the building we were in. I didn't feel there was any reasonable strategy with the kind of place we had to stop growing without actually shrinking. In other words, if you are a referral practice and you start refusing patients, then why would those other practices continue sending anything over? We had to make a decision to either continue to expand or end the process. We decided to continue."

The next stage was to find a piece of property. It took about a year, and there was a catch. The elderly property owner wanted to lease the land to the practice and sell it upon her death. DeCarlo and Trotter wanted the property, so they moved forward. It was this detail in dealing with the first bank that would pose numerous delays for the project as well as create a feeling of loss of control over the direction of the practice. They were soon on a refinancing trail.

"We had two problems with financing. There was nothing to compare this hospital to. How can we compare the value of this building to others when there aren't any? The second part is they felt uncomfortable with the fact that the property wasn't owned. That was a huge hurdle."

Initial delays in financing and construction were taking its toll on staff morale.

They rolled the dice.

"We went out on a limb and started the project without bank money. We actually had the steel frame up before we got our first installment from the bank. It was a big gamble on our part. But if my staff didn't see a shovel going into the ground, I think they would have been pretty frustrated."

The gamble paid off. The practice moved into the new building in late 2004.

For DeCarlo, success isn't defined by a building.

"Anyone's success should be based on the fact that their personal life is growing and moving in a forward direction. I think if you start measuring success, then you just start failing. I don't have an endpoint. I am not saying that I just want to get bigger and make more money, I am saying it's more about quality."