Finding success in mixed animal practice

Video courtesy of a partnership between dvm360 and The Des Moines Register

One day Rexanne Struve, DVM, saw 16 species of animals at her mixed animal clinic. The owner of Veterinary Associates of Manning, a small town in western Iowa, Struve hops from spaying a cat to pulling a calf to evaluating lameness in a horse and back again. She says it’s what makes mixed animal work so rewarding. Toss in work with an ostrich, an exotic pet and a pocket pet, and it’s all in a day’s work.

As a rural mixed animal practitioner for 37 years, Struve—like so many others—has watched large animal work decline with the country’s dwindling number of family farms and economic challenges. Yet, she and others have found success in mixed animal practice. In fact, some experts say rural mixed animal practice is on the rise. Dan Posey, DVM, Dipl. ABVP, director of special programs at Texas A&M University, and clinical associate professor in the large animal department, says he sees more students going into mixed animal practice rather than large animal practice only. “Texas A&M has always had a high percentage of mixed and large animal graduates—25 percent to 30 percent,” Posey says. “And as the economy contracts, their employment options shift. For example, as equine opportunities have decreased, students find more opportunities in small animal and mixed animal practices.”

The draw to this type of work is the skill set they come into veterinary school with, says Posey, a long-time mixed animal practitioner himself. “Students come to our university with a compassion and passion on their heart for rural communities, and nearly 80 percent of our students already know the direction they want to go. Their background and the doctors they have worked with help shape that desire to work in mixed animal practice.”

Posey says that when serving a rural area, the mixed animal veterinarian is the norm. And for students who like rural living—especially those who grew up or have already worked in rural areas—mixed animal practice is a natural choice.

Rexanne Struve, DVM, examines a horse’s teeth while tending to animals on a farm near her mixed animal practice, Veterinary Associates of Manning, in rural western Iowa. Photo by Christopher Gannon/The Des Moines Register

Rural life rewards

Steven Hjartarson, DVM, grew up in Cut Bank, Mont., a town of less than 3,000 people. After graduating from veterinary school in 2003, he worked in a three-doctor mixed animal practice in Hermiston, Ore., for five years. Then he returned to his roots in Cut Bank. He bought the clinic he had worked at in high school—Northern Veterinary Clinic—to do the type of work he always dreamed of doing. After years of being away, Hjartarson was now married with a young family and back in his hometown where his parents and grandparents still live, running the practice in which he got his start.

“Our local paper did an article about me going rural, talking about the movement of young professionals moving to more rural areas based on family values,” he says. “And that was one of the draws for me, to raise my family in a small town. My wife works in the same school my 6- and 8-year-old children attend, and we know the parents and children that our kids interact with. Living and working in a small town gives us a feeling of security.”

Hjartarson also loves the idea of rural practice—treating whatever kind of animal comes through the door. He says he enjoys offering front-line care for as many clients as possible, no matter the kind of animal. “I think that stems from my ideas of what a veterinarian does from when I was a kid,” he says. “That’s what I saw growing up in this community. Though I felt a bit nervous about coming home again.” He says it took a while for some residents, including his former teachers who had known him as a child, to acclimate to him as “Dr. Hjartarson” rather than “Steven” the child, but time and some practice experience hastened that transition. However, he says being an “insider” who returned home also worked to his advantage.

“I already had a history with the town, as opposed to a new person setting up shop where no one knows them,” he says. The town of Cut Bank is currently experiencing a generational shift, he says, in which many businesses are being taken over or managed by children or grandchildren of the original owners. “Our town is very supportive of people coming back and investing time and energies in the town,” he says. “It’s this small-town community attitude that has helped me be successful, as we all take care of each other.”

While knowing all his neighbors—and clients—has definite advantages, Hjartarson says it can be tricky to work and live in such a tight-knit community. In a suburban or urban area, the chance of running into a client who owes you money while grocery shopping or attending church or picking a child up from school is fairly small, but in a small farm town, there’s no escaping difficult interactions at times. “There is definitely a difficulty being so close to people I do business with,” Hjartarson says. “Accounts receivable is a battle all businesses face, and I do run into people who owe me money sometimes. It’s uncomfortable for me, but it puts the onus on them to settle up to avoid awkward run-ins.”

Steven Hjartarson, DVM, returned to his hometown of Cut Bank, Mont., in 2009 with his wife and young family. He purchased Northern Veterinary Clinic, the mixed-animal practice he worked at as a teenager. He says his gross receipts have grown 157 percent since he purchased the clinic in the town of less than 3,000 people.

Struve says living and working in the same little town her clients do is one of the best things about rural practice. “I shop in all the places my clients do, eat in the same restaurants and go to the same church,” she says. “I love being a part of the community.” She also loves the type of people who associate with the different types of animals she sees. “A person who enjoys snakes is different from a person who rides horses or one who would own a pocket pet,” she says. “I love the variety of the people I see as much as I do the variety of pets I see.”

Posey agrees. After 20 years in mixed animal work, he says that serving your community, seeing your clients at church or the grocery store and building relationships with them is one of the best things about this type of life. “It’s funny how, in a suburb, clients know the practice name, but in a small town, everyone knows the clinic by the doctor’s name,” Posey says. “Neighbors recognize you by the care you give.”

Hjartarson recognizes the level of dedication to his clients. “It’s a challenge when you feel a responsibility to your clients to always be there for them,” he says. “But thankfully they understand that I just have to get away sometimes and be with my family.”

Posey agrees it’s not always easy. In a small town, he says a veterinarian’s role often extends beyond his or her practice. “Many veterinarians serve on the school board, chamber of commerce or church board. In some cases, you might be one of the most educated people in town,” Posey says. “Knowing that, you must always act professionally and connect with your community. It takes a certain type of person to do that well. Rural life is more than just veterinary medicine, it’s a lifestyle.”

Mixed-up schedules

In a perfect world, Struve would schedule all surgeries and small animal/exotic work in the morning and all large animal calls for the afternoon. Unfortunately, animals don’t schedule their medical emergencies and perfectly scheduled days lead to perfect chaos. “One of the biggest issues is to deliver a calf or pull a pig, come in a mess, and have to go straight into a small animal appointment,” she says. Struve often wears coveralls or rubber suits for messy appointments. Then she can quickly strip it off, wash her hands and be presentable for indoor work in a moment’s notice. If all else fails, she keeps a change of clothes at the clinic.

Hjartarson’s balances 65 percent small animal and 35 percent cattle and horses at his practice. And, he says, thankfully, the busy season for one seems to coincide with a slower time for the other. “In the summer, cattle work slows down but small animal work is up,” he says. “Then in the fall, when school starts and small animal clients are busy with other things, I see a rise in cattle work. And again in February, I see more calving work. It all balances out.”

That doesn’t mean every day runs smoothly. A good office staff helps pave the way to a more efficient day, he says. The sole practitioner has three staff members who keep his day on track and handle scheduling and callbacks. “Scheduling is one of the most important aspects of making mixed animal practice work,” he says. “I try not to schedule myself out on the field too many days to allow me to catch up at the office, and I typically don’t schedule my weekends, except for herd work at this time of the year.”

Struve says communication is key to making a disjointed schedule work. “I have to ask clients to put themselves in other clients’ shoes at times when emergencies happen. Dogs get hit by cars, cows have calves and those things don’t always fit into a schedule, but I need to care for them. Thankfully clients usually understand.”

Technology triumphs

Hjartarson’s cell phone is a lifeline for his small-town practice. He forwards emergency calls to his cell phone and responds as quickly as possible. “I may not always be available to see the client, but a phone call offering a second choice goes a long way for client relations,” he says.

Besides using it to keep in touch with clients while on the road, he also takes cell phone pictures of analog radiographs to send them digitally to his former professors at Washington State University College of Veterinary Medicine for analysis. “I still draw on the experience of my professors at Washington State on a weekly basis,” Hjartarson says. “I e-mail or call them regularly for second opinions or guidance on different cases. I also connect digitally with a referral practice that’s two hours away, sending them digital pictures, differential lists and blood work results. They help me decide what to do, and whether I need to refer the patient for further help. Technology allows rural practitioners access to a greater pool of experience, more quickly than in years past.”

As the sole practitioner for 37 years in a rural community of 1,500 people, Struve has seen technology change drastically. She says digital radiography stands out as one of the best technological advances for the rural practitioner. “We frequently send digital radiographs to a referral center in Des Moines, Iowa, for interpretation,” she says. “Clients appreciate the extra set of eyes on their patient, and it helps build trust in us that we are doing the right thing.”

Computer reports that remind staff members to make callbacks is a practice builder for Hjartarson. Depending on the type of visit and the severity of the animal’s issue, he will have staff members call the client one to 10 days out from an appointment to check on the animal. “I don’t always have to physically see the pet, so a simple phone call shows clients we care and helps extend the time I have available to see other patients,” he says.

Creative revenue

Struve says to make the most of a mixed animal practice rural veterinarians have to look for new opportunities. “You need to think entrepreneurially and look at additional revenue streams,” she says. “Cattle work might be on the decline in some areas, but that doesn’t mean revenue has to decline, too.”

Struve currently employs an adjunct business to her practice. She cares for cesarean-derived colostrum-deprived (CDCD) pigs that vaccine companies use to test vaccines. “In rural areas, there are plenty of opportunities for veterinarians beyond just getting clients in the door,” she says. “This has been a great source of practice income for us. A mixed animal practitioner definitely does not have to work an adjunct business to be successful, but in a small town, you have to reach farther to draw in business.”

For example, Struve says many veterinarians eschew hobby farms as not worth the time, but she calls that a missed opportunity. “If your practice is one of the few in the area who serve these clients, you can turn it into a real profit center,” Struve says.

She purchased specialized equipment most doctors in the area don’t have: a surgical and therapy laser, ultrasonic dental scaling machines, full blood machine, digital radiography, a pulse oximeter and a Doppler machine. She says that not all practices in a small town offer these types of equipment and that’s a big selling point for her practice. “Instead of letting those tools sit on shelf, we learned how to use them well and market the practice as a place that offers high-quality care,” she says.

“Mixed animal practitioners, especially in rural areas, need a different mindset than just waiting for the phone to ring and clients to walk through the door. When you live in a rural area with clients more spread out, it takes more work to get them in the door. You don’t have to buy fancy equipment or see every kind of animal, but then again, those extras will make it easier to attract clients. Our client numbers are high, we keep busy, and clients come from all over to see us.”

Sarah A. Moser is a freelance writer and editor in Lenexa, Kan.