It’s been a wild few months, to put it mildly. I’ve seen less change resistance in veterinary medicine since March than in the previous entire decade. Some practices are thriving, others are struggling, others are so busy you can’t even get to them to ask how they are doing.

Our CSRs, the front lines out there wearing five hats at once, are worn out. The phone lines are ringing off the hook, people are in the parking lot banging on their horns, and the episodes of poorly behaved pet owners are escalating day by day. They’re frustrated. You’re frustrated. The stress levels are through the roof.

The summer rush of patients is anticipated to start early, driven by all of those backlogged non-essential procedures angling to catch up. If clinics hampered by staffing issues are struggling to keep up with the demand now, just wait another month, right? Are you full of anticipation at the idea of a 30% increase in revenue, or dread?

There’s a really good solution. And before you say anything, I am not one single time going to suggest you forego an abdominal palpation or otoscopic exam in the name of progress.

In the midst of the stressful times, I have spoken to some veterinarians, technicians, and practice owners who are thriving and happier than ever. Why? They tried something different.

Telemedicine vs Virtual Care

The AVMA is reporting 30% of clinics are using telemedicine now, but they don’t quite explain what they mean by that. Maybe 30% of clinics got themselves a telemedicine platform, but far fewer of them are actually using the tool to its full extent based on the discussions I’m seeing in the Veterinary Telemedicine Facebook group. It’s a sort-of kind-of add-on that’s there but no one really wants to use it because 1. They don’t know how, 2. They don’t know how to explain it to clients, 3. They think telemedicine = live video visit, and nothing else.

Let’s back up a minute.

First, let’s make sure we’re all on the same page with what we mean when we say telemedicine. Technically speaking, telemedicine means using any remote tool to diagnose or prescribe, and it requires a VCPR.

But most of what we do doesn’t require a VCPR. If you look at the bigger bucket of all the things we do and what we communicate to clients, most of it doesn’t. Many people use the word telemedicine when they’re talking stuff that doesn’t require a VCPR, and it’s making the conversations really muddy. So let’s call that bigger bucket virtual care, ok? Any time your team communicates with a client other than in a face to face interaction, that’s virtual care. Phone calls. Client education. Answering questions. Triage. “Is this normal” calls. None of that is telemedicine, technically, though telemedicine also goes in the virtual care bucket. It’s a big collective heap of things that we’ve undervalued for YEARS because we have this idea in our head that everything you put in leading up to a diagnosis isn’t worth anything, but a diagnosis is worth everything.

We make this entire bucket of communication tasks take place in the clinic, with the staff present that day. Why? Because that’s the way it’s always been done.

The Expanded Universe

Why can’t we create a virtual care team that can work from anywhere, handling these tasks and allowing the onsite staff to handle only the tasks that really need to be handled in house? Really, why? Change resistance, our old friend. We meet again. Good to see you. It’s been, what, ten years? Right around the time Facebook popped up and some of you were still spit-polishing your fax machines.

Granted, the virtual care concept is very different from how we practice now. I would venture to say, based on the ever-present number of articles about how our colleagues are in an emotional hellscape, this is a GOOD THING. I call it the Expanded Universe of Vet Med (and I expect Adam Greenbaum to help me amplify this concept. 🙂 )

This isn’t me throwing some half-baked idea out there. Dr. Ericka Carroll just published an entire masters’ thesis on the concept of virtual care teams. Dr. Hannah Cheng-Lau has been practicing as a remote veterinarian for a clinic in California, from her home in Virginia, for over a year. Modern Animal and Bond Vet are two companies built from the ground up around this concept, and they are cleaning up. Virtual care teams are a concept already in execution with great outcomes.

Much of the resistance comes from the fear that virtual care intends to move the entire interaction, including diagnosing, online. Don’t get me wrong, I think that is an option that should be available when warranted, but what I’m talking about can be implemented anywhere. Even in California (cough cough).

Those time-consuming tasks, like returning phone calls and refilling prescriptions, often get pushed to the end of the day because we’ve got too much to do in the clinic. They’re low value to us. We don’t value them or ask to be paid for that time. But to an anxious client, these are high-value interactions. They’re anxious. They’re looking to us to solve their problem, and we get mad because they’re frustrated and leave over the top one-star reviews. A good chunk of the time there was some sort of communication breakdown leading up to the scribe.

The reason we’ve never done virtual teams before is because we haven’t had the communications tools to make it realistic. That’s no longer the case.

With today’s tools like Google chat, Slack, WhatsApp, in-clinic and remote teams can communicate in real time. Remote access to your PMS and a team attitude of collaboration is essential. Virtual technicians dedicated to client support can handle all those “is this normal?” calls clogging up the lines. A virtual veterinarian can do follow-ups, refill prescriptions, and do the very important work of preparing a client in advance of a necessary visit what diagnostics they need and why. If a pet needs a hands-on exam, they still get one- and they arrive prepared, spend less time in the clinic, and thrilled because their needs were addressed.

This is really good for clients who receive faster access to care, more health literacy, and better outcomes. But wait! There’s more!

Work Life Balance

I suppose I’m extra passionate about this because I’m one of the many, many people who left full time clinical practice because I couldn’t physically commit to 40+ hours a week outside the home when my kids were little. I’m one of the mothers with the primary childcare burden who struggled with the idea of giving up on something I still loved, for someone else I loved, but didn’t see many options. I would have jumped on remote care in a heartbeat. Less than a heartbeat. Want flexibility? Team members can be 100% remote, or rotate being in house and at-home. Do you have any idea how many veterinarians, really smart and really resourceful ones, are dying for this to be an option?

After ten years of hand-wringing over work-life balance, brain drain from the profession, staff shortages, and burnout, here’s an actual solution sitting right in front of us and we didn’t even see it. Well, Modern Animal and Bond Vet did. If you think otherwise, count yourself in among the people who came up to me after a 2011 social media lecture and told me you didn’t need anything but the yellow pages to be a success. Enjoy the status quo while you can.

Add to the experience, don’t take things away

We’ve spent the last five years arguing over the value of veterinary telemedicine because the assumption has always been it’s taking something away- that hands-on exam. But with virtual care, you’re taking nothing away. You’re just handing off chunks of the client experience into the Expanded Universe to a team dedicated to a patient-centered experience, which we know from the human side is the key to improved clinical outcomes. That hands on stuff like diagnostics? Still there, still in house. You just have more time to focus on them because your colleague is 5 miles away doing the callback with the client who always takes up 30 minutes of your time.

Instead of viewing virtual visits as a separate entity, look to virtual care as one integrative part of the client experience. Virtual team members have more time to talk, more time to educate, and more time to increase that client’s loyalty to your clinic. You’re moving staff into the Expanded Universe where they’ve desperately wanted to be this whole time. You’re employing that technician who quit because she has an immunocompromised relative at home and she’s scared of exposure to COVID.

For those states that do allow a remote VCPR, yes, those remote veterinarians still use their clinical judgment to ensure the pets receive appropriate care and route patient to the hospital for necessary things. Just ask the Ontario VMA, who have not yet collapsed into chaos with remote VCPRs in place. Quite the opposite. If you don’t have the ability to establish a remote VCPR, don’t have your remote vet diagnose or prescribe. Their time still has extraordinary value.

So what do you need to make this happen?

  1. The right attitude. This more than anything. Accepting a growth curve, and a team that works together instead of at odds with one another, is crucial.
  2. Remote access to records.
  3. Good triage guidelines. This isn’t any different than knowing when to send a pet to the ER. Have some guidelines as to what is and isn’t an appropriate case for virtual care. We have examples in the VTC Facebook group.
  4. A killer website. Your website can do so much of your heavy lifting. You can educate about virtual visits, put up marketing tools and blogs, get clients to fill out forms and payment ahead of time, let people schedule virtual visits, and it’s all passive. WhiskerCloud has a great blog about what they’ve been doing and it’s awesome.
  5. Efficient communication tools. In order for team members to collaborate and provide continuity of care, you want the ability for the remote and in-house teams to function as a unit. Chat, messaging platforms, or a tool like Slack are all good options.
  6. A good telemedicine platform. Ideally with 2 way messaging as well as live video, because messaging is the overwhelming preference of clients.

If you market this correctly, clients love it. Team members are clamoring for it. Virtual care offers flexibility, convenience, fewer tied up phone lines and more time for surgery and high-revenue care. Will people pay for it? Through the nose, if you provide an incredible client experience.

The future is already here, and wow- it looks pretty great.