March 25, 2002

***** Logging started: 3/25/2002 6:49:10 PM

Heather Howell: So, our topic tonight is Techs doing appointments - is that or would that be a benefit to your practice. To get started please let me know whether you work as a tech or another position at the hospital you are at.

Jamie: Tech
Rhonda: I'm a Tech
Heather: Tech
Debbie: I am office mgr/ receptionist - with tech fill in - I where many hats
Phyllis: Office manager
Cindy: Tech

Heather Howell: Okay, do any of your clinics have "tech appointments" now? Yes or No? GA all

Phyllis: yes NT, anal glands, Adequan inj, Bordetella Remove suture also
Jamie: yes anal sacs, heart worm tests, other blood drawls, behavior, weight management, s/r, dentals
Rhonda: No. In my clinic we don't have techs in appt. I would like advice on how to work on this.
Heather: yes puppy and kitten boosters, tnt, hw tests, s/r, anal glands
Cindy: Behavior consults, dental exams
Debbie: yes only for 3-4 week follow-up boosters and s/r thinking about doing dental exams too

Jamie: How worried are you about legal issues when it comes to technicians doing vaccinations? I know rabies would be out of the question

Heather Howell: It depends on the state regs. Some states allow it if the animal has been examined by a veterinarian within a "reasonable" amount of time prior. Others require an exam that day. Some don't specify. So, check your state regs before doing this

Jamie: ok

Heather Howell: What benefits do you all see to having "tech appointments"?

Cindy: It frees up our vets time big time, so that we can have lots more done, more appointments...etc...
Phyllis: I agree with Cindy. We go with 30 minutes appts and no use having a dr spend that time on a remove suture.

Heather Howell: Do you schedule a column on the appointment book for these?

Phyllis: yes
Debbie: does everyone consider appts for blood draws, etc tech appts- .... ...we don't because the tech would be doing these anyway if the doc recommended them during an exam
Cindy: yes we just indicate them on the book, but we don't set 'aside' time for them. It just let's us know they are coming.

Heather Howell: At our clinic those are "drop ins" or tech appointments. ...whichever the client prefers. But I think it's a good idea. Yes, then you can pull the chart ahead of time, etc. What pitfalls have you seen with tech appointments, what doesn't work?

Debbie: okay, we do like Cindy ... I was wondering because I thought we were talking about stuff DVM usually do. Clients who have questions only the DVM can answer- you know scheduled for a 3 week follow up (i.e. booster and then say, by the way my dogs been limping)

Heather Howell: How do you handle that Debbie?

Debbie: If the doc has an open appt, we see the doc, if they don't we give the vacc and schedule an appt later when the doc is available usually it s the later

Heather Howell: Does that annoy the client?

Phyllis: Yes it does
Debbie: sometimes, but I rather annoy that client who was informed that it was strictly a tech visit, than make the client who has a "real" appt made because we ran late

Heather Howell: Do you ever day hospitalize the animal for the doctor to look at and the client to come back later?

Debbie: No - that makes my DVM mad and no fun to work with!
Phyllis: We do.

Heather Howell: Does that make the clients happier Phyllis?

Phyllis: Sometimes.
Cindy: I still have a comment about the pitfalls.... Pitfalls: when a tech appointment turns into a dr. appointment, usually because the client wasn't clear on the phone, and then it screws up our schedule because we hadn't planned on it that way.

Heather Howell: How can that be avoided? Do the receptionists make it clear that a tech appointment only has been scheduled and the doctor won't see them?

Cindy: I guess we 'trust' the clients too much. If they say they need s/r, but neglect to tell the reception that it is actually a drain removal that is NOT looking good, you know, something like that.
Rhonda: We only keep an animal if it needs extra work up, but the Dr. is the one who kept that animal.
Phyllis: What our problem is - when there is an opening so the dr can see them and the next time there is not, the client doesn't understand why they can't be seen the second time right away.
Debbie: Phyllis- we are very dramatic in letting our client know how LUCKY they are that we happened to have an opening. And we also note in the chart that it went from a tech appt to a dr appt, so we can "catch" habitual clients so our staff can be aware of this when scheduling future appts
Phyllis: We do have the receptionists confirm what exactly they are coming in for and who it is scheduled with and we still have problems.

Heather Howell: Would you say the problems are the exception or the rule?

Phyllis: About half and half.
Debbie: We were having a problem with "sticker" shock when the simple suture removal changed to a dr check skin appt., so now I confirm that there will be a dr exam fee before putting clients into the room. However, I worry that people will think that we are putting $ before dog. any suggestions?

Heather Howell: This all seems like a communication issue to me. If the clients are given a choice to see the doctor or have a technician appointment and it's made clear what that entails it seems like some of this could be avoided. Then if they are in a tech appointment and given the option to become a doctor appointment I think it's best to let them know that there will be an exam fee.

Cindy: We had this one client that 'figured' out the system, and routinely called in to get a tech appt ASAP, knowing full well that she would demand to see the vet when she got there. From our experience, clients routinely think we put $ b4 their pet.

Heather Howell: I think if it's phrased like, "We really need to have Fido see the doctor today due to .....would you like that? " and then "Would you like an estimate?" that gives them the option and makes them aware that you are trying to convey that info to them

Debbie: that's why I try to avoid that impression funny thing is my DVM truly doesn't (I am constantly on him to raise fees)

Heather Howell: Do you all feel tech appointments are mostly a benefit or cause too many problems to be worth it in your practices?

Debbie: benefit
Phyllis: benefit
Cindy: benefit

Heather Howell: How do you train your staff - the receptionists scheduling and the techs doing the appointments so they are prepared?

Cindy: reception AND techs scheduling appt's, and techs doing appt. Actually, if it was something like a nail trim, whoever was available would do it, reception or tech.

Heather Howell: I would suggest having them shadow some one experienced in tech appointments. Then role playing with some one experienced. then being shadowed by some one experienced while doing a tech appointment.
We also have a binder that has all the handouts pertinent to tech appointments and "scripts" for various appointments that techs can refer to.
We have a list of the type of appointment that can be seen by a technician and how long to schedule for the receptionists to refer to.
We also practice with the receptionists what they should say to communicate to the client what type of appointment it is and to make sure they have offered the doctor as an option.
Any one else have staff training ideas to make tech appointments run smoothly?

Debbie: We have also outlined when to schedule tech appts. That way a receptionist doesn't schedule a tech appt when the tech is assisting in surgery, etc

Heather Howell: Good point. I think tech appointments can be a great "client bonding" tool. The tech can be a great patient advocate, letting the client know healthcare issues, spending more time loving the pet, etc Many clients don't ask the doctor every thing on their mind or don't want to take up docs time but will ask the tech questions and advice on caring for their pet.

Debbie: we are considering starting having tech do free "does my pet need a dental cleaning" has anyone done this?

Heather Howell: I've seen a lot of clinics do that. The tech "grades" the mouth and circles the corresponding picture on a CET or other brochure so the client has some thing to take home...This reinforces what the tech says and lets the client know where their pet's mouth is in relation to others (worse or better). Then a recommendation can be made for home dental care or scheduling a dentistry etc.

Debbie: One of the biggest reason we are considering this is so that the tech knows how much time to allot for NP dentals.

Heather Howell: That's a good idea. If the grade is written in the chart then when they schedule appointments you'll know how long to plan.

Cindy: yes, if the vet thinks the pet could use a dental, he will finish up his stuff, then call the tech in for a freebie checkup

Heather Howell: Do the techs teach clients how to brush teeth in the appointment as well?

Cindy: yes
Debbie: we only have one exam room, so we discuss brushing in the lobby, which often gets other clients thinking about dental health (same way we scan for microchips after implantations

Heather Howell: Where do you do the tech appointments when the doctor is in the exam room?

Cindy: we have 2 exam rooms
Debbie: we take pet into treatment room or in the lobby when no other clients are around (s/r -big dog vaccs)

Heather Howell: Another good idea is to scan for microchips when weighing all animals before appointments. Then if that pet isn't microchipped the client asks what you are doing and you can tell them you're checking for a microchip identification.

Debbie: ! ooh I like that one!

Heather Howell: Well, thanks for coming. Have a good night and hope to see you at another chat or on the boards. Good night.

***** Logging stopped: 3/25/2002 7:51:52 PM

Participants: Cindy, Debbie, Heather, Jamie, Phyllis, Rhonda