Consultation times

RE: Consultation times

Martin Hamilton — Fri, 07 Sep 2018 21:43:15 GMT

https://www.vettimes.co.uk/news/pet-owner-concern-over-short-consultation-slots-research/

Saw this and it reminded me of this thread

RE: Consultation times

Anthony Dennison — Fri, 31 Aug 2018 12:45:59 GMT

At our main hospital we have a system similar to how Emily described. 2 consulting streams, with 2-3 vets consulting. Morning consults are 8.30-11.30am (one stream ends at 11am). Then in the afternoon one stream starts at 3pm and goes on until 8pm, other stream is 3.30-6.30pm.

Always at least 2 consulting vets in the building, one works 8.30-6, other does 9-6.30.

On call vet starts at 4.30pm, inpatient rounds normally between then and about 5.30. On call vet will start consulting 6pm-8pm then see any OOH appointments.

Works well most of the time but if we're short staffed can be tight as consulting vets often have to pick up the slack with ops which then makes the day longer. I often get scans or medicine case work-ups booked in for me, sometimes they're all on the same day so I may have 5 or 6 scans to do and then work up between 11.30am and 3pm which isn't really enough time to do properly (I'm being marketed as an internal referral service).

RE: Consultation times

Niall Taylor — Fri, 31 Aug 2018 11:44:00 GMT

[quote user="Lucy Fleming"].Niall Taylor will tell you how I have been a thorn in his side for years begging for us to have 15 minute consultations . [/quote]

No, no, not at all, we appreciate and encourage pro-active input from all stakeholders in a variety of customer-facing and other service-critical areas going forward!

Actually I think the 20 minute appointment time is going ok, although the weekends are still rammed, not sure what to do about that.

RE: Consultation times

Julie Innes — Fri, 31 Aug 2018 09:00:15 GMT

I agree with Gillian, regarding the increased cost of the extended consultation. If we were to switch to 15 or 20 minute appointments we would need to increase our charges accordingly (the consultation charge is, after all, for our time) but I don't feel most appointments need that length of time, and it would price a good few of my clients out of seeking vet treatment at all.

We give a double appointment for 2nd opinions/ complicated cases. Anything that needs worked up is either admitted or brought back. Bloods can be taken by a nurse and the owner telephoned later. Nurses can also do xrays in an emergency while we see other patients.

If you have a good team out the back, I don't feel there is any need for every appointment to be 20 minutes

RE: Consultation times

bevs2251 — Fri, 31 Aug 2018 01:50:37 GMT

Most practices in Australia run on a 20 minute appointment system, slotting in walk-ins when some time available. Old school "open surgeries" are rare now, except for some dino solo vets and some country practices. 20 minutes seems standard. Did get used to the 10 minute UK style when locummed there in 1988 - does improve one's "pattern recognition skills". However, these days, a full body check over is expected which, along with diagnostics (bloods, FNAs), deciding on Rx, dispensing meds and billing the invoice, will take longer than 10 minutes (vets usually dispense medications + bill the invoices here, not the nurses).

Consulting periods are often 9am-12 noon and again 3/4pm-6/7pm with surgery performed in the middle of the day, so 6 hours total consulting, and 2-3 hours allocated for surgery. In some practices, one vet may be rostered to start the surgeries from 9am while the other vet(s) consult. If enough vets, consultations can be booked all day with staggered lunches (most places these days usually only allocate 1/2 hour for lunch, unpaid !).

In 1995, in my own solo practice, I still ran by the "open surgery" system but then employed a vet nurse who was on the OCD spectrum. She hated the uncertainty of the walk-in system so we changed to appointments. Took a year or so for people to get used to, and some never did (always just turned up whenever, no matter how many times they were advised of the appointment system !).

Started out in 1985 on the non-appointment system but wouldn't go back to it now. Have worked in practices in the last few years that ran by non-appointment system - hated going back to that. Always scored the "Friday night special" right on closing time, of course ! Often stuck back an hour or more, at same rate of pay, mind you !

Consultation fee here is approx UK 42 pounds (on par with private doctor consultation fee), some places cheaper than that. No discount for follow up boosters but multi-pet consultations have a reduced consultation fee.

RE: Consultation times

Gillian Mostyn — Thu, 30 Aug 2018 21:34:50 GMT

[quote user="MartinH1"]The difference in reviews on social media are quite telling on what people prefer[/quote]

Can't we charge less and still have good client satisfaction? They aren't mutually exclusive. We just have to be prepared to see more clients every day!

£55 is a hell of a difference from ours, at £30.50. It would certainly mean a massive increase in practice profits. But I do think that it is rather a lot of money for a consultation. A days wage for most folk.

I do worry that we really are making vet care unaffordable, and putting too much strain on charities. I'm the first to say clients should be insured, but with most insurances having a 100 quid excess, the consultation charge for a simple problem can still be unaffordable.

But I'm obviously rare in consulting for 5 or 6 hours every day.

RE: Consultation times

Gillian Mostyn — Thu, 30 Aug 2018 21:25:43 GMT

[quote user="Martin Atkinson"]But you're sole charge as well so doesn't the same apply to you?[/quote]

No...I employed another 3 vets and had a very large debt hanging over my head.

And now I am simply an employed vet anyway, albeit still sole charge. But I guess once a grafter, always a grafter!

(I really don't feel I short change my clients in any way. I just work hard. But compared to the job my dad did..a builder...it isn't hard anyway. After 20 years, most appointments are pretty straightforward. You just have to be experienced enough to tell which ones aren't.)

RE: Consultation times

Liz Barton — Thu, 30 Aug 2018 19:05:58 GMT

[quote user="Clive Ansell"]That said, where I am currently working we have an excellent team of nurses tat will do any blood work or basic radiographs if needed[/quote]

I think 10 min appointments are fine where you have a sympathetic team. I have worked places that do and places that don't. In the latter 'Really sick, deteriorating' is booked for 10 min next to 'Itchy dog'. The nurses take about 10 minutes to locate and reception cancel the much needed 'catch up' for 'Difficulty breathing'.

If you have a well functioning team looking out for each other then 10min is do-able. But I still find myself rushing with a lot of consults (sure a bit of thumb twiddling with a straightforward vaccine), rather than building a rapport with the clients.

I prefer OOH consulting - taking as long as I like and being thorough with each consult.

I wrote a blog on this on Vetsnet, including links to articles and studies on consult times. With the increasing demands of an instant society I think 10 minutes is rapidly going out of fashion!

https://www.vetsnet.net/end-the-10-minute-consult/

RE: Consultation times

Clive Ansell — Thu, 30 Aug 2018 18:23:56 GMT

[quote user="Gillian Mostyn"]

I think I'm working too hard looking at some of the replies in this thread!

Today, I consulted from 8.30 till 11pm, then did two ops (bitch spay and cat castrate), did last week's banking, had just under an hour for lunch and then am fully booked with 10min appointments from 2.30 till 6 30 .... But with a couple of 20 minutes breaks.

[/quote]

I reckon so.

At the moment, sole charge, 10 minute appointments, I consult 0900-1030 --> ops until finished, usually between 1200 and 1300, -->off --> PM consults 1600 - 1830. Off, but on call through the afternoon. If busy and no or few ops will extend morning consults sometimes until 1200. If necessary will back book one by one from 1600 back to 1500. 1900 finish and last 3 appointments kept free for emergencies, reporting results, inpatients etc. Works really well and almost always staff get their breaks and finish on time.

RE: Consultation times

Clive Ansell — Thu, 30 Aug 2018 18:15:33 GMT

[quote user="David Mills"]

[quote user="Clive Ansell"]To put it into context a little, when I went to see a consultant dermatologist the initially appointment was 40 minutes, and that was filled with a full and thorough history, examination and discussion. No testing done at the time, had to revisit later for biopsies and bloods etc. [/quote]

Yes, but that was a referral, so it's not analogous to going seeing your GP. Referral centres will often have long consult times, but that is built into the cost.

[/quote]

True enough.

I was just making the point that a full and thorough history taking, clinical examination and discussion take much more than is possible in 10 minutes. Even allowing for banter, as Martin points out, there was good 30 minutes of work involved.

RE: Consultation times

Clive Ansell — Thu, 30 Aug 2018 18:09:49 GMT

[quote user="Emily Rainbow"]

One practice I locum at has a system I really like. A cross between open and booked. There are 3 vets consulting, 10minute appointments.

Appointment times are booked by the client but the next free Vet picks up the consult unless a particular vet is requested.

It keeps the flow going and clients see people being seen rather than sat in the waiting rooms waiting for the individual that’s running behind.

[/quote]

Yes, I have worked in clinics that run that and on the whole it seems efficient and works really well.

The only snag is when an individual vet drags their feet, cherry picks the easy or interesting cases, and avoids difficult or awkward ones. There is never a rush to pick off the next patient if it is a fractious GSD for nail clip.

The other issue with it is lack of continuity for cases, if someone just sees the next available vet because they haven't specifically requested mr/ms X

RE: Consultation times

Clive Ansell — Thu, 30 Aug 2018 18:03:51 GMT

[quote user="Chris Milligan"]

[quote user="Clive Ansell"]What is the ideal consultation time?[/quote]

Depends where you're working I think

[/quote]

I think you are absolutely right. it varies enormously from practice to practice.

Where I am at the moment is a sole charge part of a larger group clinic in a fairly poor area. It is cheap and cheerful, battlefield style medicine if you like, folk generally have lower expectations and don't want diagnostics (or rather they don't want to pay for them), just a quick fix in and out. 10 minute appointments work well.

Another clinic in the same group in a more affluent area with educated professional middle class clients has 15 minute appointments, which is barely enough time. These folk are extremely demanding and question every detail, but they tend to want answers and a diagnosis. Different work and a different niche in the market. I find it harder work, some of these guys really are hard work. That said, for a £48 (£31 at the cheaper clinic) consultation I don't blame them wanting their monies worth.

According to management, the 15 min consult clinic is the more lucrative of the two.

RE: Consultation times

Chris Milligan — Thu, 30 Aug 2018 17:31:49 GMT

[quote user="Clive Ansell"]What is the ideal consultation time?[/quote]

Depends where you're working I think. When I was in the UK my regular job was around Cambridgeshire and 15 minutes was about right - people like to have a long discussion about problems. I'm not a talker so I can't fill the void if it's 15 minutes for the sake of it and I refuse to be a salesman. I worked as a locum later and found in some of the clinics in Nottingham I worked in people liked cheap and cheerful so appointments were 5-10 mins long in and out come back tomorrow if no better - not great medicine but when people are on a budget it's ok. More than 15mins is too long for an average consult time - sure the atopic dermatitis consult or a euthanasia can easily go over but you make up for it on booster vaccines.

In Canada the general practice vets insist on half hour long appointments and work strictly 9-5 most of the time. They pack a lot more into their consults and there's a bigger emphasis on so-called wellness visits but they have no capacity to deal with the unexpected so there are a lot of emergency hospitals to soak up the rest (where I work now). We work a triage system which is akin to seeing walk-ins, but if you have really well trained nurses the safari set up can be used over the top of this and it actually works really well for us. We get the occasional idiot that huffs and puffs at reception at having to wait three hours for their dog's hotspot - those people shouldn't really be coming to the emergency to be fair but they'll get seen eventually.

RE: Consultation times

Martin Atkinson — Thu, 30 Aug 2018 17:22:21 GMT

[quote user="Gillian Mostyn"]

[quote user="Martin Atkinson"]Yes but I also want to enjoy my job, work at the pace I dictate and not get stressed. [/quote]

But it is your own business, which has very low fixed costs, and your own salary.[/Quote]But you're sole charge as well so doesn't the same apply to you?

[/quote user="Gillian Mostyn"] Was you always the same, or was your daily workload different 30 years ago?

[/quote]When I started out sole charge I was rushed off my feet, queues out the door, 15- 20 consults in 90 minute session (I didn't have appointments then but it would still have been just as busy) I didn't even make a huge amount of money because I was undercutting the competition of which there was very little anyway. I realised this was not the way to carry on, effectively doubled my prices in a short time and gradually as I've become surrounded by start-ups and corporates the workload has fallen off to what for me is a comfortably sustainable level. I would never want to go back to how I started and as said I have nightmares about full waiting rooms.

RE: Consultation times

Martin Hamilton — Thu, 30 Aug 2018 17:01:30 GMT

[quote user="Gillian Mostyn"]

[quote user="MartinH1"]So I'm going to jump into this conversation having gone from a practice where I used to do 30+, 10 minute consults a day in the UK to a Canadian practice where we have 20 minute annuals/vaccine appts up to 40 minutes for medical cases (derm included) and euthanasia's.[/quote]

What is your consultation charge?

[/quote]

At the current exchange rate, £55. Booster vaccines appointments we charge half of that (nurses are not allowed to give those here)

We have that flat fee for consults, whether it be 20 minutes or 40, with the idea being that we use the 40 minute appointments to do some workup, and therefore the turn over for that appointment will be much higher.

We are located in an area with 4 other vet practices packed in less than one km. Consults vary from the 10 minute model charging around £30, and one corporate clinic who runs their own out of hours who are not appointment based but charge around £70 per consult. The other clinic in the area run a very similar model to ours.

The difference in reviews on social media are quite telling on what people prefer - the 10 min "cheap" appointment clinic has very polarising 1 or 5 star reviews, most of the positives being based on the price rather than quality of service. Our clinic and the similar local one have a variety of stars, mostly 4 or 5, and reviews tend to be based on the customer experience, not feeling rushed, things being explained, being a bit more expensive but worth it. And then there's the walk in place, again very polarising views, with most negatives being the cost, but good reviews for the convenience and because they provide out of hours.

I'd also note this isnt an affluent area, the median income is the national average but cost of living is relatively high. Could be a cultural difference, or maybe people will find the money if they feel like they are getting a good service that warrants the cost. We also get the clients that can't afford anything, but I feel like you will always have that regardless of your prices! (Flashback to a client at the RSPCA who shouted at me because after his free consult the amoxyclav was going to cost £3 and that was "ridiculously expensive")

RE: Consultation times

Anthony Todd — Thu, 30 Aug 2018 16:41:21 GMT

[quote user="Gillian Mostyn"]I have taken 2 small lipomas off my own dog on 2 different occasions.....I'm hardly going to give the impression I don't recommend removing all lumps. [/quote]

Not poppycock then?!

Nobody's yet mentioned the small insignificant harmless "wart", and they can be tiny, that suddenly irritates and bleeds, usually over the Safavid or even just the Farrow & Ball; then it's your fault.

RE: Consultation times

Yantha Smyth — Thu, 30 Aug 2018 15:39:37 GMT

I am finding this thread really interesting!

I often ponder this 10 vs 15 vs longer, and agree there is so much variability it can be tricky.

Personally, I don't think I am given to 10min consults unless it is something straight forward with no added extras. I readily accept that I am probably not being efficient in many ways, and in my efforts to really listen to the client, be thorough in my exam and discussion of findings...can run over time easily, and thats without writing up notes. At other times it seems to flow better, can get everything done in time including notes. I find it stressful if I get behind and don't like to keep people waiting, but then I also do not want the clients to be rushed through to compensate.

I find 3hr per session is the max, otherwise it starts feeling like a treadmill/marathon. A 0900-1400 with no scheduled break sounds hellish to me too. Also not a fan of open surgeries for the reasons already mentioned.

I also find as a locum that there are things that take me longer- navigating a new PMS, finding things, figuring out which brands of which medications are stocked vs whats on the system etc. I also find it really affects efficiency if you end up having to leave the room multiple times, and some places are better set up than others for this. Also depends if you are dispensing yourself.

RE: Consultation times

Gillian Mostyn — Thu, 30 Aug 2018 14:28:34 GMT

What is your consultation charge?

RE: Consultation times

Gillian Mostyn — Thu, 30 Aug 2018 14:26:23 GMT

[quote user="Anthony Todd"]I found most clients wanted even the most benign lump off, and when I talked them out of it viz: my small lipoma in axilla, it bit me in the ass.[/quote]

I have taken 2 small lipomas off my own dog on 2 different occasions.....I'm hardly going to give the impression I don't recommend removing all lumps.

RE: Consultation times

Anthony Todd — Thu, 30 Aug 2018 14:23:46 GMT

[quote user="Gillian Mostyn"]

[quote user="Evelyn Barbour-Hill"]Acksherly, this is not my experience[/quote]

OK.

I wouldn't speculate as to why that is the case for you. That would be unkind.

[/quote]

Not my experience either, I found most clients wanted even the most benign lump off, and when I talked them out of it viz: my small lipoma in axilla, it bit me in the ass.

Just mentioning "cancer" with reference to a tiny skin tag was enough, usually.

I suspect, with the internet, clients are much more aware of everything now and perhaps tend to second guess every veterinary opinion??

PS Would be valuable to ask each and every client why; answers may surprise us all???

Apart from the spelling, I'm not going to speculate at all.....Evelyn sounds, as usual, pretty sensible.

RE: Consultation times

Gillian Mostyn — Thu, 30 Aug 2018 14:00:23 GMT

[quote user="Martin Atkinson"]Yes but I also want to enjoy my job, work at the pace I dictate and not get stressed. [/quote]

But it is your own business, which has very low fixed costs, and your own salary. Was you always the same, or was your daily workload different 30 years ago?

RE: Consultation times

Bob Russell — Thu, 30 Aug 2018 11:19:16 GMT

I hated open evening surgery's. They might start at 5pm and there would be an empty waiting room. Steady flow until the last fifteen minutes then all and his wife would arrive. They had decided to come at the end to beat the queue!

RE: Consultation times

Lucy Fleming — Thu, 30 Aug 2018 11:18:49 GMT

[quote user="Evelyn Barbour-Hill"](P'raps if you had fifteen-minute appointments you would have an extra five minutes to talk seriously about this lump and give a different message..... )[/quote]

That is not a suggestion you need to make to me...Niall Taylor will tell you how I have been a thorn in his side for years begging for us to have 15 minute consultations . We are currently trialling 10 for boosters/ 6month health checks and other 'routine' things and 20 for anything else (I'm not sure if this means I am winning or not).

RE: Consultation times

Michael Woodhouse — Thu, 30 Aug 2018 10:40:30 GMT

[quote user="Alistair Graham-Evans"]How do you know this?[/quote]

Because we've asked them, numerous times.

We offer open surgeries in the morning and after dinner, not in the evening. We will offer appointments at pretty much any other time people want (some want to come at 5.30 after work) but 95% can make the surgeries. I'd be happy changing it but it's not what I or the clients seem to want.

Not asked for a couple of years so I guess I could ask again.

RE: Consultation times

Martin Atkinson — Thu, 30 Aug 2018 10:07:06 GMT

[quote user="Gillian Mostyn"]Seriously? Aren't you at work to...work???[/quote]Yes but I also want to enjoy my job, work at the pace I dictate and not get stressed. OK I also get stressed if I'm too quiet and not making enough money but that soon passes and I'm a lot more stressed if I have several busy non-stop days. There's too many stories of burn-out/leaving the profession/suicide. I'm 68 and still going, I'm only planning my retirement because I know I will have to some day not like many who can't wait to retire.