Financial Monitoring 2

Re: Financial Monitoring 2

Mark Hedberg — Mon, 16 May 2011 20:17:49 GMT

Ooh, good idea! :p

Re: Financial Monitoring 2

Anthony Todd — Mon, 16 May 2011 20:03:09 GMT

[quote user="Andrew Kent"] I agree with you[/quote]

[crikey, someone at last!]

Yes, for sure, but comparisons must be related to number of patients seen.

Before we started this we had a vet whose figures appeared very good except that we found most things got a month of Ceporex...... And one £400 dental may be the only one the vet could be bothered doing......

Re: Financial Monitoring 2

Andrew Kent — Mon, 16 May 2011 16:36:14 GMT

[quote user="Anthony Todd"]

THIS HAS NOTHING TO DO WITH MONEY BUT EVERYTHING TO DO WITH BEST CARE!!!!

My guess is, based on 10 odd years of data, is that the percentage requiring a dental for best care will be around 2.50% so if a vet is only doing 1.0% then this is not best care.

[/quote]

I have to say Anthony this is one area that I agree with you on and I think there can be a place for using financial monitoring for improving clinical care. As you say if you have a vet that is not earning much on dentals where everybody else is then it is likely that that Vet is deliberately not 'noticing' the animals that require a dental. In my experience many vets do not like/are afraid of dentals but patient care should not be allowed to suffer as a result of this. Obviously it does require some deeper analysis as you may have a vet that asks colleagues to perform all dentals for him in which case his dental figures may be low but it may not necessarily represent poor clinical care.

In my first job after graduating I was shown at my appraisals a graphical breakdown of my earnings in certain areas compared to other vets and I think it did help me to improve clinically as well as improve my understanding of financial matters as it showed me the areas that I might have been clinically neglecting.

Andy

Re: Financial Monitoring 2

Richard Carter — Mon, 16 May 2011 14:32:58 GMT

Not so different for assistants working for an owner/ partnership where the owner/ partners have removed themselves from fee generating veterinary side for the business side of the business yet draw a full salary....

Re: Financial Monitoring 2

Bob Russell — Mon, 16 May 2011 13:04:51 GMT

When I trained the term 'salaried partner' was banded about. Practice and business training was totally lacking at university in my day but the consensus was that a salaried partner took all the risks without the rewards of full partnership!

It sounds as if I am totally against JVP, this is not necessarily true but I am against it when the vet is the one that pays the price of keeping owners happy with low prices and/or long hours whilst paying large sums to a company for life. I don't know enough about the deals offered to JVP's but do know a bit about the profitability of veterinary practice. Profits are hard earned and it can hurt to share!

Re: Financial Monitoring 2

Anthony Todd — Sun, 15 May 2011 15:10:25 GMT

[quote user="Tim Mainland"]Anthony surely the total dental income per VS or site per 100 consults is what you are looking for? A vet who hardly does any dentals could still turn in a good average fee/dental.[/quote]

NO, again,I'm repeating myself [sigh]!

If you see 100 cats there will be a certain percentage that will have bad teeth, need bloods, should be microchipped, wormed etc.

THIS HAS NOTHING TO DO WITH MONEY BUT EVERYTHING TO DO WITH BEST CARE!!!!

My guess is, based on 10 odd years of data, is that the percentage requiring a dental for best care will be around 2.50% so if a vet is only doing 1.0% then this is not best care.

Whereas if you work on money then one expensive dental is fine for that animal but not best care for the ones that are missed as a previous poster pointed out.

Re: Financial Monitoring 2

Tim Mainland — Sun, 15 May 2011 12:22:35 GMT

[quote user="Vikki Halliday"]

[quote user="Tim Mainland"] I'm beginning to see the glimmer of a concept whereby established practice could use both its management and bank respect/borrowing clout to provide JVP type opportunities for young vets. Aim being to provide a fairer longterm JVP cost structure, provide better clinical support, and keep the financials "within the professional family". [/quote]

Sounds great.

However not one partner of a stand alone business would have offered this because most are looking to maximise their share of the profits, or sell to the highest bidder.

I'd probably be the same if I was in that position........it's called business.

There's possibly too much risk for a small stand alone business to borrow based on a relationship with one person, whereas with a JVP you are borrowing more on an established business model and assets.

[/quote] Vikki Yes this would be business and a separate "bolt on" for either an individual or a partnership. The security could come largely via a freehold building, and the JVP would owe rent, loan repayments and a management fee (related to work done, not % of t/o) to the provider. Defaulting on payments would mean the provider would repossess building and practice, which he/they could then run under management or sell on again to another JVP. In the sell on process, hopefully some of the initial loan would get recouped. Please tell me what's not attractive about this from either party's perspective.

Re: Financial Monitoring 2

Tim Mainland — Sun, 15 May 2011 12:10:05 GMT

Anthony surely the total dental income per VS or site per 100 consults is what you are looking for? A vet who hardly does any dentals could still turn in a good average fee/dental.

Re: Financial Monitoring 2

Anthony Todd — Sat, 14 May 2011 23:40:53 GMT

[quote user="Evelyn Barbour-Hill"]I wonder why they are such odd sums?[/quote]

Sorry, they follow the post before, and are the average dental charges for various vets, as explained previously.

Re: Financial Monitoring 2

Vikki Halliday LLB — Sat, 14 May 2011 21:47:28 GMT

Sounds great.

However not one partner of a stand alone business would have offered this because most are looking to maximise their share of the profits, or sell to the highest bidder.

I'd probably be the same if I was in that position........it's called business.

Re: Financial Monitoring 2

Evelyn Barbour-Hill — Sat, 14 May 2011 21:42:19 GMT

[quote user="Anthony Todd"]

Looked at 3 sites,: £66.25, £66.33 and £62.64 [not including GA, analgesia etc].

Mmmm, thought there'd be a much bigger difference. Shows the value of data, not opinion.

[/quote]

Sorry if I've missed something, but what are these quotations for?

I wonder why they are such odd sums?

Re: Financial Monitoring 2

Anthony Todd — Sat, 14 May 2011 14:30:47 GMT

Looked at 3 sites,: £66.25, £66.33 and £62.64 [not including GA, analgesia etc].

Mmmm, thought there'd be a much bigger difference. Shows the value of data, not opinion.

Re: Financial Monitoring 2

Anthony Todd — Sat, 14 May 2011 14:15:01 GMT

[quote user="Tim Mainland"]Best practice will no doubt evolve with the development of clinical audit[/quote]

Most of them are obvious and unarguable.

Post op pain relief [whether included or not in the fee]

Microchipping, worming, dentals, bloods, X rays off the top of my cup-final head.

Now, before you leap on me, remember that these are measured as a percentage of total contacts which are consults plus vaccinations.

My figures show that best practice dentals, say, will run at around 3-4%, for example.

These are numbers, not values, I haven't done value but my guess is that they will vary by 100%, will let you know in an hour.

Re: Financial Monitoring 2

Tim Mainland — Sat, 14 May 2011 13:07:04 GMT

[quote user="Vikki Halliday"]

[quote user="Tim Mainland"]if you were empowered to produce an improved model, from your perspective, what would the improvements be? [/quote]

That's a difficult question, because I have never claimed to be experienced in business strategy!

I think that perhaps a more structured management fee, i.e. the longer you are up and running and actually in profit, the less likely you are to need all the services that you did at start-up. It could be claimed that because of the way the management fee is structured at present, as a percentage of your net sales, that the more you succeed, the more you pay, and that this is to an extent not benefitting the surgery directly but more likely to be supporting those further down the tree in terms of age of surgery.

I appreciate that at the moment, perhaps that aspect for me, only being opened 7 months, would be looking a gift horse in the mouth. However I can see benefits to higher initial fees with a reduction as you need less support.

But then it's not that simple either. Perhaps we begin to take more for granted as we get busier?

I don't think there is much else that needs improving in all honesty, as a model. Perhaps the development into "sub-JVP" status for some, to allow those that do not want 100% ownership but do not have a local business partner, and possibly utilising an employed support office practice manager, which may allow an even lower capital investment initially, but obviously a higher risk and less profit. However that could open a can of worms where you then have practices that are 50% owned by vet nurses, with 100% employed vets. Now before all the nurses start throwing brickbats at me, I have nothing against nurses as JVPs or practice owners, I just happen to believe that the business should have at least one Royal College member as a director.

I think also the next stage of development currently in place, i.e. stand alone businesses will prove and interesting exercise, and thats because I am not 100% convinced it will be as successful.

[/quote] Vikki it does seem inappropriate to me that established users should subsidise new entrants. Its the stuff of Competition enquiries. Its a logical business principal that you should pay for what you get. I also absolutely take Bob's point re paying for an extra layer of management. I'm beginning to see the glimmer of a concept whereby established practice could use both its management and bank respect/borrowing clout to provide JVP type opportunities for young vets. Aim being to provide a fairer longterm JVP cost structure, provide better clinical support, and keep the financials "within the professional family". Any thoughts out there?

Re: Financial Monitoring 2

Bob Russell — Fri, 13 May 2011 15:58:22 GMT

[quote user="Judith Joyce"]

[quote user="Bob Russell"]I work 51/2days a week, do no night duties [/quote]

Though not reliant on a bank, it seems that you are reliant on a deputising service. At present all appears rosy in the vet deputising business but what if that changes or if, perhaps, the major player sells out to some ruthless money-grubber?

[quote user="Bob Russell"]The banks will happily lend for joint venture partners because they see security in the size of the organisation [/quote]

The banks will happily lend to anyone who they think will turn them a profit. Unfortunately, too many veterinary practices are life-style businesses that serve their owners well but don't really stack up as "proper" businesses in terms of providing a genuine return for hours worked and capital employed. The JVPs that I have seen verge on the exploitative - vet makes all the effort, takes all the risk yet will only ever be part owner and fractional beneficiary..

[/quote]

There was an article written a number of years ago titled 'is your practice a business or an expensive hobby?'. I have to say not much has changed there. I make a reasonable living but as with many/most practices would like a better return for my hours worked. The profession has always placed itself between a rock and a hard place. A vet working in JVP has to pay for another layer of costs which has to come from the client or reduced income from the staff at the practice.

Between a larger rock and a harder place?

Re: Financial Monitoring 2

Judith Joyce — Fri, 13 May 2011 15:43:15 GMT

[quote user="Bob Russell"]I work 51/2days a week, do no night duties [/quote]

[quote user="Bob Russell"]The banks will happily lend for joint venture partners because they see security in the size of the organisation [/quote]

Re: Financial Monitoring 2

Bob Russell — Fri, 13 May 2011 12:24:21 GMT

[quote user="amanda nicholls"]

[quote user="Bob Russell"]

What I am talking about is the 'bigger' financial picture. Where does the money come from to allow this massive, up front investment? The answer is probably venture capital and this has to show a good return eventually.

[/quote]

I have oftened wondered where does all the money come from and what makes the investment so appealing to investors. I didn't look into a JVP as I always knew I wanted complete freedom in my decision making and hopefully in future when there are financial rewards I want to keep them!

I set up 15 months ago, borrowed as much as the bank and finance company would lend and ending up putting the balance on the credit card. Since month 3 the practice has generated enough to pay the bills and staff but even now would not pay a vet salary (and it would need to be one and half vets to cover the hours we are open) which does make me wonder how much it must cost to have a brand new practice, cover all the wages and pay someone to cover out of hours. Hopefully in 10 years I will have cleared most (perhaps all) of my debt and can earn a decent salary for the next 20 years, what position is a JVP in after 10 years in business?

[/quote]

Stick with it as a solo vet practice you will get there! It will all be yours!

I have long-since made the decision not to try to grow to a multivet practice. I work 51/2days a week, do no night duties and have a good work/life balance. I struggle a bit with cash flow sometimes through the year. The bank leaves me alone as long as I leave them alone!

The banks will happily lend for joint venture partners because they see security in the size of the organisation and the borrowing will be well secured anyway! Remember these banks are the same ones that thought the property bubble would never burst and needed us to bale them out so they are not necessarily the most reliable judges of sound long-term investment!!

Re: Financial Monitoring 2

Amanda Nicholls — Fri, 13 May 2011 11:57:18 GMT

[quote user="Bob Russell"]

[/quote]

Re: Financial Monitoring 2

Bob Russell — Fri, 13 May 2011 11:33:20 GMT

Vikki - I was not talking about the general public and the 'sense' it make to them to come to new premises rather than small practices. Nor was I making a comment about why a vet would wish to 'buy' into a plush new practice with all new equipment. What I am talking about is the 'bigger' financial picture. Where does the money come from to allow this massive, up front investment? The answer is probably venture capital and this has to show a good return eventually.

I know you have a new practice and hopefully the world is still rosy (I hope it still will be in 5 years+). Money for large investment does not grow on trees. Unless you can perform and keep performing to generate a suitable return for the real investors the business model will fail in the long-term.

The business model(s) that survive is yet to be seen. A solovet practice is vulnerable in some ways and robust in others. The medium sized practices are perhaps more at risk from competition that sets up down the road with massive investment half a mile down the road.

If you are a nice practice, with nice staff you will get loyal clients whether you are in a swish, gleaming practice or a small lock-up shop. The real difference is that the lock-up shop is yours and the bank will deal with you and the gleaming, shiny premises will always belong to someone else who will want their pound of flesh.

There is no such thing as a free lunch.

Re: Financial Monitoring 2

Hannah Wynne Richards — Fri, 13 May 2011 11:04:55 GMT

Amanda As another very happy solovet , I suspect a dislike of charging was at the bottomof those 3 veterinary surgeons culpable failure to bookthat poor cat in for a dental. I suspect you and I have very similar values Do the very best job you can,make decisions on clinical grounds and clinical grounds only, have the animals best interests at heart-never deviate by one iota from your oath, don't pre-judge what the owner will pay if there is a clinical ground for advising a procedure, but don't advise it for revenue only Put your basic consult fee high enough to make a proper professional income.You won't empire-build, because you won't appealtothe mass market,but you willhave an enjoyable, stress-free career

Back when I was a new practice owner, and naive enough to believe that bigger was better, I tried employing 3 assistants . One who had severe issues about charging never gave post op analgesia-he said that in his clinical judgement the animaldidn't need it. I increased the basic anaesthetic fee, to cover the cost of analgesia, and told himhe could give free analgesia for 5 days post-op.Surprise , surprise, suddenly his clinical judgement altered, so now he considered that all animals needed post-op analgesia.His fees went up,but complaints from owners about animals unwell following surgery went down

I thinka lot of the blame lies with veterinary schools-they have very few, if any staff whohave substantial practice experience I once went toa CPD session, where the lecturer was discussing urinary infections in dogs. He said "if you do a stained smear of urinary sediment you can tell if it's rods or cocci,and save your client a lab fee " I was so horrified, I had to interrupt, and say "if your charge properly for your time, I can't see how you can undercut the commercial labs " The lecturer didn't even have the grace tolook embarassed when he said "you can see I'm not a businessman " The worst thing of all is that a couple of years later, I heard the same lecturer say exactly the same thing-no wonder new grads are so woefully ill-prepared for the commmercial reality of practice

Wynne

Re: Financial Monitoring 2

Mark Hedberg — Thu, 12 May 2011 16:10:12 GMT

If something is sitting idle on your shelf, it is a liability. If nothing else, you spent money on this item which is not earning you anything, so it's a loss for you. So a white elephant is NEVER revenue neutral.

Re: Financial Monitoring 2

Mark Hedberg — Thu, 12 May 2011 16:03:34 GMT

[quote user="robloxley"]

[quote user="Mark Hedberg"]Answer: In a nutshell, assets make you money, and liabilities cost you money. Minimize liabilities, maximize assets.[/quote]

Not sure I quite agree with your definitions, in an accounting sense. Surely an asset is something you own (equipment, cash, property, intangibles) and a liability is something you owe (bills, loans, ongoing expenditure commitments). I'm sure plenty of practices have those assets in the white elephant cupboard that will never make them any money...

[/quote]

Well, it seems to me that we're saying the same thing. Any "thing" you own either earns you money or costs you money. If equipment makes you more money than you spend, then it is an asset because it is making you money. Same as property - if you are getting more money than you spend on it, then it's an asset. Same with intangibles - if it makes you money it's an asset. If something costs more money than you earn with it, you have a liability.

In fact, if you have a house with a mortgage, it's the bank's asset because a mortgage makes the bank money.

Re: Financial Monitoring 2

Vikki Halliday LLB — Thu, 12 May 2011 14:44:41 GMT

[quote user="Tim Mainland"]if you were empowered to produce an improved model, from your perspective, what would the improvements be? [/quote]

That's a difficult question, because I have never claimed to be experienced in business strategy!

But then it's not that simple either. Perhaps we begin to take more for granted as we get busier?

I think also the next stage of development currently in place, i.e. stand alone businesses will prove and interesting exercise, and thats because I am not 100% convinced it will be as successful.

Re: Financial Monitoring 2

patrick murphy — Thu, 12 May 2011 14:09:40 GMT

somewhat relaed, but I depend heavily on sending patients home with Torbutoral for pain relief and sedation should they show a need for it, and the clients reponse is almost always positive. having heard of it's lack of availabilty does anyone have a suggestion please?

Re: Financial Monitoring 2

Tim Mainland — Thu, 12 May 2011 11:44:59 GMT

Vikki Very little to disagree with there, though when you are no longer the new kid on the block, and the next new wave vet practice opens up not far away, then I suspect you may react in a business sense, and that reaction might be perceived as "parochialism" by the newcomer. But I'd like to ask you a question as an ardent JVP supporter- I know what you like about your JVP, but if you were empowered to produce an improved model, from your perspective, what would the improvements be? (Sorry not to use the quote facility but doing this on a BlackBerry from the Scottish Isles is a challenge in itself!)