February 1, 2022

Dear Friends,

In an effort to adapt to our crippling shortage of skilled medical staff, we’re implementing a few changes that we want to make you aware of. It’s our hope that keeping you fully informed of the challenges we’re facing will help you: 1. know what to expect when you call us; 2. to the extent possible, plan for your pet’s medical care.

What follows will be a description of each challenge we’re facing, and the changes we’ll be implementing in an effort to best utilize the staff we have. The last page is a summary of the changes.

THE CHALLENGES:

Acute Veterinary Shortage

There’s an acute shortage of veterinarians nationwide. Industry estimates currently run as high as 75 job openings for every 1 veterinarian seeking a job. The crisis has created the opportunity for a new kind of employer to enter the marketplace — the relief vet agency. Veterinarians join these agencies, and the agencies charge hospitals and clinics large fees for each day of veterinary coverage. Doctors in this arrangement can earn in 2-3 days of work what they’d make in a week – but without all the follow up that goes along with a traditional position – phone calls, emails, and texts that await each doctor when their appointments are over each day.

For the past 18 months we have (unsuccessfully) attempted to recruit a fourth veterinarian to our practice. Even with three full time vets, every appointment is filled every day. The only unfilled appointments are clients who we call “no shows”. Additionally, we work-in urgent or emergency cases. The pace has been exhausting for our staff. Now we face the departure of Dr. Thomas, leaving us with just two veterinarians.

Two months ago we came so very close to having another veterinarian join our team, but when she gave her notice to leave, the corporation she works for “made her an offer she couldn’t refuse”. That gets us to the next major factor rocking the vet med industry – corporate buy-outs. The impact corporate acquisitions are having on our industry can’t be understated. Nearly 50% of all small animal veterinarians are now employed by for-profit corporations.

Companion animal hospitals are being acquired at an astonishing pace. Veterinary consolidators have deep financial backing that makes it very tough for sole proprietors who don’t “sell out” to compete with the huge bonuses and incentives offered to lure vets to corporate practice. Rabun Animal Hospital is currently advertising a $30,000 signing bonus to a local veterinarian who leaves to join them… and work for a for-profit corporation.

There’s an additional ripple effect when corporations buy private animal hospitals. The experienced veterinarian owners of those practices tend to retire. Experienced veterinarians who retire to the golf course are no longer available to care for pets. The pace of these acquisitions has baby boomer vets retiring much earlier than they would have a generation ago.

“Why not just hire relief doctors” you may be thinking?

No dice, only large cities are covered by these services. Our rural location is a liability when recruiting and when trying to secure even temporary help. With so much work available everywhere, there’s little incentive for relief vets to travel for work.

Chronic Veterinary Technician Shortage

There’s been a shortage of credentialed veterinary technicians for many years, and now the problem is much worse than prior to the Covid-19 pandemic. There are fewer veterinary technicians than veterinarians. Historically the shortage has been driven by low wages. It’s a complicated job that pays far less than the human medicine equivalent. Veterinarians need skilled assistants to maximize the number of patients they can examine, diagnose, and treat in a day.

In the past, our doctors had two assistants assigned to them each day. Throughout 2021 we struggled with having only one per doctor. Add running back and forth to the parking lot in rain, sleet, heat or snow… and you get the picture… we’re as busy as one armed paper hangers! When team members call out sick, daycare or schools close, someone takes a vacation… it makes things even more challenging.

Telephone Tsunami

If you received our year-end fundraising letter, you’ll recall I discussed the negative impact on efficiency and our mental health the incessant ringing of phones has created for us. When you work in administration at Noah’s Ark, every day feels like the last hour of a Jerry Lewis Telethon… all day long. (Apologies for that reference if you’re under 50 years old.)

If you’ve called our office I’m sure you’ve experienced the strain… the phone rings longer, and you more frequently get voicemail. Many folks who get voicemail just keep calling and calling and calling until someone is able to pick up. But while all that commotion is going on in the background, we’re trying to do the work of actually attending to the folks in front of us, or already on the phone with us. Sometimes these calls are intense, people are upset about their pets injury or illness, they’ve called vets everywhere and are turned away, or we’re just trying to get the details we need to make an appointment. Ultimately, even with four to six staff answering the phones all day, it’s become untenable. The turnover for the position is sky high, and the staff who have persevered are frazzled.

Frontline Frustration

Let me preface the comments I’m about to make by saying we love the community we serve and have no intention of leaving. I often refer our chosen home as “Friendly Franklin”, where we’ve had the pleasure of meeting the nicest, friendliest people I’ve met anywhere in the world. But of late, our staff can’t help but notice that frustrations are rising. I remarked recently that we now routinely have more clients yelling / screaming / cursing at us in one week than we’d experience in ten years “in the old days”. Staff routinely hear: “I guess you don’t care about my pet”, “all you want is my money”, “I’m NOT leaving you a deposit”, “I need to be seen TODAY!” (that call usually comes in about 4 pm), and most hurtful of all… “I guess you don’t care if my pet dies!”. The point is, all manner of insults and impatience gets hurled at staff, some as young as 20 years old, the majority less than a year in the industry.

At the end of 2019 we had 20 full time employees working at Noah’s Ark. At the end of 2021, we have 14, with only six of those working on direct medical care. Over the same period of time, our business has grown almost 30%. That pace is not sustainable.

In an effort to survive our current reality, we’re implementing a number of significant changes to help the limited staff we have be more efficient, and maximize the number of pets we can care for each day. We’re keenly aware that the community relies on us to provide essential services, so we feel a sense of urgency to find ways to do more with less human capital.

THE CHANGES… Here’s what to expect in the days ahead

Give Peace A Chance.… Our Phones

Beginning next week you will get an automated attendant when you call our office. You’ll be prompted to leave a message at the extension corresponding with the reason for your call.  Our hopes are that this change will create a work environment where we can concentrate on finishing one task before starting the next. It will also allow us to train less experienced staff to specialize in just one or two types of requests. Texting is also an option for requests. Text to: 828-332-4191.

I’m truly sorry that we have to take this step. I hate calling a business and getting the dreaded “Please listen carefully as our menu options have changed…”. The truth is, we literally cannot answer the volume of calls we’re getting in real-time. We must sort and prioritize our incoming requests more efficiently since at least 50% of the calls we field do not generate any business but take time away from helping the pets in our care.

Where Pet Lovers Shop?.… Our Pharmacy

Internet veterinary pharmacy sales have skyrocketed the past two years. As clients stayed home, they were inundated with targeted advertising promising big savings over “your veterinarian’s” prices. Chewy is “where pet lovers shop”. 800 PetMeds is “America’s most trusted pet pharmacy”… but is it?

The challenge for us is two-fold. First and foremost, a substantial percentage of our ringing phones come from internet pharmacies. Even if we don’t answer those calls, our email boxes fill with client requests. Online pharmacy call centers spam customers with messages, “your vet hasn’t answered us yet!!” Shortly thereafter clients call to complain, “Why haven’t you approved my request!?!” Once we approve a prescription, we sometimes get more messages saying the approval was not received so please send again. If we don’t respond, the calls just keep coming. I once had a client yell at me “Are you kidding me?!? How long can it possibly take for you to approve my request RIGHT NOW!?” How could they know what I’d be looking at when I opened that mailbox, or how long it would take me to search and find the specific request among the dozens of new requests? As the phone kept ringing, I didn’t have the time to go into this complex explanation.

Sifting through the volume of requests we receive for prescription medication requests is technical and takes time. We have to read the request and determine whether this is a request for a patient we have medical records for. We have to determine whether we have seen this patient in the past 12 months. We have to confirm whether the prescription exists for the medication requested, we have to confirm it’s the correct medication at the correct dosage and the directions are right. We often see clients requesting items that are more expensive than buying through us, or there’s a less expensive option… but that takes time as well.

As we sort through these requests, we find close to half are not our clients at all, or are from clients we haven’t seen in one or more years. We cannot legally fill requests for non-clients or “lapsed” clients. It takes lots of time just to identify the legitimate requests. Then it takes more time when clients whose requests are denied call back and swear they “just saw us”. Then it takes more time to convince them it was 2018… you get the picture.

This is time we’re not attending to the patients in the building or clients trying to get an appointment. We’re effectively unpaid labor for large corporations. Some hospitals are opting to employ one full time person to manage the calls, emails and faxes that internet pharmacies create. But clients will pay for that… I estimate every office visit would need to increase by a minimum of $10. That solution unfairly penalizes clients who support us by purchasing their prescriptions from us.

Our move to an automated phone attendant is driven by the aggressive tactics of Chewy, and to a lesser extent PetMeds, and other minor players. Please don’t let the warm and fuzzy Chewy brand fool you. Chewy was acquired by PetSmart in 2017 and taken public in 2019. They’ve got sales well over $2 billion a year, they have very deep pockets, and the ability to lose money for years with a plan for domination of the veterinary marketplace. They will likely succeed just as Amazon has. If you can afford to lose money for years, you can, and will, run local competitors out of business.

Before you buy from corporate online pharmacies be aware of two things: First, veterinary office visit fees are subsidized by in-house pharmaceutical sales. Human doctors are not allowed to sell prescriptions, and that’s probably a very good thing. But it’s also why a visit to a human doctor costs hundreds of dollars – there aren’t other sales to offset the overhead of running the business – all the support staff, equipment, building maintenance and medical staff salaries. In house veterinary pharmacy sales are what keeps a visit with your veterinarian below $179.

Secondly, supporting family-owned businesses in your community keeps that money in your community, providing good local jobs with the opportunity for advancement.

At Noah’s Ark we have a modern pharmacy, with the same controls to reduce prescription errors found only in human hospitals. We keep our pricing very competitive, and always set at the minimum retail price manufacturers allow. We mail prescriptions if that’s more convenient, and you can pay online or we’ll have scripts ready to run to your car.

Many of you have accounts with our contracted online pharmacy. That solution is great for products we don’t carry in house, and for seasonal clients. We do receive a very small percentage of those sales, and it’s much simpler to approve those prescriptions… but it’s a tiny fraction of our sales.

Beginning next week, we are no longer going to allocate staff time to working for internet pharmacies.

Of course we hope you’ll purchase your prescription medication from us for the reasons I’ve stated, but it is absolutely your right to purchase from any business you choose. We’ll be providing written prescriptions for clients who choose to purchase from online pharmacies. This puts you in control of the process and takes us out of the middle.

Anticipation, it’s keeping us waiting…. For Appointments

Throughout 2021, as appointments became tighter, we began implementing a deposit policy for some reservations. We added this extra step not to aggravate our clients, but because we’ve always experienced a significant number of clients who make an appointment and then don’t come to it. We’ve regularly had clients who schedule two or even three pets at a time for an exam, reserving over an hour on our schedule, only to not show up or call last minute and we can’t fill the spot. This happens even after they’ve confirmed they’ll be there!

Throughout the summer we collected at least a $50 deposit for many appointments, and people still regularly don’t show up, even with the deposit. Sometimes they’re even grumpy when they’re reminded that the deposit is non-refundable.

With the imminent departure of Dr. Thomas, appointments are going to be even scarcer. When clients don’t come to the appointment they’ve reserved it’s a twofold problem. First, there’s a negative financial impact on our business that increases overhead and in the long run, prices for everything. Secondly, and more immediately important, other clients who really needed that doctor’s time got turned away.

 

There are two new policies going into effect next week to make our scheduling and appointment process more efficient.

  1. In an effort to keep our doctors 100% scheduled, we’re implementing a deposit for every appointment. That deposit will be the equivalent of the office visit fee for medical appointments, and a percentage of every surgery, based on the estimate.

With the exception of a true emergency, the deposit is non-refundable if the appointment is not cancelled within 24 hours prior to the appointment time.

  1. We’ll conduct an interview before your appointment. The scheduler who confirms your appointment will conduct the interview. In the past this interview takes place when you arrive at Noah’s for your appointment. Going forward, the person who takes your pet inside will only confirm the reason for your visit and the services we have scheduled.

Saturday in the Park…or at Noah’s?

Last week I announced that our staffing crunch forced us to close Saturday. We’ve since made the decision to stay closed all Saturdays in February. We’re still working on ways to cover our Saturday schedule. Stay tuned for updates on this by month’s end.

In summary, please know that Dr. Todd and I remain wholeheartedly committed to this community and the furry families we love and care for. The team we have remaining are all kind and dedicated people who are striving to do a great job. Although most of the staff aren’t old enough to remember, I’ve been feeling like we’re trapped in an episode of Lucy & Ethel at The Chocolate Factory, for the past 18 months. If you haven’t seen that clip in a decade or two, go straight to YouTube… and it’s still hilarious.

If you’ve made it this far in this long correspondence, I thank you sincerely for your time and caring. Although I mention issues with a minority, the vast majority of our clients are what keeps us getting up to work seven days a week. We know that what we do is valued and important. We’re doing our best not to disappoint you. This current crunch will pass, but in the meantime, we thank you in advance for your patience and understanding.

 

Highlights… for those who like to get straight to the bottom line

  1. We are experiencing a critical shortage of medical staff of all kinds, doctors most acutely.
  2. Medical appointments are at a premium. Please plan as far ahead as practical for veterinary visits.
  3. When you call our office, you will get an automated attendant and be asked to leave a detailed voicemail message. For medical appointments you can expect to be contacted the same business day. Be sure to tell us the best way to reach you that day.
  4. If you are requesting a same day appointment, it’s best to call or text us before 9 am.
  5. If you have an urgent need, it’s fastest to text us. Add Noah’s Text: 828-332-4191 to your contacts.
  6. To help us save time during your appointment, you can expect to answer a series of questions at the time we confirm your appointment. Please arrive 5-10 minutes before your scheduled appointment time.
  7. You’ll be required to leave a deposit, equivalent to the office visit fee or a percentage of the procedure estimate, in order to secure an appointment. The deposit is non-refundable unless the appointment is cancelled or rescheduled at least 24 hours prior to appointment time.
  8. If you have a Well Plan, you’ll be required to leave a deposit equivalent to the value of the appointment. Once the appointment is completed, if you have a credit balance, you will receive a refund to the card you used.
  9. When you arrive in our parking lot, you’ll find the parking spaces numbered. Please text us the number of the space you’re in, or wait for staff to approach your car.
  10. If you’re arriving to pick up a prescription or food, use the designated spaces near the front door. We’ll come to your car or you can text us that you’ve arrived.
  11. Throughout the month of February, we’ll be closed on Saturdays. Stay tuned for more information as we seek to recruit and train enough staff to cover Saturday hours.

 

We hope this information helps you understand “the big picture”. You can count on us to keep striving to do the most and be the best with the resources we have. We’ll stay in touch through email and our social media accounts.

Until next time, Dr. Todd and I wish you and your family vibrant good health.

 

Dawn Todd, Practice Manager

 

 

“The only thing that is constant is change.” Heraclitus, 535 BC – 475 BC