Recently, I spoke with a client who had an associate veterinarian coming up for contract renewal. This practice owner wanted to introduce “penalty” clauses into the associate’s new contract that would address some specific performance issues he had with the associate. The associate veterinarian took too long in the exam room, performed surgeries without pre-anesthetic bloodwork (even though this was hospital policy), and was known to not charge certain clients he liked the full cost of services. The practice owner wished to incorporate penalties into the associate’s contract so that, if these behaviors continued, the associate veterinarian would not receive his production bonuses.
When I asked the practice owner if he had ever sat down and discussed these problems with the associate, he responded, “I’ve mentioned them.” You may not be surprised that when I discussed these problems with the associate, I found he was completely unaware that these issues were problems to the practice owner.
I am amazed by how often these types of situations arise. I know that many veterinarians are non-confrontational and do not like to discuss problems with their employees, but this is the responsibility of ownership. It is not fair to your employees to not let them know how you feel and then try to penalize them in some other manner. (Plus, it would be illegal not to pay them their bonus under these circumstances.)
There need to be direct lines of communication between the practice owner and the associate doctors within the practice. If you have a practice manager or hospital administrator, then it is appropriate for them to discuss management issues with associate veterinarians and other team members. But issues pertaining to veterinary medicine still need to be addressed by the practice owner. Associates should not find out at their annual review or contract renewal that the practice owner is dissatisfied with their performance—the associate should be made aware of such problems long before that time.
I suggest that practice owners establish an open-door policy with their associate doctors. Associate veterinarians should feel free to talk to you about any problems or issues they have and, in turn, you should be able to speak directly to associates about any issues you have in the practice, both good and bad.
To facilitate this communication, most practice owners have weekly or monthly meetings with their doctors. You should spend about half of the meeting on medical issues and the other half on management topics. I have found the best time to have these meetings is during breakfast. Once the day has started, there could be any number of reasons to postpone or delay these meetings. I suggest you set a specific day and time beforehand, such as the first Wednesday of each month at 6 am at “the” breakfast spot in town. To make these meetings truly effective, the practice owner needs to create an agenda. Associates can also contribute to the agenda in order to ensure that their issues are heard. An hour and a half to two hours should be more than sufficient for this meeting. At the beginning of the meeting, enlist a volunteer from the group to take minutes and distribute them to all practice doctors after the meeting.
I would also suggest that every associate receive a formal performance review. As I stated before, a review is not the time to unload all of the problems and concerns you have stored up over the course of the year on to your associate. An effective practice owner will have already communicated these issues as they came up during the year. Instead, the performance review is a time to reflect back and discuss both the positive and negative things that have happened over the year and, most importantly, discuss a strategy for continued success in the year to come.
I have found that it is best to use task-specific evaluation forms when doing performance reviews (our VMC Comprehensive Resource Library includes task-specific evaluation forms for associate veterinarians and for all positions in a veterinary practice). As an example, a task-specific evaluation form for an associate veterinarian might ask the question, “How well does the doctor review his/her physical exam findings with the client in the exam room during wellness visits?” Another question might be, “Does the doctor maintain his/her appointment schedule and see appointments in a timely manner?” There may also be medical questions such as, “How well does the doctor keep up on new medical and surgical procedures and share that information with other doctors within the practice?”
When I recommend evaluations, I like to suggest that the associate conduct a self-evaluation using the same form the practice owner uses to complete the evaluation for the associate. While the practice owner can solicit input regarding the associate’s performance from the practice manager, hospital administrator, or other doctors, I am opposed to obtaining evaluations from other employees. I believe that the evaluation process is solely the responsibility of management. Additionally, asking employees to evaluate other employees places them in the uncomfortable position of critiquing their friends and co-workers.
Once the owner has completed their evaluation and the associate has completed their self-evaluation, the two should meet to compare their evaluation results. The differences between the two evaluations will need to be highlighted and discussed. The associate might feel they do a great job in keeping up with new trends and concepts in medicine and surgery, but the practice owner may have another opinion. These types of issues need to be discussed. At the end of the evaluation, the owner and associate should set goals for the year ahead. As an example, it could be agreed upon that the practice owner will send the associate to a veterinary conference with the expectation that the associate must present a continuing education meeting for the rest of the team upon his or her return.
I suggest that formal performance reviews be conducted after the initial three months of employment and yearly thereafter at a minimum. When I speak with associates, they say that they really want to know how well they are doing in their bosses’ eye and that they would welcome an effective performance review.
Meetings and performance reviews do not replace open and honest interaction and discussion throughout the year. It is not fair to your associate doctors (or any employee) if you don’t tell them about problems you may have with them and their work. Keeping these concerns bottled up will affect your interaction with that employee and with the entire team. If you are a practice owner who has a hard time confronting employees when there are problems, make sure that you hire a practice manager or hospital administrator who can do most of this for you. However, you will still be responsible to communicate with your associate doctors and practice manager. Being passive-aggressive or looking for ways to penalize someone is not effective management. Be a better boss, communicate with your doctors and take on a mentoring role. They will appreciate it and the practice will greatly benefit from it.