The Continuing Evolution of the Veterinary Teaching Hospital

1. The Continuing Evolution of the Veterinary Teaching Hospital • James W. Lloyd, DVM, PhD • Assistant to the Dean • Director, Office of Strategy and Innovation • College of Veterinary Medicine • Michigan State University

2. 2 Where have we been? Where are we headed?

3. 3 “It is not the strongest of the species that survive, nor the most intelligent, but those most responsive to change.” C. Darwin

4. 4 The unique challenge of the Veterinary Teaching Hospital is to • remain financially viable to enable • teaching (students, interns, residents) and • clinical research while • providing public service within the market for veterinary medical services.

5. 5 Evolutionary Forces – Market Demand – SA and EQ • Economic prosperity • Income and wealth • Human / animal bond • Increasing willingness-to-spend • Steadily increasing human population

6. 6 Evolutionary Forces – Market (cont.) Supply • Improved technology • Fixed (or slowly growing) class sizes • Expansion through new schools and off-shore programs • Gender shift / life-work balance issues • More specialists available • Training programs adequate?

7. 7 Evolutionary Forces – Market (cont.) Net Impact of Supply / Demand • Steadily increasing demand • Primary and secondary care • Slowly increasing supply • Critical need to maintain (expand?) clinical training programs

8. 8 Evolutionary Forces – Institutional • Shrinking state support for higher education • State supported vs. state assisted • Increasing costs of operation • Overhead – health insurance • Technology • Inefficiencies – highlighted by doing more with less • Administrative • Operations • Graying professoriate • Organizational inertia – resistance to change

9. 9 Where does that leave us now ? • Increased financial constraints in the VTH? • Loss of “cutting edge” facilities and equipment? • Shrinking referral caseloads? • Losing faculty to private practice? • Adequate staff support? technicians? • Faculty searches with small applicant pools? • Finishing residents headed for private practice? • Frustrated faculty and staff that remain?

10. 10 Where does that leave us now ? • Inadequate critical mass of specialists? • Changing nature of the caseload? (FA) • Need to improve quality of service? • communication, timeliness • Need to enhance diversity? • faculty, staff, students, clientele Is this an ideal situation for training students, interns, and residents?

11. 11 Faculty Comments • Most schools are not even close in the salaries… • Used to be that universities were the only place where advanced equipment could be found… • The love of teaching … can be met in practice • Plenty of space, multiple exam rooms, procedure rooms, … thousands of square feet • Biggest reward in practice is … control … less red tape

12. 12 Faculty Comments (cont.) • Present faculty can be terrible role models • In a specialty practice, fewer bottlenecks • Inefficiencies of VTHs and bureaucracy of universities… • Don’t have to take exams home to grade at night • More control over scheduling • Too much time wasted by committee work and paperwork • Not everyone can do the triple threat

13. 13 Faculty Comments (cont.) • Reasons to stay in academia: • teaching residents • research • vacation and holiday time • good benefits

14. 14 Where to go from here ? Not all doom and gloom – great opportunities exist! Need to take charge of the VTH evolution ! …create the future! Summary of discussions and progress to date…

15. 15 Background – Mega Study, 1999 • Economic health of the profession is not good • Incomes: lagging and compounding debt load • Creating demand: unprecedented and unmet • Inefficiency of healthcare delivery system • Skills, knowledge, aptitude, and attitude (SKAs)

16. Background – NCVEI 16 • Established in 2000 to follow-up the Mega Study. • Funded by AVMA, AAHA, AAVMC, and Founding sponsors Sponsors

17. 17 Is it possible to model good leadership and management practices in the Veterinary Teaching Hospital?

18. Focus Group Discussions – General 18 • Very strong interest • both from schools and the private sector • Two main sets of issues: • strategic– What will the Veterinary Teaching Hospital look like in the future? • Challenge in balancing the mission • Teaching – veterinary students, interns, residents • Service – primary, secondary, tertiary care (species mix) • Research – clinical discovery • Faculty recruitment and retention • operational – How can we best manage and operate the Veterinary Teaching Hospital on a day-to-day basis?

19. Balancing the Mission – Suggestions 19 • Strong, effective leadership is needed • Have a clear vision • start in the Dean’s office • Structured strategic planning and management are strongly recommended • focus on what’s best for the college – maybe not all colleges need to provide every program • maintain a global view, remain flexible • include faculty input • Reward system is crucial • clinical track vs. tenure • Utilize outside consultants

20. Finance Cost accounting Budgeting Reporting Benchmarks Pricing Setting prices Adjusting prices Benchmarks Legal/Ethical Human Resources Faculty issues Staff issues Marketing Referring veterinarians Clients/public Operations Efficiency Benchmarks Management Topics 20 Full report available at www.ncvei.org JAVMA 226(5):705-710, 2005

21. Progressive VTH Management 21 • Can provide the clinical, educational, and scholarly environment necessary to recruit and retain top flight clinical faculty • Can provide the resources needed to assist with recruitment and retention of clinical faculty • Is essential for maintaining an appropriate teaching caseload • Is crucial for maintaining positive relationships with alumni and clients • Is vital for financial viability of the College

22. Recommendations

23. Across Schools 23 • Communicate the VTH Business Model results to all the schools • include both administrators and faculty • National dialogue on “Balancing the Mission” • Enhance networking among VTH Directors and administrators • Develop VTH management benchmarks • financial performance • operations

24. 24 College-level • Actively engage in strategic planning and management • clearly define the vision/mission of the VTH • be progressive in setting goals • actively monitor progress toward goals • carefully consider each management topic • engage outside expertise

25. Subsequent VTH Developments 25 VTH Task Force Established • Inclusive National Dialogue – ongoing • AAVMC, AAVC, NAVCA • ACVIM, ACVS, other specialties? • Strategic Issues • Future training of specialists • Clinical research • Operational Issues • Benchmarking • Comparative Data Report • Improved management • Enhanced networking; campus visits

26. AAVMC – AAVC – NAVCA Joint Discussion – March 2004 26 • Modify agenda of AAVMC annual meeting to have the VTH as a regular discussion topic • Start discussion with an AAVMC forum at 2004 AVMA meeting in Philadelphia • Initiate NAVCA and AAVC benchmarks discussion • Coordinate at NAVCA meeting in fall 2004

27. AAVMC Forum – July 2004 27 • Key Issues and Action Steps • Training future clinical faculty and specialists • Don’t lose sight of clinical research, academic mission • Need to heighten awareness of faculty • Continue to share successes and failures • Facilitate AAVMC - AAVC - NAVCA networking • Identify benchmarks • Explore partnerships with private sector • Modify agenda of AAVMC annual meeting to have the VTH as a regular discussion topic

28. NAVCA Meeting – September 2004 28 • What benchmarks would be useful for the VTH? • Financial measures • Operating measures • Developing definitions • Recommended follow-up • Take NAVCA list to AAVC for prioritization (top 10) • Return to NAVCA with AAVC feedback • Append to (amend?) comparative data report

29. NCVEI Board Meeting – February 2005 29 • Approved funding for travel to veterinary schools / colleges to engage in SKA dialogue • Currently scheduling 15 campus visits

30. AAVMC Forum – March 2005 30 • Academic clinicians are getting tired and often dissatisfied; salaries are inadequate; role modeling is often negative. • Clinical- and tenure-track faculty can work together; practice plans and incentive packages are becoming necessary. • Lifestyle choices have an impact, especially for women; part-time work is desired; consultation opportunities may not be seen as an incentive.

31. AAVMC Forum – March 2005 (cont.) 31 • Service quality drives caseload; referral coordinators, surveys, non-DVM hospital administrators and marketing have made positive impacts. • VTH challenges are not new, just more urgent. • Some aspects of the full-service hospital may be lost; evolutionary change will occur, impacted by local forces. • Applicants for specialty training are more than the system can accommodate. Vacancies exist in academe and in the private sector; demand exceeds supply.

32. AAVMC Forum – March 2005Recommended Next Steps 32 • Help faculty understand the problems and embrace a business model. • Continue dialogue at AAVMC meeting next year; establish goals and benchmarks; measure outcomes; engage specialty colleges. • Conduct a manpower study to better define future supply/demand of specialists. • Use comparative data report to benchmark progress.

33. AAVC Meeting – March 2005 33 • Recommendations • Engage faculty / specialists in the dialogue • Meet with AAVMC Executive Board • Create VTH Benchmarking Task Force

34. ACVIM Meeting – June 2005 34 • Who will teach our students? • How will we train residents? • Will clinical research continue? • Options for collaboration with the private sector

35. 35 Where do we go from here ? • Develop issues paper “The Impending Crisis in Veterinary Medical Clinical Education” • Engage in strategic planning • Conduct manpower study • Develop VTH management tools