The Exam Room is Still the Bottleneck

In this episode of FlightPlan: Quick Consults, our panel dives into one of the biggest efficiency challenges in veterinary practice: the exam room bottleneck. We tackle a bold question—what tasks really need a vet in the room?!

Learn how empowering your staff, clarifying patient care standards, and strategically redesigning exam rooms can make a huge difference in workflow. We also explore the game-changing impact of AI digital scribes, technician utilization, and small clinic tweaks that save time, reduce burnout, and elevate the client experience.

Panelists for this episode include:

• Host = Brenda Tassava Medina, CVPM, CVJ, MVLCE, President of Encore Veterinary Consulting
• Dr. Alex Andryszak, Field Ops Veterinarian at Encore Vet Group
• Dr. Evelyn Sagastume, Practice Owner at Petsedena Animal Hospital
• Carol Hurst, LVT CVPM, CVJ, CCFP, Consultant, Encore Veterinary Consulting

Thanks for listening!

Website: https://encorevet.com/

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Instagram: @encorevetconsulting

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Transcript

SPEAKER_00 0:11

Welcome aboard. You're listening to Flight Plan Quick Consult, your go-to podcast for veterinary insights that are fast, focused, and designed to elevate your practice. I'm your host, Brenda Tasma Medina from Encore Veterinary Consulting. Whether you're between appointments or heading into a strategy session, we've got takeoff ready tips, tools, and takeaways to keep your team soaring. So buckle up and let's take off to explore. The exam room is still the bottleneck. Today's panel includes Dr. Alex Andrisak, Dr. Evelyn Sagastume, and Carol Hurst. Dr. Andresak, tell our listeners a little about yourself.

SPEAKER_01 0:47

Hi, my name is Alex Andrezak. I am the field support veterinarian for Encore Vet Group, which means I'm licensed in a couple states and travel around to clinics that need an extra set of hands. My background is mostly in emergency and general practice for small animals. I was medical director of a fairly large hospital in South Carolina. We had nine doctors and 70 support staff, and uh gave me a good idea of the benefits of efficiency.

SPEAKER_00 1:14

I'm sure it did. Next up is Dr. Sagas Dume.

SPEAKER_02 1:19

Hi, I'm Evelyn Sagastume. I am a small animal veterinarian, practice owner of Petsadena Animal Hospital in Pasadena, California. I've owned my practice for going on 12 years this year, and definitely have had my share of looking into you know how to improve efficiency, how do we work to improve our client experience and also obviously keep up our efficiency. So definitely a topic that we're constantly working on at our practice too.

SPEAKER_00 1:48

Great. And one of my favorite teammates, Carol Hirst.

SPEAKER_03 1:53

I'm almost your only teammate, but I like it. Um so my name is Carol Hurst, and I am a credential technician, turned certified veterinary practice manager, turned consultant. And uh being in the exam room as a credentialed technician and being utilized to my fullest in the practice that I came from uh really showed me the benefits of having a really strong system in place. So I love talking exam room efficiency.

SPEAKER_00 2:25

Perfect, which is why I brought the three of you together. I couldn't think of three better people to have this conversation. So let's start with you, Dr. Andra Zak. Um, what task do you believe should no longer require a veterinarian in the room?

SPEAKER_01 2:41

I I mean a fair amount of what we do on the day-to-day doesn't actually require the doctor in there. Um, I would always teach my new grads, you know, we're we're here to diagnose, we're here to uh make sure our notes are done, we're here to do surgery, and that's pretty much it. So everything else, from blood draws to other sample taking, to initially like getting the histories down to talking finance to things like that, those are all things that can be done without a veterinarian in the room. You just need to be in there to lay hands on the animal, feel them out, and go from there.

SPEAKER_00 3:19

Okay. What are your thoughts, Dr. Sagasnoumi?

SPEAKER_02 3:22

Um, I would agree. I think um ultimately the way things have evolved in utilizing our team more has allowed veterinarians to step back and be able to do the what we were trained to do and what we are passionate about is take care of our patients, diagnose, treat, and obviously do procedure surgeries. So for us, really, it's history take going from history taking in the room to talking about finances, going over treatment plans, even client education. A lot of our treatment team can provide client education on kind of you know the basic things like preventative care items, uh vaccinations, professional dental cleanings, things like that. And, you know, we complement that with our recommendations as doctors. Um, and we still, you know, want to educate clients, but they're an extension of us, right? An extension of our team, and they can provide just as much education and be able to get the buy-in from our clients so that they can provide the best care for their pets.

SPEAKER_00 4:21

Okay. Before I ask Carol this question, this same question from a technician standpoint, I want to do a follow-up, a quick follow-up with the both of you. Because, you know, uh what I see happen in practices quite frequently is, you know, I'll I'll be shadowing and the doctor will be counting pills or doing something outside of what the two of you just talked about. Um, could you share with me um your thoughts around why that happens and what what practices can do to kind of overcome that? Oh, I'm sorry.

SPEAKER_02 4:59

Um so I think um what I've gotten as you know, as a practice owner who has who actually has associates that do that, um, I've gotten from them is you know, if they see the team is, you know, hustling and maybe we're down, you know, short staff, we're down someone, someone called out sick. Many doctors have been in that position before. A lot of doctors have been technicians. Um, I personally haven't been, but I know how hard the job is. Um, and you know, they're wanting to help out. They're wanting to kind of, you know, try to expedite things and things are taking longer or provide support. I feel like it comes from a place of help, helping, but they don't realize how much it does hinder the process because then the bottleneck comes to them most of the time. It's okay, well, the next case is here and you're feeling meds, or the client called for a callback and you're not available because you're doing something that you could have a technician help. So I think it's really more of a wanting to help, but don't realize how much it can hurt um them and the team as well, right?

SPEAKER_00 5:58

Right, right.

SPEAKER_01 5:59

I totally agree. Um it does come place from a place of good, and I've been at fault of this myself. So, but um, you know, you you you try, you see everybody swamped, and then you answer the phone, and then they figure out that you're the doctor, and then you end up on the phone for 30 minutes to talk about something that you could be doing anything else, and you're stuck there because you're trying to build that rapport and everything like that, and it's hard to get off. But it it does come from a place of good, but we really do get in our own our staff's way sometimes, and we really do get in our own way too, because there should I could definitely be doing notes or I could be in a room that's been sitting there for 15 minutes while I've been stuck on the phone and everything like that. So, yeah, I think it definitely comes from a willingness and and enthusiasm to help, but we need to not get in our own way.

SPEAKER_00 6:50

Great, Carol, you're an LVT in addition to being a C VPM. So, what do you believe tasks should no longer require a veterinarian in the room? And I'm sure you've seen the the follow-up question uh example as well in practices.

SPEAKER_03 7:06

Yeah, you know, I totally agree with with both, you know, both of what they said. Anything that doesn't require the diagnose and prescribe, you know, surgery is not really going to apply here, but anything that doesn't require that should be on your technical team. And, you know, I was trying to think of what set my practice apart. And it was really that ownership and empowerment, right? Like we really gave our credentialed technicians ownership of the exam room. And so when I walked in, it was a source of pride for me to be able to collect samples, go through and educate, you know, new puppy, new kitten. You know, my doctor team wasn't spending any time doing that. If it was coming in and shaking their head, I had free range to start collecting samples, right? Because I knew what my doctors would recommend. There was a continuity of patient care standards. So the whole thing, the organization of the exam room, documentation, education all fell to me. And that was a source of pride for me. And so I think, you know, when I think about setting a good foundation, you know, making sure that we're training, setting expectations, um, because your your technical team is trained to do that and they want to do that. Like that's what I think it comes comes back to.

SPEAKER_00 8:24

Absolutely. Absolutely. Okay, so um, a lot of technology today. Um, and I'm sure that you all have varying degrees of experience with different technologies. So, how do scribes, technician utilization, or even exam room redesign actually impact flow and productivity? Let's start with you, Carol.

SPEAKER_03 8:49

So I'm gonna do the exam room like redesign, like my thoughts around that. And you know, I like to extend this even a little bit beyond that into the process around the exam room visit. Because if you look at really getting granular and evaluating what your process is, sometimes you find the smallest tweaks can make the biggest difference. I went into a practice and uh the check-in process, you know, they weren't utilizing the technology they had. The CSRs would take the clipboard and walk it all the way around pharmacy and put it in this designated spot that wasn't big enough for the appointment flow they had. And that's what told the technicians that they had, you know, they had somebody in the exam room. And when you step back and look at that, this is an inefficiency that hit multiple different departments. Um, and being able to just let them, you know, guide them to using the technology they had and keeping things a little bit more organized eliminated a lot of extra steps for the technical team and the CSR team. And so I think if you're able to look at what steps you're actually putting into your process, you're gonna find a couple of small things to just eliminate that make a big difference.

SPEAKER_01 10:15

Errol, they're getting their steps in.

SPEAKER_03 10:19

It takes up too much time.

SPEAKER_00 10:21

Too much time, not only too much time, but you're pulling a CSR from the front desk, right?

SPEAKER_03 10:27

Yep.

SPEAKER_00 10:28

Um, so Dr. Andresak, you visit a lot of different practices. What are your thoughts on this? Um, I know that you're a huge advocate of AI digital scribes.

SPEAKER_01 10:37

Oh, yes, very much so. So AI digital scribes totally changed how I did medicine. Um, when I was working uh stationary, I I was seeing probably between 23 and 30 um animals a day. And if at five minutes a um a record, that is an unbelievable amount of time spent writing notes. Um I I got Covet myself, um, and I loved it. It changed my note taking down to less than 30 seconds per note. Um, it took some getting used to uh verbalizing my exam in the rooms, but I always it it builds rapport with clients. I was like, it helps me get out of here and go home to my family. And they're like, oh yeah, we love that. And no one has been like, please don't record me um at the up to this point. I'm gonna get it tomorrow now. But um, but I absolutely love it. You got to figure out like what's your the soap you want it to say, how detailed you want it to be. But easy vet, sorry, covet allows me to do that um pretty uh pretty easily. Um I'm not the most digitally inclined person, but now I use this technology every day. And there's lots of different brands out there. Mine personally is Covet, but there's Scribble Vet, there's TalkaTwo, and many, many others that anybody can try out. There's lots of free trials, and I was resistant in the beginning, but I talked, um, I got talked into it. I did the free trial, and I am never going back.

SPEAKER_00 12:11

I I I agree. I I see it make such a difference in doctors' lives, not only the doctor's lives, but your entire team's lives because you have better notes and they're completed. That's a that's a big thing.

SPEAKER_01 12:25

And the client communication is more thorough than I would or anyone would ever write.

SPEAKER_00 12:31

Yeah.

SPEAKER_01 12:31

Like it's amazing how much we talk about in such a short amount of time that now makes it to my notes. And I feel like I'm doing a better job because other people are able to see it too.

SPEAKER_00 12:42

As an outside shadow observer, the one thing that I noticed right away when a practice switched to using something like COVID was the amount of attention and one-on-one relationship that was happening between the client and the team member that really wasn't happening before because they're looking at the computer and they're looking back and asking the question and they're typing it in. And now they were having a more genuine and authentic conversation because the tool was taking the notes for them, which I think is just amazing. Carol, you had something?

SPEAKER_03 13:17

I was just gonna say, I've also heard of it as a burnout preventer. So I just heard um a different podcast that was saying, you know, it's not while it's not a complex uh task, it's something that no one wants to do. Sit there and type in their notes. And so if you have something that does that for you, that's automatically taking away like that brain power and kind of that friction for, oh, I don't want to do this, you know, but procrastination. Yeah, exactly. And so it's kind of a burnout preventer, too, taking taking away some of that.

SPEAKER_00 13:49

Yeah. I know that you are designing a new practice, um, a new building for your practice. What kind of thought have you given to straw scribes, tech utilization, and exam room redesign with that new flow that you're building?

SPEAKER_02 14:06

Well, I have to mirror what everyone's saying about the scribes and it being a game changer. Um for me, having always struggled with my records for efficiency because I just talk a lot, take a lot of time to educate clients in rooms. So I'm not very quick to get out of the room and be able to type up a record and then go back into another room. Um, it's been amazing. Like, and and actually, interestingly, when I try to bring it on to my practice, I wasn't practicing as much at seeing patients, and I got pushback and they declined it. And I came back again a year later with it having been, you know, kind of, you know, they've added different features. It got much better because I tried to adopt it early on, and I got all the buy-in and everyone's lives have been so much better. Um, I think I would agree as far as being able to connect with clients more. I mean, that's probably been the most beneficial um aspect to me as a practice owner because we always talk about how do we engage with clients more, how do we engage with our patients. And this is a way where my treatment team can go in, get a history, and like you said, engage with the client, you know, with the patient, have that kind of connection that they couldn't have because they're typing and looking away and all that. Um, I can go through my examination much more thoroughly, much more um, much more efficiently and be able to communicate all the things and you know, let them know everything that's going on with their pet without having to worry about make sure I get in the record. But also because you have to verbalize your exam, it's also like a nice way to be able to um verbalize everything and have clients understand. And then you can provide a summary after. So I've had clients say, Oh, you know, can you call my wife? Oh, this saves me time. I can actually send your wife a summary of what we talked about, and that's pretty amazing. Um, I think as far as efficiency, it's not only obviously efficiency in the room, efficiency with record keeping, thoroughness. Um, and when you're thinking about room design, one of the things that I'm thinking about in our new practice is, you know, how can we potentially check check out clients in a room and get them in and out without bogging down the you know the reception area because we I want more exam rooms, but that means a small reception. So how do I kind of do that? And thinking about how to design a practice where you can still have that, you know, experience, but you don't necessarily have to do it the the traditional way, right? So um, yeah, I think scribes have just revolutionized things for us as a practice for me as a as a doctor. And callbacks, which we didn't mention yet, that's you know, it's amazing. I mean, and that was another issue I had, which, you know, how do you document all these things you like to tell clients? Because I give a lot of details. I can I can get my callback scribes quickly, but also then I email them a summary of our conversation. So, I mean, it's just the amount of the level of care you can provide in education has just changed dramatically without more time, right? It's actually saving us time.

SPEAKER_01 17:04

Do you oh go ahead now, Dr. I know? I was gonna say, and with what you do, especially that thoroughness and everything that you're able to do with your personal scribe, is add value because I mean, we all are in a pinch with funds and everything like that these days, and our clientele is no different. And regrettably, prices do keep going up. Um, and that is the the world we live in, but it adds value to our services by being able to add that little extra touch. Doing the physical exam in front of them and verbalizing it shows you everything you're looking at. It gives them an idea of the depth of our knowledge. Granted, it's one-dimensional, but we know a lot about these critters, and uh, but it is it's an amazing uh I feel like the client experience improves from it as well.

SPEAKER_00 17:55

And I would add to that reading my mind because that was my question. Oh, I'm so sorry.

SPEAKER_02 18:01

No, yeah, I just think it's great. Dr. Sanderson, yeah, just like you mentioned, compliance goes up, right? And so you're able to get more buy-in from the clients for all these recommendations. You know, I with experience have been able to have, you know, fairly good compliance with my clients because of the time I take. And this just elevates it even more and allows when they have to go back home and discuss whatever was recommended and come back for that professional dental cleaning. They have all these resources in addition to the time they spent, and you are able to provide better care for their pets.

SPEAKER_01 18:35

Yeah, you build that trust, absolutely. And and and we all got into this because we love helping the animals, we love the humans attached to them, and being able to build that trust allows us to do it better.

SPEAKER_00 18:47

Well, thank you all for being guest panelists today. It was a great conversation, and thanks for flying with us on Flight Plan Quick Consults. If today's insights helped you climb to new heights, be sure to subscribe, leave a review, and share this episode with your crew. Until next time, keep your mission clear, your team aligned, and your practice soaring.