When Good Medicine Feels Financially Impossible

In this episode, two veterinarians and a practice manager share how teams can balance high standards of care with the financial realities clients face.

The conversation highlights the importance of reading client cues, offering clear options along the spectrum of care, and meeting clients where they are without compromising medical integrity. The panel also dives into practical strategies to improve compliance, from communicating value and aligning as a team to ensuring consistent messaging across every touchpoint.

If you’ve ever felt the tension between great medicine and affordability, this episode offers real-world insight on navigating it with confidence!

Host: Brenda Tassava Medina, CVPM, CVJ, MVLCE

Panelists:

• Tim Loonam, DVM, Chief Veterinary Officer, Encore Vet Group and Veterinarian at Grace Animal Hospital
• Christine Merle, DVM, MBA, CVPM, Veterinarian and VMG Facilitator
• Maggie Holcomb, CVPM, CCFP, Regional Practice Manager, Encore Vet Group

Thanks for listening!

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Transcript

SPEAKER_03 0:10

Welcome aboard. You're listening to Flight Plan Quick Consults, your go-to podcast for veterinary insights that are fast, focused, and designed to elevate your practice. I'm your host, Brenda Taspa 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 set a course for when good medicine feels financially impossible. Today's panel includes Dr. Tim Lunham, Maggie Holcomb, and Dr. Christine Merle. Dr. Merle, tell our listeners a little bit about yourself.

SPEAKER_02 0:48

Sure. So glad to be here. Thanks for inviting me. I am a veterinarian. I also have an MBA and a CVPM and have been in the veterinary industry for over almost 30 years right now. Have worked on the university side as a practice management consultant in industry, and then returned after about 20 years back into practice. So currently I'm working as a part-time veterinary associate as well as the editor for the Bracky Newsletter.

SPEAKER_03 1:17

Thank you. Thanks for being here with us. Next up is Maggie Holcombe.

SPEAKER_01 1:22

Hi, um, I am the practice manager at Ronaldo Veterinary Hospital in Winston-Salem, North Carolina. Um, I have been in veterinary medicine for 20 years, um, since I was 16 working in the kennel, and I have kind of worked in all areas of the clinic. Um, last year I earned my CBPM. I'm also a CCFB, and um I have been at Rinolda since April of 2022.

SPEAKER_03 1:50

Awesome. Thanks for being here with us today, Maggie. And not to be missed, Dr. Tim Lunham.

SPEAKER_00 1:56

Thank you, Brenda. What a pleasure to be with this uh panel here, and thanks for the invitation. So I am uh I'm the director of university relations and the chief veterinary officer for the Encore Vet Group. I came uh into veterinary medicine a little bit later in life. I was a regular Army officer, and then I received a scholarship, and the U.S. Army Veterinary Corps put me through vet school where I served on active duty, including deployments, uh combat deployments overseas. When I came back from the Army, I built my own practice in Lexington, South Carolina. It was a mixed animal practice. It was a complete startup with one veterinarian, and we're very proud we've uh we've hired uh our 11th and 12th veterinarians this spring. I only have three initials after my name. I only I'm only a DVM.

SPEAKER_03 2:38

Um that is not an only.

SPEAKER_00 2:42

Uh I will add that um, and I'm so excited about this podcast. I serve as a veterinary advisor for the Stanton Foundation. The Stanton Foundation is a billion-dollar endowment made by Dr. Frank Stanton, who uh passed away. He was the former president of the central broadcasting system. And what Dr. Stanton envisioned uh with this foundation was research and projects that support uh this new term we have in veterinary medicine called the spectrum of care. And so I serve uh, again, with very few initials after my name, I serve as the voice of reason for private practice uh to help the researchers determine if the grant proposals we get from our foundation are something that are gonna absolutely help general practice and our clients in uh in general practice.

SPEAKER_03 3:30

Awesome. It's so great to have you today on this very hot topic. Um so I have a couple of questions, and we're gonna start with Dr. Merle. Um, my first question is how can practices preserve medical standards while adapting to clients who are financially stressed or overwhelmed? Because we're seeing that more and more over the last six to 12 months.

SPEAKER_02 3:54

I definitely would say that's that's becoming more common. And I think one of the biggest pieces that I see and that I try to practice as an associate is being open to a conversation and really being able to watch body language. You know, um, what might they be saying with their body language that they're not saying out loud, especially if they've traditionally been, yeah, go ahead, let's do everything, um, but maybe are asking an additional question. So I think being willing to have conversations. Um, and then also I think the other things with the financial is here are all the things that I might recommend for today. Here are things that we absolutely need to do at this visit, here are things that we may need to uh may be able to not necessarily use the word postpone, but move to a later time. What works best for you today, what makes the most sense? So I think um being very open and willing to start the conversation. Um, I know a lot of us, I still use the word estimate, you know, we we have treatment care plans, whatever the right word is. I think um being able to offer that, even if they don't suggest it saying, I'm gonna put together for you that estimate for today's visit or a care plan that may encompass the next two or three months so that they can kind of plan forward. Um, I've had more and more people apologize if they can't do something, especially if they've been ready. And I think that for me is really important to reassure them that there is no apologies. Um, everybody is in a situation, expenses are high for everyone, and we want to work with them, not against them. So I think just being open and willing to have conversations.

SPEAKER_03 5:44

Thank you so much for that. Dr. Lunham, what's your take on this?

SPEAKER_00 5:49

Sure. Uh those are great, great comments are. I agree wholeheartedly with all of them. Um, a couple things I would add. First off, uh, for the listener, um, there's this misunderstanding about what the gold standard is or the standard of care. Truthfully, there is no standard of care in veterinary medicine. The only standard of care that exists is what's um determined by veterinary malpractice. And the standard of care states that you know you're practicing the type of medicine and surgery that would that colleagues practicing in similar circumstances in the similar environment would do. So just think about the breadth across our country. You know, whether you're in downtown Manhattan, New York, where there's a veterinary practice on every corner and multiple options for referral, or if you're in East Ellay or Sopchapy, Florida, someplace where you might be the only veterinary in the county. So that's where this term spectrum of care has come from. And spectrum of care, you know, for Dr. Merle and I, this is one of those things where we were probably practicing this our entire career, but we did it with a certain degree of guilt. Um, you know, this isn't what I learned at the University of Georgia. This isn't what they're teaching right now. But we but we forget that although the the the teaching hospitals and the high-end referral centers, there's absolutely a role for those. They are real medicine, but it might not fit for everybody. So I love the term. I didn't come up with this, but I I love hearing people talking about meeting our clients where they are. And uh to follow on what Dr. Merle said there, you know, being non-judgmental and making sure that your client education, your expectations are uh that that they're they're crystal clear. I can tell you with my practice in Lexington, South Carolina, we're uh we're a uh one generation removed from being an agricultural suburb of Columbia. This doesn't happen as frequently as it used to, but there was a time when probably every other week, maybe every week, a client would say something to me after I gave a treatment care plan. Dr. Tim, why would I spend$250 on this cat when I can go to the shelter and get another one for$30? That makes us all in this profession cringe, but we also have to understand what the culture and the value system of our clients are. And again, it's so important not to be judgmental with that. I'd say um other than that, you know, um having your technicians on boards and teaching them to read that same body language that Dr. Merle talked about, so important. Absolutely.

SPEAKER_03 8:21

And and you you reminded me, I was at a VMG Congress last weekend, and I heard a speaker, uh Dr. Danny Rabwan, she used the the phrase contextualized care. And I really that resonated so much with me because it's what both of you described. It's like really being in tune to your client and what what they're able to provide and what they what their belief system is through you know, questions, building a relationship, asking more questions, and then being able to create a treatment plan based on the context of the situation as a whole. So I really like that. So, Maggie, you're a practice manager. So we're gonna get your point of view and your perspective on the same question. How can veterinary practices preserve medical standards while adapting to clients who are financially stretched or overwhelmed?

SPEAKER_01 9:14

Yeah, so I think um I think they they touched on a lot of the medicine side of it, you know, prioritizing that care and and meeting the client where they are. But um, you know, on the business side of things, having those payment options for the clients, being able to support them, there's so many out there now. Um, you know, there's Cherry, there's Care Credit, um, and a bunch of other options out there. So, but I do think with that is making sure that you pick what works best for your practice. I think offering too many can get really confusing for your staff to try to keep straight and explain, but also overwhelming for the client which one is best. Um, and then wellness plans, or I know some other hospitals have um like hospital memberships that whether you know, some of them I've seen where they have um free exams or something like that that come with that membership. Um, we offer wellness plans for our um preventative care. So your exam, your vaccines, your blood work, um, and that breaks it up because I mean, even your wellness visit can get pretty hefty whenever you come in once a year and get it all at once. And so these plans do a really good job of breaking it out into monthly payments that I think are very helpful to clients. Um, and so I think being able to offer those options and also just being transparent and upfront about what the pricing is, providing those estimates or care plans um to the client so they can kind of see and allowing them to say, I can do this, but I can't do this.

SPEAKER_03 11:02

I really like the wellness plan model. I think that we've we've seen them ebb and flow and they're successful in some practices and not others. But I see today them being even more relevant. I mean, we live in a Netflix society, right? Everything is a subscription. So it makes a lot of sense for preventative care to be a subscription model for our patients so that they can spread out those payments and just make them recurring and know that their pet is getting what they they need. Thank you for that. My second question, and here I'll start with um Dr. Lunham. What communication or pricing strategies actually improve compliance without discounting or moral distress?

SPEAKER_00 11:51

I've given this one good thought, Brenda. This is a this is a difficult one. Uh I can the first thing I thought back to was when I first opened my practice. It was a it was a private endeavor, it was a startup, I was the only veterinarian. And just to be completely transparent, it was everything my wife and I had financially. So getting that practice started, it was it was very hard to um have uh personal guidelines on that. Every rescue group, everybody came to me, it was a new business. I was very hard for me to say no. And I found that rapidly I was trying to meet everybody's needs. Um and I was unsuccessful at that. You know, I I live in a community, as I said, it's kind of a first generation removed from agricultural, yet we live on a um we live on a very large recreational lake. So there's our state government's nearby, the university's nearby, so there are there's a fairly wealthy segment of clients. But you know, trying to meet everybody's needs is impossible. I think establishing in your practice, here's what we're gonna do, this is who we are, um, this is the type of medicine we want to practice within the standard of care, not meaning that we're gonna do everything like the university says, but this is our standard of care. And when folks can't meet our pricing strategies, um, how do those pricing strategies go? I remember an older veterinarian who was who was uh a mentor to me when I was getting started. You know, he said, I I didn't get into veterinary medicine to make a fortune, I got into this to make a joyful living, and that that always resonated with me. Um determining who we are and then looking at some of these pricing options. You know, Maggie mentioned great things there with uh with the paying for cherry pay care credit. And then this is where the work comes in, and that's that's establishing a network of rescue groups and shelters and others that are willing to uh willing to help out. Um and and you know, I don't try to send every every client there, but there are some certain cases where they get inside your heart or they get inside the staff's heart, and you've got to have those options out there for for people. And many times doing that, you know, you're not embarrassing the client. They don't have to walk out of an exam room knowing that they couldn't afford you, and and that kind of feels uncomfortable. Here's some solutions for you, Mr. and Mrs. Smith, that we can we can try, and we're happy to make some phone calls for you. That takes a lot of extra work, but boy, that's built our practice over the years.

SPEAKER_03 14:21

Thank you for that. Dr. Merle, what's your take on this?

SPEAKER_02 14:25

You know, that I'd 100% agree with Dr. Linnum. Um, I think really being able to understand your standard of care and and what your practice is, the uniqueness of it. I think it's also really important to understand your numbers, the financial aspect. And so for me, I think even communicating that from the top down, so a form of open book management where the staff understand the costs of running a business, because I think sometimes we forget what that actually is. So understanding what your finances are and what pricing strategies you can employ. Um, you know, we have a lot of clients that may come to us for their not their healthy care. So from a wellness plan, but they come for us for civic. And so we aren't the cheapest when it comes to pricing for wellness care, but we offer really high-end diagnostics and have capabilities that really can mimic sometimes these more costly referral centers. And so clients have learned, you know, I can save money here, but when I really need something to be done, for example, surgeries that may not be done routinely or at low-cost locations, this might be a place I want to go to. So I think understanding your niche and your culture and the standard of care that you can provide, um, and then being able to communicate that not only to your clients, but your staff, and then being able to communicate that as well. Um, and then lastly, for pricing strategies too, is if there is a challenge, like you said, referring them to places that you can partner and work with, or even looking at, you know, do we have a slow afternoon? Is there something we can offer for clients that might be stretched on a certain day or once a month? So I think there's a lot of different things that practices can do, especially how they see themselves within their community. But the biggest thing I think is communicating for them. Um, I'll touch a little bit on that moral distress because I think we're starting to hear more and more people talk about moral distress. And I think this is a part of collegiality and getting to know networks and veterinarians in your community. Um, I'm an active member of my local VMA, and it's very disappointing to see not as many members there anymore. And I think that's really critical because we can have discussions as colleagues and find out, you know, and I talked to somebody at a dinner last night. I mean, I didn't know he did TPLOs. Now he's not a board certified surgeon, but he even said he started doing them because he wanted to offer something to his clients. That is a potential resource for clients that may not be able to afford a board certified surgeon, which there are a lot in our community. And so I think building those relationships. So I'll kind of mention that as, you know, how do you deal with moral distresses is building a network of colleagues that all can work together. And I think that that is something that I'm seeing not as common anymore. And I'd love to see that grow in in bigger communities with veterinarians.

unknown 17:39

Great.

SPEAKER_00 17:39

And I would add, I would add to Christine there, this collegiality is so important. Uh and Christine and I, we may remember back in the day, and well, all of us, um, you know, there was a time when veterinarians and the relationships with shelters and rescues were so much better than they are now. You know, we got along, we kind of had the same um end game. And boy, I've seen that fall apart. At one point, I was like Christina, I was serving on our VMA, and we had a we had a uh a legal battle in South Carolina, and it was a big battle between the shelter groups and the rescues and the veterinarians. And it was, gosh, it was so ugly, and I hated seeing that. So getting those relationships back is that's that's huge. Um, that serving too on the on the VMAs. Uh this is a little bit of an editorial, and I'll take advantage of my moment in the sun here. But I think uh we should help our our young doctors and staff members get involved in organize veterinary medicine. They don't have to be the president of the AVMA, but we should all do our penance, you know, we should do some time because our industry is at risk because of things like this. And nobody's gonna take care of our industry except ourselves.

SPEAKER_03 18:44

Yeah, I mean, right now there's there's actually a national association for for veterinary receptionists. So, I mean, we have those organizations. It's great to encourage all of our team members to get involved with their particular roles organization. Maggie, practice manager point of view.

SPEAKER_01 19:03

Yeah. Um great points all around. I do um I think a big piece of this is you know, not just leading with a price, like this cost this much, like, but explaining the value and the why behind why that is important, um, what they're getting in that service, um, is is so important for the client to understand, like, oh, I am I'm paying this much money, but it included this, this, this, and this, and it's so important to my pet's overall health. Um you know, I think I mean pets are an important part of all of all of our families now, but um, you know, some of the younger generations, like they, their their pets are their children. They're they are family members. Um, and so they will pay that, they will skimp a little bit on other things to pay for their pets' care. Um, but just you know, having that conversation, explaining that, and then meeting the client where they are. I think the other communication piece of this is having consistent communication within your staff. So they don't get one answer from the front desk, another answer from the technician, and then another one from the doctor. Um, but everyone says the same thing so that by the time they get to the doctor, there is three people that have have said the same recommendation. Um, I think that is really important. Um, another thing that we've started doing in our practice, um, and it kind of it kind of goes with spectrum of care, but it's a little different, um, is having like phased care options. So um a really good example of this with us is we started staging our dent our dentals. Um and we changed up the uh verbiage that we used as well with clients. So a dental, when you say that, is very oh, they're going and getting their teeth cleaned, just like we all go and get our teeth cleaned. Um, but instead that we've started saying stage one is your dental cleaning. Um, and they will come in, they get their dental x-rays, they get the cleaning, um, and then they go home. And we have a plan based on those dental x-rays to come back in, you know, about three months is the max will do, because after that they may need another cleaning. Um and we know exactly how many teeth we need to pull because we've already done the x-rays, and then we say you're gonna come back for stage two, your oral surgery piece um at that point. So this really helps the client. Um, there's we don't have the scary. Uh checkout time whenever we give them this big giant bill, or we're not giving estimates that are$500 apart, you know, depending on how much um how many teeth we had to pull. And so it's just very clear to the client. They can budget for it, they can, you know, okay, I paid this much today, and now I'm going to come back in a month, and I know I need to have this amount. Um, and that's been really helpful. Uh, and the I feel like it really did it is improving our compliance as far as dentistry goes. Um, because the clients do come back for that second stage.

SPEAKER_00 22:35

Yeah, I think it really helps with the thing. That's just the way we do it. That's the way we do it in human dentistry, isn't it? Mm-hmm.

SPEAKER_01 22:42

Yeah, it's exactly how we do it in human dentistry.

SPEAKER_00 22:44

I hadn't thought about that, Maggie, too, because I've talked to you about this, and I think it's a great plan. I hadn't thought about it until right now that that's exactly I had my dental cleaning uh earlier this week, and there was the next step. Here's what we're gonna do next, Tim.

SPEAKER_01 22:55

So yeah. And I think the other part too of this is um you know, being confident in our language and not apologetic. Um, you can be empathetic and understanding to the client and where they're at, but don't apologize for the service that you're providing. You know, the doctors all went to school for a really long time to be able to provide the service. Our technicians, our front staff, everybody, you know, we we've all done a lot of training to be able to provide the service. And so we shouldn't apologize for what that costs, but we need to really deliver on that value behind that service.

SPEAKER_03 23:39

And I think starting with why really lends itself to that value piece.

SPEAKER_00 23:45

Brenda, there's some evidence behind that. If I could add on Maggie's uh points. Absolutely. About three years ago, our our friends at the American Animal Hospital Association, AHA, they did a study of clients leaving the exam room. And this is one of the things I I work with students on in my talks on the universities. Um, if you survey, well, here's what AHA did. They surveyed clients coming out of the exam room, everything from wellness exams to these expensive dentals that Maggie was talking about. And when we surveyed the clients, on did they think that veterinary care was expensive? 78% of them said yes. It was higher than they thought and it was expensive. However, that number was reduced to 34% if the discharge was done first in the exam room. There's that why again. And you know, we've all been in practices and the receptionists and the techs, they want to get those folks out of here. Hey, let me go ahead and check out Mrs. Smith and then you could do the discharge in the room. Uh-uh. We need to, we need to sell what we do. We need to, you know, we've got to give that value to it. And so there's that why piece again.

SPEAKER_03 24:45

Absolutely. Well, thank you all for taking the time to be a part of our panel today. 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.