Taking a vacation from your business can be very stressful. Finding a locum vet replacement can seem impossible, but the idea of a stranger stepping into your clinic to be the face and reputation of your business is daunting. Everyone needs a vacation, and it is usually best to keep your doors open. How will the locum fit into the group dynamic with the support staff? Will the clients like the locum? Will the clinic make any money while you are gone? What if the locum is horribly incompetent? Do you find yourself wondering if you really need that vacation after all (answer: Yes you do!)
Here you will find some points to consider, that I have learned as a locum, and through conversations with other locums and practice owners. My biggest tip is to have a checklist (Figure 1) of things that should be discussed in advance. Read on to learn questions that you might not even think to ask!
Figure 1.
Sample checklist.
Money matters
Your first task with your newly appointed locum is to get a contract. If the locum does not provide you with a contract you should ask for one. This should outline at a minimum: dates and times of work, arranged payment, and any extras like accommodation or on-call duties. Make sure that your billing policies are clear. You may think it obvious that you give a 10% discount to Peter and his pomeranians, or that you charge extra for a nail trim if it takes 3 people. The locum should be billing according to your written fee guide and should not be responsible for determining fees, discounts or payment. Have these in writing, or, if possible, delegate this responsibility to a trustworthy senior staff member who knows your client relationships.
A locum veterinarian is not necessarily going to make you money. If you accept this before your vacation you may be less stressed upon your return. Profits should be considered an added bonus to your vacation. Your job is to relax, the locum’s job is to hold down the fort and see the animals that are presented. You can’t force your clients to see a locum, and some clients will wait for your return for routine appointments.
Appointments
Scheduling a day for a new locum can be challenging. The locum does not know the clinic, the staff, the clients, or the clinic layout. Be honest about how you book your appointments. Locums are also usually very meticulous about records, to avoid miscommunication, which takes some time. Most locums charge a fee for time out of hours.
At all costs, avoid the client surprise! It is crucial that clients know they are seeing a locum. Many clinics are worried that they will lose money on a locum day. An unfortunate experience for everyone is when the locum walks in the room, and the client exclaims “Where is Dr. X today?” with an accompanying horrified expression. Here’s what I suggest: when a client books an appointment, the receptionist will say “Thank you Mrs. Jones, your appointment is on Tuesday at 4 pm with Dr. Smith.” In this case, a client who wants to see Dr. X will say that they would prefer to see Dr. X, which can then be arranged if possible. A client who is willing to see a locum will not comment and will come to the appointment. This is a great opportunity to promote the locum, for example; “Dr. Smith is a caring veterinarian with 8 years of excellent experience. Dr. X trusts her and other clients are really happy with her.”
Technical skills
During the first few days with a locum there will be an adjustment period to find out where the locum’s skill sets fit in within your practice. The locum should be informed if there is an AHT on staff. If there is no AHT then the locum has the right to dictate what procedures are acceptable. Avoid booking a solo new or locum AHT with a solo locum veterinarian, a recipe for potential disaster. Imagine during an emergency:
Locum Vet: “Where are the ET tubes? I need an IV catheter and some normal saline immediately.”
Locum AHT: “I don’t know, I thought they were in this cabinet but they seem to be out.”
Locum Vet: “Try that drawer — what about in surgery? This dog is arresting!”
A locum will also likely not know how to use your x-ray machine, so have staff on site who are trained, or have a contingency plan for cases requiring radiology, such as a neighboring clinic or referral centre.
Don’t micromanage, or worse, delegate a staff member to micromanage for you! A good locum tries to fit in with the practice philosophy but will do things the way she or he sees fit. Locums will not necessarily use your first choice of antibiotic, suture pattern or type, etc. Locums must be given the flexibility to work within their comfort zone. By having a discussion about case management styles, using a checklist, and your very specific requirements in an interview ahead of time, an understanding is possible.
Euthanasia, in my experience, is a source of potential conflict. If you are particular about your euthanasia method, discuss with the locum (whether an IV catheter is placed, whether the animal is sedated, owners present, whether the locum will agree to “convenience” euthanasia).
We all know veterinarians who have different comfort levels with surgery. Get a list of acceptable surgeries from the locum. Do not book a locum to do a cruciate surgery without confirming that he or she does this procedure, and is experienced — is it the second or 70th cruciate surgery? Some locums may not do cosmetic surgeries such as tails, ears, declaws, and debarking; if you expect your locum to do these procedures it is important to discuss this.
Be honest about your caseload and review this with the locum. Do you see birds sometimes for beak and wing trims? No big deal? A locum might feel completely overwhelmed. Do you book 10-minute or 30-minute appointments? How many surgeries do you perform in a morning? Make sure your locum comes prepared for the pace at your clinic.
Case management
Most locums enjoy their job because they love learning new things; however, locums should have the flexibility to do things their own way. Your staff may feel like they are protecting your interests by telling the locum how you do things, but this can make a stressful experience for staff and locum if not delivered delicately. Discuss with your staff in advance how they should deal with these situations.
What do you do with emergency cases? A locum might not feel comfortable hospitalizing a patient overnight with no staff in attendance. If a locum stays to see an emergency they will likely charge extra. Be sure to discuss! What should the locum do with a referral? Discuss your referral policies with the locum in advance, but respect the locum’s comfort zones.
What are your routine protocols, such as vaccinations? Heartworm and deworming protocols? Do you vaccinate for feline leukemia? All cats? Only outdoor cats? Do you require a blood test prior to vaccination? Do you vaccinate with a 3-year or 1-year vaccine? Iron out any issues with routine procedures before the locum comes to the clinic. Use your checklist and make sure the locum is getting the correct information directly from you, to avoid confusion during the locum term.
If a checklist sounds like a lot of work, I guarantee it is a lot easier than dealing with a mutiny from your support staff because the locum went horribly wrong (I see you grimacing because we have all been there!). Ask your staff for help designing or editing your checklist. If you have specific policies, some idiosyncrasies, or you like to tap your feet 3 times before you spay a cat, your support staff certainly know it — probably better than you do!
Summary
Get your staff and clients excited about your locum, focus on the locum‘s positive attributes and the new ideas he/she will bring to the practice.
Find a locum who makes you think about your vacation and not the practice.
Use your checklist to discuss how your practice works.
Make sure you have a detailed contract — and verify the license status of the locum.
Consider any profit a bonus.
Hire a locum for a day if possible in advance of a large block of time to iron out any conflicts.
Have a checklist of issues to review before you go to minimize any misunderstandings — Did you read the title? I know I said this already — are you getting the picture? See the sample checklist (Figure 1). Give a copy to the locum, so you both know what you have discussed before you go on vacation. Give a copy to the support staff so they know how to book appointments.
Enjoy your time off!
Footnotes
Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office (hbroughton@cvma-acmv.org) for additional copies or permission to use this material elsewhere.