Practice consultants often recommend linking associates' pay to their performance. That is, pay them a percentage of the income
they generate. I disagree emphatically. Why? Because it creates a conflict of interest and may influence doctors to run unnecessary
tests or even to perform questionable surgical procedures.
We avoided this in my practice. If a doctor was unproductive because of laziness, incompetence, or indifference, we fired
that doctor! Otherwise, we left things as they were. Who contributes more to a practice, the doctor who sees the patient and
recommends surgery, or the doctor who performs the surgery? I'm a fast worker. I could usually see a patient in less than
half the time my late partner Dr. Bob Kind could. But Dr. Kind had an enormous, devoted clientele. Without him, many clients
would have gone elsewhere.
One reason my three partners and I had such a compatible partnership is that we shared equally in the profits and deliberately
ignored who was bringing in the most income. We also shared administrative responsibilities and worked equal hours. Our younger
associates did not complain about their caseloads or emergency duties because we four partners put in just as many—if not
more—hours. We were very different, but our priorities were the same: We wanted to have time off to spend with our families,
to practice state-of-the-art medicine with absolute service and integrity, and to earn enough money to provide a decent lifestyle
and secure a future.
Over three decades, our practice grew from a mom-and-pop house call practice to a 12-doctor group. This phenomenal growth
was due to the principles we strictly adhered to. These all related to image—I believed that the public respected a professional
image and would be willing to pay for it. And although I no longer have a connection with the practice except as a client,
it has adhered to nearly all of the principles I established.
1. Practice by appointment only, except for emergencies. When I began this practice, I knew of only one other U.S. veterinarian who practiced this way.
2. Limit the practice to medicine and surgery of all animals. We did not board or groom and sold pet supplies only for medical purposes. Our practice included all species, only drawing
the line at venomous snakes.
3. Offer 24-hour emergency service. In time, we turned our small-animal emergencies over to the local emergency clinic, but the practice continued to offer 24-hour
large-animal emergency service.
4. Adhere to absolute professionalism and integrity. No discounts, coupons, low-cost shot clinics, or advertising for our services. We adhered to the AVMA's code of ethics from
the 1950s even after the Federal Trade Commission rulings in the 1970s. Instead of growing through advertising, our practice
grew by word of mouth. We wrote a column for the local newspaper, joined the local Lion's Club, and were active in the community.
5. Practice state-of-the-art medicine. Continuing education was mandatory at our practice. If we felt that better service was available elsewhere, we referred the
How you handle incoming phone calls is another important aspect of practice. A phone call is often the first contact a potential
client has with your practice, so professionalism is essential. I retired before answering machines, automated messages, and
exasperating phone procedures. But I know that if I were still practicing, I would have live people answering my phones, whatever
the cost, because it would build my practice and, ultimately, increase my income.
My partners and I worked hard to gain new clients and keep our old ones. It was not enough to simply do a good job. We demonstrated
that we cared, that we were highly professional, and that we had absolute integrity. Real success in practice doesn't depend
on gimmicks, merchandising, or the sharp business acumen that many practice consultants advise. Real success comes from clients
that regard you with complete trust and respect. It must be earned.
Robert M. Miller, DVM, is an author and a cartoonist, speaker, and Veterinary Medicine Practitioner Advisory Board member from Thousand Oaks, Calif. His thoughts in "Mind Over Miller" are drawn from 32 years as
a mixed-animal practitioner. Visit his Web site at