Being overwhelmed and overworked are key factors in burn-out in our profession. We are all different in the way we handle cases, clients, hours, appointments, emergencies, etc.
This leads to the question of what is the ideal number of daily appointments?
- What about drop-off appointments?
- Do you get a lunch hour? We should at least try for a half-hour!
- What type of time slots do you schedule for your surgeries?
- How long should an appointment last?
- What about emergencies and work-in appoinments?
These are all things to consider when making an ideal schedule. In our profession we just never know what could walk through the door so it can make it difficult to achieve. I really do believe that there is a balance between quantity and quality.
We do appointments every 20 minutes at our hospital. When I have an appointment coming in that sounds like it may be very sick (not eating for a week, vomiting, etc.) I try to slot those as double because they will likely need labwork, x-rays, etc. but that doesn't always happen.
Our appointments are from 8:20am to 10:00am, surgery time is 10:00 until when we are finished (normally around 12-1pm). I try to start a dental if the technician is ready before I finish my morning appointments. We start afternoon appointments at 1:20 and go until 5:40 (we close at 6pm).
We regularly have 2-3 surgeries or dentals scheduled each morning (we only have 1 doctor working at a time). We quite often have to double book appointments when there is an emergency because our schedule is almost always full. Sometimes I wonder how there are this many pets that need to be seen in the world, as there are many veterinarians in our area.
I try to let the work-in appointments know that we are squeezing them in between our scheduled appointments and that I am happy to see them but there could be a wait time.
So on average there are about 5-6 regular appointments in the morning, 2-3 surgery check-ins (we begin pre-medicating them, running pre-surgical labwork, placing IV catheters when they arrive), and about 14 appointments in the afternoon (plus usually there are 2 work-ins or double booked appointments on average). This means on a regular day, I see about 20-23 pets.
Now, at this time in my career I can do this fairly easily and feel confident that I spend quality time with each client. I am still exhausted at the end of the day. I have a difficult time turning people away if they call- especially for existing clients. If it is an emergency to them, it is an emergency to me as well and I try to accommodate people as much as possible.
That being said, I do usually have a lot of notes and call backs from the day (and lab results and follow ups to do from the previous day) after closing time. Currently, my husband and I trade off work days so we are open 6 days a week, but we split work time. We are getting busy enough now that we should consider hiring an associate. I think about what it would mean if I had to work 5 days a week with this schedule and if I would be able to do that. I am not sure.
Based on the article linked above, and based on my current work load, my own personal opinion is that for a full-time new graduate veterinarian the ideal number of appointments per day would be 15 regular appointments plus 2 surgeries (or 20 if no surgeries). For veterinarians that have been practicing for a couple of years or more, the ideal number would be 18 appointments and 2-3 surgeries per day (or 25 if no surgeries).
I should also note that this number is ideal when there is a good mix of wellness and sick visits. The type of appointments being seen (wellness vs. sickness) makes the ideal number shift some.
A large factor in how many appointments you can see in a day has to do with the number of staff that you have. We have 4 techs to 1 doctor currently. Our techs are cross trained so they rotate through check-ins and follow the appointment through until check-out time.
They share responsibility for answering the phone (whoever is up next waiting for the next appointment to check-in) and help each other draw blood, etc. This is our team approach. And yes, I still help draw blood and express anal glands when needed to keep things running smoothly.
In the linked article above, one of the doctors it features sees 40-50 appointments per day but has 11 technicians helping her. So even though she has a large volume, she can manage because she is able to delegate much of her work to her techs. Can you imagine?! For me this would be too many, but she clearly manages the volume well.
There really is no right answer. I did an internship right out of vet school at a large emergency and specialty practice that was very high volume. Then I went to work in corporate day practice. I then left after 7 years there to work at a very small 1 doctor practice, and now have my own practice.
So, I do feel like I have had a variety of work-load experiences and took those into consideration when thinking about the right number of appointments when we made our schedule.
I would love to hear what you think! How many appointments can you comfortably handle in a day and that you find sustainable for your quality of life? How long do you think an appointment should last?