Re: Compensation question

January 19, 2012

Great question and one which I am certain we all have thought about.

First some facts ( some from AAHA):

1.) The overhead in a modern day, progressive veterinary practice (before COGS)

is somewhere in the 21% to 25% range, depending on many factors such a location

and age of the practice (e.g. new building vs. old) etc. Therefore, the overhead

for the Rehab service should be proportional to the square footage consumed;

2.) GP DVM's are compensated at 21 to 22% of what they gross;

3.) Specialist DVM's are compensated between 27% and 31% of what their service

grosses, depending on a multitude of factors (e.g. amount of techs required to

execute their service);

4.) In most states, only DVM's may make a diagnosis. If you have a trained rehab

DVM in the practice that is involved in the decision making process (team

approach), this will further erode the profitability of the service;

5.) It is reasonable and ethical for a hospital to expect an 18% ROI for a

service;

6.) Whether or not the hospital is leasing the equipment or owns it, this cost

( as well as equipment maintenance) needs to be recaptured.

As rehab is an extremely labor intensive service, 50%, compensation leaves NO

room for profitability for the hospital (in fact, they may not realize they are

actually subsidizing it). It is possible that the management of this hospital

knows that Rehab is underperforming and as a result, they are seeking to salvage

a poorly thought out entry into veterinary rehabilitation. Possibly, they just

do not understand finances or their accountant is sleeping at the wheel (or

doesn't know about it).

Given the aforementioned, at 50% you are being overcompensated. 60% is

incomprehensible (or possibly trying to kick start it??). This may bode poorly

for the long term survivability of the service in that practice because as soon

as the owners realize they are actually subsidizing the service (or have had

their fill of subsidizing it should their attempt at kick starting it be

unsuccessful), they may abandon Rehab.

January 19, 2012

I am a PT, CCRP. I am an independent contractor and rent space from the Vet. All my expenses: equipment, advertising, insurance, etc I pay. I do my own billing, collection and scheduling. On average I net 50% of what I collect after expenses but BEFORE taxes. So to me, this sounds like a generous arrangement. Hope that helps.Pavlakos From: VetRehab [mailto:VetRehab ] On Behalf Of WagHabSent: Wednesday, January 18, 2012 8:07 PMTo: vetrehab Subject: Compensation question I am hoping several of you can offer me some information. I am in negotiations with a local vet on contracting my rehab services with them. I am a PT, with CCRP pending. They have built a small rehab room and have some balance equipment, an UWTM and a laser. I will be an independent contractor with them. They are wanting to pay me 50% of what they charge the client for their patients. And 60% of my charges when I bring clients in from outside sources. Can others please tell me the way they are being compensated in a similar situation? And do you have have use of a tech, use of all the equipment, etc. Feel free to email me off list.Thanks so much! Day, PT, CCRP-pending

January 20, 2012

Good response and question Pam... I think the answer lies in utilizing staff for rehab much the way We do as veterinarians. The vet/ rehab practitioner is in charge of diagnosis and treatment plan while the trained staff (read LESS EXPENSIVE staff) carries out the physical labor part of the job. This may be controversial to some, but I would not be able to make rehab pay if I were the one doing the manual labor. It is no different than having techs do all the non doctor stuff that happens in my hospital; i don't place catheters, draw blood etc unless absolutely necessary. I let my staff do everything except doctor things like diagnose, plan treatments, medical records, surgery and client communication. Their job satisfaction is quite high, I have a high staff to doctor ratio and I can make a small profit on the rehab center. I'm sure this will open a loud discussion, but is just my 2cents...Pam Nichols DVM, CCRPSent from my iPadDr. Pam Nichols cell office

dogedoc wrote:

Given the aforementioned, at 50% you are being overcompensated. 60% is incomprehensible (or possibly trying to kick start it??). This may bode poorly for the long term survivability of the service in that practice because as soon as the owners realize they are actually subsidizing the service (or have had their fill of subsidizing it should their attempt at kick starting it be unsuccessful), they may abandon Rehab.

This may well be true. However, it is hard to see how an independent contractor (who must provide for his/her own benefits, SS taxes etc) could make a living at much less than 50% , since the average rehab appointment brings in what, $70 an hour? $150 maybe for first (evaluation) visits -- or what are you guys charging?? (Our evaluation is $115 but an average hour appointment runs around $60) 21% of $60 isn't going to pay the bills. In contrast, the GP who is paid at 21% ( plus benefits) can expect to gross $200 to $500 an hour, thus rendering the 21% a pretty reasonable salary.

It's my understanding that 50% of gross is standard percentage for acupuncture vets (of course they don't have any expensive equipement to cover).

This question-- of how an incredibly labor and equipment intensive but non lucrative profession can pay for itself -- vexes me a lot and I would love to hear what others think.

Pamela Mueller PhD DVM

January 20, 2012

Pam,

You hit the nail on the head and I agree totally with your assessment.

There are many examples in other industries where " levels " of a team are

responsible for different aspects of executing a service.

Take hairdressers; in highly profitable shops, the stylist only cuts and

directs. The head stylist will delegate shampooing hair, watching and the bulk

of doing perms to an " understudy " .

And so in rehab, in order to be profitable, a team approach is the best road to

success. TRAINED and dedicated staff executing different aspects of the

treatment plan is necessary.

I utilize a proprietary computer program that prices all our services ACCORDING

TO COSTS. I did this for another practice as well. As a result, the hospitals

went from subsidy to generating 18% ROI on rehab services on a regular basis.

When I first did it 6 years ago, the results knocked me over.

It is not relevant for any one of us to ask how much the other charges. The

question should be, how much should each practice be charging in order to

satisfy the multitude of requirements that this modern day business must endure

to continue staying in business: patient/customer needs, affordability,

profitability and realistic, living wages. And in order to retain talented and

caring individuals, the compensation of each member of the team needs to be well

thought out.

The alternative to proper financial analysis is failure of the business and then

no one benefits; least of all, our patients.

ph DeLucia DVM, CCRP

Valley Veterinary Rehabilitation - Director

Veterinary MRI and RT Center of NJ - Managing Member

January 20, 2012

To help clarify a little. I will recap my actual role in all of this. This a

general practice and have been in business for 15+ years. I believe building,

land, etc is paid for. They built some onto their existing building (a very

small room for rehab really) and have purchased an UWTM. They already had the

laser and have been using it. They have a vet who is going through the UT

training for CCRP, but is not experienced, or finished with the courses yet. I

am the only PT CCRP in the area. I am offering my knowledge and expertise and am

consulting with them free of charge to get this started. I am creating forms,

handouts, etc for them. I am an independent contractor and have to pay my own

liability insurance, taxes, health insurance, etc. I will have access to the

UWTM, but a tech will probably run the equipment.

The answers I have been getting have been all over the board. Some that have

emailed off list have said the 50/50 is good, or that 60/40 and even 70/30 if I

bring my own patients. I initially was going to bring my own patients in,

schedule them, do my own billing, not use any tech. But now, we are negotiating

more along the lines of the same percentage of compensation for all patients and

I get use of tech and equipment.

I don't see how it is possible to make a living off of anything less than 50%.

It is a time intensive and does not bring in much. Total of probably $70 an hour

and this does not include any paperwork time, etc. If I was only compensated at

21% there would be no way it could work. I may as well work as a veterinary

technician. I have a masters degree in physical therapy and bring in all that

expertise as well as extensive experience working with animals. That being said,

it obviously has to work for the clinic as well and if they are losing money, it

will not work. This is something they did not investigate fully before taking

on this venture. From PTs that have responded it seems like 50/50 or 60/40 is

fair and what most are getting. Many of the vets that have responded are

responding that a much lower percent is reasonable.

This has been a very interesting discussion and I look forward to hearing more

input.

>

> > Given the aforementioned, at 50% you are being overcompensated.

> > 60% is incomprehensible (or possibly trying to kick start it??). This may

> > bode poorly for the long term survivability of the service in that practice

> > because as soon as the owners realize they are actually subsidizing the

> > service (or have had their fill of subsidizing it should their attempt at

> > kick starting it be unsuccessful), they may abandon Rehab.

> >

>

> This may well be true. However, it is hard to see how an independent

> contractor (who must provide for his/her own benefits, SS taxes etc) could

> make a living at much less than 50% , since the average rehab appointment

> brings in what, $70 an hour? $150 maybe for first (evaluation) visits -- or

> what are you guys charging?? (Our evaluation is $115 but an average hour

> appointment runs around $60) 21% of $60 isn't going to pay the bills. In

> contrast, the GP who is paid at 21% ( plus benefits) can expect to gross

> $200 to $500 an hour, thus rendering the 21% a pretty reasonable salary.

>

> It's my understanding that 50% of gross is standard percentage for

> acupuncture vets (of course they don't have any expensive equipement to

> cover).

>

> This question-- of how an incredibly labor and equipment intensive but non

> lucrative profession can pay for itself -- vexes me a lot and I would love

> to hear what others think.

>

> Pamela Mueller PhD DVM

>

> >

>

January 21, 2012

I do understand that the business must be profitable, or it is obviously not

worth entering into. But I strongly feel that all of the treatments should not

be designated to a technician. While I am sure there are many well trained

technicians that can perform skilled treatments, these dogs benefit greatly from

the skills that a manually trained physical therapist can bring to the table. I

have seen impressive results from utilizing manual treatments that I have

learned through years of schooling and continuing education in the human

physical therapy world. Things that a technician even with a lot of experience

would not effectively be able to perform. That, and in addition, there is a

significant amount of ongoing evaluation that should be performed regularly

through the treatment sessions. I can outline a treatment plan that a technician

can perform consisting of exercise progression, following a laser protocol, UWTM

protocol, but when I do a treatment session, I am constantly changing my plan of

care as I see how the patient is responding. I feel quite strongly about quality

of care and the providing the patients with the best possible treatment.

That being said, there needs to be a way to make it work financially too. These

very expensive pieces of equipment that are so well marketed and advertised are

part of the problem I think. Everyone wants an UWTM, but at $50,000, and with

these class IV lasers that everyone seems to think they need at another $20,000,

this is probably where most of our profit margin is going. The reps for these

pieces of equipment must be doing very, very well, and are quite good at their

job to make everyone feel that they need one. Very effective therapy can be

performed and is performed with just the use of skilled hands and a few

inexpensive pieces of exercise equipment. Physical therapy is first and foremost

a hands-on profession and the use of equipment and gadgets is just bonus.

That is my two cents.

Day, MPT, CCRP-pending

> > Given the aforementioned, at 50% you are being overcompensated. 60% is

incomprehensible (or possibly trying to kick start it??). This may bode poorly

for the long term survivability of the service in that practice because as soon

as the owners realize they are actually subsidizing the service (or have had

their fill of subsidizing it should their attempt at kick starting it be

unsuccessful), they may abandon Rehab.

> >

> > This may well be true. However, it is hard to see how an independent

contractor (who must provide for his/her own benefits, SS taxes etc) could make

a living at much less than 50% , since the average rehab appointment brings in

what, $70 an hour? $150 maybe for first (evaluation) visits -- or what are you

guys charging?? (Our evaluation is $115 but an average hour appointment runs

around $60) 21% of $60 isn't going to pay the bills. In contrast, the GP who is

paid at 21% ( plus benefits) can expect to gross $200 to $500 an hour, thus

rendering the 21% a pretty reasonable salary.

> >

> > It's my understanding that 50% of gross is standard percentage for

acupuncture vets (of course they don't have any expensive equipement to cover).

> >

> > This question-- of how an incredibly labor and equipment intensive but non

lucrative profession can pay for itself -- vexes me a lot and I would love to

hear what others think.

> >

> > Pamela Mueller PhD DVM

> >

>

January 21, 2012

,> I believe building, land, etc is paid for. Irrespective of who owns the facility, the practice must pay rent, real estate taxes and utilities etc. Irrespective of the DVM's owning the building outright, the owners of the building, whomever they are, need a ROI on the this asset class.>They built some onto their existing building (a very small room for rehab really) and have purchased an UWTM. Then this investment needs to be paid for, maintained and a reasonable ROI for the money invested in this piece of equipment must be recaptured as well as the costs of the addition. > They have a vet who is going through the UT training for CCRP, but is not experienced, or finished with the courses yet. When he completes his certification process, if he is involved in the case (Team Approach), then recapturing the costs of his time as well as a ROI on his time will have to be figured into the mix by the practice. > I am offering my knowledge and expertise and am consulting with them free of charge to get this started. I am creating forms, handouts, etc for them. I think if a person does work, especially setting up a service, that individual needs to be compensated.> I am an independent contractor and have to pay my own liability insurance, taxes, health insurance, etc. Then your costs need to be calculated into your compensation, as the practice must calculate at what point does this become profitable or a losing proposition.> will have access to the UWTM, but a tech will probably run the equipment. As the tech is being paid by the practice, this is an additional cost to the practice for the service.> The answers I have been getting have been all over the board. Some that have emailed off list have said the 50/50 is good, or that 60/40 and even 70/30 if I bring my own patients.As I said before, each scenario is unique. Just because many PT's are doing it this way, does not necessarily make it right and profitable for those practices. > I don't see how it is possible to make a living off of anything less than 50%.Again, a financial analysis needs to be done to best utilize each professional's time in an economic manner.>It is a time intensive and does not bring in much. Total of probably $70 an hour and this does not include any paperwork time, etc. If I was only compensated at 21% there would be no way it could work. I may as well work as a veterinary technician. I have a masters degree in physical therapy and bring in all that expertise as well as extensive experience working with animals. You are completely correct about rehab being labor intensive. Therefore, no financial analysis, no good guide to work distribution and a fair fee structure to the client, the hospital AND the staff supplying such a vital service.>That being said, it obviously has to work for the clinic as well and if they are losing money, it will not work. Correct. And if you place all your efforts into building the business, and then because they realize they are subsidizing this service and call it quits, you lose the position and all your efforts in establishing the service.This is something they did not investigate fully before taking on this venture. From PTs that have responded it seems like 50/50 or 60/40 is fair and what most are getting. Many of the vets that have responded are responding that a much lower percent is reasonable.Irrelevant. Each situation needs to be taken on it's own. I know I am a broken record at this juncture, but their entry into rehabilitation seems it was not well thought out and a financial analysis still needs to be done, in concert with you.> This has been a very interesting discussion and I look forward to hearing more input. Agreed. And like the rehab profession itself, things will require time for the business model to eventually evolve into a more standardized, fair, ethical and profitable financial scheme. Also , you are obviously very serious about what you do. I would hate to see you end up empty handed after you place enormous amounts of effort into an endeavor. The devil is in the details. A well thought out and fair compensation/fee scheme for all parties at the outset is in the best interests of a long term relationship, where everyone benefits.ph DeLucia DVM, CCRP

January 22, 2012

,I find it easier to respond in the fashion of direct response to an individual statement. I know some people do not care for this type of response so my apologies in advance:> I do understand that the business must be profitable, or it is obviously not worth entering into. But I strongly feel that all of the treatments should not be designated to a technician. While I am sure there are many well trained technicians that can perform skilled treatments, My personal experience over the last 30 years with trained technicians in the ability to learn and execute veterinary medicine, Rehab, cross sectional imaging and radiation therapy has been nothing less than stellar. >these dogs benefit greatly from the skills that a manually trained physical therapist can bring to the table. I have seen impressive results from utilizing manual treatments that I have learned through years of schooling and continuing education in the human physical therapy world. Can you give some veterinary case study examples (or list) of what types of hands on treatments you are referring to? Things that a technician even with a lot of experience would not effectively be able to perform. I completely support your regard for your qualifications, I hope you did not intend to demean the veterinary professions's invaluable profession of Technicians. Without them, the veterinary Team does not function and veterinary medicine would never be where it was today. As I said before, my experience with serious, qualified technicians has been nothing but stellar. Aside from their qualifications, they have incredible resilience in truly caring for our veterinary patients. They are a unique group of people whom I respect and have learned to trust throughout my career. Many of them have worked hard to further their education and qualifications as the field of veterinary medicine morphs into specialization.>That, and in addition, there is a significant amount of ongoing evaluation that should be performed regularly through the treatment sessions. I can outline a treatment plan that a technician can perform consisting of exercise progression, following a laser protocol, UWTM protocol, but when I do a treatment session, I am constantly changing my plan of care as I see how the patient is responding. I feel quite strongly about quality of care and the providing the patients with the best possible treatment. Excellent, as I imagine most of us care about quality in this group. Your statement supports the tactical allocation of human resources of the veterinary health care delivery team, of which the PT should be a part of.> That being said, there needs to be a way to make it work financially too. These very expensive pieces of equipment that are so well marketed and advertised are part of the problem I think. Very, very true and I know of several recent, first hand examples of precisely what you are referring to. Hence, the poorly though out entry into the delivery of rehabilitation services on the part of many veterinary practices, including referral centers.>Everyone wants an UWTM, but at $50,000, and with these class IV lasers that everyone seems to think they need at another $20,000, this is probably where most of our profit margin is going. By way of introduction: speaking as an owner of several successful veterinary practices through the last 30 years, the founding and managing member of the Veterinary MRI and RT Center of NJ (3 million dollars worth of equipment), someone who has been doing veterinary rehabilitation for the last 10 years and as an individual who has performed exhaustive financial analysis for several practices, I disagree with your conclusion that this is where "our profit margin is going".> The reps for these pieces of equipment must be doing very, very well, Not entirely accurate. If you speak to equipment reps on a personal level, they are having the time of it trying to make their investment in the super costly manufacturing process pay through the sale of equipment in the veterinary market. To illustrate, the veterinary market for Pfizer represents 14 hours of Pfizer's total gross billable sales for the year!>and are quite good at their job to make everyone feel that they need one. Agree 100%.>Very effective therapy can be performed and is performed with just the use of skilled hands and a few inexpensive pieces of exercise equipment. Physical therapy is first and foremost a hands-on profession and the use of equipment and gadgets is just bonus. That is my two cents. Can you share a few case studies of exactly the manualities you used that support the comment that the "equipment and gadgets is just a bonus". ph

January 22, 2012

Sheri,

Thank you for supplying the citations.

I was requesting anecdotal conclusions through case driven experience.

While it is insightful to have human information, we must be careful not to draw

too many cross species conclusions regarding our veterinary patients.

ph

January 22, 2012

Sheri,

Sorry for this offshoot discussion but it is interesting to see how others view

things.

You are right. On the ladder of scientific evidence, (anecdotal, testimonial,

statistical and analogical) anecdotal evidence is on a lower rung. It is STILL

however classified as scientific evidence, especially when done within the

confines of the scientific method and is a gauge until refutation of the

hypothesis occurs through a higher level of scientific evidence.

Human medicine can be a guide, but that is what it should be; a guide.

I am only requesting some understanding to support some of the powerful

statements that were made by .

>

> I agree, ph, but case series are very low level evidence.Â I can say I

have treated my own dog with Trigger Point Needling and manual techniques with

excellent outcomes, but do you (or should you) really believe it?Â I have also

treated a friends dog with manual techniques to his hip, with excellent results

(no limping, and resuming sport).Â But, I also did not compare my results to

UWTM or US or Laser....so until the research is done on dogs...

>

> Sheri Morrow

> Dusty, UD, RA

> Strider and Pippin

> Cardigan Welsh Corgis

>

> Re: Compensation question

>

> Â

>

> Sheri,

> Thank you for supplying the citations.

>

> I was requesting anecdotal conclusions through case driven experience.

>

> While it is insightful to have human information, we must be careful not to

draw too many cross species conclusions regarding our veterinary patients.

>

> ph

>

January 23, 2012

i could not help but chime in here, as there seems to be some impressions of

veterinary technicians, being not trained enough, not being able to monitor

patients programs, and being useful for basically only profit margins.

i think it is fair to say in this arena, there are many different experiences of

many different people. From PT's , to PT's who continue on to learn the vet

side of things. There are well respected Veterinarians who have gone on to

train in manual therapies, then there the veterinary technicians, the grunt

people. These are the ones who carry out programs to make sure each pet is

progressing, advise veterinarians when there are problems, and in many cases are

the go to person for clients who are scared about what their pet has just gone

through. and most importantly, as it seems from this thread, we are your bottom

line!

I think we all have something to add to this profession and it is all

valuable.... I am sure i am not alone to think that many of us went into rehab

so that we could add to this growing field, and have positive input in each case

that is presented.

As a veterinary technician that runs my own business in Canada, i think perhaps

many technicians are not properly utilized. There are those of us that have

done additional training in many different fields (acupressure, osteopathy,

massage and even tried to attend seminars and courses that we are allowed to

take) I think perhaps if technicians in the field were encouraged to take

ongoing courses, that perhaps they could add to your bottom line. It seems a

waste of space and talent to have a technician who has spent a minimum of 2

years in school plus additional rehab training, and various years working beside

respectable veterinarians, to stand for 20-40 minutes in an underwater treadmill

watching a dog walk. We do have the ability to learn about how to use a low

level laser with proper training, we can learn manual techniques from respected

teachers, and most importantly i think most technicians would love to be

considered more valuable in a rehab practice. By ongoing training, especially

in manual therapies veterinary technicians can improve client expectations, and

make the business model more successful.

most importantly i think we all need to stand back and look at what each field

has to offer, and respect our differences, and support each other, in the field

of veterinary rehabilitation, so that it can be more profitable for all of us.

just my two cents

Tania

CCRP, VT,CAAP, CMT,

January 23, 2012

I actually was planning on commenting on this thread prior to Tania's

comment....

I am also a veterinary technician, have been working in vet clinics since 1999,

and exclusively in the rehab specialty field since 2005; at that time another

tech and I spearheaded and set up the rehab dept in a multi-specialty, 24 hour

vet practice in NJ. I currently work in a multi-specialty referral practice in

Las Vegas, the only facility in the city that has both a rehab dept and an UWTM.

I work alongside an MSPT, designing rehab programs for patients, analyzing gait

and function, performing manual therapies, writing up patient charts, educating

owners with HEP's, measuring for and ordering orthotics, working closely with

the vets in our practice in order to provide the best care we can for our

patients. We have vet assistants (read, paid less than tech wages) that help us

with making appointments, restraint, carrying out therapeutic exercises,

cleaning, client communication - basically things that I feel previous people in

this thread have described as the only things that technicians should be allowed

to do in a rehab facility.

We are blessed to have *all* of our doctors' full support even though we are

constantly told that the rehab dept itself does not pull in a profit; if we are

lucky, we break even during the month. The surgeons constantly tell clients that

we make *them* look good and that they are proud to have us as an important

adjunct to the practice.

I echo Tania's thoughts that as a technician, I would hate to have spent

thousands of my own dollars, spent years training in additional education for

manual therapy, rehab, nutrition and then be told I'm only allowed to do " scrub

work " . I know my own limitations and refer to the PT's expertise when needed.

Like I said, we work closely together and have learned so much from each other.

The other day we had a patient on which I palpated enlarged, firm LN's -

immediately sent her down the hall to the IM doctor (that previously treated her

for IMHA - the poor dog has been through so much!) and was dx'd with lymphoma.

The PT had seen this pt 2 days prior....

I chose to be a vet tech instead of a vet because I cherish the time I spend

with direct patient care. I didn't want to spend 15-20 min's with a client

making a diagnosis on their pet and then passing it on to a technician to carry

out treatment. When I worked as a treatment tech, one of my biggest rewards was

getting an anorexic cat to finally eat by spending time with it and showing it

love, to ease a dog's dyspnea by repositioning them; now I see the reward when

my patients come walking into the clinic after an orthopedic or neurologic

surgery, give me kisses, and their mother/father proudly tell me that he/she was

able to finally walk up the stairs, or able to scratch their own ear. So please,

allow us to bring our expertise, experience and love to your practice.

I realize that this commentary has gotten away from the original question as to

the profitability and practicality of independent rehab clinics...but I feel

that the role of the specialized tech should not be overlooked when you are

looking at your profit margins.

Respectfully,

Shinas, LVT, CCRP

January 23, 2012

Hi

Your original question has been spun in many interesting ways.

I would like to address the original compensation aspect of it, as it is very

important for those who offer mobile work in veterinary facilities vs employees

of veterinary facilities.

1) I think the best thing to do would be to " Lease " space at the veterinary

clinic and have the client pay you directly. If you need auxiliary staff you pay

them out of your company and their practice owner does not pay them if they are

employees of the host practice or you bring in someone to work with you and you

pay them.

Why do I think this?

You can write off the lease expense against your business.

You write off the employee expense.

The client pays you directly and the profit is yours. Not sure what the profit

will be as the expenses may vary where you are.

If the client pays you and you give a percentage of the invoice to the clinic

you are now fee splitting. Fee splitting in many States is considered

" Unprofessional " Please check your State Professional Conduct Laws/Policy.

2) You bringing in " your " client base that the hosting clinic may benefit

from...

This is a sticky situation if your client base has a routine care facility and

the facility you are being hosted in has routine care. The original practice

may perceive that the hosting practice is trying to " steal " clients. If your

hosting practice wants to develop a rehabilitation referral practice, a

perceived stealing of clients will not encourage the neighbor clinics to refer.

You may want to have a referral policy to build integrity in the veterinary

community. You may find that " Your " client base may dry up and business will

drop, as the confidence level to " refer " to you is lost due to the perception of

" Stealing " . Perception is reality!

3) Your consulting work with the hosting practice has value! You should not be

ashamed to charge for it. You may be able to use that consulting fee as a way

to negotiate a lower lease payment on the floor space you use. Maybe as part of

your lease agreement you can offer in-house CE to the staff on various

techniques that are a benefit to patient rehabilitation and are not offered in

the veterinary rehabilitation certification programs.

If you are an employee of the hospital then things are very different and you

can work on a commission basis. That means they cover your payroll expenses and

you then can take a percentage of sales 20-23% the higher the percentage the

lower the base wage. You could negotiate a percentage of over the counter

product and food sales at 5%-10% if they are purchased at the time of your appt

(this is a messy calculation). After all the sale may not have been made if you

did not encourage the client to purchase the item for the benefit of the pet.

Future sales of that product would generate a commission as it is over the

counter and the client can ask for it at any time. No effort is required on

your part going forward.

>

> I am hoping several of you can offer me some information. I am in

> negotiations with a local vet on contracting my rehab services with them. I

> am a PT, with CCRP pending. They have built a small rehab room and have

> some balance equipment, an UWTM and a laser. I will be an independent

> contractor with them. They are wanting to pay me 50% of what they charge

> the client for their patients. And 60% of my charges when I bring clients

> in from outside sources. Can others please tell me the way they are being

> compensated in a similar situation? And do you have have use of a tech, use

> of all the equipment, etc. Feel free to email me off list.

> Thanks so much!

> Day, PT, CCRP-pending

>

January 23, 2012

Hi

I had a typo in my last post to you about future OTC sales. You would NOT

recieve a commission on the future OTC sales that you stimulated during your

appt. Sorry about that confusion.

lu

> >

> > I am hoping several of you can offer me some information. I am in

> > negotiations with a local vet on contracting my rehab services with them. I

> > am a PT, with CCRP pending. They have built a small rehab room and have

> > some balance equipment, an UWTM and a laser. I will be an independent

> > contractor with them. They are wanting to pay me 50% of what they charge

> > the client for their patients. And 60% of my charges when I bring clients

> > in from outside sources. Can others please tell me the way they are being

> > compensated in a similar situation? And do you have have use of a tech, use

> > of all the equipment, etc. Feel free to email me off list.

> > Thanks so much!

> > Day, PT, CCRP-pending

> >

>

January 23, 2012

I think besides looking at percentages we need to look at charges. If a

professional is conducting a service, no matter what the service, and the

professional wants to be paid appropriately and the clinic needs to make a

profit, the prices should be set accordingly. If you provide professional

services at professional prices, people will come back. If you provide

professional services with unprofessional prices (not charging enough) the

professional will leave or the clinic will eliminate the service. If you supply

any services without qualified people performing these services (asking

technicians to do something they are not qualified to do), nobody is happy as

the dog does not get better and the clinic, person performing the treatment,

dog, and owner all do not have fulfilled expectations. If you have a qualified

technician that can provide some services, then the prices of these services

should reflect the salary and profit needed as well. Qualified technicians can

do a lot of things, but they can not do it all. Professionals NEED to be doing

some services like manual therapy. If you are charging a client $60 an hour for

treatment, nobody is going to be happy for long. If we can charge clients

$4,000 for a stifle surgery that takes an hour and the patient stays for 2 days,

why should we charge $60 for an hour of rehab. Now, don't get me wrong, I don't

charge $4,000 for rehab, unless we are talking 10 days of in-hospital care of a

paralyzed large dog. We charge a minimum of $200 an hour for professional

services and $140 an hour of technician services. It is the only way to get

good, qualified people and to keep them happy. With good qualified people come

better patient care and happy patients and clients.

Just my 2 cents,

Laurie McCauley, DVM

January 24, 2012

ph (and others),

I am sorry if I came across as demeaning to veterinary technicians or to the

veterinary team. I have great respect for veterinary technicians as I was one

for 9 years before going to physical therapy school. My first interest in

physical therapy was because I wanted to perform rehab with animals and I felt

that I would get the best training and be a better therapist if I went to PT

school first. A very long and costly way to go about it for sure. And I do

practice on humans part time to supplement my canine rehab. My point was meant

to convey that there is a very large skill set as well as much education and

training that goes into the making of good therapist, more than on the job

training can accomplish. And as you wouldn't let a technician perform certain

procedures such as surgery, or make important decisions about plans and

diagnoses, there are parts of rehab that should be left to those that have

greater qualifications. Again, I was not trying to demean and I apologize

greatly if I offended. I have a great respect for veterinary technicians, and

have many vet tech friends as that was my past life and career before venturing

into the rehab side of things. And I agree, effective and profitable rehab is

accomplished by the whole team working together, I did not mean to say that the

physical therapist is the only important part. We all work together and all

bring very important skills and assets to the team.

As far as the question about case examples of manual treatments versus the use

of " gadgets " , Sherri posted an article, and there are many cases and examples of

manual treatments outperforming ultrasound, e-stim, etc in regards to outcomes

and pain levels. I can dig up articles if you are interested. I just wanted to

convey that I have successfully treated many patients, human and canine with

just the use of my hands and some simple exercises. I see the modalities and

equipment as nice extras to have.

I hope that clears some things up!

>

> ,

> I find it easier to respond in the fashion of direct response to an

> individual statement. I know some people do not care for this type of

> response so my apologies in advance:

> > I do understand that the business must be profitable, or it is

> obviously not worth entering into. But I strongly feel that all of the

> treatments should not be designated to a technician. While I am sure

> there are many well trained technicians that can perform skilled

> treatments,

> My personal experience over the last 30 years with trained technicians

> in the ability to learn and execute veterinary medicine, Rehab, cross

> sectional imaging and radiation therapy has been nothing less than

> stellar.

> >these dogs benefit greatly from the skills that a manually trained

> physical therapist can bring to the table. I have seen impressive

> results from utilizing manual treatments that I have learned through

> years of schooling and continuing education in the human physical

> therapy world.

> Can you give some veterinary case study examples (or list) of what types

> of hands on treatments you are referring to?

> Things that a technician even with a lot of experience would not

> effectively be able to perform.

> I completely support your regard for your qualifications, I hope you did

> not intend to demean the veterinary professions's invaluable profession

> of Technicians. Without them, the veterinary Team does not function and

> veterinary medicine would never be where it was today. As I said before,

> my experience with serious, qualified technicians has been nothing but

> stellar. Aside from their qualifications, they have incredible

> resilience in truly caring for our veterinary patients. They are a

> unique group of people whom I respect and have learned to trust

> throughout my career. Many of them have worked hard to further their

> education and qualifications as the field of veterinary medicine morphs

> into specialization.

> >That, and in addition, there is a significant amount of ongoing

> evaluation that should be performed regularly through the treatment

> sessions. I can outline a treatment plan that a technician can perform

> consisting of exercise progression, following a laser protocol, UWTM

> protocol, but when I do a treatment session, I am constantly changing my

> plan of care as I see how the patient is responding. I feel quite

> strongly about quality of care and the providing the patients with the

> best possible treatment.

> Excellent, as I imagine most of us care about quality in this group.

> Your statement supports the tactical allocation of human resources of

> the veterinary health care delivery team, of which the PT should be a

> part of.

> > That being said, there needs to be a way to make it work financially

> too. These very expensive pieces of equipment that are so well marketed

> and advertised are part of the problem I think.

> Very, very true and I know of several recent, first hand examples of

> precisely what you are referring to. Hence, the poorly though out entry

> into the delivery of rehabilitation services on the part of many

> veterinary practices, including referral centers.

> >Everyone wants an UWTM, but at $50,000, and with these class IV lasers

> that everyone seems to think they need at another $20,000, this is

> probably where most of our profit margin is going.

> By way of introduction: speaking as an owner of several successful

> veterinary practices through the last 30 years, the founding and

> managing member of the Veterinary MRI and RT Center of NJ (3 million

> dollars worth of equipment), someone who has been doing veterinary

> rehabilitation for the last 10 years and as an individual who has

> performed exhaustive financial analysis for several practices, I

> disagree with your conclusion that this is where " our profit margin is

> going " .

> > The reps for these pieces of equipment must be doing very, very well,

> Not entirely accurate. If you speak to equipment reps on a personal

> level, they are having the time of it trying to make their investment in

> the super costly manufacturing process pay through the sale of equipment

> in the veterinary market. To illustrate, the veterinary market for

> Pfizer represents 14 hours of Pfizer's total gross billable sales for

> the year!

> >and are quite good at their job to make everyone feel that they need

> one.

> Agree 100%.

> >Very effective therapy can be performed and is performed with just the

> use of skilled hands and a few inexpensive pieces of exercise equipment.

> Physical therapy is first and foremost a hands-on profession and the use

> of equipment and gadgets is just bonus.

> That is my two cents.

> Can you share a few case studies of exactly the manualities you used

> that support the comment that the " equipment and gadgets is just a

> bonus " .

> ph

>

January 24, 2012

Thank you for all the wonderful information! I will take your advice and

information and see what I can apply, and thank you for coming back around to

the original question,

> > >

> > > I am hoping several of you can offer me some information. I am in

> > > negotiations with a local vet on contracting my rehab services with them.

I

> > > am a PT, with CCRP pending. They have built a small rehab room and have

> > > some balance equipment, an UWTM and a laser. I will be an independent

> > > contractor with them. They are wanting to pay me 50% of what they charge

> > > the client for their patients. And 60% of my charges when I bring clients

> > > in from outside sources. Can others please tell me the way they are being

> > > compensated in a similar situation? And do you have have use of a tech,

use

> > > of all the equipment, etc. Feel free to email me off list.

> > > Thanks so much!

> > > Day, PT, CCRP-pending

> > >

> >

>

January 24, 2012

ph,

I use manual treatments such as joint mobilizations, spine mobilizations, soft

tissue techniques including strain/counterstrain, myofascial release techniques,

many soft tissue techniques that I have learned from courses I have taken in

addition to appropriate exercises and have not had the use of any modalities or

special expensive equipment with great results from my patients, human and

canine. I have treated athletic dogs with psoas injuries, neurolgocially

compromised patients conservatively and post surgery, hip dysplasia,

degenerative disc disease, partial CCL tears, and more without laser, or UWTM,

or U/S or E-stim.

I feel the use of the " gadgets " is nice to have and beneficial and can help

progress, but the above mentioned therapies is most important and results in the

same eventual outcome if performed appropriately in a skilled manner. Studies

are limited to back that up in the canine world, but there are many in the human

world.