Companion animal overpopulation is a public health, welfare and safety issue because of its far reaching, costly and negative consequences.
Some folks think a mobile spay/neuter unit is an animal hospital with wheels. We view each regular animal hospital as a mobile clinic without wheels!
The resources, including a licensed veterinarian and bricks and mortar, are already on site. Collaboration between a private practice and a humane organization can make low-income services possible without opening a new clinic or mobile unit.
A private practice partnership (PPP) brings components of a public health approach into the private veterinary practice in order to create a high volume, reduced cost program that creates a revenue stream for the service provider. Financial sustainability is key.
The best-known private practice model is the voucher system, in which a reduced cost surgery is provided during a regular appointment, with a humane society or public agency paying the cost difference. By paying a higher price, voucher programs are generally expensive, however if providing a discount during the regular workday, the veterinarian competes with him/herself for a full price time slot and incurs a financial loss.
Private practice models must generate a positive income stream if they are to thrive and grow.
Using a private clinic on days in which they are otherwise closed, or by blocking out a few hours each week, both the clinic and the program are able to succeed.
This Is How We Do It…
Essentially, the private practice uses a dedicated time slot to provide high-volume services to pet owners who are otherwise unable to pay for a spay/neuter at full price.
This is for low-population areas in which a local clinic has enough time that these surgeries do not cut into their regular workload and can become an added revenue stream. The surgeries are provided at a cost equal or close to the nearest low-income program.
Benefits of a PPP:
- Provides the benefits of a low-cost spay/neuter clinic with little startup expenses.
- Facility is already compliant with state regulations.
- Volume equals a monthly visit by a mobile unit or spay neuter transport (25 to 50 per month per participating clinic). Can be combined with a different model for increased volume at start-up.
- Volunteers do not have to learn about a brand new field of services and can concentrate on outreach, leadership and “getting folks in the door”, and can immediately raise funds for sliding scale and not bricks and mortar (or rent, etc.).
- Is not a financial loss during slow times.
- Aftercare mechanism is built in (emergency aftercare capacity is mandated in most states)
- The host organization does not have to compete with other communities for available days of a mobile spay/neuter unit that visits multiple communities!
- The spaces are limited and this model may not provide a sufficient level of services.
- Ongoing, clear communication is a necessity because this model combines people who may have different priorities. If there are weekly surgeries one morning a week, the staff can perceive it as ‘extra work,’ or feel the clients are not truly needy enough, and resent the program (see box).
- It is labor intensive to juggle the program into busy practice.
- A dedicated phone line provided by the humane society for scheduling appointments and making reminder calls. A free online system such as Google docs enables multiple volunteers to schedule the clinic days without overbooking. An online site is the ONLY way that multiple people can schedule without overbooking.
- One person from the humane society must communicate with clinic staff in order to prevent and/ or quickly resolve problems that may damage the program.
- For programs which rely on clinic staff on a weekday, an inexpensive but fun incentive for the staff, such as lunch on the last Friday of each month, helps offset the fact that this creates some extra work.
- Everything must be included in the price. That means surgery, a rabies vaccine if required,the pre-op exam and pain medication. “Upselling” in order to make a few extra dollars defeats the program, generates ill will and some clients will feel it was a ‘bait and switch.’ Most clients have to save up even for the reduced cost.
- Use appropriate income screening. This can be a simple household income level (such as $40,000 per year) or based on the home receiving Food Stamps, WIC, Medicare or HUD housing. Using an overall household income level enables your program to include low income working people who receive no public benefits. A full time job at minimum wage grosses roughly $14,700 yearly, so using a basic income level enables you to serve low income working homes that do not receive aid. If the program is open income, it will compete with the veterinarian for their regular clients; this is usually a deal breaker.
- Income screening over the phone is simple and straightforward. If check-in is done by the hospital staff, confirm that the client understands if proof of income will be needed.
- Prepayment through a cash app enables the humane organization to know which clients need further subsidy, and prevents no-shows from affecting the finances of the day.
- Surgeries divided equally between male and female, cats and dogs.
- Eight to ten surgeries (three hours) per week at an average of $55/surgery totals over $23,000 per year. Many veterinarians are able to do five to ten surgeries in two to three hours. Increasing the number of surgeries increases the revenue while increasing the effectiveness of the program.
- A client co-payment of $25 is almost half of a surgery, and a small co-payment enables organizations to get 40-45 surgeries per $1000.
The differences between the once a week and the once a month models are outlined below.
In all PPP programs, the humane organization schedules the clients (maintains the phone line and returns calls), screens income requirements, provides community education and raises funds for sliding costs for those unable to pay the full price. The following two models can be combined or changed from one month to the next:
MODEL ONE: One day per month when the office is otherwise closed.
The humane organization schedules the clients, makes reminder calls, checks pets in on clinic morning, cleans instruments, remains throughout recovery and check out and cleans up afterward.
Time needed: 1 day per month
Benefits to this model:
- For a busy clinic there may be no ‘slow’ time to fit in a few hours. This model eliminates extra work for clinic staff, though more work for the organization. This works for groups with at least a few committed volunteers who will be onsite.
- Reminder calls and other tasks can be bunched till 48 hours before the clinic, although returning calls/emails throughout the month is vital.
- 30 surgeries at a $55 average brings just over $1600 into the practice. With an average cost of $12 per surgery for supplies, $1200+/- pays the clinic; roughly $15,000 net.
- The veterinarian loses one day off per month.
- Knowledgeable staff is needed, possible extra overhead costs in staffing.
- In some states, must have registered technician, so more paid staff.
- Services are less frequent, it may be necessary to make more urgent plans for pregnant animals.
MODEL TWO: Five to ten surgeries weekly, one morning each week, or 25 one day per month.
Humane society makes sure there are intake forms at the clinic and communicates regularly. Clinic staff does check-in; 8 to 10 per week, which are handled as regular clients in terms of clean up etc.
Time needed: one morning per week or one day per month
Benefits to this model:
- A clinic with some ‘down time’ can make use of a short time block once a week, within the normal day. Most clinics can provide five to eight surgeries in a two-three hour block.
- Five surgeries per week at an average of $55 brings $275 weekly, $1100 monthly or $13,000+ yearly into the practice. 10 -15 surgeries/wk are optimal.
- The humane society does only the scheduling and income screening; this is ideal if physical volunteering is impossible.
- Although staff time is used, it is during the regular workday; overhead is not increased.
- Because it is on weekdays the clinic staff is responsible for check-in.
- Unless the clinic has the space and time to do eight to 10 each week, fewer surgeries are done overall
- Ongoing communication with the clinic is needed; staff can become frustrated; remember this is our dream, not necessarily theirs!
How to start
Start with an assessment of the area, the population, general pet care habits, local resources and outreach to possible partners. PPPs are ideal for small towns within rural counties that lack nearby spay/neuter programs and have a small enough population that the lower number of surgeries may be effective.
First locate spay/neuter programs in the region to see if they have spaces open for transport, or for partners in order to increase their numbers. Then, if a PPP is your best solution, investigate the costs at regional spay/neuter programs. Those (plus a few dollars) will be the base price for this program.
Outline the services:
- Write out an agreement with the expectations of the humane organization and the veterinarian. Specifically, include the costs for spay/neuter, what volunteer tasks are expected and when, ratio of male to female and cats to dogs, costs that may be incurred by the organization (sliding scale), and which services are included (surgeries, rabies, any others).
- Before check-in, a list of clients will be emailed to the clinic. The agreement needs to outline communication (when the appointment list will be emailed to the clinic, when payment will be made, etc), and designate volunteer and staff who will remain in touch.
- The animal clinic provides surgeries, holds animals until picked up and provides aftercare.
- The humane organization provides the scheduling, reminder calls and onsite volunteers when needed.
- The humane organization reaches out to low income communities as for other spay/neuter programs. This includes posters, handouts, meeting with officials and churches, etc.
- The humane organization will collect prepayments and will pay the veterinary clinic in full
- Intake forms (carbonless triplicates) or an electronic system, aftercare forms, posters: $250.00
- Check-in supplies: $200.00
- Advertising: $200.00
- Cell phone with voice mail capabilities: $40/moTotal = Under $1000.00
As things work out…
In order to provide four (or more) surgeries per hour on a regular basis, the veterinarian and volunteers should visit or watch a video of a two table spay/neuter clinic in action. The participating PPP clinic will ultimately need additional equipment to continue to hold high-volume days and maximize their efficiency.
A second anesthesia machine, a folding table for a second surgery table, extra surgical instruments called “packs” and a medical field sterilizer may be desirable. Local fundraising may do the trick.
Additional PPP costs:
- Anesthesia machine, circuits, etc.: $2500.00
- Surgical packs (instruments), five to seven packs: $1500.00
- Medical field sterilizer: $800.00Total = $4800.00
Providing the clinic with a plastic tub for supplies for the program is a great way to make this into a convenient program in a box. If the clinic is providing more than five surgeries in one day, check-in can get hectic; including clipboards, pens, paper clips, etc., is helpful. The tub will contain the pre-printed forms, aftercare forms, any other information or paperwork that is provided by the humane organization.
A few words of wisdom for the organizers and the clinic staff…
This program will not “fit” every hospital. It is aimed at making spay neuter affordable to those who would otherwise need to use a reduced cost service. If the veterinarian is uncomfortable providing surgeries without certain protocols, or has no down time, this simply may not work.
The private practice model can be a great start-up program, requiring very little start-up money and a small crew of people. If organized properly, it can absolutely provide a positive revenue stream to the service provider. However, because it combines the non-profit mission and a private business all under one roof, PPPs demand attention to detail.
If casual mistakes in the agreed upon income level are commonplace, the result can be a damaged working relationship with that veterinary clinic. Make sure that check-in goes well, that folks arrive on time and that volunteers who are expected to be on-site are actually there. Be sure that the ratio of dogs to cats, males to females, are on track.
The clinic staff may be completely new to this effort and may not understand or even agree with your goals; communication is key to the relationship! Everyone has a stake in the success!
We screen incomes, not spending habits. The car people drive does NOT reveal their income level. If the pet owner has a “fancy car” they may be unable to purchase a home and choose to have a nice car instead; the car may belong to someone else. Full time minimum wage earners net under $15,000 per year; if they own a decent car that is their business.
Money is made by providing volume within the planned time frame, not by having each client pay an extra few dollars. Many homes must “save up” to get the pet spayed, even at $55. Make sure people leave feeling good about getting their pet being fixed, not guilty because they could not afford extras. Changing pet care habits requires good “word of mouth” after people leave.
The notion, “if they can’t afford to care for the pet they shouldn’t have it,” is a dangerous myth which punishes people and pets. Our data collection (from thousands of surgeries each year), reveals that over half of the pets we alter came to their caregiver as a stray or as a free pet from a street corner or parking lot. Feeding and caring for the pet was an act of compassion, not an act of irresponsibility.
The PPP requires good communication and the same level of organization and attention to detail that any other spay/neuter program requires.
The fact that the staff of the private practice did not get a job in a spay/neuter clinic, yet finds themselves in one for a day a week, can present challenges. The good news is that most folks working in an animal clinic care about animals; negativity can be overcome by making sure they stay in the loop and understand how important this program is to the animals they’re helping.
Many will realize that indeed, these are NOT their regular clients and welcome the opportunity to help animals that otherwise will not come through their door.
Like any remote area service, the program may need to be combined with other types of services. More than any other program, a PPP can forge new ground.
* Find resources in Oklahoma: http://okspaynetwork.org/