Bring in the experts
Tuesday, 4 December 2018
VetScript Editor's pick - December 2018
Better awareness of treatment options among New Zealand pet owners and improving rates of insurance coverage are contributing to a growing demand for specialist veterinary services. Monica Evans meets the owners of a North Shore animal referral centre whose operation has snowballed since opening less than three years ago, and who are now contemplating further expansion.
When veterinary specialists Fiona Park and Karl Mathis first applied for a loan to set up an animal referral centre on Auckland’s North Shore, the banks turned them away. Too risky, they were told. It would have been easy to take another path at that point. “We’re veterinarians – we don’t know much about business,” laughs Karl, who specialises in small animal surgery.
But the dream wouldn’t die. The couple found a sympathetic accountant, spoke to other banks, and called in support from local and international colleagues. Fiona, who is a specialist in small animal internal medicine, beavered away on their revised business plan while on maternity leave with their first child.
Eventually, one of the banks came through with the cash. “That’s when it became a reality that we could do it,” she says.
They kitted out the space they’d found – a former plant laboratory in Albany’s semi-industrial outskirts – and moved on site, baby in tow, a few months before opening the doors to the Animal Referral Centre (ARC) to the public in late 2016.
Those early days were intense. Fiona and Karl were the only specialists, accompanied by a handful of veterinary nurses. Initially a colleague ran a separate after-hours clinic in the space. “But after a few months that just didn’t work out,” says Fiona. In the meantime, however, the centre had accrued a large number of patients who needed 24-hour care. “We didn’t want to ship them elsewhere, so we decided to staff the after-hours ourselves, and run it all as one business.”
That meant they had to find three new veterinarians and a number of extra veterinary nurses very quickly, in order to keep the clinic going. “It was probably the hardest part of the past two years,” reflects Fiona. “I think it took us about six months to get staffed fully, so we ended up doing a lot of the shifts ourselves.”
Living on site made it manageable, although sleep was hard to come by in those early days. “We always had a veterinary nurse here, so they would wake us up in the night if they needed us,” she recounts. “And of course we had a little baby to juggle in there, too.”
These days, Fiona and Karl live elsewhere, and they usually get to go home at the end of the day. But the clinic is busier than ever, and demand continues to grow. The after-hours service has become an integral part of the business, says Fiona, especially as there is only one other such service on the North Shore. It also ties in well with the referral side of things. “After hours, a lot of clinics refer us patients who will need to see a specialist the next day, and it means they can still be taken care of overnight.”
While the clinic’s capacity keeps expanding, it hasn’t lost its friendly, welcoming, family business’ vibe. Nestled into the hillside at the end of a quiet, bush-clad driveway, the space boasts two entrances: one for dogs, the other for cats. These lead to separate waiting areas, which are joined by a circular reception desk. On the day I visit, I choose the cat door – a decision that would surprise none of my family or friends. “It’s always interesting to see which door non-clients choose to come through,” laughs Fiona, as she comes out to greet me with her second daughter, six-month-old Emily, on her hip.
The interior design in the waiting room is on point: modern, minimal and beautiful. “That was some of the best money we spent,” Fiona reflects. She takes me through to a room with a 16-slice CT scanner, which the practitioners use to assess a range of conditions, such as orthopaedic problems, cancer staging, respiratory issues and nasal disease. “It was quite a big-ticket item, so we deliberated for a while over whether to put it in straight off the bat, or outsource it off site,” she says. “But it’s worked out really well having it here – we use it a lot, and we can use it on patients who are more unstable. We’re hoping to use it more for things like trauma cases, because you can get a lot of information very quickly that way.”
There’s a fluoroscopy room, which is used frequently for the minimally invasive procedures that Karl is particularly passionate about, such as fracture repair. There are also ultrasound facilities – a frequent reason for referral to the centre – and an endoscopy unit, as well as an in-house laboratory, which is “absolutely essential” for a 24-hour clinic, says Fiona.
She also shows me the room that’s lined up to become a second operating theatre in the next 12 months or so. Since employing another surgeon six months ago, the need for a new space to help with the growing workload has become apparent.
There are now nine veterinarians on the team, as well as 17 veterinary nurses and two receptionists, and a visiting veterinary cardiologist who comes once a month. Some of the staff members approached ARC looking for positions, and others were brought in via more traditional advertising processes. Finding experienced veterinarians and veterinary nurses to work in the after-hours department has been the most challenging part of the hiring process, says Fiona, “especially at the moment, in the climate of the veterinary shortage”. It’s also the area with the highest turnover. So keeping the afterhours team skilled-up, happy and well integrated with the rest of the clinic remains a priority for Fiona and Karl.
The centre’s staff are diverse and well-travelled: the veterinarians’ combined experience spans seven countries. That wasn’t a deliberate decision, says Fiona, “It’s just what happened. But it’s pretty cool that all of us have trained and worked in different places, and can bring different types of experience to the place.”
“Since there’s only the one veterinary school in New Zealand, people from here tend to go abroad, get that [international] experience and then come back,” observes small animal surgery specialist Helia Zamprogno, who is from Brazil and completed her specialist training in the US (see side bar above). “It’s awesome, because I think that living in another country really seems to open people’s horizons a lot.”
The staff who VetScript speaks with all praise the level of teamwork and connection between the various departments at the centre. “It’s really neat how entwined everything is,” says Jo Christie, a medical internal veterinary nurse who’s been employed at ARC for almost two years. In other specialist clinics that she’s worked in, “we would be palming them off to different departments for this, that and the other. But with so many specialists in particular areas in the one place, we do tend to bounce ideas off each other a lot more.” She thinks that this practise contributes to each patient’s care becoming centralised.
Ryan Cattin, a specialist in small animal internal medicine who came to the centre around six months ago, agrees. “It’s [one of] the biggest [veterinary] medicine teams in the country. And that’s great because often our cases are complicated, and it means we can talk with other specialists about them. Most other places only have one specialist, so they can’t do that.”
Referrals are rolling in for the young business. “It’s grown much more rapidly than we thought, which has brought its own challenges,” says Fiona. “But we kind of had to roll with it.”
Why so much demand? Fiona puts it down to a change in mentality among pet owners, and growing awareness of treatment options and possibilities. Many pet owners now have insurance, she notes, and there are plenty for whom the expense of specialised services is not the primary concern.
While referrals to specialists have been slower to take off in the New Zealand veterinary scene than in many other parts of the world, she thinks it is catching up.
A key challenge for ARC is keeping referrers updated on the ever-expanding number of issues that can be successfully addressed through specialised care. “We’re still figuring out how to do that most effectively,” says Fiona. She and Karl offer regular seminars – both online and in person – and run a journal club for local practitioners. “One thing we’ve always tried to do, even when we’re super busy, is to get on the phone and be available to our referring veterinarians.” The trust they’ve gained from many of these practitioners within the short space of time they’ve been open has been a crucial factor in getting the whole project off the ground, she says.
So where to now? Fiona and Karl’s dreams for the place are by no means done and dusted – quite the opposite, in fact. They’re currently negotiating a lease on some of the spaces that have become available in the building that sits in front of them, where they’re hoping to start offering dermatology and physiotherapy services. They’re also keen to boost referrals for minimally invasive procedures, and to scale up that element of the practice. In short, the motivated couple won’t be resting on their laurels.
“It feels like there’s always something to do, and always something we can do better,” says Fiona.