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What happens when? Second order thinking in the Veterinary Profession

I have had a lifetime’s share of uncertainty, stress and change because of COVID-19. I’m sure many of you feel the same. From enjoying the benefits of a stable and robust economy and all the benefits it provided we are now facing a chaotic, volatile and shifting landscape as we move forward in our new world. What does that mean for the veterinary profession, our businesses and how we practice veterinary medicine? Will it all stay relatively the same, shift a little bit, or are we facing seismic changes?

Recently I’ve started to do a lot of second order thinking to help me consider what the future may hold for my own veterinary practice. First order thinking is when you consider an event or a situation and make an assumption about the future or use the information you know to quickly solve a problem. For example, a sports team (remember them) could be on a winning streak and you claim they will make the finals because they are doing so well. Or, you could face declining revenue because of CV-19 and decide you need to reduce staffing levels to save money. These are very straightforward solutions that don’t require a lot of insight. On the other hand, second order thinking is when we dig deeper and consider more variables that factor into the situation or event. It considers the consequences of a decision, it uses a longer time frame, and asks “and then what?” whenever we think we come to a final decision.

There are always unintended consequences related to any event or situation. For example, the global shutdown of the economy to flatten the curve has led to a 17% reduction in the production of greenhouse gases by the beginning of April. In the UK 20% of university bound students are considering a gap year rather than endure e-learning. Finally, a relatively little-known company in Canada called Shopify recently surpassed the Royal Bank of Canada to become the biggest company in Canada. What is its business? It creates ecommerce solutions for small businesses. Its revenue grew 47% in the first quarter of 2020! I think the biggest second order question that countries across the world are considering is the balance between public safety and the health of the economy. We are saving lives and reducing the impact on our health care systems, but at what cost to the economy? We won’t know the answer for that for years.

What about the vet profession? What are some second order thinking exercises we can apply to us? Let’s consider telemedicine. Many practices are dipping their toes into the telemedicine world, while others are full on embracing it. It’s a great first order reaction. We can’t see patients safely, so let’s use video consults. I’ve had the good fortune to talk to a few practitioners that are using telemedicine and they are discovering a few things; it works for many types of cases and clients love it. One practice I know has two vets every day seeing 8-10 cases each! They don’t see it going away and want to do even more of it.

What do we discover when we put our second order thinking cap on and consider what an increasing reliance on telemedicine means for our practices over time? Would you need the same size clinic or hospital if some of your vets are working at home seeing patients? If you are paying production based commission to your vets how will the vets that remain in the practice like it when the telemedicine vets are getting paid for the initial exam fee and the in house vets are just seeing the small percentage of patients from telemedicine appointments for diagnostics? How does this change the role of your support staff? If a doctor is handling appointments alone do you need as many technicians or receptionists? One thought I had is to create a position for a virtual host who greets clients when they call in for an appointment. Their role is to ensure that the client is comfortable with the technology required, they have their pet in hand and not hiding under the bed, and perhaps take some medical history so that when the vet comes on the call everyone is ready to go. After the appointment there may be someone on staff that edits out clips from the recording of the session to highlight key findings and include that in the medical record. Maybe if telemedicine becomes even more popular some of the receptionists in a large clinic can work from home scheduling appointments.

Finally, what is the role of locums in this increasingly virtual environment? What happens when we look at practices that keep resisting telemedicine? Clients are loving it when done well, so will these practices lose revenue to the pro virtual consult practices? Can we imagine a future where there are practices that just do telemedicine and they refer clients to diagnostic clinics for radiographs, blood analysis, etc.? I don’t have that answer, but it is something any veterinarian should be thinking about when thinking of what the future vet practice looks like.

There are so many changes happening in our lives locally, nationally and globally. I read recently that there may be an exodus of people from large urban centers to avoid congestion and the fear of disease. If more and more people continue to work from home, which many large companies are encouraging, what does that mean for our practices in city centers and suburbs. I’m sure veterinary educators are planning numerous scenarios on how best to teach vet students when in person education is changing so much.

Second order thinking is necessary when we imagine what will be the impact of CV-19 on our practices and even our profession. It isn’t enough to react to immediate events. We need to look at our surroundings and ask what will be the impact on my business if one of several things happens in my city or my province? We can all agree that the next couple of years will bring forth change, unlike anything we have seen in our lifetime. What can you do to be prosper throughout this change?

Notes from the author: I wrote this blog in April for Canadian Vet Practice magazine when the pandemic was in full force in Canada. It’s interesting to read this now because the questions about second order effects, or determining the unforeseen long term consequences of this global pandemic are even larger now. I think my thoughts on the second order effects to vet practices are still reasonable, but those affecting other businesses and society are getting more and more noticeable. I welcome your comments and opinions on second order effects to the veterinary profession.

Originally published in the Spring 2020 issue of Canadian Vet Practice Magazine.

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