Working Without Breaks

Dear Second Opinion,

I’m struggling to manage my time in the clinic. I work four 9-hour shifts per week and 2 Saturday morning shifts per month, and I have 1 hour for lunch between my morning and afternoon appointments on weekday shifts. My morning appointments typically run long and take up part of my break due to fit-in appointments, late clients, and patients presented for one problem but actually have several. I spend my remaining time catching up on records, answering questions, calling clients, and scrambling to eat. I dread my afternoon appointments and am occasionally short with team members.

I stay after my shift every day, including Saturdays (for which I do not have a scheduled break), to chart and make calls. I feel as though I never have enough time. Is it too much to want an actual break during the day or the ability to leave on time? Am I just not cut out for practice life?

Sincerely,

Please Give Me A Break

Dear Please Give Me A Break,

As a former overworked practice manager, I understand how you feel. Research shows that lack of control over scheduling, including the ability to take breaks and catch-up time, is a significant predictor of depression, anxiety, and stress in veterinary professionals.¹ The solution involves some sharp scheduling and setting boundaries. Longevity in practice comes from days that are enjoyable and work that is sustainable.

Starting the Conversation

Assuming you are an associate veterinarian and not the one who generally sets the schedule, you’ll need to approach this conversation with your management in a solutions-oriented manner. Adjusting how appointments are scheduled can benefit your mental health and acuity, which in turn can improve the environment for clients and team members and have positive effects on patient care.

It is important to not assume management is aware of your challenges with taking breaks and staying late. We are often immersed in our own day and unaware of each other’s struggles. Don’t be afraid to discuss these issues with practice management.²

Build Extra Time Into the Schedule 

Consider a 2-hour gap in the middle of the day (with 4-hour blocks of appointments in the morning and afternoon) that allows time to take a lunch break and catch up on calls, recordkeeping, and reading. Team members should be trained to maneuver appointments as needed to keep your schedule open during the midday gap.

Vary Appointment Lengths

Scheduling an equal amount of time (eg, 30 minutes) for every appointment type is common but not realistic. Determine how much time common appointment types usually take. Senior patients may take 45 minutes, patients with behavior issues may take a full hour, and a puppy on their third vaccine visit may only need 10 minutes with a credentialed technician.

Spread Out Types of Appointments

If possible, use color coding for appointment types in the practice management system. Ensure the team tries to avoid scheduling sick patients back-to-back, and spread wellness visits throughout the week. Consider having wellness-only hours in the afternoons, as these appointments rarely require extra time. Schedule empty time slots for urgent care cases. Leverage your team, especially the credentialed technicians, to do the work they are legally allowed.

Take Frequent Short Breaks

Consider taking frequent 5-minute breaks to step outside and gather your thoughts. You may feel as though you will get further behind, but you won’t; our brains cannot work as efficiently when they are overwhelmed or fatigued. Set reminders on your phone to take a break; drink water, tend to bodily needs, or stretch and breathe deeply to increase mindfulness and relaxation.

Set Consequences for Tardy Clients 

Create consequences for clients who are late to appointments. Expectations can be set via notices in the lobby, appointment reminders, and invoices. Clients >5 minutes late can be moved to walk-in status (meaning they may face a lengthy wait as other patients are seen first) or asked to reschedule. Chronically late clients can be sent a letter explaining the clinic is unable to best serve patients when clients are late and if tardiness continues, they will be considered for walk-in appointments only or a deposit will be requested in advance of scheduling an appointment.

Delegate Communication

Kindly saying, No, I just can’t do that, is a difficult but important skill to practice and learn. Consider training team members to contact clients on your behalf. It can be challenging to delegate when training is insufficient and trust is not in place. Adequate training for team members can help build confidence and trust in how these tasks are handled.³

Technology can help with dictation, text messaging, and transcribing conversations (see Technology Resources). Client communication needs can still be met, but time involved shortened.

Experiment Together

If practice management is reluctant to make several changes at once, suggest a trial period for implementation of one or more of these tips, and plan a team discussion after the trial to see where further adjustments can be made. No scheduling solution is one-size-fits-all, and teams should be able to provide feedback about what does and does not work well.

Hopefully these tips will improve your outlook on practice life.  

Signed,

Debbie Boone, CVPM