Recent graduates: financial drain or great investment?

So you're thinking of hiring a recent graduate, but are concerned about the risks involved. Some of the questions you have in mind no doubt include:

• Will they stay? An RCVS study showed 40% of new graduates leave their first job within three months. Part of the hiring process must, therefore, include identifying and providing the factors that will encourage them to stay with you.
• What will they cost me? A low starting salary is often fairly heavily outweighed by lower financial productivity as they learn the ropes. Other difficult-to-measure costs associated with hiring new graduates include:
  • time – they not only take longer to carry out procedures such as consultations and surgeries, but they also take time from more senior colleagues who need to explain things to them or provide supervision; and
  • errors – potentially expensive mistakes are more likely in the early years.
• What can they give me? Apart from enthusiasm, energy and updated information, how will employing a new graduate be of benefit to me?

At the end of it all, you are trying to work out if the risk is worth it or if you should look for someone with more experience? Really, however, your starting questions should be:

• What does my practice actually need?
• Would a new or recent graduate fulfil this need?
• How do I ensure our new hire will be successful for us – and for themselves?

What does my practice actually need?

Why are you considering hiring a new veterinarian? Are you expanding? Are you replacing someone who is leaving? Is this a temporary role, say to cover a maternity leave, or is it (potentially) a permanent role?

What specific skill set would this new veterinarian ideally bring? Are you looking for someone who will be working largely independently and, therefore, needs to be up and running from day one, which means he or she has a reasonable level of previous experience, or can you provide the supportive background that would enable you to train and form a new graduate? Do you want a generalist or a specialist? What is the graduate's future with your practice? Are they to continue as a generalist or do you want them to become more focused in certain areas of medicine or surgery, and how will you ensure this happens?

Remember, skills can be taught whereas attitude is something the individual largely brings with him or her. What sort of attitude and behaviours would best help this individual fit into and enhance your existing team? Get input from team members to identify key personal characteristics that would make the new hire an attractive one.

How desperate are you? Of course, it is never good to feel you are desperate to hire as you are more likely to make rapid and potentially erroneous choices. However, acute situations can arise and it may be better to tackle these by hiring an experienced temp for a limited and defined time period than rushing into a longer-term hire.

What can you afford? New graduates are cheaper to hire in terms of salary and conditions than experienced practitioners, but, as mentioned earlier, they are also more likely to leave, meaning increased recruitment costs, or to make costly mistakes.

Would a new or recent graduate fulfil this need?

Now that you have more clearly defined the sort of person and skill set you are looking for and the economic framework around the hire, the next question is do you want a new or recent graduate?

The Australian Veterinary Association New Graduate Friendly Practices Accreditation Programme (AVA NGFPAP) identifies five largely altruistic benefits of hiring new graduates. They are:

• you can train them from the beginning in the culture and standards within your practice
• they provide a fresh outlook and are a source of new, up-to-date knowledge
• by providing a supportive environment during their formative post-graduation years, you develop veterinarians who are more positive to the profession. In addition, the consistency in the training they receive from you means they develop a more solid and better professional skill set
• this, in turn, means they are less likely to leave the profession and they become a positive role model for younger vets
• they are an important part of your succession planning

These benefits need to be weighed against the downsides – the hidden risks and costs associated with hiring someone who is naïve and inexperienced.

How to ensure our new hire will be successful for us – and for themselves?

Three key areas you need to focus on to ensure mutual success if you hire a new graduate are:

• developing their people skill set
• developing their veterinary medical skill set
• developing their business skill set

Developing the people skill set

Veterinary practice growth is rooted in client relationships. Recently, to identify the factors that led to success, American Animal Hospital Association (AAHA) and IDEXX Laboratories gathered data from hospitals demonstrate year-on-year revenue growth greater than 10% and compared them with failing practices.

The single most important factor that differentiated the successful from the failing practice was not size, location or the state of the local or national economy, but a focus on strong, lasting client relationships. How can you teach your new graduate to build relationships like this with your clients?

Relationships are, even at the best of times, complex. Professional relationships are not exempt. Achieving that fine balance of concern and engagement in the individual patient and their all-important owners versus maintaining an appropriate professional and clinical detachment is difficult.

Being able to communicate empathetically and well with clients requires more than normal social skills and graces: it requires knowing how to listen, how to ask the right questions and how to provide information effectively and simply.

Professionalism also knows how to set limits on both personal involvement with clients and also on the demand for clinical excellence placed by the young, keen veterinarian on themselves. I have known recent graduates who, in their enthusiasm to serve clients as best as possible, were available almost 24 hours a day by phone, and who would work many, many hours of their own time to try to find diagnostic solutions to difficult cases. This behaviour is, in the long term, beneficial to no one, not least your practice.

New graduates are usually young but are required to appear as authority figures to animal owners often considerably older than themselves.

Although training in client communication at university level has improved immensely in the past decade, it is no substitute for real world experience. Clients can be perfectly horrid, which is upsetting and hurtful for young graduates who may not know how to deal with their own and other people's emotions. Combine an unpleasant client with a medical or surgical error and the self-deprecation and shame felt can be devastating.

It is, therefore, critical to ensure the new graduate is given frequent opportunities to talk with more worldly colleagues, not only about challenging animal cases, but also about challenging owners. They need a safe environment to be able to talk about and process their emotions and to gain a perspective on mistakes. Providing a collegial mentor may help here. How do your current staff view this idea?

The AVA recommends the new graduate has not only a supportive and encouraging boss, but also the possibility to develop and maintain supportive personal contacts outside work. This, in turn, means the new graduate should have reasonable working hours and conditions. Overwork and constant tiredness can quickly lead to exhaustion and depression.

In addition, the new graduate generation expects to have time outside of work for other activities as well as family and friends. What is the OOH rota your new graduate is expected to work? Is it fair based on today’s expectations – not on what you were expected to do when you were a new graduate in your first job?

Developing the veterinary medical skill set

New graduates have a large amount of knowledge, but they lack the experience to be able to consistently and rationally apply it with skill and confidence. This is learned with time, patience and good teaching. Can you consistently provide this?

One of the most important lessons I learned as a new graduate in practice is that “common things are common”. Although trained to identify a long list of differential diagnoses for every presenting set of symptoms, in the vast majority of cases the diagnoses were straightforward and required pretty standardised treatments. But it takes time to learn this – and to also remain alert for the non-typical case.

In addition, working up a case seldom follows the textbook description. Not only may the animal not be “textbook”, but clients may not want to pay for expensive and, perhaps, non-conclusive tests or may choose euthanasia rather then let you reach a satisfying diagnosis. How can you help the new graduate manage these situations?

Successful hospitals in the US work hard with preventive care and leveraging technology to drive preventive care, according to the AAHA/IDEXX study.

Working proactively with preventive care is very different from working reactively with medical and surgical care as taught in our universities. Vets are trained as medical problem solvers: these are the symptoms, what is the diagnosis and treatment? This is a very different mindset from collaborating with the animal owner in an expert advisory role to prevent diseases such as obesity, dental, and behavioural problems and it is a mindset not many veterinarians feel comfortable with. How can you teach your new graduate to work with preventive care?

Developing the business skill set

From the business perspective, a veterinarian’s key function is to generate revenue into the practice through selling professional services and products to animal-owning clients. This revenue then pays for everything in the practice: staff salaries, buildings and maintenance, services such as heating, lighting and electricity, equipment, drugs and disposables.

Put simply, a veterinarian is a professional salesperson. Many new graduates baulk at this idea, partly through naïve idealism, partly through a lack of understanding of basic business principles.

A vital part of their learning process is to be exposed to the business’ finances, for example, through presentation of the clinic’s budget at a monthly staff meeting, and talking constructively about the need to balance investments in, say, new equipment versus expected returns. This helps them gain a practical understanding of everyday economy and, most importantly, of their role in the financial success (or failure) of the practice.

Charging properly is a key daily activity. It is tempting as a new graduate faced, perhaps, by their own slowness in performing procedures, or a willingness to be “nice” to clients or even a domineering client, to give away practice revenue by not charging fully for services.

Demonstrating the effect over time of “shaving” invoices or “forgetting” charges can enlighten the novice. To help learning, one practice I came across even offered the new graduate employee a cash incentive at the end of every month for the first six months. The final amount was dependent on how many fee reductions they had made – which were withdrawn from the sum – over the month. They found new employees quickly got the message about charging properly when it was their own money they were giving away.

Learning how to talk about money comfortably with clients is critical to proper charging. This is also difficult for new graduates, who often have little idea of their own worth, and can only compare themselves with more senior and, therefore, more valuable colleagues. In addition, they may not have seen or worked in well-managed practices where the whole issue of how to discuss fees with clients was dealt with competently.

Using a standardised charging system and providing supervision of charging, initially by an experienced nurse, can also help the new employee learn to charge properly.

Tests are often expensive and not always necessary in making a reasonable working diagnosis. Of course, knowing this comes with experience – a classic catch 22 situation for the new graduate who may be over enthusiastic in his or her reliance on testing.

Gentle supervision and coaching can help guide the novice to make decisions that are professionally acceptable – and also financially acceptable for the client.

New graduate or not?

If you feel your practice can offer the support and encouragement needed to create a confident and competent veterinarian with strong interpersonal, medical and surgical and also basic business skills, then the new graduate is for you. Good luck.