Business skills are defined as those skills necessary to market and manage the business around which one’s technical skills are used. In veterinary medicine, this division occurs between the teaching and developing of medical reasoning and surgical skills versus the instruction of techniques devoted to the art of using these skills to their greatest potential. Traditionally, countless hours of veterinary curricula are devoted to formally teaching the medical skills, while little emphasis is placed on educating these future doctors in the art of practicing their chosen profession. Since the latter part of the twentieth century this has begun to change, however.

The teaching of business skills, knowledge, aptitudes, and attitudes (SKAs) in veterinary education has been deemed a core competency by organizations in North America and worldwide (AVMA, 2014; Australia Learning and Teaching Council, 2009; NAVMEC, 2011; OIE, 2013). Practitioners are also demanding that the new graduates they hire possess business acumen. In one study of practicing veterinarians in California (Walsh, Osburn, and Schumacher, 2002), when asked what further expectations of new graduates they had, the overwhelming response was “improved knowledge of veterinary business practice.” Similarly, in a survey of employers of graduates of the Iowa State University College of Veterinary Medicine (Danielson et al., 2012), it was found that nontechnical veterinary skills such as business skills were important for predicting employer satisfaction. Although these vital skills are deemed a core competency, many times the challenge for an educator comes with where and when within the curricula to teach them. The ever-expanding veterinary medical knowledge base makes available class time increasingly more limited. Likewise, inserting topics dealing with business early into a student’s academic career may prove futile while they scramble to learn anatomy, physiology, or other seemingly overwhelming topics that they may view as more important. Yet others may argue that insertion of earlier instruction may mitigate some of the accumulation of student debt (Harris, 2012). Another variable is how veterinary curricula are structured (i.e., number of clinical years, distributive model, etc.). Thus, no single method of instruction seems to be a “one size fits all.”

Agreement about subject matter when teaching business SKAs is only slightly more straightforward. All veterinary educators would agree that underlying all of the business skills should be a strong foundation in communication skills, for without an ability to communicate effectively, much of the business knowledge and many of the applications of business skills would be difficult if not impossible. Volumes have been written on the teaching of communication skills, and a summary of that information can be found elsewhere within this textbook. Another area of agreement is that a student’s understanding of these business skills is best accomplished by instilling their use in the student’s personal finances and money management. With the average veterinarian completing four and a half years of undergraduate education prior to attending veterinary school, and many students pursuing additional training with internships (one year) and residencies (two to four years) (AVMA, 2015a), the burden of student educational debt is high. Providing this knowledge as early as possible would seem to allow an individual the most opportunity to make educated decisions, apply concepts, and potentially reduce their overall debt load. In fact, the Association of American Veterinary Medical Colleges’ Student Debt Initiative Report (Harris, 2012) states that by helping “students develop personal financial paths to graduation (i.e. improving their financial literacy) the students made better financial decisions while in school, had less anxiety and were better able to focus on their academic goals.” Students should be counseled at the time of application to veterinary school on the real costs of the education and ways in which they can make smart choices in their decision-making processes.

The variances in curricular structure and the appropriate timing of relevant delivery dictate that business skill teaching is distributed throughout the learning process. Examples of methods used for teaching business skills and when they are taught are discussed in more detail in this chapter. As with clinical medicine, teaching of business skills should be performed by those who have education and experience. Students express appreciation of faculty members with private clinical experience who not only provide factual information, but also bring first-hand, “real-world” knowledge to the discussion. With veterinary business skills covering a wide range of topics, specific experts within each of the diverse areas may be utilized. For example, while a general practitioner may have lots of experience with face-to-face client interactions, someone formally trained in communications may provide a different and more effective perspective.

Early within the educational process, students should receive instruction on preparing a personal budget. While this may be the most basic of the business skills, personal observation of informal first-year Doctor of Veterinary Medicine (DVM) student surveys reveals a surprising number of students admitting to not keeping a written budget for their personal finances and, by extension, not making informed, well-thought-out decisions with regard to their personal finances and spending. Many students enter veterinary school with four or more years of accumulated educational debt. Learning the basics of budgeting can provide these students with the knowledge necessary to manage their finances effectively, and subsequently mitigate the damages of excessive student loan debt. Ideally, this instruction should occur in the first semester of their veterinary education or earlier.

Numerous online templates on budgeting specifically designed for veterinary college students are available and easily utilized (AVMA, 2015b; University of Minnesota College of Veterinary Medicine, 2015; AAHA, 2015). Utilization of the template in a year-one, first-semester course to encourage early student use begins with projection of the template in class. This projected image of a monthly budget is then completed by the instructor, with student input to ensure participant understanding, thoroughness, and appropriate categorizing. This instruction should concentrate on the benefits of budgeting, such as controlling money by being intentional with spending; deliberately saving and managing income; setting monetary goals and planning for the expected and the unexpected; and determining what adjustments can be made with spending or saving habits to have the most positive effect on your debt (see Box 30.2). At this time the concept of marginal decision-making should be explained. Marginal decision-making is the incremental process of deciding cost versus benefit instead of an all-or-nothing decision. An example of this decision-making would be choosing to prepare lunch at home versus purchasing a prepared meal at a restaurant. Discussing the differences between needs and wants is also warranted at this time. By definition, a need is something necessary for a person’s survival, whereas a want is something that is desirable but not necessary. Assessment of student understanding is accomplished by requiring students to complete a similar monthly budget exercise for their personal finances on their own and submit it for review. This review deals primarily with assuring that they understand the various expenses and income, along with ensuring that the student’s expectations are realistic. Feedback is provided where applicable. The goal of these exercises is for students to realize that budgeting reflects long-term money management and replaces their day-to-day financial decision-making. Even the overall organizational skills learned from budgeting can, and should, be applied to other life skills.

One of the first financial concepts that students must master is an understanding of the time value of money. While the processes and calculations of this concept do not necessarily require mastering, understanding the concept is a must (Drake and Fabozzi, 2009). In its simplest form, the time value of money states that money today (present value) is worth more and has more purchasing power than the same amount in the future (future value). With most veterinary students beginning a career path, time is on their side when it comes to financial decisions. Their comprehension of the time value of money should extend to its application to such behaviors as saving for retirement, as well as appreciation of its application to compounding of interest and debt management. This is a foundation on which they can build their future personal financial affluence and their business success.

Again, beginning early in the educational process students must be exposed to moral philosophy. Ethics can be defined as an inner feeling of what is wrong versus what is right (Chadwick and Schroeder, 2002). So, can ethics be taught? Almost 2500 years ago, Socrates declared that ethics consists of knowing what one ought to do and, as such, this knowledge could be taught. While ethics is an individual’s definition of wrong versus right, the profession’s code of conduct can be taught and discussed. This standard should be assessed prior to veterinary school during the application process, and questionable candidates denied entry to the profession. Once in veterinary school, ethics must not only be discussed but also modeled (Self, Baldwin, and Wolinsky, 2009). This may begin with a student code of conduct and introduction to the Principles of Veterinary Medical Ethics of the American Veterinary Medical Association (AVMA, 2015). Likewise, defining the veterinarian–client–patient relationship is important for these analyses. Additionally, instruction in basic veterinary and business law should occur. Real-life scenario case discussions (see Box 30.3) have proven a valuable and informative manner in which the differences between legal and ethical violations can be discussed (Wilson, Rollin, and Garbe, 2008).

One of the biggest fears facing new graduates is making a medical error. Fundamentally understanding the difference between committing a medical error versus negligently practicing veterinary medicine helps bolster confidence. Examples of issues that new graduates may face that would place them in a moral or ethical dilemma include cosmetic surgery (e.g., declaws, tail dock, ear crops), convenience euthanasia, and correction of congenital deformities in intact animals, to name just a few. Some of the legal and ethical issues that may be encountered include employment contract “noncompete clause” reasonableness, hospitalization of patients overnight without staff on premises, workplace safety (e.g., radiation exposure monitoring, anesthetic gas scavenging, use of chemical restraint), and individualized sterile surgical pack use. Further, it should be noted that instilling a sense of values is not counterintuitive to the teaching of business where material gain is sought.

The next phase of business instruction naturally fits within the clinical education portion of the curriculum. As previously stated, communication skills are necessary for business success. During clinical instruction that involves student interaction with doctors, technicians, staff, fellow students, and clients, the students hone their skills at various levels and across the three types of communication – written, verbal, and nonverbal. It is just this type of varied communication that is needed to emphasize the important concepts when conveying their knowledge to the caregiver. Studies have shown that client relationships built out of effective communication between veterinarians and clients lead to comprehension of a pet’s healthcare needs, better compliance, improved patient outcomes, and increased clinical revenue (Shaw, Adams, and Bonnett, 2004). The inverse – that is, poor communication with clients – leads to deficient care for the involved patient and dissatisfied clients. In this age of social media, the ramifications of having these disgruntled customers are magnified enormously, as will be discussed shortly (Tassava, 2014).

Not to be overlooked, the skill of active listening to clients has been shown to be one of the most sought-after communication skills and one of the most effective key skills for a practice’s success (Opperman and Grosdidier, 2014). Recording students in real-life client interactions during their primary care rotation is an excellent means of assessing verbal and nonverbal communication. The recordings are reviewed by clinical faculty, with direction and feedback provided to students allowing refinement of these skills. Student self-assessment of these video recordings is shown to be more critical and, subsequently, very influential in changing their communication methods. Another method that can be used for assessing written communication skills is with the assignment of a client education handout. This is a written description of a disease process or husbandry practice provided in a format that is easy for the client to read and understand. It should be assessed for thoroughness, clarity, and practical usefulness for an owner. Other encompassing forms of assessment can be derived from the discharge instructions and communication logs within the medical record. Assessment can be surmised from recommendations followed and feedback on owner comprehension during follow-up visits.

One of the biggest challenges currently facing business owners is how to manage communication in the electronic age. Social media, e-mail, and web pages have allowed us to communicate vast amounts of information to an infinite number of people. The challenge lies with differentiating factual information from opinions or perceptions. Historically, the largest and most effective single marketing tool for veterinary practices has been client word-of-mouth recommendation (Molhoek and Endenburg, 2009; DVM360.com staff, 2014). Social media has allowed the number of potential clients that can be reached to explode. Likewise, dissatisfied clients can now release their feelings on a blog that has the potential to influence a multitude without the opportunity for rebuttal. Veterinarians will continue to find managing these communication portals a challenge.

While we have stressed the importance of communication with clients, perhaps equally important is learning the team-building and leadership skills necessary to work productively within healthcare teams and accomplish their collective goals. This frequently entails new graduates leading the case management effort, a task that many are unfamiliar with undertaking. An additional skill that has been identified as a fundamental key to the success of a practice and to the professional wellbeing of a business owner is delegation (Opperman and Grosdidier, 2014). Many veterinarians find it difficult to relinquish some of the “power” associated with business ownership, but, once they do, they find the benefits to be financially and personally rewarding. Delegation of any duty that is not directly associated with the practice of veterinary medicine can allow the veterinarian to focus their time and effort on that for which they were extensively trained and for which revenue is generated. The two primary areas that lend themselves to delegation are practice management and technical staff utilization. It has been shown that practices employing veterinary managers earn as much as 13% more than those without managers (Richardson and Osborne, 2006), and effective use of technical support staff also increases practice revenue (National Research Council of the National Academies, 2015). Not only do earnings increase, job satisfaction for veterinarian owners also improves, leading to less professional “burnout.” The effective utilization of veterinary technicians in practice revenue generation continues to be lacking (Liss, 2012; Veterinary Business Advisors, 2013).

Faculty modeling of team building and leadership development within the clinical setting may be one method to encourage support staff use and allow collaborative learning. Faculty members who leverage their staff (delegate) while dealing with clinical cases are viewed as more efficient, have more time to spend interacting with students, and are appreciated by the associated staff team members. Placing students in the role of “doctor” during their clinical education facilitates learning the skills necessary to be a team leader and promotes delegation of duties for efficient case workups (Bridges et al., 2011). When professional students are instructed to utilize technical staff, they quickly learn the associated value of efficient time usage.

Another method used to teach the arts of delegation and team building involves scenario-based discussions. As an example, take a simple clinical procedure like a fecal flotation. Point out that while the leader (veterinarian) could perform all the steps needed to complete the task, it can be achieved in a much more time-efficient manner when multiple team members are involved. For instance, the owner can retrieve the sample at home and bring it with the pet. Discuss how much this frees the technician to do other productive procedures. A technician should set up the test sample and read the results. Discuss how this frees the veterinarian to do things such as case assessment, diagnostic test interpretation, and therapeutic treatment plan assignment. Isn’t each member doing what he or she is trained and capable of? Are the results or outcome different? Do you think job satisfaction is greater than if the most qualified person performed all the tasks? Simple discussions such as this can be an eye-opening experience for students.

As students approach the end of their veterinary education, skills such as résumé construction, cover letter writing, interviewing techniques, and contract negotiation become imminently important. A combination of lecture, student project assignment exercises, role playing, and group discussions assists students with enhancing these essential skills.

Creating the professional résumé is an essential task that must be refined over time (Wilson, 2010). Whether submitting a curriculum vitae or résumé, students should begin this process early in their clinical studies and add the educational experiences they encounter. A résumé is a general and concise overview of personal experiences and skills and how they relate to the particular position that one is aiming to obtain. In contrast, a curriculum vitae (CV) is a detailed summary of one’s life accomplishments. As a general rule, CVs are required when furthering one’s academic career and résumés are utilized to acquire a professional position (job). Polishing how students present these experiences and the skills learned from them is critical. Critique of the résumé should be mindful of the tremendous power that each word possesses and the image that this document portrays.

Some small business applications such as practice marketing and basic accounting procedures can also be modeled in the clinical education phase of the veterinary curriculum. These topics can be discussed by posing questions regarding the establishment of fair and profitable fees, the cost of giving services away, how to create medical care estimates, and what client-targeted marketing is. Building on the skills learned in personal financial management and budgeting, a direct inference to business practice accounting can be made. The concept of long-term money management with careful recording of income and conscientious expenditure should be stressed.