After decades of working with Veterinary practices, I’ve observed that practice managers generally fall into one of two categories: brilliantly effective and fully utilized, or ineffective, underused, and ultimately a burden on payroll. The difference almost always comes down to a clear understanding (or misunderstanding) of organizational structure by both the practice owner and the manager.
Organizational Basics: The Patient Pathway
At its core, a well-run Veterinary practice operates like any efficient business: a team of specialists who smoothly pass the client and patient from one role to the next along a defined “Patient Pathway” or “Patient Journey.”
For example:
- The CSR answers the phone, schedules the appointment, and escorts the client and pet into the exam room.
- The Veterinary assistant takes the history, records TPR, and starts the medical record.
- The DVM performs the exam, builds the Patient Care Plan (PCP), and communicates it to the client.
- The Client Coordinator then presents the estimate and secures agreement to proceed.
This pathway continues through treatment and discharge. Overarching all of it is the practice’s Purpose or Mission Statement, which unites the team under a common goal.
The Evolution from Small to Large Practices
In very small practices (under 5–6 team members), everyone wears multiple hats and the owner can manage directly. As the practice grows and patient volume increases, an “Executive Strata” becomes essential. Without this middle layer of leadership, every problem rises straight to the owner, creating overload and chaos. I call this the “Clogged Toilet Model” or CTM of practice management (sorry – I just find it’s descriptive and most DVMs understand this 100%!).
The True Role of a Practice Manager
A manager or executive is someone who, while keeping the practice’s overall mission in mind, gives clear direction to the team and keeps operations running smoothly. They step above the daily patient pathway to observe, train, coach, correct, monitor flow, and eliminate friction.
Good managers may have come from technical or front-desk roles, but they must transition out of full-time production work. Their primary job becomes hiring, training, mentoring, correcting, and sometimes offboarding team members. Their effectiveness is best measured through the practice’s Key Performance Indicators (KPIs), not just personal productivity.
The Common Problems
Two frequent issues arise:
- The “promoted CSR” problem — A staff member is given the title of Practice Manager but continues working in the trenches. Internal frictions bypass them and land on the owner, resulting in an overpaid technician with a fancy title and a burned-out owner.
- The “unused manager” problem — The owner bypasses the manager due to poor communication or lack of trust, undermining the manager’s authority and leaving them feeling disempowered.
The Solution: Build a Simple Executive Strata
Practices with more than five or six team members benefit from developing three key part-time executive roles that form the “Executive Strata”:
- Director of Administration (Practice Manager) – Oversees the front end.
- Director of Medical Services (Head Technician) – Oversees the back end.
- Director of PR & Marketing – Oversees reputation and client acquisition.
These three leaders meet weekly with the owner (CEO) in a Practice Executive Council (PEC) meeting to review KPIs and stay aligned.
Wrap-Up
Effective managers are essential for scaling a practice without crushing owner stress. However, they must be properly trained, trusted, and utilized. Owners must learn to define clear expectations, track KPIs, communicate weekly, and resist the urge to bypass their managers. When this system works well, everyone wins.
Below are action steps for creating an effective strata (and a happy owner and team):
- Appoint your three key executives (even part-time initially), selecting your most competent and respected specialists.
- Clearly define their management responsibilities versus their technical duties.
- Begin tracking meaningful Key Performance Indicators (KPIs).
- Hold a weekly Practice Executive Council (PEC) meeting.
- Have the courage to use your managers — correct them privately and support them publicly.
Struggling with your practice organization and unwanted stress? At the point in your practice ownership where you’re ready to start a transformation? Click HERE to schedule a free 30-minute Business Health Check consultation.