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Archive for the ‘Practice Management’

Guest Column: Helping Your Veterinary Practice Navigate the ACA

September 13, 2014 By: Dr. K Category: For Vets, Practice Management

The Affordable Care Act affects many veterinary practice owners and it’s vitally important to stay abreast of new laws. In particular, mandates for insurance coverage and the advent of the health insurance exchanges have muddied the waters of understanding. Below a guest columnist, Monica Maxwell, SPHR, discusses the appropriate steps in navigating the ACA mandates.

Overcoming the uncertainty: Implementing a health care plan in a veterinary clinic
By Monica Maxwell, SPHR

Many veterinary practice managers, like managers in other industries, are looking at the changes brought about by health care reform and are uncertain about how best to implement a health plan for their employees. You probably didn’t enter the veterinary business because you are particularly interested in learning about health insurance, but you do care about your employees’ well-being, and you no doubt also know that health benefits are a great recruiting and retention tool.

So how do you go about finding a plan that meets the needs of both your employees and your business?

First, talk to your staff members and find out what is important to them. What if they don’t want healthcare? Or they prefer an option that will allow them to gain access to alternative care (like acupuncture). You cannot please everyone, but at least you’ll get an idea of people’s actual priorities rather than simply making assumptions. Also, if you have fewer than 50 employees, note that sometimes individuals can find less expensive or better-value plans on a health insurance exchange than a small clinic can offer its employees. The Affordable Care Act allows for companies with fewer than 50 employees to offer insurance on the health insurance exchange without penalty. It is a viable option for many, so you might want to consider referring them to an exchange if that makes the most sense.

After you have a clear idea of your employees’ needs, you’ll want to find a good health insurance broker. Chances are you don’t have the time or expertise to dig into the details of all the plan options and keep track of changing regulations. Choosing a broker is an important decision, so take the time to conduct a thorough search and interview process. Trust and rapport are critical. Ask potential brokers about trends they’re seeing in the industry and how those trends might affect a business of your size. Talk about the renewal process, communication styles, what you need from each other and how you see each other’s roles. Make sure your broker understands your needs and is willing to have a strategic discussion when it’s time to change your plan. They should be knowledgeable and flexible with you on the changing trends.

Once you choose a health care plan, make sure the company provides the service you require and expect. The network of health care providers (and the quality of care, of course) is important, but don’t underestimate the value of customer service. Quick answers to questions and timely payment of claims reduce administrative headaches and save everyone time and money. Benefits are important and ensuring your staff feels good about the quality and service they receive is absolutely critical.

Choosing a health care plan may feel daunting, but it doesn’t need to be overwhelming, and it’s not just a bureaucratic chore. A health benefit that helps keep your employees healthy and happy will contribute to your ability to attract and retain the best staff members, thus furthering your practice’s goal of providing exceptional care and service.

Porter & MM

Monica Maxwell is the program director for On the Floor @Dove, DoveLewis’s online, on-demand training website for veterinary professionals. Maxwell graduated from Sam Houston State University with a Bachelor of Science in psychology, and she has nearly 15 years of experience at both for-profit and nonprofit organizations. She shares her expertise with other veterinary practices through On the Floor @Dove.

Handling the Winter Lull

February 17, 2013 By: Dr. K Category: For Vets, Practice Management

Winter. Short days, long underwear. The thought of winter in the Northeast conjures up the dismal gray and frigid temperatures that lull veterinary clients into a stupor. Allergic skin disease and rotten ears are distant malodorous memories. Orthopedic injuries are rare as dogs spend more time indoors. And veterinarians and staff are left twiddling their thumbs in anticipation of the next appointment. What do you do when appointments take a down turn? Follow these tips and your practice can turn the winter lull into the winter boom!

1. Update Those Reminders
Many practices have a reminder system that functions sub-optimally. Changes in protocols often require updating the client reminders, sometimes manually. Additionally, clients who have declined a vaccination or failed to bring a fecal sample to their previous appointments leave the reminders incomplete unless your staff has been meticulous in updating information. Synching annual exam dates with when vaccines are actually due, adding reminders for ancillary services like laboratory work, and reminding clients to bring in stool samples can boost the bottom line all year long. The added benefit is keeping your reception staff busy and ensuring they understand the most recent protocols and recommendations.

2. Offer Incentives

Many of the most successful practices incentivise appointments and procedures during the winter months to keep income incoming. February is National Pet Dental Health month; Offer a discount for all dental procedures scheduled in that month. January your slow month? How about $10 off an annual examination? Getting clients through the door is the name of the game.

3. Practice Your Personal Touch

During the slowest times, encourage your staff and veterinarians to take their time in their appointments to connect with clients. (I know, I know. We should always take our time and not feel rushed, but when Mrs. Pushy brings three pets to her 15 minute appointment instead of one and you have two emergencies in the wings it’s near impossible not to rush.) Connections and small talk foster trust and bolster compliance. Detailed explanations of the importance of dental hygiene, routine laboratory work, and why that Leptospirosis vaccine is really important will benefit the patient and the bottom line.

And yes, use your callback reminder system to have your staff reach out to your patients who may have fallen through the cracks. A simple phone conversation may reveal the patient you thought was thriving after discharge is not.

4. Clean

This is the easiest time of year to make your practice sparkle top to bottom. Nothing makes me cringe more than walking into a practice that smells. I’m not talking the standard smell of a hospital or a stinky Labrador who was emanating his freshly-rolled-in-poop glory. No, I’m talking the musty smell of dampness, urine, and uncleanliness that makes clients question the value and competency of the practice. There is NO excuse any time of the year.  A thorough winter cleaning keeps odors at bay and your biosecurity at its peak.

5. Educate Staff

Blocking time for a lunch and learn is a lot easier when your staff is not slammed with the spring and summer smorgasbord of cat bite wounds, limping dogs, and hot spots that all need diagnostics and treatments over the lunch period.

Educated staff equates to improved patient care leading to happier clients. It’s that simple.

Additionally, update educational material in puppy and kitten packs, handouts, and mailings.

6. Educate Clients

The stillness of winter is the perfect time to offer puppy classes, animal first-aid classes, and general pet ownership tutorials. Not only is this the perfect way to network with responsible clientele, it seats your practice as the local authority among practices in your area.

Remember: An educated client is a compliant one.

Ten Signs It’s Time To Leave Your Veterinary Practice: Part II

July 17, 2011 By: Dr. K Category: For Vets, General, Practice Management

Ten Signs It’s Time To Leave Your Veterinary Practice: Part I

I’ve listed  the first 5 signs it’s time to leave your veterinary practice in Part 1. The remaining 5 signs below are equally important. Feel free to list more signs or relate personal experiences!

6. Compromised Patient Care

Do patients sit in their filthy cages all day? Tipped over water dish never filled? If your practice fails at basic care for patients, it will never excel at advanced medical care. Practices that competently complete the basics are easy to find; Finding practices that excel at advanced care proves more challenging.

A dear friend told me about a nightmare hospital where they put on the facade of a referral hospital, even providing blood products. Of course, not one of the support staff members knew how to perform a blood transfusion. Couple that with their lack of transfusion supplies and you’ve dialed up a situation for poor patient care.

Compromised patient care, at any level, is a deal breaker. Clients entrust their beloved pets to veterinary hospitals and believe we will rightly care for them. We are obligated to peak performance. If a practice does not have its focus on patient care, refuse to compromise.

7. The Practice Is Chronically Understaffed

The formula for stress at work:

Stress = Too many tasks + Too few employees – Patient care (see #6).

If your practice is always hiring, firing, or losing employees, you can bet that turn-over rate is an indicator of severe dysfunction traceable to the leadership. Practices with high churn rates find themselves in a perpetual cycle of being understaffed. High churn also means new employees in need of training. But without staff who trains them? Too few and untrained employees results in one big problem: Poor patient care!

8. Lies, Lies, Lies

Whether it’s lying to employees or lying to clients, businesses built on lies are dangerous. Evacuate now.

9. Inability to Effect Change

The ability to effect change is integral to feeling like a contributing member of a practice. Having ideas for improvement embraced and implemented rewards free-thinking employees. Movers and shakers become frustrated when their repeated attempts at correcting problems are thwarted by ineffectual leadership.

If you’re ideas and offerings are met with cold stares, or worse, promises of compromise that never come to fruition, perhaps it’s time leave for fertile ground.

10. Life Has Changed

The fluidity of life can alter your needs so that jobs that formerly fit well then may not fit now. Marriage, children, illness, and family struggles all may change your employment needs. It’s never wrong to seek a job that fulfills your financial needs, provides better benefits, or offers the hours compatible with your life.

 

If you are in the market for a new job in the poor economy, perseverance and ingenuity are key. Make yourself more marketable by filling niches. Create job opportunities instead of just pouring over the classifieds. Thinking outside the box just may open doors for job fulfillment!

Ten Signs It’s Time To Leave Your Veterinary Practice: Part I

July 16, 2011 By: Dr. K Category: For Vets, General, Practice Management

Deciding to quit requires great consideration and, in many cases, should only occur following exhaustive attempts at improving your workplace. For tips on how to cope and avoid quitting, check out the first half of this article from US News and World Report!  If you think you are at the end of your rope, quitting your job may be the only option you have left.

Leaving your job during a down economy carries enormous weight.  Frequently the idea is abandoned because of fear of the unknown. Too often we accept mediocrity in exchange for comfort. Our griping, stress, and stagnancy linger because we don’t want to sacrifice a sure thing.

Some of the best advice I ever heard came from Mr. Vernon Hill, past-CEO of Commerce Bank. When asked what to do when management refused to budge he said pointedly, “Something’s gotta change. Either they change or you change.”

I offer you 10 signs it’s time to leave your practice. Many of the signs are interrelated, a consequence of compounded dysfunction.

Ten Signs It’s Time To Leave Your Veterinary Practice

1. Lack of Leadership

Having a definitive leader in a practice is key to maintaining balance and unity between personnel. A practice is only as strong as its leaders. The discord from lack of leadership trickles down the ranks from associates all the way to kennel staff. Leadership failures include ignoring conflict, refusing to address employee concerns, and an inability to accept feedback and criticism. If business owners and managers refuse to establish and adhere to set practices and guidelines, the practice quickly morphs into an every-man-for-himself mentality.

The strongest practice leaders seek input from their employees and strive to improve work relationships. Without that direction inconsistent policies, unresolved conflict, and disgruntled employees contribute to an even bigger problem: Poor patient and client care.

2. You No Longer Enjoy Your Job

This one seems like a no-brainer but it deserves a closer look.  Only about half of Americans report they actual enjoy their jobs. Yikes! Money, interpersonal relationships, long hours, and the job itself comprise many of the reasons for job dissatisfaction.

Burnout is one of the biggest factors affecting a veterinarian’s job satisfaction. There is a big difference between physical burnout secondary to long hours and emotional burnout secondary to chronic stress. Physical burnout can sometimes be remedied with vacations or sabbaticals. Emotionally burnt out employees may have no other choice but to leave their current position in order to reestablish balance.

We will all experience bad days, weeks, or months at work. Overall job dissatisfaction comes from chronic, systemic dysfunction resulting in more bad days than good over an extended time.

As an aside, I don’t know many veterinarians who, at one point or another, haven’t doubted their calling into the profession. The long hours, chronic stress, and interference with personal life take a toll. It leaves us second guessing. Determining whether you are unsatisfied with your job or your career is critical.

3. Work Interferes With Family Life

Veterinary professionals expect long hours and late nights. Those unfortunate enough to have the plague of  “on-call” carry a tether to the veterinary practice making maintaining your family and social life difficult.  Long hours make veterinary medicine challenging enough, throw in a chronically stressful work environment and you’ve got big trouble.

Overworked on a soft tissue rotation during my fourth year of veterinary school, the only thing I could think of on my 20-minute drive home was a hot sausage sandwich. It waited for me, an ample leftover certain to squelch my starvation. I arrived home to find my husband had eaten all of the sandwich rolls and all but three inches of coveted porky goodness. The consequences of fatigue, stress, and an 80-hr work week played into the epic at-home work-induced meltdown that ensued.

Rational thought escaped as I went on a tirade about how it was clear my husband didn’t love or respect me since he ate my long fantasized about dinner. I heated the measly morsel and continued to accost my poor husband. I stormed to the office, my husband in slow chase behind, and to my dismay my sausage rolled off of my plate and across the floor. I bawled. A lot. Work stress weaved its way into my home life and my attitude suffered for it. In retrospect, this proves another hysterical moment among many in our relationship, but a lesser man may not have been so tolerant of work-related meltdowns.

Ideals, however noble, are rarely upheld when serious long-term stress hits. Our families are the first affected by sour moods. Sometimes our work situation is so miserable no amount of positive thinking and affirmations contain the emotion of job dissatisfaction. Don’t let your family suffer.

4. Ouch! You’ve Run Into The Ceiling

Positions with little or no room for growth are frustrating. Stagnant minds rot. Stagnant paychecks are rotten.

5.  Any Other Job Is More Appealing

Find yourself thinking waiting tables looks better than your current job? Willing to take a significant pay cut just to escape? See those road workers dripping in sweat on a summer day and jealously think ‘Hey, they look so tan!’? You are not alone but it’s time to seriously rethink your current situation.

Remember the expression “The grass is always greener on the other side of the fence?” It’s true. It’s greener because it’s fertilized with bulls**t. We’ve neatly concocted scenarios in our minds as to how much better it is over there. If the only reason for leaving is  you think it’s better on the other side, think again. Perhaps you just need a vacation. But if you find yourself nodding in agreement with some other signs, this may contribute to your decision to leave.

 

Ten Signs It’s Time To Leave Your Veterinary Practice: Part II

Probationary Periods: How Long is Long Enough?

January 22, 2011 By: Dr. K Category: Practice Management

Nearly ever practice owner will experience the unpleasantness of a bad hire. Initial and working interviews can weed out the riff raff but occasionally a crumby employee slips through the process. Having a written probationary work policy is key to preventing painful and non-productive early employment snags. Below is a list of essentials to include in your policy.

Term Limit

A probationary period requires a time long enough to develop basic skills but not so long that floundering employees are permitted to wreck havoc on your practice. All employees must exhibit the ability to take direction and instruction immediately. Veterinary assistants and Veterinary Technicians should exhibit proficiency in their respective basic duties within 1-2 months of employment. Newly graduated veterinarians should cruise through basic appointments after 3 months of training and should feel confident to handle more complicated cases by six months. By the end of their first year, veterinarians should be confident to handle nearly any case that comes through the door in a systematic, diagnostic manner. Experienced veterinarians require 1-2 months to acclimate to a new practice, fee schedule, and appointment schedule.

Duties

Expectations and milestones must have clear definition in the policy. Ex, “By the end of week two, the employee is expected to perform XYZ duty to full capacity without assistance.”

Veterinary assistants should be proficient in basic animal restraint, basic veterinary communication and jargon, cleaning, and basic history taking. Development of these skills should take no longer than one month. More complex training is only pursued once the basics have been mastered.

Licensed veterinary technicians are presumed to have base knowledge of animal handling, blood handling, and anesthesia monitoring among others. Highly technical performance is reasonably expected following the initial 1-2 month acclimation period.

Newly graduated veterinarians must be comfortable with routine physical examinations, basic spay/neuter surgeries, and simple medicine case work-ups. Development of improved diagnostic skills, surgical skills, and client relations will precipitously increase over the next year but continue for their entire career.

Practice owners hiring experienced veterinarians should already have knowledge of that individual’s skill set. An expectation of improvement and expansion of skills is doctor dependent.

Training

Without an adequate outline of the hospital’s responsibility in training new hires, a practice owner/manager cannot rightly impose probation period guidelines on an employee. Expectation of performance without training is fruitless and frustrating for both parties.

Reviews

Reviews are essential for new hires to have the knowledge to change behaviors and improve skills. An initial review should occur within the first 30 days of the employment period as this gives the employer the opportunity to address shortcomings before the employee becomes habituated to bad habits, complacency, and inadequacy.  Repeat reviews within three months of employment are then used to mark improvement. Of course, excellent performances also require rewards in the form of increased pay, PTO, and/or expanded duties.

A probationary period is the safety net that prevents a new employee from slipping under the radar. Written expectations of performance allow both parties to objectively evaluate the employees performance. If an employee is not measuring up, his/her termination is in the best interest of patient care and your business.

Should We Penalize Late Clients?

June 30, 2010 By: Dr. K Category: Opinion, Practice Management

Recent news out of Australia slammed physicians for instituting late fees for patients who show up more than 10 minutes late to their appointments. Many argue these physicians are implementing a double standard given how far doctors log behind during their appointments. Perhaps this is a double standard but I guarantee one argument you’ll hear from these physicians is the patient’s tardiness contributes to the physician’s tardiness.

I have toyed with the idea of implementing late fees for chronically tardy clients (and we all have them, usually know them by name, and plan accordingly). My practice runs on a busy 15-minute appointment schedule. A client’s 10-minute tardiness can throw off the entire block of appointments. I know a late fee would go over like a lead balloon and so it remains an idea droning in my temples every time a client shows up late on a busy night. It’s my fantasy revenge.

The facts against a late fee remain: Most clients are on-time or early for their appointments. Legitimate excuses happen. You can’t teach common courtesy.

I have found some of the best ways of dealing with tardiness are as follows:

  • If owner’s are more than 10 minutes late, have front desk staff politely inform them they will need to wait because the veterinarian is seeing her next appointment. It’s unfair to clients who show up on time to have to wait even longer for their appointment.
  • Squash clients who decide to “sneak” that extra pet into their 15-minute appointment. If you simply cannot fit her in without making clients with appointments wait longer, do not do it. If you do have time to look at Little Lucy’s skin condition, use the line “Fortunately I have time to see her tonight without an appointment, but just make sure to have one down the road for when we are booked solid so we make sure to address your needs.” Spin the situation toward looking out for the owner’s best interest and you’ll avoid an awkward moment. You know the saying “If you give a mouse a cookie….” Set the tone for future appointments.
  • Veterinarians must practice excellent time management given the frequently unpredictable and sometimes emergency laden appointment schedule. If a two-minute recheck and a sick exam arrive at the same time, see the recheck while the technicians triage the sick patient.
  • Apologize and offer a reschedule. Veterinarians run behind, mostly, due to surprise illnesses mentioned at annual examinations, emergencies, and sick patients who require admission. Once we are behind it’s very difficult to catch up and we find ourselves rushing through appointments. Sometimes it’s better to reschedule than make a client sit an hour in the waiting room with a labrador who has chewed through the leash, peed on the wall, and jumped on the counter during the wait.

Open Dialogue on Client Interaction Expectations

June 30, 2010 By: Dr. K Category: Practice Management

I’m a follower of the adage ‘do unto clients as…‘ and believe the best business practices start with that idea in mind. However, sometimes in business, the “Golden Rule” mentality doesn’t quite cut it. My wants and needs as a pet owner don’t match the wants and needs of all pet owners. When I read this article by Gladys Edmunds of USA Today, it begged for reposting! It highlights the importance of open communication and proper training with staff.

Happy Employees Cultivate Happy Clients

March 31, 2010 By: Dr. K Category: Practice Management

The focus on client/patient care should comprise the majority of focus for the staff at a veterinary hospital. The same is true for the practice owner, but with one caveat. If a practice owner desires the best care for her clients, she must provide the best care for her employees. In an effort to focus solely on client care, employee relations can get tossed by the wayside.

Many employees go through motions day to day without an understanding of why and how their tasks improve patient care. What type of message does it send to employees? If you repeatedly send the message of dispensibility, you cannot cultivate loyal employees. Loyal employees are the key to practice success. Attitudes toward their boss and work, for right or wrong, affect the very behavior the employees bring to the table. If a boss has not earned employees’ trust and respect (that’s right bosses, you’ve got the earn it),  they are more likely to under perform.

Practice owners struggling with income need not worry. Not every “perk” requires significant monetary investment. I am no subscriber to kumbaya-type community builders. I seek realistic solutions. Some simple (and not so simple) steps can cultivate a culture of practice loyalty and pride that will transfer down to where it matters most – the client.

Be Kind and Approachable

All staff members deserve respect no matter what level of education or proficiency. Kindness and interest in staff members personal lives speaks volumes. Get to know a little bit about them and do something to remind them you listened.  Acts of kindness are as simple as assessing personal comfort. I often ask technicians if the table height is appropriate for them during an exam because too many times I see the short staffer on her tiptoes restraining a struggling dog.

Never forget to compliment a job well done.

Pay ‘em what they’re worth

This is usually more pay than what many technicians and receptionists currently receive. One of the surefire ways to make staff feel under-appreciated is to pay less than the average salary for the geographic area. Performance review based pay raises help ensure incentive to maximal performance.

Training and Follow-Through

New employees, especially those less familiar with the ins and outs of a veterinary practice, are typically overwhelmed. Climbing through mountains of medical jargon, procedures, and policies make them cringe. Training is essential. Follow-up meetings are also essential. New employees need regular reviews of their progress and mile markers. This is their chance to talk about what they want to improve upon and also brings any gap in training to the forefront. The time and effort put into training and following up with new employees speaks volumes for commitment to employee happiness.

Continue the Education

Veterinarians are not the only ones who need CE. Licensed vet techs are required to complete CE, but many unlicensed technicians and assistants fly under the radar of licensing boards. This staff still requires continuing education for a practice to continue to provide optimal care. Fruitful staff, committed to learning and developing new skills, are invaluable assets to any practice. Fruitful employees who see how their jobs make a difference are more committed to their position and the practice. Many drug representatives offer lunch-and-learn sessions about new medications, common disease processes, and technology updates. Who wouldn’t enjoy a free lunch, some swag, and an education all in one hour? Make the time to educate the staff.

Additionally, the onus is on the veterinarians of the practice to teach technicians skills and medical knowledge. Take every opportunity to instruct. Better education equals better medicine. Period.

Regular Staff Meetings

Including all staff in regular meetings builds a sense of community and togetherness. Staff meetings allow the practice to work through logistical issues between front and back office staff along with clarifying performance expectations. The feeling of inclusiveness goes a long way in creating employee loyalty.

Lighten’ Up

Practices that are all business all of the time are oppressive. Fun, laughter, and a little bit of chatting can go far in keeping employees happy (of course, all things in moderation). An occasional potluck, party, or birthday cake brings the crew together and builds camaraderie and trust, and therefore, increased job contentment.

Above and Beyond

Exceptional practices provide bigger perks like:

  • Gym memberships or on-site exercise equipment
  • Periodic massage days
  • CE stipends for all technicians
  • 401k and profit sharing plans for all employees
  • Uniform allowance
  • Performance-based bonuses
  • Practice-wide community service days
  • More low-cost perks
  • Recession friendly perks

When Personal Life Interferes with Work

February 17, 2010 By: Dr. K Category: Practice Management

I like to think I can separate my personal life from my professional life, but let’s admit it, we’re all guilty of letting emotions roll over from home to work and vice versa. When personal life drama spills into work everyone is affected. From patient care to interpersonal relationships, the entire practice feels the impact.  Everyone has a personal struggle that affects work occasionally, but what do we do when that person’s problem becomes the practice’s problem?

Gossip Solutions: Veterinary hospital staff is predominantly made up of women. My various experiences with large groups of women leads me to believe that, no matter where you are or what the mix of personalities, conflict will arise. A wise businessman I know adopted a no gossip policy at work: first offense received a warning, second offense resulted in termination. The policy worked very well at stopping the behind-the-back sniping (at least in the office).  Additionally, veterinarians and higher-ups must lead by example. It’s pretty difficult to correct a toxic environment if those in control are polluting it.

Relationship/Family Drama Solutions: Break-ups and divorce have no place at work. A person can talk with coworkers, however, personal relationship problems should be kept under wraps. In addition, parents with small children should be prepared for a child’s illness. They should have open communication with the employer regarding missed work days. Employers can and should allow use of sick days, vacation time, and/or unpaid time off for parents to care for sick children. However, at-will employees who repeatedly fail to show up at work are at risk for termination. Businesses require reliable help to operate properly.

Illness: Employees dealing with extended illness require us to explore our options. Nobody asks for cancer. Most reasonable small business owners will bend over backwards to accommodate ill employees as they seek treatment. There can come a time when an employer considers termination. Terminating an employee simply due to a diagnosis of cancer or disability is unethical but may not be illegal depending on employment agreements. At-will contracts allow employers to dismiss employees for any reason, extended illness and inability to perform duties included. Many employer contracts allow for legal termination if the employee cannot work for a period longer than two months.

The biggest problems arise when the illness prevents the employee from performing his/her normal duties. These employees can be reassigned different tasks in most cases. A bigger issue comes when the use of medications, fatigue, or lack of mental clarity directly affect performance. Small mistakes are forgivable. Bigger mistakes affecting client and patient care directly affect the quality of care and economics of the practice. These situations warrant medical leave and need delicate handling. Employers, though simply looking out for the best interest of the practice, can appear calloused and uncaring if they don’t make it apparent this is a professional issue and not a personal one.

Termination is a final option. Unfair? Probably. Legal? Most likely. Necessary? Maybe. Difficult? Absolutely.