TRENDS IN YOUR INBOX: Greatness from the Ground Up: 2019 AAHA-Accredited Referral Practice of the Year
When Pet Specialists of Monterey (PSM) opened in 2011, the referral hospital was brand new. It wasn’t a buildout; it wasn’t an expansion. It was something that hadn’t existed before. But owner and founder Greg Marsolais, DVM, MS, DACVS, knew he wanted to open a referral hospital that adhered to the highest standards of veterinary excellence. So he built it from the ground up to be an AAHA-class referral hospital. “I trained at [AAHA-accredited] Animal Care Clinic in San Luis Obispo, and I saw the value of the AAHA protocols,” he said. “I just believe in them.”
Their strict adherence to those principles is one of the reasons PSM was named the 2019 AAHA-Accredited Referral Practice of the Year.
This isn’t Marsolais’s first referral rodeo. A successful mobile veterinary surgeon earlier in his career, Marsolais tried partnering with a nonaccredited referral hospital in San Francisco, but, as he said simply, “it didn’t work out.” When the time came to open his own referral hospital, he knew two things for sure: that he was going to build it in Monterey, where he wanted to live, and that he was going to build it based on AAHA principles.
“When you’re building a hospital, you have no infrastructure,” he said. He needed to start somewhere, so he started with AAHA protocols. “Even our chart of accounts, we used AAHA’s. We used the AAHA DEA protocols. We used all [their] books. AAHA made it easier on us.”
Because Marsolais modeled the hospital on AAHA standards, getting AAHA accredited was a relative breeze. “We were accredited within three or four months of opening,” he said.
It’s been a successful run. Marsolais says they’ve added a doctor or two every year and experienced an average annual growth of around 20%. The hospital currently employs a staff of 76, with a total of 13 doctors on staff, including 2 surgeons, 2 internists, a cardiologist, a couple of interns, and several emergency medicine veterinarians.
An orthopedic veterinary surgeon, Marsolais describes PSM as a “classic” referral hospital, with a 50-50 split between soft tissue orthopedic appointments and emergency services. He says his favorite surgery to perform is the repair of intervertebral disc rupture, and that there’s no greater professional satisfaction than seeing a dog who came in paralyzed because of a ruptured disc walk back out into the arms of his ecstatic owners. “It makes me really happy,” said Marsolais. “It’s a really cool feeling. Just . . . joy.”
Strong Leadership, Strong Culture
Cardiologist Michael Lesser, DVM, DACVIM, says Marsolais’s leadership is one of PSM’s greatest assets. “He establishes a culture of always doing what’s in the best interest of the patient, and that trickles down to everybody else in the hospital.”
Lesser came to PSM after a successful career in private practice. He and his wife, also a veterinarian, have owned multiple practices over the years, including a referral practice in Los Angeles. “We actually moved up to Monterey to retire,” he mused. But then he met Marsolais, who told him there were no cardiologists in the area. So Lesser began doing some work for him “here and there” to help. He ended up enjoying the people so much that he agreed to come in a couple of days a week to run the cardiology department.
Although Marsolais and some of the other specialists often travel to perform procedures at other hospitals, Lesser does not. “Eighty percent of what I do is referral based,” he said. But he’s always on call, he added: “I probably get texts or questions two or three times a day, and I’ll go in two or three times a week when I’m not working to help with urgent cases that need a cardiologist.”
Retirement plans are on hold. “I’ve been pretty busy,” Lesser conceded with a laugh. “I don’t feel retired, that’s for sure.”
For Lesser, it’s about the culture as well as the PSM staff. “The technicians, the management, the front-desk staff, they’re all excellent to work with,” he said. “So we’ve got this really cohesive group of staff members that are willing to help each other out and help the doctors out.”
Lesser also enjoys a challenge, which is why he took on the job of establishing an interventional cardiology department at PSM, where he spends much of his time fixing congenital heart conditions and putting in pacemakers. He says the challenge wasn’t performing the procedures themselves but rather getting the department up and running. He’d previously established a large interventional cardiology program in Los Angeles, “but it was so big and so busy it ran itself.” This time, he was starting with a smaller operation that required his hands-on administration. “That was a challenge to me, a challenge I enjoy.”
Sara Davi has been at PSM for three years. She started out as a veterinary assistant; today, she’s the community relations manager. She does all of PSM’s media and advertising, and also manages the front office. She calls the culture at PMS special, and, having worked in a couple of other hospitals, she’s in a position to compare. She said a good culture doesn’t happen by accident: “You really have to treat your staff in a way that makes them wake up and want to come to work.”
For Davi, like Lesser, one of the main draws is the people of the practice: “We like each other,” she said. “We appreciate what we do, and we appreciate what our team leads are doing. It’s a great place to work.”
Davi says the staff has a voice in how the hospital is run, and that makes them feel respected. “If someone wants a new piece of equipment, everyone gets a say,” she said, as opposed to just being told what to do. That includes why they feel the equipment is necessary, and what company to buy it from. “It’s pretty cool to have that ability in a workplace, especially when it’s medicine,” Davi added.
She says that being an accredited practice since the beginning means they’ve always set a higher standard. “There are so many referring veterinary hospitals in this area that kind of lean on us. They know they can always send their patients here. They’re calling our doctors, asking for advice. I think as an AAHA practice, they look at us as setting the standard of how everyone should be running their practices.”
Davi says the fact that PSM staff will travel to other hospitals to perform surgeries is very popular with referring practices, and it’s not unlike making house calls to other hospitals. “We use their operating room; we bring our own equipment. And instead of having them come in and have a consult here, we can have it there.”
She says a lot of pet owners feel comfortable with that arrangement because they’ve already established a relationship with that primary care veterinarian and that hospital. It has the additional benefit of helping PSM establish a relationship with that same primary care veterinarian. When it comes time to actually send a patient over to PSM, the referring veterinarians “know we’re on their side, they know we’re there for them.”
Marsolais and another PSM veterinarian go mobile three days a week. They primarily do nonemergency orthopedic procedures such as tibial-plateau-leveling osteotomies (TPLOs), procedures that can be maintained by the primary veterinarians in their hospital once the specialists perform the operation. “If a dog is hit by a car, obviously we wouldn’t want to go mobile, but if it’s something that can be scheduled later in the week or a week from now, that’s often a popular option,” Davi said.
Support from the Community
Aaron Cohen, DVM, owner of AAHA-accredited Peninsula Animal Hospital in Pacific Grove, California, is a big fan of PSM’s mobile surgery option. He’s been referring patients to them for years, and for TPLOs in particular. “For a regular practitioner, [TPLOs are] pretty daunting,” Cohen said, “[but] Dr. Marsolais probably does five or six a week. I would cause some real problems if I did that surgery,” he said, laughing.
Cohen said that when a surgeon from a referral hospital comes to his hospital to perform surgery on one of his clients, “it’s a win-win for both hospitals. I get to have the client come here and I get revenue from that, and I have access to a surgeon who can do things I can’t.”
But it’s more than just the mobile surgery option for Cohen. “These guys have helped me in so many ways. When I have a question, I bounce it off them. They’re just a nice group to deal with.”
Pet owner Dale Meyer agrees. She recently brought her seven-year-old Maltese, Dakota, to PSM. Dakota’s conditions were complicated and interconnected, and required attention from specialists in surgery, internal medicine, and cardiology. “I couldn’t have been more impressed with the level of expertise, and the comprehensive care and compassion that Dakota and I received from the veterinarians at Pet Specialists,” she said.
Meyer was impressed by the way the staff kept her primary veterinarian informed of Dakota’s treatment every step of the way. She expects to continue to take Dakota to PSM for continued cardiac care. “I couldn’t be happier with the outcome,” she said, “and with the care we received.”
Bill Sullenberger, DVM, is PSM’s emergency medical director. He helped Marsolais open the hospital back in 2011 and started as their first emergency veterinarian. Today, he’s in charge of a staff of six emergency veterinarians. “We’ve become a support for all of the referring veterinarians. We take everything from minor emergencies they can’t squeeze in during regular hours to major trauma, pets hit by cars, attacked by wild animals.”
He says that since PSM is located in a tourist area, they get a lot of people traveling with their pets, and that many of those tourists seek them out specifically because they’re an AAHA-accredited hospital. “When they’re staying in a hotel and they’re from outside the area, we definitely get people who are looking for not just a 24-hour hospital, but for the ones that say they’re accredited on their websites,” he pointed out.
Sullenberger says that being the only hospital in the area that does on-call back surgery, cardiology, and internal medicine is another big draw. “People will drive two and a half or three hours just because of the services we offer that other hospitals don’t.”
Sullenberger grew up with AAHA. His father used to manage AAHA-accredited Eagle Rock Emergency Pet Clinic in Los Angeles, and Sullenberger worked as a technician there before he went to veterinary school and then as a full-fledged veterinarian after he got his DVM.
“It’s one thing to practice veterinary medicine. It’s another to push yourself to always be doing everything as high quality as possible,” Sullenberger said. “So adopting AAHA protocols right up front was a way to get a good grasp on protocols and to keep pushing the hospital forward to make sure we have a clean, healthy, good environment for treating sick patients.”
Sullenberger says PSM hires employees with a view toward the culture. “We work really hard to make sure that all doctors and technicians work well together. We try to support the staff so they have enough time off and enough support staff around them so that no one suffers burnout. We try to keep it a real family-friendly environment.”
The effort pays off, not only in the sentiments expressed by staff but also in their career paths. “[Many of] our staff leave to go on to veterinary school. They typically don’t leave for other reasons,” Sullenberger said. “I’ve written letters of recommendation for eight different technicians, and seven of them are either in veterinary school or heading there.”
He says that, to him, the most interesting cases are the ones that involve significant trauma, such as a dog who’s been hit by a car and has a shattered pelvis or spine or some kind of major chest trauma. “We manage their pain and stabilize the rest of their trauma until we can get them to surgery. Those can be some of the most rewarding cases because you take a patient who comes in in excruciating pain, you can manage their pain, [and] keep them as comfortable as possible until the rest of their vitals stabilize so that the surgeon can go in and put the pieces back together.”
Like Lesser, Sullenberger met Marsolais through mutual friends. Sullenberger was doing emergency medicine during the day. Marsolais reached out, they clicked, and Sullenberger joined him working nights.
Happy is a word that comes up frequently when employees talk about working at PSM, which Marsolais describes as a “family-style organization.”
“We have this magic here,” he said. “We take care of our people, they take care of our clients, and all of us take care of their pets. It’s all enmeshed together.”
Tony McReynolds is AAHA’s content editor.
Photo credits: Photos courtesy of Pet Specialists of Monterey