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Articles, Videos, & Training on Pets & Veterinary Medicine

Andy Roark DVM MS

It’s Time To Normalize Choreographed Dance

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Sometimes we have to take a stand and tell the truth, regardless of the consequences. 

Yeah, I’ve got a lot to lose. Sure, I’m probably not the best messenger to speak on this topic. Also, I have zero data to support my position. Still, I don’t care. Here goes:

Dancing in clinical medicine is wildly under-utilized and the stigma around it should be obliterated.

Do vet schools tell future doctors about how an occasional display of The Running Man in the treatment room can set a fantastic tone for the morning? No. Do tech schools even MENTION the dougie, the floss, or the body roll and how a 10 second application of these techniques can make everyone around you smile? Not once. Do you know how many times I’ve seen dance feedback given in professional development meetings? Zero times.

It’s time to change this. We should be dancing more AND we should be dancing together. Like a group handshake that only happens when a certain song comes on, we should be figuring out how to get this done.

I’m imaging learning resources, some sort of mentorship program, and possibly a certification. It’s going to take time to get where we need to go, but we can start today. We can be the change we want in the world. All you have to do is put yourself out there.

Do it. Make strong eye contact with the most likely supporter in the room and do the Macarena. Show them that your hips don’t lie. Back that azz up in a work-appropriate way. 

Don’t wait for permission. You don’t even have to wait for music. The revolution begins now!

The Battle For Privacy in Mental Health or Substance Use Disorders

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Dr. Beth Venit joins Dr. Andy Roark to discuss some of the laws and regulations surrounding licensed professionals facing mental health and substance use disorders. They explore how these regulations can often become barriers to seeking the necessary help. Dr. Beth Venit dives into the intricacies of the recently enacted model regulation known as Safe Haven. This innovative program is specifically crafted to assist licensees in seeking support while maintaining their ability to continue working.

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Federation of State Physician Health Programs, Inc. (FSPHP)

Model Regulations – Safe Haven Program (Download)

LinkedIn: Beth Venit VMD, MPH, DACVPM

Uncharted Veterinary Conference 2023

Dr. Andy Roark Charming the Angry Client Team Training Course

ABOUT OUR GUEST

Dr. Beth Venit VMD is a graduate from the University of Pennsylvania’s School of Veterinary Medicine, Class of 2007. Throughout the area of Washington, DC, she practiced small animal medicine, both ER and GP, as both a full-time associate and a relief veterinarian for the next 12 years. In that time, she earned her Masters of Public Health from the University of Iowa and became a Diplomate in the American College of Veterinary Preventive Medicine. She then worked at the US Department of State, first as a fellow with the American Association for the Advancement of Science, and then as a full-time project manager focused on training foreign partners on biorisk management and the prevention of bioterrorism. In 2022, she joined the American Association for Veterinary State Boards as their first Chief Veterinary Officer.

In her free time, she enjoys hiking in various parts of the world with her husband (past trips include hiking the Grand Canyon Rim to Rim, the Inca Trail to Machu Picchu, several 14ers in Colorado, and a successful summit of Kilimanjaro), and being lazy on the couch with her pittie mix, Eleanor Woofsevelt and maine coon/tiger mix, The Chairman Meow.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I’m your host, Dr. Andy Roark. Guys, I am here with my friend, Dr. Beth Venit. Beth is the Chief Veterinary Officer at the American Association of Veterinary State Boards. I’ve had her on the podcast before talking about what really happens if and when you have a complaint against your license and she walked me through that and she was wonderful.

She’s got a new program that she’s working on, it’s, called the the AAVSB Safe Haven Program. And she’s working on it with a, group of people in the organization, but it’s all about reporting when doctors or licensed technicians go into substance abuse programs or mental health and wellness programs and things like that.

And Beth and I get all up into what this means and how this works, and then we talk a lot about the Safe Haven Program, which is basically allowing doctors [00:01:00] and licensed technicians to remain anonymous as opposed to being automatically reported to the vet state board if they seek treatment, which is how it has been in a lot of states in the past.

There’s a lot of stuff that I wasn’t really aware of as far as the regulations that are out there. I left the conversation feeling pretty optimistic but also still feeling like we have a little ways to go.

This is an issue that I care a lot about. This is a really good resources from Beth. I hope you guys will like this. I hope you’ll enjoy it.

It will give you something to think about and at least you’ll be up to speed on things to know. If you need to help someone who is in our profession and has a mental health or a substance abuse issue that is going to need some significant treatment. What does that really mean? And how do you protect yourself? And, what do you need to be aware of? That’s mostly it. So anyway, that’s it for me. Let’s get into this episode.

Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark: Welcome to the podcast, Dr. Beth Venit, how are you?

Dr. Beth Venit: I’m good. How are you Andy?

Dr. Andy Roark: I am great. It’s wonderful to have you back on the program. For those who do not know you, you are a veterinarian. You are the chief veterinary officer at the American Association of Veterinary State Boards. You have a master’s in public health.

You went to vet school at Penn. You are a lovely and wonderful person who I have gotten to know in just the last year and I really enjoy you. You came on and talked to me about what the process was if you have to deal with a state board complaint and you’re a doctor and I just so enjoyed it.

You have a passion project that you’ve been working on recently that I wanted to bring you on. It’s something that you’ve been working on and really taking the lead on at AAVSB. And it’s called the Safe Haven Program. Why don’t you just lay out at a high level, kind of, what is that?

Dr. Beth Venit: So the safe haven program is actually, it’s a model regulation that we wrote. So we write at AAVSB we create programs to help licensees [00:03:00] maintain their license, but we also work with our regulatory member boards to create resources to help them consider new ways of doing things better. And this safe haven program is meant to let licensees, both veterinarians and veterinary technicians, who are suffering from a substance use disorder or mental health illness to, it’s geared to reduce the stigma of getting treatment sooner. Because, the idea of if you can get treated sooner then, overall, you’re more successful to become healthy, a healthier individual.

But really it’s just to support the licensee and to help the regulatory boards help the licensee through that process.

Dr. Andy Roark: I want you to talk for a little bit more about what you mean about reduce the stigma of getting treated sooner. Can you lay out the landmines or the difficulties from a licensing perspective for people who are dealing with substance abuse issues or mental health?

Dr. Beth Venit: First of all, there’s a [00:04:00] social stigma, you think it, nope, it’s hard to admit that you have a problem and then, as people have noted, it’s hard to go into treatment. There’s a social stigma of getting, going into treatment, which I think in, we’re, as a society, we’re moving away from that stigma.

We’re embracing mental health a little bit more. We’re embracing substance use disorders more. So I think that’s hopefully decreasing specific to licensees, veterinarians and veterinary technicians and also doctors, nurses. So this, problem isn’t isolated to veterinarians.

It’s for a lot of the health physicians or health professionals. When you go into, for a lot of jurisdictions, and I have to say everything I say… it all depends on the jurisdiction. So if you have questions about your jurisdiction ask, research because every jurisdiction is different in a lot of jurisdictions if you’re a health provider of any sort and you go into… you either self refer so if you [00:05:00] self refer into a physicians health program, which I’ll talk about in a little bit in a second.

So if you go into treatment for a substance use disorder or a mental illness treatment program, the board must be notified of your activity. The that can cause stress or concern on the part of the licensee that if their activity or they’re going into treatment program is reported to the board that the board will suspend their license.

So the Safe Haven idea is that if you go into a treatment program, even if there is a requirement for reporting that reporting requirement could be fulfilled if you are just reported to the Physician’s Health Program instead of to the board. So, the board will receive a notification that one of their licensees is in a program, but it is anonymized.

Dr. Andy Roark: Okay.

Dr. Beth Venit: If, and that’s the big caveat is, if the licensee continues their path towards [00:06:00] recovery. So if they relapse or, don’t abide by the treatment or monitoring requirements, then the board will be notified that there is a concern.

Dr. Andy Roark: Gotcha. Okay.

Dr. Beth Venit: And we can kind of dig into this more if you want, because it’s really complicated.

Dr. Andy Roark: I want to start, with a good understanding of the basics. So you’re saying that if there was a veterinary or a licensed technician out there who needed to be who needed to be checked in for a rehabilitation program, that they’re obligated to let the state board know, “Hey, I’m seeking treatment for substance abuse issues” Is that an obligation on them? And, the idea has been if they don’t self report that I’m seeking treatment, that’s been problematic in the past.

Dr. Beth Venit: So there’s two different ways that a licensee can enter into these treatment programs. The first one is through a disciplinary process, in which case the board knows,

Dr. Andy Roark: Sure. Of course. I get that. Yeah, I get that.

Dr. Beth Venit: The second way is the self referral. The licensee will refer themselves to the treatment programs. It is on the part of the [00:07:00] treatment programs to report the licensee’s activity to the board. It’s not the licensee who reports it. It would be the treatment program.

Dr. Andy Roark: And, they were generally required to let the board know that, “Hey, this person who’s a veterinarian has checked into our program.”

Dr. Beth Venit: By law.

Dr. Andy Roark: Wow!

Dr. Beth Venit: In a lot of jurisdictions. So some, but not all.

Dr. Andy Roark: Yep. Okay.

Dr. Beth Venit: And this, pertains to physicians or pertains to nurses because that they are in a sensitive, what do they call it? Safety sensitive worker. So if, they are, suffering from substance use disorder or mental health issue that can become a public protection issue.

And in order to protect the public that activity will need to be reported.

Dr. Andy Roark: That’s gotta be a barrier to people seeking, if you, I mean, it, this, to add to the problems you’d be having that, would bring you to, starting a program for substance abuse or for mental health and wellness and to men like, oh, if I go here, they’re going to let the state [00:08:00] board know, ah, that’s awful.

I get it.

Dr. Beth Venit: So that’s exactly right. So the Safe Haven program that we developed and I’m going to say, I’m going to say we call it Safe Haven program. It’s developed from Ohio. So they kind of developed the Safe Haven program and that’s their model that I plagiarized. Directly but other jurisdictions, already have this kind of baked into the process.

So, many jurisdictions, they don’t report to the board, they consider the requirement for reporting obligated if they report directly to the Physician’s Health Program. Okay, so the board doesn’t know. What the board will receive is anonymized patient, XYZ and they’ll receive, a lot of boards will receive like a green, yellow, or red status of a licensee.

So they’ll say licensee one, two, three, four, five is in green status, and they’ll, and then that means that they’re doing well. That’s what the [00:09:00] board hears a lot in these instances where it is anonymized. In those instances, the board is only notified if the licensee violates the term of the agreements of the treatment program.

And that means, they fail a drug or alcohol test, they don’t show up for randomized testing, they have an active relapse. So those are instances where the licensee, is no longer on the path to recovery and will then, may potentially pose a risk to the public as a result of their disease.

The board only needs to know if there’s an actual public protection problem.

Dr. Andy Roark: That makes sense.

Dr. Beth Venit: So those are instances where the licensee, is no longer on the path to recovery and will then, may potentially pose a risk to the public as a result of their disease.

The board only needs to know if there’s an actual public protection problem.

Dr. Andy Roark: That makes sense.

What does the, doctor or [00:10:00] the technician need to know for their part? Does this all kind of run in the background at this point? Is it something that you need to be aware of? If someone was saying, I’ve been struggling with depression and, may need to be hospitalized.

Is this something that I need to be aware of? Or is this going to be taken care of without me even, having to, engage?

Dr. Beth Venit: This is the beauty of the physician’s health program. So in other jurisdictions, it’s called many different things: health professionals recovery program, health care professionals foundation, peer assistance program, professional assistance program sometimes these are run through the VMA, sometimes these are run through the board, so , it’s all called different things, but essentially they’re physician’s health programs.

So what these programs do, they have four tenets, and I can share them with you. They support the early detection, evaluation, and treatment of impairing conditions. So substance use disorder, mental illness. physician’s health programs oppose discrimination based on a history of an impairing condition.

They promote the [00:11:00] use of supportive services rather than disciplinary action. So they get the licensee help and only if they are not able to use that help, are they disciplined and only until that they are able to practice safely again. And then the PhD supports the maintenance of the confidential relationship between the PHP and the participants.

And that’s something that we were just talking about. what the PHP does is if a licensee self refers into this, they say, “You know what, I think I have a problem. I think I need help. I don’t know what that is.” The PHP, which is staffed by mental health physicians, substance use order experts, like these are the experts, to help people get the help they need. They will evaluate the licensee, determine how severe this disease is. Determine, oh, you might need to be hospitalized. You can, you, maybe you just need outpatient. Maybe we can just get you into a 12 step program. They kind of are a concierge.

To help [00:12:00] the licensee get the help they need. So do they need a psychiatrist? Do they need medication? Do they need actual hospitalization? So they help. Kind of, get them where they need to go, and they answer questions like this. If you’re a licensee and you say, and you’re thinking to yourself, “gosh, I think I may have a problem, but I’m not sure.”

You can call them and say, “What is the process? Do you report? Is it mandatory reporting to my board? What will happen to me if you report?” So they’re, there to actually answer all these questions for you and help you guide you through the process.

And it’s, they’re great. I mean, they’re so passionate.

The other place that I would refer people to look is the F. S. P. H. P., which is the Federation State Physicians Health Program. And they’re kind of like the national non profit that kind of helps people get to their health in each jurisdiction. So they can also answer questions.

Dr. Andy Roark: Hey guys, you know, probably the number one plea for help that I get from [00:13:00] medical directors, from practice managers, from practice owners, from lead technicians, and especially lead CSRs is, “Hey, Andy, help me, help my staff to deal with angry and complaining clients. They need ways to help these people because angry clients, complaining clients, they need help is what they need. And, our people aren’t empowered or they aren’t trained in how to do that.”

And so why isn’t there more training for this? Why aren’t there more resources that make teams good at dealing with angry and complaining clients?

Well, the number one reason really is, the way that feels natural for your team, the skills that they have that they would bring into the situation, they’re different in every practice. So there’s not a bullet pointed. This is how you do it way.

Which is why I end up in this place where people are like, “Andy How do I do this?”

Listen, I made a course it’s called ‘Charming the Angry Client’ and it is my course meant for teams or groups to work together [00:14:00] on all about dealing with angry and complaining clients.

I use what’s called the Davidow model of organizational response, which is a super peer reviewed, empirically tested way, of addressing angry and complaining clients.

And, I break it up into pieces so that it’s easy to digest. You can scatter it across a number of meetings, it is made to be watched with a couple people together. And then there’s discussion questions about how do we do this in our practice? What does this look like for us? What, when, think about a time that this happened and we saw it. How did we handle it?

Ooh, I also put a bunch of, example videos in there of me being an angry client. So I, I will just give it to ya. As here’s Andy with his pet, and he is upset, and then you can pause it, and then you can talk about right there, “What would we do with this? How would we handle this, guys?” And it is a great, low stakes way of getting your team to talk about what they would actually do.

Guys, there’s nothing more powerful than your team. Talking about what they would actually do and comparing notes, sitting and getting lectured at is nothing close to your team, whether it’s just your [00:15:00] CSRs, whether it’s four of your technicians working together, whether it’s a whole staff meeting and a manager or owner or medical director leading the meeting and being the facilitator guys, I put a whole facilitator guide in there too. There is a whole hour long broken up in a module section on how to run an active training program using this course.

And that’s all laid out there and how I do it, how I work with big groups, how it works, small groups, all that information is there. Anyway, it’s called Charming the Angry Client. It is on the Dr. Andy Roark website. I’ll put links directly to it in the show notes. Guys, I hope you will enjoy it.

I think it’s really valuable. It is, honestly the most popular course I have ever put online. Grab yourself a copy. I hope you’ll get a lot out of it.

Let’s get back to this episode. Is there any sort of long term tracking if you go into these programs? I mean, is it something where if you do everything that you were supposed to do when you say, you know I’m in a bad [00:16:00] place or, these things have happened or this is where I am in my life .,And I’m doing the responsible thing.

I’m going to go get help. I’m self reporting, in an anonymous way hopefully. Do I need to be concerned about long term, you know, repercussions. Am I going to be on a watch list somewhere for the rest of my career? Anything like that?

Dr. Beth Venit: Not always, but typically an individual is in these programs for about five years. The treatment and monitoring program typically lasts for five years. Some actually, some licensees actually choose to extend that. So they say, “I’m thriving in this. I feel like I needed a little bit more time of your help before I can graduate.”

It’s about five years. And then after that, it’s up to the licensee is my understanding. And that’s the average, but everybody’s different, right? I will tell you some great news about these PHP programs. So the, the bad news is that physicians and healthcare providers are at higher risk of [00:17:00] a substance use disorder than the general public, so that’s bad news.

The good news though is that… there was a study done for these PHP programs and the after at a five year follow up the response rate of health care providers in these programs was way better than the general public. So, I believe this statistic is general public. Usually their success rate is like 50 percent. For these PHP programs they had a success rate of 78 percent or higher.

Dr. Andy Roark: Wow.

Dr. Beth Venit: There is a study that said at a five year follow up 78 percent were still working, and still maintain their license. And ,only 11 percent had their license revoked after this experience. So dramatically higher success rate. And it’s because of this support that people get, in these programs.

Dr. Andy Roark: When does the Safe Haven program get started? Is it in effect now?

Dr. Beth Venit: So in Ohio, it’s in effect now. They, I think they passed it this year. Again, this is done at the regulatory [00:18:00] level.

Dr. Andy Roark: Mm hmm.

Dr. Beth Venit: The requirement for reporting if you’re in a program or not is set at the law level. So it’s in statute and that’s set by the legislature. Okay. So the, state Congress, they pass a bill and they say, “Oh, this needs to be reported.”

The boards are the ones that write the regulation and they pass regulations. So the boards, the veterinary state board and medical board or whatever, they’re the ones that determine how to meet this requirement state set by the state congress. Like I said, Ohio is a Safe Haven program, but many other different jurisdictions have similar anonymous carve outs in their reporting but it, really just does, it depends on the state.

Some fulfill the requirement by just reporting to one person on the board and that, person doesn’t tell any, everybody else, it’s, very, different. Some states, I will say, still require reporting directly to the board. [00:19:00] That’s why I say, if you think you have a problem or if you think that your friend or your relative or loved one may have a substance use disorder, illness ask questions, so talk to the board, talk to the VMA call the FSPHP to find out information just on how it’s handled within your jurisdiction.

Dr. Andy Roark: So if you don’t know the way that your state operates and you’re interested, you would say the best way is to reach out directly to the state board and just say, “Hey, I have questions about reporting for substance abuse programs or mental health programs or things like that.”

Dr. Beth Venit: Yep, you call them and you can even say, “I’m calling for a friend” like you don’t need give any information.

Dr. Andy Roark: Say, can you, do a fake voice and a mustache and…

Dr. Beth Venit: Yeah with a mustache on the phone that will help. But yeah, you call them and so a lot of these a lot of this information is also online. So if you go to there, I think North Carolina is an example they have it on their website.

So if you scroll down on their website, they’ll have their monitoring program on there. [00:20:00] So a lot of times you can get the information that way, and there may be FAQs. Call the board, call the VMA. So some of these programs are actually run through the VMA, so they may be able to give you information, the state VMA.

And then also the Federation for State Physicians Health Programs can give you information as well.

Dr. Andy Roark: If your state doesn’t have something that allows for anonymous reporting or things like that and you were in that state and you wanted to try to affect change, how would you go about doing that, Beth? who would you reach out to or what steps could you take to say,” Hey, as a person affected by this program, I would like to vote for a change.

How would you start that, that kind of push?

Dr. Beth Venit: Yeah, so you don’t even have to admit that you have a problem or a disease like that. You could just say,” Hey, how do we make this different?” That could be just a phone call to the executive director of the state board. You can say, as part of that conversation, “Hey, is there anonymous reporting?”

And if they say no, you can say, [00:21:00] “What are the steps to take to get there? Or is there a way that we can have this regulation reconsidered.” You can talk to your VMA about how to get regulations reconsidered. Some boards have a lot of ownership over the regulations and some of them don’t.

So again, it all depends on the jurisdiction, how they can enact change within their regulation. So again, you can talk to them, you could talk to the VMA and ask,” What steps are required for this?”

Dr. Andy Roark: Beth, there’s a lot of things that you could do with your time and there’s a lot of things for you to work on.

What motivates you to pick this up?

Dr. Beth Venit: I, don’t know of any veterinarian that hasn’t been touched with substance use disorder in some way or any person, frankly. I mean, this is a really big problem in the U. S. One, statistic I looked at was one out of seven people have a substance use disorder. So everybody we know has one, everyone we know knows someone who has something like this.

[00:22:00] On a personal level though, the, actually the weekend that I wrote this with, help with our committees and our board of directors. My husband and I actually lost a close family member to substance use disorder and he was only 30, this is not something that Anyone is safe from it’s it affects everybody and I think as veterinarians as we said everybody veterinarians are at higher risk of this than the general public and so I, you know, it’s just something that I’m It’s really important,

Dr. Andy Roark: I thank you for doing this. It’s, something that, that we’ve talked about before in the past about reporting and things like that. And so I’m just, I love, that you’re working on this. I love this is something that the the AAVSB is, looking at.

We talked about the FSPHP, we talked about sort of state boards. Are there any other resources or things that you think would be valuable for people to hear about or know that are out there?

Dr. Beth Venit: Those are, gosh, those are the big [00:23:00] ones. Talk to them.

Dr. Andy Roark: Where can people find you online if they want to, if they have questions or if they want to learn more about you, keep up with your exploits?

Dr. Beth Venit: I’m on this little known website called LinkedIn. I don’t know if you’ve heard of it.

Dr. Andy Roark: I’ve been there before.

Dr. Beth Venit: You’ve been there before. But we, also have, if anybody does want to read our the safe haven model regulations, it’s actually on our website. So if you go toAAVSB.org and you, can go to, it’s under, I think the practice act model tab and scroll down there and all of our model regulations are there.

The Safe Haven program is on that.

Dr. Andy Roark: I will go and see if I can get a direct link so people can take a look or just write out their show notes.

Dr. Beth Venit: Yeah, that’d be great.

Dr. Andy Roark: Well, cool. Beth, thanks so much for being here. I always appreciate you and your time. Guys, thanks for tuning in and listening. Take care of yourself, everybody.

Dr. Beth Venit: Yeah. Thanks.

Dr. Andy Roark: And that’s what we got. Guys, I hope you enjoyed it. Thanks so much to Beth Venit for being here. She is amazing. Yeah, thanks a lot for being here. Like I said, this is [00:24:00] an interesting issue for me. It’s one that I have thought about a number of times. It’s a hard position of balancing public safety and then also not throwing up barriers and not discriminating against people who have had challenges, who have had struggles, who have done what they can to, get back on their feet and to get, things sorted out for themselves.

And so anyway, this is challenging, but I appreciate Beth talking through with me where we are in setting an optimistic vision for where we might go in the future. So I would like to help paddle in that direction.

Take care of yourselves. Okay? Be well. Bye.

Where New Ideas Come From

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When I was first invited by DVM Newsmagazine (Now DVM360) to write a column for their magazine, I stalled for time. “Let me think about it,” I said. 

I was honestly pretty unsure about my ability to write 12 columns in a year that would actually make sense, provide some value to at least a few of the readers, and not make me look like an arrogant ass as a first year veterinarian providing advice to people who had a ton more experience and knowledge than I did.

A week later, I responded to the opportunity. “I’m really busy,” I lied. “How about I write a column every other month for a year and we’ll see how it goes?”

My plan was to write six things and then resign under the cover of claiming my schedule was simply too hectic. No one would know I was totally out of ideas and had nothing left to say.

Well, that was 14 years ago and well before I began writing something weekly in addition to keeping a column at Today’s Veterinary Business going. Now, one of the questions I get asked most often is “how do you keep finding things to talk about?”

One answer is that I often smoosh things together. I take two ideas, one that is relevant to what I’m trying to do and another that is not, and try to squish them together in my mind until they are something useful. Last week, I smooshed together training veterinary teams with the Barbie movie and the Duolingo app. Earlier this year, I squished together a failed hunt for a moose with finding happiness in practice. I honestly think that one of the best ways to make something new is by combining two things that are both interesting.

So why am I talking about all of this? The same technique that I use to try to make things worth reading works beautifully to innovate almost everywhere else. Want to make your front desk experience flow better? Think about how you could squish your front desk together with a customer service experience you had at Disney World. Want to get the attention of new clients? Take what is great about your practice and smash it together with what you see the positive brands on Instagram doing.

There’s no set system for how to innovate. If there was, it wouldn’t be innovation. Just remember that you don’t have to be given permission to try new things, and you can always pilot things in your practice and then go back to the old way if they don’t work.

So what are you going to smoosh together? What makes you happy outside the practice that you could combine with an aspect of work inside the practice? Maybe roller skates in exam rooms aren’t a great idea… but what would a veterinary drive through look like?

Happy innovating!

A Pentobarbital Problem: Post-Euthanasia Risks are Real

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In this episode of the Cone of Shame Veterinary Podcast, host Dr. Andy Roark discusses the post-euthanasia risks associated with pentobarbital injection. Dr. Warren Hess, the first author on a notable paper in JAVMA on the subject offers valuable insight as their conversation dives into the environmental and legal implications veterinarians may face after performing euthanasia using pentobarbital. Dr. Hess emphasizes the importance of understanding the drug’s impact beyond the act of euthanasia, addressing issues such as liability, rendering, and potential impacts on food and feed. The conversation explores the need for better education among veterinarians and clients, and the importance of documentation to protect practitioners. Dr. Hess also mentions ongoing efforts by the AVMA to provide resources and education on this critical topic for veterinary professionals.

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Article Referenced: https://avmajournals.avma.org/view/journals/javma/261/11/javma.23.03.0161.xml

AVMA Axon: https://axon.avma.org/

2024 Uncharted Veterinary Conference: https://unchartedvet.com/uncharted-veterinary-conference-2024/

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: https://drandyroark.com/store/

ABOUT OUR GUEST

Dr. Hess is an associate director in the American Veterinary Medical Association’s (AVMA) Division of Animal and Public Health and as AVMA’s Disaster Coordinator.  He provides technical and scientific expertise to the Committee on Environmental Issues (CEI) , the Aquatic Veterinary Medicine Committee (AqVMC), the Council on Veterinary Service (CoVS), and the Committee on Disaster and Emergency Issues (CDEI).

Dr. Hess graduated from Colorado State University in 1989.  He worked in small animal practice with an emphasis on birds and other exotic animals until 2004 when he began working for the Utah Department of Agriculture and Food (UDAF) where he served as a field veterinarian, assistant state veterinarian and 18 months as acting state veterinarian.  He began working at the AVMA in 2016. 

Dr. Hess became involved early in his career with organized veterinary medicine and was elected president of the Utah Veterinary Medical Association (UVMA) in 2000.  Dr. Hess has led several state and national organizations including serving as president of the National Alliance of Animal and Agricultural Emergency Programs (NASAAEP).  Dr. Hess was voted Veterinarian of the Year in 2014 by the UVMA.  He was the recipient of the NASAAEP Service Award in 2017 and the American Veterinary Medical Foundation (AVMF) Paws Up Award in 2018.  He is married to his high school sweetheart (Lori), and together they have 5 children and 14 grandchildren.

Dr. Hess has enjoyed the companionship of horses, dogs, various birds, and marine fish.  He enjoys fishing, rowing/kayaking, and motorcycles and has completed a motorcycle trip from his home state of Utah to Alaska and back with his 87-year-old father in tow.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here today with Dr. Warren Hess. He’s the first author on an interesting paper that I saw in JAVMA. It was about pentobarbital and what happens after the injection. And I’ll, be honest, it was something I was not really aware of. I genuinely don’t really think about what happens after we perform euthanasia. And it turns out there’s a number of things we need to at least have some eyes on. There’s some liability for veterinarians. There are there are some environmental impacts.

There are impacts around rendering and feed and food. And it’s just, it was something I had not really considered in a long time. And so it was a really good refresh. So anyway, this is a short conversation where we get right into it and just talk about what do veterinarians need to know?

What do they need to remember? What should we be talking to pet owners and animal owners about before we do euthanasias using pentobarbital? So anyway, that’s what it is. Let’s get into this episode.

Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark

Dr. Andy Roark: Welcome to the podcast, Dr. Warren Hess. How are you?

Dr. Warren Hess: I’m great, Andy. Thanks for having me.

Dr. Andy Roark: I am very excited that you are here. For those who don’t know you, you are a veterinarian. You are also the American Veterinary Medical Association’s Disaster Coordinator, which I think is the best title you could possibly have. You are also an associate director in the AVMA’s Division of Animal and Public Health.

And I just became aware of some of your work quite recently. I was actually reading through the JAVMA issue that came out earlier this year. And you were the first author on a paper called Survey of Veterinarians Who Use Pentobarbital for Euthanasia Suggests Knowledge Gaps Regarding Animal Disposal.

It was actually an interesting survey that you did about what veterinarians know and don’t know, about what happens with animal disposal after we use pentobarbital. And it was funny because I looked at this and I thought I would check every “no, I am unaware box” on the whole survey. And so I actually found this survey quite interesting.

One, in what veterinarians know and don’t know, but also in the like, why would we do this survey? What are we supposed to know? What is important to know about animal disposal when we use pentobarbital and drugs like that? So let me just start at a really high level and just say, when I looked at this article at first, I was like, I had no idea that there was anything I need to be concerned about in this regard.

Why should we be aware? What should we know?

Dr. Warren Hess: Andy, you’re similar to most of us, I think, especially if we come from a small animal background, which, I do. We go through vet school, we’re taught pentobarbital is one of the choice agents for euthanasia and we’re taught how to use it but we’re not really taught much more than that.

And what we’re learning about pentobarbital is, it doesn’t break down very well after it’s injected into the body for, euthanasia purposes. And that can create quite a bit of a problem, the scope of the problem is multifactorial.

Dr. Andy Roark: Okay.

Dr. Warren Hess: It ranges from issues with traces of pentobarbital ending up food and feed through a variety of processes. It impacts renders and it also impacts scavenger animals that might get access to a carcass or animal remains.

And it also impacts the environment, when pentobarbital leeches out of animal remains into the ground it can reach waterways. It can impact microbial life in, the surrounding area, and it can get into waterways and impact aquatic life as well.

Dr. Andy Roark: What motivated you to start to do this survey and look at this? Do you get the impression that it is an increasing problem? Is it something that has just been around and you feel like it’s lingering without getting any attention or unawareness? But what made you decide that this was the thing that you were gonna look into?

Dr. Warren Hess: Back in 2018, there were a couple of incidents where pentobarbital was detected in pet food.

And that started a discussion between AVMA and the FDA about why was that happening and what could we do to bring better awareness to, not just veterinarians, but other industry professionals out there as well.

Dr. Andy Roark: How does that happen? how do we end up with pentobarbital in pet food?

Dr. Warren Hess: The FDA would probably be the best one that answer that accurately but my understanding is that there were two different scenarios. One where there was enough pentobarbital in some meat products that were used for pet food that it actually impacted the animals that were consuming it.

Dr. Andy Roark: Okay.

Dr. Warren Hess: The other scenario was and I don’t even recall what organization it was, but after that event happened where animals where their health was impacted. An organization just grabbed some pet food off the shelf and ran had a lab run pentobarbital levels and detected it in those products even though it wasn’t causing clinical signs in animals. So that, brings up the issue that, probably rendering products were involved and the more sensitive our tests become, the easier it is to just pick up minute amounts of pentobarbital. And, any amount of pentobarbital in a food or feed product is what FDA considers an adulteration, and would be cause for a recall.

Dr. Andy Roark: Are there guidelines or precautions that veterinarians should be taking when they use pentobarbital that you think that veterinarians don’t know or they’re not aware of?

Dr. Warren Hess: The first thing I would say is that veterinarians should understand that their responsibility about the drug, pentobarbital, that they use doesn’t end when they inject it. Their responsibility continues for any impacts that occur from that animal after it leaves their clinic or after they leave the farm or anything like that. That would be the first thing to be aware of. There have been veterinarians that have been prosecuted for the impacts that pentobarbital had on protected species of animals that ended up having access to those animal remains and being impacted by it. 

Dr. Andy Roark: There were veterinarians that were prosecuted because, I’m guessing you’re saying are we talking about endangered species or protected species scavenged something? What does that look like?

Dr. Warren Hess: Yes. They euthanize a horse, for example, and leave it with the owner to take care of. And the owner doesn’t take care of it, just leaves it out in the field. And eagles or something like that come along and feed on it and either die or are severely impacted from the pentobarbital that they’re getting from the meat that they’re eating.

Dr. Andy Roark: I’m looking at my career and I’m going, “where did I mess this up?” And so the first thing I say, do I have concerns if I’m using cremation service, something like that?

So your standard small animal veterinary and, we’ve got pets, we’ve got, we’re going to, we do our injection, we send the pet off to be cremated. Is there anything that I should be thinking about that? Is, should I give that a second thought or is that an acceptable disposal that does, is not gonna have any problems?

Dr. Warren Hess: As far as we know, cremation is probably one of the best ways to dispose of animal remains that have been euthanized with pentobarbital. There really hasn’t been a lot of study. Along that line, but the temperatures that the cremation services reach to cremate animals should degrade the pentobarbital.

Dr. Andy Roark: Hey guys, is your clinic slowing down? Are you having more open appointments than you had in the past? Are you wondering a little bit about what you need to do to get clients to, one, come into the building, and then, two, listen to your doctors and your staff when they get there? Well, you, my friend, might need to head over to the Uncharted conference in April.

That’s right! It’s in Greenville, South Carolina. It is April 18th through the 20th. This is the granddaddy of the Uncharted Veterinary Conferences. This is the one that we started with. This is our marketing and strategy conference back to our roots. I love this stuff! The theme of this conference is ‘Standing Out In A Sea Of Noise’

It is all about strategic communication. It is about getting heard. This is going to be a lot about your brand identity is understanding the modern consumer who is getting more price conscious because things are getting more expensive. We are going to need to up our marketing game, our communication game, our client bonding game, our trust building game, we’re going to have to turn the volume over on that stuff.

Guys, we didn’t have to do that for the last couple of years. People have been coming in, the pandemic was a surge in business. A lot of us are trying to keep our head above water. It’s not going to be that way going forward. It’s time to re-engage with our clients in a motivating, educating way to get them coming back into the building.

Guys, Uncharted is not a bunch of lectures. You are not going to come here and sit in lectures. You are going to work on your business at this conference. You are going to be surrounded by butt-kicking, positive people who love vet medicine, who love pet owners, and who want to create a great experience and make a wonderful place for, pets to get the care that they need.

They want to have a positive workplace. They want to have a place where people smile when they come to work and they’re working on making that happen. And so if that sounds like you, or if you want to be surrounded by those people, you got to come to the April conference. Also, this is the last time for a while that the April Uncharted conference is going to be in Greenville, South Carolina.

This is our birthplace. It’s our home base. It’s our nest, this is kind of a big deal for me. At least I, you know, I, I have loved this conference in Greenville. I still love it in Greenville. I think Greenville will always be our home, but guys, we’re spreading our wings. We are going to be moving out and doing new things and going to new places.

And it is going to be amazing. But if you want the original Uncharted experience, if you are like, man, I’ve heard so many people talk about Uncharted in downtown Greenville and how the conference just fits into that community and how amazing it is, this is your chance. You want to be here. Also, if you have been an Uncharted member, if you’ve come to our conferences before, if you loved it, you always thought there’d be a chance to come back to the old Westin Poinsett and downtown Greenville you should grab a spot.

I think that there will probably be a chance in the future, but it won’t be for a while. I think there’s going to be a lot of people coming back because they want to do it one more time at the Westin before we move on and check out some new places and do some new stuff.

So I do expect this event will sell out. Guys, go ahead, head over to UnchartedVet.com and grab your registration spot right now. I’ll put a link down in the show notes. Again, you do not want to miss it. This is an investment in yourself and in your practice and your future. It is an investment in skills that you will have and use again and again, and it’s an investment in connections.

You are the average of the people you spend time with and you’re about to be surrounded and spend time with some really amazing people. Anyway, let’s get back into this episode. 

Do you think that veterinarians need to not allow pet owners to take the body of pets’ home? Or do you think that we should not allow, say farms to dispose of bodies without some sort of supervision or some sort of a waiver or, what does that look like? Are we going to not yield access back to pet owners after they have this drug in the body?

Or are we going to legally protect ourselves? What does that look like in your mind?

Dr. Warren Hess: AVMA hasn’t come out with a position on that. My personal opinion is that I hope we don’t get to the point where people are afraid to send animals home, or leave animals at a farm, but hopefully better education, better awareness by the veterinarians, better education to the clients, and maybe some forethought about how things are going to happen rather than an afterthought of, “now that we’ve euthanized this animal, what are we going to do?” Because you want, you hopefully want with forethought, you can plan ahead and, let people know what really needs to happen if the animal’s not going to go for, stay with the veterinarian under their control and that probably will solve a lot of problems. Certainly, the number one message that’s out there that not all veterinarians apparently are aware of is that pentobarbital should not be utilized in animals that are going to go for intended for food or feed products. So that means either directly to a to be processed for meat or to go to a renderer and have rendering products. It’s a big issue right now in the rendering industry and a lot of people that deal with cattle and horses know that there’s been a major shift in the rendering industry over the past five or six years. And it’s much more difficult to a lot of renders will not even pick up horses anymore.

So that’s really limiting the options for horse carcass disposal, and some renderers won’t even pick up cattle anymore off of farms. The only products that they will pick up are from slaughterhouses. They’ll pick up unused product from slaughterhouses. And that’s all they’ll do because it costs tens of thousands of dollars to do a cleanup in a rendering facility once pentobarbital has been detected. 

And most renderers are now, because of this issue, most of them are routinely scanning doing spot tests for pentobarbital residues in their products.

Dr. Andy Roark: Do you think there’s fallout for veterinarians if you’re called out to the farm and you’re going to put cattle down or something and they go, oh, no, we’re not rendering this and then they change their mind or you’re like, is there anything that we need to do to protect ourselves is this going to come back on me when I go and I do a euthanasia and I, this is not what I thought was going to happen and maybe the story that I get is not accurate or the intentions change after I leave, do I need to cover myself in this significant way

Dr. Warren Hess: I’m not a lawyer, right? But my, my suggestion would be to document. Document your discussion, what you talked about with the owner. Make sure it’s in the record and that way you’ve probably protected yourself as best you can.

Dr. Andy Roark: if, I have a just a, dog or a cat come in and they come in for a euthanasia appointment or I go and I do a house call and I’ve had plenty of clients who say, I have a spot in the yard where I’m going to bury, Capsy and that’s, it’s her spot. I, do you have concerns about that other than maybe to talk about?

I don’t know, proper burying techniques where we’re not going to have problems with scavengers, things like that. I don’t mean to be morbid, but, those are the ones that I have done. I’ve a hundred percent used pentobarbital to put pets to sleep and the owner said, you know what? I, want to, bury, I want to bury her out by the, by the tree.

Yeah. Do, does that, does my approach to that need to change? Do I need to be having a different conversation?

Dr. Warren Hess: I, think there needs to be, there should be a conversation now that stresses the importance of the drug that was used the ramifications on if, if that carcass is accessed and also just be paying attention to what the regulations are in their location obviously a lot of these regulations are local they fluctuate from city to city, so it’s really difficult for veterinarians to know what those regulations are going to be, but if there’s shallow water tables that, leaching of that pentobarbital can certainly impact It’s not going to be treated by water treatment plants, and it’s not and it can, if it’s not going to a water plant, but going directly to a stream or something like that, it can impact the aquatic life there.

Dr. Andy Roark: If there are veterinarians out there who are just sitting and processing this and they would say, I’d like to think a little bit more about this, what resources do the AVMA have? What, would you recommend for people who wanted to learn a little bit more and, maybe start to process but what exactly they’re going to say or how this might affect the way that they practice. Where would you send them?

Dr. Warren Hess: AVMA is in the process of developing some resources, Andy, I wish I wish I could point you to an exact spot right now, but what I would say is be looking for information on AVMA’s website concerning this in the coming six months. And also, our digital education platform, which is called Axon we’ll be developing a, a webinar for veterinarians and, further education about this, expanding on what we’ve discussed today, pointing them to local resources. If you have specific questions about handling pentobarbital in larger animals certainly check with your state veterinarian, they might be a great first point of contact to understand if there’s any developing legislation in the state around this or anything like that.

Dr. Andy Roark: Good. All right, that sounds good. Dr. Warren Hess, thanks so much for being here today. I really appreciate your time. Guys, thanks for tuning in. I will put a link to the original JAVMA article in the show notes. I’ll also link up to Axon the educational portal for AVMA and hopefully you guys will be aware when they release new information there.

Dr. Warren Hess: Thanks, Andy.

Dr. Andy Roark: Hey, thanks a lot. Thanks everybody. Talk to you later.

 And that’s it guys that’s what I got for you. Thanks for being here. Thanks to Dr. Warren Hess. I hope you guys learned something from this. I hope you got something to think about I’ve been thinking about a little bit since the interview and just going, you know How would I say this and when pet owners want to take their pets home to bury them at home? What’s my communication strategy going to be? So I’ve been rolling it around. It’s definitely been a good conversation for thought provoking purposes Anyway guys, thanks for being here. Take care of yourselves everybody. I’ll talk to you later.

The Vet Education Revolution

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I saw the Barbie Movie last week with my family. I am a Ryan Gosling fan (and generally a fan of silly movies) so I expected to enjoy it quite a bit and I did. 

The biggest laugh in our house came when the primary mother-daughter duo in the movie were deciding if they could embark on a fantastic journey or not. The daughter asked “Will dad be okay?” and we then saw her father, for the first time ever, 100% absorbed in his phone learning Spanish with the Duolingo app. We burst out laughing because our whole family is using the app currently to try to learn Spanish together, and the visual felt really familiar.

If you’re not up on Duolingo, you’re missing out. It’s a fantastic app that teaches languages, but the desire to learn a second language isn’t what has made me so excited about Duolingo. It’s the WAY it guides people to learn.

When I took Spanish in college, it was a ton of reading from the textbook and memorizing vocabulary lists. The learning was tedious and relied heavily on rote memorization. In Duolingo, learners are taught small packets of information and then put to work using it in a variety of ways. Learners do matching drills, listening drills, speaking drills and writing drills. 

Challenges are presented in fun and different ways over and over. New information is introduced steadily to raise the complexity to a level that will challenge each individual learner.

Never once when I took Spanish classes was I excited to actually try to communicate in the real world. Now I use every opportunity to talk to my dog in español and my wife helped someone at the DMV using Spanish yesterday! We’re still high fiving.

Look, I know this is ridiculous and you didn’t sign up for these newsletters to get sales pitches for Duolingo (They are not a sponsor of any of my work, but if they’re reading this, Me gusto Duolingo mucho!). So why am I talking about it? I’m talking about the app because this is how adult learning happens and veterinary medicine generally stinks at it.

Think about the way we do continuing education. We are still anchored firmly in lecture formats. Most of us physically go to an improvised classroom, generally in a hotel, and sit in the dark for 8 consecutive hours while an instructor talks at us. Who thinks that this is an effective way for people to learn new information that is to be applied to practice?

Don’t get me wrong here. Sometimes a lecture is the most efficient way to share information, but I don’t think any of us actually think your average learner is retaining a meaningful amount of information presented in the 5th hour of a 6-hour CE day. Most of us are brain-soup at that point.

Fortunately there are signs that education in veterinary medicine is changing. We have seen a steady increase in the use of case-based learning in veterinary schools for the last 2 decades or so, and one benefit of the creation of new veterinary colleges is that they seem to be attempting innovative ways of teaching and training. Just last month, Penn Vet was launching an “immense” transformation in the way they will be teaching and that the class of 2026 will be the first to experience “the school’s fully integrated competency-based veterinary education curriculum.” I absolutely love this revolution in how we teach and train, and am committed to pushing the transition towards active learning forward. 

When I started the Uncharted Veterinary Conference with my team in 2017, we called it “the conference that never ends” because of our emphasis on interconnecting live events with ongoing online learning and social interaction. We capped the number of attendees at 120 to make sure discussion and collaboration would be central to the conference experience and leaned heavily into running workshops over lectures. We focused on making and showcasing educational content that solved problems and pushed the learner to create plans for what she or he would actually do.

In 2019, we introduced our “Choose Your Own Adventure” format where attendees would create approximately 40% of the conference program after their arrival. This approach ensured that the sessions we put on were what our learners needed and wanted right then, at that moment. We began training facilitators alongside speakers and lecturers so that we could challenge our guests in a variety of ways. We started practicing the art of making discussions action-oriented and impactful with stated action items coming at the end of the session… and I think we’ve gotten pretty good at it.

This week at VMX, the Uncharted Leadership Essentials Certificate got a lot of spotlight and love. We have partnered with Vetfolio to deliver the best guidance we have found in 7 years of running Uncharted for people who are leading or managing others. The sessions were filmed with a live audience so that the energy is great, the laughs are real, and any obvious questions got answered along the way. I love this certificate because it lets me teach the things I think people need the most, and deliver it on their phone, whenever they want, in bite-sized pieces. We also did some serious work to add optional journaling exercises with self reflection questions, and group discussion questions to help individuals and teams implement what they are learning into their clinics.

Now, Uncharted is continuing to push the envelope in how we train and learn. You can expect to see more games (we call them “challenges”) and gamification in both our virtual and live programs. We will be running live events across the country this year, and we are introducing our “learning cohorts” so groups can work through content at their own pace with a mixture of on-demand and live virtual interactive sessions.

Never before have we been able to push people to grow and develop in so many different ways. Never before have we had so many opportunities to challenge people to actually use the skills they are learning as they go. As I think about where I want to go personally and where I want Uncharted to go in 2024, these opportunities are what inspire me the most.

If you’ve never done an Uncharted program, definitely take a look at our Leadership Essentials Certificate, consider coming to our April Conference, or think about becoming an Uncharted member.

Now, I’ve got to check in on Duolingo. I’ve got a top spot on the leaderboard, and I plan to keep it… by learning more stuff.

When Veterinary Consolidation Slows Down

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Dr. Andy Roark and guest Ryan Leech have an insightful discussion about corporate consolidation in the veterinary industry. They dive into the significant changes that have occurred since the end of 2023, and how this has shaped the business landscape. The conversation covers aspects like the impact of interest rates, the shift in executive teams in veterinary groups, and the emerging trends in the sector. They also highlight the importance of adaptability and originality in the face of these market changes. The episode is teeming with valuable insights for those interested in the business behind veterinary medicine.

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Article Referenced: https://todaysveterinarybusiness.com/veterinary-consolidation-112723/

Ryan Leech: https://www.linkedin.com/in/leechryan

The Bird Bath Podcast: https://www.linkedin.com/showcase/the-bird-bath-podcast/

Uncharted Leadership Essentials: https://www.vetfolio.com/learning-paths/uncharted-leadership-essentials-certificate

Uncharted Veterinary Conference 2023: https://unchartedvet.com/uvc-april-2024/

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course: https://drandyroark.com/on-demand-staff-training/

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: https://drandyroark.com/store/

ABOUT OUR GUEST

Ryan Leech is an experienced leader with a history of growing businesses through highly scalable sales models. With a background that spans multiple industries, Ryan led sales for startups that raised over $100MM in funding and ran his own sales consulting firm. In his role at Digitail, he is responsible for overseeing collaborations and integrations with industry leaders and innovators to drive digital transformation in veterinary medicine. In addition to his professional experience as Director of Business Development at Galaxy Vets and Hippo Manager Software, Ryan is also the host of “The Bird Bath” podcast.

EPISODE TRANSCRIPT

Dr. Andy Roark: ​Welcome everybody to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. I have Ryan Leech on today from the Birdbath and we are talking about bidness (business). We are talking about the vet bidness (business). I’m talking with Ryan about corporate consolidation and the story of corporate consolidation and how it has radically changed since the end of 2023. There’s a story here about how money used to flow in and practices got bought and that money’s not flowing in anymore. And so the world is changing to adapt to that. And we talk about kind of what that means and what that looks like on the ground.

As Ryan’s laying down what he’s seeing, I go, “Oh, you know, I see that too. That makes sense.” It’s really a neat way of tying a number of industry trends together and I got a lot out of it. So anyway if you’re interested in the meaning of it all in overall patterns of what’s happening across our industry in understanding the business behind the business, this is a really good episode.

So anyway, I hope you enjoy it. Let’s get into it. 

Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark. 

Dr. Andy Roark: Welcome to the podcast, Ryan Leech. Thanks for being here.

Ryan Leech: Thanks for having me, Andy. It’s exciting.

Dr. Andy Roark: It’s my, it’s my pleasure. I became aware of you from your podcast, The Birdbath. So you want to take a second and talk about The Birdbath at a high level and kind of what you set out to do there?

Ryan Leech: Yeah, definitely. So what I found was that there’s a mountain of information within the veterinary landscape and not everyone can be expected to read every single newsletter and listen to every single podcast and try and keep their finger on the pulse of what’s happening. And so I wanted to find a way to be able to bring all of the new sources together, to be able to partner with The Fountain Report and Intelligence, who has been a partner for me. And take all of the top stories in veterinary medicine and make it so that a  technician, a doctor driving into the clinic on their way to work within that 10 to 15 minutes every single Tuesday morning that they can get a good understanding of what’s happening in the industry that they work within.

Dr. Andy Roark: Talk about the Fountain Report for a second. So I get the Fountain Report and I’m a big fan of it, but I think probably a lot of people still don’t, aren’t familiar, don’t really know what it is.

Ryan Leech: Yeah, so the Fountain Report, it’s spectacular.

Dr. Andy Roark: It is spectacular. I agree.

Ryan Leech: They do a really great job, and the team over at Intelligence, which puts it together, they do a wonderful job of pulling together news stories from across a lot of the different sources, but then not just sort of regurgitating them to you. I think there’s a lot of newsletters that people subscribe to that just have a list of stories, or a list of links to click on.

But the fountain report has brought a different editorial and opinion related element to it that they take stories about what’s happening in our industry and bring together top industry leaders to be able to add commentary and color to those stories. So you’re not just reading about Chewy’s most recent quarterly summary and going, “Okay, they’re up 8 percent but the stock is down.”

Why do those two things connect? But you’ll actually see the understanding of, Okay, pharmaceutical sales are trending upwards, but macroeconomic climates are trending downwards, so projections for Q1 are what are driving the stock price. So, getting a little more of that context is, is the big thing there.

Dr. Andy Roark: Yeah I said, I think you’re spot on. I’ve always enjoyed that. I very much enjoy the business of vet medicine. And it’s a lot to keep up with. And so both the Fountain Report and the Birdbath have been excellent ways, that I like to just get little bite sized nuggets.

And then also I enjoy the podcast. I, I enjoy the fact that you take a lot of these nuggets, like earning reports, for example. And I find earning reports rather bland, quite honestly, but, but you do a good job of saying, and then also you see these earning reports that are in the same segment and we can start to see what this trend looks like across the industry.

And I go, “Oh, that’s really useful synthesis of information.” 

Ryan Leech: Appreciate it. Yeah, it’s, it’s, it’s fun and it’s kind of, hopefully people listen to it and then it gives me people that I can talk to about it more without them just looking at me with glazed over looks at cocktail parties. So, they don’t just think I’m a crazy guy.

Dr. Andy Roark: I enjoy that stuff, too. And there’s not a lot of people that talk that language, you know, out out and about. And it’s just like you said, it’s just a lot to keep up with. So I think I’m hoping that the Fountain Report Birdbath will both be. I hope that their their signposts that we’re going to be have deeper, sort of more educated conversations about the industry and the business and kind of where it’s going in the future.

And again, not not as a criticism of the past, but I just enjoy thinking like that. I wanted to bring you on today, because, you know, you, so, I’ve heard you on the podcast, and then I saw an article that you wrote in Today’s Veterinary Business not long ago, and you were sort of talking about, you were talking about corporate consolidation and sort of the overall trends of what is going on there.

And I, I always think that that’s really interesting, and It falls perfectly into the category of things that I struggle to keep up with because a lot of it is not public information, a lot of it is released as little snippets in a lot of different places in a lot of different ways, and it takes someone to actually go along, collect the information, roll it together, synthesize it, and sort of say, here’s the story of corporate consolidation in vet medicine, and so that’s really what I would hope to get from you today. Is I was hoping, Ryan, that you would tell me the story of corporate consolidation end of 2023 going into 2024 kind of how did we get here and where does it look like we’re going?

Ryan Leech: Definitely. Yeah. And it is, it’s definitely something that, I think inspire vet partners their IPO that they did this year. They’re a smaller group. They, the most recent one to do an IPO. And it’s been interesting [00:06:00] because now we’re starting to see a publicly traded company that’s having to release some of the books and the financials and, and all of that.

Unfortunately, their performance this year hasn’t been great. Their stock prices is pretty low. But, I think that it’s been neat to be able to see. How the market is reacting, the general public is reacting to veterinary consolidation, but what we’ve seen over the past 12 months and before that, as everyone knows, if you’re in the veterinary space, you saw an absolute boom of private equity flooding into the veterinary industry.

So we saw large private equity groups that were pumping tens of millions to billions of dollars into acquisitions of independently owned veterinary practices. And around mid 2022, late 2022, as the interest rates began to increase, the availability of capital started to shrink and the free flow of money that people were using to be able to buy these veterinary practices [00:07:00] started to dry up.

And so as that money began to dry up, the multiples, which to sort of bring it to a really ground level, the way that people that are buying veterinary practices previously, as well as they still do look at them now, is they look at a multiple on the EBITDA, so the earnings before interest, tax, depreciation, and amortization, just a business metric that any practice, you can find the majority of those things on your tax report, and then there’s some, as someone told me one day, it’s as much magic as it is math, to be able to determine a true EBITDA for a practice and they Yeah, well, there’s, yeah. Okay, what salary should we account for? What salary is going forward? What numbers here? It’s, it’s a, it’s a massaged number,

Dr. Andy Roark: Yeah, but I mean would you so basically we throw EBITDA around a lot. It’s basically earnings, right? I mean just if someone was just walking into the conversation and they didn’t want to be intimidated. 

Ryan Leech: It’s earnings. And the nice thing about it is the reason why people use an EBITDA and adjusted EBITDA is it allows you to take a metric that will allow you to look at a [00:08:00] practice in Boise, Idaho, and a practice in Miami, And be able to look at the two of them and understand where both of their EBITDAs are, and you’re not looking at top line revenue or profit or bottom line revenue or those sort of things because there’s so many other things within the mix that adjust where the business is, but for consolidation and for the acquisition of practices, people take that number, say it’s, you know, $100,000 or $200,000 and they apply the multiple onto it.

So as you hear everyone talk about multiples are up, multiples are down. It’s time about the multiples on the, on the EBITDA. And we saw them spiking into the upper teens and into the low twenties in some situations for ERs and urgent care practices. But general practices were in the upper teens for multiple years.

And that was driving by an influx of capital in the space. People were looking at buying practices, holding onto them for a little bit and then bundling them together, which is what’s arbitrage. So taking multiple things, putting them together. To reduce the overall [00:09:00] cost of them, but by putting them together, you increase the value of those multiple things.

So, 1 plus 1 equals 3 in arbitrage. And so, when you do that, you keep flipping these practices. So this is why you saw, you know, JAB would buy a group from Vet Strategy, which would buy a group from this other, and they would continue to pile on. Well, as the capital began to tighten up, People will start holding the bag.

The last at the end of the line was holding a group of practices that they owned in the 20 times EBITDA multiple, but entire groups of practices were trading for 15, you know, 13 to 15 times. So they didn’t have the availability to be able to resell these groups. And so they’re having to hold onto them and actually find ways to do, which all of us in the industry have hoped that they would do is, find ways to actually improve what they’re doing within the practice. Not just flipping them, but actually finding ways to increase the margin within the practices.

Dr. Andy Roark: So just to summarize what was happening? There’s a lot of free money hanging around. So people [00:10:00] were buying practices, rolling them together and then selling them as a higher amount because you’re like, look, there’s more of them. So I can sell them for more and then bundling up. But ultimately, that always has to end.

There’s not an infinite upward level of people who are willing to pay more and more for, you know, for groups of practices. And then as interest rates went up, money was harder to get. And some people who thought that they could buy some practices and then send them up the chain, the interest disappeared and then they were kind of holding the practices. You sound positive and optimistic about how that went. So convince me that\ the people overall who were sort of holding, holding the practices… that that’s turning out well, as opposed to, people who never had any intention of having practices being stuck with them. 

Ryan Leech: So I wouldn’t want to sound too positive on it. I’m optimistic, or hopeful perhaps is probably the right term. I at my core believe that consolidation of veterinary medicine at its core value can be a good for the industry. I think that we’re in a situation where there’s a lot of people that were [00:11:00] reluctant business owners that were independent practice owners who got into the situation where they own a practice.

Because that was the way that they were trained that they had to become a successful veterinarian. And a lot of them, when I had conversations with them when I was acquiring practices, they were like, I’m glad to be getting rid of this burden. I just want to be, I want to have made a good income, which I think a lot of them were underpaid to begin with.

And so the ownership of the practice was a way for them to be properly paid. And now they’re going, great, I can cash in on this business that I built and still continue practicing and working and doing the thing that I went to school for and, you know, cared about since I was a little kid, all the way to the point where I became a veterinarian.

So I think getting an accountant and a CFO and a head of corporate strategy to be the ones that are worried about. Okay, what’s our marketing spend, what’s our ROI, what’s our CAC, what are all of these business metrics that aren’t part of vet school? Those people [00:12:00] want to do that and let’s find a way to allow them to offload the work the veterinarians don’t want to do, but freeing up the veterinarians in the best way to be able to really follow their passion.

Now, if you have somebody that bought something with the intention purely to flip it. Uh, that’s a difficult spot to be in, but you’ll see this there. We’ve seen a shift in a lot of the executive teams at some of the groups, and we’ve seen people that are coming in now with more operator experience.

And they’re actually saying, okay, I need to look at unifying our data. So they’re looking at something like digital to, to find a unified PIMS so that they can find, Workflow optimizations. They’re looking at ways to be able to reduce labor costs. They’re looking at ways to improve and upscale the abilities of their technicians by utilizing AHA technician utilization guidelines, those sorts things versus saying, well, let’s charge more.

You know, let’s work people harder and charge more and just try to ride this wave out. So I think in its purest form, it can be a good thing. So I’m hopeful for that.

Dr. Andy Roark: [00:13:00] I like your optimism a lot. I think that’s the beautiful vision of the future that I’m I’m hoping for is that if you just want to practice then there are good, healthy places for you just to go and practice. And there are some systems in place and training is well taken care of and you’re well supported.

And if you want to do your own thing and you want to be an entrepreneur yourself and you want to run your own practice and have autonomy, that, that you have a viable way of doing that where you can be competitive in the marketplace and, Ryan, I, am optimistic.

Ryan Leech: Yeah, well, and I think also there’s this middle ground too, where people that. Want to learn the business side of things aren’t sure of what they need to know are looking at joint venture models are looking at franchise models. They’re looking at starting a small mobile practice with support. So I think as it’s become more competitive, it has opened up more avenues for people.

To be able to research and find ways where it’s not just, Okay, Dr. Roark is selling his clinic down the street. Well, I’m his associate vet and if I want to own a practice, I buy this one. It’s, let me [00:14:00] search what fits my passion.

Dr. Andy Roark: Yeah. Oh, yeah. Well, the number of vets that I know who I said to them, how did you become a practice owner? And they were like, “Well, the old one quit and somebody had to do it. And so here I am.” like that. It’s a lot of people that was, that was their model. To your point, that’s probably not the financially healthy, culturally sound way that we want to put our profession together, you know, in the long term. 

 I am so proud to unveil the biggest project I have ever worked on. This is a partnership with NAVC’s Vetfolio and Uncharted, which is the veterinary conference that I started and run for 15 years. I have worked with people on being effective as communicators and making their practice better places to be.

Now, I am so thrilled to be launching the Leadership Essentials Certificate with Uncharted and Vetfolio. Guys, these are the seven courses that I believe, really believe anyone who’s leading other people in vet medicine should have. This is vision and [00:15:00] value setting. This is basic strategic planning. It is understanding different communication styles, and I have my friend, Stephanie Goss, uh, helping teach that session is, uh, getting the team to buy in to new ideas and initiatives.

It is how to coach and give. feedback. It is how to set priorities. It is how to delegate effectively. It is how to do time management. It is the talks and the stories that I am probably most well known for giving. My red dot talk is in here. My GPA talk is in here. Everything about the north stars, everything that I Layout where I’m like, this is just so essential to managing people.

It’s, it’s the trust game. It is everything about building and maintaining trust with your team. I think that this is something that I would recommend for anyone who is a practice owner. Uh, it’s anyone who’s definitely who’s becoming a new practice owner. It is for anybody who has especially gotten promoted up into management.

It is huge for our team leads. We take people who are CSRs, we take [00:16:00] people who are technicians, and we make them lead techs or lead CSRs, and we give them zero leadership or management training. There’s no excuse for that anymore. This is, this is on demand whenever you want. It’s broken up. It’s eight hours.

It’s got race CE. It has the. Uncharted vet folio certificate with it is it is there is accessible I I really hope that people will take this and put it to work I I went really hard on this. It has been years in the making and refining to get this content down and right So it is it is really for is everybody who is leading and managing other people in vet medicine I hope you will check it out.

I’m so proud of it. I’m so glad to be partnering with nabc on it Anyway, guys, i’ll put links in the show note. I hope you’ll have a look. Let’s get back into this episode

I think, I do think it’s interesting that we’re starting to see these corporate consolidators change out and focus more on operations and actually running businesses. I think that does make me feel good. It does feel like a lot of [00:17:00] these groups that had bought up a lot of practice are getting stuff figured out, at least that’s kind of the impression that, that I getting, it really does seem to be that there’s… They’re all slightly different in what they’re doing, sort of how they’re doing it. But, I completely agree, there’s definitely more of a hands on feel now than there has been in the past as far as making practices work together and making this conglomeration make some actual sense for the people in the trenches. Where do you think this goes? Do you think that we’re going to continue to see a focus on sort of streamlining operations in what we have now?

Do you think this is going to start to crystallize? Do you think that we’re going to jump right back into an expansion phase where, as soon as interest rates drop, I mean, what is, as you look into your crystal ball, what does the next 12 to 24 months look like?

Ryan Leech: Well, so the funny thing I say about crystal balls, I was in Wyoming. No, I was in Montana. At some wild place that’s claims that they have a vortex black hole that you can walk into and feel all these different energies and they sell crystal balls there. And so that’s the best I can think about [00:18:00] for a crystal ball.

So I don’t much into my ability to tell the future. But what I do see is I see that there’s groups and there’s people that are taking steps to be able to come up with either ways to improve the groups that they’re with. Or, create new business models of what’s happening. So I think, if you’re working in a practice that was bought in the last two to three years by a group and they, at, at the point when they bought you, they said, we don’t change anything.

We don’t touch anything. Nothing’s going to happen. Prepare yourself for that conversation to shift.

Dr. Andy Roark: Yeah. I was wondering about that. That makes sense when the plan is to, you know, change owners and move these up. But at some point we’ve got to work together in some sort of organized structure to make this model any sense. 

Ryan Leech: Someone has to do work. So, don’t feel as if… I mean, you can feel a little slighted if that happens to you, but more so understand it’s probably wasn’t their plan. And it wasn’t your plan, but you’re both in this together and, you know, collaborate and work [00:19:00] together with the, the parent company so that you can find a way to be able to increase the overall value.

And you can also find a way to influence what’s going to happen. So you can say, “Hey, this isn’t how I feel we should be doing it” and really be collaborative with it versus just pushing back on those changes. I think that’s a good way to look at it. And then I think in 2024, 2025, what we’ll see going forward is there’s been an obvious boom in the de novo practices. So fresh built practices. We’ve seen groups like Pet Folk, Pet, Pet 365, Good Vet, Better Vet on the mobile side. A lot of these are, are starting to push on that side of things because when the multiples were extremely high, it was less expensive to build a practice than it was to buy a practice.

And then, the staffing shortage was, was difficult and it still is a very difficult thing. But I think. As some of these groups are starting to change what they had said they were going to do. So if you were bought by Corporation ABC and they said, we aren’t going to touch anything. Well, now they’re [00:20:00] starting to implement changes and they don’t align with your values.

You can go down the street and look at one of these de novo groups that is perhaps looking at a different work life balance or an urgent care strategy or something that fits with you. So I think they are having a good opportunity to recruit there. And then I think as well, we’re going to see a continued growth of mobile practices.

It’s something that I’ve seen a lot of new mobile groups popping up. I think that the age of the DVMs that are coming out of college right now, a lot of them were in vet school throughout Covid. They’re coming out there. You know, I’m not young anymore, unfortunately, but I still think of myself as somewhat young.

And so the DVMs and people are coming out we’re going, ” Hey, we, we want to have some flexibility. I like knowing that at four o’clock, if. I want to go see my girls play or want to take off the afternoon and spend time with my wife or do something like that that I have that flexibility. And I think that’s where we’re seeing some of the newer DVMs migrating towards a mobile practice because they can say, [00:21:00] all right, slide the van door shut and I’m done for the day, which is kind of a different take.

And I think those people are going to be. I think there’s going to be some real cream that rises to the top of people that buy into franchise model or joint venture models of mobile groups, and then become some of these business leaders that we see in the next 10, 15 years that are really saying, I built a portfolio of 10 mobile practices, and I’ve added telemedicine, and I’ve added brick and mortar and really found a way to grow that.

Dr. Andy Roark: I agree with that. I’ve thought a lot about the mobile practice for the last five to almost ten years ever since my friends Danny McVitie and Mary Gardner Started doing lap of love and I was like god the flexibility is great here And then also the willingness of pet owners to pay for at home service is is real and there is a demand for it.

People in that service, they don’t like loading the kids and their two pets into the car and go. They would much rather you come to them. And a lot people have the [00:22:00] resources to, compensate you for that. 

Ryan Leech: Yeah, and Lap of Love is a perfect example of that. I mean they have a massive call center. Not to downgrade the skill level of the people in it, but they have a major call center that takes on a lot of those things. And you know, you don’t need a front desk staff. You don’t need four or five people for every phone to ring to be into that practice.

So you can really offload a lot of that. And I think COVID showed us the ability of flexible work and the ability to hire people wherever they need to be.

Dr. Andy Roark: Yeah. And well, I think you put a your finger right on a really good example of the benefit of, you know, sort of a distributed model or a franchise model, and they’re not franchise, but like a franchise model where you say, “What would this franchise bring to the table?” It’s like a logistical support, you know, communication support, educational support.

There’s a lot of things that organization can offer to doctors and still give them a lot of, of independence and make them, I don’t know, give them a lot of ownership of what they’re doing and also still make it sense to have some sort of a corporate partner with them.

Ryan Leech: I would love to get a list and I don’t think the Banfield will ever give this to me, but if I could [00:23:00] get a list of their charter franchise owners back in, you know, from the early nineties, when they first started franchising, before they brought that back, I think you’d find a lot of those people have gone on to be extremely successful business people. Have built, you know, new groups, new models. And when you start to pull the thread on what people have learned through the franchise model, as they’ve gone into their own businesses, it is a, it’s a on the ground MBA that, that a business can help support you in.

Dr. Andy Roark: Well, I mean, just think about it. If you’re trying to grow your own career and you have sort of entrepreneurial interests and things like that. I mean, I can tell you, I spent a decade or two beating my head against the wall, figuring out the business model for the weird thing that I do. And, if I had come in 15 years ago, underneath a mentor, into an organization that had already figured a lot of things out that would have saved me a lot of time in getting my systems down, you know, I got no regrets, believe me when I say that. But also I go, “boy, I learned the hard way.” And if I had just rolled into a system that worked, I [00:24:00] think I could have picked up a lot of things really fast in my business. 

As a doctor. As a practitioner. I did that. I went to a very high functioning practice outside of Washington D.C. And I just take for granted how much I learned about how you run a practice because it was just the way it was. And a lot of other people spent 10 years figuring out just the basics that I took in in the first week of like, “Oh, yeah, that’s how you do it. That all makes.”

And so I really like that. I like your idea of a reshuffling. I need to sit with that a little bit because it does make sense to me that if we’ve got these different types of practices, especially we’ve got practices that are starting to make some changes and make some adjustments.

I think you’re, you’re gracious and a very good outlook on this to say, I don’t think that people were lied to when these practices came in and said, hey, we’re not going to mess with things, but things have changed, and now we’re not able to go on as we were before. Life is like that.

We all have to kind of adjust and, and we are in this together and having a good attitude about it I think is the healthiest thing you can do. I think it makes sense, but it does make sense to me also [00:25:00] to your point that if you’re in this place and we’re seeing a lot of changes happening, that people are going to look around and say, well, this isn’t exactly what it used to be or it’s not what I signed up for. And, there are so many opportunities. The urgent care model is a great one. I go, that seems interesting to me. I very happy in general practice, but home health care, I’ve thought about that.

I’m looking at some practices that are doing like an open hospital model I’ve never worked at one of those hospital models. I think I could get pretty fired up about it and if I’d have to throw myself into it. I don’t think you’re halfway. I think you have to do it or not. But I started going, “oh man, you know, there’s, there’s a lot of opportunity to that.” So the idea that there would be enough change that a lot of people would kind of look around and say,” you know, Hey, look, while we’re all here, I think I’m going to go get in that boat over there because that fits more what I want. But this is still a great boat and other people might want to come here because of what we’re doing.” that, makes some sense to me. 

Ryan Leech: Yeah I’ve worked at quite a few different companies in my life, and you know, I worked one that is a spectacular company it just wasn’t the right fit for me. It was Red Hat, which is a Linux software [00:26:00] company. People that work there are fanatical about the business, and they do a spectacular job. They have wonderful onboarding, a great team. I just didn’t get fired up about it, right? It didn’t mean that there was anything wrong. There’s people I’d recommend that should go and work there and have a great time. And, and I think you probably could have the same thing if you look at Blue Pearl versus VEG, right?

Those are two, if you were to run the numbers on them, they’re both, you know, ER practices that are growing rapidly. Those are completely different businesses, completely different work life balance, completely different goals. But you could thrive at either one of those. And just because you didn’t fit well at one doesn’t make it better or worse than the other.

But you should really, you know, if you’re a DVM or a practice, you know, anybody within practice, you should look at those different models and say, Do I want this flexibility? Do I want the ability to work remote? Do I want the clinic? Do I want the patients and the pet parents right next to me the whole day?

Do I want them to be dropping them off? Do I want to go to them? Look at it. This is, this is not an industry anymore where a doctor should graduate from school and [00:27:00] walk into the neighborhood clinic down the street and just go, well, this is what it is. This is what it is everywhere. And this all that I’ll have for the next 30 years of my career.

No, you can find these nuanced differences. There’s always unique places for people.

Dr. Andy Roark: I think that there’s this perception that medicine is a ladder. At least there used to be. I think it’s present. I think it’s way overrepresented, but there’s this idea that there’s better medicine. There’s a ladder of quality clinics and you start with, we don’t call it that, but it’s low quality clinics.

And then ultimately we get to specialty clinics, which are the highest quality clinics. And there’s this idea that you’re supposed to want to move up this ladder and that’s just absolutely not true. You know, it’s it’d be like the idea that that dog breeds are a ladder to the best dog breed,

Ryan Leech: Well, we do know that it, it tops out a golden retriever. I

mean there’s a ladder and what, I don’t know what the bottom rungs are, but it does top out a golden retriever. That’s that so…

Dr. Andy Roark: Yeah. It’s a model that, I think a lot of us [00:28:00] internalized that in vet school. When they were like, “this is the higher standard of care than this, and we aspire to a higher standard of care.” And if it’s that simple and you look at it, you say, well, that makes sense that there would be this upper thing.

But that’s just not the truth. The truth is there’s, there’s an ecosystem and there’s so many different variations in how we deliver care and why we deliver care and like the experience that we’re trying to create. And I would like to continue to try to bury the idea that there’s upward ladder and just “no, no, no, no, look at the beautiful diversity of our profession and, and feel free to move around. And it’s not up or down. It’s, where do you want to be?”

Ryan Leech: Yeah. I think a doctor that’s working, doing a high volume pop up clinic at a tractor supply for pet IQ is providing as valuable, and in some situations more valuable, perhaps service then, you know, the research veterinarian at Cornell who is touching four patients a year, right? Like those are completely different things that are.

[00:29:00] Extremely valuable. And, I think the data even shows, right? Like what is your goal? What’s your goal of practicing medicine? Is it most animals that you can save? Is it a hands on impact? Is it a high level research impact? Is it, you know, mentoring? Is it growing? Like, yeah, it’s, it is not a small, small industry.

The number is what? 136 billion were spent on pet care and vet care last year. So there’s room. There’s plenty of room for people to come in and participate in it.

Dr. Andy Roark: Ryan, thanks so much for coming and talking with I just, I really enjoy you. I really enjoy chatting with you. I’d love to talk to you more in the future. Where can people find you? Where can they find the birdbath? What’s a good place for people who want to follow you?

Ryan Leech: Yeah. So the birdbath, we’re a podcast. We’re on every major podcast platform, ‘The Birdbath’. You can also check us out on LinkedIn. We have a transistor website. You can also send me a LinkedIn message as well. LinkedIn.com/leech (L-E-E-C-H) Ryan. And if you’re looking for cloud practice [00:30:00] management software, I also work with digital.

I handle all of our strategic partnerships. So if you’re a large corporation, a business, or anybody that’s looking to do cloud computing in any way, make sure you reach out to digital.com as well.

Dr. Andy Roark: Outstanding. Thanks for being here. Guys, thanks for tuning in to listen. Take care of yourselves, everybody.And that’s our episode. That’s what I got for you guys. I hope you enjoyed it. I hope you got something out of it. Thanks to Ryan for being here. Take care of yourselves, everybody. I’ll talk to you later on.