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Andy Roark DVM MS

Identifying Mobility and Pain Issues on Examination (and Even Before)

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Dr. Dycus, Chief of Orthopedics at the Nexus Veterinary Bone and Joint Center and founder of Ortho Vet Consulting, shares invaluable insights into orthopedic examinations for both dogs and cats. He discusses the importance of video documentation for evaluating mobility issues, offering indispensable guidance to veterinarians and pet owners alike.

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

LINKS

Dr. David Dycus’s website

Dr. David Dycus on Instagram

Dr. David Dycus on Facebook

C.A.M. (resource for pet owners)

C.A.R.E. (resource for pet owners)

Dr. Andy Roark Resources 

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course

Dr. Andy Roark Charming the Angry Client Team Training Course

Dr. Andy Roark Swag

ABOUT OUR GUEST

Dr. Dycus attended Mississippi State University’s College of Veterinary Medicine for his veterinary degree, Auburn University for a small animal rotating internship, and Mississippi State for a combined surgical residency and Masters degree.

Dr. Dycus is frequently asked to lecture locally, nationally, and internationally. He has given over 200 continuing education lectures and taught over 125 laboratories. He has published numerous research articles and authored or co-authored several book chapters. He is the co-editor of the textbook: Complications in Canine Cranial Cruciate Ligament Surgery. He was named by DVM360.com as one of the 10 veterinarians to watch in 2018. Dr. Dycus is a frequent contributor for updates in orthopedics to several veterinary websites and magazines. Dr. Dycus has also been featured on Sirius XMs Doctor Radio’s segment on Pet Health and Orthopedics. His passion for teaching has allowed Dr. Dycus to become a laboratory instructor for the CBLO, TPLO, extra-capsular stabilization, medial patella luxation, angular limb deformity, and fracture repair. He is on faculty for AO (Arbeitsgemeinschaft für Osteosynthesefragen), and he is an orthopedic consultant for VIN (Veterinary Information Network). 

Along with being a scientific reviewer for multiple journals, he serves on the editorial review board and is the associate editor (orthopedics) for Veterinary Surgery, the official publication of the American and European Colleges of Veterinary Surgeons. He has previously held an appointment on the research committee for the American College of Veterinary Surgeons. Currently Dr. Dycus is on the Board of Trustees for the American College of Veterinary Surgeons, is a council member for the Association for Veterinary Orthopedic Research and Education (AVORE), and is on the education committee for AO North America. Dr. Dycus became a certified canine rehabilitation practitioner through the University of Tennessee in 2015. He is the director and chief of orthopedic surgery at Nexus Veterinary Bone and Joint Center where he has a focus on total joint replacement, complex and minimally invasive fracture repair as well as angular limb deformity correction, 3D implant printing, and arthroscopy. In addition, he is the medical director for Nexus Veterinary Specialists located in Baltimore, Maryland. He is the founder of Ortho Vet Consulting, an educational consulting and orthopedic coaching service as well as the co-founder of the Veterinary Sports Medicine and Rehabilitation Institute (VSMRI).

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome, everybody, to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Guys, I’m here with my good friend, Dr. David Dycus. He’s an orthopedist. He lectures all over the world. He does a ton of things, which I’ll lay out here in a moment. Man, I always enjoy him. He is so useful. He’s such a wealth of knowledge and just super practical clinical knowledge. And guys, we are in the orthopedic exam today. And gosh, he just makes pearls of wisdom rain from above in this episode. It makes me so happy.
My face, I wish you could have seen my face when we get into talking about how to ask pet owners to take videos of their limping pet, and he’s like, “Yeah. This is my wishlist for how to film and what to get them to do.” And I’m like, “Man, if I was a pet owner, I would love this. I would feel empowered. I would feel like I have got some homework to do. I feel like my vet cares.” And then as the vet, I’m like, “Yeah. This is super helpful.” And it’s just a way… It’s like sometimes you struggle to ask for what you really need because you don’t exactly know how to articulate, “Hey. This is what makes a good video that’s actually going to make my life easier and not just give me more to do in my day.” And so anyway, that’s just one part of what he lays down. But man, that was probably my favorite part and we do it for dogs and cats.
At first we start off, we’re talking a lot about dogs. We very much get into cats and how cats are different and ways of diagnosing cats differently, and just, anyway, boy, the amount of knowledge packed into this episode is just absolutely over the top. So anyway, if you ever see limping animals, limping dogs or cats, this episode’s for you. 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, Dr. David Dycus. Thanks for being back on the show.

Dr. David Dycus:
Hey. Thanks for having me. It’s great like always to be back.

Dr. Andy Roark:
Oh, man. I so enjoy having you on here. You have been… I think I have you on about once a year. I should probably do more than that, but you are perennial here. I always enjoy the heck out of you. For those who don’t know you, you are a board certified veterinary surgeon. You have a sole focus in orthopedics, so you’re always in talking about limps and joints and aches and pains and corrective procedures and things like that. You are the chief of orthopedics at Nexus Veterinary Bone and Joint Center. And you also are the founder and owner of your own consulting firm, which is Ortho Vet Consulting.
So you are awesome. I love talking to you about these things. You have a passion for canine working dogs. And so it’s just something that I’ve always been interested in and it fits with your orthopedic interest. And I’ve had you on talking about osteoarthritis many times in the past and things like that. And so let’s go on. I want to just talk with you today. I’m interested in. I had just a flurry of questions recently about limping dogs and mobility. From those, do you think it’s torn? Is it partially torn? Do I need to come in? Do I need to do a surgery? Should I wait and see? And it’s just a lot of those sort of nuanced questions. And so I wanted to bring you in to kind of help me brush up a bit on identifying mobility and pain issues and just examination and then even pre-examination. Are there things I should be asking before from the pet owner? Are there things I should be looking at before I put the hands on the beast? Anything like that?
So let me just start it at a high level and sort of say when somebody comes to you and says, “Hey. Could you take a look at this limping dog?” where do you even start to process this in your mind?

Dr. David Dycus:
So I think first thing is going to be listening to the owners and gathering as much information as you can, because in a lot of situations when the dog or even the cat is in the veterinary hospital, they’re amped up. And so sometimes some of the things that the owners say are happening, you watch the dog walk, for example, and you’re like, “Well, I don’t see anything,” and you’re thinking the owner’s crazy or the dog’s getting better. So I always question them about how long it’s been going on, where they see the issues most. And I try to keep most things open-ended so I don’t persuade them one way or the other or they answer something the way I want them to.
I want them to tell me are they predominantly seeing stiffness upon rising and then the dog works out of it and looks beautiful? Or are they seeing something that the dog is stiff and then it stays consistent? Is it something that started out very intermittent and has now progressively gotten worse? Or are they actually seeing maybe some behavioral type changes? Maybe the dog’s sitting down on walks or maybe they’ve noticed that, “Usually he beats me up the stairs and hops on the bed at night, and now we’re kind of waiting on him to come up the stairs and then I’m having to bend over and help him up into the bed.” So they may notice some not necessarily limping, but they may notice some changes. And if it’s a cat, for example, perhaps they have stopped wanting to jump up onto the counter or they get up and find themselves, but then they start meowing or seeking out somebody to help them get down off of a surface because they don’t want to jump down. So I think certainly listening to the owners is a huge, huge one.

Dr. Andy Roark:
Do you have any slick sort of Jedi questions that you feel draw histories out naturally? Or do you sort of do a 20 questions like, “Hey. I’m going to ask you a bunch of questions,” and then just kind of go through a checklist in your mind? How does that sound when you’re trying to draw this out and without leading them too much?

Dr. David Dycus:
Yeah. I think sometimes when the owners come to see me, they’ve been to their regular veterinarian and they’ve maybe got an idea of what’s going on.
So they start telling me things that they think I want to hear, things they’ve looked up on the internet to try to persuade me in that direction. And so I say, “Listen. Let’s start at the very beginning.” I’ll say, “Why are we here?” “Well, my veterinarian…” and I say, “Well, no, no. What did you see at home when you first noticed something that was wrong?” And, “What changed your thought as to why you thought your dog needed to see a veterinarian?” And then they’ll say, “Well, he was limping.” “Okay. Well, how long ago was he limping?” “Well, a few months ago.” And then I say, “Okay. Well, has he just been limping the same way the whole time? Or did you notice something before?” And then they start thinking and they’re like, “Well, there was a few months ago where maybe he seemed like he slept wrong on his leg for a few days and then it went away. We didn’t think anything of it.” So that’s a huge important thing, especially when it comes to cruciate ligament disease.
Or I’ll say, “Well, are there certain times of the day where you notice the issue more?” I don’t want to say, “Are they stiff when they get up in the morning?” I just want to say, “Are there certain times of the day where you see it? Or are there certain activities that you notice the issue more more than others?” And if they’ve been on any sort of medications, say, “Well, did it help?” And they’re like, “Well, no. He’s still limping.” I’m like, “Well, did you notice any change at all for the better or just zero change?” And they’re like, “Well, maybe it helped a little bit,” because I think some of those things are very, very important.
And many a times they’ll say, “Well, I’ve got a video. Do you want to see it?” And I’m always like, “Yes. Absolutely.” And more times than not, it’s probably not even really focused on the dog and helpful, but I do think it’s important because sometimes you can see some things that the owner’s trying to describe, and I’m sitting there thinking, “What are they talking about?” They’ll say, “Well, he’s dragging his nails.” And we all think, “Oh, it’s got to be neurologic.” And I’m looking, and they’ll say, “We’ve got video.” And I’m watching the video, and it’s like, “Well, the dog doesn’t have a neurologic gait. The dog’s just too painful, so it can’t actually flex the knee or the hip enough to clear the paw and the nails are catching. And so it’s not neurologic. It’s actually orthopedic.”
So many a times, my technician will come in and she’ll be like, “Well, the owner says he’s dragging his feet.” And I’m like, “Oh. Well, this might not be orthopedic.” And so we have to be careful about the terms that we perceive in our brain that we hear without actually seeing. So I think the history is critical and then videos if they have them, and then before you even touch the animal, you have to watch them move.

Dr. Andy Roark:
Okay. Hold on. So I’m going to unpack this a little bit. Okay. Because like I said, I’ve just had a pile of these recently and, pat myself on the back, I have done a good job of saying, “Hey. Why don’t you get a video of it before you come in?” And that has been really helpful. However, David, I get it and they bring the video in and oftentimes, they’re holding the leash and they’re filming from behind or, as you said, there’s a variation in quality of the video and things like that.
Are there certain types of videos, are there shots that you’re looking for? Can I give them a little bit more coaching to get a better video? Because a lot of times, they love the idea of filming it, you know what I mean, and bring it with us so we can see what it looks like. And especially if I say, “Oh, often they’ll hide it when they come into the vet, so I really want you to get this video,” they feel like they’re hands-on, they’re part of what we’re doing, they’re on the diagnostic team. Do you give them any sort of guidance in how to get a good orthopedic video that’s going to help us look at lameness?

Dr. David Dycus:
Yeah. We try to. And for me, it’s actually, if I get the opportunity to tell them to get video before they come in, then my wishlist of videos would be someone else is walking the dog and someone is filming, so it’s not the same person walking and filming. The first thing I would like to see is the dog lying down and getting up to a walk and see what happens. That’s video one. Video two would be the dog just standing before walking. And then the next set of videos would be one video of the dog walking away from the camera, a video of the dog walking towards the camera and a video on both the left and the right side of the dog walking. And ultimately, if I can get even more videos, I would want those same series, but with the dog trotting, so the trotting towards me or the camera, trotting away from the camera, trotting a view on the left side and a view on the right side.
That would be my ultimate wishlist if I could have those videos because I think that would certainly help pinpoint a number of things. You’re able to see how does the dog look when it rises and then starts walking, how does the dog look when it’s standing. Some dogs will offload a limb at a stance, but then the minute they start walking, they’re engaging and using it, and that tells me things versus if the dog is offloading and then takes off walking and is limping. And then for some animals when they have a more mild issue, it’s easier to detect at the trot than it is the walk, because it’s a lot harder for them to hide things at the trot than it is the walk.

Dr. Andy Roark:
Hey, guys. I just want to jump in real quick and let you know about some great continuing education I have coming your way. Guys, I’ve partnered with Nationwide to put together a series of webinars that are 100% free to you. They have [inaudible 00:11:18]. They are good to go. And they are going to be, first of all, just genuinely entertaining and fascinating. The first thing I got coming for you is on October the 31st, that is on Halloween, with me. I am doing a webinar that is on a topic that I love and I care about. It’s keeping care accessible in veterinary hospitals, strategies for affordability and sustainability. This is me talking about exam room communication. It’s talking to people about money. It’s working with clients who have financial limitations. You get to hear me do my thing. I’m super excited about it. It’s at 3:00 PM Eastern, noon Pacific on October the 31st. Registration is open. I’ll put links to all of these down in the show notes.
The second one is coming up on November the 14th with my good friend, Dr. Emily Tincher. She’s been on the podcast a number of times. I love having her here. She’s such a fun, interesting person who’s a deep thinker. And so anyway, she is doing a webinar called Clinical Empathy: The Exam Room Skill that Can Transform Your Team. I’ve had Emily on the podcast before talking about clinical empathy. This is a really good skill building webinar. This is great for your support staff, as well as your doctors, but your team leads especially, but your technicians, your assistants, your CSRs, all of this, it’s such a great communication content. I think you’re going to really like it. So anyway, that is on November the 14th. It is at 3:00 PM Eastern, noon Pacific.
And then the last one in the series is on December 13th. It is with Dr. Simon Platt. It is called Head Cases: A Spectrum of Care Approach to Neurology in General Practice. So if you’re a neurology buff, if you like seizures, not like it, if you like knowing about seizures, if you like neurophysical exam, tips, tricks and hacks, things like that, this is going to be a great webinar. So again, this is on December 13th. It’s at 1:00 PM Eastern. That’s 10:00 AM Pacific Time. Gang, I would love to see you there. Links to all this stuff in the show notes. Go ahead and grab a spot. I’ll see you there. Let’s get back into this episode.
Is this the same wishlist that you have for cats? Or do you tailor your instructions? I know. It’s really hard, but that’s why. It feels to me like the videos of cats are so much more valuable, because they just… It’s so limited in what I can kind of get and use in the exam room, and so I want to do this just well. But yeah, do you tailor those? Is your wishlist still the same and you just say, “I know this could be challenging.”? How do you advise the cat owners?

Dr. David Dycus:
Yeah. So for the cat, I want the owner filming the cat just walking around, engaging its normal environment. And then if they can encourage the cat to play, so if they have a toy they can toss and the cat will go after, I want to see that. I want them to try to encourage the cat to jump up onto a surface, whether it’s a chair or a counter. And then I also want them to encourage the cat to jump off of a surface, an elevated surface, whether it’s a chair or a counter. And then even better if it’s a home that has stairs, if they can encourage the cat to either go up or down the stairs. Those things I think are very helpful, because the cat’s going to be very, very different to detect some things and especially in the hospital.
In most situations the owner has spent all morning trying to get the cat in the carrier to get to you, and then all of a sudden when they’re there in the hospital, the cat doesn’t want to come out of the carrier. And so we take them out of the carrier and I’ll put the carrier at one end of the room and I’ll put the cat at the other and I’ll watch what happens, and the cat walks with a crouched, light gait, well guess what? Every cat walks with a crouched, light gait in the hospital. So that doesn’t really help. But a limping cat’s a big deal. If you have a cat that’s you watching and that you’re like, “That cat looks like it’s limping,” that’s a big issue that needs to be dealt with. But if they can get me videos of just the cat in its normal environment, how it’s interacting, especially with stairs and jumping, that’s also going to be very helpful.

Dr. Andy Roark:
You just made my day. This is absolutely worth the cost of admission just to go through these videos with you. I freaking love this. Okay. Great. So we’ve got our videos. Let’s move into the exam room. So you said even before the examination, just try to watch the pet. And so we talked a little bit about the cat and separating from the carrier and things like that. How do you try to do this in the vet clinic? I have done everything from go just big and have people, “Let’s go outside together and we’ll go and leash it up and go,” to just trying to maneuver in the exam room or things like that. Yeah. Tell me kind of what you’re trying to accomplish before you start your exam with the patient.

Dr. David Dycus:
So I’ll start with the cat. As we said earlier, I want to watch the cat first walk and then I want to see how the cat’s going to engage in terms of jumping up and jumping down. And so what I’ll do is I’ll put the carrier on an elevated surface to see if I can encourage the cat to jump up. And then I’ll reverse rolls. I’ll put the carrier on the ground and the cat on an elevated surface to see if the cat will jump down, because jumping up or having trouble or refusing makes me start to think hind limb issues versus not wanting to jump off or hesitating. That makes me start thinking front limb issues. And for example, cats commonly suffer from elbow osteoarthritis. And so if they do jump down, they’re going to try to get their front legs unloaded as quickly as possible, so they’ll kind of slam their back legs down, so it won’t be a very nice elegant landing.
But for the dog, I really think if the dog’s coming in for limping or weakness or a mobility related issue, we really need to watch them walk in more than just the exam room, because the exam rooms usually just aren’t big enough to pick these things up. But while I’m talking to the owner, I’m going to watch what the dog’s doing. In other words, sometimes I’m staring at the dog while I’m talking to the owner and I’m looking to see if the dog’s standing, does the dog revert and start to offload a limb, or does the dog immediately go to sit down and doesn’t want to stand up, and how does their sit look or when they go to lie down, how does their lie look? And before I ever put hands on them, we’re going to watch them walk.
And so I think watching them walk towards you, watching them walk away from you, if a big enough area, watching them walk on the left and the right and then repeating the process for the trot is very important, but that means you have to have space for this. And so sometimes that can be a hallway. Sometimes it’s the outside in the parking lot. Sometimes it’s on the sidewalk. Sometimes it might be in a grassy area. I tell people, “If you’re going to remodel a hospital or if you’re going to build a hospital, architects love to design beautiful, elegant floorings, but many a times they’re not practical for our patients.” They’re slippery. And if we’ve got a neurologically or orthopedically compromised patient, there’s got to be good footing. And so if your hospital has slippery flooring, you got to move it somewhere where there’s better traction or get a bunch of yoga mats and line your hallway just for your gait evaluation so they have traction, then they’re not sliding because it makes it really challenging if the floors are slippery.

Dr. Andy Roark:
Got you. That totally makes sense. All right. So let’s start to move into our physical exam. And I’ve asked you about this before in the past, but walk through… Primary objectives in our physical examination. How do you start this out?

Dr. David Dycus:
So I think it’s dealer’s choice, and when we talk about dogs, for example, it’s dealer’s choice if you want to have them standing or lying down. I do think it creates a bit more stress in some of the animals if we try to force them in lateral recumbency for an exam. And so if I have a dog that’s relatively submissive and immediately rolls over to their back and is submitting, then I’ll just say, “Okay. Our technician will give them belly rubs and I’ll do the exam with them lying down.” But usually I want to have them standing up. And this isn’t the time where we’re going to try to perfect our wrestling skills.
The exam should be done the same way every time. For me, that means I start at the toes and I work my way up and I do the affected leg last. And so let’s say for example, it’s a right hind limb. Well, I’m going to do the left front leg first, and then I’m going to do the left hind limb, and then I’m going to do the right front leg, and then I’m going to do the right back leg. So that way if I hit an area that’s uncomfortable on the affected limb, I need to know how is this dog’s body language, because in some situations we’re not necessarily looking for pain per se. We’re sometimes looking more for tension or resistance or spasm to manipulation. And so I read a lot of body language. And so if I manipulate, say, the shoulder on the left side in a certain way, but then I manipulate the shoulder on the right side and the dog’s panting and it stops panting or kind of looks back at me or starts licking its lips, those are signs to me that the dog could be uncomfortable.
And I also rely on the feedback from my team. If my technician, say, holding the dog and she says, “Hey. This dog’s kind of pushing into me, kind of trying to get away from you,” that tells me that what I hit is likely an area of discomfort. And I’m notorious for palpating one limb that’s the affected limb last. And I don’t get a whole lot. And so I go back to the contralateral limb and I kind of dig in a little bit deeper and then I go back. And I’m notorious for going back and forth, just sometimes looking for those subtleties, especially if it just doesn’t jump out at you, “Hey. The dog’s legs dangling because it’s got a broken tibia.” Sometimes it can be tricky. And where it gets tricky is with a lot of the soft tissue injuries. That’s where it gets really challenging and where you have to hone in and look for those body language changes when you’re manipulating the animal.

Dr. Andy Roark:
Got you. All right. All that totally makes sense. Where do you see people making mistakes here, David? What sort of pitfalls do I have to look out for?

Dr. David Dycus:
I think people try to rush things. I think they try to quickly run joints through range of motion and then say, “Well, I could do it, didn’t bother the dog.” I also think sometimes our manipulations aren’t as calculated as they should be. Many a times we go just to grab the dog and then the dog tenses up. And I think the prime example there is if we’re checking for cranial drawer. What I see notoriously in notes coming in probably in the last five years is, “Well, full orthopedic exam not completed because the animal was too tense without sedation.” But unless the dog’s actively really trying to eat you, you can usually get instability if your motions are a bit more calculated. We don’t go home after work to pet our animals and we grab them in the position where we’re going to check cranial drawer. I mean, it’s super awkward position for a dog. And so if you go in with a really tight, quick grip, the dog’s going to tense down. And once they tense down, then it’s a fight of will and the dog’s going to win every time.
And so I think if you go very light touches. So for me, what I like to do is just even before I start manipulating them, I’ll run my hands down their back kind of lightly, so they’re getting that very light touch. And then I’ll run my hands down the front legs and run my hands down the back leg, just very light touch so the dog knows I’m there. And then I’ll sometimes kind of rub the medial and lateral side of the leg just very lightly before I even pick up the toe. And then if they start kind of pulling or fighting with me, I’ll let the leg go down for a minute, so I’ll give them a break, and then will re-pick up the process.
So I think if we’re focusing strictly on the orthopedic exam for an orthopedic ailment, it makes sense to slow the exam down. Now if you’re doing a quick orthopedic check, say, on a wellness exam with no complaints, you can get through it pretty quickly. I mean, probably three minutes, you can cover the entire orthopedic exam. But I do think you need to slow down. I think you need to make very calculated movements. We need to avoid quick grips. And then for example, what I find for… Again, going back to the knee, what a lot of people tend to do is when they try to check cranial drawer, they like to kind of pick the leg up, which means the hips flexed a little bit, and they try to check cranial drawer, which I find is very challenging. So actually what I’ll do is I’ll pick the leg up, I’ll extend the hip back a little bit. And that’ll release some of the tension that makes checking both cranial drawer and, for me, tibial thrust much easier.
And then when we talk about hip extension, a lot of people like to try to go to hip extension and then it’s tight and they’re like, “Oh, well, they’re resisting hip extension.” Well, if I walked up behind you and I shoved you down to touch your toes and you couldn’t bend your knees, you’re going to be like, “Ow,” and you’re going to be like, “Well, you’re tight.” Well, we kind of have to work into that. So when I go to hip extension, I’m going very slowly and I can feel that tightness and then I’m just going to push through it as we’re stretching. I’m basically doing a controlled stretch. And I find that many a times dogs when they come in, they’ve got hip pain, well, they don’t really have hip pain. It’s just they were tight and somebody tried to check their hip extension really quickly rather than kind of stretching it out.
And don’t get tunnel vision. For example, if the dog is tight with hip extension, it might not be the hip, because a dog with groin pain or a dog with tarsal pain or a dog with lower back pain or a dog with stifle pain, they’ll sometimes offload the limb and then they’re going to be compensating, which means that their hip’s going to be a bit more flexed, so they can centerline the limb a little bit, which means over time their hip’s going to get tight. And so it’s equivalent if I told you to bend over and walk bent over for weeks at a time and then stand up straight, you’re going to be really tight. So it’s the same thing. So we have to think about, “Okay. If I’m getting pain at the hock, but they’re tight on hip extension and ruling out what’s the primary issue versus the secondary issue, and the news flash is many a times in a skeletally mature dog with an acute lameness, it doesn’t matter really how bad the hips look. It’s usually not the hips that are causing the issue.

Dr. Andy Roark:
No. This is fantastic. I really, really appreciate it. David, where can people… Do you have any favorite resources that you like to refer people to?

Dr. David Dycus:
Yeah. So I’m going to give myself a shameless plug first, and then I’m going to provide other resources.

Dr. Andy Roark:
Do it.

Dr. David Dycus:
So first off would be my own website. It’s drdavid dycus.com, and my Instagram is ortho_vet and my Facebook is Dr. David Dycus. Now, resources for clients are a big deal for me, and we see many patients with osteoarthritis. And so there are two resources I’ll send clients to to learn more about how we manage osteoarthritis over the long term. One is called CAM. That’s Canine Arthritis Management. It’s a group based out of the UK. And the other is CARE, Canine Arthritis Resources and Education. And that’s based in the US. If you just Google Canine Arthritis Management or Canine Arthritis Resources and Education, you’ll probably be able to find both of those websites very easily. And that’s sort of my go-to for sending clients for OA management, so that way they can learn, “Here’s what things are going to be looking like for the rest of the dog’s life,” in a very client friendly language so they know what we’re going to be doing.

Dr. Andy Roark:
That’s fantastic. I’ll put links to all that stuff. I’ll link to David’s stuff and I’ll link to his socials and then also to the other resources as well. So I’ll put all this stuff in the show notes for you guys. David, thank you so much for being here. I always appreciate your time and insight. Gang, thanks for tuning in and listening. Take care of yourselves.

Dr. David Dycus:
Thank you. Was a pleasure.

Dr. Andy Roark:
And that’s it. Guys, that’s the episode. That’s what I got for you. Thanks to Dr. David Dycus for being here. Thanks to you guys for listening. If you found this podcast helpful, leave me an honest review wherever you get your podcast. It’s how people find the show. It means the world to me. I really do appreciate it. Anyway, guys, take care of yourselves. I’ll talk to you later on. Bye.

Sometimes It’s Worth The Risk

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A few months ago, I got a text from one of my neighbors. Her husband was traveling and their senior dog had collapsed and wouldn’t eat or move around. I was home when it happened and decided to walk down the street to see what was going on.

When I got to her house, you can imagine what I found. Copper, their beloved 10-ish year old hound mix, was laying sternal on the floor, panting. His gums were pale and his heart rate was elevated. His abdomen felt markedly distended.

I told Copper’s owner that I was worried about a splenic tumor (or some other internal bleeding issue) and that he should get some imaging done ASAP. She took Copper into the vet clinic.

The next day, I got another call. It was as I’d feared: Copper had a splenic tumor and secondary bleeding. His owners were asking for advice about whether or not to take Copper to surgery.

Like most veterinarians, I’ve gotten this question many times in my career, and my answer is always highly context-dependent. I generally talk to pet owners about the chances of the tumor being malignant and having already spread being around 70% versus a 30% chance of it being benign. I tell them what to expect from surgical recovery and talk about the price of the procedure. I also talk about life expectancy in the best case scenario and also in the worst. After all of that, I end with some version of the statement “I don’t think there’s a right or wrong answer.”

I hate to say it, but I think I’ve gotten accustomed to people either looking at all of these factors in a senior pet and then deciding not to go to surgery, or deciding that they will go to surgery and then finding out that the mass their pooch developed was malignant and has spread. I am supportive of either decision, but I think I’ve subconsciously come to expect that this will end badly.

I was fully prepared to be supportive of my neighbors’ decision to pass on surgery when they decided they were “going for it.” I don’t know why this caught me off guard. My neighbors are great pet owners and lovely people. Their young kids love Copper, and he has been a faithful companion for years. “Okay,” I said. “Let’s do it.”

Last night I visited my neighbors’ house for a cookout. The husband had recently… (I kid you not)… jumped out of his car while traveling, stopped a car jacking, wrestled the criminal to the ground, and handed him over to the police. He was being honored with a service award and our neighborhood was coming to congratulate him.

Right there in the middle of the cookout was Copper. He was bright, active and energetic. He asked me very politely for a tortilla chip and I absolutely did not give him one (regardless of what witnesses at the event might say). Copper played with the kids, demanded to be petted by anyone sitting down with a free hand, and made lots of friends. He was right back to his energetic old self. It was wonderful.

I have been reflecting on my reaction to Copper since I was there. Over the years, I think I kind of gave up on dogs with splenic masses coming back and having wonderful times after their diagnoses. I had convinced myself that, even though the statistics said these dogs could have benign lesions, most of the cases would turn out poorly, and I did that so I wouldn’t be so sad when people decided not to go to surgery or when the surgeries didn’t go well.

Copper is a reminder to me that sometimes things work out. Sometimes you go to surgery on a senior patient, everything goes splendidly and you get more time with a wonderful four-legged soul. He is a symbol for me that it’s worth hoping and it’s worth trying. 

From now on, when I talk about the decision to go to surgery on a senior patient, I’ll still paint an honest picture of the situation, but I will have to mention Copper and how well he recovered. I’ll have to give that head nod to hope and optimism. I’ll have to remember that sometimes trying is worth the risk.

A Profession in Crisis? Far From It.

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Dr. Eleanor Green, Founding Dean at Lyon College School of Veterinary Medicine, joins the podcast to discuss her recent article on the narrative that veterinary medicine is a profession in crisis.

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

LINKS

Article: A profession in Crisis? Far From it

Dr. Eleanor Green on LinkedIn

Dr. Andy Roark Resources 

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course

Dr. Andy Roark Charming the Angry Client Team Training Course

Dr. Andy Roark Swag

ABOUT OUR GUEST

Dr. Eleanor Green holds the Carl B. King deanship of Texas A&M University College of Veterinary Medicine & Biomedical Sciences. She is a Diplomate of ACVIM and ABVP. She received a BS in Animal Science from the University of Florida and a DVM from Auburn University.

She established a veterinary practice in Mississippi as partner/owner. She became a founding faculty member of the College of Veterinary Medicine at Mississippi State University. Her academic appointments have included: equine faculty member at University of Missouri; head of Department of Large Animal Clinical Sciences and director of large animal hospital at the University of Tennessee; chair of Department of Large Animal Clinical Sciences and Chief of Staff of large animal hospital at the University of Florida. She served as president of three national organizations: American Association of Equine Practitioners, American Board of Veterinary Practitioners, American Association of Veterinary Clinicians.

Her awards include: 2004 Award of Distinction from UF College of Agriculture and Life Sciences, 2011 Wilford S. Bailey Distinguished Alumni Award from Auburn, 2012 Women‘s Progress Award for Administration and 2015 Distinguished Achievement Award for Administration at Texas A&M, and induction into the National Cowgirl Hall of Fame in 2013.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark, as I am here with the one and only Dr. Eleanor Green. Eleanor is someone that I have admired my entire career just because she has done so many things and we get into that right at the very beginning and start to lay down what her bio is. Guys, I am a perpetual optimist. I am. I love vet medicine. I am big on the future of vet medicine. I know it’s hard, and you guys have all heard me talk about the challenges of vet medicine. I still love it and I still think it’s great, and I still think it’s sad that oftentimes I feel like we focus on the downsides and not enough on the upsides of what makes it really good. And if you feel that way, this is a great conversation.
So at first we kind of start off talking at a high level, but then Eleanor just starts to kind of unpack her ideas and we get kind of down the rabbit hole a little bit. And she’s so inspiring. We were talking after the podcast was over, and I wish this was on the podcast. So when she was the dean at Texas A&M’s College of Vet Medicine, she asked her incoming students or her students, it was like a sample of 500 vet students. She said, “Raise your hand if you were discouraged from becoming a veterinarian.” And 495 of the 500 students raised their hands. And she asked, “Who discouraged you?” And they said, “Other veterinarians.” And I get it. Again, this should not be a path that you undertake lightly, but in another way, as someone who just loves our profession and what we do, I go, man, I want to spread the positivity. I want to spread the light. I want to change the story a little bit and be more honest about the balance of good and bad, and how darn rewarding this profession can be. So anyway, that’s what we get into in this conversation, guys. I hope you will enjoy it. 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. Eleanor Green. Thank you for being here.

Dr. Eleanor Green:
Yeah, thank you for having me. This will be fun today.

Dr. Andy Roark:
Oh man, what a treat for me. I have always admired you. You are on the faculty at the University of Florida when I was a vet student there. I have seen your career from afar. You’re a veterinarian, you have been in private practice, you’ve been in academia. You were the dean at Texas A&M’s College of Veterinarian Medicine. You’ve had a consulting career. You are now the founding dean at Lyon College School of Veterinary Medicine, and I got the opportunity to talk with you. What I want to talk to you about was you’re also writing articles, and I saw one of your pieces that just spoke to me immediately and it was titled A Profession in Crisis, I think Not. And I, as a fan of optimism and positivity and a lover of vet medicine, I wanted to talk to you kind of about where your head was in that regard and what inspired you to write the article.

Dr. Eleanor Green:
Well, thank you, Andy. Again, it must be mutual admiration, because I’m so pleased with everything that you’re doing in the profession. It’s always great to see a good University of Florida graduate get out there and affect the practice of veterinary medicine and the whole profession just like you are. So the article, we have all looked around and seen headlines, and these headlines are dominated by descriptions of challenges. In fact, veterinary medicine has been called a profession in crisis. And I am not saying that we shouldn’t look at our challenges, try to make our profession better and tackle each one individually and appropriately. But I think there’s so much sensationalism about the negativity of this profession that I think it’s having an adverse effect on the profession. And that worries me, because I think this is one of the most fulfilling professions that’s out there.
It’s still highly ranked. Veterinarians are looked at more favorably than medical doctors and they’re seen to be more compassionate and understanding and approachable and so many of the things, and they’re seen as contributing to society. And so I think that we really need to take a hard look at that as veterinarians because I think we’re hurting the profession by being so focused in sensationalizing the negativity.

Dr. Andy Roark:
Yeah, one of my favorite pieces of advice that I’ve gotten in my life is your life is what you focus on. And so if you walk around looking at the negativity and you just focus on it, that’s what your life is going to be. And again, you can say that without discounting real problems and real struggles that people have, but I think that that’s really important. When you think about education, so you come out of being the dean at Texas A&M, you’re the founding dean at a new school. Talk to me about with the mindset that you hope to instill in vet students, what does that look like and how do you go about trying to set a mentality that says, “Yes, this is challenging, you’re about to do a hard job, but it’s a great job.” How do you put that together?

Dr. Eleanor Green:
Well, I think we certainly need to get to vet students early on, and maybe day one, and I don’t know if you remember this, but at University of Florida, the first day of the freshman year at the University of Florida College of Veterinary Medicine, we had a session that was co-sponsored with the Florida Veterinary Medical Association that brought in some veterinarians from different walks of professional life. And we certainly handpicked them to be the ones who are the very enthusiastic lovers of this profession. And we had them talk to the students. And so there was a purpose of that, and one is welcoming them to a wonderful profession, showing them and showcasing some veterinarians who have had unbelievable careers and throughout their profession, they’re still enormously fulfilled in all walks of life. And the other thing was to open their eyes to the many opportunities in veterinary medicine are out there, because so many of us think of veterinary medicine as just taking care of pets.
And that’s enormously important. I don’t want to minimize that at all, but veterinarians can do almost anything. And so I think that we need to make sure that students know that. I think the other thing that we need to let them know is that the education can be taxing because of so much volume, and that we’re here to help them. We’ve got support for them, we’ve got peer support, we’ve got counselors, we’ve got all kinds of ways that if they’re having any struggles, we are there for them. And there are actually a lot of programs that are going on now beyond veterinary school that can provide a lot of support for veterinarians who are struggling.

Dr. Andy Roark:
What do you see as the main pitfalls as trying to drag our mentality out of the profession and crisis and start to look at things as, I don’t know, to look at things in a more balanced way? What sort of holds people back?

Dr. Eleanor Green:
Well, let me just tell you what veterinarians have been telling me. I polled a bunch of veterinarians and have been doing this for quite some time. This is not official. I haven’t sent out a form. I’ve just talked to people and I’ve asked them several questions. I’ve said, what do you like most about this profession? What do you like the least? And if you could change one thing, what would it be? And I also asked them if they would encourage or discourage others from becoming veterinarians. And there were common themes across the first three questions. One is they were committed to the human-animal bond and they were very fulfilled by being part of a happiness that animals bring to people. They love that. They love taking care of animals and taking care of their clients as well. We talk about some people have criticized the profession that all they care about is animals, but their people with every animal.
That’s not what I found. They love taking care of the clients and their needs also. And really what they love is the experiencing the happy outcomes. They love it when things go well. They also enjoyed variety in the practice. Never a dull moment. It’s just not going and doing the same thing every day. And here’s another one that really keeps you stimulated, they love the intrigue of the mystery of unraveling the cases. Isn’t that neat? And they also, this is going to be surprising for some who are critical of perhaps the new graduates, but the veterinarians of all ages appreciated the work ethic within the profession.

Dr. Andy Roark:
Yeah, I think that that’s true. That resonates with me.

Dr. Eleanor Green:
Yeah, it does with me too. And then here’s one that I really, really love. A striking component was that the empathy was plentiful within the veterinary medicine, in a world where many have lost empathy. I think we ought to say that one again. Empathy is plentiful in our profession in a world where many have lost empathy. Now if that’s not a reason to join this profession, I don’t know what is.

Dr. Andy Roark:
Yeah, I love it. One of the big pieces of advice that I offer to vet students these days, and it’s sort of come to me in just in the last year or two, is I think you have to enjoy the mundane. And what I mean is it’s just going into the room and doing the wellness appointment and you got to enjoy that path and you have to enjoy that person and just genuinely take pleasure in helping them and sort of being there and being present. But I really do think if you focus down on those things, it’s a really good job. It’s a hard job. I am not one of the people who enjoys the mystery. I one who I enjoy fixing the problem. I will tell you just for me, the ability to put hands on a pet and fix the problem to make this animal comfortable, send this person away with one less problem than they had when they came in. That’s it for me. I guess probably I was just never the sharpest clinicians, but I was always, I very much prefer to know what the answer is and be able to do it as opposed to trying to figure it out. But that’s [inaudible 00:10:10].

Dr. Eleanor Green:
You sound like a surgeon.

Dr. Andy Roark:
I do.

Dr. Eleanor Green:
[inaudible 00:10:13] move on.

Dr. Andy Roark:
I had this thought. It’s funny, I was telling someone recently, there’s two kinds of doctors, the doctor that looks at the vomiting cat and says, “Boy, I need to know why that cat’s vomiting.” And there’s the other kind that looks at the vomiting cat and says, “I need to know how to make that cat stop vomiting.” And I’m definitely the latter of the two, which is how do I make it stop vomiting?

Dr. Eleanor Green:
Yeah. Interestingly, I started out in surgery. Everybody in my family’s a human surgeon and I thought that’s what I wanted to do. And I did. I love surgery, and this is a number of years ago, I was very frustrated by not knowing what was going on in the whole animal. I ended up in internal medicine and music play because I’m one of those ones that loves the mystery and loves the unraveling and loves the critical care and the adjusting this and that happens, but it’s a different mentality. But back to why veterinary medicine’s so intriguing and appealing is that there’s something for everyone regardless of your way of thinking.

Dr. Andy Roark:
Yeah. I love one of the questions you asked, you said, “If you could change one thing in medicine, what would it be?” Let me ask you that question, Eleanor, if you could change one thing in that medicine, what would you change?

Dr. Eleanor Green:
If I could change one thing about this profession or the veterinarians within it, I would never want to give up the traditionalism and the dedication, but I would want to add a lot more interest in the future and receptivity to the innovations in a changing world that’s actually changing at an exponential rate. And somehow we seem reluctant not only organizationally, but sometimes individually to be receptive to the new things that are possible in our profession. That’s the one thing I would love to change.

Dr. Andy Roark:
That’s a great answer.
Hey guys, I have some huge news for my technicians out there, guys. I am speaking at the NAVC Vet Nurse+Tech HiVE event in Austin, Texas. This is October 16th through the 18th. It is live in person in Austin, Texas. It is 25 bucks to register, but I got you hooked up. There’s a promo code, it’s just Andy, promo code, Andy, and you get in for $15, $15 registration for the event. I’m going to be there. I have my friend Meg Pearson who’s an improv comedian, an actress. You will recognize her from some of my funny videos. She is hilarious. She’s going to be role-playing with me. I’ve got four sessions. We are going to do what to say and how to say it when talking to difficult clients, when talking up to management, when talking to doctors and when talking to colleagues.
And so all of those challenging conversations, we are going to be not just talking through how to do it, but I’m going to try to do it for you and show you what it looks like. And I promise we are going to laugh and have a lot of fun, but it’s going to be a great time. I’d love to see you there. Remember promo code, Andy, get 10 bucks off. Come out and see me. Also, if you are a technician, team lead. If you’re any type of team lead, come and see me at the Uncharted Team Lead Summit. This is a one-day virtual summit. It’s only for team leads. Guys, we put team leads up there and we want them to lead and motivate and manage and take care of problems and take care of patients. And also we hold them accountable to management, but then also they’re accountable to the people that they’re leading.
And we don’t give them any leadership training or support. Guys, it’s time for that to be over. Unchartered is dedicated to making team leads successful. It’s a new world, it’s a team game. We need to be investing into our leads and that’s what we want to do. So if you are a team lead, come and check out our virtual summit. It’s November the 8th. I’ll put a link in the show notes over to Uncharted. One day virtual, check it out, work with other team leads. I promise you’re going to get a ton out of it. Let’s get back into this episode.
I’ve heard you speak passionately about Lyons and what you sort of envisioned there and how it’s ideally going to be a different sort of education model and things like that. Can you talk a little bit as you talk about innovation and openness to change and things, can you tell me a little bit about how you envision education and vet school and kind where it’s going?

Dr. Eleanor Green:
Yeah, I will. I want to talk about Lyon, but even before I do that, I want to throw out one thing. Adaptability. When we were on the Veterinary Futures Commission, we were looking at core competencies and what should they be for the future. And the one new core competency we added was adaptability. And that’s something else I’ve gotten intrigued with. I actually lecture on this, but there’s a thing called adaptability quotient, which actually has been shown now to Trump EQ and IQ. And it is the success of businesses, it’s the success of individuals of the future. And so I think one thing that we need to do at Lyon is make sure that we’re recruiting for adaptability, but in addition to that, adaptability is trainable. So we are training for adaptability, and then within practices I would say not only recruit and retain for, but also evaluate for.
And I think that’s going to change this big stumbling block for our professionals as we enter the future. Now back to Lyon. One thing that I’m pretty excited about and the reason that I’m the dean at Lyon is that they have given me pretty much a blank slate within reason to create a veterinary education model of the future. What’s that going to look like? I’m going to get a lot of people together to add to some opinions that I have because I’m always very open to the opinions of others. So we haven’t shaped it finally. But in essence, what I want to do conceptually is I want to create a community of collaborators, not a community of competitors. I want to make learning fun and create lifelong learners who are curious and who love the process rather than who are struggling and taken down by memorizing a thousand things for anatomy. Medical information doubles every 73 days with a half life of 18 to 24 months. We are not going to have them memorize everything they need to know. We can’t. So what we need to do is we need to expose them, teach them how to access information and how to use it and how interpret it and how to apply it. That’s the future. And then the other piece of that, and pardon me for going on, I could do this for three [inaudible 00:16:31].

Dr. Andy Roark:
No, I love it.

Dr. Eleanor Green:
Is that I’ve seen some struggles in higher education about what do we do about AI and ChatGPT, because there’s certainly some detrimental parts and potential for cheating. And there are some that were trying to fence students away from that. I want to block down all those fences and I want us to teach students how to use AI and how to use ChatGPT and how to use it ethically and what are some of the pitfalls. That’s their life. We can’t keep it from them. We have to teach them how to use it. So things like that. There’s more, I mean, simulation, I think we’ve got to minimize the use of live animals in teaching until they get to patients. So I think they need to get really good. We’ve got wonderful simulations today, and so I’d love to have an experiential and simulation-based learning center in a collaborative way. I think we need to share, I don’t think we need to recreate all the wheels we need to share with other schools, and not just schools, but industry. And there are a lot of people out there doing wonderful things that we ought to bring in to our educational process. So like I said, I could go on and on. I’ll stop there and I can crank back up anytime you want.

Dr. Andy Roark:
No, I love it. I love where your head’s at. I love the collaborative approach. All of this just resonates with me so much, as far as ChatGPT and artificial intelligence. We’re not putting the genie back in the bottle. The best thing we can do is train practitioners to utilize the tools that they have. And as you said, in an ethical and helpful way, I love where your head’s at. I want to ask you to back up for a second a little bit. I’m going to go back to adaptability, because I think that’s really interesting about adaptability quotient, and kind of how this is such an important strength. Can you give me an example of what adaptability looks like in the clinic? Help me understand what that looks like in a doctor or in a technician that I see on the floor.

Dr. Eleanor Green:
Well, adaptability or curious, they use the challenge of change as opportunity and they use that for excitement to move forward and do something good. They’re risk-takers. They want to try the new things. They don’t say no. They say, “Let me think about it.” So they consider new things, or they say yes to new things, and say, “Yes, let’s try it.” And then if it doesn’t work, that’s great. All you’ve done is made yourself better by finding something that didn’t work. And I think they’re team players, they tend to collaborate more with others. They’re inspirational for others. So that’s what an adaptable person looks like, and that’s what an adaptable business looks like as well.

Dr. Andy Roark:
No, that absolutely makes sense. So when you kind of look into your crystal ball and you sort of see the profession and where it’s going, what are you most excited about outside of the vet schools? Are there things, when you look five years into the future, how do you see our profession functioning differently than it does today?

Dr. Eleanor Green:
Well, this is another dream. I don’t know if this is a dream I’ll fulfill. Maybe I will. I hope I will. I would love to create a hospital the future, as a functioning hospital, but also a demonstration hospital, because there are so many great things available to us today that in your end, busy life and you’re trying to look at the bottom line and what’s the return on investment and how can any patients that I see, it’s hard to raise your head up and look at what’s possible and what could be implemented new. Telemedicine’s one great example of that, that’s just one tiny example. A digital health is another. How do we integrate and provide connected care? But wouldn’t it be fun to create one hospital that has the technologies that are available to us today to provide connected care, integrated care, and again, I’d love to do that where you get veterinarians who are operating in that sphere, but we also have companies and other people with new things, who can bring those new things to this hospital and sort of demonstrate what they have out there.
And that is going to accelerate growth of some of our startup companies, or quite frankly, struggling with adoption. They’ve got a great product and it’s just hard to get people to adopt it. And yet we don’t have time in practice to try everything that comes along. And so if we can find a place where we can be the ones who are trying some of these things and then saying, “You’re going to love this.” We’ll work on this one a little more, but wouldn’t that be fun? And wouldn’t that be a great facility to have in association with a vet school?

Dr. Andy Roark:
Yeah. Oh, I love this vision, like I said, I’m sort of a Chinese junkie. And so all of this gets me super excited. Do you think we’re coming to a place of a bit of reset? So what I mean when I say that is there’s a traditional vet practice, which is what pops into your mind when you think of a vet practice. And I think that people have done a good job, really. They’ve tried to upgrade different pieces, but it’s almost kind of patchwork. We had the traditional model and we’ve kind of slapped a patch on it. At some point in my career, I’ve looked at different projects. I’ve run our programs or businesses, and I keep upgrading. And at some point I finally stop and just reset. I go, look, this is all built on an old operating system. I’m going to shut it all down for a moment and then start absolutely brand new, fresh. Do you see something like that coming in our profession as technology continues to advance?

Dr. Eleanor Green:
I do. And I think it is going to be technology driven. And just one tiny example, and this is an asset, not a criticism in any way, but PIM systems. Early on, they were very competitive and they still are somewhat, and they wanted to fence in again their system. But they’ve got, I think the PIM system that will win the future is the one that’s integratable and interoperative, and that’s in the end, that’s going to win. And right now, the ones that are winning or have been winning is the ones that feel like they hoard, you have to use me. And that’s not the last. So that’s going to be a big change, I think.

Dr. Andy Roark:
Well, I think you’re right too. And I also think as there’s these other companies that come up with new technologies that are really good and that people want to use, I think that the PIM system that wins is the one that allows that kind of integration and lets you pull these new things in and use them. Because you can see in practices where they say, “Well, I’ve got this classic system and it doesn’t use the interesting thing that my friends are using in their practice. And we’re not able to do that.” And I think you’re probably spot on. It goes back to your point about adaptability, doesn’t it?

Dr. Eleanor Green:
It really does. And there are some examples of that already with cloud, those that didn’t have the cloud, now they do have the cloud. There’s a lot of migration towards the cloud. Just one tiny example of that. People are going to go where it’s better. And I want to tell you one example, and this was a number of years ago, the principle applies, but this is a time ago. I know there were some concerns about we couldn’t get anybody to buy my practice. So this is again, a number of years ago, and I was at this meeting and it was the AVMA and the AAVMC, and they had student reps there. And this was a very loudly expressed concern. Nobody will buy my practice, et cetera.
So I went and sat with the students and I said, “Say, tell me about that.” And they said, “Oh, yeah. Well, here’s the thing. We don’t mind buying a practice, but it’s antiquated. The equipment’s outdated. It just doesn’t even have digital records. It’s still all paper, medical record system. What is there to buy?” I know that’s outdated. Most people don’t do that anymore, but when are the ones today going to be outdated and not going to be sold because they’re so much more, and I think we need to be mindful of that.

Dr. Andy Roark:
Yeah. No, I think that’s a great point. I love where your head’s at. I love your positivity about the future. I love your optimism about technology. It’s so refreshing, and you and I are so in alignment in that regard. Dr. Green, where can people find you online? Where can they learn more? I love that you’re writing. But yeah, where can people who want to see more about your adventures kind of find you?

Dr. Eleanor Green:
Well, I’m on LinkedIn, so you can find me there. And I’d love to link up. I link up with several every day. My email address is dreleanorgreen@gmail.com. That’s all lowercase, no dots. And it’s D-R-E-L-E-A-N-O-R-G-R-E-E-N@gmail.com.

Dr. Andy Roark:
Perfect.

Dr. Eleanor Green:
Yeah, that’s the main two. I’m on Facebook, but I would say go to LinkedIn rather than Facebook.

Dr. Andy Roark:
It’s amazing how often guests are on LinkedIn and not the other social media, so it definitely seems to be a common place where we can find people today. Anyway, thank you so much for being here. Gang, thanks a lot for tuning in. I hope you enjoyed it. Take care of yourselves, everybody.
And that’s what I got for you. That’s it. I hope you guys enjoyed it. Thanks to Dr. Eleanor Green for being here. I can’t wait to see how her new deanship goes and the start of her new vet school. I am absolutely rooting for her and the vision that she sort of has for education in the future. Anyway, guys, thanks for being here. If you enjoyed the podcast, leave us an honest review wherever you get your podcast. It means the world to me. It’s how people find us, and I hope to talk to you again in the future. Take care of yourselves, everybody. I will talk to you soon. Bye.

NOMV: From Facebook Group to Industry Power

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Dr. Shannon Emmons, practice owner and member of the NOMV board of directors, joins Dr. Andy Roark to discuss the rapid growth of Not One More Vet (NOMV) and the mental health and wellness programs they have been developing.

This episode is brought to you ad-free by CEVA Animal Health!

LINKS

NOMV.org

Race Around the World

NOMV Lifeboat

NOMV Anti Cyber-Harassment

NOMV CLEAR Blueprint

NOMV Advocates Program

NOMV Gala

Dr. Andy Roark Resources 

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course

Dr. Andy Roark Charming the Angry Client Team Training Course

Dr. Andy Roark Swag

ABOUT OUR GUEST

Shannon Emmons DVM is a graduate of Atlantic Veterinary Class of 2017. She is a small animal veterinarian practicing in southern Maine and the owner of Eliot Veterinary Hospital.

Shannon first got involved with NOMV after her own mental health struggles and worked to start the NOMV Ambassadors Committee. She is the Education Committee Co-Chair and a member of NOMV Seacoast. Shannon joined the NOMV Board of Directors in 2023.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinarinary podcast. I am your host, Dr. Andy Roark. Guys, I got a good one today. I am here with Dr. Shannon Emon. Shannon is a, she is a practice owner and a practicing veterinarian in Maine and she is a member of the board of directors for Not One More Vet or NOMV as they’re commonly known. She’s here today talking about and all of the initiatives they have rolling out and boy, they have a lot of ’em. If you are still thinking of NOMV as a Facebook group, this is going to be a big fun episode for you because they have a ton of initiatives that are coming out and we hit some of the highlights, not nearly all the stuff they have going on, but I’m really interested in what do we do about supporting mental health and wellness in the vet profession?
And they are putting their money where their mouth is, they are doing the work. They have a lot of programs coming out, is a really interesting download on all things non being what they have going on. Guys, this episode is made possible and brought to you ad free by my friends at Ceva Animal Health. They are partnering with NOMV on their Healing Broken Hearts Initiative. This is a joint wellness program they have with where they are giving 5% of Cardis sales to NOMV Card is a drug for heart failure. If you’re unfamiliar with it, I’ll put a link in the show notes to a previous episode that we’ve done on Cardis and what it is. But yeah, it’s thanks to them for one, for doing the work and supporting NOMV and thanks to them for supporting this episode and making it possible. Guys, let’s get into this.

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. Shannon Emmons. How are you?

Dr. Shannon Emmons:
I am good, Andy. How are you?

Dr. Andy Roark:
I am so good. I feel like we almost could have done this podcast in person. For those who don’t know you, you are a practice owner in Maine. What part of Maine do you live in?

Dr. Shannon Emmons:
Southern Maine. Yeah, let’s… you won’t know where I’m from.

Dr. Andy Roark:
It’s not Bar Harbor in Maine. I that’s, that’s where I was. I just got back last night. I did the family vacation. We went to Bangor and then a Bar Harbor and then up to Nova Scotia and PEI, which is where you went to vet school.

Dr. Shannon Emmons:
That’s where I went to vet school!

Dr. Andy Roark:
School. I know. And so I was just like, I was looking at your bio and I’m like, gosh, Shannon, she’s like Visa. She’s everywhere I want to be. And so anyway, it’s a joy and a pleasure to have you on the podcast. You are a practicing vet. As I said before, you’re on the board of directors at NOMV, which is Not One More Veterinarian. And I wanted to get you on today to talk a bit about NOMV, there’s not many organizations that I have seen that have grown as fast or has branched out as much as Novi has. And I don’t know that a lot of people understand what all Novi is doing right now. And so just to kind of set the scene, my first interaction with the, Not One More Vet group was a Facebook group, which was great, but it was a very big, very raucous Facebook group about mental health and wellness in veterinarians. And that’s kind of how it imprinted in my mind. And I was just kind of shocked recently at how inaccurate that is as far as the depiction of NOMV. So lemme just pause here and ask you, why don’t you give us a little bit of background about NOMV and your path to the board of directors?

Dr. Shannon Emmons:
Sounds good. So NOMV started in 2014 after the death of Dr. Sophia Yin. Nicole MacArthur, who is a vet, was really blown away that we as a profession have such a high rate of suicide. And she said, if I don’t know about this, I’m sure there are other people who don’t, and how can we get resources to everyone or just check in on everybody. So the Facebook forum started and I graduated in 2017 and it was cool to watch because as I joined the Facebook forum, I was seeing the need for, we were doing GoFundMe for fellow vets to try and raise money for their inpatient therapy or they needed help and then it got nonprofit status and it just blew up. And even since I’ve been involved, I started working with Novi in 2021. We’ve put on a couple of huge new programs in addition to a lot of already existing programs that we’ve been able to continue to grow.
So I started after my own mental health crisis, I had a friend reach out and say, Hey, I want to figure out how we can get NOMV locally. And I was like, that’s great. I could have used someone locally. And so I talked to Carrie Journey and she said, Hey, we’re already working on that. So I joined as part of what’s called the ambassadors program, and we started making local chapters. So there are NOMVa chapters popping up all over the us. We have one in Canada now and we have one in Brazil. So that was kind of my baby for a while, was getting that up and running. And it then led me to the education committee,

Dr. Andy Roark:
Which I want to jump in here. So tell me more about that. What does a local Novi chapter actually look like? So I’m a veterinarian. I’m here in South Carolina. If there was a local Novi chapter, what does that mean? Do they have meetings? Is it a meetup? Help me get my head around what practically is that?

Dr. Shannon Emmons:
So it’s whatever the community needs really. We have guidelines for what you can and can’t do in terms of you can’t talk badly about people or something like that. But we have groups that do. Texas is our definitely by far biggest chapter. Mallory Preston, who’s in charge of that, has really done a lot of webinars and Texas is a huge state, so they’re not meeting in person a lot though they have, they’re doing a lot of webinars, meetings with local people and whether that’s educational or whether that’s walking through a guided meditation, our chapter, so I helped formed NOMV New England. We are helping with the NOMV Gala, which is going to be in Boston in October. So we’re doing some CE there. We’re going to be doing an outreach event there. And we’re also helping with the five K in. And we did a veterinary appreciation event. And all of the chapters have really made their own takes with it, which is really great to see because it could be as simple as just getting people together for coffee or going for a walk, or it can be a big organization, however people want to do it, what the need is in their community. But the big thing is that there are people available locally if somebody needs help.

Dr. Andy Roark:
Yeah, I love that. I’ve always felt like when you’re trying to run something that’s a national program, getting people who are inspired on the ground and giving them the autonomy to do the things that they’re excited about or they see a need for, I think that’s wildly underrated as far as how to set up an organization. I’ve always seen it be very successful and it just for something like nabe where you obviously have people who care a lot about mental health and wellness, giving them a platform and just sort of saying, Hey, figure out what’s going to be helpful for the people in your area and make it happen. I think I love that flexibility. I think a lot of times you can come up with things that are prescribed that don’t really meet the needs of individuals. They might work in one place, but it’s not what other people are really looking for.

Dr. Shannon Emmons:
It’s been great to see people be able to do what their community needs and get the help into their communities, whatever that may be. And they’re at local conferences, meeting vets in their area, they’re doing local events, and it’s been great to just build that community from an organization that was largely virtual. And that’s like what you said, people know Novi for the forums, but they don’t realize just how much else there is to Novi and the help that’s available rather than just the Facebook groups, which are great. And we’ve expanded off of them. There’s the support staff group as well. And I think one thing I would love for everyone to know is we are not just for vets, we’re for everyone in the vet profession.

Dr. Andy Roark:
That was a big point of growth for you guys for a long time. It was just veterinarians and it was kind of a pain point. There was support staff and paraprofessionals and things. Yeah. So when did you guys start having groups for the support staff?

Dr. Shannon Emmons:
I will be honest, I’m not sure exactly the year on that, but I believe it was just a couple of years after everything got going because we really needed support staff to have help too. I mean, everyone in this profession has a hard time. We all have our different battles we have to deal with on a day-to-day basis. So making sure, and then students too, we branched out to vet students because and vet tech students, it’s not easy to go through vet school or tech school and to make sure those people have support as well was something that we decided also needed to be taken care of.

Dr. Andy Roark:
About how many chapters are there now? So switching back to the ambassadors, what are we talking about?

Dr. Shannon Emmons:
I believe there are nine now. So it’s always a little bit of a process just because we have to go through volunteer onboarding just so that we make sure people are adhering to Avi’s guidelines in terms of talking about suicide in a healthy way, making sure people are Q P R trained, which is the suicide prevention training. So anybody who gets involved with NABI has to go through that process. So we really just launched the chapters about a year ago and we’re excited that, I mean, Brazil is awesome. We’ve already got an international chapter, which is incredible and we keep having people apply too. It’s just a little bit to get them up and running. So I think that’s our big pausing point right now. But we keep getting the interest and we keep getting the people who are, like you said, really excited and really want to do things in their

Dr. Andy Roark:
Communities. How can people find out about chapters around them if people are interested in trying to get their own chapter going or getting involved with the Ambassador program? And how would you advise people to get involved?

Dr. Shannon Emmons:
So there’s, NOMV.org is going to be our best resource for all things. And there’s a list of our chapters and each chapter has a Facebook group, which is not necessarily a private Facebook group, I should say, a Facebook page where they post whatever they want to, whether it’s ways to support one another, local events that they’re doing. And then each chapter also has their own email address. So right now I’d say go to the page, see if there’s anyone local and if there’s not, that can be you. Yeah,

Dr. Andy Roark:
I love it. Cool. Talk to me about the things that you guys have started expanded out into. So I talked to Brian Bwin on the podcast not long ago about the non-clear blueprint, which I think is fascinating for workplace wellness. It’s a great program I’ve thought a lot about since I had him on to talk with him. But yeah, lay out some of the other things that you guys are doing.

Dr. Shannon Emmons:
So yeah, clear is amazing and has been really exciting in the past year since we started that. Another one that’s newer is called Lifeboat. It’s an anonymous peer-to-peer support group. So for the people who don’t like the Facebook forums or aren’t on social media, it allows them that same one-on-one support and mentorship and can get them in touch with the help that they need. And it’s completely anonymous. So that’s been a really great new program that we’ve gotten a lot of use of. And I know one of our former board members just mentioned she was at a conference I think two days ago and someone said Lifeboat saved their life because somebody was able to get the help that they needed.

Dr. Andy Roark:
So is this sort of a standalone webpage as well? I guess

Dr. Shannon Emmons:
It’s on the Novi website, but then you get iNOMVted into, we’re very careful about anonymity. We’re very careful about who gets into veterinary things. You hate to think about it, but the public can hold things against us in ways we don’t necessarily always expect. So we’re very careful about who can get in and who can be involved. But they get in, they’re assigned a person. If you want to be somebody’s mentor support, you can also enroll for lifeboat. And there’s resources in there on how to talk to people about certain subjects and what to do if this is happening. And it gives you the resources to be able to help. And we know that I’m not a mental health professional, I’m a veterinarian. So there is always that if you don’t know what to do, there’s always a way to find the help that you need, whatever that may be. And lifeboat gives a lot of opportunities for education in that regard. But again, if you need the help, you can get in there, get matched with somebody, and then start talking.

Dr. Andy Roark:
Okay. You said the public can hold things against us. Tell me a little bit more about what you mean about that, because I’m curious about the challenges that Naves faced. Obviously it’s a delicate balance when you’re trying to help veterinarians who are in practice facing mental health struggles and things, but beyond that, tell me what you meant when you said that.

Dr. Shannon Emmons:
So I’ll talk about another program while I’m talking about this, but we just recently formed the Anti Cyber Harassment Task Force in light of M V M C had the huge cyber bullying attack last year where they took an owner’s surrender in and it ended up going all over the world. It ended up being

Dr. Andy Roark:
The huge thing. Yeah, that was a nightmare.

Dr. Shannon Emmons:
So I’m local to them, and so I was really invested and rare breed, who owns M V M C said, what can we do to make sure this never happens again? Or at least if it happens again, we had the resources, how do we get people the resources? So we’ve had to be careful with that too, because we don’t want the general public who could potentially come back and use this stuff against us to have access to the resources. We’re trying to offer veterinarians, veterinary practice owners to combat cyber harassment. So there’s always and there Facebook groups that are attacking vets and there are always those groups that just have to be the negative in the world and start stuff that is so inappropriate. It’s great. You’d be blown away by the stuff that we do with sometimes.

Dr. Andy Roark:
No, I can imagine. I’ve been around the old social media internet world for a while. I can imagine. So I’m curious, so when you think about the future, do you think about health and wellness in vet medicine? How optimistic or pessimistic are you when you look at this? Do you feel good about the progress we’ve made in the last 10 years? Do you feel like we have big challenges ahead? Talk to me a little bit about, because you get up every day and you go into practice and you do your stuff and you step up and you’re set an ambassador for your region and you’re on the board of directors at NOMV. Talk to me a little bit about the headspace that you get in when you think about where things are going as far as mental health and wellness in the vet profession.

Dr. Shannon Emmons:
I think we have dueling pros and cons and it’s hard to say just kind of how things are going to go because I think we as a society are starting to value mental health more, which is amazing. People are talking about it. There’s less of a stigma. People are asking for mental health days off. People are asking for the time that they need, whatever it may be. But then we get the pushback too from business owners of like, Ugh, they’re complaining about having to work 40 hours a week or whatever it may be. So there’s that kind of push and pull. And then there’s the lack of veterinary professionals. I think the shortages that we’re all dealing with. I mean, I’ve been hiring for an associate for a year and a half, and I know clinics that have been hiring for years. And if you look in our area, everyone’s hiring for a vet, everyone’s hiring for techs.
And that I think is hard because those of us who are still here are taking on all that extra burden. And as you know with Covid, it didn’t get easier. We saw that huge increase in pet adoption rate and where did all of the vet staff go? So that’s my biggest concern. But I think that as NOMV continues to grow and we continue to make these programs that make Vet Bed more sustainable, the more we talk about it, the more we make people aware of ways that they can get the help and they don’t need to suffer through a bad job or they don’t need to worry about cyber harassment if we can take some of the load off. We’re trying our best to do that from every angle.

Dr. Andy Roark:
Yeah. What are you most excited about when you look at NBE and you look at all the things that are coming out in the next, say five years, you’re looking ahead and you go, this makes me smile, or this makes me happy, or this makes me feel really positive.

Dr. Shannon Emmons:
We’re planning a Novi conference. It’s in our five year plan to have a Novi conference, and we’re going to do a little baby conference at our gala this fall. So it’d be nice to just dip our toes in the water, but I would love for us to have a way to get people the mental health resources, like come to this conference, we’re going to make it mental health friendly. We’ll probably do half days and then take it easy the rest of the day. It’s still very early in the works. We have no concrete plans, but I am really looking forward to that and just meeting the people in our veterinary community. Every time I speak, every time I go to a conference on behalf of nafi, hearing how much we’ve done for people, it means that what we’re doing is important and it’s helping and it just definitely makes me want to keep doing what I’m doing.

Dr. Andy Roark:
Yeah, that’s fantastic. Real quick, I’m going to let you shout out any other programs you guys have coming up. Anything else that you’re working on that you feel like people should know that either has come out recently from NOMV or is in the pipelines that people should be looking for?

Dr. Shannon Emmons:
I think the big thing that’s coming up that I would like people to know about is our race around the world, which is virtual, but we also have an in-person option this year. So it’s during the month of September and we are just promoting Novi and General Public awareness, making sure people know what we are and do it with exercising, which is good for our mental health. And it’s one of our biggest fundraisers for the year too. So you can join as an individual virtually in person. You can start a team. My clinic competes with a clinic up the street every year and we’re already trash talking one another, get a little competition going, it’s all in good fun, but it’s whatever you want it to be. But I’m really excited that we have the in-person race, which is going to be at our gala in Boston on October 7th, and we have Temple Grandin coming to that. So that’s very exciting and we’d want to thank everyone who helps our organization on a day-to-day. Siva in particular is currently running Healing Broken Hearts program where they’re donating 5% of car Dallas sales, which we super appreciate and we have so many other great sponsors who help us to do our work on a day-to-day basis because without them, we would not be able to do so much of what we do.

Dr. Andy Roark:
That’s fantastic. I’m going to put links in the show notes to all the stuff we’ve talked about. I’ll mention the Clear blueprint Brian was on recently talking about it. I’ll put links to information on that as well. novi.org where you can find the Ambassador program information, all the things that we talked about, the lifeboat links, I’ll put all that stuff in the show notes so everybody has it. Are there any other links, Shannon, or resources that you think people should make sure to check out or be aware of?

Dr. Shannon Emmons:
Novi List is on the website, so basically anything I’m saying to you can get from the website, but Novi List is kind of like Angie’s List, but for veterinary professionals. So if somebody has a therapist locally that they’ve really liked or a lawyer they’ve locally really liked, it’s a great way to find local resources. I’ll send you to the link to the Race Around the world, sign up and to our gala registration.

Dr. Andy Roark:
Sounds great. I’ll put all that stuff into the show note. Dr. Shannon Emmons, thank you so much for being here, guys. Thanks for tuning in and listening. Take care of yourselves, everybody. And that’s it. 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 Shannon for being here. Thanks to Novi for all the work they’re doing for our profession. Thanks to Siva Animal Health for making this episode ad free and for their Healing Broken Hearts initiative gang, take care of yourselves. Be well. I’ll talk to you soon. Bye.

Does Production-Based Pay Undermine Veterinary Team Well-Being?

by

Dr. Ivan “Zak” Zakharenkov joins the show to talk about a recent article of his, and the wellness research he is doing in the veterinary industry. He and Dr. Andy Roark discuss the impacts of production-based compensation on wellness and well-being, and how veterinary teams might be compensated in a more satisfying way.

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

LINKS

Article: Does Production Pay Undermine Veterinary Team Well-Being?

Galaxy Vets: An Employee-Owned Veterinary Group

Veterinary Innovation Podcast

Dr. Ivan Zak on LinkedIn

Book: Great Game of Business
(Links to Amazon.com are affiliate links and help support the show)

Dr. Andy Roark Resources 

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course

Dr. Andy Roark Charming the Angry Client Team Training Course

Dr. Andy Roark Swag

ABOUT OUR GUEST

Dr. Ivan “Zak” Zakharenkov is a veterinarian, entrepreneur, and advocate for the well-being of veterinary professionals. After graduating from the Atlantic Veterinary College, he worked in various settings across Canada, from emergency to general practice. Twelve years in veterinary medicine inspired Ivan to create Smart Flow, a workflow optimization system, and Veterinary Integration Solutions, a consultancy serving veterinary consolidators. In 2021, he founded Galaxy Vets, an employee-owned veterinary healthcare system that prioritizes burnout prevention. He holds an MBA degree from the University of Cumbria in international healthcare management. Ivan serves on the board of Galaxy Vets Foundation and co-hosts Veterinary Innovation Podcast and Consolidate That!

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I’m your host, Dr. Andy Roark. Guys, I’m here with the one and only Dr. Ivan Zak. Ivan is the CEO of Galaxy Vets, and he does a lot of things. He wears a lot of hats. He’s a practicing emergency vet. He’s a genuinely, deeply interesting guy. This is a sprawling conversation about, it starts off talking about compensation and production-based compensation and the impacts it has on wellness in vet medicine. And then we get into lots of different aspects of how vet medicine works and what are some of the underlying issues that we see with burnout, and is vet medicine really worse about burnout than other industries? And it all goes from there.
And so anyway, it is a really good, fun discussion. A lot to think about. I thoroughly enjoyed having Ivan on the podcast. Gang, I hope you’re going to enjoy this. 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, Dr. Ivan Zak, thanks for being here.

Dr. Ivan Zak:
Hey, and nice to be here. Thanks for having me.

Dr. Andy Roark:
Man, I am so psyched that you’re here. First of all, I thoroughly enjoy talking with you. You are just an interesting guy. You’re doing a ton of stuff. For those who do not know you, you are the CEO of Galaxy Vets. You were the creator of Smart Flow. You are a co-host of the Veterinary Innovation Podcast. You’re practicing, you do some emergency work, you’re still in practice. You got your hands in it. You’re just a genuinely interesting guy doing a lot of stuff. And so I was really happy to have you on because I saw something that you wrote on VIN. It was on the VIN News Service. And first of all, just stop and shout out to the VIN News Service. I love that team. They just do do great work, and they just put out really interesting stuff. So if you’re not reading VIN News, you’re missing out.
But anyway, you wrote an article called, Does Production Pay Undermine Veterinary Team Wellbeing? And this was something that I saw it immediately, it spoke to me. I think this is fascinating. So we talk a lot about compensation of veterinarians on this podcast and how the business of vet medicine happens. And so production based compensation is really common in our industry. And I actually just got an email from a veterinarian who’s not paid on ProSal or production based compensation, and they were like, “I feel like I should be. Do you agree?” And I thought, oh man, production-based compensation has become fairly ubiquitous in our industry. And I’ve always had some questions about it.
And let me be open and say I get paid on production when I work in the practice and I don’t seem to have problems with it, things like that. But I’ve always been a little wary of being like, yeah, paying doctors on production is the answer. It does not have drawbacks. It’s the way we should go. And so I saw your article and it really spoke to me. Let me just pause here for a second and say why, if you don’t mind, lay out your philosophy here as you start talking about production-based compensation as it interacts with team wellbeing.

Dr. Ivan Zak:
Yeah, so the topic is fairly early long standing with me too, because as a practicing veterinarian, I actually worked only my first year out of vet school on production because I saw the numbers. They said You could be on salary, you could be on production. And then they showed me numbers in three months and you would be an idiot not to start on production. I was making better money. And then the first year out, I think I was making more than anybody in my class. I jumped right into emerge. So that was good. But then because you’re an emergency and because I realized that when people are yelling in your face that you’re doing it only for money, then that was my, I was like, what if I was not, and I can prove it?
And then since then, after the first year, never worked on production. So I had my own thinking about it and it’s just an opinion. And you put three vets in the room, you’ll get four opinions as usual. So we tried to test that. I wanted to see actually statistically can we survey? And the third year in a row we’re doing this study where we are measuring the burnout and what we do in parallel with that, we give it a color and we say, okay, well what does burnout correlate? So one thing we do, we measure how burnout the industry is based on a sample size, usually about 2000 people.
And then with it, we had certain hypotheses that we throw in every year into a study. For example, what does compensation method do to burnout? What does the age do? What does the experience? What is the gender? And things that we want to know to better understand who’s the biggest risk, and then how can we manage hospitals, people, and everything to have less burnout? So that was the intent with which we studied it, and I wanted to prove myself right or wrong in my own hypothesis that production’s evil. So that was how we started.

Dr. Andy Roark:
Okay. You were a bit more to the point that I was, but yeah. All right. So the null hypothesis is production is evil. All right. Talk to me a little bit about, before we get into this, talk to me a little bit more about the burnout study. I have been watching this for years. I read it whenever it comes out. I’ve not talked to you about it in the past, but I have always watched it and I’ve always appreciated that you do it. It seems like good work. You do get a pretty good sample size. It’s across different roles in the vet profession, things like that. Talk to me about where your interest in burnout came from and just start to tell me the story of the previous years leading up to this one, if you don’t mind.

Dr. Ivan Zak:
So I got exposed to it through my personal experience and I’m fairly comfortable talking about it right now. But I personally almost lost my life through a suicide attempt. And essentially I didn’t know that. Now I know about myself back then and then I just thought, I hate my life now. I understand that more than myself. People hate life and a lot of them are veterinarians. And I’m comfortable because I think that we should talk about these things, especially if we get through it and then we are trying to analyze it.
So when I pivoted in my career career, we built Smart Flow, I love our profession. And at the time when it happened, I hated it. So then when I had a choice in what am I going to do next? And I was going through MBA and I chose as my thesis for the dissertation to research burnout, I wanted to find out is it systematic? Is it actually a problem in the industry? And if it is there a solution for it? And I wasn’t looking for a solution in medical or mental or anything like that. I was thinking that there’s probably a management problem to it. I think we’re driving people insane and then is there something that we can do better by managing people and prevent burnout through that? You should do yoga, you should meditate, you should work in flow that we talked about before recording. All of those things, but can we manage people better?
So I made it my career choice now in the next hopefully five, 10 years to focus on understanding how can we manage organizations better to prevent burnout. And that’s why this study became the research portion of my dissertation. And I’ve been repeating it since then. This is the third year that we came up with it.

Dr. Andy Roark:
Yeah. First of all, I love that and I think you’re spot on when I talk about burnout and preventing burnout, to me, I don’t like when I hear this idea that self-care is the answer to burnout. Because what you’re doing then is you’re acting like the person, the individual on the floor in the clinic, they have the power to take care of themselves and there’s no obligation of the practice that they’re in to not burn their people out. And I go, look, let’s be honest, it’s a division of labor here. It’s one, I have responsibility to take care of myself and to rest and recharge, and my practice has a responsibility to not throw me to the wolves every day and push and not let me take breaks or make me feel bad for taking breaks and things like that. I think about in two levels there’s the individual level and there’s a practice level when we start talking about this.
So listen, I’ve always enjoyed that you do this. I also, I a hundred percent with you on telling the stories of burnout and depression and things like that is just, I went through a period of burnout. It’s been about four years ago and I burned out pretty bad. And the thing that bothered me the most at the time was that I didn’t know anyone who had really burned out and then come back and seemed to be having a good time later on. And it felt like the end for me. And so I’m like, I did it. I would not recommend it. If you’re like, “I’m thinking about burning out,” I’d be like, “You should do yoga instead. Go on vacate, do something else, pick something different.” But if you do decide to burn out, just know that you can work through it. And honestly, you can have the best days ever on the other side.
So anyway, I love that you did that. Let’s start to talk about your findings on compensation in wellbeing. So will you break that down for me?

Dr. Ivan Zak:
Yeah. So the hypothesis, every research, our first research that we’ve done for my actual dissertation was we wanted just to measure it and then understand, is it because I thought maybe it’s like a shark attack, someone is killed by a shark and everybody’s like, “Oh my god.” But no truly we’re burnout. We determined in the first year, but then in parallel we just ask random questions like, what’s your age? What’s your gender? Do you work in corporate setting? I thought that corporate is evil, so therefore they probably burn out people more. Turned out that they’re actually not true, which-

Dr. Andy Roark:
Okay, I believe that. Yeah.

Dr. Ivan Zak:
Yeah. So that was proven wrong. So then we thought, oh cool. So we have a standard measurement of burnout. There’s a standard thing that we use, it’s called professional fulfillment. And this is just 16 questions, but it gives you this temperature gauge. And then in parallel we’ll throw in questions that we’ll read the stats and say, okay, people that are over 40, they’re less burned out than those that are under 40. And then women are more burnout than men. So there’s things that we started to look for last year. I was interested is goal setting in your career and life affecting your burnout status, which it does if you don’t have goal setting.
And this year I was wondering, okay, the evil production that I thought it was, is it actually evil in terms of burnout? Does it contribute to burnout? And that was one of the three things that we tested this year. And we’ve proven myself almost wrong. So essentially it was the reverse, which was shocking to me because there’s multiple studies in human health where it clearly says that production actually does cause burnout. So that’s an interesting finding.

Dr. Andy Roark:
All right, so talk to me about this. So what you’re saying is in the studies that you’re doing, you found that production was anti burnout related. Do you feel like being salaried is more likely to lead to a path to burnout? Tell me about that.

Dr. Ivan Zak:
So not necessarily in that direct correlation. It wasn’t like, oh, stop being on salary and you’re fine. You can’t apply it as a treatment. But the point is that what we found out, people that have less financial security and certainty in the future are more burned-out, which logical, but we wanted statistically to prove that. But then the second comparison of data showed that people that are on commission feel like they have better financial security. So it was not a direct, but it was an inference through this people that are on commission or production, they feel like they’re more secure in their financial future or retirement planning. And it turned out that those people are less burned out. So it didn’t show that it directly causes the burnout, which I was surprised. It could have proven my 20-year hypothesis being wrong. But that’s why you do the research to prove yourself wrong.

Dr. Andy Roark:
No, that makes sense to me.
Hey guys, I just want to let you know real quick, I got something really big coming down the pipes that is super fun. It’s not a workshop, it’s not a webinar, it’s not a live event, it’s not a summit, it’s not a program. It is something that is just going to be a ton of fun. And some of you have already found the path to learn more about it. I’m not going to tell you what it is here, I’m just going to tell you it’s great and it’s coming. And if you want to look around a little bit, you might be able to find the path to learn more. And so some of you already have, some of you have not.
If you’re like, “I don’t know what he’s talking about.” [inaudible 00:12:53] don’t know if you like puzzles, if you like trivia, trying to figure things out, find the root of questions. It might be worth poking around DrandyRoark.com. Definitely the newsletters, if you get the newsletters, there’s fun stuff there. But if you like figuring things out, it might be time just to poke around a little bit. We got some fun stuff going on. That’s all I’m going to say. I’m just going to leave you with that, guys. As you were. Enjoy the rest of the podcast. I’ll have some more news for you sometime soon.
So I like [inaudible 00:13:26]. Do you think the idea basically is that if you’re paid on production, then you feel like you have more control of your situation as you summarize it that way?

Dr. Ivan Zak:
I think that’s one of those things. But if I correlate it to burnout, because burnout has a lot of people only talk about burnout. They really imagine it’s like working too much. I work in a facility right now, I do a couple shifts a week in ER for fun. And I have clear understanding that people are burned out in it, but they don’t have a full workload. This hospital is not loaded enough with the patients, it’s a new startup, and they have all other things that organizations can do wrong to actually cause the burnout, such as there’s lack of control, they feel like they’re top-down managed, there’s complete disconnects of values. So that’s the second one.
These are defined in 1986 by Christina Maslach who researched burnout in organizational behavior. So these are the actual triggers. So lack of control, conflict of values, insufficient reward not only in monetary because they actually compensated well, but not enough thank you and just basic gratitude, unfairness, favoritism people on the same sort of level getting different pay rate with no explanation. And community breakdown, which means that we don’t know how to give feedback to each other and we don’t know how to resolve conflict, which is systemic.
So it’s not about working too much, it’s about other things that can happen with it. So I think that when we talk about people on compensation or not compensation, I think we need to look at the big picture of how people are working. Because let’s say I’m on production and it seems like I’ll have less burnout, but what I’m doing, I’m driving the entire team crazy and I’m just go, go, go, go, go because I am chasing the dollar. I want to be a productive, but what techs get per hour while I’m burning them out? And they’re actually more burned-out than vets usually. So I’m actually creating the environment in which techs assistants and receptionists are running crazy without compensating more. So the question of compensation of the organization is bigger than just one individual as a vet, but how do you compensate the team and align the incentives so everybody’s rowing in the same direction?

Dr. Andy Roark:
Is it possible to see that? Is it possible to look at the support staff who work with doctors paid on compensation versus support staff who work with salary doctors?

Dr. Ivan Zak:
So we are trying this, so we just launched it two months, actually two quarters ago, and we launched this and it’s very interesting. So there’s a book called Great Game of Business. It’s the whole methodology. And what they recommend is creating this bonus structure in which essentially what vets don’t do as business people, they don’t set the budget. That’s just, corporations do that. Individual vets, they never say, “This is my budget.” Because when we hear budget, we always think that budget is how much I can spend. This is not in the budget. You can’t buy an extra chair, you can’t buy another anesthetic monitor or whatever. But also budget is how much I’m planning to earn.
So what we’ve done in our bonus design, we said, okay, our plan and we reporting to investors is to be in this budget, you need to hit this number in June, this number is July, this number in August. If we all as a team hit the number above that, anything in surplus will be split between the teams as a bonus. The bonus is not in January, here is Christmas bonus for no reason. It’s not a gift. The reward with a very clearly articulated goal.
So essentially I think, and this is my new hypothesis, is that this way if the doctors on the production driving the team and driving everybody, but then the team knows is if they help this doctor to produce and they hit it above the budget that we clearly identified for them, we show it actually in the app. We have an app that all our employees have. They know how much they make per day in the clinic. It’s open book management and they’re trying to hit it above the waterline that we set. And if they do in the end of the quarter, each quarter they get a little check that represents the bonus.

Dr. Andy Roark:
Yeah, I like it. I always like it. So I’m a big fan of positive reinforcement and like you said, giving positive reinforcement when it’s a clear link to the behavior that we’re reinforcing and you’re like, this is what it is and this is what you did and this is when you’re successful and here’s how we’re being rewarded. That’s always spoken to me. Talk to me a little bit more about we have a problem with feedback and conflict resolution. You said that’s systemic. What do you mean when you say that?

Dr. Ivan Zak:
Well, we had a really interesting conversation today in our podcast about in general how we communicate in veterinary domain. So I can’t quote the study and I know that it floated through my desk one day, but apparently vet industry is the lowest EQ that you can find profession. People that want to work with animals and not talk to people, everybody says that. And then we’re just not trained through either we’re in tech school, whether we’re trained for animal attendant or veterinarian, there’s very little on how to talk to each other. There’s how to talk to clients. There’s how to articulate diagnosis in more simple terms. Now it’s there in schools, there’s never, how do you become a leader? How do you become a communicator? How do you provide and take, which is very important feedback, and then how do you resolve the conflict?
So I think that those are the huge, huge deficiencies. And whenever we go into a new team, so when we acquire practice, we go in and we understand, do people know that? And it’s just a baseline. It’s the basic training where you type people. I hate saying it like that, where you’re typing people, but you do the disc, you understand what they are so you can communicate with each other and understand that person like me would never talk to someone analytical and solve something on the spot. They’ll need a day to think about it. And then also, how do you resolve things? How do you don’t become passive-aggressive? All of these things, I think we just don’t have it. It’s just not in the curriculum wherever we come from. And I think it is pretty chronic in the industry.

Dr. Andy Roark:
That does make some sense. If you had your magic wand, and so you’re looking at this and you’re looking at the data, not just this year’s wellness study, but previous year’s wellness studies and we’re talking about feedback and we’re talking about resolving conflict and things. How do you fix this profession in the next five years? You got magic wand power, you could make some changes. What would you do?

Dr. Ivan Zak:
Yeah, that’s a good question. That’s a million dollar multimillion dollar question.

Dr. Andy Roark:
Oh, sure.

Dr. Ivan Zak:
I think if you let people solve their problems and the place where they work themselves, that’s the main thing. Stop being a manager who decides for the people that do the job how to do their job. If you can just give them the autonomy to decide that I have a problem X, but you need to give them power and say you are responsible and accountable. And then that leads to the compensation through the proper compensation structure that by fixing these problems and becoming more productive and efficient, you’re rewarded at the end as the business owner or just someone who receives bonuses is there as well. I think if we can allow all of our people, techs, vets solve things and the management would just support and create a system of idea generation and putting them into practice, I think that would be the best way.

Dr. Andy Roark:
I have this theory that veterinary medicine, I don’t have a survey to back it up, but I have this theory that veterinary medicine, I think we’re disproportionately perfectionistic. I think that there is a perfectionistic tendency in veterinary medicine. I think there’s a lot of people who want to get things right. I think we select for that tendency in veterinary schools and our education and things like that. And my thesis goes, if you buy into the idea that veterinary medicine as a whole is more perfectionist than other industries, I think that this is the number one reason that we struggle to delegate effectively is because there’s a right way to do it, and we know what the answer is, and we want to give the answer.
And in order to delegate effectively and empower people, just like you’re saying, Ivan, I’m a huge believer in this, take people the problem and let them come up with their own solution. But I feel like people struggle so much to do that because they want to say, “This is the answer, now do the answer.” And that just, it’s hard to get traction. Do you buy into any of that? Do you buy into the perfectionistic part? Do you think that that’s a barrier to letting people be empowered to fix problems on their own?

Dr. Ivan Zak:
A hundred percent. And I think that this is a huge part of our burnout problem because it’s almost like we’re in the veterinary podcast, so it’s almost like we’re breeding and selecting the breed with a certain traits for intelligence, solution orientation, everything else. But in parallel, we get this perfection. And perfectionism actually is not a good thing. People that are proud and saying, “I’m perfectionist,” it’s a form of fear. You’re afraid to make a mistake. So if you look at it from that angle and thinking that you’re proud of being perfectionist, that’s not a good thing. That means that you’re afraid to make a mistake and try something new. So I think that you’re absolutely right. We’re selecting people with a certain traits and it drags behind it, the burnout, people that are more susceptible to it and all other things.

Dr. Andy Roark:
No, I love that you say that way. It’s funny, the paradox that I put together is our selection criteria is very much pro perfectionism, right? Because you take that test by yourself, there is no delegating. It is you, yourself, self-improvement is painful because you’re both the hammer and the chisel or you’re both to stone in the chisel. And it’s sort of the same thing as people who excel in the academic part and get into vet school and do well in vet school are often that driven perfectionistic personality. But then if you want to become a high performing veterinarian, you want to build a really good, positive workplace, that’s antithetical to that mentality. It has to be the doctors that really perform there are a little bit more loosey goosey.
They’re a little more willing to let other people do things and say, “The team is excited about this. It’s not exactly what I would do, but I think it’s positive. I think my idea is better, but it’s not the one they’re excited about. So I’m just going to go along and be supportive of them.” I think that that’s one of the weird pain points that we have is what gets you a degree is not necessarily what’s going to make you happy and maximally successful afterwards.
Anyway, Ivan, thanks so much for being here. Thanks so much for talking with me. You’ve got a lot of irons in the fire. Do you want to talk real quickly about where people can find you? Where can they learn more about Galaxy Vets? Where can they hear the Veterinary Innovation Podcast? Tell me about all you got going on where people can keep up with you.

Dr. Ivan Zak:
Yeah, well, thanks for inviting me first, and then that was a great conversation.I do recommend, suggest subscribing to Veteran Innovation podcast, which you can find@veteraninnovationpodcast.com. There’s a great conversation always about innovation, so sign up for that. That’s a cool one as well. And then Galaxy Vets is just the project we’re trying to implement all of these anti burnout practices and management. So all the research that we do, it’s incorporated into building this organization that is owned by veterinarians and employee ownership is incorporated into it. And that one is at galaxyvets.com. So either one, you can find us there or on LinkedIn if you can spell my full last name, but I’m not going to do it here.

Dr. Andy Roark:
I’ll put links in the show notes to all that stuff. Guys, I’m going to link to the Great Game of Business, the book that Ivan mentioned earlier. So I’ll put a link to that in the show notes. Guys, thanks so much for being here. Thanks for listening. Take care of yourselves, everybody. I’ll see you later.

Dr. Ivan Zak:
Thanks, Andy.

Dr. Andy Roark:
And that’s what I got for you guys. I hope you enjoyed it. Thanks, doctor Ivan Zak for being here. Man, he was great. I’m going to have him back on the podcast. I just really enjoyed this conversation. I think I’d like to talk to him more often. So anyway, I thought it’s super fun. I love these idea type conversations. I hope you guys enjoyed them as well. If you did, do me a favor and write me an honest review wherever you get your podcast, share the podcast with your friends. That’s really nice thing that you can do. Anyway, guys, take care of yourselves. Be well. Talk to you later. Bye.

No, This Meeting Could Not Have Been An Email

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Every now and then, I like to hike my pants up to my nipples, slap a frown on my face, and shake my fist at kids in my yard. That’s what’s happening right now.

You know how it’s become popular for people to kvetch about work gatherings and say “That meeting could have been an email”? Well, on behalf of managers and leaders everywhere, I just want to say… “No. That meeting could not have been an email… because people don’t read their email.”

Sure, it makes total sense that if information needs to be distributed without conversation, bringing everyone together in person to do that seems wasteful and inconvenient. I felt this sentiment strongly for years… until I was the person who really needed to get his team on the same page. 

Once I started being responsible for everyone working together and understanding what was going on, I learned an important lesson: Many people do not read and process work emails. And when I say “many,” I mean “enough to make it necessary to have a lot of in-person meetings.”

I don’t want to come off as overly aggressive here (I say as I try to spray kids on bicycles with my garden hose). People are busy and swamped with email. We have all developed the habit of skimming communications just to keep our heads above water. It’s not that we are lazy or don’t care. It’s just that we are inundated with communication. And for those who DO read their emails, it isn’t fair to have to sit through meetings where they already know all the information.

My hope in making this rant is 2-fold. First, I hope it will make people pause and consider how challenging it can be for leaders to keep their teams informed and on the same page before loudly complaining that the meeting someone worked hard on is a total waste of time. Second, I hope it will serve as a grumpy-old-man-style reminder to all of us to please read our work emails (and not to roll our eyes when managers continually beg the team to do so).

Now, for anyone who wants to stick around, I’m going to sit in my rocking chair and ramble about the good ole’ days until dinner time at 4:30pm.