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Andy Roark DVM MS

Burnout: The Problem with Fitness Influencers

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Let me start by saying that this post is about veterinary medicine… I promise. 

One of the things I find most interesting about the internet is how it always skews to the extremes. Take fitness for example. The core tenets of exercise are pretty boring and haven’t changed much in the last 50 years. Sure there have been advances in how we understand nutrition, peak-performance training for professional athletes, and what pieces of equipment we find at the gym, but the human body evolves on a timescale of millions of years so we should expect radical breakthroughs in exercise and eating to be few and far between.

Well, this reality is inconvenient when your objective is to show people interested in fitness new and exciting things all day, every day. Thus, online fitness influencers looking to get attention have a real challenge on their hands! In response to the LONG lag time between human evolutionary changes, these brave, photogenic souls need to continually come up with fresh insights and novel approaches to exercise that get attention. 

Of course, the basics of fitness are out there for people to find, but videos on how to jog and the four basic food groups aren’t racking up likes, shares, and comments. Tried-and-true tenets of healthy living simply are not exciting enough to “drive traffic.” It’s up to the internet, and our influencer guides, to push fitness into places that are exciting and fresh… or at least into places we haven’t seen before.  That’s how we end up with fitness content that looks like this:

Fitness Influencer example number 1: How to deadlift a woman.

(Image: https://twitter.com/jshakeshaft/status/695379368298713088)

And this:

Fitness Influencer example number 2. Double Dare partner crunches.

(Image: https://dailyburn.com/life/fitness/inspiring-partner-workouts-instagram/)

And whatever this is:

Fitness influencer example number 3. Partner flag exercise.

(Image: https://dailyburn.com/life/fitness/inspiring-partner-workouts-instagram/)

I’m not trying to be mean to people who put fitness content on the internet, even fitness content like in these photos. The reality is that human beings are wired to lose interest in almost anything that isn’t novel. We see things, we hear them, and then we move on to find new stimuli to keep our prehistoric hunter-gatherer brains happy. Weird exercises are just giving the audience what it wants.

The problem is that, in our quest to keep things fresh, we tend to hand-wave the absolute essentials away because people have heard or seen them before. There’s not a lot of attention-grabbing potential in ideas like “eat a balanced diet,” or “set realistic fitness goals and be consistent working to achieve them.” This is where the internet’s perpetual slant toward the extremes comes from.

I bring this up today because I’ve been re-reading the Merck Animal Health 2023 Wellbeing Study, and wondering why it hasn’t gotten more attention. Burnout and wellness are areas of great interest in our profession, and for all the content I have seen (and made) on these subjects, I honestly haven’t heard nearly as much about the excellent work that Merck did as I feel is warranted. Why? My best guess has a lot to do with the challenges faced by fitness influencers.

For those unfamiliar, Merck Animal Health released the results of a comprehensive Veterinary Wellbeing Study they conducted in collaboration with the American Veterinary Medical Association (AVMA) back in January of this year. The goal of this work was to explore the state of veterinary professionals’ mental health and well-being in hopes of raising awareness about the challenges veterinarians and support teams face and how they might manage them. (I will say here that this post is not sponsored or supported by Merck in any way, and I am 100% genuine when I say I’m only talking about this because I think it’s important).

I have to say, I think this study is fantastic. It’s full of stats I find myself referencing often when discussing mental health in the profession, and I love that the authors actually included recommended action steps for both individuals and practices that want to improve well-being. 

So why hasn’t this study been shouted out all over the profession? I believe that it’s, well… boring. The study doesn’t have any wild new “exercises” that people haven’t seen before. It doesn’t involve learning any new techniques, and the recommendations don’t really translate into good TikTok content. The findings are also not particularly terrifying or upsetting. In fact, they’re actually kind of optimistic.

The study found that many people are thriving in veterinary medicine and that, from a wellness and mental health standpoint, veterinarians are not atypical of the general population.  Recommended action steps for individuals included maintaining a healthy social life, prioritizing work-life balance, and developing positive coping mechanisms for dealing with stress. The most interesting recommendation to me was for people, especially those with high debt loads, to have a financial advisor. 

Unfortunately, things like getting a full night’s sleep, exercising, working on your personal relationships, and developing a plan for managing student debt aren’t exciting… but they are vital. The action steps to building a healthy profession are not, in my opinion, likely to go viral. Instead, they are going to have to be discussed and encouraged the old-fashioned way: in our clinics. 

The best tools we have for making ourselves and our profession healthier are within our grasp. We simply have to pick them up and use them. Veterinary practices need to do whatever they can to build healthy cultures, make sure employees take breaks and allow people to detach from their work responsibilities when they go home. They need to destigmatize seeking mental health and wellness support, provide resources (like an EAP and ideally health insurance) to those they employ, and be positive and encouraging of their teams without invalidating or ignoring the real struggles of individuals.

As caregivers, we need to do the boring stuff that keeps us healthy. We need to develop sustainable coping mechanisms for stress, prioritize spending time with friends and family, get good sleep, and utilize resources like a financial planner to feel more in control of student debt if we have it. We need to support initiatives that build better workplace cultures and consider leaving practices that don’t provide a culture where we can be healthy. We need to focus on the good in practice without drifting into toxic positivity.

Like fitness influencers who really want to talk about the basics of nutrition, those of us who truly want to make a difference in wellness and mental health in veterinary medicine have a bit of an uphill climb. The most vital changes we can make are not sexy, or shocking, or terrifying. They are boring and require consistent work to make a difference. These changes will not get TikTok followers or blow up the ‘gram. We still have to get them out there, day after day, for the benefit of everyone in the profession.

Are We Really Busy Enough to Hire?

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Eric Garcia joins us to discuss staffing and technology efficiency versus the need for hiring in veterinary practices. In this week’s episode of the Cone of Shame Podcast, Dr. Andy Roark and Eric Garcia explore whether practices are truly understaffed or if the perceived need to hire more personnel is a response to inefficiency. The conversation dives into key performance indicators that suggest many practices might benefit more from enhancing operational efficiency rather than expanding their teams. They also touch on the role of technology in improving practice management through the use of automatic booking and AI record keeping. Let’s get into this episode!

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

LINKS

Eric D. Garcia: https://ericgarciafl.com/

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

When it comes to helping veterinary practices streamline their technology and attract and retain clients, Eric Garcia has a proven track record of educating the industry and producing results. Eric is an internationally recognized IT and Digital Strategist working exclusively with veterinary practices. Garcia’s work has been recognized throughout the industry. Eric was voted VMX 2020 Speaker of the Year by conference attendees. He speaks regularly at conferences all throughout the world. , Dr. Andy Roark is a practicing veterinarian in Greenville SC and the founder of the Uncharted Veterinary Conference. He has received the NAVC Practice Management Speaker of the Year Award three times, the WVC Practice Management Educator of the Year Award, the Outstanding Young Alumni Award from the University of Florida’s College of Veterinary Medicine, and the Veterinarian of the Year Award from the South Carolina Association of Veterinarians.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a great one here with my good friend, Eric Garcia. This is a sprawling, big idea, looking at the future of medicine episode. If you like episodes that make you think about what is gonna to happen in our profession the next five to ten years, there’s not a much better one in the can than this one. I really love it. We start out with this idea Eric puts forward right at the beginning as he’s heard again and again that practices are too busy and they need to hire but, when you look at the key performance indicators for these practices, their profitability is going down and down.

Maybe we don’t need to hire. Maybe it’s time to really start thinking about efficiency in our practices. And then so we, dive into that. We start talking about artificial intelligence , and how do you leverage this.

We talk about the rise of of independent practices as they’re sort of starting, we’re starting to see independent practices owners coming back. We start talking about, is there really a shortage of veterinarians in the next 20 or 30 years? And so anyway, a lot of interest in, what is the future going to look like? , 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. Eric Garcia, how are you my friend?

Dr. Eric Garcia: Oh, I’m doing well brother. How are you?

Dr. Andy Roark: I’m so great. It is so, good to see you. For those who don’t know you, stop living under a rock. What, why, like, take your head out and you gotta pay attention. Eric Garcia is one of the nicest guys in veterinary medicine.

He’s a dear friend of mine. He is an IT and digital strategist. He is a digital marketer, an industry thought leader, one of the most engaging practice management speakers that you’ll find in our industry. Just a genuine all around wonderful person. He’s one of those people I like to kick around ideas with.

We were just talking before we started recording. About Eric writes a lot about unplugging, which is setting aside doesn’t any time to get off of your devices and he and I have had debates about the idea of unplugging and how best to unplug and things for years now, it’s been at least five years.

We have been discussing and debating, and we, have very different ideas about, what getting off of your cell phone and devices should look like and can look like, and we discuss them with passion and enthusiasm every time we get together, and so we were doing that before we came on here. But, 

that’s not what we’re talking about today. Eric, I was reaching out to you recently, and I’m always curious in what you’re curious about, and like, what are you thinking about, and what are you working on, and you brought up the idea that we have a lot of people in our industry who talk about needing to hire. They say, I’m shorthanded, I need to hire, and your question is often Do you really need to hire somebody, or are we in a place where we’re not working efficiently?

And maybe hiring is not really what we need to do, but we’ve been told that’s what we need to do. And so I, I really love this idea when you laid it out, because one of the fundamental questions I have in life is, You’re just not organized enough or we’re not communicating well enough, things like that. And I say that as a guy who has always looked at his days and wondered, Could I, should I have done more today? Should I have squeezed more into this day? If I was better organized, could I get more things done? And sometimes the answer is absolutely not.

You are working at or beyond normal human capacity and you, should be kinder to yourself and you should relax, Andy. And sometimes the answer is Yes, you should have gotten your stuff together and, you know, and if you had been organized and had a plan, you could have easily gotten a lot more done today and, you know, and freed yourself up to do other things.

And so I don’t know. So I just kind of word vomited all that kind out. Let me just sort of put it over to you, Eric, and sort of say, talk to me a little bit about the idea

that we’re really busy and we need to hire versus we’re really busy and we need to get more efficient. 

Dr. Eric Garcia: Yeah, it’s interesting just to piggyback off of your last point, you know,  being more efficient and having more time doesn’t always mean that you need to do more because you have time regained, right? Sometimes it’s just doing less or actually, you know, living a more structured day. 

But yeah, I think right now what we’re seeing are so many practices that are really struggling to hire people and everyone feels like they need to hire and when you talk to a lot of practices, you hear a lot of, Oh my gosh, we’re just short staffed, we’re really busy, we’re, you know, there are days of chaos and we don’t need to focus on marketing or we don’t really need to focus on growth per se, we really need to make sure that we have enough team members and that the interesting point about that is when you hear that from a majority of practices and certainly not all but a majority of practices and you look at their key performance indicators.

So we’re looking at things like what are overall patient visits looking like? What are new client numbers looking like? What is compliance and retention looking like? And what does revenue look like? And if those areas are not up and we’re not seeing enough growth, then you’re often really struggling from an inefficiency challenge in your practice.

And what’s interesting in the practices that we work with, or even those that I talk to that have numbers and workshops and things like that, it’s more often than not, practices are not growing enough to support the need for an additional person. It’s just that they’re operating inefficiently. And my concern about this is that if a lot of practices are really looking to hire and they’re not actually understanding their key performance indicators and where things are headed as a profession, that we’re going to hire all of these people, but we’re not going to have the business to support the long term play there and paying out those salaries, which is wildly alarming.

Dr. Andy Roark: Do you think that, a lot of businesses have, I’m sort of thinking of independent practices here, but it doesn’t have to be them, but, do you think that there’s a philosophy that it’s always been, if I get busy enough, I just hire someone else, because my busyness indicates that I can support them.

You know what I mean? Of just like, if I have enough work to hire another person, I will just be there. Because of how things work out. I will have enough. The money will take care of itself to support them. Is that sort of the mentality?

Dr. Eric Garcia: I do. I think so. And to an extent, you know, there’s not enough money necessarily to support them. Who takes that hit is the practice owner, when it comes to their profitability. 

And when you actually talk to people, you know, our mutual colleague, David McCormick, And you talk about what practice appraisals are looking like, and you’re asking, you know, the very pointed questions.

What are you seeing in terms of profitability? What differences are you seeing? And David will tell you himself, you know, one of the biggest challenges he’s seeing is practices are not nearly as profitable as they once were. And a lot of that is for what we just talked about. We don’t have enough business coming in to support these additional salaries that we’re having to pay for.

The people that we’re acquiring which is troublesome, but yeah, absolutely. You know, it’s interesting, I challenge practices to have, there was a great case study that was published in Harvard Business Review on a book called Digital Transformation Best Practices. And they looked at two companies.

They looked at Amazon and Walmart. So Amazon is considered to be a tech first company. But tech first not in the way that you and I can order from an app and it comes in. Not, that kind of tech. Not consumer facing tech, but operational efficiency technology. So what Amazon does when they’re experiencing high levels of growth or when they’re anticipating growth, what they look at is they look at the operational efficiency of their warehouses and their distribution centers and the technology that they use for that, right?

So, hey, we’re going to expect, you know, Cyber Monday is coming up. Let’s make sure that our technology and algorithm is optimized to make sure that we get these orders out on time and that and we’re doing it with the teams that we currently have. Where Walmart is not looked at to be a tech first company.

Walmart’s considered to be a people first company. Although I joke people first, not necessarily in the service that they offer, but people first in the, their outlook on what they do when they’re seeing growth, when Walmart is seeing growth, they say, well, we need more people in our stores to sustain this growth, where what they don’t do is they don’t step back and they say, well, what can we do?

How can we do better with what we currently have? And so as a result of that, Amazon actually has a 67 percent better performance rate based off of the revenue and their volumes of team and comparison Walmart, which makes more, but cost them a lot more because of the volume of employees they have.

Interestingly enough, though, I was at the consumer electronic trade show this January. And that is the one thing that Amazon or that a Walmart is now looking on focusing on, and they had a whole group just on what they’re doing to improve efficiency because they now recognize the opportunity to be more efficient in their stores And so I challenge practices to think like Amazon.

It’s to say oh, we’re super busy but how can we maximize the efficiency in our practice first? And then if we’re growing and we still see this And we’re still remaining busy. Then we consider hiring rather than to be Walmart and saying oh, we’re really busy We need more people because again people doesn’t the numbers don’t always support that.

Dr. Andy Roark: Have you seen, sort of this idea from, I, I think it’s, I think it’s often stress staff driven, but the easy button when we’re feeling stressed is we need more people, you know, we’re like, Oh, we’re so big. We got, we need to hire more. And I think. And again, I want to be generous here too, but I do think that. The great thing about when you’re busy and you say we need to hire more is that nobody has to make any changes.

At least that’s not how it feels. It’s like, it’s not like we need to make some hard changes and get a new operating system or get a new, you know, workflow in place. It’s like all that requires change and people don’t like change. It’s much better to keep doing exactly what we’re doing with more people.

Dr. Eric Garcia: Yeah.

Dr. Andy Roark: And so I don’t have to change and I feel like our capacity goes up and that’s the answer. that’s kind of how I look at it. It’s sort of the easy button in that way. Do you, so on sort of a scale of one to ten, how big a challenge do you think it is for most practices to really drill in and get more efficient? 

Dr. Eric Garcia: Oh, I mean, highly, huge opportunities, for practices. In fact, there was I believe it was IDEX has a study. It’s called the practice productivity index, and there’s a self assessment. In that index that practices can go through to determine what opportunities there are for improving efficiency.

And what was really interesting is, you know, so practices can, you know, kind of go somewhere like that and, complete the self assessment to see. But it doesn’t often even take a full on assessment. It’s just taking a step back and looking at all of the things that you do on a daily basis that really, way down on the team and then say is there an opportunity for us to do that?

But I’ll give you a few examples. One is real time scheduling, right? Think about how hard it is to hire csrs and to get them onboarded and to be able to you know, check people out, create estimates, take the phone calls that are coming in, manage the online communication, all of the things that they’re burdened with.

I always used to say, back in the day when I worked in a practice and I’d have to fill in, like, that’s a chaotic job. But taking the burden of having real time or giving them the opportunity to have real time booking online, dramatically reduces the volume of appointments that they’re needing to communicate, whether it’s through an online portal or over the phone and allows them to do their job more efficient or at least spend more time with the people that are in front of them in the practice.

Little things like that. There, there’s a practice recently, and I’m going to butcher the number, but it was, over 50 percent in terms of the number of people that are booking appointments online. Andy, think about how many less phone calls. that are coming in as a result of that. But the thing that I also say with that is, you know, there are practices who are like, Oh, the idea of giving my clients control to, you know, book appointments sounds awful.

And there’s a lot of fail safe mechanisms built into it. If someone puts that their dog’s been diarrhea, having diarrhea for a certain number of days, like it won’t let them book an appointment. There, there are a lot of fail safes. And so I just challenge practices. Whoever sends out your reminders, see if they have online booking.

In most cases they do, and it doesn’t cost you anything and you can work with them to set it up. You know, having artificial intelligence produced medical notes is another huge opportunity for veterinarians, but now it’s not even just that, right, it’s also using the right tool to be able to maximize efficiency.

You know, all it really does is you download an app on your phone or any mic enabled device. And it will record the entire appointment and it’ll start the SOAP note for you and it’ll clean it up. It’ll remove any kind of personal conversations. You know, if you’re talking to an owner and you happen to know their kids and they go to school with your kids and you’re talking about that, like it, it eliminates all of that from the medical note.

And what we’re actually hearing is that a lot of practices are getting even more accurate medical notes because AI is listening to the whole appointment. a lot of times you’re producing the note at the end of the day, if it’s the same day. But it’s not even just doing that anymore. It’s also doing that in an efficient way.

So there are a lot of AI tools that now will start the medical note for you in your PIMS, so making sure that you even use the most effective and efficient version of that tool. Fun little story real quick is I started recommending this to practices at a group that I speak to every year.

And, so I introduced it to them at some point last year and, you know, they were a little skeptical about it. Some were really excited. And so I always tell people, try it, you know, you should always try something at least, once or twice. And if it doesn’t work, then I don’t ever say never just say it didn’t work right now, but let’s try it again in the future.

And so, so this practice under did she tried it? And her husband said, well, I have no idea who he is, sent me a message to thank me for recommending artificial intelligence for medical record keeping to his wife, who is now leaving work early. And that kind of goes back to the start of our conversation is, you know, maybe it’s just as simple as leaving work early, or having your lunch.

It’s not necessarily that you need to do more. She didn’t stay two hours later do other things. 

Dr. Andy Roark: I know I get it. This is my own weird neuroses of like, I’m like I should do more productive things normal people like I would just like to go home and see my family and I’m like I guess you could do that. Like, ha , yeah, or, or you could write an article about something that people don’t really care about and just

Dr. Eric Garcia: You and I should work on that, yeah. ha. Ha, Yeah.

 
Let’s get. Get back into this episode. my, so my thought, so here’s, a little bit of my concern. Let me ask you how you feel this. And so, okay, so I think the writing’s on the wall for where we’re going with artificial intelligence.

Dr. Andy Roark: I think that artificial intelligence is going to do a lot of things, but I think one of the big things it’s going to do is remove the low level, tedious work. A lot of low level teeth, like a lot of just writing things up, like, like records and stuff like that. It’s not about practicing medicine.

It’s about taking these sort of mundane things and taking them off of our plate. And so I think that’s a beautiful thing. My concern a little bit is if you push doctors right now, I don’t know if the tech is fully ready for what we want it to do, and I’m curious what you think about that.

And you, it’s if you push people too early to try something, and it’s not ready, and it breaks down on them, is it that much harder to get them into it later on. So, so do you think it’s worth fighting the battle now to try to start to try out AI stuff in your practices again? I have.

I’ve heard similar stories to what you’re talking about as far as a recording device, your cell phone in the exam room talking about, you know, pet owners, kids, and family, and all that stuff gets cut out and captured. But also, I look at, Zoom AI recordings of meetings that I have been in, and they are Looney Tunes sometimes, and it’s, it is quite funny, what AI thinks is happening in the 

meeting. And so I’m like, I don’t know, do I push, do I fight this battle now? Or do I wait till 2026 and then fight it there? And I think it goes a lot easier. How do you kind of get your head around that Eric? Are you like pedal down go for it now, or are you like I could see waiting a little bit?

Dr. Eric Garcia: Yeah. So a hundred percent pedal down and do it now And I’m actually really glad that you brought up that point because sometimes the problem is when especially when we’re talking about technology is that because there are so many options, you know, not everyone is as good, you know, not every tool is as good as the other.

And so, you know, just because someone says they do AI for medical record keeping doesn’t mean that they’re at the point in their business to have validated that. because they perfected the nuances of, you know, the veterinary appointment. And so, you know, I always tell practices, you, have to kind of do your due diligence into the right tools that are out there.

Talk to your colleagues, see which ones everyone seemed to be using, because they’re the ones who’ve already had, you know, and I say maybe a year, two years of feedback from, you know, hundreds and thousands of veterinary appointments. The problem with AI for medical record keeping is that Andy, I kid you not, there are probably a minimum of 20, 25 companies right now doing it.

And some are way further along than others. Is it perfect? No. But is it saving you the amount of time from having to do this thing yourself every single time? Absolutely. And that’s where practices are, you know, most practices will be quick to tell you, It’s not perfect, but it’s perfect a majority of the time and it’s saving me a lot of time and I have practices I was visiting with one on Friday of last week and the owner, was just like he was like I was against it.

I was against it and he’s now You know, he’s kind of addicted to it, but I to further frame kind of your question is I think I wonder about the long term effects of over reliance of AI. That’s where I do worry a little bit, especially, you know, and I’m not a veterinarian, but especially the reliance of it.

You know, when it comes to, you know, some of these tools are right, differential diagnosis for you, they’ll interpret your lab work. And so, when we’re looking at things like that, what I’m going to question is who’s feeding that? and I, that’s where I would rather wait for a, you know, an Antec or an IDEX or a massive company that is feeding it millions of cases and training it.

Then someone who’s using some iteration of chat GPT for medical based decisions. Like that’s terrifying.

Dr. Andy Roark: Yeah no, I completely agree with that. the idea that we’re feeding chat GPT into, to talk specifics of medicine is terrifying. Well, that’s it, you know, I talked Dr. Jules Benson at Nationwide, and he’s just a massive data nerd. I love Jules. but he talks and says, you know, your AI is only as good as the data that you train it on.

And so I think that you’re, I think you’re absolutely right. It’s going to take a, big data set whether I think nationwide is doing some really cool stuff. Their pet health zone I think is really a fun tool. It’s not AI but it is a neat way of leveraging the huge amount of data that they have collected over the years about illness and what breeds are likely to have different presentations and Different illnesses and things like that at different stages of their life.

If you haven’t seen it, it’s cool. But it’s got to be a player about that size who can say we’re going to start feeding this the stadium. I, you know, I look like Banfield for example, VCA, some, big corporation like that’s got, you know, they’re seeing tens of thousands of patients a day.

I’m like, boy, the potential they have to be able to generate something. But again, this would be a huge undertaking. but, I’m with you. That’s, I think, that level of change is coming. But even then. Even then, it’s still going to be, it’s still going to be about the data that we put into the system, you know what I mean?

So if you have a PET and you’re looking at the PET, and you feed the blood work into the machine, and it comes back and says, Well, based on this blood work, this is what you need to do I still would be very hesitant to do that. to go forward without integrating that information into what I’m seeing with my eyes, what the pet owners are saying to me, like those things are still going to matter, and it’s going to take someone on the ground to put those pieces together.

And so anyway, I think it’s, I think it’s going to be an interesting future, Yeah, I just, I’m excited about it, but I am also definitely wary of pedal down. The other thing I’ve seen a lot in the industry is the use of the term AI in ways that I think is probably inappropriate. 

Dr. Eric Garcia: It’s so, it’s a marketing term now. 

Dr. Andy Roark: One hundred percent it’s a marketing term now. It’s artificial intelligence. It’s like, oh, it seems like a very 

Dr. Eric Garcia: I was just going to say algorithm AI, completely different things. Yeah.

Dr. Andy Roark: Yeah, but I have a hundred percent seen very basic algorithms of you know If they select this then you do that and it’s like that’s not AI that is just following a basic pathway but I see a lot of it’s just because anything that has a I tied to it gets a lot of attention And it gets investor dollars and stuff But there’s it is a little bit of buyer beware right now about what are you really getting and what are the capacities here?

Dr. Eric Garcia: And this is why, you know, I always tell practices go on Google, type in veterinary artificial intelligence and then I schedule a demo with at least three to five of them. And I always tell practices 10 minutes is as long as this demo should be. If someone can’t convince  you of their value in 10 minutes, then move on. Because what happens, Andy, is they’ll get you on the phone for an hour and you’re like, Oh, it sounds like they do everything. I don’t, you know, and you’re just going to sign up and, you know, 10 minutes to three to five demos. So block an hour off your time, ask them how long they’ve been around for, you know, ask your colleagues and then ultimately, you know, determine what to write for your practice.

Dr. Andy Roark: What do I want in this demo? Right. Cause I show up and like, all right, I want a 10 minute demo. what are the what are my objectives going into a demo

Dr. Eric Garcia: Yeah. So it’s going to be different for every practice. So this is kind of going back to looking at the overall opportunity AI tools right now. very, low cost AI tools that don’t  integrate within your management system. they’re just recording the, conversation and they’re producing a soap note.

And so if you just want to try it out. And you’re looking for something super low cost to do that, then, you know, see who does that better, right? Can you train the, soap note to predict certain recommendations based off of, you know, if a diar a vomiting diarrhea dog comes in and it’s writing your soap note, and you’re a veterinarian who loves to dispense metronidazole for it.

You know, can you train it to automatically write that as a part of the plan for you? Where maybe another doctor has a different preference or they, you know, they go to food first, whatever it might be. So what are the levels of being able to train writing the medical note based off of the veterinarian that’s seeing that appointment?

So asking that, are you also looking to use it to produce a, summary follow up? In layman’s terms for the pet owner, not all AI tools do that. So is that something that you want to do? Do you want to be able to provide something for the owner to be able to leave with to summarize the visit and take home and have an explanation in a way that’s easy for them to understand?

Is integrating it in your management system a priority? do you want it to literally open up your management system and start their medical note for you? Do you want it to be able to to send health questionnaires ahead of the visit and then interpret what seems to be the cause before, you know, they even show up to the appointment because they completed a health questionnaire.

So looking at all those little nuances and trying to determine what problem are you trying to solve and, specifically in this area, how much do you want to go into it? Some practices want all in, some are like, Hey, I just want the basics and there’s nothing wrong with either. um,

Dr. Andy Roark: I did some work in the Netherlands a couple of years ago. And I went around to a number of different practices that were there, and I was sort of trying to get my head around how they work and how they function. And, you know, in the Netherlands, it’s really expensive to hire people. Like, you have to pay huge employment taxes. I, it is, very, again, that’s sort of like the cost of a robust social safety net. which, they have and that’s, how they roll. And so, there’s that. so, the upside is Big, nice safety net. Employees get nice, you know, support packages, things like that. Downside is, it costs a ton to hire somebody. And so, the vet practices over there have responded by being very small. the majority of the practice I went into had literally three employees. it would be a doctor and two technicians and, or one technician and one assistant. And they answered the phones and they checked people out.

And like, that was it. There wasn’t a front desk. It was those three. In the building doing that, and it was just interesting. I’ve always sort of looked at that and sort of been like, you know, this is where the model goes as we sort of pay people more. And if you want to raise salaries and things, this is one way that goes down.

And again, it was just the practices were smaller and they did a lot more with a lot fewer people. Eric, when you look into your crystal ball and dial it in for 10 years from now, Do you think practices are smaller than they are today because we have gotten more efficient and we are paying the people we have more?

Do you think that they’re about the same size as far as number of employees that we have? Or do you think that they have grown and we have larger practices possibly leveraging, you know, Fewer, maybe fewer practices overall. The big guys kind of get bigger. What do you, see ten years from now?

Just as you kind of try to see the future?

Dr. Eric Garcia: so I would definitely think they’re smaller, but they’re efficient not just in the fact that they’re smaller. I think there will be more widespread utilization of a lot of the things that we’re talking about today and that we still don’t even know are coming down the line when it comes to Just automating a lot of the tasks in the day to day running a hospital and so I think they’re smaller I think they’re more efficient and I think that you know, they’re gonna thrive and they’ll be great You know, we’re seeing this kind of at least in the practices that we’re seeing this resurgence of you know, independent ownership And when you ask them, you know, hey, what are your long term goals here?

You know, what are you trying to do in the next three to five years and longer than that? You And I would argue to say, and I’m not, this is not statistically relevant by any means, but I would argue to say that probably 100 percent of them also they want to stay small. And I think a lot of people that are starting practices are people who sold, you know, recently or have always had this dream of owning, but they realize that sometimes bigger isn’t always better.

And so I do think that there will be this kind of, you know, massive volume of these just smaller practices and, you know, practicing the medicine that they want to practice in terms of, you know, are they going to do surgery? Are they going to do dental? I think we’re seeing a lot of practices that are like, we’re just going to see wellness visits or we’ll just do, you know, basic diagnostics and refer everything else out.

That’s what I would guess. But you know, it’ll, be interesting for us to have this conversation in 10 years. Like, I know we’ll have and see where’s your head at? Are you thinking also small based off of kind of your

Dr. Andy Roark: I, yeah, I do actually. Yeah. I, do. I think one of the things I’ve been thinking a lot about recently is this. And so, you know, I, you and I were there together. I think we may have been in the same room. I remember in about 2010, 2011, the drum beats were really loud. that we had a production problem of veterinarians in terms of overproduction.

We had these new vet schools that were opening up and, class sizes were expanding and the drum beats were really loud. And it was, just common. It was the, it was common sense wisdom knowledge that we had, we were making too many veterinarians and veterinarian salaries were going to plummet. and that was it. And I just, I can’t emphasize enough that it was so widespread. It was talked about constantly. And then, I was in a room one time and Danny McVitie was in there from Lap of Love Pet Hospice. And so, and I think it was, I can’t remember if it was a panel. or if it was a lecture that I was doing and Danny was in the audience, but someone was talking about this overproduction of veterinarians and things like that.

And Danny raised her hand and she said, you know, I’m the CEO founder of Lap of Love pet hospice. And, uh, you know, I keep hearing about all of these veterinarians that were overproducing. Can you tell me where they are? Because I desperately want to hire them and I can’t find them anywhere. And then head started nodding in the room of I also want to hire them.

Cannot hire a veterinarian and just like that Eric the whole industry in my mind It just swung the other way and suddenly we were freaking there was never a happy medium It was never like oh we turns out we might not have an overproduction problem. Let’s just be happy for a while It was nope It was one extreme the world is ending and to the other extreme the world’s endless thing And so then ever since then we’ve been in a we don’t have enough veterinarians Problem. And so now you’ve got this stuff in the AAVMC, who has a vested interest in making more vet schools and turning out more people. They’re saying we’re having shortage, but the AVMA is really pushing back and saying we don’t aren’t, we don’t agree with this assessment. And I think it’s easy to kind of dismiss the AVMA sometimes because they can be kind of crotchety in their way.

And they can be a little contrary. But I can’t write them off in this one and say, ah, those guys are wrong. I don’t know that they’re wrong. And so anyway, I’m, looking at this and I, and I’m looking at this question and go, do we have a, like a, an undersupply of veterinarians in the next 30 years?

Is it going to be this catechism thing where we don’t have enough people? I don’t know that I’m sold on it. I think, when I look into my crystal ball, I think 10 years from now, I suspect we’ve probably got about the same size practices, but, and this is sort of pulling in something from human medicine, I think that we right now are starting to see administrative bloat in vet medicine that we saw like 15, 20 years ago in human medicine, where all of a sudden there are these, there’s a lot more middle managers, there’s a lot of, you know, area managers, things like that, and so some of the, practices are getting bigger, but they are having more sort of administrative people as opposed to people on the ground seeing the patients. Does that make any sense?

Dr. Eric Garcia: It does. and it’s interesting because you’re right. Even thinking in the last five years, just the volume of roles that are being created that weren’t typical in the average veterinary practice, even seeing, you know, back when you and I probably started  knowing each other, like we’re, it was, you know, everyone needs a practice manager.

And then now everyone needs an assistant manager and IT and marketing and all of this. And I agree with you. I think that. becoming very top heavy and there might be, you know, some people that are going to step back and look at that. I think the interesting thing, Andy, and I think it’s worth mentioning is that I think regardless of the conversations that we’re having in the profession about, you know, in this case, you know, shortage of veterinarians or whatever it might be, I think sometimes what happens is as practices, we kind of look at that and we’re like, Well, this is the reason I can’t do X and the reality is, that yes, the, there are always going to be problems that, that are, that the profession’s trying to predict to get ahead of the future.

But what you should really be focusing on is doing whatever’s going on in your practice really well and not using these exterior things as excuses. Because I see, I hear this all the time, you know, practices are, oh, we can’t hire well, but no one can hire because there is a shortage of veterinarians and it is what it is.

And I would challenge you to step back and say, well, no one can hire and we haven’t hired anyone. So maybe there’s a different approach that we can take to do better because it becomes very problematic where you go somewhere and you’re like You can’t hire a veterinarian and it’s actually there are people hiring veterinarians and they’re not all corporate And they’re not all paying these high bonuses.

There are people who are selling themselves a lot better And who are selling the culture of that practice a lot better beyond buzzwords and who are actively working at it And so that’s where I challenge, you know practices To just kind of say all right. Yeah, these there are things that are working against us But we could probably do better because the chances are is you probably can’t Yeah.

Dr. Andy Roark: I think that there’s a real danger right now that this has become a mantra when you say, wow, we’re really stressed. Well, that’s just because you can’t hire anybody. And you go, well, that, that would be one, one possible approach, but it’s always dangerous if that ends the conversation. You know what I mean? It’s almost like, well, there’s this thing that’s outside of your control. And so, you just stop your search because this is what the, you know, the Earth has given to you and there’s no way around it. And that’s not really true. Eric Garcia, where can people find you online? 

Dr. Eric Garcia: Anywhere ericrcfl.com or anywhere at ericrcfl on social.

Dr. Andy Roark: Cool. Thanks so much for being here. Guys, thanks for tuning in today. Everybody take care of yourselves. And that’s what I got for you guys. Thanks for being here. Thanks to Eric Garcia for being here. If you ever get a chance to see Eric Garcia’s lecture, you should definitely do it. He’s a great speaker. If you ever get a chance just to talk to him, he is a, just a genuinely wonderful person. He is up there on my list of favorite people that I know in the profession and it’s just, what a wonderful list it is.

We have so many great people in this industry and this profession, but Eric Garcia is right there at the top. So anyway gang, thanks for being here. Take care of yourselves, everybody. I’ll talk to you later on.

 

Cost of Care, Access to Care, and Payment Options

by

Dr. Emily Tincher joins us to discuss the rising costs of veterinary care and how they impact pet families. Dr. Andy Roark and Dr. Tincher dive into her co-authored book chapter on cost, access to care, and payment options, highlighting key factors driving price increases, such as staffing costs, practice economics, and the cost of consumables and drugs. Dr. Tincher also shares insights on effectively communicating with pet owners about these costs and the importance of understanding their preferences.

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

Nationwide logo

This episode is brought to you by Nationwide!

LINKS

Nationwide’s Most Common Claims: https://news.nationwide.com/041824-dermatitis-gastroenteritis-most-common-conditions-prompt-vet-visits/

Cost of Care, Access to Care, and Payment Options in Veterinary Practice: https://www.vetsmall.theclinics.com/article/S0195-5616(23)00156-0/abstract

Spectrum of Care: www.spectrum-of-care.com

Open Door Veterinary Collective: https://opendoorconsults.org/

Pyometra Peer Reviewed Article Referenced: https://avmajournals.avma.org/view/journals/javma/260/S2/javma.20.12.0713.xml

ABOUT OUR GUEST

Emily M. Tincher, DVM, is Senior Director of Pet Health at Nationwide. A second-generation veterinarian, she is co-author of a chapter in Veterinary Clinics of North America: Small Animal Practice, “Cost of Care, Access to Care, and Payment Options in Veterinary Practice.” Dr. Tincher is a member of the Board of Directors for the Veterinary Leadership Institute and has become a sought-after speaker, most recently on spectrum of care topics, presenting at major veterinary conferences across North America.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome, everybody, to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark guys, I got a great one for you today. It is all about cost of care, pricing in veterinary medicine, what the options are to keep care affordable for pet owners. This is a really good conversation that I, I really enjoyed and I sat with for quite a long time.

This is with my good friend, Dr. Emily Tincher. For those who don’t know her, she is the Senior Director of Pet Health at Nationwide and uh, she is a deep thinker on the spectrum of care. She’s got a lot of good insight. I always enjoy, uh, kicking things around with her. We don’t always agree. I think today we’re pretty much in alignment.

We might have gone back and forth about a couple of points, but anyway. Um, it’s a, it’s a, I always take away fresh ideas from my conversations with her. She is really, really, really, sharp. Anyway guys, uh, this is a great episode. I’m so glad to have her here. Let’s get into it. And let me just say this episode is made possible by our friends at Nationwide.

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. Emily Tincher. How are you?

Dr. Emily Tincher: I’m doing great. Thanks so much for having me back on. Excited to see you and chat about some interesting topics.

Dr. Andy Roark: I, I love having you on. I love having you on for a number of reasons. Number one, you and I have known each other since veterinary school, and we were business nerds together in vet school. And then two, you were one of the most beautiful polished, elegant speakers that I get to work with. You can just, I aspire to, to present

like, I said, I, um, and I’ve done like 700

Dr. Emily Tincher: Just setting me up to fail here. I see what’s happening.

Dr. Andy Roark: I know, I really, just sitting, just absolutely fluff it, fluffing you up.

That’s a very kind nonsense to say. Uh, I, I very much appreciate it. I have loved watching and learning from you speak. Uh, with the energy and, and ability to connect to audiences. I just, I really love watching people that I admire and learning from that.

Dr. Emily Tincher: So that’s, that’s a very kind thing to say.

Dr. Andy Roark: You are amazing. Um, you have got a lot of stuff going on. My friend, you are doing a lot of stuff. I’ve had you on the podcast a number of times to talk about different aspects of spectrum of care and keeping care accessible and cost of care and things like that. You have got a new book chapter that is out is in a book called Veterinary Clinics of North America: small animal practice. Um, your chapter is with, um, with, with our mutual friend, uh, Dr. Jules Benson. It’s called, uh, the chapter is called Cost of Care, Access to Care, and Payment Options in Veterinary Practice. And you told me the chapter was edited by our other friend, Dr. Peter Weinstein. It’s like this meeting of the minds.

That’s, that’s amazing. Um, let, let’s go ahead and start to talk about this one of the points that you make in the chapter that that I’ve I’ve thought a lot about over time is you make the comparison of that prices to overall inflation. Like the price of the price of living is going up, at least in the States, and to me, that’s that’s very clear at the grocery store, like every for a while, every time I went to the grocery store, it cost significantly more than it had cost before, and so life is just getting more expensive, expensive to live Day in and day out and and obviously the cost of veterinary care going up as well, but you you point to data that shows our our price increases are are not in line with inflation overall.

Why don’t we just start there and you can kind of start to unpack that for me

Dr. Emily Tincher: And just first a huge thank you to Dr. Peter Weinstein for inviting Jules and I to co author this book chapter together. It was an experience. It was our first book chapter to write. Um, it was enjoyable, but also challenging. Um, but I appreciate getting to collaborate with Jules on a number of things. So just a thank you to both of them for the chance to do that and the collaboration.

And, uh, it was a great opportunity. The, the part that to start with is, um, how our costs changing and I think why, why should we care about that primarily? What effect does that have on the pet families that we serve every day? And by extension, how does that change our conversations or, or the emotions that we may be feeling in those conversations?

And so we think about, um, just looking at the consumer price index. So, um, from the U S bureau of labor statistics, um, over a 20 year time period, all goods inflation rate has gone up, um, 61 percent less than the veterinary services bucket that they measure as one of those, uh, components of the all goods.

And so, that says, over that 20 year time period, our pure inflation. So just the cost of doing the same thing, um, pet families are experiencing that compared to, uh, you know, buying a dozen eggs at the store when they come to see us for, you know, a wellness exam and some vaccines, but they’re seeing a significant difference simply in the cost, uh, before we start to look at.

What is the care that’s actually being provided? I think I really felt this on a personal level recently. I got a puppy, his name is Sprout. He’s really cute. And, um, I’m really spoiled. So I, I being the daughter of two veterinarians. I didn’t know for a long time on that personal level what it was like to pay for my own veterinary care until I till I was adult. While I saw them deliver estimates all the time I wasn’t personally doing it, but they were my veterinarians for a very long time. Taking Sprout in for a wellness exam a round of vaccines a fecal and a microchip was um in an awesome practice.

I had a fantastic experience. No complaints. So, so hear me when I say, um, I don’t begrudge us at all, but it was about $400. Uh, and when I think back to growing up with that looked like in, in a, uh, you know, a different environment, mixed animal practice in rural Kentucky versus. You know, here in Colorado, um, that was, you know, just probably closer to 150 maximum.

So that, that change is in just the cost component is one that, um, sometimes can feel shocking to pet families if they’ve, especially if they’ve had pets longterm, not understanding why they’re seeing the changes that they are.

Dr. Andy Roark: Yeah. Oh, I think you’re, I think you’re spot on. I think whenever we start to have real conversations about pricing and medicine, we have to insert some nuance, right? The worst thing in these conversations is people, people go to extremes or we don’t allow people inside of our own profession to say, hey, We, we are quote unquote worth the money that we’re asking for.

And also your average American doesn’t have a thousand dollars in savings full stop. And it’s, and it can be hard for them. And, and I just, I think a lot of times people want you to pick a side. You’re either pro, pro Your team pet owner who doesn’t think this, who doesn’t think this is fair and, and, and people are jerks.

Or your team vet med, which is people should see our value and happily write us checks for what we ask for. And like, neither of those things is, is really realistic. You know, the, the truth is in the middle. I, I want to ask you a little bit about sort of public perception and kind of where, where you see this.

I’ve seen um, There’s been a number of sort of flare ups recently on the social medias, which I try to stay away from, but I’m not, I’m not completely removed from there’s, um, the, the most, the most recent one I saw was there’s this guy and he’s got, um, he’s got blood work and he’s ranting about how veterinary clinics will double the cost of blood work that goes to the lab.

Can you believe this? What a scam. And of course there was a huge reaction, of course, from the vets because they’re like, first of all, that’s, that’s ridiculous. You know, that’s like, um, that’s like criticizing lawyers for marking up the paper that they write on. It’s like, I’m sorry. Uh, you know, I have no idea what the carpenter paid for his hammer, but that’s not what you’re paying for now.

And so anyway, it’s, it’s that it’s, um, But there’s a big reaction around that and so I look at that and sometimes it feels like there’s this big debate and vets are charging way too much and blah, blah, blah. But I also know that, you know, the four drivers of engagement on social media are negativity, emotional, and moral language.

Tribalism and extremism. Those are the four drivers. And so I know that messages… 

Dr. Emily Tincher: It’s usually a meeting of like having meaningful conversation and trying to meet in the middle, right?

Dr. Andy Roark: Exactly. And so I don’t think that I I don’t think that what I’m seeing online is an accurate reflection of probably how your average pet owner perceives our prices. What are your thoughts on that? And what do you think that the average pet owner is sort of Do they have a strong emotional reaction? Do they notice that prices are creeping up?

We see with the, um, the VHMA surveys that come out, which are, which are excellent. We sort of talk about, you know, year over year, we see the number of visits go down, but profitability stay or go up because we’re raising prices. But, but I don’t really see accurate reporting of how pet owners perceive this trend in our industry.

Do you, what are your thoughts?

Dr. Emily Tincher: Well, we’re we’re raising prices, but then we’re also the number of goods being added to each invoice so the number of light item details are also increasing so the those components of simple cost increases, but also some of the other drivers of increasing cost of care is Is Advancing level of treatments too.

And we can maybe talk more in detail about that. But, um, I think it’s a really interesting question that we don’t know the answer to that much. I think I would advocate that what pet families do we understand the best in veterinary medicine? The ones who see us, right? The ones that come in, we have the best understanding about them because

we we see them in an exam room setting they’re often the ones that are included in market research. And those who are already accessing veterinary care are the ones that we know the most about but we’re not necessarily asking them how they feel about price sensitivity. We are seeing trends to to your point from VetSource Uh, there are other other references, but I like the VetSource, AVMA Um, weekly free report that that comes out via email if you like it.

Um, that shows us to your point, visit visits are down, but average client transaction revenue is up. So we tend to mostly talk to those who come in to see us, but we don’t ask them necessarily maybe when they’re not feeling that emotional component of, of having just received their, their invoice. I will say there’s a communications component to that, that we

sometimes do really well at and sometimes probably could have some room for improvement on when we have asked as a profession veterinary Asked pet families. How do you want to be communicated to around money? One of the big no no’s we’ve discovered is that It shouldn’t be a surprise when the pet family goes to the vet to pay for their bill, how much they’re going to be paying.

And I can tell you that I’ve had recent, um, multiple different places, um, experiences with my horse who’s lame right now, unfortunately, um, experiences with my new puppy and, um, a couple of months ago, some experiences with my cat, uh, for some monitoring blood work that, um, for just keeping track of HCM that his two brothers have, um, um, None of those cases, and maybe they’re interacting with me differently because I am a veterinarian, but in none of those cases, and we do have some data available to us, that still pretty frequently, it’s a surprise to people.

So, so that’s one level up that we could all do is to help. Make sure that we’re informing, informing pet families, what, what the costs associated with care are, and then have that, that opportunity to, to discuss the value associated with that, bring those two things together. But we don’t, we don’t do a good job.

I I’m, and I put this on all of us. I’m like, we don’t do a good job of asking pet families what truly they’re looking for, how they’re perceiving the changes in costs and the changes in care, what they want. And we also don’t do a good job of of talking to pet families that are not routinely coming in to see us for veterinary care, to ask why?

What, what is it that we’re not fulfilling for you? Is it primarily financial? There’s some evidence from the access to care coalition that, that financial barriers are a big one. Um, but what are the other barriers and how could we potentially make sure that you have the health literacy conversation about why it’s important, but also the, um, you know, different potential methods of increasing access to care?

That might come from that conversation.

Dr. Andy Roark: Yeah, it, well, it’s survivor bias. You know, when we talk about who we’re talking to. It’s the classic, it’s the classic example of like when the military would look at planes that came back from combat, and then they would look at where the bullet holes were in the planes, and they were like, oh, we have to put more armor here.

And then finally someone pointed out, we, we’re looking at the planes that come back. We need to look at the planes that come back. Don’t come back and see where they got hit, because that’s where we need more armor. And the same thing is here, too, is like, we talk to the people who come back and try to adjust to their, to their desires, but we’re not talking to the people who didn’t come back, who have, you know, have a, have a significant complainer perspective and something like that.

I think that, I think that’s true. I really like your point about surprises. I think, I think people are innately good, but I also think that we, Like to be comfortable. And I think that if you said to me, Andy, would you like to go and let this person know that they’re going to spend $675 for their two labs today?

Or would you just like to let the front desk do that? I’d be like, well, you know, I mean, it’s just about me. Then I would like to let the front desk do that, but that’s, that’s the outcome is not, is not positive. And I think that’s why we have such huge turnover at the front desk is tasks like that of surprising people with bills.

Dr. Emily Tincher: that and potentially pay discrepancies for for how challenging that that role really can be. I mean, there’s great evidence, peer reviewed evidence, that involving the entire healthcare team from veterinarians, receptionists, to our licensed technicians, all the way through, all being on the same page about costs and discussing them is really important for buy in from the client.

So, um, There are some, there are reasons to do, to do that, to have that training and conversation with the team. I do want to briefly mention, because we brought up as a problem, not, not addressing, uh, and talking to pet families and asking them what they want. That is, that is something that we tried to do.

Uh, at Nationwide with a research study that was, will hopefully be published, uh, later this year. We’ve been talking about for the last couple of years to, to ask, what are, what are the preferences that you have surrounding, um, and, and we didn’t necessarily do a straight survey because we know that there’s a lot of emotional bias for pet families.

Um, but, Asking what are what are the motivators? And we’ve talked about this before on a podcast, but I think it’s worth just briefly mentioning again that, um, we identified relatively independent of demographics that their motivators are cost, choice, and convenience. And that those different groups of people want to be talked to differently, um, in relation to, to their preference for how they’re going to choose the care that they choose.

So we’re, we’re trying to help solve that challenge that we’ve identified, but I do think it’s a, a, a larger one industry wide that we can continue to ask pet, ask pet families and involve them in the conversation for how care is evolving and how delivery of healthcare is evolving. So that we. Have that kind of, uh, service and product market fit.

Dr. Andy Roark: Yeah, I’ve, I’ve thought about that since we, since we first discussed it. I, I have found it helpful to look at PetOwners some of the time and just kind of ask myself, Is this a cost based client? Is this a convenience based client? Is this a, a choice and understanding education based client? I think, I think that that’s an interesting way to kind of

parse people apart. Again, it’s never perfect, and it’s always a mixture of things, but, but it does, it definitely helps to sort of, it’s helped me get my head around it. I want to jump back real quick. We were talking about about rising costs of pet care. You know, I, you, you’ve talked before about sort of three, I’m curious how How much weight you put on these?

Obviously, there’s a lot of reasons for the cost of care to be going up, but you, you want to kind of call out specifically staffing costs, adapting to changes, to changing practice economics, and then increased costs of consumables and drugs as kind of your big three. Do you see those as the primary drivers or are they three that you think kind of slip under the radar?

Dr. Emily Tincher: I think there are three of the main drivers, to your point, we could continue to, and, and veterinary, uh, economists have delved into further areas, but I think three of the big drivers that we’re seeing recently, and, and as we wrote about in the book chapter, Um, three big changes, uh, and, and maybe, um, there are, there are constants and there are, these things seem to be maybe accelerating right now are part of, are contributing to that, um, feeling we all have of costs seem to be rising quickly right now.

So staffing costs, I think is a really interesting one. Um, it’s really important and needed. We have needed to increase salaries, not just for veterinarians, but for more so, frankly, for our support staff for a long time, we still have some room to grow there, um, potentially considering different incentive methods.

What does it, what does it look like for, um, there to be different methods of compensation that involve the whole health care team having a, uh, production type incentive, there, there are things to be considered that are outside of my realm of expertise. But what we did talk about in the book chapter is the staffing costs of rising salaries that we need to recruit and retain

the people to do the work in a practice, in a clinical setting, um, there’s nothing bad about that. We, that, that has been needed. However, it’s important to remember that it, there are also results that, that come from that. And pet families are, uh, kind of, you know, Helping to carry that greater financial burden because we have to accordingly rise, uh, raise prices to help pay for those staffing costs.

So it’s not, again, not a bad thing that we’re doing that. It’s a good thing, but it’s also something to know that’s one of the drivers that the ultimate feeling of that, um, is being seen in invoices being and care plans being discussed.

Dr. Andy Roark: Yeah. Um, when you talk about adapting to changing practice economies, the way I took that, I want to see if I’m right here, to me, these are the sort of the changing of the landscape that we’re facing. So, for example, if a practice started to have less pharmacy business because of online pharmacies that their clients were using or things like that, that would be sort of a changing economy.

If they were introducing new services. Um, you know, they’ve got a, um, they’re doing their own ultrasound scans or they’re, they’re shifting around doctor schedules to offer telemedicine or sort of things like that. Those are all different ways of working that are being offered as services to the pet owners, but they are affecting how we price our services and what people are sort of leaving the clinic having paid.

Is that correct? Mm.

Dr. Emily Tincher: It is. I, I think that, uh, if we just look at examination fees, for example, I think exam fees is something that we’ve seen change relatively significantly in many practices over the last, since COVID. And, uh, essentially it was, we, we see less production coming from, um, pharmacy, uh, a trend, uh, that we are seeing across vet med is rising exam fees.

to, to go along with it. Now, I’m not saying causation or that that’s purposeful in every case, but it is one that, um, you’ll, you’ll hear consultants talk about, for example, as increasing your exam revenue to kind of make up for that. And again, there’s nothing inherently bad about doing that. Ultimately, we are a, uh, what are the things that we as veterinarians can, and veterinary healthcare teams can exclusively do

you know, in this case, we’re talking about an in person setting and that’s use our brains and, and have, have services, the pharmacy stuff. It, it is an opportunity for pet families to, um, say, save some money in one area. Uh, if that’s possible. You know, potentially ordering online or, or going to a Walmart for a prescription.

Dr. Andy Roark: Talk to me a little bit about your idea that we’re seeing a decrease in access to intermediate care. I think that that’s an interesting idea. Can you, can you sort of lay out what you mean when you sort of put that forward?

Dr. Emily Tincher: Yeah. So as we consider the concept of a spectrum of care, what is, what is something that most of us can do in clinical practice to increase access to care, we can provide options and, and they have to be specific to the setting that we’re in. Uh, but we can provide a range of options. And, um, you know, at the high end of that, if we consider, We recently, in April, we released our annual, um, most common claims at Nationwide.

Uh, we can attach that in the show notes, the, the press release from that for, I don’t know, many, many, many years running straight for dogs. The most, common claim yet again is skin allergies and skin infections related to skin allergies. It’s top 10 for cats as well, but not the number one spot. So why don’t we think about it that way for a skin allergy case?

Um, the most advanced level of care may be, especially for cases more chronic as they tend to become maybe to go see a dermatologist. Um, okay. But that is an option. Pet family should know that it exists. Um, in this case, there’s a lot that we can do and do frequently on a day to day basis, um, as general practitioners for treating skin allergies, uh, where we are.

That is pretty different when we think about some of the surgical things that are out there. Um, I think from a skillset perspective and, and one, just going back to the skin allergies. It’s more common than it used to be to refer to see that dermatologist. There’s a lot more access to referral care than there was even 10 years ago, much less 20 years ago or beyond.

And so again, that’s a, that’s a good thing. Um, and at the same time, having, uh, more referral, that increased level and access of care, uh, we’re sometimes managing less than how sometimes more likely to refer. Um, which is a great fit for some families and not, not as good of a fit for others from a true skill set perspective.

Sometimes, um, I think we ended up talking about surgery a lot and whether that’s a, it’s a combination of so many factors, much, much like the cost of care and rising and the why. The why for, for having, um, less experience or less, less of a skillset and general practice settings to perform intermediate level surgeries, whether that’s, you know, the, um, a lateral suture for a cruciate ligament or a perineal urethrostomy for cats.

Um, so even foreign body surgery, many, many, uh, of our, especially younger veterinarians are, are not, um, comfortable performing that surgery. Okay. Because of the mixture of, I think, fear sometimes of learning that skill set after we graduate, and there’s a lot less surgery experience while you’re a student than maybe there used to be, there’s just less of a mentorship culture, uh, and ability to continue building that skill set, especially comfortably, um, than we used to have.

Um, resulting in, you know, some, some folks simply cannot go, they, they could afford to pursue surgery with us in a general practice setting. Um, but that’s not always going to be the case and certainly hasn’t, hasn’t been when I’m providing estimates at an, at an emergency specialty hospital, not always the case that that’s an option to move forward in the, a specialty referral environment.

Dr. Andy Roark: Yeah, I, I completely buy that. I really, I was intrigued when you said that. I’ve got this idea, Emily, that, um, part of sort of the path forward as we let our support staff work at a higher, like, at the top of their licenses, I think that we can continue to, to, to pay them better and let them have more autonomy. I think that general practice veterinarians are going to have to move up more towards the top of our licenses, which means I think we can see a lot more of our basic wellness services being handled by, by our, you know, by our technicians or, um, I don’t know if a mid level practitioner will, will appear or not, and I’m not trying to, to stoke that, but, um, but, but if, if that were to happen, I could see a lot of

basic service being provided by those people. And then what would happen is general practitioners would move up more towards a management role of providers. And then also that intermediate level care. But I really do think, and I know I’m a perpetual optimist, I really do think that there’s so much fertile land there for us to cultivate.

You know, there’s just so much opportunity for us to start retaining cases that we’re, that we’re punting that maybe we don’t need to. I think surgery is a great area for that. But, but, but we’ve got it. We’ve got to get some mentorship and some growth in educational, uh, pathways so that people feel comfortable getting there.

But I, I completely agree when, even when I started in vet school, you know, 15 years ago, uh, more than that, there was, there was a lot of stuff that we did in practice that I just don’t see being done that much anymore. It goes to the specialty hospital. I, and again, it’s not. It’s not bad, but it has cost ramifications.

Let’s,

Dr. Emily Tincher: think I think that the other, you know, the, the way forward may not be the way backwards sometimes. And so one of the other interesting things that I’m seeing, and you have to have a certain population density probably for something like this, but there are now some general practice level surgery, surgery only practices cropping up.

And so I think that’s a great example of what are the new ways of, of modeling practices that may, um, more suit our current environment. So how could you efficiently have dental only practices, have general practice level surgery only practices? Um, if doing that in the general practice setting, um, uh, of my parents, you know, um, my, and the way that I grew up may not be the path for everyone.

Could it be that you were working more within a community setting of You know, my, my, I, I cannot do surgery. I don’t, It’s been a long time,

Dr. Andy Roark: Ha ha

Dr. Emily Tincher: uh, since I’ve done a spay much less, um, at this point, it’s limited to laceration repairs when I still pick up ER shifts sometimes. And I think like having. An option like that to say, like, we, there’s a practice nearby that during working hours, they, it’s not a specialist and the costs are, uh, some of them transparently like sitting on the website.

Exactly. This, this is what the cost is. If you come in to see us, um, I think it’s a really cool way forward, creative and innovative way forward for evolving some of our models. If you’re not one that says our general practice is going to be mid level surgery capable.

Dr. Andy Roark: yeah. I, I, I completely agree. I think, I think, um, I think the future of vet medicine is fragmentation. I think that’s, I think that, I, I think that’s great. You know, my, my biggest piece of career advice for people for a long time has been figure out what you enjoy doing and what you’re good at and figure out how to do more of it.

And I just, I think that, that’s great. I think there’s so many more opportunities to do that. When you say like a dental only practice, some people would just cringe away. And some people’s eyes light up of like, Oh, that would be if I could just do teeth all day, like that would be amazing. And just, I don’t know, I, I see that it would just such an optimistic lens of like, this is going to be, this is going to be great.

I think charting your own courses is, um, it’s something we’re going to be able to do in ways we haven’t done before. Talk, talk to me a little bit more. So, okay. So we’re talking, uh, we’re talking about sort of, how do we, Given that we have these drivers upwards of, of pricing and we talked about, you know, staff wages and things.

I don’t, I don’t think that those are bad things and I think that we agree, you know, they’re, and again, offering people a higher level of care. That’s not, that’s not bad or innately bad in any way, shape or form. I don’t, I really don’t think that people are, I don’t know that we get, you know, Treated fairly sometimes especially about angry people online but but I don’t think anyone’s the bad guy here. At the same time going back to our nuanced approach from the very beginning It’s challenging for people to have pets If they have limited resources, and I think that a lot of us we can get- it’s funny. We’ll get fired up and say well we you know we deserve this money or we’re worth this or this is why the price is what it is And then if you say to that same person, well, do you think that people who can’t afford that shouldn’t have pets?

And they’re going to go, you know, no, I don’t, I don’t want that to be reality. And so how do we, how do we start to find the middle ground, Emily? Like, what is, what does that path look like?

Dr. Emily Tincher: I think the, um, the question that you almost touched on there is like, is our pets a privilege? And,

Dr. Andy Roark: Oh, I almost asked that question. And then I backed away from it.

Dr. Emily Tincher: Well, it, it’s, it’s an important one to talk about. I, I see it sometimes that I think when our, in our hardest moments, in our most challenging days, that it can be tempting to say, if you don’t have the financial planning to fix the foreign body, Um, then you shouldn’t be able to own a pet, but the reality is that 60 percent of Americans live paycheck to paycheck.

And the most Americans would struggle to come up with more than 400 for an emergent situation. And so if we’re going to say that most Americans should not have a pet, I think we have to step back and say, first of all, the human animal bond is so incredible for the value it provides to us. As humans or mental and physical health development of children that that’s not we have to back away from that.

That is, we cannot understand the value of the human animal bond and at the same time believe that pets are privileged that only the wealthy should have available to them. And we have to acknowledge that no one’s asking us for our permission

Dr. Andy Roark: Right. Yes. a good point. Like, this is people like, let’s see what the vets say about whether or not we should have a pet. Like that’s not

Dr. Emily Tincher: yeah, it was, I don’t remember who said it was a comment at the American Association of Veterinary Medical Colleges a couple of years ago, um, just kind of stood up in a spectrum of care forum and, and, and mentioned that. And I, I, that’s really stuck with me of like, Yeah, no, no one’s asking us for, for our permission to add a pet to the family.

And so even coming back to a One Health perspective, then we, we have to find some way to work together with pet families for, to prevent zoonosis minimally. But then also to the, the level up from that is to protect and promote the human animal bond. And so I don’t believe that pets are a privilege. I think that

you know, that we do have to provide them a level of at least a basic level of care. Um, and how do we engage with that? How do we as, as that healthcare teams, um, say what, what can I do on an individual level, maybe a community level. And I think spectrum of care is a great one of the solutions, but, but increasing access to care requires all of us to work together and it requires a lot of different solutions layered over each other.

Financial planning resources are I think another really important one, um, to, to both help pet families say yes to the care that we’re recommending. Um, even as we come back to that idea of advanced level care and what is, what is the right, what is the right care and, and, um, and having a lot of really good conversations with how do we define best care?

Dr. Andy Roark: Yeah, I agree with 

Dr. Emily Tincher: I used that to maybe define it as like the most advanced level or the gold standard, a term that I’m desperately trying to avoid except calling out that it’s not, not very helpful. Um, the best care, in my opinion, is the care that meets pet family needs. So the pet gets what they need, but also acknowledges some of the resource and budget constraints that we’ve talked about why those are popping up today.

I 

Dr. Andy Roark: Yeah, I think for me, because I’ve thought about this as well. So for me, defining best care is still a little bit nebulous in my mind. But basically, three requirements are for me. Best care has to get done. It’s not best care if it doesn’t get done, because then it’s no care. And so best care has to get done.

It should be care that the pet owner feels good about. Like they feel good about what they provided, and it should be, uh, care that the practitioner feels good about as well. And I think if you have something that actually gets done, and the pet owner feels good about it, and the provider feels good about it, probably, you’re probably pretty close to best care.

I don’t know. Maybe that’s too low a bar. I don’t know. I have to keep working on it, but I think, I think there’s some, there’s something there.

Dr. Emily Tincher: I think that it’s, it’s really important to, you know, we’re, we’re applied scientists and the amount of evidence based medicine that we have, peer reviewed medicine that we have, it’s not as much as we might like, um, having more opportunities to measure the outcomes of care will really help us move forward in feeling good about different levels of care that are available.

Unfortunately, right now there’s more, there’s not a lot of outcomes based medicine, but there’s more evidence that’s available to support more advanced levels of care. Um, I think there’s some really great examples of, um, more intermediate level care being studied, especially through the ASPCA. We talked about some of those in the past, um, um, pyometra and timing example, in timing of that surgery, not requiring instant intervention or the pet will die.

Um, we can link that paper in the show notes too as well. I think it’s a really important one. Um, But know that I, we, we’ve talked, touched just a little bit on advancing level of care. It’s not a bad thing. And I think because when we’re talking about increasing access to care, sometimes, um, specialty or really advanced levels of care might feel like they’re getting beaten up.

Um, but I think that’s because we already, we already see the value in that and, and it might be that, um, it’s very, very likely that in most cases, if we consider nothing else but the medical outcome, in most cases, probably the most advanced level of care would be the best option. But since that’s not in line with resources that are available, and frankly, that’s not always what people want, especially when we’re considering chronic or end of life care.

Um, we have to, we have to consider some of those other options and, and bring them in.

Dr. Andy Roark: yeah. Emily, thank you so much for being here. Where can, uh, people find more information on Spectrum of Care, you have done so much with this. You’ve got so many resources and things like that. We’re gonna link up, uh, the resources you already mentioned, but, uh, where’s your favorite people for, uh, where’s your favorite place for people to go and learn more?

Dr. Emily Tincher: Yeah, there’s a couple of places I would recommend. So we have, uh, Nationwide put together, um, spectrum-of-care.com um, that’s some, just some basic awareness and we’re adding some additional, uh, resources to that over the coming months. Uh, we can find, find me on, uh, webinars or writing often about, um, or at conferences writing about spectrum of care.

Um, the other place that I would recommend, especially for some financial resources would be to go to the open door veterinary collective, which is a nonprofit, um, trying to build to kind of multi factorially look at how do we increase access to care, um, especially by re rethinking a little bit. How do, how do we, um, consider the financial options that are available to us?

Of course, of course, pet insurance, you know, work for Nationwide, a pet insurance company, is one of them. It’s an important one, but we need a lot of other, um, support methods to, to make a, a wide and lasting impact.

Dr. Andy Roark: Yeah, I agree. Thanks so much for being here, Emily. Thanks for tuning in, everybody. Take care of yourselves, gang. We’ll talk to you later. And that’s it. That’s what I got for you guys. I hope you enjoyed it. I hope you got something out of it. Thanks to Emily for being here. Thanks to Nationwide for making this episode possible and sharing tons of resources in the show notes. Gang, take care, be well, I will talk to you soon.

Perfectionism: How I Got it Wrong

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There’s a saying in veterinary medicine about how half of what we know is wrong… we just don’t know which half. It’s impossible, after all, to continually learn things without disproving or (more commonly) significantly expanding on things we once thought were complete truths.

I was reminded of this fact recently as I reflected on some writing and interviews I’ve done around perfectionism. In the past, I’ve believed that perfectionism is essentially fear-based. It’s a behavior that we hold up as aspirational when, in fact, it’s a manifestation of un-aspirational mindsets like fear of failure and fear of losing control.

I came to this belief through a lot of experience working with perfectionist veterinarians and some solid research on common workplace behaviors. There is certainly truth in this idea, and we have all known perfectionists who are unable to delegate tasks or simply take a step back because of their own anxiety. Their obsession with “getting it right” comes from worrying about cases going wrong, not having an answer, being blamed for something that someone else did, letting others down, failing to live up to a perceived reputation, and so on. The behavior in this context generally becomes damaging to both the individual and the team working with them over time.

For these reasons, I have maintained that perfectionism is a trait that probably shouldn’t be celebrated or encouraged. I have viewed perfectionist personalities to some degree as “red flags” that might need to be managed, and I have encouraged perfectionists to work on “letting it go.”

My perspective on perfectionism, however, has begun to shift.

I was recently working with a lead CSR (Customer Service Representative) and her team. We discussed how the team holds each other accountable and their expectation that the rules and policies set by their large practice be followed. It was very clear that protocols in this practice were taken seriously and that knowing and understanding policies was non-negotiable. Perfection in the execution of the handbook was clearly the target.

At one point, I decided to probe a little into the “why” of this strict adherence to policy. It’s not that I don’t see great value in what they are trying to do. It’s just that it’s rare to see such lock-step alignment in a team this large. Most practices would swoon over employees who want to “get it right every time,” and I wanted to know what motivated the behavior in this case.

When I started asking questions to this end, I expected to hear all about what the team (or more likely one of the managers) feared. I anticipated hearing about how failing to follow protocols could hurt patients and clients, damage the clinic’s reputation, lead to bad online reviews, or get people into trouble with the doctors or upper management. But I didn’t hear about any of this.

When I asked this group why “getting it right every time” was so important, they just looked at me until someone said, “Because we want to be the best.”

This team was not pursuing the highest standards because they were afraid of what would happen if they came up short. They’re pursuing the highest standards because they want to be fantastic and believe they could be. 

On reflection, I suspect that my view of perfectionism in recent years has been unfairly narrow. Yes, sometimes perfectionism does come from an unhealthy place, but that’s not always the case. Sometimes it comes from a burning desire to be exceptional. Perfectionism can stem from a belief that being organized, motivated, and disciplined every day is possible and that expecting great things from ourselves and our teams gets the best possible outcomes for our patients and clients. In these cases, I think perfectionism can be inspiring. 

As with most things in life, context matters. In recent years, I think I have looked at behaviors like perfectionism through the lens of a problem solver. It is easy, after all, to size up people’s behaviors as being driven by the most basic instincts. Yes, people are often motivated by emotional drivers like fear, but they can also be motivated by a sense of deep purpose. Perfectionistic behaviors can be aspirational, intentional, positive, and proactive. They just need to be communicated effectively.

We Have Trust Issues

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Dr. Peter Weinstein joins us to talk about some of the major mistrust we are seeing in veterinary medicine. In this week’s episode of the Cone of Shame podcast, Dr. Andy Roark and Dr. Peter Weinstein discuss how the lack of trust has emerged in the veterinary industry due to the influence of media and the current state of our country and culture. They take a deep dive into the origins of this mistrust, what can be done to address it, and their hopes for the future of the industry. Let’s get into this episode!

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

LINKS

Dr. Peter Weinstein on LinkedIn: https://www.linkedin.com/in/pawdr/

Veterinary Ownership Advocates: veterinaryownershipadvocates.com

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr Peter Weinstein is a husband, father, pet parent, veterinarian and leader. He has been involved with virtually all aspects of veterinary practice from a 15-year-old kennel kid to a hospital owner.  Organized veterinary medicine has been a passion as well with various roles and leadership and presidencies of Southern California VMA, California VMA, and Vet Partners. He is a published author, most notably of the E-Myth Veterinarian-Why Most Veterinary Practices Don’t Work and What to Do About It. Currently, he is teaching business and finance at the Veterinary College of Western University of Health Sciences. He likes to think of himself as a free-thinking change agent and disruptor who, because he has a daughter who is a recent graduate from  veterinary school, is working for an even better veterinary profession in the future. 

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark guys, I got a great one today. I’m here with my good friend, Dr. Peter Weinstein. And if you don’t know Peter Weinstein, you’re in for a treat. He’s a little bit hard to explain. He is a, he’s a veterinarian. He is a former practice owner.

He has been the Practice Management Speaker of the Year at VMX before. He teaches all over the place. He teaches vet students. He’s been a mentor of mine since I was a vet student. He is a veterinary educator and disrupter are his terms. And I think that’s fairly accurate. You’re going to hear some heresy today.

You are going to hear some ideas that are outside of the box. You are going to hear some some, he’s going to poke, he’s going to poke some sacred cows. And it is an interesting idea conversation about the trust bank that we have with our support staff, that we have with pet owners and and we get into generally declining trust in society overall.

If you have the feeling that we don’t trust people and people don’t trust us like they used to, this is going to be a great episode for you. So we really get into it when we talk about it. Let’s get into it.

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

Dr. Andy Roark: Welcome to the podcast, Dr. Peter Weinstein, thanks for being here.

Dr. Peter Weinstein: Dr. Andy Roark, always a pleasure to see you, hear you, speak to you.

Dr. Andy Roark: I love having you on the podcast. We– I’ve had you on a number of times and I always have just these fantastic conversations. I reached out to you recently and I was like, hey Let’s get back together. I want to talk to you about some stuff. What are you really excited about? And you immediately said, Oh, we have trust issues in vet medicine.

And I thought, okay, this is, I have thoughts on what this means to me. And it was really in line with some things I’ve been looking at and seeing. But let’s go ahead and just sort of open this up there. Peter, what do you mean when you say we have trust issues in veterinary medicine?

Dr. Peter Weinstein: It’s multifaceted. I think we have trust issues with our teams at times. I think we have trust issues with our clients. And I think veterinarians as a profession really have a hard time trusting people. And I don’t know why I can’t really explain it, but I really do think that we have maybe created a wall or a thick skin around ourselves.

It just– we were skeptical, cynical, and I, maybe I’m cubbyholding everybody when I shouldn’t be generalizing, but, it feels at times that we really have trust issues.

Dr. Andy Roark: Yeah, I, so let me give you, let me give you a theory and see what you think about it. So, I think that as a society overall, we are getting increasingly cynical. And I think modern media is a huge driver of that. I think tribalism is a huge driver of that. I think social media particularly is a huge driver of that.

I think we’ve just got a lot of in group, out group things going on where it’s like, Don’t, you’re with us or you’re against us. And if you don’t believe what we believe, you’re one of those people. And there’s just, there’s a lot of people who don’t trust that news source. Those people are lying. That’s fake news.

And it’s just, that never used to be the case. And it’s just, it’s constant. So one is, I think that there’s this media push that has really made a lot of us cynical and deeply mistrusting. I think that when we see things on social media, I think that there is one of the quickest, so there’s four big drivers of social media that I saw recently, it’s it’s negativity it’s just that full straight on, it’s extremism.

It’s in group, out group language, and then it’s emotional and moral language. And so, those are the four big drivers. And if you think about those four drivers: negativity, tribalism, emotional and moral language, and extremism. None of those bode well for the status quo. None of those help us have any sort of trusting relationships.

They’re just, they’re all driving towards these extreme views. And I think that’s, I think that’s, I think that’s really a problem. And the last thing I would say is, I really think in the last 8 to 10 years, we’ve had a massive degradation of trust in institutions in our country, whether it’s law enforcement, whether it’s the Supreme Court, whether it’s corporations, whether it’s anything like that. There used to be this general idea that these institutions were good and at least try to sort of look out for people and that, that’s not the perception that a lot of people have anymore.

And so I think that there’s, when I look at this, I go, I don’t know that anybody trusts anybody like they did 20 years ago. So does that kind of jive with what you’re thinking? Do you think that medicine is even more extreme than that or that it’s different?

Dr. Peter Weinstein: Thank you for joining me on the podcast today, Andy. But,

Dr. Andy Roark: Thank you. Sorry. I get excited about this. 

Dr. Peter Weinstein: I know, no, I’m kidding. No, I think you did a great job of giving an overarching view of the polarization of our country. You know, it used to be that the gap was the sidewalk crack between different beliefs. Now it’s the Grand Canyon. I don’t think veterinary medicine is any different than any other of the global issues that you talked about.

I think we are embedded in it. So you feel it more. And so when you know, you talk to staff members and you do a lot of talking to staff members, you educate staff members. They’re not always sure that they can trust the manager or the owner. To a degree, some of the national corporations have not necessarily strengthened trust within the practice modalities because they have approached a profession that is built on relationships and made it somewhat transactional. I think we have an economic environment right now, globally due to inflation, and within the veterinary profession, even more bloated inflation because the cost of care continues to grow.

That has violated a trust with pet owners who are seeking a relationship, and we’ve had a profession that has always been very high in the respect categories that I do think the cost of care has become a problem and violates trust from that standpoint. And I think in many ways because the cost of products has gone up so high, we start to question our relationships and our trust, even with industry.

So I think there’s a, we’re living on an, a fault line with all of these things, and then you throw, as you talked about social media and the news. And I’m not sure that there’s much difference between social media and the news and I keep asking where’s Walter Cronkite. Now you probably weren’t born yet. 

Dr. Andy Roark: I remember Walter Cronkite. He was, I was eight years old and he was on TV.

Dr. Peter Weinstein: Well, very good. So you know, where is the real news? Where is the factual news and I think a lot of even in veterinary medicine we expound on opinions because it’s emotional. I mean, we have become so hyper. I like to think of veterinary medicine as a demyelinated nerve. We are so hyper reactive and so easily stimulated by just the smallest thing.

We go off on clients, they go off on us. So that’s what I meant by trust issues. It touches on everything. that you brought forward as national issues because that’s how we are influenced. I mean, we’ve got five generations of people working in our veterinary hospitals. And we have five generations of clients, all of whom have different backgrounds, knowledges, and tools and resources they go to learn from.

Dr. Andy Roark: Yeah. I, so there’s a lot, there’s a lot there to unpack. It’s funny, I’m interested if you sort of agree with this. One of the things that I think has strained trust inside of individual practices is the move towards corporatization. And I’m not trying to be anti corporate at all here, other than to say there is something innately stabilizing.

Maybe when the person who owns the business is right there, shoulder to shoulder next to you, and you can turn to her and say, Hey, Dr. Smith can we talk about this decision? Or can I ask you why, this is what we’re doing, you know what I mean, and just, and knowing Dr. Smith and saying the organization has made a choice and the organization is really Dr.

Smith and we have lunch together and it’s sort of, I don’t know how you can ever bring practices together and not necessarily have that. If you don’t have that owner in the building with the rest of the people, it seems like you’re always going to have to work to try to create organizational trust that was much easier to maintain when people were there.

Now granted, if Dr. Smith is toxic and terrible, there’s, you know, there’s, already no, no trust, but does that decentralization of ownership. Do you think that is part of why we see, I don’t know, does that make it harder for teams to trust the practice they work in?

Dr. Peter Weinstein: I sold to a corporation. And so for 15 years or so, I had a mom and pop organization, me and staff and management that when there was an issue, they could come to me and say, Hey doc, the dryer is broken. What do I need to do? And they didn’t have to run it up the flagpole or we need to, you know, look to hire somebody.

And it didn’t take. You know, three memos, two texts and a carrier pigeon to get a decision made. Now you own a business too, and you have a team. And when there are issues that arise, they can go directly to you. If somebody bought you and you had to go to somebody and say, well, I want to give Maria a raise. I’m not sure we can fit it into the budget this year, but she’s really committed to the practice and I’m afraid we’re going to lose her if I don’t do that. And they say, well, if it doesn’t fit into the budget, we can’t do it. What position does that put you in with Maria, for example. So I do think. I mean, corporate influence is still a very small percentage of the practices.

It’s a large percentage of the employees. But I think we have lost a little bit of that culture that comes with a legacy owner in a mom and pop organization that’s part of the community that can make a decision to pivot. God, I hate that word because we used it so much during COVID, but that we could change.

We can morph on a dime and not have to run things up to get decisions. So I would agree with you that sometimes we lose relationships. When we lose, when the hierarchy becomes too vertical.

Dr. Andy Roark: Yeah. We have this thing called recency bias, right? Where, the things that are happening to us at present seem to carry much more weight than things that happened to us in the past. Do you really think that our with industry— so you mentioned, like product purchases and things like supplies– do you think that our relationship with industry really is different now than it was 20 or 30 years ago? Or were we complaining about prices going up in 1990 just as much as we are now, but it feels more. You know, real. It feels more. It feels more. I don’t know. We’re very much feeling the current changes and we’ve kind of selectively forgotten that. Oh, yeah, this is how it’s always been.

Dr. Peter Weinstein: Well, this is how it’s always been. But I think our nerve endings are rougher. I think we’re more reactive and less responsive. I think we had, I can go back to when I opened my hospital, which was 30 years ago, and we built relationships with our vendors. And I think to a degree, maybe the pandemic impacted it because the vendors couldn’t come in and continue that relationship.

And they were kept out in the parking lot as were our clients. And maybe a lot of this feeling is because of that three to four years of pandemic period that where we were, our relationships became there was a barrier. There was a wall between people. And I also think there’s been a tremendous amount of turnover in industry that has diminished our ability to build relationships.

Veterinary medicine is a relationship industry. We have a relationship with our staff, we have a relationship with our clients, we have a relationship with vendors. I spent more in my practice with specific vendors because of that relationship. And I let certain did not lead certain vendors in because I couldn’t stand them enough to want to have a relationship with them.

I think some of what the pandemic did, and I think it did it to your kids. I think it’s done it to other businesses, and I think we see it in all service industries is that we have started to lose that loving feeling. And it’s become transactional in many ways.

Dr. Andy Roark: So let me sort of ask you a question is sort of a cynicism test of Peter Weinstein. 

Dr. Peter Weinstein: Guaranteed.

Dr. Andy Roark: I, just don’t even need to ask the question, just

Dr. Peter Weinstein: No

Dr. Andy Roark: All right. So, so I wrote this, article on a couple of weeks ago and I put it out because there was this thing on, on social media and this guy was, you know, raging about the cost of vet services and he was specifically talking about the markup of diagnostic prices and he was just really upset and this thing got a lot of attention. And of course, I really love your demyelinated nerve example because the vet community really flared up at this and being criticized this way and I do this criticism is unbearable It’s unfair and I’m not going to get into it more than that.

But what he was saying, in my opinion, was it did not make sense. It was not fair. but he was very adamant and, people respond to that. So, so I wrote this piece and the, I was telling my brother about it and he kind of laughed and and he said, you know, Andy, I’m a lawyer and I’m having a hard time

getting too worked up about the fact that there’s a random person bashing your profession online. Like, you know that’s just imagine being a lawyer and I thought about that because my brother is a great guy He’s a good person his he does end of life planning. So he writes wills which is like I mean, he’s very much a relationship person and a wonderful person and if he cared about what the general populace thought of lawyers, he would, there’s just, there would be no end to it.

There’s no out. And so my question to you, the cynicism check here is, Peter, do we even care or should we even care what the overall perception of our profession is? Or are we going to a place where like the lawyers, we have a service and it’s a vital service and, you know, people just, crap on lawyers all the time, and we don’t look at that.

Auto mechanics. I had to go get my 60, 000 mile checkup and, I did not have warm, fuzzy feelings about the car dealership, but I paid the bill and I went on and I’ll probably go back for 90, 000 miles. You know what I mean? is that where we’re heading or do you think that there’s a different path?

Dr. Peter Weinstein: I think first of all, I don’t want to become the look like lawyer, because you know as Shakespeare said, “kill all the lawyers.” But I don’t think– I think we are hyper reactive. I mean you’ve– I’ve probably written and I know you’ve written comments about the online reviews that come through Yelp and Google and everything else and how many clients bash us from that standpoint. And I know, and, you know, you haven’t been in practice as long as I have, well, you’ve probably been in practice longer since I haven’t been in practice in a while, but it’s our reptilian brain that has us remember every negative experience that we have. And so we are so hyper reactive. Somebody said, what should you do with on negative online reviews?

I said, don’t respond to them. Have somebody else could screen him for you because you will never sleep again at night with one negative online review, because that’s how sensitive we are as a profession. And it’s what it’s good about us and it’s bad about us. So, when this doctor goes on a tirade because of our markups for lab, it shows a variety of different things.

It just shows a lack of understanding and knowledge about the business model of a small business versus an industry that is run by the insurance companies and big business. But we reacted to it very personally. Each and every one of us took it to heart as if it were us. And it’s not us. It’s, a, it’s just, that’s the way we are.

And part of it is because we, and you asked me how I want to describe myself earlier, and I said as a disruptor and an advocator and an educator, we as a profession haven’t really done a great job of being cheerleaders for ourselves. We don’t go out there and rah about veterinary medicine and talk about all the great things we do.

We spend a lot of time being defensive instead of being supportive. And so I, I really do think that when we can bring a group together as came together online to defend ourselves, I think it’s a great thing. And, I do think that, we should be doing it before the fecal material hits the oscillator and you know, take and do a much better job of advocating for ourselves because nobody else is advocating for us.

Dr. Andy Roark: Yeah, I really like that. That’s– I really like that answer. I, that’s, that is, to me, that is a strong pushback against cynicism. I really like this. We’re going to take the bull by the horns and, and start to explain to people and continue to explain to people what we do and why we do it.

I like that a lot. I wonder if that is going to inform this next question. So I had this as, you know, you start talking and we talk about a trust issue. And you have been, you’ve been kind of retired for a while now. You’re really not good at retirement. Like you are, you’re really the worst person at retirement I’ve ever seen.

But you’re, but you, but your daughter is a veterinarian and a fairly recent graduate. What is your advice to her? Right? Because she’s coming into this. And so, you know, I, it’s funny, I was looking at the Merck well being study pretty recently. And that, I don’t think that thing gets enough attention for what it is.

But it really highlighted that, that young doctors fairly recently out of vet school, are the doctors who often struggle the most in our profession. And then, I don’t know whether you get, you know, crotchetier as you go along, or, if, enough people leave and the only ones left are the people who are kind of dead inside. I don’t know but given that she’s a young doctor, what advice do you give to her?Like, what’s the action steps for her? What’s the takeaway?

Dr. Peter Weinstein: Well, as somebody who’s dead inside.

Dr. Andy Roark: Fellow dead inside doctor. 

Dr. Peter Weinstein: My advice to her and a lot of it comes with confidence and most of our recent graduates don’t graduate from veterinary school with a lot of confidence. There’s a lot of imposter syndrome that we propagate throughout the veterinary education model. And so my comments to Brooke, who’s in Australia practicing is, you know, you’re going to have hard times, but don’t take them personally.

And she had a questionable first job didn’t really get the support she needed from her owner mentor. And she’s been doing some per diem work as she waits for some visa updates. And they’ve been very supportive and very positive and very complimentary. But what do you remember? we tend to remember the negative stuff.

I mean, that’s a natural reflex from that standpoint. So I think it’s important, and I was interviewed for something else recently, and I think what we need to do, you and I, and all the other veterinarians who’ve been out in private practice, is we need to get into the veterinary schools and have a greater voice to the veterinary students about what to expect

after graduation. I think– I don’t think that we have given a lot of the veterinary students a knowledge enough about what life is after graduation. And I do think we should be teaching. I teach at Western. I do a lot of VBMA talks as do you, but I do think that we need to be in there advocating with the students about here’s, how to deal with some of these challenges.

And I agree with you. The Merck study is good. I think a lot of it points out to the financial challenges as a cause, cause for the issues. And the financial challenges stem from client communication. And they stem from cost of care and they stem from clients declining services from that standpoint.

And they also deal with salaries as well as student debt. So there are so many variables. this is a multivariate, very complex veterinary profession with very sensitive people who are demyelinated nerves, being unsure how to deal with negative outcomes and a negative outcome is a review. A negative outcome is a review from a client.

A negative outcome is a review from a boss or a manager. A negative outcome is even just, you know, how long it takes to get through the day, and we don’t How many freaking professions, Andy, get to play with puppies and kittens all day? I mean, do you want to be a proctologist and stick a tube up a dark hole? Do you want to be a dentist and look at the other end and see the proctologist at the far end?

Dr. Andy Roark: No. Yeah. I, I, say that all the time and I walk into the exam room and the pet owner says, how are you doing? And I just say, this is my job. I mean, how could it not be great? And I they, like that. It’s what they, it’s what they want to hear. And I, but, and I do believe it. Let’s imagine for a second that the profession is a ship.

The profession is a ship and you get to put your hand on the rudder. So, so that sort of, if I could sort of steer the profession as a whole. What would you do in the next five years to try to address the financial concerns or this financial stress? Because you’re spot on. Inflation is going up, you know, much faster in vet medicine than the general population.

And I agree. I think pet owners are not dumb. They see it. You know, we all see prices going up at the vet clinic and we all hear comments about it. I don’t know what the immediate fix is, but if you had the professional rudder and could actually steer the profession as a whole, what would you do? What, would you try to see, or what would you like to see in a way to try to relieve this pressure?

Dr. Peter Weinstein: Wow, I feel like I’m dealing with a cat bite abscess and I’m just waiting for the pus to come out. I, just, and I was quoted on this not that long ago, probably six, seven, eight years ago, that veterinary medicine would be great if we had socialized veterinary medicine.

Dr. Andy Roark: Mm hmm.

Dr. Peter Weinstein: Where you and I as veterinarians could go into an exam room. And for a small co-pay, go in and provide the care, the best care that the pet needed. And the client would just be able to receive the care and the medications and everything else at a reasonable cost. And we could be doctors, and we could educate.

I think education is an extremely important aspect of veterinary medicine. And everybody who’s listening to this, when you graduate from veterinary school, you go from student to teacher. And every time you walk into the exam room, every time you go back into the treatment area, every time you get on the phone, every time you hit the keyboard on your computer or your phone, you’re a teacher.

And so I’m digressing for just a minute, but socialized veterinary medicine. So we, and with that, we as veterinarians would be paid a fair and equitable salary for the work that we do, but we don’t have to talk about the cost of care, how much less stressful would that be from that standpoint. 

Dr. Andy Roark: Oh, yeah.

Dr. Peter Weinstein: Now clients could still choose to go to a PPO and we could have PPL practices out there as well for those clients who wanted it. And we could look to see how we could subsidize things more with companies like Care Credit or some of the pet health insurance companies from that standpoint. But I just think a lot of our stressors come from self value and clients who are declining services that you know would be beneficial to the pet.

And, they’re declining it for two reasons. One, they can’t afford it. And two, they don’t understand it. And there’s probably some other things in between. But I think it’s our failure to clarify the why, behind the what of everything we do. And that’s the biggest difference in the last 20 years. Andy is, because of the internet, clients can get all sorts of dis-information that forced us to talk more about why we do everything we do. When we used to just be able to talk about what we need to do.

So I’m all for socialized veterinary medicine. Now it’ll never happen, but if we could do that, would be one thing. let me continue my thought process if I can, for just a minute. I think that there has to be a way to subsidize the cost of veterinary education through more scholarships.

So that when veterinary students graduate, they have a one to one debt to income ratio so that they’re not at 250, 000 in debt or 180, 000 in debt and a salary of 120, 000. And I think there needs to be some more subsidization. And this is where I touch on industry as well and other resources. So we can take some of that out of the picture.

And I think we need to look in our business models as to what we can do to improve our efficiencies. So we can keep our profitability where it is, but be able to not continue to escalate the cost of care to clients. Which to me is one of the biggest stressors is not being able to provide optimal patient care. Because the cost is in the way and knowing that pet is not going to receive what it really needs.

Dr. Andy Roark: Dr. Peter Weinstein, thank you so much for being here and talking with me. I really appreciate it. You have a new course online that I just saw. It’s a program that you have for entrepreneurs. It’s for people who are interested in starting practices, things like that. Tell me a little bit about that and where people can find it.

Dr. Peter Weinstein: Well, Andy, thank you. Thanks for the opportunity, A, to be on the podcast and B, to talk a little bit about one of my passions. As you and I have spoken since you were just a baby in veterinary school. For those of you who don’t know, I knew Andy before he knew himself. I have a big passion for independent veterinary hospitals.

I do think there’s a definite place for corporations in the veterinary profession, but I would really love to see the growth of entrepreneurship. And so Dr. Dan Markwalder and myself created a program. He’s one of the voices on the recordings. We created 24 hours of race approved CE that basically take you from soup to nuts or from finding a location to looking for a new location after you’ve grown your practice.

of online education. It’s in forty-seven 30 minute modules that you can watch at the convenience from your home. And we call it Veterinary Ownership Advocates. And really what it’s focused on is people who are looking to buy a practice, looking to do a startup or even young entrepreneurs who already have their practice up and going, and they’re trying to find more information about how to do things.

And so, the website is www.veterinaryownershipadvocates.com all spelled out. Yeah, I should have found a smaller URL, but so veterinaryownershipadvocates.com. And it’s really focused on helping stimulate entrepreneurship in the veterinary profession. And it includes monthly mastermind calls where we will meet with the members of the veterinary ownership advocates community to talk about some of the issues, problem solve, and share best practices. And so, it can be focused at veterinarians, it can be focused at practice managers, it can be focused at technicians, but anybody who is looking to and interested in being a hospital owner.

Dr. Andy Roark: Gotcha. Cool. I will link all that up in the show notes where people can find it. Peter, thanks for being here. Guys, thanks for tuning in. Take care of yourselves, everybody.

Dr. Peter Weinstein: Thanks, Andy.

Dr. Andy Roark: And that’s it. That’s what I got guys. I hope you enjoyed it. I hope you got something out of it. Thanks to Peter for being here, guys. If you enjoy conversations like this, maybe you should try out my newsletter. I have the Dr. Andy Roark newsletter. You can sign up at drandyroark.Com. It’s totally free. I write for it every week.

And so, I often think about these types of things and this is not kind of the stuff I write about there. And so anyway, like I said, it’s totally free and I write for it every week. If you’re interested in it, go over to drandyroark.com and check out our free newsletter. Anyway, anyway, guys, thanks for being here.

Take care of yourselves, everybody. Goodbye. 

Treating the Unengaged Veterinary Team

by

Josh Vaisman joins us to tackle the challenges of a struggling, disengaged team. In this week’s episode of the Cone of Shame podcast, Dr. Andy Roark and Josh dive into the symptoms of a low-spirited team and explore effective tools as well as strategies to lift morale. The discussion also covers culture renovation and whether leaders should aim for happiness or engagement in the workplace. Tune in for valuable insights on diagnosing and treating team issues to create a more positive and productive work environment. Let’s get into this episode!

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

LINKS

Josh Vaisman at Flourish: https://www.flourish.vet/

Referenced Book: Culture Renovation: https://culturerenovation.com/

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Josh believes all veterinary professionals deserve to feel fulfilled by their work, each and every day. Through his company, Flourish Veterinary Consulting, he combines more than 20 years of veterinary experience, a master’s in applied Positive Psychology & Coaching Psychology, and education in Positive Leadership and Positive Organizational Scholarship and a passion for guiding leaders to cultivate work environments in which people can thrive.

Fun fact – Josh is also an avid beekeeper who teaches beginning beekeepers how to tend to their buzzing buddies.”, Dr. Andy Roark is a practicing veterinarian in Greenville SC and the founder of the Uncharted Veterinary Conference. He has received the NAVC Practice Management Speaker of the Year Award three times, the WVC Practice Management Educator of the Year Award, the Outstanding Young Alumni Award from the University of Florida’s College of Veterinary Medicine, and the Veterinarian of the Year Award from the South Carolina Association of Veterinarians.

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 today with my friend Josh Vaisman and I got a tough question for Josh. What do we do with the lethargic, unengaged veterinary team? I hear, probably more than anything else, hey my team is just tired and I don’t know how to get them enthused about our work.

And so I take it to our positive psychology guru, Josh Vaisman and I ask him about it. And it’s a really good conversation. I hope you guys will really enjoy it. I did not hold back on Josh. I tried to ask him some, hard questions to kind of figure out where his head’s at. and I’ve sort of tried to play both sides of the issue, which is I want my staff to be engaged and enthusiastic and at the same time, I don’t know that it’s feasible for us to make everybody happy and keep them happy all the time.

And so how do I know, when we’re where we’re supposed to be so anyway that’s what we get into today guys. I hope you’ll 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 Josh Vaisman thanks for being back, my friend.

Josh Vaisman: Oh, my gosh, I’m delighted. This is the trifecta, I think now. 

Dr. Andy Roark: Is this a three? Are you in the three timer club now?

Josh Vaisman: I think I might be, I feel exceptionally special today. I’m walking a bit lighter on my feet this morning.

Dr. Andy Roark: Well, that’s good. No, that’s great. You’re definitely somebody I really enjoy talking to and I always get a lot of our conversations. And so I’m really glad you’re here for those who don’t know you. You are the lead positive change agent at Flourish Veterinary Consulting. You write and speak all over the place.

I just read something that you wrote that we’re not talking about today, but you actually wrote an article on some research about differences in perceptions between veterinarians who work at private practice and in corporate practice. And I, I saw the research and I was like, this is really cool, and I saw your name in the byline, and I was like, it feels different for Josh.

But man, it just was a reminder that like, you are doing so many things and you’ve got this wide breadth of interest. That’s how you came top of mind recently. I saw this thing. I saw you working on it and I’m rolling this question around in my head.

And it was sort of that seeing your name and then thinking about the question. I was like, I should ask Josh about this. And so I’ve got a question I want to ask you today and here it is. And so, so first of all, you can validate the scenery for me or not. When I look at vet practice in today in general, and again, this is a sweeping generalization, but one of the challenges that I see again and again, I hear from the clinics that are in Uncharted and things like that is How do we keep the staff engaged when they’re tired. And so that’s the question again is, the staff is tired, we’ve been really busy, team engagement, team enthusiasm seems to be low. And that’s the question. And usually it comes from a medical director or manager or doctor, a practice owner that’s like, they don’t want to run around. We’ve all been the person who’s trying to bring enthusiasm to a group that does not want enthusiasm.

And it, it’s not fun. It’s not fun. You know what I mean? They’re like come on everybody! And they go, they just, they’re tired, and again, and now there’s the, so people will throw around the term toxic positivity. And I don’t think trying to be positive Immediately classifies you as toxic positivity. That’s writing off people’s concerns and telling them they’re being wimps but I do get the idea of when everyone’s exhausted and you’re trying to cheerfully get them to engage with work it can be a delicate line to walk. So let me stop here with my first question for you validate the scenery here.

Do you see this dynamic in practice? Do you think that teams really are tired and that engagement seems to be a challenge sort of across our profession? Is this a real problem or is this sort of a, scattered case by case scenario and you go, ah, this, those people are probably doing things that are wrong.

Josh Vaisman: Yes. So first of all, I have to share with you when you were talking about, like, the example of like trying to add enthusiasm to an environment of people who just are disinterested in enthusiasm. I pictured like people with the thought bubbles. Like they’re not saying it out loud, but you can just read on their face that they want to throat punch you.

Dr. Andy Roark: Yeah.

Josh Vaisman: We, definitely don’t want to do that. 

Dr. Andy Roark: It’s like in the sitcom the office You know and you just like the whole bit is michael scott is up front like all right and like like just the disengagement Of the team is just like that’s the joke. And 

Josh Vaisman: Stanley in the back doing his crossword and yeah.

Dr. Andy Roark: what I was thinking with Stanley in the back doing his crossword. And it’s such, but it’s so, common that’s what satire is today is, this is the staff meeting we’ve all seen. Like that’s the, it just feels so pervasive.

Josh Vaisman: Yeah, you know what? So, so here’s my, answer to your question. You asked me, do I feel like this is actually a thing? Like, are we really seeing teams and veterinary practices that are just as tired? Or is this more of a scattered kind of thing? And you know, those individuals who, those individual organizations are just doing it wrong.

I think it’s kind of a yes. You asked an or question and I think the response is actually kind of yes. So my, my Okay. Semi informed subjective take is that as a society, we are tired that there’s just been a general malaise and fatigue that probably is somewhat residual from the pandemic, and that we’ve just never really addressed.

And then on the societal level, there’s just been all of these polarizing issues and conversations over the last few years that have just added to a general psychological fatigue across the world. Now, add that, you know, sort of pool of context to a workplace, like a veterinary workplace that is inherently unpredictable, uncertain, stressful, and challenging.

Yes, of course, there’s a bunch of people who are just damn tired. I also think that we have to be clear about what we mean by engagement, because, you know, there’s sort of different phases of this. And I think often what we focus on is we focus on, you know, that, technician that’s just like, you just the whole day just hums. When you work with her, you know everything is going to go great. The two of you jive. You have the same sense of humor. You’re laughing about shit all day. Like it’s, just awesome. And you work with her and you can see the energy and enthusiasm she brings. This is clearly an example of an engaged person.

I think sometimes when we think of disengaged people, we think of people who are what Gallup would refer to as actively disengaged. We think of the people who are, you know, they’re in the corners and they’re farting around on their phone. They’re complaining behind closed doors about the practice. You know, they would take the next opportunity that came through the door in a heartbeat and they would have no problem leaving us in the dust.

Maybe we’ll get a two week notice. Maybe we’ll get a two day notice. Maybe we’ll get a text message. I’m not coming into work anymore. Right? Like we think of that as disengaged people. That is a small percentage of a large group of human beings. Most people who fit in the disengaged are people like, you know, we’ve all been in this situation.

We’ve all had a job where we show up on time. We do everything that’s asked of us. We generally do a pretty darn good job. But we are not excelling. We are not bringing our whole selves to work. We’re not getting something personally of value out of that work other than maybe, you know, the paycheck in eight hours out of the day or ten hours out of the day occupied.

And actually a very large percentage of people generally fit into that group. And it’s hard to see them as disengaged, but the impact that it has at the organizational level is sweeping and difficult to pinpoint. And that I think is, I don’t want to say universal, but it’s common. It’s common where you have a veterinary team who, they generally show up on time, they generally do a pretty good job, they generally support and help each other, but they’re not bringing their whole selves to work.

And I think that’s the real question that we need to ask is, what do we do with a group of people like that? How do we shift them, which is just one notch up on the spectrum, from disengaged to even mildly engaged and enthused? 

Dr. Andy Roark: Yeah, so, I like this a lot. Let me call it one thing real quick that you said that really lines up with sort of this worldview that I’ve had for a while is this idea that there are so many issues in vet medicine that are societal issues like the, I think you’re probably spot on in that disengagement or just tiredness.

I don’t think that’s a vet medicine problem. I think that is a society problem. And you also just, you just nailed it perfectly in that I will always say, veterinary medicine is a unique industry with unique challenges. And so, we can experience society wide problems, trends, stressors. And then we also things that we have to do.

So, it probably looks a little different than other places. But, I don’t think that we as individual people are all that different than probably other industries. I don’t think we’re as different as we’d like to think that we are. I think that our days are different because of our challenges and, what the way that medicine is.

Let me ask you this. Okay. So, so now we’re getting to this. When I generally am presented, there’s a couple of management questions that I get presented with and what is they come to me and they say, well, I, we’re seeing these behaviors as in these problems and they’ll laundry list off a couple of problems.

Okay, and in these rare instances, often I can kind of look at those things and say, well, none of these things are actually the problem. These are all symptoms of this other problem. So for example, I mean, you and I’ve talked about this before. there there are things when think about like psychological safety in practice and psychological safety is just the belief that the employees have that they have a voice.

And that they can be heard, that they are safe to communicate what they are feeling, where they are, what’s going on, and that they will be heard. And so, if you don’t have psychological safety, the outcome is not people walking around complaining about psychological safety. It is, it’s, gossiping.

It’s, you know, it’s sort of this back channel chatter. It’s it’s people disappearing during the staff meetings and not engaging and things like that. And so they’ll lay down all these things and I’ll say, Oh, ultimately your problem is not ineffective staff meetings. That is a symptom of this other underlying sort of condition that we need to work on.

When you talk to me about this sort of lack of engagement, not bringing their whole self. And then you say, you know, it’s sort of, it manifests throughout the organization. Josh, what are the symptoms of that look like in, in practice? So when people are this, they’re like, they’re doing enough and they’re working away enough and I’m looking at a team, like, what are the flags that I can look for and sort of say, yeah, I get that no one here is not doing their job and I’m still concerned about your group. Like what, does that look like?

Josh Vaisman: Yeah, I mean, I think it probably shows up a bit differently, but I’ll play off of 1 of the things that you just said. You said you pointed to staff meetings as you know, sometimes oftentimes it’s not that you have ineffective staff meetings is that the ineffective staff meetings are the symptom of a greater problem.

I think you can see examples like that when you have a team that is generally disengaged. Staff meetings can feel wholly ineffective. You know, I recall times, gosh, I wish that I would have known this stuff and recognized this when I was running veterinary practices. How many times did I run a staff meeting where I stood up in front and I talked at a group of people and would never hear anything in return. You know, what questions do you have? Silence, you know, you could hear the drip of the, uh, you know, the lactated ringers off in the back of the hospital from the hospitalized patient. Like, so I think those are signs of disengagement.

You just see people, they don’t, quote, step up. They don’t want to offer things beyond what’s, you know, sort of the minimum requirement. You might hear a bit of quietude, you know, sometimes you walk into a hospital and you can feel, we’ve all had this experience. You walk into a practice and nobody on the team says a word to you, but you know exactly what mood is permeating through that building.

And it’s generally not a good one. Like, you can feel that, right? Sometimes you walk into a hospital and the first thing you hear is laughter from the back of the building,

Dr. Andy Roark: Yeah.

Josh Vaisman: but both of those are signs of what’s happening within that team. One of them is probably a bit more of an engaged team. The first one is probably a highly disengaged team. Sometimes you’ll walk in and you hear nothing. It’s just quiet. Quietude can be a sign of disengagement as well. 

Dr. Andy Roark: But, but not always though, right? Like, like I worked at, I worked at, I worked at a practice where, I think I really liked this practice. And it was a really well run practice. And one of the texts to me at one point was like, Oh man, You’re the oddball here. And I said, why do you say that?

I was like, I was doing relief work. And she was like, she’s like, I love you, but you roll in here and you’re telling jokes and you’re talking to people. and only at that point did I kind of look around and realize that no one else was talking. And it wasn’t, and the thing was, I was telling jokes and laughing, but I was, because I was comfortable.

If this was a toxic place, I would, you know, I feel the, I feel that, and I can read the room, but it’s just, they weren’t unhappy, they’d smile, but they think it was one of those sort of self perpetuating cultural things, is they, they kind of had an introverted, quiet practice, and that’s who they hired, and they were all very happy, but they were not, like, that place was, you know, Quiet, like that you would just hear the soft rock classics playing over, you know, over the intercom but  that was all the sound that was there Yeah, unless I was there in which case, you know, there’s finger guns and sound effects

Josh Vaisman: Here comes Dr. Andy Guns N Roses Roark walking in the building. 

Dr. Andy Roark: Exactly right. Yeah, I think they had me there about once a month and that was probably about as much as they could take 

Josh Vaisman: That’s the dose. It’s all about dosage. Andy, it’s all about dosage.

Dr. Andy Roark: It’s exactly right. It’s exactly right. But again, great practice. Just, they they were just quiet.

Josh Vaisman: And, this is, what’s important about this is that it’s very easy to spot a highly engaged team. It’s very easy to spot a really pissed off, upset, disengaged team that in between is a bit more challenging and it’s going to show up a little bit differently depending on the culture, the type of personalities, the type of practice, all of those things are going to influence that.

And so I think it behooves those of us in leadership to be cognizant of those things and I do think that this is one of those things, you know, I’d like to be very evidence based in the stuff that I do, but we are not solely evidence based creatures. We are creatures with both a big brain and a big heart and I think we need to learn how to balance trusting both of those effectively.

When it comes to things like disengagement as a leader, I think this is one of those times when you can probably. Not in all cases, but in most cases, learn to trust your gut. If your gut is telling you there’s something off with this team, then probably there’s something off with this team and you may not be able to point to the tangible evidence of what those symptoms are, but your gut is telling you something and it’s worth pursuing and getting curious about.

Dr. Andy Roark: Yeah. That makes sense. 

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

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

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

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

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

I use what’s called the Davidow model of organizational response, which is a super peer reviewed, empirically tested way of addressing angry and complaining clients.  And, I break it up into pieces so that it’s easy to digest. You can scatter it across a number of meetings. It is made to be watched with a couple people together. And then there’s discussion questions about how do we do this in our practice? What does this look like for us? What, when, think about a time that this happened and we saw it. How did we handle it?

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

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

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

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

Talk to me a little bit about diagnostic tests here, right? Because there’s probably a lot of people out there who, most of us do not, are not rolling with a culture that we’re like, this is amazing. I wish we were. Most of us are not rolling with the cold, but most of us are also not in toxic dumps either, you know, we’re well, I don’t know, kind of in the middle.

You know, which is where all the action sort of happens is, you know, it’s sort of in the middle. So I kind of imagine it’s sort of like physical therapy, right? When they bring you in and you say, Well, I don’t know, I think my shoulders kind of messed up. And they have you do the different exercises in the range of motion and go, Well, I think I think this is our problem.

So why don’t we sort of through Josh Vaisman’s physical therapy, you know, assessment phase and how do you figure out where the actual problems is? And it seems like it can just be a, I don’t know, they’re just not really that into it. And how do I, get away from that?

Josh Vaisman: Yeah. So, diagnostics, I think, are incredibly important. I’m a huge advocate for you know, the sort of general organizational trope that we are what we measure. And if this kind of a thing is important. If engagement or team happiness or I don’t know, general enthusiasm about the workplace.

Those kinds of things are important. We need to find a way to measure it because we have to benchmark it. It’s no different than taking care of a patient. You know, we want to get during a wellness. We want to get baseline blood works, so that when things go awry, we have something to compare it to and strive, you know, or aspire to return to.

And so I think finding ways to measure it are really important. Measurement, Andy, we could spend hours talking about ways to measure it but finding some way to measure it, routinely. That’s another thing. I know that there are organizations that do like, you know, the Q12 once a year. They’ll do like a an ENPS or, you know, assessment periodically.

Annually is not sufficient. Twice a year is probably not sufficient. Daily is too much. Weekly might be too much, depending on how we’re doing it. The whims of I don’t know, the emotional and psychological experience of a team ebb and flow frequently. And so if we’re taking a singular measurement once a year, first of all, people are going to mostly feed us bullshit.

If they see that all you care about is checking in on this once a year by a survey, They’re not, that’s not going to enhance engagement. That’s going to show you how disengaged they are with the responses you get. Secondly, every single assessment, every measurement of the human experience is subject to recency bias.

And so when you ask somebody, how has the last year been? What they’re really thinking of is, how is the last week been? And so you just, one, once a year is not enough. I think that two ways of measurement are really critical in organizations that I see success with this. Number one is something quantitative.

So something like blood work, whether it’s a survey or an assessment tool, a pulse check, but something that’s being done regularly that’s targeted around the thing that you really value in the human experience in your workplace. Secondly, relationships. You mentioned before we started recording, you said that I’m calling you out here, I hope this is okay. You said that 

Dr. Andy Roark: I hope it’s okay too. I don’t know. Let’s see where this goes. 

Josh Vaisman: One of if not the most influential things in an employee’s experience is the relationship that they have with their boss. That, that the person in charge of us has the most influence of it. There’s actually quite a lot of data that supports that belief. We see that consistently when people are, when we measure job satisfaction, the largest predictor of job satisfaction, at least according to one study, is actually not the job itself.

It’s the relationships at work. And when people are scoring, how do you feel about the relationships at work? 86 percent of the variance in that score, 86 percent of what they’re thinking about is not the relationships with their peers and colleagues. It’s the relationship with their boss. That’s the influence that we have.

So if we’re not taking an active role at cultivating a high quality relationship that gives us high quality, two way communication, two way data of their consistent, their routine lived experience at work, that’s a measurement tool that we’re missing out on. And so I, I really, I’m a huge advocate for finding ways for managers to have sit down, structured, quality, effective one on ones on a routine basis with everybody who reports to them.

And by routine, I mean like once a month at a minimum. And that’s got to at least include some level of check in. Hey, Andy, how are you doing? How are things going since our, you know, the last time we met, you mentioned you were struggling a bit shifting from, you know, the day shift to the. The evening shift.

How’s that going for you? What’s been working? Like, just checking in. Establishing relationships creates a sense of community, which adds to engagement. It also gives you a really great way to get a good qualitative side of the quantitative data that you’re collecting.

Dr. Andy Roark: Yeah, that totally makes sense. I really like that a lot. If we’re putting this together and we’re doing the one on ones or we’re doing sort of our survey tools of kind of, what’s your, how excited about work do you feel? You know, what is your favorite part of the job?

Things like that, what constitutes a good day for you? Those types of things. And we’re starting to get some feedback. Are there general approaches that we take to start to rebuild this type of engagement? Or is it a hundred percent dictated by what kind of feedback we get?

Meaning, is there a general approach to to rebuilding engagement or is it entirely specific to what our team is telling us?

Josh Vaisman: There’s a really great book, the author of whom I’m going to forget. Now I’m looking around my office to see if I have it here. I don’t. It’s called Culture Renovation. It was written by an HR professional. He’s like the CEO or president of like the largest HR organization in the world. And they conducted some pretty extensive research on organizations that have successfully changed culture.

There’s two things about this I want to share. The first one is that as they were going through this work and doing this research and then starting to write this material, they changed the title from Culture Change to Culture Renovation. So I think that’s a really important lesson for leaders. to keep in mind when we’re trying to you know, shift the experience of energy, enthusiasm and engagement in a team.

We are not changing things. We are renovating. There are things that are working here. The team is showing up. They are doing good work. Like we don’t want to come into the house and ignore the good, you know, skeleton of the home and just work. Raise it to the ground and then build a new one. We come into a house and we say, you know what?

This room is actually working pretty well, but this room could use a remodel. And that’s what we do. So, so seek that renovation approach. The other thing from that book that I’ll share consistently across the board organizations that had successful culture renovations started with a intentional, authentic listening campaign.

So where I’m going with this is that I don’t think there’s a recipe. I mean, I think the things that I offered are sort of part of the recipe. Like, you’ve got to start by gathering the data. The data means we’re trying to gather human data. So we’ve got to get really good at getting inquisitive and listening.

And that will tell us the direction that we need to go. And then we need to be courageous enough to follow that direction if we can.

Dr. Andy Roark: All right. I was going to end here, but I’m not now I’m going to give you a really hard question to see what you come up with.

Josh Vaisman: Ooh, I love those! 

Dr. Andy Roark: So here’s So so, I hear all of that and agree and I love the listening campaign, but we’ve talked, throughout this entire podcast, you and I, and we’re on the same page of rarely do we deal in extremes of everyone is miserable, everyone is happy, everything is everything is great.

One of the things that I have rolled around in my head recently is How how happy should people be? And so, so I, as I talk about this again, I say this because veterinary medicine is such a compassionate place and I, love that. And I had this journey and sort of in my career and I used to say very publicly and very frequently, I want my employees to be happy.

I want employees to be happy. And I have changed that recently, to say, I want my employees to be happy doing the work the team needs them to do. Or doing the work that we as a practice need to get done. I say that because sometimes people will be like, well, I don’t want to do this particular job.

It makes me unhappy. And I have to wrestle with that so much. And now just well, not, We don’t get to do the things that make us happy all day like some everybody has part of their job they don’t like to do and this is what the team needs to have done and you’re to do it today And you know what

I mean, and it’s just I for a long time. I had this idea, I think, that I could set a business up that was and allow delegation and collaboration to the point that everybody could kind of dodge the parts of work they didn’t like. And I really tried to do that. And at some point, Josh, I’ve come to believe that’s just not true.

And I think if you focus on, you know, the quickest way to be unhappy is focus intently on your happiness.

Josh Vaisman: Unhappiness? 

Dr. Andy Roark: I mean, yeah, it’s just like, I could be more happy. Sure. You know, what’s making me unhappy right now? I can find things. And so there is part of that. So to your point of, we start with an active, engaged listening campaign.

We listen to them and we start to build. Do you have any advice for team or leaders, practice leaders, team leaders, doctors in how and how to reach that place of hearing the needs of others and keeping them in perspective and in balance with all of the other things that need to happen to say, I hear that you would be happier if your schedule was different. And at the same time,

Josh Vaisman: Yeah.

Dr. Andy Roark: We simply with the staffing that we have right now these this is the work schedule that we have available and again, there’s we always want to try to work with people and think outside the box, but at some point somebody has to mop the exam rooms.

Josh Vaisman: There’s so many things that I want to say. So I’m going to suggest that we have a fourth get together on this wonderful

Dr. Andy Roark: A fourth? Ha ha 

Josh Vaisman: and talk, talk about the cuts, but I’ll add a couple of quick things because this is a lovely and really important question that you’re asking. I very much appreciate your vulnerability in admitting how you have evolved and pivoted and how you think about happiness.

I have also gone through a similar journey. I think one of the biggest mistakes that I made as a hospital learner in the last practice that I managed was walking in on day one and essentially, I mean, I didn’t use these words, but essentially making a promise to the team, I’m going to create a space here that you will all be happy with.

Dr. Andy Roark: Yes

Josh Vaisman: There’s, you’ll notice in our entire conversation up until this question, neither of us actually used the word happy. We talked about engagement. Those are two very different psychological constructs. Happiness is often a outcome of engagement. It’s a lagging indicator of good inputs. And so I don’t think we should set our goals on lagging indicators.

I think we should set our goals on the inputs that are likely to increase the presence of those lagging indicators. And the inputs that are likely to increase that are things like thriving fulfillment, you know, as, an organization Flourish, we don’t talk about we exist, to create happiness in veterinary medicine.

We talk about we’re on a mission to ensure that every veterinary professional experiences fulfillment in their work each and every day. Fulfillment sometimes sucks. It sometimes is really annoying and frustrating. It sometimes means cleaning up, the massive blowout of diarrhea in the middle of the treatment room and almost vomiting yourself through the whole experience, right?

That is not fun. You’re not happy doing that. But sometimes those are exactly the experiences that add to joy and fulfillment. I’ll try and find this for you, Andy, and I’ll try and share it with you, but Barb Fredrickson did a really cool piece of research where she followed she basically identified folks who she referred to them as like, they’re in it for the party.

They’re in the pursuit of happiness. Right. And then people who are in the pursuit of daily meaning. So trying to experience purpose activated in their day to day life, right? Those are two, two pursuits that can be wholly occupying and both potentially worth pursuing. What she found was, the people, on average, across the group, over, I think it was a six week period that they tracked them.

They used a pager, periodically they would get you know, a beep, and then they would have to go complete a survey. And, like, one of the things they measured was the, PNAS, which is the it measures positive and negative emotional experiences in the moment, so it gives you a list of each, and you mark which ones you felt recently, that kind of thing.

She found that I’m going to forget the percentages here, but the people who were pursuing happiness were actually like 50 percent less likely to experience positive emotions. They were 70 something percent more likely to report depressive symptoms. And interestingly, when they measured they conducted blood work on these people.

The people who were pursuing happiness as their sole goal actually had significant, like statistically significantly higher levels of inflammatory markers in their bloodstream. And so the researchers at the end of this paper, they said that basically the pursuit of happiness might be about as good for you as chronic illness.

We shouldn’t, as managers, we shouldn’t be, or leaders or hospital owners, our goal should not be to make a happy team. Our goal should be to make a fulfilled team, a team that experiences meaningfulness, that experiences human connection, that gets to work in a psychologically safe space where they bring their voice to work, where they feel like they’re contributing to something meaningful, where they feel like they matter. All of those things allow space for the day to day shit that we’re all going to experience.

Dr. Andy Roark: Yeah, I did. That that is the perfect answer, really is. That’s exactly it is happiness is as a lagging indicator. Now, I think you’re spot on. I read recently the parable of Hercules at the crossroads. Do you remember that one?

Josh Vaisman: No. Share that with me. 

Dr. Andy Roark: So, so young Hercules is traveling and he comes to the crossroads and he’s tempted down each path, or these two different paths.

And the first one promises him a life of comfort and ease. And you know, it says all of your dreams will be laid out before you. And the other one is there’s a goddess on the other path and he looks at her and says, what will you promise me? And she said, hard work. And he, chooses the goddess that says hard work and, it’s the idea of the difference in vice and virtue.

And there, but there’s, I think that there’s this I think that there’s this misconception today. I think we were, we’re being told that we should be happy all the time. we’re led to believe that we should be comfortable all the time. To me, I think that’s that, path of come this way, everything will be great. It will be, you’ll be, so happy. And I, but I think the other path I promise you hard work. I do. I don’t mean to be macho about it, but I do think that is the path because in that hard work is the fulfillment, but it’s interesting of how do you get your team, to recognize that and to, buy into, I get it, it’s engagement, not happiness. But I think that’s a question for our fourth podcast, which look at, yeah, look at Josh booking the recheck appointment. Well played, sir. And so

Josh Vaisman: Hey. Forward booking. Forward booking. 

Dr. Andy Roark: Exactly. Thanks, Josh, so much for being here. Guys, thanks for listening. Josh, where can people find you online?

Josh Vaisman: Yeah, so, our website is www.flourish.vet you can find me on LinkedIn. We’re on Instagram, we’re on Facebook. All the usual places.

Dr. Andy Roark: Sounds great. Awesome. Guys, check it out. I will link up Culture Revolution and some other resources in the show notes. Take care of yourselves, everybody. I’ll talk to you later.

And that’s what I got. Guys, I hope you enjoyed it. I hope you got something out of it. If you enjoy stuff like this, check out my newsletter.

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So anyway, take a look at that. Guys, thanks for being here. Take care of yourselves. I’ll talk to you soon, everybody. Bye.