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Andy Roark DVM MS

Challenges of Selling Your Practice to Other Vets

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Dr. Patty Khuly tells us about her remarkable journey from associate to practice owner and candidly talks about the struggles of selling a practice. This week on the Cone of Shame Podcast, Dr. Patty Khuly and Dr. Andy Roark reminisce about their days writing for Vetstreet. Patty opens up about her decision to become a practice owner, emphasizing her determination to maintain creative control and high standards. They explore the challenges of practice ownership, such as hiring the right people from the start. Patti also talks about her decision to sell her practice, aiming to return to her writing roots and focus on books. Gang, 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. Patty Khuly: https://www.drpattykhuly.com/

Article by Dr. Patty Khuly: https://www.veterinarypracticenews.com/myvpnplus/why-owning-a-veterinary-practice-is-still-a-smart-move

Article by Dr. Patty Khuly: https://www.veterinarypracticenews.com/production-pay-perks-pitfalls/

Uncharted at HiVE in Minneapolis: https://unchartedvet.com/conflict-management-training-navc-hive/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Patty Khuly is a 1995 graduate of the University of Pennsylvania’s vet school and a 1997 graduate of its Wharton School. Dr. Khuly is an award-wining veterinarian known for her independent thinking, her spirited pet advocacy, her passion for the veterinary profession and her famously irreverent pet health writing.

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 here today. I am talking to my old friend, Dr. Patti Khuly. For those who don’t know Patti, she is one of my favorite writers in vet medicine. She writes for so many different outlets. She writes for pet owners. She writes for veterinarians. She’s in veterinary practice news. She’s at the Miami Herald. She just does all of these things as far as sharing ideas through the written word and she’s so creative.

And I recently ran into her and she was selling her practice, which she had gotten a lot of joy from. And she said it was time she felt like that chapter in her life was coming to an end. And then she talked about the challenges of selling her practice to other veterinarians.

And that’s what we talk about today. It’s a, It’s a lot about her decision to become a practice owner, to give herself more freedom. And we talked about, is that real? Is that how it worked out?

And then do it for 10, 12 years and decide that. That she’s done and there’s no reason for her to be done other than she wants to be done. It’s time to be done. Then the challenges that she found when she decided to go down that path. Guys, I hope you’ll enjoy it. Let’s get into this episode. 

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Kelsey Beth Carpenter: 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. Patti Khuly thanks for being here.

Dr. Patty Khuly: Thank you, Andy.

Good to be here.

Dr. Andy Roark: It’s my pleasure to have you here. You are someone who I have looked up to and admired for over, well over a decade. You, I, it’s true, when I, back in the day, when I was just starting to write, I was writing at vetstreet. com and doing stuff like that, and you were also writing over there.

Dr. Patty Khuly: I was working at Vet Street, too.

Dr. Andy Roark: Yeah, and you had, you had a wonderful reputation, and the first time that I talked to you, I said, you know, I really enjoyed reading some of your stuff, and I said, well, how much writing are you doing?

And you listed the most writing engagements I have ever seen. Ever since I’ve never heard anyone who had as many things going on as you. You had multiple regular columns. You were working on all these different things. You were doing just freelance work, and just, I was feeling good because I was writing an article a week and still a lot of people are like that’s incredible amount of stuff you put out and you just work circles around me in the stuff that you make and it’s

really good. 

You were literally publishing daily and and and you were practicing as a veterinarian. So you’re practicing doctor and you’re publishing literally daily and it’s good. And I just I don’t I don’t think I’ve ever I mean I I I I work hard, and I have made, I make a lot of stuff.

Buddy, I, I still am just in awe of, of your creativity and your productivity and how you’re able just to, just to, to turn it out. so, so Vet Street kind of went away, and you and I kind of went our separate ways, and I didn’t hear from you for a long time. And it’s because you decided that you wanted to be a practice owner.

Dr. Patty Khuly: I fell into it. Yeah.

Dr. Andy Roark: Okay, so tell me about that. How did, how did that happen? So here you are, you’re a practicing doctor, you’re, you’re, you’re writing, you’ve got a fairly rich life as far as doing a lot of different things that you enjoy. How did you end up in this practice owner seat?

Dr. Patty Khuly: I, I always worked at a practice. Since I was 10, I’ve been working at the same practice, and I, I’ve had a lot of relief and emergency gigs here and there in between, but I had always worked at this one place because they let me do whatever I wanted. You know, I am, I am not a good employee in general.

I think we were talking about that earlier. I’m not a good employee because I’m going to do what I’m going to do. You know, I’m going to practice the way I’m going to practice and I’m going to order, I’m going to get the drugs I want to get and order anything I want. And if you don’t do this, I’m just going to be unhappy.

If you don’t let me refer to the specialists I want to refer to, you know, I’m, I’m annoying. I’m just like not the easiest veterinarian and they would let me do anything I wanted. If my kid was sick, I would just be like, okay, I’m going to figure this out. I’d call the clients myself and tell them, Hey, let’s reorganize.

You know, I was, I basically ran things for myself through that practice. And so when they were getting ready to retire, I kind of figured that somebody else would buy it and, you know, but at that point it just kind of fell in my lap. And I bought most of it, and a small percentage of it I had my office manager buy in.

And non veterinarian, and she has been the best partner. She has done all the hard detail work that I haven’t liked. And I’ve done all the practicing and the hiring and the big picture stuff. And you know, it’s, I, we never even did a lot of marketing. It just kind of grew organically. I didn’t have to work too hard at it, except that, you know, it got bigger and bigger and bigger.

And so we renovated, we did all these things and I was exhausted. So I always stayed working for VPN and for the Miami Herald and the Miami Herald, I let go of a couple of years ago because that paper is getting smaller and smaller and frankly, they kept changing editors. So, but yeah, that’s what I’ve been doing for the last 10 years, managing COVID, the whole disaster that was, and all the crises of a hurricane that we had.

And that was, so things got stressful because I renovated and I doubled the space and then, you know, COVID people kept showing up and I, I mean, I make it sound like it’s a bad thing. No, it was a good thing. I just haven’t gotten back to my roots, which I feel are just writing nonstop. And hopefully. Within the next three years, I will be getting to the point where I will be back up to my original writing schedule and mostly for myself, not so much online.

I am, I’ve decided to write the books that I always wanted to write. And that’s where I’m at.

Dr. Andy Roark: Yeah, I have a friend who’s a, who’s a dear friend and he owns a practice and he had to sort of reevaluate his life at one point because what he said to me was, he said, you know. He said as practice owners, we have created jobs that no one else would want to have. And I thought that that was really sort of sad.

But the thing I’ve always liked about, the other thing I’ve always really liked about you is you, you, you’ve always been that person who’s kind of done her own thing. When I thought about you owning a practice, I’d always kind of imagined it as something that would, you know, fit into your life and sort of support and sort of get I don’t know I just don’t see you being I see you making it into what you want it to be to support you. What do you think about my friend’s statement?

What do you think about the idea that you you can make a practice, you can own a practice in a way that gives you freedom instead of takes it away from you. Do do you buy 

Dr. Patty Khuly: that?

I think that’s possible. I do think that’s possible. I just don’t think it’s possible for me. Because I am, I kind of, when I’m doing something, I kind of like throw myself into it entirely. So it’s very hard for me to, it was very important for me to do it properly, the way I thought whatever my definition of that was, and the same as with my writing.

And I, so it was like, it’s almost like I had to do one thing or the other. I thought I would be able to do it, both do them both, but no, not possible for me. Cause then I feel like I would have like a crappy this and a half assed that and I, that I felt like I, I really needed to do whole blog.

Dr. Andy Roark: What have you learned that you wish you knew when you started into this? Like if you could go back and tell yourself something as you were getting started as a practice owner and you were, you’ve made this, this sort of transition, you’re writing, you’re like, I’m going to do it. This practice kind of falls into your lap.

Yeah. What, what advice knowing what you know now, do you wish you had then?

Dr. Patty Khuly: Surround yourself with the right people. And not that I didn’t, I did, I just didn’t, I just didn’t work as hard to pursue veterinarians early on. I always thought, okay, I’m just going to grow organically. And, but you know, the crunch, I mean, obviously this hindsight is 2020, but the crunch of, of where we couldn’t find veterinarians to hire I, I wish I had gotten in earlier before that cycle hit, before there were so few veterinarians to hire.

And I think a lot of it is Miami too, because if you go to a major metropolitan area up North, there’s, there’s a wider variety of people who want to work independent, who want to make, cause, you know, We’re offering as good or better money than corporate. So there’s no reason why we couldn’t find anybody, but having access to those people it’s been, it’s been really difficult until very recently.

So I wish I had known more about how to approach those people. And now I feel like I’m better, way better at that, but it wasn’t something that came natural naturally to me. So that aspect, the human resources, wow, what a huge stress that is. And it’s almost like I should have hired somebody just to do that all the time.

And instead I have a practice manager or the, who balances her time and then a bookkeeper and, you know, these things. But. Not a dedicated human resources person. And so there’s that too. And, and I wish I had hired more certified techs upfront. That too. Just to hire talent early.

Dr. Andy Roark: Well, how did you, how did you come to the decision that you wanted to sell your practice? Was that an, was it a thunderbolt that, you know, was there something that happened? Was this a gradual decision? How did you come to this?

Dr. Patty Khuly: Well, we always said it would be a 10 year project and I’ve been realizing that, you know, the 10 years is up. I started realizing that two years ago. And I. I, I felt like, okay, I, I know we missed the mark where all these practices were being offered like big cash, but I didn’t want to go with that anyway.

I, that was like, it always felt kind of icky but it was clear to me that I needed to get back to writing because I was, I was not as happy anymore and even with all the stress of COVID and the stress of everything, I still felt happy and satisfied with my job, even. There were days I didn’t, obviously, but overall I did.

And then towards a couple of years ago, I started to feel uncomfortable in my skin again and just feeling the need to, to do something else. And yeah, those 10 years are almost up. And then my business, my partner, she said, I’m out, you buy me out, please. I got to get out of here. And so that was it. We said, okay, we got to sell this place and we got to figure it out and we’ve got two years to do it. And and we’re right now, we are in, in negotiations with someone. It’s looking positive and I’m happy with it. So happy with the process and everything. I didn’t think I would be. 

Dr. Andy Roark: Tell me about your experience with, with deciding to sell it. So you and your partner, you say, look, we’ve, we’ve come to the end of this. We said we want to do it for this amount of time. It’s like, we’re feeling the need to sort of step out. Talk to me about start picking up there.

Tell me the story about your experience. And you had decided to, you were like, we want to give this, we want to sell this to other veterinarians. Talk to me, talk to me a little bit about why that’s important. I mean, that was clear. That was clearly a conscious choice that you made.

Dr. Patty Khuly: Yes. And I’ve always. Envisioned the idea. I love the idea of several veterinarians coming together to buy a practice and to just keep, keep it owned by veterinarians. Veterinary medicine for veterinarians has always felt like the smartest thing. Because, frankly, you get somebody in the middle, and who gets the money?

It’s never the veterinarians. I mean, sure, the veterinarians who work there, they’re going to do well, but they’re never going to do great, right? And I think that everybody deserves more of an upside than just production pay. but the reality is that we as professionals tend to be risk averse more so now that we have such debt.

add debt into the mix and veterinarians are very scared to make financial decisions and understandably, I mean, take, it’s a huge leap when you’ve got, you know, you still have 150, 000 left to pay off. It’s, it’s a really big leap. And I understand, trust me, I was still paying off my student loans until a couple of years ago.

So I had. A lot of loans. So, my risk was less because I was buying a very small practice. So, at the time, it was a very small practice, but again, my idea was like, hey, you get like four or five vets come together and buy this thing, and you guys are, you know, it’s yours forever, and you, but trying to get veterinarians together is like herding cats, right?

We, we, we all say this. It’s like trying to get like five cats into a small room together, forget it. It’s really hard. It’s hard. I talked to a few who were actively looking for practices to buy and I want, and everybody either wants their own thing. And that’s a very common thing. I had three veterinarians who worked for me, who wanted to become practice owners, who, what they really wanted to do.

They’re very ambitious people, but they just wanted their own thing. And then I kind of scoured around looking to see who in the area was, was looking to buy. I kind of like tried to get in asking brokers, like, who are you talking to? That kind of thing. And recruiters trying to find recruiters.

Okay. Like, do you know anybody who’s looking to buy a practice or who wants a structure something with a, with a deal to buy in? So I thought I was being very creative and clever trying to find these people. But anybody I did find was no, it was a no go.

 Hey guys. A couple of years ago, I made a card game with my team. It’s called a What’s On My Scrubs. And a lot of you guys know it because it’s sold like crazy. I ordered multiple shipments and they just, they sold out as soon as I got them. I was thrilled that people liked the game. 

I really liked the game. I decided recently that I wanted to make something else. Maybe not another order of What’s On My Scrubs, maybe something totally different. If you are a fan of What’s On My Scrubs. If you are looking for something fun to do with your team, that is also educational and we’ll make them laugh and we’ll do a little bit of team building. I’ve got something really fun and it is coming your way. 

Okay. I can’t tell you what it is just yet, but if you’re not on the Dr. Andy Roark mailing list, check it out. Head on over to drandyroark.com jump on our mailing list. I write every week for that mailing list, you’ll get letters from me on Friday and then you’ll be up to speed, 

as soon as we drop some information about this new project that’s coming out anyway. You ready to laugh and have some fun? I hope that you’ll like what we made. Alright. Let’s get back into this episode. 

Dr. Andy Roark: So you feel like, it sounds like there was sort of a mixture of, of, of pain points, right? So, so you pointed out the, the, the financial leap. So you’ve got veterans that are carrying a lot of debt and the idea of taking on more was scary. I don’t know, do you consider it to be like an aversion to partnership?

I mean, or do you think that a lot of the vets who’s like, I would like to be an owner, is this because they have a specific vision in their head of what they’re going to build and, and having others involved would dilute that? Yeah.

Dr. Patty Khuly: Exactly. And, and I understand that because I’m, I, I’m like that too. I don’t feel like I’m the kind of person who couldn’t, who can work with other people I don’t know on a project. I have to be able to, you know, know who I’m dealing with and know them for a long time. I knew my, Partner for 20 something years before I started working with her.

So, and you have to have a certain level of trust in order to take that leap.

Dr. Andy Roark: What is your overall impression of practice ownership now? I mean, do you still think of it as as sort of a, an outlet 

that can be positive in practice? I

Dr. Patty Khuly: Oh yeah, it’s brilliant. It’s the only, it’s the only, okay. Number one, if you’re not good at working for others, it is the only way.

Dr. Andy Roark: It is the only way.

Dr. Patty Khuly: Number two is, I mean, unless you get really super lucky like I did. I loved working for the two old guys. I call it, we call them the two old guys, loved working for the two old guys because they let us do whatever the hell we wanted.

And and I, I mean, that’s, that’s the reality, but in most places there aren’t that many mom and pops out there that you can just kind of. You know, work with and then get along with the owner. It’s still like, it’s their baby, right? It’s, it’s hard to kind of get in people who are always saying, oh, I want to buy in to a practice.

But then, you know, it’s like when two people who want something that’s, that’s their own come together, it’s inevitably it’s hard. So my recommendation is that definitely that veterinarians get into practice ownership and that they, and that they either start something in an up and coming neighborhood, but do it, do it low cost to begin with

 or you buy something that somebody, an old timer really needs out as a small practice and build it.

Dr. Andy Roark: Yeah.

Dr. Patty Khuly: So.

Dr. Andy Roark: I You’ve, when we’re talking about, you know, sort of, like, bumps in the road as far as selling and stuff. You, you’ve given very pragmatic answers about, you know, people collaborating and you, and, and access to capital and things like that. Patty, do you think the mindset of veterinarians today is different than it used to be as far as ownership, or is it purely just a financial, is it purely financial?

Because all this is really about, you know, being able to access the capital to, to, to do what we’re talking about, or, or to yeah, or or to or to feel comfortable accessing capital when you’re already carrying debt. I mean, do you think like philosophically it do you think that that the modern veterinarian has different ideas about ownership than they used to?

Dr. Patty Khuly: mean, it’s inevitable. Everybody sees the, the ideal practice is they want to practice the way they practice in vet school. So they want to practice at a place that has all the, the bells and whistles, all the toys and all the, all the access to the best labs. And I mean, not that you wouldn’t a small practice, but you want to work in a place that has certain very high standards and it’s, and it’s hard. It’s hard to start a practice like that, you’re gonna, it’s really hard to own a practice that’s already that established, that big, and, and yeah, a lot of, a lot of my associates, they work part time, they’re moms, they can’t buy a practice. 

Dr. Andy Roark: So, so now that you’ve kind of, you’ve kind of, you’re optimistically, we’re coming out in a good place. It looks like, like you’re sort of working on a solution. You said it makes you feel good. You feel happy. Where do you go from here?

I mean, does this, do you, are, are you going to ride off into the sunset? Are you going to stay around and,

Dr. Patty Khuly: Oh yeah. I’m going to stay in practice and I’ll probably practice like 10 or 15 hours a week and I will probably also, and I’ll, and I’ll take longer vacations. And I will live off the interest of my earnings.

Dr. Andy Roark: Gotcha.

Dr. Patty Khuly: Yeah, and, and then, you know, maybe in two or three years just work exclusively as a writer. So phase myself out so that I can spend all my time writing.

Dr. Andy Roark: You write, you write everything that I’ve seen you write has some touch on vet medicine or animals. Is that always going to be the case? Or do you think you’re going to, may even move into, into other areas and just, and just, put vet medicine on it? 

Dr. Patty Khuly: Nope, I don’t think so. You write what you know, don’t you? And, and I really know science fiction, but why would I write, you know, your standard science fiction when there’s so much material there in veterinary medicine, you know? I really know animals, so. Why would I write anything else?

I mean, it’s what I love. I live, I live right now on an acre with two goats, six chickens. I have four dogs, there’s cats, raccoons, squirrels. I have like animals all over this property. I, I, we have crazy lizards now, crazy reptiles on our property. So this is, this is the best. So why, why would I write about anything else?

Dr. Andy Roark: I’ll be looking forward to reptile science fiction from Patty Cooley coming up.

Dr. Patty Khuly: Oh, that’s an idea. I like that idea. You keep giving feeding, feeding me ideas. I could, I could write some reptilian science fiction. Well, you know, my chickens are just like the reptiles. They, they just, you know, Oh,

Dr. Andy Roark: Yeah. They’re just dinosaurs. Yeah.

Dr. Patty Khuly: They’re so cute. I could probably show you them if I picked up the laptop, but I’m not going to.

Dr. Andy Roark: Dr. Patty Khuly, where can people find you. If people are like, I’ve got to read some of her stuff, where’s the best place for people to find you?

Dr. Patty Khuly: Dr. pattycooley. com. Dr. Patty. K H U L Y P A T T Y K H U L Y dot com and although there’s that’s kind of old stuff, but I should I’ll start updating it now that you’ve given me the push and also Veterinary Practice News. I have a lot of old stuff up at the Miami Herald, USA Today, Huffington Post that’s pretty much it for right now the stuff that you could easily find that’s That’s not boring.

Dr. Andy Roark: I’ll link up some greatest hits. How’s that? And

Dr. Patty Khuly: Yeah! Good. You do it. Some of my angry stuff.

You do have some really good angry stuff. All right. Thanks for being here, guys. Thanks for tuning in, everybody. Take care of yourselves. Okay. 

Bye. Thank you, Andy.

Dr. Andy Roark: 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 Dr. Patty Khuly for being here.

Thanks to you for listening. Gang, take care of yourselves, everybody. If you loved the episode please feel free to write me an honest review wherever you get your podcasts. It’s how people find the show. It means the world to us. Anyway, gang, take care of yourselves. I’ll talk to you later.

TMJ Luxation in a Cat (HDYTT)

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Dr. Amy “Toothy” Thomson returns to discuss diagnosing and treating maxillofacial trauma in cats. Dr. Amy Thomson and Dr. Andy Roark tackle a case involving a domestic shorthair named Malcolm, whose jaw is misaligned. Dr. Thomson explains her approach to assessing and treating jaw luxations, emphasizing the importance of physical exams and occlusion checks over skull radiographs. She also shares a simple yet effective method using a pencil to correct TMJ luxation. Tune in for valuable insights on handling similar cases and supporting pet owners through the recovery process.

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

LINKS

Toothy Thomson Website: https://toothythomson.ca/

ObviVet Course Referenced: https://obivet.com/product-category/certificates/

Reference Research Paper on Pencil Trick:
https://www.researchgate.net/publication/321002400_Temporomandibular_joint_luxation_in_the_cat_Diagnosis_and_management

Dr. Amy Thomson Instagram: https://www.instagram.com/toothy.thomson/

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. Amy Thomson, often known as “toothy”, is passionate about teeth! However, it was not always this way – she started her career in small animal practice with very minimal dentistry knowledge. She was fortunate to have a great mentor in her first job where she learned a lot and her desire to learn more grew. Once she attended her first Veterinary Dental Forum in 2013, she KNEW dentistry was her passion – and became affectionately known as “Toothy Thomson”.

With time and support from her family, friends, collogues and a big ‘shove’ from her mentor she applied for a dentistry and oral surgery residency and was overjoyed when she matched at the University of Wisconsin-Madison. During her residency her passion grew not only for dentistry, but also for teaching. And because life is always full of surprises Dr. Thomson found herself at a crossroad in 2020 in the early stages of the pandemic – so she started her own mobile dentistry practice! 

In addition to with working alongside small animal general practice teams, she also became very active online sharing her knowledge. It has always been important for her to share as much as she can, given it took hundreds of hours and thousands of dollars to obtain the knowledge she did while in general practice. Knowledge she wants to see all veterinary teams have!

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shane veterinary podcast. I am your host Dr. Andy Roark guys, I got a good one for you. We’re doing some maxillofacial trauma today. We have got a rowdy kitty cat whose jaw is now out of alignment and I’m thinking about doing some skull rads but I’ll be honest. I don’t tend to see a whole lot when I do skull rads And I think Amy may have a better way.

So anyway, we’re going to assess this patient. We’re gonna get into this case We’re gonna fix this cat and we’re gonna roll on with our day guys. Let’s get into this

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

Dr. Andy Roark: Welcome to the podcast, Dr. Amy Thomson thanks for being here.

Dr. Amy Thomson: Yeah, thank you so much for having me.

Dr. Andy Roark: It is my pleasure. I always enjoy having you on the podcast. You are such you’re such a positive person and you are just, your enthusiasm for dentistry is just so obvious. And I just, I, you always get me excited about dentistry when I talk to you.

And so for those who don’t know you, You are a boarded veterinary dentist. You were in general practice for a number of years and then went back and got your and got your specialty ironed out and you got boarded and now you are a full time dentist. Friends call you Toothy Thomson

Dr. Amy Thomson: They do, yeah.

Dr. Andy Roark: Which is a great it’s a great and terrible nickname, I think,

Dr. Amy Thomson: Yeah, I love it. I’ve I answer to Toothy now. I’m like, Amy, Toothy, it’s the same.

Dr. Andy Roark: That’s good. I love it. You’re just like that’s what, it’s who I am. I’m comfortable my dental skin.

Dr. Amy Thomson: I am who I am.

Dr. Andy Roark: Yeah, that’s it. Cool. I’ve got I’ve got a case for you that I want to talk through. So I’ve got this four year old male neutered domestic short hair and mom has come home

from work. And it’s the boys. So there’s three of them. And but this is Malcolm who’s come to see me. And when mom comes home, Malcolm, the first thing she notices, he’s drooling. He’s just got big saliva strands coming out of his mouth. And then when she looked at him, it’s almost like he’s holding his jaw over to the side.

And so when I’m looking at his lower jaw, his mandible is clearly shifted to the left so to his left. And so yeah, jaw is shifted over to the side. There’s drool. Not as uncomfortable as I thought he would be. He’s not really letting me mess with his face, but honestly, I’m not sure he’d let me mess with his face very much when his jaw was where it was supposed to be.

Dr. Amy Thomson: Okay.

Dr. Andy Roark: Before I wade into this, so I’ve I’m, I’ve got this cat. I’m, my, my tentative plan here before I reach out to you is, I was gonna sedate him and take some skull rads and things like that. But then I’m also like, honestly, between you and me, what am I gonna what am I gonna see with these skull rads?

Is this gonna be am I going to do like I just, let’s be honest, I don’t know a lot of vets that get a lot of information on skull rads and now some of them do for obvious reasons, but you get, you should have kept my point here. And I want to be a good steward of their resources.

I want to get this cat pain free as quickly as possible. Before I get my hands in here, Amy, how do you treat this? What are you looking for? How would you game plan this? How would you advise the pet owner? What kind of diagnostics are you even reaching for here?

Dr. Amy Thomson: Yeah. Yeah. No, I love that. I’m sorry to hear about Malcolm. Obviously super stressful, so I think some sedation will be helpful. To be able to do a a complete physical exam, but also an oral exam. And I agree. So I think oftentimes when there’s any sort of potential trauma, although it sounds like they came home indoor cats, no, no known trauma, but who knows what the boys get up to when we’re not home.

Dr. Andy Roark: Sure. There’s, I’m sure there’s tipped over plants and, mail on the floor. I’m sure that every day is an, as a discovery when mom comes home.

Dr. Amy Thomson: Yeah, something’s happening when she’s at work yeah, so anytime I have what I would group together as maxillofacial trauma I really want to, as much as we want to fix him and figure out what’s going wrong I find sometimes, whether it’s this or whether we know there was a trauma, like a bit by another cat or another dog or, Heaven forbid, like a hit by a car or something like that.

I think the first thing we want to do is jump to diagnostics like say skull rads and okay, what’s the problem? But I would encourage everyone, and this is something that’s taken me years to figure out in my dentistry or surgery residency and after, is just take an inventory of what do things look like from a distance?

What is happening, and you’ve already done it without maybe even, realizing or subconsciously knowing, but there’s asymmetry and that’s really important, that you’ve noticed that the lower jaw is off the hedge bingo, right there, that’s some asymmetry, and that’s something new, that you’ve noticed because you’ve seen this pet before, or perhaps you haven’t seen before, but you’re like, this is strange that it’s so asymmetrical, And probably just following up with the owner to be like, they’re not normally off to the side.

And they would agree and say, okay, something’s awry there. And so then I would focus on delving more into that. maxillofacial or oral exam. And so when there’s trauma, definitely looking for any asymmetry. So I do like a pat along the head, around the jaw, and just like looking for any obvious asymmetry just by looking, then by palpating.

And then often what I’ll do is without opening the mouth, especially if there’s any sort of trauma that could be painful I try and support keeping the mouth open closed and lift their lips up so that I can see how the teeth align. And so I will bring it back to, basics or foundations of what is the occlusion?

So how are these teeth line up with one another? And one, is it normal? And two, if it’s abnormal, is this what the pet looked like, quote unquote, pre trauma. We all know, maybe more so in dogs than little kitty cats, but we also know that there’s a lot of dogs walking around with malocclusions and jaws not totally lined up normally.

So that is something to consider. But let’s just say, I don’t know if you said, but you didn’t say it was an exotic pet. So I’m going to assume that Malcolm is a domestic shorthair. Okay, great. I’m picturing he’s black. I don’t know why.

Dr. Andy Roark: He’s a tabby. 

Dr. Amy Thomson: He is. And so he’s a, what we would call mesocephalic. So not long nosed, always cephalic or smushy face, brachycephalic.

And for the most part, these cats have what we consider normal occlusion. And so that occlusion, just as a reminder to everyone listening is that the maxillary upper incisors sit just slightly in front of the lower incisors and they just, the lower incisors, just, Hang out on the back side of the upper incisors on something called the cingulum, which is just a fun Scrabble word for any players there.

And then we have a interdigitation of the canines. So the lower mandibular canines will sit in front of the maxillary canines and then we have the premolars, both for cats and dogs, that sort of interdigitate without touching. And then the main caracal or max ray, fourth premolar sits on the outside of the first mandibular molar.

So those are like the four things to check for occlusion. And so I suspect what we’ll see with Malcolm, whether pre or post sedation, depending on how he’s feeling, is that we’ll notice. that his left canine is no longer sitting in that nice interdigitation, and it’s really shifted over, and potentially, depending on how far it’s shifted, that right canine could be hitting the upper incisors and then not allowing us to fully close. so I’m suspecting that’s what we’ll see.

Dr. Andy Roark: Yeah, sure. Okay. So all that makes sense. I do like that. Just as an open, open sort of position how common is it for pets to have sort of lateral occlusions problems, underbites and overbites. I definitely, you see those that, they’re obvious.

Do you often see a sort of I don’t know, a as asymmetry, that’s not under overbite but a lateral offset. How often do you come across that?

Dr. Amy Thomson: Almost never, unless there’s been trauma.

Dr. Andy Roark: Okay, that, that was, that’s what I was getting at. I was

Dr. Amy Thomson: yeah.

Dr. Andy Roark: looked at a lot, okay. That, woo, there for a second I was like, have I been not seeing, okay, good. Oh, wow.

Dr. Amy Thomson: That would be the, like the, so while there’s four main areas to check. They’re all, are four main malocclusions. So just briefly class one is skeletally normal, a tooth or two out of the way. Class two would be what looks like the maxilla is longer than the mandible, and then this sort of Pretty common, although I would argue with nomenclature, how I feel that, not normal, but very common in a lot of brachycephalics, is that class three, so the mandible looks longer than the maxilla and then class four is when you have a difference from one quadrant to the other.

So we have either a rostral caudal difference between one maxilla to the other, one mandible to the other, or if we have a shift from one side to the other. And so generally speaking, to get that class four malocclusion, there either needs to be some sort of trauma and you’re being presented with the pet post trauma, or potentially if there’s been a trauma in the past during growth or development we can sometimes see pets that will have different length mandibles or maxillas if they’ve had trauma when they were like a young growing kitten or puppy.

Dr. Andy Roark: That makes sense. Talk, talk to me a bit about imaging and the interface of imaging with occlusion. If that’s something that we care about.

Dr. Amy Thomson: Yeah, for sure. I. Basically never take skull rads. And the reason being I understand why it’s done. We’re just trying to find the problem so is there a fracture? Is there something luxated things like that? But if we go back to Malcolm, I would argue that we could probably localize where we think the lesion is and the type of lesion we think it is based on the our overall assessment externally as well as external palpation and then looking at that occlusion So if we go back to malcolm, we’ve got shift of his mandible to his left We’ve got we can open the mouth.

We can’t quite fully close it And the mandibles are moving together as one. So unlike you and I, we have one complete mandible. Our cats and dogs, as you all know, have two mandibles, but they meet at a joint as the front. So they still work as one unit. And so they’re moving, they’re shifted to that side and I can’t correct it, which is important.

So in addition to having that drift to the left side, I’ve got what you could call like an open bite or unable to fully close his mouth and I can’t push him into normal occlusion, even say if we’ve heavily sedated him. And so that’s got my list of differentials is getting a lot smaller. I’m starting to think, okay there’s no there’s no, between his two jaws.

They’re moving together. I can’t move them separately and I should circle back and say that I didn’t palpate anything on the outside along the ventral cortex. I didn’t feel any incongruity, any crepitus. So I would say fractures pretty low on my list. And then the fact that I do have drift to the side and can’t fully close.

I’m going to say that I’m about 90 percent certain that this is a rostral right TMJ luxation. And that’s why it’s luxated forward and then shifts away from the luxation. And then because this joint is luxated, and because of that malocclusion, I can’t fully close his mouth. So I would feel pretty confident with that assessment of Malcolm.

Dr. Andy Roark: That’s amazing. Yeah, that’s yeah, that’s amazing. I love it. I I have learned a new toy that I need to play with, which is thinking and looking a lot more at jaw position in these cases, as opposed to going to, I always take x rays in. And try to look and it never works. And so yeah, this this totally makes sense.

Okay, cool. Talk to me a little bit about sort of the communication with mom and sort of expectation setting here. If we do have a TMJ luxation, what do you, how do you how do you prime them for recovery? How do you set expectations on what life with Malcolm is going to be like in the short and longer term?

Dr. Amy Thomson: Yeah. Yeah. Great question. Yeah. So again, like I said, I’m about 90 percent certain. We can’t be 100%. So I think being very honest with owners skull x-rays are really hard to position in a way to get a good view of the TMJ. Like I’ve read the studies. It’s really hard to do unless you have an anesthetized patient.

And even then are we super comfortable saying for sure what’s going on? I would argue that. Unless we get the perfect projection and we can see that there is that luxation, it’s hard to say for sure. DV view, but like a lateral view, there’s so much superimposition. And I’ve personally seen where we thought there was a fracture, like the RDVM, and maybe even a radiologist, maybe they thought there was a fracture, but couldn’t say for sure with a skull x ray and it turned out that there wasn’t a fracture there.

I think As best we can, just let the owner know, I think in this specific case I was, working in my dentistry or surgery land, and I was called in a case similar to this by the ER doctor being like, what do I do? And I just said, listen, imaging is going to be helpful.

If we can get the perfect projection to show and confirm my high suspicion for a luxation Then we’ll feel that much better with treatment. However, in a young cat with no significant trauma, so there’s no other wounds, this malocclusion, the not being able to put them into normal occlusion. I like if I always tell owners if I’m not a gambler, but if I was, I would put me putting money down on a rostral right TMJ luxation.

And the great thing about this, especially in cats, is all that you need is heavy sedation and a number two pencil to reduce this luxation. So we can know pretty quickly if if I’m right. And That’s a nice thing to have in your back pocket is the pencil trick. And myself through the through the vet or in your, the ER vet or in your case with Malcolm, just say, based on what I’m palpating, what I’m seeing, it’s really localizing the injury to this right TMJ.

And with heavy sedation, I think we can put this I feel pretty confident we can get this back into place. And so the, there’s a paper on this and I can send it to you for the resources. And I have a little video actually of it that I post on my Instagram. But in any case, what we use is we use a pencil because we want something that’s not too hard because we don’t want to damage the teeth.

And then what we do is we put the pencil between the main chewing tooth on the side that’s luxated. And as we put pressure with our, so my right hand, I’ve got the pencil between the two carnax seals on the right side, and then with my left hand, I’m putting pressure to close the jaw. I rotate the pencil back because I want to push the jaw back and into place.

And it, it honestly takes like maybe 20, 30 seconds when you twist the jaw. I was going to say toothbrush. I’m always talking about toothbrush in the mouth. The pencil, it’s going to push the jaw down so that it can get under what we call the articular eminence, which is the front part of the socket joint.

There, like on the temporal bone, push it down so it can get underneath and pop back into place. And once you’ve pushed the mouth and twisted, then you let go, and it does, it looks like a bit of a magic trick, but then all of a sudden you can fully close that mouth and all those teeth are lined up perfectly.

And so in an acute setting, Oftentimes we don’t need to do anything other than getting it back in place. So I would use pain medication and ask for some softer food because he’s going to be sore from being stuck open that long. But generally speaking most of them if it is traumatic or they just got tousled or hit and nothing’s fractured it, it won’t recur.

If there’s like a confirmation issue, which we wouldn’t know without, say, a CT scan it may re-luxate. And I’ll tell owners that, if they’re like, you know what? I’m in for the number two pencil trick. Let’s not do imaging. I would just let them know if it recurs again.

I would be concerned that there might be something anatomically wrong and at that point we could image.

Dr. Andy Roark: yeah that I think that makes a lot of sense and setting up for the future But yeah, talk to him about where they are. Hey, that’s awesome. Amy. This has been super helpful. I really appreciate it this feel I feel like I got some guidance here. I feel I think I know what we got to try to do yeah, this makes a lot of sense. Are there, besides the pencil video which I would love to link up in the show notes I’m sure

Dr. Amy Thomson: Yeah.

Dr. Andy Roark: Are there other resources that you really a big fan of?

Dr. Amy Thomson: Does it sound weird if I say I like the resources I’ve created?

Dr. Andy Roark: No, it does not sound no. What do you got?

Dr. Amy Thomson: There’s a few different resources. I would say a free resource that’s open to anyone and everyone, whether they’re veterinary professionals or pet parents. I do a lot of education just through fun little posts and reels on Instagram.

I’m Toothy.Thomson that’s what they call me. The pencil trick is in there, but I’ll send it to you directly so you can link it here. And then for veterinary professionals that are looking for some more information, whether it’s on periodontal disease taking x-rays I have a brand new cat class, so it’s three hours of RACE approved dentistry CE just on cats, because cats are not small dogs, they’re special creatures.

Obivet.com. Or it might be dot CA. Yeah, we’re in Canada. So dot CA. And so I have four different CE courses there. It’s on demand. So you’ll have it for two years and you can go through all the videos and lectures. So that’s been a been a labor of love that I was fortunate to get to do and put together with a friend and colleague who’s a radiologist.

So there’s some other veterinarians and different topics on there as well. And then last but certainly not least, I also am a guide for something called VetHive. So it’s a by subscription veterinary community. So we put on put out some articles and some CE weekly, but it’s also a discussion group.

So it’s a very safe space. We’ll say judgment free, truly where you can post cases and get feedback. Sometimes real time, depending on who’s available. It’s not uncommon I’ve gotten a, Help me, this pet’s under anesthesia and it just works out that I’m at home and can call them. I won’t guarantee that.

But there’s over 60 guides in 27 different topics or specialties. So there’s three dentists, oral surgeons, including myself, but we’ve got the whole gamut of things. And so I do a lot of resources and training and support there as well.

Dr. Andy Roark: That’s awesome. That’s just great. Alright, cool. Guys, I’ll link all that up in the show notes. Thanks for being here, everybody. Thanks, Amy, for coming along and doing this case with me.

Dr. Amy Thomson: Yeah.

Dr. Andy Roark: Take 

care of yourselves.

Thanks for having 

Dr. Amy Thomson: me on! It was great to discuss little Malcolm.

Dr. Andy Roark: Oh, I always love having you here. Alright, take care, everybody.

Dr. Amy Thomson: Thanks.

Dr. Andy Roark: And that is our episode guys, that’s what I got for you. I hope you enjoyed it. Thanks for being here Thanks to amy for being here and lending her guidance on this case guys If you enjoy the episode leave me an honest review wherever you get your podcast, I love doing it I love putting these episodes out, but this is how people find us.

So anyway, it always means a ton. Take care of yourselves everybody. I’ll talk to you later. Bye.

Pet Insurance, A Tech Entrepreneur, & Emerging Pet Care Trends

by

Alex Douzet, Co-Founder and CEO of Pumpkin® Pet Insurance, joins us to discuss the impact of pet insurance on client behaviors and the future of the pet industry. This week on the Cone of Shame Veterinary Podcast, Dr. Andy Roark and Alex Douzet dive into Pumpkin’s research with Zoetis revealing that Pumpkin-insured pets have more frequent vet visits and higher annual spending than uninsured pets. They explore the role of technology in veterinary practices, from digital check-ins to AI, and the potential benefits of corporate structures in enhancing clinic efficiency. Alex also shares insights from his Forbes article on emerging trends in pet healthcare. This episode is brought to you by Pumpkin Pet Insurance!

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

This episode is brought to you by Pumpkin Pet Insurance!

LINKS

Pumpkin Care for Veterinarians: https://www.pumpkin.care/for-veterinarians/

https://www.forbes.com/sites/forbesbusinesscouncil/2024/01/18/five-emerging-trends-in-pet-health-care-for-2024-and-beyond/?sh=1bdf73131430

https://www.avma.org/javma-news/2021-09-01/insured-pets-received-more-care-more-frequently

Charming the Angry Client Course: https://drandyroark.com/charming-the-angry-client/

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

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Alex Douzet is the co-founder and CEO of Pumpkin®, the highest-rated pet insurance provider on Google as of January 2024, and one of the fastest growing pet insurance and wellness brands in the U.S. Pumpkin’s mission is to enable all cats and dogs to live their healthiest lives by removing the economic barriers that can prevent pet owners from providing their pets with veterinary care. 

Under Alex’s leadership, Pumpkin’s best-in-class insurance plans help make it easier for pet owners to provide their dogs and cats with advanced veterinary treatments, emergency care, and alternative or rehabilitative therapies if needed. Alex has also spearheaded a series of optional, non-insurance wellness products to help cover routine costs for essential preventive care, like vaccines and annual wellness visits.

Throughout his 20-year career as a serial entrepreneur, Alex has disrupted industries, scaled businesses, and built ‘people-first’ companies where employees grow and thrive. Prior to Pumpkin, he spent five years as CEO and Co-founder of Ollie, a next-gen, natural, and human-grade pet food brand.  Alex is also a competitive Triathlete and an 11X Ironman finisher. He is proud to have two rescue dogs: Belle, a 13-year-old Shar Pei Golden Retriever mix and Simon, a 6-year-old Dachshund mix.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Well, guys, I got a good one. Today, I am here with Alex Douzet . He is the CEO of Pumpkin. Alex is a tech entrepreneur, turned pet insurance CEO. He’s just got such an interesting perspective. I talked to him first about some research that Pumpkin put out with Zoetis on how they’re hoping to change the impact that having pet insurance has on pet owner behaviors at the vet clinic. We talk a bit about Pumpkin, what is different about, them and their perspective over there. 

And then we get into talking about one of Alex’s articles that was on Forbes. And I, he was, it was sort of talking about trends that are arising in the pet industry. We talk about artificial intelligence. We talk about telemedicine briefly. We talk about Gen Z pet owners and their interest in technology. 

And I got to tell you talking to a tech entrepreneur about young pet owners and what the future looks like for the way that we as veterinarians interact with those young pet owners. It’s it’s fascinating. Anyway, it was a great conversation. I think you guys will enjoy this episode. This episode is made possible by Pumpkin. Guys, 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 Alex Douzet, how are you?

Alex Douzet: I’m doing well. Thanks for having me.

Dr. Andy Roark: Well, it’s it is a it is a pleasure for those who don’t know you. You are the CEO of Pumpkin Pet Insurance. I first became aware of Pumpkin , when Pumpkin published some research in the AVMA News. And so it was an AVMA News article that came out. And I, I, I liked it and I sort of grabbed right onto it.

So, it’s, it’s been sort of anecdotally known, I’ve talked about it for a long time, that pets with pet insurance are more likely to come into the vet than pets that don’t have pet insurance and pets coming in with pet insurance are more likely to agree for for the services that we are recommending. And, and the Pumpkin research that sort of came out through the AVMA really backed that up And so what what you guys sort of showed was that Insured pets had 65 percent more hospital visits compared to uninsured pets and that they had a 72 percent higher annual spend compared to uninsured pets.

And both of those things have made sense and they sort of carried out some of, some of the ideas I had and sort of, sort of things that I’d seen in practice. But the thing that I really liked about it is when I’ve seen other, research on this. There’s always a bit of a sampling problem, right? When we look at insured pets, there’s this idea, you know, when you say, well, pets with pet insurance are more likely to come in more often.

I say, well, yeah, but the pet owners who are the people who get pet insurance are also likely to be the owners who bring people or bring their pets in. And so I, I liked in this research you had same, you, you compared Pets before they had pet insurance to pets after yeah, so you guys found a 22 percent Increase in the number of visits after getting pet insurance and a 43 percent increase in it in spending after getting pet insurance And so that that same pets pre and post that was not something I hadn’t seen before but I I really liked it Were you surprised by these results as you saw them or was this is this kind of what you expected?

Alex Douzet: I would say it’s both, you know, little surprised, but also what we were expecting. Cause we look, we started the Pumpkin with that promise of like enabling the best care possible for vets, right? And maybe just to answer your question better, you know, we kind of have to go back to the founding story of Pumpkin because it’s a little bit unique story, right?

We were founded with the support of a company you might have heard of called Zoetis, right? Zoetis is this little company in animal health that 

Dr. Andy Roark: They’re a boutique firm, I believe, yes.

Alex Douzet: Yeah, exactly. Like boutique very, very, very niche. Really wants to help their clients, the veterinarians, continue to do what they like to do, which is to save the life of pets, practice the best care possible.

And in 2018, 2019, when we started to think about the idea of doing pet insurance, we realized the pet insurance industry in the U.S. was relatively underpenetrated. Less than 2 percent of what we called medicalized pets. So, those are not just every pet in the U. S., but the ones that actually go see a vet.

Our estimation was about 100 million of the pets, right? There might be 165 million pets in the U. S., but like 100 million of them actually go see a vet at least like once every 18 to 24 months. Of those, only 2 percent had pet insurance. So we would look at that problem statement and say, what can we do to help that increase.

Because we’d seen market, more mature market, Sweden, the UK, with more than double digit penetration of pets with pet insurance. So what can we do? The idea came back to say, let’s create a pet insurance that is more pet centric, that is really focusing on enabling the best care possible. So to do that, you have to have great coverage.

You have to have like high annual limits, high reimbursement rates, but really, what you want to do is really partner and align with veterinarians to explain the value. I think one thing that we’d seen that was lacking in this country, unlike some European countries, was that the vet, as a community, was holding back from making a recommendation of the value of pet insurance.

So we figure like, okay we really need to like to do something there. And that’s where creating Pumpkin with the support of Zoetis made sense because what is in many cases is more than just pharmaceutical vendors to the vet industry. It’s really in many cases. We find them to be like the true partners to the veterinarians To practice better care so we then we figure okay, let’s we work together.

We create this great product. We can advocate a case, but we need to convince the community that it was a real benefit of pet insurance. We knew that pets with insurance will come more often, they’ll spend more, but we had to quantify this. And that’s where the story, the study you’re referring to came into place to really just prove the science behind it and say, hey, pets who have a great insurance product like Pumpkin will come more often. They’ll spend more with you, right?

Dr. Andy Roark: Yeah. Do you think that the way that vets talk about pet insurance in the States is the primary differentiator between the U. S. and the U.K.? So, I mean, I know that there’s been much greater uptake in other countries. Just sort of looking at it from your perspective, is it simply the way that vets in the states talk about pet insurance or are there other factors?

It seems like, I’ve always kind of imagined it’s more of a cultural, I don’t know if there’s some cultural component. What is your perspective?

Alex Douzet: I, I think there’s more than just one element. It’s, it’s a few elements. I think in the US you had a bit of a full start back in the days. I think the first real product that got some traction, you know, probably had some challenge from the product structure, the way it was structured and the way the reimbursement worked, and I think in many cases, it created what we call like a little bit of a buyer’s remorse. And that’s something that we spend a lot of time studying and really looked at, you know, it goes back to the DNA of the company and working with Zoetis and say, let’s make sure we do something that will never get the community to be upset. Right? And so we really looked at like, okay, why we need pet insurance and maybe the pet owners or customers, the veterinarians are just as important to us as the pet owners, right? It’s almost thinking about it like a two sided marketplace. Both sides need to be really happy with the equation. Otherwise, this work doesn’t takeoff. So we really focus on like creating a product that says there won’t be any kind of buyer’s remorse if the veterinarians makes a recommendation, advocate for the benefit of pet insurance. And say, look, this is a provider that we’ve had some good experience with. They deliver a good product, a good service. You should go check out pumpkin, right? That’s that’s how the experience works. So that’s I think important to also understand is like from our point of view from our research we looked at it, not every pet insurance is created equal And that’s actually a big part of what we do trying to work with the community and educating the community is like, don’t just advocate of like any pet insurance because like an insurance, you know, home insurance, car insurance, they are high end product and low end product, right?

And there’s no, what I would describe as like no magic math in insurance, meaning if something looks inexpensive, you get a quote for your dog or your cat. And you get a price that looks appealing, but low. It’s because the coverage is probably not that great. And that’s where this potential of buyer’s remorse exists, right?

Yeah, so so we were considering a developing pumpkin. With the goal in mind of like, really supporting the community enabling the best care possible. We had to look at all the scenarios and obviously looking at the situation where someone put hypothetically, you know, selecting a plan that is

 more on the lower hand in terms of coverage and reimbursement rate, they are still situation that could occur where this person could be faced by a recommendation from the veterinarians for treatment and then start to look at the math and say, well, a lot of it may not be reimbursed, and they may say no to the care in this example, or even worse, they may not even think about it consciously, go ahead and do it, and have a bad surprise post filing the claim.

They look at what they got reimbursed, and it’s probably, there’s probably a disconnect with the expectation. And I think that’s the thing that we were really conscious about that. Potentially, ultimately put us on the path to say the only way to solve for this is to create a more premium product with better coverage, higher, more generous annual limit, more generous reimbursement rate because we will avoid those situation and it ultimately prevent the buyer’s remorse and it will protect the community from having to deal with this.

And I think as a result, what we’ve seen over the past few years is that we get very strong reviews. I think when you, we Google for Pumpkin and you look at consumer reviews, you tend to see like very, very positive reviews. We get a lot of like positive comment and feedback from the clinics that we’ve been able to partner with and train them on the concept of an insurance and what we do particularly at Pumpkin.

Dr. Andy Roark: Yeah. You, you’ve got an article that came out earlier this year. It’s called Five Emerging Trends in Pet Healthcare for 2024 and Beyond. And I, and I, this is where I, I became aware of you. It’s, it’s, it’s good article. And so you’ve, you’ve got sort of five trends where you’re looking at the, at the sort of the pet health space.

And before I start, I want to ask you about a couple of them. But before I do, can you sort of lay out for me, like looking in your crystal ball in broad strokes, where do you sort of see the pet industry going in general? I mean, you talk in the article about a number of the forces that are sort of arising and converging.

Lay, lay that out for me, if you don’t mind.

Alex Douzet: Yeah. And to be honest for that, actually, I may have to like, take a step back of like how I got into this space cause my background 20 years ago was not in animal health. I’m a technology entrepreneur. My first company was a marketplace for jobs. You know, I was competing with the likes of the LinkedIn and of the world.

And I got into animal health through the first entry. My first entry was pet food. So in 2015, I came up with an idea for next gen of pet food product. Ultimately, the company and it like being called Ollie so human grade fresh product is only for dog that is custom tailored to their weight and attributes.

And it’s a point that we ship to people’s home, right? That’s how I got to learn this entire industry. The reason why I got into this is for two reasons. One because of my dog. My dog was the the inspiration. She was having some issue and I went to see a Veterinarian who educated me about the challenge I was facing with my dog and essentially what I learned there and gave me the inspiration to create that company the second thing is, was really really convincing because initially to be totally frank as an entrepreneur.

I was like I have no business being in this industry. Like, what do I know about pet food and manufacturing food? And so I was kind of like, am I over my skis here? Like, this is maybe a little bit too much, or maybe I shouldn’t go there. But ultimately what convinced me to do this was the secular trend.

The fact that the bond that exists between pet owners and pets is only getting stronger and stronger. You know, other people call that like the humanization of pets. And ultimately, what that translates into is the fact that over the last 10, 15 years, what we’ve seen is not every pet owner, but a strong group of pet owners and more and more of them are coming to market

are willing to invest in the care for their pet because they want to extend their life and the relationship that they have with their pets. And that is ultimately what I would call the secular trend that makes a product initially when I was in pet food work and succeed because again I was creating a premium product so you needed people to willing to pay for this to deliver a better experience for their pets.

And then ultimately in 2019 when I started to look at the pet insurance. I realize those trend applied as well to veterinary care and therefore pet insurance, right? And I think, you know, one thing I saw before 2014, the inflation rate, you know, what’s also called the vet CPI was pretty much 0 percent between like 2006 and 2014.

And then between 2014 and 2021, when we got it through covid It was on average 6%, so 3x the standard inflation. Since COVID, we see the inflation being at like 8, 9, sometimes 10%. So that creates a worry for a lot of people because like, hey, will the average consumer be able to continue to afford medicine?

And you have this force conflicting because you have more and more people adopting pets. Pets are taking a bigger part of our life. The good news is you have more and more people willing to invest in the care and are saying yes to new treatments or high end treatments. But at the same token, the overall cost is rising.

So this is creating creating like conflicting thoughts. And, and that’s where I decided to say, you know, it may be good for me to like write the story and, and try to do this like every year. You know, at the beginning of the year, like refreshing, like. What are my five year visions or what are the key trends that I see emerging?

Because one of the challenges that I see right now Because I, I go myself to a lot of clinics, you know, we have we have things that we partner all across the U. S. and I try to make sure I visit some of those clinics every year. I hear all the time, the biggest pain point is staffing, right? There’s a shortage of veterinarians, there’s a shortage of technicians, and that is in direct conflict with the demand.

The demand is rising, like adoptions keeps going up, pets are living longer, demand for vet services are not declining, they’re very resilient. Keeps increasing and supply demand is starting to get an imbalance. And so I quoted my story. I think the data was from IDEXX is that by 2030, there might be a 40 percent gap between the supply of people who can do the job and the demand for those services.

So something’s going to have to be there to increase the productivity.

Dr. Andy Roark: Yeah, you, you point to. You point to traditional telemedicine, which I, which I think was interesting as a possible way to, to increase increased capacity for, for vets. And I, I think that there’s, there’s some possibility there and I like, and you did a, you did a wonderful job of, painting a picture of what the future might be like.

You know, it was, it was very nuanced in not having a crystal ball, but also sort of the the convergent forces that you see. What I’d like, I’d like to you to sort of speak to here, if you don’t mind, you know, so you make a point, you know, the people are closer to their pets than they have been in the past.

And each generation is more tightly bound to their pets than they have been. And then, you know, and we see, I see increased willingness in In investing into pets as we go and then, you know, you as a tech entrepreneur, I know that you’re aware that, you know, our younger generations are also more comfortable with technology and they, they interface with the world through technology way more than previous generations do.

And so I know this is a large sort of conversation. We talk about AI and things, but you, you, you make, you make some references in the article to just things like digital self check in tools and patient intake kiosks and integrated CRM platforms, spanning every visit touch point. And like my eyes kind of got wide as I, I just like, this is really cool.

Can, can you speak? I know in just sort of broad brushstrokes. What does that interface with technology look like in 2030, say, as we’re going, if we continue to be shorthanded. I’m an optimist, Alex. I really, I think that we can solve so many problems with technology and with education. And I just, I am, I bet on, on vet medicine. I would like to see the future through your eyes, if that’s okay. What, show it, show it to me.

Alex Douzet: I mean, and look, as an entrepreneur, one of my motto is necessity is the mother of all invention, right? And so when I look at what I quote in the articles, this shortage of supply with this rising demand to me, that is the inevitable clash that’s going to force everybody to rethink the experience to say not going to suddenly manufacture more veterinarians or more technicians.

So we’re gonna have to find a way to increase productivity. And this is where technology does it. Every industry, if we look over the last 20, 30 years where technology came in, it created, if it was designed the right way, increase productivity in a tremendous way, right? Think about, like, the standard accountant that years ago was doing accounting on the paper ledger.

And now you’re introducing software that are doing accounting and A. I. These people are much more efficient and more productive, right? And the goal is not to necessarily use technology to replace the people that we see in the clinic. It’s to really give them like an exoskeleton to enhance them, so they become their co pilot.

So I think it’s got to be on two fronts. One is on the experience. You have this new generation coming in. They were born and raised on technology, right? They were born with this thing in their hands. That’s the native. I mean, it’s, it’s an unbelievable when you observe a young person and their approach to communication.

Texting is the first natural thing. Calling is not, you take someone who’s below the age of 25 and they’re like, they look, they look at you like you’re a deer in the headlight. If you say, well, you don’t call this person. Why don’t you call to make an appointment? They’re like, well, what can I go online to make an appointment?

What can I text? Make an appointment or what can I use an app to make an appointment, right? So from that standpoint, over the next 10 years, clinics gonna have to adjust to that way of doing where it will have to be self servicing tools and you can get productivity from that standpoint. So enabling appointments, booking through an online experience.

We are texting, self checking into a clinic through a kiosk. So you don’t, you need the app to like, find this person every single time. Maybe, maybe not me. I’ve seen some clinics today in the U. S. experiment with that, where the checking process is actually relatively seamless. You know, disappearing of like all the paperwork and it’s still like personally, I find this painful of mine when I walk into a clinic and I see, Oh, my God, you’re gonna make me fill up like this whole like intake form on paper.

Like, can you not be digitalized? That seems to be like such a low hanging fruit. Yeah. So things of that nature, and then we can go into the next phase, which is AI and how we can use AI to really enhance the productivity and really turn AI into a co pilot for both veterinarians and technicians.

Dr. Andy Roark: Yeah. think AI is going to take away a lot of the tedious work that we do in the practices. I think a lot of I think a lot of responding to emails and things is going to go away. I think the biggest opportunity for AI, I mean, I’m very biased as a veterinarian. I think medical record creation and management is going to be, Such a godsend, as far as AI, being able to make to make veterans faster, save them from spending time, you know, just documenting, documenting, documenting.

I think there is real opportunity there. You, you make the case in this article that you think corporation in veterinary medicine might be beneficial in increasing efficiency. Can you sort of talk to me a little bit about that and kind of what your, where your perspective is?

Alex Douzet: So promise, and I kind of go back to like first principles to, to build a thesis for this argument is most clinics are in world independence or relatively small business. Yeah. They may have three, four veterinarians working there. They may have, you know, 5, 000, 6, 000, 10 owners active who come regularly to practice.

In terms of revenue, we’re looking at maybe 3 to 4 million, right? So I put this under the category of a small business. To solve the problem that we discussed before, this requires investment in technology. And unfortunately there is a bit of a scale game there, right? So investing into a front end experience and then be a mobile first app to interact with the pet owners, digital kiosk, some of the things you may have to make a one time investments, but you can deploy that across many, many, pet owners, you’re going to get a better return on your investment.

And I think that’s where the corporatization comes in. Because if you are in continue to be just one man show as a, as a operation, there’s only so much you’re going to be able to invest. There’s just going to be natural boundaries in terms of resources that you have access to, to make those investments.

But if you’re looking at a broader group, the broader group can look at, Oh, we can make a one time investment that is meaningful, but we can deploy this across 10, 20, 30 clinics and get more efficiencies. And then at that point you standardize some of the more mundane processes, right? So that’s where I looked at it.

Now, it works great as an argument. The flip side of what I just said is the reality check. You know, today, you know, in the U S the, it’s roughly 40 percent of clinics or under the umbrella of a corporate, so that could be a large group, like an NVA, a VCA, or it could be let’s call it a private equity home group, and then 60 percent are still independent of the group of the 40%.

I would say there is underwhelming evidence that it’s actually working, right? I think what we’ve seen there is over the last 10 to 15 years, the message has been mostly join us, be you. But the challenge with that is ultimately you need to show an ability to create efficiencies, right? You know, how do you, what’s the point of like gathering 10, 20, 30, 50, 100 clinics If you can’t show any type of like standardization and any improvement.

And I think, you know, like you have to be able to look at both sides. Like you have to let the veterinarian decide how they want to practice medicine. I don’t think anybody loves being told how to practice medicine and having a top down approach. But on the flip side, on all the processes, standardizing, you know, practice management software checking processes, record keeping, all those things can be streamlined in the back end.

I think that’s probably where we see most of the corporation struggling in a big way in a way that was probably not expected, but they need to get there, right? Same, you know, like in one of your podcasts, because I do listen to your podcast, right? I listen to the one you made on the, on the wellness plan.

And I thought it was amazing and I thought it was a spot on, like every argument you made there was like spot on in the benefit of wellness plan. One of the reasons why we see such a low penetration of wellness plan in this country is mostly because all the companies will love to do it, completely struggle from a backend system and operation to implement the benefit of a wellness plan.

Dr. Andy Roark: Yeah. No, that well, thank, first of all, thank you for saying that, but I, I think I could, I, I could talk to you all day. This, this, I, I really enjoy your insight. I, I, I love your articles. I, I link it up and also the AVMA news piece down in the show notes so people can check that out. Alex, where can people find you online? Where can they learn more about Pumpkin Pet Insurance?

Alex Douzet: Yeah, I mean, super simple. You can find me on LinkedIn, you know, just just type my name and you’ll be one of the first thing that comes up. You Google my name, you’ll see all the story I write for Forbes, a contributor. You can find me on social media like X and Thread, and then, you know, you can just Google Pumpkin, Pumpkin Pet Insurance to learn more about us.Dr. Andy Roark: That’s that’s amazing. Thank you for being here guys. Thanks for tuning in and listening. Take care of yourselves everybody and that’s it that’s what I got for you guys, thanks for being here. Thanks to Alex for being here. I hope you enjoyed it. I put links in the show notes for everything that we talked about and mentioned check them out. I’ll see you guys later on take care of yourselves everybody!

Your Bio is Probably Terrible. Here’s Why

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As the owner of a veterinary conference, the host of two podcasts, the founder of a website that’s published thousands of articles, and a mentor of any veterinary professional who decides to flatter me and then ask me questions, I read a lot of bios that veterinary professionals write to explain who they are. The typical one goes like this:

Dr. Samantha Jones was born in Easly, SC and attended Auburn University for her undergraduate and veterinary medicine degrees. She then did an internship at Best Friends Veterinary Clinic in Annapolis, MD. Now she enjoys seeing internal medicine and dermatology cases. Oh, by the way, she also volunteers at the local shelter, writes articles on the most common health problems affecting senior pets, and used to be a professional flamenco dancer.

This. Is. Terrible. 

It’s also highly representative of literally hundreds of bios I’ve seen for specialists, faculty members, GPs, lecturers, entrepreneurs, and people interested in writing blog posts. 

Why do I say it’s awful? Because the point of your bio is to communicate, as quickly as possible, why readers should care about you and what you have to say. It’s not to walk people through your career starting at the most ancient, least relevant part of your training.

People today are busy, distracted, and often intellectually lazy. They don’t want to dig to find the good parts. They want the good parts to be spoon-fed to them through their eyeballs.

That’s why, if you are writing a bio for yourself, please, please, please… lead with the good parts. How about something like:

Dr. Samantha Jones has a half dozen senior dogs and 2 senior cats. She’s passionate about helping pets thrive in their golden years and lives this passion by writing articles on the most common health problems affecting senior pets and volunteering at the local shelter. When she’s not loving on every gray muzzled face she can find, you might see her out on the dance floor where she used to flamenco dance professionally!

Also, if you care, she is fascinated by internal medicine and dermatology cases. She went to Auburn University for her undergraduate and veterinary medicine degrees and did an internship in Annapolis, MD

Do you see the point here? The first bio example did nothing to communicate who this person REALLY IS, or why others might be interested in hearing from them as opposed to any other veterinarian in the world. Yes, I know I was overly dismissive of Dr. Jones’s clinical training, and I wouldn’t really communicate her academic training exactly like that. Still, I hope you get the point about what really matters and what matters a whole lot less.

So, if you have a bio that you are using to apply for jobs, let clients know who you are, get yourself introduced as a lecturer, or hope to one day include on the inside a book jacket cover, please pull it out now and make sure it’s not terrible. Tell people what makes you special and what you care about most. Let people know who you are, and why they should give you just 5 minutes of their time to hear what you have to say.

Yes, writing like this means that you may have to sit and think about what you care about and how you bring value to the world. Just do it. You are better than a bio that chronologically lists your life accomplishments. You are one-of-a-kind. Let people know it.

PTSD in Veterinary Professionals

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Sharon Kramper joins us to discuss her research on the prevalence of PTSD in the veterinary workplace and its implications for veterinary teams. Together, Dr. Andy Roark and former veterinary practice manager, Sharon Kramper, explore various factors, potential index events, and what can be done when a team member may be experiencing debilitating symptoms. Tune in to this episode of the Cone of Shame Veterinary Podcast for important insights and strategies to support mental health in the veterinary field.

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

LINKS

NOMV Lifeboat: https://www.nomv.org/lifeboat/

National Alliance on Mental Illness: https://www.nami.org/

Shanti’s Veterinary Mental Health Initiative: https://www.shanti.org/programs-services/veterinary-mental-health-initiative/

Sharon Kramper on LinkedIn: https://www.linkedin.com/in/sharonkramper/

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

Sharon Kramper is preparing to receive her PhD in Clinical Psychology from Auburn University in August 2024. Before entering the field of mental health, Sharon worked in veterinary medicine, including being employed as practice manager in a small companion animal hospital. Here, she was sensitized to the workplace-specific stressors and risk factors that contribute to negative mental health outcomes among veterinary professionals. Her research during graduate school has included describing experiences of discrimination reported by LGBTQIA+ veterinary students and professionals, estimating the prevalence of PTSD in the veterinary workplace, and characterizing the types of ethical dilemmas that support staff encounter. She is looking forward to two things after graduation: 1) being called doctor and 2) rescuing a new dog buddy.

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. I’m here with Sharon Kramper. She is a former practice manager, future clinical psychologist, and she’s been doing research with PTSD in veterinary medicine. We talk about her research and kind of what she found, what PTSD is and what it means and how it manifests in our profession and that’s what we get into. It is a really interesting discussion. I will give you just a little bit of a warning. We do talk about things that might cause PTSD or that would rise to the level of being index events for PTSD. We don’t talk in graphic detail or anything like that, but you know, we give some sort of broad examples and things like that, and they might be upsetting to people.

So know that, know that it’s not something that, that we lean into in any way, shape, or form, but, but we do talk about the types of things in vet medicine that, that might that might serve as or might cause, you know, that might cause harm. So anyway, just know that that’s there, so it’s, it’s not surprising. But that, that’s it. Gang, this is a good episode. I hope you’ll enjoy it. Let’s get into it. 

Kelsey Beth Carpenter: 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. Sharon Kramper, how are you?

Sharon Kramper: I’m great, how are you?

Dr. Andy Roark: I’m really great. It’s so good. It’s so good to see you and get to catch up with you. For those who don’t know you, you are, you are finishing up your doctorate in clinical psychology. You are 120 days away from being called doctor at this point. You fascinate me. In that you have this previous life and career in veterinary medicine. You were a practice manager. You’ve been in the profession for a long time. And then you went and went into clinical psychology training.

And so now as we talk, you’re currently working with inmates in a correctional institution as you finish your training. I don’t know if you’re going to come back to vet medicine after that. I think you’ll be well prepared if you do. I think you will be. Honestly, is all of this an elaborate plan to make you a very specific kind of practice manager? Is that what this?

Sharon Kramper: Oh, gosh. I mean, I do have, have dreams of coming back to veterinary medicine and I would love, like, I have this image of myself as being like the, the Mary Poppins and like a cardigan coming in and, and, and to like practices and helping them with their culture and, and with their mental health. You know, you, you come in and they kind of sprinkle some magic and then get out. I mean, that would be fun, but we’ll see. 

Dr. Andy Roark: I, I, I love, so I, you, you’re, you’re up on the literature, you’re actually doing clinical psychology practice and then you have this great wealth of knowledge of the vet industry and you’ve all these stories from experiences that you had and things like that. When when you and I were talking you know, a couple months back and everything, you, you were really interested in PTSD and you were sort of Uh, part of your research and part of your training was focusing on PTSD, and so you’re studying PTSD, and I was really curious in sort of how PTSD as a as a, as a phenomenon, as a, as a condition people have to overcome how that interfaces with veterinary medicine.

And, you know, we, we talked a bit at the time about sort of ethical dilemmas and, and some of the challenges in vet medicine and some of the, was some of the hardships of vet medicine. And so let me sort of stop right here for a second and sort of say, Sharon, can you talk to me a little bit about what is, what is PTSD in a, in a, I don’t know, in just a general context? And then do we see PTSD in veterinary medicine?

Sharon Kramper: Great questions. So to start off with, from a psychology point of view, PTSD or post traumatic stress disorder is a little bit different from many other disorders we see. Think of like depression or anxiety because it involves and what we call an index event, right? Something happens and then you develop symptoms afterwards, and those symptoms persist over time.

I think a really good example when talking about PTSD is to think about a car accident. And so, for example, you might get into a fender bender, right? And it shakes you up a little bit, but maybe you’re unharmed and you are you kind of go up on your way very quickly, versus, let’s say that you were in an accident where maybe your passenger died, right? Or it was very serious. You were hospitalized for a while. You had to have reconstructive surgery. You know, maybe you thought you were going to die at the moment of impact. Right? We think about the difference of scale and the difference of severity there where one is life threatening. And so when we think about things that could potentially be an index event, we’re thinking about things that could potentially be life threatening.

So, when we think about veterinary medicine, there are things that happen in the workplace that are potentially life threatening, right? You could be mauled by a dog, even if you’ve had a cat like attack you in the face, you know, and go at your eyes. If you’re a large animal veterinarian, you’re working with horses and you’re working with, with cows and bulls.

I mean, you’ve very likely had maybe some near misses or even some serious accidents that have happened to you. And so, getting back to this idea of PTSD takes two things. And one is having an index event that happens. And then there are symptoms that develop afterwards and that don’t go away over time, right? So if something’s minor, let’s say you get bitten on the finger by a dog may hurt for a little while. You may need some antibiotics, clean it up, but you know, the next day you’re probably able to go back to work. On the other hand, if you were mauled by a dog at work, okay. You might be feeling some trepidation.

It might be hard to go back to work. And so you might even have nightmares about what happened. You might find that you avoid breeds that look like that particular dog. You might find that you don’t want to go into that corner of the office where the thing happened. You may find that a certain pitch of bark will, will, you know, just set you off and you feel like you can’t even stay in the room with a dog, even if it doesn’t resemble that.

You know, I mean, there are so, so many things that can like trigger the stress response in our bodies. And when we think about PTSD, those things are things that don’t go away over time. Like they stay with us for about six months or more.

Dr. Andy Roark: So, is is that so that was part of my question? So for example, I was visiting with my nephew. He’s six years old and he was he was around this weekend and we both got stung by bees. Yeah, we both got stung by bees. I shook it off much faster than he did. I have to say, I– not trying to, you know, flex on a six year old, but really, he was very dramatic about it.

And, and, so, he’s like, I don’t want to go back to, I don’t want to go back out in the yard. And, again, this is a six year old that we’re talking about. And Well, he will forget this probably by tomorrow, and so I’m assuming that. But he did. There is technically an index event, something bad that happened.

And then he did remember. And then he did not want to go back out to the yard. Surely that doesn’t rise to the level of PTSD, right? And then when we say, Well, what would be the difference? Is that the amount of time? Is it the severity of the index event? Are there are there caveats on that? I guess I guess where I’m kind of going with this is just sort of understanding, I mean, I’ve gotten, I got bit on the finger by an old cat one time and when I see old cats, I always remember getting, cause it was bad, and I always remember getting bitten, but I, I mean, it’s not, I wouldn’t call it PTSD, it was just, I, I learned a lesson kind of like burning my hand on a stove where I’m like, oh, I’m, I don’t want to do that again, help me, help me start to parse that apart,

Sharon Kramper: Yeah, some things are stressful, but they don’t rise to the level of being traumatic or resulting in like a cluster of symptoms. Generally, what we look at is what is your level of impairment afterwards, right? So let’s say that you did have something happen at work, and you found that you couldn’t get yourself to go back to work.

Well, we would look at that as like a level of impairment, right? If you, if you were trained as a veterinarian, but now you can’t go back to work, you know, we might start considering PTSD because the level of impairment of what happened…

Dr. Andy Roark: Yeah.

Sharon Kramper: is so high, versus, you know, is your, it was your nephew, right? You know, he’s probably gonna be able to go back out in the yard like you said.

It’s probably not gonna impair him, but there, you know, there are people who have things So, you know, a lot of the times when we are thinking about PTSD, we’re also thinking of examples having to do with like the military, combat, physical…

Dr. Andy Roark: Of course. 

Sharon Kramper: assault, and things like that. And so we think about people who associate certain triggers, smells, sounds, types of people, locations, environments, with the thing that happened to them, the index event. And therefore, let’s say, let’s say they were in a car accident and now they can no longer drive, right? They’re too scared to get into a car. They’re too scared of what’s going to happen. And so that would really impair your life if you could no longer drive yourself anymore, right?

Dr. Andy Roark: Yeah, absolutely.

Sharon Kramper: That is one of the things that we look at with PTSD, we take into consideration is how impaired has your life been?

Dr. Andy Roark: Interesting. Okay. How much, how much of a prevalence of PTSD did you find in, sort of, in your research when we look at, at veterinary medicine versus, versus the general population?

Sharon Kramper: Yeah. So, in the research that I did, we collected stories from veterinarians, but also support staff. And we asked them to tell us about an event that had haunted them, right? Something that really stuck them. And We looked at those stories and we evaluated them for whether we felt that they were an index event, like I’ve been talking about, right?

Did something rise to the level? And let me tell you, so there’s actually A little detour here. There are four guidelines that we use when we’re considering whether something might be a traumatic event. And one is that the thing happened to you, right? Are you the one who got mauled by a dog, who got gored by a bull?

Did you witness something happen to someone else? Did you witness someone get mauled by a dog or trampled by a horse, right? That could be traumatizing. Did you hear about the violent and sudden death of someone who’s close to you? So this is not like grandma died of cancer and I found out.

This is like, I found out that, you know, my sibling was coming over to my house and I found out that he was shot dead in the convenience store robbery, right? It has to be sudden and violent and somebody who’s really close to you. And then the fourth thing that we look at that could be potentially traumatic events would be repeated exposure to extreme and gruesome things happening.

Like, for example, First responders having to pick up human remains or being exposed to stories of child abuse, right? We look at things like that, like this accumulated experience over time. a little bit more background on that. So in veterinary medicine, so one of the things that I was curious about is The I thought that there were things happening in veterinary medicine that might qualify as like these index events, but they don’t fit neatly into those categories that we just talked about.

And so we went through these narratives and read people’s stories and tried to see if they met the criteria for possibly being an index event. And what we found is that there were especially stories of people who had had a patient die during a procedure related complication that seemed really analogous to what can happen in human medicine, right?

Where doctors can lose patients and those can be considered traumatic events. But when you look at, like, the very strict definition of what an index event was, for a psychologist, it didn’t include anything about animals. Right? There was nothing, nothing saying like it was about having to pick up human remains.

Well, what about if you’re working in an environment where you’re seeing gruesome animal remains? You’re seeing, you know, big dog, little dog kind of things or car accidents and you’re being exposed to that. Or maybe you work in shelter medicine where you’re performing a lot of euthanasia. And so one of the things that I wanted to, to look at is are we making the bucket large enough as psychologists, right?

Do we maybe need to expand our criterion a little bit for what an index event is? And then, once we had an idea of we would categorize these different narratives that we had captured then I went through and analyzed for, we’d ask, also ask people what kind of symptoms that they’d had associated with that event.

So we were able to kind of calculate, okay, they’re having an event and they’re having a symptom, right? Because it takes both in order to have a diagnosis of PTSD. And so, we’re finally getting to the meat of this here. So, the prevalence of PTSD within the sample that I was working with, was 3. 6 percent if we only considered a very, like, small, strict interpretation of what an index event was, right?

So if we were only considering It’s like, humans. Let’s see if I can explain this a little bit better. So we actually had gone through the narratives and evaluated them for whether they met the strict criterion for whether they were an index event under, like, a very strict interpretation, meaning it was like you had to do something with human remains or basically there’s a human victim involved.

But what we did is we also went through and we re evaluated every one of the narratives for what if we consider animal victims Then, so basically if we expand this idea of what an index event could be that include animal victims, then what does our prevalence of PTSD look like? Does that make sense?

Dr. Andy Roark: Yeah, 

Sharon Kramper: So it’s kind of like we figured out PTSD with a very strict definition that like psychologists are using, but then we also like I opened it up and I said, well, but what if we consider animals as victims? What does that do to the prevalence rate of PTSD within veterinarians? So we went from 3. 6 percent under the very strict interpretation of what an index event is, which is very similar to what you find in the general population, like everyone who’s not working in veterinary medicine.

But when we, when I expanded that definition of what an index event could be, the prevalence increased to 13. 9%, so just about 14%. . quite a difference. And what it means to me is that there are potentially a lot of people out there who have been impacted by traumatic events that have happened at work, but we’re not catching that.

Dr. Andy Roark: Hey guys, did you know that I have another podcast? I am the host of the Uncharted Veterinary Podcast with my dear friend, practice management goddess, Stephanie Goss. We have been answering questions for years. We started a year before Cone of Shame. I started doing the Uncharted Vet Podcast with Stephanie.

We take questions from our mailbag. We have listeners who write to us and they tell us about what’s going on in their practice and we try to answer their questions and they are all about communication, leadership, management, things like that. It’s about working with clients. It’s about working with staff.

It’s about working with your boss. It is about all of those sorts of things. We have everything from, trying to establish some trust in your team when you’re a brand new baby doctor, actually fresh out of vet school to managing an employee with mental health issues to how to give notice without, without the guilt.

If you are in a place, you just can’t be there anymore. We’ve got all that stuff. We’ve got hiring, firing, working together, working with clients, reviewing your systems, getting your practice to run smoothly and efficiently, and how to manage your time. All that stuff is there. Check it out. I said 250 episodes.

You can see what everyone is about, from the title because it’s what, it’s basically the question that we’re being asked. But anyway, it is a very popular podcast. I hope that you’ll check it out and enjoy it and love it. I just love making it. So anyway, I just want to tell you it’s there guys. Let’s get back into this episode. So help me with this a little bit, right? So we’re talking about PTSD. It’s really interesting when we talk about this way a big part of PTSD is in the response of the individual to the event and I’m not saying I’m missing is a choice that the person has but but, you know, two people could have a similar experience.

Like, you know, two people could be in different car accidents. They could be in the exact same car accident. And one person is going to be terrified to drive thereafter, and the other person is, is simply not. I mean, I would assume that that’s kind of the same thing when we talk about this with vet medicine, right?

I mean, there’s, there’s a, just because there’s a larger, there’s a, there’s a high percentage of people who could develop PTSD. A lot of, a lot of them presumably won’t, right?

Sharon Kramper: That’s correct, yes. Just because you are exposed to something that could be an index event does not mean that you are going to develop PTSD. And so there are like resilience factors, and I’ll be honest, I’m wading into a territory that’s not as familiar to me because we didn’t really look at resilience factors in my research, right?

But there are individual differences between people. There could be people who have been through similar situations in the past and they become more resilient as a result. Right? We’ve probably seen that in veterinarians or, or support staff who you know, they’ve been through it so many times that These things just don’t get under their skin anymore.

On the other hand, there may be someone who I’m thinking of like your nephew, right? If he’s never encountered a bee sting before, right? If you’ve never had something terrible happen to you, and all of a sudden, boom!

Dr. Andy Roark: Yeah.

Sharon Kramper: Your whole worldview changes, and what you thought was safe is no longer safe. And actually a lot of PTSD treatment tries to get at that, at how, essentially like the, what you believed about the world and your safety in the world has now changed.

And how do we, how do we go so essentially you kind of become more extreme in a way, right? Like nothing’s safe anymore. You, and so what we work with during treatment is how do we get you to a more realistic place?

Dr. Andy Roark: Right. Gotcha. Okay. So, when we look at, you know, just say that, that there is, that there’s a 14 percent chance of a vet professional being exposed to a potential index event if we use this sort of more broad, bigger bucket, as you said, sort of, sort of idea. Are there things that we can do for our teams or for ourselves to kind of say, well, hey, look, this, this exposure might happen.

Are there things that we can do to kind of, to prepare ourselves to, to maybe lessen our reaction? And again, I don’t say it’s not, it’s not emotional numbing, but are there conversations that we could have or just things that we could start to, I don’t, I mean, I’m thinking about, about training, you know, is there a, is there a way of sort of having at least conversations about what these things look like if we’re having at, at veterinary technician school or at veterinary veterinary school or, or for onboarding into, into working at the clinics?

Are there? Are there sort of expectations that we should set, or things like that? I don’t, I don’t know, and like, that we may be headed on a very gruesome path of bringing people in and, and exposing them to horrible things, or telling them about horrible things. I, I don’t know. Do you have any insight there?

Sharon Kramper: Let’s see. So first of all, I kind of want to go, go back and the, the 14 percent would be like the number of people who would actually be potentially diagnosed as clinically having…. 

Dr. Andy Roark: Oh, diagnosed. Oh, oh, I thought that was, I thought a percentage was coming in to contact. 

Sharon Kramper: The exposure is much higher, right? Yeah. I mean, think about how many veterinarians are, but you know, like how many people you’ve worked with who’ve probably been exposed to something in the, you know, it’s much higher.

It’s going to be over 50%. but, but like you’re pointing out, like a lot of those exposures happen, but they don’t result in PTSD. So, how do we prepare ourselves, or how do we, because here’s the thing, is we can’t this is one of those things where we can implement all this safety, like safe handling guidelines as we want, and things are still going to happen, right? So we kind of, rather than trying to completely eliminate that from the workplace, because that’s probably not a reasonable goal, yeah, how do we prepare ourselves? So getting back to like, how would we treat somebody if they have PTSD?

And one of the things we do is prolonged exposures. Okay, I don’t know if you’ve heard about this, but so, a lot of times what happens is that the, the body, getting back to this idea that people start to avoid things that, that cause them distress. Because it’s related to the thing that happened to them, like avoiding a particular breed of dog or maybe the area in the hospital where the thing happened to them is as much as possible exposing yourself to that thing that happened.

So you don’t have to do it in a dangerous way. But It’s that sort of adage of getting back up on the horse again in a safe way so that your nervous system learns like that thing happened to me once, but it’s not going to happen to me every time.

Dr. Andy Roark: I have a friend who is terrified of roller coasters, and, and and she worked through it. And the way she worked through it was, at first, you would go to, like, the fair and just be there. And then, she would go and she would stand in line for the rollercoaster. Never intending to ride it, I’m gonna stand in line.

And then, you know, and then she kind of worked her way up like that of just, kind of this exposure to this thing until ultimately, she never got, she never got to where she loved rollercoasters, but it wasn’t this you know, debilitating thing. I think she felt compelled to sort of tackle this thing that, that she felt she was maybe overly afraid of in her, in her mind anyway.

And so that, that, that totally makes sense. 

Sharon Kramper: Yeah, just said a really key word there, which is debilitating, right? It’s, it’s getting back to this idea of like the level of impairment that it causes. So if that thing is really getting in the way of you being able to go about and do normal things in your life, things that you want to achieve, things that you value that are important to you.

Like if you want to go to the fair, like, you know, the roller coasters there. Yeah, a lot of times it’s, it’s just a matter of deciding, right? I just, I don’t want to be afraid of that thing anymore to that  extent. And yeah, exposures over time.

Dr. Andy Roark: I mean, I’ve seen vet professionals work through fear of cats or, I mean, through, like, again, I’m sure that, I’m sure people work through fears of dogs, but, like, the one I’ve seen and remember is someone who, like, they, they didn’t have cats as a kid, they weren’t very familiar but they wanted to be a companion animal veterinarian, and, and it’s one thing to say, well, this is, I, Yeah. I don’t want cats to be my primary focus. It’s another thing to say, I don’t want to see cats at all. And that person was like, I don’t, I don’t want to, I don’t want to be that way. But it was something where they, they had to spend time with cats. They had to, they had to be around them. And like, they would go, they’d go to my friend’s house, who had a bunch of cats.

They’d just kind of be there. And, and then they would sort of start to see them in the exam rooms and stuff like that. But it was, but it was very much just sort of a process through that. So I like this topic and then I think it’s, it’s important for us to be aware of kind of how we stress ourselves so that we can support each other and then also if there’s things that we can do to try to build resilience so that people don’t get sort of, blindsided and, and put into a bad place and then also I, I really love the idea that, that there’s always things that we can do to try to sort of work through these issues and I, I think that’s an important

Sharon Kramper: Yeah. Some, some of them. And then I do want to bring up, like, there is a whole other category that we found in my research of things like, losing a patient through you know, from procedural complications, right? That is the kind of thing that can be traumatic, especially if maybe there was like a medical error and, and that’s related to why the pet died or animal died.

And so, that’s the kind of thing where exposure to it, you know, that, that may not be the right route for getting that. Except, well, going back to surgery, right? Going back to surgery is going to be a route through it because you’re going to have many, many more successful surgeries, right? That one go well, but you take what you can learn and you go back to surgery.

But I’m thinking of, for some people, it’s just the getting stuck in like that mental state of you know, I did something wrong. You and I have talked about this before, that you get into like a negative cycle of yourself, right, all the things that you are, all the awful things that you’ve done in your life.

And so that might be the point in time when it’s good to get an outside perspective from like a mental health professional.

Dr. Andy Roark: Oh, that, yeah, that totally makes Yeah. Some, sometimes getting back on the horse is just like that. Maybe that’s not, maybe that’s not the immediate right suck it up kind of move.

Sharon Kramper: Going back to surgery is, but going back to like losing patients isn’t, right?

Dr. Andy Roark: No, exactly. Right. Yeah. Let’s not do it. Let’s just, let’s just not do that again.

Sharon Kramper: Right, yes, yes, and yet, every time you go into surgery, you are taking that risk.

It’s always going to be there, and it’s so hard to, it’s so hard to face it, and that’s one of the places where the mental health professional can kind of help you to get into a more neutral place about going into surgery and how do you handle the risk that you’re taking every time, what the outcome could be.

Dr. Andy Roark: Yeah, well Sharon thanks so much for being here. Do you have favorite resources in sort of the veterinary mental health kind of space? Yeah.

Sharon Kramper: Yeah, one of them that I would recommend that is very specific to veterinary professionals would be it’s called Lifeboat, L I F E B O A T and that is through NOMV, right? Not one more of that. And Lifeboat is a peer support application that you can find on the computer. and like if you’re seeking help for burnout, depression, anxiety, PTSD, you will be supported by peers who are also veterinary professionals and who can, who have been there, right?

They’ve been there, they’ve had their own mental health struggles, and they can help support you. If you wanted to go more broadly than veterinary medicine, there’s of course NAMI, which is also usually called, like, NAMI, I think, the National Alliance on Mental Illness, and they’ve just got a lot of great resources for a variety of different kinds of mental health issues.

And if you yourself were like, I really would like to find a psychologist, I would probably say go to Psychology Today Their website, they’ve got a, a directory of psychologists all across the country.

Dr. Andy Roark: Very cool. Cool. Thank you for being here. Thank you so much for sharing with us. Where can people find you online? And are you on LinkedIn? Are you out in the world where people can you re–

Sharon Kramper: I am LinkedIn, yes, yes, you could probably search for me as Sharon Kramper. But yes, I don’t have a very large social media presence, to be honest.

Dr. Andy Roark: We’re gonna, we’re gonna blow, we’re gonna blow you up. That’s, that’s what we’re gonna do. Great. Well, thank you for being here, guys. Thanks for tuning in, everybody. Take care of yourselves. I’ll talk to you later. And that’s what we got. Guys, I hope you enjoyed it. I hope you got something out of it. Thanks to Sharon for being here. Guys, thanks to you for listening. Take care of yourselves, everybody.

5 Pieces of Advice for New Veterinary School Grads

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Imagine a brand new veterinary school graduate walking past you and out of the graduation ceremony, degree in hand. Just before they pass out of the building and into the blinding sunlight beyond, they pause and turn back to you. “Do you have any last pieces of advice?”

What would you say in this brief moment? I’ve been thinking about that for the last few days. I think I’d rattle off these five things as quickly as I could and then wish them luck. Here goes:

  1. Remember veterinary medicine is a journey – The person who loves to walk will go much farther than the person who just wants to reach a destination. Learn to love the walk, not the endpoints you think will make you happy.
  1. Don’t stress so much – He who suffers before he needs to, suffers longer than he has to. Whenever you find yourself starting to worry, ask yourself “What can I do right this moment to improve my situation?” Then do that. 
  1. Be intentional with your attention – Your life is controlled by what you focus on. Resist making unkind assumptions, dwelling on the negative, and ruminating on things you can’t control. (These things include: the past, the future, and other people)
  1. Be present and part of the group – There is nothing better you can do for your happiness and your ability to do your job than to truly know the people around you. Don’t sequester yourself among the veterinarians. Become an interconnected piece of the fabric making up your practice and community.
  1. Take online veterinary medicine with a grain of salt – Social media incentivizes negativity, extremism, moral and emotional language, and in-group/out-group conflict. Your emotional energy is precious. Don’t let it get taken from you so some corporation can generate ad revenue.

If I could tick these 5 things off and then shake the new grad’s hand, that’s what I’d do. How about you? If you had this opportunity, what would you say?