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Podcast

The Art of Pricing Veterinary Medicine

December 28, 2022 by Andy Roark DVM MS

Fritz Wood, a renowned animal health consultant and advisor, joins Dr. Andy Roark to talk about pricing in veterinary medicine. Are increasing prices justified by inflationary pressures and rising costs of living? Do pet owners agree and/or accept this? What are the potential benefits and pitfalls of veterinary clinics raising prices? Should they do fewer large raises or more frequent smaller raises? The discussion ends with a conversation about the impact of corporate medicine and the coming future of telemedicine.

Cone Of Shame Veterinary Podcast · COS – 177 – The Art Of Pricing Veterinary Medicine

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

LINKS

Fritz Wood Website: https://www.fritzwood.com/

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

AAHA Veterinary Fee Reference (2020 edition): https://amzn.to/3W2lWeU

Profitsolver: https://profitsolver.com/

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

Links to Amazon.com are affiliate links and help support the show. (They’re also much smaller than normal links and easier to copy when typing up show notes!)

ABOUT OUR GUEST

Fritz Wood owns and operates an animal health consulting practice in Kansas City. He’s focused on the business of veterinary medicine for more than 30 years, conducting important research on veterinary productivity and attributes of high-performing practices. Fritz is an author, speaker, business consultant, and key opinion leader. He was on the Editorial Advisory Board of Veterinary Economics, Veterinary Team Brief, and Today’s Veterinary Business. He’s authored scores of articles related to the business of veterinary medicine and personal finance. He often presents at local, state, regional, national and international veterinary conferences. Fritz holds Bachelor of Science degrees in Accounting and Business Administration from the University of Kansas (1986). For decades, he was actively licensed as a Certified Public Accountant and Certified Financial Planner. Fritz is also affiliated with a personal financial planning, investment management, and 401(k) practice, where they help people reach their lifetime goals. His pre-vet experience included nine years as a management consultant with a top global consultancy.


EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome everybody to the Cone of Shame veterinarian podcast. I am your host, Dr. Andy Roark. I am here with my good friend, Fritz Wood. Fritz is an industry advisor and observer. He does a ton of personal finance with veterinarians and I’m talking to him about pricing strategy in the veterinary industry. How do veterinary clinics set prices? Are we doing what we can to keep care affordable? What are the benefits and the drawbacks of raising prices? How much elasticity is there in these prices, meaning how much more competitors take or what are they going to say when we do raise prices? And how do we get the staff onboard and is that an issue or something to be concerned about? Spoiler alert, yes it is.
Anyway, it is a really good, very high level discussion about pricing and medicine. It’s not about how you set your prices in your clinic, it’s more about what the prices of medicine mean and what the ripple effects are from changing them and from not changing them in an inflationary environment. So anyway, guys, that’s what we get into. It is a really good discussion, sprawling all across our profession. We talk about corporations coming in and what that means. We talk about virtual care and just all sorts of stuff. And so anyway, it is really, really interesting conversation. 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. Fritz Wood, thanks for being here, my friend.

Fritz Wood:
I appreciate the opportunity.

Dr. Andy Roark:
Oh man. For those who don’t know you, you have been a CPA, certified financial planner, you are an industry advisor and observer. You work with a lot of veterinarians on personal finance, things like that. You have been a mentor for me throughout my entire career. I have always looked up to you. You’ve given me some of the best advice that I’ve gotten in my career. I’m not kidding when I say that. I love having you here. I love getting a chance to talk with you. You write for Today’s Veterinary Business as well as a bunch of other outlets and everything. And I always look through and check out your column when it comes in. And there was something you wrote about recently, you wrote about the upsides and pitfalls of adjusting prices.
And I’ve been thinking a lot about this. So I’m looking at inflationary economy, I’m looking at upward pressure to raise wages in the practice, I look at keeping care affordable for pet owners. I just came out of the Uncharted Veterinary Practice Owner Summit and that was a concern I heard again and again is affordability of care. “My staff can’t afford the care that we provide to our clients and that bothers me,” and I listen to a lot of those things. And so I wanted to get in with you and just start to get into vet pricing and where the prices come from and just start at that level and then just start to play around with what price setting looks like in our industry. Is that okay to start out with?

Fritz Wood:
You bet. And I appreciate the very kind words, Andy and I am flattered and honored to be here and look forward to contributing and hopefully, have a little value. And I think this topic of professional fees, it’s probably always timely and it’s probably always germane. Before we sort of dive into any detail, I found this interesting, you might find this interesting, in preparation for today, I sort of looked back at presentations I had given on the topic of professional fees. And the most recent one was four and a half years ago, so not recent. And the one before that was six years before that. So I’ve literally talked probably about professional fees twice maybe in the last decade. And then I thought, “Well, that’s kind of odd because I used to talk about it all the time.”
So if we start at the 50,000-foot level, what happened? The accounting and consulting firm, KPMG came out with a study commonly called the Mega Study. It came out in 1999 and one of the conclusions was that veterinary fees had not even kept up with inflation during the 1970s, the 1980s, and the 1990s. Okay, so it is fair to say that that raised a big flag in the profession. And my observation and anecdotal observation is that subsequent to that, so in the 22 years since then, or 24 years since then, veterinary fees have riven at about twice the rate of inflation over that time period. So inflation had been going in the first two decades of this century at about 2%, veterinary fees had increased about 4% or even more. So veterinarians, the profession clearly got this message loud and clear, “Oh my gosh, we’re not even keeping up with inflation.”
But I would argue that there was sort of a pendulum swung rapidly and perhaps too far and too fast in the other direction. And I agree with you completely. Let’s start at the 50,000-foot level, I agree with you that there’s an affordability problem and increasingly so, right? I mean I’ve read things that indicate the cost of veterinary care is pretty comfortable for people, let’s say, households making a hundred thousand dollars or more a year. Well, median household income’s about $65,000 so that’s a problem. And we’re not going to solve this today. But I would argue the problem with that is the model we’ve created, let’s just round numbers say 30,000 veterinary hospitals is a pretty expensive way to deliver veterinary medical care. In other words, if you design the profession from scratch to deliver care cost efficiently, it wouldn’t look at all like this.
I mean, for example, there are 6,000 or five times fewer human hospitals than there are animal hospitals. There’s about 6,000 compared to 30,000 animal hospitals. There’s more humans than there are pets. So we’ve got all these really highly specialized, highly capable hospitals that are not used near capacity. And that’s an expensive way to deliver veterinary care and nobody’s going to change that overnight. So we got to talk about professional fees because veterinary medicine from a business standpoint, I would characterize it as a gigantically large number of relatively small dollar transactions. If you take a clinic and you say, “Okay, how many transactions were in that clinic last year?” And then you divide it by the number of doctors, full-time equivalent doctors, it’s going to be 4,000 or 5,000 transactions per doctor per year. And that doesn’t mean you lay your hands on 5,000 animals or talk to 5,000 clients, but some of those are coming in for medication repurchases and things like that.
But it’s a business of a hugely large number of transactions at a relatively low dollar amount. So small changes to the fee structure have a large impact on the business because of the number of transactions. So that’s where we are, where we have been. I mean I’m hearing people struggle with the same thing. There is an affordability issue, the people at the front desk are hearing it all the time. Clearly this notion of inflation… I just saw today, the most recent numbers are 7%. So everyone is having a larger percentage of their family budget or household budget necessarily allocated to things like utilities or energy, gas for their cars-

Dr. Andy Roark:
The groceries, gas.

Fritz Wood:
Food at the grocery store and household income’s a zero-sum game. So if more gets allocated to these categories, less is available here. And I was just looking at some charts today in preparation for this. And basically business exploded from about June of 2020 for the next year. That was the nadir, was June of 2020. And then from there, the next 12 months through June of ’21, things just shot through the roof. And then for the last six quarters since then, there’s been a marked and decided decline in client visits and number of transactions. It started again in about the summer of 2021, and inflation began to pick up hugely about the first quarter of 2021. So I don’t think it’s a coincidence that as inflation began to rage, transactions, client visits began to decline. And guess what happens when you increase fees? You should absolutely expect fewer transactions, right?

Dr. Andy Roark:
Yeah.

Fritz Wood:
And we could talk more about what’s called price elasticity and what we know about that in the veterinary profession. But it’s kind of like you squeeze the balloon, it’s not taking up space there anymore, but that air went somewhere else and it’s still in the balloon, just changed places.

Dr. Andy Roark:
Yeah. Do you think that rising prices in vet clinics have played a big part in the six quarters that we’ve seen of declining number of transactions? Do you think there’s other factors at play besides that?

Fritz Wood:
No, I think there’s a host of factors that have little or nothing to do with the fact that we’ve raised fees, right? I mean, I don’t think I can draw that decline. In other words, fees have increased continuously. This isn’t just a matter that happened in the last six quarters, they have increased continuously. I think it was the inflation that kicked off. So of the six quarters where things have declined, four of those, we were comparing against a period before that was really abnormally inflated. So we would expect it to be back to normal. But then the last two, we’ve lapped that now. And so the last two quarters, we’re looking at results from a period that had already been in decline. And it’s going further. I mean I think visits, they’re off 3% or something like that, 3 or 4%.

Dr. Andy Roark:
Yeah.

Fritz Wood:
So here’s kind of the way I think we’re off. Transactions are down this year 3 or 4%, veterinary clinics are reporting revenues up about 4%. So that’s a 7% difference. So my guess is that’s the fee increase, right? That’s 7% fee increase. So we’re down three in visits, but we’re up four total. Well, that was the 7% increase in professional fees. I’m assuming, by the way, for the purpose of this conversation that we’re only talking about professional fees. I think implicit in this conversation has to be that people have good controls in their clinics, such that when the prices of products or inventory items change, that is immediately reflected in a change of their prices. In other words, they’ve got control over their inventory to make sure that supplier or manufacturer increase in prices are passed along immediately and they will. I mean every pharma company is going to increase the price of every product, every year. You can bank on that. So that needs to be mechanical in the clinic and automated with the practice management system.

Dr. Andy Roark:
Speaking of inventory, so staying on this topic, do you see inventory revenue decreasing in practices and how does that affect the prices in clinics, right? So I guess I’ve really sort of wrestled with this a little bit. It’s been a perception of mine that more and more pharmacy businesses has left the practice to go online to Chewy or Amazon or wherever. Does that increase elasticity for prices for diagnostics or for your physical exam? It’s never made sense to me the idea that we would run a practice and it’s built on this product model, which time machine, if you’re going back, please set that up differently. But unless somebody does that, that’s what our business has been built on. It was we sell vaccines, we sell products instead of traditionally we sell our expertise like an accountant or a financial advisor or something like that.
And so it’s never made sense to me, I guess, if you see products leaving the practices. It makes sense to me that that revenue has to come from somewhere, it’s going to come from our intellectual property in our services that way. Do you see that, I guess as I’m saying, as, first of all, valid? Do you see inventory transactions leaving practices? And when you do, does that leave the ability to raise prices on the other services that we keep in the practice?

Fritz Wood:
Yeah, I think there’s several questions in there. I mean, I think the first is people have predicted the demise of the pharmacy as long as I’ve been working in the profession and it just has not happened yet. When I read the financial or the veterinary press, I would be led to believe that the pharmacy is completely being crushed by the competition online, let’s say. The problem is when I look at sort of data, when I look at the facts, when I look at tax returns, when I look at financial statements, what I don’t see is a marked decline in the pharmacy, what I don’t see is robust growth. But more and more, I’m seeing clinics choosing to be price competitive in the pharmacy with alternatives the consumer has elsewhere, largely because they don’t want to appear to be guilty of what PetMeds accused them for so long, just fleeing the client.
It’s like, “Hey, you can buy it here, you can buy it there at the same price,” and that still leaves a healthy enough margin. So I would not abandon the pharmacy just yet. I think there’s still great opportunities there to improve compliance, which is one of the things that you might do in lieu of price increases. Because that’s one of the things I hope we talk a minute about is what are things you might consider instead of price increases despite the fact I think fees do need to keep up. I mean let’s face it, the bottom line is the biggest expense in a veterinary clinic by far, bar none is labor. It’s probably consuming 40% of gross income, maybe more. And I believe, and I think most veterinary practice owners believe that people deserve to at least not fall behind to inflation.
I mean I think it’s a moral issue. I mean when I used to work at the veterinary schools, I told them that build into your contract, and this is not even negotiable, cost of living increases. So you simply don’t fall behind. And that’s not a reward of any kind. That’s just a, “Hey, we stay even with last year.” But you know what, if I’m making a hundred thousand dollars a year and inflation’s 8%, or if I’m a technician making $50,000 a year and inflation’s 8%, I need to make $4,000 more or $8,000 more next year just to make the same amount, just to buy the same number of gallons of gasoline or go to the grocery store the same number of times. And so it’s almost a morality or fairness issue to me.
So if we say, “Okay, we’ve got this huge expense that’s non-negotiable, it’s critical to your success. If these people abandon, you got no business left,” we got to do everything in our power to try to retain them and one of those is through fair and reasonable compensation that, to my mind, at least increase with the level of inflation. And look, I’ll also tell you obviously there are veterinarians that I’ve seen, practice managers, that use professional fees as a cop out, a quick fix, “Let’s just hit it with that dopamine.” And what you tend to have in those kind of clinic, in other words, without changing anything at all about the client experience, let’s say, or adding value in any other areas, and I think if you’re charging dramatically more than what you were five or 10 years ago, and you probably are and you’re not delivering a substantially different and better experience, then I think you probably are in harm’s way.
I think client defections, you should expect. I don’t think it’s just a one-way street where you can hit the button over here and across the board and these fees go up and it produces a lower… That may work for a year. But in year two and three and five, I’m thinking your results are going to come back down to earth because you’re going to… Nothing more important to a clinic than client retention. All the data in the world show clients come back more often, they spend more, their pets are getting older. But they defect because they don’t feel like they’re getting a good value.

Dr. Andy Roark:
I need you to square this up for me, but here’s what I’m hearing you say and I want to make sure, so we’re talking about cost of living increases and we say inflation goes up… Let’s keep the numbers easy and say 5%. So the inflation goes up 5% a year. For my tech who’s making $50,000, she needs to make $2,500 more this year than last year to buy the same amount of gas and put the same groceries on the table and all that makes sense to me. It sounds like you’re also saying that while my tech expects a 5% raise to keep up with inflation, you don’t think the pet owners expect to pay 5% more so that I can pay my tech 5% more just because another year has gone by? Is that what you’re saying?

Fritz Wood:
Not the first part exactly. The second part, I think, whenever any of us leave a place of business, including pet owners leaving a veterinary clinic, I think you got three things that if I asked you a question, you’d be able to answer them immediately. Question number one, did you get your money’s worth? Or in other words, was it a good value? Question number two, are you ever coming back? Question number three, would you tell your buddies about this place? And you just know intuitively. Now what we know about veterinary fees, most people are going to find disagreeable because they’re not going to believe it, but if you think very long from a consumer’s perspective about veterinary care, it is two things. It is purchased infrequently and it’s a relatively small dollar amount. So the fact of the matter is people have no idea what they paid last time.

Dr. Andy Roark:
What do you mean by that?

Fritz Wood:
You might only have done it once, but if it was a house and you signed a big mortgage, you probably remember what you paid for that house, doesn’t matter how long ago it was, right? If you buy gasoline, you probably know what the price of gas is, not because it’s a huge expense, but you buy it all the time, like a loaf of bread or gallon of milk, right? Veterinary care falls right smack in the middle. It’s not purchased frequently, nor is it a huge dollar. It’s not a life changing dollar amount. And we did some just fun accident interviews at clinics a long time ago and just ask people, “Hey, just out of curiosity, what did you spend last time you were here?” And frankly, people don’t want to answer that question because they don’t know.
And if you force them to answer, they’ll end up guessing about the same amount they spent today and then you go look it up in the practice management system and they’ll miss it by 300% too high and too low. Excepting breeders, maybe excepting people that have a chronic condition with their pet are in there all the time, the fact is they’re, for the most part, not going to notice. I mean somebody used to say, “My fees need to go up 12%, should I do it all at once or should I do it 1% a month for the next year?” And the answer is, “Well, would you like to upset your staff once or would you like to upset your staff monthly for the next 12 months?” It’s like clients aren’t going to know but we are going to, and that hurdle you mentioned is a big one, it’s getting the staff comfortable.
I tend to be a fan of, and I’m reading more articles about in the veterinary press about open book management. Let’s share with people that it costs $6,000 a day to open the door here and this is why we need to be vigilant, for example, in charging for the things that we do. I mean I think that’s a big opportunity, Andy. I think before I got high and mighty with professional fees and making big increases, let’s double-check and make sure our controls are really good and we’re charging for the things that’s happening today in the exam room or in the hospital or in the lab. Because I think plugging those holes, I mean, has an immediate and extraordinary impact on the bottom line and that kind of thing mitigates the need for maybe as large or as frequent a fee increase.

Dr. Andy Roark:
Hey, guys, I just want to hop in really quick and give a quick plug. The Uncharted Veterinary Conference is coming in April. Guys, I founded the Uncharted Veterinary Conference in 2017. It is a one-of-a-kind conference. It is all about business. It is about internal communications, working effectively inside your practice. If you’re a leader, that means you can be a medical director, it means you can be an associate vet who really wants to work well with your technicians, it means you can be a head technician, a head CSR, you can be a practice owner, practice manager, multi-site manager, multi-site medical director. We work with a lot of those people. This is all about building systems, setting expectations to work effectively with your people. Guys, Uncharted is a pure mentorship conference. That means that we come together and there is a lot of discussion. We create a significant percentage of the schedule, the agenda at the event, which means we are going to talk about the things that you are interested in.
It is always, as I said, business communication focused but lots of freedom inside that to make sure that you get to talk about what you want to talk about. We really prioritize people being able to have one-on-one conversations to pick people’s brains, to get advice from people who have wrestled with the problems that they are currently wrestling with. We make all that stuff happen. If you want to come to a conference where you do not sit and get lectured at, but you work on your own practice, your own challenges, your own growth and development, that’s what Uncharted is. Take a chance, give us a look, come and check it out. It is in April. I’ll put a link in the show notes for registration. Ask anybody who’s been, it’s something special. All right, let’s get back into this episode.
I think one of the big things for me, coming up, practicing as a vet in a bunch of different practices, I do think that there’s always some question and I get it. So there’s always some question where you’re a technician and you know that the pet owners you’re working with are going to have a hard time financially with what you’re going on. Whether they told you that or whether you made that assumption, but you have that in your mind that that’s true. So the dog is shaking its head and you take the cotton tip applicator and you swab this dog’s ears and roll it on a slide and look at it under the microscope, stain it and look at it under the microscope and then you toss that thing away. And then I think a lot of people struggle with that being a $55 service or whatever you charge for it.
They go, “Well, there was no real cost to that, I just looked at it under the microscope.” You know what I mean? And so it’s hard I think for a lot of people to say, “No, I firmly believe that that was $55 and it needs to be $55,” when there’s very little hard cost associated with that except for the piece of glass that we put this on. And so it’s always been important to me to make the staff believe that the prices matter. Yes, it is $55 and it needs to be $55. And I don’t think you can do that without some level of transparency and without a reputation with your staff of being honest, you know what I mean? They’re smart.
If they believe that you’re an honest person and you can be transparent with them and say, “This is why these prices are what they are, and even if you don’t understand why this was is specifically what it is, I need you to believe that it’s set for a reason at this place,” I have found that if I worked in practices and people said, “Yes, I believe the prices are what they are for a reason,” that was a healthier practice of people charging the prices that had been set than places that I’ve worked where people were like, “You know what? These guys are always just raising the prices and see what they can get away with.” And the staff did not buy into that. And as a result, you saw all kinds of little, “We only charge for one ear,” sort of stuff that you go, “I don’t think that’s what was intended,” but it happens all the time. But that transparency and people believing in the prices, I think that that’s really important.

Fritz Wood:
Well, I couldn’t agree more. And whether that’s through open book management, whether that’s through confidence they gain maybe by looking at some industry resources… I’d put a pitch out for the American Animal Hospital Association’s veterinary fee reference. I just think that’s an invaluable resource for every clinic, comes out every two years and by far the biggest database, thousands of clinics that are certainly AHA and non-AHA clinics and it’s broken down by numbers of doctors, it’s broken down by the region of the country. It’s broken down by urban, suburban, rural, and there’s thousands of fees in there. So it’s just a reference point. I think any comparisons that you could get from similar clinics. I don’t think the clinic down the street if it’s not similar should really matter to you. But if you have a high-end, high tech, well-skilled, four doctor clinic, then you ought to be comparing yourself to a suburban location.
You got to be comparing yourself to other clinics that look like you. And I am absolutely not making an endorsement and I don’t know enough about it and haven’t talked to enough people that have used it, but there is a program called Profit Solver that basically is a mechanical process of inputting the costs of everything, labor, overhead, property, and loading everything up, and who’s doing these things, and how long is it taking. And so it’s a very objective and it’s a technical thing, but it’s a way to make all your fees defensible.

Dr. Andy Roark:
I’ve always liked that program and I don’t have any stake in this, I don’t work with those guys. I don’t have any connection to them at all. But I’ve always liked that program. And basically the idea I think that I like about it is it’s basically a big powerful spreadsheet and you put your expenses in and you set your prices and it says to, “You can’t keep the lights on if you price this.” And then if you want to reduce the cost of that ear cytology, if you say, “$55 is too much, I’m going to take it down to $42,” it will say, “Great. What are you going to raise to make up for the amount of money that you just reduced?” And I just like that. I just think a lot of people feel like they’re floating in space and just making up numbers.
And whenever I found myself in my career setting prices and just making up numbers, I never feel good about it. I always have this insecurity that I’m way undercharging what I’m going to end up needing for my business to work or I’m way overcharging and someone’s going to say, “How dare you charge this when other people charge half this and do just as good of work?” Well, I don’t want that. I’m not trying to do that. And so to me, I really like the idea of something that gives you a place to put your foot. And so I’ll put a link to the AHA vet fee reference. I love that as a resource of look, just at least get some numbers you’re going to put your foot on.
Let’s go ahead and play a game real quick here, where if I came to you and I said, “Fritz, I’ve got my practice and,” let’s just say it’s a six doctor practice and, “I want to give cost of living increases to match inflationary pressures and I need to get my staff up and I’m feeling pressure to raise my salaries to retain my staff,” which is something I hear a lot about. “I am looking at this, I’m thinking I need to raise my fees,” what advice would you give me before I did that? So you’d mentioned some alternatives, what would you walk me through before you said, “Yeah, let’s look at those fees?”

Fritz Wood:
The very first thing, Andy, would be let’s talk carefully about this fee increase or, I’m sorry, about this payroll increase.

Dr. Andy Roark:
Okay.

Fritz Wood:
And I think we need to define whether that’s built into all future payroll or if that’s a discretionary more like bonus type payout. In other words, back to the technician making $50,000 and we had a 5% increase, one option is to write him a check for $2,500. One is to doll it out quarterly, one is to do it at the end of the year. So got different strategies there. If people know that’s the plan and even though the dollar amount is the same as far as the employee’s concerned, it does give the business owner a little more flexibility in the sense that it’s not permanently built into the cost and you just have to think longer term.
I always like to use the example, I started work at Arthur Anderson in 1986 and had a secretary and she had begun working there about five years before I had been born. Had there been years like there are now of 7% or 8% and there were, even higher in the late seventies, real high inflation, you’d have the secretary making five, $600,000 a year. And that’s not palatable for that particular position. So you don’t want to permanently graduate out of… And one of the things I’d like to know is where are we now? In other words, I’d like to see what’s your total labor as a percentage as your expense? And there are some other things I would tell you that would be beyond the scope of our conversation here, but let’s look at our staff effectiveness. In other words, let’s look at things like number of revenue dollars per labor hour, number of transactions per total labor hour that give us a measure of how efficient are we already compared to the averages or the medians and things like that.
So we got to decide is this sort of paid out as a bonus or is it part of the permanent increase in the hourly wage or salary on the one hand. And then I think when we start thinking about fees, I mean I agree that… One of the things I think we got to point out, Andy, is what we never want to do in my mind is keep a potential client from coming in the first time. We don’t want to build up a wall to opening up that door to the lifetime value of a pet. And then even more broadly, which in my calculations I just took the AHA fee reference and the protocol I used was like the AHA Partners for Healthy Pets. And if you price that protocol out using fees that people are now charging, the lifetime value of a dog, probably $25,000.
So guess what? Pets live in multi-pet households. So let’s start talking about the lifetime value of that household. Or somebody like me, I don’t have multi pets, but I’ll probably have six in my life. So suddenly you’re talking about tens and tens and tens of thousands of dollars, which is another reason why you want to be fair on your pharmacy prices. It’d be silly to lose the lifetime value of a client because you were $5 too high on flea control. That’s bad math, right?

Dr. Andy Roark:
Yeah.

Fritz Wood:
So I think we have to distinguish between the sort of shopped and exposed fees. And look, the first thing I would tell you, I should’ve started this whole podcast by saying this subject is a lot more art than science. And that’s why things like that Profit Solver tool intuitively appeal to people like you who are a scientist or me who’s an accountant, because it’s bringing some objectivity to something that is really very… I’ll give you another one. I mean inherently people believe things that are more expensive are more valuable and worth more. So that’s one reason you may want to be the most expensive clinic in town.
One of the odd things about professional fees is we all tend to think, “Well, it’s that low clinic in town that’s holding us all back,” and that’s completely false. It’s the highest clinic in your town, it’s their reluctance to go higher. And that’s why in certain communities, you have these, what I’d call pockets of affluence or pockets of poverty. And it all has to do with the highest clinic in that area and their reluctance or their eagerness to continuously move higher because the fact of the matter is veterinary care is never going to grow less expensive. It will always grow more expensive, unfortunately, at least with the model we’re using today.

Dr. Andy Roark:
Yeah. I was having a conversation with a bunch of practice owners and they were sort of talking about corporations buying into vet practices and stuff like that, and there were mixed emotions obviously about corporate practices, especially among independent business owners. Maybe not all that mixed, maybe just generally kind of negative. And it was funny, but sort of my comment to them, we were talking about the impacts that corporates have actually had in vet medicine and I was like, “By coming in and raising fees over the past decades, they have dragged a lot of practices kicking and screaming into financial solvency.” As they have come in and been more aggressive and said, “These numbers don’t work, we’re going to raise these fees,” that makes a lot of other people feel at least okay about saying, “Well, we have been scraping by and maybe we could charge a little bit more.”
And I go, “There’s been a lot of good from corporate medicine coming in and just looking at things from an unemotional eye and raising prices.” And I think those of us in the trenches, we want to find the balance between keeping things affordable, but also paying ourselves and our staff. So it was just an interesting conversation of, “Let’s not pretend that corporations have not been good for medicine in a lot of ways.” But as you say it’s not the poorest practice in town that’s holding everyone back, it’s the richest, and I go, “That really makes sense.” I really like the way you laid that out. I’d not considered that.

Fritz Wood:
Well, there’s always a price leader in any community. And as you point out very often, that’s going to be a corporate practice today. They’re not known for low cost. I guess there’s one. THRIVE Affordable has the $15 a month plan, but for the most part, they’ve taken the strategy of high-end leader. Even Banfield, I mean, you look at their wellness plans or you can go to Walmart and look in the clinics where they have the vet clinics. I can give you some links to the two companies that are operating there and all their fees are on their website and everything. I mean it’s Walmart pricing, but at the same time, I wouldn’t say it’s cheap. I’d hate to think somebody would look at those fees and cause them to increase their own, but you might.

Dr. Andy Roark:
Yeah. Yeah. I’m sorry.

Fritz Wood:
I just was wanting to circle back. One thing I don’t think I answered very well, if the pharmacy were lost, let’s just say tomorrow we wake up and there is no pharmacy and veterinary medicine, then the implication of that is that everything else that you do becomes a lot more expensive necessarily, right? Because you’re right, the product business has basically subsidized the medicine part of the business. And so if the product business goes away in its entirety, then the services necessarily become more expensive. So I would try to push that day as far down the road as I could. I would fight until I’m dead and it’s getting more difficult. But I think if you choose to be price competitive, there’s still huge opportunity in the pharmacy.

Dr. Andy Roark:
Yeah. Oh I know. I completely agree with that too. I really like your position earlier. I have to sit and process it. If you said to me, and it sounded like you said this earlier, “The media coverage of the pharmacy disappearing is definitely much more real than the actual loss of the pharmacy,” I go, “That kind of tracks honestly.” I have not seen a reduction in the pharmacy that I send out the door, even though it’s been at least 10 years of people telling me that that was coming. And you can look at the world and see how you squint and sort of see it. But I think your point is really valid. That day has not really come in practice that I’ve seen. The last question I want to ask, and I want to get you to squint into your crystal ball a little bit. And we talked about corporates in practice and then I’m looking and seeing a lot of virtual visits and things like that.
I got an email from a big pet retailer that has free vet consults by text and by video when you sign up for their auto-ship. And I don’t think it’s free, you can use this all the time. I think it’s maybe you get one free trial, something like that. But basically it was fairly $15 for a text consult or 20 bucks for a virtual consult and then it was free with auto-ship for X amount of time or things like that. Well, I see a lot of value in that to pet owners. I can see pet owners getting on board with it. When you look and see things like that, do you think that that will bring about a radical way in how we price our services or charge for our time? Or do you think that’s just going to get rolled in to our current model and things will sort of go on in roughly the same sort of in a price breakdown, price priority that they have in the past?

Fritz Wood:
I would say my crystal ball is cloudy probably, Andy, not that they’ve been great at predicting the future, but I think what you’re talking about represents a threat in my mind. I’m mildly concerned. On the one hand, we’ve got labor issues and part of that is you can’t make a veterinarian overnight and yada, yada. And people are retiring faster than they’re coming in and the growth in the industry. And so on the one hand, to me, it’s kind of like there’s this faction pushing towards a looser veterinary client-patient relationship definition. Look, back up a step. I mean, industry, multi-billion dollar companies have always considered the veterinary channel to be a stranglehold on distribution. I mean, veterinarians aren’t notoriously outstanding retailers or merchandisers. For example, they’re not open on Sunday very often, which tends to be the busy shopping day. They’re less likely to do home delivery and these different things that consumers want, online ordering.
And if you’re a manufacturer or distributor, what you’re interested in is getting that product in the consumer’s hand. The consumer in this case is the pet owner. So if you look at press releases from the major companies, and they’re publicly traded for the most parts, they have to be honest and they have to tell you what their plans are, I mean, you see continuously this what I’d call direct-to-consumer. And the way I would define direct-to-consumer is around the veterinarian. So if you’re a major internet retailer, of course you would’ve doctors on staff. I’m surprised they would charge anything for a consult. I thought it was free if you signed up for the auto-ship. Now, I’m not suggesting that that consult is going to take a lot of veterinary services necessarily away from the independent practitioner, but I think it’s highly likely they’re going to take all the pharmacy.
Because if that virtual doctor who’s never seen the pet, doesn’t know the client or anything else, is able to establish that relationship then they can dispense. So suddenly you’ve opened the floodgates. By those companies having their sort of in-house doctors, you open the floodgates. I mean, let’s face it, you see the same thing with men’s health, right? I mean, you see these commercials. I guess you’re able to establish some sort of client-patient relationship virtually and they dispense some or prescribe some sort of products. So it’s the same idea. It’s just circumventing the vet. And I think the forces that are for that are greater than the forces that are against that right now. So when I say that, I mean manufacturers are for… Come on, what do you want if you’re a consumer? You want home delivery, you want auto-ship, you want the free consult. You may never use it, but you want it. You want a competitive or low price, you want all those things that you’re getting, right?
And to a large extent, a veterinary clinic is a single purpose errand for people. I mean, they’re going there to pick up one thing. And so it’s inefficient. Those are the kind of things. I mean, of all things people buy on the internet, pet food is like number three or four because it’s bulky and because people never want to worry about running out. I mean, they just have it auto-shipped. So that bothers me. Again, I think the death of the pharmacy’s premature here, but at the same time, the future looks more grim and difficult than the past. I already think, like I said, we have an affordability problem in veterinary medicine, but if we lose the pharmacy, then it gets really ugly. And then I think you’re going to see a real push for things like the practice acts changing, let’s say technician clinics where they’re dispensing vaccinations and doing wellness visits and yeah, sure, dispensing flea control and heartworm preventative may be, and certainly catching a blood sample for a diagnostic test. Go look at the Walmart offerings, it’s pretty robust.
I mean, when they take that sample for the heartworm test and the vector-borne disease test, I mean, they’re trying to sell CBC also, just an extra 50 or 60 bucks, something like that. So I mean, that’s the low-hanging fruit. I mean, those are things that, as we’ve discussed, have historically subsidized the expensive medicine that we haven’t charged enough for. At the end of the day, consumers love their pets and tend to love their veterinarians so nothing’s going to change quick.

Dr. Andy Roark:
Yeah, I get that mean. It’s definitely interesting to look down the road. That’s kind of what I was playing with. Fritz, overall, what are your final thoughts, words of encouragement, anything like that that you would put forward to vets that are looking at their prices?

Fritz Wood:
Well, I would say veterinary fee increases are inevitable unfortunately. None of us like it, but it’s a fact of life. I find that veterinarians, they drag their feet, but once they get around to changing their fees, I’ve never had someone regret it. One of the great things about fee increases is they’re absolutely revocable. So look at it as a no sweat decision. You can change your mind. I’ve never seen anybody do that but you can always change your mind. You can go back to the way you used to do it. So it’s safe. There’s a gap there. Anything you can make it more defensible through some of the tool tools we talked about today, so it’s well received by the staff is very important.
And look for these other opportunities. Make sure you’re charging for everything that’s happening. I mean, make sure that we’re trying to get that pet in there for one extra visit. Those kind of things necessitate a much less or much less frequent fee increase. So let’s make sure we’re doing the blocking and tackling too because there is a ceiling, and I think we’re hitting it now in terms of affordability and I think we’re getting close too. So I appreciate the opportunity to participate today, Andy. Thank you.

Dr. Andy Roark:
Well, yeah, thanks for being here. Where can people find you online? Where can they learn more, Fritz?

Fritz Wood:
Just fritzwood.com or just Google Fritz Wood and you’ll find telephone number and email address and website and all those kind of things. Also LinkedIn and Facebook. But the best would be email.

Dr. Andy Roark:
All right, perfect. Well, I’ll go ahead and put links in the show notes. Thanks so much for being here. Guys, thanks for tuning in. I hope you got something out of today.
And that is our episode. Guys, that’s what I got for you. I hope you enjoyed it, hope you liked, I hope you got something out of it, hope it made you think heavy stuff, interesting stuff. Man, I hear what Fritz was saying. I definitely see where advances in technology will radically change vet medicine. I am optimistic that the future is bright for veterinarians and for veterinary staff. I think it’s going to be different. I do. I think that our model is going to change. My crystal ball has been wrong many times before. I think this is really fascinating to think about and keep our eyes on just so that we can adapt as the world changes around us, because it is going to change around us. But I love this profession, I don’t want to do anything else. I’m super positive about where this all goes. Anyway, guys, take care of yourself. Be well. I’ll talk to you later.

Filed Under: Podcast Tagged With: Life With Clients, Team Culture

Pandemic Impacts on the Pet Overpopulation Problem

December 13, 2022 by Andy Roark DVM MS

Dr. Simone Guerios, Clinical Assistant Professor of Shelter Medicine at the University of Florida College of Veterinary Medicine, joins the podcast to discuss her recently published research on the long-lasting impact of the 2020 pandemic on dog and cat overpopulation.

Cone Of Shame Veterinary Podcast · COS – 176 – Pandemic Impacts On The Pet Overpopulation Problem

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

LINKS

COVID-19 associated reduction in elective spay-neuter surgeries for dogs and cats: https://www.frontiersin.org/articles/10.3389/fvets.2022.912893/full

Online Graduate Certificate In Shelter Medicine (UF): https://onlinesheltermedicine.vetmed.ufl.edu/programs/graduate-certificate-in-shelter-medicine/

UF Veterinary Shelter Medicine Clerkship: https://www.vetmed.ufl.edu/2022/05/09/uf-veterinary-students-gain-shelter-medicine-skills-through-clerkship/

Veterinary Community Outreach Program (VCOP): https://sacs.vetmed.ufl.edu/programs/vcop/

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

Simone Guerios, DVM, MS, PhD

I’m a Clinical Assistant Professor of Shelter Medicine and Coordinator of the Shelter Medicine Practice elective, at the University of Florida College of Veterinary Medicine. This course is a full-time two-week clinical rotation for 3rd and 4th year veterinary students at the Alachua County Animal Resources and Care. In my position, I focus on training and educating students to make veterinarians ready for shelter practice.

My research focuses on clinical problems that affect the health and well-being of companion animals, with the aim of developing practical and reliable surgical procedures often performed on shelter animals, thus providing solutions for shelter veterinarians. The use of innovative, low-cost, and simple surgical techniques offers shelter animals alternatives that can save lives, increase the adoption of shelter animals, and reduce euthanasia rates.

Prior to accepting a faculty position at University of Florida, I worked as a Clinical Associate Professor in Soft Tissue Surgery and Surgical Oncology at Federal University of Parana, Brazil. I started working with shelter medicine in Brazil, where I co-founded a spay-neuter program for the local low-income community. This outreach program also provided community education, including public health, zoonosis and animal welfare.


EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome, everybody, to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Rourk. Guys, I got a good one for you. Today I am talking to Dr. Simone Guerios about her recent article on the impact of the COVID-19 pandemic on spay/neuter surgeries and on pet overpopulation. I was shocked by the impact of this, it totally makes sense that we would see shelters in spay/neuter facilities shut down for the pandemic and then there’d be those animals who didn’t get spayed or neutered. I guess my thought had always been that they would be reabsorbed, but that has not been the case and now we’re seeing not just the pets that didn’t get done during the pandemic. We’re seeing the progeny, the litters from the pets that didn’t get done during the pandemic and it is shocking. It is a fascinating and unsettling reality in our profession. So I was really interested to dig in with Simone on this and talk about it. Guys, a lot of food for thought here. I hope it’s interesting to you. I definitely enjoyed the conversation. Let’s get into this episode.

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

Dr. Andy Roark:
Welcome to the podcast, Dr. Simone Guerios. Thank you for being here.

Dr. Simone Guerios:
hank you, Andy.

Dr. Andy Roark:
Oh, it’s my pleasure to have you here. For those who don’t know you, you are a clinical assistant professor in shelter medicine at the University of Florida. I did not have the pleasure of having you as my shelter professor at University of Florida, although I took that rotation multiple times because I loved it. I really, really loved it. I did not get to have you as a professor. I became aware of you when I saw a publication you [inaudible 00:02:04] that came out. I’ll put a link down in the show notes. But basically you were talking about a significant setback to our goals of a population control for stray pets due to COVID pandemic. I wanted to understand that math and kind of what that looks like today with you and so if we could start off, can you paint me a picture of what spay neuter efforts look like before the pandemic? How were we doing before the pandemic? What was that like? Then we’ll talk about how the pandemic changed things.

Dr. Simone Guerios:
We’ve been doing a very good job animal welfare plus shelter veterinarians for almost 50 years that we’ve been working to reduce or to control pet over population, and the most thing that we have been able to do is spay/neuter, so we start doing a good program and that ultimately reduce number of animals that have been euthanized in shelters. We’ve been doing a very good number all over US and our study, since we have COVID pandemic, that it blocked almost no essential services for almost four to five months. We want to see what happened with spay/neuter programs since they were considered as no essential. Mainly our goal to this paper was to show what happened with spay/neuter surgery during this pandemic, so 2020 and 2021, and we compare with 2019 that was a normal year, a regular year.

Dr. Andy Roark:
When you started off, so you left 2019 numbers to get started and then non-essential services shut down, and then you said what? About basically like five months of having a significant reduction in the services we were able to offer, correct?

Dr. Simone Guerios:
Yes.

Dr. Andy Roark:
All right, cool. Let’s talk about point of impact. Walk me through what that meant. How do you measure that? How do we try to get our head around, one, what you saw in your survey, but then how that extrapolates out across the US? Help me understand the magnitude of what we’re talking about.

Dr. Simone Guerios:
We use a software based program that is made basically for high volume spay/neuter clinics. In their software, we’re able to use 400 clinics that normally use this program as they are regular clinics program. From this 400, we had to use the clinics that were in service for 2019, 2020 and 2021. Our numbers represents around 212 clinics. With that, we saw for 2020 a decrease in 13% of surgeries, the total number of surgeries, and 2021 we saw a still 3% less surgery when we compare with 2019, the baseline year.

Dr. Andy Roark:
Significant dip in 2020. What does that translate to as far as … so two questions in my mind at the same time. When we decrease 13%, what does that look like in those clinics and then what does that look like when we extrapolate out? You’re talking about 212 clinics, which is a lot of clinics, but it’s a drop in the bucket compared to the number of total clinics out there that are doing spay and neuter. Help me understand that. What does that look like as far as in these clinics, a 13% reduction, give me a number, what does that look like? Then help me extrapolate this. How big is that nationally?

Dr. Simone Guerios:
We extrapolate for the national about 2.7 million of spay/neuter surgeries for the whole deficit that we might have. Our numbers got around 198,000 fewer surgeries and in 2020. Basically we are still low in 2021, but basically were the month on March until June/July that we can see a very big drop in surgeries because we weren’t allowed to perform surgery.

Dr. Andy Roark:
Has there been an overcompensation … or not an overcompensation, but has there been a compensation since we come back? If we were down 3% in 2021, are we at where we were in 2019? Are we over? Because if you said we’re 20% more than we were in 2019 now. I would say, “Well, maybe that’s a good thing, maybe we’re catching back up.” Help me think about that. As we look forward into where we are today, extrapolate that out, is there a sense that we’re still in the deficit? Do you feel like we’ve returned to 2019 levels? Are we exceeding 2019 levels to help make up for missed opportunities at that time? What’s your optimism level like?

Dr. Simone Guerios:
I believe we are at the same kind of level of 2019, but we still have this big gap that I don’t know how we are going to fill that up. Because now we have shortage of veterinarians and shortage of vet technicians, so everybody’s overcrowded, it’s hard to book spay/neuter surgery in a low-cost clinic. At the shelters, at this point we are overcrowded, so what we saw this past year is that we are looking at many litters of puppies that we weren’t being able to see it before COVID. We have many puppies entering the shelter, the rescues are also overcrowded, so nobody’s pulling them. We also saw overcrowded shelters because people start to work back and they are bringing animals back to shelters.
Unfortunately we are worried that shelters are going to start euthanizing for space again, which is very unfortunate. I believe we are at the same level at surgeries at this point, but for us to go up to almost 16% because we have 13 in 2020 and 3% less in 2021. We need to over overlap that, so we need to pay more attention and try to increase fundings and resources so the clinics can actually try to catch up with all the work we have been doing for the past almost 50 years.

Dr. Andy Roark:
Well, as I think about this, if we have a glut of pets from 2020 that would’ve been spayed or neutered and not, those pets are now two years old, which is probably optimal maximal breeding output levels that we’re going to see from those pets. What you’re saying is you feel like the progeny of those pets that were missed are hitting … it’s not just, we didn’t neuter a cat two years ago and so now there’s an un-neutered cat out there. It’s like, oh no, we didn’t neuter a cat and now we’re getting two to three litters per year from this cat, which is exponentially impacting our capacity.
Talk to me a little bit about catching up because this is a thing that I’m really interested in is labor shortage, the shortage of veterinarian, things like that. What are the levers that we pull to try to get out of this program? You’re a professor of shelter medicine, are there efficiencies that we see coming in shelter medicine or that we could be using in shelter medicine? How do we get out of this hole, Simone?

Dr. Simone Guerios:
That’s a great question and I don’t know if I can have a solution with that, but I think the best way for us to work with … so at University of Florida, we are trying to make our students to get out of school ready for being able to work in a high volume surgery situation. We kind of open another clerkship. Now we have three shelter medicines clerkship at University of Florida that they used to get out of the school with one or two space for student. After one of two of these clerkships that they are mandatory now, they are able to be done at least 25 to 30 surgeries during two weeks. We are trying to capacitate more students so they feel ready when they get out of the school so they can join a shelter or a nonprofit organization and they are able to help. However, I think we need more grants and money to work with numbers for sterilization of animals for dogs and cats to be spayed and neutered, so we can try to catch up with that.

Dr. Andy Roark:
Hey, everybody. I just want to jump in real quick and give you heads up to the April Uncharted veterinary conferences coming at ya. This is the flagship, the granddaddy, the mama of them all. This is our original conference. It is here in my hometown, Greenville, South Carolina. Guys, this is a communication business strategy conference. We are doing all internal communication and strategy this year. It’s about talking to your team, getting them on the same page, making sure messages don’t get dropped, making sure we’re communicating well, we’re treating each other well, making sure that we are on the same page and not repeating work or having people stand around and not know what to do with themselves. That’s what this conference is all about.
Guys, this is a peer conference. We do our choose your own adventure sessions. We make up about 40% of the agenda of the conference here on the spot with our attendees so we can make sure we are doing what they want to do. It is really a magical experience. If you’ve never been to an Uncharted conference, this is a great one to jump into. I’ll put a link in the show notes, get registered, come to Greenville. I’ll see you in person. Guys, let’s get back into this episode.
When you think about the future of shelter medicine, do you see it at … traditionally when we talked about spay and neuter efforts, a lot of that weight was carried by general practitioners and they would do spays and neuters and things like that. I’ve really kind of fallen in love with this idea that the future is fragmentation, meaning there’s going to be a lot of different ways of practicing medicine and they’re just different. I guess coming around to my question, do you see spay and neuter surgeries, things like that, standing alone more or do you continue to see them being integrated into types of wellness practice, general practice, things like that. When you’re training students to talking about the future of shelter, what does that look like in your eyes?

Dr. Simone Guerios:
I think everybody needs to work together. I don’t want to say, okay, spay/neuter to be done only by shelter veterinarians or high volume clinics. I think it’s very important for general practitioner also to increase the number of surgeries that they can also help to reduce the number of unwanted pets. I know there are many of a discussion about aging and when should I spay my animals. This is very important for general practitioners to, okay, can we spay this animal sooner than later because of tumors or anything that is happening because this is a big issue at this point. But I think it’s important for us to work together because you never know when your pet’s going to end or what’s going to happen with you if you didn’t spay your pet and then something happened in your life and in the shelter or somewhere else and start having liters.
I think it’s very important for us to work with general practitioners together to try to spay another everything that’s not supposed to be reproducing. The goal is not to have litters, so it’s better to get it done. I don’t know the other part of her question. Was it … Sorry. Oh, I think I lost in the middle.

Dr. Andy Roark:
No, no, no. I was just sort of thinking about how do you see shelter medicine being practiced sort of going forward? Is it the low-cost high volume practices? Is it integration across different types of practices? I think you answered it. I think you answered it pretty well.

Dr. Simone Guerios:
Also increasing the number of low-cost clinics. That’s very important because general practitioners also need … I think they should work with animals, helping them in different ways. If I have a chronic condition or if I have any other issues, that’s the way they can help more than just doing other simple procedures. I think we have to work all together to get almost all the animals that we don’t want them to reproduce and then they can work more with other disease that affect pets. I always tell my students because during the clerkship, my students always … I have like 20% or less that wants to go to shelter medicine, to work with shelter medicine after they graduate. But I tell them that’s very important for them not only this surgical experience, but it’s very important for them to learn what happened in a shelter.
Because you probably see an animal that was adopted from a shelter or rescue, so you can see how things are done differently. Instead of being against the shelter veterinarian, support and work with us, which is very important for them. This clerkships also help them to get more hands-on surgical experience, but also, okay, why we did a vaccine at this age and not at that age because it’s a shelter medicine, they might not be able to do a rabies vaccine, never again. It’s better to get it at 12 weeks instead of 16. It’s very important for them to see what’s happening because it’s good that … people are adopting more than before, so you’ll probably see and treat animals that were adopted or came from a shelter.

Dr. Andy Roark:
You said something earlier I want to circle back to a little bit. As veterinarians have been more open to discussing with pet owners health benefits of delaying spaying and neutering, do you feel like you’re seeing an increase in litters associated with those types of behaviors? Because I’ve always wondered that. There’s always a trade off. There’s always a trade off of if we do it earlier, we’re learning there’s health impacts to that. But if we do it later, we’re also risking having unwanted liters, things like that. Have you seen any sort of research to back up that correlation or anecdotally do you feel that impact?

Dr. Simone Guerios:
Yes. There are many research that show some cancers, the cancer associated with early spay neuter, but the numbers are not … and also some orthopedics in large breed dogs, but the numbers are not as reliable. The big numbers that we see is that the animals that are spayed or neuter, they will live longer. I still think it’s more beneficial for the animals to be spayed earlier than later if you are not interested in having puppies or kittens. Another important thing is for one of the most disease that we see in animals that are not spayed are mammary tumors. In Brazil, since I’m from Brazil, we don’t have the same culture of sterilizing animals earlier in life and 80% of my patients were mammary tumors.

Dr. Andy Roark:
Oh, wow.

Dr. Simone Guerios:
Because they wait for a year and then they would spay one or two heats and then they would spay it and we see so many mammary tumors and sometimes they don’t progress badly, but sometimes they do. If you do it earlier, you won’t have this problem. Also, other hormone related disease, these are the most important, [inaudible 00:19:27] and other stuff that you can actually save their lives or make them healthier, if you think the percentage of cancer that will show up in an animal that was spayed is not as relevant as if you compare with hormone related disease. Overall, of course, you have to think about each breed and each animal and how the owner is. If it’s a person that will follow up with the animal and then will bring later on one year or two years for spay or neuter you have education. So it’s very important. You have to educate your clients and I think education is the gold standard. You cannot just do spay/neuter program and do not educate whoever is adopting or owners or community.

Dr. Andy Roark:
When we circle back around to talking about the COVID pandemic and the pause in sterilizations and things like that, do you think pet owners have any idea? Are you seeing initiatives, pet owner facing initiatives or messaging to help raise awareness to the fact that this is going on?

Dr. Simone Guerios:
I don’t believe pet owners still have, but I know animal welfare is trying to show the public and everybody that we are in the backlog with surgeries and with the overcrowding shelters and so many puppies and kittens getting into the shelter, they’re trying to advertise that we need to have more conscious and work into that gap that we had.

Dr. Andy Roark:
What would you like to see veterinarians do? If we talk about action steps, I always like to leave on a positive note and say what are the steps that veterinarians can take that would be beneficial?

Dr. Simone Guerios:
I think educating their owners to sterilize their animals earlier and more often so it can work. If you don’t have the money for the surgery, you can also refer to a low-cost clinic, just they can get it done. I think the main issue is the low income customers that they are not … sometimes, especially with all this COVID, sometimes they do cannot afford surgery, so try to work with educating them the importance and to get it done. I think that will be a way to go.

Dr. Andy Roark:
No, I appreciate. I think that’s good insight. Are there any resources that you really like? If someone’s listening and they think, “I’d really like to learn more about this,” I linked to your original article and the publication that you put out in the show notes, so people should have to check that out, but just do you have general favorite recommendations if someone said, “I’m interested in shelter medicine, I’m interested in population control,” where would you get people started?

Dr. Simone Guerios:
You’re talking about veterinarians or …

Dr. Andy Roark:
Sure. Well, actually, either one, but mostly veterinarians is what I look for.

Dr. Simone Guerios:
I would recommend for them to look for their local shelter. Our community have many shelters that do not have a veterinarian on board, so sometimes they do have the facility and everything, but they do not have a veterinarian. Try to work with them as a relief veterinarian or maybe you can start volunteering. I know volunteer after you graduate sometimes is not the best.

Dr. Andy Roark:
No, it’s good. I feel like people get stuck in a rut and a lot of people are interested in doing different things than what they do. I love it. I’m a huge fan of volunteering in different areas in medicine. Use your skills differently, shake things up, try things different from what you do. I think it’s good for your soul.

Dr. Simone Guerios:
Yes, I agree. I agree. I would recommend for you to reach out the local shelters and see how they are at this point and go from there. Of course, University of Florida is always open to any questions and we have a great shelter medicine team.

Dr. Andy Roark:
You have an amazing shelter medicine team. I’m sorry, Julie Levy’s there and-

Dr. Simone Guerios:
Dr. Crawford.

Dr. Andy Roark:
Yeah, Cindy Crawford is so, so great. I’ll never forget that when I applied to vet school, Cindy Crawford was one of the first who interviewed me and she was so nice and reassuring. I’ve just been a fan of hers. For the rest of my life since then.,I’ve been a fan of hers. But you have such a wonderful group.

Dr. Simone Guerios:
Yeah, they’re amazing. Now that we have three clerkships, so we have the [inaudible 00:24:18] County Animal Services I do when I’m working now here in [inaudible 00:24:23], then they have Miami Dade Animal Services. If you have the opportunity to go visit, that shelter is one of the best shelters in the US. It’s amazing. VCOP, the veterinary outreach program probably was there when you start studying in Florida. I don’t know if you had the opportunity to enroll to that clerkship.

Dr. Andy Roark:
I did not. It was not there. I think it came in shortly after I left.

Dr. Simone Guerios:
We have these three hands-on clerkships so the students can really get hands-on and they learn everything since primary, basic, vaccines and everything. They visit shelters and also they do spay/neuter surgeries, more like a shelter veterinarian, like a high volume. So not like surgery at UF that you do a laparotomy, exploratory laparotomy incision size. So they learn how to do it efficiently and accurately, safe. Other procedures like amputations, inoculation, everything that in the daily base in the shelter needs to help more pets to get adopted so they’ll have all this experience. Then they also have the online shelter certification that they can go it, which can also be done by professionals.
If you’re a veterinarian and even want to start shelter medicine, you can do the online certification, which is good. When I started here in US, I was a soft tissue surgeon and I didn’t have as many opportunity to do shelter medicine in Brazil because you do not have … now we do, but five years ago we didn’t have really real shelters, so I went through the certification and you can learn a lot from the classes and everything. It’s very good, so I recommend.

Dr. Andy Roark:
Well, I will put links in the show notes for that so people can check it out. I will link to the UF shelter program just because it’s a great program and everybody should see it and be aware of it. Simone, thank you so much for being here. Guys, thanks for tuning in and listening. I hope this was interesting and helpful. Gang, take care of yourselves.

Dr. Simone Guerios:
Thank you.

Dr. Andy Roark:
That is our episode. Guys, I hope you enjoyed it. I hope you got something out of it. Thanks to Simone for being here. Gang, if you enjoyed the podcast, if you got something out of it, leave me an honest review wherever you get your podcast. Apple Podcast is a big place that a lot of people find it. Same thing on Spotify, things like that. But anything that you could do to spread the word is super duper appreciated. It’s how people find us and I just love being able to share stuff like this with the world and just get the word out and just get people thinking. It just means a lot to me. Anyway, gang, take care of yourselves. Be well. I’ll talk to you soon.

Filed Under: Podcast Tagged With: Life With Clients

An Economist’s Take on Keeping Care Affordable

December 13, 2022 by Andy Roark DVM MS

Are continuously rising prices in veterinary medicine inevitable, or is there a way to provide higher wages and better care while keeping costs reasonable? Economist Dr. Matthew Salois joins Dr. Andy Roark to discuss the economics of pricing in veterinary medicine.

Cone Of Shame Veterinary Podcast · COS – 175 – An Economist's Take On Keeping Care Affordable

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

LINKS

Veterinary Study Groups: https://www.veterinarystudygroups.com/

Uncharted Veterinary Conference: https://unchartedvet.com/upcoming-events/

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

Matthew Salois, PhD is currently the President of the Veterinary Study Groups, Inc. (VSG), where he is responsible for enhancing the economic and cultural success of more than 1,800 veterinary member practices.

Most recently, Matt was the chief economist and head of the veterinary economics division at the AVMA between 2018 and 2022, where he applied his skills in economics, business, and communication to support the daily lives of veterinarians.

From 2014 to 2018, he served as director of global scientific affairs and policy at Elanco Animal Health, supervising a team of scientists in veterinary medicine, human medicine, animal welfare, economics and sustainability. His group devised and executed scientific engagement strategy, and built collaborative partnerships with universities, non-profit associations and scientific societies.

Matt is also an adjunct professor of applied economics at the University of Florida, where he previously taught and advised graduate and undergraduate students. He earned his Ph.D. in Applied Economics from the University of Florida and holds an M.A. in Economics and a B.S. in Health Services Administration from the University of Central Florida.


EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I’m here with my friend economist, Dr. Matt Salois today, and we are talking about keeping veterinary care affordable. How’s it look from the outside? How does it look from a numbers’ perspective, from the autonomous point of view? That’s what we get into today. Guys, I hope you’ll enjoy it. Let’s get into this episode.

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

Dr. Andy Roark:
Welcome to the podcast, Dr. Matt Salois. Thanks for being here.

Dr. Matthew Salois:
Yeah, thanks, Andy. Good to see you again.

Dr. Andy Roark:
To you as well. I love having you here. For those who do not know you, you are a PhD economist. You work primarily with the Veterinary Management Groups. You are the president of their veterinary study groups program, correct?

Dr. Matthew Salois:
Yes.

Dr. Andy Roark:
Or, am I mischaracterizing that?

Dr. Matthew Salois:
If someone made a change, I don’t know yet, but yes.

Dr. Andy Roark:
Yeah. It’s like, every day I wake up and they’re like, “Are you in charge?” I was yesterday.

Dr. Matthew Salois:
Right.

Dr. Andy Roark:
We’ll see how the day ends. Oh man, thank you so much for being here. I’ve really enjoyed our conversations. We’re getting towards the end of the year and I look back and there’s always people at the end of the year that I go, “Man, this is someone I met this year that my life is richer and I really enjoy them,” and you were in that category for me. You were someone that I did not know you until this year, and I’ve just, I’ve thoroughly enjoyed talking to you, and I’m glad that you’re back on the podcast again. Thanks for being here.

Dr. Matthew Salois:
Yeah, that’s super. Thanks, and me too, and you just gave me an early Christmas present because I’ve followed you for years. I’m like, “Yeah, Andy, I get to talk to him again. This is awesome.”

Dr. Andy Roark:
Oh right. Well, cool. I wanted to bring you on here. You have a unique perspective as an economist who works in veterinary medicine, and I just, I’ve always got sort of questions about where our industry is going and things like that and you bring a unique perspective. My question for you today is about the affordability of care in veterinary medicine. I bring this up a lot on the podcast because it is something that I think about.
I’m really stuck in the balance of wanting a good standard of living for veterinary professionals, right? I want our support staff, our paraprofessionals to make a living wage. I want my colleagues, the veterinarians, to not be buried in student debt and to not feel guilty all the time for charging prices that are going to help them get out of the debt that they’re in and to live a standard of life where they’re comfortable coming home after the sacrifices that they make, and I feel strongly about that. And at the same time, I really don’t want pet ownership to become a status symbol or a luxury item. I think about the value of pets and the human animal bond and what it means to people, and I go, “I don’t want us to price pet ownership, not intentionally, but I don’t want pet ownership to be priced above what a lot of people can afford.”
And so, as I look at the way that our industry’s going, there’s increased corporatization, we’ve got inflationary pressures, we’ve got raising wages in the workplace. What do you see at a high level? Let’s just start out kind of wide and say do you think I’m justified to have a concern about affordability of care going forward?

Dr. Matthew Salois:
Yeah, absolutely, and it’s not just affordability of veterinary care. It’s affordability of everything right now. It’s a topic as we’re in a period of inflation that we haven’t seen since the ’80s, honestly. Now, we’re not in a period of hyperinflation, so we just want to ground everyone there. Yes, this is high inflation. It is concerning. I would add, as an economist, this is probably the most concerning thing about our economy right now, above and beyond whether it is or will be in a recession. But it’s far from the hyper dangerous inflation that countries like Argentina and Germany experienced in their history. We’re nowhere near there, right?
So, I think that’s important context and background, but absolutely a key area to be concerned about, and I think something that we’ve thought through or been thinking about in the profession for years, honestly. It’s just coming to a point where I think there’s a lot of tense conversations, and it’s right to want care for your pet to not just be in the realm of the rich or something in that space. There are few things that are as ubiquitous as a pet in the United States. More people have a pet than have an iPhone, right? So, it transcends income and so should veterinary care.

Dr. Andy Roark:
Talk to me a little bit about how you look at the landscape that is driving prices in vet medicine. So, I’ve got a lot of ideas about what’s going on, but I’m seeing steadily upward trends in pricing. I see people continually raising prices. I hear rumors of vet clinics doing a 40% price increase over a year, and I just go, “Are you serious?” I don’t have data to back that up. Can you validate or disprove the idea that prices are going up, and then can you start to elaborate a little bit about what the factors are that are actually driving that?

Dr. Matthew Salois:
Yeah, absolutely. So, I mean, yes, definitely validate that and looking at sources like the consumer price index and Vet Success has been doing some interesting work here and reporting on that, the average cost of veterinary care, veterinary services. Before COVID, we’re in the three to 5% range. That was pretty typical year over year. And of course, you’d have the individual practices that would be doing something different, not raising prices at all, and others, like you say, 20, 30 or 40%. Right now, we’re hovering around 10% or so on average in terms of year over year price rises in veterinary services, and like you, I still hear some of those stories from individual practices of saying, “I rose my prices 20% last year and I rose them again another 20% this year,” and their clients haven’t batted an eye. Some are providing more pushback.
So, like anything, you’re going to see a distribution of what’s happening out there, but on average, we’re pretty parallel to the general consumer price index which is the overall measure of inflation for goods and services produced in the economy. But you’re going to get a lot of market and regional variability to that, for sure.

Dr. Andy Roark:
Okay. That actually makes me feel good. I like to believe that, I know that our prices are going up, I like to feel that we’re at least in line. We’re not doing the academia thing where tuition prices just jump up and jump up and jump up at significantly higher rates than the consumer price index. So, that makes me happy. Where’s the pressure coming from? What is pushing prices up?

Dr. Matthew Salois:
Yeah, two big things, and it’s going to come at any business, including a typical practice from multiple areas, but it is supply chain, the cost of goods sold, your cogs, the cost of inputs into delivering veterinary care, that’s going up, whether it’s your real estate and your rent going up, or the cost of medicines, the cost of supplies, other things. Those are increasing, in part due to a supply chain that continues to be under pressure from low inventories and other things that’s happening in our economy at large.
But the biggest piece I think is probably labor. In this tense, tight labor market, we have the competition for talent is pretty fierce. And so, the need to offer more and increasingly competitive wages, benefits, and other non-monetary things, it’s there. And so, that’s going to drive up the cost of veterinary care because the single largest cost center for pretty much every veterinary practice I know of has been and will continue to be labor, their talent, for good reason because veterinary professionals, DVMs, technicians, practice managers, assistants, they’re all trained to deliver veterinary care, support, delivery of veterinary care which can be very complicated at times.

Dr. Andy Roark:
Yeah. That definitely makes sense and that tracks kind of what I’ve been saying. I like the fact that we’re able to raise wages. I think it’s way overdue for a lot of reasons. Okay, so here we are. Here’s the rub, as we say. We raise wages to go up and we do need to attract talent and the increasing cost of good sold, that’s not a decision that we make. That is us adapting to the world that is being applied to us, and at the same time, we’ve both said very much that we like to try to keep care affordable. From an economist perspective, Matt, how do we square these two conflicting conundrums?

Dr. Matthew Salois:
Yeah, it’s not easy, right? I mean, especially if you’re in a position as being a practice owner or a manager. You want to pay your people appropriately and competitively above and beyond a living wage, and we’ve seen some positive momentum there in our profession. I think we touched on last time when we talked Andy, around what we’ve seen in technician pay and some of the tremendous positive momentum we’ve seen in the last 18 to 24 months. I’m not sure honestly we would’ve seen that momentum had we not been in the labor shortage.

Dr. Andy Roark:
I agree with that, yeah.

Dr. Matthew Salois:
Yeah. That’s part good news, and I’m sure there’s still tremendous runway to continue to increase that at a level that they’re contributing to the practice, and we’ve seen this too in starting salaries for DVMs. They’ve gone up significantly in the last few years, the last year especially. So, I’ll remind everybody here that for a period of years following the 2008 recession, average earnings of new DVMs was actually going down once you adjusted for inflation for a number of reasons. There was an oversupply or a perceived oversupply demand for veterinary [inaudible 00:10:36] like every industry was going through a bit of some downward pressure too, and that was having some impact.
Just now, if you look at salaries, new starting salaries with DVMs, they hit the trend line of what they would’ve been had the 2008 recession not have happened. And so, myself and others have called this a 12-year market correction, honestly, that’s been slow and steady and really just increased pace the last few years there. So, yes, good progress has been made, but let’s keep in mind some of the challenging years that this profession experienced following the 2008 recession, as have a lot of clients and people as well. Some are still recovering from that.

Dr. Andy Roark:
Okay. I graduated in 2008 right into that.

Dr. Matthew Salois:
Whoa.

Dr. Andy Roark:
One of my colleagues, Mary Gardner is like… You try to explain it to new graduates today. This is one of my friends who also speaks at vet schools, and you’re like, “Listen,” you sound so old, you’re like, “Back in my day, people thought there were too many vets and they couldn’t get jobs.” So yeah.

Dr. Matthew Salois:
Legal markets are sticky, especially veterinary medicine because there’s a lag, right? I mean, it takes four years at least to produce a DVM post undergraduate degree. Markets are constantly evolving. But you’re honestly on this four or five-year delay where in the labor market, particularly in veterinary medicine and other health professions, you’re still producing graduates based on market conditions four or five years ago. So, it takes time for these things to adjust.

Dr. Andy Roark:
Do you think that is going to… Well, let me try to figure out how to ask this question without getting me in too much trouble. But I mean, do you see the long creation time for vet professionals, both for veterinarians but then also for vet technicians, is that pushing our market towards alternative sources for care? I’m talking about is that going to push forward technician licensing, the nurse practitioner level, healthcare providers, things like that? Is that where this goes or not necessarily?

Dr. Matthew Salois:
Yeah, I mean, it can and not necessarily all at the same time. I think it’s more around… It’s less around the quantity of graduates and more around the quality of graduates and what they’re able to do once they exit from whatever training, whether it’s a new DVM or a new credential technician, what are they capable of doing and what value are they going to be contributing to the practice and to their clients, because the biggest constraint for any business owner of a veterinary practice or otherwise is profitability and performance in terms of what they’re able to give back to their staff in terms of additional raises and benefits and so forth. And so, you need to grow, you need to improve profitability if you’re going to be able to also improve the wages and earnings of your staff and your people.

Dr. Andy Roark:
So, is that in your mind, it’s probably the answer’s both, but in your mind, is that a training issue or is that a practice management issue, this sort of increasing of profitability?

Dr. Matthew Salois:
Yeah, I think it’s probably all of it, and we all have heard different opinions and stories on that around, I’ll ad lib this but I’m sure you’ve heard it too, Andy, around, “Oh, these graduates, they just don’t produce like they used to.”

Dr. Andy Roark:
Yeah.

Dr. Matthew Salois:
I feel like every generation says that about the generation that comes after it, right? I think that’s just part of just the reality. I don’t know if that’s truly true. It’s hard to really assess that because you’ve got to think back around, well, what really were you capable of doing 25 years ago? Were you really any different? I mean, are there metrics? We certainly have perceptions around, sure, I was 10 times better, but is that really true? I don’t know. But the world’s more complicated too, I think, for any professional, and you’re having to come to terms with different ways of providing care that probably weren’t a part of life 25 years ago. And so, everything, that’s sort of the other-

Dr. Andy Roark:
There’s no doubt that medicine has gotten more complicated. There’s just no doubt. The number of skills that veterinarians today are expected to master coming out of the gates compared to what someone who came out in 1990 was expected. Those are just different things. It’s not throwing shade at anybody, but it’s just the truth is medical technology continues to improve and scope of services continue to improve.
I get to talk to a lot of people on this podcast. We’re talking about genetic testing and genetic screening and things like that. I think that stuff is fascinating. It’s not something I learned about in 2008 even, graduating from vet school. This was just unheard of stuff. Monoclonal antibody therapies are just like, this is awesome stuff, but it’s things that we weren’t responsible for knowing and being up to speed on as we came out the gates, and now new graduates are. They got a lot more things I think to be aware of, and they’re all getting trained by specialists as well. So, they’re getting trained to the higher and higher standard of care than we were in the past. I’m not convinced that that’s a net positive for the profession.

Dr. Matthew Salois:
Yeah, I hear you. I’m trying to draw up parallels for my own profession too, economics. I’m thinking around when I graduated with my PhD, it’s like I thought I knew it. You think you know so much. You’ve spent all these years investing in your education and then it’s like I wasn’t capable of doing anything outside of a textbook. So, you’re asked to do something, like, “Where is that in Econ 101 textbook? I don’t see that there. How am I supposed to do this?”

Dr. Andy Roark:
Yeah.

Dr. Matthew Salois:
I think any profession, your on the job is so important, and I think a lot of it also comes down to good mentorship and good leadership, and those first few years post-graduation of any discipline that is a trade and a profession like veterinary medicine or economics or whatever is are you going under the employee of someone who’s going to help you grow, and take what you’ve learned the last few years and put it into a practical term and an ability to translate knowledge into action. Again, whether it’s delivering economic advice, god to help you if you’re in that position, or more importantly, delivering veterinary care. I think there’s so much similarity there.

Dr. Andy Roark:
Hey everybody, I just want to jump in real quick and give you heads up to the April Uncharted Veterinary Conference is coming at ya. This is the flagship, the granddaddy, the mama of them all. This is our original conference. It is here in my hometown, Greenville, South Carolina. Guys, this is a communication business strategy conference. We are doing all internal communication and strategy this year. It’s about talking to your team, getting them on the same page, making sure messages don’t get dropped, making sure we’re communicating well, we’re treating each other well, making sure that we are on the same page, and not repeating work, or having people stand around and not know what to do with themselves. That’s what this conference is all about.
Guys, this is a peer conference. We do our Choose Your Own Adventure sessions. We make up about 40% of the agenda of the conference here on the spot with our attendees so we can make sure we’re doing what they want to do. It is really a magical experience. If you’ve never been to an Uncharted Conference, this is a great one to jump into. I’ll put a link in the show notes. Get registered to come to Greenville. I’ll see you in person. Guys, let’s get back into this episode.
Talk to me a bit about opportunities for efficiency and increased productivity. So, when you step back and look at the profession from an economic standpoint, are there areas where you say these are traditionally bloated areas of expenditure that could be cut down? Are there obvious trends in the way that we’re practicing medicine where you just say, just based on the numbers, these are real opportunities to sort of make some shifts or make some cuts or make some alterations that are going to help us keep up with upward pricing pressures and then also keep care affordable at the same time?

Dr. Matthew Salois:
Yeah, I think that’s a big question. We got to build a bridge to get there, I think a little bit, and for making the connection I think between what our discussion and labor and paying people fair wages and living wages to what that means and why it’s related to productivity is so important. I think a really germane context for this is the labor shortage that we’re in, in this tight labor market. There’s lots of discussion around how are we going to meet the demands for veterinary care. There’s not enough people, whether that’s technicians or veterinarians, and so let’s expand, let’s grow our class sizes, let’s add more schools. No doubt, there’s a runway there.
My perspective has been, yes, there’s a runway, let’s be mindful of how long we make that runway because if we try to attack this problem of blockages and getting a vet appointment or removing frictions in our labor market by just adding more people to it, we are contributing to the largest cost center in our veterinary practice. And so, if we keep adding more people to our practices, we’re going to have to increase the price of veterinary care unless, unless we match that or supersede it with advancements in productivity and efficiency so that those price increases aren’t necessary or not as much as they would’ve been.
In other words, instead of focusing on the top line in terms of your prices, focusing on the bottom line and your cost and how you can deliver care more efficiently, more productively. Maybe along the way if we do that, we might find maybe we don’t need as many people as we thought we needed in the future because we can meet those needs with additional efficiencies and productivity which is going to translate into more affordable care, which is obviously what we want for our clients and for our industry and profession.

Dr. Andy Roark:
That definitely makes sense. I think as I sort of just try to step back and get my head around it, there’s a real pinch point here that I continue to see where I see veterinary professionals unable to hire, and they are thus just working harder. They’re like, “Well, I must work harder. I must carry the load.” I hear from doctors who have a real problem stepping back and they have a real problem telling people, “I’m sorry, I can’t get you in today or I can’t get you in this week.” And so, I think that that’s really a challenge. I think what I’m really looking for, I guess, at this point is even high level ideas about where does that relief come from. How can we release that tension valve, given our realities with the labor market? What knobs can we turn to try to make a change in how we’re running our businesses?

Dr. Matthew Salois:
Yeah, that’s a good question. I think if you’re looking at not just what’s happening in your practice, but you’re looking at what’s happening in the profession and probably what a lot of your peers are experiencing here is we’ve got a situation where everyone is working harder than they ever have before. At least that’s how it feels, right?

Dr. Andy Roark:
Sure.

Dr. Matthew Salois:
I think maybe we’ve talked about this last time. This is the sad, tragic, irony of inefficiency is you can actually work harder but not get more done, and you don’t always see it. It’s beneath the surface because we look at production a lot, that there is a subtlety between production and productivity. Production is how many patients you saw in a week, and maybe you’re seeing more patients than you ever have in a given week. But productivity takes that and says, “How many patients did you see per hour? Or, if you saw how many patients in a week, how many hours did you put in that week?” It’s timestamped somehow.
If you’re seeing more patients but you’re putting in more hours, it could be such that you’re actually putting in more hours than what you are patients there. And so, your total production may have been, but your productivity actually decreased which is such a huge contributor to burnout, right? And so, here’s [inaudible 00:23:20], if we focus on productivity, not only is there a workforce dividend because we might not need as many people and we’re not feeling so pained there by open roles that aren’t getting filled, but there’s a wellbeing dividend too because if you can be more efficient and make it easier just to do your jobs, you’re not going to feel so burnt out too.
So, there’s definitely a sweet spot here where by focusing on productivity, you’ve got these dual dividends to workforce and wellbeing. I think that’s an important context because many people think of productivity or efficiency as squeezing the sponge, like, “Oh great, my [inaudible 00:24:01] owner wants to be more efficient. That’s just going to mean squeezing the life out of me.” No, it’s really the opposite. It’s trying to put forward the right technologies, the right people, the right workflows so that it’s working for you and making it easier to deliver veterinary care.

Dr. Andy Roark:
Yeah, it’s funny, I feel like the word efficiency has gotten a bad rap, and it’s taken on sort of a negative connotation last couple, because you’re right, it’s the experience that people have. When the boss comes and says, “We need to work on efficiency,” that generally means we have to work harder. I don’t think that’s what most of us mean. I’ve really started to hear the term organization come back, like, “Oh, we need to get organized.” I understand why people are making that shift is efficiency feels like work… It’s code for we’re going to work harder, where as organization is getting our ducks in a row and communicating well, training people, onboarding, things like that.

Dr. Matthew Salois:
Absolutely. And I think it’s an important mindset shift, right?

Dr. Andy Roark:
Yeah, absolutely. Are there metrics that you look at for productivity? So, if I want to say how productive am I. Well, I’m going home at the end of the day and I’m tired and I’m saying, “Am I being productive with my time or am I just working harder?” I mean, how do you know?

Dr. Matthew Salois:
Yeah. So, there’s a lot of different metrics. There’s no one single one that’s going to give you all the answers there. One measure I’ll throw out there, which is actually one that’s a broad economic measure for the US economy is output per worker. The US Bureau of Labor Statistics publishes this number which basically is an index that adds up all the inputs into producing goods and services across our economy and then looks at the outputs that are translated from those inputs, and then does it on a per hour basis. Labor productivity, so that’s a measure of labor productivity which is a important [inaudible 00:25:59] for the quality of an economy in terms of how good it’s doing, how it’s evolving, and generating more value so that it can translate into higher wages for people. A similar metric there in veterinary medicine would be patients per DVM per hour. I’ve looked at that through different data sets.
What we saw the last couple of years is that was significantly impacted, both in the broad economy and in veterinary medicine, and in fact, the quarterly numbers for this year, the Q1 or Q2 number for 2022 was the biggest decline in US labor productivity since the 1940s. Huge, and it contrasts with all that we hear around with remote work that people are more productive, and no doubt, I’m sure there are circumstances where so that’s true. But I think a lot of those discussions are conflating with production, again, with productivity. I’ve never worked more. Assuredly, I’ve never answered more emails in the last two years than I have now, but I’m also putting in more hours in order to respond to those emails. So, am I more productive? I don’t know. I’m definitely doing more, but am I translating that into more efficiency? If I did the numbers, I’m not quite so sure.
So, I think COVID created a lot of barriers to doing your work effectively, a lot of frictions that we didn’t have before, and some of these frictions have stayed with us, and we experienced that in veterinary medicine too. When you look at a metric like patients per DVM per hour, that went down. AVMA’s reported on that and others have as well. And so, it’s so important to look at that because you’re working harder just to get the same amount of work done. Again, it’s that tragic irony that you don’t really see, and it’s something definitely for us to address going forward.

Dr. Andy Roark:
What’s the driving force behind that? Why do we see fewer patients per doctor per hour in the last two years?

Dr. Matthew Salois:
Well, how it began-

Dr. Andy Roark:
Is it because is the loss of support staff? Is that what it is?

Dr. Matthew Salois:
That’s a big piece of it, yeah. So, in the early days of COVID and then in the months that followed, it was doing everything that we did in order to deliver care in the most complicated environment imaginable, right? So, switching to curbside care, taking payments over the phone, deep cleaning exam rooms between patient visits, breaking your staff into teams, keeping a limited number of people in and out of the practice at a given time, and that created inefficiencies. I mean, just simple things like taking payments over the phone, right?

Dr. Andy Roark:
Yeah.

Dr. Matthew Salois:
You’ve got a 16-digit credit card number that someone’s giving that number to you, and then at the 15th number, they’d get it wrong so then they have to repeat the whole number all over again, right? I mean, that should be like a two-second swipe, right? Instead, it turns a minute transaction. So, things like that add up. And so, that created significant inefficiencies that hampered the ability to deliver care more effectively and productively. Appointments took longer. That was another thing because of some of these realities that we were doing with COVID. How and why that’s still persisting. I’m hearing things such as, “My staff got used to 30-minute appointments. They really don’t like 15 and 20-minute appointments, so I’m intentionally keeping things longer.” That’s going to create backlogs, it’s going to create blockages, and certainly, it’s going to create inefficiencies.
Is that the right thing to do? I think there’s definitely an emotional answer to that and there’s also a business answer too. They always have to be in balance. I think we’re still there. I think we’re coming out of it, but definitely, I think we’re still in the middle of this where we haven’t quite found what’s working truly yet most effectively in this post-COVID environment that we find ourselves navigating through.

Dr. Andy Roark:
Yeah, I think there’s an optimal workload, not maximal, but optimal that we’re kind of going for. I’ve been using the metaphor of veterinarians as widget makers a lot recently because it sort of strips the emotion out of it just to sort of say there’s a lot of people who have a widget factory, which is their practice, and they have the capacity with their current staff to make 500 widgets in a day, and their community wants 700 widgets a day. That helps me sort of rationalize it and say, “Well, we have a capacity that we can maintain.” A lot of people are pushing their machines until their machines are glowing red and people are dropping out of the workforce because they don’t want to work in the widget factory that’s just pushed way beyond capacity. At the same time, there’s definitely room for efficiency and things like that.
I think it’s one of the real challenges that we have. You use the example of we went to half an hour appointments and the staff doesn’t really want to go back. I say, “Well, if we were pushing beyond capacity and that’s how we’ve adjusted and we’re kind of back in capacity, there’s nothing wrong with that.” At the same time, I think real challenges I think as a leader is helping people, including ourselves, to understand what is real and what is our perception.
There’s a lot of days that I feel like, god, I’m working so hard, and then I got to look back at my day and go, “I was wildly inefficient today.” I worked all day, but I did work that other people had already done. There was redundancy in what I did. I could have been more organized. I made three trips out of the house because I didn’t get organized at the end of my day to go do these errands and I had to come back, and it was just poorly done, and I could have done this yesterday when I was on the other side of town, and it would’ve already been taken care of, and whatever your things are. It’s always hard to determine, I think, how to be fair to yourself and to others and say, “Yes, we are working at maximum or optimal efficiency,” versus, “Yeah, we’re working hard, but we’re not working as smart as we could possibly work.” Does that resonate at all?

Dr. Matthew Salois:
Oh, it so does. I mean, it boils down to that adage we’ve all heard, right? Work smarter, not harder. I mean, basically, it comes down to that. We can work so hard and it feels like we’ve done so much, but you’ve got to look at the numbers to actually tell you what you’ve accomplished in the amount of time that you’ve put into it. This is why I don’t run. I hate exercise in all its forms. I just would rather be out to dinner with my wife. But if you’re looking to trim the fat, if you talk to a personal trainer or someone in exercise science, they’ll tell you heavy cardio is not the way to do it. Sure, you’re going to get a strong heart, but actually, the optimal area is fast, brisk walking. That optimizes your heart rate to focus in on burning the fat, not heavy cardio.
And so, it’s just like you think you’re working so hard to get and you’re getting that outcome done, but when you translate it into the numbers and you take a step back, you’ll find that there’s probably a better way to do what you just did.

Dr. Andy Roark:
Yeah. As you sort of look ahead at 2023, what is your economist’s wish for the profession? What would you like to see happen?

Dr. Matthew Salois:
Yeah. I think we’ve got our challenges, right? Never ever have things been so interesting in our profession and certainly the world around us, but I think we also have such significant opportunity to transform veterinary medicine now, right? This is the moment of change here, and we don’t want to lose that momentum. During COVID, we changed because we had to. Now we can change because we want to. I think everyone’s ready for that. We began this conversation with affordability. This is an issue right now for every household in our country affording anything. For many, it’s food or rent. Inflation is just making that worse. How’re we going to fix that? How’re we going to address affordability of care? How’re we going to address our own wellbeing challenges? We talk more than ever about burnout, but are we really, truly leading towards a solution here?
As well as our workforce situation, right? Every day it’s something new or the same headline. We can’t hire, and yet, the same turnover of any of the health professions. When you look at average turnover of a DVM or technician, it’s worse than an MD, it’s worse than a registered nurse. They’re just, they’re horrible. So, if you’re losing 50% of your technicians every year because it’s not a great workplace environment, how can you complain that there’s not of people because you can’t retain the ones that you have. So, we’ve really got to put that on the table and address that, and I think we can. I think there’s a roadmap for us to adapt and transform, and it’s not recreating the wheel, but it’s doing these things that we’ve talked about so much, you and others around leverage your people more effectively, right? If your technician is trained to deliver vaccines, then why are you or the DVM doing that, right? You can do other things.
I understand the desires to keep appointment length longer because it feels less stressful, but going back to profitability, if you want to grow and pay your people more, if you’re holding back the number of business that you can take on, that’s going to affect those numbers and your ability to do that, and bet you some practice down the street who you’re in competition with is going to figure this out and do what needs to be done in order to support both wellbeing and profitability, because economics and people, they do go hand in hand. They’re not at tug of war with one another. There’s two sides of the same coin. So, doing that in a way that’s effective and efficient and delivers good wellbeing and good wages and earnings to your people as well as delivering the best care possible to clients while growing as a business, I think we can do all three of those things.

Dr. Andy Roark:
That sounds great. I think that’s a great place to leave it. Dr. Matt Salois, where can people learn more about the VMG groups? Where can they find you online?

Dr. Matthew Salois:
Yeah, great. So, you can learn more about us at our website, veterinarystudygroups.com, learn about what we do, what makes us special, and how we can help you as a practice owner. And then you can find me on LinkedIn. I post not as frequently as I used to, but occasionally I pontificate about the economy and data and throw in an occasional dad joke here and there too.

Dr. Andy Roark:
That sounds fantastic. Thanks for being here. Hey guys, you guys take care of yourself. Thanks for tuning in.

Dr. Matthew Salois:
Awesome. Thanks, Andy, so much.

Dr. Andy Roark:
And that is our episode, guys. I hope you enjoyed it. I hope you got something out of that. As always, if you did, the kindest thing you can do is leave me an honest review where you get your podcast, especially Apple Podcast is where a lot of people find it. If you’re watching our video on YouTube, hit that like and subscribe button. If you’re like, “What? Videos on YouTube?” That’s right. You can watch Cone of Shame videos on YouTube. They’re the Cone of Shame YouTube channel. Anyway, gang, take care of yourselves. Be well. I’ll talk to you soon.

Filed Under: Podcast Tagged With: Life With Clients

Career Options Beyond General Practice

December 9, 2022 by Andy Roark DVM MS

What happens when general practitioners feel stuck and need something different? Dr. Catherine Ruggiero joins the podcast to discuss her diverse and winding career, and what is involved in leaving general practice to become a veterinary specialist.

Cone Of Shame Veterinary Podcast · COS – 174 – What Happens When We Don’t Want To Do GP Anymore?

This episode has been made possible ad-free by Hill’s Pet Nutrition!

LINKS

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. Catherine Ruggiero is a board certified veterinary nutritionist® and Scientific Communications Specialist for Hill’s. She completed her Doctor of Veterinary Medicine training at the University of Missouri in 2014. Prior to that, she received a Bachelor of Science at St. Lawrence University and a Master of Science in Biological Sciences at Fordham University. She was an associate veterinarian at a small animal veterinary practice in Upstate New York for just over three years before returning to the University of Missouri to pursue residency training in small animal clinical nutrition. Upon completion of an ACVN residency program in 2019, Dr. Ruggiero joined Hill’s Pet Nutrition as a Consulting Clinician in VCS before joining the Scientific Affairs team.


EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome, everybody, to the Cone of Shame Veterinary Podcast. I am your hose, Dr. Andy Roark. Guys, I’m here with my friend, Dr. Catherine Ruggiero. She is a board-certified nutritionist at Hill’s Pet Nutrition, and we are talking about her journey through general practice to specialty. And there’s a lot of people, I think, how feel stuck sometimes in their job, whether they’re a veterinarian or a technician or a front desk person or a manager. I think this is a ray of hope as far as reminding us that you have options, and you can go lots of places. And the experiences you have, they translate. And there’s opportunity for you to grow, if you want to do it. I think Catherine is super impressive. You’re going to hear somebody who … She’s very kind of laid back about it, but she takes the bull by the horns and makes her career what she wants it to be. And I found that really interesting and inspiring, and I kind of pushed her into the details of … Who did you reach out to, and what did you do, and what did you say to get this opportunity?
And so anyway, if you’re somebody who’s looking at your career and going I wonder what it would be like to make a change one day, this is a great episode for you. Guys, this episode is made possible ad free by the support of Hill’s Pet Nutrition. Let’s get into this episode.

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

Dr. Andy Roark:
Welcome to the podcast, Dr. Catherine Ruggiero. How are you?

Dr. Catherine Ruggiero:
I’m doing pretty good. How are you?

Dr. Andy Roark:
I am very good. I am super glad that you’re here. I’ve got some stuff. For those who don’t know you, you are a board-conference nutritionist. You are with Hill’s Pet Nutrition. And yeah, that’s it. You’ve been with them probably about four years now and just a genuinely splendid, wonderful person and someone that I want to talk to you about career paths. What I want to talk about today, I get a lot of questions about people who are interested in doing something nontraditional with their careers. They’re like I’ve done practice, and practice isn’t for me. And it breaks my heart, but I totally get it. And some people are like I’m going to leave practice for a while and maybe come back. And I want to talk to you, one, because you are a veterinary specialist. And then also because you’ve had a sort of nontraditional career path and done different things and interfaced with a number of different specialists who have kind of done that.
And so I just want to open up and talk a little bit about your story and then also kind of weave into your philosophy on defining and redefining your career. And I think a lot of people are interested in that topic, and that’s kind of what I want to lay down. Does that sound all right?

Dr. Catherine Ruggiero:
Sounds great, let’s do it.

Dr. Andy Roark:
Cool, so let’s go ahead and start off. So let’s start at the beginning. Why don’t you go ahead and just kind of lay out the beginning part of your career? You’re a vet nutritionist. That was not the plan.

Dr. Catherine Ruggiero:
Not the plan.

Dr. Andy Roark:
Tell me how you got that, because you and I have a lot in common. As you and I just talked before, and you talked about your career, beside the whole being super smart and being a specialist, we don’t have that in common. But we have a lot of the other things in common, and so I want to talk about that, because I think that there’s some similarities in our career paths that are probably true for other people. So begin at the beginning. Tell me a little bit about your career and how you got to be a nutritionist.

Dr. Catherine Ruggiero:
Yeah, well I was not one of the … I knew I wanted to be a veterinarian when I was five or eight. Is that the average these days? I think, so it took me a little while to get to that point where I knew veterinary medicine was where I wanted to head. So that path took me a little longer I did a master’s in between undergraduate and veterinary school.

Dr. Andy Roark:
What’d you do a master’s in?

Dr. Catherine Ruggiero:
Molecular biology.

Dr. Andy Roark:
I did one in zoology. I’m with you. That’s why I was like man, we got a lot of things in common. I also did not know I wanted to be a vet. I wanted to be a human doctor, and then I got to my junior year in college, and I was volunteering in hospitals. And I was like forget, this is not what I want to do. There’s people here.

Dr. Catherine Ruggiero:
Yeah, I think that’s how it goes. You go no to humans, and then you go okay, I guess yes to vet med. That’s something I’ve never thought about, but okay.

Dr. Andy Roark:
So my wife is a college professor, and I have this theory based on her interactions. I think that the fear of not knowing what you’re going to do is bigger than people’s fear of ending up in a job that they hate. That’s what I think.

Dr. Catherine Ruggiero:
I think that’s true.

Dr. Andy Roark:
I think that there is a ton of people who are like this is what, I have to be a lawyer, or I have to be a doctor. And I see them in undergrad all the time now in some of my life students and things. I’m like this is a person who decided at age seven they were going to go be a physician, and they’re not cut out for it. It’s not what they think it is, and the fear of not knowing what they’re going to do is big enough to make them overlook all the signs that they should not be here. And so I wonder how lonely we are as people who are like I didn’t know I wanted to be here. I thought I was going to be something else, and then I looked around and changed paths. But I like to call that out. I think a lot of people are like you need to be called from birth to be in this profession. I was like I love this profession. It was not plan A.

Dr. Catherine Ruggiero:
No, not at all, and it’s true. I kind of focused on what I liked in school, because I liked school. I think that’s the nerdy party, is I really liked school, so I focused on what I liked in school. And then I did get to the point where I’m getting towards the end of my undergraduate career. I kind of have to take these skills that I’ve accumulated through my transcript and apply it somewhere. And human medicine made a lot of sense, but I have a great mentor who said, “What about vet med?”
And I said, “I’ve had dogs. I grew up with dogs in my household, but I never really … I guess, yeah, we could look into that.” So I took some time right after undergrad to work in a few vet practices. And I think unexpectedly I decided I didn’t want to go to vet school after that, which says nothing about the veterinarians I worked with. I think it says something, maybe, about the clientele I was interacting with as a vet assistant.

Dr. Andy Roark:
Got you.

Dr. Catherine Ruggiero:
But that’s when I decided well, I’ll go to grad school. Again, I liked school. Well we’ll spend some more time in school. But that’s when I really decided, when I was in graduate school and kind of thinking okay, where am I going to be longterm? That veterinary medicine checked all the boxes, just maybe not in the way that I thought that they would. So yeah, so I applied to vet school while I was finishing up my master’s which ended up working out nicely. The master’s, I think, helped me get into some good programs and helped with my application process. Plus I’d already learned what it was like to get a C in something, because graduate level molecular biology courses kind of … It’s not the first time.

Dr. Andy Roark:
Yeah, that box had been, that perfect piece of glass had been shattered already. Yeah, so tell me a little bit about the thought process when you’re like no, I don’t want to do that. Okay, I’ll do that. What is the thing that swings you back, when you’ve decided that you didn’t want to do it before? How did that process come around?

Dr. Catherine Ruggiero:
Yeah, well I think what I loved and what I’d done in undergraduate school and what my mentor saw in me was I really liked the science. I’m definitely a science nerd. I like the biology. I like the problem solving of medicine. And of course when you are just entering the veterinary world as a receptionist and client services representative and vet assistant, which is what I was doing, you’re not actually doing that part of vet med. You’re doing a lot of the problem solving, the troubleshooting, the selling. A big part of what I did was going at the end of the appointment and really try to sell products that I didn’t understand why I was selling them. So I didn’t like that part of it. I felt like I saw really the money side of the business. And not that the veterinarians I was working with were making a ton of money, but I saw this kind of culture of we need to sell things. We need to make money in this profession, which I now completely respect and encourage.
But I didn’t have the knowledge base to kind of see where that was coming from. And I didn’t get to see the cool stuff that was happening to get to the point where you sell the ear ointment. I just knew we were selling a lot of ear ointment.

Dr. Andy Roark:
Yeah, it sounds like the why was missing, right? You were in there like, “Hey, you need to send this flea and tick prevention home, because money.” And that’s not a rewarding, fulfilling thing at all. The truth is, the people who were behind the scenes had good, good reason for doing this. And they probably were very … In their minds, the why was very clear. But it wasn’t coming down to you, and you didn’t have that background understanding. I think a lot of people wrestle with that.
And I’ll also tell you this. I look around at how busy practices and stuff are, and as a business owner, it is really easy sometimes to look at the bills that are due and payroll and trying to pay people what they’re worth and to go crap, we have got to make money. And then to talk to your staff and be like, “Guys, we’ve got to make this money.” And the staff is like wait a second. This feels like a real focus on money. And that’s not what you wanted it to be, but I am very empathetic now to business owners that are feeling stressed. Because I’ve been through that period of crap, where is payroll going to come from? And I can 100% see how that communication can happen, and it’s understandable. It’s still really sad.

Dr. Catherine Ruggiero:
Yeah, I mean I think once I tried on a few practices and found one mentor who I still talk to today, who’s a veterinarian, who really did and found out this wasn’t my summer job. I wasn’t there to clean kennels. I wanted to go to veterinary school. And so when there was time in those busy days, we had a big whiteboard in the back. And he would take me back and say, “Let’s draw through this disease process. Let’s talk through what this test means.” And really did put in a lot of time to try to get me excited about the part that I should have been excited about. But I pretty quickly was like this is not for me. And I was surrounded by a lot of people who weren’t really enjoying it. Yeah, so I went, and I said, “Let’s go back to school and figure it out.” And really it was once I was in school that I was like no, it’s the medicine that excites me.
That’s the fun part, not the test development not the biomedical science. It’s a portion of things, which is so important to both the human and veterinary side. It’s the medicine, the problem solving and the client interaction. It’s the talking to pet owners part that I actually really missed, which I wouldn’t have known, if I didn’t leave.

Dr. Andy Roark:
Yeah, sometimes you don’t … Wise man once said, “Don’t know what you got until it’s gone.” That’s where that is. So you went to Mizzou, and like me, you fell in love with the VBMA and the business side, it sounds like. So tell me about that, and then let’s talk about going into practice.

Dr. Catherine Ruggiero:
Yeah, well I really enjoy school, so I did enjoy vet school and really enjoyed being in every club that I could find the time to be in. But VBMA was especially a passion, and I got to be on the executive board at Mizzou while I was there during my time as a student. But I kind of thought this is where you shine. This is where the pinnacle … I’m going to be in school, but then I’m going to stop being in school. What am I going to do after school? I need to keep working towards something. That something is practice ownership. That is going to be a constant ladder-climbing kind of thing, always a new challenge. That’s going to be the path for me.
And so I was definitely small animal, always small animal focused. But that VBMA really reinforced that this is the way. This is the way I’m going to get a good quality of life out of this profession. This is how I’m going to touch the most lives, touch the most animals. This is how I’m going to build something, build a legacy, is with practice ownership. So that’s really, when I graduated, how I headed out the door, was looking for a practice that assuming probably it wouldn’t be my first practice that I landed in but a practice where eventually ownership was going to be on the table, or I could head out on my own and start something.

Dr. Andy Roark:
Okay, so this is where I want to start to dig in a little bit. Because I think up to this point, I think you’ve been through a career that’s a lot like other people’s that have. And so I kind of want to walk with you a little bit through this part right here. So you’ve graduated from vet school, and you’ve gone into the general practice. And I really like the idea of practice ownership as the ladder climbing, because that was 100% it for me as well. I need to be going somewhere and feel like I’m working on something. And I feel like a lot of us coming through vet school have always had the next achievement. And so that was a big part for me as well. And so I want to talk to you, because I think this is going to resonate with a lot of people. Talk to me a little bit about your experience in practice and the abandonment of that plan.

Dr. Catherine Ruggiero:
What happened?

Dr. Andy Roark:
Yeah, because I think a lot of people are here right now, and they’re going maybe this isn’t what I thought it was going to be. Or what I always had planned on is not coming together the way that I wanted. And to my point at the beginning, I think uncertainty is really scary. And so what I really want to do with you is unpack this journey a little bit, because I think a lot of times hearing other people’s path makes the unknown feel a bit less scary. And so yeah, can you just start to unpack that for me? And let’s walk together.

Dr. Catherine Ruggiero:
Yeah, well I would say first of all that I had the dream practice. I mean especially coming right out of veterinary school, it was a six-department, small-animal practice with the most fantastic practice owners who were interested in eventually selling and eventually selling to me. I had other associates at that practice that were extremely collaborative and supportive and helped train me. I had technicians who had been in the field for 20, 30 years. I think I learning more about vet med from my technicians in the first two weeks of practice than I did probably in six months of clinics. And I had amazing, amazing support staff and really great clients. So it’s hard sometimes. I’ll talk to friends who are in situations, and I hit the jackpot of jobs, especially right out of vet school. And the mentorship I had was just so, so great. If I didn’t feel comfortable with something, one of the owners or the associates was there. People would look at x-rays with me from day one all the way through three years in. I had this really great, collaborative environment.
And the first year or so, it was stressful. It’s stressful. Pet med is stressful. Any new job is stressful. It was stressful, but I had a lot of great support. And I said “Well I think I just need to get used to it. I need to get my feet wet. I don’t love surgery. I don’t love this. I don’t love that.” But I knew I’m a baby vet. I got to get settled, knowledge got to just keep working on it. And so my second year I’m like okay, it’s not my first year anymore. I’m still a baby vet. Maybe I really need to … I’m not really loving every single day of this. And I was working in a practice with such passionate people, so the associate veterinarians there, we did love it.
I mean everyone has hard days, and there are hard clients, and there are hard cases, but they loved it. I mean they came to work every day just enamored with their job. And I was like I’m not there yet. Maybe I need to figure out how to get there. So again, I had a very, very supportive practice that kind of said, “Well let’s kind of narrow down what you’re passionate about, and we’ll steer you in that direction. We’ve got six doctors. Everyone can have their little niche of what they like to do.” And so I really liked nutrition. I liked it in vet school. I also really liked ophthalmology, and so I kind of became one of the nutrition or the eye people. Especially a new client came in or a client that had an issue and really wanted to talk deeply about one of those topics, they would get funneled to me, which was fantastic. I mean it really let me do the things I wanted to do. I still was doing the things that you’ve got to do but don’t always want to do. But that’s life.
So I had great support there and was developing a really wonderful clientele and was talking about nutrition a lot and was kind of training technicians on nutrition and my support staff on nutrition. And the third year I still … It’s great. I’m glad I’m doing this, but I just don’t think I like this. And it’s such a scary thing, because I was just starting to get into the conversations, going to the meetings with the practice owners on how does one acquire a loan to purchase a practice. And what is the 10, 15-year plan for doing that look like? And I just said, “I don’t think I can do this for another 10 or 15 years. And if I am going to be a practice owner, the only way I can imagine doing this is if I’m not practicing, if I’m just a practice owner.” And that’s not what I wanted to do, and it’s not the culture of the clinic that I was at either. I mean it was one where the owners were very much involved and were primarily clinicians on the floor all the time. So it just wasn’t a good fit.

Dr. Andy Roark:
I look at practice ownership as like a 10-year deal. If you’re in it, and this is just a sloppy rule of thumb, but if you’re going to do it, plan on it being 10 years of you being involved in this thing. So there’s not like let’s try it out for a year. It’s a commitment. All right, so when you’re having these thoughts at year three, and you’re like I don’t know if I’m really liking this, when did you recognize that might be a problem? Everybody has those fleeting thoughts of like that was a bad day, or man, I’m really tired. Was there something that you can point to where you were like this is when I was like I’m not sure I want to keep doing what I’m doing?

Dr. Catherine Ruggiero:
Yeah. I don’t know that there was one particular thing or incident or case or anything like that, but I felt myself becoming less confident in my skills, even though I was working a lot, and I had successful cases. I was becoming less confident in my skills and more anxious about some of the day-to-day parts of veterinary medicine. And I couldn’t really figure out why. I was doing well, and my bosses said, “You’re doing well.” I was making money. I had really loyal clients.
The support staff was saying, “You’re awesome. You’re doing great.” But there was something about it where I didn’t feel like I was doing a good job. And I think there’s the jack of all trades, master of none idea. I don’t totally agree with that, because I think there are plenty of general practitioners, I’ve worked with them, who are masters of everything. They’re just people who can be that way. But I think I started to realize I really … I think just the way that my brain works, I like to focus. I like to focus on something small or a few small things. My day would work out that it was all derm patients, I was in heaven. But you throw one limping dog in there, and suddenly the day was very stressful. So I didn’t like the variety, which is the thing I thought I’d love about general practice. I didn’t like the pivoting from the puppy appointment to the euthanasia, which is something I thought I was actually fairly good at.
But it came with a lot of anxiety for me, and it was just, when I was in practice, it was just around the time that not one more vet was starting up. And so I felt grateful that there was this community of other people who were really anxious. They were really anxious about veterinary medicine. They were really anxious about their clients and their patients. And I wasn’t alone in that, but it also was this idea that maybe that’s what it is, and you kind of just have to tough through it and deal with it. And I didn’t like that option, so I had changed things a few times. I changed the course a few times, and I’d gone back to school a few times. And I knew that was totally possible, so it’s around then that I started thinking, well what do I like?
If I could have a day full of patients just talking to clients about X, what would it be? And nutrition came right to the top of that list. And I said, “Well could I go back to school?” Because I like school, and just focus on nutrition. And yeah, turns out that’s totally doable, which I had never thought of going back, after being in practice, going back to the university.

Dr. Andy Roark:
I remember being in vet school. This may be something that screwed me up for life. But I remember being in vet school, and I was involved in a conversation I should not have been involved in where, there there was clinicians that were talking about behind-the-scenes residency stuff. And I was just standing there, and I was uncharacteristically quiet, I guess, at the moment. And I remember one of the applicants had been in general practice for a couple of year. And the other applicants had come straight out of internship programs. And one of the current residents was like, “Why are we looking at this person? They’re in general practice. They haven’t been doing this.” And she blew them off, and it looked to me, and I wasn’t there beyond that, it looked to me like that guy’s chances were tanked after this conversation. And I’ve never forgotten that, and I remember being angry. I remember being like, why is it that, if you make this choice, and you go into general practice, that there’s no path back?
And the person who’s been in general practice, you don’t know him. He may have more experience than the person who did a one-year residency, regardless of where they did it. You know?

Dr. Catherine Ruggiero:
Yeah.

Dr. Andy Roark:
And that was one conversation, but I’ve never forgotten it, and it’s always bothered me. Tell me a bit about that transition back, where you are in GP. You’re not coming out of some big New York internship program or out of some academic program somewhere. Help me see the light there. What does that even look like, to try to go back?

Dr. Catherine Ruggiero:
Yeah, I mean I’ll say, first of all, it’s hard if you’re considering it, because you’ve been out in the world, making money.

Dr. Andy Roark:
Yes, that makes sense.

Dr. Catherine Ruggiero:
So interns don’t know. When they go into a residency, it looks like a little pay bump. They don’t know. They’ve been eating ramen the whole time. I had gotten used to a nice bottle of wine and going out to dinner and having a lifestyle of a professional person. So that was like for me, that was actually one of the really hard things. And I think for people who maybe start to go down that step, when you look at what a resident’s salary is, you go well, do I really want to do this? I mean it’s a finite amount of time, but it’s a tough thing when you’ve been out in the world, working and working independently. Because you know I had fantastic mentorship, I was doing it, my own thing. And so the idea of the pay cut with the intense supervision when you’ve been an independent, money-making adult is kind of challenging.
I think also it depends on the program. There are programs where they really would prefer that you’re in one or two or three different internships before you show up in a residency. And I won’t say that for all of them, but I think there is a protectiveness in academia that they like to train people a certain way, right?

Dr. Andy Roark:
Mm-hmm.

Dr. Catherine Ruggiero:
And you learn to go rogue when you’re in practice.

Dr. Andy Roark:
Yeah, I learned on the streets.

Dr. Catherine Ruggiero:
Yeah, exactly. And nutrition is one of those specialties where that street smarts from being in general practice actually are really highly valued, Because it’s those communication skills. It’s being able to talk to owners and kind of relate to owners. That’s a skill I think you really can build most successfully in private practice or in general practice. And it’s a skill that you need.

Dr. Andy Roark:
You’ve got to get reps, right?

Dr. Catherine Ruggiero:
Yeah.

Dr. Andy Roark:
It’s a skill that you got to get reps in. And in general practice, you’re talking to client after client after client after client. And so I love that you’ve put it that way, really taking a moment and looking at what are the strengths that I’ve built here, that I would take back to this program. That makes a lot of sense.

Dr. Catherine Ruggiero:
Yeah, and I really liked talking about nutrition. I wanted to build my knowledge base. I did a lot of CE, nutrition-focused CE when I was in practice. But I knew I liked that part of it, and I did have tons of experience talking to people, whether they wanted to talk about nutrition or not. We were talking about it. And so it’s actually, I think, a skill. That general practice experience is a skill that is undervalued in a lot of residency training programs. Nutrition is one where I’d say it’s a little bit more common to have people out in general practice or maybe doing emergency medicine for a few years and then going back and doing a residency, because you build those communication chops. Not to say you can’t come right from an internship, but yeah. I don’t know, if I had gone into an internship first, if I would have fallen in love with nutrition the way I fell in love with it in practice.

Dr. Andy Roark:
Sometimes it’s finding that path, isn’t it? As opposed to I think there’s a huge amount of pressure that’s put on young people to know what they want to be. And that just to me has always seemed like kind of ridiculousness. I have never had clarity on what I wanted, until I got into it and did it for a while. And so I really like this idea that you go out in practice, and you figure out what you like. I really like a lot. I know this is stepping back for a second, but the idea that you were like I like eyes and nutrition, and that’s what I like.
I really preach that a lot when I talk to veterinarians and also support staff, is figure out … And this is simple, but I tell you, my best career advice that I try to give everyone is, figure out what you like doing, and figure out how to do more of that. And figure out what you don’t like doing, and figure out how to do less of that. And when you talked about I stepped in, I really wanted to do eyes and nutrition, and my staff knew that. And I got the chance to do that and to train in that. Can you tell me a little bit kind of what that looked like? Because to me, that’s the quintessential self-created career growth path. I love that you did that. What did that look like?

Dr. Catherine Ruggiero:
I mean it really started by looking, as a six-doctor practice, at what niche needed to be filled. So I wasn’t going to … I didn’t like surgery anyway, but there was a couple doctors who really loved surgery. That would’ve been a hard one for me to be like I love surgery too, and I’m the new vet. Let me in. So part of it was also looking at the need that needed to be filled from the practice standpoint. But the other part of it was the stuff that, by the time I was doing that, I kind of had had a year to play around with things. I don’t want to say they were weaknesses in the practice. That’s not a fair thing to say, but there were gaps that weren’t being filled.

Dr. Andy Roark:
Sure, I like it.

Dr. Catherine Ruggiero:
Where it was a lot of those conversations were getting deferred, or those people were getting referred out to specialists. And by all means, refer to an ophthalmologist. But I ended up saying, “Well maybe some of these I can deal with while they’re waiting to get to the ophthalmologist.”
So again, I had very, very encouraging management who said, “Reach out to the local ophthalmologists. Go visit them. See if you can learn from them. Go to CE. We’ll pay for you to go to CE and learn more about eyes and nutrition. And they did. I did a lot of extra CE in those areas. I connected a lot with the specialists. We didn’t have any nutritionists in the area, but we had fantastic ophthalmologists who let me come and bother them and follow them around.

Dr. Andy Roark:
Tell me what that looked like, because I’ve heard of other people doing that. And I’m pretty darn extroverted. I like making friends. My hands are sweating now, imagining going to the specialty hospital like, “Hey, can you show me what you do?” How did you even present that idea to them, and what was the reaction?

Dr. Catherine Ruggiero:
Yeah, I think we, my practice had a great relationship with local specialists. I mean when I was looking for jobs, I was trying to find that sweet spot between … You don’t refer everything, but you’re not afraid to refer something. That’s what I was looking for, and that’s the hospital that I was in. So it somewhat naturally developed, this relationship between me, and at the beginning there was one ophthalmologist. Another ophthalmologist joined the specialty practice that was available locally. But I was sending her cases, so we were talking a lot. We were talking on the phone, and then it was, “Well here’s my cellphone number. Send me pictures of these eyes that you’re rechecking.” And then it was, “Well this one is coming in for a recheck next week. I kind of want to see what you do with it.”
And the invitation was, “Come on down.” So I think I was lucky in that I was working with very approachable people who had a long wait list and were excited by the idea that a general practitioner would maybe take some of those rechecks and do things the way they wanted it done and consultant with them and let them know, “Hey, this is the progress I’m seeing. Should we throw in this extra med?” And they could say yes without needing to fit in another emergency. So it was a really nice, reciprocal relationship. But I had very open specialists. Then again, I had practice owners who were very encouraging of me picking up that niche in the practice.

Dr. Andy Roark:
That’s awesome. I really like that. So now that you’ve gone through your residency, you’ve been in practice for three or four years now, working as a nutritionist, is there anything that you do differently? Or do you have advice for people who have an area, whether they’re a doctor or a technician or a manager or anything like that? If you have people who have an area of special expertise, whether it’s nutrition or something else, what would you say to those people? Is there anything that you would put forward as advice for them?

Dr. Catherine Ruggiero:
I guess just that you can. I think that we get told that so much in vet school. When you start vet school, you get told the two things, that it’s a small community, and everyone knows each other, which is true, and that you can do whatever you want with this degree. There are so many paths, which is also true. You can’t end up forgetting that we know each other, because once you start getting out there too and going to conferences, you realize we really all do know each other. But I think we do forget the … You can do whatever you want with this.
And I was not happy in practice. I was not the best version of myself. I mean I feel like I was a decent veterinarian, but I was not the best veterinarian that I could be. And I really wasn’t that happy, and it was really scary to admit that and then say, “I’m not just going to grit my teeth and get through it.” Because that’s how you get through vet school. That’s how you get through everything, is you’re just going to put your head down and get through it. And I don’t know the moment or the magic. There was nothing that happened where I said, “Well maybe I don’t need to.” But I was probably in that position where I said, “Do I want to leave the profession?” I knew I didn’t want to leave my practice, because I was in the dream practice. So there was no grass-is-greener practice out there for me. I knew how lucky I was there. But the fact that I still was not really happy made me think this is not I just need to keep trying different things.
This is like maybe I’ll just … I need to make a change. And I didn’t want to leave vet med. It took me a while to get there, didn’t want to abandon veterinary medicine. But you start thinking for all those people at orientation who said, “You can do whatever you want with your veterinary medicine degree.” And once you start looking, it’s really true. You can. There’s so many options. And I knew I liked school, so that helps. If you like school, you can be in school forever. It’s not the most lucrative choice.

Dr. Andy Roark:
Professional student, yeah.

Dr. Catherine Ruggiero:
Look, maybe they turn you away eventually, but they haven’t turned me away yet. And I really like that part of veterinary medicine. There’s always more to learn. There’s always more to do.

Dr. Andy Roark:
If someone came up to you, and they said, “I’m thinking about making a change kind of like you did. Do you have any resources for me? How do I get started?” Where would you point them?

Dr. Catherine Ruggiero:
For me, I started reaching out to … I decided I think I want to leave general practice, and I think I want to specialize. That decision was sort of made. So once I had that decision made, I started reaching out to specialists that I knew from when I was in university and when I was in vet school. And it’s amazing how people will remember you and how professors will remember you. So I reached out to the nutritionists that I knew. I also reached out to the ophthalmologists that I knew and said, “Hey, I’m kind of tinkering with this idea of going back and specializing.” And once you say that to especially a specialist, I mean they get super excited. Now you’re talking about wanting to do the thing that they love. So then you get a lot of support, a lot of resources. What can we do? Here’s how we can do it. Here’s how the pathway looks. You don’t have to figure it out on your own at that point, because they’ve been through it.
They’ve been through the residency program. What maybe is a little bit unique for some specialists is trying to guide you through that program when you’re coming from practice. And there are certainly some programs where you’re probably going to need to do an internship or something like that before you get into a residency program. But that’s stuff that you don’t necessarily have to figure out on your own. I remember sitting on the computer, trying to figure out what is the match. And how does the match work? Because I was never going to specialize, was never going to do an internship or a residency before. And I realized, well this is stupid. I’m talking to people who’ve done this. Let me just ask them what the match is and how I do it. And again, it’s all people have been through that portion of things. But I think we build a lot of resources, even in school, that we forget about. And I was lucky enough to go back to where I went to vet school to do my residency, and it was such great fun to see all these people again.
You’re like no one is going to remember me. I was a little vet student. I wasn’t going to specialize. I was going to go into general practice. No one is going to remember me except maybe the people in community practice. But no, it’s not like that. There really is, I think, a profound investment that faculty … I guess I can just speak for Mizzou, but I will say I think most institutions are that way, where they really have invested in you. And so you can reach back out. You paid a lot of money. You can reach back out to ask them for advice, even though you’re not a student anymore.

Dr. Andy Roark:
Dr. Catherine Ruggiero, thank you so much for being here. Where can people find you online? Where can they follow you? Where can they hear what you’re up to?

Dr. Catherine Ruggiero:
I’m a little bit of a shadow. I don’t have a huge online presence, but I’m on LinkedIn, so find me on LinkedIn. That’s probably the only thing that’s up to date.

Dr. Andy Roark:
I love it. “I’m a shadow.” What I hear is you lurk on social media.

Dr. Catherine Ruggiero:
For sure, yeah.

Dr. Andy Roark:
All right, everybody, take care of yourself. We’ll talk to you next time.

Dr. Catherine Ruggiero:
Thank you, bye.

Dr. Andy Roark:
And that is our episode, guys. That’s what I got for you. I hope you enjoyed it. Special shout out to Catherine. Thank you so much for being here. Thanks to Hill’s Pet Nutrition for making this episode possible. Gang, take care of yourselves, be well. Talk to you next time, bye.

Filed Under: Podcast Tagged With: Perspective, Wellness

Home On Time – Practice Responsibility for Staff Wellness

December 6, 2022 by Andy Roark DVM MS

Dr. Bob Lester, CMO of Wellhaven Pet Health, joins Dr. Andy Roark to discuss his recent article in Today’s Veterinary Business Magazine. The topic is “Home On Time (H.O.T.)” – prioritizing staff wellness and setting systems, tools and boundaries to get staff members out of the building on time.

Cone Of Shame Veterinary Podcast · COS – 173 – Home On Time – Practice Responsibility For Staff Wellness

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

LINKS

Uncharted Veterinary Conference: https://unchartedvet.com/upcoming-events/

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. Lester remains as passionate about the veterinary profession as the day he entered veterinary school (sometime last century). He is a firm believer in the veterinary profession’s double bottom line proposition of doing well by doing good.

Dr. Lester is a graduate of Oregon State and Washington State University’s College of Veterinary Medicine and completed the American Association of Veterinary Medical Colleges Leadership Academy.

He spent his early career as a small-town mixed animal practice owner before joining the founding leadership team at Banfield Pet Hospitals. At Banfield, he held positions in medicine, operations, franchising, human resources, and professional relations. After a rewarding career at Banfield/Mars Inc., he left as Vice President of Professional Relations to help found the Lincoln Memorial University College of Veterinary Medicine where he served as Assistant Dean. Dr. Lester’s LMU-CVM team pioneered a novel community-based clinical education program and developed the professional skills curriculum including instruction in communication, leadership, teamwork, and practice management.

Bob is now a co-founder, Chief Medical Officer, and member of the Board of Directors for WellHaven Pet Health, a family of companion animal practices that believes in caring for the caregivers so that they can care for others. WellHaven Pet Hospitals are both new build full-service AAHA/Fear Free hospitals, acquired and joint venture affiliate practices.

Bob was a two-time gubernatorial appointee and Chair of the Oregon Veterinary Medical Examining Board. He was the state delegate to the American Association of Veterinary State Boards. He served as a site team member for the AVMA Council on Education, and on the Job Analysis Task Force for the International Council for Veterinary Assessment. Dr. Lester authors the column “Creative Disruption” for Today’s Veterinary Business.

In addition to his board position at WellHaven Pet Health, he serves as a board member and Treasurer of Pet Peace of Mind a non-profit which keeps hospice patients together with their pets through the end of life. He also serves as Vice President of the board of the North American Veterinary Community, and on the advisory boards of easyvetclinic, Pet Desk, AirVet, and the LMU College of Veterinary Medicine.

Dr. Lester’s interests include all things veterinary, writing, start-ups, speaking, business and leadership development, the human-animal bond, and giving back to the profession that has done so much for him and others.

His family includes his wife Crystal, two amazing daughters McKenzie and Paige, and two rescue Yorkie’s Jessie and Woody.


EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am talking to my friend Dr. Bob Lester today. Dr. Lester is a regular podcast ghost. He’s a regular podcast ghost. Dr. Bob Lester is a podcast guest regularly here on Cone of Shame. I’ll get into his bona fides in a moment as I introduce him.
Guys, we talk about getting home on time. We talk about what that looks like at the practice level. We talk about at the individual level, we talk about leveraging nurse practitioners. We talk about guilt and resentment, and going home and staying home. We talk about getting organized. We talk a lot about just the general philosophy of being overwhelmed and managing it. So if you’re like, oh, I’ve felt overwhelmed recently and I would like to talk about managing it, you’re in the right place. Come on in, get a chair, a fresh beverage. We can do that for you. All right. Guys, that’s enough of me jabbering on. Let’s get into this episode.

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

Dr. Andy Roark:
Welcome to the podcast, Dr. Bob Lester. Thanks for being here, my friend.

Dr. Bob Lester:
Great to be here, Andy. I always enjoy catching up with you.

Dr. Andy Roark:
I love our podcast. It’s been too long. I want to get back on, for those who don’t know you, you are a columnist at Today’s Veterinary business. I enthusiastically flip to your column every other month-

Dr. Bob Lester:
Thank you.

Dr. Andy Roark:
… when the magazine comes out. I always enjoy your writing and your perspective, which is why you’re one of the most regular guests I have on this podcast. Anyway, you are the co-founder and chief medical officer at WellHaven. You have done many, many things all over our industry and just have a really interesting background and track record. And so you wrote last month about HOT, which is home on time and the importance of getting people out of the clinic. And I love it. As the chief medical officer at WellHaven, I think that’s a really interesting perspective and philosophy. And then you have some honest to goodness steps and ideas about how to actually do that. And as I look at them, I go, oh man, these are really good. And they line up a lot with the things that I’m looking at. And so I thought that maybe we could just start to unpack that idea. When you start talking about home on time, why don’t you just open at a high level and tell me what does that mean to you?

Dr. Bob Lester:
Yeah, happy to Andy. So it’s never been harder to get home on time. We’re blessed with more business than we can keep up with. That’s wonderful that pet spending is up, pet lifespans are up, visits are up, the bond is up. However, there’s not enough of us to keep up, and this is likely going to be a long term shortage. There’s a chronic shortage of veterinary healthcare providers underway, just like there has been with human healthcare. So what can we do? And there’s a lot of short term and long term solutions.
But when we focus on the short term and our people are overworked now, what can we do today to help people get home on time? And I think part of the stress is it hurts us to be turning away business every day. It hurts my heart to know that I can’t get that pet in to help today that needs help. That they’re put off till tomorrow or next week or next month. So how can I get people home on time, and can I squeeze one more pet in today? And to do that, I’ve got to re-look at the way I do things today. We can’t work any harder. What can we do differently? What can we look at that we’ve done for years that frankly isn’t working anymore? And what can we stop doing? There’s things that we can stop doing to get those efficiencies, to get us home on time, and help one more pet today.

Dr. Andy Roark:
Yeah, it’s a reallocation of effort. I think that’s really good. I think you also put your finger right on it. I think cynically, or for people outside of our industry, they look and say, “Oh boy, it’s really hard to leave that business on the table, to not get those customers in.” And I was like, “I don’t think that that’s bothering people at all.” I really do think, for most of us, it’s about helping people, and having to tell people who are concerned about their pet, or people who, we are their veterinarian and they’re trying to do what’s right for their pet, and we’re telling them, “We can’t see you for a month and a half.”

Dr. Bob Lester:
Yeah. We’ve spent our whole career saying, “Come in now, come in now, come in now.” And now we have to say, “Come in later.” And that’s hard to do.

Dr. Andy Roark:
We’ve kind of trained people into this problem of we’ve set the idea that when that reminder hits, it’s important that you get seen. And now we’re trying to tell people, “Look, six weeks isn’t going to hurt anything.” And those are conflicting messages.

Dr. Bob Lester:
A real shift in how we’ve always, maybe subliminally, we always put pets and clients ahead of vets and teams. I mean, that’s just the way we’re wired. We’re givers. We want to take care of people. And we’re learning. And a lot of good things have come out of COVID. And one of the things that we’re learning, and perhaps it’s a generational thing as well, as a boomer, we are what we do. We always put work ahead of life. That’s wrong. But what we’re finding out is we’ve got to take care of ourselves, then take care of our teams, then take care of pets and clients. You don’t take care of pets and clients, and leave yourself and your team second, third, or fourth. It’s take care of yourself first, then your team, then you can take care of pets and clients. And as obvious as that sounds, it’s not at all obvious. It’s not the way we’re wired. It’s not how our profession has done things.

Dr. Andy Roark:
I was going to say, it’s not how our profession has done things. It’s not our culture. And I’m having some pretty seismic shifts in philosophy. And it sounds like heresy some of the things that I’ve really come to entertain. I’m not saying I’m 100% in, but I can see 100% in from where I am, as far as I don’t like the term a calling for veterinarians and vet medicine. Just because if you’re called to service, then that puts serving clients as the driving factor that makes success. And I go, we’re in a place where that’s a recipe for burnout. I don’t like the idea that there’s this moral weight on you giving of yourself no matter how you feel. That’s not a long term strategy that makes any sense to me.
I think that we’ve always, you serve the pets and serve the pet owners. But even I who really lean heavily into that, I’ve really had to step back and say, looking at the math, this doesn’t make any sense. The only thing that makes sense is taking care of the staff preferentially and taking care of ourself preferentially so that we can keep going. And that’s not how I felt early on. And I struggled to square this desire to serve and the greater purpose of doing good in the world against prioritizing myself and the staff over the desires of the pet owner.
But at some point, you have to get unemotional about it and just say the math has to work. And I say the math, I’ve been playing a lot with this analogy of vet medicine as a widget factory. And a lot of people don’t like that comparison. We don’t make widgets, we fix pets, we fix family members. And I get it. But at some point, you have to look at what is logistically possible in a day. And we make widgets. We have a widget factory. And at some point if your factory can turn out 700 widgets, and you’re somehow pushing it to turn out 1,000, your machines are going to break down, your workers are going to break down, your factory is going to break and burn and be unsafe. You just can’t consistently overproduce widgets.
Yet, that’s where a lot of us have lived since pre-pandemic times. And they go, man, your factory’s breaking down and your workforce is burning out. And they have options of other places they can go now. If you’re going to keep the factory open for the long term, you’ve got to look at what is feasible and make adjustments. And that feels kind of gross. And another way I go, I don’t see another way to look at this that keeps us in the profession and keeps us healthy. Do you agree?

Dr. Bob Lester:
I do, and there’s got to be a way to balance. The idea of calling, the idea of a desire to serve, that’s so admirable. That’s at our core. That’s made our profession so strong. But we can’t do that if the cost we’re paying is we feel guilty all the time that we didn’t spend 24/7 at work. So that desire to serve, that core warmth and giving that comes with everyone in our profession, we’ve got to hang on to. But we’ve got to remember to reprioritize that we come before pets and clients.

Dr. Andy Roark:
Yeah, I tell you, I love the mention of the word guilt. I remember I went through a period of burnout years ago. And I took some of the best lessons of my life away from that. One star, don’t recommend. If anyone offers you the opportunity to burn out, you should say no. You should take a pass. But I did. I went over there and checked it out. And one of the lessons that I learned along the way, and I say a lot, is if it comes to a place where you have to choose between guilt and resentment, always choose guilt.
And what I mean is if I have to go home and feel guilty, or I go home after my kids are in bed and my wife is angry because she hasn’t seen me, you know what I mean, and I told her I’d be home for dinner and I let her down again, that’s going to make me resentful. And I would rather be guilty today than resentful in a way that’s going to negatively impact my life. If you have to choose between guilt and resentment, choose guilt and figure out how to manage it. So I’m right there with you. Let’s talk about making adjustment.

Dr. Bob Lester:
Before you leave that, I mean, that’s just a great testimonial that you went through burnout, you came out the other side, and if there’s a poster child for passion for veterinary medicine in our industry, it’s you. So you can come through burnout and still be passionate about the profession. For those that are suffering, there’s a light at the end of the tunnel.

Dr. Andy Roark:
Yeah. Well, thanks for saying that. I forget about that sometimes. I made a conscious decision years ago that I was going to talk about burnout, and just be open about it. And be like, “Yeah, I went through this thing. It was really not fun.” But the reason I do that is because when I had really burned out, and I had really burned out and I was depressed, and one of the things that scared me the most was that I didn’t know anyone, I’m sure I did, but I didn’t know that I knew anyone who had been through that and was happy again and back and doing vet medicine. And that was the scariest thing for me was like, I don’t know anyone who’s been through this and has come back and has been happy again in the future.
And so I’m open to talking about it. I don’t want to beat people over the head with it and make it a big deal. And it’s a thing that, well, we did it and it’s over. But I do talk about it because that bothered me so much. And so if anyone’s facing burnout or been through it, I did it. It sucked. Not fun. 100% happy on the other side. You figure things out. You make changes to your life. You can reengage. The profession’s not done for you. Just there’s adjustments that we have to make and things that we learn about ourselves and we fix things. And that’s one foot in front of the other, and then we go on. But yeah, thanks for saying that and calling that out. I do appreciate it.

Dr. Bob Lester:
Of course.

Dr. Andy Roark:
Well, let’s get some strategies. I think you’ve got a number of them, right? So we’ve got our workload. And I think I would summarize, let me see if I’m accurately summarizing your position, but I’ll summarize my position and say the first thing to do is say can we get more efficient? As we make our widgets, as we go through the day and we service pets and pet owners, can we get more efficient? And the answer is probably yes.
And then after we have gotten efficient, at some point we have to say this is as efficiently as our practice can run right now with the staff that we have and where we are. And then we’re going to have to set boundaries. And I think it’s not one or the other of those things. It’s not just throw up walls. And it’s also not just figure out how to be more efficient until you magically get where you want to be. I’m like, I think you have to do both of those things. But let’s talk a little bit about that. Talk to me about efficiency overall. When you look at teams and you’re talking about getting home on time, where do you see opportunities to improve efficiency?

Dr. Bob Lester:
Yes, we are aligned as usual. I think you have to be careful with efficiency. In my experience, if you toss that out, that somehow implies that we’re not working hard enough. And that’s not what we’re telling people at all. So we’re just saying, how can we work differently? And a great place to start, and it’s blocking and tackling, is at a team meeting. As veterinarians, you and I have one perspective of workflow, but every member of that team has a different view. And where there may be opportunities to do things differently, we need to open it up to them.
To me, the big buckets fall in technology and in team based care. In those two areas, there’s just so many opportunities. Team based healthcare delivery in particular. Are we delegating? As veterinarians, are we sticking to diagnosing, prescribing, and surgery, and delegating everything else? Are we investing in our team to train them to do those things? You’ve talked about it before it, and it seems counterintuitive, but it’s so true. We’re all short staffed. We want to be doing more and work faster. So we hire that new person. And what do we do? We want to go faster, so we just throw them into it. When in fact, the counterintuitive part is you need to slow down to go fast. When you bring those new people on, invest in their training, show them how to do things, define your workflows, your duties, we have to do that, or they’re just going to burn out and leave in six months.

Dr. Andy Roark:
Hey guys, I just want to pop in real quick with a couple of quick updates. Number one first, I got to give a shout out to Banfield Pet Hospital for making transcripts possible. Guys, they do it to increase inclusivity and accessibility in this profession. And so they make this format available for everybody. So I couldn’t do it without them. Thanks. You guys could check out transcripts of this podcast at drandyroark.com.
Also, guys, as you are hearing this, the Practice Owner Summit is going on. That is the Uncharted Practice Owner Summit. I’m sorry you can’t come because it’s happening right now as you’re hearing my voice. But don’t worry, because the April Uncharted Veterinary Conference is right around the corner. Registration is opening right now. We’re opening up registration at the Practice Owner Summit. And so in the next day or two, you’re going to be able to grab a spot. Go ahead, head over to unchartedvet.com, and get your spot at the April conference. This is in person. It is in my hometown, Greenville, South Carolina. It is a fan-freaking-tastic conference. We are focusing on internal communications, internal team communications, and strategies for practice management when we have a high caseload. Those are the things that we are really focusing on. I’d love for you to be there. Go grab your spot. Guys, that’s enough out of me. Let’s get back into this episode.
We ran the Uncharted Get Shit Done Shorthanded conference last month. That’s what it was called. And when we do our conferences, they’re peer conferences to a large degree. We’re very workshop based, very discussion based. And one of the things that I heard that I’d never heard it put this way, but I thought was amazing, was we actually had people who said, “We’re more efficient when we’re shorthanded. When everyone’s there, we have people running into each other, bumping into each other.” And I had not heard that. And when I say that to you, have you ever seen anything like that? Does that resonate as an issue. Not everyone, but when you talk about onboard… And that’s where it comes from, is they had onboarded new people, and they’re like, “We’re actually better off when some people don’t show up.” Does that ring any bells with you?

Dr. Bob Lester:
Oh, definitely. And I think it highlights the importance of training and getting people up to speed. I was talking with a great doctor the other day. She was telling me, “Give me these two people and get out of my way, and I’ll help all kinds of pets and have a great day. But I need these two people. I don’t need six new people. Just give me those two.” And of course, those two were vet techs, they were tenured, they were hardworking, they were wonderful. But they didn’t get that way overnight. Somebody invested in them to get them to where they could be those two people that allowed that doctor to be so productive.

Dr. Andy Roark:
Yeah. Oh, I completely agree with that. I want to take your opinion on one more thing. So you mentioned team meetings right off the bat, which I think is interesting. And then put it together with the effective delegation and working together and also training. I tell you, and I’m curious if you’ve seen this, one of the hardest parts I think for vet professionals when they’re overwhelmed is working on the business instead of working in the business. And I feel that so much right now.
I really feel like, because business is pouring in, pet owners want to get seen, I see so many of us who are putting our head down and we are working so hard. Which to your point earlier about being careful about saying efficiency, you’re exactly right. I’m not advocating that people need to work harder at all, but I think a lot of people see it that way. And I think one of the hardest things to do is to not see patients and step back and get organized and get on the same page and communicate, and to do some training. Do you agree with that? I mean, what does that look like in practice in your eyes?

Dr. Bob Lester:
Oh, completely agree. The analogy I’ve always used is we’ve got our head down, we’re in the canoe, and we’re rowing just as fast as we can, but we’re rowing in circles. Every now and again, you need to stand up in the canoe and look at the horizon. Where are we going? And that comes at several levels, depending on the size of your organization. In a hospital team, that might mean that there’s once or twice a year offsites between the ownership and the department leads, whoever it might be, just to talk about where are we going, where are we at today, how are we going to get there?
And then another level of that back to team meetings is just having engaging, agenda driven regular team meetings to just talk about where are we at? And it’s not just download, it’s listening to the teams. It’s the pleases and thank yous. It’s how are we doing? How can we do better? Those things. To your point, we get so busy, those are some of the first things we quit doing. We don’t have time to train, we don’t have time for team meetings, we don’t have time to set a vision, a strategy, objectives. And then what happens? You just are rowing faster and faster and faster in a tighter and tighter circle, but you’re not getting anywhere.

Dr. Andy Roark:
Do you have any insight when people say everything feels like it’s on fire, I don’t know what to tackle first? As far as getting people organized, and again focusing on home on time, where do you start, Bob? How does an overwhelmed leader on the floor, maybe a medical director, maybe even a head technician, what are the first things that you look to try to get some order back into your life and into your practice?

Dr. Bob Lester:
Well, two things come to mind, Andy. One is first to just take a deep breath and acknowledge everybody. We just survived COVID. What a hell of a couple of years. Give yourself some grace here. This has been really hard, and good for you for just getting through this. So take a deep breath, pat yourself on the back. Now what do we need to do going forward? The first thing that comes to my mind is you don’t have to have all the answers. I think as veterinarians and leaders in general, you go through school, you’re top of the GPA, you got to get the A. We come into this thinking I got to have the answers. We don’t have all the answers.
You sit down with your team and say, “This is where I think we’re at. What do you guys think?” And just start having those conversations. Be transparent, be open, and it’s amazing what will emerge from that. And then it’s just a matter of prioritizing. Once those six or eight things pop up that are the direction we need to go in, pick two or three of them. We can’t do them all, but pick the top two or three, and let’s go after them. And then you just get into planning them out. What’s our goal? What’s our timeline? What’s our duties?

Dr. Andy Roark:
Yeah, I agree with that. Do you have any insight on scheduling? I mean that was one of the things that you brought up in the article as just kind of a one off, but just schedule better. What does that look like?

Dr. Bob Lester:
Well, I think a couple of things come to my mind when I think scheduling as well. One, as flat forehead obvious as it seems, not everybody is still using vet tech columns. We’re not scheduling vet tech appointments. Why are we not doing that? That’s just crazy, and charging for it. Those people have the talents, the skills they need to do it. We certainly have the business. I mean, you and I could spend the next hour talking about just the value of that. So look at your vet tech appointments.
Dropoffs. I think we learned in COVID that some clients like dropoffs. And dropoffs, if done right, can be pretty efficient. If that pet’s in the back, and I can squeeze them in when I get a chance to, and not every appointment’s appropriate for a dropoff, but there are some. And we found clients that actually like that. Some actually like curbside and dropoffs. The other thing that occurs to me, and none of these are rocket science, a lot of practices do these things already, is just leaving a little bit of space every day, particularly when we’re now booked out often time weeks in advance, for those couple of urgents. There’s one or two spots that you leave open. They’re going to fill up during the day, but have those spots available for the urgents. When that phone call comes, that longtime client has to be seen. If you’ve already double booked yourself all day long, you’re going to be in trouble.
And maybe the last thing that comes to my mind as we’re rambling here is somewhat heresy, but again, looking at life comes before work, some practices have had to temporarily stop evening hours, stop Saturday hours. If you’re short staffed, if you don’t have enough doctors, if you’re still trying to take fewer people and cover the hours that you were when you were fully staffed, they’re not going to stay with you. I’m not saying we do that forever. We need to be accessible to clients. But in some cases you’re going to have to back up before you can go forward.

Dr. Andy Roark:
We had a practice at the GSD conference that closed on Friday. They’d been closed on the weekend and they closed on Friday, and they celebrated. They were like, “It’s a game changer.” They were like, “We’re going to lose our staff.” And they closed, and they can make the numbers work. And they were like, “We’re here on Monday to Thursday going wide open. And we’re booked solid, and everybody gets three day weekends.” And I’m like, “Do you need a vet? That sounds pretty amazing.”
But yeah, but you’re right, it’s heresy. I remember during the pandemic, we had a number of clinics in Uncharted that shut down on Wednesdays. And at some point you go, this is the capacity that we have, and we’re burning people out. And we’re going to lose our staff if we don’t shut down. And yes, if we can get another doctor or two hired, then we’ll open back up on Wednesday.
But it takes a certain amount of discipline to say, “We should be open all the time. We should also have three more doctors than we have. But that’s not reality. And so we’re going to adjust what we’re doing to meet up with reality.” And so they shut it down. But I agree with you. I think it sounds like heresy. I’m seeing it pretty commonly when people say, “We’re shutting these down.” And then people say, “Well, what do you say to the pet owners?” And you say, “Want a job?” We say, “As soon as we can get staffing, we’ll open it back up. We want to be open. We can’t get the staff to do this.” And it’s just being honest.

Dr. Bob Lester:
And I think there’s learnings as we do open up. As the economy, as we’re able to start hiring again and knock on wood, someday we get back up to full staffing, you can still do four day work weeks. You can do flexible hours. You don’t have to work every evening, every weekend. As you get your team built up, you can build that flexibility into meet their life needs, as well as better meet the needs of those consumers that are ringing our phones off the hook.

Dr. Andy Roark:
Yeah. Talk to me a little bit, we’ve been talking about efficiency, let’s switch over to some sort of boundaries. I don’t want to overplay efficiency. A lot of people like the idea that you can magically work faster in a different way and get all the work done. And I think that there’s limited upside here. It’s worth investigating, and trying our best and getting organized. A lot of efficiency for me is really more organization than efficiency. It’s cutting out redundancies. Stopping people from stepping on each other’s toes, getting in each other’s way. Making it a more pleasant place to be. The phones continue to ring and people continue to come in. What are some strategies, what are some ways that practices are looking at this and saying, “How do we decide who gets in and who doesn’t get in? How do we set boundaries to turn people away?” At the organizational level, what does that look like?

Dr. Bob Lester:
It’s hard. And something I tried to talk about in this column is it’s not just HOT, home on time. It’s home on time and help one more pet. Can we do both? And to do that, if the boundary is all about home on time and we’re closing the books at 4:00, and we’re blocking two hours for lunch and we’ve dropped evenings and weekends, well pretty soon, to your point, the numbers don’t work. So how can we get home on time and get that other person? We’ve got to look at how we do things.
Boundaries are part of that. Who does what and when? It’s always hard to say no. And I think we’ve gotten good at triaging. If it’s a nail trim, we feel okay about putting that off till next week. If it’s bleeding, we’re going to find a way to get it in today. I think the other piece that sometimes I kind of put in with boundaries, and maybe doesn’t entirely go there, I see way too many people that aren’t taking time away. Even when they have these generous vacation and holiday and sick days and PTOs, they’re so eager to help. And again, that’s so admirable. Back to the calling, the desire to help. But if you’re not taking your vacation days, one, your family’s losing out, you’re losing out. And ultimately you’re not going to be as good at your job if you’re just there constantly. So I lump that under the boundaries as well. It’s okay to be away from work. It’s okay to turn off the phone. It’s okay to not be looking at emails every day.

Dr. Andy Roark:
Yeah, I agree with that. There’s a lot of people who struggle to be off. Do you think that production based compensation plays a role in that for doctors? Do you think the fact that they get compensated by seeing appointments undermines some of them’s willingness to take a vacation?

Dr. Bob Lester:
I don’t see much of that. I mean, that’s a hot button, production compensation, and I see both sides of it. However, back to do the numbers add up? At the end of the day, you can make the case we’re all on production based compensation. If you’re on straight salary, if I’m your boss, I’ve got to look at the numbers at some point. So there’s ways to be more fair. There’s negative accruals, and there’s all these crazy things that go on with some of these things that are just out to lunch. But ultimately, I mean, we all want to believe we live in a meritocracy. You deserve, you earn what you get. And it’s largely that way.

Dr. Andy Roark:
Do you have to pry doctors’ fingers off of the steering wheel to get them to stay home? I run into this a lot. I think that there’s a lot of mentality of, I saw this case, I need to know what happened with the blood work. Or the results are coming back in and I need to be involved. And I’m like, “You need to be off. You need to be off.” Is that a common mentality you run into and what drives that?

Dr. Bob Lester:
I think it is common. And it’s not just doctors, it’s practice managers, it’s CVTs, it’s others. It goes back to that core that drew us to this profession. We want to give back, we want to fix, we want to give, but we can’t do that all the time. So yes, I do see that, and it is hard to let go. And you and I have probably been guilty of it more than once as well.

Dr. Andy Roark:
That’s very true. When you look in your crystal ball, what do you think 2023 is going to look like? Do you see significant changes? Do you see reduced caseload due to inflation or recession? I mean anything like that that you’re thinking? Is the current situation just going to continue on for another year? What are you kind of bracing yourself for?

Dr. Bob Lester:
Well, I am an optimist by choice. And the macro economy, are we heading for a recession, are we in a recession? I don’t pretend to be an economist. I can point to history and say, good economies and bad, our profession does pretty well. Should things soften, should there be less discretionary income, the bond will still be just as strong as it was before. And we’ve got so much pen up demand out there now that we’re booked so far out, it would take a pretty deep and long recession, I think, to make much dent.
So I see next year as hopefully it gets a little easier to bring on staff, that the hiring becomes a little simpler. I think the vet tech and DVM shortage are here to stay. That’s a chronic thing that we’re going to have to keep working on. And there’s great strides being made to address that. But as I look at my crystal ball, I’m pretty bullish on 2023. As a profession, we had such a whipsaw from COVID. There was a month or two there we wondered if we were going to be employed at all to being so busy we didn’t know how to keep up with it.
It’s tailed off a little bit this year, but we’re still growing. Our practice is growing double digits. And I think as an industry, we’re growing high single digits. Next year, that may grow a little bit, that may shrink a little bit, but we’re still going to be positive growth. I can’t imagine a deep and long enough recession in 2023 to put very much of a den in our profession. And frankly, if we slowed down a little bit, that wouldn’t be a bad thing. We’re still growing.

Dr. Andy Roark:
I agree with that. Dr. Bob Lester, thanks so much for being here. I always enjoy our conversations. Where can people find you online? Where can they learn more about WellHaven?

Dr. Bob Lester:
They can learn more about WellHaven by just looking up wellhavenpethealth.com, wellhaven.com, and they can reach me on LinkedIn, or they’re welcome to reach out directly through my email address, bob.lesterdbm@wellhaven.com.

Dr. Andy Roark:
Awesome. Thanks so much for being here. Have a great week everybody.

Dr. Bob Lester:
Always fun talking with you, Andy. Thank you.

Dr. Andy Roark:
And that is our show. Guys, I hope you enjoyed it. I hope you got something out of it. Big shout out to Dr. Bob Lester for being here. Really, really appreciate it. Guys, if you enjoy the episode, please, please, please, please, please give me an honest review wherever you get your podcast. Apple Podcast is the biggest place, and it really does make a big difference. It’s how people find the show. If you didn’t enjoy the show, then maybe write that down on a piece of paper, and just put it in a drawer somewhere. And just keep it. Just keep it. Just keep it there. Just kidding. I’m kidding. Anyway, guys, take care of yourselves. Be well. Talk to you later. Bye.

Filed Under: Podcast Tagged With: Team Culture, Wellness

Modern Marketing for Veterinary Practices

November 26, 2022 by Andy Roark DVM MS

Dr. Caitlin DeWilde joins the podcast to discuss modern veterinary marketing, how we communicate with pet owners when our caseloads are overflowing, and what the future of pet owner communications may look like.

Cone Of Shame Veterinary Podcast · COS – 172 – Modern Marketing For Veterinary Practices

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

LINKS

Links to Amazon.com are affiliate links and help support the show. (They’re also much smaller than normal links and easier to copy when typing up show notes!)

Caitlin DeWilde: @thesocialdvm

Social Media and Marketing for Veterinary Professionals:

https://amzn.to/3DgGrMA

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. Caitlin DeWilde is the founder of The Social DVM, a consulting firm devoted to helping veterinary professionals learn how to manage and grow their social media, online reputation and marketing strategies. Working with large industry groups and individual practices alike, Caitlin and her team are passionate about translating the “geek speak” to “veterinary speak,” and helping vets reach more clients and pets.

Caitlin is a graduate of the University of Illinois College of Veterinary Medicine and a recipient of their Outstanding Young Alumni Award, and also an alum of the AVMA’s Future Leaders Program. She served as medical director for a large AAHA/Fear Free/Cat-Friendly certified hospital in St. Louis before stepping back to focus on her marketing passion. Today, she divides her time between practice, consulting, and writing. She is the author of a new book, “Social Media and Marketing for Veterinary Professionals,” and a columnist for Today’s Veterinary Business.


EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome, everybody, to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here today with the one and only, the social deviant, Caitlin DeWilde. We are talking about her brand new book on Social Media and Marketing for Veterinary Professionals. We talk about the value of marketing today. What’s it look like when we’re completely overwhelmed? I asked some big eye level questions of, what’s the point, and how does this work, and how do we make it simple, and how do we make it work for most practices today? Caitlin has got great answers, and I really enjoyed it. I love marketing, I love talking marketing. But I like to think about it honestly and say, “Where’s the return on investment here? What this does this mean for pet owners and how we communicate with them?” I think this is a really good conversation around those things and about how to make marketing viable and useful for vet professionals.
Anyway, guys, I love this episode. Caitlin DeWilde is amazing, she’s a dear friend of mine, as you’ll tell in the episode, and I love spending time with her. So anyway, without further ado, let’s get into this episode.

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

Dr. Andy Roark:
Welcome to the podcast, Dr. Caitlin DeWilde, thanks for being here.

Dr. Caitlin DeWilde:
Hey, thanks for having me.

Dr. Andy Roark:
Oh, it is my pleasure. I am here, I am holding your book, Social Media and Marketing for Veterinary Professionals. How’s it feel to have this out in the world where people can pick it up?

Dr. Caitlin DeWilde:
Oh, I’m thrilled that it’s out there. I hope it’s helpful to anyone other than me or anything that’s not being used as a door stop, I’m pretty excited about it. I am really, really glad it’s out there and I hope it can help someone.

Dr. Andy Roark:
It’s an excellent book to write on. I use it as a lap desk and so if people are looking for alternate uses on a door stop, lap desk, things like that, it is an excellent book. I really, really like it. I really, really like it. We’re going to talk about it, we’re going to talk about marketing and vet medicine in a moment. I met you, I usually start the podcast by, if I know people, I start with how I met them. It’s just kind of a good refresher for me. I met you, you picked me up at the airport many years ago. Do you have any idea what year it was? I don’t even remember. It was a long time ago.

Dr. Caitlin DeWilde:
Probably like 2012, 2013.

Dr. Andy Roark:
Yeah, it was 10 years ago.

Dr. Caitlin DeWilde:
It’s been many [inaudible 00:02:33].

Dr. Andy Roark:
There’s been many minutes. You know, you were such a genius. I want to pause here for a second and just say, I talk about mentorship, okay. So, I don’t know if this comes off the right way. So you picked me up and you were like, “I’ll pick Andy up at the airport,” and I didn’t know you and you picked me up and you were like, “Can we get dinner?” And I said, “Sure.” And we went to dinner and you were planning on launching your consultancy and you were practicing full time and you were thinking about making the switch over and doing some speaking and some consulting and things like that. And we went to dinner. And one of the things I always tell people when we talk about mentorship, I said, “You know, the way mentorship really happens is tell somebody what you’re working on and then ask them specific questions.”
Because I think a lot of people are like, I want to mentor. And they look at me and I’m like, “I don’t know how to help you.” Or they look at anybody else. But you came and you were like, “This is the plan that I have and these are the things that I have questions about or that I wonder about or that I’m struggling with. And I would, will you answer my questions?” And the answer, of course, is yes, best I can. But I remember that being a wildly productive dinner and we just banged out a bunch of the logistics of getting your business up and going, and you were hugely successful. Now, you were going to be hugely successful no matter what. But boy, when I think about people who took advantage of a situation in a really great way and said, “I had this opportunity, I’m going to get the most out of this time,” when you and I went to dinner and you were just like, “This is my business play.” And I was like, “This is great. This is the most interesting dinner I’ve had in a long time.”

Dr. Caitlin DeWilde:
I think we should point out that I didn’t just pick you randomly at the airport.

Dr. Andy Roark:
I thought you were fine to me. Yeah, no, I didn’t get into a car for a stranger.

Dr. Caitlin DeWilde:
Because that could be perceived as a different way to get a new mentor.

Dr. Andy Roark:
Yeah, that’s exactly right.

Dr. Caitlin DeWilde:
Maybe not as…

Dr. Andy Roark:
Yeah…

Dr. Caitlin DeWilde:
No, yeah, for sure. No, you were very helpful to me and others. That’s what I needed was somebody to just be like, “That’s a terrible idea.”

Dr. Andy Roark:
I didn’t…

Dr. Caitlin DeWilde:
“That’s like you, you’re fine.”

Dr. Andy Roark:
You were fine. You were more than fine from the very beginning. I did not say it was a terrible idea. All right, let’s talk. So since that fateful evening of us having dinner, you have, you’ve done a lot, you run your consultancy, you are an international speaker, you write magazine articles all over the place. You write for today’s veterinary business. I see you in there every other month when it comes out. You’ve written for DVM 360, you’ve come to Unchartered and lectured for us a number of times. I hired you recently when I needed help in my business. I’m just being honest, I needed some help with a significant marketing project that we were running and we just didn’t have the bandwidth inside the team. And somebody said we should bring Caitlin in. She’s amazing and you know she’s incredible. And I did. And I sent you a thank you note because that’s how good you were.
You were amazing. And so anyway, she is, she’s that good. So anyway, you are that good. Let’s talk a bit about your book. I just want to point the elephant in the room. Whenever I start to talk about marketing, I love to talk about marketing and one of the biggest pushbacks to just talking about marketing that I get, is that people say, “Hey look, we are slammed. We are so busy, we can’t do all of this work. Why do we need to be talking about marketing right now?” And so I want to just open up with a question of what’s the point of marketing when we’re completely kind of overwhelmed? How do you look at that?

Dr. Caitlin DeWilde:
So it’s a loaded question, I’ll be honest. I look at it differently a little bit every day, right? ‘Cause it changes, unfortunately a lot of times, which makes it harder to answer. And I’m going to be kind of a jerk and answer with a not real answer, which is that it totally depends. And I think that’s what a lot of people are looking for. They want one very clear, obviously you do it because of this one statistic or this fact or this obvious answer. And that’s not the case. So the reason I do marketing for my practice is totally different from why you do marketing as your business, why my best friends practice down the road does marketing, it’s totally different and what it is right now, it’s unlikely to be the reason you’re doing it 3, 6, 9 months, 12 months from now. Which when you answer that, people are like, blah.

Dr. Andy Roark:
No, I think that’s true. I think that’s a great answer. And I think it brings us to the next obvious question, which is, well we need to define terms then. What is marketing? I think a lot of people still think marketing and advertising are synonyms. And they were for a long time, marketing and advertising were the same. And then 10 years ago, 15 years ago, they really started to diverge. And I would say they’re very different things. So when we say marketing for veterinary professionals, what does that mean? What are we talking about?

Dr. Caitlin DeWilde:
The way I like to frame it, and I’ve found myself using this term a lot lately, and I don’t know if I made it up or if it’s a real term or what, but I really like to think of it as multi-modal marketing because I think so many people, like you said, are just like, “Oh, marketing, it’s your social media or it’s your website or it’s your, God forbid yellow pages ad or something like that,” but really it’s just like we would handle complex disease. It’s the same thing for our practices. So marketing to me is anything that goes out from your clinic and touches a client and not in a creepy way.

Dr. Andy Roark:
But that’s also marketing. That’s probably not good marketing. But…

Dr. Caitlin DeWilde:
Yeah, probably wouldn’t recommend it, put it lower on the list. But I think a lot of people don’t think about, I think reminders are marketing and a lot of people are like, “What are you talking about?” I think it goes so far beyond social media. It’s social, it’s your website, it’s your app, it’s your signage, it’s your client education handouts, it’s your reminders and emails that are going out. So to me, that’s why I say kind of multi-modal to make that transition to our normal way of thinking in that med.

Dr. Andy Roark:
Yeah. Well I think that’s the answer to the first question. When I say, “Well, what’s the point?” It sounds like, to me, to summarize and I’ve thought about this for a long time, I would say that marketing is just, it’s talking to pet owners outside your practice. And you might even say it’s talking to pet owners inside your practice, but just to make it simple, I would say any communication you do with pet owners who are your clients outside of your practice, that’s marketing. And so absolutely, reminders, to me, fall into marketing and I’ll put it forward. I’ve worked with a number of practices and something happens and the reminder system gets shut down and buddy, you’ll see your appointment schedule open wide up really fast. And if that’s not the [inaudible 00:09:51] of effective marketing is when you stop and business stops coming through the door, you know that you were doing something important before you stopped.
And I’ve just seen that with the reminders and stuff. So I think of it a lot as just it’s how we talk to pet owners and you can say, “I know you’re totally slammed.” Communication with pet owners is still vital. And I would say honestly, I think probably effective communication, smart communication is more effect… Is more important when we are really busy than it is when we’re not really busy. I think that if we take it back to communication, you say, what’s your email newsletter? What do your reminders look like? Are you making it possible to book appointments online? I think all those things for me absolutely fall under marketing, text space, communication, anything like that. I go, these things can be efficiencies inside your practice. And I would still put them under the category of marketing or they’re through marketing pathways. Do you agree?

Dr. Caitlin DeWilde:
Yeah, 100%. I think, again, a lot of people now are like, “Oh, I’m not accepting new clients or our schedules booked so I can’t want to think about marketing.” But the reality is you could instead be using that marketing to help save your team time or you could be using it, get clients to take more efficient ways, have them book online instead of calling or have them use your refill service instead of showing up at 4:55 wanting their 360 [inaudible 00:11:19] in quarters. There’s other things you can do with those channels.

Dr. Andy Roark:
Yeah, that makes sense to me too. So let’s unpack this a little bit more. Talk to me about marketing for the sake of efficiency. So if we’re talking about pushing this communications outside, I love the refills for medications, that is when I still see people taking phone calls and writing these things down and it’s just adding to the load on the front desk and people are calling multiple times and asking about their stuff and you go, this could all be automated, it could all be moved to a different pathway that would make everything run a lot more smoothly. What are some other sort of communication strategies that you see that make businesses run more efficiently?

Dr. Caitlin DeWilde:
Yeah, I think the refills has been a huge one. Online booking, the average appointment takes eight minutes to make on a phone and zero minutes to make online. And even if you don’t have real-time booking, even an appointment request form. So directing people to that URL using app chat or telemedicine at all, if your practice does that, any of the texting based services, those or anything that you can take it to be asynchronous, meaning somebody can batch process these things instead of waiting until they get off the phone I think is really, really important.

Dr. Andy Roark:
Do you think that that marketing is growing as far as how much effort it sort of takes? It used to feel like marketing was this little thing we kind of did on the side, we did some flyers, we got the value pack. And then social media started…

Dr. Caitlin DeWilde:
Yeah, yeah.

Dr. Andy Roark:
We’re like, we’re going to have a Facebook page and now it feels like this sprawling thing. I love that you used the word multi-modal. I had actually in prep for the interview, which I’m going to mention because I actually prepped for this interview. And so I’m going to throw that out that prep actually happened. In prep for this interview, as I do, I actually wrote down the word multi-modal because that’s what it seems like. It’s my impression that marketing has gotten more complicated and more, sort of, intertwined across platforms and things like that. And it seems like a much bigger effort than it used to be. Do you think that that’s true? And do you see practices that sort of struggle to be like, “I don’t even know where to get started.” How do I make, what’s the minimum viable product here? What is the most elegant little thing I can do to start to be effective in my marketing?

Dr. Caitlin DeWilde:
Yeah, I think, I’ll be honest, I think that it is something that honestly, most practices are getting to a point where they need someone to be their marketing person. And I hate to say marketing, exclusively, because really at what I would call it is our communications person. Because the minimum viable product to me, is making sure that whatever the channels you use, they all say the same thing and they’re all effective. Because that’s what happens, you’re outsourcing your social media to the new kennel assistant because they’re under the age of 40 and that person has no idea what the reminders say and that person doesn’t know what the tech’s are saying in the exam room because your handout says something totally different. So I mean, realistically to me, if you’re more than a one doctor practice, you need somebody doing this and it’s almost becoming a full time position, which is a hard pill for a lot of practices to swallow that idea.
But I think that’s where it’s going and where it’s headed. Now that does not mean you need to be on every stinking platform, and I think that’s the societal pressure that’s happening now. I probably get the question, “Do I need to be on TikTok every week?” And it’s, the answer is, maybe. But I don’t think that, right now, until we get to where practices do have someone or do work with companies or do have a plan in place to handle all of that, it’s impossible to do a good job on every one of them. So I think to me, the one thing that you could do that would make a difference and would give you that minimum product is to talk to your top people and ask them, where do they want to communicate with you?

Dr. Andy Roark:
By top people you mean your A clients?

Dr. Caitlin DeWilde:
Yeah, A clients. The people that you see the schedule and you’re like, “Yay.” Instead of like, “Oh God.”

Dr. Andy Roark:
Yeah, I agree. I feel that. I completely agree with that. Okay, talk to me about interconnectedness of services. So we’re talking about, do we need to be everywhere and I’m going to do this and I’m going to do that. And we talk about marketing, we’re talking about website, we’re talking about, there’s a lot of people encouraging blog content, there is social media, there’s email reminders, there’s newsletters, which is sort of regular ongoing email communication and content. There’s text reminders, all of these sorts of things. It’s been my impression that as things have gotten more complicated, you can’t really pick up one thing and just do it exclusively anymore. And you can push back on that if you want to. But I think that we’re at a place where you need to have a couple of things and they need to be aligned and sort of interconnected so that they support each other.
Can you talk to me a little bit about that? First of all, do you agree with that? And then can start to, let’s paint a picture about what this interconnectedness of different services looks like. Because I want people to not be overwhelmed by all the things out there. ‘Cause I agree with you, I think trying to be everywhere is lunacy. I struggle to get my head around a return on investment for TikTok and there’s a lot of people who give me a hard time about that and they point out that I am not in my 30s anymore or my 20s or in my teens, very much. So anyway, let’s talk about how these things kind of work together, how they should work together, and what sort of an interconnected marketing plan looks like that’s not completely overwhelming, knowing that it’s going to be different for every practice.

Dr. Caitlin DeWilde:
So I think the good news is there’s a lot of, I want to say hacks or software that can help you do some of the things and push it out to multiple places. And I think it’s really important to start by knowing why are you doing marketing to begin with and what are our key points of messaging that support that. If you do that, if you have very clear about what those two things are, then it’s much easier to make sure they all say the same. I think when you figure out, with your eight clients and with the things that help your practice that you know have made a difference, I would start there and look at them because I think that’s the mistake that a lot of practices make is that they don’t think about updating. I just worked with someone that still had curbside stuff on their automatic responses because they just hadn’t reevaluated.
And the good news is a lot of the services that we’re talking about, working with your app, working with social media, working with email, a lot of these things you can invest 30 minutes or less and update them, but if you haven’t looked at them in two years, then they’re unlikely to jive. So, I think the first thing you have to do is know your why, know your key messaging. The next thing you have to do is look at what you’re already sending and you might get overwhelmed there because if you’re using Facebook and Instagram and email and app and website, it might get overwhelming. So pick one every month, update it and go through the line. I think that’s a more doable response for a lot of practices.

Dr. Andy Roark:
What is the most important platform for… What’s your most important marketing asset? Let me just give it to you like that. We talk a lot about where we invest in, for you number one, and we talk about what is your objectives, but where do you, Caitlin DeWilde, when you walk in, it’s first day, day one, you’re like, this is the thing we’re going to fix first.

Dr. Caitlin DeWilde:
I want to get email addresses.

Dr. Andy Roark:
Yeah. Tell me about that.

Dr. Caitlin DeWilde:
And that’s probably a bit of a surprise…

Dr. Andy Roark:
I love it.

Dr. Caitlin DeWilde:
To some people, but realistically we don’t own anything. Facebook and it’s… Instagram today is down totally down. We don’t own anything that’s on Facebook. It could get hacked or deleted and we could lose it all in a second and we would have no backup. Email, if they’re actually a good email address, is emails like a gateway drug. You can get into all kinds of different platforms if you have someone’s email and if it’s the right email. So I think when I see practices that don’t ask, that’s a huge missed opportunity because you can build audiences and target people based on their email address in all of the social media platforms. You could yourself email them natively or through an email marketing app, there’s a lot of opportunities there and it’s the one thing that we can own and we can take with us no matter what platform you’re losing or you’re using, not losing.

Dr. Andy Roark:
Guys, I just want to jump in here real quick with one quick announcement. If you’re a practice owner, the Uncharted Practice Owner Summit is coming. It is me and my friend Stephanie Goss, the practice management guru. We are going to be leading that, heading that up. It is in person in Greenville, South Carolina. If you are a practice owner and you’re like, “Man, I want to go to a thing that’s only practice owners and work with other practice owners,” head over to unchartedvet.dot com and check out what we’re doing. Guys, that’s it from me. Let’s get back into the episode.
I’ll tell you a story. I don’t know if I told you this. I lost 40% of my Facebook traffic in one week one time. And so to set the stage, we built this, my team had built up the Dr. Andy Roark Facebook page, which was, it’s got 300 and some thousand followers. But boy, I tell you, we were reaching a million people a week through Facebook just again and again and again. Just count it every week. And then the 2016 election happened and then there were outcries about fake news and then all of a sudden we were not reaching a million people a week. We were nowhere close to it and we never ever got back. And it was just absolutely hammered. It was like us, they turned off the spigot and that was that and I’ve always been, I still am angry about that, it’s been six years, still angry.
How dare you. But I, who cares, the world moves on for sure, but just as an example. But it’ll happen with any other social media platform. Always just remember that you don’t own anything and no one’s there to hear you scream when you have to switch and you can no longer reach your people. Just, and the lesson for me was just count on it. Just count on it happening. Do social media with the full knowledge that they are going to, you are going to get screwed and they’re not going to care. It’s a question of when, as long as you go in with eyes wide open and say this is what I’m doing. There is a return on investment right now and the whole time I am using this to generate clients that I will actually see in my practice that I can build loyalty with and can actually turn into repeat loyal customers who are still going to come if social media just disappears.
I think that that’s really the thing for me. I still think probably the biggest one for me, Caitlin, is the website. And I think a lot of the website maybe doesn’t feel as important as it used to. In the heyday of social media, it really didn’t feel very important to me because you could just be on social and you were so easy to find. But going back today, the way we set up our website, the way it presents our staff, our doctors, the way it humanizes us, presents a face, so the way it gets, hopefully it collect, I’d love for it, collect email addresses, the way it sets up text messaging with my clients, the way it helps book reminders or appointments, things like that. To me it kind of is the bedrock for all of our outreach and I feel like it’s smart to try to continue to keep that up as the face of our practice. But social media can come and go, but you own your website and you own the story that it tells.

Dr. Caitlin DeWilde:
Yeah, I think it’s a solid foundation. You can’t… All the other things kind of build the house on top of it? But I think you’re right, that there’s a good solid reason to invest some serious time in that and to make sure, again, that it’s a piece of the puzzle that not just serves as a hub of information but shows your people and what makes you different.

Dr. Andy Roark:
Well, I love that you said emails. I just think that that’s really smart. People respond to emails in a way that they do not respond on social media. And I say this as a guy who’s had a lot of experience with social media and getting people to take action on social media and a pretty good amount of experience with emails. And I can tell you there’s no comparison between the two of them. They really are. And I think that for a lot of small businesses, I think the move to texting has been pretty profound since the pandemic. But I found that the price of texting has gone up since the pandemic hit. And people, I think people are suddenly like, “Oh this is super popular.” The price of being able to text has gone up a lot from what it used to be. But I still think going forward, text messages actually appear on people’s phones and they actually read them. I think a lot of us have really full inboxes and so there could very much be a good return on investment.

Dr. Caitlin DeWilde:
And clinics are not great at asking clients. And I’ve noticed that several of the new software programs, practice management softwares will ask, not only can you put this information in, but which is their preference, right? ‘Cause there’s nothing worse than that calling someone for blood work results and they never answer their phone, right? So, to me, it’s still email because I can use that information to target on social media and I can use it as a communication, but if a client only wants to text, that’s totally fine. I just want to know that so I’m not wasting my time. Or to your point, cost, if you’re paying per text message, which a lot of the services are, if the client doesn’t want a text and they prefer an email or they prefer a phone call, then why are we spending our money in time and effort doing it? So I think that’s a second point for that.

Dr. Andy Roark:
Talk to me about paid advertising. So we talk about using email addresses to do targeted advertising. It’s been my impression that social media has very much gone pay to play and I think paid advertising is probably the best use of social media as far as getting a return on investment. How does that sound when you hear me say it? Do you agree? Am I close to right or am I way off the reservation?

Dr. Caitlin DeWilde:
No, you’re right. I definitely agree. If you’re not spending any money, you, no matter what you’re doing, it could be the best content in the world. If you’ve not spent money on your page in the past few months, I hope your mom enjoys it, because that’s the only person who’s going to like it, right? Like, it’s just like…

Dr. Andy Roark:
So brutal.

Dr. Caitlin DeWilde:
I’m just going to call it…

Dr. Andy Roark:
Yeah, no, I love it. You’re right. I agree.

Dr. Caitlin DeWilde:
It’s frustrating to me because I see some really creative and really emotional effort and heartfelt effort…

Dr. Andy Roark:
Thank you.

Dr. Caitlin DeWilde:
Putting out great content, and no one sees it [inaudible 00:27:01]. Oh, it’s so sad, right? But that’s the reality. There are some people that will not spend a single dollar on Facebook or Instagram and I’m like, “What are you doing?” So I think that if you’re not doing that, it’s a mistake. And it’s really the only way, and this is another soapbox of mine, it’s the only way to get targeted. I don’t care if somebody in Arizona or in Germany sees a great, awesome video I made for my practice in St. Louis. If you’re not going to bring your pet in and spend some money and be nice to my team, then I don’t really care about you.

Dr. Andy Roark:
I had…

Dr. Caitlin DeWilde:
So again, brutal.

Dr. Andy Roark:
I had this…

Dr. Caitlin DeWilde:
I just feel that way.

Dr. Andy Roark:
I had this practice email me years ago and they emailed me and they said, “Hey, we have a problem. Every time we put up an educational picture like radiographs or something, we lose 20 social media subscribers.” And I went and I looked and there’s this little practice and they have 40,000 social medias on Facebook, they had 40,000 Facebook followers. And that one, I think it was one, the owners of the practice was like a photographer. And she was amazing. And she painted these amazing pictures of pets, and I was like, “You, you’re entertaining the world with your beautiful photography, but these people are not here for your veterinary services at all.” And so whenever she put a bot fly, people were like, “Oh my god.” And they’re just fleeing. So I sound down on social media, the truth is, I think social media for your bang buck is still pretty flipping fantastic.
But you have to be smarter about it and it’s a 100% pay to play. I look at social media a lot like the radio, I think. Meaning, it’s pay to play. You better plan on paying money for your promotions to get out into the world. And so I don’t expect my local radio stations to play whatever I have to say to the pet owners. I’m not going to plan for social media to show whatever I made to pet owners in my area. They’ve just made it clear that’s their game is they want to be the radio. They want you to pay to run your content. And if you just accept that, then what you can do with targeting is really amazing. And the truth is, when we’re up against other businesses that are trying to run ads, guys, we have the potential to crush because we’re a vet clinic, everybody wants to see what we’re doing. Can you imagine trying to get your auto mechanic ads to show up or “Hey, I’m Dale from Comcast, look at my YouTube show.” No, Dale.

Dr. Caitlin DeWilde:
Yeah. Sweet muffler. Yeah, I like to think about it. I really have had to reframe it with myself and several of my clients. To me, the paying on social media is, it unlocks targeting. So you’re not just paying to boost it, you’re unlocking the ability to make sure your post is seen by the people you care about and that you actually want. And so if you think, I think that reframing has helped a lot of people. So hopefully it helps somebody that’s listening to this now.

Dr. Andy Roark:
Yeah, I want to give people, a lot of people, myself included, the biggest pain point for me was that I used to do social media and never paid anything and it was great and everybody saw it. And it’s just the acceptance of those days are over. It’s almost like if I came into marketing right now, I would look around and go, this is pretty good deal. But I didn’t, I came into it when it was free and I’m like, this is a terrible deal. This is horrible compared to what it used to be and…

Dr. Caitlin DeWilde:
How come I didn’t get 400 likes on this post for free?

Dr. Andy Roark:
Yeah, I know. It’s soul crushing. So, yeah…

Dr. Caitlin DeWilde:
You got to let it go, man.

Dr. Andy Roark:
I know.

Dr. Caitlin DeWilde:
We already had a Frozen reference. You got to let it go.

Dr. Andy Roark:
Let it go. Yeah. I think that was before, I think it was before we started recording, but yeah.

Dr. Caitlin DeWilde:
Oh, sorry.

Dr. Andy Roark:
No, it’s okay. Now people know what we talk about before we record. It’s Frozen.

Dr. Caitlin DeWilde:
It’s Frozen.

Dr. Andy Roark:
So let’s talk about return on investment, right? ‘Cause that’s the other question is you go, “Well now they’re talking about paying to target ads and things and how do we know that this makes sense?” I think for a lot of people this is absolutely crucial is that we say, “Hey, you’ve got to look at your return on investment here.” And I think that that can make a lot of sense for people. But I’ve found that this is wildly frustrating to actually do. And so let me stop there and just of say, talk to me a little bit about return on investment. You’ve got a whole chapter in your book on ROI, I love it. I think it’s great. But lay, lay out how you look at this for me please.

Dr. Caitlin DeWilde:
It is, it’s a tricky and frustrating topic like you said and it’s a very common question, right? And so I think that some key points to know are, you can track some of it, but you have to put some measures in place. And we could talk about that a little bit more. I think it’s important that when people are spending money and time, the key thing I see a lot of veterinary professionals missing is that they don’t go back to look at it. So I think right now there’s a big, just like with social media in general, I have clients that all the time I’ll say, “Why are you doing social?” And they’ll say, “Because you’re supposed to.” And I don’t want that to be true for spending money. I don’t want you just boosting and spending ads because you’re supposed to. That’s not going to work and that’s going to make it impossible for you to track.
So I think key things are, think about looking at those booths or those posts or those ads that you make. Did it work? If so, spend more money. If not, you can turn it off which is also a good, wonderful thing. But I think we really need to get a handle on what does it cost? What are you comfortable spending to get a new client or to get a booked appointment? In general, I think my third point that I’ll say is I think a lot of people think about this only from a time standpoint. And to me it’s valuable or essential even that you also consider the time and energy you’re putting into this content. So, there’s a labor cost, right? To create content to deploy it, things like that. So those are kind of my soapboxes. And I know we’re don’t have eight hours because I could talk about it for eight hours.
But think about if you just want to track money, that’s fine, that’s easy to do in the software. But that’s only on your Facebook ads and your Facebook boost and Instagram promoted posts, that’s not the whole picture, right? So that’s where it gets tricky. You need to think about, “Well how much time went into that? How many hours did I pay that staff member to do this stuff?” So, that’s number one. Number two, you got to have somebody looking at this stuff and knowing, did it pay off or not? And then you have to be willing to invest that time in tracking. You can do all kinds of nerdy stuff, you can put a pixel on your website, you can have whole other softwares that track your exact down to the cent, how much did this new client cost me? But if you don’t know why you’re doing it, then it’s not going to work out, right? It’s not going to be worth your effort. In even trying to track it. I was a little bit all over the place, but hopefully that gave you a few nuggets.

Dr. Andy Roark:
No, I like it. I like it. Yes, it’s generally, I found this to be very frustrating. I’ll tell you. Well, I’ll tell you a story. So let’s just imagine for a second that we run a vet clinic and Mrs. Jenkins is out with her dog at the dog park and she’s with her best friend. And she says to her best friend, where do you take your pet? And the woman says, Andy and Caitlin’s practice. And then she goes home and she Googles Andy and Caitlin’s practice and she sees all the reviews and she looks around all of our website and she goes, “Oh, next time I need to go to the vet, I might go there.” And then she leaves and she goes somewhere else and she talks to someone else who also says that we’re great. And then she goes home and she logs onto social media and there’s an ad for Andy and Caitlin’s practice.
She’s like, “You know what, let’s go ahead and talk to them.” And she clicks the button and then Facebook is like, we made a sale. Look at we, that’s a Facebook sale. And you’re like, “That is not a Facebook sale, that was six other people that was,” honestly, Mrs. Jenkins’ friend of the dog park is probably the driver there. It just happened to be that there was an ad that says, click here to make an appointment in front of her face. And so then you see this inflated value and this, now it works the other way too, where people see social media content all day long and then they go to your website directly and then make an appointment.
And there’s no obvious tracked return on investment. But you definitely made an impact. I look back at my own career and say, my wife used to be like, “Why are you spending so much time on Facebook for God’s sakes?” And I don’t know how I, you could never track a thing that says, I spent this amount of time and energy on Facebook and as a result, this is what I got to do later in my career. But I’m confident that they are absolutely related, there’s no way they’re not. But I can’t prove that correlation at all.

Dr. Caitlin DeWilde:
Right. And most people can’t. Even me, I do a lot of ROI tracking for my practice alone, just for purely experimental reasons, and I won’t say it’s perfect. But I do think a lot of clinics are not even trying, they’ve just assumed that it’s not. And I think the easiest thing is if you’re using marketing to get new clients, then the easiest thing is to ask them when they come in for their first appointment, that’s the one thing that’s like the baby ROI tracking is to say, “Okay, add that to your client referral source tracking and actually run that.” If you do nothing else, that’s the first thing. So you could say, “Oh, this quarter I got seven new clients from Facebook.” And then you know that you spent this much time and this much money on Facebook that costs this much for clients.

Dr. Andy Roark:
Yeah.

Dr. Caitlin DeWilde:
Was it worth it?

Dr. Andy Roark:
That is the simple hack that I highly recommend. ‘Cause Facebook will be like, “Look at these insights. It’s a spreadsheet that goes on for miles,” and none of it’s really useful. And the truth is just ask people, “Hey, what would you say the number one reason you came in here was?” And they’re like, “Oh, Facebook.” “Great, thanks bud.” And that’s the actual rubber meeting the road of the person coming into your practice, I think old school af, but still works really, really well.

Dr. Caitlin DeWilde:
Agree, agree.

Dr. Andy Roark:
Awesome. Talk to me a little bit about outsourcing for marketing, because I agree with you. I think that in a lot of ways the complexity of, in a lot of ways the complexity of marketing and communication has continued to grow. And I think that you’re right about a position in larger practices, for sure, of someone who just oversees this. I can see in a lot of smaller practices, people saying, “We don’t have that capacity here. I need to get some help.” Can you kind of lay out the landscape a little bit of what does outsourcing marketing look like today when it’s so tied into our PIM system, into our reminders, into how we communicate, give me some advice on how a practice might go about engaging in that.

Dr. Caitlin DeWilde:
Yeah, totally. Totally a common, again, common question, common concern. And the reality is that for many, many years, and I think you and I’ve spoken about this before, I have been the hugest proponent of, “No, you should do it in house.” And that’s what I love to do is train people to do it. You have someone that has the interest and has the time. It’s always going to be best done by somebody that’s on the ground, knows the clinic, knows the practice, knows the clients. That is a reality most practices cannot now justify, right?

Dr. Andy Roark:
Yeah, it’s hard if you, that’s a hard pill to swallow, but it’s true.

Dr. Caitlin DeWilde:
But you got to be on the floor. You got to be seeing appointments, right? I need you in surgery. I don’t have time for this. So I think what makes sense for many practices is to do an audit of what it is that they really want to do, what amount of time they can realistically contribute. And from there maybe that person who actually was interested and actually wanted to do it, they work with someone to make sure that it gets done. Because a lot of times the ideas and the why’s and the passion can still come from the practice, but maybe there’s someone else that can take care of actually deploying it. The biggest example I’ll give the for this is video. So everyone knows video is key, video does great on social media. Sometimes we like creating video or capturing it. Let’s not say creating. How many million videos do you have from your practice on your phone that have never left your phone because they need editing?
They need branded with a clinic name. They need a call to action and a caption. And I think you should still get credit for capturing the video because you have that relationship that you were able to capture the video and you knew and recognized that this could be valuable marketing material, but outsourcing it to someone on any number of companies to actually edit it and get it done and posted is a beautiful thing. And you should still get credit for doing that. And I think that’s kind of the hybrid model that a lot of practices need to adopt.
They need to figure out what can they do very easily and still get their mission and their passion and their why accomplished, but how can they hand it off to someone who actually gets it done? I think that hybrid model needs to be promoted a little bit more because realistically, even for us, I outsource all of our video editing, I hate video editing. I’m terrible at it. So it’s totally worth it to me to pay someone on a service to edit it and then it’s done and it can be actually used. So I think the hybrid is where a lot of practices are headed.

Dr. Andy Roark:
I love it. That makes a ton of sense. Caitlin DeWilde, you are the author of the new book, Social Media and Marketing for Veterinary Professionals. I’ll put a link in the show notes for people to pick it up. If you’re a practice manager and your practice is doing a fair amount of marketing or if an area you’re interested in growing in, you should grab a copy and have it on your shelf. Caitlin, where can people find you online? Where can they learn more?

Dr. Caitlin DeWilde:
I would love to connect with anyone that is nerdy about this stuff or wants to be nerdy about it. And you can find me at the social DBM on all the social channels, of course, or at thesocialdbm.com or heywhatsup@thesocialdvm.com if you want to send me an email.

Dr. Andy Roark:
Perfect. Awesome. Well, thanks so much for being here. Guys, take care of yourselves.

Dr. Caitlin DeWilde:
Bye everyone.

Dr. Andy Roark:
And that’s it, guys. That’s what I got for you. I hope you enjoyed it. I hope it was a fun conversation for you guys. It certainly was for me. Anyway, if this is helpful, if you love it, one, get Caitlin’s book and number two, write me an artist review wherever you get your podcast. Apple, the Apple Podcast app is a huge place where most people find their podcasts, and honestly, if you could leave me a quick review there, it really means the world to me. But anyway, guys, take care of yourselves. Be well. I’ll talk to you later on. All right, bye.

Filed Under: Podcast Tagged With: Life With Clients

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