Dr. Jessica Vogelsang, Chief Medical Officer at the American Animal Hospital Association (AAHA), joins us to discuss the evolving role of veterinarians in modern veterinary practices. Dr. Vogelsang introduces the concept of “decentering” the veterinarian to create a more team-based approach that places the patient at the heart of care, similar to patient-centered models in human medicine. She explains how this shift can improve efficiency and client satisfaction by empowering veterinary technicians and support staff to handle many tasks traditionally managed by DVMs. Together, Dr. Andy Roark and Dr. Vogelsang explore the barriers to this model, including liability concerns and the importance of training and trust in a collaborative practice. This thought-provoking conversation is a must-listen for anyone interested in the future of veterinary medicine and the evolving dynamics within the field.
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ABOUT OUR GUEST
Dr. Jessica Vogelsang is a noted veterinarian, internationally recognized speaker, and bestselling author of All Dogs Go to Kevin. She serves as the Chief Medical Officer at AAHA and is the founder of Pawcurious Media, established in 2009. An early adopter in utilizing the internet for veterinary purposes, she successfully built an online community, influencing hundreds of thousands of pet owners globally. Her achievements include launching several veterinary brands and founding the Veterinary Telemedicine community during the COVID-19 pandemic. Besides her role at AAHA, she is an active board member of the Mark Morris Institute and the Veterinary Virtual Care Association.
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host Dr. Andy Roark. Guys, I am here with one of my dear good friends Dr. Jessica Vogelsang. She is amazing. She is one of those people who really makes me think we are talking about Is it time to decenter the veterinarian from veterinary care?
Don’t have an aneurysm. Just it’s a very provocative title. It is A very good grounded discussion that’s probably not going to panic anybody, but it is a good place to start thinking about what care should look like in the future and the role of veterinarians going forward. So anyway, I really enjoy this.
I hope you guys are going to get it and get a lot of it. It’s just really smart to start thinking about what practice going forward will look like. I think there’s some really good practical actionable tips in here. Yeah, I hope you guys will enjoy it. I’m going to stop talking now and let you guys get into the episode.
Kelsey Beth Carpenter: This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast. Dr. Jessica Vogelsang, how are you?
Dr. Jessica Vogelsang: Hello. Hello, I’m good. How are you?
Dr. Andy Roark: I am good. It’s good to have you back on the podcast. The last time you were here, we were talking about the retention study from the American Animal Hospital Association. For those who don’t know you, you are the Chief Medical Officer at the American Animal Hospital Association, but we’re not talking about AAHA stuff specifically today. You and I have just been kicking around some ideas recently and I said, what are you excited to talk about? And one of the ideas that you had that you’ve been thinking about that immediately got me interested and excited was the idea that may be time decenter the DVM from the delivery of veterinary services.
Did I quote you correctly on that? Do you believe that it might be time to decenter? What do you even
mean when you say that?
Dr. Jessica Vogelsang: when you think about models of care, right, who is the primary decision maker who directs the whole cycle of care in human medicine, they’ve gotten away from this sort of physician centered care and they talk about patient centered care. And so the patient is at the center of the wheel and there’s all these different little hub and spokes.
You have your nursing care your doctors, your specialists, and they all coordinate together to funnel into this patient. And in veterinary medicine, I think we, we think we work that way, but in actuality, we don’t, we’re still very DVM centered. And really what actually represented this for me and got me thinking about it was I was looking at something actually about telehealth and VCPR.
And there was a diagram about how you know, care is delivered to patients, but it’s still the vet at the center of it. And the patient was kind of off on the side. It’s oh, they’re talking to this person, they’re talking to that person, but why is it the patient? at the center. And so it started this whole sort of rabbit hole that I went down asking questions about, do we actually perform team based medicine in veterinary medicine?
So you can look at it in different ways. There’s, it’s all going at the same thing. But in order to provide really patient centered care, you need a team based approach, which involves the veterinarian sort of decentering themselves from being the one and only person through which all information and decisions are funneled.
And that’s It’s very hard for many, many reasons as I’ve been learning over the last year, but it’s an important conversation for us to have.
Dr. Andy Roark: When we start to talk about this and the idea that it is possible to have the patient in the center of the, of the spoken wheel, if you will, it seems like there’s pretty fundamental changes there. So before I start to ask too many questions about this, can you paint me a picture, Jessica, of what this might actually look like in practice?
What would the experience be like in an imaginary vet hospital that has this decenter DVM approach? In which they have the pain. The administration in the center of the wheel. How does that even look?
Dr. Jessica Vogelsang: There’s sort of different layers of the onion, right? Like part of it is just what happens inside the clinic. Part of it is, are you plugged into the community, right? To, to other people who have a stake in this person and their family and their lives. But inside the clinic itself, really in terms of workflow at its most basic level, it is a veterinarian doing the things for which a DVM is required.
So diagnosing, prescribing, prognosing, performing surgery, and your team does really, everything else. That is it at its most fundamental core. That is the core of workplace efficiency. Leveraging your technicians, as a profession, I think that’s been our first sort of dig into exploring this is in the conversation surrounding technician utilization.
Okay. Well, what does that mean? It means that the technician does everything that they’re legally allowed to do, depending on your state practice act. And then the veterinarian just does the stuff that, that they need to do. And even that one little thing, you immediately run into a brick wall.
It’s how do I trust that they’re going to do it? Why do we have veterinarians out there writing prescriptions? Do they need to actually be like, they need to be the one to determine what the prescription is, but they, do they need to be the one to enter it into the record? Do they need to be the one to like count out the pills?
And some people say, yes, some people say no. So how do you even begin to have those conversations about truly understanding? roles and responsibilities. How do you delegate? And, once you decide, yes, I know that this is what this person should do. Do I trust them to do it? And if not, why not?
Who’s responsible for determining if that person has the right skill sets? who’s liable if they don’t do it right. There’s a lot of things that separate how veterinary medicine works from human medicine. So it’s not like you can just go up to a vet and say, just trust him. It’s fine. But it’s worth going down that hole and trying to play it out.
I mean, there are clinics that function that way. I was talking with Mark Thompson. He’s the president of AAHA this year and he, I think he sees 50 patients a day and I couldn’t get my head around that 50 patients a day. He works from nine to five and everybody leaves on time. I think his technician to DVM ratio is, is something It’s like eight to one or something. And don’t quote me on that, but it’s, it’s, Because he leverages every one of their health, but it’s taken him 25 years of practice. To get to that workflow and he knows that he’s certainly the exception, but that’s what we’re shooting for
Dr. Andy Roark: would you say I think that the sort of stereotypical dentist, human dentist, is kind of an example of what this might look like. There’s, when we talk about decentering the DVM, there’s always this question I think that comes into people’s minds, and I think that’s why they react really strongly to this is, how decentered are we talking about?
Is it the veteran, is that guy a veteran, a dentist dental hygienist relationship, or is it there’s a vet in a building, two cities away, and a technician here with a pet, and that’s how decentered the veterinarian is.
Dr. Jessica Vogelsang: That’s why it gets scary, right? And we’re not talking about like direct versus indirect supervision, anything like that. Like certainly you still like the veterinarian has oversight of what’s happening. And so it’s not about lack of oversight, right? It’s not about taking decisions away that the veterinarian is legally obligated to make, but it’s about when you’re at the center, everything goes through you.
Everything. Does everything need to go through you? Certainly a lot of stuff needs to, but does everything, do you need to be the one to go through follow up instructions? Do you need to be the one, like I said, to like count out the individual pills and check off that it was filled, right? Like I, it, there, there’s a happy medium in there somewhere.
And I think we haven’t quite figured out what that is. So that’s what I mean by by de-centered. And when decisions are being made, are we taking into account all of the other factors? When you talk about patient centered veterinary medicine, so it’s not just about who’s making the decisions, but what are they thinking about when they make the decisions?
So you know, as a veterinarian, as veterinarians, we’re trained oftentimes to look at the patient in front of us and recommend things that have, that are in the best interest medically of the patient. But all of the conversations that we’re having now around spectrum of care, contextualized care requires you to take a little bit more of a step back and to say, there are other confounding layering factors on there about finances, about accessibility is the client able to do the things that, that you’re recommending just physically or mentally.
And so can you leverage your team to help have some of those conversations and have some understanding so that you’re making recommendations that are really family centered it’s complex and you are never going to be able to get to that model.
If you’re the one who has to make every little decision, like it’s exhausting.
Dr. Andy Roark: Yeah,
Dr. Jessica Vogelsang: It’s not going to work.
Dr. Andy Roark: It’s not feasible, it’s not sustainable. Do you think that pet owners are open to this type of practice, or do you think, and again, I know we’re speaking in about broad generalities here, but whenever I bring this, because I, I, you and I are pretty much in alignment, I think, based on this conversation of how I think practices should run and what they look like in the future and what makes sense.
One of the big, biggest pieces of pushback that I receive is, pet owners won’t allow that. They want to talk to the veterinarian. They want to know what the veterinarian thinks. They want
Dr. Jessica Vogelsang: Who created that
Dr. Andy Roark: I agree. I agree.
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Dr. Jessica Vogelsang: My first day in the clinic, I was a brand new grad, so I had practiced for exactly zero hours at that time. And I show up and my mentor’s there. And what does he do? So the first thing that happens is my name tag isn’t printed yet. So my name tag still has my maiden name and says student of veterinary medicine.
Dr. Andy Roark: Oh,
Dr. Jessica Vogelsang: thing he does is say, wear that. I’m like, that’s not gonna help.
Dr. Andy Roark: That’s a terrible idea. Oh,
Dr. Jessica Vogelsang: He introduced me as the brand new grad who didn’t know anything. So of course they’re going to want to talk to him. You have set the expectation that this person doesn’t know what they’re doing.
And it’s the same with your staff. How are we introducing our technicians, and our front desk staff is this is the person who knows so much more about financial plans than I do. This is our absolute maestro at dental care. This is our technician who does this day in, day out.
She is going to teach you everything you need to know. there is zero pushback about taking advice from someone. If you let the client know, this is who I trust. And this is who you should trust too. That’s it. That’s it. It’s about trust. So when you look at some of the surveys out there about telehealth, people are complaining about going to Dr. Google and all that kind of stuff. They’re not going there because they like Dr. Google more. They’re going there because you’ve been inaccessible for the most part. And so we know that the studies have proven in human medicine and veterinary medicine, people preferentially that their number one most trusted source of information is their vet in the vet clinic.
Number two is any vet. And number three is the random public. If you make yourself and by proxy your team accessible, that’s who they’re gonna go to first. I see no barriers there other than the ones that we’ve created ourselves.
Dr. Andy Roark: I like that a lot. I think your statement about how we introduce our support team is, I think you’re spot on. I don’t think that’s ever been more relevant. The thought that was sort of in my mind is we sort of talk about these decentering the vet and what that looks like. I always sort of swing back and forth.
I don’t think I’m indecisive, but I think I tend to lean one way and then evaluate my views and then kind of went lean back the other way and it’s for a long time and always said it said, you know We really need to sort of decentralize the vet. We really need to vet medicine as a team game and I still do believe that as I look around the world I can’t help but notice influencer culture really growing and spreading like crazy. And whether you’re into TikTok or Instagram, or whether you’re just watching on TV, I mean, I’ll give you an example. We have Snoop Dogg at the Olympics right now, as we’re recording this, he’s…
Dr. Jessica Vogelsang: Who had that on their bingo card 10 years ago?
Dr. Andy Roark: No, not at all. Not at all. And. Even more shockingly, he’s crushing it. People love him. People who you wouldn’t think love him.
My mom loves him. And boy, she didn’t like him when I played his music in the 90s. was not about it at all.
Dr. Jessica Vogelsang: and, the man knows more about dressage than I do.
Dr. Andy Roark: Yeah, his coverage amazing. But so all that to say, I promise there’s a point here. The point here is We have this influencer culture where people are going and they’re saying, Oh this individual is great. I really like them. I really like what they have to say. And that’s all TikTok things are these short sort of video clips of people talking to the camera and stuff like that.
We see people building these audiences. We see them building credibility. We know that TikTok has surpassed Google In the first place that young people go to find information, which blows my mind. They search TikTok And and so i’m looking at and I go, okay if this is how the world is going and people are leaning more and more into what do these, I don’t know, famous figures these people I pseudo know, what do they say, what do they think?
I can’t help but wonder a little bit, are we shooting ourselves in the foot if we move veterinarians out of the public spotlight? Does that make sense?
Dr. Jessica Vogelsang: I want to be really, really careful when I say decentering. Again, it doesn’t mean that you’re not present in a way that you were before. Like one, it’s about efficiency, but two really decentering also has to do with, with your prioritization and decision making.
It’s about making decisions that are truly driven by the needs and priorities of the patient rather than necessarily just what you think. And so When a client comes in and they have all this stuff they found on TikTok, you have to take that into account in your conversations, which is really hard for people.
So again, it is centering them in here. They went and did that for a reason. There’s some reason that they came in thinking that raw food’s the way to go. Or, and if you immediately discount that and say, that’s stupid and I know better that then they’re going to shut down. Because you have to center them as the person who knows themselves and their pet best. they may not know the medicine the best but they know their lives best. And so really to me, that’s what centering means. So it doesn’t matter what you would do in that situation. And that’s why it’s always funny when someone asks, what would you do? It doesn’t necessarily always really matter what I would do because I’m not you.
And I have different resources and needs and priorities. To me, that’s really what about the centering means. And so I think the reason that people love influencers so much is that influencers are really, really good at centering the viewer in those conversations. I know this is what you care about, and here’s my thoughts on it.
And you don’t have to play the same game or be on TikTok. You just have to take the same approach. I know this is what you care about. this is my recommendation. And again, you don’t have to be the only one having that conversation. I guarantee that there are probably 75 percent of your clinic who’s more adept at TikTok and knows these influencers more than you do.
Dr. Andy Roark: I think you totally blew my mind. What I thought you were going to say was if we introduce our and we endorse them, you can have the veterinarian being this influencer type figure, the person who, you know who has the relationship, but then delegates effectively to the team and does so by bringing up their status in the eyes of the pet owner.
And you can still have this almost like a PR, veterinary centered experience. And that’s what I thought you were going to go. You did not go there. You completely flipped it on its head and I really love your answer much more than what I was thinking you were probably going to say.
And the idea of the idea that influencers do a great job because they center the viewer, meaning they create this content that makes the viewer feel seen and feel special and feel important. I think that’s probably the answer. And so I, think it’s. Suddenly, it makes a lot of sense going back to sort of the original idea of the patient slash client as the center of the care wheel, as opposed to the veterinarian center of the care wheel.
I, I think what does our engagement with the public, what is our marketing, what is our public relations, what does that stuff look like if we put Patient slash client in the center of everything and we make this client based care environment. I think that’s, I think that’s a really good answer.
I’m gonna, I have to sit with that as far as what it looks like. But
Dr. Jessica Vogelsang: Can you write that down for me? You just explained it really well.
Dr. Andy Roark: I’m still processing. I’m like, Oh I thought I think that your take on it is, is really, I think that’s really good. I’m really going to sit and think with that. It’s I think you’re probably spot on.
I think that you can 100 percent lean into everything that we’ve been talking about, about decentering the veterinarian and still creating the experience. That the pet owner is looking for. I think it’s quite possible that the pet owner thinks that they want the veterinarian’s attention. The truth is the pet owner wants to feel seen and heard and listened to.
They want to feel reassured and safe, and if we create that experience for them, then magically, direct face time with the veterinarian for an extended period of time becomes a lot less important. I think if you ask them what they want, they’re going to tell you, I want an hour with the veterinarian.
I don’t think that they really do. And I think if you show them a healthy alternative they’ll just let that idea go.
Dr. Jessica Vogelsang: Well, and to take it even a step further, I would say what they really want is to know that they did the right thing at the end of the day.
Dr. Andy Roark: Yeah.
Dr. Jessica Vogelsang: It is not about, I want you to fix this. I want to know that I did the right thing by coming to you. I want to know that I did the right thing by following your recommendations.
Dr. Andy Roark: Yeah. No, I, I think you’re, I think you’re right. I think there’s a big validation component. And I think if they could probably receive that validation from the team. Then that would relieve that tension or that feeling of, I need more time with the veterinarian. I think in order for them to receive that validation, we have to do a good job of giving our team a reputation of setting them up for success in the pet owner’s eyes, for making them for making the pet owner feel like our team is a worthy source of validation.
You know what I mean? I, I want to be validated by an expert and if I don’t believe you’re an expert then your validation doesn’t mean that much to me but if I do believe you are an expert, you’re knowledgeable, you’re someone that I respect, then that validation is great. I think we have to make sure that our team falls into that expert category in order all of this to work.
Dr. Jessica Vogelsang: This reference is going to be, like, super dated by the time this comes out, but, Simone Biles, greatest of all time, bowed to Rebecca Andrade when she won the gold medal. Yeah, you’re the greatest, but also, like, in this, somebody else did really, really exceptional. It doesn’t take anything away from you to acknowledge that to celebrate it in front of the world.
Actually, it makes you stronger. It makes the entire world stronger. Sportive gymnastics stronger. It makes the entire profession stronger for us to have that message. Like when you come into the clinic, yeah. Like, look, I’m great. I know you love me. And also this team that I work with every day is also amazing.
It wouldn’t work with them if they didn’t. We are here to make sure you leave feeling like you did the right thing.
Dr. Andy Roark: What do you think is the main driver of pushback against this? Because this is not a new concept, the idea of, using our technicians like dentists use their hygienists. None of this is new. I think that perspectives are changing. I think that there are significant incentives for us to get more efficient today than there were 10 years ago.
There’s still pushback. Where do you think that pushback primarily comes from?
Dr. Jessica Vogelsang: Yeah. It’s interesting, you know, depending on who you ask. And when we were working on the technician utilization guidelines, the technicians were saying, why don’t you trust us? It’s that you don’t think we know how to do a good job. And the veterinarian said, well, no, it’s, not that it’s, I’m worried about liability.
So I think a lot of it is about the perception of whose responsibility is it to ensure that this person. is actually doing those things that you’re delegating to them and that they’re trained appropriately to do so. that was sort of like an aha moment for me where I know for me as an associate, cause it’s happened to me, it’s happened to a lot of my colleagues, you’re an associate.
I know that I’m working with this credential technician and that I’m being told that they’re trained in order to do X, Y, Z. But if something goes off the rails, I’m still the one who’s going to be liable in court, my license is online. That makes it really, really hard. If I don’t truly believe in my heart of hearts that you’ve seen this and that you know how to do it.
And it’s not the same on the human side. If you go into the hospital and the nurse pulls up the wrong medication and administers it to you and something bad happens, it’s the hospital who carries the liability. So I think there’s some fundamental ways that we address that, that’s like legal and that’s all this other stuff and that’s cultural.
That it’s gonna take us a while to untangle. But that’s real, like that fear is real. So I get why it’s really hard for for veterinarians. Especially when you’re not the one who, has oversight as to how the rest of the team is being trained, And so it’s going to take some time.
It’s certainly not a matter of just flipping it off and on switch, right? It’s a lot of teamwork. It’s a lot of transparency in terms of very specific core competencies, that It’s really great conversations that organizations are having right now. There, there’s different levels of assistants and technicians and registered technicians, all the way up to specialists.
What does that mean? What exactly are those skillsets and how have they been validated? And I think, as we build those out and everybody has a much clearer understanding of what they are, that’s going to make it easier for us to trust and to delegate, but it’s going to take some time
Dr. Andy Roark: Dr. Jessica Vogel saying, thanks for being here. Where can people find you online? Where can they see what you’re up to with the American Animal Hospital Association?
Dr. Jessica Vogelsang: at aaha.org
Dr. Andy Roark: awesome. Thank you so much. Guys, thanks for tuning in and listening. I hope you had I hope you had fun. I hope you got some good ideas to roll around like I did. Take care of yourselves, everybody.
And that’s what I got. Guys, I hope you enjoyed it. I hope you got something out of it. Thanks to Dr. Jessica Vogelsang from the American Animal Hospital Association for being here and kicking ideas back and forth with me. She is, she’s amazing. I just so enjoy her. I so enjoy you as well.
Thanks for tuning in. Take care of yourselves, everybody. I’ll talk to you soon.
