Dr. Kate Boatright joins The Cone of Shame Podcast to discuss how new veterinary graduates can sometimes be perceived as money-hungry, not because they are, but because they lack confidence in case management and lean heavily on full diagnostic workups. She and Dr. Andy Roark explore how vet school training, imposter syndrome, and communication challenges contribute to this perception. They dive into the importance of spectrum of care, mentorship strategies for guiding young doctors, and how clinicians can balance thorough medicine with client trust. Whether you’re a new grad, a mentor, or someone passionate about communication in veterinary practice, this episode is packed with valuable insights.
You can also listen to this episode on Apple Podcasts, Amazon Music, Spotify, YouTube or wherever you get your podcasts!
LINKS
Blog: https://writetheboat.com/
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ABOUT OUR GUEST
Dr. Kate Boatright has been in small animal practice since graduating from the University of Pennsylvania in 2013. After nearly 8 years of full time practice in both general practice and emergency clinics, she moved to part-time clinical work to pursue her passion for educating veterinary professionals as a freelance speaker and author. Dr. Boatright enjoys discussing mentorship, the unique challenges facing recent graduates, wellness, and the spectrum of care. She believes deeply in the role of organized veterinary medicine and holds leadership positions in the AVMA and her local and state VMAs. She is a former national officer of the VBMA and was a founding member of the VBMA Alumni. In her remaining time, she stays busy chasing her toddler, running, reading, and watching movies with her husband and cats.
Fun facts: 1. Pizza is my favorite food. I prefer pineapple pizza which i know is a polarizing choice! 2. I love Disney movies and have run half marathons at Disney 3 times, plus a 10-miler in April 2025. 3. I love learning and am considered a “CE junkie” by my colleagues
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. I got a fun one today. I’m here with my friend, Dr. Kate Boatright. She is a practicing veterinarian and a writer and a speaker. She’s actually going to be doing the general session at the Uncharted Medical Directors Summit on May the 6th, 2025. She’ll be kicking us off there talking about a team approach and leading a team around spectrum of care. So if you’re a medical director, man, that’s going to be a great place to be. We got a whole day for you. Come and check it out. We get in today to a piece that Kate wrote where she said that new veterinary school graduates sometimes wrestle with confidence and as a result they come across as being money hungry when they’re just trying to make the recommendations. They feel like they’re supposed to make and I thought that was really interesting.
I wasn’t sold on if that was true or not exactly and so I brought Kate in to talk to her about it and so she lays out her argument and saying this is how I believe is happening. This is what I’m seeing. This is what doctors that I’m mentoring are saying to me, and this is why it’s happening and this is how I’m trying to mentor them and also how I’m trying to get them to approach
their cases from a sort of headspace standpoint. Anyway, really good conversation if you are if you’re a new graduate, a young career doctor, if you’re a mentor or grower of doctors, if you know a doctor, if doctor rhymes with proctor, and you think that’s funny, anybody in those categories I think will like this episode. Let’s get into it.
Kelsey Beth Carpenter: This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast. Dr. Kate Boatright. Thank you for being here.
Dr. Kate Boatright: I’m super happy to be back.
Dr. Andy Roark: I love having you on the podcast. You are, you’re one of those people who make me super happy for a variety of reasons. For those who don’t know you, you are a practicing veterinarian. You are a prolific author and writer.
You’ve got some, you’ve got some book chapters coming out. I love your blog. You write for God, you write for a variety of different publications. I, see a lot of your stuff. You write in AAHA Trends. You are doing a lot of stuff. I got to to see you lecturing at VMX.
You were doing that. You’re going to be lecturing at Fetch conferences coming up. You are just doing a ton of stuff and you’re one of those people who’s doing it for the right reasons. I said you’re a practicing doctor. I cheer for you. I really do. I just, you make me so happy and I was just thinking we met when you were in vet school and I had, I was a fairly recent graduate.
It was when you started as student, you were on the national VBMA leadership team.
Dr. Kate Boatright: Yeah.
Dr. Andy Roark: How was that? When was that?
Dr. Kate Boatright: I’m going to age us here, but that was in 2010. I was on the board in 2011, started my role in 2010.
Dr. Andy Roark: That’s incredible. Yeah.
Dr. Kate Boatright: I always tell people like I knew Dr. Andy Roark before he was Dr. Andy Roark. Yeah.
Dr. Andy Roark: Yeah, boy, we go way back. I wanted to reach out to you because I saw something that you wrote that I really made me think. I don’t know if I liked it, but it’s not that I didn’t like what you wrote, but it didn’t, it really made me think in that you wrote and you said that it was your perception that new graduate veterinarians, right?
So young veterinarians, we know that young veterans struggle with confidence. And when you talk to young veterinarians and especially to vet students, they talk a lot about imposter syndrome, about feeling like worthy of being there. They want to really be taken seriously. And the point that you made was that you felt at least veterinarians felt like, there’s a risk of that sort of insecurity being perceived as being money hungry. Lay out this argument for me. Tell me. Break this down for me, make me believe it.
Dr. Kate Boatright: Yeah. Yeah. I’ll be honest. One of the reasons I came to that conclusion was because I myself was called money hungry by an early team. Yeah.
Dr. Andy Roark: Really? You are like the nicest, least money hungry person that I know.
Dr. Kate Boatright: Yeah, and it, yeah, so it’s all in the perception. So what I find when I work with new grads and, thinking back to my own new grad period, is that because we lack that confidence, and we’re coming out of veterinary school where every case got the full workup. So we were doing CBC, chemistry, thyroid, urinalysis probably some imaging, radiographs and or ultrasound, probably both sometimes CTs and MRIs.
So that was the environment you were taught and you had all this information at your fingertips for every patient. And then you go into general practice and you get the dog that comes in and it’s been vomiting for two days. And so as a new grad, when you haven’t started to organize that thought process as much you start going through, okay, this could be a foreign body.
This could be addison’s disease. This could be, probably it’s mild GI upset when the dog is bouncing around the room and, licking your face. But, you’re so worried of having that, I don’t want to miss anything. So I’m going to recommend the full workup. I’m going to recommend the full blood work.
I’m going to recommend radiographs. And that’s not wrong. That is absolutely, that’s the way we’re taught. That is, the gold standard which I hate that term, but I’m going to use it anyways. But, I think that as we get more experienced, then we start to be better about picking and choosing the diagnostics that we’re going to do.
And so for a team, or even clients who maybe have worked with more experienced veterinarians in the practice, and now this new graduate is coming in, and hey, the last time when I saw the owner doctor and my dog was vomiting, he didn’t recommend any diagnostics initially, or he recommended like a small panel of blood work, or just x rays.
And now I’ve got this new grad coming in and presenting me with a 500 estimate. And so I think that’s where the perception comes, and the reality is we’re not, they’re not doing it for the money. I wasn’t doing it for the money. I was doing it because I was so scared of missing something.
Dr. Andy Roark: but you want to do a good job. And I guess the question is, how do you define a good job? And in vet school, it is defined as a thorough diagnostic workup to maximize potential for recovery and minimize potential for, deterioration of the patient. And that’s how success is determined in vet school.
But that’s not success in the eyes of a lot of our clients. A lot of our clients are, we’re going take the most financially conservative approach that is going to meet our needs and ultimately get us where we need with as little sort of overkill as possible. And again, I’m not saying that’s what your goal should be as a veterinarian, but I do think there’s just a different definition of success, honestly, for each pet owner, but definitely the chasm between what it was in vet school and what it was out of that school. Those things are pretty different. Kate, my of my dad’s favorite sayings has always been that good judgment comes from experience and experience from bad judgment. And so I think about working up cases and things I definitely have a different philosophy. Yeah, I do. I would say I have a different philosophy than I did when I was a new graduate.
I just have so much more experience and I can’t even put my finger on exactly why I walk into some rooms. I know every other vet does this too. You walk into the room and there’s a vomiting dog and you’re like, this one feels different. This is, this one feels bad.
Dr. Kate Boatright: Yeah.
Dr. Andy Roark: Seriously. I’m like, why do I? do I feel compelled to really work this one up as opposed to the last one I saw that was basically the same presentation? I’m like, I, there’s something about I, this dog is not right. And so I don’t know how you get that when you’re a brand new graduate or doctor. I think it has to come from establishing your own little pile of bones where you’ve had, that have gone not the way you wanted.
Dr. Andy Roark: I think talking through this with you. I think I would prefer that young doctors err more on the side of overworking up cases or making recommendations that pet owners decline than I would at saying, no, guys, I don’t want you to be perceived as money hungry. Let’s dial down the quality of medicine that you’re practicing. I don’t know.
Dr. Kate Boatright: Yeah.
Dr. Andy Roark: What do you say? How do you go forward with this, right?
Dr. Kate Boatright: Yeah.
Dr. Andy Roark: There’s two parts to this, right? first I would say, not as the veterinarian, but as mentors of the veterinarian. What kind of advice would you be giving to young vets? How would you get your head around this? Because I’m not exactly sure I know how to guide someone through it.
Dr. Kate Boatright: Yeah, so for me, it comes down to that spectrum of care approach. And so for those who aren’t familiar, spectrum of care is the idea that you know, we have a range of very acceptable diagnostic and treatment options for any given case. And that can range from your traditional gold standard to, something that’s more cost effective, less invasive, less intensive.
And the reality is most of our pet owners really fall in that middle ground. And so I think sometimes we come out of school with that all or nothing thinking. And it’s, okay, if I can’t do everything, there is, there’s so much more we can do than just jumping to nothing. And when I talk to, and I absolutely agree.
I encourage my new graduates, yeah, come up with your ideal treatment plan. If you can do anything and everything, then, know what you want to do. Because there are some clients who will do it. And, but it’s in the way we present it, I think, is the most important thing. Because one risk we run, if we’re always walking into the room and we’re always presenting gold standard first, if that’s the first thing that comes out of our mouth, and you already know that client has said, Hey, I’ve got 200 with me today.
You risk making them feel guilty. Because,
Dr. Andy Roark: It’s a failure of trust, right? If I come to you and I say, Hey Kate, I need your help, and I got 200, and you’re like, alright, let me show you our 1, 000 package. I’m like…
Dr. Kate Boatright: Did you listen?
Dr. Andy Roark: Did you not hear what I said to you? Are you listening…
Dr. Kate Boatright: Yeah.
Dr. Andy Roark: to me?
Dr. Kate Boatright: Yeah, so as a mentor, what I encourage my mentees to do is, come to me with your plan and say, Hey, this is what I would like to, I would like to do all of these tests. And then we’re going to look at each test and I’m going to ask you a couple of questions. So one is what information are you trying to get with that test and how will that information change the way you treat this patient?
And if the answer is it’s not going to change how I treat the patient, it goes to the bottom of my priority list. Now, we know there’s tests where we don’t, I’ve had patients where I’m like, Oh, we’re just running this to be cautious. And then it comes up, I’m surprised by the results and I’m like, Oh, glad we ran that lab work.
And certainly yeah, you, you don’t want to miss things, but it is about thinking, I’m often if I have a dog. Like I had one recently that came in and it was an older dog, just looked like the textbook Cushing’s dog, like pot bellied, PU/PD, ravenously hungry, and the client did have financial constraints.
And so yes, I would ideally I would run my full senior panel, which is a CBC full chemistry, UA, T4, but that wasn’t in the budget. And so we said, okay, what’s the most important information for us to get? I want to make sure with PUPD I’m ruling out diabetes and kidney disease. I want to know what that ALP is for a Cushing’s, suspicion.
And so we ran a mini panel. So we did a CBC, a smaller chemistry panel, and a urine. And, and I warned the owner, we may need to do some additional testing, depending on what this says. But this is our starting point where, so you don’t leave feeling like we’ve done nothing towards figuring out what your dog is going through. I’m not saying, come back when you have the 200 to run the full panel.
Dr. Andy Roark: That totally makes sense. So you’re seeing this more as a communication training issue than one of trying to change the diagnostic approach they’re taking coming out of vet school, which again, I think that’s good. I think new grads are underrated as they come into practice, like this is a chance for the practice to say, what is being taught in, at the schools now, what is the cutting edge of how we’re approaching this?
I think a lot of times people blow that away and go, oh, in, let me show you how we do it here. And I go, that’s a missed opportunity. So I really like this idea of respecting and honoring what young doctors know and what they bring and then leaning into it as a sort of a communications approach. Okay, what do you do here if you’re the young doctor? And so you say, all right, I’m hearing this. I don’t want to seem overly pushy, but I do want to work these cases up. Are there things, say I’m not getting support from, say I don’t have a mentor, say I’m just a young doctor that’s going in.
If you were this person, what would your headspace be? How would you be thinking about these appointments as you go in and saying, I’m nervous, I want to advocate for the pet, but I don’t want to, to get blowback from the client or make them feel like, I’m not trying to do the right thing for the right reason. How do you, how would you be thinking if you were that person?
Dr. Kate Boatright: Yeah, I think there’s, some of it is experience and trial and error. And you’re going to have some cases where you don’t connect with clients. I remember one of my cases early on, it was like a wellness appointment and it was the mom and daughters in the room. And I came in and I did the exam and I found a mammary mass.
And so I go into my spiel about potential mammary cancer and that we need to biopsy this. And the mom called the office after she left and reamed out the office manager that I would dare talk about cancer in front of her daughters.
Dr. Andy Roark: Oh, wow.
Dr. Kate Boatright: and that was like, okay, that didn’t even cross my mind.
Dr. Andy Roark: I know.
Dr. Kate Boatright: it was, I’m telling you what I’m finding. I’m making my recommendations. and these weren’t like little, kids. These were like, probably like 10, 11 years old. Old enough to understand what I was saying. And so, now sometimes when there are kids in the room, like if I do find something concerning, sometimes I’ll say Hey, we’ve got a bunch of coloring books out in the lobby. Why don’t you go talk to my receptionist and grab those? Or, I’ll have one of my technicians come in and distract the kids or find a way to subtly ask the parent, I think we can say a lot without saying it and say, Hey, I have some concerns I want to discuss with you.
Do you want to do that privately? Are you okay with the kids being here? Yeah. So I think some of it is, it’s just trial and error and learning from experience and. I think some of it, too, is just, being honest with the clients and saying, if you can explain why you want to do those tests, there’s a lot of value to that.
And so it’s saying, I want to run blood work because I’m concerned about, in this vomiting dog, it’s an older dog, I’m worried that we could be dealing with something more serious that’s just starting to show itself from internal disease and this is what we’re looking for in this test.
We’re looking for our kidney values and our liver function, these are organs that can cause vomiting. And so I think it’s, learning how to explain it to clients. And then if they do decline it, saying that’s okay, I understand that we’re not able to do that test today.
How about this? So I think it’s also going in equipped with a couple different options.
Dr. Andy Roark: Yeah. Okay. Okay. If you could add one component the training every graduate that’s coming out of graduate school, or out of vet school now, right? So can say, I would want all of the people coming out of vet schools to magically know this one sort of piece of knowledge, like this one area of knowledge. Which one are you picking and why?
Dr. Kate Boatright: Really, I think it’s spectrum of care. I think it’s that ability to be flexible and get creative.
Dr. Andy Roark: Yeah, I like that a lot. I would tell you so we do a lot of work training doctor leaders at Uncharted. And we would work with a lot of medical directors and again, we work with practice managers, but a lot, of medical directors and multi site medical directors and the most underrated leadership attribute at that level.
Self awareness is a big one, but generally people don’t become a multi site medical director if they don’t have some level of self awareness. The most underrated attribute of leadership is adaptability, and I think it’s really that flexibility to look at a situation and say, not ideal. But this is how we’re going to navigate. there’s not a great answer here. But this is how we’re going to, how we’re going to make it work. And I don’t know how you train people to be adaptable like that. I think a lot of it comes with experience and, just navigating case after case and picking bad outcomes, from a list of bad outcomes and things like that.
But I think that’s a, I think that adaptability is probably a pretty fantastic call. I like that. Good choice. You get a gold star. I’m calling you the winner of today’s Cone of Shame episode.
Dr. Kate Boatright: Yay!
Dr. Andy Roark: Dr. Kate Boatright. Where where can people find you online? Where, can they keep up with all the stuff you’re doing?
Dr. Kate Boatright: Yeah. my website is www dot wright W-R-I-T-E, the boat. So that’s where my blog lives. It’s been on a little bit of a hiatus, but it’ll be picking back up again here shortly. And then I do a lot on Instagram and LinkedIn. And that is same tag, Write the Boat, as well as, on LinkedIn. It’s just Kate Boatright the MD.
Dr. Andy Roark: You will be speaking at the Medical Director Summit on May the 6th.
And you’re going to be talking about a team approach to spectrum of care. Which is tailored entirely for medical directors. So that’s the only people at the summit
Dr. Kate Boatright: Yeah. and what I’m focusing on there is, some of it will be how do we support young doctors or, maybe it’s just a doctor. They don’t necessarily have to be, young or early career, but I’ve seen doctors who come from like a city environment where there’s lots of specialty hospitals nearby to a rural area where I work, where the closest specialty is an hour away.
So I get a lot of cases where clients just say, I can’t, I don’t want to drive that far. what can you do here? And I love doing that. I’ve worked in rural medicine my whole life. And I love having that ability to take on those more challenging cases and do more. But so some of it’s about how do we support those doctors, but then also how do we communicate with our team?
We come out of the exam room and we have this crazy treatment plan that has cobbled together different diagnostics and treatments. And it’s definitely not by the book. And our technicians look at us like we have three heads when we say, Hey, we’re going to do this. And so how do we better communicate with our team of, Hey, these are the barriers we’re working with.
And this is how we came to this decision so that everyone’s comfortable with how we’re practicing.
Dr. Andy Roark: Yeah, this is, it’s going to be fantastic. Thank you, Kate Boatright for being here. Thanks for speaking at Medical Director Summit on May the 6th. I’m looking forward to that. Gang, thanks for tuning in, everybody. I appreciate you.
Dr. Andy Roark: And that’s what I got for you guys. Thanks for being here. Thanks to Dr. Kate Boatwright for jumping in. I hope that some of you of the Medical Director persuasion will be joining me and Kate at the Medical Director Summit, the Uncharted Medical Director Summit on May the 6th. Anyway, gang, take care of yourselves, everybody.
Talk to you later. Bye.
