Dr. Peter Weinstein explores the feasibility of implementing a production-based compensation model for veterinary support staff with Cone of Shame host, Dr. Andy Roark. They touch on the potential benefits and drawbacks of this approach, discussing how it might improve job satisfaction, retention, and appreciation for technicians, assistants, and other support roles. Dr. Weinstein argues that while veterinarians benefit directly from production-based pay, the staff executing the bulk of the work often remain on fixed salaries, creating a disconnect in compensation fairness. The conversation also touches on broader topics such as profit-sharing and the overall drive to enhance workplace morale and productivity. They examine whether tying wages to service delivery could equitably distribute earnings and reflect individual contributions more accurately, potentially revolutionizing compensation structures in veterinary practices.
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LINKS
Dr. Peter Weinstein on LinkedIn: https://www.linkedin.com/in/pawdr/
Veterinary Ownership Advocates: veterinaryownershipadvocates.com
Dr. Andy Roark Exam Room Communication Tool Box Team Training Course: https://drandyroark.com/on-demand-staff-training/
Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Dr Peter Weinstein is a husband, father, pet parent, veterinarian and leader. He has been involved with virtually all aspects of veterinary practice from a 15-year-old kennel kid to a hospital owner. Organized veterinary medicine has been a passion as well with various roles and leadership and presidencies of Southern California VMA, California VMA, and Vet Partners. He is a published author, most notably of the E-Myth Veterinarian-Why Most Veterinary Practices Don’t Work and What to Do About It. Currently, he is teaching business and finance at the Veterinary College of Western University of Health Sciences. He likes to think of himself as a free-thinking change agent and disruptor who, because he has a daughter who is a recent graduate from veterinary school, is working for an even better veterinary profession in the future.
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome, everybody, to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. I am here with my good friend, Dr. Peter Weinstein. And we are talking about the question of should veterinary support staff be paid on some sort of a production model like a lot of veterinarians are? What are the benefits?
What are the drawbacks? Is that the future for vet medicine? Would that motivate a change in behaviors? Would it show appreciation to our support staff? Would it help us keep technicians, assistants, front desk people, kennel techs, would it help us keep them in the profession longer? Anyway, this is a great idea discussion.
We kind of sprawl all over the place. I really hope you guys will 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. Peter Weinstein. Thanks for being here.
Dr. Peter Weinstein: Dr. Roark, always a pleasure to be with you, my son.
Dr. Andy Roark: I’m my son My son. Peter, what advice do you have for me? I, you know, it’s funny. Whenever we, I should start blocking more time on my schedule to do our podcast because we, we talk for hours around the podcast that we actually record. And you and I, you even had a sprawling conversation about the profession so far and what the future looks like.
And I think we sort of naturally in our conversation came to what I want to talk to you about today. But first, let me say, for those who don’t know you, you are a, a failed retiree. You really have not retired very well at all. You are an entrepreneur coach. You’re an educator and advocate for the vet profession.
You have worn many, many hats. You were just running the practice management program at the AVMA convention when I saw you last. You just do many, many things. And. You are one of the main people that I go to when I when I start thinking about the future and looking at my crystal ball and kind of trying to figure out where is this crazy profession going and and you and I have a lot of of philosophies that line up really well and we care about a lot of the same things and so I I came to you recently and I was sort of saying hey look you know Peter we’re looking at We’re looking at changes in profession.
We’ve got corporatization. We’ve got a lot of private equity things coming in. I’m looking at a push to raise the the salaries of our support staff, especially. We know that that’s a big a big factor of stress for our, for our staff members. And I was trying to talk about how do we do this? Like, how do we, how do we make life better for our support staff?
How do, how do we, how do we pay them better? And so, you and I have gone back and forth. We’ve had different conversations about production based pay. We’ve talked about how we pay doctors. And I’m always kind of interested in how those things sort of come together in your mind. And so, the question that I, you and I have sort of kicked around, and you sort of posed this question to me is, Does production based pay in veterinary medicine accurately or adequately recognize and reward the support staff who are doing the work that gets the patient taken care of.
And so I want to go ahead and start to unpack this because you and I have talked before about production based pay for for veterinarians. I’ve had a number of guests on the podcast talking about The benefits and and then the drawbacks and also like is this the culture that we want to foster in our profession?
So I’m fairly neutral on production based pay. But i’m definitely open to change. I am very interested in growing the income of our support staff and keeping them our profession longer and making this a more attractive profession for people to be in. So let me sort of bring that to a close and sort of start, stop talking there.
Yes or no, our current system of production based compensation for most veterinarians totally takes care of support staff in an adequate way. Do you believe it?
Dr. Peter Weinstein: No I think production based pay rewards the doctor for the services that they feel the pet is needed, has needed. However, the individuals who, in many, many, many cases, actually deliver those services are the health care team.
Dr. Andy Roark: Mm hmm.
Dr. Peter Weinstein: So the doctor gets rewarded by salary, and in many cases a percentage of what they put on the health care plan, treatment plan, estimate, whatever you want to call it. They hand it off for somebody else to do the work, who is paid a salary. So no matter how hard they work, per hour, or don’t work, they’re going to get paid the same amount.
Dr. Andy Roark: Right.
Dr. Peter Weinstein: But in many ways, the doctor keeps pushing the work, they keep making more money as the doctor, But the staff isn’t recognized for how much work they’re doing.
And that’s why I think that there’s a disconnect. And if we’re going to look at team based healthcare delivery, where everybody is working together from the person who answers the phone, Oh, and by the way, doctors who are on production, you don’t see clients unless somebody makes those appointments. Oh, by the way, doctors who are on production, you can’t see more people if you’re the one in the treatment area taking radiographs, pulling blood samples, and putting in catheters.
Oh, and by the way, doctor, you’re not the one cleaning the cage for that pet that was in the cage. But you are the one getting paid for all those services that you do. So that’s why I think there’s a disconnect in, and, and I, we have to figure out a way that rewards everybody on the team for all the work that the team does in a collaborative fashion.
Dr. Andy Roark: Is this idea, are you looking at this, if we could magic wand, you know, make it so that the, the revenue of the hospital went to the team based on how much they did or how much, you know, what they, what they generated, that would come back in sort of a, almost like a profit sharing. Are you imagining that as the team should be rewarded?
Or, Are you willing to go a step further? I have long maintained, one of my sort of core values is work ethic. I like, I like working with people who work hard. And I like to work hard. We have set up a lot of pay scales in vet practices, which I think are generally a good thing. But they’re almost entirely, the ones that I’ve seen, built on skill acquisition.
Or knowledge acquisition. The pay scales are not generally, they don’t reflect this person busts her hump and takes back twice as many patients in a day as the average, you know, say technician in our practice does. And I would say, this person might not be the most technically skilled person in your practice, but she has her hands on way more pets than any of your other technicians.
And I think that those, I think those truths are often unrecognized in practice. Do you, do you agree with that?
Dr. Peter Weinstein: Absolutely. But what you’re talking about is a subjective measure and we are an objective profession. In other words, we can measure now, unless we start to measure the number animals that an individual. Team member touches, then we’re making a judgment that says, well, they’re working harder than anybody else.
Maybe they should make more money. And then somebody complains and says, why are they making more money? So what we’re dealing with as well is an environment that’s somewhat competitive at all levels. And how do we create an objective measure of how hard people are working?
Dr. Andy Roark: Yeah. I mean, yeah, I agree with that. And I think that it gets tricky when you say, well, we’ve got one technician in the lab, and we have one technicians at the treatment room tech, and their names don’t really get put on the cases. I definitely get that. I have always thought that there was great value in recognizing, say, the technicians who are doing more senior blood work
than the other technicians. And maybe that’s because the doctor they’re working with is better at recommending senior blood work. But I’m finding more and more that’s not really true, you know. When we have well leveraged technicians and they know what the plan is and they know what our wellness protocols are, they’re in there talking about heartworm testing, you know, senior blood work.
They’re talking about, in some cases, they’re talking about dentistry. They’re talking about a lot of services that can be objectively measured. I think it’s, it’s a little bit challenging to tie those services to the individual technician or support staff, but that’s kind of my holy grail. I think Peter is, I really would, the way we track services for doctors, I would love to try to figure out some way, and it’s going to be sloppy because it’s because of how, how the team works together.
I really think that there’s great value in that. I think that there are some support staff members who just absolutely crush it. And I think that they could. share best practices with the rest of the team. And, and also I think they should be compensated for their skills and their effort in a way that, that, I don’t think we’ve done that very well so far.
Dr. Peter Weinstein: Well, let’s put it this way. When you, as a Dr. Roark schedule my pet, Bruce, for a dentistry, the invoice gets processed
Dr. Andy Roark: Mm hmm.
Dr. Peter Weinstein: the end of the day and everything on the line items associated with that dentistry goes to Dr. Roark
Dr. Andy Roark: Mm hmm.
Dr. Peter Weinstein: in most cases, but Dr. Roark never touched the teeth. except to check and make sure that they were clean.
Dr. Andy Roark: Yeah, I looked at them. I looked at them.
Dr. Peter Weinstein: Yes, but you didn’t touch them. So what if that invoice said your dental hygienist today was Susie, her assistant today was Judy, and the animal caretaker who took care of your pet’s cage was Jane. We are not giving, oh and by the way your receptionist today was Crystal. We’re not using our invoices to identify and recognize the team
for the work that they’re doing. And I would suggest that every dentistry should be linked to probably a credential technician and an assistant. Every surgery should be linked to a credential technician, an assistant, and a doctor. Because I think it’s time to start recognizing them in the same way that we don’t, we have started to do more and more, quote unquote, tech exams.
But does it give credit to the technician by name who did the tech exam? So now we’re going to make it even more complex and we have a hard enough time getting invoices right in veterinary medicine And especially if you’re on production based pay where every line item could determine what your paycheck is think about now we have to give credit to the technicians now I’m not taking away from the doctor But I am wanting to give credit to the technician who was tasked to do the work And we have to leverage it.
I think, you know, you’re talking about giving more credit to the techs. I think we need to give more credit to the CSRs because they’re the ones who are making the appointments. And they’re the ones who check, in many cases, checking clients out. And they’re the ones, in many cases, who are dealing with the really difficult clients from an emotional standpoint.
Dr. Andy Roark: Well, it’s,
Dr. Peter Weinstein: It’s a team based effort. We can’t get the rowboat down the lake unless everybody is stroking at the same cadence.
Dr. Andy Roark: I, I, I do, I completely agree with that.
Hey guys, national veterinary technician week is coming at ya. And if you’re someone who wants to do something nice for your technicians and you haven’t thought about what yet. Don’t worry. I got ya, but you need to add now my new card game, Dr. Know-It-All is out. This is a veterinary specific card game.
It is vet trivia. It is fun for the whole team. You can play with the whole team. It is fast. It is funny. You will have a really great time. Anyway. it is geared up here. Ready? I’ve got it at my house. I will send it. Directly to you or to your practice. All you gotta do is buy a copy.
I’ll put a link in the show notes, head over to drandyroark.com. Grab a copy grab a copy for everybody. This is something that the techs are gonna really love. The trivia questions are meant to be at the level of the veterinary technician licensing exam. And so they are a little bit spicy in their questioning.
We have a hard mode that you can use with the doctors. We can make this much more challenging. We can also make it much more easy for onboarding new people in there. You know, they’re new to the vet medicine. They just want to learn. So anyway, got you covered from an education standpoint. Gotcha
covered from a fund standpoint. Gotcha covered from a gift standpoint. I really, I think I got you covered all the ways. All you gotta do is get yourself a copy of Dr. Know-It-All and get it wrapped up for the technician that you want to say thank you to anyway, that’s what I got. Link in the show notes.
Let’s get back into this episode.
Dr. Andy Roark: I have been a big proponent for a long time. I think the front desk is the most underrated position in the practice and they have for a long time. That’s not taking anything away from anybody, but because they’re up front, most of us don’t see them and think about them and what they deal with.
And so I, I don’t think that they get necessarily the recognition they should. I had this thought. I’m just curious if you’re going to bite on this. I yeah. So, we was at the AVMA convention and we were in Austin, Texas, and I went up to a restaurant and I ordered myself, like on the screen, I punched in my, well I put in my phone number, I punched in my order, and then after I had ordered self checkout on the screen.
It then asked me for a tip. It asked me if I would like to tip. And, I mean, I swiped my own credit card. I did the whole thing. And I just kind of looked at it like, I guess this is where we are in that I am not tipping. And first of all, it asked me for a tip before I got my food. It wasn’t even like, didn’t you like your food?
Would you like to tip? And I just thought, this strange idea of tipping has become so ubiquitous. I mentioned it. I wrote an article and said, Are We Ready for Tipping? And I got a lot of flack for even I don’t know, asking the question of whether or not Vet Medicine was ready for this. Would you be open to tipping the staff at a vet clinic or do you think that’s totally gauche?
Dr. Peter Weinstein: would not be adverse to tipping the staff at a vet clinic if it is done by the leadership, management, and ownership of the clinic, which of course doesn’t make it a tip.
Dr. Andy Roark: That’s not a tip, that’s a bonus!
Dr. Peter Weinstein: Yes. I would have a problem somebody individually giving a tip to the technician who did the profi, for example. And I, and I think we’ve seen tipping quote, unquote, occur
when house calls are made or other things, and probably not even being reported. In those situations where everything is pretty much automated and you get that request for a tip, the reason I might give a low end tip, maybe not the 20 percent I normally give, but 12 to 15%, is because there is still somebody putting the coffee in the cup, putting the lid on the coffee cup, making the latte, and doing the work there.
Now whether that gets bundled into the cost of the coffee, I don’t know. In in many restaurants the tips are all brought together so that the busboys, who do the heavy lifting. The busboys in a restaurant are the equivalent to the technicians in many cases. Maybe they’re the assistants, because the waiters and waitresses would probably be the technicians.
But then who’s the doctor? Anyhow, the chef, the chef would be the doctor.
Dr. Andy Roark: Okay, okay,
Dr. Peter Weinstein: And then you have a sous, you have sous chefs who doing a lot of the line work that you never get credit for. I mean the, Chef Ramsay gets all the attention, but who’s actually doing all the work?
Dr. Andy Roark: No, I, I like it. I think, I think that may, I, I’m not even, I’m not even advocating. I like to bring it up. I’m just when I see tipping like that, it just, in my mind, it’s interesting. Clearly, this is a, this is a strategy that other businesses and other industries have employed to try to increase the income of people who are working there without raising the actual prices.
And so, I think that’s why it pops into my mind. I’m not, I don’t know that I feel good about it. I think. I think there’s probably lots of ways it can go badly, but I just, as we start to talk about recognizing the team, things like that, it just, it occurs to me that, that that is something we see in other, in other industries.
And I like your analogy too, of the way, my understanding is the way those tips work is, they go into a pool, and it gets split amongst every, the people who are there. And I think that that’s a fair way. Of kind of compensating across the board again. I don’t know that we’re ready for tips or that we want that, but it’s just that you should always be looking at other industries and sort of seeing seeing what they what they do.
Dr. Peter Weinstein: I’m sitting here and you know, you know I’m in Los Angeles and I’m sitting here and I’m thinking of all the plastic surgeons in LA, you know, do you think that they get a tip for doing a perfect nose job? Do you think they get a tip for, you know, we don’t tip in human healthcare in most cases, even if it’s the elective procedures? We don’t tip our dentists.
And I mean, as much as, and, and I’ve said this before and I’ll say it again, as much as veterinary medicine is a service industry that provides healthcare, we don’t tip on the healthcare side of things. It just seems to be a it, it’s, it’s, it just doesn’t fit in being a healthcare professional from that standpoint.
On the other hand, you all read All Creatures Great and Small, and let’s just say that James Herriot got tipped with bacon and eggs and sides of beef but that was a different era. And so, it’s really, I mean, if you want to look at tipping, it goes back to something you, you superficially talked about earlier, which is profit sharing.
Dr. Andy Roark: Yeah,
Dr. Peter Weinstein: And, and I, I really do think, that that’s in the sense, essentially, that’s what production based pay is, but let’s look at profit sharing for the entire team and not just for the doctors, although the doctors do deserve to be rewarded for the work that they do. We can’t do this if we don’t have a team to support us.
We cannot make as much money for the practice without a team to support us. And Unless the doctors start to take some of their production based pay and give it to their team. Hey, Andy, you want to give some of your production base to your team?
Dr. Andy Roark: I mean,
Dr. Peter Weinstein: I put you in a corner there.
Dr. Andy Roark: yeah, ooh yeah, no, that’s I think that that’s the, that’s the question that comes into everybody’s mind, right? Is, is we say, well, should we play the team on production? And then the doctors kind of go, well, I’m, you know, I’m, I’m, I’m not interested in giving up what, what I’m earning and this is how I’m getting paid and again, I, I think that that’s very, I don’t think anyone expects that level of altruism from the average veterinarian across the board of let me, let me reduce my salary and hand it over to the support staff.
I think that that would, I think that’d be a lovely thing, but we also know from the Merck 2023 well being study that student debt is one of the main stressors, especially for young vets, and like, so people have got, they, they’ve got their own sort of burdens that they’re, that they’re carrying.
Dr. Peter Weinstein: Well, and again, ladies and gentlemen, veterinary medicine, although you may think it’s a not for profit business, is a for profit business.
Dr. Andy Roark: Yeah.
Dr. Peter Weinstein: 50 percent of the hospitals out there probably aren’t making a profit when it comes down to it, but we’re a for profit business. Which means, theoretically, we should have a budget.
Theoretically, we should be looking at the numbers that, from which that budget feeds. Whether it’s income or whether it’s expense. And, when it’s all is said and done, as the practice does better, the team that helps the practice do better, if you are an, an above board owner, we’ll turn around and say, Thank you for helping us get us to where we are.
Dr. Andy Roark: Mm hmm.
Dr. Peter Weinstein: Because that profit, let’s just say we’re at a, a really nice number of 20% profit. What if we took 2% of that profit? So as the owner, I only got 18%. And let’s say that’s $2 million. Now Andy, get your abacus out and tell me what 2% of $2 million is
Dr. Andy Roark: Fast math!
Dr. Peter Weinstein: So $40 million, $40,000. What if we took that amongst our team of 20? And spread it out in some fashion that represents both subjective and objective work and maybe longevity. And if one member of that team got a thousand bucks, maybe even a quarter or at the end of the year, maybe they got 250 a quarter.
How big would that be for somebody who’s only making 18 an hour?
Dr. Andy Roark: Yeah.
Dr. Peter Weinstein: I mean, that’s, you think about the motivation there that doesn’t necessarily impact the doctors. Because they’re still doing production based upon their budget and everything else. It’s really looking at an owner and saying, I want to keep my team.
I want to recognize my team, those who work hard, and I want to reward them for the work that they’re doing.
Dr. Andy Roark: You know, I’ve heard, I’ve heard of practices talk about this a number of times. I’ve talked to practitioners about profit sharing and things in the past. And I think that you’re probably understanding. I like the way you’re looking at it as a, as a way of rewarding and showing appreciation. I think that a lot of people in vet medicine have tried this as a motivational tool.
And, and generally it doesn’t work that well to motivate. You know, they say, Oh, we’re going to do a profit share. I think people very much appreciate it, but I don’t think a lot of our support staff is not, they’re not super money motivated driven or the frequency that we’re making sort of payouts and things like that doesn’t, doesn’t, it doesn’t click the, you know, the box for them the way that people sometimes think that it will.
And so I, yeah, I, I, I like this as a, as a way of rewarding and, and and showing appreciation. I think that makes a lot of sense.
Dr. Peter Weinstein: Here’s, here it is in a nutshell, for lack of a cliche. If we run our businesses so that passion drives profit, we will have a successful business. But if we run our businesses where profit tries to motivate passion, you’ll fall on your face.
Dr. Andy Roark: Yeah, that’s I think that’s I think you’re spot on. I think that’s a really good way to summarize what I have seen with profit sharing that that totally makes sense.
Dr. Peter Weinstein: Keep the passion, because passion is really, and, and maybe it’s overused, maybe it’s trite, but we’re not in this field, you know, you do, Andy, do a, do a survey sometime of your, of your followers and see how many people entered veterinary medicine to get rich.
Dr. Andy Roark: Right.
Dr. Peter Weinstein: You know, we’re in it because we have a focus, we have a direction, we have a desire to make a difference.
That’s passion. And reward passion. And I think we’ll all be in a much better position.
Dr. Andy Roark: No, I agree. Dr. Peter Weinstein. Thanks so much for being here. Where can people find you online? Tell us tell us a little bit about your entrepreneurship program that you’re doing right now.
Dr. Peter Weinstein: Thank you, Andy. We just released a a program that’s focused on helping create the next generation of veterinary entrepreneurs. You can find that at www.veterinaryownershipadvocates.com. And it’s an online course. We have 24 hours of race approved CE with a monthly, what we call a mastermind call to talk about how you can be successful, the problems that you’re having in running your practice.
And so we’re really hoping to build a community of entrepreneurs to keep veterinary medicine independent And to build this next generation of hospital owners So that’s one of my passions and the best place to find me is probably on linkedin and you’ll find some of my thoughts and opinions and sharings there and you know It’s hard not to find me at most of these meetings, too.
I’m the one walking behind andy in great awe
Dr. Andy Roark: Right. Thank you so much for being here, guys. Thanks for tuning in, everybody. Take care of yourselves.
And that’s what I got for you guys. I hope you enjoyed it. I hope you got something out of it. Thanks to Peter for being with me. I always enjoy kicking ideas around with him. It always affects my thinking. I’m gonna definitely have to meditate on this episode a little bit for a while. I think there’s a lot here.
So anyway, guys take care of yourselves. Be well. I’ll talk to you soon. Bye.
