Medicine

Tyler Grogan, CVT and Creative Marketing Director at Uncharted Veterinary Conference, is on the podcast today to discuss transitioning out of practice and what it means to walk away from what you consider your “life’s work.” In this episode of the Cone of Shame Veterinary Podcast, Dr. Andy Roark and Tyler share personal experiences and reflections on leaving clinical veterinary work, struggling with identity, and redefining success. They also dive into the emotional complexities veterinary professionals face when stepping away from practice. This episode provides valuable insight for those looking to transition into new roles while staying connected to the veterinary profession.

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

LINKS

Tyler Grogan on LinkedIn: https://www.linkedin.com/in/tyler-grogan-63247a192/

Uncharted Veterinary Conference & Community: https://www.unchartedvet.com

Leadership Essentials Certificate: https://unchartedvet.com/certificates/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Tyler Grogan is a Certified Veterinary Technician with experience in specialty, emergency and general practice. She currently serves as the Creative Marketing Director for the Uncharted Veterinary Conference where she focuses on brand building, marketing, storytelling across multiple digital platforms, and exploring new ways to elevate the client experience.

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 my friend Tyler Grogan. She is a CVT and she works for me at the Uncharted Veterinary Conference and we are talking about what happens when you are done with your life’s work. And so Tyler’s got a great question here that came from one of our community members in Uncharted.

And it’s, it’s a really good philosophic discussion about phases of our life and what happens when we don’t want to do the thing that we’ve been doing in the past. And the guilt that a lot of people wrestle with when they say, I, I want to leave. I want to change. I want to. to try something different, but I feel like I’m giving up on the legacy I’ve been trying to build, or I feel like I’m quitting on a field that I was called to.

And anyway, we get into all of that. This is a really interesting conversation. I hope you guys will enjoy it. 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 Tyler Grogan, CVT. How are you?

Tyler Grogan: I’m great. How are you Andy?

Dr. Andy Roark: I’m doing really well. It’s always good to see your smiling face, which I get to see quite regularly because we live in the same town and you, you work for me. And so that, that makes us see each other quite regularly. So for those who do not know you, you are the Creative Marketing Director at Uncharted Veterinary Conference.

What does that mean? What does that entail, Tyler? What does that mean?

Tyler Grogan: You know, I do a little bit of everything, Andy. A little bit of promoting our events and telling people what we’re doing over at Uncharted. I help out with our events when we put them on, creating stuff on our social media, all kinds of things like that, writing newsletters. So yeah. A little bit of everything. 

You’re 

Dr. Andy Roark: doing, you’re doing a bit of speaking these days and you are actually doing really good stuff. Now you’re blushing. You do really good. You do really good lectures. You do really great lectures on the customer experience, I think is sort of your area of expertise. I think it’s, it blends in with the marketing work that you do, but you do very cool stuff on engaging your clients as they come into the building.

You do work on queue theory, which is the science of getting people to enjoy waiting and lots of really interesting stuff. That I just, I love. I don’t think anybody else is talking about it. And so, anyway, you do, you do excellent work in a lot of different areas. And, you’re also writing a bit. And you wrote something that really, I thought was very interesting.

And I have not seen other people talking about it. And so let me pause here and just open sort of the floor to you for a second. Why don’t you sort of talk about the piece about the end of our life’s work.

Tyler Grogan: Sure. one of the things that I do over at Uncharted is our community newsletter. So every month our members get a newsletter from us. And a few months ago I was encouraged to write for it. So I started writing and

Dr. Andy Roark: You were volun-told, I think is the

Tyler Grogan: I, yes,

Dr. Andy Roark: I think is

Tyler Grogan: well, I wasn’t going to call you out on the podcast that you run, but yes, you volun-told me to write more.

So, I started writing these letters from the editor and every month go into the community and look for some things that people are doing and share kind of their wins and their trophies and also just see, you know, what everybody’s doing that’s great in their practices. And there was one post that came out this past month that I recognized someone was struggling with.

This idea of selling their practice or moving on from being a practice veterinarian to pursue other things and there was a kind of a feeling of guilt it seemed like in the post and that really struck me because I remember when I left practice and started working full time with uncharted. I had a really hard time dealing with the idea of not being a vet tech, not being the person on the floor handling the pets.

And what did that mean about my identity and my role in veterinary medicine? And so I could really resonate with perhaps what she was going through. So, it just gave me this thought of what does it mean when you’re done with what you considered was your life’s work? I mean, I’ve never been a business owner or a practice owner, so I can’t directly relate, but I can imagine dedicating your entire world to building this business.

And then considering walking away from that or working in it in a different way could be scary and a really big question to answer. So what do you do when you’re done with what you considered your life’s work?

Dr. Andy Roark: Yeah.

Tyler Grogan: So that’s where it came from.

Dr. Andy Roark: It’s I love that. I think that’s really interesting. And I, it’s funny, I get a lot of private phone calls about this. It’s not, you know, not, people don’t raise their hand at lectures or anything and ask me about it, but I get a lot of questions because I’ve done a lot of different things in my career, I think, and so people say, well, Andy’s, he has done things and then done different things, and, you know, when they’re kind of looking at ending a chapter, I get those phone calls sometimes, and it’s, it’s funny, I’ve thought, I’ve thought a lot about it, I think, I think there’s a couple pieces to this, I think that, I think you put your finger right on it at the beginning, Tyler, I think that, There’s a couple weird things about vet medicine that I don’t think other industries have and I think the identity aspect I don’t think happens so much in other other areas like I don’t know that people see themselves as a barista. 

Tyler Grogan: Like, I’m an insurance provider.

Dr. Andy Roark: exactly right. I mean, it totally, and like, I am actually blown away sometimes when I talk to people who are not remotely defined by their career. And I, I have tried hard to not let veterinarian define me as a person. But it’s a constant battle because it’s, it’s, I always say, it doesn’t define me.

And then I’ll meet new people. I’m like, Hi, I’m Andy. I’m a veterinarian. Because I know that they’re going to like that. It’s going to make them happy. And they’re going to want to know me. And like, I say it and it’s just. It reemphasizes this idea of like, this is who I am as a, as a person. And, and I don’t know the other, the other people have those, have those thoughts.

I think, I think also there’s the calling. And so, you know, I don’t know, I think there’s some, some vet techs that feel this way for sure, but I think it’s, it’s definitely heavy on the doctors. People say vet medicine is a calling. And if you buy into that, it really does feel like leaving is a failure of some great, like, spiritual call that you’ve had.

You know, you’re like, I was called to vet medicine. And I got tired of it and decided I was gonna go into, you know, into pharmaceutical sales. And it just feels awful. I’ve always kind of pushed back against that idea that, that medicine is a calling. And some people really don’t like when I say that because I speak so lovingly of that medicine.

But I could, two things can be true at the same time. You can really like that medicine and also say, I don’t, I don’t feel like it’s a calling. I feel like it’s a job and it’s something I’m happy to do while I’m doing it. But I think a lot of people really struggle with that.

Tyler Grogan: I completely agree with that. And you know, I was definitely one of those people, you know, walking out of practice. I felt like I suddenly wasn’t fulfilling some greater purpose. Like it almost felt like I was abandoning something that was bigger than me. And, I remember sitting with that for awhile and thinking about, okay, who was I before I worked in a veterinary practice?

And like, what are the things about me that define me beyond that, that title? And I’ve also had conversations with people that work in different, in veterinary medicine, but in different countries and their perspective on work in their life is such, it can be so different and their definition, they do really care and are very dedicated to this profession, but they’re also talking more about the things they do outside of that, like their role in their community. The things that they’re active within their community doing, maybe gardening and the local community garden, or, you know, the things that they do with their families or talking about their families.

And I think that there’s just kind of a different perspective and When I thought about this person that I, I know relatively well, thanks to Uncharted being such a tight knit community, I know her for who she is more than I, like, I’ve never worked with her in practice. So I know her as a person and the way that she, she has impacted me in my life,

as a person outside of veterinary practice. And so I think it’s really easy to forget that you have a purpose as a person outside of the context of the walls of a veterinary practice, like how you impact people is so much beyond, like it grows so far beyond that. And then the article that I wrote, I talk about, you know, Was your goal, what was your goal in starting this in this business or starting your practice?

Was it to create a space that you could have medicine be practiced in a way that you felt was good for the animals? Did you want to create an environment for people that also love to practice medicine and that they would want to stay and they would have a lifelong fulfilling career there because as you walk away from that that is still probably true.

You probably created exactly what you were aiming to create. And just because your hands on involvement may change, it doesn’t necessarily mean that it’s not part of who you are anymore. And so there was just so much to, to dig into there. And, and like I said, as a person she’s had a great impact on me in my life.

And so it was just really interesting to think about that. She didn’t see the impact she could have in the same way outside of her practice.

Dr. Andy Roark: Yeah, I think, I think you really put your finger right on it. I, I’m guilty of looking at things like a practice and saying, yes, this is the mark I will make on the world. You know, like, this will be my legacy. And, and you, you look at that and it, it feels like a tangible thing that you need to have.

Like, I need a gold watch from doing 30 years in this, you know, organization or whatever. And, as the world has changed the idea that any of us are going to stay in a job for 30 years is, you know, it’s not as common as it used to be. Now, if you, if you own the place, that can be a little bit different, but for most of us, you know, we’re getting more accustomed to the idea of having multiple jobs and not having one thing.

And so I, I think that that’s, that’s important for the changing state of the world. I think you’re spot on in this idea. A lot of us look at a thing and you say, I’m going to be a house call veterinarian and I’m going to serve this community and that will be my legacy. I am in it and I’m going to do it for the rest of my career.

And then you do it for 15 years and you say, well, I, I’m, I’m, I’m ready for something else. And. If you have tied your legacy to this house call business, walking away from it feels like quitting. It feels like abandoning the legacy that was so important to you. And so I, but I think that that’s a mental trap.

And I think you, you put your finger right on it. The idea that your practice or your time in practice is your legacy. It’s a mental fallacy. I think what’s exactly right, Tyler, is what you said of it is. Why did you start this practice? What did you hope to accomplish? What was your goal in starting it?

Because you can set down that practice and walk away and continue to pursue that goal. And thereby your legacy becomes, I want to have this supportive impact on my community. And I’m not going to do it with my house call practice. I’m going to do it in other ways. I’m going to go and partner up with another group of doctors and do something different, but I am still pursuing the goal and making that legacy true.

And now I’ll say I have served my community for 15 years as a house call veterinarian, and then for 10 more years as a co owner of the emergency hospital, and then blah, blah, blah. And you put together this really great resume, and I don’t know what great resume means in this context, but you put together this resume of continuing to pursue your goal, continuing to make a difference, even though the housecall vet chapter of your life has closed.

But I think, I think, if you don’t break the, what was the point with all of this? Was it really to have a big building and a sign that people recognize? Or was it to do something great? If, if you break that point out, I think that that’s really the key, and I think you can carry that key oftentimes into retirement.

I think a lot of people who are just like, you know, it’s not even about shutting down what I’m doing and doing something else. I think for a lot of people going into retirement, they really do kind of have to figure out what their why is and what pursuit of that why in a different way looks like. And it may just be being the most engaged grandparent that you can be.

That’s, that’s part of your legacy. It’s really, it’s probably, it’s probably one of the most important parts of your legacy.

Tyler Grogan: It’s so true. And I love what you said about, you know, this is a different way to serve your community because. We evolve, and I think this is something I’m, I’m learning more about myself, but we evolve as we age and get older, and our priorities shift, and the things that we care about shift, and then the beauty of veterinary medicine is that the people that come into practices are people that really care about what we do and there are people that by opening the door for them to have a different role in that space may give them the catalyst to do the next amazing thing that they’re going to do.

So, you know, stepping out of that role and allowing someone else to fulfill it or fulfill a different role within that community or that group of people, you know, it, it opens doors for everyone. And it also, you can shift and evolve and do different things. And you’re still growing and you’re still learning and you can still use it to, again, like you said, serve the same people, you know, still help the, if that was your goal from the beginning was to be someone that your community could rely on for the, this information and this care for their pets, it could be different.

It can just be different. Be something new and I think that that’s that’s so fun. I mean, I don’t get me wrong. You work with me you know well enough that I’m not always the most eager about change or uncertainty definitely uncertainty. So I might come off like I’m like change is great. Everything is super easy.

Like this is no problem. It’s definitely not and it’s not for me but it is, you know taking a step back and allowing yourself to have that perspective for a minute and just think okay, this could be really cool. This could be really fun. And the work that we do that we’re excited about is the work that makes the biggest impact.

You know, those are the things that really leave the mark or the things that you did when you were so in it and so in your flow and you were excited about it at the time. So it would almost be a disservice not to pursue what you’re excited about. Rather to stay in something that’s comfortable. So I have to remind myself of these things, like I said, on a regular and daily basis.

I think that it’s a good opportunity to step back and have a different perspective for a minute to let yourself not feel those feelings of, am I walking away from what my life was supposed to be? Because your life is so much more than just one thing.

Dr. Andy Roark: I think there’s also this, this idea. So part of it is, there’s this fear about the unknown. You know, you get quite comfortable in where we are. And that, and there, there’s fear about, about the unknown. Changing and moving in something else.

I think another way to kind of look at it is a lot of us have told ourselves that there is a finish line in our career. So when we say this is my life’s work and I’m going to walk away from this work, probably at some point we decided that this job, this, you know, a position, you know, whatever that was, that was the finish line.

I was like, I will get here and I will do this and my life will be a success. And then what always happens is you get there and you realize that it doesn’t make you a success in your own eyes. You know what I mean? Like you don’t feel any different about yourself now that you’ve been doing this for 20 years than you did when you did it for five years.

And you don’t feel any different about yourself now that you have this, I don’t know, this academic position at the vet school than you did when you were grinding it out in private practice. Like those that we tell ourselves this is going to transform me or this is going to make my life meaningful or this is going to, at least for me, it’s always been like I’m going to do this thing.

I’m going to accomplish this thing. I’m going to build this thing. And then I will have certifiable proof that I have been successful or I’ve made the impact that I wanted to make. And that, that, that transformation has never happened for me, and so I think that, that happens to a lot of us. I, you know, I heard a, a phrase, and I, I say this all the time, and you’ve probably heard me say it a million times, but, you know, Life is what you experience.

It’s not what you accomplish, it’s what you experience. And so, every day that we’re out there, In practice, your life is what you’re focusing on. It is on the actual doing of the work. And so I think it’s easy to say, Oh, no, I’m leaving my life’s work behind. And I say, well, but that’s that’s a thing that you did.

It’s not, one, it’s not who you are, and also, two, it’s not what your life was like as an experience. It was not, it was not the the process of being, if you will. And so I, I think that, that that’s sort of a construct that people kind of get, get sort of tied up in. And so I, I, that was just sort of the, the a big part of it for me is if you can get your head around the idea that your life is not anything that you leave behind, but is instead is the The sum of the experiences that you have along the way and when I say experiences I don’t mean like going on vacation stuff like that.

I mean, the experience I have if you and I are hanging out together and we’re riding a bus And i’m looking at my phone the whole time and scrolling on instagram. That’s my experience right like my life is a bus ride looking instagram And if I don’t have my phone in my hands and i’m talking to you about you know, what, what the end of a career looks like or what career change looks like and we’re having this, this back and forth discussion that’s, that’s, that’s really interesting and engaging and you and I are building our relationship and we’re thinking about things in different ways.

That’s my experience. That’s my life. And those are two wildly different experiences on the same bus ride. But that’s what your life becomes at the end of the day. Did you scroll Instagram all day? Because that’s the life you’re leading or did you engage with other people and talk to them about what’s important to them and feel like you grew the social fabric around you and you made these stronger relationships that, that they’re going to continue to, to be able to take joy in.

I just really think that, that life is the experience. I think that that can help you feel that your life is rolling on, even though you’ve left this big part of you behind. I think the last thing for me. I don’t know if it’s a good story or not, but it’s definitely something that happened in my life and it really affected me.

It’s just so silly when it’s just a simple conversation and the other person doesn’t even remember. But when I was in vet school, and all the way up until vet school, I really enjoyed watching movies. I was a movie fan. I just, I really, I just liked movies. I liked getting lost in the story and just watching movies.

Tyler Grogan: I’ve heard you nerd out about Star Wars a couple of times, so I had an idea.

Dr. Andy Roark: I just watched a bunch of movies. I watched a little art house stuff. I watched all kinds of stuff. I just, I really like movies a lot. And then Alison my wife, was pregnant. And and so we were heading for our first child, and I was at the end of vet school. And my mother in law, was talking to me about something and I said something like, Oh, you know, I don’t know these movies are coming out or there was a movie, you know, the release date was like the next year or something.

And I said something to her. And she said, well, you’re not going to have any time to watch movies after this. And she kind of laughed at me. And I, I remember being, angry, like really angry, like, how dare you, you know what I mean? I think I was probably afraid, like, because you don’t know what’s gonna happen when you have a baby.

And I was like, is this, is this gonna be the end of my movie watching? Like, it really scared me in that, like, I, I imagined something I love being just taken away from me. And I was like, oh crap. And then we had the baby. And the truth, Tyler, after that is, I just, I didn’t watch movies. But also, it was, I didn’t really want to watch movies. The truth is, I just wanted to go to bed. I was exhausted all the time.

Tyler Grogan: I can imagine.

Dr. Andy Roark: You know what I mean? And like, so it just, I, it just didn’t occur to me. And then we had, we just had other stuff going on. And it wasn’t like I was pining to watch movies and not getting to. It was, I just, that phase of my life of my, my girlfriend slash Fiancee slash new bride and I hanging out watching movies and going on dates like that that that we did that and it was great. But then that sort of phase of our life came to an end and then we had kids and things and it was hard to get out to the movie theater and it just so But I didn’t pine for it, it just kind of, that, that chapter ended.

And that was the first time I, I sort of started to realize and recognize, like, sometimes you have chapters in your life, and those chapters just kind of close. I saw, I saw this post in social media one time, it was this person, and I’m not, I’m still not exactly sure if they were in good faith or bad faith, but basically they were someone in their 20s, and they were asking the question of, hey, people who are 30 and older, what do you live for?

Like, you’re past your prime in every meaningful way. I know! They were like, you’re past your prime in every meaningful way. And again, how ridiculous was this? It was a person in their, probably late teens, early 20s, saying people over the age of 30, not 90, 30. And, again, I wasn’t sure if this person was in good faith or bad faith, but I was just kind of like, I can’t, the idea this person would say to someone in their 30s or 40s or 50s or whatever Why do you keep living?

You, all, the best stuff is behind you. I, I, and here I am with my young family, like, living the most rewarding phase of my life. So far, at that time. You know what I mean? And and the fact that this person who’s 21 who’s like, Psh, now that I can go to the bars, I guess there’s nothing left. And I’m like, you have no idea how you’re going to feel in five years.

You have no idea what you’re going to want in 10 years. You just, you don’t know. And the things that I enjoy doing, I get up early and go to the gym now, and I get teased about it. But, I did not want to get up early and go to the gym in my 20s. But now, I love it. It’s great. And if you told me that when I was 30, I would have said, You’re crazy.

Leave me alone so I can sleep because my child is distracted. It’s amazing. All that to say, it’s through these sort of a couple of experiences that I really came to believe. There are chapters in our life, and you might really, really want things for a certain amount of time in your life. And then that chapter comes to an end by external circumstances.

You just get older, and you tend to feel differently about things when you’re in different phases of your life. Yeah. And the idea that you would feel guilty because what you want in this new chapter of your life is not what you wanted in your previous chapter of your life. I think that’s, I think that’s sad.

And that, that whole chapter of your life thing, it has made me so much more open to change. And so much more I don’t know, just, just flexible when I look ahead and I say, Oh my gosh, the city of Greenville where we live. It’s beautiful. It’s booming, Tyler. Like, there’s people moving here all day, every day.

It’s, it’s gone from a town to being a tiny city, and like, it does not look like it’s slowing down. And I can go, boy, am I gonna wanna be here in ten years? And the truth is, I have no idea. In ten years, my kids will have moved out hopefully. And, you know, they might be, they might be starting families, and like, maybe I wanna be where they are.

Who, who knows? Maybe it won’t be a sad thing. I, I don’t know how I’m gonna feel. When we get to that point, but I talk about this because that, that, that phases of life, those chapters of life, I think that’s so vital to growing and being happy in different phases. And so when someone says to me, how do I put my life’s work behind me?

One, I go back to your point, which is, I think you should tease out the original goal and I think you could probably continue that goal and you will continue your life’s work even as you leave the thing behind. And then number two, I would say. You have chapters and phases in your life. And if a, there’s nothing sadder than someone who has gone on to the next chapter, but is too afraid to turn the page.

And it’s just, it just, it chains them down. And they’re not happy and they don’t enjoy these things they’ve made for themselves. And they feel like because they don’t enjoy them now, they must have been untruthful in the past. And that’s just not true. It’s just We change, and we grow, and we evolve, and these phases, I just think that they’re very, very real.

And so, anyway, for anyone who’s feeling sort of guilty out there about moving into a new phase, I don’t, I don’t, that, the phases of life has helped me a lot, just to say, Yep, I’ve done this, I was in practice full time for this amount of time, and then I did relief work, and I did that, and then I was the parent of two kids.

You know, babies and toddlers. And I, I did that. I’m not, I’m not there anymore. And when I see parents who were in that phase, I look back with nostalgia, but I ain’t confused. My, my teenagers are very, very different, and I do not have toddler problems anymore. I did that, and I empathize. And I, and again, I’m not interested in going back, but it was very rewarding when I was there.

Tyler Grogan: I think that that’s a really good point in comparing it. I mean, I have not been a parent, but I have seen, kind of, people go through the different phases of their child’s lives and how their lives evolve and change, and it’s so true that it’s a good comparison to make. And I’ll just, you know, say that, in terms of a career example, you know, if you had told me that you’d introduced me on a podcast one day, like first, let’s start there.

But second that I’d be, have just got back talking to people about queue theory and queue management. I would have laughed in your face because I would have said, how in the world does that even happen? Like, tell me how that world unfolds because I don’t understand. 

Dr. Andy Roark: You just came back from lecturing in Canada, like you were

in another country. International speaker coming back for a podcast.

Tyler Grogan: I’m working on them, inviting me to be, you know, a dual citizen. So, you know, because the mountains are amazing, but yes, so very fortunate to have had those opportunities, but you know, it’s because of random other parts of my life that those things that even came to be, that was just because of someone I knew that was outside of veterinary medicine, that it came to be, that that would be how I would start to speak.

So, you know, things happen that. You don’t expect they change the chapters of your life open and close. And I think you just have to, you know, walk into those moments and say, this is a good thing. Like, even if it feels scary right now I met, I’ve met so many veterinary professionals and especially technicians, but they’re like, I can’t, I don’t know anything else.

I don’t know how to do anything else. Everything you do in practice is transferable to life or to other careers. And you can do anything that you believe in yourself that you can, that you want to do. And so much of what we do is goes beyond the walls of the veterinary practice. So when you’re faced with that moment where you’re not sure you’re ready to walk away from being in practice or, or whatever it is, whatever part of your career, you’re ready to walk into practice.

If you’re not sure if it feels like the thing that excites you the most then go for it. You can totally you can do it. So I’m, very grateful for our community for being so vulnerable and honest with each other because it really allows us to have these conversations and you know to close i’ll say that this person received so much support and options and you know offers for people to call to talk it out people that have been in similar situations or maybe are also in a similar place. And it was followed by a post somewhat by someone else that’s working on post retirement writing stories about their life in practice.

And it’s been a great memory kind of jogging exercise for them. So I’m really grateful for our community for providing these conversations for us. Cause I mean, it’s, it’s inspiring to watch for sure.

Dr. Andy Roark: No, I agree. Tyler, thanks so much for being here. Where can people, where can they find you? And then where can they learn more about the Uncharted Veterinary Conference and Community?

Tyler Grogan: You could find me on LinkedIn or, you know, in the Uncharted Community. I’m usually most active there. Uncharted. If you’re not familiar, we we are at unchartedvet.com we put on virtual events and we also do lots of other things, and we have a podcast as well. So if you’re interested in that and uncharted @unchartedvet is where we’re at on social, so check us out.

Dr. Andy Roark: Sounds good. Thanks for being here, Tyler. Guys, thanks for listening, everybody. Take care of yourselves. I’ll talk to you later on.

And that’s what I got. Guys, thanks for being here. Thanks to Tyler Grogan for joining us. I hope you got something out of this episode. This is one of those episodes that I really, I’ve very much enjoyed thinking about when I recorded it. I have enjoyed thinking about it since then. I hope, guys find, find some value in it, or at least to stimulate some thought and discussion. So anyway, Take care of yourselves, everybody. I’ll talk to you later on. 

The DermVet, Dr. Ashley Bourgeois returns to help us navigate canine allergies. In this episode of The Cone of Shame Veterinary Podcast, Dr. Andy Roark welcomes board-certified veterinary dermatologist Dr. Ashley Bourgeois to discuss managing difficult canine allergy cases that don’t respond well to Apoquel or Cytopoint. Dr. Bourgeois offers practical advice on identifying hidden infections in claw folds, using consistent treatment regimens, and when to consider alternatives like skin biopsies or recognizing allergy mimickers such as autoimmune diseases or lymphoma. Tune in for insights on allergy testing, immunotherapy, and effective long-term strategies for managing atopic dermatitis. Gang, let’s get into this episode!

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

LINKS

Dr. Ashley Bourgeois: https://thedermvet.com/about

Dr. Ashley Bourgeois on Instagram: https://www.instagram.com/thedermvet/

Dr. Ashley Bourgeois on LinkedIn: https://www.linkedin.com/in/ashley-bourgeois-dvm-dip-acvd-9169208/

Exam Room Communication Toolkit: https://drandyroark.com/exam-room-communication-toolkit/

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

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

ABOUT OUR GUEST

Dr. Ashley Bourgeois is a board-certified veterinary dermatologist passionate about providing practical knowledge to general practitioners to help itchy pets! She completed her bachelor’s degree at Iowa State University and graduated from the University of Missouri’s College of Veterinary Medicine in 2010. She then completed a one-year small animal internship at Purdue University. Upon finishing her internship, she accepted a residency position with the Animal Dermatology Clinic’s Tustin, California location in 2011. She became a Diplomate of the American College of Veterinary Dermatology in 2014. Dr. Bourgeois moved to Portland, Oregon in 2016 to help expand the company. She is an owner within the company and on the board of directors. She has a strong interest in autoimmune skin diseases, allergies, cytology, and otology. In her leisure, Dr. Bourgeois enjoys outdoor activities, traveling, and watching sports. She and her husband stay busy with their daughter, son, and rescue Lab/Boxer/Pit mix. Dr. Bourgeois is passionate about educating veterinarians in dermatology and work/life integration through her podcast, lecturing, and social media presence (The Derm Vet).

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a good one here. I am with my friend Dr. Ashley Bourgeois she is a veterinary dermatologist, and we are talking about allergies when Apoquel doesn’t work. That’s right, if you’ve been in practice for a while, you’ve seen those cases roll in, and you’re like, Oh, we tried Apoquel, we tried Cytopoint, and we’re still, we’ve still got an itchy dog and I talked with Ashley here. She’s got all kinds of pearls and insights and we walked through what do you do with these cases? is a fantastic episode. I hope you’re gonna get a ton out of it I got a ton out of listening to Ashley break it down, And so anyway, 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, Dr. Ashley Bourgeois how are you?

Dr. Ashley Bourgeois: I am doing so good. We are actually going to talk about one of my favorite topics today. So I’m just so excited to go through this journey with you today. 

Dr. Andy Roark: I love when I have brilliant people on the podcast, and I take them problems, and they’re like, this is one of my favorite things to talk about. 

Dr. Ashley Bourgeois: But I’m a dermatologist I like, I could say that about any topic, but this is such a common issue. I can’t wait to shed some light onto it.

Dr. Andy Roark: Oh, yeah, what we want to talk about today, and sort of what I went to you with, is, Ashley, what are your, what are your tips and tricks for treating the canine allergy patient who’s getting Apoquel or Cytopoint and it’s still not cutting it? And so I’m thinking of the case, let’s say we’ve sent home flea and tick preventative and we have, you know, tried to, treat these allergies in the classic way, and they’re getting Apoquel or Cytopoint, things like that.

And we’re still having issues. I think a lot of times people kind of look at their hands and go, Oh boy, you know, what do we need to do here? What do we need to do here? I’ll tell you. I always have a panic moment at, at that, at that, at that point. Not that I don’t have other tools, but it’s almost like, oh, my go-to move isn’t working.

And and I, I need to, I need to walk this back or, or try to approach this differently. So let me just pause there and kind of turn it over to you and say, how often do you see. Allergy cases that make their way to you that are getting sort of what you consider to be quality Sort of top line therapy and you’re still seeing breakthroughs.

Dr. Ashley Bourgeois: Yeah. I think it’s a bit of a double edged sword because let’s say it’s typical for me to get that history where the client comes in and says that, right. But I’d say the two things I see, if that is not true, let’s say like the client comes in with that impression, maybe the veterinarian has that impression.

But I kind of get to the point where I’m not really sure that’s true. I’d say there’s two, two fold one for sure. Flare factors. So like things aren’t infection aren’t controlled. So we see oftentimes where if they do break out with Malassezia or a pyoderma, you know, interdigital spaces, claw folds, claw folds are huge.

When I lecture about cytology, it’s one of the best things you could be doing. Is getting a toothpick, scraping material out of that claw fold. If you have a dog that’s looking and chewing their paws incessantly, but when you look at the paws, they don’t look that bad. Check those claw folds. Malassezia, infection, bacteria really like to hide in there, and they can look pretty darn normal, and then all of a sudden you’ll find a bunch of stuff hiding there.

Dr. Andy Roark: You’re not seeing you’re not seeing kind of pus crusty stuff around the the edges there? You’re not seeing hair loss anything like that?

Dr. Ashley Bourgeois: You can be, you don’t have to. I mean, especially if they have long coats. Like a lot of times I have pictures where they look totally normal. You flip back the claw fold and there is stuff in there or you flip back the claw fold. You don’t see too much, but then when you get a sample, there’s actually quite a bit of infection that’s hiding in that tissue.

So they don’t have to necessarily be lesional, but I always check those areas. I’d say the second kind of, it didn’t work, but actually I think it maybe could, is not consistent. So, Apoquel is a great tool, and I think as a general practitioner, you probably get away a little bit more with, Oh, let’s just do two weeks and you can stop.

But when you keep doing the two weeks and stop, two weeks and stop, two weeks and stop, and the dog keeps breaking out, then they come to us and I’ll say, well, have you just given it consistently? And they’ll say, no, I’m like, well, you might be a dog that just needs it consistently. So I think those are probably the more common things I see.

Now there can be true statements to that. I’ve certainly had cases that don’t respond. You know, I am managing the infections. I have them on the flea control. We’ve done the diet trials. Like they truly are atopic. I don’t have a flare factor present and they’re just not responding. No medication is a hundred percent.

So certainly there are some difficult cases. And that’s when I start thinking of either alternatives or I’d say the flip side is, is it actually allergies? Because sometimes we have allergy mimickers that can present as well. 

Dr. Andy Roark: Okay. Tell me tell me more about that. What what are your what are your top allergy mimickers?

Dr. Ashley Bourgeois: So I would say some of the main mimickers we think of are either like autoimmune or neoplastic. I think when we talk about, say, like, pymphagus, right? Because that’s the one people always think of. They think, oh, it has to be the dog coming in where the nose is completely crusted and depigmented and their paw pads are completely crusted.

But if you think about it, pyoderma, what does that look like? It can be colorette, scaly, but it can also be crusty. So when you get some of these pymphagus cases that their mucous membranes aren’t affected, you know, they are just kind of crusty throughout the trunk. And we don’t do cytology. We don’t identify like, oh, there’s not an infection causing that.

They actually can look a lot like allergies. And then I would say one of the other big ones, and it’s going to sound crazy, but it’s so true. And we see this a lot is skin lymphoma. Skin lymphoma can do anything from being detrimental. You know, completely eating away the skin ulcerative. They look awful to a focal area of erythema and scaling.

I mean, it really can be pretty mild in some of these early cases. And a lot of times our till for that is it has started when they’re older and they haven’t really had a history of dermatologic issues in the past.

Dr. Andy Roark: Okay, so old dog with a lesion and that’s, that’s not, not normal for this dog. You would have like cutaneous lymphoma on your, on your list. Are you going to see anything on that with, with cytology, like just regular skin cytology? Are you going to pick anything up or no?

Dr. Ashley Bourgeois: You can. So a lot of times you will pick up these neoplastic cells. And what I try to tell general veterinarians, because some of them will be like, well, I don’t feel comfortable saying that. Yeah. 

Dr. Andy Roark: Oh, I definitely don’t want to say that.

Like, 

I’m like, ooh, we need to send this out and get, get a second, get a second opinion on this.

Dr. Ashley Bourgeois: and you totally could. And what I would tell you as a dermatologist is, I don’t really care if you would say, Oh, I’m Andy Roark. And I feel like this looks like cutaneous lymphoma. Like what I care about is that you can say that’s weird, right? Because if you can even say that’s weird, like that happens to me all the time, you know, I’m a dermatologist, but I’ll look at something.

I’m like, well, that’s weird. Okay. But at least I know my next step should be, well, you know, I can’t, I shouldn’t probably refer, I mean, I could refer to someone else, but it should be me, but you would refer or you’d biopsy. Right? So like you could at least say, okay, well maybe we don’t just throw apoquel at this case.

So to me, there’s a ton of value in that, even if you’re not confident to say. This is an autoimmune disease. You can say, well, there’s not bacteria here. That’s pretty weird. So now what do I think about in this case?

Dr. Andy Roark: Have you got any pearls for me on skin biopsies? I mean, they’re pretty, they’re pretty straightforward. I do love, I love a, I love a punch biopsy. It makes me feel so cultured. I don’t know. It works well. It tends to go well. I know what I’m doing. But I, if, if another doctor turned to me and said, Andy, I hey, you got any concerns about me biopsying this weird spot?

Is there anything that should be on my radar, or should I say, no, go for it?

Dr. Ashley Bourgeois: Yeah, I’d say multiple things. I would collect cytology first because if it’s severely infected, you’re probably better off trying to treat that infection first, because if there’s just a rip roaring bacterial folliculitis, you’re going to get a biopsy that says there’s a bacterial folliculitis. And that’s not going to be that helpful.

You know, other basic stuff is if there’s diffuse lesions, you know, you should be getting multiple sites. You should not just be taking one site if there is diffuse. And it’s not just like a mass you’re taking off. You do not want to sterilely prep them. So I think surgeons probably lose their mind when they walk by a dermatologist biopsying them.

Right. Cause we want the crests. Like sometimes that’s how you get your diagnosis. So we are almost never sterilely prepping unless we’re removing a nodule or mass, but. Or we’re doing a tissue culture, but for just a run of the mill histopathology, we’re actually getting the crust. We’re getting the nasty stuff with it.

And then just making sure that you’re getting bigger punches. So we shouldn’t really be taking two millimeter punches. Like we should be doing more like eight millimeter punches if we’re doing diffuse disease.

Dr. Andy Roark: Not sterilely prepping the area feels like sacrilege. But I mean, I know, I know I’m supposed to do it, but I feel people looking at me like, are you just gonna, you’re just gonna. Do it like that and yeah,

Dr. Ashley Bourgeois: Just come spend a day in derm. Like, I mean, we are just like, you know, crust and nasty and like I said, the surgeons probably lose their mind because we’re just like not sterilely prepping. And I will tell you, I biopsy all the time. I’ve just done derm now for like 13 years. None have ever been like, Oh my God, you cause this patient to be septic

cause he took a skin biopsy. Right. Cause I’ve done cytology. If there’s infection, I’m probably going to treat them anyway. But you’ll, you’ll be 

okay. 

Dr. Andy Roark: That totally makes sense. 

 Hey guys, communication is key to creating amazing experiences in the clinic. From the phones to the front desk, to the exam room. The way our teams interact with pet owners makes a difference. The team training bundle I have drandyroark.com brings together my Charming The Angry Client and Exam Room Communication Toolkit courses to provide flexible on demand communication training for your veterinary practice. Check them out. 

These courses are made to be taken. in groups, they have discussion questions. They are all about taking these trainings and getting them to apply to your practice, your culture. And your clients, whether it’s handling angry clients. Or being effective in the exam room. We’ve got some great training resources that you can grab and drop and use pieces of. 

They’re all broken up into five minute modules to make it super easy for you to use what you want and skip over what you don’t want. Tag them onto the end of staff meetings, or just make a whole staff meeting out of the trainings. Anyway, super flexible. It’s drandyroark.com/team-training Gang, 

let’s get back into this episode. 

Dr. Andy Roark: We’ve laid down a lot a lot of different possibilities here, but we’ve got something. We feel like it’s it should be resolving and it’s not we’re digging in the nail beds Which I think is a beautiful little pearl i’m going to put in my pocket and keep for sure we’ll move towards skin biopsy thing things like that. Are there are there anything that that pet owners should be aware of is there anything that I should

you say to them about where this treatment path might go so that they’re prepped?

Dr. Ashley Bourgeois: Yeah. I mean, usually when I’m giving, so let’s assume it is an allergic case, right? Like it’s not a mimicker. It’s truly an allergic case. That’s like not responding. I certainly talked to owners about, I kind of break it into two options. If I’m managing atopic dermatitis, one is symptom treatment.

And I break that into infection control because we know. We have to control the infection or the itch won’t fully resolve. And then my second kind of symptom control category is the allergic itch itself. And when I do that for dogs, I write Apoquel, cytopoint, cyclosporine and steroids. The reason being, apoquel and cytopoint have been amazing tools for us, you know, you can certainly use them together, you can do all sorts of things, but again, no medication is 100%, so we certainly have cases that do not respond.

They’re allergic, they’re not a mimicker, we’re managing infection, they don’t respond. And you cannot forget about those other possibilities. And I would say I still have cases that respond better to cyclosporine. It’s a more broad spectrum anti inflammatory. It’s certainly something, especially with our crazy pododermis titus cases, things like that, where they can still respond the best.

So just because they don’t respond to apoquel or cytopoint, you know, they’re allergic doesn’t mean you have no option. And then sometimes we do end up with steroids. Like we try not to. You know, but again, if the reality is they didn’t respond to anything else, then we got to still provide comfort. And then I’m also pushing my second category of managing allergies is pushing allergy testing and immunotherapy, especially if they’re a younger, middle aged dog, right?

If they’re not responding to apoquel cytopoint, like what is the next 10 years look like for that dog? We’re going to have a better chance to desensitize them earlier in the disease process if we can.

Dr. Andy Roark: so I got a couple questions here. So when we’re talking about apoquel cytopoint, cyclosporine, steroids What are your feelings about overlapping these? Are you trying to kind of? say we’re not getting the results that we want. Are we adding in something else with the idea that we may keep all the things?

Or are you going to add in something else and maybe wean off of one of our earlier treatments? Are you, so yeah, talk, talk to me about that is, I don’t want to end up, you know, throwing everything in the kitchen sink at this problem, especially if we’re not getting results. But I always wonder, you know, if I take this dog off of Apoquel to try something else, am I gonna, am I gonna make things worse?

How do you sort of assess what to do with that crossroads?

Dr. Ashley Bourgeois: Yeah, it is a very good question. I’m very individual in the case, but I agree with you. So if I started a dog on let’s say we, for that particular case, we started with Apoquel. They recheck with me and let’s say like, they’re like kind of better, but it’s not a hundred percent better, and I want to try Cytopoint.

I usually have them still give a few days of Apoquel initially. After I give the Cytopoint, a lot of the studies show within three days is when you usually get that response, like a bit over half within a day, see a response. The nice thing about Apoquel is you can start, stop it, right? So I usually say, give it a few days.

If you’re starting to notice the pet’s doing really well, try to stop it and let’s see what happens. So I give them the freedom to do that. If we’re starting something like Cyclosporin, if they were on Apoquel, you can very safely bridge the gap. Like, you can keep them on Apoquel because cyclosporine doesn’t act really quickly, right?

It can take a few weeks, a month to work. So you can still safely keep them on Apoquel in that time if you need to. A lot of times I am using like low dose steroid as I’m bridging them to the cyclosporine as a way to provide some comfort. But that’s why the rechecks are important, right? Cause I want to check in and if the dog’s doing awesome, I’m with you.

I want to try to take things away. Like I already have a lot of my patients on a lot of things. I always want to try to take things away, but I also want to see them, evaluate them to make sure they’ve responded the way that I want.

Dr. Andy Roark: How often do you recheck these types of cases, Ashley? Are you getting them every week or is it a sort of a longer, do you have a tapering where you’re like, I’ll see you in a week and then two weeks and then it’s to go from there? Like, how, how is that?

Dr. Ashley Bourgeois: Yeah, I mean, we actually don’t usually see them back within a week, unless it’s like a rip roaring crazy ear or, you know, like, I think you’ve got some terrible autoimmune disease and I’m just treating the infection to know when to biopsy you, but for an allergy case, at least for me, I would say pretty typical is like, I try something, have them come back three weeks, maybe four weeks.

A lot of that’s very dependent on infection. But if it’s just your response to a medication, yeah. Then usually if I’m going to start on Apoquel, you know, I may do the twice daily for 14 days and then drop down. But I always tell people to let me know if things are not improving and we could try to get them in sooner.

But I give them a bit of time and just don’t want to frustrate the owner if I’m trying to jump the gun a bit quickly and see them that soon. So I would say usually like three weeks is fairly typical, maybe four if we’re not dealing with a bunch of infection.

Dr. Andy Roark: I know that you’re a big fan of allergy testing and immunotherapy in cats. How big are you on this, in our canine patients? So, just, just in us talking, you know, we’ve got a pretty good list of medications that we go through, and then you kind of felt like you added on allergy testing immunotherapy as a sort of like, man, if there’s nothing, if that doesn’t work.

Then, then let’s talk about this. Is that, is that really how you kind of feel or should we be thinking about immunotherapy earlier in our canine patients?

Dr. Ashley Bourgeois: Ooh, I’m really glad you’re asking us to differentiate this cause I’m going to not want to give that impression. I am an advocate to allergy tests whenever the owner is willing. So I love a dog that comes in. It doesn’t happen often, but I love a dog that comes in. They’re doing well on their symptomatic treatment, whether it’s cytopoint cyclosporine, whichever one is working for them.

And they are coming because they, they know it’s a young dog. They want to try to minimize drugs long time, and they want to allergy test them. That is actually most of our dreams as a dermatologist. It doesn’t happen very often. Usually it’s, Oh, this worked. And until it did it, and now you should go see them.

But we absolutely, if owners are willing, we are a hundred percent. So happy to allergy test them at a, at a young age, or even when they’re symptomatically doing well, just to see if we can get ahead of it. Remember, this is a progressive disease. So just because they’re doing great on apoquel when they’re three years old, doesn’t mean when they’re eight years old, they’ll necessarily be controlled.

We know that there’s a progression to it, and that’s what I try to explain to owners, too, is if they’re proactive, it gives us the best chance to try to keep that in control.

Dr. Andy Roark: How do you talk about immunotherapy compared to, you know, medical management in a way that sets good expectations? Like, I guess my idea is if I said to the owner as well, I can do this cytopoint injection or we can do allergy testing and then maybe immunotherapy, which is its own set of injections.

What do you want to do? How do you, how do you sort of explain that in the way the owner says, okay, I understand the investment immunotherapy and I would, I’m going to invest my time and energy there now instead of just taking the, the short term medical fix.

Dr. Ashley Bourgeois: Yeah, to me, it’s not necessarily an or, right? It’s almost an and, because the reality is if I allergy test them, Most of the time they’re on some sort of symptom control while we are giving that time to work. So I really try to have them think more of longevity marathon, you know, rather than like the sprint, the comfort now both are really important, but if we are trying to get ahead of the longterm aspect of this disease, none of us have a crystal ball, you know, if you knew that dog would just get cytopoint and be great the rest of its life with no progression of disease, Cool.

But we don’t know that. So ultimately I really tried to break down kind of that longterm aspect. And let me tell you this, not all of my clients allergy test. I have plenty that don’t, I mean, we love it, but we have to meet that owner where they’re at. And I know I can still help them even if that’s not the route they’re going to go.

But to me, what I tell them is these things can make them comfortable. It can still be tools in our toolbox. What I can do is try to identify what they’re allergic to, put it in a bottle, give it to them in small amounts, and basically see if I can teach their immune system to not react the way it’s reacting.

But that takes time and every response is different.

Dr. Andy Roark: No, that, that totally makes sense. Are there any final pearls, any last words of wisdom for people who are looking at some of these more challenging allergy cases?

Dr. Ashley Bourgeois: I would say for sure, like, control the controllable is one thing I like to say. So I know we have talked about this when we’ve discussed cats, but controlling the controllable means don’t forget the other things, right? The flea control, you know, being able to bathe these pets if they’re able to. There’s a reason you always hear dermatologists talk about multimodal therapy.

This is actually a very complex disease. We think of it being simple, right? Allergies, they’re itchy. You know, you know, we, you and I were talking about how we’re getting to be the older ones now. But when we first started practicing, we didn’t have apoquel or cytopoint. You know, that came out at the end of my residency.

So I did my years with not those tools. And so, you know, those things are, have been amazing. And I hope we keep getting lots of tools. But the reality is like we say multimodal because it’s a complex disease. They’re itchy. They’re skin barrier defects, right? Like. There is an abnormal immune system, their microbiome, we’re starting to learn more about.

So that’s why you often see dermatologists do all the things bathing and, you know, skin support and things like that. So definitely control the things that we can control because there’s a lot that we can’t control. And then certainly like going back to your point, if you are able to, I know not everyone has a dermatologist by them, try to refer them earlier.

You know, it is just nice to start with these cases before it’s been, Oh, well, now we’re eight and we have a methicillin resistant staph pyoderma, and we have to get through that and spend all the money there. And then we’re like, Oh yeah, we also could do this. And we’ve lost all those years to maybe get ahead of it.

Dr. Andy Roark: And the owners are tired and, you know, and they’re frustrated and they’re like, I just don’t want to deal with this anymore.

Dr. Ashley Bourgeois: Yeah. I mean, we set aside that time, right? Like we are usually setting aside longer appointment times. We don’t have the emergency hit by car trying to rush in the same day. So don’t get me wrong, like we’re busy and I know a lot of us have waiting lists. But ultimately like that is what we’re experts in and we have a better success rate if we kind of start managing them earlier.

I think people think I’ve heard even some of my local vets be like, well, they’re not bad enough. I’m like, I can see things besides train wrecks all day. I’m so happy to see the one year old boxer that wants to allergy tests, like bring them on. So I would definitely say like get to know your local dermatologist if you can, and do not be afraid to refer them earlier in the disease process.

Dr. Andy Roark: Dr. Ashley Bourgeois thank you so much for being here. Where can people find you online?

Dr. Ashley Bourgeois: Yeah. Everything I do is under the Derm vet. So I have a podcast that I put weekly tips on, and then a lot of social media that I put under the Derm vet, including cases and just day to day clinical tips. I really like to keep things real life for you guys, and hopefully you guys find that information helpful.

Dr. Andy Roark: That’s fantastic. Thanks so much for being here. Guys, thanks for listening everybody. Take care of yourselves. I’ll talk to you later on.

Dr. Andy Roark: and that’s what I got for you guys. I hope you enjoyed it I hope you got something out of it. Thanks to Ashley for being here. Thanks to you guys for being here. Take care I’ll talk to you guys later on

Dr. Chris Pachel joins us to discuss the complexities of integrating behavior health into veterinary practice. In this episode of the Cone of Shame Veterinary Podcast, Dr. Andy Roark and Dr. Chris Pachel dive into the challenges veterinarians face when addressing behavioral issues within the constraints of typical appointment times. Dr. Pachel shares insights on effective communication strategies, the importance of proper training for veterinary staff in handling behavioral consultations, and the potential benefits of leveraging telehealth for behavioral management. The conversation highlights the need for practical approaches to behavioral health in veterinary settings, emphasizing efficient client education and the strategic use of support staff.

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

LINKS

Dr. Chris Pachel: www.drpachel.com

Uncharted Team Leads Summit: www.unchartedvet.com/tls2024

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. Chris Pachel is a board-certified veterinary behaviorist and is the owner and lead clinician at the Animal Behavior Clinic in Portland, Oregon. Dr. Pachel lectures extensively worldwide, teaches courses at multiple veterinary schools in the United States, and has authored numerous articles and book chapters for veterinarians and pet owners. He is a sought-after expert witness for legal cases and serves on the Editorial Advisory Board for dvm360. He is also a Vice-president of Veterinary Behavior for Instinct Dog Behavior and Training, as well as co-owner of Instinct Portland, which opened in the fall of 2020.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Same Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here with veterinary behaviorist Dr. Chris Pachel, and we are talking about actually getting behavior appointments done in vet practice.

Look, we all know that doing behavior in our appointments is important. Pet owners are interested in behavior, and they have tons of behavior questions and challenges. And, if you’ve done any work in behavior, you know that it takes time. It is not a magic wand.

You can’t give a behavior pill and just script it out and send it home. It is a process of working with people and giving them our time and focus and attention. And guys, a lot of us are shorthanded. A lot of us are really busy. We are trying to juggle a lot of things. So, oftentimes, People bring their pets in for one thing, and then, oh, surprise, here’s a big behavior issue right on top of it.

And I expect you to deal with both of them in this 20 minute appointment that we have. . This is going to be a good one. 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. Christopher Pachel how are you?

Dr. Chris Pachel: I am doing fantastic, Andy. Thanks for having me on.

Dr. Andy Roark: I always enjoy having you on. I really, I’m glad you made it. For those who don’t know you, you are a Veterinary Behaviorist in Portland, Oregon. You are, you’re a busy guy. You have a lot of things going on. A couple of the things I will pull from the pile are you were at the Animal Behavior Clinic. You were also at Instinct Dog Training.

You have done a number of podcasts with me. You were lecturing. You were just, you were very, very busy. And so I appreciate you making time for me.

Dr. Chris Pachel: No, absolutely. The opportunity like this to really have a conversation with someone like yourself, to get into some of these meaty topics that we can cover in these little bite sized snippets. Ah, man, I’ll make time for that in my schedule every day.

Dr. Andy Roark: I always appreciate your perspective. I think you do a really good job. You’re, you’re a thinker. You, you are philosophic in your views and then also you take that philosophy and you translate it into very pragmatic action steps of what people can do or, or what we can say or how conversations can go smoothly.

And so I, I, I love to think about the implications of things and then, okay, what are we going to do about it? And I think you do that really well. And so that’s, that’s what I want to kind of come to you today with. I want to talk to you about behavior, animal behavior, behavior training in veterinary practices.

I love having you on the podcast. You and I have talked through a number of different cases at this point, I will tell you when I am out in the world and I’m sure other people in the vet profession will agree to this. The number one behavior, or the number one thing I get asked about, you know, when people are like, Hey, can I ask you a question?

Behavior is number, is number one. How do I get my pet to stop doing this? How do I get my pet to start, stop jumping up on the countertop, stealing food, barking at the window, yanking me down when we go for walks? It’s the, the percentage of behavior. It’s probably 50 50 behavior and everything else.

Really? And people, they want to talk about their pets. They want to get into behavior. Where the rubber meets the road in practice is, you know, we have 20 minute appointments often. And people, we are shorthanded. There’s a labor shortage. We are trying to go fast and get things done. And so there’s great demand for behavior and behavior services from the pet owners.

We also know that keeping pets out of shelter oftentimes depending, depends on, you know, having having some behavior services and helping them And at the same time, I think a lot of veterinarians and vet professionals wonder, do we have time to have these conversations and how do we do this?

It’s, it’s, it seems like it’s challenging to bill for, you know, clients want to come and have an appointment. And they want to talk to us for an hour and a half, but they don’t want to pay for an hour and a half Of veterinary in time. And so anyway, I just kind of just dumped a lot on you here. Chris, can you just speak at a high level?

Do you see this stress as someone in the veterinary behavior world? Do you see the conflict between vets trying to support people and then also? Let’s be honest some challenging logistics in getting behavior done in the way We were taught in vet school that behavior needs to be done

Dr. Chris Pachel: yeah, it’s absolutely one of the most common questions that I get when I am lecturing at veterinary conferences or I’m doing vet to vet consults with practitioners who are trying to get advice on how to handle a particular case. There’s that sort of that underlying theme of, but how do I actually put this information into common practice?

It’s going to take me forever. I can’t block my schedule. You know, I, you know, I can wait, make way more revenue for myself and my team if I’m doing dentistry procedures or surgeries or other diagnostics. And so how do I, how do I do that? And I think sometimes we, we kind of, if it’s still appropriate to say, throw the baby out with the bath water to some degree, right?

Where we’re, we’re, we’re trying to say, you know, gosh, if I can’t do a two hour behavior consult, then I just can’t do behavior. And, you know, in some ways I think about it almost the same way as saying, you know what, I was in general practice for a number of years. I didn’t do a TPLO myself. I, I didn’t do total hip replacements.

I, I didn’t do intradermal allergy testing of dogs. I, there were a lot of advanced procedures that I didn’t do, but I still had to have a basic understanding of when and if those procedures were appropriate. How to talk to a client about how to choose between their available options. And even from the standpoint of saying, if I, you know, saw that dog let’s say it’s a hind limb lameness, for example, cruciate until proven otherwise sort of an idea.

And I don’t have time to evaluate that dog today. It’s not an acute injury. I can say, cool, we’re going to schedule you to come back on Tuesday. It’s going to take about two hours for the sedation and the radiographs. We do it all the time where we delay the diagnostic or the conversation until we have a window to actually perform the service.

And I think sometimes one of the easiest things to do if we have an interest in really diving into that conversation is say, that’s a great question. It’s gonna take more time than I have available. So let’s see you back on Tuesday. Let’s do it. It’ll take us about an hour to run through the details.

I’ll have some questions. I’ll share my perspective. We can troubleshoot and figure out what’s the best option for going forward. I’ll see you at nine a. m. You know, we can do that in that little snippet that we have at the end of an appointment and still provide that service for the client.

Dr. Andy Roark: I I tell this story sometimes. I went to a physical therapist one time because my my foot was, was bothering me. But also my shoulder was bothering me because I am a master’s athlete. And so, so I, I go in and the person’s like, Great, you’re here for your foot? And I was like, Yeah, my shoulder also hurts.

And she just didn’t miss a beat. And she said, Which one do you want to work on today? And I thought, wow! You could do that? You could just ask which one of these do you want to do? And so, I picked one, but I just, I’ve always remembered that in the vet world I’ve been like, oh well we better go fast then.

And that just did not seem to cross her mind. She was like no. Which, what’s the focus for today? And we can work on the other one next week or make another appointment and I just when you say that it’s so funny I think a lot of us don’t really feel like we have permission to just punt somebody until later in the week.,

Dr. Chris Pachel: Yes, and what I love about that is for that individual who responded in that way to you, they heard your concern and they provided you with a solution and the power of choice and agency to choose your own adventure.

Dr. Andy Roark: It was, it was, it was really well done. It was just, and it was so casual too. It wasn’t like, Hey, look, I’m really sorry about this. It was just great. Which one? So I, I, I think that there’s a, I do think that there’s a lot to that. I, I think that feeling empowered to say, this is gonna take, I really like the wording that you used.

This is gonna take more time than what we have for today, let’s get back in. It’s probably going to take about an hour, but let’s really go through this. I think that you can, I think that you can communicate real value there. I think if the doctor says to you, I, I want to spend enough time with you to really get this problem worked out, and I would not be helping you if I don’t give you that, that amount of time.

I think it makes them feel seen and taken seriously, and, and I, I suspect it conveys value to them. I, I really like that a lot. You know, I, I’m always I’m a big advocate for technician and technician utilization. I, I really, I I think we can use our technicians more than we do. What I see in technicians and support staff really is a desire to learn and develop, you know, not, not everybody, but there is, there’s a hunger for, for knowledge and to be valuable and useful to the pets and the pet owners.

And so I, I look at this and I, and I wonder about technician and support staff. Utilization in these cases. Now, I, I know that there’s, there’s different degrees where we have, you know, some behavioral cases may be pretty complicated. They may have medical components wrapped into them, things like that.

But the vast majority of behavioral questions that we get about, you know, litter boxes, things like that. I feel like that’s things that, that can be delegated whether, whether it’s done by the technician in the appointment or whether we allow technicians to have technician appointments to address things like this.

I know I’m starting to see a move in our profession towards more technician appointments, more technicians working independently. What do you think of when you hear that, Chris? Do you think that things like that are possible? Have you seen technicians taking the lead on behavior cases in practices in a way that makes sense?

Dr. Chris Pachel: Absolutely. And especially in the general practice setting around behavior, the ability to go in and to learn how and to practice taking a good history, where we can ask those questions. Where, you know, let’s say it’s the cat that’s eliminating outside of the litter box. There’s a list of pretty standard questions

that we should know the answers to before we recommend a particular treatment. Simply saying, oh your cat’s peeing outside the box, add a box. Or try a different litter. It’s sort of like saying, oh I’ve got a cat who’s, you know, peeing excessively, here’s some insulin, try that first. We would never do that.

We need the diagnostic information to actually know what the solution to the identified problem is, even at a working diagnosis level and a technician who’s been trained in that area who has a, you know, a foundational knowledge and behavior can do a lot of that heavy lifting and in some of those cases do all of the lifting to really help those clients understand, you know, again, is this something that needs to be approached from a medical side of things?

And, you know, maybe they get that history for that cat who’s peeing outside the box. And in asking some of the routine questions, we also identify the fact that the cat is not jumping up on the furniture the way that it used to. And it’s a nine year old and this is a new onset problem. And awesome.

That dog or that cat likely needs to be evaluated by the veterinary team and there’s probably some diagnostics. Awesome. That didn’t necessarily need the veterinarian to spend 20 minutes gathering the history to be able to determine that that’s the next step. The technician is going to be able to say, okay, I can identify what is quote unquote behavior only and what needs the veterinary lens.

Go for it.

Dr. Andy Roark: Yeah, I, I, I really like that idea of, of the, the history leading into the conversations that we, that we want to have and having my technicians train so that they have the history and then, I don’t want to make it into a, into a, into an algorithm necessarily, but if the answer to this question is yes, then this is kind of the path that we start to go down.

Do you have favorite training resources? So, you know, I think a lot of times. A lot of times we throw our assistants and our technicians kind of into the room and we’re like, here’s the history. Anything that’s weird, just ask them more questions. do you, how do you get your staff up to the point where they can have these conversations?

I’ve seen, I’ll be honest with you, I’ve seen a lot of practices where where everybody’s kind of freestyling, you know what I mean? And you’re getting markedly different behavioral information from the different people that you see in the practice. I don’t want that. How do you, how do I get my people on the same page?

What does that sort of training and support of the team look like?

Dr. Chris Pachel: Yeah, I think one of the easiest places to start is to use a hand, a standardized history form, you know, and those are available through out, you know, and essentially any of the, the textbooks that we have, the, the handbooks that we have for behavior problems of companion animals, they include a history form that you can use to start with in, in the back of that.

And I think the reason I often start with one of those standardized forms is if you’re just on the early side of learning how to do this. You’re going to miss stuff. Of course you are. Unless we have that standardized checklist to follow and whether that’s something that we’re working through with the client in real time or whether it’s something that we’re asking them to fill out before they come in, it’s something that, for example, even when I look at a history form that for my practices, I think it’s five or six pages long by the time it spits all that data, not six pages of text.

But but but looking all that I can review that efficiently, usually in about 6 to 8 minutes. and verbalize my diagnostic plan, the additional questions that I need answered. I can verbalize that over and include, you know, if this, then this, or if we see this, this is going to redirect them to medical, or these are the things that we can recommend from a training standpoint.

So from a doctor, I could do six of those in an hour with a skilled training team and technician team who can implement a lot of that. Now, I say that knowing that the general practice cases, at least there are more of the straightforward cases that would apply for something like that. By the time we get to the point where they’re being referred over to a veterinary behaviors, there’s probably more layers that require the clinician to be involved.

But at an intake level of basically saying, is there something that we can do here before we consider referral to a veterinary behaviorist, or as a way of setting them up with the right trainer who’s going to be able to coach them on the implementation of skills knowing that if we’re going down, let’s say, a separation anxiety pathway versus a leash reactive dog pathway, we may have different trainers that we use based on their skill set and the actual problems that they like to work on.

But we can do all of that intake efficiently in the veterinary practice.

Dr. Andy Roark: Talk to me about the potential in telemedicine that you see. Do you think it’s going to be possible that we’re going to be able to have our, our, you know, our, our our behavior specialists in our, in our practice, whoever that, that may be. I mean, are they going to be able to just do a Zoom call with this client instead of having them come in repeatedly?

Is that, is that way more limited than people think? Help me, help me see what you see in your crystal ball.

Dr. Chris Pachel: I. Love. I love telehealth for behavior. I really, really do. And especially when we’re working with a veterinary team that does have hands on to the limit of safety with or without sedation, but we have that team that has the ability to have that established veterinary patient client relationship. I love coming into that conversation as a consulting specialist to say, let me ask a few of the questions that maybe you just didn’t know to ask.

And then let’s give you some some more guidance as to what we can do next and how that works and in real time, then be able to talk through medication options, perhaps even some of the diagnostic testing that we can do to really tease out some of those differentials that might not have been ruled out yet.

I love being able to do that. Truthfully, it’s one of my favorite things on my schedule most days. Not only from the standpoint of being able to reach patients that I otherwise wouldn’t reach, but more importantly for me, if I’m working through that primary care veterinarian, part of my education is to the veterinarian themselves to try to expand their knowledge base.

So the next time around they can perhaps get just a little bit farther with that case before they need to reach for me. So I’m trying to on board a more robust toolbox for them in the process of helping this single patient that’s in front of them so that they don’t have that same level of dependence on me for every single case that comes through.

Dr. Andy Roark: How do you differentiate behavior and training, Chris? I find myself using them largely interchangeably, but I feel like behavior is sort of very much in the veterinary medicine realm, and training may be a bit different. You know, there’s just a huge amount of overlap there. When I think of training, I think of puppy classes at Petco, or people out in a field really working with schutzendogs.

Not to, make it negative, but that feels different than hey, I’m the veterinary and let’s, let’s do a behavior appointment. Those feel very different to me, but do you, do you see them as being different? If so, how, how do you separate them?

Dr. Chris Pachel: So it the lines are blurry. That’s the short answer to that question, because it’s really hard sometimes to know kind of where one begins and one ends. Even we could go as far as to say that almost everything that we see is behavior, right? Movement patterns, ingestive behaviors, where the animal is looking or what they’re responding to.

It’s all behavior. What we do about it and the tools that are in our toolbox to really tease out why behavior is showing up the way that it that it is or how we’re going to modify that, that’s where those roles really start to differentiate themselves. Meaning if I’ve got a naive puppy or a dog that is

newly out of the shelter and doesn’t have its basic cues of sit, come, down, stay you know, things like that. Training is perfect for that. Those dogs don’t necessarily need a behavior assessment or a veterinarian to be involved. However, when we’re doing an assessment where there’s a behavior change, or where there’s any level of suspicion that there might be an underlying medical component.

And whether that’s gastrointestinal sensitivity, whether that’s recurrent itch issues that’s creating a level of irritability, whether it’s airway problems that’s impacting a dog’s ability to sleep restfully overnight, or whether we’re looking at actually prescribing for behavioral interventions, those are all within the purview of the veterinarian and absolutely need that medical lens and that medical knowledge.

The behavior modification piece kind of straddles between there where we’re saying I’ve got a dog who’s doing one thing or a cat who’s behaving in a certain way, assuming that we’ve ruled out or addressed any underlying medical issues, how can I apply the science of behavior change to manage that environment to coach the owner on how to utilize reinforcement based training to modify that and to build a better set of coping skills for that animal who’s doing the best they can, but they might be acting in an unsafe or unproductive way.

And that’s where the behavior consultants and a lot of the behavior professionals come into play. Not in isolation, but in my opinion, in collaboration with the veterinary team. So I don’t have to coach the veterinarian on how to do all the little micromanagement of individual training or behavior modification sessions, but that I also have that veterinary team who understands what underlying medical issues may be showing up with a change in appetite,

or a difference in behavior or a new onset aggression or a disruption in sleep wake cycle. That’s where the differentiation really comes into play for me.

Dr. Andy Roark: No, that, that makes sense. The last question I have for you, when you look into your crystal ball, And you look five years into the future and you’re thinking about artificial intelligence and you’re thinking about, you know, cloud based practice management software and corporate consolidation, all these kinds of things.

What changes do you see coming down the pipeline in the way that we engage with behavior cases?

Dr. Chris Pachel: Yeah, I think there’s a, there’s a couple of intersections here that are really meaningful for me. I personally don’t want to give up any of my client time to AI. I really don’t. I love being able to spend that time to really observe the animal, to ask the questions that I need answered, to be able to do that.

And I like looking at the history data in real time and assimilating my own thoughts about what that, what that might mean. Where I really struggle and where a lot of my colleagues who practice behavior really struggle is getting it all documented efficiently in a way that actually then makes a meaningful list of recommendations to clients.

And that’s truthfully where I use AI in my practice is not necessarily to generate my differential lists. I’m not asking it to assess my history forms. I’m basically saying, Hey, distill this down in my brain. Let me run through the education. But if there’s a little recording playing in the background that can pair that down into an actionable bullet point list.

Oh, man, I’m a happy camper. That is exactly what I’m looking for. So capture my words, put them on paper and assimilated into action items. That’s where I use AI. And that’s where I think, you know, if I could wave my magic wand. getting that dialed in so that I can walk out of an hour long appointment and just check the box and say, yep, captured it.

That’s what I want.

Dr. Andy Roark: It’s done and they’ve got good resources to go home with. I like it. I like where your head’s at. That’s wonderful. Dr. Chris Pachel thank you so much for being here. Where can people find you online? Where can they keep up with all of the adventures you’re having?

Dr. Chris Pachel: Yeah, the easiest place to find me is on my website, which is drpachel.Com, so d r p a c h e l. com. And if you go to that main landing page, there’ll be links there to all of the different projects, the things we’re doing at Animal Behavior Clinic, the things we’re doing at Instinct Dog Behavior and Training.

There’s a link there to my media pages, which will take you to podcast recordings like this one, as well as any other things that I’m involved with. You can keep tabs on me there. It also takes you to my socials on the business side, too. So everything is linked from drpachel.com

Dr. Andy Roark: Outstanding. Thanks for being here, Chris. Thanks for being here, everybody. Take care of yourselves, gang. See you later.

And that’s what I got. Guys, thanks for being here. Thanks to Chris Pachel for being here. Take care of yourselves, everybody. Be well. I’ll talk to you later on.

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.

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

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. 

Have you noticed the online backlash against veterinarians seems to be growing? In this episode of the Cone of Shame Veterinary Podcast, host Dr. Andy Roark and Kelsey Beth Carpenter discuss the challenges veterinarians face with online vilification, particularly related to the rising costs of veterinary care. They explore the impact of social media on public perceptions and debate whether engaging with negative comments is beneficial for the veterinary profession. The discussion also touches on how veterinary professionals can better manage online criticism through education and by maintaining a positive digital presence to build trust with their clients.

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

LINKS

Leadership Essentials Certificate: https://unchartedvet.com/certificates/

Uncharted Podcast: https://unchartedvet.com/uncharted-veterinary-podcast/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Kelsey Beth Carpenter is a Registered Veterinary Technician with over a decade of experience working in emergency hospitals across California. She currently works as the Social Media Manager for DrAndyRoark.com and a Content Specialist for the Uncharted Veterinary Conference. Some of Kelsey’s passions include the open hospital concept, the power of creativity and humor, the overlap of science and art, and sharing lessons learned from living life with chronic illness. Kelsey is probably most known for two of her favorite hobbies: writing and performing comedic songs about veterinary medicine and acting as a full time stage mom for her Chihuahua mix, Birdie.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Wirt. Guys, I’m here with the one and only Vet Tech Kelsey. Kelsey Beth Carpenter, and we are talking about a recent sort of string of veterinarians and vet medicine getting vilified online. There definitely seems to be increased animosity online towards veterinarians.

There’s a lot of people who are understandably upset about the rising cost of medicine, and that may be taking it a little bit far. I asked the question with Kelsey Should we just accept this? Is this just where we’re going? Is it worth even engaging with these people? I don’t know, guys. I, I wonder if some people are gonna be bound and determined to vilify those of us in the vet profession because they’re frustrated about about the cost of care.

And I don’t know if we can talk those people out of that, and I don’t know if we should if we should take it personally or not. So, anyway, those are the type of things that we get into and discuss. It is a really fun episode. I hope you guys will enjoy it. 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 back to the podcast Kelsey Beth Carpenter RVT. How are you? I’m pretty excited. I think this might be my third time on the podcast.

Dr. Andy Roark: It’s yeah, we have a special we have a special jacket that we give to people who have been on the podcast three times.

Kelsey Carpenter: like a robe or something, you

Dr. Andy Roark: It’s it is it is a robe. It’s it. It’s actually one of those, it’s actually an isolation gown. It’s it’s a disposal one. Don’t tell the clinic, I take them and I give them to our three time guests.

And that’s, that’s what you get.

Kelsey Carpenter: I can’t wait.

Dr. Andy Roark: Congratulations. So just put this on now and just turn and turn and turn. And I’m going to hand you the tab. It’s that. Alright. thanks for being here. being here. You know, for those who don’t know you, you are a you’ve been in a social media presence.

You write music for Vet Medicine, which I love. You are the social media manager for drandyroark.com or Dr. Andy Roark..

Kelsey Carpenter: Yeah, I was gonna say. 

Dr. Andy Roark: You’re a social media manager. You work for me is what I’m trying to get at.

Kelsey Carpenter: We’re talking in third person now.

Dr. Andy Roark: exactly. You know, your podcast is successful when you talk about yourself in the third person, that’s, that’s the prime measurement of success, I think, and that’s how I tell when people are making it.

Anyway, I had something that I wrote a couple of weeks back, and you all that stuff, sort of, you know, go through you and you see it all. And you just specifically, you reached back out and you said, I think we should talk about, about this, this newsletter that you wrote. And what it was, was it was around the time that that guy was on TikTok and he was just ranting about the vet marking up the blood work and just really vitriolic.

And he was talking about, it was a scam and, and what, what the prices were and stuff, and, and, and there was just tons and tons of people. that were online, and this was just a huge debate, was this angry person saying that vets were, were horrible and they were gouging peddlers. And, and I wrote about mentioning it to my brother, and so I, I was talking to my brother, and I sort of mentioned, yeah, there’s this guy, and he’s, Raging and my brother was laughing and he started laughing because he said, Andy, I, I’m a lawyer.

The idea that people saying bad things about your profession on the internet is upsetting to you is just a foreign concept to me. And I thought about that because my brother is like the nicest guy that I know. he does wills and trusts. And so he talks to people about the end of their life and what really matters to them, you know, all day, all day long.

And he’s a lovely, wonderful person, and I’m sure he does not get down about what people say about lawyers on the internet. And so anyway, that was sort of what I had written about, and you sort of reached out and, and were sort of saying that, that it was, it was something of interest. And so, you and I, the last time you were on the podcast, we talked a bit about you were kind of sort of stepping back a little bit from social media.

And, and, yeah, so. Let me, let me sort of start there and kind of open it up. Are you still sort of having that stepping away from social media kind of vibe? Or are you are you drifting back into being a part of that sort of community?

Kelsey Carpenter: I will say I drifted back in simply for the fact that I had a plant recently, that the leaves were turning brown, and I really needed plant advice.

Dr. Andy Roark: Yeah.

Kelsey Carpenter: That’s the extent to which I’ve used social media recently. I’ve still been kind of staying away a little bit. It’s still, I don’t know, the vibes are off.

My vibes are off. I don’t know how much of it is me and how much of it is social media I suspect it’s a little of both and I feel like you’ve had some similar feelings about social media recently, too, I think.

Dr. Andy Roark: Yeah. Well, I mean, I, I have, some of it’s about social media. And honestly, a lot of it is about our industry as a whole. And so, like, I went to the AVMA convention recently, and it was great. It was a lovely convention. They did a great job. But, Kelsey, you know, I, I feel like our industry is, is changed in some fundamental ways.

There’s There’s a lot of money that has come into our industry and you can sort of see it in the exhibit halls where there are There’s not as many small companies as they used to be like definitely like there’s a bunch of small companies But there’s not many mid sized companies like there used to be or they’re not big enough to have a exhibit, exhibition space and things like that But there are some really big companies, and they’re publicly traded companies, and it feels like we’re hearing more and more about a focus on the bottom line and generating revenue in these companies and stuff like that.

And it wasn’t that that medicine in the past didn’t care about being profitable, they did, but it did not feel to me as profit driven as a lot of companies feel today. And again, I just have a sort of interesting perspective, I guess, because, you know, these people, I get asked to speak and prevent present for people.

And with Uncharted, you know, we’re always sort of talking about conference sponsors and, and, and things like that. And there is definitely a focus on return on investment that I have not seen in the last 15 years before of just this directness of we’re here to basically we’re here to generate money and and I, I know I’m getting that vibe sort of inside of our profession and this is the same time that there’s sort of been a string of articles in the New York Times coming out talking about people not being able to afford their pets care and why is the cost of that medicine going up so much?

And anyway, it’s just, it’s kind of, it kind of feels like this sort of storm of there’s outside attention. Yeah, there’s outside attention about the cost of medicine again medicine is getting more expensive like in it’s just part of its inflationary, but the cost of medicine is much more than inflation And, and I’m sort of rambling here, but, you know, the other part of that that I look at is, you know, we’re at the convention, I’m looking around, and this is not tied to the profit driven companies or anything, but I’m looking around, and outside the convention hall, there are these big advertisements for Librela which is an amazing product.

I mean, it’s a game, it’s a game changing product. It’s, it’s, I mean, again, and people have their emotions, I’m not, there’s not a, Promotion for that product specifically, but just the idea of Librela is it’s amazing this injectable pain control that works this novel way and Elanco’s got their monoclonal antibody antiparvo virus drug that again game changer like this is it’s it’s So, from what I’ve heard, it’s fairly magical in the impacts on some of these Parvo cases.

And then you’ve got Ceva’s got panoquell is an anti pancreatitis medication that works in this novel way, this anti neutrophilic inflammation control. The point in all this is not to plug products at all, but just to go, there’s just these new things that are rolling out that are amazing and just things we didn’t have in the past.

And so, Yes, the cost of medicine is going up. The capabilities of medicine are also increasing, and so I don’t think this idea that vets are gouging people, I don’t buy into that, but anyway, I’m, I’m sort of concerned that public sentiment is turning against veterinarians in a way that it hasn’t in the past.

And so, I don’t know, from, from what you sort of see online, do you, do you agree with that?

Kelsey Carpenter: Yes, painfully so. You know, I th Think gosh, there’s just so many so many things that go into what you just said But I think you know, we saw this beautiful change this gradual change over time where people are Seeing their pets as such a bigger part of their lives, right? And taking their health a lot more seriously and being willing to invest a lot more How many people 50 years ago were willing to drop thousands of dollars on

a bloat surgery? You know, like, who, who knows? It was a lot different of a market. And then we’re also seeing, you know, education and things expanding like crazy because of technology and our ability to communicate and all these things. And so things are growing in this beautiful way, but at the same time, the way housing and the economy and inflation and everything is happening is also making that a very ugly thing.

So it’s just, I think one of the things that’s difficult for us as veterinary professionals is that, at least for many of us, like myself, probably for you as well, when we went to get into medicine, social media was not yet, A thing, or it was not yet as big of a thing as it was, right?

And so, the only thing we had to go off of in terms of reputation for veterinary medicine was, what did society see it as? And I grew up seeing medicine as this beautiful, admired, heroic thing, right? Like every show you watch, every movie you watch, every advertisement you see was about these people being absolute heroes, and that’s how we saw them.

The introduction I think of social media and technology and things has allowed more people to have a voice and contribute to then the public perception of who we are and so I went into this field thinking You know, my mom was a neonatal intensive care unit nurse I thought she was an absolute hero and I thought I want to be in medicine I want to do that kind of stuff like she did And and now I find myself in a field that people are seeing a lot differently than when I first got into it.

And I think social media contributes to that in a large way. I’ll stop there. What are your thoughts so far?

Dr. Andy Roark: Well, so, okay, so, so, yeah, I, I think one of the things that I wonder about is what is the perception that we see online and then is that what people actually hold in their minds? And so, Up until about 2016, I kind of thought that social media was a, a fairly accurate reflection of what people in the U.S. were thinking. So if you heard a sentiment on social media, it was kind of a mirror of what people actually thought. And I think that that was much more true back then than it is now. And a big part of that was when social media started out, there was no algorithm. It was, everything was chronological. A lot of people have, you’ve followed your friends.

And then when they posted things, it was in chronological order. So you’re seeing people that you knew. And they weren’t, I mean, they were trying to get attention, but it was not playing to an algorithm trying to get a ton of attention. It was generally, hey, these are people that I know, and this is what I think, and I’m sharing my thoughts.

And then the algorithm changed everything, because the ability to reach huge numbers of people was there. If you could make this algorithm happy, it wasn’t about reflecting what you actually thought, it was about playing this, this sorting game to get the biggest audience. And so I saw some research that came out, this was a couple of years ago, but I’ve, I’ve memorized it because I think it’s so valuable.

But, but this guy was doing research on, on sort of social media and what made posts get a big reach. And there was four driving factors. And so negativity drives engagement. People tend to respond to things that are, that are bad or that are scary or that are terrible. bashing something else. They like that.

It, it, it gets them to engage. Number two is extremism. People don’t respond to ideas where I say, I think ice cream is okay. That’s not, ice cream either has to be the best thing ever, or ice cream should be bad. And those are the two positions that will actually get, get some, some attention. There’s emotional and moral language, which is anything that pulls on your emotions or that talks about this is wrong.

That’s a big one. And then the last one is in group, out group differentiators of we need to come together and punish those people over there. Those, those are the four big drivers, and when I think about the guy ranting on TikTok about the cost of that medicine, it was all it was definitely negativity, but it was all emotional and moral language, and there was a bit of extremism there about it wasn’t, I’m unhappy, it was, these people are the worst, and so all, all those things sort of combine, and so anyway, if you buy that those are the big drivers of social media, you can see that what we’re going to see on social is not representative of the average person, and so I see I see a lot of negativity around the vet profession online, especially, you know, New York Times puts an article out that says prices of vet medicine are going up.

Like, don’t read the comments. Just don’t. You’re not going to see a biased response or a fair response. There is going to be highly biased. And so, I don’t know. That’s why I say I’m looking at it. I’m still a little bit, I’m still a little bit wary of drawing parallels between what I see online and what actual clients seem to think.

Kelsey Carpenter: Well,

Dr. Andy Roark: I think that’s kind of where my head’s at in that

Kelsey Carpenter: I, I actually, I’ve never thought about it that way. That maybe It’s not the reality of what people are thinking. I think maybe the people posting It’s not always the reality of what they’re thinking because you’re right a lot of people play into what we mean That 10 years ago. We didn’t have the term clickbait at least that I remember now half the content on instagram is clickbait, the people posting the clickbait stuff, maybe that’s not how they truly believe.

But then the people receiving that clickbait stuff, I think often times those people commenting are truly feeling emotions around it. And what’s funny is when you list off those four drivers of engagement at least when we’re talking about more negatively influenced posts, they’re all fear based. It doesn’t matter if it’s the emotional strings, or if it’s the polarization, all of it is fear based.

And so, Wow, that post that we were originally talking about from this human doctor you know, I can absolutely acknowledge it was frustrating, it made me immediately feel defensive it was just nasty, it was not cool. So, as a pet owner, I can absolutely see why. People would watch that video, feel intense fear about the ability to pay for their own pet’s medical care, and believe it, right?

And I think one of the things that I’ve noticed that we may be lacking in our industry we have very little, at least that I’m aware of client facing social media presence in the veterinary medicine industry.

Dr. Andy Roark: Yeah.

Kelsey Carpenter: I’m gonna get canceled for this. But we, you know I’m wearing my Ninja Turtle shirt, I’m feeling rowdy today.

We have plenty of people posting their fig scrubs. Those are very, you know, very industry facing influencers, right? Which we need industry facing influencers. I’m not negating that. Like people posting fantastic, you know, I was watching Toothy Thompson and Dr. Sue Cancer Vet. I love their content.

I learned so much from it. So those are important, important accounts. But what we’re really lack is we don’t have a lot of client facing social media accounts or the ones that we do are simply based on cute videos of look at this vet who went over the scared dog. You know, they’re not education based, right?

And so I think part of the problem we run into is we’ve got this human doctor you know, talking negatively about our industry and yet where’s, where’s the other side of it? Where’s our side? What? We don’t have the proactive side. We have the reactive side where I really liked Dr. Peter Weinstein’s take on your on an episode of the Cone of Shame recently where he was saying he actually really liked the way that.

Things like that bring our Vet Med community together. The way we come together in those moments when we are being attacked actually is extremely powerful and I do admire that. At the same time what I wish we had was more proactive content going out there. So I love that people did react to that and tried to put out more content to let clients know, actually here’s the reality of how it works.

But imagine if we could get that out before people. We’re claiming otherwise right that would change the game for us

Dr. Andy Roark: I don’t know if that’s possible. Do you think it’s possible? So okay So here’s the the analogy that popped into my head is if you and I were to go online and make a video about how The earth is round and we’re like look guys This the earth is round and this is how it’s round It’s like it seems pretty boring to me But if we went on and made a video about how the earth is flat we could get some attention there’s a, there’s a certain group of people who would be like, Yes!

Finally, somebody’s saying it. And so, I, I, but it’s, it’s real, it’s, but it is, it’s really hard to make positive educational content. There’s ways to do it. I think we’ve, we’ve, you and I have worked together on those stuff as far as making some, you know, funny, positive videos It’s about, about enjoying the profession, but it’s, it’s much harder to do that than it is to just find something, call it evil, and try to, you know, tear, tear it apart.

I just think that’s the easy

Kelsey Carpenter: I do agree with you And I also feel you know you speak about our trust bank in veterinary medicine, and I do feel that If we had more of that kind of proactive content going out, it does build trust to some level. I also think we’re speaking to a very different audience now. There are a lot more intense very helicopter parent, pet parents now.

I speak, I say that lovingly, because I am one. But there are a lot more people out there who, They want to know what’s going on with their pets and they want to better understand it so that they can come into the vet more prepared. So you picture, how well would a video do if someone sat there and said, Let me tell you one of the most common things we see at the vet.

I have seen at least 500 times in my career people bring their dog in with a tick and it turns out to be a nipple, okay? How well would that do on social media? And then people could explain, here’s why it’s confusing, here’s what you can do, etc., right? That builds our trust bank already so that then when someone does say something negative about us and we can come back and say, hey, I want to break down and show you how these markups work for our bill, that trust bank is already set up.

starting to build and so they’re going to believe us rather than us coming at it from a defensive perspective and they’ve never heard from us before, right? Like I think that’s where. It could be helpful. I do agree with you the negative content’s always gonna Uh kind of try to outshine us in the algorithm, but I still think there’s Potential there if I was not in the vet industry I would for sure be following if there were some vets out there some veterinary technicians some vet tech Specialists and they had accounts that were doing education on dogs and I have a pet dog.

I’d be following those accounts for sure

Dr. Andy Roark: Yeah, I think, I think there’s something to that. I think it’s a, I think it’s a harder, it’s kind of like, It’s kind of like in Harry Potter, where if you’re on, if you’re on the, on the bad guy team, you get, you get more spells. You get to, you get to do the unforbo, unforgivable curses. you know what I mean?

And if you’re in the good guy’s team, team, you don’t get to do that. You don’t get to just Avada Kedavra someone and they’re dead. Like, super easy shortcut, but you’re not allowed to take it. But the bad guys can do it. And I feel like that’s sort of true in vet medicine because there’s an easy button of just being negative, being extreme, you know, leaning into moral and emotional language, things like that.

And when you’re trying to positively educate, you don’t get to use those tools that are so successful. But I do really like your idea of, if you make things and you put them out there, especially if If you can get your clients to consume that content, I think it’s a possibility. I think you sort of swung me a little bit.

I really, I think that my take with this has been recently. I think that veterinarians in practice probably need to start tightening their focus down on who they’re looking at. I can’t. Do anything about some guy in Arkansas, I don’t know where he was, but some guy in Arkansas losing his mind over his vet bill, like I’m in South Carolina, he’s not my client, even if he was my client, I don’t know that I could make him see the world differently, but he’s definitely, but he’s not my client, and so, and the people in the comments section generally are not my clients, my clients who know me I think, to your point about Trust Bank, I think that they trust me and trust the practice.

And again, that’s the only thing that I can control, right? So going back to my brother, he goes out every day and he helps people and helps them with their family and making the plan for the end of their life. And he doesn’t sit around and read. What people are putting on social media about lawyers. And I just, I think that we are so compassionate and we care so much and we worry so much that people are not going to take care of their pets if they get bad information.

I don’t know that it’s viable to, to hold that type of anxiety. And we, I don’t think we can continue to take these things personally. Yeah, I think this is sort of a new experience of being sort of vilified, and I think, I think we have to let it go, but I, I think you, you have affected me, and you know, I, I tend to focus a lot on what can we actually control, and so I do think taking some time and saying this is, This is how it is, or these are the things that we’re trying to do, or these are the things that we think is important and not doing it in an emotional reactive space that just spins the whole, you know, debacle up and gets more views for the angry people making, you know, extreme content.

I, I think that that’s probably the way to go, but I don’t know. 

 Hey guys, I just want to jump in real quick. The Team Lead Summit is coming from Uncharted Veterinary Conference. Guys, the Veterinary Team Lead Summit, it is for your veterinary team leaders. This is your lead technician. It’s your lead CSR front desk person. It’s your kennel lead. It’s your office lead.

It is anybody who is managing people on the ground, in the trenches, on the floor, those, you know, your team leads. That’s what it is. This is a one day, it is virtual event. It’s, it super accessible, super affordable, super available, super practical. Kelsey Beth Carpenter, who’s on this episode that you’re listening to right now, is going to be speaking at the Team Lead Summit and It is kicking off on September the 18th.

That means registration is going to be closing soon. You have got less than two weeks to get registered for the team lead summit. Jump on that. Take a look at it. Head over to unchartedvet. com. Put a direct link in the show notes. You don’t want to miss out on this. If you’re like, I don’t know if this is for me.

Jump over there and take a look. I love it when practices send multiple team leads. It is something great for them to do together. They get inspired together. They share ideas together. This is super interactive. They’re gonna get to see what other practices are doing and help bring it back to your practice. Anyway, it is a wonderful use of time effort and energy.

I promise that I do everything in my power to help make it that So anyway registration closes in less than two weeks. Don’t miss out. I’d love to see you at the Team Lead Summit on September 18th. All right You Let’s get back into this episode.

Dr. Andy Roark: I, I’ve asked a lot of people, do you think veterinarians should get thicker skin? And I’ve gotten mixed results. Some people just sort of say, yeah, I think we should just ignore a lot of crap. And I’ve had other very persuasive people say, no, I don’t think we should.

I think that we’re compassionate people and we should try to educate and we should, you know, engage where we can to just to keep, you know, to keep making people feel supported and to keep, to your point, trying to build a trust bank. And so let me let me ask you that question. Are you more on team thicker skin or are you more on team, no, this is, we should, we should protect ourselves, but we should continue to kind of engage in the battle for truth.

Where do you, where do you fall?

Kelsey Beth Carpenter: Right down the middle Right the middle just to make it complicated, you know,

Dr. Andy Roark: No, I think that’s the right answer. I mean, you know, the middle path is usually the right one. 

Kelsey Carpenter: I absolutely agree with you. We we can’t take things so personally. We can’t. We have to recognize. That this is all of this is part of some ridiculous social media algorithm followers game which we’re not interested in anyways, right?

Dr. Andy Roark: We shouldn’t It’s funny how much people get sucked into that and they’re like, Oh, I’ve got get more followers. And I’m like, these people are not coming into your practice. They’re not supporting you. They’re fighting with you. They’re taking your time and your emotional energy, but they are not bringing their pet to you.

Kelsey Beth Carpenter: But I, I think the other thing too is for myself, something I’ve been working on is that space in between You know my gut reaction to something and then a more logical less emotion based reaction to something. Here’s the problem in social media is that social media moves quick So the second that doctor that video it goes viral within a matter of hours, right?

And you’ve got about 24 hour window to respond before people have forgotten about it entirely. So that’s the problem. However, I I I do wish you that was something we could all work on, which is how do we respond to things in a way that’s less emotionally based and more factually based? And I say that with, again, a lot of heart because it’s something I struggle with as well.

But I think we come off a lot differently when we react defensively rather than reacting from an educational standpoint. Because here’s what I see is this. Angry doctor posting this negative content attacking another industry, right? If i’m a logical person on the internet I’m going to take what he says with a grain of salt because I can already see who this person is But if I then see let’s say a vet tech respond and say well actually I called this guy’s practice and here’s how he marks up his stuff. Are we not just doing the same thing?

Dr. Andy Roark: Exactly right. Yeah. Yes.

Kelsey Carpenter: I just want to be very clear that i’m saying this with so much heart. It’s exactly what I wanted to do in the moment, right? When I saw it. Okay, 1000%. But again, if I’m a pet owner on the internet and I see this video from this guy, I’m going to take it with a grain of salt, but I’m still going to be like, wow, those are some heavy markups.

That’s a little rough. How am I going to afford that when it comes to it? And now I see this vet tech posting. Well, what about this guy? Doctors don’t have, human doctors don’t have the best reputation right now either. So, I’m just gonna lump you all into one class and say all medical professionals 

Dr. Andy Roark: Yeah. 

Kelsey Carpenter: are dramatic and crazy and they’re all marking it up and they’re all screwing us over and I can’t trust any of them.

Versus if I’ve got, Dr. Andrew Roark comes over here on the internet and he goes, Hey, I saw this video go viral recently and if I was a pet owner watching it, I’d be really concerned. I really want to break this down for you guys so you can better understand what’s going on. Why your vet bills look the way they are.

And how they work. That’s gonna change my view completely. I’m gonna say, wow, that guy was really angry and trying to start some stuff on the internet. Look at this Dr. Andy Roark guy, like, I feel like I can trust this guy. I’m gonna listen to what he says a little bit better, you know?

Dr. Andy Roark: I, I, I like your, I like your perspective here. I think that it’s funny when you sort of say, you know, human medicine, you say, oh, these people are, are the worst. My idea, my idea is about human healthcare. You and I have talked about this before. We, we, this is one of the podcasts that we did was talking about being a patient and what, and what we sort of learned.

Human healthcare in this country is broken, in my mind. I love my general practice doctor. Her, she is, she is great. Like, I like her, I trust her. I’m so glad that I found her. I think that that’s probably the duality that we’re probably heading for. I think we can try to fight the good fight, and it’s worth it.

But ultimately, I think you framed it up really nicely. In my mind, I don’t have great feelings about human health care right now. But I do really, really like my general practice doctor, and I do listen to her, and I do trust her, and ask for her advice, and I expect that when I ask her things, she tells me the truth, and she helps me in the best way that she can.

And so anyway, I think that that’s, that may be That may be the future and kind of where we’re going. So anyway, Kelsey. Thank you for coming on and talking through this with me I really appreciate it. I really appreciate the opportunity Always just to kind of flesh ideas out with us with you and always love your thoughts on what’s going on online and just sort Of I don’t know on life in general.

So where can people find you online?

Kelsey Carpenter: I’m hiding in the depths of Instagram watching funny dog videos.

Dr. Andy Roark: Ha, ha, ha,

Kelsey Carpenter: No, I’m a Kelsey Beth Carpenter

Dr. Andy Roark: Send a self addressed stamped envelope to the P. O. Box.

Kelsey Carpenter: You can fax me at- No, I’m Kelsey Beth Carpenter. I’m mostly Instagram and a little bit on Facebook these days.

Dr. Andy Roark: You’re so old. 

Kelsey Carpenter: I’m so old, but can I tell you real quick? My favorite thing on Facebook is this Facebook group. It’s huge It’s got thousands of members in it. It’s called the dull men’s club and it’s literally it’s not just for men It’s all people but it’s just

Dr. Andy Roark: That was not remotely where I thought you were going with

Kelsey Carpenter: It’s literally just people posting the most dull moments of their life that that make them so happy. So like someone posted the other day you guys I finally finished my chapstick And it’s like how often do you finish a chat a whole chapstick, you know, it is like what an accomplishment man. That’s really made my day It’s like that’s my

Dr. Andy Roark: The Dull Man’s Group.

Kelsey Carpenter: Anyways, Kelsey Beth Carpenter on facebook and instagram I’m pretty quiet on there these days, but i’m just kind of lurking in the background

Dr. Andy Roark: Alright, well, I, I know what I’m gonna go check out on Facebook, so. Anyway. Alright, thank you for being here. Guys, thanks for tuning in and listening. Take care of yourselves, everybody.

And that’s what I got for you guys.

Thank you for being here. Thanks to Kelsey Carpenter for coming along and being my co pilot on the episode. Guys, if you’re enjoying the podcast, please leave me a review wherever you get your podcasts. It’s how people find the show and it means a lot to me. So, anyway, thank you very, very much. You guys take care of yourselves.

I’ll talk to you later.

Ron Sosa, a Certified Veterinary Practice Manager and advocate for neurodiversity, dives deep into the operational challenges and management strategies that can help create an inclusive environment. On this episode of the Cone of Shame Podcast, Dr. Andy Roark and Ron Sosa explore practical ways to manage workload effectively while being cognizant of the unique needs of neurodivergent staff. This episode is invaluable for anyone looking to enhance team dynamics and understand the nuances of neurodiversity in the workplace. Don’t miss these insights that aim to foster a supportive and efficient practice environment.

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

LINKS

Ron Sosa on LinkedIn: https://www.linkedin.com/in/ronald-sosa-cvpm-53453797/

Synaptic Neuro-inclusive Leadership: https://ronsosa84.wixsite.com/synaptic-leadership

Dr. Know-It-All Card Game: https://drandyroark.com/in-the-know/

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

Ron is a Certified Veterinary Practice Manager and a former practice owner and business director for multisite animal hospitals. He also hold certificates in Neurodiversity, compassion fatigue, veterinary business leadership, and the human animal bond. He currently serves as the Executive Director for the Uncharted Veterinary Conference., Dr. Andy Roark is a practicing veterinarian in Greenville SC and the founder of the Uncharted Veterinary Conference. He has received the NAVC Practice Management Speaker of the Year Award three times, the WVC Practice Management Educator of the Year Award, the Outstanding Young Alumni Award from the University of Florida’s College of Veterinary Medicine, and the Veterinarian of the Year Award from the South Carolina Association of Veterinarians.

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 today with my good friend Ron Sosa. Ron is a Certified Vet Practice Manager and an educator and advocate on Neurodiversity in veterinary medicine and I give him kind of hard question. I think I talked to him about wanting to support neurodivergent team members and also being honest about the workload that we have in practices And the fact that people in practice might not even know this person is neurodivergent and can get frustrated with behaviors or struggles that they don’t understand.

How do we do those two things? How do we support and also manage the individual and the rest of the team as far as their expectations so that everybody gets along and feels good and the work that we have gets done.

And so anyway, we, we get pretty deep into some of the management struggles around neurodiversity and Ron is fantastic. So anyway, if you have someone on your team who you think might be neurodivergent or who has disclosed that they are neurodivergent, this is going to be a phenomenal episode just for helping you get your head around you know, how to be a good supporter and how to work effectively with these people.

And so anyway, it just. Great conversation. Ron is so wonderful and positive and helpful. And just, I feel like I took a lot away from this episode. I hope you will too. 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, Ron Sosa, how are you, my friend?

Ron Sosa: I’m good. How are you, Andy?

Dr. Andy Roark: I am really good. For those who don’t know you, you are the Executive Director of the Uncharted Veterinary Conference. You are a certified veterinary practice manager, and your career has taken an interesting turn in the last year or two.

Because you’ve been doing a lot of writing on neurodivergence and neurodiversity in veterinary medicine and you write about it from a management perspective, which of course aligns with the Uncharted focus of running smooth teams and practices. And it’s just been really fascinating to watch you grow.

You’re doing workshops in this space and things like that. And so yours has been a career that I just creatively has really blossomed and I’m just glad, you know, as a, as the founder of Uncharted to, to get to watch it up close, but but I’ve got. I’ve got something that I’ve been kind of rolling around and I thought that you were the perfect person to talk to about it.

And so let me, let me set the stage and then kind of, kind of bring you in here. So, you know, I read a lot about running effective teams in vet medicine, something I care a lot about and, you know, for a long time. I, you know, I’ve taught SMART goals as a tool in our toolbox. For those who aren’t familiar with SMART goals it’s just making goals that are Specific, Measurable, Achievable, Relevant, and Time-bound, meaning they have a deadline on them. And so it’s, it’s a, it’s a good way to sort of format your thoughts and make a structured goal that you can then check yourself against and make sure you’re actually doing what you intended to do and that you’re moving forward in the way that you set out to move.

And so anyway, this is sort of something that I’ve talked about for years and And kind of had it and used it. And then I saw a post from one of my friends. So Dr. Kate Boatwright is she’s writing a lot these days as well. And I think she’s, she’s pretty smart. I do enjoy her. I, she’s been on the podcast before.

And so she had this post recently about the fact that she had been teaching smart goals and someone really pushed back against her and said, boy, I really, I hate SMART goals. And she said, SMART goals the way it was put to her was, SMART goals don’t often work or don’t tend to work for people who are neurodiverse.

They just the, the format doesn’t, doesn’t make sense to them and there are better ways to format information and work with people who are neurodiverse. I know neurodiverse is a big bucket. But really, it was interesting to see this strong pushback against sort of a, a format that seemed pretty sort of common sense to me at this point.

And so I was thinking about that and I was thinking back to something that you wrote recently about time blindness and you talked about people who are neurodivergent in some instances might struggle with deadlines and just being sort of time unaware. And I thought, Hey, you know, I would like to know more about this.

And so I’ve talked a lot here, sort of setting up, setting up the the reason that we’re sort of talking. Ron, let me kind of hand this over to you. Can you talk to me a little bit about let’s start at a high level. As a CVPM, as someone who is focused on efficiency and operations, and someone who is really interested in being supportive of neurodivergence in our practices, can you talk to me a little bit about the challenges that neurodivergent people face from an operations standpoint in practice?

Ron Sosa: Yeah. I think the number one thing that gets spotted probably the most is just what you said. We talk about time blindness and time blindness is basically the inability to tell how long things take what time of day it is, how long you’ve been spending. Like think about our exam room common problems where you send a technician in and they’ve taken 30 minutes of the appointment getting a history, Any one of us can experience time blindness. So it’s like, I didn’t even realize it was in there or think of time. You drove home from work and had no idea how you got home. You know, it was that autopilot moment, right? That is time blindness where we just, our mind goes on the auto drive. We have no idea, a sense of time, how long things are taking, how long things are not taking.

We’re just doing the thing right in front of us.

Dr. Andy Roark: it’s just it’s to me. I always look at that. It’s kind of a good thing in practice, right? It means you’re fully engaged with with what you’re doing. So if I’m working on a team with someone who’s neurodiverse is How often is is things like time dialing this? How does that come into play?

Is this is this someone who is constantly? Unaware of time or like what does that look like in in in day to day practice and how I’m working with this person

Ron Sosa: Yeah. I would say that, you know, the neurotypical person, it probably happens to, you know, a few times a month, maybe, but for the neurodivergent person, we’ve got to be really, really careful. And so I would say that being somebody who didn’t, was late diagnosed, didn’t really understand myself. I would say I had been late.

Torn to the other side where I’ve been extremely overly conscious of my time. And so when I’m in an exam room, I’m going to get in and get out and getting a history, but for others, if they may not recognize how much 10 minutes is or five minutes, I do a lot for that. And so it happens all at the time.

They have no idea how long they’ve been shooting an x ray for, or taking care of a treatment on a pet or, you know, educating a client. It’s just. They have no concept of what 10 minutes feels like, because 10 minutes will feel like an eternity in one moment, and it’ll also feel like two seconds have gone by in another moment.

So there’s no consistency of what it feels like.

Dr. Andy Roark: I think a lot of people Probably feel a little bit, I don’t know, a little bit torn or a little bit trapped when we start talking about colleagues with neurodivergence because we have a very compassionate profession and I want to be compassionate and I want to set people up to succeed. And at the same time, nobody wants to be buried under work and not having appointments get seen and things like that.

Hey guys, communication is key to creating amazing experiences in the clinic. From the phones to the front desk, to the exam room. The way our teams interact with pet owners makes a difference. The team training bundle I have Dr. Andy wrote.com brings together my charming, the angry client and exam room communication toolkit courses to provide flexible on demand communication training for your veterinary practice. Check them out. 

These courses are made to be taken. in groups, they have discussion questions. They are all about taking these trainings and getting them to apply to your practice, your culture. And your clients, whether it’s handling angry clients. Or being effective in the exam room. We’ve got some great training resources that you can grab and drop and use pieces of. 

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Let’s get back into this episode. And so it’s funny when I look at this post about SMART goals and, and, and my friend is getting this pushback that says, you know, this, this doesn’t work, this doesn’t help. And then I see things about like time blindness and I go, okay, I see that and I want to be compassionate. And also I don’t know how, how we run an effective team if we can’t pay attention to time or set, you know, actionable goals and hold people accountable.

Dr. Andy Roark: And, and, and, and also I would never want to have a profession that wasn’t open to everyone. And there are neurodivergent people that, that we work with who are, who’ve been absolutely, absolutely wonderful to be around. And so let me, let me sort of give you that little bit of conundrum because I know it’s something that you.

that you think about and write about a lot is, Ronic, start to unpack for me a little bit about what it looks like to provide a supportive environment and to be open and I don’t know, welcoming of neurodivergent people in our teams and also not have the rest of the staff get frustrated because we say, well this person, we’ve told them what the goal is and they, they don’t, they don’t work to it or we’ve, you know, we’ve told them what our constraints are and they’re not being met.

How do you manage those things?

Ron Sosa: Yeah, I think first we’ve got to recognize the fact that we’ve built society around the average brain chemistry, right? So, When we think about, Oh, we’re frustrated because somebody hasn’t achieved their goals. It’s because we’re, we’re being very rigid and not thoughtful about how different brain brain chemistries work.

And so, you know, I think about the smart goal and there’s something called a demand avoid, avoidance. So once you tell me I have to do a thing, it is much harder for me to want to do the thing. Whereas if I was already going to do it and I was already committed myself to doing the thing, I could, I can easily get it done.

Also with ADHD, you have the. It’s either now or not now. And so I’m either going to do it right this moment, or I’m going to forget about it until the deadline comes. And I’m going to do it in the last 10 minutes. so I think that’s part of the issue with, with smart goals is it does not unnecessarily allow for the followup needed or consistency of followup needed or the understanding of sensory needs that would preclude from being able to achieve the smart goals.

Dr. Andy Roark: Talk, talk to me more about sensory needs to achieve a SMART goal. What do you mean when you say that?

Ron Sosa: Yeah. So sensory, obviously we have our five senses, you know, we’ve got sight, smell, taste, touch and hearing. And so with neurodivergent individuals, we have a heightened or desensitized sensory system. And so, you know, fluorescent lighting, I think affects most of us, but think about that lighting situation, how that flickering fluorescent ball would bother the normal person now times that by 10 or a hundred, and that’s overly affecting that person.

And so I have a sensory hypersensitivity. You know, like this, some people have the hypersensitivity to a certain smell or I always equate this with allergies when you talk about the allergy pet who has a threshold, right? They’re allergic to trees, grasses, molds, weeds, and something tips them over the edge and they have an allergy flare up, right?

So they could be allergic to 10 things, but that 11th thing pushes them over the edge. That’s how I think of sensory. We can be fine with some of our sensory inputs until you hit that 11 thing and it completely pours over and you get breakdowns. You get emotional dysregulation. You get the inability to effectively do a task.

You get all of that. Just kind of breakdown and shame kind of. Sets in because you can’t do the thing.

Dr. Andy Roark: Do you think that that usually presents in a way that people recognize it and say, Oh, well, this is sort of sensory overload, or does it present generally as this is this is a team member who’s struggling this person? I don’t understand why he’s so upset about having to work in the isolation room. And the reality is, this is a really hard environment for him.

Let’s just say. But I don’t, I mean, most of us, we’re busy, you know what I mean? And we try to, we try to pay attention to other people, but we’re generally focused on ourselves and what we’re doing. And so, yeah, talk to me a little bit about that, about, about the presentation to management or in the team where you say, okay, how do I, how do I recognize when a team member is struggling say from a conflict with neurodivergence, from sensory input overload, things like that.

Or do I, or do I just. Do I just approach this person as an individual who’s struggling and help me, help me sort of start to put one foot in front of the other to, to trying to, to, to work with this person effectively.

Ron Sosa: And I think as a leader, I want to treat, treat the person like a human being, but I want to be aware of the possibility of what they’re going through. And so, and the other problem is most people born in our age group are underdiagnosed, like. I wasn’t diagnosed with ADHD until I was in my late 20s. I got an autism diagnosis in my mid thirties, and so I had no clue I had these quote unquote sensory problems until I was more aware and educated myself as to what was going on.

So I think that just seeing someone struggling is. The leader’s job is to like, Hey, what’s going on? And they may have no clue that it’s today. It’s the, you know, the Parvo dog smell and the block cat smell, plus the lighting, plus the, the kennel saw or whatever the smells that are going on. They just don’t have a clue as why they’re necessarily overwhelmed.

And I think a lot of people can relate to that. Like, I just feel overwhelmed today and I have no idea why. I can do the same job yesterday and be completely fine. But today is overwhelming me and the caseload is not as high.

Dr. Andy Roark: That, that, okay. So that totally makes sense. And it also, it makes it easier for me to sort of approach people because you just approach them as, as people and say, okay, I see this person is struggling. Imagine, imagine for a sec, Ron, that you were coaching someone who was a manager in a hospital or a veterinarian, who was, who was a rule following person, you know what I mean, who is very much a process version of this is how we do it, and this is how we do it, and this is how we do it, and everyone, you need to get your job done, and again, I, I, those people can be really, really valuable in a, in a hospital.

I, I can imagine a situation where people who are process people or rule sort of following people might particularly struggle with working with someone who’s neurodiverse and who maybe struggles with this structure or this, I don’t you know, just, just, Has a, has a hard day for reasons that aren’t obvious to, to someone outside.

Co, coach this manager, this leader for me a little bit to help them get their head into the right place where they can start to, instead of saying, well, she’s not following the rules. She’s not, she didn’t, she didn’t do this thing. We had this clearly stated objective and she didn’t get to it. How do you, how do you start to change that person’s mindset?

And then how do you, how do you help them? To be more successful and also be more comfortable.

Ron Sosa: sure. I think, the answer I’ll give to anyone is I really feel like we need to go through some neurodiverse sensitivity training. And even if we don’t call it that, we need to just be able to understand that everybody’s brain chemistry works different. In fact, I would probably say the person who is your you know, High justice, you know, seeking person is probably on the neurodivergent spectrum themselves because most autistics need to follow the rules and neurodivergent as a whole have justice sensitivity where they have a complete sensitivity to Need to follow the rules, need to be fair.

We need to have the same setting applied to each person. And it’s just not the case. Like every individual is a person, every individual has their own strengths and weaknesses, and we just need to treat people like people. And that’s what I would probably talk to, you know, this leader or this person who is coming up to me about the need for justice, so to speak.

It’s be like, you know, I don’t treat everybody equally. I treat everybody fairly. And I think that really goes down to what is their strengths? What is their weaknesses? How can I help them? What supports have they already received? What supports can I already, can I give them next? You know, what are they, what do they think they need versus what do I think they need?

I think there’s a lot of questions to answer.

Dr. Andy Roark: yeah, I, I, I agree with that. So if you’re working with someone who’s a neurodiverse team member, are there questions that you can ask Ron that you think help to open that conversation up? You know, it’s, I’m imagining things like are there, are there Are there days that you have noticed that you particularly struggle?

Are there tasks that are I, you know, I, I’m, I’m kind of digging at, at those types of things. I want to ask some open ended questions to have this person sort of tell me how they’re feeling or, or what their struggles are or where they feel like they get lost or bogged down. 

Because if I don’t have that conversation, I don’t understand what the challenges are I can’t really support them. Have you heard questions that help sort of open those conversations up in a nonjudgmental way that allows us to support neurodivergent team members?

Ron Sosa: Yeah. I it’s, it’s hard because number one, I would say most don’t disclose their neurodivergence because of shame of their past or, you know, Shame of, will I even get the job if I do this or will I get fired if I, they think I can’t do my job. So there’s a lot of non disclosure that happens. And then what I don’t want to do is have leaders out in the vet clinics trying to diagnose their, their team.

Right. And so if we have somebody who has disclosed, then we can start to talk to them about their specifics. You know, what sensory things. have you had problems with what, what sensory things have you not had problems with? Like, I think we can very, we can ask very specific questions once we know that there’s disclosure, but if not, and we have those who have no idea that they are neurodivergent.

And so I think I have to try to go back to like treating the person like a person. And you and I have done the whole, you know, let’s just sit down and talk and see what’s bothering you. I see you’re struggling. I look, we go right to the behavior and not the person. Like this is what I’m seeing. You know, how can we work best together to achieve what it is we’re trying to achieve over here?

Dr. Andy Roark: No, that, that totally makes sense. Ron, thanks so much for just talking through this with me. I mean, this is I think you, You put this in great perspective. This is really helpful. It’s not, you know, it’s a lot of it’s just sort of a mindset change. And a lot of it’s just sort of trying to understand and go, Oh, people’s brains work very differently than mine.

And and we’re just gonna have to talk to people and try to meet them where they are and figure out you know, it’s not about right or wrong. It’s just about different and sort of come up with a solution that kind of works for everybody. Ron, you’re writing a lot on LinkedIn. Is there other places that people can find your work or should they be following you there?

Ron Sosa: Yeah. I just started writing on LinkedIn. I’ve never considered myself a writer. And then I just, Decided to write an article that I was feeling really passionate about and it’s kind of taken off. And so I will say I’m hopefully going to have a book published in the next year is the timeline, is my smart goal, so to speak. So maybe we’ll have it out by next April is the goal. But yeah, all my writing right now is usually two to five minute blog articles on LinkedIn.

Dr. Andy Roark: That’s outstanding. Thank you so much for being here, my friend. Guys, thanks for tuning in and listening. Take care of yourselves, everybody.

Ron Sosa: Yeah. 

Dr. Andy Roark: And that’s it guys. That’s what I got for you. I hope you enjoyed it. I hope you took something out of it. Thanks again to Ron for being here. Guys. If you enjoyed the episode, please leave me an honest review wherever you get your podcasts. It means the world to me. It’s how people find the show. Anyway, take care of yourselves, everybody.

I’ll talk to you later. Bye.