Medicine

Mark Cushing Joins Dr. Andy Roark to review recent trends and policy battles in veterinary medicine. He discusses the veterinary labor shortage, telemedicine, nurse practitioners, lawsuit damages and CBD regulation. He also gives his predictions for the midterm 2022 elections and how they will impact veterinary medicine in the coming year.

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

LINKS

Practice Owner Summit: https://unchartedvet.com/practice-owner-summit-2022/

Pet Nation: https://amzn.to/3yNT8gj

Animal Policy Group: https://animalpolicygroup.com/

Mark Cushing Website: https://www.marklcushing.com/

Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/on-demand-staff-training/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Mark is the Founder and Managing Partner of the Animal Policy Group, LLC, based in Scottsdale, AZ, Portland, OR, and Los Angeles. APG’s clients represent a wide-range of pet health, animal welfare and veterinary educational interests. Mark focuses his practice on providing high-level strategic advice, government advocacy, regulatory and policy services to animal health and veterinary clients with needs at any level of government, and universities and industry groups throughout North America. Mark is a frequent speaker at veterinary medicine and other animal policy conferences. He is a former partner of major regional and national law firms and served as an adjunct professor of law at the LMU Duncan School of Law in Knoxville, Lewis & Clark Law School in Portland, and the University of Oregon School of Law. He is an Honors graduate with distinction from Stanford University and the Willamette University College of Law. Most recently, Mark is the author of Pet Nation, a book released by Penguin Random House that illustrates an inside look at the forces behind how our pets transformed American society and culture.

EPISODE TRANSCRIPT

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

Dr. Andy Roark:
Welcome, everybody, to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I’m here today with the one and only, Mark Cushing. If you haven’t heard Mark before, you’re in for a treat. He’s very opinionated. He has got his fingers in a lot of pies. He knows a lot about how our industry works. And I’m just thrilled to have him here. Gang, we talk about everything from the vet med labor shortage, to nurse practitioners and telemedicine, to noneconomic damages and lawsuits too. And we focus on this [inaudible 00:00:41] CBD oil and CBD regulations. Gang, it is today a sprawling, sprawling conversation. We even talk some politics, we talk midterm elections and inflation and what that means or could mean for vet medicine in the coming year. It’s a really fun one. Gang, I hope you’ll enjoy it. Let’s get into this episode.

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

Dr. Andy Roark:
Welcome to the podcast, Mark Cushing. Thanks for being here.

Mark Cushing:
Great to join us as always, Andy. Hope you’re well.

Dr. Andy Roark:
I am. So I love having you here. For those who don’t know you, Mark Cushing is a lawyer. He is a founder and CEO of the Animal Policy Group. And he is the author of the book Pet Nation. I’ve had you on the podcast before. We’ve talked about the book. We’ve talked about a lot of things. You always come to my mind this time of year because I used to get to see you at the Banfield Industry Summit, which is a great event. But you are generally invited to share your perspective on the industry and where it’s going. And what are the hot topics in the coming year? And I love that, I love hearing you speak about that. You just always give me a ton of ideas.
And I just wanted to have you on the podcast today and kind of run … I think I’d like to sort of hear an overview because I didn’t get to hear you at Banfield this year. What are the hot topics you see coming down the pipes for the industry? And then one area that I know that you’re involved is in the legality of CBD. That was a topic that got really hot, and then it kind of seemed to cool down. And I’m sensing it’s warming back up and I’m seeing a lot more about it again. I wanted to talk to you about that. Does that sound okay?

Mark Cushing:
Let’s go. I’ll jump in on the first.

Dr. Andy Roark:
Yeah, take it from there.

Mark Cushing:
And Banfield punished the attendees by making them sit through breakfast to hear my overview. So I go about 180 miles an hour because I try to cover all the legislation the past year. We started out my group by looking at 25,000 bills and reduced it down to about 350. The point being, when you’re successful and financially, the industry as you know, 2020, 2021, now 2022 are each the greatest years financially than the year before ever, so that puts a bullseye on your back, and I kind of reminded the industry leaders that, that attracts attention. And it often attracts legislation of people wanting to help you, I.E, get a piece of your action, so to speak.
And what were some interesting trends this year? Industry wide, the conversation right now is dominated by the veterinary shortage and the vet tech shortage, period. And there has been reluctance, I think foolish on the part of some trade associations to acknowledge it because all you have to do is talk to a practicing veterinarian anywhere in the country, rural, suburban, urban, East, West, North, South, doesn’t matter. They’re in an acute shortage scenario. And the law of economics, as you know, Andy, means if you have a shortage of something, a shortage of supply of veterinarians, fewer people get care and the price of care goes up. Neither one of those are trends that people feel comfortable with.
I’m not trained enough to talk about the impact and the burnout on veterinary staffs, which is obvious. But we have this millennial and gen Z pet owner group, the largest cohorts of pet owners now in the country, they want to spend money on vet care, they want to treat their pets’ healthcare at the same scale that they take care of their own healthcare. And money really isn’t an issue, which is, quote, a great problem to have, but you’ve got to have enough caregivers to do that. And they’re frustrated. And the headwind we’re heading into will be people that were going to get a second dog, or a cat, or a second cat, or a third because they want playmates and they enjoy the first ones they have so much. But if you can’t get in to see a vet, I can see the conversation between a couple being, “Honey, why are we thinking about a second dog when we can’t get Sparky in to see our veterinarian for a month?” So that’s a tough issue, and it surfaces in different directions.
One is, and you know I’m an advocate for telemedicine. I wrote the first article for the industry back in 2015. I didn’t create telemedicine, I just watched what it’s done in human medicines. It’s legal in all 50 states and it’s now important. It’s a fundamental way people get care if they can’t get in to see a doc. And telemedicine is on the table now in a different context than just it’s convenient and I don’t want to leave my house, or I don’t want to go to a clinic. It’s I can’t get into a clinic. So the arguments against telemedicine become more and more theoretical and less and less real. Number one, number two, it’s opened the door for people to say, “Yeah, human medicine’s had PAs and nurse practitioners for 60 years.” Let me tell you what 60 years means. That means there’s grandparents, kids, and grandkids that have been PAs in this country. We have them all through the US. And again, we would have enormous medical deserts absent nurse practitioners and PAs.
So we’ve had 60 years to learn from it. Obviously, I’m a fan of that. Lincoln Memorial’s opened its first master’s program to create that. And that thinking’s changed. We find people saying, “We certainly shouldn’t fear competition from PAs. Good Lord, we don’t have enough vets as is.” And it would free veterinarians up to do more things, higher value things. So that conversation’s changed. You now see more states, they’re blue states, they’re mainly in the Northeast and Mid-Atlantic, look at noneconomic damages and saying, “We see all this literature where veterinarians say, ‘We treat your pets as family,'” which is true. They have that. They have a unique role in our lives that’s more like kids, and that is like certainly a chair or a skateboard. So why don’t we get the damage awards to include emotional damages, loss of companionship, that human medicine gets? And that’s a tough issue.
I’m still a strong critic of that idea, and my clients are. Why? Because all that does is drive up the cost of vet care, and therefore reduces access. Why is that? Because we pay 750 bucks for liability insurance, vets do now, versus 200,000 that an OB/GYN pays. And if you think that number doesn’t show up in new technology, defensive medicine, and rising costs, which shrinks access, so it’s an interesting debate. But that’s got some tailwind behind it, and we’ll see more and more states want to push that.

Dr. Andy Roark:
Yeah. And let me ask you about that because you’re actually the perfect person to ask this about. I think a lot about this, and whenever I hear noneconomic damages, I’ll be honest, I feel the muscles in my face tighten. You know what I mean? I feel the stress in my forehead come in because just to me, that seems catastrophic, I mean really. And I want you to talk me down here.

Mark Cushing:
It is.

Dr. Andy Roark:
Give me some … Don’t say, “It is.” I wanted you to say, “No, Andy. It’s bad, but it’s not awful.” But it just seems to me, I go, “Look, we’re trying to do everything that we can to provide access,” but when people start suing for six, seven figures when something goes wrong with their pet, suddenly we go, “No, I’m not doing this without an ultrasound, or I’m not doing this without a CT scan.” And I don’t see how that doesn’t just rocket the cost of care multiple times above what it is now. Am I wrong? Are there shades of gray that I’m not seeing here?

Mark Cushing:
You’re not wrong. The truth is, all lawsuits against doctors, the plaintiff’s lawyers that take those cases have them on contingent fees. You see the ads, the billboards in every highway in America. Doesn’t cost you anything. Mark Cushing, come see me, in a car accident, won’t cost you anything. It’s true. You don’t have an out of pocket cost. But they get a third of it. There aren’t lawsuits against veterinarians now with any scale or volume for a simple reason. Lawyers don’t get out of bed for one third of $2000.

Dr. Andy Roark:
Right.

Mark Cushing:
You don’t spend two years pursuing a case that you might make 600 bucks. So when you change that, two things happen. The number of lawsuit, when people recover … Your Shih Tzu dies at age 12, and they claim that the doctor negligently performed surgery, when the gates are open on whatever a jury things would emotionally reward you or compensate you for that loss, two things happen. Lawsuits get filed. Plaintiff’s lawyers get organized. TV ads start appearing of the sort, they ask if you’re in a certain group, asbestos, you’re in a certain group for something else. Now it’s: Are you a pet [inaudible 00:09:56] a pet in America? Have you lost a pet in your life? Really emotionally compelling ads.
The second thing that happens that’s even more troublesome is the insurance underwriters, if one state does that, they step back and go, “Wait a second. Our job’s to manage risk here. The risk just went up by X amount,” so now across the country, they start raising premiums to get ready for it. And then you bake that in, if you’re a veterinarian and you’re cost of doing business increases by $50,000 in the year, you don’t think you find a way to try to recover that. And so the rich can afford it, but we’ve never had healthcare for pets, nor have we had pet ownership be one that’s dependent on income, period.
I did a study nationally in 2015. People that made less than $30,000 a year owned dogs at the same percentage level as people that made over $100,000. And that goes away in this scenario. So there’s nothing good about it, and you might say, “Well, it compensates Mrs. Brown that loved that dog, and she got a nice check for a million five.” Well, actually, she got a million because her lawyers got $500,000. But is that worth it as a social policy? That’s why on the human side, you can’t make a claim for your brother, your sister, your favorite aunt or uncle, your favorite grandparent, your best friend, your girlfriend. It’s limited to your spouse or a child. And so the argument tries to shoehorn pets into being a child. My view is, and I’ve said it publicly, I’ve appeared in front of legislatures and debates all the time, I say pets aren’t children. Pets are a different species. In fact, of course they’re a different species. They’re dog and cat or some other pet.
But they’re also, they have a different relationship. In many cases, they’re nicer than kids. I have five kids. And the point is, you can’t simply say they are kids. They’re not. They’re something different. They live a short life, sadly. We’d all love our favorite dog to live to 60. Not the case, obviously, you know as a doctor. So that analogy, and we’ve won for all 16 years I’ve been involved in the industry. But the waves are bigger coming at us right now, and I don’t think it’s going to go away. So that’s bed news, I’m sorry to start your program off with [inaudible 00:12:24]. But we’re winning. The point is when we make the case that I just said, people go, “Oh, okay. I get it. I’m okay [inaudible 00:12:33].”

Dr. Andy Roark:
That seems obvious to me is you go, “Boy, the impact of this on people’s ability to have pets and pay for them is just so monumental.” It would be so sad to have to make those adjustments.
Hey guys, I just want to jump in real fast and give all of my practice owner friends a heads up. The Practice Owner Summit is coming in December. It is an Uncharted veterinary conference. It is only for practice owners. It is a summit, which means plan for it to be very hands on. You’re going to meet with everyone, other practice owners, everyone there basically is going to be a practice owner. I expect we’ll have 75 practice owners coming together in Greenville, South Carolina December 8th through the 10th. This is a program that I am super happy to put on and run it with my team at Uncharted. It is unlike anything that you’ve seen before. If you want to work on your business, you want to talk with people who get it and who understand the stresses of being an owner, come on and check it out. I’ll put a link in the show notes. Guys, let’s get back into this episode.
Let me ask you one more thing before we go on. So I thought a lot about this, and we say to people, “Your pets are family, and we treat your fur babies,” and we talk like that, I like that language in a lot of ways because it’s always been about raising the human animal bond, and emphasizing people’s connections to pet, and recognizing and honoring that connection.
At the same time, Mark, as I listen to these things and we talk about noneconomic damages, and then also the inability to get pets in to the clinic, and I say, we say, “This is your fur baby, but I can’t see you today.” No shade at all for not being able to get people into the clinic. I am 100% one of those people who says, “If you have a capacity in what you can see in a day, and when you surpass it, you can’t just push your staff harder.” That’s not how this works, and so no shade on not being able to get people in. However, do we need as an industry to start adjusting the language that we use when we talk about pets? So how does that feel when I say it to you?

Mark Cushing:
I have contractors all over my property right now, so I’m just waving them off saying I’m [inaudible 00:14:48]. I’m talking to this esteemed national veterinarian [inaudible 00:14:52]. So I’m a free speech guy. I’ve always believed strongly, not just as a lawyer, but as a citizen. So attempting to regulate language to me is a fool’s mission, Andy, even if it’s well-intentioned, you’ll never quite achieve it. And we’ve used those phrases about pets for 15, 20 years, and not had noneconomic damages come back to bite us. So I think we can manage our way through it at that level. What will change is that the plaintiff’s lawyers, who are busy with opioid lawsuits, following gun control lawsuits, following asbestos, following cigarette, following just fill in the blank, where the scale of reward is billion dollars, so you get a third of a billion dollars versus $100,000. You get a little more excited.
So when that groups turns their eyes, and I’ve waited for 16 years to see when that group shows up, their lobbying power is almost unbeatable, almost. That’ll be different, we’ll see, and language may have to change. But I think for now, we can continue to do it. And the nice thing is pet owners aren’t crying for those damages. That’s the other thing. Those cases always have people that have died horrible deaths, and they’re on the ads, and it’s super compelling. Well, people know pets live short lives. So it’s a different narrative to say, “My 13 year old retriever had to say goodbye.” Well, chances are in the next year, you would’ve had to. Does that sound callous from a lawyer? Sorry, but that’s sort of the reality of it.

Dr. Andy Roark:
No, I hear that. All that totally makes sense. No, this is insightful. I appreciate your insight. Let’s evolve this a little bit, and I want to swing over to CBD. This was a topic a couple years ago we heard a ton about, and CBD was everywhere, and the CBD stores were popping up. There were just new products really coming into the vet market. And then I felt like things kind of hit a stable point, sort of an equilibrium, and they sort of were normalized to some degree, and things sort of quieted down. And now I’m hearing a lot more about the legalities of CBD, sort of changes to access of CBD. Can you sort of start to lay that out for me? Why is this becoming an issue again?

Mark Cushing:
Well, it’s becoming an issue again because so many states have legalized recreational marijuana. A majority have legalized medical marijuana. CBD’s not marijuana, but the point is the culture is much more comfortable with it, number one. Number two, you’ve seen people get comfortable using gummies and a whole host of just CBD products themselves, and particularly when it relates to stress. The argument, I don’t want to keep giving my dog gabapentin because we’re driving eight hours down to Florida for Easter or something. Is there something that’s less aggressive and maybe has less residual, potential residual issues? So there’s that, but you now have legislation, and now, surprise, California has jumped to the head of the pack. And the legal standing right now of CBD supplements in California is that there is no restriction, no restriction on a veterinarian recommending or selling it from their practice to a client.
And there’s uncertainty, Andy, you know this because you’ve podcast all over the country. There’s uncertainty all over the country by veterinarians. Can I even discuss CBD with my clients? Let me just take issues one at a time. The answer is we have a thing called the First Amendment. You can talk about space travel, you can try to tell your clients the world is flat. You can talk to your clients about anything you want. You can. I mean, the truth is you can talk about it. So there’s no thought police, speech police zooming in from a vet med board saying, “Did I hear you mention CBD? Let me have that license of yours and we’ll kindly excuse you,” number one.
Number two, the problem has been the FDA. And let me tell you what the FDA hasn’t done, and it’s what they haven’t done that’s frustrating. So Congress passed in 2018, the Farm Bill. It was signed by the president. That means the language of that bill is the law of the United States. And that law said the following, “If it’s hemp based and the THC, the psychoactive level, that high level of the CBD and hemp, is below .3, that is legal in America.” That’s legal right now. And so if a supplement fits that category, it’s legal. A veterinarian can recommend it. And in my view, they could sell it.
Now what the FDA’s done is say, “Well, we won’t pronounce on that. We won’t make a statement.” So you have one agency sitting there that everybody looks to, being silent. But they will say, “If you’re a supplement manufacturer and you make a therapeutic claim, if you claim that supplement’s going to do something good for a pet, or it’s going to change their bodily structure or function,” that’s the language they use, then we’ll shut you down because only we can approve a therapeutic product. So CBD manufacturers have gotten a lot smarter. And you just pay attention to their marketing, and they’re not making the claims that they might’ve made or want to make, the truth is. So it’s not helpful in my view, and I’ve told the FDA that. It’s not helpful for them to not just step up and say, “We know it’s the law, if you fit this category, hemp based below .3 THC, you’re okay by us.” You can say we’re not going to regulate you, but we’re not going to punish anybody for using you.
So that’s the uncertainty out there, but it’s going to go the way that human marijuana use went. State after state, including SEC states, which tend to be very conservative, other than when they’re talking about SEC football, but states increasingly are saying, “Yes, marijuana, we can live with it within our culture.” And you’re going to see that trend. And so I think what’s going to happen is more and more states are going to say, “Veterinarians, officially, you can do this.” Right now, veterinarians are like, “I don’t know. I want someone to tell me for sure my license isn’t at risk.” And I’m involved, it probably won’t surprise you, but I’m involved with trying to get some of those reforms initiated in states that clarify it. The ones that have are Nevada and California right now on the veterinary side. And those numbers need to increase. And I think once more states do that, people will get comfortable.

Dr. Andy Roark:
What do you think as far as pace of this change? I mean, so Nevada, California, is this in five years, the majority of the states? I mean, I know we’re just sort of forecasting here. But is it a couple years, or is it much longer term than that? What are you thinking as far as timeline?

Mark Cushing:
I think a five year window’s a good way to look at it. And I’ll be disappointed if we’re not at the 10 to 15 states in five years, crazy successful, 20 states. I think in 10 years, over half the states will. And again, I think if you tie it to a veterinary client patient relationship, so you’re saying, and that’s what I favor, so you’re saying, “Yes, you can recommend and dispense, and you can administer in your practice if you need to, a product that fits that legal definition if you have a VCPR with the client.” Then I think we built in a whole set of standards and care that veterinarians have to bring to bear, rather than just sort of casually recommending to a friend, “Yeah, why don’t you try this?” So I think if we have safeguards, people get comfortable. And the key to me, Andy, is that the state VMAs not come out against it, and let … And you never know until you’re in the battle whether they’re going to come out.

Dr. Andy Roark:
Yeah. That makes sense. So getting my head around this, so when we talk about manufacturers that are doing more than .3 THC, things like that, are those not available for purchase in other states? Or owners are just, I’m assuming, ordering them online, it’s just they’re not coming through veterinary clinics. Help me understand that.

Mark Cushing:
Yeah. They’re not coming through veterinary channels, and it’s probably CBD for humans. And to me, that’s dangerous. I mean, I’m a baby boomer. I’ve been exposed to cannabis in CBD in my life. That will shock people. I did live in America in the 60s and 70s and 80s and 90s and now. Point being, a lot of people, I mean, sadly, some people are just taking marijuana in some manner, feeding it to a pet, which is very dangerous. And so that’s the mistake being made there. But people are saying, “Hell, it makes me feel good, and I weigh X number of pounds, so my retriever weighs 65 pounds. I’ll cut it in third, or I’ll cut it in half, or a quarter,” and not a good plan. But there is that going on, no question.
So I think what you want to have happen is let the … And I work with a company going through FDA clinical trials right now, so once you start to have standards that people understand, I’m surprised how many veterinarians don’t know about the Farm Bill, don’t know the hemp based less than .3 THC means something. They’re like, “Oh, what’s that? I never heard about that?” Well, that’s the law. And so we kind of have to get the word out, and I’m hoping that med boards and vet medical associations are comfortable saying, “Yes, that’s okay.” But I think they’re being told by lawyers, “You’ve got to be cautious here. Wait and see what the FDA does.” And I always say to people, “We can wait.” But the truth is, federal law already says the following, which you’ve heard me say. Don’t be afraid to adhere to federal law. And the FDA’s angle is, don’t make a special therapeutic claim about it, but you can get around that. And so smart companies use language that, that’s not claiming it’s going to heal this or cure that.

Dr. Andy Roark:
Got you. Well, let me wrap this up. I want to ask you one of your future facing questions because I’m always interested in your perspective. We’re going into midterm elections. We’ve got signs of continued inflation and prices continue to stay high, even with adjustments to interest rates from the Fed, things like that. Where do you see vet medicine in the next 12, 16, 24 months? Are there forces you’re expecting to be impacting us that are not yet apparent?

Mark Cushing:
I think that the Republicans will take the House back. Whatever your party is, the beauty of that is when we have dual governments, Republicans have this, Republicans have that, but both parties have some power. The pace of federal spending always slows down, and inflation is driven mainly by just massive federal spending that puts money into the market, into the world. And everybody says, “Well, that sounds good.” But then it has the effect we’re now experiencing. I think that’ll slow down fears about a recession. What’s changed in the narrative is inflation, inflation, inflation, oh, my God. Now we’re getting near. Oh, you read the Wall Street Journal today, everyone’s saying, “Recession likely.”
I think that threat will abate. That will cause people will calm down about: Do I have to start making adjustments in my lifestyle right now? Because there’s still jobs available, so if somebody wants a job, they can get a job. But I think you’re going to see that the recession threat and the scale of inflation, if just that one thing happens, Republicans take the house because that means that the Democrats can’t simply push through a spending plan that Republicans can’t stop, so I’m being very political in saying that. There’s things about Republicans taking control that I don’t necessarily like, but that’s one positive.
So the threat to veterinary medicine is there of a recession, but it’ll be on the edges of it. I do not see people saying, “I’m not going to feed my dog. I’m not going to feed my cat. I’m going to drive my dog to the shelter.” You know why people are giving pets back to shelters now? Because they can’t get veterinary care. That threat is independent of any national election. That’s a professional saying, “We have to open up avenues for care or remove barriers to care so people can get care other than going to a clinic,” because clinics have said, “There’s no room at the inn. Sorry, there’s just no room at this hotel. You can’t stay here.” So I’m less concerned for this industry than others about how a full on recession plays out. It’ll slow some things down for sure, but look at what’s happened.
Market Watch shows us every week that vet spending’s up from a year ago and up from the year before that, so that’s my one political ad for this interview, is that I like divided governments. You know why? Because it forces the extremes of both party, which drive most people nuts, myself included. It forces extremes to have conversations because you just can’t yell at each other all day if in fact nothing can happen if you don’t sit down because one side has to get buy in, and the other side has to get buy in, so that’s my hope. If not, I will tell you, it’ll be pretty interesting what’s going to happen. Tighten your seat belt and watch out.

Dr. Andy Roark:
Awesome.

Mark Cushing:
You heard it from the oracle. Yeah, there you go.

Dr. Andy Roark:
Mark Cushing, you are the author of Pet Nation. I’ll put a link to the book in the show notes for those who’ve not checked it out. There’s a podcast you and I have done in the past about it. It’s a very, very interesting read. I really enjoyed it. Where can people follow you? Where can they read more of your writing and your thoughts?

Mark Cushing:
Well, they can go to, I think it’s markcushing.com or marklcushing.com. I can’t remember if I have my dad’s middle name, Lewis. But animalpolicygroup.com for our business. And then Pet Nation, you can get every way possible. And if you like the sound of my voice, for some reason, you can get the audio version. And as you’re walking on the beaches in Carolina, you can hear what I have to say.

Dr. Andy Roark:
It’s like I’m walking on the beach with Mark Cushing, and it doesn’t get better than that.

Mark Cushing:
How could you top that? I agree. So Andy, great seeing you. Great questions, as always. You’re ahead of the game, and you just pull the rest of us along, so thanks a lot.

Dr. Andy Roark:
You’re very kind. Guys, take care of yourselves. And that is our show, guys. That’s what I got. I hope you enjoyed it. I hope you’ve enjoyed hearing thoughts and ponderings of Mark Cushing. As I may have mentioned before, Mark is the founder and CEO of Animal Policy Group. His opinions are his own, although I do very much enjoy hearing where his head is and hearing him talk and predict the future. So anyway, I hope you guys having him on here. Check out his book if you get a chance. Yeah, and that’s it from me, gang. Take care of yourselves. Be well. See you next week. Bye.

Dr. Tannetje’ Crocker, a practicing emergency room veterinarian and social media personality, joins Dr. Andy Roark to discuss how work overwhelm is pitting emergency vets and general practitioners against each other.

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

LINKS

Uncharted Practice Owner Summit: https://unchartedvet.com/practice-owner-summit-2022/

Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/on-demand-staff-training/

What’s on my Scrubs?! Card Game: https://drandyroark.com/training-tools/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Tannetje’ Crocker is a 2009 graduate from the Texas A&M University College of Veterinary Medicine. She is passionate about mentorship and empowering veterinary professionals to embrace the profession and find joy and success. Growing up Dr. Crocker competed on horses and was inspired to become a veterinarian. Since graduation she has worked as an equine ambulatory vet, small animal general practitioner, and emergency veterinarian. She currently lives in Texas with her spirited 10 year old daughter, funny 6 year old son, and supportive husband of 16 years.

She works as an ER Veterinarian for Veterinary Emergency Group in Dallas, TX. Recently she was excited to purchase Alta Vista Animal Hospital in Fort Worth, TX. She plans to continue her support of fellow veterinary professionals, both virtually and in person through her various endeavors.

Follow her veterinary journey @dr.tannetje.crocker or www.drcrockerpetvet.com

EPISODE TRANSCRIPT

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

Dr. Andy Roark:
Welcome everybody, to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a great episode here today with my friend, Dr. Tannetje Crocker. We are talking about interactions between general practice, veterinary care, and emergency veterinary care, and we’re talking about it in the sense of being overwhelmed. What does it look like? What does it feel like when the GPs have too much work to do, and they’re giving it to the ER, and the ERs have too much work to do, and they don’t have anywhere to give it back? And how do we feel about each other, and how do we talk to each other, and how can we make this better? Guys, those are some of the things that we talk about today. 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. Tannetje Crocker. Thanks for being here. I met you when you accosted me outside of a bar in Orlando. I was leaving and you said, “Hey, Roark, I’ve got a beef with you.” That’s what I remember.

Dr. Tannetje Crocker:
That’s a variation, but I’m not going to say you’re wrong. I’m not going to say that you’re wrong.

Dr. Andy Roark:
No, and I will say that’s how I met a lot of friends in my life with people who were like, “I have a beef with you,” and you took issue with something that I had said about TikTok and you were like, “You miss the advantages of TikTok and you miss the good that it can do,” and I honestly ended up thinking a little bit differently about TikTok, after talking with you. And so, I’m very interested in the work that you’re doing. So, for those who don’t know Tannetje, she’s a practicing emergency veterinarian. She also has a fairly active social media presence. She’s got almost 50,000 followers on Instagram. She’s doing TikTok now for just about a month, and she’s got about 80 some thousand followers on TikTok. She’s doing a lot of interesting work with social media, and guys, she’s doing it in a really positive way.
So, it’s nice. The reason that I have really enjoyed getting to know you in the last probably six, eight months, is the work that you do is good in that you’re positive about our profession. You’re not using social media to crap on what we do, or complain about how bad things are. You’re actually out there talking about the things that you like, and things that are actually helpful, and things that might make other people enjoy our profession. And so, I just want to start and say, well, first of all, thank you for doing that. It’s something obviously that I care a lot about, and it’s just refreshing to see somebody out there who’s doing emergency medicine, and who’s still determined to find the positivity and to present it to the world in a positive way, so thank you.

Dr. Tannetje Crocker:
I appreciate that, because that’s definitely the intention. When I first joined social media, it was literally because I was frustrated with everyone saying, “You shouldn’t have become a veterinarian,” telling vet students they made a wrong decision. Can you imagine being in that school and someone saying like, “Hey, wrong decision. You really messed up?” And so, my message, I guess, resonated with people, and now I just get to have a lot of fun with it, really connect online with people, encourage them, and I don’t sugarcoat anything. I mean, emergency work is hard, I talk about the realities of that, but I try to bring it back to the choices that I’ve made that have made me still really, really enjoy and love it after 14 years, and hopefully encourage other people to find their joy in this profession, which can be hard.

Dr. Andy Roark:
Yeah, we’ve hit this weird tipping point in medicine talking about students. So, this is 100% just my perspective of things that I’ve seen, and I think a lot of people are like, “Vet students, they need to understand the harsh realities of the choice they’ve made,” and that might be true, but the truth is, there’s a lot of people who have had that idea, and then they go to the vet students and they’re like, “This is going to be real hard,” and if everyone’s telling them it’s great, and one person tells them it’s going to be hard, that’s probably a good thing, but if everyone tells them how hard it’s going to be, at some point, it’s just soul-crushing and not helpful.
And I feel like we have, in a lot of ways, have crossed over that line. Not to say it’s not hard, but boy, I have seen instances where I’ve really feel like vet students have just been pounded on for months and months of people talking to them about how hard the profession’s going to be, and at some point you go, “Let’s also make sure that we’re giving air time to why we got into this, and to the good things about it,” because there are good things about it. And so, anyway, that’s sort of my take in talking to young doctors these days.

Dr. Tannetje Crocker:
I would agree, and we’re not here to talk about this, but I would say, wouldn’t it be great to give them ways that you’ve dealt with those difficult things, and how you’ve kind of pushed through those hard times, versus just saying, “Hey, you’re going to be stuck there forever.?”Let’s give them the resources to find the success and sustainability, and not just say, “Nope, this is how you’re going to feel.”
And when especially people talk a lot about the tough clients, I will go to talks at vet schools and they’ll say, “How do you handle this? Oh, I’m so worried about this,” and I will tell them, “I see a ton of people in the ER in a week, and I don’t have those interactions 100% of the time. That is a very small percentage of those interactions in a very high stress, difficult time. So, don’t focus on that. Let’s focus on all the things that you do good and all the great things that happen, and let’s talk about gratitude and strategies, versus let’s focus on that one horrible client that happened in a three month time period.” And that’s where social media really, that vocal minority that’s telling them, “Yeah, it’s going to suck, and all the clients are horrible,” I don’t know, it’s really tough on them. So, I’m glad that people like you and me are out there, and I heard a rumor that you might eventually be joining TikTok with me, and so, maybe we’ll spread the word even more.

Dr. Andy Roark:
I-

Dr. Tannetje Crocker:
You’re thinking about it.

Dr. Andy Roark:
I am thinking about it. I have a notebook of things that I have been jotting down. I’m not going to do something just to do it. If I’m going to do something, it needs to be good in my own eyes, and I also have to approach it from a way where I go, “I enjoy doing this, and this has value,” and I’ve been thinking about it for a long time, and just sort kicking around that little notebook of things I jot down where I say, “I would be happy to do this,” or “I genuinely think this would be helpful.” And honestly, I think you have been a piece of me getting more open to that idea, just because I see you and I go, “Nah, she’s doing a good job. I got to say, she’s doing a good job,” and that makes me think, “Okay, this may be a worthy problem to sit with for a while.” And so, yeah, you’ve definitely moved me in that way, but I’m not making promises, but it’s on the radar.
The last thing I want to say on this is, not on TikTok, a healthy problem looks like this: There’s a problem, and then the first step is raising awareness about that problem, and then the second step is now that awareness has been raised, it is coming up with actionable, productive steps to take to manage or to treat said problem. And I feel like in the world of social media, unfortunately sometimes we get stuck in action step number one, which is raising awareness, where we raise awareness, and we raise awareness, and we raise awareness, but actually taking steps to do things in the real world, that gets lost on the way, and raising awareness gets a lot of attention, right? The things that drive attention are fear and anger, and we can raise awareness with fear and anger, but fear and anger don’t turn into productive action steps.
And so, I really do think that you’re absolutely right. I think we’ve done a good job of raising awareness of challenges of medicine, and challenges to mental health, and that stuff is good, and we should keep that, and at the same time, I think it’s also very important that now while people are raising awareness, they transition to step two, which is, “Here’s some things that have been helpful to me,” not “This is what you have to do, but let me share with you what has been helpful for me, or lessons that I have learned,” and I think that’s a positive place to be. All right, but that’s not why you came here. It kind of is. Things are hard.

Dr. Tannetje Crocker:
Oh sorry, my dogs are barking.

Dr. Andy Roark:
They’re excited. So, here’s why we’re here, because vet medicine is hard, and I want to talk to you about a specific aspect I think is really challenging that I see again and again, and it’s the interaction between general practices and emergency practices. So, let me tell you what I kind of see from my side, on the general practice side. Basically, a lot of our practices are overwhelmed. There’s a general shortfall in the amount of labor that we have, and that’s in trained and untrained, but I mean, licensed doctors, and technicians, and support staff. All across the board, we’re having worker shortages, and we have very, very high demand. And so, there’s a caseload that is not able to be met in the general practice, and they’re referring that away to the emergency clinic.
And so, when I talk to these practices and they say, “Aha, I am overwhelmed and my staff is burned out, the answer is I need to refer these things away, because we simply can’t see them,” and I completely agree with that. You cannot see more than you can see. We all have a capacity, and if you push past it, there are very negative outcomes that happen, especially in the long term, and so, that is true. Ultimately where the conversation goes is, “I’m referring these guys to the emergency clinic, and there’s a six hour wait or an eight hour wait, or our emergency clinic is not taking animals, what do we do now?” And that’s a hard question, but that’s what I kind of want to start to unpack with you a little bit. So, let me sort of open up to you in that way and say, when I tell that story, does that resonate with you? Is that kind of what you see? Have you come across that narrative?

Dr. Tannetje Crocker:
Definitely have seen that, and it’s interesting, because I’ve seen it from the general practicing veterinarians, I’ve also seen it from the local specialty clinics. So, we will have specialty clinics call our emergency facility and say, “What’s your wait time? We have a packed room, ours is this. Can we send people to you?” And so, it’s not even between general practicing vets and emergency clinics in general, it’s everybody right now, and I think there’s a little bit of a public Amazon effect. So, more and more pet owners want really immediate results. They also have greatly changed the way they look at their pets, and what level of care they want for their pets, and so, they’re more likely to take them in quicker for things that maybe previously, they would’ve waited through the weekend to see their regular vet for, or they know their regular vet is already booked out two weeks, and they’re not going to see them, and so, might as well go to the emergency clinic.
I would say from my perspective, if an owner is concerned and they’re willing to wait, whatever the wait time is, then I’m going to give them my full attention, and I’m going to help them to the best of my ability, no matter why they’re there. So, if it’s a broken toenail, if it’s they vomited once, I’m still going to try to help them in any way that I can, because I’ve been that pet owner, and something happens with my pets and I can’t even process it, right? Another vet has to take care of it because my mind just… And so, I put myself in their shoes and I want to help them, even if I feel like this probably isn’t a true emergency, it’s not a hemoabdomen, it’s not respiratory distress.
So, I think we have to change a little bit perspectives on both sides. One, I would love to see the general practices train clients a little bit better that wait times are not a bad thing, and what is a true emergency, and not just use the ER as I guess, a dumping ground a little bit, for the things that they don’t want to deal with. And then two, I think that as emergency veterinarians, we have to learn how to communicate that we still care and we want to help pets, without making owners feel like they are silly for coming in or they are wasting our time, because I don’t think that’s fair to them either. Sometimes they just don’t know, and I like the phrase, “This is in good intent,” right? So.

Dr. Andy Roark:
Sure. No, I definitely get that. I have a buddy who tells a story about, he’s not a vet person at all, and his dog was reverse sneezing one morning, and he came sprinting to my house and he was like, “You saved my dog’s life,” and I was like, “I did not. There was nothing urgent emergency about any of this.” But he was like, “I don’t care. I was terrified, and then I was not terrified anymore, because you talked to me and you looked at me, and you told me everything was okay, and then it was okay. And so, you did the magic, you did the thing,” and I was like, “Okay, I get it.” It’s interesting to think from his perspective yeah, that knowledge that really matters. Tell me about what constitutes, because this is an interesting topic, what constitutes the feeling in the ER of a dumping ground? What makes people at the ER feel that they’re being treated that way? Because I want to unpack that a little bit, and see what makes up that emotion.

Dr. Tannetje Crocker:
Let me give an example. So, we had someone come in late two nights ago, and they had been at the football game, they were a little tipsy, they had a really good time, but they came in, rushed in with their really young golden retriever puppy, she was adorable. This puppy looked amazing, she looked great. She had been boarding while they were having a weekend at the football game, and apparently the boarding facility did a fecal, and they sent the owner a message afterwards that said, “It’s a positive fecal, and you need to get it checked out.” And so, the owner called the regular veterinarian, and it was a Saturday and the vet was like, “You need to go to the emergency room.” And this was a-

Dr. Andy Roark:
Oh my god.

Dr. Tannetje Crocker:
… completely normal puppy that had no diarrhea, that was eating and drinking well. It could’ve waited until Monday, but they freaked the owner out and they said, “Well, just go to the ER, they’ll take care of it,” and we were a little surprised that they wouldn’t at least get the fecal results, talk to them about it, maybe prescribe medications. I mean, they already had a relationship with her, but it was the feeling of they just didn’t want to deal with it on a Saturday, and we’re there and we’re open. So, we did, and we saw the pet, we actually got a negative fecal in house, so that was interesting. But it’s those types of circumstances where they don’t want to tell the owner no, so they give them the option of coming to us for something that they probably could’ve set appropriate expectation for.

Dr. Andy Roark:
Yeah. I think that’s really interesting, okay? So, here’s where I’m really tied up, is I want this profession to work for everybody, I really do. That’s super important to me, and there is a nightmare scenario where imagine that the pets are a stream of water, and we’re just pouring from this bucket, and we’re pouring down onto the general practice, and the general practice is completely full, and the water’s now pouring over the top of the general practice, and down into the emergency practice, and now the emergency practice is overflowing, and then the question then is, where does that water go? The water that is now overflowing past the emergencies, where does that go? And I think in the nightmare catastrophic scenario, in the minds of emergency vets it’s, “I never go home, I just stay here. I stay here through the day continuing to work in triage, and I never get to go home.”
That’s not possible. And so, I’m thinking a lot about that. I think there are limits to what we can do. We can’t magically make more veterinarians. I can’t just be like, “Voila, here are 10,000 more emergency vets,” and a lot of people are like, “You can’t, are you sure? You should try, at least try.” There’s nothing that we can do. We’ve got what we’ve got. I believe that we have to move these cases around more. I think that there’s a lot of things that we can do, and just like you and I were talking about before, at some point, you raise awareness, and then you have to come up with action steps. And so, awareness of, “Boy, we’re all really, really busy, and there’s big wait times in a lot of emergency clinics.” Let me also pause here for a second and say, this is 100% regional, in my experience. There are some places where they’re like, “No, we got this, we’re fine,” and there’s other places where they’re not fine. And so, if it’s not happening in your area, that’s great. Know that it’s happening in other areas.
So, I like your idea a lot. That’s actually one that I’ve had in my list of trying to set realistic expectations of what is an emergency, and put some time and space there. My family’s had some illness stuff recently we’ve been sort of working through, and so, we’ve been getting to deal with the joys of human medicine, and let me tell you, they do not tell you to rush in. They do not tell you that you should go… You can have some serious problems and they’ll be like, “We’ll see you a week from Wednesday,” and that’s it.

Dr. Tannetje Crocker:
Yes.

Dr. Andy Roark:
And they say it to you with a straight face, and it’s normal, and they’re just like, “That’s just what it is,’ and it’s amazing to me coming from vet medicine, I am like, “Are you serious? 10 days before we do the next thing?” And they’re like, “Yep, that’s what it is.” And again, I do not want us to be human medicine. At the same time, you can’t tell me that we cannot set some deadlines down the road sometimes, and have them be okay.

Dr. Tannetje Crocker:
I think that there’s actually quite a few very practical things that we can do on both sides. So, at our emergency clinic, we actually answer phones after hours for a lot of the general practices that sign up for our program, and those phones ring through to us, if the owner calls, and it says, “In case of emergency, push this,” and we will talk to the owner about what’s going on. Sometimes they’ll send us a picture or video, and very much triage in that way. And so, I’ve had quite a few that I’ve said, “think you can watch for A, B, and C. If that happens, come in. If not, call your veterinarian in the morning.” And so, people feel heard, people feel seen, they feel calmed, but they’re not rushing in for something that they could watch for a couple hours. And so, I think that’s one option that would help practices out a lot more, if there could be some more sort of tele-triage option.
And the other thing is scheduling-wise, I’ve worked in GP and ER, I know that in GP, you want to make the money, you want to make sure your schedule’s full, you have people there, but there’s been a lot of discussion of how to schedule, making sure that there is room open for those same day urgent emergency type cases, and knowing again, what is a true emergency and what absolutely needs to come to us right away, versus what can you triage and treat, and then see how it does? And so, both sides could do a little bit better with communication, with I guess supporting each other. Like that dog that came over that had the parasite, supposed parasite, I will never say, “You shouldn’t have come.” I will never throw a general practice under the bus, right?

Dr. Andy Roark:
Right. Mm-hmm. Sure. Oh, totally. No, no, no.

Dr. Tannetje Crocker:
I’ll support them no matter what. But on the flip side, I have GPs that’ll say, “I can’t believe that you guys didn’t see them, or you didn’t do this, you didn’t do that.” And so, I think that’s a little bit of the issue too right now too, is what does the client tell them happened or didn’t happen? And so, I’m seeing a lot of general and emergency practices struggling, because they feel like the cases aren’t handled the way that they would handle them. And so, then when you feel that judgment, you kind of feel like, “Why am I staying open? Why am I staying two hours after my shift to see your patients, if you’re just going to throw me under the bus or you’re going to question what I’m doing?” So, I don’t know if you’ve seen that, but I think that’s another component of this that makes it hard to work together.

Dr. Andy Roark:
Oh, 100%, the Monday morning quarterback. I’ve been that guy who comes in on Monday and looks, and I’m like, “Oh, [inaudible 00:19:42] emergency clinic. Let’s see what they did,” and I have seen vets get their reading glasses out and I’m like, “You don’t read anything that closely,” but they’re like, “Let’s see what happened here,” and they look. And again, it’s easy to look at someone else’s work and be like, “Well I wouldn’t have done it that way, or blah, blah, blah.” I think that there’s areas of this that are just fine, and they’re just human nature. I think that there’s always a bit of insecurity that people have when someone else sees their case, right?
So, it’s like, “You saw another doctor,” and in my little fragile heart it’s like, “I bet they liked her more than you. I wonder if she thinks that what you did last time was not good. Does she have the records? Is she looking at what I have done in the past and been like, “What is this idiot thinking?” I hope not, but I think we all have that little bit of insecurity as well. And so, we want to look and see like, “Oh, did they do what I would’ve done, or did they follow suit with what I said?”
So, I really do think that that’s a big part of it. There’s part of that that’s normal. There’s a part of that that’s not normal and not helpful, and part of it is I think if you’re going to use an emergency clinic, which we all do and we all should, then you have to one, assume good intent, as you said earlier, which is, I’m not there. I don’t know what the pet owner said to them. I do not know what state the pet owner was in. I don’t know what the pet looked like when they walked in the door. I can look at where they are now and I can hear the story, but that may not have been what that vet was looking at at that moment.
And so, I always try to give grace and say, “I wasn’t there, I didn’t see it,” and I’ve seen cases change. I’ve seen them where I’ll see them in the morning and I’ll say, “Hey, if this doesn’t get better, come back, or blah, blah, blah,” and they’ll come back at the end of the day and I’ll be like, “Oh my god, this is three hours’ difference or this is four hours’ difference?” Things can look radically different.
And so, there’s that part of giving grace, but I do think a lot of us, and I’ll tell you this is a general part of our profession, are perfectionists, and it needs to be done just right, and it needs to be done the way that we would do it, and I think that that is a constant struggle, I’m sure for emergency vets. Like I said, it’s not a position I’ve held, but I know that there are perfectionists who get cases back and say, “Well, this is not how I would’ve done it, this is wrong.” And I think really, part of being happy as a veterinarian, is it sucks that being a perfectionist is what helps you ace vet school, and gets you into vet school, and gets you through vet school, and then as soon as you’re out, it’s a burden, it’s a crutch, it’s a pain, because being a perfectionist limits your abilities to delegate.
I think it makes it hard to leverage your technicians, as much as you can leverage them, and it makes it hard to work with emergencies and support services, and to refer, and things like that. And people say, “But if you’re a perfectionist, that means you’re doing it right,” and then it’s like, well, at some point, when you’re dealing with large numbers of cases, perfect is the enemy of done, and I would say if you’re overwhelmed and you need to get the work done, and you’re trying to help as many patients as you can help, having such high demands that no one else is deemed worthy to help you, that is career limiting, and it is going to be a long-term harm to your mental health.

Dr. Tannetje Crocker:
Definitely, and I work a lot with new grad veterinarians, we have a training program that’s really intentional in our ER, and so, that is one of the main things that I have to teach them is number one, why is the pet there? What is the owner’s concern, and let’s actually focus on that, right? Yes, this is a 15 year old pet that probably has multiple disease processes going on, but why are they there? Let’s figure out how we can help that problem in this moment. And then number two, you’re not always going to know. So, you’re not going to know maybe why that dog vomited. It would be great to do full workups on every single pet, but that’s just not the reality of people’s finances sometimes, or your time constraints and what you have going on.
So, you have to make your best guesses sometimes, and you have to be comfortable with that, and knowing that if it’s not better, it’ll get rechecked, but I see that, and I don’t know if you’ve seen that with the younger generation, where they really want to know, they have to have an answer, they want to want to fix it right away, and that ability and that maturity kind of as you get in your career and sit back and say, “This is not actively dying. I think it’s going to be stable for a little bit. Let me try A, B, and C. If that doesn’t work, then they can reassess and recheck with their vet, and move on to plan D,” is perfectly acceptable.

Dr. Andy Roark:
Guys, I just want to jump in here real quick with one quick announcement. If you’re a practice owner, the Uncharted Practice Owner Summit is coming. It is me and my friend, Stephanie Goss, the practice management guru. We are going to be leading that, heading that up. It is in person in Greenville, South Carolina. If you are a owner and you’re like, “Man, I want to go to a thing that’s only practice owners and work with other practice owners,” head over to unchartedvet.com, and check out what we’re doing. Guys, that’s it from me. Let’s get back into the episode.
There’s two pieces to this, right? and I think you put your finger on it it. First of all, let me just call out the fact that you and I are 100% having a deep conversation about spectrum of care, which is what is the gold standard, and then-

Dr. Tannetje Crocker:
Very true.

Dr. Andy Roark:
… what is a perfectly acceptable lower standard that works for this client in this moment, with the resources that we have? I think that I like that terminology, I think that that’s really important. But yeah, I think a lot of people have said, “Only the best care, only the best care,” and I’d say, “Look buddy, when we’re 30% shorthanded and we’ve got more work than we can do, we’re going to provide a standard of care up to what our practice standard of care is.” We need to decide what is our standard of care here, and we can provide up to that. But beyond that, at some point you have to say, “This is what we’re going to do today, and then we’re kick the can down the road.”
I think about it sometimes. I went to a chiropractor one time a long time ago, and I said it was a chiropractor, it was a physical therapist. I went to a physical therapist years ago and they said, “What’s wrong?” And I said, “I have plantar fasciitis that’s flared up in my foot. Also, I hurt my shoulder yesterday,” and she looked at me and she said, “Which one do you want to work on today?” And I thought that was fascinating, because in vet medicine, we would’ve been like, “We better get going fast, because now we’ve got 100% more things to do.” And it’s just a simple thing of “Which one are we doing today?” I go, Wow, that’s some boundary setting, and it’s smart, because we’re going to actually make some progress on one of the things.And so, I don’t think that we do that very well. I also completely agree with the education of veterinarians, is we’re taught gold standard of care, and we’re taught by specialists and we come out, and then there’s this idea of we have to get it right, we have to practice the top standard, and we have to get a diagnosis today, and I really do think two things that we don’t learn in vet medicine and we don’t learn in vet school are how to break apart problems and triage, and handle the first thing, and then work on the recheck, and then work on the recheck. And again, to give grace to the vet schools, they’re working with specialists, and they are teaching people the highest standard of care, and if you did that, then rotations would be really frustrating, because you would come in for two weeks and you would see someone’s third visit-

Dr. Tannetje Crocker:
[inaudible 00:26:52].

Dr. Andy Roark:
… and that’s all that you would see. It’s not how you want to learn, but I do think that that is a part of it, and then the other part, I would say that is a real struggle in vet school, is how to leverage the staff, because they train you to be the doctor and to know all the things, and I think it’s a real challenge to say, “You are the doctor and you know all the things, and here’s how you delegate those things away to other people, and here’s how you take help,” and I think that those are things that right now, we don’t have a good training system for those things.

Dr. Tannetje Crocker:
I’d agree, and earlier when you said everyone’s looking for veterinarians, honestly, give me two, three good vet techs, and I can get a heck of a lot done. I would always love another veterinarian, but I will tell you that the team that I work with in the veterinary ER, those technicians, they do it all, and they’re incredible, and they help me so much every day, and I would love other vets, I enjoy working with other vets, but man, give me more of them, 100%.

Dr. Andy Roark:
Oh yeah, absolutely. No, I am right there with you. I’ve got this idea, I’ve been thinking a lot about capacity in vet medicine, and so, we’ve got all these cases coming in, and most of us are shorthanded, and I hear a lot of people who just say, “I don’t know how to get this done. I don’t know how to hand these things off. I don’t know how to turn people away.”
We just finished up our GSD conference for Uncharted, which is How to Get Stuff Done When You’re Shorthanded, and it was really, really great, and the big spoiler alert, one of the big takeaways really is you have to work on your business as well as in your business, meaning you have to step back and make systems, and figure things out. At some point, you can’t just flail around working hard, you have to stop and get organized, and communicate with your people and say, “Well, what are you going to do, and how do we work together so that the sum of our labor is greater than just us individually flailing and working as hard as we can?”
And one of the big questions was, “How do I make time for that when I’m so busy?” And so, the idea that I’ve had recently, I’ve been kicking this around, and it’s still sort of fetal idea, but I think one of the ways to really look at this stuff well is to strip the emotion out of it. And so, imagine that veterinarians are widget makers, right? They’re widget makers, and a veterinarian and a widget maker can make say, 700 widgets in a day, right? That’s what they can make. If you live in a community and they need a thousand widgets a day, and you can make 700 widgets a day, what are your options? What are you going to do? And I think that that’s an interesting thing to think about, and unfortunately, what a lot of people say is, “I will sacrifice my body, mind, and soul, and the people around me to bend reality, and burn up our machines and our systems, and make a thousand widgets. We will do it by strength of will.”
And I go, “Oh really? What will you do the next day?” And they’re like, “I’ll do it again, and I’ll do it the day after that,” and I’m like, “Oh, that seems like a bad long term strategy,” and it is. But you think about what actually would work, you’d say, “Okay, honestly, increasing capacity, getting technicians in there to help you make widgets, to delegate”. If you can’t get another widget maker, which is a veterinarian, get more people to help you make the widgets that you can delegate to, and try to increase your efficiency.
Another part is to say, “The community’s going to have to wait for their widgets, because we can only make 700 a day, which means they’re going to have to figure it out or they’re going to have to get their widgets somewhere else,” and vets go, “Oh my God, somewhere else?” And I’m like, “Look, man, this is hard choices. They need a thousand widgets. You can make 700. Do you want to have angry people yelling at you because they didn’t get their widgets, or do you want them to go somewhere else and get them?” And my advice is to have them go somewhere else, because you’re selling every widget you can make. You’re not hurting for customers.
And I understand that people don’t like this analogy probably in a lot of ways, because it does strip out all the emotion. You’re like, “They’re really adorable widgets, and people really care about these widgets,” and I go,” That doesn’t change the widget math,” right? Honestly, the fact that these widgets are family members, that does not change the math. You can make 700, they need a thousand. We’re going to have to figure this out, and that’s probably going to mean that they’re going to have to go somewhere else, or they’re going to have to come back down the road, or we’re going to have to figure out who needs widgets the most, and the rest of the people are going to have to wait. But I don’t think that we want to make those calls, and that’s why I think this is a useful analogy, because I think a lot of us, all we can see are the pets and we’re like, “There’s no alternative but to just get the work done,” and I go, “That math doesn’t work.”

Dr. Tannetje Crocker:
It doesn’t, and eventually, you burn out, and then nobody gets widgets, right?

Dr. Andy Roark:
Right, yeah.

Dr. Tannetje Crocker:
And that is a huge issue we’re noticing. That’s ultimately your other option, and that’s not one that any of us want to do.

Dr. Andy Roark:
I’m really big on virtual care right now. I mean, there are a number of companies that help with virtual work. There’s virtual CSR companies, there’s GuardianVets, and Chronos, and some companies like that, that their whole job is, “Hey, we’ll take over your phones at the end of the night,” or “We’ll help provide virtual people for the front desk,” and I’m like, man, I think that stuff is so valuable, and I’m sure there’s a lot of people who like to do the virtual work, and boy, we’ve got needs for it. But what you and I are talking about as far as setting expectations with the pet owners, doing tele-triage when we say, “Is this an emergency, or can this wait until tomorrow morning?” I think that that stuff is really, really valuable.
When you were saying, “Hey, I felt like we got sort of dumped on and this person said, ‘Well, I don’t want to deal with it on Saturday, and so, I’m just going to send them straight to the emergency clinic,'” I love the idea of having a service that takes your phone calls, who can do triage, and the truth is, I would rather see that patient myself, than have them go to the emergency clinic. I would like to be the one to talk to them. I don’t want them to go wait for eight hours on a Saturday. I don’t want them to pay emergency bills, which are totally justified, but I would rather save them that money and that time, and for me to be the one to work with them, we just need to figure out a triage system. And I say they turfed them, I think I’m assuming bad intent when I use that language, and I don’t mean it that way, but you get the point. I don’t know. What are your thoughts on virtual workers in vet medicine?

Dr. Tannetje Crocker:
I think that it serves a couple needs. I think one, it definitely helps with the triage, and the overflow, and overcapacity issue that we have. There’s no doubt. When I have a sick child, I call my pediatrician, the nurse calls me back, we go over the symptoms, and they tell me it can wait, or to go to the ER. It’s a very similar model that we deal with consistently, and I think one that is very fair in human medicine. The other component of it though, is it opens up another whole range of positions and jobs, and even increasing the financial means of support team members. And so, a lot of these companies that provide those services are using technicians or people that are from veterinary medicine that want to work from home, or want to continue to make money in this space, or can do that along with the job that they already have.
And so, by opening up more positions in our profession that help pet owners and also help the hospitals, I think that’s a win-win, and it’s frustrating to me, because I think ultimately, the issue is trust, right? That a lot of the general practices want to see their own people, they want to help their own people. They don’t trust that things are going to be done their way, and that ultimately is hurting them in the long run. And pet owners, they do love their veterinarian, but in that moment, they don’t care. They don’t care who they talk to, they just want to talk to somebody, so that they can sleep. And I always say, “If you’re not going to be able to sleep, you come right in, but you also can watch for these things, and then you can see your vet in the morning,” and 90% of people say, “Okay, I’m going to watch for those things. Thank you so much. Thank you so much for just talking to me. I just needed to talk to somebody.” And so, that tells me that that model works, and I think it helps both sides.

Dr. Andy Roark:
Yeah. No, I do as well. It’s funny, I do think part of it is trust. I think another part of it is there’s a scarcity mentality that veterinarians have that has been bred in, which is this idea of like, “At some point, the pet owners are going to stop coming, and then I’m going to go out of business, and no one’s going to want me to help, and I’m going to get buried under my student loans, and I’m going to live in a cardboard box in the forest,” and that’s where this all goes. And that’s why I feel like they struggle so much to tell people “Just go to the emergency clinic,” or, and this is controversial, but it’s what I believe, tell them to go to another general practice, and people go, “That’s heresy. That’s the sacred cow, Andy. You are slaughtering the sacred cow.”
It’s like, look, man, if you’re slammed from dust until dawn every day, who the heck do you think you’re competing with? If you can’t see them, tell them to go down the road. The kindest thing that you can do is direct them to a place where they can get care, and they’ll probably come back, or maybe they won’t. But trust me, you’re never going to go to a business because there’s not enough work to do. If you’re doing good quality medicine and you treat people well, and you earn their trust and you’re a good steward of their trust, you, my friend, will be as busy as you want to be for the rest of your career. You will. There is no risk in sending people away.

Dr. Tannetje Crocker:
I agree. And as a pet owner, I would say that if I call and I’m worried, and you just say, “Well, we don’t have anything for you, and there’s just no options,” right? It’s a, “In two weeks, we can help you,” and there’s nothing, there’s no compassion, but if I say, “I am so, so sorry you’re dealing with this, and we would love to be able to fit you in, but we honestly can’t, but I know there’s other practices in the area that might have some availability. Why don’t you call A, B, and C? We’d be happy to send the records, so they know.” I’m going to come back to you, because you cared enough to give me another option and to listen to me, versus just drawing a hard line, or sending me to the ER, like you said, where it costs a lot more, if there’s another option during the day. So, I would come back to that practice personally, because they actually cared.

Dr. Andy Roark:
No, I completely agree. I think here’s the thing, right? They called you for help, and if you say, “We can’t get you in,” you’re not helping. If you say, “We can’t get you in, however, I do have some other practices that I can point you towards who may have availability, A, B, and C,” and you give some sort of endorsement and sort of say, “These are good practices and these are places to go,” then to me, you are checking that helping box.
The other thing is imagine it’s a restaurant. Imagine that there is a awesome restaurant and you want to go there, and you go there and they’re like, “We do not have any availability tonight, but there’s a couple other restaurants in the area that I would recommend.” I’m still going back to that restaurant. The fact that I can’t get in there tonight, makes me want to go there more, quite honestly, but I do appreciate getting pointed to some. I do appreciate getting pointed somewhere else.
But I think that’s just a shift in mentality, but you have to really buy into the widget idea, this idea that, “I have capacity, and if people are demanding widgets beyond the capacity that I can make, they’re just going to get mad and they’re going to get angry, and they’re going to stomp off somewhere else, and I can refer them somewhere else, and hopefully keep that goodwill.” But at some point, I really do feel like we’re holding on to the workload that we have, as it drags us like an anchor down to the bottom. So, that’s that.

Dr. Tannetje Crocker:
Yeah.

Dr. Andy Roark:
Well, Tannetje, thanks for talking through this with me. Any final thoughts, any words of wisdom, anything else you want to put forward as far as GPs, ERs, collaboration, working together?

Dr. Tannetje Crocker:
I would say that I’ve been on both sides of things. I’ve been a general practicing vet, I’m a ER veterinarian now, and I definitely think this profession as a whole, if we all work together, trust each other, and together set client expectations appropriately, while still showing people that we care about them and their pets, I think it’ll be better for all of us in the long run.

Dr. Andy Roark:
Yeah. No, I completely agree. I think right now as a profession, we’re all in this together. We need to be communicating with each other. We need to be passing the ball. We need to be assuming good intent. We need to think about how we can communicate with pet owners, and set realistic expectations. I do not think that the business model for us anymore can be put your head down, and work as hard as you can, and collapse into bed at night. That is not a sustainable business model. It does not work anymore. It needs to be, think about working on your businesses, it’s thinking about what your capacity is, how many widgets you can make comfortably and sustainably, and then making that many widgets, and then directing the overflow to the most productive place you can, and then also creating expectations with clients when they say, “All right, well, I’m not getting in for a wellness appointment for a couple weeks.”
That’s okay, man. Your dog’s not going to burst into flames because it didn’t get its leptospirosis booster right on the day that it was due. That’s it. We can also start to reach out with our reminders earlier, knowing it’s going to take people longer to get in and say, “Hey, go ahead, and it may take a little while to get in, so I’m going to put this on your radar.” All those things, those are the types of thoughts we should be having is, how do we pace ourselves for the marathon that we’re in, so that we don’t burn our people out, so we can keep going, so we can keep helping the people who need it the most.So anyway, that’s it. Awesome. Well, guys, thanks for tuning in, and everybody, have a wonderful rest of your week. Tannetje, thank you so much for being here. You can follow Dr. Tannetje Crocker on Instagram, and TikTok, and anywhere else I should mention?

Dr. Tannetje Crocker:
I’m on Facebook, kind of. You’re the king of Facebook.

Dr. Andy Roark:
Kind of. Yeah, no, I got the whole Facebook thing just staked down. It’s just-

Dr. Tannetje Crocker:
Yeah. Yeah. There’s no room for any of us.

Dr. Andy Roark:
… yeah, you have to come through my neighborhood. Nope, no room for anybody else there. All right, guys. Take it easy, everybody, and that’s what we got for you guys. I hope you enjoyed it. I hope you got something out of it. As always, if you did, you can leave me a nice review wherever you get your podcasts. If you’re watching this on YouTube, hit that Like and Subscribe button. Gang, take care of yourselves. Be well. Be kind to each other. See you next week. Bye.