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Medicine

Advice For and From the Next Generation of Vet Medicine

July 13, 2022 by Andy Roark DVM MS

Dr. Peter Weinstein and his daughter Brooke Weinstein, a current veterinary student at Oregon State’s College of Veterinary Medicine, join Dr. Andy Roark to talk about how veterinary medicine has changed over the last 20-30 years, and how it’s going to change in the future. Our guests talk about how the education of veterinarians today differs from the past, and what these changes will mean for how the profession evolves going forward.

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Cone Of Shame Veterinary Podcast · COS 148 Advice For From The Next Generation Of Vet Medicine

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ABOUT OUR GUESTS

Dr. Peter Weinstein attended Cornell Universityundergraduate and the University of Illinois to receive his DVM. After graduation, he worked as an associatefor three years before opening his practice.

As he was running his practice, he identified the need for increasedbusiness acumen to make his practice successful. Thus, while managing andpracticing full time, he attended University of Redlands to receive his MBA. As a result of the MBA, he was able to relocate, expand andsell his practice to a corporate consolidator.

Politically, he served as President of the SouthernCalifornia Veterinary Medical Association and the California Veterinary MedicalAssociation and President for VetPartners, the national consultantsassociation. He just completed three years as the Chair of the Veterinary EconomicStrategy Committee of the AVMA’s Veterinary Economics Division

In the veterinary industry, he acted as Medical Directoroverseeing the Claims Department for Veterinary Pet Insurance.

Dr. Weinstein has provided small business and corporateconsulting via his company, PAW Consulting

After 14 years, Dr. Weinstein retired from his role as theExecutive Director for the Southern California Veterinary Medical Associationto pursue other interests including teaching at Western University

He was the 2018 Speaker of the Year for the Western VeterinaryConference Practice Management Section. Andin 2021 for the VMX Practice Management section.

He co-authored with Michael E Gerber, “The EMyth Veterinarian-Why Most Veterinary Practices Don’t Work and What to Do About It”.

Dr. Weinstein has spoken and written extensively on practice management, team building, leadership, collegiality, marketing, and other topics focused on making the veterinary profession better for all those affiliated with it.

Dr Weinstein lives in Orange County, California with hiswife Sharon, two daughters (one a veterinary student at Oregon State), two dogs, and Bazinga, a Senegal parrot.

Brooke Weinstein is finishing her third year of veterinary school at Oregon State University Carlson College of Veterinary Medicine. During her time there, she has loved working with her community through free wellness clinics for the houseless community as well as conducting research on tick-borne diseases in the underserved community. Outside of school , Brooke spends time hiking, snowboarding, and exploring Oregon.


EPISODE TRANSCRIPT

Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. I got a fun episode today. I am interviewing Dr. Peter Weinstein and soon to be Dr. Brooke Weinstein. Peter is a Brooke’s father, and we are talking about generational differences in veterinary medicine, basically, where are we going? And how do we feel about the future? And should we be comfortable with our kids going to veterinary school and coming into this profession? Should we be more than comfortable? Peter and I, and Brooke, all talk about where education is today and where it’s going for veterinarians.

Andy Roark:
We talk about what the future of the profession looks like. There is really good conversation here about the future of recession. Are we looking right down the barrel of the next recession? What does that look like? What’s that going to do to the salaries that we’re seeing for veterinarians and for support staff? Is it going to change the way that we practice? Is it going to change pet owners’ ability to pay for our services? And how do we adapt to that? How do we keep that medicine accessible? Wide ranging conversation topics, really fun episode. Guys, I hope you’ll enjoy it. I’m going to stop here and say, thank you. Thank you. Thank you so much. This episode is ad free. Thanks to the support of my friends at CareCredit. Guys, 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.

Andy Roark:
Welcome to the podcast, Dr. Peter Weinstein, and soon to be Dr. Brooke Weinstein. How are you guys doing?

Peter Weinstein:
Great, Andy. Good to see you. Oh, Dr. Roark.

Andy Roark:
You call me Andy, please. Yeah, let’s do first names. Let’s all do first names, so Peter and Brooke and Andy. That’s what we’ll go with this time. Brooke, how are you doing?

Brooke Weinstein:
I’m good. Having some break from midterm, so thanks for inviting me on your podcast.

Andy Roark:
My pleasure. Thanks for making time. Guys, I want to have you guys on the podcast and talk a little bit about generational differences in vet medicine. Honestly, I’m thinking a lot about the future of vet medicine and what it looks like as it’s changing, because we’re going to a rapid period of change. Then also I’m kind of looking at the future of vet medicine and I have a daughter, she’s 14 and she has decided that she wants to be a veterinarian. I’m going to be honest and say, I have some mixed emotions about that. I want to talk with you guys a little bit about sort of your experiences and perspectives on what the future kind of looks like and sort of your experience as Brooke has gone through her training and just generally overall your perspective on life in the profession and that sort of evolution as well. Is that Okay?

Peter Weinstein:
Absolutely.

Andy Roark:
Awesome. Well, cool. Let’s go ahead and start. Let’s do some quick bios. Peter, I’ve known you for a long, long time. You have been a mentor of mine since I blew my own mind this morning. I woke up this morning for whatever reason and I’ll be honest. I had school dreams last night and I wondered, do you guys have? I’m sure Brooke does. The exams coming, and I forgot I had a class. I, a 100%, had those dreams last night and I had exams coming up and I woke up and thought, oh my God, I’m not in school anymore. Then I thought I graduated in 2008 and then I did some math and I’m like, that’s 14 years ago, which blows my own mind. It’s been a minute since I was in school. Peter Weinstein, do you ever have dreams of exams or classes that you forgot?

Peter Weinstein:
No. It’s funny when you had school dreams, all I could remember was the dream of showing up to school naked when you were a kid and having to go. You never had that dream?

Andy Roark:
Oh, no, I did. Yeah, I totally did. Yeah, I still have those dreams. That’s funny. Brooke, do you wake up having panic dreams about your exams?

Brooke Weinstein:
Not often, if I do, it’s like, I completely did not make it to the test and everything from my car ride, from leaving home to class, everything went wrong and I just didn’t make it.

Andy Roark:
Oh yeah, you guys are much more balanced than me. All right. Back on topic. Peter, I’ve known you since vet school. You’ve been a mentor mine for a long, long time. You gave me some of the first advice that I ever got on being a presenter and speaker. I said to you, “Hey, how do you get to do more presenting and speaking?” You said, “You need to write more.” I still remember you telling me that, and we were on a bus at the AVMA convention. I was like, “Huh, that sounds like good advice.” It’s advice that I still remember you giving to me today and it turned out to be pretty good. It’s worked out pretty well for me, so thank you for that. You are also the author of the E-Myth Veterinarian. You have been the president of the Southern California Veterinary Medical Association. I’m just going off the top of my head right now. I don’t have anything written down. What else? You are the owner of PAW Consulting. What else am I missing or forgetting in your bio?

Peter Weinstein:
Andy, I have known you since you were Brooke’s age, when you were president of the VBMA at University of Florida. That’s when we first connected, and so this is almost like déjà vu.

Andy Roark:
Yeah.

Peter Weinstein:
Now, I mean, for the past, I just got done teaching my first year of the business and finance class at Western University so I’m giving back to the students by teaching at the vet school here in Los Angeles. I’ve done a whole bunch of different things within the profession, but now as I head into the twilight years, it’s really more focused on education and growing the profession and really disrupting it and creating a better future for Brooke and others, because I feel like I have an investment that will be maturing in about a year and a month. I’m hoping to get a very good return on my investment, but it’s not just Brooke, it’s 4,000 other veterinary students that are graduating this year, next year and all the years down the road.

Andy Roark:
Oh yeah, no. Yeah. Well, I know the students appreciate you being involved, and like I said, you’ve been a mentor for me. It’s funny before we even started recording, I was talking to you about my business and things that I’m doing and being like, “Hey, Peter, how do you look at this? Because you wrote that you met veterinarian, and you always have excellent insight to give. Brooke, you are in your third year at Oregon State, is that correct?

Brooke Weinstein:
Yeah, I have about a month left of my third year.

Andy Roark:
Oh yeah. And so, have you started clinical rotations yet?

Brooke Weinstein:
No, I get to start June 11th, I think.

Andy Roark:
All right, so coming up very, very… When people hear this, then you’ll be in your rotations.

Brooke Weinstein:
It should.

Andy Roark:
All right. Exactly. It’s been a long time coming. All right. Brooke, when did you decide that you wanted to go to vet school? Did you know from a really young age, or is it something you came to later sort of in your education?

Brooke Weinstein:
I’ve been asked this question a lot and I really can’t pinpoint anything. I feel like it was junior or senior year of high school when I kind of had to start thinking about college and I think it was just something I knew about. And so, my dad kind of shoved me into a hospital, obviously not his because he didn’t have one. It was like, well, if you can survive surgery and you’re still standing, then maybe it’ll work. And so then yeah, I survived that and I was like, might as well see if I like this and kind of applied to colleges with veterinary school in mind and I stuck with it, so yeah.

Andy Roark:
Peter, were you excited about that from the beginning when your daughter was going into college and starting to talk about pre-vet? What was your emotional experience at that time?

Peter Weinstein:
Woo.

Andy Roark:
All right. You were fired up?

Peter Weinstein:
I was fired up. I really was because I had sold my practice when Brooke was three or four or five or something like that. And so, she really wasn’t raised in a stainless steel cage, like most veterinarians babies are. And so, when Brooke was showed interest in becoming a veterinarian and I think some of it was nature, some of it was nurture and she would go to the zoo with my wife and help out at the zoo as well. I think she had some different exposures that maybe pushed her to that level. But when Brooke said she wanted to become a veterinarian, all I said is, Brooke, I’ll do whatever you want to do to help, but I’m not going to… I don’t feel that I formally pushed her one way or the other except open doors and give her opportunities.

Andy Roark:
Yeah. I think that there’s a difference in saying I’ll be supportive versus, hey, I’m sort of driving the bus. Brooke, did you feel pressured to go towards vet medicine because your dad was so involved in it?

Brooke Weinstein:
No, I don’t think he made a single decision for me, besides me just asking him where do I go? Then he was like, here’s this clinic, go there.

Andy Roark:
Oh, that’s fine.

Brooke Weinstein:
Yeah, no, vet school wise, he was like, wherever you get in.

Andy Roark:
Right. Peter, did you ever rethink that emotional response? Was there ever a time when you have thought in the last eight years when you have thought, maybe this isn’t the best place for my child to go?

Peter Weinstein:
Absolutely not.

Andy Roark:
No? Yours a hardcore no.

Peter Weinstein:
No, I was very much supportive. If I’m going to have the roles that I’ve had in the profession, as an advocate, as an educator, even as a disruptor, then it would be wrong for me to have any second guessings from that standpoint. I really have to feel that being an advocate for the profession as I am, that being an advocate for what my daughter wants is the right thing as well.

Andy Roark:
That’s interesting. I don’t know if I am sold on that. Here’s why, so you and I both love that medicine and we worked hard on it. There’s definitely things about that medicine that I look at and I go, I don’t know about this, or where does that go? And so, it’s funny that you say no, as an advocate, I’m sort of all in. I go as an advocate, I still have questions and things. Again, like I said, I’m honestly wrestling with these things, looking at my own kids, for example, the change in practice ownership in our profession, and we’ve got corporation and things like that. Where I came from is a little bit different in that, I thought that I was going to be a physician for most of my life.

Andy Roark:
Because my dad was a small town surgeon, and that’s kind of where I wanted to go. I had the experience, I got to be about my junior year in college and my dad, I was talking to him and I was getting ready to take the MCAT. And he said to me, he was like, “Son, I’m not sure I would do this if I were starting over now.” This is about human medicine. Man, I was kind of thunderstruck by that. And so, I ended up not going to med school and I have never regretted not going to medical school like that, but it was still that jarring thing at the time.

Andy Roark:
And so, I’ve had that experience of having this idea of something that I thought was great and then had it sort of rocked and then going, wow, well, this has fundamentally changed. And so, I kind of went through that. I look at that medicine and I’m still very positive and optimistic, but it has radically changed in the last 10 years and I see it continuing to change and so, I don’t know. When we look at things, when we gaze into our crystal ball and think about what the life of a veterinarian is going to look like in 20 years, do you think that looks significantly different from what it looks like now?

Peter Weinstein:
I probably would throw that on Brooke.

Andy Roark:
Yeah.

Peter Weinstein:
Where does she see her job and her future? I mean, she knows that I’m a workaholic, but I think it’d be interesting to see what Brooke thinks about her future and the future of the profession.

Brooke Weinstein:
I do think it will be different. I guess as a third year, going into fourth year, people are starting to think, or a lot of my classmates are starting to think about, where are they going to work? Are they going to go corporate? Are they going to go private? How many practices they’re looking at that they think are private, but are actually corporate? I think the increasing amount of corporate practices is going to just change the profession and how veterinarians or what your job as a veterinarian’s going to be, because people will have the opportunities to work three or four day weeks instead of the five day weeks for 12 hours a day. I think the work life balance will get better. I also see the push towards like referring in specialty practices over just the GPs doing everything, kind of how human medicine is a little bit, I guess. I think that’s going to continue to go that way is what it looks like, at least from where I am.

Andy Roark:
Yeah. Are you considering specialization doing a residency, things like that, or are you still interested in being a GP given that you perceive a shift in that direction?

Brooke Weinstein:
At this point, I don’t want to do more school.

Andy Roark:
Yeah, I get that.

Brooke Weinstein:
But yeah, I’m also at the point where I have no idea what I want to do right now.

Andy Roark:
Gotcha. Understand. Okay. Talking about this, so you sort of mentioned work life balance as something that you see coming in the future in vet medicine, and I do agree. I think that’s been a huge move from where we have been in the past and a big cultural shift. Brooke, when you start to look at the priorities that you have as a third year vet student, and then also the priorities that your classmates have, rank out for me, what do you think people care the most about?

Andy Roark:
I think a lot of people say, what do young doctors want? Or what do people coming out of that school want in their career? Or what are they looking for in a practice? I know with a very competitive hiring environment, a lot of people kind of want to know that. You mentioned the hours and work life balance off the top. What do you think are the main drivers for you and your classmates, as you start to think about where you’re going to go next and what jobs you would take?

Brooke Weinstein:
Well, I think after vet school, lot of my classmates just want some time to breathe. I feel like I’ve heard a lot of people looking for a four day work week, the longer hours, but less days of working. Honestly, I feel like at least with the people that I talk to the most, we haven’t talked about what we want from our jobs. I think we’re just kind of so excited to start fourth year that haven’t even thought about after that.

Andy Roark:
Oh, really? That was sort of a question I was kind of leading up to, do you feel, because I’ve sort of heard rumors that vet students seem to be making employment decisions earlier and earlier in their school time than they did in the past. That’s always just kind of been a rumor and I’ve never really been able to pin that down. Is that your impression that you think that people are making decisions about where they’re going to go? Are they taking jobs in their second year and in their third year, that then the way that I hear or is that fairly uncommon?

Brooke Weinstein:
I’ve heard the rumors. I know very few people who have, I wouldn’t say the majority or even half the class is like that. I think I only specifically know one person who has considered or has interviewed for a job in her third year. Maybe it’s different at other schools or maybe that’s just not this, I just don’t know who they are.

Andy Roark:
Interesting. Oh no, when I talk to vet students, I kind of get a similar answer of. I haven’t met a lot of vet students who actually are seeing that trend, but I do hear a lot of excited whispers. Peter, you’re teaching at Western, I mean, do you have a similar perspective? Do you think the timing of people taking jobs is changing?

Peter Weinstein:
We actually talked about this yesterday, it was the final class of the year, and I just had what I call AMA, Ask Me Anything. We talked about, I suggested that they’re a year from graduating and that they should be looking now. I would suggest there’s probably five to eight people in the class of 105 that have probably got hard job offers already, contracts. We started her talking about the economy as well because there’s this threat of a recession in the next 12 months and what impact that might have on the business of veterinary medicine and some of these highly inflated salaries, maybe I shouldn’t say highly inflated salaries, some of the growth in salaries over the past two years and what impact the recession may have.

Peter Weinstein:
I don’t think it’s too early now to be looking for a position a year from now. Especially if we look at Economics 101 that says supply and demand. Right now, there’s a huge demand and a small supply. If you can find someplace that you want to work in a location that you want to work, that gives you a life balance and mentoring and all of those other keywords, take it now, get the contract, get it signed, sealed and delivered, get a signing bonus or whatever you can from that standpoint and spend the entire of your senior year learning and not worrying.

Andy Roark:
Yeah. Where are you when you look into your crystal ball on the finances in the next 12 to 16 months? And what I mean when I say that is, we’re seeing rising, staff salaries, we’re seeing rising, doctor salaries, we’re seeing, quote unquote signing bonuses, which are actually retention bonuses for the most part to encourage people to stay on for multiple years. If there is a recession, right, we’re seeing we’re seeing rising inflation is the number one things that people are upset about. We’re hearing the fed talk about the economy running hot and taking active steps to clamp that back down.

Andy Roark:
If we move in a recessionary direction, are you of the mindset that medicine is a recession resistant industry and demand for doctors is so high because supply is so low that veterinarians will be fairly insulated from that? Or do you think that there’s a recession coming and we have a lot of exposure because of the private equity and the high multiples that people are paying and the upward trend in salaries where we’re going to see a significant pullback in the money being spent in medicine? Where are you in that? In between those two kind of think of it as a spectrum.

Peter Weinstein:
Dr. Roark, Andy, when you were a baby doctor between 2008 and 2012, we had the great recession.

Andy Roark:
Yeah.

Peter Weinstein:
Now, depending upon where you were in the country, there was a shortage of jobs, an overabundance of relief doctors, and some tremendous anxiety on the case of general practitioners in their ability to pay their bills, pay their staff. We had doctors getting laid off, et cetera. I don’t think we’re going to get to that point in the current situation. I think a lot of the escalation of salaries has been a response to the inability to find doctors for positions, especially at the corporate level, because they have an investment in a business that without doctors, no business.

Andy Roark:
Right.

Peter Weinstein:
And so, they’ve used money as a retention as opposed to culture. And so, I think what we’re going to start to see, and if you look at the trends economically in the profession right now, transactions are down. I mean, same period last year, we’re not seeing nearly as many people. Revenue is up about 4%, which is essentially fee increases. We’re busy because of our inefficiencies as a profession, but we’re not busy because people are… We’re not busy because we have a shortage of doctors, we’re busy because of the inefficient business model, the failure to leverage our staff, the failure to pay and keep our staff and a high turnover. There’s so many variables from that standpoint that we don’t have time to get into today. But what I do anticipate is we’re going to start to see a flattening out.

Peter Weinstein:
I think we had a perfect storm economically during the first two years of the pandemic where people had money, they weren’t going anywhere, they weren’t spending money on travel and then big screen TVs, they were sitting next to their pet and the pet had a hiccup and they thought it had brain cancer. And so, they would bring it in and have it seen and they would spend money because they actually had liquid income. But I think as we see this great retirement or whatever it’s being called, resignation, and we see less money being pumped into the people by the government, I think that spending is going to slow down.

Peter Weinstein:
I think [inaudible 00:22:01]. I think travel has increased in everything else, especially if you’ve been on an airplane, as I know you have. I think what we’re going to start to see is a normalization getting back to where we were to a degree in 2019, 2020, but then it’s going to be, how do we deliver veterinary medicine at that point in time? What’s it going to look like in terms of increasing our efficiency levels? Bottom line is I think we’re going to see a normalization and I think we’re going to see a flattening out, but I think we’re not going to see salaries drop. I just think we’re going to see a slow down in the growth of those salaries from that standpoint.

Andy Roark:
Yeah. That makes sense. Let’s talk about the impact of recessionary forces on pet owners and on spending because I think that you point that out rather astutely, are we going to see pet owners pulling back in their spending on pets? And if so, are we set up to deal with more cash strapped clients than we have been in the past? What does that look like?

Peter Weinstein:
It’s a great question because I think what we’re starting to see is almost a haves and have not economy.

Andy Roark:
Yeah. I hate it, but I think you’re right.

Peter Weinstein:
I asked it a couple of the meetings where I was speaking at, in the last 12 months, how many of you used fee increases as a barrier to access to care, to slow down the funnel of people coming in? 30 to 35% of the room said, “Yeah, we raised our fees with the hope that it would slow down people coming in.” The next question is, well, what did it? The answer was no.

Andy Roark:
Right.

Peter Weinstein:
Now, we have these fees that are up there, but we have people who don’t have the cash flow to make it happen. I think what we’re going to start to see is as happened in 2008 to 2012 delays of people coming in, so now, they come in a more critical stage. Pets ending up in the shelters because people couldn’t afford what they invested in and I think we’re going to have to look at some sort of normalization of fee schedules because we have really started to create a rift between what people can afford and what we’re charging.

Peter Weinstein:
Some of the communities that we do some work within LA, where people can’t afford veterinary care, it’s going to become even harder for them to be able to access veterinary care. And so, we’ve got to start to look at some of these spectrums of care and all sorts of different things that we’ve talked about to make veterinary services accessible, because I don’t think we’re underpaid and I don’t think we’re undercharging. I think we just haven’t created that whole value proposition for the client experience that people put a value in what we do yet.

Andy Roark:
Brooke, do you feel like vet students are getting some, or at least in your experience at Oregon State, do you feel like there’s part of the curriculum that’s focusing on talking to clients about money or accessibility to care? Is that something that’s kind of front and center in training today? Or is it something that’s kind of put off until after we get the medicine learned?

Brooke Weinstein:
Yeah. Well, we have one business course. I think maybe only my dad or maybe a few speakers did talk about finances and people’s ability to pay, but otherwise, no, it’s mostly just the medicine.

Andy Roark:
Yeah. I get that. You should always learn how to do the medicine first. It’s just one of those things where I guess, and this is the passion point of mine as well is, how do we communicate with pet owners and just sort of meet them where they are. I feel like there’s sort of growing interest and emphasis there, but it’s still, there’s so much to fit into a curriculum, but I still, I don’t know, I’d personally like to see more education in those type of hard conversations, just because I think that they’re coming.

Peter Weinstein:
Well, I think, Brooke worked with me in LA at some of the clinics and has been running clinics for underserved communities in Oregon. I think when you start to do that, you see how important pets are in people’s lives and how eager they are to take care of them, but they also have to feed their kids and put shoes on themselves.

Andy Roark:
Sure.

Peter Weinstein:
I think part of the curriculum really does need to be enhanced understanding of the entire population. They don’t need to take a course in economics. They need to take a course in understanding people and pets and communication and the human animal bond. I think that’s why Brooke has been involved with the Shelter Medicine Club, and I don’t mean to put words in Brooke’s mouth, but I’m happy for her.

Brooke Weinstein:
I mean, I could continue this if you want.

Andy Roark:
[Inaudible 00:26:38].

Brooke Weinstein:
Yeah, I kind of have a little bit different experience than probably a lot of people in my class. Also, last term, I worked at a wellness clinic that only gave vaccines, dewormers, preventatives, and stuff. A lot of people were coming in either because they couldn’t get an appointment at their primary veterinarian or just like the prices keep going up, and they’re like, I can’t afford that. Also, I guess going back to like where’s vet med going to be in 10 years? These pop-ups of wellness clinics, I think are also going to change why people go to general practitioners?

Brooke Weinstein:
Because I see a lot of people going to wellness clinics for their vaccines and preventatives to get them at lower costs. But then, the wellness clinics can’t provide any more care than that. Then they’ll start going to their GPs for when they actually have the ear problems and the eye problems and the skin problems. That’s also been really interesting for me to see because I’ve never actually seen a wellness clinic before, besides the ones that we do for the communities that are for free for the low income population, which I’ve also been a part of. It’s been really interesting seeing all of that from like kind of different levels of income.

Andy Roark:
Yeah. That totally makes sense. I’m fond of the saying right now the future is fragmentation. Meaning I think our profession is really going to split apart and you’re going to see how practice is doing a lot of different things, filling a lot of different niches. I don’t think that there’s going to be a uniform model at practice.

Peter Weinstein:
I know you were talking before that you couldn’t be an advocate. I think you have to be more of an advocate now. Andy, we have a broken profession, education model, association model, business model. Well, we, as doctors want to fix broken things. I think our role, yours and mine, is to identify where things are broken and come up with new solutions, different solutions, unique solutions, reconfigured solutions to help fix these things for the future. That’s why I’m an advocate because it forces me to think differently about how we can create this wellness clinic concept, the CVS clinic concept that the urgent care concept and all of these different things that retool this profession going forward because we ain’t going to get where we want to go by doing what we’ve done in the past.

Andy Roark:
Yeah, I agree with that. I think it’s funny for me, the fact that my daughter seems to be serious about vet school. I feel pressure to fix problems that I didn’t necessarily feel that much pressure to fix in the past. Like, oh, this isn’t going to affect me. I’m going to go on. And now, I’m like, oh crap, there comes [inaudible 00:29:29], we got to work on this. There’s a lot of that in my mind.

Peter Weinstein:
Yeah, welcome to my world.

Andy Roark:
Yeah. Oh totally. Brooke, let me ask you this. Is there advice that you got from your dad, the veterinary business consultant, business teacher, before you went into vet school that you have found to be very useful that other people would wish that they had gotten?

Brooke Weinstein:
Let me see if I can remember this.

Andy Roark:
I was just curious if there was anything that stuck out in your mind of like, “Yeah, my dad sort of told me this or he helped me understand this and it served me well?”

Brooke Weinstein:
I don’t know. I don’t think I can remember any exact words, but I feel like there were concepts in the words that he was telling me, kind of just like watch out for yourself because all you’re going to know is school. The amount of times, he was like, whatever happened in the news between the years that he was in vet school, he didn’t get.

Andy Roark:
Yeah. Yeah.

Brooke Weinstein:
I was like, okay, well, I will be prepared to live in a bubble for four years, but also cognizant of the fact that I need to look after myself when I can remember.

Andy Roark:
Yeah. Well, it’s funny you say that. When Peter was talking about the recession from 2008, 2012, I’m like I missed that. I was head down in my first job, I just learned in medicine and putting one foot in front of the other, but it’s funny. Yeah, I think that there’s a lot of truth to the idea of just putting our heads down and getting done what we needed to get done. I’m thinking a lot about these days about what do I have control over and what do I not have control over? I feel like if we look at modern media, we are bombarded all day every day with terrible things and injustices and hardships. I think that there’s a balance of not blowing those things off.

Andy Roark:
I’m not trying to ignore the problems in our society or not help other people. At the same time, I also don’t think that we can live all day every day, just immersed in challenges and hardships that we really don’t have any control over. You just take, for example, some sort of problems in our government. I know they’re hard to find, but I’m sure that they were there, problems in our government. I get one vote and I can be educated about who I vote for. Beyond that, there’s not a whole lot that I can do and I sort of have to figure out how invested this do I want to be, what is a healthy level of investment versus just me being upset all the time about things that I can’t control?

Andy Roark:
And so, I think about that a lot with vet medicine too, and go, what is in my power and what is not? It’s interesting. I always sort of put this forward to a lot of vets and other practices. I think it’s important to be able to step back and look at the profession as a whole, but I think it’s a lot more useful and probably mentally healthy to be able to dial in and look at where you are and what you need to do and look at your practice and what your practice can do and what is available, in that specific context, because those are the things that you can control. But anyway, I’ve just been thinking a lot about dialing in and dialing out and so when we have these sort conversations about where is the profession going and what can we do for it, I always sort of try to file that away in the back of my mind.

Peter Weinstein:
Well, I think what I’ve been most proud of in watching Brooke through the first three years is her finding time for herself, whether it’s snowboarding, whether it is working the clinics and doing the research, but trying to have a balance in what she does. I think that’s something I neglected to do, I neglected to do after I was in practice. I don’t remember any music from the ’80s and early ’90s. Also, not getting sucked into a lot of the news, not getting inundated with what’s going on in the world because the little world is the veterinary school world right now, but you have to get out of that bubble as well. I think if you spend too much time surrounding yourself with your classmates, some of those naysayers, those negative people have an impact on you as well. I think finding that balance and understanding herself and her needs and watching that is very rewarding as a father.

Andy Roark:
Brooke, what is the thing that you’re most looking forward to in veterinary medicine? As you move towards graduation, what are you most looking forward to?

Brooke Weinstein:
Doing what I went to school for, just very basic. Yeah, I’ve been telling people this because we’ve had junior clinics. We’re basically shadowing fourth years during this term. We’ve gone from three years of sitting for 12 hours a day to going into standing for 12 hours a day. Our bodies are kind of hurting just from the four hours of shadowing. But yeah, I’m just excited to just do what I went to school for.

Andy Roark:
Yeah. That’s awesome. Peter, as the parent of a veterinary student, and then also as a lecture and teacher at a veterinary school, what is your number one piece of advice for people who are entering the profession? What is the thing that you think will serve them well going forward?

Peter Weinstein:
I think we need to bring fun back into veterinary medicine.

Andy Roark:
Amen.

Peter Weinstein:
I think that we take ourselves too seriously at times, and it makes it very stressful work environment. I think we create a lot of our own mental health issues and there are external variables as well, but I really do think that hospital owners need to shut down and take people to the movies or bowling or the improv, or just hear Andy Roark, whatever. But I do think we need to take back control of ourselves and I think we need to have some fun and we need to make sure that fun is one of our core values.

Peter Weinstein:
I think we’re so focused on other things that we lose track the fact that we are people too. That if we are not healthy, we can’t take care of our clients and our patients. And so, if I was going to give a message to my colleagues, and if I’m going to give a message to the next generation is, “Yeah, take your job serious, but take life and have some fun with it as well, and make sure you go out and engage in the world and be a contributor in the world, but have fun doing so.”

Andy Roark:
Well, I think I’m going to take what Peter said and then what Brooke said and kind of put it together, I think in my mind, because I think you guys are both right on. I completely agree with putting fun back in what we do. I think that we should, we need to find the fun in just being in practice. I think that’s important for our long term happiness and to Brooke’s point about just being excited about doing the job, I think that we get sucked up into this big picture of what we’re supposed to be and this great meaning and purpose and the truth is we should remember to be happy just seeing appointments. We should be happy just to do vaccines and get to meet a family that’s excited about their new kitten.

Andy Roark:
Just to find enjoyment and fixing a urinary tract infection or lancing abscess, like that stuff is amazing. We get to do that for our job. I think that we have a bad habit, at least I do, is you forget that it’s awesome and we stop looking at it as awesome. We focus on the sort of existential headaches and hardships that we really don’t have any control over. And so, anyway, I just wanted to put those things together. I think that’s my big takeaway from our discussion here is, remember to have fun. And the other thing is, remember that what we do is awesome and people are excited, they would love to do what we do, and they think what we do is fascinating.

Andy Roark:
We should remember to enjoy doing it. When I say we enjoy doing it, I mean, enjoy doing the small things, enjoy seeing the appointments, doing the easy stuff, fixing the coughing dog. Like we should be proud of that and we should enjoy the process of doing it. Guys, thank you both so much for being here. I really, really appreciate your time.

Peter Weinstein:
Andy, thanks for the invitation. It’s not often that Brooke and I are actually together for 30 to 45 minutes and have a chance to talk. Thank you for bringing the family together. It was a nice thing.

Brooke Weinstein:
Yeah, thanks for having me on too.

Andy Roark:
Thanks guys. Thanks everybody. Take care of yourself. And that’s our episode. Guys, I hope you enjoyed it. I hope you got something out of it. Thanks again to CareCredit for making this podcast possible ad free. Gang, take care of yourselves. Be well. I’ll talk to you soon. Bye-bye.

Filed Under: Podcast Tagged With: Medicine, Perspective

The Shy Sulcata (HDYTT)

June 29, 2022 by Andy Roark DVM MS

Dr. Doug Mader joins the podcast to discuss treatment of a wounded tortoise that won’t come out of his shell. This 10 year-old Sulcata was attacked by a dog and needs care, but has pulled back tightly into his shell making treatment difficult.

In this episode, we discuss tortoise sedation and analgesia, antibiotic therapy and feeding tube placement.

Cone Of Shame Veterinary Podcast · COS – 146 – The Shy Sulcatta (HDYTT)

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


LINKS

Dr. Mader’s New Book: https://www.amazon.com/Vet-Noahs-Ark-Survival-Inner-City/dp/1954641044

Dr. Mader’s Website: https://www.dougmader.com/

Dr. Mader’s Facebook page: https://www.facebook.com/douglas.mader.9

NEW Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/store/

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

Douglas R. Mader, MS, DVM, Diplomate ABVP (Canine/Feline), Diplomate, ABVP (Reptile/Amphibian), Diplomate, ECZM (Herpetology), Fellow, Royal Society of Medicine

Dr. Mader received his DVM from the University of California, Davis in 1986. In addition, he completed a Residency in Primate and Zoo animal medicine. He is the consulting veterinarian for the Monroe County Sheriff’s Zoo, the Key West Aquarium, Dynasty Marine, the Sea Turtle Hospital, the Everglades Alligator Farm and the Theater of the Sea. Previously Dr. Mader owned the Marathon Veterinary Hospital, a double AAHA accredited 24 hr emergency/referral hospital. Dr. Mader is an internationally acclaimed lecturer and is on the review boards of several scientific journals. He has published numerous articles in scientific and veterinary journals, national magazines, and, is the author/editor and co-editor of three textbooks on Reptile Medicine and Surgery.­­ Dr. Mader’s latest project is his new book “The Vet at Noah’s Ark – Stories of Survival from an Inner-city Animal Hospital.”


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 back today with the man, the myth, the legend, Dr. Doug Mader, exotic veterinarian and writer extraordinaire. Dr. Mader has a brand new book out it’s called The Vet at Noah’s Arc: Stories of Survival From an Inner-City Animal Hospital. We’re not talking about that today, but I am going to get him back on the podcast very soon, and we’re going to talk about his book.

Dr. Andy Roark:
Today, he’s helping me out with a medical case. We are talking about an African spurred tortoise that has trauma. It’s been slashed up a bit, and it’s doing that thing that tortoise do where it has pulled its legs into its shell as tightly as it possibly can, and I can’t do anything with it. Guys, if you see tortoises, if you see turtles, this is a great episode for just a refreshing on how to work with them.

Dr. Andy Roark:
Guys, I got to tell you, this is what has me stumped. I go, I can’t do anything with this patient. Doug made it to the rescue. Guys, this is a fantastic set of little pearls to have in your pearl box, I guess. Not to a box of if it’s pearls, unless you want to put pearls in your toolbox. You can do that. I have a pearl box for medical pearls and Doug Mader is filling it up. And that’s what we’re doing today. Guys, that’s that’s enough of that 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. Doug Mader. Thanks for being here. Dr.

Doug Mader:
Dr. Roark, Andy, thank you so much for your invitation. I really appreciate. It’s quite an honor.

Dr. Andy Roark:
I love having you here. I’m not going to lie, whenever I have guests on the podcast, I take notes. I make this podcast because I want to be a better doctor and I want to learn. Buddy, I don’t know that I’ve ever taken as many notes as I did last time you were on the podcast. I filled up. I’m trying to make it quietly as I turn pages to get more of your pearls of wisdom. Thank you for being here. I have a case, and I’d be honest, I’m a bit flummoxed, and I need your help.

Doug Mader:
All right.

Dr. Andy Roark:
All right. Again, I’m embarrassed to ask this, but it’s true. I have a 15 kilogram, so 30… Yeah, 22 pound tortoise, I have one of the sulcata tortoises, the African spurs.

Dr. Andy Roark:
This is a 10 year old tortoise. The owners have this beast and let it run around their backyard. Unfortunately, not funnily, it was attacked by a dog. And so this tortoise has been injured. The owners say that the injury is significant. I believe that’s true.

Dr. Andy Roark:
Doug. I can’t see this. It has pulled back into its shell and I can’t really work with it. I don’t know how to examine this patient, much less, how to sort of treat these wounds. And so, let me just reach out with that big, broad opening and say, how do you treat this? How do right by this patient?

Doug Mader:
Yeah. You know what, Andy? Sadly, that’s a fairly common scenario, and don’t be at all embarrassed about asking that kind of question because-

Dr. Andy Roark:
It’s super embarrassing. I don’t know how to do this.

Doug Mader:
[inaudible 00:03:39] I mean, a dog or a cat comes in and you put your hands on him and do an exam and look at the paw, look in the ear, open the mouth. How do you that to an animal that’s a black box, when in like this? And you have to remember that, for these tortoises, they can’t fight back. Their response to fear, to pain, to anything, is to suck into their shell, right?

Dr. Andy Roark:
Yeah.

Doug Mader:
The dog attacks it and treats it like a big moving raw hide and chew it to pieces. And then they bring it to you, and now you want to handle it and carefully, with loving hands, protect it and take care of it. It doesn’t know any better. All it knows is that it hurts and it’s scared and it’s had a bad time, so it’s going to suck in even tighter.

Doug Mader:
Of course, if you try and grab it, a foot or a head or a tail, what’s it going to do? It’s going to fight you and pull back even more. So, don’t be embarrassed-

Dr. Andy Roark:
[inaudible 00:04:27].

Doug Mader:
That’s a good question. That’s a challenge. It really is.

Dr. Andy Roark:
And I’m pulling on these legs that I know are injured. You know? I know that this is where this thing got bitten and I’m like, “I don’t want to pull this guy’s leg out.” I mean [inaudible 00:04:39]-

Doug Mader:
Your point is great. If you fall off your skateboard or your bike or whatever, and you break your arm, do you want that doctor grabbing your arm? No, you don’t. Okay. Analgesia number one, okay?

Dr. Andy Roark:
Okay.

Doug Mader:
Don’t be afraid to sedate this animal. Now, here’s your biggest challenge that you’re going to have, is to convince the client that it’s okay to sedate an injured animal. Because so often times, they’re like, “Oh, I read on the internet that if you sedate a reptile, they don’t breathe and they die.” That’s not true. So, you’re fighting Dr. Google.

Dr. Andy Roark:
Right.

Doug Mader:
You need to be able to wordsmith it. I know your clients adore you and you have their trust, but maybe this client’s a new client, has never met you before. You’ve got to be able to convince them that, “You need to trust me and respect that I’ve done this before. Your pet tortoise, A, is in a lot of pain and, B, is afraid and, C, I need to be able to get to him and help him. I’m going to have to give him something for pain so that he’s not hurting, and something that sedate him so I can do a proper exam. And that allows me to make him feel better, and I know that’s what we both want.”

Dr. Andy Roark:
Yep.

Doug Mader:
So, what do we use? Okay. I’ve been doing this now for almost 40 years and my go-to drug, hands down, across the board for reptiles, Steelers.

Dr. Andy Roark:
Okay.

Doug Mader:
A combination Theledomine and Zelezopan. Theledomine is a dissociative like ketamine. Zelezopan is a benzodiazepine, like Midazolam or Valium. It’s a great combination drug. Why do I like it? A, because it’s a cocktail. B, because the Theledomine does offer some analgesia. C, it works quickly. So, you get this 10 kilogram tortoise, and sulcatas, I start with 10 mgs per kg, IM in the front leg, but I’ve gone up as highest 30, because sulcatas, I have found of all the species, all the different tortoise species, sulcatas tend to be one of the most difficult to sedate.

Doug Mader:
I start with 10 mgs per kg, give it a half an hour, and if there’s no relaxation, give it another 10 mgs per kg. Most of the time, it takes about 15 minutes, if the patient is warm. Now, it’s South Carolina and the animal’s out playing in the snow, which it shouldn’t have been, and it comes in hypothermic, 100 mgs per kg is not going to work. The animal has to be warmed. If you warm them up to their preferred temperature zone, which for a sulcata is about 90 degrees…

Dr. Andy Roark:
Okay.

Doug Mader:
… they’re going to respond like a mammal. Okay?

Dr. Andy Roark:
Hey everybody. I just want to jump in real quick with a couple of updates. Gang, before I do, though, I got to get a shout out. I got to get some love to Banfield Pet Hospital. Guys, they have stepped up and supported us in getting transcripts for both this podcast and the Cone of Shame Veterinary Podcast, which is the other podcast that I host. They do it to increase accessibility and inclusion in our profession. That is a big point for them right now, is something that they are doing for our whole profession and industry. And they stepped up and put their money where their mouth was and said, “How can we help you?” And I said, “Hey, this is a thing that people have asked for, and it’s a big lift for us.” And Banfield said, “We got you, buddy.”

Dr. Andy Roark:
They have made this happen, so if you want transcripts for our podcast, we got them. Head over to unchartedvet.com. You can see all of our podcasts and you can see transcripts for those. Feel free to share them and help us get the word out. But I just got to give some love to Bandfield, because they didn’t have to do that, but they did, and it is awesome. So, thanks to them.

Dr. Andy Roark:
Over at Uncharted online on June 29th at 8:30 PM, Eastern time, 5:30 Pacific, that is PM, not AM. Not doing 5:30 AM Pacific thing. Guys, over at Uncharted online, so you can join from anywhere, my friend, the one and only practice management goddess, Stephanie Goss, is doing her teamwork mind meld, setting expectations for team communication. Guys, do your teams struggle from a lack of accountability? You’re like, people don’t do what they say they’re going to do, and people don’t follow up the way that they should, and people don’t communicate in a way that stuff actually gets done. And they are making assumptions about what is going to happen that are not realistic, and it is continuing to cause problems between the team and management,

Dr. Andy Roark:
Guys, I see this all the time. Stephanie Goss’ workshop is all about setting expectations for how the team is going to communicate. Just think about how much you need that. Gang, this is a two hour actual workshop. Come with your camera. Come ready to talk about your practice. So, this is going to be stuff that you can take home and plug right into what you are doing and actually make a difference in the way your practice functions and to take this back and engage it with your team in a way that’s going to make a difference.

Dr. Andy Roark:
Guys, I hope you’ll check it out. Stephanie Goss is amazing. Uncharted Workshops are, they’re uniformly pretty freaking and fantastic. I do love them. I’ll put a link to that down in the show notes. Guys, as you might have heard, my brand new exam room communication training course, it launched on June the 7th. It is my 17 tips, tools, tricks, and hacks to make you and or your team more effective in the exam room.

Dr. Andy Roark:
Guys, this is the stuff that I lecture on all over the world, is my absolute best material. I wanted to make it available to everybody. I have people who always come up to me after my talks and say, “That was great. How do I teach my staff to do that?” And I got you now, buddy. I’ve got you covered because you can take this to your team. It is a hundred percent module.

Dr. Andy Roark:
It is broken up into five-minute modules that you can drop into your staff meetings, tag it onto the end of a team training meeting. You can do it in the morning huddle. You can go through and everything stands alone, so you can pick the things that you like, skip the ones that you don’t. You can look and say, “We need this the most in our practice. Let’s do this.”

Dr. Andy Roark:
Guys, the course pays for itself. If there’s one thing that you take and you give to your team and they go, “Oh, light bulb moment,” the fact that it’s made to go back to your team and be interactive, which means everything comes with discussion questions. So, you can say to your team, “How do we do this? What does this look like in our practice? How could we do this better? What opportunities do we have for improvement here?”

Dr. Andy Roark:
I give you those suggested wordings and questions to ask so that you can get your team to engage. Guys, I’m super proud of this. I’m super happy. For the first 30 days, so until July the 8th, it’s $100 off. Is a launch special. I don’t want this to slip past you. If you’re like, “I want to try that out,” grab it now. Grab it while it’s got $100 off. I’ll put a link in this show notes, but guys, I hope you love it, and you enjoy it. If you haven’t checked out my Charming the Angry Client course, it’s built in a similar model. It’s been very, very popular. People who have had it can tell you about what it’s like. You feel free to ask, because it has gotten very good reviews, and a lot of people have gotten a lot of mileage out of this.

Dr. Andy Roark:
But guys, I want you to be able to train your team, specifically your team, not some generic team. I want you to train your team in a way that’s going to work in your practice. And this is why I made this tool, so it can get taken and used as you want to use it. So, it supports your culture and your practice and the way that you guys work.

Dr. Andy Roark:
Anyway, I hope you’ll check it out. Like I said, I’m over the moon that has launched, and boy, it’s been a lot of work for me and my team, but I think it’s going to be totally worth it for those of you who check it out. All right. Let’s get into this episode.

Dr. Andy Roark:
Yeah. How long does it take to warm a… I think I misspoke at the beginning. We’re talking about 15 kilograms, so 33 pounds. If this tourist is cool, how long are we talking about to warm it up to a temperature that I’m going to be able to work with it well?

Doug Mader:
Excellent question. That brings up two real, very important side points. Number one, I’ve heard people say gradually warm them, and that’s baloney. If it’s an emergency, warm them up. If you have an incubator, I’d set that incubator at 95 degrees Fahrenheit and take that tortoise and put him in there.

Doug Mader:
How long does it take? To answer question number two, about 24 hours.

Dr. Andy Roark:
Okay.

Doug Mader:
Point number three. It is the rare reptile that can’t wait 24 hours to be properly warmed up and hydrated. If it is not warm, all the medications you give are not going to work. They’re not predictable. Okay. Let’s just jump ahead and assume that the animal was brought to you this morning. You were in surgery. Your awesome technician put it in the incubator. You went ahead and you took a spot temperature with it, with a gun, or maybe you’re lucky enough to get a cloaca and get a cloacal temperature, and it’s 88 degrees.

Doug Mader:
Okay. Telazol. I like it. I’d start with 10 mgs per kg, IM in the tricep. They have a hepatic portal system. So, if you give it in the back legs, first pass effect, it goes through hepatic conjugation, and it has been well documented that it minimizes the effect of the Telazol. You give it in the front legs. Boom. They go down like that. 15 minutes, 30 minutes maximum, totally relaxed.

Doug Mader:
You can extend the limbs, do your exams, get your radiographs, extend the head, access either jugular vein, get a blood test. Telazol, 10 mgs per kg. What else can you use? I’ve heard people say they don’t like Telazol because you have to reconstitute it, and if you don’t use it within 14 days, it goes bad. If you’re like me, I go through a bottle a day just about, it seems like. But you can put it in a freezer, too. It’ll last.

Doug Mader:
If you don’t want to use Telazol, you can use dexmedetomidine.

Dr. Andy Roark:
Okay.

Doug Mader:
50, 5-0, micrograms per kilogram, IM in the front leg again. There’s a first pass effect with a hepatic portal system. You can reverse the dexmedetomidine, but remember, dexmedetomidine is a really good analgesic.

Dr. Andy Roark:
Yeah.

Doug Mader:
And that is not an anesthetic dose. That’s a sedative dose. That’s enough to open their mouth and intubate them if you wanted to induce them with ISO. But oftentimes, I don’t reverse it. The reason I don’t is because it’s such a great analgesic. Takes about the same amount of time. I do know some people, throw in a little bit of ketamine with it, but a few studies that have been done have shown really that ketamine doesn’t make a lot of difference. So, I just go straight 50 micrograms per kilogram of the dexmedetomidine.

Doug Mader:
You can use midazolam. I like it because it can be IM. I usually use about 0.2 to 0.5. On a sulcata, I’d probably use 0.5 mgs per kg, IM, and that takes a little longer to work, about an hour. And then you can reverse it with [inaudible 00:15:07] if you need to. That’s not an analgesic. That is just a sedative. But again, my go to drug of choice, hands down is Telazol, and I’m going to circle back to that. And one of the reasons I really like it is the dose is really small.

Doug Mader:
If you get yourself a big sulcata that weighs a hundred kilograms, which is not unrealistic, okay?

Dr. Andy Roark:
Wow.

Doug Mader:
And you’re only giving 2 CCs. Whereas you might be giving 20 CCs of dexmedetomidine.

Dr. Andy Roark:
Right.

Doug Mader:
What’s easier to do?

Dr. Andy Roark:
Yeah, absolutely. Yeah.

Doug Mader:
[inaudible 00:15:37] is awesome stuff. Okay.

Dr. Andy Roark:
Gotcha.

Doug Mader:
Get that animal in. You warm it up. Even if you have to wait a little while, warm it up. If it’s got some obvious surface injuries to it, on a heating pad, start using warm water, flushing it, cleaning it, addressing the surface wounds. Once that patient’s, afterward it’s warmed up a bit, give it the sedative. Once it relaxes, then you can do your proper exam. Get your radiographs, get your blood work, address wounds.

Doug Mader:
Now, if you’re one of these animals that have severe, severe wounds, and some of these dog bites can be horrific. I mean, large pieces of flesh torn off, and you can’t really graft reptiles well. They don’t have a subcu layer. It’s hard to do sliding graphs and punch graphs. But the beauty of a reptile is that they have a tendency to granulate in, from the outside in. I’ve had animals come in with horrific, giant defects that with proper wet to dry, honey bandages, things like that, will heal in four to six months.

Doug Mader:
Now, if you have to change the bandage on this guy every day, okay. You give him the Citizol today. He wakes up, he’s doing better. The next day, you go out to change his manage and he’s doing this again. Okay, we need to sedate him again. Don’t fight him. Why do you want to grab that injured limb that we talked about and give him more pain? Just sedate him again. I think of one case that I have that was attacked by a pack of dogs, and it was literally sedated every day for four months. And we actually had to rotate between Telazol and dexmedetomidine and midazolam, because it kind of developed a resistance to the Telazol. We were giving it 40 mgs per kg, about three to four weeks into it, and it was still fighting the sedation. So, then we switched to dexmedetomidine.

Doug Mader:
Don’t be afraid to sedate it every day. I did my residency in primate medicine, and when we would get these primates that would get in these large monkey brawls, we would literally have to put them under every single day to change wounds.

Dr. Andy Roark:
Wow.

Doug Mader:
And it’s amazing how well they do. And it’s so much easier to sedate them, do the wound care and the vet care and then let them wake up, than it is to try and stress them and use [inaudible 00:17:39]. We don’t want to do that.

Dr. Andy Roark:
Yeah, definitely.

Doug Mader:
It comes in, you sedated, you do your wound care. Of course, utmost importance, address analgesia. If there’s wounds, it’s perfectly appropriate to use an antibiotic in these cases, and it’s going to be a gram positive in this situation, because it’s environmental. If it’s a dog bite, you worry about the anaerobes, so bacteroides, [inaudible 00:18:00] Peptostreptococcus. All the things found in dog mouths.

Doug Mader:
You might want to use something along the lines of subtazidine, because that gets your environmentals, and it’s about 80% effective against your anaerobes. I think that’s a good go for something like a dog bite. If you went with a fluoroquinolone, wouldn’t be my drug of choice. You would want to use something like a penicillin or maybe a metronidazole for the anaerobes, in a bite wound. But again, that wouldn’t be my first line of choice.

Doug Mader:
Analgesics, I like Ketofen, and it’s easy to give injectably. And then the other thing, too, is when this animal is out, when you have it under sedation, go ahead and put in a feeding tube. Now, because there’s that old adage, if the mouth works, use it. And I can’t stress out enough to veterinarians and the technicians and the pet owners. If the mouth works, use it.

Doug Mader:
Now you can give them oral fluids. You can give them oral antibiotics. You can give them oral analgesics, and you can give them calories. And the beauty is, they handle these feeding tubes so well, and then as the animal’s feeling better, you can pull the tube without sedation and the little fistula where the tube was, heels up like in a dog and a cat.

Dr. Andy Roark:
Yeah. Okay

Doug Mader:
Again, it’s a reptile. In this case, they may have gotten injured very quickly, but healing is going to take time. You got to give some of these wounds three, four, five months sometimes, depending on how bad it is, and they will heal.

Dr. Andy Roark:
So, setting expectations for the clients, because this makes perfect sense. And the feeding tube makes a ton of sense. For those tortoises that we think we may have to sedate, say, we’re doing bandage changes daily or every other day, and we’re expecting a couple of months to granulate in. In your experience, if I have a patient like this and I have to sedate them the first day and I have to sedate the second day, should I be going ahead and prepping the pet owner to say, “Hey, this is what’s it’s going to be for the long term”? Or do you have patients that get more on board?

Doug Mader:
You bring up really good point. I talk like everything is a perfect world, and we’d like it to be, but we know it isn’t. Many of these cases, they’re going to heal. They’re going to get better, you just have to be patient, but you need to prep the client that this animal may take six, four to six months of bandage changing. Intense initially, progressively getting less and less and less, but you’re looking at a lot of money. Make sure they understand that, because I mean, to sedate that animal with Telazol or dexmedetomidine every day, you’re looking at some bucks, plus the [inaudible 00:20:29] time, the bandage time, the doctor assessment time, the follow-up, blood work or cultures, or drugs.

Doug Mader:
So, “You know what? Your pet’s going to be okay, Mrs. Smith. But you should be aware, it’s not going to be better by Monday.” And frequently what I’ll do, is I have a lot of drama. I’ll walk over to the calendar in the room and I’ll flip forward two or three months. I say, “You know, it’s March right now. April, May, June. Probably June, July, right about here on the calendar. I think, that might be pretty close to where we’re getting the resolution.” When we see the pages flipped, they understand, we’re not talking about a week’s worth of drugs.

Dr. Andy Roark:
Yeah.

Doug Mader:
If they’re willing to buy that commitment, great. And you know what? I always believe that the patient comes first. It doesn’t hurt my feelings if they want to buy the meds online. I don’t care. I want that pet to get better. I’ll write the scripts for them. If they want to do the bandage changes at home. If they’re comfortable with that, I’m good with that.

Doug Mader:
I want that human-animal bond, we need to preserve that. And whatever we need to do to help them within their financial constraints, get to that end goal of a healthy pet, that’s what we got to do. So much of what we do is the art of medicine, the art of veterinary medicine, as opposed to just the drugs and everything else.

Dr. Andy Roark:
No, I agree. This is fantastic. This is super helpful. I feel like I’ve got some tools in the toolbox and I know the ways to use them. To get a good exam, to start to take care of this patient, to get us back on the road to healing. Are there any last pearls that you have that I should keep in mind as I approach a case like this? Are there any pitfalls that I should make sure that I avoid?

Doug Mader:
Yeah. You know what? I think we hit most of. There’s a couple things, and again, this could be a future podcast. We’re assuming that most of these wounds are soft tissue wounds, but we also know that big dogs, when they bite turtles, they can damage the shell. Cracks in the shell have to be approached like a fracture because the shell is living bone, so we treat it like we would treat any bone fracture.

Doug Mader:
Punctures in the shell we need to treat almost like they were punctures into the thorax. Reptiles don’t have a diaphragm. They don’t have a negative space, but if you puncture their shell and pathogens and bad stuff get inside, it can cause [inaudible 00:22:46]. So, you need to treat those as open wounds. It’s funny, because I probably haven’t used fiberglass on a turtle shell in 30 years.

Doug Mader:
Everything I do now is wet to dries or honey bandages. I love wet to dries. And these shell wounds, even big defects will regranulate and grow new bone from the inside out. It’s amazing how reptiles heal. I always joke and it’s really not a joke, because people think I’m smart. I’m not, I just picked an animal that’s very good at healing, and I tend to be their spokesman. Reptiles are pretty amazing animals, we just have to be patient

Dr. Andy Roark:
That’s amazing. Doug, thank you so much for being here. Where can people find you online?

Doug Mader:
Well, if you want to try and get a hold of me or find out more, I do have a website, it’s called dougmader.com. I also have a good Facebook page. My contact information is on the website. If you need some help, reach out. I’m good about answering email questions. My goal, Andy, is just like yours, and that is I wake up every morning and I want to do everything I can to support that human-pet bond. Any way that I can help you and your technicians, our colleagues and our clients, keep that bond growing and staying alive, I’ll do what I can. You know what? Thank you so much for the invitation and it means a lot. It really it’s quite an honor to be invited. Thank you.

Dr. Andy Roark:
Thank you, my friend. And that’s our episode. Guys, I hope you enjoyed it. I hope you got something out of it. Dr. Doug Mader is flipping amazing. Check out his book, The Vet at Noah’s Ark: Stories of Survival from an Inner-City Animal Hospital. He is a fantastic writer. He’s an amazing educator.

Dr. Andy Roark:
As I talked at the very beginning, he has such an impressive resume. He is someone that I look up to and, man, I aspire to be able to teach like he does in some capacity, on some topic, someday. I just, I appreciate Dr. Mader for being with us. Guys, take care of yourselves. Be well. I’ll talk to you soon.

Filed Under: Podcast Tagged With: Medicine, reptile, tortoise

How Burnt Hills Veterinary Hospital Started Home Delivery for Diets

June 27, 2022 by Andy Roark DVM MS

*** This episode is made possible ad-free by Purina ProPlan VetDirect***

Have you started home delivery of therapeutic diets yet? In this episode, Dr. Matt Duemler tells the story of how and why Burnt Hills Veterinary Hospital took up home delivery. He talks about how he discussed it with the staff to get them on-board, and what his experience has been like so far.

Cone Of Shame Veterinary Podcast · COS 145 How Burnt Hills Veterinary Hospital Started Home Delivery For Diets
Purina Pro Plan Veterinary Diets Logo

This episode is made possible ad-free by Purina ProPlan VetDirect.


LINKS

Purina ProPlan VetDirect: https://www.proplanvetdirect.com/

Purina Institute: https://www.purinainstitute.com/

Burnt Hills Veterinary Hospital: https://www.burnthillsvethosp.com/

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. Matt Duemler – Burnt Hills Veterinary Hospital, Burnt Hills, NY. There are very few people in this world I would change lives with! I have had many blessings in my life but finding a career that not only provides me the ability to support my family but also gives me a purpose each and every day has been one of the best. The old saying is “Find a job you enjoy and you will never work a day in your life”. This is so true!

Providing animal care has always been a part of my life, since growing up on my parent’s farm in Perth, NY. A graduate of Broadalbin-Perth, my college years were spent first at St. Lawrence University where I majored in Neuroscience and studied abroad in Denmark. I was then fortunate to be accepted to and attend veterinary school at the University of Tennessee. Throughout school, the complexities and capabilities of medicine left me in awe. I knew I wanted to spend my days helping people, and combined with my fondness for animals, veterinary medicine became a no brainer.

Every day is different, and I love it! I especially enjoy the days I spend in surgery putting Humpty Dumpty back together again. I have challenged myself to learn advanced techniques allowing me to treat a variety of issues. I have completed multiple advanced training courses and received a variety of professional certifications. This training allows me to evaluate a patient from start to finish.

I am able to perform the diagnostic test necessary such as diagnostic ultrasounds, repair multiple orthopedic issues including fractures, cruciate repairs and patella luxation, general surgical procedures such as removal of kidneys, spleens and gall bladders, as well as advanced certifications in regenerative medicine techniques such as Stem Cell and Platelet Rich Plasma therapies. There is no better moment than when a family is reunited for the first time after seeing a loved one battle through an illness. Our patients are resilient and very often inspiring.

When not “working” on animals, I spend my days with my beautiful wife and 2 amazing children. We have built our forever home here in Burnt Hills, the same town in which my mother-in-law grew up. My children will be able to learn in the same classrooms she did. Family and community have always been important to me. This is one of the main reasons my wife and I agreed to take over the leadership of the hospital. We are very proud to lead the community’s best veterinary hospital, while continuing its rich history of being a family run business. Unfortunately, in today’s veterinary community, being a family run business, centered on family values, is a rare commodity.


EPISODE TRANSCRIPT

Dr. Andy Roark:
This episode is made possible ad-free by Purina Pro Plan Veterinary Diets.

Dr. Andy Roark:
Welcome, everybody, to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Guys, I am here with a fantastic guest today. My buddy, Dr. Matt Duemler, he and his wife are co-owners of Burnt Hills Veterinary Hospital in Burnt Hills, New York. A quick aside, plug: Matt, like so many of us, is looking to hire associates and support staff so if you’re in the Burnt Hills, New York area and you’re like, “That guy sounds awesome.” Maybe give him a call. That’s it, Matt. That’s as much of a plug as I’m doing for you. I promised to help. That’s all I got.

Dr. Andy Roark:
Gang, I am talking with Matt today about home delivery. Listen, I am a huge fan of the idea of home delivery and subscription services in vet medicine. Guys, we need to make vet medicine and pet health convenient because convenience trumps all right now and it’s only getting more that way. And automatic payment, subscription payments, things that keep one-time, big-lump payments to a minimum, I think that stuff is financially critical for the health of our profession going forward and us being able to get care to pets and to pet owners.

Dr. Andy Roark:
So guys, that’s what we’re talking about today is how Burnt Hills Veterinary Hospital set up direct delivery in their hospital. I asked Matt the hard questions: how did you get your team on board? What did this look like? What were the headaches? What were the push backs? What did the clients say? What did they like? What did they not like? And we just run through it all. Guys, I hope this will be a super useful episode for you. I love to hear how real practices are doing real, interesting things. And I think that is what we’re doing here. Gang, without further ado, 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. Matt Duemler, how are you?

Dr. Matt Duemler:
Hi Andy, I’m doing well today. How are you?

Dr. Andy Roark:
I’m doing great. I appreciate you making time to be here. You have a fascinating story. You have something that I really geek out about. And so I feel like I’m going to kind of ambush you with my enthusiasm here and I’m sorry about that, but I’m just going to lay it out. So just for those who don’t know you, you are a co-practice owner with your wife, correct?

Dr. Matt Duemler:
Correct.

Dr. Andy Roark:
At Burnt Hills Veterinary Hospital in New York, it’s an 11-doctor practice. Just real quick, tell me about how you became the practice owner at Burnt Hills because it’s a head-slapping story that I think a lot of people will relate to.

Dr. Matt Duemler:
Yeah. So when I was in veterinary school, my grandmother came here for a pet and she raved of the doctors here. So I actually did my externship here as a student and fell in love with the place and came here right out of the veterinary school and had two great mentors who really advocated for us to learn procedures and do more and were not just, “Refer everything,” It was very hands-on, do as much as you can and I fell in love with it. 13 years later, they decided it was time for them to retire and the way the world was going, they did not want to sell to a corporation. They wanted to keep it family-owned. And so my wife and I decided that it would be a good opportunity for us to step up and continue the practice running the exact way that we had been practicing for years and wanted to keep it that way.

Dr. Andy Roark:
Yeah. So let me ask you this, were you the driver of this or was your wife? Who was the one who was like, “I want to do this.”

Dr. Matt Duemler:
I was the driver. Yeah. My wife loves the medicine but we do kind of divide it a little bit where I do more business stuff and she does more of the medical directing.

Dr. Andy Roark:
Yeah. Okay. I just always think that’s interesting, when you have a married couple go in and I always wonder how hard one spouse has to push the other. I remember one time my wife and I had just moved to South Carolina and we thought we had housing lined up and we did not. We got there and the apartment we were renting fell apart and so we were homeless in South Carolina and we had to find a place to live. We had two little kids at this time. I mean like, baby and four years old.

Dr. Andy Roark:
And so we were driving around and I found this house on Craigslist and a bunch of frat guys had lived in it and we got there and it was a dump. And the guy was like, “Hey, I haven’t had time to clean it up yet.” And I was just like, “We’ll take it.” And it was the one time in my life that I totally said, “We should do this,” when my wife was like, “No, I don’t know.” And I remember the stress that that caused me until it worked out to be OK. But yeah, I always think that “Hey, we should do this,” conversation is interesting.

Dr. Matt Duemler:
My boss and I had had a conversation for a few years like “When you retire, we’ll do this,” we worked through this for a few years, kind of planning and they kept saying, “No, not yet, not yet.” And I remember clear as day, I went, I said, “Hey, Dr. [inaudible 00:05:14], my wife is pregnant.” He’s like, “Oh great, congratulations,” blah, blah, blah. The next week he said, “Hey, we’re going to retire this day.” Awesome. So yeah, my son was born in September and we purchased the practice in January.

Dr. Andy Roark:
Oh, man. That’s amazing. That’s some stress.

Dr. Matt Duemler:
It was little stressful. Yeah.

Dr. Andy Roark:
A little stressful. All right. Well, let’s talk about what we’re here to talk about a little bit. So here’s where my head is at. I have this vision of the future in my crystal ball where vet medicine is really focused on convenience for pet owners, because I believe that convenience is king, even more so than price, for a lot of pet owners. I think people are busy. They want pet ownership to fit into their life. I don’t think people like making extra trips to the vet clinic. I just look at my own life and running kids around to extracurriculars and making extra trips for pet food or things like that. That stuff is just… It feels like more of a hurdle than it ever did before. And so I’m looking at how does that medicine integrate into this “convenience first” culture?

Dr. Andy Roark:
And I’m looking a lot at home delivery of medications and especially diets and therapeutic diets. And I think that setting up home delivery and things like that, I think that keeps the veterinarian and the veterinary practice very much central in the nutrition conversation, also just in the therapeutics conversation. And the other thing is, I feel like as a society, people are getting much more comfortable with home delivery. There’s an Amazon box coming to my house every other day, of just random things. Dish soap showed up today and that used to never be the case. You know? I remember being very skeptical of Amazon and buying anything online 20 years ago. And during the pandemic, my wife and I used home delivery of groceries for the first time. And again, I never would’ve had somebody bring groceries or just even think…And now we’ve done it. And we’re like, “Well, it’s a thing.” And I know a lot of people do that and use it.

Dr. Andy Roark:
And so I’m really looking at practices, especially established practices, who have leaned into home delivery and have gotten their team to buy into it and are actually making it work and you are doing that. You are doing that with the Vet Direct platform from Purina. And I would like to kind of start real high like that with you and sort of say, first of all, what’s your experience been? Tell the story of kind of what you’re doing and kind of what your general impression has been.

Dr. Matt Duemler:
So I think like everyone else, COVID changed how we did everything. And we initially were all having our diets here, tried to sell our diets from the hospital. And when a lot of shortages happened with the different diets, it was really difficult to make sure that our patients were getting the right diet in the right amount of time, they weren’t running out, those type of things. So we did reach out to Purina, we did partner with them and very happy that we did in that we found…

Dr. Matt Duemler:
The way that we do it here is we keep a small bag of all the diets that we want to sell. And so the first day, when we’re talking to the owners about it, we can send them home with it right then, they don’t have to go and wait for it. They don’t have to order it, it’s there, they can have it, their dog can try it, and then they can sign up to get it shipped directly to them after that.

Dr. Matt Duemler:
And that has really… Like you said, the convenience is great. We also found that the freshness is a lot better as well. And so we have a lot of clients who do buy stuff from some of the online retailers. And what we found is when they’re ordering from Purina directly versus online retailers, the expiration date is usually a few months fresher from Purina directly.

Dr. Matt Duemler:
And so that really was a added bonus we weren’t expecting. And I think that people are also very cost-conscious. And if you’re in the veterinary hospital, you have a lot of things that you want to… Medicine you want to practice, drugs you want to sell, what have you. And if you can say to them, say, “Hey, try this bag and then order it directly from Purina.” And they’re like, “Oh, they’ll ship it to me?” “Yep.” It’s not like you’re trying to upsell them on something else, it’s something they’re more willing to try if they feel like you’re trying to make it more convenient for them, which we definitely are.

Dr. Andy Roark:
Yeah. So a couple things there, I hadn’t really thought about. One, the freshness thing never occurred to me. Like I just… It totally makes sense, did not cross my mind. The other part is… And we see this a lot, and this is why I’m big on the subscription sort of model. We’ve seen this when you have pets that come in and they’re getting their heartworm prevention, they’re getting their flea and tick prevention and then you’re talking about some blood work and a therapeutic diet. It’s just not going to happen. And it’s just because of that one-time expense versus if they don’t get flea and tick and heartworm prevention right now, they’re much more open to doing that senior blood work. Really, it’s kind of this weird mentality.

Dr. Andy Roark:
It’s kind of the mentality a lot of people have been putting forward with wellness plans for a long time. They’re like, “Oh, people will do stuff. It’s just that what they’re writing the check for today seems to really matter to them.” And so by sort of offloading or spreading out those costs, they seem much more willing to sort of go along. And so that makes a ton of sense to me.

Dr. Andy Roark:
I want to get into what this really looks like in practice, but the first thing I always got to say is, I think the question I get most often is how did your team receive this idea? We’re talking about during the pandemic. You’re like, “Hey guys, we’re going to start having this conversation. We’re going to start setting this thing up.” What was the reaction of the team when you rolled out something else for them to do during a pandemic?

Dr. Matt Duemler:
So if I break it down, I’d say our veterinarians, our doctors were very accepting of it, because we were already using a lot of Purina diets, so doctors were on board right away. Our staff, we kind of slowly rolled it out. We made one person our Purina point person. And whenever a client had a question about how to set up their account or how to order it, she would walk them through that. And I would say that’s probably the only glitch we had is that your initial setup of Purina is a little bit more complicated than going to Chewy and just clicking the button. And so we did have some non-computer savvy clients that Chewy’s much easier, “I understand the benefits. I’m just going go to Chewy.”

Dr. Matt Duemler:
And so we had one kind of point person who would go through every day and check, make sure that the orders were approved when they were needed. And the doctor would just write the note of what diet they wanted and they could approve that. And then, I think that the next thing that we did was every time that we received a request for food, whether it was to buy it from us or to buy it from our online retailer, we sent the clients an email stating, “Hey, we recommend buying it through Vet Direct because it’s fresher, it’s guaranteed,” all the different things that we liked about it. And “If you’d still like to get it somewhere else, great, but we recommend this,” and I’d say probably 75% of our clients follow that email and will go to Vet Direct and order it from there.

Dr. Andy Roark:
Okay. That makes sense. What kind of training did you do? Talk to me about the workflow in your practice to have these conversations. Is this a technician conversation, is it a doctor conversation? Who’s having the conversation and where are they having it?

Dr. Matt Duemler:
Yeah. So I think that the initial conversation always comes from the doctor and which type of food they recommend and why they recommend it. And therefore, the really nice thing with both the Purina food we sell here and if they get it from Vet Direct, we can tell the client very clearly, “Hey, try this bag of food. If your dog won’t eat it just either donate it to a shelter or what have you, but we’ll give you a refund for it.” And Purina has been really, really great at working with our clients on that and helping. So that’s the one fear, it’s like you said, you have this big bill already, now you’re adding on a $50 bag of food, but will he eat it? Will they eat it? Will they not? And it gets kind of rid of that issue.

Dr. Matt Duemler:
And then the second training really goes through our front-end team when people are calling to request these refills or requesting food in general, to be able to just kind of direct them to the website and direct them on different ways to order. And we have three main points that we make to them, why we recommend to order it there. And so they’re all kind of training those points. And if there’s more conversation we had, our doctors can have that, but it’s typically handled with our front-end staff.

Dr. Andy Roark:
Yeah. That’s nice to move it out of the exam room. What are the main questions or what are the main pushback that you get from clients? How do they receive these recommendations? Are there sort of standard responses or obstacles that you get from them?

Dr. Matt Duemler:
You know, I think for our brand-new diets, our brand-new clients who are taking those, again, they’re very happy to have that small bag to try and then to have it shipped to them later. They think that’s great. The challenge does come with clients who have already ordered it from an online retailer. Like you said, with those subscriptions and the way that they’re set up, they’re perfect. They do it very seamlessly. They feel like they’ve already purchased it. They’ve committed to these people. And it’s that’s a little bit of a bigger challenge. And I think those are probably the two main things is letting them know that they’re getting it fresh, they’re getting the best price and that we can still get it from someplace other than online retailers.

Dr. Andy Roark:
Yeah. Is there anything that you wish you knew when you started that you know now?

Dr. Matt Duemler:
So I learned a lot more about online retailers than I wanted to know, to be honest. So I think the only thing that was really difficult with the rollout of the Vet Direct is truly the initial sign up on the website is a little bit more difficult than Chewy or PetMeds or any of the other ones. And so we weren’t quite ready to answer those questions, why is it harder? Because we hadn’t done it yet. Now, I think we’re pretty well-trained in being able to walk them through and help them set that up.

Dr. Andy Roark:
Gotcha. Okay.

Dr. Matt Duemler:
I think the other point of it is the fact that we can get paid and never actually touch the bag of food is amazing.

Dr. Andy Roark:
Yeah. I’m sure. Keeping the vet involved in that is fantastic. When they go and they register, they indicate who their vet is or how’s that communication done? How do you sort of stay in that loop, I guess?

Dr. Matt Duemler:
Sure. So there’s two different ways. If you go to Vet Direct, you can search for your veterinarian and our name pops up or every hospital has a code. And so we do hand them a flyer with our code on it that gives them all the directions of “Here, go online, go to this website, punch in this code, order it.” And then the only thing that we have to do after they do that is approve it for a year or six months or however long we want to approve it for. But that proceeded pretty seamless, it works well.

Dr. Andy Roark:
What is your impression of compliance with this compared to before you were having home delivery? Do you feel like it moves the needle as far as how much of a therapeutic diet pets are getting or how long they’re staying on it?

Dr. Matt Duemler:
So I don’t know that I have those numbers accurately. My impression would be that because of the convenience, people are using it more readily. And we do it more, besides the food, things like FortiFlora or the probiotics, I think where, before they’d be like, “Oh, I’m on a probiotic, let me just pick up a random probiotic at the drug store.” It’s easy for them to click on Vet Direct and have it shipped right to them again. And so I feel like a diet, there’s not really other alternatives and people have been pretty… They either are going to use it or they’re not, but when you have the [inaudible 00:17:37] and the FortiFloras and those type of things, and they will start to look for comparables out there if it’s not convenient for them.

Dr. Andy Roark:
Perfect. No, that totally makes… I hadn’t thought about adding in the probiotics, things like that. Awesome. Well, Matt, thanks a lot for walking me through it. Any final words of wisdom, pearls for vet clinics that are thinking about adding home delivery, any pitfalls that you want to point out and be like, “Watch out for this”?

Dr. Matt Duemler:
I think that when you hear a lot of people lecture about the business aspect of veterinary medicine, there definitely are lectures who just say, “Eh, let your pharmacy go. You can’t compete with online. You can’t compete with at these bigger box stores,” what have you. And I disagree with that wholeheartedly. We have acted very aggressively in matching prices and helping with convenience, with setting up places like Vet Direct. We made the philosophy of partnering with really good companies and saying, “We want to provide the best. How do we do this together?” And whether it’s rebates or discounts or what have you, I feel like we’ve really been able to continue to offer the best medicine and keep those business profits and those incentives in our hospital to help fuel other things that we need, whether it’s new equipment or more staff, or we’re always hiring up with a plug out there for you.

Dr. Andy Roark:
Burnt Hill Veterinary Hospital. That’s fantastic.

Dr. Matt Duemler:
So I think that’s what our philosophy has been. Practice good medicine, partner with really good companies, good people. And the business aspect works out itself.

Dr. Andy Roark:
Are you doing home delivery in other product areas like parasiticides, things like that as well? Talk to me a little bit about that.

Dr. Matt Duemler:
Yeah. So we’re doing a in-house. So we have, with a couple of those products, been able to match them. And we’ll tell clients, say, “If you want us to ship them to you, we’ll ship them.” And the companies that we partnered with have been paying those shipping costs for us. And we’ve been able to both help financially by selling more products, but also take away some of the stress on our staff of having to receive the request, to validate the request, send them back. And that was a huge headache that we’ve really reduced significantly by using things like Vet Direct and also setting up our own kind of shipping to home from our products. And we haven’t used any of the big suppliers for online pharmacies. At this point, we’ve kept what we could in-house.

Dr. Andy Roark:
Yeah. That totally makes sense. Thanks for being here. Thanks for sharing your experience and expertise. I really do appreciate it.

Dr. Matt Duemler:
Well, thank you. It was very nice meeting you and very nice being on your show.

Dr. Andy Roark:
And that is our episode. Guys, I hope you enjoyed it. I hope you got something out of it. Special mega thanks to Purina Pro Plan Veterinary Diets for making this podcast episode possible. Guys, until next week, please take care of yourselves, be well. And don’t forget to enjoy the little things you find along the way in practice. Guys, that medicine is still a wonderful, wonderful place. Don’t lose sight of that. Take care, everybody. See you later.

Filed Under: Podcast Tagged With: Life With Clients, Medicine

New Veterinary Business Models to Keep Pet Care Affordable

June 23, 2022 by Andy Roark DVM MS

Dr. Bob Lester believes owning pets shouldn’t be a luxury that few people can afford. The veterinary profession needs to think creatively about how to keep medicine accessible to pet owners across socioeconomic groups. In this episode, Dr. Lester joins Dr. Andy Roark to discuss his recent article which outlines 15 new business models our profession might approach to help pets get the care they need.

Cone Of Shame Veterinary Podcast · COS – 144 – New Veterinary Buisness Models To Keep Pet Casre Affordable

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


LINKS

Tear Down the Wall (Original Article):

Tear Down the Wall

Wellhaven Pet Health: https://wellhaven.com/

Uncharted Veterinary Podcast: https://unchartedvet.com/blog/

NEW Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/store/

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. Bob Lester remains as passionate about the veterinary profession as the day he entered veterinary school (sometime last century). He is a firm believer in the veterinary profession’s double bottom line proposition of doing well by doing good.

Dr. Lester is a graduate of Oregon State and Washington State University’s College of Veterinary Medicine and completed the American Association of Veterinary Medical Colleges Leadership Academy.

He spent his early career as a small-town mixed animal practice owner before joining the founding leadership team at Banfield Pet Hospitals. At Banfield, he held positions in medicine, operations, franchising, human resources, and professional relations. After a rewarding career at Banfield/Mars Inc., he left as Vice President of Professional Relations to help found the Lincoln Memorial University College of Veterinary Medicine where he served as Assistant Dean. Dr. Lester’s LMU-CVM team pioneered a novel community-based clinical education program and developed the professional skills curriculum including instruction in communication, leadership, teamwork, and practice management.

Bob is now a co-founder, Chief Medical Officer, and member of the Board of Directors for WellHaven Pet Health, a family of companion animal practices that believes in caring for the caregivers so that they can care for others. WellHaven Pet Hospitals are both new build full-service AAHA/Fear Free hospitals, acquired and joint venture affiliate practices.

Bob was a two-time gubernatorial appointee and Chair of the Oregon Veterinary Medical Examining Board. He was the state delegate to the American Association of Veterinary State Boards. He served as a site team member for the AVMA Council on Education, and on the Job Analysis Task Force for the International Council for Veterinary Assessment. Dr. Lester authors the column “Creative Disruption” for Today’s Veterinary Business.

In addition to his board position at WellHaven Pet Health, he serves as a board member and Treasurer of Pet Peace of Mind a non-profit which keeps hospice patients together with their pets through the end of life. He also serves as Vice President of the board of the North American Veterinary Community, and on the advisory boards of easyvetclinic, Pet Desk, AirVet, and the LMU College of Veterinary Medicine.

Dr. Lester’s interests include all things veterinary, writing, start-ups, speaking, business and leadership development, the human-animal bond, and giving back to the profession that has done so much for him and others.

His family includes his wife Crystal, two amazing daughters McKenzie and Paige, and two rescue Yorkie’s Jessie and Woody.


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 am here today with my friend, Dr. Bob Lester. We are talking about paradigm-shifting ways, business model-changing ways to keep pet care affordable for pet owners. And so, we start to just unpack some ideas. What could the future look like? What are some things that we might see going forward?

Dr. Andy Roark:
I know this will get some people fired up. We do talk about changing the way that we leverage nurses in our profession. We talk about employer subsidized care. We talk about government subsidized care. We talk about tax benefits for pet owners. It’s really all over the place, as far as, what are things that we could possibly unpack as a profession to make sure that pet care stays affordable for pet owners?

Dr. Andy Roark:
While we take care of ourselves, while we address the student debt issue for veterinarians, while we lift up our support staff and pay them a living wage. Guys, super thought-provoking episode. Dr. Lester is always awesome. 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 back to the podcast, Dr. Bob Lester. Thanks for being here.

Dr. Bob Lester:
Great to be here, Andy. Always fun to catch up with you.

Dr. Andy Roark:
Man, I was thinking earlier. I don’t think I’ve invited anybody on the podcast as often as I have invited you. You are one of my favorite thinkers. I read your stuff whenever it comes out in Today’s Veterinary Business. I like your perspective and I like to hear your thoughts on things. Thanks for making time for me.

Dr. Bob Lester:
I am honored. Likewise, I listen to you on my walk virtually every morning.

Dr. Andy Roark:
For those who don’t know, you are a co-founder, chief medical officer at WellHaven Pet Health.

Dr. Bob Lester:
Correct.

Dr. Andy Roark:
You are also, because you have so much free time, the president-elect of NAVC.

Dr. Bob Lester:
Yes, indeed.

Dr. Andy Roark:
And you are a regular columnist in Today’s Veterinary Business, so you stay busy.

Dr. Bob Lester:
As we all do in this profession.

Dr. Andy Roark:
I wanted to talk to you about … You wrote an article called Tear Down the Wall in February’s Today’s Veterinary Business magazine. The premise was, “More pets from lower-income households and their owners will reap the benefits, if we are imaginative about how we deliver veterinary care.” And so, I want to talk to you, because this is a big thing in my mind these days.

Dr. Andy Roark:
I am looking a lot at accessibility and affordability of vet care. I’m looking at the marketplace. I see salaries for veterinarians going up, which is good given student debt. I see salaries for support staff going up, which is way overdue and needs to happen. I see more and more specialists. I went to a CE event last night, which was great. It’s the third specialty clinic in our area, where we had one forever.

Dr. Andy Roark:
All of a sudden, we just bang, bang. We’ve got two more now. And I’m going, “Wow. Specialty care is coming up.” At some point, how does this not trickle down to the pet owners in a way that makes us inaccessible? You look at shortage of veterinarians. Classic supply and demand says, “Well, there’s not enough supply.” And so, the demand goes up and the prices go up, which is going to attract more people to vet medicine.

Dr. Andy Roark:
But we’ve got this ethical ceiling that most of us see. Where you go, “I don’t want prices to go up to make what we do inaccessible to a lot of people.” And so, that’s where my head has been these days. I’m really thinking a lot about, how do we do this? How do we keep our profession financially viable, and meet the needs of our people, and not burn them out as they’re overworked and overstressed? And at the same time, keep our services available where people can have pets? Because I don’t think any of us want pets to be a luxury item.

Dr. Bob Lester:
I think you’ve summed up the issue well. As further backdrop, I think we have to acknowledge that the profession is in a time of abundance. So much is going on. Pet numbers are up. Pet spending is up. Pet lifespans are up. Euthanasia is down. America’s love affair with the pet has never been stronger.

Dr. Andy Roark:
Yep.

Dr. Bob Lester:
However, against a backdrop of a workforce shortage. The supply and demand mismatch, as you pointed out. What are we going to do? Our teams deserve more money. They deserve flexible schedules. They deserve better benefits. To meet that, recognizing that we’ve never had more pricing power with the increase in demand, fees go up and up and up.

Dr. Bob Lester:
Good, as you point out, that people within our profession are certainly earning that and deserve that and more. Bad, in that it continues to raise that barrier of care. How can we help those somewhere near half the pets in the US that won’t see a veterinarian this year? While maintaining quality care and taking care of our teams and our doctors, their compensation needs and benefits and flexibility, wellness and life needs and all of those things?

Dr. Bob Lester:
It always comes down to raising fees as a result. I think we need to be looking at different models. From the traditional model that we all grew up on. We love it. The James Herriot, “All creatures, great and small. All things to all people,” has got to change to, “Some creatures, great and small. Some things to some people.” So that we can become more efficient, help more pets, continue to compensate and treat our team members well, while delivering a broader service to more people.

Dr. Andy Roark:
I completely agree. Somebody was talking to me recently about the future of vet medicine. And I said, “I think the future is shattered.” Meaning, you’re going to see a wide variety of different kinds of practices. You’re going to see high volume, low cost practices. Or limited services practices, or mobile practices, or white glove practices.

Dr. Andy Roark:
I don’t think that’s bad at all. I think that’s what needs to happen. But we cannot have everybody doing all things and pulling our hair out about, “How do we practice the gold standard of care and also be accessible to every pet owner?” That’s a losing proposition for us as individuals and practices.

Dr. Bob Lester:
We’re singing from the same sheet. Our consumers have changed. Millennials and Gen Zs are the dominant consumer now. Their needs are different. Their expectations are higher. Their bond is stronger. Our workforce has changed. Our workforce isn’t willing to be on call every other week. Work six days a week, take one week of vacation. All of that has changed, so we have to change the model.

Dr. Bob Lester:
Change is always painful, but it’s necessary. That doesn’t mean we completely walk away from that primary care, great citizen, great person there in each community that is there to be the quarterback. To be the general practitioner, the primary care provider, that knows you and your pets. However, there are other models as well to take on some of the other needs. In some cases, in a more efficient manner.

Dr. Andy Roark:
I agree. I also really like the way you laid this out. I don’t think there’s a silver bullet. I don’t think you think that either. It’s a multimodal approach. It’s not, “Hey. We’re going to do this one thing and the problem’s going to go away.” It’s like, “No. I think we need to approach it from a variety of different aspects.”

Dr. Andy Roark:
How do you want to start to lay this out? Because I want to talk to you about some of the options that you and I both see, as far as how we can get this job done or what the future might look like. Do you have favorites? Do you have things that you think should happen first? Do you have things that you think we are closer to that might be easier to implement?

Dr. Bob Lester:
Definitely have favorites. As you point out, it’s an, “And.” There isn’t a silver bullet. We have to do this and that and the other. As we specifically look at some of the new models that are out there and emerging, there’s several that I find really appealing. The idea of nurse-driven care.

Dr. Bob Lester:
We’ve got States in which the Practice Act reads that under indirect supervision, our veterinary technician nurses can do virtually anything but diagnose, prescribe, and do surgery. Why not have one veterinarian oversee five or six limited care run by nurses? We’re seeing those pop up in a number of states now.

Dr. Bob Lester:
I think that’s one model that has a lot of potential to better utilize our teams, better empower veterinarian technician nurses, offer higher compensation, and treat more pets at a lower price point. It’s not, “All things to all creatures,” but it is, “Some to some,” and will help break down those barriers to care.

Dr. Andy Roark:
For me, I think that’s a big one as well. I know it’s a controversial idea.

Dr. Bob Lester:
Yes.

Dr. Andy Roark:
I think people can get really fired up about it. But as I look at this and I say, “We don’t have enough veterinarians.” We also have a problem attracting, especially, credentialed or licensed technicians. I was talking to someone just a while ago, who’s very big into technician regulations and things like that at the state-level. She was saying, “When you look at what unlicensed technicians make relative to licensed technicians, in a lot of cases, it’s hard to make the case that they should go and they should get that education.”

Dr. Andy Roark:
The other thing is that when you go … This person teaches at the tech college, where you have technician programs. She says, “We have these people come in, and they look at our program. They look at the average salary of credentialed techs. And it’s $30,000.” Something like that. And then, they look next to it, and there’s an ultrasound technician for human healthcare and it’s $70,000.

Dr. Andy Roark:
They go, “That’s a big difference for a similar length of program.” I go, “How do we make this competitive for them?” There’s a way to do it. And I think nuance is important. But that may be the win-win. Empowering credentialed technicians. You’ve got to have a licensing program. Because we’re not talking about taking people off the street, training them in-house, and having them do significant procedures.

Dr. Bob Lester:
Right.

Dr. Andy Roark:
But that may be the win-win of it. It gives the technicians things to aspire to, to grow new skills. A way to justify salary that makes our profession attractive to them. And it also reduces the burden of overload on veterinarians. Because I don’t see anybody turning on the spigot to release a bunch of new veterinarians soon.

Dr. Bob Lester:
No. That’s a 6, 8, 10-year fix. I’m encouraged over COVID. I think we have finally seen our profession take some significant steps towards embracing team healthcare delivery. Our profession’s roots have always been one doctor, one exam room, one truck, one stable. Whatever it might be.

Dr. Bob Lester:
We’re the fiercely independent John Wayne out there doing everything ourselves. We shoot every film, chart every chart, fill every pill bottle. And it’s silly. No other healthcare profession does that. COVID and the mismatch in supply and demand is really driving veterinarians, in some cases for the first time, to delegate and really take advantage and leverage and empower and honor their teams.

Dr. Andy Roark:
I think that’s true. I think that dentists have it right. I think the dental model with the dental hygienist carrying a lot of the weight, doing a lot of the heavy lifting, making a good living for themselves. And then, also, you are efficiently moving a dentist through that office. I go, “Man. I think those guys have a lot figured out.”

Dr. Andy Roark:
I wonder how much of this transition … Because I think you and I are on the same page. The opportunity for this to take root, I think it happens a lot in our education systems. I’m seeing some movement in that direction of starting to talk more about, “When you’re a doctor, this is how you interface with a team.” And, “Hey, doctors. Here’s how you leverage the technicians.”

Dr. Andy Roark:
I don’t think it used to be taught that way. I remember going through vet school back in the day. It was very much you were trained as the technician. That was part of the training process, is you were trained how to do everything. I get that. The doctors should be able to do everything. But I think you should be able to do it, and then be trained how to utilize and leverage your technicians so you don’t have to.

Dr. Bob Lester:
Exactly. It’s part of our education. We should be training side by-side veterinary students with tech students. That only takes place in two or three schools today in the human model. You certainly see them training side-by-side. Veterinarians need to remember their job is diagnose, prescribe, and surgery. Everything else, we can delegate.

Dr. Andy Roark:
What do you think about the potential of more non-profit practices?

Dr. Bob Lester:
I like the move. The shelter world has an interesting business model. They essentially were set up to put themselves out of business. Let’s place every pet in a home, and once they’re all placed … What is it the shelter will do? Well, we’re not there yet.

Dr. Andy Roark:
Right.

Dr. Bob Lester:
But in the case of dog overpopulation, we’ve largely turned the corner. We’re making big strides with cats. The shelter world has such a great reputation, does such wonderful things. However, as their primary mission in placing homeless pets begins to wane, they’re taking on new things. From forensics to wildlife to community education to community veterinary care. To fill that niche that you and I aren’t filling, because people don’t have $60, $70, $80, $90 for an office call to come in.

Dr. Bob Lester:
I’m really encouraged by what they’re doing. They’re picking up a segment of the population that traditional veterinary medicine has been poor to serve. And that’s not a blame thing. We can’t do it for free. With the benefits of pet ownership, comes the responsibility of paying for good care for that pet. For those that can’t afford the traditional, this gives them one more lower cost alternative to get good basic care.

Dr. Andy Roark:
It’s funny. I always joke that we can beat ourselves up no matter how well we’re doing. You can beat yourself up for working too much and you can beat yourself up for not working enough. It seems like a lot of us jump back and forth. When we talk about non-profits or we talk about shelter, medicine, things like that … And I get it. I’m not criticizing.

Dr. Andy Roark:
But veterinarians can jump really fast from, “We are overwhelmed and people can’t afford our services.” And then, they flip to the other side and go, “How dare these shelters do medicine there and take this clientele?” And I go, “We’ve got to pick our poison here.” Do we want to have the accessibility in our own practices? Or are we okay to let that part of the market go, so that we can focus on our target clientele and still feel good about it?

Dr. Bob Lester:
And still partner with those shelters. They’re still placing pets. Those pets are going to need a veterinarian. In many cases, it’s going to be you or I. As veterinarians, I think we’re silly not to be best friends with our rescues, our shelters, and do all we can to help them and be thankful if they can take care of some of the pets that we’re unable to.

Dr. Andy Roark:
I think that’s interesting. I see a niche I had for non-shelter, purpose-driven, non-profit practices. I think that there are people out there who want to live their values and believe in accessibility. I could 100% see non-profit practices being set up for the purpose of providing care for people who couldn’t otherwise get it. And it just being a very intentional decision of, “This is the market that we’re going to serve.”

Dr. Bob Lester:
We’re in, again, this period of abundance in our profession. There is certainly more business than they can handle. The challenge is, “Can we get people in there to take care of that?” In the shelter world, in the non-profit model that we’re talking about, they have an enormous recruiting advantage.

Dr. Bob Lester:
You can go to that student that’s two or $300,000 in debt, have them go to work for a qualified non-profit for 10 years, and erase the debt. They may not be able to pay what a traditional for-profit is, but if they invest 10 years … To your point, it’s mission, it’s hard, it’s purpose. It feels right. And at 10 years into it, my debt disappears. That’s tremendous. That’s a win-win.

Dr. Andy Roark:
I agree. Hey, everybody. I just want to jump in real quick with a couple of updates. Gang, before I do though, I’ve got to give a shout out. I’ve got to give some love to Banfield. The pet hospital. Guys, they have stepped up and supported us in getting transcripts for both this podcast and The Cone of Shame Veterinary Podcast, which is the other podcast that I host.

Dr. Andy Roark:
They do it to increase accessibility and inclusion in our profession. That is a big point for them right now. It’s something that they are doing for our whole profession and industry. They stepped up and put their money where their mouth was and said, “How can we help you?” I said, “Hey. This is a thing that people have asked for.” And it’s a big lift for us. Banfield said, “We got you, buddy.”

Dr. Andy Roark:
They have made this happen. If you want transcripts for our podcast, we’ve got them. Head over to unchartedvet.com. You can see all of our podcasts and you can see transcripts for those. Feel free to share them. Help us get the word out. But I’ve just got to give some love to Banfield. Because they didn’t have to do that, but they did. And it is awesome. Thanks to them.

Dr. Andy Roark:
Over at Uncharted Online on June 29th at 8:30 PM, Eastern Time, 5:30 Pacific. That is PM, not AM. We’re not doing a 5:30 AM Pacific thing. Guys, over at Uncharted Online. You can join from anywhere. My friend, the one and only practice management goddess, Stephanie Goss, is doing her Teamwork Mind Meld: Setting Expectations for Team Communication.

Dr. Andy Roark:
Guys, do your teams struggle from a lack of accountability? You’re like, “People don’t do what they say they’re going to do. People don’t follow up the way that they should. People don’t communicate in a way that stuff actually gets done. They are making assumptions about what is going to happen that are not realistic, and it is continuing to cause problems between the team and management.” Guys, I see this all the time.

Dr. Andy Roark:
Stephanie Goss’s workshop is all about setting expectations for how the team is going to communicate. Just think about how much you need that. This is a two-hour actual workshop. Come with your camera. Come ready to talk about your practice. This is going to be stuff that you can take home and plug right into what you’re doing and actually make a difference in the way your practice functions. To take this back and engage it with your team in a way that’s going to make a difference. Guys, I hope you’ll check it out.

Dr. Andy Roark:
Stephanie Goss is amazing. Uncharted workshops. They’re uniformly pretty freaking fantastic. I do love them. I’ll put a link to that down in the show notes. Guys, as you might have heard, my brand new Exam Room Communication Training Course, it launched on June the 7th. It is my 17 tips, tools, tricks, and hacks to make you and/or your team more effective in the exam room. Guys, this is the stuff that I lecture on all over the world. It is my absolute best material. I wanted to make it available to everybody.

Dr. Andy Roark:
I have people who always come up to me after my talks and say, “That was great. How do I teach my staff to do that?” I’ve got you now, buddy. I’ve got you covered. Because you can take this to your team. It is 100% module. It is broken up into five-minute modules that you can drop into your staff meetings. Tag it onto the end of a team training meeting. You can do it in the morning huddle. You can go through. Everything stands alone, so you can pick the things that you like. Skip the ones that you don’t.

Dr. Andy Roark:
You can look and say, “We need this the most in our practice. Let’s do this.” Guys, the course pays for itself. If there’s one thing that you take and you give to your team and they go, “Light bulb moment,” it is the fact that it’s made to go back to your team and be interactive, which means everything comes with discussion questions. You can say to your team, “How do we do this? What does this look like in our practice? How could we do this better? What opportunities do we have for improvement here?”

Dr. Andy Roark:
I give you those suggested wordings and questions to ask, so that you can get your team to engage. Guys, I’m super proud of this. I’m super happy. For the first 30 days, so until July the 8th, it’s $100 off. It is a launch special. I don’t want this to slip past you. If you’re like, “I want to try that out.” Grab it now. Grab it while it’s got $100 off. I will put a link in this show notes. But guys, I hope you love it and you enjoy it.

Dr. Andy Roark:
And if you haven’t checked out my Charming the Angry Client course, it’s built in a similar model. It’s been very popular. People who have had it can tell you about what it’s like. You feel free to ask, because it has gotten very good reviews. A lot of people have gotten a lot of mileage out of this. But guys, I want you to be able to train your team. Specifically, your team. Not some generic team.

Dr. Andy Roark:
I want you to train your team in a way that’s going to work in your practice. This is why I made this tool, so it can get taken and used as you want to use it. So it supports your culture and your practice and the way that you guys work. Anyway, I hope you’ll check it out. Like I said, I’m over the moon that it has launched. Boy, it’s been a lot of work for me and my team, but I think it’s going to be totally worth it for those of you who check it out. All right. Let’s get into this episode.

Dr. Andy Roark:
Let’s talk a little bit about support coming from outside the industry. You were one of the first people that I had heard talk about employer subsidized care. I think that’s an interesting idea. Can you lay out the thought process there and what that would look like?

Dr. Bob Lester:
We talk about the workforce shortage within the veterinary profession. It’s certainly a big issue. Approaching a crisis issue. However, there’s a workforce shortage across many segments of society. Those employers are looking to attract and retain good talent. They’re looking at their benefit offerings. Well, two-thirds of Americans own a pet. We’re crazy about our pets.

Dr. Bob Lester:
If you could go to work for one employer that offered you some a pet subsidy, whether it’s through a wellness plan or pet insurance, or whatever it might be … That might be a deciding factor in you taking that job or not. We’re seeing more and more that employers outside of the veterinary world are offering benefits within their offerings to their employees to help better care for their pets.

Dr. Andy Roark:
That’s my favorite. The employers pick up the tab? I like that. That still seems really good to me. It’s interesting. Have you seen evidence of that happening?

Dr. Bob Lester:
In fact, I had a neighbor the other day telling me that their employer offered a specific pet insurance company. I’ve forgotten which one it was, but they were asking me about pet insurance. “Hey. My employer subsidizes this. What do you think? Is that a good deal?” And that was just a completely unsolicited person telling me about it. Anecdotally, I’m certainly seeing more and more of it.

Dr. Andy Roark:
I think that’s interesting. I had Dr. Michael Blackwell on the podcast a while back. We didn’t really get much into aligned care, but that’s his baby. You put that forward as something that you’re positive about.

Dr. Bob Lester:
What Dr. Blackwell is doing is so noble. He no doubt described it better than I could, but working again to help people that are underserved today. He’s brought quite a collaboration of people together and spent the last number of years on it. Noble effort, and one more, “And,” as we look at, “How can we knock down barriers to care?”

Dr. Andy Roark:
His premise, when I was talking about … I don’t want to misstate how he was working with it. He was working with a number of local groups to assess the need in underserved communities and things like that. I’m trying to remember where. It was almost a political action committee that he was working on.

Dr. Bob Lester:
My expertise is limited as well. My recollection and my last reading on it. He was taking an approach, at least my interpretation, as they’ve done in human care. Looking at all the different providers out there that could help subsidize. How could he pull those similar groups together with an aim towards veterinary care as opposed to human healthcare?

Dr. Andy Roark:
It was the idea of … There are so many health benefits to owning a pet that this is worth subsidizing from a human public health perspective. That was how he was approaching it. I like that case a lot. I think that’s the type of innovative thinking, kind of like what we were talking about. With employers outside the profession looking for ways to attract employees.

Dr. Andy Roark:
You say, “Well, let’s take a look at this.” And I think that was really the core of his insight and his genius is to say, “We know the benefits of healthcare that people get from having pets. At some level, it’s worth subsidizing pet care for the health benefits that people get from them.” I think that’s a really interesting approach and argument. I hope he finds success and gets traction making that pitch.

Dr. Bob Lester:
I think it’s brilliant. If you own pets, you’re less likely to be obese. You have lower blood pressure. You’re less likely to have a heart attack. Your children have fewer allergies. Your emotional wellbeing is stronger. The savings in human healthcare, which is what? 20% of GDP. It’s huge. Just a rounding error of savings by having pets in your household to human healthcare could really reverberate through the vet profession, once that’s widely recognized.

Dr. Andy Roark:
Talk about those sorts of benefits. You had the idea of pet ownership as tax savings. Talk about how those connect.

Dr. Bob Lester:
Same concept, and not my idea. I think there was actually legislation introduced in California, a number of years ago. It went nowhere and its time may not have come. But again, when you look at the savings in human healthcare to families that own pets. By having fewer medical needs for two-legged animals, I think there’s a big case to be made that by having a pet you save money on the human side.

Dr. Bob Lester:
Hopefully, we’ll see that in our lifetime. We’re certainly seeing more and more data to that. Just looking at HABRI and what Dr. Blackwell and others are doing. It’s a potential big win for pet society and our profession.

Dr. Andy Roark:
It would be pretty nice if you could write off your bad dog who eats socks. That would help me out. That would help me out a lot. It’s funny how our relationship with pets continues to grow and change. We talk about the health benefits and things like that. People’s level of connectedness with their pets. I look at the interface of technology with this.

Dr. Andy Roark:
We talk about the insight into our pets that we’ve had before that we never used to have. My technician that I work with has a water bowl that’s got a microchip scanner on it and a scale built into it. It’s called a Felaqua. She gets updates on her phone when her cats drink water and how much water they have drank today. She loves it. She’s always sharing with me.

Dr. Andy Roark:
She’s funny. She has a pirate theme among her cats. She has all pirate names for her cats. She named the water bowl, “The Sea.” And so, she gets alerts that say things like, “Anne Bonny drank one ounce from The Sea.” She just laughs and laughs every time.

Dr. Bob Lester:
That whole concept, I think of as a connected pet. In our lifetimes, I think that’s also going to lower barriers to care. Imagine sensors in the water. The scale, the food, the litter box. Cameras in your home that can pick up gaits and activity and facial expressions indicating pain. Wearables.

Dr. Bob Lester:
Connect all that data together along with what we see through virtual or physical exams, client observations, and all those millions of data points coming in filtered through some form of artificial intelligence. I think, in our lifetime, we’re going to see some big changes in how we practice medicine. And once again, the opportunity to lower barriers to care to help more pets.

Dr. Andy Roark:
I had Dr. Sheila Robertson on just a little while ago. She was talking about the new international guidelines in feline pain management. They were using the Feline Grimace Scale, and they have an app that goes with it. That’s educational for pet owners, to help them figure things out.

Dr. Andy Roark:
I think about that app and I think about Google photos that I have and what it can do, which is ridiculous, as far as processing images and facial recognition stuff. And I go, “How long is it until we do shoot a video of a pet?” Or we do take a photo of a pet and it automatically runs a Feline Grimace Scale on our cat and says, “This is concerning.” Why wouldn’t we go that way?

Dr. Bob Lester:
Yep.

Dr. Andy Roark:
I think that’s really interesting.

Dr. Bob Lester:
It’s exciting. And that dovetails into the whole idea around telehealth. Again, sometimes controversial. But can we remotely reach out and help more pets at a different price point? Well, in my mind, we can and we should. We’re moving in that direction slowly, but we’re moving that way.

Dr. Andy Roark:
I think the staffing shortage is the biggest thing that’s screwing us up there. You know what I mean? The very understandable pushback that we get when we talk about telehealth is that people say, “Look, I’m in the exam room more than I want to be.” Stepping out of the exam room to do telehealth, especially if I don’t have high demand for it right now from clients, it doesn’t make financial sense.

Dr. Andy Roark:
I could be in the exam room putting hands on pets and actually staying really busy. Financially, at present, that makes a lot more sense. I think that there’s a tipping point. There are some practices that are starting to do more telehealth. The model that I’ve seen that’s really cool … I actually had one of the co-owners and the virtual manager at Adobe Animal Hospital on the podcast recently.

Dr. Andy Roark:
They were talking about their hospital. And so, what they’ve done is they’ve started having some people work from home. And so, part of their workforces work from home, and they have a chat set up through their website. When people go to the website, it says, “Would you like to talk to somebody?” They made the point that you can have a CSR working from home.

Dr. Bob Lester:
Got you.

Dr. Andy Roark:
They can chat with three people instead of talking on the phone to one. And then, they had a doctor set up that they could kick questions over to as a virtual visit and say, “Well, would you like to see our doctor virtually?” They could just kick over there. They’re also a big enough hospital that they could keep that doctor busy with scheduled virtual appointments. And then, also picking up stuff coming in through the chat.

Dr. Andy Roark:
And I go, “Well, that makes a ton of sense.” It also drives a lot of their other business, because they only work with their own clients. And then, they’re often bringing these people in. And so, they’ve got this flywheel, where this thing makes sense and feeds a lot of other things going on in their practice. I say, there’s insight there. As far as how this tool fits in with the other things that we’re doing.

Dr. Bob Lester:
Without a doubt. The opportunity to delegate to your team … In that case, CSRs. Or in many cases, nurses, before it gets to the doctor to triage. And then, the efficiencies around asynchronous. So much can be done through telehealth when you have a minute.

Dr. Bob Lester:
They send us a message, a picture, whatever it might be, between appointments or at home in your bunny slippers. Taking care of those cases, that can bring huge efficiencies to a practice. But again, to your point that we’re so understaffed now. It’s difficult to go in and disrupt existing workflows when we’re all running at 110% already.

Dr. Andy Roark:
Yes, it is. Change takes effort. Even delegation takes effort. I’ve been talking to people a lot about this recently. We struggle to hire or we struggle to delegate. And then, I have people who actually do hire. They do delegate or they’re trying to make change.

Dr. Andy Roark:
We’re doing that in my business right now. Trying to do some significant change in our workflows and the way we do things. Man, it’s a ton of work. Because basically, you’re doing your whole workflow, while you’re training someone else to also do the job that you could just do faster yourself.

Dr. Bob Lester:
Yep.

Dr. Andy Roark:
But that’s the short view. And so, I think a lot of times … You’re right. When we are just barely keeping our nose out of the water, it’s really hard to consider making a shift in our workflow, in our processes, and trying new things. You go, “I’m working too hard to experiment.”

Dr. Bob Lester:
You got to slow down to go faster. And that’s a tough sell.

Dr. Andy Roark:
It is a tough sell. Well, Bob, thanks so much for being on. I always appreciate your time and coming and talking with me about these things. I get fired up and I really appreciate your perspective on the industry. I like how you think outside the box. Where can people find you? Where can they learn more about WellHaven and what you’re doing?

Dr. Bob Lester:
They can learn more about WellHaven at our website, wellhaven.com. I can be reached through LinkedIn. Or if someone wants to email me directly, I can be reached at bob.lesterdvm@wellhaven.com.

Dr. Andy Roark:
All right. Thank you, sir.

Dr. Bob Lester:
Great talking with you, Andy.

Dr. Andy Roark:
And that’s it. That’s what I got for you guys. I hope you enjoyed it. I hope you got something out of it. If you’re checking us out on YouTube, hit that subscribe button. If you’re listening on podcast, guys, leave us an honest review wherever you get your podcast. It’s really the nicest thing you can do. It’s how people find us. It makes my day when it happens. Gang, take care of yourselves. Be well. Talk to you later. Bye.

Filed Under: Podcast Tagged With: Life With Clients, Medicine, Team Culture, Wellness

What Do Veterinary Practices Need to Start & Stop Doing?

June 17, 2022 by Andy Roark DVM MS

Dr. Adam Little joins us to discuss what veterinary practices need to start doing and stop doing to adapt to a changing world. He and Dr. Andy Roark discuss everything from remote work to the challenges of recruiting and hiring in a super-tight labor market. If you like big ideas and inspiration for a bright future, this is the episode for you!

Cone Of Shame Veterinary Podcast · COS – 143 – What Do Veterinary Practices Need To Start & Stop Doing?

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


LINKS

GoFetch: https://www.gofetch.ca/

NEW Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/store/

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. Adam Little works at the intersection of accelerating technologies and veterinary medicine. His career has spanned areas of focus ranging from artificial intelligence to telemedicine to connected devices. He is the co-founder and Chief Medical Officer of GoFetch where his team is building a new subscription care model focused on making local vet care more accessible and affordable.

Prior to co-founding GoFetch, he served as the first ever Director of Innovation & Entrepreneurship for Texas A&M College of Veterinary Medicine where he spearheaded such initiatives as the Veterinary Innovation Summit and the Veterinary Entrepreneurship Academy.

Dr. Little holds a Doctor of Veterinary Medicine degree from the Ontario Veterinary College He is a past Board member of the Ontario Veterinary Medical Association, Veterinarians without Borders and the Vet Futures Commission


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.

Andy Roark:
Hey, everybody. Welcome to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Guys, I have a fun episode today with Dr. Adam Little. This guy is super innovative, he is an idea guy, I’m going to get into his bio in a second when he comes on the podcast. If you like to be excited about vet medicine, if you like to think about hospitals and where they’re going and what the future looks like, this is a great episode. But you can hear he gets me fired up and we geek out about the future and what is possible and what is defining hospitals today and what will define them in the future. If you like new ideas, if you like rolling around and looking at where we are and where we’re going, man, you’re going to enjoy this episode. 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.

Andy Roark:
Welcome to the podcast my friend, Dr. Adam Little. How are you?

Adam Little:
Great, Andy. Nice to be with you.

Andy Roark:
Man, it’s good to see you again. It has been too long.

Adam Little:
Very much so. Yeah, it’s great to reconnect and chat a bit and hope you and everybody in the Uncharted community are doing well.

Andy Roark:
Yeah, yeah. Well, I speak for me, yeah, it’s going very well. I’ve known you since vet school. You have a DVM. You are a veterinarian. You’ve done work with artificial intelligence. You were the first ever director of innovation and entrepreneurship for Texas A&M’s College of Vet Medicine. You also spearheaded initiatives like the Veterinary Innovation Summit, which is still going on, and also the Veterinary Entrepreneurship Academy. And now you are the co-founder of GoFetch. Why don’t you give me a quick rundown on what that is?

Adam Little:
Yeah, for sure. What we’re trying to do at GoFetch is bring a subscription model to vet practices that helps clients afford and access care and combine some of the best parts of traditional wellness plans, savings and loyalty accounts and financing in a much simpler and easier to implement model that any practice can offer to their clients. Practically speaking, what that means is that a pet owner signs up, they pay a subscription fee to us, we manage that responsibility, and then they get benefits that are delivered by our practice partners. Things like access to visits, 24/7 support, they have access to interest free financing for big and unexpected bills. Then the ability to accumulate and save up rewards that act like a pet savings account or the ability to actually donate those rewards to help pets in need.
One of the really neat things that we do is we have this community based component of our program, where we build a fund that practices can have access to and actually use to support low income pets and families in their community. People who just can’t afford care at all that are coming in and saying, “My pet needs essential support right now and I just can’t afford it.” What we’re really trying to do it at a high level, is create a more sustainable, profitable model for practices that really focuses on eliminating cost from the care that’s provided. Yeah, that’s what we’re working on.

Andy Roark:
That’s awesome, man. That’s really, really cool. I invited you to be here because, coming into 2022, I reached out at the beginning of 2022 and I was trying to peer into my crystal ball for the year and I was like, “Hmm, where is this year going?” You’re such an innovative thinker and you’ve got your finger on the pulse in technology and a lot of communication things and just in the way that practices grow and evolve and your work with the Veterinary Innovation Summit, you are really tapped into new and interesting things.
And so I reached out to you at the beginning of the year and said, “Hey, you want to come on and do some future casting with me?” And you said, “I’m a bit busy. We’re having a baby and it’s going to have to wait a little while.” So we had to put it off, but I still want to go, even though it’s not the first of the year, I still want to see your vision for the future. Let’s do a little exercise called start, stop, continue. The way I want to do it is, I want you to pick some things and tell me what you think veterinary practices need to start doing, tell me what you think they need to stop doing, and tell me what you think they’d like to continue and let’s kick those ideas back and forth a little bit.

Adam Little:
Yeah, that sounds great. I think to level set all three of those categories, practices are at a very interesting junction point because in many ways we’re coming out of what has been, in some ways as many practices still going through it, but a very challenging, disruptive time for how veterinary practices serve their clients. It meant that things that maybe practices could have put off or thought more about down the road, things like telemedicine, things like in-home delivery of medications and food, these just became almost necessities. There’s a huge accelerant that required practices to move at a pace that I think traditionally they would’ve been less comfortable with.
Now we’re dealing with a little bit of the fallout of some of these things where people now, I think their relationships with their pets continue to deepen and for many practices they’re just overextended in that capacity. They’ve been through the wringer where they’ve had this boomerang effect of, hey, we went to longer appointment times or curbside. How do we come back to that? What are the best practices that we’re still trying to absorb? When really trying to maintain a staff that is increasingly burnt out and overextended. So that’s a really challenging position to be in.
So what do I see to continue in for the next couple of years and what does that mean for practices in terms of the actions that they can start taking now? One of the first ones that comes to mind is we need to find ways to better augment your team. What I mean by that is your clinic is likely to continue to have clients that have higher expectations, they’re looking for more engagement, they’re asking more of you and it’s going to be increasingly difficult for practices to wear all the hats that they have as a small business to serve those clients. There’s a couple different ways that I think you can break that down.
The first is really understanding what your team’s core focus is for your community and for your clients. It might mean that there’s opportunities for you to start doing things to support some of the less critical interactions by technology or partnering with other providers to help really extend the support of your team. So I’ll give you a specific example. I think this idea that clients are going to continue to want help 24/7 is here to stay. I think that there’s a lot of value in really trying to figure out what is the connectivity and the continuity of care, so that if you have a client that’s messaging you after hours, when you do see them in person, you’re building upon that interaction, you’re actually able to drive, ideally, a more compliant and efficient visit.
However, you can’t just put your team on call 24/7, that’s not realistic. One of the things that you need to think about is how do we augment our team in particular during those periods where we know it’s going to be difficult for our team to provide those services? We’ve seen an explosion now of these teletriage and other services that can plug into your practice to provide general advice and initial access to support. Not necessarily with the intention of replacing the need for the visit, but really acting as a more accessible, easier touchpoint so that when your team gets involved, you can really focus in on elevating the care as needed, without sacrificing that always on availability.
So, I think that’s one to consider. What does that look like when your clients need support, but you can’t be the people to provide it?

Andy Roark:
Yeah. So this is mostly probably clients outside the building type support, right? I mean, accessibility, things like that. Scheduling, phone support, advice. Yeah, okay. Yeah, I get that. I believe that’s true. I also think the other thing that supports that, I think the laborer push for more flexible work hours and then also work from home. I think also both of those things feed into this new model of, hey, you can provide support from outside the clinic in a way that’s valuable. No, I agree with that.

Adam Little:
That’s a really important point because I think this is maybe there’s a bit of a misconception about the type of support you can provide. There’s clearly a portion of the profession that gets, I think, reasonably, and rightfully so, nervous about the idea of, is this other vets or medical professionals that are informing my clients? Where do I get looped in? There’s varied levels of comfort of it.
But what we’re really talking about is there’s a huge segment of tasks that have nothing to do necessarily with that high end medical advice or case management that are required to power the client experience that you depend on. And to your point, Andy, about the recruitment piece, if you’re a practice that has the option for hybrid work environments, where you can actually create an opportunity for staff members to add value to your practice, help to take on some of those tasks and really offset that workload for your in clinic team, it’s a huge way to recruit a completely different pool of individuals. They’re more attractive jobs in many ways, they’re more flexible, it’s a great balance for folks and it ends up becoming a huge differentiator between you and other clinics.
And so I think that’s another piece of this, where if you can go as a practice to say we’re going to hire for a client representative, or we’re going to hire for a manager and there is a remote or flexible work component, that already puts you in a very small percentage of practices that offer that type of working environment, which people now are increasingly coming to expect. And I think it actually broadens the applicant pool beyond the traditional types of people that would work in vet clinics. People that come from client service backgrounds or other areas that now are saying, “Wait a second. I don’t have maybe as much veterinary experience, but this job sounds really interesting.” So I think those two go hand in hand.

Andy Roark:
Yeah. No, I think that makes total sense. Yeah. That fits for me.

Adam Little:
I think, to pull in that thread a little bit more, for you to take advantage or even create those opportunities in the first place, you need to have hospital systems and processes that people remotely can plug into.

Andy Roark:
Yeah.

Adam Little:
So if you’re a practice that is paper based, or you have hospital systems that mean that you have to be on premises to even log in and get basic information, there isn’t the ability to communicate with your team in a remote way, you’re not going to be set up to take advantage of some of these new opportunities. And so maybe another start doing is really optimizing for your team, how they can function together, both in person and remotely, by using things like Slack or some of these other tools but really focusing on what are the two or three key tasks and workflows that we need to optimize these tools around so that whether you are the front desk person, that’s at the other side of the building, you’re a vet that’s stepped out for a break or you’re a remote team member. You can still actively participate and contribute to these practices.
And I think what we’re finding is the same sort of basic infrastructure of remote first businesses that they just needed to have in order to function. Our company is completely remote, we have an office that people can kind of go into what they want, but these tools aren’t kind of optional add-ons, they are the infrastructure of our entire business. We couldn’t do what we do without them. And I think what’s happening is, if you can bring that layer in that thinking to a vet clinic, wow, that’s a really powerful one two punch because you have all the benefits of working and the purpose of a practice bond with the flexibility and connectivity of those remote first companies. And I think that can be really powerful for practices.

Andy Roark:
Yeah, I agree with that. You kind of blew my mind there for a second because you’re right. How many of our practices have we had this old school way of doing things and we’ve kind of added to it, augmented it, we kind of dipped our toe into some electronic record stuff, but we’ve still got half of our paper stuff. And the idea of stepping back and looking at your practice with fresh eyes and going, “Okay. Let’s look 10 years down the road, what base model do we want to be built on?” Right?
Because that’s what we’re talking about. And you don’t want to switch your PIM systems around, you don’t want to keep jumping from one thing to another. And so I think that there’s a lot of wisdom in stepping back and saying, “All right. How do we lay the groundwork so that we know that accessing from outside the building, or allowing other people to come in virtually and interface with our team, that’s going to be important.” Man, laying that groundwork as opposed to waiting until you get to a place where you really need to have that sort of flexibility, and you don’t have it? That’s insightful.

Adam Little:
Yeah. I think the other thing too is, it’s been really easy for a very long time for practices to say things like, “Well, our clients don’t want these things. They don’t need it.” There really hasn’t been maybe the internal push within the profession to accelerate towards these new ways of working. But for the first time ever, you’re seeing associates and new staff members that are saying, “Look, if your practice works like this, I’m not going to work for you.” If you’re a practice that doesn’t have access to these tools, you’re a practice that’s going to make me all of a sudden write my records, or you’re even a practice now that doesn’t have some of these cloud based systems. You’re seeing that because there’s so much more technology and it’s so much more in your face. People are developing relationships and getting exposed to these tools far earlier in their career.
And so they’re going to these employers and saying, “These are the tools that I work with. This is what I want to do. Oh, you don’t have them? Well, that’s another cognitive kind of load that I’m going to have to bring on to this practice, because I’m going to have to have a completely different way of doing things.” And for certain team members, if they’re already really used to it, they’re not going to want to go back, right?

Andy Roark:
Yeah.

Adam Little:
It’s kind of the equivalent of being an accountant and then there’s one accounting shop that uses Microsoft Excel and another one that uses Tickertape and you’ve grown up in the school of Excel, you’re not going to go work at the Tickertape office. And in fact, your mindset is that business is not long for this world. And so it’s not just practically speaking what the day to day work looks like, but what is the signal that you’re sending to your team, to potential new applicants and to your clients about the type of practice that you are going to become and where you’re investing your time and energy. Because we don’t have the luxury now, I think, of just putting our heads in the sand and it’s really beginning to shape the types of people you can recruit and the types of people that want to stay and work in your clinics.

Andy Roark:
Yeah. I agree. I think one of the things that’s really interesting is I think a lot of us like to believe that we’re going to have a lot more runway than we do. You know what I mean? Five years ago, I mean people working outside the clinic, I don’t know. And if people start getting excited about it, then maybe I’ll get on board. Well, all of a sudden, consumer technology shifts so it shows up in other industries and six months later, pet owners are like, “Oh, I’m very used to communicating this way. And now I 100% want a text driven, chat driven interface.”
And you’re right about other veterinarians coming in as well. I think a lot of us thought that this would be a slow march towards accessibility and it has not been, it has kind of been flipped a switch and very quickly you look outdated or you feel outdated.

Adam Little:
And I think it’s okay to understand and take a step back and be like, it makes sense that veterinarians would feel that way because for the longest time, the career arc of a veterinary profession was very well defined from the earliest days that you decided to be a vet. And so you can develop this mental model that you really kept from vet school, from volunteering to vet school, to your first days in practice. And it’s natural to be like, this is the kind of almost reliability and I want that plan. And I think Mike Tyson said, “Everybody has a plan until you get punched in the mouth.” And I think for a lot of people COVID was that punch in the mouth and they’re realizing, geez, my transition plan is 10 years of maybe waiting out these changes so I don’t have to make them to my practice and I can transition, or sell, or go to… That doesn’t exist anymore.
And I think the other thing is that, the pet owners don’t have to ask for your permission, right? Pet owners today are voting with their wallets and their decisions and where they’re going for information. And so they’re not necessarily considering when they’re pet’s sick or when you’re unavailable. I wonder what Dr. Smith is going to think about this if I go to this vet or I’d buy this product here? They’re just saying what’s quicker, easier, better for me and the same way that I think we’d all do in our other lives.
So I think this is often times like a really helpful mental model where it’s like, if you were a client in your own practice, can you put yourselves in those shoes? How would you actually feel? Because when we go to our dentist, or our therapist, or any other medical profession, we have no problem highlighting all the reasons it can be frustrating or difficult. But when our clients raise those similar concerns, we can really easily justify why they are maybe not realistic or what have you. And so that’s that balance, I think, is really difficult to really navigate sometimes.

Andy Roark:
Yeah. No, I agree with that. Yeah. It’s hard to look at yourself with fresh eyes and to detach yourself and say, “If I wasn’t me and I didn’t know anything about that medicine, how would I feel about this? And would I be okay?” And you go, honestly, probably not. I would probably complain.

Adam Little:
Yeah. It’s really challenging but I think one of the solutions to this is to broaden that applicant pool and bring in people that maybe can help you see that from another perspective.
I think one of the things that I never see practices doing, and I don’t understand why, why not recruit from your clients? Every practice is having difficulty recruiting for, in particular, support staff roles and those sorts of client facing roles in particular. They have lots of high turnover, they have people that maybe don’t have the experience, they tend to be more transient positions. You have thousands of people a year that love your business to a certain degree and want to see you succeed and they don’t even know that you’re hiring. They have no visibility to where you are in the life of your business. And you can imagine what that might look differently if you did little things like had a careers page on your website, on the bottom of your email templates, we are hiring for these positions, and really starting to engage, even if it’s only a couple of people, it really broadens, again, that visibility to the type of clinic that you’re becoming and bringing in some of those fresh perspectives, at a time when I think staffing is challenging.

Andy Roark:
Yeah. I agree with that. With the staffing challenges, I think a lot about having a developmental pipeline, being more important now than in the past. Meaning, if you know you can’t just grab a trained technician or assistant or even veterinarian off the road, can you start the development process much earlier and try to groom people who can come up and either take those positions, or you can groom them to come up and take the workload off of the people that you have. Meaning, bring that person up so that you reduce the communication workload, say, on the veterinarian so the veterinarian has more time to do the clinical things that you can’t delegate away from them.

Adam Little:
Yeah. It’s a really interesting point of one that I think will actually end up being a much bigger issue than people realize, because if you take that point and you extrapolate out, what you’re seeing is exactly that. In particular, a lot of the larger corporate groups are saying, “Wait a second. We need to lock in these graduates far earlier than their final year. We need to lock them in first year. We need to lock them in when they’re interested in even becoming a vet in the first place.” And so what you end up having is this sort of downward pressure where at the earliest stages of veterinary education, it’s like the recruiting for the NCAA, right? If you’re a promising basketball player on your age 10? You’re in this pipeline.
I wonder what that will do for higher education where a significant part of that individual’s development is going to be tied to that process. They’re going to supply you with resources and mentorship and financial relief, they’re going to fast track you to positions in their organization, and they’re going to give you those remote opportunities. And I think it’s going to be increasingly difficult for your independent practice to sort of say, “Let’s get the talent to come to me” because they are so many further steps ahead of where you normally interact.
So I think to your point, what are the strengths and the unfair advantages that an independent practice has in a world like that? And I think it’s things like authenticity and community and personal relationships and maybe different outcomes in terms of career trajectory. But you certainly need to be investing in that because otherwise that pool… You go back, how many new grads are there this year? It’s not 100, 120. It might be 10. And the others are already spoken for in their second and third year, which is a very different shift for practices.

Andy Roark:
Yeah. Yeah. Oh, I completely agree. Yeah. I agree with you. I’m a big fan of the independent practices. I think culture, having core values, a purpose that you serve, everybody wants to have a good place to work. I definitely think that there’s ways these little guys compete. But to your point, yes. Why wouldn’t we see recruiting earlier in the vet training pathway than we have in the past?
I had Lance Roasa, who’s a vet and a lawyer, on not long ago and we were talking about signing bonuses. So signing bonuses have really taken off and new grad salaries are going up. And he really made the point that we call them signing bonuses, but they’re not. They’re retention bonuses. Meaning, you come in and then you stay for three years or four years or whatever, and then you’ll get this money. And if you don’t, then you have to give it back or if they’re smart, they get it prorated. But they have to give it back.
And so, yes. When you think about it and you say, “How do you go to a second year vet student and recruit that person?” Well, if you’re willing to do something like retention bonuses and things like that, there’s a lot of tricks in your bag that you can actually use to make this type of recruiting work. And so I would not be surprised to see more and more of that. That’s definitely a shift.
So then again, it goes back to the pipeline question of how do you get in? How do you start mentoring? How do you start building relationships? How do you stay involved? And I look at the vet schools and I look at the technician schools because I feel like for a lot of places, that’s a lot easier. But they’re looking for preceptorships at the tech schools and you say, we are a hospital that likes to teach and we have a good culture and we’re willing to take some people on and we do it in an organized way. Again, it’s the long game and it’s definitely not guaranteed. I see a lot of people who are like, “I had three externs and none of them came here!” And I go, well, that is part of the deal. But yeah, it’s fishing.
Hey everybody, I just want to jump in real quick with a couple of updates. Gang, before I do, though, I got to get a shout out, I got to get some love to Banfield the Pet Hospital. Guys, they have stepped up and supported us in getting transcripts for both this podcast and the Cone of Shame Veterinary Podcast, which is the other podcast that I host. They do it to increase accessibility and inclusion in our profession. That is a big point for them right now. It’s something that they are doing for our whole profession industry and they stepped up and put their money where their mouth was and said, “How can we help you?” And I said, “Hey, this is a thing that people have asked for and it’s a big lift for us.” And Banfield said, “We got you, buddy.” And they have made this happen. So if you want transcripts for our podcast, we got them. Head over to unchartedvet.com, you can see all of our podcasts and you can see transcripts for those. They are feel free to share them and help us get the word out but I just got to give some love to Banfield because they didn’t have to do that, but they did and it is awesome, so thanks to them.
Over at Uncharted Online on June 29th at 8:30PM, Eastern time, 5.30PM Pacific. That is PM, not AM. We’re not doing 5:30AM Pacific thing. Guys, over at Uncharted Online, so you can join from anywhere, my friend, the one and only practice management goddess, Stephanie Goss is doing her teamwork, mind meld. Setting expectations for team communication. Guys, do your teams struggle from a lack of accountability? You’re like, people don’t do what they say they’re going to do. And people don’t follow up the way that they should. And people don’t communicate in a way that stuff actually gets done. And they are making assumptions about what is going to happen. That they’re not realistic and it is continuing to cause problems between the team and management.
Guys, I see this all the time. Stephanie Goss’ workshop is all about setting expectations for how the team is going to communicate. Just think about how much you need that. Gang, this is a two hour actual workshop. Come with your camera. Come ready to talk about your practice. So this is going to be stuff that you can take home and plug right into what you are doing and actually make a difference in the way your practice functions and to take this back and engage it with your team in a way that’s going to make a difference. Guys, I hope you’ll check it out, Stephanie Goss is amazing. Uncharted workshops are uniformly pretty freaking and fantastic. I do love them. I’ll put a link to that down in the show notes.
Guys, as you might have heard my brand new exam room communication training course, it launched on June 7th. It is my 17 tips, tools, tricks, and hats to make you and or your team more effective in the exam room. Guys, this is the stuff that I lecture on all over the world. It’s my absolute best material. I wanted to make it available to everybody. I have people who always come up to me after my talks and say, “That was great! How do I teach my staff to do that?” I got you now, buddy. I’ve got you covered because you can take this to your team. It is 100% module. It is broken up into five minute modules that you can drop into your staff meetings, tag it onto the end of a team training meeting. You can do it in the morning huddle. You can go through and everything stands alone so you can pick the things that you like, skip the ones that you don’t. You can look and say, we need this the most in our practice. Let’s do this.
Guys, the course pays for itself. If there’s one thing that you take and you give to your team and they go, “Oh! Light bulb moment!” The fact that it’s made to go back to your team and be interactive, which means everything comes with discussion questions so you can say to your team, how do we do this? What does this look like in our practice? How could we do this better? What opportunities do we have for improvement here? And I give you those suggested wordings and questions to ask so that you can get your team to engage.
Guys, I’m super proud of this. I’m super happy. For the first 30 days, so until July 8th, it’s a $100 off. It’s a launch special. I don’t want to slip past you. If you’re like, “I want to try that out!” Grab it. Grab it now. Grab it while it’s got a $100 off. I’ll put a link in this show notes. Guys, I hope you love it and you enjoy it.
And if you haven’t checked out my charmingly angry client course, it’s built in a similar model. It’s been very, very popular. People who have had it can tell you about what it’s like, feel free to ask because it has gotten very good reviews and a lot of people have gotten a lot of mileage out of this. But guys, I want you to be able to train your team, specifically your team, not some generic team. I want you to train your team in a way that’s going to work in your practice. And this is why I made this tool, so it can get taken and used as you want to use it so it supports your culture and your practice and the way that you guys work. Anyway, I hope you’ll check it out. Like I said, I’m over the moon that is launched and boy, it’s been a lot of work for me and my team, but I think it’s going to be totally worth it for those of you who check it out.
All right, let’s get into this episode.

Adam Little:
And then the other point that you raise is, okay, you have that person. How do you allow them to develop their career and themselves in their jobs, in your community? And I think this is again where it’s a bit of a mind shift, but traditionally, you have these very kind of almost like rigid identifiers for roles and practices, right? So you have a registered veterinary technician, you have a veterinarian, you have… And the reality is, it’s much more of a fluid spectrum where, depending on your experience and your interest, there’s a huge gradient in terms of a registered veterinary technician that specializes in surgery and supporting the surgical services of a practice versus an entry level one. And I think what people are going to want is, they’re going to want to see from employers a much clearer map of how they can advance themselves, how they can make more money, how they can take more accountability and ownership by staying with you. And this is where there’s an opportunity to carve out and actually be a lot more nimble as an independent practice, because you can develop levels yourself.
And this is some of the best practices that we’ve even heard in the Uncharted community where, I think, when I look at the practices in that community that are really successful, one of the things that they pay in particular attention to is really clearly lying out this is the expectations for you, but more importantly, this is where we think we can get you to and why, when we make decisions, your role looks like this.
I think one of the things about the culture, which can really kind of get away from you, is that without those clear expectations, without opportunities for advancement and without a transparent set of rules and guides and opportunities, the ambiguity can really paralyze people or get your good people to leave are frustration. And the practices on Uncharted, that I think are fantastic, are the ones that are like, “We’ve introduced three levels of technicians and this is the hours of the work that you need to do.” And those are the types of people they’re going to stay with you because they want to grow and they see that you have an opportunity to do that with them.

Andy Roark:
Especially for the technician levels, pay scales, things like that. There’s a nice wage transparency that comes with it. But you can also sort of gamify your training and your development and you say, “This is what you need to get to the next level and this is how you get rewarded when you get there.” And I think it makes a lot of sense.
I really like your point, even with doctors, one of the things, when we talk about change and evolution, one of the things that’s really important is that people need to be able to see themselves in the future that you’re creating. They need to know that there’s a place for them there. If they can’t see themselves in where you’re going, that’s very demotivating. And so when I come to you and I say, “Adam, this is what I’m really excited about.” And you say, “Andy, I could see you doing more and more of that and ultimately moving in this direction”. I think that’s really powerful.
I was up at a practice in New York, it was outside of Syracuse, and they were breaking ground on a huge rehabilitation facility behind the vet clinic. And they had had some technicians who 10 years ago, just twisted arms to get a little closet at the back of the building where they could do rehab stuff and they loved it and they advocated for it and they built that business up. And they got an aquatic treadmill and they’re doing a lot of rehab. And they finally grew that thing up to where the owners were like, “Look, we’re going to build you the real deal.” And they’re building a new building just for rehab. But again, they had this person who drove the bus and she was super motivated and they continued to say to her, “Hey, we’re growing this with you. We want you here and we can see this is where this goes.” And they delivered on what they said and now they’re going to lead the whole area in this niche of medicine. They’re really doing impressive things.

Adam Little:
That’s such an interesting story because there’s so many takeaways that are weaved into that for this conversation. So one is, you had somebody with enormous pride in themselves and their work and the opportunities to do that. And I think that’s a really undervalued aspect of this entire thing. If you have a team that wakes up every day and they really truly believe that their work is meaningful and they can be proud of their team and their output and the clinic and they’re standing within the community, I think regardless of all the future stuff that’s going to come out there, that is such an important element of being on that right trajectory.
The second thing is, in your example, they found a way to make strides so that this big monolithic building wasn’t something that might happen in the future. Okay, we’re going to start with this service. We’re going to get this cause. So we’re going to keep pushing forward. And then they had a really aspirational, this is where we want to get to.
And I think that is a really difficult thing in life to pull off, where you have a lot of conviction on the vision and a lot of clarity on what the first steps are in the milestones to get to that vision. So they’re like, we want to build the rebound center, we’re going to knock it out of the park with a little bit of space, we’re going to build this service up, we’re going to train people. It requires such a unique individual and the right conditions in that environment in order to move that forward, and I think that’s part of this for the practices. Are you creating the environment and the conditions to allow people and ideas like that to propagate? Or are you actively discouraging those types of people and ideas from joining your practice?

Andy Roark:
Yeah. No, I think you’re right and then that sort of encouragement. So it was funny, what I was talking to this person about, her question from me was, how do I streamline the process of getting our surgeries to make the recommendation for physical therapy and to educate the clients about what that looks like? How do I interface with that? So that every time we have a surgery go out, they get this information, they understand what we could do. And I was like, that’s the level this person is thinking at is, we’re here. We’ve got this service. It’s growing. How do I continue to integrate it into what we’re doing? And to have that coming from the technician level? That’s amazing.
But the other part of it is, that would scare the hell out of a lot of practice owners. You know what I mean? A lot of people would be like, “Whoa, whoa, whoa. You’re pushing hard here.” This practice had not done that. They had listened to this person and supported and tried to work with her and figure out, okay, we see where you’re going. How do we do this? And what does this look like? And they’ve got this video monitor in the waiting room that looks really good. It was a vertical one, so it’s four feet tall, two feet wide, kind of cool. And they’ve got rehab videos that are playing in the waiting room, so when clients are in the waiting room, they’re watching this stuff. But that was all technician driven. It was technician driven and owner facilitated and supported. As I say, it was impressive.

Adam Little:
Yeah. There’s kind of an interesting parallel between startups and that experience where, oftentimes the people that are closest to the customer, the closest to the user when you’re building something, they have such powerful insights because they can see what they’re reacting to and how they’re learning. And in practices, that’s usually not the owner, it’s usually not the manager, it’s usually the front desk staff. So how are you empowering those people to have a meaningful voice and actually, more importantly, take that step further and take actions that are in the best interest of those individuals?
To your point about how do you kind of get that information in? I think a lot of times this is one of the biggest challenges for practices. They spend a lot of time on the setup of something, but they’re not really thinking from the perspective of, an owner might need to know about this six or seven times. And if they only come in twice a year, that means that I need to tell them every single time that they’re in, for three years in order to actually make that decision, plus the nature of their pets and their care and where they’re at financially.
And so if you have a practice that’s reluctant that first time to talk about rehab, they’re never going to cross that threshold where they’ve hit somebody enough times to make that top of mind so you have to be creative. You have to say, is there ways that we can expose people to what we’re offering, that isn’t hanging on the recommendation of an individual face to face conversation. The videos are a great touch. Surfacing up those patient stories, the newsletters, all those things that are just maybe not where they make the decision, but they build a bit of a foundation that when that recommendation ultimately might be reinforced or come from the vet, they’re like, “Huh, this isn’t the first time I’ve heard about this. I saw those writing room videos. I saw that patient. I saw that cute thing on Facebook.” You’re just pulling that last push to get them over the edge as opposed to beginning it from a cold start which is really hard for practices in general, I find,

Andy Roark:
Oh, I completely agree. But the idea when you look at how crowded the media environment is and how much messaging pet owners receive from Google ads, on social media, from TV ads, from all these places. The idea that they’re going to roll into the vet clinic, I’m going to see them once a year, I’m going to say this is what you need to do, and it’s going to cut through all that noise. That’s really hard.
I think we have so many things that we talk about exactly one time. A new puppy comes in and we talk about pet insurance, or we talk about dental care, or we talk about whatever it is. We talk about weight control and feeding a good diet. And then we’re done and we don’t talk about a diet again, and we don’t talk about weight control, and we don’t talk about dental health, and we don’t talk about any of these things. And it’s sort of like we know that if you want to get someone to commit to letting you clean their pet’s teeth, they can’t learn about dental cleanings the day that you recommend them. They really need to have heard this seven times before, probably in different ways, in conversations with the doctor, with the tech. They probably need to read something about it, see videos on what it is, get a newsletter. Just this multimodal education.

Adam Little:
I think the examples that you shared really amplify this problem which is that I feel like practices are really just receiving. They’re like this is a new priority of the month, this is a new priority. There are so many things that now I’m expected to do which means that, what do I actually stand for? What’s the one thing that people respond for me for?
And I think that the start doing thing I also encourage. Practices need to be polarizing in the sense that you need to have something that when a friend is talking to a friend, they’re like where do you take your pet? I go to this clinic because of X. And really focus on that because otherwise you’re swimming in a seat of priorities. All these topics are important for pet health, which means that none of them are important for pet health, because none of them are actually receiving the focus and attention they deserve.
And on the flip side, I think that people are going to gravitate towards businesses that carve out positions on things and for pets, I think that there’s such an opportunity there to say we are great at this, we’re going to make this a priority. It might mean that we’re not the best vet for you, and that’s okay. But as a result, the things that we’re going to do, we’re going to do very well. We’re going to reinforce them and we’re going to start to see the fruits of that labor. And that’s why I think you’re seeing some of these new practices come out with like membership models where they’re like, we know that for us, as a clinic, we have a commitment to this client or to this patient over the lifetime of that pet. And we want to work with people that are going to make that commitment to us. So we have a business model and a care model that allows us to go deeper for your pet’s needs, allows us to be more supportive and as a result, it means that we can’t take on thousands of new clients. But for the clients that we do have, this is what we’re going to do.
And the other thing too, is it gives permission to your staff to say no. And I think that’s where things get really important where, if you stand for something and you create that culture, it allows your staff to confidently say, “This is what we’re going to do and this is what we’re not going to do” as opposed to, I think what’s happening right now, where there’s more than ever before, there’s more to keep up and you’re kind of like where are the priorities? Where is our focus?

Andy Roark:
Yeah. It’s the all things to all people problem, right? The best ex the best example of this, just to validate your point here, I was working at this practice in Florida and I was working with one of their technicians and she was in charge of their marketing and she was trying to figure out sort of what the brand messaging of the practice would be. And it was a feline only practice and so I was talking to her and we were talking about their approach to low stress handling, and they were very into that.
And so we were talking and she was walking me through what appointments are like and I said, “Well, you know what happens when you have a stressful patient coming in, or a cat that you think might be high stress or high anxiety and stuff?” And she said, “Well, we have these calming packages that the owners come and pick up”. And it’s a towel and it’s the Feliway and it’s Gabapentin, or whatever it was. And I said to her, “What happens if the pet owner doesn’t make time to come in and get that, or doesn’t want to come in and get it?” And she said, “Well, then they’re not a good client for our practice.” Or they’re not a good fit for our practice. And I remember that and I was like, man, they’ve got it. I can’t believe we’re talking about your brand message, you’ve got this nailed down.

Adam Little:
Exactly.

Andy Roark:
And it wasn’t like we also do these other things, but they were like, no. We are a low stress practice and we want cats to be happy coming to the vet and if you’re not on a board, then you’re not the right client for us. And I thought not only is that a powerful message for attracting clients but Adam, isn’t that the place you’d want to work?

Adam Little:
100%. In some ways it’s this simple but powerful concept because you’re just like there is no negotiation. This is how we treat our patients. And if you’re a client, you’re either going to be, wow, that’s fantastic. I am anxious about my pet. My pet does get stressed. But if you’re saying, well, my pet isn’t like that, I don’t care, then they’re opting out, right? It’s such a powerful thing to find those moments where you’re like, no, this is who we are. And let’s double down on that and make sure it’s part of each interaction that we have.
And to your point about recruitment, these are the things that I think the next generation of veterinarians wants to hear, right? That’s fantastic. Things that used to be optional, that are now required and now are almost baked into the DNA of the practice. Pain management is another one. There’s a bunch of these medical things that you have saw. Well, maybe we’ll do it, maybe we’ll not, to it’s required, to no, actually we have a really strong reaction when you go against what we believe is true. And I think that’s a really powerful trend for practices to continue to explore.

Andy Roark:
Yeah. I completely agree. Picking your values, picking the thing that you stand for and saying these are our people and this is what we believe. Again, I don’t think you can pick every aspect of medicine and say we stand strongly on all of these things. I think you need to figure out what you’re really about.
Adam Little, thank you so much for being here, my friend. Where can people find you online? Where can they learn more about GoFetch?

Adam Little:
Yeah, so check out GoFetch.ca. They can reach me at Adam@GoFetch.ca or Twitter @exponentialvetand. I’m happy to connect with anybody.

Andy Roark:
Good. Thanks for being here.

Adam Little:
Thanks, man.

Andy Roark:
And that is our episode, that’s what we got guys. I hope you enjoyed it. Dr. Adam Little is amazing. Taking time out of his busy GoFetch, running, iddy biddy baby raising schedule. I appreciate it. Anyway. I appreciate that guy. He’s super fun to talk to.
Anyway, gang, if you enjoyed this, if you’re watching a YouTube, hit that subscribe button. If you’re listening on your podcast, go ahead and give us an honest review wherever you get your podcast from, it makes a big difference to me. So anyway, gang. Take care of yourselves. Be well, talk to you later. Bye.

Filed Under: Podcast Tagged With: Medicine, Team Culture

Mystery Toxicosis! Chlorfenapyr in Dogs (HDYTT)

June 8, 2022 by Andy Roark DVM MS

Dr. Tina Wismer, Senior Director of ASPCA Pet Poison Control Center joins Dr. Andy Roark to talk about a scary case. Vomiting, fever, muscle tremors, and a stiff gait…. what could be the cause??

Chlorfenapyr is a chemical used in some pest control sprays, and it can be a fatal toxin for pets. Dr. Wismer discusses the risks and how to treat these cases if/when we see them.

Cone Of Shame Veterinary Podcast · COS – 142 – Mystery Toxicosis! Chlorfenapyr In Dogs (HDYTT)

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


LINKS

ASPCA Animal Poison Control: https://www.aspca.org/pet-care/animal-poison-control

NEW Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/store/

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

Tina Wismer, DVM, MS, DABVT, DABT, is the Senior Director of the ASPCA Animal Poison Control Center. She earned her undergraduate degree from Ohio’s University of Findlay and received her DVM from Purdue University. Dr. Wismer worked in both small animal and emergency practice before joining the ASPCA Animal Poison Control Center in 1998. Dr. Wismer is a Diplomate of the American Board of Toxicology and the American Board of Veterinary Toxicology. She is an adjunct instructor at the University of Illinois, a visiting professor at St. Matthews University (Grand Cayman), a consultant for VIN (Veterinary Information Network) and a Master Gardener.


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. Andrew Roark:
Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andrew Roark. Guys, I’ve got a fun toxicology case for you today. What’s going on with this trembling, shaking dog? Why did its two housemates die suddenly? What are we going to do about it? How concerned do we need to be in the future? Are we having good conversations with pet owners about what to do when they have the insect home protection guy come into their house? 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. Andrew Roark:
Welcome to the podcast. Dr. Tina Wismer, thanks for being here.

Dr. Tina Wismer:
Thank you for inviting me.

Dr. Andrew Roark:
My absolute pleasure. I love having you on here. You’ve been on a number of times. You’re at my go to for toxicity questions that I have when I’m losing sleep about my patients eating things, you are the person that I reach out to. For those who do not know you, Dr. Tina Wismer is the senior director of the ASPCA Animal Poison Control Center. Thanks for being here.

Dr. Tina Wismer:
Thank you for inviting me.

Dr. Andrew Roark:
I think… Yeah. Sorry. I keep thanking you.

Dr. Tina Wismer:
I think we already did that. That’s okay.

Dr. Andrew Roark:
We did that already. Okay. I’m sorry. Let’s move on to the next session. I invited you here because I saw an article. It was actually in today’s Veterinary Nurse Magazine, which is a great magazine. They do good work. I enjoy a lot of stuff. They had a case that scared the willies out of me. I wanted to get some more information on it, and get your thoughts on, one, treatment of this thing. But then two, also, what are the risks and how likely am I to have to deal with it, and just get a more clear view of it. The case that they talk about, that I want to put to you presented like this, there is a pet owner and she went to school for the day. She came home and her three dogs were acting normally. She has a Labrador, she has a Chihuahua, and she has a Jack Russell, so big dog and two little dogs. They’re all acting normally.

Dr. Andrew Roark:
Then she takes them for a walk. When she comes back, it’s been about two hours since she got home. The big dog is acting normal, but the two small dogs are not. They are panting and they have both vomited multiple times. Then they had a stiff gait in their hind end, as they walked around. The vomitus was described as frothy fluid with a red tinge. Then about one hour after they started showing signs, both of the small dogs had died. The bigger dog was starting to show the same signs, the stiff gait, mostly it was the panting and appeared to be in distress. This dog was rushed into emergency care and was thankfully saved. The diagnosis that was given was chlorfenapyr poisoning. I just want to start to talk about that and what that means. Starting at the high level, what is chlorfenapyr?

Dr. Tina Wismer:
Chlorfenapyr is an insecticide. It is labeled for use on both agricultural products and for in the household.

Dr. Andrew Roark:
Okay. We most commonly see this where? I mean, I guess, how do companion animal vets tend see this? How is this used in our households? Is this something that people go down to Home Depot and pick up, and they’re just sort of spraying around the house? It sounds like this is sort of the next level up from that.

Dr. Tina Wismer:
Right. This can only be used by licensed pest control operators. This would be the company that you would pay to come in and spray your house for termites, or if you had a severe roach infestation. You’re not going to be able to go to Home Depot or Walmart and buy this yourself.

Dr. Andrew Roark:
Okay. How often does this happen? I mean, I get my house sprayed for termites, because I live in the woods. Is this a common occurrence? Is it fairly uncommon? How concerned about this type of toxicity should I be?

Dr. Tina Wismer:
Sure. Fortunately, it’s pretty rare. This product has been on the market since about 2001. We see the occasional animal that gets exposed and has problems, but it’s not very common.

Dr. Andrew Roark:
Well, why do we think it’s uncommon? Is this type of chemical not used really widely by the guys who are spraying? Is it dose dependent, and so most pets don’t reach a dose that is going to cause clinical signs? Were all three of these dogs just the weird cases that had a reaction? Yeah. What’s your take on why we don’t see this more commonly?

Dr. Tina Wismer:
Right. Number one, I don’t think it’s very commonly used as compared to our other like pyrethrin-based products, which we know are quite safe around mammals. I also think that most people remove their animals from the household when this person is coming over to spray. All of our cases have been animals that were inside the household when the spraying was occurring.

Dr. Andrew Roark:
Okay. Is there anything that, on the surface level, I could see or I could advise pet owners to see? If pet owners call me and they say, “Hey, I’m getting ready to get my house sprayed. Is there anything I should be looking for in the pest control guys?” Because I have gotten those questions a number of times, is there any red flags or anything that I should just put out to them and say, “Hey, here’s something to look out for.”

Dr. Tina Wismer:
Right. Most pest control operators will give you the name of the product that they’re using, things like EPA registration numbers. You can check and see how safe is this to use around pets. Also, the most important thing, remove them from the environment.

Dr. Andrew Roark:
Yeah, no matter what.

Dr. Tina Wismer:
Yeah. Don’t bring them back until you can’t smell the product anymore.

Dr. Andrew Roark:
Okay. That’s a good rule. If you can’t smell it, then it’s probably okay. Am I paraphrasing that appropriately?

Dr. Tina Wismer:
Yes, yes.

Dr. Andrew Roark:
Awesome. All right. Sweet. Okay. What do we tend to see on clinical presentation in these dogs? I told you, the pet owner said that she saw, what other signs do we see beyond that? Are there things that we’re going to find on admission to the hospital that maybe the pet owner would not have seen?

Dr. Tina Wismer:
Yeah. These guys tend to have pretty impressive tremors, muscle tremors. Then we get secondary hyperthermia, your body temperature goes up.

Dr. Andrew Roark:
Got it.

Dr. Tina Wismer:
Some of these guys will also develop pulmonary edema.

Dr. Andrew Roark:
What temperature levels are you talking about when you say the temperature goes up, because I see a lot of nervous dogs that come in at 102.5. Is that what we’re talking about? Are we talking about 104, 105?

Dr. Tina Wismer:
We’re talking, these guys can present at like 107 or 108.

Dr. Andrew Roark:
Okay.

Dr. Tina Wismer:
So badness. Bad.

Dr. Andrew Roark:
Yeah, badness. All right. That’s super helpful. Okay. That way I won’t be like, “Oh my God, he’s 103, is this [inaudible 00:07:28]. Have you had-

Dr. Tina Wismer:
No, not chlorfenapyr.

Dr. Andrew Roark:
What other presentations… Clearly we’ve got muscle fasciculation, stiff gait, vomiting, panting, things like that. This is going to look like a toxicity of some point. What else looks this way? What are my other differentials that I want to separate this from?

Dr. Tina Wismer:
Sure. The one thing this looks very common or very similar to is hops toxicosis. If you’re home brewing beer, dogs that get into the hop pellets or they get into the hops flowers that are in your compost pile will present the same way. They’ll be extremely hyperthermic, they’ll be panting.

Dr. Andrew Roark:
Okay. That’s a question I don’t have in my repertoire for pet owners. “Have you been brewing beer?”

Dr. Tina Wismer:
Perfect.

Dr. Andrew Roark:
No, yeah.

Dr. Tina Wismer:
It’s pretty popular now.

Dr. Andrew Roark:
I mean, yes in way, but if I… “Have you…” Okay. People, yeah. That’s going to get me some weird looks from people when I… “Quick,” as I race them the back, “have you brewed any beer? Tell me now.”

Dr. Tina Wismer:
“If so, can you bring me some?” Exactly.

Dr. Andrew Roark:
Exactly. “If not, that’s good. If yes, that’s all so good because I’m going to need one.” Okay. My main differential is hops from beer brewing. “Have you had any insecticide sprayed? You don’t brew beer, do ya?” Those are two good questions. Okay. Basically same muscle fasciculations, high body temperature, vomiting, things like that, I’m going to see in both of those cases.

Dr. Tina Wismer:
Yes.

Dr. Andrew Roark:
What am I going to see on my diagnostic tests? Is there anything I’m going to see on the blood work that’s going to tip me off, either that I’m looking at these two, either hops or chlorfenapyr, or that’s going to differentiate them? Am I going to see on radiographs? Walk me through my diagnostics, if you don’t mind.

Dr. Tina Wismer:
Yeah. On blood work, you’re really not going to see anything initially, everything’s going to be normal. As the process goes on, things like CK are going to rise because you’ve got a lot of muscle activity. Then we can potentially see coagulopathies because of high body temperature, DIC. But nothing initially, it’s going be completely normal. Radiographs, once again, also going to look pretty benign.

Dr. Andrew Roark:
The main way I’m hearing from you is clinical history is your guiding light.

Dr. Tina Wismer:
History.

Dr. Andrew Roark:
That’s going to make it or break it.

Dr. Tina Wismer:
Yes.

Dr. Andrew Roark:
When the pet owner says to you, “Yeah. We had the guy in to spray the house today while I was at work.” How big of a blaring siren is that for you? Is that a big, red flashing, “This is an emergency.” Or is that kind of a, “Hmm, we’re definitely going to need to look into… We’re going to need to take this seriously.” Yeah. How many alarm fire is this for you?

Dr. Tina Wismer:
Right. With most insecticides that are contacted by the inhalation route, we’re going to see signs within a couple of hours, so we’re going to also ask about timeframe. But if we’ve got clinical signs that fit, we’ve got tremors, we’ve got hypothermia, then, yes, this is your nine-alarm fire.

Dr. Andrew Roark:
Yeah. Okay. I wasn’t sure how many alarms we could have. I thought five was the most.

Dr. Tina Wismer:
I don’t know. I just make that up.

Dr. Andrew Roark:
But maybe nine, if it’s a nine-alarm, I’m like, “That’s bigger fire than I had even thought.” I love it. I got it.

Dr. Tina Wismer:
Infinity, I don’t know.

Dr. Andrew Roark:
Yeah, exactly. I’m just going to be honest, my knowledge of the alarm system that firemen used is very limited. When you said nine, I was like, “Holy crap.”

Dr. Tina Wismer:
Zero. Zero, I have no idea. Zero. Zero knowledge.

Dr. Andrew Roark:
Okay. Yeah, there’s got to be a better medical way of describing this than in a fire alarm categories. Okay. All right. Moving on. I get the point. I get the point. We’re not sleeping on this.

Dr. Tina Wismer:
No.

Dr. Andrew Roark:
We’re not going to sleep on this. How do we treat it? This dog presents and I need to take action, what are my main concerns as I do this? How am I going to treat this?

Dr. Tina Wismer:
Sure. We want to get our body temperature down. You’re going to use things like IV fluids, wet the fur, a cool fan. Then for vomiting, pick your favorite antiemetic. For tremors, you’re going to use methocarbamol. You’re great. Muscle relaxant. Then, these guys actually respond pretty well to lipids.

Dr. Andrew Roark:
Okay. Tell me more about that. They respond pretty well to lipids.

Dr. Tina Wismer:
Sure.

Dr. Andrew Roark:
Walk me through that. That’s not something I reach for a whole lot.

Dr. Tina Wismer:
Sure. When we’re talking about lipids, we’re talking about the 20% solution that you use for partial parenteral nutrition, right?

Dr. Andrew Roark:
Okay.

Dr. Tina Wismer:
You’re feeding them through the vein. The thought is that we have certain toxins, including chlorfenapyr, that are highly lipid soluble. The thought is, if we give dogs lipids, we’re going to bind the toxin within the bloodstream and therefore it can’t get out and it can’t affect the receptors and cause clinical signs.

Dr. Andrew Roark:
Okay. Talk to me about a dosing regime and a timeframe for this, if you don’t mind.

Dr. Tina Wismer:
Sure. We start out with a bolus of about one and a half mils per kilo. You can give that over about 20 to 30 minutes. Then we drop down to a constant rate infusion of 0.5 mils per kilo per minute, and we’re going to do that for another 30 to 60 minutes. Right?

Dr. Andrew Roark:
Okay.

Dr. Tina Wismer:
The big thing is, if you’ve got a small dog we don’t want to volume overload, so make sure you go on the low end. Then we’re going to stop our constant rate infusion for about four hours. We’re going to then check and see if we’re lipemic. If we’re lipemic, we’re going to hold off. But if we’re no longer lipemic and our animal is still symptomatic, then they get another dose of lipids.

Dr. Andrew Roark:
What kind of timeframe am I looking for to see a change, or ideally, a resolution of symptoms? If I’m seeing muscle fasciculations and things like that, and I start to give some lipids and things, is this a 30 minutes in and I start to see improvements? Is this a longer play? Is this magic where you start to… It’s like deworming… or blood transfusion in a hookworm puppy where they just open their eyes and feel better? What are we talking about?

Dr. Tina Wismer:
Sure. With something like chlorfenapyr, typically it just takes like one dose of lipids. Usually by the time we finish that one to two hour timeframe, they’re much better. If we’re using lipids to treat something like marijuana or avermectins, things like ivermectin or Moxidectin, then you may need to give multiple doses of lipids before we see an improvement.

Dr. Andrew Roark:
Okay. Then what is the ultimate official cause of death in these cases?

Dr. Tina Wismer:
They can either die from severe hypothermia, or they can die from pulmonary edema.

Dr. Andrew Roark:
Okay. I’m assuming I’m going to pay special attention to lung sounds, things like that, as we’re treating and just try to manage to that.

Dr. Tina Wismer:
Exactly, yes.

Dr. Andrew Roark:
Okay. All right. Any other pearls of wisdom for me? Any words of advice as I would wade into something like this? Any mistakes I really want to avoid making?

Dr. Tina Wismer:
I think the important thing is to keep a pretty close eye on these guys for the first couple of hours that you have them. If they’re going to die, they tend to die pretty quickly.

Dr. Andrew Roark:
Okay.

Dr. Tina Wismer:
If we can get that temperature back down quickly, then they do well. Otherwise, then we have to manage DIC, and no one wants to do that. Just, let’s take-

Dr. Andrew Roark:
No, yeah. Let’s not do that. Awesome. Dr. Wismer, thank you so much for being here. Tina, I appreciate you so much. I really appreciate your time.

Dr. Tina Wismer:
Thanks for inviting me.

Dr. Andrew Roark:
That is our episode. Guys, I hope you enjoyed it. I hope you got something out of it. If you’re watching on YouTube, hit that Like and Subscribe button. If you’re checking out the podcast, the nicest thing you can do is leave an honest review wherever you get your podcast, it’s how people find the show. Means the world to me. Guys, thank you so much for being here. I hope you learned something. I hope you enjoyed your time with me. I hope see you again soon. Take care of yourselves, all right? Be well. Bye.

Filed Under: Podcast Tagged With: Medicine

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