Medicine

Dr. Peter Weinstein explores the feasibility of implementing a production-based compensation model for veterinary support staff with Cone of Shame host, Dr. Andy Roark. They touch on the potential benefits and drawbacks of this approach, discussing how it might improve job satisfaction, retention, and appreciation for technicians, assistants, and other support roles. Dr. Weinstein argues that while veterinarians benefit directly from production-based pay, the staff executing the bulk of the work often remain on fixed salaries, creating a disconnect in compensation fairness. The conversation also touches on broader topics such as profit-sharing and the overall drive to enhance workplace morale and productivity. They examine whether tying wages to service delivery could equitably distribute earnings and reflect individual contributions more accurately, potentially revolutionizing compensation structures in veterinary practices.

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

LINKS

Dr. Peter Weinstein on LinkedIn: https://www.linkedin.com/in/pawdr/

Veterinary Ownership Advocates: veterinaryownershipadvocates.com

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

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr Peter Weinstein is a husband, father, pet parent, veterinarian and leader. He has been involved with virtually all aspects of veterinary practice from a 15-year-old kennel kid to a hospital owner.  Organized veterinary medicine has been a passion as well with various roles and leadership and presidencies of Southern California VMA, California VMA, and Vet Partners. He is a published author, most notably of the E-Myth Veterinarian-Why Most Veterinary Practices Don’t Work and What to Do About It. Currently, he is teaching business and finance at the Veterinary College of Western University of Health Sciences. He likes to think of himself as a free-thinking change agent and disruptor who, because he has a daughter who is a recent graduate from  veterinary school, is working for an even better veterinary profession in the future. 

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome, everybody, to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. I am here with my good friend, Dr. Peter Weinstein. And we are talking about the question of should veterinary support staff be paid on some sort of a production model like a lot of veterinarians are? What are the benefits?

What are the drawbacks? Is that the future for vet medicine? Would that motivate a change in behaviors? Would it show appreciation to our support staff? Would it help us keep technicians, assistants, front desk people, kennel techs, would it help us keep them in the profession longer? Anyway, this is a great idea discussion.

We kind of sprawl all over the place. I really hope you guys will enjoy it. Let’s get into this episode.

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

Dr. Andy Roark: Welcome to the podcast. Dr. Peter Weinstein. Thanks for being here.

Dr. Peter Weinstein: Dr. Roark, always a pleasure to be with you, my son.

Dr. Andy Roark: I’m my son My son. Peter, what advice do you have for me? I, you know, it’s funny. Whenever we, I should start blocking more time on my schedule to do our podcast because we, we talk for hours around the podcast that we actually record. And you and I, you even had a sprawling conversation about the profession so far and what the future looks like.

And I think we sort of naturally in our conversation came to what I want to talk to you about today. But first, let me say, for those who don’t know you, you are a, a failed retiree. You really have not retired very well at all. You are an entrepreneur coach. You’re an educator and advocate for the vet profession.

You have worn many, many hats. You were just running the practice management program at the AVMA convention when I saw you last. You just do many, many things. And. You are one of the main people that I go to when I when I start thinking about the future and looking at my crystal ball and kind of trying to figure out where is this crazy profession going and and you and I have a lot of of philosophies that line up really well and we care about a lot of the same things and so I I came to you recently and I was sort of saying hey look you know Peter we’re looking at We’re looking at changes in profession.

We’ve got corporatization. We’ve got a lot of private equity things coming in. I’m looking at a push to raise the the salaries of our support staff, especially. We know that that’s a big a big factor of stress for our, for our staff members. And I was trying to talk about how do we do this? Like, how do we, how do we make life better for our support staff?

How do, how do we, how do we pay them better? And so, you and I have gone back and forth. We’ve had different conversations about production based pay. We’ve talked about how we pay doctors. And I’m always kind of interested in how those things sort of come together in your mind. And so, the question that I, you and I have sort of kicked around, and you sort of posed this question to me is, Does production based pay in veterinary medicine accurately or adequately recognize and reward the support staff who are doing the work that gets the patient taken care of.

And so I want to go ahead and start to unpack this because you and I have talked before about production based pay for for veterinarians. I’ve had a number of guests on the podcast talking about The benefits and and then the drawbacks and also like is this the culture that we want to foster in our profession?

So I’m fairly neutral on production based pay. But i’m definitely open to change. I am very interested in growing the income of our support staff and keeping them our profession longer and making this a more attractive profession for people to be in. So let me sort of bring that to a close and sort of start, stop talking there.

Yes or no, our current system of production based compensation for most veterinarians totally takes care of support staff in an adequate way. Do you believe it?

Dr. Peter Weinstein: No I think production based pay rewards the doctor for the services that they feel the pet is needed, has needed. However, the individuals who, in many, many, many cases, actually deliver those services are the health care team.

Dr. Andy Roark: Mm hmm.

Dr. Peter Weinstein: So the doctor gets rewarded by salary, and in many cases a percentage of what they put on the health care plan, treatment plan, estimate, whatever you want to call it. They hand it off for somebody else to do the work, who is paid a salary. So no matter how hard they work, per hour, or don’t work, they’re going to get paid the same amount.

Dr. Andy Roark: Right.

Dr. Peter Weinstein: But in many ways, the doctor keeps pushing the work, they keep making more money as the doctor, But the staff isn’t recognized for how much work they’re doing.

And that’s why I think that there’s a disconnect. And if we’re going to look at team based healthcare delivery, where everybody is working together from the person who answers the phone, Oh, and by the way, doctors who are on production, you don’t see clients unless somebody makes those appointments. Oh, by the way, doctors who are on production, you can’t see more people if you’re the one in the treatment area taking radiographs, pulling blood samples, and putting in catheters.

Oh, and by the way, doctor, you’re not the one cleaning the cage for that pet that was in the cage. But you are the one getting paid for all those services that you do. So that’s why I think there’s a disconnect in, and, and I, we have to figure out a way that rewards everybody on the team for all the work that the team does in a collaborative fashion.

Dr. Andy Roark: Is this idea, are you looking at this, if we could magic wand, you know, make it so that the, the revenue of the hospital went to the team based on how much they did or how much, you know, what they, what they generated, that would come back in sort of a, almost like a profit sharing. Are you imagining that as the team should be rewarded?

Or, Are you willing to go a step further? I have long maintained, one of my sort of core values is work ethic. I like, I like working with people who work hard. And I like to work hard. We have set up a lot of pay scales in vet practices, which I think are generally a good thing. But they’re almost entirely, the ones that I’ve seen, built on skill acquisition.

Or knowledge acquisition. The pay scales are not generally, they don’t reflect this person busts her hump and takes back twice as many patients in a day as the average, you know, say technician in our practice does. And I would say, this person might not be the most technically skilled person in your practice, but she has her hands on way more pets than any of your other technicians.

And I think that those, I think those truths are often unrecognized in practice. Do you, do you agree with that?

Dr. Peter Weinstein: Absolutely. But what you’re talking about is a subjective measure and we are an objective profession. In other words, we can measure now, unless we start to measure the number animals that an individual. Team member touches, then we’re making a judgment that says, well, they’re working harder than anybody else.

Maybe they should make more money. And then somebody complains and says, why are they making more money? So what we’re dealing with as well is an environment that’s somewhat competitive at all levels. And how do we create an objective measure of how hard people are working?

Dr. Andy Roark: Yeah. I mean, yeah, I agree with that. And I think that it gets tricky when you say, well, we’ve got one technician in the lab, and we have one technicians at the treatment room tech, and their names don’t really get put on the cases. I definitely get that. I have always thought that there was great value in recognizing, say, the technicians who are doing more senior blood work

than the other technicians. And maybe that’s because the doctor they’re working with is better at recommending senior blood work. But I’m finding more and more that’s not really true, you know. When we have well leveraged technicians and they know what the plan is and they know what our wellness protocols are, they’re in there talking about heartworm testing, you know, senior blood work.

They’re talking about, in some cases, they’re talking about dentistry. They’re talking about a lot of services that can be objectively measured. I think it’s, it’s a little bit challenging to tie those services to the individual technician or support staff, but that’s kind of my holy grail. I think Peter is, I really would, the way we track services for doctors, I would love to try to figure out some way, and it’s going to be sloppy because it’s because of how, how the team works together.

I really think that there’s great value in that. I think that there are some support staff members who just absolutely crush it. And I think that they could. share best practices with the rest of the team. And, and also I think they should be compensated for their skills and their effort in a way that, that, I don’t think we’ve done that very well so far.

Dr. Peter Weinstein: Well, let’s put it this way. When you, as a Dr. Roark schedule my pet, Bruce, for a dentistry, the invoice gets processed

Dr. Andy Roark: Mm hmm.

Dr. Peter Weinstein: the end of the day and everything on the line items associated with that dentistry goes to Dr. Roark 

Dr. Andy Roark: Mm hmm. 

Dr. Peter Weinstein: in most cases, but Dr. Roark never touched the teeth. except to check and make sure that they were clean.

Dr. Andy Roark: Yeah, I looked at them. I looked at them.

Dr. Peter Weinstein: Yes, but you didn’t touch them. So what if that invoice said your dental hygienist today was Susie, her assistant today was Judy, and the animal caretaker who took care of your pet’s cage was Jane. We are not giving, oh and by the way your receptionist today was Crystal. We’re not using our invoices to identify and recognize the team

for the work that they’re doing. And I would suggest that every dentistry should be linked to probably a credential technician and an assistant. Every surgery should be linked to a credential technician, an assistant, and a doctor. Because I think it’s time to start recognizing them in the same way that we don’t, we have started to do more and more, quote unquote, tech exams.

But does it give credit to the technician by name who did the tech exam? So now we’re going to make it even more complex and we have a hard enough time getting invoices right in veterinary medicine And especially if you’re on production based pay where every line item could determine what your paycheck is think about now we have to give credit to the technicians now I’m not taking away from the doctor But I am wanting to give credit to the technician who was tasked to do the work And we have to leverage it.

I think, you know, you’re talking about giving more credit to the techs. I think we need to give more credit to the CSRs because they’re the ones who are making the appointments. And they’re the ones who check, in many cases, checking clients out. And they’re the ones, in many cases, who are dealing with the really difficult clients from an emotional standpoint.

Dr. Andy Roark: Well, it’s,

Dr. Peter Weinstein: It’s a team based effort. We can’t get the rowboat down the lake unless everybody is stroking at the same cadence.

Dr. Andy Roark: I, I, I do, I completely agree with that. 

 Hey guys, national veterinary technician week is coming at ya. And if you’re someone who wants to do something nice for your technicians and you haven’t thought about what yet. Don’t worry. I got ya, but you need to add now my new card game, Dr. Know-It-All is out. This is a veterinary specific card game. 

It is vet trivia. It is fun for the whole team. You can play with the whole team. It is fast. It is funny. You will have a really great time. Anyway. it is geared up here. Ready? I’ve got it at my house. I will send it. Directly to you or to your practice. All you gotta do is buy a copy. 

I’ll put a link in the show notes, head over to drandyroark.com. Grab a copy grab a copy for everybody. This is something that the techs are gonna really love. The trivia questions are meant to be at the level of the veterinary technician licensing exam. And so they are a little bit spicy in their questioning. 

We have a hard mode that you can use with the doctors. We can make this much more challenging. We can also make it much more easy for onboarding new people in there. You know, they’re new to the vet medicine. They just want to learn. So anyway, got you covered from an education standpoint. Gotcha 

covered from a fund standpoint. Gotcha covered from a gift standpoint. I really, I think I got you covered all the ways. All you gotta do is get yourself a copy of Dr. Know-It-All and get it wrapped up for the technician that you want to say thank you to anyway, that’s what I got. Link in the show notes. 

Let’s get back into this episode. 

Dr. Andy Roark: I have been a big proponent for a long time. I think the front desk is the most underrated position in the practice and they have for a long time. That’s not taking anything away from anybody, but because they’re up front, most of us don’t see them and think about them and what they deal with.

And so I, I don’t think that they get necessarily the recognition they should. I had this thought. I’m just curious if you’re going to bite on this. I yeah. So, we was at the AVMA convention and we were in Austin, Texas, and I went up to a restaurant and I ordered myself, like on the screen, I punched in my, well I put in my phone number, I punched in my order, and then after I had ordered self checkout on the screen.

It then asked me for a tip. It asked me if I would like to tip. And, I mean, I swiped my own credit card. I did the whole thing. And I just kind of looked at it like, I guess this is where we are in that I am not tipping. And first of all, it asked me for a tip before I got my food. It wasn’t even like, didn’t you like your food?

Would you like to tip? And I just thought, this strange idea of tipping has become so ubiquitous. I mentioned it. I wrote an article and said, Are We Ready for Tipping? And I got a lot of flack for even I don’t know, asking the question of whether or not Vet Medicine was ready for this. Would you be open to tipping the staff at a vet clinic or do you think that’s totally gauche?

Dr. Peter Weinstein: would not be adverse to tipping the staff at a vet clinic if it is done by the leadership, management, and ownership of the clinic, which of course doesn’t make it a tip.

Dr. Andy Roark: That’s not a tip, that’s a bonus!

Dr. Peter Weinstein: Yes. I would have a problem somebody individually giving a tip to the technician who did the profi, for example. And I, and I think we’ve seen tipping quote, unquote, occur

when house calls are made or other things, and probably not even being reported. In those situations where everything is pretty much automated and you get that request for a tip, the reason I might give a low end tip, maybe not the 20 percent I normally give, but 12 to 15%, is because there is still somebody putting the coffee in the cup, putting the lid on the coffee cup, making the latte, and doing the work there.

Now whether that gets bundled into the cost of the coffee, I don’t know. In in many restaurants the tips are all brought together so that the busboys, who do the heavy lifting. The busboys in a restaurant are the equivalent to the technicians in many cases. Maybe they’re the assistants, because the waiters and waitresses would probably be the technicians.

But then who’s the doctor? Anyhow, the chef, the chef would be the doctor.

Dr. Andy Roark:  Okay, okay, 

Dr. Peter Weinstein: And then you have a sous, you have sous chefs who doing a lot of the line work that you never get credit for. I mean the, Chef Ramsay gets all the attention, but who’s actually doing all the work?

Dr. Andy Roark: No, I, I like it. I think, I think that may, I, I’m not even, I’m not even advocating. I like to bring it up. I’m just when I see tipping like that, it just, in my mind, it’s interesting. Clearly, this is a, this is a strategy that other businesses and other industries have employed to try to increase the income of people who are working there without raising the actual prices.

And so, I think that’s why it pops into my mind. I’m not, I don’t know that I feel good about it. I think. I think there’s probably lots of ways it can go badly, but I just, as we start to talk about recognizing the team, things like that, it just, it occurs to me that, that that is something we see in other, in other industries.

And I like your analogy too, of the way, my understanding is the way those tips work is, they go into a pool, and it gets split amongst every, the people who are there. And I think that that’s a fair way. Of kind of compensating across the board again. I don’t know that we’re ready for tips or that we want that, but it’s just that you should always be looking at other industries and sort of seeing seeing what they what they do.

Dr. Peter Weinstein: I’m sitting here and you know, you know I’m in Los Angeles and I’m sitting here and I’m thinking of all the plastic surgeons in LA, you know, do you think that they get a tip for doing a perfect nose job? Do you think they get a tip for, you know, we don’t tip in human healthcare in most cases, even if it’s the elective procedures? We don’t tip our dentists.

And I mean, as much as, and, and I’ve said this before and I’ll say it again, as much as veterinary medicine is a service industry that provides healthcare, we don’t tip on the healthcare side of things. It just seems to be a it, it’s, it’s, it just doesn’t fit in being a healthcare professional from that standpoint.

On the other hand, you all read All Creatures Great and Small, and let’s just say that James Herriot got tipped with bacon and eggs and sides of beef but that was a different era. And so, it’s really, I mean, if you want to look at tipping, it goes back to something you, you superficially talked about earlier, which is profit sharing.

Dr. Andy Roark: Yeah,

Dr. Peter Weinstein: And, and I, I really do think, that that’s in the sense, essentially, that’s what production based pay is, but let’s look at profit sharing for the entire team and not just for the doctors, although the doctors do deserve to be rewarded for the work that they do. We can’t do this if we don’t have a team to support us.

We cannot make as much money for the practice without a team to support us. And Unless the doctors start to take some of their production based pay and give it to their team. Hey, Andy, you want to give some of your production base to your team? 

Dr. Andy Roark: I mean, 

Dr. Peter Weinstein: I put you in a corner there.

Dr. Andy Roark: yeah, ooh yeah, no, that’s I think that that’s the, that’s the question that comes into everybody’s mind, right? Is, is we say, well, should we play the team on production? And then the doctors kind of go, well, I’m, you know, I’m, I’m, I’m not interested in giving up what, what I’m earning and this is how I’m getting paid and again, I, I think that that’s very, I don’t think anyone expects that level of altruism from the average veterinarian across the board of let me, let me reduce my salary and hand it over to the support staff.

I think that that would, I think that’d be a lovely thing, but we also know from the Merck 2023 well being study that student debt is one of the main stressors, especially for young vets, and like, so people have got, they, they’ve got their own sort of burdens that they’re, that they’re carrying.

Dr. Peter Weinstein: Well, and again, ladies and gentlemen, veterinary medicine, although you may think it’s a not for profit business, is a for profit business. 

Dr. Andy Roark: Yeah. 

Dr. Peter Weinstein: 50 percent of the hospitals out there probably aren’t making a profit when it comes down to it, but we’re a for profit business. Which means, theoretically, we should have a budget.

Theoretically, we should be looking at the numbers that, from which that budget feeds. Whether it’s income or whether it’s expense. And, when it’s all is said and done, as the practice does better, the team that helps the practice do better, if you are an, an above board owner, we’ll turn around and say, Thank you for helping us get us to where we are.

Dr. Andy Roark: Mm hmm.

Dr. Peter Weinstein: Because that profit, let’s just say we’re at a, a really nice number of 20% profit. What if we took 2% of that profit? So as the owner, I only got 18%. And let’s say that’s $2 million. Now Andy, get your abacus out and tell me what 2% of $2 million is

Dr. Andy Roark: Fast math!

Dr. Peter Weinstein: So $40 million, $40,000. What if we took that amongst our team of 20? And spread it out in some fashion that represents both subjective and objective work and maybe longevity. And if one member of that team got a thousand bucks, maybe even a quarter or at the end of the year, maybe they got 250 a quarter.

How big would that be for somebody who’s only making 18 an hour?

Dr. Andy Roark: Yeah.

Dr. Peter Weinstein: I mean, that’s, you think about the motivation there that doesn’t necessarily impact the doctors. Because they’re still doing production based upon their budget and everything else. It’s really looking at an owner and saying, I want to keep my team.

I want to recognize my team, those who work hard, and I want to reward them for the work that they’re doing.

Dr. Andy Roark: You know, I’ve heard, I’ve heard of practices talk about this a number of times. I’ve talked to practitioners about profit sharing and things in the past. And I think that you’re probably understanding. I like the way you’re looking at it as a, as a way of rewarding and showing appreciation. I think that a lot of people in vet medicine have tried this as a motivational tool.

And, and generally it doesn’t work that well to motivate. You know, they say, Oh, we’re going to do a profit share. I think people very much appreciate it, but I don’t think a lot of our support staff is not, they’re not super money motivated driven or the frequency that we’re making sort of payouts and things like that doesn’t, doesn’t, it doesn’t click the, you know, the box for them the way that people sometimes think that it will.

And so I, yeah, I, I, I like this as a, as a way of rewarding and, and and showing appreciation. I think that makes a lot of sense.

Dr. Peter Weinstein: Here’s, here it is in a nutshell, for lack of a cliche. If we run our businesses so that passion drives profit, we will have a successful business. But if we run our businesses where profit tries to motivate passion, you’ll fall on your face.

Dr. Andy Roark: Yeah, that’s I think that’s I think you’re spot on. I think that’s a really good way to summarize what I have seen with profit sharing that that totally makes sense. 

Dr. Peter Weinstein: Keep the passion, because passion is really, and, and maybe it’s overused, maybe it’s trite, but we’re not in this field, you know, you do, Andy, do a, do a survey sometime of your, of your followers and see how many people entered veterinary medicine to get rich.

Dr. Andy Roark: Right.

Dr. Peter Weinstein: You know, we’re in it because we have a focus, we have a direction, we have a desire to make a difference.

That’s passion. And reward passion. And I think we’ll all be in a much better position.

Dr. Andy Roark: No, I agree. Dr. Peter Weinstein. Thanks so much for being here. Where can people find you online? Tell us tell us a little bit about your entrepreneurship program that you’re doing right now.

Dr. Peter Weinstein: Thank you, Andy. We just released a a program that’s focused on helping create the next generation of veterinary entrepreneurs. You can find that at www.veterinaryownershipadvocates.com. And it’s an online course. We have 24 hours of race approved CE with a monthly, what we call a mastermind call to talk about how you can be successful, the problems that you’re having in running your practice.

And so we’re really hoping to build a community of entrepreneurs to keep veterinary medicine independent And to build this next generation of hospital owners So that’s one of my passions and the best place to find me is probably on linkedin and you’ll find some of my thoughts and opinions and sharings there and you know It’s hard not to find me at most of these meetings, too.

I’m the one walking behind andy in great awe

Dr. Andy Roark: Right. Thank you so much for being here, guys. Thanks for tuning in, everybody. Take care of yourselves.

 And that’s what I got for you guys. I hope you enjoyed it. I hope you got something out of it. Thanks to Peter for being with me. I always enjoy kicking ideas around with him. It always affects my thinking. I’m gonna definitely have to meditate on this episode a little bit for a while. I think there’s a lot here.

So anyway, guys take care of yourselves. Be well. I’ll talk to you soon. Bye. 

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

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

LINKS

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

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

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

EPISODE TRANSCRIPT

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

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

And I don’t know if we can talk those people out of that, and I don’t know if we should if we should take it personally or not. So, anyway, those are the type of things that we get into and discuss. It is a really fun episode. I hope you guys will enjoy it. Let’s get into it! 

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

Dr. Andy Roark: Welcome back to the podcast Kelsey Beth Carpenter RVT. How are you? I’m pretty excited. I think this might be my third time on the podcast.

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

Kelsey Carpenter: like a robe or something, you

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

And that’s, that’s what you get.

Kelsey Carpenter: I can’t wait.

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

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

Kelsey Carpenter: Yeah, I was gonna say. 

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

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

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

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

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

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

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

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

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

Dr. Andy Roark: Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Kelsey Carpenter: Well,

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

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

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

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

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

Dr. Andy Roark: Yeah.

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

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

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

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

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

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

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

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

I just think that’s the easy

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

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

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

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

I’d be following those accounts for sure

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Where do you, where do you fall?

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

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

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

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

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

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

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

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

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

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

Dr. Andy Roark: Yeah. 

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

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

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

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

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

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

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

So where can people find you online?

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

Dr. Andy Roark: Ha, ha, ha,

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

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

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

Dr. Andy Roark: You’re so old. 

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

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

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

Dr. Andy Roark: The Dull Man’s Group.

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

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

And that’s what I got for you guys.

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

I’ll talk to you later.

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

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

LINKS

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

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

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

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

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

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

EPISODE TRANSCRIPT

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

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

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

And so anyway, it just. Great conversation. Ron is so wonderful and positive and helpful. And just, I feel like I took a lot away from this episode. I hope you will too. Let’s get into it.

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

Dr. Andy Roark: Welcome to the podcast, Ron Sosa, how are you, my friend?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How do you manage those things?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ron Sosa: Yeah. 

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

I’ll talk to you later. Bye. 

Beloved influencer and LVT, Sarah Parsons joins us to talk about her journey building a brand online. Join Dr. Andy Roark and Sarah Parsons, LVT, on the Cone of Shame Veterinary Podcast as they dive into the world of brand building in veterinary medicine. Sarah, the creative force behind the popular @Wat_Really_Happens_at_The_Vet social media channels, shares her journey and insights on leveraging platforms like TikTok, Instagram, and Facebook to engage with veterinary professionals. This episode explores the importance of creating content that resonates with a professional audience, the dynamics of social media growth, and tips for veterinary technicians aspiring to establish their own unique brand.

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

LINKS

Sarah Parsons on Instagram: https://www.instagram.com/watreallyhappensatthevet/

Sarah Parsons: www.vettechsarahparsons.com

Team Leads Summit: www.unchartedvet.com/tls2024

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

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Sarah Parsons, LVT, is a distinguished social media Influencer within the veterinary community, renowned for her engaging portrayal as the “silly vet tech” Through vibrant videos showcasing life in Vet Med, Sarah inspires laughter and learning among Veterinary Professionals. She is deeply passionate about fostering a joyful and fulfilling workplace environment. Her dedication has led to being one of the co-founders of Camp VetMed. In addition to her impactful career, Sarah is a devoted mother to two boys. She resides on a ranch in Houston, Texas, where she cherishes outdoor activities, sports, and quality time with friends.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast.I am your host. Dr. Andy Roark guys. I am here with Sarah Parsons, LVT. For those you do not know her. Sarah is the creative force behind the What Really Happens at The Vet Instagram TikTok young person social media outlet that she runs. She’s an LVT and she makes really funny videos and content. We talked about in one of her videos about getting 48 million views and like she’s got a string of hits . If you want to find some stuff that is positive and funny check her stuff out. She’s really I– she she makes me laugh.

And so yeah, I was really glad that she was here. We were talking about brand building today. We’re gonna talk about what it means to build a brand in modern social media. And that’s really her interest is in video creation and in putting stuff out online and starting to build a following. And so I know a lot of people are interested in what it means to build a brand as a vet professional. Maybe specifically a veterinary technician and we, we get into that. And so she’s got some good advice. It’s been, it’s fun talking to her sort of about her journey. I think you guys will enjoy it. Let’s get into this episode.

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

Dr. Andy Roark: Welcome to the podcast, Sarah Parsons. Thanks for being here.

Sarah Parsons: Hello! Thank you for having me! Super excited! Aaaahhh!

Dr. Andy Roark: It’s my pleasure. For those who do not know you, you are the create, you are an LVT and the creative force behind the what really happens at the vet Instagram and TikTok channels. You are very funny. I genuinely really enjoy. I really enjoy your work.

Yeah, you have got, you have amassed a massive following. You are one of the most popular veterinary influencers that I see out there. I, you are definitely one of my favorites for reasons that we’ll talk about here in a moment when we get going. You are going to be speaking at the Uncharted Team Lead Summit with me in in September, September 17th.

Tickets are going to go on sale in July. It’s a virtual summit for Head technicians, head CSRs, things like that. Yeah, so, yeah, let’s go ahead. I want to go ahead and just sort of start off. I want to talk today about brand building, and it’s something that I think a lot of people are really interested in.

It’s sort of an interesting topic. I want to talk to you. Honestly, I sat down and I was, I was, you and I were going to do some work together in some other ways. And so I had a couple things I kind of wanted to do with you, but, but then I started, I was like, what is the one thing that I would honestly like to talk to Sarah about?

And it’s this. Yeah. So this is, this is my, my, my real topic about, I want to kind of look at, I want to look at building a brand. I want to look at building a brand as a technician or support staff member. I want to talk a little bit about modern social media. I want to talk about vets, the vet world on modern social media and stuff like that.

So let me, let’s go ahead and start off with your resume. Can you kind of lay down Where do you publish your content? You know, how long have you been doing it? Just give me a, give me a picture of the what really happens at the vet empire.

Sarah Parsons: Of course. So it’s, you know, I feel like it’s a lot more simple than really, you know, how it’s being portrayed. But I do post on I know.

Dr. Andy Roark: Roll with it. Just act you’re like as one influencer to another, like take yourself very seriously and with it and roll with.

Sarah Parsons: No, there’s really a lot more that actually goes on behind the scenes and what looks at it. Cause I think a lot of people say like, oh, she posts funny videos and like, and what?

That’s, you know, and basically that’s it. But there’s a whole lot more that goes into it. I do post videos. That’s, you know, my main platform, of course, is posting my social media videos. I post on TikTok and Instagram and Facebook, you know, cross, cross posts on most of those platforms and and everything.

And I post funny, silly, relatable videos about veterinary medicine. My handle is what really happens at the vet. I honestly thought that my main audience was going to be pet owners. So whenever I started that, that is kind of why the handle was what it was.

And that’s just kind of how I started and how my thought process was starting off. But I realized very quickly that my audience was mainly veterinary medicine, veterinary professionals. I’m talking veterinarians, vet techs, veterinary assistants, CSRs, practice managers, anyone in the veterinary professional field.

And the reason, you know, I think people resignated with these videos is because they’re so relatable to veterinary medicine. You know, if you know, you know, whenever I post my videos, I think pet owners, you know, You know, realize what’s going on in the videos, but veterinary professors are like, Oh my gosh.

Yes. That’s so true And I love posting those videos But it basically became this, you know, platform where I would be talking to other veterinary professionals and so it kind of grew from there and I, and I’ve wanted to expand and do more things other than just videos.

I started doing Project Golden Vet, which was me going and gifting these gifting free things to other, you know, hardworking, deserving clinics or, you know, in Vet Tech Week doing the same thing, you know, gifting things to other vet techs.

Dr. Andy Roark: So one of the things I think I like the most about you is when, when I look at a lot of your work, it a lot with me. Because I, I have had that same journey of talking to vet professionals. Cause I also, my original plan was to talk to pet owners. I just, it never sparked the same enjoyment for me as talking to other vet professionals. And no, no shade on, on pet owners. You know what I mean? But like, and, and again, I see a lot of people who really love talking directly to pet owners. And there are some great Adam Christman is, is an example.

Oh, he’s fabulous. He does great work owners. And there’s just, there’s, there’s lots of others, but he’s the first one that pops into my mind. And like, but he clearly loves it. And I just, I never got that excited about making pet education videos. I, did it, and I went through a phase where I alright, I’m gonna really try this.

And it just, it never lit my fire. Like talking to other vet professionals who get it and like having those sort of inside jokes. And so I I really love it. Talk to me about about the Golden Vet Program So I love this idea that that you that you sort of show up and you do something nice. What like what did that how did you get that idea that like you were gonna?

Presumably you just, this is always a fear that I have is I, I think, I think about half the vet clinics in America, probably someone in there knows who I am. Like that’s, but that’s it. Like tops like.

Sarah Parsons: Oh yeah, I could just say Andy Roark and immediately people would know who I’m talking about.

Dr. Andy Roark: but I, but I never, never that for granted or anything. And so it would, the idea of me walking into a vet clinic, like I’d have to be primed.

I would have to know that someone there knows me and, not going to just look like a weirdo. Like, like, how did this become a thing in your life? So it’s imagine coming being like, sir, I, you have an appointment, sir? I’m like, I would,

Sarah Parsons: I was afraid of that happening too, but I, I made it, there’s a, again, a whole lot of behind the scenes that went on to make sure that that didn’t happen because not everybody knows who I am. So yes, whenever I did Project Golden Vet and I think a lot of people thought I was crazy when I was like, yeah, I’m just going to go give free stuff to these clinics and just really contest.

And they’re like, okay, Sarah, great. Great. Like. How does this benefit you in any way? And I’m like, it doesn’t so what I would do, and I would work with like, I would get, donated items or sponsors and stuff. And I would I’m, I get this big basket of just stuff, gift cards and just stuff that veterinary professionals can use, like those little clippers off of Amazon and just a whole bunch of different items.

that veterinary professionals would use, and I made sure I said, to all these, you know, companies that I would work with, I said, I want everyone to have one. I’m talking from the veterinarians and practice managers all the way down to the janitor a clipper. 

Andy Roark: You get a clipper! You get a clipper.

Sarah Parsons: Exactly, you get a TV! And so, what I would do, and this is a kind of, you know, sneak peek as far as behind the scenes, what people don’t know what happens, is the way I would surprise them because it’s actually all those were genuine surprises Whenever I would go and I would film their actual responses actual reactions I would contact the practice manager first And I you know, I would honestly get on the phone call the clinic and pretend i’m someone else And I would like 

Dr. Andy Roark: Hello, I’m calling for Cheryl.

Sarah Parsons: Yeah. I would be like I just I had to get the practice manager on the phone somehow and then tell when I was like And I would tell them, I’d say, okay, is anyone else listening?

And they’d be like, no. And I’d be like, okay, not on speaker, like, and everything. And they’d be so weirded out until they found out why. And I’d be like, okay, cool. I’m actually Sarah. This is the reason I’m calling. And we would schedule a time, you know, the practice manager would help me schedule time, you know, for like a, quote, fake staff meeting.

And that’s whenever I would go and I would, you know, we’d provide lunch and I would go and surprise them during that time. The practice manager would be in on it. I would have another person come help me film and whatnot. And so that’s how I kind of, you know, got all that done. But it’s also when, you know, a lot of the clinics were nominated.

and the whole point of it was to also make sure that we feel appreciated in veterinary medicine and it’s important to get that on film, in my opinion, so that Everybody else knows that like, oh my gosh, we are appreciated as an industry.

like we’ve said, you know, before, it’s so hard in veterinary medicine. You get in this headspace of just, oh my gosh, depression, compassion fatigue, burnout. It’s just out the wazoo. So I think, movements like that and, you know, in videos and everything, anything I can is just so, so important to show veterinary medicine that, you know, it’s possible.

Yeah, 

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Dr. Andy Roark: What do you think are the to sort of starting to build a brand as a technician? So let’s sort of talk about that a little bit because you’ve you kind of started into this and you were you enjoyed making videos and then my impression you for a bit in the past has been that it kind of um, I don’t think that you expected exactly what you got.

Talk to me a little bit about that. What is, what is, if someone came up to you and said I’m a technician, I’m interested in building my brand. First of all, what does that, what does that even mean to you? 

Sarah Parsons: Building a brand, in my opinion, this is just me personally building a brand is, I think having something that is unique to, something that’s unique that you can give people and you can show people and something that, exemplifies yourself. So in building a brand, I think you do have to find something that is unique.

And you know this as well with Uncharted. Uncharted is a very unique program. A lot of what you do, there’s uniqueness behind it. And whenever people say, Oh, I want to do social media videos. I want to make my own brand. I’m like, okay, well. What is it going to be? Oh, well, it’s just going to be some funny videos, maybe some educational videos and whatnot.

And I think you really have to narrow down your niche. And whenever you are building that brand to who you want your audience to be and who you are talking to, because if it’s just, again, you know, I thought it would be pet owners, but then it turned out to be veterinary professionals. Once I found that out, I kind of zeroed in on that and I was like, okay, there’s so much I could do with this.

And so those are my videos. I make silly, funny, relatable videos. No, they’re not really educational, but people can kind of understand that I know what I’m talking about whenever it comes to the industry, I guess. And building your brand, there’s, it’s not just making the videos.

It’s going out of your way to do what other people really haven’t done or figuring, I don’t know, it’s figuring out your own style, I guess, think 

Dr. Andy Roark: I think your own style is a big part of it. I i’m curious if this is true with you. I I never had a big plan And I think people ask me about like how i’m making a brand and like they’re scaffolding And it’s funny. Um You know, we had a huge discussion with, the team today about Game of Thrones, and we were, I don’t know, it totally got in talking about Game of Thrones.

we’re talking about George, George Martin who wrote Game of Thrones. He has this quote that I really like, though. He’s talking about other people writing books, and he said, he said, there’s two kinds of authors. architects And the architects are the people who scaffold everything. They have an, they have a plan.

They know what they’re building and they go in the building. And he said, I’m more of a gardener where I just plant things. And then, you know, see it see what grows here and I water it. And the other stuff just kind of dies. And I just kind of go, Oh, I just kind of go on. And I, I was much more of a gardener of

You’re just, and what I mean, I feel like that’s probably the path with you as well, at least, especially talking to vet professionals is like I cast some seeds talk to pet owners and like, it’s not that they didn’t grow, it’s just that they didn’t spark joy in my heart, you know what I mean?

And so I like, kind of, kind of let them wither in the sun and then kind of, kind kept watering the part that brought me joy. And it kind of, I don’t know, it went there. I think, I think a lot of it too. So I sort of look at your, your career and then, and then my own is like, you know, when I came, When I came up, really, started building a brand and things like that, Facebook was the only game, it was Facebook and Twitter.

And that like the only game in town, and, and I, I liked Facebook at the time, and kind of what it was, and, and it worked for me, and I liked to tell jokes, and Facebook was good for like, at the time, letting me, letting me do some, some writing in paragraph kind of format and things like that. And then now now the world has kind of changed and it’s just it’s not the same and that path isn’t necessarily open. But then here you come and you’re kind of making these these short 60 second videos And and they and they they work really well and you found you’ve sort of found this medium that works for you and it’s funny.

I I think it’s because of how sort of what i’ve done in the past I struggle to make things in 60 seconds that are really funny and sort of punchy. It’s just it’s not it’s not my art. And so when you’re saying you should You Find the thing, you know, find the thing that’s your thing or find your style. I think that that’s really true.

And and I think that, you know, sometimes your style matches up with platforms that are available really well. And sometimes I think it doesn’t. I think there’s probably some really amazing writers out there, but I think it’s probably much harder. to really build your brand. There’s just not as many opportunities and people just don’t read like they did 10, 20 years ago, you know?

Sarah Parsons: I can say that because my sister’s an author and she’s trying social media and it is a lot more of a struggle because she’s, you know, because again, people don’t read as many books as I think they used to. There’s still a, there’s still a niche for that. There’s still, you know, area, you know, for growth there.

But it, I think it’s a lot more difficult for her. And I think honestly, luck was on my side as well. Like, I don’t, I don’t chalk it up to like, Oh yes, this was a plan all the time. And I made myself the way it is. Like, I think a lot of it, like you said, was luck and just like, once something worked, then you zero in on that.

So I definitely agree with that.

Dr. Andy Roark: Well, it was definitely luck for me. I tell people that all the time, like I, you know, we, my wife and I had our first child in 2008 and that’s when I graduated from vet school. So I was a brand new vet with just wide eyes. And I got on Facebook to share pictures of my baby with my family and like all of these, and Facebook was just taking off and they were like, sure You’re come on.

And it was was no, like there was no money driving it. It was, there was no algorithm. It was just like, got. Whoever, posted in order it was there. And it was just, but it was, it was kind of this, this right place, right time. But I think that the opportunities keep opening up for people, but I, I don’t know.

I think you have to find your art. I think you have to find your style. I think that was, that was part of the thing for me. And I just kind of wanted to see how you feel at this is for, for me, I think one of the mistakes that I think a lot of people make in sort of Working online or trying to sort of build a brand or something like that.

Is that they, they really focus on trying to go viral. And I think what I did that worked well was I, I put that out of my mind. And I tried to find people who liked my specific goofy self. And, and tried to talk to them again and again and again. You know what I mean? And, and you, you, you zoom in on those people who go, Oh, I think she’s really funny.

And if, If someone likes your different types of dogs on the scale video, they’re probably going to like your you know, I don’t know Everyone Finds Underwear and Dogs like whatever, whatever the other, the things are, but like, I don’t know, I, I’m curious if you, I’m curious if you agree with that.

I’m curious if you have found that kind of zeroing in on what you enjoy and what you get feedback on has been beneficial over continuing just things. I don’t know. What do you think?

Sarah Parsons: Yes. No, I actually wholeheartedly agree with that because if your channel, whatever it is, for me, it was my, Tik mainly, for me, it was my channels. If you don’t have a purpose or something that you are adding value to your followers, your viewers, so if you’re just basing it off of like, I just want the video to go viral, then yes, I don’t think it’s going to work out very well if you’re just like, I want this one to go viral.

Like then if that’s the whole point, then it’s not going to, your, your channel has to have some sort of value to your viewers. So whether that, you know, means they’re coming to me because they are a self conscious veterinary technician that, you know, just needs those laughs or you’re a veterinarian that just, you know, wants to.

You know, find happiness at the end of the day, whatever, you know, those are, you know, the people that you’re finding. So you have to really focus on that and adding value to other people’s lives. 

I still actually remember one of your older videos and this is one of the ones that inspired me to do my channel. It was a technician talking to a pet owner and the technician says, you know, okay, so what’s wrong with, you know, Max today? And the owner says, Oh, you know, nothing that can, or sorry. No, he says, is there anything Max could have eaten or gotten into that you could think of? And the owner’s like, no, I really can’t think of anything.

Dr. Roark comes in. Okay. I hear, you know, Max hasn’t been eating. Oh, he ate an entire meatloaf. It I died because we all know that’s so relatable the vet techs go in and we’re like anything and then the veterinarian comes in and they Give you the life story and you’re like, well great I just you know, I look like I can’t get a history and everything But just the fact that it’s so relatable and so and I also love that You know, one of your ways your brand got built up is also, you know, advocating for the veterinary technicians and for education and everything.

So the fact that you add that value to people’s lives and that you have these all these other things to offer, people are curious. People click on your profile and they say, oh, what is Dr. Rourke about? Like, I like this video. What else do they have? So, yeah. In that, once that starts happening, then I feel like people have developed their own brand whenever they’re like, What else do you have?

Oh my gosh, I love their stuff. Let me follow them. Let me keep up with them.

Dr. Andy Roark: Yeah. Do you still think that consistency is the key in posting? So so let me so let me me give you a hard choice here. from like one to ten, ten is a maximum number Output of videos or content is maximum content output That’s low quality and one is minimum content output, but high, high, high quality.

Like you have really worked hard on this. Where are you on this, on this spectrum? Are you, are you team just fire, fire, fire, fire something will be good? Are you team don’t let it go until it’s perfect? Where are you in that spectrum?

Sarah Parsons: I’m more on the end of the higher quality, but also it’s important to be consistent. So, it is, I, there’s a both, but I would say let’s say a four. Because I’m more on the end of higher quality. If I don’t love a video that I, I’m about to post. I don’t post it. I’ve gone through and I’ve deleted drafts and I’ve been like, nope I’m not gonna post that one just cuz like if I haven’t posted it in like a week and it’s just still sitting there Then I’m like, I don’t and then it’s not gonna do well in my mind, you know And sometimes you know ones that you think are gonna go well, you know don’t and sometimes one that you’re like Okay, like the the black tongue bit video that I had talked to you about earlier the one that has 47 million views on Instagram, you know, was just like a, okay, you know, not one that I just, not one that I didn’t think would do well, but I’m like, okay, know, I’ll just post this one.

Dr. Andy Roark: I never would have thought that, you know what I mean? That, I was like, I would have been like, this is a fun little afternoon thing that I’m doing. But again, if you said to me, Andy, true or false, this video is going to get 47 million views. I would be like the odds are astronomically small but here we are. I’m with you like I I could never have looked at that and been like, yep this is viral sensation like I

Sarah Parsons: Right. I’m never that, you know, I’m never that way. I love to post videos and I’m never like, Oh, this one’s going to do so well. Like, but you never know, man. The algorithm works in mysterious ways sometimes.

Dr. Andy Roark: The more I love something, the more it is to die a horrible algorithm That’s what I’ve found. If I’m like, yeah, is it, it’s If I’m like, no, no, no, we’ll see what happens. 

Sarah Parsons, thanks so much for being here. Where can people find you online if they haven’t seen your 47 million view black tongue video. 

Sarah Parsons: I’m on TikTok, Instagram, and Facebook, my social media videos and my handle is at what really happens at the vet with what spelled W A T, so what really happens at the vet. And then my website’s vettechsarahparsons.com, so you can find me on any of those platforms.

Dr. Andy Roark: Awesome. Sarah, thanks for being here. Guys, thanks for tuning in and listening. Take care of yourselves, everybody.

And That’s it. That’s what we got guys. Thanks for tuning in Sarah. Thanks for being here Sarah will be speaking at the uncharted team lead summit on September the 18th. That is a virtual summit for team lead so if you’re a head technician if you are a head kennel technician if you are a If you are a lead CSR lead receptionist, check it out.

It’s a one day leadership communication summit. I think you’ll really enjoy it. Sarah will be there putting on a workshop. I’ll be there as well doing some stuff. It’ll be a good time. Anyway, take care of yourselves everybody. I’ll talk to you later.

Veterinary dermatologist Dr. Ashley Bourgeois returns to shed light on a topic often overlooked in veterinary care: dermatology issues in cats. Dr. Andy Roark and Dr. Bourgeois discuss the nuances of feline dermatology, emphasizing the challenges and underrepresentation of cats in dermatological care. They dive into common symptoms, diagnostic approaches, and effective treatments, providing valuable insights into managing allergies and skin conditions in cats. This conversation includes effective communication and expectation setting with clients in order to increase compliance. Tune in to another episode packed with practical advice and innovative solutions for veterinary professionals looking to enhance their dermatological care for feline patients. Gang, let’s get into this episode!

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

LINKS

The DermVet: https://thedermvet.com/

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

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Ashley Bourgeois is a board-certified veterinary dermatologist passionate about providing practical knowledge to general practitioners to help itchy pets! She completed her bachelor’s degree at Iowa State University and graduated from the University of Missouri’s College of Veterinary Medicine in 2010. She then completed a one-year small animal internship at Purdue University. Upon finishing her internship, she accepted a residency position with the Animal Dermatology Clinic’s Tustin, California location in 2011. She became a Diplomate of the American College of Veterinary Dermatology in 2014. Dr. Bourgeois moved to Portland, Oregon in 2016 to help expand the company. She is an owner within the company and on the board of directors. She has a strong interest in autoimmune skin diseases, allergies, cytology, and otology.

In her leisure, Dr. Bourgeois enjoys outdoor activities, traveling, and watching sports. She and her husband stay busy with their daughter, son, and rescue Lab/Boxer/Pit mix. Dr. Bourgeois is passionate about educating veterinarians in dermatology and work/life integration through her podcast, lecturing, and social media presence (The Derm Vet).

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Guys, I am here with veterinary dermatologist and good friend, Dr. Ashley Bourgeois. Ashley is on the podcast today. Guys, we are talking about our top tools for cats when it comes to dermatology cases. Guys, I don’t think cats get enough love

when we do allergy and derm workups, honestly, and so I want to talk about that with Ashley and we dive right into it. Gang, let’s help some itchy cats by getting into it. 

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

Dr. Andy Roark: Welcome to the podcast, Dr. Ashley Bourgeois how are you, my friend?

Dr. Ashley Bourgeois: Dr. Andy Roark, I am so good. Very excited to be back on the podcast. 

Dr. Andy Roark: It’s great to have you here. For those who don’t know you, you are you are a longtime friend of mine. You are a veterinary dermatologist. You lecture all over the world on veterinary dermatology. You are at the Animal Dermatology Clinic in Portland, Oregon. You’ve been on the podcast many, many times.

You have, you’re a, you’ve got articles. You just, you just do a ton of stuff, Ashley. I wanted to ask you about something today and you’re always so gracious with your time. You know, it’s it’s summer as we’re recording this and I’m in the south and so summer means allergies and lots of ear infections and itchy skin and things like that.

And so I was wondering if If you would be up for talking with me a bit about the tools in our toolbox for dealing with dermatology problems in cats. I feel like derm and cats does not get a whole lot of spotlight, and I always like to kind of run back through the toolbox and make sure that I know what I can do, and make sure that I’m aware of all my options in trying to help out our cats because I don’t think know that they get as much care in dermatology as they probably should.

So, let me actually, let me just pause there and start with that. Do you agree with that? Do you think that cats are underrepresented in our dermatology caseload? Or do you think that they’re just less likely to manifest problems?

Dr. Ashley Bourgeois: totally think they’re underrepresented and I think there’s kind of a few different layers to that. Like I think one, owners don’t recognize it as readily, right? Like if a dog’s going to have an allergic flare, they’re going to slurp their paws next to you. A cat’s going to go hide and all of a sudden have a bald belly and cats are naturally groomers.

So it’s really easy for owners to think, well, they’re licking their belly, but that’s normal because they’re groomers. I also think just because we are more limited on what we have available for cats that, you know, we kind of want to give up on them a little bit easier. Like, well, sorry, that’s what I got and that’s it.

But there’s so many simple things that we can try to get these cats more comfortable and they deserve to be comfortable. You know, we should still be working with our cat clients. So that we can provide comfort for these itchy cats.

Dr. Andy Roark: Do you think we make assumptions about what cat clients are willing to do with their cats?

Dr. Ashley Bourgeois: Totally. I totally think that we make assumptions and sometimes they’re true,

Dr. Andy Roark: Yeah,

sure. 

Dr. Ashley Bourgeois: but there are really good about giving medications or doing the things with them.

Dr. Andy Roark: Start to unpack the toolbox for me a little bit. So, we, we’ve got allergies in cats. First of all most common presentations of allergies in cats. What are we talking about? Like, what do you think gets overlooked?

Dr. Ashley Bourgeois: Yeah. I would say that if we think about the most common things, bald belly cats are probably pretty high up there. So they just come in, they’re coming in for your wellness exam as a GP. And then you just look at them and start to notice they’re kind of thinning on their belly. And again, because they’re naturally groomers, owners don’t think much of it.

We also see a lot of head and neck itchiness. So they’ll kind of like really scratch their head and neck and they’ll have excoriations all over. And then of course the different representations of eosinophilic granuloma complex, which I think those are kind of tricky because the oral lesions, a lot of owners don’t look for unless they’re actually showing us symptoms.

So I always try to encourage vets to try to do oral exams and cats if they’re accepting of it, because you’ll be surprised what you can find.

Dr. Andy Roark: Yeah, it’s funny. I, I always do my absolute best to do oral exam on cats. I don’t ever think about it as an allergy check. But it makes, I mean, it, it totally makes sense.

Dr. Ashley Bourgeois: It doesn’t have to be crazy things. People think like the weird pictures of like this nasty eosinophilic granuloma we put up, but it’s very common just to find like really little rodent ulcers right here. So I’ll just, even if they won’t let me do full exam, I try to like lift their lips up and just see if there’s any like signs of a beginning of a rodent ulcer.

Because that’s gonna confirm to me that we probably have some sort of allergy going on.

Dr. Andy Roark: Just kind of along the front 

Dr. Ashley Bourgeois: gums?

Mm hmm.

Dr. Andy Roark: Okay. Yeah. That totally makes sense. Okay, so when you see that, you see the ball belly, you see sort of rodent ulcers, things like that. you’ve got some idea that we’ve got some sort of an allergy problem going on. Where do you start to go from there?

How do you, how do you sort of approach this?

Dr. Ashley Bourgeois: Can I tell you a secret for most dermatologists when we are talking about itchy cats? We are so excited if they just present to us on good quality flea control. That sounds incredibly simple, but I’ll tell you what, I think I diagnosed three flea allergic cats last week. So like we, yeah, we get them all the time and we’ll see kind of, you know, the exam like flea comb, no fleas and,

that’s our first step because to me flea, flea allergies are very common in cats. Even if they’re indoor, I have diagnosed them in indoor cats in Southern California, living on a high rise in Los Angeles. Like we see flea allergy fairly commonly. It’s called a cat flea, right? Like the flea wants to be on cats, but ultimately if they come in already on good, Isoxazoline flea preventions, what there’s quite a few options in cats.

If they come in on that and they’re still showing symptoms. It is just a huge step that I don’t have to waste the time and money and effort into for that initial exam. And that includes everyone in the household. That’s the other thing we see is like the itchy cat will be on flea control, but not the other animals in the household.

And I have actually had many cases where if we just treat all the other animals, that cat gets better.

Dr. Andy Roark: How did these cats present? Because, Ashley I would say, you know, when I look at cats and they’ve, and they have flea allergy stuff, it’s always that sort of racing stripe up the back, not always, but in my mind, it’s almost always that racing stripe, you know, the triangle above the tail and the dorsal aspect of the, of the lower back, Is that how these cats are presenting as well, or are you seeing I’m a little bit perplexed at, at flea allergy cats showing up with a dermatologist. I guess, being honest, I think that’s why I’m kind of asking this question.

Dr. Ashley Bourgeois: Yeah, all of the above. So racing stripe for sure. We like to say if a cat’s not wearing pants, meaning that they’re hairless, like on the caudal thighs, rump belly, I’ve had them just do the ball belly. I’ve had them completely be ripping their entire, I mean, I have videos of a case completely obliterating itself in the, in the clinic. Just completely hairless,

had came in on a flea collar, but not a good quality flea control. And then within two months, that cat was on nothing, but flea prevention and has been completely controlled now for three years, just on flea prevention. So they really can do present in a lot of ways, but yes, a lot of times if they have that racing stripe, if they don’t have hair towards the backend, you think of it.

But even if you have to remember two, cats like to get more than one allergy. So, even if you don’t get them fully under control by having them on good flea prevention, as a dermatologist, when I go to work that case up, I just can get that out of my mind that there’s even a component of it, right? Like if they’re food and flea, if I just know we’re on good flea prevention, I’ve crossed that bridge and we can focus on everything else versus they’re both of those, but we keep having to give them steroid injections because we don’t control one aspect of their disease.

Dr. Andy Roark: Right. Okay. That makes sense. So, flea medication seems like a great place to start.

Dr. Ashley Bourgeois: Yes, please. Please, please, please. We do. We see it quite often, which I think surprises a lot of people. But we actually get a ton of flea allergic cats in our clinic and we feel bad because they have to wait to see us. We’re more expensive and it’s something like pretty straightforward.

Dr. Andy Roark: What else do you like to go to?

Dr. Ashley Bourgeois: Yeah, so then I would say we assume they have good flea control, then we’re starting to think of, to me, kind of two things. Like one, how do we make them comfortable? And then two, how do we continue to work them up? So there are some important things to realize about feline allergies, one of them being distribution.

So there has been a study, a multicenter study, that showed if cats tend to scratch towards their head and neck pretty frequently, that they’re a bit more likely to have food allergy as a indication of their itchiness. So if they are really exhibiting that kind of head and neck itchiness, then, and I know they’re on good fleet control, then that’s usually my next step.

And you have to be really willing to work with clients over, you know, what they’ll feed, can they be strict if they have multiple cats, is that possible for them? And so then we kind of dive into that discussion. To rule out a food allergic component. Many cats don’t have abnormal gastrointestinal signs.

So even if they seem to be defecating normally, not really vomiting, they can still be extremely itchy from a food allergy. And so the, to me, if I can get any cat under control with flea control, indoor food, long term and not have to give them oral medications. You know, I’m very happy for that owner. Then assuming that portion we’ve got under control and we’re going to go down the feline atopic skin syndrome, which if you don’t know, that is the official name for environmental allergies and cats, which is kind of long and complicated, but it just is meant to be a representation of how crazy their allergies can present.

If you think about environmental allergies and cats, it can be anything from, I have a rodent ulcer eating my front lip, to I have asthma, to I get itchy all over my body. So they just present in so many different ways. Then we’re going to work on making them comfortable, but really be trying to drive them to allergy test and do immunotherapy.

Because that’s one of the main ways we can start limiting how many oral medications they can take longterm if we can help it.

Dr. Andy Roark: Jumping back real quick, I have always had the impression, I’ll just say, for me, it has been substantially harder to get cat owners to go in, in a way I believe, on on diet trials. Then it has been for dog owners. Have you seen that as well? I mean, I don’t know if it’s true or the perception is just oh, well she’s only gonna eat what she wants to eat or she has this specific food that she demands. I don’t tend to get that much pushback.

There may be pushback about price or things like that for dogs, but there’s I’ve, I’ve had such challenges in getting pet owners to buy in and do a food trial in cats. I’m assuming by the time, you know, if we have someone who’s come to the dermatologist, they’re probably more open to, to advice maybe than the general populace.

But have you found that to be true at all? And if so, how do you sort of approach that conversation of getting the owners to say, Okay, we’ll, we’ll try a different diet even though, even though, you know, Fluffy really loves her Frisky’s diet.

Dr. Ashley Bourgeois: Yeah. I think there’s probably some truth to that. I mean, I certainly have dog owners who are still hesitant or we get finicky dogs, but we know cats are kind of like little aliens, right? They kind of, They make the rule book and we’re just there to live in their world. So there’s a couple of tips I do.

One, I say like, what do they like? What do they need? I have my preferences on diets, but there are some limitations, right? Like Ultimino is great, but if they need a wet food that doesn’t have a wet food. So then I need to kind of consider other options of, okay, if we’re going to go novel protein, that’s fine, but then I have to know what they’ve been on so I can make sure it’s actually novel for them.

So I start out by asking like, what is it your cat does tend to prefer? Do they need a wet? Do they need a stew? Do they need a treat? Are they fine with just kibble? Are there other cats in the household that have nutritional needs and can you keep them strict? So, you know, if, if we can, ideally you just put all the cats in the household on it, but that’s not always the case.

If we have a cat who has renal disease that we can’t ignore just because we’re trying to do a diet trial and another cat. So then I just make sure one, we don’t have nutritional needs of another cat we have to consider. And then three, the way that I think I have a decent job, I still get people who won’t do it, but a decent job at getting people to do diet trials is I give them the end point.

I think we really need to focus on the fact that this is a diagnostic test. You know, if we just say, Oh, we’re just switching the food. I think people visualize forever, right? They visualize like, Oh, well now I have to buy this really expensive food. And the friskies is like my love language to the cat.

And you’re taking that away forever. And I’m like, I’m not, I need eight weeks. I need eight weeks. Because if the, if Fluffy is no better for this diet change, cool. I can feel comfortable knowing we’re not missing something. We move on from food. If we get through eight weeks and the diet has made a huge difference, that doesn’t mean we can’t feed anything else the rest of Fluffy’s life.

We just know what baseline looks like and then we can kind of add the other fun things back in and see what makes them flare and what doesn’t. So I think really giving a finite amount of time is super helpful.

Dr. Andy Roark: I really like that a lot. That’s it’s a much smaller ask to say we’re gonna do this for eight weeks and eight weeks It’s not an intimate substantial amount of time, but it feels like a Defined thing that okay, we’re gonna do this So my my dog is wearing the elizabethan collar right now cuz he got he got a he got his teeth cleaned and he got wart taken off of his leg and he will pull the stitches out immediately if he can and I feel bad for him. You know, he doesn’t understand.

He bangs it. He’s that dog that just refuses to acknowledge he’s wearing it. So he like hits, you know hits the doorframe and he’ll take you out, you know paste that thing into your shins and The fact that it’s going to be ten days makes it all Absolutely doable. If it was kind of like, let’s just see if this helps and maybe he’ll wear it forever, I would be, I would be out.

But knowing that we’re going to do this, I’m going at the end of this time, we will have accomplished something and that will be over. And so I love your point of we do this for eight weeks and then we’re going to know some things and we will have that information. I think that’s, that’s, that makes a lot of sense.

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Dr. Andy Roark: Talk, talk to me a little bit, Ashley, about About comfort of the cats and specifically sort of itch control while this is going on So we’ve got this cat and they’re coming in and they’ve got the bald belly or they’ve got you know You know evidence of scratching around their neck and things like that and you say well, you know I want to try this diet trial or you know I think this may be feline atopic skin syndrome and and we’re gonna set you up for some allergy testing with the dermatologist. What are you doing for comfort for these cats,

while you’re doing this? Are you, are you doing anything or are you concerned that what you do is going to negate the efficacy? You know what I mean? If I, if I do a steroid injection and then send them out to do a diet trial, they’ll go, oh my gosh, she immediately is better. And I go, well, is she better?

Or are we still, are we riding out this, this other, you know, medication that I gave? Something like that. So help me sort of understand that.

Dr. Ashley Bourgeois: Yeah, I mean I still use a decent amount of steroids in cats to be honest because they get quick relief as long as they’re not a contraindication based on their other comorbidities. I don’t use a ton of injections, but a lot of that is just because by the time they come to me, they’ve kind of gone that route, right?

Like, they’re, they’re trying to get away from that, they can’t really do that as often. So I do tend to use a bit more oral steroids, and I work with owners to kind of get them to take that. But I still think they deserve to be comfortable. You can not send them out the door saying, here’s your bag of food.

See you in eight weeks. Like they’re going to call you in a week and be ticked off. So ultimately you still need to make them comfortable. When I started a steroid, I’ll tell owners, like if they’re great in a couple of days, this is steroid, not the food. But I, the way that we figure out if the food is helping is to get them off the steroid eventually.

And then a lot of the answers in the challenge, right? Because your two months, it’s a long time. You could switch seasons, like a lot of other things can happen. So when owners ask, well, how are we going to know? I’m like, well, no, because we’ll try to stop the steroid and we will try to ultimately challenge that diet.

I also just want to stress the importance of really the thing that only thing we have on label for cats for allergic itch is a topic and we still use a ton of cyclosporine in cats and it can work very, very well, I think some things that people forget is that you can use the capsules in cats. So the liquids on label, and that’s what’s kind of marketed for cats.

But I asked cat owners like what’s easier for you, a liquid or a capsules. You will be surprised how many cat owners actually will prefer capsules. Now they’re not the smallest capsules in the world. So we have to be honest about that. But the liquid has a bitter taste to it. So if I’m going to utilize cyclosporine, I kind of ask them for a starting point.

Like, which one do you think you’d be have more success with giving? And if that doesn’t work, we can go to the other one.

Dr. Andy Roark: Yeah. So, I really like what you’re doing here. The emphasis on the challenge makes a ton of sense to me. Because if you say, the emphasis is on the elimination part, then that’s always the question for me is, well, if I, if I send them home on steroids and then the, you know, it’s springtime and we, you know, very quickly, you know, things fall apart.

flare up. I can’t, you know, I’m all snotty and, and congested for seven days, 10 days, something like that. And then I kind of move on. You go, well, if it’s just the diet trial, I still question, you know, what, what did we actually learn here? I like the idea that the whole time you’re telling them, we are going to challenge

when we get to the end. I think that that’s I, I just, I like how you stage it and, and go ahead and set them up for that. I, I will say, I have been guilty in the past of saying, let’s try this other diet and we’ll do a sort of a diet trial, quote unquote, and let’s see how it goes. And then they say, well, it’s, you know, it’s great.

It’s working great. And I said, well, let’s just go on and not come back and done the trial or the challenge to actually say, oh, yep. When we. When we did challenge, we got this response and now we, now we know this. And so I, I like that you set that expectation at the very beginning. When we’re talking about sort of comfort and itch control and things like that, if the plan is to do some sort of allergy testing, things like that, talk to me a little bit about what is, what is safe for me to intervene with to sort of provide comfort before we do this allergy testing versus where am I potentially hampering the test?

Dr. Ashley Bourgeois: So that’s a really great question and something that’s very individual on the dermatologist. So one thing I would suggest is if you have a local dermatologist in your area that you’re going to be referring to checking in with them, I can give you kind of the general synopsis for me. You know, for if we’re going to serum test, so cats notoriously do not pop up their skin tests very well.

So it’s kind of hit or miss if dermatologists will skin test them. Something that we have been doing and is reported in the literature, but not everyone does is something called IV fluorescein. So you actually skin test a cat. You have to do it fairly quickly. So you have to have yourself or staff trained in it.

And then you actually give a little bit of IV fluorescein through a catheter, and then you read it with a black light and it enhances their positives. Now again, not everybody does that, but more and more people are starting to do that and we’ve had some pretty good success with that. There are some people that will prefer serum tests just because cats don’t tend to, again, pop up their positives.

Like dogs, like horses are like the best dogs are kind of next. And then cats like. Again, they like to be difficult. For a lot of the serum panels you and there’s pros and cons to all of them. They’re the steroids and cyclosporine, things like that don’t really have a huge effect on them. So I don’t personally get too worried if someone refers me to them and we’re just going to serum test for whatever reason.

I preferably try to do both. That’s an individual preference. If finances aren’t an issue, just to collect as much info as possible for my skin tests, they can’t be on steroids. So they would have to be off of steroids for at least a month, usually is our preference. So if they get a long acting injection, say like depo, right, that could actually be a few months because it’s in their system for a couple of months.

So cyclosporine though, if you are using off label Apoquil. You know, to our knowledge, there’s not a huge impact on skin testing. So steroids and then antihistamines, if you are using an antihistamine, depending on how long they’ve been on it, most of us say like one, two weeks, they need to be off of it before we can skin test.

There’s not a huge impact though on serum testing.

Dr. Andy Roark: There’s always been a bit of a question, I think, around serum testing. I, I think in, in just, and this is over the last year, 15 years or so. So, overall, you, you seem to be, to be positive on the, on the benefits of serum testing. And it sounds like, you know, depending on the panel that you choose, results and mileage may vary.

When I have pet owners that come to me and asking about serum testing, what kind of general guidance would you give to them as far as efficacy, a worthwhile investment, things like that?

Dr. Ashley Bourgeois: Yeah. So ultimately if you use some of the more like quality serum panels first of all, food’s not there. So there’s some interesting research being done in food, but we never suggest it as like a diagnostic test. So we don’t run food panels, but if you’re just looking at environmental, the couple of things I can tell you is one.

We utilize those results to help us formulate immunotherapy, but you still, it’s not a, Oh, that’s a high number. So that’s automatically what goes in. You’re still supposed to be evaluating like their history, their seasonality cross reaction. So there’s this weird art form that goes into it. And if you want to start a fight at a derm conference, ask about serum versus skin testing, because there’s a lot of opinions and there’s a lot that we just honestly are still discovering and don’t know, which is why I will try to do both,

if I can. Because I think there can be some different value in both of those tests. But another important thing to realize is please don’t allergy test them unless they are committed to immunotherapy because it’s not the cheapest test and we want to be able to utilize that information to help that pet.

And if that’s not going to be in their wheelhouse, the finances are better off with the symptomatic treatments because allergies are very expensive.

Dr. Andy Roark: Yeah, that, that totally makes sense. Help me set expectations around immunotherapy. So if I have a pet owner and they’re like Yeah, you know, I would consider immunotherapy. What does that, what does that involve? How do you talk to them about what they’re getting into?

Dr. Ashley Bourgeois: Yep. So for immunotherapy, I think it’s a great option in cats because a lot of cats are actually very accepting of injections, though there is sublingual forms, and I have some cats who do great on that as well. It’s just given more often than the injections are long term. I tell owners there’s about a 70 percent success rate, and that’s pretty consistent throughout the literature.

Now, when I say 70 percent success rate, that does not mean there’s a 70 percent chance or just off of everything, but there’s a 70 percent chance we’re going to see benefit. So benefit could be, okay, we were even on cyclosporine, you know, in all the things we’re still pretty itchy in a year. Oh, we need cyclosporine, but now we’re actually responding quite well with the addition of immunotherapy.

Or I’m a cat who used to break out with pyoderma. Yeah. Seven times a year. Now I really only break out like one time of year. So there’s a lot of different ways that we kind of judge benefit. I really like to simplify things for owners. So I like to tell owners, if we’re going to make this decision, an allergy test that I have a students, B and C students and F students and a student is within a year, that’s all you really need.

And that’s our dream for every patient. Like you you’re off the steroids. You’re off the cyclosporine. You know, if you’re just immunotherapy and flea control, That would be amazing and very safe. We get a lot of B and C students and B and C to me is I still need some help, but I am better. So I still need some cyclosporine maybe in the spring, but I am much better than I was when I was not on immunotherapy.

We do unfortunately have about 30 percent of F students. Like we put the time effort money into it and we just don’t see any benefit. And that’s really hard to ask an owner to commit to something for a year, year and a half. And there’s not a guarantee to work, but we do know cats tend to respond really well.

They tend to be very accepting of it. And that’s one of the only natural therapies we have to truly work with their immune system. So they don’t keep progressing their disease.

Dr. Andy Roark: Yeah, well, 30 percent is not an inconsequential number. I think you’re, I think you’re really smart to make sure we’re setting these expectations up front at the very beginning of, hey, you know, there’s almost a one in three chance that, that after a year and a half, we’re not going to, to see improvement here.

I could see that absolutely being quite frustrating, but at least going in, they have to know it’s an option on the table. I think, I think that’s I think that’s just smart communication. Ashley Boussois, thank you so much for being here. Where can people find you online? You do great social media stuff.

Where, where should I send them?

Dr. Ashley Bourgeois: Oh, thank you. I am simple. I keep everything under the derm fat. So I’m strongest on Instagram. I also have a weekly podcast that just goes over dermatology information. And then, as you said, I’ve been enjoying being back on the lecture circuit. So hopefully continuing to do lots of conferences in person.

Dr. Andy Roark: Thank you so much for being here. And guys, thanks for tuning in and listening. Take care of yourselves, everybody. And that’s what we got. Guys, thanks for being here. Thanks to Ashley for being here. If you enjoyed the podcast, share with your friends or leave me an honest review wherever you get your podcasts. It means the world to me. It’s how people find the show. So anyway, thanks for that. Take care of yourselves, everybody.

I’ll talk to you later on.