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Perspective

Gambling in (and on) Vet Medicine

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Career and wellness advice from professional gamblers

I’ve never been a gambler. I did however go through a period where I was traveling to Las Vegas pretty regularly for veterinary stuff, and I would play blackjack when I arrived. I think I felt like gambling was required when staying in a casino, and I wouldn’t be doing the “las vegas thing” if I didn’t drop $50 in the first hour of my visit.

Given how quickly I seemed to lose any chips that came into my possession (seriously, I should have just handed them to the waitress), I came to wonder how anyone could ever make a living gambling. I know there are people who do it… but it all seems pretty impossible to me. What I found from reading a slew of highly embellished stories about real-world gamblers is that the only way to make it is to focus less on getting spectacular wins and more on setting yourself up for success over and over again.

Let’s take professional sports bettors as an example. Most professional bettors don’t have a win percentage over 55%, and it’s not uncommon for the pros to hang somewhere around 53-54%. This is far from the glitzy “always winning” lifestyle we might have expected. The key to success in professional gambling, it seems, isn’t about winning everyday. It’s about consistently making profitable bets over the long term. 

I think the same is true for successful veterinarians. 

All day long, vet professionals are making bets. We are deciding to go to surgery instead of waiting. We are deciding to emphasize the worst possible outcome to the client instead of downplaying it. We are betting that using our break to do callbacks will pay off and get us out of the clinic earlier. Some of the choices we make will pay off, and others will not. At our core, we are all gamblers whether we like it or not.

The important point to take away from all of this is that, to be successful, we must approach our days the way professional gamblers do. We need to remember that our success is rarely based on a big win or a single dramatic choice. It’s based on putting ourselves in the most advantageous position over and over again. This means doing the mundane things that slightly increase our chances of having good outcomes time after time. 

We all know veterinarians who have stressful mornings and then spend their lunch breaks drinking jumbo-sized coffees, reading anxiety-inducing news feeds, and then doom scrolling through the comment sections. This is the opposite of putting ourselves in a place to be consistently successful. Surely we have all done it. At the same time, it’s not hard to see how “playing this hand” is hardly maximizing our chances of success in each afternoon appointment. We are just using our personal time to milk our adrenals instead of calm them down, and that’s not putting us in the best position to navigate a hectic afternoon with grace and poise.

Just like gambling to win 53% of the time isn’t particularly glamorous, going to bed early, ditching our cell phone for a while, and making time to do a hobby that recharges us isn’t going to win us a lot of cool points. It is, however, going to make what we do sustainable. That type of boring math is what makes a healthy and more enjoyable career. 

When we talk about well-being in the profession, this is what we are really discussing. Wellness isn’t winning the jackpot. It’s laying down smart bets over and over again, knowing that even smart bets won’t pay off every time. 

So, while the occasional “jackpot” case or client might feel great, remember that the real wins come from those consistent, mindful choices. Invest in your well-being, make those small but impactful bets each day, and you can bet on a fulfilling and sustainable career in veterinary medicine.

Experience and Hard Decisions

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A note for anyone who is trying to make a tough decision or going through a hard time

Someone recently asked me how to make hard decisions. “How do you know when to give up on a marriage or a complicated family relationship? When should you quit the job you’ve had for a decade or shut down the small business that’s barely profitable?” Decisions like these feel monumental, and there is often no objectively right answer. 

If you’ve been reading my stuff for very long, you know I believe our lives are defined by struggle. I don’t view that as a depressing thing at all. I believe we are all on a “hero’s journey” towards self improvement and personal development, and no one can become a hero without facing (and ultimately overcoming) challenges. (Let that sink in for a moment. Andy Roark believes that you are a hero and the hardship you are facing is a battle you will overcome. I hope that makes you smile.)

Given that life is defined by challenge, I agree with the Buddhist idea that empowerment comes from consciously choosing how we will struggle. We can struggle with boredom from sitting attentively at our kid’s holiday dance recital, or we can struggle with the frustration from our spouse and the relationship fallout with our kid that comes from being on our phone during something that was deemed important to the family. We can struggle to deal with the client who wants a giant bottle of antibiotics for her multiple dogs at home that we haven’t seen, or we can struggle with the ethical and legal ramifications of just giving her what she wants. We can struggle with the financial burden of buying a new car or the stress of limping along with the one we have. You get the picture.

This concept shouldn’t be seen as morbid. It should instead be a guide to setting healthy expectations and believing our choices matter. We have great power over what paths we end up walking in life. Let us never forget that.

If you accept this worldview, or at least see the value in it, then the question of how to make hard decisions becomes pretty straightforward. You simply look at your options and try your best to predict the type and quantity of suffering you will endure under each one. If you decide to fire the toxic person at your clinic, you will work shorthanded and may have to manage the emotions of those who actually liked the one let go. If you keep this person, you will continue to deal with crying staff members, a feeling of guilt that you aren’t providing people with the workplace culture you want them to have, and the possibility of good staff members leaving. If you sell the veterinary clinic that you built then you will suffer with a greatly reduced level of control over what happens there. If you don’t sell it, you’ll continue to carry the burden of making decisions and sweating practice finances. 

The biggest challenge in making good choices is thus the ability to predict suffering on a path you have not yet walked. This, my friends, is the value of experience!

Experience is the ability to more accurately predict struggles and suffering if you choose a given path. For example, if you have dealt with a toxic staff member before, you will be better able to predict the struggles associated with keeping or letting someone like this go. Alternatively, if you have never worked in a veterinary clinic that you did not own, you’ll probably find it quite difficult to anticipate how you will truly feel when you are no longer the chief decision maker in the practice you built. This is the irreplaceable power of life experience.

My father’s favorite expression has always been “Good judgment comes from experience…and experience from bad judgment.” If you’re having a hard time right now, I want you to remember that there is no path forward that doesn’t involve struggle. And even if you feel like you might have chosen the wrong path, you are still gaining experience – the most valuable thing you can have for making tough choices in the future. 

So, whether you are struggling to make a hard decision or just to get through the day, hang in there. You are most likely doing what you need to do to go forward. Remember, you are on a hero’s journey… and it’s going to work out.

Major Heat Up in Consolidation – Consolidation for Consolidators

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Are we seeing an increase in veterinary consolidation? In this episode of the Cone of Shame Veterinary Podcast, Dr. Andy Roark is joined by Ryan Leech, host of The Birdbath podcast to discuss the ongoing trend of consolidation in the veterinary industry, where corporate groups and private equity firms are purchasing veterinary practices, leading to a transformed industry landscape. Ryan shares insights into the slowing and recent rejuvenation of practice acquisitions, and the implications for practice owners, veterinarians, and staff. They also dive into the economic pressures, such as rising wages, and how these financial trends may impact the future of independent practices and corporate-owned hospitals. This is a must-listen for anyone interested in the big-picture changes happening in veterinary medicine and what it means for veterinary professionals.

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

LINKS

Ryan Leech on LinkedIn: https://www.linkedin.com/in/leechryan/

The Birdbath Podcast: https://podcasts.apple.com/us/podcast/the-bird-bath/id1697270947

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

Ryan Leech is an experienced leader with a history of growing businesses through highly scalable sales models. With a background that spans multiple industries, Ryan led sales for startups that raised over $100MM in funding and ran his own sales consulting firm. In his role at Digitail, he is responsible for overseeing collaborations and integrations with industry leaders and innovators to drive digital transformation in veterinary medicine. In addition to his professional experience as Director of Business Development at Galaxy Vets and Hippo Manager Software, Ryan is also the host of “The Bird Bath” podcast.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host. Dr. Andy Roark guys. I got to go in for you today I am here with Ryan Leech he is the host of the podcast The Birdbath. He does a podcast all about the like plate tectonic level movements of the vet industry So he talks a lot about earnings in the big pharma companies. He talks a lot about consolidation where groups of practices buy other groups of practices or who gets paid big venture capital investments.

I just think that stuff is interesting. I don’t track it like Ryan does, but he, that’s his jam. He’s all about where is the money going into our profession? Where is it coming from? I hate to say it, but boy, you can figure out a lot about what’s going on in our profession by looking at where the money comes from.

And so, anyway, that’s his jam. I wanted to talk to him today about what’s going on as far as consolidation among practice groups. We see groups of practices buying other groups of practices. It’s slowed down. I it is picking back up and has continued to pick back up. I talked to him about if is that true?

Where does that go? Does he see it going on? Are we looking at the risk at the economy and thinking maybe there’s a recession. This is going to change. He has thoughts on all of these again, and we’re kind of gazing into the crystal ball here. There’s a very interesting conversation about big level high level. What is going on in our profession and what is it going to look like in the coming years?

So Ryan’s got some good ideas. Let’s get into this episode 

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

Dr. Andy Roark: Welcome to the podcast, Ryan Leech. Thanks for being here, my friend.

Ryan Leech: Thanks for having me back. I always enjoy listening and honestly, if you know me, I enjoy participating more than listening.

Dr. Andy Roark: You’re like me, like, I like to be an active participant in my conversations.

Ryan Leech: I like to talk about it not just listen to it. So thanks for having me. I’m excited for what we’re going to talk about today. I know you’re, you’re pulling, you brought me in and I’m ready.

And, but I told you not to prep me on 

Dr. Andy Roark: anything.

That’s right,

Ryan Leech: That way we can a raw and fun conversation.

Dr. Andy Roark: That’s good cause I’ve got, I’ve got some stuff I’m working on. Okay, for those who do not know you, you are the host of Ryan Leech probably the podcast I would consider to be the most required listening in Vet Medicine. Aside from my own, of course, but, but other than mine, other than mine, no in all serious.

Ryan Leech: The number two podcast on this 

Dr. Andy Roark: show.

That’s okay, by in my estimation, you’re probably the number two podcast host in on the industry. No. You are the host of The Birdbath, which is which is this really great, it’s very short, it’s weekly. It is a recap of what is happening at the industry level of vet medicine. So you talk a lot about the earnings reports of different like pharma companies.

You talk about consolidation. You talk about what practice groups have bought other groups and what they’re doing. And that may sound ridiculously boring to people who are in the trenches of that medicine. I get it. However, It is basically a report of how the landscape that we live on is changing and fluctuating.

So I really encourage people if you haven’t given the podcast a try you should just listen to it. It’s something that’s really good to just keep checking in on because the things that Ryan talks about are the things that come to fruition and affect our lives in the practices A year down the line.

And so anyway,

Ryan Leech: yeah, and the thing though about the show that I, cause yes, it’s, if you’re not in the vet industry, you shouldn’t listen. You’ll be so bored unless you’re wanting to invest in it or do something.

Dr. Andy Roark: I tried to get my wife to listen one time in the car and she was like, I’m not, we’re not doing this. 

Ryan Leech: Yeah, my wife doesn’t even listen to it. You’d think she would, but yeah, the thing is, I want it to be a kennel attendant driving into their first day of work and I want Kristen Peck at Zoetis to both be able to listen and leave with something that they didn’t know was happening in the space.

So it’s supposed to be extremely digestible. It’s less than 15 minutes every single week. We just had our one year anniversary with it. So yeah, I’m really, really happy with the show.

Dr. Andy Roark: You do a really good job of taking this stuff. And it’s, it’s, it is very accessible. Like just between, you was gonna say, just between you and me, just between you and me and 

Ryan Leech: everyone listening 

Dr. Andy Roark: I, I think you do a good job of saying, this is what this means, or this is why this result could be important going forward.

And I just, I think you do that really well. You are also a a consultant in the veterinary industry. You work with, with. companies that are interested in entering the Vetspace or working in this Vetspace and want to grow.

Ryan Leech: Yeah. All the things I talked about on the birdbath are kind of my preppers in my mind of how to help businesses grow in the vet space or enter the U S market or, or things like that.

Dr. Andy Roark: So that’s great and it brings me to kind of what I wanted to ambush you with today. So it’s, it’s this, I wrote a little newsletter, so I write newsletters like every week and I just often kind of write about what I’m thinking about and things that people say to me. And so, so I wrote recently this little newsletter and it called it that eventually the numbers have to work.

And the basic premise, Ryan, is, is I’ve talked to some, some veterinary students who are getting close to graduation, and they were talking about signing bonuses and salaries for some of their for some of their graduating vet students. And I’m going, oh my god, you gotta be kidding me. And again, no shade on the vet students, but it’s just, wow.

And then I talked to some of my friends or people who are at Uncharted, and they have their own hospitals their private practice owners, and they’re like, I cannot afford to hire a new graduate at the rates that they’re, they’re getting from other places. And it’s just really interesting when I hear these sort of concerns from practice owners and I hear these things from vets that are looking at these contracts and things and I go, I just want to lean in and say, you know, guys, eventually the numbers have to work.

Like at some point, no one’s doing this as a charity. Like this is all investment and ultimately the numbers have to work. And so I’ve been looking at that and thinking about that and I think it’s sort of a testament to how our profession has been stretched by private equity money coming in, by investment coming in, by corporate consolidation, where people are willing to do things to acquire practices that don’t make sense in the short term and that most of us could never afford to do.

But the idea is down the road this will make sense. And so, I’m really interested in talking with you today a little bit about how the numbers eventually make sense. You’ve been covering a lot in terms of consolidation within our industry. The last couple of months it seems like there has just really been a huge amount of movement as far as companies that own vet practices.

Buying other companies that own vet practices and so I wanted to come in and get an overview sort of like a every week you’re doing a report from the week I would really like to get sort of a review discussion from you of what do you see going on over the last six twelve months as far as corporate consolidation and then I want to get into what you think that looks like and what is that?

Going to mean going forward. So let me just sort of pause here and say am I capturing this correctly? Do you agree that there seems to be increasing momentum in terms of consolidation in our industry?

Ryan Leech: Without a doubt, there is definitely a rejuvenation of the veterinary consolidation that’s happening. There was a, about a 18 month sort of slowdown that we saw in the previous 18 months or 2023 part of 2022. It, it slowed down a lot. And there’s a ton of economic factors that, that play into that. But the thing is it has shifted back now.

People are acquiring practices. I would say. Just roughly estimating in the last six months in just the U S alone, there’ve been two to 4 billion worth of consolidation and investment in vet practices. So it is definitely growing and taking off. There’s a massive deal that’s on the horizon that depending on when this comes out, people will either know about it or they’ll have heard rumors about it.

But yeah there’s a lot going on. There’s a lot going on. It’s going to continue to happen. We’ve got just the shrinking of the number of players that are owning the practices is happening as well. So it’s big. One thing I will say though, that I think was interesting when you’re saying the numbers need to make sense, that is kind of what happened 18 months ago.

And for the past 18 months or the past 18 months of slowdown was the numbers didn’t make 

Dr. Andy Roark: sense.

Right.

Ryan Leech: So you had groups that were acquiring practices where the numbers didn’t make sense and they were playing hot potato basically with these practices. And they were just saying, yeah, someone else will take, someone else will take it, someone else will take it.

And they weren’t making these improvements within the businesses. And eventually when the money’s slowed down, they were caught and kept holding the bag of all these practices where they had never intended to actually run them or improve them or perform the practices. And now the numbers didn’t make sense.

Which is now causing a bit of a paradigm shift where people are needing to do things that improve the financials of the businesses that they own.

Dr. Andy Roark: Do you think that that’s an accurate metaphor? So the hot potato, I want to go back to that. So what you’re saying is, there were players, and there were definitely players, who had no intention of actually running the hospitals they were buying. They were buying them, they were rolling them together, and the whole plan was, we’re going to sell this to somebody else as a bigger bundle, and we’re going to get a bigger multiple, because instead of buying, I don’t know, 10 practices, they’re buying a hundred practices, and we’re going to, we’re going to jack the multiple up, and we’re going to get out of here.

Having never actually, quote unquote, run these vet hospitals. And I could see that, and you would see some of the groups, and you thought these people clearly don’t have any real intention of wading into the operation side. And then It seems like the buying frenzy just sort of stopped, and the people at the top who were supposed to buy up everybody else, they stopped buying, and the people under them stopped buying, and the whole thing kind of backed down.

And then, you have some very responsible, very smart people who are holding practices and running them well. But you also had some people who were like, Oh crap, I thought I’d be out of this deal in six more months. And now it looks like I’m in the business of running a hundred vet hospitals or 25 vet hospitals or whatever.

And so is that sort of the hot potato metaphor

Ryan Leech: That’s the hot potato. Yeah. Because, I played in that world with Galaxy Vets that I was on the founding team of. And I was pitching to practices that wanted to sell practices against a lot of those. And the first question that a lot of people would say is what are you going to change?

And there’s an entire world of veterinary consolidators where their motto was, we’re not going to touch anything. And in a lot of them, they never did. You never saw them. The paychecks just changed names on them. Maybe they had a new bookkeeping system in the backend to be able to consolidate the numbers, but they didn’t do anything.

And that was what the seller in a lot of situations wanted. They wanted to be able to liquidate their sale of the practice. But the problem came when that hot potato, when you were the one caught holding it and you had to start operating the practice and then you realized, well, you can’t improve a business without making 

changes,

Dr. Andy Roark: Yes 

Ryan Leech: and so now they’re having to say Yeah, we’re going to make a few changes here they’re like, Whoa, I know that I want to keep running my business. Exactly how it was. And the difficulty there is it’s not your business anymore. It’s the group’s business. And whether they said they wouldn’t change anything or they said they would, ultimately it comes down to whatever they want to do.

It’s business too. 

Dr. Andy Roark: Eventually the numbers have to make sense, right? There’s no world where they can buy your practice, pay way more than it would be traditionally worth, and then not change anything, and everybody’s okay with, like that’s, it’s just, It’s not going to happen there. If they’re going to pay a lot, they’re going to try to increase efficiency and do things to make that practice justify what they paid for.

And so it’s that warning advice that I’ve been kind of leaning into is, if it looks too good to be true, it probably is. And ultimately, the numbers have to make sense. And so I do feel like days of getting bought and no one touching anything, they feel like they’re largely over to me. Unless you do have a corporate group that is serious about wanting individual practices to control their own culture. I mean, and at this point, you can tell that they’re not screwing around.

They will have made some changes and stuff, but there are some people who they were serious about it from the beginning, and they have, they have put their money where their mouth is, and I don’t want to, want to badmouth those groups, but that was not what most people were doing when they were saying, we won’t change anything.

Ryan Leech: I believe and I’ve said it and I’m happy to say it again publicly as many times as possible. I think that consolidation can be a greater good for the industry as a whole. When done in its most altruistic and true fashion, I do think that consolidation can help the veterinary industry.

It allows people that didn’t want to own a practice to liquidate their largest asset and continue practicing medicine and focus on that. Now there’s a mountain of things that can be terrible about consolidation and it wasn’t unique to the veterinary space. It’s uh, if you have a favorite restaurant that you started seeing a bunch of them popping up all over and they turned into a chain and then the quality of the food went down.

It’s usually interesting to Google the name of the restaurant and then type the word investor and you’ll find that they had some outside investor that didn’t have any history in that space and just poured money in and they lost what really made it there, but think the really interesting practices that don’t need things changed what you almost find there is that the owners of those practices either aren’t looking to sell because they’re bringing in enough profit and enough revenue to be able to sustain a very healthy business without having a boss, or they’re actually the ones that are being approached by groups or private equity companies that are saying, Hey, can you replicate what you did here?

And they’re actually the ones creating these new brands DeNovo or fresh built out strategies that are replicating their formula across the industry.

Dr. Andy Roark: I’ve heard it said that what sort of happened in medicine as far as consolidation has been seen again and again in other industries, and it’s fairly predictable cycle, as the way it was put to me is. We have these periods of consolidation, and they start out, and there’s a lot of players, and everyone’s grabbing at practices.

And ultimately, the prediction that I heard was we were going to end up with about seven, seven significant players, something like that. Do you think that we’re tacking towards that? Yeah.

Ryan Leech: Definitely. I like to look at the European market as a precursor to what the US market is doing on quite a few things in the vet space. It’s interesting if you look at where the UK was eight years ago and where we are today, they’re very similar worlds. I was predicting this on pet insurance.

I don’t know if it’s going to happen. I had some cool conversations with people around the actual world. legality differences between the two, but in the consolidation market, the same thing happened in the UK. They had dozens of smaller players acquiring practices. And then that partners came through there.

IVC Evidencia and Mars came in, acquired much of those practices. CVS group, which is massive in Europe as well as Swedish family that I’m completely forgetting the name. But. They probably own a lot of things and they, those just continue to consolidate those. So there’s about five to seven major players in the UK market.

And we’re now actually starting to see a few of those make investments first in Canada, which is pretty common that we see because the U S market is, it’s tough. It’s a very tough place to survive and be. But a lot of companies that are coming from overseas move to Canada and start that as their North American footprint.

And then we start to see them making some investments. So we saw this with Peloton, which recently made a, an investment in Lakefield group. They own a group of practices called P3 in Canada, and they just made this investment in Lakefield, which is a very well respected family run business by a Canadian family as well.

But they have a U S footprint. And so we’re starting to see that. trickle through of the border there. And I think we’ll continue to see that.

Dr. Andy Roark: So where does this ultimately go for people on the ground, Ryan? So is this going to are we getting near the end of the period of sort of radical change in a lot of practices? Are we, are we going to be stable in about five years and you’ll be in the program that you’re going to be? Or do you think things are going to continue to shift as far as new ownership, new way of doing things?

Get ready for more change. 

Ryan Leech: We’re still well below a 50 percent threshold of consolidated practices. The UK is 70 to 80 percent consolidated. So if you take what I just said, you should expect to continue to see independent practices being acquired and rolled up. I do think that one of the main things that comes by finding operational improvement in practices is one, technology is one of the quick ways that a lot of people look at that.

I come from a PIMS background in a lot of worlds. I think that you could start to see more of the unification of a practice management system across groups. So I guess one word of advice, if you’re in a corporately owned practice. And anyone says, hey, we’re thinking about doing this. If you want your voice heard, raise your hand and be the one that offers debate, a test them or check them out or do the demos.

Because I do know that these larger groups in a lot of situations don’t have as many boots on the ground experience, and they will really want to hear from the people in the clinics that are excited about embracing the change. So if your practice is sold and it’s owned by a large group. You’re not going to stop the wave of change, but you can probably direct the flow to places where you feel like it’s going to do the things that got you excited about practicing veterinary medicine.

Dr. Andy Roark: I do like that, I think a lot of times if we dig in our heels we just get plowed over

Ryan Leech: And then you get this the thing that happens then is we begin this continuous conversation where people say, I’ll never work at a corporately owned clinic. They don’t ever listen. And it’s like, well, did you also, was it a collaboration or was it a line in the sand that either side put? I think there’s great employers that are corporate groups and there’s great employers that are independent groups and the flip side for both.

Dr. Andy Roark: I’m seeing this trend of consolidation and practice groups buying other practice groups. And, at the same time, I’m starting to hear more and more grumblings about uncertainty around the economy. About I’m hearing people sort of start to talk about a recession. There’s definitely been more guarding of budgets on the industry side, things like that, that are starting to shape up.

How do those two forces interact, Ryan? Are we looking at a pause in consolidation, do you think? Do you think that corporate consolidation is going to continue on at this sort of this rate unaffected in the short term? What are your, what is your sort of feeling there?

Ryan Leech: first off, if I put a big asterisk on my face, I’m not an economist in any way. I read and listen to a lot of it, but One thing that, you know, if you look at, like, I’m not going to say we’re gonna have a Great Depression, right? But who left the Great Depression in the best system? Like, who was in the best place at the end of the Great Depression?

Were the people that had the most money at the beginning of the Great Depression.

And if you look at the contraction of that distribution of wealth and how that affects the recession, you’re not going to bankrupt a private equity group unless you do something like a GameStop did with Citadel. If you haven’t heard that whole dumb money story that’s the only way these companies ultimately do get taken down, but you’re not going to bankrupt one of these companies by them not being successful with a hundred veterinary practices that they bought.

So I think there, they have the deep enough pockets to wait out things that what you might see then is. Dr. Jones, who owns a practice and was thinking of retirement, but the value of their practice has been falling over the last 18 months or 24 months. And they’re going, well, you know, I still want to retire.

Okay. Well, maybe I’ll sell it for less than I would have, or what I thought it was going to. But so now the people that had the more money have the money and they can still afford to pay somebody that wants to find liquidity. So I don’t think it’s going to slow down. Yeah,

Dr. Andy Roark: Do think, you know ongoing consolidation, we’ve seen veterinary salaries go up, and I think that’s probably partly, partly due to the pandemic. supply and demand. It’s probably more than partly supply and demand. It’s, it’s a big piece of it. It’s hard to get veterinarians. Do you see those types of impacts trickling down to the support staff?

Whenever we start to talk about the numbers have to work, the comment section fills up with technicians saying, I can’t, I need to make more money. I should have a living wage. And I think that there’s truth to that. I’m not, I’m not yeah, exactly. I’m not downplaying that at all. Is there any clarity as far as when we’re looking at what’s happening at the industry level that would say it’s likely or this is going to continue to be a point of we’re trying to maximize shareholder value.

And so it’s going to be hard to see an increase in in salaries for, for staff. Is, I don’t know if there’s any ideas there.

Ryan Leech: There. Yeah. I mean, there’s definitely some ideas and there’s some trends that are happening. I think one is that we saw and we continue to see the prices of veterinary services increase. There’s two sides to that. I, from looking at financials of a lot of practices, there are a lot of practices that I think were acquired because they were seen as places where the prices weren’t increased.

There were, I think everyone knows a vet practice that they could walk into and see something on the shelf that’s being sold for less than what they bought it for because they haven’t updated their system.

Dr. Andy Roark: Right.

Ryan Leech: And as a private equity group, if you look at that, you go, all I have to do is start charging at least what we’re paying for it and I can make more profit.

But it’s not rocket science to them. So I think you see that. I do believe, though, that we are seeing a continued Increase in the demand for proper technician utilization. And I think that we might begin to continue to see that as newer veterinarians graduate. I know that there’s obviously that there’s always been the doctor versus technician divide in some ways.

And not to say it’s, acrimonious or evil in any way. There’s just always been sort of the, these are doctor roles, these are technician roles, the two shall not meet. But I do think that a younger generation is less rigid in their beliefs of hierarchy within spaces. It’s a generation of veterinarians that are coming out that someone probably called their elementary school teachers by their first name because that was expected of them.

And so when you have someone like that coming out, they’re probably not walking into a clinic with the technician that’s been there for 20 years and saying, I’m the doctor. You do what I say.

Dr. Andy Roark: Right.

Ryan Leech: They’re saying, Hey, Amy, what’s going on? And hey, this is what we do. Okay, cool. Oh, that’s so helpful. And then I also think that there’s an ability and an opportunity through consolidation for technicians to be able to improve and increase their skill set, which is much easier for a business to stomach as a reason to give someone more money than if we just say, I’ve been doing this for a long time.

The business is doing well. Give me more of this

Dr. Andy Roark: Yes.

Yeah, think that’s the difference there.

I think, I think you’re right. I think it’s I think that’s the key. I am very optimistic about technicians in the future and support staff in the future. I think that they are going to continue to make more money and I think that’s going to go hand in hand with them being better utilized and having more responsibilities and things like that.

I don’t think the, hey, we’re just going to ratchet salaries up. I just, I don’t think that’s going to happen. Not even that it’s not justified. It’s just, I don’t see it. I don’t see it happening. But I do think there’s opportunities. I think that there are things. I’m with you in that. I am an optimist.

I want to believe that consolidation can bring around good things. And I certainly can. I hope it will. But there, there are paths. With consolidation with bigger organizations where care stays affordable to pet owners, support staff get to do more things, get to earn better salaries, and then veterinarians get to stay engaged and be the center of the healthcare experience for pets and pet owners.

And so I, I think that is absolutely possible. I hope that veterinarians get excited and engaged and pushed to make that happen. Back to the earlier discussion we were having about digging your heels in. I think that if you do dig your heels in and you say, I don’t want to play with these companies. I don’t want to, I don’t want to play with this hospital group.

I don’t think they care what you want. And I think you’re going to get squished. I think the best thing you can do is jump in and say, how can I participate? Where can I land insight? What can I pilot here and give you feedback on that? I think that’s, I think that’s the path.

Ryan Leech: that’s part of why I do my podcast too, right? You, if you have the knowledge that the corporate group is looking at as well, and you can find an understanding of, wow, my parent company just brought in you know, 300 million in growth equity investment. And then you go to them and say, Hey, I know you want to grow these businesses.

Can we grow our revenue within our practice by looking at these three other businesses that I heard about? That’s kind of why, one of the reasons my sister in law’s a vet. And at her graduation, one of her co or colleagues or fellow students was telling me about the practice they worked at.

And they said, well, it’s not owned by a corporate group, but they manage it. And I said, that’s not how that works.

Dr. Andy Roark: Yeah.

Ryan Leech: And we went through and she was like, no, no, no. And I said, do you have a pay stub? And she said, yeah, I have one on my phone and pulled up the name of the company was there. I said, that’s who owns your practice.

The former owner still works there, but they don’t own it. So understanding what that means and who, if you want to ask a question or, or reach out to, or, make sure you have health insurance. There’s things that you can demand from a much larger company that they can afford as well.

Like you said, the money has to make sense. They have more of it, they can afford it, but it has to make sense as a reason to give it out.

Dr. Andy Roark: Ryan, thanks so much for being here and talking through this with me. Where can people find you online?

Ryan Leech: Yeah, so I have a couple of places you can find me online. You can always find me on LinkedIn, every social media. Plus I’ve got the birdbath. io. That’s where you can find all of the latest episodes of the podcast. And I also have first100. io. But anywhere you want to reach out to me, I’m not hard to find.

And it’s L E E C H. Put that in. There’s a professional BMX biker, but he’s a different guy than me.

Dr. Andy Roark: Sounds good. Ryan, thanks for being here. Guys, thanks for tuning in and listening. Take care of yourselves, everybody. I’ll see you later.

Ryan Leech: Thanks, Andy.

Dr. Andy Roark: And that’s it. That’s what I got for you guys. I hope you enjoyed it. I hope you got a ton out of it. Thanks to Ryan for being here. Thanks to you for being here. If you enjoyed the episode, leave me an honest review wherever you get your podcasts.

This is how people find us and it just means a lot to me. Anyway, gang, take care of yourselves. Be well. I’ll talk to you later.

Pumpkin Spice Vet Care

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A reminder for anyone who wants to break the monotony and re-engage their team

I’m going to admit it right here: I’m a pumpkin spice guy. Even more, I’m a Fall Season Guy. I love the changing leaves, the outdoor activities in crisp air, and the warm clothes I get to wear after the humid South Carolina Summer. It makes me happy to smell cinnamon and sandalwood when I walk into stores, to drink apple cider and to get pumpkin pie for dessert. I just love all of that… but you know what I love most? A limited-time break from the established norm.

Let me be honest for a second. I don’t REALLY care about apple cider. Cinnamon flavored coffee is fine, but I wouldn’t drink it every morning. If I had crisp weather for a few consecutive months, I’d be more than ready to escape to a warmer climate whenever I got the chance. You get the point.

I love the fall theme because it brings new experiences, it’s only around for a limited time, and it has distinct activities tied to it that I enjoy (even if only in small doses). I think this is important because one of the greatest challenges we face in the marathon that is modern veterinary medicine is keeping ourselves and our teams engaged.

If you’ve been leading in vet medicine for more than a year, your team has already heard your pep talks. They know your passion, purpose and your “why.” They know what standard of care is expected and they have shown up day after day after day and delivered it. So now, when their motivation is flagging, how can you get them to re-engage and look at the work we do with fresh eyes?

I think we can draw some inspiration from those of us who love the fall.

Sometimes the best way to breathe new life into something well known is to switch up its theme. Just think, how many stores, products, books, streaming shows, escape rooms, putt-putt courses, and magazines change their look and feel for different seasons? How many stores throw down to decorate for Christmas? How many restaurants, coffee shops and breweries change up menu items for pumpkin time? Even Crossfit gyms and spin classes roll out special workouts just for holidays! Why? Because themes (seasonal, holiday or other) are fun ways to get people to re-engage. The fact that fall will soon be over makes me more excited to try fall flavors and do fall activities because the stakes are low (e.g. if I don’t like pumpkin bagels, they won’t be taking up space on the grocery shelf for very long) and scarcity is high (I might LOVE pumpkin bagels so I better get them before they are gone!).

So what do themes look like in veterinary clinics? Simple. They have the fun parts of whatever theme you are injecting tied firmly to the educational piece you want to re-prioritize. Think of Halloween with a focus on (black) cat health, fall with a focus on senior pets, spring with puppy love, Valentines with heart health (I’m serious! Think heartworms!).

Changing up themes in your practice can be fun. It can shake up the appearance of the clinic where you and your team spend a good chunk of your life. It can give your staff meetings a new focus and provide opportunities to try new educational and therapeutic programs. Most of all, it’s a way to break the grind that so many teams find themselves in. 

Don’t do themes in your clinic for the clients (although they will appreciate them), do them for your team. Do them for mental stimulation, to break monotony, to make things fresh, and to give people a different daily experience. Inject some pumpkin spice into your clinic, or some Halloween horror, or some peppermint and wintergreen… Keep practice fun, and keep it changing with the seasons.

Sometimes Things End

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Not everything we do has to last forever.

I recently sat with a crying practice manager. She works at a small clinic with a single veterinarian who is the longtime clinic owner. He’s relatively young, has young children, and is dying of a terminal illness. My heart broke for her. She has been lining up relief veterinarians when she can, and the owner works when he is able, but that is becoming increasingly irregular. Practices nearby have begun running new-client specials, and she sees this as targeting her clinic’s pet owners (and maybe it is).

During our talk, she asked me how she could keep the clinic going. I didn’t have an answer, and talked to her a bit about how sometimes there isn’t anything for us to do other than to keep walking. When there are no choices to make, sometimes we hike in the rain.

Later in our conversation, I told her a lesson I have personally learned but never really shared before. It is that sometimes things end, and that’s okay. It’s not failure, it’s just that everything has its time.

For most of my life, I subconsciously believed that success inherently involves building. Being successful means growing or advancing. Staying in the same place was acceptable only in the short term, and stopping meant failure. A business that closed had died. A hobby that ended was quit. A project that got discontinued had failed. 

I did believe that failure was okay, as long as we kept trying things. However “endings” and “failures” were definitely synonymous in my mind.

The thing in my life that made me question this belief was improv comedy. Every Friday night I would take the stage with a group of friends to try to make strangers laugh. We would pour our hearts into creating something hilarious for ourselves and for the audience, and you know what came of it? Absolutely nothing. 

The shows were generally very fun but no one recorded them and even if they had, improv is no fun to watch on a screen. It lives exclusively among the people who are there, at that moment. Have you ever heard someone trying to explain what happened at an improv comedy show? It’s like hearing someone describe a dream. It obviously means something to the person who experienced it, but it’s an awful story to sit through.

Relatedly, the shows never “went anywhere.” We were not trying to get bigger gigs, to travel, or to get on TV. The theater we used was tiny, so it wasn’t possible to increase the number of tickets we sold. There was no “next step” other than to come back the following week and try to make an entirely different group of people laugh just as hard.  

As someone who always felt that success meant growth, I struggled with this reality. How do you succeed when there is nothing left of what you created?

I asked the founder of the comedy theater this question and he had an easy answer. “Success comes in the joy of creation.” His idea was that beautiful things are temporary, and sometimes we create valuable experiences that are not meant to last. This was a hard concept for me to get my head around, and I wrestled to truly internalize it for years. 

Now, I see it in the pets that grow old under my care as a veterinarian. There is no beloved family pet that will live forever. They will all come to us, bring us joy, make our lives richer, and then they will leave us. Their lives can in no way be seen as a “failure” because they came and went. The same is true for so many other things in our lives.

It will be sad if this tiny clinic cannot keep its doors open, and my heart breaks for this tiny team, the doctor, and especially for his family. However, the good they did in the world and the experience they created for pets, clients, and each other should not be forgotten. We would all be lucky to work in a wonderful place for five or ten years, or to have a clinic like this in our community. The fact that it might not last forever is a reason to be sad, but never to feel like a failure. 

I don’t want this manager to give up hope. I also don’t want her to live with a belief that she failed because a wonderful chapter in her life and the lives of others came to an end that she has no control over. Sometimes we have to consciously decide to accept changes that are beyond our control. In those instances, I think Dr. Suess gave the best advice, “Don’t cry because it’s over, smile because it happened.”

Eventually, the Numbers Have to Work

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I was talking to a 4th-year veterinary student recently, and he was telling me about the starting salaries his friends were signing on for with their first jobs. Figures in the $150,000 range were not uncommon. [I’ve heard anecdotally about salaries hitting $200,000 for new grads in some metropolitan areas]. This may not sound like a shocking amount of money for a veterinarian to make in a year, but we’re talking about graduates who have zero experience working as doctors and who presumably would like some support and mentorship from their fellow clinicians as they grow.

A few weeks ago, one of my friends who owns a veterinary practice mentioned to me her frustration about not being able to afford to hire a new graduate veterinarian. She said “I know practices are throwing a lot of money at new grads, and there’s no way I can match it. I don’t know how I’m going to hire now or in the future.” I have heard this concern voiced many times in the last few years.

We are living through a period of unprecedented change in our profession. Never before has money flowed into veterinary medicine the way it is coming in now, and that money is making a lot of things quite wonky. I think a lot of people are starting to believe that this “magical money” will become the new normal in our industry and that the old rules of economics have gone out the window for good. Well, at the risk of being the child who points out the emperor having no clothes, I think it’s important to state the truth that seems to be getting lost: Eventually, the numbers have to work.

Business is challenging… but it’s not complicated. You have to spend money to make money. Ultimately, you need to make more money than you spend. If you do this, you get to keep going. If you do not, you go out of business. Sometimes companies are able to go a LONG time without making more than they spend, but eventually… the numbers have to work.

I do not blame any veterinarian for being smart and negotiating when it comes to his or her salary. What I’m about to say is not a condemnation of anyone. In fact, I respect people who are willing to see opportunities in a time of change and take them. That said, the flow of money into our profession is not charity. It’s an investment, and the people behind it intend to get a nice ROI on their money.

In the last few years, we have seen businesses that were willing to spend tons of cash to buy up practices. Now those practices are willing to spend tons of cash to staff the practices they bought. These decisions are not being made for any reason other than the belief in an even greater upside in the coming years. One way or another, the wild spending phase we are seeing is going to end and the “where’s our return on investment?” phase will begin.

When that happens, veterinarians are going to be asked to account for the salaries they have agreed to. The strings in our contracts will be pulled tight. After all, there is no world where a venture capitalist is going to lose money paying a veterinarian’s salary over the long term and be fine with it. As the “where’s our return on investment?” phase approaches, I think it’s important to remind both veterinarians and practice leaders of a few things:

  1. If it looks too good to be true, it probably is — Be wary of any agreement that doesn’t seem to make sense for both parties, even if you appear to be benefiting.
  2. Money is important, but so are other things — Workplace culture, developmental opportunities, and work-life balance all matter… a lot.
  3. Times change — This is a once-in-a-lifetime period of change in the profession. Don’t expect it to last much longer.

To my new graduate friend: I hope you’ll find a job that offers you a good salary which you will be able to grow to support. More importantly, I hope you will end up in a place that fills your cup, appreciates you, and develops you to be the person and doctor that you aspire to be.

To my practice owner friend: I hope you hang in there and continue to do all you can to make your practice a great place to work and visit. I hope you recognize all that you would have to offer the right young doctor, and that you keep pushing to make your practice one that can support new doctors and staff members going forward. I have faith that the right person will eventually cross your path. 

It’s an exciting time to be in veterinary medicine, and there are so many opportunities coming from the radical changes in our industry. Whether you are thrilled about the opportunities being offered or terrified of the shifting landscape, I hope you’ll try to keep at least this one thing in mind: Eventually, the numbers have to work.