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We Have Trust Issues

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Dr. Peter Weinstein joins us to talk about some of the major mistrust we are seeing in veterinary medicine. In this week’s episode of the Cone of Shame podcast, Dr. Andy Roark and Dr. Peter Weinstein discuss how the lack of trust has emerged in the veterinary industry due to the influence of media and the current state of our country and culture. They take a deep dive into the origins of this mistrust, what can be done to address it, and their hopes for the future of the industry. Let’s get into this episode!

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

LINKS

Dr. 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 guys, I got a great one today. I’m here with my good friend, Dr. Peter Weinstein. And if you don’t know Peter Weinstein, you’re in for a treat. He’s a little bit hard to explain. He is a, he’s a veterinarian. He is a former practice owner.

He has been the Practice Management Speaker of the Year at VMX before. He teaches all over the place. He teaches vet students. He’s been a mentor of mine since I was a vet student. He is a veterinary educator and disrupter are his terms. And I think that’s fairly accurate. You’re going to hear some heresy today.

You are going to hear some ideas that are outside of the box. You are going to hear some some, he’s going to poke, he’s going to poke some sacred cows. And it is an interesting idea conversation about the trust bank that we have with our support staff, that we have with pet owners and and we get into generally declining trust in society overall.

If you have the feeling that we don’t trust people and people don’t trust us like they used to, this is going to be a great episode for you. So we really get into it when we talk about it. Let’s get into it.

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

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

Dr. Peter Weinstein: Dr. Andy Roark, always a pleasure to see you, hear you, speak to you.

Dr. Andy Roark: I love having you on the podcast. We– I’ve had you on a number of times and I always have just these fantastic conversations. I reached out to you recently and I was like, hey Let’s get back together. I want to talk to you about some stuff. What are you really excited about? And you immediately said, Oh, we have trust issues in vet medicine.

And I thought, okay, this is, I have thoughts on what this means to me. And it was really in line with some things I’ve been looking at and seeing. But let’s go ahead and just sort of open this up there. Peter, what do you mean when you say we have trust issues in veterinary medicine?

Dr. Peter Weinstein: It’s multifaceted. I think we have trust issues with our teams at times. I think we have trust issues with our clients. And I think veterinarians as a profession really have a hard time trusting people. And I don’t know why I can’t really explain it, but I really do think that we have maybe created a wall or a thick skin around ourselves.

It just– we were skeptical, cynical, and I, maybe I’m cubbyholding everybody when I shouldn’t be generalizing, but, it feels at times that we really have trust issues.

Dr. Andy Roark: Yeah, I, so let me give you, let me give you a theory and see what you think about it. So, I think that as a society overall, we are getting increasingly cynical. And I think modern media is a huge driver of that. I think tribalism is a huge driver of that. I think social media particularly is a huge driver of that.

I think we’ve just got a lot of in group, out group things going on where it’s like, Don’t, you’re with us or you’re against us. And if you don’t believe what we believe, you’re one of those people. And there’s just, there’s a lot of people who don’t trust that news source. Those people are lying. That’s fake news.

And it’s just, that never used to be the case. And it’s just, it’s constant. So one is, I think that there’s this media push that has really made a lot of us cynical and deeply mistrusting. I think that when we see things on social media, I think that there is one of the quickest, so there’s four big drivers of social media that I saw recently, it’s it’s negativity it’s just that full straight on, it’s extremism.

It’s in group, out group language, and then it’s emotional and moral language. And so, those are the four big drivers. And if you think about those four drivers: negativity, tribalism, emotional and moral language, and extremism. None of those bode well for the status quo. None of those help us have any sort of trusting relationships.

They’re just, they’re all driving towards these extreme views. And I think that’s, I think that’s, I think that’s really a problem. And the last thing I would say is, I really think in the last 8 to 10 years, we’ve had a massive degradation of trust in institutions in our country, whether it’s law enforcement, whether it’s the Supreme Court, whether it’s corporations, whether it’s anything like that. There used to be this general idea that these institutions were good and at least try to sort of look out for people and that, that’s not the perception that a lot of people have anymore.

And so I think that there’s, when I look at this, I go, I don’t know that anybody trusts anybody like they did 20 years ago. So does that kind of jive with what you’re thinking? Do you think that medicine is even more extreme than that or that it’s different?

Dr. Peter Weinstein: Thank you for joining me on the podcast today, Andy. But,

Dr. Andy Roark: Thank you. Sorry. I get excited about this. 

Dr. Peter Weinstein: I know, no, I’m kidding. No, I think you did a great job of giving an overarching view of the polarization of our country. You know, it used to be that the gap was the sidewalk crack between different beliefs. Now it’s the Grand Canyon. I don’t think veterinary medicine is any different than any other of the global issues that you talked about.

I think we are embedded in it. So you feel it more. And so when you know, you talk to staff members and you do a lot of talking to staff members, you educate staff members. They’re not always sure that they can trust the manager or the owner. To a degree, some of the national corporations have not necessarily strengthened trust within the practice modalities because they have approached a profession that is built on relationships and made it somewhat transactional. I think we have an economic environment right now, globally due to inflation, and within the veterinary profession, even more bloated inflation because the cost of care continues to grow.

That has violated a trust with pet owners who are seeking a relationship, and we’ve had a profession that has always been very high in the respect categories that I do think the cost of care has become a problem and violates trust from that standpoint. And I think in many ways because the cost of products has gone up so high, we start to question our relationships and our trust, even with industry.

So I think there’s a, we’re living on an, a fault line with all of these things, and then you throw, as you talked about social media and the news. And I’m not sure that there’s much difference between social media and the news and I keep asking where’s Walter Cronkite. Now you probably weren’t born yet. 

Dr. Andy Roark: I remember Walter Cronkite. He was, I was eight years old and he was on TV.

Dr. Peter Weinstein: Well, very good. So you know, where is the real news? Where is the factual news and I think a lot of even in veterinary medicine we expound on opinions because it’s emotional. I mean, we have become so hyper. I like to think of veterinary medicine as a demyelinated nerve. We are so hyper reactive and so easily stimulated by just the smallest thing.

We go off on clients, they go off on us. So that’s what I meant by trust issues. It touches on everything. that you brought forward as national issues because that’s how we are influenced. I mean, we’ve got five generations of people working in our veterinary hospitals. And we have five generations of clients, all of whom have different backgrounds, knowledges, and tools and resources they go to learn from.

Dr. Andy Roark: Yeah. I, so there’s a lot, there’s a lot there to unpack. It’s funny, I’m interested if you sort of agree with this. One of the things that I think has strained trust inside of individual practices is the move towards corporatization. And I’m not trying to be anti corporate at all here, other than to say there is something innately stabilizing.

Maybe when the person who owns the business is right there, shoulder to shoulder next to you, and you can turn to her and say, Hey, Dr. Smith can we talk about this decision? Or can I ask you why, this is what we’re doing, you know what I mean, and just, and knowing Dr. Smith and saying the organization has made a choice and the organization is really Dr.

Smith and we have lunch together and it’s sort of, I don’t know how you can ever bring practices together and not necessarily have that. If you don’t have that owner in the building with the rest of the people, it seems like you’re always going to have to work to try to create organizational trust that was much easier to maintain when people were there.

Now granted, if Dr. Smith is toxic and terrible, there’s, you know, there’s, already no, no trust, but does that decentralization of ownership. Do you think that is part of why we see, I don’t know, does that make it harder for teams to trust the practice they work in?

Dr. Peter Weinstein: I sold to a corporation. And so for 15 years or so, I had a mom and pop organization, me and staff and management that when there was an issue, they could come to me and say, Hey doc, the dryer is broken. What do I need to do? And they didn’t have to run it up the flagpole or we need to, you know, look to hire somebody.

And it didn’t take. You know, three memos, two texts and a carrier pigeon to get a decision made. Now you own a business too, and you have a team. And when there are issues that arise, they can go directly to you. If somebody bought you and you had to go to somebody and say, well, I want to give Maria a raise. I’m not sure we can fit it into the budget this year, but she’s really committed to the practice and I’m afraid we’re going to lose her if I don’t do that. And they say, well, if it doesn’t fit into the budget, we can’t do it. What position does that put you in with Maria, for example. So I do think. I mean, corporate influence is still a very small percentage of the practices.

It’s a large percentage of the employees. But I think we have lost a little bit of that culture that comes with a legacy owner in a mom and pop organization that’s part of the community that can make a decision to pivot. God, I hate that word because we used it so much during COVID, but that we could change.

We can morph on a dime and not have to run things up to get decisions. So I would agree with you that sometimes we lose relationships. When we lose, when the hierarchy becomes too vertical.

Dr. Andy Roark: Yeah. We have this thing called recency bias, right? Where, the things that are happening to us at present seem to carry much more weight than things that happened to us in the past. Do you really think that our with industry— so you mentioned, like product purchases and things like supplies– do you think that our relationship with industry really is different now than it was 20 or 30 years ago? Or were we complaining about prices going up in 1990 just as much as we are now, but it feels more. You know, real. It feels more. It feels more. I don’t know. We’re very much feeling the current changes and we’ve kind of selectively forgotten that. Oh, yeah, this is how it’s always been.

Dr. Peter Weinstein: Well, this is how it’s always been. But I think our nerve endings are rougher. I think we’re more reactive and less responsive. I think we had, I can go back to when I opened my hospital, which was 30 years ago, and we built relationships with our vendors. And I think to a degree, maybe the pandemic impacted it because the vendors couldn’t come in and continue that relationship.

And they were kept out in the parking lot as were our clients. And maybe a lot of this feeling is because of that three to four years of pandemic period that where we were, our relationships became there was a barrier. There was a wall between people. And I also think there’s been a tremendous amount of turnover in industry that has diminished our ability to build relationships.

Veterinary medicine is a relationship industry. We have a relationship with our staff, we have a relationship with our clients, we have a relationship with vendors. I spent more in my practice with specific vendors because of that relationship. And I let certain did not lead certain vendors in because I couldn’t stand them enough to want to have a relationship with them.

I think some of what the pandemic did, and I think it did it to your kids. I think it’s done it to other businesses, and I think we see it in all service industries is that we have started to lose that loving feeling. And it’s become transactional in many ways.

Dr. Andy Roark: So let me sort of ask you a question is sort of a cynicism test of Peter Weinstein. 

Dr. Peter Weinstein: Guaranteed.

Dr. Andy Roark: I, just don’t even need to ask the question, just

Dr. Peter Weinstein: No

Dr. Andy Roark: All right. So, so I wrote this, article on a couple of weeks ago and I put it out because there was this thing on, on social media and this guy was, you know, raging about the cost of vet services and he was specifically talking about the markup of diagnostic prices and he was just really upset and this thing got a lot of attention. And of course, I really love your demyelinated nerve example because the vet community really flared up at this and being criticized this way and I do this criticism is unbearable It’s unfair and I’m not going to get into it more than that.

But what he was saying, in my opinion, was it did not make sense. It was not fair. but he was very adamant and, people respond to that. So, so I wrote this piece and the, I was telling my brother about it and he kind of laughed and and he said, you know, Andy, I’m a lawyer and I’m having a hard time

getting too worked up about the fact that there’s a random person bashing your profession online. Like, you know that’s just imagine being a lawyer and I thought about that because my brother is a great guy He’s a good person his he does end of life planning. So he writes wills which is like I mean, he’s very much a relationship person and a wonderful person and if he cared about what the general populace thought of lawyers, he would, there’s just, there would be no end to it.

There’s no out. And so my question to you, the cynicism check here is, Peter, do we even care or should we even care what the overall perception of our profession is? Or are we going to a place where like the lawyers, we have a service and it’s a vital service and, you know, people just, crap on lawyers all the time, and we don’t look at that.

Auto mechanics. I had to go get my 60, 000 mile checkup and, I did not have warm, fuzzy feelings about the car dealership, but I paid the bill and I went on and I’ll probably go back for 90, 000 miles. You know what I mean? is that where we’re heading or do you think that there’s a different path?

Dr. Peter Weinstein: I think first of all, I don’t want to become the look like lawyer, because you know as Shakespeare said, “kill all the lawyers.” But I don’t think– I think we are hyper reactive. I mean you’ve– I’ve probably written and I know you’ve written comments about the online reviews that come through Yelp and Google and everything else and how many clients bash us from that standpoint. And I know, and, you know, you haven’t been in practice as long as I have, well, you’ve probably been in practice longer since I haven’t been in practice in a while, but it’s our reptilian brain that has us remember every negative experience that we have. And so we are so hyper reactive. Somebody said, what should you do with on negative online reviews?

I said, don’t respond to them. Have somebody else could screen him for you because you will never sleep again at night with one negative online review, because that’s how sensitive we are as a profession. And it’s what it’s good about us and it’s bad about us. So, when this doctor goes on a tirade because of our markups for lab, it shows a variety of different things.

It just shows a lack of understanding and knowledge about the business model of a small business versus an industry that is run by the insurance companies and big business. But we reacted to it very personally. Each and every one of us took it to heart as if it were us. And it’s not us. It’s, a, it’s just, that’s the way we are.

And part of it is because we, and you asked me how I want to describe myself earlier, and I said as a disruptor and an advocator and an educator, we as a profession haven’t really done a great job of being cheerleaders for ourselves. We don’t go out there and rah about veterinary medicine and talk about all the great things we do.

We spend a lot of time being defensive instead of being supportive. And so I, I really do think that when we can bring a group together as came together online to defend ourselves, I think it’s a great thing. And, I do think that, we should be doing it before the fecal material hits the oscillator and you know, take and do a much better job of advocating for ourselves because nobody else is advocating for us.

Dr. Andy Roark: Yeah, I really like that. That’s– I really like that answer. I, that’s, that is, to me, that is a strong pushback against cynicism. I really like this. We’re going to take the bull by the horns and, and start to explain to people and continue to explain to people what we do and why we do it.

I like that a lot. I wonder if that is going to inform this next question. So I had this as, you know, you start talking and we talk about a trust issue. And you have been, you’ve been kind of retired for a while now. You’re really not good at retirement. Like you are, you’re really the worst person at retirement I’ve ever seen.

But you’re, but you, but your daughter is a veterinarian and a fairly recent graduate. What is your advice to her? Right? Because she’s coming into this. And so, you know, I, it’s funny, I was looking at the Merck well being study pretty recently. And that, I don’t think that thing gets enough attention for what it is.

But it really highlighted that, that young doctors fairly recently out of vet school, are the doctors who often struggle the most in our profession. And then, I don’t know whether you get, you know, crotchetier as you go along, or, if, enough people leave and the only ones left are the people who are kind of dead inside. I don’t know but given that she’s a young doctor, what advice do you give to her?Like, what’s the action steps for her? What’s the takeaway?

Dr. Peter Weinstein: Well, as somebody who’s dead inside.

Dr. Andy Roark: Fellow dead inside doctor. 

Dr. Peter Weinstein: My advice to her and a lot of it comes with confidence and most of our recent graduates don’t graduate from veterinary school with a lot of confidence. There’s a lot of imposter syndrome that we propagate throughout the veterinary education model. And so my comments to Brooke, who’s in Australia practicing is, you know, you’re going to have hard times, but don’t take them personally.

And she had a questionable first job didn’t really get the support she needed from her owner mentor. And she’s been doing some per diem work as she waits for some visa updates. And they’ve been very supportive and very positive and very complimentary. But what do you remember? we tend to remember the negative stuff.

I mean, that’s a natural reflex from that standpoint. So I think it’s important, and I was interviewed for something else recently, and I think what we need to do, you and I, and all the other veterinarians who’ve been out in private practice, is we need to get into the veterinary schools and have a greater voice to the veterinary students about what to expect

after graduation. I think– I don’t think that we have given a lot of the veterinary students a knowledge enough about what life is after graduation. And I do think we should be teaching. I teach at Western. I do a lot of VBMA talks as do you, but I do think that we need to be in there advocating with the students about here’s, how to deal with some of these challenges.

And I agree with you. The Merck study is good. I think a lot of it points out to the financial challenges as a cause, cause for the issues. And the financial challenges stem from client communication. And they stem from cost of care and they stem from clients declining services from that standpoint.

And they also deal with salaries as well as student debt. So there are so many variables. this is a multivariate, very complex veterinary profession with very sensitive people who are demyelinated nerves, being unsure how to deal with negative outcomes and a negative outcome is a review. A negative outcome is a review from a client.

A negative outcome is a review from a boss or a manager. A negative outcome is even just, you know, how long it takes to get through the day, and we don’t How many freaking professions, Andy, get to play with puppies and kittens all day? I mean, do you want to be a proctologist and stick a tube up a dark hole? Do you want to be a dentist and look at the other end and see the proctologist at the far end?

Dr. Andy Roark: No. Yeah. I, I, say that all the time and I walk into the exam room and the pet owner says, how are you doing? And I just say, this is my job. I mean, how could it not be great? And I they, like that. It’s what they, it’s what they want to hear. And I, but, and I do believe it. Let’s imagine for a second that the profession is a ship.

The profession is a ship and you get to put your hand on the rudder. So, so that sort of, if I could sort of steer the profession as a whole. What would you do in the next five years to try to address the financial concerns or this financial stress? Because you’re spot on. Inflation is going up, you know, much faster in vet medicine than the general population.

And I agree. I think pet owners are not dumb. They see it. You know, we all see prices going up at the vet clinic and we all hear comments about it. I don’t know what the immediate fix is, but if you had the professional rudder and could actually steer the profession as a whole, what would you do? What, would you try to see, or what would you like to see in a way to try to relieve this pressure?

Dr. Peter Weinstein: Wow, I feel like I’m dealing with a cat bite abscess and I’m just waiting for the pus to come out. I, just, and I was quoted on this not that long ago, probably six, seven, eight years ago, that veterinary medicine would be great if we had socialized veterinary medicine.

Dr. Andy Roark: Mm hmm.

Dr. Peter Weinstein: Where you and I as veterinarians could go into an exam room. And for a small co-pay, go in and provide the care, the best care that the pet needed. And the client would just be able to receive the care and the medications and everything else at a reasonable cost. And we could be doctors, and we could educate.

I think education is an extremely important aspect of veterinary medicine. And everybody who’s listening to this, when you graduate from veterinary school, you go from student to teacher. And every time you walk into the exam room, every time you go back into the treatment area, every time you get on the phone, every time you hit the keyboard on your computer or your phone, you’re a teacher.

And so I’m digressing for just a minute, but socialized veterinary medicine. So we, and with that, we as veterinarians would be paid a fair and equitable salary for the work that we do, but we don’t have to talk about the cost of care, how much less stressful would that be from that standpoint. 

Dr. Andy Roark: Oh, yeah.

Dr. Peter Weinstein: Now clients could still choose to go to a PPO and we could have PPL practices out there as well for those clients who wanted it. And we could look to see how we could subsidize things more with companies like Care Credit or some of the pet health insurance companies from that standpoint. But I just think a lot of our stressors come from self value and clients who are declining services that you know would be beneficial to the pet.

And, they’re declining it for two reasons. One, they can’t afford it. And two, they don’t understand it. And there’s probably some other things in between. But I think it’s our failure to clarify the why, behind the what of everything we do. And that’s the biggest difference in the last 20 years. Andy is, because of the internet, clients can get all sorts of dis-information that forced us to talk more about why we do everything we do. When we used to just be able to talk about what we need to do.

So I’m all for socialized veterinary medicine. Now it’ll never happen, but if we could do that, would be one thing. let me continue my thought process if I can, for just a minute. I think that there has to be a way to subsidize the cost of veterinary education through more scholarships.

So that when veterinary students graduate, they have a one to one debt to income ratio so that they’re not at 250, 000 in debt or 180, 000 in debt and a salary of 120, 000. And I think there needs to be some more subsidization. And this is where I touch on industry as well and other resources. So we can take some of that out of the picture.

And I think we need to look in our business models as to what we can do to improve our efficiencies. So we can keep our profitability where it is, but be able to not continue to escalate the cost of care to clients. Which to me is one of the biggest stressors is not being able to provide optimal patient care. Because the cost is in the way and knowing that pet is not going to receive what it really needs.

Dr. Andy Roark: Dr. Peter Weinstein, thank you so much for being here and talking with me. I really appreciate it. You have a new course online that I just saw. It’s a program that you have for entrepreneurs. It’s for people who are interested in starting practices, things like that. Tell me a little bit about that and where people can find it.

Dr. Peter Weinstein: Well, Andy, thank you. Thanks for the opportunity, A, to be on the podcast and B, to talk a little bit about one of my passions. As you and I have spoken since you were just a baby in veterinary school. For those of you who don’t know, I knew Andy before he knew himself. I have a big passion for independent veterinary hospitals.

I do think there’s a definite place for corporations in the veterinary profession, but I would really love to see the growth of entrepreneurship. And so Dr. Dan Markwalder and myself created a program. He’s one of the voices on the recordings. We created 24 hours of race approved CE that basically take you from soup to nuts or from finding a location to looking for a new location after you’ve grown your practice.

of online education. It’s in forty-seven 30 minute modules that you can watch at the convenience from your home. And we call it Veterinary Ownership Advocates. And really what it’s focused on is people who are looking to buy a practice, looking to do a startup or even young entrepreneurs who already have their practice up and going, and they’re trying to find more information about how to do things.

And so, the website is www.veterinaryownershipadvocates.com all spelled out. Yeah, I should have found a smaller URL, but so veterinaryownershipadvocates.com. And it’s really focused on helping stimulate entrepreneurship in the veterinary profession. And it includes monthly mastermind calls where we will meet with the members of the veterinary ownership advocates community to talk about some of the issues, problem solve, and share best practices. And so, it can be focused at veterinarians, it can be focused at practice managers, it can be focused at technicians, but anybody who is looking to and interested in being a hospital owner.

Dr. Andy Roark: Gotcha. Cool. I will link all that up in the show notes where people can find it. Peter, thanks for being here. Guys, thanks for tuning in. Take care of yourselves, everybody.

Dr. Peter Weinstein: Thanks, Andy.

Dr. Andy Roark: And that’s it. That’s what I got guys. I hope you enjoyed it. I hope you got something out of it. Thanks to Peter for being here, guys. If you enjoy conversations like this, maybe you should try out my newsletter. I have the Dr. Andy Roark newsletter. You can sign up at drandyroark.Com. It’s totally free. I write for it every week.

And so, I often think about these types of things and this is not kind of the stuff I write about there. And so anyway, like I said, it’s totally free and I write for it every week. If you’re interested in it, go over to drandyroark.com and check out our free newsletter. Anyway, anyway, guys, thanks for being here.

Take care of yourselves, everybody. Goodbye. 

PTSD in Veterinary Professionals

by

Sharon Kramper joins us to discuss her research on the prevalence of PTSD in the veterinary workplace and its implications for veterinary teams. Together, Dr. Andy Roark and former veterinary practice manager, Sharon Kramper, explore various factors, potential index events, and what can be done when a team member may be experiencing debilitating symptoms. Tune in to this episode of the Cone of Shame Veterinary Podcast for important insights and strategies to support mental health in the veterinary field.

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

LINKS

NOMV Lifeboat: https://www.nomv.org/lifeboat/

National Alliance on Mental Illness: https://www.nami.org/

Shanti’s Veterinary Mental Health Initiative: https://www.shanti.org/programs-services/veterinary-mental-health-initiative/

Sharon Kramper on LinkedIn: https://www.linkedin.com/in/sharonkramper/

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

Sharon Kramper is preparing to receive her PhD in Clinical Psychology from Auburn University in August 2024. Before entering the field of mental health, Sharon worked in veterinary medicine, including being employed as practice manager in a small companion animal hospital. Here, she was sensitized to the workplace-specific stressors and risk factors that contribute to negative mental health outcomes among veterinary professionals. Her research during graduate school has included describing experiences of discrimination reported by LGBTQIA+ veterinary students and professionals, estimating the prevalence of PTSD in the veterinary workplace, and characterizing the types of ethical dilemmas that support staff encounter. She is looking forward to two things after graduation: 1) being called doctor and 2) rescuing a new dog buddy.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Guys, I got a great one for you today. I’m here with Sharon Kramper. She is a former practice manager, future clinical psychologist, and she’s been doing research with PTSD in veterinary medicine. We talk about her research and kind of what she found, what PTSD is and what it means and how it manifests in our profession and that’s what we get into. It is a really interesting discussion. I will give you just a little bit of a warning. We do talk about things that might cause PTSD or that would rise to the level of being index events for PTSD. We don’t talk in graphic detail or anything like that, but you know, we give some sort of broad examples and things like that, and they might be upsetting to people.

So know that, know that it’s not something that, that we lean into in any way, shape, or form, but, but we do talk about the types of things in vet medicine that, that might that might serve as or might cause, you know, that might cause harm. So anyway, just know that that’s there, so it’s, it’s not surprising. But that, that’s it. Gang, this is a good episode. I hope you’ll enjoy it. Let’s get into it. 

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

Dr. Andy Roark: Welcome to the podcast. Sharon Kramper, how are you?

Sharon Kramper: I’m great, how are you?

Dr. Andy Roark: I’m really great. It’s so good. It’s so good to see you and get to catch up with you. For those who don’t know you, you are, you are finishing up your doctorate in clinical psychology. You are 120 days away from being called doctor at this point. You fascinate me. In that you have this previous life and career in veterinary medicine. You were a practice manager. You’ve been in the profession for a long time. And then you went and went into clinical psychology training.

And so now as we talk, you’re currently working with inmates in a correctional institution as you finish your training. I don’t know if you’re going to come back to vet medicine after that. I think you’ll be well prepared if you do. I think you will be. Honestly, is all of this an elaborate plan to make you a very specific kind of practice manager? Is that what this?

Sharon Kramper: Oh, gosh. I mean, I do have, have dreams of coming back to veterinary medicine and I would love, like, I have this image of myself as being like the, the Mary Poppins and like a cardigan coming in and, and, and to like practices and helping them with their culture and, and with their mental health. You know, you, you come in and they kind of sprinkle some magic and then get out. I mean, that would be fun, but we’ll see. 

Dr. Andy Roark: I, I, I love, so I, you, you’re, you’re up on the literature, you’re actually doing clinical psychology practice and then you have this great wealth of knowledge of the vet industry and you’ve all these stories from experiences that you had and things like that. When when you and I were talking you know, a couple months back and everything, you, you were really interested in PTSD and you were sort of Uh, part of your research and part of your training was focusing on PTSD, and so you’re studying PTSD, and I was really curious in sort of how PTSD as a as a, as a phenomenon, as a, as a condition people have to overcome how that interfaces with veterinary medicine.

And, you know, we, we talked a bit at the time about sort of ethical dilemmas and, and some of the challenges in vet medicine and some of the, was some of the hardships of vet medicine. And so let me sort of stop right here for a second and sort of say, Sharon, can you talk to me a little bit about what is, what is PTSD in a, in a, I don’t know, in just a general context? And then do we see PTSD in veterinary medicine?

Sharon Kramper: Great questions. So to start off with, from a psychology point of view, PTSD or post traumatic stress disorder is a little bit different from many other disorders we see. Think of like depression or anxiety because it involves and what we call an index event, right? Something happens and then you develop symptoms afterwards, and those symptoms persist over time.

I think a really good example when talking about PTSD is to think about a car accident. And so, for example, you might get into a fender bender, right? And it shakes you up a little bit, but maybe you’re unharmed and you are you kind of go up on your way very quickly, versus, let’s say that you were in an accident where maybe your passenger died, right? Or it was very serious. You were hospitalized for a while. You had to have reconstructive surgery. You know, maybe you thought you were going to die at the moment of impact. Right? We think about the difference of scale and the difference of severity there where one is life threatening. And so when we think about things that could potentially be an index event, we’re thinking about things that could potentially be life threatening.

So, when we think about veterinary medicine, there are things that happen in the workplace that are potentially life threatening, right? You could be mauled by a dog, even if you’ve had a cat like attack you in the face, you know, and go at your eyes. If you’re a large animal veterinarian, you’re working with horses and you’re working with, with cows and bulls.

I mean, you’ve very likely had maybe some near misses or even some serious accidents that have happened to you. And so, getting back to this idea of PTSD takes two things. And one is having an index event that happens. And then there are symptoms that develop afterwards and that don’t go away over time, right? So if something’s minor, let’s say you get bitten on the finger by a dog may hurt for a little while. You may need some antibiotics, clean it up, but you know, the next day you’re probably able to go back to work. On the other hand, if you were mauled by a dog at work, okay. You might be feeling some trepidation.

It might be hard to go back to work. And so you might even have nightmares about what happened. You might find that you avoid breeds that look like that particular dog. You might find that you don’t want to go into that corner of the office where the thing happened. You may find that a certain pitch of bark will, will, you know, just set you off and you feel like you can’t even stay in the room with a dog, even if it doesn’t resemble that.

You know, I mean, there are so, so many things that can like trigger the stress response in our bodies. And when we think about PTSD, those things are things that don’t go away over time. Like they stay with us for about six months or more.

Dr. Andy Roark: So, is is that so that was part of my question? So for example, I was visiting with my nephew. He’s six years old and he was he was around this weekend and we both got stung by bees. Yeah, we both got stung by bees. I shook it off much faster than he did. I have to say, I– not trying to, you know, flex on a six year old, but really, he was very dramatic about it.

And, and, so, he’s like, I don’t want to go back to, I don’t want to go back out in the yard. And, again, this is a six year old that we’re talking about. And Well, he will forget this probably by tomorrow, and so I’m assuming that. But he did. There is technically an index event, something bad that happened.

And then he did remember. And then he did not want to go back out to the yard. Surely that doesn’t rise to the level of PTSD, right? And then when we say, Well, what would be the difference? Is that the amount of time? Is it the severity of the index event? Are there are there caveats on that? I guess I guess where I’m kind of going with this is just sort of understanding, I mean, I’ve gotten, I got bit on the finger by an old cat one time and when I see old cats, I always remember getting, cause it was bad, and I always remember getting bitten, but I, I mean, it’s not, I wouldn’t call it PTSD, it was just, I, I learned a lesson kind of like burning my hand on a stove where I’m like, oh, I’m, I don’t want to do that again, help me, help me start to parse that apart,

Sharon Kramper: Yeah, some things are stressful, but they don’t rise to the level of being traumatic or resulting in like a cluster of symptoms. Generally, what we look at is what is your level of impairment afterwards, right? So let’s say that you did have something happen at work, and you found that you couldn’t get yourself to go back to work.

Well, we would look at that as like a level of impairment, right? If you, if you were trained as a veterinarian, but now you can’t go back to work, you know, we might start considering PTSD because the level of impairment of what happened…

Dr. Andy Roark: Yeah.

Sharon Kramper: is so high, versus, you know, is your, it was your nephew, right? You know, he’s probably gonna be able to go back out in the yard like you said.

It’s probably not gonna impair him, but there, you know, there are people who have things So, you know, a lot of the times when we are thinking about PTSD, we’re also thinking of examples having to do with like the military, combat, physical…

Dr. Andy Roark: Of course. 

Sharon Kramper: assault, and things like that. And so we think about people who associate certain triggers, smells, sounds, types of people, locations, environments, with the thing that happened to them, the index event. And therefore, let’s say, let’s say they were in a car accident and now they can no longer drive, right? They’re too scared to get into a car. They’re too scared of what’s going to happen. And so that would really impair your life if you could no longer drive yourself anymore, right?

Dr. Andy Roark: Yeah, absolutely.

Sharon Kramper: That is one of the things that we look at with PTSD, we take into consideration is how impaired has your life been?

Dr. Andy Roark: Interesting. Okay. How much, how much of a prevalence of PTSD did you find in, sort of, in your research when we look at, at veterinary medicine versus, versus the general population?

Sharon Kramper: Yeah. So, in the research that I did, we collected stories from veterinarians, but also support staff. And we asked them to tell us about an event that had haunted them, right? Something that really stuck them. And We looked at those stories and we evaluated them for whether we felt that they were an index event, like I’ve been talking about, right?

Did something rise to the level? And let me tell you, so there’s actually A little detour here. There are four guidelines that we use when we’re considering whether something might be a traumatic event. And one is that the thing happened to you, right? Are you the one who got mauled by a dog, who got gored by a bull?

Did you witness something happen to someone else? Did you witness someone get mauled by a dog or trampled by a horse, right? That could be traumatizing. Did you hear about the violent and sudden death of someone who’s close to you? So this is not like grandma died of cancer and I found out.

This is like, I found out that, you know, my sibling was coming over to my house and I found out that he was shot dead in the convenience store robbery, right? It has to be sudden and violent and somebody who’s really close to you. And then the fourth thing that we look at that could be potentially traumatic events would be repeated exposure to extreme and gruesome things happening.

Like, for example, First responders having to pick up human remains or being exposed to stories of child abuse, right? We look at things like that, like this accumulated experience over time. a little bit more background on that. So in veterinary medicine, so one of the things that I was curious about is The I thought that there were things happening in veterinary medicine that might qualify as like these index events, but they don’t fit neatly into those categories that we just talked about.

And so we went through these narratives and read people’s stories and tried to see if they met the criteria for possibly being an index event. And what we found is that there were especially stories of people who had had a patient die during a procedure related complication that seemed really analogous to what can happen in human medicine, right?

Where doctors can lose patients and those can be considered traumatic events. But when you look at, like, the very strict definition of what an index event was, for a psychologist, it didn’t include anything about animals. Right? There was nothing, nothing saying like it was about having to pick up human remains.

Well, what about if you’re working in an environment where you’re seeing gruesome animal remains? You’re seeing, you know, big dog, little dog kind of things or car accidents and you’re being exposed to that. Or maybe you work in shelter medicine where you’re performing a lot of euthanasia. And so one of the things that I wanted to, to look at is are we making the bucket large enough as psychologists, right?

Do we maybe need to expand our criterion a little bit for what an index event is? And then, once we had an idea of we would categorize these different narratives that we had captured then I went through and analyzed for, we’d ask, also ask people what kind of symptoms that they’d had associated with that event.

So we were able to kind of calculate, okay, they’re having an event and they’re having a symptom, right? Because it takes both in order to have a diagnosis of PTSD. And so, we’re finally getting to the meat of this here. So, the prevalence of PTSD within the sample that I was working with, was 3. 6 percent if we only considered a very, like, small, strict interpretation of what an index event was, right?

So if we were only considering It’s like, humans. Let’s see if I can explain this a little bit better. So we actually had gone through the narratives and evaluated them for whether they met the strict criterion for whether they were an index event under, like, a very strict interpretation, meaning it was like you had to do something with human remains or basically there’s a human victim involved.

But what we did is we also went through and we re evaluated every one of the narratives for what if we consider animal victims Then, so basically if we expand this idea of what an index event could be that include animal victims, then what does our prevalence of PTSD look like? Does that make sense?

Dr. Andy Roark: Yeah, 

Sharon Kramper: So it’s kind of like we figured out PTSD with a very strict definition that like psychologists are using, but then we also like I opened it up and I said, well, but what if we consider animals as victims? What does that do to the prevalence rate of PTSD within veterinarians? So we went from 3. 6 percent under the very strict interpretation of what an index event is, which is very similar to what you find in the general population, like everyone who’s not working in veterinary medicine.

But when we, when I expanded that definition of what an index event could be, the prevalence increased to 13. 9%, so just about 14%. . quite a difference. And what it means to me is that there are potentially a lot of people out there who have been impacted by traumatic events that have happened at work, but we’re not catching that.

Dr. Andy Roark: Hey guys, did you know that I have another podcast? I am the host of the Uncharted Veterinary Podcast with my dear friend, practice management goddess, Stephanie Goss. We have been answering questions for years. We started a year before Cone of Shame. I started doing the Uncharted Vet Podcast with Stephanie.

We take questions from our mailbag. We have listeners who write to us and they tell us about what’s going on in their practice and we try to answer their questions and they are all about communication, leadership, management, things like that. It’s about working with clients. It’s about working with staff.

It’s about working with your boss. It is about all of those sorts of things. We have everything from, trying to establish some trust in your team when you’re a brand new baby doctor, actually fresh out of vet school to managing an employee with mental health issues to how to give notice without, without the guilt.

If you are in a place, you just can’t be there anymore. We’ve got all that stuff. We’ve got hiring, firing, working together, working with clients, reviewing your systems, getting your practice to run smoothly and efficiently, and how to manage your time. All that stuff is there. Check it out. I said 250 episodes.

You can see what everyone is about, from the title because it’s what, it’s basically the question that we’re being asked. But anyway, it is a very popular podcast. I hope that you’ll check it out and enjoy it and love it. I just love making it. So anyway, I just want to tell you it’s there guys. Let’s get back into this episode. So help me with this a little bit, right? So we’re talking about PTSD. It’s really interesting when we talk about this way a big part of PTSD is in the response of the individual to the event and I’m not saying I’m missing is a choice that the person has but but, you know, two people could have a similar experience.

Like, you know, two people could be in different car accidents. They could be in the exact same car accident. And one person is going to be terrified to drive thereafter, and the other person is, is simply not. I mean, I would assume that that’s kind of the same thing when we talk about this with vet medicine, right?

I mean, there’s, there’s a, just because there’s a larger, there’s a, there’s a high percentage of people who could develop PTSD. A lot of, a lot of them presumably won’t, right?

Sharon Kramper: That’s correct, yes. Just because you are exposed to something that could be an index event does not mean that you are going to develop PTSD. And so there are like resilience factors, and I’ll be honest, I’m wading into a territory that’s not as familiar to me because we didn’t really look at resilience factors in my research, right?

But there are individual differences between people. There could be people who have been through similar situations in the past and they become more resilient as a result. Right? We’ve probably seen that in veterinarians or, or support staff who you know, they’ve been through it so many times that These things just don’t get under their skin anymore.

On the other hand, there may be someone who I’m thinking of like your nephew, right? If he’s never encountered a bee sting before, right? If you’ve never had something terrible happen to you, and all of a sudden, boom!

Dr. Andy Roark: Yeah.

Sharon Kramper: Your whole worldview changes, and what you thought was safe is no longer safe. And actually a lot of PTSD treatment tries to get at that, at how, essentially like the, what you believed about the world and your safety in the world has now changed.

And how do we, how do we go so essentially you kind of become more extreme in a way, right? Like nothing’s safe anymore. You, and so what we work with during treatment is how do we get you to a more realistic place?

Dr. Andy Roark: Right. Gotcha. Okay. So, when we look at, you know, just say that, that there is, that there’s a 14 percent chance of a vet professional being exposed to a potential index event if we use this sort of more broad, bigger bucket, as you said, sort of, sort of idea. Are there things that we can do for our teams or for ourselves to kind of say, well, hey, look, this, this exposure might happen.

Are there things that we can do to kind of, to prepare ourselves to, to maybe lessen our reaction? And again, I don’t say it’s not, it’s not emotional numbing, but are there conversations that we could have or just things that we could start to, I don’t, I mean, I’m thinking about, about training, you know, is there a, is there a way of sort of having at least conversations about what these things look like if we’re having at, at veterinary technician school or at veterinary veterinary school or, or for onboarding into, into working at the clinics?

Are there? Are there sort of expectations that we should set, or things like that? I don’t, I don’t know, and like, that we may be headed on a very gruesome path of bringing people in and, and exposing them to horrible things, or telling them about horrible things. I, I don’t know. Do you have any insight there?

Sharon Kramper: Let’s see. So first of all, I kind of want to go, go back and the, the 14 percent would be like the number of people who would actually be potentially diagnosed as clinically having…. 

Dr. Andy Roark: Oh, diagnosed. Oh, oh, I thought that was, I thought a percentage was coming in to contact. 

Sharon Kramper: The exposure is much higher, right? Yeah. I mean, think about how many veterinarians are, but you know, like how many people you’ve worked with who’ve probably been exposed to something in the, you know, it’s much higher.

It’s going to be over 50%. but, but like you’re pointing out, like a lot of those exposures happen, but they don’t result in PTSD. So, how do we prepare ourselves, or how do we, because here’s the thing, is we can’t this is one of those things where we can implement all this safety, like safe handling guidelines as we want, and things are still going to happen, right? So we kind of, rather than trying to completely eliminate that from the workplace, because that’s probably not a reasonable goal, yeah, how do we prepare ourselves? So getting back to like, how would we treat somebody if they have PTSD?

And one of the things we do is prolonged exposures. Okay, I don’t know if you’ve heard about this, but so, a lot of times what happens is that the, the body, getting back to this idea that people start to avoid things that, that cause them distress. Because it’s related to the thing that happened to them, like avoiding a particular breed of dog or maybe the area in the hospital where the thing happened to them is as much as possible exposing yourself to that thing that happened.

So you don’t have to do it in a dangerous way. But It’s that sort of adage of getting back up on the horse again in a safe way so that your nervous system learns like that thing happened to me once, but it’s not going to happen to me every time.

Dr. Andy Roark: I have a friend who is terrified of roller coasters, and, and and she worked through it. And the way she worked through it was, at first, you would go to, like, the fair and just be there. And then, she would go and she would stand in line for the rollercoaster. Never intending to ride it, I’m gonna stand in line.

And then, you know, and then she kind of worked her way up like that of just, kind of this exposure to this thing until ultimately, she never got, she never got to where she loved rollercoasters, but it wasn’t this you know, debilitating thing. I think she felt compelled to sort of tackle this thing that, that she felt she was maybe overly afraid of in her, in her mind anyway.

And so that, that, that totally makes sense. 

Sharon Kramper: Yeah, just said a really key word there, which is debilitating, right? It’s, it’s getting back to this idea of like the level of impairment that it causes. So if that thing is really getting in the way of you being able to go about and do normal things in your life, things that you want to achieve, things that you value that are important to you.

Like if you want to go to the fair, like, you know, the roller coasters there. Yeah, a lot of times it’s, it’s just a matter of deciding, right? I just, I don’t want to be afraid of that thing anymore to that  extent. And yeah, exposures over time.

Dr. Andy Roark: I mean, I’ve seen vet professionals work through fear of cats or, I mean, through, like, again, I’m sure that, I’m sure people work through fears of dogs, but, like, the one I’ve seen and remember is someone who, like, they, they didn’t have cats as a kid, they weren’t very familiar but they wanted to be a companion animal veterinarian, and, and it’s one thing to say, well, this is, I, Yeah. I don’t want cats to be my primary focus. It’s another thing to say, I don’t want to see cats at all. And that person was like, I don’t, I don’t want to, I don’t want to be that way. But it was something where they, they had to spend time with cats. They had to, they had to be around them. And like, they would go, they’d go to my friend’s house, who had a bunch of cats.

They’d just kind of be there. And, and then they would sort of start to see them in the exam rooms and stuff like that. But it was, but it was very much just sort of a process through that. So I like this topic and then I think it’s, it’s important for us to be aware of kind of how we stress ourselves so that we can support each other and then also if there’s things that we can do to try to build resilience so that people don’t get sort of, blindsided and, and put into a bad place and then also I, I really love the idea that, that there’s always things that we can do to try to sort of work through these issues and I, I think that’s an important

Sharon Kramper: Yeah. Some, some of them. And then I do want to bring up, like, there is a whole other category that we found in my research of things like, losing a patient through you know, from procedural complications, right? That is the kind of thing that can be traumatic, especially if maybe there was like a medical error and, and that’s related to why the pet died or animal died.

And so, that’s the kind of thing where exposure to it, you know, that, that may not be the right route for getting that. Except, well, going back to surgery, right? Going back to surgery is going to be a route through it because you’re going to have many, many more successful surgeries, right? That one go well, but you take what you can learn and you go back to surgery.

But I’m thinking of, for some people, it’s just the getting stuck in like that mental state of you know, I did something wrong. You and I have talked about this before, that you get into like a negative cycle of yourself, right, all the things that you are, all the awful things that you’ve done in your life.

And so that might be the point in time when it’s good to get an outside perspective from like a mental health professional.

Dr. Andy Roark: Oh, that, yeah, that totally makes Yeah. Some, sometimes getting back on the horse is just like that. Maybe that’s not, maybe that’s not the immediate right suck it up kind of move.

Sharon Kramper: Going back to surgery is, but going back to like losing patients isn’t, right?

Dr. Andy Roark: No, exactly. Right. Yeah. Let’s not do it. Let’s just, let’s just not do that again.

Sharon Kramper: Right, yes, yes, and yet, every time you go into surgery, you are taking that risk.

It’s always going to be there, and it’s so hard to, it’s so hard to face it, and that’s one of the places where the mental health professional can kind of help you to get into a more neutral place about going into surgery and how do you handle the risk that you’re taking every time, what the outcome could be.

Dr. Andy Roark: Yeah, well Sharon thanks so much for being here. Do you have favorite resources in sort of the veterinary mental health kind of space? Yeah.

Sharon Kramper: Yeah, one of them that I would recommend that is very specific to veterinary professionals would be it’s called Lifeboat, L I F E B O A T and that is through NOMV, right? Not one more of that. And Lifeboat is a peer support application that you can find on the computer. and like if you’re seeking help for burnout, depression, anxiety, PTSD, you will be supported by peers who are also veterinary professionals and who can, who have been there, right?

They’ve been there, they’ve had their own mental health struggles, and they can help support you. If you wanted to go more broadly than veterinary medicine, there’s of course NAMI, which is also usually called, like, NAMI, I think, the National Alliance on Mental Illness, and they’ve just got a lot of great resources for a variety of different kinds of mental health issues.

And if you yourself were like, I really would like to find a psychologist, I would probably say go to Psychology Today Their website, they’ve got a, a directory of psychologists all across the country.

Dr. Andy Roark: Very cool. Cool. Thank you for being here. Thank you so much for sharing with us. Where can people find you online? And are you on LinkedIn? Are you out in the world where people can you re–

Sharon Kramper: I am LinkedIn, yes, yes, you could probably search for me as Sharon Kramper. But yes, I don’t have a very large social media presence, to be honest.

Dr. Andy Roark: We’re gonna, we’re gonna blow, we’re gonna blow you up. That’s, that’s what we’re gonna do. Great. Well, thank you for being here, guys. Thanks for tuning in, everybody. Take care of yourselves. I’ll talk to you later. And that’s what we got. Guys, I hope you enjoyed it. I hope you got something out of it. Thanks to Sharon for being here. Guys, thanks to you for listening. Take care of yourselves, everybody.

5 Pieces of Advice for New Veterinary School Grads

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Imagine a brand new veterinary school graduate walking past you and out of the graduation ceremony, degree in hand. Just before they pass out of the building and into the blinding sunlight beyond, they pause and turn back to you. “Do you have any last pieces of advice?”

What would you say in this brief moment? I’ve been thinking about that for the last few days. I think I’d rattle off these five things as quickly as I could and then wish them luck. Here goes:

  1. Remember veterinary medicine is a journey – The person who loves to walk will go much farther than the person who just wants to reach a destination. Learn to love the walk, not the endpoints you think will make you happy.
  1. Don’t stress so much – He who suffers before he needs to, suffers longer than he has to. Whenever you find yourself starting to worry, ask yourself “What can I do right this moment to improve my situation?” Then do that. 
  1. Be intentional with your attention – Your life is controlled by what you focus on. Resist making unkind assumptions, dwelling on the negative, and ruminating on things you can’t control. (These things include: the past, the future, and other people)
  1. Be present and part of the group – There is nothing better you can do for your happiness and your ability to do your job than to truly know the people around you. Don’t sequester yourself among the veterinarians. Become an interconnected piece of the fabric making up your practice and community.
  1. Take online veterinary medicine with a grain of salt – Social media incentivizes negativity, extremism, moral and emotional language, and in-group/out-group conflict. Your emotional energy is precious. Don’t let it get taken from you so some corporation can generate ad revenue.

If I could tick these 5 things off and then shake the new grad’s hand, that’s what I’d do. How about you? If you had this opportunity, what would you say?

The Work of The Veterinarian

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When I entered veterinary school, I thought I’d graduate into a position of decisive clarity. After all, knowledge was clearly a ladder and as each class stacked on top of the last, I felt I must be getting closer and closer to having all the information necessary to be a doctor who knew what to do. Surely the accumulation of almost 20 years of (mostly) correct answers would grant me a sense of both control and certainty as I looked into the sad eyes of the ill patients set before me. At some point, all of this was going to come together and give me a sense of confidence about how to practice medicine… right?

Well… that didn’t happen.

Friends, I’d like to share with you (and especially those of you who are just graduating from veterinary school and entering the workforce) one of the great secrets of practice. Here it is:

Neither graduation from veterinary school, internships, residencies, nor decades of practice will grant us the control or certainty most of us thought we’d have when we became doctors. Instead, and quite conversely, our training has granted us the opportunity and responsibility of being the person who gets to make decisions when there is little or no certainty.

That’s it.

Veterinary school does not lead us to the job of continually selecting what is good for our patients and what is bad for them. It instead transforms us into people who are educated and respected enough to carry the burden of frequently choosing between two or more objectively bad options. Our DVM degrees don’t give us clarity. They qualify us to lead others into and through the humbling fog of uncertainty that surrounds emotion, resource management, illness, and death.

I don’t tell you this to deflate anyone’s spirits. I’m also not saying it to take anything away from our wonderful profession. I simply think that we do young doctors a disservice when we don’t tell them clearly what the job they are training for entails. We set them up to believe that decisions should be much easier than they actually are, and that can make them feel like they are failing when they are, in fact, just searching like the rest of us.

The reality of what we do, the navigation of uncertainty, shouldn’t be surprising to us. This challenge is what waits for all who climb to the top of their chosen vocations. To be truly great at something is to have risen past the easy answers so that people come to you with problems others are unable to solve. As Dean Acheson, secretary of state for Harry Truman, once said: “At the top, there are no easy choices. All are between evils, the consequences of which are hard to judge.”

The same is true for facing down illness. Our training often does not light the correct path for us, our clients, and our patients. It simply makes us the best people available to hold the torch and lead the search in the darkness. 

If you find yourself searching and wonder why you never seem to get the easy cases, please know that you are not doing anything wrong. You are simply living the life of a healer in the real world. You are shouldering the responsibility that our patients, clients, and society need someone to carry. Yes, the burden feels heavy sometimes, but it is a responsibility we should be proud of. Anyone can google a “right answer.” It takes a special kind of person to make decisions when there IS no right answer. That is the work of the veterinarian.

Return of the Independent Practice Owners

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Dr. Matt Salois joins the podcast to discuss the currently perfect conditions for an influx of new independent practice owners. In this episode of the Cone of Shame Podcast, he and Dr. Andy Roark explore how the slowdown in corporate consolidation combined with the availability of technology and services could spark a renaissance in veterinary practice ownership. They also touch on the future of independent practice ownership and the changing demographics within the field. Tune in to understand the evolving landscape and what it means for aspiring veterinary practice owners.

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

LINKS

Matt Salois LinkedIn: https://www.linkedin.com/in/msalois/

VMG: https://www.myvmg.com/

Team Training Kit: https://drandyroark.com/product/team-training-bundle/

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

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

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Matthew Salois, PhD is currently the President of the Veterinary Management Groups (VMG), where he is responsible for enhancing the economic and cultural success of more than 2,000 veterinary member practices. Most recently, Matt was the chief economist and head of the veterinary economics division at the AVMA between 2018 and 2022, where he applied his skills in economics, business, and communication to support the daily lives of veterinarians. From 2014 to 2018, he served as senior director of global scientific affairs and policy at Elanco Animal Health. Matt is also an adjunct professor of applied economics at the University of Florida, where he previously taught and advised graduate and undergraduate students. He earned his Ph.D. in Applied Economics from the University of Florida and holds an M.A. in Economics and a B.S. in Health Services Administration from the University of Central Florida.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a fun business nerdy episode today. It’s me and Dr. Matt Salois. Matt is the president of VMG, the Veterinary Management Group, and we are talking about the possible resurgence of the independent practice owner.

We went through a period where corporate consolidation was happening and we were seeing corporate groups buying and buying and buying practices. And that has slowed dramatically. Are we seeing the independent owners coming back now? Has the landscape changed enough that it is favorable?

Are there people who want to own their practices independently? Matt says there are, and I want to believe him. And so we get into that and kind of what the demographics look like for practice going forward. We talk about, we talk about what practice might look like in the future. He talks about three big drivers that are sort of driving an independent practice resurgence.

And then we talk a little bit about the future and what the next five years might look like. And so anyway, it’s a good, honest conversation with some good stuff and maybe some stuff that’ll keep you awake at night if you’re a practice owner, but it’s all mixed in there. So anyway, I love having that on.

So insightful, such a wealth of knowledge. 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. Dr. Matt Salois how are you?

Matt Salois: I’m doing great. Good to see you again, Andy.

Dr. Andy Roark: You as well. I always love having you on the podcast. I was at VMG and I was hanging out with a couple of my friends. We were, I think I don’t remember looking at the program or what but your name came up and someone that I respect said You know, I would go wherever that guy was to hear what he had to say And it was just very complimentary statement about how insightful some people that I respect find your commentary.

So anyway, I just I was like, I gotta get, I gotta get Matt back on the podcast.

Matt Salois: That was a plant. That was the person that I put in there to do that. Yeah. No, just kidding.

Dr. Andy Roark: There was money, traded hands and, here.

Matt Salois: Yeah. No, appreciate that. It’s always great to be on here. I always feel like I’m on the premiere daytime talk show for veterinary medicine. When I come to talk to you, I love it.

Dr. Andy Roark: Well, thank you for saying that. I just, I genuinely am always interested in kind of what your thoughts are. You pay a lot of attention to the industry and which way it’s sort of going. And especially trends around practice ownership and independent practice ownership.

You are the president of the VMG, Veteran Management Groups, and you just generally have your finger on the pulse of, kind of, independent practice ownership in a significant way. And so, I’ve had this idea for a long time, and I, think independent practice ownership is a just, important. It’s a vital part of our culture in vet medicine and I just, I always want to support independent practices.

I mean, I don’t have any problem with corporate practices as well. I think that there’s a good mixture and there’s a lot of benefits for a mixed model like we have, but I still want to, I don’t want independent practice to go away. go away. And there for a while, there was so much consolidation and private practices were being bought at such a high rate of speed.

A lot of people were like, how far is this going to go? And we’ve seen a slowdown in that regard. It’s probably over, you know, increased interest rates and, money is more expensive to borrow now than it was. But, I just anecdotally, Matt, I had this feeling that we’re starting to see possibly an upswing in independent ownership.

We’re starting to see some consolidation has slowed down. We’re starting to see maybe some people who sold their practices, three, five, years ago are now sort of circling back around and saying, I think I’d like to make another pass at this. And boy, I’ve learned a lot of lessons. And now I’ve also got a nice chunk of change that I could play with to get something started.

It reminds me of, you know, if you’ve ever built something. And then you look back at it and you’re like, I love it, but boy, I could build this in one third of the time now that I know what I’m doing. And I hear that sentiment a lot from people who have sold practices. So let me sort of stop talking here for a second.

I just want to put it to you and sort of say, Do you share my optimism in the idea that maybe there’s a pendulum swing? And maybe we saw independent owners sort of exiting the field and maybe now they’re starting to come back in? Or do you think that’s maybe wishful thinking on my part? Yeah.

Matt Salois: No, I don’t think it’s just wishful thinking. It’s like this conversation was meant to happen, Andy, because you’re not alone in this. In fact Martin Traub Warner and I gave a talk at the PSI Symposium just this last past October on this very topic, you know, our title was Independence Day.

Why the conditions are right for a Renaissance of independent veterinary practice ownership. And it’s just on this entire thesis of what you’re talking about. And our genesis for this talk was, A year long experience that Martin and I were having what you just shared was owners who had sold to corporate coming back and reopening new independently owned practices because they could do it like you say, to the third of the time they could do it twice as well as they did it before, as well as some of the promises that I think that the corporate buyout just never, revealed themselves.

You know, and I think this is a Time tested story. You might’ve heard, Martin and I have heard it around, you know, I sold to corporate, they said nothing would change the culture, remained the same. They promised the practice to grow and some of the promises just didn’t happen and things did change. The culture of the practice wasn’t the same.

And they didn’t like the way things were left. And so it wasn’t just a do over for them. It was, Maybe amending the sins of the past and doing something again that they wanted to create this practice and how they felt a practice should be run and what a culture of that practice should look like.

Dr. Andy Roark: Well, so do you think that so I’ve heard this story before as well And I believe that there’s truth to it a lot of cases. How much do you think it is that? People who sold their practices again when you talk about corporates, that’s like talking about independent practices as if they’re all uniform And so just wild differences and so We’re, it’s, a big stereotype here, but, people have this have, you know, have that sort of story that they tell, but I gotta tell you, Matt, when I look at it, you know, having run businesses.

I don’t have clarity of what the next year is going to bring. And you know, and when you’re building a business and you’re putting things together, I do think that you could have the best intentions to say, we want to maintain what’s here. We want to maintain this culture, but none of us have the foresight to get in and you look and, who knows what’s going to happen in the world or who’s going to leave or, who’s going to come in or be brought in to run a region or a group of hospitals.

And there’s just so many moving parts. I have a hard time. In some cases, you wonder if that was ever really the plan. In most cases, I think it probably was the plan, but it just doesn’t shake out that way. And so, how much of that, if you own a practice and you sell it, how much of feeling that way is unavoidable?

Because it’s never going to stay the same as it was. Like, even if you ran it, it still wouldn’t be the same as it was. But, how much is that? How much it is, oftentimes, A lot of people and I go through this too, I a hundred percent, so I still work in practice. I was in the vet clinic today seeing appointments as an associate and I romanticize being an associate.

I’m like, Oh man, I could just go back and I could just roll in and see appointments and go home at the end of the day. But the truth is I can’t, I could never give up the control that I have. Like I just, I couldn’t do it, but I tell myself I could. And how much of it is that, you know, We, you sell your business and then only then do you really realize how much you enjoyed being the one who got to make decisions or you got to be the final decision maker.

Matt Salois: I mean, that has to be a part of it, right? Because, and we see this carry out in the data, AVMA and others have shown, they look at some of the wellbeing metrics around compassion fatigue and those sorts of measures compassion satisfaction, and they’re higher for, Practice owners and they are associates.

And while it may sound contrived in a way, but it’s true owning your own destiny, choosing the path that you’d want to walk. There’s value in that. There’s reward in that. And, you know, to your point around corporates and totally not meant not meaning to use the word pejoratively. I don’t think we should or should do that at all.

But they’re wildly different. And I think promises are made with always the best intentions, but this is part of the challenge with corporate ownership. You have to look at who owns that business, who owns that organization. And for the most part, there are plenty of exceptions, but for the most part, most of the corporate practices are owned by private equity groups in veterinary medicine.

And their whole fundamental purpose is, revenue return, to buy something, invest in it, and then sell it for a return. And so these practices change ownership hands, you see it time and again with NVA and others who are emerging the equity owners change, they’re selling to one another, and the priorities of those equity owners may be different, or how they strategize and build a strategy on practice growth could be wildly different than the previous owners.

And so it’s hard to have that consistency over time when the ownership of that business or that practice is changing hands too.

Dr. Andy Roark: That totally makes sense. Shifting gears a little bit. Talk to me about this conditions are favorable for independent practice ownership. Start to talk to me about what that looks like in your eyes.

Matt Salois: So I think it’s a number of things. The first thing and you alluded to it is just the economics of things. The fact that interest rates have reversed themselves definitely changed changes the tide in terms of what’s happening with consolidation. So the pace of consolidation has slowed way down.

The cost of capital is a lot different than what it used to be. Like you said before, money’s, money was really cheap and now it’s more expensive. Interest rates are coming down a bit from the highs of the last year or so, but we’re still amongst, you know, 20 year high interest rates for our economy, so it’s a lot more expensive to invest to gobble up practices, whereas before, particularly post covid immediately when interest rates were actually negative for a period of time because of some of the actions by the Federal Reserve and fiscal policy from the government, it made interest rates effectively negative, which is just odd.

We do have occasions of that in our economic history, but they’re generally pretty rare. So the incentive to sell a practice, I think, first and foremost, is a lot less than what once was. And so I think that’s slowing things down and creates a incentive motivation for a lot of independent practices just to focus on their practice and their growth rather than sell.

And on the flip side of that, From the corporate perspective, now the business isn’t investing in, in, in practices and growing through number of practices. Now they have to be business managers here. Now they have to be the owner and an operator of a veterinary practice. That’s how they, need to grow.

That’s a very different mindset. So I think that’s why we see a lot of corporate struggling right now. The other piece of this, the second piece I’ll say is technology access and affordability of technology has never been more accessible. Never been more affordable. And so the things that corporates could have done on their own because they had the capital, they had the cash the most expensive equipment, the best systems, the most cutting edge.

That’s not in the domain of the corporates anymore that I think independent small business in general. can access those types of technologies to incorporate into their practices. I mean, chat GPT is, it’s cheap, right? And so just the ability of AI and other types of technology to use that in your practice, no longer the domain for large businesses.

And the third and the final thing I’ll say is the level of support. And services available within veterinary medicine has matured greatly. And so, what that means for an independent veterinary practice is they no longer have to have their own tech department. They no longer have to have their own marketing department.

They don’t need their own bookkeeping. There are all these organizations and companies and services that can come in and support a veterinary practice in so many ways, allowing them just to focus more. On the delivery of the medicine and the patient care. So I think those are the big three ways that Renaissance is happening.

Dr. Andy Roark: Yeah. I like this a lot. I really, it’s funny, as I sit and think a little bit about the level of support and services, I think you’re, I think you’re spot on. 

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 at drandyroark.com brings together my Charming The Angry Client and Exam Room Communication Toolkit courses to provide flexible on demand communication training for your veterinary practice. Check them out. 

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

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

Dr. Andy Roark: You know, it was funny for a long time, the narrative was that you were going to see vet practices getting bigger and bigger. Yeah. because there was an economy of scale and you could have this technology if you had five, six, ten veterinarians using it.

So just imagine, you know, that we were all going to get CT scans. Well, one vet could never support a CT scanner, but if you had 20 vets, then they could, between them, they would have enough cases that would justify the cost and you could have this equipment. But that’s not really the way that medical technology has gone.

It has really shifted more and more towards being more and more portable, affordable, you know, sort of a subscription service type model. Um, And that, yeah, that’s, I think you’re spot on. I think that’s really powerful. I think the ability to outsource a lot of the services is really exciting in a lot of ways.

You really, you don’t have to wear all the hats because all of those things are readily available. I think that’s, I think that’s. I think that’s interesting. Can you speak a little bit about what the real estate market looks like for veterinary practices? It used to be that, you know, vets tended to own the real estate, or they tended to have standalone buildings.

And then there was definitely a shift in the, you know, late 2020 or early 2010s. We started to see a shift towards these buildouts in sort of strip malls, you know, kind of, startup spaces and things like that. Do you see or foresee build outs of those clinics in those types of rental spaces going forward?

Is that making practices more accessible if you wanted to get one set up or is it having a, you know, a sort of a net neutral effect?

Matt Salois: Yeah, that was a good one. And there’s a lot in there. I think, 

Dr. Andy Roark: Yeah, I kind of threw a lot, I kind of threw a lot at you around around where do we put vet practices?

Matt Salois: I think there’s a lot of opportunity in real estate. I mean, the real estate is one of those goat rodeos right now. I mean, it’s coming back, but it was a hot mess the last couple of years. In particular, you look at office real estate and commercial real estate, like there’s huge vacancies there as a lot of work from home, hybrid, remote, conditions evolved and are sticking for the most part. You still have some employers pulling back on that, but that’s another conversation. There’s a lot of vacancies, and so I think there’s a lot of opportunities for small businesses to take advantage of what a lot of real estate owners are doing, which is, you know, reducing their rents.

Or reducing some of their prices in order to have that real estate move. And the housing market, that’s a completely different story. And that’s a completely different market. But when you look at the available real estate for a veterinary practice, I mean, there, the availability is out there and many are building standalones.

And we’re having that within VMG. And I will say. I don’t know enough to know which one is dominating, but within our member practices, we’ve got members who are probably all over the place in terms of, you know, are they in a strip mall or in a, you know, organized commercial real estate venue versus are they standalone practices?

And we know, I know that there are plenty of members who are opening and expanding their own standalone veterinary practices too. I think there’s a lot of potential, a lot of opportunity there.

Dr. Andy Roark: Where do you think the new sort of wave of practice owners will come from? I mean, if it sort of shapes up this way, are these people who are later in their career who are circling back around? Is there a new wave of sort of entrepreneurs coming in who are maybe veterinarians? Who have come into vet school with this sort of dream or, I mean, give me an idea of what is, what demographics do you see sort of driving a potential resurgence in independent ownership?

Matt Salois: Yeah, all over. Quite honestly, which is a good thing. I’ll say again, bring up my VMG perspective as we’re seeing the membership get younger. And we have for the first time tipped majority female in terms of our members. And I’d have to look at the AVMA trends to see how that squares more generally with practice owners in the profession.

But it’s growing amongst that, that demographic makeup of being younger, being women. And you know, it sort of has to in a way because we’re more and more, you know, women dominated the profession and we are getting younger. We’re seeing this in the workforce, not just the veterinary workforce, but in our general workforce as you know, 11, 000 plus boomers are retiring every day.

So they will exit. Now, I’ve seen this in veterinary space more than in other industries and professions. The retirement age seems to be a lot, further out than, the typical you know, 62, 65, particularly when you look at some things like equine and food medicine, food animal medicine.

But we’re seeing that too. We are seeing owners step in who were previous owners, like we talked about, sold their practice, took some time off, decided that wasn’t for them. They were too early to too young to retire. And so now they’re opening new, businesses, new, veterinary practices, and they bring a lot to the table.

So I think we’re going to see a very strong mishmash who those owners are and what their demographic makeup is. Yeah.

Dr. Andy Roark: Do you think these people are going to be cranking out practices that are your standard companion animal practices like we’ve seen for the last 20 or 30 years? Or do you see a different sort of iteration coming down the pipes? 

Matt Salois: It has to evolve. I think there’s no question about it. In terms of the business model, in terms of, you know, how you run a veterinary practice, what you focus on and what you don’t, I think the specialization of veterinary medicine is going to continue that we’re going to see more and more

specialized, targeted veterinary practices, whether that’s at a, you know, specific specialization or even just focusing on, a specific species. You know, exotic pets, cats only, dogs only, those types of veterinary practices. We’re seeing that again within VMG that specialization, we’re, actually starting for the first time an urgent care group within our membership because they’re just growing number of urgent care, specifically veterinary practices. They’re not er, but they’re not general, right? they’re, urgent care. And so I think that caters to almost the consumer trend we see in the economy as a whole is people want the product or service designed for them.

And so you have this ability now to go onto a website and get almost anything Customized to what you’re looking for now. There are limits within health care, which is what veterinary medicine is. But as someone like Peter Weinstein keeps pointing out, it’s consumer health care. You know, so we’re at this hybridization of healthcare and almost, you know, retail in a sense that yes, it’s healthcare and it’s complicated.

And it’s also a consumer market in the sense that you have consumers who want things on their terms and they want it their way and veterinary medicine is going to have to adapt to that. And we are, it’s not easy, but we will, we have to.

Dr. Andy Roark: I do agree with that. I saw a lady today that was very well informed, and had very strong opinions about what she wanted for her pet and what she did not want for her pet. And, you know, it was not worth wrestling to the ground and her opinions were not, they were not detrimental in any way, but she was just, it was, I laugh not because she was wrong, but just because she was very particular and very certain about what she wanted and, you know, that’s not entirely new.

It’s definitely not going away. I think the age of sort of self education in pet owners is here to stay. I think I think we’re probably gonna be dealing with even a more educated level of pet owner than we have in the past going forward. Just accessibility, it’s easy to ask Chat GPT, what might be wrong with your pet and come in with a list of five things that are fairly well thought out.

Matt Salois: Yeah, exactly. Right. You know, gone are the days where you’re happy going into Target or Walmart and you’re pleased with the variety of what’s being offered to you now. And so I think, you know, again, you go to the Amazonification of everything where there’s thousands of options for that one product that you’re looking for.

Yeah. But people are wanting that. People are wanting to know that what they’re doing, what’s being provided to them, has been provided to them as an individual, this increasing individualization that seems to be occurring, you know, in our demography and in our markets.

Dr. Andy Roark: Yeah, when you look into your crystal ball five years from now, what do you see? I mean, do you see a steady steady march of sort of independent practices coming back in different niches? Do you see a specific type of practice really kind of jumping out ahead? What are you most optimistic about in the next five years?

Matt Salois: Oh, that’s a good one. I think most optimistic is that, you know, veterinarians are going to be in need of veterinary professionals in general, and it’s not just for the companion side. It’s all these things that veterinarians provide their skills and their talents towards on food safety, public zoonotic diseases, anything related to the one health arena.

Veterinarians are so important to our society. And I think the continued renaissance of the human animal bond. will grow. I mean, we’ve seen that. We saw that through COVID. Yes. I think that’s going to continue and sustain itself. I do think from a business and economic perspective, we’ve got volatile times ahead.

And so veterinary practices are going to have to, like any business, rise up to that challenge. They can’t just be about the veterinary medicine. I think gone are those days where you can be a practice owner and just be focused in your head, buried in the medicine. That is first and foremost, always the most important that you’re delivering the best care possible to patients.

The challenge now is that you’re going to have to be an astute, savvy business owner manager in order to survive. I think those volatile times because we’ve been through them, we’re going to, we’re going to see more of that and every business is going to need that fortitude.

Dr. Andy Roark: Yeah. Talk to me a little bit more about this volatility that you say. You say there’s volatility coming to tell me a little bit more about that so I can lose sleep at night.

Matt Salois: Yeah, so you could lose sleep at night. So I mean, I think, well, first of all, there’s always a business cycle and we’re going, we’re approaching the downside of our cycle. You see that with the softening of visits, yeah, there’s revenue growth, but it’s by far and large, you know, price driven. 

Dr. Andy Roark: Price increases.

Matt Salois: Right. And so there will be a market correction. That’s always the case. There is always a next recession. And we shouldn’t be afraid of it. It’s just part of the natural cycle. It’s hard not to talk about what’s going to happen next and leave out all of the complicated things that’s happening in our economy, in our society, the increased polarization, the inability of monetary policy and fiscal policy, excuse me.

To get us through some of those difficult times. We bought our way out of the oh, eight recession. We bought our way out of COVID. You see this when you look at aggregate debt levels in our country. And so there is a ceiling here in Japan hit it and we saw. The stagflation that Japan experienced for quite literally decades and only now, you know, since the eighties, only now, really, are they coming out of it and potentially seeing a new era in their economy and that’s my worry for, our, economy as well.

We’re also, we talked about the demographic change, that’s going to be hard. We’re going to see the non working population explode relative to the working population. And so what that means for services like social security and medicare, there’s going to be a funding problem. And, you have the confluence of these forces.

Excuse me, the doorbell rang and the puppy, the little puppy that we got for Christmas is, uh, barking up a storm. She was napping so peacefully next to me and now she’s on guard dog alert. That was sweet little Molly. She’s actually quite sweet. So those are the issues that we’re facing and they’re all going to be kind of at a confluence in the next five to 10 years as these forces are coming together all at once.

Dr. Andy Roark: Well, I think that’s no, I think you’re spot on. I appreciate you sort of sharing that. I think it makes sense. I I, love owning my own business. It’s not easy. I am surprised by how not easy it is sometimes but it’s rewarding and it’s something that I really have enjoyed. So anyway, Matt, thank you so much for being here. Where can people find you? Where can they learn more about VMG?

Matt Salois: Yeah, that’s great. A joy to be here. Talk to you Andy. I always get so much out of our conversations. I’m available LinkedIn. I’m active on there. Message me really to reach out to me. And you can learn more about VMG at our website, myvmg.com.

Dr. Andy Roark: Great. Well, I’ll put links in the show notes, guys. Thanks for tuning in, everybody. Thanks, Matt. Take care of yourselves, everybody.

Matt Salois: You too. Take care. Thank you.

Dr. Andy Roark: And that’s it. That’s what I got for you guys. Thanks so much for being here. Thanks to Matt for being here I’ll put a link to his LinkedIn and the VMG website down in the show notes And that’ll be that gang. Take care of yourselves everybody.

I’ll talk to you later. Bye

Why Do They Leave? Why Do They Stay? Retention & Attrition in Vet Medicine

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Dr. Jessica Vogelsang discusses the latest findings in veterinary retention and attrition. She is joined by Dr. Andy Roark as they dive into the American Animal Hospital Association’s new white paper, “Stay Please.” Together, they explore both expected and unexpected insights gathered from a survey of over 15,000 veterinary professionals. Tune in to discover the reasons behind the departures and commitments of veterinary professionals, and what these trends could mean for the future of the veterinary field.

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

LINKS

AAHA White Paper: https://www.aaha.org/practice-resources/research-center/white-paper-form-the-path-to-increasing-retention-in-veterinary-medicine/

All Dogs Go to Kevin by Jessica Vogelsang: https://www.amazon.com/All-Dogs-Kevin-Everything-Veterinary/dp/145555491X

Jessica Vogelsang on LinkedIn: https://www.linkedin.com/in/jessicavogelsang/

Uncharted at HiVE in Minneapolis: https://unchartedvet.com/conflict-management-training-navc-hive/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Jessica Vogelsang is a noted veterinarian, internationally recognized speaker, and bestselling author of All Dogs Go to Kevin. She serves as the Chief Medical Officer at AAHA and is the founder of Pawcurious Media, established in 2009. An early adopter in utilizing the internet for veterinary purposes, she successfully built an online community, influencing hundreds of thousands of pet owners globally. Her achievements include launching several veterinary brands and founding the Veterinary Telemedicine community during the COVID-19 pandemic. Besides her role at AAHA, she is an active board member of the Mark Morris Institute and the Veterinary Virtual Care Association.

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 the one and only Dr. Jessica Vogelsang saying she is the chief medical officer at the American Animal Hospital Association or AAHA as it’s often called. She is here talking with me about a new white paper that AAHA just published.

Put it, put out, it’s called, officially it’s called Stay Please. It is a retention attrition survey about why people leave the profession, why they leave the clinic. Are they thinking about leaving the clinic in the next year? And are they thinking about staying? If they’re staying, why are they staying?

What makes them want to stay? And so we have this really nice conversation about why people leave the profession and why they leave their clinic and then why they don’t leave and what matters. And so it’s just sort of the tip of the iceberg, but I think it’s a really good conversation to start thinking about what people care about and how do we keep people? How do we keep them in our practice? How do we keep them in our profession? So anyway, that’s what we’re talking about. It is a good time. 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. Jessica Vogelsang, how are you?

Dr. Jessica Vogelsang: I’m great. How are you doing?

Dr. Andy Roark: Man, I’m good. It’s so good to see you. Is this your first time on the Cone of Shame podcast? I think it is.

Dr. Jessica Vogelsang: Yes, it is!

Dr. Andy Roark: That’s amazing. 

Dr. Jessica Vogelsang: I remember you back when you were doing YouTube in your basement.

Dr. Andy Roark: Exactly. Well, that’s where I’m, that’s where I’m recording now, old YouTube studio in my basement. I was thinking you know, I always sort of reflect back on when I met people that I interview. I met you in like, 2012, I think, and we were at the Starbucks in San Diego, and I, I reached out to you because I was a huge fan of you, and you were writing, you were writing your blog, Paul Curious, and this is when blogs were really blowing up on the internet and all of that sort of stuff, and it was a long time ago.

Dr. Andy Roark: It was a long time ago. It was a different world. There was no TikTok. It was all just writing blogs on Facebook. And you, you are such a wonderful writer. You, I always enjoyed your perspective so much. You have a book. It’s one of my favorite veterinary books. It’s called All Dogs Go to Kevin. And so anybody who wants kind of a fun it’s, it’s fun, honest read on, it’s sort of a humorous look at, at vet medicine and you’ll sort of your life as a general practitioner and I just, I highly recommend it.

So anyway, you are now onto bigger, bolder things. I’m not saying better because I really liked your blog, but you’re on to bigger, bolder things as the Chief Medical Officer at the American Animal Hospital Association.

Dr. Jessica Vogelsang: That’s right.

Dr. Andy Roark: And I saw you recently, and I was asking you about this initiative that I’ve seen from AAHA that I wanted to kind of break down and I didn’t realize what a big hand you had in it when we first started talking.

So AAHA put out a white paper. It is a retention attrition survey. It’s called Stay Please. It is a— it is a survey mechanism for AAHA hospitals all about basically employee retention and what makes people stay and what makes people leave. And so let me, let me just sort of pause here for one second and kind of hand it over to you for a second. Tell me a little bit about the survey. Tell me about what it does. Tell me about what it was intended for. 

Dr. Jessica Vogelsang: That’s a great question. During the pandemic, McKinsey put out a big survey called the great the great attrition kind of studying all the different factors that make people leave their jobs or make them want to stay. And so our CEO Garth Jordan came to us. We’ve been interested in doing some research anyway and said, what do you guys think about this, modifying this for a veterinary audience. And I said, I’m in, because what we had never seen up until that point was a survey that asks people not only why are you leaving, but asking them why are they staying? And we hadn’t split it up by job roles. So we decided if we’re going to do this survey we really need to get information from people.

What job role do you have in the clinic? And we broke it down into six different groups. And also the other thing that was incredibly important to me was to include people in the survey who left because that was the other narrative that I think had been out there was that people leave by choice. Rather than I’m really, really sad to leave and I really don’t want to.

And so we really wanted to include those people. I was really inspired to participate in the survey. When I was at the moms with the DVM encouragement conference, that’s Julie Busby’s conference that she does every year. And I was looking at this room of moms, many of whom had left the profession and

I think I had been sort of beaten down and disheartened thinking the profession doesn’t want me back. They’re not making a house that’s built for me. And that made me really sad because I’d been there too. This idea that I want to live here, but this isn’t a livable situation for me. So what can we do to make it better?

And that was really the Genesis for me of wanting to be involved in this survey. And we were so excited when we put it out, we normally get About 2 to 3,000 respondents for a typical survey. We had 15,000 people. You couldn’t stop people from responding. They had a lot to say.

Dr. Andy Roark: Yeah, that’s amazing. So I love this, I love this statement, not making a house that’s built for me. Talk to me a little bit about that. So, so that’s sort of, I totally understand. Julie Busby does a great job. Her mom’s with a DVM conference. I’ve heard wonderful things about it. Tell me a little bit more about kind of what the house is not built for me.

Did that bear out in the survey results? What does that sort of look like when you say it?

Dr. Jessica Vogelsang: Yeah, you know, I, I think and again, I’ve been out for a while, but I remember going through vet school and that there’s a certain amount of assumptions. Right? Like if you’re going to vet school, you want to own a practice and, and that’s what you’re going to do. And what does owning a practice look like?

Well, how does that bear out for your life? And sort of a set of assumptions, maybe that you’re not the primary caretaker for someone that you’re not going to have these other challenges or obligations in your life that you will always put veterinary medicine first every single time in every situation for the entirety of your career.

And if you are not able to do that. For some reason, be it temporary or permanent. you’re out, right? You’re out. And once you’re out, you can’t come back. So, so there’s this, all of these competing narratives that veterinary medicine is only allowed to be a part of your life if you’re willing to commit 100 percent to it.

And, you know, whether or not that’s true, I don’t know, but that was, that was always sort of how I felt. And when I was in situations in my life where I needed to take some time off to take care of family members because I had a baby. It was always sort of this sense of disappointment. Great. You know, another one bites the dust rather than like, cool, you know, we’ll see you in six months.

We’ll see you in, in a year when you’re ready to come back bigger and better. And so we’re doing a much better job of, I think, allowing people that flexibility and helping them see that there’s a place for them, but in my opinion, it was very hard one. It wasn’t that we have as a profession ever built that house for them. Like they had to fight. We had to fight our way back in and say, I’m still here. I still have something to give, boss.

Dr. Andy Roark: Well, it, it totally makes sense and I, and I love that this sort of inspired you to, to sort of pay attention to the voices of the people who had, who had left the career or left, left the profession or left their jobs and that, that, that totally makes sense to me. Was that bared out in the results when you look at attrition data, Jessica?

Is that kind of the feedback that you started to see? Tell me more kind of about what this, tell me more, I guess, about why people leave. Yeah. Yeah.

Dr. Jessica Vogelsang: So it’s interesting. We have the data broken down sort of as a monolith and then broken down by job roles. And so when you dig in, we had 15 different factors. The reasons people leave far and away, and this shouldn’t surprise anyone. The number one reason people leave is cause you’re not paying me enough.

You know, I, I, I can’t survive on this. And also unsurprisingly, although it was the top factor for pretty much everyone, it was the top factor by orders of magnitude for our credential technicians. And some of the, some of the things that they said in the survey, like the quotes you get back would, would break your heart.

You know, like I, I, I, I love this profession, but I have to eat. I can’t keep stealing peanut butter from the treat jar in the back because I can’t afford groceries. I’m like, Oh my gosh, what, what is wrong with us that, that we’re doing that? And so it really sort of reinforced a narrative to me that, People are aren’t leaving because I decided the field wasn’t right for me, or I didn’t love it.

I left because there is an untenable situation. So the other factors we don’t work as a team. You know, I don’t feel appreciated. The leadership isn’t caring. You know that all of those top factors are similar across job roles, just in different different degrees of importance. But it gives us a really clear blueprint for if you want people to stay, you know, here are the things that that you need to do that you need to make better for them so they won’t want to leave.

Because most people And so we, so we asked them, you know, are you planning on staying? Why are you planning on leaving? Why? And if they said that they were planning on leaving in the next year and 30 percent of the respondents said, I’m thinking about leaving and we know statistically 25 percent of them actually do 25 percent turnover in this profession across all job roles, which is huge.

But you asked them what they wanted to do, and most of them were looking for another job within the profession. Very few people were like, I’m out, you know, they were looking for either a job in another clinic, but half of them were doing that. And the other half were saying, I’m looking for a job in industry.

So people were just really, we’re tied. We’re tied emotionally to this vet profession. People don’t get into this for the same reason that people go into other jobs. Like there is a deep emotional connection to the work that we do. People find it very meaningful. And so when they leave. I think most of us are trying really, really hard to still keep a finger in it.

Now, you don’t put years and years of your life into a profession to leave after five years, but that’s what’s happening with our technicians. The average length in this field is five years. Like how that’s, that’s not good.

Dr. Andy Roark: Yeah.

Dr. Jessica Vogelsang: That’s a big problem. Well,

Hey guys, I just have to jump in with incredible news. I will be traveling with the Uncharted Veterinary Conference team. That includes Stephanie Goss and Maria Pirita we are going to Minneapolis for the NAVC HiVE conference that is there. This is on June 15th and 16th. Guys, we are doing a one day Uncharted conflict management training program. 

That’s right. And it is included with the cost of HiVE. All you have to do is register for the HiVE conference that’s $99 for two days. One day, you can spend it with us, bring your team, send multiple people from your practice, put them together. We’ll put them at round tables. We will have them working together, talking about conflict management. 

We’re going to take them through a whole day. This is not a series of lectures. It’s not, they’re going to go to one and they’re going to do something else. Nope. Check the box register for the Uncharted event at HiVE. And you will spend the day with us. And I guess you’re never going to see an Uncharted event that is a day long. 

That is $99. Again, like this is the best price you will ever see on conflict management. So anyway, if you are anywhere near Minneapolis, June 15th and 16th, Come to the HiVE event it’s $99 and you get a day with Uncharted. If you register for it and the other day, you can use it HiVE and get their amazing CE for technicians and managers. Anyway I’ll put links in the show notes. 

You should learn more. I’m serious. If you were within hours of HiVE, there was never going to be a chance for you to sign up multiple team members come together. And do conflict management training as a group. This is a phenomenal opportunity, please don’t miss it. If you’re able to make it, it’s going to be great. 

Let’s get back into this episode. 

Dr. Andy Roark: Were there big drivers that were role specific? So, so I totally understand that, you know, there’s basically the same sort of drivers and they’re sort of re prioritized across roles, but when you say that pay is an orders of magnitude larger concern for our credential technicians, that, that tracks to me.

Were there other items like that where you said this role specifically is being disproportionately impacted by this factor or, or was it otherwise mostly just sort of a reorganization of, of The, the general factors.

Dr. Jessica Vogelsang: I think far and away, you know, the, the pay is, is the big one. And so, You know, what that means is as soon as you get that part sorted out, right, then you have a lot more leeway to figure out what the rest of the factors are. So it’s something that was really interesting to me was when you look at retention factors the top three retention factors for associate DVMs and credential technicians, they map perfectly one to one.

This is a cohort of people who are in it for the same reasons and care for the same reasons. So meaningful work, modern medicine staff works as. And so the thing that was different was that we’re not You know, the associate DVMs for the most part weren’t saying, I can’t afford a car. You know, that’s the sort of thing that our credential technicians were saying, but their attention factors were very, very similar.

These are people that were very motivated by the same things. And the other thing that really, really jumped out to me was talking about, Your, your CSRs and, and support staff, the professional development was a huge retention factor. And oftentimes when I’m presenting this research or talking to to groups, I’ll say, how many of you offer continuing education or professional development for your CSRs?

And a fraction, a small fraction of the room will raise their hands. And so the sorts of things that we were hearing from them is it. Clearly, I’m not in this for the money. I could make the same amount of money at at a grocery store or a retail job and probably be a lot less stressful. I’m in this because I love it.

But in return, I would really love if you would help support my professional development so I can be better at my job. There’s very specific job specific roles. And I want to I want to do better. Help me.

Dr. Andy Roark: Yeah, Yeah, that, that, that totally makes sense. What is it? What do you think it means Jessica, when, when, you know, number three, the staff works as a team? Do you get inside into, like, what, give me an example of what that looks like when a staff works as a team versus when they don’t. Is that everybody is, is working off sort of a unicor–, a uniform treatment protocol?

Like we’re all kind of practicing the medicine, like, is that, is that, is that a workplace culture response? What do you, what do you think that means?

Dr. Jessica Vogelsang: Yeah. I’m so glad you asked that actually. And I swear this wasn’t a plant everyone. We actually just had a meeting about that this morning and trying to figure out how we can research that more because we were pretty intentional when we asked that we didn’t define it. And so the people who responded all had something different in their heads.

So now we sort of have a framework for the next white paper. What does that mean? Team based medicine is a very specific defined discipline specifically on the human side. And I think there are some groups in vet med that are really starting to pick at that. But we have a lot of work to do in order to define what that means.

For me personally, it’s about creating a culture that is family centered practice, right? You put the patient and their family members at the center of every decision that’s made and then everybody else is supporting that. And so everybody on the periphery has to figure out how to work together to support that as opposed to, I think, some of the ways that we maybe center ourselves right now

in, in that decision making process or how things function in the clinic. So it’s just a very different way of thinking, but we’re going to spend some time teasing that out.

Dr. Andy Roark: Yeah. That, that. That totally makes sense. I just think, I think it’s when you get feedback like that, I often say, what exactly does that it, does it look the same for everybody? So, so we’ve talked a bit about, about sort of the reasons people leave and we talk a bit about the reasons that they stay.

I, I, I love the idea that the, the vets and the techs both, both are top three are the exact same. That, that totally makes sense to me. I think, I think, you know, it’s funny with a meaningful work as number one, I see as we’ve had sort of corporate groups moving into vet medicine, and all corporate groups are different, but I have seen conflict in that way where there’s a lot of a lot of companies will use sort of operations language to try to talk to the doctors and the technicians and it doesn’t go well because they’re not here to hit your operation numbers.

They’re here for a much more sort of heartfelt purpose. And it’s just that has been a communication like conflict that I’ve kind of seen over and over again in the last couple years. So that totally tracks number one for when you start sort of looking at these things, you know, one of the things about the survey that I think is interesting is, you know, what do you do with it and where do you go with it?

Can you talk to me a little bit about, you know, I know a lot of people are listening because they’re like, well, you know, I wanted to hear about retention in the practice and what can I do? How can I assess my own practice and what can I do to try to, to try to keep people here? Can you talk to me a little bit about, about best practices?

Dr. Jessica Vogelsang: Yeah. And this is all, it’s so early stages in terms of the work that we have to do. So, you know, at AAHA, our whole purpose and mission is to simplify the journey to excellence for veterinary practices. So it’s not about hitting a mark or hitting a brass ring. It is about doing better every day. And so what we need to do and what our challenges as an organization is, again, we have this information in front of us.

What next? So how do we help people regardless of whether you’re a practice manager who wants to help their team function better or whether you are maybe a new grad trying to figure out is this, how do I figure out what the right job is for me? What questions do I need to be asking my interview? I want to build out a tool set that help people explore all of those things.

So you know what to ask for because we all know how to ask for salary right now. I think it’s, you know, at the very least we’ve done a better job at helping people ask for that. But as we know now, that’s just the beginning because there are lots and lots of people who picked a job that paid the most.

Who are wretchedly miserable that there’s other things that matter. How do you know how to ask for those things? How do you know how to determine whether or not you’re going to be able to get them at the job that you’re at? So it’s, there’s a lot of work ahead of us, but it’s energizing. It’s so energizing to me.

Dr. Andy Roark: Do you think that it’s possible to teach people that? I’ve been thinking about this a lot because, you know, when I work with practice owners and you know, they’ll be talking about recruiting or hiring veterinarians, whatever. And it sounds like so many people come with a salary number and that’s it. Like, that’s all they got.

It’s like, I don’t know what else you do, but this is the financial number. And it’s just, it’s interesting to look and to say, I’m not, I’m not shaming anybody for a salary number they come with but. But I, I don’t know that that number is really what is going to make people happy versus the culture of the place that they’re working, other things like, like time off to support the continuing education support, all of those sorts of things.

And I don’t know, it’s, it’s sort of a nuanced conversation, but I still, I continue to see people that hold so tightly to the money and I think when you jump back to what we were talking about the very beginning, when we look at the number of, one reason that people leave, I think that justifiably there’s, there is concern about money in vet medicine and what people get paid.

So again, I’m not, not trying to knock that, but I, I’ve been rolling around a lot trying to have good, productive, nonjudgmental conversations about what makes people happy and practice beyond salary. But I don’t know that there’s a good way to approach it.

Dr. Jessica Vogelsang: Well, it’s not an either or conversation, right? It’s a yes. And so you need to have a living salary and you need to have these other things. And that is part of the challenge because I don’t, you don’t necessarily know how much you need something until you’re in the middle of it. So some of that is time and experience.

I think mentorship and we have so many great programs out there that are starting to help people understand and develop that having a mentor who can maybe help you get some clarity on that can be super helpful. And one of the other things that really jumped out at me as one of the factors that we asked about for folks was flexibility.

And the only group where flexibility was a top factor in retention was associate DVMs. And you know, you can theorize about why that is, but that’s a group and I’m thinking again about the moms at the DVM group. That’s huge. Do people even know to ask for that? Is it something that you know you’re going to want in, in your job or career?

And so those are all the conversations that we still need to be having. And so how do you offer that? If you are a team, that’s really proud of what you have to offer. And because we hear that all the time, I can’t compete with the salaries that maybe another clinic in town is offering. How do you help people understand?

How do you quantify the value of the rest of it? And it’s not about, you can’t really put a dollar amount on those things. So I think we have to start telling those stories and finding those people who, at the end of the day I think meaningful work is the hardest thing to quantify. That’s going to look different for you, for me, but we have to be asking ourselves what makes life meaningful, and to me, you know, the reason that that I love being in vet med.

And the reason that every time I got kicked out, I came back, it’s like, there’s nothing else I want to do. Meaningful work to me is doing anything to honor that human animal bond. So when I was in the clinic, my goal was to make sure that that, that pet and that owner left. That that somehow improve their outcome, right?

That means a lot of different things. And there’s a lot of things that have to go to play to make that happen. And so now at AAHA, I want people to stay in this profession and find value and find meaning in it and being in an organization where I’m in. The ability to help tell those stories and elevate those conversations that is meaningful to me.

Dr. Andy Roark: Yeah, it sounds like it sounds like you have a lot of sort of next steps, you know, with this, with this program as we look at it.

It’s it And funny, you know, you and I talked about with you, what’s it mean when we say the team works well together? I think you can equally just ask, you know, what does it mean to have meaningful work?

Like, do do is that uniformly defined? I’m sure it’s probably not. But talk to me a little bit. Where do you see this going? Jessica? Like, what are sort of the next steps? Where does this research take you?

Dr. Jessica Vogelsang: Yep. So, next steps for us are starting to build out some of those, those tools for people. And so asking people, figuring out which of these things do we want to focus on first? What do people need? Who is the audience that we’re trying to give these tools to, right? And I think employers and employees both have a different set of tools that they need.

So we’re going to be talking to people and finding out what’s the number one thing that you need help with right now is understanding what understanding what teamwork looks like is a big one. So I think we’re probably going to go in that direction, helping to quantify what What their pay means.

That’s very challenging to do for a lot of different reasons. But just helping people understand, you know, we did a separate survey a couple years ago where we were asking everybody in the team. What do you think your technicians make? What do you think they should make? And what do you want to make?

And so for the vast majority of technicians, what they were asking for wasn’t like twice what they were making. They’re saying I need 5000 more. I need 5000 more, which, you know, when you look at what it costs to lose a good technician, it’s going to be a lot more than that. So even just starting with some of those basic conversations, do you even really understand what the problem is and what you need to do to solve it in the short term or long term?

So. So that’s a really long answer to a short question, but this is a lifelong, like, I could write out the rest of my career just trying to figure out what all this means.

Dr. Andy Roark: I’m going to put links in the show notes, everybody to the white paper. You’ll be able to check that out. I will link to the AAHA website just so people can can have that. Jessica, where can people follow you online?

Dr. Jessica Vogelsang: I am on LinkedIn a lot, so feel free to look me up there. I love to have conversations and talk with folks about all of these things. It’s really grown as I, because I know Andy, when we first when we first met at the Hilton or wherever that was you were just asking me how to get on Twitter. That’s how long ago it was.

Dr. Andy Roark: How, yeah, how, it’s– there’s new thing called Twitter, really interested in it. Yeah yep It was that, back in a much simpler, more naive time online.

Dr. Jessica Vogelsang: So now we’re all LinkedIn.

Dr. Andy Roark: Well, thank you so much for being here. Guys, thanks for tuning in and listening. Take care of yourselves, everybody!

And that’s it. That’s what I got for you. Thanks so much for being here, everybody. Thanks to Dr. Vogelsang for being here. She is a dear longtime friend of mine.

I’m so glad to get to have her on the podcast. Anyway, guys, take care of yourselves, everybody. Be well. I’ll talk to you later on.