DrAndyRoark.com

Articles, Videos, & Training on Pets & Veterinary Medicine

Perspective

The Work of The Veterinarian

by

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

by

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

by

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.

Optimism & The Long(er) Nosed Frenchie

by

As someone who posts a ton of veterinary photos and videos online, I find brachycephalic pets to be a bit of a tricky fish. On the one hand, I often see brachycephalic (aka “smooshed-faced”) pets with absolutely wonderful personalities and are a joy to be around. These include brachycephalic dog breeds like pugs, Frenchies, and bulldogs as well as cat breeds like Persians, Himalayans, and Burmese. I love these pets as individuals, and I celebrate the joy they bring to their families.

At the same time, breeding trends that have pushed these guys to have shorter and shorter noses have also led to more and more health concerns (Here’s some very good data if you are interested). For this reason, I generally don’t post pictures of these breeds on my social media feeds. My thought here is not that I want to boycott or shame anyone. It’s simply that I don’t want to encourage people to seek out or request traits in pets that are physically detrimental to those pets’ health.

Simply put, I think breeders will always breed what consumers want to buy. I don’t think it’s contradictory to love an individual pet and want the best for him or her and also refrain from publicly celebrating a trend you don’t want to perpetuate. That’s been my position on the brachycephalics for years now.

Well, the other day I saw my first long(er) nosed Frenchie! He didn’t have medial patellar luxations, his back wasn’t painful, and he didn’t make any abnormal noises when he breathed. I told the owner “This is exceptional! I love his little snout!” She said she knew she wanted a Frenchie and found a breeder who was actively working to breed length back into the nose and focused on making the healthiest Frenchies possible.

This little dog made my day. Not just because he was wonderful to interact with, but because he reminded me that sometimes we can make changes for the better. Sometimes we can raise awareness of issues and pet owners will listen. Sometimes we can communicate productively and collaboratively with breeders to make the world a healthier place. Sometimes we can push a pendulum that has swung too far back in the other direction.

I don’t mean this post to be about what kinds of dogs people should like, where they should get them, or how they should spend their money. I mean it to be about recognizing that things can change, and negative trends can be reversed if people want them to be. I left my appointment feeling optimistic and a renewed belief that while it might sometimes feel like everything naturally slides towards getting worse, this isn’t actually true. 

Cynicism seems to be in style these days, but I don’t believe the world is bending inevitably towards darkness. Instead, I think the world is just messy. Some parts of our lives and jobs will get worse, and some parts will get better, and some parts will get worse and then better. Remembering that it’s possible for tides to turn is the first step in developing a rosier view of our futures.

A Comedian Walks into an Emergency Room

by

Dr. Matt Asciutto explores the power of comedy in veterinary medicine as he applies the “yes, and” principle from his improv comedy background to enhance client and team interactions. Dr. Roark shares how humor has shaped his approach to the profession. Together, they discuss how comedy can bring light to even the darkest moments in veterinary practice, ultimately making them more effective veterinarians. Join them on this episode of the Cone of Shame podcast as they share laughs and insights in a conversation filled with humor and heart.

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

LINKS

Matt Asciutto Website: www.MattAsciutto.com

Podcast: www.thegreatestprofession.com

Related Article: https://drandyroark.com/the-open-mic/

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

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

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

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

ABOUT OUR GUEST

Matt Asciutto spent many years performing improv comedy, designing polymers, and teaching MCAT for Kaplan before pursuing an incredibly sensible career in veterinary medicine. 

A 2017 graduate of the College of Veterinary Medicine at The University of Tennessee, Dr. Asciutto has been working as a full-time emergency relief veterinarian since 2018, working for over 35 hospitals and traveling across 6 states to get there. 

When he isn’t working, Matt can be found making good use of his National Parks Annual Pass, incessantly bothering his fiancé with opinions about everything, and collecting an unreasonable number of guitars and surfboards. These days he spends far too much time attempting to start a de novo practice in Fort Collins, CO, editing his upcoming book, or endlessly droning on about his podcast: The Greatest Profession.

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 with Dr. Matthew Asciutto. This is real fun. And so we start off talking about his career as a relief, a traveling relief emergency veterinarian. And what that’s like. And that kind of dovetails into sort of his backstory with improv comedy.

And so then we sort of started to start talking about what– how improv comedy sort of actually works in practice. And, the lessons he learned from that and what he takes into his emergency practice today. And it’s just, it’s a really, very fun look at practice in general, and we talk a bit about comedy and humor.

Not homedy. We talk about comedy and humor. Anyway, guys, if you like to laugh, that is amazing. If you like to imagine interesting professions where, I don’t know, maybe you do emergency in the middle of a metropolitan area, and then next week you’re in the middle of nowhere yeah, this is a great episode.

Guys, 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. Matthew Asciutto. How are you?

Dr. Matt Asciutto: I’m doing all right. Thanks for having me

Dr. Andy Roark: Man, I’m, so glad you’re here. I I love getting to know you this year. We, you know, I’ve gotten to talk a number of times and I you fall into that camp of people where I’m like, I, this is someone I just enjoy talking to and I feel awkward just calling him like when I’m walking my dog And so I’m just gonna send him an email and say can I podcast with you?

And then that will let me that will let me have the conversation I want. For those who don’t know you for the last six years you have been a traveling ER relief veterinarian So you have a company called Bendel Vet and you fly is a base. It’s all over the U.S. Right you?

Dr. Matt Asciutto: Yeah. Right now it’s mostly North Carolina, Virginia. And then I was doing like kind of all over.

Dr. Andy Roark: but you live in Colorado. You’re in 

Fort Collins. 

Dr. Matt Asciutto: Yeah. Yeah. Yeah. And I’ve never practiced here. I am licensed in Colorado. practiced in the state.

Dr. Andy Roark: You’ve never practiced in the state you live in. That’s fun. That’s interesting. You are, but you will, because you are starting your own emergency clinic in Fort Collins. You want to tell me about that real quick?

Dr. Matt Asciutto: Yeah. I mean, the idea is that basically all these things that I’ve learned from all these hospitals and traveling around, I’m like, well, we can do it better. And at some point I decided, I guess I have to actually try. Yeah.

Dr. Andy Roark: I will tell you, true story, that’s how I the Uncharted Veterinary Conference, is I, for like 15 years, I spoke at conferences all over the world, and I felt like some of them were amazing. And I would sit on the plane and I would be like, Why was that so amazing? Like, what did they do? What were the circumstances that made that amazing?

And other times, I would fly away and I was like, Oh, 

Dr. Matt Asciutto: Right.

Dr. Andy Roark: I wish I could have that four days back. That was rare. That was rare, but, you could definitely, just in all candor, you could, like, some events you just go, that was incredible. I mean, it’s like in life, where you’ve gone to some parties and you’ve been like, that was a great party, and you’ve been to other parties, you’re like, I’m, it’s 8 30.

I’m ready to leave. so, 

Dr. Matt Asciutto: There’s like certain weddings like that in my life where I’m just like, that was fantastic. I’m going to remember that moment forever. And then others were like, what happened?

Dr. Andy Roark: Yes, and it doesn’t, it does not correlate to the wedding spend. I think that’s really important to note. I have been to, I have, one of my favorite weddings was in someone’s backyard and it slapped. It was just a great time. And I have been to crazy over the top mega weddings and been like, oh, you know, 

Dr. Matt Asciutto: Yeah. 

Dr. Andy Roark: that was a thing.

Dr. Matt Asciutto: Yeah. And similarly, I mean, when I’m thinking about all these, you know, hospitals, one with the fancy toys and all that kind of stuff, there’s pieces of it that are great. And then there’s pieces of it that are not so great. And you can take all those little things.

And if you, I don’t know, if you think that you have enough of a point of view, trying to institute it yourself seems to be the thing to do so I’m doing it.

Dr. Andy Roark: I think that’s always been my position with relief vets in general. Like, if you see yourself as a possible practice owner in the future, start up, starting up a practice, go and be a relief vet for a year or two. And, you just see how everybody does it. And you very quickly will be like, I like that PIM system.

I do not like this PIM system. I like that approach in the exam room or like the, or the way they leverage their technicians and not the way they do it. It’s just, if you just go to vet school and then you go to one place, that’s kind of all, you know, just, but that, that sample platter of being able to go and look at how different people do things.

I mean, so in, in the practices that you’ve called on as an, as a relief emergency vet, How much variability have you seen in, in how these places run? Is it, night and day, they’re different countries, or is it like, no, you know, it’s a 10 percent grade?

Dr. Matt Asciutto: I would say it’s kind of more the former than the latter. I do think that there is, you know, there’s commonality, right? There’s common experience that we all have, especially when it comes to ER, right? Oh, it’s busy and we feel like we can’t see everything. And we’re questioning whether or not we’re doing the right medicine at the right time for these people in front of us.

Yeah. You and the rest of us, we all feel that way. Right? But the cool thing, I mean, the way that I did it is I just sort of said, yes to whatever opportunity came in front of me. And that was everything from, you know, high level specialty ERs in the middle of, you know, metropolitan areas to like overnight only ERs kind of in the middle of nowhere and then kind of everything in between.

Which then allows you to see, okay, well, what is the, what am I, what is required of me as a veterinarian? What is the expectation of the person across the way? And what’s the relationship to the referring community? All that stuff. Who are these people here? Every, everything ends up being kind of different in those ways.

Dr. Andy Roark: Okay. So, so going into the metropolitan area ER and then out into the sort of middle of nowhere ER,

do you think that having those two distinctly different experiences was, is that a plus for you? Was that a net neutral or was that like a detriment where you were like, man, it was just a different world and things that I had learned didn’t carry over?

Like, so yeah. So tell me on the idea that this was, it sounds like it was positive. Tell me on the idea that what you learned in. You know, downtown Chicago was helped you in easily South Carolina.

Dr. Matt Asciutto: Yeah, I think that what you see in real time is, you know, this thing that’s being thrown around now is this like spectrum of care and things like that. But, you know, when I’m downtown, if I’m, you know, outside of Washington, D. C. I’m going to be elevating to the specialists for every small thing, right? And there is this sort of downside that exists in that, which is then you kind of, I don’t know, you lose confidence in yourself a little bit.

When you constantly have to sort of refer up and out, right? Whereas when you’re in the middle of nowhere and the nearest surgeon is three hours away. You’re like, well, I guess I’m the surgeon, right? And I can use everything that I’ve seen from the people who, you know, have all the letters who go to all the big conferences.

I can use all of that as best, you know, as best as I can to these, other locations, right? And so for me, it’s kind of a, it’s a big, it’s a About application of that spectrum, but it’s also about like, Hey, look, I can do this too. And then, you know, by doing the things you sort of say, oh, okay, I can do it.

I’d never want to do it again. Right.

Dr. Andy Roark: so no, I love it. So it’s funny I don’t I’m gonna get myself in trouble here, but I don’t mean to but it’s almost like so I started practicing in DC outside of Washington DC and there very much was this belief that I could punt so Easily like there was just six other referral places around us And I can that was some of the culture too is you just punt it up You know, it was funny that the culture was very much like yeah, sure Just send it up And, if you don’t watch out, you can be, you can fall into this mindset of like the kid who defers to the grownups in the room, you mean?

Of like, Oh yeah, you know, we’re gonna, we’re gonna, I’m going to get, I’m going to appeal to an authority figure here. I’m going to get a grownup as opposed to when you’re out in the middle of nowhere, that’s it. It’s like, there are no grownups. You better figure out your own problems. And again, I don’t mean to push that too, far, but I will tell you that the veterinarians that I have seen,

seen who are just, I mean, kind of James Harriet style. they’re all the rural veterinarians. And, like, I’ve heard that again and again, as the people, they’re like, yeah, I can, I’ll totally do these surgeries or those surgeries. And I’ll say, how did you kind of get started doing that?

And they were like, well, there was no other option. And I told people I’m not the right guy, but I’m the only guy you got. Do you still want to do this?

Dr. Matt Asciutto: Right. That’s exactly it. It becomes out of necessity and same with working overnights. Even if you are in the middle of kind of a, like, Hey, there is a specialty hospital, even that you’re working in it for whatever reason you can’t call people in, it’s like, it’s just you. And I started doing relief so early in my career.

I had so much of the. Am I doing this right? Like there’s, I need somebody to tell me that I’m doing it right. But in doing overnights, you’re just like, I guess it’s me. Like, there are no other people that I can talk to. So I have to make this decision. 

Dr. Andy Roark: Yeah. Unless someone comes back and tells you didn’t do it right, you’re like, I guess I pulled that off.

Dr. Matt Asciutto: Right. Exactly. Yeah. And then there’s the comfort of like, if you are in one of these specialty hospitals, you can then ask in the morning, am I a moron? Did I do this right? Would you have done something different?

Dr. Andy Roark: Exactly right! When the internist comes in, oh, that would be hard for me. Every morning, I’d be like, oh. I would want to know, but also I would just not want to know. But I would want to know.

Dr. Matt Asciutto: Which is why, honestly, I approach it that way. I mean, this is sort of the benefit of then adding levity and humor and the things that you do, right? If I come in and be like, hi, am I an idiot? Did I do something? But I’m, you know, tongue in cheek. I’m saying this, right? I mean, the idea is it’s like, I’m approachable.

I’m not taking myself too seriously in this moment. I want to know. And also you’ve been there as an internist, you know what it’s like to be the, you know, intern or somebody early on in your career who has no idea what they’re doing. Who just has to do something.

Dr. Andy Roark: Well, I love I think you’re spot on like that is really how you get coached is if you put out the vibe of I’m, not taking myself too seriously like generally or genuinely, what do you think? You know, what are you going to do with this? And what should I have maybe consider what should I consider next time?

But again that I do like that No, i’m Like, I’m an idiot. just lay it on me. What should I do? but they’ll laugh, and then they’ll give you honest feedback as opposed to, you know it’s hard when you’re a specialist and there’s a GP that hands you a case and you’re looking at it and you’re like, Do I tell them that this was not what I would have done?

Do I just smile and roll with it? And, you kind of take that off their shoulders of like, Alright, lay it on me. What, how would you approach this differently?

Dr. Matt Asciutto: Yeah. Yeah. Cause they’re human beings and it’s always awkward to tell somebody else, Hey, you did something wrong or, Hey, you got kale in your teeth. Right. It’s just like, these are awkward things, but if I ask you, Hey, do I have kale in my teeth?

Dr. Andy Roark: Yeah. I have a hundred percent said to my technicians. Look, if I ever look stupid, like I’ve got like a booger or like, like just, I expect, just tell me to please just tell me. And I just, I was like, that’s like ground rules. If I ever come to work at your practice on day one, I’ll be like, look, I don’t take myself very seriously. If I’m doing something dumb or I’m wearing something dumb, it’s probably not intentional. Just tell me. 

Dr. Matt Asciutto: Yes, which is how I as a relief vet have approached and I feel like found my place within, honestly, the industry, but within these jobs, you come in and you’re immediately the guest and as long as I come in sort of, like that. And yeah, a little lower in the shoulders and be like, Hey, I’m just a moron vet who’s doing my best.

You know what I mean? Like if I’m doing something silly, just tell me if I’m doing something that seems crazy, just tell me. And I think it’s helped me a lot.

Dr. Andy Roark: Well, I think that’s so important too. And so let me just say here, I don’t know of anyone who’s had a better background pre veterinary training to be able to just go into radically different hospitals and just, “yes, and” your way into what they’re doing. And so can you speak for that for a second?

So you, it’s not, okay. I do improv, like there’s a local improv theater. I make drunk people laugh on Friday nights. Like you have done real improv. Like tell me a little bit about your background with improv. And so talk to me about that and kind of the timeline between improv comedy and then veterinary medicine.

Dr. Matt Asciutto: Yeah. I mean, I will say that a lot of real improv is entertaining drunk people on Friday nights.

Dr. Andy Roark: Yeah, no, you don’t get away from that. 

Dr. Matt Asciutto: Most of it. Yeah, exactly. Whether or not you’re doing it in like the theater or the comedy sports type. Yeah. It’s just drunk people on Fridays. Yeah. When I. I mean, truly, I started doing it in high school because people forced me to do it.

I had friends who would literally carry me to improv practice and we had a little high school team and it was a national comedy theater was the name of the group in San Diego. And they made me do it until one day I said, please stop carrying me. It’s embarrassing. I’ll go myself but that was most of that was probably junior.

No, that was sophomore year all the way through. And I don’t. I don’t know. You have no concept of that. But what it was, it something that kind of became a part of me? And so when I went to college, I felt like something was missing and I ended up auditioning for the same team, but the professional team that was there.

So National Comedy Theater in San Diego. This is, gosh, I guess 2003, 2004, whatever. And I stayed doing that. They hired me. They like, they said, sure, why not? Come on board. And I ended up, through the following seven years, doing improv with them for I started teaching at the high school league. I started, you know, being the person who was there to teach improv fridays and Saturday nights. And that was just my gig until we left for Chicago just as a kind of a life choice. And I’d realized actually, no backing up a little bit. I did. They gave– I had an opportunity to teach at an arts Academy. I was a teaching artist. That was an improv comedy, teaching artists as an arts Academy.

I’m trying to teach these kids how to do kind of more advanced improv. But I was just the fool who was, you know, doing the sportscaster games on a Friday night in front of drunk people. So I actually read all of the books, you know, truth and comedy and impro by Keith Johnstone and all that stuff.

I, to try to figure out what am I going to teach these kids. And so when later on we moved to Chicago, I thought I should probably figure out if I was right. So all of the places, so ImprovOlympic and Second City, which are kind of these Just major institutions in for, yeah. 

Dr. Andy Roark: Yeah, they’re legendary. 

Dr. Matt Asciutto: You know, they all have training programs as a part of them. And so I went into those training programs and I, you know, I have almost a, you know, seven years or whatever of improv experience behind me plus high school. And I come in and I’m immediately humbled by it. I thought I knew, but I guess I didn’t. And I thought I read this book the way that it was supposed to be, but then there’s all this nuance to it.

So then I spent the next, you know, probably year for both of those going through the training programs. And then I got into the house teams and you know, you kind of end up in this world where now you’re doing improv both in those institutions as well as around the city. And so it was phenomenal.

Then I decided to go to vet school. So I guess I actually got my master’s degree in chemistry or I was pursuing it kind of during that time as well. And so that was probably three years of doing improv in Chicago before leaving to Tennessee. My partner at the time got into vet school and then the year after that, I’m just like, well, I guess I’ll apply to, and that’s the timeline.

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. 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, how to manage your time. All that stuff is there. Check it out. I said 250 episodes.

I hope that you’ll check it out and enjoy it and love it. I just love making it. So Let’s get back into this episode. 

So, talk to me about improv when you’re walking into these practices, right? So it seemed to me very much the story, what I heard you say was I kind of show up and then sort of “yes, and” my way into it. I was like, Oh, this is what we’re doing here. Okay.

Dr. Matt Asciutto: That’s exactly right. 

Dr. Andy Roark: Gonna to do it.

Dr. Matt Asciutto: improv is all about the, all right, here we are. I’m going to agree to the circumstance, to agree the situation that we’re in, and I’m going to, you know, interact, right? I’m not going to be like, oh no, that’s not how I do it. I don’t, you know, I come into a practice like I don’t use cornerstone.

I have my own PIMS. You could never do it. So you have to sort of say, okay, what is going on here? And then how do I exist within this world that you’ve created? And that’s, I mean, that’s just improv.

Dr. Andy Roark: It was funny. I had a client today in the practice. And so I was talking to my technician. He was just kind of flustered and he was like, I’m not getting a straight answer, I’m not getting straight answers out of her. And I’m trying to remember what was going on with the dog. It was a senior dog, but it was like she he was going in and he was asking her questions like, is he peeing in the house?

And she says, well, he was, but then I got pee pads and now he just pees on them. So I guess not. And he was, yeah. He was really bothered by that. He was like, that’s not a straight answer. And I was like, look, you just, you’re going to have to roll with this. Like, you’re just going to have to nod your head.

But she gave about six answers like that. And he was just tied in knots. And I went in and I sat down and she was like, you know, that technician, I think my boy’s really taken to him. He’s genuinely a wonderful person. I came back out and said, well, you want to really be confused. She likes you a lot. But

Dr. Matt Asciutto: That’s amazing.

Dr. Andy Roark: It’s just like, I just, you like, you have to go in and just listen to the person and just kind of accept their worldview and then being like, okay, this is how we’re talking and this is what we’re doing. And I’m going to ask a lot of very specific questions before we go forward.

Dr. Matt Asciutto: Yeah. I, and I think that you’re right. I mean, especially with client communication, the other way that people talk about it is, you know, meeting people where they are and all that, but there is almost this kind of nuance that maybe you as also an improviser can see, which is that’s a bit that person’s doing right.

Dr. Andy Roark: Yeah.

Dr. Matt Asciutto: Like in any other circumstance, if you as a character were just to be like, I’m going to answer your question, but in like this most circuitous way possible, that is now a bit. And that’s the game. And one of the things that we kind of talked about in, you know, in, in Chicago, I guess this is like in the IO thing, but what is the game of the scene?

What is the game of this, you know, long form thing that we’re doing? We always come back to that. So, so yeah, you, as a doctor, if you were to want to, right. You could also do some things like we’re going to do medicine in this hospital, not necessarily in this room, but definitely within these walls. Sorry.

Dr. Andy Roark: That’s funny but I’d never thought of that. Every, like every, exam room is basically a scene and every, interaction is a bit, and it’s just, you know, like you’ll, have those clients and they will speak to you like their cat is their child and I’m not going to correct them and I’m not, you know, like I’m, I was like, all right, we’re doing cats as children.

That’s the game of the scene. All right. Well, let’s get them in here. All right. Are you saving for college? Cause that’s going to come at ya. 

Dr. Matt Asciutto: That is so powerful because those things, if you can acknowledge just that little bit that they’re offering you, right, like they say, this cat is my child and then they just kind of keep doing it, it’s like fantastic. Now we have a whole list of exactly like saving for college cat toys or baby toys baby Bjorn carrying the cat around in the baby Bjorn, like, you know, all of these things you can now sprinkle in and that becomes now again, this bit that you’re doing with the client.

But really what it is. I’m listening to you, right? I’m here for you. We’re here together as two human beings talking, and now we can then make some recommendations about medicine, you know?

Dr. Andy Roark: You know, I, really, I love that you say this, right. And so, so one of the things I’ve been thinking a lot about, I’m just going to ask you about one of the things I’ve been thinking a lot about, Matthew, is like, there, there’s humor is so valuable in practice and the ability to smile and find humor in, in just sort of talking to people.

To me, it’s absolutely mission critical. It’s the only way I get through the day is just, it’s just, you know, Finding the humor, but yet, but you have to find a positive humor. I was looking at some social media stuff recently. And so there’s all these veterinarians that are sort of on Instagram and things like that.

And I wouldn’t throw any shade or anything at all, but those platforms have really morphed in my opinion to reward bad behavior in a lot of ways and the comedy, the humor in the vet space that seems to do well is generally kind of cutting humor. It’s about you know, I mean, it’s about sort of boy The clients are dumb or boy that the if it’s from technicians, it’s like boy the doctors are dumb and you know, and it’s just There’s just kind of a lot of that sort of honest kind of eye roll sort of humor. At least I see my impression is that is what gets rewarded on those platforms You And I just want to ask you, when you look at humor and sort of how we use it in practice, to you, is there a good humor and a bad humor?

Is there, sort of a line between them? How does, when does, humor kind of go bad in practice or do you think it can?

Dr. Matt Asciutto: I mean, I think it definitely can. I think that, And maybe this is just my style of humor that, so I don’t mean to maybe overstep in terms of what humor is overall, but I do feel like when we, as team members within a, within any situation, but you know, as veterinarians in a client veterinary relationship or whatever, or even just sort of who your techs are and who you are, I think that the humor that we should be using is like collaborative we’re in this together type of humor, if we’re ever going to make fun of something I was actually just talking to a friend of mine yesterday who’s an oncologist, and he was just like, we were talking about how frustrating certain mast cell tumors can be, right?

And it’s like, that’s funny. That’s a funny bit. That’s not at anyone’s expense. That is, you know, there’s something about that. But it’s like, we are in this together. We have this common experience and we’re in this together. And there’s not really an other, right? And I do think that works in my opinion.

I think that’s the humor that we should be using if, at all possible within these situations, as opposed to putting other people down.

Dr. Andy Roark: No, I think that’s, I think you just gave me a really good rule of thumb. That, that, that humor with when there’s an other, when there’s an outside, I think if you’re punching with your humor, I think that’s probably bad. So yeah, that makes a lot of sense. I think it’s a really good answer.

Dr. Matt Asciutto: Right? We all really want to use it. And there is something that’s kind of funny about the like metronidazole on the shelf, just like beckoning you like and you’re just like, ah, I can’t, you know, and you have this like weird push pull relationship, like that’s funny.

Right?

Dr. Andy Roark: That’s so funny.

Dr. Matt Asciutto: But it’s not like, Oh, people who use metronidazole are, you know, behind the times or whatever. Right. Like that’s a judgment based other type of thing. And I just don’t think that’s, I think that in the moment it can be funny, but it may be depending on how you do it, but I just don’t think it’s useful.

It’s not useful humor.

Dr. Andy Roark: No, but, oh man, that’s such a perfect example of metronidazole beckoning to you from the shelf because, like, it resonates and, like, ah, my favorite humor is sort of inside humor. I don’t mean to make people feel excluded, but the best stuff is the stuff that’s really niche. And so that, the metronidazole calling to you from the shelf.

Like I feel that so much. I was literally in the radiograph room today and we were going to do a system in this cat that was peeing outside the litter box. And of course the cat comes in, his bladder is tiny. There’s no urine. And the technician looks at me and goes, well, what do you want to do?

And I was like, I know what old school Andy would want to do. And that’s sent him home with antibiotics and sent him home, which like, nope, that’s not what we do. That’s what, 1999 Andy would have a hundred percent been on board with. We’re not doing that anymore. 

Dr. Matt Asciutto: Yeah. And then you have like this thing that now, for me, it’s in those moments where you’re kind of outside of yourself a little bit, where now you can laugh on this, at this little tiny bit that, that shows up in your mind, right? Like old school, Andy hops on your shelf and is now, you know, be like, ah, do it, man. Just get just a little Convenia. Just a little Convenia.

Dr. Andy Roark: Just do a little convenia, this won’t hurt anything. Just, just, try it. Just try it and see how it feels.

Dr. Matt Asciutto: Right.

Dr. Andy Roark: No, that’s terrible. 

Dr. Matt Asciutto: but I do think that, you know, when you look at, I’ve actually been thinking about humor kind of a lot over this past, you know, six months or a year or so and how I particularly use it, but it really is, it’s like finding these small moments of connection that then can be something else that I think there’s a lot of power in that.

And then, and those things, you know, you can take a euthanasia. And maybe you’re not like guffawing, right? No one is feeling what’s happening in there, but there’s smiling. There’s even chuckling. There’s like, Hey, this is actually a good human moment. And it can just come from these little things.

Like, someone said to me the other day, and this was just horrible news that I had given them. And they said something along the lines of you know, I’m speechless. And that never happens. Like, I’m never speechless. Right. Which by the way, that was her offer. She was the client.

Dr. Andy Roark: Yeah. She’s given you a lot to work with.

Dr. Matt Asciutto: right? And it’s not, you know, you don’t come in and be like, I know I could tell this whole time you’ve been talking or whatever, like that’s me against her. But just this idea of, Hey, being speechless. And that’s something that never happens is something that you can kind of work with and it’s an opening, right?

And that’s an opening for humor. And I think things like that are present and can allow us to connect even more, even in bad situations.

Dr. Andy Roark: Yeah, no, I think that’s true. Gallows humor. Emergency veterinarians are notorious for, I don’t want to say notorious, are known for some gallows humor. Do you ascribe to the idea that again, not, it’s not hurting to others, but do you ascribe to the idea that a shared laugh, if it’s a dark laugh, is a good thing?

Or do you think that there are things about gallows humor that maybe don’t have a place in vet medicine?

Dr. Matt Asciutto: Oh, I feel like if we are laughing and it’s together, that it’s okay. I’m sure that there’s a line here and I’m not going to be able to come up with it. 

Dr. Andy Roark: Exactly, right! I don’t know what the line is but I feel like there’s a line. There has got to be a line and at the same time

Dr. Matt Asciutto: We’ll find it. Yeah. Yeah.

Dr. Andy Roark: (Laughter) Unfortunately, we’ll know it when we’re well past it and we’re like, oh that was the line.

Dr. Matt Asciutto: Right. And like, you know, something small you know, I know this is, I don’t know, this sounds terrible, but like when it’s a really bad you know, a night and there’s like a lot of euthanasias or, you know, and then there’s like this really critical case that I have to kind of take care of, I might say just to myself and around something along the lines of like, Well, I got to go murder this dog real quick, but then I’ll be back and we’ll do it.

Right? And it’s not like for me, it’s not obviously, you know, I’m not, I’m going to take this seriously. It’s not, but in that way, for me, it sort of does take away the heaviness of it. Right? I’m obviously not committing murder, but it’s like, I just takes the moment. Cause then I’m going to be able to come back and sort of say, okay, cool, like now this is what we have to do to the dog and oxygen. This is what we have to do with this one. Who’s bleeding out, et cetera.

Dr. Andy Roark: Well, yeah, I think I think you’re spot on. I think a lot of people would sort of say, you know, humor like that, it, it, breaks that tension that we all carry. And if you can just set that weight down for a second and everybody sort of laughs, then you can, then you can pick that weight back up and maybe move forward in a way that it doesn’t, drag you down the way that not setting the weight down does. So anyway, I think that’s great. 

Dr. Matt Asciutto: Right. I think light stuff is a way to do that. Like for me it’s, I use a lot of silly language, like Okie dokey and you know, stuff like that. Like if something comes in and it’s, you know, oh we gotta do this and you know, heart failure cases are like this that are really bad, right? It’s like, okay, there are okie dokie, like here we go.

Or you know, little things that are. Obviously, they don’t take track from anything, but they’re definitely unexpected that then does break that tension, which then allows us to focus, right? It’s on purpose. I don’t want us to feel like we’re balancing plates on top of sticks the whole time. We’re never going to be able to do our job effectively.

But if we can just kind of be like, Oh, now I’m out of this cycle. Now I can focus on, you know, doing CPR and chest compressions and whatever that might be.

Dr. Andy Roark: Oh man, Dr. Matt Asciutto, thanks so much for being here. Where can people find you online? Ooh, have you got a webpage for Inkwell or anything like that?

Dr. Matt Asciutto: Not yet, but I will have a webpage that is fully functional in mid June for Inkwell, which is my new veterinary practice. You can find me on thegreatestprofession.com. I have a podcast that’s basically about the human behind the professional. So thegreatestprofession.com and also MattAsciutto.com.

Dr. Andy Roark: Awesome. Well, I’ll put links in the show notes. Thanks so much for being here guys. Thanks for tuning in. Take care of yourselves, everybody.

And that’s it. That’s what I got for you guys. I hope you enjoy it. I hope you got something out of it. Thanks to Matt for being here guys. Thanks for coming along and laughing. If you are thinking about improv comedy, you’re like I might like to do that. I strongly encourage you. I love it. I have so much fun with it.

It gives me something to do. That’s not vet medicine. It gives me a friend group that’s not related to vet medicine. It just makes me so much better in the exam room. It makes me better to work with. It makes me a better spouse and father. All of those things really do come out of skills from learning to think on your feet, to talk to other people, to listen really intently.

So anyway, I’m just, I’ll always be an advocate for improv comedy. If you’re thinking about it, find an improv theater near you, take some classes. Sometimes they have just one or two day weekend intensives. Think about it. Anyway, I would really encourage anybody who’s in vet medicine. Just think about it.

Take care of yourselves guys. I’ll talk to you later. Bye.

Lessons Learned Around Caregiver Burden

by

Dr. Ashley Bourgeois joins us for a candid discussion about caregiver fatigue and its wide-ranging effects on individuals. Dr. Andy Roark and Dr. Bourgeois share how the lessons they’ve learned have impacted their careers. 

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

LINKS

Dr. Ashley Bourgeois: https://thedermvet.com/about

Dr. Ashley Bourgeois on Instagram: https://www.instagram.com/thedermvet/

Dr. Ashley Bourgeois on LinkedIn: https://www.linkedin.com/in/ashley-bourgeois-dvm-dip-acvd-9169208/

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

Uncharted on the Road: https://unchartedvet.com/on-the-road/

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

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

ABOUT OUR GUEST

Dr. Ashley Bourgeois is a board-certified veterinary dermatologist passionate about providing practical knowledge to general practitioners to help itchy pets! She completed her bachelor’s degree at Iowa State University and graduated from the University of Missouri’s College of Veterinary Medicine in 2010. She then completed a one-year small animal internship at Purdue University. Upon finishing her internship, she accepted a residency position with the Animal Dermatology Clinic’s Tustin, California location in 2011. She became a Diplomate of the American College of Veterinary Dermatology in 2014. Dr. Bourgeois moved to Portland, Oregon in 2016 to help expand the company. She is an owner within the company and on the board of directors. She has a strong interest in autoimmune skin diseases, allergies, cytology, and otology. In her leisure, Dr. Bourgeois enjoys outdoor activities, traveling, and watching sports. She and her husband stay busy with their daughter, son, and rescue Lab/Boxer/Pit mix. Dr. Bourgeois is passionate about educating veterinarians in dermatology and work/life integration through her podcast, lecturing, and social media presence (The Derm Vet).

EPISODE TRANSCRIPT

Dr Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Me and my allergies are here.

With the one and only Dr. Ashley Bourgeois, she is amazing. I tell a story about this episode when we get started. This is on caregiver fatigue and Ashley’s had a lot going on in her life and she talked candidly about that on this episode, which is really fascinating. And basically we were talking about what does hardship do to our ability to empathize?

What does having our own hardship teach us about being better caregivers? Caregivers, how do we let the personal burdens that we carry spill over into our professional life? How much is just unavoidable? We can’t we’re not two different people we’re not a we’re not a professional human being in a personal life human being and the two don’t intermingle That’s not realistic either.

And so we talk a lot about just about about carrying weights. We talk a lot about carrying weights in this episode. We talk about Ashley’s son’s battle with leukemia. We talk a bit about my wife’s battle with breast cancer. We talk about this at the end. And in both cases, things look good.

I don’t want you to think this is a sad episode. It’s definitely not. This is a life lessons learned episode. And I think it’s a really good one. I hope you guys will enjoy it. Let’s get into it.

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

Dr Andy Roark: Welcome to the podcast, Dr. Ashley Bourgeois:. Thanks for being here.

Dr. Ashley Bourgeois: Thank you so much for having me. I’m so excited.

Dr Andy Roark: You can’t still be excited. you’re on this podcast. I’ve had you so many times on the podcast because you’re just, you’re so lovely. And I always just enjoy you. And it’s funny the last time that you were on the podcast, you know, we were going along and we were talking and you were talking about fluorescent light energy FLE and that was just as I really appreciate it was something I reached out to you about and then You know at the end of the episode I’m always fascinated in what people like you who are doing so many things I’m always interested in what you’re interested in, you know, and so it what are the things I’ve learned in running a podcast is The best podcasts don’t come from me having an idea and reaching out to people.

They come from hearing people talking and saying, well that’s something that person has going on in their life, or that’s something they have real expertise or real passion about. And I’d much rather engage people in what they’re passionate about because you just learn so much more and you can just tell that it’s what, it’s sort of, I don’t know, it’s, where they’re heads at and kind of, kind of what their experience has been.

And so I was talking to you last time we were together and I said, you know, are there things that are on your radar or things that you wanted to talk about? And you kind of caught me off guard. Cause you said, well, you know, I’d be interested in talking about caregiver burden. And I thought that was really I thought that was really interesting ’cause you and I have known each other since vet school and so, I’m not gonna tell your story, but you have had you’ve had a tough road in a lot of ways, and I don’t know, most people probably don’t know that about you because they see you lecturing at, you know, you’re at all the conferences.

You, you’re traveling, you’re speaking. You’re just so well regarded. You’re writing. I’d love to have you as a guest on here and you, just do so many things, but you know, as one of your friends, I, have, I’ve. You know, known about your journey and sort of watched your journey for years. And I don’t know that most people understand sort of the weight that you kind of carry.

And so when you sort of start to talk about caregiver burden, let me just sort of pause here and kind of open it up to you and sort of say, tell me a little bit about kind of what you mean by that. And also what, what makes you say that as something that, I don’t know, that you think needs sort of more attention.

What does that look like in your eyes?

Dr. Ashley Bourgeois: Definitely. I think the idea with caregiver burden, we have to realize does we extrapolate that term from human medicine. That is something that is actually really well researched in human medicine and what caregiver burden means. It means is when you are the person that’s not necessarily getting diagnosed or going through the treatment, but you are the person that has to take care of someone going through that.

And traditionally, actually, so what has done a lot of kind of initial research into this dealing with allergic pets, and it’s something I’ve lectured on. Just through my relationship of kind of teaching about allergies and dogs. And then, you know, we’re going to talk about some of the journeys that we’ve had personally.

But when you start to talk about caregiver burden, we think about it in a different way compared to when we have to go through it. So in human medicine, we often think about this with say that your parent is elderly and you have to take care of them or if you have a child who is sick or a spouse who is sick, someone that you have to, you know, drive to the appointments, you have to advocate for them when they’re not feeling well, you have to pick up medications at the pharmacy.

Obviously there’s financial burdens associated with that. So once you really experienced having to go through that yourself, whether it is for a pet, a human. You start to realize all the different aspects that are there. It’s not just when someone’s in the exam room with you, there are so many different layers that we have to deal with when we are a caregiver for a pet, a person, whatever that looks like.

Dr Andy Roark: Well, you see it in You see it in some of the elderly pets for sure, right? You see it as far as you know, this pet has 16 different medications and a routine they have to have at the end of the day and there’s all of that sort of stuff and I think that’s I think we’ve all seen patients like that, but I think those people are sort of on the outliers.

I, I think, one of the things that I was really interested in is, you know, we look at a lot of mental health and wellness stuff in vet medicine, and people say, you know, vet medicine is so hard, vet medicine is so hard. It is a challenging profession, that’s true. But when you look at mental health, wellness, you look at depression, things like that, most of the time, Most of the underlying factors that are really, most of those conditions are multifactorial.

You know, we look at it and there’s generally an acute cause or there’s an acute pain, something that’s particularly challenging for people, but it’s usually layered on top of a number of other sort of burdens that they’re carrying in their life. And so, you know, when you look at depression, yes, professional stress is on the list, but it’s generally added on along with relationship stress, you know, medical concerns, you know, illnesses of self or others, family problems you know, genetic predisposition, all of these sorts of things.

And so when you and I started talking about caregiver burden, I think that it’s, I’m always interested in talking about what else is going on with people kind of in the background and how these things kind of layer. And so, you know, we’ve seen people. and they’re having a hard day.

So, for example, I had this client that came in and she had this golden retriever that had been hit by a car. And so I go in and see her, and it’s her and like five kids and this golden retriever, and I said to her look, you know this, back leg is broken. You know, we’re going to need to, it’s orthopedic surgery is the answer, you know, and it’s going to be 4 or 5,000, something like that.

And she just absolutely came apart. And she said, can I talk to you in the hall? And so I said, yeah. And so we stepped out into the hall and she said, listen, my husband walked out on our family. And he had all the bank accounts in his name and someone from our church gave the kids this dog as, you know, as a, to, to help them during this hard time.

And I’m the one who hit it with the car and just like, Oh my God, it was the, and I was just like the load that she was carrying sort of, behind the scenes. And yes, this dog was devastating, but it had to be a culmination of all these other things that she had on her shoulders. And like when she laid that out, you just go, Oh, I’ve got, we’ve got to figure out how to help you.

 but a lot of us would just see someone coming apart and think it was about the money or something like that. And you just go, Oh man, people have a lot going on that we just can’t see. And I think that’s really important to remember.

Dr. Ashley Bourgeois: It is really important to remember, and when I, you know, discuss this topic, I like to think of all the roles that all of us have. So you know, I can speak as a mom of two young kids. You know, when you have kids and you don’t have to have kids, there’s lots of other ways you can be taking care of someone.

You could have a brother or sister who needs help. But when I just think about beyond some of the issues we dealt with our son’s health issues, you know, chauffeur, not sleeping well, you know, then having, you know, both being working parents, we all hold so many titles. You know, we, a lot of us identify as veterinarians and that is really important to us.

And it’s super important to me. I mean, that’s a huge part of my identity. But there are times where that’s not as important as being a mom. That’s times where that’s not as important as being a wife or, you know, having a parent who’s going through something or having to be a friend. But we only see people in that exam room for a finite amount of time.

And at that point in time, we really often just see them as a pet owner. And there could be so many other things going on in the background, you know, especially if you are dealing with something really traumatic in your life, like your owner was. You know, but sometimes it’s also hard to find that line of boundaries and empathy.

And that can be extremely difficult because of course we are in a challenging profession. And I can speak as a dermatologist. I think there’s some things that we obviously have a little bit easier because most of our things are not life threatening, but we’re dealing with a lot of chronic issues that add up and are expensive and are frustrating.

So it is, it can be difficult to find that line of protecting your own mental health, but being empathetic to others. Especially when you often don’t have the full story, not everyone’s as forthcoming of information like your own or what.

Dr Andy Roark: Yeah. So, you, I think, the way I remember it, and correct me if I’m wrong, I think you were at a speaking engagement when you learned that your son had cancer. Is that true?

Dr. Ashley Bourgeois: So I was at our veterinary dermatology conference. And what’s interesting about that is I was about to speak like in an hour. I was supposed to give an abstract and this was the first conference. And if you know, I know, you know, a lot of dermatologists. We are a pretty close knit group. We’re kind of a medium sized specialty.

Most of us are kind of weird, right? And I’m including myself in that top tier. We’re kind of weird. We’re kind of funky, but we talk a lot because that’s what we do all day, every day with our clients. So we’re a pretty tight knit group. And so we, this is the first conference in 2022 we had since COVID in person.

So we’re all so excited, right? We are in new Orleans. We are having a ball. We are. We are, you know, cheersing. We were having a good time. And I had found out second day into our conference, that our son was severely anemic. So luckily I didn’t find out about his diagnosis until I got home, but we found out he was severely anemic in that he needed a blood transfusion.

Which there’s lots of reasons kids need blood transfusions, but it’s scary and you have no idea why. So I pretty much had to drop everything. And what I’ll say about our community is pretty much everyone rallied around me because I just said, I just found out my son needs a blood transfusion. I am going home.

And you know, between the people, someone spoke for me, they got me into my hotel room and got me on a plane as fast as they could. And then I went straight to the hospital from the airport. And then the next morning is when we found out that our, at the time, three year old son had leukemia.

Dr Andy Roark: Yeah. Oh, man. When you sort of go through this and you’re learning these things about your son and your family, and you’re sort of coming back together what was your sort of thought about the arrangement of your life, right? So you’re a specialist, you, you’ve got all these things.

I love the fact that you’re sort of able to say, guys, I’m leaving and I, you know, and I just, and you just go. I think a lot of people who’ve had those sorts of realizations have that experience. I found out my wife had breast cancer. I was just like, all right I’m gonna go for a walk.

And no one had a problem with that. No one had a problem with that. And so it is, but I think everyone sort of has that sort of lightning strike moment. 

I was sort of secondary in that this was my wife’s diagnosis. But at the beginning, you know, we didn’t know really anything about it.

And so there was this great uncertainty and wait. And it was funny, but we came back to sort of together. And we talked about it and so she sort of said, this is a diagnosis and things like that. And I said, okay, well, what are you going to do? And she’s like, well, I’m going to go to work. And I was like, okay, well, I, me too.

and we went back to work and people asked me about it. And my sort of thought was like, I didn’t know what else to do. 

Hey guys on Uncharted, April is this weekend in my hometown Greenville, South Carolina guys. I am looking forward to diving into all kinds of topics on marketing and strategy and growing practices and streamlining communication with pet owners and with our team. Anyway, this is, um, this is the flagship conference of Uncharted. 

It is the first conference we ever did. It is an absolutely magical experience. I am so sorry if you’re not going to be there. Uh, It’s it’s. It’s awesome. But don’t worry. I didn’t, I didn’t jump on here. Uh, to tell you bad things. I jumped on here to tell you good things. We’ve got tons of stuff coming down the pipelines at Uncharted, head over to The vet.com/events to see all the stuff we have coming. 

If you live in Atlanta the Uncharted team, including me will be there next month. We will be there in May. We are doing our leadership essential certificate together in person. It’s going to be amazing. You should come, you should bring your leadership team. You should bring your team, lead your head, CSR, your head technician, uh, your, uh, your, your veterinarian, your associate vet, who might want to be a medical director. 

One day, you guys should come together. You should get all the information downloaded into your brains at one time. That’s in Atlanta in may. We’ll be doing that again in Minneapolis, in June. And so come and see me. I’d love to meet you in person. It’s going to be small, intimate, boutique, deep training on everything. 

You know, you need to have to lead and manage other people. So it is our leadership essentials program. It’s going to be incredible guys. Back half of the year, we’ve got our virtual summits coming up. We’ve got our practice owner summit at the end of the year. I just uncharteredvet.com/events. You’ll see all the chefs coming down the pipelines. 

You don’t want to miss it. All right, let’s get back into this episode. 

Dr Andy Roark: And so let me ask you that. And again, I know this may sound strange, but I’m always curious. How did you reconcile sort of the rest of your day with this thing that’s going on at home?

Did you want it to be, did you want to be away from work or did you want to go right back to it? How did you sort of square those things in your mind?

Dr. Ashley Bourgeois: Yeah, that’s a really great question, and I think the first important thing to realize it is that it is different for everybody. So, and it’s hard when you get connected to people who, so for leukemia is one of the top pediatric cancer. So it’s kind of interesting. I didn’t know anything about it, but then as you start telling people, you find a friend of a friend, you have, right.

Like you get all of a sudden these indirect connections and you get in these groups and you know, all these things, but then you realize everyone does things differently. Like the pediatric leukemia journey, at least the one that my son is currently on. Is about two and a half years of treatment. And so there are some people who completely just quit working for those two and a half years.

So what I ended up doing is there’s all these in right, kind of similar, probably to your journey. You went from knowing nothing about something to all of a sudden, almost being like a layman expert right now, like anyone who connected with the thing, be like, here’s this phase, here’s this phase, here’s this phase.

Here’s when they lose their hair. Here’s when they do this. But you don’t know any of that. Like I’m not trained in that. And so what I did was pretty much like that Saturday, we found out the first month is the induction phase, at least for what our son deal or dealt with is the most, one of the most intense.

And so he ended up going on steroids twice daily. And then a bunch of different lumbar punctures and chemo rounds that he has to go through. And so I essentially just took those initial, like that initial month, and a half off. He also ended up throwing like a clot in his arm. And so we had to give him heparin injections.

There was just a lot going on. And I very much identify with work. So it was hard, but not hard because I knew in that time, like if I was at work and our son ended up gaining a bunch of weight, couldn’t walk cause they get neuropathies from the chemo and they’re, you know, he’s three and he gained like eight pounds, which is a lot for a three year old just from all the steroid weight.

And I was like, if I’m in an exam room and someone’s mad, cause I won’t refill Apoquel, like I am not in that mindset. Like I am not there. Now I was still doing some stuff like podcasts or things I could control. Like I’d be like, this is a bad day. I’m not going to do it. But I wasn’t in the clinic for about a month and a half because I just had to, I couldn’t control that.

And I love being in the clinic, but I was still doing little things like interviews, podcasts, content. But when I needed it, when I knew I could be like, okay, I like to you, your point. A lot of walking. My dog got walked a lot during that month. But I wasn’t in the clinic cause I knew I couldn’t, I just couldn’t mentally be there.

But after that month and a half, I was also very much ready to go back. So probably a middle ground where I kind of got through that initial time, but then I needed to get my mind off of it.

Dr Andy Roark: Well, that makes sense. I really like your example of like, if a client was gonna get mad about Apoquel.

Dr. Ashley Bourgeois: I was like, I can’t.

Dr Andy Roark: Well, and I was, that’s what, that’s where I kinda wanna go with this, is started to talk to you about sort of the experience of working with people when you’re carrying a burden and working with people with the idea that they might be carrying a burden.

I, it was funny, I tell this story sometimes now because so, so. My wife came to where I was and just to talk to me in person was just like, Hey, this is the diagnosis. and, we decided that we would come back to work. She was like, well, I gotta go, I gotta go teach. And I was like, okay.

And again, everybody handles. Things are on the way and so I went back to my team and I was like, I have to go for a walk. And so I went for a walk and I walked down main street and I went to this coffee shop. And so I was like, I, you know, it’s been a hard morning. I think I would like a bougie coffee.

And so I, walked into the coffee shop and the guy was behind the counter and he had this big smile on his face and he was like, Hey man, how’s your day going? And I was just standing there and I thought I just found out my wife has cancer. How’s your day going? and of course I didn’t say that but I’ve never forgotten that and just and having that internal thought of it ain’t the best and so of course I said something like, you know, one one step at a time and then I sort of placed my order But, I’ve never had such clarity in my life that people, they’d have no idea what you’re going through.

And I have been that happy guy to be like, hey buddy, how’s everything going? And I’m sure that there is a heavy weight that other people carry. I was texting with somebody. last week, and she said, oh, I just got terrible news about my father having metastatic cancer, and I was like, oh, and I kind of carried on with the conversation thinking that she had gotten that news in the last couple of weeks, and it was like, oh, no, it’s been less than an hour, Andy, and I was like, oh, no, I’m so sorry.

But even like, I just, you don’t process and you don’t know that people are carrying sort of a burden like this. And you look at them, you, I don’t know, I always kind of imagined that you would know, but you, I don’t think that you do. And so, I just, that whole ownership of the idea that people don’t, They’re going to continue to have their own things and they’re not going to know about your things.

I don’t know. I think that’s important. I think that was sort of an eye opening realization for me. And the other thing I wanted to ask you about with this is just and it makes sense also that you would take time off. Like, I was mad for a while. Like, you know what I mean? Like, I did not want to hear.

about how other people were having a tough day because, you know, because traffic was bad. I was like, are you kidding me right now? Are you kidding me right now? And so I think that was something that I had to kind of manage was just not having a lot of patience for things that seem trivial in the light of kind of this weight that I was kind of holding.

And again, I know people have a lot worse things than I had, you know, and so I don’t know. So does any of that sort of resonate with you when you think about it? Did you feel that? I don’t know. Did you feel that? Were you frustrated with other people? Did you have less patience at least initially?

Dr. Ashley Bourgeois: You know, it’s funny as it would be very situational for me. So like, to your point, that’s kind of why I ended up taking that month off, right? Because if it was someone I know coming in saying like, Oh, I just want the antibiotic skin without cytology. I’d been like, I’m sure I would have been fine and faked my way through it, but I just didn’t need to, right?

Like I didn’t need to. I had a supportive company. We could figure it out. I didn’t need to, but where I kind of ran into were a couple things. I can be a deflector, meaning people be, I’m a very positive person for the most part. So when people, right, everyone saw, I left the meeting early. So everyone’s like, let’s go get drinks.

I’m like, I’m on my way home for some reason. My son needs a blood transfusion. I don’t know why they were still all at the conference when I found out, but I didn’t want to like call and tell everyone, like, let’s let everyone know. I’m not there cause my son has cancer. So, you know, for me, everyone was calling to check in when they got back.

I didn’t know exact cause. With our son, he couldn’t go to school for about a year. So there’s about a year because he was so immunosuppressed. He couldn’t. So basically, my husband and I kind of divided and conquered. We’re very fortunate. We could do that. So, you know, I was down to two days a week in the clinic.

He was kind of down to two, he’s an engineer. He was down to two days a week in the office. And then the fifth day we’d kind of like. Divide and conquer whatever needed to happen. And in that time period, there’s lots of appointments happening and he had to have a few more blood transfusions, bone marrow you know, ask for things like that.

So there were times that people would call and because I think I tend to be a positive person, I would just like, well, we’re very, we’re really lucky because we, you know, we caught it early. We’re very lucky because we have supportive jobs. So I would, and people would be like, You can be lucky. It could still really suck.

Like you have a child with cancer, like it’s okay to say it sucks. And I’m like, yeah, it does. But then you end up in this weird competition. Right? So like I was connected to people I knew who’s my son is what’s called standard risk with kind of medium risk. And I got connected to people who had children with high risk.

So they were having a different protocol. I ran into a lot of people, even in the last year when he’s been on maintenance now for a year and, you know. See, fairly normal kid. If you saw him, you would not know. He just got a haircut again, like, he’s crazy, he’s about to turn five, his birthday’s coming up.

Like, you would not look at him and know he’s still going through chemo. Like, he’s been pretty good for, I mean, we still have our challenges, but he’s been pretty good for about a year since he hit maintenance. But a lot of times when I talk to people, they’ll have something hard going on in their life.

And they’ll say, here’s my hard thing, but it’s nothing compared to what you’re going through. I’m like, I don’t need that anymore. Like, yes, I appreciate you want to say that, but I still want to be here for you as a friend. And I don’t have this magic. You know, trump card because I have a child with cancer.

That means you can’t go through something hard. So that’s what I’ve had to kind of explain to my friends is I love that you want to be appreciative and supportive, but like, I still want to hear about your hard stuff, but I think that is very different for people. I know people who can’t do that. They can’t.

But I’m a very external person. I’m a verbal person. I’m an external person, like to my husband’s dismay sometimes, but I’m a chatter like I want to talk through things like if you have a problem, like I want to be able to sit there and talk to you about it. And I’m okay to not be like, well, Like I, I remember my friend, his dog slipped his disc and he was like, Oh, but it’s nothing.

I’m like, no, that’s terrible. It’s terrible that you have to go to acute surgery with your dog. You know, do we have to be in a competition? But I think that is very individual on a person because I know people who kind of have to seclude themselves when they’re going through something like this.

But I’m such an external person, I almost craved not hearing about other people’s bad things, but I craved to know what was going on in the world because I knew the world didn’t stop just because I was going through something.

Dr Andy Roark: It seems like there’s sort of a switch that some people go through and maybe others don’t. There’s a part, I think. I mean, everyone’s different, as you say, but there’s a part when we’re sort of carrying a burden or we have something that happens that’s significant in our lives, where I think, it’s justifiable to look around and say, this isn’t fair.

You know, this isn’t fair. Why is this happening to me? I don’t think anyone would fault people for having those thoughts. And I think that’s justifiable. I think it’s justifiable. for a while and then I think one of the transitions that happens or it doesn’t happen is The feelings that we have of having carried this burden.

They can either transition into empathy for other people or They stay as this sort of source of frustration. You know what I mean? It feels like at some point we have the potential to make the choice. I’ve had this hardship. I had this thing that happened to me that really sucks.

And so I don’t want to hear about other people’s complaining or I’ve had this hardship. I’ve had this burden, had this bad thing that happens to me. And so I understand that other people are also struggling and I’m going to be more empathetic than I would have earlier because now I’ve, I know, that things can suck, you know, does that make sense, I guess, that sort of dichotomy of perspectives and I just, you so exemplify the second one to me and all the times I’ve talked with you and of, being someone who has never seemed angry to me, who has never seemed you have never, and let it make you sort of angry or, you know, or bitter, but in fact, it’s the opposite where you just seem you’re, you just seem so much more empathetic and more open and you’re the first one to say things like, well, we don’t know what that person’s dealing with, you know, and stuff like that.

And it’s just, I don’t know. Do you, did you. Did you feel like you had a transition in that way? Do you feel like you just from the very beginning you always sort of had This rise in empathy. Did you ever have the I don’t want to hear about your crap kind of phase or was that not a thing for you?

Dr. Ashley Bourgeois: Yeah, I don’t want to paint a picture that like the day after we found out I was just like, all’s good. 

Dr Andy Roark: Yeah, mother teresa, like 

Dr. Ashley Bourgeois: Right, no, I don’t want to paint a fake picture. I definitely I went through grief like anybody else. You know, I definitely went through like, why or. You know, cause when we found out we had a couple of people tell us like he looked pale and you know, I would joke about it.

Like, I’d be like, we’re not exactly the tannest of people. Right? Like I’m Norwegian German. Like, so I don’t want to definitely give a false impression that it was just like, Oh, he’s got cancer. No big deal. Not at all. But I think that you, I mean, there would be good and bad days, right? There’d be days where I would be like, Well, why?

And our son has had a couple of medical issues, like he was born with a congenital heart defect. I like to call him our English Bulldog. He is just our daughter, nothing. She’s like had nothing. Our son has been to the Children’s Hospital for a heart procedure when he was 13 days old, tubes put in his ears when he was, you know, 10 months old and now cancer.

So he saw like the Children’s Hospital for three different diagnoses before he was even like when he was three. But I think I’m also just very trusting in like medicine. So the good news is as soon we had, I will say the way that our initial oncologist told us, was wonderful. And I’ve been in situations like when we initially got told about our son’s heart defect, the communication bedside manner was not wonderful.

And that was way different as far as how I processed it. But the oncologist we had was wonderful. It was very like, here’s what we’re dealing with. Here’s exactly, I mean, there’s a roadmap. Here’s exactly what it is. Here’s the things we need to do. But then she also, and we’re very fortunate, like pediatric leukemia, the type he has is like a 90 to 95 percent cure rate.

So it’s like, this is going to be a sucky road and I’m so sorry. You have to go through this, but I just want you to know there’s plenty of options. So I think I was able to also, I’m kind of a. Tell me what needs to be done and it will happen. That is just, that is me to like a fault. Sometimes my husband would be like, we don’t have to just do everything cause you can. But so I was like, I went through grief. I went through uncertainty, right? Cause I didn’t know what our world was going to look like. He has a port in. So anytime he gets a fever, which kids, right. They always get fevers. He has to go to the hospital. Cause they have to do blood cultures just to rule out sepsis.

So it was here’s all these uncertain things. But there is a roadmap and an endpoint and I can just, I’m just, my personality can be like, tell me what needs to be done and it will happen. That can also be a fault because sometimes I have a hard time like just relaxing or, you know, being like trusting and not having to be on so much.

So I definitely had my doubts. But I just want everyone to know whatever you’re going through, like there’s not a right or wrong. Like I definitely had things I probably didn’t handle as well, but it’s just like how I identified with it. And I just tend to be very trusting in like the research and science.

And once they said, you know, there’s, a, really high chance for a cure rate, then I just had some peace with that.

Dr Andy Roark: What are some of the things that changed in your perspective or in the way that you practice based on the experience that you had? So, I mean, I can’t imagine having this experience and you get this diagnosis and it’s not delivered well, and there’s a lack of bedside manager manner.

And then you go and you have this other diagnosis and this person delivers it well and things like, surely you took things away from that, sort of influenced you and how you communicate and how you practice medicine. Like, are there things that stand out in your mind?

Dr. Ashley Bourgeois: Oh, you bet. I mean, for sure. We just had a situation where we had to ask to not see someone anymore because even two years in, when we were seeing a certain person, we didn’t have the best feeling. And that includes my husband who is like, I’m pretty nice and patient. He is like a saint compared to me. So when he was I don’t know, I was like, Oh, that’s it.

Like we need to probably just advocate that we don’t feel good about seeing that person. So I took a lot away from that delivery. Making sure, so, you know, when we were talking before we hop on, like if someone’s a couple of minutes late, of course I have boundaries, but often I understand I have been panicked because I’m a couple of minutes late for an appointment.

You know, I have been like, I cannot go to everything. I’m the more medical minded person in our family. I can’t go to every single appointment for our son over two and a half years. Like it is not like my husband’s job is a bit more flexible than mine. Like we have to balance that, you know, if he gets a fever, we have to drop everything and run in, that’s a little bit easier for his schedule.

So if someone says like, Oh, my wife sent me a list of questions, you know, historically it would be like, well, why, doesn’t she come in now? I’m like, okay, great. Show me the list of questions. You know, okay, great. Can you FaceTime them? Can you put them on speaker? Like when, you know, I used to be annoyed at people would be like, Oh, they’re on speakerphone.

And now I’m like, cool, great. Put them on. I’m on FaceTime a lot. Like, I’m just like, 

Dr Andy Roark: I’m glad we made this happen. Yeah. That’s great. 

Dr. Ashley Bourgeois: It just saves a lot of frustration. Cause I don’t know, to your point, I have no idea if they just had. A child that was diagnosed with something. I have no idea if the wife is the breadwinner of the family And she needs to go be the one that’s working. I don’t know that now.

I have a lot of clients who confide a lot in me because it’s dermatologists We get to know our clients a lot pretty well but I don’t know that so if I can reasonably make it happen without breaking a boundary and it’s not just because i’m stubborn In saying, well, it’s just the way that it should be.

Then I will try my best to accommodate it. Now I will have boundaries if they’re like 25 minutes late for the 30 minute appointment and they’re like, you have to see me this second. Of course I have boundaries, but I really, tried to just think about how I have felt in those situations. I also, almost every single exam.

I, even if it’s a happy, you’re doing great. You’re just here for blood work. I almost always end with what questions do you have for me? Because so many situations and I’m, you know, my texts will be like, cause I’m a talker, like you’re a couple minutes late, but I kind of know where I can make it up in my schedule at this point, practicing so long, but I like to ask that cause I’ve written so many situations in the last few years where we’ve seen many people and you just know the ones that, you know, Make you feel rushed, you know that just make you feel like oh I’m just checking off the box and moving on and of course if I like know that they’ve been taking too much time I can Say, okay.

Well great. I’m gonna do this if you have any other questions, like, you know, we can set another appointment But even if it’s just I could get in and out fast just having that question and oftentimes it’s oh not really or something quick I just feel like people feel like, Hey, you appreciated my time that I just paid you for.

So I really try to be thoughtful of that because I’ve had so many situations where they just run out and I have, like two questions I want to ask them and I never got that opportunity.

Dr Andy Roark: Yeah. Well, actually, I know people are going to want to know, how’s Carson doing now?

Dr. Ashley Bourgeois: He is doing great. He is so currently he’s about to turn five. And he has been in school now for a year and as it stands now, things go well. You know, he’s still on chemo every single day. But as it stands now in July, he is supposed to finish treatment. So my hope is he starts kindergarten this fall.

As a normal boy that gets to put all this behind him. And then we’ll just kind of keep every step of the journey, checking and making sure things stay in check. But so far, so good.

Dr Andy Roark: That’s awesome. Allison’s now well over a year post treatment. Everything is going well also. So, yeah. Some bright skies ahead. Ashley, thank you so much for being here. Where can people find you online? You have such a wonderful online presence. You do so much stuff on Instagram and just, you make educational videos and you’re just, I don’t know, you’re such a great online presence.

Where can people find you?

Dr. Ashley Bourgeois: Yeah. I mean, I try to keep things simple. Everything’s under the DERM VET, which includes, you know, some motivational stuff, some parent stuff, but mostly dermatology education, the idea just to make it really tangible and easy for general practitioners to learn. And then. You know, my own podcast, the DermVet podcast.

And I just really appreciate you having me on and being open to having this discussion. I know it’s not easy for everyone to share journeys like we feel comfortable with, but I hope people can take some stuff away from it. Cause we are a really great community, but we have things that we have to navigate as well.

Dr Andy Roark: Oh, thanks 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 guys. Thanks for being here. Thanks so much to Ashley for being here and sharing her story and providing her perspective and everyone has a.

Their own personal journey and there’s no one way to feel about things but I just– I really feel like talking to people who have had experiences in practice in life and kind of understanding what their perspective was. I think it’s, I think it’s helpful in getting her own ideas straight in her own minds and kind of parsing to her own feelings So I really appreciate her coming here and just sort of sharing of herself . Anyway guys, take care of yourselves.

Be well everybody. I’ll talk to you later on. Okay. Bye