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Team Culture

The Technician is Here. The Doctor is Remote.

January 26, 2023 by Andy Roark DVM MS

Dr. Katie Cutter, co-founder of BoosterPet, joins Dr. Andy Roark to explain how her practices utilize in-person veterinary technicians and remote veterinarians to provide wellness care to pets.

Cone Of Shame Veterinary Podcast · COS – 182 – The Technician Is Here. The Doctor Is Remote.

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

LINKS

BoosterPet: https://boosterpet.com/

Uncharted April Conference (April 20-22): https://unchartedvet.com/uvc-april-2023/

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. Katie Cutter is a North Carolina native.  She received both her BS and DVM from North Carolina State University.  She then completed her small animal rotating internship in 2001 and her comparative ophthalmology residency in 2004 at Cornell University.  She became a Diplomate of the American College of Veterinary Ophthalmologists in 2004.  After spending time in private practice, Katie and her husband opened boutique specialty practices in New Mexico, Arizona, and Texas.  Katie recently co-founded BoosterPet with other like-minded veterinary revolutionaries who seek to make positive changes in the veterinary space. Katie and her husband have three kids, Zander (14), Zac (12), and Zoie (3), all to be run by the queen of the house, their Boxer named Sophie.


EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. I’m here today with Dr. Katie Cutter, she is the co-founder of Booster Pet, which is a chain of four hospitals in Washington State looking to grow and expand, and you’ll hear us talk about that in the coming episode. I want to say up front, this is not a sponsored episode. I don’t work with Booster Pet. I’ve not done any work with Booster Pet. I talk about how I sort of met Katie. I think that she and Booster Pet are doing something that is, whether you like it or not, it is innovative. And it is absolutely fascinating. You’re going to hear about their business model. In their wellness pet business, they have technicians working remotely with pet owners, and the veterinarian basically does telemedicine while the technician is there. And so the vet is not in the building while the techs are working with pet owners doing wellness exams. It’s their business. It is up and functioning in the state of Washington. And I heard about it and I was like, “I have to understand, I have understand how this works and what it really looks like.”
And that’s what our conversation is today. So guys, buckle up. I had my mind stretched and twisted in this conversation, and I think you will as well. 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. Katie Cutter. Thanks for being here.

Dr. Katie Cutter:
Oh, thank you for having me. I’m excited.

Dr. Andy Roark:
I’m looking forward. I’ve been looking forward to this. I met you just recently. I was talking to Dr. Bob Lester, who’s been on the podcast a number of times, and we were talking about leveraging technicians and technician utilization in the future. And I was sort of saying I very much can foresee a future where technicians are working much more independently from doctors than they have been at the past. And Dr. Lester said, “You’ve got to talk to Dr. Katie Cutter. She’s doing absolutely amazing things with her company Booster Pet.”
And so I went and I Googled and I’ve kind of blown away and I have questions and I want to understand what you’re doing, and then I just have a lot of questions.

Dr. Katie Cutter:
Perfect.

Dr. Andy Roark:
And so what I want to do is I’m going to let you lay this out. So before I do, let me just say real quick. So you are a veterinarian, you are a boarded veterinary ophthalmologist, you have owned boutique specialty practices, three of them, you have done so many things. You have just been named DVM 360’s Innovator of the Year, which is really cool. You’ve done a lot of things. Tell me about Booster Pet. Just lay out for me, what is your business model? How does this work?

Dr. Katie Cutter:
Yeah, well, Booster Pet was born on the idea that we can just do better in the vet space. So it’s no surprise to I think anyone who would be listening to this podcast that the veterinary industry has been in a crisis for a bit as far as staffing. And that crisis creates hamster wheel of problems that we ride out in the clinic every day. And a lot of what we see that create the stress in the veterinary clinic certainly result from some practice inefficiencies that we have. And we don’t leverage our talent in new and novel ways to create just a better life for the people that provide the services to the pet owners. And so Booster Pet is really focused on how can we provide a better life for our veterinary technicians, our veterinarians, so that they have more left in the tank to give to the community and to give to themselves.
So that’s the whole passion project that Booster Pet is. And so we started by saying, “Hey, our LVTs that are out there, they’re very, very capable and all too often they’re under leveraged in the clinic and we can really do a lot more with our LVTs.” And by doing so, we can actually raise their pay scale and create efficiencies in the clinic to take some of the burden also off the veterinarian. So to make everyone’s life a little bit better in the clinic. And so at Booster Pet for our wellness portion of the exams, we elevate the LVT into that physician’s assistant nurse practitioner kind of role by utilizing in-clinic telemedicine for part of their veterinarian support through those wellness exams.

Dr. Andy Roark:
Sot talk to me a little bit about that. So the way it was described to me was basically you have technicians that are working by themselves and then they have access to veterinarians through telemedicine to oversee what they’re doing. Is that accurate?

Dr. Katie Cutter:
It’s pretty accurate, yeah. So I mean, most times people are like, “How does that even work?” And then they come into the clinic and they’re like, “Oh my God, this is really, really cool.”
So for a wellness appointment, so a client would come in with their pet, the LVT and the VA greet the client, get them into the exam room, take the history and do the physical exam, things like that, put all the notes into the medical record. We leverage technology in the form of Bluetooth stethoscope, so heart and lung sounds get recorded and uploaded automatically to a database that can be accessed from anywhere, anything that can be documented with a picture or video, things like that we do. And when we’re ready for that veterinary consultation, the veterinarian Zooms into the exam room and has that interaction real-time but through that in-clinic telemedicine approach with the owner and the technician, they talk about what’s going on with the pet and usually it’s like, “Oh, well Fluffy is here for the DHPPL booster and we’re set to go with that.” Right?

Dr. Andy Roark:
Yeah.

Dr. Katie Cutter:
Something like that. So these are only wellness appointments. And then when everyone comes to a consensus that we’re, “Okay, we’re on the same game plan, this is going to be what’s happening today,” the veterinarian peaces out and the LVT and MBA team complete the treatment and then the owner is able to go home and they were able to get an exam in a timely fashion, get the services that they needed in an economical way and were able to pay our techs more because they’re actually in a revenue generating capacity.
We also do have urgent care services at our hospital. So there is also some direct veterinarian action for cases that are new, new clients or every now and then there’s someone who schedules a wellness appointment, but you’re like, “Hmm, this actually doesn’t fit the parameters of what we feel is it would be acceptable for us to move forward with an in-clinic telemedicine appointment.” And so those will get shifted over to the urgent care side of the house.

Dr. Andy Roark:
That totally makes sense. Okay. Now questions. I’m imagining a sort of a space age white plastic room with a wall screen like Star Trek, you know what I mean? And the doctor appears and the doctor appears on the screen and everyone is there in the room together and they all sort of talk it out from start to finish. Is that accurate? I guess what I’m really digging at is there back channel communication because a lot of times my techs come out of the room and they’re like, “Look, before we go in there, you should know this.” I think any of us would wonder. “How do I get… Give me the heads-up here on what I’m walking into virtually.” Is there any sort of back channel communication? Is it all a hundred percent we’re all together in a room and we’d talk it through from start to finish in front of the pet owner? Help me see that vision.

Dr. Katie Cutter:
There’s both. So definitely when the technician is ready for the exam, we have a platform where the wellness veterinarian gets messaged, “Hey, I’m ready, and this clinic exam room one when you’re ready.” And so if there’s anything that the veterinarian needs a heads-up on, like, “Hey, they were 15 minutes late, but they have a dinner appointment here and we’re trying to speed this through,” or anything like that, “Hey, they came in for a wellness, but I really have a question about something I found on my exam, da da da da da.” That all happens through that… Initially through, it’s like a text messaging application, but then we can have real-time phone and video chat that can either be in front of the owner or not in front of the owner, depending on what would be most appropriate.
Yeah, because it would be kind of weird if you had some things that you needed to talk about discreetly sometimes in order to set the stage, every veterinarian needs to have a little bit of a stage-setting before walking into that room cold. And so yeah, we do have that system in place.

Dr. Andy Roark:
Not in a bad way. I’m just thinking of things like, “There’s some married couple here and they’re actively fighting with each other about something not related to the pet. And you should just know that before you go in there.” I’m just curious how those signals get sent. Those have saved me so many times and I was just curious.

Dr. Katie Cutter:
Right.

Dr. Andy Roark:
So tell me about visualization. So there’s a screen on the wall. Is that all that the vet can see is from the screen? I’m assuming, do you have other kind of cameras? You said you’ve sort of filmed everything. What do you get to see?

Dr. Katie Cutter:
Yeah, we don’t record the exams, just like regular veterinarian exams aren’t recorded. That would just take up a lot of database. But we do have other cameras that we can utilize that are portable. So if the veterinarians like, “Hey, I’d like to get a better look at the teeth or let me see that skin lesion, that hotspot that you were talking about,” something like that that we can Zoom into that and that can be real time or we can take pictures from that or whatever.

Dr. Andy Roark:
That totally, I was just like, “Let me see those ears.” Those are the things I was trying to think of. That totally makes sense. What are the pet owners think about this? It’s on your website, you’re very clear. You’re like, “This is what is going to happen when you get here,” which I think is great. I’m sure that they still don’t get it or they, they’ve got to be surprised. What do you hear from the pet owners when they walk in and they’re like, “No, you’re not actually going to shake the doctor’s hand.” What is that like?

Dr. Katie Cutter:
Yeah, most pet owners, especially this day and age, are so appreciative that they were just able to get in and be seen that they’re actually, they’re just super like, “Wow, this was different, but this was great and I got the service that I needed. I didn’t have to wait for weeks.” Or a lot of people are getting new puppies and there are a lot of clinics in our area at least that aren’t even taking new clients. So they have a puppy that needs a round of vaccinations, they’re getting ready to go out of town. They can’t even board the puppy until these vaccinations are completed. And we can usually fit them in within a couple of days at any one of our clinics.
And so they’re mostly just filled with gratitude. A lot of people got used to using telemedicine for their own health issues during COVID. So I think in a pre-COVID environment, it would seem super funky for owners to walk in and be like, “Woo, what is this?” But COVID changed the landscape for people’s comfort level with telemedicine for their own needs, for their children’s needs. And there’s an expectation that they should be able to get convenient care for simple things.
And unfortunately with the systems that we have in place at most clinics, it’s really hard to provide convenient care for simple things a lot of times when the clinic is swamped, their appointment schedule’s full, they’re short staffed. So the pet owners are feeling that. And so we need to… This isn’t the only mechanism, it’s a mechanism. And so what we see with the pet owners, is just that gratitude that’s there every now and then we have someone that’s like, “Dude, I’m not comfortable with this,” and we totally get it. Let’s help you find, find a more conventional veterinary hospital that would be a better fit for you.

Dr. Andy Roark:
Yeah, I think that’s, and seems like you have a really healthy approach on it. Do get, and I’m just thinking of this through the lens of being a veterinarian, tell me about client loyalty. Are there clients that are just like, do they connect to the veterinarian individually that way? Do you see people who go, oh, I only want to see Dr. Smith because when I go, she’s the one who appears on the screen and I like her? Or is it just a different dynamic when someone’s on the screen? I’m just trying to think about what that experience would be like. Have you noticed a difference there?

Dr. Katie Cutter:
Yeah. Well, I don’t think there’s necessarily a difference in the client loyalty. Our wellness veterinarians are amazing and we really search for people who can reach through the screen almost and make people feel really welcome. So I think a lot of our clients still feel a connection with a veterinarian.
What does shift is that we see a lot more loyalty to the veterinary technician. So our veterinary technicians are the ones that they do a lot of the handholding with the clients and a lot of the explaining, and “This is what’s going on and this is why we’re doing this today,” and things like that. And so they have a kind of front and center appearance with that client, which a lot of clinics don’t have in place. And so I would say the loyalty, they’re still loyal to the veterinarians, but we see a lot more loyalty bridging to the technicians.

Dr. Andy Roark:
Yeah, that totally makes sense.
Hey guys, I just want to hop in really quick and give a quick plug, the Uncharted Veterinary Conference is coming in April. Guys, I founded the Uncharted Veterinary Conference in 2017. It is one-of-a-kind conference. It is all about business. It is about internal communications, working effectively inside your practice. If you’re a leader, that means you can be a medical director. It means you can be an associate vet who really wants to work well with your technicians. It means you can be a head technician, a head CSR, you be practice owner, practice manager, multi-site manager, multi-site medical director. We work with a lot of those people. This is all about building systems, setting expectations to work effectively with your people.
Guys, Uncharted is a pure mentorship conference. That means that we come together and there is a lot of discussion. We create a significant percentage of the schedule, the agenda at the event, which means we are going to talk about the things that you are interested in. It is always, as I said, business communication focused, but lots of freedom inside that to make sure that you get to talk about what you want to talk about.
We really prioritize people being able to have one-on-one conversations to pick people’s brains, to get advice from people who have wrestled with the problems that they are currently wrestled with. We make all that stuff happen.
If you want to come to a conference where you do not sit and get lectured at, but you work on your own practice, your own challenges, your own growth and development, that’s what Uncharted is. Take a chance, give us a look. Come and check it out. It is in April. I’ll put a link in the show notes for registration. Asking anybody who’s been, it’s something special. All right, let’s get back into this episode.
What is the technician experience coming into this? Do you have technicians who show up and go, “This is not what I thought,” or, “This is… I don’t like this,” or, “This is more than I can chew.” I’m certain you have technicians who come in and go, “This is great.” Well, what is the technician experience? I’m sure it’s a mixed bag, but help me, how do they respond to it? Help me put my head around that.

Dr. Katie Cutter:
Yeah, so I find that technicians, we kind of have… Just with veterinarians, there’s kind of two main varieties of… Sorry, my daughter painted my fingernails there earlier this morning. So it’s a little… Looks like I just killed something here.
But no, so I feel like the technicians and the veterinarians kind of come in two flavors to be just really broad. There’s the ones that kind of the urgent care and the emergency medicine and the procedures, they kind of like that fast-paced, the sick cases. And then there’s the ones that more of the client interaction and the wellness cases. So we have technicians that come to us and there’s some technicians that overlap the entire spectrum. They work urgent care, they work procedures, they can work wellness, they kind of do it all. But we do sort through those technicians, the ones that really want to be client-facing and really the ones that want to be on those wellness cases.
And for them, the platform really resonates for them. I had one technician pull me aside last month and she had just been working with us for, I want to say it’s 30 or 60 days. She pull me aside and she was like, “Oh my God, I feel like this is rehab for techs.” And I was like, “Uh, can you explain that a little further?” And she’s like, “Typically, because our pay scale is higher, so we typically are drawing from a really experienced tech pool. And so these are technicians that have worked in the field for 15, 20 years and they have been in experiences largely where they just feel undervalued and feel like there’s not a next level for their career path, either financially or even just professionally. Like, ‘I’m kind of capped out at what I’m going to do.'” And so I think for those technicians that it’s really refreshing to be able to come into a place and be a part of a team and to have that leadership role in the clinic as well and to be trusted. So I think for most of our technicians, it’s a breath of fresh air for sure.

Dr. Andy Roark:
Oh, I’m sure. Are there special characteristics or traits you look for in technicians? Things that you say, this is really important in this kind of business model where you’re working more independently than you would at other places.

Dr. Katie Cutter:
Yeah. So here you go. Because the model is [inaudible 00:18:48].

Dr. Andy Roark:
Yeah, it seems like it takes a certain kind of person, I guess.

Dr. Katie Cutter:
Yeah, no, for sure. You have to really like people. You can’t just like the dogs and the cats and the puppies and the kittens you have to like their owners that come with them and really want to help the people, the pet parents that are in the industry. You have to work well with your teammates for sure. You’ve got to be a team player.
And then we also pair, like I said, most of the time these are highly experienced technicians, but we do a training period where we’re pairing you up with another technician for anywhere from two weeks is the shortest period of time, but sometimes it’s up to six weeks depending on how the transition is going.
Where there’s a lot of handholding to say, “Okay, this is how we greet a client. This is how we do the physical exam. This is how you document things.” There’s a lot of specifics that we go into with our procedures because we are different and we want to make sure that all the I’s are getting dotted and the T’s are getting crossed. And so we are more procedure-oriented than a lot of clinics are, just to make sure that clients have a consistent experience and our techs have a consistent experience. It is new and that consistency I think keeps everyone on the same page for sure.

Dr. Andy Roark:
You mentioned before you try to hire doctors that can reach through the screen and make people feel good or feel safe. Are there characteristics or traits in the doctors that tend to do this kind of work that you’ve seen? Is there a certain type of vet personality type when you meet them and say, “Yeah, you would be someone that we would probably do well here.” I’m just curious. So any personality pieces that you say, “These are the types of doctors that do well here.”

Dr. Katie Cutter:
You know what the most important doctor piece… I used to think, like, “Okay, you’ve got to love the pet parents.” And of course that’s a given. I mean, I think that’s just a good doctor in general. You’ve got to be able to connect sure with the people that are making the financial decisions for the pet in order to get your plans across. More than anything else is that we have to have doctors that value technicians. And I wish that that was something that was universal in our industry, but it’s not. And there are certainly lots of doctors out there that have practiced for quite a long time who haven’t worked with technicians in the capacity that we are advocating. And so if you come in and you’re like, “I don’t believe in technicians, I don’t believe they should be doing this,” then you’re probably not going to be a good fit for us.
So it’s really like, “Hey, are you a team player? Do you really believe in the techs and the staff and believe in the vision and the model? Do you want to change the industry and do you want to push it forward?” And so really it’s getting people that want to make a change for the better. Our whole mantra, the whole reason we exist is we want to improve the lives of the veterinary technicians. We want to improve the professional lives of our veterinarians. And so you’ve got to be dedicated to that cause And if you’re just doing this to clock in and clock out and you’re not in it to create that greater difference, probably not going to be the best fit.

Dr. Andy Roark:
That makes sense. Speaking of clocking in and clocking out, what are the veterinarian work schedules like? How does that work?

Dr. Katie Cutter:
Yeah, yeah. I mean, urgent care is urgent. I mean, there’s nothing novel on really what we do on that side of the house. So our wellness veterinarians, they can work remotely, which is a nice option for veterinarians to be able to have. We have a largely women workforce and as a mom of three and a CEO and fellow veterinarian, time, there’s not enough of it. And so to have options that I could still be a professional, I can still be a veterinarian, but I have more flexibility to do it a little bit more on the terms that suit me, is kind of a novel take on what a veterinarian can be expected to do in our field. And we need to have, I think, more innovators out there that are looking to be creative with the workforce that we have.
And so we can schedule and you can do, we have some veterinarians that have picked up a part day shift or a full day shift. We have full-time veterinarians, part-time veterinarians. And so usually it’s the clinic rounds. All the clinics get on a platform together at currently it’s 9:00, we’re switching it to 8:30 in the morning and we all round together. And so all the techs, the wellness doctors, everything, we’re all… It’s like a Brady Bunch Zoom meeting and it’s like, “Hey, this is what’s happening today teams, does anyone have any questions with anything on their schedule? Anyone have any questions about cases that you saw yesterday or blood work analysis or anything like that?” So to really keep that community feel going. And I think our wellness veterinarians especially appreciate that because you need to feel that connection with the clinic still. And that’s where our model differs from just a call-up telemedicine company is that the clients are in the clinic, you have your LVT, you have staff in the clinic, you actually have a fellow urgent care veterinarian there in the clinic. So you can provide some really meaningful medicine right there, boots on ground, but you need to feel connected to your team. You need to feel like you’re almost like in the clinic. And so we really strive to create that feeling and to create that community.
So every day before the day starts, everyone meets together based on the screen and we talk it out, talk what the day’s going to be like, anyone have any concerns, anyone need to leave early, anyone’s kid is sick that we need to find coverage for, things like that. The basic life stuff that happens. And so that both the community feel of things and the flexibility of the work schedule, not only in just the hours that we offer, but also the ability of being able to do it remotely, I think are novel concepts for veterinarians and very, very well received.

Dr. Andy Roark:
Yeah. Oh, I agree. So you have three locations now, is that correct?

Dr. Katie Cutter:
Four. Yep.

Dr. Andy Roark:
And they’re all in the state of Washington?

Dr. Katie Cutter:
They’re all, they’re all in the greater Seattle area and we’re looking to kind of double our footprint in 2023. I never sit still for long.

Dr. Andy Roark:
Yeah, right. Were there any sort of regulatory headaches? Were there things that you had to work around in order to start doing this? I’m sure that you got some pushback from veterinarians who were like, “You can’t do this.” Were there any actual challenges to you getting up and getting it going?

Dr. Katie Cutter:
Yeah, yeah. So initially we were able to get up and going under some COVID legislation that was favorable for us in Washington State. Recently, they’ve backed out of that legislation. The Board of Governors is reviewing more permanent legislation that would potentially be more compatible with what the COVID legislation was. With our marriage of both an in-house veterinarian there and the telemedicine things, we’re able to piece together protocols that check all of our boxes there.

Dr. Andy Roark:
Gotcha.

Dr. Katie Cutter:
It’s not always streamlined. I wouldn’t say it’s the most efficient process that certainly if we had legislation that could make it more efficient, we would be very favorable for that. But yeah, we’ve set up our protocols, like I said, dot every I and cross every T, that we have in place to make sure that we fall within the Washington State legislation. And really it would work in I’d say 49 out of the 50 states.

Dr. Andy Roark:
How stressful was that to open up a hospital using… Because these things are here in place and the pandemic happens and they make this legislation and you’re like, “That’s it. We’re going to start a business.” With this thing that was related to the pandemic, I don’t think I’ could have slept at night. How did you do that?

Dr. Katie Cutter:
I mean, definitely you do have some sleepless nights, but I think in the long run you got to have a passion and you’ve got to have… Your heart’s got be in the right place. You’ve got to be operating from a standpoint of, “Why am I doing this?” We’re not doing this to make gobs of money, although my investors probably don’t want to hear that, we’re doing this to change this space. We’re doing this to improve the lives of our veterinary technicians and our veterinarians because I think they’ve been overlooked and the stress that they feel in the clinic has been ignored for quite some time. So we need to start being better. We need to have better systems in place so that’s the driver through it. And so we did just focus when we first opened our clinics, we did just focus on the wellness model and then back added urgent care to it just because the wellness model is the part that’s really different.
And so just to say, “Hey, we think it’s going to work on paper, this seems great, but is this really going to work? Is this thing that’s an idea, once we turn it into a brick and mortar living entity, how is that going to fly?” And it went amazingly smoothly. And so then back adding urgent care and then knowing, we had a year and a half knowing that, “Okay, we’re able to do these things under COVID legislation.” But that whole year and a half working towards what are we going to do if when we don’t have COVID legislation and what would we want to do? What would we change to put it in a state that had conventional legislation? So those goals were never ignored. We were able to get up and running with some very favorable legislation, which really let us prove the proof of concept. Does this even work? And we found out, yes. And owners love it and technicians love it, and veterinarians love it. Okay, so now that we have that answer, now let’s put the systems in place to make it so this would be something that would be sustainable in almost every state.

Dr. Andy Roark:
If you could go back and tell yourself something when you were getting started with Booster, what would you tell yourself? What is the message you would send back in time?

Dr. Katie Cutter:
Yeah. Yeah, that’s a great question. So my husband always makes fun of me because I’m always… I come up with an idea and I’m like, “How hard could it be? Honestly, this just seems so simple.” And I’ve gotten myself into a lot of trouble with that. And so this is one of those things where it’s like, “Yeah, sister, this is going to be hard. This is going to be a little bit harder than you might initially think but it’s also all going to be worth it.” To go into the clinics.

Dr. Andy Roark:
That’s great.

Dr. Katie Cutter:
And to see those technician teams working, to hear their stories of where they’re been and where they are now, it’s so fulfilling. And then our veterinarians that are looking, they’re burned out, they’re looking for a different opportunity for a different option. Even our urgent care veterinarians, because we do urgent care, of course, we can’t do anything just exactly like other people do it. So our urgent care is a little bit different too. No telemedicine involved in that, but we really believe in creating systems that are healthy.
We don’t believe in squeezing the lemon to get as much lemonade as possible. We want people to leave the clinic after their shift and still have part of themselves left in the tank. I want you to be able to go home and have energy to have dinner with your family, to go to your kids’ basketball game, to go to the gym, to go for a hike. Whatever it is that fulfills you are more than just your career. Yeah. “So it’s hard and it’s going to be harder than you thought, sister, but you’re going to start creating the change that you want to see out there in the world. And it’s worth it. It’s worth those sleepless nights.”

Dr. Andy Roark:
Definitely.
Dr. Katie Cutter, where can people learn more about Booster Pet? Where can they find you online?

Dr. Katie Cutter:
Oh yeah. So we have of course a webpage, www.BoosterPet.com. I’m always happy for people to reach out to me directly. So my email address is Katie.Cutter@boosterpet.com. And that’s K-A-T-I-E-C-U-T-T-E-R.
Yeah, I love to talk about what we do. I love to share ideas and have conversations about how we can make the space a better place. So I’m always encouraging people to reach out and let’s get dialogues going. But even more important than that, let’s turn these dialogues into actual concepts that start to change the space.

Dr. Andy Roark:
Thanks so much for being here, guys. Thanks for tuning in and listening. I hope everybody has a wonderful week.

Dr. Katie Cutter:
Thanks, Andy. I super appreciate it.

Dr. Andy Roark:
And that is our episode.
Guys, I hope you enjoyed it. I hope you got something out of it. Thanks to Dr. Cutter for being here and sharing what she’s doing. Boy, I got to sit with this one. This is, it made me think about what the future in medicine’s going to look like, and that’s always exciting to me. So anyway, guys, take care of yourselves. Be well. I’ll talk to you later on. Bye.

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

More Vets, More Diversity, Fewer Men – Trends in Vet Schools

January 4, 2023 by Andy Roark DVM MS

Dr. Kate Boatright joins the podcast to discuss her recent article on veterinary school admissions and demographic trends.

Cone Of Shame Veterinary Podcast · COS – 178 – More Vets, More Diversity, Fewer Men – Trends In Vet Schools

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

LINKS

The Next Generation of Veterinarians (Article): https://todaysveterinarypractice.com/diversity-equity-and-inclusion/the-next-generation-of-veterinarians/?oly_enc_id=5467B7086134E1Y

The Boy Crisis: Why Our Boys are Struggling and What We Can Do About It – https://amzn.to/3gNeG70

Pawsibilities Vet Med: https://www.pawsibilitiesvetmed.com/

Journey for Teams: https://www.avma.org/resources-tools/diversity-and-inclusion-veterinary-medicine/journey-teams

Blend: https://www.blend.vet/

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

Links to Amazon.com are affiliate links and help support the show. (They’re also much smaller than normal links and easier to copy when typing up show notes!)

ABOUT OUR GUEST

Dr. Kate Boatright has been in small animal practice since graduating from the University of Pennsylvania in 2013. After nearly 8 years of full time practice in both general practice and emergency clinics, she moved to part-time clinical work to pursue her passion for educating veterinary professionals as a freelance speaker and author. Dr. Boatright enjoys discussing mentorship, the unique challenges facing recent graduates, wellness, and the spectrum of care. She believes deeply in the role of organized veterinary medicine and holds leadership positions in the AVMA and her local and state VMAs. She is a former national officer of the VBMA and was a founding member of the VBMA Alumni. In her remaining time, she stays busy chasing her toddler, running, reading, and watching movies with her husband and cats.


EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Guys, I’m here with my friend Dr. Kate Boatright, and we were talking about a new article she put out recently looking at the demographics of vet medicine and where it’s going. She’s looking at demographic trends in veterinary school in the new class for veterinary school, and it’s fascinating stuff, guys. Enrollment for vet schools is going up, the vet schools are getting bigger, and we’ve got LMU putting out two classes a year coming up and getting started. We’ve got larger class sizes, we have got increasing diversity in our profession. Yay.
We have decreasing percentages of men in our profession. Ooh. We talk about the driving factors for those trends. We talk about what it looks like and where it goes in the future. We talk a bit about feminization of that medicine. We talk a bit about what’s going on in the education in general. We talk about a lower number of men graduating college, and what that means for vet schools and things like that. So it’s a sprawling demographic conversation as we look at medicine and the composition of medicine and where’s it going. So guys, I hope you’ll enjoy this conversation as much as I did. 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. Kate Boatright, how are you doing?

Dr. Kate Boatright:
I’m doing great. How are you Andy?

Dr. Andy Roark:
I am doing pretty darn well, actually. So yeah, thanks so much for being here. It is a real thrill for me to have you here, because I remember when you were a baby vet student. When we met is when you were in vet school, you went to Penn, right? VMD?

Dr. Kate Boatright:
Mm-hmm. Yeah. I’m a Pennwe.

Dr. Andy Roark:
I remember when we met. I’ve been thinking, I may need to stop saying that, because there’s more and more people now is like, “I remember you were in vet school.” And I’m like, “I don’t know if people like to be introduced that way.” I remember you from there, but you have gone on and already had a distinguished career pretty quickly. You are writing a lot. I see your name a lot. You write for dvm360, you’re doing some stuff, you have a regular thing at AAHA trends, I think. You do NEWStat, you write for today’s vet practice, is what we’re going to talk about today. I saw an article there that you did that I really liked, that I want to talk to you about. You’re just doing a lot of stuff. You’re doing some speaking stuff, I’m seeing you on some of the conference programs and things like that.
I wanted to get in with you and talk about this article. So it was in the October, Today’s Vet Practice, and it was called, The Next Generation of Veterinarians. This article is about enrollment in vet schools today, and changing demographic trends that we are seeing. And I actually thought it was really interesting. And so, what I want to do with you today, is just walk through what are we seeing from a diversity, equity and inclusion standpoint? What are we seeing as far as changing demographics in the vet school? Talk to me at a high level and then let’s start to drill down.

Dr. Kate Boatright:
Yeah, absolutely. The article focused on the AAVMC’s data report on the current demographics of the veterinary student population that was published, I think it was over last summer. And the big three trends that they highlighted were increasing enrollment, which is a good thing for our veterinary shortage right now. And then significant improvement in DEI, but a continued decline in our male student population. And I was able to talk to Dr. Lisa Greenhill over at AAVMC for the article, and she gave me a lot of the context of the data. I think I quoted her, the story the data tells, is the fun part.

Dr. Andy Roark:
Gotcha. Okay. Well, I’m going to let you take it from here. I’m interested in, when we talk about increased enrollment, how much enrollment are we talking about? So let me start with that before we dig into the story the data tell. What are we talking, is this a 5% increase? Is it a 20% increase? What scale of increased veterinarian production are we seeing now?

Dr. Kate Boatright:
Yeah. The current in the incoming class, so this would be for the class of 2025 that we’re entering vet school this fall, we saw about, it was a little over 4%. I think it was 4.7% overall increased enrollment from the previous year. And one of the big drivers of that has been the opening of some new schools, so we’ve seen new schools pop up. We’re starting to see schools like Lincoln Memorial are introducing a second class in the calendar year, which is going to be another increase in our enrollment. I remember when I started vet school, there was a huge jump in enrollment around that time. So I started vet school back in 2009, and I remember that everybody was saying there was a veterinarian shortage.

Dr. Andy Roark:
I remember that.

Dr. Kate Boatright:
Yeah.

Dr. Andy Roark:
No, there has been a surplus. They were saying there has been a surplus.

Dr. Kate Boatright:
Yeah.

Dr. Andy Roark:
I’ve never forgotten this. So I’ll tell you the story just real quick, because it has always affected my thinking ever since. So I graduated in 2008, and there was this anger about the surplus of veterinarians, and we are going to be swamped in veterinarians and nobody’s going to have a job, and veterinarians are going to work for peanuts, because there’s going to be so many of us. People were angry, and that was the defining narrative. It was everywhere. And then jump ahead about three, four, five years, I was watching Dani McVety lecture at a conference one time. It was a town forum type thing, so it was this open discussion. And someone from the audience was grilling Dani, who’s a good friend of mine, and grilling her.
And they were like, “With all of these veterinarians, and blah, blah, blah.” And Dani was the first person I ever heard just really pushed back. She’s the founder of Lap of Love Vet Hospice and they were growing really fast at the time. And she said, “Where are these veterinarians that you’re talking about, because I can’t find them. Because I would hire them, and they’re not there.” And there was murmuring in the room from people who were like, “I have also struggled to hire a veterinarian.” And that was, for me, was almost like, I just saw the tide turn in this room, and it never went back. And after that, the chorus just came up of, “We can’t get help.” But I say that, because the narrative people were so certain, and they were just like, “This is what it is.”
And then I saw it turn in that room and then it just ran away. And it’s funny, I’ve always remembered that, because you hear these things and people say, “Well that’s just what it is.” And I go, I’ve heard that story before, and sometimes that’s not what it is. And sometimes the idea changes really fast. And so, it’s just funny whenever people talk about doom and gloom, it was just funny that the doom and gloom was, there’s too many of us. And it immediately flipped in doom and gloom of, there’s not enough of us.

Dr. Kate Boatright:
Yeah. Yeah. And it’s also always been the question of, are there too many in one area versus another, both geographically and just practice area? I have a lot of friends from vet school who aren’t in practice anymore. And so, I think that’s been another trend that we’ve seen just in the overall veterinary population, is people who are still working as veterinarians but in different capacities. So I think it’ll be interesting to see where these vet students that are in school now, where they’re going to go. Are they going to end up in clinical practice? Are they going to end up out in industry or academia, or where they’re going to go?

Dr. Andy Roark:
Yeah, I had a guest on a nutritionist just recently, and she was telling about being in general practice for a while and then ultimately feeling stuck and then doing a non-traditional residency. And now she works with Hills, and it’s just been… Yeah, I see a uptick in that. And I’m curious, I don’t know if you have data to support veterinarians working in larger numbers outside of practice or more non-traditional veterinary roles, but just anecdotally, I don’t know if it’s the circles that we run in, a lot of our friends do things that are not in the clinic anymore, or if that’s a more nationwide trend. I don’t know, do you have insight?

Dr. Kate Boatright:
I don’t know that I have specific data. I mean, obviously I hear lots of conversations about, “Hey, it’s really hard to hire.” I’ve been in multiple small animal and emergency hospitals that are struggling and short staffed, and I’m in a pretty rural area, so sometimes it’s hard to recruit. People don’t want to come live in the boondocks, Western Pennsylvania. But I think the people that I talk to either are moving out of practice or, like I did where I work part-time now in practice, and that was so that I could have more time to do all this other stuff that I do. So I think there’s a movement of that as well. The way I’ve heard it explained is, looking at veterinary working hours as opposed to just the number of veterinarians.

Dr. Andy Roark:
That makes sense. So we talked about increased enrollment. I think the LMU model of turning out multiple classes per year is really interesting. We’ve seen this in the Caribbean schools. I think some of the Caribbean schools were doing three classes a year.

Dr. Kate Boatright:
Yeah.

Dr. Andy Roark:
Is that true? Okay. I thought that was at least true.

Dr. Kate Boatright:
I’m pretty sure it is. Yeah.

Dr. Andy Roark:
Yeah. So it’s not unheard of. It’s not unprecedented. It’s unprecedented to see a school in the United States doing it, but there seems to be a demand.

Dr. Kate Boatright:
Yeah. Well, I think a big limiting factor is just the size of the school building and the space. I was reading an article recently where LMU announced its increased extra class, and they built their school to accommodate that. They’ve got the space to put people. I remember, at Penn there are three large lecture halls, so there is one for first year, second year and third year. You’d have to create new space if you were going to add another class, and I think that’s the case in a lot of the older schools.

Dr. Andy Roark:
Have you ever been to LMU? Have you been out there?

Dr. Kate Boatright:
I haven’t. I haven’t. One of my goals is to get to all the vet schools, so they are on my list, but I have not made it yet.

Dr. Andy Roark:
All right. So I’ve been to Penn a number of times, obviously. And Penn, for those people who haven’t been there, it’s in downtown Philadelphia. It is in a develop city. How do you expand Penn? I have no idea. You would have to acquire some real estate that already exists that someone else vacated, and they would have to be ready to leave. I don’t know how you grow Penn. However, LMU is in the middle of nowhere. And I say that with love, it is absolutely gorgeous. I mean, it’s right on the line of North Carolina, Tennessee, Kentucky. It’s up in that really rural mountainous area. I think it’s Cumberland Gap area. The hiking and backpacking is gorgeous. It is just absolutely pristine, beautiful. I want to go up there, I want to spend time up there and just walk around, because I love being outside.
That said, there’s stuff in there, I mean, I’ve been up there a number of times, and I really like it, but they have room to expand, is a generous way to say it, a 100%. There is very little holding them back from just expanding their facilities. And so, that’s where they are. The other thing is, they have a mindset to expand and they’re willing to expand. So I went up there a couple of years ago, and I’ll never forget, it was when LMU was just getting going. And I went up there, and they had been in practice for two years, so they only had first and second year students.
And I remember getting the tour and walking around the school. And Kate, there were big sections of the school where the rooms were empty except they had purchased everything they needed, and it was all piled in the middle of the room and wrapped in plastic. And half the school was just empty rooms with chairs and tables and microscopes wrapped in plastic. It was the oddest thing. It was like someone was setting up a laboratory like some science fiction place. Anyway, but they were in it and they were like, “Yeah, we’re doing this now with the expectation that people will be here.” And they have just continued to grow. That school in general has continued to grow. So anyway, they’re just doing interesting, innovative things, two classes a year.

Dr. Kate Boatright:
Absolutely.

Dr. Andy Roark:
I’ll be interested to see what it looks like. Let’s talk about the demographic shift. So we’re talking about enrollment and where that’s coming from. Tell me the story of demographics in vet medicine.

Dr. Kate Boatright:
Yeah. I think that we’re all pretty aware. I could remember being on the floor of the ABA House of Delegates back in, I think it would’ve been 2021, the first time we met back in person, and watching the video that was released from the Diversify VetMed, those groups, the Multicultural Vet Med Association, I think was spearheaded, and just watching that video of the experiences that people in vet med had, had of being excluded, racism, all of those things.
And I grew up in a pretty diverse area in Pittsburgh. My mom is a minister, and her whole life has been about anti-racism. I grew up in an interracial church. And so, that really spoke to me. And so, I very closely followed the story of improving diversity in vet med. And I think we’re starting to finally see a lot of that work really paying off. And that’s not work that started in 2021, that started well, well before. And so, it’s exciting to see that we’ve had this big increase. I believe it was about 23% of the student body now comes from what has been historically underrepresented backgrounds.

Dr. Andy Roark:
Wow, that’s amazing. That is amazing. Honestly, that feels really rapid, which is great. I know a lot of the groundwork have been laid for a long time, but really, it’s only been probably the Multicultural VetMed Association came onto my radar. I remember it as pre pandemic, but not very pre pandemic that I became aware of those guys and what they were doing. They seemed to have made a significant impact, and that’s a 23% increase. It’s pretty incredible.

Dr. Kate Boatright:
Yeah, it might have been the 2020 Summer Delegates meeting, but it was within the last couple years. And just the amazing impact that we’ve seen and the profession really coming together and saying, “Yes, this is important. We need to address this.”

Dr. Andy Roark:
Hey guys, I just want to hop in really quick and give a quick plug. The Uncharted Veterinary Conference is coming in April. Guys, I founded the Uncharted Veterinary Conference in 2017. It is a one-of-a-kind conference. It is all about business. It is about internal communications working effectively inside your practice. If you’re a leader, that means you can be a medical director, it means you can be an associate vet who really wants to work well with your technicians, it means you can be a head technician, a head CSR, you can be a practice owner, a practice manager, multi-site manager, multi-site medical director. We work with a lot of those people. This is all about building systems, setting expectations to work effectively with your people.
Guys, Uncharted is a pure mentorship conference. That means that we come together and there is a lot of discussion. We create a significant percentage of the schedule, the agenda at the event, which means we are going to talk about the things that you are interested in. It is always, as I said, business communication focused, but lots of freedom inside that to make sure that you get to talk about what you want to talk about. We really prioritize people being able to have one-on-one conversations to pick people’s brains, to get advice from people who have wrestled with the problems that they are currently wrestling with. We make all that stuff happen.
If you want to come to a conference where you do not sit and get lectured at, but you work on your own practice, your own challenges, your own growth and development, that’s what Uncharted is. Take a chance, give us a look, come and check it out. It is in April. I’ll put a link in the show notes for registration. Ask anybody who’s been, it’s something special. All right, let’s get back into this episode.
What’s actually driving it? I mean, it’s one thing to say, “Hey, we would like to increase diversity.” And I think that’s the first step. The first step is awareness, and the second step is, what are we actually going to do about it? So tell me about that.

Dr. Kate Boatright:
Yeah. So I think that, like I said, this is coming from years of work from a lot of people who recognize the lack of diversity a lot earlier than it was a widespread conversation. And it’s about intentionally mentoring students who are coming from underrepresented backgrounds, making sure that they’re even just aware of this as a profession. I think about, we know that there’s a lot of pets who don’t receive veterinary care, and that whole access to veterinary care conversation. And a lot of those are in lower income communities, in more rural communities. And I think there’s a big overlap between that where people aren’t seeing veterinarians who look like them.
And so, getting out into elementary schools and middle schools and high schools and colleges, and just the more that we expose the profession to the public and with a focus on those from underrepresented backgrounds. And there’s some great work from Possibilities, VetMed, and there’s BlendVet and Journey for Teams from AVMA, all these groups are really working hard to improve diversity and having that exposure in the pipeline.

Dr. Andy Roark:
So Positivity Vet, BlendVet, and what was the last group?

Dr. Kate Boatright:
Possibilities, Blend, and then AVMA just launched, it’s called Journey for Teams, which is a DEI training program for vet clinics. They launched this summer.

Dr. Andy Roark:
All right, so I’ll put links to all three of those in the show notes for people who want to check it out and learn more. Is there anything you were surprised by? Is there anything, I don’t know, that that seemed counterintuitive to you as you looked at the changing demographics in the vet schools?

Dr. Kate Boatright:
The biggest surprise to me wasn’t necessarily that we’re seeing a decrease in male veterinarian students, but in talking to Dr. Greenhill and understanding the larger picture of men in higher education, was really eye-opening for me. Historically, for years, we’ve been seeing a decrease in male enrollment. I remember when I was a kid and I said I wanted to be a veterinarian at five, like most of us, my mom was very intentional about making sure that she only took our pets to veterinarians who were female, because she wanted me to see females in veterinary medicine, because when she was a child and said, “I want to be a veterinarian”, everyone said, “You can’t, you’re a woman. Women aren’t in vet med.” And this was in the late ’50s, early ’60s. And so, she went into a completely different profession that was male dominated, which was ministry.
But for her, it was was really important that I saw that from the beginning. I always knew that I wanted to do it and I had that support. By the time I entered school, it had definitely flipped, and women were in the majority at that point, and that trend has just continued where you watch the women increasing and the men decreasing. But when you actually look at the applicant pool, I think it was something like 12% of the applicants were male, but 18% of the class is, so there is an advantage there for men in that population.
But when we look at just the undergraduate student population, it’s also female dominated, so we’re already pulling from a pool that is female dominated. So it’s not so much that vet med is trying to push men out or anything. I think we absolutely need men in our profession. It’s another component of diversity, is that gender component. And they’ve only recently started tracking non-binary and other identifications, so there isn’t as much data on that. But I just think it was really fascinating to me, looking at the broader picture of men in education, I think was one of the really eye-opening things for me.

Dr. Andy Roark:
I think that’s fascinating. There’s, I think it’s the book, it’s called Crisis of Men and Boys. It’s a new book that came out fairly recently. I’ll put a link in the show notes, but it’s gotten a lot of my attention recently. It’s talking about education in men in America. And as we look along, there’s fewer and fewer men who graduate from high school than they used to be. Women graduate from high school at much higher rates. Women are much more likely to be high school valedictorian. Women are much more likely to go to college. Women are much more likely to finish college and they’re more likely to finish college at the top of their class, which obviously sets women up to be much more likely to go into that school, because that school is competitive, it is academically rigorous, is attractive to the strongest students who feel like, “Yeah, I can handle that.”
And so, I do think that we’re a part of this much larger trend, but I do think it’s interesting to us to think about what that means for diversity to have so few men in the profession. I mean, I think about 12% applicants are male, and 50, what, 48% of the population is male? Something like that. Basically 50% of the population is male. That is incredible. And then, one of the things I also think is really interesting, is when you talk to the economist about what feminization of a profession looks like and how that tends to go, and we look at other professions that have skewed to a predominantly female ratio. There are a number of things that come along with that, just that trend in an industry. And you say, “Well, we tend to see lower salaries, and we tend to see things like that.” And again, I do not like that, and that is not a fun story and I don’t want us to be a part of that story. That’s broken.

Dr. Kate Boatright:
Yeah. And salaries are implicated as being part of the reason that we see that differential, is that if you were pulling from, we’ve got a smaller pool of men in the STEM majors and they tend to gravitate towards those majors and those disciplines that have higher starting salaries. And unfortunately, Vet Med is not one of them.

Dr. Andy Roark:
Yeah. Oh, yeah.

Dr. Kate Boatright:
So that is definitely part of the conversation, is how the starting salary impacts the choice of career.

Dr. Andy Roark:
Oh, I think that’s true. I think that there’s a reality and a perception too around the financial security that comes from veterinary medicine. And I think that, that’s one of the things the profession need to keep working on. I want people to look at vet medicine and say, “Yes, if I went there, I would be able to support my family. I would be able to pay my bills.” It don’t think any of us are trying to get rich, but we would like to feel like we’re financially stable. I think the debt problem in vet medicine has hurt us as far as attracting applicants who say, “Well, yeah, I want to have a profession that I know that I’ll be able to send my kids to college.” And I think that those are real realities as you look at where we are. And well, they’re all interconnected, but I don’t know if we’ll be able to attract men back to our profession if we don’t affect the economics of what it means to be a veterinarian.
And maybe that’s a cynical view. Maybe that’s not remotely true. I tend to think it probably is. I don’t know. Where do you think this all goes, Kate? When you look in your crystal ball and you look ahead five years, 10 years, I mean really, yeah, what do you see? I mean, I’m not going to ask you to say we’re going to be this percent underrepresented minorities or this percent male, but I mean, overall trends, is there anything to make us think that…? First of all, I feel good about the increase in diversity that we’re seeing in our profession. I like it. It’s going to be a long road, it’s going to be continuous work, but hey-

Dr. Kate Boatright:
Hard work.

Dr. Andy Roark:
… it feels good to look around… Yeah, it’s going to be hard work, but it does feel good to look around and say, we’re putting one foot in front of the other. I think people have good hearts and they’re doing the work. And I think people generally see the value in increasing diversity in our profession. I felt that most people have been like, “Yeah, we’ve got work to do in this area”, and there’s a lot of benefits for our profession to have this and there’s a lot of benefits for pet owners for us to increase diversity. And so, I’ve been really happy to actually see people put their money where their mouth is and do the work and not just talk about it. So I’m very proud of our profession that way. Yeah, I hope that we continue to see that going. I wonder what’s going to happen with the gender ratio in our profession. I don’t know. What are your thoughts?

Dr. Kate Boatright:
I mean, I think definitely the economics of just where we are right now is a big part of that conversation. And I am far from an economist, but we’ve seen declines in undergraduate enrollment, and unfortunately the people who are most affected by that are our first generation students, our underrepresented backgrounds, our lower income families. And so, I hope that we do continue to see that growth in diversity. And I certainly hope we don’t backslide, but I do worry that with the current economics of undergraduate education that, that’s something we have to be aware of, because no, you don’t have to finish, get your bachelor’s degree to get into vet school, but you at least have to have the classes done.
And so, making sure that, that’s remaining accessible, I think, is big. I hope that we are able to get a little more of an equal balance between male and female students, but we talked about the landscape of that already, and so I wouldn’t be surprised if that trend continues. I’m sure at some point it stabilizes out. I doubt we’re going to get to the point where there’s no men coming in.

Dr. Andy Roark:
Yeah, I don’t think so.

Dr. Kate Boatright:
But certainly, it’ll be interesting to see where it all ends in the end.

Dr. Andy Roark:
Well, yeah, and it’s a work in progress. I’ll tell you, I look at my crystal ball, which is highly unreliable. It’s been proven to be in the last few years.

Dr. Kate Boatright:
I’m still waiting for mine. Mine hasn’t come yet.

Dr. Andy Roark:
It got lost. Supposed to get lost in the mail. It’s probably the best thing when that happens. But I see a path in the future that’s more attractive for technicians. I really do, because when you look at the cost of going to college, and people are starting to have real questions about, what’s the return on investment on a college education? And then you look at the debt load and vet school, I think that if technicians become more empowered and we leverage our technicians better and we compensate our technicians better, I think that, that technician certification, the associates degrees, things where you can do a shorter program, a lower cost to get your credentials, now the compensation has to come around to make that worthwhile, but I think it’s a whole lot. It makes more economic sense to have more support staff, more para professionals that are well trained and well compensated, than it does to keep growing veterinarians, which is a long, super expensive path.
So I suspect that we’ll continue to see, I hope we’ll continue to see more certified credentialed technicians and we’ll be using them more, and they’ll be better compensated. I think when we look at the vet schools, I’m optimistic with the rising salaries for veterinarians right now. So starting salaries of vets have gone up. There’s been a lot of change, and I hope that, that will continue on. It definitely makes the debt more palatable when vets have more earning power and are starting at higher salaries. So that helps.
But I don’t know, Kate. I don’t see the debt problem going away, I’m not seeing anything really effective. There was a student loan forgiveness program that came out that felt like a drop in the bucket to me, without really addressing the underlying problem. So yeah, I look at those economics and I go, I don’t know what we’re going to do about making veterinary medicine more attractive to be a stronger magnet. But I really think, that’s my goal is, if we can make this profession financially attractive to people, I think we sort a lot of problems out. I think we have to continue to fight against the debt problem and we have to keep working for doctor and support staff compensation, and balance that with keeping care affordable, but I am optimistic.

Dr. Kate Boatright:
Right, absolutely. I agree. I think definitely, I love working with students and mentoring and seeing them grow. And I work with a lot of pre-vet students and watching them get into vet school. I now have some that have graduated that I wrote recommendation letters for, which makes me feel super old. And I realize I’m still very early in my career, but it’s exciting to see that changing landscape. And yeah, I think like said, the big challenge is going to be making it an attractive profession and a solvent profession, while still keeping our care the way it is for all of our patients.

Dr. Andy Roark:
Yeah, I agree. There’s a shared glory in writing a rec letter for somebody who gets into vet school in there.

Dr. Kate Boatright:
Yeah, it really is.

Dr. Andy Roark:
It’s just like, I get the [inaudible 00:31:00] in their glow. I love it. I’m like, “I know I didn’t really do anything.” He like, “You did all the work, but I wrote a nice note that went with you, and so I’m going to…” Exactly right. Exactly right. So that always makes me feel good. Kate Boatright, thanks so much for being here. Where can people find you? Where can they read your writing and keep up with what you’re doing?

Dr. Kate Boatright:
Yeah. I am on Instagram. It’s @writetheboat, it’s W-R-I-T-E, the boat. I am on Facebook and LinkedIn at Kate Boatright. And then I do have a website, www.writetheboat.com. Again, it’s W-R-I-T-E, the boat. And that’s where all of my upcoming speaking, all of my articles are archived there. And soon we’ll be launching a mentorship program for practices through there.

Dr. Andy Roark:
Very great. Very great. Well, congratulations, Kate. Thanks so much for being here. Guys, thanks for tuning in. You guys take care of yourself, we’ll talk to you next week. And that is our show. Guys, I hope you enjoyed it. I hope you got something out of it. Thanks to Kate Boatright for being here. As always, if you enjoyed the show, there’s nothing else you could do that would help me more than just sharing it with your friends. I love when people write honest reviews. Wherever you get your podcast, Apple Podcast is a big place that people look when they’re looking for a podcast, so that helps a lot. But honestly, just if you think it’s good, send it to other people who might also think it’s good. I’d super appreciate it. Anyway guys, that’s what I got. Take care of yourselves. Be well. Talk to you later. Bye.

Filed Under: Podcast Tagged With: Team Culture

The Art of Pricing Veterinary Medicine

December 28, 2022 by Andy Roark DVM MS

Fritz Wood, a renowned animal health consultant and advisor, joins Dr. Andy Roark to talk about pricing in veterinary medicine. Are increasing prices justified by inflationary pressures and rising costs of living? Do pet owners agree and/or accept this? What are the potential benefits and pitfalls of veterinary clinics raising prices? Should they do fewer large raises or more frequent smaller raises? The discussion ends with a conversation about the impact of corporate medicine and the coming future of telemedicine.

Cone Of Shame Veterinary Podcast · COS – 177 – The Art Of Pricing Veterinary Medicine

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

LINKS

Fritz Wood Website: https://www.fritzwood.com/

Uncharted Veterinary Conference: https://unchartedvet.com/uvc-april-2023/

AAHA Veterinary Fee Reference (2020 edition): https://amzn.to/3W2lWeU

Profitsolver: https://profitsolver.com/

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

Links to Amazon.com are affiliate links and help support the show. (They’re also much smaller than normal links and easier to copy when typing up show notes!)

ABOUT OUR GUEST

Fritz Wood owns and operates an animal health consulting practice in Kansas City. He’s focused on the business of veterinary medicine for more than 30 years, conducting important research on veterinary productivity and attributes of high-performing practices. Fritz is an author, speaker, business consultant, and key opinion leader. He was on the Editorial Advisory Board of Veterinary Economics, Veterinary Team Brief, and Today’s Veterinary Business. He’s authored scores of articles related to the business of veterinary medicine and personal finance. He often presents at local, state, regional, national and international veterinary conferences. Fritz holds Bachelor of Science degrees in Accounting and Business Administration from the University of Kansas (1986). For decades, he was actively licensed as a Certified Public Accountant and Certified Financial Planner. Fritz is also affiliated with a personal financial planning, investment management, and 401(k) practice, where they help people reach their lifetime goals. His pre-vet experience included nine years as a management consultant with a top global consultancy.


EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome everybody to the Cone of Shame veterinarian podcast. I am your host, Dr. Andy Roark. I am here with my good friend, Fritz Wood. Fritz is an industry advisor and observer. He does a ton of personal finance with veterinarians and I’m talking to him about pricing strategy in the veterinary industry. How do veterinary clinics set prices? Are we doing what we can to keep care affordable? What are the benefits and the drawbacks of raising prices? How much elasticity is there in these prices, meaning how much more competitors take or what are they going to say when we do raise prices? And how do we get the staff onboard and is that an issue or something to be concerned about? Spoiler alert, yes it is.
Anyway, it is a really good, very high level discussion about pricing and medicine. It’s not about how you set your prices in your clinic, it’s more about what the prices of medicine mean and what the ripple effects are from changing them and from not changing them in an inflationary environment. So anyway, guys, that’s what we get into. It is a really good discussion, sprawling all across our profession. We talk about corporations coming in and what that means. We talk about virtual care and just all sorts of stuff. And so anyway, it is really, really interesting conversation. 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. Fritz Wood, thanks for being here, my friend.

Fritz Wood:
I appreciate the opportunity.

Dr. Andy Roark:
Oh man. For those who don’t know you, you have been a CPA, certified financial planner, you are an industry advisor and observer. You work with a lot of veterinarians on personal finance, things like that. You have been a mentor for me throughout my entire career. I have always looked up to you. You’ve given me some of the best advice that I’ve gotten in my career. I’m not kidding when I say that. I love having you here. I love getting a chance to talk with you. You write for Today’s Veterinary Business as well as a bunch of other outlets and everything. And I always look through and check out your column when it comes in. And there was something you wrote about recently, you wrote about the upsides and pitfalls of adjusting prices.
And I’ve been thinking a lot about this. So I’m looking at inflationary economy, I’m looking at upward pressure to raise wages in the practice, I look at keeping care affordable for pet owners. I just came out of the Uncharted Veterinary Practice Owner Summit and that was a concern I heard again and again is affordability of care. “My staff can’t afford the care that we provide to our clients and that bothers me,” and I listen to a lot of those things. And so I wanted to get in with you and just start to get into vet pricing and where the prices come from and just start at that level and then just start to play around with what price setting looks like in our industry. Is that okay to start out with?

Fritz Wood:
You bet. And I appreciate the very kind words, Andy and I am flattered and honored to be here and look forward to contributing and hopefully, have a little value. And I think this topic of professional fees, it’s probably always timely and it’s probably always germane. Before we sort of dive into any detail, I found this interesting, you might find this interesting, in preparation for today, I sort of looked back at presentations I had given on the topic of professional fees. And the most recent one was four and a half years ago, so not recent. And the one before that was six years before that. So I’ve literally talked probably about professional fees twice maybe in the last decade. And then I thought, “Well, that’s kind of odd because I used to talk about it all the time.”
So if we start at the 50,000-foot level, what happened? The accounting and consulting firm, KPMG came out with a study commonly called the Mega Study. It came out in 1999 and one of the conclusions was that veterinary fees had not even kept up with inflation during the 1970s, the 1980s, and the 1990s. Okay, so it is fair to say that that raised a big flag in the profession. And my observation and anecdotal observation is that subsequent to that, so in the 22 years since then, or 24 years since then, veterinary fees have riven at about twice the rate of inflation over that time period. So inflation had been going in the first two decades of this century at about 2%, veterinary fees had increased about 4% or even more. So veterinarians, the profession clearly got this message loud and clear, “Oh my gosh, we’re not even keeping up with inflation.”
But I would argue that there was sort of a pendulum swung rapidly and perhaps too far and too fast in the other direction. And I agree with you completely. Let’s start at the 50,000-foot level, I agree with you that there’s an affordability problem and increasingly so, right? I mean I’ve read things that indicate the cost of veterinary care is pretty comfortable for people, let’s say, households making a hundred thousand dollars or more a year. Well, median household income’s about $65,000 so that’s a problem. And we’re not going to solve this today. But I would argue the problem with that is the model we’ve created, let’s just round numbers say 30,000 veterinary hospitals is a pretty expensive way to deliver veterinary medical care. In other words, if you design the profession from scratch to deliver care cost efficiently, it wouldn’t look at all like this.
I mean, for example, there are 6,000 or five times fewer human hospitals than there are animal hospitals. There’s about 6,000 compared to 30,000 animal hospitals. There’s more humans than there are pets. So we’ve got all these really highly specialized, highly capable hospitals that are not used near capacity. And that’s an expensive way to deliver veterinary care and nobody’s going to change that overnight. So we got to talk about professional fees because veterinary medicine from a business standpoint, I would characterize it as a gigantically large number of relatively small dollar transactions. If you take a clinic and you say, “Okay, how many transactions were in that clinic last year?” And then you divide it by the number of doctors, full-time equivalent doctors, it’s going to be 4,000 or 5,000 transactions per doctor per year. And that doesn’t mean you lay your hands on 5,000 animals or talk to 5,000 clients, but some of those are coming in for medication repurchases and things like that.
But it’s a business of a hugely large number of transactions at a relatively low dollar amount. So small changes to the fee structure have a large impact on the business because of the number of transactions. So that’s where we are, where we have been. I mean I’m hearing people struggle with the same thing. There is an affordability issue, the people at the front desk are hearing it all the time. Clearly this notion of inflation… I just saw today, the most recent numbers are 7%. So everyone is having a larger percentage of their family budget or household budget necessarily allocated to things like utilities or energy, gas for their cars-

Dr. Andy Roark:
The groceries, gas.

Fritz Wood:
Food at the grocery store and household income’s a zero-sum game. So if more gets allocated to these categories, less is available here. And I was just looking at some charts today in preparation for this. And basically business exploded from about June of 2020 for the next year. That was the nadir, was June of 2020. And then from there, the next 12 months through June of ’21, things just shot through the roof. And then for the last six quarters since then, there’s been a marked and decided decline in client visits and number of transactions. It started again in about the summer of 2021, and inflation began to pick up hugely about the first quarter of 2021. So I don’t think it’s a coincidence that as inflation began to rage, transactions, client visits began to decline. And guess what happens when you increase fees? You should absolutely expect fewer transactions, right?

Dr. Andy Roark:
Yeah.

Fritz Wood:
And we could talk more about what’s called price elasticity and what we know about that in the veterinary profession. But it’s kind of like you squeeze the balloon, it’s not taking up space there anymore, but that air went somewhere else and it’s still in the balloon, just changed places.

Dr. Andy Roark:
Yeah. Do you think that rising prices in vet clinics have played a big part in the six quarters that we’ve seen of declining number of transactions? Do you think there’s other factors at play besides that?

Fritz Wood:
No, I think there’s a host of factors that have little or nothing to do with the fact that we’ve raised fees, right? I mean, I don’t think I can draw that decline. In other words, fees have increased continuously. This isn’t just a matter that happened in the last six quarters, they have increased continuously. I think it was the inflation that kicked off. So of the six quarters where things have declined, four of those, we were comparing against a period before that was really abnormally inflated. So we would expect it to be back to normal. But then the last two, we’ve lapped that now. And so the last two quarters, we’re looking at results from a period that had already been in decline. And it’s going further. I mean I think visits, they’re off 3% or something like that, 3 or 4%.

Dr. Andy Roark:
Yeah.

Fritz Wood:
So here’s kind of the way I think we’re off. Transactions are down this year 3 or 4%, veterinary clinics are reporting revenues up about 4%. So that’s a 7% difference. So my guess is that’s the fee increase, right? That’s 7% fee increase. So we’re down three in visits, but we’re up four total. Well, that was the 7% increase in professional fees. I’m assuming, by the way, for the purpose of this conversation that we’re only talking about professional fees. I think implicit in this conversation has to be that people have good controls in their clinics, such that when the prices of products or inventory items change, that is immediately reflected in a change of their prices. In other words, they’ve got control over their inventory to make sure that supplier or manufacturer increase in prices are passed along immediately and they will. I mean every pharma company is going to increase the price of every product, every year. You can bank on that. So that needs to be mechanical in the clinic and automated with the practice management system.

Dr. Andy Roark:
Speaking of inventory, so staying on this topic, do you see inventory revenue decreasing in practices and how does that affect the prices in clinics, right? So I guess I’ve really sort of wrestled with this a little bit. It’s been a perception of mine that more and more pharmacy businesses has left the practice to go online to Chewy or Amazon or wherever. Does that increase elasticity for prices for diagnostics or for your physical exam? It’s never made sense to me the idea that we would run a practice and it’s built on this product model, which time machine, if you’re going back, please set that up differently. But unless somebody does that, that’s what our business has been built on. It was we sell vaccines, we sell products instead of traditionally we sell our expertise like an accountant or a financial advisor or something like that.
And so it’s never made sense to me, I guess, if you see products leaving the practices. It makes sense to me that that revenue has to come from somewhere, it’s going to come from our intellectual property in our services that way. Do you see that, I guess as I’m saying, as, first of all, valid? Do you see inventory transactions leaving practices? And when you do, does that leave the ability to raise prices on the other services that we keep in the practice?

Fritz Wood:
Yeah, I think there’s several questions in there. I mean, I think the first is people have predicted the demise of the pharmacy as long as I’ve been working in the profession and it just has not happened yet. When I read the financial or the veterinary press, I would be led to believe that the pharmacy is completely being crushed by the competition online, let’s say. The problem is when I look at sort of data, when I look at the facts, when I look at tax returns, when I look at financial statements, what I don’t see is a marked decline in the pharmacy, what I don’t see is robust growth. But more and more, I’m seeing clinics choosing to be price competitive in the pharmacy with alternatives the consumer has elsewhere, largely because they don’t want to appear to be guilty of what PetMeds accused them for so long, just fleeing the client.
It’s like, “Hey, you can buy it here, you can buy it there at the same price,” and that still leaves a healthy enough margin. So I would not abandon the pharmacy just yet. I think there’s still great opportunities there to improve compliance, which is one of the things that you might do in lieu of price increases. Because that’s one of the things I hope we talk a minute about is what are things you might consider instead of price increases despite the fact I think fees do need to keep up. I mean let’s face it, the bottom line is the biggest expense in a veterinary clinic by far, bar none is labor. It’s probably consuming 40% of gross income, maybe more. And I believe, and I think most veterinary practice owners believe that people deserve to at least not fall behind to inflation.
I mean I think it’s a moral issue. I mean when I used to work at the veterinary schools, I told them that build into your contract, and this is not even negotiable, cost of living increases. So you simply don’t fall behind. And that’s not a reward of any kind. That’s just a, “Hey, we stay even with last year.” But you know what, if I’m making a hundred thousand dollars a year and inflation’s 8%, or if I’m a technician making $50,000 a year and inflation’s 8%, I need to make $4,000 more or $8,000 more next year just to make the same amount, just to buy the same number of gallons of gasoline or go to the grocery store the same number of times. And so it’s almost a morality or fairness issue to me.
So if we say, “Okay, we’ve got this huge expense that’s non-negotiable, it’s critical to your success. If these people abandon, you got no business left,” we got to do everything in our power to try to retain them and one of those is through fair and reasonable compensation that, to my mind, at least increase with the level of inflation. And look, I’ll also tell you obviously there are veterinarians that I’ve seen, practice managers, that use professional fees as a cop out, a quick fix, “Let’s just hit it with that dopamine.” And what you tend to have in those kind of clinic, in other words, without changing anything at all about the client experience, let’s say, or adding value in any other areas, and I think if you’re charging dramatically more than what you were five or 10 years ago, and you probably are and you’re not delivering a substantially different and better experience, then I think you probably are in harm’s way.
I think client defections, you should expect. I don’t think it’s just a one-way street where you can hit the button over here and across the board and these fees go up and it produces a lower… That may work for a year. But in year two and three and five, I’m thinking your results are going to come back down to earth because you’re going to… Nothing more important to a clinic than client retention. All the data in the world show clients come back more often, they spend more, their pets are getting older. But they defect because they don’t feel like they’re getting a good value.

Dr. Andy Roark:
I need you to square this up for me, but here’s what I’m hearing you say and I want to make sure, so we’re talking about cost of living increases and we say inflation goes up… Let’s keep the numbers easy and say 5%. So the inflation goes up 5% a year. For my tech who’s making $50,000, she needs to make $2,500 more this year than last year to buy the same amount of gas and put the same groceries on the table and all that makes sense to me. It sounds like you’re also saying that while my tech expects a 5% raise to keep up with inflation, you don’t think the pet owners expect to pay 5% more so that I can pay my tech 5% more just because another year has gone by? Is that what you’re saying?

Fritz Wood:
Not the first part exactly. The second part, I think, whenever any of us leave a place of business, including pet owners leaving a veterinary clinic, I think you got three things that if I asked you a question, you’d be able to answer them immediately. Question number one, did you get your money’s worth? Or in other words, was it a good value? Question number two, are you ever coming back? Question number three, would you tell your buddies about this place? And you just know intuitively. Now what we know about veterinary fees, most people are going to find disagreeable because they’re not going to believe it, but if you think very long from a consumer’s perspective about veterinary care, it is two things. It is purchased infrequently and it’s a relatively small dollar amount. So the fact of the matter is people have no idea what they paid last time.

Dr. Andy Roark:
What do you mean by that?

Fritz Wood:
You might only have done it once, but if it was a house and you signed a big mortgage, you probably remember what you paid for that house, doesn’t matter how long ago it was, right? If you buy gasoline, you probably know what the price of gas is, not because it’s a huge expense, but you buy it all the time, like a loaf of bread or gallon of milk, right? Veterinary care falls right smack in the middle. It’s not purchased frequently, nor is it a huge dollar. It’s not a life changing dollar amount. And we did some just fun accident interviews at clinics a long time ago and just ask people, “Hey, just out of curiosity, what did you spend last time you were here?” And frankly, people don’t want to answer that question because they don’t know.
And if you force them to answer, they’ll end up guessing about the same amount they spent today and then you go look it up in the practice management system and they’ll miss it by 300% too high and too low. Excepting breeders, maybe excepting people that have a chronic condition with their pet are in there all the time, the fact is they’re, for the most part, not going to notice. I mean somebody used to say, “My fees need to go up 12%, should I do it all at once or should I do it 1% a month for the next year?” And the answer is, “Well, would you like to upset your staff once or would you like to upset your staff monthly for the next 12 months?” It’s like clients aren’t going to know but we are going to, and that hurdle you mentioned is a big one, it’s getting the staff comfortable.
I tend to be a fan of, and I’m reading more articles about in the veterinary press about open book management. Let’s share with people that it costs $6,000 a day to open the door here and this is why we need to be vigilant, for example, in charging for the things that we do. I mean I think that’s a big opportunity, Andy. I think before I got high and mighty with professional fees and making big increases, let’s double-check and make sure our controls are really good and we’re charging for the things that’s happening today in the exam room or in the hospital or in the lab. Because I think plugging those holes, I mean, has an immediate and extraordinary impact on the bottom line and that kind of thing mitigates the need for maybe as large or as frequent a fee increase.

Dr. Andy Roark:
Hey, guys, I just want to hop in really quick and give a quick plug. The Uncharted Veterinary Conference is coming in April. Guys, I founded the Uncharted Veterinary Conference in 2017. It is a one-of-a-kind conference. It is all about business. It is about internal communications, working effectively inside your practice. If you’re a leader, that means you can be a medical director, it means you can be an associate vet who really wants to work well with your technicians, it means you can be a head technician, a head CSR, you can be a practice owner, practice manager, multi-site manager, multi-site medical director. We work with a lot of those people. This is all about building systems, setting expectations to work effectively with your people. Guys, Uncharted is a pure mentorship conference. That means that we come together and there is a lot of discussion. We create a significant percentage of the schedule, the agenda at the event, which means we are going to talk about the things that you are interested in.
It is always, as I said, business communication focused but lots of freedom inside that to make sure that you get to talk about what you want to talk about. We really prioritize people being able to have one-on-one conversations to pick people’s brains, to get advice from people who have wrestled with the problems that they are currently wrestling with. We make all that stuff happen. If you want to come to a conference where you do not sit and get lectured at, but you work on your own practice, your own challenges, your own growth and development, that’s what Uncharted is. Take a chance, give us a look, come and check it out. It is in April. I’ll put a link in the show notes for registration. Ask anybody who’s been, it’s something special. All right, let’s get back into this episode.
I think one of the big things for me, coming up, practicing as a vet in a bunch of different practices, I do think that there’s always some question and I get it. So there’s always some question where you’re a technician and you know that the pet owners you’re working with are going to have a hard time financially with what you’re going on. Whether they told you that or whether you made that assumption, but you have that in your mind that that’s true. So the dog is shaking its head and you take the cotton tip applicator and you swab this dog’s ears and roll it on a slide and look at it under the microscope, stain it and look at it under the microscope and then you toss that thing away. And then I think a lot of people struggle with that being a $55 service or whatever you charge for it.
They go, “Well, there was no real cost to that, I just looked at it under the microscope.” You know what I mean? And so it’s hard I think for a lot of people to say, “No, I firmly believe that that was $55 and it needs to be $55,” when there’s very little hard cost associated with that except for the piece of glass that we put this on. And so it’s always been important to me to make the staff believe that the prices matter. Yes, it is $55 and it needs to be $55. And I don’t think you can do that without some level of transparency and without a reputation with your staff of being honest, you know what I mean? They’re smart.
If they believe that you’re an honest person and you can be transparent with them and say, “This is why these prices are what they are, and even if you don’t understand why this was is specifically what it is, I need you to believe that it’s set for a reason at this place,” I have found that if I worked in practices and people said, “Yes, I believe the prices are what they are for a reason,” that was a healthier practice of people charging the prices that had been set than places that I’ve worked where people were like, “You know what? These guys are always just raising the prices and see what they can get away with.” And the staff did not buy into that. And as a result, you saw all kinds of little, “We only charge for one ear,” sort of stuff that you go, “I don’t think that’s what was intended,” but it happens all the time. But that transparency and people believing in the prices, I think that that’s really important.

Fritz Wood:
Well, I couldn’t agree more. And whether that’s through open book management, whether that’s through confidence they gain maybe by looking at some industry resources… I’d put a pitch out for the American Animal Hospital Association’s veterinary fee reference. I just think that’s an invaluable resource for every clinic, comes out every two years and by far the biggest database, thousands of clinics that are certainly AHA and non-AHA clinics and it’s broken down by numbers of doctors, it’s broken down by the region of the country. It’s broken down by urban, suburban, rural, and there’s thousands of fees in there. So it’s just a reference point. I think any comparisons that you could get from similar clinics. I don’t think the clinic down the street if it’s not similar should really matter to you. But if you have a high-end, high tech, well-skilled, four doctor clinic, then you ought to be comparing yourself to a suburban location.
You got to be comparing yourself to other clinics that look like you. And I am absolutely not making an endorsement and I don’t know enough about it and haven’t talked to enough people that have used it, but there is a program called Profit Solver that basically is a mechanical process of inputting the costs of everything, labor, overhead, property, and loading everything up, and who’s doing these things, and how long is it taking. And so it’s a very objective and it’s a technical thing, but it’s a way to make all your fees defensible.

Dr. Andy Roark:
I’ve always liked that program and I don’t have any stake in this, I don’t work with those guys. I don’t have any connection to them at all. But I’ve always liked that program. And basically the idea I think that I like about it is it’s basically a big powerful spreadsheet and you put your expenses in and you set your prices and it says to, “You can’t keep the lights on if you price this.” And then if you want to reduce the cost of that ear cytology, if you say, “$55 is too much, I’m going to take it down to $42,” it will say, “Great. What are you going to raise to make up for the amount of money that you just reduced?” And I just like that. I just think a lot of people feel like they’re floating in space and just making up numbers.
And whenever I found myself in my career setting prices and just making up numbers, I never feel good about it. I always have this insecurity that I’m way undercharging what I’m going to end up needing for my business to work or I’m way overcharging and someone’s going to say, “How dare you charge this when other people charge half this and do just as good of work?” Well, I don’t want that. I’m not trying to do that. And so to me, I really like the idea of something that gives you a place to put your foot. And so I’ll put a link to the AHA vet fee reference. I love that as a resource of look, just at least get some numbers you’re going to put your foot on.
Let’s go ahead and play a game real quick here, where if I came to you and I said, “Fritz, I’ve got my practice and,” let’s just say it’s a six doctor practice and, “I want to give cost of living increases to match inflationary pressures and I need to get my staff up and I’m feeling pressure to raise my salaries to retain my staff,” which is something I hear a lot about. “I am looking at this, I’m thinking I need to raise my fees,” what advice would you give me before I did that? So you’d mentioned some alternatives, what would you walk me through before you said, “Yeah, let’s look at those fees?”

Fritz Wood:
The very first thing, Andy, would be let’s talk carefully about this fee increase or, I’m sorry, about this payroll increase.

Dr. Andy Roark:
Okay.

Fritz Wood:
And I think we need to define whether that’s built into all future payroll or if that’s a discretionary more like bonus type payout. In other words, back to the technician making $50,000 and we had a 5% increase, one option is to write him a check for $2,500. One is to doll it out quarterly, one is to do it at the end of the year. So got different strategies there. If people know that’s the plan and even though the dollar amount is the same as far as the employee’s concerned, it does give the business owner a little more flexibility in the sense that it’s not permanently built into the cost and you just have to think longer term.
I always like to use the example, I started work at Arthur Anderson in 1986 and had a secretary and she had begun working there about five years before I had been born. Had there been years like there are now of 7% or 8% and there were, even higher in the late seventies, real high inflation, you’d have the secretary making five, $600,000 a year. And that’s not palatable for that particular position. So you don’t want to permanently graduate out of… And one of the things I’d like to know is where are we now? In other words, I’d like to see what’s your total labor as a percentage as your expense? And there are some other things I would tell you that would be beyond the scope of our conversation here, but let’s look at our staff effectiveness. In other words, let’s look at things like number of revenue dollars per labor hour, number of transactions per total labor hour that give us a measure of how efficient are we already compared to the averages or the medians and things like that.
So we got to decide is this sort of paid out as a bonus or is it part of the permanent increase in the hourly wage or salary on the one hand. And then I think when we start thinking about fees, I mean I agree that… One of the things I think we got to point out, Andy, is what we never want to do in my mind is keep a potential client from coming in the first time. We don’t want to build up a wall to opening up that door to the lifetime value of a pet. And then even more broadly, which in my calculations I just took the AHA fee reference and the protocol I used was like the AHA Partners for Healthy Pets. And if you price that protocol out using fees that people are now charging, the lifetime value of a dog, probably $25,000.
So guess what? Pets live in multi-pet households. So let’s start talking about the lifetime value of that household. Or somebody like me, I don’t have multi pets, but I’ll probably have six in my life. So suddenly you’re talking about tens and tens and tens of thousands of dollars, which is another reason why you want to be fair on your pharmacy prices. It’d be silly to lose the lifetime value of a client because you were $5 too high on flea control. That’s bad math, right?

Dr. Andy Roark:
Yeah.

Fritz Wood:
So I think we have to distinguish between the sort of shopped and exposed fees. And look, the first thing I would tell you, I should’ve started this whole podcast by saying this subject is a lot more art than science. And that’s why things like that Profit Solver tool intuitively appeal to people like you who are a scientist or me who’s an accountant, because it’s bringing some objectivity to something that is really very… I’ll give you another one. I mean inherently people believe things that are more expensive are more valuable and worth more. So that’s one reason you may want to be the most expensive clinic in town.
One of the odd things about professional fees is we all tend to think, “Well, it’s that low clinic in town that’s holding us all back,” and that’s completely false. It’s the highest clinic in your town, it’s their reluctance to go higher. And that’s why in certain communities, you have these, what I’d call pockets of affluence or pockets of poverty. And it all has to do with the highest clinic in that area and their reluctance or their eagerness to continuously move higher because the fact of the matter is veterinary care is never going to grow less expensive. It will always grow more expensive, unfortunately, at least with the model we’re using today.

Dr. Andy Roark:
Yeah. I was having a conversation with a bunch of practice owners and they were sort of talking about corporations buying into vet practices and stuff like that, and there were mixed emotions obviously about corporate practices, especially among independent business owners. Maybe not all that mixed, maybe just generally kind of negative. And it was funny, but sort of my comment to them, we were talking about the impacts that corporates have actually had in vet medicine and I was like, “By coming in and raising fees over the past decades, they have dragged a lot of practices kicking and screaming into financial solvency.” As they have come in and been more aggressive and said, “These numbers don’t work, we’re going to raise these fees,” that makes a lot of other people feel at least okay about saying, “Well, we have been scraping by and maybe we could charge a little bit more.”
And I go, “There’s been a lot of good from corporate medicine coming in and just looking at things from an unemotional eye and raising prices.” And I think those of us in the trenches, we want to find the balance between keeping things affordable, but also paying ourselves and our staff. So it was just an interesting conversation of, “Let’s not pretend that corporations have not been good for medicine in a lot of ways.” But as you say it’s not the poorest practice in town that’s holding everyone back, it’s the richest, and I go, “That really makes sense.” I really like the way you laid that out. I’d not considered that.

Fritz Wood:
Well, there’s always a price leader in any community. And as you point out very often, that’s going to be a corporate practice today. They’re not known for low cost. I guess there’s one. THRIVE Affordable has the $15 a month plan, but for the most part, they’ve taken the strategy of high-end leader. Even Banfield, I mean, you look at their wellness plans or you can go to Walmart and look in the clinics where they have the vet clinics. I can give you some links to the two companies that are operating there and all their fees are on their website and everything. I mean it’s Walmart pricing, but at the same time, I wouldn’t say it’s cheap. I’d hate to think somebody would look at those fees and cause them to increase their own, but you might.

Dr. Andy Roark:
Yeah. Yeah. I’m sorry.

Fritz Wood:
I just was wanting to circle back. One thing I don’t think I answered very well, if the pharmacy were lost, let’s just say tomorrow we wake up and there is no pharmacy and veterinary medicine, then the implication of that is that everything else that you do becomes a lot more expensive necessarily, right? Because you’re right, the product business has basically subsidized the medicine part of the business. And so if the product business goes away in its entirety, then the services necessarily become more expensive. So I would try to push that day as far down the road as I could. I would fight until I’m dead and it’s getting more difficult. But I think if you choose to be price competitive, there’s still huge opportunity in the pharmacy.

Dr. Andy Roark:
Yeah. Oh I know. I completely agree with that too. I really like your position earlier. I have to sit and process it. If you said to me, and it sounded like you said this earlier, “The media coverage of the pharmacy disappearing is definitely much more real than the actual loss of the pharmacy,” I go, “That kind of tracks honestly.” I have not seen a reduction in the pharmacy that I send out the door, even though it’s been at least 10 years of people telling me that that was coming. And you can look at the world and see how you squint and sort of see it. But I think your point is really valid. That day has not really come in practice that I’ve seen. The last question I want to ask, and I want to get you to squint into your crystal ball a little bit. And we talked about corporates in practice and then I’m looking and seeing a lot of virtual visits and things like that.
I got an email from a big pet retailer that has free vet consults by text and by video when you sign up for their auto-ship. And I don’t think it’s free, you can use this all the time. I think it’s maybe you get one free trial, something like that. But basically it was fairly $15 for a text consult or 20 bucks for a virtual consult and then it was free with auto-ship for X amount of time or things like that. Well, I see a lot of value in that to pet owners. I can see pet owners getting on board with it. When you look and see things like that, do you think that that will bring about a radical way in how we price our services or charge for our time? Or do you think that’s just going to get rolled in to our current model and things will sort of go on in roughly the same sort of in a price breakdown, price priority that they have in the past?

Fritz Wood:
I would say my crystal ball is cloudy probably, Andy, not that they’ve been great at predicting the future, but I think what you’re talking about represents a threat in my mind. I’m mildly concerned. On the one hand, we’ve got labor issues and part of that is you can’t make a veterinarian overnight and yada, yada. And people are retiring faster than they’re coming in and the growth in the industry. And so on the one hand, to me, it’s kind of like there’s this faction pushing towards a looser veterinary client-patient relationship definition. Look, back up a step. I mean, industry, multi-billion dollar companies have always considered the veterinary channel to be a stranglehold on distribution. I mean, veterinarians aren’t notoriously outstanding retailers or merchandisers. For example, they’re not open on Sunday very often, which tends to be the busy shopping day. They’re less likely to do home delivery and these different things that consumers want, online ordering.
And if you’re a manufacturer or distributor, what you’re interested in is getting that product in the consumer’s hand. The consumer in this case is the pet owner. So if you look at press releases from the major companies, and they’re publicly traded for the most parts, they have to be honest and they have to tell you what their plans are, I mean, you see continuously this what I’d call direct-to-consumer. And the way I would define direct-to-consumer is around the veterinarian. So if you’re a major internet retailer, of course you would’ve doctors on staff. I’m surprised they would charge anything for a consult. I thought it was free if you signed up for the auto-ship. Now, I’m not suggesting that that consult is going to take a lot of veterinary services necessarily away from the independent practitioner, but I think it’s highly likely they’re going to take all the pharmacy.
Because if that virtual doctor who’s never seen the pet, doesn’t know the client or anything else, is able to establish that relationship then they can dispense. So suddenly you’ve opened the floodgates. By those companies having their sort of in-house doctors, you open the floodgates. I mean, let’s face it, you see the same thing with men’s health, right? I mean, you see these commercials. I guess you’re able to establish some sort of client-patient relationship virtually and they dispense some or prescribe some sort of products. So it’s the same idea. It’s just circumventing the vet. And I think the forces that are for that are greater than the forces that are against that right now. So when I say that, I mean manufacturers are for… Come on, what do you want if you’re a consumer? You want home delivery, you want auto-ship, you want the free consult. You may never use it, but you want it. You want a competitive or low price, you want all those things that you’re getting, right?
And to a large extent, a veterinary clinic is a single purpose errand for people. I mean, they’re going there to pick up one thing. And so it’s inefficient. Those are the kind of things. I mean, of all things people buy on the internet, pet food is like number three or four because it’s bulky and because people never want to worry about running out. I mean, they just have it auto-shipped. So that bothers me. Again, I think the death of the pharmacy’s premature here, but at the same time, the future looks more grim and difficult than the past. I already think, like I said, we have an affordability problem in veterinary medicine, but if we lose the pharmacy, then it gets really ugly. And then I think you’re going to see a real push for things like the practice acts changing, let’s say technician clinics where they’re dispensing vaccinations and doing wellness visits and yeah, sure, dispensing flea control and heartworm preventative may be, and certainly catching a blood sample for a diagnostic test. Go look at the Walmart offerings, it’s pretty robust.
I mean, when they take that sample for the heartworm test and the vector-borne disease test, I mean, they’re trying to sell CBC also, just an extra 50 or 60 bucks, something like that. So I mean, that’s the low-hanging fruit. I mean, those are things that, as we’ve discussed, have historically subsidized the expensive medicine that we haven’t charged enough for. At the end of the day, consumers love their pets and tend to love their veterinarians so nothing’s going to change quick.

Dr. Andy Roark:
Yeah, I get that mean. It’s definitely interesting to look down the road. That’s kind of what I was playing with. Fritz, overall, what are your final thoughts, words of encouragement, anything like that that you would put forward to vets that are looking at their prices?

Fritz Wood:
Well, I would say veterinary fee increases are inevitable unfortunately. None of us like it, but it’s a fact of life. I find that veterinarians, they drag their feet, but once they get around to changing their fees, I’ve never had someone regret it. One of the great things about fee increases is they’re absolutely revocable. So look at it as a no sweat decision. You can change your mind. I’ve never seen anybody do that but you can always change your mind. You can go back to the way you used to do it. So it’s safe. There’s a gap there. Anything you can make it more defensible through some of the tool tools we talked about today, so it’s well received by the staff is very important.
And look for these other opportunities. Make sure you’re charging for everything that’s happening. I mean, make sure that we’re trying to get that pet in there for one extra visit. Those kind of things necessitate a much less or much less frequent fee increase. So let’s make sure we’re doing the blocking and tackling too because there is a ceiling, and I think we’re hitting it now in terms of affordability and I think we’re getting close too. So I appreciate the opportunity to participate today, Andy. Thank you.

Dr. Andy Roark:
Well, yeah, thanks for being here. Where can people find you online? Where can they learn more, Fritz?

Fritz Wood:
Just fritzwood.com or just Google Fritz Wood and you’ll find telephone number and email address and website and all those kind of things. Also LinkedIn and Facebook. But the best would be email.

Dr. Andy Roark:
All right, perfect. Well, I’ll go ahead and put links in the show notes. Thanks so much for being here. Guys, thanks for tuning in. I hope you got something out of today.
And that is our episode. Guys, that’s what I got for you. I hope you enjoyed it, hope you liked, I hope you got something out of it, hope it made you think heavy stuff, interesting stuff. Man, I hear what Fritz was saying. I definitely see where advances in technology will radically change vet medicine. I am optimistic that the future is bright for veterinarians and for veterinary staff. I think it’s going to be different. I do. I think that our model is going to change. My crystal ball has been wrong many times before. I think this is really fascinating to think about and keep our eyes on just so that we can adapt as the world changes around us, because it is going to change around us. But I love this profession, I don’t want to do anything else. I’m super positive about where this all goes. Anyway, guys, take care of yourself. Be well. I’ll talk to you later.

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

Home On Time – Practice Responsibility for Staff Wellness

December 6, 2022 by Andy Roark DVM MS

Dr. Bob Lester, CMO of Wellhaven Pet Health, joins Dr. Andy Roark to discuss his recent article in Today’s Veterinary Business Magazine. The topic is “Home On Time (H.O.T.)” – prioritizing staff wellness and setting systems, tools and boundaries to get staff members out of the building on time.

Cone Of Shame Veterinary Podcast · COS – 173 – Home On Time – Practice Responsibility For Staff Wellness

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

LINKS

Uncharted Veterinary Conference: https://unchartedvet.com/upcoming-events/

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

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

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

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

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

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

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

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


EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am talking to my friend Dr. Bob Lester today. Dr. Lester is a regular podcast ghost. He’s a regular podcast ghost. Dr. Bob Lester is a podcast guest regularly here on Cone of Shame. I’ll get into his bona fides in a moment as I introduce him.
Guys, we talk about getting home on time. We talk about what that looks like at the practice level. We talk about at the individual level, we talk about leveraging nurse practitioners. We talk about guilt and resentment, and going home and staying home. We talk about getting organized. We talk a lot about just the general philosophy of being overwhelmed and managing it. So if you’re like, oh, I’ve felt overwhelmed recently and I would like to talk about managing it, you’re in the right place. Come on in, get a chair, a fresh beverage. We can do that for you. All right. Guys, that’s enough of me jabbering on. 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. Bob Lester. Thanks for being here, my friend.

Dr. Bob Lester:
Great to be here, Andy. I always enjoy catching up with you.

Dr. Andy Roark:
I love our podcast. It’s been too long. I want to get back on, for those who don’t know you, you are a columnist at Today’s Veterinary business. I enthusiastically flip to your column every other month-

Dr. Bob Lester:
Thank you.

Dr. Andy Roark:
… when the magazine comes out. I always enjoy your writing and your perspective, which is why you’re one of the most regular guests I have on this podcast. Anyway, you are the co-founder and chief medical officer at WellHaven. You have done many, many things all over our industry and just have a really interesting background and track record. And so you wrote last month about HOT, which is home on time and the importance of getting people out of the clinic. And I love it. As the chief medical officer at WellHaven, I think that’s a really interesting perspective and philosophy. And then you have some honest to goodness steps and ideas about how to actually do that. And as I look at them, I go, oh man, these are really good. And they line up a lot with the things that I’m looking at. And so I thought that maybe we could just start to unpack that idea. When you start talking about home on time, why don’t you just open at a high level and tell me what does that mean to you?

Dr. Bob Lester:
Yeah, happy to Andy. So it’s never been harder to get home on time. We’re blessed with more business than we can keep up with. That’s wonderful that pet spending is up, pet lifespans are up, visits are up, the bond is up. However, there’s not enough of us to keep up, and this is likely going to be a long term shortage. There’s a chronic shortage of veterinary healthcare providers underway, just like there has been with human healthcare. So what can we do? And there’s a lot of short term and long term solutions.
But when we focus on the short term and our people are overworked now, what can we do today to help people get home on time? And I think part of the stress is it hurts us to be turning away business every day. It hurts my heart to know that I can’t get that pet in to help today that needs help. That they’re put off till tomorrow or next week or next month. So how can I get people home on time, and can I squeeze one more pet in today? And to do that, I’ve got to re-look at the way I do things today. We can’t work any harder. What can we do differently? What can we look at that we’ve done for years that frankly isn’t working anymore? And what can we stop doing? There’s things that we can stop doing to get those efficiencies, to get us home on time, and help one more pet today.

Dr. Andy Roark:
Yeah, it’s a reallocation of effort. I think that’s really good. I think you also put your finger right on it. I think cynically, or for people outside of our industry, they look and say, “Oh boy, it’s really hard to leave that business on the table, to not get those customers in.” And I was like, “I don’t think that that’s bothering people at all.” I really do think, for most of us, it’s about helping people, and having to tell people who are concerned about their pet, or people who, we are their veterinarian and they’re trying to do what’s right for their pet, and we’re telling them, “We can’t see you for a month and a half.”

Dr. Bob Lester:
Yeah. We’ve spent our whole career saying, “Come in now, come in now, come in now.” And now we have to say, “Come in later.” And that’s hard to do.

Dr. Andy Roark:
We’ve kind of trained people into this problem of we’ve set the idea that when that reminder hits, it’s important that you get seen. And now we’re trying to tell people, “Look, six weeks isn’t going to hurt anything.” And those are conflicting messages.

Dr. Bob Lester:
A real shift in how we’ve always, maybe subliminally, we always put pets and clients ahead of vets and teams. I mean, that’s just the way we’re wired. We’re givers. We want to take care of people. And we’re learning. And a lot of good things have come out of COVID. And one of the things that we’re learning, and perhaps it’s a generational thing as well, as a boomer, we are what we do. We always put work ahead of life. That’s wrong. But what we’re finding out is we’ve got to take care of ourselves, then take care of our teams, then take care of pets and clients. You don’t take care of pets and clients, and leave yourself and your team second, third, or fourth. It’s take care of yourself first, then your team, then you can take care of pets and clients. And as obvious as that sounds, it’s not at all obvious. It’s not the way we’re wired. It’s not how our profession has done things.

Dr. Andy Roark:
I was going to say, it’s not how our profession has done things. It’s not our culture. And I’m having some pretty seismic shifts in philosophy. And it sounds like heresy some of the things that I’ve really come to entertain. I’m not saying I’m 100% in, but I can see 100% in from where I am, as far as I don’t like the term a calling for veterinarians and vet medicine. Just because if you’re called to service, then that puts serving clients as the driving factor that makes success. And I go, we’re in a place where that’s a recipe for burnout. I don’t like the idea that there’s this moral weight on you giving of yourself no matter how you feel. That’s not a long term strategy that makes any sense to me.
I think that we’ve always, you serve the pets and serve the pet owners. But even I who really lean heavily into that, I’ve really had to step back and say, looking at the math, this doesn’t make any sense. The only thing that makes sense is taking care of the staff preferentially and taking care of ourself preferentially so that we can keep going. And that’s not how I felt early on. And I struggled to square this desire to serve and the greater purpose of doing good in the world against prioritizing myself and the staff over the desires of the pet owner.
But at some point, you have to get unemotional about it and just say the math has to work. And I say the math, I’ve been playing a lot with this analogy of vet medicine as a widget factory. And a lot of people don’t like that comparison. We don’t make widgets, we fix pets, we fix family members. And I get it. But at some point, you have to look at what is logistically possible in a day. And we make widgets. We have a widget factory. And at some point if your factory can turn out 700 widgets, and you’re somehow pushing it to turn out 1,000, your machines are going to break down, your workers are going to break down, your factory is going to break and burn and be unsafe. You just can’t consistently overproduce widgets.
Yet, that’s where a lot of us have lived since pre-pandemic times. And they go, man, your factory’s breaking down and your workforce is burning out. And they have options of other places they can go now. If you’re going to keep the factory open for the long term, you’ve got to look at what is feasible and make adjustments. And that feels kind of gross. And another way I go, I don’t see another way to look at this that keeps us in the profession and keeps us healthy. Do you agree?

Dr. Bob Lester:
I do, and there’s got to be a way to balance. The idea of calling, the idea of a desire to serve, that’s so admirable. That’s at our core. That’s made our profession so strong. But we can’t do that if the cost we’re paying is we feel guilty all the time that we didn’t spend 24/7 at work. So that desire to serve, that core warmth and giving that comes with everyone in our profession, we’ve got to hang on to. But we’ve got to remember to reprioritize that we come before pets and clients.

Dr. Andy Roark:
Yeah, I tell you, I love the mention of the word guilt. I remember I went through a period of burnout years ago. And I took some of the best lessons of my life away from that. One star, don’t recommend. If anyone offers you the opportunity to burn out, you should say no. You should take a pass. But I did. I went over there and checked it out. And one of the lessons that I learned along the way, and I say a lot, is if it comes to a place where you have to choose between guilt and resentment, always choose guilt.
And what I mean is if I have to go home and feel guilty, or I go home after my kids are in bed and my wife is angry because she hasn’t seen me, you know what I mean, and I told her I’d be home for dinner and I let her down again, that’s going to make me resentful. And I would rather be guilty today than resentful in a way that’s going to negatively impact my life. If you have to choose between guilt and resentment, choose guilt and figure out how to manage it. So I’m right there with you. Let’s talk about making adjustment.

Dr. Bob Lester:
Before you leave that, I mean, that’s just a great testimonial that you went through burnout, you came out the other side, and if there’s a poster child for passion for veterinary medicine in our industry, it’s you. So you can come through burnout and still be passionate about the profession. For those that are suffering, there’s a light at the end of the tunnel.

Dr. Andy Roark:
Yeah. Well, thanks for saying that. I forget about that sometimes. I made a conscious decision years ago that I was going to talk about burnout, and just be open about it. And be like, “Yeah, I went through this thing. It was really not fun.” But the reason I do that is because when I had really burned out, and I had really burned out and I was depressed, and one of the things that scared me the most was that I didn’t know anyone, I’m sure I did, but I didn’t know that I knew anyone who had been through that and was happy again and back and doing vet medicine. And that was the scariest thing for me was like, I don’t know anyone who’s been through this and has come back and has been happy again in the future.
And so I’m open to talking about it. I don’t want to beat people over the head with it and make it a big deal. And it’s a thing that, well, we did it and it’s over. But I do talk about it because that bothered me so much. And so if anyone’s facing burnout or been through it, I did it. It sucked. Not fun. 100% happy on the other side. You figure things out. You make changes to your life. You can reengage. The profession’s not done for you. Just there’s adjustments that we have to make and things that we learn about ourselves and we fix things. And that’s one foot in front of the other, and then we go on. But yeah, thanks for saying that and calling that out. I do appreciate it.

Dr. Bob Lester:
Of course.

Dr. Andy Roark:
Well, let’s get some strategies. I think you’ve got a number of them, right? So we’ve got our workload. And I think I would summarize, let me see if I’m accurately summarizing your position, but I’ll summarize my position and say the first thing to do is say can we get more efficient? As we make our widgets, as we go through the day and we service pets and pet owners, can we get more efficient? And the answer is probably yes.
And then after we have gotten efficient, at some point we have to say this is as efficiently as our practice can run right now with the staff that we have and where we are. And then we’re going to have to set boundaries. And I think it’s not one or the other of those things. It’s not just throw up walls. And it’s also not just figure out how to be more efficient until you magically get where you want to be. I’m like, I think you have to do both of those things. But let’s talk a little bit about that. Talk to me about efficiency overall. When you look at teams and you’re talking about getting home on time, where do you see opportunities to improve efficiency?

Dr. Bob Lester:
Yes, we are aligned as usual. I think you have to be careful with efficiency. In my experience, if you toss that out, that somehow implies that we’re not working hard enough. And that’s not what we’re telling people at all. So we’re just saying, how can we work differently? And a great place to start, and it’s blocking and tackling, is at a team meeting. As veterinarians, you and I have one perspective of workflow, but every member of that team has a different view. And where there may be opportunities to do things differently, we need to open it up to them.
To me, the big buckets fall in technology and in team based care. In those two areas, there’s just so many opportunities. Team based healthcare delivery in particular. Are we delegating? As veterinarians, are we sticking to diagnosing, prescribing, and surgery, and delegating everything else? Are we investing in our team to train them to do those things? You’ve talked about it before it, and it seems counterintuitive, but it’s so true. We’re all short staffed. We want to be doing more and work faster. So we hire that new person. And what do we do? We want to go faster, so we just throw them into it. When in fact, the counterintuitive part is you need to slow down to go fast. When you bring those new people on, invest in their training, show them how to do things, define your workflows, your duties, we have to do that, or they’re just going to burn out and leave in six months.

Dr. Andy Roark:
Hey guys, I just want to pop in real quick with a couple of quick updates. Number one first, I got to give a shout out to Banfield Pet Hospital for making transcripts possible. Guys, they do it to increase inclusivity and accessibility in this profession. And so they make this format available for everybody. So I couldn’t do it without them. Thanks. You guys could check out transcripts of this podcast at drandyroark.com.
Also, guys, as you are hearing this, the Practice Owner Summit is going on. That is the Uncharted Practice Owner Summit. I’m sorry you can’t come because it’s happening right now as you’re hearing my voice. But don’t worry, because the April Uncharted Veterinary Conference is right around the corner. Registration is opening right now. We’re opening up registration at the Practice Owner Summit. And so in the next day or two, you’re going to be able to grab a spot. Go ahead, head over to unchartedvet.com, and get your spot at the April conference. This is in person. It is in my hometown, Greenville, South Carolina. It is a fan-freaking-tastic conference. We are focusing on internal communications, internal team communications, and strategies for practice management when we have a high caseload. Those are the things that we are really focusing on. I’d love for you to be there. Go grab your spot. Guys, that’s enough out of me. Let’s get back into this episode.
We ran the Uncharted Get Shit Done Shorthanded conference last month. That’s what it was called. And when we do our conferences, they’re peer conferences to a large degree. We’re very workshop based, very discussion based. And one of the things that I heard that I’d never heard it put this way, but I thought was amazing, was we actually had people who said, “We’re more efficient when we’re shorthanded. When everyone’s there, we have people running into each other, bumping into each other.” And I had not heard that. And when I say that to you, have you ever seen anything like that? Does that resonate as an issue. Not everyone, but when you talk about onboard… And that’s where it comes from, is they had onboarded new people, and they’re like, “We’re actually better off when some people don’t show up.” Does that ring any bells with you?

Dr. Bob Lester:
Oh, definitely. And I think it highlights the importance of training and getting people up to speed. I was talking with a great doctor the other day. She was telling me, “Give me these two people and get out of my way, and I’ll help all kinds of pets and have a great day. But I need these two people. I don’t need six new people. Just give me those two.” And of course, those two were vet techs, they were tenured, they were hardworking, they were wonderful. But they didn’t get that way overnight. Somebody invested in them to get them to where they could be those two people that allowed that doctor to be so productive.

Dr. Andy Roark:
Yeah. Oh, I completely agree with that. I want to take your opinion on one more thing. So you mentioned team meetings right off the bat, which I think is interesting. And then put it together with the effective delegation and working together and also training. I tell you, and I’m curious if you’ve seen this, one of the hardest parts I think for vet professionals when they’re overwhelmed is working on the business instead of working in the business. And I feel that so much right now.
I really feel like, because business is pouring in, pet owners want to get seen, I see so many of us who are putting our head down and we are working so hard. Which to your point earlier about being careful about saying efficiency, you’re exactly right. I’m not advocating that people need to work harder at all, but I think a lot of people see it that way. And I think one of the hardest things to do is to not see patients and step back and get organized and get on the same page and communicate, and to do some training. Do you agree with that? I mean, what does that look like in practice in your eyes?

Dr. Bob Lester:
Oh, completely agree. The analogy I’ve always used is we’ve got our head down, we’re in the canoe, and we’re rowing just as fast as we can, but we’re rowing in circles. Every now and again, you need to stand up in the canoe and look at the horizon. Where are we going? And that comes at several levels, depending on the size of your organization. In a hospital team, that might mean that there’s once or twice a year offsites between the ownership and the department leads, whoever it might be, just to talk about where are we going, where are we at today, how are we going to get there?
And then another level of that back to team meetings is just having engaging, agenda driven regular team meetings to just talk about where are we at? And it’s not just download, it’s listening to the teams. It’s the pleases and thank yous. It’s how are we doing? How can we do better? Those things. To your point, we get so busy, those are some of the first things we quit doing. We don’t have time to train, we don’t have time for team meetings, we don’t have time to set a vision, a strategy, objectives. And then what happens? You just are rowing faster and faster and faster in a tighter and tighter circle, but you’re not getting anywhere.

Dr. Andy Roark:
Do you have any insight when people say everything feels like it’s on fire, I don’t know what to tackle first? As far as getting people organized, and again focusing on home on time, where do you start, Bob? How does an overwhelmed leader on the floor, maybe a medical director, maybe even a head technician, what are the first things that you look to try to get some order back into your life and into your practice?

Dr. Bob Lester:
Well, two things come to mind, Andy. One is first to just take a deep breath and acknowledge everybody. We just survived COVID. What a hell of a couple of years. Give yourself some grace here. This has been really hard, and good for you for just getting through this. So take a deep breath, pat yourself on the back. Now what do we need to do going forward? The first thing that comes to my mind is you don’t have to have all the answers. I think as veterinarians and leaders in general, you go through school, you’re top of the GPA, you got to get the A. We come into this thinking I got to have the answers. We don’t have all the answers.
You sit down with your team and say, “This is where I think we’re at. What do you guys think?” And just start having those conversations. Be transparent, be open, and it’s amazing what will emerge from that. And then it’s just a matter of prioritizing. Once those six or eight things pop up that are the direction we need to go in, pick two or three of them. We can’t do them all, but pick the top two or three, and let’s go after them. And then you just get into planning them out. What’s our goal? What’s our timeline? What’s our duties?

Dr. Andy Roark:
Yeah, I agree with that. Do you have any insight on scheduling? I mean that was one of the things that you brought up in the article as just kind of a one off, but just schedule better. What does that look like?

Dr. Bob Lester:
Well, I think a couple of things come to my mind when I think scheduling as well. One, as flat forehead obvious as it seems, not everybody is still using vet tech columns. We’re not scheduling vet tech appointments. Why are we not doing that? That’s just crazy, and charging for it. Those people have the talents, the skills they need to do it. We certainly have the business. I mean, you and I could spend the next hour talking about just the value of that. So look at your vet tech appointments.
Dropoffs. I think we learned in COVID that some clients like dropoffs. And dropoffs, if done right, can be pretty efficient. If that pet’s in the back, and I can squeeze them in when I get a chance to, and not every appointment’s appropriate for a dropoff, but there are some. And we found clients that actually like that. Some actually like curbside and dropoffs. The other thing that occurs to me, and none of these are rocket science, a lot of practices do these things already, is just leaving a little bit of space every day, particularly when we’re now booked out often time weeks in advance, for those couple of urgents. There’s one or two spots that you leave open. They’re going to fill up during the day, but have those spots available for the urgents. When that phone call comes, that longtime client has to be seen. If you’ve already double booked yourself all day long, you’re going to be in trouble.
And maybe the last thing that comes to my mind as we’re rambling here is somewhat heresy, but again, looking at life comes before work, some practices have had to temporarily stop evening hours, stop Saturday hours. If you’re short staffed, if you don’t have enough doctors, if you’re still trying to take fewer people and cover the hours that you were when you were fully staffed, they’re not going to stay with you. I’m not saying we do that forever. We need to be accessible to clients. But in some cases you’re going to have to back up before you can go forward.

Dr. Andy Roark:
We had a practice at the GSD conference that closed on Friday. They’d been closed on the weekend and they closed on Friday, and they celebrated. They were like, “It’s a game changer.” They were like, “We’re going to lose our staff.” And they closed, and they can make the numbers work. And they were like, “We’re here on Monday to Thursday going wide open. And we’re booked solid, and everybody gets three day weekends.” And I’m like, “Do you need a vet? That sounds pretty amazing.”
But yeah, but you’re right, it’s heresy. I remember during the pandemic, we had a number of clinics in Uncharted that shut down on Wednesdays. And at some point you go, this is the capacity that we have, and we’re burning people out. And we’re going to lose our staff if we don’t shut down. And yes, if we can get another doctor or two hired, then we’ll open back up on Wednesday.
But it takes a certain amount of discipline to say, “We should be open all the time. We should also have three more doctors than we have. But that’s not reality. And so we’re going to adjust what we’re doing to meet up with reality.” And so they shut it down. But I agree with you. I think it sounds like heresy. I’m seeing it pretty commonly when people say, “We’re shutting these down.” And then people say, “Well, what do you say to the pet owners?” And you say, “Want a job?” We say, “As soon as we can get staffing, we’ll open it back up. We want to be open. We can’t get the staff to do this.” And it’s just being honest.

Dr. Bob Lester:
And I think there’s learnings as we do open up. As the economy, as we’re able to start hiring again and knock on wood, someday we get back up to full staffing, you can still do four day work weeks. You can do flexible hours. You don’t have to work every evening, every weekend. As you get your team built up, you can build that flexibility into meet their life needs, as well as better meet the needs of those consumers that are ringing our phones off the hook.

Dr. Andy Roark:
Yeah. Talk to me a little bit, we’ve been talking about efficiency, let’s switch over to some sort of boundaries. I don’t want to overplay efficiency. A lot of people like the idea that you can magically work faster in a different way and get all the work done. And I think that there’s limited upside here. It’s worth investigating, and trying our best and getting organized. A lot of efficiency for me is really more organization than efficiency. It’s cutting out redundancies. Stopping people from stepping on each other’s toes, getting in each other’s way. Making it a more pleasant place to be. The phones continue to ring and people continue to come in. What are some strategies, what are some ways that practices are looking at this and saying, “How do we decide who gets in and who doesn’t get in? How do we set boundaries to turn people away?” At the organizational level, what does that look like?

Dr. Bob Lester:
It’s hard. And something I tried to talk about in this column is it’s not just HOT, home on time. It’s home on time and help one more pet. Can we do both? And to do that, if the boundary is all about home on time and we’re closing the books at 4:00, and we’re blocking two hours for lunch and we’ve dropped evenings and weekends, well pretty soon, to your point, the numbers don’t work. So how can we get home on time and get that other person? We’ve got to look at how we do things.
Boundaries are part of that. Who does what and when? It’s always hard to say no. And I think we’ve gotten good at triaging. If it’s a nail trim, we feel okay about putting that off till next week. If it’s bleeding, we’re going to find a way to get it in today. I think the other piece that sometimes I kind of put in with boundaries, and maybe doesn’t entirely go there, I see way too many people that aren’t taking time away. Even when they have these generous vacation and holiday and sick days and PTOs, they’re so eager to help. And again, that’s so admirable. Back to the calling, the desire to help. But if you’re not taking your vacation days, one, your family’s losing out, you’re losing out. And ultimately you’re not going to be as good at your job if you’re just there constantly. So I lump that under the boundaries as well. It’s okay to be away from work. It’s okay to turn off the phone. It’s okay to not be looking at emails every day.

Dr. Andy Roark:
Yeah, I agree with that. There’s a lot of people who struggle to be off. Do you think that production based compensation plays a role in that for doctors? Do you think the fact that they get compensated by seeing appointments undermines some of them’s willingness to take a vacation?

Dr. Bob Lester:
I don’t see much of that. I mean, that’s a hot button, production compensation, and I see both sides of it. However, back to do the numbers add up? At the end of the day, you can make the case we’re all on production based compensation. If you’re on straight salary, if I’m your boss, I’ve got to look at the numbers at some point. So there’s ways to be more fair. There’s negative accruals, and there’s all these crazy things that go on with some of these things that are just out to lunch. But ultimately, I mean, we all want to believe we live in a meritocracy. You deserve, you earn what you get. And it’s largely that way.

Dr. Andy Roark:
Do you have to pry doctors’ fingers off of the steering wheel to get them to stay home? I run into this a lot. I think that there’s a lot of mentality of, I saw this case, I need to know what happened with the blood work. Or the results are coming back in and I need to be involved. And I’m like, “You need to be off. You need to be off.” Is that a common mentality you run into and what drives that?

Dr. Bob Lester:
I think it is common. And it’s not just doctors, it’s practice managers, it’s CVTs, it’s others. It goes back to that core that drew us to this profession. We want to give back, we want to fix, we want to give, but we can’t do that all the time. So yes, I do see that, and it is hard to let go. And you and I have probably been guilty of it more than once as well.

Dr. Andy Roark:
That’s very true. When you look in your crystal ball, what do you think 2023 is going to look like? Do you see significant changes? Do you see reduced caseload due to inflation or recession? I mean anything like that that you’re thinking? Is the current situation just going to continue on for another year? What are you kind of bracing yourself for?

Dr. Bob Lester:
Well, I am an optimist by choice. And the macro economy, are we heading for a recession, are we in a recession? I don’t pretend to be an economist. I can point to history and say, good economies and bad, our profession does pretty well. Should things soften, should there be less discretionary income, the bond will still be just as strong as it was before. And we’ve got so much pen up demand out there now that we’re booked so far out, it would take a pretty deep and long recession, I think, to make much dent.
So I see next year as hopefully it gets a little easier to bring on staff, that the hiring becomes a little simpler. I think the vet tech and DVM shortage are here to stay. That’s a chronic thing that we’re going to have to keep working on. And there’s great strides being made to address that. But as I look at my crystal ball, I’m pretty bullish on 2023. As a profession, we had such a whipsaw from COVID. There was a month or two there we wondered if we were going to be employed at all to being so busy we didn’t know how to keep up with it.
It’s tailed off a little bit this year, but we’re still growing. Our practice is growing double digits. And I think as an industry, we’re growing high single digits. Next year, that may grow a little bit, that may shrink a little bit, but we’re still going to be positive growth. I can’t imagine a deep and long enough recession in 2023 to put very much of a den in our profession. And frankly, if we slowed down a little bit, that wouldn’t be a bad thing. We’re still growing.

Dr. Andy Roark:
I agree with that. Dr. Bob Lester, thanks so much for being here. I always enjoy our conversations. Where can people find you online? Where can they learn more about WellHaven?

Dr. Bob Lester:
They can learn more about WellHaven by just looking up wellhavenpethealth.com, wellhaven.com, and they can reach me on LinkedIn, or they’re welcome to reach out directly through my email address, bob.lesterdbm@wellhaven.com.

Dr. Andy Roark:
Awesome. Thanks so much for being here. Have a great week everybody.

Dr. Bob Lester:
Always fun talking with you, Andy. Thank you.

Dr. Andy Roark:
And that is our show. Guys, I hope you enjoyed it. I hope you got something out of it. Big shout out to Dr. Bob Lester for being here. Really, really appreciate it. Guys, if you enjoy the episode, please, please, please, please, please give me an honest review wherever you get your podcast. Apple Podcast is the biggest place, and it really does make a big difference. It’s how people find the show. If you didn’t enjoy the show, then maybe write that down on a piece of paper, and just put it in a drawer somewhere. And just keep it. Just keep it. Just keep it there. Just kidding. I’m kidding. Anyway, guys, take care of yourselves. Be well. Talk to you later. Bye.

Filed Under: Podcast Tagged With: Team Culture, Wellness

Embezzlement in Veterinary Medicine

November 26, 2022 by Andy Roark DVM MS

Mira Johnson CPA, CVPM joins Dr. Andy Roark to discuss embezzlement in veterinary medicine. In an AAHA survey, 86% of respondents said employees had stolen from their clinic. Why does this happen so commonly in our industry? Who is responsible and what motivates the behavior? What can practices do about it?

Cone Of Shame Veterinary Podcast · COS – 171 – Embezzlement In Veterinary Medicine

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

LINKS

JF Bell Group: https://cpasforveterinarians.com/

Practice Owner Summit: https://unchartedvet.com/practice-owner-summit-2022/

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

Mira Johnson holds a Masters’ Degree in Financial Management and Accounting is a CPA, and is a Certified Veterinary Practice Manager. She is a managing partner in the JF Bell Group, CPAs for Veterinarians. Mira’s passion is helping veterinarians to start, manage and grow the practice of their dreams. She embraces the use of apps to help automate the business side of their practice. Her articles about financial automation and employee motivation have been published in Today’s Veterinary Business and dvm360.


EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a great one for you today. It’s going to be eye-opening. It’s going to freak some people out. Mira Johnson is with me. She is a CPA and a CVPM. You can hang on, and we’ll talk to you about what all those letters mean, if you’re not familiar. She’s an accountant who works with veterinary practices, and she is talking about embezzlement.
We get in and we talk a little bit about embezzlement, and what it looks like. Boy, the back half of this episode is just her telling stories. It’s amazing. It’ll freak you out. But, I think we come out at a really good place of, “Hey, there’s some things that you can do to set up your practice, and to protect yourself, and just to be aware of.” Yeah, I think it’s a really good, interesting episode. It’s going to breeze by. She is wonderful. Gang, 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. Mira Johnson, thanks for being here.

Mira Johnson:
Thank you for having me.

Dr. Andy Roark:
Oh, it’s my pleasure. I became aware of you through your writing. You write for dvm360, you write for Today’s Veterinary Practice or Today’s Veterinary Business?

Mira Johnson:
Today’s Veterinary Business.

Dr. Andy Roark:
Wonderful. I became aware of you because of your writing there. I like a lot of your stuff. I was like, “Wow, who is this who’s writing this neat stuff that I don’t see?” You have a really interesting background. You are a CPA and a Certified Vet Practice Manager, a CVPM. How did you come to have a CPA and a CVPM? How did that happen?

Mira Johnson:
The CPA was definitely my passion. I am very organized and I love the numbers. Then I joined JF Bell Group, which is the CPA firm that I work for, and they had passion for veterinarian industry. So, I fall into it. We had a lot of veterinarians, a lot of friends in there. Started going to the national conferences. That’s when I saw actually first time, you talking about management practices and all sorts of things that I was just opening the door to a different world and I wanted to learn more. So I’m really eager to learn, self-driven self-improvement is a big part of me. And when I discover the credentials, a couple years ago I was talking and I said, “Well, how could I improve myself and what can I learn to getting the credentials?” So it wasn’t much of I just want to be a CVPPM, it was more like what can I learn along the journey?

Dr. Andy Roark:
Yeah.

Mira Johnson:
So that was my drive.

Dr. Andy Roark:
That’s awesome. That’s really cool.

Mira Johnson:
I just got it a couple of years ago. Well, I think it was this year actually.

Dr. Andy Roark:
Oh, well congratulations. That’s wonderful. I love the CVPM. I think it’s such a great program and it’s wonderful to see people working in practices and learning the nuts and the bolts. I have nuts and bolts questions for you today. I want to talk about an article that you wrote on embezzlement, it’s called Sticky Situations. It was in a recent issue of the Today’s Veterinary Business. And you talked about embezzlement and you talked about the frequency with which embezzlement happens in vet practices. Can you start at a high level with that? How common is embezzlement in private practice?

Mira Johnson:
So based on ADMA research, it shows that one in nine practices do experience embezzlement or theft from employees. So that doesn’t even include any other theft outside of your clients or burglaries. This is definitely just employee related theft and I think it’s, a lot of people say, “Wow, really, one in nine? That seems like a huge number.” And for the rest of the businesses the number is still high but it’s 75%. So definitely the vet industry is much bigger. And I think Marsha Heinke, she did a study and in her studies it was based on, because most of the vet practices are family based, they have a lot of close relationships or they’re small. So that’s where I think the higher numbers are coming from potentially.

Dr. Andy Roark:
That’s interesting. I was going to ask you that. Why do you think this stands out? So tell me about, you think because they’re family based, why do you say that? What does that mean?

Mira Johnson:
So I don’t necessarily mean just family, close family, but our firm specializes in small clinics and the small practices. So we do see a lot of, it’s a dad with two sons, it was always their dream and there’s a son that stole from them, so it was crushed dreams. It does happen in the family settings. A lot of my best friend is now my practice manager, so very close relationships, which I think in the big corporations you don’t have those kind of relationships inside of the corporations.

Dr. Andy Roark:
It sounds like maybe there’s a bit more trust and that trust gets exploited a little bit more. I don’t know, I could see that. Just thinking about it, why would vet practices be so common and say, “Well we were trusting a lot.” We tend to see the good in people sometimes who are in detriments perhaps. Tell me when we talk about embezzlement, what are we talking about here? This is a big term, just making it clear examples of investment. Are we talking about people manipulating credit card machines? Are we talking about taking cash out of the cash register? What does embezzlement in a small animal clinical practice look like?

Mira Johnson:
So pretty much all and above, I think the statistics shows one in three are monetary, which means that would be the cash stall and the credit cards, some money related, but the two out three is non-monetary, which means it’s the inventory equipment, pretty much the food that walks out of your back door that the employees take home with them for their pets, payroll paddings.

Dr. Andy Roark:
Gotcha. No, that totally makes sense. So I’m parsing in some of mine. Yeah, so the majority is definitely inventory walking away. Okay. I get that. You talk a little bit in your article about ideas about why this seems to happen and how people rationalize it. So most of us, we look at people that we work with or we look at our family, our best friend who’s the practice manager and we go, “They would never steal from our company.” You have some interesting ideas about how people mentally get their head around that. Talk me through that.

Mira Johnson:
Yeah. And this is the part that I really enjoy talking the most about because I think a lot of people don’t have the mindset that, “Hey, this is going to happen to me eventually.” There’s a good chance it will unfortunately. And the rationalization. There is three things that have to be present for the fraud or embezzlement to occur. One is rationalization and that is that I will tell in my head … I don’t think there’s very many people who go around and it’s like, “I just want to steal from somebody. Let me find somebody who can steal from.”

Dr. Andy Roark:
Yeah.

Mira Johnson:
That’s a small percentage of people. Most of us will go around and try to do the good in the world, at least that’s what I believe in. And there will be instances when we can rationalize our actions. I can see that you are very successful practice and you have all these resources. Man, if I would have all these money, I would help all those stray cats or something. So you start taking money and putting it into this nonprofit that maybe you founded or maybe you just giving them money so you can help the greater good. In your mind it’s justifiable Or then that can be the malicious, “The inflation is huge. I can’t even not put gas in my car anymore. I should have got a raise last year, so I’m going to take my raise because I deserve it.”

Dr. Andy Roark:
That makes sense.

Mira Johnson:
The rationalization is a big thing.

Dr. Andy Roark:
So rationalization is the first piece, what’s the second piece?

Mira Johnson:
The second piece is, oh there’s opportunity, but let talk about the financial pressure, of course. So there must be a reason why you want the money. And lots of people when they say, “Oh, financial pressure,” I don’t know how many people, they’re gambling or I don’t know how many people that are drag addicts. I don’t need to worry about that. It’s this big thing that people usually tend to think about but it doesn’t have to be. So it can be keeping it with Jones, the coworker got a new car, I want something better.
They want on this fancy vacation, it’s all over the Instagram and Facebook and I want to prove them that I can do the same thing. So there might be a different financial pressures, it might be as simple as that I’m already accustomed to some lifestyle. My spouse lost a job and now I’m kind of left with bills to cover and I can’t afford them because I have all these monthly recurring payments, which is very common for Americans to have all these car payment, mortgage and subscription for anything and everything you can think about. So to keeping up might be hard when there’s a loss of income.
So that’s the financial pressure. And the last one is the opportunity, which I think this is the part that we all need to pay better attention in the clinic because this is the part that we can influence. I cannot change your vision of I need to keep up with Jones different, I can’t really influence that and I can’t influence your rationalization necessarily. But I can influence the opportunity, if you do have the chance to take from me.

Dr. Andy Roark:
Right. Talk to me about how we do that. Yeah.

Mira Johnson:
I think in the family business or where you have long trusted employees, the thing where you’re getting exposed or your clinic gets exposed is where suddenly you trust a lot and then you offload all these tasks, right? Because you trust them. So pretty soon they’re running the payroll for you and they know you don’t review it because you don’t have time. Or maybe that there isn’t a procedure for receiving inventory or purchasing inventory. So those are the little things that they will start noticing. And if there is a financial pressure and if there is the rationalization, they see the opportunity and they can seize on the opportunity. So if you have strong internal controls and protect yourself, you’re minimizing them. And I know there was a lot there.

Dr. Andy Roark:
No, this is good. So I want to start to parse this apart a little bit. So you talk about trusting and delegating. Where are the big opportunities for embezzlement? So what are the things that I need to be careful when I delegate away or places where I want to make sure I have good internal control specifically?

Mira Johnson:
So when it comes to cash handling, that’s one of the things that we see that most of the practices lack their internal control. Where the receptionist, some of them don’t even count the cash in the end of the day. It’s like, “Oh, once a week I’ll just take whatever cash is in there and I deposit in the bank.” Well there should be a daily reconciliation in the end of the day and it shouldn’t be the receptionist who takes the money to the bank. And there should be some checks in the background. So if the receptionist is the one who does the daily closeout and creates the deposit, it should be taken into the safe. And then the owner or somebody else who is not handling the cash should take it to the bank. And then again, somebody else who is not doing either or should do the bookkeeping records and reconciliations and stuff like that in the end of the month or weekly basis.

Dr. Andy Roark:
Okay, cool. And then it seems like inventory would also be on that same path if we’re talking about two-thirds of embezzlement is it sounds like inventory controls are probably more important than a lot of people think.

Mira Johnson:
Yes, the purchasing and accepting. So it shouldn’t be the same person that can purchase the product and receive the product because then there is room for altered records. So I can say, “Well I purchased seven things and we receive seven things,” but we only received six or five and the rest I just took home.

Dr. Andy Roark:
Got you. Yeah. That never would’ve occurred to me. That was definitely a blind spot. It makes total sense when you say it that way. Okay. So any other areas specifically that we want to make sure? The cash handling totally makes sense. Purchasing and receiving totally makes sense. Other areas where we should make sure we have good control systems?

Mira Johnson:
Yeah, I think there’s a lots of new things that surfacing currently, but I get surprised by it. So for example, most of the people probably now use Vetco for their purchasing. And Vetco has a great thing that they reward you with this gift card, gift cards, you can redeem a gift card.

Dr. Andy Roark:
Yeah.

Mira Johnson:
I would encourage every owner …

Dr. Andy Roark:
I see where this is going now, okay.

Mira Johnson:
… to check where the gift cards are going because sometimes you just don’t see that $25 was redeemed and where it went. So if they can intercept the mail and take the gift card. So that’s one. And you know think, “Well that’s $25 bucks Mira, who cares? It’s not a big deal,” but it usually starts small.

Dr. Andy Roark:
It adds up. Yeah.

Mira Johnson:
Yeah. And then it adds up.

Dr. Andy Roark:
Yeah.

Mira Johnson:
And the average is average theft in veterinary medicine is $200,000. And a lot of people are like, “Well I would think I would see the $200,000,” but it takes about 24 months to catch the person that’s stealing. And one of the reasons is because they start small and then they get crazy.

Dr. Andy Roark:
Okay, so what you’re saying is usually by the time that embezzlement of gets caught or reported, the average amount we’re talking about is $200,000. Is that correct?

Mira Johnson:
Yes.

Dr. Andy Roark:
And it usually starts small and then we see larger. I a hundred percent see that as people would say, “I’d never do this,” and then they break the ice and maybe every time it gets a little bit more and comfort levels go up. But wow, $200,000. That’s amazing.
Guys, I just want to jump in here real quick with one quick announcement. If you’re a practice owner, the Uncharted Practice Owner Summit is coming, it is me and my friend Stephanie Goss, the practice management guru. We are going to be leading that, heading that up. It is in person in Greenville, South Carolina. If you are a practice owner and you’re like, “Man, I want to go to a thing that’s only practice owners and work with other practice owners,” head over to unchartedvet.com and check out what we’re doing. Guys, that’s it from me. Let’s get back into the episode.
How do practices tend to catch onto these things? Do you have a sense of that? When these things are brought to light, how does that often happen?

Mira Johnson:
It can come from different sources. So it can be an employee that saw something and came to you and said something. It can come from a third party. So for example, usually when we prepare financial statements or reports, we do discuss it with the business owners and we go through it. So for example, on one of the instances we notice that the anesthesia costs was going up and up and up while the revenue was pretty much flat. So I brought it up to doctor and the doctor said, “Well what are you doing in there? There’s no way I’m spending this much money on anesthesia.” And when he looked into it, he was a bunch of Dolorex and he said, “Well I can’t get use this in a whole year.” So then he went to control substance log and that’s how it got discovered.
So that came from a third party. Also, I know that there was some merchants, like credit card processors that came back and said, “Hey,” this happened actually closed by in Idaho that the receptionist was a very clever one and when the purchases was made, she refunded it or not refunded, she returned it. So she would return product, but the product was physically returned back so you don’t miss anything but the refund, she issued it to a different form of payment. So all these purchases are coming for the business credit card and are being refunded to her personal bank account.

Dr. Andy Roark:
Gotcha. Oh wow. Okay. All right. That makes a lot of sense. What steps do practices usually take if they know or if they suspect that this is going on? So I imagine being a business owner and let’s just say that there’s something and you say, “Oh, this has come to my attention,” where do people go from it? Is it straight to the police? How do people report this? What’s the mechanism for that?

Mira Johnson:
Yeah, that’s a great question. It depends. So we try to always advise our clients to definitely not alert the person that you think it’s on it and also don’t alert the rest of your staff because it’s not always just one person. There’s instances when it’s two people or three people. So if you do have the purchasing and receiving separated, maybe those two got together and they’re taking advantage of that. So definitely don’t try to spread the news across or try to figure out. We also try to say don’t change anything yet as far as the records, because you want to build a history.
If you see something, you can look in the history and if there’s already you can pinpoint it, then great, you can move forward. But if there’s just small things, maybe just installing a camera in the practice, if it’s a cash being stolen from the client, fake refunds and stuff like that. So from there you could, so let’s just say you have established a history, then you can contact your insurance, your lawyer, because you’ll have to let that employee go. So you want to make sure that you do it correctly so you don’t violate any other problems along the ways. And then we always encourage to prosecute. So there’s tons of practices who have all the evidence and they just want to be done.

Dr. Andy Roark:
I understand that.

Mira Johnson:
They’re hurt and it’s a terrible feeling because it is your long term employee or it is your family member. And I think in these instances, I’ve seen so many people cry and just be ashamed that that’s what they allowed to happen. And the thing is that there is all these, what we call red flags. So there, there’s the employee complain, the employee did this and that and you usually don’t see it or they’re very subtle until it’s all gone. And when it comes down as a whole group, you can come together and you’re like, “Man, how do we not see it? We’re such an idiots.” People just beat themselves up.

Dr. Andy Roark:
I would. I would be so brutal on myself, I totally can see this. I want to talk about this just because I can see myself as the kindly veterinarian because I tend to trust people and think people are doing things for the best. And I would be embarrassed, I would feel so ashamed that this happened and “Oh, I can’t believe that this happened to me,” or that I was so naive and I came completely see people being beaten up. I want to ask you a couple different questions about this, but I want to step back for a second. Let’s talk about these red flags. So you say people start to see red flags. It sounds like a lot of times they see them in retrospect, but what are some of the red flags, aside from your accountant saying, “Hey, we have a problem.” What are some of those red flags that people reflect back on and say, “I wish I had paid more attention to that?”

Mira Johnson:
Yeah, it depends on a position, but some of the red flags are, for example, that the employee never takes vacation because they’re trying to stay in where they are. Meaning if I’m the one who, let’s just say that I do accounts receivable fraud, which would mean that you come and pay and I say you didn’t, but I have the cash now, then I have to record it, anyway it’s called floating accounts receivables. If somebody else intertwines in that role, it’s easier to discover, but if you are in there, it’s much easier to attain because when the customer calls, you’re like, “Yeah, I know you paid. Yeah, we just didn’t record it yet. It’ll be their next statement,” and then you make a note of it and you record that payment when somebody else comes in. And that’s a complicated case, but other things can be [inaudible 00:20:25]-

Dr. Andy Roark:
No. I get what you’re saying.

Mira Johnson:
Okay, so other red flags can be that the person is always the nagging one, right? They don’t like something, they’re talking about the practices, “I can’t believe how much money the owner has. And we didn’t get any bonuses this year. Did you see how much it’s charging for rabies shot? Did you see how much it actually costs to buy it?” There’s that talk in the background maybe. Also, the obvious that they come to the practice and they have brand new car that’s completely out of their lifestyle. Those are the more obvious ones.
But we had one that at the clinic that the doctor’s like, “I can’t believe I didn’t see this. There was a bloody needle in the ladies bathroom and the employee walked out without a sock on her foot just completely high.” And you were just feeling bad for the person because she had some other problems and you look back, and you were like, “Well, that’s obvious,” but it wasn’t.

Dr. Andy Roark:
Yeah.

Mira Johnson:
Because she had lack of sleep. Her husband kick her out of the house the night before. So it all makes sense to you because you’re this compassionate person, you just go and buy her coffee and pretty soon you’re just like, “Wait, what just happened?”

Dr. Andy Roark:
Yeah, wait a second. Yeah, I can believe it. We tie ourselves up in knots, all that stuff makes sense. Do you have any resources that you recommend? Where can people learn more if they’re a small business owner or they just want to investigate more or try to understand more how they can protect themselves, what out there can be helpful for them?

Mira Johnson:
Yeah, I think the first thing that I would do is to look into the internal controls. And if you have no clue what that means, that’s fine. You at least take the time that you’re trying to understand. So reach out to your CPA or accountant and say, “Hey, how can I improve my process?” And just explain what you do and they will give you some suggestions on what can be done differently. So I would start there. And then one of the things that I always tell people is to start with yourself. So if I as a practice owner comes to the clinic and take the dog food and just walk out in the back door and it doesn’t go through any system, you’re just showing that it’s possible to get out of the clinic with a bag of food with no trace.

Dr. Andy Roark:
Yeah. Interesting. Okay. I never would’ve thought that, but it totally makes sense.

Mira Johnson:
Inventory counting, count your inventory, utilize your practice management software. There’s great technologies out there that you can utilize. I know it takes time and effort that there’s just so much that you can do and automate to protect yourself. So to learn more, you can reach out to your practice management software rep and said, “Hey, I would like to start tracking all the inventory in the software. Where do I start? How do I do this? I know there is some restrictions on permissions. How can I do this? So there’s only one person that can receive,” or whatever, how many you want, but certain people that can receive the product and some people who can do the purchase order. So your accountant, practice management software, the vendors have some great ideas too. You would not believe some drug reps, they tell us some crazy stories about how people resell the free samples to the practice and then pocket the money. So there’s also-

Dr. Andy Roark:
Oh wow. That’s crazy.

Mira Johnson:
Since I’ve been talking about fraud, there’s just all these people who come to me. We were just speaking at the Western this year in Vegas, and there was a guy who stood up and said, “I want to share a story. It doesn’t matter how it happens, but he has tears in his eyes and he said, “It was my best friend, we grew up together. I gave him a job, he was paid well. We went having picnics on the weekends.” And it was $150 or whatever. I can’t remember the exact amount. And that’s just so hurtful to me that you have to experience that and then you beat yourself up.
If I can leave you with one thing is to please don’t beat yourself up. I think it happens to the best of us. And another thing is, please don’t panic because there is things that now you would be like, “Oh, my receptionist just said that her utility is going to be shut down because she can make the payment.” So it shouldn’t be like, “Oh my gosh, she’s going to steal for me.” It should be more like a antenna should come up, ding, that’s a red flag. But it doesn’t mean because she’s asking for advance that now she’s going to take from me.

Dr. Andy Roark:
Yeah, when you start going down this path, it’s easy to start imagining. You’re like, “Fraud is everywhere.” Yeah. I love this approach. I love just talking about that it’s real. I think most of us just don’t have any idea or we don’t ever want to think that could happen in our practices. And so I really appreciate you coming in and talking about it and you really humanize it and make it go like, “Okay, I get it. I can definitely see how it happened.” I think I really like the phrase keeping honest people honest, and I think that that’s how I like to look at these things is to say, “I don want to live in a world of fear or mistrusting people.” At the same time, it’s just smart to build good systems that first of all, they help you run a better business and a better practice. And then also they just keep honest people honest and you just never have to deal with these things. And so I love your approach as you lay these steps out.

Mira Johnson:
I didn’t mean to be completely a downer, like, “Oh my gosh, you going to have to do all this and don’t trust anyone.”

Dr. Andy Roark:
I know.

Mira Johnson:
I do want to say one more thing and that is there’s a saying in my homeland, I’m from Slovakia originally, that we say, [foreign language 00:26:19] which means trust, but check.

Dr. Andy Roark:
I love that.

Mira Johnson:
Which means you can delegate all these things, but you have to have a system in place that you can just verify that’s happening.

Dr. Andy Roark:
I love it. I love it, I love it.

Mira Johnson:
Because the people are the biggest asset that the veterinary clinic has in my opinion, because they are the ones who will lift you up.

Dr. Andy Roark:
Mira, where can people find you? Tell me about the firm that you’re with. Tell me about the work that you do. Where can people learn more from you?

Mira Johnson:
Yeah. So our firm is called JF Bell Group. We’re a CPA for veterinarians. You can find us on LinkedIn or Facebook or Instagram.

Dr. Andy Roark:
I’ll put a link in the show notes as well. Yeah.

Mira Johnson:
Awesome. Yeah, CPAs for veterinarians and we do help small practices, startups to grow, start their practice of their dreams and help them manage it.

Dr. Andy Roark:
Very nice. Thanks so much for being here. Guys, take care of yourself. Thanks for being here.

Mira Johnson:
Thank you.

Dr. Andy Roark:
And that is our show, guys. I hope you enjoyed it. I hope you got something out of it. A big thanks to Mira for being here. Guys, if you enjoy the show, there’s a couple things you can do. If you’re watching on YouTube, hit that subscribe button, that’s wonderful. If you’re not, give me a give me a rating, give me a review wherever you get your podcast. Apple Podcast is a big place. It really is how people find the show. But yeah, I always love your feedback and it’s just a kind thing that you can do if you’re liking what we’re doing. Anyway, gang, take care of yourself, be well. I’ll talk to you soon. Bye.

Stephanie Goss:
I just want to take a quick second and give a big shout out to our friends at Banfield Pet Hospital for making the transcriptions of this podcast possible. The podcast transcripts are brought to you thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity all across the veterinary profession. If you would love to find out more about the DEI initiatives for Banfield, you can head on over to the link in the show notes.

Filed Under: Podcast Tagged With: Team Culture

Saying “No” With a Smile & Keeping the Team Motivated – November Mailbag pt. 2

November 16, 2022 by Andy Roark DVM MS

Dr. Andy Roark takes more questions from the mailbag!

Questions in this episode:

How involved should associate veterinarians be with boarding in the clinic?

Phone etiquette when trying to help non-clients on the phone who need assistance but they can’t be seen due to lack of appointment availability

What are the best things to do for your staff on one of those crazy days when everything is on fire to keep them motivated ?

What’s the best thing to do when you’re feeling overwhelmed?

What advice would you give those that have trouble making boundaries at work?

How do you bridge the gap between “front and back”?

How do you coach someone that gives very blunt delivery of feedback and rubs people the wrong way?

Cone Of Shame Veterinary Podcast · COS – 170 – Saying "No" With A Smile & Keeping The Team Motivated – November Mailbag Pt. 2

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

LINKS

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


EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I’m back experimenting. This is Part 2 of my recent experiment of live streaming the podcast into the Uncharted community and so, I got questions from the Uncharted Veterinary community. If you’re not familiar with those guys, you can check them out at unchartedvet.com. It is where I spend a lot of time hanging out talking about leadership and communication and management and stuff like that that I love. But anyway, I’m here with these guys and just going to go through questions that I got from them and that will be it, so let’s see.
Yeah, I’d love to hear your feedback on this podcast. If you like it, you can send me an email at podcast@drandyroark.com. You can also leave me a review wherever you get your podcast. But I really haven’t decided if I’m going to do more episodes like this. I’m really kind of waiting to see if people tell me that they like them and I can tell you, I really enjoyed the first one, so this has been really fun.
If you’re listening and you’re like, “Man, these questions where Andy is just talking through problems that people ask him about, I really, really love them,” I have another podcast, it’s called Uncharted Veterinary Podcast and I do it with my friend, practice management goddess, Stephanie Goss. And that’s all we do there, is breakdown questions about practice that people ask us. So, if you really love this, no matter what, you can have more of me talking about problems at the Uncharted Veterinary Podcast, which is the other podcast that I do. All right, let me go ahead and 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:
All right, everybody. So, the first question is an anonymous question. This is from a veterinarian. She is a veterinarian that has a boarding facility built onto her practice and she says that, a little backstory, she had a dog that had a medical problem. It was some sort of like a chemical burn or something when it left the boarding facility. She ended up looking at it and then the client ended up bashing the boarding facility and specifically, this vet who’s like, “I didn’t do any… I didn’t have any idea what was happening,” is basically it.
And so her question is, if a dog is being boarded with a vet clinic, how involved are veterinarians in the daily care and monitoring of the pet? If I’m unhappy of the vet with the care that a dog received and don’t think the issue was handled appropriately when I brought it up to the practice manager, how should that be handled? Meaning, if I don’t like how this went and I said so to the management and they ignored me, what do I do about it?
All right, cool. Let’s do the first one first and let’s talk about the boarding, that’s in boarding, okay? How involved should vets be in the boarding that the clinic does? First of all for me, I guess, there’s not a right answer. There’s only clear expectations and so, there are clinics that the vets are very involved. That’s not wrong. And there are clinics where the vets are not involved at all. They’re barely aware that the boarding is happening in the building. That’s not wrong either.
As long as everybody is clear and honest about what is happening and how involved the vet is or how involved the vet is not, the pet owners should not think that their pets are being examined twice a day by the veterinarian if that’s not happening at all. That’s only setting the vets up to get hammered. They aren’t doing anything. And at the same time, if the pet owners think they’re just dropping off for boarding and their pet ends up doing a bunch of medical stuff and then they’re surprised when they come back and find that out, that’s also really bad.
And so, it’s really about what are the expectations here about how involved the vets are with what’s happening ? Ad is the clinic communicating that to the clients and do they communicate that to the vets? Because I will tell you that boarding can burn vets up. I have seen vets that are absolutely ready to mutiny over boarding because they’re like, “This never ends.” And I’ve worked at some of those practices. It’s never real bad, but I can definitely see how it gets bad.
But it’s just there’s times that you’re a vet and just the number of little problems, torn toenails, diarrhea, coughing dogs, kennel cough, people coming back with kennel cough, things like that, it can suck up your time and suck up your time and suck up your time. And if you are the doctor and that’s not accounted for in your schedule if you’re not getting compensated for that, if these are no charge appointments because the pet started coughing on boarding and things like that, if that hasn’t been discussed with the veterinarians, they can get really resentful and it’s not hard to see why.
At the same time, if boarding is part of what your clinic does and you want to be a good team member, you got to support the team. And so, there is a part where you say, “Hey, we should all be supportive of what the practice is doing to pay our paychecks and to serve the community.” And so, it really, it’s a give and take and that’s why I said there’s not a right answer. There’s clear communication. There’s clear expectations. If you are working in a practice and this goes to the second part where she says, “What do I do when this wasn’t heard?” Talk about it.
If you’re a vet and you’re like, “This is eating me up and this is taking so much time and it’s really frustrating, “you need to have that conversation. And not in like an, “I’m angry way,” but in a, “Hey, we’re in a relationship together and part of the relationship is knowing where the other person is. And so, I want to let you know that this is kind of where I am. And I’m not resentful, but I can see resentful from here. It’s just kind of over the hill.” I think you should say that.
And my question is always what is kind? Do the kind thing? It’s not kind to keep your mouth shut until you’re really, really angry and then blow up on the practice that you work at. And if you’re the practice, it’s not kind to keep your mouth shut and go, “Well, maybe she won’t notice how much work she’s doing.” And just hope that it all works out and the other person doesn’t notice that they’re dealing with a lot of cases from the back. So, anyway, there can be some real drama with boarding.
That’s just my thing is clear expectations, clear communication to the client and between the practice and the doctors. If the doctors are expected to contribute to the boarding, you just need to talk that through and everybody needs to be okay. No surprises. And as long as it works for everybody, I think that’s the best thing. I think that’s the best that we can do.
All right. I got a question Kyle Ann. She says, “Do you have tips on phone etiquette when trying to help non-clients on the phone who need assistance, but they can’t be seen due to a lack of appointment availability?”
Okay. I think a lot of us are dealing with this, so we have people on the phone and we can’t get them in and that is a problem. Now, I would say this writer makes this pretty easy for me because she says non-clients. And so, this is not a person that has been coming here, this is not a long-term client. What do you do in helping this person who needs assistance, but we can’t get them in? I just said clear is kind and I go back to it. Clear is kind.
I said, what is kind? Clear is kind. That’s what is kind. Clear is kind. We need to tell people that we don’t have availability and don’t beat around the bush, don’t act like, “I don’t know. Maybe we can do this or maybe we can do that.” And I understand. We don’t like to tell people things that they don’t want to hear. And so, it is hard to say to someone, “I’m sorry. We can’t get you in.” Clear is kind.
Set expectations and the expectation is “I can’t get you in.” The longer you wait to say that, the more you’re going to frustrate this person. And so, the first thing is be honest, be clear, and then be polite and be firm. And I think a lot of us really struggle with this and we end up, we cave. We fold like origami. We’re like, “I don’t have any availability but I don’t want to tell this person they can’t be seated, so I’m just going to through strength of will make this happen.” And I go, “That’s ridiculous.”
I’m talking a lot these days about capacity and teams and if your team is working as hard as they can work every day and they’re burning out, you can’t just want to do more work and make it happen. You’re pushing your team into the red and there’s going to be consequences. And there are going to be possibly your staff leaving and then you’re more shorthanded. And so, by pushing this far, you’ve limited your ability to do work for the foreseeable future because it’s the hard hire. And so, you have pushed this to a point that you have damaged your long-term potential to do good in the world by trying to squeeze in this short-term thing.
The other thing is even if they don’t leave, you burn these people out. You end up with just people who are tired. They’re grumpy, they’re angry, your practice culture suffers. You are running a sprint every day and that’s ridiculous because this is a marathon and so, pace yourself for a marathon. And you just have to be honest about what your team can do. And then here’s the thing, you got to let it go. You’ve got to process your lack of responsibility here.
One of the big things for me is, look, if there’s something and I didn’t want it, I don’t have control over it. I can’t make it stop and I don’t benefit from it, I’ve got to step back and say, “I’m not responsible for this.” And that’s the case with our overwhelm a lot of these practices. “I don’t want this, I didn’t make it happen. I can’t fix it and I don’t benefit from it because my people are burning out. It doesn’t help me to turn people away. That’s not helpful.” And so, at some point I have to say, “Well, if all those things are true then I’m not going to hold myself responsible and beat myself up about it.”
I hear from practices that are like, “Our front desk just apologizes all day long.” I’m like, “You have to stop. That’s not healthy.” It’s not healthy for practices to be on the phone apologizing all day long. It is what it is. I didn’t want this to be the case. The honest truth is we’re not taking new clients. Just say it and be kind and be firm. And then facilitate this person getting seen somewhere else. And that doesn’t mean you have to call and try to get them an appointment, give them a recommendation. If you can’t see them then tell them if you were them, where would you go?
And this idea that we don’t refer to other general practices, that’s ridiculous. That doesn’t make any sense. That is pennywise and dollar foolish. We are trying to do good in the world. We’ve got more business than we can do. Take care of the people who come to your practice and help other people get seen elsewhere. And feel good about yourself and go on with your life and stop burning yourself out and burning other people out.
Hang up the phone. Practice saying no by saying yes. And so, this is the one piece of phone etiquette is be clear. “We cannot do this. We are not doing this. I have some recommended practices you can call who do good work,” and say it. Don’t tell people what you can’t do for them any more than you have to. Tell them what you can do. When they say, “I need to get in,” we’ll say, “I can get you in. It’s going to be in January,” to get in to start a new client relationship here. And that’s not saying, “No, I can’t see you.” It’s saying, “I can see you in January.”
And if they want to do that, they can, that’s fine. If they say, “I can’t do that,” and you say, “Great. Well, I can refer you to another vet practice?” And I’m trying to tell you what I can do for you, but ultimately I’m not going to waiver. These are the boundaries. And so, I know that we struggle a lot with the desire to get people in and help people and I know that it feels awful to send people away. These are things that we have to do right now, guys.
It really is a question of do you want to do a good job today or do you want to do a good job in your career? Because if you “do a good job” by squeezing everybody in today, you’re not going to do a good job in your career because you’re going to be short-staffed, and you’re going to be burned out and you’re going to be angry and you may end up depressed. And so anyway, that’s my thing. Clear is kind. Be honest. Facilitate them as best you can in getting seen and that doesn’t have to be at your practice. And tell them what you can do as opposed to just focusing on what you can’t do.
Jodi asked, “What are the best things to do for your staff on one of those crazy days when everything is on fire to keep them motivated?” I’m getting a lot of questions like this. “How do we keep morale up? How do I keep people motivated? How do I make people feel appreciated?” I love this question. Here’s the answer. I have no idea. I have no idea. Here’s why because I don’t know your staff and every staff is different and that’s not good or bad, it’s just the truth of the matter.
And so, you say, “What are the best things to do for your staff on those crazy days?” My advice to you is ask the staff. Ask them what they want. Ask them what makes them feel good on those crazy days. Now, you have to ask it in a certain way because what I’ve found is if I go to the staff and I say, “Guys, when we are crazy like this, what would make you feel better?” They have no idea.
And of course, they don’t because if I came to you and you had a really bad day and I was like, “What would make you feel better?” You’re like, “I don’t know.” The truth is ask them and ask them when things are not on fire. So, at the end of the day when they’re exhausted, asking them what they wish is just another mental burden to put on them. And most people have a hard time asking those questions.
The questions that I really like are, “Tell me about a time that you were stressed out and someone did something that made you feel better. What was it?” And so ask them questions like that. “Tell me about a time that you felt really appreciated.” I love those questions. “What’s your favorite snack? What’s your favorite candy? What’s your favorite music? What’s your language of appreciation?
And there’s a book, it’s called, The Five Languages of Appreciation in the Workplace. It’s written by the guy, who wrote The 5 Love Languages. They’re the same book. Just so you know, they’re the same book and one of them is just work appropriate, but it’s good stuff. If you want a quick read, there’s five languages that make people feel appreciated. I’m going to try to rattle them off, but it’s words of affirmation, it’s service, it’s quality time, it’s gifts, and it’s physical touch. Bam, nailed it. That’s the five. But anyway, and you can dig into. It’s a good book for anyone in management and motivation to read and you can skim through it and get the gist of it pretty darn fast. But those are the things you say. And what resonates with my people?
I really like the idea of having a sheet that, and you have to update this every now and then. You can’t be like they filled out a sheet when they came to work here and I’m like, “When did they come to work?” And you’re like, “Seven years ago.” I’m like, “How do you know they still Butterfinger?” It’s like, “Who stops liking Butterfinger?” People’s preferences change and so, just update it. But some questions like that, not when things are on fire. Those things are good, but it helps you figure out what motivates people, so that we can do those things.
One of the things you can always do in the moment, always in the moment, is when people are really working hard, go the extra mile to make them feel seen. It doesn’t cost anything. You don’t have to buy anything. It’s just taking a moment to say to somebody, not I appreciate you or thank you because those are just really generic.
It sounds something like, “Hey I want to tell you, I saw earlier today when we took that patient out of its little den and you dove in there and just cleaned it out and wiped it down and you were just on it. And I just want to tell you, I recognize how hard you work around here. And I recognize that you could have been like, ‘That’s not my job,’ and backed away, but you didn’t. And I just, it’s hard for me to express how much I appreciate you and what you do here.” And if that sounds heartfelt, it’s because it is because I’m imagining one of my techs.
And you go, yeah. It’s not buying anything, it’s not having anything, it’s not planning anything, but sometimes people just want to feel seen. And that is something that we can always do, but you got to be present. You got to be on the floor. You got to be paying attention and you have to set out to do it and you can’t do it for the whole team at once. It has to be a thing where you catch people, who are really going to town. But anyway, that is something that even if you’re unprepared, you can make people feel seen, but you have to give it a little bit of thought and you have to get their attention if to talk right to them, look them in the eye, and make them feel seen.
Jen asks, “What’s the best thing to do when you’re feeling overwhelmed?” She has a follow-up question, which is, “What advice would you give to those who are having trouble setting boundaries at work?” I’m going to take the first one first. “What’s the best thing to do when you’re feeling overwhelmed?” I think a lot of us are feeling overwhelmed. I’ll run you through my list.
Number one is make a list. I think of like Dumbledore is pensive. A lot of times, we’ve got this nebulous list in our brain. And I tell you that’s the worst part for me of feeling overwhelmed is the emotional feeling of, “I just have so much to do,” and you’re like, “Andy, what exactly do you have to do?” And I’m like, “I don’t know. Just everything. I just feel like I have to do everything.” I think a lot of us get that place. You got to get out of there and the quickest way to get out of there is you have to crystallize what you’re up against.
You have to turn this nebulous cloud of stress and anxiety into something tangible that you can look at and measure up and make some plans about how you’re going to address it. So, the first thing is just get it down. You can use a to-do list app. You just write it on paper, but you’ve really got to take the floating anxiety in your mind, which is driving that feeling of overwhelmed. You’ve got to translate that into something tangible that you can actually see.
And then you look at this list and you ask yourself what here is actually on fire and what’s just smoking from the things around it? And I think a lot of us struggle with that. We say, “Everything is on fire.” It’s like, “No,. Everything is not on fire.” You got a couple of things that are on fire and you maybe have one significant fire. Everything else is just reefed in smoke from those burning fires, but it is not actually on fire, which means those problems can sit until tomorrow and you should feel okay with them.
I’m a big fan of everyone, people make to-do lists and they’re like, “This is what I have to do today. And if I don’t do this today then I’ve failed.” And I go, “That’s ridiculous.” It can’t be about what you did today. It’s got to be about, “This my to-do list and this is what I’m going to do today. And this is what I’m going to do tomorrow. And this is what I’m going to do next week.” And you’re already lifting that overwhelm off your chest just by saying, “I see this and I’m saying it’s important and I commit to doing it next week.” And you can do that.
And I think we have this horrible tendency as a human being species to wildly over imagine what we can do in a day. And we under imagine what we can do in a year or in five years or in 10 years. And so, the biggest problem is we look… I mean, how many of us have had these to-do lists and we have 10 things on them and we’re like, “Yeah, I’m going to do this today.” No, you’re not. You’re going to do three things on that list or maybe five things on that list and then you’re going to feel defeated because you didn’t do 10 things.
And I would say, “That’s ridiculous. You did five things on your to-do list today.” That’s bonkers. If you do three things on your to-do list and keep a clinic going and keep a family going and feed yourself and wear pants, then you have succeeded in the day and you should be happy about that. That’s what you should do with your to-do list. So, what here is actually on fire? And then what’s just smoky from the things around it? What’s mission critical? What’s causing the most pain? Meaning, what is bothering me the most?
Some of this is mental health stuff, where it’s like, “I understand organizationally what the top priorities are, but this squeaking chair makes me angry every time I sit down in it.” And I would say, “That’s causing you pain.” Yes, there’s other things that are important, but that squeaking chair is bothering you every time you sit on it. And it’s affecting your head space and your enjoyment of being here, and so, for me that is a thing that’s actually bothering me more than anything else. So, fix the chair. Just grease the chair. If it’s causing you pain, then fix it.
And the last thing is what will free up my capacity? And so, I’m looking at my to-do list, what is mission critical? What is bothering me the most? And the last thing is what will free up my capacity? Meaning, I want to prioritize the things that are going to give me more time to deal with the other things.
And so, you might have something on your task list and say, “This is not super important but it takes a ton of time and people keep asking me about it and asking me about it and asking me about it.” And I go, “Well, if you got that off your list then people will stop asking you about it and you would have time to do the other thing.” So, even though it by itself is that important, getting it done will free up your capacity. And so, anyway, those are the ways that I look at being overwhelmed. I hope that that’s something helpful.
The second follow-up question is, “What advice would you give those people have trouble making boundaries at work?” And I kind of touched on this when I talked a little bit earlier about the phone calls and people wanting to get in and us not having space. The big keys for me in setting boundaries at work is you need to make boundary decisions intentionally and when you’re not in the moment. The biggest way that we fail in personal boundaries is we are like, “When it happens, I will say no.”
No, you won’t and that’s okay. It’s because you’re a good person and you want to help people and if you have not clearly committed to what you’re going to do, then it’s a toss up in the air. And if it comes down to looking at this person who’s got tears in their eyes and saying, “No, I’m not going to help you,” and that’s boundary setting, then you’re going to fail every time and you probably should because it means, again, that you’re a good caring person. The only way to make this stuff happen, guys, is to think about the boundary failings that we have.
Where do we fail to set boundaries? How do people set us up, so that we say yes and then we regret it or we’re resentful later on? If you were having those experiences where you say, “I feel I say yes and then I’m angry about it later,” I would say to you, my friend, that’s resentment. You are feeling resentment. And the fact that you did this and you felt resentful of it, to me that means you need to fix the problem for next time. And that is about making decisions when you’re not in the moment. Moral decisions made on the floor are a real problem and they’re one of the big problems in why we don’t have good boundaries in vet medicine.
Because we’ll say things like, “Oh, when the client comes in at the end of the day and if they get in the door before we close it, then it’s up to the doctor whether or not we see them.” And I say, “So, you’re going to see them is what you’re saying?” Because the doctor is almost certainly not going to be able to look at this person who says, “Please don’t make me leave. I drove all the way over here and my dog is sick. And please don’t turn me away into the cold.” They’re going to say yes, because they’re good people.
And make the decision ahead of time. “We close at 6:00. We don’t take walk-ins after 5:30.” And it’s not a question of asking the doctor because the doctor is not empowered to make that decision. Has a policy decision that was made and we will apologize and let them know where the emergency clinic is. That’s it. Maybe one of our techs can look and say, “Yes, this could wait until tomorrow,” or “No, it needs to go to the emergency clinic.” But that’s as much as they get, but that’s a policy decision.
I mean, I know it all comes from a good place. It comes from us saying, “Well, I want the vets to be able to look at this.” And try to take care of our clients. Nobody is bad here, but at some point you got to look and say, “In this world where people are burned out and they’re overwhelmed and they’re working and they’re working and they’re working, if that’s the reality in your practice, you, my friend, you need to set policies that protect your people.”
Now, in 10 years when there is a global pet shortage and you got nothing but free times, you can change that policy and say, “No, when they come in, we’re seeing them. You know why because we only see five appointments a day?” Then that’s a whole different thing.
I’m not saying you have to do that, but you can. Things change. And the fact that you make a policy right now doesn’t mean you’re not going to relax that policy when you hire the three doctors you’ve been trying to hire for the last two years, then you can make that adjustment. But right now, you got to make the decision, make it ahead of time, make it with clear eyes, make it non-emotionally and just make it. In order to do that, because a lot of people go, “But this is painful, Andy. I feel bad turning people away or setting these boundaries or telling people no.” There’s really two mental shifts that have to happen if you want to feel okay with this, in my experience.
The first is you have got to stop thinking in the short term and think in the long term. I alluded to it earlier, but if you look at everything that walks in your door and say, “I’m thinking about this today and the good that I can do in the world today,” then you are going to suck it up and you’re going to see every patient that comes in and you are going to take every phone call that rings through. That’s not healthy because the goal is not to be successful today. The goal is to be successful for 30 years or for the rest of your career and so, you need to look at it long term.
And so, if you say, “I need to do maximum good in the next couple of decades,” then pacing yourself makes sense. And you say, “Well, I’m not going to stay tonight and take extra cases because I need to rest, so that I can continue to keep this up for the next year as it’s hard to hire people. And as we continue to be so darn busy, I’ve got to pace myself.” And so, I’m not thinking about today. I’m thinking about this year or the next five years or the next 10 years or whatever. But if you’re only thinking about today then you, my friend, you are in a sprint mindset of go, go, go, go. Fall into bed, jump up tomorrow, and go, go, go, again. And that’s not sustainable guys. It’s a marathon. It’s not a sprint.
And the other mental shift I think that people need to get comfortable with is switching from fixating on the person in need to thinking about everyone affected. And so, when the pet owner comes in and they say, “Please, don’t turn us away. I know you’re locking the door and the staff is trying to leave, but we need to get seen for this itching,” if you think about the individual affected, which is the pet and the pet owner and you say, “Ah, it’s help them or it’s don’t help them,” that’s a really hard mental place to get out of. And morally, you think, “Oh, I need to help them.” But those are not the only people affected, are they?
Your staff is affected. Your staff wants to go home. They want to go see their families. They want go home and recharge. They have hobbies that they are looking forward to doing. They want to rest. They want to do whatever they want to do. It’s their life, but they want to live their life. So, if you say yes, it’s not just about you and this pet owner, it’s about you and the staff and doctor and payroll if you put people into overtime. And more importantly, it’s about your family at home and the time that you’re not getting to spend with your kids and your spouse or doing your hobbies or relaxing. What does your boyfriend think about you staying late every night? If he has concerns, then he’s being negatively affected by you saying yes.
I’m not saying you say no. I’m not saying you say yes. It changes. But what I’m saying is when you make these decisions, you need to not think just about the person in front of you who’s asking for help. You need to try to balance what is being asked across all stakeholders, which is them, which is the staff, which is the doctors, which is the practice, which is your friends and family who are waiting for you to get home or your pets who need to pee because they haven’t been let out since lunchtime.
All those things matter and it’s a whole lot easier to set boundaries if you look at everyone’s needs and how everyone is affected and go, “Just I can’t do this. This is not in balance. There’s too many ripple effects from this.” And again, this math might change in the future. If you never come home late and somebody shows up and says, “Please squeeze me in,” then maybe you do that and it’s because it’s a rarity, but if it happens every day then it’s okay to say no now. It’s just interesting. There’s no all or none, but it’s about being healthy and being intentional about where you are.
And the last thing that I’ll say about setting professional boundaries, and this is kind of hard to hear, and I just want you to sit with it a little bit. And I hope that neither of these things is true for you, but if you have to make a boundaries decision and the decision comes down to feeling guilty or feeling resentful, choose guilt. Choose it every time.
And what I mean when I say that is if your choices are to set a boundary and say, “No, I can’t do this and I’m going to go home and I’m going to feel guilty about it,” or to say, “I’m going to make this happen. I’m going to stay and do this. I’m going to sacrifice this boundary. I’m going to make this exception and then I’m going to be mad about it. And I’m going to go home and I’m going to be angry at myself and at my staff and at my job.” That anger eats you up. It will.
Go home and feel guilty because that beats the heck out of going home and feeling resentful and angry because that’s a path to a dark place and you don’t want to be there. I hope that you can rationalize in your head. That’s why I talk about thinking in the long term, thinking about everybody infected because I want to help you deal with that guilt. But if it comes down to it, you got to choose guilt or resentment. Choose guilt.
Okay. Jody asked, “How do you bridge the gap between the front and the back?” It’s probably one of the most common management questions I get. There’s a lot of communication issues between the front and the back. And people always ask, “How do you,” when she says, “bridge the gap?” Generally, it’s making these people know and respect each other. It’s making them assume good intent about each other. Meaning, the front assumed that the back is trying their best and the back assumes the front is trying their best. How do we make those things happen? How do we make these people, who are physically separated? Generally, they’re in different parts of the building. They’re having different problems. “How do we get them to bridge the gap,” as Jodi says?
And the first thing is I think is really important is a shared mission. We need to talk about what we’re doing here. What are the core values of our practice, of our clinic? Why do we come into work? It’s not to make money. That’s not why anybody’s here. I mean, maybe some of us, but those people made bad choices, but it’s here. We have a mission that we are pursuing and we are a team. And the front and the back are 100% both pursuing that mission and they are both required mission critical for pursuing our mission.
And so, make sure you’re talking about the mission. Make sure you’re pointing to the North Star that your whole team is rowing towards. And if I believe that they’re working in a different place and they’re doing things differently, but they are committed to our mission and I am committed to our mission, suddenly that commonality that brings us together and it makes it easier for me to assume good intent. And if I have conflict, it’s easier for me to talk it through when I believe that we’re both ultimately working for the same outcome and we both are trying to get the same place. So, the shared mission is important.
Focus on interdependence. I want to continue to emphasize again and again to the team that they need each other. The front needs the back and the back needs the front. I think a lot of times, people just like the… I think it happens more in the back. Maybe it’s just because I’m back there and I’m not up at the front. But in the back, I think there’s this idea that the front is just in the way of getting things done, and that’s nonsense. That’s foolishness.
The truth is they are handling the clients and the communication and the phones and the checking in and checking out and they are completely a 100% in this trench with us. And they are helping us do the things that we need to do, and we need them. We need them and they need us. And I think that that’s language that we should use and remind people of is, “Hey, guys, we need the front desk and we need them to be happy. And we need them to help us take care of these clients because without them, all this communication falls back on us and we cannot keep up. We need them. They have a great impact on how our day goes and we need to support them and we need to try to make their jobs better. And they’re going to work hard to support us and try to make our jobs better.” But it comes down to that focus on interdependence.
And the last thing is knowledge about what the other group is doing. Oftentimes, the people in the back do not know what’s happening at the front desk and they do not know what they’re up against and they don’t know the headaches and they don’t understand what it’s like to sit up there and have a waiting room full of people staring at you and they’ve waited 35 minutes and they’re getting frustrated. But that’s just is an experience.
And so I think talking about those things and pointing out to people and say, “Hey guys, it’s hard up front.” And the same thing at the front, they don’t know what we’re doing in the back. They don’t understand why suddenly there’s a huge log jam and it’s like, “Well, they don’t know that the procedures that they brought in these specific ones take a lot of time. And our regular procedures, they don’t know maybe what goes fast or slow or maybe they just don’t know that one of the doctors got caught on a phone call and couldn’t get off and couldn’t get off and now, we’re behind.” If you don’t have a way to communicate that, then they don’t know it and so, make sure that we’re trying to talk about that.
And a lot of people will say, “Cross-training, cross-training, cross-training.” To me, cross training is knowing what the other group is doing and I think that’s good if you can do it. If you can get some of the technical people back up to help with the front desk and answer phones, that’s great. And if you can get some of your front desk people CSRs trained as assistant, so they can come back and help hold pets and participate in the back just for that experience, that’s great. I think that those things are really good.
The bigger thing is good communication. It’s about these people knowing each other as people. And it’s just about them being able to talk about issues before they become big screaming issues. When there’s mild frustration being able to come together and say, “Hey, let’s talk about what’s happening and why it’s happening and what we’re going to do about it.” And that’s just good ongoing communication in the practice. That stops us from getting to the place where we build walls and where we split into groups. And us versus them is a very powerful, very simple way to divide people.
And in practice, if we start having that type of language where there’s us in the back and them in the front or vice versa that leads to division really fast. It leads to a lack of assumed good intent and that leads to anger. So, anyway, those are my big things on bridging the gap between the front and the back.
And then the last one, Jackie asks, “How do you coach someone that gives very blunt delivery of feedback and rubs people the wrong way?” All right. I like this question. This, I get this a lot. How do you coach someone who gives very blunt feedback? I don’t find this to be particularly hard feedback to give. I really don’t. I like it. And so, the big thing is, let me go ahead and frame this up.
So, the first thing that I want to do there, there’s really two kinds of corrective feedback that you can give. The first is critical and the second is developmental. And so, if you give critical feedback then what happens is that’s me saying, “Hey, you messed this thing up yesterday and I want to talk about how you messed it up. Okay?” And so, that’s critical feedback.
Developmental feedback is me saying, “Hey, I want to talk about where you’re going and what I want to see from you in the next six months. Hey, I want to talk about your developmental pathway and what I see as the next big steps for you to take, to move onward and upwards, to be even more fantastic at your job than you are. I want to talk to you about the things that I’m really looking for you in the next year as far as your own personal leadership development.” And that’s developmental feedback and it feels very different.
It’s not me saying, “Let’s talk about how you screwed these things up.” It’s me saying, “Let’s talk about the future and what we’re going to do in the next year.” And so, this type of blunt feedback, I’m not going to hold it as a trial and be like, “Come back in here. Now, you’re going to sit here. I’m going to bring in the first witness to talk about your bluntness when you said, ‘That’s not what I asked for.'” I’m not going to put him on the spot. We’re not having a trial. We’re not doing any of that.
And so, “Hey, I need to talk to you. I want talk about what I want to see from you in the next year as far as your leadership development and where I see potential for you to really blossom.” And then I talk not about them giving blunt feedback because blunt feedback is very subjective. It’s very subjective. What I consider blunt feedback living in the Southern United States my whole life is very different than what my friend, who lives in New York City considers to be blunt feedback. What he considers to be normal communication. I would like, “Oh, my God. You said that?”
It’s a cultural thing. And yeah, I say that with love, but there are places where very direct communication is just the norm and there’s other places where that’s just not how we talk. And so, this person may fit like a glove in another place. I don’t want to lose this person, but what they’re saying is not wrong. It’s just it’s being received in a way that they do not intend. And I talk a lot about how the person is being perceived. Not what they’re doing and that’s big important point in coaching people.
If I say, “Hey, you are doing this wrong,” that’s very different from saying, “Hey, I understand where you’re coming from and I appreciate you enforcing our policies and giving clear feedback. I do and I do not want that to stop. I want to work on how that feedback is being perceived because some people are hearing it as very blunt or they are taking it in a way that is probably stronger than you intend. And so, I want to work with you in how we can deliver the feedback in a way that’s not going to be perceived as over the top or aggressive. I want you to work on softening your delivery, so that it is as effective as you want it to be.”
And that’s how I put it. And really, I hope you can kind of hear that I’m really trying to take this away from being any sort of criticism of the person because it’s a skill criticism. And just say, “Hey, I want you to work on softening your delivery, so that your feedback is as effective as you want it to be. And we can talk about how to do that.” And if they want specific examples, I hopefully can give them and say, “Here’s some of the things that I heard.”
And it’s just, again, a lot of times, communication doesn’t happen at the mouth, it happens at the ear. And we don’t have a ton of control over what happens at someone else’s ear other than to receive feedback and make adjustments based on how they’re interpreting what we’re saying. That’s just life. It’s not a critique of you as an individual or your skill or your smarts or anything else. “I told you what it is. I gave you the feedback. This is where it is. Let’s just make some adjustments and go on. You’re doing great. I appreciate you.”
And that, I try to keep it low stakes and just give that feedback. If you want to unpack it some more, we teach a DISC in Uncharted. So, DISC is a very simple style of communication profile and so, basically people kind of fall into four categories. D is a dominant direct personality type and that’s often the ones that I get the feedback about, “This person is very blunt.” This person is probably just a D style communicator, which is I think it’s great. I’m very comfortable with these, but they are straight to the point. They don’t want details. They’re just, “Tell me what I need to know and I’m going to tell you what you need to know and let’s go on.”
And you guys probably work with those people. A lot of doctors are that way and they can be seen as uncaring. That’s not true. That’s not remotely true. It’s just that they are no nonsense, “Let’s go. Let’s get going.” And that’s their communication style. And what I love about DISC is it breaks people up.
And you can say, “Oh, I know those people. I know exactly who that is.” And I will say, “Great. Do you know how that person likes to communicate?” And you say, “Yes, they’re very direct.” And I say, “Great. Here’s a little trick. They also like to be communicated that way.” Which mean, and that makes the feedback even a little bit tricky if you don’t do it right, because the person is like, “I’m not blunt. This is how I would want people to talk to me.”
And that’s true. That is how they want them to talk. It’s like, “This is how I communicate. I told you what you need to know. Tell me what I need to know and let’s go our separate ways.” And that’s it. And so, anyways, like Ron Swanson from Parks and Rec, goes like, “Tell me what you want and I’ll tell you what I want.” And that’s it. Anyway, I don’t find it to be super problematic because it’s 100% just, “Hey. This is how it’s being received. We need to adjust so that these specific people are hearing what you’re saying and your feedback is effective. Can you work with me on that? Help me soften it.”
And they’re going to have to struggle because a lot of times they’re like, “I just want to say it and go on.” And I go, “I get that.” The worst case is I kind of have to get them to understand how blunt feedback does not save them time. They’re like, “I just tell them. It saves time.” I was like, “You just tell them, and then they come into my office and now, I’m talking to them and it takes me 30 minutes to talk them down. And now, you and I are having this conversation. And if it keeps happening, we’re going to have another conversation like this. And now, if you want to have a good relationship with this person, you may have to go and apologize and tell them that you didn’t mean to come off direct. And how much time does that waste?”
It’s like, “Just soften your delivery. And ultimately, it takes more time in the moment and saves more time in the long run by far.” And so, I might have to explain that. Usually, I don’t. Usually, I just say, “Hey, I want you to be more effective. This is what I need from you is just soften tone, so that people perceive it differently.”
Guys, that’s it. That’s what I got. Those are my questions that I got from the Uncharted community. Thanks to everybody there who dropped those questions for me. Gang, I hope you enjoyed it. It’s been a fun experiment. I’m going to go back to the lab and tinker around on this and maybe we’ll do some more of these. Maybe we’ll switch it up a little bit. I don’t know. We’re going to see what happens.
But anyway, gang, thank you guys so much for being here. If you enjoy the podcast, lead me an honest review wherever you get your podcast. If you’re watching on YouTube, click that Like and Subscribe button. Gang, I hope you all are well. Take care of yourselves. All right, talk to you soon. Bye.

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

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