Team Culture

Sheri Gilmartin, head of data services at Vetsource, joins the podcast today to break down data on what happened in 2022 at over 6500 veterinary practices across the United States. In short, patient visits were down and prices were up, but the story is much more complicated than that. Let’s get into it!

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

LINKS

Practice Managers’ Summit – March 22, 2023: https://unchartedvet.com/upcoming-events/

Uncharted Veterinary Conference – April 20-22, 2023: 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

Sheri Gilmartin is a Credentialed Veterinary Technician and has been working in the veterinary industry for 30 years. She started her career in a small animal hospital outside of Boston MA where she worked as a technician for 8 years. In 2000, she made the move to Industry and has held various positions in sales and marketing at Hill’s Pet Nutrition, Vetsource, Patterson, and VetSuccess. In 2018, Vetsource acquired VetSuccess, where Sheri leads sales of Data Services today.

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 one and only Sheri Gilmartin. She is the head of data services at Vetsource and they’re working with 6,500 practices across the industry. And I’m going to talk to her about the data from 6,500 practices that came out in 2022. I want to understand what’s going on in practices, what the big industry trends are, what the revenue trends are, what the pet owner trends are.
And what I’m trying to do is get a clear picture of what 2023 might look like. Guys, this is a great conversation. It’s a lot of mixed messaging, which of course that’s why, that’s the real world. Visits by pet owners is down, our revenue’s up, prices are up. What does that mean? Can we keep going that way? Can we keep losing pet owners coming in and just increase the prices? We all know that at some point that doesn’t work anymore. When is that going to happen? What can we do to reverse the trend? Where are these pet owners going? That’s all stuff we get into. It’s a really good conversation. Guys, I hope you’ll enjoy it. Let’s get into this episode.

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

Dr. Andy Roark:
Welcome to the podcast, Sheri Gilmartin, thanks for being here.

Sheri Gilmartin:
Thank you for having me. Happy to be here.

Dr. Andy Roark:
Oh, it is my pleasure. I’ve been looking forward to this conversation for a while now. So you are, for people who don’t know, you are a certified veterinary technician. You are the head of data services at Vetsource and I was introduced to you through our mutual friend Dr. Emily Tincher and I was talking to her about this desire that I have to be able to look into 2023 and get a better feel of where our industry is going. And so I started trying to make some better predictions about what the future’s going to be like.
And we were still talking about the best way to see the future is to look at the past and she recommended you as someone who has a lot of insight into the trends in our industry and what’s happening. And so I was hoping that you and I could talk today and here in the first two weeks of January, if we could look back at 2022. And I’m interested in your rundown of the industry as you saw it and the trends that you thought were really interesting and the ones that you think will kind of define maybe what 2023 might look like.

Sheri Gilmartin:
Yeah, good question. So I’m happy to be here and appreciate Emily connecting us. I have access to 6,500 practices, the data from 6,500 practices. We provide data services, analytics and reporting to these practices and we’ve aggregated it to get a sense of what’s happening across the industry. And looking back at 22, certainly it was an interesting year, right? Decline in visits across practices beginning in January and continuing through December, an increase in revenue. But we know that practices had multiple revenue increases last year.
And so when we look toward the end of the year, we’re seeing that revenue was up 5%, which is lower than the price increases that were taken last year.

Dr. Andy Roark:
Sure.

Sheri Gilmartin:
So, when we compare it to the prior year, we see that we were down in 2022 compared to 2021. Now that being said, we really do need to dig in a bit deeper because 2021 was an exceptional year and we had tremendous growth. And so you would expect level setting. And so it’s hard to look at that and be able to predict what’s going to happen in 2023.

Dr. Andy Roark:
Yeah.

Sheri Gilmartin:
Certainly the economy is going to play a big part there in what happens, but I think the takeaway for me is we really do need to be paying close attention to the numbers because we need to be more proactive and less reactive, as we were in 2020 for example.

Dr. Andy Roark:
Okay, let’s start to break some of this apart. So 2021 was a huge, huge growth year sort of coming out of the pandemic and the world sort of opening back up and big demands and pandemic puppies and kittens and things like that. When you look at sort of 2022, has there been a time that you’ve looked at it and said, let’s take 2021 out of the equation. Is there any attempt to normalize what this might look like? If we pretend the pandemic years 2020, 2021 didn’t happen, does that look more normal? If there was just a hole in the data, would they look much more smooth or is there any way to try to predict of what… I guess what I’m trying to get at is what does level setting look like and have we done that?

Sheri Gilmartin:
Yeah, good question. And it’s hard. So the data that we have for practices, we have data back to 2018, 2019. And so 2020 was also an interesting year because we had everybody on lockdown in March, in April. So the numbers for 2020 are kind of skewed by that. And so when you compare 2021 to 2020, you have some outpaced growth there. If we go back to 2019 and I look at things like appointments and unique patients, revenue per patient back in 2019, 2022 is pretty comparable to 2019. So if we took the pandemic years out of it certainly takes away some of the doom and gloom that people might feel when they look at the 2022 numbers. There’s still a lot of good things happening at the patient level and across practices overall looking back pre pandemic.

Dr. Andy Roark:
Okay, that makes me feel better. I do like that. That’s actually what I was looking for, is how does this match up to 2019. Let’s talk a little bit about decreasing visits. So you said this really sort of started in January, 2022 we’re starting to see this decrease in visits. What is your perception of the drivers of this decrease?

Sheri Gilmartin:
Yeah, that’s a good question. And so that’s a challenge with data because we can see what’s happening but really understanding the why, that’s where you have to speculate a bit and it’s probably a combination of things and I think for me, the workforce challenges that practices have faced is a significant part of that. Many practices are down, doctors don’t have enough support staff and have had to reduce the number of available appointments as a result. So certainly that plays into it. And then there’s also a little bit of culture shift happening where practices are really focused on preventing burnout, trying to preserve the staff that they do have and have extended appointment times, not seeing as many walk-ins or agreeing to see add on appointments at the end of the day. So there’s a whole host of things that can contribute to that.

Dr. Andy Roark:
Well, I didn’t hear you say, there’s economy concerns, there’s people deciding that their pet doesn’t need wellness visits to the vet, things like that. Is that type of consumer driven? Because what you just said is very much veterinary side driven, which makes some sense to me. I work with a lot of practices who don’t have the capacity, they have a capacity problem and so they’re saying we can’t see this many patients.
And so if you said, well your patient numbers are down and they said, well I was five vets and now I’m three vets, of course they’re down. And I would say that that makes sense. And when you talk about the health of the practice, it’s not really bad. There’s nothing wrong with running a three vet practice that is at maximum capacity as long as it’s a well run practice and it’s profitable and you’re taking care of your people. There’s nothing magical about more vets is better. It depends, I guess it depends on your worldview, but to me a three vet practice where the people are healthy and happy, they are going to see fewer appointments, but that doesn’t mean that they’re failing, it means that they’re actually have as much business as they can do. So talk to me a little bit about that. Are there things that appear to be on the pet owner client side that are pushing this?

Sheri Gilmartin:
Yeah, so I don’t think people are going to stop seeking veterinary care. So we think about the economy and we know that the economy is slowing and it’s unknown yet if we’re going to go into a recession in 2023. But ahead of that, we know that people cut back on spending. We know that consumer spending was up in 2021, people weren’t going out as much after COVID they had more money to spend as a result, they were with their pets more often and so they were spending more at their veterinarian in 2020 and 2021. We know that people are starting to pull back on spending and if we think about it, a slowing economy, some people are going to stop going to the veterinarian, their pets still need care. We know that they’re part of the family now. And so that will happen, but they will look for lower cost alternatives potentially.

Dr. Andy Roark:
Yeah.

Sheri Gilmartin:
And they will, for some elective services, they may say, I’m going to skip that blood work this year or I’m going to skip that fecal this year.

Dr. Andy Roark:
Yeah.

Sheri Gilmartin:
So I think that from an economy perspective, we will potentially see lower revenue per patient, but I don’t think that if your pet is sick or your pet needs their vaccination, we’re not going to see a decline in visits from that. We may see the time between visits be a bit longer. So the other thing with visits is, and it’s not just service visits. When we look at visits, we’re also looking at invoices that may just be for product purchases. I needed food or I needed prevention for my pet. And so those are counted as visits. And so when we look at the decline in visits, it’s almost like touchpoints with the pet.

Dr. Andy Roark:
Right.

Sheri Gilmartin:
And it could be more than one visit per year for that patient. It could be people coming in to purchase supplies. And so that is down overall.

Dr. Andy Roark:
Yeah.

Sheri Gilmartin:
Again, there’s a bunch of different factors. And so I think that active patients, patients that are part of your practice, that probably hasn’t changed and it hasn’t grown over time, but length between visits, maybe looking to get some of their medications through online pharmacies, we’re certainly seeing an increase in that and that’s contributing to a decline in visits. To address your comment about, hey, we were a five doctor practice and now we’re three, but we’re profitable and maybe that’s okay. There’s certainly truth to that and it’s about profitability at the end of the day for sure. I think with that, if you’re still providing good customer service, your clients are happy, that’s going to be reflected in your revenue and your profitability and so that makes sense. I think that part of the challenge with practices is they may be down a doctor but they’re still trying to see those patients.

Dr. Andy Roark:
Yes. And I think that is a big driver of a lot of wellness and burnout problems that we see. And so that’s kind of why I say that is. You can work at capacity at five vet practice and then work at capacity at a three vet practice. But what you can’t do is be a three vet practice working at a five vet practice capacity. And I see a lot of people trying to do that and it ends badly. So I do see that. I do think that’s a big driver for sort of our burnout.
I’m assuming that it is hard to look at practices across a group of practices and tease out what actual examinations are doing year to year. And I’m just guessing that it’s because every vet practice codes their examinations differently. But I guess why I’m saying that is, when you say this and you say, well that includes food and includes set aside purchase and stuff like that, I go, okay, that’s interesting. I’d love to strip all that stuff out and say how many times are veterinarians putting their hands on the pets and what is the change like there? Am I correct in saying that’s really hard to look at because of how practices code and record these veterinarian interactions differently?

Sheri Gilmartin:
Yeah. So every single practice has their own unique set of codes and descriptions for their services and you would be amazed at how many different ways you could describe Simparica trio for example. You could find thousands of different descriptions. It is unique. We’ve spent years normalizing data from practices so that we can be able to identify exams or visits where they’re just coming in to buy product and what that product is. And so we’ve done a lot of work over the past 10 years to normalize practice data to be able to provide these insights. So when we look at practice data, regardless of what the practice has for an exam and there’s rechecks and then there’s pre surgical exams and then there’s well visits and sick visits, we are able to see that all of those were exams and something that the patient had to be present for. So we are able to separate that versus something like a product only visit. So we usually categorize visits as a well visit and we categorize a well visit as they’ve had a vaccination on the invoice and we know that that’s not perfect, but we…

Dr. Andy Roark:
Yeah. No, I get you.

Sheri Gilmartin:
It’s as close as we can get. We know that there’s maybe exams that the patient didn’t need vaccines or on a three year protocol, but we’re using that as our identifier for a well visit versus an invoice where there was no vaccination, no heart room test. We’re going to say, okay, that was a sick visit. And then if there’s no exam, we’ll say, okay, this was for product only where they’re just coming in to buy drugs and medication supplies. So I can tell you all visits are down across practices and when I say this, all visits are down, note that this is the average across all practices. So there are some that are up, there’s some that are down more than what we’re seeing. That’s the average. We see sick and well visits are down, but what’s actually down the most is product only visits. Those have had the biggest decline from the prior year.

Dr. Andy Roark:
Yeah. Is the assumption that those products are not getting picked up or that they’re getting picked up from a non veterinary channel?

Sheri Gilmartin:
Yeah.

Dr. Andy Roark:
Or do you have an opinion?

Sheri Gilmartin:
Yeah. No, I suspect that those transactions are going to third party online pharmacies.

Dr. Andy Roark:
Yeah, okay. Just checking.

Sheri Gilmartin:
No, I was going to jump into the whole efficiency thing. We talked about capacity and there is a workforce shortage and many practices are over capacity or at capacity. And so, one of the things that we talk about often is efficiencies. And both for pet owners and for practices, it’s more efficient for a pet owner to be able to have their product shipped to their home than to have to go run one more errand. And from a practice perspective, practices that have their own online pharmacies and leverage it appropriately and market it and promote it with their pet owners, they don’t have to touch that either. It goes right to the pet owners. So it’s helping make them more efficient. So thinking about efficiencies to increase our capacity without having to add headcount is something that we really need to focus on in 2023.

Dr. Andy Roark:
Oh absolutely. Yeah. I’m a big believer in that. Direct ship, autoship, things like that, that we can set up through the practices. It just, it’s the pet owners, it makes sense for us, it’s good for our workforce and being able to keep our capacity and still put our hands on pets and do the work that matters. So I completely agree with that.
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 can 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 a 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. Ask anybody who’s been, it’s something special. All right, let’s get back into this episode.
Let’s talk a little bit about the pricing increases that we see on the other side of this. So we see visits going down, but we see pricing coming up so that basically we end up with, you said about a 5% increase in revenue, I think 2022 over 2021. And so talk to me a little bit about that. Are there trends in price increases that you’re seeing? Are these generally being done in large jumps? So are there anything that you just look at it from a picture of what’s going on, perspective. How does that break down? What’s the nuance in those numbers?

Sheri Gilmartin:
Yeah. So if we look at last year we saw that on average practices had about an eight and a half to 9% increase in prices.

Dr. Andy Roark:
Okay.

Sheri Gilmartin:
But what’s interesting is we saw that the overall impact on practice revenue was lower than it has been in the past. If we look back at 2021 and 2020, practices had about a four and a half to 5% increase on prices, but the impact on revenue was 10%. And that is because of the reduction in visits and patients per practice, right?

Dr. Andy Roark:
Right.

Sheri Gilmartin:
So we’re seeing higher price increases, but a lower impact on revenue because our visits are down. And so we did an analysis a few years ago when we said, what’s it a stronger driver of practice revenue growth? Is it a higher ECT or is it more visits per year per patient?

Dr. Andy Roark:
Okay.

Sheri Gilmartin:
And what we found is, well while both will contribute to revenue growth obviously, having more visits per year per patient is going to be a stronger revenue driver for the practice overall. And so similar to what we saw last year, we have higher price increases, but lower revenue growth because we had fewer visits. And so it’s interesting because as you know, the decline in visits has happened over the last 12 months. It’s already continuing in the beginning of January. If the economy, we’re seeing potentially a recession, we expect that we’re going to continue to see a decline in visits. And so the reaction from practices is going to be, well, we have to increase prices to maintain revenue. And then at what point and after how many price increases do pet owners start to have some sticker shock and then that further drives a reduction in visits.

Dr. Andy Roark:
Well, that was going to be my next question. So I had Fritz Wood on, who’s a financial sort of advisor for the industry and for veterinarians. And we talked a bit about setting prices in vet medicine and he talked a lot about price elasticity. And it sounds like that’s what you’re getting into, is the pricing is elastic to a point where you can increase the prices and pet owners will continue to pay them. But at some point there’s a place where pet owners start to balk at the prices and say, well, I’m not paying this. Do you think that there… Are there benchmarks that you look at that signal to you when we’re reaching a point of price inelasticity? Do you think that there is an ability, a capacity to continue to raise prices for another year like this? Or do you think that 2023 is going to be the year that pet owners go, no, I can’t. I’m not doing this.

Sheri Gilmartin:
Yeah. That’s a good question. Certainly when we look at the average percent price increase on a service and in 2022, it was a larger increase on professional services. I think for our products, for the most part, were just passing on any price increases from the manufacturers. But then the price increases that we saw last year were predominantly on professional services. And we then will look to see how many invoices did that service then continue to appear on, to try to get a sense of after that price increases, did owners start saying no to that?

Dr. Andy Roark:
Interesting.

Sheri Gilmartin:
And I think it’s when we look at compliance numbers from last year, compliance with wellness care, so vaccinations and heartworm tests and annual blood work and fecals, compliance is actually up across the board. So we’re seeing the pet owners that are coming in continuing to say yes to services for their pet, which is a great thing, but we’re seeing the decline in visits. So to answer the question about at what point this impact, I think that people will continue to come in. People want to provide good care to their pets. That situation where your pet is shaking their head and you think, okay, every time I go to the veterinarian it costs me $500. So can I get away with not going for this head shaking right now?

Dr. Andy Roark:
Sure.

Sheri Gilmartin:
Can I phone a friend? Can I do a Google search? How can I get away with not going? And so that probably will continue to impact the visits.

Dr. Andy Roark:
Yeah, that makes sense to me. I have two friends and they’re arguing right now and one of them says that there are things we can do in efficiency and in home delivery with our pharmacy that can keep us cost competitive and that is a battle worth fighting. And I have another friend and they’re both very smart people and the other friend says, we should let this go. We should increase the prices on our professional services, our diagnostics, and let a lot of the product services go. Or I mean, and his position is rather extreme. He’s like, well, I think we should get out of this product business. I listen to the two of them argue and they both have some good points. And I’m curious, where do you fall in this argument?

Sheri Gilmartin:
Yeah. I agree with you that they both have good points. If you just look at percentage of total revenue from professional services, obviously it’s a lot higher, it’s a bigger piece of your business and your margins are higher there. At the same time, your product sales are 25% of your revenue. And so if you let them go, you have to increase the prices on your professional services to make up for that. And we know that pet owners get sticker shock, right?

Dr. Andy Roark:
Yeah.

Sheri Gilmartin:
When we are thinking about implementing price increases for 2023, VHMA is a great resource in terms of strategic pricing and really being intentional with your price increases as opposed to just doing a blanket price increase across the board to try to reduce any sticker shock, but still having a significant impact on your practice revenue. I think that not only is the product purchases a big percentage of your total revenue, but it’s like destination shopping, right?
You need to get prevention, you need to get food, you need to get glucosamine supplements. And having those, the pet owners are going to do that and having them get it from you and having those touchpoints, whether it be through your online store or whether it be coming into your practice, it’s maintaining that relationship and that total service for the pet. So, while I think that they both have good points. If I owned a practice, I would try and compete. I would try and compete and try to keep that business to the best I can. And there’s tools for practices to be able to compete.

Dr. Andy Roark:
Oh, I agree. I’m split down the middle. I think I really go back and forth. I say I am generally a pro competition guy. I think that there’s a lot of things that we can do. I think there’s good communication. I think there’s a lot of, like I said, autoship, direct home delivery, things like that. I think convenience is a huge deal for a lot of people. I think that there’s some things that are going to be really hard to keep. I don’t think it’s all or none.
I think it’s about having a smart strategy about where you can be competitive, where you bring the best value, where you can support pet owners and making things as simple and convenient for them as possible. I think that there’s a lot of good strategy in that. I also hear my friend who says, we should charge for our knowledge and our intellect and our hands on services because those are the things that we really excel at that other people can’t do. So to me this is very much a happy medium. I was just curious as to where you fell in it. And I also thought it’s sort of an interesting way to ask you what your advice would be for practices and how if you had one, you would approach this. So that’s why I want to put that out to you.

Sheri Gilmartin:
Well, I think most practices today have an online pharmacy and offer home delivery, but they don’t promote it. If you asked their clients, if their clients knew that they had home delivery and an online store, maybe and I’m being generous, maybe half of them might say, oh, that… So they don’t promote it. And when you think about the third party pharmacies that are out there, they have heavy marketing.
I mean, you’re getting bills and retargeting as some social media. I mean they are all over the place marketing to your clients. And so there’s the practices know who their patients are and what medications they’re on or what diets they’re on. I know who’s had a heartworm test and who’s been in the last year and you need prevention and I know what you’re buying and there’s automated services that will do this marketing for you. Companies, Vetsource will do this marketing for you. We’ll send reminder emails that you need to get more medication and here’s a link to do that easily. Practices just need to market to their clients that this is available in the same way that the competitors are.

Dr. Andy Roark:
Yeah, it was funny you say that. Because I was thinking about that today when I woke up this morning and I opened up my inbox and I got eight different emails from companies that I haven’t really engaged with that are like, do you need this for your pet? Do you need this for your pet? And they’re like, they’re fishing. They have no idea what I need for my pet. But they’re like, we got this thing and we got that thing. And I don’t think veterinarians should be that way, but I do think there is a happy ethical medium in between. Hey, we have these things but we feel kind of awkward talking to you about them, so we’re just not going to say anything and buy some random stuff from us.
There’s a lot of healthy space between those two things. And I really think, the way I put it to people is, my position is, I would say that veterinarians have a moral obligation to tell pet owners what we can do for them and to educate them about how we can help keep their pet healthier. And to me a lot about communicating our services and as far as home delivery and things like that to make their life easier and to make these things appear as needed, it kind of falls into that, this is a good thing for them and it’s a good thing for us category. So anyway, that’s just where I am. It sounds like you and I are in a pretty similar position there.

Sheri Gilmartin:
What you said about you’re getting these emails with just blanket marketing, hey, look at all the stuff we have. That’s not what we’re suggesting. Part of our job at data services is to utilize the data in the practice management software to find who’s that canine that he’s had an exam and in the last 12 months he’s had a heartworm test, he needs heartworm protection, and he’s on this product and oh, we’re going to help that pet owner out and say, hey, Fluffy still needs their heartworm prevention, just a reminder for you to do this.

Dr. Andy Roark:
Yeah.

Sheri Gilmartin:
And it’s very specific and it’s very personalized and it is continuation of care for that patient. It is not just neon signs of sale.

Dr. Andy Roark:
Yeah.

Sheri Gilmartin:
Look at all these things.

Dr. Andy Roark:
Yeah, exactly.

Sheri Gilmartin:
And so, that to me is a service that I would want to provide my clients.

Dr. Andy Roark:
Yeah, it’s the difference in a recommendation from your doctor and just a general drive-by advertising campaign for whatever happened to be on sale. They’re radically different things.

Sheri Gilmartin:
But that’s what the competitors are doing, right? I mean, it’s that they’re retargeting, they know what you searched for on their website, but they don’t know your pet and they don’t know what’s going on with your pet and what medications your pet’s on and the practices do. And so I think that they have a huge advantage over some of the other pharmacies and just need to choose to compete and utilize the services that are available.

Dr. Andy Roark:
Sheri, thanks so much for being here. Thanks for talking through this with me. I really appreciate it. Where can people find you? Where can they learn more about Vetsource, about data services?

Sheri Gilmartin:
So on vetsource.com, you can learn more about data services and the work that we do for veterinary practices and for the industry with market research. And then if anybody has any questions or wants to talk about data specifically with me, I am on LinkedIn under Sheri Gilmartin.

Dr. Andy Roark:
Awesome. Guys, thanks so much for being here. Thanks again, Sheri.

Sheri Gilmartin:
Thank you.

Dr. Andy Roark:
And that is our episode. Thanks again to Sheri for being here. Guys, thanks to you for being here. If you got something out of the episode, if it made you smile, if you learned something, feel free to share it with your friends who might like it. It’s how people find the podcast. Always feel free to write us an honest review wherever you get your podcast. That always means the world to me. But again, take care of yourselves, be well. I’ll talk to you later. Bye.

Dr. Karen Felsted joins the podcast to explain the rollercoaster ride that has been the veterinary practice sale market over the last 5-10 years. If you are interested in understanding corporate consolidation in the veterinary industry, or in one day buying or owning a veterinary practice yourself, this episode is not to be missed!

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

LINKS

PantheraT: https://www.pantherat.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

ABOUT OUR GUEST

Dr. Felsted is a CPA as well as a veterinarian and has spent the last 20 years working as a financial and operational consultant to veterinary practices and the animal health industry. She is active in multiple veterinary organizations, has written an extensive number of articles for a wide range of veterinary publications and speaks regularly at national and international veterinary meetings. In 2011 and 2017, she was awarded the Western Veterinary Conference Practice Management Continuing Educator of the Year and in 2014, the VetPartners Distinguished Life Member Award.

EPISODE TRANSCRIPT

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Dr. Andy Roark:
Welcome everybody to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. I’m here with my good friend, Dr Karen Felsted said she is amazing. We talk all about what is going on with practice sales in vet medicine, meaning corporations buying practices, individuals buying practices, individuals selling practices, corporations selling practices. What does this all mean? Where is it going? What are the trends? What can we look forward in the future? Because guys, I really do think that ownership of practices, it shapes the culture of our profession in very profound ways. And so guys, Karen’s got some of the best insight that I have heard on what this really looked like, and she changed the way that I thought a bit about how ownership is shaping up in our profession. So anyway, really interesting conversation. If you’re interested in things, the economics of our profession, I’m so glad she was here. She’s really, really amazing 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, Dr. Karen Felsted. Thanks for being here.

Dr. Karen Felsted:
Thank you for inviting me.

Dr. Andy Roark:
It is absolutely my pleasure. You are a legend in vet medicine. For those who don’t know you, you do many things. You are a veterinarian, you are Dr. Karen Felsted. You are also a certified appraiser for veterinary practices. You’re a CVPM, you lecture all over the world, you write all over the place. I read your column in the Fountain Report, which is a nerdy business newsletter that if you like business, you should get it. It’s called the Fountain Report. I’ll put a link in the show notes. You write for Today’s Vet Business as well. I think I see you in AHA Trends sometimes. You tend to write all over the place. I remember getting started as a speaker and you were already established, and I have seen you do presentations on industry research. I’ve seen you talk about buying practices, selling practices. I’ve seen you talk about key performance indicators. I’m kind of a fan boy, if you haven’t noticed, I celebrate your whole catalog. I’ve watched you for years and you just do great, great work. So thank you for being here.

Dr. Karen Felsted:
Thank you. It’s very high praise from you because you’ve certainly done a fantastic job in getting out there and talking to practices and sharing information and making it fun and interesting too.

Dr. Andy Roark:
Well, thank you. So I read a lot of your stuff. I saw something that you wrote recently and you were talking about the veterinary practice sale market. And this is just something that I’m just really interested in is the buying and selling of vet practices. I think that there’s real implications for our future of our profession in what that looks like and how that goes. I will tell you, I’m kind of a romantic in the way of, I want veterinarians to be involved in running veterinary medicine. That’s a thing for me. I like small businesses and small business owners, and I want to keep that in our profession to some degree. And so I’m just interested in that and all those things that come along with the selling and buying of vet practices.
And so I want to talk to you about that today, and I really want to try to get my head around where are we with the sale market of vet practices. So let me start out wide, and I just want to ask you, just pitch you softball, but let you kind of open this conversation up. Tell me the story of veterinary practice sales over the last, say five years or so. So jump back two years, pre-pandemic-

Dr. Karen Felsted:
Pre pandemic.

Dr. Andy Roark:
And talk to me about what’s going on and then just bring me up to speed with where we are.

Dr. Karen Felsted:
Yeah, this is a great topic. I love talking about this topic because like you said, there’s just a lot of nuances to it and certainly had a major impact on veterinary medicine. Much of it good, some things I think are a little bit challenging. So it’s a good topic. But anyways, if we talked four years ago, five years ago, whatever, pre-pandemic, there were certainly a lot of corporate groups around then, you also had individual sales. And I think the biggest thing that we have to start off is by separating the sales market into selling a practice to a corporate group or selling a practice to an individual veterinarian, whether that’s an associate or somebody that you find through a broker and comes in and buys all of your practice because it’s the same in that you’re selling your practice, but the markets are very, very different.
If we’re talking about the really hot market these days, it’s the corporate sale market, and that’s certainly the one that gets all the discussion and that people talk about and the amazing multiples that get tossed around out there, the prices that people are getting. That’s from the corporate market. Certainly, corporate sales were very strong a couple of years ago, pre-pandemic, when finally the Coronavirus hit, I’d say there was a couple of months there, there was a little bit of a pause because nobody knew what was going to happen. And corporate groups and individuals for that matter were a little concerned about buying. Though I had a couple of individual sales go through at a time I would’ve considered the most risky, and those practices have done great. We got incredibly lucky in that we were designated in essential service. And so practices have done really well, as you well know, I mean sometimes almost too well. I mean, people are tired, they’re burned out. We struggle with mental health issues. But from a money standpoint, a business standpoint, it’s been great.

Dr. Andy Roark:
So hold on. I need to parse this apart a little bit. So convince me that there’s two different markets when you say selling to corporates and selling to individual people because I had not thought of it that way. I guess part of the thing I wrestle with is I look at corporations buying practices and I look at individual veterinarians wanting to buy practices, and I’m like, these are just different species. These are not remotely the same entities talking about this. So I just hadn’t thought of it as two different markets because if we’re buying and selling baseball cards, they’re just baseball cards. You know what I mean? And whether you are an individual person or a company, you’re still just buying a baseball card. So convince me a little bit more about these being two different markets. Help me crystallize that in my mind because that’s a different concept than what I’m used to.

Dr. Karen Felsted:
I think when I think about them being two different markets, there’s probably two major areas that drive that comment. So one is just if you sell to an individual, usually the practice is going to operate the way it’s always operated. Largely, I mean, it’s not that a new buyer won’t come in and make some changes, but it’s essentially going to operate the same way that it has. And you as the seller, sometimes you’ll stay in the practice, you may work full-time, you may work part-time, you may entirely leave, and the buyer, the individual veterinarian and the independent veterinarian buying the practice replaces you. Now, if you sell corporate, I mean, in many ways the practice operates the way that it has. It’s going to be in its same location. I mean, you’re still going to offer the same services. You’re presumably going to have the same client base, but there are some major internal changes there.
Probably the biggest area of changes, it’s not so much in the medicine side of it. I think most people that sell to corporate and most veterinarians who work for corporate are fairly pleased with how corporate approaches the medicine side. But there are definitely big changes in the management side. If you’re the practice manager, if you’re anybody in the practice who’s had a lot to do with the management of the practice, that changes. I mean, corporate’s going to have its own way of doing the accounting, its own way of the steps you have to go through to purchase supplies, drugs, equipment, whatever, their own ways of dealing with HR type issues. A lot of that is positive. A lot of that makes it very easy now. So practices get sick to death sometimes, or managers and owners get sick to death of having to do all that administrative stuff.
So now they don’t have to go out and find the best payroll service or find who should handle their retirement plan or whatever because there’s a group that’s helping them. Or I think corporate groups are better at finding veterinarians, although it’s hard for everybody right now. So the corporate group helps with that. They have definitely positive things that they do, but it absolutely changes what is done inside the practice. And people like some of that, but they don’t always like some of it and there’s no question that the corporate owners are going to do some things differently. So that’s one thing that to me makes this two different markets. And as a seller, you’ve got to make sure that you understand what your responsibilities will be going forward after selling and that you’re willing to do that. You’re almost always going to have to stay with the practice for X number of years, particularly in the smaller the practice is, the longer you’re going to have to commit to.
Whereas sometimes when you sell to another independent person, you can leave immediately. And now part of that is just because we have such a tight market for veterinarians, but the other piece, and this is probably the biggest one that I think drives that distinction of there being two different markets, is the price that’s paid. I would say typically when we talk about the multiple, that’s a translation of the profits of the practice into the price that somebody’s willing to pay. And the multiple is the number that gets you from the earnings, from the profits to the price. And I would say typically a multiple in an independent practice sale is somewhere from four to maybe not quite six.
I don’t really usually see them much over six, and five give or take a little bit is pretty typical. A multiple when you’re selling to a corporate group, and multiples are changing now, and we can talk about that as well. But instead of four to six, let’s say last year it was 15 to 20.

Dr. Andy Roark:
Yeah, that’s bonkers.

Dr. Karen Felsted:
So instead of getting a million dollars for your practice, you get four million dollars for your practice. I mean, enormous differences and the money that corporate can and will pay for it is different than what individuals can and will pay for it. In that regard it’s very separate markets, even though it’s the same practice.

Dr. Andy Roark:
Yeah. So when we talk about internal changes that we tend to see with corporates that will take over our practice, it’s been my impression that five, six, eight years ago, it seemed fairly rare that they would make significant internal changes or that those changes were few and far between. They would update generally the business operations, but left a lot of things alone. And it’s been my anecdotal impression that the number of internal changes have been increasing in recent years. And I don’t know if it’s because the market is becoming more mature. And again, I don’t have anything to back that up. That’s just me looking at practices and feeling like there’s a lot more change that tends to happen today than used to happen. And I think that’s probably a lot of the corporate groups figuring out how to run practices or how they want to run practices or their business is maturing. Does that resonate with you at all, or would you push back on that? Am I misguided?

Dr. Karen Felsted:
No, I think I could see that. It’s not the first thing I think of when I think of the corporate market, but I think that’s probably true. But I think it depends on the kind of practice you are. Largely, if you’re doing well, they’re going to leave you alone except for some of the things that are going to change. I mean, they’re going to change how you do the accounting, how bills are paid, how payroll’s done, how you order drugs and that kind of stuff. But a lot of the other stuff, they’re not necessarily going to change, but it does. If you’re doing well, they’ll leave you alone if you are not doing well, if the practice isn’t performing the way that they want it to or that it should, or there’s a lot of turnover in employees, or there’s a lot of customer pet owner complaints, then I do think they’re going to get involved more.
And I think that comes back to what you said. I think they’re learning how to run practices better, but I think they’re being forced to learn how to run practices better because it’s a challenging environment within the corporate world right now. And it used to be you could put together a small group and you could buy 100 practices and you’d flip it and you’d make a ton of money just through essentially the arbitrage effect. But now it’s not a guarantee that you’ll get this increased multiple when you sell your 100 practices or your 500 practices or whatever it is, and you’ve got to do better. And you may end up holding onto those practices for longer. And if you’re going to make any money out of it, it means operations have to be strong. And also with the prices that corporate are paying, profits have to be strong because they’re paying these enormous amounts of money even now with multiples coming down.

Dr. Andy Roark:
Yeah, I want to unpack the changes that we’re seeing in some corporate pressures, but first I just want to explore this. This is a little bit more in the two markets. In order to have a healthy market, you have to have buyers and sellers, that’s what makes a market. And so I understand who the buyers and sellers for the corporate market are. When you’re talking about the independent market, who are the sellers? Who are the people who are like, I’m-

Dr. Karen Felsted:
That’s a great question.

Dr. Andy Roark:
That 15 times multiple sounds high to me, I’d rather have four times multiples. How do I get in that market? Help me understand how that market survives.

Dr. Karen Felsted:
So it’s partially, I mean, probably the biggest distinguishing factor between the two markets is the size of the practice. And whether you measure that by revenue or number of veterinarians, that’s going to be the biggest. The corporate groups want a million and in half in revenue and two or three doctors at a minimum. A year ago, we were seeing corporate groups by practices that were, say a million in revenue and even one doctor practices, at least in my experience, they backed off a lot on doing that. And even that, I wouldn’t say was massively common. There were plenty of corporate groups that didn’t want to buy practices that small. So what, 50% of practices are still these tiny practices or relatively small practices. So those, they’re going to be sold independently because there’s no other way to sell them.
And then you do run into a few veterinarians who are just like, “I don’t like the corporate market. This isn’t where I want veterinary medicine to go and I’m going to sell it independently.” I’ve actually worked with two practices this year. One’s a big practice, I mean, close to five million dollars in revenue. They’d get a fortune if they sold it to corporate, but they’re not. He’s selling to an associate and another one that’s a little smaller, a couple million in revenue. Both of those though, most practices of that size, and similar to these practices, I’m thinking of sell to corporate, but you get a few that don’t, and honestly, those are really lucky associates that can buy those practices.

Dr. Andy Roark:
Yeah, I have seen some of those. That makes sense to me. I’ll buy into that. I used to think that we were going in a direction where independent practices would either, if you wanted to be an independent practice owner, you were going to need a startup or you were going to need to do a turnaround. But what I’m hearing from you is you can probably buy a small place that’s doing okay. All right, that makes sense to me.

Dr. Karen Felsted:
Yeah, you can definitely buy a small practice. I think buyers have less interest in doing that, independent buyers, but you can definitely do that and you can build it. And if you’ve got the ideas of how to make this be a cool practice and attract pet owners to it, you can do amazingly well with it.

Dr. Andy Roark:
Yeah. How do you think these two markets balance out, Karen? Are we going to a 60/40 corporate independent ownership ratio, or can you prognosticate that?

Dr. Karen Felsted:
Yeah, I would say that if we talk about general practices, because we’re mostly talking about small animal, both general and specialty practices. But let’s talk about small animal general practices. Now, I would say somewhere between 25 and 30% of the physical practices, the locations have been sold to corporate. So let’s say a quarter, little bit more than a quarter, maybe. Now when you look at it from a revenue standpoint, it’s probably twice that it’s 45, 50%, because they’re mostly buying the bigger practices. So if we talk about specialty in emergency, it’s a much bigger number. 70%, 80% of those practices have been sold. So that part of veterinary medicine is very, very corporatized. General practices less so, but there’s still a fair amount there that have been bought by corporate, at least from the revenue perspective, not so much the location perspective.

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 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.
Let’s talk about what you touched on earlier on. Let’s start to unpack some of the changing pressures on the corporate sides and the corporate practices. So you said that their position is a little bit different than it used to be. Yeah, talk to me a little bit about that with we have rising inflation, we have possibly some pressures coming from being a more mature market. I think there was a lot of money flowing into vet medicine, and I hear whispers now that people kind of want to know what their return on investment has been, and there’s things like that. Is any of that true and does it look like?

Dr. Karen Felsted:
Oh no. I definitely think there’s more pressure on corporate, and I think the bubble has, if not entirely burst, it’s leaking a little bit. And a year ago, there was so much competition amongst corporate groups for the good practices. I mean, some of the prices that I saw are beyond belief, and I stopped telling clients, “oh, that’ll never happen.” Because as soon as I said, “That’ll never happen,” they get this totally astounding offer and I look like an idiot. So I have tempered how I phrased things.

Dr. Andy Roark:
Yeah, I understand that.

Dr. Karen Felsted:
Because it was nuts, but I think multiples are definitely coming down and I think corporate groups are managing their risk a little bit more. And it’s all because of the things that you mentioned. I think it’s two big issues. We have the inflation, we’re unclear what pet owners are going to do as far as taking care of their pets, and we also have the hiring problem. And finding a veterinarian right now is an utter nightmare. Finding a registered technician is an utter nightmare. And this is not anything that anybody thinks it’s going to change any anytime soon. Matt Salois, who used to be the chief economist with the AVMA, he did a webinar a couple of months ago. He thinks this is a 10 year problem. And I’m like, oh my God. That’s a long-

Dr. Andy Roark:
He’s been on the podcast a couple of times. Yeah, I really appreciate his insight.

Dr. Karen Felsted:
He’s great.

Dr. Andy Roark:
He’s a smart guy.

Dr. Karen Felsted:
And I believe him when he says things. So that’s a big issue. So because of that, the corporates are paying less for practices. Though if you’re a good practice, I mean, you can still get a very nice amount of money, but as I said, they’re managing their risk a little bit more as well, which means when they’re buying a practice, they’re buying revenue essentially, and they are working hard to make sure that that revenue is going to be in place. So if that means an owner doctor maybe a year ago would only have to stay a year and now they have to stay two years, or maybe it’s not an all cash offer. Maybe what they want is a joint venture where the corporate group owns 60% of the practice, the seller continues to own 40%, but they have more skin in the game. The seller has more skin in the game to make sure that this still works well.
Or they have earn outs, which means that you’ve got to hit certain revenue levels or profit levels before you’ll get all of the purchase price. Or the non-compete is more stringent than it used to be. And I think sometimes sellers quibble about that, but it’s kind of hard to complain when somebody’s handing you bazillions of dollars. I mean, you can understand why the corporate groups are nailing that down.

Dr. Andy Roark:
That absolutely makes sense. Where do you see this going? As you look ahead in 2023 and… Yeah, I mean, I know my crystal ball, I thought it was good until 2019 and then it just fell apart and it’s got duct tape on it now.

Dr. Karen Felsted:
I agree.

Dr. Andy Roark:
But yeah-

Dr. Karen Felsted:
I think prior to the pandemic, we had a pretty good idea where veterinary medicine was going. And now every time I think, this is what’s going to happen, it doesn’t.

Dr. Andy Roark:
Yeah.

Dr. Karen Felsted:
Yeah.

Dr. Andy Roark:
Yeah, I agree.

Dr. Karen Felsted:
I think independent sales, they haven’t been as heavily impacted by the pandemic as the corporate sales. Are there fewer veterinarians wanting to buy practices? Maybe, but we’ve been saying that for 10 or 15 years and yet it still happens.

Dr. Andy Roark:
I wonder about that. I think that there’s a narrative that, and there may be a little bit of misogyny baked in here of, as pet medicine has gone increasingly female, people go, “Oh, well, veterinarians don’t want to own practices.” And I go, “Are you just saying that, or is that really true?” I’m not sure I’m on board with that. I don’t know. Some people can make a good work-life balance argument and say, “Well, the younger generation doesn’t want that type of ownership.” And maybe there’s something true. I’m just not sold on the idea that entrepreneurial spirit’s not there.

Dr. Karen Felsted:
I totally agree with you, and I saw a very interesting study, I probably read this 10 years ago, and it talked about how women’s career paths are somewhat different from men’s. So men come in early, charging ahead from the very beginning. Women come in at the time they’re starting in their careers, they’re also starting families. They may have parents that they have to take care of, whatever. So you sometimes don’t see women really surge forward and want to own practices or start their own businesses or whatever until later in their careers than men do. So when we’re all busy saying, “Hey, veterinarians don’t want to own practices.” And certainly we’ve had the whole feminization of the profession, but some of that is we’ve also had women in the early stages of their careers. So I’m not completely convinced about this either. I do think the rising salaries, some veterinarians are like, “Hey, it’s just easier to stay an associate because I’ve got a great salary, good benefits. I want to have family time. I want to have time to do whatever my hobbies are.” And that does make it easier.

Dr. Andy Roark:
I see that with some of the corporate groups that I work with where if you’re in a well-managed practice, and boy, especially as busy as we are, if you get paid on production and things like that, there’s a lot of doctors who generate a really good salary for themselves, and they wash their hands at the end of the day and go home and nobody calls them and they go, I don’t have to worry about making payroll. Yeah, I like this. I definitely get that. I think it’s interesting. It’s interesting kind of the decisions that people make. Let’s talk a little bit about best practices, pitfalls on both sides. So let’s say that you were someone who, say you own a practice and you’re considering selling. Give me some, let’s start with pitfalls, most common pitfalls I want to look out for, and then a couple best practices. How do I do this?

Dr. Karen Felsted:
Yeah. I mean, you want to have a well run practice. Because I mean, everybody, whether it’s an independent veterinarian looking to buy a practice or a corporate group, the better run the practice is and the more profitable it is, the better that’s going to be for the seller. The more profitable it is means the more money you’re going to get for it, and the better managed it is, you’re just more likely to have more potential buyers. And so that comes down to all the usual stuff, better inventory control, expense control, a well-organized team, a well trained team, a well managed team, obviously good quality medicine, but I almost think that’s kind of a given. Good customer service, people like you, they come back to the practice. It’s all that same stuff we’ve talked about in management for as long as I’ve been doing this. And those are kind of the core basics, but I think they’re more important now than they used to be.

Dr. Andy Roark:
Yeah, that totally makes sense to me. All right. Let’s flip it to the other side and just say that you are a young doctor or a doctor practice management dynamic duo who I love to see. I love to see a technician and doctor buy a practice together. I’ve seen it a number of times. God, it just makes me happy for some reason I can’t explain, but I love it. So say we have our young entrepreneur or entrepreneurial partners and they want to do their thing and they would like to buy an established practice, give me pit pitfalls to look out, for best practices. What do you say to these people as you ride in the elevator with them?

Dr. Karen Felsted:
Obviously, it’s due your due diligence. And I know it sounds self-serving, but you need an advisor. Particularly on the financial side, because if you’re going to buy a practice, and this is whether it’s a veterinarian or a veterinarian and a non-veterinarian or whatever, but you need to thoroughly understand the price that’s being asked for the practice and whether that’s a reasonable price. And just because somebody puts a price out there doesn’t necessarily mean it’s a reasonable price. And sellers need advisors too, because they need somebody to help them decide what is a reasonable price. So you need financial and legal due diligence, and it doesn’t mean… You can find a practice that has some problems and as long as it’s low-hanging fruit, it’s things you feel like you can really make a change on, as long as it’s priced fairly to recognize the fact that the practice has those problems, that can be a great opportunity.
You don’t want to buy a practice that has some really significant deal breaker kinds of things. It has a terrible reputation in the community, or it’s going to take a fortune to buy the equipment that you now need or renovate the facility or something like that. I mean, there’s some practices out there that… There’s a situation I’m aware of where, I mean, there’s a veterinarian in a smaller community can’t even give this practice away. I mean, it’s too bad. It’s a sad situation when a veterinarian who’s had a decent practice for years and years and years ends up in that situation.
I will say if you’re a seller, and there’s not a lot you can do about this at some point in your career, but buyers are more interested in practices that are located in bigger communities. So urban areas, suburban areas. If you’re in Timbuktu, Texas, it’s a little bit more of a challenge to find an individual buyer or find a corporate buyer. But what do you do about makes sense that if you’re 55 and this has been your practice for 30 years? Then what you do about it is you focus on making the money you’re going to need for retirement before selling. And hopefully-

Dr. Andy Roark:
Yeah, I was going to say.

Dr. Karen Felsted:
[inaudible 00:30:42] You sell the real estate.

Dr. Andy Roark:
There you go. I mean, that’s really it, hope for the best and prepare for the worst to say, “Well, I’ve got 10 years before I’m out of here. I need to look at my cash flow and make this happen.” And the other thing I do see people doing, which I think can be a beautiful thing, is if you’ve got some time, is to build that pipeline and mentor somebody if you can. And say, “Hey, I know it’s going to take me a long time to find someone, so I’m going to go ahead and start 10 years early trying to bring someone in.” I’ve seen that that work for people if you can find the right person.

Dr. Karen Felsted:
If you can find the right person and somebody that wants to be in the community that you’re in, if you’re in Timbuktu, Texas, but you find somebody that grew up in Timbuktu, Texas and wants to come back there. Yeah, exactly.

Dr. Andy Roark:
I think it works better if you can also do the cash flow thing as well. Because when it gets sad is when people are desperate to bring someone in and it’s just a painful situation. It’s not good for anybody.

Dr. Karen Felsted:
It’s painful. Those are the worst situations when I get somebody call and they’re like, “I’m a one doctor practice and I could even be a very profitable one doctor practice, but I can’t find a buyer.” Or it’s a one doctor practice and it’s not as profitable as they thought it was. And it’s like, you should have thought about this 20 years ago.

Dr. Andy Roark:
Yeah, I know some very profitable, very good practices from a cultural standpoint, meaning they’re very happy and their teams are very happy. Don’t get the impression like, oh, if they had a great place, someone would want to come there and work there. Geography is a powerful motivator and moving to someplace that someone doesn’t have any roots and there’s not a lot of nightlife or opportunities for a spouse, those things are hard. Nobody’s doing anything wrong, but those are obstacles. What are your favorite resources for somebody who’s interested in this? They want to learn more about how veterinary markets work or what’s going on in our profession, or part two, if they’re interested in buying or selling a practice, where do you send people just to get started reading and learning more?

Dr. Karen Felsted:
So certainly if you look at many of the conferences that are out there, whether we’re talking in-person or virtual, there will often be a session or a couple of sessions on buying or selling a practice. That can be useful. Look at some of the major publications out there. So you mentioned the Fountain Report. You mentioned Today’s Veterinary Business. They will regularly have articles on buying and selling practices. That can all be very useful. Like I said, again, I understand it sounds self-serving, but I strongly believe that you need a good team when you’re buying a practice or selling it, either way. And you’re going to need a financial advisor to help either put a price on the practice or evaluate an offer being made. And you are also ultimately going to need a legal advisor as well, somebody to help with the contracts for that.
I think that that is critically important for any practice, purchase or sale, especially important on a corporate sale because they have fleets of Wall Street lawyers who are protecting them, the corporate groups. And so a seller needs that as well, but it’s important all the way around. And then ultimately they’re going to need, everybody has a strong sense of how to run a practice once they come in. And so when you talk about getting up to speed and resources and stuff, a ton of what’s available out there at conferences and in publications and webinars and whatever, it’s just about how to manage a practice. And so thinking about, okay, what do I want this practice to be like once I own it? And that’s a little bit farther down the line, but you can’t start too soon on that.

Dr. Andy Roark:
Yeah. Karen, where can people find you online? How can they reach out if they have questions, things like?

Dr. Karen Felsted:
That? They can reach out to me. My company name is PantheraT, which is P-A-N-T-H-E-R-A-T. It’s short for Panthera Tigress, which is the genus species of tigers. And I just picked it because I wanted kind of an interesting and fun company name, but when I called GoDaddy, the guy said, “Pan the Rat, is that really what you want for your domain name?” So that was an unintended consequence.

Dr. Andy Roark:
Oh, that’s so funny. Pan the Rat.

Dr. Karen Felsted:
But people remember it.

Dr. Andy Roark:
I thought it was, I was Panthera. I thought you were big into eighties heavy metal. That was-

Dr. Karen Felsted:
No, it’s the genus and species of tigers. So like I said, I like tigers. Just wanted to do something fun.

Dr. Andy Roark:
Pan the Rat.

Dr. Karen Felsted:
So you can Google PantheraT, you can Google my name, it’ll come up. But love to talk to people about anything that they’re dealing with in their practices.

Dr. Andy Roark:
Well, you are amazing. Thank you for being here. I’ll put links in the show notes for the references that we talked about. I’ll put links for-

Dr. Karen Felsted:
Pan the Rat.

Dr. Andy Roark:
Now all I can see is Pan the Rat. That’s all I can see when I look at it. Anyway, I’ll put links to Karen and Karen’s practice as well. And yeah, guys, she’s wonderful. If you have questions, definitely reach out. Gang, take care of yourselves, be well everybody.
And that’s it guys, that’s our show. I hope you enjoyed it. I hope you got a lot out of it. Special thanks to Karen for being here. She is amazing. If you enjoyed this show, as always, tell your friends, share the podcast. Leave me an honest review wherever you get your podcasts. It’s how people find the show. It means the world to me. And if you’re like, God, that Andy Roark is so awesome, I’d love to hang out with him.” Check out some of my online training courses for teams. I have a Charming the Angry Client course and a Exam Room Communication Toolkit course. They are on-demand courses. They’re made for teams to take and for groups to take together. It’s all about discussion questions and I’ve got some goofy video examples and things like that. But anyway, you guys be well, take care of yourselves. I’ll talk to you soon. Bye.

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

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.