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Wellness

New Veterinary Business Models to Keep Pet Care Affordable

June 23, 2022 by Andy Roark DVM MS

Dr. Bob Lester believes owning pets shouldn’t be a luxury that few people can afford. The veterinary profession needs to think creatively about how to keep medicine accessible to pet owners across socioeconomic groups. In this episode, Dr. Lester joins Dr. Andy Roark to discuss his recent article which outlines 15 new business models our profession might approach to help pets get the care they need.

Cone Of Shame Veterinary Podcast · COS – 144 – New Veterinary Buisness Models To Keep Pet Casre Affordable

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


LINKS

Tear Down the Wall (Original Article):

Tear Down the Wall

Wellhaven Pet Health: https://wellhaven.com/

Uncharted Veterinary Podcast: https://unchartedvet.com/blog/

NEW Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/store/

What’s on my Scrubs?! Card Game: https://drandyroark.com/training-tools/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark


ABOUT OUR GUEST

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

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

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

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

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

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

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

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


EPISODE TRANSCRIPT

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

Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here today with my friend, Dr. Bob Lester. We are talking about paradigm-shifting ways, business model-changing ways to keep pet care affordable for pet owners. And so, we start to just unpack some ideas. What could the future look like? What are some things that we might see going forward?

Dr. Andy Roark:
I know this will get some people fired up. We do talk about changing the way that we leverage nurses in our profession. We talk about employer subsidized care. We talk about government subsidized care. We talk about tax benefits for pet owners. It’s really all over the place, as far as, what are things that we could possibly unpack as a profession to make sure that pet care stays affordable for pet owners?

Dr. Andy Roark:
While we take care of ourselves, while we address the student debt issue for veterinarians, while we lift up our support staff and pay them a living wage. Guys, super thought-provoking episode. Dr. Lester is always awesome. 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 back to the podcast, Dr. Bob Lester. Thanks for being here.

Dr. Bob Lester:
Great to be here, Andy. Always fun to catch up with you.

Dr. Andy Roark:
Man, I was thinking earlier. I don’t think I’ve invited anybody on the podcast as often as I have invited you. You are one of my favorite thinkers. I read your stuff whenever it comes out in Today’s Veterinary Business. I like your perspective and I like to hear your thoughts on things. Thanks for making time for me.

Dr. Bob Lester:
I am honored. Likewise, I listen to you on my walk virtually every morning.

Dr. Andy Roark:
For those who don’t know, you are a co-founder, chief medical officer at WellHaven Pet Health.

Dr. Bob Lester:
Correct.

Dr. Andy Roark:
You are also, because you have so much free time, the president-elect of NAVC.

Dr. Bob Lester:
Yes, indeed.

Dr. Andy Roark:
And you are a regular columnist in Today’s Veterinary Business, so you stay busy.

Dr. Bob Lester:
As we all do in this profession.

Dr. Andy Roark:
I wanted to talk to you about … You wrote an article called Tear Down the Wall in February’s Today’s Veterinary Business magazine. The premise was, “More pets from lower-income households and their owners will reap the benefits, if we are imaginative about how we deliver veterinary care.” And so, I want to talk to you, because this is a big thing in my mind these days.

Dr. Andy Roark:
I am looking a lot at accessibility and affordability of vet care. I’m looking at the marketplace. I see salaries for veterinarians going up, which is good given student debt. I see salaries for support staff going up, which is way overdue and needs to happen. I see more and more specialists. I went to a CE event last night, which was great. It’s the third specialty clinic in our area, where we had one forever.

Dr. Andy Roark:
All of a sudden, we just bang, bang. We’ve got two more now. And I’m going, “Wow. Specialty care is coming up.” At some point, how does this not trickle down to the pet owners in a way that makes us inaccessible? You look at shortage of veterinarians. Classic supply and demand says, “Well, there’s not enough supply.” And so, the demand goes up and the prices go up, which is going to attract more people to vet medicine.

Dr. Andy Roark:
But we’ve got this ethical ceiling that most of us see. Where you go, “I don’t want prices to go up to make what we do inaccessible to a lot of people.” And so, that’s where my head has been these days. I’m really thinking a lot about, how do we do this? How do we keep our profession financially viable, and meet the needs of our people, and not burn them out as they’re overworked and overstressed? And at the same time, keep our services available where people can have pets? Because I don’t think any of us want pets to be a luxury item.

Dr. Bob Lester:
I think you’ve summed up the issue well. As further backdrop, I think we have to acknowledge that the profession is in a time of abundance. So much is going on. Pet numbers are up. Pet spending is up. Pet lifespans are up. Euthanasia is down. America’s love affair with the pet has never been stronger.

Dr. Andy Roark:
Yep.

Dr. Bob Lester:
However, against a backdrop of a workforce shortage. The supply and demand mismatch, as you pointed out. What are we going to do? Our teams deserve more money. They deserve flexible schedules. They deserve better benefits. To meet that, recognizing that we’ve never had more pricing power with the increase in demand, fees go up and up and up.

Dr. Bob Lester:
Good, as you point out, that people within our profession are certainly earning that and deserve that and more. Bad, in that it continues to raise that barrier of care. How can we help those somewhere near half the pets in the US that won’t see a veterinarian this year? While maintaining quality care and taking care of our teams and our doctors, their compensation needs and benefits and flexibility, wellness and life needs and all of those things?

Dr. Bob Lester:
It always comes down to raising fees as a result. I think we need to be looking at different models. From the traditional model that we all grew up on. We love it. The James Herriot, “All creatures, great and small. All things to all people,” has got to change to, “Some creatures, great and small. Some things to some people.” So that we can become more efficient, help more pets, continue to compensate and treat our team members well, while delivering a broader service to more people.

Dr. Andy Roark:
I completely agree. Somebody was talking to me recently about the future of vet medicine. And I said, “I think the future is shattered.” Meaning, you’re going to see a wide variety of different kinds of practices. You’re going to see high volume, low cost practices. Or limited services practices, or mobile practices, or white glove practices.

Dr. Andy Roark:
I don’t think that’s bad at all. I think that’s what needs to happen. But we cannot have everybody doing all things and pulling our hair out about, “How do we practice the gold standard of care and also be accessible to every pet owner?” That’s a losing proposition for us as individuals and practices.

Dr. Bob Lester:
We’re singing from the same sheet. Our consumers have changed. Millennials and Gen Zs are the dominant consumer now. Their needs are different. Their expectations are higher. Their bond is stronger. Our workforce has changed. Our workforce isn’t willing to be on call every other week. Work six days a week, take one week of vacation. All of that has changed, so we have to change the model.

Dr. Bob Lester:
Change is always painful, but it’s necessary. That doesn’t mean we completely walk away from that primary care, great citizen, great person there in each community that is there to be the quarterback. To be the general practitioner, the primary care provider, that knows you and your pets. However, there are other models as well to take on some of the other needs. In some cases, in a more efficient manner.

Dr. Andy Roark:
I agree. I also really like the way you laid this out. I don’t think there’s a silver bullet. I don’t think you think that either. It’s a multimodal approach. It’s not, “Hey. We’re going to do this one thing and the problem’s going to go away.” It’s like, “No. I think we need to approach it from a variety of different aspects.”

Dr. Andy Roark:
How do you want to start to lay this out? Because I want to talk to you about some of the options that you and I both see, as far as how we can get this job done or what the future might look like. Do you have favorites? Do you have things that you think should happen first? Do you have things that you think we are closer to that might be easier to implement?

Dr. Bob Lester:
Definitely have favorites. As you point out, it’s an, “And.” There isn’t a silver bullet. We have to do this and that and the other. As we specifically look at some of the new models that are out there and emerging, there’s several that I find really appealing. The idea of nurse-driven care.

Dr. Bob Lester:
We’ve got States in which the Practice Act reads that under indirect supervision, our veterinary technician nurses can do virtually anything but diagnose, prescribe, and do surgery. Why not have one veterinarian oversee five or six limited care run by nurses? We’re seeing those pop up in a number of states now.

Dr. Bob Lester:
I think that’s one model that has a lot of potential to better utilize our teams, better empower veterinarian technician nurses, offer higher compensation, and treat more pets at a lower price point. It’s not, “All things to all creatures,” but it is, “Some to some,” and will help break down those barriers to care.

Dr. Andy Roark:
For me, I think that’s a big one as well. I know it’s a controversial idea.

Dr. Bob Lester:
Yes.

Dr. Andy Roark:
I think people can get really fired up about it. But as I look at this and I say, “We don’t have enough veterinarians.” We also have a problem attracting, especially, credentialed or licensed technicians. I was talking to someone just a while ago, who’s very big into technician regulations and things like that at the state-level. She was saying, “When you look at what unlicensed technicians make relative to licensed technicians, in a lot of cases, it’s hard to make the case that they should go and they should get that education.”

Dr. Andy Roark:
The other thing is that when you go … This person teaches at the tech college, where you have technician programs. She says, “We have these people come in, and they look at our program. They look at the average salary of credentialed techs. And it’s $30,000.” Something like that. And then, they look next to it, and there’s an ultrasound technician for human healthcare and it’s $70,000.

Dr. Andy Roark:
They go, “That’s a big difference for a similar length of program.” I go, “How do we make this competitive for them?” There’s a way to do it. And I think nuance is important. But that may be the win-win. Empowering credentialed technicians. You’ve got to have a licensing program. Because we’re not talking about taking people off the street, training them in-house, and having them do significant procedures.

Dr. Bob Lester:
Right.

Dr. Andy Roark:
But that may be the win-win of it. It gives the technicians things to aspire to, to grow new skills. A way to justify salary that makes our profession attractive to them. And it also reduces the burden of overload on veterinarians. Because I don’t see anybody turning on the spigot to release a bunch of new veterinarians soon.

Dr. Bob Lester:
No. That’s a 6, 8, 10-year fix. I’m encouraged over COVID. I think we have finally seen our profession take some significant steps towards embracing team healthcare delivery. Our profession’s roots have always been one doctor, one exam room, one truck, one stable. Whatever it might be.

Dr. Bob Lester:
We’re the fiercely independent John Wayne out there doing everything ourselves. We shoot every film, chart every chart, fill every pill bottle. And it’s silly. No other healthcare profession does that. COVID and the mismatch in supply and demand is really driving veterinarians, in some cases for the first time, to delegate and really take advantage and leverage and empower and honor their teams.

Dr. Andy Roark:
I think that’s true. I think that dentists have it right. I think the dental model with the dental hygienist carrying a lot of the weight, doing a lot of the heavy lifting, making a good living for themselves. And then, also, you are efficiently moving a dentist through that office. I go, “Man. I think those guys have a lot figured out.”

Dr. Andy Roark:
I wonder how much of this transition … Because I think you and I are on the same page. The opportunity for this to take root, I think it happens a lot in our education systems. I’m seeing some movement in that direction of starting to talk more about, “When you’re a doctor, this is how you interface with a team.” And, “Hey, doctors. Here’s how you leverage the technicians.”

Dr. Andy Roark:
I don’t think it used to be taught that way. I remember going through vet school back in the day. It was very much you were trained as the technician. That was part of the training process, is you were trained how to do everything. I get that. The doctors should be able to do everything. But I think you should be able to do it, and then be trained how to utilize and leverage your technicians so you don’t have to.

Dr. Bob Lester:
Exactly. It’s part of our education. We should be training side by-side veterinary students with tech students. That only takes place in two or three schools today in the human model. You certainly see them training side-by-side. Veterinarians need to remember their job is diagnose, prescribe, and surgery. Everything else, we can delegate.

Dr. Andy Roark:
What do you think about the potential of more non-profit practices?

Dr. Bob Lester:
I like the move. The shelter world has an interesting business model. They essentially were set up to put themselves out of business. Let’s place every pet in a home, and once they’re all placed … What is it the shelter will do? Well, we’re not there yet.

Dr. Andy Roark:
Right.

Dr. Bob Lester:
But in the case of dog overpopulation, we’ve largely turned the corner. We’re making big strides with cats. The shelter world has such a great reputation, does such wonderful things. However, as their primary mission in placing homeless pets begins to wane, they’re taking on new things. From forensics to wildlife to community education to community veterinary care. To fill that niche that you and I aren’t filling, because people don’t have $60, $70, $80, $90 for an office call to come in.

Dr. Bob Lester:
I’m really encouraged by what they’re doing. They’re picking up a segment of the population that traditional veterinary medicine has been poor to serve. And that’s not a blame thing. We can’t do it for free. With the benefits of pet ownership, comes the responsibility of paying for good care for that pet. For those that can’t afford the traditional, this gives them one more lower cost alternative to get good basic care.

Dr. Andy Roark:
It’s funny. I always joke that we can beat ourselves up no matter how well we’re doing. You can beat yourself up for working too much and you can beat yourself up for not working enough. It seems like a lot of us jump back and forth. When we talk about non-profits or we talk about shelter, medicine, things like that … And I get it. I’m not criticizing.

Dr. Andy Roark:
But veterinarians can jump really fast from, “We are overwhelmed and people can’t afford our services.” And then, they flip to the other side and go, “How dare these shelters do medicine there and take this clientele?” And I go, “We’ve got to pick our poison here.” Do we want to have the accessibility in our own practices? Or are we okay to let that part of the market go, so that we can focus on our target clientele and still feel good about it?

Dr. Bob Lester:
And still partner with those shelters. They’re still placing pets. Those pets are going to need a veterinarian. In many cases, it’s going to be you or I. As veterinarians, I think we’re silly not to be best friends with our rescues, our shelters, and do all we can to help them and be thankful if they can take care of some of the pets that we’re unable to.

Dr. Andy Roark:
I think that’s interesting. I see a niche I had for non-shelter, purpose-driven, non-profit practices. I think that there are people out there who want to live their values and believe in accessibility. I could 100% see non-profit practices being set up for the purpose of providing care for people who couldn’t otherwise get it. And it just being a very intentional decision of, “This is the market that we’re going to serve.”

Dr. Bob Lester:
We’re in, again, this period of abundance in our profession. There is certainly more business than they can handle. The challenge is, “Can we get people in there to take care of that?” In the shelter world, in the non-profit model that we’re talking about, they have an enormous recruiting advantage.

Dr. Bob Lester:
You can go to that student that’s two or $300,000 in debt, have them go to work for a qualified non-profit for 10 years, and erase the debt. They may not be able to pay what a traditional for-profit is, but if they invest 10 years … To your point, it’s mission, it’s hard, it’s purpose. It feels right. And at 10 years into it, my debt disappears. That’s tremendous. That’s a win-win.

Dr. Andy Roark:
I agree. Hey, everybody. I just want to jump in real quick with a couple of updates. Gang, before I do though, I’ve got to give a shout out. I’ve got to give some love to Banfield. The pet hospital. Guys, they have stepped up and supported us in getting transcripts for both this podcast and The Cone of Shame Veterinary Podcast, which is the other podcast that I host.

Dr. Andy Roark:
They do it to increase accessibility and inclusion in our profession. That is a big point for them right now. It’s something that they are doing for our whole profession and industry. They stepped up and put their money where their mouth was and said, “How can we help you?” I said, “Hey. This is a thing that people have asked for.” And it’s a big lift for us. Banfield said, “We got you, buddy.”

Dr. Andy Roark:
They have made this happen. If you want transcripts for our podcast, we’ve got them. Head over to unchartedvet.com. You can see all of our podcasts and you can see transcripts for those. Feel free to share them. Help us get the word out. But I’ve just got to give some love to Banfield. Because they didn’t have to do that, but they did. And it is awesome. Thanks to them.

Dr. Andy Roark:
Over at Uncharted Online on June 29th at 8:30 PM, Eastern Time, 5:30 Pacific. That is PM, not AM. We’re not doing a 5:30 AM Pacific thing. Guys, over at Uncharted Online. You can join from anywhere. My friend, the one and only practice management goddess, Stephanie Goss, is doing her Teamwork Mind Meld: Setting Expectations for Team Communication.

Dr. Andy Roark:
Guys, do your teams struggle from a lack of accountability? You’re like, “People don’t do what they say they’re going to do. People don’t follow up the way that they should. People don’t communicate in a way that stuff actually gets done. They are making assumptions about what is going to happen that are not realistic, and it is continuing to cause problems between the team and management.” Guys, I see this all the time.

Dr. Andy Roark:
Stephanie Goss’s workshop is all about setting expectations for how the team is going to communicate. Just think about how much you need that. This is a two-hour actual workshop. Come with your camera. Come ready to talk about your practice. This is going to be stuff that you can take home and plug right into what you’re doing and actually make a difference in the way your practice functions. To take this back and engage it with your team in a way that’s going to make a difference. Guys, I hope you’ll check it out.

Dr. Andy Roark:
Stephanie Goss is amazing. Uncharted workshops. They’re uniformly pretty freaking fantastic. I do love them. I’ll put a link to that down in the show notes. Guys, as you might have heard, my brand new Exam Room Communication Training Course, it launched on June the 7th. It is my 17 tips, tools, tricks, and hacks to make you and/or your team more effective in the exam room. Guys, this is the stuff that I lecture on all over the world. It is my absolute best material. I wanted to make it available to everybody.

Dr. Andy Roark:
I have people who always come up to me after my talks and say, “That was great. How do I teach my staff to do that?” I’ve got you now, buddy. I’ve got you covered. Because you can take this to your team. It is 100% module. It is broken up into five-minute modules that you can drop into your staff meetings. Tag it onto the end of a team training meeting. You can do it in the morning huddle. You can go through. Everything stands alone, so you can pick the things that you like. Skip the ones that you don’t.

Dr. Andy Roark:
You can look and say, “We need this the most in our practice. Let’s do this.” Guys, the course pays for itself. If there’s one thing that you take and you give to your team and they go, “Light bulb moment,” it is the fact that it’s made to go back to your team and be interactive, which means everything comes with discussion questions. You can say to your team, “How do we do this? What does this look like in our practice? How could we do this better? What opportunities do we have for improvement here?”

Dr. Andy Roark:
I give you those suggested wordings and questions to ask, so that you can get your team to engage. Guys, I’m super proud of this. I’m super happy. For the first 30 days, so until July the 8th, it’s $100 off. It is a launch special. I don’t want this to slip past you. If you’re like, “I want to try that out.” Grab it now. Grab it while it’s got $100 off. I will put a link in this show notes. But guys, I hope you love it and you enjoy it.

Dr. Andy Roark:
And if you haven’t checked out my Charming the Angry Client course, it’s built in a similar model. It’s been very popular. People who have had it can tell you about what it’s like. You feel free to ask, because it has gotten very good reviews. A lot of people have gotten a lot of mileage out of this. But guys, I want you to be able to train your team. Specifically, your team. Not some generic team.

Dr. Andy Roark:
I want you to train your team in a way that’s going to work in your practice. This is why I made this tool, so it can get taken and used as you want to use it. So it supports your culture and your practice and the way that you guys work. Anyway, I hope you’ll check it out. Like I said, I’m over the moon that it has launched. Boy, it’s been a lot of work for me and my team, but I think it’s going to be totally worth it for those of you who check it out. All right. Let’s get into this episode.

Dr. Andy Roark:
Let’s talk a little bit about support coming from outside the industry. You were one of the first people that I had heard talk about employer subsidized care. I think that’s an interesting idea. Can you lay out the thought process there and what that would look like?

Dr. Bob Lester:
We talk about the workforce shortage within the veterinary profession. It’s certainly a big issue. Approaching a crisis issue. However, there’s a workforce shortage across many segments of society. Those employers are looking to attract and retain good talent. They’re looking at their benefit offerings. Well, two-thirds of Americans own a pet. We’re crazy about our pets.

Dr. Bob Lester:
If you could go to work for one employer that offered you some a pet subsidy, whether it’s through a wellness plan or pet insurance, or whatever it might be … That might be a deciding factor in you taking that job or not. We’re seeing more and more that employers outside of the veterinary world are offering benefits within their offerings to their employees to help better care for their pets.

Dr. Andy Roark:
That’s my favorite. The employers pick up the tab? I like that. That still seems really good to me. It’s interesting. Have you seen evidence of that happening?

Dr. Bob Lester:
In fact, I had a neighbor the other day telling me that their employer offered a specific pet insurance company. I’ve forgotten which one it was, but they were asking me about pet insurance. “Hey. My employer subsidizes this. What do you think? Is that a good deal?” And that was just a completely unsolicited person telling me about it. Anecdotally, I’m certainly seeing more and more of it.

Dr. Andy Roark:
I think that’s interesting. I had Dr. Michael Blackwell on the podcast a while back. We didn’t really get much into aligned care, but that’s his baby. You put that forward as something that you’re positive about.

Dr. Bob Lester:
What Dr. Blackwell is doing is so noble. He no doubt described it better than I could, but working again to help people that are underserved today. He’s brought quite a collaboration of people together and spent the last number of years on it. Noble effort, and one more, “And,” as we look at, “How can we knock down barriers to care?”

Dr. Andy Roark:
His premise, when I was talking about … I don’t want to misstate how he was working with it. He was working with a number of local groups to assess the need in underserved communities and things like that. I’m trying to remember where. It was almost a political action committee that he was working on.

Dr. Bob Lester:
My expertise is limited as well. My recollection and my last reading on it. He was taking an approach, at least my interpretation, as they’ve done in human care. Looking at all the different providers out there that could help subsidize. How could he pull those similar groups together with an aim towards veterinary care as opposed to human healthcare?

Dr. Andy Roark:
It was the idea of … There are so many health benefits to owning a pet that this is worth subsidizing from a human public health perspective. That was how he was approaching it. I like that case a lot. I think that’s the type of innovative thinking, kind of like what we were talking about. With employers outside the profession looking for ways to attract employees.

Dr. Andy Roark:
You say, “Well, let’s take a look at this.” And I think that was really the core of his insight and his genius is to say, “We know the benefits of healthcare that people get from having pets. At some level, it’s worth subsidizing pet care for the health benefits that people get from them.” I think that’s a really interesting approach and argument. I hope he finds success and gets traction making that pitch.

Dr. Bob Lester:
I think it’s brilliant. If you own pets, you’re less likely to be obese. You have lower blood pressure. You’re less likely to have a heart attack. Your children have fewer allergies. Your emotional wellbeing is stronger. The savings in human healthcare, which is what? 20% of GDP. It’s huge. Just a rounding error of savings by having pets in your household to human healthcare could really reverberate through the vet profession, once that’s widely recognized.

Dr. Andy Roark:
Talk about those sorts of benefits. You had the idea of pet ownership as tax savings. Talk about how those connect.

Dr. Bob Lester:
Same concept, and not my idea. I think there was actually legislation introduced in California, a number of years ago. It went nowhere and its time may not have come. But again, when you look at the savings in human healthcare to families that own pets. By having fewer medical needs for two-legged animals, I think there’s a big case to be made that by having a pet you save money on the human side.

Dr. Bob Lester:
Hopefully, we’ll see that in our lifetime. We’re certainly seeing more and more data to that. Just looking at HABRI and what Dr. Blackwell and others are doing. It’s a potential big win for pet society and our profession.

Dr. Andy Roark:
It would be pretty nice if you could write off your bad dog who eats socks. That would help me out. That would help me out a lot. It’s funny how our relationship with pets continues to grow and change. We talk about the health benefits and things like that. People’s level of connectedness with their pets. I look at the interface of technology with this.

Dr. Andy Roark:
We talk about the insight into our pets that we’ve had before that we never used to have. My technician that I work with has a water bowl that’s got a microchip scanner on it and a scale built into it. It’s called a Felaqua. She gets updates on her phone when her cats drink water and how much water they have drank today. She loves it. She’s always sharing with me.

Dr. Andy Roark:
She’s funny. She has a pirate theme among her cats. She has all pirate names for her cats. She named the water bowl, “The Sea.” And so, she gets alerts that say things like, “Anne Bonny drank one ounce from The Sea.” She just laughs and laughs every time.

Dr. Bob Lester:
That whole concept, I think of as a connected pet. In our lifetimes, I think that’s also going to lower barriers to care. Imagine sensors in the water. The scale, the food, the litter box. Cameras in your home that can pick up gaits and activity and facial expressions indicating pain. Wearables.

Dr. Bob Lester:
Connect all that data together along with what we see through virtual or physical exams, client observations, and all those millions of data points coming in filtered through some form of artificial intelligence. I think, in our lifetime, we’re going to see some big changes in how we practice medicine. And once again, the opportunity to lower barriers to care to help more pets.

Dr. Andy Roark:
I had Dr. Sheila Robertson on just a little while ago. She was talking about the new international guidelines in feline pain management. They were using the Feline Grimace Scale, and they have an app that goes with it. That’s educational for pet owners, to help them figure things out.

Dr. Andy Roark:
I think about that app and I think about Google photos that I have and what it can do, which is ridiculous, as far as processing images and facial recognition stuff. And I go, “How long is it until we do shoot a video of a pet?” Or we do take a photo of a pet and it automatically runs a Feline Grimace Scale on our cat and says, “This is concerning.” Why wouldn’t we go that way?

Dr. Bob Lester:
Yep.

Dr. Andy Roark:
I think that’s really interesting.

Dr. Bob Lester:
It’s exciting. And that dovetails into the whole idea around telehealth. Again, sometimes controversial. But can we remotely reach out and help more pets at a different price point? Well, in my mind, we can and we should. We’re moving in that direction slowly, but we’re moving that way.

Dr. Andy Roark:
I think the staffing shortage is the biggest thing that’s screwing us up there. You know what I mean? The very understandable pushback that we get when we talk about telehealth is that people say, “Look, I’m in the exam room more than I want to be.” Stepping out of the exam room to do telehealth, especially if I don’t have high demand for it right now from clients, it doesn’t make financial sense.

Dr. Andy Roark:
I could be in the exam room putting hands on pets and actually staying really busy. Financially, at present, that makes a lot more sense. I think that there’s a tipping point. There are some practices that are starting to do more telehealth. The model that I’ve seen that’s really cool … I actually had one of the co-owners and the virtual manager at Adobe Animal Hospital on the podcast recently.

Dr. Andy Roark:
They were talking about their hospital. And so, what they’ve done is they’ve started having some people work from home. And so, part of their workforces work from home, and they have a chat set up through their website. When people go to the website, it says, “Would you like to talk to somebody?” They made the point that you can have a CSR working from home.

Dr. Bob Lester:
Got you.

Dr. Andy Roark:
They can chat with three people instead of talking on the phone to one. And then, they had a doctor set up that they could kick questions over to as a virtual visit and say, “Well, would you like to see our doctor virtually?” They could just kick over there. They’re also a big enough hospital that they could keep that doctor busy with scheduled virtual appointments. And then, also picking up stuff coming in through the chat.

Dr. Andy Roark:
And I go, “Well, that makes a ton of sense.” It also drives a lot of their other business, because they only work with their own clients. And then, they’re often bringing these people in. And so, they’ve got this flywheel, where this thing makes sense and feeds a lot of other things going on in their practice. I say, there’s insight there. As far as how this tool fits in with the other things that we’re doing.

Dr. Bob Lester:
Without a doubt. The opportunity to delegate to your team … In that case, CSRs. Or in many cases, nurses, before it gets to the doctor to triage. And then, the efficiencies around asynchronous. So much can be done through telehealth when you have a minute.

Dr. Bob Lester:
They send us a message, a picture, whatever it might be, between appointments or at home in your bunny slippers. Taking care of those cases, that can bring huge efficiencies to a practice. But again, to your point that we’re so understaffed now. It’s difficult to go in and disrupt existing workflows when we’re all running at 110% already.

Dr. Andy Roark:
Yes, it is. Change takes effort. Even delegation takes effort. I’ve been talking to people a lot about this recently. We struggle to hire or we struggle to delegate. And then, I have people who actually do hire. They do delegate or they’re trying to make change.

Dr. Andy Roark:
We’re doing that in my business right now. Trying to do some significant change in our workflows and the way we do things. Man, it’s a ton of work. Because basically, you’re doing your whole workflow, while you’re training someone else to also do the job that you could just do faster yourself.

Dr. Bob Lester:
Yep.

Dr. Andy Roark:
But that’s the short view. And so, I think a lot of times … You’re right. When we are just barely keeping our nose out of the water, it’s really hard to consider making a shift in our workflow, in our processes, and trying new things. You go, “I’m working too hard to experiment.”

Dr. Bob Lester:
You got to slow down to go faster. And that’s a tough sell.

Dr. Andy Roark:
It is a tough sell. Well, Bob, thanks so much for being on. I always appreciate your time and coming and talking with me about these things. I get fired up and I really appreciate your perspective on the industry. I like how you think outside the box. Where can people find you? Where can they learn more about WellHaven and what you’re doing?

Dr. Bob Lester:
They can learn more about WellHaven at our website, wellhaven.com. I can be reached through LinkedIn. Or if someone wants to email me directly, I can be reached at bob.lesterdvm@wellhaven.com.

Dr. Andy Roark:
All right. Thank you, sir.

Dr. Bob Lester:
Great talking with you, Andy.

Dr. Andy Roark:
And that’s it. That’s what I got for you guys. I hope you enjoyed it. I hope you got something out of it. If you’re checking us out on YouTube, hit that subscribe button. If you’re listening on podcast, guys, leave us an honest review wherever you get your podcast. It’s really the nicest thing you can do. It’s how people find us. It makes my day when it happens. Gang, take care of yourselves. Be well. Talk to you later. Bye.

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

New Research – Wellness for Vets, Staff & How They Differ

April 7, 2022 by Andy Roark DVM MS

Guest: Dr. Addie Reinhard – It’s no surprise that both veterinarians and their support staff have high rates of burnout, but are these groups experiencing stress for the same reasons? What can individuals do to reduce these stresses? What can practices do to protect their people, and what role does personal autonomy play in all of this? New research, the Merck Animal Health Veterinary Wellbeing Study III, sheds light on not just the factors causing psychological stress in the veterinary profession, but also what we can do about it.

Cone Of Shame Veterinary Podcast · COS 130 New Research- Wellness For Vets, Staff & How They Differ

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

LINKS

Merck Animal Health Veterinary Wellbeing Study III: www.merck-animal-health-usa.com/about-us/…ing-study

Are They Ready? Trials, Tribulations, and Professional Skills Vital for New Veterinary Graduate Success: www.frontiersin.org/articles/10.338…021.785844/full

AVMA Wellbeing Resources: www.avma.org/resources-tools/wellbeing

QPR Training: www.avma.org/resources-tools/we…revention-training

MentorVet Website: www.mentorvet.net

MentorVet Instagram: www.instagram.com/mentorvet/

Uncharted Veterinary Podcast: unchartedvet.com/blog/

Uncharted Veterinary Conference: unchartedvet.com/uncharted-april-2022/

What’s on my Scrubs?! Card Game: drandyroark.com/training-tools/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Addie Reinhard is a veterinary wellbeing researcher. Her research focuses on developing and evaluating innovative interventions to support mental health and wellbeing within the veterinary profession. She is the Founder and CEO of MentorVet, an evidence-based mentorship and professional development program for recent veterinary graduates. She is on the research team for the next phase of the Merck Animal Health Veterinary Wellbeing Study. In 2021, she completed a master’s degree in Community and Leadership Development and a Graduate Certificate in College Teaching and Learning from the University of Kentucky and holds a certificate in Veterinary Human Support from the University of Tennessee. She is also a certified QPR instructor.


EPISODE TRANSCRIPT

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

Dr. Andy Roark:

Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here today with one of my good friends, Dr. Addie Reinhard. For those of you who do not know her, she’s a veterinary wellbeing researcher. She is the founder and CEO of MentorVet. She is an awesome, enthusiastic speaker, presenter, thought leader. She is someone who you are going to hear about in the coming years and decades in vet medicine because she just brings such passion and enthusiasm, and she’s doing such cool stuff. I’m super fan boy over Dr. Reinhard. She’s just phenomenal. You’ll hear why I’m such a big fan on this podcast.

Dr. Andy Roark:

She is here talking about brand new research. It’s the Merck animal health veterinary wellbeing study. She presented this at VMX conference, which is where I got to become aware of it. Man, this is not just research on stress and burnout. This is research on what do we do about it, and how does the staff feel it, and why and how is the staff different than the doctors, and what do we do about that, and what are the role of the individual doctors, and what are the role of the practices, and what are the role of the individual staff members as far as actually fixing some of these problems.

Dr. Andy Roark:

So if you’re ready to get a little bit more insight and then some actual real thoughts on what steps we as a profession can take to start making this problem better, guys, this is the podcast for you. Let’s get into it.

Kelsey Beth Carpenter:

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

Dr. Andy Roark:

Welcome to the podcast, Dr. Addie Reinhard. Thanks for being here.

Dr. Addie Reinhard:

Hi. Thanks for having me. So excited to join.

Dr. Andy Roark:

It’s my pleasure. You are a shooting star. A shooting star is like somebody’s falling, but you’re the opposite. You’re like a launching star like Magellan. We’re going into space. I just met you a year ago and you are doing the most amazing things, and I’m not kidding. I’m kidding about Magellan, but otherwise, I’m 100% serious about your meteor rise, and you’re doing freaking amazing stuff. So I met you through the company that you are the CEO and founder of, which is MentorVet. You are leaning heavy into a research-based approach into mentorship and wellness, mental health wellness, and veterinary medicine, and you are doing really good work.

Dr. Andy Roark:

You and I talked a couple times on the phone and then I got to meet you in-person at VMX. I’m so impressed with you and such a big fan and supporter of what you’re doing. So I am really thrilled to be able to have you here to talk about some research that you are actually presenting at VMX.

Dr. Addie Reinhard:

Yes. Yeah. One, thank you for inviting me, and it’s been great to connect. Yeah. I think it’s been an amazing journey to get here. I feel like where I was a year ago, I was actually in grad school still one year ago, and I hadn’t even started MentorVet. I mean, we had piloted MentorVet, but really, just the transformation in one year has been really incredible to see just how far that we’ve come. So yes, we presented the data from the wellbeing study at VMX, which is super exciting. We have a lot of exciting new data to share with the community.

Dr. Andy Roark:

Yeah. So I was looking at it. So this is the Merck animal health veterinary wellbeing study that came out just this year, 2022. It was done in September-October, 2021. Merck, just pause for a second, their wellbeing studies, this is I think the third one that they’ve put out, they have been very good and very insightful and very useful for actionable steps as we look at our profession and be like, “Hey, what’s working? What’s not working?”

Dr. Andy Roark:

So just props to Merck for supporting this because, honestly, I don’t know exactly what their return on investment on a study like this is compared to selling products. I feel like it’s just a good thing that they are doing and have done. So I just want to stop for a second and say thanks to those guys for investing into the wellbeing of our profession. That was really an awesome thing.

Dr. Addie Reinhard:

Yeah. Yeah. They’ve been in the wellbeing space. I say this, they’ve been in the wellbeing space before it was cool. So they’ve actually been doing these studies for, this is the third study that they’ve done of the wellbeing study. So I feel like in the last year or two there’s really been a drive for more wellbeing initiatives, but they’ve been doing this before anybody else was doing it. I think that I’m very grateful for them for that, not only that research, but they also support MentorVet in a big way. So they’re really backing a lot of other wellbeing initiatives that are evidence-based and really making an impact on the profession.

Dr. Addie Reinhard:

So yeah, they’re very aligned with sustainability of the veterinarian and the profession because without veterinarians, who’s going to sell the product? So I think they recognize how important the vets are in this entire picture of our veterinarian industry. We have to keep our vets healthy and well so that we can continue in the good work that we’re doing in the communities.

Dr. Andy Roark:

Yeah. One of the things I like a lot about this particular study, too, is they dig a lot into the support staff. So I just loved it. It’s more of a holistic view on the practice, I think. So anyway, let’s get into this because, honestly, I was looking at this, I didn’t get a chance to come to the talk at VMX and I was like, “Ah, I know what I’ll do. I’ll get Addie to come here and just give me the information directly,” and it’s more convenient in my schedule. That’s the arrogant thought that I had.

Dr. Addie Reinhard:

You get a private viewing of the wellbeing stuff.

Dr. Andy Roark:

That’s what I wanted. I was like, “Break this down for me.”

Dr. Addie Reinhard:

“I don’t have time to go to the VMX presentation. I want a private viewing of this presentation.”

Dr. Andy Roark:

I know. I lead a charmed life. There you go. So wellbeing study, what is new? What are high level takeaways? Let’s just get started and crack this thing open. So break down the study a little bit. How did it go? What was it? Then you and I will start to dig to some findings and then we’re going to get into some recommended action steps after that.

Dr. Addie Reinhard:

Okay. Yeah. So I think big picture, not a huge surprise, but as far as psychological distress, we’re in a worse place as we were two years ago. So there’s a higher rate of serious psychological distress among veterinarians, and we think that a lot of this might be related to pandemic stressors. We also know, interestingly, burnout has not increased since two years ago, and wellbeing has actually stayed pretty consistent as well.

Dr. Addie Reinhard:

We know also that the burnout rate among veterinarians is actually not, sorry, the wellbeing rate among veterinarians is actually not significantly different than the general population. So wellbeing, in general, seems to be, average wellbeing, seems to be consistent for veterinarians in the general population, but the level of serious psychological distress is the concern.

Dr. Addie Reinhard:

I think when we break it down, too, by age, the levels of serious psychological distress or burnout or poor wellbeing tends to be much worse in the earlier career for younger veterinarians is really what we’re seeing. I think that’s new for this study is that when we’re looking at essentially concerns and what vets are concerned about really consistent from previous waves of the study that vets are concerned about the stress levels of vets and the staff. They’re concerned about the high student debt. They’re concerned about the suicide rate, but new for this phase is they’re concerned about perceived shortage of veterinarians.

Dr. Addie Reinhard:

So there’s definitely a lot of more concern, I think. I’m sure just with workflow and efficiencies, people are really starting to see some strain and stressors with that. Then you mentioned the support staff side of things. So yeah, we got some data, which I’m really excited about because I feel like there’s not been a lot of survey research done on veterinary support staff. So we knew that maybe they were having issues as well.

Dr. Addie Reinhard:

There was a few studies here and there. Recent studies showed that the suicide rate of veterinary technicians may be even higher than veterinarians. So there’s definitely been some concern there, but we did find actually that the mental health and wellbeing of our support staff does seem to be worse than veterinarians, which is also pretty concerning.

Dr. Addie Reinhard:

I think there’s also a concern about the shortage of qualified support staff as well in addition to the shortage of veterinarians, too. So I think those are some of the big takeaways from the research, but essentially, a big part of doing this research is to track trends over time. So doing a temperature check of the profession every two years to see where we’re at, and it does appear, at least when we’re looking at serious psychological distress, that things have gotten worse since two years ago, which is concerning to me.

Dr. Andy Roark:

Okay. All right. So there’s a lot to unpack, Addie. That’s a lot. All right. I need to step back for a second. Let’s define some terms because there’s important nuance here. So talk to me a little bit about serious psychological stress or psychological stress as you put it, burnout and wellbeing as three distinct states. So while serious psychological stress is going up, our wellbeing seems to be staying the same. Break it down enough for me so that I can understand the terms so I can see how those things can be true at the same time.

Dr. Addie Reinhard:

Yes. Love it. Thank you for that. I think when you’re so ingrained in this research, sometimes these terms are very just used commonly and people might not understand the distinction. So I appreciate the question. So essentially when we’re looking at wellbeing, that is levels of happiness. So wellbeing is not the absence of mental illness. You can have no mental illness and still have poor wellbeing. So essentially, it’s your level of happiness in life and your life satisfaction or work satisfaction or overall satisfaction with your life as a whole.

Dr. Addie Reinhard:

So that’s wellbeing, and then we have psychological distress or we use a scale called the Kessler-6 to measure serious psychological distress, and that’s really gauging mental health and mental health conditions. So it asks six questions. Some of the questions might be related to how often in the last month have you been feeling hopeless or anxious or stressed, things like that. So it really tracks more of your mental health.

Dr. Addie Reinhard:

Then the third is burnout. So we know burnout is a work-related condition, and this burnout is essentially a psychological syndrome that emerges when you have prolonged stress on the job, you’re not coping with it in a healthy way, and the main three symptoms of burnout are cynicism, exhaustion, and lack of professional efficacy or feeling like the work that you’re doing isn’t making any impact.

Dr. Addie Reinhard:

So there are three very distinct things, and they measure each of these scales that we ask essentially measure three very different things. So you can have worse, serious psychological distress, but wellbeing could be okay, right? So I think that that’s the distinction there.

Dr. Andy Roark:

Okay. All right. That makes sense. So jumping back, tell me the story about how wellbeing and psychological stress interfaces for the veterinarian. So I guess when you say wellbeing doesn’t seem like it’s changed, but psychological stress has changed. What does that mean in layman’s terms as far as what is the experience of veterinarians when we’re seeing these intersection of burnout, psychological stress, and then maintaining wellbeing?

Dr. Addie Reinhard:

Yeah. So I think that just tells us that perhaps individuals are having more mental health or a higher proportion of individuals are having mental health challenges right now, but the overall level of happiness in the profession hasn’t really changed in the past two years.

Dr. Andy Roark:

Gotcha. Okay.

Dr. Addie Reinhard:

So I think that’s how I would break that down if that makes sense.

Dr. Andy Roark:

All right. That definitely makes sense. Let’s talk a little bit about, we talked about the last two years specifically, and these are exceptional times, and there’s a global pandemic, and we saw all the things that come with that, and people picking up curbside, and clients not wearing masks or worrying about the staff being sick and having staff being out because someone got COVID and now the staff is contact tracing and things like that. I mean, these were really strange times. Can you unpack a little bit more what exactly the impacts of COVID were on the mental health of the doctors and staff and how does that manifest?

Dr. Addie Reinhard:

Yeah. So we essentially asked several questions about the impact of the COVID-19 pandemic on both the team, as well as veterinarians, and some of the most pressing issues that were experienced were some of the things that you mentioned. So the practice being short staffed due to individuals being away for illness or family care, the job just increased the exposure to COVID-19, people were working longer hours. Many people did report working longer hours during the pandemic. So I think being that short staffed part of this, I think that was a huge driver in some of the challenges that our veterinarians were facing as far as looking at the impact of this on our bets.

Dr. Andy Roark:

Tell me a little bit about how the staff experience is different from the veterinarian experience.

Dr. Addie Reinhard:

Hmm. Ooh, that’s good. I think that, in general, what we saw at least from the data is that the clinic staff were more impacted by being shorthanded than the veterinarians were, at least looking at the percentage of vets who felt like they faced a barrier because of being shorthanded, but a lot of the staff, I think, faced more challenges. Oftentimes, these individuals are on the front lines, being the first contact for owners at times. Everybody’s on edge right now, right? So there’s likely a lot more conflict happening. They’re getting a lot more of that, I think, than some of the veterinarians are, potentially.

Dr. Addie Reinhard:

Yeah. I think just having a shortage of veterinary support staff in general makes it really hard for the support staff that are currently working. So I don’t know too many of the other differences that we saw, but that was the main one is that the staff were a little bit more impacted by the shortages than the veterinarians were.

Dr. Andy Roark:

Okay. Is there insight into retention inside the profession as far as … Do we think that these shifts that we’re seeing are going to lead to a higher number of doctors or support staff leaving in the coming years?

Dr. Addie Reinhard:

So as far as retention goes, there was very little concern that we would have retention issues in the next two years, at least for the veterinarian side of things. So most of the veterinarians actually answered that they were unlikely or very unlikely to leave the profession in the next two years. So looking at the veterinarians who were under the age of 55, around 75% of them said very unlikely or unlikely to be leaving the profession in the next two years.

Dr. Addie Reinhard:

So I don’t think we’re horribly concerned about a mass exodus, at least from these data, but I think with the shortage of the support staff, so a lot more support staff said that they would be leaving the profession in the next two years. So I think there are more concerns about retention for our support staff, and that’s definitely, I think, an area that we probably need to focus on a bit more. I think nearly a third of vet staff were likely to leave the practice in the next two years. So definitely much more of a concern on that side of things.

Dr. Andy Roark:

Yeah. That’s brutal. I’m going to come back to where we go from here and what do we do about that, but can you unpack a little bit of demographic differences? So I’m talking about types of practice, and then also ages or time in the profession because that seem to have a significant impact.

Dr. Addie Reinhard:

Yeah. So in general when we’re looking at most of these data, in general, younger veterinarians are typically going to be more at risk for serious psychological distress, for burnout, for lower wellbeing as compared to older veterinarians. So I think age has a huge factor in this. So when we’re looking at particularly burnout, around 75% of vets under the age of 35 are moderately or severely burnt out based on the survey.

Dr. Andy Roark:

That’s abysmal.

Dr. Addie Reinhard:

That’s a lot. Only a quarter of vets of early career vets were feeling low levels of burnout. So that’s a concern because I think when you look later in the career, so it tends to slowly improve over time. So I think a little over around 60% of vets over the age of 35 were in that range. So still a lot, yeah, right around 60% vets are feeling moderate to severe burnout right now even in the older age groups. So that’s a concern to me.

Dr. Addie Reinhard:

I mean, we know burnout is an issue in the general population as well. So I don’t think it’s unique to veterinary medicine, but it still is a problem that we need to address, right? So that’s very concerning to me, especially we’re looking at interventions or what we can do about it. Definitely, our early career vets are a huge focus, and for a lot of the work that I do, a big focus is how can we reduce burnout and make this career more enjoyable because the vets aren’t going to leave. They said they’re not going to leave the profession the next year, but they’re so, so incredibly burnt out.

Dr. Addie Reinhard:

So how can we make it to where they’re not so upset and feeling trapped because I think that’s where you get into trouble when somebody feels like they’re trapped in the career or they’re not going to leave in two years, but they’re so incredibly burnt out. When you’re incredibly burnt out, you feel like quitting the career.

Dr. Addie Reinhard:

So to me, that suggests perhaps these individuals might feel just overwhelmed, trapped by the work that they’re doing. As far as the practice groups, we definitely see, in general, companion animal veterinarians having lower, worse mental health and the equine and food animal veterinarians, at least from this study, had better mental health.

Dr. Addie Reinhard:

So I think that that’s interesting to me, but there are stressors in every industry. I sometimes wonder, and this is an aside from the study speaking from a personal viewpoint, I wonder sometimes the impact, especially when we’re looking at food animal versus companion animal, how much of the stressors that our veterinarians are experiencing are related to access to care issues and these ethical dilemmas and providing care given limited client finances. That’s something that food animal practitioners don’t really have to, they have their own ethical issues, but a lot of our companion animal veterinarians are dealing with these kinds of situations almost every day.

Dr. Addie Reinhard:

When you’ve been taught one way, and this is the gold standard way and this best care or you’re not doing the best that you could do, there’s, I think, a lot of guilt and moral stress there when you’re not able to provide the care that you think you should. So I do think when I look at, at least the distinction between companion animal and food animal, that that’s one factor that I think plays a part in this at least.

Dr. Andy Roark:

Hey, guys. I just want to jump in here with a couple quick updates. If you haven’t checked them out yet, you got to check out the cool gift that we got from our friends at Banfield Pet Hospital. They have decided to support us in putting out transcripts of The Cone of Shame Podcast and also The Uncharted Veterinary Podcast. They’re supporting us in improving accessibility and inclusivity in vet medicine. It is something that Banfield feels strong about and they actually have stepped up and leaned in to make this possible. We could not do it without them. I am so proud to be able to do this, but, yeah. Head over to the drandyroark.com website. You can click on the show notes and you can find the link tree. It’ll take you there as well, but for all of our episodes, we have transcripts.

Dr. Andy Roark:

So spread the word. Check them out. Use them how you need to, however they’ll be helpful to get the word out about the work that we’re doing on the podcast. I just have to say, thanks so much to Banfield.

Dr. Andy Roark:

Over on The Unchartered Veterinary Podcast, speaking of which, we have a brand new episode came out yesterday. It’s about being the newly promoted manager and being friends with the people that you used to work shoulder to shoulder with. We had someone who was like, “Hey, they went out for drinks and I didn’t get invited because I’m the manager now, and this really hurts my feelings.” Yeah, that’ll happen. Stephanie Goss and I break it down. We talk all about how to navigate that, what that’s like, what that emotional process is, maybe where your head should be, some of the pitfalls that people fall into when they go through this transition of going from working with people to going to being the manager of people. If that sounds like you, if that sounds interesting, check out The Uncharted Podcast wherever you get your podcasts. There’s also a link in the show notes.

Dr. Andy Roark:

Guys, that’s enough of that. Let’s get back into this episode.

Dr. Andy Roark:

I saw some research not long ago that talks about the mental health benefits of being outside.

Dr. Addie Reinhard:

Ooh, yeah.

Dr. Andy Roark:

Again, that seems so super simple, but I do wonder, is that a piece of it as well? I mean, really, it’s like when you think about, just think about the workplace, right? So there’s this Buddhist idea that the environment that you’re in deeply affects your thinking and your experience. I think that’s true, and I sit in a messy, cluttered office. I feel anxious and crappy, and when it’s nice and clean, I feel like my life is in control. So I think about the difference in working in an exam room all day long and then also being outside, going to a farm, going to a production area, things like that. It’s part of it.

Dr. Andy Roark:

The other part I actually wonder, and again, this may be absolutely nothing, but the travel time. If you’re a large animal person or you’re going between places, having those little breaks in the middle of the day and actually changing environment, again, this is complete hypotheses just on my part, but anyway, I think about that. The idea of the economics are different. There’s different economic structure. I think that makes a ton of sense and I think that’s maybe more. I’m like, “It’s truck time,” and you’re like, “No. It’s the economics of the …” I’m like, “No. I think it’s the trucks.”

Dr. Addie Reinhard:

It’s the trucks. I do agree with you, though, and just talking with a lot of my mentees in the program, at least some of the vets who do farm calls, they get a little bit more break in between, and they get more time to process, and they have more time to think about cases in between, not saying that it’s still not really stressful and they’re working a ton of hours, but I think when you’re going, and this is coming from a companion animal practitioner’s perspective, but-

Dr. Andy Roark:

Yeah. Totally. We are two dog and cat that’s being like, “I don’t know what their experience.”

Dr. Addie Reinhard:

I don’t know. I don’t know. Yeah.

Dr. Andy Roark:

I think it’s because they’re wearing boots.

Dr. Addie Reinhard:

There’s most certainly I think stressors in both, and it’s really interesting because I’ve done a lot of my own research on the stressors in the early career and why do we see these higher rates of stress and poor mental health specifically in the early career. It’s really interesting because when I’ve talked with vets in small animal or food animal, swine or equine, the interesting thing is the stressors. They are all essentially the same, but the context is slightly different, but the heart of it, the heart of the stressors like conflict, like ethics, like issues around leadership, all of these things are very similar.

Dr. Addie Reinhard:

So it’s really interesting because when I educate a lot of the early career vets on how to cope with some of these stressors that they’re experiencing, in general, the curriculum is pretty consistent across the board for a food animal vet, an equine vet or a small animal vet, but the case examples that I provide are just different and tailored to that aspect of the career.

Dr. Addie Reinhard:

So it is really interesting to think, and I think part of going forward with this issue is all of us, as far as any walk of life in veterinary medicine, are having these similar shared challenges. So if we can come together, instead of saying they have it worse or we have it worse, we’re all facing really similar challenges, and I think coming together and working on these as a shared community will be good going forward.

Dr. Andy Roark:

Oh, yeah. The suffering Olympics are something that we do not want to participate in and we need to stop going. No, I agree with that, and 100%. I only look at that to say, well, if there’s a group that seems less burned out than another group, we should look at what they’re doing, and try to parse that out and say, “What are they doing?” and how do we bring into other places, not, “Look, that’s why I have it worse than them.” It’s like, “No, no.” How do we move this forward? What do you think?

Dr. Addie Reinhard:

That’s a good point. We have to stop that, too, with looking at vets have it worse than just people in general. I think I hear it a lot, especially with the suicide rate. That concerns me, and I think we have to have an awareness that these issues are present within our profession, but I think we need to pull away from the blame game, as well as the comparison game of we have it worse than you because, gosh, we all have it. Everybody, not just vets, are having struggles right now.

Dr. Andy Roark:

Oh, yeah. I think that’s important context. I’ve gotten in trouble for of this a couple times, but I keep trying to bring it back up because I think it’s really important. There’s obviously a lot of specific stressors for our profession. We do have a very stressful job. The narrative that we are the worst profession for suicide, that’s not true. That’s not factually correct.

Dr. Addie Reinhard:

Not true.

Dr. Andy Roark:

That doesn’t mean the individual people aren’t struggling and suffering. Those things can both be true. I think that we have a bad habit of playing a martyr game where we say, “I have it worse.” Again, I think a lot of people take their suffering as a badge of commitment. You know what I mean? It’s almost like, “I give so much that that’s how I see value in myself is I shoulder this heavy burden.” I just think that’s something we need to work back against. The other-

Dr. Addie Reinhard:

Yeah. Oh, go ahead.

Dr. Andy Roark:

The other thing I guess I would just jump in and say real quick is when we talk about mental health is occupational stress is a driver of mental health issues, but it is not the driver of mental health issues that family genetics predisposition or family history relationship, stress, chronic illness, chronic pain, all these other things that generally mental health issues are multifactorial, and a stressful profession can definitely be a factor and a big factor, but again, to break it down to, “Well, this profession feels this way and this profession feels this way,” I think that oversimplifies it and it puts so much weight on our job that if …

Dr. Andy Roark:

I think you touched on it really nicely earlier on, right? If you have this idea that, “I’m not going to leave the profession, but this profession is guaranteed to make me miserable, then I have just given away all of my personal agency, my ability to,” I don’t know, “to feel like I can fix this or I can get out of it. Essentially, I’ve abandoned hope because I say there’s no escape from this, and I refuse to leave, and I go, ‘Well, I don’t know what the path is. That’s not into darkness from there.'” So I think we set ourselves up into that place.

Dr. Addie Reinhard:

Yeah, and I think you bring up a really good point of all the factors with mental health and wellbeing, and that’s one thing, at least with the study that we’ve found is that’s our more neurotic. There’s higher levels of neuroticism in our profession than the general population. We have lower levels of extroversion as well. So we have, in general, more neurotic, more introverted profession, and neuroticism is essentially a level of worry, how much you’re worried about stuff in general.

Dr. Addie Reinhard:

So we know that neuroticism can play a factor in mental health and can be predictive of mental health challenges, especially when put in a stressful environment. So when you’re working, so somebody without high levels of neuroticism may work 50, 60, 70 hours a week and be fine. Whereas somebody with neuroticism working that many hours may predispose them or contribute to mental health challenges, right?

Dr. Addie Reinhard:

So some of these personality factors definitely do play a role. So I think knowing your own personality and what you are able to cope with, and you might not be able to pull the 80 hours a week like your mentor is doing in the practice, and you might not be able to do that and still be okay, and that’s fine. You might have to set boundaries so that you’re not doing that so that you keep yourself well.

Dr. Addie Reinhard:

So I think, again, trying not to, I think you called it a badge, we don’t have to wear that badge. I think we can admit that, “I am not able to work 70 hours a week.” I burnt out at 40 hours a week in veterinary medicine. I experienced a fear burnout twice at 40 hours a week in veterinary medicine. So it can happen, I think, even not working a lot of hours, but I definitely think hours worked combined with personality type of our profession is another factor in all of this.

Dr. Andy Roark:

Yeah. So taking that, one of the things I’m just really interested in, whether it’s in the wellbeing study or whether it’s just your own experience from MentorVet, what is your take as far as the primary drivers for earlier career vets being more burned out than later career vets? Is it financial? Is it a debt thing? Is it a lack of financial stability thing? Is it, I don’t know, a cultural thing? Is it access to social media? I don’t know. What is it?

Dr. Addie Reinhard:

Yeah. So I think in general when we’re looking at wellbeing, it typically improves over time in the general population. So we know, in general, the older you get, the happier you get. So there’s a little bit of just that factor in general, but I think when we’re specifically looking at the veterinary profession, so I did a focus group. It’s been about two years ago now, pre-COVID, assessing the stressors of our early career veterinarians.

Dr. Addie Reinhard:

I think a big factor is essentially going from an environment where you have little responsibility as a fourth year vet student. You have a lot of checks all along the way. You’re transitioning into this environment now where you’re expected to have full responsibility so suddenly. It happens overnight. These are your patients and you are terrified of screwing up. You’re just so scared, this fear, overwhelming fear of making mistakes, and maybe you don’t even make the mistakes, but you’re just terrified of screwing up. I think that’s a big factor is this self-sufficiency and self-doubt.

Dr. Addie Reinhard:

I think another factor is conflict. So learning how to navigate conflict or how to navigate these tough ethical situations, and when you’ve been in practice five, 10 years, you learn as you go. You learn these skills. You get more comfortable with these conversations or how to operate in this gray area. I think that’s a huge stressor for our early career vets is learning how to operate in the gray area because in veterinary school, often we’re taught a gold standard approach and not really any in between options.

Dr. Addie Reinhard:

So when you get into a practice setting where there’s barriers, whether that be financial, your own skills and availability, your staff’s availability, you can’t always do the gold standard, and maybe it’s not always the right thing to do, the gold standard. So I think a lot of the stressors that they experience is learning how to be a practitioner in not an academic setting, operating in that gray area, and feeling good about the care that they’re providing. I think that’s the really tough part because often they feel like they are a bad vet. They’re not doing what was modeled in the academic institution.

Dr. Addie Reinhard:

There’s been a lot of research around essentially identity developments in the early career and in vet school, and veterinarians who have this more diagnosis-focused identity where, “I am only getting joy from my work if I diagnose this pet and provide the gold standard treatment,” right? So those vets are going to be really unhappy in private practice because they aren’t going to get to do that very often. Whereas there’s another identity, essentially this challenge-focused identity, that’s more focused on professional autonomy and how I can use my judgment in each individual case to provide the care for this context and this situation and adapt and manage challenges and looking at how my joy is coming from my work and more than one way than just treating and diagnosing animals.

Dr. Addie Reinhard:

So is it helping an owner? They had $100 and I helped them and, wow, we made the pet better. Maybe we didn’t do the gold standard thing, but the pet’s better now. So that’s a huge win. So I think those are the main things I see at least assuming a leadership role as well, just learning how to delegate, being new in a practice and really learning to navigate the intricacies of the support staff and learning how to delegate. So I think as far as my research goes, particularly looking at the transition of practice, those are some of the main contributors to stress.

Dr. Andy Roark:

Yeah. That’s really insightful. That makes a ton of sense. Let’s transition now to some action steps. Actually, one of the things I really liked in this were recommended steps for both the individual and then also the employer. I think they’re both important to hit on. I’ve got this real belief that our best approach to mental health problems in our profession is three-tiered. It’s at a professional level, it’s at a practice level and it’s at an individual level. So I like to see things broken out into this is what the individual can do, and this is what the employer can do. I feel like those two things go hand-in-hand. So do you want to lay down the pieces, whether we do individual or employer first, but lay down those pieces and then how they interact?

Dr. Addie Reinhard:

Yeah. Let’s start with individual because I’m a big fan of the individual approaches. I know these get critiqued a lot because I think that, I mean, it can feel hard when you’re feeling burnt out and somebody’s just telling you do more self-care and your organization is not changing, right?

Dr. Andy Roark:

You know what helps me? Breathing. That helps me and you go, “I can’t. I can’t with you.”

Dr. Addie Reinhard:

Yeah, but I do believe that individuals have such power, and teaching individuals how to advocate and speak up about their needs because often our employers don’t even know that there is an issue. So part of this whole aspect of self-care stress management is just learning how to speak up about what you’re experiencing and what your challenges are. So essentially from the study, when we’re looking at individual strategies, one of the, this profession is inherently stressful, right? We know that veterinary medicine, clients aren’t magically going to be nicer to us, and the ethical dilemmas are never going to go away.

Dr. Addie Reinhard:

There are things that can be reduced as far as stressors go, but even in the most supportive practice environments, if we’re not taking care of ourselves, then you’re probably still going to burn out, right? So one of the big factors at promoting wellbeing and mental health is having a healthy way to manage your stress. So individuals that felt like they had a healthy way to manage their stress were less likely to have distress or serious psychological distress and mental health challenges. So just starting to think about what is your stress management plan, what are you doing to manage your own stress, and I’m not just saying meditation and breathing, and it can be helpful.

Dr. Andy Roark:

Yeah. That can be great. I wasn’t trying to knock it earlier on, but-

Dr. Addie Reinhard:

Yeah, yeah. It can be helpful for some, but for others maybe not, but looking at self-care in a different way of instead, how are you setting boundaries? How are you talking with your practice about your needs? How are you advocating for yourself and your team? What are you doing? Because self-care is not going to work unless you set boundaries to make it happen. Then the self-care comes after that.

Dr. Addie Reinhard:

I’m an advocate of individualized self care. Everybody’s self-care is going to look a little different, basic exercise, sleep, nutrition, and then advanced self-care, whatever works best for you, but just knowing what works to reduce your stress. I know when I’m stressed, I need to exercise. I need to go for a run. I need to do 10 minutes of meditation. There are things that I know that I need to do when I’m starting to feel overwhelmed and stressed. I know that I have a healthy way to manage my stress.

Dr. Addie Reinhard:

So I think for listeners out there, if there’s one thing that you can do, it’s start to think about what is your stress management plan, what are you going to do when you start feeling stressed and do those things, and really having that work-life integration and figuring out what that means for you I think is also really important. I think the individual strategies can be really helpful and talking about, especially the student debt, and that’s a stressor that I didn’t mention before for early career vets that you did, and I do think that’s a big stressor is financial health, and graduating with a huge mountain of student debt and, “How am I going to pay this off?”

Dr. Addie Reinhard:

So engaging with a financial planner or a financial coach, somebody that can help you work through your personal finances so that it doesn’t feel so overwhelming, so it doesn’t feel like you’re trapped in the profession because you’re not, and really engaging with somebody who can help you get some hope around your financial situation I think is really, really important as far as individual strategies go.

Dr. Andy Roark:

Yeah. That makes a ton of sense. What are the key strategies for employers who want to take care of their people?

Dr. Addie Reinhard:

Yeah. So there are a lot of things that employers can do. I think one of the biggest things that we’re talking about now is employee assistance programs. So making sure that your employees have access to an EAP. They’re not horribly expensive. They’re really not. It’s just a thing, and not even just having one, but making sure that your team knows that you have one, too, and communicating that because that was one thing from the study is a lot of people didn’t even know. A lot of people didn’t even know that if their health insurance covered mental health challenges or not. So being able to communicate with your employees, “This health insurance does cover these mental health things or this EAP is available to you,” and communicating that.

Dr. Addie Reinhard:

I think there’s still stigma in the profession around mental health and wellbeing. So I think acknowledging that this is an issue, encouraging our team members to address those issues and, again, not making them feel bad if they have to take off some time from work. I think a lot of individuals who might be in that space might feel guilty for taking some time off for themselves to seek mental health help, but if our employers are very supportive and you don’t guilt them if they have to take morning off to go to a therapy appointment, making sure that this is a normal part of our jobs and our careers is keeping our brains healthy, too, right? It’s just like any other body system. We have to keep ourselves well if we’re going to keep doing the work that we need to do.

Dr. Addie Reinhard:

I think that really thinking about practice environment, so making sure that we’re making a collaborative environment. Chaotic versus collaborative was an interesting finding in that. There was more burnout in these chaotic work environments, which makes sense, right?

Dr. Andy Roark:

Totally.

Dr. Addie Reinhard:

So having more of a calm, collaborative environment versus this chaotic, competing environment I think is definitely really important. Growing the belongingness to the team, team building activities, developing trust in the organization, candid and open communication, and allowing your, I think, and this is not from the study, but flexibility and autonomy is huge. So if your employees feel like they have the flexibility, for example, you want to go to a concert on a Thursday night and you don’t want to feel bad about leaving work early and you give your employee the flexibility to do that thing that they enjoy doing.

Dr. Addie Reinhard:

It’s interesting with the MentorVet curriculum, a lot of my mentees, we have meetings, monthly meetings, and they meet with about five to 10 vets every month, and it’s once a month, and it’s in the evening. It’s usually at 7:30-8:30 at night or on a Sunday, and we’re very flexible with these times. Yet still, a lot of them are not able to make it to their meeting. They miss their meeting. They work late. They’re charting. Make this thing more of a priority. Why can’t we include this in the first hour of the day? Block off an hour for your staff to be able to do professional developments or I don’t know.

Dr. Addie Reinhard:

I think making it a little bit more flexible so our team members don’t feel bad. I think some of this is self-inflicted, too. I mean, I’ve been there, right? I’ve been there. Nobody was pressuring me to stay late and see these patients, and I did it because I wanted to help the pets, but you can also encourage your employees to take care of themselves, too. It makes it easier as an employee to take care of yourself when your employer is encouraging you to.

Dr. Andy Roark:

Yeah. That’s one of my big things that I beat up on employers about is if your wellness strategy is the veterinarian looking at a crying pet owner and setting personal boundaries, then that’s a crap wellness strategy. That’s just a terrible strategy, protocols that, again, you don’t have to dictate everything, but protocols that dictate how we’re going to end our day, what’s going to happen when people come in after a certain time and how we’re going to hand them off to an emergency clinic and just have things like that are protocols that are not on the ground decisions that someone has to make, and we know that making those moral and ethical decisions again and again leads to ethical fatigue. The more of those things that we can systematize in a way that protect our people while still serving our values as a practice, I think those things are really important.

Dr. Addie Reinhard:

Yeah. I agree. The ethical thing, I think, having more open communication about those ethical dilemmas and creating that environment where we are regularly debriefing and talking about this really tough stuff instead of just ignoring it and hoping it goes away, but really starting these open … I think that speaks to candid and open communication among the team. The more that we can openly talk about the shared challenges and struggles, and then not make it a ranting test but a productive discussion of, “These are some of the challenges that we are facing. What is one thing that we can do in the next month to address one of these challenges?” Starting small and, really, anytime I’m developing any kind of intervention, starting first with what are the specific stressors that your practice is experiencing, and to learn that, you have to ask your team. Get your team together, ask them what challenges they’re experiencing, and have them identify one or two of their top concerns, and then make some type of intervention and just do it, and have the team provide feedback on how that’s going.

Dr. Addie Reinhard:

It can be really small, but really starting to listen to your team and starting to implement some of the changes that maybe they could see because often our frontline workers know better than we do what could work, right? So really, I believe in these local solutions, for sure, for our team.

Dr. Andy Roark:

No, I completely agree. Addie, thank you so much for being here. Where can people learn more about MentorVet? Where can they learn more about the Merck wellbeing study?

Dr. Addie Reinhard:

So our website, mentorvet.net and you can also follow us on social media. So we’re @MentorVet on Instagram. We are @MentorVet1 on Facebook. You can learn more about the Merck animal health veterinary wellbeing study on the Merck animal health website. There is a wonderful page that includes a PowerPoint of all this information. So I would recommend going there and checking out the PowerPoint and fact checking some of my statistics that I shared today. Yeah. I think if you’re at a conference, we’re definitely speaking a lot on this topic this year. So if you’re at a conference, see if we’re talking about this topic to learn more, for sure.

Dr. Andy Roark:

Awesome. Awesome. I’ll put links to the show notes, links in the show notes to all of those things. Guys, take care of yourselves. Have a wonderful week. Addie, thanks for being here.

Dr. Addie Reinhard:

Thank you so much. It was fantastic.

Dr. Andy Roark:

That’s what we got for you. That’s the episode. Guys, I hope you enjoyed it. I hope you got something out of it. As always, the kindest thing that you can do is leave an honest review wherever you get your podcast. I really do appreciate it. It helps people find the show. Guys, take care of yourself. Be well. Talk to you soon. Bye.

Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram

Filed Under: Podcast Tagged With: Wellness

Battling Back Against Moral Distress

March 17, 2022 by Andy Roark DVM MS

Dr. Indu Mani is on the podcast today discussing moral distress in veterinary medicine. The pain we experience when we know the “right” thing to do but are unable to do it can take an ethical toll. For those of us practicing veterinary medicine, this toll may contribute to burnout, depression and other job stressors. So what do we do about it? How do we battle back against a condition that seems ubiquitous to our profession? Let’s get into this episode!

Cone Of Shame Veterinary Podcast · COS 126 Battling Back Against Moral Distress

LINKS

Original Moral Distress Article: www.nydailynews.com/opinion/ny-oped…zvsa-story.html

Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians – pubmed.ncbi.nlm.nih.gov/30320478/

Uncharted Veterinary Podcast: unchartedvet.com/blog/

Uncharted Veterinary Conference: unchartedvet.com/uncharted-april-2022/

Put on Your PANTS! How to Hold Meetings that Matter: unchartedvet.com/product/put-on-y…-pants-meetings/

What’s on my Scrubs?! Card Game: drandyroark.com/training-tools/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Indu Mani, DVM, DSc, is the Chief Scientific Officer of Brief Media, editor of Clinician’s Brief journal, and associate veterinarian at VCA Brookline Animal Hospital. She is a Fellow in Bioethics at the Harvard Medical School and a Master of Science in Bioethics student at Albany Medical College. She received her Doctor of Veterinary Medicine degree from Colorado State University and her Doctor of Science degree from the Harvard School of Public Health. She is interested in all aspects of veterinary bioethics, particularly moral distress, and infectious disease bioethics. She was a Distinguished Practitioner/Fellow at the National Academies of Practice and is on the One Health Initiative Website Advisory Board.


EPISODE TRANSCRIPT

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

Dr. Andy Roark:

Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a great one today. I am here with my friend Dr. Indu Mani. Indu is the chief scientific officer at Brief Media, the editor of Clinicians Brief Journal and an associate veterinarian. She is also a fellow in bioethics at the Harvard Medical School. She’s amazing. I saw that my friend Indu had written an article on moral distress in veterinary medicine and she laid out what that means.

Dr. Andy Roark:

And, guys, this episode meant a lot to me because I have tried to explain this to people so many times. Veterinary medicine has unique challenges and Indu really puts her finger on what they are and names the moral distress. And I think her wording is so good and I think her understanding of exactly what this means and the ethical implications for veterinarians is so good and so useful in us figuring out how we’re going to go forward and how we’re going to make our profession better. So, guys, that’s what we get into. I love this episode. I hope you’ll love it too. Let’s get into it.

Kelsey Beth Carpenter:

(Singing) This is your show, we’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark:

Welcome to the podcast. Dr. Indu Mani, thanks for being here.

Dr. Indu Mani:

Thank you, Andy.

Dr. Andy Roark:

Oh, man. First of all, I am such a huge fan of yours and I’m so glad that you make time for me. You are the best. For those who don’t know you, what is your official title at Brief Media?

Dr. Indu Mani:

I’m chief scientific officer at Brief Media, that publisher of Clinicians Brief, Plumb’s Veterinary Drugs, the new Plumb’s Pro.

Dr. Andy Roark:

Yeah. The new Plumb’s Pro is exciting. It’s super cool little product you guys are putting out. You and I met, I hate to even say this, it’s probably been like 10 years ago.

Dr. Indu Mani:

Been a really long time.

Dr. Andy Roark:

It’s been a long time. And I was doing some work over at Brief Media, which I loved and there are great people over there and I was super. I still look back.

Dr. Indu Mani:

We love you.

Dr. Andy Roark:

Oh, man. That was the first sort of real consulting job I ever got was with Beth Green at Brief Media and she sort of gave me a chance and I’ve never forgiven her. Never stopped thanking her for taking a chance and let me write some stuff and do some stuff with her. But anyway.

Dr. Indu Mani:

It was all our benefit-

Dr. Andy Roark:

Well, thank you.

Dr. Indu Mani:

… to have you there, Andy.

Dr. Andy Roark:

You wrote an article for the New York Post that-

Dr. Indu Mani:

New York Daily News. Yes.

Dr. Andy Roark:

New York Daily News, which kind of went sort of viral in the vet world. I saw a bajillion different places. And so that’s when I picked it up as I saw it on social media. It came across my feed a couple of times and I was like, what is this? And then I saw, oh, wait, this is Indu wrote this. And you talk a bit about moral distress in veterinary medicine. And so as I sort of unpacked as I read through it, I have strong feelings about what you wrote and I want to get into them with you.

Dr. Andy Roark:

But first can tell me a little bit about how you came to be thinking in this area. I know you’re doing some work in the field of medical ethics and doing advanced training there. Can you sort lay out your background and kind of how you started to get your head into this place?

Dr. Indu Mani:

Yeah. Absolutely. I have atypical background as a veterinarian. Being of Indian origin my parents wanted me to go to medical school, of course. And so I disappointed them greatly by going to veterinary medical school, but they’re happy with it now. I graduated from Colorado State University, I did an internship at the University of Minnesota, after that decided I wanted to work for the CDC, applied to a doctoral degree in virology at Harvard, got in, did finish that, and then decided at that point that I wanted to have children.

Dr. Indu Mani:

And then so went into medical publishing and medical writing and science writing rather than creating science, writing about it. And that seemed to be a better fit. Throughout all this I’ve continued to work in the small animal clinical practice situation, whether I was doing emergency, or urgent care, or primary care. So throughout this entire time I’ve been an active, small animal veterinarian.

Dr. Indu Mani:

I got involved with Clinicians Brief and publishing and I would say about two years ago there are certain things that I think I took for granted as a veterinarian, certain feelings, certain client relations, just dealing with things that were upsetting. And I started to look around a little bit at ways of coping, and let’s just say coping in a very broad amorphous way with the stresses sort of engendered by being a veterinarian, not really understanding what that was.

Dr. Andy Roark:

Yeah. I think most of us in practice have those feelings of that sort of stress and I think we wrestle to put a label on it. So I think the amorphous feelings are pretty calm among us.

Dr. Indu Mani:

And if you’re like me, and I don’t know, Andy, what you guys had, we had one ethics course taught by the late legend Bernie Rawlin at Colorado State, more of an animal ethics course having us consider companion animals, food animals, et cetera, not so much focused heavily on what we feel as practitioners. And we didn’t have any courses in psychology, just some random, I don’t know whether you guys had a little bit more when you were in vet school.

Dr. Andy Roark:

I mean, it was still fairly minimal. I think when I was in vet school the main focus sort of from a wellbeing standpoint was starting to be student debt. And so I think that was starting to unpack and I kind of feel like we went through a student debt wave and still that problem hasn’t gone away. But I feel like it’s been the last probably five to six years that there’s really been a shift over to wellbeing being taught in that schools.

Dr. Indu Mani:

Yeah. And so armed with that kind of dearth of training I started thinking about what makes us different because living in the Boston area, I know a lot of physicians, a lot of nurses, a lot of people who have really stressful jobs, psychologists, but there’s something different about being a veterinarian and I couldn’t really put my finger on it at all. And why we kind of accept living in this soup per se where we have these feelings that we don’t really understand.

Dr. Indu Mani:

In the process of doing that, Lisa Moses, she’s a veterinary internist, she is at Angel Memorial and she’s someone we referred cases to on a regular basis. So we knew her. She’s an incredible doctor, incredible person. She was head of the pain and palliative service. And I noticed that she had been doing some co-associated research on ethics and moral distress. Moral distress was sort of an emerging thing for her at that time. So basically a field of veterinary ethics. And I reached out to her, we talked, she had done a fellowship in bioethics at the Harvard Medical School.

Dr. Indu Mani:

And I talked to her, discussed what she was studying, what she was doing. And she said, I’m the only veterinarian that has done this program, the pioneer veterinarian, you should apply as a practitioner and so I did. And I think transformative is a euphemism for the experience of being in this fellowship. It was incredible. My classmates are about 12 of us. My classmates was an attorney, several psychologists, psychiatrists, neonatologists, anesthesiologists.

Dr. Indu Mani:

And we would get together once a week and talk, we had a bioethics curriculum, we’d have readings and it was so amazing because I always had the 13th perspective. Do you know what I mean? Everybody else had a more common experience with bioethics in the clinical situation except for me who always had a weird experience being a veterinarian.

Dr. Andy Roark:

Yeah. I love to hear that and it fits if it was with kind of what I’m sort of seen in the world. The reason I was so grabbed by sort of what you wrote in the concept of more ethics and moral distress when you put it down and the reason is because I’ve wrestled for years trying to explain, even not really understand for myself. the nuances of the challenges of our profession.

Dr. Andy Roark:

And I’m really been going to this thing recently where I’m pushing back against this narrative sort of is put forward of federating medicine is the worst for mental health. And I understand why we say that. I think a lot of people struggle, right? We have a real burnout problem. We have a real sort of problem with depression and just compassion, fatigue, all those. They’re all real and I’m not discounting them. And I feel like I think most of us struggle to articulate what we’re really feeling with, we just know it feels really bad or that we’ve had these real significant challenges.

Dr. Andy Roark:

And so I think that the shorthand is, oh, that medicine is the worst, we have this mental health nightmare is just so damaging. And I push back against that just because I want to articulate the nuance of our struggle in a truthful way that’s also not leaving people feeling hopeless. And I feel like your piece of moral distress really does that.

Dr. Andy Roark:

I did a podcast a while back with Jen Brandt from the AVMA, it was really great, but I got myself in trouble on social media because we put the podcasts out and I posted a pull quote that basically said, hey, truth matters. Veterinary medicine is not the worst mental health profession and that’s true. That’s never been put forward. No one said that, the CDC didn’t say that.

Dr. Andy Roark:

It’s a thing that sort of came up on social media and people started saying, oh, we are the worst, we have it the worst. And again, I think that comes from people trying to articulate what they’re feeling. I got sort of in trouble because when I say, hey, look, it’s not the worst stop. Think it’s the worst. That feels very dismissive of people and their struggles. And I go, well, that’s not what I wanted to do either. So I missed, that was a mistake on my part, but I believe that we have unique challenges.

Dr. Indu Mani:

We do. I don’t think that was the mistake, Andy. I think this is a very difficult thing to unpack. And there’s a trend, now I’m going to get myself in trouble. There’s a perception people start to examine this that I started to notice. And I think what you’re saying maybe is a little bit in line with what I’m going to try to articulate.

Dr. Indu Mani:

But there’s a perception of individual agency, meaning that we tend to select people, the individuals that encompass this profession have an aptitude towards this type of situation. Or we either select people who are trade perfectionists, or we select people who have trauma. And I’m not sure the data bears that out. And I think we need to look to the institution to see why this is happening and not look to its individual members.

Dr. Andy Roark:

Okay. I want to get into this. So let’s start to unpack. I think in order to talk about this let’s talk about moral distress and we have to put that down and then I want to come back to this individual agency because it’s definitely something I want to talk about. Can you define for me moral distress? For people who haven’t seen the article I have links to the article in the show notes, but go ahead and lay it out from me. What is moral distress and how is that different from burnout or just general, I don’t know, depression, being tired?

Dr. Indu Mani:

Yeah. Moral distress is an ethical framework. It was coined by Andrew Jameton philosopher in 1984. So a very long time ago with respect to nurses, which if you think about it, nurses are the population who embodies this. Moral distress is when you have to perform an action you either feel compelled to perform an action or you have to perform an action, or you perform an action which is the opposite of what you feel is right. So it’s a very simple definition, what you feel is morally correct.

Dr. Indu Mani:

So if we were doing an extreme example, convenience euthanasia would be an example where we would feel a tremendous moral distress. You see a, I don’t know, a two year old adorable pit bull who’s in the shelter and you’ve got to euthanize it. That is classic moral distress. That’s extreme, but it is that very hard to define sort of liminal sensation when that happens. What’s also important with that definition is the definition of moral injury, which I think that’s a really potent, maybe something that a war veteran might experience on the battlefield, a potent morally injurious event.

Dr. Indu Mani:

So take that moral distress, concentrate it into a really painful event and that’s a morally injurious event. Then there’s a graphic. And I think it’s a 2009 paper by Epstein. I’ll send it to you, but it’s so biological because it talks about moral distress and then moral residue. So waves of moral distress that keep occurring over time and it leaves a residue. And that just really connected with me for veterinarians what we experience, and then over time biologically the set point of moral residue it just slowly and incrementally increases.

Dr. Andy Roark:

Yeah. I’m imagining almost like a water line where you have a waves that kind of wash up against and the salt on whatever, on the building. The salt line is higher and higher over time.

Dr. Indu Mani:

Exactly. That’s exactly it. I mean, that’s a perfect example. It’s what is tolerable resets? You almost adapt to living in this negative environment, but it’s not a positive adaptation. It’s kind of a negative adaptation.

Dr. Andy Roark:

So let’s get into this personal autonomy part because I’m really interested in that. Are different people affected by moral distress differently? Do they feel it differently? And when I say different people, is it personality types? I guess my question to you is do the perfectionist personalities among us, are they more bothered because they feel more clearly that there is a right way or I’m not living up to the perfect standard and that adds to the moral stress that I feel as opposed to someone who obviously wants to do a good job but that level of perfection doesn’t drive it? Or those totally different things and you say no, whether you’re perfectionist or not, you still feel the same moral discomfort?

Dr. Indu Mani:

Yeah. I’d say that’s probably I think, I mean, I’m in my infancy in my ethics training, but that’s what I’d say, that moral distress will occur no matter your personality type. How you deal with it might be affected by your personality type. I work with someone who’s extraordinarily resilient. He’s a resilient person and he has dealt with really concretely distressing issues over time through his career.

Dr. Indu Mani:

He is someone that I think I don’t know if he can articulate why he’s able to consider, think about it, recognize it, move past it. I think most of us don’t talk about it in this way and that’s the problem. That’s the problem is we have to start talking about it. And for me personally, I’m sure we can all define things that provide distress for us, for me it’s being forced to perform non-beneficial or futile care on some of our patients or not being able to perform care on our patients.

Dr. Indu Mani:

And my own theory that I’m kind of working on is that because animals in many ways are property. How do we work on shared decision making models that empower the veterinarian to be able to articulate what they think is right for their patient?

Dr. Andy Roark:

Yeah. No, I agree with that. I think the first part of all this is is getting our terms down and all talking about the same thing. And that’s why I was so taken with what you wrote and just under understanding moral distress. So I completely agree with you. I think to me when I think about moral distress so much of it boils down to the fact that we know what is the right thing to do, say the morally right thing to do, but we don’t have the agency who necessarily carry those things out.

Dr. Andy Roark:

And what I mean by that is I can’t make the pet owner take their pet to surgery. I can’t make the pet owner go to the emergency clinic for overnight monitoring. I can’t make them do any of those things. And so when I think about moral distress, yes. I mean, I have heard, honestly, when you said moral injury the things that come to my mind is I know veterinarians who were forced to do procedures they didn’t want to do and to me that feels like that next level, like that moral injury and these people carry scars years later that I can see and go, I did not want to this. And I was forced to it or the implication was, I will lose my job and you go, that’s next level.

Dr. Indu Mani:

And nobody talks about it, Andy. That’s the whole thing. We don’t have that built in to recognize this weakness in our profession. Have you read that book The Things They Carried by Tim O’Brien?

Dr. Andy Roark:

No, tell me about that.

Dr. Indu Mani:

Yeah. It’s just a recollection. My daughter is reading it now in school. And I remember when I read it for the first time I was completely overcome, but it talks about morally injurious events among a platoon of Vietnam warriors. And I couldn’t really articulate why it resonated with me so strongly, but I think sometimes I feel like we’re on a battlefield. To expand on what you said because I think what you said is so important, pediatricians, because that’s the easiest comparison, if you think about medical models.

Dr. Andy Roark:

Yeah. No, that makes sense.

Dr. Indu Mani:

Yeah. Pediatricians have the right to advocate for their patients in their patient’s best interest even if it supersedes what the parent wants to do, which is unfortunately happening more and more these days or the harm principle that if you elect a certain procedure will it result in harm to your patient? And it occurred to me that we don’t have any of those protections in our shared decision making models.

Dr. Indu Mani:

And I’m lucky enough to practice outside of Boston in an area where more and more people are getting pet insurance and the pet owner who’s the proxy for the pet and I in this triad of the pet patient, me as the provider and the owner, the pet owner or pet parent, the three of us in that triad can engage in really productive, shared decision making that doesn’t elicit moral distress. That would be the goal.

Dr. Andy Roark:

Tell me a little bit more about what you mean when you say pediatricians have a right to advocate. What exactly does that mean? As a opposed to, I have a right to advocate meaning I can advocate all at one, but I can be ignored. What do you mean? What does that look like in human healthcare? I’m just not familiar enough with that.

Dr. Indu Mani:

They just have legal protections. If they’re struggling with a client most hospitals cannot, not the client, but the patient family, see, it’s so hard to not-

Dr. Andy Roark:

I know.

Dr. Indu Mani:

It’s so hard to not fall into that. But they can call an ethics committee. They’re often ethics committees at hospitals, which will be typically teams of clinicians, nurses, psychologists, psychiatrists, all of whom have significant investment and time and intellectual investment in thinking about these exact issues. So that’s one thing. And there are legal protections. You can involve the law. We can’t.

Dr. Andy Roark:

Yeah. No, that makes sense. Hey, guys. I just want to jump in here with a couple quick updates. This week over on the Uncharted Veterinary Podcast Stephanie Goss and I are talking about modernizing and updating an old school practice. If you have any interest in the advice we give to a manager who’s like, hey, we got new ownership and now it’s time to update and modernize the practice that we’re in, how do we do that with the established team and culture?

Dr. Andy Roark:

That is what Stephanie Goss and I unpack up. Link in the show notes to the podcast, but you can get it wherever you get podcast. That is the Uncharted Veterinary Podcast. Upcoming events, big ones. My dear, dear, dear, dear, dear, dear friend Jamie Holmes is doing a workshop on April 6th. It’s called Put On Your Pants P-A-N-T-S, how to hold meetings that matter. This is all about spending less time in meetings and more time getting effective results.

Dr. Andy Roark:

If you, I don’t know, happen to be kind of busy and trying to get things done and you don’t want to end up having a bunch of meetings to make that happen, you need to be efficient. You need to be effective. You need to know about the parent system. Jamie Holmes is going to teach you that is 6:00 PM Eastern, 3:00 PM Pacific on April the 6th. That is free to Uncharted members and $99 for the public. I’ll put a link in the show notes.

Dr. Andy Roark:

And the other big one is the April Uncharted Conference that is April 21st through the 23rd that is live in person here in my hometown Greenville, South Carolina. It is all about running smoother, more efficient, more rewarding practices. If you are a practice leader and you are looking for something to inspire you to get you to see possibilities, to feel good about the work that you’re doing again, and to feel like, man, we could do interesting and amazing things in the future.

Dr. Andy Roark:

If you need that feeling, come down to Greenville, South Carolina on the 21st to the 23rd for the April conference. Guys, head over the website, I’ll put a link in the show notes, get an Unchartered membership, get in the conference, come and check it out. It’s something magical and it’s almost full too. We are almost sold out. I don’t want you guys to miss the boat on that. Anyway, guys, that’s enough. Let’s get back into this episode. One of the questions I had for you coming in, when I think a lot about wellness and sort of how we take care of ourselves.

Dr. Andy Roark:

Now, I get pretty fired up when I see systems and protocols where individuals on the ground are called upon to make ethical and moral decisions in place of some sort of a stated protocol. And I think the reason that people do that and our practices are set up that way, so I’ll give you an example, when someone comes in and they say my pet is sick and I need to be seen and it’s seven minutes before the clinic closes a lot of practices will say, well, the doctor gets to decide if they see the patient or not.

Dr. Andy Roark:

I have a problem with that because I feel like you’re putting this moral decision on the individual. And if you are wellness plan, if you plan to take care of your people in the long term prevent burnout is people on the ground are going to look a crying pattern in the eyes and set a personal boundary. I think you’re out of your mind. That’s just not going to happen. It’s not who we are.

Dr. Andy Roark:

And so I really am leaning into this idea of sometimes the kindest thing is to set boundaries and protocols at the practice level and say, we’re going to take this moral decision or this on the moment decision. We’re going to take it off the shoulders of our staff, our employees or we’re going to make a decision at the practice level.

Dr. Andy Roark:

And then that’s just, they’re not going to be called on to make this hard decision when half the staff, three quarters of staff they want to go home and the doctor is looking at this person who wants to have their pet taken care of, and now either whatever you choose, you’re going to make someone upset. And I go, that’s unnecessary stress that just shouldn’t be there. There should be a plan of what happens and not just a in the moment decision.

Dr. Andy Roark:

And so let me put that to you and sort of say, do you believe that there are ways to reduce moral distress by having protocols in place? Or are we still in that same place of just because there’s a rule and this person doesn’t get seen doesn’t mean that I don’t feel bad about it and I feel the same moral distress? So help me with that. Is there value to having some sort of a set structure that takes some of these decisions off of the people on the ground?

Dr. Indu Mani:

Absolutely. And I’m glad you’ve said that because, I mean, and I know you are the same way, but I don’t think I could have made it through this pandemic without my CSRs, without my technicians. I mean, and I’m just going to shout out to VCA Brookline Animal Hospital because they are my family. We are a family. And in many ways, my God, they’re the ones who walk out to the car and get the pet from the car.

Dr. Indu Mani:

They have worked so hard. I’m going to start to cry, but I just they’re… And I think we are buoyed by them and a lot of what we’re talking about. And I want to say this to all the technicians, all the non-veterinarians who functions part of our team, this is all equally about you. If not more we’re all together. Nurses were the ones who this concept was first intellectually recognized. So I just want to emphasize the importance of taking care of that staff.

Dr. Andy Roark:

Yeah. I think that’s really important to say because I’m coming at very much. You and I both being veterinarians we come from a veterinarian centric mindset, but the truth is we have much more autonomy and agency in these situations than my technicians or the CSRs who that’s are just told this, go tell them no. And then they’re really put in this type position. And, again, I feel like that’s sometimes a manifestation of that whole, we haven’t set protocols. We don’t have plans. And so then the plan is have the front desk go tell them no because it sounds better coming from them than it does coming from the doctor. And I go, well, that’s-

Dr. Indu Mani:

That’s right.

Dr. Andy Roark:

… that’s awful. That takes a human toll. It takes a human toll on our support staff.

Dr. Indu Mani:

It really does. And, I mean, I’m so glad you said that. I do think, and I’m working on this right now actually so I’ll share more next time we talk because I’m just trying to get something together, but there is a, she just passed away, she’s a philosopher named Renee Fox and she wrote a lot about medical ethics education. And reading her, she told about infusing.

Dr. Indu Mani:

We have such a dichotomy in clinical aspects of a case and nonclinical aspects of a case to our detriment honestly, Andy, to our huge detriment because I think we have to consider each case in each clinical situation holistically. And we are better off for it if we start to recognize the potential ethical situations implicit in each case. Someone comes in, doesn’t have cash, just adopted this dog, doesn’t have financial means, no insurance, mother is ill with a chronic disease in the hospital. I mean, you hear that, we hear that. We smoosh all that information in our heads.

Dr. Indu Mani:

Our technicians are sad because they heard that and then we don’t really do anything with it. We try our best to harness our empathy, our skills we’re kind of [inaudible 00:29:45] in the way that we try to maximize good clinical outcomes for our patients. But then we take it home and then I’m trying to sleep and I’m like, oh my God, I can’t stop thinking about this.

Dr. Indu Mani:

Wouldn’t it be great if we had some ability to take this information and be considering it along with all the clinical considerations? And I’ll say that I’m trying to think of a way that maybe we can do that. And at least articulating that information among our team will help us deal with it going forward.

Dr. Andy Roark:

Are you talking more about having good ways to discuss these types of stressors with your team inside the clinic? Or are you talking more about having this way to discuss sort of across say veterinarians, across multiple practices or some sort of external support structure? Or are you talking more about training in veterinary schools to sort of help people have better vocabulary to explain where they are, what their stressors are so this thing could be addressed? Help me understand what exactly where you’re coming down there.

Dr. Indu Mani:

I mean, you’re so perceptive because that’s exact, it’s all of those things. I read somewhere that when you’re trying to, and I have to find the reference for this, when you’re trying to ameliorate the effects of moral distress it has to be at the clinical situation, so with the patient at hand in the institution, in the organization, in the profession. So it’s multi-leveled.

Dr. Andy Roark:

Yeah. I like that a lot. When people ask me about burnout out and what do we do about the problem with suicide, or depression, or just a high turnover, things like that in our profession, to me it’s got to be a multilevel approach. And so I talk about I think there’s things we do at the professional level, at the practice level is really the boundaries and systems I was talking about before of I take those weight off the individual. And ultimately there really is never going to be a way around this where there’s not agency that has to be taken at the personal level. We are all going to have to figure out how we process-

Dr. Indu Mani:

We are. Absolutely.

Dr. Andy Roark:

… what we deal with. And we also are going to need to set some amount of personal boundaries for ourselves. But God, if the whole program, the whole the wellness program is the individual will process these things and set personal boundaries, that’s baloney. That doesn’t work.

Dr. Indu Mani:

And that’s what’s happening right now. I think this is my informal, anecdotal perception is that we have to, there’s nothing weak in looking at our profession under the microscope. And so what are doing wrong? What are we doing wrong? We have to make the change. Otherwise, quite honestly I worry that what’s going to happen to our workforce. It’s interesting. I have a brilliant, one of my fellowship mates is a psychologist and I presented some of this stuff to my group.

Dr. Indu Mani:

And she’s so articulate, but she said, it feels like you’re a profession in slow degradation in some ways. And I didn’t like hearing that because it made me very, very, very sad but it also made me feel empowered. And I said, if we are a field in slow degradation we’re not doing something right. What can we do? We have to do something else.

Dr. Indu Mani:

So take something which seems ominous and start to say, we need to look at this in a different way and make it because I love this profession, Andy. I still, when I go to work, I’m excited to see. I really love it. I love it. And I would like to help it. I would like us to help it, but it will require us to be self-critical as a profession and not put it on the agency of our members to have these little dots of fixing it. We have to fix it on mass.

Dr. Andy Roark:

No, I completely agree with that. I love that nursing. I love being a veterinarian. I mean, let me push back against you a little bit here and say, Indu, I’m positive about where we’re going. Again, I really am. What most inspired me about what you are talking about is my friend what you write, you are part of the diagnostic process and we know how to figure this out, right? The first thing you do is you run a diagnostics and you say, where is the pain coming from?

Dr. Andy Roark:

As quickly as we can drill into it what are the actual things that are causing this to happen? But once you’ve got the diagnosis usually the treatment part can come along much better. I feel like for the last 10 years we have been in a degradation slide, but I also think our perception of where we are has been, I don’t want to say it’s been counterproductive.

Dr. Andy Roark:

I think the truth, in the modern world when we deal with problems especially in the world of social media and the Internet, Step 1 is awareness of the problem. And I think that we have really lived in awareness and I think that’s a good thing, but talking about-

Dr. Indu Mani:

[crosstalk 00:35:04] too

Dr. Andy Roark:

Exactly. Right.

Dr. Indu Mani:

Articulation bit.

Dr. Andy Roark:

Completely agree. So we started off and people were like, hey, burnout is terrible and we’re having these problems and we’re having high turnover. And the suicide rate for veterinarians and veterinary technicians is high and all those things are true. And we do need to raise awareness to those. And I think that we’ve done that and I think where I am and I think where a lot of people in the industry are is I go, it’s time to transition into some better diagnostics and then into a multimodal treatment approach.

Dr. Andy Roark:

And I feel like when I read your piece and I’m more distressed I go, that’s a diagnostic I didn’t have. That helps me articulate the problem and exactly what’s going on in a way that I think can help our profession to develop ways to approach it. And so I’m not down. I feel like work that people like you do, Jen Brandt, Kerry Journey has been on the podcast recently. And I think that we’re shifting this paradigm from the awareness to the diagnostic part, and then on the treatment part.

Dr. Indu Mani:

Something actionable.

Dr. Andy Roark:

Yeah. I do see this as more of an actionable step or a pathway to actionable steps. And so that’s why I am optimistic, but I do. I mean, I do agree. I still love being a vet and I think these are worthy challenges.

Dr. Indu Mani:

And I think we can love being veterinarians and we can be critical profession.

Dr. Andy Roark:

We should be. I mean, we should be.

Dr. Indu Mani:

Because if we don’t progress and evolve, even in the past two years the profession has really changed the demand on veterinarians right now. I mean, my God in my life, Angel Memorials here in Boston they’ve gone on diversion a few times. Well, they’re referring out, Angel Memorial. If we’re referring away from, and I’m sure you’re seeing that too where you are, Andy, but I agree.

Dr. Indu Mani:

And yes, there’s no reason to dwell in the misery. We have to look for the light and I love how you made this a clinical case diagnostics and therapeutics, but it’s absolutely true. And so that’s where I’m looking right now and focusing on some of my next research is thinking about some solutions that we might be able to implement more quickly.

Dr. Andy Roark:

Yeah. No, I think that’s wonderful. I said, I do see it as a diagnostic. I think for me where I really start to think about moral distress and where it’s super helpful is I would sit and I would wrestle with these things and I would say burnout is a problem and it’s stressful. And that’s stressful when we’ve got these things. But then I would turn around and I would say, first line healthcare responders have a stressful job and social service workers have a stressful job and I’m sure they feel this as well.

Dr. Andy Roark:

And now I have a friend who’s a pediatric palliative care special. I mean, she helps children in pain with cancer, oh my God. And so we don’t have the market cornered on pain. We don’t, but I believe and this is why I like the way you put it so much, I believe that we have a special kind of pain that is different often from what other people feel. And I just think that you unlock that in my mind and that’s why I was like, this is so useful.

Dr. Indu Mani:

Yeah. Andy, we have a special kind of pain and we don’t really have ways professionally to handle that pain or we don’t have those-

Dr. Andy Roark:

What do they look like? I mean, when you gaze into your crystal ball and you say five, 10 years down the road and you say when we continue to work on these things, what does some of those mechanisms look like? Help me understand, to stick with our metaphor, what could a treatment program look like theoretically?

Dr. Indu Mani:

I mean, I wonder if we start to recognize outline situations. Even as pedestrian as it seems maybe we have clinical situations that we teach our students about, we implement in practice. As pedestrian as it seems if somebody came over and said, I want you to declaw my cat. She’s not scratching anything, but I want you to declaw. I want you to declaw. And we can talk about what that I elicits in the veterinarian. Try to explain to the client why that elicits moral distress in the veterinarian to be forced to do something like that, cosmetic procedures, the very existence of brachialis dogs.

Dr. Indu Mani:

And I love all my little Frenchies and all the guys that come in, but I do find sometimes that the clients are somewhat bewildered by the inevitable slew of medical issues that will follow and will sometimes take it out on us, be upset, be angry, and even something like that, education of the client why this elicits moral distress in the veterinarian to have these discussions all of that can potentially help.

Dr. Andy Roark:

Yeah. That makes a lot of sense to me. I do see real value in that. One of the things I really like about sort of your approach and kind of where you’re putting this, I see a lot of people who push and say, well, we need to put this on the clients, or we need to make clients aware of how they come across. And I get it, as a pragmatist I go, hey, I don’t know that we’re going to talk clients into behaving differently than they behave.

Dr. Indu Mani:

No way.

Dr. Andy Roark:

I do feel like it has to be honest and it’s not fair that I have to feel the burden or figure out a coping strategy for a pet owner that’s going to be verbal abusive, or they’re upset because of this thing that they should not be asking me to do or pushing me to. It sucks that I’m the one who has to figure that out. But I do think it’s true and I think if we push back and go, well, you need to tell that client to go stuff it. I don’t. I know I said stuff it today. I called something baloney. I’m aging.

Dr. Indu Mani:

Yeah. You sound from 1950.

Dr. Andy Roark:

I think I’m like a 1950s radio host.

Dr. Indu Mani:

1950s guy. Oh my, no. I mean-

Dr. Andy Roark:

What’s happening to me?

Dr. Indu Mani:

… you’re completely right though. And sometimes I see things on social media, be kind to your vet and that’s a great sentiment, but that can’t be our crutch here. We can’t.

Dr. Andy Roark:

Right. That’s not the go-to strategy.

Dr. Indu Mani:

No, we can’t do that. And, I mean, don’t get me wrong. I’ve had a bad Yelp review a few years ago and apparently I was too pushy with asking for diagnostics and I was very upset. I separated on it. I bugged my poor husband and he was like, why do you care? And I was like, I care, Gary.

Dr. Andy Roark:

Yeah. Well, I mean, I’ll tell you why you care. Because at some point it’s your personal identity and you take this seriously.

Dr. Indu Mani:

Yeah. That’s right.

Dr. Andy Roark:

And I would also say that’s the moral trap. If you feel like this is what should happen and you advocate for it and then someone publicly slams you for doing what you think is right, you really need know when situation, right?

Dr. Indu Mani:

Absolutely.

Dr. Andy Roark:

You either don’t do what you think is important and because you might antagonize this person, or you might upset them, or you might make them a little bit uncomfortable, or you do what you think is right and then you get sort of publicly hammered for it and you go, and I don’t have an answer for that.

Dr. Indu Mani:

The only thing that makes you feel better with that, and this is what I wonder about harnessing, is it helps me when I… With that review I went to two veterinarians I was working with that day and I was like, “Can you believe this? Look at this. What is this?” And they were like, “Oh my God. That’s awful, blah.” But again, that was a mini, it was just a snapshot of what we could do as a profession to buoy one another up in those situations.

Dr. Andy Roark:

No, that’s a great point. The validation and support from our colleagues is super important and we’re not going to get that validation from pet owners. They just don’t understand. They just don’t.

Dr. Indu Mani:

For some you will. I think there’s some, I mean, we both have amazing pet owners who do that, but one thing this is random, but I have to tell you, Andy, that the advent of insurance and more people adopting pet insurance to me has helped my patient population in terms of ameliorating these dilemmas a little bit.

Dr. Andy Roark:

Yeah. I do agree. I think reducing that threshold, that resource-

Dr. Indu Mani:

Financial.

Dr. Andy Roark:

… scarcity threshold that’s a big part of it. Most pet owners are totally happy to follow our recommendations if they have the resources to do so. And I don’t want to leave this as vilifying pet owners in someone because I think we’re all sort of doing our best. It’s a challenge. Anyway, Indu Mani, thank you so much for being here. Thanks for talking with me. This is so great.

Dr. Indu Mani:

Thank you, Andy. I mean, I think about many of our ridiculous conversations that we’ve had, many, many ridiculous conversations and it’s kind of hilarious that we’re having more significant one.

Dr. Andy Roark:

I miss seeing you at conferences because you and I have business suits that look almost identical. Remember that? We both have great businesses.

Dr. Indu Mani:

We were twins. We were twinning.

Dr. Andy Roark:

They looked so similar.

Dr. Indu Mani:

And it had like a cranberry colored shirt or something. Do you remember?

Dr. Andy Roark:

Yeah. We showed up-

Dr. Indu Mani:

And I showed-

Dr. Andy Roark:

We showed up wearing the same thing.

Dr. Indu Mani:

And then I have to tell you. I showed my technicians that and they were like, you know Dr. Andy Roark? It was so awesome.

Dr. Andy Roark:

Oh, man. Well, thank you for being here.

Dr. Indu Mani:

Good to see you.

Dr. Andy Roark:

I’m going to drop the links from our conversation into the show notes for people who want to see them. Indu, I can’t wait to see what you do next. Thanks for all the work you’re doing for veterinaries.

Dr. Indu Mani:

Thank you, Andy, and vice versa.

Dr. Andy Roark:

And that is our episode. Guys, that’s what we got for you. Thanks so much for being here. I had to stop for a second and give a shout out to my friends at Banfield, the pet hospital for supporting our transcripts. We have transcripts of the podcast now. In an effort to increase inclusivity and accessibility Banfield has reached out and they were like, hey, let’s make this thing happen.

Dr. Andy Roark:

Let’s make this thing accessible to everybody. And they have made possible transcripts of both the Uncharted Veterinary Podcast and this here Cone of Shame Veterinary Podcast. So special thanks to them. Guys, you can find it on drandyroak.com and you can find transcripts for all of our podcasting to them there. So guys anyway, wanted to just say thanks and I want to say thanks to you for listening.

Dr. Andy Roark:

If you enjoy the episode, if you got something out of it, please feel free to leave us an honest review wherever you get podcasts. It really is how people find the show and it means the world to me. So guys, that’s it. Take care of yourselves. Be well, talk to you later. Bye.

Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram

Filed Under: Podcast Tagged With: Wellness

Are You Trying to Be Someone Else?

March 10, 2022 by Andy Roark DVM MS

In veterinary school, future vets are generally taught that there is a “right” way to do things. There is a gold standard, a best practice, and a correct answer. That mentality tends to seep into our minds… and our minds were already largely programmed this way in college if not before. We’re taught early on, it seems, that there are very specific ways to get gold stars.

I bring this up because I want to remind you that, while there may be a “right way” in veterinary school, that idea is largely BS in most of our lives. Every day, I talk to people in practice who have bought into the idea that there is a model they are supposed to follow. There is a mentor they are supposed to mimic. There is a pattern of behavior that they are supposed to demonstrate.

I’ve been fortunate enough to work with literally hundreds of very successful people in veterinary medicine, and there’s one thing about them that I can tell you for sure: they are all different people. They are unique and they have become successful in their own way. Not ONE person that I have met who is thriving in vet medicine is doing so because they are using the exact same skills or behaving in the exact same way as someone else.

I know people who have been successful because they are organized and create processes for almost every situation. I also know people who thrive by thinking outside the box and trying new things whenever possible. I know people who have become successful because they are gregarious and charismatic. I know others who got there by being introspective and slow to speak. I know people who are excellent managers of others, and people who have excelled by delegating those responsibilities away. I know people who became leaders using exceptional medical skills to gain credibility, and those who became leaders joking that NO ONE wants them to actually practice medicine.

Today, I want you to stop for a moment and ask yourself “am I trying to be someone else?” It’s scary to be yourself, because there’s no model to help you be you. You have to make it up as you go, and that’s not how we were trained. Also, we know how people we respect turned out because we can see (or think we can see) their success. We don’t know how we’ll turn out, so it feels safer to be less like us and more like those other people, doesn’t it?

But hear me when I say, you’ll never reach your true potential without being true to yourself and your unique skill set. Your greatest power is in being your own quirky, flawed, unique self and in using the unique combination of skills that you have. So let go of the picture of success you have in your head. Stop trying to be that other person or to walk the path that he or she walked. You’re not doing that. You’re doing your own thing. Yes, that thing is scary because you don’t know how it will turn out, but if you trust yourself, you’ll enjoy the journey so much more.

Take care of yourself,

   Andy

Filed Under: Blog Tagged With: Perspective, Wellness

The Economic Toll of Burnout in Veterinary Medicine

February 17, 2022 by Andy Roark DVM MS

Clinton Neill, PhD, assistant professor at Cornell University College of Veterinary Medicine’s Center for Veterinary Business and Entrepreneurship, joins Dr. Andy Roark to discuss the economic impact of burnout on the veterinary profession.

Cone Of Shame Veterinary Podcast · COS 120: The Economic Toll of Burnout in Veterinary Medicine

LINKS

Burnout’s Economic Toll on Veterinarians Calculated (JAVMA): www.avma.org/javma-news/2021-12…4&dlv-mlid=3330547

Uncharted Podcast on iTunes: podcasts.apple.com/us/podcast/the-…st/id1449897688

WORKSHOP – Loading the Bus w/ Dr. Andy Roark & Stephanie Goss:
unchartedvet.com/strategic-planning/

UNCHARTED APRIL CONFERENCE: 
unchartedvet.com/uncharted-april-2022/

Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/

What’s on my Scrubs?! Card Game: drandyroark.com/training-tools/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Clinton Neill is currently an Assistant Professor in veterinary economics for the Cornell Center of Veterinary Business and Entrepreneurship. Dr. Neill’s research primarily focuses on the broad scope of issues that face the veterinary industry. He also has grant funded research projects in food policy, labeling, and the integration of producer and consumer decision making. Before coming to Cornell, Dr. Neill was an Assistant Professor in Food Systems Economics at Virginia Tech. Dr. Neill completed his bachelor’s and master’s degrees in Agricultural and Applied Economics at Texas Tech University, and received his Doctorate in Agricultural Economics from Oklahoma State University. In addition to his research Dr. Neill focuses on bringing his academic research to real solutions for the veterinary and food industries. Email: cln64@cornell.edu


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. Guy, I have a good episode for you today, super interesting. Look, we all know that burnout is a problem in vet medicine, but how big of a problem is it? Can we put a number on that problem? Can we put a dollar figure on that problem? That’s what we get into today with my guest, Dr. Clinton Neil. Dr. Neil is currently an assistant professor in veterinary economics for the Cornell Center of Veterinary Business and Entrepreneurship. Dr. Neil’s got some new research out and I want to go through it with him on what is the economic cost of burnout in vet medicine? Let’s get into this episode.

Kelsey Beth Carpenter:

This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to The Cone of Shame with Dr. Andy Rourke.

Dr. Andy Roark:

Welcome to the podcast Dr. Clinton Neil. Thanks for being here.

Dr. Clinton Neill:

Thanks for having me Andy.

Dr. Andy Roark:

Oh man. My pleasure. So you and I met about two years ago in the before times at the Women’s Veterinary Leadership Summit, and you were doing some presentations there and you were doing some research. You do a lot of research with AVMA correct? And their economic summit?

Dr. Clinton Neill:

Yep, I’ve been doing work with AVMA since when I started my PhD actually back in 2014, and that has evolved time on different topics and things. And so when we met a couples years I was doing a bunch of work on gender wage gaps, which I had a big JAVMA article come out early this year, and then now we’re moving on to new things.

Dr. Andy Roark:

I guess your main job is at Cornell, right? Can you tell me a little bit about that?

Dr. Clinton Neill:

Yeah, so I’m at Cornell now and before when we met a couple years ago I was at Virginia Tech, and I was actually getting ready to interview for this position at Cornell. So my job here at Cornell now is working for the College of Veterinary Medicine, and specifically through their brand new center or Veterinary Business and Entrepreneurship. And so it’s a big center, we’ve got a big research component which is what I’m leading, a big education component to give every veterinary student that comes through Cornell business education so that they know what’s going on in the industry and things like that. Then we have an outreach and entrepreneurship and an entrepreneurship piece as well to help with innovation, both inside the university and the college, as well as outside with our partners.

Dr. Andy Roark:

That’s fantastic. I love it. I’m such a big fan of business education in vet schools, and out of vet schools, but business education for vet professionals is hugely important. I wanted to talk to you today, I saw last month in JAVMA there was an article that came out and it was talking about burnout’s economic toll on veterinarians. And so you had done the lions share of the research on that, and putting forward a pretty strong case about the economic damages that are done by burnout and I think this is really important. Obviously burnout is something that I care a lot about, and I think it’s a real problem in our industry.

Dr. Andy Roark:

But I do think that digging into the economic implications and ramifications of burnout could be a really good tool for motivating some of the corporate practices, practice owners in general to prioritize, wellness and burnout prevention strategies. And so I want to unpack that with you a little bit, make an economic case for me for preventing burnout, I guess is where we’re going. And so just start with that, let me toss you a softball, I guess, just to start with. What is burnout in an economic context? Let’s start by defining terms.

Dr. Clinton Neill:

Yeah. So I like to take that back a step slightly to what burnout really is, because understanding what burnout is in that context of how it’s actually defined by the World Health Organization and those types of things has a really big meaning and then we extrapolate to what are the economic outcomes of that.

Dr. Andy Roark:

Sure.

Dr. Clinton Neill:

And so according to World Health Organization, WHO, it’s a phenomenon that happens at work, it is all about work. It’s not necessarily about what’s going on personally, it’s about work having a really big impact on the amount of stress you’re getting, and that affects how well you’re able to work. And I’m trying to put my thoughts together, but it’s really about these feelings of energy depletion and exhaustion, and just really cynicism towards your job. And that’s where burnout is defined, and when we take that and we think, okay, well, I don’t like my job, right?

Dr. Andy Roark:

Okay.

Dr. Clinton Neill:

What tends to happen? We maybe don’t do all this tasks that we’re supposed to be doing, right? And this is across all fields, right?

Dr. Andy Roark:

Yeah, sure.

Dr. Clinton Neill:

We don’t want to go to work, we may call in sick more, we may try to reduce how much we’re working, and if it gets bad enough we want to leave, right? And find a new job.

Dr. Andy Roark:

Yeah.

Dr. Clinton Neill:

And so those are the economic outcomes of that, which is what’s happening to the labor force, right? Which is reducing those work hours, leaving their jobs, or even retiring early for some people which we see has an effect as well. Is that they’re at their end of their careers, they’re burned out and they just don’t want to be there anymore so they retire early.

Dr. Andy Roark:

Yeah. I would push into that a little bit and say one of the things when you talk about work output, our job as veterinarians is patient advocacy a lot. We’re advocating for patients and people who are burned out just don’t want to do it. You know what I mean? When you’re burned out the idea of getting up and really trying to be persuasive to get people to do what they should do, it’s monumentally hard. And so the idea that someone who’s burned out would have a significant drop in their productivity in the practice, that makes perfect sense to me. Even if they don’t change jobs, even if they’re not reducing their hours, they’re just working much less effectively. I mean, we’ve all probably gone through periods of that where it’s just hard to get up to do the flea talk yet again.

Dr. Clinton Neill:

Yeah. And that’s the other that you’re pointing straight to, right? Which is there’s some cases in the human medical world, burnout leads to increased medical errors, and these other types of outcomes that just aren’t good for medicine in any sort.

Dr. Andy Roark:

Not good for anybody.

Dr. Clinton Neill:

Yeah.

Dr. Andy Roark:

Okay. Cool. So I think it’s pretty easy to grasp the idea and go, okay if that’s how you define burnout and you see how burnout interacts with people showing up and doing their job, it’s not hard to believe that this is going to have an economic impact. How do you actually calculate any… Okay, so walk me through the math, because I think up until this point it was really easy. I have no idea how to calculate lost wages, economic impact from burnout like this. So give me a mile high view of how do you even start to look at a problem like that?

Dr. Clinton Neill:

Yeah. The methodology I follow here in this larger article and the work we’ve been doing is called a cost consequence analysis. And so that’s purely really comes from this medical, human medical side of literature, we follow a bunch of stuff in JAMA and those types of things, but the big thing is understanding two key components. Which is how much revenue is the person bringing in to a business or practice in this case and vet med, right? And we can back out okay so if they’re working this many hours a year and they’re bringing in $300,000 for the practice, right?

Dr. Clinton Neill:

You can figure out what an hourly cost is if they’re not working that hour. When we think about turnover which is the other… The two big pieces we look at are reduced working hours which I talked about, and then turnover. When somebody leaves your practice, right? You’re revenue because they’re no longer there, and when you have to fill that position, right? You have to spend money to try and find somebody. When you find somebody, you have to train them.

Dr. Andy Roark:

And they’re not insignificant. I think people blow that off, right? Bringing in someone new into your practice, they’re not going to be at their maximum product level the first day. Anyone who’s had a new person come in knows that. It’s going to be three months before they really start to get up to where they’re going to generate revenue that’s comparable to what they’ll probably generate going forward.

Dr. Clinton Neill:

Right. And so the way we look at that is look at what is it, search costs is how we call it, or which is all the money that goes into posting a job, and where are you posting it all those costs, and recruiting, and interviewing, and the time spent by other people to do all of that. And then looking at just training and all of that. And so replacement costs, there’s a lot of estimates for this and we vary what we do here, but it’s about two thirds to three quarters of an annual salary for vet.

Dr. Andy Roark:

Okay.

Dr. Clinton Neill:

And so that’s what we use as a mark as we look at average salary, or not salary in this case, but average income because people are in production, and then back out that two thirds to 75% of that. And then add all this up and look at the probability of you being burned out and those types of things. So the complicated part really is just figuring out people who are churning over, reducing work hours, those types of things, how much of that is actually due to burnout? And we have some data to help back all that up, but getting those costs is really just about understanding what revenue are you missing when somebody’s not there, reducing work hours, or leaving, and you have to hire somebody. Those types of things.

Dr. Andy Roark:

Talk to me a little bit about the probability of being burned out, because that’s an interesting statistic, right? So in order to calculate this, we have to know what percentage of veterinarians are burned out so talk to me about those numbers a little bit.

Dr. Clinton Neill:

Yeah. So all this work in conjunction with AVMA, and you brought up a point earlier that I just want to touch back on. All of this work about calculating the economic cost was to motivate and give us something tangible to address the problems. And so when we started talking about this, Dr. Matt [Soloy 00:10:41] and I with AVMA economics division, this actually happened before times. And we were trying to build up and trying to understand people are burnt out, the issue of burnout in vet has been growing for a while and has been increasingly talked about. And so what they did, they as in AVMA when they do their annual surveys through the economics division, one of them is I think they do a census it’s called the census of veterinarians that they do every year, which is just a random sample.

Dr. Clinton Neill:

But within that, they ask a set of questions from the professional quality of life scale that actually has questions about burnout, and compassion fatigue, and these types of things. And from that, we can construct a measure of whether somebody is burned out or not. And so that’s how we get that data, and then we also are observing through that survey data do they want to reduce their work hours? Why do they want to reduce their work hours? Did they leave their job? And those types of things. And so that we grabbed that measure of burnout through these types of questions, and then used that to create these probabilities and these calculations.

Dr. Andy Roark:

Did you see different probabilities in different segments of practice?

Dr. Clinton Neill:

Definitely. So we broke it down into four categories, and we look at the overall. We look at companion animals, we look at equine practitioner, food animal, and then mixed practices. And we see that burnout was really high among the mixed practice associates. So we don’t really look at practice owners because they actually don’t have a lot of burnout.

Dr. Andy Roark:

Really?

Dr. Clinton Neill:

That was very few, it was very low probability of having burnout if you’re practice owner.

Dr. Andy Roark:

That’s fascinating to me. Okay. And you buried the lead there, I was like, wow. Really? That’s crazy. I mean, as a business owner, I’m like, “Oh man, this is stressful as heck for me.”

Dr. Clinton Neill:

Yeah. I think it’s part of it is that practice owners have a little bit more say about when they work, and how much they’re working, and those types of things and so-

Dr. Andy Roark:

Yeah, no, I think that’s a good point. I think autonomy is a big part of it, right? Even though bear the responsibility, they maybe have some more levers in work life balance that associates don’t have.

Dr. Clinton Neill:

Right. And so when we look at associates with this work, mixed practices I think had ended up having a higher level of burnout. Well, companion animal actually had the highest level of burnout, and then it was mixed and equine were about equal. I’m looking at my numbers here. You saw about 62% of companion animal associates were burned out, at least a moderate level of burnout, and then it goes down to 56% for equine, mix and food animals had the lowest at 51%.

Dr. Andy Roark:

Okay, hold on. Wait, the lowest is half the people are burned out?

Dr. Clinton Neill:

Yeah.

Dr. Andy Roark:

Oh my God. All right. Huh. It’s one of those laughs to stop from crying things. Oh my God. Okay. Yeah. That’s that’s enormous. Okay, I’m processing.

Dr. Clinton Neill:

That’s again, moderate level of burnout. So there’s a scale of I think I can do this.

Dr. Andy Roark:

Yeah, I think that’s a good point. Burnout it’s not a zero sum binary thing you’re burned out or you’re not, there’s definitely levels to that.

Dr. Clinton Neill:

Yeah. And this is moderate, and this is people who score at least in the middle of range and upwards. If we get into those upward ranges, so you’re still talking like 48%, 30 to 40% of vet med so not an insignificant change.

Dr. Andy Roark:

Hey guys, I just want to hop in real quick with an update on a couple of things over on the Uncharted Veterinary Podcast, that is a podcast I do with Stephanie Goss on veterinary business. We got a question from the mail bag, it is what do I do about my cowboy technician? This is a technician who takes risks, they put themselves in harm’s way, they’ve been bitten recently. And when they’re talked to about taking risks with their body and themselves, they act like it’s not a big deal. They don’t see a problem, they act like taking risks is what makes them good at their job. That’s not true. How do we reach this person? How do we change their behaviors? Because guys, you can’t put yourself at risk like this. Hard conversations that’s what we do, that’s what we talk about on the podcast.

Dr. Andy Roark:

So anyway, wherever you get your podcast, Uncharted Veterinary Podcast I’ll put a link directly to the episode in the show notes. Check it out. In education news, guys on March the 9th we are having our last in our to strategic planning series. Stephanie Goss is taking the lead and leading her workshop called if you can’t measure it, you can’t manage it all about the metrics. If you need to get your head straight and get a dashboard so you can look at your practice and see what is going on, and know how you’re doing, and know how to make some decisions, and have some hard numbers to back up the choices that you have to make you need to be in this workshop. It is free to Uncharted members, it is $99 to the public. That’s all it is. It is a fantastic deal. If you need this, you need this. It is March 9th, it is at 5:00 PM Pacific Time, 8:00 PM. Eastern Time. Jump in, get registered, I’ll put a link in the show.

Dr. Andy Roark:

The last thing is the April conference, it is the April Unchartered Veterinary Conference. It is in person in my hometown in Greenville, South Carolina. If you’ve never been to an Unchartered Conference, it is magic. It is not a conference, it is a community. It is where we come together and we build relationships and we support each other. And you get to meet positive, excited, enthusiastic people who are doing cool things and new things, and who see possibilities in the future, and who are excited about that medicine. If that sounds like you and you’re like, “I want to be around people like that.” This is how you make it happen. You should get on the plane, you should come to Greenville, you should meet these people, you should be a part of uncharted. And when you come the Uncharted Conference you’re not there for two or three days, oh, no, no, no, no you’re in for a year.

Dr. Andy Roark:

You’re going to come in, you’re going to do the live event, and then you’re going to stay in our online community and you are going to get support and encouragement throughout the whole year. It is the conference that does not end. It is truly different and unique. Ask anybody who’s been in Uncharted and been a part of it, it is something truly special. Anyway, if that sounds exciting to you, if you’re like, “Gosh, that sounds like it would fill me back up. I’ve lost my passion. I’ve lost my spark. I need something to get me reignited.” That’s what we do at Uncharted. Come and check it out. Don’t miss this. Take the gamble, come and see if it’s for you. It might just be the thing that you desperately need. Anyway, guys that’s enough of that. Let’s get back into this episode.

Dr. Andy Roark:

Talk to me a little bit about support staff here, right? So we’re talking a lot about veterinarians, right? You do have information on support staff as well, right?

Dr. Clinton Neill:

Yeah. Specifically veterinary technicians/nurses, depending on where you’re at and how you define that. When we look at those, their burnout rate some of that work had been done by NAVDA, the North American Vet Tech Association, or I can’t remember-

Dr. Andy Roark:

No, you nailed it. Yeah. North American Vet Tech Association.

Dr. Clinton Neill:

Yeah. They did some numbers and these are a little bit older numbers, but they’re looking at like 41% of vet techs are burned out, or have compassion fatigue of some sort. But that rate of turnover for them is still pretty high as well so that’s a big piece of that as well. And I don’t have any numbers on that different perspectives of different practice types, but it’s a problem across both support staff as well as the doctors themselves and that’s a big piece that, well, I can’t dig into those numbers as much as I want in the data.

Dr. Andy Roark:

Yeah.

Dr. Clinton Neill:

It’s important to know that and to take into account this matters to the whole industry, not just one piece.

Dr. Andy Roark:

Yeah. So in your research, you put forward that if you look at the economic impact of burnout in veterinarians, we’re talking about $1 billion a year in lost revenue attributed to burnout. And then you said, if you add in veterinary technicians, it goes up to basically two billion, right? It’s like 1.9 billion. So I was really struck by if we go with these numbers, basically the economic impact of the veterinary technician burnout is almost equal from a revenue standpoint to the doctors. I think it’d be easy to say, well, a burned out doctor is a greater financial liability than a burned out technician. And I don’t know, I assume that comes a lot from there are more in a practice than a doctor. Maybe having a smaller financial impact individually, but when you add together, burned out technicians across the practice you end up with almost the same economic impact as burned out doctors. Is that true?

Dr. Clinton Neill:

Yeah. I mean, you hit the nail on the head with that. You’ve got over a 100,000 vet techs working across all of these different practices, and then you’re also probably have about 60 to 80,000 actual veterinarians that are associates and not practice owners. So it’s a pretty big number. The other big piece here is that the cost of a vet tech leaving your practice is more than what you’re paying that vet tech, is what we actually find, and that’s a key component to that as well.

Dr. Andy Roark:

Break that down for me a little bit. Why is that the case? How could it possibly cost me more to have a vet tech leave than to keep a vet tech and continue to pay them?

Dr. Clinton Neill:

Right. Well, I mean, think about it when you have a vet tech leaving, right? How much work are they actually doing keeping that practice running?

Dr. Andy Roark:

My vet tech, like all of it.

Dr. Clinton Neill:

Yeah. I was going to say, and think how many vet techs do you have per doctor in a practice?

Dr. Andy Roark:

There’s a variation across the industry, but it’s probably three to four in my practice.

Dr. Clinton Neill:

Yeah. And so if you have one person down, that’s 25% of the work is having to be distributed across other people, which means they’re doing less work, and so it compounds. It’s not just that vet tech leaving, it’s the fact that they’re leaving, other people have to pick up the slack, which means they can’t do as much work or they’re doing too much work and burning themselves out, right? And so a lot of that comes from the fact that vet techs help bring in that revenue that a doctor’s bringing in just as much as the doctor itself. And so when they churn over, they’re not able to help contribute to that revenue generation, and that’s the important piece that we find there.

Dr. Andy Roark:

Yeah. So the opportunity cost basically is what we’re talking about, right?

Dr. Clinton Neill:

Yeah. Exactly. Which is the big economics term that economists like to throw around., is Opportunity costs is what can we be doing with that time?

Dr. Andy Roark:

Yeah, that does make sense.

Dr. Clinton Neill:

What’s the next best alternative to our time, right? Which is not trying to hire another person and then not trying to do other people’s work.

Dr. Andy Roark:

What does that number mean when we say $1 billion in lost revenue or or $2 billion if we factor in vet techs? Is that a lot? Is that a little? I think if we look at the whole industry, I honestly don’t have a good… We’re talking about imaginary money at this point to me, this is theoretical money and so it’s a bajillion dollars. And what is that money actually? What are we talking about?

Dr. Clinton Neill:

And I think it is important to say that all these numbers are really the opportunity cost, right? That even if we didn’t have as much turnover and these types of things, right? Is it really going to be $2 billion? Maybe. There’s also other things we’re not taking into account in the work that I’ve done, but taking that number and moving that forward.

Dr. Andy Roark:

Well, even what we were talking about before is say we’re looking at lost hours or job turnover. Oh, I don’t know how you calculate decreased effectiveness communicating with pet owners, but to me that’s a significant driver. So all this is going to be a little bit of shades of gray. Yeah, some got us some hand waving, can you just squinch your eyes a little bit and you can see it, but it’s important to get a general perspective of what we’re talking about.

Dr. Clinton Neill:

Yeah. And so when we look at $1 billion let’s start there, that’s 2% of the total revenue for the whole industry in the US.

Dr. Andy Roark:

Okay.

Dr. Clinton Neill:

So not a large percentage of the industry, right? You’re talking about a 2% gain just from veterinarians. If you add vet techs, right? It’s probably another almost 2% of that, so 4% of the whole industry when we round up. So it doesn’t seem like a lot, but if you put that in perspective and you look at what I enjoyed doing was taking the amount of debt from the 2020 graduating class from all the vet schools. And if you look at that, the amount of revenue that you’re not generating say if we take that number as given, could pay back all that debt twice over. And I think that’s the number that is a little more tangible than going, “Oh, it’s 2% of an industry that generates $46 billion in revenue, right?”

Dr. Andy Roark:

Yeah.

Dr. Clinton Neill:

There’s these different pieces of how we can think about it, but $500 million in debt for the 2020 graduating class of vet med, that’s a lot of revenue that could help pay back debt and reduce that stress and those types of things as well.

Dr. Andy Roark:

Yeah. I wonder whether that break down it at an individual practice level, right? So if you say companion animal practices generally have the highest level of burnout, and you’re talking about say 4% productivity loss, what does that translate to as a practice? Would that be a 4% increase in overall gross revenue? Probably more than that if you’re looking at companion animal. And then I’m sure it’s also very practice type specific, geography specific, all those sorts of things. If you have a practice that doesn’t have a lot of burnout, then you’re probably not that negatively affected, but that means that somebody else has probably got a burnout problem and they’re probably significantly more affected.

Dr. Clinton Neill:

Yeah. And I won’t say I don’t have those exact numbers I think to the question you’re asking, but for companion animals that’s where most of the cost is coming from, right? Because that’s also the largest part of the industry. You’ve got almost 56,000 companion associates.

Dr. Andy Roark:

Yep.

Dr. Clinton Neill:

And so if you look at what their numbers, total costs for the companion animal part of the industry and break down just averaging across everybody, those burned out or not, you’re looking at like $17,000 a vet.

Dr. Andy Roark:

Okay. Yeah, that’s what I was looking for. So $17,000 per vet give or take, rough math. Man, that’s not insignificant.

Dr. Clinton Neill:

No. And if you take that number and you take out all the people who aren’t burned out, right? So that number’s just going to go up, you’re talking probably more around 25 to 30,000.

Dr. Andy Roark:

Oh yeah, so when you remove the non burned out vets, which is 30, 40% of them, maybe when they come out and you just look at the impact on the burned out vets, you’re looking even higher than that. Yeah, that’s significant. That makes sense to me. And again, we’re fudging the numbers here just for conversation’s sake, but looking at a burned out doctor and saying that person’s burnout is $25,000 a year, that seems right to me. I’m not blown away by that number, I could 100% see how that would shape up into that level of lost revenue, right? And I’m not saying this as a way of increasing more revenue, but rather as a way of looking at the price that burnout takes on a practice.

Dr. Clinton Neill:

Yeah. And so even if you think about, so say you’ve got a 10 doctor practice and three of them are burned out, right? That’s almost a $100,000 in revenue, that’s $75,000 that you’re missing out on, right?

Dr. Andy Roark:

Right. Oh yeah. And that’s also bottom line money too, right? You’ve already probably covered your hard costs, this is practice profitability, this is staff salary money, this is bonus money, this is profitability on the practice money. This is money that you could actually use to affect the life of the people who work there, and to make significant changes because this is all gravy, right? This is the profitability of the practice that’s being eaten away, not the hard costs.

Dr. Clinton Neill:

Right. I mean, because vet is profitable overall in general. I mean not every practice is, but most practices are and the industry itself is producing 12% profit over cost.

Dr. Andy Roark:

Are these numbers significantly different from other professions? Are we a burned out profession compared to other professions, I guess? And there’s a lot of narratives that are thrown around, especially online people say the burnout in vet medicine is worse than anything. I don’t know that I’ve ever seen any numbers to that, is there anything comparable in other industries that we can look at? Even from a financial perspective and say, “Oh man, the toll here is significantly greater than is in other service type industries?”

Dr. Clinton Neill:

Yeah. So I mean, everything I was doing was based off of studies done in human health positions and those types of things, and so the study I did was pretty much comparable to what they were doing for human health physicians. And I’m trying to remember what the cost is, I want to say the per doctor cost is higher, but the industry cost isn’t because there’s a lot more human physicians, right?

Dr. Andy Roark:

Right.

Dr. Clinton Neill:

But it’s pretty high. We have a higher level of burnout as compared to human physicians based on… It’s not exactly comparable measures because they’re measuring it slightly differently just using a different scale, but it’s not an insignificant amount, and vet med is probably slightly more burned out than everybody else. We have higher turnover rates than most of these other industries as well, and I think that reflects that as well.

Dr. Andy Roark:

That’s fascinating when you look at turnover rate, especially when you think of the amount of training time that goes into getting a medical professional up and going in vet medicine. Or you think about, so you’re talking about credential technicians or veterinarians that ended up sinking a lot of time and effort into their training. And then oftentimes there’s non-compete…. Oh, I forget the term for it, the contractual term, but the non-compete clauses that we have that make it hard to leave, and then the fact that you would still see turnover. That’s pretty significant.

Dr. Clinton Neill:

Yeah. When I was looking at these numbers, 2020 turnover numbers you would know which was pandemic and everything else, was 20% for companion animal veterinarians. And I think AHA, the Animal Hospital Association was stating 15% the year prior, or something like that.

Dr. Andy Roark:

Yeah.

Dr. Clinton Neill:

So it’s much, much larger. And I don’t have the physician numbers right in front of me, but I’m trying to think off the top of my head, but I’m pretty sure I know turnover rates are higher.

Dr. Andy Roark:

Gotcha.

Dr. Clinton Neill:

And then just overall rate of burnout is higher as well.

Dr. Andy Roark:

What do we know as far as root cause? So when we look at this, where does burnout come from? I mean, if we know the impact that it has, we start to look at then immediately to where’s it coming from?

Dr. Clinton Neill:

Yeah. I think when I was digging into this, and I’ll say I have some data, some anecdotal data about this, just because I haven’t done any [crosstalk 00:30:03].

Dr. Andy Roark:

Yeah. Anecdotal data.

Dr. Clinton Neill:

It’s not me asking people what’s going on, there’s actual data behind this. When we would look at why people wanted to reduce their work hours or why they left, a lot of it was because the expectations of what they were told when they were hired or they were told that they were to expect for that year were much lower than what they were actually doing. In terms of how many hours they were working a week, how many emergency days they were working, or things like that. And that tended to be when they said, “I want to reduce my work hours because I’m working more than I was expecting to work and now I’m burned out.” And all those things always came up together.

Dr. Andy Roark:

That’s interesting. So one of my favorite sayings is that, “People don’t get upset about what you give them, they get upset about the difference between what they expected to get and what they got.” And yeah, expectations are important. So just for me to say this back to you, one of the continued trends is not just how much people work, but what they expected to work versus what they actually work. Is that true?

Dr. Clinton Neill:

Yeah. And I think that’s spot on. And the way that vet med’s going, right? I don’t think anybody can work less hours at this point. I think all practices are busy, I think they need people to work and that’s either hiring more people and everybody works less hours, right? Which isn’t always feasible. Or everybody needs to continue to work the amount of hours they’re working. I think just bringing that expectation up front and being like, “The need is I need somebody to work 60, 70 hour weeks. I’m not going to tell you you’re going to work 40 and then work 60, right?” I think that’s where the conversation needs to lead a little bit, and not misalign people’s expectations with reality.

Dr. Andy Roark:

Therein lies the rub, right? My wife and I are still waiting on a package for Christmas, and so we’re recording this the week after Christmas, but it did not show up in time. And she’s quite frustrated at me because we sat down together and we decided to order this thing, and we looked at a number of different places that were selling it and we went with the place that said they could deliver it by Christmas. And they totally did not and now we’re miffed, but we still placed the order with those guys.

Dr. Andy Roark:

You know what I mean? And it’s almost like one of those things, I completely agree with you, expectations are key and we should be honest about what people are getting into. I think the fear that a lot of people have is if I’m the only one who’s honest, then everyone else is going to tell a fairy tale and we’re going to lose people, but I think that transparency is the answer to that. Don’t you agree? Of saying, “This is what you can expect when you come to this hospital.” And having other people to say, “Yes, that is true. This is what you’re getting into.”

Dr. Clinton Neill:

Yeah. And I agree with the transparency piece, and I agree with that piece across a lot of different topics. I think I argued that for within the gender wage gap work that I had done and all of that, because just being honest with people, and I think that’s especially important for these younger generations when you get into the millennials and now the gen Zs are starting to get into vet school and coming out of vet school. What they care about is honesty and about being upfront and just telling them what they are to expect. And I think that’s… The transparency piece, I’m a huge advocate for, I guess is what I’ll say.

Dr. Andy Roark:

Well, no, I’m a big advocate for it. I also think it’s reality, right? It’s a force of nature, which is in the world we live in where social media is a thing and people have a voice and we’re all way more connected than we ever were in the past, right? I’m still Facebook friends with the vast majority of people I went to vet school with, and I can reach out to them and say, “Hey, you work in this area. How much do you work? And do you mind me asking what your salary is?” And generally people are very willing to share that information privately. That didn’t used to be the case, right? In vet medicine of old, everyone they graduated, they went to work in their little practice. What? Are they going to write a letter to an old classmate?

Dr. Andy Roark:

That didn’t happen, but now it’s wide open. And so now we’re starting to see pay scales, which I think are great, just wage transparency of this is what you get paid at this level, and this is what you get paid at this level. And this is how compensation is done. I think it’s been painful for a lot of clinics in vet medicine that we’re not set up that way, maybe that means a good pain. I think it’s a transformation people go through, but I think that that type of transparency is really good and it’s just interesting now to see. I think we are resetting expectations, and I think a lot of it is in schools, in vet schools. New graduates come out and I’ll talk to vets that are out looking for their first job, and they’re not dim, they’re well prepared as far as what is my life going to really be like when I get here?

Dr. Andy Roark:

When can I expect to leave the building? Not when is my shift in? Not when is the last appointment for me scheduled? When do I really leave this building? And how am I going to be contacted when I’m gone, and when I’m at home? Are you going to be calling me? Am I going to be doing those things or not? I don’t think most of us had the wherewithal to ask those types of questions. They were just unheard of in the past, but I think that that’s the new world, and so I think probably ultimately it’s going to be really good.

Dr. Clinton Neill:

Yeah. And now you have people like me working at vet school, teachings vet students to ask these type of questions.

Dr. Andy Roark:

Yeah, exactly right. Hey guys, so at best 50% of you are going to be mildly burned out in a few years. Let’s talk about that. Yeah, those are not conversations of old. Dr. Clinton Neil, thanks for being here. Where can people learn more about your research? If they want to look more into this topic, where can they go?

Dr. Clinton Neill:

Yeah. I mean, feel free to email me, my email’s public through Cornell anyways, but we can post it here and now.

Dr. Andy Roark:

Sure, absolutely.

Dr. Clinton Neill:

Feel free to email me directly, but a lot of the burnout stuff in vet med is especially new, and so I’m trying to build that out and have those resources in a place we’ll hopefully have some stuff out on the Cornell website and things like that. Working on publishing the stuff as well, so we’re working on that, but I mean, look into the position literature, research burnout in physicians you’ll find a lot of stuff there. But it’s all the same things, it’s just trying to apply it to vet med and trying to figure out what are the actual solutions to that? And that’s the next steps where we’re going.

Dr. Andy Roark:

Thanks. Guys, I’ll put a link down to the original article that we discussed in the show notes. The term I was thinking of earlier is restrictive covenant, that’s the do not compete clause that came to me later, things like that. I’m sure there’s a million other things that we messed up along the way, but man, what a good conversation. Thank you. Thanks for being here, Dr. Neil. And guys take care of yourselves, I’ll talk to you later on.

Dr. Clinton Neill:

Thanks.

Dr. Andy Roark:

And that is our episode. Guys, I hope you liked it. I hope you got something out of it. Guys, I got to give a quick shout out right now to Banfield the Pet Hospital. Listen, Banfield has given us a generous grant to have transcripts for the podcast. That’s right, you can find transcripts of both the Cone of Shame Podcast and my other podcast the Uncharted Veterinary Podcast, which is a business podcast. If you haven’t checked it out for vet medicine, check it out you might like it. If you like this one, you might like that one. Anyway, in effort to increase accessibility ,inclusion in the veterinary space, Banfield has made these transcripts possible. It’s a wonderful gift to my team, it is a wonderful a gift to our audience.

Dr. Andy Roark:

We’ve gotten emails that says, “Hey, when are you going to have transcripts so that people who are not able to hear can enjoy this content and can get information from it?” And thanks to Banfield, we’re able to make that possible, and so I just have to thank them for what they do. It was above and beyond, they didn’t have to do this, but man, it means the world to me. And I am so glad to have these transcripts to put out so that everybody can take advantage of what we’re doing here. Click the show notes, if you want to find the transcripts. And again, thanks to Banfield. Guys, take care. Be well. Talk to you later. Bye.

Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram

Filed Under: Podcast Tagged With: Wellness

Minding Our Thoughts

February 10, 2022 by Andy Roark DVM MS

As veterinary medicine continues to wrestle with its burnout problem, an emphasis on engaged and positive workplace cultures is on the rise. In today’s episode, Jeff Thoren visits to discuss the power and importance of minding our thoughts.

Cone Of Shame Veterinary Podcast · COS 119 Minding Our Thoughts

LINKS

Uncharted Podcast on iTunes: podcasts.apple.com/us/podcast/the-…st/id1449897688

WORKSHOP – What Vet Med Can Learn From Improv:
unchartedvet.com/product/what-vet…arn-from-improv/

WORKSHOP – Loading the Bus w/ Dr. Andy Roark & Stephanie Goss:
unchartedvet.com/strategic-planning/

UNCHARTED APRIL CONFERENCE: 
unchartedvet.com/uncharted-april-2022/

Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/

What’s on my Scrubs?! Card Game: drandyroark.com/training-tools/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Jeff Thoren is a husband, father, cat parent, and avid road cyclist who values uniqueness and lightheartedness.

His career highlights include:

– Founder of Gifted Leaders, LLC an established executive and team coaching company.
– Clinical Assistant Professor of Veterinary Communication at Midwestern University in Glendale, AZ
– One of only five veterinarians in the world who also hold a credential from the International Coaching Federation (PCC)
– Board Certified Coach specializing in leadership and team development
– Over 300 hours of accredited, coach-specific training and continuing education
– Extensive individual and team coaching experience
– Founding member of the Extraordinary Teams Partnership
– Co-Founder of the Enlightened Rebel Alliance
– Co-Author of a featured column in Today’s Veterinary Business

Jeff is committed to helping build engaging, innovative, and humane workplace cultures characterized by collective leadership, self-directed teams, and a spirit of partnership.

He has experience in private & corporate veterinary practice, industry, operating his own coaching/consulting business, and, most recently, academia!


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 think a lot and I write a lot and I talk a lot about what we put into our minds and why it matters so much, because it does matter. It matters a lot. We are the thoughts we choose to have, in a lot of ways. And that’s what I want to bring on and talk to our guests today. Our guest is Jeff Thoren. He’s an author at his regular column for Today’s Veterinary Business, which is where I was reading some of this stuff. He is the founder of Gifted Leaders and established executive and team coaching company. He’s a clinical assistant professor of veterinary communication at Midwestern University in Glendale, Arizona. The list goes on and on. I’ve known Jeff for years and years and years and he’s a thinker when it comes to positive psychology and how we choose to look at our profession. And that’s what we talk about today. So guys, without further ado, let’s get into this episode.

Kelsey Beth Carpenter:

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

Dr. Andy Roark:

Welcome to the podcast. Jeff Thoren, thanks for being here.

Jeff Thoren:

Hey, thanks, Andy. Glad to be here.

Dr. Andy Roark:

My pleasure to have you on. I’ve known you for years. And I’ve always really enjoyed our conversations. And you’ve done so much sort of facilitation that I’ve seen over the years and your work on communication before communication was cool in that matter. Take that the right way. Don’t take that as a Jeff Thoren is old. Take that as Jeff Thoren was ahead …

Jeff Thoren:

I was ahead of my time. I was ahead.

Dr. Andy Roark:

That’s exactly right.

Jeff Thoren:

Yeah.

Dr. Andy Roark:

For those who don’t know, you are the founder of Gifted Leaders, which is an executive team coaching company. You are a clinical assistant professor of veterinary communications at Midwestern University in Glendale, Arizona. You have your board certified coaching specialist for leadership and team development. You do a lot of things. And I’ve been wrestling with something that’s very much in your wheelhouse. And so, I’m really glad that you agreed to come on and let me pick your brain a little bit.

Jeff Thoren:

All right. Sounds good.

Dr. Andy Roark:

Here’s what I wanted to talk about today. I’m really big on this kick right now of the stories that we tell ourselves matter. And I am looking at this from a wellness and mental health standpoint. And I’m definitely not taking a toxic positivity position or the everything’s a panacea if you just choose to be happy idea. But I really believe that if we want to have a healthy profession, if we as individuals want to have a healthy career, the stories that we tell ourselves matter. The thoughts that we choose to allow ourselves to have about our job, it really matters.

Dr. Andy Roark:

And I am deeply concerned, when I look at the media and social media. And the voices that get amplified there are generally … There’s Chicken Little sky is falling voices in some cases. In other cases, it’s just, people are having legitimate problems or really legitimate struggles. But those voices get so amplified. And there’s so many people who have legitimate struggles, that if you look at the profession, it’s very easy to feel that everything is bad. Everyone is struggling, the profession has set us up to fail and to struggle, and there is no light at the end of the tunnel. Everything is darkness.

Dr. Andy Roark:

And I go, “I’m sorry. I don’t believe that that’s real.” And I’m trying to understand, I guess, how we choose our thoughts. Am I right on this? And what do we, as a profession, do about that? So anyway, that’s just to sort of set the table and say, “Thank you. Thank you for coming, Jeff. Here’s a tiny little problem that I want to present to you.” We’ll have this done in five minutes and we’ll be out of here.

Jeff Thoren:

Yeah. Wow. I’m thinking yes, five hours, we’ve probably not even start to scratch the surface. But I think I agree. And I think as you were kind of framing your challenge, which is not just your challenge, obviously it’s my challenge, it’s our profession’s challenge right now. I’m thinking back to when I first started to get into coach training. And there’s a quote which I will not remember perfectly by Viktor Frankl that says something along the lines of between stimulus and response, there’s a space and in that space lies our power to choose and really lies our happiness.

Dr. Andy Roark:

Yeah.

Jeff Thoren:

And it speaks to the idea, the important power of choice and when stuff happens, we can choose to tell one story. Or we can choose maybe some different stories. So I think you’re exactly right. That got me thinking amongst lots of other things that I read and was exposed to as part of that training. The questions we ask, the stories we tell, whatever our narrative is, what we focus on becomes our reality. And that is, I think, what you’re alluding to is there’s a lot of focus on what’s not working. And when we focus on what’s not working, we see more and more of what’s not working.

Dr. Andy Roark:

Yeah.

Jeff Thoren:

And you’re right, it’s not about being Pollyanna. It’s not about saying, “All is good, nothing’s wrong. I’m just going to blah, blah, blah, blah, blah. I’m just going to ignore it all.” It’s really about acknowledging that there’s maybe some challenges, but choosing to focus more on what can you be grateful for in that challenge? What’s there to learn in that challenge? Instead of asking what’s wrong? Who’s to blame? Which is our predominant media, right, it’s really about, it’s your fault, Andy, you did this. And if you just do what I think then everything would be better.

Dr. Andy Roark:

Yeah. This person is making my job hard. This person is awful or they’re making this bad. And I’m being negatively affected by them and they should stop doing this thing.

Jeff Thoren:

Yeah. Yeah. And then try externalizing it and not taking responsibility for the fact that it’s a dance, right? It’s a two way street. Yeah, I think, focusing on blame, focusing on what the other person is doing wrong, just keeps you in that space. And so, there’s a way to shift out of that. Actually, you really want to get to the point where you’re asking, what’s here for me to learn? What am I being called to step into or step up to that maybe I have been ignoring or I’ve not been paying attention to.

Jeff Thoren:

So really, shifting to more of a what can I learn from this? What’s useful about this? What little tiny thing related to this challenge might I be grateful for? What strength internally can I build on? Those are all part of a coaching process, really, where we all have issues and we all have challenges and we need to figure out how to kind of shift into getting more what we want.

Dr. Andy Roark:

Jeff, unpack that for me a little bit when you talk about what strengths can I build upon? That’s an interesting turn of phrase, what do you mean when you say that?

Jeff Thoren:

Well, it could be a lot of things, right? It could be, oftentimes, when there’s challenges, we get lost in the external pressures, we get lost in the external expectations, we kind of lose ourselves. And I think a big part of moving forward in the age of uncertainty that we’re in is really being clear on who we are, what our gifts are. So it could be certain passions that we have for certain things, it could be specific gifts, strengths, things that we’re really good at. It could be values. It could be things that are purposeful and valuable to us or important to us. So, qualities of being. I think that’s often a place that we forget about because we’re just responding to, again, all this external stuff and trying to just make it go away or whatever we’re doing. But, yeah, coming back to a place of stress, it’s a centered place, right? It’s about a place of strength and we all have strengths, we all have weaknesses. We need to embrace all of that. I don’t know if that’s getting us off track, but.

Dr. Andy Roark:

No, no, it was definitely not. I feel like this is the groundwork into the larger question, right? So when we say, our thoughts matter, you go, well, where do these thoughts come from? If we’re not going to be Pollyannaish, because it’s not what we’re talking about, when you’re not going to just pretend that everything is great. But instead, you want to have a productive mindset that’s based in reality. I think a lot of people, I guess, that was going to be sort of my question to you next was how do you get there? And I feel like you’re starting to lay the groundwork for that and sort of say, well, if you’re going to build a healthy perspective, it has to be built on something of substance.

Jeff Thoren:

Yeah.

Dr. Andy Roark:

And so knowing yourself, knowing your strengths, knowing your values, knowing your weaknesses, that feels like fairly firm substrate on which I can build a grounded perspective.

Jeff Thoren:

Yes. Yeah, absolutely. Well said, I don’t know that I can add much to that other than that it’s often the work that I think we forget to do. Because we, as a professional, you and I know as veterinarians, right, it’s really about competing to get into that school. And it’s about basically performing and developing skills and competencies. It’s a lot about doing. And I don’t remember, at least in my training, and I’m trying to bring that into what I’m doing at Midwestern in the communications program is, I need to balance that with, well, who’s the person that’s bringing this, right? What are the unique gifts? What’s the difference that I can uniquely make that you can’t? And then, how do we put our collective gifts together for the greater good? We tend to, I think, it kind of boxed into it’s a solo, we’re all doing our own little heroic thing and it all depends on us.

Jeff Thoren:

But really, we need to depend more on each other, which is one of the challenges we’re seeing in society right now is there’s a lot of polarization and people aren’t appreciating each other and the gifts that different people bring and are not even open to listening to that, so.

Dr. Andy Roark:

I like your point a lot about the way that doctors are educated. I do believe that we’re all brought into this. It’s a purely academic system, for the most part, and academic achievement is what is rewarding it. It’s getting the right answer, it’s doing the right thing on the test. And then, we’re kind of turned out into this profession that does not have those black and white answers and no one comes along and gives you a gold star. And there is no right answer when the client is unwilling to do the “best thing.” There is no right answer. It’s only what is possible here in this situation with these very specific circumstances.

Dr. Andy Roark:

I don’t know that we’re really trained for that. And so, now that you’re saying this, I go, what is the best training for that? Again, I think, you’re right to just say it’s this base, this understanding, of ourselves and our values and our skills and our self-worth and our weaknesses. So, you, as a clinical professor, you’re working with veterinary students now, how do you help them start to unpack that for themselves? I think there’s a lot of us who have probably not even had these thoughts. And honestly, I know, I talked to the most gifted and talented and wonderful people. And I’ll say to them, “What do you use your strengths and your weaknesses?”

Dr. Andy Roark:

And they look at me with just a blank stare, and they’re like, “You want me to tell you what I’m uniquely good at? Or what my specific patterns of struggle are that I do encounter over and over?” And I say, “Yes.” And they’re like, “I can’t. I have no idea.”

Jeff Thoren:

Yeah.

Dr. Andy Roark:

How do you help people start to have this discovery?

Jeff Thoren:

Oh, man, Andy, this is …

Dr. Andy Roark:

No, this is a huge question. Lifelong journey is what it is, but for people who just go, I don’t know how to begin to understand myself this way. Where would you even point these people?

Jeff Thoren:

Well, there’s a lot there, obviously. And I think I want to come back to, we’re talking about kind of being very clear on who you are, what your gifts are, what difference you want to make in the world. And then there’s also, and I don’t want to lose what you brought up before about being comfortable not knowing which is very, like you say, in our academic background, that is a very challenging thing for us to be able to go into a place. But I think they go hand-in-hand, it’s being clear on who I am and then being able to go into a situation that’s uncertain, that’s volatile that I can’t control and there is no right answer, at least not one that I can provide. Maybe there might be an answer that collectively we can come up with.

Jeff Thoren:

So I think it’s a combination of both those things. So on the front side, I’ll come back to that, because that’s the question you just asked. And then, this not knowing side is really about being present. I think it’s about mindfulness. It’s about developing that capacity so we can circle back around to that. But I think to answer your original question, self-awareness, well, number one, you and I are still working on, right, we haven’t figured it out.

Dr. Andy Roark:

Yeah, exactly.

Jeff Thoren:

And we have our blind spots, unconscious biases, we have all those things. And it’s, I think, number one, it’s being open to constantly learning about yourself. And then of course, there’s a bazillion ways to do that. Read reading books, getting a coach or a therapist, if that’s something that’s needed. It’s lots of assessments. There’s a great assessment called the VIA Survey of Character Strengths that you can Google. And that is a model that came out of the University of Pennsylvania, Martin Seligman’s work. That’s basically it looks at kind of key core values that we all share, but we all emphasize and prioritize in different ways. So knowing, hey, this value is really important to me, this is going to be something that’s important. In any situation I’m in to honor that, that can be very useful. Strengths Finder …

Dr. Andy Roark:

I was going to ask you about that one. That’s one that I’ve really liked. It’s pretty easy to get your head around. I found that to be a great introduction. I first did it probably 15 years ago and those are still my strengths. And I still go back to them. Yeah. That’s what I’m good at.

Jeff Thoren:

Because those are the things that, yeah, historically, if you can play to those strengths, you’re going to enjoy whatever it is that you’re doing more, and you’re going to be able to contribute in a way that is most fulfilling for you.

Dr. Andy Roark:

Yeah. I’ll put links to this stuff down in the show notes for people who are interested in checking them out.

Jeff Thoren:

Yeah. And actually, the Today’s Veterinary Business column that Trey Cutler and I co-write, we’re at the next article, I think, that will come out, which is probably a couple months down the road. Or a subsequent article anyway, is going to have some information along these lines too.

Dr. Andy Roark:

Cool. Yeah.

Jeff Thoren:

Some links to those two specific assessments.

Dr. Andy Roark:

Yeah. Today’s Veterinary Business, if you guys don’t read it, I’m so impressed with the writers that they line up. I don’t say that because I’m one of them, although I am one of them as well. But I pick it up and read it just to make sure that they spell my name right. And then, I am always sucked into the other columns that are there. So, I don’t think that that publication gets enough spotlight, there’s just such good stuff in there.

Dr. Andy Roark:

So let’s circle back, talk to me a little bit about being present in mindfulness. What does that look like in the day in the clinic, right? Basically, I don’t have time to be present. I’m getting swamped in cases. I think those things are almost counter to each other. But I hear a lot of people who are too busy to be mind.

Jeff Thoren:

Well, mindfulness, as you know, is really about just being in the present moment, without judgment, and just being with what is, right, not trying to change it or do anything about it. It’s really about acceptance, which, as you and I know with our improv backgrounds, there’s a key tenant in improv that really about saying yes, right, it’s just being open to what’s there. And whether it’s useful or not useful or desired or not desired, it really starts with just being open to it and not resisting it, working with it versus against it. So I think that alone can be very useful in a busy practice setting because oftentimes, I know for me, I get triggered, I get reactive, I start resisting things, I start pushing back. I start emotionally reacting and not in a good way.

Jeff Thoren:

And those things can really get in the way of success interpersonally and many other ways. So, I think, it starts with kind of that mindset. There are some obviously, some practices of mindfulness. Breathing is one of the ones you hear the most about. But just getting used to just being present in the moment and not letting time travel, which could be catastrophizing what’s going to happen and coming up with all kinds of stories around that, and or replaying the past and kind of getting stuck in, running old tapes over and over and again.

Jeff Thoren:

So it’s really about kind of being able to get rid of some of that stuff that’s not useful and just focus on what’s right there.

Dr. Andy Roark:

Yeah [crosstalk 00:18:44].

Jeff Thoren:

So back to the quote about between stimulus and response, there’s a space. It’s really about becoming more aware of that space, and then being able to be a choice as far as what you do with that space and not just operating off autopilot, which might take you down a road that’s not going to end well.

Dr. Andy Roark:

Yeah. The book that I sort of stumbled onto, that I think is so great for people who are in practice and kind of feeling overwhelmed, and they’re not really familiar with what it means to be mindful or the science behind or things like that. It’s called Unwinding Anxiety and it’s by Judson Brewer. It’s written for people who have anxiety. And so I sort of picked it up at a time when COVID was hitting and cases are blowing up and people are … I’m trying to see people in their cars and some people don’t want to be there. It’s sort of a very science based perspective to dealing with high stress situations. And I picked it up and, honestly, Jeff, it was the best presentation of mindfulness from a very pragmatic standpoint that I’ve ever seen. If you’re someone feeling overwhelmed, I really love it.

Dr. Andy Roark:

As far as just coping strategies working with the team and working in that mess and you put your finger on one of the two biggest ones in my life is improv comedy. Improv is one of those things where you do it. And what you don’t realize is that you’re building muscles that you use for so many other things. And I found a number of things like that in my life where I go, “I’m here and I’m doing this thing, and I’m doing it for the sake of doing it. And oh, by the way, I happen to get a lot better at other things I use all the time.” I mean, just basic communication, relationship building, all of those things. So improv comedy is making up theater on the spot, for those who are unfamiliar. And Jeff and I sort of picked it up at different times.

Dr. Andy Roark:

And just the idea of walking out, especially being on stage, I think, that replicates the pressure of being in an exam room quite nicely, where you go, “Oh, I’m being watched while I do this. And the words that I say matter and I’m being judged on what to say.” And that replication of that feeling, I know they’re very different, but in the same way, that pressure is the same for me. And I think that that really helped me get more comfortable in the exam room. And working in uncertainty, I don’t know what the other person is going to say or where this is going to go. But I’m not going to resist them. I’m going to lean into where they go. And ultimately, I believe that we’ll get to a good place.

Dr. Andy Roark:

And I’ve just found that skill and practicing it, doing it and getting it, so, so valuable. The other resource for me that I would recommend to young vets all the time is Toastmasters International, the public speaking group. And so, Toastmasters, if you Google it, you’ll find their website and they have chapters everywhere. But it’s a public speaking thing and it’s fun. You go and you prepare a little speech and you do it and you get feedback on it, and you get feedback to other people in their speaking. But I will just tell you, as a young professional starting out whether you’re a manager, a CSR, technician, being comfortable formulating your thoughts, and then communicating the things that are important clearly and concisely. It’s a skill that you just don’t learn otherwise, man, that investment paid back in spades, it really did.

Jeff Thoren:

Yeah, a couple things that come to mind back to kind of the awareness piece. And you mentioned the Judson Brewer book, I would also add to that list, Search Inside Yourself by Chade-Meng Tan. I don’t know if he’s still with Google, but he’s a Google engineer and he basically writes a lot about emotional self-awareness, which again, in our profession, we’re heady people, right? We’re rational. We’re trained kind of in left brain kinds of stuff. The right brain emotional stuff is a little bit less, we’re less familiar with that.

Jeff Thoren:

And so this book is a nice way, again, evidence-based, that kind of bridges that gap and helps us realize the importance of being aware of our emotions as data, our thoughts are data, our emotions are data. And then, how does that all fit together? So, that and then plus one for your comments about improv. There’s a great book there that got me into thinking about actually getting on stage. And it’s called Do Improvise by Robert Poynton, P-O-Y-N-T-O-N, that just kind of connects the dots between the basic principles of improv and how to show up and be present in the moment with what’s there and not knowing not being able to control things. Those are incredibly important.

Jeff Thoren:

And then, two other points in improv is you talked about the exam room. And the exam is all about relationship centered care. It’s all about partnership. And improv is all about the ensemble, right? You’re up there with a group, right? The group succeeds based on everyone contributing versus not having one hero kind of take the scene and make it funny. So, it’s really an ensemble sport. And that’s what being in the room with a client is, that’s what working as a team in a veterinary practice is all about. So, those things all blend. And then it’s not about being fun. It’s not about being on stage and performing. It’s about being present and just offering your gift in the moment as it’s appropriate.

Jeff Thoren:

So, people kind of think, “Oh, I can do improv because Wayne Brady goes up there and they give him a song title and the genre and he makes up jokes on the spot.” I could never do that. Well, no, no, I could never do that. However I can learn to get more comfortable being in the moment with what the client has given me, which may not be what I want the client to give me and being able to respond in a way that’s in the spirit of partnership and the greater good for me, the client and the pet.

Dr. Andy Roark:

Yeah. So, I’m going to put links to all the resources we just talked about down in the show notes, we’ll have that. I want to switch gears a little bit here. In your coaching business, when you’re working with professionals, you’re working with veterinarians, are there recurring problems that you were seeing a lot today? Are there things that you feel like are on the upswing as far as what people are wrestling with and how they’re wrestling? I guess, I’m sort of looking for common perspective struggles that doctors or technicians are having.

Jeff Thoren:

It’s all individual. I would say that the challenges that people face are probably typical of the challenges that our culture are facing. And I think as a profession, obviously, one of the big things right now his staff shortages and having to change and being able to do that effectively.

Dr. Andy Roark:

Yeah.

Jeff Thoren:

So pivoting, being more responsive and adaptable, whereas COVID basically forced that, so …

Dr. Andy Roark:

Yeah. I love the old saying, people want change, they don’t want to change. I was like, oh yeah, we’re all ready for something different. But I don’t want to …

Jeff Thoren:

Yeah, you go first.

Dr. Andy Roark:

Yeah, exactly.

Jeff Thoren:

Yeah, yeah. So I think it’s really kind of, I would say, Andy, it’s a reflection of just some of the things that we’re facing as a profession. Certainly, burnout is an issue, I think, there are some serious things, again, what we focus on becomes a reality. But we don’t want to just brush aside the fact that it’s challenging for new grads to come in and meet the demands and to work at a pace that some of us that have been in practice expect. And I think there is more of a need to balance being and doing.

Dr. Andy Roark:

Yeah.

Jeff Thoren:

And so all these things are kind of all coming together and different people have different things that are important to them. But there’s just a myriad of struggles. And a lot of it comes down to just being open to having a conversation and talking about, well, what do we want, right? Again, shifting the conversation away from, well, this sucks, and this isn’t working, when will it end? To, well, what would we want to create together? And how would we do that? And how would we use each of our individual gifts to contribute to that? The conversation, I think, is overall, I’m kind of straying away from your original question but …

Dr. Andy Roark:

No, no, that’s fine.

Jeff Thoren:

In coaching, the conversation, again, it’s about the narrative, right, and what do you want that narrative to be? I think, on a larger scale in the profession, what you’re doing is great because you’re bringing up this idea of is the conversation we’re having helpful or is it, you’re keeping us stuck in the place that we don’t want to be stuck in.

Dr. Andy Roark:

Yeah, I mean, you put your finger right on. That’s exactly my concern. I see good people working very hard to try to make the profession better. And I go, is this the way that we need to work? Yeah. Are we working on the right thing to move us forward? And again, I don’t have the answer. It’s really deeply kind of what I’m searching for.

Jeff Thoren:

Yeah. It will involve change and will involve us … We’ve been pretty comfortable as a profession. We’ve been very successful as a profession. The world’s changing around us. The workplace is changing as far as what people want out of it. We’re all going to have to be open to building something maybe a little different together, which hasn’t been the norm in the past.

Dr. Andy Roark:

All right, so here comes the hard question. What does that look like to you, Jeff Thoren? Where do we go from here?

Jeff Thoren:

Well, how much time do I have to [inaudible 00:28:53]? What do you think about that? Well, I think it’s been said, it’s really first being open to the cheese has been moved, to quote a very old management book about having to be open to change. I think it also means, again, this is from my perspective, it means kind of us redefining leadership and it not being top down and not being one group kind of controlling things. It really has to be more of a collective approach. We need to create a dialogue that everyone is equipped to have, where we can talk to each other without going into one camp versus the other. There’s just so many things but there needs to be kind of a collective dialogue that we all have together that moves us forward versus expecting the AVMA to come up with answers or putting unnecessary burden on practice managers and practice owners to have all the answers.

Dr. Andy Roark:

That’s a good one. Yeah, that’s a good point.

Jeff Thoren:

Really, I think, it comes down to this is something we all have a stake in. And so, how do we get all the stakeholders to talk together about what could be, right? Not what is and how do we preserve our old sacred cow ways of doing things, but what do we want and then how do we move towards that?

Dr. Andy Roark:

Yeah. No, that makes sense. I guess one of the things I hear you say here, the idea that someone up the chain is going to make us happy. I think that’s deeply flawed. I think that’s a recipe for ongoing frustration. Like the AVMA is not going to make us happy. It’s a balance, right? I would say that practice leadership, practice owners, practice managers, they do have a responsibility to provide a fertile ground for a healthy, satisfying career. They do have power that the individual doesn’t have. The struggle I see here, right, is I see some people who put too much emphasis on the practice owner, practice manager, medical director and say, “Well, they’re not making me,” or yeah, “They’re not generating the culture that’s forcing me to be happy or putting in a position to be happy every day.”

Dr. Andy Roark:

And I really do think that that’s an easy choice to make is we think, well, the people higher up the chain, they have the power, they need to make this happen for me. And I think that’s the problem. The other problem, though, that I do see is the idea that personal boundaries are the answer to everything. I don’t buy that either. I think going to the technician and saying, “Oh, you’re burned out and stressed out and tired, because you don’t have good personal boundaries.” That’s ridiculous. When the person doesn’t have options, they don’t have agency, they’re following the policies that have been put forward. They’re working through their lunch break, not because they really want to, because that is the unspoken expectation that’s being put on them.

Dr. Andy Roark:

And so the idea that, personal boundaries and it’s all in the individual, I don’t buy the either. But I think that that balance is really important. I think the more personal responsibility we take for our own happiness and our own position, I think, the better off we’re going to be. And part of that personal responsibility is being honest about where you’re working. And if you’re working in a place that’s not going to allow you to be happy or successful or not going to take care of you, you need to use your personal agency, and you need to go somewhere else, because it’s pretty easy to find a job right now.

Jeff Thoren:

Yeah. A lot of these, a lot of the things you’re talking about are symptoms of kind of the traditional parent-child dynamic, leader-follower, boss-subordinate, that kind of comes with the territory is the kids basically do what they’re told or not and get in trouble. And they depend on the parental unit to make all the decisions but we need to level up the playing field, which is I think, what you’re talking about, what you’re calling for, is it needs to be an adult-adult dialogue, and more of a level playing field and a level conversation.

Jeff Thoren:

Sure. I do agree with you that positional leaders have the responsibility of facilitating that process. That’s why they’re in that role is really not to be the boss and tell people what to do. But to facilitate the conversations that often don’t happen, that need to happen to address some of the challenges that we’re facing. And to also, I think, be someone that is appreciative, is modeling the idea of what you focus on becomes a reality, right? So not centering the conversation around what’s broken and who’s to blame, but more around, here’s our collective challenge team. What do we want to do about that? And what will each of us commit to, right? It’s really about, like you said, personal responsibility.

Dr. Andy Roark:

Yeah. Jeff, where can people find you online? Where can they learn more about your sort of your teaching and writing? And where can they dig deeper into this conversation if they want?

Jeff Thoren:

Well, number one as you mentioned Today’s Veterinary Business. So, the Go With The Flow column that Tray Cutler and I co-author would be a great place because there’s a lot of content along these lines of what we’ve been talking about today. They can certainly just check out giftedleader.com. And that will provide a link to my LinkedIn profile. If they want to reach out directly just have them email me at jeff@giftedleaders.com.

Dr. Andy Roark:

Awesome. Thank you so much. Thanks for being here, my friend.

Jeff Thoren:

Yup. Thank you.

Dr. Andy Roark:

And that is our episode. Guys, I hope you enjoyed it. I hope you got something out of it. As always, the best, kindest nicest thing you can possibly do for me if you liked the episode is to leave an honest review on iTunes or wherever you get your podcast episodes. It’s how people find the show. It gives me some guidance about what people like and it keeps me encouraged to keep doing the episode, so I really appreciate it. Guys, take care of yourselves, be well. I’ll talk to you soon.

Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram

Filed Under: Podcast Tagged With: Wellness

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