Wellness

Dr. Donnell Hansen, veterinary dentist, sits down with Dr. Andy Roark to advise on the case of a 12 year old yorkie with mild kidney disease who may or may not need multiple extractions. Chanel has approximately 30% horizontal bone loss across the maxillary premolars, and the teeth feel stable on palpation. What do we do? Do we pull them? Or do we leave them? How do we decide?

LINKS

Four Legged Tooth Fairy: fourleggedtoothfairy.com/

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

Dr. Donnell Hansen, a Minnesota native, and a small group of friends joined together to form the Moxie Center (which was the first hospital to be now known as BluePearl) in Minnesota’s twin cities of Minneapolis/Saint Paul. Although her daily life is spent in specialty care, in 2011, her and her husband, also a veterinarian, opened Rice Creek Animal Hospital which provides a little balance and perspective about life in family practice. In 2019, Donnell developed Four Legged Tooth Fairy, an interactive small group conference center for the veterinary community to enhance their patient health, practice health, and mental health through veterinary dentistry. Dr. Hansen’s special interest in maxillofacial surgery, however the truth is, she loves the whole darn gig… especially when she gets to share the fun of veterinary dentistry with others!

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. Donnell Hansen, veterinary dentist. I am asking her about that case. You know the case, the one where you have the little dog on the dental table and you are going, “Ooh, do I take these teeth? Do I leave these teeth? They are right on the line.” And this dog’s had a little bit of renal disease, and it kind of makes me want to hurry up and get this procedure over with.

Dr. Andy Roark:

But I also want to do what’s right by this dog from a dental and health well-being standpoint in his mouth. I don’t know, guys. I’m torn. Do I take it? Do I leave it? How do I know?” Dr. Donnell Hansen weighs in on that question? Let’s get into this episode.

Kelsey Beth Carpenter:

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

Dr. Andy Roark:

Welcome to the podcast. Dr. Donnell Hansen, thanks for being here.

Dr. Donnell Hansen:

Hi, guys.

Dr. Andy Roark:

Oh man. I appreciate you making time because you’re living in the strange virtual school world that I am living in. Your children are in the house, and they never leave.

Dr. Donnell Hansen:

They’re always here.

Dr. Andy Roark:

I know.

Dr. Donnell Hansen:

They’re always around.

Dr. Andy Roark:

I feel that so much. It’s like, I love you, but get out of my bedroom. Get out of my bedroom.

Dr. Donnell Hansen:

You got to go.

Dr. Andy Roark:

Yeah. It’s that. I’m not doing that. Well, thanks for being here. How you been? You’ve been doing okay as we kick off 2022?

Dr. Donnell Hansen:

Don’t you wonder when people ask you that, how have you been, you kind of want to say, “Well, I think I’m fine. I’m miserable, but I’m wonderful all at the same time.” I don’t never know how to answer that question anymore.

Dr. Andy Roark:

In the pandemic world, yeah, I agree. How you are doing? I’m like, what do you want to know when you ask me that? There’s some nuance here to unpack, but yeah, no, I appreciate you being here. You are a board veterinary dentist. You are one of my favorite people to talk to, and you are a regular guest on the program. I am so glad that you took my call, because we’re heading into until health month, which is the thing that a lot of practices do. I’m a big fan of. I got a case for you. You want to help me out?

Dr. Donnell Hansen:

I’m ready. Thanks for having me, Andy. It’s always fun.

Dr. Andy Roark:

I super enjoy it. All right, here’s what we got. I’ve got a 12 year old female Yorkie named Chanel. Chanel, I’m worried… I’m worried Chanel has a little bit of kidney disease, right? Her creatine levels are a little bit elevated, but she seems to be in pretty good health overall, but I have some concerns about prolonged anesthesia time, things like that, just in the back of my mind. I’m in here. I’m getting ready to do this dentistry. We’ll say I am halfway through the dentistry. I have magically paused space and time to ask you this question right here at this moment.

Dr. Andy Roark:

I am looking at… Chanel’s got some dental disease. She has got a furcation and cross, the maxillary pre-molars. She’s got about 30% horizontal bone loss. The teeth are stable. They’re not the wiggly Yorkie teeth where I’m like, “Blink! Oh, look, this one’s out.” It’s not that. They seem pretty solid. But I’m looking at this and this is 100% percent a should I, shouldn’t I, when do I go forward with extraction, and when do I not question.

Dr. Andy Roark:

To make this a little bit more nuanced here, on Chanel’s lower jaw, she’s got about 10% bone loss on that first molar, like the 309, 409 big tooth down there. I’m looking at that as well. I’m kind of like, do I want to get into that mess, because that’s big mess in a little dog’s little jaw. I think my question for you today is, can you help me decide what is best to do and what is best to medically treat and keep an eye on and how much is too much to do in one setting? These are hard questions, I think, a lot of vets have. Donnell, how do you treat that?

Dr. Donnell Hansen:

It kind of cracks me up actually that you bring up Chanel, the 12 year old Yorkie, because literally on like Tuesday of last week, an old friend client, you know how clients become friends over time, showed up to bring the Christmas gift basket of packaged sausage, right? That gift basket we all know about.

Dr. Andy Roark:

Yeah.

Dr. Donnell Hansen:

And her pet’s names are Audrey Hepburn and Halle Berry, two Yorkies that have since passed away, but Chanel fits perfectly for this 12 year old Yorkie of yours.

Dr. Andy Roark:

Oh, I was going to say Coco Chanel was the third one, the one she hasn’t had yet.

Dr. Donnell Hansen:

Yeah, right. It’s coming. It’s coming.

Dr. Andy Roark:

Yeah, exactly. I see your future.

Dr. Donnell Hansen:

It’s a wonderful family. They’ve become friends after a while. Anyways, listen, I totally get this case. I think like radiographs, we kind of joke that extraction should be black or white. This is when you extract. This is when you don’t extract. I think as dentists, sometimes we get a little bit like, “Oh, you got to do it this way.” I sit there on a Thursday looking at the same Yorkie, thinking, “Hmm. Do I have to do this? Do I want to do this? Do I have to pick up my kids at 6:30?”

Dr. Donnell Hansen:

You’re thinking all these things when you’re sitting down to this patient to try and make what’s the right choice. Have you learned Andy, maybe it’s just me, but it feels like there’s no such thing as right and wrong anymore, right?

Dr. Andy Roark:

Oh yeah. It’s all shades of gray.

Dr. Donnell Hansen:

Just a little bit better.

Dr. Andy Roark:

Yeah, no. When I was growing up, there were good guys and bad guys, and good people and bad people, and good decisions and bad decisions. I don’t see a whole lot of those clear lines anymore, unfortunately. It’s all shades of gray.

Dr. Donnell Hansen:

Right. You have to navigate that, especially when you’re doing this and you’re thinking about in the back of your brain… I don’t know about you guys, but I’m always thinking like I’m going to be on A Few Good Men where Tom Cruise is interrogating me. Should you extract this tooth?

Dr. Andy Roark:

You can’t I handle the extractor.

Dr. Donnell Hansen:

I don’t know. I need to rationalize everything. There’s so much that goes into this. Can I ask you? You’re looking at this. You found horizontal bone loss on your x-rays. Did you feel anything while probing? With your little probe when you went along, what did you sense there?

Dr. Andy Roark:

It’s a Yorkie, right? It’s got some gum recession, and it’s got this tiny little mouth. I think that if I want to feel some stuff, then I can feel some stuff. It didn’t drop all the way to the base of the probe or anything. I don’t know if that makes it better or worse, but it’s not like, “Oh, this is a cavern.” If I stuck the probe in there and it was just cavernous space, I would have much stronger feeling about out like yeah. I don’t know if that makes it better or worse.

Dr. Donnell Hansen:

Here’s what you’re doing, right? X-rays will tell you one story, they’ll be one part of the story, and then your oral exam is going to tell the other part of the story. We’re really looking for what is the degree of attachment loss on this tooth, right? And remember, attachment loss is technically your recession. You found recession on this little mouth. You got to add that to your periodontal pockets. Maybe you had three millimeters of recession and you had a three millimeter periodontal pocket.

Dr. Donnell Hansen:

Your brain might just did a little red flag because you think, wait a minute, three millimeters of probing depths can be normal. That’s what we say in the books. One to three millimeters is a normal sulcus. That’s where there’s no attachment loss. It’s just the space between the tooth and the gums, right?

Dr. Andy Roark:

Right.

Dr. Donnell Hansen:

So now we got six, right? And that number is relative. Six millimeters, again, on the Yorkie first premolar is different than six millimeters on a Labrador. Those are two different numbers, and it’s relative the ratio of that dang tooth that you want to think about. The books will say 50% bone loss is where we extract. Have you heard that before?

Dr. Andy Roark:

Yeah.

Dr. Donnell Hansen:

But you guys all know it. At 20%, at 30%, you might have furcation already at 20% on some of these teeth. Because in dogs and cats, their furcation is really coronal compared to what a human tooth might be. You all know what? If furcation is exposed, how many of you guys can floss the tooth of your Yorkie?

Dr. Andy Roark:

Hey, guys. I just want to jump in real quick with a couple announcements over on the Uncharted Veterinary Podcast, which came out yesterday. Stephanie Goss and I are talking about battling negativity in our practices. If you are like, “Eh, people counting down and starting to hear some sort of grumbling and some negativity, and I’d like to handle that in a graceful way and try to help get people back to seeing some of the good stuff that we do,” this episode is for you. I’ll put a link to the Uncharted Podcast down below in the show notes.

Dr. Andy Roark:

Also, in real world things, in person things, the Uncharted Veterinary Conference is coming in April. It is April 21st through the 23rd. It is in person. It is in my hometown, Greenville, South Carolina. Guys, I would love to meet you. I would love to you in person. I would love for you to meet my friends. I would love for you to be part of our community and to get fired up about what you’re doing again, and to see what’s possible, and to see the future as a bright place that can be affected by you. You can take yourself there, and you can take your team there.

Dr. Andy Roark:

You can enjoy and feel excited about what’s coming down the road again. If that sounds good and you’re like, “Man, I’d like to get excited about the future, and I’d like to feel like a lot of things are possible. I’d like to have new friends and see other people who are making their way and who inspire me and who support me and cheer me on and who I can teach and who I can learn from,” then come and check out Uncharted in April. Guys, we are going to have a limited attendance this year just for COVID reasons. I want to keep people safe.

Dr. Andy Roark:

It is a very hands-on active conference, but it’s super special. I mean, ask anybody who’s been to Uncharted. It’s not like anything else. I think most of those people will tell you it’s kind of magic. Anyway, I would love to see you guys there. If you’re not up for traveling to Greenville, and even if you are, other things on the Uncharted side of the house that are virtual, I am working with my wingman Stephanie Goss on some strategic planning courses. On February 23rd, for example, we have a two hour workshop on assessing your employees and loading the bus.

Dr. Andy Roark:

If you are like, “Hmm, I have no idea how I should be evaluating my staff or even what to look for or how to do that. I would like to learn what other people do and how they do that and how I can use those assessments to make my clinic run better and to kind of hold people accountable and things like that,” that’s what this workshop is about. It is from 8:00 PM Eastern to 10:00 PM Eastern on that February 23rd. You can do with math and decide what it is in your time zone, but it’s 8:00 to 10:00 Eastern PM on the East Coast.

Dr. Andy Roark:

Anyway, that’s it. That is the strategic planning, loading the bus. We have another workshop, What vet med can learn from improv, and that’s improv comedy, with Dr. Adam Little. Super fun fundamentals of improv comedy that helps you in practice, as well as life. That is February 17th. That is free to Uncharted members. Guys, that’s enough. We got, like I said, tons of stuff. Head over to unchartedvet.com to learn all about it. I’ll put links to everything in the show notes below. If you are not familiar with Uncharted, check it out.

Dr. Andy Roark:

It’s pretty awesome. I love it. I’m a bit biased. It’s my favorite. It’s my baby. It’s the thing that I work on more than anything else. All right, that’s enough of that. Guys, let’s get back into this episode.

Dr. Andy Roark:

When we’re talking about these really small dogs, does that percent in your mind change based on their size? To your point, 50% loss in a Labrador is still a decent amount of actual not loss. Compared to this tiny Yorkie where you’re talking about, man, 50% is a tiny little bit of bone and tissue. Does the breed make a how difference in this decision if you’re talking about percentage of bone loss?

Dr. Donnell Hansen:

Not really. The reality is as a dentist, we’re probably way more aggressive with the extractions than maybe the average family practitioner would be, which is ironic because my job is to save teeth, right? But really you send us a case and you say, “Oh, these four need to be extracted,” and we end up taking out 12. And that might feel counterintuitive, right? But we recognize that in the vast majority of patients, peridontal disease is not going to get better. We see, okay, it’s a 12 year old Yorkie.”

Dr. Donnell Hansen:

The reason why a breed matters is because it’s a Yorkie, so the propensity for period disease is going to be dramatic, right? Compared to a Labrador. Maybe with a Labrador that was a unique tooth. Something happened to that tooth that caused that one to have more disease than the rest, but you’re not prone to have disease across all the arcades on a Labrador, right? For your case, ooh, 30%, it’s only going to get worse.

Dr. Donnell Hansen:

I’m extracting that one and probably its neighbors, because it’s probably at 20 or 40% or some place in the same neighborhood, right?

Dr. Andy Roark:

Yeah, okay. That makes sense to me.

Dr. Donnell Hansen:

The breed itself doesn’t change my plan. It’s what’s this dog’s risk that changes our plan. And being a Yorkie, the risk is high.

Dr. Andy Roark:

Okay. All right. What other markers are you looking for here as far as how you make this decision?

Dr. Donnell Hansen:

The things that we go through in our heads when we’re thinking about extraction, and right now we have a resident, which is… We’ve always had vets come and shadow us and hang out with us, which is one thing. But now I have a resident who’s shadowing and she’s watching every move, right? I have to rationalize every single extraction or not. If I choose to leave one, I have to have an explanation for that. That makes it harder.

Dr. Andy Roark:

Yeah. It’s just not the gut feel. It’s not the art. I feel this tooth wants to be here.

Dr. Donnell Hansen:

I have to explain myself all the time now. Let’s think about that same Yorkie. If I have a tooth that’s on the fence, now imagine that lower first molar you mentioned, you said there’s 10% bone loss on that lower first molar. Those upper guys, I should clarify, the 30% bone loss on those upper guys, boy, unless I have a very dedicated owner, a family who’s like, “I come every six months. I just adopted this dog.

Dr. Donnell Hansen:

It’s never gotten care before, but now it’s going to get care. That 30% is likely to be stabilized,” I might be convinced on borderline teeth to keep them around with a commitment from the family, right?

Dr. Andy Roark:

Yeah. You’re more trusting than I am. I’m totally going to get onboard now. We’re going to take good care of these teeth starting right now. Okay.

Dr. Donnell Hansen:

I hate to admit, I’m always assessing families, right?

Dr. Andy Roark:

Okay, yeah.

Dr. Donnell Hansen:

I’m quick to say I’m hopefully not judging them, right?

Dr. Andy Roark:

Right. No. No.

Dr. Donnell Hansen:

Listen, my own pets don’t get the same kind of care. That’s my family’s offer.

Dr. Andy Roark:

No. I mean, it makes sense. What I’m hearing from you basically is there’s nuance in this decision of, does this come out or does it not? It’s on the line and some of it is. How vigilant are going to be at home? If this goes south, am I going to get a chance to catch it in a reasonable amount of time? Am I making this decision for the next year, or am I making this decision for the rest of this pet’s life? If it’s the rest of this pet’s life, I may be a bit more heavy handed than if it’s just, hey, I get to look at this in six months or a year.

Dr. Donnell Hansen:

Right. Have they mentioned costs, right? I get it. I can’t always pay for the things that I want to pay for too.

Dr. Andy Roark:

Sure.

Dr. Donnell Hansen:

Have they mentioned it? Have they focused on cost? Have they mentioned time? Maybe they’ve got six kids and taking this Yorkie to the dentist is not going to happen coming in every year. Have they mentioned a fear of anesthesia, right? Some of those families are petrified, and that’s not the kind of family to be saving teeth in.

Dr. Andy Roark:

Yeah, no, that makes less. And when we talked a little bit about this dog’s got a little bit elevated creatinine, how big a deal is that? How big a deal do they perceive that to be? That makes a ton of sense in this decision.

Dr. Donnell Hansen:

Right? Do we expect it to get significantly worse? We can do care on pets with kidney disease all the time. There’s lots of things to do to prevent exacerbation of that kidney stuff with anesthesia and with fluids and with support. It doesn’t stop me in any way, shape, or form. But is it going to halt the family? Is it going to become an issue long-term? Well, then again, I’m more aggressive assuming our current anesthesia is going well, right?

Dr. Andy Roark:

Yeah. Okay. Yeah, that makes sense. Where does this case go bad for me? What are the big mistakes that I need to be watching out for? What are the things you see vets get wrong in this scenario?

Dr. Donnell Hansen:

That’s a hard one, right? I don’t know if there’s really a right or wrong. Here’s the things I’m thinking about. I don’t like to keep a patient under anesthesia if they’re hypotensive, right?

Dr. Andy Roark:

Yep.

Dr. Donnell Hansen:

Bradycardia, we all have come to find ways to manage bradycardia. We know that dexamethasone does that for us. A lot of our anesthetic drugs do that. It’s very rare for me to stop a procedure because of bradycardia, as long as their blood pressures are maintained, right? If I’m debating about a tooth, I’m not…

Dr. Donnell Hansen:

If I have to prioritize a tooth and I have one with endodontic disease, AKA pulp disease, think abscess, and I have one with periodontal disease, think horizontal bone loss or vertical bone loss, if I have to prioritize which one is going to get my priority, the answer’s going to be endo, because that’s the one that’s going to have known pain associated with it.

Dr. Donnell Hansen:

I won’t minimize that perio has pain, so please don’t interpret me as saying that periodontal disease doesn’t have pain. But endodontic disease, AKA abscess teeth, fractured teeth, those guys we know are overtly painful. We all have people in our lives who have periodontal disease and they aren’t wandering around complaining all the time. If I have to pick one, I’m going to pick the fractured tooth.I’m going to clean like heck around the one with perio if I have to get down my procedure now.

Dr. Andy Roark:

Right.

Dr. Donnell Hansen:

Right?

Dr. Andy Roark:

Okay.

Dr. Donnell Hansen:

That one’s going to be my priority. But nonetheless, if we’re having trouble aesthetically, we can stop at any point. We don’t have to proceed. We can regroup and schedule again for two weeks from now to finish the procedure. Make sense?

Dr. Andy Roark:

Yeah, yeah, it does. If I make that call, right? So I say, “I’ve got these concerns. I’m worried about some hypotension, or I’m worried about where we are, or yeah, just financial concerns or whatever,” what are the key things that I need to communicate to the pet owner? What do I need to do going out here? I’ve got some teeth I’ve decided to save, but my expectation is I’m going to get a chance to watch them. How do I set expectations with the pet owner? What are the important parts of that conversation as they leave?

Dr. Donnell Hansen:

The tricky part with what we say to families about we’re going to watch teeth, right?

Dr. Andy Roark:

Yeah.

Dr. Donnell Hansen:

We’re going to watch them. Families assume that means that they can at home assess, “Oh, they’re painful now, or oh, I can watch for swellings or draining tracks or they’ll stop eating,” and they just won’t. If I ever dare to say we’re going to watch something or monitor something and I always clear my notes to say via anesthetized oral exams and dental radiographs. That’s what watching them means. Most times, dear family, you’re not going to know if something’s up.

Dr. Donnell Hansen:

You and I have to have such relationship that you trust me that every year I got to get this patient under anesthesia. Even with the kidney disease, I got to go around and look around in there. And if we can do a yearly care that is an hour long, rather than the three hour adventure of constant extractions, that would be awesome. That’s the goal.

Dr. Andy Roark:

Is that what monitoring kind of looks like in… Monitoring. Is that what ongoing care looks like in your mind is getting the passing back on a regular basis, anesthesia, maybe any grade one cleaning that needs to get done, and then some repeat radiographs? Is that kind of where your head’s at?

Dr. Donnell Hansen:

Here’s the tricky part too, we feel… Maybe I’m projecting, but I think we feel as veterinarians, if we get under anesthesia and we find nothing, we almost feel skivvy be about it like, “Oh, we didn’t need to do this,” right? If it’s beautiful in there, why did I spend their money? Why did I take their time? Why did I take the risk of anesthesia? You guys, the hope is to find nothing. That’s the goal, right? Under anesthesia, clean the teeth, take the x-rays, find out, hey, it’s healthy. I want to find nothing.

Dr. Donnell Hansen:

When I go to the dentist, “Oh, clean bill health. Bye, guys. Thanks. That’s the goal. Don’t feely skivvy about that. That’s preventative care. That’s prophylactic care. That’s the point.

Dr. Andy Roark:

That’s awesome. Donnell, thank you so much for being here. Where can people find you online? Talk to me real quick about the Four Legged Tooth Fairy.

Dr. Donnell Hansen:

Oh heck. Four Legged Tooth Fairy was just a maybe selfish invention for us to be able to offer really, I hope you guys, high quality dental education for the family practitioner. It’s selfish, because then everybody comes to us. We have all the equipment that we need. We got everything that we’ve got in one spot. We all become besties for about three days, and we have so much fun. You have to come to Minnesota. Right now it’s January and I’m wearing my down jacket inside.

Dr. Donnell Hansen:

It’s negative 10 right now inside, and we’re all freezing, but it’s okay. It’s a beautiful place to come. You can embrace the cold. In the summertime it’s gorgeous.

Dr. Andy Roark:

Where can people learn more?

Dr. Donnell Hansen:

Fourleggedtoothfairy.com. Www.Fourleggedtoothfairy.com.

Dr. Andy Roark:

Awesome. Thanks for being here.

Dr. Donnell Hansen:

It’s a side hustle, but we love it.

Dr. Andy Roark:

And that’s what we got for you guys. I hope you enjoyed it. I hope you got something out of it. If you did, as always, the kindest thing you can do is leave me an honest review wherever you get your podcast. I love it. It’s how I get feedback on the show. It means the world to me. I like positive reinforcement. I also love to hear what you guys think we should be talking about and what types of cases you would like to hear. Anyway, that stuff’s always useful to me. Please feel free to let me know. Gang, take care of yourselves. Be well. Talk to you soon. Bye.

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

This episode is made possible ad-free by the sponsorship of Hill’s Pet Nutrition!

Dr. Andy Roark has a 4yo FS Labrador that is 6-7/9 body condition score. He’s wondering why he struggles to motivate clients to make changes that will get this dog back to an ideal condition. Dr. Mike Robbins is in to discuss what vets get wrong in these conversations, how vets and technicians can make better recommendations to motivate these clients, and the missed opportunities we all have in doing nutritional assessments.

This episode has been sponsored by Hill’s Pet Nutrition.

LINKS

Hill’s Quick Reco Tool for personalized feeding fecommendations made easy:
quickreco.com/

Hill’s Veterinary Resources for Patient Weight Loss:
www.hillsvet.com/pet-solutions/we…agement-pet-food

American College of Veterinary Nutrition specialty website: 
acvn.org/

WASAVA for Diet History Form:
Full Form: 
wsava.org/wp-content/uploads/2…ssment-Checklist.pdf
Shortened Form: wsava.org/wp-content/uploads/2…iet-History-Form.pdf

Veterinary Technician Nutrition Specialty Program/Info:
nutritiontechs.com/

Veterinary Healthcare Team site: www.endpetobesity.com/vet

Pet Parent Friendly site: www.endpetobesity.com

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Michael T. Robbins, DVM, Dipl. ACVN received his veterinary medical degree in 2015 from the University of Tennessee and completed a rotating internship at the BluePearl Veterinary Hospital in Louisville, KY. This was followed by a residency in small animal clinical nutrition at North Carolina State University College of Veterinary Medicine. He then stayed on with the Clinical Nutrition Service for 7 months following his residency to further hone his skills prior to accepting the position of Scientific Communications Specialist with Hill’s Pet Nutrition. During
his time at NC State, Dr. Robbins was involved with developing specifically tailored assisted feeding tube diet blends, outlining feeding plans for all ICU patients, creating appropriate homemade diets for those patients with specific and complex nutritional needs (as well as extremely particular taste preferences), while also providing nutritional advice to referring veterinarians. He also assisted with teaching responsibilities of third and fourth year veterinary students as well as rotating interns. In 2021, Dr. Robbins received his diplomate status with the American College of Veterinary Nutrition which has recently been altered to American College of Veterinary Internal Medicine (Nutrition). His current responsibilities with Hill’s are to deliver education to veterinary staff, students, and those involved with Hill’s tours; provide technical support to Hill’s Veterinary Consultation Service; assist with review of technical documents; support the execution and development of digital education and social media strategy; and build relationships with Key Thought Leaders.

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. Gosh, I got a treat for you today. His name is Dr. Mike Robbins. I had a wonderful conversation with Dr. Robbins. He is a board of nutritionists and, generally, a delightful person. We do a how do you treat that episode. I talked to him, quite frankly and vulnerably, about the difficulty of getting pet owners to buy into doing something about their slightly overweight dog. And, some of it is just making time in the exam room to have the conversation, part of it is trying to keep things in proportion about what we’re recommending and how hard we push things and I needed his insight on how to think about these things. And then, also, what’s effective in getting people to say, “Oh, I know this isn’t obesity.”?

Dr. Andy Roark:

But we really need to get on this and make some changes. And I’ve always found that to be a hard conversational balance and, man, really good insight, a lot to think about here. This is a super practical, useful episode. Thank you to Hill’s Pet Nutrition for making this episode possible, ad free. I hope you guys love what we got for you. So, 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 help you in your veteran veterinary career. Welcome to Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark:

Welcome to the show, Mike Robbins, I really appreciate you being here.

Dr. Mike Robbins:

Of course, Andy, this is amazing. I’ve heard of you, I’ve seen some of your clips on Facebook and stuff, this is like star struck.

Dr. Andy Roark:

Oh, well, thank you for saying that.

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

Well, I appreciate that, you make my day. Well, listen, so you’re here, you are a boarded veterinary nutritionist, you are the manager of the US education for Hill’s Pet Nutrition and you’re a genuinely wonderful, nice, engaging, charismatic guy and I have a nutrition question.

Dr. Mike Robbins:

Oh, my God. Well, thank you for flattering me on that, too. I do appreciate that. But yeah, [inaudible 00:02:22] your question, let’s go.

Dr. Andy Roark:

Let’s go. All right. So, we’re going to play how do you treat that and this is the thing where I tell you about problem that I have and you don’t resolve it.

Dr. Mike Robbins:

All right.

Dr. Andy Roark:

So, here’s what I got. I’m just going to be real vulnerable here because I know that everybody likes to flex and be like, “Oh, nutrition conversations, I got this. I do this all day long.” I also talk about nutrition all day long. It doesn’t mean I’m particularly great at it and it doesn’t mean that I don’t run into brick walls. And so, I’m wrestling a bit-

Dr. Mike Robbins:

Okay.

Dr. Andy Roark:

… and I’ll tell you this. In the exam room, I struggle with the BCS seven of nine dogs and the reason is because I do this math in my head. So, I’m in there and I need to talk to them about the weight of their pet. They are over ideal, I know that they’re in a place where this is having negative health consequences. I’m also doing all the other things I’m doing in the exam room and I struggle to have a productive conversation and they’ll go, “Well, is he obese?” And I’m like, “Well, no, he’s not obese but he’s also not really where he needs to be.”

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

And so, I want to talk to you about the BCS seven of nine dog and having good action-oriented conversations with pet owners that are actually going to get me somewhere because I feel like, and I’m sure I’m not the only one, who sees these dogs, let some slide a bit and then, ultimately, when they’re an eight of nine, that’s when I’m having the conversation. And, as someone who’s now squarely in the middle of his 40s, as I have gotten older, it’s a whole lot easier to try to fix things before they get out of hand in my body because it takes a lot more work later on.

Dr. Mike Robbins:

Yeah, I was going to say, the whole proactive before being reactive and, technically, if they’re a seven out of nine, we should have been having the conversation even prior.

Dr. Andy Roark:

Yeah, yeah.

Dr. Mike Robbins:

But I do realize it does get difficult when you’re in general practice or whatnot and you have what? A 20-minute appointment that you’re probably already maybe five minutes late to from the last appointment that ran over. Yeah, that’s a great, very real, realistic question, yeah.

Dr. Andy Roark:

Even six out of nine. I guess what I’m saying is, you’re running your hand over the pet, they don’t have the little tuck to their waist they used to, there’s a little bit of layer you have to press through to feel their ribs, you know what I mean?

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

So, here’s a specific case. Let me give you some specifics. Let’s look at this. So, I have a four-year-old, female, spayed Labrador Retriever named Sadie and Sadie is in love with life. She’s not laying around, she is super happy, that tail just swings around, reaping destruction on anything on the coffee table. She thumps against your knee as she wags halfway-

Dr. Mike Robbins:

Yeah, yeah, yeah, this common bruise on your knee. You’re like, “Where does this bruise keep coming from?”

Dr. Andy Roark:

Mm-hmm (affirmative).

Dr. Mike Robbins:

Oh, yeah, that’s my thought.

Dr. Andy Roark:

Exactly right. That’s where she positions herself and she just shares her love with you and so, that’s her. So, her owners are empty nesters, they’re probably about 60, late 50s, early 60s, the kids are gone to college, Sadie is their friend and companion. They’re not marathon runners, they’re just normal people, you get the idea they putter around the house a bit, laid back, enjoying coming up on retirement, that’s where they are. And so, whenever I bring up Sadie’s weight, I get this soft push back of, “But she’s so happy, but she needs her treats. It’s what we do,” and I feel like a jerk.

Dr. Mike Robbins:

[crosstalk 00:06:18]

Dr. Andy Roark:

It’d be like, “I know you love this and this makes you happy and her happy.” So, I need to gracefully crack this conversation open and I’m struggling a bit with that. So, let me just your hand it to you at this point. So, that’s what I got, that’s where I am. How do you treat that?

Dr. Mike Robbins:

Yeah, amongst all the other stuff, right?

Dr. Andy Roark:

Yeah.

Dr. Mike Robbins:

Yeah, I can definitely empathize, that’s a difficult conversation. And the way I would start talking about it, let’s assume that the conversation has already come up, you’ve reached Sadie’s weight and then they’re giving, maybe, a little bit of pushback about the treats and whatnot. And where I really, really like to start, especially with people who have such a connection, this emotional bond with their animals is, I really like to go back to that longevity study that was done in Labs and that’s great that Sadie’s a Lab, too. So, you can look at this and you say, “You look at the study where, really, all they did was control the amount of food that these animals got and these animals that were on the four, four and a half,” I know you’re not really supposed to split the nine scale into halves and whatnot but we’ll just say four, I should practice what I preach. So, I should practice what I preach. [inaudible 00:07:34].

Dr. Andy Roark:

It doesn’t matter how many numbers we give to vets, they’re always going to split it.

Dr. Mike Robbins:

Absolutely.

Dr. Andy Roark:

If we had a-

Dr. Mike Robbins:

[crosstalk 00:07:41] so, right.

Dr. Andy Roark:

If we had an 18-point scale, you would still get nine and a half.

Dr. Mike Robbins:

Yeah, absolutely. Yeah, yeah. So, we have this four out of nine and they lived, on average, two years longer, nothing but controlling their weight. And that’s compared to not an eight out of nine, that is compared to those six, seven out of nine. So, that’s what that study showed. So, I’m not even going to call them necessarily obese because obese starts to hit at about the seven, eight out of nine, they’re just considered overweight. So, there is technically a definition of overweight versus obese and it really just depends on the amount of the extra body fat that the animal is carrying around with them, the extra weight that they’re carrying around with them.

Dr. Mike Robbins:

So, these six out of nines, seven out of nines, again, aren’t necessarily obese but they’re overweight but we know that, as we mentioned, they live longer if you keep them skinnier and they have less health problems that come along and you can offset that by years. I think it’s two years for comorbidities and then three years for succumbing to arthritis [crosstalk 00:08:49].

Dr. Andy Roark:

What do you mean when you say that?

Dr. Mike Robbins:

When I say the comorbidities, they tend to-

Dr. Andy Roark:

Yeah, yeah, in offsetting years, help me understand that.

Dr. Mike Robbins:

Yeah, so the heavier set animals, the ones that were free fed, ended up being diagnosed with comorbidities, I guess I shouldn’t say comorbidities because that’s to say that they necessarily had something first starting out, but they were diagnosed with long term conditions, potentially, osteoarthritis that started three years later in the lean dogs compared to the overweight dogs.

Dr. Andy Roark:

Got you.

Dr. Mike Robbins:

Other conditions like dermatological conditions, urinary tract problems, respiratory concerns, so just a lot of different health concerns started earlier on in the overweight animals compared.

Dr. Andy Roark:

Got you.

Dr. Mike Robbins:

So, it’s crazy that we can prevent a lot of health concerns and a lot of other conversations down the road if we start this conversation early. So, again, I guess I haven’t quite said exactly how to address these owners, but I still want to just highlight the importance of us needing to still have these conversations with them.

Dr. Andy Roark:

Yeah. Well, there’s two pieces, I guess, as to what you’re saying to me.

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

One of them is, the case I gave you is we’re in a bit of a hole and I still want to do that but I also want to dig in with you a little bit of are the things we can do to not getting into this hole in the first place? And that’s the easiest solution.

Dr. Mike Robbins:

Yeah, yeah, not digging a hole and I think that goes back to us having conversations, us as veterinarians and technicians and nurses having conversations with owners when their pets are at ideal weight because I think we forget to coach them on that, too. We still need to coach them when they’re doing well, praise them when they’re doing well, still get information, making sure that they’re not increasing treats or whatnot and still asking about activity level. So, that’s still really important even if an animal comes in and is ideal weight, is not overweight or obese, we need to really solidify this with the owners and make them feel good about having a healthy weight pet. So, that’s how I would try and, I guess, avoid getting to this point in the first place is paying attention to a situation when we don’t have a problem, it’s not a problem yet, but that’s what we want to avoid.

Dr. Andy Roark:

What exactly do you say to those people? So, let’s take Sadie and let’s go back to she’s two years old in our time machine and she’s a BCS five of nine and she’s happy and she’s active.

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

Yeah, so, in our time machine, what do I do with this dog that doesn’t have a weight problem that’s going to save me this effort later on? So, help me with the wording of that? What exactly do I say? What exactly do I do to positively reinforce where they are right now?

Dr. Mike Robbins:

Yeah, let’s pretend that this is the yearly appointment, lab work has come back fine, so there’s nothing else to have a conversation really about. This is a really positive yearly annual exam. At the very end, I know I’m nutrition focused so I might be a little biased, but as they’re going out the door thing or the last part of the appointment and I say, “Let’s talk about Sadie’s weight and how Sadie’s doing at home with eating.” And I feel like, usually, when you’ve reached that conversation, owner’s start to recoil because when you always start it with let’s talk about weight, they think they’re going to get something negative. And then you pop in with, “You’re doing an awesome job, Sadie is looking great.” You praise them for what they’re doing, you praise Sadie because they love Sadie and that helps build your relationship with Sadie regardless by just giving positive praise.

Dr. Andy Roark:

Mm-hmm (affirmative).

Dr. Mike Robbins:

You talk still about the food that they’re feeding, “Hey, what are you feeding? How much are you feeding? How are treats going with Sadie? You’re doing a great job now and we want to make sure that when I see Sadie once Sadie comes back at three years old that Sadie isn’t overweight because we know that being overweight can predispose to a lot of other health conditions down the road and can shorten their lifespan. I want to keep Sadie with you as long as possible and you guys are doing great now. So, let’s make sure that we continue to do great from now on.”

Dr. Andy Roark:

Yeah, you know what? When I do exam room training with doctors, there’s a couple things that are pretty scientifically proven, well researched and backed up that they help build trust in people and being complimentary of people builds trust. We all like to feel praised and feel that we’re being told that we’re doing a good job. If someone’s always telling you, “Oh, you should do this differently,” or, “You should really buy this,” or, “You should really let us do this service,” that doesn’t help trust. Saying things like, “Oh, this is perfect, you’re doing a wonderful job here,” it sounds simplistic but those are the building blocks that we build relationships on.

Dr. Andy Roark:

As you’re saying this, too, I was trying to be complimentary, it strikes me that this would be an ideal conversation for the nurses, the vet techs to be having as well. It’s something in their repertoire that they can do to help build relationships and just support recommendations. But yeah, talk to me about leveraging technicians in nutritional assessments like this.

Dr. Mike Robbins:

Sure, yeah. Well, what I will say is, by no means do, I think, we need to be diminishing our techs and our nurses, we need to be supporting them-

Dr. Andy Roark:

Oh, no.

Dr. Mike Robbins:

… and we need to be giving them, I guess, some level of autonomy to manage some use cases like this but I also don’t want to forget about the pet owner’s perception of a doctor praising them because I think-

Dr. Andy Roark:

Sure, okay.

Dr. Mike Robbins:

So, whether or not, the doctor doesn’t need to go through all the things, like the what are we feeding and whatnot, I think the doctor still needs to praise though, that needs to still happen because that relationship still needs to be built.

Dr. Andy Roark:

Oh, yeah.

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

I completely agree with that. I think, also, in the modern media world that we live in where they’re getting messaging 24/7 from every different place, I really think that doctors and technicians delivering-

Dr. Mike Robbins:

Delivering it.

Dr. Andy Roark:

… the same message, I think, that’s super important. They need to hear a consistent message from us, from multiple people on our team, we’re all in lockstep, this is what we need to do or this is what we believe in or this is what is important. And so, not to take it away and say the doctor should do this, I think it’s more important than ever that the technicians deliver a message that the doctors reinforce.

Dr. Mike Robbins:

Yes, yeah, absolutely. I support you 100% on that. So, yeah. So, not forgetting, again, necessarily that the doctor needs to give praise, how do you leverage the rest of the veterinary team to help you out with that. And personally, the way I like to do it, because I think weight loss can be a little nuanced and just the weight conversations can be a little nuanced. And again, especially when you get into the heavier set animals, let’s not even talk about, necessarily, bringing an overweight person bringing an overweight pet in.

Dr. Mike Robbins:

I think having a dedicated team member, one or two dedicated team members, in my personal opinion, I think it’s great to have a dedicated doctor and a dedicated nurse or technician so you have both in case the conversations get a little difficult. So, maybe, if the nurse needs to say, “Hey, I need a little bit of help here,” they can tag in a doctor who can come in who’s good with that.

Dr. Mike Robbins:

So, I think having dedicated team members is probably the first and foremost step because that shows to clients, A, that you have this specialized person, you, as the clinic, as the doctor, as this business know that this is important and putting someone aside who is especially dedicated to this. So, I think that’s positive, that’s a positive look in pet owner’s eyes.

Dr. Andy Roark:

Yeah.

Dr. Mike Robbins:

And then, it also just, I think, makes it a lot easier to delegate who is expected to do what in the vet clinic. So, if appointments are getting really busy or something, you know who you need to go to and try and prioritize to get into the room to talk to the owners positively or constructively, whatever that means.

Dr. Andy Roark:

We know that one of the keys in retaining staff is them seeing themselves in the future and feeling like they’re being developed and they’re getting to do new things and flex new muscles and build new skills. And so, yeah, these are the types of positions that, honestly, are very attractive and that let people do new things and they should be compensated for their knowledge and for what they bring to the practice. And so, I really like those types of investment in the staff and I’ve seen that work really well in hospitals.

Dr. Mike Robbins:

Yeah, I think that’s a fabulous idea that, I will admit, I didn’t necessarily even think about. So-

Dr. Andy Roark:

Oh, yeah.

Dr. Mike Robbins:

… new doctor here learning things on the podcast, too. I love that.

Dr. Andy Roark:

Yeah. No, it’s true. It feels good as a technician to have an area of expertise and people are like, “Yeah, this is what he does,” or, “This is what he’s really strong in.” And, especially you back them up with resources, you have ongoing training, you get them continuing education that fits into this area of expertise and specialty and then you leverage them and you figure out how to charge effectively for their time to pet owners and everybody benefits. We all want to practice at an appropriate skill and challenge level, you know what I mean? We want to do hard things, I really think that most of us enjoy that, we just want to be prepared for them and feel like we’re set up for success. So, this is a program that I saw years ago when that practice started doing nutrition advocates and nutrition experts in the paraprofessionals and it has always made a ton of sense to me.

Dr. Mike Robbins:

Yeah, definitely. And I’ll even plug a resource on here or not necessarily Yeah, I guess the resource. So, if you have technicians or nurses who want to know more of the, I guess, technical aspects of it or what to potentially do in rooms, excuse me. Just as with specialist doctors, there are specialty nurses and veterinary technician programs and there is one for nutrition. So, they could definitely reach out to that specialty program and I’m blanking now what website that is to get onto that, especially now that the ACVN has changed. So, our-

Dr. Andy Roark:

Yeah, yeah.

Dr. Mike Robbins:

That’s also added. I’ll get you that resource if you need [crosstalk 00:19:12].

Dr. Andy Roark:

Yeah, yeah. We’ll link to it in the show notes, yeah.

Dr. Mike Robbins:

Yeah, let’s do that because I’m not sure what’s changed with that. So, yeah, as you mentioned, leveraging your team and getting someone who’s dedicated is really, really helpful. Again, they’re going to know where the resources are to utilize and have effective conversations and I think that also, A, makes conversations more efficient. Efficiency is really, that’s the name of the game in general practice, right?

Dr. Andy Roark:

Yeah.

Dr. Mike Robbins:

So-

Dr. Andy Roark:

Oh, absolutely. Yeah, having this conversation set up and the doctor can come through, it’s a whole lot easier to reinforce than it is to introduce a new idea and a new concept.

Dr. Mike Robbins:

Yes, definitely.

Dr. Andy Roark:

To say, “Hey, I know that Kayla talked to you about this and I just wanted to follow up with you on it because this is really important and you’re doing an excellent job.” I really like the idea, positive reinforcement. People are simple animals. I don’t care how many degrees you have, positive reinforcement works, it works on you and it works on me. And yeah, catching people when they’re doing a great job and leaning into that and creating a picture in their own mind that, “Oh, yeah, this is what my pet is and this is something that I’m good at that,” that helps later on.

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

All right. So, when we get behind the eight ball, we’re not badly behind the eight ball, but you can see where this is going.

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

So, Sadie is four years old, her metabolism is not going to speed up, I have a pretty good guess that there are some detrimental habits at home that could easily slide further. Once we start treating from the table and from the kitchen cutting board, that’s a slippery slope from what I’ve seen. People like it and Sadie, of course, responds very positively.

Dr. Mike Robbins:

Of course.

Dr. Andy Roark:

She’s super happy about this. Let’s be honest, they’re getting positive reinforcement from Sadie for slipping treats. I love it when I give my dog a treat and he just celebrates and bounces around in a circle like a goofus, it makes me very happy. That’s what we’re up against and so, we have to figure out how do I reverse course before this gets out of hand?

Dr. Mike Robbins:

Yeah. So, getting back to Sadie with this. So, I believe, if I’m recalling correctly, we’ve reached the topic, they push back a little bit. Correct [inaudible 00:21:30]?

Dr. Andy Roark:

Yeah. Well, they like making Sadie happy and she’s super happy. If it’s a problem, then let me know, that [inaudible 00:21:38] and you go, “Oh, we’re getting there.”

Dr. Mike Robbins:

Yeah, yeah, and that’s where I also like to talk. I think they can tell that Sadie really wants to please them, wants to make them happy, likes to be happy around them and all that stuff. And animals push through pain so much, but, us, humans, were babies, the vast majority of us are babies. But animals want to push through pain and Sadie might be starting some arthritis with this extra weight that’s coming on. And, even if Sadie is not, we can tell them that this is going to be predisposing to arthritis, not even just the physics of the abnormal weight, there are cytokines, there are molecules that are being pumped out at higher amounts from this adipose tissue that are actually encouraging the cartilage to be broken down, so that’s a problem. So, we can talk to that and then, again, as I mentioned, this narrative that they’re fat and happy and they’re happy for us and these animals push through pain for us and we don’t want them to do that. We don’t want them to pretend to be happy for us or try and force themselves to be happy.

Dr. Mike Robbins:

So, what I like to talk about is treats. Yes, absolutely, treats are loved. Especially for a Lab, they definitely take that as something positive, you’re paying attention to them but I think a lot of it, too, is paying attention, that’s part of it too. These animals want our attention, doesn’t necessarily have to be treats. So, I think let’s shift how we show attention to Sadie. Does Sadie really like to get praises? A pat on the head? Throwing something? If Sadie’s a Lab, she’s going to want to retrieve something, I’m sure. So, just different ways of showing love and what we need to do is figure out what ways Sadie feels loved or the way that the owners perceive Sadie feels love.

Dr. Andy Roark:

Yeah.

Dr. Mike Robbins:

So, currently, they’re perceiving that she feels love with treats. I’m sure that they would-

Dr. Andy Roark:

[crosstalk 00:23:31]

Dr. Mike Robbins:

I’m sure that they would agree that they sit down on the couch, Sadie loves to come up to them and pet them or, sorry, loves when they pet her or when they’re outside. So, we just need to fix the type of love that we’re giving Sadie.

Dr. Andy Roark:

Yeah.

Dr. Mike Robbins:

And that’s-

Dr. Andy Roark:

No, I like it.

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

That totally makes sense to me. What is Sadie’s love language? What is her language of appreciation and how do we engage with that? I like that. I think that makes a ton of sense.

Dr. Mike Robbins:

Yeah. You said love language, I think that’s a perfect [inaudible 00:24:07] about love languages then-

Dr. Andy Roark:

That’s the thing it reminds me of.

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

So, I was talking about my wife, there’s this book of the five love languages, I have not read it. There’s a business version called the five languages of appreciation which, from what I can tell, is the same book with a different cover on it.

Dr. Mike Robbins:

Probably.

Dr. Andy Roark:

But just change the examples to be work appropriate. Definitely, that’s what it is. But it’s things like service, I do things for people that I care about. Or, spending time, I spend time with people I care about. Or, verbal appreciation is you’re telling people that they’re appreciated and giving them verbal praise. And physical touch and those sorts of things and it’s like there’s these different things that resonate with different people. I think it’s hard to argue with people that food is love and, what I was saying, I can hear the pet owner saying to me when I say, “We need to find Sadie’s love language.” They’re like, “I know what her love language is, it’s food.” And I was like, “Okay, she’s got a secondary love language too and we need to find that and lean heavily into that.”

Dr. Mike Robbins:

Pun intended.

Dr. Andy Roark:

And so, that makes sense to me.

Dr. Mike Robbins:

Yeah, yeah. So, I think that’s the first bit that we start with and just trying to retrain humans brains. Because as you said too, they’re getting positive reinforcement from their pet too.

Dr. Andy Roark:

Yeah, yeah.

Dr. Mike Robbins:

So, we have to train. This is training both the humans and the pets as well. And what I’ll say is, even if I chat with owners and we try and figure out the secondary love language for the dog, if they’re super reluctant to that, usually, I like to try and figure out what are … And we’re not even talking about getting into calories right now.

Dr. Andy Roark:

Yeah.

Dr. Mike Robbins:

This is just trying to just fix a habit. If Sadie really likes the kibble that Sadie’s being fed, let’s take some of the kibble and Sadie’s daily kibble amount, put it in a bag that the owners get to carry around and that’s how they treat. If Sadie doesn’t care the difference between a kibble and a piece of cold cut or something that’s coming off of the table, why does it matter to you? We need to fix the human brain. Is it the human brain that’s like, “Well, the kibble is the same thing she gets every day.” Sadie doesn’t care, Sadie just wants your attention. [inaudible 00:26:23].

Dr. Andy Roark:

Yeah, I think that’s a great point. I think it’s a fantastic point. The truth is, we’re not talking about calories at all. But the truth is, if we don’t fix the behavior, we’re never going to win on calories. We’ve got to talk to these people about what this means to them because, if we can’t get through to them in that way, we’re never going to be able to wrestle the calorie count down when their behaviors are just undermining us at every step.

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

I think it’s great. It’s like, what is the line to achieve a celebration for Sadie?

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

And we want the lowest calories that get us over that line. I think that’s great. I still recommend vegetables, things like that and people could really and say, “Hey, look, if she loves her vegetables, then why would you not feed her vegetables?”

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

I think the kibble is a great idea. It’s funny, we can pull a fast one on Sadie. Just put it in a different bag and she’ll be so thrilled.

Dr. Mike Robbins:

Right. She’s going to be like, “This is the best thing ever. Look, it came out of a purple bag instead of the tub that mom and dad”-

Dr. Andy Roark:

Exactly right.

Dr. Mike Robbins:

Yeah, yeah.

Dr. Andy Roark:

This is a special one.

Dr. Mike Robbins:

Yeah, yeah. So, that’s just treating their psyche, basically. And then, once we get past the treats or the habits, I should say, then we need to start talking about calories like kcals and stuff. I’d be remiss if I didn’t mention any of that.

Dr. Andy Roark:

Yeah, sure.

Dr. Mike Robbins:

So, especially when they’re starting to gain weight and if you’ve been able to look back at previous history, patient history and showing that Sadie was ideal weight a year ago or two years ago, that’s when we need to start having this conversation especially. So, let’s talk about what are your feeding, and this is, again, where your veterinary technician or your veterinary nurse can come in and finish this conversation.

Dr. Andy Roark:

Yeah.

Dr. Mike Robbins:

You can say, “We need to address Sadie’s weight. You guys were doing a great job before, Sadie was looking great, we’re getting a little heavy now. Let’s try and figure out how we can just get Sadie a little bit back on track and I’m going to have my Joe so and so who’s our special nutrition veterinary nurse and they’re going to come in and we’re just going to get a little more information and talk about maybe what Sadie is being fed now and how we can look at the calories that Sadie’s bringing brought in and maybe switch some calories out with different things that are either no calories or less calories and that are still going to provide that really positive reinforcement with you and your relationship with Sadie.”

Dr. Andy Roark:

Yeah. No, I think that makes sense. So, real quick, I guess as we wrap up.

Dr. Mike Robbins:

Mm-hmm (affirmative).

Dr. Andy Roark:

The kcal conversation, what points are you trying to … Because I completely agree, I think a lot of people jump to talking about nutrition and calories when the truth is, this is not a calorie conversation, this is a relationship conversation. This is-

Dr. Mike Robbins:

I would argue that it’s probably both.

Dr. Andy Roark:

Okay.

Dr. Mike Robbins:

I would say it’s definitely both but it’s-

Dr. Andy Roark:

Tell me about that.

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

So, I always lean towards this is a relationship conversation of what it means to them to feed. Tell me why you push back.

Dr. Mike Robbins:

Well, I guess let me push back a little bit and say-

Dr. Andy Roark:

Please.

Dr. Mike Robbins:

… I may have jumped a little bit ahead and can you explain why you’d say calories? You don’t [inaudible 00:29:32] the calorie thing. Because I’m like, “No,” and now I’m second guessing you-

Dr. Andy Roark:

Yeah, no, no, no.

Dr. Mike Robbins:

… [crosstalk 00:29:37] what you meant.

Dr. Andy Roark:

Yeah, yeah. So, I guess the thing for me is I would say that, generally, this is not a conversation about I don’t think your pet is getting enough calories and you think that we do or even about, “Hey, you should feed a low calorie food instead of the food that you’re feeding.” And I found most pet owners are much more malleable in what they feed than we give them credit for. They want a recommendation from us, they want advice on what to feed their pet, most of them are not willing to fight this battle, they just want to feed a good food that they can feel good about, they want to do a good job. And beyond that, I think that they’re very open to our recommendations and what they want to feed. What they’re less open to, I think, is stepping away from behaviors that make them feel good about themselves and about their relationship with their pet.

Dr. Andy Roark:

And so, I think that I can talk to them all day about the type of food that we’re feeding and the calories in the food but, if I don’t talk to them about what feeding their pets treats means to them, you know what I mean? We can have them on the greatest weight loss food in the world and still lose the battle. And we have all done that, we have all shipped prescription weight loss diet out the door again and again to pets that are gaining weight and just been like, “What is going on here?” I think that we probably won the kcal conversation and lost the relationship interaction with your pet conversation. I guess that’s what I mean.

Dr. Mike Robbins:

Yup, and that I will 100% agree with. I was going to say we’re not talking about changing food to a lower calorie food and we still haven’t necessarily addressed the [inaudible 00:31:19], so I will redact what I said.

Dr. Andy Roark:

No, but to your point, am I wrong to have the idea that a lot of us do these pithily recommendations that don’t really make sense? I guess what pops in my mind is, I’ve talked with a nutritionist on the show before and we’ll be talking about soft stools or having diarrhea, things like that. And I was asked about adding pumpkin or adding psyllium and they’re always like, “You can do that.” The truth is, if you switch to a high fiber food, you’re going to do so much more as opposed to feeding something low fiber and putting some psyllium on top.

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

It is night and day. Would you agree with that analogy as far as how we feed pets? I don’t know. When we say, “Feed vegetables but don’t change the food,” are we spitting into the wind or is that a viable approach?

Dr. Mike Robbins:

I think we’re spitting a little bit into the wind here because-

Dr. Andy Roark:

Okay.

Dr. Mike Robbins:

… again, pet parents want that specific recommendation. So, if you’re not actually looking at what they’re feeding and evaluating a little bit. Because, again, I 100% agree, we need to address the behavior because you’re right, you could give a low calorie food and, if you feed a bunch of a low calorie food, you’re still feeding high calories at the end of the day or kcals at the end.

Dr. Andy Roark:

Yeah.

Dr. Mike Robbins:

So, all that is correct, yup. So, I think what we’re missing is, sometimes, and especially as time comes up, you’re pressed for time in an appointment or, again, as Sadie is just a little bit overweight, not necessarily obese, weight loss is a journey. It needs to happen, it needs to happen at an adequate rate because we don’t want to happen too quickly and, obviously, if it’s too slow then pet parents just forget about it. So, I think what we do is we give ambiguous or relatively ambiguous recommendations and we don’t give something specific that the owners can follow and that’s really we need to be specific. Even if it is just a simple overweight conversation, we still need to be specific. If I went into my primary care physician and they just were like, “You know what? Just eat more fiber or something.” What does that mean? [crosstalk 00:33:30]

Dr. Andy Roark:

Yeah, [crosstalk 00:33:32] myself.

Dr. Mike Robbins:

I’m going to go get more cereal.

Dr. Andy Roark:

I would be like, “Yeah, I’m totally doing this.”

Dr. Mike Robbins:

[crosstalk 00:33:34] and eat a bunch of fiber. That’s in that, right?

Dr. Andy Roark:

Yeah.

Dr. Mike Robbins:

That’s not a good recommendation. So, we still need to do our due diligence as the veterinary team and give these specific recommendations. So, that still gets into what are you feeding and whatnot.

Dr. Andy Roark:

That’s a weakness of mine. I tend to say things like, “All right, let’s work on this,” or, “Yeah, let’s try to get this down a little bit.” I think that’s the thing I need to work on too, is being more specific. What follow up do you recommend for this BCS six to seven of nine dog? Are you getting them back in, you putting them on the scale? If so, when are you doing that?

Dr. Mike Robbins:

Biggest recommendations for weight loss, I’m going to say very quickly, always use the same scale if you can because there are going to be variabilities between scale and the last thing you want is them to come into your clinic and weigh two pounds less and then go home and now they’re two pounds more automatically and something like that. So, using the same scale same time of day, ideally before meal and after going to the bathroom. So, let’s just set up the ideal time to look at weight.

Dr. Mike Robbins:

Because just with you and I, our weight fluctuates throughout the day depending on if we’ve eaten, if we’ve chugged a bunch of water because we’re really thirsty, something like that. So, I think that’s important. But initial follow ups and, again, for Sadie’s case too, I would also praise the owners or maybe not praise but let them know we’re starting this early so this is going to be so much easier or this is going to be a lot easier than if we dealt with this a year or two down the road. It’s going to be easier on you, it’s going to be easier on Sadie.

Dr. Mike Robbins:

So, again, just positive reinforcement on that. And then, coming in, I usually like to have rechecks to every two weeks, probably for the first month, month and a half depending on how successful the weight loss is going. If I feel like I’ve been able to change those habits, checking in with the owners, seeing how everything’s going at home with the new plan, if it seems like they’re doing really well, you can start going out every month, every four weeks and these don’t have to be in person appointments either. So-

Dr. Andy Roark:

No? Oh.

Dr. Mike Robbins:

… you might want to open up your clinic for larger animals to bring the animals on to weigh them, but they don’t need to be there for an appointment. [inaudible 00:35:45].

Dr. Andy Roark:

That’s great. That makes a ton of sense. I was going to say, I know a lot of people are like, “Look, we’re so busy. Where do these appointments go?”

Dr. Mike Robbins:

Yup.

Dr. Andy Roark:

It doesn’t have to be big deal.

Dr. Mike Robbins:

Yeah, and you can even email. That email gets into a whole how do you bill for that and I would say, if you’re going to do a weight loss plan, build that into the structure if you’re going to have email because, I think as we all know, owners, you give them an email and that opens up an unlimited communication door for them. So, we need to make sure that there are boundaries set for that, I think, for everyone’s benefit, both veterinary healthcare team member and the pet parent so they don’t get frustrated by not hearing back if they’re sending 12 emails a day and only hearing back once.

Dr. Andy Roark:

Yeah, yeah. No, I agree with that. Using the clinic email for something like that is ideal so it’s not a personal email and then, also-

Dr. Mike Robbins:

Yes. Oh, my gosh, please don’t. Don’t give them your personal.

Dr. Andy Roark:

Well, even a personal email as like andy@andys.hospital.com.

Dr. Mike Robbins:

Yeah, yeah.

Dr. Andy Roark:

But yeah, using the clinic email and then, also, just one of the things I really like about clinic texting these days is that you can send it from your own computer and it goes through the clinic text outlet and when it comes back, it goes to the front desk and they can respond and say, “We’ll pass this message on to Dr. Roark and he’ll generally respond within 24 to 48 hours,” and you give them that feedback and set expectations.

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

Well, Mike, this has been fantastic. Thank you so much for taking time. Thanks for talking through everything with me. Where can people learn more? What resources do you recommend for people who thought, “Oh, that’s really good. I want to tighten these screws in my own practice. I’m a technician who is interested in the nutritional advocate position that you talked about.”?

Dr. Mike Robbins:

So, Hill’s, we have a bunch of really great resources. Queue the first quarter of every year now, we’re going to start making our annual weight loss campaign. Hill’s is really behind building and strengthening the quality of life and relationship between pet and pet parents. So, we are really trying to get as many vets and vet hospitals and stuff on board with making sure that we keep pets ideal weight. So, hillsvet.com has a lot of great tools. Quick Reco is really nice that Hill’s has set up.

Dr. Mike Robbins:

You can provide visuals for pet parents showing graphs and whatnot, where weight has been, where we want to see weight going and WSAVA. I think externally, outside of that, WSAVA is a really great organization. And then ACVN, I’m pretty sure it’s still running, I should have checked this earlier. Again, with the college of nutrition now being incorporated in the college of internal medicine, I’m not sure what’s going to happen to our big website, but acvm.org, you can get some good information there.

Dr. Mike Robbins:

And then further, one other thing that I’d like to say too, even with these Sadie’s cases, again, as we talked about positive reinforcement, setting up milestones or very attainable goals and emotional goals is going to be important. Let’s see Sadie fit into a jersey of her favorite team or something like that.

Dr. Andy Roark:

Got you.

Dr. Mike Robbins:

And then, also, sending home super simple certificates. Just like, “Yay, Sadie got her first goal,” and they can put it up on the refrigerator. I’ve had pet owners send me a picture of their dog or cat next to their certificate and they love it, so just something to get them on board.

Dr. Andy Roark:

That’s so silly and simple and I 100% believe it works. While you’re saying that, I’m like-

Dr. Mike Robbins:

It really does.

Dr. Andy Roark:

Oh, you blew my mind. I love those simple things but, man, people love a certificate and they especially love an award for their pet.

Dr. Mike Robbins:

Yes.

Dr. Andy Roark:

That is awesome.

Dr. Mike Robbins:

I [inaudible 00:39:14] especially if they’re like a dog with a collar, if can get them a gold medal or something once they reach their ideal weight that they can put on their collar. If you can find something like that, pet owners eat this stuff up.

Dr. Andy Roark:

Oh, well that’s social media goal, too.

Dr. Mike Robbins:

Yeah, that too, yeah.

Dr. Andy Roark:

Your clinic newsletter-

Dr. Mike Robbins:

Mm-hmm (affirmative).

Dr. Andy Roark:

… there’s so much you can do with that.

Dr. Mike Robbins:

Yeah.

Dr. Andy Roark:

Oh, man. Mike, thanks again for being here. I really appreciate you.

Dr. Mike Robbins:

Of course, yeah. Andy, this was great, this is a lot of fun. I really hope that all your listeners learned some things. I know I learned some stuff from you which is great and, hopefully, you learned some stuff from me.

Dr. Andy Roark:

I did as well.

Dr. Mike Robbins:

Great.

Dr. Andy Roark:

Awesome. Thanks, buddy.

Dr. Mike Robbins:

All right, man.

Dr. Andy Roark:

And that is our episode. Guys, I hope you enjoyed it. Thanks a lot to Dr. Robbins for being here, thanks for Hill’s Pet Nutrition, making this episode possible. Guys, I have taken the links from Mike and put them in the show notes, so you should have those there. Please check them out. Gang, take care of yourself and I will talk to you again soon.

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

Dr. Sam Morello is on the podcast to discuss her recent publication in JAVMA, Comparison of resident and intern salaries with the current living wage as a quantitative estimate of financial strain among postgraduate veterinary trainees. Dr. Morello makes the case that early career pay plays a role in our ability to increase diversity in the profession, support women and families, reduce the frequency of burnout and increase doctor retention in the clinical space.

LINKS

Original Article: avmajournals.avma.org/view/journals/…21-07-0336.xml

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

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

Sam Morello received her BS and DVM from Cornell University and completed a large animal surgical residency at the University of Pennsylvania’s New Bolton Center. She spent over a decade in academia as an Associate Professor Surgery focused on musculoskeletal and upper airway diseases. In addition to her clinical research on those topics, Dr. Morello has extensive experience investigating and speaking on professional sustainability, economic, and personal life issues in veterinary medicine with a particular focus on gender. She has been an invited speaker nationally and internationally and at veterinary schools across the country. Projects have focused on women and other underrepresented groups in veterinary surgery and human orthopedics, on work-life issues for veterinarians, residency-selection and compensation, and how gender stereotypes affect perceptions of veterinary medicine to those outside. Her goals are to provide data to improve mentorship, inform career decisions, and to guide those in management and leadership roles to shape the policies that best serve the profession. She serves as the Assistant Director for Continuing Education for the American College of Veterinary Surgeons, a member of the AOVet North America Faculty where she serves on the Education Committee and leads a task force on Faculty and Leader Development for the internationally run AO Access program, a program she helped to design and launch dedicated to improving diversity, opportunity, and mentorship among global community of human and veterinary orthopedic surgeons. She also serves on the board for the Women’s Veterinary Leadership Development Initiative. Sam is now self employed as a consultant, based in Madison, Wisconsin, and recently joined the Cornell Center for Veterinary Business and Entrepreneurship as a Courtesy Associate Professor.

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, Doctor Andy Roark. Guys, I’m here today with my friend, Doctor Sam Morello and we are talking about her brand spanking new research which was published in JAVMA in January. The title of her publication is “Comparison of Resident and Intern Salaries with the Current Living Wage As a Quantitative Estimate of Financial Strain Among Postgraduate Veterinary Trainees”. That’s a mouthful. We’re talking about what interns and residents get paid in vet medicine and we’re talking about why that is important for the profession as whole, why it is the way that it is, and what it might be in the future. That’s what we’re talking about. Guys, 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 Cone of Shame with Doctor Andy Roark.

Dr. Andy Roark:

Welcome back to the podcast. Doctor Sam Morello, thanks for being here.

Dr. Sam Morello:

Thanks for having me, Andy. I’m excited to be back.

Dr. Andy Roark:

Well you’re going to keep coming back I hope as long as you keep putting out fascinating articles that are well researched and that help push our profession forward, so thank you for doing that.

Dr. Sam Morello:

Always my pleasure, and yeah, that’s my goal. So we’ll keep tallying these up.

Dr. Andy Roark:

So for those who don’t know, I met you at a women’s leadership summit before in the before days, before the pandemic. You have since then can continued to publish on gender equity and professional sustainability. You touch on finance and education and a number of other aspects of our profession. What have you been up to recently? How have you been through the pandemic?

Dr. Sam Morello:

So I guess I’m one of the statistics that are out there in the great, what are they calling it, the great-

Dr. Andy Roark:

The great resignation?

Dr. Sam Morello:

The great resignation.

Dr. Andy Roark:

They big quit.

Dr. Sam Morello:

Yeah. So I’ve made some professional life changes since then. I spent over a decade in academia as a large animal surgeon, and it was a great decade in my life. But I’ve decided that it was time for me to experience something different in the professional space and I wanted to see kind of how more veterinarians were actually experiencing their lives out in private practice. So I decided to move on from my academic job. I, too, now am out in the private practice realm really working for myself, doing some consulting, doing a lot in imaging space.

Dr. Sam Morello:

But I haven’t left my research efforts and passion behind. So I’m continuing that, mostly through collaborations with the Cornell Center for Veterinary Business and Entrepreneurship, where I have a faculty appointment. I’m interfacing with a bunch of new groups. I’m excited to be part of the Women’s Veterinary Leadership Development Initiative. I’m on the board now. Just making my way through that new life and excited to be there, here, and all the challenges, but new adventures that’s going to also to help me with my research.

Dr. Andy Roark:

Yeah. You stay very busy. You have a new article out in JAVMA, the Journal of VMA. It’s coming out in print in January, but the digital version is already out and it’s open to everyone. I’ll put a link in the show notes. It’s called “Comparison of Resident and Intern Salaries with the Current Living Wage as a Quantitative Estimate of Financial Strain Among Postgraduate Veterinary Trainees.” Sam Morello, in plain English, what the heck does that mean?

Dr. Sam Morello:

Yeah, so very academic title, as usual.

Dr. Andy Roark:

Extremely impressive title.

Dr. Sam Morello:

What it really means is it’s a really simple topic, which is that house officers or residents and interns get paid pretty poorly, which is something everybody knows, everybody’s known for a million years. But how poorly is a hard thing to quantify. So it’s a topic I’ve wanted to study for a long time because I think it really intersects well with a lot of the broader topics that I, and a lot of other people in our industry, have been interested in. It intersects with mental and physical wellbeing. It intersects with diversity, women and families. It intersects with how we value people in our profession and concepts of burnout and retention.

Dr. Sam Morello:

So what we did with this paper is tried to really quantitate how are individuals paid and to do that, we used a metric called the living wage. The living wage is actually a quantifiable thing. It’s an estimate or it’s that it’s actually a quantified number of essentially how much money you need to live on. It’s the line between where you’re relying on some sort of federal or state subsistence programs, subsidies like food stamps or other government programs that basically help you meet your minimum needs, like housing or food or transportation or healthcare. Just above that line is the amount of money that meets a living wage. So we used that number, which using a specific website, which I’ll get to later, that allowed us to evaluate minimum wage based on local area so we could look at it at the county level, so we could compare how much interns and residents were making in their specific location of practice to the local living wage and really compare just how much, or how little, money they were making with respect to how much money they needed to live on at a very low level.

Dr. Andy Roark:

So let me say this back to you in a different way. When we talk about living wage, we’re talking about not sustenance wage. This actually just being able to not have assistance, not have food stamps, things like that. That dollar amount is going to be significantly different depending where you are in the world, right?

Dr. Sam Morello:

Right.

Dr. Andy Roark:

Like if you’re in New York city, there is a bigger amount of money that you need to have a basic standard of life, as opposed to if you live in the Appalachian mountains in North Carolina where cost of living is extremely low. Correct?

Dr. Sam Morello:

Right. That’s exactly right. I like using the analogy there’s a Manhattan, New York and there’s a Manhattan, Kansas, and those two Manhattans are never going to be the same. So yeah, you’ve nailed it. It accounts for things like basic healthcare needs, basic lower level living. But it doesn’t account for things that most people in veterinary medicine are contending with, like certainly student loans, but even simple things like paying for a pet, their food, their vaccinations, their preventative care, seeing family, going out to eat, if you need new tires for your car. None of a living wage accounts for any of those life things that you and I, at this point in our lives I think, Andy, take for granted as something that we can pay for when it comes up.

Dr. Andy Roark:

Yeah. I want to hear a little bit more philosophically about this. I think it’s fascinating and I hadn’t really put together the larger implications. Talk to me a little bit about resident intern pay in the intersection with equity, with burnout and retention with women and families. Make that argument for me a little bit that this matters in the context of those larger issues.

Dr. Sam Morello:

So yeah, that’s actually probably a couple arguments rolled into one.

Dr. Andy Roark:

Yeah, it is a lot. But I guess, help me see through your eyes in this.

Dr. Sam Morello:

Let’s start with that. Let’s start with the burnout phenomenon. So there’s a lot of evidence out there that financial strain is deeply linked to mental health and burnout. So one great piece of evidence in the veterinary realm comes from the Merck well being studies, they have two of them actually. One came out in 2018, one came out, I think, in 2020. I think I’m getting those dates right. Volk was the primary author on those. They were able to directly link that financial strain and inadequate financial reward were two of the biggest factors that predisposed individuals in the veterinary profession to burnout. Given what we can show are the average incomes for interns and residents, they’re in the low 30s, that’s a pretty clear recipe for predisposing those individuals to burnout.

Dr. Sam Morello:

Recognizing that these are the early years of your career, especially for a resident. We’re looking at internship and residency years, so anywhere from four to five, sometimes even six years, depending on how many internships it takes to get into that residency program. That sets the ton and really can create almost a negative accrual of however you want to quantify what leads to burnout really early on in a career and can set people down a path to lower that threshold for leading to burnout.

Dr. Sam Morello:

There’s also wonderful evidence. I think wonderful is probably the wrong word for it. But there’s also very specific evidence from the American Psychological Association that financial strain is the largest source of stress for Americans year after year in this country. So I think a lot of that’s pretty implicit. Just being able to demonstrate how large that strain is, was a really important part of this study for us. So I think that gets to that burnout side of it. should we move on to the [crosstalk 00:10:43] the other stuff or you want to drill down [crosstalk 00:10:45] more on the burnout start?

Dr. Andy Roark:

No. I think that’s good. I think, to me, that makes a lot of sense. Especially, I think what I really needed to hear was the point that we were talking about the beginning of people’s careers and the ripple effects and we talk about compounding and opportunity costs where you could be doing other things. It sets off a career trajectory. So I guess that makes a lot of sense to me as to why we would see the downstream effects of resident/intern pay that we see.

Dr. Sam Morello:

Yeah. To actually to make a comment on what you just said, you said “compounding effects”, there’s this idea of almost needing to play catch up later. So you have these years of sometimes we refer to it as lost income. So these four or five, six years, you’re making very little money, your debt is accruing, or you’re accruing more debt sometimes. Because something we showed in this study is that for some people, the amount of money that they’re earning is actually less than what a living wage might be in the area that they’re living in for I think between 15% of residents and 22% of interns their pretax income was less than what their local living wage was. So that’s a pretty high percent of individuals who may not be able to meet their living needs.

Dr. Andy Roark:

These are people working at specialty hospitals, working in universities with teaching positions, a lot of them. I remember in vet school, residents did a lot of the teaching and the mentoring, and things like that.

Dr. Sam Morello:

Yeah, absolutely. They’re working in big, well respected hospitals and they’re taking on a lot of the same duties that specialists are. So they may be accruing even more debt aside from what their interest rate is already doing for them, for those of them that come in with debt. So the years afterwards, trying to play catch up to get out of that debt or to make the money that they didn’t make over those years, to say nothing of the amount of money that they weren’t able to put towards a retirement account.

Dr. Sam Morello:

A goo friend of mine, Doctor Brent Mayabb, he’s one of the chief medical officers at Royal Keenan, he’s really invested in, in personal finance and in helping young veterinarians tackle that issue. He did some great rough calculations, back of the napkin sort of calculations, for me to show what a hypothetical loss of retirement savings might look like for an average resident. Hypothetically, if you were not doing an internship or residency and you were saving $200 a month, so about $2,400 a year, versus if you were doing an internship and residency and you weren’t saving that much money over 4 years, it’s only a difference of somebody who might be saving about $9600 over those 4 years, versus somebody that isn’t. But that $9,600 over the course of a career where you retire at 65, with an 8% compounding interest rate could add up to almost $200,000 by the time you retire. So that loss of income, just trying to catch up to that over the course of your career, that’s an added stress in and of itself. That’s a stress that’s going to stay with you over time.

Dr. Andy Roark:

Hey gang, I just want to jump in here with a couple of quick updates, big stuff going on. First of all, I got to thank Banfield Vet Hospital. Guys, through a generous grant from those guys, we are able to provide transcripts of both the Cone of Shame Vet Podcast and the Uncharted Veterinary Podcast. They’re doing this in the spirit of inclusivity and increasing accessibility to resources in the vet space. So we were the beneficiaries of their generosity and we are able to have transcripts for everybody who wants to see them. You can head over to drandyroark.com or unchartedvet.com. Follow us on social media, and you’ll see these when they come out. But we are going to be linking the transcripts just to make these podcasts accessible to anyone and everyone who wants to participate, who wants who wants to check them out.

Dr. Andy Roark:

Other updates that are important. Number one, strategic planning all up on you. If you’re looking at 2022, and you’re like, “I wish I had a plan,” we should figure some things out about what we’re doing so we’re not just putting out fires, but instead, doing things that are actually important that we want to do. Guys, I got you covered, but you got to act fast. I am doing workshops. I’m doing four workshops on strategic planning with my wing man, the one and only practice management goddess, Stephanie Goss. The first one is on January the 26th. The second one is February 9th, February 23rd, and March 9th. They all have different focuses. The first one is on running a strategic planning meeting for your team. It’s how do you get your people together and talk about where your business is going and make some decisions. That is the one that I’ll be doing on January 26th with Stephanie Goss, you can register for them separately. They are $99 each to the public or buy them together as a bundle for $299. They are free to Uncharted members, so if you’re like, “I want to do them all and I’ve been putting off being an Uncharted member,” this is a great reason to get on board and do it. So strategic planning workshops, I would love to see you there. They are super hands on, super active, super useful. So that is going on. Don’t miss them. You got to register. Especially if you do the bundle, grab them both before the first one goes.

Dr. Andy Roark:

The April Uncharted Vet Conferences in Greenville, South Carolina. We are back in person. It is our homecoming, and that’s the theme, it’s homecoming. The five year anniversary of Uncharted is going to be a great time. We are going to cap attendance at 100 or less just to keep everybody safe. But we’re still going to get together and do a wonderful conference. If you’ve never been to an Unchartered conference, they are super magical. It is not like other conferences. It is very active, very engaged. You are going to meet people. You are going to make friends. You are going to talk about your business.

Dr. Andy Roark:

The theme of this conference in April is all about running smoother, more enjoyable, more rewarding practices. It’s not about getting more customers. It’s not about working harder. It’s not about finding things to do that you’re not doing. It’s about doing less things and making the things that you do now go more smoothly. So if you’re like, “Oh, that sounds good, I’d like to be a part of that,” get over to unchartedvet.com, get registered for the conference. You do have to be an Uncharted member to come to that, but you can grab your membership, get on board with, the conference. It is something super special. You do not want to miss it.

Dr. Andy Roark:

And finally, over on the Uncharted Veterinary Podcast, that is the podcast I do with my buddy, Stephanie Goss, we are talking about is human health insurance the problem with getting people to do pet insurance. Steph and I both believe that getting people to get their pets insured is a great way to ensure that those pets get the care that they need. Getting more clients insured means getting more pets that have resources to get the care that they need, which means we get to do the job and the work that we really want to do and that we enjoy doing. So we get into this with our special guest, Melissa Gutierrez, and we talk about the barriers to getting people on board with pet health insurance. If you’re like, “Hey man, I’d like to get more of your going pet health insurance up in my practice,” head over there, check it out. Subscribe to Uncharted. It is a great podcast, totally free. We’d love to have you on board. With that, I think that’s enough, let’s get back into this episode.

Dr. Andy Roark:

What’s the median age range for interns and residents? We’re talking about people who are what, 28 to 32-33 years old? Is that the basic age range for these people?

Dr. Sam Morello:

Yeah. So every year about a 1000 people, just over 1000 people, match into internships through the VIRP. That’s out of about 3,200 people that are graduating from veterinary schools. So I’m not exactly sure what the average age of veterinary school graduates are right now, but it’s somewhere in the mid to late 20s. For residencies, it’s just over 300 people. So about a third of those internships are matching people into residencies. Again, it’s taking some people anywhere between one and three internships. So if you add that on, yeah, most people that are finishing their residencies are probably around the age of about 30 or a little bit older.

Dr. Andy Roark:

How big is the variance in income among programs? Are they pretty uniformly low paying programs? Are there some private practice residencies and interns out there that have a very different financial picture? Help me understand that.

Dr. Sam Morello:

Yeah, that’s a great question. We address that in our paper. So when you look at academia, it’s a pretty tight narrow band. Most of the programs exist within a pretty narrow band, somewhere in the 30s, with an average salary I think somewhere around $34,000. But in private practice, the range is much, much larger. I believe the range was somewhere between the low 30s and all the up to about %75,000.

Dr. Sam Morello:

I think there’s a whole lot more flexibility, of course, in private practice. An individual private practice may take one resident in one specialty or they may take multiple residents in multiple specialties, versus an academic program, which is likely to populate most of their specialties with multiple residents. So there’s a different financial sort of commitment, I think, for the different hospitals. But there’s clearly much more flexibility you in setting salaries in that private or corporate structure.

Dr. Andy Roark:

Yeah. Well when we start to talk about internship and residency programs and the salary structure that we have, I guess, how do you explain the position that we’re in there? So if you say to me, “Hey, a significant percent of people doing residencies, internships are making below living wage.” If I said to you, “Why,” how would you answer that question?

Dr. Sam Morello:

I think there’s a not great answer, which is that it’s because the way we’ve always done it. It’s the way we’ve always done it. And-

Dr. Andy Roark:

That’s what it feels like, is residents and interns, they work on all the time and they don’t make any money, and that’s the way it’s always been. But as the economics of vet medicine have changed is there a reason that’s persisting?

Dr. Sam Morello:

Yeah. I think the other also not great answer is unfortunately, that we use the term in the paper that it’s a monopsony like market, which means you have a captive audience, The people that really want to do residencies and internships and have the ability to make the choice to do that, and I think that’s a very important point that we should revisit, but I’m not going to drill down on it with the rest of this statement, are going to do this program no matter what. So it’s not going to matter if you offer them $25,000 or $40,000 or $65,000, they will figure out a way to do it.

Dr. Andy Roark:

Yeah, they’ll say, “Yes.” They’ll take the seat.

Dr. Sam Morello:

Right.

Dr. Andy Roark:

Isn’t that a big part of of our student debt problem, as well, is that you have so many people who are so motivated and they’re going to take the spot, come hell or high water? I’ve struggled with that a lot is you say, “Well, there’s the autonomy part,” the responsibility part, I guess where people say, “I know what I’m signing up for and I’m signing up for this.” There’s another part where you go, “Ah, but it feels more complicated than that.” I love the term monopsony like market. I’m going to incorporate that into daily speech. I’m in love with this term. But it does feel like a monopoly like if you want to be a vet, there’s only one path to do it and if you want to be a specialist, there’s only one path to do it and there’s not a lot of opportunities. You really have no leverage as you would in a larger market.

Dr. Sam Morello:

Yeah. It’s almost like Shakespeare wrote this tragedy into the profession where everybody’s so passion driven that it’s going to, at some point at, play negatively against what’s best for us in the end, and that is what happens. Everybody is so dedicated to the animals, to their education, and honestly, to each other. This gets outside of, of course, just interns and residents, that it’s against rational thinking. It’s behavioral economics at its finest that it’s irrational, but we all do it anyway.

Dr. Andy Roark:

You see it a lot in technicians and assistants. We talk about the percentage of technicians and assistants that make below a living wage, and there’s a high percentage.

Dr. Sam Morello:

Correct.

Dr. Andy Roark:

You say, “Well, why do they do this? Why don’t they go somewhere else?” I do feel like that passion, that desire to be a part of this specific profession, it almost holds our feet against the fire, not in a good way, of I don’t want to leave because I love this, or this is what I feel called to do. I feel like calling has become an increasingly loaded term. I’ve started push back against calling that medicine a calling because I think it feeds that belief like this is my passion and I don’t have any other options. I feel like when we don’t feel like we have any options that’s when we start to feel trapped. I think that’s a big part of burnout.

Dr. Sam Morello:

I think it’s a way of describing it. I had a colleague tell me once, “Dreams are nightmares too,” because we all talk about how these are our dreams and we follow our dreams. I believed in that my whole life. That’s why I became a veterinarian, that’s why I went down the paths I went down, and that’s great. But that’s not always necessarily going to lead you down the path of making choices that are going to optimally support your ability to live a safe or secure life that can support the other choices you want to make. The choice that you make when you’re 25 or 30 is not necessarily the choice you would make when you’re 40 or you’re 50. But your 40 or 50 year old self has no ability to inform that person or vice versa. It’s hard to mediate those things or have to clean up the choices or account for them later on. Unfortunately, finances are things that end up being a constant thread and permeate a lot of life in a continuous way.

Dr. Andy Roark:

You can’t make up for lost time when you’re talking about compounding, you’re talking about building wealth, you’re talking about retirement, things like that.

Dr. Sam Morello:

Right.

Dr. Andy Roark:

I have those thoughts a lot, if I could go back and talk to my younger self what would I say? The more interesting question I think is if you could go back and talk to your younger self, what would your younger self hear and understand? I think that’s a harder question than what would I say, because I know what I would say. I think knowing younger Andy, I think it would all go right over his head or he would just be like, “That’s ridiculous.” I would not [crosstalk 00:27:12] take future Andy seriously at all, I would not have. I would’ve been like, “That’s ridiculous”.

Dr. Andy Roark:

Knowing who you are at 20 and 25, what is possible in that phase of our life? Because once that phase is over, it’s passed. I hear this cynical voice in my head that I’m sure that when we talk about intern and residency, compensation comes back and they say, “But they’re going to be a specialist.” This is, yes, this is a bump in the road, but won’t the ultimate outcome be so worth it and make this up? I know that’s beyond the scope of the research that you published, but are you comfortable speaking to that a little bit of the financial picture coming out of a residency/intern program?

Dr. Sam Morello:

Yeah.

Dr. Andy Roark:

Is it the bounce back phenomenon that we like to think that it would?

Dr. Sam Morello:

Yeah. So I think there are a lot of things that go into that. One, I think that it needs to be another element of this conversation that every decision we make, finances play a role in it, but it’s not the only thing that plays a role. Certainly, that’s true for becoming a specialist. I’ll get into that a little bit more I think later. But the financial outcome of specialty medicine is it’s not universally lucrative. There are certain specialties where you can bank, literally bank, on coming out and making quite a lot of money. I’ve generated some of that evidence through previous publications. We published on some of the professional and personal life integration and finances for ACVS and ACVIM diplomates, and certainly small animal surgeons, neurologists, cardiologists. Those are individuals who come out and make quite a bit of money, or the average and median incomes for those individuals are quite high. That data is just a couple years old now. We know that with the economic boom and the competitive market for those specialists right now, those numbers are only getting higher, and certainly anecdotal evidence for starting salaries for those individuals is just fantastic.

Dr. Sam Morello:

But it’s not quite the same for some of the large animal surgeons. There’s some new data that’s actually also out on JAVMA now for zoo med veterinarians, which shows that the average salaries are not very high. So it’s not universally lucrative. Then when you start to factor in the other personal life choices about how much do you want to work, are you taking time out of the workforce in those early years to start a family, are you taking time out more than once to start a family? That’s time that you’re not necessarily going to be earning money. It looks different depending on where you work, how you work and how you want to work. So do you want to have to be tied to a certain way of working? There are only so many people that can become a certain type of specialist in any given year, so it’s not universally lucrative.

Dr. Andy Roark:

Where do you see possibility here? With the takeaways when we’re looking at this, and we say, look at the strain that we’re putting on our young and recent graduates who are going into advanced training, what do you think is possible? What do you think it takes to right the ship or to make significant headway in setting our colleagues up for success?

Dr. Sam Morello:

I think that there are a couple big topics and, ideally, movements that should come out of this. One of them, of course, the biggest one, of course, is improving the incomes for interns and residents. We’ve said for a long time that interns and residents cost money because they’re not fully trained veterinarians, they slow us down. That’s part of the reason that their incomes or their salaries are so low.

Dr. Sam Morello:

I think that if most of us who worked in big specialty hospitals look back over the last couple years during the pandemic and figure out how our hospitals stayed afloat, and even look at the years when there wasn’t a pandemic and look at how we worked and how emergency rooms stayed functional, especially in hospitals, where there are interns and residents, I think we can all see how valuable those individuals certainly have been recently, and really have always been towards keeping the workflow in a positive direction and generating revenue, and, as you mentioned earlier, supporting the teaching mission in a lot of hospitals. I think if we were to be able to quantify some of that, it would demonstrate that they much more than generate their own income, and generate a much higher income.

Dr. Sam Morello:

We talk about in the paper, some other examples of how postgraduate medically or scientifically educated trainees in this country, both MD residents, and also those undergoing postgraduate training programs like through the NIH, how those individuals are valued by which, I mean, what sort of incomes are they making. So I think that there are ways to quantitatively value their time in a much more supportive and effective way. I think making that step would go a long way towards supporting these individuals.

Dr. Sam Morello:

Which I think leads me to the second point, which I think is really important. The choice to do an internship for residency is really multifactorial. It’s not just do I want to make a lot of money as a specialist or do I want to or not want to make so little money as an internal resident. I think that there are a lot of people out there that don’t feel that they can spend those years making so little money. They either have a lot of debt, they have other responsibilities. It’s a stressor they don’t feel that they can take on for other reasons, which essentially means there’s an entire population where we have limited their professional choices. So it’s not a choice that I believe is open to everybody. What we want to do in veterinary medicine is leave that choice open to everybody. We want every choice to be on the table. It doesn’t mean everybody will match into whatever program they want to. But the choices should be there for everybody and they should be comfortable for everybody, and that’s not what we’ve created.

Dr. Sam Morello:

So creating a more stable economic situation for postgraduate veterinary trainees creates a more equitable future and more equitable opportunity for everybody in the profession, no matter what their background or current situation or future situation would be, and I think that’s very important.

Dr. Sam Morello:

Then I think the third part of that gets into what you mentioned earlier, which is the idea of diversity supporting women, supporting families. Lisa Greenhill, and James Lloyd put together the AAVMC, I think, focus on diversity report this last year. It showed that black indigenous people of color and PELL grant students were more likely to enter veterinary school carrying debt and carrying a higher volume of debt than white students, which means that those individuals their threshold for being able to accrue more debt or take on a position that imposes more financial strain is likely to be lower at the end of veterinary school.

Dr. Sam Morello:

We already see that there’s much lower representation of people of color and various ethnicity in specialties. I’ve generated quite a bit of that data in my previous research reports and there’s a lot of that coming out over the past year or so since some of the specialty colleges have been effective at putting together their own commissions and there have been some great new groups popping up to work on the really important diversity issues that we have. So that means that’s one of the big groups that we are limiting choice to and limiting opportunity from, we’re just creating another barrier, essentially.

Dr. Sam Morello:

I think that’s true also for women, families, anybody that has children. A salary in the low $30,000s is hardly going to cover childcare for people. So unless they have a partner who can really carry the entire load of the family, it might not be an option for those individuals. We see that women specialists are less likely to be married or have children and very, very few of them have children during residency, and even a relatively small proportion of men have during residency. So again, we’re limiting opportunities for a large portion of our workforce.

Dr. Andy Roark:

Doctor Sam Morello, thank you so much for being here. Thanks for talking with me as always. Are there any last points, words of wisdom, pieces of advice that you’d like to leave us with?

Dr. Sam Morello:

I think the 10,000 foot perspective on this is that we need to think about how we value the time, education and work of really everybody in our profession, that’s not just the interns and residents, that’s the technicians, it’s some of our general practitioners. If we can’t value ourselves in each other, then how do we ask people outside of our profession to value us? So this is a holistic idea. This is about all of us and this is the time to take a harder look at that idea. There are a lot of people in this profession that we need to think about when we think about that and a lot of corners of the profession that we need to solve that problem for.

Dr. Andy Roark:

No, I completely agree. Thank you so much. Your article “Comparison of Resident and Intern Salaries with the Current Living Wage as a Quantitative Estimate of Financial Strain Among Postgraduate Veterinary Trainees” is out online in JAVMA. I put a link in the show notes. It’ll be out in print January one. Thank you again for being here.

Dr. Sam Morello:

Thanks so much Andy.

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 and it keeps me encouraged to keep doing the episodes. 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

This episode of the Cone of Shame Veterinary Podcast is made possible by Cubex – Protect your people, practice and profits.

Dr. Carrie Jurney, President of Not One More Vet (NOMV) is visiting today to talk about the changes we have seen in the veterinary mental health space during the COVID pandemic. In the last 2 years NOMV has grown radically, and has become one of the most recognizable groups working to improve wellness and mental health in our industry. Carrie and Dr. Andy Roark discuss where mental health initiatives are going, and how they will look very different in years to come.

This episode has been sponsored by Cubex.

LINKS

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

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. Carrie Jurney is a veterinary neurologist in the San Francisco Bay Area and owner of Jurney Veterinary Neurology. When she’s not in the clinic, she’s the president of Not One More Vet, a global mental health support group and charity for veterinary professionals. In her spare time, she is a metal artist, Burning Man Camp lead, and podcaster on the Veterinary Superfriends Podcast.

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 welcome to the Cone of Shame Veterinary podcast. My name is Dr. Andrew Roark and I’ll be your host. I am here today with my friend, the neurologist and president of Not One More Vet, Dr. Carrie Jurney.

Dr. Andy Roark:

We are talking about burnout during the pandemic, the shifting paradigm of wellness in vet medicine and what wellness and vet medicine looks like going forward. What advances have we made in the last couple of years and what advances will we make in the very near future. I’m super happy with the interview as far as how we talk about wellness in a forward thinking progressive action oriented way.

Dr. Andy Roark:

That helps me imagine a better world. That’s what I really like about it. This is a great episode. Carrie and I do touch on suicide. If that is something that you do not want to listen to, then this is a good episode to skip. Otherwise, we just talk briefly about three quarters of the way through the episode. That is what is there. So just be aware of that.

Dr. Andy Roark:

Also, be aware this episode is sponsored by my friends at CUBEX. CUBEX is a maker of DEA compliance smart cabinets that are suitable for any practice size. You can learn more about them at CUBEX.com. 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 help you in your veterinary career, welcome to the Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark:

Welcome to the podcast. Dr. Carrie Jurney, how are you?

Dr. Carrie Jurney:

I’m well, Andy. How are you?

Dr. Andy Roark:

It’s good to have you back. Are we talking about today? Are we doing your neurology wisdom or are we doing your burnout wisdom? I think we’re doing burnout.

Dr. Carrie Jurney:

I think we’re talking about the other stuff. The other stuff. The stuff around practice.

Dr. Andy Roark:

Maybe if people stick around until the end, we’ll do a tight five on the neurologic examination.

Dr. Carrie Jurney:

Hot tips, procedure meds at the end.

Dr. Andy Roark:

Right at the very end, squeeze it in. Oh man. But it’s good to see you. You are a board certified neurologist. You are also the president of Not One More Vet. You had the great fortune to take over Not One More Vet, probably the premier mental health outlet for veterinarians in February of 2020 at the beginning of a global pandemic. Boy, you won the lottery on that one.

Dr. Carrie Jurney:

I really did. I really did. I look back to that board meeting and I think to myself, “My God! My God.” I thought I was like, “Well, I’ve got a big job, but I can do it.” And then we went into lockdown and the world turned crazy.

Dr. Andy Roark:

My last trip was February of 2021. That was the last time that I traveled before a month or so ago.

Dr. Carrie Jurney:

I think we were at the same conference [inaudible 00:03:08] that board meeting at Western. So yeah, I think that’s probably what it was.

Dr. Andy Roark:

That was my last flight and I drove and spoke to some wonderful technicians in Georgia like a week or two after that. I’ll never forget. When we were there, it was weird because other things were shutting down and I remember I called them. I was like, “Are we doing this?” And they were like, “Are you comfortable doing it?”

Dr. Andy Roark:

I was like, “I think so.” But at the point, COVID was moving across the country and it was almost like we were looking out the window and waiting for it to arrive. But it was about the week after that we started having real lockdowns and things. Man. Wow.

Dr. Andy Roark:

Anyway, you take over NOMV. What I want to talk to you today about is the change that we’re seeing in how we talk about mental health and what’s happening in mental health. Have we made any new progress? I think a lot of people go, “Oh my God. Are we doing the same things we were doing years ago over the last few years?”

Dr. Andy Roark:

I go, “I don’t think so.” I’m an optimist. I see progress being made. Let’s go ahead and start to talk about that. You want to talk about burnout in our profession over the last two years? Let’s say between 2020 and now, talk to me a little bit about that.

Dr. Carrie Jurney:

I think there’s so much an important context into realizing that these problems in our profession have been there since we started collecting data. We have data on mental health concerns in veterinary medicine dating back to the 1960s. None of this stuff is new.

Dr. Carrie Jurney:

What I do think that has changed in the last five years and particularly in the last two is that it has been okay to talk about it. And that we are pushing that conversation more and more. Sometimes, that’s uncomfortable. Sometimes that conversation goes a way that somebody’s not entirely pleased about, but at the same time, we are really starting to lean into those hard conversations.

Dr. Carrie Jurney:

Certainly, NOMV is largely run online and so we have those conversations online a lot, but I’m also starting to see them happen in practices and [inaudible 00:05:07] to be a real conversation that is happening around a lot of aspects of practice.

Dr. Carrie Jurney:

And so I think when I look about, look at things like burnout and wellness, I look at them holistically. We always say at NOMV, like suicide prevention isn’t just that conversation that you have. Suicide prevention is also things like financial resources. It’s things like…

Dr. Carrie Jurney:

To get back to your actual question, which was about burnout. How has the last couple of years been? Terrible. Honestly, it’s been a… I’ve worked in veterinary medicine for 20 years. These have been the hardest two years I’ve ever seen for our profession.

Dr. Carrie Jurney:

I think we’re not alone in the world in feeling that it’s been a hard couple of years. But I see the silver linings that I see there. Because I’m not an optimist, Andy. I’ll tell you, but I’ve worked very hard on trying to be one. I see that our profession had some hard changes that it needed to make and this has forced us into some of them. Yeah.

Dr. Andy Roark:

I agree.

Dr. Carrie Jurney:

Yeah.

Dr. Andy Roark:

Let me jump in with my optimism. Here comes the sunshine. Yeah. The pandemic has been hard. I thoroughly and strongly believe that a lot of good has come out of the pandemic for our profession. It’s because we were hammered into making some real changes that we would not otherwise have made.

Dr. Andy Roark:

We talk holistically. Everything from better, smoother communication systems. As far as we’re going to do text messaging and we’re going to do online booking and appointment booking and people go, “That’s not wellness.” I go, “Yeah. It is.” Anything like that that smooths workflow-

Dr. Carrie Jurney:

It super is. I’ve been messing around with telemedicine for like five years and never like made it stick. I figured it out in one day. One day. I’m a single doctor practice, I got COVID and it was like I have employees to support. I’ve got to figure this out today. As soon as my fever broke and I was still at home because it was early on, we didn’t have tests, it was a whole mess.

Dr. Carrie Jurney:

I figured out telemedicine in one day and I still use it to this day. In fact, we do one entire day from home as a veterinary clinic.

Dr. Andy Roark:

Really?

Dr. Carrie Jurney:

It’s amazing. It’s transformational for my practice.

Dr. Andy Roark:

Yeah. I’m sure.

Dr. Carrie Jurney:

My clients love it. My clients love it. All those hard, long conversations, all those really complicated diagnostics, we get on Zoom, we talk, they have focused time. I’m not chasing people on the phone. It’s magical.

Dr. Carrie Jurney:

And so talk about something for burnout and wellness, that’s one day my employees aren’t commuting, that’s one day that we have where I can be wearing my pajama pants. It’s awesome.

Dr. Andy Roark:

No. I completely agree. That’s a fantastic example because you’re right. It’s like, there’s a lot of stuff where we go, “I just don’t want to do this.” And you get kicked in the butt and you’re like, “I can figure this out in a day or two.” Now that the world sort of opens back up, I think a lot of us are using those tools in proportion.

Dr. Andy Roark:

Maybe we’re not using telemedicine all the time like we do. Or curbside, for example. Maybe it’s not all the time, but maybe it’s some of the time and maybe our tiny little vet practice can now see more appointments because we are using outdoor space and there’s all of these things.

Dr. Carrie Jurney:

Maybe you figured out how to check people out remotely. And so now you’ve got a better workflow. I think there’s so much there and I think there’s also a shift in the attitude that needed to happen as well. I certainly have seen amongst practice owners a focus on staff. Realizing that staff is important and staff is precious and they were always important and precious, but I don’t think that attitude was quite as pervasive and I’m glad to see it.

Dr. Carrie Jurney:

I’m glad to see it.

Dr. Andy Roark:

I agree with that.

Dr. Carrie Jurney:

I see wages going up which needed to happen. I think of places like [inaudible 00:08:49] who’ve kind of put it out there of like, “This is what we’re paying.” It brings the status quo to a better place. 95% of technicians don’t make a living wage. So that’s something that we need to address as a profession.

Dr. Carrie Jurney:

I think the pandemic started to push these conversations a little faster.

Dr. Andy Roark:

I completely agree with that. I feel very much that wages in vet medicine, especially for paraprofessionals has not been where they need to be for a long time. And we know that and we talk openly about that. I always hold this up and people look at me and they kind of roll their eyes, but then I think they appreciate that I say it.

Dr. Andy Roark:

I don’t think it’s because veterinarians are bad. I think it’s because they very much want to keep medicine affordable for pet owners and I think veterinarian don’t get paid probably what they’re worth, especially relative to other medical professionals. Absolutely.

Dr. Carrie Jurney:

I 100% agree. I 100% agree.

Dr. Andy Roark:

Again, like there’s no boogieman in this scenario for me, but this is another perfect example of like COVID is good for our profession is that is the kick in the butt where people are like, “Hey, I want to keep my staff.” And now there’s other corporations coming in, there’s a shortage of staff. People are paying more. And I go, “You know what? This is painful. Ouchie! Ouchie!”

Dr. Andy Roark:

It’s good in the long term. I think a lot of people get hung up on like, “That’s not what we’ve paid in the past.” Or, “That’s not what I used to make.” Or things like that. And I go, “That’s not the mindset.” The mindset now needs to be, “How do I make this happen?” That’s the question. How do I do this? How do we go forward?

Dr. Carrie Jurney:

It’s easy to be stagnant until [inaudible 00:10:22] have-to and it became a have-to. I think it’s good. Yeah.

Dr. Andy Roark:

The other have to, for me, it was very much the personal boundary have to. I think there’s a lot of people who just sucked it up. That’s it. Just get it done, just suck it up. I’ll stay late. I’ll put up with the angry clients and blah, blah, blah. I think that having the caseload that we’ve had and people having personal stress at home and people having other things that they have to do, that they didn’t necessarily have to deal with during the pandemic. I think enough people said, “I just can’t suck it up anymore.”

Dr. Carrie Jurney:

It became impossible. It always rode unreasonable. We always achieve… We are an overachieving bunch of squirrels. We really are. But it became impossible.

Dr. Carrie Jurney:

I’ll tell you, Andy. I’m that doctor who doesn’t say no. I’m that doctor, I admit it fully. I admit and I try really hard to like manage that behavior but right now, I’m booked out more than a month and a half and as a neurologist, I typically would never be booked out more than a week.

Dr. Carrie Jurney:

Neurologists [inaudible 00:11:27] emergency have [inaudible 00:11:29]. People are pretty freaked out and I would take emergencies no matter what, and I just can’t do it anymore. We’ve put hard limits on it and it’s still comfy, but I know that it’s what I need to do and I know that I can’t push my staff that way and that I can’t push myself that way. Those boundaries are so important.

Dr. Andy Roark:

I did a lecture today for the first time. It was a virtual lecture in the Netherlands, which is pretty cool. I’m doing this new talk. It’s the first time I ever did it. It’s called practical boundaries for busy practices.

Dr. Andy Roark:

So I started talking about it. One of the big things that I sort of started to put on that is there’s a cognitive sort of distortion that’s called present bias. What present bias is it says that we sort of as a species are wired to favor immediate, smaller gains over later long term gains. Which if you evolve in a resource scarce environment, it makes sense. Eat the berry now even if it might be riper tomorrow, because you don’t know if it’s going to be there tomorrow.

Dr. Andy Roark:

Yeah. And so that’s it. There’s so much of this stuff where we say, we take the thing that’s easy right now and we sacrifice the benefit we could have in the longer term. And so when people say, “Hey, I need to get in. Hey, I need to get seen. Hey, I really want to get in this week.”

Dr. Andy Roark:

There is an immediate benefit to accommodating them because we want to make them happy and we should. It’s funny, the long term benefit in some of those of saying no and saying we are at capacity, that’s harder to see and it comes down the road because you’re like, “Could I get them in? Yeah, I probably could.”

Dr. Andy Roark:

But then there would be more people next week and there’d be more people after that. And at some point, it’s death by a thousand cuts.

Dr. Andy Roark:

But anyway, I just think about that when we say it’s still uncomfortable and it is uncomfortable to say no. You have to believe in the longer term benefit being greater. I think a lot of us, we’re forced to finally go, “Can’t just keep making the short sacrifice. I’ve got to make some changes.” What’s funny is I don’t think many of us are going to go back. I think that once we’ve seen the greater gains down the road of having better boundaries, I think a lot of us are going to keep them.

Dr. Carrie Jurney:

I hope so. I hope so. I also think a lot of us were so busy, are so busy still that we were able to reprioritize the clients that we have a good relationship with and deprioritize the ones we have a bad relationship with.

Dr. Carrie Jurney:

Instead of the squeaky wheel getting all the attention, something that I’ve really noticed in the pandemic is a real focus on I have 300 people that want that appointment. “If you are going to act like this, no, I’m sorry. No, I’m not… I don’t have time to put up with your toddler fit, Ms. Smith. I wish you the best.”

Dr. Carrie Jurney:

I think veterinary professionals on the whole, we’re terrible with boundaries. We all care entirely too much or we wouldn’t even be in this profession. And so that was a really hard one thing. I’ll tell you, I don’t think I’ve even [inaudible 00:14:38] one client a year in my entire career. In the last year, two years, probably five or six. And that’s not a ton given the volume that we’ve seen, but comparatively it is, comparatively it’s like, “Look at that.” Like, no, I’m not actually going to put up with verbal abuse to my staff. Like nope, just not going to happen.

Dr. Andy Roark:

I don’t think there’s a ton of clients that need to be fired, but there’s a couple for most of us. But the thing is that small number take up a wildly disproportionate space in your brain. When you think about clients, you have this wildly out-sized view of the ones that you should be done with.

Dr. Andy Roark:

I think that that’s super important. What do you see as the main differences? When you look through the NOMV lens, what are the differences that you’re seeing now as opposed to at the beginning of the pandemic? Are there different stressors that you’re seeing now that you didn’t see before?

Dr. Carrie Jurney:

I think there’s a change in attitude. I think everybody was in emergency mode for a really, really long time. Me included. I actually really love emergency mode. It is kind of where I thrive. Neurochemically, I have ADHD. My brain is always seeking adrenaline, always, always, always. I just really enjoy that space. It’s exciting.

Dr. Carrie Jurney:

I remember I was talking to our mutual friend, Bruce, about… He set up a war room in his practice where they would strategize new things every day. And I was like it’s exciting. It’s exciting. But as the months rolled on, you can’t stay there forever and you have to adapt. I think what I’ve noticed in the last probably… Probably six months ago, we really started to reach true exhaustion.

Dr. Carrie Jurney:

People just truly, truly exhausted. Now, what I’m starting to see is adaptation. Like people adjusting to the new normal. People taking the lessons they’ve learned and really trying to find something sustainable. Not everybody’s there yet. Even in my practice, I don’t know that we found what truly sustainable feels like, but we are so much closer than we were six months ago.

Dr. Carrie Jurney:

We’ve already come to grips to the fact we need to have these boundaries. We’ve already worked out all these technologic systems and now, we’re in the refining point of like, okay. All of this was great stuff that we’ve learned. I do feel like I’ve put enough boundaries in place and I’m starting to take a breath and say like, “Okay. How do we move on from here?”

Dr. Carrie Jurney:

I’m excited for that. I think that that’s going to be a place of extreme growth. I truly really think that the pandemic will have forced a paradigm shift in veterinary medicine. It was a long time coming. We needed something dramatic to kind of kick us in the butt and here we have it.

Dr. Andy Roark:

Yeah. Well, let’s push through into some specifics here. What do you see? Because you and I keep talking about, yeah, boundaries are better and we’ve got better boundaries. What specific boundaries are you seeing that you think are having a positive effect?

Dr. Carrie Jurney:

People started going home on time. I think that one’s huge. I think that’s one that we let slip a little too often in our profession. We take that one more case. We just stay a little bit later. We’ve got to stay to make those phone calls. It’s just not happening as much anymore.

Dr. Carrie Jurney:

I think sort of the wonderful but slightly unrealistic expectations we’ve put on ourselves for customer service. Like I don’t know about you, but my personal doctor has never called me back same day with my blood work results.

Dr. Carrie Jurney:

Especially ones that were not critical like life threatening type things. I see a lot of people saying like, “Yeah, it’s going to be a few days. You might get an email, you might talk to a technician.” Those sorts of things that we’re always okay but we, as a culture didn’t really do are now okay.

Dr. Andy Roark:

Yeah. I’ve gotten good at saying two to three days. “So I’ll have some blood work back for you in two to three days.” Do you know how many people get when you tell them it’ll be two to three days? None. Not one. Nobody cares. But then they’re thrilled when I call them the next day, because things are good.

Dr. Carrie Jurney:

That’s right. That’s right. I try to set up everyone who like, “Hey, if it’s easy, this is what we’re going to do and you’re going to hear from the technician. If we need to talk more, I’ll give you a call.” And if we need to talk more, we set up a telemedicine appointment and we only do those on Thursdays. So like, “Hey, the doctor wants some in-depth time with you. We’ve set 20 minutes aside on Thursday for you guys to have a Zoom, so you can really dig in.” They love it. They love it.

Dr. Carrie Jurney:

Sometimes that means people are waiting five days for results, which I think three years ago, that would’ve given me like heartburn. But yeah, that’s just what it is.

Dr. Andy Roark:

As I’ve gotten older, I’ve had more interactions with human medicine and I can tell you that nobody’s rushing to call me the next morning about anything.

Dr. Andy Roark:

I don’t think that it’s a wild concept to people. I was goofing around with some numbers when I was putting that practical boundaries talk together. I was like, it’s funny. There’s all these things that we do or that we don’t do and we have these sort of systems where we don’t really have good boundaries towards the end of the day or we don’t have good processes for getting people done at the practice and out the door.

Dr. Andy Roark:

I was like let’s just say that there’s something that we do that’s not super efficient. When it kind of goes wrong or when we take that extra appointment or whatever, let’s just say that the team stays seven minutes late. Seven minutes, not a big deal. But let’s say it happens like three times a week.

Dr. Andy Roark:

Three days a week, we stay an extra seven minutes. I’m like, that’s nothing. We go well, that’s 20 minutes a week, X 50 weeks a year is a 1,000 minutes. That’s 17 hours out of the year that you spent just not quite getting done and getting out. That’s 170 hours in 10 years. 300 and some hours in a 20 year career.

Dr. Andy Roark:

Again, I’m not trying to split hairs but that stuff matters and we’ve just always kind of been [inaudible 00:20:31] about what’s a 10 minute break every day? That’s that’s 50 minutes a week X 50 weeks. You do the math. That’s rest time. That’s time for you just to detach and get your head straight and come back to work.

Dr. Carrie Jurney:

Yeah. No, absolutely. I think that those little moments they were on us, they wear on our staff, there’s a lot of great work that’s come out on burnout and technicians in the last year and predictability and control of our scale was one of the main ways that you could protect against burnout in your technical staff. Doesn’t that just speak volumes?

Dr. Andy Roark:

Yeah. I have been blown away by the lack of predictability in scheduling in our profession. I don’t think I really realized until the last year or two, how many technicians don’t know what their schedule’s going to be next week. They’re like, “I don’t know what I’d do next week.” And I go, “That’s a real hard way to live.”

Dr. Carrie Jurney:

How do you live life? How do you live life as an adult, not knowing can I have a hair appointment next week? Come on, a dentist appointment, anything. I have come so much further with retaining staff and having happy staff and having a happy practice by making sure every one of my staff members gets treated like a grown up with important things in their life that aren’t work.

Dr. Carrie Jurney:

One of my techs who’s been with me for 10 years that I love to pieces, [Evie 00:22:00] is great, she told me during her review, we’re talking about goals, where she wanted to go. She’s like, “I honestly just appreciate that you let me be a mom too.” Like, I don’t care if she’s on the front, her kid calls her from home like he’s doing Zoom class and he needs… I don’t care. Go take your call. We can wait five minutes for you. That means I get this great RVT who otherwise just would’ve left the workforce.

Dr. Andy Roark:

Yeah.

Dr. Carrie Jurney:

One of my other RVTs came to work for me. The job she was at previously told her that she absolutely had to be on call on Saturdays. There was no other option. She takes care of her disabled mother on Saturdays. That’s her day in the family to do it. She can’t do that.

Dr. Carrie Jurney:

Just by saying like, “Okay. No. That’s something I can work with.” That level, it’s the level of respect that I want. Sending that to everybody, gosh, everybody just wants to be treated well like they’re a human being.

Dr. Andy Roark:

Yeah. Oh yeah. Yeah. I think that’s true. It’s been interesting watching some of the boundaries that I’ve seen practices put in place. At first all kind of look a little sideways at them and then later on, as I hear more feedback about these things, I’m kind of impressed.

Dr. Andy Roark:

I’ll give you an example. Enforcing breaks. When I first heard of practices being like, “We enforce breaks. Not only do we give you time to take breaks, but we are going to make you… You have to take them.” I was like, “I don’t like that.” As someone who doesn’t like to be told what to do, I don’t like that.

Dr. Carrie Jurney:

I will tell you that lunch is legally mandated in California. I live in the great state of California where we have a law for everything. When I moved here, that was the one that I was like, “Are you kidding? Come on.” This is medicine. And really, we’re going to legally enforce this?

Dr. Carrie Jurney:

But I will tell you, I never had a lunch break in veterinary medicine until it was legally required. It wasn’t legally required for the doctors, but you saw the techs doing it. And you were like, “Well, maybe I can too.”

Dr. Andy Roark:

Well, yeah. I don’t have any help. I might as well just sit down and eat lunch.

Dr. Carrie Jurney:

[inaudible 00:23:58] I’ve got no one to help me, so I guess I’m going to go eat. That’s huge. That’s huge. It feels Draconian at first, but then you realize that we’re fighting against a big cultural push. We’re fighting against a cultural push, not to do it. Sometimes you’ve got to fight back.

Dr. Andy Roark:

I agree with that. I think that’s a big part of this, fighting the cultural push. The other thing that kind of blew my mind and where I sort came around on this is work ethic is one of my core values. I believe that to work hard. I think that that’s just part of what it means to be a good person is you work hard.

Dr. Andy Roark:

That’s a 100% how I was raised. When we say, “Hey, techs. You guys can take lunch break and here is the time to do it.” I’ve seen a lot of practices that will say, “Yep, you have this time to do it.” Meanwhile, I’m going to keep working over here just so you know, I’ll be working and you go, oh, now you’re laying this guilt on them.

Dr. Andy Roark:

And the other thing is there are other people who go, “You know what? You guys go ahead and lunch. I’ll stay here and help.” And those people get ahead and the work ethic part of me goes, they should get ahead because they’re there and they’re working there putting the time. And I go, yes, but if you flip this around, if I reward someone for staying and working, that’s the exact same thing as me penalizing other people for not staying and working.

Dr. Andy Roark:

And now I am penalizing people for taking lunch by allowing other people to stay through lunch and gain favor, gain opportunities, gain experience, gain knowledge. I kind of had to roll that around in my mind a bit before I was like okay. I’m on board with saying, “You know what? Everyone goes to lunch. That’s what we do.”

Dr. Carrie Jurney:

Yeah. No, I agree. I think the more that we… Be the change you want to see in the world. As I started to talk about wellbeing and started to collect data and statistics on things like… I mean, we were talking about lunch.

Dr. Carrie Jurney:

When I did the poll three years ago, 75% of veterinarians didn’t regularly take lunch. 75%. Oh my God! Guess what? I was one of them. Like, I’m doing the poll, I’m giving the lecture. And I was like, “That’s really hypocritical of me to be talking about this and not doing it. I think that these changes, they aren’t impossible, but they do take some neurons.

Dr. Carrie Jurney:

You’ve got to say to yourself, “No, as much as I feel like I should sit here and make phone calls for the next half hour, I’m actually going to go walk to Starbucks.” And that’s just what you got to do.

Dr. Carrie Jurney:

What I have learned is I am a better, more efficient, more focused doctor when I take those 10, 15, 30 minutes and you come back refreshed, you come back, you work faster. You don’t lose time. I think a lot of people think like, “Oh gosh. Well, I’m never going to get on home on time if I don’t do that.” Actually you will. You’ll just be more efficient when you get back because your brain will be exhausted.

Dr. Andy Roark:

Yeah. I agree. What do you see going forward as far as changes that we can anticipate in practices? What do you think people are getting on board with? What do you see five years down the road that you think is going to be more normal than is now?

Dr. Carrie Jurney:

I hope very much that we continue to be creative with how we run our practices. We came up with curbside medicine collectively as a profession in two days and I think perfected it over two months. That means there’s tremendous room for creativity. There’s tremendous room for innovation. I know and you know, I think our profession on the whole tends to be a little bit stagnant.

Dr. Carrie Jurney:

We tend to be like, “This is the way we used to do it.” I think about how many times I have to use the fax machine every single day and it’s 2021 for God’s sake.

Dr. Carrie Jurney:

I’m very much hoping that we keep this creative energy and we keep this… I think I will probably always do a little bit of curbside. Some of my clients really, really like it. My clients are busy professionals. They need to be taking a call in the car. They don’t want to be sitting in the vet. Drop off appointments, we’ve done a lot of those too.

Dr. Carrie Jurney:

We’ve just gotten more creative with systems and I hope that continues. I deeply, deeply, deeply hope that we continue to appreciate our staff and push for fair and equal work practices, push for excellent benefits, excellent pay for everybody. There’s a shortage of vets, there’s a shortage of techs. Let’s make our profession attractive again.

Dr. Carrie Jurney:

Not just because everyone wants to help dogs and cats and horses. Of course, but also because it’s a great job because it’s a great job where you not only feel fulfilled from your career, but are also like rewarded in all the other ways that being adult takes. Yeah. So you have health insurance, stuff like that.

Dr. Andy Roark:

Yeah. I hope we keep adding wellness resources and lifelines and that they can be very practical and pragmatic and fit into small businesses really well. I’m a big fan of EAPs, Employee Assistance Programs, things like that so that…

Dr. Andy Roark:

I don’t buy into the idea of people should have personal boundaries and we should tell our employees that they matter, but we don’t really support them or we don’t really have anything for them. And at the same time, I also think, I think this is really important, as we talk about mental health and we normalize talking about mental health, veterinarians are not therapists and they should not be therapists and they should not act like therapists.

Dr. Andy Roark:

I don’t want to be a therapist for my employees or my technicians or my staff or whoever. That’s not what I’m good at. And that’s not what I’m for. That’s not stress that I want to carry.

Dr. Carrie Jurney:

Well, I think there’s a really interesting intersection between peer support, which is clearly something that NOMV was built upon and so I feel very strongly about and mental health. Peer support is not a replacement for mental health and mental health is not a replacement for peer support and both have their spaces and their time and the way that they work together.

Dr. Carrie Jurney:

Talking about resources, EAPs are great. They’re under-utilized. 17% of practices have them, only 14% of employees use them when they exist. That’s a great resource that just isn’t getting traction for some reason. That’s something we could do better at. Absolutely. I could certainly speak to what my organization is doing. We have a couple of really big programs coming out soon.

Dr. Carrie Jurney:

We have a new program called Lifeboat, which is going to soft launch hopefully next week because we realized that a lot of people needed peer support and Facebook wasn’t a good place for it either.

Dr. Carrie Jurney:

They didn’t want to be a member of Facebook. Facebook isn’t private and it’s never going to be private. We made a completely anonymous online support service, where we match you with three trained volunteers. These guys get pretty intense training. They do a lot of training and in the background, they have mental health care workers as support.

Dr. Carrie Jurney:

They have people that they can ask questions who are suggesting resources. But I’m really excited about that environment because not every person out there wants be peer support or is even appropriate to be peer support. We want to provide that for them. And then the other thing we’re making is something called Clear Blueprint, which is a new program where we don’t want to just make a practice certification.

Dr. Carrie Jurney:

Those things often end up just being box checks that people do, but what we’re doing as we’re going to practices and we’ve developed this with lawyers and psychiatrists and a bunch of professionals and we’re giving kind of like some evaluations. We give evaluations to the practice. We take anonymous surveys, we observe and then we, we see where that practice is actually struggling as far as wellness goes and then provide targeted resources around that.

Dr. Carrie Jurney:

It’s great to say like, “Go take a wellness class. Go take a professional development class.” But maybe it’s not the one you actually need right now. It can be hard. You can lose the forest for the trees. I’m hoping that these two programs particularly together provide like a big leg up and everybody who owns a practice wants their workplace to be a happy place..

Dr. Carrie Jurney:

Nobody goes into practice and be like, “I’d love to have a really toxic, horrible environment. Can we just get that going?” Like that’s not real life, but it’s can be really ephemeral and like how do I get there? What do I do? Pizza parties are not doing it. Where do I go next?

Dr. Carrie Jurney:

I’m hopeful that we can really… Instead of just saying like, “Wellness is really important.” Like what? What is important? And really start to drill down and it’s going to be different for everybody which is why I love how Claire is approaching it.

Dr. Andy Roark:

No. I like that as well. I think my point is for sure is most of us are here running vet hospitals. That is our interest and it’s what we’re good at and it’s what we know. We want our people, our colleagues to have support and get support and we ourselves may not know how to give it. We may have reservations about getting it. We don’t have time to give it.

Dr. Andy Roark:

I think it’s really important for practices to have those types of outlets and be able to direct people to those types of resources. Yeah, somethings like things places where our staff can get counseling just exactly what we’re talking about, whether it’s peer counseling or one-on-one counseling, things like that, virtual counseling, the assistance programs I think are really good.

Dr. Andy Roark:

I put drug restriction into that category as well as a resource also. When we look at depression, suicide, things like that and we look at deaths of despair in our country, which have gone steadily up, especially during the pandemic, we’re talking about opioid abuse, we’re talking about suicide, we’re talking about drug overdoses, things like that.

Dr. Andy Roark:

I really think that drug restriction is important. I think that our profession is still way behind probably where we need to be, but I see a lot of movement in that direction. I see places getting much more serious about how they control their drugs. [inaudible 00:33:59] Use that to keep their employees safe, whether it’s from addiction or overdose or things like that.

Dr. Carrie Jurney:

No, I agree. I agree. I think restriction to access to drugs is always something that kind of ruffles some feathers. Especially when you, you do it in the lens of mental health because it doesn’t feel good. It doesn’t feel as nice as, “We’re going to get you a counselor. We care about you. We’re going to give you the day off.”

Dr. Carrie Jurney:

It’s not a fuzzy thing and truthfully, it doesn’t fix the underlying problem. Like whatever’s happening, it doesn’t fix the underlying problem and that’s why it doesn’t feel satisfying. But that doesn’t mean it’s not important. Specifically along the lens of suicide, unfortunately data has shown that the primary way that veterinarians die by suicide is Pentobarbital poisoning in the United States.

Dr. Carrie Jurney:

Opioid poisoning is very high for our veterinary technicians. And so just from a very practical standpoint, that’s something we need to address. Across suicide prevention, no matter what lens you’re talking about, across suicide prevention, preventing access to means of suicide is one of the primary ways that we intervene in the acute phase.

Dr. Carrie Jurney:

Every everywhere it’s done, it gets pushed back. I remember when they put the nets, I live in San Francisco, unfortunately the Golden Gate Bridge used to be one of the top places in the world for people to die by suicide. That’s really not something you want [inaudible 00:35:24]-

Dr. Andy Roark:

Yeah, that doesn’t go on the pamphlet.

Dr. Carrie Jurney:

It’s not a Postcard. The Park Rangers who take care of the Golden Gate Bridge have done a lot of things. There are phones that you get directly connected to a crisis line every 20 feet on the Golden Gate Bridge. A couple of years ago, they put up nets and the nets were really expensive, really expensive. Of course, it was another tax on your registration and et cetera, et cetera.

Dr. Carrie Jurney:

People kind of rattled their fist at them, but it worked. I think that some of the solutions to wellness issues, like we were talking about in the beginning, they’re not… Suicide prevention, isn’t just crisis lines and mental health days. It’s wages, it’s prevention of access to means, it’s a lot of different things.

Dr. Carrie Jurney:

I know my own practice, right now we share space with an emergency hospital and very recently, they went from the cabinet with the key that was off always on the counter and sometimes was… It was supposed to not be on the counter, but it was on the counter or in the lock. That system and they got a CUBEX. Even just time-wise from like a paperwork perspective-

Dr. Andy Roark:

That’s becoming a bigger and bigger deal. Honestly, the amount of logging and paperwork had to keep up with for our control drugs, especially if you’re carrying the heavy stuff, it’s getting more and more. That’s a quiet advantage of just having all electronically done and you’re like, “Here’s our log. It already finished. I didn’t touch it.”

Dr. Carrie Jurney:

As a practice owner, those things are on investment. CUBEX is an investment.

Dr. Andy Roark:

Oh yeah.

Dr. Carrie Jurney:

And you start to, of course it’s important, of course wellness is important. But there’s always other things to think about and staff time and logging all that stuff-

Dr. Andy Roark:

Well, even around to your first point too of… I really like thinking of wellness this way as this massively multimodal thing and say, “Decreasing employee workload is a wellness program.” It’s sort of like, if I can outsource my inventory management to a drug box.

Dr. Carrie Jurney:

No one likes menial task. Come on.

Dr. Andy Roark:

Yeah.

Dr. Carrie Jurney:

Nobody likes. Yeah.

Dr. Andy Roark:

Yeah. But yeah, I just… I think that’s the point where I want to leave it today. I think the struggle is real and we all know that, but guys, I think that there’s a lot of things that we are doing. I think we’re getting some things right. I think things are better than… I think things are better than they were a few years ago for a lot of us, as far as our boundaries and honestly, the way that practices are looking at staff, I see paraprofessional wages going up and that makes me feel good.

Dr. Andy Roark:

I see better boundaries of people saying, “We’re going home and we’re taking lunch.” That makes my heart feel good. I think that a lot of us are figuring out ways to be more efficient. I love to use the word precious. Our staff is precious and I go, “Yeah, I think that’s true.” I think the paradigm shift of we take care of our staff and they’ll take care of our clients beats the hell out of we’ll take care of clients and hope our staff is okay.

Dr. Andy Roark:

I think a lot of us have gone through that and I think that’s really good.

Dr. Carrie Jurney:

Yeah. Let’s stop trauma bonding.

Dr. Andy Roark:

Yes. I love that. I love that phrase, trauma bonding. Let’s definitely… There’s no suffering award that we want to win. And so let’s not do that.

Dr. Carrie Jurney:

This is not the struggle Olympics. You do not need some medal. We can make the profession something. There’s a really great quote about self-care that I always think about. True self care is building a life you don’t need to run away from.

Dr. Carrie Jurney:

That’s just so powerful. But that takes focus. It takes forethought. It takes doing the stuff that’s not fun in the moment, but it’s so, so important. All of this stuff kind of falls into that category for me, but it’s worth it. Super worth it.

Dr. Andy Roark:

Yeah. Carrie Jurney, can people more about NOMV? Where can they find you? Yeah. Where can they read more?

Dr. Carrie Jurney:

Well, you can always visit nomv.org, N-O-M-V.O-R-G, we are always looking for donations, we’re always looking for volunteers. You can learn about all of our great programs.

Dr. Carrie Jurney:

I would be remissed if I didn’t mention that our good friends at CUBEX are actually about to run a charity auction for us. They are going to auction off a one year deluxe subscription to the CUBEX MiniPlus and that’s what we use at my hospital. It handles all the things. It’s great.

Dr. Carrie Jurney:

There’s going to be two winners. There’s going to be kind of a random draw as well as the highest bidder is going to win and they’re donating all proceeds to NOMV.

Dr. Carrie Jurney:

CUBEX has been really awesome to NOMV actually. They’ve been supporting us for quite a while and we super appreciate them. And then you can always find NOMV on social media. We’re on Instagram, we’re on Facebook, we’re around. Reach out if you need help. We’re here.

Dr. Andy Roark:

Awesome. Thanks for being here.

Dr. Carrie Jurney:

My pleasure.

Dr. Andy Roark:Guys, that’s our episode. That’s what I got for you. I hope you enjoyed, I hope you got a lot out of it. If you’re interested in CUBEX and learning more about their inventory control systems and DEA compliance storage cabinets, check out cubex.com. I’ll put a link down those show notes. Guys, take care of yourselves. Be well, I’ll talk to you soon. Bye.

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

“Eliminating problems is not the answer to mental health and wellness challenges.” If you spend 100% of your time weeding a garden, and 0% of your time planting it, ultimately you will have a frustrating and barren garden. This is the basic premise that Josh Vaisman brings to the podcast as he and Dr. Andy Roark discuss how we cannot remove challenges until we are happy, and what other approaches we should consider.

LINKS

Zack Mercurio Homepage: www.zachmercurio.com/

Strategic Planning Workshop Series: unchartedvet.com/upcoming-events/

Uncharted Veterinary Conference April 21-23, 2022: unchartedvet.com/uncharted-april-2022/

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

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

Josh believes all veterinary professionals deserve to feel fulfilled by their work, each and every day. Through his company, Flourish Veterinary Consulting, he combines more than 20 years of veterinary experience, a master’s in applied Positive Psychology & Coaching Psychology, and education in Positive Leadership and Positive Organizational Scholarship and a passion for guiding leaders to cultivate work environments in which people can thrive.

Fun fact – Josh is also an avid beekeeper who teaches beginning beekeepers how to tend to their buzzing buddies.

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, today Josh Vaisman from Flourish Veterinary Consulting is back on the podcast, and we are going to unpack his idea, his theory, his position, that eliminating problems is not the answer to mental health and wellness in vet medicine. I think it’s a fascinating position. I think he makes a lot of really good points. Maybe there’s more to this than just fixing broke stuff. I don’t know. 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. Welcome to the podcast, Josh Vaisman. How are you?

Josh Vaisman:

I’m doing well, Andy. Thanks for having me back. I appreciate you.

Dr. Andy Roark:

Oh my pleasure. I always enjoy when we get to talk, and I wanted to pick up what you and I were talking about last time you were on the episode. We had a really good conversation, and we got to the end, and you said, “Eliminating challenges in the vet clinic is not the answer for making our profession healthier.” And I thought that that was really interesting. And I wanted to come back today and unpack that a little bit.

Dr. Andy Roark:

We talk a lot about having healthy practices. We talk about mental health and wellness. We talk about having a positive workplace culture. And the idea that eliminating problems is not the approach that’s going to get us to a positive workplace culture, to me is, is counterintuitive. And I think it’s counterintuitive for a lot of people, right?

Josh Vaisman:

Yes.

Dr. Andy Roark:

Because we’re problem-solving people. That’s what I do for a living is I’m, “What’s the problem? Let’s run some diagnostics and better understand the problem. And now let’s remove this problem.”

Josh Vaisman:

Correct.

Dr. Andy Roark:

Walk me through why you say that.

Josh Vaisman:

Yeah. There’s so many different ways that I feel like I can approach this, and I use a whole wide variety of analogies. I’m going to pull from one that I’ve been using a lot lately, when I talk to veterinary leaders about positive leadership, the science of positive leadership, which is really a big passion for me. I start off these presentations, often, by recognizing the challenges of our work. Our work is hard, and what we do, it’s really difficult. It takes a lot out of us, physically. It’s emotionally and psychologically expensive. There’s a great deal of uncertainty in our work each and every day. And there’s challenges; challenges that contribute to risks of things like burnout and compassion fatigue and depression. And all those kinds of things. Those are real. And those realities, they’ve always existed. They still exist today. They will exist in five and 10 and 20 years.

Josh Vaisman:

And then I paint a picture. I say, “Imagine that, tonight a miracle happens. Literally, you go to bed, and overnight, a miracle occurs. And tomorrow you wake up to discover that all veterinary debt has disappeared. It’s all gone. All of your student debt; even your mortgage payment; it’s all gone. No more debt. And then, you go to work to discover that your boss has tripled your salary. Boom, just like that; snap of a finger. As a practicing veterinarian or a practicing veterinary technician, you’re now making more than most of your human medical cohorts.”

Dr. Andy Roark:

Mm-hmm (affirmative)?

Josh Vaisman:

Oh. “And you don’t have to work a minute over 35 hours a week to make that pay. That’s it. You get to 35 hours, period; you go home, if you even have to work that many hours. And there’s no more double books. One appointment at a time. One after another. No more emergencies. No more squeeze-ins. No more day admits. Easy peasy throughout the day. And by the way, every single one of your clients has also gotten a triple increase in their salary. So, they are now ready to say yes to every one of your recommendations.” What a glorious scenario, right?

Dr. Andy Roark:

Yeah. Have a good day.

Josh Vaisman:

Eliminating almost all of the problems that we identify in veterinary medicine, in one fell swoop, with this great miracle. And I tell this story, and I look out at the audience. And I see the reactions in their face and the nods and the smiles and the thumbs up. And everybody’s happy because this would be great. And I completely agree, it would be absolutely wonderful. And then, the next thing I say is, “Raise your hand if you agree with this statement: if this miracle scenario happened overnight, everybody in veterinary medicine would be happy, joyful, and fulfilled.” And no one raises their hand. Why is that? Because the elimination of those problems, while wonderful, while helpful, while beneficial, isn’t cultivating what we’re trying to grow.

Josh Vaisman:

There’s a difference between eliminating something that’s a problem and growing what you intend to have or hope to have.

Dr. Andy Roark:

Yeah. Yeah. No, I agree with that. I lean a lot into evolutionary biology in these things. I definitely look at happiness through a science lens. The truth that I have settled on is, I believe we are ruled by natural selection. I believe that that has made us, as human beings. And contented species are dead species; they die. They stop exploring. They stop pushing themselves. They stop innovating. They stop doing things to colonize new areas. They are content, and they are dead. And that is why I believe that we, the way we are made, we are not made to be content. I think we are made to be slightly unhappy all the time. I do!

Dr. Andy Roark:

And people hear me talk. This is why I gravitate to a lot of the Buddhism teachings. Because one of the key tenants there, that people hear me talk about, is “life is suffering.” And they go, “Oh, that’s really morbid.” And I’m, “I don’t think it is. I think you should accept it, and you should decide how you’re going to suffer because that is empowerment.”

Dr. Andy Roark:

Kind of a twisted worldview, but that is a core tenant in my life that I’ve come to, over the years. And so, yeah, it’s a hundred percent true. When I come in, and the magic has happened, and my salary has gone up, and all these things are great, I think I would be happy. And other people would too, for a couple weeks. A couple of weeks. It’s called the hedonic treadmill. You can’t just be happy. Whatever you’re doing becomes the new norm, and then it becomes boring, or it becomes unfulfilling, or there’s a new stress or struggle.

Dr. Andy Roark:

At some point, you would get frustrated, and you’d be “My job is not as challenging as it used to be.” [crosstalk 00:06:57]Find something to be unhappy about.

Josh Vaisman:

Yeah, absolutely. Actually, you’re bringing up a really wonderful point, Andy, when you talk about this hedonic treadmill. That’s built on our incredible capacity, as living creatures, to adapt to our situation. “Hedonic adaptation” is what psychologists refer to that. But I like to use the example of olfactory adaptation. When you walk into the treatment room, instantly, as soon as you walk back there, you know somebody’s expressed anal glands recently here. You know. But then you spend a few minutes in treatment, and all of a sudden, you don’t notice the anal glands anymore. And it’s not because those molecules have disappeared from the air; they’re still there. It’s just that you’re body’s adapted to it. We’re built the same way, psychologically. We have to be able to adapt.

Josh Vaisman:

It would not be beneficial to us to be bouncing creatures back and forth. In fact, that’s what we call “mental illness, bipolar disorder,” when we go from extremely ecstatic to thoroughly depressed in one fell swoop, moment after moment. That’s not helpful; it’s not beneficial. So, you’re absolutely right. In these scenarios, if all of these problems were eliminated, what we would end up doing is finding new problems because that’s how we’re built. So, what I’m interested in is, how do we, then, cultivate environments that are not so deficit-focused? That are actually cultivation and growth- focused? How do we create environments that allow people to experience, as you refer to, “the good challenges and the good stresses” so that the suffering that we have to go through in life is fulfilling and meaningful to us, and we get something valuable out of it?

Dr. Andy Roark:

Yeah. Yeah. It’s sort of like when you say how, “How do you suffer? How do you struggle?” Yeah. How do we set ourselves up, so that the challenges are things that, when they’re over, you go, “Oh, that was really good. I’m glad I did that”? Think of it like a feeling of reward that you would get after going on a long hike or running a marathon or whatever insanity struggle you choose and prefer, but where you’re, “Yes, that was a challenge. And yes, that was hard. I’m glad I did it.” That’s the apex, isn’t it?

Josh Vaisman:

Yes.

Dr. Andy Roark:

That’s got to be the aspirational goal.

Josh Vaisman:

A hundred percent, a hundred percent. I’ve been thinking about this a lot, over the last few years, in particular, because I was very much the deficit- focused leader. I came into work, looking for problems to solve. And listen, that’s part of leadership, and that’s part of life, and that’s part of the work that we do. We are problem-solvers, and we have to continue to solve those problems. My concern is that, if all we’re focused on is identifying and solving problems, we’re not growing anything. It’s sort of like having a garden, where all you ever do is pull the weeds. What about planting a seed? What about fertilizing the earth? What about watering that seed and applying sunlight to it and nurturing it so that it grows? I feel like we don’t do enough of that. And I think that drives some of our focus. When we talk about things like burnout, compassion fatigue, we’re looking at deficit and elimination. And that’s important, but then, what happens if we do eliminate those things? Then what? We’ve got to do something else to grow something.

Dr. Andy Roark:

Well, I really like that analogy a lot. Because the question I was going to put to you, in a second is, ignoring our problems and being, “Oh, we’re not going to problem-solve our way to happiness,” that’s not realistic either, right?

Josh Vaisman:

Yeah.

Dr. Andy Roark:

I guess what I was wrestling with is, what I’ve found a lot, in practice and in life, a lot of times, there’s not a grand plan that any of us have. It’s sort of like the old saying: “If you want to make God laugh tell Him your plans.” I’ve found that to be true, again and again. Very recently. And the last couple of years really hammered the point home.

Josh Vaisman:

Yeah. Right?

Dr. Andy Roark:

Yeah. But at the same time, what does tend to help, is getting a little bit better at every day. Focusing on those steady improvements and not making the same mistakes twice. And not repeating my errors. All those sorts of things. Just saying, “Hey, how do I make my day at the clinic just a little bit better tomorrow than it was today?” And repeat and repeat and repeat and repeat for 5, 7, 10 years. And boy, you’ve got a great place to work.

Josh Vaisman:

I love that.

Dr. Andy Roark:

And so, that’s true. I think your analogy of the gardening, I think that that’s a great one. I’m not saying you don’t weed; obviously, you don’t let your garden become overgrown. At the same time, if all you do is weed, you’re not really going… you’re maintaining stasis, I guess. And stasis isn’t always bad, but it’s definitely not growing and developing and taking you to a place where you’re going to say, “I’ve been at this for 15 years. And now, I look around, and this is a beautiful garden to be in.” No, it’s going to look about the same as it did before, because you’ve been sort of playing whackamole with weeds.

Josh Vaisman:

Yeah. I a hundred percent agree. I love that you brought that up because to me, what I hear in what you’re saying here, is this idea of both/and. I think that we have a tendency, and of course we do; it’s part of how our psychology evolved. As human beings, we have a tendency to think in either/ors, black and whites. Things are good, or they’re bad. There are problems, or there are not. And I think that we can embrace more of a both/and approach and find that it will be healthier and more enlivening for us. So yeah, listen, if you’re going to be a gardener, every gardener knows, if all you do is pull weeds, at the best, you’re going to maintain stasis. At worst, you’re going to frustrate the hell out of yourself because there’s always another weed to pull.

Josh Vaisman:

I don’t know if you guys down in the Carolinas have these things, but in Colorado, we’ve got a thing called bind weed. And bind weed, the core of that plant is more than six feet underground. There’s no way I’m ever going to get rid of my bind weed, right?

Dr. Andy Roark:

Yeah.

Josh Vaisman:

So, if I go out in my garden, and that’s all I ever try and do, my gosh, Andy, all I’m ever going to be doing is pulling weeds and never succeed in anything. And never accomplish anything. On the flip side, if I don’t do any management to my garden, from a weed perspective, then it becomes really difficult for the things that I’m trying to grow, to actually flourish. So, you’ve got to be able to do both. And that’s what I’d really like to see our profession do. I feel like we’ve put an inordinate amount of energy, resources, investment, and time in eliminating problems. And I’ll tell you, unequivocally: eliminating those problems is not going to get us what we want. My wife currently works in a job where she is not burnt out. Not at all. She’s not at risk for it. It’s not going to happen to her. And let me tell you, she’s a hundred percent miserable in her job, because even if you eliminate burnout, it doesn’t mean you’re going to create satisfied, fulfilled people.

Dr. Andy Roark:

Yeah. Okay, so this is hitting a couple different buttons for me, I want to unpack. First one: I want to add a little nuance to the weeding conversation because I’ll tell you something that I have… I like the analogy a lot. One of the things that I am saying to a lot of people these days, and so this is a good metaphor for it: We have weeds in our practice. And we want to plant, and we want to grow. And then also, we have to deal with weeds. I got really into gardening during the pandemic. And so that’s been something, especially, if you remember early on in lockdowns, I found a lot of peace in my yard, planting and doing.

Josh Vaisman:

Yep.

Dr. Andy Roark:

And so, I got through the first year. And I got into the summertime, and here in South Carolina, it’s hot. And it’s humid. It’s too hot to plant anything because it’s going to die before… I’ll water it frantically, and it still dies. And so, I actually looked up “summer gardening” in my area. And I found this great article. And what it said, across the top, the first line was: “If you’re doing summer gardening in the Carolinas, decide to enjoy weeding” because that’s what you’re going to do.

Dr. Andy Roark:

And it was funny, but it was a great thing for me because I thought I was failing because I was not doing anything, but all the weeds are everywhere and I’m, “Everything I plant dies, and what the heck is going on?” And so, I throw that down and just say, I’m talking to a lot of people in practice right now who are, “I’m barely keeping my head above water. The team is burned out. And all I’m doing is fixing problems.”

Dr. Andy Roark:

And what I would say to people, too, in this analogy is, “It has been meaningful in my life to realize that there are some phases you’re going to go through, where all you’re going to do is pull weeds. And there’s going to be other phases where this is the perfect time to plant and grow. And you’ve got fertile soil, and you’ve got opportunity.” And I think that a lot of people look and say, “I should be balancing these things at all times. At all times, I should be doing new things and cultivating things and also solving X amount of problems. And there’s a ratio.” And I have just found that that’s not true. And so, I just want to say that, as we unpack this to people.

Dr. Andy Roark:

There are people out there who go, “I do not have time to start new things, to develop new things. I’m keeping my head above water.” And I go, “You know what? Sometimes, it’s summertime gardening, and we just weed. And know that that season will pass. And we will get to a place where we can do other things to grow and develop.” So, yeah. That makes a lot of sense to me. The other thing that you said, that I think is really interesting here; so, walk with me, and tell me if you see this: I see an emphasis in some of that practices on resting that seems over- emphasized.

Dr. Andy Roark:

So, I’m going to get in a lot of trouble here if I don’t explain myself. I’m not saying that we shouldn’t rest; we should. And we should have boundaries, and we should take care of our staff. You know what I mean? And we should all be able to go home and unplug. And I talk a lot about “the key to resilience is how you rest, as much or more than as how you work.” And so, resting is vitally important. I’m not saying that. But I do see some environments, some teams, that seem to have grabbed onto this idea that if we could rest. We can take breaks to happiness. We can take breaks until we have mental health and wellness. If we rest enough, if we enforce lunch breaks hard enough, then people will be happy at work, or we will have mental health and wellness.

Dr. Andy Roark:

And I’ve never been able to buy into that. And again, I’m not saying that resting is not important; it is important. I just don’t believe that a team can rest their way to happiness. There’s got to be more of it than that. But I do feel like there’s a misperception, among some teams, where they’ve grabbed onto this. I think it’s because people are busy, and they’re, “If I wasn’t busy, then I would be happy.” And I always felt like, if you weren’t busy, I don’t think that would be the panacea that you think it is. Do you see that mentality?

Josh Vaisman:

I do. I think you bring up a really great point, Andy. I think that rest, it’s a core, essential part of life. And so, to believe that we can rest ourselves to happiness is, in many ways, no different from believing that we can breathe ourselves to happiness. We have to have oxygen to survive. We need to have rest to survive. And if the goal is survival, then absolutely, rest should be the top priority. But if the goal is to get beyond survival into a state of thriving, where we actually extrapolate something of value and meaning from the work that we do, from our relationships, from our life, to feel what we might call “happiness.” That’s something that you add on. That’s something that you grow.

Josh Vaisman:

There’s an example I’ll use, to describe what I think you’re getting at here. Andy, you’re a practicing doctor. You have definitely had days like this, where you’ve gone into the practice, and your alarm went off late, or it was chaos with the kids at home, or there was horrible traffic, or there was an accident. You get to work 10 minutes late to discover that actually, it wasn’t that big a deal because your first appointment is going to be a half hour late anyway. Oh, and by the way, two of your credential technicians have called in sick that day. And three of your very best clients have called in with emergencies. You hit the ground running, and it is chaos.

Josh Vaisman:

You finally get to the end of the day, at six o’clock, and you realize, I haven’t taken a break. Oh, I haven’t actually peed yet today, right? So, you go to the bathroom, you go back to your office, you collapse into your chair, utterly depleted; physically exhausted, emotionally drained. You can’t even imagine doing anything else. And now you’ve got two or three hours of medical records to catch up on. And then, you look at your desk to realize… I know, right? I can see your face.

Dr. Andy Roark:

Yeah, yeah [crosstalk 00:19:51].

Josh Vaisman:

… you’re making this, oh gosh.

Dr. Andy Roark:

Yeah, I’m actively trying to relax my face.

Josh Vaisman:

Right? Yeah. So, you’re in that state, where you’re feeling what your face was belying right there. You’re in that state, and you glance over at your desk before you start your medical records. And you notice that the mail’s been delivered. It’s been sitting there for hours, but at the top of it is what looks like a card, a personal card, like what might be a birthday card or something. You grab that envelope, and you open it up. And sure enough, it is; it’s a card. It’s a handwritten card from one of your favorite clients, this woman who, she knows you so well, that she’s gone to the store and picked out a card that’s absolutely perfect for you. It’s the perfect fit.

Josh Vaisman:

In fact, you look at it, and you kind of smile because you know, she really gets me. You open it up to find a handwritten thank you note. See, last week, you did something that, to you, at the time, felt innocuous and maybe a little bit extra. On your way home, you dropped off some meds at her house. You drive by her house every day, anyway; what’s the big deal? You dropped it off. But gosh, it was so meaningful to her; she went to the store, picked out this custom card for you and hand wrote a thank you note. How do you feel in that moment?

Dr. Andy Roark:

Yeah. You feel like the work you’re putting in is, at least, worth it, to some degree.

Josh Vaisman:

Yeah. And to be able to do the next activity you’re going to do: filling out those medical records; you’re probably going to sit up a little bit taller. You’re going to be a little more awake. You’re going to be a little bit more engaged and energized. These are the things that we can add to induce happiness. Now, if you came to the end of that day and all you did was quote, rest, you might have the energy to endure a day like that again tomorrow. You might be able to survive that day one more time. But you’re not going to get joy out of that day without adding something. And that’s what those kinds of things are. And I think leaders have an incredible gift, a wonderful opportunity to enable more of those kinds of experiences that energize people and give them joy in their work.

Dr. Andy Roark:

Hey guys, I just want to jump in real fast with a couple of updates over on the Uncharted side of the house. Guys, I’ve got my strategic planning workshops coming up with the one and only practice management goddess, Stephanie Goss. We have four independent, standalone strategic planning workshops. I’m going to put a link, so you can check them all out. They start at the end of January. You can go to one of them. You can go to all of them. They are free to Uncharted members. They are $99 to the public for a session, or $299 for all four. We’re going to go through evaluating your employees, setting your vision. We’ll be looking at dashboards and metrics. We’ll be looking at priority and goal- setting and action steps and accountability. All those things are covered. Take a look. If you’re, “Man, we got to get our heads straight. We got to get a plan. We got to get this business going in the right direction,” I’d love to work with you on that. So check them out. They are virtual. Jump right in and participate. Take part in the workshop.

Dr. Andy Roark:

On April 21st, we are kicking off the Uncharted Veterinary Conference. It runs from the 21st to the 23rd. It is in person. It is in my hometown, Greenville, South Carolina. Is about running smoother, simpler, more enjoyable businesses. That’s what we’re doing. We are getting into communication that gets things done. We are getting into using technology to simplify and streamline, not to add more stuff for us to do in our businesses. Everybody is busy. Now is the time to start to work together to make your business run smoothly, so you’re not just running from one fire to another fire to another fire. And if you’re feeling like you’re just putting out fires all the time, and you’re tired, God, you need to come to this event.

Dr. Andy Roark:

It is open to Uncharted members, so you’ll need to grab a membership, and then come on. I’ll put links to that in the show note, as well. I would love to see you there in April. It is going to be a limited attendance event. We’re going to keep the numbers down, for COVID precautions, and just to make sure we have a wonderful experience and safe experience, for the people who are there. Guys, I would love to see you there. Let’s get back into this episode.

Dr. Andy Roark:

The transition I’m going to make is into practicality. So I think that you and I are on the same page, as far as, we’re not going to remove problems to get to happiness. And we have to manage problems, but we also have to add in something else that’s going to give us that purpose, to give us that encouragement; things like that. Som I’m sure there’s a lot of doctors and technicians that are listening, going “Great. Sounds real good. How does that help me tomorrow?” And so, that’s where I want to go now, is, “Okay, cool. I’m a hundred percent on board with where we are. I believe, philosophically, that we are right in line. What does that look like, as far as implementation in a vet practice that’s swamped right now? Or that just doesn’t have that? Or has been really working hard to try to make sure that people get breaks, and that is the extent of their wellness program. Where do you even start with that?

Josh Vaisman:

Yeah, that’s a really great question. How many hours do we have? No, listen, I want to stress, I’m not telling people to give up on their current wellness approaches of trying to stress breaks and make sure people have rest, and they get out of work on time, and we have the support that we need and that the resources are available. Those things are important. Keep doing that stuff. You got to do that stuff. That makes a difference, and it helps. It enables higher level capacity, to get to the kind of things that you and I are talking about.

Josh Vaisman:

And then, the truth is that, a lot of this stuff that I’m talking about, I’ve got a whole myriad list of tools. Literally yesterday, I finished the first draft of a book on the science of positive leadership in veterinary medicine that I’m writing for AHA Press. So hopefully, sometime next year, that book is going to be published, and it’ll have a whole bunch of tools and practices around this framework that I’ve developed, that can help enable this kind of thing in leaders. But the book’s not out yet, and we don’t have time to talk about 300 pages of material. Some of the simplest things that we can do is really just notice and affirm. And I want to give credit where credit is due. I’m taking that exact verbiage from a friend and colleague of mine, Dr. Zach Mercurio, M-E-R-C-U-R-I-O. I encourage all your listeners to look up Zach. Zach is a wonderful, wonderful guide. And it’s really incredible and meaningful work.

Josh Vaisman:

So what do I mean by “notice and affirm”? I’ll often stand in front of a group of veterinary leaders, hospital owners, practice managers, medical directors, tech leads. And I’ll ask them, “Raise your hands if you agree with this statement: the people I work with matter.” And everybody in the room instantly raises their hand because we all believe that. We’re all good people who care about the people around us. Then, the next question I ask them is, “Okay, keep your hands up. If you agree with this statement: every day, the people I work with do things that matter.” And everybody keeps their hands up, because it happens. We know this. It’s in our minds. We get it. What I want to encourage us to do is to shift from thinking to showing. If people matter, show them how. If the things that they do matter, show them how. There are super simple ways to do that, on a routine basis.

Josh Vaisman:

You’re interacting with your team every single day. Choose, with intention, moments in time, where you can use that interaction to show them that they matter and to show them that the things that they do matter. Because that client that wrote you the letter, that’s what she was doing. She was noticing what you did and affirming the impact that it had. You can do that as a leader because it’s happening all around you all the time.

Dr. Andy Roark:

That’s super insightful. And I’m sitting here, of course, and I’m going, I would have my hand up. I would have my hand up. I would put my hand down. When you ask, do I communicate that to those people? I know I do not do as good a job with that as I should.

Josh Vaisman:

I have a feeling that you probably do it fairly well, just because of who you are. You’re somebody who notices things. Just in this conversation, you’ve picked out and noticed the nuance of some of the stuff that I’ve said, and then you’ve repeated it in your own stories, in your own words, with questions.

Dr. Andy Roark:

Well, thanks for saying that. I try to. One of the weaknesses that I have, that I have noticed recently: I have come to really understand in the last couple of years, how different people appreciate differently and feel appreciated differently. And so, there are ways that I feel appreciated, and there’s ways that don’t affect me as much, in how I’m appreciated. So, for example, I will go through my family really quickly and say, my youngest daughter, her language of appreciation is time. She wants to spend time together. And if you want to make her happy, then you spend time with her. Have a project. Just take her with you to run errands, but just let her control the radio. She likes to deejay with my phone. But just take her and just be with her. And she loves it.

Dr. Andy Roark:

And my older daughter, her language of appreciation, her love language, is gifts. It doesn’t have to be expensive, but just a thing that shows that you were thinking of her. Just something like that. She loves to bake for other people, and she does it because it’s something special that she makes that they can’t buy. And she says, “I made this for you.” And she gives it to you.

Dr. Andy Roark:

My wife’s language of appreciation is service. And if you want to make her feel appreciated, help her. Help her on the things that she cares about. My language of appreciation is verbal appreciation. I like to get patted on the back. Just tell me you appreciate me, and that means a lot to me. And so, I’m good at verbal appreciation. And that is something. I feel like I say things to people, and I point things out. And that’s true. Even if I know someone’s language of appreciation is gifts or time or things like that, I often don’t lean into those things. And that’s something I’m trying to get better at, is to say, “Okay.” And I really do feel that being fair to people, I feel like a lot of people struggle to make people feel appreciated, or to make people feel that they matter.

Dr. Andy Roark:

I think if it was really easy, everybody would do it. I do think that it’s more challenging than we make it out to be, especially when you’re appreciating people who see the world a bit differently than we do. And so, I’m sitting here, and I’m going, I really need to write those thank you notes or pick out some gifts or just schedule some time with the people for whom this matters.

Dr. Andy Roark:

This falls into the category for me as, I talk a lot about using positive reinforcement in practice and pouncing on the good things that people do. And calling them out, right?

Josh Vaisman:

Yeah.

Dr. Andy Roark:

We know, from training animals, and people are just simple animals; I don’t care how many degrees you have, you’re a simple animal. We know that positive reinforcement works. And we know that it’s a whole lot easier and better to jump on things that people do well and celebrate them than it is to follow them around and catch them when they mess up and always have these corrective, “Hey, you messed up” conversations. And so, why doesn’t everybody just do that? It’s because-

Josh Vaisman:

It’s hard.

Dr. Andy Roark:

It takes effort. It is hard.

Josh Vaisman:

It’s hard. It’s hard.

Dr. Andy Roark:

It takes effort.

Josh Vaisman:

Yeah.

Dr. Andy Roark:

And so, I appreciate you saying that. But it’s funny, I’m sitting here, and I’m just as human as everybody else. And I’m going, oh man, I should-

Josh Vaisman:

I don’t do that enough. I want to share three quick things with you.

Dr. Andy Roark:

Yeah.

Josh Vaisman:

Number one, I want to share some appreciation for you. Number two, I want to recap a little bit of what you said. And then, number three, I want to talk about what I hear as an opportunity, in what you shared there.

Dr. Andy Roark:

Yeah, sure.

Josh Vaisman:

The first thing I want to share with you: genuine appreciation for me, you and I got to meet for the first time in person at Western. And it was a wonderful lunch and a great conversation. And then, you reached out to me about being on your podcast. And we had a good conversation a few weeks back. And then you invited me back to talk about this topic. And to me, what that speaks to is your character and your values.

Josh Vaisman:

And I don’t mean that in a puffing myself up sense. What I mean by that is that this stuff matters to you, which means to me, that people matter to you. And people matter to you enough to actually take time out of your busy schedule, to talk about how we can help them. That’s important. That’s meaningful stuff, and I really appreciate you for doing that, for using your platform for that kind of good. The second thing I want to do is… well, I’m going to do a 1A, which is to point out that what I just said to you is exactly what I’m talking about. Just noticing those kinds of things about people in the day to day and then sharing it with them, makes a difference.

Dr. Andy Roark:

Yeah.

Josh Vaisman:

So number two, I said, I want to kind of recap some of the things you talked about. And you brought up some of these language of appreciation ideas and how you recognize that you do well with verbal appreciation; it has a real big impact on you. You used the verbiage of, I like to get the pat on the back. And I got to be honest with you, Andy, I’m the same way.

Josh Vaisman:

And then, you talked about your wife. And your wife really responds well to service. If you really want to show her that she matters to you, help her with something. I don’t think it was your intention, and I apologize if I’m coming across abrasively here, it’s not my intention-

Dr. Andy Roark:

No.

Josh Vaisman:

… but implied in how you were describing that, was a little bit of what I mean by that either/or; this idea that, okay, I’m really good at verbal appreciation, but I know that not everybody responds as strongly to that. Some people like gifts; some people like time; some people like service. And I’m not as good at that. Implied in that is that, if I don’t provide service to my wife, then I’m not appreciating her; that’s an either/or mentality. And actually, what I think is that there’s a both/and here. Because what I think that you can do, is still verbally appreciate her, and it will impact her positively; just not as strongly as the service does.

Josh Vaisman:

But if you can continue to use your strength of verbal appreciation and show that you’re trying to learn her style of appreciation too, that’ll make a difference as well. And I think that’s the opportunity that we have, as leaders in our practice, which leads to point number two: “Notice and affirm” is the foundation. But if you don’t understand people, if you don’t develop a relationship with them, whereby you can discover that verbal appreciation makes a difference, but gosh, a gift really is going to have an impact, and then learn about, what are the kinds of gifts and what are the things that this person’s interested in? Man, if you can develop that high-quality relationship with your people, notice and affirm will be easy for you on a daily basis.

Dr. Andy Roark:

No, that makes a lot of sense. That makes a lot of sense. Josh, thank you for being here. Thanks for talking through everything with me. Where can people find you and Flourish Consulting?

Josh Vaisman:

Yeah. Our website is Flourish.vet, F-L-O-U-R-I-S-H.vet. I am also quite active on LinkedIn; I post a lot of blog articles and concepts. A lot of what I do is I take what the research shares. Actually, this one, I’m very fascinated by it. I’m holding it up to show you. It’s a big article that was recently published on what leaders can do to support their own wellbeing, which I think is incredibly important as well.

Josh Vaisman:

So, I’ll take articles like that, and then I’ll condense it down into a three to five minute read, with some tangible tools and practices. I do a lot of that; I post those on the website and on LinkedIn.

Dr. Andy Roark:

Oh, yeah. I’ll have to take a look. I haven’t logged into LinkedIn forever. My LinkedIn profile actually says “Dr. Andy Roark: father, veterinarian, guy who doesn’t check LinkedIn.” And every time I logged in, I have 7,000 friend requests on LinkedIn. And so, I just get overwhelmed and then just leave. So, I’ll have to wade back into LinkedIn.

Josh Vaisman:

I wish you all the best of luck in navigating that pool of notifications.

Dr. Andy Roark:

Oh, yeah. Oh, man. Well, thanks again, buddy. It’s always good to see you.

Josh Vaisman:

Yeah, it’s a pleasure. Thanks for having me.

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 like 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 episodes, 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

From Angell Memorial Animal Hospital in Boston to the Los Angeles Zoo, Dr. Mark Goldstein has had a fascinating career. Today he joins Dr. Andy Roark to reflect on his life as a veterinary professional, his fight against pancreatic cancer, and the lessons he has learned from people and pets.

***TW: There is a brief but graphic mention of suicide in this podcast.***

LINKS

Lions and Tigers and Hamsters: What Animals Large and Small Taught Me About Life, Love, and Humanity (Amazon.com): www.amazon.com/Lions-Tigers-Hams…ooks%2C252&sr=1-1

Strategic Planning Workshop Series: unchartedvet.com/upcoming-events/

Uncharted Veterinary Conference April 21-23, 2022: unchartedvet.com/uncharted-april-2022/

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

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

Mark Goldstein, DVM, has spent over 40 years caring, advocating, and fighting for the welfare of animals. The institutions he worked at are all recognized leaders in their respective fields and the variety of animals he worked with and the varied responsibilities he has had are unique. He was a senior staff clinician in the medicine department at Angell Memorial Animal Hospital in Boston. After being hired to head the Boston Zoos, he led a turnaround for the failing inner city Franklin Park Zoo. “Dr. Mark” then moved west with his wife Kristine and their two daughters when he was appointed to lead the Los Angeles Zoo. During his tenure at the Los Angeles Zoo he was involved with one of the most successful release programs, the reintroduction of the California Condor back into the wild. He vividly remembers watching the first bird being re-released into the Los Padres National Forest soar free one misty beautiful morning. He followed his heart to shine a light on the importance of the human-animal bond and took the helm at the San Diego Humane Society and SPCA where he oversaw the design, development, and completion of the “San Diego Campus for Animal Care.” Many aspects of the campus, its programs and its unique partnership with the municipal animal care department have been copied numerous times both nationally and internationally. He has a BS in Animal Science and a DVM degree from Cornell University. Health Communications Inc. (HCI) recently published his book “Lions and Tigers and Hamsters” What large and small animals taught me about life, love and humanity.

Dr. Mark enjoys giving presentations that are both educational and entertaining. His talks not only draw upon stories from his book “Lions and Tigers and Hamsters” but also from his 40 years of experience caring for animals and their welfare along with supporting the people who care for them. He has vast experience talking to a variety of groups from book clubs, service organizations, and at professional conferences as the keynote speaker. He was also the UCSD OSHER visiting author during the 2020 spring semester. He imparts to his audience the importance of the human-animal bond and how it helps create the fabric of a healthy community. He calls upon his experiences to share with colleagues how he feels honored to
have been able to serve in what he sees as a sacred profession, the practice of veterinary medicine. He enjoys making his presentations interactive and encourages Q/A when the program allows.

SHOW TRANSCRIPT

Dr. Andy Roark:

Welcome, everybody, to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I’ve got a good one today. I’m sitting down with Dr. Mark Goldstein. Dr. Goldstein has had a rich career in veterinary medicine. He has been a senior staff clinician at Angel Memorial Animal Hospital in Austin. He has been the director of the LA Zoo. He’s been director of the San Diego Humane Society and SPCA. He is just a fascinating person who has done a ton of stuff. Unfortunately, right now, Dr. Goldstein is battling pancreatic adenocarcinoma, as we talk about a bit in the podcast, and it’s led him to reflect a bit on his career.

Dr. Andy Roark:

And I saw that he was doing a keynote presentation at the Fetch Conference, talking about his life and lessons that he learned in practice and what he sees as important in this space of his life, and I wasn’t at that conference, and I wanted to hear what he had to say. It seemed very important to me, and it just… I don’t know. I wanted to soak up his knowledge. And so, I invited him on the podcast, and he came along, and he shared a lot of great stuff that you’re going to get to hear.

Dr. Andy Roark:

And so, without further ado, I’m going to jump into it after one quick thing. I do need to mention, there is a brief but slightly graphic mention of suicide in this episode. If that does bother you, you may want to pass. But it is there, and I just wanted to give people a heads up. So, anyway, 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 help you in your veterinary career, welcome to the Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark:

Welcome to the podcast, Dr. Mark Goldstein. Thanks for being here.

Dr. Mark Goldstein:

It’s just an honor to be here, Andy. You’ve been such an inspiration to this profession. It’s really nice to do this with you.

Dr. Andy Roark:

Well, thank you for saying that first of all, but you as well. I first became aware of you and your work back in 2019. You had a book, Lions and Tigers and Hamsters, that came out. And it came across my desk. I didn’t know you at all. And so, I looked into your background. You were at Cornell. You’ve had a leadership position at Angel Animal Medical Center. You were the director of the LA Zoo. You’re the director of San Diego SPCA. You have had a rich and robust career, a fascinating career. And so, I was looking at that, and I was aware of your book, and then you did the keynote address at the Fetch Conference in San Diego, just as we’re recording this, so it was just a couple of days ago. And it was called I Wouldn’t Change a Thing. And you talked about your career, and you reflected on a life well lived.

Dr. Andy Roark:

And I thought, that’s the conversation I want to have. I want to talk to Dr. Goldstein. You have done so much, and you have seen so much, and I know that I have a ton of things that I can learn from you, and so I wanted you to come on and just have you talk a bit about your keynote and mostly just talk a bit about your career, and as you reflect on it, what are your takeaways? What are your words of advice, I guess, for the next generation?

Dr. Mark Goldstein:

Talking to our colleagues, and even to animal vet techs, and all the people that are in animal welfare, I think one of the tools that I talked about on Saturday to do when it gets dark, and we all know we have some very dark days in our profession… an irate client, somebody’s complaining about the bill, things that are unrelated to why we got into this in the first place. When those things happen, one of the things I always went back to was the fact that 80% plus of the world has a job to put food on the table and take care of their family. It’s not necessarily what they love doing. We are in the 20%. We got to choose, and we got to do what our calling was and what our passion was. We’re really wealthy for that, that we’re able to do what we wanted to do as opposed to do what we had to do. And it also offers us ways of changing. If you get into small animal medicine, it’s not what you thought it would be, you can change. You can go into a different field. You can go into all the various aspects that veterinary medicine touches.

Dr. Mark Goldstein:

The next message I guess I’d share is that the reason I say I wouldn’t change a thing, I really consider our profession a sacred profession. I Googled the other day what the public things of veterinarians, and what came up was, it said, and I’m paraphrasing here, that people think that veterinarians are passionate, trusting. They really feel like they can go to them in a time of need. It was all positive. Versus physicians, who most people think are arrogant, and it had some negative words.

Dr. Andy Roark:

Yeah.

Dr. Mark Goldstein:

And I basically said to the people in the room, and there were about 600 people in the room, “Hey, folks, if the public thinks that of us, why can’t we?”

Dr. Andy Roark:

Yeah.

Dr. Mark Goldstein:

We are in a profession that affects animals and people. Maybe in a little bit we can talk about taking a tumor off a goldfish. Now, I want to watch your eyes, because most people do that. And they go, “Mark, I think you’ve gone over the line here.” We can talk about it when you want here in a bit, but we really do affect not just animals, but people’s lives.

Dr. Mark Goldstein:

And I also made another point, which we can go into more if you’d like, but I put up this slide that said, “There’s roadblocks that we create. An example…” When I was in charge of the Angel Internship Program, with picking new interns, it was like chalk on a board when I would ask someone, “Why did you become a veterinarian and not a physician?” And they said, “Because I like animals more than people.” Don’t hire that person. Really.

Dr. Andy Roark:

Yeah. I agree.

Dr. Mark Goldstein:

You’re in the people profession. We’re not just in the animal profession. And I say that because if you’re sick and you go to a physician, you may not like them, but you’re going to take their advice because you’re hurting. When someone comes into our office as veterinarians, if I don’t get their respect, they’re not going to listen and treat their animal the way I’m asking. So, I need to realize that we’re people… Then someone says, “Well, I don’t know, I’m not in clinics. I’m in lab medicine, or I’m in zoos,” or whatever. There’s always something that you’re working with, with that animal. It’s a keeper, a farmer. There’s always a person involved. So, I think we have to be careful about taking people… And if I’m talking to someone that thinks that way, that might be part of the issue that you’ve struggled with. But we are a people profession.

Dr. Mark Goldstein:

So, those are some of the points I made. There were a couple others, and it was just to inspire them, and to get them to laugh. And I guess I was successful because I heard later that… Well, we can talk about it at the end, but I got a standing ovation twice at the end. I’ve never seen that happen at a medical convention. I’m very humble about it. I know it almost sounds like I’m bragging. I’m not. It was just a terrific opportunity. And I said to Marty on the stage, “This is the happiest I’ve been in a couple of months now,” because I’m dealing with this issue we’ll talk about maybe at the end.

Dr. Andy Roark:

Yeah. So, Marty Becker is who you were talking to, correct?

Dr. Mark Goldstein:

I was talking to the whole group when I said that. He was up on the stage, and I just told him that, after I was done… Yes, after I was done, he gave me a hug, and I whispered in his ear, “This is the happiest I’ve been in months.” I really was honored when Adam called me and said… Adam’s the person that puts together the 360 DVM conferences, and Marty arranged after I told him the day before about the problem I’m challenged with, and they got online and said, “We’d like you to do the keynote.” This was a couple of months ago. And they even said, “We know, you can tell us 30 seconds before you have to go on that you can’t do it,” because my life changes every day a little bit, and they said, “Marty will step in for you.” It was just really an honor for them to take that risk. It was just a great feeling, to talk to my colleagues and connect. And I got to speak to about 150 of them, because that’s how many books I sold right after the talk in two hours, which I had never done.

Dr. Andy Roark:

Wow.

Dr. Mark Goldstein:

So, it was a great experience for me, and I hope I stimulated some people, because… I’ll stop here in a second. I said to my wife, “If I can touch one person that comes up and says, ‘Hey, you reignited my spark,’ I’m going to feel successful.” I had a couple of dozen people when I was signing books come up and say, “I was that 65% of veterinarians that would tell a 16 year old today not to go into veterinary medicine. There’s too many problems.” And they said, “You just changed my mind.” Wow. That’s just… It’s so rewarding. I hope you’ve experienced that, too, because you’re very inspirational.

Dr. Andy Roark:

Oh, yeah.

Dr. Mark Goldstein:

I mean that. Yeah. You feel good about the fact that you can do something positive like that.

Dr. Andy Roark:

Oh, absolutely. Are you comfortable talking a little bit about the challenges that you reference and what’s going on?

Dr. Mark Goldstein:

Sure. Yep. Very well. Let me go to the talk I did on Saturday. One of the last slides I showed was first, my last point was don’t give up. Follow your dreams. Don’t let somebody take them from you because they have expectations. So, what I did was show a slide of the rejection letter I got from Cornell my junior year applying. And the last paragraph said, and I blew that paragraph up, “You’re welcome to apply after you graduate next year, but we don’t expect the competition to get any better, any easier. So, we strongly suggest that you find a new career.”

Dr. Andy Roark:

Wow.

Dr. Mark Goldstein:

I put that up, and everybody in the room laughed like… because I do have an impact, I think. And then I said, “Folks, this is just not theory. Don’t give up. I applied, and I think I did okay. What do you think?” And they stood up and applauded. It was like, wait a second, come on. And then I went on to just explain that a lot of us listen to people who talk theory, don’t live it, really. So, for me, I want to tell you, when I say don’t give up, I’m really going through it right now. I was diagnosed with pancreatic adenocarcinoma. When I was a veterinarian in clinical medicine, I was an oncologist and hematologist. That was my area of interest. So, I know enough to be dangerous now. But I know what I’m facing.

Dr. Mark Goldstein:

I put that up, and I said, “I’m not giving up. I’ve talked to Adam, and he said, ‘If you’re around next year, you have the stage again, and I plan to be here next year to talk to you.” And they stood up again and applauded. It was just crazy at the end, but I mean that. I’m going to fight this. I’ve got a lot to live for. It is a tough diagnosis. I’ve gone through three months of chemotherapy. I’m probably looking at a surgery the end of January. But I’m not trying to be morbid here. Everybody gets a problem in their life. I’m a little bit… gone through those stages of grieving because it happened… I’m 69, and I expected something like this to be 20 more years down the road.

Dr. Andy Roark:

Yeah.

Dr. Mark Goldstein:

But, it is what it is. And why I say I wouldn’t change a thing is because I’m actually facing this, being able to say, it’s okay. My wife and I have had so many adventures in our life that could fill three or four lifetimes. It’s okay. I have no regrets. How many people can say that at my age? So, I feel very lucky even though I’m facing the hardest battle of my life, for my life. We’ll see where it takes us.

Dr. Andy Roark:

You say you have no regrets, and I look at your career, and you’ve done so many things. What were some of the challenges professionally that you remember facing that seemed insurmountable at the time that you grew past or that you overcame? I don’t know, I have no doubt that you have faced down some monumental challenges, and I always like to try to learn from people who have been through those things and excelled.

Dr. Mark Goldstein:

The greatest challenge is because of the nature of the jobs that I had, for instance, as director first at the Boston Zoos, and then I went to Los Angeles, was the politics. When I was at that level, in Massachusetts, it was the commissioner [inaudible 00:12:31] and then the governor, Mike Dukakis, who hired me, and it was a Friends Of organization, and they made sort of a mistake by not bringing them into the fold picking me to do this. And, because of that, I opened up a newspaper once. I was shaving, actually. I was holding a blade, and I went out to the front, got my newspaper, put it down. I had just been appointed. And on the front page of the paper, it was, “A new director for the metropolitan zoos. Some people are really happy, and some don’t like it.” I was like, “What?” And I was holding the shaver at the time, a blade, and I did have this thought of, “Oh, come on. Let’s just end it here.” I never have been in a public… At Angel, I did do some live television slots, but nothing like this.

Dr. Andy Roark:

Yeah.

Dr. Mark Goldstein:

And what it was, is that the volunteer organization, which raises half the money for our budget there, was not pulled into the decision making to appoint me. That taught me something: bring a lot of people into the tent. Try and do it before you make decisions if you can, if they should be there, and look for consensus. This was a tough start at first. Ironically, I right away called the board chair and asked if I could just meet with the board, just myself and them, and he said sure, and he set up a meeting for an evening, I remember. And I went to dinner first by myself, just to think, and it hit me. We’ve all been taught to SOAP things: subjective, objective, assessment, and plan. Approaching a medical case. You know what? For the veterinarians listening here, use the same thing when it comes to business practices. Use the same process when it comes to personnel issues. Subjectively look what you see. Objectively look at what the findings are. What’s the bottom line? P&L sheet, whatever.

Dr. Mark Goldstein:

But we are talented, and we can take that thought process, and when I explained that to them and they said, “Why do you think you can run the zoo?” And I went into the SOAP thing, and I said, “I’m ready to do that. This is my passion.” And we reached consensus, then became good friends. It worked. Now, I laugh because Governor Dukakis left office, a Republican came in, and I really believe… We had two zoos at the time. They cut the budget, and when it comes to that, I made a decision, we’ve got to close one of the zoos. I’m not going to stand by and… Zoos are wonderful things to educate people, but if you can’t educate them properly, they shouldn’t be there. That tiger behind a cage now. No. You have to naturalize the exhibit so that you get to see what they really are like. And education’s a big part of that, whether it’s in clinical medicine, whether it’s in zoo medicine, whether it’s in animal welfare.

Dr. Mark Goldstein:

There’s usually three legs. One of them is conservation, for instance, and whatever that means in the zoo world, it’s easy. Conservation of animals. Education, and entertainment, or interacting with the public. If one of those legs gets pulled out, the stool falls over. We’ve got to keep connecting with people. We’ve got to make sure that we’re educating them. My biggest complaint in clinics from chief of staff [Gus Thornton 00:15:48] was, “Mark, you’re terrific. You’re the third biggest producer. The other two stayed there till 2:00 in the morning, were great clinicians, but I wasn’t going to do that.” But the third best out of 60 veterinarians. “But Mark, a 15-minute appointment is not 45 minutes.”

Dr. Andy Roark:

Yeah.

Dr. Mark Goldstein:

I said, “Gus, I’m sorry. I stay late. I never complain about it. But nobody leaves my office without having their questions answered.” And that’s important to me. I really thought it was very important. And I don’t find that in human medicine today. It’s gotten much worse. There’s 10-minute and 20-minute appointments.

Dr. Andy Roark:

How do you balance that? You and I sat down to record this podcast, and we talked for 35 minutes before I got to hit record and start the podcast because you tell stories and you draw it and you explain, you expand. How do you balance that? Because you also seem to have a rich home life, and you say, “I’m not willing to stay late. I go home.” Looking back at your career, how do you balance that desire, obviously, to build these relationships and to explain, and then still to be able to put your work down and go home? Did you ever wrestle with that?

Dr. Mark Goldstein:

I did. You commit yourself to both, and I think it’s important. In my case, I’m very fortunate, I really am. I’ve been married for 41 years to this wonderful person. I have two wonderful children and a great son-in-law. Two grandchildren. Three grand-dogs. That was important to me. I really understood that you’ve got to balance those two. Was it difficult sometimes? Sure. But, I just worked at it. Some people were critical. There are veterinarians who think you should be working 24/7. Nope. I was always available to my clients, don’t get me wrong.

Dr. Mark Goldstein:

In fact, the only time once that I had to tell them, “Find another doctor,” was a dog that was crashing, a patient, and they called me. I wasn’t in clinics at the time, but they called me, and I always knew I wanted to know that. And I had to say to her, because I was in the children’s hospital. My daughter was having a medical problem, and my wife actually had a problem right then, too. And, I had to say… I called them up and I said, “Nancy,” that was her name, “find another doctor to take this.” I had never done that before. I never did it after that.

Dr. Mark Goldstein:

And, I was always available, but I made sure that there was time for me to get home, whether it was at breakfast or dinner, to spend time with my kids and my wife. Was it challenging? Yes. But if you commit yourself to do it, and you approach it with an open mind, you can make it work. But I wouldn’t say it wasn’t difficult sometimes.

Dr. Andy Roark:

Hey, guys. I just want to jump in here real fast with a couple updates from the Uncharted Veterinary Conference side of the house. I am running my strategic planning workshop series with my wing man, the one and only practice management goddess Stephanie Goss. We have four different strategic planning workshops: January 26th, February 9th, February 23rd, and March 9th. Information coming soon on those. I’ll put a link so you can watch for when registration opens up. You can come to one of them. They all stand alone. They all do very different things. They are $99 to attend a workshop, or $299 for all four workshops, or if you’re an Uncharted member, you can come for free. They’re all included. And also, you can get replays through our online school.

Dr. Andy Roark:

So, guys, don’t sleep on that. If you’re like, “Hey, man, we really need to plan,” I’ve got your back, and I’m happy to work with you. Come on and be a part of this workshop, because it’s going to be great, and I enjoy working with people and where their business and where their careers are going. It’s something I get a lot out of. So, I would love for you to be there and to work with me.

Dr. Andy Roark:

Also, big one. In April, April 21st through the 23rd, the Uncharted Veterinary Conference is back together live and in person. Guys, we’re going to keep this small. It’s going to be probably under 100 people. And we’re just doing that for COVID precautions, but at the same time, we need to get back together. It’s time for people to come together and get recharged and get refocused and work together, and just rebuild those connections, those face-to-face connections.

Dr. Andy Roark:

Guys, we did our practice owner summit in December, and it was so great, and it was so powerful, and it was so meaningful. I know I got so much out of it, and I think our attendees did as well. So, yeah, it’s time for us to get back together. This conference is all about running smoother, simpler, more efficient practices that are enjoyable. It’s not about getting more people in the building. I don’t think we need that. It’s not about finding new things to do. I don’t think we need that. It is very much about clear communication, building systems, training staff to get more done with less. And also, just to shake off the stress. If you feel like you’re just running from one fire to another fire to another fire, this conference is for you.

Dr. Andy Roark:

You can register now. It is in Greenville, South Carolina. As I said, it will be in person. It is only for our Uncharted members, so grab yourself an Uncharted membership and head on down to see us in Greenville, South Carolina, the 21st through the 23rd. Links to both of these things in the show notes. Guys, without further ado, let’s get back into this episode.

Dr. Andy Roark:

How did you know when it was time to make a change? So, I think about you leaving clinical practice and going to be the director at the zoo. That’s a massive change. And you’ve moved from place to place. And at the very beginning, one of the first things you said when we sat down was you talked about vet medicine gives you options, and I always loved the idea that vet medicine is a house with a million rooms. That is a very attractive thing about the profession to me as well, is you can bend and you can mold and you can do different things. What was your decision process when you said, “It’s time for me to try something new or to go to something else?” How do you make those decisions?

Dr. Mark Goldstein:

It’s great. In that case, Governor Dukakis running for president at the time in Massachusetts back in 1987, ’88, and it took a year for me… because I was actually offered a very prestigious position at Angel if I would stay. I said to them, “Hey, guys, I’ve been offered the job, director of the Boston Zoos,” and I had worked with captive wildlife before. I had took them in clinical medicine. The decision was when I was sitting on a beach up in Massachusetts. We really do have them, but they’re not like beaches in the south. But, we were sitting there with my wife, and I finally just looked at her and I said, “I can probably, if this doesn’t work, go back into medicine,” because I was practicing at a fairly high level with people that were incredible. “I could probably go back to that if this doesn’t work. But if I don’t try this, it’s like somebody just put a mountain in front of me and said, ‘I dare you.'”

Dr. Mark Goldstein:

I said, “I’ve got to give it a try.” And to put my clinical medicine on the shelf… I loved being a doctor. I loved being a clinician, I mean. But the decision was because here I was, presented with a great challenge, and I saw the opportunity to now affect the populations of animals versus individual animals like we do in clinical medicine. That got my interest. And, when somebody’s running for president of the United States and asks you something like that, and they’re willing to put the money into it, and I knew I was going to be able to complete the $26 million tropical forest exhibit, it was, how can I turn this down? Let’s give it a try. And so, I made that change.

Dr. Mark Goldstein:

It was hard, because I loved what I did in clinics, but it was a good decision. I have no regrets. I went from that to being a director of zoos, and then politics played a part. Like I said, there was a change in administration, and they wanted to change things, and when I wanted to close one zoo, the state senator from there went after me with a vengeance. That’s another lesson. My wife never understood why these people could be pretty nasty publicly, saying things, and yet when I would go to a meeting and a state senator or a state rep was there that I knew was thinking that, I’d still shake their hand, say, “Hi, Senator.” My dad taught me something. He said, “If you don’t like a teacher, get an A in their class. Don’t complain. Don’t let their problems direct you in a different way.”

Dr. Mark Goldstein:

And the same goes for veterinary medicine. We have this whole list of things that we talk about depression and suicide. Years ago, when I gave this talk, kind of, I would talk about them and say, “Folks, this is what we’re facing.” Today, I feel differently, because of people like you, Steve [Dale 00:24:22], Marty. It’s, “Hey, folks, these are the challenges that we have. Now let’s take them on ourself.” Nobody else is going to help us with them.

Dr. Andy Roark:

Yeah.

Dr. Mark Goldstein:

So, for instance, one of them is that we struggle with the fact that people’s expectations… They want to do everything for their animal, and then they ask, “But it’s going to cost that much?” Nope. Our job, then, is to educate them, to let them know that, “Hey, wait a second, we have the same training that a physician has, and if you went in with the same problem to your doctor, it would cost you five times the amount I’m charging. But the skill’s the same. The equipment we use is the same. And all the other things that make it very similar.” And you know what? If it’s a person who’s willing to listen, you change their mind, but we have to be proactive.

Dr. Mark Goldstein:

I would love… and maybe you could give this talk. I’d love to see a poster made which says, “This is a physician’s training. This is a veterinarian’s training.” Wow, it’s the same. But we have to be proactive. We have to look at that list and start to chip away with it, the cost, the debt we incur, the euthanasia serum being right on the shelf so it’s readily available, all of these things that we say contribute to this depression and suicide and everything. Well, let’s stop just saying them, and accepting they’re there, and change them, because nobody else, like I said, is going to do it for us.

Dr. Andy Roark:

Yeah.

Dr. Mark Goldstein:

I’ve tried to do that.

Dr. Andy Roark:

We have to believe it ourselves. I think that’s a big part of it as well. When the clients come in and say, “Why do you charge this for your time?” Or whatever, I think a lot of us, we need pet owners to believe our value so that we can believe our value. I think that’s misguided. I think we have to believe ourselves. We know what training we did, and we know what our time is worth, and we know how many things we’re juggling, and we know what we put up with and how hard we work. I think we should work to explain ourselves and educate people, and at the same time, I think it’s more important that we ourselves believe it, and live that.

Dr. Mark Goldstein:

You really just hit a point that I made. I looked up on Google about a week before the talk, and I put in, “What does the public think of veterinarians?” I kid you not, I got this statement that said, “The public believes in veterinarians. They trust them. They think they’re compassionate. They think they’re caring.” It was all these positive words that the public feels about veterinarians, versus physicians, who they think are arrogant, stubborn, and it was negatives. And, what I said to them is, “Folks, if the public thinks of us like that, why can’t we think of ourselves like that? We are. We are compassionate. We are caring. We got into this profession most likely because we weren’t going to make six figure plus salaries,” though I would suggest that we deserve it, but there’s got to be a balance there. “We got into it for the right reasons, and we’ve got to remember that. And if the public thinks that way, we certain should.”

Dr. Andy Roark:

What are the things in your career that you didn’t think that you would enjoy, that you ended up finding reward and enjoyment in?

Dr. Mark Goldstein:

Interesting question. That’s a new one for me, Andy. Thanks. Tough question.

Dr. Andy Roark:

I think about, you’re going into these positions, and you’re at the SPCA, and you know the politics are coming and things like that. Are there things like that, that you said, “Oh, what am I doing here?” And then you got into it and found that you were adept at it, or that you enjoyed it?

Dr. Mark Goldstein:

Well, let me talk about clinically first. When I started practice, I sort of dreaded ever telling a seven or eight year old it was time to say goodbye, and I found out very quickly that age bounces back very quickly. You tell them, and they cry maybe, or whatever, and then 15 minutes later, it’s, “Mom, can we go get ice cream?” I was a bit surprised, but I learned that the second hardest population to tell that to, and I’ll get to the first in a second, is… I still remember the first time it happened, an 18-year-old young lady came in with a 16-year-old Cocker Spaniel. It was time to say goodbye. Now, I realize that she had probably told this animal things, this dog things that she never told anyone else in the privacy of her room. She never had a death in her life. She went to counseling for six months.

Dr. Mark Goldstein:

So, for people listening here, if you’ve got a 15 to 25 year old, someone who is just learning, really, the finality of death, and all the things that go with it, be careful. They will hold… It’s natural for those people to hold it inside and not let you know. But, if they’ve had a dog most of their life, or a cat, or a pet, don’t dismiss it. Now, the hardest population I found, which I was surprised, I didn’t think of this, senior citizens. That person who gets unconditional love, and it may be the only source of unconditional love. I had three people come to my office threatening suicide. One of them did after we put her animal down.

Dr. Andy Roark:

Oh, no.

Dr. Mark Goldstein:

She started the conversation with she had a 19-year-old dog, and she said, “My husband loved him like, I’m not sure, maybe more than me, before he passed away last year.” And I realized she had transferred her love for her husband to this dog. And, a month or two later, she said goodbye. So, telling a senior citizen… And again, for people who are listening, if Grandma or Grandpa or your uncle or your aunt, and they’re 75, more, be aware that if they have to put down their animal, it’s going to tear their heart out possibly, and you’ve got to be there to support them.

Dr. Mark Goldstein:

Please avoid those terms, even though I tell people when they’re going to go through it, “Hey, don’t be upset when someone says to you, ‘Let’s go down to the shelter or the campus and get a new animal.'” Who would ever say that to someone who just lost a spouse? Well, maybe my wife. They might tell her, “Hey, go get a new husband. You’re doing better now.” No, I’m kidding. Sorry, I make jokes like that. But you wouldn’t tell someone if they lost a child, so why would you say that if they’ve lost a dog? They’ve got to go through that grieving and mourning process. But, I try and tell people, they mean well. They’re trying to get you off center and get you smiling. Then it’s, “Oh, come on, it’s just an animal. Come back to work.” Or maybe their work doesn’t even give them grieving time off. When you lose an animal that’s been in your life for 10 years plus, you deserve to take a day or two off work to grieve it, just like a person.

Dr. Mark Goldstein:

So, those challenges… Again, like my talk, instead of just accepting that it exists, you look for solutions. One of them for me is to maybe hopefully educate others to be aware, be cognizant. Don’t tell Grandma or Grandpa, “Hey, come on, you need to go into assisted living, and we’ll just give the dog to the shelter. They’ll find a new home.” We have to work and advocate maybe for more assisted living facilities that allow people and animals who have been together, because there are a lot of people who avoid going into assisted living because they’re not going to give up their pets and they should go into assisted living. They need that care. Those are the challenges I’ve seen.

Dr. Mark Goldstein:

Another one that I faced, and I work hard at, I showed slides, that’s the terms and words that we use in veterinary medicine. For instance… I’m sorry, Andy. I get this chemo brain from being in therapy, and I lose my track here.

Dr. Andy Roark:

Yeah, no, take your time.

Dr. Mark Goldstein:

But, was the words that we use. And I put up a slide, for instance. This would be the external force that come to play. Years ago, there was a headline in the LA Times, “The governor has cut the budget, allowing shelter workers to kill animals sooner.” Come on, folks. What it should have said is, “The governor has cut the budget forcing,” or making it for shelter workers to have to euthanize the animal sooner.

Dr. Andy Roark:

Yeah.

Dr. Mark Goldstein:

Those two words, kill and allowing them to do it, they don’t belong there.

Dr. Andy Roark:

Oh, yeah.

Dr. Mark Goldstein:

We ourselves accept those things. Another example is low-cost spay and neuter. I may surprise you with this. We should get rid of that term. I always ask, and I did this time, I said, “Anybody in this room take low-cost parachute lessons?” This time, for the first time in 10 years, two people raised their hand, and I said, “I think you need counseling.” But most people go, “No, no way,” because low cost implies you cut corners. Okay. But as veterinarians, we even allow that term to be used. It should be subsidized or affordable, or someone’s paying that bill. And by doing that, veterinarians don’t even realize they’re hurting themself, because if the shelter has low-cost spay and neuter, the public thinks, “What’s my veterinarian doing? He’s trying to just get me to spend more money. A spay and neuter for him is $200, and the shelter’s doing it for $25. How come?” Because somebody else is paying the $175 or whatever.

Dr. Mark Goldstein:

So, we should be vigilant about terms. Kill. We don’t kill animals in animal welfare. We euthanize them. The difference is kill implies the intention to do harm. That’s not our reason. So, these no-kill/kill shelter terms… People watch me in meetings, when I went to them nationally, and if somebody used low-cost or kill, my hand went wait up. “Wait a second.” We’ve got to think of the impact of those words. So, those have been some of the challenges I didn’t expect.

Dr. Andy Roark:

You are 69 years old now. Are there things that if you could go back and talk to yourself at age 35, you would try to get young Mark to understand?

Dr. Mark Goldstein:

Pretty interesting question. You weren’t at my talk, but you’re hitting every piece of it.

Dr. Andy Roark:

Well, I think that there are things that are fundamentally important for a lot of us. And so, yeah, I didn’t get to hear your keynote. I didn’t know anything about it coming in. But, these are the questions I rustle with, is, “What am I going to wish that I knew?”

Dr. Mark Goldstein:

Well, I was asked, and I put this up also, is a slide, it’s exactly what you were asking here. Someone who was turning 50, and I wasn’t sure if it was a compliment or not, but he said… He called me and he said, “I’m searching out people that I respect, that have been very successful in their fields, who are older than I am, and what would you tell yourself at 50 that you’ve learned since?” So, I actually put this slide up because I thought about it. I gave it some time, then I wrote to him, and I had four points, because I can never… As you can tell today, I’m not very good at being brief. So, I had four points. I’ll try and remember them here.

Dr. Mark Goldstein:

It was, first of all, celebrate the fact that you have good health. At the time that I put that, I didn’t realize how impactful or important that was. Keep your friends and family close. Follow your dreams. And, don’t give up. These were the things I put on there. I asked my wife the same question. She was much more brief. She said celebrate your accomplishments and realize that you still have a lot to learn. Never stop learning. That’s what I would’ve told myself. And I actually followed that path. But, think about that. You never know it all. You need to be challenged, because if you become complacent and you don’t continue to challenge yourself, you’re going to go backwards, as we said.

Dr. Mark Goldstein:

So, that really guided me, and that’s the words I gave him. And that’s what I would say to the 30 year old, is celebrate your health, protect it, friends and family are important. I will say, I’m a little bit different. We’ve all heard that thing when you’re on your last days, whatever, you’re not going to even think about your work. For me, I think about my family first with what I’m going through, by far, but I also will celebrate my work, and I feel like I had still more to contribute, and I may or may not get that opportunity. So, I’ve had to deal with that, but I’m going to fight it. I’m not going to give up. That’s what I would say to a 30 year old. Just follow your dreams, don’t give up, and look at it with an optimistic attitude. That’s why I love when you talk, Andy. You’re always optimistic.

Dr. Andy Roark:

Well, thank you.

Dr. Mark Goldstein:

That’s a really important thing. I put up the fish philosophy, if people are familiar with the Seattle Fish Market. I suspect you are. I don’t know, have you ever heard of that term?

Dr. Andy Roark:

I don’t know this. I’m familiar with the fish market. I know they throw the fish in Seattle.

Dr. Mark Goldstein:

Right, throw the fish. That’s what I’m talking about. These guys got together a couple of decades ago and said, “We’re going to have fun and we’re going to make money.” And they have a hell of a time. Excuse me. I hope that’s okay. But, like you said, you walk up to this guy and you say, “I want a two-pound salmon,” and a two-pound salmon comes flying across the room. They have four points that they make to do that, the fish philosophy. First of all, when you’re in a situation, be there. When I say be there, I’m not just talking physically. Emotionally. Mentally. Turn that phone onto focus, which iPhones have where you get the important calls but not all the other stuff. But be there, if you’re working by yourself or even with a group of people.

Dr. Mark Goldstein:

The second is play. If people don’t know the story of Endeavor, it was Captain Shackleton in 1916, took 26 to the Antarctic. They got stuck there for… Their boat got caught in the ice, got smashed. 26 men survived two yeas in the Antarctic in 1916. They didn’t have REI equipment, they didn’t have GPS equipment, they didn’t have computers. It was his leadership that played that part, and part of his leadership was as hard as they were trying to survive, every day they had an hour to play. He took an ice ball and made it into a soccer ball, and they played with it. Or, he came up with ways to have games. When somebody was really, “Hey, leave me alone, I’m going off into the snow. I’m going,” that’s the person he slept next to that night and talked to.

Dr. Mark Goldstein:

So, I just lost my train of thought. Sorry.

Dr. Andy Roark:

Oh, yeah. No, no.

Dr. Mark Goldstein:

This stuff just affects it. But anyway, what was the question again? So, yeah. Yeah, no, I got you also because I rattle on, but the four points. So, it’s play. And the next is basically, make their day. By that, I mean say something good. Find people that are doing something good. Doug Myers, who is the zoo director at San Diego for, gosh, 45 years, he said, “Mark, when I’m having a tough time, I go out there and I find somebody doing something good, and I thank them, and I recognize it. And I walk away feeling better myself.” I’ve told people, especially after this pandemic, try it. Next time you go through the checkout line on your supermarket, look at the person’s name. Use it. Thank them for what they do. Talk to them as a person, not just someone sitting there checking out your food. You will be shocked. You’ll get a smile from ear to ear. Servers in restaurants, when they come over, “This is what we’ve got.” “Hey, what’s your name?” “Steve.” “Steve, thanks for being here.” Boom.

Dr. Mark Goldstein:

And then the last, basically, is just be thankful for what you’ve got, and you get to choose what your day’s like. One of the gentleman from the fish market looks in the camera and he says, “Folks, you get up in the morning, look in the mirror, and you get to decide if it’s a good day or bad day, no matter what you face,” including what I’m facing. You can put a smile on your face, or you can let it pull you down. You get to choose that. Nobody else does. So, be there, play, find someone doing something good, and look in that mirror and decide, “I’m going to have a good day no matter what I’m doing. I’m going to smile, I’m going to laugh, and I’m going to make it work.” It works.

Dr. Andy Roark:

Yeah. The stories that we tell ourselves matter, is an idea that I’ve been holding onto a lot recently. The stories that we tell ourselves become the truth for us, and I really like that. You decide if you have a good day or not. Thank you so much for being here. I know when we first talked, you had mentioned you wanted to touch on some of the points you made at the very end of your keynote. And so, are there any final points you want to make sure to pass on?

Dr. Mark Goldstein:

No. Actually, we touched on it, and that was my diagnosis and putting up that slide from Cornell that said find a new career. I put that up on the screen, like I said, and people just laughed when they saw that, and I said, “I think I’ve done okay,” and that’s when they stood up and clapped. And yeah, it was the example of that. I guess I’d leave it with the fact that if you put the effort in, like I just said, to bring these points to an individual or a group or your local Kiwanis, or a large group of colleagues… Wow, it was gratifying. As I mentioned earlier, and it’s a good one to end on, I told my wife if somebody comes up and says, “You made a difference for me…” When I signed those books after my talk, I must’ve had a couple of dozen people say, “I’m going to be here next year. I want you to be on that stage.”

Dr. Andy Roark:

Yeah.

Dr. Mark Goldstein:

Or, one woman came up and she said, “My daughter just got a rejection letter from vet school, and she’s a junior also, and she’s just devastated. She doesn’t want to apply again. Wouldn’t you talk to her?” And I spent a couple of minutes with her. And her mom came back with her and she said, “You changed her mind. She’s like a different person.” Man, that’s so gratifying. It just doesn’t really happen often. And these people just said, “You just reminded me of why I got into this.” So, I hope people here listening, even if you’re just listening and you’re in different professions, and you’re a volunteer in animal welfare, first of all, thank you. We both know we can’t do our work without some volunteers in many positions. Remember why you got into it. Don’t let somebody let you go down a rabbit hole. Control your life. Be optimistic and laugh. Laughter’s a wonderful thing.

Dr. Andy Roark:

Yeah, I agree. Oh, man. Well, thank you so much for being here. I really appreciate your time. I really appreciate you coming on.

Dr. Mark Goldstein:

Well, I appreciate you, Andy. I meant what I said at the beginning. I’ll say it again. If people haven’t seen you in person, boy, you light up a room. I did the same thing, I hope, with this talk, but really, you’re an inspiration to this profession, so thanks.

Dr. Andy Roark:

Thank you. I appreciate it.

Dr. Mark Goldstein:

All right, sir.

Dr. Andy Roark:

Take care.

Dr. Mark Goldstein:

Have a great day. Thank you, folks, for listening.

Dr. Andy Roark:

Guys, that is the episode. That’s what I got for you. I hope you enjoyed it. I hope you got something out of it. I enjoyed this episode. I enjoyed hearing these stories and thoughts and perspective, and I just… Yeah, I really soaked this up. Anyway, I hope you found things that made you think and reflect on your own career and where you are, and what medicine means, and the opportunities that it offers us, and the responsibilities that it puts on us. So, anyway, if you get any of those things, then this was a win for me. And so, that’s my only hope going into it. Guys, that’s it. Thank you so much for being here, and for listening.

Dr. Andy Roark:

If you enjoyed the podcast, please take a moment and write me an honest review wherever you get your podcast. It means a lot. It’s how people find the show, and it’s just a nice word of encouragement for me and for my team who are putting these episodes out. So, anyway, that’s it. Take care. Be well. Talk to you later. Bye.

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