Dr. Peter Weinstein and Dr. Andy Roark discuss the emotional and physical fatigue of veterinary medicine. The discuss mental and physical preparation for practice, why doctors and staff aren’t building the habits they need, and what can be done to change this. They talk about controlling appointment schedules, setting boundaries and learning to say “no.”
This episode has been sponsored by Pawp. Pawp is a membership that gives you unlimited 24/7 access to vets for chats, video calls, and texts. It’s a great way to avoid those unnecessary clinic vet visits. Check it out now at www.pawp.com and use my code “andyroark” for 25% off the first 3 months before it expires November 7th.
LINKS
Uncharted Practice Owner Summit LIVE:
unchartedvet.com/uncharted-practi…ner-summit-2021/
Uncharted Podcast on iTunes: podcasts.apple.com/us/podcast/the-…st/id1449897688
Workshop: Communication Foundations w/ Stephanie Goss:
unchartedvet.com/product/communic…ion-foundations/
Workshop: Content Calendars That Will Cure Your Creative Burnout
unchartedvet.com/product/content-…lendar-planning/
Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Dr. Peter Weinstein attended Cornell Universityundergraduate and the University of Illinois to receive his DVM. After graduation, he worked as an associatefor three years before opening his practice.
As he was running his practice, he identified the need for increasedbusiness acumen to make his practice successful. Thus, while managing andpracticing full time, he attended University of Redlands to receive his MBA.
As a result of the MBA, he was able to relocate, expand andsell his practice to a corporate consolidator.
Politically, he served as President of the SouthernCalifornia Veterinary Medical Association and the California Veterinary MedicalAssociation and President for VetPartners, the national consultants association. He just completed three years as the Chair of the Veterinary EconomicStrategy Committee of the AVMA’s Veterinary Economics Division
In the veterinary industry, he acted as Medical Directoroverseeing the Claims Department for Veterinary Pet Insurance.
Dr. Weinstein has provided small business and corporate consulting via his company, PAW Consulting
After 14 years, Dr. Weinstein retired from his role as theExecutive Director for the Southern California Veterinary Medical Associationto pursue other interests including teaching at Western University.
He was the 2018 Speaker of the Year for the Western VeterinaryConference Practice Management Section. Andin 2021 for the VMX Practice Management section.
He co-authored with Michael E Gerber, “The EMyth Veterinarian-Why Most Veterinary Practices Don’t Work and What to Do About It”.
Dr. Weinstein has spoken and written extensively on practice management, team building, leadership, collegiality, marketing, and other topics focused on making the veterinary profession better for all those affiliated with it.
Dr Weinstein lives in Orange County, California with his wife Sharon, two daughters (one a veterinary student at Oregon State), two dogs, and Bazinga, a Senegal parrot.
Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram
SHOW TRANSCRIPT
Dr. Andy Roark:
Welcome, welcome, welcome to the Cone of Shame Veterinary Podcast. I’m your host, Dr. Andy Roark. Guys, today, me and my friend, Dr. Peter Weinstein, sit down and we talk about fatigue in medicine. We talk about how medicine is a marathon, but so many of us run it like a daily sprint.
Dr. Andy Roark:
I love now with Dr. Peter Weinstein. He is a mentor and a friend of mine. You may hear some familiarity in this conversation. And that’s authentic. That’s just because I genuinely really enjoy him and I know him well. And so I’m really glad that we just got to talk about this.
Dr. Andy Roark:
We started talking about physical preparation for practice, mental preparation for practice. We talk about the control that we have and the levers that we can pull to make practice more of what we want to be and make it more what’s sustainable. 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 veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark:
Welcome to the Cone of Shame Podcast, Dr. Peter Weinstein. Thanks for being here.
Dr. Peter Weinstein:
Dr. Roark, pleasure to always hanging with you. Thank you for the invitation.
Dr. Andy Roark:
Man, you and I go way back. I remember talking to you. You were a mentor to me just in general thought on that business, and especially on speaking and lecturing when I was in vet school. I distinctly remember pep talk and some good advice I got from you on a bus at the AVMA convention when I was about second year of vet student.
Dr. Andy Roark:
You’ve done a lot of things. In all honesty and total candor, you’re one of my favorite people to talk to in the industry. It is because you think outside the box and you have a background. You have an MBA. You have been a practice owner. You have been the president of the Southern California Veterinary Medical Association. You’ve been the president of that partners which is a national consulting agency working inside of vet medicine.
Dr. Andy Roark:
You have been on the chair of the Veterinary Economic Strategy Committee of the AVMA’s Economics Division. You’ve done a ton of things. You have published your book, the E-Myth Veterinary edition, which if people consider themselves to be business book aficionados and you haven’t read the E-Myth coauthored with Peter Weinstein, you are 100% missing out.
Dr. Andy Roark:
So, you have an amazingly diverse and interesting resume. And so, I’m always glad to get to talk to you.
Dr. Peter Weinstein:
Well, you just told me how old I was there, Dr. Roark. Thank you.
Dr. Andy Roark:
I went to veterinary kindergarten and you were there. Feel like you were old when you were there, yeah.
Dr. Peter Weinstein:
Yeah. I joked with you when we last saw you that I have an email from you from 2009 or something like that or 2007. It was way back when that you sent me when you were the president of the VBMA at University of Florida.
Dr. Andy Roark:
2006, yeah.
Dr. Peter Weinstein:
I have evidence that you actually went to vet school.
Dr. Andy Roark:
You and I have gotten to talk a bit recently. It’s been pretty fantastic. As the world has opened up a little bit, I’ve done a couple of trips. So I went out to Western Vet Conference. And then I went out to Denver to do some work with PSIvet. And those were the only two trips that I’ve made. And you’ve been at both of them and we’ve gotten to have dinner at both of them. So you and I have gotten to catch up a lot which has been really phenomenal.
Dr. Andy Roark:
One of the things that we talked about that I want to talk about with you some more here, the troops are tired. Over the course of the pandemic, there was a lot of discussion about fatigue in practices. And there’s just wear and tear on our paraprofessionals and our doctors and people generally burning out. And just I’m thinking a lot these days about leading tired teams. I guess that’s the topic I’m really interested in is knowing that people have a lot on their plates that they’re feeling stress and fatigue.
Dr. Andy Roark:
How do we motivate people? And how do we lead people when we can’t necessarily make them promises of sunshine and rainbows? How do we keep them going? And I want to talk with you. The phrase that you said was you said, “Well, veteran medicine is a marathon. And a lot of us are running it like a sprint or like a series of sprints.”
Dr. Andy Roark:
And so, I wanted to pick that conversation back up here and unpack your thoughts a bit more on what’s sustainable.
Dr. Peter Weinstein:
It’s a great discussion and it’s a combination of physical health and mental health that goes into running a marathon. A marathon is not just your ability physically to do 26.2 miles. It’s your ability mentally to go 26.2 miles.
Dr. Peter Weinstein:
In veterinary medicine, we tend to run, run, run, run, run throughout the day and get exhausted. And then we do it again the next day. And we do it again the next day. And we do it again the next day. And we do it again the next day. And we do it again the next day. Sorry, if it was repetitive, the record was skipping.
Dr. Peter Weinstein:
And I think every once in a while, we don’t prepare ourselves physically because it’s a very physically demanding profession. And we definitely don’t prepare ourselves mentally for this long-term situation which is why I think we see attrition in the paraprofessional. And I think we started to see more and more attrition in the professional levels is because we don’t go through the training to run the marathon.
Dr. Peter Weinstein:
And I think the training is taking time to eat correctly. It’s taking time to prepare physically and mentally. It’s also taking time to rest. You can’t run a marathon every day. You have to rest between marathons and build yourself back up. So, that’s why I think that analogy applies very much in veterinary medicine. The question is, how do we create the resources so that teams are preparing for that marathon every day so that they can sustain themselves long term?
Dr. Andy Roark:
Yeah, I agree with that. I came up with the mantra of make it work. That was what I heard was make it work, make it work. And I don’t want to go too far in this. I think people rush to extremes. It’s either make it work every time, “Suck it up,” or it’s, “Don’t ever overexert yourself.” And you go, “Neither of those is true.”
Dr. Andy Roark:
We’ve got a profession that doesn’t necessarily fit straight up business hours. I think that that’s probably baked in. I had a case yesterday when I was in the clinic. And I’d looked at my schedule and I was like, “This all looks really manageable.” And then, a husky that couldn’t stand came in the door.
Dr. Andy Roark:
And they were like, “It’s just acute onset.” It was an eight-year-old husky came in the door and they said, “Hey, can you look at this?” And, of course, I looked and the dog’s gums are just yellow. And it turns out this dog’s got IMHA. And I’m trying to get the dog set up and stabilized, and talk to the owners about what’s possible and get a diagnosis for him and things like that.
Dr. Andy Roark:
And ultimately, things came together. And I got out of the practice not too far after closing time. But it was just one of those things where that’s … there are things that are part of the job I guess is what I’m trying to get to. You can’t just be like, “Oh, I’m done. I’m sorry I don’t know what’s wrong with your dog. See you later.”
Dr. Andy Roark:
There’s always going to be these things that are going to push us a bit. I think to your point, it’s one thing to sprint, it’s another thing to sprint every single day and have a plan to sprint every day for the rest of your career is. Am I accurately summing up your position?
Dr. Peter Weinstein:
Absolutely. Absolutely. And see, we can control our appointment books. And all too often, we let our clients control our appointment books. And all too often, we let our client service teams control our appointment books without a direction.
Dr. Peter Weinstein:
Just as an example. As a single doctor practice, trying to integrate surgeries into outpatient, well, you know what’s going to happen. You’re going to get into the stay at lunchtime and you’re going to drop a stump. Or it’s going to be a pile or something off the wall and all of a sudden, your 2:30 appointment now becomes a 3:30 appointment because what looked to be an easily triaged surgical time now becomes a mess.
Dr. Peter Weinstein:
Well, what if you just had a surgery day and an outpatient day? What if you just did your surgeries in the morning and had a break for lunch and then you went to your outpatient? What about taking control of the way things are so that you have the ability to take a break and maybe take a nap, maybe get some lunch, maybe not have to put in a urinary catheter so you can actually go to the bathroom or wear the pads? I don’t know what you prefer, the pads or catheter.
Dr. Peter Weinstein:
But the concept of suck it up is not relevant in 2021. The concept of balancing your practice, your life and taking care of your team, Simon Sinek’s book after Start with Why was Leaders Eat Last. And it’s all about leaders taking care of their teams.
Dr. Peter Weinstein:
Well, we have to do that as well. And I think we need to be ultrasensitive to the challenges that COVID has presented from a physical standpoint and from a mental standpoint on top of what already existed in terms of challenging inefficiencies within our practice model.
Dr. Andy Roark:
Yeah, I like that a lot. I think one of the things I’ve picked up that I like a lot is that life balance happens three months from now. And what I mean when I say that is I think a lot of us end up bogged down and overwhelmed. And we feel like, “Oh, my God. Clearly, my time is not allocated correctly. I don’t have boundaries and I’m completely overrun. I need to fix this right this second.”
Dr. Andy Roark:
And when I say life balance happens three months from now, what I’m really saying is the systems policies, plans and commitments that we make now are what are going to dictate our life balance three months from now. I think a lot of people feel hopeless because they look at themselves and say, “I don’t know how to make tomorrow better than today.”
Dr. Andy Roark:
And I say, “I don’t know that you can make tomorrow better than today. But you can make February better than November, that’s for sure.” You definitely haven’t had power to make those changes and to start setting some policies that are going to protect you in the future.
Dr. Andy Roark:
So, I don’t know. I’m curious what your thoughts are on that. I think a lot of us think of work-life balance. I think we put too much emphasis on the individual saying, “No, I’m not available for this,” or the individual holding their personal boundaries.
Dr. Andy Roark:
And what I found with personal boundaries, the story that I like a lot is there’s this guy that wrote Deep Work. His name is Cal Newport I think his name is. He wrote this book called Deep Work. And it’s all about the benefit of uninterfered with time. Its head-down work where no one bothers you, you don’t respond to email, you just get work done.
Dr. Andy Roark:
And I deeply believe in that. I think he’s totally right. So apparently, he writes the book. And he goes on the book tour. And again and again, people came up to him and said, “Yeah, this is really great. Why don’t you tell my boss that I’m not going to respond to email for 90 minutes?” And that’s not the end of the world because we get rated on how fast we respond to email.
Dr. Andy Roark:
And Cal realized, like, “Oh, crap, I can talk to the individual.” But ultimately, if the organizational culture doesn’t allow this type of deep work or this type of independent boundary setting, these people are screwed. And that was the origin story of his next book which is The End of Gmail.
Dr. Andy Roark:
But I think about that a lot in vet medicine. I think we preach to veterinarians, “You got to set boundaries. You got to set boundaries.” And there’s truth to that. And you do need to look out for yourself. At the same time. I think the organizational power to set up systems that promote healthy lifestyles is pretty large.
Dr. Peter Weinstein:
This concept of boundaries is something that veterinarians … well, we haven’t always had boundaries. And I think part of what’s happened with COVID has exacerbated that because we haven’t learned how to say no. I think we’ve been afraid to turn down clients because if we don’t let them come in now, they won’t come in later.
Dr. Peter Weinstein:
And what’s happened in many cases is by not saying no, we have actually done damage to existing clients because we’ve seen not prior clients to the detriment of existing clients. So, our unwillingness to say, “No, you can’t get in to see a doctor for six months,” and that’s routine. “You can’t get in to see a veterinarian for six days,” and a panic ensues.
Dr. Peter Weinstein:
So, we have to start to set boundaries within our practice. And we have to start to set boundaries by the vision, mission and values that our practice has. And maybe, just maybe, there are clients that you don’t need to see because they don’t adhere to your vision, mission and values. Your staff needs to know what your vision, mission and values are from that standpoint.
Dr. Peter Weinstein:
I think the boundaries start to come. And it’s not just a fee schedule, it’s a standard of care. It’s the business hours that you’re open. The balance from a life standpoint comes from a balance on a day-to-day standpoint. I love this life balance occurs three months from now. I would challenge everybody who hears this to take their four weeks of paid vacation, six weeks of paid vacation and book them now. Get them on the calendar a year in advance.
Dr. Peter Weinstein:
And that gives you something to look forward to. Because what generally happens is we book vacation in a reactionary fashion, not a proactive fashion.
Dr. Andy Roark:
Yeah, that’s 100% what I learned in my career. After going a couple of years without taking a vacation, I really had to look at that and say, “Well, how was this going to happen?” And it never shapes up. And my schedule never opens up to allow me six weeks from now to have a vacation. It’s just never going to happen.
Dr. Andy Roark:
The only way it happens is in October, November. I look at my calendar for the next year and put those times on there and say, “This is when I’m going.” And it’s either because there are specifically something I want to do and I’m looking at which is ideal or, and this is what I push for, even if you don’t have a place to go, put your vacation on the calendar. Just put it down and go ahead and ask for the days off and get it.
Dr. Andy Roark:
And if it gets pushed around, that’s fine. You can move that week or you can move that long weekend. But at some point, you’re not going to delete it, it needs to get scheduled in. It needs to be a thing. And you need to be out of the clinic. And I think a lot of us just … I don’t know, I think it’s exactly what your point is. I think you make a strong argument.
Dr. Andy Roark:
I think a lot of us have fear that if we’re not there, then our clients are going to go somewhere else. And that’s if you’re the practice owner. If you’re the associate vet, the idea that like, “If I’m not there, then my clients are going to be frustrated because they can’t see me,” or, “They’re going to go see another vet and maybe they’ll like that other associate vet better,” and whatever the catastrophic thoughts we have are.
Dr. Andy Roark:
I do think that we tell ourselves we’re too important to be gone. And we just never get around to putting our days off on the calendar. And then they roll by. Or we’re not compensated in a way that rewards that at all. And I’m not saying it’s wrong.
Dr. Andy Roark:
But I do remember that from me early on with production-based compensation and ProSal and things like that, I took a financial hit to not take vacation. And I thought I’m fine. I am young and energetic and I don’t need to be away. And I don’t want to incur this financial hit. So I’m just going to work through. And we do incentivize people not resting and taking care of themselves that way.
Dr. Peter Weinstein:
Yeah. Well, there’s so many things you just said that I want to jump all over. But we as a profession, we want to be loved, Andy. Listen, dude, I want to love you, man. You’re 3000 miles away and I want to give you a big hug. So as a result, we try to be everything to everybody. And the miniature everything to everybody is the miniature nothing to anybody.
Dr. Peter Weinstein:
We are so weak, become so exhausted trying to be everything to everybody. And I think it’s because we want to be loved. And I blame the vet schools on that one because they spent four years beating the love out of us with all of the forced education and drinking from a firehose. And we leave vet school with cerebral constipation and we didn’t come out of school wanting to be loved.
Dr. Peter Weinstein:
And that means trying to be everything to everybody. And it doesn’t work. It’s exhausting trying to be everything to everybody. You know it as a speaker and an author. I know it as a speaker and an author. You know it as a veterinarian. I know it as a veterinarian. We need to find those clients that love us and take good care of us which is why I think, speaking personally and I’ve said this in public as well, I think veterinary medicine is the perfect profession for a concierge business.
Dr. Peter Weinstein:
I think we could choose 500 clients charge them 1,000 bucks a year or something like that. And net 50% working part-time and have 500 clients that love us and not 15,000 clients who don’t. Take the top 20% of your clients. Take them off the top. Give them everything that they want at a high level, give them everything they wanted at a high level. And you’ll be happy and they’ll be happy.
Dr. Andy Roark:
I think a part of that comes from, “I think we just need to be loved.” I completely agree with that and then also serving the people who best fit us. But the need to be loved, part of it for me, I think it’s a need to be right. It’s a need to be perfect. It’s the perfectionist tendencies.
Dr. Andy Roark:
And I think that there’s this cruel reality in vet medicine where what gets you to the top of the class in vet school is what tears you down as a veterinarian. So like the getting everything right, getting the perfect score perfection, that is a highly-prized trait in vet school. And then when you get into vet medicine, you realize that it’s a wildly imperfect world and a wildly imperfect system working with wildly imperfect pet owners in wildly imperfect circumstances. And you think, “Oh, perfection is not possible yet I have been pushed to achieve it.”
Dr. Andy Roark:
I think that that’s where people come into the be-all things to all people and they want to be loved. I think a lot of us want to be perfect. And we will lay down to be perfect because that’s how we’ve been trained. And the truth is perfection is it’s impossible in a complex world, but it’s also destructive.
Dr. Peter Weinstein:
Absolutely. I think we’ve had this conversation about veterinary school. I think we’ve had this conversation about veterinary school where we choose adversely choose veterinary students for a profession that doesn’t need as much IQ, but now needs more EQ.
Dr. Peter Weinstein:
And I think that if we were to focus more on a balanced individual with communication skills, some leadership skills and clinical skills, they might be a better contributor long term to the profession and less likely to get burned out than those people who have always been at the top of the class, made it through vet school at the top of the class, only to find out that there is no top of the class when you get out of vet school.
Dr. Peter Weinstein:
And every day, you will be having to deal with mistakes maybe that you made, maybe that somebody that’s part of your team has made. And there is no definition of perfection in veterinary medicine. I don’t think you can define perfection in veterinary medicine.
Dr. Andy Roark:
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Dr. Andy Roark:
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Dr. Andy Roark:
Hey, guys. I just want to jump in real quick with a couple of announcements over on the Uncharted Veterinary Podcast. Stephanie Goss and I are breaking out one of our Hall of Fame episodes just called Where Do You Find New Hires. I don’t know. It feels like that some people out there are trying to hire people. I don’t know. Maybe that’s crazy talk. I suspect it’s not.
Dr. Andy Roark:
How do you find new hires? And how do you get them into your practice? How do you get the right people on board when it is really hard to hire? That’s what we’re talking about. I’ll put a link in the show notes over the Uncharted Podcast. And you guys can definitely check that out.
Dr. Andy Roark:
On the Uncharted side of the house, we have just finished up our culture conference. It was the biggest virtual conference we’ve ever had, the biggest virtual event we’ve ever had. It was big. And what I’m trying to get at is large, it was large and it’s flipping awesome. It filled my bucket.
Dr. Andy Roark:
You ever done like a program and then you’re like, “Man, I feel energized coming out of that and not let down.” That was the Unchartered Culture Conference last week. And so I am still riding the high of that. So that is in the books. But don’t fear, we have got communications foundations workshop with Stephanie Goss. That is coming up on November 7th, from 4:00 to 6:00 p.m. Eastern, 1:00 to 3:00 p.m. Pacific.
Dr. Andy Roark:
We have got content calendars that will cure your creative burnout. [inaudible 00:23:09], content calendars that will cure your creative burnout. That is with the dynamic duo, Tyler Grogan and vet tech Kelsey Beth Carpenter. So, Kelsey Carpenter and Tyler Grogan who runs social media for Uncharted and Dr. Andy Roark, who were both just wonderfully creative articulate, just amazing just people, are talking about building content calendars that make your life easier.
Dr. Andy Roark:
And so if you’re like, “Man, I don’t know what to post. I’m tired of figuring out what to post. I’m tired figuring out what to send out in emails,” we got you covered. Check that out. That is November 12th. It’s from 2:00 to 3:30 Eastern Time, 11:00 a.m. to 12:30 p.m. Pacific Time. Both of those workshops are free to Uncharted members. They are $99 to the public, you can grab them.
Dr. Andy Roark:
And if you are a practice owner, the first ever in-person practice owner summit is going down December 2nd through the 4th. It is in Greenville, South Carolina. That’s right. What did I say? Yes, it is in Greenville, South Carolina. The magic is back, gang. We are getting back together. This is going to be a smaller event. You can check out registration for more information on COVID protocols but we are doing it.
Dr. Andy Roark:
Practice owners coming together circling up, collaborative learning, working together on their practices, share their experiences. This is going to be such good stuff. And man, it’s going to feel good to be back together with the gang. If you want to be a part of that, head over again to unchartedvet.com. Get signed up. You need to be a member to come, but you can get a membership so you can become a member and then you can head into the Practice Owner Conference. We would love to see you there.
Dr. Andy Roark:
Anyway, guys, that’s enough of that stuff. Even though it’s awesome, we should get back into this episode. So first of all, let’s take this back to the paraprofessionals and say, what are the things you see coming down the pipe that will help make their lives better? What do we do to help paraprofessionals? They don’t have nearly as much control over the race as the vets do.
Dr. Andy Roark:
I have a lot more decision-making power than my technicians do. And so, I feel like vet technicians and front desk staff, to a lesser degree, just get sucked up a lot of time into what’s going on around them. Are there things that we should be doing as practices, as organizations to protect our paraprofessionals?
Dr. Peter Weinstein:
Absolutely. Absolutely. I want to see paraprofessionals owning veterinary hospitals.
Dr. Andy Roark:
Do you really?
Dr. Peter Weinstein:
Oh, yeah. Here’s my perfect business model, Dr. Roark, in 2022. Three veterinarians each working three days a week in a practice owning 20% each, 20% of the practice owned by the manager and 20%, owned by a technician, they all share in the profits. The doctors focus on being the doctors. The management team focuses on getting the work done correctly. And the technicians focus on the animal care and oversight from that standpoint.
Dr. Peter Weinstein:
They have governance at the top because there are three doctors making the decision on the standards of care. The doctors don’t have to worry about the hiring, the firing, the finances and everything else because if they are good doctors, they get to share in the profits. But now, you’ve got a technician with skin in the game who has a voice, you have a manager with skin in the game who has a voice. And I don’t have a problem if you have a client service person who wants to have some skin in the game and has a voice.
Dr. Peter Weinstein:
I think we need to give some ownership to our paraprofessional team so that they feel that they have a voice in building the practice. I think somebody asked me at a meeting not that long ago, what do I think the greatest weakness is in veterinary medicine. Maybe I should ask you that. Let me ask you that question first before I answer it. What do you think is the greatest weakness in the veterinary profession?
Dr. Andy Roark:
So the greatest weakness in the veteran profession I think is … let’s see, this is not an easy question. And it depends on what we mean by weakness. So from a pure business standpoint, the greatest weakness we have is our inability to just say no a lot of the times. So, no other business is there a scenario where the worker desperately wants to do the work like there is in vet medicine.
Dr. Andy Roark:
And I don’t want to change that. But I do think from a business standpoint, the fact that someone brings me their dog with parvo and they don’t have any money and I desperately want to do this work. I think that that makes things challenging from a business standpoint as far as how do we go forward and run a classic business and have boundaries when you desperately want to help?
Dr. Andy Roark:
I think that’s an interesting conflicting problem. So from a business standpoint, it’s a desire not to say no to doing work. I think the other part is probably what I said before of perfectionism as a problem in our profession. It is having sky-high standards in an industry that has just so many conflicting variables and obstacles and no perfect outcomes.
Dr. Peter Weinstein:
So, let me go on with that for a second before I give you my answer.
Dr. Andy Roark:
Okay.
Dr. Peter Weinstein:
In the E-Myth Revisited by Michael Gerber, and to a lesser degree, the E-Myth Veterinarian, Michael talks about entrepreneurs and small business owners wearing three hats, the hat of the technician, the hat of the manager, and the hat of the entrepreneur.
Dr. Peter Weinstein:
The technician is the individual who does the technical work, surgery, putting in catheters, whatever the case may be. The manager gets the work done. And the entrepreneur has a vision for the practice. What you said by the fact that we just can’t say no is putting the technician hat on. Basically, I’m a technician, I want to do the work, I want to do the work, I want to do the work, I want to do the work. And that’s what veterinarians are really good at is being a technician.
Dr. Peter Weinstein:
Perfectionism, you know as an entrepreneur, there is no such thing as perfectionism. And as a manager, your goal is to get people to become perfect. So, to a degree, perfectionism is really technician as well and maybe to a little bit management. So, my feeling in one of the greatest weaknesses in veterinary medicine comes from a lack of true leadership and a lack of true entrepreneurship because I still think that most veterinary practices are just to quote Michael Gerber, “Technicians who had an entrepreneurial seizure.”
Dr. Andy Roark:
Yeah.
Dr. Peter Weinstein:
And so, lack of leadership in a practice because if you’re a real leader and a real entrepreneur, you will come up with a way to deliver the care and the service and take care of your team so that you’re satisfied, the client is satisfied, and the staff is satisfied, and the patient is cared for. That’s what leaders do. Technicians do more work. Leaders find ways to do work easier, better, smoother, faster, happier so that the team is well balanced at all levels.
Dr. Andy Roark:
What do you think about the idea that it’s time to shift how we prioritize our focuses inside the practice? So, I’ve been feeling more and more that it’s time for us to take care of our team first. And trust that the team will take care of the clients. As opposed to what feels like the classic example which is take care of the clients and everything will work out for your business. What are your thoughts on that?
Dr. Peter Weinstein:
We have lived since Noah in a doctor-centric business. Everything is all about the doctor and the doctoring. In 2021, we need to be a team-centered business to delivering client-centered care. And the team has to help build that experience for the client. My envisioning of the practice of the future, and we’re talking about paraprofessionals, is delegating them with the responsibility of better defining that client experience and the patient experience and giving them the leadership role to make those things happen.
Dr. Peter Weinstein:
We need to create a team-centered health care model where the team has a voice in ultimately making the decisions that support the vision, the mission and the core values that the practice has. If you go to a team right now, what is it, sometime in October and said, “Listen, Christmas is coming up. Christmas is on a Saturday this year. When should we close? What days should we close? When do you want to be with your family?”
Dr. Peter Weinstein:
And you let them have a voice. And you say, “You know what, that’s what we’re going to do.” And maybe, you miss out on a really busy day. But you listened to your team and you let them have a voice and you supported them. They’re going to be there next year. Whereas in another practice that maybe had the staff … maybe they were open Friday, Saturday, Sunday, and whatever the legal holiday they took but they didn’t take anything more than that, maybe that team gets a little bit more burned out. Maybe that team starts to look for a practice that has a better culture that they can work at.
Dr. Peter Weinstein:
I really do think the move from a doctor-centric health care delivery model to a team-centric health care delivery model with responsibilities delegated with decision making shared that ultimately delivers on a client experience and a patient experience.
Dr. Peter Weinstein:
I think we need to start to move away from the classic 1920s sweatshop. Oh, I’m going to get some pushback on that, aren’t I? Somebody is going to be unhappy with that. From the 1920s sweatshop that said, “Hey, I work 60 hours a week, you need to work 60 hours a week, too,” to a, “Hey, I’m going to hire three people to do the work of one-and-a-half. And it’s all fine. We’ll get it all taken care of.”
Dr. Peter Weinstein:
Instead of trying to continue to push square pegs into round holes, let’s just see if we can smooth out some of the edges and get a whole bunch of people fitting into one hole.
Dr. Andy Roark:
Do you feel like we’re starting to see a cultural arms race where practices especially corporate practices … so I think they’re sort of driving this. There’s such competition for labor right now, skilled professionals. It feels to me like we’re seeing big jumps forward in things like work-life balance and holidays and programs to help take care of staff as opposed to just a battle in salaries. I do think salaries are going up.
Dr. Andy Roark:
But I feel like the landscape is getting more competitive about taking care of the staff and making your place a place that people would want to be. Are you seeing that?
Dr. Peter Weinstein:
I’m reading about it. I’m hearing about it. But let’s just say that in 2021, there’s been a lot of bright, shiny objects that people are chasing, classic veterinarian. It’s like squirrel, squirrel, squirrel, squirrel. We’re chasing new bright, shiny objects and culture is the buzzword that many corporations are using. It’s the stickiness, how long they can stand with that culture support. That’s what I want to see.
Dr. Peter Weinstein:
It’s marketing. It’s the new coke. It’s the new Tesla. It’s the new this. But how long can it stay on the market and do that and still be profitable especially when you’re talking about corporations? God, I hope they can stick to it. I hope that we can continue to see improvement in cultures. I hope we can continue to see the ongoing salary escalation that we’re getting. I do think that there’s a great upswing in salaries.
Dr. Peter Weinstein:
I’d love to see a greater upswing in salaries for the paraprofessionals. We need to start paying our paraprofessionals a life salary that they can live in the communities in which they work and, exclamation point, can actually afford to pay for the veterinary care at the hospitals at which they work as well.
Dr. Peter Weinstein:
And to do that, we need to have more profitable practices. They need to be more efficient. They need to be more productive. We need to create veterinary careers for people that we hire and not just jobs. And that basically goes back to some of the things we talked about with the paraprofessionals which is training and giving them the opportunity to grow, giving them the tools and the resources to grow. And giving them the opportunity to be leaders within the practice and have a voice that’s heard.
Dr. Andy Roark:
Yeah. There is some data that’s come out and people are sort of pointing to. And this is not new, but we’re seeing that pet owners are starting to hit near the top of their financial flexibility, meaning it’s unclear how much elasticity there is in pricing, meaning how much vet medicine can continue to increase their prices with pet owners being able and willing to pay for those prices.
Dr. Andy Roark:
When you talk about running healthier practices, do you see some of that coming from increases in prices? Are you seeing more of that coming from efficiency and changes in how we do business? Because I want that, too, I want our paraprofessionals to have living wages. And I want them to be able to afford to have a career and not a job.
Dr. Andy Roark:
I want them to stay with us. I want to see long-term paraprofessionals in our practices. And I’m just thinking about how do we make that happen? And so, when you talk about more financially healthy practice, what does that look like in your mind?
Dr. Peter Weinstein:
I think instead of looking just at revenue and expenses, I think the practice should set, to begin with, a profitability mark. Let’s just say 20% and work backwards. How can we get there? What on the expense side can we control? What on the revenue side can we control so that we get that 20%? Because generally, what happens is we set a growth mark of 10% revenue. And we say we’ll try to keep the expenses the same. So we’ll get a little bit of a push in profitability.
Dr. Peter Weinstein:
But what if we started with a profit margin and reverse engineer that profit margin focusing on paying our people more, maybe keeping our inventory a little bit better under control because as you know, there are three major cost centers that cover 60% or more of your expenses, people at the doctor side, people at the paraprofessional side and cost of goods or products.
Dr. Peter Weinstein:
The cost of goods, you actually can start to make cuts in and still be an effective and efficient practice. The people side is where I’d like to see some of that redirected. So, if we take that 60% and tweak it, maybe drop it a little bit, could your profits be there? And maybe some of that profit gets fed back to the staff. So, people need to be paid appropriately but we need to keep that profit margins.
Dr. Peter Weinstein:
Then we get to the pricing side at the top. Well, let me address one more thing on the expense side. We have large hospitals with not enough doctors that aren’t being utilized to their full capacity. So, for example, if you do boarding and grooming, that boarding is probably working at 30% efficiency over the year. It’s at 100% efficiency over the holidays. But if you average it out over the year, it’s only a 30%. But you’re still paying for that part of the physical plant. Same thing with grooming.
Dr. Peter Weinstein:
So, how can we create greater utilization of our physical plants so we get a greater return on the physical location? I jest that with curbside, what it told us is we don’t need a waiting room. Make the cars the waiting room. Add more exam rooms. Get people from car to exam room back to car. Do we need all of the bells and whistles? The bottom line is there’s a number of areas on the expense side that can be tweaked.
Dr. Peter Weinstein:
If you look at the revenue side, can we continue to have a pharmacy and be cost-competitive with the Chewys and Amazons and Targets and Costcos and Walgreens of the world? Can we figure out whether we want to run a practice that’s based upon a higher quality of clients who spend more but we see less often which would be earns.
Dr. Peter Weinstein:
Or as Mike Dicks when he was with the economics division said, “Earns or turns.” Earns means you make more money per visit. Turns means you see more people at a lower visit cost. I think it’s very hard to be a practice that does both. So, can you decide which practice model you want? Do you want to be the high volume low cost and try to see more people then you have to leverage your staff? Or do you want to see fewer people at a higher cost?
Dr. Peter Weinstein:
I think the way veterinary medicine starts to make more on the revenue side is to leverage technicians in exam rooms, utilizing them to the ultimate abilities that they have, and to what the Practice Act allows them to perform. And to start having a line item where it actually reflects to the clients a charge for technician time in the same way that your dentist has line item that charges for their hygienist’s time.
Dr. Peter Weinstein:
We need to start reflecting the fact that our technicians are generating income for us, thus, they are an asset and not just on the expense side of liability. So, leverage staff to generate income, reward them with having their name on the invoice. Your technician today was Suzy, your receptionist today was Crystal, and start to give a name to the team who are delivering veterinary care as well.
Dr. Peter Weinstein:
So, whether that answered your question or not, it was a pretty roundabout way to say that we can, we just need to look at reimagining our business models so that we’re more effective, more efficient, greater utilization of staff, maybe adding two technicians instead of a doctor to do more. There are only three things that average doctor has to do, diagnose, prescribe and do surgery, and maybe give a rabies shot depending on your state.
Dr. Peter Weinstein:
Anytime they’re not doing one of those, then that doctor’s being inefficient. Everything else can be delegated if you train them how to do it. So, I’m sorry I went off on that one.
Dr. Andy Roark:
No, that’s great. That’s fantastic. Where can people find you online? Where can they read more of your writing? Where can they find the E-Myth Veterinarian?
Dr. Peter Weinstein:
They can find the E-Myth Veterinarian on Amazon, both the audible book. If you’re not tired of hearing me now, you can listen to me on audible. You can get a hard copy of the book. You will see more and more of me in the next few months as we start to launch a new business. Myself and a business partner are going to be launching a new business that’s going to focus on some niche areas.
Dr. Peter Weinstein:
But what I’m looking forward to in my next life is to help create simple solutions for practices for the things that are pain points such as compliance, regulatory issues, OSHA, HR malpractice, all of these things that are just like little gnats or fleas sucking the blood out of you that you can’t find the answer for when you need them. We’re looking forward to building some different resources to help practices get the help that they need when they need it.
Dr. Peter Weinstein:
And so, that’s what I’m looking forward to doing in the years ahead. I want to put the F back in fun in veterinary practices. I really do think we’ve lost the fun. And we all got into this because of the thing, that’s the animals. And we’ve gotten distracted from the animals to the stressors of the people and the finance and everything else.
Dr. Peter Weinstein:
And I think you and I talked about this when we were together more recently. I said, “If we had socialized veterinary medicine and all we had to do is go in and take care of pets and the bills were taken care of and we got paid a fair and equitable salary and our staff members got paid fair and equitable salary and we didn’t have to talk about money, think about how much less stress we would all have in our practices.”
Dr. Peter Weinstein:
I think money, student debt, cost of care are huge … I mean, they’re great white sharks taking bites out of us every day.
Dr. Andy Roark:
I completely agree. I love that you enjoy the profession. And I appreciate all that you do to help support it. Peter, thanks a lot for being here. I’ll put some links down in the show notes to help people find the book. And I look forward to see what you’ve got coming down the pipes.
Dr. Peter Weinstein:
Andy, thanks. Thanks for the opportunity to hang with you today. And anytime you want to come back and throw some feces against the wall and see what sticks, I’m all about throwing feces.
Dr. Andy Roark:
Sounds great. That is it. That was my conversation with Peter Weinstein. I hope you enjoyed it. I hope you got something out of it. I always love talking with Peter. Yeah, this is hopefully one of those thought-stimulating conversations. It definitely gave me something to think about.
Dr. Andy Roark:
If you enjoyed it, do me a favor and write an honest review wherever you get podcasts. That always means the world to me. I really do appreciate it. Yeah, that’s what keeps us going here. It helps people find the show. And tell your friends, hit Share on the episode. Help us get the word out.
Dr. Andy Roark:
Anyway, that’s enough for me. Gang, I hope that you are well. I hope you’re getting fired up for Halloween. Yeah, they’re looking forward to get some candy or giving out some candy or just be a near candy if that’s your thing. Yeah. I hope that that is something that is on your radar. Gang, take care. Be well. I’ll talk to you later on. Bye.
